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116th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 2d Session                                                     116-445

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



 
     MILITARY CONSTRUCTION, VETERANS AFFAIRS, AND RELATED AGENCIES 
                       APPROPRIATIONS BILL, 2021

                                _______
                                

 July 13, 2020.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

Ms. Wasserman Schultz of Florida, from the Committee on Appropriations, 
                        submitted the following

                              R E P O R T

                             together with

                             MINORITY VIEWS

                        [To accompany H.R. 7609]

    The Committee on Appropriations submits the following 
report in explanation of the accompanying bill making 
appropriations for military construction, veterans affairs and 
related agencies for the fiscal year ending September 30, 2021.

                        INDEX TO BILL AND REPORT

                                                            Page Number

                                                            Bill Report
Purpose of the Bill........................................
                                                                      2
Summary of Committee Recommendation........................
                                                                      2
Management and Oversight Initiatives.......................
                                                                      4
Department of Defense:
        Military Construction..............................     2
                                                                      8
        NATO Security Investment Program...................     8
                                                                     28
        Department of Defense Base Closure Account.........     9
                                                                     28
        Family Housing Construction and Operation and 
            Maintenance....................................     9
                                                                     31
         Department of Defense Family Housing Improvement 
            Fund...........................................    11
                                                                     32
         Department of Defense Military Unaccompanied 
            Housing Improvement Fund.......................    11
                                                                     32
         Administrative Provisions.........................    12
                                                                     32
Department of Veterans Affairs:
        Veterans Benefits Administration...................    26
                                                                     36
        Veterans Health Administration.....................    30
                                                                     44
        National Cemetery Administration...................    36
                                                                     86
        Departmental Administration........................    36
                                                                     88
        Administrative Provisions..........................    44
                                                                    100
Related Agencies:
        American Battle Monuments Commission...............    73
                                                                    106
        U.S. Court of Appeals for Veterans Claims..........    74
                                                                    106
        Cemeterial Expenses, Army..........................    75
                                                                    107
        Armed Forces Retirement Home.......................    75
                                                                    107
        Administrative Provision...........................    76
                                                                    108
Department of Defense:
        Overseas Contingency Operations....................    76
                                                                    108
        Administrative Provision...........................    77
                                                                    109
General Provisions.........................................    78
                                                                    109
House of Representatives Report Requirements:
        Statement of General Performance Goals and 
            Objectives.....................................
                                                                    110
        Rescissions........................................
                                                                    111
        Transfer of Funds..................................
                                                                    111
        Disclosure of Earmarks and Congressionally Directed 
            Spending Items.................................
                                                                    112
        Ramseyer Rule......................................
                                                                    112
        Changes in Application of Existing Law.............
                                                                    114
        Appropriations Not Authorized by Law...............
                                                                    120
        Program Duplication................................
                                                                    122
        Committee Hearings.................................
                                                                    122
        Comparison With the Budget Resolution..............
                                                                    124
        Five-Year Projection of Outlays....................
                                                                    124
        Assistance to State and Local Governments..........
                                                                    124
        Full Committee Votes...............................
                                                                    125
        Comparative Statement of New Budget (Obligational) 
            Authority......................................
                                                                    127
        State and Country Project List.....................
                                                                    148
        Overseas Contingency Operations Project List.......
                                                                    157
        Minority Views.....................................
                                                                    159

                          Purpose of the Bill

    The purpose of the bill is to support our military and 
their families and provide the benefits and medical care that 
our Veterans have earned because of their service to our 
Nation. This is accomplished through the programs funded in the 
bill, which provide the facilities and infrastructure needed to 
house, treat, train, and equip our military personnel to defend 
this Nation, both in the United States and abroad; provide the 
housing and military community infrastructure that supports a 
good quality of life for them and their families; and allow the 
military to maintain an efficient and effective base structure. 
The quality of life for our servicemembers and their families 
is a key component of readiness. The bill also funds a wide 
variety of assistance programs for Veterans, including 
disability and pension benefits, healthcare in many different 
settings, educational assistance, and home loan and insurance 
programs. Finally, the bill funds four related agencies that 
provide support to our Nation's heroes: the American Battle 
Monuments Commission, Cemeterial Expenses, Army (including 
Arlington National Cemetery), the United States Court of 
Appeals for Veterans Claims, and the Armed Forces Retirement 
Home.

                  Summary of Committee Recommendation

    The Committee recommends $250,926,222,000 in total budget 
authority, including emergency funding, for the fiscal year 
2021 programs and activities funded in the bill. The fiscal 
year 2021 recommendation represents an increase of 
$15,214,696,000 above the comparable fiscal year 2020 enacted 
level and $2,262,624,000 above the President's request. Of the 
increase over the fiscal year 2020 enacted level, 
$10,081,909,000 is in mandatory programs. Included in the total 
budget authority is $135,434,234,000 in mandatory budget 
authority and $115,491,988,000 in discretionary budget 
authority, which includes $12,493,988,000 in emergency funding.
    The Committee recommendation highlights the continued 
commitment to our servicemembers and their families and to our 
Veterans. In overall discretionary budget authority, including 
emergency and overseas contingency funding, the bill is 4.7 
percent above the fiscal year 2020 enacted level. While the 
Committee recommendation continues essential support for 
servicemembers and Veterans, it does not provide funds for 
projects or activities that lacked sufficient justification or 
urgency.
    The programs funded in the bill for the Department of 
Defense (DOD) address the priorities of the Department's 
Agencies and the Services for the numerous facility challenges 
that they face. The funds provided support readiness 
improvements with new construction, family housing, and 
continued cleanup of military bases closed during previous Base 
Realignment and Closure rounds, support Combatant Commanders' 
requirements where appropriate, and ensure that our military 
personnel and their families' quality of life is preserved.
    The total recommended funding level for military 
construction and family housing, including Overseas Contingency 
Operations, is $10,440,000,000 which is $1,519,526,000 below 
the fiscal year 2020 enacted level (not including hurricane 
disaster funding) and $2,276,675,000 above the budget request. 
The recommendation provides funding for Family Housing, 
construction on our bases, including barracks, health 
facilities and schools, and support for critical overseas 
investments as well as an additional $135,000,000 to address 
privatized family housing issues. Within the total, 
$350,000,000 is included for the European Deterrence Initiative 
and construction, which helps ensure the protection of our 
allies and protects the warfighter. The recommendation also 
supports $1,809,972,000 for the Services' unfunded priorities 
that are more than 35 percent complete in design and can be 
executed in fiscal year 2021. Finally, the total provides 
$554,500,000 for the Services' cost to complete projects, which 
are previously appropriated projects that have experienced an 
increase in cost from the original contract award.
    The total recommended funding level for fiscal year 2021 
for the Department of Veterans Affairs, including emergency 
funding, is $240,210,107,000, an increase of $22,347,382,000 
over the fiscal year 2020 enacted level. Of the total, 
$135,434,234,000 is provided for mandatory benefit programs and 
$104,775,873,000, including $12,493,988,000 in emergency 
funding, is allocated to discretionary programs such as medical 
care, claims processing, and construction. In this bill, 
discretionary funding for the Department of Veterans Affairs is 
recommended at 13 percent over the fiscal year 2020 enacted 
level. Of the total for fiscal year 2021, $87,636,650,000 for 
medical care has been appropriated in advance.
    In addition, the Committee recommendation includes 
$94,183,260,000 in advance appropriations for fiscal year 2022 
for the four health care accounts of the Department and 
$145,311,218,000 in advance appropriations for mandatory 
benefits programs in fiscal year 2022.
    The Committee recommendation provides a total of 
$276,115,000 for the four Related Agencies: the American Battle 
Monuments Commission (ABMC), the U.S. Court of Appeals for 
Veterans Claims, Arlington National Cemetery, and the Armed 
Forces Retirement Home. The recommendation represents an 
increase of $21,015,000 above the budget request. These funds 
are provided to ensure that these agencies are able to continue 
their missions of honoring the service and sacrifice of our 
servicemembers and Veterans.

                  Management and Oversight Initiatives

    The Committee believes the effective stewardship of 
taxpayer dollars is of the highest priority. In the interest of 
eliminating waste, fraud, and abuse in Federal programs, the 
Committee has and will continue to use public hearings, 
briefings, information requests, and reviews by the Government 
Accountability Office (GAO) and the Inspectors General to 
promote strong financial and program management, oversight and 
leadership at the Department of Defense (DOD), the Department 
of Veterans Affairs (VA), and Related Agencies under the 
jurisdiction of this bill.
    The fiscal year 2021 appropriations Act and the 
accompanying report address management challenges of the 
Federal agencies it funds, including directives to strengthen 
financial and program management, eliminate redundancy, and 
improve implementation and oversight of initiatives that 
support the mission of this bill. The Committee will use every 
means at its disposal to reduce mismanagement that results in 
waste, fraud, and abuse.
    Performance Measures.--The Committee directs each of the 
agencies funded by this Act to comply with title 31 of the 
United States Code, including the development of their 
organizational priority goals and outcomes such as performance 
outcome measures, output measures, efficiency measures, and 
customer service measures. Each of the agencies funded by the 
Act shall submit a report to the Committee within 60 days of 
enactment of the Act on the progress it has made on Performance 
Measures.
    Customer Service Standards.--The Committee continues to 
support efforts to improve customer service in accordance with 
Executive Order 13571--Streamlining Service Delivery and 
Improving Customer Service. The Committee directs the Secretary 
of Veterans Affairs to develop standards to improve customer 
service and incorporate the standards into the performance 
plans required under 31 U.S.C. 1115. The Committee requests a 
report on the progress the Secretary has made on this issue 
within 60 days of enactment of the Act.
    Federal Law Enforcement.--The Committee notes that the 
Commerce, Justice, Science, and Related Agencies Appropriations 
Act, 2021 directs the Attorney General to establish a training 
program to cover the use of force and de-escalation, racial 
profiling, implicit bias, and procedural justice, to include 
training on the duty of Federal law enforcement officers to 
intervene in cases where another law enforcement officer is 
using excessive force, and make such training a requirement for 
Federal law enforcement officers. The Committee further notes 
that several offices funded by this Act employ Federal law 
enforcement officers and are Federal Law Enforcement Training 
Centers partner organizations. The Committee directs such 
offices to adopt and follow the training program established by 
the Attorney General, and to make such training a requirement 
for its Federal law enforcement officers. The Committee further 
directs such offices to brief the House and Senate Committees 
on Appropriations on their efforts relating to training no 
later than 90 days after the Attorney General has established 
such a training program.
    In addition, the Committee directs such offices, to the 
extent that such offices have not already done so, to submit 
their use of force data to the Federal Bureau of Investigation 
(FBI)'s National Use of Force Data Collection database. The 
Committee further directs such offices to brief the House and 
Senate Committees on Appropriations no later than 90 days after 
enactment of this Act on their current efforts to tabulate and 
submit its use of force data to the FBI.
    Department of Defense Military Family Housing.--Privatized 
housing has come under scrutiny in recent years. Complaints of 
inadequate housing across the DOD enterprise include lack of 
repairs, rodents, mold, cracks in walls and peeling paint. The 
military housing privatization initiative (MHPI) was 
established by Congress in 1996 as a tool to help DOD improve 
the quality of life for its servicemembers by improving the 
condition of their housing. MHPI is a public/private venture 
(PPV) where private sector developers may own, operate, 
maintain, improve and assume responsibility for military family 
housing. The private entity is responsible for managing the 
construction, renovation, and day-to-day maintenance and 
services for the community. The PPV housing may be located on 
or off government property and may be former military family 
housing. Congress has mandated that all military family housing 
in the United States be eventually privatized. In order to 
address ongoing concerns regarding unacceptable housing 
conditions, the recommendation includes $135,000,000 in section 
127. Although these funds are not proposed in the budget 
request, the Committee believes additional resources are 
required in order to secure a satisfactory outcome to enhance 
the Services' ability to provide oversight and management, 
including personnel to track current and future issues that may 
occur in privatized housing. The Committee also includes report 
language directing DOD to submit various reports and maintain a 
maintenance database to track any issues that may be prevalent 
in the future. The Committee notes that the general welfare of 
a servicemember's family contributes to the overall state of 
readiness for DOD.
    VA Electronic Health Record Modernization (EHRM).--After at 
least a decade of Congressional encouragement to DOD and VA to 
develop a single electronic health record (EHR), VA finalized a 
contract in 2018 to acquire the same EHR system that DOD is 
adopting. The bill includes $2,627,000,000 for EHRM and 
continues strict quarterly reporting of timelines, performance 
milestones, costs, implementation, and change management. The 
bill also continues the requirement for GAO to review EHRM 
implementation so that Congress can be informed of any problems 
at a point where they can be promptly and economically 
addressed.
    Disability Claims and Appeals.--Due to the significant 
investments Congress has provided in recent years, VA has been 
able to hire the staff, acquire the technology, and change work 
processes necessary to significantly reduce the disability 
claims backlog. But as the number of claims continues to 
increase and the number of appeals skyrockets once claims are 
decided, VA again runs the risk of falling into serious claims 
and appeals backlogs. This is of particular concern as VA 
receives additional claims under the Blue Water Navy Vietnam 
Veterans Act. The Committee recognizes this threat and provides 
resources within the Veterans Benefits Administration to 
support staffing, scanning of records, and other efforts to 
respond to Blue Water Navy claims. The Committee additionally 
provides increases to the Board of Veterans Appeals and the 
Court of Appeals for Veterans Claims to help ensure the prompt 
resolution of cases. The Committee hopes that with these 
additional investments and the recently passed legislation to 
reform the appeals process, Congress will have taken the 
necessary management action to prevent Veterans from enduring 
excessive wait times to receive the disability benefits they 
deserve.
    Information Technology (IT).--The Committee continues to 
include bill language indicating that funds for information 
technology systems development are available only for the 
projects and in the amounts specified in the report. The bill 
limits the amount of funds that can be transferred into the IT 
account to ten percent of the total of either the source or 
destination account. The bill contains language that permits 
the reprogramming of funds among development projects upon 
prior notification to, and approval by, the Committees.
    Stricter Control of Construction Funding.--The Committee 
continues to request that VA provide quarterly briefings on the 
progress and cost of each facility managed by an outside 
entity. Several additional bill language provisions are 
included to enhance the Committee's capacity to conduct 
oversight of VA's facility construction efforts including: (1) 
no funding greater than $7,000,000 may be reprogrammed between 
construction projects unless approved by the Committees on 
Appropriations of both Houses of Congress; (2) any change to 
the scope of a construction project is prohibited without the 
approval of the Committees; and (3) VA must report any bid 
savings of $5,000,000 or more on projects as soon as they are 
identified.
    Department of Defense Civil Cemeterial Expenses.--The 
Committee rejects the proposed cut in the President's budget 
request and instead provides $81,815,000 for Arlington National 
Cemetery so that it can maintain a consistent level of services 
and ensure that critical operations continue.
    Armed Forces Retirement Home (AFRH).--The Committee 
continues to provide funding for AFRH to work on deferred 
maintenance projects and directs AFRH to provide an expenditure 
plan for these projects. Additionally, the bill makes 
operations and maintenance funds available for two years to 
allow AFRH to make more effective use of its funds. These 
efforts will ensure that AFRH is well-positioned to continue to 
improve its standing and increase revenue for the long term. 
The Committee notes that efforts are underway to stabilize the 
AFRH Trust Fund and reduce reliance on transfers from the 
General Fund, and directs AFRH to continue making progress 
toward improving AFRH's sustainability.
    Army Corps of Engineers Updates on VA projects.--The 
Committee is concerned that VA projects under management of the 
Army Corps of Engineers (USACE) might be delayed due to 
administrative delays during the initial transitional phase 
between projects being authorized and appropriated by Congress, 
and an interagency agreement being signed. Accordingly, the 
Committee directs VA to continue to provide monthly updates on 
all current and subsequent VA construction projects worth more 
than $100 million and jointly managed by VA and USACE. Regular 
reports for certain projects may be submitted on a quarterly 
basis if the Department and Committee come to an agreement that 
more frequent reports are not necessary.
    Historic Preservation Study.--Section 106 of the National 
Historic Preservation Act requires Federal agencies to take 
into account the effects of their undertakings on historic 
properties. The Section 106 process seeks to accommodate 
historic preservation concerns through consultations with 
interested parties with a goal of commencing consultations 
during the early stages of project planning. The consultations 
seek to identify historic properties potentially affected by 
any undertaking, assess their potential effects and find ways 
to avoid, minimize or mitigate adverse effects on a historic 
property. This consultative process generally includes State 
Historic Preservation Offices (SHPOs), and a Federal agency can 
provide various assistance to a SHPO under limited 
circumstances. To better assess this assistance and determine 
what additional support may be needed to help the services more 
effectively work with SHPOs, the Assistant Deputy Under 
Secretary of Defense Energy, Installations, and Environment 
shall issue a report within 180 days of enactment of this Act 
detailing: (1) discretionary services provided by the 
Department to SHPOs, such as tailored training, cultural 
resources surveys, data recovery, and data recordation; (2) 
systemic departmental challenges to obtaining historical 
designation from SHPOs; (3) best practices for enhancing the 
Section 106 compliance; and (4) potential regulatory and legal 
options for accelerating individual project reviews at the 
installation level.
    Advertising and Contracts for Small Business.--The 
Committee understands that, as the largest advertiser in the 
United States, the Federal government should work to ensure 
fair access to its advertising contracts for small 
disadvantaged businesses and businesses owned by minorities and 
women. The Committee directs each department and agency to 
include the following information in its fiscal year 2022 
budget justification: Expenditures for fiscal year 2020 and 
expected expenditures for fiscal year 2022, respectively, for 
(1) all contracts for advertising services; and (2) contracts 
for the advertising services of (I) socially and economically 
disadvantaged small businesses concerns (as defined in section 
8(a)(4) of the Small Business Act (15 U.S.C. 637 (a)(4)); and 
(II) women-and minority-owned businesses.

                                TITLE I


                         DEPARTMENT OF DEFENSE


                     Military Construction Overview


 
 
 
Appropriation, fiscal year 2020.......................   $11,315,000,000
Budget request, fiscal year 2021......................     7,813,563,000
Recommended in the bill...............................    10,090,000,000
Bill compared with:
    Appropriation, fiscal year 2020...................    -1,225,000,000
    Budget request, fiscal year 2021..................    +2,276,437,000
 

    Military construction accounts provide funds for new 
construction, construction improvements, planning and design, 
and host nation support. Projects funded by these accounts 
include facilities for operations, training, readiness, 
maintenance, research and development, supply, medical care, 
and force protection, as well as unaccompanied housing, 
military-owned family housing, utilities infrastructure, and 
land acquisition.
    In addition to the notification and reporting requirements 
for military construction programs contained in Title 10, 
United States Code, the Committee's recommendations include 
several provisions requiring DOD to report on various aspects 
of military construction programs, or to provide notification 
to the Committee when certain actions are taken. The Committee 
also retains prior approval authority for any reprogramming of 
funds exceeding a specific threshold.
    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) that has been specifically reduced by 
Congress in acting on the budget request is considered to be a 
Congressional interest item and as such, prior approval is 
required. Accordingly, no reprogramming to an item specifically 
reduced below the threshold by Congress is permitted, except 
that DOD may seek reprogramming for appropriated increments.
    The reprogramming criteria that applies to military 
construction projects is 25 percent of the funded amount or 
$2,000,000, and includes new housing construction projects and 
improvements. 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, if such 
remediation requirements could not be reasonably anticipated at 
the time of the budget submission. Reprogramming is a courtesy 
provided to DOD and can be taken away if the authority is 
abused. 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. Planning and design 
costs associated with military construction and family housing 
projects may also be excluded from these guidelines. In 
instances where prior approval for a reprogramming request for 
a project or account has been received from the Committees on 
Appropriations of both Houses of Congress, the adjusted amount 
approved becomes the new base for any future increase or 
decrease via below-threshold reprogramming (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 
reprogramming actions and notifications, including the 
pertinent statutory authorities contained in DOD Financial 
Management Regulation 7000.14-R and relevant updates and policy 
memoranda. The Committee further encourages the Office of the 
Director of National Intelligence to use a format similar to 
that used by the Office of the Secretary of Defense to submit 
reprogramming requests.
    Diversion of Military Construction Funds for a Border 
Wall.--On February 15, 2019, President Trump declared a 
National Emergency for the purpose of using section 2808 of 
title 10, United States Code to bypass congressional intent and 
divert valuable military construction funding from previously 
approved national security projects to fund a border wall 
instead. Congress chose not to fund this wall in the 
Consolidated Appropriations Act, 2019 (P.L. 116-6). The 
Committee notes there is bipartisan opposition to the action 
taken by the President, as both the House and Senate voted to 
disapprove the President's emergency declaration. Despite 
bipartisan congressional opposition, the fiscal year 2020 
budget request for military construction included 
$7,200,000,000 to restore funding (up to $3,600,000,000) that 
would be diverted for the wall as well as provide the next 
installment of wall funding ($3,600,000,000). Throughout the 
fiscal year 2020 appropriations cycle, the Committee rejected 
the Administration's proposal and made clear that Congress 
would not provide resources to ``backfill'' these projects. 
This position was ratified when the final enacted appropriation 
for fiscal year 2020 explicitly included zero funds to backfill 
projects whose funding had been redirected.
    In defiance of such unmistakable congressional intent, on 
April 28, 2020 DOD announced its intention to cancel fiscal 
year 2020 Overseas Contingency Operations Funds for the 
European Deterrence Initiative in order to provide the 
necessary resources to backfill projects originally funded in 
fiscal years 2018 and 2019 and subsequently canceled for the 
border wall in 2019. The Committee previously appropriated 
these funds for disaster recovery, flood protection, military 
base construction projects, defense of Europe against Russia 
aggression and to maintain and improve military readiness. As 
such, the Committee expects that the resources should indeed be 
used for those specific purposes. The Committee believes that 
the deferral or ultimate cancellation of those projects will 
inhibit military construction project planning in the future 
and diminish military readiness. The Committee emphasizes that 
in the interest of national security and constitutional 
prerogatives, military construction funding should only be used 
for the purpose they are provided, which is to support DOD's 
mission, military readiness, servicemembers, and their 
families.
    The accompanying fiscal year 2021 bill includes language 
that protects both previously appropriated projects, as well as 
fiscal year 2021 projects funded in this bill from being used 
as a source for border wall projects. The Committee believes 
that Congress must assert its role as a co-equal branch of the 
Federal government and insist upon the appropriate and 
constitutional use of appropriated funds.
    Facilities Sustainment, Restoration and Modernization 
(FSRM).--DOD is directed to continue describing on form 1390 
the backlog of FSRM requirements at installations with future 
construction projects. For troop housing requests, form 1391 
should describe any FSRM conducted in the past two years. 
Likewise, future requirements for unaccompanied housing at the 
corresponding installation should be included. Additionally, 
the forms should include English equivalent measurements for 
projects presented in metric measurement. Rules for funding 
repairs of facilities under the operation and maintenance 
accounts are described below:
          (1) components of the facility may be repaired by 
        replacement. Such replacement can be up to current 
        standards or codes;
          (2) interior arrangements and restorations may be 
        included as repair;
          (3) additions and new facilities, may be done 
        concurrently with repair projects as long as the final 
        conjunctively funded project is a complete and usable 
        facility; and
          (4) the appropriate Service Secretary shall notify 
        the appropriate committees 21 days prior to carrying 
        out any repair project with an estimated cost in excess 
        of $7,500,000.
    Quarterly Summary of Notifications.--The Committee directs 
the Services and the Office of the Secretary of Defense (on 
behalf of itself and defense agencies) to continue to submit a 
quarterly report listing all notifications that have been 
submitted to the Committees during the preceding three-month 
period.
    Work in Progress or Planned (WIP) Curve.--The Committee 
directs the Services and the Office of the Secretary of Defense 
(on behalf of itself and defense agencies) to submit a WIP 
curve for each project requested in a budget submission above 
$90,000,000 with the form 1391 justification to the 
congressional defense committees. The Committee acknowledges 
that there is an alarming amount of unawarded prior-year 
military construction projects, and therefore the Committee 
directs the Secretary of Defense to report to the congressional 
defense committees quarterly, beginning in the second quarter 
of fiscal year 2021 and each quarter thereafter of projects 
that remain unawarded from the current and prior fiscal years 
and the reasons for delay.
    Transfer of Funds To and From the Foreign Currency 
Fluctuations, Construction, Defense Account.--The Committee 
directs DOD to submit a quarterly report to the Committees on 
Appropriations of both Houses of Congress on the transfer of 
funds from military construction and family housing accounts to 
the Foreign Currency Fluctuations, Construction, Defense 
account. The report shall specify the amount transferred to the 
Foreign Currency account from each military construction and/or 
family housing account, and all other accounts for which an 
appropriation is provided in this Act, during the preceding 
fiscal quarter, and the amounts transferred from the Foreign 
Currency account to the above accounts during the same period. 
This report shall be submitted no later than 30 days after the 
close of each fiscal quarter. In addition, DOD shall notify the 
Committees on Appropriations of both Houses of Congress within 
seven days of transferring any amount in excess of $10,000,000 
to or from the Foreign Currency account.
    Bid Savings.--The Committee directs the Secretary of 
Defense to continue to submit 1002 reports on military 
construction bid savings at the end of each fiscal quarter to 
the Subcommittees on Military Construction, Veterans Affairs, 
and Related Agencies of both Houses of Congress.
    Incremental Funding of Projects.--In general, the Committee 
supports full funding for military construction projects if 
they are executable. However, it continues to be the practice 
of the Committee to provide incremental funding for certain 
large projects 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 recommendation includes four projects that have been 
incrementally funded; however, the full authorization of the 
projects will be provided in the fiscal year 2021 National 
Defense Authorization Act.
    Hawaii Infrastructure Readiness Initiative.--The Committee 
recognizes the strategic and critical role the Hawaii 
Infrastructure Readiness Initiative (HIRI) plays in DOD's 
strategic plans for the Indo-Pacific region. At the direction 
of Congress, United States Army Pacific created the HIRI to 
address critical priorities established in its military 
construction submissions and major restoration and maintenance 
(R&M) programming requests. According to the Army's analysis, 
45 percent of the infrastructure in Hawaii is failed or 
failing, putting efforts to meet operational needs at risk. To 
remedy this issue, HIRI allocates between $50,000,000 and 
$150,000,000 per year through fiscal year 2030 to address major 
infrastructure needs, and has a ten-year cost of 
$1,100,000,000. The program addresses several major facility 
and infrastructure deficiencies, including aviation maintenance 
facilities, operations facilities, tactical equipment 
maintenance facilities, Pohakuloa Training Area, West Loch 
Ammunition Storage, and base operations. Continued and 
consistent funding is needed at a time of growing national 
security needs in the Pacific. Therefore, the Committee directs 
the Secretary of the Army to certify that the Initiative's plan 
for the next 10 fiscal years does not create gaps in funding 
that will result in inconsistent program implementation that 
could undermine the interconnected nature of HIRI's projects.
    Adequate Childcare for Military Families.--The Committee is 
aware of the importance of secure and adequate childcare for 
military families. DOD has argued that these childcare services 
and benefits help support their recruiting, retention and 
readiness goals, and that there is generally a high level of 
satisfaction among servicemembers who use DOD childcare 
services. However, the success of the program depends, in part, 
on ensuring adequate facilities for child development centers 
(CDCs) and School Age Care (SAC) Program facilities, preferably 
on military installations. Hearings before the subcommittee 
have noted a lack of facilities in some locations. Thus, the 
Committee directs the Service Secretaries to submit a report to 
the congressional defense committees no later than 180 days 
after enactment of this Act detailing (1) all installations 
that have CDCs and SAC facilities, (2) the physical condition 
of these facilities, and (3) the length of time military 
families must wait before enrolling their children into CDCs 
and SAC programs.
    Quality of Life (QOL) Project Funding and Priority List.--
In recognition of the difficulties the lack of QOL facilities 
can cause for servicemembers and their families, the Committee 
provides an additional $152,000,000 for the construction of 
three Child Development Centers (CDCs) on Army installations, 
as identified on the unfunded requirements list submitted to 
Congress. Understanding that stable family life is a key 
component of mission readiness and retention, the Committee 
believes the Services should make QOL projects, particularly 
CDCs, a priority in their annual budget requests and directs 
the Service Secretaries to submit a report to the congressional 
defense committees, no later than 90 days after enactment of 
this Act, to address QOL shortfalls. The report should identify 
the installations that are most in need of QOL projects in 
fiscal year 2022 and the following four fiscal years, the 
specific projects needed, and associated funding requirements. 
In addition, the Committee directs the Secretary to create a 
unified list of QOL projects to be submitted with the annual 
budget request.
    Review of Area Cost Factors for the Indo-Pacific.--The DOD 
Facilities Pricing Guide (UFC 3-701-01) supports a spectrum of 
facility planning, investment, and analysis needs for each 
Service. This guide reflects updated cost, pricing data, and 
methodologies used to prepare the military's construction 
budget. It is essential for project scoping and cost estimates 
built using this guide to be accurate for the effective 
utilization of scarce taxpayer resources. The methodology 
behind these estimates must take into account the unique market 
specific considerations, especially in geographically isolated 
locations in the Indo-Pacific, including Hawaii. Therefore, the 
Committee directs the Secretary to submit a report to the 
congressional defense committees, no later than 180 days after 
enactment of this Act, that: (1) compares initial price guide 
estimates to final construction costs for each of fiscal years 
2015 through 2019 for construction projects in the Indo-
Pacific, to include Hawaii; (2) describes factors unique to 
construction on Indo-Pacific islands that are included in the 
Services' pricing estimates based on the DOD Facilities Pricing 
Guide; (3) compares military and private sector construction 
costs in the Indo-Pacific for buildings of comparable purposes; 
(4) describes the major cost factors considered by private 
sector construction companies operating in the Indo-Pacific 
that are not considered by the military and why; and (5) 
analyzes the effect of ocean shipping rates and U.S. ocean 
shipping laws on construction costs and regulatory and legal 
options for reducing those costs.
    Naval Air Weapons Station (NAWS) China Lake Earthquake 
Recovery Efforts.--NAWS China Lake is a critical installation 
that serves as a cornerstone of our national defense 
architecture. The Committee appreciates the Navy's efforts to 
rebuild NAWS China Lake as expeditiously as possible and 
recognizes the important role that supporting communities will 
play with the rebuilding effort. By strengthening ties with the 
local community, the Committee believes that this action 
enables the base to be rebuilt in a timely manner while also 
fostering a good return on taxpayer funds. In order to help 
facilitate good communication and long-term, strategic planning 
by local stakeholders and to assist with congressional 
oversight responsibilities, the Committee directs the Secretary 
to produce a biannual publicly releasable report that provides 
an update on the rebuilding efforts of NAWS China Lake until 
all work is complete. The report should not only discuss the 
past, present, and future construction efforts, but also 
highlight opportunities that local community members may be 
able to help address. The report shall be submitted to the 
Committees on Appropriations and be posted online.
    Federally Recognized Tribes.--The Committee notes our 
Nation's commitment to honoring treaty and trust obligations to 
Federally Recognized Tribes. While military operations and 
facility protection are important, upholding our commitments to 
Indian Country must be an equal priority. It has been observed 
that DOD has struggled to proactively engage with affected 
Tribes at the start of the planning process to ensure 
meaningful consultation can occur. Moreover, the Department 
does not identify sufficient funds to cover mitigation and 
alternatives should they be agreed upon. To understand the 
scale of this problem, the Committee directs the Secretary of 
Defense to provide the Committee a list of military 
construction projects related to mitigation and/or changes to 
projects were required within the past five years where 
consultation with a Federally Recognized Tribe, the outcome of 
each consultation, a list of all project modifications and/or 
mitigation requests made by the Tribe (or Tribes) in question 
for each project, the cost of each measure, and which 
modifications and or mitigations were adopted no later than 180 
days after enactment of this Act. Further DOD is encouraged to 
each establish a central account from which mitigation projects 
can be funded.
    Military Construction Planning for the Indo-Pacific 
Region.--According to the National Defense Strategy, the United 
States is seeking to strengthen our nation's alliances and 
partnerships in the Indo-Pacific Region with a networked 
security architecture capable of deterring aggression, 
maintaining stability, and ensuring free access to common 
domains. This effort will include significant military 
construction requirements throughout the Indo-Pacific region. 
Properly executing this investment requires advance planning 
and design work to develop DD Form 1391s matched to mission-
critical requirements. Thus, the Committee directs the 
Assistant Secretary of Defense (Sustainment) to submit a report 
to the congressional defense committees within 180 days of 
enactment of this Act detailing: (1) the number of DD Form 
1391s for facilities in the Indo-Pacific generated by each 
military service and agency for fiscal year 2015 through fiscal 
year 2020, (2) the number of military construction projects in 
the Indo-Pacific that were included in the Future Years Defense 
Program for each military service and agency for fiscal year 
2015 through fiscal year 2020, and (3) efforts by the 
department to accelerate planning and design efforts by the 
Services to better align departmental strategies with 
executable projects.
    Efficiency within the Military Construction Accounts.--The 
Committee supports military construction projects that 
incorporate requirements from Active Duty, Reserve and Guard 
components in order to maximize efficiency, eliminate the need 
for multiple construction projects and reduces costs.
    Cross Laminated Timber.--The Committee is aware that the 
use of cross laminated timber and other mass timber products as 
a building material has the potential for reducing costs and 
increasing functionality of various military structures. The 
Committee encourages the Secretary of Defense to expand the 
application of these innovative technologies in future military 
construction projects.
    Defense Access Roads (DAR) Program.--The Committee supports 
Defense Access Roads as a vital mechanism to improve 
transportation infrastructure at domestic installations and 
their surrounding communities. The Fiscal Year 2020 National 
Defense Authorization Act clarified that appropriated funds for 
the DAR Program may be used to cover the cost of repairing 
damage or mitigating infrastructure risk to access roads caused 
by recurrent flooding or sea level fluctuation. The Committee 
urges the Department to identify military installations with 
transportation infrastructure affected by sea level fluctuation 
and recurrent flooding and, through the appropriate contacts at 
affected installations and sites, work with surrounding local 
communities to identify affected transportation infrastructure 
and conduct transportation needs assessments to understand the 
magnitude of the improvement required.
    Investing in Multi-hazard Resilient Defense Infrastructure 
Planning, Development, and Testing.--The Committee supports the 
Department's continued focus on building lasting and resilient 
military installations, including its update of hurricane-
resistant building codes for bases, barracks, hospitals, and 
airfields, and consideration of the effects of severe drought 
and desertification on military installations and missions. In 
addition to Department-wide initiatives, such as revised 
structure planning, conservation programs and modeling new 
installations with the threat of sea-level rise in mind, the 
Committee encourages the Department to prioritize investing in 
climate-sustainable infrastructure projects that have yielded 
positive results. To support these efforts, the bill includes 
section 512 prohibiting the use of funds to construct 
facilities that do not meet resiliency standards.
    Broadband In/Around Military Installations.--The Committee 
is concerned with the lack of broadband access at remote or 
rural installations across the United States. The absence of 
high-quality broadband significantly limits professional 
development and employment opportunities for military spouses, 
exacerbating existing workforce challenges faced by spouses who 
often relocate their families every two to three years. It also 
means children of servicemembers may not have the resources to 
complete their homework and can creates difficulty accessing 
the telemedicine services military families need when 
specialists and advanced treatment facilities are hours of 
driving away. Therefore, the Secretary is directed to provide a 
report to the congressional defense committees no later than 90 
days after enactment of this Act that discusses broadband 
access at remote and rural military installations, identifies 
installations that lack such access, and assesses the 
availability of low-cost broadband technologies that could 
extend access to these installations.
    Ultra-High Performance Concrete.--The Committee is aware of 
the Department of Defense's collaboration with Federally 
designated research universities to accelerate research on the 
development of additive manufacturing techniques and processes 
that use superior and resilient building products, in 
particular ultra-high performance concrete. Additive 
manufacturing will be critical for rapidly enhancing the 
resilience and readiness of military installations, base 
housing, roads and bridges in a cost-effective manner. The 
Committee encourages the Secretary of Defense to expand the 
application of these innovative technologies and building 
products in future military construction projects.

                      Military Construction, Army


 
 
 
Appropriation, fiscal year 2020.......................    $1,178,499,000
Budget request, fiscal year 2021......................       650,336,000
Recommended in the bill...............................       608,336,000
Bill compared with:
    Appropriation, fiscal year 2020...................      -570,163,000
    Budget request, fiscal year 2021..................       -42,000,000
 

    Military Construction, Army.--The bill includes 
$608,336,000 for the following projects in the following 
amounts:

------------------------------------------------------------------------
                       Project                               Amount
------------------------------------------------------------------------
Yuma Proving Ground--Ready Building..................        $14,000,000
Fort Carson--Physical Fitness Facility...............         28,000,000
Fort Gillem--Forensic Laboratory.....................         71,000,000
Fort Gordon--Advanced Individual Training Barracks            80,000,000
 Complex, Phase 3....................................
Wheeler Army Airfield--Aircraft Maintenance Hangar...         89,000,000
Fort Polk--Information Systems Facility..............         25,000,000
McAlester APP--Ammunition Demolition Shop............         35,000,000
Carlisle Barracks--General Instruction Building,              38,000,000
 Increment 2.........................................
Humphreys Engineering Center--Training Support                51,000,000
 Facility............................................
 
Planning and Design..................................        126,436,000
Minor Construction...................................         50,900,000
    Total, Military Construction, Army...............        608,336,000
------------------------------------------------------------------------

    Within the total for Army planning and design, the 
recommendation includes $8,000,000 for a SOUTHCOM headquarters 
replacement facility, as requested by the Command.
    In addition, for unfunded requirements and cost to complete 
projects of the Army, the bill includes $567,500,000 in 
sections 123 and 126 for the following projects in the 
following amounts:

------------------------------------------------------------------------
                       Project                               Amount
------------------------------------------------------------------------
Cost to Complete (Section 126)
Fort Irwin--Multi-purpose Range......................        $23,000,000
Lucius D. Clay Kaserne--Controlled Humidity..........          2,500,000
Kwajalein Atoll--Air Traffic Control Tower...........         17,500,000
White Sands Missile Range--Information Systems                20,000,000
 Facility............................................
Fort Drum--Railhead..................................          9,000,000
Fort Sill--AIT Barracks Complex, Phase 2.............         19,000,000
Fort Jackson--Trainee Barracks Complex 3, Phase 2....         19,000,000
Fort Jackson--Reception Barracks Complex, Phase 1....         18,200,000
Corpus Christi Army Depot--Powertrain Facility.......          4,300,000
Fort Hood--Battalion Headquarters Complex............         19,200,000
Fort Hood--Vehicle Maintenance Shop..................         10,500,000
Camp Bullis--Vehicle Maintenance Shop................         11,600,000
Camp Williams--Live Fire Shoothouse..................          4,100,000
Fort Belvoir--Vehicle Maintenance Shop...............         15,000,000
Joint Base Langley-Eustis--AIT Barracks Complex,              32,000,000
 Phase 4.............................................
    Total, Cost to Complete, Army....................        224,900,000
 
Unfunded Requirements (Section 123)
Fort Jackson--Trainee Barracks Complex 3, Phase 2....         $7,000,000
Fort Wainwright--Unaccompanied Enlisted Personnel             59,000,000
 Housing.............................................
Schofield Barracks--Child Development Center.........         39,000,000
Fort Shafter--Child Development Center--School Age...         58,000,000
Fort Wainwright--Child Development Center............         55,000,000
Fort McCoy--Transient Training Enlisted Barracks.....         29,200,000
Fort McCoy--Transient Training Enlisted Barracks.....         29,200,000
Caserma Renato Del Din--Access Control Point.........         10,200,000
Military Ocean Terminal Concord--Ammunition Holding           46,000,000
 Area................................................
Fort Detrick--Incinerator Facility...................         10,000,000
    Total, Unfunded Requirements, Army...............        342,600,000
------------------------------------------------------------------------

    Immediate Response Force.--The Committee is concerned that 
without significant investment, the Army is not prepared to 
maintain the requirements of the Immediate Response Force (IRF) 
to be able to deploy anywhere in the world within 18 hours. In 
order to deter aggression against US interests and maintain an 
effective global deterrent, there are significant military 
construction needs at several installations that cannot be 
sufficiently mitigated with other funding sources. The 
Committee urges the Army to prioritize facilities that will 
support the global mission of the IRF and maintain this 
critical capability.
    Motor Pools.--In order to be able to deploy on command and 
conduct decisive full-spectrum operations, the Army must have 
well-maintained and ready-to-deploy equipment. The readiness of 
this equipment relies on an effective, comprehensive 
maintenance program, which in turn, enhances and facilitates 
training and warfighting. This is particularly important for 
units that rely on armored vehicles as their primary weapons 
system. However, quality maintenance requires appropriately 
designed, sized, supplied, and staffed motor pools and 
maintenance facilities. The Committee requests a report on the 
condition, current and anticipated capacity requirements, and 
modernization needs of motor pools that support the rapid 
deployment of armored combat units within 90 days after 
enactment of this Act. The report should include information on 
recent upgrades and construction of motor pools, as well as 
planned investments included in the future years defense 
program.
    Firefighting Houses and Equipment.--The Secretary of the 
Army is directed to provide a report to the Committee, within 
180 days of enactment of this Act, regarding firehouses, 
firefighting equipment, and firefighting personnel on military 
installations in noncontiguous states and territories. This 
report should include a timeline, details, and projected costs 
for the building of any firehouses on DOD installations that 
have firefighting personnel but have substandard working and 
living conditions for personnel and their equipment, suited to 
their mission and needs. The report also should include 
information on remediation efforts to mitigate substandard 
conditions and to protect personnel and equipment.
    Land Use and Housing Issues at U.S. Army Garrison.--The 
Committee is aware of the Army's desire to examine various 
options to address land use and housing issues at U.S. Army 
Garrison Hawaii. Among the options under consideration is an 
unsolicited gift of real property under Army Regulation 1-100, 
The Army Gift Program. Although the gift process requires a 
National Environmental Policy Act (NEPA) Environmental Impact 
Assessment, the Committee notes that members of the local 
community may have expectations regarding the land use rules 
for properties that may have been designated solely for 
agricultural and other non-housing uses. To provide the 
greatest public transparency possible consistent with existing 
law, the Committee directs the Secretary of the Army to provide 
to the congressional defense committees a report no later than 
180 days after enactment of this Act on: (1) what state and 
county land use laws in the State of Hawaii would be negated if 
the Army processes a land proffer under NEPA and (2) the Army's 
public engagement plan for ensuring reasonable community 
engagement before accepting a proffer.

              Military Construction, Navy and Marine Corps


 
 
 
Appropriation, fiscal year 2020.......................    $2,449,632,000
Budget request fiscal year 2021.......................     1,975,606,000
Recommended in the bill...............................     1,611,914,000
Comparison with:
    Appropriation, fiscal year 2020...................      -837,718,000
    Budget request, fiscal year 2021..................      -363,692,000
 

    Military Construction, Navy and Marine Corps.--The bill 
includes $1,611,914,000 for the following projects in the 
following amounts:

------------------------------------------------------------------------
                       Project                               Amount
------------------------------------------------------------------------
Camp Pendleton--1st MARDIV Operations Complex........        $68,530,000
Camp Pendleton--I MEF Consolidated Information                37,000,000
 Center, Increment 2.................................
LeMoore--F-35C Hangar 6, Phase 2 (MOD 3/4)...........         98,070,000
LeMoore--F-35C Simulator Facility and Electrical              59,150,000
 Upgrade.............................................
San Diego--Pier 8 Replacement, Increment 2...........         98,500,000
Twentynine Palms--Wastewater Treatment Plant.........         76,500,000
JB Pearl Harbor-Hickam--Waterfront Improvements               48,990,000
 Wharves S1,S11-13,S20-21............................
Joint Base Pearl Harbor-Hickam--Waterfront                    65,910,000
 Improvements Wharves S8-S10.........................
Kittery--Multi-mission Drydock 1 Extension, Phase 1..        160,000,000
Fallon--Range Training Complex, Phase 1..............         29,040,000
Camp Lejeune--II MEF Operations Center and                    20,000,000
 Replacement, Increment 2............................
Norfolk--E-2D Training Facility......................         30,400,000
Norfolk--MH-60 & CMV-22B Corrosion Control & Paint            17,671,000
 Facility............................................
SW Asia--Ship to Shore Utility Services..............         68,340,000
Souda Bay--Communications Center.....................         50,180,000
Andersen AFB--Ordnance Operations Admin..............         21,280,000
Joint Region Marianas--Base Warehouse................         55,410,000
Joint Region Marianas--Central Fuel Station..........         35,950,000
Joint Region Marianas--Central Issue Facility........         45,290,000
Joint Region Marianas--Combined EOD Facility.........         37,600,000
Joint Region Marianas--DAR Bridge Improvements.......         40,180,000
Joint Region Marianas--DAR Road Strengthening........         70,760,000
Joint Region Marianas--Distribution Warehouse........         77,930,000
Joint Region Marianas--Individual Combat Skills               17,430,000
 Training............................................
Joint Region Marianas--Joint Communications Upgrade..         22,000,000
Rota--MH-60R Squadron Support Facilities.............         60,110,000
 
Planning and Design..................................        160,710,000
Minor Construction...................................         38,983,000
    Total, Military Construction, Navy and Marine          1,611,914,000
     Corps...........................................
------------------------------------------------------------------------

    In addition, for unfunded requirements and cost to complete 
projects of the Navy and Marine Corps, the bill includes 
$910,837,000 in sections 123 and 126 for the following projects 
in the following:

------------------------------------------------------------------------
                       Project                               Amount
------------------------------------------------------------------------
Cost to Complete (Section 126)
Joint Region Marianas--Hardening Petroleum Oil, and          $19,200,000
 Lubricant Infrastructure............................
NAS Key West--Aircraft Maintenance Hangar............         37,200,000
NAS Whiting Field--Air Traffic Control Tower.........          7,900,000
NAS Point Mugu--Missile Assembly Building and High            13,100,000
 Explosive Magazine..................................
MCAS Cherry Point--F-35B Vertical Lift Fan Test                7,000,000
 Facility............................................
MCAS Beaufort--Recycling and Hazardous Waste Facility         10,000,000
Camp Lejeune--Water Treatment Plant Replacement,              50,500,000
 Hadnot Point........................................
    Total, Cost to Complete, Navy and Marine Corps...        144,900,000
 
Unfunded Requirements (Section 123)
Yuma--Bachelor Enlisted Quarters.....................        $31,537,000
NC TAMSLANT Cutler--Perimeter Security...............         26,100,000
Camp Pendleton--Combat Water Survival Training                25,200,000
 Facility............................................
Comalpa--Long Range Maritime Patrol Aircraft Hangar           28,000,000
 and Ramp............................................
Seal Beach--Magazines................................         46,800,000
Port Hueneme--Combat Vehicle Maintenance Facility....         43,500,000
Mechanicsburg--Machinery Control Development Center..         74,600,000
Point Mugu--Directed Energy Test Facility............         26,700,000
Norfolk--Sub Logistics Support.......................          9,400,000
Coronado--CMV-22 Hangar..............................         75,800,000
NS Guam--X-Ray Wharf Berth 2.........................         94,500,000
NOSC Minneapolis--Joint Reserve Intel Center.........         12,800,000
Whidbey Island--E/A-18G Fleet Readiness Squadron              29,900,000
 Training Facility...................................
Norfolk--CMV-22 Airfield and Hangar Improvements.....         56,100,000
NAS Jacksonville--Consolidated Ordnance Operations            14,300,000
 Facility............................................
Yorktown--Ordnance Facilities........................         71,800,000
Camp Pendleton--Combat Water Survival Training                25,200,000
 Facility............................................
Camp Pendleton--Warehouse Consolidation and                   21,800,000
 Modernization.......................................
MCAS Cherry Point--Fitness Center Replacement and             51,900,000
 Training Pool.......................................
    Total, Unfunded Requirements, Navy and Marine            765,937,000
     Corps...........................................
------------------------------------------------------------------------

    Marine Corps Military Construction Projects in Darwin, 
Australia.--The Committee is concerned that the Navy has not 
properly synchronized or planned the necessary construction 
projects needed for a Marine Corps presence in the INDOPACOM 
AOR. The Committee directs the Secretary of Navy to provide a 
master plan, in unclassified and classified format, to the 
congressional defense committees. The plan should outline by 
fiscal year and dollar amount the planned military construction 
projects to support Marines in Darwin no later than 90 days 
after enactment of this Act.
    Support Planning for Unmanned Vehicles.--The Committee 
notes that the Navy's recent budget submissions include 
significant investments into the research, development and 
procurement of unmanned undersea vehicles (UUVs), Extra Large 
Unmanned Undersea Vehicles (XLUUVs), Medium Unmanned Surface 
Vehicles (MUSVs) and Large Unmanned Surface Vehicles (LUSVs). 
These platforms are part of an effort to shift the Navy to a 
new fleet architecture that is more widely distributed. These 
vessels will require changes to the support requirement at 
various Naval installations throughout the globe that were 
built for manned naval vessels. Thus, the Committee directs the 
Department of the Navy to submit a report to the congressional 
defense committees within 180 days of enactment of this Act 
detailing: (1) the current capability of existing pier and 
related shore infrastructure to support unmanned vehicles, (2) 
currently planned investments to prepare pier and related shore 
infrastructure to support unmanned vehicles, and (3) plans for 
utilizing existing public naval shipyards to support unmanned 
vehicles.
    Shipyard Infrastructure Optimization Plan.--The Committee 
recognizes that Project Labor Agreements (PLAs) promote economy 
and efficiency in contracting, as well as foster labor-
management stability and ensure compliance with worker 
protection laws. The Committee is also aware that the first 
military construction project which used a PLA, the Explosive 
Handling Wharf at Naval Base Kitsap, came under budget by more 
than $250,000,000 when it was completed in 2016. For these 
reasons, the Committee encourages the Department of the Navy to 
utilize PLAs for military construction projects that will take 
place at the Navy's four public shipyards as part of the 
Shipyard Infrastructure Optimization Plan.

                    Military Construction, Air Force


 
 
 
Appropriation, fiscal year 2020.......................    $1,687,230,000
Budget request, fiscal year 2021......................       767,132,000
Recommended in the bill...............................       569,792,000
Bill compared with:
    Appropriation, fiscal year 2020...................    -1,117,438,000
    Budget request, fiscal year 2021..................      -197,340,000
 

    Military Construction, Air Force.--The bill includes 
$569,792,000 for the following projects in the following 
amounts:

------------------------------------------------------------------------
                       Project                               Amount
------------------------------------------------------------------------
Schriever AFB--Consolidated Space Operations Facility        $88,000,000
JB McGuire-Dix-Lakehurst--Munitions Storage Area.....         22,000,000
JB San Antonio--BMT Recruit Dormitory 8, Increment 2.         36,000,000
JB San Antonio--T-XADAL Ground Based Training System          19,500,000
 Simulator...........................................
Hill AFB--GBSD Mission Integration Facility,                  68,000,000
 Increment 2.........................................
JB Langley-Eustis--Access Control Point Main Gate             19,500,000
 with Land Acquisitions..............................
Joint Region Marianas--Stand Off Weapons Complex, MSA         56,000,000
 2...................................................
Al Udeid--Cargo Marshalling Yard.....................         26,000,000
Planning and Design..................................        166,192,000
Minor Construction...................................         68,600,000
    Total, Military Construction, Air Force..........        569,792,000
------------------------------------------------------------------------

    In addition, for unfunded requirements and cost to complete 
projects of the Air Force, the bill includes $594,500,000 in 
sections 123 and 126 for the following projects in the 
following amounts:

------------------------------------------------------------------------
                       Project                               Amount
------------------------------------------------------------------------
Cost to Complete (Section 126)
FE Warren AFB--Weapons Storage Facility..............        $12,000,000
Joint Base Andrews--Consolidate Communications Center         13,000,000
Eglin AFB--Advanced Munitions Technology Complex.....         35,000,000
Scott AFB--Add/Alt Consolidated Communications                 3,000,000
 Facility............................................
Joint Base Charleston--Fire and Rescue Station.......          5,000,000
Joint Base Langley-Eustis--Targeting Center Facility.         10,000,000
Joint Base Langley-Eustis--Fuel System Maintenance             7,000,000
 Dock................................................
Hanscom AFB--Vandenberg Gate Complex.................          6,000,000
US Air Force Academy--Air Force Cyberworx............         17,000,000
RAF Lakenheath--Consolidate Corrosion Control                 35,500,000
 Facility............................................
Cannon AFB--Dangerous Cargo Pad Relocate CATM........          2,000,000
Shaw AFB--CPIP MQ-9 MCE Group........................          5,000,000
Patrick AFB--Main Gate...............................          5,000,000
Andersen AFB--Munitions Storage Igloos Phase 3.......          8,000,000
Yokota AB--Fuel Receipt and Distribution Upgrades....          3,000,000
    Total, Cost to Complete, Air Force...............        166,500,000
 
Unfunded Requirements (Section 123)
Hill AFB--GBSD Organic Software Sustainment Center...       $132,000,000
Fort Worth JRB--F-35 Squadron Ops/Aircraft                    25,000,000
 Maintenance Unit....................................
US Air Force Academy--Cadet Preparatory School                49,000,000
 Dormitory...........................................
Joint Base Andrews--Crash Rescue Station #1..........         26,000,000
Edwards AFB--Flight Test Engineering Laboratory               40,000,000
 Complex.............................................
Ellsworth AFB--B-21 2-Bay Low Observable Restoration          96,000,000
 Facility............................................
Space Command (various locations)--Planning and               60,000,000
 Design..............................................
    Total, Unfunded Requirements, Air Force..........        428,000,000
------------------------------------------------------------------------

    The recommendation does not include funding for the three 
Air Force projects requested for Tinian. The Committee directs 
the Secretary of the Air Force to provide an update to the 
congressional defenses committees on the timeline and updated 
costs for executing military construction on the island and the 
role of the airfield and related support infrastructure to 
support INDOPACOM AOR no later than 120 days after enactment of 
this Act.
    The Weapons Technology Integration Center (WTIC).--The 
Committee is concerned that the WTIC infrastructure is old, 
inefficient, and lacking in secure areas. As directed by the 
National Security Strategy (NSS) and National Defense Strategy 
(NDS), to keep our asymmetric military advantage, the Nation 
needs to modernize our weapon systems, and be able to do so at 
the speed of relevance. The WTIC would enable the US to achieve 
these needs with modern, secure laboratory space that allows 
the digital transition in weapons research and development and 
increases collaboration across a multi-disciplinary workforce 
that enables rapid transition of technologies to the 
warfighter. The Committee directs the Secretary of the Air 
Force to report to the congressional defense committees on the 
total cost of the WTIC and what fiscal years the replacement 
construction would be submitted no later than 60 days after 
enactment of this Act.
    MIT Lincoln West Lab CSL/MIF, Increment 3.--The Committee 
is concerned that the Air Force did not submit a request for 
the final increment of the MIT-Lincoln West Lab CSL/MIF in the 
fiscal year 2021 budget request. The Committee provided 
increments 1 and 2 in fiscal years 2019 and 2020. The Committee 
understands the importance of labs to the Air Force, especially 
MIT-Lincoln Lab and is perplexed as to why the final increment 
has not been requested. Therefore, the Committee directs the 
Secretary of the Air Force to report to the congressional 
defense committees no later than 60 days after enactment of 
this Act on the status of obligation and execution for 
increments 1 and 2, the fiscal year in which the third 
increment will be requested and the amount and a timeline for 
completion of the project.
    Air Traffic Control Towers.--The Committee is concerned 
that the Air Force's ATC Towers have been neglected over the 
years, and funding for military construction has been deferred 
to the out years of budget submissions. Many of the air towers 
are deteriorating and antiquated, creating significant life, 
safety, and health concerns. In some cases, towers have 
developed extensive mold issues and contain health risks 
related to the use of asbestos and lead-based paint. 
Additionally, obstructed views in some cases prevent 100 
percent positive visual control of aircraft landing and taxiing 
on the airfield. The Committee urges the Air Force to 
prioritize funding for these towers in a much timelier manner. 
The Committee believes that these towers are valuable national 
security assets that the Department of the Air Force should 
maintain in a manner that will ensure their vital role in 
protecting United States national security interests.
    Air Education and Training Command (AETC).--The Committee 
recognizes the importance of adequate facilities for basic 
military training, flight training, and the other training 
missions of the AETC. Outdated and inadequate AETC facilities, 
including dormitories, harm the Air Force's ability to recruit, 
train, and retain Airmen and increase operations and 
maintenance costs. The Committee urges the Air Force to 
prioritize funding for AETC facility design, construction, and 
construction improvements because of the critical role training 
plays in force readiness for future threats to U.S. national 
security.
    Air Education and Training Command Drainage Projects.--The 
Committee recognizes the adverse impact that flooding and other 
infrastructure challenges have had on AETC facilities, 
equipment, operations, and training. The Committee also 
recognizes the steps that the Air Force has taken to begin 
mitigating the damage through multi-year projects. The 
Committee supports these efforts and urges the Secretary of the 
Air Force to prioritize these projects.
    Access Control Points at Air Force and Air National Guard 
Installations in Urban Areas.--The Committee expects the Air 
Force to accelerate funding for current access control point 
construction projects to installations that face high-security 
risks to critical missions. Priority in allocating funds shall 
be given to access control points in heavily congested areas in 
large urban settings that place major transportation links at 
risk of incident closures, or that are required for heavy 
traffic hazard mitigation, airport security and installation 
force protection.

                  Military Construction, Defense-Wide


 
 
 
Appropriation, fiscal year 2020.......................    $2,362,529,000
    Budget request, fiscal year 2021..................     2,027,520,000
    Recommended in the bill...........................     2,234,517,000
Comparison with:
    Appropriation, fiscal year 2020...................      -128,012,000
    Budget request, fiscal year 2021..................      +206,997,000
 

    Military Construction, Defense-Wide.--The bill includes 
$2,234,517,000 for the following projects in the following 
amounts:

------------------------------------------------------------------------
                       Project                               Amount
------------------------------------------------------------------------
Anniston Army Depot--Demilitarization Facility.......        $18,000,000
Fort Greely--Communications Center...................         48,000,000
Fort Huachuca--Laboratory Building...................         33,728,000
Yuma--SOF Hangar.....................................         49,500,000
Beale AFB--Bulk Fuel Tank............................         22,800,000
Fort Carson--SOF Tactical Equipment Maintenance               15,600,000
 Facility............................................
Hurlburt Field--SOF Combat Aircraft Parking Apron,            38,310,000
 North...............................................
Hurlburt Field--SOF Special Tactics Ops Facility (23          44,810,000
 STS)................................................
Fort Knox--Van Voorhis Elementary School.............         69,310,000
Bethesda Naval Hospital--MEDCEN Addition/Alteration,         100,000,000
 Increment 4.........................................
Fort Meade--NSAW Recapitalize Building, Increment 3..        250,000,000
Fort Leonard Wood--Hospital Replacement, Increment 3.         40,000,000
St. Louis--NGA West (N2W) Complex Phase, Increment 2.        119,000,000
Kirtland AFB--Administrative Building................         46,600,000
Fort Bragg--SOF Group Headquarters...................         53,100,000
Fort Bragg--SOF Military Working Dog Facility........         17,700,000
Fort Bragg--SOF Operations Facility..................         43,000,000
Wright Patterson AFB--Hydrant Fuel System............         23,500,000
Fort Hood--Fuel Facilities...........................         32,700,000
JEB Little Creek-Story--SOF DCS Operations Facility &         54,500,000
 Command Center......................................
JEB Little Creek-Story--SOF NSWG-2 NSWTG CSS                  58,000,000
 Facilities..........................................
Joint Base Lewis-McChord--Fuel Facilities (Lewis              10,900,000
 Main)...............................................
Joint Base Lewis-McChord--Fuel Facilities (Lewis              10,900,000
 North)..............................................
Manchester--Bulk Fuel Storage Tanks, Phase 1.........         82,000,000
CONUS Unspecified--Training Target Structure.........         14,400,000
Rhine Ordnance Barracks--Medical Center Replacement,         200,000,000
 Increment 9.........................................
Def Fuel Support Point Tsurumi--Fuel Wharf...........         49,500,000
Energy Resilience & Conservation Investment Program..        439,497,000
Planning and Design..................................        179,976,000
Minor Construction...................................         69,186,000
    Total, Military Construction, Defense-Wide.......      2,234,517,000
------------------------------------------------------------------------

    Energy Resilience and Conservation Investment Program 
(ERCIP).--The Committee supports DOD's investments in energy 
efficiency, resilience, renewable energy systems, and energy 
security, and as such provides $439,497,000 for the Energy 
Resilience and Conservation Program, an increase of 
$296,997,000 above the request. The recommendation also 
includes an increase of $10,000,000 for planning and design 
specifically for ERCIP.
    The bill includes $296,997,000 for the following projects 
in the following amounts:

------------------------------------------------------------------------
                       Project                               Amount
------------------------------------------------------------------------
Unfunded Requirements ERCIP--Defense-Wide:
Fort Bragg--SOTF Chilled Water Upgrade...............         $6,100,000
Fort Smith--ANG PV Arrays and Battery Storage........          2,600,000
Joint Base Anacostia Bolling--Industrial Controls              8,749,000
 System Modernization................................
NSA Bethesda--NSAB-16 Replace Chillers 3 Through 9...         13,840,000
Fort Benning--Construct 4.8MW Generation & Microgrid.         17,000,000
Wright Patterson AFB--Intelligence Facility Central           35,000,000
 Utility Plant.......................................
NAWS China Lake--Solar Energy Storage System.........          8,950,000
Fort Rucker--10MW Generation & Microgrid.............         24,000,000
Memphis ANG--PV Arrays and Battery Storage...........          4,780,000
Joint Base Anacostia Bolling--PV Carports............         25,221,000
Joint Base Anacostia Bolling--DIA HQ Cooling Towers            1,963,000
 and Cond Pumps......................................
MTA Camp Shelby--10MW Generation Plant and Microgrid          30,000,000
 System..............................................
Aguadilla-Ramey--Microgrid Control System............          8,400,000
Camp Grayling--600 kW Gas-Fired Microturbine.........          5,700,000
Fort Allen--Microgrid Control System.................         10,400,000
MTA Camp Shelby--Electrical Distribution.............          9,700,000
NSA Andersen--ICS Infrastructure Andersen Smart Grid.         16,970,000
Mountain Home AFB--Water Treatment Plant and Pump             31,000,000
 Station.............................................
Fort Drum--Well Field Expansion Project..............         22,000,000
Pentagon--Three High Efficiency Trim Chillers........         12,024,000
Pentagon--Recommissioning of HVAC Systems, Part B....          2,600,000
    Total, Military Construction, Defense-Wide, ERCIP        296,997,000
------------------------------------------------------------------------

    Investment in Renewable Energy Systems.--The Committee 
supports the military's continued investment in renewable 
energy systems, including the use and application of solar 
energy for mobility and resilience capabilities at defense 
military installations including military bases, barracks, 
hospitals, and airfields. Such investments have yielded 
positive results such as increased resiliency and cost-savings. 
The Committee encourages DOD to prioritize funding for 
renewable energy-related projects, including solar, to mitigate 
risk to mission-critical assets and to promote energy security 
and efficiency at military installations. Accordingly, the 
Committee requests a report no later than 180 days after 
enactment of this Act, detailing DOD's plans for further 
development of renewable energy systems at military 
installations and a timeline and goals for increased 
utilization.
    Renewable Energy Supply Investment.--The Committee 
recognizes the advances the Department has made in increasing 
sustainable and renewable energy supply to its facilities and 
encourages the continued investment in renewable energy 
systems, including the use of solar energy, which is vital to 
preserving national security and ensuring military preparedness 
and response. Construction of resilient, renewable energy 
infrastructure on military bases, both foreign and domestic, 
aids our military in building defenses against threats such as 
natural disasters, extreme weather, and cyber-attacks, and 
decreases our military's vulnerabilities while reducing energy 
costs.
    Tripler Army Medical Center Parking Assessment.--The 
Tripler Army Medical Center and the Spark M. Matsunaga Veterans 
Affairs (VA) Medical Center share a facility on the Island of 
Oahu. As the largest military and Veterans medical facility in 
the Pacific Basin, it is responsible for nearly 450,000 
beneficiaries who are eligible to receive care at the facility. 
According to the Army's own assessment using formulas included 
in the Department of Defense Unified Facilities Criteria (UFC) 
4-510-01, Design: Medical Military Facilities, the facility 
should have 5,936 parking stalls to accommodate its workforce 
and patients. However, the facility only has 3,713 stalls. The 
facility is also not readily accessible to public transit, 
making ground transportation with parking the only reasonable 
option. Due to this geographic fact and parking shortfall, 
veterans and servicemembers have difficulty finding parking, 
which is particularly challenging for elderly veterans, wounded 
soldiers and those who have difficulty walking unassisted. 
Therefore, the Committee directs the Secretary of the Army and 
the Director of the Defense Health Agency to submit a joint 
report to the congressional defense committees no later than 
180 days after enactment of this Act detailing the efforts to: 
(1) update the facility's master infrastructure plan and (2) 
address the parking shortfall at the facility, to include the 
possible location, cost, and timeline for building a new 
parking garage that sufficiently fulfills the parking demands 
for both the Army and VA.
    Energy Conservation.--The Committee commends DOD's forward 
posture on the need to improve energy resilience and mission 
assurance, save energy, and reduce energy costs. As DOD works 
to construct new facilities and upgrade facilities, the 
Committee directs DOD to increase the integration of 
alternative energy sources, particularly through renewable 
sources, throughout military facilities and installations. The 
Committee directs the Secretary of Defense to provide an 
updated report no later than 60 days after enactment of this 
Act on DOD's strategy to: (1) provide latest summary of 
progress toward achieving Defense base energy independence, 
including Guard and Reserve facilities; (2) increase energy 
conservation efforts and on energy cost savings; (3) improved 
unit readiness; (4) and opportunities for return on investments 
of existing and planned projects.
    Defense Information Systems Agency (DISA).--The Committee 
recognizes the need to move the Joint Spectrum Center (JSC) 
from the David Taylor Research Center (DTRC) site in Annapolis, 
Maryland. DTRC was closed 2005 under Base Realignment and 
Closure process and the surrounding facilities and grounds are 
no longer maintained by the Federal government. JSC's current 
building at the DTRC site contains asbestos, significant 
infrastructure problems, and cannot meet Anti-Terrorism Force 
Protection (AT/FP) security standards. Failure to meet these 
security standards requires ongoing security waivers by JCS's 
parent organization, DISA, for its remaining lease term. JSC's 
relocation and existing lease termination were authorized in 
the Fiscal Year 2008 National Defense Authorization Act and 
were intended to ensure JSC personnel are performing JSC's 
mission in a building that meets all required AT/FP, 
environmental protection, and building safety requirements. The 
Committee reminds the Department of its responsibility to 
ensure the safety and security of military and civilian 
personnel and recommends DISA begin the process to relocate 
JSC's to a more suitable facility as soon as possible.

                      Guard and Reserve Initiative

    Regional Training Institutes.--The Committees recognize the 
importance of Regional Training Institutes (RTI) across the 
country for the readiness of Army National Guard (ARNG) and are 
concerned about the lack of infrastructure to support the 
mission of the RTIs. For example, the RTI at Fort Hood is 
lacking sufficient facilities to provide the proper training to 
achieve optimum readiness. The Committee urges the Department 
to prioritize facilities for this important and vital mission 
of ARNG and Army Reserve.

               Military Construction, Army National Guard


 
 
 
Appropriation, fiscal year 2020.......................      $210,819,000
    Budget request, fiscal year 2021..................       321,437,000
    Recommended in the bill...........................       349,437,000
Bill compared with:
    Appropriation, fiscal year 2020...................      +138,618,000
    Budget request, fiscal year 2021..................      +28,000,0000
 

    Military Construction, Army National Guard.--The bill 
includes $349,437,000 for the following projects in the 
following amounts:

------------------------------------------------------------------------
                       Project                               Amount
------------------------------------------------------------------------
Tucson--National Guard Readiness Center..............        $18,100,000
Peterson AFB--National Guard Readiness Center........         15,000,000
Shelbyville--National Guard/Reserve Center Building           12,000,000
 Add/Alt.............................................
Frankfort--National Guard/Reserve Center Building....         15,000,000
Brandon--National Guard Vehicle Maintenance Shop.....         10,400,000
North Platte--National Guard Vehicle Maintenance Shop          9,300,000
Joint Base McGuire-Dix-Lakehurst--National Guard              15,000,000
 Readiness Center....................................
Columbus--National Guard Readiness Center............         15,000,000
Hermiston--Enlisted Barracks, Transient Training.....          9,300,000
Joint Base Charleston--National Guard Readiness               15,000,000
 Center..............................................
McMinnville--National Guard Readiness Center.........         11,200,000
Fort Worth--Aircraft Maintenance Hangar Addition/Alt.          6,000,000
Fort Worth--Vehicle Maintenance Shop Addition/Alt....          7,800,000
Nephi--National Guard Readiness Center...............         12,000,000
Appleton--National Guard Readiness Center Add/Alt....         11,600,000
Fort Allen--National Guard Readiness Center..........         37,000,000
St. Croix--Army Aviation Support Facility (AASF).....         28,000,000
St. Croix--CTS Ready Building........................         11,400,000
Planning and Design..................................         44,593,000
Minor Construction...................................         45,744,000
    Total, Military Construction, Army National Guard        349,437,000
------------------------------------------------------------------------

    In addition, for unfunded requirements of the Army National 
Guard in section 123, the bill includes $34,835,000 for the 
following projects in the following amounts:

------------------------------------------------------------------------
                       Project                               Amount
------------------------------------------------------------------------
Unfunded Requirements (Section 123)
Herminston--Enlisted Barracks Transient Training.....        $15,735,000
Bakersfield--Vehicle Maintenance Shop................          9,300,000
Ardmore--Vehicle Maintenance Shop....................          9,800,000
    Total, Unfunded Requirements, Army National Guard         34,835,000
------------------------------------------------------------------------

    Army National Guard (ARNG) Readiness Center Transformation 
Master Plan.--The ARNG completed its Readiness Center 
Transformation Master Plan (RCTMP) in 2015; however, since that 
time, the investment in executing the military construction 
required under the RCTMP has not kept up with the demand. The 
Committee is concerned that the mission readiness of these 
critical facilities is further deteriorating, and it encourages 
increased investments in ARNG Readiness Centers over the FYDP. 
Further, given the changing conditions of readiness centers 
across the country since the last RCTMP was completed, the 
Committee encourages the ARNG to update the RCTMP to ensure its 
current military construction priorities align with the 
Transformation Master Plan. Accordingly, the Committee provides 
an additional $15,000,000 in Army National Guard planning & 
design for completion of a Readiness Center Transformation 
Master Plan update.
    Army National Guard Readiness Centers Investment.-- The 
Committee appreciates the Army's prioritization of Army 
National Guard Readiness Centers in its budget request for 
fiscal year 2021. The Committee remains concerned by the 
failure of the Army to prioritize investment in ARNG Readiness 
Centers and arsenals. These facilities are critical to 
protecting the homeland and responding to domestic emergencies. 
Their deteriorating conditions are detrimental to the readiness 
of the ARNG and, in some cases, present significant safety 
concerns. The Committee encourages the Army to accelerate 
investments in Readiness Centers in the fiscal year 2022 budget 
request and Future Years Defense Program and include 
$1,200,000,000 for the ARNG Transformation Plan.
    Army National Guard Infrastructure and Unspecified Minor 
Military Construction.--The Committee is concerned with the 
state of ARNG infrastructure across the country. The ARNG has 
been continuously underfunded for the last several decades. The 
Committee is aware that reviews have found that billions of 
dollars will be needed to bring Readiness Centers up to modern 
standards, yet despite that little progress has been made. With 
new higher thresholds for Unspecified Minor Military 
Construction (UMMC), many smaller projects can be accomplished 
with an increase in this account. While not completely solving 
the ARNG military construction appropriations issue, this will 
speed up projects across the country and increase the readiness 
of the ARNG. The Committee provides $13,000,000 for this effort 
in fiscal year 2021 and directs DOD to properly budget for the 
UMMC account in future years.
    ARNG Aviation Support Facilities.--The Committee is 
concerned that ARNG Aviation Support Facilities (AASF) are not 
prepared to protect and properly maintain next generation 
airframe priorities simultaneously as the Army. The operation 
and maintenance of new aircraft platforms requires significant 
investment in AASFs across the country so that they can provide 
the required shelter and support for new airframes, as well as 
regular maintenance for the existing airframes. The Committee 
urges both the Army and the ARNG to prioritize facilities that 
support readiness of ARNG aviation units as they prepare to 
gain new aircraft platforms.
    National Guard Training Center.--Committee recognizes the 
importance of the National Guard Texas Training Center, which 
has been in development since 2010 and has had execution 
delays. The Committee recognizes that the Texas Training Center 
remains a high priority and the Texas Army National Guard shall 
continue its efforts to establish the Center.
    Maneuver Area Training Equipment Site (MATES).--The 
Committee recognizes the critical role of the Maneuver Area 
Training Equipment Site (MATES) in providing needed wheel 
vehicle maintenance for M1 Abrams Tanks and M2 Bradley Infantry 
Fighting Vehicles at installations such as Camp Shelby. 
Therefore, the Committee encourages the Army National Guard to 
prioritize the modernization of these types of facilities.

               Military Construction, Air National Guard


 
 
 
Appropriation, fiscal year 2020.......................      $164,471,000
Budget request, fiscal year 2021......................        64,214,000
Recommended in the bill...............................        64,214,000
Comparison with:
    Appropriation, fiscal year 2020...................      -100,257,000
    Budget request, fiscal year 2021..................             - - -
 

    Military Construction, Air National Guard.--The bill 
includes $64,214,000 for the following projects in the 
following amounts:

------------------------------------------------------------------------
                       Project                               Amount
------------------------------------------------------------------------
Montgomery Regional Airport--F-35 Simulator Facility.        $11,600,000
Joint Base Andrews--F-16 Mission Training Center.....          9,400,000
Joint Base San Antonio--F-16 Mission Training Center.         10,800,000
Joint Region Marianas--Space Control Facility 5......         20,000,000
Planning and Design..................................          3,414,000
Minor Construction...................................          9,000,000
    Total, Military Construction, Air National Guard.         64,214,000
------------------------------------------------------------------------

    In addition, for unfunded requirements of the Air National 
Guard, the bill includes $54,700,000 in section 123 for the 
following projects in the following amounts:

------------------------------------------------------------------------
                       Project                               Amount
------------------------------------------------------------------------
Unfunded Requirements (Section 123)
Hector International Airport--Consolidated RPA               $17,500,000
 Operational Facilities..............................
Montgomery International Airport--Base Supply Complex         10,200,000
Camp Murray--Air Support Operations Complex..........         27,000,000
    Total, Unfunded Requirements, Air National Guard.         54,700,000
------------------------------------------------------------------------

    Wildland Fire Mission.--The Committee directs the National 
Guard Bureau to prioritize the remodeling and replacement of 
Air National Guard (ANG) Wing Buildings that support the 
wildland fire suppression mission and utilize the Modular 
Airborne Fire Fighting System but are not in compliance with 
Executive Order 13423. The Committee requests a report within 
60 days of enactment of this Act regarding the condition of ANG 
facilities that support the wildland fire-fighting mission.

                  Military Construction, Army Reserve


 
 
 
Appropriation, fiscal year 2020.......................       $60,928,000
Budget request, fiscal year 2021......................        88,337,000
Recommended in the bill...............................        88,337,000
Bill compared with:
    Appropriation, fiscal year 2020...................       +27,409,000
    Budget request, fiscal year 2021..................             - - -
 

    Military Construction, Army Reserve.--The bill includes 
$88,337,000 for the following projects in the following 
amounts:

------------------------------------------------------------------------
                       Project                               Amount
------------------------------------------------------------------------
Gainesville--ECS TEMF Warehouse......................        $36,000,000
Devens RFTS--Automated Multipurpose Machine Gun Range          8,700,000
Ashevelle--Army Reserve Center & Land................         24,000,000
Fort McCoy--Scout Reconnaissance Range...............         14,600,000
Planning and Design..................................          1,218,000
Minor Construction...................................          3,819,000
    Total, Military Construction, Army Reserve.......         88,337,000
------------------------------------------------------------------------

    In addition, for unfunded requirements and cost to complete 
projects of the Army Reserve, the bill includes $59,100,000 in 
sections 123 and 126 for the following projects in the 
following amounts:

------------------------------------------------------------------------
                       Project                               Amount
------------------------------------------------------------------------
Cost to Complete (Section 126)
Fort McCoy--Transient Training Barracks..............         $1,000,000
Yakima--ECS/TEMF.....................................          7,000,000
Starkville--Reserve Center...........................          2,200,000
    Total, Cost to Complete, Army Reserve............         10,200,000
 
Unfunded Requirements (Section 123)
Wright Patterson AFB--Area Maintenance Support               $11,300,000
 Activity............................................
Sheridan--Area Maintenance Support Activity..........         18,900,000
Yakima--Equipment Concentration Site Warehouse.......         16,200,000
Fort McCoy--Transient Trainee Barracks...............          2,500,000
    Total, Unfunded Requirements, Army Reserve.......         48,900,000
------------------------------------------------------------------------

                  Military Construction, Navy Reserve


 
 
 
Appropriation, fiscal year 2020.......................       $54,955,000
Budget request, fiscal year 2021......................        70,995,000
Recommended in the bill...............................        70,995,000
Comparison with:
    Appropriation, fiscal year 2020...................       +16,040,000
    Budget request, fiscal year 2021..................             - - -
 

    Military Construction, Navy Reserve.--The bill includes 
$70,995,000 for the following projects in the following 
amounts:

------------------------------------------------------------------------
                       Project                               Amount
------------------------------------------------------------------------
Reisterstown--Reserve Training Center................        $39,500,000
Hill AFB--Naval Operations Support Center............         25,010,000
Planning and Design..................................          3,485,000
Minor Construction...................................          3,000,000
    Total, Military Construction, Navy Reserve.......         70,995,000
------------------------------------------------------------------------

    In addition, for cost to complete projects of the Navy 
Reserve, the bill includes $3,500,000 in section 126 for the 
following projects in the following amounts:

------------------------------------------------------------------------
                       Project                               Amount
------------------------------------------------------------------------
Cost to Complete (Section 126)
Marine Corps Reserve Station Galveston--Reserve               $3,500,000
 Center Annex........................................
    Total, Unfunded Requirements, Navy Reserve.......          3,500,000
------------------------------------------------------------------------

                Military Construction, Air Force Reserve


 
 
 
Appropriation, fiscal year 2020.......................       $59,750,000
Budget request, fiscal year 2021......................        23,117,000
Recommended in the bill...............................        23,117,000
Bill compared with:
    Appropriation, fiscal year 2020...................       -36,633,000
    Budget request, fiscal year.......................             - - -
 

    Military Construction, Air Force Reserve.--The bill 
includes $23,117,000 for the following projects in the 
following amounts:

------------------------------------------------------------------------
                       Project                               Amount
------------------------------------------------------------------------
Fort Worth--F-35A Simulator Facility.................        $14,200,000
Planning and Design..................................          3,270,000
Minor Construction...................................          5,647,000
    Total, Military Construction, Air Force Reserve..         23,117,000
------------------------------------------------------------------------

     North Atlantic Treaty Organization Security Investment Program


 
 
 
Appropriation, fiscal year 2020.......................      $172,005,000
Budget request, fiscal year 2021......................       173,030,000
Recommended in the bill...............................       173,030,000
Comparison with:
    Appropriation, fiscal year 2020...................        +1,025,000
    Budget request, fiscal year 2021..................             - - -
 

    The North Atlantic Treaty Organization Security Investment 
Program (NSIP) consists of annual contributions by North 
Atlantic Treaty Organization (NATO) member countries. The 
program finances the costs of construction needed to support 
the roles of the major NATO commands. The investments cover 
facilities such as airfields, fuel pipelines and storage, 
harbors, communications and information systems, radar and 
navigational aids, and military headquarters, both within NATO 
Nations and for ``out of area'' operations such as Afghanistan.
    The United States occasionally has been forced to 
temporarily delay the authorization of projects due to 
shortfalls in United States obligation authority. The Committee 
directs the Secretary of Defense to notify the Committee within 
14 days of the United States taking action to delay the 
authorization of projects temporarily, or to temporarily 
withhold funds from previously authorized projects, due to 
shortfalls in U.S. obligation authority.

               Department of Defense Base Closure Account


 
 
 
Appropriation, fiscal year 2020.......................      $398,526,000
    Budget request, fiscal year 2021..................       300,447,000
    Recommended in the bill...........................       580,447,000
Bill compared with:
    Appropriation, fiscal year 2020...................      +181,921,000
    Budget request, fiscal year 2021..................      +280,000,000
 

    The recommendation provides an additional $80,000,000 for 
the Navy to accelerate environmental remediation at 
installations closed under previous Base Closure and 
Realignment (BRAC) rounds. Furthermore, the Navy shall provide 
to the Committee a spend plan for these additional funds no 
later than 60 days after enactment of this Act.
    Perfluorooctane Sulfonate (PFOS) and Perfluorooctanoic Acid 
(PFOA).--The Committee is concerned about the extent of PFOS/
PFOA contamination at U.S. military installations and how that 
contamination is measured. The Committee believes the 
Department should prioritize protecting servicemembers, their 
families, and the Department's civilian employees from the 
health problems associated with exposure to these chemicals 
that are linked in various ways to developmental delays in 
fetuses and children; premature births and low birth weights; 
decreased fertility; immune suppression; liver damage; 
respiratory disorders; metabolic disorders; and prostate, 
kidney, and testicular cancer. Therefore, the Committee 
includes an additional $200,000,000 above the budget request 
within the Base Closure Account to increase the pace of cleanup 
at the military installations affected by PFOS/PFOA.
    PFOS/PFOA Regulation and Research.--Recognizing that this 
issue is not limited to DOD and affects many communities across 
the Nation, the Committee is encouraged by the Environmental 
Protection Agency's (EPA) February 2020 announcement that it 
plans to regulate PFOS/PFOA and to require that proposed new 
uses be reviewed under the Toxic Substances Control Act. DOD 
and affected communities are urged to work closely with EPA on 
these regulatory initiatives. DOD is also encouraged to engage 
the research community so as to ensure that it is using the 
best and most up-to-date science to guide DOD remediation plans 
and processes.
    PFOS/PFOA Reporting Requirement.--In fiscal year 2020, the 
Committee directed the Department to keep it apprised of new 
findings of PFOS/PFOA at BRAC sites. The Committee recognizes 
that the Services have provided some information. However, the 
Committee is concerned that the process for identifying PFOS/
PFOA contamination at BRAC sites and determining the 
appropriate remediation plan is not transparent. Therefore, the 
Deputy Assistant Secretary of Defense for Environment is 
directed to report to the congressional defense committees no 
later than 30 days after this report is been filed with the 
Clerk of the U.S. House of Representatives, and quarterly 
thereafter, on the progress the Department is making on 
identifying and remediating PFOS/PFOA at closed military 
installations. At a minimum, the first report should include 
information on the existing process and make recommendations 
for improving its transparency; identifying all detections of 
PFOS/PFOA and existing remediation sites plans; and estimating 
current and future costs and timelines for remediation.

                        Family Housing Overview


 
 
 
Appropriation, fiscal year 2020.......................    $1,324,002,000
Budget request, fiscal year 2021......................     1,351,392,000
Recommended in the bill...............................     1,351,392,000
Bill compared with:
    Appropriation, fiscal year 2020...................       +27,390,000
    Budget request, fiscal year 2021..................             - - -
 

    Family housing construction accounts provide funds for new 
construction, construction improvements, the Federal 
government's costs for family housing privatization projects, 
and planning and design. The operation and maintenance accounts 
provide funds to pay for maintenance and repair, furnishings, 
management, services, utilities, leasing, interest, mortgage 
insurance, and miscellaneous expenses.
    Housing Support Costs and Management Accounts.--The 
recommendation includes $135,000,000 within Housing Support 
Costs under Family Housing Operation and Maintenance accounts 
for the Services. The funding is to increase the Services' 
ability to provide oversight and management, and personnel to 
track current and future issues that may occur in military 
family housing.
    Privatized Military Housing.--Quality military housing a 
key component of military readiness and military family 
stability. Recognizing the chronic underinvestment in military 
housing on domestic military installations and related 
readiness concerns, Congress authorized the Military Privatized 
Housing Initiative (MPHI) as part of the National Defense 
Authorization Act for Fiscal Year 1996, (P.L. 104-106). Under 
MPHI, the Department partnered with private sector companies to 
build and renovate military housing.
    Through MPHI, military housing improved. However, serious 
shortcomings were uncovered over the past two years. Through 
the Committee's oversight work, unsafe conditions, mold 
contamination, and unresponsive and unhelpful private partners 
were brought to light.
    The Committee recognizes the efforts of the Services to 
improve their management and oversight of their private sector 
partners and appreciates the new requirements developed by the 
House and Senate Armed Services Committees in the National 
Defense Authorization Act for Fiscal Year 2020, (P.L. 116-92). 
However, the Committee continues to have numerous concerns and 
requests the Services report back to the Committee within 90 
days of enactment of this Act, except as otherwise noted, 
regarding the following issues.
    The Committee is concerned that the Services do not have 
the ability to readily assess the satisfaction of 
servicemembers with the quality of their privatized homes and 
housing communities because existing installation reporting 
systems do not capture this type of information. The Committee 
requests that the Services provide a report analyzing this 
concern and include options and recommendations.
    At this time, the Tenant Bill of Rights, as proscribed by 
the National Defense Authorization Act for Fiscal Year 2020, 
has been implemented except for Rights #16, #17, and #18. The 
Committee directs the Services to report on the status of 
implementation of these three Rights within 60 days of 
enactment of this Act.
    The Committee remains concerned with the number and 
seriousness of complaints regarding mold. It directs DOD to 
work with the private sector partners to prioritize funding for 
mold remediation and report on its efforts.
    The Committee expects the Services to hold their private 
sector partners to a standard of both good performance and 
accurate and transparent reporting to military commanders and 
managers regarding their actions and practices. The Services 
should not tolerate any systemic or specific instances of 
dishonesty, deception, or fraud by their private sector 
partners. Instead, they should remain actively engaged with 
them and keep the Committee informed of any issues as they 
arise.
    The Committee is concerned that claim settlement non-
disclosure agreements between servicemember tenants and private 
sector partners that are not part of a litigated matter but 
purport to bar tenants from reporting or speaking out about 
their housing conditions may have contributed to delays in 
addressing ongoing health and safety threats in military 
housing, as well as mismanagement by MHPI companies. The 
Committee directs the Services to prevent, to the extent 
practicable, the use of non-disclosure agreements by MHPI 
companies in the settlement of non-litigated housing condition-
related claims with military tenants and report to the 
Committee if a non-disclosure agreement has been used within 30 
days of discovering the use.
    Leasing Reporting Requirements.--The Secretary of Defense 
is directed to report to the Committees on Appropriations of 
both Houses of Congress quarterly on the details of all new or 
renewed domestic leases entered into during the previous 
quarter that exceeds the cost threshold set by 10 U.S.C. 
2828(b)(2), including certification that less expensive housing 
was not available for lease. For foreign leases, the Department 
is directed to: (1) perform an economic analysis on all new 
leases or lease/contract agreements where more than 25 units 
are involved; (2) report the details of new or renewed lease 
agreements that exceed the cost threshold set by 10 U.S.C. 
2828(e)(1) 21 days before entering into such an agreement; and 
(3) base leasing decisions on the economic analysis.

                   Family Housing Construction, Army


 
 
 
Appropriation, fiscal year 2020.......................      $141,372,000
Budget request, fiscal year 2021......................       119,400,000
Recommended in the bill...............................       119,400,000
Bill compared with:
    Appropriation, fiscal year 2020...................       -21,972,000
    Budget request, fiscal year 2021..................             - - -
 

    The bill includes $4,500,000 for the following cost to 
complete project in the following amount in section 126:

------------------------------------------------------------------------
                       Project                               Amount
------------------------------------------------------------------------
Project Amount Cost to Complete (Section 126)
Fort Gordon--Army Family Housing Construction........         $4,500,000
    Total, Cost to Complete, Family Housing                    4,500,000
     Construction, Army..............................
------------------------------------------------------------------------

             Family Housing Operation and Maintenance, Army


 
 
 
Appropriation, fiscal year 2020.......................      $357,907,000
Budget request, fiscal year 2021......................       367,142,000
Recommended in the bill...............................       367,142,000
Bill compared with:
    Appropriation, fiscal year 2020...................        +9,235,000
    Budget request, fiscal year 2021..................             - - -
 

           Family Housing Construction, Navy and Marine Corps


 
 
 
Appropriation, fiscal year 2020.......................       $47,661,000
Budget request, fiscal year 2021......................        42,897,000
Recommended in the bill...............................        42,897,000
Bill compared with:
    Appropriation, fiscal year 2020...................        -4,764,000
    Budget request, fiscal year 2021..................             - - -
 

    Family Housing Operation And Maintenance, Navy And Marine Corps


 
 
 
Appropriation, fiscal year 2020.......................      $317,870,000
Budget request, fiscal year 2021......................       346,493,000
Recommended in the bill...............................       346,493,000
Bill compared with:
    Appropriation, fiscal year 2020...................        28,623,000
    Budget request, fiscal year 2021..................             - - -
 

                 Family Housing Construction, Air Force


 
 
 
Appropriation, fiscal year 2020.......................      $103,631,000
Budget request, fiscal year 2021......................        97,214,000
Recommended in the bill...............................        97,214,000
Bill compared with:
    Appropriation, fiscal year 2020...................        -6,417,000
    Budget request, fiscal year 2021..................             - - -
 

          Family Housing Operation and Maintenance, Air Force


 
 
 
Appropriation, fiscal year 2020.......................      $295,016,000
Budget request, fiscal year 2021......................       317,021,000
Recommended in the bill...............................       317,021,000
Bill compared with:
    Appropriation, fiscal year 2020...................       +22,005,000
    Budget request, fiscal year 2021..................             - - -
 

         Family Housing Operation and Maintenance, Defense-Wide


 
 
 
Appropriation, fiscal year 2020.......................       $57,000,000
Budget request, fiscal year 2021......................        54,728,000
Recommended in the bill...............................        54,728,000
Bill compared with:
    Appropriation, fiscal year 2020...................        -2,272,000
    Budget request, fiscal year 2021..................             - - -
 

         Department of Defense Family Housing Improvement Fund


 
 
 
Appropriation, fiscal year 2020.......................        $3,045,000
Budget request, fiscal year 2021......................         5,897,000
Recommended in the bill...............................         5,897,000
Bill compared with:
    Appropriation, fiscal year 2020...................        +2,852,000
    Budget request, fiscal year 2021..................             - - -
 

 Department of Defense Military Unaccompanied Housing Improvement Fund


 
 
 
Appropriation, fiscal year 2020.......................          $500,000
Budget request, fiscal year 2021......................           600,000
Recommended in the bill...............................           600,000
Bill compared with:
    Appropriation, fiscal year 2020...................          +100,000
    Budget request, fiscal year 2021..................             - - -
 

                       Administrative Provisions

    The bill includes a total of 30 Administrative provisions, 
27 of which are effective in fiscal year 2020.
    The bill includes section 101 prohibiting the use of funds 
for payments under a cost-plus-a-fixed-fee contract for 
construction where cost estimates exceed $25,000. An exception 
for Alaska is provided.
    The bill includes section 102 permitting the use of 
construction funds for the hire of passenger motor vehicles.
    The bill includes section 103 permitting funds to be 
expended on the construction of defense access roads under 
certain circumstances.
    The bill includes section 104 prohibiting construction of 
new bases in the United States without a specific 
appropriation.
    The bill includes section 105 limiting the use of funds for 
the purchase of land or land easements that exceed 100 percent 
of value except under certain conditions.
    The bill includes section 106 prohibiting the use of funds 
to acquire land, prepare sites, or install utilities for family 
housing except housing for which funds have been appropriated.
    The bill includes section 107 limiting the use of minor 
construction funds to relocate any activity from one 
installation to another without prior notification.
    The bill includes section 108 prohibiting the procurement 
of steel unless American producers, fabricators, and 
manufacturers have been allowed to compete.
    The bill includes section 109 prohibiting the use of funds 
to pay real property taxes in foreign nations.
    The bill includes section 110 prohibiting the use of funds 
to initiate a new installation overseas without prior 
notification.
    The bill includes section 111 establishing a preference for 
United States architectural and engineering services where the 
services are in Japan, NATO member countries, or countries 
bordering the Arabian Sea.
    The bill includes section 112 establishing a preference for 
United States contractors for military construction in the 
United States territories and possessions in the Pacific and on 
Kwajalein Atoll, or countries within the Central Command area 
of responsibility, except bids by Marshallese contractors for 
military construction on Kwajalein Atoll.
    The bill includes section 113 requiring the Secretary of 
Defense to give prior notice to Congress of military exercises 
where construction costs exceed $100,000.
    The bill includes section 114 allowing funds appropriated 
in prior years to be used for new projects authorized during 
the current session of Congress.
    The bill includes section 115 allowing the use of expired 
or lapsed funds to pay the cost of supervision for any project 
being completed with lapsed funds.
    The bill includes section 116 providing that funds for 
military construction projects are available until the end of 
the fourth fiscal year following the fiscal year in which funds 
are appropriated, subject to certain conditions.

                     (INCLUDING TRANSFER OF FUNDS)

    The bill includes section 117 allowing for the transfer of 
funds from Family Housing Construction accounts to the 
Department of Defense Family Housing Improvement Fund and funds 
from Military Construction accounts to the Department of 
Defense Military Unaccompanied Housing Improvement Fund.

                     (INCLUDING TRANSFER OF FUNDS)

    The bill includes section 118 providing transfer authority 
to the Homeowners Assistance Program.
    The bill includes section 119 requiring that funds in this 
title be the sole source of all operation and maintenance for 
flag and general officer quarter houses and limits the repair 
on these quarters to $15,000 per year without notification.
    The bill includes section 120 making funds in the Ford 
Island Improvement Fund available until expended.

                     (INCLUDING TRANSFER OF FUNDS)

    The bill includes section 121 allowing the transfer of 
expired funds to the ``Foreign Currency Fluctuations, 
Construction, Defense'' account.
    The bill includes section 122 prohibiting the use of funds 
for projects at Arlington National Cemetery.
    The bill includes section 123 providing additional funds 
for various military construction accounts and requires a spend 
plan for each.
    The bill includes section 124 defining the congressional 
defense committees.
    The bill includes section 125 directing all amounts 
appropriated to Military Construction (all accounts) be 
immediately available and allotted for the full scope of the 
authorized project.
    The bill includes section 126 providing additional funds 
for cost to complete projects identified by the Services.
    The bill includes section 127 providing additional funds 
for family housing operation and maintenance.
    The bill includes section 128 prohibiting the use of funds 
for any other purpose not specified in the bill.
    The bill includes section 129 prohibiting the use of funds 
in this Act and previous Acts for the construction of a wall, 
barrier, fence, or road along the Southern border of the United 
States or a road to provide access to a wall, barrier, or fence 
constructed along the Southern border of the United States or 
for any military construction projects for which previously 
appropriated funds were rescinded or postponed by the emergency 
declaration of a national emergency on February 15, 2019.
    The bill includes section 130 prohibiting the construction 
of a facility on a military installation bearing the name of a 
confederate officer unless a process has been initiated to 
rename the installation.

                                TITLE II


                     DEPARTMENT OF VETERANS AFFAIRS


 
 
 
Fiscal year 2020 enacted level1...........              $217,862,725,000
Fiscal year 2021 budget request1..........               240,245,173,000
Committee recommendation in the bill1.....               240,210,107,000
Comparison with:
    Fiscal year 2020 enacted..............               +22,347,382,000
    Fiscal year 2021 budget request.......                   -35,066,000
Fiscal year 2022 advance budget request...               239,494,478,000
Fiscal year 2022 Committee recommendation                239,494,478,000
 in the bill..............................
 
1All funding cited excludes amounts in the Medical Care Collections
  Fund.

    The Department of Veterans Affairs (VA) provides health 
care for 9,300,000 Veteran enrollees, disability compensation 
benefits to over 5,700,000 Veterans and survivors, pension 
benefits for over 392,000 Veterans and survivors, life 
insurance for nearly 5,800,000 Veterans, servicemembers and 
their families, educational assistance for nearly 950,000 
trainees, and interment of 137,000 Veterans and eligible family 
members in national cemeteries. To serve adequately the 
Nation's Veterans, VA employs more than 400,000 people, making 
it one of the largest Federal agencies in terms of employment.
    Resiliency.--The Stafford Act requires VA and its 
facilities to be prepared to support local communities in the 
event of a major disaster or medical emergency. In such a 
scenario, VA's ability to adequately respond relies heavily 
upon the energy resiliency of its medical centers. VA Medical 
Centers must be able to recover from energy disruptions and 
have access to reliable power to ensure it can handle a 
significant emergency. To ensure VA is adequately prioritizing 
the reliability of its energy and water infrastructure, the 
Committee directs VA to provide a report within 180 days of 
enactment of this Act detailing VA's plans to develop energy 
resilient medical facilities, including planned investments in 
distributed generation, energy and water efficiency efforts, 
and other improvements that can protect mission-critical 
operations at VA facilities from disruptions to the power grid. 
This plan should include details on VHA energy engineering and 
VHA energy contracting staffing needs.
    Native Hawaiian, Pacific Islander and United States-
Affiliated Pacific Islander Veteran Health Care.--Native 
Hawaiian, Pacific Islander, and United States-Affiliated 
Pacific Islanders disproportionately serve in the U.S. military 
and therefore represent significant numbers of Veterans across 
the United States and Pacific, particularly in rural and remote 
locations. While VA has centers dedicated to health policy, 
innovation, health economics and more, the Committee notes that 
VA would benefit from additional research, service, and 
education to improve the lives of Native Hawaiian, Pacific 
Islander and U.S.-Affiliated Pacific Islander Veterans. In 
performing this effort, VA should consider partnering with non-
government institutions and universities to examine telehealth 
and telepharmacy; models of interprofessional primary care, 
including the integration of pharmacists and behavioral health; 
electronic health records and data analytics; health workforce; 
and indigenous people innovation.
    Fraud Protection System.--VA continues to face challenges 
preventing fraud, waste, and abuse (FWA), despite previous 
efforts. A January 2019 report issued by a VA-established FWA 
panel recommended six specific actions VA could adopt to reduce 
FWA, including a recommendation to expand the Department's use 
of data analytics and predictive modeling capabilities across 
the enterprise, creating a holistic view of FWA, and providing 
comprehensive prevention solutions. VA is encouraged to 
investigate the feasibility of establishing a department-wide 
Fraud Prevention System that uses predicative modeling and 
other analytics technologies to identify and prevent FWA.
    Women Veteran Transitional Housing Support.--The Committee 
recognizes the need for transitional and supportive housing 
services for women Veterans who are experiencing homelessness 
or housing insecurity. The Committee also recognizes that in 
the past, Veteran services were primarily designed for men and 
do not always meet the needs of women Veterans. Women Veterans 
struggling with the acclimation to civilian and community life 
often find themselves in at-risk circumstances that may differ 
from those of men, and therefore women Veterans require 
specialized interventions and programming. The Committee 
encourages the Department to work with the Department of 
Defense and the Department of Labor to provide robust gender-
specific case management services for women Veterans 
transitioning from military service.

                 Veterans Benefits Administration (VBA)


                       COMPENSATION AND PENSIONS

                     (INCLUDING TRANSFER OF FUNDS)

 
 
 
Appropriation, fiscal year 2021......................   $118,246,975,000
Budget request, fiscal year 2021.....................      2,813,922,000
Recommended in the bill, fiscal year 2021............      2,813,922,000
Budget request, fiscal year 2022.....................    130,227,650,000
Recommended in the bill, fiscal year 2022............    130,227,650,000
Bill compared with:
    Appropriation, fiscal year 2021..................    +11,980,675,000
    Budget request, fiscal year 2022.................              - - -
 

    This appropriation provides funds for service-connected 
compensation payments to an estimated 5,724,000 Veterans, 
survivors, and dependents in fiscal year 2021. In addition, 
pension payments will be funded for 393,000 Veterans and their 
survivors. The average payment per compensation case for 
Veterans in fiscal year 2021 is estimated at $19,974 and 
pension payments are projected at $14,186.
    The appropriation includes authority to transfer funding 
not to exceed $20,115,000 in fiscal year 2022 to General 
Operating Expenses, Veterans Benefits Administration and 
Information Technology Systems. These funds are for the 
administrative expenses of implementing cost-saving provisions 
required by the Omnibus Budget Reconciliation Act of 1990 (P.L. 
101-508), the Veterans' Benefits Act of 1992 (P.L. 102-568), 
and the Veterans' Benefits Improvements Act of 1994 (P.L. 103-
446). These cost-saving provisions include verifying pension 
income against Internal Revenue Service and Social Security 
Administration (SSA) data; establishing a match with SSA to 
obtain verification of Social Security numbers; and applying 
the VA pension cap for Medicaid-eligible single Veterans and 
surviving spouses alone in Medicaid-covered nursing homes. The 
bill also continues to include language permitting this 
appropriation to reimburse such sums as may be earned to the 
Medical Care Collections Fund to help defray the operating 
expenses of individual medical facilities for nursing home care 
provided to pensioners.
    Pro-bono Legal Services.--The Committee recognizes an unmet 
need for holistic programs that offer pro-bono legal services 
to Veterans and their dependents. The Committee acknowledges 
existing VA initiatives that guide Veterans during benefit-
related interactions with administrative agencies and believes 
that public land-grant university law schools are suited to 
complement existing agency efforts in underserved areas.
    Financial Hardship and Bankruptcy.--The Committee continues 
to support VA programs, such as disability-related benefits, 
that seek to address 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.
    Performance Measures and Communication Efforts.--The 
Committee remains interested in VA's implementation of 
performance measures in response to the findings of the 
Government Accountability Office (GAO) report entitled, 
``Better Measures Needed to Assess Regional Office Performance 
in Processing Claims'' (GAO 19-15). The Committee encourages VA 
to continue to improve regional office communication with 
Veterans Service Organizations (VSOs) and congressional 
caseworkers, including discussions surrounding the feasibility 
of locating satellite congressional member offices within VA 
Medical Centers (VAMCs).

                         READJUSTMENT BENEFITS

 
 
 
Appropriation, fiscal year 2021.......................   $12,578,965,000
Budget request, fiscal year 2022......................    14,946,618,000
Recommended in the bill, fiscal year 2022.............    14,946,618,000
Bill compared with:
    Appropriation, fiscal year 2021...................    +2,367,653,000
    Budget request, fiscal year 2022..................             - - -
 

    This appropriation funds the education and training of 
Veterans and servicemembers through the Post-9/11 GI Bill and 
the All-Volunteer Force Educational Assistance Program. 
Supplemental education benefits are also provided to certain 
Veteran members of the Selected Reserve and are funded through 
transfers from DOD. In addition, certain disabled Veterans are 
provided with vocational rehabilitation, specially adapted 
housing grants, and grants for automobiles with approved 
adaptive equipment. This account also funds educational 
assistance allowances for eligible dependents of Veterans who 
died from service-connected causes or have a total and 
permanent service-connected disability, as well as dependents 
of servicemembers who were captured or are missing in action. 
Almost 80 percent of the funds in the account support the Post-
9/11 GI Bill.
    VetSuccess on Campus (VSOC).--The Committee recognizes the 
tremendous value of counseling in assisting the transition of 
Veterans from military service to academic life. Therefore, the 
Committee encourages VBA to continue to expand the availability 
of services through the VSOC program to additional sites, with 
particular attention to geographic regions without current 
access to VSOC programs, or where travel time makes current 
VSOC programs difficult to access.
    Vocational Rehabilitation and Employment.--The Committee 
supports the work of vocational rehabilitation and employment 
programs that provide no-cost, wrap-around support services for 
the Veterans community, including career track and job 
readiness programs. These services help participants develop 
both job-specific knowledge and abilities, as well as the 
attitudes, habits, and behaviors needed to successfully secure 
and retain employment and earn family-sustaining wages in 
occupations that offer opportunities for career progression.
    Veteran Readiness and Employment Service Counselor to 
Client Ratio.--The Committee continues to encourage the 
Department to seek opportunities to expand staffing counselors 
within the Veteran Readiness and Employment Service (VR&E), 
formerly known as the Vocational Rehabilitation and Employment 
Service, in order to maintain a ratio of 125 Veterans to one 
full-time equivalent (FTE) position, and to provide the 
comprehensive individualized services that these Veterans have 
earned. The Committee is also concerned about reports that 
Veterans experience frustration when being transferred from one 
counselor to another, often without proper notification to the 
Veteran. The Committee urges the Department to put procedures 
in place to improve implementation of the program by ensuring a 
smooth transition when Veterans are transferred among 
counselors.
    Improving Technology to Deliver GI Bill Benefits.--The 
Committee notes that to fully achieve the promise of the Harry 
W. Colmery Veterans Educational Assistance Act (P.L. 115-48), 
also known as the ``Forever GI Bill,'' and other educational 
benefits provided to Veterans, a modernized information 
technology platform is needed to provide GI Bill beneficiaries 
with the world-class experience they have earned and deserve. 
The Committee encourages VBA to pursue a digital platform that 
will provide faster and more accurate payments to GI Bill 
beneficiaries and ensure Veterans and their families have more 
convenient options when interacting with the Veterans Benefit 
Administration, including the use of mobile phones and 
electronic correspondence.
    GI Bill Allowance for Housing.--The Post-9/11 GI Bill 
allowance for housing is a critical benefit to GI Bill 
recipients. The Committee is aware that in municipalities 
covered by more than one military housing area, GI Bill housing 
benefits may differ substantially throughout the municipality, 
creating inequities. The Committee directs the Department to 
review whether housing benefits in municipalities covered by 
more than one military housing area are adequate to meet the 
financial needs of GI Bill recipients located in those areas 
and to report to the Committee on Appropriations no later than 
180 days after enactment of this Act on whether changes to the 
housing benefit are needed to ensure fairly distributed housing 
benefits that provide sufficient assistance to students. The 
Committee encourages VA to incorporate into this review 
publicly available housing data, including the median rent in 
affected municipalities, as paid by the same population used to 
calculate the housing allowance. Additionally, the Committee 
urges the Department to raise this issue as part of the DOD-VA 
working group on GI Bill issues.
    Cyber Training.--The Committee urges VA to establish a 
cyber training pilot program that, in addition to training VA's 
internal cyber workforce, can be scaled up and offered to 
transitioning military to help Veterans reintegrate into the 
workforce. In doing so, VA should also consider collaboratively 
working with the Centers of Academic Excellence in 
Cybersecurity (CAE-C) community to jointly develop cyber 
curriculums, hands-on skills development, and performance-based 
assessment solutions that align specifically to work roles 
within the National Initiative for Cybersecurity Education 
(NICE) Cyber Workforce Framework and can be integrated into the 
cyber training program.
    Transition Coordination.--The Committee believes that VA, 
in consultation with the Departments of Labor and Defense, 
should further coordinate efforts and resources to ensure 
Veterans have a successful transition to civilian life. This 
includes sharing information on community resources, including 
nonprofits and VSOs, that are available to the Veteran and 
their family as they depart the service. The Committee also 
urges VA to explore options for Veterans to access hands-on job 
placement services that connect Veterans directly with 
employers, and encourages VA to look at successful state and 
local programs in this area.
    Veteran Awareness of Student Loan Forgiveness.--The 
Committee understands that Veterans may have student loans they 
acquired either prior to enlistment or outside of their GI Bill 
benefits. The Committee encourages VA to coordinate with other 
agencies, including the Departments of Education and Defense, 
and increase efforts to ensure that Veterans are aware of all 
their student loan forgiveness options or repayment programs 
for which they may be eligible.
    GI Bill Comparison Tool.--The Committee emphasizes the 
importance of providing Veterans with the necessary information 
to make informed decisions when selecting institutions of 
higher education (IHE). The Committee strongly urges VA to make 
available through the GI Bill Comparison Tool, in a searchable 
format, the following information: whether an IHE is a minority 
serving institution (MSI), a gender-specific institution, or a 
religiously-affiliated school. These categories should be 
broken down into subcategories that specify the type of MSI and 
religious affiliation.

                   VETERANS INSURANCE AND INDEMNITIES

 
 
 
Appropriation, fiscal year 2021.......................      $129,224,000
Budget request, fiscal year 2021......................         2,148,000
Recommended in the bill, fiscal year 2021.............         2,148,000
Budget request, fiscal year 2022......................       136,950,000
Recommended in the bill, fiscal year 2022.............       136,950,000
Bill compared with:
    Appropriation, fiscal year 2021...................        +7,726,000
    Budget request, fiscal year 2022..................             - - -
 

    The Veterans Insurance and Indemnities appropriation is 
made up of the former appropriations for military and naval 
insurance, applicable to World War I Veterans; national service 
life insurance (NSLI), applicable to certain World War II 
Veterans; servicemember's indemnities, applicable to Korean 
conflict Veterans; and Veterans mortgage life insurance, 
applicable to individuals who have received a grant for 
specially adapted housing.
    The amount provided will enable the Department to transfer 
funding to the service-disabled Veterans insurance fund and 
transfer additional amounts for payments for policies under the 
Veterans mortgage life insurance program. These policies are 
identified under the Veterans Insurance and Indemnities 
appropriation since they provide insurance to service-disabled 
Veterans unable to qualify under basic NSLI.

         VETERANS HOUSING BENEFIT PROGRAM FUND PROGRAM ACCOUNT

----------------------------------------------------------------------------------------------------------------
                                                                              Limitation on
                                                                             direct loans for    Administrative
                                                           Program Account  specially adapted       Expenses
                                                                              housing loans
----------------------------------------------------------------------------------------------------------------
Appropriation, fiscal year 2020..........................            - - -         ($500,000)       $200,377,391
Budget request est., fiscal year 2021....................            - - -          (500,000)        204,400,000
Recommended in the bill..................................            - - -          (500,000)        204,400,000
Bill compared with:
    Appropriation, fiscal year 2020......................            - - -              - - -         +4,022,609
    Budget request, fiscal year 2021.....................            - - -              - - -              - - -
----------------------------------------------------------------------------------------------------------------

    The purpose of the home loan guaranty program is to 
facilitate the extension of mortgage credit on favorable terms 
by private lenders to eligible Veterans. This appropriation 
provides for all costs, with the exception of the Native 
American Veterans housing loan program, of the Department's 
direct and guaranteed loans programs. The Federal Credit Reform 
Act of 1990 (P.L. 101-508) requires budgetary resources to be 
available prior to incurring a direct loan obligation or a loan 
guaranty commitment. In addition, the bill requires all 
administrative expenses of a direct or guaranteed loan program 
to be funded through a program account. Loan guaranties are 
made to servicemembers, Veterans, reservists, and single 
surviving spouses for the purchase of homes, condominiums, and 
manufactured homes and for refinancing loans. The Department 
guarantees part of the total loan, permitting the purchaser to 
obtain a mortgage with a competitive interest rate, even 
without a down payment if the lender agrees. The Department 
requires that a down payment be made for a manufactured home. 
With a Department guaranty, the lender is protected against 
loss, up to the amount of the guaranty, if the borrower fails 
to repay the loan.
    Home Loan Income Verification.--The Committee is aware of 
the Department's denial of home loan guarantees to Veterans 
solely on the basis of the Veteran's documented income being 
derived from state-legalized cannabis activities, and has 
previously expressed concern that confusion on this issue 
hinders Veterans' ability to fully understand and consider how 
employment decisions could affect future eligibility for earned 
benefits. The Committee understands that as directed by House 
Report 116-63, VA has clarified that nothing in VA statutes or 
regulations specifically prohibits a Veteran whose income is 
derived from state-legalized cannabis activities from obtaining 
a certificate of eligibility for VA home loan benefits. The 
Committee directs the VA to improve communication with eligible 
lending institutions to reduce confusion among lenders and 
borrowers on this matter.

            VOCATIONAL REHABILITATION LOANS PROGRAM ACCOUNT

----------------------------------------------------------------------------------------------------------------
                                                                              Limitation on      Administrative
                                                           Program Account     direct loans         Expenses
----------------------------------------------------------------------------------------------------------------
Appropriation, fiscal year 2020..........................          $57,729       ($2,008,232)           $401,880
Budget request, fiscal year 2021.........................           33,826        (2,469,522)            424,272
Recommended in the bill..................................           33,826        (2,469,522)            424,272
Bill compared with:
    Appropriation, fiscal year 2020......................          -23,903          (461,290)            +22,392
    Budget request, fiscal year 2021.....................            - - -              - - -              - - -
----------------------------------------------------------------------------------------------------------------

    This appropriation covers the subsidy cost of direct loans 
for vocational rehabilitation of eligible Veterans and includes 
administrative expenses necessary to carry out the direct loan 
program. Loans of up to $1,260 (based on indexed chapter 31 
subsistence allowance rate) are available to service-connected 
disabled Veterans enrolled in vocational rehabilitation 
programs 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. Most loans are repaid 
in full in less than one year. The Federal Credit Reform Act of 
1990 (P.L. 101-508) requires budgetary resources to be 
available prior to incurring a direct loan obligation.
    It is estimated that the Department will make 2,376 loans 
in fiscal year 2021, with an average amount of $1,040.

              NATIVE AMERICAN VETERAN HOUSING LOAN PROGRAM

 
 
 
Administrative expenses:
Appropriation, fiscal year 2020.......................        $1,186,000
Budget request, fiscal year 2021......................         1,163,000
Recommended in the bill...............................         1,186,000
Bill compared with:
    Appropriation, fiscal year 2020...................             - - -
    Budget request, fiscal year 2021..................           +23,000
 

    The Native American Veteran Housing Loan Program, as 
authorized by title 38 United States Code, chapter 37, 
subchapter V, provides the Secretary with authority to make 
direct housing loans to Native American Veterans for the 
purpose of purchasing, constructing, or improving dwellings on 
trust lands, including Hawaiian Home Lands. Native Hawaiians, 
Alaska Natives, and Native Americans enroll in the military at 
higher rates than non-Natives. These loans are available to 
purchase, construct, or improve homes to be occupied as 
Veterans' residences.

      GENERAL OPERATING EXPENSES, VETERANS BENEFITS ADMINISTRATION

 
 
 
Appropriation, fiscal year 2020.......................    $3,125,000,000
Budget request, fiscal year 2021......................     3,207,000,000
Recommended in the bill...............................     3,187,000,000
Bill compared with:
    Appropriation, fiscal year 2020...................       +62,000,000
    Budget request, fiscal year 2021..................       -20,000,000
 

    The General Operating Expenses, Veterans Benefits 
Administration account provides funding for VBA to administer 
entitlement programs such as service-connected disability 
compensation, education benefits, and vocational rehabilitation 
services.
    The bill makes available through September 30, 2022, up to 
ten percent of these funds.
    The Committee provides $3,187,000,000 for the General 
Operating Expenses, VBA account, to enable VBA to deliver the 
benefits that our Veterans rely on.
    In addition, the Coronavirus Aid, Relief, and Economic 
Security Act (CARES Act) (P.L. 116-136) included $13,000,000 
for VBA to prevent, prepare for, and respond to coronavirus.
    Blue Water Navy Veterans.--The Committee continues to 
closely follow the implementation of the Blue Water Navy 
Vietnam Veterans Act (P.L. 116-23). The Committee provides 
requested funds to support implementation of the law, including 
staffing, scanning of records, and correspondence with 
Veterans. The Committee continues the requirement that VA 
report to the Committees on Appropriations of both Houses of 
Congress on a quarterly basis information related to claims 
considered under the Blue Water Navy Vietnam Veterans Act. This 
information should include timeliness measures as well as grant 
and denial rates for these claims.
    Disability Claims.--The Committee continues to be concerned 
about reports of delays Veterans experience in the resolution 
of pending compensation and pension claims. While the Committee 
appreciates the focus in attention and resources the Department 
has given to this concern, reducing the claims backlog and 
making sustainable improvement in the waiting period for claims 
adjudication is essential. The Committee urges the Department 
to prioritize resources toward providing Veterans with the 
timely relief and support they deserve. The funding level is 
sufficient to continue programs that support effective 
management of claims, including the Veterans Claims Intake 
Program.
    Conditions Presumptively Associated with Agent Orange.--The 
Committee is aware that VA has not yet acted in response to the 
2018 report from the National Academies of Science, 
Engineering, and Medicine that concluded that bladder cancer, 
hypothyroidism, Parkinson-like syndromes, and hypertension all 
have at least ``limited or suggestive'' evidence of an 
association with exposure to Agent Orange herbicides. The 
Committee notes that the ``limited or suggestive'' threshold 
has been deemed sufficient by VA in years past to add multiple 
prior conditions to the category of diseases presumptively 
recognized by VA as service-connected. However, Veterans with 
these four particular conditions have been made to wait for 
fair treatment in light of VA's inaction on adding these 
conditions to the presumptive category. The Committee is 
concerned that VA officials intend to wait for evidence these 
conditions are caused by, rather than associated with, exposure 
to Agent Orange. As such, the Committee reminds the Department 
that there is no legal requirement that sets causation as the 
standard. To the contrary, the Department's apparent policy 
runs counter to statutory text and longstanding case law, 
including the landmark Nehmer v. U.S. Department of Veterans 
Affairs case. The Committee directs the Department to report to 
the Committees on Appropriations of both Houses of Congress no 
later than 60 days after enactment of this Act, detailing the 
legal basis the Department is relying upon to demand causation 
as the standard for adding these four conditions to the 
presumptively service-connected category. Further, the 
Committee expects the Department to act on the conclusions of 
the National Academies of Science, Engineering, and Medicine in 
a fair and expeditious manner to avoid causing Veterans 
additional delays in receiving the benefits they have earned.
    Equitable Relief.--The Committee reiterates that it 
understands VA is working to implement new systems and 
protocols to eliminate instances of administrative error. 
However, as VA enacts system-wide reforms, ending equitable 
relief for Veterans who were deemed eligible for benefits in 
error would place an unfair burden on Veterans and their 
families. The Secretary is directed to continue to grant or 
extend equitable relief to eligible Veterans initially deemed 
eligible in instances of administrative error. Not later than 
April 1, 2021, the Secretary shall submit to the Committees a 
report containing a statement as to the disposition of each 
case recommended to the Secretary for equitable relief under 38 
U.S.C 503 during the preceding calendar year.
    Military Sexual Trauma (MST) Claims.--The 2018 Inspector 
General's report found that almost half of denied MST-related 
claims were not properly adjudicated in accordance with VBA 
policies. The Committee is concerned that VBA has not 
implemented all of the recommendations of the Inspector 
General's report and that OIG's concerns regarding VBA's 
process for reevaluating previously denied claims has resulted 
in a new audit of VBA. The Committee directs VA to report to 
the Committee by October 31, 2020, on implementation of the 
Inspector General's recommendations, and to consult with the 
Committee prior to any changes in the system for handling MST-
related claims. The Committee welcomes VBA's expressed 
commitment to engaging with MST survivors and willingness to 
incorporate input from MST survivors in its training for MST 
claim processors. However, the Committee is concerned that 
research has shown that MST-related claims by males are less 
likely to be approved than those filed by females. The 
Committee urges VBA to investigate this discrepancy and to 
ensure that input from male MST survivors is also incorporated 
in training. The Committee is also concerned that Veterans 
suffering from a mental health disorder as a result of sexual 
trauma during service have different standards of evidence 
based on their diagnosis. The Committee recognizes that 
evidence in personnel files is rare, no matter the resulting 
condition following MST. Therefore, the Committee urges VA to 
support the extension of the relaxed evidentiary standard to 
all those suffering from mental health disorders as a result of 
MST. Further, the Committee urges VA to continue to report to 
the Committees on Appropriations of both Houses of Congress on 
information relating to claims for disabilities incurred or 
aggravated by MST, as provided by section 113 of the Jeff 
Miller and Richard Blumenthal Veterans Health Care and Benefits 
Improvement Act of 2016 (P.L. 114-315).
    Veterans Benefits Staffing in Remote Locations.--The 
Committee directs VBA to continue to improve access and 
outreach to Veterans living in remote and underserved areas, 
such as the Commonwealth of the Northern Mariana Islands, by 
increasing staff presence in these areas. VA shall provide the 
necessary staff and resources to provide more frequent outreach 
and ensure access to benefits, and must also ensure the 
Veterans in these areas are notified when a benefits counselor 
is available to provide assistance and information about the VA 
claims process and benefits available to Veterans and their 
families. Additionally, the Committee directs VA to assess the 
feasibility of placing at least one full-time Veterans Benefits 
Counselor in remote and underserved areas that do not have a VA 
Benefits Office, such as the Northern Mariana Islands, and 
providing such staff the necessary support, space and 
equipment, and funds to travel to other areas within each 
jurisdiction where Veterans reside on a regular basis. The 
Committee directs the Department to report to the Committee on 
this assessment no later than 180 days after enactment of this 
Act. The report shall include information on the beneficiary 
population (Veterans, spouses, and dependents), including their 
feedback on VBA services, the demand for direct VBA assistance, 
VBA's current efforts to serve the beneficiary population, and 
the plan to serve them in the future. The Committee also 
encourages the department to assess the feasibility of having 
such staff conduct outreach to Veterans living in the Freely 
Associated States.

                  Veterans Health Administration (VHA)

    The Department operates the largest Federal medical care 
delivery system in the country, with 148 hospitals, 116 
residential rehabilitation treatment programs, 135 nursing 
homes, 300 Vet Centers, 80 Mobile Vet Centers, and 765 
Community-Based outpatient Clinics (CBOCs). Approximately 
7,200,000 patients will be treated in fiscal year 2021.
    The Veterans Health Administration budget is comprised of 
five accounts: Medical Services, Medical Community Care, 
Medical Support and Compliance, Medical Facilities, and Medical 
and Prosthetic Research. For the first four accounts, the 
Administration has requested total resources for fiscal year 
2022 of $94,183,260,000 in direct appropriations to fund the 
four advance appropriations of VHA. The Committee provides an 
additional $2,328,268,000 for the first four accounts for 
fiscal year 2021, which is equal to the budget request. In 
addition, VA will receive an estimated $4,403,000,000 in the 
Medical Care Collections Fund in fiscal year 2021. The 
Committee also provides $840,000,000 for Medical and Prosthetic 
Research.
    VA Fourth Mission.--The Committee encourages VA, as part of 
its Fourth Mission, to support national, state, and local 
emergency management, public health, and safety efforts in 
response to the COVID-19 national public health emergency, when 
called upon by the Department of Health and Human Services and/
or the Federal Emergency Management Agency, and to take steps 
to identify and make available VA resources and facilities, 
such as hospital beds and medical personnel, that can be 
utilized to help address this unprecedented national emergency.
    Health Navigator.--Section 731 of the National Defense 
Authorization Act for Fiscal Year 2018 (P.L. 115-91) required 
the Secretary of Defense to conduct a pilot program to improve 
health outcomes and patient experience for beneficiaries with 
complex medical conditions. The Committee believes that VA 
should conduct a similar pilot and looks forward to the results 
of the report due no later than January 1, 2021 containing an 
evaluation of its success. The Committee will continue to 
address this issue as the bill moves through the process.

                            MEDICAL SERVICES

 
 
 
Fiscal year 2020 enacted level........................   $51,411,165,000
Fiscal year 2021 enacted level........................    56,158,015,000
Fiscal year 2021 budget year request..................       497,468,000
Committee 2021 budget year recommendation.............       497,468,000
Fiscal year 2022 advance appropriation request........    58,897,219,000
Committee 2022 advance appropriation recommendation...    58,897,219,000
Comparison with:
    Fiscal year 2021 enacted level....................    +2,739,204,000
    Fiscal year 2022 advance budget request...........             - - -
 

    The bill provides the request of $58,897,219,000 for 
advance fiscal year 2022 funding. The Committee has included 
bill language to make available through September 30, 2023, 
$1,500,000,000 of the Medical Services advance appropriation 
for fiscal year 2022. The Committee provides an additional 
$497,468,000 to be available for fiscal year 2021, of which 
$40,000,000 is provided for mental health for a total of 
$10,297,500,000; $40,000,000 is provided for homelessness 
initiatives for a total of $1,928,508,000; $30,000,000 is 
provided for rural health for a total of $300,000,000; 
$35,000,000 is provided for gender-specific care for women for 
a total of $660,691,000; $20,000,000 is provided for Whole 
Health initiatives for a total of $83,600,000; $85,008,000 is 
provided for suicide prevention efforts for a total of 
$312,635,000, as requested in the budget; $75,000,000 is 
provided for precision oncology, as requested in the budget; 
$64,650,000 is provided for opioid prevention and treatment for 
a total of $503,660,000, as requested in the budget; 
$93,810,000 is provided for medical equipment; and $14,000,000 
is provided for other initiatives specified by the Committee.
    In addition, the Coronavirus Preparedness and Response 
Supplemental Appropriations Act (P.L. 116-123) included 
$30,000,000 and the Coronavirus Aid, Relief, and Economic 
Security Act (CARES Act) (P.L. 116-136) included 
$14,432,000,000 for the Medical Services account to prevent, 
prepare for, and respond to coronavirus, including related 
impacts on health care delivery, and for support to Veterans 
who are homeless or at risk of becoming homeless.
    Changes in Funding Requirements Due to Modeling.--The 
Committee expects VA to continue to include in the sufficiency 
letter required by section 117(d) of title 38, United States 
Code, which is due to the Congress on July 31 of each year, a 
description of any changes exceeding $250,000,000 in funding 
requirements for the Medical Services account resulting from 
the spring recalculation of the Enrollee Healthcare Projection 
Model.
    Caregivers Program.--The caregivers program provides an 
unprecedented level of benefits to families with Veterans 
seriously injured in the line of duty in post-9/11 service. 
These benefits include stipends paid directly to the family 
caregiver, enrollment for the family member in the VA Civilian 
Health and Medical Program (CHAMPVA), an expanded respite 
benefit, and mental health treatment. The Committee provides 
the request of $1,195,486,000 for the caregivers. The Committee 
also continues the requirement from the fiscal year 2018 
conference report on quarterly reporting on obligations for the 
caregivers program.
    Allocation of Health Funding.--The Committee continues to 
be concerned that the process VA uses to allocate the health 
services appropriation through the Veterans Integrated Service 
Networks (VISNs) and from them to the medical centers may 
shortchange the ultimate users because of excessive funding 
retained at headquarters or at the VISNs. The Committee 
continues to request a report each year, no later than 30 days 
after VA allocates the medical services appropriation to the 
VISNs, that identifies: (1) the amount of general purpose 
funding that is allocated to each VISN; (2) the amount of 
funding that is retained by central headquarters for specific 
purposes, with amounts identified for each purpose; and (3) the 
amount of funding that is retained by each VISN before 
allocating it to the medical centers, identifying separately 
the amounts retained for purposes such as network operations, 
network initiatives, and emergencies.

                             MENTAL HEALTH

    The Committee provides $10,297,500,000 for mental health 
programs, which is $40,000,000 above the request. Of the 
amounts provided for mental health programs in fiscal year 
2021, $1,939,329,000 shall be used for suicide prevention and 
treatment programs. Specifically, $312,635,000 shall be used 
for suicide prevention outreach, which is $90,870,000 above 
fiscal year 2020. With the additional funds, the Committee 
directs the Department to implement suicide safety plans that 
address parking lot suicides and expand the Coaching Into Care 
Program to better help Veterans, their family members, and 
other loved ones find the appropriate services at their local 
VA facilities and/or in their community. The Committee requests 
a report within 90 days of enactment of this Act on the 
Department's plans.
    The Department should also continue to engage with Veterans 
Service Organizations (VSOs) to help remove the stigma that is 
associated with seeking mental healthcare. Furthermore, VA is 
directed to remove barriers that affect a Veteran when trying 
to receive mental healthcare and to implement a twenty-first 
century outreach program that incorporates social media and 
other electronic means to reach Veterans before they are at a 
crisis point.
    In addition, the Committee directs VA to engage with DOD to 
help servicemembers transition from active duty to civilian 
life to ensure that mental health needs are addressed 
throughout the transition process. The Department is directed 
to provide a report to the Committee, no later than 90 days 
after enactment of this Act, identifying a detailed expenditure 
plan for all suicide outreach and treatment programs and how VA 
is meeting the Committee's directives.
    Improving the Veterans Crisis Line (VCL).--The Committee 
continues to monitor the VCL to ensure Veterans are receiving 
appropriate clinical care. To support this critical care, the 
Committee instructs the Secretary to ensure that Federal 
funding for the VCL is utilized to make any necessary 
improvements to VCL's operations in order to best meet the 
needs of Veterans seeking assistance. This includes, but is not 
limited to, ensuring appropriate staffing for call centers and 
back-up centers, providing necessary training for VCL staff, 
and ensuring that staff are able to appropriately and 
effectively respond to the needs of Veterans needing assistance 
through the VCL.
    The Committee has repeated bill language requiring the VCL 
to: (1) provide to individuals who contact the hotline 
immediate assistance from a trained professional; and (2) to 
adhere to all requirements of the American Association of 
Suicidology.
    Community Clinic Mental Health Services.--The Committee 
remains concerned that in-person mental healthcare is not 
available to all Veterans who require this care. VA is 
encouraged to ensure critical in-person mental health services 
are available at facilities that currently are not served, even 
on a temporary basis.
    Mental Health Services.--Women Veterans are twice as likely 
as women in the general population to die by suicide. To 
address this alarming trend, the Committee encourages VA to 
take aggressive steps to improve mental health services for 
women Veterans and ensure that women's mental health needs, 
which often differ from men in prevalence and expression, are 
met.
    Post-Traumatic Growth Programs.--The Committee recognizes 
there is a shortage of adequate, timely, and effective mental 
health care available to Veterans across the United States. As 
the Department continues to highlight Veterans' mental 
healthcare and suicide prevention as a key priority, there is 
an opportunity to explore effective alternative treatments 
focused on the area of post-traumatic growth. The Committee 
continues to encourage the establishment of a pilot program to 
study the effectiveness and benefits of nonprofit post-
traumatic growth programs to determine the outcomes of such 
programs in contrast to traditional models of mental 
healthcare, the possible integration of such nonprofit programs 
into mental healthcare programs provided by the Department, and 
the budgetary impacts of such integration.
    Post-Traumatic Stress Disorder (PTSD) Service Dogs.--The 
Committee recognizes the positive role that service, guide, and 
hearing dogs have played in mitigating Veterans' disabilities 
and providing assistance and rehabilitation. The Energy and 
Water, Legislative Branch, and Military Construction and 
Veterans Affairs Appropriations Act, 2019 (P.L. 115-244) urged 
VA to prioritize support of veterinary healthcare and other 
benefits for service dogs for wounded warriors. The Committee 
also notes that VA is currently engaged in a study to assess 
the potential therapeutic effectiveness of service dogs in the 
treatment of PTSD and that the study was originally expected to 
be completed in June 2020. However, the Committee is concerned 
that the report detailing the results and economic impact of 
the study will be delayed, and the results of the study will be 
broken up into two reports. The Committee directs VA to 
expeditiously provide the results of the study to the 
Committees on Appropriations of both Houses of Congress within 
30 days of enactment of this Act and further requires monthly 
reports on the status of the study until it is fully completed 
beginning 30 days after this report is filed. The Committee is 
interested in the possibility of providing service dogs to 
Veterans with a mental health mobility disorder related to 
post-traumatic stress or traumatic brain injury. According to 
the Department, as many as 20 percent of those who served in 
Iraq or Afghanistan are diagnosed with post-traumatic stress. 
This disorder can cause debilitating symptoms in Veterans, 
leading to depression, social isolation, and suicide. Studies 
demonstrate that service dogs provide support to Veterans by 
mitigating their disability, allowing for professional and 
social reintegration. Currently, waiting lists for service dogs 
average between 18 and 24 months, with intensive compulsory 
training costing an average of $25,000 per service dog, which 
makes this an expensive option for Veterans. The Committee 
looks forward to this study and will address this issue as the 
bill moves through the process.
    Service Dogs for Veterans.--The assistance that service, 
guide, and hearing dogs provide to Veterans, especially those 
with mobility, visual, auditory, psychological, or psychiatric 
disabilities, is encouraging and sometimes life-saving. 
However, the Committee is aware of the time and cost of 
appropriately training a dog and matching it with a Veteran. As 
such, the Committee requests a comprehensive report within 180 
days of enactment of this Act regarding potential options and 
estimated costs associated with each option, as practicable, to 
help meet the increasing demand from Veterans for service dogs. 
The report should include information on the number of service 
dogs matched with Veterans and in training, accreditation 
standards and the number of accredited service dog training 
organizations, and estimated current and future demand for 
service dogs. The Department should consult with accredited 
service dog training organizations and the Wounded Warrior 
Service Dog Program, which is funded through the Defense Health 
Program and is managed by the Uniformed Services University of 
the Health Sciences, on the benefits and challenges of the 
existing model for training and matching service dogs with 
Veterans.
    Public-Private Partnerships.--The Committee is concerned by 
the alarming number of suicides committed by Veterans each day. 
While the Committee appreciates the important work being done 
by the Department to combat suicide and improve mental health 
among Veterans, more can and must be done. The Committee 
recommends the Department actively seek out public-private 
partnerships, in particular with research universities, 
teaching hospitals, and other partners, to expand upon its 
existing efforts related to suicide prevention, PTSD, traumatic 
brain injury (TBI), and substance use disorders. The Secretary 
shall report to the Committee no later than 60 days after 
enactment of this Act on the status of creating public-private 
partnerships related to suicide prevention, PTSD, TBI, and 
substance use disorders. Of the funds provided for mental 
health programs in fiscal year 2021, no less than $5,000,000 is 
to expand the public-private partnerships.
    Law Enforcement Liaison.--The Committee appreciates VHA's 
past efforts in working to educate the law enforcement 
community regarding the unique issues facing Veterans, 
especially those returning from combat operations. Such 
education is invaluable in cases where Veterans are determined 
to be an immediate threat to themselves or others. In such 
instances, it is imperative that the Veteran's needs be 
addressed in an expeditious, humane, and respectful manner.
    Non-Citizen Veteran Outreach.--The Committee is concerned 
about the level of awareness regarding mental health services 
by at-risk, non-citizen Veterans. The Committee therefore urges 
VA to conduct more aggressive outreach targeting this group of 
Veterans to offer mental health and other early intervention 
services, drug and alcohol services, and mental health 
counseling.
    Post-Traumatic Stress Disorder Research.--The Committee 
welcomes the Secretary's commitment to addressing mental health 
in the Veteran population. The Committee also recognizes the 
importance of the National Center for PTSD at VA in promoting 
better prevention, diagnoses, and treatment of PTSD. Consistent 
with findings from the VA National Center for PTSD, the 
Committee recognizes that some groups of Veterans, including 
African-Americans and Latino-Americans, are more likely to 
develop PTSD. As such, the Committee directs VHA in 
coordination with the VA National Center for PTSD to provide a 
report no later than 180 days after enactment of this Act 
detailing whether cultural competency training is provided to 
healthcare professionals serving Veterans of color, and at what 
stage(s) in their career, and analyzing whether minority 
Veterans receive quality and culturally appropriate care. This 
report should also include recommendations on how to address 
the unique mental health needs of minority Veterans, and 
disparities, whether perceived or real, in the care they 
receive.
    Adverse Childhood Experiences (ACEs).--ACEs exist within 
the Veteran population at a substantially higher rate than the 
general public. These experiences correlate with significant 
negative health outcomes, including on behavioral, mental, and 
physical health. The Committee encourages VA to track ACEs 
among Veterans and target individualized treatment. To ensure 
appropriate treatment from the moment a Veteran enters VA, it 
is critical that VA coordinate with DOD to obtain information 
on ACEs from servicemembers and provide a seamless transition 
in care.
    Agritherapy.--An increasing number of states now have 
programs that assist Veterans in starting farms, and many 
Veterans turning to farming 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. VA is 
encouraged to work with the Department of Agriculture on 
providing agritherapy programs to Veterans. Additionally, the 
Committee supports a pilot program to train Veterans in 
agricultural vocations, including urban and vertical farming, 
while also tending to behavioral and mental health needs with 
behavioral healthcare services and treatments from licensed 
providers at no fewer than three locations.
    Mental Health Data on Asian Pacific American Veterans.--The 
Committee recognizes the lack of mental health data specific to 
Asian Pacific American Veterans. The Committee directs the 
Department to submit a report within 90 days after enactment of 
this Act on its data collection efforts.
    Military Sexual Assault.--The Committee is aware of the 
high prevalence of sexual assault, among both men and women, 
during their service. Effects from this assault persist once 
servicemembers return home and can manifest in mental health 
disorders such as depression, PTSD, SUDs, eating disorders, and 
anxiety. Because sexual trauma is so prevalent, the Committee 
recommends that all Veterans seeking treatment services are 
screened for sexual assault using an evidence-based screening 
tool in order to successfully treat those who have experienced 
assault.
    Military Sexual Trauma-Related Care for Servicemembers at 
VA Facilities.--The Veterans Access, Choice and Accountability 
Act of 2014 (P.L. 113-146), as amended, allows all 
servicemembers regardless of duty status to receive military 
sexual trauma-related care from VA, although a VA directive 
limits the access to servicemembers to Vet Centers only. VA has 
invested considerable resources to increase the capacity of the 
VA health care system to provide a range of mental health and 
medical care services to assist those who have experienced 
military sexual assault. The Committee believes that 
servicemembers would benefit from greater access to this 
capacity and directs the Secretary to provide to the Committee 
no later than 90 days after enactment of this Act a plan to 
expand access to military sexual trauma-related care at all VA 
health facilities.
    Aiding Military Personnel Transitioning to Civilian Life.--
Military Personnel transitioning to civilian life have reported 
significant challenges in reintegrating into civilian culture. 
Filmmaking has been used as a therapeutic intervention to 
enhance the community reintegration of Veterans by encouraging 
self-reflection and interactions with other Veterans about 
shared experiences. The Committee notes the outcomes of 
filmmaking workshops among Veterans, which included Veteran 
engagement in mental health care, improved attitudes toward 
engaging in mental health care, mitigating symptoms of PTSD and 
depression, and reported perception of community interest in 
their experience as Veterans. Accordingly, VA is urged to make 
funds available to implement these workshops at VA medical 
centers across the country so that all Veterans struggling with 
PTSD and depression can benefit from this encouraging therapy.
    Timely Mental Health Checks.--The Committee recognizes that 
Veterans are significantly more likely to suffer from trauma, 
PTSD, or to die by suicide than civilians and often times are 
undiagnosed. To combat the increasing suicide rate among 
Veterans, the Committee strongly recommends that VA identify, 
establish, and support programs that promote mental health 
screenings for Veterans preparing to transition to civilian 
life. It is the Committee's understanding that these mental 
health screenings should occur within 30 days of a Veteran's 
end of service date to ensure they have the proper resources 
needed to transition to civilian life.
    Post-Deployment Rehabilitation and Evaluation Program 
(PREP).--The Committee believes that the physical 
rehabilitation and mental health needs of our active duty 
servicemembers and Veterans is a top priority. The Post-
Deployment Rehabilitation and Evaluation Program (PREP) run by 
VA is an inpatient initiative that focuses on an individualized 
evaluation for servicemembers and Veterans to treat combat-
related physical, cognitive and mental health systems. The 
Committee believes it is important to expand the number of 
servicemembers and Veterans able to receive care through this 
initiative. The Committee is pleased to see further investment 
in fiscal year 2020 in PREP and expects to see VA continue the 
trend of furthering the investment in the program in fiscal 
year 2021. The Committee directs VA to include programmatic 
information and funding levels for PREP in future budget 
requests.
    Wrongfully Turned Away Due to ``Bad Paper''.--The Committee 
is concerned about reports that VA has erroneously and 
unlawfully turned away Veterans who seek VA care and whose DD 
Form 214, Certificate of Release or Discharge from Active Duty, 
does not reflect an ``Honorable Discharge,'' also known as 
``bad paper.'' Studies have shown that higher rates of Veterans 
with bad paper suffer from mental health conditions. The 
Committee directs the Secretary to submit a report no later 
than 90 days after enactment of this Act on (1) actions taken, 
such as requiring VHA staff to notify denied Veterans of their 
appeal rights and VHA staff retraining, to eliminate wrongful 
turn away of Veterans, and (2) plans to collaborate with VSOs, 
Veterans Claims Officers, and state and local Veterans services 
on correcting any misinformation on eligibility of VA care for 
all Veterans.
    Modeling and Simulation Treatment of PTSD.--As a mechanism 
to explore treatments for PTSD, the Committee is aware that the 
use of modeling and simulation technology has enabled the 
development of innovative and immersive therapies, which can 
extend trauma management therapy protocol. The Committee 
encourages the establishment of a Trauma Management Therapy 
pilot program that utilizes exposure therapy involving virtual 
reality in combination with group therapy for the treatment of 
individuals with symptoms relating to PTSD. House Report 116-63 
directed VA to provide a report detailing the feasibility of 
such a pilot program and the metrics required. The Committee 
further directs the Department to update this report to include 
the feasibility of allowing these technologies to provide 
treatment through telehealth to treat PTSD within 90 days of 
enactment of this Act.
    Collaboration on Gun Safety and Storage.--The Committee 
supports continued collaboration across public and private 
sectors to end the national tragedy of suicide, and encourages 
VA medical centers to collaborate with state and local law 
enforcement and health officials in states that have adopted 
extreme risk protection orders, also known as ``red flag'' 
laws, and similar gun safety laws, to adopt programs and 
protocols on firearm safety and storage to assist Veterans who 
may be struggling with suicidal thoughts.

                      SUICIDE PREVENTION OUTREACH

    VetsCorps.--The Committee continues to strongly support the 
VetsCorps pilot program directed in House Report 116-63. The 
VetsCorps, comprised of Veterans themselves, will conduct 
outreach and recruitment to bring in Veterans who have not been 
served by the Department and will connect them with available 
programs and services. The VetsCorps should be designed to 
reach Veterans wherever they are and provide a personal 
connection to VA, including peer-to-peer Veteran support 
networks with VetsCorp for Veterans who are trained in suicide 
prevention and crisis intervention to help other Veterans 
transition from military service to civilian life. The 
Committee continues to direct the pilot be carried out at no 
fewer than six sites, targeted to regions with low rates of VA 
utilization and including at least one rural and urban site. 
The Committee directs the Department to provide quarterly 
reports on the status of the implementation of the VetsCorp 
pilot program. Furthermore, at the conclusion of the pilot, the 
Committee directs the Department to report to the Committees on 
Appropriations of both Houses of Congress on the effectiveness 
of the pilot program at reaching Veterans, particularly those 
in need, and increasing utilization of VA services and evaluate 
the cost-effectiveness of the program compared to existing 
outreach efforts.
    GRIT Suicide Prevention Mobile Application.--The Committee 
supports the Department's current efforts to use twenty-first 
century technology to promote social connectedness in order to 
prevent Veteran suicides. The Department, in collaboration with 
technology organizations, is developing mobile applications and 
online platforms in an effort to reach more Veterans, such as 
the Getting Results in Transition (GRIT) mobile application for 
transitioning servicemembers and Veterans. The Committee 
directs the Department to continue its efforts to work with 
technology organizations to develop and implement innovative 
platforms to prevent Veteran suicide and requests a report 
within 90 days of enactment of this Act on the status of these 
efforts.
    Veterans Suicide Prevention Grant Program.--The Committee 
continues to support VA's efforts to coordinate suicide 
prevention efforts across Federal agencies, prioritize research 
activities, and strengthen coordination across the public and 
private sectors under the PREVENTS Initiative.
    Social Media.--The Committee encourages the Department to 
investigate using social media platforms to identify and engage 
Veterans at risk of suicide and work with academic partners to 
develop and test tools for identifying and engaging these 
veterans.
    Artificial Intelligence and Machine Learning.--The 
Committee urges the Department to utilize its growing 
electronic data resources to provide improved services to 
Veterans, including preventing Veteran suicides, and notes that 
commercial off-the-shelf tools, such as artificial intelligence 
and machine learning software, can provide predictive analysis 
and can help prevent suicides before they occur.
    Suicide Prevention Outreach.--The Committee directs the 
Secretary to submit a report to the Committees on 
Appropriations of both Houses of Congress on Suicide Prevention 
Outreach activities within 60 days of enactment of this Act. 
The report should include how VA has executed Federal funding 
for the last two fiscal years and an assessment on what funding 
and resources are needed to accomplish the Department's suicide 
prevention outreach mission. Furthermore, the report should 
include the number of Veterans that VA has reached out to 
through the suicide prevention outreach initiative, and an 
analysis of the program's effectiveness, including how COVID-19 
has impacted this initiative in fiscal year 2020.
    Models of Care for Suicide Prevention.--Soldier and Veteran 
suicide remains a significant scourge on America. Despite 
diligent efforts to prevent suicide, the existing clinical care 
model does not appear to be improving outcomes. As such, the 
Committee encourages VA to determine whether current clinical 
care practices should be enhanced, and new models of care 
developed. In making such a determination, the Department 
should involve its clinical leaders and experts, academia, 
advocate organizations, and other stakeholders and also ensure 
survivors of attempted suicide and families who have lost a 
loved one are provided the opportunity to engage in the 
process.

                          HOMELESS ASSISTANCE

    The Committee provides $1,928,508,000 for VA homeless 
assistance programs, which is $40,000,000 above the budget 
request. Additionally, an estimated $7,868,860,000 is provided 
for homeless Veterans treatment costs. Programs to assist 
homeless Veterans include the Homeless Providers Grant and Per 
Diem (GPD), Health Care for Homeless Vets (HCHV), the 
Domiciliary Care for Homeless Veterans, the Supportive Services 
for Low Income Veterans and Families (SSVF), Justice Outreach 
Homeless Prevention, and the Department of Housing and Urban 
Development-Department of Veterans Affairs Supported Housing 
(HUD-VASH) programs, among others.
    Healthcare for Homeless Veterans.--The Committee directs 
the Secretary to submit a report to the Committees on 
Appropriations of both Houses of Congress within 90 days of 
enactment of this Act on the benefits of expanding the 
Healthcare for Homeless Veterans Program H-PACT program, to 
include the benefits of expanding the program, location of 
additional locations, to include rural areas, and additional 
services to improve the program.
    Ending Veteran Homelessness.--The Committee recognizes the 
value and impact of the HUD-VASH program, which serves Veterans 
experiencing homelessness. Case management services are 
critically important to the function of the program, and public 
housing authorities rely on VA Medical Centers referrals to 
house Veterans. Due to the joint nature of HUD-VASH funding, 
the Committee recommends that VA's budget for case managers be 
increased commensurate with any increases in HUD's budget for 
new vouchers.
    HUD-VASH Program.--The Committee continues to support the 
HUD-VASH program and reminds the Department to provide the 
annual report on distribution of HUD-VASH vouchers as requested 
in House Report 115-188. Furthermore, the Committee requests 
that this annual report also identify how many HUD-VASH 
vouchers are given to women Veterans with children, women 
Veterans without children, male Veterans with children, and 
male Veterans without children in each state. The report should 
also include the number of HUD-VASH vouchers distributed to 
Veterans in rural, suburban, and urban areas per state. The 
Committee believes that an annual report with this information 
will be an important data point over time to assess the success 
of VA's efforts to combat Veteran homelessness.
    Extended HUD-VASH Support Services.--The Committee is aware 
of the positive role the HUD-VASH program plays in helping 
homeless Veterans. A key component of the program is VA's case 
management services. These services are designed to assist 
Veterans in obtaining and sustaining permanent housing and 
engage in needed treatment and other supportive services that 
improve Veterans' quality of life and end their homelessness. 
Examples include access to a caseworker that could help prevent 
Veterans from hurting themselves or others, committing a 
serious crime, or damaging the rented property when 
experiencing an emergent mental health or substance abuse 
crisis. To assist with efforts to evaluate the case management 
services, the Committee directs VHA to provide a report to the 
Committees on Appropriations of both Houses of Congress within 
180 days after enactment of this Act detailing: (1) a summary 
of the current agency guidance for implementing case management 
services after core working hours, (2) a list of any VISN that 
does not offer extended support services after core working 
hours, (3) how a VISN provides support to Veterans in locations 
that do not provide extended case management services after 
core business hours, and (4) plans to provide expanded extended 
case management services in locations that do not currently 
have these services after core business hours.
    HUD-VASH Caseworker Staffing.--The Committee remains 
concerned that the Department is not properly staffing its HUD-
VASH program to meet the needs of the homeless Veterans 
population, which may be contributing to increasing 
homelessness nationwide. As of December 31, 2019, there were 
over 650 vacant HUD-VASH caseworker positions across the 
country. Accordingly, the Committee urges the Secretary to use 
existing authority to contract for HUD-VASH caseworker 
positions when such positions have remained vacant for more 
than nine months and when a VA Medical Center has not used 15 
percent of its allotted vouchers in the previous year. 
Furthermore, the Committee directs the Secretary to submit a 
report to the Committees on Appropriations of both Houses of 
Congress within 90 days of the enactment of this Act that is 
consistent with the report requirements set forth in Division F 
of the Joint Explanatory Statement accompanying the 
Consolidated Appropriations Act, 2020 (Public Law 116-94).
    Legal Assistance for the SSVF Program.--The Committee notes 
that university law schools are willing to work with Veterans 
on a pro-bono basis to provide legal assistance. This can 
result in additional benefits such as training law students in 
Veteran disability law and legal skills critical to providing 
advocacy within the VA system and inspiring next-generation 
lawyers to serve Veterans in practice. The Committee encourages 
the SSVF program to work with grantees to expand their legal 
service offerings, particularly in rural areas where access to 
private legal assistance can be limited. Within the funds 
provided, the Department is encouraged to establish one or more 
pilot projects to partner SSVF grantees with university law 
schools in rural areas to enhance legal assistance to Veterans.
    Shallow Subsidy Initiative.--The Committee encourages VA to 
prioritize funding within the SSVF program for the Shallow 
Subsidy Initiative to expand the number of counties eligible to 
provide the Shallow Subsidy, targeting areas with high rental 
costs and large homeless Veteran populations.
    Homeless Veterans Near the United States-Mexico Border.--
The Committee notes that there may be homeless Veterans living 
near the United States-Mexico border who, historically, may not 
have been counted in point-in-time homeless surveys. The 
Committee directs VA to work with HUD to develop strategies and 
recommendations for addressing Veteran homelessness near the 
United States-Mexico border and to take into account these 
undercounted Veterans when awarding HUD-VASH vouchers. The 
Committee appreciates VA's efforts to implement strategies and 
make recommendations to decrease Veteran homelessness on the 
border, such as the development of a Homelessness Screening 
Clinical Reminder, data sharing, improving the accuracy of 
data, and contracting case management in rural areas.

                            STAFFING ISSUES

    Mental Health Professionals Hiring.--The Committee 
continues to direct the Department to prioritize hiring mental 
health professionals.
    Unfilled Positions.--The current number of unfilled 
positions at VA is nearly 49,000 system-wide. These unfilled 
positions include VHA physicians and mental health 
professionals, and the lack of these professionals negatively 
impacts the delivery of care for Veterans at VHA medical 
centers and CBOCs across the country. VHA facilities have been 
forced to provide care with fewer staff than are medically 
necessary to properly care for our Nation's Veterans. As a 
result, the Committee is concerned that the significant number 
of vacancies will lead to longer wait times for Veterans. 
Section 505 of the John S. McCain III, Daniel K. Akaka, and 
Samuel R. Johnson VA Maintaining Internal Systems and 
Strengthening Integrated Outside Networks (MISSION) Act of 2018 
(P.L. 115-182), requires VA to post data on unfilled positions. 
The Committee expects VA to continue to comply with this 
mandate and expects VA to actively recruit and hire full-time 
professionals to fill these system-wide vacancies with the 
resources provided by the Committee. The Committee continues to 
direct the Secretary to provide a quarterly report to the 
Committees on Appropriations of both Houses of Congress 
detailing hiring initiatives and system-wide progress on hiring 
and specifically what actions are being taken to fill physician 
positions and mental health provider positions, as well as any 
impediments to such efforts. The report should include the 
resources provided for these efforts and recommendations for 
relevant legislation.
    Medical Staff Retention.--The Committee expects VA to 
continue to report every six months on the number of all 
clinical staff directly responsible for patient care who have 
left VA, including a summary of the principal reasons 
explaining their departure, and the steps being taken to 
mitigate the principal reasons providers leave. The data should 
be aggregated at the VISN level and should also include the 
percentage of staff in primary care versus specialty care and 
mental health care, and the percentage of medical staff at each 
facility who complete an exit survey upon their departure. Exit 
surveys should be conducted anonymously, including through the 
use of a location that allows for privacy, is not directly 
visible by another employee, and does not require the departing 
employee to include any personally identifiable data.
    Hiring Delays.--The Committee is concerned that VA's hiring 
and credentialing process may be contributing to longer wait 
times for Veterans seeking healthcare. The Committee requests 
VA to report on the average length of time to fill a healthcare 
provider slot at a representative sample of medical centers, 
including: the time it takes the resource board to approve the 
hire of a new position; the time it takes to post the job 
announcement; how long the interview process takes; and the 
length of time for credentialing; as well as any internal VA 
goals that exist for the time each step in the process should 
take. The report should also describe how often a healthcare 
provider reaches the credentialing process phase of the 
process, but exits the process because of another opportunity 
outside VA. This report should be provided to the Committee no 
later than 60 days after enactment of this Act.
    Lack of Team-based Staffing.--The Committee is encouraged 
by improvement in Primary Care access and wait times. However, 
the Committee remains concerned about primary care Patient 
Aligned Care Team (PACT) team staffing at VA Medical Centers. 
Team-based care has been shown to improve health outcomes, 
improve team member satisfaction, including providers, which 
also correlates to lower team burnout, and increases Veteran 
experience and satisfaction. The Committee directs VA to submit 
a report, no later than 120 days after enactment of this Act, 
providing information on the number and percentage of fully 
staffed and implemented PACTs as well as the number of fully 
trained PACTs within VA. This report should also include 
correlation of fully staffed PACTs to health outcomes as well 
as employee and Veteran satisfaction.
    Staffing Shortages.--The Committee recognizes the growing 
shortage of VHA physicians and medical professionals has 
negatively affected the delivery of care for Veterans at VHA 
medical centers and clinics across the country. VHA facilities 
have been forced to provide care with fewer staff than are 
medically necessary to properly care for our nation's Veterans. 
In House Report 116-63 and in Division F of the Joint 
Explanatory Statement accompanying the Consolidated 
Appropriations Act, 2020 (Public Law 116-94), the Committee 
requested various reports on what VHA is doing to fill medical 
vacancies, recruit new talent, and address workforce-training 
opportunities, not limited to, but including, psychiatric and 
behavioral health professionals. The Committee is concerned VA 
has not produced these reports in a timely manner and is 
further concerned as VA health professional staff vacancies 
have not decreased. The Committee directs VA to submit the 
staffing issues reports no later than 30 days after enactment 
of this Act.

                       ACCESS FOR RURAL VETERANS

    Office of Rural Health (ORH).--The Committee provides 
$300,000,000 for rural health, which is $30,000,000 above the 
request, to improve access and quality of care for the more 
than 3,000,000 enrolled Veterans residing in rural and highly 
rural areas. ORH improves access and quality of care for 
enrolled Veterans residing in geographically rural areas. 
Developing evidence-based policies and innovative practices to 
bring healthcare to rural areas is key to serving Veterans in 
geographically remote areas, including remote facilities in 
Hawaii, many of whom would otherwise need to travel by air to 
reach their nearest VA facility. In addition to providing 
healthcare services, ORH's important work includes identifying 
barriers to healthcare delivery in rural areas and implementing 
new ways to deliver healthcare and services to Veterans in 
these locations. The Committee supports the Office of Rural 
Health's ongoing efforts to refine and promulgate best 
practices and innovative and successful programs to improve 
care and services for Veterans who reside in rural areas, 
including the designation of Rural Promising Practices.
    Operating Plan.--The Committee directs the Office of Rural 
Health to submit to the Committee no later than 30 days after 
enactment of this Act an operating plan for fiscal year 2021 
funding, as well as for the fiscal year 2022 funding provided 
in advance by this Act.
    VSO Wellness.--The Committee is concerned that VA is taking 
too much time to implement the VSO Wellness pilot program, 
authorized in Section 252 of the Consolidated Appropriations 
Act, 2018 (P.L. 115-141). This remains a priority of the 
Committee, and the Department is directed to implement the 
pilot program expeditiously. House Report 116-63 directed the 
Department to provide a status update on the pilot program no 
later than 14 days after the report was filed, and the 
Committee has yet to receive the status report. The Committee 
directs the Department to provide monthly updates on the status 
of the VSO Wellness pilot program, in addition to the initial 
status report required in House Report 116-63 no later than 14 
days after this report is filed.
    Rural Transportation Study.--The Committee provides 
funding, as requested, for the Office of Rural Health's rural 
transportation study by the Veterans Rural Health Resource 
Center, Iowa City. The Committee supports this study and 
directs the Secretary to provide a report with the President's 
Budget Request for fiscal year 2022 that assesses whether there 
are gaps in the Department's comprehensive rural transportation 
program, how they should be closed, and if additional funding 
is needed.
    Rural Health Resource Centers.--Given the important role 
ORH's Rural Health Resource Centers play in expanding access to 
care, the Committee encourages VA to continue considering 
expanding these centers. ORH has played a major role in VA's 
overall strategy to combat opioid abuse by funding pilot 
programs through the Rural Health Initiative focused on pain 
coaching and modalities that increase Veterans' access to 
alternatives to opioid-centered pain management. The Committee 
recommends that as ORH considers expansion, combatting the 
opioid epidemic and non-opioid pain management in rural areas 
remain key components of its focus.
    Vet Center Travel Reimbursement.--The Committee 
acknowledges continued progress in addressing transportation 
barriers for Veterans, especially those in rural or highly 
rural areas. While the Committee recognizes the important work 
of VSOs and the existence of the Veterans Transportation 
Program, a transportation gap still exists for rural and non-
rural areas. The Committee directs VA to submit a report 
outlining the feasibility of expansion of payments and 
allowances for beneficiary travel in connection with Veterans 
receiving care from Vet Centers in (a) rural areas and (b) all 
areas. The Committee is aware of the Congressional Report 
submitted in November 2018 in response to Public Law 112-154; 
126 Stat.1169, Section 104a where the Department performed a 
feasibility study for expansion of beneficiary travel for 
highly rural Veterans receiving care from Vet Centers and 
ultimately advised against expanding beneficiary travel to 
Veterans due to the lack of software and/or automation between 
Vet Centers and VA Medical Centers. This report should also 
include an analysis of options for automating the process for 
information sharing and workload tracking between Vet Centers 
and VA Medical Centers and building an infrastructure at Vet 
Centers for processing beneficiary claims in order to expand 
beneficiary travel to Veterans traveling to Vet Centers. This 
report is due no later than 120 days after enactment of this 
Act.
    Transportation Challenges.--The Committee recognizes the 
transportation challenges and barriers to care that rural and 
remote Veterans face and encourages VA to look into the 
feasibility of utilizing autonomous electric vehicles in the 
future to overcome these challenges.
    Clinical Resource Hub.--The Committee supports the success 
of the recently established Clinical Resource Hub at the Office 
of Rural Health. This program is an innovative model that 
delivers high-quality health care services to Veterans in 
underserved locations. The Committee recognizes the unique 
challenges faced by Veterans living in rural communities who 
often require access to a suite of health services across a 
spectrum of specialty medical professionals. The Clinical 
Resource Hub combines telehealth services with in-person care 
to bring access within reach for Veterans across rural America. 
The Committee will continue monitoring the progress of this 
program through the fiscal year.

                     TELEHEALTH AND CONNECTED CARE

    The Committee provides $1,329,566,000 for telehealth and 
connected care, which includes home telehealth, home telehealth 
prosthetics, and clinic-based telehealth.
    The Committee notes that within the total amount provided 
for Medical Services in the Coronavirus Aid, Relief, and 
Economic Security Act (CARES Act) (P.L. 116-136), VA allocated 
$250,000,000 for telehealth expansion.
    Telehealth Benefits.--Telehealth services increase Veteran 
access to care. The Committee directs VA to continue to expand 
telehealth availability to include additional mental health, 
primary care, and rehabilitation services as a means to deliver 
care in rural and underserved communities.
    Telehealth Services.--The Committee directs VA to develop a 
plan to improve Veteran and provider satisfaction, increase 
awareness of the telehealth program, and enhance adoption of 
telehealth by Veterans and providers. The Department's plan 
should include actions that will be taken to make telehealth 
more accessible to patients in highly rural areas. The 
Committee looks forward to the Department's report, as directed 
in Division F of the Joint Explanatory Statement accompanying 
the Consolidated Appropriations Act, 2020 (Public Law 116-94) 
within 60 days of enactment of the Act.
    Telehealth for Maternal Fetal Medicine.--The Committee 
recognizes the needs of women Veterans and expanding access to 
maternal fetal medicine (MFM) via telehealth to ensure the 
health of mothers, pregnancies, and babies. The Committee also 
recognizes the further potential for VA to partner with 
universities to expand access to maternal and perinatal care 
via telehealth. To assist with efforts to evaluate the 
potential for creating pilot programs in support of MFM, the 
Committee directs the Department to provide a report to the 
Committees on Appropriations of both Houses of Congress with 
180 days after enactment of this Act detailing: (1) the current 
extent of VA support for MFM telehealth and (2) the potential 
for entering into MFM partnerships with academic institutions 
in states that serve a high percentage of Veterans and their 
families in rural, isolated communities in noncontiguous states 
and territories.

                     GENDER-SPECIFIC CARE FOR WOMEN

    The number of women Veterans using VHA services has 
increased 29 percent in five years from 423,642 women Veterans 
in 2014 to 545,670 in 2019. The increased number of women using 
VHA services necessitates the greater need to provide and 
expand VA's gender-specific services to women Veterans. The 
bill provides $660,691,000 for gender-specific care for women, 
which is $35,000,000 above the request. VA is directed to 
continue redesigning its women's healthcare delivery system and 
facilities to ensure women receive equitable, timely, and high-
quality healthcare.
    The additional $35,000,000 is provided for the purposes of 
expanding programmatic support for women's healthcare. VA is 
directed to provide an expenditure plan detailing how the 
additional funding will be spent no later than 90 days after 
enactment of this Act, and the Committee further requires 
quarterly briefings on the expenditure of these funds. The 
Committee directs the delivery of care to women Veterans be 
through an organized program within normal business operations 
of VA. The women's health program is required to have 
appropriate staffing levels and executive support that is 
operationalized to ensure all aspects of care for women 
Veterans are available.
    Program managers within each VA facility should be 
equipped, at a minimum, with at least one designated women's 
health provider, the appropriate number of nurses, 
administrative support, care coordinators, and peer navigators. 
The Committee directs VA to continue to build on its training 
initiatives for women's health providers and nurses in order to 
meet the increased demand in care. VA is further directed to 
provide greater resources at the field level to build visible 
women-specific health programs, including suicide prevention 
programs, reproductive mental health programs, and combined 
pain and opioid use programs, and the Committee requests a 
report within 90 days of enactment of this Act on VA's plans to 
provide and expand these programs for women.
    The Department is further directed to prioritize hiring 
women primary care providers and psychologists for women's 
clinics using the Medical Services appropriation. To supplement 
VA's recruitment efforts to hire and retain women clinicians at 
the field and VISN levels, the Committee directs the Department 
to deploy a large national women-specific advertising campaign 
to appeal to women Veterans to receive their care at VA 
facilities and to women-specific healthcare providers to work 
at VA.
    Additionally, the Committee continues to direct that 
Women's Health Program Managers be full-time jobs and not be 
tasked with supplemental responsibilities outside of their 
specified job descriptions.
    Gender-Specific Women Veterans' Healthcare.--Women are now 
the fastest growing cohort within the Veteran community. The 
Committee remains concerned that VA is not adequately 
addressing the health needs of women Veterans, including 
obstetrics, gynecological care, and treatment for gender-
specific conditions and diseases. The Committee urges VA to 
continue expanding access to care in these areas and ensure 
women Veterans' health needs, which often differ from men, are 
met.
    Women Medical Staff.--The Committee continues to support 
the hiring of more women healthcare professionals in order to 
provide women Veterans greater opportunities to choose the 
gender of their healthcare provider.
    Access to Gender-Specific Care for Women.--The Committee 
expects VA to continue to work to improve care for women 
Veterans. VA must provide women Veterans equitable access to 
the same health care services and programs as male Veterans, 
including VA's specialized services for substance use 
disorders, homelessness, and treatment for PTSD related to 
combat military sexual trauma. Most importantly, these programs 
must be tailored to meet the unique needs of women Veterans by 
expanding the list of requirements that facility staff inspects 
for compliance to align with the women's health handbook of the 
Veterans Health Administration. The Committee further directs 
VA to ensure proper coordination of care for 1) women patients 
with complex care needs who must frequently access gender-
specific health care services in the community and 2) for women 
Veterans with war-related injuries and/or service conditions 
who are at higher risk for poor outcomes. VA should monitor 
these efforts and report to the Committees on Appropriations of 
both Houses of Congress within 120 days of enactment of this 
Act on its work to improve these outcomes for women Veterans.
    Breast Cancer Screening Guidelines.--The Committee commends 
VA's decision to offer breast cancer screening and mammography 
to eligible women Veterans beginning at age 40. However, the 
Department should be prepared to offer screening to eligible 
younger women Veterans should a physician determine, or risk 
factors warrant, screening before age 40. The Committee 
supports this effort to ensure that the care women Veterans 
receive is consistent with the private sector and will continue 
to monitor the Department's implementation of this policy. The 
Department should closely follow ongoing debate within the 
scientific community on breast cancer screening and mammography 
coverage to provide Veterans the best care possible. The 
recommendation includes bill language to ensure VA maintains 
this policy through fiscal year 2024.
    Maternity Care Benefits, Survey, and Education Campaign.--
The Committee requests a report within 90 days of enactment of 
this Act on the following data related to VA maternity care 
benefits: the number of eligible women Veterans and actual 
utilization from each of the last 10 years in each VISN, to the 
extent that data are available; the number of Veterans who 
receive prenatal care and have births at a VA facility, and the 
number of Veterans who receive prenatal care-related services 
through contracted non-VA providers; information on the 
transition from VA to non-VA providers and how medical records 
are returned to VA once a woman is postpartum, particularly if 
she has an underlying medical condition; and the number of 
maternity care coordinators in each VISN and specific data on 
minimum employment requirements and caseload. The Committee 
also directs VHA to develop a patient survey to collect 
feedback from women Veterans who utilize the maternity care 
benefit, including their satisfaction with VA maternity care 
benefits; whether the benefit met their needs; the patient's 
interaction with the maternity care coordinator; and whether 
there were barriers to care, providers, or specific services 
related to the maternity care benefit. Further, the Committee 
encourages VHA to develop an education campaign publicizing the 
maternity care benefit, including clarifying who is eligible, 
what the benefit covers and does not cover, and any cost 
sharing that may be required with the benefit. The education 
campaign materials should be easy for patients to understand 
and be easily accessible online and at each center for women's 
health, medical center and CBOC.
    Women Veterans Peer Support.--The Committee welcomes the 
role of Women Veterans Network (WoVeN), a national peer support 
network for women Veterans in providing group support 
specifically tailored to the unique needs of women Veterans, 
including life transitions, balance, stress relief, 
connections, healthy living and esteem, which is run by 
researchers from the National Center for PTSD--Women's Health 
Sciences Division, which develops clinical practices to treat 
PTSD in women. The research component of this peer support 
program will drive innovation in addressing PTSD in women 
Veterans. The Committee provides no less than $1,000,000 for 
peer support programs for women Veterans.
    Combatting Maternal Mortality.--The Committee recognizes 
that the United States maternal mortality rates are 
significantly higher than many of our international 
counterparts. In 2018, the Center for Disease Control and 
Prevention found that in the United States, 658 women, 
including women Veterans, died from complications while giving 
birth. The Committee directs VA to provide a report within 90 
days of enactment of this Act on the historical maternal 
mortality rates of women Veterans and recommendations on how to 
combat the rising rates.
    Women Veterans Contact Call Center.--The Committee directs 
the Secretary to enhance the capabilities of the women Veterans 
contact call center to respond to requests by women Veterans 
for assistance with accessing health care and benefits 
furnished under the laws administered by the Secretary, and to 
refer such Veterans to resources provided by the Federal 
government and the community to obtain assistance with services 
not furnished by the Department.
    Sexual Assault and Harassment Policy at VA.--The Committee 
continues to be concerned about the harassment women Veterans 
have had to endure at some VA healthcare facilities, but is 
pleased VHA has initiated the Stand-Up to Stop Harassment 
Campaign to promote a harassment-free healthcare environment 
for staff, Veterans and visitors to VA health facilities. The 
Committee directs the Secretary to provide a report no later 
than 90 days after enactment of this Act to the Committees on 
Appropriations of both Houses of Congress on VA's plan to 
expand and implement a similar initiative across all VA 
components, including implementing mandatory bystander 
intervention training for all employees, contractors, on-site 
vendors, and volunteers.

                            PHARMACY ISSUES

    Drug Pricing Report.--Rising drug prices are a significant 
cost driver in healthcare. However, VA receives substantial 
discounts when purchasing prescription drugs. Common sense 
approaches such as using lower-cost generic drugs, providing 
care from expert pharmacists, and making drug companies compete 
for business can help drive down the cost of healthcare. The 
Committee is interested in VA's spending on prescription drugs 
and requests a robust report on drug pricing no later than 120 
days after enactment of this Act. The report should include 
prescription drug prices (net of rebates) paid by VA for the 
ten most frequently prescribed drugs and the ten highest-cost 
drugs for VA. In addition, the report should include total 
annual costs to VA for all prescription drugs. If data is 
unavailable, the report should provide a detailed explanation 
of why.
    At-home Drug Disposal for Veterans.--In 2019, over 125 
million prescriptions, representing 80 percent of outpatient 
prescriptions were mailed directly to the Veteran's home. While 
extremely beneficial to Veterans, this method may contribute to 
the prevalence of excess, expired, unused, and unwanted 
prescriptions remaining in Veterans' medicine cabinets. In a 
recent VA study of almost 5 million Veterans with prescriptions 
through VA, 64 percent had at least one duplicated medication, 
which can increase the risk of adverse events and overdose. In 
addition, recent studies indicate as many as 72 percent of 
opioids prescribed for post-surgical pain go unused by the 
patient, but without active engagement at discharge, patients 
are highly unlikely to dispose of unused drugs leaving them 
vulnerable for misuse and abuse. The Committee supports VA's 
efforts to engage Veterans on the safe disposal of prescribed 
medication while continuing to pursue and advance additional 
methods to limit and dispose of excess medications in Veteran 
homes. The Committee directs the Department to provide a report 
within 120 days of enactment of this Act on the feasibility of 
conducting a pilot program to evaluate the benefits of co-
dispensing at-home drug disposal products for post-surgical 
patients as a part of the Opioid Overdose Education and 
Naloxone Distribution program and drug-take back activities of 
the Department.
    Safe Medicine.--The Committee recognizes the nation's 
increased reliance on foreign-based sources of medicine and 
active pharmaceutical ingredients. The Committee is concerned 
the health security risk this presents VA as it provides 
medicine to Veterans. The Committee requests a report within 90 
days of enactment of this Act detailing potential 
vulnerabilities VA faces purchasing medicine from offshore 
sources, including dependency issues, and that addresses 
strategies to buy American and produce medicine domestically. 
The report should also provide information on VA's medicinal 
purchasing guidelines, with relation to drug cost and safety, 
to ensure VA is acquiring the safest medicine possible for 
Veterans.

       OPIOID SAFETY INITIATIVES AND SUBSTANCE USE DISORDER CARE

    Opioid Abuse.--The Committee is pleased that VA has taken 
an aggressive posture in reducing the volume of opioid 
prescriptions it dispenses and is turning to alternative 
approaches to pain relief, including the use of complementary 
medicine tools. The Committee is pleased to see that despite 
the 7 percent increase in the number of Veterans using pharmacy 
services between 2012 and 2019, there has been a 60 percent 
reduction of Veterans on long-term opioids and an 82 percent 
reduction of Veterans receiving opioid and benzodiazepine 
medications together. The Committee encourages VA to continue 
the challenging effort to reduce opioid use among Veterans, 
half of whom suffer from chronic pain. The Committee provides 
$503,660,000 for opioid treatment and prevention efforts, of 
which $120,812,000 is provided for activities authorized by the 
Comprehensive Addiction and Recovery Act of 2016 (P.L. 114-
198), which is $66,758,000 above fiscal year 2020.
    Opioid Therapy Risk Report.--The Committee urges VA to 
ensure that all VA providers who prescribe opioids use VA's 
Opioid Therapy Risk Report tool consistently, including prior 
to initiating opioid therapy, to ensure safe prescribing and to 
help prevent diversion, abuse, and double-prescribing. The 
Committee also urges VA to further improve the timeliness of 
data available in the tool to allow providers to have real-time 
access to data. It is critical that VA clinicians have access 
to patients' opioid therapy history from outside providers to 
ensure safe pain management care, as many Veterans also seek 
care from providers in the community who may prescribe them 
medication.
    Behavioral Health and Substance Use Screening.--The 
Committee is aware of the high prevalence of mental illness and 
substance abuse among Veterans, particularly PTSD, depression, 
anxiety, and alcohol and opioid abuse. The Committee strongly 
recommends that all Veterans seeking treatment services in a VA 
facility be screened for the listed illnesses, at a minimum 
annually, using evidence-based assessment tools.
    Substance Abuse Among Women.--In recent years, rates of 
problematic substance use among women Veterans have been 
increasing. While men have greater rates of addiction than 
women, many women Veterans have characteristics that make them 
more prone to substance use disorders than men, including past 
trauma (physical and sexual). As such, the Committee recommends 
that the Department ensures women Veterans have timely access 
to a full spectrum of integrated substance abuse treatment 
services, from detoxification to rehabilitation. Additionally, 
the Department should increase the availability of gender-
specific substance use disorder programming and ensure all 
programming venues comply with the environment of care 
standards for women's privacy and safety.
    Substance Use Disorders.--The Committee supports new and 
innovative solutions to address substance use disorders and 
substance misuse, including efforts to intervene early with at-
risk Veterans and support programs that provide Veterans and 
their families with the tools they need to meet these 
challenges, such as harm reduction techniques and confidential 
education that can reduce substance use, relapse, hospital 
visits and suicide. The Committee encourages VA to increase 
education among its primary care practitioners on the diagnosis 
and treatment of alcohol use disorders with Federal Drug 
Administration (FDA)-approved medication assisted treatments.
    Internet-based Substance Abuse Education.--The Committee 
recognizes the ongoing work of VA to reduce substance use 
disorder among Veterans. The Committee is aware of Substance 
Abuse and Mental Health Services Administration studies that 
conclude that 90 percent of people who die by suicide suffer 
from depression, substance use disorders, or both. Veterans 
face unique health challenges and the suicide rate among 
Veterans continues to be unacceptable. The Committee is aware 
that male Veterans have greater rates of substance abuse 
addiction but that the rates of problematic substance use among 
women Veterans is increasing. The Committee supports new and 
innovative solutions to intervene early with at-risk Veterans 
and supports programs that provide Veterans and their families 
with the tools they need to meet these challenges. The 
Committee recognizes the importance of programs that utilize 
harm reduction techniques and offer confidential education 
information that can reduce substance use, relapse, hospital 
visits and suicide, and therefore directs the Department to 
provide a feasibility study to establish a comprehensive, 
evidence-based and confidential internet-based substance abuse 
education, case management, and peer coaching pilot program 
within 90 days of enactment on this Act.

                        WHOLE HEALTH INITIATIVE

    Traditionally, Veteran medical providers have focused on 
the physical symptoms of Veterans, zeroing in on their diseases 
and ailments. However, VA is continuing to work to expand this 
focus by incorporating a whole health model of care, which is a 
holistic look at the many areas of life that can affect a 
Veteran's health, including their work environment, 
relationships, diet, sleep patterns, and more. Whole Health is 
an approach to healthcare that empowers and enables the Veteran 
to take charge of their health and well-being and live their 
life to the fullest. The Committee is extremely pleased with 
the Whole Health model of care and includes $83,600,000, which 
is $20,000,000 above the request, to continue to implement and 
expand Whole Health to all VA facilities.
    Interactive Patient Care Beyond the Inpatient Setting.--The 
Committee supports Whole Health as a model of care delivery at 
all points of care whether in VA facilities, in the community, 
or at home. The Committee understands that several VA Medical 
Centers (VAMC) are implementing the Whole Health model through 
interactive patient care, but the Committee is concerned about 
how the Department will ensure the Whole Health model is 
sustained when the Veteran is outside of the VA inpatient 
setting. To achieve success, VA must facilitate the Veteran's 
care team's ability to provide the same consistent and 
collaborative patient engagement and interactive patient care 
outside of VAMCs and enable the Veteran and the Veteran's care 
team to be actively involved in the Veteran's Whole Health 
Plan. The Committee directs the Department to leverage 
technology to facilitate management and adaptations of the 
Veterans Whole Health Plan, ongoing communication, and 
awareness of additional VA services to support fulfillment of 
the Whole Health Plan.
    Creative Arts Therapies.--The Committee acknowledges the 
effective use of creative arts therapies in treating Veterans 
with traumatic brain injuries and psychological health 
conditions. The Committee supports the integration of the arts 
and creative arts therapies provided by VA's Office of Patient 
Centered Care and Cultural Transformation through the Whole 
Health initiative and encourages VA's continued partnerships 
with healing arts providers. The Committee strongly supports 
the Secretary in continuing to expand these innovative programs 
throughout the Veterans Healthcare Networks and provides an 
additional $5,000,000 to do so.
    Continued Support and Expansion for Whole Heath.--As of 
October 2017, 18 VA medical centers have received funding to 
implement the Whole Health System of Care (WHS). WHS, a three-
year pilot program, meets the intent of the Comprehensive 
Addiction and Recovery Act by delivering patient-centered care 
and complementary and integrative health approaches to our 
nation's Veterans especially those who are struggling with 
opioid use disorder and chronic pain. In January 2020, VA 
released an evaluation of the WHS, which concluded: (1) the 
program had a positive impact on reducing opioid use among 
Veterans; (2) Veterans who used WHS, compared to those who did 
not, experienced greater improvements in perceived stress 
indicating improvements in overall well-being; and (3) 
comprehensive WHS service revealed potential savings in 
pharmacy costs. The Committee is pleased by the results of this 
evaluation and urges VA to continue supporting the WHS and to 
expand it beyond the 18 flagship sites in fiscal year 2021.
    Whole Health Services.--The Committee supports VA's focus 
on Whole Health and as VA continues to expand access to Whole 
Health services, the Committee directs VA to analyze the 
accessibility and availability of each of the following 
services: massage, chiropractic services, whole health 
clinician services, whole health coaching, acupuncture, healing 
touch, whole health group services, guided imagery, meditation, 
hypnosis, yoga, Tai chi or Qi gong, equine assisted therapy, 
and any other services the Secretary determines appropriate, at 
VA medical facilities, including Medical Centers, Community-
Based Outpatient Clinics, Vet Centers, and Community Living 
Centers. Furthermore, the Committee directs the Department to 
submit a report to Committees on Appropriations of both Houses 
of Congress on the outcomes derived from these specified Whole 
Health services, the resources required to expand these 
specified services, and the plan to provide these specified 
services to Veterans who reside in geographic areas where no 
Medical Center, Community-Based Outpatient Clinic, Vet Center, 
or Community Living Center is located. The report should be 
submitted no later than 180 days after enactment of this Act.

                          OTHER HEALTH ISSUES

    Central Alabama Veterans Health Care System (CAVHCS).--The 
Committee calls the Department's attention to the urgent need 
to improve the care provided at and the management of CAVHCS. 
The Department is directed to immediately and fully correct 
deficiencies and problems at CAVHCS and ensure VA Southeast 
Network (VISN 7) is focused on providing appropriate and 
additional assistance to the system. The Committee directs the 
Department to develop a plan to resolve these problems and to 
fill vacancies of permanent leadership and senior member staff 
and to submit quarterly reports describing implementation of 
the plan, including current status of hiring permanent 
leadership and senior member staff. The Committee strongly 
urges the Department to fully utilize every incentive, bonus, 
or other measures to hire and retain permanent medical staff to 
provide quality care for Veterans in Central Alabama. The 
Committee directs the Department to issue quarterly reports on 
all levels of permanent staffing at CAVHCS along with vacancies 
and efforts that are being made to fill those vacancies.
    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 servicemembers, the Committee directs that 
skin cancer be included as a priority as well.
    Rare Cancers.--The Committee is pleased by the December 
2017 signing of the collaboration agreement between the 
Department, the John P. Murtha Cancer Center at Walter Reed 
National Military Medical Center, and the National Cancer 
Institute focused on improving cancer care for common cancers 
affecting servicemembers and Veterans. However, the Committee 
remains concerned about the need for a better understanding of, 
and treatment options for, rare cancers. There are 55 cancers 
that disproportionately affect those serving in the military 
and 67 percent of them are rare. Of the 396 total cancers, 374 
are rare and few treatment options are available. 
Servicemembers are uniquely exposed to carcinogens, including 
asbestos, industrial solvents, nuclear radiation, depleted 
uranium, lead, fuels, polychlorinated biphenyls, and components 
of Chemical Agent Resistance Coating, all hazards that may 
increase the risk of cancer for servicemembers and Veterans. 
Therefore, the Committee directs the Department to issue a 
report no later than 90 days after enactment of this Act on how 
the collaboration between the Department, the John P. Murtha 
Cancer Center at Walter Reed National Military Medical Center, 
and the National Cancer Institute will address rare cancer, 
including molecular subtyping, systemic research and 
development gaps, and inadequacies in targeted treatment 
options.
    Nuclear Medicine Quality Improvements.--The Committee is 
aware of evidence demonstrating the prevalence of 
extravasations in nuclear medicine procedures. Extravasations 
of diagnostic radio-pharmaceuticals negatively affect the 
sensitivity and quantification of nuclear medicine scans. 
Extravasations can affect disease staging and treatment 
assessment, result in unnecessary invasive procedures and 
additional radiation exposure, and lead to higher costs for 
patients and payers. Additionally, extravasations of diagnostic 
and therapeutic radiopharmaceuticals can expose patient's 
tissue to radiation doses that far exceed dose thresholds that 
are known to lead to side effects. As America's largest 
integrated healthcare system, VHA should lead by example in 
acting to reduce medical errors and medical waste. The 
Committee encourages VHA to monitor injection quality, image 
extravasations when they occur, perform dosimetry, notify 
patients and their physicians when doses exceed reportable 
limits, and implement programs to reduce extravasations in the 
future. The Committee requests an update on this issue in the 
fiscal year 2022 Congressional Budget Justification.
    Hospital-Acquired Pressure Ulcers and Pressure Injuries.--
The Committee understands that ulcers and pressure injuries are 
reported to be 52 percent more prevalent in VA hospitals than 
in non-VA hospitals, and that the application of evidence-based 
protocols can help prevent Hospital-Acquired Pressure Ulcers. 
The Committee urges VA to implement the Standardized Pressure 
Injury Prevention Protocol, as included in the 2019 
International Clinical Practice Guidelines for the Prevention 
and Treatment of Pressure Ulcers/Injuries, and directs VA to 
provide a report to the Committees on Appropriations of both 
Houses of Congress no later than 90 days after enactment of 
this Act on steps taken to implement such protocols.
    Wheelchairs.--The Committee encourages the Department to 
work with Veterans who are eligible to receive a wheelchair to 
determine the best options for restoring their maximum 
achievable mobility and function for daily life.
    Nutrition and Food Services.--The Committee recognizes the 
value of proper nutrition and food's impact on one's health and 
remains concerned regarding the nutritional health and well-
being of Veterans. Patients with three or more chronic 
conditions represent 35 percent of Veterans receiving VA care 
and account for 65 percent of VHA costs. Acknowledging the 
correlation between obesity and co-occurring chronic 
conditions, such as diabetes, the Committee directs VA to 
provide a report on the ways VA is currently promoting positive 
nutritional habits among Veterans, such as nutritional coaching 
and meal programs. The report should include how many Veterans 
the Department is currently serving in this capacity, and how 
to expand the initiative to more Veterans. Furthermore, the 
Committee urges VA to be proactive in promoting wellness and 
disease prevention by providing evidence-based nutritional 
guidelines for Veterans and their caretakers.
    Produce Prescription Pilot Program.--The Committee is 
concerned with food insecurity among the Veteran population and 
recognizes the role of access to healthy produce in managing 
chronic disease and reducing health care utilization. The 
Committee is aware of produce prescription programs across the 
country that allow medical providers to prescribe fresh fruits 
and vegetables to individuals or households who are at-risk due 
to health status or income, often pairing these prescriptions 
with financial incentives or nutrition education resources. The 
Committee encourages the Secretary to create a pilot program to 
provide produce prescriptions to Veterans in partnership with 
community-based organizations and/or government entities with 
demonstrated experience and expertise in providing produce 
prescriptions.
    Long-Term Care.--The Committee is aware of the aging 
Veteran population and supports long-term care that focuses on 
facilitating Veteran independence, enhancing quality of life, 
and supporting the family members of Veterans. The Committee 
supports home- and community-based care, residential settings, 
nursing homes, geriatric services, and advanced care planning 
for Veterans and their families. Multiple chronic conditions, 
life-limiting illness, or disability associated with disease, 
aging, or injury can be factors of consideration. The Committee 
acknowledges that the Veteran population faces unique health 
risks and that each Veteran requires an individualized approach 
to care.
    Medical School Affiliations.--The Committee continues to be 
pleased with VHA's implementation of its collaborative 
agreements with academically affiliated minority medical 
schools. The Committee encourages VHA and the Office of 
Academic Affiliations (OAA) to further align academic 
partnerships with training opportunities and patient needs of 
Veterans in surrounding communities and to convene a summit of 
minority health professions schools to achieve this goal. The 
Committee directs VA to provide a report to the Committees on 
Appropriations of both Houses of Congress on the progress. The 
Committee further encourages VA to identify opportunities to 
expand community-based inpatient and outpatient clinical 
facilities on the campuses of Historically Black Colleges and 
Universities (HBCUs) and other minority serving medical 
schools. The Committee recommends that VA solicit and expand 
its medical support systems to HBCUs that have medical 
facilities on their campuses. Within 120 days of enactment of 
this Act, the Committee directs the Department to report back 
to the Committees on Appropriations of both Houses of Congress 
on the progress of both initiatives.
    Minority Veteran Care.--The Committee acknowledges the 
Department's efforts to streamline data collection practices 
through a working group and other initiatives. The Committee 
notes that the Veteran population is becoming increasingly 
diverse. According to VA's Center for Minority Veterans, more 
than one-third of Veterans will come from minority groups by 
the year 2040. The Committee also acknowledges that the 
Department currently has a working group, which has the goal of 
developing streamlined data collection processes. Accordingly, 
the Committee directs the Secretary to provide a report to the 
Committees on Appropriations of both Houses of Congress no 
later than 180 days after enactment of this Act that details 
how VA can restructure its data collection practices to more 
accurately and consistently capture data on the race and 
ethnicity of Veterans across its various systems. This report 
should take into consideration VA's new electronic health 
record system that will combine the Department's current data 
collecting programs and make recommendations on how the 
implementation of this new system can help improve data 
collection on Veterans.
    Hispanic-Serving Institution (HSI) Affiliations with VA 
Health Care Facilities.--The Committee continues to be 
concerned by the lack of HSI medical school participation and 
collaboration with local VA hospitals in areas where HSI 
medical schools are located. The Committee urges the Secretary 
to develop a plan to expand local VA medical facilities' 
participation with HSI medical schools.
    Freely Associated States (FAS) Veterans.--The Committee 
directs the Department to provide hospital care and medical 
services to Veterans in the FAS, and to provide a report within 
180 days of enactment of this Act to the Committees on 
Appropriations of both Houses of Congress on the feasibility 
and advisability of establishing regional offices, sub-offices, 
contact units, or other subordinate offices in the FAS to 
provide such care and services.
    VA Healthcare Expansion.--The Committee directs VA to 
increase access to direct VA care for Veterans living in remote 
and underserved areas, such as the Commonwealth of the Northern 
Mariana Islands, and strongly urges VA to increase the number 
of full-time, dedicated, VA medical and mental health providers 
in these areas.
    Cost Analysis of Community Care versus Direct Care in the 
United States Pacific Territories.--The Committee directs VA to 
conduct an analysis of the costs to send Veterans residing in 
the U.S. Pacific territories, including the Northern Mariana 
Islands, into the community to receive care, and the cost of 
placing or adding a full-time VA clinician to provide such 
services. For jurisdictions that do not have a VA Community-
Based Outpatient Clinic, or full-time clinicians providing 
services exclusively to Veterans, the analysis should include 
an evaluation and comparison of costs, the quality of care 
provided to, and health outcomes of, Veterans receiving care 
through community providers. The analysis should also include 
feedback on access to care, the quality of care, and health 
outcomes from the Veterans who reside in the jurisdiction. The 
Department is directed to submit this report to the Committees 
on Appropriations of both Houses of Congress and to the 
Government Accountability Office (GAO) no later than 180 days 
after enactment of this Act. GAO is directed to review and 
analyze the Department's cost estimates and analysis and report 
to the Committees on Appropriations of both Houses of Congress 
whether the Department's estimates and the evaluations are 
comprehensive, accurate, and credible.
    Audit of Hiring Practices for VA positions in the 
Pacific.--The Committee directs GAO to report to the Committees 
on Appropriations of both Houses of Congress on VA's efforts 
over the last 10 years to fill vacancies/positions with duty 
stations in the U.S. Pacific Insular Areas, to evaluate the use 
of current hiring authorities, and to provide recommendations 
on additional authorities that may be needed to recruit and 
retain qualified candidates to serve Veterans in these areas.
    Vet Center Services.--The Committee strongly encourages VA 
to provide at least one full-time VA Readjustment Counseling 
Therapist in each state or U.S. territory that does not have a 
Vet Center located within its jurisdiction within 180 days of 
enactment of this Act to ensure parity of services for all 
Veterans receiving care through VA. Such staff should be 
provided the necessary support, space, equipment, and funds to 
facilitate travel to other areas within such jurisdiction where 
Veterans reside on a regular basis. The Committee urges VA to 
ensure Veterans in these areas are notified that a VA 
Readjustment Counseling Therapist is available to provide 
services to them and their families. Furthermore, no later than 
one year after the date this report is filed, the Committee 
directs VA to provide a report to the Committees on 
Appropriations of both Houses of Congress on the services and 
outreach conducted by VA in such areas, an evaluation of such 
activities, and an assessment of the need to establish a Vet 
Center in such areas that should include input from Veterans 
residing in these areas. If VA determines there is no need to 
establish a Vet Center in a particular jurisdiction, VA is 
directed to include in the report its plans to continue serving 
Veterans and their families in such areas.
    Dialysis Services.--The Committee understands that VA has a 
long history of providing dialysis services through community 
dialysis providers under the Nationwide Dialysis Services 
contracts when VA is unable to directly provide such care. The 
Committee expects VA will ensure that care is not disrupted or 
diminished for the Veterans who receive treatment through 
experienced providers under the Nationwide Dialysis Services 
contracts.
    Reducing Airborne Infections.--The Committee recognizes 
airborne bacteria and viruses remain a significant source of 
healthcare-associated infections at health care facilities. 
Although High Efficiency Particulate Air (HEPA) filters are 
widely used to filter the air, airborne transmission still 
accounts for a significant portion of health care-associated 
infections. Within 120 days of enactment of this Act, the 
Committee directs VA to initiate a pilot program of new 
commercial, off-the-shelf technology that has the potential to 
capture and destroy airborne contaminants.
    Creutzfeldt-Jakob Disease Monitoring.--Veterans and their 
dependents who resided at United States military installations 
in Germany, Belgium, and the Netherlands for six months or more 
from 1980 through 1990, and Veterans and their dependents who 
resided at United States military installations in Greece, 
Turkey, Spain, Portugal, and Italy for six months or more from 
1980 through 1996 are barred from donating blood due to their 
potential exposure during their military service to beef that 
was infected with bovine spongiform encephalopathy, resulting 
in possible infection of Creutzfeldt-Jakob Disease (CJD), a 
human prion disease. The Committee is committed to 
understanding the residual impacts of CJD within the Veteran 
community. The Committee urges the Department to reference data 
from existing medical records of Veterans to determine the 
percentage of Veterans from the above referenced subgroup that 
have more frequent or unexplained symptoms associated with CJD 
compared to the civilian population. This body of data could be 
helpful in clarifying the extent and specifics of the medical 
issues suffered by Veterans from exposure to CJD.
    Tobacco Use Among Veterans.--A 2018 government study found 
almost 30 percent of Veterans are smokers. Interventions for 
Veterans are critical to reduce tobacco use and lead to 
improved health outcomes. Women Veterans are uniquely impacted 
by the effects of tobacco use, including difficulty getting 
pregnant, early menopause, osteoporosis, cervical cancer, and 
breast cancer. The Committee encourages VA to continue 
promoting cessation and evidence-based tobacco interventions 
for our Veterans.
    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 
that exposure during military service has had on the health of 
Veterans. Therefore, the Committee continues to support 
language included in House Report 116-63 on burn pits and 
includes $7,500,000 to carry out responsibilities and 
activities of the Airborne Hazards and Burn Pits Center of 
Excellence.
    Burn Pits Center of Excellence Expansion.--The Committee is 
concerned that research and clinical trials are urgently needed 
to develop effective treatments for Veterans exposed to toxic 
environmental hazards. The VA Research Advisory Committee has 
recommended the establishment of Centers of Excellence to 
facilitate the development and availability of new treatments 
in clinical settings. Cost effective models for rapid 
development of new treatments for Gulf War Illness using 
computational models, research funding through the Department 
of Defense's Congressionally Directed Medical Research 
Programs, and clinical experts in environmental medicine have 
been proven effective in partnership with VA medical centers. 
The Committee directs the Secretary to establish a Center of 
Excellence focused on toxic environmental exposures including 
investigations of gender-based differences in disease and 
treatment to leverage research funding through partnerships.
    Jason Simcakoski Memorial and PROMISE Act Implementation.--
The Committee supports robust funding to support the continued 
implementation of the Jason Simcakoski Memorial and Promise 
Act, which passed as Title IX of the Comprehensive Addiction 
and Recovery Act of 2016 (P.L. 114-198), including updating 
therapy and pain management guidelines, strengthening provider 
education and training, and improving patient advocacy.
    Health Videos for Veterans.--Hospitals and physicians' 
offices around the country are currently utilizing health 
videos in their lobbies, waiting rooms, and exam rooms to 
supplement and reinforce the medical care, advice, and 
instruction physicians are providing. The Committee notes that 
educational resources, such as these could result in cost 
savings and quality of life improvement for Veterans. The 
Committee encourages VHA to continue its efforts in providing 
informative video content to veterans in VA facility lobbies 
with a focus on health education and suicide prevention.
    Reliance on Community Care Versus VA Medical Center and 
Clinic Expansion and Development.--The Committee recommends the 
Department develop a system to accurately compare the costs of 
providing care in the community, as envisioned by the MISSION 
Act, to the costs of providing care within the VA healthcare 
system. The data captured by the system should be gathered and 
made available in a manner that allows the accurate comparison 
of the cost of various services to help inform future decisions 
regarding the most cost-effective delivery of healthcare 
services to Veterans. The Committee looks forward to working 
with the Department to develop a medical care cost data 
collection system.
    Residency Programs.--The MISSION Act expanded VA's support 
of residency programs. However, the Committee understands some 
states have not taken advantage of this expansion. The 
Committee requests a status report, within 180 days of 
enactment of this Act, on the implementation of the MISSION 
Act's residency program expansion and its efforts to encourage 
states, especially rural and non-contiguous states, to utilize 
the program.
    Domiciliary Care for Veterans with Dementia.--The Committee 
is aware that Veterans with dementia who require less than 
Skilled Nursing Care are not eligible for VA domiciliary care 
under current regulations, and that the population of Veterans 
with dementia is expected to grow. The Committee appreciates 
the Secretary's willingness to consider appropriate revisions 
of regulations and directs VA to provide a report to the 
Committee no later than 90 days after enactment of this Act on 
the Department's plan to address care for such Veterans.
    Antimicrobial Resistance.--The Committee recognizes the 
growing threat from bacterial resistant infections and is 
interested in novel antibiotic remedies. The Secretary is 
directed to submit a report to the Committees on Appropriations 
of both Houses of Congress on the Department's approach to 
preventing and managing antibiotic-resistant infections and its 
activities regarding novel antibiotic medicines and treatments 
no later than 120 days after enactment of this Act.
    Sleep Apnea.--Noting the Office of Inspector General report 
titled, ``Opportunities Missed to Contain Spending on Sleep 
Apnea Devices and Improve Veterans Outcomes'' (VAOIG-19-00021-
41), the Committee directs VHA to expeditiously implement the 
Inspector General's recommendations, especially that the Under 
Secretary coordinate with appropriate offices whether 
purchasing and distributing sleep apnea devices is in the best 
interest of the Department and Veterans and develop and provide 
clear guidance before any changes to current purchasing 
processes. Should the recommendations not be implemented within 
30 days of enactment of this Act, VHA should provide a report 
on its proposed timeline and milestones to the Committees on 
Appropriations of both Houses of Congress.
    Prostate and Breast Cancer Molecular Diagnostics.--Prostate 
cancer and breast cancer are among the most frequently detected 
cancers among male and female Veterans, respectively. 
Unfortunately, early detection and diagnosis is not yet an 
exact science. Advancements in molecular diagnostics have been 
proven to improve clinical outcomes and reduce economic spend. 
The Committee includes $5,000,000 for VA to accelerate the 
adoption of prostate and breast cancer molecular diagnostics.
    Rapid Testing and Self-Testing.--The Committee notes the 
growing body of public health literature touting the impact of 
rapid point-of-care testing and rapid self-testing for Human 
Immunodeficiency Virus and Hepatitis C Virus. VA is encouraged 
to integrate innovative testing options to ensure screening 
services engage hard-to-reach Veterans, including affected 
Veterans that do not regularly receive care at VA facilities.
    Innovative Technological Solutions for Injured Veterans.--
The Department is encouraged to ensure injured Veterans are 
integrated into product development teams so that adaptive 
technologies are effectively tailored to meet the needs of 
these Veterans.
    Musical, Occupational, and Rehabilitative Therapies.--The 
Committee encourages VA to utilize musical, occupational, and 
rehabilitative therapeutic care at VA facilities. Early results 
of these types of care indicate improved patient outcomes and 
reduced overall Veteran rehabilitation time. The Committee 
directs VA to provide a report within 120 days of enactment of 
this Act on the types of new technologies and therapy models 
developed for the purpose of adaptive therapeutic care offered 
at VA facilities and a plan for how to expand this type of care 
across all VA facilities.
    Child Care Demonstration Program.--The Committee strongly 
supports efforts by VA to provide access to free child care for 
Veterans receiving treatment at VISNs, as authorized by the 
Caregivers and Veterans Omnibus Health Services Act of 2010 
(P.L. 111-163), and encourages the Department to furnish 
qualified veterans with assistance for childcare. Past VA 
surveys have found that one in ten Veterans have had to either 
cancel or reschedule a VA healthcare appointment due to a lack 
of childcare. A 2015 report to Congress from VA found the 
program achieved a reasonable cost per hour as the number of 
children cared for increased. The Committee therefore expects 
VA to adhere to the authorized funding level given for the 
operation of the Veterans Access to Child Care demonstration 
program so that Veterans may continue uninterrupted access to 
medical appointments.
    Epilepsy Centers of Excellence.--The Committee includes 
$10,000,000 toward maintaining and expanding the Epilepsy 
Centers of Excellence within VA. The Committee directs the 
Department to provide an update on the status of these Centers 
to the Committee no later than 30 days after enactment of this 
Act.
    Oral Contraceptives.--Given the findings of the 2019 study, 
``Financial Implications of 12-Month Dispensing of Oral 
Contraceptive Pills in the Veterans Affairs Health Care 
System'', published in JAMA Internal Medicine, VA is strongly 
encouraged to investigate the feasibility of offering patients 
the option to receive a full year's supply of birth control at 
one time and ensuring Veterans are notified of that option.
    Intimate Partner Violence Program.--The Committee continues 
to support VA's efforts to expand its Intimate Partner Violence 
Program to all sites within the next three years and directs VA 
to expeditiously implement this program. The Committee supports 
VA's plans to screen all Veterans for Intimate Partner Violence 
and directs the Department provide the appropriate resources to 
do so. Therefore, the Committee requests a report with 90 days 
of enactment of this Act on VA's implementation timeline to 
deploy this program across the healthcare system.
    Adaptive Sports.--The Committee includes $27,048,000 for 
National Veterans Sports Programs, which is $2,500,000 above 
the request, including $16,000,000 for adaptive sports 
programs. Veterans have shown marked improvements in mental and 
physical health from participating in adaptive sports and 
recreational therapy and 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. The 
Department is directed to make recreational and lifelong 
sports, such as open-ocean swimming, surfing, outrigger 
canoeing, hunting, and fishing eligible for grants.
    Equine Therapy.--The Committee recommends the Department 
use no less than $1,500,000 of funding provided for the 
adaptive sports program for equine therapy. Moreover, the 
Department should 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.
    Medical Waste.--The Committee is interested in the costs 
and benefits of on-site medical waste treatment systems and 
requests a report that discusses VA's current approach to 
handling regulated medical waste, the costs of installing and 
operating onsite systems, the incidence of their use within the 
VA system, and includes a comparison with other medical waste 
treatment options, and makes potential recommendations.
    Access to Safe and Effective Therapies for Difficult to 
Treat Depression.--The Committee is aware of a recent 
international consensus statement acknowledging the challenges 
individuals, including many Veterans, face when their 
depression does not respond to common therapies. The Committee 
supports Veterans' access to alternative, innovative treatments 
for difficult to treat depression, including FDA-approved 
medical devices, and encourages VHA to ensure access to safe 
and effective treatment options.
    Vet Centers.--The Committee recognizes the importance of 
Vet Centers and the role they play in helping Veterans readjust 
to civilian life. The Committee encourages VA to work with 
local stakeholders to increase access to the readjustment 
counseling services provided by Vet Centers, Mobile Vet 
Centers, Outstations, and Community Access Points, and directs 
the Department to increase outreach to Veterans so they are 
aware of these counseling centers and services.
    Coronary Heart Disease.--In House Report 115-673, the 
Committee directed the Department to conduct a study on non-
invasive diagnostic technologies for cardiac heart disease. The 
Committee is aware the Department has prepared a preliminary 
report, but that it includes technologies not yet approved by 
FDA. In order to provide the greatest benefit to the greatest 
number of Veterans, the Committee directs the Department to 
provide an updated report to the Committees on Appropriations 
of both Houses of Congress on FDA-approved technologies within 
180 days of enactment of this Act.
    Joint Appointment Arrangements.--The Committee encourages 
the Department to pursue joint appointment arrangements between 
VA medical staff and other outside VA organizations, including 
industry, universities, and academic affiliates, and further 
encourages the Department to ensure that VA medical staff are 
granted sufficient time to engage in clinical research.
    Assisted Reproductive Services.--The Committee is extremely 
displeased that VA does not have its own policy on providing 
assisted reproductive services to Veterans who have sustained 
serious or severe illness and/or injury while on active duty 
that led to the loss of their natural procreative ability, and 
instead relies on outdated and discriminatory guidance from 
DOD. VA should develop its own guidance on providing assisted 
reproductive services that does not discriminate against women 
who cannot carry their own child to term, and therefore should 
include gestational surrogacy benefits. The Committee directs 
the Department, in consultation with DOD, to review how VA can 
adopt a policy that removes barriers to gestational surrogacy 
as a covered fertility benefit for eligible Veterans. Within 90 
days of enactment of this Act, VA shall provide a 
recommendation to the Committees on Appropriations of both 
Houses of Congress on how VA can fix this gap in coverage so 
that gestational surrogacy is included as an assisted 
reproductive service available to wounded Veterans with 
impacted fertility due to combat.
    Fertility Treatment.--The Committee directs the Secretary 
to submit to the Committees on Appropriations of both Houses of 
Congress a report on the fertility treatment and counseling 
furnished by VA during the year preceding the submittal of the 
report no later than 120 days after enactment of this Act. The 
report should include the following: (1) the number of Veterans 
who received fertility treatment or counseling furnished by the 
Department of Veterans Affairs, disaggregated by era of 
military service of such Veterans; (2) the number of spouses, 
partners, and gestational surrogates of Veterans who received 
fertility treatment or counseling furnished by the Department; 
(3) the cost to the Department of furnishing fertility 
treatment and counseling, disaggregated by cost of services and 
administration; (4) the average cost to the Department per 
recipient of fertility treatment and counseling; (5) in cases 
in which the Department furnished fertility treatment through 
the use of assisted reproductive technology, the average number 
of cycles per person furnished, disaggregated by type of 
treatment; and (6) a description of how fertility treatment and 
counseling services of the Department are coordinated with 
similar services of the Department of Defense.
    Infertility Services.--The Committee recognizes the 
Department's effort to allow eligible Veterans to receive in 
vitro fertilization (IVF) treatment or other forms of assisted 
reproductive technology services. However, the Committee is 
concerned that VA infertility services are denied to a growing 
number of women Veterans due to marital status. The Committee 
strongly encourages VHA to not disqualify unmarried women 
Veterans from IVF treatment due to marital status and to submit 
a report within 180 days of enactment of this Act on the number 
of unmarried women Veterans denied of these services since the 
inception of the program, disaggregated by state of residence, 
race, and age.
    Affiliation Agreements with Accredited International 
Medical Schools.--The Committee is concerned VA may not be 
fully utilizing the available physician pipeline to develop its 
current and future physician workforce. The Committee 
understands there are many highly qualified United States 
citizens from international medical schools, but VA does not 
currently permit international medical students to participate 
in VA clinical training programs, regardless of whether the 
students are United States citizens. The Committee urges the 
Office of Academic Affiliation to consider the feasibility of 
allowing new affiliation agreements with accredited 
international medical schools that would permit students who 
are United States citizens from these medical schools to 
perform their clinical training requirements at VA facilities 
as space and faculty allow. OAA should submit a report to the 
Committee within 180 days of the enactment of this Act that 
describes the findings of its review.

                         MEDICAL COMMUNITY CARE

 
 
 
Fiscal year 2020 enacted level........................   $15,279,799,000
Fiscal year 2021 enacted level........................    17,131,179,000
Fiscal year 2021 budget year request..................     1,380,800,000
Committee 2021 budget year recommendation.............     1,380,800,000
Fiscal year 2022 advance appropriation request........    20,148,244,000
Committee 2022 advance appropriation recommendation...    20,148,244,000
Comparison with:
    Fiscal year 2021 enacted level....................    +3,017,065,000
    Fiscal year 2022 advance budget request...........             - - -
 

    The Medical Community Care account was created in the 
Surface Transportation and Veterans Health Care Choice 
Improvement Act of 2015 (P.L. 114-41). Per the MISSION Act of 
2018, all community care programs are consolidated into one 
community care program. For fiscal year 2022, the bill provides 
$20,148,244,000, of which $2,000,000,000 is available until 
September 30, 2023.
    The Committee provides an additional $1,380,800,000 to be 
available for fiscal year 2021 as requested in the budget 
request to readjust the actuarial estimates for medical 
community care.
    In addition, the Coronavirus Preparedness and Response 
Supplemental Appropriations Act (P.L. 116-123) included 
$30,000,000 and the Coronavirus Aid, Relief, and Economic 
Security Act (CARES Act) (P.L. 116-136) included $2,100,000,000 
for the Medical Community Care account to prevent, prepare for, 
and respond to coronavirus, including related impacts on health 
care delivery.
    Third-Party Payments and Reimbursements.--The Committee 
continues to be concerned about the timeliness of 
reimbursements by VA to private healthcare/third-party 
providers and believes VA has created an inefficient process 
that must be reformed. As VA continues the MISSION Act 
implementation, the Committee believes VA must prioritize 
efficient and prompt payment to community providers to ensure 
timely access to quality care. Delays in processing of such 
payments undermine the ability to recruit and retain private 
healthcare providers to service our Nation's Veterans. House 
Report 116-63 required comprehensive reports on a quarterly 
basis detailing the amount owed to outside providers for every 
state, and the Committee has yet to receive a single report. 
The Committee reiterates the direction to provide quarterly 
reports to include outstanding payments over six months old and 
the corrective actions being implemented to address these 
outstanding balances as well as average time for repayment. 
Furthermore, the initial report should include a comprehensive 
plan to prevent this issue from reoccurring in the future. The 
Committee directs the Department to provide its first report no 
later than 7 days of the filing of this report.
    Choice Program Third-Party Payments and Reimbursements.--
The Committee recognizes the massive undertaking it took to 
develop and implement the Veterans Choice Program and the 
difficulties that patients and providers have experienced in 
dealing with the third-party administrators of the program. The 
Committee continues to await the fiscal year 2019 report, as 
requested in House Report 115-673 and House Report 116-63, on 
the effectiveness of the programs with third-party 
administrators, and directs the Department to provide the 
report no later than 7 days of the filing of this report.
    Transportation Assistance.--The Committee is concerned with 
the lack of access to transportation for Veterans who have 
challenges traveling to work, school or medical appointments 
due to disability, illness, or financial hardships. Veterans 
who live in both rural and urban areas experience a lack of 
consistent and efficient travel, especially access to medical 
care. As VA continues to implement the Veterans Community Care 
Program, transportation to medical care and services in the 
community will be an even bigger obstacle for Veterans in the 
future. The Committee urges VA to prioritize transportation 
assistance for Veterans who live in both rural and urban areas, 
and encourages VA to work with state, regional and local 
groups, local VSOs, and nonprofits on transportation assistance 
programs and provide direct transportation services for 
Veterans who have limited access to transportation networks.
    Long-Term Care for Veterans with TBI.--The Committee notes 
the increasing prevalence of deployment-related traumatic brain 
injuries. This increase continues to demonstrate the 
longstanding need for providing adequate long-term specialty 
care for Veterans suffering from severe TBIs. The Committee 
further notes the GAO report entitled, ``Veterans Use of Long-
Term Care is Increasing, and VA Faces Challenges in Meeting the 
Demand'' (GAO-20-284), which reached a similar conclusion. The 
Committee remains concerned about the Department's inability to 
articulate a plan to provide such residential care to Veterans 
with severe TBIs. The Committee directs VA to 1) ensure an 
adequate number of long-term residential care facilities are 
available; 2) provide a report within 120 days of enactment of 
this Act detailing VA's plan for how it will provide long-term 
residential care for these Veterans if VA does not have its own 
facilities to do so; and 3) make publicly available and easily 
accessible on VA's website a list of long-term care community 
providers that are within VA's community care networks.
    Long-Term Care for Veterans in Rural Areas.--The Committee 
notes the conclusion in GAO's report entitled, ``Veterans Use 
of Long-Term Care is Increasing, and VA Faces Challenges in 
Meeting the Demand'' (GAO-20-284), that the Department faces 
challenges providing long-term residential care to Veterans in 
rural areas, and directs the Department to submit a report on 
the current and projected need for residential care for 
Veterans with severe TBI, especially in rural areas, no later 
than 180 days after enactment of this Act.

                     MEDICAL SUPPORT AND COMPLIANCE

 
 
 
Fiscal year 2020 enacted level........................    $7,337,956,000
Fiscal year 2021 enacted level........................     7,914,191,000
Fiscal year 2021 budget year request..................       300,000,000
Committee 2021 budget year recommendation.............       279,880,000
Fiscal year 2022 advance appropriation request........     8,403,117,000
Committee 2022 advance appropriation recommendation...     8,403,117,000
Comparison with:
    Fiscal year 2021 enacted level....................      +488,926,000
    Fiscal year 2022 advance budget request...........             - - -
 

    The Medical Support and Compliance appropriation funds the 
expenses of management and administration of the Department's 
healthcare system, including financial management, public 
health and environmental hazard, quality and performance 
management, medical inspection, human research oversight, 
training programs and continuing education, security, volunteer 
operations, and human resources.
    The bill provides $8,403,117,000 in advance fiscal year 
2022 funding. The Committee has included bill language to make 
available through September 30, 2023, $150,000,000 of the 
Medical Support and Compliance appropriation for fiscal year 
2022.
    The Committee provides an additional $279,880,000 to be 
available for fiscal year 2021, of which $124,000,000 is 
provided for logistics system enhancements, as requested in the 
budget and $155,880,000 is provided for additional medical 
center administrative support, which is equal to the budget 
request. The Committee does not include additional funding for 
the high reliability organization initiative requested in the 
budget.
    In addition, the Coronavirus Aid, Relief, and Economic 
Security Act (CARES Act) (P.L. 116-136) included $100,000,000 
for the Medical Support and Compliance account to prevent, 
prepare for, and respond to coronavirus, including related 
impacts on health care delivery.
    Report on Wage Surveys for Housekeeping Aides of Department 
of Veterans Affairs.--The Committee directs the Secretary of 
Veterans Affairs, in consultation with the Secretary of Defense 
and the Director of the Office of Personnel Management (OPM), 
to submit to the Committees on Appropriations of both Houses of 
Congress, no later than 90 days after enactment of this Act, a 
report on the methodology used to conduct wage surveys for the 
Federal Wage System pursuant to section 5343 of title 5, United 
States Code, for Housekeeping Aides of the Department of 
Veterans Affairs. The report should include: (1) whether the 
methodology used to conduct wage surveys for the Federal Wage 
System considers differences in sanitation requirements with 
respect to Housekeeping Aides employed in healthcare settings 
versus non-healthcare settings; (2) whether the Secretary of VA 
requires Housekeeping Aides to receive specialized training to 
satisfy requirements relating to infection control at medical 
facilities of VA, and whether the methodology used to conduct 
such wage surveys considers the effectiveness of the relevant 
wage schedule in accounting for such requirements; and (3) how 
the methodology of the Department of Defense used to establish 
wage schedules and rates of pay pursuant to section 5343 of 
title 5, United States Code, for Housekeeping Aides compares to 
the methodology OPM used to establish rates of pay under the 
General Schedule pursuant to section 5332 of such title for 
positions involving substantially equal work.
    Clinical Trials Administrative Support.--The Committee 
includes $3,000,000 to provide additional administrative 
support to VA clinicians conducting clinical trials so that VA 
is better able to assist veterans navigate the clinical trials 
process.

                           MEDICAL FACILITIES

 
 
 
Fiscal year 2020 enacted level........................    $6,141,880,000
Fiscal year 2021 enacted level........................     6,433,265,000
Fiscal year 2021 budget year request..................       150,000,000
Committee 2021 budget year recommendation.............       170,120,000
Fiscal year 2022 advance appropriation request........     6,734,680,000
Committee 2022 advance appropriation recommendation...     6,734,680,000
Comparison with:
    Fiscal year 2021 enacted level....................      +301,415,000
    Fiscal year 2022 advance budget request...........             - - -
 

    The Medical Facilities appropriation provides funds for the 
operation and maintenance of the Department's healthcare 
system's capital infrastructure. Included under this heading 
are provisions for costs associated with utilities, 
engineering, capital planning, leases, laundry, groundskeeping, 
garbage, housekeeping, facility repair, and property 
disposition and acquisition.
    The bill provides $6,734,680,000 in advance fiscal year 
2022 funding. The Committee has included bill language to make 
available through September 30, 2023, $250,000,000 of the 
advance Medical Facilities appropriation for fiscal year 2022.
    The Committee provides an additional $170,120,000 to be 
available for fiscal year 2021, of which $150,000,000 is 
provided for non-recurring maintenance (NRM) projects to 
support the electronic health record modernization as requested 
in the budget, and $20,120,000 is provided for NRM projects to 
repurpose vacant and underutilized space for mental health 
needs and to expand women's access to gender-specific care. 
Within the additional NRM funding for mental health, the 
Committee directs VA to prioritize construction to increase the 
number of beds available for overnight mental health treatment 
for Veterans. VA is directed to provide an expenditure plan 
detailing how the additional funding will meet both of these 
initiatives no later than 90 days after enactment of this Act.
    In addition, the Coronavirus Aid, Relief, and Economic 
Security Act (CARES Act) (P.L. 116-136) included $606,000,000 
for the Medical Facilities account to prevent, prepare for, and 
respond to coronavirus, including related impacts on health 
care delivery.
    Spend Plan.--The Committee expects VA to provide, no later 
than 30 days after enactment of this Act, an expenditure plan 
detailing the planned use of the funds provided. The Committee 
understands that some of the projects planned for fiscal year 
2021 may not be ready within that timeframe, requiring an 
adjustment to the spending plan. The Committee requests a 
quarterly update of the plan if the funding for any single 
project changes by more than $3,000,000 during that time 
period.
    Community-Based Outpatient Clinic in Bakersfield, 
California.--The Committee remains extremely concerned about 
the delays to a new community-based outpatient clinic in 
Bakersfield, California that was authorized by Congress over 10 
years ago. Accordingly, the Committee directs the Secretary to 
expeditiously execute the timeline, including awarding a lease 
no later than August 31, 2020, and beginning sitework shortly 
before the end of calendar year 2020. Furthermore, the 
Committee directs the Secretary to provide monthly update 
reports to the Committees on Appropriations of both Houses of 
Congress, which should include an assessment on maintaining the 
November 20, 2019 timeline and detailed reasons for any 
deviations from that timeline, until the new clinic in 
Bakersfield is activated.
    Facility Transformations.--The Committee directs the 
Department to provide a report no later than 90 days after 
enactment of this Act on specific measures it takes to track 
and prioritize both the physical and cultural transformation 
within VA medical facilities to better serve women Veterans. 
The Committee is concerned that VA has failed to keep up with a 
growing population of women Veterans who deserve equitable 
access to medical care. When one in four women Veterans report 
having experienced unwanted sexual attention while serving, it 
is concerning that the very system intended to address their 
trauma is failing to foster a safe environment for them. The 
Committee directs the Department to prioritize funding for 
medical facilities to accommodate women Veterans.
    Use of Smart Technologies.--The Committee continues to 
encourage VA to pursue a demonstration program regarding the 
use of innovative devices, systems, networks, and sensors to 
improve, enhance, and modernize methods to operate and manage 
VA facility energy, infrastructure, mechanical and waste 
management systems, emergency response, perimeter security and 
access, and traffic control systems that could be adapted for 
use by a variety of VA facilities.
    Medical Facilities Realignment.--The Committee remains 
concerned that VA medical care realignments are being 
approached in an ad hoc manner by each individual VISN rather 
than on a comprehensive basis by VA Central Office. Moreover, 
such an approach may lead to inequitable and inefficient 
distribution of medical resources throughout the Nation. Before 
VA makes any decision to relocate, close, or diminish services 
at an existing facility, or proceeds with any such realignment 
already underway, consideration must be given to the impact 
such action would have on Veterans, especially tribal Veterans 
or Veterans in rural or highly rural areas. The Committee 
directs VA to adhere to a clear and transparent process that 
engages all parties from the onset and is consistent with a 
national realignment strategy. Since the conference report for 
the Consolidated Appropriations Act, 2016 (P.L. 114-113), the 
Committees have suspended the proposed realignment of services 
in VISN 23 until a report was transmitted to the Committees, 
and that report has not been received. The Department is again 
directed to comply with the request for the report and 
meanwhile suspend the proposed realignment of services in VISN 
23 until such time as the Department transmits to the Committee 
a report that outlines the following: (1) a national 
realignment strategy that includes a detailed description of 
realignment plans within each VISN; (2) an explanation of the 
process by which those plans were developed and coordinated 
within each VISN; (3) a cost versus benefit analysis of each 
realignment, including the cost of replacing VHA services with 
contract or other outsourced services; (4) an analysis of how 
any realignment will impact tribal, rural, and highly rural 
Veteran healthcare within each VISN; and (5) an analysis of how 
any realignment will impact access to, enrollment in, and the 
capacity of VA PTSD and Residential Rehabilitation Treatment 
Program services within each VISN and nationally.
    Research Facilities Infrastructure Report.--The Committee 
is pleased it received the Phase II Research Facilities 
Infrastructure report requested in House Report 116-63 and 
directs the Department to provide a report within 120 days of 
enactment on its plan to correct the infrastructure 
deficiencies identified in the report.
    High Enrollee Growth.--The Committee is concerned that 
Veterans health care systems with high enrollee growth, such as 
those in Texas and Florida, are not receiving sufficient 
priority for much-needed capital improvements. The Committee 
urges VA to prioritize infrastructure projects in high enrollee 
growth systems to ensure that VA infrastructure is prepared for 
the growing number of Veterans needing care. Therefore, the 
Secretary is directed to submit to the Committees on 
Appropriations of both Houses of Congress a report on the 
infrastructure needs of high enrollee growth Veterans health 
care systems and a plan by fiscal year to address those needs 
no later than 90 days after the enactment of this Act.
    VA Facility Security.--The Committee continues to encourage 
the Department to improve the security of its campuses and 
facilities to ensure the safety of Veterans, visitors, and 
employees and supports the Department's investments in this 
area. The Committee recommends that security and technology 
upgrades take a holistic approach and deploy proven 
technologies. The Committee directs the Department to provide 
an update to the ``Response to Security Threats'' report as 
requested in Division J of the Explanatory Statement 
accompanying P.L. 114-113, and provided to the Committees on 
Appropriations of both Houses of Congress on May 13, 2016, to 
include current VA security policy, an assessment of security 
at VA facilities, initiatives to improve the safety of patients 
and staff in VA facilities, and how intelligent policing 
solutions could enhance security in VA facilities, within 120 
days of enactment of this Act.
    Facility Donations.--The Committee recognizes the vital 
role of VA's health care facilities in serving the unique needs 
of Veterans. The Committee also recognizes the potential for 
innovative partnerships with community stakeholders, 
particularly when it comes to community donations of well-
maintained medical facilities that can be converted into VA 
health care facilities. Therefore, the Committee encourages VA 
to continue working with community stakeholders that have 
expressed an interest in medical facility donations.
    Research Lease.--The Committee supports the long-standing 
affiliation between the Truman VA and the University of 
Missouri and encourages the Department and the House Veterans 
Affairs Committee to expeditiously resolve outstanding budget 
scoring issues.
    Landscaping at VA Facilities.--The Committee encourages the 
Department to include landscaping and the planting of trees in 
its designs for new or replacement facilities, as practicable.
    Major Medical Lease.--The Veterans Access, Choice, and 
Accountability Act of 2014 (VACAA) (P.L. 113-146) authorized VA 
to enter into various major medical leases across the nation. 
This includes the Advanced Leeward Outpatient Healthcare Access 
(ALOHA) Project that will open a 66,000 square foot leased 
facility to better serve Veterans in Hawaii and those enrolled 
in the VA Pacific Islands Health Care System. The Committee 
notes that multiple lease projects were included in the fiscal 
year 2014 budget request and authorized in VACAA, but certain 
facilities have been significantly delayed and still have not 
opened. Therefore, the Committee directs the Secretary to 
provide a report to the Committees on Appropriations and 
Veterans Affairs of both Houses of Congress no later than 60 
days after enactment of this Act detailing: (1) the timeline 
and explanation of events that have delayed any major medical 
lease authorized under VACAA that has not been awarded, 
including the ALOHA Project, (2) planned award dates and other 
major actions that need to occur for these projects to proceed, 
including an estimated timeline for completing each action, and 
(3) a summary of any concerns raised by other Federal agencies 
assisting the VA with awarding these projects.

                    MEDICAL AND PROSTHETIC RESEARCH

 
 
 
Fiscal year 2020 enacted level........................      $800,000,000
Fiscal year 2021 budget request.......................       787,000,000
Committee recommendation in the bill..................       840,000,000
Comparison with:
    Fiscal year 2020 enacted level....................       +40,000,000
    Fiscal year 2021 budget request...................       +53,000,000
 

    This appropriation provides for medical, rehabilitative, 
and health services research. The bill provides $840,000,000 
available through September 30, 2022. The Committee recognizes 
the importance of the research conducted by VA for Veterans' 
quality of life and health and provides $53,000,000 above the 
request and $40,000,000 above fiscal year 2020 for these 
activities.
    Medical research, which helps ensure the best medical and 
hospital services for Veterans, is an important aspect of the 
Department's programs. The prosthetic research program is also 
essential in the development and testing of prosthetic, 
orthopedic, and sensory aids for the purpose of improving the 
care and rehabilitation of eligible disabled Veterans, 
including amputees, paraplegics, and the blind. The health 
services research program provides unique opportunities to 
improve the effectiveness and efficiency of the healthcare 
delivery system. Budgetary resources from a number of areas, 
including appropriations from the medical care accounts, 
reimbursements from DOD, grants from the National Institutes of 
Health, private proprietary sources, and voluntary 
organizations, provide support for the Department's 
researchers. Estimated fiscal year 2021 research resources in 
addition to those provided in the research account are 
$1,263,950,000.
    National Center for Post-traumatic Stress Disorder 
Research.--The National Center for PTSD sets the VA agenda for 
research and education on PTSD, with seven research divisions 
located at VA facilities. The Center also conducts education 
and training and coordinates the VA National PTSD Brain Bank. 
The Committee recognizes the importance of the VA National 
Center for PTSD in promoting better prevention, diagnoses, and 
treatment of PTSD, and applauds the VA National PTSD Brain Bank 
on its development of the largest data set of PTSD. The 
Committee provides $40,000,000 for the Center in fiscal year 
2021, which includes $10,000,000 for the coordination of the VA 
National PTSD Brain Bank. The Committee encourages the National 
Center to use funding for the Brain Bank to accelerate the 
discovery of novel therapeutic targets for the treatment of 
PTSD utilizing post-mortem brain datasets, cell-based and other 
models for target identification and validation.
    Dystonia.--The Committee notes the connection between 
traumatic brain injury and the onset of dystonia. The Committee 
further notes recent events that have led more servicemembers 
to be diagnosed with TBI and continues to urge VA to pursue 
collaboration with stakeholders to advance critical research on 
dystonia.
    Cannabis Research.--The Committee requests an update on the 
status of the study on cannabis research, as described in House 
Report 116-63.
    Access to Clinical Trials.--The Committee applauds the 
ongoing collaborative efforts between VA medical centers and 
NCI-designated comprehensive cancer centers that will allow 
Veterans to have access to the highest quality cancer care 
available, including cutting-edge clinical trials. The 
Committee is concerned that States with large Veteran 
populations are not able to access these treatments. The 
Committee directs VA to expand 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 commends the work of the 
NAVIGATE partnership (NCI and VA Interagency Group to 
Accelerate Trials Enrollment) in providing NCI funding for VA 
health centers, which have already established clinical trials 
partnerships with academic cancer centers. The Committee is 
concerned, however, that this partnership does not include 
certain States with large Veteran populations. To address this 
need, the Committee directs VA to provide up to $5,000,000 to 
support the establishment of partnerships between VA hospitals 
and NCI-designated facilities that allow for Veterans to access 
cancer clinical trials at VA health centers. Additionally, the 
Committee directs the Department to provide a report within 120 
days of enactment of this Act detailing best practices of VA 
facilities in providing access to clinical trials to Veterans.
    PFAS Contamination.--The Committee directs VA to continue 
collaborating with the Defense Department's Per- and 
Polyfluoroalkyl Substances (PFAS) Task Force, academia, and 
other health institutions to monitor research activities, 
results, and publications on the health effects from PFAS.
    Exposure to Herbicide-Related Toxins.--Veterans have 
frequently expressed long-held concerns that toxic exposure 
during their military service is related to adverse health 
conditions. The Committee is committed to understanding the 
residual impacts of Agent Orange/Dioxin and other herbicide-
related toxic exposures among Veterans who served in Vietnam, 
Thailand, Guam, the Northern Mariana Islands, America Samoa, 
and all other geographic areas where these toxic substances 
were dispersed. The Committee urges the Department to reference 
data from existing medical records of Veterans to determine the 
percentage of Veterans from the above referenced subgroup that 
have more frequent or unexplained diseases compared to the 
civilian population. This body of data could be helpful in 
clarifying the extent and specifics of the medical issues 
suffered by Veterans from exposure to herbicides.
    Research on Toxic Exposures.--The Committee encourages the 
Department to continue and expand its research on the effects 
of and treatments for Veterans exposed to toxins, such as Agent 
Orange, burn pits, PFOS/PFOA, radiation, and asbestos, during 
the course of their active duty service.
    Prosthetics Research.--Women have different physical 
requirements for prosthetics compared to men. The Committee 
directs VA to prioritize medical and prosthetic research to 
adequately address prosthetics meant for women.
    Neural-Enabled Prosthetics.--The Committee understands the 
uniqueness of limb trauma injuries sustained by servicemembers 
in combat. Traumatic injury or neurological diseases can also 
significantly alter or impair the lifestyle of the individual 
and their caregivers. The Committee encourages VA to fund 
research that will design and develop technology to offset the 
effects of limb amputation, orthopedic injury and disease, 
neuropathic pain, and other neurodegenerative diseases. Thus, 
the Committee includes $25,000,000 for VA to prioritize and 
fund collaborative research with a coalition of universities 
aimed at accelerating functional recovery and rehabilitation of 
sensorimotor function through engineering of wirelessly 
activated implantable biomedical technologies capable of focal 
stimulation inside nerves and that is personalized to the needs 
of the patient.
    Gulf War Illness Studies.--Even as Congress, the 
Administration, and the public await the results of the 
National Academies of Sciences report on Gulf War illness, 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 encourages 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 be made publicly 
available as soon as possible. The Committee also 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, 
recognized by the Institute of Medicine (IOM) as 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 
Multisymptom Illness 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.
    Public Access to Scientific Data.--The Committee commends 
the Department on issuing its Policy and Implementation Plan 
for Public Access to Scientific Publications and Digital Data 
from Research Funded by the Department of Veterans Affairs on 
July 23, 2015. The Committee urges VA to continue its efforts 
towards full implementation of the plan and requires an update 
on progress made be included in its fiscal year 2022 budget 
request.
    NICoE Collaboration.--The Committee recognizes the high-
quality mental health care and neurological research being 
conducted at Walter Reed National Intrepid Center of Excellence 
(NICoE). The Committee directs VA to strengthen its 
collaboration with NICoE so VA researchers and health 
professionals can learn from NICoE's important work and 
contribution to the health community. Furthermore, as Veterans 
and servicemembers continue to face higher rates of brain 
trauma than civilians, impacting brain function, it is 
imperative agencies collaborate to study neurological 
conditions such as PTSD, bipolar, schizophrenia, depression, 
suicide and substance use disorders. The Committee requests a 
report within 120 days of enactment of this Act on existing 
collaborative efforts between VA and NICoE and the expansion of 
such collaborations. The report should also include a summary 
of current VA neurological research objectives, data from VA 
summarizing the presence among Veterans of the conditions 
referenced above as a percentage of VA annual inpatient 
hospitalizations, the percentage of the annual VA research 
budget over the last five years dedicated to researching those 
conditions, list any new or ongoing trials for pharmacological 
treatments underway to address such conditions, and provide the 
total 2019 expenditure by VA for medications to treat these 
patients and its percentage of total pharmacological 
expenditures.
    Hyperbaric Therapy.--The Committee supports continued study 
of the use of hyperbaric oxygen treatments for Veterans 
suffering from post-traumatic stress disorder.
    Advanced Platform Technology (APT) Center.--The Committee 
is pleased about the progress being made to provide our 
nation's Veterans with new assistive and restorative 
technologies that address sensory, motor, or cognitive 
deficits, as well as limb loss. The APT Center has effectively 
utilized a partnership model to leverage local and national 
research expertise to make progress in diverse areas including 
artificial lung development, wound healing, and neurally-
connected sensory prosthesis. The Committee supports the APT 
Center's efforts.
    Regional Research Networks.--The Committee supports the 
Department's efforts in continuing to establish regional 
research networks in areas where existing small VA research 
programs align with a co-located academic partners. The 
Committee directs the Department to provide a report within 120 
days of enactment of this Act on how it is achieving the 
following objectives and/or steps the Department can take to 
better meet these objectives: (1) supporting the development 
and/or enhancement of infrastructure and human resources 
required to address clinical and translational research needs 
in small under-resourced VA jurisdictions, (2) fostering and 
sustaining collaboration and coordination of clinical and 
translational activities within and across VA jurisdictions, 
and (3) addressing the broad spectrum of health challenges and 
concerns faced by populations served by small underfunded VA 
research programs.
    Spinal Cord Research.--The Committee encourages the 
Department to work with outside organizations on spinal cord 
injury translational research to improve the quality of life of 
impaired and disabled Veterans, and provides $10,000,000 to do 
so.
    Rare Cancer and Molecular Diagnostics.--The Committee 
believes that every veteran with cancer deserves the highest 
quality and most medically advanced diagnosis and treatment 
available. Those who have served are uniquely exposed to 
numerous hazards, which are associated with an increased risk 
of cancer during and following their service. Over 60 forms of 
cancer disproportionately impact those who have served in the 
military, and the majority of those cancers are rare, defined 
as having fewer than six new cases per 100,000 Americans per 
year. Molecular diagnostics, including microarray and next 
generation sequencing, performed at the first occurrence of 
cancer can provide medical providers and patients with vital 
information regarding the specific tumor type and its drivers, 
which can lead to the most accurate precision medicine for 
cancer patients. Therefore, the Committee recommends that VHA 
provide molecular diagnostics at the time of diagnosis as well 
as at the time of tumor recurrence for all cancer patients. 
Further, the Committee requires the Department to issue a 
report no later than 60 days after the enactment of this Act 
describing the how it is using specific types of molecular 
diagnostics, such as microarray, whole exome, and RNA-Seq in 
research and development, as well as outlining how it is 
collaborating with the external research community to advance 
understanding and research in rare cancer treatments for 
Veterans.
    Severe Depression and Suicide Prevention.--The Committee 
recognizes the important work by the Departments of Veterans 
Affairs, Defense, and Health and Human Services, including the 
National Institutes of Mental Health, to study treatments for 
severe depression and options to prevent suicides and 
encourages continued collaboration on these studies, including 
the potential use of scopolamine in treating depression, for 
the benefit of Veterans, servicemembers, and the general 
public.
    Psychological Health and TBI.--The Committee supports the 
Department's research efforts focusing on psychological health 
and traumatic brain injury.

                     Medical Care Collections Fund

    The Department of Veterans Affairs Medical Care Collections 
Fund (MCCF) was established by the Balanced Budget Act of 1997 
(P.L. 105-33). The Department deposits first-party and pharmacy 
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 Department uses these funds for medical care and 
services to Veterans. The estimate of fees that will be 
collected in fiscal year 2021 is $4,403,000,000.
    MCCF Third-Party Billing.--The Committee remains concerned 
over potential discrepancies in VA's billing and collection 
processes. Procedures to provide for correct billing and prompt 
collection must be improved at VA. Therefore, the Department is 
required to submit to the Committees on Appropriations of both 
Houses of Congress a quarterly report identifying the amount of 
third-party health billings that were owed to VA in the 
previous quarter and the amount collected. The first quarter 
report also should include billings and collections data for 
fiscal years 2017 through 2020. The report should include 
billings and collections data for both large claims (greater 
than $1,000) and small claims (equal to or less than $1,000). 
In addition, the first quarter report should also include 
current efforts underway to increase VA's efficiency, accuracy, 
and collection process, as well as what management practices 
are in place to provide proper oversight of the billing 
process, including appeals, so as to eliminate unnecessary and 
duplicative functions. The initial report also should include 
the status and results of the pilot program that emphasized the 
use of automated solutions and the use of private sector 
revenue cycle management techniques and small balance recovery 
and appeal processes as directed in the Joint Explanatory 
Statement accompanying the Consolidated Appropriations Act, 
2016 (P.L. 114-113).

                    National Cemetery Administration


 
 
 
Appropriation, fiscal year 2020.......................      $329,000,000
Budget request, fiscal year 2021......................       360,000,000
Recommended in the bill...............................       349,000,000
Bill compared with:
    Appropriation, fiscal year 2020...................       +20,000,000
    Budget request, fiscal year 2021..................       -11,000,000
 

    The National Cemetery Administration (NCA) was established 
in accordance with the National Cemeteries Act of 1973 (P.L. 
93-43). It has a fourfold mission: to provide for the interment 
of, in any national cemetery with available grave space, the 
remains of eligible deceased servicemembers and discharged 
Veterans, together with their spouses and certain dependents, 
and to permanently maintain their graves; to provide headstones 
for, and to mark graves of eligible persons in National, State 
and Tribal, and private cemeteries; to administer the grant 
program for aid to States and tribal governments in 
establishing, expanding, or improving State and tribal 
government Veterans' cemeteries; and to administer the 
Presidential Memorial Certificate Program. This appropriation 
will provide for the operation and maintenance of 156 national 
cemeteries, including 11 cemeteries being transferred from the 
Department of the Army, and 33 other cemeterial installations.
    The Committee provides these funds to meet increasing 
workload and burial expansions. NCA should prioritize 
maintaining the current level of services at existing 
cemeteries and activating new cemeteries to increase burial 
access.
    The bill includes language making ten percent of the total 
available until September 30, 2022.
    Prisoners of War Headstones.--The Committee is extremely 
disturbed by the presence of headstones of prisoners of war in 
Fort Sam Houston National Cemetery and Fort Douglas National 
Cemetery that feature swastikas and inscriptions honoring Adolf 
Hitler, and is pleased that the Department has agreed to take 
immediate steps to swiftly replace these headstones with ones 
that do not feature Nazi insignia or inscriptions glorifying 
the Nazi regime. While the Committee understands that the 
Department has initiated a consultation process under the 
National Historic Preservation Act, the Committee makes clear 
that this process should not unnecessarily delay action on 
replacing these headstones. The Committee directs VA to provide 
its plan for the consultation process and the timeline for 
removal of these headstones to the Committees on Appropriations 
of both Houses of Congress within 30 days after this report is 
filed, and further requires monthly reports on the status of 
the process. Furthermore, the Committee understands that VA 
intends to add signage at relevant cemeteries providing 
historical context on the burial of prisoners of war in U.S. 
cemeteries, and emphasizes that the design and wording of such 
signage must be carefully crafted in order to allow this 
history to be studied without causing undue pain for those most 
affected by it. The Committee therefore directs VA to include 
details on its proposal to provide historical context for 
headstones of prisoners of war in its report to the Committees 
on Appropriations of both Houses of Congress.
    Rural Cemetery Access.--The Committee continues to be 
concerned that NCA is not adequately serving the Nation's 
Veterans in rural areas and that there are geographic pockets 
in the country which continue to go unserved. The Committee 
therefore directs VA to continue to pursue efforts to ensure 
that a burial option, including those utilizing public-private 
partnerships, within 75 miles of all Veteran homes is available 
and accessible.
    County-run Veteran Cemeteries.--The Committee is committed 
to ensuring Veterans' burial needs are met and that they can be 
buried at a Veterans cemetery close to their home. The 
Committee encourages the Department to explore ways to support 
county-run Veteran cemeteries to further meet the needs of 
Veterans seeking burial.
    Burial of Unclaimed Veteran Remains.--The Committee 
recognizes the efforts of VA to improve the burial of unclaimed 
Veteran remains; however, the Committee remains concerned about 
the current state of unclaimed Veteran remains nationally. The 
Committee directs VA to submit a report to the Committee on 
Appropriations, no later than 120 days after enactment of this 
Act, providing an update to the Report to Congress on Unclaimed 
Veterans' Remains required by Section 303 of the Jeff Miller 
and Richard Blumenthal Veterans Health Care and Benefits 
Improvement Act of 2016 (P.L. 114-315). The report shall 
incorporate input from the Veterans Health Administration, 
National Cemetery Administration, and Veterans Benefit 
Administration, and include what VA has done to enhance its 
efforts to communicate with and educate stakeholders on 
applicable VA burial benefits and procedures, including metrics 
(e.g. who was contacted, how they were contacted, etc), 
obstacles to such communications, and an update on tracking and 
reporting mechanisms and implementation of a comprehensive, 
web-based Memorial Benefits Management System (MBMS).

                      Departmental Administration


                         GENERAL ADMINISTRATION

                     (INCLUDING TRANSFER OF FUNDS)

 
 
 
Fiscal year 2020 enacted level........................      $355,911,000
Fiscal year 2021 budget request.......................       413,000,000
Committee recommendation in the bill..................       355,911,000
Comparison with:
    Fiscal year 2020 enacted level....................             - - -
    Fiscal year 2021 budget request...................       -57,089,000
 

    The General Administration account provides funds for the 
Office of the Secretary, the General Counsel, six Assistant 
Secretaries, and two Department-level staff offices. The 
Committee has included bill language to make available through 
September 30, 2022, up to ten percent of these funds and to 
permit the transfer of funds in this account to the General 
Operating Expenses, Veterans Benefits Administration account.
    In addition, the Coronavirus Aid, Relief, and Economic 
Security Act (CARES Act) (P.L. 116-136) included $6,000,000 for 
the General Administration account to prevent, prepare for, and 
respond to coronavirus.
    VA Five Year Development Plan (VFYDP).--The Committee is 
very pleased that the Department has provided a VFYDP in its 
fiscal year 2021 budget. The Committee looks forward to 
reviewing the VFYDP in future VA budget submissions.
    Quarterly Financial Information Reports.--The bill includes 
an administrative provision that extends the requirement for 
submission of the quarterly financial information required in 
the fiscal year 2017 bill and conference report.
    Additional Budgetary Information.--The Committee continues 
its request that items described in previous House reports 
continue to be included in the budget justifications submitted 
each year. Further, the Committee directs VA to include in its 
budget justification materials a table for each account that 
shows a five-year funding history for requested and enacted 
levels.
    Staff Relocations Within VA.--The bill continues the 
administrative provision requiring written notification 15 days 
prior to organizational changes that result in the transfer of 
25 or more full-time equivalent staff from one organizational 
unit of the Department to another.
    Performance Bonuses.--The Committee believes it is 
important to know how VA is allocating its resources with 
regard to performance bonuses. Therefore, the Committee directs 
VA to submit a report, no later than 90 days after enactment of 
this Act, which provides the aggregate total of VA performance 
bonuses covering the five most recent fiscal years for which 
the data is available. The data should be divided between 
bonuses for Senior Executive Service (SES) staff and non-SES 
staff. The report should also include the percentage of SES and 
non-SES employees who received a bonus and the average dollar 
amount of the bonuses by grade covering the same time period. 
The report, however, should not include any personally 
identifiable information.
    Financial Management Business Transformation (FMBT).--The 
Committee provides $221,319,000 for FMBT, of which $13,924,000 
is provided in this account and $111,060,000 in the Information 
Technology Systems account. An additional $96,335,000 will be 
provided from the VA customer offices through the Franchise 
Fund and Supply Fund. The current legacy financial management 
system is over 30 years old, and its imminent failure presents 
significant risks to VA. In the fiscal year 2018 conference 
report, VA was directed to provide the Committee, on a 
quarterly basis, a report that compares actual progress on the 
financial management system to the performance benchmarks and 
timeline provided in the first report. The Committee continues 
to expect the Department to continue this quarterly report 
throughout fiscal year 2021.
    Office of Accountability and Whistleblower Protection.--The 
Committee views the work of the Office of Accountability and 
Whistleblower Protection (OAWP) as very important to the 
Veterans community. OAWP was established to provide support and 
protection to VA employees who are whistleblowers. However, on 
October 24, 2019, the Inspector General released a report 
noting failures in implementing critical aspects of the VA 
Accountability and Whistleblower Protection Act of 2017. During 
a hearing before the Committee on November 14, 2019, the 
Inspector General testified that the recommendations to address 
the concerns remained open and unimplemented. Further, the 
Committee understands that OAWP has not fully performed many of 
its core functions. For example, OAWP is required to 
investigate allegations by whistleblowers, including 
retaliation against whistleblowers, however, OAWP has a backlog 
of hundreds of investigations. Further, although required to 
recommend actions to the Secretary for actions based on these 
recommendations, only one recommendation had been made during 
the calendar year as of the Committee's hearing. The Committee 
expects OAWP to complete fully, and in a timely manner, all its 
core functions. Further, the Committee expects OAWP to report 
to the Committees on Appropriations of both Houses of Congress 
within 60 days of enactment of this Act on its compliance with 
the 2017 statute, including (1) a complete listing of all 
recommendations for action to the Secretary; (2) a complete 
listing of all stays established during investigations during 
the previous two years; (3) progress toward eliminating the 
backlog of investigative cases; and (4) progress toward 
providing training to VA employees and supervisors.
    Supporting Minority and Disadvantaged Contractors.--The 
Committee recognizes the need to continue to meet its goals for 
contracting with minority, disadvantaged, and women-owned 
businesses. Therefore, the Committee directs the Department to 
prioritize awarding contracts to contractors that consistently 
execute approved small business subcontracting plans. The 
Committee further urges the Department to prioritize minority-
owned and disadvantaged contractors and subcontractors. The 
Committee requests a report, within 180 days of enactment of 
this Act and annually thereafter, detailing the number of 
contractors that submitted a small business subcontracting plan 
during the fiscal year, disaggregated by race and ethnicity. 
This report should include an analysis detailing which 
contractors successfully implemented subcontracting plans and 
recommendations on how the Department could better achieve its 
prime and subcontracting goals for small businesses.
    Data on Women and Minority Veterans.--The Committee 
recognizes the lack of data specific to women and minority 
Veterans made available to Congress by the Department. The 
Committee recommends, when applicable, the Secretary display 
information in the annual report(s) submitted to Congress 
separately for women Veterans and minority Veterans.
    Office of Enterprise Integration.--The Committee is 
supportive of the work carried out by the Office of Enterprise 
Integration and the Innovation Ecosystem for the continuous 
improvement of the Veteran experience by utilizing data 
analytics and data governance, in addition to other 
capabilities. Even with this work there are still gaps in 
awareness and knowledge of services in which Veterans are 
eligible. With this in mind, the Committee encourages the 
Department to prioritize funding for the Office of Enterprise 
Integration to streamline innovation efforts and initiatives 
across VA and to transform Veterans' experience by providing 
customized lifetime communication and outreach through various 
channels of communication to ensure Veterans receive eligible 
services and benefits from VA.
    VA Chief Financial Officer.--The Committee directs the 
Secretary to develop and submit to the Committees on 
Appropriations of both Houses of Congress within 180 days of 
enactment of this Act, a plan to address the material weakness 
of the Department, as identified in the November 2019 OIG 
Report, ``Audit of VA's Financial Statements for Fiscal Years 
2019 and 2018'' (VAOIG-19-06453-12). The report should include 
timelines for fully addressing the repeated material weakness 
of the Department and recommendations related to entity level 
controls, including the organizational structure of the office 
of the Chief Financial Officer of the Department, and the steps 
the Secretary plans to take to provide sufficient authority to 
the Chief Financial Officer to carry out the requirements of 
section 902 of title 31, United States Code.
    Veterans First Contracting Program.--The Committee 
recognizes the tremendous value of the Veterans First 
Contracting Program in assisting in the expansion and growth of 
service-disabled Veteran and Veteran-owned small businesses. 
Therefore, the Committee encourages VA to continue to expand 
and make mandatory the training of contracting officers in the 
requirements of the Veterans First Contracting Program, with 
particular attention being paid to conducting the market 
research necessary to ensure that service-disabled Veteran and 
Veteran-owned small businesses are awarded VA contracts when 
appropriate.

                       BOARD OF VETERANS APPEALS

 
 
 
Appropriation, fiscal year 2020.......................      $182,000,000
Budget request, fiscal year 2021......................       198,000,000
Recommended in the bill...............................       198,000,000
Bill compared with:
    Appropriation, fiscal year 2020...................       +16,000,000
    Budget request, fiscal year 2021..................             - - -
 

    The bill makes ten percent of this funding available 
through September 30, 2022.
    The Board of Veterans' Appeals (BVA) is the component of VA 
responsible for making final decisions on behalf of the 
Secretary for the thousands of claims for Veterans' benefits 
that are presented to BVA for appellate review. The majority of 
BVA's workload derives from the benefit claims initiated at VBA 
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 a regional office determination, 
he or she may appeal to BVA for a final agency decision. BVA 
adjudicates appeals covering all areas of Veterans' benefits, 
but most of the workload concerns appeals for Veterans' 
disability compensation or pension benefits. On February 19, 
2019, VA implemented the new legislative framework that 
modernized the claims and appeals process and provided greater 
choice to Veterans by providing them three options for claims 
and appeals: (1) a supplemental claim; (2) a higher-level 
review; or (3) a direct appeal to the Board of Veterans' 
Appeals. BVA decided a record number of 95,000 cases in 2019, 
even as the number of individual issues decided within cases 
rose by more than 50,000 from the previous year. Additionally, 
BVA has increased the number of hearings held by 38 percent 
over the previous year.
    The bill also provides the $6,000,000 as proposed in the 
budget request to support phase three of the Appeals 
Modernization initiative. The initiative will convert the 
Board's 1980s-era case control and locator system to a new, 
automated integrated community developed suite that is used to 
process initial disability claims.
    Off-site Teleconference Hearings.--The Committee recognizes 
the strides made by the Board to make it easier for Veterans to 
participate in appeals hearings by allowing appellants to 
appear before the board via teleconference from locations other 
than VA facilities. The Committee encourages further 
implementation of teleconference hearings to allow Veterans to 
teleconference without sacrificing the security of Veterans' 
personal information and without negatively impacting the 
outcome of their appeals. Appellants before the Board should be 
permitted to teleconference from a location of their choosing 
and via a secure internet platform established and maintained 
by the Secretary that protects sensitive personal information 
from a data breach. Further, the Committee directs the 
Department to submit a report to the Committee detailing the 
number of such teleconference hearings that have been 
scheduled; the number of such teleconference hearings that were 
cancelled; and any statistical difference in outcomes between 
cases heard by teleconference at location of the appellant's 
choosing and those held at the principal location of the Board 
or by picture and voice transmission at a VA facility.

                     INFORMATION TECHNOLOGY SYSTEMS

                     (INCLUDING TRANSFER OF FUNDS)

 
 
 
Fiscal year 2020 enacted level........................    $4,371,615,000
Fiscal year 2021 budget request.......................     4,912,000,000
Committee recommendation in the bill..................     4,912,000,000
Comparison with:
    Fiscal year 2020 enacted level....................      +540,385,000
    Fiscal year 2021 budget request...................             - - -
 

    The Information Technology (IT) Systems account supports IT 
services such as systems development and performance, 
operations and maintenance, information protection, and 
customer support. The program permits the effective and 
efficient delivery of Veterans' healthcare services and 
benefits programs.
    Within the account total, the Committee allocates in bill 
language $1,211,238,000 for pay and associated costs, 
$3,205,216,000 for operations and maintenance, and $495,546,000 
for development. The bill makes available three percent of pay 
and associated costs and five percent of operations and 
maintenance funds until September 30, 2022. All development 
funds are available until September 30, 2022.
    In addition, the Coronavirus Aid, Relief, and Economic 
Security Act (CARES Act) (P.L. 116-136) included $2,150,000,000 
for the Information Technology Systems account to prevent, 
prepare for, and respond to coronavirus, including related 
impacts on health care delivery.
    The bill provides $111,060,000 to continue the Financial 
Management Business Transformation (in addition to the 
$13,924,000 provided for FMBT in the General Administration 
account and the $96,335,000 provided out of the Franchise Fund 
and Supply Fund).
    The Committee continues bill language permitting the 
transfer of funding among the three subaccounts upon approval 
of the Committees on Appropriations of both Houses of Congress.
    The bill contains language allowing for the reprogramming 
of funds among development projects upon prior notification to, 
and approval by, the Committees on Appropriations of both 
Houses of Congress. The bill continues to include language 
indicating that funds for development are available only for 
the projects and in the amounts specified in the report 
accompanying the Act.
    The chart below reflects the Committee's recommendation for 
each development project. This chart will serve as the 
Department's approved list of development projects, and all 
requested changes are subject to the reprogramming guidelines 
as outlined in the accompanying Act.

               INFORMATION TECHNOLOGY DEVELOPMENT PROJECTS
                        (In thousands of dollars)
------------------------------------------------------------------------
                                                           Committee
                       Project                           Recommendation
------------------------------------------------------------------------
Clinical Applications................................            $95,763
Health Management Platforms..........................             63,827
Benefits Systems.....................................            160,216
Memorial Affairs.....................................             15,130
Other IT Systems.....................................            114,550
Cybersecurity........................................             11,380
Information/Infrastructure Management................             34,680
                                                      ------------------
    Total All Development............................            495,546
------------------------------------------------------------------------

    The Committee expects the Office of Information and 
Technology to continue to provide an IT expenditure report to 
the Committees on Appropriations of both Houses of Congress on 
a monthly basis. This report should include a comparison to the 
project costs included in the development funding chart above 
and provide an explanation for any differences in excess of 
$1,000,000.
    Balancing VHA IT National Standards with Local, Short-term 
IT needs.--The Committee continues to encourage VA to 
vigilantly pursue its national IT goals and do all that is 
necessary to maintain needed national standards in IT while at 
the same time meeting short-term local IT needs of individual 
VA medical centers. VA should solicit, review, and respond in a 
timely fashion to short-term IT requests from its medical 
centers and clinics. The Committee supports keeping on track 
with beneficial national IT plans and standards, but the 
Committee also supports serving Veterans well on location in 
the short run. Long-term IT synchronization and short-term 
outstanding service should both be a part of the VA's 
management strategy.
    VA Forms Modernization.--The Committee supports the 
Department's efforts to modernize its internal and external 
digital services consistent with the requirements of the 21st 
Century Integrated Digital Experience Act (IDEA) (P.L. 115-
336). The Committee believes the 21st Century IDEA will enable 
the Office of Information and Technology and Veterans 
Experience Office to improve digital service delivery for 
Veterans and internal workflows. Therefore, the Committee 
recommendation includes $5,000,000 to implement those 21st 
Century IDEA requirements that have the most significant impact 
on mission enhancement and that most effectively modernize 
Veteran-facing services; specifically, the Committee encourages 
the Department to modernize and secure its paper-based forms to 
ensure they are mobile responsive to help achieve cost savings 
and workflow efficiencies.
    VA Medical and Prosthetic Research Program IT 
Infrastructure.--The Committee directs VA to submit a report 
providing an analysis and assessment of information technology 
infrastructure needs as well as projects and funding that have 
been allocated and/or obligated to the Medical and Prosthetic 
Research Program to support VA Research Infrastructure over the 
last 5 years as compared to the overall VA IT expenditures or 
allocations. This report is due no later than 120 days after 
enactment of this Act.
    Release of Names and Addresses.--To help make Veterans 
aware of the benefits and services they are entitled to, VA was 
given the authority to release the names and addresses of 
Veterans to non-profit organizations and Members of Congress. 
However, VA faces significant challenges in providing name and 
address information in a timely and useful manner due to 
reliance on legacy mainframe computer systems to store data, 
the labor-intensive process of pulling data from mainframe 
systems, reductions in IT staff, increasing numbers of 
Veterans, and fluctuating numbers of requests. The Committee 
encourages the Department to continue to make improvements to 
its processes, and directs a report on the stability and 
security of VA's existing mainframe computer systems and 
estimated costs and benefits of upgrading them within 60 days 
of enactment of this Act.
    Zero-Trust Data Protection.--The Committee encourages VA to 
implement a zero-trust approach to access its information 
systems to increase its security posture and protect personally 
identifiable information, personal health information, and 
Electronic Health Records.
    Digital Protection Pilot Program.--The Committee believes 
it is our country's duty to protect our Veterans, the 
Department of Veterans Affairs, and Congressionally Chartered 
VSOs from both foreign and domestic threats across the digital 
landscape attempting to steal money, pilfer personal 
information or peddle foreign influence via social media or 
other online campaigns. The Committee provides $5,000,000 for a 
pilot program that taps into commercially available, proven, 
automated technology to launch a robust digital protection 
initiative.
    Standard of Care.--The Committee is encouraged to see some 
VA medical facilities have or are pursuing a surgical workflow 
solution that provides access to surgical facilities, 
coordinates patient, staff and surgical resources, and adheres 
to surgical safety standards. The Committee encourages VHA to 
standardize these services across all VA medical surgical 
facilitates to enhance Veterans' safety and improve surgical 
care. Within 60 days of enactment of this Act, the Department 
is directed to provide a report to the Committee on its 
standard of care for surgical services.
    OPEN Government Data Act Implementation.--The Committee 
encourages the department to comply with the OPEN Government 
Data Act, Title II of the Foundations for Evidence-Based 
Policymaking Act (P.L. 115-435), which requires Federal 
agencies to default, when possible, to making data (and 
metadata) public, to publish that public data in a machine-
readable format, and catalog it online.

                VETERANS ELECTRONIC HEALTH RECORD (EHR)

 
 
 
Fiscal year 2020 enacted level........................    $1,500,000,000
Fiscal year 2021 budget request.......................     2,627,000,000
Committee recommendation in the bill..................     2,627,000,000
Comparison with:
    Fiscal year 2020 enacted level....................    +1,127,000,000
    Fiscal year 2021 budget request...................             - - -
 

    The Veterans Electronic Health Record is a unified account 
designed to manage the effort to develop an interoperable 
electronic health record system that will access seamlessly the 
records of Veterans in the VA system and those of the 
Department of Defense and of community providers. The VA system 
is the same as the one chosen by DOD and is planned to be 
rolled out with the same timeline and geographic areas as DOD 
in order to realize cost efficiency savings.
    Within the total funding, the bill provides $1,191,000,000 
for the electronic health record contract, $255,000,000 for 
program management, and $1,181,000,000 for infrastructure 
support. Funding is made available for three years due to the 
uncertainty of the timing of obligations for this substantial 
effort.
    This account is intended to be the single source of funding 
within VA for the electronic health record effort. No authority 
is provided for funds from other VA accounts to be transferred 
into this account nor for funds from this account to be 
transferred out to other accounts. Consistent with the effort 
to centralize financial management of the development of the 
electronic health record, the Committee continues to direct the 
Department to manage this effort at the headquarters level in 
the Office of the Deputy Secretary.
    The bill continues language requiring the Secretary to 
submit a quarterly report to the Committees on Appropriations 
of both Houses of Congress detailing obligations, expenditures, 
and deployment strategy by facility. VA is directed to continue 
quarterly briefings on performance milestones, costs, and 
changes to implementation and management plans, and to provide 
an accurate up-to-date deployment schedule each quarterly 
briefing. In addition, bill language is included requiring 
notice to and approval from the Committees on Appropriations of 
both Houses of Congress on any changes to the deployment 
schedule. Should there be any deviation from the deployment 
schedule, the Committee directs the Department to formally 
submit in writing a proposed updated deployment schedule within 
7 days of notification to the Committees of any potential 
change. The Committee repeats the fiscal year 2020 directive 
for GAO to perform quarterly performance reviews of the VA 
electronic health record deployment. It is expected that this 
quarterly reporting will provide the Committees and VA with 
timely information to properly oversee this effort and address 
important issues.
    The Committee is displeased with the lack of transparency 
and communication from the Office of Electronic Health Record 
Modernization and expects all status updates, changes to 
scheduling, cost, or overall execution of the project be 
communicated promptly and directly to the Committees on 
Appropriations of both Houses of Congress.
    Interoperability with the Private Sector.--The Committee is 
concerned about the compatibility and interoperability of the 
new EHRM system with community care providers and requires 
updates on plans and efforts on integration with community care 
providers into the system to be submitted concurrently with the 
quarterly updates on obligations, expenditure, and deployment 
strategy.
    Customizing VA's EHR.--The Committee is concerned that too 
much customization of VA's EHR system presents risk to 
interoperability with DOD's Military Health System (MHS) 
GENESIS implementation, and urges the Department to ensure all 
customization is fundamentally necessary to meet VA's 
healthcare system needs and will not inhibit the 
interoperability of records between both Departments.
    End-User Adoption.--The Committee directs the Department to 
ensure lessons learned from DOD's MHS GENESIS rollout are taken 
into consideration when deploying EHRM, including that end 
users receive sufficient training prior to the implementation.
    Medical Records Portability.--The Committee supports 
Veterans having real-time, seamless, and portable access to all 
of their medical records and urges VA to develop, as part of 
EHRM, the means by which Veterans can have secure, portable 
access to their own medical records.
    Cybersecurity Implementation.--The Committee is concerned 
about the pace at which implementation of cybersecurity best 
practices are occurring at the Department, especially as VA and 
DOD continue to integrate electronic health information. The 
Committee directs the Department to identify for the Committee 
steps it has taken to protect data and patient records across 
physical, virtual, and mobile networks and the devices and 
systems attached to these networks. If such review warrants, 
the Department should consider a layered defensive strategy 
that includes perimeter security, segmentation within the data 
center to increase lateral security, and data and application 
protections. The Committee also urges VA to ensure that patient 
records being transferred from DOD to VA have the same level of 
security and data-level protections as provided by DOD.
    Clinical Workflow Challenges.--The Committee is concerned 
about the significant amount of time clinicians spend on the 
current electronic health record documentation in their 
treatment of Veterans, as well as their inability to easily 
incorporate such information from within the Veterans' 
continuum of care, particularly the community care environment. 
This administrative burden also means clinicians have less time 
to spend providing care to each patient and fewer patients are 
seen in a given day, potentially resulting in longer wait times 
for Veterans. VA's ongoing efforts with EHRM and 
interoperability with DOD provide an opportunity to assess 
innovative technologies' ability to solve this challenge. The 
EHRM technology must enhance clinicians' efficacy so they can 
spend more time with patients. The Committee commends the 
Department's efforts to involve clinicians at all stages of the 
EHRM rollout and encourages the continued collaboration with 
clinicians to ensure the most efficient workflow solutions are 
developed with clinician input.
    Electronic Health Records Modernization.--The VA transition 
to a commercial-based EHR system continues to be challenging, 
and it is uncertain if this capability will be delivered across 
the enterprise by 2027. The Committee directs VA to maintain 
frequent, timely, and transparent communication with Congress. 
Additionally, the Committee recommends VA leverage lessons 
learned from the DOD's MHS GENESIS Electronic Health Record 
modernization effort to ensure that this capability is 
delivered to transitioning servicemembers, Veterans, and 
outside care providers as soon as possible.
    Interagency Program Office (IPO).--The Committee 
understands that the Department, in coordination with DOD, 
continues its organizational process for the IPO. The Committee 
is concerned that the Director of the IPO does not have a 
singular supervisory entity, as this structure could present 
challenges with decision making and accountability. Therefore, 
the Committee directs the Secretary to work with the Secretary 
of Defense to develop a reporting structure that ensures the 
Director of the IPO has a single supervisory entity. The 
Committee notes that one of the determining factors setting the 
timeline for the deployment of the electronic health record is 
the need to improve informational technology and related 
infrastructure at VA facilities. Therefore, the Committee 
directs the Secretary to provide a report to the Committees on 
Appropriations of both Houses of Congress no later than 
December 1, 2020 on the total cost of the installation of all 
remaining information technology and related infrastructure 
required to complete the deployment of the electronic health 
record, and the timeline to complete this installation.
    Cybersecurity for Electronic Health Records.--Recognizing 
the ongoing challenges of sharing data between MHS GENESIS and 
the Department's EHRM initiative, the Committee requests a 
report within 90 days of enactment of this Act on what the 
Department is doing to protect Veterans' sensitive information 
when implementing EHRM, and recommends the Department consider 
emerging technologies, such as blockchain technology, if future 
requirements drive a need to modify VA's security architecture 
and technical solutions.
    Standards of Care and Safety.--The Committee is encouraged 
by the Department's use of Integrated Clinical Communities 
(ICC) to establish standards of care and safety and requests a 
report within 90 days of enactment of this Act describing its 
plans to evaluate and incorporate information technology 
applications that support ICC efforts.

                      OFFICE OF INSPECTOR GENERAL

 
 
 
Fiscal year 2020 enacted level........................      $210,000,000
Fiscal year 2021 budget request.......................       228,000,000
Committee recommendation in the bill..................       228,000,000
Comparison with:
    Fiscal year 2020 enacted level....................       +18,000,000
    Fiscal year 2021 budget request...................             - - -
 

    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 VA programs and 
operations. The overall operational objective is to focus 
available resources on areas that would help improve services 
to Veterans and their beneficiaries, assist managers of 
Department programs to operate economically in accomplishing 
program goals, and to prevent and deter recurring and potential 
fraud, waste, and inefficiencies.
    The bill makes up to ten percent of this funding available 
until September 30, 2022.
    The Committee continues to request robust oversight of 
MISSION Act and EHRM implementation.
    In addition, the Coronavirus Aid, Relief, and Economic 
Security Act (CARES Act) (P.L. 116-136) included $12,500,000 
for the Office of Inspector General to prevent, prepare for, 
and respond to coronavirus, for oversight and audit of VA 
programs, activities, grants and projects funded in the CARES 
Act.

                      CONSTRUCTION, MAJOR PROJECTS

 
 
 
Appropriation, fiscal year 2020.......................    $1,235,200,000
Budget request, fiscal year 2021......................     1,373,000,000
Recommended in the bill...............................     1,373,000,000
Bill compared with:
    Appropriation, fiscal year 2020...................      +137,800,000
    Budget request, fiscal year 2021..................             - - -
 

    The Construction, Major Projects appropriation provides for 
constructing, altering, extending, and improving any of the 
facilities under the jurisdiction or for the use of VA, 
including planning, architectural and engineering services, 
assessments, and site acquisition where the estimated cost of a 
project is more than $20,000,000.
    The Committee recommendation makes all but $392,362,000 of 
these funds available for a five-year period.
    As required by language that is in permanent law, all major 
construction projects costing more than $100,000,000 must be 
managed by a non-VA government entity such as the Army Corps of 
Engineers. While the Committee no longer duplicates this 
language, the Committee intends to continue its oversight of 
the quality of the outside entity management and will continue 
to receive quarterly briefings on each of the large 
construction projects.
    The chart below reflects the Committee's recommendation for 
Major Construction projects.

                      CONSTRUCTION, MAJOR PROJECTS
                        (In thousands of dollars)
------------------------------------------------------------------------
                       Project                               Amount
------------------------------------------------------------------------
Veterans Health Administration:
American Lake, WA New Specialty Care Building 201....            $94,340
Long Beach, CA Mental Health & Community Living                   50,000
 Center..............................................
Canandaigua, NY Construction & Renovation............             30,000
Alameda, CA Community Based Outpatient Clinic &                  152,868
 National Cemetery...................................
San Diego, CA SCI & Seismic Building 11..............             21,260
Livermore, CA Realignment and Closure of the                     143,270
 Livermore Campus....................................
Dallas, TX Spinal Cord Injury........................             78,500
Tulsa, OK Inpatient Facility.........................            120,000
Advance Planning and Design Fund.....................            117,781
Asbestos.............................................             15,000
Major Construction Staff.............................            102,719
Hazardous Waste......................................              2,000
Judgment Fund........................................             25,000
Non-Dept. Fed. Entity Project Management Support.....             79,350
Seismic Corrections..................................            237,198
    Total, VHA.......................................          1,269,286
National Cemetery Administration:
San Antonio, TX Ft. Sam Houston Expansion............             56,000
San Diego, CA Miramar Phase 2 Expansion..............             31,000
Advance Planning and Design Fund.....................              2,000
NCA Land Acquisition.................................              5,000
    Total, NCA.......................................             94,000
General Administration:
Staff Offices Advanced Planning Fund.................              9,714
    Total, Major Construction........................          1,373,000
------------------------------------------------------------------------

    To enhance the Committee's capacity to conduct oversight on 
VA's facility construction efforts, several administrative 
provisions are continued in the bill: (1) No funding amount 
greater than $7,000,000 may be reprogrammed between 
construction projects unless approved by the Committees on 
Appropriations of both Houses of Congress; (2) any change to 
the scope of a construction project is not permitted without 
the approval of the Committees; and (3) VA must report any bid 
savings of $5,000,000 or more on projects as soon as they are 
identified.
    Budget Justification Documents.--The Committee reminds the 
Department of the requirement in section 258 of Division A of 
the Continuing Appropriations and Military Construction, 
Veterans Affairs, and Related Agencies Appropriations Act, 
2017, and Zika Response and Preparedness Act (P.L. 114-223) 
regarding specific materials to be included in Major 
Construction budget justification documents for fiscal year 
2017 and each fiscal year thereafter.
    West Los Angeles VA Homeless Housing Development.--The 
Committee recognizes the Department's concrete progress in 
implementing the Draft Master Plan for the West Los Angeles VA 
Campus and in fulfilling the commitments of settlement of the 
Valentini v. Shinseki litigation. The Committee encourages the 
Department and its Principal Developer to move quickly to 
deliver the more than 1,200 homeless housing units on campus, 
primarily through Enhanced Use Leases, and supports the 
Department's efforts to address known deficiencies in utility 
infrastructure.
    Flood and Disaster Mitigation Projects.--The Committee 
recognizes that deficiencies in flood and disaster mitigation 
infrastructure pose challenges to Veterans receiving health 
care, particularly when Veterans are unable to access medical 
facilities as a result of flooding or other infrastructure 
failures. The Committee further notes that state and local 
government infrastructure projects may enhance the resilience 
of VA medical facilities or the quality of life of Veterans 
eligible to receive care at these medical facilities. The 
Committee encourages VA to work collaboratively with state and 
local governments in support of infrastructure projects that 
will benefit VA facilities and the Veterans they serve.

                      CONSTRUCTION, MINOR PROJECTS

 
 
 
Appropriation, fiscal year 2020.......................      $398,800,000
Budget request, fiscal year 2021......................       400,000,000
Recommended in the bill...............................       400,000,000
Bill compared with:
    Appropriation, fiscal year 2020...................        +1,200,000
    Budget request, fiscal year 2021..................             - - -
 

    The Construction, Minor Projects appropriation provides for 
constructing, altering, extending, and improving any of the 
facilities under the jurisdiction of, or for the use of, the 
Department, 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.
    As with the Major Construction account, the Committee 
recommendation makes these funds available for a five-year 
period.
    The Committee encourages the Department to prioritize 
construction for expanding gender-specific care for women and 
mental health programs, in particular mental health Residential 
Rehabilitation Treatment Program facilities and new inpatient 
Substance Use Disorder treatment facilities within the VA 
system. The Committee also notes that inpatient Substance Use 
Disorder facilities are of particular importance for Veterans 
in rural communities.
    The Committee notes that restorative and rehabilitative 
nursing care provided to elderly Veterans at VA community 
living centers is a critical part of the benefits and care 
promised to Veterans for their entire life after their service 
to our country. Unfortunately, in some Veterans health care 
systems there are not enough high-quality contract nursing 
homes available to meet Veteran demand. The Committee urges VA 
to prioritize construction projects to address nursing care 
capacity issues across VA.
    Construction of Housing for Rural Homeless Veterans.--The 
Department has made great efforts to find suitable housing for 
homeless Veterans and their families. The Committee encourages 
more non-traditional efforts to eliminate Veteran homelessness. 
For example, some cities and towns have started pilot programs 
using ``Micro'' or ``Tiny Homes'', or renovated shipping 
containers, to help deal with homelessness. The Committee 
encourages VA to continue its efforts to house homeless 
Veterans and their families and explore the feasibility of 
providing ``Tiny Homes'' or renovated shipping containers as 
housing.
    Expediting VA Projects.--The Committee urges VA to put in 
place an improved process to help guide infrastructure 
investments through energy performance contracts management, 
including Energy Savings Performance Contracts (ESPCs) and 
Utility Energy Savings Contracts (UESCs), in order to 
effectively and efficiently reduce energy costs and improve 
facilities for our Veterans. The Committee understands that 
challenges with the energy performance program include a 
separate round of required reviews by the Office of Capital 
Asset Management (OCAM) that has bottlenecked new projects, as 
well as problems of capacity and bandwidth for oversight and 
new project starts. The Committee urges VA to streamline and 
find efficiencies in the approval of projects in order to 
continue to provide Veterans the care they need.

       GRANTS FOR CONSTRUCTION OF STATE EXTENDED CARE FACILITIES

 
 
 
Appropriation, fiscal year 2020.......................       $90,000,000
Budget request, fiscal year 2021......................        90,000,000
Recommended in the bill...............................        90,000,000
Bill compared with:
    Appropriation, fiscal year 2020...................             - - -
    Budget request, fiscal year 2021..................             - - -
 

    This appropriation provides grants to assist States in 
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. A grant may 
not exceed 65 percent of the total cost of the project. The 
bill makes this funding available until expended.
    In addition, the Coronavirus Aid, Relief, and Economic 
Security Act (CARES Act) (P.L. 116-136) included $150,000,000 
for Grants for Construction of State Extended Care Facilities 
to prevent, prepare for, and respond to coronavirus.

             GRANTS FOR CONSTRUCTION OF VETERANS CEMETERIES

 
 
 
Appropriation, fiscal year 2020.......................       $45,000,000
Budget request, fiscal year 2021......................        45,000,000
Recommended in the bill...............................        45,000,000
Bill compared with:
    Appropriation, fiscal year 2020...................             - - -
    Budget request, fiscal year 2021..................             - - -
 

    This program provides grants to assist States and tribal 
governments with the establishment, expansion, and improvement 
of Veterans' cemeteries that are operated and permanently 
maintained by the States and tribal governments. Grants under 
this program fund up to 100 percent of construction costs and 
the initial equipment expenses when the cemetery is 
established. State and tribal governments remain responsible 
for providing the land and for paying all costs related to the 
operation and maintenance of the State cemeteries, including 
the costs for subsequent equipment purchases. The bill makes 
this funding available until expended.

                       Administrative Provisions

    The bill includes 51 administrative provisions, of which 49 
were in effect in fiscal year 2020 in some form and 2 are new 
provisions. The administrative provisions included in the bill 
are as follows:

                     (INCLUDING TRANSFER OF FUNDS)

    The bill includes section 201 allowing for the transfer of 
funds among three mandatory appropriations. The Administration 
proposal to modify this provision is not adopted.

                     (INCLUDING TRANSFER OF FUNDS)

    The bill includes section 202 allowing the Department to 
transfer funding among the four medical appropriations accounts 
in fiscal year 2021. The Administration proposal to modify this 
provision is not adopted.
    The bill includes section 203 allowing for salaries and 
expenses funds to be used for hire of passenger vehicles, lease 
of facilities or land, and purchase of uniforms.
    The bill includes section 204 providing that only funding 
in ``Construction, Major Projects'' and ``Construction, Minor 
Projects'' can be used for the purchase of any site for any new 
hospital or home or to construct any new hospital or home.
    The bill includes section 205 requiring the Department to 
be reimbursed for medical services it provides to any person 
not defined as a beneficiary to ensure the Department is 
receiving payment for all medical services provided.
    The bill includes section 206 allowing for the use of funds 
appropriated in fiscal year 2021 for ``Compensation and 
Pensions'', ``Readjustment Benefits'', and ``Veterans Insurance 
and Indemnities'' for payment of accrued obligations recorded 
in the last quarter of fiscal year 2020.
    The bill includes section 207 allowing for the use of 
fiscal year 2021 funds to pay prior year obligations resulting 
from implementation of sections 3328(a), 3334, and 3712(a) of 
title 31, United States Code.

                     (INCLUDING TRANSFER OF FUNDS)

    The bill includes section 208 allowing the Department to 
use surplus earnings from the national service life insurance, 
U.S. Government life insurance, and Veterans' special life 
insurance program to administer these programs.
    The bill includes section 209 allowing the Department to 
obligate enhanced-use lease proceeds for administrative 
expenses that were incurred in a prior fiscal year during the 
year funds are received.

                     (INCLUDING TRANSFER OF FUNDS)

    The bill includes section 210 limiting the amount of 
reimbursement the Office of Resolution Management, the Office 
of Employment Discrimination Complaint Adjudication, and the 
Office of Diversity and Inclusion can charge other offices and 
accounts of the Department for services provided.
    The bill includes section 211 requiring the Department to 
collect current and accurate third-party reimbursement 
information for the purposes of third-party insurance 
collections. If persons receiving care or medical services do 
not disclose this information, the Department is allowed to 
bill them reasonable charges for services provided.

                     (INCLUDING TRANSFER OF FUNDS)

    The bill includes section 212 allowing the Department to 
use enhanced-use lease funds for construction and alteration of 
medical facilities.
    The bill includes section 213 allowing the Department to 
use the Medical Services appropriation for expenses related to 
the broader mission of medical care to Veterans.

                     (INCLUDING TRANSFER OF FUNDS)

    The bill includes section 214 allowing the Department to 
transfer Medical Care Collections to the ``Medical Services'' 
and ``Medical Community Care'' accounts to be used for Veterans 
medical care and makes those funds available until expended.
    The bill includes section 215 allowing Veterans who reside 
in Alaska to obtain medical services from medical facilities 
supported by the Indian Health Service or tribal organizations, 
and provides for reimbursement for those services from VA.

                     (INCLUDING TRANSFER OF FUNDS)

    The bill includes section 216 allowing the Department to 
transfer the proceeds received from the transfer of real 
property deposited into the VA Capital Asset Fund to the Major 
and Minor Construction appropriations accounts and makes those 
funds available until expended.
    The bill includes section 217 requiring the Secretary to 
submit quarterly reports to the Committees on Appropriations of 
both Houses of Congress on the financial status of the Veterans 
Health Administration.

                     (INCLUDING TRANSFER OF FUNDS)

    The bill includes section 218 prohibiting the Department 
from increasing total resources of the Information Technology 
appropriation by more than ten percent by transferring funding 
from the other VA accounts and requires the Department to 
receive approval from the Committees on Appropriations of both 
Houses of Congress before such transfer. The Administration 
proposal to modify this provision is not adopted.

                     (INCLUDING TRANSFER OF FUNDS)

    The bill includes section 219 providing up to $322,932,000 
of fiscal year 2021 funds for transfer to the Joint DOD-VA 
Medical Facility Demonstration Fund. Additional funding may be 
transferred from these accounts upon written notification to 
the Committees on Appropriations of both Houses of Congress.

                     (INCLUDING TRANSFER OF FUNDS)

    The bill includes section 220 permitting the transfer of 
$327,126,000 of fiscal year 2021 funding appropriated for 
medical accounts to the Joint DOD-VA Medical Facility 
Demonstration Fund for the operation of facilities designated 
as combined Federal medical facilities.

                     (INCLUDING TRANSFER OF FUNDS)

    The bill includes section 221 permitting the transfer of 
funds deposited in the Medical Care Collections Fund to the 
Joint DOD-VA Medical Facility Demonstration Fund for facilities 
designated as combined Federal medical facilities.

                     (INCLUDING TRANSFER OF FUNDS)

    The bill includes section 222 directing that a minimum of 
$15,000,000 shall be transferred from the four medical care 
appropriations to the Department of Defense/Department of 
Veterans Affairs Health Care Sharing Incentive Fund, to be 
available until expended.
    The bill includes section 223 requiring the Secretary to 
notify the Committees on Appropriations of both Houses of 
Congress of all bid savings when identified in Major 
Construction projects that total at least $5,000,000 or five 
percent of the programmed amount of the project. The 
Administration proposal to delete this provision is not 
adopted.
    The bill includes section 224 prohibiting the original 
scope of work for a Major Construction project from being 
increased above the scope specified for that project in the 
original justification data provided to Congress unless 
approved by the Committees on Appropriations of both Houses of 
Congress. The Administration proposal to delete this provision 
is not adopted.
    The bill includes section 225 requiring a quarterly report 
from each VBA regional office on pending disability claims, 
both initial and supplemental; error rates; the number of 
claims processing personnel; corrective actions taken; training 
programs; and review team audit results. In addition, the bill 
requires quarterly reporting on pending appeals at VBA, as well 
as BVA. The Administration proposal to delete this provision is 
not adopted.
    The bill includes section 226 requiring advance written 
notification to the Committees on Appropriations of both Houses 
of Congress 15 days prior to organizational changes which 
result in the transfer of 25 or more full-time equivalent staff 
from one organizational unit to another. The Administration 
proposal to delete this provision is not adopted.
    The bill includes section 227 requiring the Secretary to 
provide, on a quarterly basis to the Committees on 
Appropriations of both Houses of Congress, notification of any 
single national outreach and awareness marketing campaign in 
which obligations exceed $1,000,000. The Administration 
proposal to delete this provision is not adopted.

                     (INCLUDING TRANSFER OF FUNDS)

    The bill includes section 228 permitting the transfer to 
``Medical Services'' from any discretionary program except 
``General Operating Expenses, Veterans Benefits 
Administration'' upon approval of the Committees on 
Appropriations of both Houses of Congress. This provision is 
intended to give VA flexibility as it administers the changes 
to its traditional healthcare program and the MISSION Act. The 
Administration proposal to modify this provision is not 
adopted.

                     (INCLUDING TRANSFER OF FUNDS)

    The bill includes section 229 permitting the transfer of 
funds between the ``Board of Veterans Appeals'' and ``General 
Operating Expenses, Veterans Benefits Administration'' upon 
approval of the Appropriations Committees on Appropriations of 
both Houses of Congress. The Administration proposal to modify 
this provision is not adopted.
    The bill includes section 230 prohibiting the reprogramming 
of funds exceeding $7,000,000 among the Major Construction 
projects unless the Committees on Appropriations of both Houses 
of Congress approve the request. The Administration proposal to 
delete this provision is not adopted.
    The bill includes section 231 requiring the Secretary to 
ensure that the toll-free suicide hotline provides immediate 
assistance from a trained professional and adheres to all 
requirements of the American Association of Suicidology. The 
Administration request to delete this provision is not adopted.
    The bill includes section 232 restricting funds from being 
used to close certain medical facilities in the absence of a 
national realignment strategy. The Administration request to 
delete this provision is not adopted.
    The bill includes section 233 requiring VA to use the 
mammography screening guidelines announced by the Secretary on 
May 10, 2017 through January 1, 2024. The Administration 
request to delete this provision is not adopted.
    The bill includes section 234 permanently 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.
    The bill includes section 235 prohibiting any funds from 
being used in a manner that is inconsistent with statutory 
limitations on outsourcing. The Administration request to 
delete this provision is not adopted.
    The bill includes section 236 pertaining to exceptions for 
Indian- or Native Hawaiian-owned businesses contracting with 
VA. The Administration request to delete this provision is not 
adopted.
    The bill includes section 237 directing the elimination 
over a series of years of the use of Social Security numbers in 
VA programs. The Administration request to delete this 
provision is not adopted.
    The bill includes section 238 referencing the provision in 
the Continuing Appropriations and Military Construction, 
Veterans Affairs, and Related Agencies Appropriations Act, 
2017, and Zika Response and Preparedness Act (P.L. 114-223) 
pertaining to certification of marriage and family therapists. 
The Administration request to delete this provision is not 
adopted.
    The bill includes section 239 which prohibits funds from 
being used to transfer funding from the Filipino Veterans 
Equity Compensation Fund to any other VA account. The 
Administration request to delete this provision is not adopted.
    The bill includes section 240 permitting funding to be used 
in fiscal years 2021 and 2022 to carry out and expand the 
childcare pilot program authorized by section 205 of the 
Caregivers and Veterans Omnibus Health Services Act of 2010 
(P.L. 111-163).
    The bill includes section 241 prohibiting VA from using 
funds to enter into an agreement to resolve a dispute or claim 
with an individual that would restrict the individual from 
speaking to Members of Congress or their staff on any topic, 
except those required to be kept secret in the interest of 
national defense or the conduct of foreign affairs. The 
Administration request to delete this provision is not adopted.
    The bill includes section 242 referencing language in the 
Continuing Appropriations and Military Construction, Veterans 
Affairs, and Related Agencies Appropriations Act, 2017, and 
Zika Response and Preparedness Act (P.L. 114-223) requiring 
certain data to be included in budget justifications for major 
construction projects. The Administration request to delete 
this provision is not adopted.
    The bill includes section 243 prohibiting the use of funds 
to deny the Inspector General timely access to information, 
unless a provision of law expressly refers to the Inspector 
General and expressly limits such access. The Administration 
request to delete this provision is not adopted.
    The bill includes section 244 prohibiting funding from 
being used in a manner that would increase wait times for 
Veterans at medical facilities. The Administration request to 
delete this provision is not adopted.
    The bill includes section 245 prohibiting the use of funds 
in fiscal year 2021 to convert any program that received 
specific purpose funds in fiscal year 2020 to a general 
purpose-funded program without the approval of the Committees 
on Appropriations of both Houses of Congress at least 30 days 
prior to any such action. The Administration request to delete 
this provision is not adopted.
    The bill includes section 246 eliminating category D or E 
pain testing on dogs.
    The bill includes section 247 prohibiting the closure of 
the CBOC in Bainbridge, New York until the Secretary submits a 
completed market area assessment to the Committees on 
Appropriations of both Houses of Congress. The Administration 
proposal to delete this provision is not adopted.
    The bill includes section 248 requiring the Department to 
update the Planning and Activating CBOC handbook every five 
years and provide guidance and training to employees on each 
update of the handbook. The Administration proposal to delete 
this provision is not adopted.
    The bill includes section 249 to allow fiscal year 2021 and 
2022 ``Medical Community Care'' funds to be used to cover 
obligations that would have otherwise been paid by the Veterans 
Choice Fund.
    The bill includes section 250 allowing obligations and 
expenditures applicable to the ``Medical Services'' account in 
fiscal years 2017 through 2019 for aid to state homes remain in 
the ``Medical Community Care'' account for such fiscal years.
    This bill includes section 251 specifying an amount from 
the four medical care accounts for gender-specific care for 
women.

                               TITLE III


                            RELATED AGENCIES

    Funds under Title III support the agencies that honor and 
respect the service of our Nation's heroes. Though it may be a 
smaller title of the bill, the agencies funded under Title III 
are the public face of America's commitment to our 
servicemembers and Veterans. The American Battle Monuments 
Commission and Arlington Cemetery commemorate those who made 
the ultimate sacrifice, while the Armed Forces Retirement Home 
and the United States Court of Appeals for Veterans Claims are 
critical parts of keeping our promise to serve those who served 
our Nation.

                  American Battle Monuments Commission


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2020.......................       $84,100,000
Budget request, fiscal year 2021......................        75,100,000
Recommended in the bill...............................        84,100,000
Bill compared with:
    Appropriation, fiscal year 2020...................             - - -
    Budget request, fiscal year 2021..................        +9,000,000
 

    The recommendation includes $84,100,000 for Salaries and 
Expenses of the American Battle Monuments Commission (ABMC).
    The Committee notes the significant maintenance needs of 
the American Battle Monuments around the world, which are 
specifically designed to honor our fallen servicemembers. The 
Committee continues to direct ABMC to emphasize maintaining and 
repairing existing monuments and memorials in a proactive and 
timely manner that honors the service, achievements, and 
sacrifices of the United States Armed Forces.
    Non-Federal Memorials.--The Committee appreciates ABMC's 
continued dialogue and engagement with non-Federal sponsors of 
memorials and other community stakeholders. The Committee 
encourages ABMC to continue these efforts and to have 
productive exchanges with those looking to best preserve 
memorials that reflect significant historical moments.
    Pacific Battle Commemorations.--The Committee is grateful 
for ABMC's commitment to telling the World War II story at its 
sites and visitors centers and urges ABMC to ensure the story 
of the Pacific theater is fully told. The Committee requests 
that ABMC report to the Committees on Appropriations of both 
Houses of Congress on its efforts to commemorate World War II 
battles in the Pacific at existing ABMC sites.
    World War I Memorial Preservation.--The Committee supports 
the preservation and rehabilitation of World War I memorials 
across the country and in Europe to honor the more than four 
million men and women who bravely served the United States and 
fought to preserve our freedom.

                 FOREIGN CURRENCY FLUCTUATIONS ACCOUNT

    The recommendation includes such sums as necessary for the 
Foreign Currency Fluctuations Account.

           United States Court of Appeals for Veterans Claims


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2020.......................       $35,400,000
Budget request, fiscal year 2021......................        38,900,000
Recommended in the bill...............................        37,100,000
Bill compared with:
    Appropriation, fiscal year 2020...................        +1,700,000
    Budget request, fiscal year 2021..................        -1,800,000
 

    The recommendation includes $37,100,000 for Salaries and 
Expenses for the United States Court of Appeals for Veterans 
Claims (the Court).
    Caseload.--The Committee recognizes that caseloads at the 
Court continue to increase and directs the Court to continue 
using available resources to respond effectively to the growing 
demand. While the recommendation does not include requested 
funding to reconfigure the Court's physical space for recalled, 
retired Judges, the Committee encourages the Court to continue 
to use them efficiently to address increasing caseloads.

                      Department of Defense--Civil


                       Cemeterial Expenses, Army


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2020.......................       $80,800,000
Budget request, fiscal year 2021......................        70,800,000
Recommended in the bill...............................        81,815,000
Bill compared with:
    Appropriation, fiscal year 2020...................        +1,015,000
    Budget request, fiscal year 2021..................       +11,015,000
 

    The recommendation includes $81,815,000 for Salaries and 
Expenses for Arlington National Cemetery (the Cemetery), which 
is $11,015,000 above the fiscal year 2021 budget request. The 
Committee has provided this additional funding to respond to 
increased costs and to maintain current services.
    The Committee has previously noted its concern that the 
budget request for the Cemetery's operating account has been 
continually inadequate to maintain the current level of 
services, and reiterates that it is unacceptable for the 
Cemetery's budget request to fall short of reflecting real 
needs.
    Updated Interment Policy.--The Committee is aware that the 
Secretary of the Army has proposed revised criteria for 
interment at the Cemetery to preserve it as an active burial 
ground well into the future, and understands that these 
criteria will be published as a draft rule in the Federal 
Register for public comment. The Committee notes that it will 
continue to follow closely to ensure that the Cemetery can 
continue to live up to its mission to honor those who have 
served.

                              CONSTRUCTION

    Southern Expansion.--The Committee remains strongly 
supportive of the Southern Expansion project and recognizes its 
importance in extending the life of our Nation's most 
prestigious cemetery.

                      Armed Forces Retirement Home


                               TRUST FUND

    The recommendation includes $73,100,000 for the Armed 
Forces Retirement Home (AFRH), including $8,800,000 for capital 
projects, although $22,000,000 of the total is provided from 
the general fund of the Treasury, and not the Trust Fund. The 
Committee makes these operation and maintenance funds available 
until September 30, 2022, as requested, to provide AFRH greater 
ability to respond to emergency situations and ensure stable 
operations.
    In addition, the Coronavirus Aid, Relief, and Economic 
Security Act (CARES Act) (P.L. 116-136) included $2,800,000 for 
AFRH to prevent, prepare for, and respond to coronavirus.
    Land Redevelopment.--The Committee understands that AFRH 
has selected a developer to redevelop the 80-acre master 
planned parcel on the Washington campus and directs AFRH to 
continue to report to the Committee on the progress of the 
redevelopment project and the status of the lease negotiations.

                       OPERATION AND MAINTENANCE

 
 
 
Appropriation, fiscal year 2020.......................       $63,300,000
Budget request, fiscal year 2021......................        64,300,000
Recommended in the bill...............................        64,300,000
Bill compared with:
    Appropriation, fiscal year 2020...................        +1,000,000
    Budget request, fiscal year 2021..................             - - -
 

    General Fund.--The Committee has previously expressed 
concern about the use of the General Fund to support the work 
of AFRH. The Committee is pleased that efforts are underway to 
increase revenues and stabilize the AFRH Trust Fund for the 
long term, and directs AFRH to continue to make progress in 
this area and report to the Committee on its further 
initiatives to improve sustainability and maintain the high-
quality services provided to AFRH residents.

                            CAPITAL PROGRAM

 
 
 
Appropriation, fiscal year 2020.......................       $12,000,000
Budget request, fiscal year 2021......................         6,000,000
Recommended in the bill...............................         8,800,000
Bill compared with:
    Appropriation, fiscal year 2020...................        -3,200,000
    Budget request, fiscal year 2021..................        +2,800,000
 

    Capital Maintenance Spending Plan.--The Committee directs 
AFRH to provide, no later than 30 days after enactment of this 
Act, an expenditure plan detailing the planned use of the funds 
provided for construction and renovation. The Committee further 
directs AFRH to prioritize completing projects that are 
currently underway.

                        Administrative Provision

    The bill includes section 301 permitting funds from 
concessions at Army National Military Cemeteries to be used to 
support activities at the Cemeteries.

                                TITLE IV


                    OVERSEAS CONTINGENCY OPERATIONS


                         Department of Defense


 
 
 
Appropriation, fiscal year 2020.......................      $644,526,000
Budget request, fiscal year 2021......................       349,762,000
Recommended in the bill...............................       350,000,000
Bill compared with:
    Appropriation, fiscal year 2020...................      -294,526,000
    Budget request, fiscal year 2021..................          +238,000
 

    The recommendation includes Overseas Contingency Operations 
for military construction projects and planning and design 
related to the European Deterrence Initiative (EDI).

                      Military Construction, Army


 
 
 
Appropriation, fiscal year 2020.......................       $78,168,000
Budget request, fiscal year 2021......................        15,873,000
Recommended in the bill...............................        16,111,000
Bill compared with:
    Appropriation, fiscal year 2020...................       -62,057,000
    Budget request, fiscal year 2021..................          +238,000
 

    The recommendation includes $16,111,000 for Army military 
construction and planning and design for Overseas Contingency 
Operations and European Deterrence Initiative projects.

              Military Construction, Navy and Marine Corps


 
 
 
Appropriation, fiscal year 2020.......................       $94,570,000
Fiscal year 2021 budget request.......................        70,020,000
Recommended in the bill...............................        70,020,000
Bill compared with:...................................
    Appropriation fiscal year 2020....................       -24,550,000
    Budget request, fiscal year 2021..................             - - -
 

    The recommendation includes $70,020,000 for Navy and Marine 
Corps military construction and planning and design for 
European Deterrence Initiative projects.

                    Military Construction, Air Force


 
 
 
Appropriation, fiscal year 2020.......................      $325,988,000
Budget request, fiscal year 2021......................       263,869,000
Recommended in the bill...............................       263,869,000
Bill compared with:
    Appropriation, fiscal year 2020...................       -62,119,000
    Budget request, fiscal year 2021..................             - - -
 

    The recommendation includes $263,869,000 for Air Force 
military construction and planning and design for European 
Deterrence Initiative projects.

                        Administrative Provision

    The bill includes one provision that was in effect in 
fiscal year 2020.
    The bill includes section 401 that designates that funding 
shall be available only if the President so designates all 
amounts and transmits such designations to Congress.

                                TITLE V


                           GENERAL PROVISIONS

    The bill includes a total of 14 provisions: 12 provisions 
that are effective in fiscal year 2020:
    The bill includes section 501 prohibiting the obligation of 
funds beyond the current fiscal year unless expressly so 
provided.
    The bill includes section 502 prohibiting 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.
    The bill includes section 503 encouraging all departments 
and agencies funded in this Act to expand the use of ``E-
Commerce'' technologies and procedures.
    The bill includes section 504 specifying the Congressional 
committees that are to receive all reports and notifications.
    The bill includes section 505 prohibiting the transfer of 
funds to any instrumentality of the United States Government 
without authority from an appropriations Act.
    The bill includes section 506 prohibiting any funds in this 
Act to be used for a project or program named for an individual 
serving as a Member, Delegate, or Resident Commissioner of the 
United States House of Representatives.
    The bill includes section 507 requiring all reports 
submitted to the Congress to be posted on official websites of 
the submitting agency.
    The bill includes section 508 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.
    The bill includes section 509 prohibiting the use of funds 
for payment of first-class travel by an employee of the 
executive branch.
    The bill includes section 510 prohibiting the use of funds 
in this Act for any contract where the contractor has not 
complied with E-Verify requirements.
    The bill includes section 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.
    The bill includes section 512 prohibiting the use of funds 
in this Act to construct facilities on military installations 
that do not meet resiliency standards.
    The bill includes section 513 prohibiting the use of funds 
in this Act and previous Acts for the construction of a wall, 
barrier, fence, or road along the Southern border of the United 
States or a road to provide access to a wall, barrier, or fence 
constructed along the Southern border of the United States.
    The bill includes section 514 designating emergency funding 
pursuant to section 251(b)(2)(A)(i) of the Balanced Budget and 
Emergency Deficit Control Act of 1985.

              HOUSE OF REPRESENTATIVES REPORT REQUIREMENTS

    The following items are included in accordance with various 
requirements of the Rules of the House of Representatives:

         Statement of General Performance Goals and Objectives

    Pursuant to clause 3(c)(4) of rule XIII of the Rules of the 
House of Representatives, the following is a statement of 
general performance goals and objectives for which this measure 
authorizes funding:
    The Committee on Appropriations considers program 
performance, including a program's success in developing and 
attaining outcome-related goals and objectives, in developing 
funding recommendations.

                              Rescissions

    The bill does not contain any rescissions, as defined in 
clause 3(f)(2) of rule XIII of the Rules of the House of 
Representatives.

                           Transfer of Funds

    Pursuant to clause 3(f)(2) of rule XIII of the Rules of the 
House of Representatives, the following statements are 
submitted describing the transfer of funds provided in the 
accompanying bill.
    Language is included to allow for the transfer of funds 
from Family Housing, Construction accounts to the Department of 
Defense Family Housing Improvement Fund and funds from Military 
Construction accounts to the Department of Defense Military 
Unaccompanied Housing Improvement Fund.
    Language is included to provide transfer authority from the 
BRAC account to the Homeowners Assistance Program.
    Language is included to allow the transfer of expired funds 
to the ``Foreign Currency Fluctuations, Construction, Defense'' 
account.
    Language is included to transfer not to exceed $20,115,000 
in fiscal year 2022 from Compensation and Pensions to General 
Operating Expenses, Veterans Benefits Administration and 
Information Technology Systems. These funds are for the 
administrative costs of implementing cost-savings proposals 
required by the Omnibus Budget Reconciliation Act of 1990 and 
the Veterans' Benefits Act of 1992. Language is also included 
transferring funds to the medical care collections fund to 
augment funding of medical facilities for nursing home care 
provided to pensioners.
    Language is included to permit the transfer of funds from 
General Administration to General Operating Expenses, Veterans 
Benefits Administration.
    Language is included to permit the transfer of funds 
between Information Technology Systems development projects and 
among the three sub-accounts identified in bill language 
subject to the approval of the Committee.
    Language is included to provide authority for the 
Department of Veterans Affairs for any funds appropriated in 
2021 for Compensation and Pensions, Readjustment Benefits, and 
Veterans Insurance and Indemnities to be transferred among 
those three accounts.
    Language is included to transfer funds among the Medical 
Services, Medical Community Care, Medical Support and 
Compliance, and Medical Facilities accounts.
    Language is included to permit the funds from three life 
insurance funds to be transferred to General Operating 
Expenses, Veterans Benefits Administration and Information 
Technology Systems for the costs of administering such 
programs.
    Language is included to permit funding up to $71,490,000 to 
be transferred to General Administration and Information 
Technology Systems from any funds appropriated in fiscal year 
2021 to reimburse three headquarters offices for services 
provided.
    Language is included to transfer certain funds derived from 
enhanced-use leasing activities to the Construction, Major 
Projects and Construction, Minor Projects accounts.
    Language is included to transfer funds from the Medical 
Care Collections Fund to the Medical Services and Medical 
Community Care accounts.
    Language is included to allow the transfer of funds from 
the Capital Asset Fund to the Construction, Major Projects and 
Construction, Minor Projects accounts.
    Language is included to allow the transfer of funds from 
various accounts to the Information Technology Systems account 
in an aggregate amount not to exceed ten percent of the account 
appropriation, subject to approval by the Committee.
    Language is included to allow the transfer of funds in 
fiscal year 2021 provided for the Department of Veterans 
Affairs to the Joint Department of Defense-Department of 
Veterans Affairs Medical Facility Demonstration Fund.
    Language is included allowing fiscal year 2022 medical care 
funding to be transferred to the Joint Department of Defense-
Department of Veterans Affairs Medical Facility Demonstration 
fund.
    Language is included permitting funds deposited to the 
Medical Care Collections Fund for healthcare provided at a 
combined Federal medical facility to be transferred to the 
Joint Department of Defense-Department of Veterans Affairs 
Medical Facility Demonstration Fund.
    Language is included under the Department of Veterans 
Affairs that would transfer no less than $15,000,000 for the 
DOD-VA Health Care Sharing Incentive Fund as authorized by 
section 8111(d) of title 38, United States Code.
    Language is included that permits the transfer from all 
discretionary accounts except General Operating Expenses, 
Veterans Benefits Administration, to Medical Services, subject 
to approval by the Committee.
    Language is included that permits transfer of funds between 
General Operating Expenses, Veterans Benefits Administration 
and the Board of Veterans Appeals, subject to approval by the 
Committee.

   Disclosure of Earmarks and Congressionally Directed Spending Items

    Neither the bill nor the report contains any Congressional 
earmarks, limited tax benefits, or limited tariff benefits as 
defined in clause 9 of rule XXI of the Rules of the House of 
Representatives.

          Compliance With Rule XIII, cl. 3(e) (Ramseyer Rule)

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italics, existing law in which no change 
is proposed is shown in roman):

SECTION 219 OF THE MILITARY CONSTRUCTION, VETERANS AFFAIRS, AND RELATED 
                   AGENCIES APPROPRIATIONS ACT, 2020

                   (Division F of Public Law 116-94)

                     [(INCLUDING TRANSFER OF FUNDS)

  [Sec. 219.  Of the amounts appropriated to the Department of 
Veterans Affairs for fiscal year 2020 for ``Medical Services'', 
``Medical Community Care'', ``Medical Support and Compliance'', 
``Medical Facilities'', ``Construction, Minor Projects'', and 
``Information Technology Systems'', up to $314,409,000, 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: Provided further, 
That section 220 of title II of division C of Public Law 115-
244 is repealed.]
                              ----------                              


                      TITLE 38, UNITED STATES CODE



           *       *       *       *       *       *       *
PART II--GENERAL BENEFITS

           *       *       *       *       *       *       *


   CHAPTER 17--HOSPITAL, NURSING HOME, DOMICILIARY, AND MEDICAL CARE

                          SUBCHAPTER I--GENERAL

Sec.
1701. Definitions.
     * * * * * * *

 SUBCHAPTER II--HOSPITAL, NURSING HOME, OR DOMICILIARY CARE AND MEDICAL 
                                TREATMENT

     * * * * * * *
1720J. Provision of assisted reproductive technology or adoption 
          reimbursements for certain disabled veterans.

           *       *       *       *       *       *       *


SUBCHAPTER II--HOSPITAL, NURSING HOME, OR DOMICILIARY CARE AND MEDICAL 
TREATMENT

           *       *       *       *       *       *       *


Sec. 1720J. Provision of assisted reproductive technology or adoption 
                    reimbursements for certain disabled veterans

  (a) Provision of Services.--Subject to the availability of 
appropriations, the Secretary may provide--
          (1) fertility counseling and treatment using assisted 
        reproductive technology to a covered veteran or the 
        spouse of a covered veteran; or
          (2) adoption reimbursement to a covered veteran.
  (b) Limitations.--Amounts made available for the purposes 
specified in subsection (a) are subject to the requirements for 
funds contained in section 508 of division H of the 
Consolidated Appropriations Act, 2017 (Public Law 115-31).
  (c) Definitions.--In this section:
          (1) The term ``adoption reimbursement'' means 
        reimbursement for the adoption-related expenses for an 
        adoption that is finalized after the date of the 
        enactment of this section under the same terms as apply 
        under the adoption reimbursement program of the 
        Department of Defense, as authorized in Department of 
        Defense Instruction 1341.09, including the 
        reimbursement limits and requirements set forth in such 
        instruction, as in effect on the date of the enactment 
        of this section.
          (2) The term ``assisted reproductive technology'' 
        means benefits relating to reproductive assistance 
        provided to a member of the Armed Forces who incurs a 
        serious injury or illness on active duty pursuant to 
        section 1074(c)(4)(A) of title 10, as described in the 
        memorandum on the subject of ``Policy for Assisted 
        Reproductive Services for the Benefit of Seriously or 
        Severely Ill/Injured (Category II or III) Active Duty 
        Service Members'' issued by the Assistant Secretary of 
        Defense for Health Affairs on April 3, 2012, and the 
        guidance issued to implement such policy, as in effect 
        on the date of the enactment of this section, including 
        any limitations on the amount of such benefits 
        available to such a member, except that--
                  (A) the periods regarding embryo 
                cryopreservation and storage set forth in part 
                III(G) and in part IV(H) of the first part IV 
                of such memorandum shall not apply; and
                  (B) such term includes embryo 
                cryopreservation and storage without limitation 
                on the duration of such cryopreservation and 
                storage.
          (3) The term ``covered veteran'' means a veteran who 
        has a service-connected disability that results in the 
        inability of the veteran to procreate without the use 
        of fertility treatment.

           *       *       *       *       *       *       *


                 Changes in Application of Existing Law

    Pursuant to clause 3(f)(1)(A) of rule XIII of the Rules of 
the House of Representatives, the following statements are 
submitted describing the effect of provisions in the 
accompanying bill that directly or indirectly change the 
application of existing law.
    Language is included in various parts of the bill to 
continue on-going activities that require annual authorization 
or additional legislation, which to date have not been enacted.
    Language is included in various parts of the bill to place 
limitations on the use of funds in the bill or change existing 
limitations and which might, under some circumstances, be 
construed as changing the application of existing law.
    Language is included in various parts of the bill to allow 
the Secretary of Defense to exceed certain limitations upon 
notification to the Committee.
    Language is included in various parts of the bill to allow 
funding to be used for official reception and representation 
expenses.
    Language is included in various parts of the bill to enable 
various appropriations to remain available for more than one 
year for some programs for which the basic authority 
legislation does not presently authorize such extended 
availability.
    Language is included in various parts of the bill to permit 
the transfer of funds to other accounts.
    Language is included under Title I to prohibit payments for 
cost-plus-a-fixed-fee contracts under certain circumstances.
    Language is included in various parts of the bill to allow 
funds to be used for the hire of passenger motor vehicles.
    Language is included under Title I to allow advances to the 
Federal Highway Administration, Department of Transportation 
under certain circumstances.
    Language is included under Title I to prohibit the use of 
funds to begin construction of new bases without specific 
appropriations.
    Language is included under Title I to prohibit the use of 
funds for purchase of land or land easements under certain 
circumstances.
    Language is included under Title I to prohibit the use of 
funds for land acquisition, site preparation, and utility 
installation for family housing unless funds have been made 
available in annual appropriations Acts.
    Language is included under Title I to prohibit the use of 
minor construction funds to transfer an activity between 
installations without prior notification.
    Language is included under Title I to prohibit the use of 
funds for the procurement of steel for any activity if American 
steel producers have been denied the opportunity to compete for 
such steel procurements.
    Language is included under Title I to prohibit the use of 
funds to pay real property taxes in any foreign nation.
    Language is included under Title I to prohibit the use of 
funds to initiate a new installation overseas without prior 
notification.
    Language is included under Title I to limit the use of 
funds for architect and engineer contracts under certain 
circumstances.
    Language is included under Title I to limit the use of 
funds for awarding contracts to foreign contractors under 
certain circumstances.
    Language is included under Title I to require the 
Department of Defense to notify the appropriate committees of 
Congress of any proposed military exercises under certain 
circumstances.
    Language is included under Title I to allow prior year 
construction funding to be available for currently authorized 
projects.
    Language is included under Title I to allow payment for the 
cost associated with supervision, inspection, overhead, 
engineering and design on family housing or military 
construction projects that are being completed with expired or 
lapsed funds.
    Language is included under Title I to allow funds to be 
expended on military construction projects for four fiscal 
years after enactment under certain circumstances.
    Language is included under Title I to allow construction 
funds to be transferred to Housing Improvement Funds.
    Language is included under Title I to allow for the 
transfer of BRAC funds to the Homeowners Assistance Program.
    Language is included under Title I to limit funds for the 
operation and maintenance of family housing to those provided 
in this appropriation and to limit amounts expended on repairs 
of general and flag officer quarters under certain 
circumstances.
    Language is included under Title I to allow funds in the 
Ford Island Improvement Account to be available until expended 
for certain purposes.
    Language is included under Title I to allow for the 
transfer of expired funding to the Foreign Currency Fluctuation 
Account under certain circumstances.
    Language is included under Title I to prohibit funds to be 
used for projects at Arlington Cemetery.
    Language is included under Title I providing additional 
funds for Military Construction, Army.
    Language is included under Title I providing additional 
funds for Military Construction, Navy and Marine Corps.
    Language is included under Title I providing additional 
funds for Military Construction, Air Force.
    Language is included under Title I providing additional 
funds for Military Construction, Army National Guard.
    Language is included under Title I providing additional 
funds for Military Construction, Air National Guard.
    Language is included under Title I providing additional 
funds for Military Construction, Army Reserve.
    Language is included under Title I defining the 
congressional defense committees.
    Language is included under Title I directing all amounts 
appropriated to Military Construction (all accounts) be 
immediately available and allotted for the full scope of the 
authorized project.
    Language is included under Title I providing additional 
funds for Military Construction, Army for cost to complete 
projects.
    Language is included under Title I providing additional 
funds for Military Construction, Navy and Marine Corps for cost 
to complete projects.
    Language is included under Title I providing additional 
funds for Military Construction, Air Force for cost to complete 
projects.
    Language is included under Title I providing additional 
funds for Military Construction, Army Reserve for cost to 
complete projects.
    Language is included under Title I providing additional 
funds for Military Construction, Navy Reserve for cost to 
complete projects.
    Language is included under Title I providing additional 
funds for Family Housing Construction, Army for cost to 
complete projects.
    Language is included under Title I providing additional 
funds for Family Housing Operations and Maintenance, Army.
    Language is included under Title I providing additional 
funds for Family Housing Operations and Maintenance, Navy and 
Marine Corps.
    Language is included under Title I providing additional 
funds for Family Housing Operations and Maintenance, Air Force.
    Language is included under Title I requiring funds made 
available are only to be use for the purposes specifically 
described under each heading.
    Language is included under Title I to prohibit the use of 
military construction funds to build a border wall, or road to 
access a border wall.
    Language is included under Title I to prohibit the 
construction of a facility on a military installation bearing 
the name of a confederate officer unless a process has been 
initiated to rename the installation.
    Language is included under Title II providing for the 
reimbursement to the Department of Defense for the costs of 
overseas employee mail.
    Language is included under Title II designating certain 
fiscal year 2020 advance appropriations for fiscal year 2021 
within the four medical care accounts be designated as 
emergency funding.
    Language is included under Title II to require that the 
Secretary of Veterans Affairs establish a priority for 
treatment of Veterans who are service-connected disabled, lower 
income, or have special needs.
    Language is included under Title II to require that the 
Secretary of Veterans Affairs give priority funding of basic 
medical benefits to priority groups 1 through 6.
    Language is included under Title II to allow the Secretary 
of Veterans Affairs to dispense prescription drugs from VHA 
facilities to enrolled Veterans with privately written 
prescriptions at no additional cost to the Department.
    Language is included under Title II requiring the Secretary 
to ensure sufficient funding is available for the acquisition 
of prosthetics designed for women Veterans.
    Language is included under Title II requiring sufficient 
funding is available for prosthetic research specifically for 
female Veterans and for toxic exposure research.
    Language is included under Title II designating certain 
funding within the Information Technology Systems account as 
emergency funding.
    Language is included under Title II to require approval of 
a transfer between development projects in the Information 
Technology Systems account.
    Language is included under Title II designating certain 
funding within the Veterans Electronic Health Record account as 
emergency funding.
    Language is included under Title II prohibiting funding in 
the Veterans Electronic Health Record account from being 
obligated in a manner inconsistent with deployment schedules.
    Language is included under Title II establishing time 
limitations and reporting requirements concerning the 
obligation of Major Construction funds, limiting the use of 
funds, allowing the use of funds for program costs, and 
allowing for the reimbursement to the ``General 
Administration'' account for the salaries and expenses of the 
Office of Construction and Facilities Management employees.
    Language is included under Title II to allow Minor 
Construction funds to be used to repair non-medical facilities 
damaged by natural disaster or catastrophe.
    Language is included under Title II permitting transfers 
between mandatory and discretionary accounts, limiting and 
providing for the use of certain funds, funding administrative 
expenses associated with life insurance programs from excess 
program revenues, allowing reimbursement from enhanced-use 
leases and for certain services, requiring notification of 
construction bid savings, limiting reprogramming amount of 
major construction projects, restricting changes in the scope 
of major construction projects, requiring disclosure of 
insurance and income information, allowing a recovery audit 
collection program, allowing Veterans in the State of Alaska to 
use Indian Health Service facilities under certain conditions, 
requiring quarterly reports on the Department's financial 
status, performance measures, and data, allowing medical 
services funds for recreational and funeral expenses, and 
requiring notification of organizational changes that transfer 
25 or more employees from one VA organizational unit to 
another.
    Language is included under Title II requiring notification 
of any single national outreach and awareness marketing 
campaign in which obligations exceed $1,000,000.
    Language is included under Title II requiring the Secretary 
to maintain certain requirements in operating the toll-free 
suicide hotline.
    Language is included under Title II prohibiting funds from 
being used to close hospitals, domiciliaries, or clinics, or 
conduct environmental assessment or diminish services in the 
Veterans Integrated Service Network 23 as part of a realignment 
of VA services until the Secretary provides a report that 
includes a national realignment strategy, a cost benefit 
analysis, and an inventory of buildings with historic 
designation.
    Language is included under Title II to allow covered 
Veterans and their spouses, under certain conditions, to 
receive assisted reproductive technology services and adoption 
reimbursement.
    Language is included under Title II pertaining to 
exceptions for Indian- or Native Hawaiian-owned businesses 
contracting with the Department.
    Language is included under Title II directing the 
elimination of using Social Security account numbers to 
identify individuals in all information systems of the 
Department.
    Language is included under Title II pertaining to 
certification of marriage and family therapists.
    Language is included under Title II prohibiting funds from 
being used to transfer funding from the Filipino Veterans 
Equity Compensation Fund to any other VA account.
    Language is included under Title II permitting funds to 
carry out and expand the child care program.
    Language is included under Title II prohibiting funds to 
enter into an agreement to resolve a dispute or claim with an 
individual that would restrict the individual from speaking to 
Members of Congress or their staff.
    Language is included under Title II requiring certain data 
to be included in budget justifications for major construction 
projects.
    Language is included under Title II prohibiting the 
Inspector General timely access to information.
    Language is included under Title II prohibiting funding to 
be used that would increase wait times for Veterans who seek 
medical care.
    Language is included under Title II prohibiting the use of 
funds in fiscal year 2020 to convert any program that received 
specific purpose funding in fiscal year 2019 to a general 
purpose-funded program.
    Language is included under Title II prohibiting the use of 
dogs as part of the conduct of any study.
    Language is included under Title II prohibiting the closure 
of a certain community-based outpatient clinic until the 
Secretary completes a market area assessment.
    Language is included under Title II requiring the Secretary 
to update the ``Planning and Activating Community Based 
Outpatient Clinics'' handbook.
    Language is included under Title II allowing for funds 
within the Medical Community Care account to be used for 
expenses that would have otherwise been payable from the 
Veterans Choice Fund.
    Language is included under Title II allowing for 
obligations and expenditures applicable to the Medical Services 
account in fiscal years 2017 through 2019 for aid to state 
homes to remain in the Medical Community Care account for such 
fiscal years.
    Language is included under Title II providing for a certain 
amount within the medical care accounts to be made available 
for gender-specific care for women.
    Language is included under Title III United States Court of 
Appeals for Veterans Claims, Salaries and Expenses, to permit 
the use of funds for a pro bono program.
    Language is included under Title III Cemeterial Expenses, 
Army, Salaries and Expenses, to permit the use of funds for 
parking maintenance and repairs.
    Language is included under Title III Armed Forces 
Retirement Home to permit payment from the general fund of the 
Treasury to the Trust Fund.
    Language is included under Title III to allow for the use 
of concession fees.
    Language is included under Title IV providing Overseas 
Contingency Operations funding with an emergency designation.
    Language is included under Title IV providing funds with 
emergency designation, for Overseas Contingency Operations and 
European Deterrence Initiative for the Army.
    Language is included under Title IV providing funds with 
emergency designation, for Overseas Contingency Operations and 
European Deterrence Initiative for the Navy and Marine Corps.
    Language is included under Title IV providing funds with 
emergency designation, for Overseas Contingency Operations and 
European Deterrence Initiative for the Air Force.
    Language is included under Title IV directing the Secretary 
of Defense to provide, in classified and unclassified format a 
list of the construction projects for European Deterrence 
Initiative for fiscal years 2022 through 2026.
    Language is included under Title V prohibiting funding 
beyond the current fiscal year unless expressly so provided.
    Language is included under Title V to limit the use of 
funds for Federal entities when they are not in compliance with 
Federal law relating to risk assessment, the protection of 
private property rights, or unfunded mandates.
    Language is included under Title V providing funding to 
expand the use of ``E Commerce'' technologies and procedures.
    Language is included under Title V specifying the 
Congressional committees that are to receive all reports and 
notifications.
    Language is included under Title V prohibiting the transfer 
of funds to any instrumentality of the United States Government 
without authority from an appropriations Act.
    Language is included under Title V prohibiting the use of 
funds for a project or program named for an individual serving 
as a Member, Delegate, or Resident Commissioner of the United 
States House of Representatives.
    Language is included under Title V requiring all reports 
submitted to the Congress to be posted on the official public 
Website of that agency.
    Language is included under Title V prohibiting funds from 
being used to maintain or establish a computer network unless 
such network blocks the viewing, downloading, and exchanging of 
pornography.
    Language is included under Title V prohibiting funds from 
being used to pay for first-class travel in violation of 
Federal regulations.
    Language is included under Title V prohibiting funds from 
being used to execute a contract for goods or services where a 
contractor has not complied with Executive Order 12989.
    Language is included under Title V prohibiting funds from 
being used 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.
    Language is included under Title V prohibiting the use of 
funds in this Act to construct facilities on military 
installations that do not meet resiliency standards.
    Language is included under Title V prohibiting the use of 
funds for the construction of a wall, barrier, fence, or road 
along the Southern border of the United States or a road to 
provide access to a wall, barrier, or fence constructed along 
the Southern border of the United States.
    Language is included under Title V designating amounts in 
this Act by Congress are for an emergency requirement pursuant 
to section 251(b)(2)(A)(i) of the Balanced Budget and Emergency 
Control Act of 1985.

                  Appropriations Not Authorized by Law

    Pursuant to clause 3(f)(1)(B) of rule XIII of the Rules of 
the House of Representatives, the following table lists the 
appropriations in the accompanying bill which are not 
authorized by law for the period concerned:


                          Program Duplication

    No provision of this bill establishes or reauthorizes a 
program of the Federal Government known to be duplicative of 
another Federal program, a program that was included in any 
report from the Government Accountability Office to Congress 
pursuant to section 21 of Public Law 111-139, or a program 
related to a program identified in the most recent Catalog of 
Federal Domestic Assistance.

                           Committee Hearings

    For the purposes of section 103(i) of H. Res. 6 of the 
116th Congress--
    The following hearings were used to develop or consider the 
Military Construction, Department of Veterans Affairs, and 
Related Agencies Appropriations Act, 2021:
    The Subcommittee on Military Construction, Department of 
Veterans Affairs, and Related Agencies held a hearing on 
February 27, 2020, entitled ``Oversight of VA's Electronic 
Health Record Modernization Implementation''. The Subcommittee 
received testimony from:
    Dr. Melissa Glynn, Assistant Secretary for Enterprise 
Integration
    Dr. Richard Stone, Executive in Charge, Veterans Health 
Administration
    Mr. John H. Windom, Executive Director, Office of 
Electronic Health Record Modernization
    The Subcommittee on Military Construction, Department of 
Veterans Affairs, and Related Agencies held a hearing on March 
3, 2020, entitled ``Military Privatized Housing''. The 
Subcommittee received testimony from:
    Colonel Scott Gerber
    Ms. Linne Gherdovich
    Mr. Rick Taylor, President, Facility Operations, 
Renovations & Construction, Balfour Beatty Communities
    Mr. Heath Burleson, Corvias' Partnership Advisor
    Mr. Denis Hickey, CEO, Lendlease Americas
    Mr. John Ehle, President, Hunt Military Communities
    Mr. Jeff Guild, Vice President, Lincoln Military Housing
    Mr. Pete Potochney, Acting Assistant Secretary of Defense 
(Sustainment) OSD
    Ms. Elizabeth A. Field, Director, Defense Capabilities and 
Management (GAO)
    The Subcommittee on Military Construction, Department of 
Veterans Affairs, and Related Agencies held a hearing on March 
4, 2020, entitled ``Department of Veterans Affairs FY2021 
Budget Overview''. The Subcommittee received testimony from:
    The Honorable Robert Wilkie, Secretary of Veterans Affairs
    Richard A. Stone, M.D., Executive in Charge, Veterans 
Health Administration
    Dr. Paul R. Lawrence, Under Secretary for Benefits, 
Veterans Affairs
    Mr. Jon Rychalski, Assistant Secretary for Management and 
Chief Financial Officer, Veterans Affairs
    The Subcommittee on Military Construction, Department of 
Veterans Affairs, and Related Agencies held a hearing on March 
10, 2020, entitled ``Member's Day''. The Subcommittee received 
testimony from:
    The Honorable Gilbert Cisneros, Member of Congress
    The Honorable Jared Golden, Member of Congress
    The Honorable Mike Johnson, Member of Congress
    The Honorable Jenniffer Gonzalez-Colon, Member of Congress
    The Honorable Angie Craig, Member of Congress
    The Honorable Richard Hudson, Member of Congress
    The Subcommittee on Military Construction, Department of 
Veterans Affairs, and Related Agencies held a hearing on March 
10, 2020, entitled ``Public Witness Day''. The Subcommittee 
received testimony from:
    Mr. Adrian M. Atizado, Deputy National Legislative Director 
of Disabled American Veterans
    Mr. Roscoe G. Butler, Associate Legislative Director of 
Paralyzed Veterans of America
    Mr. Carlos Fuentes, Director of National Legislative 
Service for Veterans of Foreign Wars of the United States
    The Subcommittee on Military Construction, Department of 
Veterans Affairs, and Related Agencies held a hearing on March 
11, 2020, entitled ``Impact of PFAS Exposure on 
Servicemembers'''. The Subcommittee received testimony from:
    Mr. Jim Holmes, U.S. Army and Air Force Veteran
    Mr. Scott Faber, Senior Vice President of Government 
Affairs Environmental Working Group
    Ms. Maureen Sullivan, Deputy Assistant Secretary of Defense 
for Environment, Department of Defense
    The Subcommittee on Military Construction, Department of 
Veterans Affairs, and Related Agencies held a hearing on May 
28, 2020, entitled ``Department of Veterans Affairs Response to 
COVID-19''. The Subcommittee received testimony from:
    The Honorable Robert Wilkie, Secretary of Veterans Affairs
    Dr. Paul Lawrence, Under Secretary for Benefits, Department 
of Veterans Affairs
    Dr. Jennifer MacDonald, Chief Consultant to the Deputy 
Under Secretary for Health, Department of Veterans Affairs
    Mr. Jon Rychalski, Assistant Secretary for Management and 
Chief Financial Officer, Department of Veterans Affairs


      Comparative Statement of New Budget (Obligational) Authority

    The following table provides a detailed summary, for each 
Department and agency, comparing the amounts recommended in the 
bill with amounts enacted for fiscal year 2020 and budget 
estimates presented for fiscal year 2021.



                             MINORITY VIEWS

    The Military Construction, Veterans Affairs, and Related 
Agencies Appropriations Bill, 2021, includes much needed 
funding for Veterans programs, military construction projects, 
and military family housing. It provides funding for many of 
the Services' unfunded priorities, as well as funding to allow 
the Services to complete many projects already underway.
    We note with appreciation the $135,000,000 provided to 
improve the oversight of privatized military family housing and 
the nearly $105,000,000,000 in discretionary funding for 
Veterans programs, including funding for Veterans healthcare. 
The bill provides funding increases for critical programs, 
including mental health, suicide prevention, homeless 
assistance, medical center construction, and information 
technology.
    We strongly support Veterans' programs but are concerned 
that the bill pays for these increases by designating 
$12,500,000,000 as emergency funding. By doing this, the 
majority sets aside the Bipartisan Budget Act of 2019 (P.L. 
116-37), which was enacted less than one year ago, and that set 
caps for defense and non-defense discretionary spending for 
fiscal year 2021. We should maintain these caps and make the 
difficult funding choices we have the responsibility to make.
    We are also concerned about Sections 129, 130, and 513, 
which unnecessarily restrict funds for military construction 
projects. These provisions could actually harm our men and 
women in uniform and make America less safe.
    Despite our concerns with the issues discussed above, we 
appreciate the Majority's willingness to address Member 
priorities in the bill and report. The Subcommittee has a long-
standing tradition of bipartisanship, and we will continue to 
work in good faith with our colleagues as we proceed through 
the appropriations process. By working together, we can best 
address the needs of our Nation's military and its Veterans and 
reach an agreement on funding for the Military Construction, 
Veterans Affairs, and Related Agencies for fiscal year 2021.

                                   Kay Granger.
                                   John R. Carter.