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116th Congress   }                                      {       Report
                        HOUSE OF REPRESENTATIVES
 1st Session     }                                      {       116-63

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



 
     MILITARY CONSTRUCTION, VETERANS AFFAIRS, AND RELATED AGENCIES 
                       APPROPRIATIONS BILL, 2020

                                _______
                                

  May 15, 2019.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

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

                              R E P O R T

                             together with

                             MINORITY VIEWS

                        [To accompany H.R. 2745]

    The Committee on Appropriations submits the following 
report in explanation of the accompanying bill making 
appropriations for military construction, the Department of 
Veterans Affairs, and related agencies for the fiscal year 
ending September 30, 2020, and for other purposes.

                                CONTENTS

                                                                   Page
Purpose of the Bill..............................................     2
Summary of Committee Recommendation..............................     2
Management and Oversight Initiatives.............................     4
Department of Defense:
    Military Construction........................................     7
    NATO Security Investment Program.............................    22
    Department of Defense Base Closure Account...................    22
    Family Housing Construction and Operation and Maintenance....    23
    Department of Defense Family Housing Improvement Fund........    26
    Department of Defense Military Unaccompanied Housing 
      Improvement Fund...........................................    26
    Administrative Provisions....................................    26
Department of Veterans Affairs:
    Veterans Benefits Administration.............................    29
    Veterans Health Administration...............................    35
    National Cemetery Administration.............................    68
    Departmental Administration..................................    69
    Administrative Provisions....................................    79
Related Agencies:
    American Battle Monuments Commission.........................    84
    U.S. Court of Appeals for Veterans Claims....................    85
    Cemeterial Expenses, Army....................................    85
    Armed Forces Retirement Home.................................    86
    Administrative Provision.....................................    86
Department of Defense:
    Overseas Contingency Operations..............................    86
    Administrative Provision.....................................    87
Department of Defense:
    Natural Disaster Relief......................................    87
    Administrative Provision.....................................    88
General Provisions...............................................    88
House of Representatives Report Requirements:
    Statement of General Performance Goals and Objectives........    89
    Rescissions..................................................    89
    Transfer of Funds............................................    89
    Disclosure of Earmarks and Congressionally Directed Spending 
      Items......................................................    91
    Ramseyer Rule................................................    91
    Changes in Application of Existing Law.......................    93
    Appropriations Not Authorized by Law.........................    98
    Program Duplication..........................................   100
    Committee Hearings...........................................   100
    Full Committee Votes.........................................   101
    Comparison With the Budget Resolution........................   107
    Five-Year Projection of Outlays..............................   107
    Assistance to State and Local Governments....................   107
    Comparative Statement of New Budget Authority................   108
    State and Country Project List...............................   120
    Overseas Contingency Operations Project List.................   135
    Minority Views...............................................   137

                          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 $231,349,814,000 in budget 
authority for the fiscal year 2020 programs and activities 
funded in the bill. The fiscal year 2020 recommendation is an 
increase of $22,588,146,000 above the fiscal year 2019 enacted 
level and $6,130,359,000 below the President's request. Of the 
increase over the fiscal year 2019 enacted level, 
$12,507,301,000 is in mandatory programs. Included in the total 
budget authority is $123,211,394,000 in mandatory budget 
authority and $108,138,420,000 in discretionary budget 
authority which includes $2,000,000,000 in emergency funding.
    The Committee recommendation highlights the continued 
commitment to our servicemembers and their families and to our 
Veterans. In discretionary budget authority, the bill is 10 
percent over the fiscal year 2019 enacted level. The bill 
includes an increase in military construction, which is 2 
percent above the fiscal year 2019 level, and an increase in 
the Department of Veterans Affairs budget, which is 9 percent 
over the fiscal year 2019 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 were less 
mission-critical. Where it was prudent, the Committee 
recommendation rescinds prior year funding that is no longer 
needed for the purpose for which it was originally appropriated 
while leaving sufficient resources to close out contracts. 
Finally, the recommendation rescinds unobligated balances in 
certain military construction and VA accounts.
    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 base and Overseas 
Contingency Operations funding, including the European 
Reassurance Initiative, is $13,460,420,000 which is 
$2,207,000,000 above the fiscal year 2019 enacted level and 
$7,625,759,000 below the budget request. The recommendation 
includes funding for Family Housing, funding for necessary 
construction on our bases, including barracks, health 
facilities and schools, and support for critical overseas 
investments as well as an additional $140,800,000 to address 
privatized family housing issues. The recommendation includes 
$921,420,000 for the European Deterrence Initiative and 
construction related to Overseas Contingency Operations, which 
helps ensure the protection of our allies and protects the 
warfighter. The recommendation also includes $2,000,000,000 to 
address the needs of military facilities damaged by Hurricanes 
Florence and Michael. The recommendation also includes 
$1,093,500,000 for the Services' unfunded priorities that are 
more than 35 percent complete in design and can be executed in 
fiscal year 2020.
    The total funding level for fiscal year 2020 for the 
Department of Veterans Affairs is $217,467,894,000, an increase 
of $20,277,301,000 over the fiscal year 2019 enacted level. Of 
the total, $123,211,394,000 is provided for mandatory benefit 
programs and $94,256,500,000 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 9 percent over 
the fiscal year 2019 enacted level. For fiscal year 2020, 
$75,550,600,000 for medical care has been appropriated in 
advance.
    In addition, the Committee recommendation includes 
$87,636,650,000 in advance appropriations for fiscal year 2021 
for the four health care accounts of the Department and 
$129,509,505,000 in advance appropriations for mandatory 
benefits programs for fiscal year 2021.
    The Committee recommendation provides a total of 
$421,500,000 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 is an increase of 
$175,900,000 over the budget request and $103,845,000 over the 
fiscal year 2019 enacted level. These funds are provided to 
achieve the level of services and facility maintenance that is 
necessary to properly ensure that these agencies are able to 
continue their missions of honoring the service and sacrifice 
of our servicemembers and Veterans. In addition, the 
recommendation includes funding for planning, design, and 
construction of the Southern Expansion at Arlington National 
Cemetery, in order to extend the life of the cemetery.

                  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 2020 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.
    Customer Service Standards.--The Committee emphasizes the 
importance of implementing proper customer service standards. 
Development of these standards includes providing significant 
services directly to the public, identifying and surveying 
target customers, establishing effective service standards and 
tracking internal performance against those standards.
    Department of Defense Military Family Housing.--Privatized 
housing has come under scrutiny over the last year with 
complaints of inadequate housing across the DOD enterprise due 
to 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. DOD has mandated that all military family housing in 
the United States be eventually privatized. The recommendation 
includes an additional $140,800,000 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. 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.
    Department of Veterans Affairs (VA).--With the 
$217,467,894,000 provided for VA in this bill, the increase in 
the number of Veterans seeking VA medical services, and the 
transformative initiatives VA is undertaking, the Committee 
believes it is important to strengthen its tools to monitor 
spending as well as the operating procedures of the VA 
workforce. The following initiatives demonstrate the 
Committee's oversight focus:
    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 has 
completed a contract to acquire the same EHR that DOD is 
adopting. The bill includes $1,603,000,000 for the EHR contract 
entered in 2018, 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.--Thanks to the significant 
investments Congress has provided over the past eight years, VA 
has been able to hire the staff, acquire the technology, and 
change work processes necessary to reduce the disability claims 
backlog to an ``effective'' zero. 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. The Committee recognizes 
this threat and provides $25,000,000,000 above the Veterans 
Benefits Administration request to support staff overtime and 
digital claims scanning. The Committee hopes that with this 
additional investment and the recently passed legislation to 
reform the appeals process, Congress will have taken the 
necessary management action to prevent Veterans from enduring 
excessive waits to claim the disability benefits they deserve.
    Information Technology (IT).--The Committee continues to 
include bill language prohibiting obligation or expenditure of 
funds for information technology systems development until VA 
submits to the Committees a certification of the amounts. 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 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 on 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.
    American Battle Monuments Commission (ABMC).--The Committee 
continues to provide funds to address the maintenance and 
repair needs of the American Battle Monuments around the world. 
The Committee directs ABMC to undertake these efforts in a 
proactive and timely manner, which will ensure that monuments 
do not fall into disrepair and require even greater investments 
to correct.
    Department of Defense Civil Cemeterial Expenses.--The 
Committee continues to provide $80,800,000 for Arlington 
National Cemetery to maintain current services and ensure that 
critical operations do not go unaddressed. Additionally, the 
Committee provides $131,000,000 for the Southern Expansion 
project, to expand cemetery capacity in a timely manner and 
extend the life of the cemetery into the 2050 timeframe. The 
bill also maintains an Administrative Provision permitting 
funds from concessions at Army National Military Cemeteries to 
be used to support activities at the Cemeteries.
    Armed Forces Retirement Home (AFRH).--The Committee 
provides increased funding to allow AFRH to address anticipated 
increases in costs such as personnel costs and contract 
inflation, as well as to address critical capital projects, 
particularly those affecting the health and safety of 
residents. This funding will allow AFRH to begin work on 
deferred maintenance projects, ensuring that AFRH is well-
positioned to continue to improve its standing and increase 
revenue for the long term. The Committee notes efforts that are 
underway to stabilize the AFRH Trust Fund and reduce reliance 
on transfers from the General Fund, and directs AFRH to 
continue to make progress in improving AFRH's sustainability.

                                TITLE I


                         DEPARTMENT OF DEFENSE


                     Military Construction Overview


 
 
 
Fiscal year 2019 enacted level (including rescissions)   $10,332,000,000
Fiscal year 2020 budget request.......................    11,241,653,000
Committee recommendation in the bill (including one       10,539,000,000
 rescission)..........................................
Comparison with:
    Fiscal year 2019 enacted level....................       207,000,000
    Fiscal year 2020 budget request...................     (702,653,000)
 

    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 one percent of the funded amount to 
include 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 to use 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. 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). 
The Committee recommendation does not provide these requested 
funds. Also, the accompanying bill includes language that 
protects previously appropriated projects, as well as fiscal 
year 2020 projects included in this bill from being used as a 
source for wall funding. The Committee believes that Congress 
must assert its role as a co-equal branch of the Federal 
government and insist upon the regular appropriation of funds--
funds this Committee has previously appropriated for disaster 
recovery, flood protection, and military base construction 
projects to maintain and improve military readiness. The 
Committee believes that military construction dollars should be 
used only for the purpose they are provided, which is to 
support DOD's mission, servicemembers, and their families.
    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, new facilities, and functional 
        conversions must be performed as military construction 
        projects. Such projects 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. The Committee strongly encourages the 
        Services and defense agencies to indicate the plant 
        replacement value of the facility to be repaired on 
        each such notification.
    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 over 
$25,000,000 with the form 1391 justification to the 
congressional defense committees. The Committee is concerned 
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 2020 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 has ascertained from cost 
variation notices required by 10 U.S.C. 2853 that DOD has 
canceled two projects that were previously appropriated 
military construction projects. The Committee's recommendation, 
therefore, includes a rescission to the Military Construction, 
Defense-Wide account. 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 19 projects that have been 
incrementally funded; however, the full authorization of the 
projects will be provided in the fiscal year 2020 National 
Defense Authorization Act.
    Impacts of Climate Change and Investing in Multi-Hazard 
Resilient Defense Infrastructure.--The Committee is concerned 
by increasing magnitudes and frequencies of environmental 
shocks (e.g., hurricane-force winds, storm surge, and extreme 
rainfall) and long-term stresses (e.g., from sea level rise) on 
DOD facilities worldwide. Recent extreme weather and natural 
disasters, for example, Hurricane Michael in 2018 that heavily 
damaged Tyndall Air Force Base in Florida, illustrate the 
challenges facing DOD in mitigating and preparing for 
inevitable future disasters and improving the security and 
readiness of the Nation's coastal military installations and 
the safety of military housing. The Committee supports the 
military's continued focus on building lasting and resilient 
military installations, including methods that update 
hurricane-resistant building codes for bases, barracks, 
hospitals, and airfields. It also encourages continued 
consideration of severe drought and desertification as 
potential threats to 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 DOD to prioritize investing in climate-
sustainable infrastructure projects. Such investments have 
yielded positive results including increased resiliency and 
cost savings. The Committee urges DOD to collaborate with 
existing research universities with federally designated 
testing facilities to accelerate investments to assess DOD 
installation vulnerabilities at home and abroad and to develop 
and test resilient infrastructure and technologies capable of 
withstanding 200 mph winds and high levels of storm surge and 
flooding. Furthermore, the Committee directs the Secretary of 
Defense to report to the congressional defense committees no 
later than 180 days after enactment of this Act detailing DOD's 
plans to develop lasting and resilient military installations, 
and what year these projects will appear in the Future Years 
Defense Plan.
    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 (USARPAC) created the 
HIRI to address critical priorities established in USARPAC's 
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 fix this crisis, HIRI allocates between $50,000,000 and 
$150,000,000 per year through fiscal year 2030 to address major 
infrastructure needs, with 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. The President's Budget for fiscal 
year 2019 included funds for this critical initiative. The 
fiscal year 2020 budget submission includes the West Loch 
Ammunition Storage Facility, a vital military construction 
project. 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.
    Strengthening our Alliances in the Indo-Pacific Area of 
Responsibility (AOR).--According to the National Defense 
Strategy, the United States is seeking to strengthen our 
alliances and partnerships in the Indo-Pacific AOR to include a 
networked security architecture capable of deterring 
aggression, maintaining stability and ensuring free access to 
common domains. This effort to rebalance toward the Pacific 
will include significant military construction requirements 
throughout the Indo-Pacific AOR. Therefore, 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) military construction 
requirements in the Indo-Pacific AOR over the next ten years, 
sorted by fiscal year, country and State and (2) efforts to 
coordinate these requirements across the Services.
    Adequate Childcare for Military Families.--The Committee is 
aware of the importance of helping military families secure 
adequate childcare for their children. DOD has argued that 
these childcare 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 Committee 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.
    Recycling of Tire Rubber.--The Committee is aware of recent 
advances in the use of waste tire rubber in asphalt, known as 
rubber modified asphalt (RMA), and encourages the Army to 
engage the research community and academia to study the 
potential benefits of rubber modified asphalt and to consider 
utilizing RMA on domestic military installations.
    Quality of Life (QOL) Projects Priority List.--The 
Committee notes the ongoing challenges that the lack of QOL 
projects, such as the lack of Childcare Development Centers 
(CDCs), creates a hardship to servicemembers and their 
families. The Committee is concerned that too often QOL 
projects are not included in budget submissions and this 
absence negatively impacts the QOL for servicemembers and their 
families. Given the demanding jobs that servicemembers must 
execute, creating unique solutions is required. The Committee 
notes that stable family life is a key component to mission 
readiness and retention. The Committee believes that requesting 
these QOL projects, like CDCs, should be a top priority amongst 
the Services. The recommendation includes an additional 
$11,000,000 in each of the Services' planning and design 
accounts to support the Services preparation for construction 
of new CDCs at the most underserved military installation. 
Therefore, the Committee directs the Service Secretaries to 
submit a report to the congressional defense committees no 
later than 90 days after the enactment of this Act that 
provides a plan to provide address QOL shortfalls, with an 
emphasis on CDCs, and at what installations they are most 
needed for the fiscal year 2020 and in the FYDP. The report 
should include associated funding requirements for every 
installation with an emphasis on CDCs. Further, the Committee 
directs that the Secretary of Defense to create a unified list 
of needed QOL projects with an emphasis on CDCs across the 
enterprise which shall be submitted concurrently with the 
annual budget submission hereafter.
    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.
    Securing Mission-Critical Infrastructure.--The Committee is 
aware that DOD is undertaking efforts to secure mission-
critical infrastructure through modernization of industrial 
control systems at priority locations. Modernized electrical, 
mechanical, and hydraulic systems can improve energy management 
and reduce operating costs at DOD facilities. However, higher 
connectivity to these systems exposes exploitable 
vulnerabilities and increases the threat from potential 
cyberattacks. The Committee directs quarterly reports by DOD 
beginning in the first quarter of fiscal year 2020 showing the 
steps the Department is taking to ensure that industrial 
control systems in ongoing and future military construction 
projects are secure.
    Other Transaction Authority.--The Committee is aware that 
the use of Other Transaction Authority provides a streamlined 
acquisition tool to accelerate project delivery. When leveraged 
appropriately, Other Transaction Authority also gives the 
Federal government greater access to innovative, state-of-the-
art technology solutions from the commercial sector. DOD is 
encouraged, in consultation with the Corps of Engineers, to 
expand its use of Other Transaction Agreements to execute the 
Military Construction program.
    High Performance and Sustainable Building Requirements.--
The Committee recognizes that innovative technologies, 
including advanced wood products and recycled aerospace grade 
carbon fiber composite, have expanded the availability of 
materials with lower embodied energy for facilities that 
require exceptional durability and blast resistance. In 
addition, design techniques such as advanced framing contribute 
to lower material costs, increased energy efficiency, and 
reduced waste in facilities. Therefore, the Committee directs 
the Secretary of Defense to continue to utilize innovative 
renewable building materials, systems, and design techniques 
that support the requirements of UFC 1 200 02 and UFGS 06 17 
19. Furthermore, the Committee directs the Secretary of Defense 
to work with universities, public agencies, and experienced 
nonprofit organizations to develop a plan to expand the 
application of these innovative technologies in future military 
construction projects and report to the Committee no later than 
90 days after enactment of this Act on how the Department will 
implement the plan.
    Defense Access Roads (DAR) Program.--The Committee is 
supportive of the DAR program as a vital mechanism in providing 
transportation infrastructure to domestic installations and 
additional funding from DOD for mission-critical, off-base 
transportation improvements. The Committee notes the expansion 
of DAR for the first time in fiscal year 2019, which made funds 
available to pay the cost of repairing and mitigating damage to 
infrastructure and highways by recurrent flooding and sea-level 
fluctuation if the Secretary determined that continued access 
to military installations were affected by flooding and 
projected sea-level fluctuation. The Services recently reported 
to Congress that there currently are no flood-prone locations 
creating a national security risk to transportation access for 
military installations and that DOD has the necessary means to 
address any flooding issues or risks (storm or non-storm surge) 
that may impact DOD missions for roads that meet DAR criteria. 
The Committee understands that there are numerous roadways 
providing transportation access to military installations that 
experience flooding and sea-level fluctuation and expects the 
Services to work with the local communities to certify these 
public roads that are hampering readiness for the military.
    Cyberspace Operations Facilities.--The Committee recognizes 
the importance of secure, up-to-date, and centralized 
cyberspace operations facilities at military installations 
because of the crucial role they play in securing information 
technology infrastructure. Therefore, the Secretary of Defense 
is directed to conduct a review of the condition of cyberspace 
operations facilities at military installations and submit the 
review and a plan to address the issues identified in the 
review by fiscal year to the congressional defense committees 
no later than 180 days after the enactment of this Act.
    HVAC Efficiency.--The Committee recognizes that the Federal 
Acquisition Regulation (48 C.F.R. Subpart 23.8) requires DOD, 
in servicing or replacing existing HVAC systems that use R-22, 
to give preference to alternatives that reduce overall risks to 
the environment, including stratospheric ozone depletion and 
global warming potential (GWP). Where feasible, DOD must use R-
22 alternatives that have been approved by EPA as acceptable 
under its Significant New Alternatives Policy (SNAP) program 
and that have lower GWP than R-22. Accordingly, the Committee 
instructs DOD to use such alternatives in servicing or 
replacing existing HVAC systems. The Committee believes that 
DOD's replacement of R-22 with alternatives that have a GWP 
lower than R-22, and are at least as energy efficient, will 
greatly reduce the overall environmental impacts of DOD 
operations.
    Access Control Points in Urban Areas.--The Committee 
supports accelerating funding for access control point 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.

                      Military Construction, Army


 
 
 
Fiscal year 2019 enacted level........................    $1,021,768,000
Fiscal year 2020 budget request.......................     1,453,499,000
Committee recommendation in the bill..................     1,132,499,000
Comparison with:
    Fiscal year 2019 enacted level....................       110,731,000
    Fiscal year 2020 budget request...................     (321,000,000)
 

    The recommendation includes additional funding for the Army 
in section 124 under Administrative Provisions for projects on 
the Services Unfunded Priority lists as provided by the Office 
of the Secretary of Defense and submitted to Congress in 
priority order.
    Rapid Deployment Requirements.--The Committee is concerned 
that installations with rapid deployment requirements have 
insufficient rail and transport logistics infrastructure to 
efficiently move equipment in support of deployments, training 
operations, and evolving Army requirements. For example, Fort 
Bliss has only one railhead connection point for its deployment 
and redeployment activities. Therefore, the Secretary of the 
Army is directed to conduct a review of rail and transport 
logistics infrastructure and equipment deployment methods at 
installations with rapid deployment requirements and submit the 
review and a plan to address the issues identified in the 
review by fiscal year to the congressional defense committees 
no later than 90 days after the enactment of this Act.
    Access Control Points.--The Committee is aware that the 
Army has access control points (ACP) at military installations 
that do not meet current design criteria and U.S. Army Corps of 
Engineers standards as noted in House Report 115-673. 
Unfortunately, these concerns have not been addressed. Army 
installations are still encountering traffic backups, are 
operating at less than optimal efficiency and are vulnerable to 
hostile direct action and penetration attempts. Replacing an 
ACP is a military construction project that includes several 
discrete components, such as a visitor control center, 
gatehouses, canopy areas, guard booths, barriers, and 
cybersecurity and surveillance systems. Given that upgrading an 
ACP can take several years, the Committee directs the Army to 
both prioritize these important security projects in its 
construction program and to review the backlog of existing ACP 
projects to determine which can be accomplished sooner through 
smaller, incremental components within the minor construction 
account that would enhance installation security and achieve 
U.S. Army Corps of Engineers Standards.
    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 of 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.

              Military Construction, Navy and Marine Corps


 
 
 
Fiscal year 2019 enacted level........................    $2,118,619,000
Fiscal year 2020 budget request.......................     2,805,743,000
Committee recommendation in the bill..................     2,205,771,000
Comparison with:
    Fiscal year 2019 enacted level....................        87,152,000
    Fiscal year 2020 budget request...................     (599,972,000)
 

    The recommendation includes additional funding for the Navy 
and Marine Corps in section 124 under Administrative Provisions 
for projects on the Services Unfunded Priority lists as 
provided by the Office of Secretary of Defense and submitted to 
Congress in priority order.
    Navy Pier Replacement Master Plan.--The Committee is 
concerned that the Navy has not properly synchronized or 
prioritized pier replacement projects. Many of the current 
piers are in disrepair or in need of complete replacement. The 
Committee directs the Secretary of the Navy to provide to the 
congressional defense committees a report 90 days after 
enactment of this Act on pier replacement projects in the 
fiscal years defense plan for 2021-2025.
    Major Range and Test Infrastructure.--The Committee is 
aware of significant infrastructure and upgrades that are 
needed across the enterprise of Major Range and Test Facility 
bases (MRTFB) of the Department of Defense. Many MRTFBs have 
significant backlogs in infrastructure needs because they do 
not score well in the military construction prioritization 
process. The Committee is concerned that as new technologies 
are tested, there are not adequate facilities that will allow 
for successful testing, like with hypersonic weapons and other 
emerging technologies. Additionally, the Committee notes that 
DOD has not provided to the congressional defense committees an 
annual report, as required by section 2806 of the National 
Defense Authorization Act for Fiscal Year 2018, (P.L. 115-91), 
on DOD laboratory construction needs. The Committee is also 
aware of a specific backlog of construction projects at Naval 
Air Station (NAS) Patuxent River. NAS Patuxent River has been 
pivotal in testing many new systems that support the fleet. The 
Aircraft Prototype Facility has enabled aircraft preparation 
and technology support to permit full-scale fabrication of 
advanced structures. The third and final phase would directly 
support the Navy's emphasis on rapid prototyping consistent 
with Maritime Accelerated Capabilities Office to capture 
innovation and speed solutions to the warfighters. The Navy 
expects that the facility is needed given current capacity 
constraints. The Committee is also aware that significant 
upgrades are needed to the Webster Outlying Field (WOLF) Air 
Traffic Control (ATC) tower to enable basic operational needs 
for the Navy test pilot program and UAV platforms. The current 
ATC was constructed in 1978 and needs urgent replacement. The 
Navy has included these projects in their FYDP. The Committee 
urges the Navy to keep these projects, as planned, and more 
broadly, better address the broader infrastructure needs at 
MRTFBs.
    The Strategic and Critical Role of Public Shipyards.--The 
Committee recognizes the strategic and critical role our public 
shipyards play in the national security of our Nation. However, 
our shipyards are in direct need of maintenance and upgrade. 
The National Defense Authorization Act for Fiscal Year 2018, 
(P.L. 115-91) included language directing DOD to create a 
Shipyard Infrastructure Optimization Plan. This plan included 
recommendations and future year projects that would help to 
restore our public shipyards to support our fleet around the 
world. The Committee directs the Secretary of Defense no later 
than 180 days after enactment of this Act to submit to 
congressional defense committees a prioritized list of projects 
to be constructed under the Shipyard Infrastructure 
Optimization Plan necessary for national security requirements 
over the next ten years.

                    Military Construction, Air Force


 
 
 
Fiscal year 2019 enacted level........................    $1,440,323,000
Fiscal year 2020 budget request.......................     2,179,230,000
Committee recommendation in the bill..................     1,588,730,000
Comparison with:
    Fiscal year 2019 enacted level....................       148,407,000
    Fiscal year 2019 budget request...................     (590,500,000)
 

    The recommendation includes additional funding for the Air 
Force in section 124 under Administrative Provisions for 
projects on the Services Unfunded Priority lists as provided by 
the Office of the Secretary of Defense and submitted to 
Congress in priority order.
    F-35 Beddown and 21st Century Installation.--The current 
estimate for F-35 beddown at Tyndall Air Force Base is 
$350,000,000. It is the understanding of the Committee that the 
Air Force is still determining what additional facilities would 
be required for the additional three squadrons. The Committee 
believes that it would not be prudent to have 5th generation 
air assets like the F-35 housed in inappropriate hangars that 
fail to protect the aircraft from the elements. Therefore, the 
Committee directs the Air Force to provide a detailed timeline 
by fiscal year, location and costs of necessary facilities, 
including estimates for hurricane-related military construction 
at Tyndall Air Force Base and the F-35 aircraft delivery 
timeline, by base to the congressional defense committees no 
later than 60 days after enactment of this Act.
    F-22 Rebasing.--Hurricane Michael caused catastrophic 
damage to the Tyndall Air Force Base and dislocated the 43rd 
Fighter Squadron. It is the understanding of the Committee that 
the Air Force has the opportunity to restructure F-22 Raptor 
rebasing for long-term health and readiness. The current 
estimate for the relocation of F-22s is $150,000,000 for 
additional facilities required at existing F-22 bases to 
support the formal training unit and operational squadron. The 
Committee directs the Secretary of the Air Force to provide by 
cost, location and fiscal year the necessary military 
construction projects no later than 60 days after enactment of 
this Act.
    Air Traffic Control Towers.--The Committee is concerned 
that the Department of 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 Department of 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 Force Dormitories.--The Committee is concerned with the 
condition of dormitories at numerous Air Force bases around the 
country, especially at those in cities with large military 
populations. The Committee, therefore, directs the Secretary of 
the Air Force to submit a report to the congressional defense 
committees detailing the process and formulas it uses to 
prioritize its infrastructure renovation and upgrade projects 
no later than 60 days after enactment of this Act.
     Offutt Air Force Base.--The Committee continues to have 
concerns on the impacts of recent flooding at Offutt Air Force 
Base. The Committee is committed to ensuring United States 
Strategic Command, the 55th Wing, and the Nebraska National 
Guard receive the necessary funding to return Offutt Air Force 
Base to fully mission capable. The unique facilities and assets 
at Offutt Air Force Base are a cornerstone of our national 
security and provide many one-of-a-kind capabilities, thereby 
guaranteeing the Nation's airborne intelligence gathering 
superiority, survivable nuclear command and control, and the 
effectiveness of our strategic deterrent.
    Air Education and Training Command (AETC).--The Committee 
recognizes the importance of adequate facilities for basic 
military training, flying training, and the other training 
missions of the AETC. Outdated and inadequate AETC facilities, 
including dormitories, harm the Department of the Air Force's 
ability to recruit, train, and retain Airmen and increase 
operations and maintenance costs. The Committee urges the 
Department of 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.

                  Military Construction, Defense-Wide


                     (INCLUDING TRANSFER OF FUNDS)

 
 
 
Fiscal year 2019 enacted level........................    $2,550,728,000
Fiscal year 2020 budget request.......................     2,504,190,000
Committee recommendation in the bill..................     2,025,799,000
Comparison with:
    Fiscal year 2019 enacted level....................     (524,929,000)
    Fiscal year 2020 budget request...................     (478,391,000)
 

    Transfer of Funds.--The accompanying bill provides transfer 
authority to the Secretary of Defense to allow the transfer of 
funds to such appropriations of DOD available for military 
construction or family housing as the Secretary may designate.
    The recommendation includes a reduction of $10,000,000 from 
the contingency construction account.
    The recommendation includes a rescission of $45,055,000 
from unobligated balances in section 125 under Administrative 
Provisions.
    Excess Inventory of Infrastructure.--The Committee 
recognizes the issue of excess inventory within DOD and 
encourages the Department to consider a Military Installation 
Savings Commission (MISC). This would create a focus on 
integrating and consolidating functions, outsourcing services, 
assisting in the transition of underused facilities to higher 
economic use, and provision of the necessary resources for 
successful outcomes in affected communities.
    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.
    Natural Disasters and Military Installations Resiliency.--
The Committee supports the military's continued focus on 
building lasting and resilient military installations, 
including methods that update hurricane-resistant building 
codes for bases, barracks, hospitals, and airfields. It further 
considers the impact of severe drought and desertification as 
high potential instability areas and how these two hazards 
impact bases 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 DOD to prioritize 
investing in climate-sustainable infrastructure projects. Such 
investments have yielded positive results like increased 
resiliency and cost-savings. Accordingly, the Committee 
requests a report no later than 180 days after enactment of 
this Act detailing DOD's plans to further develop lasting and 
resilient military installations.
    Energy Conservation.--The Committee commends DOD's forward 
posture on the need to improve energy resilience, improve 
mission assurance, save energy, and reduce energy costs. DOD 
must continue to increase the integration of alternative energy 
sources, particularly through renewable sources, throughout 
military facilities and installations. Energy resilience is 
critical to mission assurance for military units that perform 
cyber and intelligence, surveillance, and reconnaissance 
functions, missions vitally important to America's complex 
global engagements. The Committee directs the Secretary of 
Defense to provide a report no later than 90 days after 
enactment of this Act on DOD's strategy to increase energy 
conservation efforts and on energy cost savings, improved unit 
readiness, and opportunities for return on investments of 
existing and planned projects.
    Rhine Ordnance Barracks Medical Center Replacement.--The 
Committee fully understands the strategic importance of this 
hospital. In the Consolidated Appropriations Act, 2018 (P.L. 
115-141) the Committee directed the Director of the Defense 
Health Agency to report to the congressional defense 
committees: (1) specific changes in German energy law that 
affected the energy study; (2) what United States sources of 
energy the new German energy laws incorporate; (3) what United 
States sources are no longer able to be used in Germany; (4) 
what effect the changes in law have on other military 
construction projects, construction costs and current utilities 
contracts in the region; and (5) what effect this delay may 
have on other aspects of the Rhine Ordnance Barracks Medical 
Center Replacement Project. In addition to this requirement, 
the Committee directed the Director of the Defense Health 
Agency to provide to the congressional defense committees (1) 
an updated form 1391 to include a WIP curve; (2) the total 
amount of funding for the utility plant that is within the 
military construction program; and (3) a list of other of 
appropriations, if any, that are being used for utility costs. 
This report has not yet been received by the Committee. In 
addition to the prior reporting requirement, the Committee 
directs the Director of the Defense Health Agency to provide 
the total amount of funding that has been obligated of the 
$50,095,000 requested in the original form 1391 for the central 
utility plant and the percentages of Russian-exported natural 
gas and domestically-sourced natural gas that will be used at 
the utility plant no later than 90 days after enactment of this 
Act. We need to ensure our military installations are not 
compromised, as well as ensure energy security through 
diversification of fuel sources.
    DOD Installation Energy Policy.--DOD installation energy 
use accounts for nearly a quarter of all Federal government 
energy consumption. In fiscal year 2015, according to DOD's 
Annual Energy Management Report, the Department spent 
$3,900,000 on installation energy. While DOD has made great 
strides in increasing installation energy efficiency and 
reducing overall energy consumption, more needs to be done to 
bring down the energy costs throughout the Department. DOD must 
also ramp up its efforts to enhance energy security on its 
installations through a range of actions, including investing 
in renewable energy and smart technology that can shield 
mission-critical operations from disruptions to the power grid. 
According to a January 2017 report commissioned by the Pew 
Charitable Trusts (Power Begins at Home: Assured Energy for 
U.S. Military Bases), DOD could enhance energy security on 
installations and save hundreds of millions of dollars annually 
by investing in microgrids and renewable energy systems, and by 
increasing energy efficiency on military bases. The report 
found that microgrid power systems are more reliable than the 
stand-alone diesel generators typically used for backup power 
and could save $8,000,000 to $20,000,000 over a 20-year period. 
The report also found that DOD could save as much as 
$1,000,000,000 a year simply by increasing the use of 
commercially available energy efficiency measures in its 
facilities. The Committee notes that military installations in 
Hawaii are among those at the forefront of DOD's efforts to 
increase energy efficiency and security, including projects to 
develop net-zero energy military housing and installation 
facilities, upgrade and retrofit systems to improve energy and 
water efficiency and demonstrate microgrid technology. The 
Committee supports DOD's investments in energy efficiency, 
renewable energy systems, and energy security, and provides 
$190,000,000 for the Energy Resilience and Conservation 
Program, an increase of $40,000,000 above the request.
    Information Technology Infrastructure for Military 
Construction Projects.--In the fiscal year 2019 conference 
agreement, the Committee directed the Secretary of Defense to 
report to the Committee no later than 60 days after enactment 
on how the Department is incorporating technology advancements 
and working with industry partners to gain efficiencies and 
savings on military construction projects. The Committee 
directs the Secretary to provide a status on the fiscal year 
2019 directive.

               Military Construction, Army National Guard


 
 
 
Fiscal year 2019 enacted level........................      $190,122,000
Fiscal year 2020 budget request.......................       210,819,000
Committee recommendation in the bill..................       210,819,000
Comparison with:
    Fiscal year 2019 enacted level....................        20,697,000
    Fiscal year 2020 budget request...................             - - -
 

    The recommendation includes additional funding for the Army 
National Guard in section 124 under Administrative Provisions 
for projects on the Services Unfunded Priority lists as 
provided by the Office of the Secretary of Defense and 
submitted to Congress in priority order.
    Army National Guard Readiness Centers Investment.--The 
Committee remains concerned by the failure of the Army to 
prioritize investment in Army National Guard Readiness Centers. 
These facilities are critical infrastructure in the protection 
of the homeland and in responding to domestic emergencies. 
Their deteriorating conditions are detrimental to the readiness 
of the Army Guard and present significant safety concerns. The 
Committee encourages the Army to accelerate investments in 
Readiness Centers within the fiscal year 2020 FYDP to include 
the $1,200,000,000 for the Army National Guard Transformation 
Plan.

               Military Construction, Air National Guard


 
 
 
Fiscal year 2019 enacted level........................      $129,126,000
Fiscal year 2020 budget request.......................       165,971,000
Committee recommendation in the bill..................       115,971,000
Comparison with:
    Fiscal year 2019 enacted level....................      (13,155,000)
    Fiscal year 2020 budget request...................      (50,000,000)
 

    The recommendation includes additional funding for the Air 
National Guard in section 124 under Administrative Provisions 
for projects on the Services Unfunded Priority lists as 
provided by the Office of the Secretary of Defense and 
submitted to Congress in priority order.
    Puerto Rico Construction.--The Committee is concerned that 
the Department has yet to obligate supplemental funding 
provided by Congress to assist Puerto Rico in recovering from 
the devastating Hurricane Maria. The Committee believes 
hurricane-related damage should be addressed prior to new 
construction, and as such, the recommendation does not include 
funding for Air National Guard projects at the Luis Munoz-Marin 
International Airport. However, the Committee expects the 
Department to submit these projects for consideration in the 
future.
    Dannelly Field Environmental Impact Statement (EIS) and 
Record of Decision (ROD).--The Committee encourages the 
Department to maintain its schedule for finalizing the EIS and 
ROD for Dannelly Field and to ensure future projects are not 
delayed.

                  Military Construction, Army Reserve


 
 
 
Fiscal year 2019 enacted level........................       $64,919,000
Fiscal year 2020 budget request.......................        60,928,000
Committee recommendation in the bill..................        60,928,000
Comparison with:
    Fiscal year 2019 enacted level....................       (3,991,000)
    Fiscal year 2020 budget request...................             - - -
 

                  Military Construction, Navy Reserve


 
 
 
Fiscal year 2019 enacted level........................       $43,065,000
Fiscal year 2020 budget request.......................        54,955,000
Committee recommendation in the bill..................        54,955,000
Comparison with:
    Fiscal year 2019 enacted level....................        11,890,000
    Fiscal year 2020 budget request...................             - - -
 

                Military Construction, Air Force Reserve


 
 
 
Fiscal year 2019 enacted level........................       $38,063,000
Fiscal year 2020 budget request.......................        59,750,000
Committee recommendation in the bill..................        59,750,000
Comparison with:
    Fiscal year 2019 enacted level....................        21,687,000
    Fiscal year 2020 budget request...................             - - -
 

    The recommendation includes additional funding for the Air 
Force Reserve in section 124 under Administrative Provisions 
for projects on the Services Unfunded Priority lists as 
provided by the Office of the Secretary of Defense and 
submitted to Congress in priority order.
    Air Force Reserve Hangars.--The Committee is concerned that 
many of the Air Force Reserve hangars that were damaged during 
the record-breaking 2017 hurricane season are unsafe, 
antiquated, and do not provide adequate protection of Air Force 
Reserve air assets. For example, hangars located at Homestead 
Air Reserve Base have become wholly inadequate due to 
constrained military construction budgets and devastating storm 
damage and are putting equipment and air assets at risk. The 
Committee is concerned that this could be a problem throughout 
the Air Force Reserve enterprise with the recent reductions to 
DOD's construction accounts. Therefore, the Secretary of the 
Air Force is directed to conduct a risk assessment on Air Force 
Reserve hangars damaged by natural events throughout the Air 
Force Reserve enterprise and develop a plan to update these 
facilities in the fiscal years 2021-2025 FYDP. This assessment 
shall be submitted to the congressional defense committees no 
later than 60 days after enactment of this Act.

     North Atlantic Treaty Organization Security Investment Program


 
 
 
Fiscal year 2019 enacted level........................      $171,064,000
Fiscal year 2020 budget request.......................       144,040,000
Committee recommendation in the bill..................       172,005,000
Comparison with:
    Fiscal year 2019 enacted level....................           941,000
    Fiscal year 2020 budget request...................        27,965,000
 

    The North Atlantic Treaty Organization Security Investment 
Program (NSIP) consists of annual contributions by 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.
    The recommendation includes an increase of $27,965,000 for 
the NATO Security Investment Program (NSIP) for fiscal year 
2020 to continue to assure our partner Nations and provide 
support against Russian aggression.

               Department of Defense Base Closure Account


 
 
 
Fiscal year 2019 enacted level........................      $342,000,000
Fiscal year 2020 budget request.......................       278,526,000
Committee recommendation in the bill..................       398,526,000
Comparison with:
    Fiscal year 2019 enacted level....................        56,526,000
    Fiscal year 2020 budget request...................       120,000,000
 

    The recommendation provides an additional $60,000,000 for 
the Navy to accelerate environmental remediation at 
installations closed under previous Base Closure and 
Realignment 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 United States military installations. 
While this bill only covers military installations funded 
through the Base Realignment and Closure (BRAC) account that 
are affected by PFOS/PFOA, the issue is not limited to the 
Defense Department and affects many communities across the 
Nation. The Committee is encouraged by the Environmental 
Protection Agency's (EPA) announced plan to evaluate the need 
for a maximum contaminant level, as provided by the Safe 
Drinking Water Act, as well as designate these chemicals as 
hazardous substances under the Comprehensive Environmental 
Response, Compensation, and Liability Act, and urges the 
Department and affected communities to work closely with EPA. 
The Committee directs the Department to keep it apprised of new 
findings of PFOS/PFOA at BRAC sites and provides additional 
funds in this bill for the continued review of sites 
contaminated by PFOS/PFOA. Furthermore, the recommendation 
provides an additional $60,000,000 above the budget request to 
address PFOS and PFOA cleanup.

                        Family Housing Overview


 
 
 
Fiscal year 2019 enacted level........................    $1,582,632,000
Fiscal year 2020 budget request.......................     1,324,002,000
Committee recommendation in the bill..................     1,464,802,000
Comparison with:
    Fiscal year 2019 enacted level....................       117,830,000
    Fiscal year 2020 budget request...................       140,800,000
 

    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.--The recommendation includes an 
additional $140,800,000 within Housing Support Costs under 
Family Housing Operation and Maintenance accounts for the 
Services. The additional funds were identified by the Services 
on the Unfunded Priority list submitted to Congress by the 
Service Secretaries. 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.
    Military Privatized Housing.--The Committee is concerned 
about the ability of the Department to readily assess the 
quality of its privatized housing. The quality of military 
housing is a key component of military readiness and quality of 
life. The National Defense Authorization Act for Fiscal Year 
1996 (P.L. 104-106) allowed DOD to work with the private sector 
to build and renovate military housing. The Committee's 
oversight work has identified potentially unsafe conditions at 
privatized military housing throughout the Nation, ranging from 
electrical issues to mold, which undermines the 
congressionally-authorized privatized housing initiative. The 
Committee urges DOD to work with the private contractor 
management companies to prioritize funding for mold remediation 
in military housing in a timelier manner. The Committee 
believes that the health of our servicemembers is of the utmost 
importance, and substandard living conditions negatively impact 
the ability to recruit and retain servicemembers, to the 
detriment of United States national security interests. In 
addition, DOD had to conduct extensive work to obtain an 
overview status report about these facilities since they do not 
feed into standard defense installations systems. Further, 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) how the Services 
monitor privatized facilities at a national level and (2) any 
planned upgrades to this system to improve transparency.
    Privatized Housing-Safety and Health Threat Reporting.--The 
Committee expects DOD and the Services to establish and 
maintain procedures for ensuring response and remediation 
efforts to safety and health threats in military housing 
managed by private sector property management companies. The 
Committee expects privatized housing companies chosen by the 
Department to be knowledgeable, professionally trained, and 
capable of performing the proper response for the safety and 
health threats. The Services should constantly review the 
competency of repair personnel and contractors. The Committee 
notes that military personnel and family members are by their 
very nature temporary tenants of base housing. They are often 
not in a particular housing unit or building long enough to 
undertake a lengthy administrative process with a landlord. 
Rather than relying on the temporary tenants for much of the 
overall oversight of the safety and health aspects of 
privatized base housing, the Committee believes that the 
Services must fully shoulder this responsibility as the only 
reliable, long-term stewards of living standards in privatized 
base quarters. The Committee also urges DOD to take the 
necessary steps to ensure that families who have suffered as a 
result of negligent maintenance that resulted in issues such as 
mold, asbestos, radon, faulty electrical wiring, rodent and 
insect infestations, gas leaks and other safety and health 
threats are made whole when there has been failure of 
performance by contractors. Additionally, the Committee directs 
DOD to take immediate action when servicemembers or base 
housing residents experience the onset of physical or mental 
ailments, or disabilities caused or suspected to be caused by 
negligent property maintenance and management. Furthermore, the 
Committee directs DOD and the Services to establish and 
maintain procedures for tenant reporting of safety and health 
threats in military family housing managed by private 
contractors, that include the following: (1) active outreach on 
how to file a complaint or make a maintenance request, (2) a 
record-keeping and reporting system of housing complaints and 
maintenance requests that are reviewable by Department 
leadership and available to Members of Congress upon request, 
and (3) provide the annual reports regarding the status of 
remediation requests and efforts acted upon by private 
contractors, and should be reviewable by base commanders, DOD 
leadership, and submitted to the congressional defense 
committees annually.
    Tenant Rights.--The Committee is aware that DOD is creating 
a process to assist servicemembers with their tenant rights 
while living in base housing, and simultaneously renegotiating 
department leases with private housing providers. The Committee 
directs the Department to provide a report no later than 60 
days after enactment of this Act, and then every quarter, 
regarding the status of the tenant contracts, leases with 
private housing providers and overall implementation measures 
that were taken to improve quality of housing for 
servicemembers.
    Foreign Currency Savings and Sub-Account Transfers.--The 
Committee directs that savings in family housing operation and 
maintenance accounts from foreign currency re-estimates be used 
to maintain and repair existing family housing units. The 
Comptroller is directed to report to the Committees on 
Appropriations of both Houses of Congress on how these savings 
are allocated 90 days after enactment of this Act. In addition, 
the Committee directs the Services and Defense agencies to 
notify the Committees on Appropriations of both Houses of 
Congress within 30 days of a transfer of funds between sub-
accounts within the family housing construction and family 
housing operation and maintenance accounts, if such transfer is 
in excess of 10 percent of the funds appropriated to the sub-
account to which the funds are being transferred. Notifications 
to the Committees shall indicate the sub-accounts and amounts 
that are being used to source the transfer.
    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


 
 
 
Fiscal year 2019 enacted level........................      $330,660,000
Fiscal year 2020 budget request.......................       141,372,000
Committee recommendation in the bill..................       141,372,000
Comparison with:
    Fiscal year 2019 enacted level....................     (189,288,000)
    Fiscal year 2020 budget request...................             - - -
 

             Family Housing Operation and Maintenance, Army


 
 
 
Fiscal year 2019 enacted level........................      $376,509,000
Fiscal year 2020 budget request.......................       357,907,000
Committee recommendation in the bill..................       407,907,000
Comparison with:
    Fiscal year 2019 enacted level....................        31,398,000
    Fiscal year 2020 budget request...................        50,000,000
 

           Family Housing Construction, Navy and Marine Corps


 
 
 
Fiscal year 2019 enacted level........................      $104,581,000
Fiscal year 2020 budget request.......................        47,661,000
Committee recommendation in the bill..................        47,661,000
Comparison with:
    Fiscal year 2019 enacted level....................      (56,920,000)
    Fiscal year 2020 budget request...................             - - -
 

    Family Housing Operation and Maintenance, Navy and Marine Corps


 
 
 
Fiscal year 2019 enacted level........................      $314,536,000
Fiscal year 2020 budget request.......................       317,870,000
Committee recommendation in the bill..................       377,470,000
Comparison with:
    Fiscal year 2019 enacted level....................        62,934,000
    Fiscal year 2020 budget request...................        59,600,000
 

                 Family Housing Construction, Air Force


 
 
 
Fiscal year 2019 enacted level........................       $78,446,000
Fiscal year 2020 budget request.......................       103,631,000
Committee recommendation in the bill..................       103,631,000
Comparison with:
    Fiscal year 2019 enacted level....................        25,185,000
    Fiscal year 2020 budget request...................             - - -
 

          Family Housing Operation and Maintenance, Air Force


 
 
 
Fiscal year 2019 enacted level........................      $317,274,000
Fiscal year 2020 budget request.......................       295,016,000
Committee recommendation in the bill..................       326,216,000
Comparison with:
    Fiscal year 2019 enacted level....................         8,942,000
    Fiscal year 2020 budget request...................        31,200,000
 

         Family Housing Operation and Maintenance, Defense-Wide


 
 
 
Fiscal year 2019 enacted level........................       $58,373,000
Fiscal year 2020 budget request.......................        57,000,000
Committee recommendation in the bill..................        57,000,000
Comparison with:
    Fiscal year 2019 enacted level....................       (1,373,000)
    Fiscal year 2020 budget request...................             - - -
 

         Department of Defense Family Housing Improvement Fund


 
 
 
Fiscal year 2019 enacted level........................        $1,653,000
Fiscal year 2020 budget request.......................         3,045,000
Committee recommendation in the bill..................         3,045,000
Comparison with:
    Fiscal year 2019 enacted level....................         1,392,000
    Fiscal year 2020 budget request...................             - - -
 

 Department of Defense Military Unaccompanied Housing Improvement Fund


 
 
 
Fiscal year 2019 enacted level........................          $600,000
Fiscal year 2020 budget request.......................           500,000
Committee recommendation in the bill..................           500,000
Comparison with:
    Fiscal year 2019 enacted level....................         (100,000)
    Fiscal year 2020 budget request...................             - - -
 

                       Administrative Provisions

    The bill retains 27 provisions that were in effect in 
fiscal year 2019. The administrative provisions included in the 
bill are as follows:
    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.

                     (INCLUDING TRANSFER OF FUNDS)

    The bill includes section 122 allowing the transfer of 
funds among projects and activities in accordance with the 
reprogramming guidelines.
    The bill includes section 123 prohibiting the use of funds 
for projects at Arlington National Cemetery.
    The bill includes section 124 providing additional funds 
for various military construction accounts and requires a spend 
plan for each.

                         (RESCISSION OF FUNDS)

    The bill includes section 125 rescinding funds from prior 
appropriations Acts.
    The bill includes section 126 defining the congressional 
defense committees.
    The bill includes section 127 directing all amounts 
appropriated to Military Construction (all accounts) be 
immediately available and allotted for the full scope of the 
authorized project.

                                TITLE II


                     DEPARTMENT OF VETERANS AFFAIRS


 
 
 
Fiscal year 2019 enacted level\1\ (Including one        $197,190,593,000
 rescission)........................................
Fiscal year 2020 budget request\1\..................     216,148,394,000
Committee recommendation in the bill\1\ (Including       217,467,894,000
 one rescission)....................................
Comparison with:
    Fiscal year 2019 enacted........................      20,277,301,000
    Fiscal year 2020 budget request.................       1,319,500,000
Fiscal year 2021 advance budget request.............     217,146,155,000
Fiscal year 2021 Committee recommendation in the         217,146,155,000
 bill...............................................
 
\1\All funding cited excludes amounts in the Medical Care Collections
  Fund.

    The Department of Veterans Affairs (VA) serves 
approximately 41,350,000 people--19,500,000 Veterans and 
23,900,000 family members and dependents who may be eligible 
for certain VA benefits. To serve adequately the Nation's 
Veterans, VA employs more than 377,000 people, making it one of 
the largest federal agencies in terms of employment.

                 Veterans Benefits Administration (VBA)


                       COMPENSATION AND PENSIONS

                     (INCLUDING TRANSFER OF FUNDS)

 
 
 
Fiscal year 2020 enacted level......................    $109,017,152,000
Fiscal year 2021 advance budget request.............     116,801,316,000
Fiscal year 2021 Committee recommendation in the         116,801,316,000
 bill...............................................
Comparison with:
    Fiscal year 2020 enacted level..................       7,784,164,000
    Fiscal year 2021 budget request.................               - - -
 

    This appropriation will provide funds for service-connected 
compensation payments to an estimated 5,477,000 Veterans, 
survivors, and dependents in 2020. In addition, pension 
payments will be funded for 444,000 Veterans and their 
survivors. The average payment per compensation case for 
Veterans in 2020 is estimated at $18,883 and pension payments 
are projected at $13,619.
    The appropriation includes authority to transfer funding 
not to exceed $18,147,000 in 2021 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 (IRS) 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.
    Performance Measures.--Based on 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 directs the 
Under Secretary for Benefits to: (1) implement a new measure to 
assess regional offices' performance and accuracy to better 
target resources to low-performing offices; (2) clarify how 
Veterans Services Representatives should handle claims when 
they identify an error; (3) evaluate its policy for regional 
office communication with Veterans Service Organizations (VSOs) 
to ensure that it is clear, that it aligns with practice, and 
that it meets the communication needs of VSOs; and (4) develop 
and implement a mechanism to obtain periodic feedback from 
congressional caseworkers on their communication with regional 
offices regarding claims and needed information or support. The 
Committee requests a report on the Department's efforts no 
later than 60 days after enactment of this Act.
    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.

                         READJUSTMENT BENEFITS

 
 
 
Fiscal year 2020 enacted level......................     $14,065,282,000
Fiscal year 2021 advance budget request.............      12,578,965,000
Fiscal year 2021 Committee recommendation in the          12,578,965,000
 bill...............................................
Comparison with:
    Fiscal year 2020 enacted level..................     (1,486,317,000)
    Fiscal year 2021 budget request.................               - - -
 

    This appropriation finances 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 finances 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.
    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 the Secretary to use the Veteran treatment courts system 
to educate Veterans on job training and small business services 
offered by the Department (and in partnership with the Small 
Business Administration and the Department of Labor).
    Gender-Specific Women Veteran Case Management.--The 
Committee recognizes traditional 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 INSURANCE AND INDEMNITIES

 
 
 
Fiscal year 2020 enacted level........................      $111,340,000
Fiscal year 2020 budget year request..................        17,620,000
Fiscal year 2020 budget year Committee recommendation         17,620,000
 in the bill..........................................
Fiscal year 2021 advance budget request...............       129,224,000
Fiscal year 2021 Committee recommendation in the bill.       129,224,000
Comparison with:
    Fiscal year 2020 enacted level....................        17,884,000
    Fiscal year 2021 budget request...................             - - -
 

    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
                                                              Program account    for  specially   Administrative
                                                                                    adapted          expenses
                                                                                 housing loans
----------------------------------------------------------------------------------------------------------------
Fiscal year 2019 enacted level.............................              - - -       ($500,000)     $200,612,000
Fiscal year 2020 budget request est........................              - - -        (500,000)      200,377,391
Committee recommendation est. in the bill..................              - - -        (500,000)      200,377,391
Comparison with:
    Fiscal year 2019 enacted level.........................              - - -            - - -        (234,609)
    Fiscal year 2020 budget request........................              - - -            - - -            - - -
----------------------------------------------------------------------------------------------------------------

    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. The Committee 
is concerned that the Department has never publicly stated its 
position on this matter, hindering Veterans' ability to fully 
understand and consider how employment decisions could affect 
future eligibility for earned benefits. The Committee therefore 
directs VA to publicly clarify its position on this matter no 
later than 180 days after the enactment of this Act.
    Home Loan Utilization.--The Committee notes with concern 
that Veterans significantly under-utilize their available Home 
Loan Benefit from the Department of Veterans Affairs. 
Therefore, VA is directed to provide a report no later than 180 
days after enactment of this Act determining the reasons for 
this under-utilization, along with recommendations to improve 
its use and effectiveness.

            VOCATIONAL REHABILITATION LOANS PROGRAM ACCOUNT

----------------------------------------------------------------------------------------------------------------
                                                                                 Limitation on    Administrative
                                                              Program account     direct loans       expenses
----------------------------------------------------------------------------------------------------------------
Fiscal year 2019 enacted level.............................            $39,000     ($2,037,000)         $396,000
Fiscal year 2020 budget request............................             57,729      (2,008,232)          401,880
Committee recommendation in the bill.......................             57,729      (2,008,232)          401,880
Comparison with:
    Fiscal year 2019 enacted level.........................             18,729         (28,768)            5,880
    Fiscal year 2020 budget request........................              - - -            - - -            - - -
----------------------------------------------------------------------------------------------------------------

    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 1,970 loans 
in fiscal year 2020, with an average amount of $1,019.

              NATIVE AMERICAN VETERAN HOUSING LOAN PROGRAM

 
 
 
Administrative expenses:
Fiscal year 2019 enacted level........................        $1,163,000
Fiscal year 2020 budget request.......................         1,163,000
Committee recommendation in the bill..................         1,186,000
Comparison with:
    Fiscal year 2019 enacted level....................            23,000
    Fiscal year 2020 budget request...................            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

 
 
 
Fiscal year 2019 enacted level........................    $2,956,316,000
Fiscal year 2020 budget request.......................     3,000,000,000
Committee recommendation in the bill..................     3,025,000,000
Comparison with:
    Fiscal year 2019 enacted level....................        68,684,000
    Fiscal year 2020 budget request...................        25,000,000
 

    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, 2021, up to 
ten percent of these funds.
    The Committee provides $3,025,000,000 for the General 
Operating Expenses, VBA account, which is $25,000,000 above the 
Administration request. The Committee provides these additional 
funds for hiring additional claims and appellate staff, digital 
scanning of health records, and overtime pay.
    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, 2020, 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 that found that almost half of denied MST-
related claims were not properly adjudicated in accordance with 
VBA policies. The Committee is concerned that efforts to 
address the massive claim backlog caused VBA leadership to lose 
focus regarding these sensitive claims, abandoning appropriate 
and ongoing training, case audits, and specialized processors 
for MST-related claims. The Committee directs VA to report to 
the Committee by October 31, 2019, 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 is 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 
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).
    Transition Assistance.--The Committee is aware of VA's 
efforts to expand Veterans education connection centers at 
medical centers and outpatient clinics, such as the one 
established at the Louis Stokes Veterans Medical Center in 
Cleveland, Ohio. As directed in fiscal year 2019, the Committee 
continues to encourage VA to explore opportunities for 
education connection centers at VA Medical Centers with a high 
need. Furthermore, the Committee directs VA to provide the 
Committee with a report detailing: (1) the current education 
connection centers project, (2) an explanation of how the 
center currently benefits Veterans it serves and, (3) its 
potential plans to expand the number of education connection 
centers. In addition, this report should include an action plan 
with a detailed timeline for possible further expansion to one 
education connection center in at least ten of the 21 Veterans 
Integration Service Networks (VISN) within the next three 
years, projected timelines for implementation of this expansion 
effort, an analysis of projected added benefit to Veterans 
under the expansion, as well as potential funding costs and 
needs. The fiscal year 2019 report has not yet been submitted 
to the Committee, thus the Committee requires VA to provide a 
briefing to the Committee no later than 30 days after enactment 
of this Act on how they will produce this report in a timely 
manner.
    Outreach to Remote Locations.--The Committee directs VBA 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. 
Veterans living in these areas, particularly elderly and 
disabled Veterans who may have difficulty accessing VBA 
services via the internet or phone, should have an opportunity 
to speak and obtain assistance, in-person, with VBA staff.
    Weatherization and Other Benefits.--The Committee 
recognizes the importance of housing stability for Veterans and 
encourages VA to increase its outreach efforts to make Veterans 
aware of the Department of Energy's Weatherization Assistance 
Program, Department of Housing and Urban Development grants, 
and similar programs in conjunction with existing Veterans 
Benefit Administration programs as Veterans start the claims 
submission process. The Committee urges VA to take steps to 
inform Veterans about benefits beyond traditional Veterans 
benefits and incorporate this information into education and 
outreach materials when Veterans utilize the VA Home Loan 
program or housing assistance programs.
    GI Bill Benefits.--The Committee recognizes the GI Bill is 
an earned benefit from service with limits, so it is critical 
Veterans have the information they need to make informed 
decisions. They need better information not just on colleges, 
but on outcomes of the programs that will prepare them well for 
their civilian careers. Currently, all public Federal databases 
lack program level data that would allow potential students to 
compare the outcomes of specific programs across institutions. 
Therefore, the Committee encourages VA to work with other 
Federal agencies and the private sector to provide program 
level information on Veterans on the GI Bill Comparison Tool or 
other Federal databases including, but not limited to, 
graduation rates, total cost, time to completion, and percent 
of graduates employed in the field and post-graduate salaries. 
Providing such information would empower Veterans to choose 
both the college and program that is best for them by 
considering outcomes of other Veterans in the specific programs 
they are considering.

                  Veterans Health Administration (VHA)

    The Department operates the largest Federal medical care 
delivery system in the country, with 143 hospitals, 119 
residential rehabilitation treatment programs, 134 nursing 
homes, 300 Vet Centers, 80 mobile Vet Centers, and 728 
outpatient clinics. Approximately 7,000,000 patients will be 
treated in 2020.
    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 
2021 of $87,636,650,000 in direct appropriations to fund the 
four advance appropriations of the VHA. The Committee provides 
an additional $4,809,360,000 for the first four accounts for 
fiscal year 2020, which is $189,160,000 over the budget 
request. In addition, VA will receive an estimated 
$3,912,000,000 in the Medical Care Collections Fund in fiscal 
year 2020. The Committee also provides $840,000,000 for medical 
and prosthetic research.

                            MEDICAL SERVICES

 
 
 
Fiscal year 2019 enacted level........................   $49,911,165,000
Fiscal year 2020 enacted level........................    51,411,165,000
Fiscal year 2020 budget year request..................             - - -
Committee 2020 budget year recommendation.............       169,160,000
Fiscal year 2021 advance appropriation request........    56,158,015,000
Committee 2021 advance appropriation recommendation...    56,158,015,000
Comparison with:
    Fiscal year 2020 enacted level....................     4,746,850,000
    Fiscal year 2021 budget request...................             - - -
 

    This appropriation provides for medical services of 
eligible Veterans and beneficiaries in Department medical 
centers, outpatient clinic facilities, contract hospitals, 
State homes, and outpatient programs on a fee basis. VA also 
supports hospital and outpatient care through the private 
sector for certain dependents and survivors of Veterans under 
DOD civilian health and medical programs.
    The bill provides the request of $56,158,015,000 for 
advance fiscal year 2021 funding. The Committee has included 
bill language to make available through September 30, 2022, 
$1,500,000,000 of the Medical Services advance appropriation 
for fiscal year 2021. The Committee provides an additional 
$169,160,000 to be available for fiscal year 2020; of which 
$35,000,000 shall be for gender-specific care for women; 
$30,000,000 shall be for suicide prevention, $20,000,000 shall 
be for Whole Health initiatives; $40,000,000 shall be for 
homelessness initiatives; $17,000,000 shall be for other 
initiatives specified by the Committee; and $27,160,000 shall 
be to reimburse the Medical Care account for the April 2019 
reprogramming to the Information Technology (IT) Systems 
account to support 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) implementation. The Committee directs that as of 
the date of enactment of this Act, all reprogramming requests 
from the Department to the Committees on Appropriations of both 
Houses of Congress to support the MISSION Act may come from the 
Medical Community Care account only, and not from the Medical 
Services account.
    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 $705,219,000 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 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 $9,452,633,000 for mental health 
programs, which is $30,000,000 above the budget request. Of the 
amounts provided for mental health programs in fiscal year 
2020, $1,526,059,000 shall be used for suicide prevention and 
treatment programs. Specifically, $221,764,000 shall be used 
for suicide prevention outreach. 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 
Department should also engage with VSOs to help remove the 
stigma that is associated with seeking mental healthcare. 
Furthermore, VA is directed to remove barriers that impact a 
Veteran when trying to receive mental healthcare. The Committee 
also directs VA 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.
    Mental Health Services.--Women Veterans are twice as likely 
to commit suicide than women in the general population. To 
address this alarming trend, the Committee directs 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.
    PREVENTS Initiative.--The Committee is aware of efforts to 
coordinate Veteran suicide prevention efforts under the 
Presidential Task Force established under the PREVENTS 
Initiative. A primary focus of these efforts is to engender 
collaboration across public and private sectors to end the 
national tragedy of suicide, including the use of public-
private partnerships. This is a strategy the Committee has 
supported and believes vital to address critical mental health 
issues in our Veteran population. VA has awarded grants as part 
of an existing public-private pilot program in six states and 
the District of Columbia to address the causes and contributing 
factors that lead to suicides among our Veteran populations. 
Because firearms were used in nearly 70 percent of all Veteran 
suicide deaths, an important focus of the pilot program 
includes the safe storage of firearms. The Committee provides 
an additional $3,000,000 above the request to continue and 
broaden this initiative.
    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 
encourages 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. The Secretary shall submit a report no 
later than 180 days after enactment of this Act, detailing the 
feasibility of such a pilot program and the metrics required to 
determine the value of post-traumatic growth programs.
    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.
    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 noted 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 will be completed in June 
2019. 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 of Veterans Affairs, 
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.
    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 appropriated for mental 
health programs in fiscal year 2020, no less than $5,000,000 
shall be appropriated 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. The 
Committee, therefore, directs VA to implement a program that 
would designate a VA liaison to work with local law enforcement 
to address such circumstances and to submit a report to the 
Committees on Appropriations of both Houses of Congress 
detailing its efforts no later than 60 days after enactment of 
this Act.
    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, and directs the Department to submit a report to 
Congress no later than 60 days after the enactment of this Act.
    Cultural Competency Training.--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 Latinos, are more likely to develop PTSD. 
As such, the Committee directs the Veterans Health 
Administration 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 shall 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.
    National Academies of Sciences.--A survey conducted by the 
National Academies of Sciences, Engineering, and Medicine in 
2017 found that while the Department of Veterans Affairs 
provides mental healthcare to Veterans of the Iraq and 
Afghanistan Wars of comparable or superior quality to other 
providers, substantial needs remain unmet. The Committee 
strongly encourages the implementation of the Academy's 
recommendations, including the development of a comprehensive 
five-year strategic plan for mental health services. Moreover, 
the plan should address how VA will become a high-reliability 
organization that provides accessible, high-quality, and 
integrated mental healthcare services while also providing 
explicit attention to the unique needs of women Veterans within 
the VA system.
    Adverse Childhood Experiences (ACEs).--ACEs exist within 
the Veterans 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 the Department of Defense 
to obtain information on ACEs from servicemembers and provide a 
seamless transition in care.
    Mental Health Pilot Program.--The Committee urges VA to 
implement a comprehensive medication selection, adherence, 
compliance and digital education pilot program for Veterans 
suffering from mental health issues, including PTSD and the 
long-term side-effects of increased exposure to TBI, through 
the utilization of cutting-edge, off-the-shelf technology and 
pharmacy management protocols to reduce suicide, relapse and 
hospital visits.
    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. The 
Department is encouraged to work with the Department of 
Agriculture on providing agritherapy programs to Veterans.
    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.

                      SUICIDE PREVENTION OUTREACH

    The Committee remains concerned that 14 of the 20 Veterans 
who commit suicide each day are not using VA services. The 
Committee urges VA to develop and implement a strategy to 
conduct outreach to this Veteran population and report to the 
House Committee on Appropriations 90 days after enactment of 
this Act.
    VetsCorps.--Existing suicide prevention efforts are failing 
to reach the majority of Veterans in need. The Committee 
directs the Department to create a pilot program, carried out 
over a two-year period, establishing a VetsCorps. This Corps, 
comprised of Veterans themselves, will conduct outreach and 
recruitment to bring in Veterans who have not been served by 
the Department and connect them with available programs and 
services. The VetsCorps will be designed to reach Veterans 
wherever they are and provide a personal connection to VA.
    Furthermore, the Committee encourages the Department to 
facilitate peer-to-peer Veteran support networks within 
VetsCorps for Veterans who are trained in suicide prevention 
and crisis intervention to help other Veterans transition from 
military service to civilian life. The pilot program shall 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 one urban site. At the conclusion of the pilot 
program, the Department shall report to 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. The Committee provides 
$5,000,000 for this pilot program.
    Suicide Prevention Paid Media GAO Report.--The Committee is 
concerned with the findings of the GAO report entitled, 
``Improvements Needed in Suicide Prevention Media Outreach 
Campaign Oversight and Evaluation'' (GAO-19-66), which found 
that VHA had only spent $57,000 of its $6,200,000 fiscal year 
2018 budget for suicide prevention paid media as of September 
2018. In accordance with the GAO report, the Committee 
recommends that the Office of Suicide Prevention and Mental 
Health (OSPMH) establish targets for its metrics to improve its 
evaluation of the effectiveness of its suicide prevention media 
outreach campaign. Further, the Committee directs that OSPMH 
provide the Committee with an expenditure plan on how it 
intends to effectively use fiscal year 2020 suicide prevention 
outreach funds no later than 30 days after enactment of this 
Act.
    Social Media Contact.--The Committee recognizes the 
incidence of mental illness within the Veteran community, and 
the Committee encourages the Department to investigate the use 
of technology, specifically social media database algorithms, 
to detect and identify, via indirect contact such as social 
media, Veterans who are at risk of harming themselves or 
others. Once these individuals are identified, the Department 
would use indirect means of communication to interact with the 
troubled individual to provide help and support in the hope of 
preventing tragedy.
    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.

                          HOMELESS ASSISTANCE

    The Committee provides $1,858,534,000 for VA homeless 
assistance programs, an increase of $40,000,000 above the 
budget request. Additionally, an estimated $7,465,430,000 is 
provided for homeless Veterans treatment costs. These programs 
include the Homeless Providers Grant and Per Diem, the 
Domiciliary Care for Homeless Veterans, the Supportive Services 
for Low Income Veterans and Families, and the Department of 
Housing and Urban Development-Department of Veterans Affairs 
Supported Housing (HUD-VASH) programs. Within this total, the 
bill includes $380,000,000 for the Supportive Services to 
Veteran Families program.
    Homeless Patient Aligned Care Teams (H-PACT) Expansion.--
The Committee directs the Secretary to submit to the Committees 
on Appropriations of both Houses of Congress within 180 days of 
enactment of this Act a report on (1) the benefits of expanding 
the H-PACT program; (2) the expansion to additional locations, 
including rural areas; and (3) additional services to improve 
the program.
    HUD-VASH Program.--The Committee continues to support the 
HUD-VASH program and reminds the Department to continue 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.
    HUD-VASH Case Management.--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.
    Legal Assistance for the Supportive Services for Veteran 
Families (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 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.
    Homeless Women Veterans.--The Committee is concerned with 
the growing number of women Veterans identified as homeless or 
unstably housed and strongly encourages the Department to 
complete an analysis of programs that provide assistance to 
women Veterans to identify the areas in which such programs are 
failing to meet the needs of such women. Therefore, no later 
than 180 days after enactment of this Act, the Committee 
directs the Department to submit a report on the analyses to 
the Committees on Appropriations of both Houses of Congress.
    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. The 
Committee directs VA to work with HUD to submit a report to 
Congress detailing the effectiveness of these measures in 
addressing Veteran homelessness on the United States-Mexico 
border no later than 60 days after enactment of this Act.
    Underemployment of Veterans.--The Committee is encouraged 
by the historically low rates of unemployment and homelessness 
among Veterans. The Committee urges the Secretary to develop a 
strategy to address underemployment, which includes 
partnerships with non-governmental organizations, the private 
sector, and appropriate Federal agencies, which ensures that 
the job skills Veterans gain during active duty service are 
fully realized in professional workplaces.

                            STAFFING ISSUES

    Mental Health Professionals Hiring.--The Committee 
recognizes the growing need for mental health professionals and 
in particular the need for mental health professionals at VA 
facilities. Therefore, the Committee directs the Department to 
prioritize hiring mental health professionals.
    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 input any personally identifiable data. In 
addition, the Committee directs VA to submit a separate report, 
no later than 90 days after enactment of this Act, on efforts 
to recruit and hire medical officers and nurses within VHA, as 
well as any impediments to such efforts. The report should 
include the resources provided for these efforts and 
recommendations for relevant legislation.
    Hiring and Credentialing.--The Committee is concerned if 
the VA hiring and credentialing process may contribute 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.
    Unfilled Positions.--The number of unfilled positions at VA 
has steadily grown and is at present 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 waits for Veterans 
going without service. Section 505 of the MISSION Act required 
VA to post data on unfilled positions and the Committee expects 
VA to comply with this mandate. Therefore, the Committee 
expects VA to actively recruit and hire full-time professionals 
to fill these system-wide vacancies with the resources provided 
from the Committee. The Committee directs the Secretary of 
Veterans Affairs 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. Finally, the 
Committee directs the Secretary to include in this report an 
analysis of the amount of care and services carried out by non-
Department facilities because of unfilled VA positions and how 
much money that has cost taxpayers.

                       ACCESS FOR RURAL VETERANS

    Office of Rural Health (ORH).--The Committee provides 
$270,000,000 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.
    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 2020 
funding, as well as the fiscal year 2021 funding provided in 
advance by this Act.
    Hard-to-Reach Veterans.--The Committee directs VA to submit 
a report providing an analysis of the hardest-to-reach rural 
Veterans, the barriers to accessing these Veterans, and next 
steps to address the needs of these Veterans, no later than 120 
days after enactment of this Act.
    Rural Transportation Barriers.--The Committee recognizes 
that many Veterans in rural areas face significant 
transportation barriers, such as limited transit options or 
long distances without the capability to drive, to attending in 
person appointments. While the Committee recognizes the 
important work of VSOs and the existence of the Veterans 
Transportation Program, a rural transportation gap still 
exists. Of the funds provided for ORH, $5,000,000 shall be for 
a pilot program in which VA provides grants to State Veterans 
Affairs Agencies and VSOs to provide transportation to VA 
appointments for Veterans who live in rural areas. Further, the 
Committee directs the Secretary to submit a report concurrent 
with the President's Budget Request for fiscal year 2021 that 
assesses the viability of this pilot grant program, an analysis 
of rural transportation needs, and whether there is sufficient 
need to increase its funding level to reach additional rural 
Veterans.
    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.
    Lack of Rural Health Providers.--The Committee notes 
persistent issues for VA health facilities in rural areas in 
recruiting and retaining health providers in the face of 
national provider shortages and a highly competitive 
environment. The Committee encourages VA to continue to 
consider expanded use of physician assistants, through both 
physical facilities and expanded access to telehealth services, 
to address the rural health provider gap. The Committee directs 
VA to submit a report, no later than 90 days after enactment of 
this Act, providing an update on VA hiring needs in rural areas 
and VA plans to address the provider gap in rural areas to the 
Committees on Appropriations of both Houses of Congress.
    Telehealth in Rural Areas.--The Committee is encouraged by 
recent efforts by VA with regard to investment in telehealth 
programs. The Committee acknowledges the recent report 
submitted by VA outlining their collaborative efforts with 
several other Federal agencies on this issue. However, the 
report fails to provide an adequate explanation of the specific 
plan/strategy that VA will pursue to provide telehealth access 
to the 33 percent of Veterans who reside in rural areas 
nationwide. Additionally, the Committee remains concerned that 
not enough is being done to expand access to those Veterans in 
rural areas with limited broadband internet access. The 
Committee directs the Secretary and ORH, to elaborate with 
specificity on measures to expand capabilities of telehealth to 
these regions, and continue collaborating with the Department 
of Health and Human Services, which has dedicated programs 
specifically for rural hospital access, and the Department of 
Agriculture, which has dedicated programs specifically for 
rural broadband access, as well as continued participation with 
the President's Rural Prosperity Task Force. The Committee also 
encourages VA to consider partnerships with state and local 
governments to ensure VA and medical facility inclusion in 
ongoing broadband expansion projects. The Committee directs the 
Department to submit a report to the Committee on the cross 
collaboration of departments and programs in regards to a 
specific plan and/or strategy to expand telehealth in rural 
areas, no later than 60 days after enactment of this Act.
    Telehealth For Mental Health.--The Committee recognizes the 
strides made by the Department to reach rural communities with 
telehealth solutions. The Committee encourages further 
development and implementation of telemedicine to treat 
Veterans with mental health issues in rural communities. 
Telemedicine should be used to its maximum capabilities by VA.

                     GENDER-SPECIFIC CARE FOR WOMEN

    The number of women Veterans using VHA services has 
increased 22 percent in four years from 423,642 women Veterans 
in 2014 to 517,241 in 2018. 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 $581,514,000 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.
    Of the amount provided, no less than $35,000,000 shall be 
used to implement women's healthcare programs, and 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. The Committee further requires quarterly 
briefings on the expenditure of these funds. The Committee 
directs VA to provide greater resources at VA Central Office 
and in the field for Mental Health to support the new Women's 
Mental Health initiatives and directs funding to be provided 
for three new staff for the Women's Mental Health section in 
the Office of Mental Health and Suicide Prevention. The 
Committee directs funding for the education of primary care 
providers and women-specific programs, including weight loss 
and pain management, and for the education of peer navigators. 
The Department is further directed to prioritize hiring women 
primary care providers and psychologists for women's clinics 
out of the Medical Services appropriation.
    Additionally, the Committee directs 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.--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 its 
efforts to expand access to care in these areas and ensure 
women veteran health needs, which often differ from men, are 
met.
    Access to Gender-Specific Care for Women.--The Committee 
expects VA to improve care for women Veterans by monitoring 
women Veterans' access to gender-specific care services under 
current and future community care contracts. The monitoring 
should include an examination of appointment scheduling and 
completion times, driving times to appointments, and reasons 
appointments could not be scheduled with community providers. 
VA must provide women Veterans equitable access to the same 
healthcare 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, and the 
Committee expects VHA will expand the list of inspection 
requirements for facility staff to ensure compliance with the 
womens health handbook. It is also important to ensure proper 
coordination of care for women patients with complex care needs 
who must frequently access gender-specific healthcare services 
in the community. This is especially important for women 
Veterans with war-related injuries and/or service conditions 
who are at higher risk for poor outcomes.
    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.
    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.
    Childbirth Data.--The Committee directs VA to provide a 
report no later than 180 days after enactment of this Act 
identifying the number of women Veterans participating in the 
VA healthcare system who have given birth in the five most 
recent years for which data are available, how many of the 
pregnancies were high risk, the number of complications related 
to the mother or baby, and the number of maternal mortalities 
that occurred.
    Maternity Care Benefits, Survey, and Education Campaign.--
The Committee requests a report 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; 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's Health Transition Training.--Women are the fastest 
growing subgroup of Veterans, yet fewer women Veterans seek 
services and support from the Department than men. The 
Committee expresses its support for the expansion of the 
Veterans Affairs Women's Health Transition Training Pilot 
Program and programs similar to it to better support the 
increasing numbers of women who leave the military and enter 
the Veterans Affairs support system.
    Personal Hygiene Products.--The Committee is concerned that 
not all VA facilities have committed to VHA Directive 
1330.01(2) with regards to personal hygiene products, 
specifically menstrual hygiene products, being available in 
public female, unisex, and family restrooms at no charge. The 
Committee directs VHA to submit a report no later than 180 days 
after enactment of this Act on the distribution and 
accessibility of these products across all VA facilities.
    Maternal Mental Health Services.--An estimated one out of 
seven new mothers experience postpartum depression. The 
Committee requests a report on the maternal mental health 
services available to women Veterans at each VISN through VHA 
and the MISSION Act. The report should include mental health 
support services for women Veterans who: have miscarried; had a 
stillborn baby; who have had challenges related to fertility; 
have or have had a high-risk pregnancy; or have postpartum 
depression. The report should also specifically address if 
women Veterans are screened for postpartum depression, as well 
as how many women mental health professionals are available in 
each VA medical facility.

                            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. 
The Committee directs the Secretary of Veterans Affairs to 
submit a report to the Committee on Appropriations of both 
Houses of Congress 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.

                        PRESCRIPTION DRUG ABUSE

    Opioid Abuse.--As the reports of increasing numbers of 
opioid overdoses roil the Nation, 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 VA Opioid Safety Initiative, begun in 2013, 
has resulted in a 25 percent reduction in the number of 
Veterans prescribed opioids for pain relief and the rate of 
overdose among Veterans prescribed a prescription opioid has 
been cut in half. The Committee encourages VA to continue the 
challenging effort to reduce opioid use among Veterans, half of 
whom suffer from chronic pain. The bill provides $396,924,000 
for opioid treatment and prevention efforts, of which 
$54,054,000 is provided for activities authorized by the 
Comprehensive Addiction and Recovery Act of 2016 (P.L. 114-
198).
    Opioid Safety Initiative.--The Committee recognizes that 
VHA has made progress in addressing opioid safety for Veterans 
through its Opioid Safety Initiative (OSI). The Committee 
requests VHA to provide an impact study of OSI's effectiveness 
and challenges no later than 90 days after enactment of this 
Act.
    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 a provider to have real-
time access to data. It is critical that VA clinicians have 
access to a patient's 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.
    Naloxone.--Public health agencies have appropriately 
highlighted the risk of overdose from doses of opioids greater 
than 90 morphine milligram equivalents (MME) per day. The 
Committee is concerned about the hundreds of millions of 
prescriptions each year of immediate release (IR) lower MME 
opioids, such as hydrocodone and oxycodone. These opioids are 
commonly associated with abuse, are a common pathway to 
addiction, and present a risk of overdose. Some States have 
limited the prescribing of these IR opioids. An alternative 
approach might be to assess the benefit of co-prescribing 
naloxone with IR and extended release opioids. Prescribers, 
including dentists and other primary care providers, have an 
opportunity to become more attuned to the risks of all opioids 
through the consideration of co-prescribing naloxone with each 
opioid prescription. The Committee awaits the report for the 
Veterans Health Administration to develop a strategy to test 
this hypothesis, execute a pilot program and assess the benefit 
for enacting such a policy for Veteran patients, as directed in 
House Report 115-673.
    Opioid Treatment Alternatives.--The Committee notes that 
the United States is grappling with an opioid epidemic. Some 
areas, such as Appalachia, are disproportionately hard-hit by 
this crisis. The Committee, therefore, encourages VA to ensure 
pain treatment alternatives to opioids, such as chiropractic 
care, are available to Veterans where they are most needed. 
Further, the Committee encourages VA to integrate such 
treatments into VA's medical centers or clinics to be provided 
by VA staff, or on a contract basis where needed.
    Pain University.--The Committee recognizes the excellent 
and inspiring work from the Tomah VA facility in Tomah, 
Wisconsin, which has successfully implemented a program called 
Pain University. The program seeks to incorporate alternative 
medicine, such as acupuncture and meditation, to reduce 
Veterans' reliance on prescription pain medications, which have 
a higher likelihood of addiction leading to substance abuse. 
The Pain University program was recognized as a gold status 
program by VHA in 2016 for its work. The Committee encourages 
VHA to continue to expand implementation of the Pain University 
program to other VA clinics so more Veterans have access to 
non-addictive pain management therapies.
    Substance Use Disorder (SUD) Study.--As the Committee 
supports VA's ongoing work to reduce substance use disorder 
among Veterans, the Committee is concerned VA has yet to report 
on the number and proportion of Veterans with substance use 
disorder, broken down by age, including a breakdown by state, 
and additionally include available demographic data, as 
requested in House Report 115-673. The report deadline was 120 
days after passage and VA should consider this report a 
priority. The Committee directs VA to provide a status update 
on this study 15 days after this report is filed.
    Opioid Safety and SUD.--The Committee urges VA to implement 
a comprehensive medication selection, adherence, compliance and 
internet-based education pilot program related to opioid safety 
and substance use disorder in order to provide assistance for 
at-risk Veterans. Using off-the-shelf technology, such as smart 
pill bottles, internet-based technologies, and bi-lateral text 
messaging, VA can reduce suicide, relapse, and hospital visits.
    Military Sexual Assault Screening.--In 2016, it was 
estimated that 14,900 servicemembers, both men and women, were 
sexually assaulted, usually more than once. One in four women 
and one in three men were assaulted by someone in their chain 
of command. Due to this high prevalence, it is important to 
ensure that all those who are victims are identified and 
receive proper treatment. The Committee is concerned about the 
high prevalence of sexual assault among servicemembers, both 
men and women, during their service. The Committee is concerned 
that the effects from this assault persist once servicemembers 
return home and can manifest in mental health disorders such as 
depression, PTSD, substance use disorders, eating disorders, 
and anxiety. Because military sexual trauma is prevalent, the 
Committee recommends that all Veterans seeking treatment 
services are screened for sexual assault using evidence-based 
screening tools in order to successfully treat those who have 
experienced assault.
    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.

                        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 working to shift this focus by 
moving to a whole health model, 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. The recommendation provides $20,000,000 above the request 
to expand the use of the Whole Health model.
    Interactive Patient Care.--The Committee is impressed by 
the remarkable work that the Office of Patient Centered Care 
and Cultural Transformation is doing to approach Veterans' 
health with a holistic effort. Early data indicates that 
Veterans who are using Whole Health are using less opioids and 
derive greater satisfaction and meaning in their lives. Yet, 
only 18 Flagship Whole Health facilities exist that are 
implementing the Whole Health System. The Committee is 
concerned that only one-third of VA Medical Centers have 
implemented the Whole Health initiative through interactive 
patient care, a model that empowers patients and educates them 
on the care they receive. Interactive patient care 
implementation has shown increases in patient satisfaction and 
improvement in quality and safety outcomes. Therefore, the 
Committee directs VA to expand use of interactive patient care 
through use of a national contract to ensure coordination and 
standardization of field implementation of the Whole Health 
initiative. Furthermore, the Committee directs the Department 
to submit a report to Congress on the outcomes derived from the 
Whole Health System and the resources needed to expand the 
Whole Health System across all VISNs. The report shall be 
submitted no later than 180 days after enactment of this Act.
    Interactive Patient Care Outside VA Medical Centers 
(VAMCs).--The Committee understands that several VAMCs are 
implementing the Whole Health model through interactive patient 
care, but the Committee is concerned 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 
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.

                          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 
submit the plan by August 1, 2019, to the Committees on 
Appropriations of both Houses of Congress. In addition, the 
Department is directed to submit quarterly reports describing 
implementation of the plan and improvements made for Veterans 
in central Alabama. The Committee further directs the 
Department to develop a plan to address urgent needs at other 
VA healthcare systems with poor or failing grades and to submit 
the report to the Committees on Appropriations of both Houses 
of Congress within 90 days after enactment of this Act.
    Hepatitis C Virus (HCV) Outreach and Testing.--The 
Committee is pleased with VA's significant progress in reaching 
and treating Veterans who have lived with HCV for years, and it 
continues to dedicate resources towards the goal of screening 
and treating Veterans who are disproportionately affected by 
the disease. The Committee notes that the prevalence of 
Hepatitis C is higher among servicemembers, but that prevalence 
data for the cohort at greatest risk, Vietnam Era Veterans, 
remains unknown. VA is encouraged to work with other 
stakeholders and VSOs to conduct an outreach testing campaign 
that establishes the prevalence number for this cohort while 
evaluating point-of-care testing opportunities that can reach 
Veterans outside of the VA system. Furthermore, the Secretary 
is urged to implement a pilot program to evaluate the benefits 
of providing access to rapid point-of-care outreach testing for 
Hepatitis C for Vietnam and Vietnam-era Veterans utilizing 
enhanced eligibility criteria that would make such services 
available to all honorably discharged servicemembers who served 
between February 28, 1961, and May 7, 1975.
    Lung Cancer Screening.--The Committee continues to note 
with concern that Veterans at high risk of developing lung 
cancer do not have access to lung cancer screening programs 
that are available to Medicare beneficiaries. The Committee 
encourages the Department to expand access to lung cancer 
screening for high-risk Veterans by developing a VA Centers of 
Excellence for Lung Cancer program.
    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.
    Colorectal Cancer Screening.--The Committee reminds VA of 
the direction in the Statement of Managers accompanying the 
Consolidated Appropriations Act, 2018 (P.L. 115-141) that 
directed the Department to offer all seven colorectal cancer 
screening strategies recommended by the United States 
Preventive Services Task Force or to notify the Committee if it 
is not using all seven approaches.
    Prostate Cancer.--Prostate cancer is the most frequently 
detected cancer among Veterans, with an estimated 10,000 new 
cases diagnosed annually. Unfortunately, early detection is not 
yet an exact science. Although prostate biopsies are the 
standard of care, they often miss detecting cancer. This fear 
of missed cancer often leads to multiple, invasive biopsies, 
many of which may be unnecessary. Recent biotechnology 
advancements within the emerging field of prostate cancer 
biomarkers have hastened the detection of prostate cancer and 
curbed the financial costs associated with unnecessary repeat 
diagnostic procedures. The Committee encourages VA to 
accelerate the adoption of such technologies within VHA, 
particularly for biomarker tests on the Federal supply 
schedule, to help rule out false-negative biopsy concerns and 
alleviate financial and mental anguish for Veterans.
    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 medical procedures. Extravasations of 
diagnostic radiopharmaceuticals 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. As America's largest integrated healthcare 
system, the VAMC should lead by example in acting to reduce 
medical errors and medical waste. The Committee encourages 
VAMCs to monitor injection quality and develop a physician/
patient reporting system to disclose when extravasations occur. 
No later than 90 days after the enactment of this Act, VHA 
shall provide to the Committees on Appropriations of both 
Houses of Congress a report on efforts to monitor injection 
quality and reduce the incidence of extravasations.
    Pressure Ulcer Prevention.--The Committee remains concerned 
about the incidence of facility-acquired pressure ulcers and 
the associated $1,300,000,000 to $3,600,000,000 in annual costs 
for the treatment of hospitalized patients with pressure ulcers 
in VA facilities. The Committee understands that significant 
health benefits and cost savings may be possible through non-
invasive innovative biometric sensor technologies that have 
produced promising results in the early detection of pressure 
ulcers. The Committee looks forward to receiving the report 
from VA, as requested in House Report 115-673, presenting the 
steps VHA is taking in this area, including the status of 
technologies VA has assessed. However, the Committee believes 
more can be done to reduce the rate of facility-acquired 
pressure ulcers that affect thousands of Veterans each year. 
The Committee directs the Secretary to continue prioritizing 
wound care by executing a pilot program to reduce the incidence 
of pressure ulcers in VA facilities. The Committee provides 
$2,000,000 for the purpose of carrying out a pressure ulcer 
prevention pilot program. The Committee encourages VA to 
consider pilot sites with a clinical and research focus on 
wound care, and locations with higher incidence rates of 
pressure ulcers, such as sites that serve patient populations 
with limited mobility and spinal-cord injury.
    Pressure Ulcer Transparency.--The Committee acknowledges 
the need to better analyze and prevent hospital-acquired 
pressure ulcers/injuries, as well as associated complications, 
in the VA healthcare system. To date, inadequate information is 
available to measure the incidence rates and impact of pressure 
ulcers/injuries at VHA facilities. Department of Health and 
Human Services data demonstrates growing rates of fatal 
hospital-acquired pressure ulcers/injuries nationwide, and 
research published by the National Institutes of Health shows 
more than one-third of Veterans with spinal cord injuries 
report costly pressure ulcer/injuries annually. The Committee 
directs VHA to conduct an assessment of the Department's 
efforts to (1) monitor the incidence and impact of unintended 
Hospital-Acquired Conditions; (2) reduce the incidence of 
pressure ulcers/injuries and Surgical Site Infections; and (3) 
expand public reporting on U.S. Centers for Medicare and 
Medicaid Services hospital comparisons to include total 
pressure ulcer/injury incidence at VA medical centers. The 
Committee further instructs VHA to incorporate never-event 
reduction protocols into existing best practices for its 
Veterans healthcare providers. VHA has adopted healthcare 
transparency as a strategy to enhance public trust and to help 
Veterans make informed choices about their healthcare and 
therefore, the Committee encourages the Department to continue 
its efforts in transparency.
    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.
    Food as Medicine.--The Committee recognizes the value of 
proper nutrition and food's effect on health. Patients with 
three or more chronic conditions represent 35 percent of 
Veterans receiving VA care and account for 65 percent of VHA 
costs. Additionally, 78 percent of Veterans receiving VA care 
are overweight and 41 percent are obese. The Committee 
continues to urge VHA to be proactive in promoting wellness and 
disease prevention by providing evidence-based nutritional 
services. The Committee directs VA to provide a status update 
on current practices as well as a plan to expand nutritional 
education and means to increase access to nutritional foods for 
Veterans 15 days after this report is filed.
    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.
    Hospice Care for Veterans.--The Energy and Water, 
Legislative Branch, and Military Construction and Veterans 
Affairs Appropriations Act, 2019 (P.L. 115-244) urged VA to 
undertake a pilot program to develop techniques, best 
practices, and support mechanisms to improve end-of-life care 
for combat Veterans and Vietnam-era Veterans. Due to the lack 
of meaningful advancement toward addressing the unique needs of 
Vietnam Veterans, VA is directed to carry out this pilot 
program and to engage nonprofit hospice and palliative care 
providers with Vietnam Veteran-centric programs in implementing 
the pilot program. The Committee is aware that organizations 
such as the nonprofit National Partnership for Hospice 
Innovation are developing programs designed to meet the 
specific end-of-life care needs for Vietnam-era Veterans and 
strongly reiterates that such an approach could be beneficial 
to Iraq, Afghanistan, and Syria combat Veterans in the future. 
The Committee directs VA to provide to the Committees on 
Appropriations for both Houses of Congress an update, no later 
than 30 days after enactment of this Act, on the status of this 
pilot program.
    VA Affiliation With Minority Medical Schools.--The 
Committee is pleased with the Department's improvements to its 
academic affiliation activities with minority medical schools. 
For the purposes of enhancing training initiatives, improving 
patient care, and providing educational opportunities for our 
Nation's Veterans, the Committee urges VHA and the Office of 
Academic Affiliations to maintain this ongoing commitment to 
minority health professions schools and report back to Congress 
no later than 90 days after enactment of this Act on the 
progress.
    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 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 
shall take into consideration that the Department is in the 
midst of an acquisition of a new electronic health record 
system that will combine the Department's current data 
collecting programs and make recommendations of how 
implementation of this new program can help improve data 
collection on Veterans.
    Freely Associated States (FAS) Veterans' Access.--The 
Committee is concerned about impediments to VA healthcare 
access for FAS Veterans. Veterans in the FAS must travel 
hundreds to thousands of miles to the nearest VA medical center 
in Guam or Hawaii, in some circumstances at their own expense, 
to get healthcare. For those who are able to travel to seek 
care, the collective costs are magnified by lost wages 
resulting from missed days at work and childcare costs, as well 
as time away from families. Given the significant time, 
resources, and high costs for travel for some Veterans, 
including airfare, transportation, and lodging, many FAS 
Veterans are never able to access the VA health services they 
have earned through their military service. As VA works to 
transform its Community Care programs, the Committee directs 
VA, no later than 90 days after enactment of this Act, to 
provide a report that assesses options for improving access to 
VA healthcare for FAS Veterans. The report should include the 
number of Veterans residing in the FAS who have utilized 
services in VA Pacific Islands Health Care System facilities 
over the last three fiscal years, the extent of travel benefits 
offered to Veterans and eligibility requirements for the 
benefits, an average estimated personal cost for an FAS Veteran 
to access VA care, the estimated costs for providing telehealth 
services in FAS through a pilot program, and recommendations 
for how VA can reduce burdensome restrictions under the Foreign 
Medical Program using existing authorities. Furthermore, the 
Committee encourages VA to work with Federal and non-Federal 
partners, including the Departments of Defense, Interior, and 
Health and Human Services, as well as non-VA healthcare 
facilities and educational institutions, to leverage shared 
resources and improve access for delivery of care through 
collaboration.
    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, by increasing the number of full-time, 
dedicated, VA medical and mental health providers in these 
areas.
    FAS Data Collection.--The Committee remains concerned about 
the challenges to accessing quality healthcare for Veterans 
residing in outlying areas, such as the Northern Mariana 
Islands and the Freely Associated States. The Committee is 
aware of potential obstacles in data collection to account for 
the number of Veterans residing in these areas. The Committee 
seeks to understand the data limitations that may exist, and 
how VA can improve data collection from the outlying areas to 
help inform the development of proposals to ensure that health 
needs of Veterans, including Pacific Island Veterans, are met. 
The Committee looks forward to receiving the strategic plan as 
requested in Conference Report 115-929 to improve the 
utilization of healthcare services of Veterans in outlying 
areas. In addition, the Secretary is directed to provide the 
Committees on Appropriations of both Houses of Congress with 
information regarding VA's process for informing Veterans in 
the outlying areas about enrollment in the Foreign Medical 
Program and if the Department discloses information about 
potential barriers Veterans may face in utilizing services and 
other VA benefits in outlying and remote 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. 
Today, approximately 15,000 Veterans receive timely access to 
high-quality dialysis services through these national dialysis 
contracts. The Committee will monitor the Department's 
transition to the Community Care Network (CCN) contracts when 
an adequate network of dialysis providers is available in the 
CCN. 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.
    Healthcare-Associated Infection (HAI) Reduction.--The 
Committee is concerned with improving the quality of healthcare 
for Veterans and their family members, including by reducing 
the incidence of HAIs and methicillin-resistant Staphylococcus 
aureus (MRSA) infections. According to the Centers for Disease 
Control and Prevention, roughly one in thirty-one hospital 
patients has at least one HAI at any given time. HAIs are 
associated with roughly 99,000 deaths per year and contribute 
billions of dollars annually to the total cost of healthcare. 
Within medical treatment facilities, medical gowns, bed linens, 
and other textiles and hard surfaces such as bed-rails, work 
stations, and trays are major vectors for these types of 
infections. Therefore, the Committee directs the Department to 
submit a report no later than 180 days after enactment of this 
Act to the Committees on Appropriations of both Houses of 
Congress on the rate of incidence of HAIs within all medical 
care facilities under its jurisdiction; recommend means of 
reducing the incidence of HAIs at such facilities; and consider 
infection reduction functionality in procurement decisions 
regarding textiles and hard-surface items. The Committee 
further encourages the Department to use evidence-based tools 
to significantly reduce the incidence of HAIs.
    Creutzfeldt-Jakob Disease Monitoring.--Veterans and their 
dependents who resided at United States Military bases 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 bases 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.
    Artificial Intelligence And Machine Learning.--The 
Committee directs the Secretary to submit a report to the 
Committees on Appropriations of both Houses of Congress no 
later than 180 days after enactment of this Act on how the 
Department is utilizing artificial intelligence and machine 
learning to improve healthcare services to Veterans.
    Prosthetics.--The Committee is concerned about the proposed 
regulation regarding prosthetic and orthotic providers and 
strongly encourages the Department to allow Veterans to choose 
the best provider for their needs.
    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.
    Burn Pits.--The Committee continues to support VA's work 
through the Airborne Hazards and Burn Pits Center of Excellence 
on diagnoses, mitigation, and treatment of conditions related 
to airborne hazards and burn pits. The Committee continues to 
encourage VA to partner with the Department of Defense, 
institutes of higher learning, and other public and private 
entities to carry out this initiative and provides an 
additional $5,000,000 for the Center.
    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.
    VSO Wellness Pilot Program.--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. 155-141). This is a priority of 
the Committee, and the Department is directed to implement the 
pilot program expeditiously. The Committee directs VA to 
provide a status update on the pilot program no later than 14 
days after the report is filed.
    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, where possible, to have health videos 
available to Veterans and directs the Secretary to develop a 
plan to implement educational video systems within VHA.

                         Medical Community Care


 
 
 
Fiscal year 2019 enacted level......................      $9,384,704,000
Fiscal year 2020 enacted level......................      10,758,399,000
Fiscal year 2020 budget year request................       4,521,400,000
Committee 2020 budget year recommendation...........       4,521,400,000
Fiscal year 2021 advance appropriation request......      17,131,179,000
Committee 2021 advance appropriation recommendation.      17,131,179,000
Comparison with:
    Fiscal year 2020 enacted level..................       6,372,780,000
    Fiscal year 2021 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 2021, the bill provides 
$17,131,179,000, of which $2,000,000,000 is available until 
September 30, 2022.
    The Committee provides $4,521,400,000 for an additional 
amount for fiscal year 2020 as requested in the budget request.
    Third-Party Payments and Reimbursements.--The Committee 
is concerned about the timeliness of reimbursements by VA to 
private healthcare/third-party providers. The Committee remains 
concerned that VA has created an inefficient process that must 
be reformed. As VA continues the MISSION Act implementation, 
the Committee believes VA must further prioritize efficient and 
prompt payment to community providers to ensure timely access 
to quality care. Delays in processing of such payments 
undermines the ability to recruit and retain private healthcare 
providers to service our Nation's Veterans, especially among 
rural communities. Therefore, no later than 90 days after 
enactment of this Act and then on a quarterly basis, the 
Secretary shall provide the Committees on Appropriations of 
both Houses of Congress a comprehensive report detailing the 
amount owed to outside providers for every State. The report 
shall 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, this report will include a comprehensive plan to 
prevent this issue from reoccurring in the future.
    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 awaits the fiscal year 2019 report, as requested in 
House Report 115-673, on the effectiveness of the programs with 
third-party administrators.
    Transportation to Community Care Providers.--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 moving forward. 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.

                     Medical Support and Compliance


 
 
 
Fiscal year 2019 enacted level......................      $7,239,156,000
Fiscal year 2020 enacted level......................       7,239,156,000
Fiscal year 2020 budget year request................          98,800,000
Committee 2020 budget year recommendation...........          98,800,000
Fiscal year 2021 advance appropriation request......       7,914,191,000
Committee 2021 advance appropriation recommendation.       7,914,191,000
Comparison with:
    Fiscal year 2020 enacted level..................         675,035,000
    Fiscal year 2021 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 $7,914,191,000 in advance fiscal year 
2021 funding. The Committee has included bill language to make 
available through September 30, 2022, $150,000,000 of the 
Medical Support and Compliance appropriation for fiscal year 
2021.
    The Committee provides $98,880,000 for an additional amount 
for fiscal year 2020 as requested in the budget request.

                           Medical Facilities


 
 
 
Fiscal year 2019 enacted level......................      $6,004,468,000
Fiscal year 2020 enacted level......................       6,141,880,000
Fiscal year 2020 budget year request................               - - -
Committee 2020 budget year recommendation...........          20,000,000
Fiscal year 2021 advance appropriation request......       6,433,265,000
Committee 2021 advance appropriation recommendation.       6,433,265,000
Comparison with:
    Fiscal year 2020 enacted level..................         291,385,000
    Fiscal year 2021 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 $6,433,265,000 in advance fiscal year 
2021 funding. The Committee has included bill language to make 
available through September 30, 2022, $250,000,000 of the 
advance Medical Facilities appropriation for fiscal year 2021.
    The Committee provides $20,000,000 as an additional amount 
above the non-recurring maintenance (NRM) fiscal year 2020 
appropriation of $1,175,581,000 for women's health and mental 
health NRM projects. 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.
    Spending 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 2020 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.
    Facility Expansion.--The Committee continues to support an 
expansion of the number of clinics available to Veterans. To 
help accomplish this, the Committee encourages VA to identify 
CBOC facilities, with a priority in underserved, rural, and 
remote areas, for facility expansion opportunities in order to 
accommodate additional patients and provide enhanced services, 
thereby reducing the need for Veterans to travel long distances 
for care. VA is encouraged to look at existing CBOCs that are 
operating at full capacity, have a proven record of delivering 
services, and have community support to expand the facility. 
Additionally, the Committee urges VA to continue to explore the 
potential benefits of placing VA clinics on military 
installations located in areas with high Veteran populations 
and where nearby VA infrastructure is overburdened.
    Community-Based Outpatient Clinic in California.--The 
Committee is encouraged by the issuance of a lease for a new 
community-based outpatient clinic in Bakersfield, California, 
and directs the Department to expeditiously finalize this 
project and continue to provide regular updates as directed in 
House Report 114-497.
    Operating Room Patient Safety and Fire Prevention.--The 
Committee is concerned that operating room fires have been 
increasing and encourages the Department to look at technology 
that can mitigate risks of fires. The Committee directs of the 
funds provided not less than $1,000,000 shall be utilized by 
the Department to carry out a pilot project that tests and 
validates operating room fire safety technology at multiple VHA 
medical facilities and report back to the Committee on the 
status of the pilot within 90 days of enactment of this Act. 
Furthermore, the Committee directs the Department to provide an 
annual report concurrent with the budget submission to the 
Committees on Appropriations of both Houses of Congress, on the 
number of operating room fire events, data showing the total 
number of tort claims, the amount per claim, and the total 
amount of these claims, paid by the Department of the 
Treasury's Judgment Fund or any other taxpayer-funded sources 
as a result of VA operating room fires and safety issues and 
VHA's effort to reduce the risk of operating room fires 
utilizing available technology.
    Strategic Analytics for Improvement and Learning (SAIL).--
The Committee directs the Secretary to quarterly address and 
provide the Committees on Appropriations of both Houses of 
Congress material on failing VA facilities as defined by VA's 
SAIL data. The quarterly update will include the current state 
of failing facilities and any steps or improvements that are in 
place.
    Facility Transformations.--The Committee directs the 
Department to report 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 need 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. VA's 
own 2015 Study of Barriers for Women Veterans to VA Health Care 
noted that women Veterans experienced unwanted sexual attention 
at VA facilities. The President's Budget for Fiscal Year 2020 
identifies the need to upgrade facilities to better serve women 
Veterans, such as separate entrances and parking accommodations 
that will take several years to implement. VA's construction 
priority list was established over decades and contains 
billions of urgently needed repairs. The 2019 VA Strategic 
Capital Investment Planning Process (SCIP) list of construction 
projects had approximately $120,000,000 in unfunded facilities 
improvements for women Veterans. The Committee directs the 
Department to prioritize funding for medical facilities to 
accommodate women Veterans.
    Use of Smart Technologies.--The Committee is interested in 
the potential use of new and innovative devices, systems, and 
networks to improve the operation and management of VA 
facilities, such as energy, traffic control, perimeter security 
and access control systems, and encourages the Department to 
work with industry leaders to develop a demonstration project 
that could be adapted 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.
    War Related Illness and Injury Study Centers (WRIISC).--The 
Committee is concerned that research and clinical trials are 
urgently needed to develop effective treatments for Veterans 
exposed to toxic environmental hazards, such as burn pits. Cost 
effective models for rapid development of new treatments for 
Gulf War Illness using computational models, research funding 
through DOD's Congressionally Directed Medical Research Program 
(CDMRP), and clinical experts in environmental medicine have 
proven effective in partnership with VA medical centers. The 
Committee notes the Department's extensive discussions of 
adding additional WRIISC sites, and directs the Secretary to 
establish a WRIISC focused on toxic environmental exposures to 
leverage research funding through the CDMRP and clinical 
partnerships.
    Women Veterans Health Facilities.--The Committee is 
concerned about the harassment women Veterans have had to 
endure at VA healthcare facilities. The Committee requests VHA 
to conduct a feasibility study of establishing women-only 
clinics in each VISN no later than 180 days after enactment of 
this Act.

                    Medical and Prosthetic Research


 
 
 
Fiscal year 2019 enacted level........................      $779,000,000
Fiscal year 2020 budget request.......................       762,000,000
Committee recommendation in the bill..................       840,000,000
Comparison with:
    Fiscal year 2019 enacted level....................        61,000,000
    Fiscal year 2020 budget request...................        78,000,000
 

    This appropriation provides for medical, rehabilitative, 
and health services research. The bill provides $840,000,000 
available through September 30, 2021. The Committee recognizes 
the importance of the research conducted by VA for Veterans' 
quality of life and health and provides $78,000,000 above the 
request and $61,000,000 above fiscal year 2019 for these 
activities.
    Medical research is an important aspect of the Department's 
programs, providing complete medical and hospital services for 
Veterans. 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 2020 research resources beyond the research account 
are $1,217,000,000.
    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 provides $40,000,000 for the Center in fiscal 
year 2020, 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.
    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. The Secretary shall 
submit a report to the Committees on Appropriations of both 
Houses of Congress no later than 180 days after enactment of 
this Act, detailing the feasibility of such a pilot program and 
the metrics required to determine the value of exposure therapy 
utilizing therapeutic virtual environments using real-time 
modeling and simulation training to treat PTSD.
    Dystonia.--The Committee notes the connection between 
traumatic brain injury and the onset of dystonia. The Committee 
continues to urge VA to pursue collaboration with stakeholders 
to advance critical research on dystonia.
    Cannabis Research.--The Committee recognizes that continued 
focus on the discovery of treatment alternatives for Veterans 
diagnosed with various conditions, such as chronic pain and 
PTSD, is essential to reducing the number of Veteran suicides. 
For this reason, the Energy and Water, Legislative Branch, and 
Military Construction and Veterans Affairs Appropriations Act, 
2019 (P.L. 115-244) urged VA to utilize funds to prioritize 
investments in research on the efficacy and safety of cannabis 
usage among the Veteran population for medicinal purposes and 
submit a report to the Committee no later than 180 days after 
enactment of that Act. The report has yet to be submitted to 
the Committee, therefore the Committee directs VA to provide a 
status update of this outstanding report no later than 15 days 
after the report is filed.
    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.
    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.
    Female Prosthetics Research.--The Committee strongly 
supports robust funding for medical and prosthetic research. 
Recognizing that approximately six percent of wounded Veterans 
returning from Iraq and Afghanistan are amputees, and the 
number of Veterans accessing VA healthcare for prosthetics and 
sensory aids continues to increase, this funding greatly 
enhances Veterans' quality of life. However, there is an acute 
need for research specializing in female prosthetics, as most 
prostheses are designed to fit male Veterans. Since three 
percent of military amputees are female, 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. The 
Committee directs $25,000,000 for VA to prioritize and fund 
extramural research that accelerates 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.--The Committee recommends the 
Department continue to conduct epidemiological studies 
regarding the prevalence of Gulf War Illness, morbidity, and 
mortality in Persian Gulf War Veterans and the development of 
effective treatments, preventions, and cures. The Committee is 
concerned by the lack of public availability of the findings of 
all research conducted by or for the Executive Branch relating 
to the health consequences of military service in the Persian 
Gulf theater of operations during the Persian Gulf War, and by 
the lack of coordination by the Department in ensuring the 
public availability of this information. The Committee urges 
the Department to publish disease-specific mortality data 
related specifically to Persian Gulf War Veterans. The 
Committee remains concerned by VA's ever-evolving terminology 
for the signature adverse health outcome of the Persian Gulf 
War, 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.--This 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 2021 budget 
request.
    Ultrasound Guided Regional Anesthesia for Opioid 
Reduction.--The Committee continues to be concerned about the 
use of opioids to address pain in the VA Healthcare System. The 
Committee is aware of several protocols being tested in non-VA 
hospitals, such as Alternatives to Opioids in the Emergency 
Department, Enhanced Recovery After Surgery, and the 
Perioperative Surgical Medical Home. The Committee encourages 
VA as part of its opioid prevention efforts to provide VA 
clinicians with resources to study and potentially adopt these 
and other ultrasound guided regional anesthesia protocols to 
reduce the number of opioids prescribed and used to treat 
Veterans' acute and urgent pain.
    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 the Department of Veterans 
Affairs 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. The 
Committee directs VA to submit a report no later than 120 days 
after enactment of this Act to the Committees on Appropriations 
of both Houses of Congress on existing collaborative efforts 
between VA and NICoE and the expansion of such collaborations.
    Collaboration on Precision Medicine.--The Committee 
supports expanding the reach of the Department's research 
program, such as by partnering with non-federal entities and 
initiatives and co-locating VA and university biomedical 
scientists, and encourages the Department to expeditiously seek 
opportunities for collaboration on precision medicine and other 
multi-disciplinary research for wounded warriors and other at-
risk Veterans.
    Hyperbaric Therapy.--The Committee supports continued study 
of the use of hyperbaric oxygen treatments for Veterans 
suffering from post-traumatic stress disorder.
    Drug Development for Depression and Suicide Prevention.--
Depression, post-traumatic stress disorder, and suicide 
threaten to reach epidemic proportions among America's Veteran 
warfighters. Recent National Institute of Mental Health 
clinical trials investigating the use of intravenous 
Scopolamine to treat depression have shown potentially 
promising initial results to address this issue and the 
potential to assist in the prevention of suicide. The Committee 
encourages the Department to look at all drug development to 
build upon current research efforts to prevent depression and 
suicides.
    Rapid Cerebral Therapeutic Hypothermia.--Veterans who 
suffer from brain injury frequently experience long-term 
cognitive effects. Evidence has demonstrated that immediate 
cooling of the brain following traumatic injury can reduce 
brain damage and improve outcomes. The Committee supports the 
research of rapid cerebral therapeutic hypothermia to lessen 
the long-term effects of traumatic brain injuries.
    Parkinson's Disease Research.--Parkinson's Disease 
Research, Education and Clinical Centers (PADRECCs) allow for 
approximately 110,000 United States Veterans diagnosed with 
Parkinson's disease to receive specialized, multidisciplinary 
care of the highest quality, leading to improved quality of 
life and improved health outcomes. The six PADRECCs located 
throughout the United States have expanded care through a 
National Consortium that offers specialized Parkinson's disease 
and movement disorder specialty care in 51 Consortium Centers 
to Veterans who cannot travel to a PADRECC. The mission of the 
PADRECCs is to support quality of life by providing 
comprehensive medical and surgical care to Veteran patients 
with Parkinson's disease and other movement disorders, 
advancing investigation into the cause and cure for Parkinson's 
disease, and enhancing understanding of the disorder through 
education and research. The Committee strongly supports 
Parkinson's disease research and encourages the Department to 
increase funding to PADRECCs to allow the Centers to address 
the growing and complex needs of the population, while 
continuing to provide specialized, multidisciplinary care to 
Veterans diagnosed with Parkinson's disease and other movement 
disorders.

                     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 2020 is $3,912,000,000.
    MCCF Third-Party Billing.--Congress remains concerned over 
potential discrepancies in VA's billing process. Procedures to 
provide for correct billing and prompt collection must improve 
at VA. Therefore, the Department shall submit to 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 report shall 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 shall 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.

                    National Cemetery Administration


 
 
 
Fiscal year 2019 enacted level........................      $315,836,000
Fiscal year 2020 budget request.......................       329,000,000
Committee recommendation in the bill..................       329,000,000
Comparison with:
    Fiscal year 2019 enacted level....................        13,164,000
    Fiscal year 2020 budget request...................             - - -
 

    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 144 
operational national cemeteries, 11 cemeteries transferred from 
the Department of the Army, and 33 other cemeterial 
installations.
    The bill includes language making ten percent of the total 
available until September 30, 2021.
    Rural Cemetery Access.--In House Report 112-94 and House 
Report 115-188 the Committee expressed concern that NCA is not 
adequately serving the Nation's Veterans in rural areas. The 
Committee continues to be concerned that there are geographic 
pockets in the country that are not being served, as VA has 
failed to meet its goals of having access for all Veterans to a 
burial option within 75 miles of a Veteran's home. The 
Committee has previously requested a report on this issue and 
in fiscal year 2018 requested that GAO examine this issue as 
well. The Committee remains interested and looks forward to 
this report no later than 60 days after enactment of this Act.

                      Departmental Administration


                         GENERAL ADMINISTRATION

                     (INCLUDING TRANSFER OF FUNDS)

 
 
 
Fiscal year 2019 enacted level........................      $355,897,000
Fiscal year 2020 budget request.......................       369,200,000
Committee recommendation in the bill..................       369,200,000
Comparison with:
    Fiscal year 2019 enacted level....................        13,303,000
    Fiscal year 2020 budget request...................             - - -
 

    The General Administration account provides funds for the 
Office of the Secretary, seven Assistant Secretaries, and three 
independent staff offices. The Committee has included bill 
language to make available through September 30, 2021, 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. Included in this funding is 
$22,000,000 for the Office of Accountability and Whistleblower 
Protection. This office was previously funded out of 
reimbursements, and the recommendation provides a direct 
funding source to ensure its independence from Department 
leadership.
    VA Five Year Development Plan (VFYDP).--The Committee is 
very pleased that the Department has provided a VFYDP in its 
fiscal year 2020 budget. The Committee looks forward to 
continued annual review of the VFYDP in 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 feels 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 $11,900,000 in this account as well as 
$66,000,000 in the Information Technology Systems account for 
FMBT. An additional $107,000,000 will be provided from the VA 
customer offices through the Franchise 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 2020.
    Whistleblower Protection.--The Committee reiterates that 
the purpose of the Department of Veterans Affairs 
Accountability and Whistleblower Protection Act of 2017 (P.L. 
115-41), was to increase accountability and the integrity of 
Veterans services and care. Public Law 115-41 is not a 
retaliatory tool for management to use against employees or a 
means of discrimination against employees who are also 
Veterans. In order for this legislation to work as intended, it 
must be applied consistently and as intended, which is why the 
Department of Defense and Labor, Health and Human Services, and 
Education Appropriations Act, 2019 and Continuing 
Appropriations Act, 2019 (P.L. 115-245) directed the Secretary 
of Veterans Affairs to provide a report on this matter. 
Unfortunately, the Committee has yet to receive a report, which 
is concerning as the congressional intent was to receive 
information on the application of such authorities to employees 
organized by wage grade, an assessment of whether such 
authorities are being disproportionately applied to lower wage 
grades, as well as the information on the frequency of appeals. 
In addition, the report was to include demographic data on 
overall VA workforce terminations since fiscal year 2016. 
Therefore, the Committee directs the Secretary of Veterans 
Affairs to provide a status update on this report 15 days after 
the filing of this report.
    Small, Minority- and Women-Owned Businesses.--The Committee 
recognizes the need for the Department to continue to meet its 
goals for contracting with minority, disadvantaged, and women-
owned businesses. The Committee is concerned that in fiscal 
years 2016 and 2017, the Department missed its prime 
contracting goals for women-owned businesses, and businesses in 
HUBZones. In fiscal year 2016, the Department missed all of its 
subcontracting goals for women-owned businesses, small 
disadvantaged businesses, service-disabled Veteran-owned 
businesses, and businesses in HUBZones. 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 
directs the Department to submit a report, no later than 180 
days after enactment of this Act and annually thereafter, 
detailing the number of contractors that submitted a small 
business subcontracting plan during the fiscal year. This 
report shall 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.
    Advertising With Small and Disadvantaged Businesses.--The 
Committee notes 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 the Department to include the following 
information concurrent with the fiscal year 2021 budget 
request: Expenditures for fiscal year 2020 and expected 
expenditures for fiscal year 2021, respectively, for (1) all 
contracts for advertising services; and (2) contracts for the 
advertising services of (i) socially and economically 
disadvantaged small business 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.
    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 of 
Veterans Affairs display information in the annual report(s) 
submitted to Congress separately for women Veterans and 
minority Veterans.
    Mail Management.--The Committee notes the GAO report 
titled, ``VA: Actions Needed to More Effectively Manage 
Outgoing Mail'' (GAO-17-581), and requests the Department 
provide a report on the potential costs and benefits of 
centralizing its mail management system no later than 180 days 
after enactment of this Act. The report should include 
information on innovative information technology platforms that 
could result in savings and increased efficiency.

                       Board of Veterans' Appeals


 
 
 
Fiscal year 2019 enacted level........................      $174,748,000
Fiscal year 2020 budget request.......................       182,000,000
Committee recommendation in the bill..................       182,000,000
Comparison with:
    Fiscal year 2019 enacted level....................         7,252,000
    Fiscal year 2020 budget request...................             - - -
 

    The bill makes ten percent of this funding available 
through September 30, 2021.
    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. VA decided 85,000 cases in fiscal year 2018, which was 
a record level by 25,000 cases, and was VA's best year since 
2009 for efficiencies. VA is on pace to exceed the 2019 goal of 
90,050 decisions.
    The bill also provides the $4,100,000 as requested in the 
Information Technology Systems budget 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.

                     INFORMATION TECHNOLOGY SYSTEMS

                     (INCLUDING TRANSFER OF FUNDS)

 
 
 
Fiscal year 2019 enacted level........................    $4,103,000,000
Fiscal year 2020 budget request.......................     4,343,000,000
Committee recommendation in the bill..................     4,343,000,000
Comparison with:
    Fiscal year 2019 enacted level....................       240,000,000
    Fiscal year 2020 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 $1,204,238,000 for pay and associated costs, which is 
equal to the budget request; $2,737,482,000 for operations and 
maintenance, which is equal to the request; and $401,280,000 
for development, which is equal to the request. The bill makes 
available three percent of pay and associated costs and five 
percent of operations and maintenance funds until September 30, 
2021. All development funds are available until September 30, 
2021.
    The bill provides $66,000,000 to continue the Financial 
Management Business Transformation (in addition to the 
$11,900,000 provided for FMBT in the General Administration 
account and the $107,000,000 provided out of the Franchise 
Fund), $36,785,000 for the supply chain management 
modernization, and $6,000,000 for the VA Center for Innovation 
to improve existing programs or inform decisions about new 
programs.
    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................................            $32,910
Health Management Platforms..........................             80,690
Benefits Systems.....................................            136,823
Memorial Affairs.....................................             13,877
Other IT Systems.....................................            100,480
Cybersecurity........................................             16,600
Information/Infrastructure Management................             19,900
    Total All Development............................            401,280
------------------------------------------------------------------------

    The Committee expects the Office of Information 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 shall 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.
    Information Technology National Standards.--The Committee 
encourages the Veterans Health Administration to vigilantly 
pursue the Department of Veterans Affairs 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, including maintaining up-to-
date security systems and security infrastructure. VHA should 
solicit, review, and respond in a timely fashion to short-term 
IT requests from its Medical Centers. 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 sync and short-
term outstanding service should both be a part of VHA's 
management strategy.

                VETERANS ELECTRONIC HEALTH RECORD (EHR)

 
 
 
Fiscal year 2019 enacted level........................    $1,107,000,000
Fiscal year 2020 budget request.......................     1,603,000,000
Committee recommendation in the bill..................     1,603,000,000
Comparison with:
    Fiscal year 2019 enacted level....................       496,000,000
    Fiscal year 2020 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 $1,106,500,000 
for the electronic health record contract, $161,800,000 for 
program management, and $334,700,000 for infrastructure 
support. Funding is made available for three years because of 
the uncertainty of the timing of obligations in this 
substantial new effort.
    The recommendation includes a rescission of $70,000,000 
from unobligated balances in section 250 under Administration 
Provisions.
    The Department has committed in future years to provide 
approximately 30 percent of the total cost of this ten-year 
project. The Committee expects that this pledge will be 
maintained even if there are changes in the Department's 
leadership.
    The bill does not include the transfer language requested 
by the Administration. 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 to this account or for funds from 
this account to be transferred 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 language for this account continues to require the 
Secretary to submit a report quarterly to the Committees on 
Appropriations of both Houses of Congress detailing 
obligations, expenditures, and deployment strategy by facility. 
In addition, bill language is included requiring notice to the 
Committees on Appropriations of both Houses of Congress on any 
changes to the deployment schedule. The Committee repeats the 
fiscal year 2019 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. 
Furthermore, the Committee directs VA to provide quarterly 
reporting on EHRM obligations.
    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.
    Informatics.--In conjunction with the implementation of the 
EHRM program, the Committee recommends that VA continue to 
develop and implement, within the Veterans Health 
Administration, a comprehensive enterprise interoperability and 
intelligence strategy in order to benefit from advances in the 
health information technology marketplace for utilization by 
both Office of Information Technology and Informatics purposes. 
Such a strategy should include modernized enterprise data and 
analytics capabilities, a clinical interoperability platform, 
and open-application program interfaces leveraging community 
healthcare interoperability standards.
    Cybersecurity.--Recognizing the cybersecurity challenges of 
sharing data between the Military Healthcare System GENESIS and 
the VA EHRM initiative, the Committee urges the Department to 
explore and invest in modern, software-defined networking and 
hybrid cloud technologies to ensure that its EHRM network and 
IT infrastructure will effectively support the Cerner 
implementation and its subsequent use.
    Open Architecture.--The Committee encourages VA to ensure 
the new EHR initiative provides an open architecture that 
allows a governance and oversight process for administering 
access and support to deploy third-party applications, 
components, and application programming interfaces to ensure 
longevity of the EHR platform and requests information on the 
EHRM architecture be included in quarterly reports.
    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, resulting in long wait times for Veterans. 
VA's ongoing efforts with EHRM and interoperability with the 
Department of Defense 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.
    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. VA is encouraged to conduct 
this pilot in a VA Region where it can operate in tandem with 
DOD's rollout of the EHR platform and the Defense Health 
Agency's pilot project as directed in Section 731 of Public Law 
115-91.

                      OFFICE OF INSPECTOR GENERAL

 
 
 
Fiscal year 2019 enacted level........................      $192,000,000
Fiscal year 2020 budget request.......................       207,000,000
Committee recommendation in the bill..................       222,000,000
Comparison with:
    Fiscal year 2019 enacted level....................        30,000,000
    Fiscal year 2020 budget request...................        15,000,000
 

    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, 2021.
    The Committee provides an additional $15,000,000 above the 
budget request to ensure robust oversight by OIG of MISSION Act 
and EHRM implementation.

                      CONSTRUCTION, MAJOR PROJECTS

 
 
 
Fiscal year 2019 enacted level........................    $1,127,486,000
Fiscal year 2020 budget request.......................     1,235,200,000
Committee recommendation in the bill..................     1,235,200,000
Comparison with:
    Fiscal year 2019 enacted level....................       107,714,000
    Fiscal year 2020 budget request...................             - - -
 

    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 $480,000,000 of 
these funds available for a five-year period.
    In past years, this appropriations bill repeated language 
that is in permanent law requiring that all major construction 
projects costing more than $100,000,000 be managed by a non-VA 
government entity such as the Army Corps of Engineers. Because 
this policy is now well-established, the Committee no longer 
feels a need to duplicate the language. However, 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)
------------------------------------------------------------------------
                                                           Committee
            Location                  Description        Recommendation
------------------------------------------------------------------------
VHA:
New York, NY, Manhattan VAMC....  Flood Recovery.....            150,000
Bay Pines, FL...................  Inpatient/                      30,000
                                   Outpatient
                                   Improvements.
San Juan, PR....................  Seismic                         30,000
                                   Corrections--Build
                                   ing #1.
San Diego, CA...................  SCI & Seismic                   20,000
                                   Corrections.
Reno, NV........................  Correct Seismic                 10,000
                                   Deficiencies &
                                   Expand Clinical
                                   Services Building.
Louisville, KY..................  New Medical                    410,000
                                   Facility.
West Los Angeles, CA............  Build New Critical              25,000
                                   Care Center.
Alameda, CA.....................  Outpatient Clinic &             26,000
                                   National Cemetery.
Advance Planning and Design Fund  Various Locations..             72,000
Asbestos:.......................  Various Locations..             12,000
Major Construction Staff:.......  Various Locations..             88,700
Judgment Fund:..................  Various Locations..             25,000
Non-Dept. Fed. Entity Project     Various Locations..            120,000
 Management Support.
Seismic Corrections:............  Various Locations..             35,000
    Total VHA...................  ...................          1,053,700
National Cemetery Admin. (NCA):
Bayamon, PR.....................  Replacement                     10,000
                                   Cemetery (Morovis).
Riverside, CA...................  Gravesite Expansion              3,000
                                   & Cemetery
                                   Improvements.
Elmira, NY......................  Western New York                10,000
                                   Cemetery.
Houston, TX.....................  Gravesite Expansion             34,000
Bourne, MA......................  Massachusetts Phase             32,000
                                   4 Expansion.
Dallas, TX......................  Dallas National                 28,000
                                   Cemetery Expansion.
Advance Planning and Design Fund  ...................             35,000
NCA Land Acquisition............  ...................             20,000
    Total, NCA..................  ...................            172,000
General Admin.:.................  Staff Offices                    9,500
                                   Advance Planning
                                   Fund.
    Major Construction Total....  ...................          1,235,200
------------------------------------------------------------------------

    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.
    Joint VA and U.S. Army Corps of Engineers Projects.--The 
Committee is concerned the Department projects under management 
of the United States Army Corps of Engineers (USACE) may 
experience unecessary administrative delays during the initial 
transitional phase between projects being authorized and 
appropriated by Congress and an interagency agreement being 
signed by VA and USACE. Accordingly, no later than 60 days 
after enactment of this Act, the Committee directs VA to 
provide monthly updates on all current and subsequent VA 
construction projects worth more than $100,000,000, 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.
    Research Facilities Infrastructure Report.--In fiscal year 
2006, the Committee directed VA to conduct a comprehensive 
review of its research facilities and report to Congress on the 
deficiencies found and suggestions for correction. VA released 
its initial review in 2012, and recently completed Phase II 
assessments of a subset of those facilities. The Committee 
directs VA to submit the completed Phase II research facilities 
infrastructure report updates to the Committees on 
Appropriations of both Houses of Congress no later than October 
1, 2019.

                      CONSTRUCTION, MINOR PROJECTS

 
 
 
Fiscal year 2019 enacted level........................      $649,514,000
Fiscal year 2020 budget request.......................       398,800,000
Committee recommendation in the bill..................       421,117,000
Comparison with:
    Fiscal year 2019 enacted level....................     (228,397,000)
    Fiscal year 2020 budget request...................        22,317,000
 

    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.
    Within the amounts provided, the Committee directs 
$22,317,000 for the construction related to expanding gender-
specific care for women and mental health programs.
    The recommendation includes $150,000,000 in additional 
funding in section 243 under Administration Provisions for 
minor construction projects.
    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'' 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''.

       GRANTS FOR CONSTRUCTION OF STATE EXTENDED CARE FACILITIES

 
 
 
Fiscal year 2019 enacted level........................      $150,000,000
Fiscal year 2020 budget request.......................        90,000,000
Committee recommendation in the bill..................       150,000,000
Comparison with:
    Fiscal year 2019 enacted level....................             - - -
    Fiscal year 2020 budget request...................        60,000,000
 

    This appropriation provides grants to assist States to 
construct 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.

             GRANTS FOR CONSTRUCTION OF VETERANS CEMETERIES

 
 
 
Fiscal year 2019 enacted level........................       $45,000,000
Fiscal year 2020 budget request.......................        45,000,000
Committee recommendation in the bill..................        45,000,000
Comparison with:
    Fiscal year 2019 enacted level....................             - - -
    Fiscal year 2020 budget request...................             - - -
 

    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 52 administrative provisions, of which 47 
were in effect in fiscal year 2019 in some form and 5 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 2020. 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 2020 for ``Compensation and 
Pensions'', ``Readjustment Benefits'', and ``Veterans Insurance 
and Indemnities'' for payment of accrued obligations recorded 
in the last quarter of fiscal year 2019.
    The bill includes section 207 allowing for the use of 
fiscal year 2020 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 $314,409,000 
of fiscal year 2020 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 
$322,931,000 of fiscal year 2020 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 
budget request 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 budget request 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 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 2020 and 2021 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 providing $1,000,000,000 to 
be available until expended for VA infrastructure needs, of 
which $850,000,000 is for seismic improvement projects and 
seismic management activities and $150,000,000 is for Minor 
Construction. This funding is not made available until VA 
provides and the Committees on Appropriations of both Houses of 
Congress approve a detailed expenditure plan.
    The bill includes section 244 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 245 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 246 prohibiting the use of funds 
in fiscal year 2020 to convert any program that received 
specific purpose funds in fiscal year 2019 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 247 eliminating category D or E 
pain testing on dogs.
    The bill includes section 248 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 bill includes section 249 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.

                    (INCLUDING RESCISSION OF FUNDS)

    The bill includes section 250 rescinding $70,000,000 of 
unobligated fiscal year 2019 funding for the Veterans 
Electronic Health Record account.
    The bill includes section 251 extending the VSO wellness 
pilot program authorized in section 252 of the Consolidated 
Appropriations Act, 2018 (P.L. 155-141) until 2022.

                               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.
    The Committee is disappointed that these agencies are kept 
largely flat funded in their requests by the Office of 
Management and Budget (OMB), despite the very real needs of 
these agencies. The Committee expects OMB to provide budget 
requests that properly reflect the needs of these agencies, not 
to shortchange these critical agencies under the guise of 
fiscal responsibility.

                  American Battle Monuments Commission


                         SALARIES AND EXPENSES

    The recommendation includes $104,000,000 for Salaries and 
Expenses of the ABMC, an increase of $28,900,000 above the 
request to support ABMC's unfunded requirements for high-
priority projects.
    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 directs ABMC to emphasize maintaining and repairing 
these monuments and memorials in a proactive and timely manner 
that honors the service, achievements, and sacrifices of the 
United States Armed Forces.
    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

    The recommendation includes $35,400,000 for Salaries and 
Expenses for the United States Court of Appeals for Veterans 
Claims (the Court). The Consolidated Appropriations Act, 2018 
(P.L. 115-141) included bill language requiring a feasibility 
study before the purchase of a new courthouse. The study has 
not been completed, and the Committee does not support the 
Court using the requested fiscal year 2020 funds for this 
purpose. Instead, the Committee directs the Court to use the 
$800,000 to address its growing caseload.
    Caseload.--The Committee is concerned about indications of 
a growing caseload at the Court, particularly as the Court has 
now received authority to hear class action litigation. While 
reforms have recently been enacted that may slow this increase, 
the Committee acknowledges that the Court may need additional 
resources in the future, potentially including additional 
judges, to meet the caseload needs.

         Department of Defense Civil Cemeterial Expenses, Army


                         SALARIES AND EXPENSES

    The recommendation includes $80,800,000 for Salaries and 
Expenses for Arlington National Cemetery (the Cemetery), which 
is $10,000,000 above the fiscal year 2020 budget request. The 
Committee has provided this additional $10,000,000 to maintain 
current services, as was previously identified as a need during 
the fiscal year 2019 cycle.

                              CONSTRUCTION

    The recommendation includes $131,000,000 for planning and 
design and construction of Southern Expansion to remain 
available until expended.
    Southern Expansion.--The recommendation includes 
$131,000,000 for planning and design and construction of 
Southern Expansion to remain available until expended. This 
will complete the anticipated $350,000,000 cost of the Southern 
Expansion and road realignments to extend the life of the 
cemetery. The Committee provides this funding to ensure that 
the life of our Nation's most prestigious cemetery is extended 
into the 2050 timeframe.
    Updated Interment Policy.--The Committee notes that the 
National Defense Authorization Act for Fiscal Year 2019 (P.L. 
115-232) required the Secretary of the Army to revise criteria 
for interment at Arlington National Cemetery to preserve the 
Cemetery as an active burial ground well into the future. The 
Committee understands that the Secretary is currently reviewing 
proposals and notes that it will be following closely to ensure 
that the Cemetery can continue to live up to its mission to 
honor those who have served.

                      Armed Forces Retirement Home


                               TRUST FUND

    The recommendation includes $70,300,000 for the Armed 
Forces Retirement Home (AFRH), an increase of $6,000,000 above 
the requested amount, although $22,000,000 of the total is 
provided from the general fund of the Treasury, and not the 
Trust Fund. The Committee provides this increase to keep pace 
with anticipated personnel costs and contract cost inflation, 
as well as to support urgently needed capital maintenance and 
other improvements, in particular, infrastructure related to 
the health and safety of AFRH residents. The Committee 
understands that deferred maintenance projects are in critical 
need of attention, and provides this funding as a clear 
statement of priorities for future budget requests.
    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.
    Land Redevelopment.--The Committee understands that AFRH 
has issued a request for proposals to redevelop the 80-acre 
master planned parcel on the Washington campus, and looks 
forward to seeing the selection process conducted in a fair, 
open, and transparent manner without undue outside influence. 
AFRH is directed to report to the Committee on the status of 
the selection process and resulting lease negotiations.

                        Administrative Provision

    The bill includes one provision that was in effect in 
fiscal year 2019. The administrative provision included in the 
bill is as follows:
    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


 
 
 
Fiscal year 2019 enacted level........................      $921,000,000
Fiscal year 2020 budget request.......................     9,844,526,000
Committee recommendation in the bill..................       921,000,000
Comparison with:
    Fiscal year 2019 enacted level....................             - - -
    Fiscal year 2020 budget request...................   (8,923,526,000)
 

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

                      Military Construction, Army

    The recommendation includes $156,860,000 for Army military 
construction and planning and design for Overseas Contingency 
Operations and European Deterrence Initiative projects.
    The recommendation does not include $88,500,000 as 
requested for the High-Value Detention Facility replacement at 
Guantanamo Bay, Cuba.
    The recommendation does not include $7,200,000,000 for a 
border wall as requested by the Administration.

              Military Construction, Navy and Marine Corps

    The recommendation includes $281,576,000 for Navy and 
Marine Corps military construction and planning and design for 
European Deterrence Initiative projects.

                    Military Construction, Air Force

    The recommendation includes $436,564,000 for Air Force 
military construction and planning and design for European 
Deterrence Initiative projects.

                  Military Construction, Defense-Wide

    The recommendation includes $46,000,000 for Defense-Wide 
Overseas Contingency Operations and planning and design for 
European Deterrence Initiative projects.

                        Administrative Provision

    The bill includes one provision that was in effect in 
fiscal year 2019.
    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


                        NATURAL DISASTER RELIEF


                         Department of Defense


 
 
 
Fiscal year 2019 enacted level.................                    - - -
Fiscal year 2020 budget request................           $9,200,000,000
Committee recommendation in the bill...........            2,300,000,000
Comparison with:
    Fiscal year 2019 enacted level.............            2,300,000,000
    Fiscal year 2020 budget request............          (6,900,000,000)
 

              Military Construction, Navy and Marine Corps

    The recommendation includes $1,210,948,000 for Navy and 
Marine Corps military construction and planning and design for 
damages related to Hurricanes Florence and Michael.

                    Military Construction, Air Force

    The recommendation includes $1,035,752,000 for Air Force 
military construction and planning and design for damages 
related to Hurricanes Florence and Michael and 2019 flooding.

               Military Construction, Army National Guard

    The recommendation includes $50,000,000 for Army National 
Guard military construction and planning and design for damages 
related to Hurricanes Florence and Michael.

                  Military Construction, Army Reserve

    The recommendation includes $3,300,000 for Army Reserve 
military construction and planning and design for damages 
related to Hurricanes Florence and Michael.

                        Administrative Provision

    The bill includes one new Administrative Provision.
    The bill includes section 501 that designates that funding 
shall be available only if the President so designates all 
amounts and transmits such designation to Congress and requires 
a spend plan.

                                TITLE VI


                           GENERAL PROVISIONS

    The bill includes a total of 14 provisions: 11 provisions 
that are effective in fiscal year 2019:
    The bill includes section 601 prohibiting the obligation of 
funds beyond the current fiscal year unless expressly so 
provided.
    The bill includes section 602 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 603 encouraging all departments 
and agencies funded in this Act to expand the use of ``E-
Commerce'' technologies and procedures.
    The bill includes section 604 specifying the Congressional 
committees that are to receive all reports and notifications.
    The bill includes section 605 prohibiting the transfer of 
funds to any instrumentality of the United States Government 
without authority from an appropriations Act.
    The bill includes section 606 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 607 requiring all reports 
submitted to the Congress to be posted on official websites of 
the submitting agency.
    The bill includes section 608 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 609 prohibiting the use of funds 
for payment of first-class travel by an employee of the 
executive branch.
    The bill includes section 610 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 611 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 612 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 613 prohibiting childcare 
centers, agencies, or providers to employ an individual 
convicted of a sex offense, an offense involving a child 
victim, or a violent crime.
    The bill includes section 614 prohibiting funds to be used 
to replace or diminish the quality of care provided by the 
TRICARE program.

              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

    Pursuant to clause 3(f)(2) of rule XIII of the Rules of the 
House of Representatives, the following table lists the 
rescissions in the accompanying bill:

                          Department/Activity


                   AMOUNTS RECOMMENDED FOR RESCISSION

 
 
 
Department of Defense, Military Construction, Defense-       $45,055,000
 Wide (Sec. 125)......................................
Department of Veterans Affairs, Departmental                 $70,000,000
 Administration, Veterans Electronic Health Record
 (Sec. 250)...........................................
 

                           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 that allows transfer of funds from 
``Military Construction, Defense-Wide'' to other military 
construction accounts and family housing.
    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 allow the transfer of funds among 
projects and activities in accordance with reprogramming 
guidelines.
    Language is included to transfer not to exceed $18,147,000 
in fiscal year 2021 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 
2020 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 $67,891,000 to 
be transferred to General Administration and Information 
Technology Systems from any funds appropriated in fiscal year 
2020 to reimburse four 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 2020 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 2021 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.

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

SECTION 220 OF THE MILITARY CONSTRUCTION, VETERANS AFFAIRS, AND RELATED 
                   AGENCIES APPROPRIATIONS ACT, 2019

  [Sec. 220.  Of the amounts appropriated to the Department of 
Veterans Affairs which become available on October 1, 2019, for 
``Medical Services'', ``Medical Community Care'', ``Medical 
Support and Compliance'', and ``Medical Facilities'', up to 
$307,609,000, 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.]
                              ----------                              


                      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 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.

           *       *       *       *       *       *       *

                              ----------                              


SECTION 252 OF THE MILITARY CONSTRUCTION, VETERANS AFFAIRS, AND RELATED 
                   AGENCIES APPROPRIATIONS ACT, 2018

  Sec. 252. [The Secretary may carry out a 2-year pilot 
program] During the period preceding October 1, 2022, the 
Secretary of Veterans Affairs may carry out a 2-year pilot 
program making grants to nonprofit veterans services 
organizations recognized by the Secretary in accordance with 
section 5902 of title 38, United States Code, to upgrade, 
through construction and repair, VSO community facilities into 
health and wellness centers and to promote and expand 
complementary and integrative wellness programs: Provided, That 
no single grant may exceed a total of $500,000: Provided 
further, That the Secretary may not provide more than 20 grants 
during the 2-year pilot program: Provided further, That the 
recipient of a grant under this section may not use the grant 
to purchase real estate or to carry out repair of facilities 
leased by the recipient or to construct facilities on property 
leased by the recipient: Provided further, That the Secretary 
ensures that the grant recipients use grant funds to construct 
or repair facilities located in at least 10 different 
geographic locations in economically depressed areas or areas 
designated as highly rural that are not in close proximity to 
Department of Veterans Affairs medical centers: Provided 
further, That the Secretary shall report to the Committees on 
Appropriations of both Houses of Congress no later than 180 
days after enactment of this Act, on the grant program 
established under this section.

                 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 allow for transfer of 
funds among projects and activities in accordance with 
reprogramming guidelines.
    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, Air Force Reserve.
    Language is included under Title I defining the 
congressional defense committees.
    Language is included under Title I to require funds 
appropriated shall be immediately available and allotted to 
contract for the full scope of authorized projects.
    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 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.
    Language is included until Title II requiring the Secretary 
to ensure sufficient funding is available for the acquisition 
of prosthetics designed for women Veterans.
    Language is included until Title II specifies funding for 
gender-specific care for women.
    Language is included under Title II to require approval of 
a transfer between development projects in the Information 
Technology Systems account.
    Language is included prohibiting funding in the Veterans 
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, 
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 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 in Title II directing the elimination 
of using Social Security account numbers to identify 
individuals in all information systems of the Department.
    Language is included in Title II pertaining to 
certification of marriage and family therapists.
    Language is included in 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 in Title II permitting funds to carry 
out and expand the child care program.
    Language is included in 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 in Title II requiring certain data to 
be included in budget justifications for major construction 
projects.
    Language is included until Title II providing funding for 
infrastructure improvements.
    Language is included in Title II prohibiting the Inspector 
General timely access to information.
    Language is included in Title II prohibiting funding to be 
used that would increase wait times for veterans who seek 
medical care.
    Language is included in 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 extending the duration 
of the VSO pilot program.
    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 Defense Initiative for the Army.
    Language is included under Title IV providing funds with 
emergency designation, for Overseas Contingency Operations and 
European Defense Initiative for the Navy and Marine Corps.
    Language is included under Title IV providing funds with 
emergency designation, for Overseas Contingency Operations and 
European Defense Initiative for the Air Force.
    Language is included under Title IV providing funds with 
emergency designation, for Overseas Contingency Operations and 
European Defense Initiative for the Defense Agencies.
    Language is include under Title V providing Natural 
Disaster Relief funding with an emergency designation.
    Language is included under Title V providing funds with an 
emergency designation, for hurricane damages sustained by the 
Navy and Marine Corps.
    Language is included under Title V providing funds with an 
emergency designation, for hurricane damages sustained by the 
Air Force.
    Language is included under Title V providing funds with an 
emergency designation, for hurricane damages sustained by the 
Army National Guard.
    Language is included under Title V providing funds with an 
emergency designation, for hurricane damages sustained by the 
Army Reserve.
    Language is included under Title VI 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 VI to prohibit the use of 
funds for a project or program named for a serving Member of 
the United States Congress.
    Language is included under Title VI 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 VI prohibiting funds from 
being used to pay for first class travel in violation of 
federal regulations.
    Language is included under Title VI 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 VI 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.

                  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:

[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                          Program Duplication

    Pursuant to clause 3(c)(5) of rule XIII of the Rules of the 
House of Representatives, 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

    In compliance with Sec. 103(i) of H. Res. 6 (116th 
Congress) the following hearings were used to develop the 
fiscal year 2020 Military Construction, Department of Veterans 
Affairs, and Related Agencies Appropriations Bill:

------------------------------------------------------------------------
              Date                 Title of Hearing        Witnesses
------------------------------------------------------------------------
Feb. 7, 2019....................  Quality of Life in  Sergeant Major
                                   the Military        Daniel A. Dailey,
                                   Hearing.            Sergeant Major of
                                                       the Army; Master
                                                       Chief Petty
                                                       Officer Russell
                                                       Smith, Master
                                                       Chief Petty
                                                       Officer of the
                                                       Navy; Sergeant
                                                       Major Ronald L.
                                                       Green, Sergeant
                                                       Major of the
                                                       Marine Corps; and
                                                       Chief Master
                                                       Sergeant Kaleth
                                                       O. Wright, Chief
                                                       Master Sergeant
                                                       of the Air Force
Feb. 13, 2019...................  Veterans Long Term  Dr. Teresa Boyd,
                                   Care and Health     ADUSH for
                                   Challenges          Clinical
                                   Hearing.            Operations; and
                                                       Dr. Scotte R.
                                                       Hartronft, Acting
                                                       Executive
                                                       Director, VA
                                                       Office of
                                                       Geriatrics &
                                                       Extended Care
Feb. 26, 2019...................  VA General          The Honorable
                                   Oversight Hearing.  Robert Wilkie,
                                                       Secretary of
                                                       Veterans Affairs;
                                                       and Richard A.
                                                       Stone, M.D.
                                                       Executive in
                                                       Charge, Veterans
                                                       Health
                                                       Administration
Feb. 27, 2019...................  The President's     The Honorable
                                   2019 National       Robert H.
                                   Emergency           McMahon,
                                   Declaration         Assistant
                                   Circumventing       Secretary of
                                   Congress to Build   Defense for
                                   a Border Wall &     Sustainment; Mr.
                                   its Effect on       Robert G.
                                   Military            Salesses, Deputy
                                   Construction and    Assistant
                                   Readiness.          Secretary of
                                                       Defense for
                                                       Homeland Defense
                                                       Integration and
                                                       DSCA; Mr. Alex A.
                                                       Beehler,
                                                       Assistant
                                                       Secretary of the
                                                       Army
                                                       Installations,
                                                       Energy and
                                                       Environment; The
                                                       Honorable Phyllis
                                                       L. Bayer,
                                                       Assistant
                                                       Secretary of the
                                                       Navy Energy,
                                                       Installations and
                                                       Environment; and
                                                       The Honorable
                                                       John W.
                                                       Henderson,
                                                       Assistant
                                                       Secretary of the
                                                       Air Force
                                                       Installations,
                                                       Environment and
                                                       Energy
Feb. 28, 2019...................  Female Veterans     Dr. Patricia
                                   Access to VA        Hayes, Chief
                                   Hearing.            Consultant,
                                                       Women's Health
                                                       Services; and Dr.
                                                       Susan McCutcheon,
                                                       National MH
                                                       Director, Family
                                                       Svc/Women's MH/
                                                       MST
Mar. 6, 2019....................  Electronic Health   James M. Byrne,
                                   Record              General Counsel,
                                   Modernization and   Performing the
                                   Information         Duties of the
                                   Technology          Deputy Secretary;
                                   Oversight Hearing.  James P. Gfrerer,
                                                       Assistant
                                                       Secretary for
                                                       Information and
                                                       Technology and
                                                       Chief Information
                                                       Officer; and John
                                                       Windom, Executive
                                                       Director, OEHRM
Mar. 7, 2019....................  VA Whole Health,    Dr. Tracy Gaudet,
                                   Mental Health and   Director, Office
                                   Homelessness        of Patient
                                   Hearing.            Centered Care
                                                       (10NE), VHA; Dr.
                                                       David Carroll,
                                                       Executive
                                                       Director, Mental
                                                       Health
                                                       Operations; and
                                                       Dr. Roger Casey,
                                                       Director,
                                                       Education-
                                                       Dissemination,
                                                       National Center
                                                       on Homelessness
Mar. 12, 2019...................  Related Agencies    Secretary William
                                   Hearing.            M. Matz Jr.,
                                                       American Battle
                                                       Monuments
                                                       Commission; Ms.
                                                       Karen Durham-
                                                       Aguilera,
                                                       Executive
                                                       Director,
                                                       Department of the
                                                       Army, Arlington
                                                       National
                                                       Cemetery; Stephen
                                                       T. Rippe, Chief
                                                       Executive
                                                       Officer, Armed
                                                       Forces Retirement
                                                       Home; and Chief
                                                       Judge Robert N.
                                                       Davis, United
                                                       States Court of
                                                       Appeals for
                                                       Veterans Claims
Mar. 13, 2019...................  Veterans Affairs    The Honorable
                                   Office of           Michael J.
                                   Inspector General   Missal, Inspector
                                   Hearing.            General
Mar. 26, 2019...................  Military            The Honorable
                                   Installations and   Robert H. McMahon
                                   BRAC Budget         Assistant
                                   Hearing.            Secretary of
                                                       Defense for
                                                       Sustainment;
                                                       Lieutenant
                                                       General Gwen
                                                       Bingham,
                                                       Assistant Chief
                                                       for Installations
                                                       Management; Vice
                                                       Admiral Dixon R.
                                                       Smith, Deputy
                                                       Chief of Naval
                                                       Operations, Fleet
                                                       Readiness and
                                                       Logistics; Major
                                                       General Vincent
                                                       A. Coglianese,
                                                       Marine Corps
                                                       Installations
                                                       Command/Assistant
                                                       Deputy
                                                       Commandant,
                                                       Installations &
                                                       Logistics
                                                       (Facilities); and
                                                       Brigadier General
                                                       John J. Allen,
                                                       Air Force
                                                       Director of Civil
                                                       Engineers, Deputy
                                                       Chief of Staff
                                                       for Logistics,
                                                       Engineering &
                                                       Force Protection
Mar. 27, 2019...................  Veterans Affairs    The Honorable
                                   FY 2020 Budget      Robert Wilkie
                                   Hearing.            Secretary of
                                                       Veterans Affairs;
                                                       Dr. Paul R.
                                                       Lawrence, Under
                                                       Secretary for
                                                       Benefits; Richard
                                                       A. Stone, M.D.
                                                       Executive in
                                                       Charge, Veterans
                                                       Health
                                                       Administration;
                                                       and Jon
                                                       Rychalski,
                                                       Assistant
                                                       Secretary for
                                                       Management and
                                                       Chief Financial
                                                       Officer
Apr. 2, 2019....................  Members Day         The Honorable
                                   Hearing.            Anthony Brindisi;
                                                       The Honorable
                                                       Salud O.
                                                       Carbajal; The
                                                       Honorable Gilbert
                                                       Ray Cisneros; The
                                                       Honorable Neal P.
                                                       Dunn, The
                                                       Honorable Daniel
                                                       T. Kildee; The
                                                       Honorable
                                                       Gregorio Kilili
                                                       Camacho Sablan;
                                                       and The Honorable
                                                       Glenn Thompson
Apr. 2, 2019....................  Public Witness      Ms. Heather L.
                                   Hearing.            Ansley, Associate
                                                       Executive
                                                       Director of
                                                       Government
                                                       Affairs,
                                                       Paralyzed
                                                       Veterans of
                                                       America,
                                                       Washington, D.C.;
                                                       Ms. Joy J. Ilem,
                                                       National
                                                       Legislative
                                                       Director,
                                                       Disabled Veterans
                                                       of America,
                                                       Washington, D.C.;
                                                       and Mr. Patrick
                                                       D. Murray,
                                                       National
                                                       Legislative
                                                       Service, Veterans
                                                       of Foreign Wars,
                                                       Washington, D.C.
------------------------------------------------------------------------

                          Full Committee Votes

[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

    BUDGETARY IMPACT OF THE FY 2020 MILITARY CONSTRUCTION, VETERANS 
     AFFAIRS, AND RELATED AGENCIES APPROPRIATIONS BILL PREPARED IN 
  CONSULTATION WITH THE CONGRESSIONAL BUDGET OFFICE PURSUANT TO SEC. 
                 308(A), PUBLIC LAW 93-344, AS AMENDED

                        [IN MILLIONS OF DOLLARS]

                   COMPARISION WITH BUDGET RESOLUTION

    Pursuant to clause 3(c)(2) of rule XIII of the Rules of the 
House of Representatives and Section 308(a)(1)(A) of the 
Congressional Budget Act requires the report accompanying a 
bill providing new budget authority to contain a statement 
comparing the levels in the bill to the suballocations 
submitted under section 302(b) of the Act for the most recently 
agreed to concurrent resolution on the budget for the 
applicable fiscal year.

                                            [In millions of dollars]
----------------------------------------------------------------------------------------------------------------
                                                                  302(b) Allocation             This Bill
                                                             ---------------------------------------------------
                                                                 Budget                    Budget
                                                               Authority     Outlays     Authority     Outlays
----------------------------------------------------------------------------------------------------------------
Comparison of amounts in the bill with Committee allocations
 to its subcommittees: Subcommittee on Military
 Construction, Veterans Affairs, and Related Agencies
    General Purpose Discretionary...........................      105,217       99,500   106,138\1\       99,219
    Mandatory...............................................      114,950      114,775   114,950\1\      114,775
----------------------------------------------------------------------------------------------------------------
\1\Includes outlays from prior-year budget authority.
NOTE--Consistent with the funding recommended in the bill for overseas contingency operations/global war on
  terrorism, in accordance with section 251(b)(2) of the Balanced Budget and Emergency Deficit Control Act of
  1985, and after the bill is reported to the House, the Chairman of the Committee on the Budget will provide a
  revised section 302(a) allocation reflecting an additional $921,000,000 in discretionary budget authority and
  $7,000,000 in associated outlays. That new allocation will eliminate the technical difference prior to Floor
  consideration.
In addition, the amounts in this report do not include $2,300,000,000 in discretionary budget authority and
  $23,000,000 in associated outlays from funding designated as being for emergency requirements pursuant to
  section 251 of the Balanced Budget and Emergency Deficit Control Act of 1985. Consistent with the
  Congressional Budget Act of 1974, in the House of Representatives such funding does not count against the
  Committee's allocation.

                    FIVE-YEAR PROJECTION OF OUTLAYS

    Pursuant to clause 3(c)(2) of rule XIII of the Rules of the 
House of Representatives and in compliance with section 
308(a)(1)(B) of the Congressional Budget and Impoundment 
Control Act of 1974 (Public Law 93-344), as amended, the 
following table contains five-year projections

                                            [In millions of dollars]
----------------------------------------------------------------------------------------------------------------
 
----------------------------------------------------------------------------------------------------------------
Projection of outlays associated with the recommendation:
    2020....................................................  ...........  ...........          \1\      128,782
    2021....................................................  ...........  ...........  ...........        7,442
    2022....................................................  ...........  ...........  ...........        5,680
    2023....................................................  ...........  ...........  ...........        3,322
    2024 and future years...................................  ...........  ...........  ...........        3,298
----------------------------------------------------------------------------------------------------------------
\1\Excludes outlays from prior-year budget authority.

          FINANCIAL ASSISTANCE TO STATE AND LOCAL GOVERNMENTS

    Pursuant to clause 3(c)(2) of rule XIII of the Rules of the 
House of Representatives and in accordance with section 
308(a)(1)(C) of the Congressional Budget Act of 1974, as 
amended, the Congressional Budget Office has provided the 
following estimates of new budget authority and

                        [In millions of dollars]
------------------------------------------------------------------------
                                                   Budget
                                                 Authority     Outlays
------------------------------------------------------------------------
Financial assistance to State and local              260\1\           47
 governments for 2020.........................
------------------------------------------------------------------------
\1\Excludes outlays from prior-year budget authority.

      Comparative Statement of New Budget Authority and State List

    The following is a complete listing, by title, State and 
country, of the Committee's recommendations for military 
construction and family housing projects, including Overseas 
Contingency Operations projects:

[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]


                             MINORITY VIEWS

    As reported by the Committee, the Military Construction, 
Veterans Affairs, and Related Agencies Appropriations bill for 
fiscal year 2020 provides a total of $231,349,814,000 in budget 
authority. Of this amount, $123,211,394,000 is for mandatory 
programs and $108,438,000,000 is for discretionary programs. 
The discretionary funding total includes $2,300,000,000 in 
emergency funds. The bill also includes $87,636,650,000 in 
advance appropriations for the Department of Veterans Affairs' 
health care accounts and $129,509,505,000 in advance 
appropriations for mandatory veterans' benefits programs for 
fiscal year 2021. Unfortunately, due to concerns about spending 
levels and numerous policy provisions contained in the bill, we 
are unable to support the bill as written at this time.
    We are troubled that the Majority party's budget framework 
does not reflect a bipartisan, bicameral agreement. That 
framework puts the Federal government on track to add nearly 
$2,000,000,000,000 in deficits over 10 years, while the 
national debt is already more than $22,000,000,000,000. In 
addition, the Majority supports more than twice as much 
additional funding in fiscal year 2020 for non-defense programs 
as for defense programs.
    We need to come together with the Senate and the 
Administration to reach an agreement on the topline funding 
level before we allocate funding among the various 
appropriations bills. We should see how the Military 
Construction and Veterans Affairs bill fits into the larger 
picture before moving forward.
    In addition to overall funding concerns, Republican Members 
of the Committee were disappointed by several policy provisions 
and funding decisions made within the bill. These positions 
could prevent this bill from being signed into law, and House 
Republicans will continue to work to address these issues as 
the appropriations process continues.
    Of particular concern is Section 612, which limits the 
President's use of military construction funds. It is an 
unnecessary restriction on the President's ability and 
responsibility to respond to national emergencies. We believe 
we must provide the President with the tools to address the 
humanitarian and security crisis on our Southern border.
    The facts are undeniable, and the strain on the system is 
unsustainable. Record-breaking numbers of people, primarily 
from Central American countries but also from other countries 
around the world, are coming through Mexico to the Southern 
border. Unauthorized border crossings are now at a 12-year 
high, and the system is overwhelmed by unaccompanied children 
and family units. More than 109,000 people came to the border 
in April alone, compared to approximately 400,000 in all of 
2018.
    Recognizing the bipartisan concern about using previously 
appropriated military construction funds for border security 
projects and well aware of the indisputable need to reinvest in 
our military's readiness and infrastructure, Republican Members 
of the Committee supported Subcommittee Ranking Member Rep. 
John Carter's amendment to provide $7,200,000,000 in emergency 
funding for border security projects. The amendment provided 
the same amount the President requested in the fiscal year 2020 
budget request and would have transferred funds to the 
Department of Homeland Security to implement the Border 
Security Improvement Plan.
    While the amendment was defeated, we continue to believe 
the Committee will need to address the President's request and 
provide funding for border security and humanitarian needs 
before the fiscal year 2020 appropriations cycle concludes.
    The bill also does not continue the current prohibition on 
the transfer of detainees at Guantanamo Bay, Cuba, to the 
United States, nor does it provide funding for a new detention 
facility at Guantanamo Bay. We believe the prohibition on 
transferring detainees to the United States and the new funding 
are needed. We must not bring the world's most dangerous 
terrorists to American soil, and the Service men and women 
guarding the detainees at Guantanamo Bay must have the safest 
possible work environment.
    Despite our disagreements over the issues discussed above, 
we appreciate the Majority's willingness to address Member 
priorities in the bill and report and to include Minority 
Committee Members in the development of the bill. 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 the next fiscal year.

                                   Kay Granger.
                                   John R. Carter.

                                  [all]