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House Report 116-445: Military Construction, Veterans Affairs Appropriations Bill, 2021 (July 13, 2020)

Summary

House Report 116-445, dated July 13, 2020, is the Committee on Appropriations report, submitted by Wasserman Schultz of Florida with minority views, on the Military Construction, Veterans Affairs, and Related Agencies Appropriations Bill, 2021. The Committee recommends $250,926,222,000 in total budget authority, including emergency funding, for fiscal year 2021, which is $15,214,696,000 above the fiscal year 2020 enacted level. The total for the Department of Veterans Affairs is $240,210,107,000, and the bill includes $135,000,000 for privatized family housing issues and $2,627,000,000 for VA Electronic Health Record Modernization. The minority views express concern about designating $12,500,000,000 as emergency funding.

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Congressional materials
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Crpt Crpt 116Hrpt445 Crpt 116Hrpt445
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Crpt Crpt 116Hrpt445 Crpt 116Hrpt445

Cite this document

“House Report 116-445: Military Construction, Veterans Affairs Appropriations Bill, 2021 (July 13, 2020).” Original at www.govinfo.gov. Archived at Pandemic Darlings, https://pandemicdarlings.com/source-documents/crpt-crpt-116hrpt445-crpt-116hrpt445/, SHA-256 e70762fb96601427708109affac1c33ffebb202518b5271c884ce92b62c4239a.

Full text

                                                                               116TH CONGRESS                                                                                         REPORT
                                                                                              " HOUSE OF REPRESENTATIVES                                                      !
                                                                                  2d Session                                                                                          116–445




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


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



                                                                                     Ms. WASSERMAN SCHULTZ of Florida, from the Committee on
                                                                                              Appropriations, submitted the following


                                                                                                                              R E P O R T
                                                                                                                                 together with

                                                                                                                            MINORITY VIEWS

                                                                                                                          [To accompany H.R. 7609]

                                                                                  The Committee on Appropriations submits the following report in
                                                                               explanation of the accompanying bill making appropriations for
                                                                               military construction, veterans affairs and related agencies for the
                                                                               fiscal year ending September 30, 2021.
                                                                                                                         INDEX TO BILL AND REPORT
                                                                                                                                                                                           Page Number
                                                                                                                                                                                            Bill   Report
                                                                               Purpose of the Bill ...................................................................................... ........     2
                                                                               Summary of Committee Recommendation ............................................... ........                            2
                                                                               Management and Oversight Initiatives .................................................... ........                      4
                                                                               Department of Defense:
                                                                                  Military Construction .........................................................................               2      8
                                                                                  NATO Security Investment Program ................................................                             8     28
                                                                                  Department of Defense Base Closure Account .................................                                  9     28
                                                                                  Family Housing Construction and Operation and Maintenance ....                                                9     31
                                                                                  Department of Defense Family Housing Improvement Fund .........                                             11      32
                                                                                  Department of Defense Military Unaccompanied Housing Im-
                                                                                    provement Fund ..............................................................................             11      32
                                                                                  Administrative Provisions ..................................................................                12      32
                                                                               Department of Veterans Affairs:
                                                                                  Veterans Benefits Administration .....................................................                      26      36
                                                                                  Veterans Health Administration .......................................................                      30      44
                                                                                  National Cemetery Administration ...................................................                        36      86
                                                                                  Departmental Administration ............................................................                    36      88
                                                                                  Administrative Provisions ..................................................................                44     100




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                                                                                                                                                                                                Page Number
                                                                                                                                                                                                 Bill   Report
                                                                               Related Agencies:
                                                                                   American Battle Monuments Commission ........................................                                   73     106
                                                                                   U.S. Court of Appeals for Veterans Claims ......................................                                74     106
                                                                                   Cemeterial Expenses, Army ...............................................................                       75     107
                                                                                   Armed Forces Retirement Home .......................................................                            75     107
                                                                                   Administrative Provision ....................................................................                   76     108
                                                                               Department of Defense:
                                                                                   Overseas Contingency Operations .....................................................                           76     108
                                                                                   Administrative Provision ....................................................................                   77     109
                                                                               General Provisions .....................................................................................            78     109
                                                                               House of Representatives Report Requirements:
                                                                                   Statement of General Performance Goals and Objectives ...............                                       ........   110
                                                                                   Rescissions ...........................................................................................     ........   111
                                                                                   Transfer of Funds ...............................................................................           ........   111
                                                                                   Disclosure of Earmarks and Congressionally Directed Spending
                                                                                     Items .................................................................................................   ........   112
                                                                                   Ramseyer Rule ....................................................................................          ........   112
                                                                                   Changes in Application of Existing Law ...........................................                          ........   114
                                                                                   Appropriations Not Authorized by Law ............................................                           ........   120
                                                                                   Program Duplication ...........................................................................             ........   122
                                                                                   Committee Hearings ...........................................................................              ........   122
                                                                                   Comparison With the Budget Resolution ..........................................                            ........   124
                                                                                   Five-Year Projection of Outlays .........................................................                   ........   124
                                                                                   Assistance to State and Local Governments .....................................                             ........   124
                                                                                   Full Committee Votes .........................................................................              ........   125
                                                                                   Comparative Statement of New Budget (Obligational) Authority ..                                             ........   127
                                                                                   State and Country Project List ..........................................................                   ........   148
                                                                                   Overseas Contingency Operations Project List ................................                               ........   157
                                                                                   Minority Views ....................................................................................         ........   159

                                                                                                                           PURPOSE OF THE BILL
                                                                                  The purpose of the bill is to support our military and their fami-
                                                                               lies and provide the benefits and medical care that our Veterans
                                                                               have earned because of their service to our Nation. This is accom-
                                                                               plished 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 in-
                                                                               frastructure that supports a good quality of life for them and their
                                                                               families; and allow the military to maintain an efficient and effec-
                                                                               tive 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 dis-
                                                                               ability and pension benefits, healthcare in many different settings,
                                                                               educational assistance, and home loan and insurance programs. Fi-
                                                                               nally, 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 Ceme-
                                                                               tery), the United States Court of Appeals for Veterans Claims, and
                                                                               the Armed Forces Retirement Home.
                                                                                                      SUMMARY OF COMMITTEE RECOMMENDATION
                                                                                 The Committee recommends $250,926,222,000 in total budget au-
                                                                               thority, including emergency funding, for the fiscal year 2021 pro-
                                                                               grams and activities funded in the bill. The fiscal year 2021 rec-




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                                                                               ommendation represents an increase of $15,214,696,000 above the




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                                                                               comparable fiscal year 2020 enacted level and $2,262,624,000 above
                                                                               the President’s request. Of the increase over the fiscal year 2020
                                                                               enacted level, $10,081,909,000 is in mandatory programs. Included
                                                                               in the total budget authority is $135,434,234,000 in mandatory
                                                                               budget authority and $115,491,988,000 in discretionary budget au-
                                                                               thority, which includes $12,493,988,000 in emergency funding.
                                                                                  The Committee recommendation highlights the continued com-
                                                                               mitment to our servicemembers and their families and to our Vet-
                                                                               erans. In overall discretionary budget authority, including emer-
                                                                               gency and overseas contingency funding, the bill is 4.7 percent
                                                                               above the fiscal year 2020 enacted level. While the Committee rec-
                                                                               ommendation continues essential support for servicemembers and
                                                                               Veterans, it does not provide funds for projects or activities that
                                                                               lacked sufficient justification or urgency.
                                                                                  The programs funded in the bill for the Department of Defense
                                                                               (DOD) address the priorities of the Department’s Agencies and the
                                                                               Services for the numerous facility challenges that they face. The
                                                                               funds provided support readiness improvements with new construc-
                                                                               tion, family housing, and continued cleanup of military bases closed
                                                                               during previous Base Realignment and Closure rounds, support
                                                                               Combatant Commanders’ requirements where appropriate, and en-
                                                                               sure that our military personnel and their families’ quality of life
                                                                               is preserved.
                                                                                  The total recommended funding level for military construction
                                                                               and family housing, including Overseas Contingency Operations, is
                                                                               $10,440,000,000 which is $1,519,526,000 below the fiscal year 2020
                                                                               enacted level (not including hurricane disaster funding) and
                                                                               $2,276,675,000 above the budget request. The recommendation pro-
                                                                               vides funding for Family Housing, construction on our bases, in-
                                                                               cluding barracks, health facilities and schools, and support for crit-
                                                                               ical overseas investments as well as an additional $135,000,000 to
                                                                               address privatized family housing issues. Within the total,
                                                                               $350,000,000 is included for the European Deterrence Initiative
                                                                               and construction, which helps ensure the protection of our allies
                                                                               and protects the warfighter. The recommendation also supports
                                                                               $1,809,972,000 for the Services’ unfunded priorities that are more
                                                                               than 35 percent complete in design and can be executed in fiscal
                                                                               year 2021. Finally, the total provides $554,500,000 for the Services’
                                                                               cost to complete projects, which are previously appropriated
                                                                               projects that have experienced an increase in cost from the original
                                                                               contract award.
                                                                                  The total recommended funding level for fiscal year 2021 for the
                                                                               Department of Veterans Affairs, including emergency funding, is
                                                                               $240,210,107,000, an increase of $22,347,382,000 over the fiscal
                                                                               year 2020 enacted level. Of the total, $135,434,234,000 is provided
                                                                               for mandatory benefit programs and $104,775,873,000, including
                                                                               $12,493,988,000 in emergency funding, is allocated to discretionary
                                                                               programs such as medical care, claims processing, and construc-
                                                                               tion. In this bill, discretionary funding for the Department of Vet-
                                                                               erans Affairs is recommended at 13 percent over the fiscal year
                                                                               2020 enacted level. Of the total for fiscal year 2021,
                                                                               $87,636,650,000 for medical care has been appropriated in advance.
                                                                                  In   addition,     the    Committee    recommendation    includes
                                                                               $94,183,260,000 in advance appropriations for fiscal year 2022 for




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                                                                               the four health care accounts of the Department and




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                                                                               $145,311,218,000 in advance appropriations for mandatory benefits
                                                                               programs in fiscal year 2022.
                                                                                  The Committee recommendation provides a total of $276,115,000
                                                                               for the four Related Agencies: the American Battle Monuments
                                                                               Commission (ABMC), the U.S. Court of Appeals for Veterans
                                                                               Claims, Arlington National Cemetery, and the Armed Forces Re-
                                                                               tirement Home. The recommendation represents an increase of
                                                                               $21,015,000 above the budget request. These funds are provided to
                                                                               ensure that these agencies are able to continue their missions of
                                                                               honoring the service and sacrifice of our servicemembers and Vet-
                                                                               erans.
                                                                                                   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 re-
                                                                               quests, and reviews by the Government Accountability Office
                                                                               (GAO) and the Inspectors General to promote strong financial and
                                                                               program management, oversight and leadership at the Department
                                                                               of Defense (DOD), the Department of Veterans Affairs (VA), and
                                                                               Related Agencies under the jurisdiction of this bill.
                                                                                  The fiscal year 2021 appropriations Act and the accompanying
                                                                               report address management challenges of the Federal agencies it
                                                                               funds, including directives to strengthen financial and program
                                                                               management, eliminate redundancy, and improve implementation
                                                                               and oversight of initiatives that support the mission of this bill.
                                                                               The Committee will use every means at its disposal to reduce mis-
                                                                               management that results in waste, fraud, and abuse.
                                                                                  Performance Measures.—The Committee directs each of the agen-
                                                                               cies funded by this Act to comply with title 31 of the United States
                                                                               Code, including the development of their organizational priority
                                                                               goals and outcomes such as performance outcome measures, output
                                                                               measures, efficiency measures, and customer service measures.
                                                                               Each of the agencies funded by the Act shall submit a report to the
                                                                               Committee within 60 days of enactment of the Act on the progress
                                                                               it has made on Performance Measures.
                                                                                  Customer Service Standards.—The Committee continues to sup-
                                                                               port efforts to improve customer service in accordance with Execu-
                                                                               tive Order 13571—Streamlining Service Delivery and Improving
                                                                               Customer Service. The Committee directs the Secretary of Veterans
                                                                               Affairs to develop standards to improve customer service and incor-
                                                                               porate the standards into the performance plans required under 31
                                                                               U.S.C. 1115. The Committee requests a report on the progress the
                                                                               Secretary has made on this issue within 60 days of enactment of
                                                                               the Act.
                                                                                  Federal Law Enforcement.—The Committee notes that the Com-
                                                                               merce, Justice, Science, and Related Agencies Appropriations Act,
                                                                               2021 directs the Attorney General to establish a training program
                                                                               to cover the use of force and de-escalation, racial profiling, implicit
                                                                               bias, and procedural justice, to include training on the duty of Fed-
                                                                               eral law enforcement officers to intervene in cases where another
                                                                               law enforcement officer is using excessive force, and make such
                                                                               training a requirement for Federal law enforcement officers. The




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                                                                               Committee further notes that several offices funded by this Act em-




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                                                                               ploy Federal law enforcement officers and are Federal Law En-
                                                                               forcement Training Centers partner organizations. The Committee
                                                                               directs such offices to adopt and follow the training program estab-
                                                                               lished by the Attorney General, and to make such training a re-
                                                                               quirement for its Federal law enforcement officers. The Committee
                                                                               further directs such offices to brief the House and Senate Commit-
                                                                               tees on Appropriations on their efforts relating to training no later
                                                                               than 90 days after the Attorney General has established such a
                                                                               training program.
                                                                                  In addition, the Committee directs such offices, to the extent that
                                                                               such offices have not already done so, to submit their use of force
                                                                               data to the Federal Bureau of Investigation (FBI)’s National Use
                                                                               of Force Data Collection database. The Committee further directs
                                                                               such offices to brief the House and Senate Committees on Appro-
                                                                               priations no later than 90 days after enactment of this Act on their
                                                                               current efforts to tabulate and submit its use of force data to the
                                                                               FBI.
                                                                                  Department of Defense Military Family Housing.—Privatized
                                                                               housing has come under scrutiny in recent years. Complaints of in-
                                                                               adequate housing across the DOD enterprise include lack of re-
                                                                               pairs, rodents, mold, cracks in walls and peeling paint. The mili-
                                                                               tary 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 devel-
                                                                               opers may own, operate, maintain, improve and assume responsi-
                                                                               bility for military family housing. The private entity is responsible
                                                                               for managing the construction, renovation, and day-to-day mainte-
                                                                               nance and services for the community. The PPV housing may be
                                                                               located on or off government property and may be former military
                                                                               family housing. Congress has mandated that all military family
                                                                               housing in the United States be eventually privatized. In order to
                                                                               address ongoing concerns regarding unacceptable housing condi-
                                                                               tions, the recommendation includes $135,000,000 in section 127.
                                                                               Although these funds are not proposed in the budget request, the
                                                                               Committee believes additional resources are required in order to
                                                                               secure a satisfactory outcome to enhance the Services’ ability to
                                                                               provide oversight and management, including personnel to track
                                                                               current and future issues that may occur in privatized housing.
                                                                               The Committee also includes report language directing DOD to
                                                                               submit various reports and maintain a maintenance database to
                                                                               track any issues that may be prevalent in the future. The Com-
                                                                               mittee notes that the general welfare of a servicemember’s family
                                                                               contributes to the overall state of readiness for DOD.
                                                                                  VA Electronic Health Record Modernization (EHRM).—After at
                                                                               least a decade of Congressional encouragement to DOD and VA to
                                                                               develop a single electronic health record (EHR), VA finalized a con-
                                                                               tract in 2018 to acquire the same EHR system that DOD is adopt-
                                                                               ing. The bill includes $2,627,000,000 for EHRM and continues
                                                                               strict quarterly reporting of timelines, performance milestones,
                                                                               costs, implementation, and change management. The bill also con-
                                                                               tinues the requirement for GAO to review EHRM implementation
                                                                               so that Congress can be informed of any problems at a point where




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                                                                               they can be promptly and economically addressed.




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                                                                                  Disability Claims and Appeals.—Due to the significant invest-
                                                                               ments Congress has provided in recent years, VA has been able to
                                                                               hire the staff, acquire the technology, and change work processes
                                                                               necessary to significantly reduce the disability claims backlog. But
                                                                               as the number of claims continues to increase and the number of
                                                                               appeals skyrockets once claims are decided, VA again runs the risk
                                                                               of falling into serious claims and appeals backlogs. This is of par-
                                                                               ticular concern as VA receives additional claims under the Blue
                                                                               Water Navy Vietnam Veterans Act. The Committee recognizes this
                                                                               threat and provides resources within the Veterans Benefits Admin-
                                                                               istration to support staffing, scanning of records, and other efforts
                                                                               to respond to Blue Water Navy claims. The Committee additionally
                                                                               provides increases to the Board of Veterans Appeals and the Court
                                                                               of Appeals for Veterans Claims to help ensure the prompt resolu-
                                                                               tion of cases. The Committee hopes that with these additional in-
                                                                               vestments and the recently passed legislation to reform the appeals
                                                                               process, Congress will have taken the necessary management ac-
                                                                               tion to prevent Veterans from enduring excessive wait times to re-
                                                                               ceive the disability benefits they deserve.
                                                                                  Information Technology (IT).—The Committee continues to in-
                                                                               clude bill language indicating that funds for information technology
                                                                               systems development are available only for the projects and in the
                                                                               amounts specified in the report. The bill limits the amount of funds
                                                                               that can be transferred into the IT account to ten percent of the
                                                                               total of either the source or destination account. The bill contains
                                                                               language that permits the reprogramming of funds among develop-
                                                                               ment projects upon prior notification to, and approval by, the Com-
                                                                               mittees.
                                                                                  Stricter Control of Construction Funding.—The Committee con-
                                                                               tinues to request that VA provide quarterly briefings on the
                                                                               progress and cost of each facility managed by an outside entity.
                                                                               Several additional bill language provisions are included to enhance
                                                                               the Committee’s capacity to conduct oversight of VA’s facility con-
                                                                               struction efforts including: (1) no funding greater than $7,000,000
                                                                               may be reprogrammed between construction projects unless ap-
                                                                               proved by the Committees on Appropriations of both Houses of
                                                                               Congress; (2) any change to the scope of a construction project is
                                                                               prohibited without the approval of the Committees; and (3) VA
                                                                               must report any bid savings of $5,000,000 or more on projects as
                                                                               soon as they are identified.
                                                                                  Department of Defense Civil Cemeterial Expenses.—The Com-
                                                                               mittee rejects the proposed cut in the President’s budget request
                                                                               and instead provides $81,815,000 for Arlington National Cemetery
                                                                               so that it can maintain a consistent level of services and ensure
                                                                               that critical operations continue.
                                                                                  Armed Forces Retirement Home (AFRH).—The Committee con-
                                                                               tinues to provide funding for AFRH to work on deferred mainte-
                                                                               nance projects and directs AFRH to provide an expenditure plan
                                                                               for these projects. Additionally, the bill makes operations and
                                                                               maintenance funds available for two years to allow AFRH to make
                                                                               more effective use of its funds. These efforts will ensure that AFRH
                                                                               is well-positioned to continue to improve its standing and increase
                                                                               revenue for the long term. The Committee notes that efforts are




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                                                                               underway to stabilize the AFRH Trust Fund and reduce reliance




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                                                                               on transfers from the General Fund, and directs AFRH to continue
                                                                               making progress toward improving AFRH’s sustainability.
                                                                                  Army Corps of Engineers Updates on VA projects.—The Com-
                                                                               mittee is concerned that VA projects under management of the
                                                                               Army Corps of Engineers (USACE) might be delayed due to admin-
                                                                               istrative delays during the initial transitional phase between
                                                                               projects being authorized and appropriated by Congress, and an
                                                                               interagency agreement being signed. Accordingly, the Committee
                                                                               directs VA to continue to provide monthly updates on all current
                                                                               and subsequent VA construction projects worth more than $100
                                                                               million and jointly managed by VA and USACE. Regular reports
                                                                               for certain projects may be submitted on a quarterly basis if the
                                                                               Department and Committee come to an agreement that more fre-
                                                                               quent reports are not necessary.
                                                                                  Historic Preservation Study.—Section 106 of the National His-
                                                                               toric Preservation Act requires Federal agencies to take into ac-
                                                                               count the effects of their undertakings on historic properties. The
                                                                               Section 106 process seeks to accommodate historic preservation
                                                                               concerns through consultations with interested parties with a goal
                                                                               of commencing consultations during the early stages of project
                                                                               planning. The consultations seek to identify historic properties po-
                                                                               tentially affected by any undertaking, assess their potential effects
                                                                               and find ways to avoid, minimize or mitigate adverse effects on a
                                                                               historic property. This consultative process generally includes State
                                                                               Historic Preservation Offices (SHPOs), and a Federal agency can
                                                                               provide various assistance to a SHPO under limited circumstances.
                                                                               To better assess this assistance and determine what additional
                                                                               support may be needed to help the services more effectively work
                                                                               with SHPOs, the Assistant Deputy Under Secretary of Defense En-
                                                                               ergy, Installations, and Environment shall issue a report within
                                                                               180 days of enactment of this Act detailing: (1) discretionary serv-
                                                                               ices provided by the Department to SHPOs, such as tailored train-
                                                                               ing, cultural resources surveys, data recovery, and data recorda-
                                                                               tion; (2) systemic departmental challenges to obtaining historical
                                                                               designation from SHPOs; (3) best practices for enhancing the Sec-
                                                                               tion 106 compliance; and (4) potential regulatory and legal options
                                                                               for accelerating individual project reviews at the installation level.
                                                                                  Advertising and Contracts for Small Business.—The Committee
                                                                               understands that, as the largest advertiser in the United States,
                                                                               the Federal government should work to ensure fair access to its ad-
                                                                               vertising contracts for small disadvantaged businesses and busi-
                                                                               nesses owned by minorities and women. The Committee directs
                                                                               each department and agency to include the following information
                                                                               in its fiscal year 2022 budget justification: Expenditures for fiscal
                                                                               year 2020 and expected expenditures for fiscal year 2022, respec-
                                                                               tively, for (1) all contracts for advertising services; and (2) contracts
                                                                               for the advertising services of (I) socially and economically dis-
                                                                               advantaged small businesses concerns (as defined in section 8(a)(4)
                                                                               of the Small Business Act (15 U.S.C. 637 (a)(4)); and (II) women-
                                                                               and minority-owned businesses.




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                                                                                                                                  TITLE I
                                                                                                              DEPARTMENT OF DEFENSE
                                                                                                          MILITARY CONSTRUCTION OVERVIEW
                                                                               Appropriation, fiscal year 2020 .........................................................     $11,315,000,000
                                                                               Budget request, fiscal year 2021 .......................................................        7,813,563,000
                                                                               Recommended in the bill ...................................................................    10,090,000,000
                                                                               Bill compared with:
                                                                                    Appropriation, fiscal year 2020 ..................................................       ¥1,225,000,000
                                                                                    Budget request, fiscal year 2021 ................................................        +2,276,437,000
                                                                                  Military construction accounts provide funds for new construc-
                                                                               tion, construction improvements, planning and design, and host na-
                                                                               tion support. Projects funded by these accounts include facilities for
                                                                               operations, training, readiness, maintenance, research and develop-
                                                                               ment, supply, medical care, and force protection, as well as unac-
                                                                               companied housing, military-owned family housing, utilities infra-
                                                                               structure, 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 au-
                                                                               thority for any reprogramming of funds exceeding a specific thresh-
                                                                               old.
                                                                                  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 ac-
                                                                               count) 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 re-
                                                                               programming to an item specifically reduced below the threshold
                                                                               by Congress is permitted, except that DOD may seek reprogram-
                                                                               ming for appropriated increments.
                                                                                  The reprogramming criteria that applies to military construction
                                                                               projects is 25 percent of the funded amount or $2,000,000, and in-
                                                                               cludes new housing construction projects and improvements. To
                                                                               provide the Services the flexibility to proceed with construction con-
                                                                               tracts without disruption or delay, the costs associated with envi-
                                                                               ronmental 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 ex-
                                                                               cluded 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 Con-
                                                                               gress, the adjusted amount approved becomes the new base for any




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                                                                               future increase or decrease via below-threshold reprogramming




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                                                                               (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 ad-
                                                                               here to the guidance for military construction reprogramming ac-
                                                                               tions and notifications, including the pertinent statutory authori-
                                                                               ties contained in DOD Financial Management Regulation 7000.14–
                                                                               R and relevant updates and policy memoranda. The Committee fur-
                                                                               ther 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 Emer-
                                                                               gency for the purpose of using section 2808 of title 10, United
                                                                               States Code to bypass congressional intent and divert valuable
                                                                               military construction funding from previously approved national se-
                                                                               curity projects to fund a border wall instead. Congress chose not to
                                                                               fund this wall in the Consolidated Appropriations Act, 2019 (P.L.
                                                                               116–6). The Committee notes there is bipartisan opposition to the
                                                                               action taken by the President, as both the House and Senate voted
                                                                               to disapprove the President’s emergency declaration. Despite bipar-
                                                                               tisan congressional opposition, the fiscal year 2020 budget request
                                                                               for military construction included $7,200,000,000 to restore funding
                                                                               (up to $3,600,000,000) that would be diverted for the wall as well
                                                                               as provide the next installment of wall funding ($3,600,000,000).
                                                                               Throughout the fiscal year 2020 appropriations cycle, the Com-
                                                                               mittee rejected the Administration’s proposal and made clear that
                                                                               Congress would not provide resources to ‘‘backfill’’ these projects.
                                                                               This position was ratified when the final enacted appropriation for
                                                                               fiscal year 2020 explicitly included zero funds to backfill projects
                                                                               whose funding had been redirected.
                                                                                  In defiance of such unmistakable congressional intent, on April
                                                                               28, 2020 DOD announced its intention to cancel fiscal year 2020
                                                                               Overseas Contingency Operations Funds for the European Deter-
                                                                               rence Initiative in order to provide the necessary resources to back-
                                                                               fill projects originally funded in fiscal years 2018 and 2019 and
                                                                               subsequently canceled for the border wall in 2019. The Committee
                                                                               previously appropriated these funds for disaster recovery, flood pro-
                                                                               tection, military base construction projects, defense of Europe
                                                                               against Russia aggression and to maintain and improve military
                                                                               readiness. As such, the Committee expects that the resources
                                                                               should indeed be used for those specific purposes. The Committee
                                                                               believes that the deferral or ultimate cancellation of those projects
                                                                               will inhibit military construction project planning in the future and
                                                                               diminish military readiness. The Committee emphasizes that in the
                                                                               interest of national security and constitutional prerogatives, mili-
                                                                               tary construction funding should only be used for the purpose they
                                                                               are provided, which is to support DOD’s mission, military readi-
                                                                               ness, servicemembers, and their families.
                                                                                  The accompanying fiscal year 2021 bill includes language that
                                                                               protects both previously appropriated projects, as well as fiscal
                                                                               year 2021 projects funded in this bill from being used as a source
                                                                               for border wall projects. The Committee believes that Congress
                                                                               must assert its role as a co-equal branch of the Federal government
                                                                               and insist upon the appropriate and constitutional use of appro-




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                                                                               priated funds.




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                                                                                  Facilities    Sustainment,    Restoration     and   Modernization
                                                                               (FSRM).—DOD is directed to continue describing on form 1390 the
                                                                               backlog of FSRM requirements at installations with future con-
                                                                               struction projects. For troop housing requests, form 1391 should de-
                                                                               scribe any FSRM conducted in the past two years. Likewise, future
                                                                               requirements for unaccompanied housing at the corresponding in-
                                                                               stallation should be included. Additionally, the forms should in-
                                                                               clude 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 replace-
                                                                                    ment. Such replacement can be up to current standards or
                                                                                    codes;
                                                                                      (2) interior arrangements and restorations may be included
                                                                                    as repair;
                                                                                      (3) additions and new facilities, may be done concurrently
                                                                                    with repair projects as long as the final conjunctively funded
                                                                                    project is a complete and usable facility; and
                                                                                      (4) the appropriate Service Secretary shall notify the appro-
                                                                                    priate committees 21 days prior to carrying out any repair
                                                                                    project with an estimated cost in excess of $7,500,000.
                                                                                  Quarterly Summary of Notifications.—The Committee directs the
                                                                               Services and the Office of the Secretary of Defense (on behalf of
                                                                               itself and defense agencies) to continue to submit a quarterly re-
                                                                               port listing all notifications that have been submitted to the Com-
                                                                               mittees during the preceding three-month period.
                                                                                  Work in Progress or Planned (WIP) Curve.—The Committee di-
                                                                               rects the Services and the Office of the Secretary of Defense (on be-
                                                                               half of itself and defense agencies) to submit a WIP curve for each
                                                                               project requested in a budget submission above $90,000,000 with
                                                                               the form 1391 justification to the congressional defense committees.
                                                                               The Committee acknowledges that there is an alarming amount of
                                                                               unawarded prior-year military construction projects, and therefore
                                                                               the Committee directs the Secretary of Defense to report to the
                                                                               congressional defense committees quarterly, beginning in the sec-
                                                                               ond quarter of fiscal year 2021 and each quarter thereafter of
                                                                               projects that remain unawarded from the current and prior fiscal
                                                                               years and the reasons for delay.
                                                                                  Transfer of Funds To and From the Foreign Currency Fluctua-
                                                                               tions, 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 speci-
                                                                               fy 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 Con-
                                                                               gress within seven days of transferring any amount in excess of




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                                                                               $10,000,000 to or from the Foreign Currency account.




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                                                                                  Bid Savings.—The Committee directs the Secretary of Defense to
                                                                               continue to submit 1002 reports on military construction bid sav-
                                                                               ings at the end of each fiscal quarter to the Subcommittees on Mili-
                                                                               tary 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 Com-
                                                                               mittee to provide incremental funding for certain large projects to
                                                                               enable the Services to more efficiently allocate military construc-
                                                                               tion dollars among projects that can be executed in the year of ap-
                                                                               propriation. Therefore, the Committee recommendation includes
                                                                               four projects that have been incrementally funded; however, the
                                                                               full authorization of the projects will be provided in the fiscal year
                                                                               2021 National Defense Authorization Act.
                                                                                  Hawaii Infrastructure Readiness Initiative.—The Committee rec-
                                                                               ognizes the strategic and critical role the Hawaii Infrastructure
                                                                               Readiness Initiative (HIRI) plays in DOD’s strategic plans for the
                                                                               Indo-Pacific region. At the direction of Congress, United States
                                                                               Army Pacific created the HIRI to address critical priorities estab-
                                                                               lished in its military construction submissions and major restora-
                                                                               tion and maintenance (R&M) programming requests. According to
                                                                               the Army’s analysis, 45 percent of the infrastructure in Hawaii is
                                                                               failed or failing, putting efforts to meet operational needs at risk.
                                                                               To remedy this issue, HIRI allocates between $50,000,000 and
                                                                               $150,000,000 per year through fiscal year 2030 to address major in-
                                                                               frastructure needs, and has a ten-year cost of $1,100,000,000. The
                                                                               program addresses several major facility and infrastructure defi-
                                                                               ciencies, including aviation maintenance facilities, operations facili-
                                                                               ties, tactical equipment maintenance facilities, Pohakuloa Training
                                                                               Area, West Loch Ammunition Storage, and base operations. Con-
                                                                               tinued and consistent funding is needed at a time of growing na-
                                                                               tional security needs in the Pacific. Therefore, the Committee di-
                                                                               rects 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 un-
                                                                               dermine the interconnected nature of HIRI’s projects.
                                                                                  Adequate Childcare for Military Families.—The Committee is
                                                                               aware of the importance of secure and adequate childcare for mili-
                                                                               tary families. DOD has argued that these childcare services and
                                                                               benefits help support their recruiting, retention and readiness
                                                                               goals, and that there is generally a high level of satisfaction among
                                                                               servicemembers who use DOD childcare services. However, the suc-
                                                                               cess of the program depends, in part, on ensuring adequate facili-
                                                                               ties for child development centers (CDCs) and School Age Care
                                                                               (SAC) Program facilities, preferably on military installations. Hear-
                                                                               ings before the subcommittee have noted a lack of facilities in some
                                                                               locations. Thus, the Committee directs the Service Secretaries to
                                                                               submit a report to the congressional defense committees no later
                                                                               than 180 days after enactment of this Act detailing (1) all installa-
                                                                               tions that have CDCs and SAC facilities, (2) the physical condition
                                                                               of these facilities, and (3) the length of time military families must
                                                                               wait before enrolling their children into CDCs and SAC programs.
                                                                                  Quality of Life (QOL) Project Funding and Priority List.—In rec-




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                                                                               ognition of the difficulties the lack of QOL facilities can cause for




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                                                                               servicemembers and their families, the Committee provides an ad-
                                                                               ditional $152,000,000 for the construction of three Child Develop-
                                                                               ment Centers (CDCs) on Army installations, as identified on the
                                                                               unfunded requirements list submitted to Congress. Understanding
                                                                               that stable family life is a key component of mission readiness and
                                                                               retention, the Committee believes the Services should make QOL
                                                                               projects, particularly CDCs, a priority in their annual budget re-
                                                                               quests and directs the Service Secretaries to submit a report to the
                                                                               congressional defense committees, no later than 90 days after en-
                                                                               actment of this Act, to address QOL shortfalls. The report should
                                                                               identify the installations that are most in need of QOL projects in
                                                                               fiscal year 2022 and the following four fiscal years, the specific
                                                                               projects needed, and associated funding requirements. In addition,
                                                                               the Committee directs the Secretary to create a unified list of QOL
                                                                               projects to be submitted with the annual budget request.
                                                                                  Review of Area Cost Factors for the Indo-Pacific.—The DOD Fa-
                                                                               cilities Pricing Guide (UFC 3–701–01) supports a spectrum of facil-
                                                                               ity planning, investment, and analysis needs for each Service. This
                                                                               guide reflects updated cost, pricing data, and methodologies used
                                                                               to prepare the military’s construction budget. It is essential for
                                                                               project scoping and cost estimates built using this guide to be accu-
                                                                               rate for the effective utilization of scarce taxpayer resources. The
                                                                               methodology behind these estimates must take into account the
                                                                               unique market specific considerations, especially in geographically
                                                                               isolated locations in the Indo-Pacific, including Hawaii. Therefore,
                                                                               the Committee directs the Secretary to submit a report to the con-
                                                                               gressional defense committees, no later than 180 days after enact-
                                                                               ment of this Act, that: (1) compares initial price guide estimates to
                                                                               final construction costs for each of fiscal years 2015 through 2019
                                                                               for construction projects in the Indo-Pacific, to include Hawaii; (2)
                                                                               describes factors unique to construction on Indo-Pacific islands that
                                                                               are included in the Services’ pricing estimates based on the DOD
                                                                               Facilities Pricing Guide; (3) compares military and private sector
                                                                               construction costs in the Indo-Pacific for buildings of comparable
                                                                               purposes; (4) describes the major cost factors considered by private
                                                                               sector construction companies operating in the Indo-Pacific that are
                                                                               not considered by the military and why; and (5) analyzes the effect
                                                                               of ocean shipping rates and U.S. ocean shipping laws on construc-
                                                                               tion costs and regulatory and legal options for reducing those costs.
                                                                                  Naval Air Weapons Station (NAWS) China Lake Earthquake Re-
                                                                               covery Efforts.—NAWS China Lake is a critical installation that
                                                                               serves as a cornerstone of our national defense architecture. The
                                                                               Committee appreciates the Navy’s efforts to rebuild NAWS China
                                                                               Lake as expeditiously as possible and recognizes the important role
                                                                               that supporting communities will play with the rebuilding effort.
                                                                               By strengthening ties with the local community, the Committee be-
                                                                               lieves that this action enables the base to be rebuilt in a timely
                                                                               manner while also fostering a good return on taxpayer funds. In
                                                                               order to help facilitate good communication and long-term, stra-
                                                                               tegic planning by local stakeholders and to assist with congres-
                                                                               sional oversight responsibilities, the Committee directs the Sec-
                                                                               retary to produce a biannual publicly releasable report that pro-
                                                                               vides an update on the rebuilding efforts of NAWS China Lake
                                                                               until all work is complete. The report should not only discuss the




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                                                                               past, present, and future construction efforts, but also highlight op-




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                                                                               portunities that local community members may be able to help ad-
                                                                               dress. The report shall be submitted to the Committees on Appro-
                                                                               priations and be posted online.
                                                                                  Federally Recognized Tribes.—The Committee notes our Nation’s
                                                                               commitment to honoring treaty and trust obligations to Federally
                                                                               Recognized Tribes. While military operations and facility protection
                                                                               are important, upholding our commitments to Indian Country must
                                                                               be an equal priority. It has been observed that DOD has struggled
                                                                               to proactively engage with affected Tribes at the start of the plan-
                                                                               ning process to ensure meaningful consultation can occur. More-
                                                                               over, the Department does not identify sufficient funds to cover
                                                                               mitigation and alternatives should they be agreed upon. To under-
                                                                               stand the scale of this problem, the Committee directs the Sec-
                                                                               retary of Defense to provide the Committee a list of military con-
                                                                               struction projects related to mitigation and/or changes to projects
                                                                               were required within the past five years where consultation with
                                                                               a Federally Recognized Tribe, the outcome of each consultation, a
                                                                               list of all project modifications and/or mitigation requests made by
                                                                               the Tribe (or Tribes) in question for each project, the cost of each
                                                                               measure, and which modifications and or mitigations were adopted
                                                                               no later than 180 days after enactment of this Act. Further DOD
                                                                               is encouraged to each establish a central account from which miti-
                                                                               gation projects can be funded.
                                                                                  Military Construction Planning for the Indo-Pacific Region.—Ac-
                                                                               cording to the National Defense Strategy, the United States is
                                                                               seeking to strengthen our nation’s alliances and partnerships in
                                                                               the Indo-Pacific Region with a networked security architecture ca-
                                                                               pable of deterring aggression, maintaining stability, and ensuring
                                                                               free access to common domains. This effort will include significant
                                                                               military construction requirements throughout the Indo-Pacific re-
                                                                               gion. Properly executing this investment requires advance planning
                                                                               and design work to develop DD Form 1391s matched to mission-
                                                                               critical requirements. Thus, the Committee directs the Assistant
                                                                               Secretary of Defense (Sustainment) to submit a report to the con-
                                                                               gressional defense committees within 180 days of enactment of this
                                                                               Act detailing: (1) the number of DD Form 1391s for facilities in the
                                                                               Indo-Pacific generated by each military service and agency for fis-
                                                                               cal year 2015 through fiscal year 2020, (2) the number of military
                                                                               construction projects in the Indo-Pacific that were included in the
                                                                               Future Years Defense Program for each military service and agen-
                                                                               cy for fiscal year 2015 through fiscal year 2020, and (3) efforts by
                                                                               the department to accelerate planning and design efforts by the
                                                                               Services to better align departmental strategies with executable
                                                                               projects.
                                                                                  Efficiency within the Military Construction Accounts.—The Com-
                                                                               mittee supports military construction projects that incorporate re-
                                                                               quirements from Active Duty, Reserve and Guard components in
                                                                               order to maximize efficiency, eliminate the need for multiple con-
                                                                               struction projects and reduces costs.
                                                                                  Cross Laminated Timber.—The Committee is aware that the use
                                                                               of cross laminated timber and other mass timber products as a
                                                                               building material has the potential for reducing costs and increas-
                                                                               ing functionality of various military structures. The Committee en-




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                                                                               courages the Secretary of Defense to expand the application of




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                                                                               these innovative technologies in future military construction
                                                                               projects.
                                                                                  Defense Access Roads (DAR) Program.—The Committee supports
                                                                               Defense Access Roads as a vital mechanism to improve transpor-
                                                                               tation infrastructure at domestic installations and their sur-
                                                                               rounding communities. The Fiscal Year 2020 National Defense Au-
                                                                               thorization Act clarified that appropriated funds for the DAR Pro-
                                                                               gram may be used to cover the cost of repairing damage or miti-
                                                                               gating infrastructure risk to access roads caused by recurrent flood-
                                                                               ing or sea level fluctuation. The Committee urges the Department
                                                                               to identify military installations with transportation infrastructure
                                                                               affected by sea level fluctuation and recurrent flooding and,
                                                                               through the appropriate contacts at affected installations and sites,
                                                                               work with surrounding local communities to identify affected trans-
                                                                               portation infrastructure and conduct transportation needs assess-
                                                                               ments to understand the magnitude of the improvement required.
                                                                                  Investing in Multi-hazard Resilient Defense Infrastructure Plan-
                                                                               ning, Development, and Testing.—The Committee supports the De-
                                                                               partment’s continued focus on building lasting and resilient mili-
                                                                               tary installations, including its update of hurricane-resistant build-
                                                                               ing codes for bases, barracks, hospitals, and airfields, and consider-
                                                                               ation of the effects of severe drought and desertification on military
                                                                               installations and missions. In addition to Department-wide initia-
                                                                               tives, such as revised structure planning, conservation programs
                                                                               and modeling new installations with the threat of sea-level rise in
                                                                               mind, the Committee encourages the Department to prioritize in-
                                                                               vesting in climate-sustainable infrastructure projects that have
                                                                               yielded positive results. To support these efforts, the bill includes
                                                                               section 512 prohibiting the use of funds to construct facilities that
                                                                               do not meet resiliency standards.
                                                                                  Broadband In/Around Military Installations.—The Committee is
                                                                               concerned with the lack of broadband access at remote or rural in-
                                                                               stallations across the United States. The absence of high-quality
                                                                               broadband significantly limits professional development and em-
                                                                               ployment opportunities for military spouses, exacerbating existing
                                                                               workforce challenges faced by spouses who often relocate their fam-
                                                                               ilies every two to three years. It also means children of
                                                                               servicemembers may not have the resources to complete their
                                                                               homework and can creates difficulty accessing the telemedicine
                                                                               services military families need when specialists and advanced
                                                                               treatment facilities are hours of driving away. Therefore, the Sec-
                                                                               retary is directed to provide a report to the congressional defense
                                                                               committees no later than 90 days after enactment of this Act that
                                                                               discusses broadband access at remote and rural military installa-
                                                                               tions, identifies installations that lack such access, and assesses
                                                                               the availability of low-cost broadband technologies that could ex-
                                                                               tend access to these installations.
                                                                                  Ultra-High Performance Concrete.—The Committee is aware of
                                                                               the Department of Defense’s collaboration with Federally des-
                                                                               ignated research universities to accelerate research on the develop-
                                                                               ment of additive manufacturing techniques and processes that use
                                                                               superior and resilient building products, in particular ultra-high
                                                                               performance concrete. Additive manufacturing will be critical for
                                                                               rapidly enhancing the resilience and readiness of military installa-




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                                                                               tions, base housing, roads and bridges in a cost-effective manner.




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                                                                               The Committee encourages the Secretary of Defense to expand the
                                                                               application of these innovative technologies and building products
                                                                               in future military construction projects.
                                                                                                                                MILITARY CONSTRUCTION, ARMY
                                                                               Appropriation, fiscal year 2020 .........................................................                                                                  $1,178,499,000
                                                                               Budget request, fiscal year 2021 .......................................................                                                                      650,336,000
                                                                               Recommended in the bill ...................................................................                                                                   608,336,000
                                                                               Bill compared with:
                                                                                    Appropriation, fiscal year 2020 ..................................................                                                                        ¥570,163,000
                                                                                    Budget request, fiscal year 2021 ................................................                                                                          ¥42,000,000
                                                                                 Military Construction, Army.—The bill includes $608,336,000 for
                                                                               the following projects in the following amounts:
                                                                                                                                                        Project                                                                                   Amount

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

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

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




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                                                                               Fort McCoy—Transient Training Enlisted Barracks ......................................................................................                                 29,200,000
                                                                               Caserma Renato Del Din—Access Control Point ..........................................................................................                                 10,200,000




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                                                                                                                                                     Project                                                                               Amount

                                                                               Military Ocean Terminal Concord—Ammunition Holding Area .....................................................................                                46,000,000
                                                                               Fort Detrick—Incinerator Facility ...................................................................................................................        10,000,000
                                                                                     Total, Unfunded Requirements, Army ...................................................................................................                342,600,000

                                                                                  Immediate Response Force.—The Committee is concerned that
                                                                               without significant investment, the Army is not prepared to main-
                                                                               tain the requirements of the Immediate Response Force (IRF) to be
                                                                               able to deploy anywhere in the world within 18 hours. In order to
                                                                               deter aggression against US interests and maintain an effective
                                                                               global deterrent, there are significant military construction needs
                                                                               at several installations that cannot be sufficiently mitigated with
                                                                               other funding sources. The Committee urges the Army to prioritize
                                                                               facilities that will support the global mission of the IRF and main-
                                                                               tain this critical capability.
                                                                                  Motor Pools.—In order to be able to deploy on command and con-
                                                                               duct 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 pro-
                                                                               gram, 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, qual-
                                                                               ity maintenance requires appropriately designed, sized, supplied,
                                                                               and staffed motor pools and maintenance facilities. The Committee
                                                                               requests a report on the condition, current and anticipated capacity
                                                                               requirements, and modernization needs of motor pools that support
                                                                               the rapid deployment of armored combat units within 90 days after
                                                                               enactment of this Act. The report should include information on re-
                                                                               cent upgrades and construction of motor pools, as well as planned
                                                                               investments included in the future years defense program.
                                                                                  Firefighting Houses and Equipment.—The Secretary of the Army
                                                                               is directed to provide a report to the Committee, within 180 days
                                                                               of enactment of this Act, regarding firehouses, firefighting equip-
                                                                               ment, and firefighting personnel on military installations in non-
                                                                               contiguous states and territories. This report should include a
                                                                               timeline, details, and projected costs for the building of any
                                                                               firehouses on DOD installations that have firefighting personnel
                                                                               but have substandard working and living conditions for personnel
                                                                               and their equipment, suited to their mission and needs. The report
                                                                               also should include information on remediation efforts to mitigate
                                                                               substandard conditions and to protect personnel and equipment.
                                                                                  Land Use and Housing Issues at U.S. Army Garrison.—The Com-
                                                                               mittee is aware of the Army’s desire to examine various options to
                                                                               address land use and housing issues at U.S. Army Garrison Ha-
                                                                               waii. Among the options under consideration is an unsolicited gift
                                                                               of real property under Army Regulation 1–100, The Army Gift Pro-
                                                                               gram. Although the gift process requires a National Environmental
                                                                               Policy Act (NEPA) Environmental Impact Assessment, the Com-
                                                                               mittee notes that members of the local community may have expec-
                                                                               tations regarding the land use rules for properties that may have
                                                                               been designated solely for agricultural and other non-housing uses.
                                                                               To provide the greatest public transparency possible consistent
                                                                               with existing law, the Committee directs the Secretary of the Army
                                                                               to provide to the congressional defense committees a report no later




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                                                                               than 180 days after enactment of this Act on: (1) what state and




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                                                                               county land use laws in the State of Hawaii would be negated if
                                                                               the Army processes a land proffer under NEPA and (2) the Army’s
                                                                               public engagement plan for ensuring reasonable community en-
                                                                               gagement before accepting a proffer.
                                                                                                    MILITARY CONSTRUCTION, NAVY AND MARINE CORPS
                                                                               Appropriation, fiscal year 2020 .........................................................                                                                  $2,449,632,000
                                                                               Budget request fiscal year 2021 ........................................................                                                                    1,975,606,000
                                                                               Recommended in the bill ...................................................................                                                                 1,611,914,000
                                                                               Comparison with:
                                                                                   Appropriation, fiscal year 2020 ..................................................                                                                         ¥837,718,000
                                                                                   Budget request, fiscal year 2021 ................................................                                                                          ¥363,692,000
                                                                                 Military Construction, Navy and Marine Corps.—The bill in-
                                                                               cludes $1,611,914,000 for the following projects in the following
                                                                               amounts:
                                                                                                                                                        Project                                                                                   Amount

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

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

                                                                               Cost to Complete (Section 126)
                                                                               Joint Region Marianas—Hardening Petroleum Oil, and Lubricant Infrastructure ........................................                                               $19,200,000
                                                                               NAS Key West—Aircraft Maintenance Hangar ..............................................................................................                             37,200,000
                                                                               NAS Whiting Field—Air Traffic Control Tower ...............................................................................................                          7,900,000
                                                                               NAS Point Mugu—Missile Assembly Building and High Explosive Magazine ..............................................                                                 13,100,000
                                                                               MCAS Cherry Point—F–35B Vertical Lift Fan Test Facility ..........................................................................                                   7,000,000
                                                                               MCAS Beaufort—Recycling and Hazardous Waste Facility ...........................................................................                                    10,000,000




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                                                                               Camp Lejeune—Water Treatment Plant Replacement, Hadnot Point ...........................................................                                            50,500,000
                                                                                     Total, Cost to Complete, Navy and Marine Corps ................................................................................                              144,900,000




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                                                                                                                                                     Project                                                                               Amount

                                                                               Unfunded Requirements (Section 123)
                                                                               Yuma—Bachelor Enlisted Quarters ...............................................................................................................             $31,537,000
                                                                               NC TAMSLANT Cutler—Perimeter Security .....................................................................................................                  26,100,000
                                                                               Camp Pendleton—Combat Water Survival Training Facility ........................................................................                              25,200,000
                                                                               Comalpa—Long Range Maritime Patrol Aircraft Hangar and Ramp ...........................................................                                      28,000,000
                                                                               Seal Beach—Magazines ................................................................................................................................        46,800,000
                                                                               Port Hueneme—Combat Vehicle Maintenance Facility .................................................................................                           43,500,000
                                                                               Mechanicsburg—Machinery Control Development Center .............................................................................                             74,600,000
                                                                               Point Mugu—Directed Energy Test Facility ...................................................................................................                 26,700,000
                                                                               Norfolk—Sub Logistics Support .....................................................................................................................           9,400,000
                                                                               Coronado—CMV–22 Hangar ..........................................................................................................................            75,800,000
                                                                               NS Guam—X-Ray Wharf Berth 2 ..................................................................................................................               94,500,000
                                                                               NOSC Minneapolis—Joint Reserve Intel Center ............................................................................................                     12,800,000
                                                                               Whidbey Island—E/A–18G Fleet Readiness Squadron Training Facility ......................................................                                     29,900,000
                                                                               Norfolk—CMV–22 Airfield and Hangar Improvements ..................................................................................                           56,100,000
                                                                               NAS Jacksonville—Consolidated Ordnance Operations Facility ....................................................................                              14,300,000
                                                                               Yorktown—Ordnance Facilities ......................................................................................................................          71,800,000
                                                                               Camp Pendleton—Combat Water Survival Training Facility ........................................................................                              25,200,000
                                                                               Camp Pendleton—Warehouse Consolidation and Modernization ..................................................................                                  21,800,000
                                                                               MCAS Cherry Point—Fitness Center Replacement and Training Pool ..........................................................                                    51,900,000
                                                                                     Total, Unfunded Requirements, Navy and Marine Corps .....................................................................                             765,937,000

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




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                                                                               the Department of the Navy to utilize PLAs for military construc-




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                                                                               tion projects that will take place at the Navy’s four public ship-
                                                                               yards as part of the Shipyard Infrastructure Optimization Plan.
                                                                                                                         MILITARY CONSTRUCTION, AIR FORCE
                                                                               Appropriation, fiscal year 2020 .........................................................                                                                  $1,687,230,000
                                                                               Budget request, fiscal year 2021 .......................................................                                                                      767,132,000
                                                                               Recommended in the bill ...................................................................                                                                   569,792,000
                                                                               Bill compared with:
                                                                                    Appropriation, fiscal year 2020 ..................................................                                                                  ¥1,117,438,000
                                                                                    Budget request, fiscal year 2021 ................................................                                                                    ¥197,340,000
                                                                                 Military Construction, Air Force.—The bill includes $569,792,000
                                                                               for the following projects in the following amounts:
                                                                                                                                                        Project                                                                                   Amount

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

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

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

                                                                                 The recommendation does not include funding for the three Air
                                                                               Force projects requested for Tinian. The Committee directs the Sec-
                                                                               retary of the Air Force to provide an update to the congressional




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                                                                               defenses committees on the timeline and updated costs for exe-




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                                                                               cuting military construction on the island and the role of the air-
                                                                               field and related support infrastructure to support INDOPACOM
                                                                               AOR no later than 120 days after enactment of this Act.
                                                                                  The Weapons Technology Integration Center (WTIC).—The Com-
                                                                               mittee is concerned that the WTIC infrastructure is old, inefficient,
                                                                               and lacking in secure areas. As directed by the National Security
                                                                               Strategy (NSS) and National Defense Strategy (NDS), to keep our
                                                                               asymmetric military advantage, the Nation needs to modernize our
                                                                               weapon systems, and be able to do so at the speed of relevance. The
                                                                               WTIC would enable the US to achieve these needs with modern,
                                                                               secure laboratory space that allows the digital transition in weap-
                                                                               ons research and development and increases collaboration across a
                                                                               multi-disciplinary workforce that enables rapid transition of tech-
                                                                               nologies to the warfighter. The Committee directs the Secretary of
                                                                               the Air Force to report to the congressional defense committees on
                                                                               the total cost of the WTIC and what fiscal years the replacement
                                                                               construction would be submitted no later than 60 days after enact-
                                                                               ment of this Act.
                                                                                  MIT Lincoln West Lab CSL/MIF, Increment 3.—The Committee
                                                                               is concerned that the Air Force did not submit a request for the
                                                                               final increment of the MIT-Lincoln West Lab CSL/MIF in the fiscal
                                                                               year 2021 budget request. The Committee provided increments 1
                                                                               and 2 in fiscal years 2019 and 2020. The Committee understands
                                                                               the importance of labs to the Air Force, especially MIT-Lincoln Lab
                                                                               and is perplexed as to why the final increment has not been re-
                                                                               quested. Therefore, the Committee directs the Secretary of the Air
                                                                               Force to report to the congressional defense committees no later
                                                                               than 60 days after enactment of this Act on the status of obligation
                                                                               and execution for increments 1 and 2, the fiscal year in which the
                                                                               third increment will be requested and the amount and a timeline
                                                                               for completion of the project.
                                                                                  Air Traffic Control Towers.—The Committee is concerned that
                                                                               the Air Force’s ATC Towers have been neglected over the years,
                                                                               and funding for military construction has been deferred to the out
                                                                               years of budget submissions. Many of the air towers are deterio-
                                                                               rating 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 pre-
                                                                               vent 100 percent positive visual control of aircraft landing and tax-
                                                                               iing on the airfield. The Committee urges the Air Force to prioritize
                                                                               funding for these towers in a much timelier manner. The Com-
                                                                               mittee believes that these towers are valuable national security as-
                                                                               sets that the Department of the Air Force should maintain in a
                                                                               manner that will ensure their vital role in protecting United States
                                                                               national security interests.
                                                                                  Air Education and Training Command (AETC).—The Committee
                                                                               recognizes the importance of adequate facilities for basic military
                                                                               training, flight training, and the other training missions of the
                                                                               AETC. Outdated and inadequate AETC facilities, including dor-
                                                                               mitories, harm the Air Force’s ability to recruit, train, and retain
                                                                               Airmen and increase operations and maintenance costs. The Com-
                                                                               mittee urges the Air Force to prioritize funding for AETC facility




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                                                                               design, construction, and construction improvements because of the




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                                                                               critical role training plays in force readiness for future threats to
                                                                               U.S. national security.
                                                                                 Air Education and Training Command Drainage Projects.—The
                                                                               Committee recognizes the adverse impact that flooding and other
                                                                               infrastructure challenges have had on AETC facilities, equipment,
                                                                               operations, and training. The Committee also recognizes the steps
                                                                               that the Air Force has taken to begin mitigating the damage
                                                                               through multi-year projects. The Committee supports these efforts
                                                                               and urges the Secretary of the Air Force to prioritize these projects.
                                                                                 Access Control Points at Air Force and Air National Guard In-
                                                                               stallations in Urban Areas.—The Committee expects the Air Force
                                                                               to accelerate funding for current access control point construction
                                                                               projects to installations that face high-security risks to critical mis-
                                                                               sions. Priority in allocating funds shall be given to access control
                                                                               points in heavily congested areas in large urban settings that place
                                                                               major transportation links at risk of incident closures, or that are
                                                                               required for heavy traffic hazard mitigation, airport security and
                                                                               installation force protection.
                                                                                                                   MILITARY CONSTRUCTION, DEFENSE-WIDE
                                                                               Appropriation, fiscal year 2020 .........................................................                                                                  $2,362,529,000
                                                                                  Budget request, fiscal year 2021 ................................................                                                                        2,027,520,000
                                                                                  Recommended in the bill ............................................................                                                                     2,234,517,000
                                                                               Comparison with:
                                                                                  Appropriation, fiscal year 2020 ..................................................                                                                          ¥128,012,000
                                                                                  Budget request, fiscal year 2021 ................................................                                                                           +206,997,000
                                                                                 Military   Construction,    Defense-Wide.—The       bill  includes
                                                                               $2,234,517,000 for the following projects in the following amounts:
                                                                                                                                                        Project                                                                                   Amount

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




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                                                                                     Total, Military Construction, Defense-Wide ...........................................................................................                      2,234,517,000




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

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

                                                                                  Investment in Renewable Energy Systems.—The Committee sup-
                                                                               ports the military’s continued investment in renewable energy sys-
                                                                               tems, including the use and application of solar energy for mobility
                                                                               and resilience capabilities at defense military installations includ-
                                                                               ing military bases, barracks, hospitals, and airfields. Such invest-
                                                                               ments 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 secu-
                                                                               rity and efficiency at military installations. Accordingly, the Com-
                                                                               mittee requests a report no later than 180 days after enactment of
                                                                               this Act, detailing DOD’s plans for further development of renew-
                                                                               able energy systems at military installations and a timeline and
                                                                               goals for increased utilization.
                                                                                  Renewable Energy Supply Investment.—The Committee recog-
                                                                               nizes the advances the Department has made in increasing sus-
                                                                               tainable and renewable energy supply to its facilities and encour-
                                                                               ages the continued investment in renewable energy systems, in-
                                                                               cluding the use of solar energy, which is vital to preserving na-
                                                                               tional security and ensuring military preparedness and response.
                                                                               Construction of resilient, renewable energy infrastructure on mili-
                                                                               tary bases, both foreign and domestic, aids our military in building
                                                                               defenses against threats such as natural disasters, extreme weath-
                                                                               er, and cyber-attacks, and decreases our military’s vulnerabilities




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                                                                               while reducing energy costs.




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                                                                                  Tripler Army Medical Center Parking Assessment.—The Tripler
                                                                               Army Medical Center and the Spark M. Matsunaga Veterans Af-
                                                                               fairs (VA) Medical Center share a facility on the Island of Oahu.
                                                                               As the largest military and Veterans medical facility in the Pacific
                                                                               Basin, it is responsible for nearly 450,000 beneficiaries who are eli-
                                                                               gible to receive care at the facility. According to the Army’s own as-
                                                                               sessment using formulas included in the Department of Defense
                                                                               Unified Facilities Criteria (UFC) 4–510–01, Design: Medical Mili-
                                                                               tary Facilities, the facility should have 5,936 parking stalls to ac-
                                                                               commodate its workforce and patients. However, the facility only
                                                                               has 3,713 stalls. The facility is also not readily accessible to public
                                                                               transit, making ground transportation with parking the only rea-
                                                                               sonable option. Due to this geographic fact and parking shortfall,
                                                                               veterans and servicemembers have difficulty finding parking,
                                                                               which is particularly challenging for elderly veterans, wounded sol-
                                                                               diers and those who have difficulty walking unassisted. Therefore,
                                                                               the Committee directs the Secretary of the Army and the Director
                                                                               of the Defense Health Agency to submit a joint report to the con-
                                                                               gressional defense committees no later than 180 days after enact-
                                                                               ment of this Act detailing the efforts to: (1) update the facility’s
                                                                               master infrastructure plan and (2) address the parking shortfall at
                                                                               the facility, to include the possible location, cost, and timeline for
                                                                               building a new parking garage that sufficiently fulfills the parking
                                                                               demands for both the Army and VA.
                                                                                  Energy Conservation.—The Committee commends DOD’s forward
                                                                               posture on the need to improve energy resilience and mission as-
                                                                               surance, save energy, and reduce energy costs. As DOD works to
                                                                               construct new facilities and upgrade facilities, the Committee di-
                                                                               rects DOD to increase the integration of alternative energy sources,
                                                                               particularly through renewable sources, throughout military facili-
                                                                               ties and installations. The Committee directs the Secretary of De-
                                                                               fense to provide an updated report no later than 60 days after en-
                                                                               actment of this Act on DOD’s strategy to: (1) provide latest sum-
                                                                               mary of progress toward achieving Defense base energy independ-
                                                                               ence, including Guard and Reserve facilities; (2) increase energy
                                                                               conservation efforts and on energy cost savings; (3) improved unit
                                                                               readiness; (4) and opportunities for return on investments of exist-
                                                                               ing and planned projects.
                                                                                  Defense Information Systems Agency (DISA).—The Committee
                                                                               recognizes the need to move the Joint Spectrum Center (JSC) from
                                                                               the David Taylor Research Center (DTRC) site in Annapolis, Mary-
                                                                               land. DTRC was closed 2005 under Base Realignment and Closure
                                                                               process and the surrounding facilities and grounds are no longer
                                                                               maintained by the Federal government. JSC’s current building at
                                                                               the DTRC site contains asbestos, significant infrastructure prob-
                                                                               lems, and cannot meet Anti-Terrorism Force Protection (AT/FP) se-
                                                                               curity standards. Failure to meet these security standards requires
                                                                               ongoing security waivers by JCS’s parent organization, DISA, for
                                                                               its remaining lease term. JSC’s relocation and existing lease termi-
                                                                               nation were authorized in the Fiscal Year 2008 National Defense
                                                                               Authorization Act and were intended to ensure JSC personnel are
                                                                               performing JSC’s mission in a building that meets all required AT/
                                                                               FP, environmental protection, and building safety requirements.
                                                                               The Committee reminds the Department of its responsibility to en-




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                                                                               sure the safety and security of military and civilian personnel and




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                                                                                                                                                                         24

                                                                               recommends DISA begin the process to relocate JSC’s to a more
                                                                               suitable facility as soon as possible.
                                                                                                                                GUARD AND RESERVE INITIATIVE
                                                                                 Regional Training Institutes.—The Committees recognize the im-
                                                                               portance of Regional Training Institutes (RTI) across the country
                                                                               for the readiness of Army National Guard (ARNG) and are con-
                                                                               cerned about the lack of infrastructure to support the mission of
                                                                               the RTIs. For example, the RTI at Fort Hood is lacking sufficient
                                                                               facilities to provide the proper training to achieve optimum readi-
                                                                               ness. The Committee urges the Department to prioritize facilities
                                                                               for this important and vital mission of ARNG and Army Reserve.
                                                                                                       MILITARY CONSTRUCTION, ARMY NATIONAL GUARD
                                                                               Appropriation, fiscal year 2020 .........................................................                                                                      $210,819,000
                                                                                    Budget request, fiscal year 2021 ................................................                                                                          321,437,000
                                                                                    Recommended in the bill ............................................................                                                                       349,437,000
                                                                               Bill compared with:
                                                                                    Appropriation, fiscal year 2020 ..................................................                                                                        +138,618,000
                                                                                    Budget request, fiscal year 2021 ................................................                                                                         +28,000,0000
                                                                                 Military Construction, Army National Guard.—The bill includes
                                                                               $349,437,000 for the following projects in the following amounts:
                                                                                                                                                        Project                                                                                   Amount

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

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

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

                                                                                 Army National Guard (ARNG) Readiness Center Transformation
                                                                               Master Plan.—The ARNG completed its Readiness Center Trans-




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                                                                               formation Master Plan (RCTMP) in 2015; however, since that time,




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                                                                               the investment in executing the military construction required
                                                                               under the RCTMP has not kept up with the demand. The Com-
                                                                               mittee is concerned that the mission readiness of these critical fa-
                                                                               cilities is further deteriorating, and it encourages increased invest-
                                                                               ments in ARNG Readiness Centers over the FYDP. Further, given
                                                                               the changing conditions of readiness centers across the country
                                                                               since the last RCTMP was completed, the Committee encourages
                                                                               the ARNG to update the RCTMP to ensure its current military con-
                                                                               struction priorities align with the Transformation Master Plan. Ac-
                                                                               cordingly, the Committee provides an additional $15,000,000 in
                                                                               Army National Guard planning & design for completion of a Readi-
                                                                               ness Center Transformation Master Plan update.
                                                                                  Army National Guard Readiness Centers Investment.— The Com-
                                                                               mittee appreciates the Army’s prioritization of Army National
                                                                               Guard Readiness Centers in its budget request for fiscal year 2021.
                                                                               The Committee remains concerned by the failure of the Army to
                                                                               prioritize investment in ARNG Readiness Centers and arsenals.
                                                                               These facilities are critical to protecting the homeland and respond-
                                                                               ing to domestic emergencies. Their deteriorating conditions are det-
                                                                               rimental to the readiness of the ARNG and, in some cases, present
                                                                               significant safety concerns. The Committee encourages the Army to
                                                                               accelerate investments in Readiness Centers in the fiscal year 2022
                                                                               budget request and Future Years Defense Program and include
                                                                               $1,200,000,000 for the ARNG Transformation Plan.
                                                                                  Army National Guard Infrastructure and Unspecified Minor Mili-
                                                                               tary Construction.—The Committee is concerned with the state of
                                                                               ARNG infrastructure across the country. The ARNG has been con-
                                                                               tinuously underfunded for the last several decades. The Committee
                                                                               is aware that reviews have found that billions of dollars will be
                                                                               needed to bring Readiness Centers up to modern standards, yet de-
                                                                               spite that little progress has been made. With new higher thresh-
                                                                               olds for Unspecified Minor Military Construction (UMMC), many
                                                                               smaller projects can be accomplished with an increase in this ac-
                                                                               count. While not completely solving the ARNG military construc-
                                                                               tion appropriations issue, this will speed up projects across the
                                                                               country and increase the readiness of the ARNG. The Committee
                                                                               provides $13,000,000 for this effort in fiscal year 2021 and directs
                                                                               DOD to properly budget for the UMMC account in future years.
                                                                                  ARNG Aviation Support Facilities.—The Committee is concerned
                                                                               that ARNG Aviation Support Facilities (AASF) are not prepared to
                                                                               protect and properly maintain next generation airframe priorities
                                                                               simultaneously as the Army. The operation and maintenance of
                                                                               new aircraft platforms requires significant investment in AASFs
                                                                               across the country so that they can provide the required shelter
                                                                               and support for new airframes, as well as regular maintenance for
                                                                               the existing airframes. The Committee urges both the Army and
                                                                               the ARNG to prioritize facilities that support readiness of ARNG
                                                                               aviation units as they prepare to gain new aircraft platforms.
                                                                                  National Guard Training Center.—Committee recognizes the im-
                                                                               portance of the National Guard Texas Training Center, which has
                                                                               been in development since 2010 and has had execution delays. The
                                                                               Committee recognizes that the Texas Training Center remains a
                                                                               high priority and the Texas Army National Guard shall continue




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                                                                               its efforts to establish the Center.




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                                                                                 Maneuver Area Training Equipment Site (MATES).—The Com-
                                                                               mittee recognizes the critical role of the Maneuver Area Training
                                                                               Equipment Site (MATES) in providing needed wheel vehicle main-
                                                                               tenance for M1 Abrams Tanks and M2 Bradley Infantry Fighting
                                                                               Vehicles at installations such as Camp Shelby. Therefore, the Com-
                                                                               mittee encourages the Army National Guard to prioritize the mod-
                                                                               ernization of these types of facilities.
                                                                                                          MILITARY CONSTRUCTION, AIR NATIONAL GUARD
                                                                               Appropriation, fiscal year 2020 .........................................................                                                                      $164,471,000
                                                                               Budget request, fiscal year 2021 .......................................................                                                                         64,214,000
                                                                               Recommended in the bill ...................................................................                                                                      64,214,000
                                                                               Comparison with:
                                                                                   Appropriation, fiscal year 2020 ..................................................                                                                         ¥100,257,000
                                                                                   Budget request, fiscal year 2021 ................................................                                                                                 –––
                                                                                 Military Construction, Air National Guard.—The bill includes
                                                                               $64,214,000 for the following projects in the following amounts:
                                                                                                                                                        Project                                                                                   Amount

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

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

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

                                                                                  Wildland Fire Mission.—The Committee directs the National
                                                                               Guard Bureau to prioritize the remodeling and replacement of Air
                                                                               National Guard (ANG) Wing Buildings that support the wildland
                                                                               fire suppression mission and utilize the Modular Airborne Fire
                                                                               Fighting System but are not in compliance with Executive Order
                                                                               13423. The Committee requests a report within 60 days of enact-
                                                                               ment of this Act regarding the condition of ANG facilities that sup-
                                                                               port the wildland fire-fighting mission.
                                                                                                                   MILITARY CONSTRUCTION, ARMY RESERVE
                                                                               Appropriation, fiscal year 2020 .........................................................                                                                       $60,928,000
                                                                               Budget request, fiscal year 2021 .......................................................                                                                         88,337,000
                                                                               Recommended in the bill ...................................................................                                                                      88,337,000
                                                                               Bill compared with:
                                                                                    Appropriation, fiscal year 2020 ..................................................                                                                         +27,409,000
                                                                                    Budget request, fiscal year 2021 ................................................                                                                                –––
                                                                                 Military Construction, Army Reserve.—The bill includes




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                                                                               $88,337,000 for the following projects in the following amounts:




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                                                                                                                                                                         27
                                                                                                                                                        Project                                                                                   Amount

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

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

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


                                                                                                                   MILITARY CONSTRUCTION, NAVY RESERVE
                                                                               Appropriation, fiscal year 2020 .........................................................                                                                       $54,955,000
                                                                               Budget request, fiscal year 2021 .......................................................                                                                         70,995,000
                                                                               Recommended in the bill ...................................................................                                                                      70,995,000
                                                                               Comparison with:
                                                                                   Appropriation, fiscal year 2020 ..................................................                                                                          +16,040,000
                                                                                   Budget request, fiscal year 2021 ................................................                                                                                 –––
                                                                                 Military Construction, Navy Reserve.—The bill includes
                                                                               $70,995,000 for the following projects in the following amounts:
                                                                                                                                                        Project                                                                                   Amount

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

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

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




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                                                                                                            MILITARY CONSTRUCTION, AIR FORCE RESERVE
                                                                               Appropriation, fiscal year 2020 .........................................................                                                                       $59,750,000
                                                                               Budget request, fiscal year 2021 .......................................................                                                                         23,117,000
                                                                               Recommended in the bill ...................................................................                                                                      23,117,000
                                                                               Bill compared with:
                                                                                    Appropriation, fiscal year 2020 ..................................................                                                                        ¥36,633,000
                                                                                    Budget request, fiscal year .........................................................                                                                           –––
                                                                                 Military Construction, Air Force Reserve.—The bill includes
                                                                               $23,117,000 for the following projects in the following amounts:
                                                                                                                                                        Project                                                                                   Amount

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


                                                                                    NORTH ATLANTIC TREATY ORGANIZATION SECURITY INVESTMENT
                                                                                                           PROGRAM
                                                                               Appropriation, fiscal year 2020 .........................................................                                                                      $172,005,000
                                                                               Budget request, fiscal year 2021 .......................................................                                                                        173,030,000
                                                                               Recommended in the bill ...................................................................                                                                     173,030,000
                                                                               Comparison with:
                                                                                   Appropriation, fiscal year 2020 ..................................................                                                                           +1,025,000
                                                                                   Budget request, fiscal year 2021 ................................................                                                                                 –––
                                                                                 The North Atlantic Treaty Organization Security Investment
                                                                               Program (NSIP) consists of annual contributions by North Atlantic
                                                                               Treaty Organization (NATO) member countries. The program fi-
                                                                               nances 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’’ op-
                                                                               erations 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 tempo-
                                                                               rarily, or to temporarily withhold funds from previously authorized
                                                                               projects, due to shortfalls in U.S. obligation authority.
                                                                                                     DEPARTMENT OF DEFENSE BASE CLOSURE ACCOUNT
                                                                               Appropriation, fiscal year 2020 .........................................................                                                                      $398,526,000
                                                                                    Budget request, fiscal year 2021 ................................................                                                                          300,447,000
                                                                                    Recommended in the bill ............................................................                                                                       580,447,000
                                                                               Bill compared with:
                                                                                    Appropriation, fiscal year 2020 ..................................................                                                                        +181,921,000
                                                                                    Budget request, fiscal year 2021 ................................................                                                                         +280,000,000
                                                                                 The recommendation provides an additional $80,000,000 for the
                                                                               Navy to accelerate environmental remediation at installations
                                                                               closed under previous Base Closure and Realignment (BRAC)
                                                                               rounds. Furthermore, the Navy shall provide to the Committee a
                                                                               spend plan for these additional funds no later than 60 days after
                                                                               enactment of this Act.
                                                                                 Perfluorooctane Sulfonate (PFOS) and Perfluorooctanoic Acid




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                                                                               (PFOA).—The Committee is concerned about the extent of PFOS/




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                                                                               PFOA contamination at U.S. military installations and how that
                                                                               contamination is measured. The Committee believes the Depart-
                                                                               ment should prioritize protecting servicemembers, their families,
                                                                               and the Department’s civilian employees from the health problems
                                                                               associated with exposure to these chemicals that are linked in var-
                                                                               ious ways to developmental delays in fetuses and children; pre-
                                                                               mature births and low birth weights; decreased fertility; immune
                                                                               suppression; liver damage; respiratory disorders; metabolic dis-
                                                                               orders; and prostate, kidney, and testicular cancer. Therefore, the
                                                                               Committee includes an additional $200,000,000 above the budget
                                                                               request within the Base Closure Account to increase the pace of
                                                                               cleanup at the military installations affected by PFOS/PFOA.
                                                                                  PFOS/PFOA Regulation and Research.—Recognizing that this
                                                                               issue is not limited to DOD and affects many communities across
                                                                               the Nation, the Committee is encouraged by the Environmental
                                                                               Protection Agency’s (EPA) February 2020 announcement that it
                                                                               plans to regulate PFOS/PFOA and to require that proposed new
                                                                               uses be reviewed under the Toxic Substances Control Act. DOD
                                                                               and affected communities are urged to work closely with EPA on
                                                                               these regulatory initiatives. DOD is also encouraged to engage the
                                                                               research community so as to ensure that it is using the best and
                                                                               most up-to-date science to guide DOD remediation plans and proc-
                                                                               esses.
                                                                                  PFOS/PFOA Reporting Requirement.—In fiscal year 2020, the
                                                                               Committee directed the Department to keep it apprised of new
                                                                               findings of PFOS/PFOA at BRAC sites. The Committee recognizes
                                                                               that the Services have provided some information. However, the
                                                                               Committee is concerned that the process for identifying PFOS/
                                                                               PFOA contamination at BRAC sites and determining the appro-
                                                                               priate remediation plan is not transparent. Therefore, the Deputy
                                                                               Assistant Secretary of Defense for Environment is directed to re-
                                                                               port to the congressional defense committees no later than 30 days
                                                                               after this report is been filed with the Clerk of the U.S. House of
                                                                               Representatives, and quarterly thereafter, on the progress the De-
                                                                               partment is making on identifying and remediating PFOS/PFOA at
                                                                               closed military installations. At a minimum, the first report should
                                                                               include information on the existing process and make recommenda-
                                                                               tions for improving its transparency; identifying all detections of
                                                                               PFOS/PFOA and existing remediation sites plans; and estimating
                                                                               current and future costs and timelines for remediation.
                                                                                                                 FAMILY HOUSING OVERVIEW
                                                                               Appropriation, fiscal year 2020 .........................................................     $1,324,002,000
                                                                               Budget request, fiscal year 2021 .......................................................       1,351,392,000
                                                                               Recommended in the bill ...................................................................    1,351,392,000
                                                                               Bill compared with:
                                                                                    Appropriation, fiscal year 2020 ..................................................         +27,390,000
                                                                                    Budget request, fiscal year 2021 ................................................                –––
                                                                                 Family housing construction accounts provide funds for new con-
                                                                               struction, 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, serv-
                                                                               ices, utilities, leasing, interest, mortgage insurance, and miscella-




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                                                                               neous expenses.




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                                                                                  Housing Support Costs and Management Accounts.—The rec-
                                                                               ommendation includes $135,000,000 within Housing Support Costs
                                                                               under Family Housing Operation and Maintenance accounts for the
                                                                               Services. The funding is to increase the Services’ ability to provide
                                                                               oversight and management, and personnel to track current and fu-
                                                                               ture issues that may occur in military family housing.
                                                                                  Privatized Military Housing.—Quality military housing a key
                                                                               component of military readiness and military family stability. Rec-
                                                                               ognizing the chronic underinvestment in military housing on do-
                                                                               mestic military installations and related readiness concerns, Con-
                                                                               gress authorized the Military Privatized Housing Initiative (MPHI)
                                                                               as part of the National Defense Authorization Act for Fiscal Year
                                                                               1996, (P.L. 104–106). Under MPHI, the Department partnered with
                                                                               private sector companies to build and renovate military housing.
                                                                                  Through MPHI, military housing improved. However, serious
                                                                               shortcomings were uncovered over the past two years. Through the
                                                                               Committee’s oversight work, unsafe conditions, mold contamina-
                                                                               tion, and unresponsive and unhelpful private partners were
                                                                               brought to light.
                                                                                  The Committee recognizes the efforts of the Services to improve
                                                                               their management and oversight of their private sector partners
                                                                               and appreciates the new requirements developed by the House and
                                                                               Senate Armed Services Committees in the National Defense Au-
                                                                               thorization Act for Fiscal Year 2020, (P.L. 116–92). However, the
                                                                               Committee continues to have numerous concerns and requests the
                                                                               Services report back to the Committee within 90 days of enactment
                                                                               of this Act, except as otherwise noted, regarding the following
                                                                               issues.
                                                                                  The Committee is concerned that the Services do not have the
                                                                               ability to readily assess the satisfaction of servicemembers with the
                                                                               quality of their privatized homes and housing communities because
                                                                               existing installation reporting systems do not capture this type of
                                                                               information. The Committee requests that the Services provide a
                                                                               report analyzing this concern and include options and recommenda-
                                                                               tions.
                                                                                  At this time, the Tenant Bill of Rights, as proscribed by the Na-
                                                                               tional Defense Authorization Act for Fiscal Year 2020, has been im-
                                                                               plemented except for Rights #16, #17, and #18. The Committee di-
                                                                               rects the Services to report on the status of implementation of
                                                                               these three Rights within 60 days of enactment of this Act.
                                                                                  The Committee remains concerned with the number and serious-
                                                                               ness of complaints regarding mold. It directs DOD to work with the
                                                                               private sector partners to prioritize funding for mold remediation
                                                                               and report on its efforts.
                                                                                  The Committee expects the Services to hold their private sector
                                                                               partners to a standard of both good performance and accurate and
                                                                               transparent reporting to military commanders and managers re-
                                                                               garding their actions and practices. The Services should not tol-
                                                                               erate any systemic or specific instances of dishonesty, deception, or
                                                                               fraud by their private sector partners. Instead, they should remain
                                                                               actively engaged with them and keep the Committee informed of
                                                                               any issues as they arise.
                                                                                  The Committee is concerned that claim settlement non-disclosure
                                                                               agreements between servicemember tenants and private sector




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                                                                               partners that are not part of a litigated matter but purport to bar




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                                                                               tenants from reporting or speaking out about their housing condi-
                                                                               tions may have contributed to delays in addressing ongoing health
                                                                               and safety threats in military housing, as well as mismanagement
                                                                               by MHPI companies. The Committee directs the Services to pre-
                                                                               vent, to the extent practicable, the use of non-disclosure agree-
                                                                               ments by MHPI companies in the settlement of non-litigated hous-
                                                                               ing condition-related claims with military tenants and report to the
                                                                               Committee if a non-disclosure agreement has been used within 30
                                                                               days of discovering the use.
                                                                                  Leasing Reporting Requirements.—The Secretary of Defense is di-
                                                                               rected 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 ex-
                                                                               ceeds the cost threshold set by 10 U.S.C. 2828(b)(2), including cer-
                                                                               tification that less expensive housing was not available for lease.
                                                                               For foreign leases, the Department is directed to: (1) perform an
                                                                               economic analysis on all new leases or lease/contract agreements
                                                                               where more than 25 units are involved; (2) report the details of
                                                                               new or renewed lease agreements that exceed the cost threshold
                                                                               set by 10 U.S.C. 2828(e)(1) 21 days before entering into such an
                                                                               agreement; and (3) base leasing decisions on the economic analysis.
                                                                                                                FAMILY HOUSING CONSTRUCTION, ARMY
                                                                               Appropriation, fiscal year 2020 .........................................................                                                $141,372,000
                                                                               Budget request, fiscal year 2021 .......................................................                                                  119,400,000
                                                                               Recommended in the bill ...................................................................                                               119,400,000
                                                                               Bill compared with:
                                                                                    Appropriation, fiscal year 2020 ..................................................                                                  ¥21,972,000
                                                                                    Budget request, fiscal year 2021 ................................................                                                         –––
                                                                                 The bill includes $4,500,000 for the following cost to complete
                                                                               project in the following amount in section 126:
                                                                                                                                              Project                                                                       Amount

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


                                                                                             FAMILY HOUSING OPERATION AND MAINTENANCE, ARMY
                                                                               Appropriation, fiscal year 2020 .........................................................                                                $357,907,000
                                                                               Budget request, fiscal year 2021 .......................................................                                                  367,142,000
                                                                               Recommended in the bill ...................................................................                                               367,142,000
                                                                               Bill compared with:
                                                                                    Appropriation, fiscal year 2020 ..................................................                                                    +9,235,000
                                                                                    Budget request, fiscal year 2021 ................................................                                                          –––

                                                                                        FAMILY HOUSING CONSTRUCTION, NAVY AND MARINE CORPS
                                                                               Appropriation, fiscal year 2020 .........................................................                                                 $47,661,000
                                                                               Budget request, fiscal year 2021 .......................................................                                                   42,897,000
                                                                               Recommended in the bill ...................................................................                                                42,897,000
                                                                               Bill compared with:
                                                                                    Appropriation, fiscal year 2020 ..................................................                                                   ¥4,764,000
                                                                                    Budget request, fiscal year 2021 ................................................                                                         –––




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                                                                                     FAMILY HOUSING OPERATION AND MAINTENANCE, NAVY AND
                                                                                                        MARINE CORPS
                                                                               Appropriation, fiscal year 2020 .........................................................     $317,870,000
                                                                               Budget request, fiscal year 2021 .......................................................       346,493,000
                                                                               Recommended in the bill ...................................................................    346,493,000
                                                                               Bill compared with:
                                                                                    Appropriation, fiscal year 2020 ..................................................         28,623,000
                                                                                    Budget request, fiscal year 2021 ................................................               –––

                                                                                                  FAMILY HOUSING CONSTRUCTION, AIR FORCE
                                                                               Appropriation, fiscal year 2020 .........................................................     $103,631,000
                                                                               Budget request, fiscal year 2021 .......................................................        97,214,000
                                                                               Recommended in the bill ...................................................................     97,214,000
                                                                               Bill compared with:
                                                                                    Appropriation, fiscal year 2020 ..................................................        ¥6,417,000
                                                                                    Budget request, fiscal year 2021 ................................................              –––

                                                                                     FAMILY HOUSING OPERATION AND MAINTENANCE, AIR FORCE
                                                                               Appropriation, fiscal year 2020 .........................................................     $295,016,000
                                                                               Budget request, fiscal year 2021 .......................................................       317,021,000
                                                                               Recommended in the bill ...................................................................    317,021,000
                                                                               Bill compared with:
                                                                                    Appropriation, fiscal year 2020 ..................................................        +22,005,000
                                                                                    Budget request, fiscal year 2021 ................................................               –––

                                                                                   FAMILY HOUSING OPERATION AND MAINTENANCE, DEFENSE-WIDE
                                                                               Appropriation, fiscal year 2020 .........................................................      $57,000,000
                                                                               Budget request, fiscal year 2021 .......................................................        54,728,000
                                                                               Recommended in the bill ...................................................................     54,728,000
                                                                               Bill compared with:
                                                                                    Appropriation, fiscal year 2020 ..................................................        ¥2,272,000
                                                                                    Budget request, fiscal year 2021 ................................................              –––

                                                                                   DEPARTMENT OF DEFENSE FAMILY HOUSING IMPROVEMENT FUND
                                                                               Appropriation, fiscal year 2020 .........................................................       $3,045,000
                                                                               Budget request, fiscal year 2021 .......................................................         5,897,000
                                                                               Recommended in the bill ...................................................................      5,897,000
                                                                               Bill compared with:
                                                                                    Appropriation, fiscal year 2020 ..................................................         +2,852,000
                                                                                    Budget request, fiscal year 2021 ................................................               –––

                                                                                   DEPARTMENT OF DEFENSE MILITARY UNACCOMPANIED HOUSING
                                                                                                    IMPROVEMENT FUND
                                                                               Appropriation, fiscal year 2020 .........................................................         $500,000
                                                                               Budget request, fiscal year 2021 .......................................................           600,000
                                                                               Recommended in the bill ...................................................................        600,000
                                                                               Bill compared with:
                                                                                    Appropriation, fiscal year 2020 ..................................................           +100,000
                                                                                    Budget request, fiscal year 2021 ................................................               –––

                                                                                                                ADMINISTRATIVE PROVISIONS
                                                                                 The bill includes a total of 30 Administrative provisions, 27 of
                                                                               which are effective in fiscal year 2020.
                                                                                 The bill includes section 101 prohibiting the use of funds for pay-
                                                                               ments 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




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                                                                               funds for the hire of passenger motor vehicles.




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                                                                                  The bill includes section 103 permitting funds to be expended on
                                                                               the construction of defense access roads under certain cir-
                                                                               cumstances.
                                                                                  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 ac-
                                                                               quire land, prepare sites, or install utilities for family housing ex-
                                                                               cept housing for which funds have been appropriated.
                                                                                  The bill includes section 107 limiting the use of minor construc-
                                                                               tion 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 ini-
                                                                               tiate 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, ex-
                                                                               cept 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 con-
                                                                               struction 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 ses-
                                                                               sion 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, sub-
                                                                               ject 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 Mili-
                                                                               tary 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




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                                                                               Homeowners Assistance Program.




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                                                                                 The bill includes section 119 requiring that funds in this title be
                                                                               the sole source of all operation and maintenance for flag and gen-
                                                                               eral 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, De-
                                                                               fense’’ account.
                                                                                  The bill includes section 122 prohibiting the use of funds for
                                                                               projects at Arlington National Cemetery.
                                                                                  The bill includes section 123 providing additional funds for var-
                                                                               ious military construction accounts and requires a spend plan for
                                                                               each.
                                                                                  The bill includes section 124 defining the congressional defense
                                                                               committees.
                                                                                  The bill includes section 125 directing all amounts appropriated
                                                                               to Military Construction (all accounts) be immediately available
                                                                               and allotted for the full scope of the authorized project.
                                                                                  The bill includes section 126 providing additional funds for cost
                                                                               to complete projects identified by the Services.
                                                                                  The bill includes section 127 providing additional funds for fam-
                                                                               ily housing operation and maintenance.
                                                                                  The bill includes section 128 prohibiting the use of funds for any
                                                                               other purpose not specified in the bill.
                                                                                  The bill includes section 129 prohibiting the use of funds in this
                                                                               Act and previous Acts for the construction of a wall, barrier, fence,
                                                                               or road along the Southern border of the United States or a road
                                                                               to provide access to a wall, barrier, or fence constructed along the
                                                                               Southern border of the United States or for any military construc-
                                                                               tion projects for which previously appropriated funds were re-
                                                                               scinded or postponed by the emergency declaration of a national
                                                                               emergency on February 15, 2019.
                                                                                  The bill includes section 130 prohibiting the construction of a fa-
                                                                               cility on a military installation bearing the name of a confederate
                                                                               officer unless a process has been initiated to rename the installa-
                                                                               tion.
                                                                                                                                         TITLE II
                                                                                                       DEPARTMENT OF VETERANS AFFAIRS
                                                                               Fiscal year 2020 enacted level 1 ...................................                               $217,862,725,000
                                                                               Fiscal year 2021 budget request 1 ...............................                                   240,245,173,000
                                                                               Committee recommendation in the bill 1 ....................                                         240,210,107,000
                                                                               Comparison with:
                                                                                   Fiscal year 2020 enacted ......................................                                 +22,347,382,000
                                                                                   Fiscal year 2021 budget request ..........................                                         ¥35,066,000
                                                                               Fiscal year 2022 advance budget request ...................                                         239,494,478,000
                                                                               Fiscal year 2022 Committee recommendation in the
                                                                                 bill ..............................................................................               239,494,478,000
                                                                                   1 All funding cited excludes amounts in the Medical Care Collections Fund.


                                                                                 The Department of Veterans Affairs (VA) provides health care for
                                                                               9,300,000 Veteran enrollees, disability compensation benefits to




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                                                                               over 5,700,000 Veterans and survivors, pension benefits for over




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                                                                               392,000 Veterans and survivors, life insurance for nearly 5,800,000
                                                                               Veterans, servicemembers and their families, educational assist-
                                                                               ance for nearly 950,000 trainees, and interment of 137,000 Vet-
                                                                               erans and eligible family members in national cemeteries. To serve
                                                                               adequately the Nation’s Veterans, VA employs more than 400,000
                                                                               people, making it one of the largest Federal agencies in terms of
                                                                               employment.
                                                                                 Resiliency.—The Stafford Act requires VA and its facilities to be
                                                                               prepared to support local communities in the event of a major dis-
                                                                               aster or medical emergency. In such a scenario, VA’s ability to ade-
                                                                               quately respond relies heavily upon the energy resiliency of its
                                                                               medical centers. VA Medical Centers must be able to recover from
                                                                               energy disruptions and have access to reliable power to ensure it
                                                                               can handle a significant emergency. To ensure VA is adequately
                                                                               prioritizing the reliability of its energy and water infrastructure,
                                                                               the Committee directs VA to provide a report within 180 days of
                                                                               enactment of this Act detailing VA’s plans to develop energy resil-
                                                                               ient medical facilities, including planned investments in distributed
                                                                               generation, energy and water efficiency efforts, and other improve-
                                                                               ments that can protect mission-critical operations at VA facilities
                                                                               from disruptions to the power grid. This plan should include details
                                                                               on VHA energy engineering and VHA energy contracting staffing
                                                                               needs.
                                                                                 Native Hawaiian, Pacific Islander and United States-Affiliated
                                                                               Pacific Islander Veteran Health Care.—Native Hawaiian, Pacific Is-
                                                                               lander, and United States-Affiliated Pacific Islanders disproportion-
                                                                               ately serve in the U.S. military and therefore represent significant
                                                                               numbers of Veterans across the United States and Pacific, particu-
                                                                               larly in rural and remote locations. While VA has centers dedicated
                                                                               to health policy, innovation, health economics and more, the Com-
                                                                               mittee notes that VA would benefit from additional research, serv-
                                                                               ice, and education to improve the lives of Native Hawaiian, Pacific
                                                                               Islander and U.S.-Affiliated Pacific Islander Veterans. In per-
                                                                               forming this effort, VA should consider partnering with non-govern-
                                                                               ment institutions and universities to examine telehealth and tele-
                                                                               pharmacy; models of interprofessional primary care, including the
                                                                               integration of pharmacists and behavioral health; electronic health
                                                                               records and data analytics; health workforce; and indigenous peo-
                                                                               ple innovation.
                                                                                 Fraud Protection System.—VA continues to face challenges pre-
                                                                               venting fraud, waste, and abuse (FWA), despite previous efforts. A
                                                                               January 2019 report issued by a VA-established FWA panel rec-
                                                                               ommended six specific actions VA could adopt to reduce FWA, in-
                                                                               cluding a recommendation to expand the Department’s use of data
                                                                               analytics and predictive modeling capabilities across the enterprise,
                                                                               creating a holistic view of FWA, and providing comprehensive pre-
                                                                               vention solutions. VA is encouraged to investigate the feasibility of
                                                                               establishing a department-wide Fraud Prevention System that uses
                                                                               predicative modeling and other analytics technologies to identify
                                                                               and prevent FWA.
                                                                                 Women Veteran Transitional Housing Support.—The Committee
                                                                               recognizes the need for transitional and supportive housing serv-
                                                                               ices for women Veterans who are experiencing homelessness or
                                                                               housing insecurity. The Committee also recognizes that in the past,




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                                                                               Veteran services were primarily designed for men and do not al-




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                                                                               ways meet the needs of women Veterans. Women Veterans strug-
                                                                               gling 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 interven-
                                                                               tions and programming. The Committee encourages the Depart-
                                                                               ment to work with the Department of Defense and the Department
                                                                               of Labor to provide robust gender-specific case management serv-
                                                                               ices for women Veterans transitioning from military service.
                                                                                                  VETERANS BENEFITS ADMINISTRATION (VBA)
                                                                                                               COMPENSATION AND PENSIONS

                                                                                                            (INCLUDING TRANSFER OF FUNDS)

                                                                               Appropriation, fiscal year 2021 .......................................................   $118,246,975,000
                                                                               Budget request, fiscal year 2021 .....................................................       2,813,922,000
                                                                               Recommended in the bill, fiscal year 2021 .....................................              2,813,922,000
                                                                               Budget request, fiscal year 2022 .....................................................     130,227,650,000
                                                                               Recommended in the bill, fiscal year 2022 .....................................            130,227,650,000
                                                                               Bill compared with:
                                                                                    Appropriation, fiscal year 2021 ................................................      +11,980,675,000
                                                                                    Budget request, fiscal year 2022 ..............................................                 –––
                                                                                 This appropriation provides funds for service-connected com-
                                                                               pensation payments to an estimated 5,724,000 Veterans, survivors,
                                                                               and dependents in fiscal year 2021. In addition, pension payments
                                                                               will be funded for 393,000 Veterans and their survivors. The aver-
                                                                               age payment per compensation case for Veterans in fiscal year
                                                                               2021 is estimated at $19,974 and pension payments are projected
                                                                               at $14,186.
                                                                                 The appropriation includes authority to transfer funding not to
                                                                               exceed $20,115,000 in fiscal year 2022 to General Operating Ex-
                                                                               penses, Veterans Benefits Administration and Information Tech-
                                                                               nology 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 Im-
                                                                               provements Act of 1994 (P.L. 103–446). These cost-saving provi-
                                                                               sions include verifying pension income against Internal Revenue
                                                                               Service and Social Security Administration (SSA) data; establishing
                                                                               a match with SSA to obtain verification of Social Security numbers;
                                                                               and applying the VA pension cap for Medicaid-eligible single Vet-
                                                                               erans 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 ex-
                                                                               penses of individual medical facilities for nursing home care pro-
                                                                               vided to pensioners.
                                                                                 Pro-bono Legal Services.—The Committee recognizes an unmet
                                                                               need for holistic programs that offer pro-bono legal services to Vet-
                                                                               erans and their dependents. The Committee acknowledges existing
                                                                               VA initiatives that guide Veterans during benefit-related inter-
                                                                               actions with administrative agencies and believes that public land-
                                                                               grant university law schools are suited to complement existing
                                                                               agency efforts in underserved areas.
                                                                                 Financial Hardship and Bankruptcy.—The Committee continues
                                                                               to support VA programs, such as disability-related benefits, that




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                                                                               seek to address the root causes of Veteran and dependent financial




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                                                                               hardship, which is a known contributory factor to negative out-
                                                                               comes such as mental health issues, substance use disorder, and
                                                                               suicide.
                                                                                  Performance Measures and Communication Efforts.—The Com-
                                                                               mittee remains interested in VA’s implementation of performance
                                                                               measures in response to the findings of the Government Account-
                                                                               ability Office (GAO) report entitled, ‘‘Better Measures Needed to
                                                                               Assess Regional Office Performance in Processing Claims’’ (GAO
                                                                               19–15). The Committee encourages VA to continue to improve re-
                                                                               gional office communication with Veterans Service Organizations
                                                                               (VSOs) and congressional caseworkers, including discussions sur-
                                                                               rounding the feasibility of locating satellite congressional member
                                                                               offices within VA Medical Centers (VAMCs).
                                                                                                                   READJUSTMENT BENEFITS

                                                                               Appropriation, fiscal year 2021 .........................................................   $12,578,965,000
                                                                               Budget request, fiscal year 2022 .......................................................     14,946,618,000
                                                                               Recommended in the bill, fiscal year 2022 .......................................            14,946,618,000
                                                                               Bill compared with:
                                                                                    Appropriation, fiscal year 2021 ..................................................      +2,367,653,000
                                                                                    Budget request, fiscal year 2022 ................................................                –––
                                                                                  This appropriation funds the education and training of Veterans
                                                                               and servicemembers through the Post-9/11 GI Bill and the All-Vol-
                                                                               unteer Force Educational Assistance Program. Supplemental edu-
                                                                               cation 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 re-
                                                                               habilitation, specially adapted housing grants, and grants for auto-
                                                                               mobiles with approved adaptive equipment. This account also funds
                                                                               educational assistance allowances for eligible dependents of Vet-
                                                                               erans 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. Al-
                                                                               most 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 Vet-
                                                                               erans from military service to academic life. Therefore, the Com-
                                                                               mittee encourages VBA to continue to expand the availability of
                                                                               services through the VSOC program to additional sites, with par-
                                                                               ticular attention to geographic regions without current access to
                                                                               VSOC programs, or where travel time makes current VSOC pro-
                                                                               grams difficult to access.
                                                                                  Vocational Rehabilitation and Employment.—The Committee
                                                                               supports the work of vocational rehabilitation and employment pro-
                                                                               grams that provide no-cost, wrap-around support services for the
                                                                               Veterans community, including career track and job readiness pro-
                                                                               grams. These services help participants develop both job-specific
                                                                               knowledge and abilities, as well as the attitudes, habits, and be-
                                                                               haviors needed to successfully secure and retain employment and
                                                                               earn family-sustaining wages in occupations that offer opportuni-
                                                                               ties for career progression.
                                                                                  Veteran Readiness and Employment Service Counselor to Client
                                                                               Ratio.—The Committee continues to encourage the Department to
                                                                               seek opportunities to expand staffing counselors within the Veteran




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                                                                               Readiness and Employment Service (VR&E), formerly known as




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                                                                                                                                  38

                                                                               the Vocational Rehabilitation and Employment Service, in order to
                                                                               maintain a ratio of 125 Veterans to one full-time equivalent (FTE)
                                                                               position, and to provide the comprehensive individualized services
                                                                               that these Veterans have earned. The Committee is also concerned
                                                                               about reports that Veterans experience frustration when being
                                                                               transferred from one counselor to another, often without proper no-
                                                                               tification to the Veteran. The Committee urges the Department to
                                                                               put procedures in place to improve implementation of the program
                                                                               by ensuring a smooth transition when Veterans are transferred
                                                                               among counselors.
                                                                                  Improving Technology to Deliver GI Bill Benefits.—The Com-
                                                                               mittee notes that to fully achieve the promise of the Harry W.
                                                                               Colmery Veterans Educational Assistance Act (P.L. 115–48), also
                                                                               known as the ‘‘Forever GI Bill,’’ and other educational benefits pro-
                                                                               vided to Veterans, a modernized information technology platform is
                                                                               needed to provide GI Bill beneficiaries with the world-class experi-
                                                                               ence they have earned and deserve. The Committee encourages
                                                                               VBA to pursue a digital platform that will provide faster and more
                                                                               accurate payments to GI Bill beneficiaries and ensure Veterans
                                                                               and their families have more convenient options when interacting
                                                                               with the Veterans Benefit Administration, including the use of mo-
                                                                               bile phones and electronic correspondence.
                                                                                  GI Bill Allowance for Housing.—The Post-9/11 GI Bill allowance
                                                                               for housing is a critical benefit to GI Bill recipients. The Committee
                                                                               is aware that in municipalities covered by more than one military
                                                                               housing area, GI Bill housing benefits may differ substantially
                                                                               throughout the municipality, creating inequities. The Committee
                                                                               directs the Department to review whether housing benefits in mu-
                                                                               nicipalities covered by more than one military housing area are
                                                                               adequate to meet the financial needs of GI Bill recipients located
                                                                               in those areas and to report to the Committee on Appropriations
                                                                               no later than 180 days after enactment of this Act on whether
                                                                               changes to the housing benefit are needed to ensure fairly distrib-
                                                                               uted housing benefits that provide sufficient assistance to students.
                                                                               The Committee encourages VA to incorporate into this review pub-
                                                                               licly available housing data, including the median rent in affected
                                                                               municipalities, as paid by the same population used to calculate
                                                                               the housing allowance. Additionally, the Committee urges the De-
                                                                               partment to raise this issue as part of the DOD–VA working group
                                                                               on GI Bill issues.
                                                                                  Cyber Training.—The Committee urges VA to establish a cyber
                                                                               training pilot program that, in addition to training VA’s internal
                                                                               cyber workforce, can be scaled up and offered to transitioning mili-
                                                                               tary to help Veterans reintegrate into the workforce. In doing so,
                                                                               VA should also consider collaboratively working with the Centers
                                                                               of Academic Excellence in Cybersecurity (CAE–C) community to
                                                                               jointly develop cyber curriculums, hands-on skills development, and
                                                                               performance-based assessment solutions that align specifically to
                                                                               work roles within the National Initiative for Cybersecurity Edu-
                                                                               cation (NICE) Cyber Workforce Framework and can be integrated
                                                                               into the cyber training program.
                                                                                  Transition Coordination.—The Committee believes that VA, in
                                                                               consultation with the Departments of Labor and Defense, should
                                                                               further coordinate efforts and resources to ensure Veterans have a




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                                                                               successful transition to civilian life. This includes sharing informa-




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                                                                               tion on community resources, including nonprofits and VSOs, that
                                                                               are available to the Veteran and their family as they depart the
                                                                               service. The Committee also urges VA to explore options for Vet-
                                                                               erans to access hands-on job placement services that connect Vet-
                                                                               erans directly with employers, and encourages VA to look at suc-
                                                                               cessful state and local programs in this area.
                                                                                  Veteran Awareness of Student Loan Forgiveness.—The Com-
                                                                               mittee understands that Veterans may have student loans they ac-
                                                                               quired either prior to enlistment or outside of their GI Bill benefits.
                                                                               The Committee encourages VA to coordinate with other agencies,
                                                                               including the Departments of Education and Defense, and increase
                                                                               efforts to ensure that Veterans are aware of all their student loan
                                                                               forgiveness options or repayment programs for which they may be
                                                                               eligible.
                                                                                  GI Bill Comparison Tool.—The Committee emphasizes the im-
                                                                               portance of providing Veterans with the necessary information to
                                                                               make informed decisions when selecting institutions of higher edu-
                                                                               cation (IHE). The Committee strongly urges VA to make available
                                                                               through the GI Bill Comparison Tool, in a searchable format, the
                                                                               following information: whether an IHE is a minority serving insti-
                                                                               tution (MSI), a gender-specific institution, or a religiously-affiliated
                                                                               school. These categories should be broken down into subcategories
                                                                               that specify the type of MSI and religious affiliation.
                                                                                                                  VETERANS INSURANCE AND INDEMNITIES

                                                                               Appropriation, fiscal year 2021 .........................................................                                        $129,224,000
                                                                               Budget request, fiscal year 2021 .......................................................                                            2,148,000
                                                                               Recommended in the bill, fiscal year 2021 .......................................                                                   2,148,000
                                                                               Budget request, fiscal year 2022 .......................................................                                          136,950,000
                                                                               Recommended in the bill, fiscal year 2022 .......................................                                                 136,950,000
                                                                               Bill compared with:
                                                                                    Appropriation, fiscal year 2021 ..................................................                                            +7,726,000
                                                                                    Budget request, fiscal year 2022 ................................................                                                  –––
                                                                                  The Veterans Insurance and Indemnities appropriation is made
                                                                               up of the former appropriations for military and naval insurance,
                                                                               applicable to World War I Veterans; national service life insurance
                                                                               (NSLI), applicable to certain World War II Veterans;
                                                                               servicemember’s indemnities, applicable to Korean conflict Vet-
                                                                               erans; and Veterans mortgage life insurance, applicable to individ-
                                                                               uals 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 trans-
                                                                               fer additional amounts for payments for policies under the Vet-
                                                                               erans mortgage life insurance program. These policies are identi-
                                                                               fied under the Veterans Insurance and Indemnities appropriation
                                                                               since they provide insurance to service-disabled Veterans unable to
                                                                               qualify under basic NSLI.
                                                                                    VETERANS HOUSING BENEFIT PROGRAM FUND PROGRAM ACCOUNT

                                                                                                                                                                                         Limitation on direct
                                                                                                                                                                                          loans for specially     Administrative
                                                                                                                                                                       Program Account     adapted housing          Expenses
                                                                                                                                                                                                loans

                                                                               Appropriation, fiscal year 2020 ....................................................             –––              ($500,000)         $200,377,391




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                                                                               Budget request est., fiscal year 2021 .........................................                  –––               (500,000)          204,400,000
                                                                               Recommended in the bill .............................................................            –––               (500,000)          204,400,000




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                                                                                                                                                                                         Limitation on direct
                                                                                                                                                                                          loans for specially     Administrative
                                                                                                                                                                       Program Account     adapted housing          Expenses
                                                                                                                                                                                                loans

                                                                               Bill compared with:
                                                                                     Appropriation, fiscal year 2020 ...........................................                –––                   –––               +4,022,609
                                                                                     Budget request, fiscal year 2021 ........................................                  –––                   –––                    –––

                                                                                  The purpose of the home loan guaranty program is to facilitate
                                                                               the extension of mortgage credit on favorable terms by private
                                                                               lenders to eligible Veterans. This appropriation provides for all
                                                                               costs, with the exception of the Native American Veterans housing
                                                                               loan program, of the Department’s direct and guaranteed loans pro-
                                                                               grams. The Federal Credit Reform Act of 1990 (P.L. 101–508) re-
                                                                               quires budgetary resources to be available prior to incurring a di-
                                                                               rect loan obligation or a loan guaranty commitment. In addition,
                                                                               the bill requires all administrative expenses of a direct or guaran-
                                                                               teed 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 Depart-
                                                                               ment guarantees part of the total loan, permitting the purchaser
                                                                               to obtain a mortgage with a competitive interest rate, even without
                                                                               a down payment if the lender agrees. The Department requires
                                                                               that a down payment be made for a manufactured home. With a
                                                                               Department guaranty, the lender is protected against loss, up to
                                                                               the amount of the guaranty, if the borrower fails to repay the loan.
                                                                                  Home Loan Income Verification.—The Committee is aware of the
                                                                               Department’s denial of home loan guarantees to Veterans solely on
                                                                               the basis of the Veteran’s documented income being derived from
                                                                               state-legalized cannabis activities, and has previously expressed
                                                                               concern that confusion on this issue hinders Veterans’ ability to
                                                                               fully understand and consider how employment decisions could af-
                                                                               fect future eligibility for earned benefits. The Committee under-
                                                                               stands that as directed by House Report 116–63, VA has clarified
                                                                               that nothing in VA statutes or regulations specifically prohibits a
                                                                               Veteran whose income is derived from state-legalized cannabis ac-
                                                                               tivities from obtaining a certificate of eligibility for VA home loan
                                                                               benefits. The Committee directs the VA to improve communication
                                                                               with eligible lending institutions to reduce confusion among lenders
                                                                               and borrowers on this matter.
                                                                                              VOCATIONAL REHABILITATION LOANS PROGRAM ACCOUNT

                                                                                                                                                                                         Limitation on direct    Administrative Ex-
                                                                                                                                                                       Program Account          loans                 penses

                                                                               Appropriation, fiscal year 2020 ....................................................           $57,729          ($2,008,232)               $401,880
                                                                               Budget request, fiscal year 2021 .................................................              33,826           (2,469,522)                424,272
                                                                               Recommended in the bill .............................................................           33,826           (2,469,522)                424,272
                                                                               Bill compared with:
                                                                                     Appropriation, fiscal year 2020 ...........................................             ¥23,903              (461,290)                +22,392
                                                                                     Budget request, fiscal year 2021 ........................................                 –––                   –––                     –––

                                                                                  This appropriation covers the subsidy cost of direct loans for vo-
                                                                               cational rehabilitation of eligible Veterans and includes administra-
                                                                               tive expenses necessary to carry out the direct loan program. Loans
                                                                               of up to $1,260 (based on indexed chapter 31 subsistence allowance




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                                                                               rate) are available to service-connected disabled Veterans enrolled




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                                                                               in vocational rehabilitation programs when the Veteran is tempo-
                                                                               rarily in need of additional assistance. Repayment is made in
                                                                               monthly installments, without interest, through deductions from
                                                                               future payments of compensation, pension, subsistence allowance,
                                                                               educational assistance allowance, or retirement pay. Most loans are
                                                                               repaid in full in less than one year. The Federal Credit Reform Act
                                                                               of 1990 (P.L. 101–508) requires budgetary resources to be available
                                                                               prior to incurring a direct loan obligation.
                                                                                 It is estimated that the Department will make 2,376 loans in fis-
                                                                               cal year 2021, with an average amount of $1,040.
                                                                                            NATIVE AMERICAN VETERAN HOUSING LOAN PROGRAM

                                                                               Administrative expenses:
                                                                               Appropriation, fiscal year 2020 .........................................................        $1,186,000
                                                                               Budget request, fiscal year 2021 .......................................................          1,163,000
                                                                               Recommended in the bill ...................................................................       1,186,000
                                                                               Bill compared with:
                                                                                    Appropriation, fiscal year 2020 ..................................................                  –––
                                                                                    Budget request, fiscal year 2021 ................................................                 +23,000
                                                                                 The Native American Veteran Housing Loan Program, as author-
                                                                               ized by title 38 United States Code, chapter 37, subchapter V, pro-
                                                                               vides the Secretary with authority to make direct housing loans to
                                                                               Native American Veterans for the purpose of purchasing, con-
                                                                               structing, or improving dwellings on trust lands, including Hawai-
                                                                               ian Home Lands. Native Hawaiians, Alaska Natives, and Native
                                                                               Americans enroll in the military at higher rates than non-Natives.
                                                                               These loans are available to purchase, construct, or improve homes
                                                                               to be occupied as Veterans’ residences.
                                                                                             GENERAL OPERATING EXPENSES, VETERANS BENEFITS
                                                                                                            ADMINISTRATION

                                                                               Appropriation, fiscal year 2020 .........................................................     $3,125,000,000
                                                                               Budget request, fiscal year 2021 .......................................................       3,207,000,000
                                                                               Recommended in the bill ...................................................................    3,187,000,000
                                                                               Bill compared with:
                                                                                    Appropriation, fiscal year 2020 ..................................................        +62,000,000
                                                                                    Budget request, fiscal year 2021 ................................................         ¥20,000,000
                                                                                  The General Operating Expenses, Veterans Benefits Administra-
                                                                               tion account provides funding for VBA to administer entitlement
                                                                               programs such as service-connected disability compensation, edu-
                                                                               cation benefits, and vocational rehabilitation services.
                                                                                  The bill makes available through September 30, 2022, up to ten
                                                                               percent of these funds.
                                                                                  The Committee provides $3,187,000,000 for the General Oper-
                                                                               ating Expenses, VBA account, to enable VBA to deliver the benefits
                                                                               that our Veterans rely on.
                                                                                  In addition, the Coronavirus Aid, Relief, and Economic Security
                                                                               Act (CARES Act) (P.L. 116–136) included $13,000,000 for VBA to
                                                                               prevent, prepare for, and respond to coronavirus.
                                                                                  Blue Water Navy Veterans.—The Committee continues to closely
                                                                               follow the implementation of the Blue Water Navy Vietnam Vet-
                                                                               erans Act (P.L. 116–23). The Committee provides requested funds
                                                                               to support implementation of the law, including staffing, scanning
                                                                               of records, and correspondence with Veterans. The Committee con-
                                                                               tinues the requirement that VA report to the Committees on Ap-




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                                                                               propriations of both Houses of Congress on a quarterly basis infor-




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                                                                               mation related to claims considered under the Blue Water Navy
                                                                               Vietnam Veterans Act. This information should include timeliness
                                                                               measures as well as grant and denial rates for these claims.
                                                                                  Disability Claims.—The Committee continues to be concerned
                                                                               about reports of delays Veterans experience in the resolution of
                                                                               pending compensation and pension claims. While the Committee
                                                                               appreciates the focus in attention and resources the Department
                                                                               has given to this concern, reducing the claims backlog and making
                                                                               sustainable improvement in the waiting period for claims adjudica-
                                                                               tion is essential. The Committee urges the Department to prioritize
                                                                               resources toward providing Veterans with the timely relief and
                                                                               support they deserve. The funding level is sufficient to continue
                                                                               programs that support effective management of claims, including
                                                                               the Veterans Claims Intake Program.
                                                                                  Conditions Presumptively Associated with Agent Orange.—The
                                                                               Committee is aware that VA has not yet acted in response to the
                                                                               2018 report from the National Academies of Science, Engineering,
                                                                               and Medicine that concluded that bladder cancer, hypothyroidism,
                                                                               Parkinson-like syndromes, and hypertension all have at least ‘‘lim-
                                                                               ited or suggestive’’ evidence of an association with exposure to
                                                                               Agent Orange herbicides. The Committee notes that the ‘‘limited or
                                                                               suggestive’’ threshold has been deemed sufficient by VA in years
                                                                               past to add multiple prior conditions to the category of diseases
                                                                               presumptively recognized by VA as service-connected. However,
                                                                               Veterans with these four particular conditions have been made to
                                                                               wait for fair treatment in light of VA’s inaction on adding these
                                                                               conditions to the presumptive category. The Committee is con-
                                                                               cerned that VA officials intend to wait for evidence these conditions
                                                                               are caused by, rather than associated with, exposure to Agent Or-
                                                                               ange. As such, the Committee reminds the Department that there
                                                                               is no legal requirement that sets causation as the standard. To the
                                                                               contrary, the Department’s apparent policy runs counter to statu-
                                                                               tory text and longstanding case law, including the landmark
                                                                               Nehmer v. U.S. Department of Veterans Affairs case. The Com-
                                                                               mittee directs the Department to report to the Committees on Ap-
                                                                               propriations of both Houses of Congress no later than 60 days after
                                                                               enactment of this Act, detailing the legal basis the Department is
                                                                               relying upon to demand causation as the standard for adding these
                                                                               four conditions to the presumptively service-connected category.
                                                                               Further, the Committee expects the Department to act on the con-
                                                                               clusions of the National Academies of Science, Engineering, and
                                                                               Medicine in a fair and expeditious manner to avoid causing Vet-
                                                                               erans additional delays in receiving the benefits they have earned.
                                                                                  Equitable Relief.—The Committee reiterates that it understands
                                                                               VA is working to implement new systems and protocols to elimi-
                                                                               nate instances of administrative error. However, as VA enacts sys-
                                                                               tem-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 con-
                                                                               tinue to grant or extend equitable relief to eligible Veterans ini-
                                                                               tially deemed eligible in instances of administrative error. Not later
                                                                               than April 1, 2021, the Secretary shall submit to the Committees
                                                                               a report containing a statement as to the disposition of each case
                                                                               recommended to the Secretary for equitable relief under 38 U.S.C




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                                                                               503 during the preceding calendar year.




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                                                                                                                                  43

                                                                                  Military Sexual Trauma (MST) Claims.—The 2018 Inspector
                                                                               General’s report found that almost half of denied MST-related
                                                                               claims were not properly adjudicated in accordance with VBA poli-
                                                                               cies. The Committee is concerned that VBA has not implemented
                                                                               all of the recommendations of the Inspector General’s report and
                                                                               that OIG’s concerns regarding VBA’s process for reevaluating pre-
                                                                               viously denied claims has resulted in a new audit of VBA. The
                                                                               Committee directs VA to report to the Committee by October 31,
                                                                               2020, on implementation of the Inspector General’s recommenda-
                                                                               tions, and to consult with the Committee prior to any changes in
                                                                               the system for handling MST-related claims. The Committee wel-
                                                                               comes VBA’s expressed commitment to engaging with MST sur-
                                                                               vivors and willingness to incorporate input from MST survivors in
                                                                               its training for MST claim processors. However, the Committee is
                                                                               concerned that research has shown that MST-related claims by
                                                                               males are less likely to be approved than those filed by females.
                                                                               The Committee urges VBA to investigate this discrepancy and to
                                                                               ensure that input from male MST survivors is also incorporated in
                                                                               training. The Committee is also concerned that Veterans suffering
                                                                               from a mental health disorder as a result of sexual trauma during
                                                                               service have different standards of evidence based on their diag-
                                                                               nosis. 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 dis-
                                                                               orders as a result of MST. Further, the Committee urges VA to
                                                                               continue to report to the Committees on Appropriations of both
                                                                               Houses of Congress on information relating to claims for disabil-
                                                                               ities incurred or aggravated by MST, as provided by section 113 of
                                                                               the Jeff Miller and Richard Blumenthal Veterans Health Care and
                                                                               Benefits Improvement Act of 2016 (P.L. 114–315).
                                                                                  Veterans Benefits Staffing in Remote Locations.—The Committee
                                                                               directs VBA to continue to improve access and outreach to Vet-
                                                                               erans living in remote and underserved areas, such as the Com-
                                                                               monwealth of the Northern Mariana Islands, by increasing staff
                                                                               presence in these areas. VA shall provide the necessary staff and
                                                                               resources to provide more frequent outreach and ensure access to
                                                                               benefits, and must also ensure the Veterans in these areas are no-
                                                                               tified when a benefits counselor is available to provide assistance
                                                                               and information about the VA claims process and benefits available
                                                                               to Veterans and their families. Additionally, the Committee directs
                                                                               VA to assess the feasibility of placing at least one full-time Vet-
                                                                               erans Benefits Counselor in remote and underserved areas that do
                                                                               not have a VA Benefits Office, such as the Northern Mariana Is-
                                                                               lands, and providing such staff the necessary support, space and
                                                                               equipment, and funds to travel to other areas within each jurisdic-
                                                                               tion where Veterans reside on a regular basis. The Committee di-
                                                                               rects the Department to report to the Committee on this assess-
                                                                               ment no later than 180 days after enactment of this Act. The re-
                                                                               port shall include information on the beneficiary population (Vet-
                                                                               erans, spouses, and dependents), including their feedback on VBA
                                                                               services, the demand for direct VBA assistance, VBA’s current ef-
                                                                               forts to serve the beneficiary population, and the plan to serve




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                                                                               them in the future. The Committee also encourages the department




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

                                                                               Fiscal year 2020 enacted level ...........................................................   $51,411,165,000
                                                                               Fiscal year 2021 enacted level ...........................................................    56,158,015,000
                                                                               Fiscal year 2021 budget year request ...............................................             497,468,000
                                                                               Committee 2021 budget year recommendation ................................                       497,468,000
                                                                               Fiscal year 2022 advance appropriation request .............................                  58,897,219,000
                                                                               Committee 2022 advance appropriation recommendation ..............                            58,897,219,000
                                                                               Comparison with:
                                                                                   Fiscal year 2021 enacted level ...................................................        +2,739,204,000
                                                                                   Fiscal year 2022 advance budget request .................................                          –––
                                                                                 The bill provides the request of $58,897,219,000 for advance fis-
                                                                               cal year 2022 funding. The Committee has included bill language
                                                                               to make available through September 30, 2023, $1,500,000,000 of
                                                                               the Medical Services advance appropriation for fiscal year 2022.




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                                                                               The Committee provides an additional $497,468,000 to be available




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                                                                               for fiscal year 2021, of which $40,000,000 is provided for mental
                                                                               health for a total of $10,297,500,000; $40,000,000 is provided for
                                                                               homelessness initiatives for a total of $1,928,508,000; $30,000,000
                                                                               is provided for rural health for a total of $300,000,000; $35,000,000
                                                                               is provided for gender-specific care for women for a total of
                                                                               $660,691,000; $20,000,000 is provided for Whole Health initiatives
                                                                               for a total of $83,600,000; $85,008,000 is provided for suicide pre-
                                                                               vention efforts for a total of $312,635,000, as requested in the
                                                                               budget; $75,000,000 is provided for precision oncology, as requested
                                                                               in the budget; $64,650,000 is provided for opioid prevention and
                                                                               treatment for a total of $503,660,000, as requested in the budget;
                                                                               $93,810,000 is provided for medical equipment; and $14,000,000 is
                                                                               provided for other initiatives specified by the Committee.
                                                                                  In addition, the Coronavirus Preparedness and Response Supple-
                                                                               mental Appropriations Act (P.L. 116–123) included $30,000,000 and
                                                                               the Coronavirus Aid, Relief, and Economic Security Act (CARES
                                                                               Act) (P.L. 116–136) included $14,432,000,000 for the Medical Serv-
                                                                               ices account to prevent, prepare for, and respond to coronavirus, in-
                                                                               cluding related impacts on health care delivery, and for support to
                                                                               Veterans who are homeless or at risk of becoming homeless.
                                                                                  Changes in Funding Requirements Due to Modeling.—The Com-
                                                                               mittee expects VA to continue to include in the sufficiency letter re-
                                                                               quired 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 un-
                                                                               precedented level of benefits to families with Veterans seriously in-
                                                                               jured 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 treat-
                                                                               ment. The Committee provides the request of $1,195,486,000 for
                                                                               the caregivers. The Committee also continues the requirement from
                                                                               the fiscal year 2018 conference report on quarterly reporting on ob-
                                                                               ligations for the caregivers program.
                                                                                  Allocation of Health Funding.—The Committee continues to be
                                                                               concerned that the process VA uses to allocate the health services
                                                                               appropriation through the Veterans Integrated Service Networks
                                                                               (VISNs) and from them to the medical centers may shortchange the
                                                                               ultimate users because of excessive funding retained at head-
                                                                               quarters or at the VISNs. The Committee continues to request a
                                                                               report each year, no later than 30 days after VA allocates the med-
                                                                               ical 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 al-
                                                                               locating it to the medical centers, identifying separately the
                                                                               amounts retained for purposes such as network operations, net-
                                                                               work initiatives, and emergencies.




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                                                                                                                       MENTAL HEALTH

                                                                                 The Committee provides $10,297,500,000 for mental health pro-
                                                                               grams, which is $40,000,000 above the request. Of the amounts
                                                                               provided for mental health programs in fiscal year 2021,
                                                                               $1,939,329,000 shall be used for suicide prevention and treatment
                                                                               programs. Specifically, $312,635,000 shall be used for suicide pre-
                                                                               vention outreach, which is $90,870,000 above fiscal year 2020. With
                                                                               the additional funds, the Committee directs the Department to im-
                                                                               plement suicide safety plans that address parking lot suicides and
                                                                               expand the Coaching Into Care Program to better help Veterans,
                                                                               their family members, and other loved ones find the appropriate
                                                                               services at their local VA facilities and/or in their community. The
                                                                               Committee requests a report within 90 days of enactment of this
                                                                               Act on the Department’s plans.
                                                                                 The Department should also continue to engage with Veterans
                                                                               Service Organizations (VSOs) to help remove the stigma that is as-
                                                                               sociated with seeking mental healthcare. Furthermore, VA is di-
                                                                               rected to remove barriers that affect a Veteran when trying to re-
                                                                               ceive mental healthcare and to implement a twenty-first century
                                                                               outreach program that incorporates social media and other elec-
                                                                               tronic means to reach Veterans before they are at a crisis point.
                                                                                 In addition, the Committee directs VA to engage with DOD to
                                                                               help servicemembers transition from active duty to civilian life to
                                                                               ensure that mental health needs are addressed throughout the
                                                                               transition process. The Department is directed to provide a report
                                                                               to the Committee, no later than 90 days after enactment of this
                                                                               Act, identifying a detailed expenditure plan for all suicide outreach
                                                                               and treatment programs and how VA is meeting the Committee’s
                                                                               directives.
                                                                                 Improving the Veterans Crisis Line (VCL).—The Committee con-
                                                                               tinues to monitor the VCL to ensure Veterans are receiving appro-
                                                                               priate clinical care. To support this critical care, the Committee in-
                                                                               structs the Secretary to ensure that Federal funding for the VCL
                                                                               is utilized to make any necessary improvements to VCL’s oper-
                                                                               ations in order to best meet the needs of Veterans seeking assist-
                                                                               ance. 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 appro-
                                                                               priately 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 assist-
                                                                               ance from a trained professional; and (2) to adhere to all require-
                                                                               ments of the American Association of Suicidology.
                                                                                 Community Clinic Mental Health Services.—The Committee re-
                                                                               mains concerned that in-person mental healthcare is not available
                                                                               to all Veterans who require this care. VA is encouraged to ensure
                                                                               critical in-person mental health services are available at facilities
                                                                               that currently are not served, even on a temporary basis.
                                                                                 Mental Health Services.—Women Veterans are twice as likely as
                                                                               women in the general population to die by suicide. To address this
                                                                               alarming trend, the Committee encourages VA to take aggressive




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                                                                               steps to improve mental health services for women Veterans and




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                                                                               ensure that women’s mental health needs, which often differ from
                                                                               men in prevalence and expression, are met.
                                                                                  Post-Traumatic Growth Programs.—The Committee recognizes
                                                                               there is a shortage of adequate, timely, and effective mental health
                                                                               care available to Veterans across the United States. As the Depart-
                                                                               ment continues to highlight Veterans’ mental healthcare and sui-
                                                                               cide prevention as a key priority, there is an opportunity to explore
                                                                               effective alternative treatments focused on the area of post-trau-
                                                                               matic growth. The Committee continues to encourage the establish-
                                                                               ment of a pilot program to study the effectiveness and benefits of
                                                                               nonprofit post-traumatic growth programs to determine the out-
                                                                               comes of such programs in contrast to traditional models of mental
                                                                               healthcare, the possible integration of such nonprofit programs into
                                                                               mental healthcare programs provided by the Department, and the
                                                                               budgetary impacts of such integration.
                                                                                  Post-Traumatic Stress Disorder (PTSD) Service Dogs.—The Com-
                                                                               mittee 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 Appropria-
                                                                               tions Act, 2019 (P.L. 115–244) urged VA to prioritize support of
                                                                               veterinary healthcare and other benefits for service dogs for
                                                                               wounded warriors. The Committee also notes that VA is currently
                                                                               engaged in a study to assess the potential therapeutic effectiveness
                                                                               of service dogs in the treatment of PTSD and that the study was
                                                                               originally expected to be completed in June 2020. However, the
                                                                               Committee is concerned that the report detailing the results and
                                                                               economic impact of the study will be delayed, and the results of the
                                                                               study will be broken up into two reports. The Committee directs
                                                                               VA to expeditiously provide the results of the study to the Commit-
                                                                               tees on Appropriations of both Houses of Congress within 30 days
                                                                               of enactment of this Act and further requires monthly reports on
                                                                               the status of the study until it is fully completed beginning 30 days
                                                                               after this report is filed. The Committee is interested in the possi-
                                                                               bility of providing service dogs to Veterans with a mental health
                                                                               mobility disorder related to post-traumatic stress or traumatic
                                                                               brain injury. According to the Department, as many as 20 percent
                                                                               of those who served in Iraq or Afghanistan are diagnosed with
                                                                               post-traumatic stress. This disorder can cause debilitating symp-
                                                                               toms in Veterans, leading to depression, social isolation, and sui-
                                                                               cide. Studies demonstrate that service dogs provide support to Vet-
                                                                               erans by mitigating their disability, allowing for professional and
                                                                               social reintegration. Currently, waiting lists for service dogs aver-
                                                                               age between 18 and 24 months, with intensive compulsory training
                                                                               costing an average of $25,000 per service dog, which makes this an
                                                                               expensive option for Veterans. The Committee looks forward to this
                                                                               study and will address this issue as the bill moves through the
                                                                               process.
                                                                                  Service Dogs for Veterans.—The assistance that service, guide,
                                                                               and hearing dogs provide to Veterans, especially those with mobil-
                                                                               ity, visual, auditory, psychological, or psychiatric disabilities, is en-
                                                                               couraging and sometimes life-saving. However, the Committee is
                                                                               aware of the time and cost of appropriately training a dog and
                                                                               matching it with a Veteran. As such, the Committee requests a




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                                                                               comprehensive report within 180 days of enactment of this Act re-




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                                                                               garding potential options and estimated costs associated with each
                                                                               option, as practicable, to help meet the increasing demand from
                                                                               Veterans for service dogs. The report should include information on
                                                                               the number of service dogs matched with Veterans and in training,
                                                                               accreditation standards and the number of accredited service dog
                                                                               training organizations, and estimated current and future demand
                                                                               for service dogs. The Department should consult with accredited
                                                                               service dog training organizations and the Wounded Warrior Serv-
                                                                               ice Dog Program, which is funded through the Defense Health Pro-
                                                                               gram and is managed by the Uniformed Services University of the
                                                                               Health Sciences, on the benefits and challenges of the existing
                                                                               model for training and matching service dogs with Veterans.
                                                                                  Public-Private Partnerships.—The Committee is concerned by the
                                                                               alarming number of suicides committed by Veterans each day.
                                                                               While the Committee appreciates the important work being done
                                                                               by the Department to combat suicide and improve mental health
                                                                               among Veterans, more can and must be done. The Committee rec-
                                                                               ommends the Department actively seek out public-private partner-
                                                                               ships, 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 sub-
                                                                               stance use disorders. The Secretary shall report to the Committee
                                                                               no later than 60 days after enactment of this Act on the status of
                                                                               creating public-private partnerships related to suicide prevention,
                                                                               PTSD, TBI, and substance use disorders. Of the funds provided for
                                                                               mental health programs in fiscal year 2021, no less than
                                                                               $5,000,000 is to expand the public-private partnerships.
                                                                                  Law Enforcement Liaison.—The Committee appreciates VHA’s
                                                                               past efforts in working to educate the law enforcement community
                                                                               regarding the unique issues facing Veterans, especially those re-
                                                                               turning 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 re-
                                                                               spectful manner.
                                                                                  Non-Citizen Veteran Outreach.—The Committee is concerned
                                                                               about the level of awareness regarding mental health services by
                                                                               at-risk, non-citizen Veterans. The Committee therefore urges VA to
                                                                               conduct more aggressive outreach targeting this group of Veterans
                                                                               to offer mental health and other early intervention services, drug
                                                                               and alcohol services, and mental health counseling.
                                                                                  Post-Traumatic Stress Disorder Research.—The Committee wel-
                                                                               comes the Secretary’s commitment to addressing mental health in
                                                                               the Veteran population. The Committee also recognizes the impor-
                                                                               tance 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-Ameri-
                                                                               cans and Latino-Americans, are more likely to develop PTSD. As
                                                                               such, the Committee directs VHA in coordination with the VA Na-
                                                                               tional 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




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                                                                               minority Veterans receive quality and culturally appropriate care.




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                                                                               This report should also include recommendations on how to address
                                                                               the unique mental health needs of minority Veterans, and dispari-
                                                                               ties, whether perceived or real, in the care they receive.
                                                                                  Adverse Childhood Experiences (ACEs).—ACEs exist within the
                                                                               Veteran population at a substantially higher rate than the general
                                                                               public. These experiences correlate with significant negative health
                                                                               outcomes, including on behavioral, mental, and physical health.
                                                                               The Committee encourages VA to track ACEs among Veterans and
                                                                               target individualized treatment. To ensure appropriate treatment
                                                                               from the moment a Veteran enters VA, it is critical that VA coordi-
                                                                               nate with DOD to obtain information on ACEs from
                                                                               servicemembers and provide a seamless transition in care.
                                                                                  Agritherapy.—An increasing number of states now have pro-
                                                                               grams that assist Veterans in starting farms, and many Veterans
                                                                               turning to farming suffer from PTSD. The benefits of agritherapy
                                                                               have been reported in the news media; however, limited research
                                                                               and insufficient opportunities exist to offer the benefits of
                                                                               agritherapy to those suffering from PTSD. VA is encouraged to
                                                                               work with the Department of Agriculture on providing agritherapy
                                                                               programs to Veterans. Additionally, the Committee supports a pilot
                                                                               program to train Veterans in agricultural vocations, including
                                                                               urban and vertical farming, while also tending to behavioral and
                                                                               mental health needs with behavioral healthcare services and treat-
                                                                               ments from licensed providers at no fewer than three locations.
                                                                                  Mental Health Data on Asian Pacific American Veterans.—The
                                                                               Committee recognizes the lack of mental health data specific to
                                                                               Asian Pacific American Veterans. The Committee directs the De-
                                                                               partment to submit a report within 90 days after enactment of this
                                                                               Act on its data collection efforts.
                                                                                  Military Sexual Assault.—The Committee is aware of the high
                                                                               prevalence of sexual assault, among both men and women, during
                                                                               their service. Effects from this assault persist once servicemembers
                                                                               return home and can manifest in mental health disorders such as
                                                                               depression, PTSD, SUDs, eating disorders, and anxiety. Because
                                                                               sexual trauma is so prevalent, the Committee recommends that all
                                                                               Veterans seeking treatment services are screened for sexual as-
                                                                               sault using an evidence-based screening tool in order to success-
                                                                               fully treat those who have experienced assault.
                                                                                  Military Sexual Trauma-Related Care for Servicemembers at VA
                                                                               Facilities.—The Veterans Access, Choice and Accountability Act of
                                                                               2014 (P.L. 113–146), as amended, allows all servicemembers re-
                                                                               gardless of duty status to receive military sexual trauma-related
                                                                               care from VA, although a VA directive limits the access to
                                                                               servicemembers to Vet Centers only. VA has invested considerable
                                                                               resources to increase the capacity of the VA health care system to
                                                                               provide a range of mental health and medical care services to as-
                                                                               sist those who have experienced military sexual assault. The Com-
                                                                               mittee believes that servicemembers would benefit from greater ac-
                                                                               cess to this capacity and directs the Secretary to provide to the
                                                                               Committee no later than 90 days after enactment of this Act a plan
                                                                               to expand access to military sexual trauma-related care at all VA
                                                                               health facilities.
                                                                                  Aiding Military Personnel Transitioning to Civilian Life.—Mili-
                                                                               tary Personnel transitioning to civilian life have reported signifi-




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                                                                               cant challenges in reintegrating into civilian culture. Filmmaking




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                                                                               has been used as a therapeutic intervention to enhance the commu-
                                                                               nity reintegration of Veterans by encouraging self-reflection and
                                                                               interactions with other Veterans about shared experiences. The
                                                                               Committee notes the outcomes of filmmaking workshops among
                                                                               Veterans, which included Veteran engagement in mental health
                                                                               care, improved attitudes toward engaging in mental health care,
                                                                               mitigating symptoms of PTSD and depression, and reported percep-
                                                                               tion of community interest in their experience as Veterans. Accord-
                                                                               ingly, VA is urged to make funds available to implement these
                                                                               workshops at VA medical centers across the country so that all
                                                                               Veterans struggling with PTSD and depression can benefit from
                                                                               this encouraging therapy.
                                                                                  Timely Mental Health Checks.—The Committee recognizes that
                                                                               Veterans are significantly more likely to suffer from trauma, PTSD,
                                                                               or to die by suicide than civilians and often times are undiagnosed.
                                                                               To combat the increasing suicide rate among Veterans, the Com-
                                                                               mittee strongly recommends that VA identify, establish, and sup-
                                                                               port programs that promote mental health screenings for Veterans
                                                                               preparing to transition to civilian life. It is the Committee’s under-
                                                                               standing that these mental health screenings should occur within
                                                                               30 days of a Veteran’s end of service date to ensure they have the
                                                                               proper resources needed to transition to civilian life.
                                                                                  Post-Deployment Rehabilitation and Evaluation Program
                                                                               (PREP).—The Committee believes that the physical rehabilitation
                                                                               and mental health needs of our active duty servicemembers and
                                                                               Veterans is a top priority. The Post-Deployment Rehabilitation and
                                                                               Evaluation Program (PREP) run by VA is an inpatient initiative
                                                                               that focuses on an individualized evaluation for servicemembers
                                                                               and Veterans to treat combat-related physical, cognitive and men-
                                                                               tal health systems. The Committee believes it is important to ex-
                                                                               pand the number of servicemembers and Veterans able to receive
                                                                               care through this initiative. The Committee is pleased to see fur-
                                                                               ther investment in fiscal year 2020 in PREP and expects to see VA
                                                                               continue the trend of furthering the investment in the program in
                                                                               fiscal year 2021. The Committee directs VA to include pro-
                                                                               grammatic information and funding levels for PREP in future
                                                                               budget requests.
                                                                                  Wrongfully Turned Away Due to ‘‘Bad Paper’’.—The Committee
                                                                               is concerned about reports that VA has erroneously and unlawfully
                                                                               turned away Veterans who seek VA care and whose DD Form 214,
                                                                               Certificate of Release or Discharge from Active Duty, does not re-
                                                                               flect an ‘‘Honorable Discharge,’’ also known as ‘‘bad paper.’’ Studies
                                                                               have shown that higher rates of Veterans with bad paper suffer
                                                                               from mental health conditions. The Committee directs the Sec-
                                                                               retary to submit a report no later than 90 days after enactment of
                                                                               this Act on (1) actions taken, such as requiring VHA staff to notify
                                                                               denied Veterans of their appeal rights and VHA staff retraining, to
                                                                               eliminate wrongful turn away of Veterans, and (2) plans to collabo-
                                                                               rate with VSOs, Veterans Claims Officers, and state and local Vet-
                                                                               erans services on correcting any misinformation on eligibility of VA
                                                                               care for all Veterans.
                                                                                  Modeling and Simulation Treatment of PTSD.—As a mechanism
                                                                               to explore treatments for PTSD, the Committee is aware that the
                                                                               use of modeling and simulation technology has enabled the devel-




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                                                                               opment of innovative and immersive therapies, which can extend




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                                                                               trauma management therapy protocol. The Committee encourages
                                                                               the establishment of a Trauma Management Therapy pilot pro-
                                                                               gram that utilizes exposure therapy involving virtual reality in
                                                                               combination with group therapy for the treatment of individuals
                                                                               with symptoms relating to PTSD. House Report 116–63 directed
                                                                               VA to provide a report detailing the feasibility of such a pilot pro-
                                                                               gram and the metrics required. The Committee further directs the
                                                                               Department to update this report to include the feasibility of allow-
                                                                               ing these technologies to provide treatment through telehealth to
                                                                               treat PTSD within 90 days of enactment of this Act.
                                                                                 Collaboration on Gun Safety and Storage.—The Committee sup-
                                                                               ports continued collaboration across public and private sectors to
                                                                               end the national tragedy of suicide, and encourages VA medical
                                                                               centers to collaborate with state and local law enforcement and
                                                                               health officials in states that have adopted extreme risk protection
                                                                               orders, also known as ‘‘red flag’’ laws, and similar gun safety laws,
                                                                               to adopt programs and protocols on firearm safety and storage to
                                                                               assist Veterans who may be struggling with suicidal thoughts.
                                                                                                           SUICIDE PREVENTION OUTREACH

                                                                                 VetsCorps.—The Committee continues to strongly support the
                                                                               VetsCorps pilot program directed in House Report 116–63. The
                                                                               VetsCorps, comprised of Veterans themselves, will conduct out-
                                                                               reach and recruitment to bring in Veterans who have not been
                                                                               served by the Department and will connect them with available
                                                                               programs and services. The VetsCorps should be designed to reach
                                                                               Veterans wherever they are and provide a personal connection to
                                                                               VA, including peer-to-peer Veteran support networks with
                                                                               VetsCorp for Veterans who are trained in suicide prevention and
                                                                               crisis intervention to help other Veterans transition from military
                                                                               service to civilian life. The Committee continues to direct the pilot
                                                                               be carried out at no fewer than six sites, targeted to regions with
                                                                               low rates of VA utilization and including at least one rural and
                                                                               urban site. The Committee directs the Department to provide quar-
                                                                               terly reports on the status of the implementation of the VetsCorp
                                                                               pilot program. Furthermore, at the conclusion of the pilot, the Com-
                                                                               mittee directs the Department to report to the Committees on Ap-
                                                                               propriations of both Houses of Congress on the effectiveness of the
                                                                               pilot program at reaching Veterans, particularly those in need, and
                                                                               increasing utilization of VA services and evaluate the cost-effective-
                                                                               ness of the program compared to existing outreach efforts.
                                                                                 GRIT Suicide Prevention Mobile Application.—The Committee
                                                                               supports the Department’s current efforts to use twenty-first cen-
                                                                               tury technology to promote social connectedness in order to prevent
                                                                               Veteran suicides. The Department, in collaboration with technology
                                                                               organizations, is developing mobile applications and online plat-
                                                                               forms in an effort to reach more Veterans, such as the Getting Re-
                                                                               sults in Transition (GRIT) mobile application for transitioning
                                                                               servicemembers and Veterans. The Committee directs the Depart-
                                                                               ment to continue its efforts to work with technology organizations
                                                                               to develop and implement innovative platforms to prevent Veteran
                                                                               suicide and requests a report within 90 days of enactment of this
                                                                               Act on the status of these efforts.
                                                                                 Veterans Suicide Prevention Grant Program.—The Committee




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                                                                               continues to support VA’s efforts to coordinate suicide prevention




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                                                                               efforts across Federal agencies, prioritize research activities, and
                                                                               strengthen coordination across the public and private sectors under
                                                                               the PREVENTS Initiative.
                                                                                  Social Media.—The Committee encourages the Department to in-
                                                                               vestigate using social media platforms to identify and engage Vet-
                                                                               erans at risk of suicide and work with academic partners to de-
                                                                               velop and test tools for identifying and engaging these veterans.
                                                                                  Artificial Intelligence and Machine Learning.—The Committee
                                                                               urges the Department to utilize its growing electronic data re-
                                                                               sources to provide improved services to Veterans, including pre-
                                                                               venting Veteran suicides, and notes that commercial off-the-shelf
                                                                               tools, such as artificial intelligence and machine learning software,
                                                                               can provide predictive analysis and can help prevent suicides be-
                                                                               fore they occur.
                                                                                  Suicide Prevention Outreach.—The Committee directs the Sec-
                                                                               retary to submit a report to the Committees on Appropriations of
                                                                               both Houses of Congress on Suicide Prevention Outreach activities
                                                                               within 60 days of enactment of this Act. The report should include
                                                                               how VA has executed Federal funding for the last two fiscal years
                                                                               and an assessment on what funding and resources are needed to
                                                                               accomplish the Department’s suicide prevention outreach mission.
                                                                               Furthermore, the report should include the number of Veterans
                                                                               that VA has reached out to through the suicide prevention outreach
                                                                               initiative, and an analysis of the program’s effectiveness, including
                                                                               how COVID–19 has impacted this initiative in fiscal year 2020.
                                                                                  Models of Care for Suicide Prevention.—Soldier and Veteran sui-
                                                                               cide remains a significant scourge on America. Despite diligent ef-
                                                                               forts to prevent suicide, the existing clinical care model does not
                                                                               appear to be improving outcomes. As such, the Committee encour-
                                                                               ages VA to determine whether current clinical care practices
                                                                               should be enhanced, and new models of care developed. In making
                                                                               such a determination, the Department should involve its clinical
                                                                               leaders and experts, academia, advocate organizations, and other
                                                                               stakeholders and also ensure survivors of attempted suicide and
                                                                               families who have lost a loved one are provided the opportunity to
                                                                               engage in the process.
                                                                                                                 HOMELESS ASSISTANCE

                                                                                 The Committee provides $1,928,508,000 for VA homeless assist-
                                                                               ance programs, which is $40,000,000 above the budget request. Ad-
                                                                               ditionally, an estimated $7,868,860,000 is provided for homeless
                                                                               Veterans treatment costs. Programs to assist homeless Veterans in-
                                                                               clude the Homeless Providers Grant and Per Diem (GPD), Health
                                                                               Care for Homeless Vets (HCHV), the Domiciliary Care for Home-
                                                                               less Veterans, the Supportive Services for Low Income Veterans
                                                                               and Families (SSVF), Justice Outreach Homeless Prevention, and
                                                                               the Department of Housing and Urban Development-Department of
                                                                               Veterans Affairs Supported Housing (HUD–VASH) programs,
                                                                               among others.
                                                                                 Healthcare for Homeless Veterans.—The Committee directs the
                                                                               Secretary to submit a report to the Committees on Appropriations
                                                                               of both Houses of Congress within 90 days of enactment of this Act
                                                                               on the benefits of expanding the Healthcare for Homeless Veterans




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                                                                               Program H–PACT program, to include the benefits of expanding




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                                                                               the program, location of additional locations, to include rural areas,
                                                                               and additional services to improve the program.
                                                                                  Ending Veteran Homelessness.—The Committee recognizes the
                                                                               value and impact of the HUD–VASH program, which serves Vet-
                                                                               erans 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 Com-
                                                                               mittee recommends that VA’s budget for case managers be in-
                                                                               creased commensurate with any increases in HUD’s budget for new
                                                                               vouchers.
                                                                                  HUD–VASH Program.—The Committee continues to support the
                                                                               HUD–VASH program and reminds the Department to provide the
                                                                               annual report on distribution of HUD–VASH vouchers as requested
                                                                               in House Report 115–188. Furthermore, the Committee requests
                                                                               that this annual report also identify how many HUD–VASH vouch-
                                                                               ers 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 Vet-
                                                                               eran homelessness.
                                                                                  Extended HUD–VASH Support Services.—The Committee is
                                                                               aware of the positive role the HUD–VASH program plays in help-
                                                                               ing homeless Veterans. A key component of the program is VA’s
                                                                               case management services. These services are designed to assist
                                                                               Veterans in obtaining and sustaining permanent housing and en-
                                                                               gage in needed treatment and other supportive services that im-
                                                                               prove Veterans’ quality of life and end their homelessness. Exam-
                                                                               ples include access to a caseworker that could help prevent Vet-
                                                                               erans from hurting themselves or others, committing a serious
                                                                               crime, or damaging the rented property when experiencing an
                                                                               emergent mental health or substance abuse crisis. To assist with
                                                                               efforts to evaluate the case management services, the Committee
                                                                               directs VHA to provide a report to the Committees on Appropria-
                                                                               tions of both Houses of Congress within 180 days after enactment
                                                                               of this Act detailing: (1) a summary of the current agency guidance
                                                                               for implementing case management services after core working
                                                                               hours, (2) a list of any VISN that does not offer extended support
                                                                               services after core working hours, (3) how a VISN provides support
                                                                               to Veterans in locations that do not provide extended case manage-
                                                                               ment services after core business hours, and (4) plans to provide
                                                                               expanded extended case management services in locations that do
                                                                               not currently have these services after core business hours.
                                                                                  HUD–VASH Caseworker Staffing.—The Committee remains con-
                                                                               cerned that the Department is not properly staffing its HUD–
                                                                               VASH program to meet the needs of the homeless Veterans popu-
                                                                               lation, which may be contributing to increasing homelessness na-
                                                                               tionwide. As of December 31, 2019, there were over 650 vacant
                                                                               HUD–VASH caseworker positions across the country. Accordingly,
                                                                               the Committee urges the Secretary to use existing authority to con-
                                                                               tract for HUD–VASH caseworker positions when such positions




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                                                                               have remained vacant for more than nine months and when a VA




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                                                                               Medical Center has not used 15 percent of its allotted vouchers in
                                                                               the previous year. Furthermore, the Committee directs the Sec-
                                                                               retary to submit a report to the Committees on Appropriations of
                                                                               both Houses of Congress within 90 days of the enactment of this
                                                                               Act that is consistent with the report requirements set forth in Di-
                                                                               vision F of the Joint Explanatory Statement accompanying the
                                                                               Consolidated Appropriations Act, 2020 (Public Law 116–94).
                                                                                  Legal Assistance for the SSVF Program.—The Committee notes
                                                                               that university law schools are willing to work with Veterans on
                                                                               a pro-bono basis to provide legal assistance. This can result in ad-
                                                                               ditional benefits such as training law students in Veteran disability
                                                                               law and legal skills critical to providing advocacy within the VA
                                                                               system and inspiring next-generation lawyers to serve Veterans in
                                                                               practice. The Committee encourages the SSVF program to work
                                                                               with grantees to expand their legal service offerings, particularly in
                                                                               rural areas where access to private legal assistance can be limited.
                                                                               Within the funds provided, the Department is encouraged to estab-
                                                                               lish one or more pilot projects to partner SSVF grantees with uni-
                                                                               versity law schools in rural areas to enhance legal assistance to
                                                                               Veterans.
                                                                                  Shallow Subsidy Initiative.—The Committee encourages VA to
                                                                               prioritize funding within the SSVF program for the Shallow Sub-
                                                                               sidy Initiative to expand the number of counties eligible to provide
                                                                               the Shallow Subsidy, targeting areas with high rental costs and
                                                                               large homeless Veteran populations.
                                                                                  Homeless Veterans Near the United States-Mexico Border.—The
                                                                               Committee notes that there may be homeless Veterans living near
                                                                               the United States-Mexico border who, historically, may not have
                                                                               been counted in point-in-time homeless surveys. The Committee di-
                                                                               rects VA to work with HUD to develop strategies and recommenda-
                                                                               tions for addressing Veteran homelessness near the United States-
                                                                               Mexico border and to take into account these undercounted Vet-
                                                                               erans when awarding HUD–VASH vouchers. The Committee ap-
                                                                               preciates VA’s efforts to implement strategies and make rec-
                                                                               ommendations to decrease Veteran homelessness on the border,
                                                                               such as the development of a Homelessness Screening Clinical Re-
                                                                               minder, data sharing, improving the accuracy of data, and con-
                                                                               tracting case management in rural areas.
                                                                                                                       STAFFING ISSUES

                                                                                  Mental Health Professionals Hiring.—The Committee continues
                                                                               to direct the Department to prioritize hiring mental health profes-
                                                                               sionals.
                                                                                  Unfilled Positions.—The current number of unfilled positions at
                                                                               VA is nearly 49,000 system-wide. These unfilled positions include
                                                                               VHA physicians and mental health professionals, and the lack of
                                                                               these professionals negatively impacts the delivery of care for Vet-
                                                                               erans at VHA medical centers and CBOCs across the country. VHA
                                                                               facilities have been forced to provide care with fewer staff than are
                                                                               medically necessary to properly care for our Nation’s Veterans. As
                                                                               a result, the Committee is concerned that the significant number
                                                                               of vacancies will lead to longer wait times for Veterans. Section 505
                                                                               of the John S. McCain III, Daniel K. Akaka, and Samuel R. John-
                                                                               son VA Maintaining Internal Systems and Strengthening Inte-




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                                                                               grated Outside Networks (MISSION) Act of 2018 (P.L. 115–182),




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                                                                               requires VA to post data on unfilled positions. The Committee ex-
                                                                               pects VA to continue to comply with this mandate and expects VA
                                                                               to actively recruit and hire full-time professionals to fill these sys-
                                                                               tem-wide vacancies with the resources provided by the Committee.
                                                                               The Committee continues to direct the Secretary to provide a quar-
                                                                               terly 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 physi-
                                                                               cian positions and mental health provider positions, as well as any
                                                                               impediments to such efforts. The report should include the re-
                                                                               sources provided for these efforts and recommendations for rel-
                                                                               evant legislation.
                                                                                  Medical Staff Retention.—The Committee expects VA to continue
                                                                               to report every six months on the number of all clinical staff di-
                                                                               rectly responsible for patient care who have left VA, including a
                                                                               summary of the principal reasons explaining their departure, and
                                                                               the steps being taken to mitigate the principal reasons providers
                                                                               leave. The data should be aggregated at the VISN level and should
                                                                               also include the percentage of staff in primary care versus specialty
                                                                               care and mental health care, and the percentage of medical staff
                                                                               at each facility who complete an exit survey upon their departure.
                                                                               Exit surveys should be conducted anonymously, including through
                                                                               the use of a location that allows for privacy, is not directly visible
                                                                               by another employee, and does not require the departing employee
                                                                               to include any personally identifiable data.
                                                                                  Hiring Delays.—The Committee is concerned that VA’s hiring
                                                                               and credentialing process may be contributing to longer wait times
                                                                               for Veterans seeking healthcare. The Committee requests VA to re-
                                                                               port 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 inter-
                                                                               view 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 out-
                                                                               side VA. This report should be provided to the Committee no later
                                                                               than 60 days after enactment of this Act.
                                                                                  Lack of Team-based Staffing.—The Committee is encouraged by
                                                                               improvement in Primary Care access and wait times. However, the
                                                                               Committee remains concerned about primary care Patient Aligned
                                                                               Care Team (PACT) team staffing at VA Medical Centers. Team-
                                                                               based care has been shown to improve health outcomes, improve
                                                                               team member satisfaction, including providers, which also cor-
                                                                               relates to lower team burnout, and increases Veteran experience
                                                                               and satisfaction. The Committee directs VA to submit a report, no
                                                                               later than 120 days after enactment of this Act, providing informa-
                                                                               tion on the number and percentage of fully staffed and imple-
                                                                               mented PACTs as well as the number of fully trained PACTs with-
                                                                               in VA. This report should also include correlation of fully staffed
                                                                               PACTs to health outcomes as well as employee and Veteran satis-
                                                                               faction.
                                                                                  Staffing Shortages.—The Committee recognizes the growing




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                                                                               shortage of VHA physicians and medical professionals has nega-




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                                                                               tively affected the delivery of care for Veterans at VHA medical
                                                                               centers and clinics across the country. VHA facilities have been
                                                                               forced to provide care with fewer staff than are medically necessary
                                                                               to properly care for our nation’s Veterans. In House Report 116–
                                                                               63 and in Division F of the Joint Explanatory Statement accom-
                                                                               panying the Consolidated Appropriations Act, 2020 (Public Law
                                                                               116–94), the Committee requested various reports on what VHA is
                                                                               doing to fill medical vacancies, recruit new talent, and address
                                                                               workforce-training opportunities, not limited to, but including, psy-
                                                                               chiatric and behavioral health professionals. The Committee is con-
                                                                               cerned VA has not produced these reports in a timely manner and
                                                                               is further concerned as VA health professional staff vacancies have
                                                                               not decreased. The Committee directs VA to submit the staffing
                                                                               issues reports no later than 30 days after enactment of this Act.
                                                                                                            ACCESS FOR RURAL VETERANS

                                                                                  Office of Rural Health (ORH).—The Committee provides
                                                                               $300,000,000 for rural health, which is $30,000,000 above the re-
                                                                               quest, 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 Vet-
                                                                               erans 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, in-
                                                                               cluding 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 imple-
                                                                               menting new ways to deliver healthcare and services to Veterans
                                                                               in these locations. The Committee supports the Office of Rural
                                                                               Health’s ongoing efforts to refine and promulgate best practices
                                                                               and innovative and successful programs to improve care and serv-
                                                                               ices for Veterans who reside in rural areas, including the designa-
                                                                               tion of Rural Promising Practices.
                                                                                  Operating Plan.—The Committee directs the Office of Rural
                                                                               Health to submit to the Committee no later than 30 days after en-
                                                                               actment of this Act an operating plan for fiscal year 2021 funding,
                                                                               as well as for the fiscal year 2022 funding provided in advance by
                                                                               this Act.
                                                                                  VSO Wellness.—The Committee is concerned that VA is taking
                                                                               too much time to implement the VSO Wellness pilot program, au-
                                                                               thorized in Section 252 of the Consolidated Appropriations Act,
                                                                               2018 (P.L. 115–141). This remains a priority of the Committee, and
                                                                               the Department is directed to implement the pilot program expedi-
                                                                               tiously. House Report 116–63 directed the Department to provide
                                                                               a status update on the pilot program no later than 14 days after
                                                                               the report was filed, and the Committee has yet to receive the sta-
                                                                               tus report. The Committee directs the Department to provide
                                                                               monthly updates on the status of the VSO Wellness pilot program,
                                                                               in addition to the initial status report required in House Report
                                                                               116–63 no later than 14 days after this report is filed.
                                                                                  Rural Transportation Study.—The Committee provides funding,
                                                                               as requested, for the Office of Rural Health’s rural transportation
                                                                               study by the Veterans Rural Health Resource Center, Iowa City.




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                                                                               The Committee supports this study and directs the Secretary to




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                                                                               provide a report with the President’s Budget Request for fiscal year
                                                                               2022 that assesses whether there are gaps in the Department’s
                                                                               comprehensive rural transportation program, how they should be
                                                                               closed, and if additional funding is needed.
                                                                                  Rural Health Resource Centers.—Given the important role ORH’s
                                                                               Rural Health Resource Centers play in expanding access to care,
                                                                               the Committee encourages VA to continue considering expanding
                                                                               these centers. ORH has played a major role in VA’s overall strategy
                                                                               to combat opioid abuse by funding pilot programs through the
                                                                               Rural Health Initiative focused on pain coaching and modalities
                                                                               that increase Veterans’ access to alternatives to opioid-centered
                                                                               pain management. The Committee recommends that as ORH con-
                                                                               siders expansion, combatting the opioid epidemic and non-opioid
                                                                               pain management in rural areas remain key components of its
                                                                               focus.
                                                                                  Vet Center Travel Reimbursement.—The Committee acknowl-
                                                                               edges continued progress in addressing transportation barriers for
                                                                               Veterans, especially those in rural or highly rural areas. While the
                                                                               Committee recognizes the important work of VSOs and the exist-
                                                                               ence of the Veterans Transportation Program, a transportation gap
                                                                               still exists for rural and non-rural areas. The Committee directs
                                                                               VA to submit a report outlining the feasibility of expansion of pay-
                                                                               ments and allowances for beneficiary travel in connection with Vet-
                                                                               erans receiving care from Vet Centers in (a) rural areas and (b) all
                                                                               areas. The Committee is aware of the Congressional Report sub-
                                                                               mitted in November 2018 in response to Public Law 112–154; 126
                                                                               Stat.1169, Section 104a where the Department performed a feasi-
                                                                               bility study for expansion of beneficiary travel for highly rural Vet-
                                                                               erans receiving care from Vet Centers and ultimately advised
                                                                               against expanding beneficiary travel to Veterans due to the lack of
                                                                               software and/or automation between Vet Centers and VA Medical
                                                                               Centers. This report should also include an analysis of options for
                                                                               automating the process for information sharing and workload
                                                                               tracking between Vet Centers and VA Medical Centers and build-
                                                                               ing an infrastructure at Vet Centers for processing beneficiary
                                                                               claims in order to expand beneficiary travel to Veterans traveling
                                                                               to Vet Centers. This report is due no later than 120 days after en-
                                                                               actment of this Act.
                                                                                  Transportation Challenges.—The Committee recognizes the
                                                                               transportation challenges and barriers to care that rural and re-
                                                                               mote Veterans face and encourages VA to look into the feasibility
                                                                               of utilizing autonomous electric vehicles in the future to overcome
                                                                               these challenges.
                                                                                  Clinical Resource Hub.—The Committee supports the success of
                                                                               the recently established Clinical Resource Hub at the Office of
                                                                               Rural Health. This program is an innovative model that delivers
                                                                               high-quality health care services to Veterans in underserved loca-
                                                                               tions. The Committee recognizes the unique challenges faced by
                                                                               Veterans living in rural communities who often require access to
                                                                               a suite of health services across a spectrum of specialty medical
                                                                               professionals. The Clinical Resource Hub combines telehealth serv-
                                                                               ices with in-person care to bring access within reach for Veterans
                                                                               across rural America. The Committee will continue monitoring the




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                                                                               progress of this program through the fiscal year.




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                                                                                                       TELEHEALTH AND CONNECTED CARE

                                                                                  The Committee provides $1,329,566,000 for telehealth and con-
                                                                               nected care, which includes home telehealth, home telehealth pros-
                                                                               thetics, and clinic-based telehealth.
                                                                                  The Committee notes that within the total amount provided for
                                                                               Medical Services in the Coronavirus Aid, Relief, and Economic Se-
                                                                               curity Act (CARES Act) (P.L. 116–136), VA allocated $250,000,000
                                                                               for telehealth expansion.
                                                                                  Telehealth Benefits.—Telehealth services increase Veteran access
                                                                               to care. The Committee directs VA to continue to expand telehealth
                                                                               availability to include additional mental health, primary care, and
                                                                               rehabilitation services as a means to deliver care in rural and un-
                                                                               derserved communities.
                                                                                  Telehealth Services.—The Committee directs VA to develop a
                                                                               plan to improve Veteran and provider satisfaction, increase aware-
                                                                               ness of the telehealth program, and enhance adoption of telehealth
                                                                               by Veterans and providers. The Department’s plan should include
                                                                               actions that will be taken to make telehealth more accessible to pa-
                                                                               tients in highly rural areas. The Committee looks forward to the
                                                                               Department’s report, as directed in Division F of the Joint Explan-
                                                                               atory Statement accompanying the Consolidated Appropriations
                                                                               Act, 2020 (Public Law 116–94) within 60 days of enactment of the
                                                                               Act.
                                                                                  Telehealth for Maternal Fetal Medicine.—The Committee recog-
                                                                               nizes the needs of women Veterans and expanding access to mater-
                                                                               nal fetal medicine (MFM) via telehealth to ensure the health of
                                                                               mothers, pregnancies, and babies. The Committee also recognizes
                                                                               the further potential for VA to partner with universities to expand
                                                                               access to maternal and perinatal care via telehealth. To assist with
                                                                               efforts to evaluate the potential for creating pilot programs in sup-
                                                                               port of MFM, the Committee directs the Department to provide a
                                                                               report to the Committees on Appropriations of both Houses of Con-
                                                                               gress with 180 days after enactment of this Act detailing: (1) the
                                                                               current extent of VA support for MFM telehealth and (2) the poten-
                                                                               tial for entering into MFM partnerships with academic institutions
                                                                               in states that serve a high percentage of Veterans and their fami-
                                                                               lies in rural, isolated communities in noncontiguous states and ter-
                                                                               ritories.
                                                                                                       GENDER-SPECIFIC CARE FOR WOMEN

                                                                                 The number of women Veterans using VHA services has in-
                                                                               creased 29 percent in five years from 423,642 women Veterans in
                                                                               2014 to 545,670 in 2019. The increased number of women using
                                                                               VHA services necessitates the greater need to provide and expand
                                                                               VA’s gender-specific services to women Veterans. The bill provides
                                                                               $660,691,000 for gender-specific care for women, which is
                                                                               $35,000,000 above the request. VA is directed to continue rede-
                                                                               signing its women’s healthcare delivery system and facilities to en-
                                                                               sure women receive equitable, timely, and high-quality healthcare.
                                                                                 The additional $35,000,000 is provided for the purposes of ex-
                                                                               panding programmatic support for women’s healthcare. VA is di-
                                                                               rected to provide an expenditure plan detailing how the additional
                                                                               funding will be spent no later than 90 days after enactment of this




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                                                                               Act, and the Committee further requires quarterly briefings on the




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                                                                               expenditure of these funds. The Committee directs the delivery of
                                                                               care to women Veterans be through an organized program within
                                                                               normal business operations of VA. The women’s health program is
                                                                               required to have appropriate staffing levels and executive support
                                                                               that is operationalized to ensure all aspects of care for women Vet-
                                                                               erans are available.
                                                                                  Program managers within each VA facility should be equipped,
                                                                               at a minimum, with at least one designated women’s health pro-
                                                                               vider, the appropriate number of nurses, administrative support,
                                                                               care coordinators, and peer navigators. The Committee directs VA
                                                                               to continue to build on its training initiatives for women’s health
                                                                               providers and nurses in order to meet the increased demand in
                                                                               care. VA is further directed to provide greater resources at the field
                                                                               level to build visible women-specific health programs, including sui-
                                                                               cide prevention programs, reproductive mental health programs,
                                                                               and combined pain and opioid use programs, and the Committee
                                                                               requests a report within 90 days of enactment of this Act on VA’s
                                                                               plans to provide and expand these programs for women.
                                                                                  The Department is further directed to prioritize hiring women
                                                                               primary care providers and psychologists for women’s clinics using
                                                                               the Medical Services appropriation. To supplement VA’s recruit-
                                                                               ment efforts to hire and retain women clinicians at the field and
                                                                               VISN levels, the Committee directs the Department to deploy a
                                                                               large national women-specific advertising campaign to appeal to
                                                                               women Veterans to receive their care at VA facilities and to
                                                                               women-specific healthcare providers to work at VA.
                                                                                  Additionally, the Committee continues to direct that Women’s
                                                                               Health Program Managers be full-time jobs and not be tasked with
                                                                               supplemental responsibilities outside of their specified job descrip-
                                                                               tions.
                                                                                  Gender-Specific Women Veterans’ Healthcare.—Women are now
                                                                               the fastest growing cohort within the Veteran community. The
                                                                               Committee remains concerned that VA is not adequately address-
                                                                               ing the health needs of women Veterans, including obstetrics, gyne-
                                                                               cological care, and treatment for gender-specific conditions and dis-
                                                                               eases. The Committee urges VA to continue expanding access to
                                                                               care in these areas and ensure women Veterans’ health needs,
                                                                               which often differ from men, are met.
                                                                                  Women Medical Staff.—The Committee continues to support the
                                                                               hiring of more women healthcare professionals in order to provide
                                                                               women Veterans greater opportunities to choose the gender of their
                                                                               healthcare provider.
                                                                                  Access to Gender-Specific Care for Women.—The Committee ex-
                                                                               pects VA to continue to work to improve care for women Veterans.
                                                                               VA must provide women Veterans equitable access to the same
                                                                               health care services and programs as male Veterans, including
                                                                               VA’s specialized services for substance use disorders, homelessness,
                                                                               and treatment for PTSD related to combat military sexual trauma.
                                                                               Most importantly, these programs must be tailored to meet the
                                                                               unique needs of women Veterans by expanding the list of require-
                                                                               ments that facility staff inspects for compliance to align with the
                                                                               women’s health handbook of the Veterans Health Administration.
                                                                               The Committee further directs VA to ensure proper coordination of
                                                                               care for 1) women patients with complex care needs who must fre-




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                                                                               quently access gender-specific health care services in the commu-




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                                                                               nity and 2) for women Veterans with war-related injuries and/or
                                                                               service conditions who are at higher risk for poor outcomes. VA
                                                                               should monitor these efforts and report to the Committees on Ap-
                                                                               propriations of both Houses of Congress within 120 days of enact-
                                                                               ment of this Act on its work to improve these outcomes for women
                                                                               Veterans.
                                                                                  Breast Cancer Screening Guidelines.—The Committee commends
                                                                               VA’s decision to offer breast cancer screening and mammography
                                                                               to eligible women Veterans beginning at age 40. However, the De-
                                                                               partment should be prepared to offer screening to eligible younger
                                                                               women Veterans should a physician determine, or risk factors war-
                                                                               rant, 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 fol-
                                                                               low ongoing debate within the scientific community on breast can-
                                                                               cer screening and mammography coverage to provide Veterans the
                                                                               best care possible. The recommendation includes bill language to
                                                                               ensure VA maintains this policy through fiscal year 2024.
                                                                                  Maternity Care Benefits, Survey, and Education Campaign.—The
                                                                               Committee requests a report within 90 days of enactment of this
                                                                               Act on the following data related to VA maternity care benefits: the
                                                                               number of eligible women Veterans and actual utilization from
                                                                               each of the last 10 years in each VISN, to the extent that data are
                                                                               available; the number of Veterans who receive prenatal care and
                                                                               have births at a VA facility, and the number of Veterans who re-
                                                                               ceive prenatal care-related services through contracted non-VA pro-
                                                                               viders; 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 condi-
                                                                               tion; and the number of maternity care coordinators in each VISN
                                                                               and specific data on minimum employment requirements and case-
                                                                               load. 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 inter-
                                                                               action with the maternity care coordinator; and whether there were
                                                                               barriers to care, providers, or specific services related to the mater-
                                                                               nity care benefit. Further, the Committee encourages VHA to de-
                                                                               velop an education campaign publicizing the maternity care ben-
                                                                               efit, including clarifying who is eligible, what the benefit covers
                                                                               and does not cover, and any cost sharing that may be required with
                                                                               the benefit. The education campaign materials should be easy for
                                                                               patients to understand and be easily accessible online and at each
                                                                               center for women’s health, medical center and CBOC.
                                                                                  Women Veterans Peer Support.—The Committee welcomes the
                                                                               role of Women Veterans Network (WoVeN), a national peer support
                                                                               network for women Veterans in providing group support specifi-
                                                                               cally tailored to the unique needs of women Veterans, including life
                                                                               transitions, balance, stress relief, connections, healthy living and
                                                                               esteem, which is run by researchers from the National Center for
                                                                               PTSD—Women’s Health Sciences Division, which develops clinical
                                                                               practices to treat PTSD in women. The research component of this




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                                                                               peer support program will drive innovation in addressing PTSD in




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                                                                               women Veterans. The Committee provides no less than $1,000,000
                                                                               for peer support programs for women Veterans.
                                                                                  Combatting Maternal Mortality.—The Committee recognizes that
                                                                               the United States maternal mortality rates are significantly higher
                                                                               than many of our international counterparts. In 2018, the Center
                                                                               for Disease Control and Prevention found that in the United
                                                                               States, 658 women, including women Veterans, died from complica-
                                                                               tions while giving birth. The Committee directs VA to provide a re-
                                                                               port within 90 days of enactment of this Act on the historical ma-
                                                                               ternal mortality rates of women Veterans and recommendations on
                                                                               how to combat the rising rates.
                                                                                  Women Veterans Contact Call Center.—The Committee directs
                                                                               the Secretary to enhance the capabilities of the women Veterans
                                                                               contact call center to respond to requests by women Veterans for
                                                                               assistance with accessing health care and benefits furnished under
                                                                               the laws administered by the Secretary, and to refer such Veterans
                                                                               to resources provided by the Federal government and the commu-
                                                                               nity to obtain assistance with services not furnished by the Depart-
                                                                               ment.
                                                                                  Sexual Assault and Harassment Policy at VA.—The Committee
                                                                               continues to be concerned about the harassment women Veterans
                                                                               have had to endure at some VA healthcare facilities, but is pleased
                                                                               VHA has initiated the Stand-Up to Stop Harassment Campaign to
                                                                               promote a harassment-free healthcare environment for staff, Vet-
                                                                               erans and visitors to VA health facilities. The Committee directs
                                                                               the Secretary to provide a report no later than 90 days after enact-
                                                                               ment of this Act to the Committees on Appropriations of both
                                                                               Houses of Congress on VA’s plan to expand and implement a simi-
                                                                               lar initiative across all VA components, including implementing
                                                                               mandatory bystander intervention training for all employees, con-
                                                                               tractors, on-site vendors, and volunteers.
                                                                                                                       PHARMACY ISSUES

                                                                                  Drug Pricing Report.—Rising drug prices are a significant cost
                                                                               driver in healthcare. However, VA receives substantial discounts
                                                                               when purchasing prescription drugs. Common sense approaches
                                                                               such as using lower-cost generic drugs, providing care from expert
                                                                               pharmacists, and making drug companies compete for business can
                                                                               help drive down the cost of healthcare. The Committee is interested
                                                                               in VA’s spending on prescription drugs and requests a robust re-
                                                                               port on drug pricing no later than 120 days after enactment of this
                                                                               Act. The report should include prescription drug prices (net of re-
                                                                               bates) paid by VA for the ten most frequently prescribed drugs and
                                                                               the ten highest-cost drugs for VA. In addition, the report should in-
                                                                               clude total annual costs to VA for all prescription drugs. If data is
                                                                               unavailable, the report should provide a detailed explanation of
                                                                               why.
                                                                                  At-home Drug Disposal for Veterans.—In 2019, over 125 million
                                                                               prescriptions, representing 80 percent of outpatient prescriptions
                                                                               were mailed directly to the Veteran’s home. While extremely bene-
                                                                               ficial to Veterans, this method may contribute to the prevalence of
                                                                               excess, expired, unused, and unwanted prescriptions remaining in
                                                                               Veterans’ medicine cabinets. In a recent VA study of almost 5 mil-
                                                                               lion Veterans with prescriptions through VA, 64 percent had at




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                                                                               least one duplicated medication, which can increase the risk of ad-




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                                                                               verse events and overdose. In addition, recent studies indicate as
                                                                               many as 72 percent of opioids prescribed for post-surgical pain go
                                                                               unused by the patient, but without active engagement at discharge,
                                                                               patients are highly unlikely to dispose of unused drugs leaving
                                                                               them vulnerable for misuse and abuse. The Committee supports
                                                                               VA’s efforts to engage Veterans on the safe disposal of prescribed
                                                                               medication while continuing to pursue and advance additional
                                                                               methods to limit and dispose of excess medications in Veteran
                                                                               homes. The Committee directs the Department to provide a report
                                                                               within 120 days of enactment of this Act on the feasibility of con-
                                                                               ducting a pilot program to evaluate the benefits of co-dispensing at-
                                                                               home drug disposal products for post-surgical patients as a part of
                                                                               the Opioid Overdose Education and Naloxone Distribution program
                                                                               and drug-take back activities of the Department.
                                                                                  Safe Medicine.—The Committee recognizes the nation’s increased
                                                                               reliance on foreign-based sources of medicine and active pharma-
                                                                               ceutical ingredients. The Committee is concerned the health secu-
                                                                               rity risk this presents VA as it provides medicine to Veterans. The
                                                                               Committee requests a report within 90 days of enactment of this
                                                                               Act detailing potential vulnerabilities VA faces purchasing medi-
                                                                               cine from offshore sources, including dependency issues, and that
                                                                               addresses strategies to buy American and produce medicine domes-
                                                                               tically. The report should also provide information on VA’s medic-
                                                                               inal purchasing guidelines, with relation to drug cost and safety, to
                                                                               ensure VA is acquiring the safest medicine possible for Veterans.
                                                                                   OPIOID SAFETY INITIATIVES AND SUBSTANCE USE DISORDER CARE

                                                                                  Opioid Abuse.—The Committee is pleased that VA has taken an
                                                                               aggressive posture in reducing the volume of opioid prescriptions it
                                                                               dispenses and is turning to alternative approaches to pain relief,
                                                                               including the use of complementary medicine tools. The Committee
                                                                               is pleased to see that despite the 7 percent increase in the number
                                                                               of Veterans using pharmacy services between 2012 and 2019, there
                                                                               has been a 60 percent reduction of Veterans on long-term opioids
                                                                               and an 82 percent reduction of Veterans receiving opioid and
                                                                               benzodiazepine medications together. The Committee encourages
                                                                               VA to continue the challenging effort to reduce opioid use among
                                                                               Veterans, half of whom suffer from chronic pain. The Committee
                                                                               provides $503,660,000 for opioid treatment and prevention efforts,
                                                                               of which $120,812,000 is provided for activities authorized by the
                                                                               Comprehensive Addiction and Recovery Act of 2016 (P.L. 114–198),
                                                                               which is $66,758,000 above fiscal year 2020.
                                                                                  Opioid Therapy Risk Report.—The Committee urges VA to en-
                                                                               sure 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 di-
                                                                               version, abuse, and double-prescribing. The Committee also urges
                                                                               VA to further improve the timeliness of data available in the tool
                                                                               to allow providers to have real-time access to data. It is critical
                                                                               that VA clinicians have access to patients’ opioid therapy history
                                                                               from outside providers to ensure safe pain management care, as
                                                                               many Veterans also seek care from providers in the community
                                                                               who may prescribe them medication.
                                                                                  Behavioral Health and Substance Use Screening.—The Com-




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                                                                               mittee is aware of the high prevalence of mental illness and sub-




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                                                                               stance abuse among Veterans, particularly PTSD, depression, anx-
                                                                               iety, and alcohol and opioid abuse. The Committee strongly rec-
                                                                               ommends that all Veterans seeking treatment services in a VA fa-
                                                                               cility be screened for the listed illnesses, at a minimum annually,
                                                                               using evidence-based assessment tools.
                                                                                  Substance Abuse Among Women.—In recent years, rates of prob-
                                                                               lematic substance use among women Veterans have been increas-
                                                                               ing. 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 (phys-
                                                                               ical and sexual). As such, the Committee recommends that the De-
                                                                               partment ensures women Veterans have timely access to a full
                                                                               spectrum of integrated substance abuse treatment services, from
                                                                               detoxification to rehabilitation. Additionally, the Department
                                                                               should increase the availability of gender-specific substance use
                                                                               disorder programming and ensure all programming venues comply
                                                                               with the environment of care standards for women’s privacy and
                                                                               safety.
                                                                                  Substance Use Disorders.—The Committee supports new and in-
                                                                               novative solutions to address substance use disorders and sub-
                                                                               stance misuse, including efforts to intervene early with at-risk Vet-
                                                                               erans and support programs that provide Veterans and their fami-
                                                                               lies with the tools they need to meet these challenges, such as
                                                                               harm reduction techniques and confidential education that can re-
                                                                               duce substance use, relapse, hospital visits and suicide. The Com-
                                                                               mittee encourages VA to increase education among its primary care
                                                                               practitioners on the diagnosis and treatment of alcohol use dis-
                                                                               orders with Federal Drug Administration (FDA)-approved medica-
                                                                               tion assisted treatments.
                                                                                  Internet-based Substance Abuse Education.—The Committee rec-
                                                                               ognizes the ongoing work of VA to reduce substance use disorder
                                                                               among Veterans. The Committee is aware of Substance Abuse and
                                                                               Mental Health Services Administration studies that conclude that
                                                                               90 percent of people who die by suicide suffer from depression, sub-
                                                                               stance use disorders, or both. Veterans face unique health chal-
                                                                               lenges and the suicide rate among Veterans continues to be unac-
                                                                               ceptable. The Committee is aware that male Veterans have greater
                                                                               rates of substance abuse addiction but that the rates of problematic
                                                                               substance use among women Veterans is increasing. The Com-
                                                                               mittee supports new and innovative solutions to intervene early
                                                                               with at-risk Veterans and supports programs that provide Veterans
                                                                               and their families with the tools they need to meet these chal-
                                                                               lenges. The Committee recognizes the importance of programs that
                                                                               utilize harm reduction techniques and offer confidential education
                                                                               information that can reduce substance use, relapse, hospital visits
                                                                               and suicide, and therefore directs the Department to provide a fea-
                                                                               sibility study to establish a comprehensive, evidence-based and con-
                                                                               fidential internet-based substance abuse education, case manage-
                                                                               ment, and peer coaching pilot program within 90 days of enactment
                                                                               on this Act.
                                                                                                              WHOLE HEALTH INITIATIVE

                                                                                 Traditionally, Veteran medical providers have focused on the
                                                                               physical symptoms of Veterans, zeroing in on their diseases and




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                                                                               by incorporating a whole health model of care, which is a holistic
                                                                               look at the many areas of life that can affect a Veteran’s health,
                                                                               including their work environment, relationships, diet, sleep pat-
                                                                               terns, and more. Whole Health is an approach to healthcare that
                                                                               empowers and enables the Veteran to take charge of their health
                                                                               and well-being and live their life to the fullest. The Committee is
                                                                               extremely pleased with the Whole Health model of care and in-
                                                                               cludes $83,600,000, which is $20,000,000 above the request, to con-
                                                                               tinue to implement and expand Whole Health to all VA facilities.
                                                                                  Interactive Patient Care Beyond the Inpatient Setting.—The Com-
                                                                               mittee supports Whole Health as a model of care delivery at all
                                                                               points of care whether in VA facilities, in the community, or at
                                                                               home. The Committee understands that several VA Medical Cen-
                                                                               ters (VAMC) are implementing the Whole Health model through
                                                                               interactive patient care, but the Committee is concerned about how
                                                                               the Department will ensure the Whole Health model is sustained
                                                                               when the Veteran is outside of the VA inpatient setting. To achieve
                                                                               success, VA must facilitate the Veteran’s care team’s ability to pro-
                                                                               vide 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 le-
                                                                               verage technology to facilitate management and adaptations of the
                                                                               Veterans Whole Health Plan, ongoing communication, and aware-
                                                                               ness of additional VA services to support fulfillment of the Whole
                                                                               Health Plan.
                                                                                  Creative Arts Therapies.—The Committee acknowledges the effec-
                                                                               tive use of creative arts therapies in treating Veterans with trau-
                                                                               matic brain injuries and psychological health conditions. The Com-
                                                                               mittee supports the integration of the arts and creative arts thera-
                                                                               pies provided by VA’s Office of Patient Centered Care and Cultural
                                                                               Transformation through the Whole Health initiative and encour-
                                                                               ages VA’s continued partnerships with healing arts providers. The
                                                                               Committee strongly supports the Secretary in continuing to expand
                                                                               these innovative programs throughout the Veterans Healthcare
                                                                               Networks and provides an additional $5,000,000 to do so.
                                                                                  Continued Support and Expansion for Whole Heath.—As of Octo-
                                                                               ber 2017, 18 VA medical centers have received funding to imple-
                                                                               ment the Whole Health System of Care (WHS). WHS, a three-year
                                                                               pilot program, meets the intent of the Comprehensive Addiction
                                                                               and Recovery Act by delivering patient-centered care and com-
                                                                               plementary and integrative health approaches to our nation’s Vet-
                                                                               erans especially those who are struggling with opioid use disorder
                                                                               and chronic pain. In January 2020, VA released an evaluation of
                                                                               the WHS, which concluded: (1) the program had a positive impact
                                                                               on reducing opioid use among Veterans; (2) Veterans who used
                                                                               WHS, compared to those who did not, experienced greater improve-
                                                                               ments in perceived stress indicating improvements in overall well-
                                                                               being; and (3) comprehensive WHS service revealed potential sav-
                                                                               ings in pharmacy costs. The Committee is pleased by the results
                                                                               of this evaluation and urges VA to continue supporting the WHS
                                                                               and to expand it beyond the 18 flagship sites in fiscal year 2021.
                                                                                  Whole Health Services.—The Committee supports VA’s focus on
                                                                               Whole Health and as VA continues to expand access to Whole




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                                                                               Health services, the Committee directs VA to analyze the accessi-




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                                                                               bility and availability of each of the following services: massage,
                                                                               chiropractic services, whole health clinician services, whole health
                                                                               coaching, acupuncture, healing touch, whole health group services,
                                                                               guided imagery, meditation, hypnosis, yoga, Tai chi or Qi gong,
                                                                               equine assisted therapy, and any other services the Secretary de-
                                                                               termines appropriate, at VA medical facilities, including Medical
                                                                               Centers, Community-Based Outpatient Clinics, Vet Centers, and
                                                                               Community Living Centers. Furthermore, the Committee directs
                                                                               the Department to submit a report to Committees on Appropria-
                                                                               tions of both Houses of Congress on the outcomes derived from
                                                                               these specified Whole Health services, the resources required to ex-
                                                                               pand these specified services, and the plan to provide these speci-
                                                                               fied services to Veterans who reside in geographic areas where no
                                                                               Medical Center, Community-Based Outpatient Clinic, Vet Center,
                                                                               or Community Living Center is located. The report should be sub-
                                                                               mitted no later than 180 days after enactment of this Act.
                                                                                                                 OTHER HEALTH ISSUES

                                                                                  Central Alabama Veterans Health Care System (CAVHCS).—The
                                                                               Committee calls the Department’s attention to the urgent need to
                                                                               improve the care provided at and the management of CAVHCS.
                                                                               The Department is directed to immediately and fully correct defi-
                                                                               ciencies and problems at CAVHCS and ensure VA Southeast Net-
                                                                               work (VISN 7) is focused on providing appropriate and additional
                                                                               assistance to the system. The Committee directs the Department to
                                                                               develop a plan to resolve these problems and to fill vacancies of
                                                                               permanent leadership and senior member staff and to submit quar-
                                                                               terly reports describing implementation of the plan, including cur-
                                                                               rent status of hiring permanent leadership and senior member
                                                                               staff. The Committee strongly urges the Department to fully utilize
                                                                               every incentive, bonus, or other measures to hire and retain perma-
                                                                               nent medical staff to provide quality care for Veterans in Central
                                                                               Alabama. The Committee directs the Department to issue quarterly
                                                                               reports on all levels of permanent staffing at CAVHCS along with
                                                                               vacancies and efforts that are being made to fill those vacancies.
                                                                                  Cancer Moonshot Contribution.—The Committee supports the
                                                                               Beau Biden Cancer Moonshot Initiative and the Department’s con-
                                                                               tribution 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 in-
                                                                               cluded as a priority as well.
                                                                                  Rare Cancers.—The Committee is pleased by the December 2017
                                                                               signing of the collaboration agreement between the Department,
                                                                               the John P. Murtha Cancer Center at Walter Reed National Mili-
                                                                               tary 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 treat-
                                                                               ment options for, rare cancers. There are 55 cancers that dispropor-
                                                                               tionately affect those serving in the military and 67 percent of
                                                                               them are rare. Of the 396 total cancers, 374 are rare and few treat-
                                                                               ment options are available. Servicemembers are uniquely exposed




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                                                                               to carcinogens, including asbestos, industrial solvents, nuclear radi-




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                                                                               ation, 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 col-
                                                                               laboration 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 mo-
                                                                               lecular subtyping, systemic research and development gaps, and in-
                                                                               adequacies in targeted treatment options.
                                                                                  Nuclear Medicine Quality Improvements.—The Committee is
                                                                               aware of evidence demonstrating the prevalence of extravasations
                                                                               in nuclear medicine procedures. Extravasations of diagnostic radio-
                                                                               pharmaceuticals negatively affect the sensitivity and quantification
                                                                               of nuclear medicine scans. Extravasations can affect disease stag-
                                                                               ing and treatment assessment, result in unnecessary invasive pro-
                                                                               cedures and additional radiation exposure, and lead to higher costs
                                                                               for patients and payers. Additionally, extravasations of diagnostic
                                                                               and therapeutic radiopharmaceuticals can expose patient’s tissue to
                                                                               radiation doses that far exceed dose thresholds that are known to
                                                                               lead to side effects. As America’s largest integrated healthcare sys-
                                                                               tem, VHA should lead by example in acting to reduce medical er-
                                                                               rors and medical waste. The Committee encourages VHA to mon-
                                                                               itor injection quality, image extravasations when they occur, per-
                                                                               form dosimetry, notify patients and their physicians when doses ex-
                                                                               ceed reportable limits, and implement programs to reduce
                                                                               extravasations in the future. The Committee requests an update on
                                                                               this issue in the fiscal year 2022 Congressional Budget Justifica-
                                                                               tion.
                                                                                  Hospital-Acquired Pressure Ulcers and Pressure Injuries.—The
                                                                               Committee understands that ulcers and pressure injuries are re-
                                                                               ported to be 52 percent more prevalent in VA hospitals than in
                                                                               non-VA hospitals, and that the application of evidence-based proto-
                                                                               cols can help prevent Hospital-Acquired Pressure Ulcers. The Com-
                                                                               mittee urges VA to implement the Standardized Pressure Injury
                                                                               Prevention Protocol, as included in the 2019 International Clinical
                                                                               Practice Guidelines for the Prevention and Treatment of Pressure
                                                                               Ulcers/Injuries, and directs VA to provide a report to the Commit-
                                                                               tees on Appropriations of both Houses of Congress no later than 90
                                                                               days after enactment of this Act on steps taken to implement such
                                                                               protocols.
                                                                                  Wheelchairs.—The Committee encourages the Department to
                                                                               work with Veterans who are eligible to receive a wheelchair to de-
                                                                               termine the best options for restoring their maximum achievable
                                                                               mobility and function for daily life.
                                                                                  Nutrition and Food Services.—The Committee recognizes the
                                                                               value of proper nutrition and food’s impact on one’s health and re-
                                                                               mains concerned regarding the nutritional health and well-being of
                                                                               Veterans. Patients with three or more chronic conditions represent
                                                                               35 percent of Veterans receiving VA care and account for 65 per-
                                                                               cent of VHA costs. Acknowledging the correlation between obesity
                                                                               and co-occurring chronic conditions, such as diabetes, the Com-
                                                                               mittee directs VA to provide a report on the ways VA is currently
                                                                               promoting positive nutritional habits among Veterans, such as nu-




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                                                                               tritional coaching and meal programs. The report should include




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                                                                               how many Veterans the Department is currently serving in this ca-
                                                                               pacity, and how to expand the initiative to more Veterans. Further-
                                                                               more, the Committee urges VA to be proactive in promoting
                                                                               wellness and disease prevention by providing evidence-based nutri-
                                                                               tional guidelines for Veterans and their caretakers.
                                                                                  Produce Prescription Pilot Program.—The Committee is con-
                                                                               cerned with food insecurity among the Veteran population and rec-
                                                                               ognizes the role of access to healthy produce in managing chronic
                                                                               disease and reducing health care utilization. The Committee is
                                                                               aware of produce prescription programs across the country that
                                                                               allow medical providers to prescribe fresh fruits and vegetables to
                                                                               individuals or households who are at-risk due to health status or
                                                                               income, often pairing these prescriptions with financial incentives
                                                                               or nutrition education resources. The Committee encourages the
                                                                               Secretary to create a pilot program to provide produce prescriptions
                                                                               to Veterans in partnership with community-based organizations
                                                                               and/or government entities with demonstrated experience and ex-
                                                                               pertise in providing produce prescriptions.
                                                                                  Long-Term Care.—The Committee is aware of the aging Veteran
                                                                               population and supports long-term care that focuses on facilitating
                                                                               Veteran independence, enhancing quality of life, and supporting
                                                                               the family members of Veterans. The Committee supports home-
                                                                               and community-based care, residential settings, nursing homes,
                                                                               geriatric services, and advanced care planning for Veterans and
                                                                               their families. Multiple chronic conditions, life-limiting illness, or
                                                                               disability associated with disease, aging, or injury can be factors of
                                                                               consideration. The Committee acknowledges that the Veteran pop-
                                                                               ulation faces unique health risks and that each Veteran requires
                                                                               an individualized approach to care.
                                                                                  Medical School Affiliations.—The Committee continues to be
                                                                               pleased with VHA’s implementation of its collaborative agreements
                                                                               with academically affiliated minority medical schools. The Com-
                                                                               mittee encourages VHA and the Office of Academic Affiliations
                                                                               (OAA) to further align academic partnerships with training oppor-
                                                                               tunities and patient needs of Veterans in surrounding communities
                                                                               and to convene a summit of minority health professions schools to
                                                                               achieve this goal. The Committee directs VA to provide a report to
                                                                               the Committees on Appropriations of both Houses of Congress on
                                                                               the progress. The Committee further encourages VA to identify op-
                                                                               portunities to expand community-based inpatient and outpatient
                                                                               clinical facilities on the campuses of Historically Black Colleges
                                                                               and Universities (HBCUs) and other minority serving medical
                                                                               schools. The Committee recommends that VA solicit and expand its
                                                                               medical support systems to HBCUs that have medical facilities on
                                                                               their campuses. Within 120 days of enactment of this Act, the Com-
                                                                               mittee directs the Department to report back to the Committees on
                                                                               Appropriations of both Houses of Congress on the progress of both
                                                                               initiatives.
                                                                                  Minority Veteran Care.—The Committee acknowledges the De-
                                                                               partment’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 Vet-
                                                                               erans will come from minority groups by the year 2040. The Com-




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                                                                               mittee also acknowledges that the Department currently has a




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                                                                               working group, which has the goal of developing streamlined data
                                                                               collection processes. Accordingly, the Committee directs the Sec-
                                                                               retary to provide a report to the Committees on Appropriations of
                                                                               both Houses of Congress no later than 180 days after enactment
                                                                               of this Act that details how VA can restructure its data collection
                                                                               practices to more accurately and consistently capture data on the
                                                                               race and ethnicity of Veterans across its various systems. This re-
                                                                               port should take into consideration VA’s new electronic health
                                                                               record system that will combine the Department’s current data col-
                                                                               lecting programs and make recommendations on how the imple-
                                                                               mentation of this new system can help improve data collection on
                                                                               Veterans.
                                                                                  Hispanic-Serving Institution (HSI) Affiliations with VA Health
                                                                               Care Facilities.—The Committee continues to be concerned by the
                                                                               lack of HSI medical school participation and collaboration with
                                                                               local VA hospitals in areas where HSI medical schools are located.
                                                                               The Committee urges the Secretary to develop a plan to expand
                                                                               local VA medical facilities’ participation with HSI medical schools.
                                                                                  Freely Associated States (FAS) Veterans.—The Committee directs
                                                                               the Department to provide hospital care and medical services to
                                                                               Veterans in the FAS, and to provide a report within 180 days of
                                                                               enactment of this Act to the Committees on Appropriations of both
                                                                               Houses of Congress on the feasibility and advisability of estab-
                                                                               lishing regional offices, sub-offices, contact units, or other subordi-
                                                                               nate offices in the FAS to provide such care and services.
                                                                                  VA Healthcare Expansion.—The Committee directs VA to in-
                                                                               crease access to direct VA care for Veterans living in remote and
                                                                               underserved areas, such as the Commonwealth of the Northern
                                                                               Mariana Islands, and strongly urges VA to increase the number of
                                                                               full-time, dedicated, VA medical and mental health providers in
                                                                               these areas.
                                                                                  Cost Analysis of Community Care versus Direct Care in the
                                                                               United States Pacific Territories.—The Committee directs VA to
                                                                               conduct an analysis of the costs to send Veterans residing in the
                                                                               U.S. Pacific territories, including the Northern Mariana Islands,
                                                                               into the community to receive care, and the cost of placing or add-
                                                                               ing a full-time VA clinician to provide such services. For jurisdic-
                                                                               tions that do not have a VA Community-Based Outpatient Clinic,
                                                                               or full-time clinicians providing services exclusively to Veterans,
                                                                               the analysis should include an evaluation and comparison of costs,
                                                                               the quality of care provided to, and health outcomes of, Veterans
                                                                               receiving care through community providers. The analysis should
                                                                               also include feedback on access to care, the quality of care, and
                                                                               health outcomes from the Veterans who reside in the jurisdiction.
                                                                               The Department is directed to submit this report to the Commit-
                                                                               tees on Appropriations of both Houses of Congress and to the Gov-
                                                                               ernment Accountability Office (GAO) no later than 180 days after
                                                                               enactment of this Act. GAO is directed to review and analyze the
                                                                               Department’s cost estimates and analysis and report to the Com-
                                                                               mittees on Appropriations of both Houses of Congress whether the
                                                                               Department’s estimates and the evaluations are comprehensive, ac-
                                                                               curate, and credible.
                                                                                  Audit of Hiring Practices for VA positions in the Pacific.—The
                                                                               Committee directs GAO to report to the Committees on Appropria-




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                                                                               tions of both Houses of Congress on VA’s efforts over the last 10




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                                                                               years to fill vacancies/positions with duty stations in the U.S. Pa-
                                                                               cific Insular Areas, to evaluate the use of current hiring authori-
                                                                               ties, and to provide recommendations on additional authorities that
                                                                               may be needed to recruit and retain qualified candidates to serve
                                                                               Veterans in these areas.
                                                                                  Vet Center Services.—The Committee strongly encourages VA to
                                                                               provide at least one full-time VA Readjustment Counseling Thera-
                                                                               pist in each state or U.S. territory that does not have a Vet Center
                                                                               located within its jurisdiction within 180 days of enactment of this
                                                                               Act to ensure parity of services for all Veterans receiving care
                                                                               through VA. Such staff should be provided the necessary support,
                                                                               space, equipment, and funds to facilitate travel to other areas with-
                                                                               in such jurisdiction where Veterans reside on a regular basis. The
                                                                               Committee urges VA to ensure Veterans in these areas are notified
                                                                               that a VA Readjustment Counseling Therapist is available to pro-
                                                                               vide services to them and their families. Furthermore, no later
                                                                               than one year after the date this report is filed, the Committee di-
                                                                               rects VA to provide a report to the Committees on Appropriations
                                                                               of both Houses of Congress on the services and outreach conducted
                                                                               by VA in such areas, an evaluation of such activities, and an as-
                                                                               sessment of the need to establish a Vet Center in such areas that
                                                                               should include input from Veterans residing in these areas. If VA
                                                                               determines there is no need to establish a Vet Center in a par-
                                                                               ticular jurisdiction, VA is directed to include in the report its plans
                                                                               to continue serving Veterans and their families in such areas.
                                                                                  Dialysis Services.—The Committee understands that VA has a
                                                                               long history of providing dialysis services through community di-
                                                                               alysis providers under the Nationwide Dialysis Services contracts
                                                                               when VA is unable to directly provide such care. The Committee
                                                                               expects VA will ensure that care is not disrupted or diminished for
                                                                               the Veterans who receive treatment through experienced providers
                                                                               under the Nationwide Dialysis Services contracts.
                                                                                  Reducing Airborne Infections.—The Committee recognizes air-
                                                                               borne bacteria and viruses remain a significant source of
                                                                               healthcare-associated infections at health care facilities. Although
                                                                               High Efficiency Particulate Air (HEPA) filters are widely used to
                                                                               filter the air, airborne transmission still accounts for a significant
                                                                               portion of health care-associated infections. Within 120 days of en-
                                                                               actment of this Act, the Committee directs VA to initiate a pilot
                                                                               program of new commercial, off-the-shelf technology that has the
                                                                               potential to capture and destroy airborne contaminants.
                                                                                  Creutzfeldt-Jakob Disease Monitoring.—Veterans and their de-
                                                                               pendents who resided at United States military installations in
                                                                               Germany, Belgium, and the Netherlands for six months or more
                                                                               from 1980 through 1990, and Veterans and their dependents who
                                                                               resided at United States military installations in Greece, Turkey,
                                                                               Spain, Portugal, and Italy for six months or more from 1980
                                                                               through 1996 are barred from donating blood due to their potential
                                                                               exposure during their military service to beef that was infected
                                                                               with bovine spongiform encephalopathy, resulting in possible infec-
                                                                               tion 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 Vet-




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                                                                               erans to determine the percentage of Veterans from the above ref-




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                                                                               erenced subgroup that have more frequent or unexplained symp-
                                                                               toms associated with CJD compared to the civilian population. This
                                                                               body of data could be helpful in clarifying the extent and specifics
                                                                               of the medical issues suffered by Veterans from exposure to CJD.
                                                                                  Tobacco Use Among Veterans.—A 2018 government study found
                                                                               almost 30 percent of Veterans are smokers. Interventions for Vet-
                                                                               erans 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 en-
                                                                               courages VA to continue promoting cessation and evidence-based
                                                                               tobacco interventions for our Veterans.
                                                                                  Veterans Exposed to Open Burn Pits and Airborne Hazards.—In
                                                                               order to provide full and effective medical care, it is essential for
                                                                               the Department to better understand the impacts that exposure
                                                                               during military service has had on the health of Veterans. There-
                                                                               fore, the Committee continues to support language included in
                                                                               House Report 116–63 on burn pits and includes $7,500,000 to carry
                                                                               out responsibilities and activities of the Airborne Hazards and
                                                                               Burn Pits Center of Excellence.
                                                                                  Burn Pits Center of Excellence Expansion.—The Committee is
                                                                               concerned that research and clinical trials are urgently needed to
                                                                               develop effective treatments for Veterans exposed to toxic environ-
                                                                               mental hazards. The VA Research Advisory Committee has rec-
                                                                               ommended the establishment of Centers of Excellence to facilitate
                                                                               the development and availability of new treatments in clinical set-
                                                                               tings. Cost effective models for rapid development of new treat-
                                                                               ments for Gulf War Illness using computational models, research
                                                                               funding through the Department of Defense’s Congressionally Di-
                                                                               rected Medical Research Programs, and clinical experts in environ-
                                                                               mental medicine have been proven effective in partnership with VA
                                                                               medical centers. The Committee directs the Secretary to establish
                                                                               a Center of Excellence focused on toxic environmental exposures in-
                                                                               cluding investigations of gender-based differences in disease and
                                                                               treatment to leverage research funding through partnerships.
                                                                                  Jason Simcakoski Memorial and PROMISE Act Implementa-
                                                                               tion.—The Committee supports robust funding to support the con-
                                                                               tinued implementation of the Jason Simcakoski Memorial and
                                                                               Promise Act, which passed as Title IX of the Comprehensive Addic-
                                                                               tion and Recovery Act of 2016 (P.L. 114–198), including updating
                                                                               therapy and pain management guidelines, strengthening provider
                                                                               education and training, and improving patient advocacy.
                                                                                  Health Videos for Veterans.—Hospitals and physicians’ offices
                                                                               around the country are currently utilizing health videos in their
                                                                               lobbies, waiting rooms, and exam rooms to supplement and rein-
                                                                               force the medical care, advice, and instruction physicians are pro-
                                                                               viding. The Committee notes that educational resources, such as
                                                                               these could result in cost savings and quality of life improvement
                                                                               for Veterans. The Committee encourages VHA to continue its ef-
                                                                               forts in providing informative video content to veterans in VA facil-
                                                                               ity lobbies with a focus on health education and suicide prevention.
                                                                                  Reliance on Community Care Versus VA Medical Center and
                                                                               Clinic Expansion and Development.—The Committee recommends
                                                                               the Department develop a system to accurately compare the costs




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                                                                               of providing care in the community, as envisioned by the MISSION




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                                                                               Act, to the costs of providing care within the VA healthcare system.
                                                                               The data captured by the system should be gathered and made
                                                                               available in a manner that allows the accurate comparison of the
                                                                               cost of various services to help inform future decisions regarding
                                                                               the most cost-effective delivery of healthcare services to Veterans.
                                                                               The Committee looks forward to working with the Department to
                                                                               develop a medical care cost data collection system.
                                                                                  Residency Programs.—The MISSION Act expanded VA’s support
                                                                               of residency programs. However, the Committee understands some
                                                                               states have not taken advantage of this expansion. The Committee
                                                                               requests a status report, within 180 days of enactment of this Act,
                                                                               on the implementation of the MISSION Act’s residency program ex-
                                                                               pansion and its efforts to encourage states, especially rural and
                                                                               non-contiguous states, to utilize the program.
                                                                                  Domiciliary Care for Veterans with Dementia.—The Committee is
                                                                               aware that Veterans with dementia who require less than Skilled
                                                                               Nursing Care are not eligible for VA domiciliary care under current
                                                                               regulations, and that the population of Veterans with dementia is
                                                                               expected to grow. The Committee appreciates the Secretary’s will-
                                                                               ingness to consider appropriate revisions of regulations and directs
                                                                               VA to provide a report to the Committee no later than 90 days
                                                                               after enactment of this Act on the Department’s plan to address
                                                                               care for such Veterans.
                                                                                  Antimicrobial Resistance.—The Committee recognizes the grow-
                                                                               ing threat from bacterial resistant infections and is interested in
                                                                               novel antibiotic remedies. The Secretary is directed to submit a re-
                                                                               port to the Committees on Appropriations of both Houses of Con-
                                                                               gress on the Department’s approach to preventing and managing
                                                                               antibiotic-resistant infections and its activities regarding novel an-
                                                                               tibiotic medicines and treatments no later than 120 days after en-
                                                                               actment of this Act.
                                                                                  Sleep Apnea.—Noting the Office of Inspector General report ti-
                                                                               tled, ‘‘Opportunities Missed to Contain Spending on Sleep Apnea
                                                                               Devices and Improve Veterans Outcomes’’ (VAOIG–19–00021–41),
                                                                               the Committee directs VHA to expeditiously implement the Inspec-
                                                                               tor General’s recommendations, especially that the Under Sec-
                                                                               retary coordinate with appropriate offices whether purchasing and
                                                                               distributing sleep apnea devices is in the best interest of the De-
                                                                               partment and Veterans and develop and provide clear guidance be-
                                                                               fore any changes to current purchasing processes. Should the rec-
                                                                               ommendations not be implemented within 30 days of enactment of
                                                                               this Act, VHA should provide a report on its proposed timeline and
                                                                               milestones to the Committees on Appropriations of both Houses of
                                                                               Congress.
                                                                                  Prostate and Breast Cancer Molecular Diagnostics.—Prostate
                                                                               cancer and breast cancer are among the most frequently detected
                                                                               cancers among male and female Veterans, respectively. Unfortu-
                                                                               nately, early detection and diagnosis is not yet an exact science.
                                                                               Advancements in molecular diagnostics have been proven to im-
                                                                               prove clinical outcomes and reduce economic spend. The Committee
                                                                               includes $5,000,000 for VA to accelerate the adoption of prostate
                                                                               and breast cancer molecular diagnostics.
                                                                                  Rapid Testing and Self-Testing.—The Committee notes the grow-
                                                                               ing body of public health literature touting the impact of rapid




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                                                                               point-of-care testing and rapid self-testing for Human Immuno-




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                                                                               deficiency Virus and Hepatitis C Virus. VA is encouraged to inte-
                                                                               grate innovative testing options to ensure screening services en-
                                                                               gage hard-to-reach Veterans, including affected Veterans that do
                                                                               not regularly receive care at VA facilities.
                                                                                  Innovative Technological Solutions for Injured Veterans.—The
                                                                               Department is encouraged to ensure injured Veterans are inte-
                                                                               grated into product development teams so that adaptive tech-
                                                                               nologies are effectively tailored to meet the needs of these Vet-
                                                                               erans.
                                                                                  Musical, Occupational, and Rehabilitative Therapies.—The Com-
                                                                               mittee encourages VA to utilize musical, occupational, and rehabili-
                                                                               tative therapeutic care at VA facilities. Early results of these types
                                                                               of care indicate improved patient outcomes and reduced overall
                                                                               Veteran rehabilitation time. The Committee directs VA to provide
                                                                               a report within 120 days of enactment of this Act on the types of
                                                                               new technologies and therapy models developed for the purpose of
                                                                               adaptive therapeutic care offered at VA facilities and a plan for
                                                                               how to expand this type of care across all VA facilities.
                                                                                  Child Care Demonstration Program.—The Committee strongly
                                                                               supports efforts by VA to provide access to free child care for Vet-
                                                                               erans receiving treatment at VISNs, as authorized by the Care-
                                                                               givers and Veterans Omnibus Health Services Act of 2010 (P.L.
                                                                               111–163), and encourages the Department to furnish qualified vet-
                                                                               erans with assistance for childcare. Past VA surveys have found
                                                                               that one in ten Veterans have had to either cancel or reschedule
                                                                               a VA healthcare appointment due to a lack of childcare. A 2015 re-
                                                                               port to Congress from VA found the program achieved a reasonable
                                                                               cost per hour as the number of children cared for increased. The
                                                                               Committee therefore expects VA to adhere to the authorized fund-
                                                                               ing level given for the operation of the Veterans Access to Child
                                                                               Care demonstration program so that Veterans may continue unin-
                                                                               terrupted access to medical appointments.
                                                                                  Epilepsy Centers of Excellence.—The Committee includes
                                                                               $10,000,000 toward maintaining and expanding the Epilepsy Cen-
                                                                               ters of Excellence within VA. The Committee directs the Depart-
                                                                               ment to provide an update on the status of these Centers to the
                                                                               Committee no later than 30 days after enactment of this Act.
                                                                                  Oral Contraceptives.—Given the findings of the 2019 study, ‘‘Fi-
                                                                               nancial Implications of 12-Month Dispensing of Oral Contraceptive
                                                                               Pills in the Veterans Affairs Health Care System’’, published in
                                                                               JAMA Internal Medicine, VA is strongly encouraged to investigate
                                                                               the feasibility of offering patients the option to receive a full year’s
                                                                               supply of birth control at one time and ensuring Veterans are noti-
                                                                               fied of that option.
                                                                                  Intimate Partner Violence Program.—The Committee continues
                                                                               to support VA’s efforts to expand its Intimate Partner Violence Pro-
                                                                               gram to all sites within the next three years and directs VA to ex-
                                                                               peditiously implement this program. The Committee supports VA’s
                                                                               plans to screen all Veterans for Intimate Partner Violence and di-
                                                                               rects the Department provide the appropriate resources to do so.
                                                                               Therefore, the Committee requests a report with 90 days of enact-
                                                                               ment of this Act on VA’s implementation timeline to deploy this
                                                                               program across the healthcare system.
                                                                                  Adaptive Sports.—The Committee includes $27,048,000 for Na-




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                                                                               tional Veterans Sports Programs, which is $2,500,000 above the re-




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                                                                               quest, including $16,000,000 for adaptive sports programs. Vet-
                                                                               erans have shown marked improvements in mental and physical
                                                                               health from participating in adaptive sports and recreational ther-
                                                                               apy and Veterans have expressed the need for these activities to
                                                                               be included in the healthcare services VA offers. The Committee
                                                                               also recognizes that adaptive sports and recreational therapy pro-
                                                                               vide a low-cost alternative to other healthcare services that produce
                                                                               similar health outcomes. The Department is directed to make rec-
                                                                               reational and lifelong sports, such as open-ocean swimming, surf-
                                                                               ing, outrigger canoeing, hunting, and fishing eligible for grants.
                                                                                  Equine Therapy.—The Committee recommends the Department
                                                                               use no less than $1,500,000 of funding provided for the adaptive
                                                                               sports program for equine therapy. Moreover, the Department
                                                                               should utilize funding to conduct a comprehensive program evalua-
                                                                               tion to ensure the continued effectiveness of equine therapy in ad-
                                                                               dressing the mental health needs of Veterans that participate in
                                                                               these programs, including through the systematic assessment and
                                                                               tracking of mental health issues and symptoms, and the measure-
                                                                               ment of key outcomes, such as functional improvement in Veterans’
                                                                               different life domains.
                                                                                  Medical Waste.—The Committee is interested in the costs and
                                                                               benefits of on-site medical waste treatment systems and requests
                                                                               a report that discusses VA’s current approach to handling regu-
                                                                               lated medical waste, the costs of installing and operating onsite
                                                                               systems, the incidence of their use within the VA system, and in-
                                                                               cludes a comparison with other medical waste treatment options,
                                                                               and makes potential recommendations.
                                                                                  Access to Safe and Effective Therapies for Difficult to Treat De-
                                                                               pression.—The Committee is aware of a recent international con-
                                                                               sensus statement acknowledging the challenges individuals, includ-
                                                                               ing many Veterans, face when their depression does not respond to
                                                                               common therapies. The Committee supports Veterans’ access to al-
                                                                               ternative, innovative treatments for difficult to treat depression, in-
                                                                               cluding FDA-approved medical devices, and encourages VHA to en-
                                                                               sure access to safe and effective treatment options.
                                                                                  Vet Centers.—The Committee recognizes the importance of Vet
                                                                               Centers and the role they play in helping Veterans readjust to ci-
                                                                               vilian life. The Committee encourages VA to work with local stake-
                                                                               holders to increase access to the readjustment counseling services
                                                                               provided by Vet Centers, Mobile Vet Centers, Outstations, and
                                                                               Community Access Points, and directs the Department to increase
                                                                               outreach to Veterans so they are aware of these counseling centers
                                                                               and services.
                                                                                  Coronary Heart Disease.—In House Report 115–673, the Com-
                                                                               mittee directed the Department to conduct a study on non-invasive
                                                                               diagnostic technologies for cardiac heart disease. The Committee is
                                                                               aware the Department has prepared a preliminary report, but that
                                                                               it includes technologies not yet approved by FDA. In order to pro-
                                                                               vide the greatest benefit to the greatest number of Veterans, the
                                                                               Committee directs the Department to provide an updated report to
                                                                               the Committees on Appropriations of both Houses of Congress on
                                                                               FDA-approved technologies within 180 days of enactment of this
                                                                               Act.
                                                                                  Joint Appointment Arrangements.—The Committee encourages




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                                                                               the Department to pursue joint appointment arrangements be-




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                                                                               tween VA medical staff and other outside VA organizations, includ-
                                                                               ing industry, universities, and academic affiliates, and further en-
                                                                               courages the Department to ensure that VA medical staff are
                                                                               granted sufficient time to engage in clinical research.
                                                                                  Assisted Reproductive Services.—The Committee is extremely dis-
                                                                               pleased that VA does not have its own policy on providing assisted
                                                                               reproductive services to Veterans who have sustained serious or se-
                                                                               vere illness and/or injury while on active duty that led to the loss
                                                                               of their natural procreative ability, and instead relies on outdated
                                                                               and discriminatory guidance from DOD. VA should develop its own
                                                                               guidance on providing assisted reproductive services that does not
                                                                               discriminate against women who cannot carry their own child to
                                                                               term, and therefore should include gestational surrogacy benefits.
                                                                               The Committee directs the Department, in consultation with DOD,
                                                                               to review how VA can adopt a policy that removes barriers to ges-
                                                                               tational surrogacy as a covered fertility benefit for eligible Vet-
                                                                               erans. Within 90 days of enactment of this Act, VA shall provide
                                                                               a recommendation to the Committees on Appropriations of both
                                                                               Houses of Congress on how VA can fix this gap in coverage so that
                                                                               gestational surrogacy is included as an assisted reproductive serv-
                                                                               ice available to wounded Veterans with impacted fertility due to
                                                                               combat.
                                                                                  Fertility Treatment.—The Committee directs the Secretary to
                                                                               submit to the Committees on Appropriations of both Houses of
                                                                               Congress a report on the fertility treatment and counseling fur-
                                                                               nished by VA during the year preceding the submittal of the report
                                                                               no later than 120 days after enactment of this Act. The report
                                                                               should include the following: (1) the number of Veterans who re-
                                                                               ceived fertility treatment or counseling furnished by the Depart-
                                                                               ment of Veterans Affairs, disaggregated by era of military service
                                                                               of such Veterans; (2) the number of spouses, partners, and gesta-
                                                                               tional surrogates of Veterans who received fertility treatment or
                                                                               counseling furnished by the Department; (3) the cost to the Depart-
                                                                               ment of furnishing fertility treatment and counseling,
                                                                               disaggregated by cost of services and administration; (4) the aver-
                                                                               age cost to the Department per recipient of fertility treatment and
                                                                               counseling; (5) in cases in which the Department furnished fertility
                                                                               treatment through the use of assisted reproductive technology, the
                                                                               average number of cycles per person furnished, disaggregated by
                                                                               type of treatment; and (6) a description of how fertility treatment
                                                                               and counseling services of the Department are coordinated with
                                                                               similar services of the Department of Defense.
                                                                                  Infertility Services.—The Committee recognizes the Department’s
                                                                               effort to allow eligible Veterans to receive in vitro fertilization
                                                                               (IVF) treatment or other forms of assisted reproductive technology
                                                                               services. However, the Committee is concerned that VA infertility
                                                                               services are denied to a growing number of women Veterans due
                                                                               to marital status. The Committee strongly encourages VHA to not
                                                                               disqualify unmarried women Veterans from IVF treatment due to
                                                                               marital status and to submit a report within 180 days of enactment
                                                                               of this Act on the number of unmarried women Veterans denied of
                                                                               these services since the inception of the program, disaggregated by
                                                                               state of residence, race, and age.
                                                                                  Affiliation Agreements with Accredited International Medical




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                                                                               Schools.—The Committee is concerned VA may not be fully uti-




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                                                                               lizing the available physician pipeline to develop its current and fu-
                                                                               ture physician workforce. The Committee understands there are
                                                                               many highly qualified United States citizens from international
                                                                               medical schools, but VA does not currently permit international
                                                                               medical students to participate in VA clinical training programs,
                                                                               regardless of whether the students are United States citizens. The
                                                                               Committee urges the Office of Academic Affiliation to consider the
                                                                               feasibility of allowing new affiliation agreements with accredited
                                                                               international medical schools that would permit students who are
                                                                               United States citizens from these medical schools to perform their
                                                                               clinical training requirements at VA facilities as space and faculty
                                                                               allow. OAA should submit a report to the Committee within 180
                                                                               days of the enactment of this Act that describes the findings of its
                                                                               review.
                                                                                                                  MEDICAL COMMUNITY CARE

                                                                               Fiscal year 2020 enacted level ...........................................................   $15,279,799,000
                                                                               Fiscal year 2021 enacted level ...........................................................    17,131,179,000
                                                                               Fiscal year 2021 budget year request ...............................................           1,380,800,000
                                                                               Committee 2021 budget year recommendation ................................                     1,380,800,000
                                                                               Fiscal year 2022 advance appropriation request .............................                  20,148,244,000
                                                                               Committee 2022 advance appropriation recommendation ..............                            20,148,244,000
                                                                               Comparison with:
                                                                                   Fiscal year 2021 enacted level ...................................................        +3,017,065,000
                                                                                   Fiscal year 2022 advance budget request .................................                          –––
                                                                                  The Medical Community Care account was created in the Surface
                                                                               Transportation and Veterans Health Care Choice Improvement Act
                                                                               of 2015 (P.L. 114–41). Per the MISSION Act of 2018, all commu-
                                                                               nity care programs are consolidated into one community care pro-
                                                                               gram. For fiscal year 2022, the bill provides $20,148,244,000, of
                                                                               which $2,000,000,000 is available until September 30, 2023.
                                                                                  The Committee provides an additional $1,380,800,000 to be avail-
                                                                               able for fiscal year 2021 as requested in the budget request to read-
                                                                               just the actuarial estimates for medical community care.
                                                                                  In addition, the Coronavirus Preparedness and Response Supple-
                                                                               mental Appropriations Act (P.L. 116–123) included $30,000,000 and
                                                                               the Coronavirus Aid, Relief, and Economic Security Act (CARES
                                                                               Act) (P.L. 116–136) included $2,100,000,000 for the Medical Com-
                                                                               munity Care account to prevent, prepare for, and respond to
                                                                               coronavirus, including related impacts on health care delivery.
                                                                                  Third-Party Payments and Reimbursements.—The Committee
                                                                               continues to be concerned about the timeliness of reimbursements
                                                                               by VA to private healthcare/third-party providers and believes VA
                                                                               has created an inefficient process that must be reformed. As VA
                                                                               continues the MISSION Act implementation, the Committee be-
                                                                               lieves VA must prioritize efficient and prompt payment to commu-
                                                                               nity providers to ensure timely access to quality care. Delays in
                                                                               processing of such payments undermine the ability to recruit and
                                                                               retain private healthcare providers to service our Nation’s Vet-
                                                                               erans. House Report 116–63 required comprehensive reports on a
                                                                               quarterly basis detailing the amount owed to outside providers for
                                                                               every state, and the Committee has yet to receive a single report.
                                                                               The Committee reiterates the direction to provide quarterly reports
                                                                               to include outstanding payments over six months old and the cor-
                                                                               rective actions being implemented to address these outstanding




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                                                                               balances as well as average time for repayment. Furthermore, the




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                                                                               initial report should include a comprehensive plan to prevent this
                                                                               issue from reoccurring in the future. The Committee directs the
                                                                               Department to provide its first report no later than 7 days of the
                                                                               filing of this report.
                                                                                  Choice Program Third-Party Payments and Reimbursements.—
                                                                               The Committee recognizes the massive undertaking it took to de-
                                                                               velop and implement the Veterans Choice Program and the difficul-
                                                                               ties that patients and providers have experienced in dealing with
                                                                               the third-party administrators of the program. The Committee con-
                                                                               tinues to await the fiscal year 2019 report, as requested in House
                                                                               Report 115–673 and House Report 116–63, on the effectiveness of
                                                                               the programs with third-party administrators, and directs the De-
                                                                               partment to provide the report no later than 7 days of the filing
                                                                               of this report.
                                                                                  Transportation Assistance.—The Committee is concerned with
                                                                               the lack of access to transportation for Veterans who have chal-
                                                                               lenges 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 imple-
                                                                               ment the Veterans Community Care Program, transportation to
                                                                               medical care and services in the community will be an even bigger
                                                                               obstacle for Veterans in the future. The Committee urges VA to
                                                                               prioritize transportation assistance for Veterans who live in both
                                                                               rural and urban areas, and encourages VA to work with state, re-
                                                                               gional and local groups, local VSOs, and nonprofits on transpor-
                                                                               tation assistance programs and provide direct transportation serv-
                                                                               ices for Veterans who have limited access to transportation net-
                                                                               works.
                                                                                  Long-Term Care for Veterans with TBI.—The Committee notes
                                                                               the increasing prevalence of deployment-related traumatic brain in-
                                                                               juries. This increase continues to demonstrate the longstanding
                                                                               need for providing adequate long-term specialty care for Veterans
                                                                               suffering from severe TBIs. The Committee further notes the GAO
                                                                               report entitled, ‘‘Veterans Use of Long-Term Care is Increasing,
                                                                               and VA Faces Challenges in Meeting the Demand’’ (GAO–20–284),
                                                                               which reached a similar conclusion. The Committee remains con-
                                                                               cerned about the Department’s inability to articulate a plan to pro-
                                                                               vide such residential care to Veterans with severe TBIs. The Com-
                                                                               mittee directs VA to 1) ensure an adequate number of long-term
                                                                               residential care facilities are available; 2) provide a report within
                                                                               120 days of enactment of this Act detailing VA’s plan for how it
                                                                               will provide long-term residential care for these Veterans if VA
                                                                               does not have its own facilities to do so; and 3) make publicly avail-
                                                                               able and easily accessible on VA’s website a list of long-term care
                                                                               community providers that are within VA’s community care net-
                                                                               works.
                                                                                  Long-Term Care for Veterans in Rural Areas.—The Committee
                                                                               notes the conclusion in GAO’s report entitled, ‘‘Veterans Use of
                                                                               Long-Term Care is Increasing, and VA Faces Challenges in Meet-
                                                                               ing the Demand’’ (GAO–20–284), that the Department faces chal-
                                                                               lenges providing long-term residential care to Veterans in rural
                                                                               areas, and directs the Department to submit a report on the cur-




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                                                                               rent and projected need for residential care for Veterans with se-




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                                                                               vere TBI, especially in rural areas, no later than 180 days after en-
                                                                               actment of this Act.
                                                                                                          MEDICAL SUPPORT AND COMPLIANCE

                                                                               Fiscal year 2020 enacted level ...........................................................   $7,337,956,000
                                                                               Fiscal year 2021 enacted level ...........................................................    7,914,191,000
                                                                               Fiscal year 2021 budget year request ...............................................            300,000,000
                                                                               Committee 2021 budget year recommendation ................................                      279,880,000
                                                                               Fiscal year 2022 advance appropriation request .............................                  8,403,117,000
                                                                               Committee 2022 advance appropriation recommendation ..............                            8,403,117,000
                                                                               Comparison with:
                                                                                   Fiscal year 2021 enacted level ...................................................        +488,926,000
                                                                                   Fiscal year 2022 advance budget request .................................                        –––
                                                                                  The Medical Support and Compliance appropriation funds the ex-
                                                                               penses of management and administration of the Department’s
                                                                               healthcare system, including financial management, public health
                                                                               and environmental hazard, quality and performance management,
                                                                               medical inspection, human research oversight, training programs
                                                                               and continuing education, security, volunteer operations, and
                                                                               human resources.
                                                                                  The bill provides $8,403,117,000 in advance fiscal year 2022
                                                                               funding. The Committee has included bill language to make avail-
                                                                               able through September 30, 2023, $150,000,000 of the Medical Sup-
                                                                               port and Compliance appropriation for fiscal year 2022.
                                                                                  The Committee provides an additional $279,880,000 to be avail-
                                                                               able for fiscal year 2021, of which $124,000,000 is provided for lo-
                                                                               gistics system enhancements, as requested in the budget and
                                                                               $155,880,000 is provided for additional medical center administra-
                                                                               tive support, which is equal to the budget request. The Committee
                                                                               does not include additional funding for the high reliability organi-
                                                                               zation initiative requested in the budget.
                                                                                  In addition, the Coronavirus Aid, Relief, and Economic Security
                                                                               Act (CARES Act) (P.L. 116–136) included $100,000,000 for the
                                                                               Medical Support and Compliance account to prevent, prepare for,
                                                                               and respond to coronavirus, including related impacts on health
                                                                               care delivery.
                                                                                  Report on Wage Surveys for Housekeeping Aides of Department of
                                                                               Veterans Affairs.—The Committee directs the Secretary of Veterans
                                                                               Affairs, in consultation with the Secretary of Defense and the Di-
                                                                               rector of the Office of Personnel Management (OPM), to submit to
                                                                               the Committees on Appropriations of both Houses of Congress, no
                                                                               later than 90 days after enactment of this Act, a report on the
                                                                               methodology used to conduct wage surveys for the Federal Wage
                                                                               System pursuant to section 5343 of title 5, United States Code, for
                                                                               Housekeeping Aides of the Department of Veterans Affairs. The re-
                                                                               port should include: (1) whether the methodology used to conduct
                                                                               wage surveys for the Federal Wage System considers differences in
                                                                               sanitation requirements with respect to Housekeeping Aides em-
                                                                               ployed in healthcare settings versus non-healthcare settings; (2)
                                                                               whether the Secretary of VA requires Housekeeping Aides to re-
                                                                               ceive specialized training to satisfy requirements relating to infec-
                                                                               tion control at medical facilities of VA, and whether the method-
                                                                               ology used to conduct such wage surveys considers the effectiveness
                                                                               of the relevant wage schedule in accounting for such requirements;
                                                                               and (3) how the methodology of the Department of Defense used to




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                                                                               establish wage schedules and rates of pay pursuant to section 5343




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                                                                               of title 5, United States Code, for Housekeeping Aides compares to
                                                                               the methodology OPM used to establish rates of pay under the
                                                                               General Schedule pursuant to section 5332 of such title for posi-
                                                                               tions involving substantially equal work.
                                                                                  Clinical Trials Administrative Support.—The Committee includes
                                                                               $3,000,000 to provide additional administrative support to VA clini-
                                                                               cians conducting clinical trials so that VA is better able to assist
                                                                               veterans navigate the clinical trials process.
                                                                                                                        MEDICAL FACILITIES

                                                                               Fiscal year 2020 enacted level ...........................................................   $6,141,880,000
                                                                               Fiscal year 2021 enacted level ...........................................................    6,433,265,000
                                                                               Fiscal year 2021 budget year request ...............................................            150,000,000
                                                                               Committee 2021 budget year recommendation ................................                      170,120,000
                                                                               Fiscal year 2022 advance appropriation request .............................                  6,734,680,000
                                                                               Committee 2022 advance appropriation recommendation ..............                            6,734,680,000
                                                                               Comparison with:
                                                                                   Fiscal year 2021 enacted level ...................................................        +301,415,000
                                                                                   Fiscal year 2022 advance budget request .................................                        –––
                                                                                 The Medical Facilities appropriation provides funds for the oper-
                                                                               ation 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 re-
                                                                               pair, and property disposition and acquisition.
                                                                                 The bill provides $6,734,680,000 in advance fiscal year 2022
                                                                               funding. The Committee has included bill language to make avail-
                                                                               able through September 30, 2023, $250,000,000 of the advance
                                                                               Medical Facilities appropriation for fiscal year 2022.
                                                                                 The Committee provides an additional $170,120,000 to be avail-
                                                                               able for fiscal year 2021, of which $150,000,000 is provided for non-
                                                                               recurring maintenance (NRM) projects to support the electronic
                                                                               health record modernization as requested in the budget, and
                                                                               $20,120,000 is provided for NRM projects to repurpose vacant and
                                                                               underutilized space for mental health needs and to expand wom-
                                                                               en’s access to gender-specific care. Within the additional NRM
                                                                               funding for mental health, the Committee directs VA to prioritize
                                                                               construction to increase the number of beds available for overnight
                                                                               mental health treatment for Veterans. VA is directed to provide an
                                                                               expenditure plan detailing how the additional funding will meet
                                                                               both of these initiatives no later than 90 days after enactment of
                                                                               this Act.
                                                                                 In addition, the Coronavirus Aid, Relief, and Economic Security
                                                                               Act (CARES Act) (P.L. 116–136) included $606,000,000 for the
                                                                               Medical Facilities account to prevent, prepare for, and respond to
                                                                               coronavirus, including related impacts on health care delivery.
                                                                                 Spend Plan.—The Committee expects VA to provide, no later
                                                                               than 30 days after enactment of this Act, an expenditure plan de-
                                                                               tailing the planned use of the funds provided. The Committee un-
                                                                               derstands that some of the projects planned for fiscal year 2021
                                                                               may not be ready within that timeframe, requiring an adjustment
                                                                               to the spending plan. The Committee requests a quarterly update
                                                                               of the plan if the funding for any single project changes by more
                                                                               than $3,000,000 during that time period.
                                                                                 Community-Based Outpatient Clinic in Bakersfield, California.—




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                                                                               The Committee remains extremely concerned about the delays to a




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                                                                               new community-based outpatient clinic in Bakersfield, California
                                                                               that was authorized by Congress over 10 years ago. Accordingly,
                                                                               the Committee directs the Secretary to expeditiously execute the
                                                                               timeline, including awarding a lease no later than August 31, 2020,
                                                                               and beginning sitework shortly before the end of calendar year
                                                                               2020. Furthermore, the Committee directs the Secretary to provide
                                                                               monthly update reports to the Committees on Appropriations of
                                                                               both Houses of Congress, which should include an assessment on
                                                                               maintaining the November 20, 2019 timeline and detailed reasons
                                                                               for any deviations from that timeline, until the new clinic in Ba-
                                                                               kersfield is activated.
                                                                                  Facility Transformations.—The Committee directs the Depart-
                                                                               ment to provide a report no later than 90 days after enactment of
                                                                               this Act on specific measures it takes to track and prioritize both
                                                                               the physical and cultural transformation within VA medical facili-
                                                                               ties to better serve women Veterans. The Committee is concerned
                                                                               that VA has failed to keep up with a growing population of women
                                                                               Veterans who deserve equitable access to medical care. When one
                                                                               in four women Veterans report having experienced unwanted sex-
                                                                               ual attention while serving, it is concerning that the very system
                                                                               intended to address their trauma is failing to foster a safe environ-
                                                                               ment for them. The Committee directs the Department to prioritize
                                                                               funding for medical facilities to accommodate women Veterans.
                                                                                  Use of Smart Technologies.—The Committee continues to encour-
                                                                               age VA to pursue a demonstration program regarding the use of in-
                                                                               novative devices, systems, networks, and sensors to improve, en-
                                                                               hance, and modernize methods to operate and manage VA facility
                                                                               energy, infrastructure, mechanical and waste management sys-
                                                                               tems, emergency response, perimeter security and access, and traf-
                                                                               fic control systems that could be adapted for use by a variety of VA
                                                                               facilities.
                                                                                  Medical Facilities Realignment.—The Committee remains con-
                                                                               cerned that VA medical care realignments are being approached in
                                                                               an ad hoc manner by each individual VISN rather than on a com-
                                                                               prehensive basis by VA Central Office. Moreover, such an approach
                                                                               may lead to inequitable and inefficient distribution of medical re-
                                                                               sources throughout the Nation. Before VA makes any decision to
                                                                               relocate, close, or diminish services at an existing facility, or pro-
                                                                               ceeds 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 trans-
                                                                               parent process that engages all parties from the onset and is con-
                                                                               sistent 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 Commit-
                                                                               tees, and that report has not been received. The Department is
                                                                               again directed to comply with the request for the report and mean-
                                                                               while 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 strat-
                                                                               egy that includes a detailed description of realignment plans within
                                                                               each VISN; (2) an explanation of the process by which those plans




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                                                                               were developed and coordinated within each VISN; (3) a cost




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                                                                               versus benefit analysis of each realignment, including the cost of
                                                                               replacing VHA services with contract or other outsourced services;
                                                                               (4) an analysis of how any realignment will impact tribal, rural,
                                                                               and highly rural Veteran healthcare within each VISN; and (5) an
                                                                               analysis of how any realignment will impact access to, enrollment
                                                                               in, and the capacity of VA PTSD and Residential Rehabilitation
                                                                               Treatment Program services within each VISN and nationally.
                                                                                  Research Facilities Infrastructure Report.—The Committee is
                                                                               pleased it received the Phase II Research Facilities Infrastructure
                                                                               report requested in House Report 116–63 and directs the Depart-
                                                                               ment to provide a report within 120 days of enactment on its plan
                                                                               to correct the infrastructure deficiencies identified in the report.
                                                                                  High Enrollee Growth.—The Committee is concerned that Vet-
                                                                               erans health care systems with high enrollee growth, such as those
                                                                               in Texas and Florida, are not receiving sufficient priority for much-
                                                                               needed capital improvements. The Committee urges VA to
                                                                               prioritize infrastructure projects in high enrollee growth systems to
                                                                               ensure that VA infrastructure is prepared for the growing number
                                                                               of Veterans needing care. Therefore, the Secretary is directed to
                                                                               submit to the Committees on Appropriations of both Houses of
                                                                               Congress a report on the infrastructure needs of high enrollee
                                                                               growth Veterans health care systems and a plan by fiscal year to
                                                                               address those needs no later than 90 days after the enactment of
                                                                               this Act.
                                                                                  VA Facility Security.—The Committee continues to encourage the
                                                                               Department to improve the security of its campuses and facilities
                                                                               to ensure the safety of Veterans, visitors, and employees and sup-
                                                                               ports the Department’s investments in this area. The Committee
                                                                               recommends that security and technology upgrades take a holistic
                                                                               approach and deploy proven technologies. The Committee directs
                                                                               the Department to provide an update to the ‘‘Response to Security
                                                                               Threats’’ report as requested in Division J of the Explanatory
                                                                               Statement accompanying P.L. 114–113, and provided to the Com-
                                                                               mittees on Appropriations of both Houses of Congress on May 13,
                                                                               2016, to include current VA security policy, an assessment of secu-
                                                                               rity at VA facilities, initiatives to improve the safety of patients
                                                                               and staff in VA facilities, and how intelligent policing solutions
                                                                               could enhance security in VA facilities, within 120 days of enact-
                                                                               ment of this Act.
                                                                                  Facility Donations.—The Committee recognizes the vital role of
                                                                               VA’s health care facilities in serving the unique needs of Veterans.
                                                                               The Committee also recognizes the potential for innovative partner-
                                                                               ships with community stakeholders, particularly when it comes to
                                                                               community donations of well-maintained medical facilities that can
                                                                               be converted into VA health care facilities. Therefore, the Com-
                                                                               mittee encourages VA to continue working with community stake-
                                                                               holders that have expressed an interest in medical facility dona-
                                                                               tions.
                                                                                  Research Lease.—The Committee supports the long-standing af-
                                                                               filiation between the Truman VA and the University of Missouri
                                                                               and encourages the Department and the House Veterans Affairs
                                                                               Committee to expeditiously resolve outstanding budget scoring




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                                                                               issues.




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                                                                                 Landscaping at VA Facilities.—The Committee encourages the
                                                                               Department to include landscaping and the planting of trees in its
                                                                               designs for new or replacement facilities, as practicable.
                                                                                 Major Medical Lease.—The Veterans Access, Choice, and Ac-
                                                                               countability Act of 2014 (VACAA) (P.L. 113–146) authorized VA to
                                                                               enter into various major medical leases across the nation. This in-
                                                                               cludes the Advanced Leeward Outpatient Healthcare Access
                                                                               (ALOHA) Project that will open a 66,000 square foot leased facility
                                                                               to better serve Veterans in Hawaii and those enrolled in the VA
                                                                               Pacific Islands Health Care System. The Committee notes that
                                                                               multiple lease projects were included in the fiscal year 2014 budget
                                                                               request and authorized in VACAA, but certain facilities have been
                                                                               significantly delayed and still have not opened. Therefore, the Com-
                                                                               mittee directs the Secretary to provide a report to the Committees
                                                                               on Appropriations and Veterans Affairs of both Houses of Congress
                                                                               no later than 60 days after enactment of this Act detailing: (1) the
                                                                               timeline and explanation of events that have delayed any major
                                                                               medical lease authorized under VACAA that has not been awarded,
                                                                               including the ALOHA Project, (2) planned award dates and other
                                                                               major actions that need to occur for these projects to proceed, in-
                                                                               cluding an estimated timeline for completing each action, and (3)
                                                                               a summary of any concerns raised by other Federal agencies assist-
                                                                               ing the VA with awarding these projects.
                                                                                                         MEDICAL AND PROSTHETIC RESEARCH

                                                                               Fiscal year 2020 enacted level ...........................................................   $800,000,000
                                                                               Fiscal year 2021 budget request .......................................................       787,000,000
                                                                               Committee recommendation in the bill ............................................             840,000,000
                                                                               Comparison with:
                                                                                   Fiscal year 2020 enacted level ...................................................        +40,000,000
                                                                                   Fiscal year 2021 budget request ................................................          +53,000,000
                                                                                  This appropriation provides for medical, rehabilitative, and
                                                                               health services research. The bill provides $840,000,000 available
                                                                               through September 30, 2022. The Committee recognizes the impor-
                                                                               tance of the research conducted by VA for Veterans’ quality of life
                                                                               and health and provides $53,000,000 above the request and
                                                                               $40,000,000 above fiscal year 2020 for these activities.
                                                                                  Medical research, which helps ensure the best medical and hos-
                                                                               pital services for Veterans, is an important aspect of the Depart-
                                                                               ment’s programs. The prosthetic research program is also essential
                                                                               in the development and testing of prosthetic, orthopedic, and sen-
                                                                               sory 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, re-
                                                                               imbursements from DOD, grants from the National Institutes of
                                                                               Health, private proprietary sources, and voluntary organizations,
                                                                               provide support for the Department’s researchers. Estimated fiscal
                                                                               year 2021 research resources in addition to those provided in the
                                                                               research account are $1,263,950,000.
                                                                                  National Center for Post-traumatic Stress Disorder Research.—
                                                                               The National Center for PTSD sets the VA agenda for research and
                                                                               education on PTSD, with seven research divisions located at VA fa-




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                                                                               cilities. The Center also conducts education and training and co-




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                                                                               ordinates the VA National PTSD Brain Bank. The Committee rec-
                                                                               ognizes the importance of the VA National Center for PTSD in pro-
                                                                               moting better prevention, diagnoses, and treatment of PTSD, and
                                                                               applauds the VA National PTSD Brain Bank on its development of
                                                                               the largest data set of PTSD. The Committee provides $40,000,000
                                                                               for the Center in fiscal year 2021, which includes $10,000,000 for
                                                                               the coordination of the VA National PTSD Brain Bank. The Com-
                                                                               mittee encourages the National Center to use funding for the Brain
                                                                               Bank to accelerate the discovery of novel therapeutic targets for
                                                                               the treatment of PTSD utilizing post-mortem brain datasets, cell-
                                                                               based and other models for target identification and validation.
                                                                                  Dystonia.—The Committee notes the connection between trau-
                                                                               matic brain injury and the onset of dystonia. The Committee fur-
                                                                               ther notes recent events that have led more servicemembers to be
                                                                               diagnosed with TBI and continues to urge VA to pursue collabora-
                                                                               tion with stakeholders to advance critical research on dystonia.
                                                                                  Cannabis Research.—The Committee requests an update on the
                                                                               status of the study on cannabis research, as described in House Re-
                                                                               port 116–63.
                                                                                  Access to Clinical Trials.—The Committee applauds the ongoing
                                                                               collaborative efforts between VA medical centers and NCI-des-
                                                                               ignated 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 treat-
                                                                               ments. The Committee directs VA to expand these efforts, espe-
                                                                               cially as they relate to providing Veterans access to
                                                                               groundbreaking new treatments through clinical trials led by aca-
                                                                               demic 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 Accel-
                                                                               erate 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, how-
                                                                               ever, that this partnership does not include certain States with
                                                                               large Veteran populations. To address this need, the Committee di-
                                                                               rects VA to provide up to $5,000,000 to support the establishment
                                                                               of partnerships between VA hospitals and NCI-designated facilities
                                                                               that allow for Veterans to access cancer clinical trials at VA health
                                                                               centers. Additionally, the Committee directs the Department to
                                                                               provide a report within 120 days of enactment of this Act detailing
                                                                               best practices of VA facilities in providing access to clinical trials
                                                                               to Veterans.
                                                                                  PFAS Contamination.—The Committee directs VA to continue
                                                                               collaborating with the Defense Department’s Per- and
                                                                               Polyfluoroalkyl Substances (PFAS) Task Force, academia, and
                                                                               other health institutions to monitor research activities, results, and
                                                                               publications on the health effects from PFAS.
                                                                                  Exposure to Herbicide-Related Toxins.—Veterans have frequently
                                                                               expressed long-held concerns that toxic exposure during their mili-
                                                                               tary service is related to adverse health conditions. The Committee
                                                                               is committed to understanding the residual impacts of Agent Or-
                                                                               ange/Dioxin and other herbicide-related toxic exposures among Vet-




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                                                                               erans who served in Vietnam, Thailand, Guam, the Northern Mar-




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                                                                               iana 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 Vet-
                                                                               erans to determine the percentage of Veterans from the above ref-
                                                                               erenced subgroup that have more frequent or unexplained diseases
                                                                               compared to the civilian population. This body of data could be
                                                                               helpful in clarifying the extent and specifics of the medical issues
                                                                               suffered by Veterans from exposure to herbicides.
                                                                                  Research on Toxic Exposures.—The Committee encourages the
                                                                               Department to continue and expand its research on the effects of
                                                                               and treatments for Veterans exposed to toxins, such as Agent Or-
                                                                               ange, burn pits, PFOS/PFOA, radiation, and asbestos, during the
                                                                               course of their active duty service.
                                                                                  Prosthetics Research.—Women have different physical require-
                                                                               ments for prosthetics compared to men. The Committee directs VA
                                                                               to prioritize medical and prosthetic research to adequately address
                                                                               prosthetics meant for women.
                                                                                  Neural-Enabled Prosthetics.—The Committee understands the
                                                                               uniqueness of limb trauma injuries sustained by servicemembers in
                                                                               combat. Traumatic injury or neurological diseases can also signifi-
                                                                               cantly alter or impair the lifestyle of the individual and their care-
                                                                               givers. The Committee encourages VA to fund research that will
                                                                               design and develop technology to offset the effects of limb amputa-
                                                                               tion, orthopedic injury and disease, neuropathic pain, and other
                                                                               neurodegenerative diseases. Thus, the Committee includes
                                                                               $25,000,000 for VA to prioritize and fund collaborative research
                                                                               with a coalition of universities aimed at accelerating functional re-
                                                                               covery and rehabilitation of sensorimotor function through engi-
                                                                               neering of wirelessly activated implantable biomedical technologies
                                                                               capable of focal stimulation inside nerves and that is personalized
                                                                               to the needs of the patient.
                                                                                  Gulf War Illness Studies.—Even as Congress, the Administra-
                                                                               tion, and the public await the results of the National Academies of
                                                                               Sciences report on Gulf War illness, the Committee recommends
                                                                               the Department continue to conduct epidemiological studies regard-
                                                                               ing the prevalence of Gulf War Illness, morbidity, and mortality in
                                                                               Persian Gulf War Veterans and the development of effective treat-
                                                                               ments, preventions, and cures. The Committee encourages the find-
                                                                               ings of all research conducted by or for the Executive Branch relat-
                                                                               ing to the health consequences of military service in the Persian
                                                                               Gulf theater of operations during the Persian Gulf War be made
                                                                               publicly available as soon as possible. The Committee also urges
                                                                               the Department to publish disease-specific mortality data related
                                                                               specifically to Persian Gulf War Veterans. The Committee remains
                                                                               concerned by VA’s ever-evolving terminology for the signature ad-
                                                                               verse 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 Vet-
                                                                               erans 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




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                                                                               ongoing Gulf War Illness treatment research direction. Further-




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                                                                               more, the Committee once again encourages VA to strengthen the
                                                                               training of primary, specialty, and mental healthcare providers on
                                                                               the Gulf War Illness case definitions recommended by IOM.
                                                                                  Public Access to Scientific Data.—The Committee commends the
                                                                               Department on issuing its Policy and Implementation Plan for Pub-
                                                                               lic 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 imple-
                                                                               mentation of the plan and requires an update on progress made be
                                                                               included in its fiscal year 2022 budget request.
                                                                                  NICoE Collaboration.—The Committee recognizes the high-qual-
                                                                               ity mental health care and neurological research being conducted
                                                                               at Walter Reed National Intrepid Center of Excellence (NICoE).
                                                                               The Committee directs VA to strengthen its collaboration with
                                                                               NICoE so VA researchers and health professionals can learn from
                                                                               NICoE’s important work and contribution to the health community.
                                                                               Furthermore, as Veterans and servicemembers continue to face
                                                                               higher rates of brain trauma than civilians, impacting brain func-
                                                                               tion, it is imperative agencies collaborate to study neurological con-
                                                                               ditions such as PTSD, bipolar, schizophrenia, depression, suicide
                                                                               and substance use disorders. The Committee requests a report
                                                                               within 120 days of enactment of this Act on existing collaborative
                                                                               efforts between VA and NICoE and the expansion of such collabo-
                                                                               rations. The report should also include a summary of current VA
                                                                               neurological research objectives, data from VA summarizing the
                                                                               presence among Veterans of the conditions referenced above as a
                                                                               percentage of VA annual inpatient hospitalizations, the percentage
                                                                               of the annual VA research budget over the last five years dedicated
                                                                               to researching those conditions, list any new or ongoing trials for
                                                                               pharmacological treatments underway to address such conditions,
                                                                               and provide the total 2019 expenditure by VA for medications to
                                                                               treat these patients and its percentage of total pharmacological ex-
                                                                               penditures.
                                                                                  Hyperbaric Therapy.—The Committee supports continued study
                                                                               of the use of hyperbaric oxygen treatments for Veterans suffering
                                                                               from post-traumatic stress disorder.
                                                                                  Advanced Platform Technology (APT) Center.—The Committee is
                                                                               pleased about the progress being made to provide our nation’s Vet-
                                                                               erans with new assistive and restorative technologies that address
                                                                               sensory, motor, or cognitive deficits, as well as limb loss. The APT
                                                                               Center has effectively utilized a partnership model to leverage local
                                                                               and national research expertise to make progress in diverse areas
                                                                               including artificial lung development, wound healing, and neurally-
                                                                               connected sensory prosthesis. The Committee supports the APT
                                                                               Center’s efforts.
                                                                                  Regional Research Networks.—The Committee supports the De-
                                                                               partment’s efforts in continuing to establish regional research net-
                                                                               works in areas where existing small VA research programs align
                                                                               with a co-located academic partners. The Committee directs the
                                                                               Department to provide a report within 120 days of enactment of
                                                                               this Act on how it is achieving the following objectives and/or steps
                                                                               the Department can take to better meet these objectives: (1) sup-
                                                                               porting the development and/or enhancement of infrastructure and
                                                                               human resources required to address clinical and translational re-




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                                                                               search needs in small under-resourced VA jurisdictions, (2) fos-




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                                                                               tering and sustaining collaboration and coordination of clinical and
                                                                               translational activities within and across VA jurisdictions, and (3)
                                                                               addressing the broad spectrum of health challenges and concerns
                                                                               faced by populations served by small underfunded VA research pro-
                                                                               grams.
                                                                                  Spinal Cord Research.—The Committee encourages the Depart-
                                                                               ment to work with outside organizations on spinal cord injury
                                                                               translational research to improve the quality of life of impaired and
                                                                               disabled Veterans, and provides $10,000,000 to do so.
                                                                                  Rare Cancer and Molecular Diagnostics.—The Committee be-
                                                                               lieves that every veteran with cancer deserves the highest quality
                                                                               and most medically advanced diagnosis and treatment available.
                                                                               Those who have served are uniquely exposed to numerous hazards,
                                                                               which are associated with an increased risk of cancer during and
                                                                               following their service. Over 60 forms of cancer disproportionately
                                                                               impact those who have served in the military, and the majority of
                                                                               those cancers are rare, defined as having fewer than six new cases
                                                                               per 100,000 Americans per year. Molecular diagnostics, including
                                                                               microarray and next generation sequencing, performed at the first
                                                                               occurrence of cancer can provide medical providers and patients
                                                                               with vital information regarding the specific tumor type and its
                                                                               drivers, which can lead to the most accurate precision medicine for
                                                                               cancer patients. Therefore, the Committee recommends that VHA
                                                                               provide molecular diagnostics at the time of diagnosis as well as at
                                                                               the time of tumor recurrence for all cancer patients. Further, the
                                                                               Committee requires the Department to issue a report no later than
                                                                               60 days after the enactment of this Act describing the how it is
                                                                               using specific types of molecular diagnostics, such as microarray,
                                                                               whole exome, and RNA-Seq in research and development, as well
                                                                               as outlining how it is collaborating with the external research com-
                                                                               munity to advance understanding and research in rare cancer
                                                                               treatments for Veterans.
                                                                                  Severe Depression and Suicide Prevention.—The Committee rec-
                                                                               ognizes the important work by the Departments of Veterans Af-
                                                                               fairs, Defense, and Health and Human Services, including the Na-
                                                                               tional Institutes of Mental Health, to study treatments for severe
                                                                               depression and options to prevent suicides and encourages contin-
                                                                               ued collaboration on these studies, including the potential use of
                                                                               scopolamine in treating depression, for the benefit of Veterans,
                                                                               servicemembers, and the general public.
                                                                                  Psychological Health and TBI.—The Committee supports the De-
                                                                               partment’s research efforts focusing on psychological health and
                                                                               traumatic brain injury.
                                                                                                       MEDICAL CARE COLLECTIONS FUND
                                                                                  The Department of Veterans Affairs Medical Care Collections
                                                                               Fund (MCCF) was established by the Balanced Budget Act of 1997
                                                                               (P.L. 105–33). The Department deposits first-party and pharmacy
                                                                               co-payments, third-party insurance payments and enhanced-use
                                                                               collections, long-term care co-payments, Compensated Work Ther-
                                                                               apy Program collections, Compensation and Pension Living Ex-
                                                                               penses 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




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                                                                               fiscal year 2021 is $4,403,000,000.




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                                                                                 MCCF Third-Party Billing.—The Committee remains concerned
                                                                               over potential discrepancies in VA’s billing and collection processes.
                                                                               Procedures to provide for correct billing and prompt collection must
                                                                               be improved at VA. Therefore, the Department is required to sub-
                                                                               mit to the Committees on Appropriations of both Houses of Con-
                                                                               gress a quarterly report identifying the amount of third-party
                                                                               health billings that were owed to VA in the previous quarter and
                                                                               the amount collected. The first quarter report also should include
                                                                               billings and collections data for fiscal years 2017 through 2020. The
                                                                               report should include billings and collections data for both large
                                                                               claims (greater than $1,000) and small claims (equal to or less than
                                                                               $1,000). In addition, the first quarter report should also include
                                                                               current efforts underway to increase VA’s efficiency, accuracy, and
                                                                               collection process, as well as what management practices are in
                                                                               place to provide proper oversight of the billing process, including
                                                                               appeals, so as to eliminate unnecessary and duplicative functions.
                                                                               The initial report also should include the status and results of the
                                                                               pilot program that emphasized the use of automated solutions and
                                                                               the use of private sector revenue cycle management techniques and
                                                                               small balance recovery and appeal processes as directed in the
                                                                               Joint Explanatory Statement accompanying the Consolidated Ap-
                                                                               propriations Act, 2016 (P.L. 114–113).
                                                                                                        NATIONAL CEMETERY ADMINISTRATION
                                                                               Appropriation, fiscal year 2020 .........................................................     $329,000,000
                                                                               Budget request, fiscal year 2021 .......................................................       360,000,000
                                                                               Recommended in the bill ...................................................................    349,000,000
                                                                               Bill compared with:
                                                                                    Appropriation, fiscal year 2020 ..................................................       +20,000,000
                                                                                    Budget request, fiscal year 2021 ................................................        ¥11,000,000
                                                                                  The National Cemetery Administration (NCA) was established in
                                                                               accordance with the National Cemeteries Act of 1973 (P.L. 93–43).
                                                                               It has a fourfold mission: to provide for the interment of, in any
                                                                               national cemetery with available grave space, the remains of eligi-
                                                                               ble deceased servicemembers and discharged Veterans, together
                                                                               with their spouses and certain dependents, and to permanently
                                                                               maintain their graves; to provide headstones for, and to mark
                                                                               graves of eligible persons in National, State and Tribal, and private
                                                                               cemeteries; to administer the grant program for aid to States and
                                                                               tribal governments in establishing, expanding, or improving State
                                                                               and tribal government Veterans’ cemeteries; and to administer the
                                                                               Presidential Memorial Certificate Program. This appropriation will
                                                                               provide for the operation and maintenance of 156 national ceme-
                                                                               teries, including 11 cemeteries being transferred from the Depart-
                                                                               ment of the Army, and 33 other cemeterial installations.
                                                                                  The Committee provides these funds to meet increasing workload
                                                                               and burial expansions. NCA should prioritize maintaining the cur-
                                                                               rent level of services at existing cemeteries and activating new
                                                                               cemeteries to increase burial access.
                                                                                  The bill includes language making ten percent of the total avail-
                                                                               able until September 30, 2022.
                                                                                  Prisoners of War Headstones.—The Committee is extremely dis-
                                                                               turbed by the presence of headstones of prisoners of war in Fort
                                                                               Sam Houston National Cemetery and Fort Douglas National Ceme-




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                                                                               tery that feature swastikas and inscriptions honoring Adolf Hitler,




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                                                                               and is pleased that the Department has agreed to take immediate
                                                                               steps to swiftly replace these headstones with ones that do not fea-
                                                                               ture Nazi insignia or inscriptions glorifying the Nazi regime. While
                                                                               the Committee understands that the Department has initiated a
                                                                               consultation process under the National Historic Preservation Act,
                                                                               the Committee makes clear that this process should not unneces-
                                                                               sarily delay action on replacing these headstones. The Committee
                                                                               directs VA to provide its plan for the consultation process and the
                                                                               timeline for removal of these headstones to the Committees on Ap-
                                                                               propriations of both Houses of Congress within 30 days after this
                                                                               report is filed, and further requires monthly reports on the status
                                                                               of the process. Furthermore, the Committee understands that VA
                                                                               intends to add signage at relevant cemeteries providing historical
                                                                               context on the burial of prisoners of war in U.S. cemeteries, and
                                                                               emphasizes that the design and wording of such signage must be
                                                                               carefully crafted in order to allow this history to be studied without
                                                                               causing undue pain for those most affected by it. The Committee
                                                                               therefore directs VA to include details on its proposal to provide
                                                                               historical context for headstones of prisoners of war in its report
                                                                               to the Committees on Appropriations of both Houses of Congress.
                                                                                  Rural Cemetery Access.—The Committee continues to be con-
                                                                               cerned that NCA is not adequately serving the Nation’s Veterans
                                                                               in rural areas and that there are geographic pockets in the country
                                                                               which continue to go unserved. The Committee therefore directs
                                                                               VA to continue to pursue efforts to ensure that a burial option, in-
                                                                               cluding those utilizing public-private partnerships, within 75 miles
                                                                               of all Veteran homes is available and accessible.
                                                                                  County-run Veteran Cemeteries.—The Committee is committed to
                                                                               ensuring Veterans’ burial needs are met and that they can be bur-
                                                                               ied at a Veterans cemetery close to their home. The Committee en-
                                                                               courages the Department to explore ways to support county-run
                                                                               Veteran cemeteries to further meet the needs of Veterans seeking
                                                                               burial.
                                                                                  Burial of Unclaimed Veteran Remains.—The Committee recog-
                                                                               nizes the efforts of VA to improve the burial of unclaimed Veteran
                                                                               remains; however, the Committee remains concerned about the cur-
                                                                               rent state of unclaimed Veteran remains nationally. The Com-
                                                                               mittee directs VA to submit a report to the Committee on Appro-
                                                                               priations, no later than 120 days after enactment of this Act, pro-
                                                                               viding an update to the Report to Congress on Unclaimed Veterans’
                                                                               Remains required by Section 303 of the Jeff Miller and Richard
                                                                               Blumenthal Veterans Health Care and Benefits Improvement Act
                                                                               of 2016 (P.L. 114–315). The report shall incorporate input from the
                                                                               Veterans Health Administration, National Cemetery Administra-
                                                                               tion, and Veterans Benefit Administration, and include what VA
                                                                               has done to enhance its efforts to communicate with and educate
                                                                               stakeholders on applicable VA burial benefits and procedures, in-
                                                                               cluding metrics (e.g. who was contacted, how they were contacted,
                                                                               etc), obstacles to such communications, and an update on tracking
                                                                               and reporting mechanisms and implementation of a comprehensive,
                                                                               web-based Memorial Benefits Management System (MBMS).




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                                                                                                            DEPARTMENTAL ADMINISTRATION
                                                                                                                  GENERAL ADMINISTRATION

                                                                                                             (INCLUDING TRANSFER OF FUNDS)

                                                                               Fiscal year 2020 enacted level ...........................................................   $355,911,000
                                                                               Fiscal year 2021 budget request .......................................................       413,000,000
                                                                               Committee recommendation in the bill ............................................             355,911,000
                                                                               Comparison with:
                                                                                   Fiscal year 2020 enacted level ...................................................             –––
                                                                                   Fiscal year 2021 budget request ................................................         ¥57,089,000
                                                                                  The General Administration account provides funds for the Office
                                                                               of the Secretary, the General Counsel, six Assistant Secretaries,
                                                                               and two Department-level staff offices. The Committee has in-
                                                                               cluded bill language to make available through September 30,
                                                                               2022, up to ten percent of these funds and to permit the transfer
                                                                               of funds in this account to the General Operating Expenses, Vet-
                                                                               erans Benefits Administration account.
                                                                                  In addition, the Coronavirus Aid, Relief, and Economic Security
                                                                               Act (CARES Act) (P.L. 116–136) included $6,000,000 for the Gen-
                                                                               eral Administration account to prevent, prepare for, and respond to
                                                                               coronavirus.
                                                                                  VA Five Year Development Plan (VFYDP).—The Committee is
                                                                               very pleased that the Department has provided a VFYDP in its fis-
                                                                               cal year 2021 budget. The Committee looks forward to reviewing
                                                                               the VFYDP in future VA budget submissions.
                                                                                  Quarterly Financial Information Reports.—The bill includes an
                                                                               administrative provision that extends the requirement for submis-
                                                                               sion 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. Fur-
                                                                               ther, 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 administra-
                                                                               tive provision requiring written notification 15 days prior to organi-
                                                                               zational changes that result in the transfer of 25 or more full-time
                                                                               equivalent staff from one organizational unit of the Department to
                                                                               another.
                                                                                  Performance Bonuses.—The Committee believes it is important to
                                                                               know how VA is allocating its resources with regard to performance
                                                                               bonuses. Therefore, the Committee directs VA to submit a report,
                                                                               no later than 90 days after enactment of this Act, which provides
                                                                               the aggregate total of VA performance bonuses covering the five
                                                                               most recent fiscal years for which the data is available. The data
                                                                               should be divided between bonuses for Senior Executive Service
                                                                               (SES) staff and non-SES staff. The report should also include the
                                                                               percentage of SES and non-SES employees who received a bonus
                                                                               and the average dollar amount of the bonuses by grade covering
                                                                               the same time period. The report, however, should not include any
                                                                               personally identifiable information.
                                                                                  Financial Management Business Transformation (FMBT).—The
                                                                               Committee provides $221,319,000 for FMBT, of which $13,924,000




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                                                                               is provided in this account and $111,060,000 in the Information




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                                                                               Technology Systems account. An additional $96,335,000 will be pro-
                                                                               vided from the VA customer offices through the Franchise Fund
                                                                               and Supply Fund. The current legacy financial management sys-
                                                                               tem is over 30 years old, and its imminent failure presents signifi-
                                                                               cant 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 con-
                                                                               tinue this quarterly report throughout fiscal year 2021.
                                                                                  Office of Accountability and Whistleblower Protection.—The Com-
                                                                               mittee views the work of the Office of Accountability and Whistle-
                                                                               blower Protection (OAWP) as very important to the Veterans com-
                                                                               munity. OAWP was established to provide support and protection
                                                                               to VA employees who are whistleblowers. However, on October 24,
                                                                               2019, the Inspector General released a report noting failures in im-
                                                                               plementing critical aspects of the VA Accountability and Whistle-
                                                                               blower Protection Act of 2017. During a hearing before the Com-
                                                                               mittee on November 14, 2019, the Inspector General testified that
                                                                               the recommendations to address the concerns remained open and
                                                                               unimplemented. Further, the Committee understands that OAWP
                                                                               has not fully performed many of its core functions. For example,
                                                                               OAWP is required to investigate allegations by whistleblowers, in-
                                                                               cluding retaliation against whistleblowers, however, OAWP has a
                                                                               backlog of hundreds of investigations. Further, although required
                                                                               to recommend actions to the Secretary for actions based on these
                                                                               recommendations, only one recommendation had been made during
                                                                               the calendar year as of the Committee’s hearing. The Committee
                                                                               expects OAWP to complete fully, and in a timely manner, all its
                                                                               core functions. Further, the Committee expects OAWP to report to
                                                                               the Committees on Appropriations of both Houses of Congress
                                                                               within 60 days of enactment of this Act on its compliance with the
                                                                               2017 statute, including (1) a complete listing of all recommenda-
                                                                               tions for action to the Secretary; (2) a complete listing of all stays
                                                                               established during investigations during the previous two years; (3)
                                                                               progress toward eliminating the backlog of investigative cases; and
                                                                               (4) progress toward providing training to VA employees and super-
                                                                               visors.
                                                                                  Supporting Minority and Disadvantaged Contractors.—The Com-
                                                                               mittee recognizes the need to continue to meet its goals for con-
                                                                               tracting with minority, disadvantaged, and women-owned busi-
                                                                               nesses. Therefore, the Committee directs the Department to
                                                                               prioritize awarding contracts to contractors that consistently exe-
                                                                               cute approved small business subcontracting plans. The Committee
                                                                               further urges the Department to prioritize minority-owned and dis-
                                                                               advantaged contractors and subcontractors. The Committee re-
                                                                               quests a report, within 180 days of enactment of this Act and annu-
                                                                               ally thereafter, detailing the number of contractors that submitted
                                                                               a small business subcontracting plan during the fiscal year,
                                                                               disaggregated by race and ethnicity. This report should include an
                                                                               analysis detailing which contractors successfully implemented sub-
                                                                               contracting plans and recommendations on how the Department
                                                                               could better achieve its prime and subcontracting goals for small




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                                                                               businesses.




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                                                                                  Data on Women and Minority Veterans.—The Committee recog-
                                                                               nizes the lack of data specific to women and minority Veterans
                                                                               made available to Congress by the Department. The Committee
                                                                               recommends, when applicable, the Secretary display information in
                                                                               the annual report(s) submitted to Congress separately for women
                                                                               Veterans and minority Veterans.
                                                                                  Office of Enterprise Integration.—The Committee is supportive of
                                                                               the work carried out by the Office of Enterprise Integration and
                                                                               the Innovation Ecosystem for the continuous improvement of the
                                                                               Veteran experience by utilizing data analytics and data govern-
                                                                               ance, in addition to other capabilities. Even with this work there
                                                                               are still gaps in awareness and knowledge of services in which Vet-
                                                                               erans are eligible. With this in mind, the Committee encourages
                                                                               the Department to prioritize funding for the Office of Enterprise
                                                                               Integration to streamline innovation efforts and initiatives across
                                                                               VA and to transform Veterans’ experience by providing customized
                                                                               lifetime communication and outreach through various channels of
                                                                               communication to ensure Veterans receive eligible services and
                                                                               benefits from VA.
                                                                                  VA Chief Financial Officer.—The Committee directs the Sec-
                                                                               retary to develop and submit to the Committees on Appropriations
                                                                               of both Houses of Congress within 180 days of enactment of this
                                                                               Act, a plan to address the material weakness of the Department,
                                                                               as identified in the November 2019 OIG Report, ‘‘Audit of VA’s Fi-
                                                                               nancial Statements for Fiscal Years 2019 and 2018’’ (VAOIG–19–
                                                                               06453–12). The report should include timelines for fully addressing
                                                                               the repeated material weakness of the Department and rec-
                                                                               ommendations related to entity level controls, including the organi-
                                                                               zational structure of the office of the Chief Financial Officer of the
                                                                               Department, and the steps the Secretary plans to take to provide
                                                                               sufficient authority to the Chief Financial Officer to carry out the
                                                                               requirements of section 902 of title 31, United States Code.
                                                                                  Veterans First Contracting Program.—The Committee recognizes
                                                                               the tremendous value of the Veterans First Contracting Program in
                                                                               assisting in the expansion and growth of service-disabled Veteran
                                                                               and Veteran-owned small businesses. Therefore, the Committee en-
                                                                               courages VA to continue to expand and make mandatory the train-
                                                                               ing of contracting officers in the requirements of the Veterans First
                                                                               Contracting Program, with particular attention being paid to con-
                                                                               ducting the market research necessary to ensure that service-dis-
                                                                               abled Veteran and Veteran-owned small businesses are awarded
                                                                               VA contracts when appropriate.
                                                                                                                BOARD OF VETERANS APPEALS

                                                                               Appropriation, fiscal year 2020 .........................................................     $182,000,000
                                                                               Budget request, fiscal year 2021 .......................................................       198,000,000
                                                                               Recommended in the bill ...................................................................    198,000,000
                                                                               Bill compared with:
                                                                                    Appropriation, fiscal year 2020 ..................................................        +16,000,000
                                                                                    Budget request, fiscal year 2021 ................................................               –––
                                                                                 The bill makes ten percent of this funding available through Sep-
                                                                               tember 30, 2022.
                                                                                 The Board of Veterans’ Appeals (BVA) is the component of VA
                                                                               responsible for making final decisions on behalf of the Secretary for
                                                                               the thousands of claims for Veterans’ benefits that are presented




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                                                                               to BVA for appellate review. The majority of BVA’s workload de-




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                                                                               rives 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 re-
                                                                               gional office determination, he or she may appeal to BVA for a final
                                                                               agency decision. BVA adjudicates appeals covering all areas of Vet-
                                                                               erans’ benefits, but most of the workload concerns appeals for Vet-
                                                                               erans’ disability compensation or pension benefits. On February 19,
                                                                               2019, VA implemented the new legislative framework that modern-
                                                                               ized the claims and appeals process and provided greater choice to
                                                                               Veterans by providing them three options for claims and appeals:
                                                                               (1) a supplemental claim; (2) a higher-level review; or (3) a direct
                                                                               appeal to the Board of Veterans’ Appeals. BVA decided a record
                                                                               number of 95,000 cases in 2019, even as the number of individual
                                                                               issues decided within cases rose by more than 50,000 from the pre-
                                                                               vious year. Additionally, BVA has increased the number of hear-
                                                                               ings held by 38 percent over the previous year.
                                                                                  The bill also provides the $6,000,000 as proposed in the budget
                                                                               request to support phase three of the Appeals Modernization initia-
                                                                               tive. The initiative will convert the Board’s 1980s-era case control
                                                                               and locator system to a new, automated integrated community de-
                                                                               veloped suite that is used to process initial disability claims.
                                                                                  Off-site Teleconference Hearings.—The Committee recognizes the
                                                                               strides made by the Board to make it easier for Veterans to partici-
                                                                               pate in appeals hearings by allowing appellants to appear before
                                                                               the board via teleconference from locations other than VA facilities.
                                                                               The Committee encourages further implementation of teleconfer-
                                                                               ence hearings to allow Veterans to teleconference without sacri-
                                                                               ficing the security of Veterans’ personal information and without
                                                                               negatively impacting the outcome of their appeals. Appellants be-
                                                                               fore the Board should be permitted to teleconference from a loca-
                                                                               tion of their choosing and via a secure internet platform estab-
                                                                               lished and maintained by the Secretary that protects sensitive per-
                                                                               sonal information from a data breach. Further, the Committee di-
                                                                               rects the Department to submit a report to the Committee detailing
                                                                               the number of such teleconference hearings that have been sched-
                                                                               uled; the number of such teleconference hearings that were can-
                                                                               celled; and any statistical difference in outcomes between cases
                                                                               heard by teleconference at location of the appellant’s choosing and
                                                                               those held at the principal location of the Board or by picture and
                                                                               voice transmission at a VA facility.
                                                                                                          INFORMATION TECHNOLOGY SYSTEMS

                                                                                                             (INCLUDING TRANSFER OF FUNDS)

                                                                               Fiscal year 2020 enacted level ...........................................................   $4,371,615,000
                                                                               Fiscal year 2021 budget request .......................................................       4,912,000,000
                                                                               Committee recommendation in the bill ............................................             4,912,000,000
                                                                               Comparison with:
                                                                                   Fiscal year 2020 enacted level ...................................................        +540,385,000
                                                                                   Fiscal year 2021 budget request ................................................                 –––
                                                                                 The Information Technology (IT) Systems account supports IT
                                                                               services such as systems development and performance, operations
                                                                               and maintenance, information protection, and customer support.
                                                                               The program permits the effective and efficient delivery of Vet-




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                                                                               erans’ healthcare services and benefits programs.




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                                                                                 Within the account total, the Committee allocates in bill lan-
                                                                               guage $1,211,238,000 for pay and associated costs, $3,205,216,000
                                                                               for operations and maintenance, and $495,546,000 for development.
                                                                               The bill makes available three percent of pay and associated costs
                                                                               and five percent of operations and maintenance funds until Sep-
                                                                               tember 30, 2022. All development funds are available until Sep-
                                                                               tember 30, 2022.
                                                                                 In addition, the Coronavirus Aid, Relief, and Economic Security
                                                                               Act (CARES Act) (P.L. 116–136) included $2,150,000,000 for the In-
                                                                               formation Technology Systems account to prevent, prepare for, and
                                                                               respond to coronavirus, including related impacts on health care
                                                                               delivery.
                                                                                 The bill provides $111,060,000 to continue the Financial Manage-
                                                                               ment Business Transformation (in addition to the $13,924,000 pro-
                                                                               vided for FMBT in the General Administration account and the
                                                                               $96,335,000 provided out of the Franchise Fund and Supply Fund).
                                                                                 The Committee continues bill language permitting the transfer of
                                                                               funding among the three subaccounts upon approval of the Com-
                                                                               mittees 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 Depart-
                                                                               ment’s approved list of development projects, and all requested
                                                                               changes are subject to the reprogramming guidelines as outlined in
                                                                               the accompanying Act.
                                                                                                                           INFORMATION TECHNOLOGY DEVELOPMENT PROJECTS
                                                                                                                                                            (In thousands of dollars)

                                                                                                                                                                                                                                                       Committee
                                                                                                                                                          Project                                                                                   Recommendation

                                                                               Clinical Applications ......................................................................................................................................                 $95,763
                                                                               Health Management Platforms ......................................................................................................................                            63,827
                                                                               Benefits Systems ............................................................................................................................................                160,216
                                                                               Memorial Affairs .............................................................................................................................................                15,130
                                                                               Other IT Systems ............................................................................................................................................                114,550
                                                                               Cybersecurity ..................................................................................................................................................              11,380
                                                                               Information/Infrastructure Management ........................................................................................................                                34,680

                                                                                       Total All Development ...........................................................................................................................                    495,546

                                                                                 The Committee expects the Office of Information and Technology
                                                                               to continue to provide an IT expenditure report to the Committees
                                                                               on Appropriations of both Houses of Congress on a monthly basis.
                                                                               This report should include a comparison to the project costs in-
                                                                               cluded in the development funding chart above and provide an ex-
                                                                               planation for any differences in excess of $1,000,000.
                                                                                 Balancing VHA IT National Standards with Local, Short-term IT
                                                                               needs.—The Committee continues to encourage VA to vigilantly
                                                                               pursue its national IT goals and do all that is necessary to main-
                                                                               tain needed national standards in IT while at the same time meet-




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                                                                               ing short-term local IT needs of individual VA medical centers. VA




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                                                                               should solicit, review, and respond in a timely fashion to short-
                                                                               term IT requests from its medical centers and clinics. The Com-
                                                                               mittee supports keeping on track with beneficial national IT plans
                                                                               and standards, but the Committee also supports serving Veterans
                                                                               well on location in the short run. Long-term IT synchronization and
                                                                               short-term outstanding service should both be a part of the VA’s
                                                                               management strategy.
                                                                                  VA Forms Modernization.—The Committee supports the Depart-
                                                                               ment’s efforts to modernize its internal and external digital serv-
                                                                               ices consistent with the requirements of the 21st Century Inte-
                                                                               grated Digital Experience Act (IDEA) (P.L. 115–336). The Com-
                                                                               mittee believes the 21st Century IDEA will enable the Office of In-
                                                                               formation and Technology and Veterans Experience Office to im-
                                                                               prove digital service delivery for Veterans and internal workflows.
                                                                               Therefore, the Committee recommendation includes $5,000,000 to
                                                                               implement those 21st Century IDEA requirements that have the
                                                                               most significant impact on mission enhancement and that most ef-
                                                                               fectively modernize Veteran-facing services; specifically, the Com-
                                                                               mittee encourages the Department to modernize and secure its
                                                                               paper-based forms to ensure they are mobile responsive to help
                                                                               achieve cost savings and workflow efficiencies.
                                                                                  VA Medical and Prosthetic Research Program IT Infrastruc-
                                                                               ture.—The Committee directs VA to submit a report providing an
                                                                               analysis and assessment of information technology infrastructure
                                                                               needs as well as projects and funding that have been allocated and/
                                                                               or obligated to the Medical and Prosthetic Research Program to
                                                                               support VA Research Infrastructure over the last 5 years as com-
                                                                               pared to the overall VA IT expenditures or allocations. This report
                                                                               is due no later than 120 days after enactment of this Act.
                                                                                  Release of Names and Addresses.—To help make Veterans aware
                                                                               of the benefits and services they are entitled to, VA was given the
                                                                               authority to release the names and addresses of Veterans to non-
                                                                               profit organizations and Members of Congress. However, VA faces
                                                                               significant challenges in providing name and address information
                                                                               in a timely and useful manner due to reliance on legacy mainframe
                                                                               computer systems to store data, the labor-intensive process of pull-
                                                                               ing data from mainframe systems, reductions in IT staff, increasing
                                                                               numbers of Veterans, and fluctuating numbers of requests. The
                                                                               Committee encourages the Department to continue to make im-
                                                                               provements to its processes, and directs a report on the stability
                                                                               and security of VA’s existing mainframe computer systems and es-
                                                                               timated costs and benefits of upgrading them within 60 days of en-
                                                                               actment of this Act.
                                                                                  Zero-Trust Data Protection.—The Committee encourages VA to
                                                                               implement a zero-trust approach to access its information systems
                                                                               to increase its security posture and protect personally identifiable
                                                                               information, personal health information, and Electronic Health
                                                                               Records.
                                                                                  Digital Protection Pilot Program.—The Committee believes it is
                                                                               our country’s duty to protect our Veterans, the Department of Vet-
                                                                               erans Affairs, and Congressionally Chartered VSOs from both for-
                                                                               eign and domestic threats across the digital landscape attempting
                                                                               to steal money, pilfer personal information or peddle foreign influ-
                                                                               ence via social media or other online campaigns. The Committee




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                                                                               provides $5,000,000 for a pilot program that taps into commercially




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                                                                               available, proven, automated technology to launch a robust digital
                                                                               protection initiative.
                                                                                  Standard of Care.—The Committee is encouraged to see some VA
                                                                               medical facilities have or are pursuing a surgical workflow solution
                                                                               that provides access to surgical facilities, coordinates patient, staff
                                                                               and surgical resources, and adheres to surgical safety standards.
                                                                               The Committee encourages VHA to standardize these services
                                                                               across all VA medical surgical facilitates to enhance Veterans’ safe-
                                                                               ty and improve surgical care. Within 60 days of enactment of this
                                                                               Act, the Department is directed to provide a report to the Com-
                                                                               mittee on its standard of care for surgical services.
                                                                                  OPEN Government Data Act Implementation.—The Committee
                                                                               encourages the department to comply with the OPEN Government
                                                                               Data Act, Title II of the Foundations for Evidence-Based Policy-
                                                                               making Act (P.L. 115–435), which requires Federal agencies to de-
                                                                               fault, when possible, to making data (and metadata) public, to pub-
                                                                               lish that public data in a machine-readable format, and catalog it
                                                                               online.
                                                                                                  VETERANS ELECTRONIC HEALTH RECORD (EHR)

                                                                               Fiscal year 2020 enacted level ...........................................................   $1,500,000,000
                                                                               Fiscal year 2021 budget request .......................................................       2,627,000,000
                                                                               Committee recommendation in the bill ............................................             2,627,000,000
                                                                               Comparison with:
                                                                                   Fiscal year 2020 enacted level ...................................................       +1,127,000,000
                                                                                   Fiscal year 2021 budget request ................................................                  –––
                                                                                  The Veterans Electronic Health Record is a unified account de-
                                                                               signed to manage the effort to develop an interoperable electronic
                                                                               health record system that will access seamlessly the records of Vet-
                                                                               erans 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 effi-
                                                                               ciency savings.
                                                                                  Within the total funding, the bill provides $1,191,000,000 for the
                                                                               electronic health record contract, $255,000,000 for program man-
                                                                               agement, and $1,181,000,000 for infrastructure support. Funding is
                                                                               made available for three years due to the uncertainty of the timing
                                                                               of obligations for this substantial effort.
                                                                                  This account is intended to be the single source of funding within
                                                                               VA for the electronic health record effort. No authority is provided
                                                                               for funds from other VA accounts to be transferred into this ac-
                                                                               count nor for funds from this account to be transferred out to other
                                                                               accounts. Consistent with the effort to centralize financial manage-
                                                                               ment of the development of the electronic health record, the Com-
                                                                               mittee continues to direct the Department to manage this effort at
                                                                               the headquarters level in the Office of the Deputy Secretary.
                                                                                  The bill continues language requiring the Secretary to submit a
                                                                               quarterly report to the Committees on Appropriations of both
                                                                               Houses of Congress detailing obligations, expenditures, and deploy-
                                                                               ment strategy by facility. VA is directed to continue quarterly brief-
                                                                               ings on performance milestones, costs, and changes to implementa-
                                                                               tion and management plans, and to provide an accurate up-to-date
                                                                               deployment schedule each quarterly briefing. In addition, bill lan-
                                                                               guage is included requiring notice to and approval from the Com-




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                                                                               mittees on Appropriations of both Houses of Congress on any




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                                                                               changes to the deployment schedule. Should there be any deviation
                                                                               from the deployment schedule, the Committee directs the Depart-
                                                                               ment to formally submit in writing a proposed updated deployment
                                                                               schedule within 7 days of notification to the Committees of any po-
                                                                               tential change. The Committee repeats the fiscal year 2020 direc-
                                                                               tive for GAO to perform quarterly performance reviews of the VA
                                                                               electronic health record deployment. It is expected that this quar-
                                                                               terly reporting will provide the Committees and VA with timely in-
                                                                               formation to properly oversee this effort and address important
                                                                               issues.
                                                                                  The Committee is displeased with the lack of transparency and
                                                                               communication from the Office of Electronic Health Record Mod-
                                                                               ernization and expects all status updates, changes to scheduling,
                                                                               cost, or overall execution of the project be communicated promptly
                                                                               and directly to the Committees on Appropriations of both Houses
                                                                               of Congress.
                                                                                  Interoperability with the Private Sector.—The Committee is con-
                                                                               cerned about the compatibility and interoperability of the new
                                                                               EHRM system with community care providers and requires up-
                                                                               dates on plans and efforts on integration with community care pro-
                                                                               viders into the system to be submitted concurrently with the quar-
                                                                               terly updates on obligations, expenditure, and deployment strategy.
                                                                                  Customizing VA’s EHR.—The Committee is concerned that too
                                                                               much customization of VA’s EHR system presents risk to interoper-
                                                                               ability with DOD’s Military Health System (MHS) GENESIS im-
                                                                               plementation, and urges the Department to ensure all
                                                                               customization is fundamentally necessary to meet VA’s healthcare
                                                                               system needs and will not inhibit the interoperability of records be-
                                                                               tween both Departments.
                                                                                  End-User Adoption.—The Committee directs the Department to
                                                                               ensure lessons learned from DOD’s MHS GENESIS rollout are
                                                                               taken into consideration when deploying EHRM, including that end
                                                                               users receive sufficient training prior to the implementation.
                                                                                  Medical Records Portability.—The Committee supports Veterans
                                                                               having real-time, seamless, and portable access to all of their med-
                                                                               ical 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 prac-
                                                                               tices 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, seg-
                                                                               mentation 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 pro-
                                                                               vided by DOD.
                                                                                  Clinical Workflow Challenges.—The Committee is concerned
                                                                               about the significant amount of time clinicians spend on the cur-




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                                                                               rent electronic health record documentation in their treatment of




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                                                                               Veterans, as well as their inability to easily incorporate such infor-
                                                                               mation 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 pa-
                                                                               tient and fewer patients are seen in a given day, potentially result-
                                                                               ing in longer wait times for Veterans. VA’s ongoing efforts with
                                                                               EHRM and interoperability with DOD provide an opportunity to
                                                                               assess innovative technologies’ ability to solve this challenge. The
                                                                               EHRM technology must enhance clinicians’ efficacy so they can
                                                                               spend more time with patients. The Committee commends the De-
                                                                               partment’s efforts to involve clinicians at all stages of the EHRM
                                                                               rollout and encourages the continued collaboration with clinicians
                                                                               to ensure the most efficient workflow solutions are developed with
                                                                               clinician input.
                                                                                  Electronic Health Records Modernization.—The VA transition to
                                                                               a commercial-based EHR system continues to be challenging, and
                                                                               it is uncertain if this capability will be delivered across the enter-
                                                                               prise by 2027. The Committee directs VA to maintain frequent,
                                                                               timely, and transparent communication with Congress. Addition-
                                                                               ally, the Committee recommends VA leverage lessons learned from
                                                                               the DOD’s MHS GENESIS Electronic Health Record modernization
                                                                               effort to ensure that this capability is delivered to transitioning
                                                                               servicemembers, Veterans, and outside care providers as soon as
                                                                               possible.
                                                                                  Interagency Program Office (IPO).—The Committee understands
                                                                               that the Department, in coordination with DOD, continues its orga-
                                                                               nizational process for the IPO. The Committee is concerned that
                                                                               the Director of the IPO does not have a singular supervisory entity,
                                                                               as this structure could present challenges with decision making
                                                                               and accountability. Therefore, the Committee directs the Secretary
                                                                               to work with the Secretary of Defense to develop a reporting struc-
                                                                               ture that ensures the Director of the IPO has a single supervisory
                                                                               entity. The Committee notes that one of the determining factors
                                                                               setting the timeline for the deployment of the electronic health
                                                                               record is the need to improve informational technology and related
                                                                               infrastructure at VA facilities. Therefore, the Committee directs the
                                                                               Secretary to provide a report to the Committees on Appropriations
                                                                               of both Houses of Congress no later than December 1, 2020 on the
                                                                               total cost of the installation of all remaining information technology
                                                                               and related infrastructure required to complete the deployment of
                                                                               the electronic health record, and the timeline to complete this in-
                                                                               stallation.
                                                                                  Cybersecurity for Electronic Health Records.—Recognizing the on-
                                                                               going challenges of sharing data between MHS GENESIS and the
                                                                               Department’s EHRM initiative, the Committee requests a report
                                                                               within 90 days of enactment of this Act on what the Department
                                                                               is doing to protect Veterans’ sensitive information when imple-
                                                                               menting EHRM, and recommends the Department consider emerg-
                                                                               ing technologies, such as blockchain technology, if future require-
                                                                               ments drive a need to modify VA’s security architecture and tech-
                                                                               nical solutions.
                                                                                  Standards of Care and Safety.—The Committee is encouraged by
                                                                               the Department’s use of Integrated Clinical Communities (ICC) to
                                                                               establish standards of care and safety and requests a report within




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                                                                               90 days of enactment of this Act describing its plans to evaluate




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                                                                               and incorporate information technology applications that support
                                                                               ICC efforts.
                                                                                                               OFFICE OF INSPECTOR GENERAL

                                                                               Fiscal year 2020 enacted level ...........................................................     $210,000,000
                                                                               Fiscal year 2021 budget request .......................................................         228,000,000
                                                                               Committee recommendation in the bill ............................................               228,000,000
                                                                               Comparison with:
                                                                                   Fiscal year 2020 enacted level ...................................................          +18,000,000
                                                                                   Fiscal year 2021 budget request ................................................                  –––
                                                                                  The Office of Inspector General (OIG) was established by the In-
                                                                               spector General Act of 1978 and is responsible for the audit, inves-
                                                                               tigation, 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 bene-
                                                                               ficiaries, assist managers of Department programs to operate eco-
                                                                               nomically in accomplishing program goals, and to prevent and
                                                                               deter recurring and potential fraud, waste, and inefficiencies.
                                                                                  The bill makes up to ten percent of this funding available until
                                                                               September 30, 2022.
                                                                                  The Committee continues to request robust oversight of MIS-
                                                                               SION Act and EHRM implementation.
                                                                                  In addition, the Coronavirus Aid, Relief, and Economic Security
                                                                               Act (CARES Act) (P.L. 116–136) included $12,500,000 for the Office
                                                                               of Inspector General to prevent, prepare for, and respond to
                                                                               coronavirus, for oversight and audit of VA programs, activities,
                                                                               grants and projects funded in the CARES Act.
                                                                                                             CONSTRUCTION, MAJOR PROJECTS

                                                                               Appropriation, fiscal year 2020 .........................................................     $1,235,200,000
                                                                               Budget request, fiscal year 2021 .......................................................       1,373,000,000
                                                                               Recommended in the bill ...................................................................    1,373,000,000
                                                                               Bill compared with:
                                                                                    Appropriation, fiscal year 2020 ..................................................        +137,800,000
                                                                                    Budget request, fiscal year 2021 ................................................                –––
                                                                                  The Construction, Major Projects appropriation provides for con-
                                                                               structing, altering, extending, and improving any of the facilities
                                                                               under the jurisdiction or for the use of VA, including planning, ar-
                                                                               chitectural and engineering services, assessments, and site acquisi-
                                                                               tion where the estimated cost of a project is more than $20,000,000.
                                                                                  The Committee recommendation makes all but $392,362,000 of
                                                                               these funds available for a five-year period.
                                                                                  As required by language that is in permanent law, all major con-
                                                                               struction projects costing more than $100,000,000 must be man-
                                                                               aged by a non-VA government entity such as the Army Corps of
                                                                               Engineers. While the Committee no longer duplicates this lan-
                                                                               guage, the Committee intends to continue its oversight of the qual-
                                                                               ity 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.




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                                                                                                                                              CONSTRUCTION, MAJOR PROJECTS
                                                                                                                                                             (In thousands of dollars)

                                                                                                                                                           Project                                                                                      Amount

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

                                                                                 To enhance the Committee’s capacity to conduct oversight on
                                                                               VA’s facility construction efforts, several administrative provisions
                                                                               are continued in the bill: (1) No funding amount greater than
                                                                               $7,000,000 may be reprogrammed between construction projects
                                                                               unless approved by the Committees on Appropriations of both
                                                                               Houses of Congress; (2) any change to the scope of a construction
                                                                               project is not permitted without the approval of the Committees;
                                                                               and (3) VA must report any bid savings of $5,000,000 or more on
                                                                               projects as soon as they are identified.
                                                                                 Budget Justification Documents.—The Committee reminds the
                                                                               Department of the requirement in section 258 of Division A of the
                                                                               Continuing Appropriations and Military Construction, Veterans Af-
                                                                               fairs, and Related Agencies Appropriations Act, 2017, and Zika Re-
                                                                               sponse and Preparedness Act (P.L. 114–223) regarding specific ma-
                                                                               terials to be included in Major Construction budget justification
                                                                               documents for fiscal year 2017 and each fiscal year thereafter.
                                                                                 West Los Angeles VA Homeless Housing Development.—The Com-
                                                                               mittee recognizes the Department’s concrete progress in imple-
                                                                               menting the Draft Master Plan for the West Los Angeles VA Cam-
                                                                               pus and in fulfilling the commitments of settlement of the
                                                                               Valentini v. Shinseki litigation. The Committee encourages the De-
                                                                               partment and its Principal Developer to move quickly to deliver the
                                                                               more than 1,200 homeless housing units on campus, primarily
                                                                               through Enhanced Use Leases, and supports the Department’s ef-
                                                                               forts to address known deficiencies in utility infrastructure.
                                                                                 Flood and Disaster Mitigation Projects.—The Committee recog-
                                                                               nizes that deficiencies in flood and disaster mitigation infrastruc-
                                                                               ture pose challenges to Veterans receiving health care, particularly




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                                                                               of flooding or other infrastructure failures. The Committee further
                                                                               notes that state and local government infrastructure projects may
                                                                               enhance the resilience of VA medical facilities or the quality of life
                                                                               of Veterans eligible to receive care at these medical facilities. The
                                                                               Committee encourages VA to work collaboratively with state and
                                                                               local governments in support of infrastructure projects that will
                                                                               benefit VA facilities and the Veterans they serve.
                                                                                                             CONSTRUCTION, MINOR PROJECTS

                                                                               Appropriation, fiscal year 2020 .........................................................     $398,800,000
                                                                               Budget request, fiscal year 2021 .......................................................       400,000,000
                                                                               Recommended in the bill ...................................................................    400,000,000
                                                                               Bill compared with:
                                                                                    Appropriation, fiscal year 2020 ..................................................         +1,200,000
                                                                                    Budget request, fiscal year 2021 ................................................               –––
                                                                                  The Construction, Minor Projects appropriation provides for con-
                                                                               structing, altering, extending, and improving any of the facilities
                                                                               under the jurisdiction of, or for the use of, the Department, includ-
                                                                               ing 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 rec-
                                                                               ommendation makes these funds available for a five-year period.
                                                                                  The Committee encourages the Department to prioritize con-
                                                                               struction for expanding gender-specific care for women and mental
                                                                               health programs, in particular mental health Residential Rehabili-
                                                                               tation Treatment Program facilities and new inpatient Substance
                                                                               Use Disorder treatment facilities within the VA system. The Com-
                                                                               mittee also notes that inpatient Substance Use Disorder facilities
                                                                               are of particular importance for Veterans in rural communities.
                                                                                  The Committee notes that restorative and rehabilitative nursing
                                                                               care provided to elderly Veterans at VA community living centers
                                                                               is a critical part of the benefits and care promised to Veterans for
                                                                               their entire life after their service to our country. Unfortunately, in
                                                                               some Veterans health care systems there are not enough high-qual-
                                                                               ity contract nursing homes available to meet Veteran demand. The
                                                                               Committee urges VA to prioritize construction projects to address
                                                                               nursing care capacity issues across VA.
                                                                                  Construction of Housing for Rural Homeless Veterans.—The De-
                                                                               partment has made great efforts to find suitable housing for home-
                                                                               less Veterans and their families. The Committee encourages more
                                                                               non-traditional efforts to eliminate Veteran homelessness. For ex-
                                                                               ample, some cities and towns have started pilot programs using
                                                                               ‘‘Micro’’ or ‘‘Tiny Homes’’, or renovated shipping containers, to help
                                                                               deal with homelessness. The Committee encourages VA to continue
                                                                               its efforts to house homeless Veterans and their families and ex-
                                                                               plore the feasibility of providing ‘‘Tiny Homes’’ or renovated ship-
                                                                               ping containers as housing.
                                                                                  Expediting VA Projects.—The Committee urges VA to put in
                                                                               place an improved process to help guide infrastructure investments
                                                                               through energy performance contracts management, including En-
                                                                               ergy Savings Performance Contracts (ESPCs) and Utility Energy
                                                                               Savings Contracts (UESCs), in order to effectively and efficiently
                                                                               reduce energy costs and improve facilities for our Veterans. The
                                                                               Committee understands that challenges with the energy perform-




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                                                                               ance program include a separate round of required reviews by the




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                                                                               Office of Capital Asset Management (OCAM) that has bottlenecked
                                                                               new projects, as well as problems of capacity and bandwidth for
                                                                               oversight and new project starts. The Committee urges VA to
                                                                               streamline and find efficiencies in the approval of projects in order
                                                                               to continue to provide Veterans the care they need.
                                                                                   GRANTS FOR CONSTRUCTION OF STATE EXTENDED CARE FACILITIES

                                                                               Appropriation, fiscal year 2020 .........................................................      $90,000,000
                                                                               Budget request, fiscal year 2021 .......................................................        90,000,000
                                                                               Recommended in the bill ...................................................................     90,000,000
                                                                               Bill compared with:
                                                                                    Appropriation, fiscal year 2020 ..................................................               –––
                                                                                    Budget request, fiscal year 2021 ................................................                –––
                                                                                 This appropriation provides grants to assist States in con-
                                                                               structing State home facilities, for furnishing domiciliary or nurs-
                                                                               ing home care to Veterans, and to expand, remodel, or alter exist-
                                                                               ing buildings for furnishing domiciliary, nursing home, or hospital
                                                                               care to Veterans in State homes. A grant may not exceed 65 per-
                                                                               cent of the total cost of the project. The bill makes this funding
                                                                               available until expended.
                                                                                 In addition, the Coronavirus Aid, Relief, and Economic Security
                                                                               Act (CARES Act) (P.L. 116–136) included $150,000,000 for Grants
                                                                               for Construction of State Extended Care Facilities to prevent, pre-
                                                                               pare for, and respond to coronavirus.
                                                                                           GRANTS FOR CONSTRUCTION OF VETERANS CEMETERIES

                                                                               Appropriation, fiscal year 2020 .........................................................      $45,000,000
                                                                               Budget request, fiscal year 2021 .......................................................        45,000,000
                                                                               Recommended in the bill ...................................................................     45,000,000
                                                                               Bill compared with:
                                                                                    Appropriation, fiscal year 2020 ..................................................               –––
                                                                                    Budget request, fiscal year 2021 ................................................                –––
                                                                                 This program provides grants to assist States and tribal govern-
                                                                               ments with the establishment, expansion, and improvement of Vet-
                                                                               erans’ 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 equip-
                                                                               ment expenses when the cemetery is established. State and tribal
                                                                               governments remain responsible for providing the land and for pay-
                                                                               ing all costs related to the operation and maintenance of the State
                                                                               cemeteries, including the costs for subsequent equipment pur-
                                                                               chases. The bill makes this funding available until expended.
                                                                                                                ADMINISTRATIVE PROVISIONS
                                                                                 The bill includes 51 administrative provisions, of which 49 were
                                                                               in effect in fiscal year 2020 in some form and 2 are new provisions.
                                                                               The administrative provisions included in the bill are as follows:
                                                                                                             (INCLUDING TRANSFER OF FUNDS)

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




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                                                                                                           (INCLUDING TRANSFER OF FUNDS)

                                                                                  The bill includes section 202 allowing the Department to transfer
                                                                               funding among the four medical appropriations accounts in fiscal
                                                                               year 2021. The Administration proposal to modify this provision is
                                                                               not adopted.
                                                                                  The bill includes section 203 allowing for salaries and expenses
                                                                               funds to be used for hire of passenger vehicles, lease of facilities
                                                                               or land, and purchase of uniforms.
                                                                                  The bill includes section 204 providing that only funding in ‘‘Con-
                                                                               struction, 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 re-
                                                                               imbursed 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 appro-
                                                                               priated in fiscal year 2021 for ‘‘Compensation and Pensions’’, ‘‘Re-
                                                                               adjustment Benefits’’, and ‘‘Veterans Insurance and Indemnities’’
                                                                               for payment of accrued obligations recorded in the last quarter of
                                                                               fiscal year 2020.
                                                                                  The bill includes section 207 allowing for the use of fiscal year
                                                                               2021 funds to pay prior year obligations resulting from implemen-
                                                                               tation 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 sur-
                                                                               plus earnings from the national service life insurance, U.S. Govern-
                                                                               ment 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 reimburse-
                                                                               ment the Office of Resolution Management, the Office of Employ-
                                                                               ment Discrimination Complaint Adjudication, and the Office of Di-
                                                                               versity 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 receiv-
                                                                               ing 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 en-
                                                                               hanced-use lease funds for construction and alteration of medical




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                                                                               facilities.




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                                                                                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 Construc-
                                                                               tion 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 in-
                                                                               creasing total resources of the Information Technology appropria-
                                                                               tion by more than ten percent by transferring funding from the
                                                                               other VA accounts and requires the Department to receive approval
                                                                               from the Committees on Appropriations of both Houses of Congress
                                                                               before such transfer. The Administration proposal to modify this
                                                                               provision is not adopted.
                                                                                                           (INCLUDING TRANSFER OF FUNDS)

                                                                                  The bill includes section 219 providing up to $322,932,000 of fis-
                                                                               cal year 2021 funds for transfer to the Joint DOD–VA Medical Fa-
                                                                               cility Demonstration Fund. Additional funding may be transferred
                                                                               from these accounts upon written notification to the Committees on
                                                                               Appropriations of both Houses of Congress.
                                                                                                           (INCLUDING TRANSFER OF FUNDS)

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

                                                                                 The bill includes section 221 permitting the transfer of funds de-
                                                                               posited in the Medical Care Collections Fund to the Joint DOD–VA
                                                                               Medical Facility Demonstration Fund for facilities designated as




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                                                                               combined Federal medical facilities.




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                                                                                                           (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 appro-
                                                                               priations to the Department of Defense/Department of Veterans Af-
                                                                               fairs Health Care Sharing Incentive Fund, to be available until ex-
                                                                               pended.
                                                                                  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 Appro-
                                                                               priations 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 report-
                                                                               ing on pending appeals at VBA, as well as BVA. The Administra-
                                                                               tion proposal to delete this provision is not adopted.
                                                                                  The bill includes section 226 requiring advance written notifica-
                                                                               tion to the Committees on Appropriations of both Houses of Con-
                                                                               gress 15 days prior to organizational changes which result in the
                                                                               transfer of 25 or more full-time equivalent staff from one organiza-
                                                                               tional 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 Oper-
                                                                               ating 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 MIS-
                                                                               SION Act. The Administration proposal to modify this provision is
                                                                               not adopted.
                                                                                                           (INCLUDING TRANSFER OF FUNDS)

                                                                                 The bill includes section 229 permitting the transfer of funds be-
                                                                               tween the ‘‘Board of Veterans Appeals’’ and ‘‘General Operating Ex-
                                                                               penses, Veterans Benefits Administration’’ upon approval of the




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                                                                               Appropriations Committees on Appropriations of both Houses of




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                                                                               Congress. The Administration proposal to modify this provision is
                                                                               not adopted.
                                                                                  The bill includes section 230 prohibiting the reprogramming of
                                                                               funds exceeding $7,000,000 among the Major Construction projects
                                                                               unless the Committees on Appropriations of both Houses of Con-
                                                                               gress 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 realign-
                                                                               ment strategy. The Administration request to delete this provision
                                                                               is not adopted.
                                                                                  The bill includes section 233 requiring VA to use the mammog-
                                                                               raphy screening guidelines announced by the Secretary on May 10,
                                                                               2017 through January 1, 2024. The Administration request to de-
                                                                               lete this provision is not adopted.
                                                                                  The bill includes section 234 permanently allowing the use of
                                                                               Medical Services funding for assisted reproductive technology treat-
                                                                               ment and adoption reimbursement for Veterans and their spouses
                                                                               if the Veteran has a service-connected disability that results in
                                                                               being unable to procreate without such fertility treatment.
                                                                                  The bill includes section 235 prohibiting any funds from being
                                                                               used in a manner that is inconsistent with statutory limitations on
                                                                               outsourcing. The Administration request to delete this provision is
                                                                               not adopted.
                                                                                  The bill includes section 236 pertaining to exceptions for Indian-
                                                                               or Native Hawaiian-owned businesses contracting with VA. The
                                                                               Administration request to delete this provision is not adopted.
                                                                                  The bill includes section 237 directing the elimination over a se-
                                                                               ries 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 Af-
                                                                               fairs, and Related Agencies Appropriations Act, 2017, and Zika Re-
                                                                               sponse and Preparedness Act (P.L. 114–223) pertaining to certifi-
                                                                               cation of marriage and family therapists. The Administration re-
                                                                               quest 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 Com-
                                                                               pensation Fund to any other VA account. The Administration re-
                                                                               quest to delete this provision is not adopted.
                                                                                  The bill includes section 240 permitting funding to be used in fis-
                                                                               cal years 2021 and 2022 to carry out and expand the childcare pilot
                                                                               program authorized by section 205 of the Caregivers and Veterans
                                                                               Omnibus Health Services Act of 2010 (P.L. 111–163).
                                                                                  The bill includes section 241 prohibiting VA from using funds to
                                                                               enter into an agreement to resolve a dispute or claim with an indi-
                                                                               vidual that would restrict the individual from speaking to Members
                                                                               of Congress or their staff on any topic, except those required to be




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                                                                               kept secret in the interest of national defense or the conduct of for-




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                                                                               eign affairs. The Administration request to delete this provision is
                                                                               not adopted.
                                                                                  The bill includes section 242 referencing language in the Con-
                                                                               tinuing Appropriations and Military Construction, Veterans Af-
                                                                               fairs, and Related Agencies Appropriations Act, 2017, and Zika Re-
                                                                               sponse and Preparedness Act (P.L. 114–223) requiring certain data
                                                                               to be included in budget justifications for major construction
                                                                               projects. The Administration request to delete this provision is not
                                                                               adopted.
                                                                                  The bill includes section 243 prohibiting the use of funds to deny
                                                                               the Inspector General timely access to information, unless a provi-
                                                                               sion of law expressly refers to the Inspector General and expressly
                                                                               limits such access. The Administration request to delete this provi-
                                                                               sion is not adopted.
                                                                                  The bill includes section 244 prohibiting funding from being used
                                                                               in a manner that would increase wait times for Veterans at med-
                                                                               ical facilities. The Administration request to delete this provision
                                                                               is not adopted.
                                                                                  The bill includes section 245 prohibiting the use of funds in fiscal
                                                                               year 2021 to convert any program that received specific purpose
                                                                               funds in fiscal year 2020 to a general purpose-funded program
                                                                               without the approval of the Committees on Appropriations of both
                                                                               Houses of Congress at least 30 days prior to any such action. The
                                                                               Administration request to delete this provision is not adopted.
                                                                                  The bill includes section 246 eliminating category D or E pain
                                                                               testing on dogs.
                                                                                  The bill includes section 247 prohibiting the closure of the CBOC
                                                                               in Bainbridge, New York until the Secretary submits a completed
                                                                               market area assessment to the Committees on Appropriations of
                                                                               both Houses of Congress. The Administration proposal to delete
                                                                               this provision is not adopted.
                                                                                  The bill includes section 248 requiring the Department to update
                                                                               the Planning and Activating CBOC handbook every five years and
                                                                               provide guidance and training to employees on each update of the
                                                                               handbook. The Administration proposal to delete this provision is
                                                                               not adopted.
                                                                                  The bill includes section 249 to allow fiscal year 2021 and 2022
                                                                               ‘‘Medical Community Care’’ funds to be used to cover obligations
                                                                               that would have otherwise been paid by the Veterans Choice Fund.
                                                                                  The bill includes section 250 allowing obligations and expendi-
                                                                               tures applicable to the ‘‘Medical Services’’ account in fiscal years
                                                                               2017 through 2019 for aid to state homes remain in the ‘‘Medical
                                                                               Community Care’’ account for such fiscal years.
                                                                                  This bill includes section 251 specifying an amount from the four
                                                                               medical care accounts for gender-specific care for women.
                                                                                                                          TITLE III
                                                                                                                RELATED AGENCIES
                                                                                  Funds under Title III support the agencies that honor and re-
                                                                               spect the service of our Nation’s heroes. Though it may be a small-
                                                                               er title of the bill, the agencies funded under Title III are the pub-
                                                                               lic face of America’s commitment to our servicemembers and Vet-
                                                                               erans. The American Battle Monuments Commission and Arlington




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                                                                               Cemetery commemorate those who made the ultimate sacrifice,




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                                                                               while the Armed Forces Retirement Home and the United States
                                                                               Court of Appeals for Veterans Claims are critical parts of keeping
                                                                               our promise to serve those who served our Nation.
                                                                                                  AMERICAN BATTLE MONUMENTS COMMISSION
                                                                                                                    SALARIES AND EXPENSES

                                                                               Appropriation, fiscal year 2020 .........................................................      $84,100,000
                                                                               Budget request, fiscal year 2021 .......................................................        75,100,000
                                                                               Recommended in the bill ...................................................................     84,100,000
                                                                               Bill compared with:
                                                                                    Appropriation, fiscal year 2020 ..................................................              –––
                                                                                    Budget request, fiscal year 2021 ................................................          +9,000,000
                                                                                  The recommendation includes $84,100,000 for Salaries and Ex-
                                                                               penses of the American Battle Monuments Commission (ABMC).
                                                                                  The Committee notes the significant maintenance needs of the
                                                                               American Battle Monuments around the world, which are specifi-
                                                                               cally designed to honor our fallen servicemembers. The Committee
                                                                               continues to direct ABMC to emphasize maintaining and repairing
                                                                               existing monuments and memorials in a proactive and timely man-
                                                                               ner that honors the service, achievements, and sacrifices of the
                                                                               United States Armed Forces.
                                                                                  Non-Federal Memorials.—The Committee appreciates ABMC’s
                                                                               continued dialogue and engagement with non-Federal sponsors of
                                                                               memorials and other community stakeholders. The Committee en-
                                                                               courages ABMC to continue these efforts and to have productive
                                                                               exchanges with those looking to best preserve memorials that re-
                                                                               flect significant historical moments.
                                                                                  Pacific Battle Commemorations.—The Committee is grateful for
                                                                               ABMC’s commitment to telling the World War II story at its sites
                                                                               and visitors centers and urges ABMC to ensure the story of the Pa-
                                                                               cific theater is fully told. The Committee requests that ABMC re-
                                                                               port to the Committees on Appropriations of both Houses of Con-
                                                                               gress on its efforts to commemorate World War II battles in the Pa-
                                                                               cific at existing ABMC sites.
                                                                                  World War I Memorial Preservation.—The Committee supports
                                                                               the preservation and rehabilitation of World War I memorials
                                                                               across the country and in Europe to honor the more than four mil-
                                                                               lion men and women who bravely served the United States and
                                                                               fought to preserve our freedom.
                                                                                                   FOREIGN CURRENCY FLUCTUATIONS ACCOUNT

                                                                                 The recommendation includes such sums as necessary for the
                                                                               Foreign Currency Fluctuations Account.
                                                                                       UNITED STATES COURT OF APPEALS FOR VETERANS CLAIMS
                                                                                                                    SALARIES AND EXPENSES

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




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                                                                                    Appropriation, fiscal year 2020 ..................................................        +1,700,000
                                                                                    Budget request, fiscal year 2021 ................................................         ¥1,800,000




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                                                                                 The recommendation includes $37,100,000 for Salaries and Ex-
                                                                               penses for the United States Court of Appeals for Veterans Claims
                                                                               (the Court).
                                                                                 Caseload.—The Committee recognizes that caseloads at the
                                                                               Court continue to increase and directs the Court to continue using
                                                                               available resources to respond effectively to the growing demand.
                                                                               While the recommendation does not include requested funding to
                                                                               reconfigure the Court’s physical space for recalled, retired Judges,
                                                                               the Committee encourages the Court to continue to use them effi-
                                                                               ciently to address increasing caseloads.
                                                                                                            DEPARTMENT OF DEFENSE—CIVIL
                                                                                                               CEMETERIAL EXPENSES, ARMY
                                                                                                                    SALARIES AND EXPENSES

                                                                               Appropriation, fiscal year 2020 .........................................................      $80,800,000
                                                                               Budget request, fiscal year 2021 .......................................................        70,800,000
                                                                               Recommended in the bill ...................................................................     81,815,000
                                                                               Bill compared with:
                                                                                    Appropriation, fiscal year 2020 ..................................................         +1,015,000
                                                                                    Budget request, fiscal year 2021 ................................................         +11,015,000
                                                                                 The recommendation includes $81,815,000 for Salaries and Ex-
                                                                               penses for Arlington National Cemetery (the Cemetery), which is
                                                                               $11,015,000 above the fiscal year 2021 budget request. The Com-
                                                                               mittee has provided this additional funding to respond to increased
                                                                               costs and to maintain current services.
                                                                                 The Committee has previously noted its concern that the budget
                                                                               request for the Cemetery’s operating account has been continually
                                                                               inadequate to maintain the current level of services, and reiterates
                                                                               that it is unacceptable for the Cemetery’s budget request to fall
                                                                               short of reflecting real needs.
                                                                                 Updated Interment Policy.—The Committee is aware that the
                                                                               Secretary of the Army has proposed revised criteria for interment
                                                                               at the Cemetery to preserve it as an active burial ground well into
                                                                               the future, and understands that these criteria will be published as
                                                                               a draft rule in the Federal Register for public comment. The Com-
                                                                               mittee notes that it will continue to follow closely to ensure that
                                                                               the Cemetery can continue to live up to its mission to honor those
                                                                               who have served.
                                                                                                                            CONSTRUCTION

                                                                                 Southern Expansion.—The Committee remains strongly sup-
                                                                               portive of the Southern Expansion project and recognizes its impor-
                                                                               tance in extending the life of our Nation’s most prestigious ceme-
                                                                               tery.
                                                                                                           ARMED FORCES RETIREMENT HOME
                                                                                                                               TRUST FUND

                                                                                 The recommendation includes $73,100,000 for the Armed Forces
                                                                               Retirement Home (AFRH), including $8,800,000 for capital
                                                                               projects, although $22,000,000 of the total is provided from the gen-
                                                                               eral fund of the Treasury, and not the Trust Fund. The Committee




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                                                                               makes these operation and maintenance funds available until Sep-




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                                                                               tember 30, 2022, as requested, to provide AFRH greater ability to
                                                                               respond to emergency situations and ensure stable operations.
                                                                                 In addition, the Coronavirus Aid, Relief, and Economic Security
                                                                               Act (CARES Act) (P.L. 116–136) included $2,800,000 for AFRH to
                                                                               prevent, prepare for, and respond to coronavirus.
                                                                                 Land Redevelopment.—The Committee understands that AFRH
                                                                               has selected a developer to redevelop the 80-acre master planned
                                                                               parcel on the Washington campus and directs AFRH to continue to
                                                                               report to the Committee on the progress of the redevelopment
                                                                               project and the status of the lease negotiations.
                                                                                                               OPERATION AND MAINTENANCE

                                                                               Appropriation, fiscal year 2020 .........................................................      $63,300,000
                                                                               Budget request, fiscal year 2021 .......................................................        64,300,000
                                                                               Recommended in the bill ...................................................................     64,300,000
                                                                               Bill compared with:
                                                                                    Appropriation, fiscal year 2020 ..................................................         +1,000,000
                                                                                    Budget request, fiscal year 2021 ................................................               –––
                                                                                 General Fund.—The Committee has previously expressed concern
                                                                               about the use of the General Fund to support the work of AFRH.
                                                                               The Committee is pleased that efforts are underway to increase
                                                                               revenues and stabilize the AFRH Trust Fund for the long term,
                                                                               and directs AFRH to continue to make progress in this area and
                                                                               report to the Committee on its further initiatives to improve sus-
                                                                               tainability and maintain the high-quality services provided to
                                                                               AFRH residents.
                                                                                                                          CAPITAL PROGRAM

                                                                               Appropriation, fiscal year 2020 .........................................................      $12,000,000
                                                                               Budget request, fiscal year 2021 .......................................................         6,000,000
                                                                               Recommended in the bill ...................................................................      8,800,000
                                                                               Bill compared with:
                                                                                    Appropriation, fiscal year 2020 ..................................................         ¥3,200,000
                                                                                    Budget request, fiscal year 2021 ................................................          +2,800,000
                                                                                 Capital Maintenance Spending Plan.—The Committee directs
                                                                               AFRH to provide, no later than 30 days after enactment of this Act,
                                                                               an expenditure plan detailing the planned use of the funds pro-
                                                                               vided for construction and renovation. The Committee further di-
                                                                               rects AFRH to prioritize completing projects that are currently un-
                                                                               derway.
                                                                                                                 ADMINISTRATIVE PROVISION
                                                                                  The bill includes section 301 permitting funds from concessions
                                                                               at Army National Military Cemeteries to be used to support activi-
                                                                               ties at the Cemeteries.
                                                                                                                                TITLE IV
                                                                                                  OVERSEAS CONTINGENCY OPERATIONS
                                                                                                                   DEPARTMENT OF DEFENSE
                                                                               Appropriation, fiscal year 2020 .........................................................     $644,526,000
                                                                               Budget request, fiscal year 2021 .......................................................       349,762,000
                                                                               Recommended in the bill ...................................................................    350,000,000
                                                                               Bill compared with:




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                                                                                    Appropriation, fiscal year 2020 ..................................................       ¥294,526,000
                                                                                    Budget request, fiscal year 2021 ................................................           +238,000




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                                                                                 The recommendation includes Overseas Contingency Operations
                                                                               for military construction projects and planning and design related
                                                                               to the European Deterrence Initiative (EDI).
                                                                                                             MILITARY CONSTRUCTION, ARMY
                                                                               Appropriation, fiscal year 2020 .........................................................      $78,168,000
                                                                               Budget request, fiscal year 2021 .......................................................        15,873,000
                                                                               Recommended in the bill ...................................................................     16,111,000
                                                                               Bill compared with:
                                                                                    Appropriation, fiscal year 2020 ..................................................       ¥62,057,000
                                                                                    Budget request, fiscal year 2021 ................................................          +238,000
                                                                                 The recommendation includes $16,111,000 for Army military con-
                                                                               struction and planning and design for Overseas Contingency Oper-
                                                                               ations and European Deterrence Initiative projects.
                                                                                            MILITARY CONSTRUCTION, NAVY AND MARINE CORPS
                                                                               Appropriation, fiscal year 2020 .........................................................      $94,570,000
                                                                               Fiscal year 2021 budget request .......................................................         70,020,000
                                                                               Recommended in the bill ...................................................................     70,020,000
                                                                               Bill compared with:
                                                                                    Appropriation fiscal year 2020 ...................................................       ¥24,550,000
                                                                                    Budget request, fiscal year 2021 ................................................              –––
                                                                                 The recommendation includes $70,020,000 for Navy and Marine
                                                                               Corps military construction and planning and design for European
                                                                               Deterrence Initiative projects.
                                                                                                         MILITARY CONSTRUCTION, AIR FORCE
                                                                               Appropriation, fiscal year 2020 .........................................................     $325,988,000
                                                                               Budget request, fiscal year 2021 .......................................................       263,869,000
                                                                               Recommended in the bill ...................................................................    263,869,000
                                                                               Bill compared with:
                                                                                    Appropriation, fiscal year 2020 ..................................................       ¥62,119,000
                                                                                    Budget request, fiscal year 2021 ................................................              –––
                                                                                 The recommendation includes $263,869,000 for Air Force mili-
                                                                               tary construction and planning and design for European Deterrence
                                                                               Initiative projects.
                                                                                                                 ADMINISTRATIVE PROVISION
                                                                                 The bill includes one provision that was in effect in fiscal year
                                                                               2020.
                                                                                 The bill includes section 401 that designates that funding shall
                                                                               be available only if the President so designates all amounts and
                                                                               transmits such designations to Congress.
                                                                                                                                 TITLE V
                                                                                                                   GENERAL PROVISIONS
                                                                                  The bill includes a total of 14 provisions: 12 provisions that are
                                                                               effective in fiscal year 2020:
                                                                                  The bill includes section 501 prohibiting the obligation of funds
                                                                               beyond the current fiscal year unless expressly so provided.
                                                                                  The bill includes section 502 prohibiting the use of funds for pro-
                                                                               grams, projects or activities not in compliance with Federal law re-
                                                                               lating to risk assessment, the protection of private property rights,




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                                                                               or unfunded mandates.




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                                                                                  The bill includes section 503 encouraging all departments and
                                                                               agencies funded in this Act to expand the use of ‘‘E-Commerce’’
                                                                               technologies and procedures.
                                                                                  The bill includes section 504 specifying the Congressional com-
                                                                               mittees that are to receive all reports and notifications.
                                                                                  The bill includes section 505 prohibiting the transfer of funds to
                                                                               any instrumentality of the United States Government without au-
                                                                               thority from an appropriations Act.
                                                                                  The bill includes section 506 prohibiting any funds in this Act to
                                                                               be used for a project or program named for an individual serving
                                                                               as a Member, Delegate, or Resident Commissioner of the United
                                                                               States House of Representatives.
                                                                                  The bill includes section 507 requiring all reports submitted to
                                                                               the Congress to be posted on official websites of the submitting
                                                                               agency.
                                                                                  The bill includes section 508 prohibiting the use of funds to es-
                                                                               tablish or maintain a computer network unless such network
                                                                               blocks the viewing, downloading, and exchanging of pornography,
                                                                               except for law enforcement investigation, prosecution or adjudica-
                                                                               tion activities.
                                                                                  The bill includes section 509 prohibiting the use of funds for pay-
                                                                               ment of first-class travel by an employee of the executive branch.
                                                                                  The bill includes section 510 prohibiting the use of funds in this
                                                                               Act for any contract where the contractor has not complied with E-
                                                                               Verify requirements.
                                                                                  The bill includes section 511 prohibiting the use of funds in this
                                                                               Act by the Department of Defense or the Department of Veterans
                                                                               Affairs for the purchase or lease of a new vehicle except in accord-
                                                                               ance with Presidential Memorandum—Federal Fleet Performance,
                                                                               dated May 24, 2011.
                                                                                  The bill includes section 512 prohibiting the use of funds in this
                                                                               Act to construct facilities on military installations that do not meet
                                                                               resiliency standards.
                                                                                  The bill includes section 513 prohibiting the use of funds in this
                                                                               Act and previous Acts for the construction of a wall, barrier, fence,
                                                                               or road along the Southern border of the United States or a road
                                                                               to provide access to a wall, barrier, or fence constructed along the
                                                                               Southern border of the United States.
                                                                                  The bill includes section 514 designating emergency funding pur-
                                                                               suant to section 251(b)(2)(A)(i) of the Balanced Budget and Emer-
                                                                               gency Deficit Control Act of 1985.
                                                                                   HOUSE OF REPRESENTATIVES REPORT REQUIREMENTS
                                                                                 The following items are included in accordance with various re-
                                                                               quirements 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 perform-
                                                                               ance goals and objectives for which this measure authorizes fund-
                                                                               ing:
                                                                                 The Committee on Appropriations considers program perform-




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                                                                               ance, including a program’s success in developing and attaining




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                                                                                                                              111

                                                                               outcome-related goals and objectives, in developing funding rec-
                                                                               ommendations.
                                                                                                                        RESCISSIONS
                                                                                 The bill does not contain any rescissions, as defined in clause
                                                                               3(f)(2) of rule XIII of the Rules of the House of Representatives.
                                                                                                                  TRANSFER OF FUNDS
                                                                                  Pursuant to clause 3(f)(2) of rule XIII of the Rules of the House
                                                                               of Representatives, the following statements are submitted describ-
                                                                               ing the transfer of funds provided in the accompanying bill.
                                                                                  Language is included to allow for the transfer of funds from
                                                                               Family Housing, Construction accounts to the Department of De-
                                                                               fense Family Housing Improvement Fund and funds from Military
                                                                               Construction accounts to the Department of Defense Military Unac-
                                                                               companied Housing Improvement Fund.
                                                                                  Language is included to provide transfer authority from the
                                                                               BRAC account to the Homeowners Assistance Program.
                                                                                  Language is included to allow the transfer of expired funds to the
                                                                               ‘‘Foreign Currency Fluctuations, Construction, Defense’’ account.
                                                                                  Language is included to transfer not to exceed $20,115,000 in fis-
                                                                               cal year 2022 from Compensation and Pensions to General Oper-
                                                                               ating 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 med-
                                                                               ical 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 Gen-
                                                                               eral Administration to General Operating Expenses, Veterans Ben-
                                                                               efits Administration.
                                                                                  Language is included to permit the transfer of funds between In-
                                                                               formation Technology Systems development projects and among the
                                                                               three sub-accounts identified in bill language subject to the ap-
                                                                               proval of the Committee.
                                                                                  Language is included to provide authority for the Department of
                                                                               Veterans Affairs for any funds appropriated in 2021 for Compensa-
                                                                               tion 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 Serv-
                                                                               ices, Medical Community Care, Medical Support and Compliance,
                                                                               and Medical Facilities accounts.
                                                                                  Language is included to permit the funds from three life insur-
                                                                               ance funds to be transferred to General Operating Expenses, Vet-
                                                                               erans Benefits Administration and Information Technology Sys-
                                                                               tems for the costs of administering such programs.
                                                                                  Language is included to permit funding up to $71,490,000 to be
                                                                               transferred to General Administration and Information Technology
                                                                               Systems from any funds appropriated in fiscal year 2021 to reim-
                                                                               burse three headquarters offices for services provided.
                                                                                  Language is included to transfer certain funds derived from en-
                                                                               hanced-use leasing activities to the Construction, Major Projects




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                                                                               and Construction, Minor Projects accounts.




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                                                                                  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 Cap-
                                                                               ital Asset Fund to the Construction, Major Projects and Construc-
                                                                               tion, Minor Projects accounts.
                                                                                  Language is included to allow the transfer of funds from various
                                                                               accounts to the Information Technology Systems account in an ag-
                                                                               gregate amount not to exceed ten percent of the account appropria-
                                                                               tion, subject to approval by the Committee.
                                                                                  Language is included to allow the transfer of funds in fiscal year
                                                                               2021 provided for the Department of Veterans Affairs to the Joint
                                                                               Department of Defense–Department of Veterans Affairs Medical
                                                                               Facility Demonstration Fund.
                                                                                  Language is included allowing fiscal year 2022 medical care
                                                                               funding to be transferred to the Joint Department of Defense–De-
                                                                               partment 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 Fed-
                                                                               eral medical facility to be transferred to the Joint Department of
                                                                               Defense-Department of Veterans Affairs Medical Facility Dem-
                                                                               onstration 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 discre-
                                                                               tionary 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 ear-
                                                                               marks, limited tax benefits, or limited tariff benefits as defined in
                                                                               clause 9 of rule XXI of the Rules of the House of Representatives.
                                                                                        COMPLIANCE WITH RULE XIII, CL. 3(e) (RAMSEYER RULE)
                                                                                 In compliance with clause 3(e) of rule XIII of the Rules of the
                                                                               House of Representatives, changes in existing law made by the bill,
                                                                               as reported, are shown as follows (existing law proposed to be omit-
                                                                               ted is enclosed in black brackets, new matter is printed in italics,
                                                                               existing law in which no change is proposed is shown in roman):




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                                                                                                                                   113

                                                                               SECTION 219 OF THE MILITARY CONSTRUCTION, VET-
                                                                                ERANS AFFAIRS, AND RELATED AGENCIES APPRO-
                                                                                PRIATIONS ACT, 2020

                                                                                                           (Division F of Public Law 116–94)
                                                                                                   ø(INCLUDING TRANSFER OF FUNDS)
                                                                                  øSEC. 219. Of the amounts appropriated to the Department of
                                                                               Veterans Affairs for fiscal year 2020 for ‘‘Medical Services’’, ‘‘Med-
                                                                               ical Community Care’’, ‘‘Medical Support and Compliance’’, ‘‘Med-
                                                                               ical Facilities’’, ‘‘Construction, Minor Projects’’, and ‘‘Information
                                                                               Technology Systems’’, up to $314,409,000, plus reimbursements,
                                                                               may be transferred to the Joint Department of Defense—Depart-
                                                                               ment of Veterans Affairs Medical Facility Demonstration Fund, es-
                                                                               tablished 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 Af-
                                                                               fairs Medical Facility Demonstration Fund upon written notifica-
                                                                               tion by the Secretary of Veterans Affairs to the Committees on Ap-
                                                                               propriations of both Houses of Congress: Provided further, That
                                                                               section 220 of title II of division C of Public Law 115–244 is re-
                                                                               pealed.¿

                                                                                                     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




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                                                                                          *            *            *                  *           *          *           *




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                                                                               § 1720J. Provision of assisted reproductive technology or
                                                                                             adoption reimbursements for certain disabled vet-
                                                                                             erans
                                                                                  (a) PROVISION OF SERVICES.—Subject to the availability of appro-
                                                                               priations, the Secretary may provide—
                                                                                        (1) fertility counseling and treatment using assisted reproduc-
                                                                                     tive 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 spec-
                                                                               ified in subsection (a) are subject to the requirements for funds con-
                                                                               tained in section 508 of division H of the Consolidated Appropria-
                                                                               tions 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 final-
                                                                                     ized after the date of the enactment of this section under the
                                                                                     same terms as apply under the adoption reimbursement pro-
                                                                                     gram of the Department of Defense, as authorized in Depart-
                                                                                     ment of Defense Instruction 1341.09, including the reimburse-
                                                                                     ment 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 bene-
                                                                                     fits relating to reproductive assistance provided to a member of
                                                                                     the Armed Forces who incurs a serious injury or illness on ac-
                                                                                     tive duty pursuant to section 1074(c)(4)(A) of title 10, as de-
                                                                                     scribed in the memorandum on the subject of ‘‘Policy for As-
                                                                                     sisted Reproductive Services for the Benefit of Seriously or Se-
                                                                                     verely Ill/Injured (Category II or III) Active Duty Service Mem-
                                                                                     bers’’ issued by the Assistant Secretary of Defense for Health Af-
                                                                                     fairs on April 3, 2012, and the guidance issued to implement
                                                                                     such policy, as in effect on the date of the enactment of this sec-
                                                                                     tion, including any limitations on the amount of such benefits
                                                                                     available to such a member, except that—
                                                                                             (A) the periods regarding embryo cryopreservation and
                                                                                          storage set forth in part III(G) and in part IV(H) of the first
                                                                                          part IV of such memorandum shall not apply; and
                                                                                             (B) such term includes embryo cryopreservation and stor-
                                                                                          age without limitation on the duration of such
                                                                                          cryopreservation and storage.
                                                                                        (3) The term ‘‘covered veteran’’ means a veteran who has a
                                                                                     service-connected disability that results in the inability of the
                                                                                     veteran to procreate without the use of fertility treatment.
                                                                                          *            *           *              *           *          *           *
                                                                                                  CHANGES IN APPLICATION OF EXISTING LAW
                                                                                  Pursuant to clause 3(f)(1)(A) of rule XIII of the Rules of the
                                                                               House of Representatives, the following statements are submitted
                                                                               describing the effect of provisions in the accompanying bill that di-
                                                                               rectly 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 leg-




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                                                                               islation, which to date have not been enacted.




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                                                                                                                              115

                                                                                  Language is included in various parts of the bill to place limita-
                                                                               tions 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 Sec-
                                                                               retary 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 var-
                                                                               ious 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 Fed-
                                                                               eral 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 cir-
                                                                               cumstances.
                                                                                  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 pro-
                                                                               ducers 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 cir-
                                                                               cumstances.
                                                                                  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 construc-
                                                                               tion funding to be available for currently authorized projects.
                                                                                  Language is included under Title I to allow payment for the cost




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                                                                               associated with supervision, inspection, overhead, engineering and




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                                                                                                                              116

                                                                               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 enact-
                                                                               ment 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 oper-
                                                                               ation 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 Is-
                                                                               land Improvement Account to be available until expended for cer-
                                                                               tain purposes.
                                                                                 Language is included under Title I to allow for the transfer of ex-
                                                                               pired funding to the Foreign Currency Fluctuation Account under
                                                                               certain circumstances.
                                                                                 Language is included under Title I to prohibit funds to be used
                                                                               for projects at Arlington Cemetery.
                                                                                 Language is included under Title I providing additional funds for
                                                                               Military Construction, Army.
                                                                                 Language is included under Title I providing additional funds for
                                                                               Military Construction, Navy and Marine Corps.
                                                                                 Language is included under Title I providing additional funds for
                                                                               Military Construction, Air Force.
                                                                                 Language is included under Title I providing additional funds for
                                                                               Military Construction, Army National Guard.
                                                                                 Language is included under Title I providing additional funds for
                                                                               Military Construction, Air National Guard.
                                                                                 Language is included under Title I providing additional funds for
                                                                               Military Construction, Army Reserve.
                                                                                 Language is included under Title I defining the congressional de-
                                                                               fense committees.
                                                                                 Language is included under Title I directing all amounts appro-
                                                                               priated to Military Construction (all accounts) be immediately
                                                                               available and allotted for the full scope of the authorized project.
                                                                                 Language is included under Title I providing additional funds for
                                                                               Military Construction, Army for cost to complete projects.
                                                                                 Language is included under Title I providing additional funds for
                                                                               Military Construction, Navy and Marine Corps for cost to complete
                                                                               projects.
                                                                                 Language is included under Title I providing additional funds for
                                                                               Military Construction, Air Force for cost to complete projects.
                                                                                 Language is included under Title I providing additional funds for
                                                                               Military Construction, Army Reserve for cost to complete projects.
                                                                                 Language is included under Title I providing additional funds for
                                                                               Military Construction, Navy Reserve for cost to complete projects.
                                                                                 Language is included under Title I providing additional funds for
                                                                               Family Housing Construction, Army for cost to complete projects.
                                                                                 Language is included under Title I providing additional funds for




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                                                                               Family Housing Operations and Maintenance, Army.




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                                                                                  Language is included under Title I providing additional funds for
                                                                               Family Housing Operations and Maintenance, Navy and Marine
                                                                               Corps.
                                                                                  Language is included under Title I providing additional funds for
                                                                               Family Housing Operations and Maintenance, Air Force.
                                                                                  Language is included under Title I requiring funds made avail-
                                                                               able are only to be use for the purposes specifically described under
                                                                               each heading.
                                                                                  Language is included under Title I to prohibit the use of military
                                                                               construction funds to build a border wall, or road to access a border
                                                                               wall.
                                                                                  Language is included under Title I to prohibit the construction
                                                                               of a facility on a military installation bearing the name of a confed-
                                                                               erate officer unless a process has been initiated to rename the in-
                                                                               stallation.
                                                                                  Language is included under Title II providing for the reimburse-
                                                                               ment to the Department of Defense for the costs of overseas em-
                                                                               ployee mail.
                                                                                  Language is included under Title II designating certain fiscal
                                                                               year 2020 advance appropriations for fiscal year 2021 within the
                                                                               four medical care accounts be designated as emergency funding.
                                                                                  Language is included under Title II to require that the Secretary
                                                                               of Veterans Affairs establish a priority for treatment of Veterans
                                                                               who are service-connected disabled, lower income, or have special
                                                                               needs.
                                                                                  Language is included under Title II to require that the Secretary
                                                                               of Veterans Affairs give priority funding of basic medical benefits
                                                                               to priority groups 1 through 6.
                                                                                  Language is included under Title II to allow the Secretary of Vet-
                                                                               erans Affairs to dispense prescription drugs from VHA facilities to
                                                                               enrolled Veterans with privately written prescriptions at no addi-
                                                                               tional cost to the Department.
                                                                                  Language is included under Title II requiring the Secretary to
                                                                               ensure sufficient funding is available for the acquisition of pros-
                                                                               thetics designed for women Veterans.
                                                                                  Language is included under Title II requiring sufficient funding
                                                                               is available for prosthetic research specifically for female Veterans
                                                                               and for toxic exposure research.
                                                                                  Language is included under Title II designating certain funding
                                                                               within the Information Technology Systems account as emergency
                                                                               funding.
                                                                                  Language is included under Title II to require approval of a
                                                                               transfer between development projects in the Information Tech-
                                                                               nology Systems account.
                                                                                  Language is included under Title II designating certain funding
                                                                               within the Veterans Electronic Health Record account as emer-
                                                                               gency funding.
                                                                                  Language is included under Title II prohibiting funding in the
                                                                               Veterans Electronic Health Record account from being obligated in
                                                                               a manner inconsistent with deployment schedules.
                                                                                  Language is included under Title II establishing time limitations
                                                                               and reporting requirements concerning the obligation of Major Con-
                                                                               struction funds, limiting the use of funds, allowing the use of funds




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                                                                               for program costs, and allowing for the reimbursement to the ‘‘Gen-




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                                                                                                                              118

                                                                               eral 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 nat-
                                                                               ural 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 associ-
                                                                               ated 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 dis-
                                                                               closure 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, re-
                                                                               quiring quarterly reports on the Department’s financial status, per-
                                                                               formance measures, and data, allowing medical services funds for
                                                                               recreational and funeral expenses, and requiring notification of or-
                                                                               ganizational changes that transfer 25 or more employees from one
                                                                               VA organizational unit to another.
                                                                                 Language is included under Title II requiring notification of any
                                                                               single national outreach and awareness marketing campaign in
                                                                               which obligations exceed $1,000,000.
                                                                                 Language is included under Title II requiring the Secretary to
                                                                               maintain certain requirements in operating the toll-free suicide
                                                                               hotline.
                                                                                 Language is included under Title II prohibiting funds from being
                                                                               used to close hospitals, domiciliaries, or clinics, or conduct environ-
                                                                               mental 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 realign-
                                                                               ment strategy, a cost benefit analysis, and an inventory of build-
                                                                               ings with historic designation.
                                                                                 Language is included under Title II to allow covered Veterans
                                                                               and their spouses, under certain conditions, to receive assisted re-
                                                                               productive technology services and adoption reimbursement.
                                                                                 Language is included under Title II pertaining to exceptions for
                                                                               Indian- or Native Hawaiian-owned businesses contracting with the
                                                                               Department.
                                                                                 Language is included under Title II directing the elimination of
                                                                               using Social Security account numbers to identify individuals in all
                                                                               information systems of the Department.
                                                                                 Language is included under Title II pertaining to certification of
                                                                               marriage and family therapists.
                                                                                 Language is included under Title II prohibiting funds from being
                                                                               used to transfer funding from the Filipino Veterans Equity Com-
                                                                               pensation Fund to any other VA account.
                                                                                 Language is included under Title II permitting funds to carry out
                                                                               and expand the child care program.
                                                                                 Language is included under Title II prohibiting funds to enter
                                                                               into an agreement to resolve a dispute or claim with an individual
                                                                               that would restrict the individual from speaking to Members of




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                                                                               Congress or their staff.




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                                                                                 Language is included under Title II requiring certain data to be
                                                                               included in budget justifications for major construction projects.
                                                                                 Language is included under Title II prohibiting the Inspector
                                                                               General timely access to information.
                                                                                 Language is included under Title II prohibiting funding to be
                                                                               used that would increase wait times for Veterans who seek medical
                                                                               care.
                                                                                 Language is included under Title II prohibiting the use of funds
                                                                               in fiscal year 2020 to convert any program that received specific
                                                                               purpose funding in fiscal year 2019 to a general purpose-funded
                                                                               program.
                                                                                 Language is included under Title II prohibiting the use of dogs
                                                                               as part of the conduct of any study.
                                                                                 Language is included under Title II prohibiting the closure of a
                                                                               certain community-based outpatient clinic until the Secretary com-
                                                                               pletes a market area assessment.
                                                                                 Language is included under Title II requiring the Secretary to
                                                                               update the ‘‘Planning and Activating Community Based Outpatient
                                                                               Clinics’’ handbook.
                                                                                 Language is included under Title II allowing for funds within the
                                                                               Medical Community Care account to be used for expenses that
                                                                               would have otherwise been payable from the Veterans Choice
                                                                               Fund.
                                                                                 Language is included under Title II allowing for obligations and
                                                                               expenditures applicable to the Medical Services account in fiscal
                                                                               years 2017 through 2019 for aid to state homes to remain in the
                                                                               Medical Community Care account for such fiscal years.
                                                                                 Language is included under Title II providing for a certain
                                                                               amount within the medical care accounts to be made available for
                                                                               gender-specific care for women.
                                                                                 Language is included under Title III United States Court of Ap-
                                                                               peals 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 con-
                                                                               cession fees.
                                                                                 Language is included under Title IV providing Overseas Contin-
                                                                               gency Operations funding with an emergency designation.
                                                                                 Language is included under Title IV providing funds with emer-
                                                                               gency designation, for Overseas Contingency Operations and Euro-
                                                                               pean Deterrence Initiative for the Army.
                                                                                 Language is included under Title IV providing funds with emer-
                                                                               gency designation, for Overseas Contingency Operations and Euro-
                                                                               pean Deterrence Initiative for the Navy and Marine Corps.
                                                                                 Language is included under Title IV providing funds with emer-
                                                                               gency designation, for Overseas Contingency Operations and Euro-
                                                                               pean Deterrence Initiative for the Air Force.
                                                                                 Language is included under Title IV directing the Secretary of




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                                                                               Defense to provide, in classified and unclassified format a list of




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                                                                               the construction projects for European Deterrence Initiative for fis-
                                                                               cal years 2022 through 2026.
                                                                                  Language is included under Title V prohibiting funding beyond
                                                                               the current fiscal year unless expressly so provided.
                                                                                  Language is included under Title V to limit the use of funds for
                                                                               Federal entities when they are not in compliance with Federal law
                                                                               relating to risk assessment, the protection of private property
                                                                               rights, or unfunded mandates.
                                                                                  Language is included under Title V providing funding to expand
                                                                               the use of ‘‘E Commerce’’ technologies and procedures.
                                                                                  Language is included under Title V specifying the Congressional
                                                                               committees that are to receive all reports and notifications.
                                                                                  Language is included under Title V prohibiting the transfer of
                                                                               funds to any instrumentality of the United States Government
                                                                               without authority from an appropriations Act.
                                                                                  Language is included under Title V prohibiting the use of funds
                                                                               for a project or program named for an individual serving as a Mem-
                                                                               ber, Delegate, or Resident Commissioner of the United States
                                                                               House of Representatives.
                                                                                  Language is included under Title V requiring all reports sub-
                                                                               mitted to the Congress to be posted on the official public Website
                                                                               of that agency.
                                                                                  Language is included under Title V prohibiting funds from being
                                                                               used to maintain or establish a computer network unless such net-
                                                                               work blocks the viewing, downloading, and exchanging of pornog-
                                                                               raphy.
                                                                                  Language is included under Title V prohibiting funds from being
                                                                               used to pay for first-class travel in violation of Federal regulations.
                                                                                  Language is included under Title V prohibiting funds from being
                                                                               used to execute a contract for goods or services where a contractor
                                                                               has not complied with Executive Order 12989.
                                                                                  Language is included under Title V prohibiting funds from being
                                                                               used by the Department of Defense or the Department of Veterans
                                                                               Affairs for the purchase or lease of a new vehicle except in accord-
                                                                               ance with Presidential Memorandum Federal Fleet Performance,
                                                                               dated May 24, 2011.
                                                                                  Language is included under Title V prohibiting the use of funds
                                                                               in this Act to construct facilities on military installations that do
                                                                               not meet resiliency standards.
                                                                                  Language is included under Title V prohibiting the use of funds
                                                                               for the construction of a wall, barrier, fence, or road along the
                                                                               Southern border of the United States or a road to provide access
                                                                               to a wall, barrier, or fence constructed along the Southern border
                                                                               of the United States.
                                                                                  Language is included under Title V designating amounts in this
                                                                               Act by Congress are for an emergency requirement pursuant to sec-
                                                                               tion 251(b)(2)(A)(i) of the Balanced Budget and Emergency Control
                                                                               Act of 1985.
                                                                                                  APPROPRIATIONS NOT AUTHORIZED BY LAW
                                                                                  Pursuant to clause 3(f)(1)(B) of rule XIII of the Rules of the
                                                                               House of Representatives, the following table lists the appropria-
                                                                               tions in the accompanying bill which are not authorized by law for




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                                                                               the period concerned:




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                                                                                                                                        121

                                                                                                                                 [dollars in thousands]


                                                                                                                                            Last year of     Authorization Appropriations Appropriations
                                                                                                    Agency/program
                                                                                                                                            authorization        level     in last year of  in this bill
                                                                                                                                                                            authorization
                                                                               Military Construction, Army ...                                      2020       1,270,999       1,178,499        608,336
                                                                               Military Construction, Navy and Marine Corps ...                     2020       2,774,961       2,449,632      1,611,914
                                                                               Military Construction, Air Force ..                                  2020       1,723,579       1,687,230        569,792
                                                                               Military Construction, Defense-Wide ..                               2020       2,267,595       2,362,529      2,234,517
                                                                               Military Construction, Army National Guard ..                        2020         365,819         210,819        349,437
                                                                               Military Construction, Air National Guard .... ,. .                  2020         221,471         164,471         64,214
                                                                               Military Construction, Army Reserve ..                               2020          60,928          60,928         88,337
                                                                               Military Construction, Navy Reserve .. .                             2020          54,955          54,955         70,995
                                                                               Military Construction, Air Force Reserve ..                          2020          84,550          59,750         23,117
                                                                               North Atlantic Treaty Organization Security Investment
                                                                                  Program ..                                                        2020         144,040         172,005        173,030
                                                                               Family Housing Construction, Army...                                 2020         146,372         141,372        119,400
                                                                               Family Housing Operation and Maintenance, Army...                    2020         457,640         357,907        367,142
                                                                               Family Housing Construction, Navy and Marine Corps .... .            2020          47,661          47,661         42,897
                                                                               Family Housing Operation and Maintenance, Navy and
                                                                                 Marine Corps ...                                                   2020         432,203         317,870        346,493
                                                                               Family Housing Construction, Air Force ..                            2020         103,631         103,631         97,214
                                                                               Family Housing Operation and Maintenance, Air Force .. ...           2020         380,949         295,016        317,021
                                                                               Family Housing Operation and Maintenance,
                                                                                  Defense-Wide ....                                                 2020          57,000          57,000         54,728
                                                                               Department of Defense Family Housing Improvement
                                                                                  Fund ....                                                         2020           3,045           3,045          5,897
                                                                               Department of Defense Family Housing Improvement
                                                                                  Fund ..                                                          2020              500             500            600
                                                                               Base Realignment and Closure Account. .. .                          2020          392,526         398,526        580,447
                                                                               Dept. of Veterans Affairs, Major Construction ..             done each yr.                      1,235,200      1,373,000
                                                                               Dept. of Veteran Affairs, Major Leases ..                    done each yr.                        682,323        535,540
                                                                               Armed Forces Retirement Home ..                                      2020          64,300          75,300         73,100




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                                                                                                                              122

                                                                                                                PROGRAM DUPLICATION
                                                                                  No provision of this bill establishes or reauthorizes a program of
                                                                               the Federal Government known to be duplicative of another Fed-
                                                                               eral 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 iden-
                                                                               tified in the most recent Catalog of Federal Domestic Assistance.
                                                                                                                 COMMITTEE HEARINGS
                                                                                  For the purposes of section 103(i) of H. Res. 6 of the 116th Con-
                                                                               gress—
                                                                                  The following hearings were used to develop or consider the Mili-
                                                                               tary Construction, Department of Veterans Affairs, and Related
                                                                               Agencies Appropriations Act, 2021:
                                                                                  The Subcommittee on Military Construction, Department of Vet-
                                                                               erans Affairs, and Related Agencies held a hearing on February 27,
                                                                               2020, entitled ‘‘Oversight of VA’s Electronic Health Record Mod-
                                                                               ernization Implementation’’. The Subcommittee received testimony
                                                                               from:
                                                                                  Dr. Melissa Glynn, Assistant Secretary for Enterprise Integra-
                                                                               tion
                                                                                  Dr. Richard Stone, Executive in Charge, Veterans Health Admin-
                                                                               istration
                                                                                  Mr. John H. Windom, Executive Director, Office of Electronic
                                                                               Health Record Modernization
                                                                                  The Subcommittee on Military Construction, Department of Vet-
                                                                               erans Affairs, and Related Agencies held a hearing on March 3,
                                                                               2020, entitled ‘‘Military Privatized Housing’’. The Subcommittee re-
                                                                               ceived testimony from:
                                                                                  Colonel Scott Gerber
                                                                                  Ms. Linne Gherdovich
                                                                                  Mr. Rick Taylor, President, Facility Operations, Renovations &
                                                                               Construction, Balfour Beatty Communities
                                                                                  Mr. Heath Burleson, Corvias’ Partnership Advisor
                                                                                  Mr. Denis Hickey, CEO, Lendlease Americas
                                                                                  Mr. John Ehle, President, Hunt Military Communities
                                                                                  Mr. Jeff Guild, Vice President, Lincoln Military Housing
                                                                                  Mr. Pete Potochney, Acting Assistant Secretary of Defense
                                                                               (Sustainment) OSD
                                                                                  Ms. Elizabeth A. Field, Director, Defense Capabilities and Man-
                                                                               agement (GAO)
                                                                                  The Subcommittee on Military Construction, Department of Vet-
                                                                               erans Affairs, and Related Agencies held a hearing on March 4,
                                                                               2020, entitled ‘‘Department of Veterans Affairs FY2021 Budget
                                                                               Overview’’. The Subcommittee received testimony from:
                                                                                  The Honorable Robert Wilkie, Secretary of Veterans Affairs
                                                                                  Richard A. Stone, M.D., Executive in Charge, Veterans Health
                                                                               Administration
                                                                                  Dr. Paul R. Lawrence, Under Secretary for Benefits, Veterans Af-
                                                                               fairs
                                                                                  Mr. Jon Rychalski, Assistant Secretary for Management and
                                                                               Chief Financial Officer, Veterans Affairs
                                                                                  The Subcommittee on Military Construction, Department of Vet-




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                                                                               erans Affairs, and Related Agencies held a hearing on March 10,




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                                                                                                                              123

                                                                               2020, entitled ‘‘Member’s Day’’. The Subcommittee received testi-
                                                                               mony from:
                                                                                 The Honorable Gilbert Cisneros, Member of Congress
                                                                                 The Honorable Jared Golden, Member of Congress
                                                                                 The Honorable Mike Johnson, Member of Congress
                                                                                 The Honorable Jenniffer González-Colón, Member of Congress
                                                                                 The Honorable Angie Craig, Member of Congress
                                                                                 The Honorable Richard Hudson, Member of Congress
                                                                                 The Subcommittee on Military Construction, Department of Vet-
                                                                               erans Affairs, and Related Agencies held a hearing on March 10,
                                                                               2020, entitled ‘‘Public Witness Day’’. The Subcommittee received
                                                                               testimony from:
                                                                                 Mr. Adrian M. Atizado, Deputy National Legislative Director of
                                                                               Disabled American Veterans
                                                                                 Mr. Roscoe G. Butler, Associate Legislative Director of Paralyzed
                                                                               Veterans of America
                                                                                 Mr. Carlos Fuentes, Director of National Legislative Service for
                                                                               Veterans of Foreign Wars of the United States
                                                                                 The Subcommittee on Military Construction, Department of Vet-
                                                                               erans Affairs, and Related Agencies held a hearing on March 11,
                                                                               2020, entitled ‘‘Impact of PFAS Exposure on Servicemembers’’’. The
                                                                               Subcommittee received testimony from:
                                                                                 Mr. Jim Holmes, U.S. Army and Air Force Veteran
                                                                                 Mr. Scott Faber, Senior Vice President of Government Affairs
                                                                               Environmental Working Group
                                                                                 Ms. Maureen Sullivan, Deputy Assistant Secretary of Defense for
                                                                               Environment, Department of Defense
                                                                                 The Subcommittee on Military Construction, Department of Vet-
                                                                               erans Affairs, and Related Agencies held a hearing on May 28,
                                                                               2020, entitled ‘‘Department of Veterans Affairs Response to
                                                                               COVID–19’’. The Subcommittee received testimony from:
                                                                                 The Honorable Robert Wilkie, Secretary of Veterans Affairs
                                                                                 Dr. Paul Lawrence, Under Secretary for Benefits, Department of
                                                                               Veterans Affairs
                                                                                 Dr. Jennifer MacDonald, Chief Consultant to the Deputy Under
                                                                               Secretary for Health, Department of Veterans Affairs
                                                                                 Mr. Jon Rychalski, Assistant Secretary for Management and
                                                                               Chief Financial Officer, Department of Veterans Affairs




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                                                                                                                                                                    124
                                                                                                                               BUDGETARY IMPACT OF THE
                                                                                            FY 2021 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]

                                                                                                                                  COMPARISON WITH BUDGET RESOLUTION
                                                                                  Section 308(a)( I)(A) of the Congressional Budget Act requires the report accompanying a bi!J 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} A1location                                       This Bill

                                                                                                                                                                             Budget                                                  Budget
                                                                                                                                                                           Authority                   Outlays                      Authority             Outlays

                                                                               Comparison of amounts in the bill with Committee aBocations to its
                                                                                     subcommittees: Subcommittee on Military Construction, Veterans
                                                                                     Affairs, and Related Agencies

                                                                                         General Purpose Discretionary,. ....                                                 102,648                    102,800                       102,648      ii     102,298
                                                                                           Mandatory ..                                                                       126,202                    126,202                       126,202      ii     126,202
                                                                                   !/ Jncludes outlays from prior-year budget authority

                                                                               NOTE-Consistent with the funding recommended in the bill for overseas contingency operations/global war on terrorism. m accordance with section 25 l(bX2XA) of the
                                                                               Balanced Budget and Emergency Deficit Control Act of 1985, and after the bill is reported to the House, the Chaimmn of the Cornminee on the Budget will provide a revised
                                                                               section 302(a) allocation reflecting an additional $350 million in discretionary budget authority and $5 million in associated outlays. That new allocation will eliminate the
                                                                               technical difference prior to floor consideration

                                                                               In add1t10n, the amounts in this report do not include $12,494 million in discretionary budget authority and $10,120 million in associated outlays from amounts provided in this bill
                                                                               that are designated as bemg for emergency requirements pursuant to section 25 l(bX2) of the Balanced Budge! Balanced Budget and Emergency Deficit Control Act of 1985
                                                                               Further, the amounts in this report do not include an additional $7,093 million in discretionary outlays from such funding that was provided by the Families First Coronavirus
                                                                               Response Act (Public Law 116-127) and the CARES Act (Public Law 116-136). Consistent Wlth the Congressional Budget Act of 1974, in the House of Representatives such
                                                                               amounts do not cowit against the Committee's allocation


                                                                                                                                                       Five-Year Outlay Projet'tions
                                                                                  In compliance with section 308(a)(l )(B) of the Congressional Budget and Impoundment Control Act of 1974 (Public Law 93-344), as amended, the
                                                                               following table contains five-year projections associated with the budget authority provided in the accompanying bill.

                                                                                                                                                            [In millions of dollars]

                                                                                                                                                                                                                                                         Outla s
                                                                               Projection of outlays associated with the recommendation:
                                                                                        2021...                                                                                                                                                     !/     129,100
                                                                                        2022 .. .                                                                                                                                                           88,449
                                                                                        2023 .. .                                                                                                                                                           14,364
                                                                                        2024 ..... .                                                                                                                                                          3,651
                                                                                      2025 and future years ...                                                                                                                                               3,374
                                                                                   l/ Excludes outlays from plior-year budget authority



                                                                                                                                           Financial Assistance to State and Local Governments
                                                                                  In accordance with section 308(a)( l )(C) of the Congressional Budget Act of 1974, as amended, the Congressional Budget Office has provided the
                                                                               following estimates of new budget authority and outlays provided by the accompanying bill for financial assistance to State and local governments,

                                                                                                                                                            [In millions of dollars]

                                                                                                                                                                                                                                     Budget
                                                                                                                                                                                                                                    Authority            Outlays
                                                                                   Financial assistance to State and local governments for 2021.. ...                                                                                        101    11             ~ll

                                                                                   1/ Excludes outlays from prior-year budget authority.




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                                                                                                                                  125

                                                                                                                    FULL COMMITTEE VOTES



                                                                                        Pursuant to the provisions of clause 3(b) of rule XIII of the House of Representatives, the results
                                                                               of each roll call vote on an amendment or on the motion to report, together with the names of those voting
                                                                               for and those voting against, are printed below:

                                                                                                                               Roll Call 1

                                                                               Date: July 9, 2020
                                                                               Measure: Military Construction, Veterans Affairs and Related Agencies Appropriations Bill, FY 2021
                                                                               Motion by: Mr. Harris
                                                                               Description of Motion: To strike sections 129 and 513 prohibiting the use of military construction funds
                                                                               for a wall, barrier, fence, or road along the southern border.
                                                                               Results: Defeated 19 yeas to 31 nays


                                                                                   Members Voting Yea                                 Members Voting Nay
                                                                                   Mr. Aderholt                                       Mr. Aguilar
                                                                                   Mr.Amodei                                          Mr. Bishop
                                                                                   Mr. Calvert                                        Mrs. Bustos
                                                                                   Mr. Carter                                         Mr. Cartwright
                                                                                   Mr. Cole                                           Mr. Case
                                                                                   Mr. Diaz-Balart                                    Ms. Clark
                                                                                   Mr. Fleischmann                                    Mr. Crist
                                                                                   Mr. Fortenberry                                    Mr. Cuellar
                                                                                   Ms. Granger                                        Ms. DeLauro
                                                                                   Mr. Graves                                         Ms. Frankel
                                                                                   Dr. Harris                                         Mr. Hurd
                                                                                   Ms. Herrera Beutler                                Ms. Kaptur
                                                                                   Mr. Joyce                                          Mr.Kilmer
                                                                                   Mr. Moolenaar                                      Mrs. Kirkpatrick
                                                                                   Mr. Newhouse                                       Mrs. Lawrence
                                                                                   Mr. Palazzo                                        Ms. Lee
                                                                                   Mr. Rogers                                         Mrs. Lowey
                                                                                   Mr. Simpson                                        Ms.Mccollum
                                                                                   Mr. Womack                                         Ms. Meng
                                                                                                                                      Ms. Pingree
                                                                                                                                      Mr. Pocan
                                                                                                                                      Mr. Price
                                                                                                                                      Mr. Quigley
                                                                                                                                      Ms. Roybal-Allard
                                                                                                                                      Mr. Ruppersberger
                                                                                                                                      Mr. Rutherford
                                                                                                                                      Mr. Ryan
                                                                                                                                      Mrs. Torres
                                                                                                                                      Mr. Visclosky
                                                                                                                                      Ms. Wasserman Schultz
                                                                                                                                      Mrs. Watson Coleman




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                                                                                                                                  126

                                                                                                                    FULL COMMITTEE VOTES

                                                                                        Pursuant to the provisions of clause 3(b) of rule XIII of the House of Representatives, the results
                                                                               of each roll call vote on an amendment or on the motion to report, together with the names of those voting
                                                                               for and those voting against, are printed below:



                                                                                                                               RollCall 2

                                                                               Date: July 9. 2020
                                                                               Measure: Military Construction, Veterans Affairs and Related Agencies Appropriations Bill, FY 2021
                                                                               Motion by: Ms. Kaptur
                                                                               Description of Motion: To report the bill to the House, as amended.
                                                                               Results: Adopted 30 yeas to 20 nays


                                                                                   Members Voting Yea                                 Members Voting Nay
                                                                                   Mr. Aguilar                                        Mr. Aderholt
                                                                                   Mr. Bishop                                         Mr.Amodei
                                                                                   Mrs. Bustos                                        Mr. Calvert
                                                                                   Mr. Cartwright                                     Mr. Carter
                                                                                   Mr. Case                                           Mr. Cole
                                                                                   Ms. Clark                                          Mr. Diaz-Balart
                                                                                   Mr. Crist                                          Mr. Fleischmann
                                                                                   Mr. Cuellar                                        Mr. Fortenberry
                                                                                   Ms. DeLauro                                        Ms. Granger
                                                                                   Ms. Frankel                                        Mr. Graves
                                                                                   Mr. Hurd                                           Dr. Harris
                                                                                   Ms. Kaptur                                         Ms. Herrera Beutler
                                                                                   Mr. Kilmer                                         Mr. Joyce
                                                                                   Mrs. Kirkpatrick                                   Mr. Moolenaar
                                                                                   Mrs. Lawrence                                      Mr. Newhouse
                                                                                   Ms. Lee                                            Mr. Palazzo
                                                                                   Mrs. Lowey                                         Mr. Rogers
                                                                                   Ms.McCollum                                        Mr. Rutherford
                                                                                   Ms.Meng                                            Mr. Simpson
                                                                                   Ms. Pingree                                        Mr. Womack
                                                                                   Mr. Pocan
                                                                                   Mr. Price
                                                                                   Mr. Quigley
                                                                                   Ms. Roybal-Allard
                                                                                   Mr. Ruppersberger
                                                                                   Mr. Ryan
                                                                                   Mrs. Torres
                                                                                   Mr. Visclosky
                                                                                   Ms. Wasserman Schultz
                                                                                   Mrs. Watson Coleman




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                                                                                                                              127

                                                                                      COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL)
                                                                                                          AUTHORITY
                                                                                 The following table provides a detailed summary, for each De-
                                                                               partment and agency, comparing the amounts recommended in the
                                                                               bill with amounts enacted for fiscal year 2020 and budget esti-
                                                                               mates presented for fiscal year 2021.




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                                                                                COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2020
                                                                                  AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 2021

Jkt 040806
                                                                                                        (Amounts in thousands)

                                                                                                                 FY 2020           FY 2021                            Bill vs.         Bill vs.
                                                                                                                 Enacted           Request              Bi 11          Enacted          Request


PO 00000                                               TITLE I - DEPARTMENT OF DEFENSE

                                          Military Construction,     Army ...                                 1,178,499           650,336           608,336          -570, 163         -42,000


Frm 00128
                                          Military Construction,     Navy and Marine Corps ... .              2,449,632         1,975,606         1,611,914          -837, 718         363,692
                                          Military Construction,     Air Force ................. .            1,687,230           767,132           569,792        -1, 117,438        -197,340
                                          Military Construction,     Defense-Wide ................ .          2,362,529         2,027,520         2,234,517          -128 ,012        +206,997
                                                                                                         ---------------   ---------------   ---------------    --------------   --------------
                                                Total, Active components ............. .                      7,677,890         5,420,594         5,024,559        -2,653,331          396,035

Fmt 6659                                  Military Construction,     Army National Guard ............           210,819           321,437           349,437          +138,618          +28,000
                                          Military Construction,     Air National Guard ........                164,471            64,214            64,214          -100,257
                                                                                                                                                                                                  128
                                          Military Construction,     Army Reserve ...................            60,928            88,337            88,337           +27,409


Sfmt 6602
                                          Military Construction,     Navy Reserve ..   .... ......
                                                                                                "                54,955            70,995            70,995           +16,040
                                          Military Construction,     Air Force Reserve ..............            59,750            23,117            23,117            36,633
                                                                                                         ---------------   ---------------   ---------------    --------------   --------------
                                                Total, Reserve components .......................               550,923           568,100           596,100           +45, 177         +28,000




E:\HR\OC\HR445.XXX
                                          North Atlantic Treaty Organization Security Investment
                                            Program..                       . ................... .             172,005           173,030           173,030            +1,025
                                          Department of Defense Base Closure Account .......... .               398,526           300,447           580,447          +181 ,921        +280,000

                                                Total, Military Construction . . . . . . . . . . . . .        8,799,344         6,462,171         6,374,136        -2,425,208          -88,035

                                          Family Housing Construction, Army.         . " .....                  141,372           119,400           119,400           -21, 972
                                          Family Housing Operation and Maintenance, Army ........               357,907           367,142           367, 142           +9,235
HR445
                                          Family Housing Construction, Navy and Marine Corps ...                 47,661            42,897            42,897            -4,764
                                          Family Housing Operation and Maintenance, Navy and
                                            Marine Corps.                                                       317,870           346,493           346,493           +28,623




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                                                                           COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2020
                                                                             AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 2021

Jkt 040806
                                                                                                   (Amounts in thousands)

                                                                                                              FY 2020           FY 2021                            Bill vs.         Bill vs.
                                                                                                              Enacted           Request              Bi 11          Enacted          Request


PO 00000                                  Family Housing Construction, Air Force ..                          103,631            97,214            97,214            -6,417
                                          Family Housing Operation and Maintenance, Air Force ...            295,016           317,021           317,021           +22,005
                                          Family Housing Operation and Maintenance, Defense-Wide              57,000            54,728            54,728            -2,272


Frm 00129
                                          Department of Defense Family Housing Improvement Fund.               3,045             5,897             5,897            +2,852
                                          Department of Defense Military Unaccompanied Housing
                                            Improvement Fund ................................. .                 500               600               600              +100
                                                                                                      ---------------   ---------------   ---------------    --------------   --------------
                                                Total, Family Housing ................ .                   1,324,002        1,351,392          1,351,392           +27,390

Fmt 6659                                                Administrative Provisions

                                                                                                                                                                                               129
                                          Unfunded Requirements   Services:


Sfmt 6602
                                          Military Construction, Army (Sec. 123).        .......              79,500                             342,600          +263, 100        +342,600
                                          Military Construction, Navy and Marine Corps (Sec.
                                            123) ..                                     .........            374,529                             765,937          +391,408         +765,937
                                          Military Construction, Air Force (Sec.123) ..     ......           288,200                             428,000          +139,800         +428,000
                                          Military Construction, Army National Guard (Sec. 123).             155,000                              34,835          -120, 165         +34,835




E:\HR\OC\HR445.XXX
                                          Military Construction, Air National Guard (Sec. 123) ..             57,000                              54,700             2,300          +54,700
                                          Military Construction, Army Reserve (Sec. 123) .......                                                  48,900           +48,900          +48,900
                                          Military Construction, Air Force Reserve (Sec. 124) ...             24,800                                                24,800
                                          Military Construction, Defense-Wide (Sec. 124) .... ..              66,880                                               -66,880
                                          Military Construction - Military Installation
                                            Resilience (Sec 130) ................ ... . . . . . . .           75,000                                               -75,000




HR445




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                                                                           COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2020
                                                                             AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 2021

Jkt 040806
                                                                                                   (Amounts in thousands)

                                                                                                           FY 2020        FY 2021                        Bill vs.        Bill vs.
                                                                                                           Enacted        Request            Bi 11        Enacted         Request


PO 00000                                  NATO Security Investment Program (rescission)
                                            (Sec.125).                       . ........... .              25,000                                         +25,000
                                          Family Housing Support and Management Costs (Sec.127).         140,800                         135,000          -5,800       +135,000


Frm 00130
                                          Military Construction, Defense-Wide (Sec. 125)
                                            (rescission).   .......     . .................... .          -45,055                                        +45,055

                                                Subtotal, Unfunded Requirements - Services .... .      1,191,654                       1,809,972        +618,318     +1 , 809,972


Fmt 6659
                                          Cost to Complete Projects - Services:
                                          Military Construction, Army (Sec. 126) ..                                                      224,900        +224,900       +224,900
                                          Military Construction, Navy and Marine Corps (Sec.
                                                                                                                                                                                    130
                                            126).........                       . ............... .                                      144,900        +144,900       +144,900


Sfmt 6602
                                          Military Construction, Air Force (Sec. 126) .......... .                                       166,500        +166,500       +166,500
                                          Military Construction, Army Reserve (Sec. 126) ....... .                                        10,200         +10,200        +10, 200
                                          Military Construction, Navy Reserve (Sec. 126) ....... .                                         3,500          +3,500         +3,500
                                          Family Housing Construction, Army (Sec. 126) ......... .                                         4,500          +4,500         +4,500




E:\HR\OC\HR445.XXX
                                                Subtotal, Cost to Complete Projects - Services.                                          554,500        +554,500       +554,500


                                                Total, Administrative Provisions ............. .       1,191,654                       2,364,472     +1,172,818      +2,364,472


                                                Total, title I, Department of Defense ........ .       11,315,000      7,813,563      10,090,000       1,225,000      +2,276,437
                                                    Appropriations ..                                 (11,385,055)    (7,813,563)    (10,090,000)    (-1,295,055)    (+2,276,437)
                                                    Rescissions ..... .                                  ( 70,055)                                       (+70,055)
HR445




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05:39 Jul 14, 2020

                                                                           COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2020
                                                                             AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 2021

Jkt 040806
                                                                                                   (Amounts in thousands)

                                                                                                             FY 2020           FY 2021                            Bill vs.         Bill vs.
                                                                                                             Enacted           Request              Bi 11          Enacted          Request


PO 00000                                        TITLE II - DEPARTMENT OF VETERANS AFFAIRS

                                                     Veterans Benefits Administration


Frm 00131
                                          Compensation and pensions:
                                             Budget year request              ............... .          1,439,931         2,813,922         2,813,922        +1,373,991
                                             Advance from prior year appropriations ......... .        109,017,152       118,246,975       118,246,975        +9,229,823


Fmt 6659
                                                  Total, Compensation and pensions available in
                                                    fiscal year 2021 ...................... .          110,457,083       121,060,897       121,060,897       +10,603,814

                                                                                                                                                                                              131
                                              Advance appropriations.                                   118,246,975       130,227,650       130,227,650      +11,980,675


Sfmt 6602
                                              Less appropriations from prior year advances ....        -109,017,152      -118,246,975      -118,246,975       -9,229,823

                                                  Total, Compensation and pensions appropriated
                                                    in this bill ............................... .     119,686,906       133,041,572       133,041,572       +13,354,666




E:\HR\OC\HR445.XXX
                                          Readjustment benefits:
                                              Budget year request                  ............ .
                                              Advance from prior year appropriations ........... .      14,065,282        12,578,965        12,578,965         1,486,317

                                                  Total, Readjustment benefits available in
                                                    fiscal year 2021.   . ................... .         14,065,282         12,578,965       12,578,965         -1,486,317

                                              Advance appropriations ..                                 12,578,965         14,946,618       14,946,618        +2,367,653
                                              Less appropriations from prior year advances ....         14,065,282        -12,578,965       12,578,965        +1 ,486,317
HR445
                                                                                                     ---------------   ---------------   ---------------    --------------   --------------
                                                  Total, Readjustment benefits appropriated in
                                                    this bill ..                                        12,578,965        14,946,618        14,946,618        +2,367,653




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05:39 Jul 14, 2020

                                                                                   COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2020
                                                                                     AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 2021

Jkt 040806
                                                                                                           (Amounts in thousands)

                                                                                                                    FY 2020       FY 2021                    Bill vs,    Bill vs,
                                                                                                                    Enacted       Request            Bi 11    Enacted     Request


PO 00000
                                          Veterans insurance and indemnities:
                                              Budget year request                . , , , , , , , .. , , , , , .    17,620          2,148           2,148     -15, 4 72


Frm 00132
                                              Advance from prior year appropriations ........ .                   111,340        129,224         129,224     +17,884

                                                    Total, Veterans insurance and indemnities
                                                     available in fiscal year 2021. _________ _                   128,960        131,372         131,372      +2,412


Fmt 6659
                                               Advance appropriations ___ _                                        129,224       136,950         136,950      +7,726
                                               Less appropriations from prior year advances, __ _                 -111, 340     -129,224        -129,224     -17, 884

                                                                                                                                                                                    132
                                                    Total, Veterans insurance and indemnities
                                                     appropriated in this bill __________________ _

Sfmt 6602
                                                                                                                  146,844        139,098         139,098       7,746




E:\HR\OC\HR445.XXX




HR445




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05:39 Jul 14, 2020

                                                                            COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2020
                                                                              AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 2021

Jkt 040806
                                                                                                    (Amounts in thousands)

                                                                                                             FY 2020           FY 2021                              Bill vs.          Bill vs.
                                                                                                             Enacted           Request                 Bill          Enacted           Request


PO 00000                                  Veterans housing benefit program fund:

                                              Credit subsidy:


Frm 00133
                                                  Direct.                                                    -7,000           -18,000            -18,000            -11, 000
                                                  Guaranteed ...                                            708,000         1,681,000          1,681,000           +973,000
                                                                                                     ---------------   ---------------    ---------------     --------------    --------------
                                                Subtotal (Credit subsidy) ........ .                        701,000         1,663,000          1 , 663,000         +962,000


Fmt 6659
                                              (Limitation on direct loans).                                    (500)             (500)                (500)
                                              Administrative expenses ...                                   200,377           204,400              204,400           +4,023

                                                                                                                                                                                                 133
                                          Vocational rehabilitation loans program account.                      58                  34                34                -24


Sfmt 6602
                                              (Limitation on direct loans) ..................... .          (2,008)             (2,470)           (2,470)             (+462)
                                              Administrative expenses.                                         402                 424               424                +22
                                          Native American veteran housing loan program account ..            1,186               1,163             1,186                                 +23
                                          General operating expenses, VBA.    . ....... .                3,125,000           3,207,000         3,187,000            +62,000         -20,000
                                                                                                     ------- --- ---     --- -             -----     ------          -- --   ------ - -----




E:\HR\OC\HR445.XXX
                                                Total, Veterans Benefits Administration ....... .       136,440,738       153,203,309        153,183,332        +16,742,594         -19, 977
                                                    Appropriations ............................. .       (5,485,574)        (7,892,091)       (7,872,114)       (+2,386,540)       (-19, 977)
                                                    Advance appropriations ..................... .     (130,955,164)     (145,311,218)      (145,311,218)      (+14,356,054)

                                                Advances from prior year appropriations ........ .     (123,193,774)     (130,955,164)      (130,955,164)       (+7, 761,390)


                                                      Veterans Health Administration

HR445
                                          Medical services (MS):
                                              Budget year request ......... .                                                 497,468            497,468          +497,468
                                             Advance from prior year.                                   51,411,165         56,158,015         56,158,015        +4,746,850




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05:39 Jul 14, 2020

                                                                           COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2020
                                                                             AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 2021

Jkt 040806
                                                                                                   (Amounts in thousands)

                                                                                                          FY 2020         FY 2021                       Bill vs.       Bill vs.
                                                                                                          Enacted         Request            Bi 11       Enacted        Request


PO 00000                                      Reclassification of prior year appropriations ...                                       -5,594,318     -5,594,318     -5,594,318
                                               Reclassification of prior year appropriations
                                                  (emergency).                    . .......... .                                       5,594,318     +5,594,318     +5,594,318


Frm 00134
                                                  Total, MS available in fiscal year 2021 ..          51,411,165      56,655,483      56,655,483     +5,244,318

                                              Advance appropriations.                                 56,158,015      58,897,219      58,897,219     +2,739,204
                                              Less appropriations from prior years ............ .     51,411,165      56,158,015      56,158,015      4,746,850

Fmt 6659
                                                                                                      ----------      ----------
                                                  Total, MS appropriated in this bill .......... .    56,158,015      59,394,687      59,394,687     +3,236,672

                                                                                                                                                                                  134
Sfmt 6602
                                          Medical community care (MCC):
                                             Advance from prior year ...                              10,758,399      17,131,179      17,131,179     +6 ,372, 780
                                              Reclassification of prior year appropriations .....                                     -3,847, 180    -3,847,180     -3,847,180
                                                Reclassification of prior year appropriations
                                                  (emergency).                       . ... .                                           3,847,180     +3 ,847, 180   +3,847,180




E:\HR\OC\HR445.XXX
                                              Budget year request...    . ............... .            4,521,400       1,380,800       1,380,800      3,140,600
                                                Veterans Choice Fund (by transfer).                     (615,000)                                     (-615,000)

                                                    Total, MCC available in fiscal year 2021 ...      15,279,799      18,511,979      18,511,979     +3,232,180

                                              Advance appropriations.                                 17,131,179      20,148,244      20,148,244     +3 ,017 ,065
                                              Less appropriations from prior years ............. .    10,758,399      17,131,179      17,131,179      6,372,780
                                                                                                      ----------      ----------      ----------
                                                  Total, MCC appropriated in this bill ......... .    21,652,579      21,529,044      21,529,044        123,535
HR445




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05:39 Jul 14, 2020

                                                                            COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2020
                                                                              AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 2021

Jkt 040806
                                                                                                    (Amounts in thousands)

                                                                                                               FY 2020           FY 2021                            Bill vs.         Bill vs.
                                                                                                               Enacted           Request              Bi 11          Enacted          Request


PO 00000                                  Medical support and compliance (MSC):
                                              Budget year request .............................. .             98,800           300,000           279,880          +181,080           20,120
                                             Advance from prior year.                . ........... .        7,239,156         7,914,191         7,914,191          +675,035


Frm 00135
                                              Reclassification of prior year appropriations .... .                                                886,235          -886,235          886,235
                                                Reclassification of prior year appropriations
                                                  (emergency)..........           . ............. .                                               886,235          +886,235         +886,235
                                                                                                       ---------------   ---------------   ---------------    --------------   --------------
                                                  Total, MSC available in fiscal year 2021 ..... .          7,337,956        8,214,191         8,194,071           +856,115           20,120

Fmt 6659                                      Advance appropriations ........................... .          7,914,191         8,403,117         8,403,117          +488,926
                                              Less appropriations from prior years ... .                   -7,239,156        -7,914,191        -7,914,191          -675,035
                                                                                                                                                                                                135
Sfmt 6602
                                                  Total, MSC appropriated in this bill.                     8,012,991        8,703,117         8,682,997           +670,006          -20, 120

                                          Medical facilities (MF):
                                              Budget year request . .   . ....................... .                            150,000            170,120          +170,120          +20, 120
                                             Advance from prior year.                                       6,141,880        6,433,265          6,433,265          +291,385




E:\HR\OC\HR445.XXX
                                              Reclassification of prior year appropriations .....                                                 441,385          -441,385          441,385
                                                Reclassification of prior year appropriations
                                                  (emergency) ................................. .                                                 441,385          +441,385         +441, 385
                                                                                                       ---------------   ---------------   ---------------    --------------   --------------
                                                  Total, MF available in fiscal year 2021 .... .            6,141,880        6,583,265          6,603,385          +461,505          +20, 120

                                              Advance appropriations.          . ............. .            6,433,265         6,734,680         6,734,680          +301,415
                                              Less appropriations from prior years .. .                    -6,141,880        -6,433,265        -6,433,265          -291,385

HR445
                                                  Total, MF appropriated in this bill                       6,433,265        6,884,680          6,904,800          +471,535          +20, 120




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05:39 Jul 14, 2020

                                                                            COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2020
                                                                              AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 2021

Jkt 040806
                                                                                                    (Amounts in thousands)

                                                                                                            FY 2020         FY 2021                        Bill vs.          Bill vs.
                                                                                                            Enacted         Request            Bill         Enacted           Request


PO 00000                                  Medical and prosthetic research ....... .                       800,000         787,000         840,000          +40,000           +53,000

                                          Medical care cost recovery collections:


Frm 00136
                                              Offsetting collections.                                   -3,729,000      -4,403,000      -4,403,000        -674,000
                                              Appropriations (indefinite) ...................... .       3,729,000       4,403,000       4,403,000        +674,000

                                                Subtotal ....... .


Fmt 6659
                                          Medical Care Collections Fund (MCCF) (transfer out)
                                            (Sec. 214).                                                  (-446,000)      (-784,000)      (-784,000)      (-338,000)
                                          Medical Community Care and Medical Services (by
                                                                                                                                                                                         136
                                            transfer) (Sec. 214).                                         (446,000)       (784,000)       (784,000)      (+338,000)


Sfmt 6602
                                          VA medical funds (transfer out) (Sec. 219) ..                  ( 314,409)      ( 322,932)      ( 322,932)        ( 8,523)
                                          DoD-VA Joint Medical Facility Demonstration Fund (by
                                            transfer) (Sec. 219)..........             . ......... .      (314,409)       (322,932)       (322,932)        (+8,523)
                                          MCCF to DoD-VA Joint Medical Facility Demonstration
                                            Fund (transfer out) (Sec. 221) ..................... .        ( 17,000)       (-18,000)       ( 18,000)        ( -1, 000)




E:\HR\OC\HR445.XXX
                                          DoD-VA Joint Medical Facility Demonstration Fund (by
                                            transfer) (Sec. 221).                 .. ......                (17,000)        (18,000)        (18,000)        (+1, 000)
                                          VA Medical Care Funds (transfer out) (Sec. 222) ..              (-15, 000)      (-15,000)       (-15,000)
                                          DoD-VA Health Care Sharing Incentive Fund (by
                                            transfer) (Sec. 222) ........................... .             (15,000)        (15,000)        (15,000)
                                                                                                         ----------      ----------      ----------
                                                Total, Veterans Health Administration .......... .      93,056,850      97,298,528      97 ,351,528     +4,294,678           +53,000
                                                    Appropriations (budget year) .... .                 (5,420,200)     (3,115,268)     (3,168,268)    (-2,251,932)         (+53,000)
                                                    Advance appropriations (FY 2022) ........... .     (87,636,650)    (94,183,260)    (94,183,260)    (+6, 546,610)
HR445                                           Advances from prior year appropriations ..             (75,550,600)    (87,636,650)    (87,636,650)   (+12,086,050)
                                                Reclassification of prior year appropriations.                                        (-10,769,118)   (-10,769,118)     (-10, 769,118)




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05:39 Jul 14, 2020

                                                                               COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2020
                                                                                 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 2021

Jkt 040806
                                                                                                       (Amounts in thousands)

                                                                                                                 FY 2020        FY 2021                              Bill vs,            Bill vs,
                                                                                                                 Enacted        Request              Bi 11            Enacted             Request


PO 00000                                        Reclassification from prior year appropriations
                                                  (emergency) ... ,, ...... ,., .... , .......... , .... .                                (10,769,118)        (+10, 769,118)        (+10, 769,118)



Frm 00137
                                                (By transfer) .. .                                           (1,407,409)    (1,139,932)    (1,139,932)            (-267,477)
                                                (Trans fer out) .                                             (-792,409)   (-1,139,932)   (-1,139,932)            (-347,523)

                                                      National Cemetery Administration


Fmt 6659
                                          National Cemetery Administration ..................... .             329,000        360,000           349,000              +20,000             -11 ,000

                                                         Departmental Administration
                                                                                                                                                                                                     137
Sfmt 6602
                                          General administration ............................... .             355,911        413,000           355,911                                   57,089
                                          Board of Veterans Appeals,,,                                         182,000        198,000           198,000                 +16,000
                                          Information Technology Systems (IT Systems) .......... .           4,371,615      4,912,000        4,371,615                                   540,385
                                            Emergency appropriations,,.,,,.,,,,.,,,,,.,,, .. .                                                  540,385                +540,385         +540,385
                                                                                                                                          .. - - . - . - - - - - - - -     ----·      ----- ·---




E:\HR\OC\HR445.XXX
                                                Subtotal, IT Systems ..                                      4,371,615      4,912,000        4,912,000                 +540,385

                                          Veterans Electronic Health Record (EHR) .............. .           1,500,000      2,627,000       1,442,515                -57,485         -1,184,485
                                            Emergency appropriations .................... .                                                 1,184,485           +1 , 184,485         +1 , 184,485
                                                                                                                                          -·-   --------     --------------        --------------
                                                Subtotal, EHR ................ .                             1,500,000      2,627,000       2,627,000           +1 , 127,000

                                          Office of Inspector General ...... .                                 210,000        228,000         228,000               +18,000
                                          Construction, major projects ... .                                   235,200      1,373,000       1,373,000              +137,800
HR445
                                          Construction, minor projects.                                        398,800        400,000         400,000                +1, 200
                                          Grants for construction of State extended care
                                            facilities.                                                          90,000         90,000          90,000




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05:39 Jul 14, 2020

                                                                           COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2020
                                                                             AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 2021

Jkt 040806
                                                                                                   (Amounts in thousands)

                                                                                                          FY 2020         FY 2021                        Bill vs.       Bill vs.
                                                                                                          Enacted         Request            Bi 11        Enacted        Request


PO 00000                                  Grants for the construction of Veterans cemeteries ..           45,000          45,000          45,000

                                                Total, Departmental Administration ........... .       8,388,526      10,286,000      10,228,911      +1,840,385         -57,089


Frm 00138
                                                    Appropriations ............................ .     (8,388,526)    (10,286,000)     (8,504,041)      (+115,515)   ( 1,781,959)
                                                    Emergency appropriations ................... .                                    (1,724,870)    (+1,724,870)   (+1, 724,870)




Fmt 6659

                                                                                                                                                                                    138
Sfmt 6602




E:\HR\OC\HR445.XXX




HR445




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05:39 Jul 14, 2020

                                                                              COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2020
                                                                                AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 2021

Jkt 040806
                                                                                                      (Amounts in thousands)

                                                                                                                 FY 2020         FY 2021                         Bill vs.         Bill vs.
                                                                                                                 Enacted         Request            Bi 11         Enacted          Request


PO 00000                                                 Administrative Provisions

                                          Medical Support and Compliance (rescission) (Sec. 253)                -10 ,000                                         +10,000


Frm 00139
                                          DOD-VA Health Care Sharing Incentive Fund
                                            (rescission) (Sec. 253) ..... .                                     -15, 949                                         +15,949
                                          Veterans Electronic Health Record (rescission) (Sec.
                                            253).              ...........       . . _______________ _          -70,000                                          +70,000
                                          Medical and Prosthetic Research (rescission) (Sec.

Fmt 6659
                                            253).    .......                ........      . .......... .         50,000                                          +50,000
                                          Board of Veterans Appeals (rescission) (Sec. 253) ..                   -8,000                                           +8,000
                                          National Cemetery Administration (recission) (Sec.
                                                                                                                                                                                              139
                                            253).                                . .... .                        -1 ,000                                          +1, 000


Sfmt 6602
                                          Medical Services (rescission) (Sec. 253) ............. .              350,000                                         +350,000

                                                Total, Administrative Provisions .... .                        -504,949                                         +504,949




E:\HR\OC\HR445.XXX
                                                Total, title II, Department of Veterans Affairs.           237,710,165     261,147,837     261,112,771       +23,402,606           -35,066
                                                    Appropriations.    . ........................ .        (19,623,300)    (21,653,359)    (19,893,423)        (+270, 123)    (-1,759,936)
                                                    Emergency appropriations.     . .............. .                                       (12,493,988)     (+12,493,988)    (+12,493,988)
                                                      (Emergencies in this bill) ............... .                                          (1,724,870)      (+1, 724,870)    (+1,724,870)
                                                      (Reclassification of prior year
                                                        appropriations (emergency)) .....                                                   (10,769,118)    (+10, 769,118)   (+10, 769,118)
                                                    Reclassification of prior year
                                                      appropriations .................. .                                                  (-10,769,118)    (-10,769,118)    (-10,769,118)
                                                     Rescissions ................................ .           ( 504,949)                                       (+504,949)
HR445
                                                     Advance Appropriations:
                                                       (Mandatory) ......... .                             (130,955,164)   (145,311,218)   (145,311,218)    (+14,356,054)
                                                       (Discretionary).                                     (87,636,650)    (94,183,260)    (94,183,260)     (+6, 546,610)




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05:39 Jul 14, 2020

                                                                     COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2020
                                                                       AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 2021

Jkt 040806
                                                                                             (Amounts in thousands)

                                                                                                    FY 2020         FY 2021                     Bill vs.    Bill vs.
                                                                                                    Enacted         Request            Bi 11     Enacted     Request


PO 00000                                  (By transfer) .............................. .        (1,407,409)     (1,139,932)     (1,139,932)    (-267,477)
                                          (Transfer out).        . ................. .           (-792,409)    (-1,139,932)    (-1,139,932)    (-347,523)
                                          (Limitation on direct loans) ............... .            (2,508)          (2,970)        (2,970)        (+462)


Frm 00140




Fmt 6659

                                                                                                                                                                       140
Sfmt 6602




E:\HR\OC\HR445.XXX




HR445




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05:39 Jul 14, 2020

                                                                     COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2020
                                                                       AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 2021

Jkt 040806
                                                                                             (Amounts in thousands)

                                                                                                       FY 2020         FY 2021                        Bill vs.      Bill vs.
                                                                                                       Enacted         Request            Bill         Enacted       Request


PO 00000                                  Advances from prior year appropriations:
                                            (Mandatory) ........................... .            (123,193,774)   (130,955,164)   (130,955,164)    (+7, 761,390)
                                            (Discretionary) .......................... .          (75,550,600)    (87,636,650)    (87,636,650)   (+12,086,050)


Frm 00141
                                          Total, available this fiscal year .............. .      217,862,725     240,245,173     240,210,107     +22, 347,382      -35,066
                                              (Mandatory).    . ......... .                      (125,352,325)   (135,434,234)   (135,434,234)   (+10 ,081,909)
                                              (Discretionary) ............................ .      (92,510,400)   (104,810,939)   (104,775,873)   (+12,265,473)     (-35 ,066)
                                                                                               --------------- --------------- --------------- -------------- --------------
Fmt 6659

                                                                                                                                                                                141
Sfmt 6602




E:\HR\OC\HR445.XXX




HR445




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05:39 Jul 14, 2020

                                                                          COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2020
                                                                            AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 2021

Jkt 040806
                                                                                                  (Amounts in thousands)

                                                                                                         FY 2020         FY 2021                    Bill vs.   Bill vs.
                                                                                                         Enacted         Request            Bi 11    Enacted    Request


PO 00000                                               TITLE III - RELATED AGENCIES

                                                   American Battle Monuments Commission


Frm 00142
                                          Salaries and expenses .....                                    84, 100         75,100          84,100                 +9,000

                                                U.S. Court of Appeals for Veterans Claims


Fmt 6659
                                          Salaries and expenses ..                                       35,400          38,900          37,100      +1,700     -1 ,800

                                                      Department of Defense - Civil
                                                                                                                                                                          142
Sfmt 6602
                                                        Cemeterial Expenses, Army
                                          Salaries and expenses ...                                      80,800          70,800          81,815     +1,015     +11 ,015

                                                Armed Forces Retirement Home - Trust Fund




E:\HR\OC\HR445.XXX
                                          Operation and maintenance ....... .                            41,300          42,300          42,300     +1,000
                                          Capital program ..                                             12,000           6,000           8,800     -3,200      +2,800
                                          Payment from General Fund .....                                22,000          22,000          22,000

                                                Total, Armed Forces Retirement Home .....                75,300          70,300          73,100       2,200     +2,800


                                                Total, title III, Related Agencies ...                  275,600         255,100         276,115        +515    +21 ,015

HR445




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                                                                            COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2020
                                                                              AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 2021

Jkt 040806
                                                                                                    (Amounts in thousands)

                                                                                                              FY 2020           FY 2021                            Bill vs.         Bill vs.
                                                                                                              Enacted           Request              Bi 11          Enacted          Request


PO 00000                                        TITLE IV - OVERSEAS CONTINGENCY OPERATIONS

                                                      Overseas Contingency Operations


Frm 00143
                                          Military Construction, Army ............. .                         33,800                                               -33,800
                                          Military Construction, Air Force ..................... .            66,000                                                66,000
                                          Military Construction, Defense-Wide ................ .


Fmt 6659
                                                Subtotal, Overseas Contingency Operations .... .              99,800                                               -99,800

                                               European Deterrence / Reassurance Initiative
                                                                                                                                                                                               143
Sfmt 6602
                                          Military Construction,   Army ..                                    78,168            15,873            16,111           -62,057             +238
                                          Military Construction,   Navy and Marine Corps ..........           94,570            70,020            70,020            24,550
                                          Military Construction,   Air Force ......................          325,988           263,869           263,869           -62, 119
                                          Military Construction,   Defense-Wide ...................           46,000                                                46,000
                                                                                                      ---------------   ---------------   ---------------    --------------   --------------




E:\HR\OC\HR445.XXX
                                                Subtotal, European Deterrence / Reassurance
                                                  Initiative ................................. .             544,726           349,762           350,000          -194,726             +238


                                                Total, Overseas Contingency Operations .....                 644,526           349,762           350,000           294,526             +238




HR445




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                                                                            COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2020
                                                                              AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 2021

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                                                                                                    (Amounts in thousands)

                                                                                                           FY 2020         FY 2021                       Bill vs.   Bill vs.
                                                                                                           Enacted         Request            Bi 11       Enacted    Request


PO 00000                                            TITLE V - NATURAL DISASTER RELIEF

                                          Military Construction,   Navy and Marine Corps


Frm 00144
                                           (emergency) .....                                            3,477,000                                      3,477,000
                                          Military Construction,   Air Force (emergency) ..             2,605,200                                     -2,605,200
                                          Military Construction,   Defense-Wide (emergency) ..             77,175                                          77,175
                                          Military Construction,   Army National Guard (emergency)         66,000                                         -66,000
                                          Military Construction,   Army Reserve (emergency) ..... .         3,300                                           3,300

Fmt 6659
                                              Total, title V, Natural Disaster Relief
                                                                                                                                                                               144
                                                (emergencies) ......................... .               6,228,675                                     6,228,675


Sfmt 6602




E:\HR\OC\HR445.XXX




HR445




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                                                                           COMPARATIVE STATEMENT OF NEW BUDGET {OBLIGATIONAL) AUTHORITY FOR 2020
                                                                             AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 2021

Jkt 040806
                                                                                                   {Amounts in thousands)

                                                                                                          FY 2020         FY 2021                        Bill vs.   Bill vs.
                                                                                                          Enacted         Request            Bi 11        Enacted    Request


PO 00000                                                   OTHER APPROPRIATIONS

                                              SECOND CORONAVIRUS PREPAREDNESS AND RESPONSE


Frm 00145
                                          SUPPLEMENTAL APPROPRIATIONS ACT, 2020 {P. L. 116 127
                                                                 DIV A)

                                                      Department of Veterans Affairs


Fmt 6659
                                          Medical Services {emergency).                                   30,000                                         -30,000
                                          Medical Community Care {emergency).                             30,000                                          30,000

                                                                                                                                                                               145
                                              Total, Second Coronavirus Preparedness and


Sfmt 6602
                                                Response Supplemental Appropriations Act, 2020 ..         60,000                                         -60,000


                                              EMERGENCY APPROPRIATIONS FOR CORONAVIRUS HEALTH
                                           RESPONSE AND AGENCY OPERATIONS {P. L. 116-136 DIV B)




E:\HR\OC\HR445.XXX
                                                      DEPARTMENT OF VETERANS AFFAIRS

                                                     Veterans Benefits Administration

                                          General Operating Expenses {emergency) .....                    13,000                                         -13 ,000

                                                      Veterans Health Administration

HR445
                                          Medical Services {emergency).   . ...... .                  14,432,000                                     -14,432,000
                                          Medical Community Care {emergency) ...... .                  2,100,000                                       2,100,000
                                          Medical Support and Compliance {emergency).                    100,000                                        -100 ,000




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                                                                             COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2020
                                                                               AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 2021

Jkt 040806
                                                                                                     (Amounts in thousands)

                                                                                                            FY 2020         FY 2021                        Bill vs.   Bill vs.
                                                                                                            Enacted         Request            Bi 11        Enacted    Request


PO 00000                                  Medical Facilities (emergency) .... _..... __ ... _..... .       606,000                                        -606,000

                                              Total, Veterans Health Administration.                    17,238,000                                     -17,238,000


Frm 00146
                                                         Departmental Administration

                                          General Administration (emergency).                                6,000                                         -6,000
                                          Information Technology Systems (emergency). _____ _            2,150,000                                      2,150,000

Fmt 6659
                                          Office of Inspector General (emergency)._.                        12,500                                        -12, 500
                                          Grants for Construction of State Extended Care
                                            Facilities (emergency)._   __... _..... __ ... _..... _        150,000                                        -150,000
                                                                                                                                                                                 146
Sfmt 6602
                                                Total, Departmental Administration.                      2,318,500                                      -2,318,500

                                                Total, Department of Veterans Affairs ... _...          19,569,500                                     -19,569,500

                                                               RELATED AGENCIES




E:\HR\OC\HR445.XXX
                                                       Armed Forces Retirement Home
                                          Payment from General Fund (emergency). _______________ _           2,800                                           2,800


                                                Total, Emergency Appropriations for Coronavirus
                                                  Health Response and Agency Operations. ______ _       19,572,300                                     19,572,300



HR445
                                                Total, Other Appropriations ................... _.      19,632,300                                     -19,632,300




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05:39 Jul 14, 2020

                                                                           COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2020
                                                                             AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 2021

Jkt 040806
                                                                                                   (Amounts in thousands)

                                                                                                           FY 2020         FY 2021                          Bill vs.         Bill vs.
                                                                                                           Enacted         Request             Bi 11         Enacted          Request


PO 00000
                                          Grand total.                                               275,806,266     269,566,262      271,828,886        -3 ,977 ,380     +2,262,624
                                              Appropriations ................................. .     (31,283,955)    (29,722,022)     (30,259,538)      (-1,024,417)       (+537,516)


Frm 00147
                                              Emergency appropriations in this bill ............ .   (25,860,975)                     (12,493,988)     (-13,366,987)    (+12,493,988)
                                                  (Emergencies) ..................... .              (25,860,975)                      (1,724,870)     (-24, 136,105)    (+1, 724,870)
                                                  (Reclassification of prior year appropriations
                                                    (emergency)) ............................... .                                     (10,769,118)    (+10,769,118)    (+10, 769,118)
                                              Reclassification of prior year appropriations .. .                                      (-10,769,118)    (-10, 769,118)   (-10, 769,118)

Fmt 6659
                                              Rescissions .................................. .          (-575,004)                                        (+575,004)
                                              Advance appropriations.                                (218,591,814)   (239,494,478)    (239,494,478)    (+20,902,664)
                                              Overseas contingency operations .............. .           (644,526)       (349,762)        (350,000)       (-294,526)           (+238)
                                                                                                                                                                                         147
Sfmt 6602
                                          Advances from prior year appropriations.                   (198,744,374)   (218,591,814)    (218,591,814)    (+19,847,440)

                                          (By transfer) ........................................ .     (1,407,409)     (1,139,932)      (1,139,932)       (-267,477)
                                          (Transfer out).           . ......... .                       (-792,409)    (-1,139,932)     (-1,139,932)       (-347,523)
                                          (Limitation on direct loans) ......................... .         (2,508)          (2,970)         (2,970)           (+462)




E:\HR\OC\HR445.XXX




HR445




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                                                                                                                               148

                                                                                                                       MILITARY CONSTRUCTION
                                                                                                                       (AMOUNTS IN THOUSANDS)

                                                                                                                                                         BUDGET
                                                                                                                                                        REQUEST            HOUSE

                                                                                                           ALABAMA
                                                                                   AIR NATIONAL GUARD
                                                                                     MONTGOMERY REGIONAL AIRPORT
                                                                                       F-35 SIMULATOR FACILITY.                                         11,600        11,600
                                                                                   DEFENSE-WIDE
                                                                                     ANNISTON ARMY DEPOT
                                                                                       DEMILITARIZATION FACILITY.                                       18,000        18,000
                                                                                         TOTAL ALABAMA                                                  29,600        29,600

                                                                                                           ALASKA
                                                                                   DEFENSE-WIDE
                                                                                     FORT GREELY
                                                                                       COMMUNICATIONS CENTER.                                           48,000        48,000
                                                                                         TOTAL, ALASKA                                                  48,000        48,000

                                                                                                            ARIZONA
                                                                                   ARMY
                                                                                     YUMA PROVING GROUND
                                                                                        READY BUILDING                                                  14,000        14,000
                                                                                   DEFENSE-WIDE
                                                                                     FORT HUACHUCA
                                                                                        LABORATORY BUILDING                                             33,728        33,728
                                                                                     YUMA
                                                                                        SOF HANGAR.                                                     49,500        49,500
                                                                                   ARMY NATIONAL GUARD
                                                                                     TUCSON
                                                                                        NATIONAL GUARD READINESS CENTER                                 18,100        18,100
                                                                                          TOTAL, ARIZONA.                                              115,328       115,328

                                                                                                          CALIFORNIA
                                                                                   NAVY
                                                                                     CAMP PENDLETON
                                                                                        1ST MARDIV OPERATIONS COMPLEX.                                  68, 530       68, 530
                                                                                        I MEF CONSOLIDATED INFORMATION CENTER (INC 2)                   37, 000       37, 000
                                                                                     LEMOORE
                                                                                        F-35C HANGAR 6 PHASE 2 (MOD 3/4)                               128, 070       98, 070
                                                                                        F-35C SIMULATOR FACILITY & ELECTRICAL UPGRADE                   59, 150       59, 150
                                                                                     SAN DIEGO
                                                                                        PIER 8 REPLACEMENT (INC 2)                                     128, 500       98, 500
                                                                                     TWENTYNINE PALMS
                                                                                        WASTEWATER TREATMENT PLANT                                      76, 500       76, 500
                                                                                   DEFENSE-WIDE
                                                                                     BEALE AFB
                                                                                        BULK FUEL TANK.                                                 22, 800       22, 800
                                                                                          TOTAL, CALIFORNIA.                                           520, 550      460, 550

                                                                                                           COLORADO
                                                                                   ARMY
                                                                                     FORT CARSON
                                                                                        PHYSICAL FITNESS FACILITY.                                      28,000        28,000
                                                                                   AIR FORCE
                                                                                     SCHRIEVER AFB
                                                                                        CONSOLIDATED SPACE OPERATIONS FACILITY.                         88,000        88,000
                                                                                   DEFENSE-WIDE
                                                                                     FORT CARSON
                                                                                        SOF TACTICAL EQUIPMENT MAINTENANCE FACILITY.                    15,600        15,600
                                                                                   ARMY NATIONAL GUARD
                                                                                     PETERSON AFB
                                                                                        NATIONAL GUARD READINESS CENTER                                 15,000        15,000
                                                                                          TOTAL, COLORADO                                              146,600       146,600

                                                                                                           FLORIDA
                                                                                   DEFENSE-WIDE
                                                                                     HURLBURT FIELD
                                                                                       SOF COMBAT AIRCRAFT PARKING APRON-NORTH                          38,310        38,310




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                                                                                                                               149

                                                                                                                       MILITARY CONSTRUCTION
                                                                                                                       (AMOUNTS IN THOUSANDS)

                                                                                                                                                         BUDGET
                                                                                                                                                        REQUEST            HOUSE

                                                                                       SOF SPECIAL TACTICS OPS FACILITY (23 STS)                        44,810        44,810
                                                                                   ARMY RESERVE
                                                                                     GAINESVILLE
                                                                                       ECS TEMF/WAREHOUSE                                               36,000        36,000
                                                                                         TOTAL, FLORIDA.                                               119,120       119,120

                                                                                                             GEORGIA
                                                                                   ARMY
                                                                                     FORT GILLEM
                                                                                        FORENSIC LABORATORY.                                            71,000        71,000
                                                                                     FORT GORDON
                                                                                        ADV INDIVIDUAL TRAINING BARRACKS CPLX, PH3                      80,000        80,000
                                                                                          TOTAL, GEORGIA.                                              151,000       151,000

                                                                                                            HAWAII
                                                                                   ARMY
                                                                                     WHEELER ARMY AIR FIELD
                                                                                        AIRCRAFT MAINTENANCE HANGAR.                                    89,000        89,000
                                                                                   NAVY
                                                                                     JOINT BASE PEARL HARBOR-HICKAM
                                                                                        WATERFRONT IMPROVEMENTS WHARVES S1, S11-13, S20-21              48,990        48,990
                                                                                        WATERFRONT IMPROVEMENTS WHARVES S8-S10                          65,910        65,910
                                                                                          TOTAL, HAWAII                                                203,900       203,900

                                                                                                           INDIANA
                                                                                   ARMY NATIONAL GUARD
                                                                                     SHELBYVILLE
                                                                                       NATIONAL GUARD/RESERVE CENTER BUILDING ADD ALT                   12,000        12,000
                                                                                         TOTAL, INDIANA.                                                12,000        12,000
                                                                                                          KENTUCKY
                                                                                   DEFENSE-WIDE
                                                                                     FORT KNOX
                                                                                       VAN VOORHIS ELEMENTARY SCHOOL                                    69,310        69,310
                                                                                   ARMY NATIONAL GUARD
                                                                                     FRANKFORT
                                                                                       NATIONAL GUARD/RESERVE CENTER BUILDING                           15,000        15,000
                                                                                         TOTAL, KENTUCKY                                                84,310        84,310

                                                                                                          LOUISIANA
                                                                                   ARMY
                                                                                     FORT POLK
                                                                                        INFORMATION SYSTEMS FACILITY                                    25,000        25,000
                                                                                          TOTAL, LOUISIANA.                                             25,000        25,000

                                                                                                            MAINE
                                                                                   NAVY
                                                                                     KITTERY
                                                                                        MULTI-MISSION DRYDOCK 1 EXTENSION PH1                          160,000       160,000
                                                                                         TOTAL, MAINE                                                  160,000       160,000

                                                                                                           MARYLAND
                                                                                   DEFENSE-WIDE
                                                                                     BETHESDA NAVAL HOSPITAL
                                                                                       MEDCEN ADDITION/ALTERATION (INC 4)                              180,000       100,000
                                                                                     FORT MEADE
                                                                                       NSAW RECAPITALIZE BUILDING (INC 3)                              250,000       250,000
                                                                                   AIR NATIONAL GUARD
                                                                                     JOINT BASE ANDREWS
                                                                                       F-16 MISSION TRAINING CENTER                                      9,400         9,400
                                                                                   NAVY RESERVE
                                                                                     REISTERSTOWN - CAMP FRETTERD MILITARY RESERVATION
                                                                                       RESERVE TRAINING CENTER.                                         39,500        39,500
                                                                                          TOTAL, MARYLAND                                              478,900       398,900




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                                                                                                                       MILITARY CONSTRUCTION
                                                                                                                       (AMOUNTS IN THOUSANDS)

                                                                                                                                                         BUDGET
                                                                                                                                                        REQUEST            HOUSE



                                                                                                       MASSACHUSETTS
                                                                                   ARMY RESERVE
                                                                                     DEVENS RESERVE FORCES TRAINING AREA
                                                                                       AUTOMATED MULTIPURPOSE MACHINE GUN RANGE                          8, 700        8, 700
                                                                                         TOTAL, MASSACHUSETTS                                            8, 700        8, 700

                                                                                                         MISSISSIPPI
                                                                                   ARMY NATIONAL GUARD
                                                                                     BRANDON
                                                                                       NATIONAL GUARD VEHICLE MAINTENANCE SHOP                          10, 400       10, 400
                                                                                         TOTAL, MISSISSIPPI                                             10, 400       10, 400

                                                                                                          MISSOURI
                                                                                   DEFENSE-WIDE
                                                                                     FORT LEONARD WOOD
                                                                                       HOSPITAL REPLACEMENT (INC 3)                                     40, 000       40, 000
                                                                                     ST LOUIS
                                                                                       NGA WEST (N2W) COMPLEX PHASE (INC 2)                            119, 000      119, 000
                                                                                         TOTAL, MISSOURI                                               159, 000      159, 000

                                                                                                           MONTANA
                                                                                   AIR FORCE
                                                                                     MALMSTROM AFB
                                                                                       WEAPONS STORAGE AND MAINTENANCE FACILITY (INC 2)                 25,000
                                                                                         TOTAL, MONTANA.                                                25,000

                                                                                                          NEBRASKA
                                                                                   ARMY NATIONAL GUARD
                                                                                     NORTH PLATTE
                                                                                       NATIONAL GUARD VEHICHLE MAINTENANCE SHOP                          9,300         9,300
                                                                                         TOTAL, NEBRASKA                                                 9,300         9,300

                                                                                                            NEVADA
                                                                                   NAVY
                                                                                     FALLON
                                                                                        RANGE TRAINING COMPLEX, PHASE 1                                 29,040        29,040
                                                                                          TOTAL, NEVADA                                                 29,040        29,040

                                                                                                         NEW JERSEY
                                                                                   AIR FORCE
                                                                                     JOINT BASE MCGUIRE-DIX-LAKEHURST
                                                                                       MUNITIONS STORAGE AREA                                           22,000        22,000
                                                                                   ARMY NATIONAL GUARD
                                                                                     JOINT BASE MCGUIRE-DIX-LAKEHURST
                                                                                       NATIONAL GUARD READINESS CENTER                                  15,000        15,000
                                                                                         TOTAL, NEW JERSEY.                                             37,000        37,000

                                                                                                          NEW MEXICO
                                                                                   DEFENSE-WIDE
                                                                                     KIRTLAND AFB
                                                                                       ADMINISTRATIVE BUILDING                                          46,600        46,600
                                                                                        TOTAL, NEW MEXICO                                               46,600        46,600

                                                                                                        NORTH CAROLI NA
                                                                                   NAVY
                                                                                     CAMP LEJEUNE
                                                                                        II MEF OPERATIONS CENTER REPLACEMENT (INC 2)                    20,000        20,000
                                                                                   DEFENSE-WIDE
                                                                                     FORT BRAGG
                                                                                        SOF GROUP HEADQUARTERS                                          53,100        53,100
                                                                                        SOF MILITARY WORKING DOG FACILITY                               17,700        17,700
                                                                                        SOF OPERATIONS FACILITY.                                        43,000        43,000
                                                                                   ARMY RESERVE
                                                                                     ASHEVELLE




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                                                                                                                       MILITARY CONSTRUCTION
                                                                                                                       (AMOUNTS IN THOUSANDS)

                                                                                                                                                         BUDGET
                                                                                                                                                        REQUEST            HOUSE

                                                                                       ARMY RESERVE CENTER/LAND                                         24,000        24,000
                                                                                         TOTAL, NORTH CAROLINA.                                        157,800       157,800

                                                                                                            OHIO
                                                                                   DEFENSE-WIDE
                                                                                     WRIGHT-PATTERSON AFB
                                                                                       HYDRANT FUEL SYSTEM                                              23,500        23,500
                                                                                   ARMY NATIONAL GUARD
                                                                                     COLUMBUS
                                                                                       NATIONAL GUARD READINESS CENTER                                  15,000        15,000
                                                                                         TOTAL, OHIO                                                    38,500        38,500

                                                                                                           OKLAHOMA
                                                                                   ARMY
                                                                                     MCALESTER APP
                                                                                        AMMUNITION DEMOLITION SHOP                                      35,000        35,000
                                                                                          TOTAL, OKLAHOMA                                               35,000        35,000

                                                                                                           OREGON
                                                                                   ARMY NATIONAL GUARD
                                                                                     HERMISTON
                                                                                       ENLISTED BARRACKS, TRANSIENT TRAINING                             9,300         9,300
                                                                                         TOTAL, OREGON                                                   9,300         9,300

                                                                                                          PENNSYLVANIA
                                                                                   ARMY
                                                                                     CARLISLE BARRACKS
                                                                                        GENERAL INSTRUCTION BUILDING (INC 2)                            38,000        38,000
                                                                                          TOTAL, PENNSYLVANIA.                                          38,000        38,000

                                                                                                       SOUTH CAROLI NA
                                                                                   ARMY NATIONAL GUARD
                                                                                     JOINT BASE CHARLESTON
                                                                                         NATIONAL GUARD READINESS CENTER                                15,000        15,000
                                                                                         TOTAL, SOUTH CAROLINA.                                         15,000        15,000

                                                                                                          TENNESSEE
                                                                                   ARMY NATIONAL GUARD
                                                                                     MCMINNVILLE
                                                                                      NATIONAL GUARD READINESS CENTER                                   11,200        11,200
                                                                                         TOTAL, TENNESSEE                                               11,200        11,200

                                                                                                            TEXAS
                                                                                   AIR FORCE
                                                                                     JOINT BASE SAN ANTONIO
                                                                                       BMT RECRUIT DORMITORY 8 (INC 2)                                  36, 000       36, 000
                                                                                       T-X ADAL GROUND BASED TRNG SYS SIM                               19, 500       19, 500
                                                                                   DEFENSE-WIDE
                                                                                    FORT HOOD
                                                                                       FUEL FACILITIES                                                  32,700        32,700
                                                                                   ARMY NATIONAL GUARD
                                                                                     FORT WORTH
                                                                                       AIRCRAFT MAINTENANCE HANGAR ADDITION/ALT                          6, 000        6, 000
                                                                                       VEHICLE MAINTENANCE SHOP ADDITION/ALT                             7, 800        7, 800
                                                                                   AIR NATIONAL GUARD
                                                                                     JOINT BASE SAN ANTONIO
                                                                                       F-16 MISSION TRAINING CENTER                                     10,800        10,800
                                                                                   AIR FORCE RESERVE
                                                                                     FORT WORTH
                                                                                       F-35A SIMULATOR FACILITY                                         14, 200       14, 200
                                                                                         TOTAL, TEXAS                                                  127, 000      127, 000




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                                                                                                                       MILITARY CONSTRUCTION
                                                                                                                       (AMOUNTS IN THOUSANDS)

                                                                                                                                                         BUDGET
                                                                                                                                                        REQUEST            HOUSE



                                                                                                            UTAH
                                                                                   AIR FORCE
                                                                                     HILL AFB
                                                                                       GBSD MISSION INTEGRATION FACILITY (INC 2)                        68,000        68,000
                                                                                   ARMY NATIONAL GUARD
                                                                                     NEPHI
                                                                                       NATIONAL GUARD READINESS CENTER                                  12,000        12,000
                                                                                   NAVY RESERVE
                                                                                     HILL AFB
                                                                                       NAVAL OPERATIONAL SUPPORT CENTER.                                25,010        25,010
                                                                                         TOTAL, UTAH                                                   105,010       105,010

                                                                                                           VIRGINIA
                                                                                   ARMY
                                                                                     HUMPHREYS ENGINEER CENTER
                                                                                        TRAINING SUPPORT FACILITY.                                      51,000        51,000
                                                                                   NAVY
                                                                                     NORFOLK
                                                                                        E-2D TRAINING FACILITY                                          30,400        30,400
                                                                                        MH60 & CMV-22B CORROSION CONTROL & PAINT FACILITY.              17,671        17,671
                                                                                   AIR FORCE
                                                                                     JOINT BASE LANGLEY-EUSTIS
                                                                                        ACCESS CONTROL POINT MAIN GATE WITH LAND ACQ                    19,500        19,500
                                                                                   DEFENSE-WIDE
                                                                                     JOINT EXPEDITIONARY BASE LITTLE CREEK-STORY
                                                                                        SOF DCS OPERATIONS FAC AND COMMAND CENTER                       54,500        54,500
                                                                                        SOF NSWG-2 NSWTG CSS FACILITIES                                 58,000        58,000
                                                                                          TOTAL, VIRGINIA                                              231,071       231,071

                                                                                                         WASHINGTON
                                                                                   DEFENSE-WIDE
                                                                                     JOINT BASE LEWIS-MCCHORD
                                                                                       FUEL FACILITIES (LEWIS MAIN)                                     10,900        10,900
                                                                                       FUEL FACILITIES (LEWIS NORTH)                                    10,900        10,900
                                                                                     MANCHESTER
                                                                                       BULK FUEL STORAGE TANKS PHASE                                    82,000        82,000
                                                                                         TOTAL, WASHINGTON                                             103,800       103,800

                                                                                                          WISCONSIN
                                                                                   ARMY NATIONAL GUARD
                                                                                     APPLETON
                                                                                       NATIONAL GUARD READINESS CENTER ADD/ALT                          11,600        11,600
                                                                                   ARMY RESERVE
                                                                                     FORT MCCOY
                                                                                       SCOUT RECONNAISSANCE RANGE                                       14,600        14,600
                                                                                         TOTAL, WISCONSIN                                               26,200        26,200

                                                                                                     CONUS UNSPECIFIED
                                                                                   DEFENSE-WIDE
                                                                                     CONUS UNSPECIFIED
                                                                                       TRAINING TARGET STRUCTURE                                        14,400        14,400
                                                                                         TOTAL, CONUS CLASSIFIED                                        14,400        14,400

                                                                                                        BAHRAIN ISLAND
                                                                                   NAVY
                                                                                     SW ASIA
                                                                                        SHIP TO SHORE UTILITY SERVICES                                  68,340        68,340
                                                                                          TOTAL, BAHRAIN ISLAND                                         68,340        68,340

                                                                                                           GERMANY
                                                                                   DEFENSE-WIDE
                                                                                     RHINE ORDNANCE BARRACKS
                                                                                       MEDICAL CENTER REPLACEMENT (INC 9)                              200,000       200,000
                                                                                         TOTAL, GERMANY.                                               200,000       200,000




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                                                                                                                                153

                                                                                                                        MILITARY CONSTRUCTION
                                                                                                                        (AMOUNTS IN THOUSANDS)

                                                                                                                                                          BUDGET
                                                                                                                                                         REQUEST            HOUSE



                                                                                                               GREECE
                                                                                   NAVY
                                                                                   SOUDA BAY
                                                                                        COMMUNICATION CENTER                                             50, 180       50, 180
                                                                                          TOTAL, GREECE                                                  50, 180       50, 180

                                                                                                             GUAM
                                                                                   NAVY
                                                                                     ANDERSON AFB
                                                                                        ORDNANCE OPERATIONS ADMIN                                        21 ,280       21 , 280
                                                                                     JOINT REGION MARIANAS
                                                                                        BACHELOR ENLISTED QUARTERS                                       80, 000
                                                                                        BASE WAREHOUSE                                                   55, 410       55, 410
                                                                                        CENTRAL FUEL STATION                                             35, 950       35, 950
                                                                                        CENTRAL ISSUE FACILITY                                           45, 290       45, 290
                                                                                        COMBINED EOD FACILITY.                                           37, 600       37, 600
                                                                                        DAR BRIDGE IMPROVEMENTS                                          40, 180       40, 180
                                                                                        DAR ROAD STRENGTHENING                                           70, 760       70, 760
                                                                                        DISTRIBUTION WAREHOUSE                                           77, 930       77, 930
                                                                                        INDIVIDUAL COMBAT SKILLS TRAINING                                17, 430       17, 430
                                                                                        JOINT COMMUNICATION UPGRADE                                     166, 000       22, 000
                                                                                   AIR FORCE
                                                                                     JOINT REGION MARIANAS
                                                                                        STAND OFF WEAPONS COMPLEX, MSA 2                                 56,000        56,000
                                                                                   AIR NATIONAL GUARD
                                                                                     JOINT REGION MARIANAS
                                                                                        SPACE CONTROL FACILITY 5                                         20, 000       20, 000
                                                                                          TOTAL, GUAM                                                   723, 830      499, 830

                                                                                                            JAPAN
                                                                                   NAVY
                                                                                     YOKO SU KA
                                                                                        PIER 5 (BERTHS 2 AND 3) (INC 2)                                  74,692
                                                                                   DEFENSE-WIDE
                                                                                     YOKO SU KA
                                                                                        KINNICK HIGH SCHOOL                                              30, 000
                                                                                     DEF FUEL SUPPORT POINT TSURUMI
                                                                                        FUEL WHARF                                                       49, 500       49, 500
                                                                                          TOTAL, JAPAN                                                  154, 192       49, 500

                                                                                                         MARIANA ISLANDS
                                                                                   AIR FORCE
                                                                                     TI NIAN
                                                                                        AIRFIELD DEVELOPMENT, PHASE 1 (INC 2)                            20, 000
                                                                                        FUEL TANKS W/ PIPELINE/HYDRANT SYSTEM (INC 2)                     7, 000
                                                                                        PARKING APRON (INC 2)                                            15, 000
                                                                                          TOTAL, MARIANA ISLANDS                                         42, 000

                                                                                                         PUERTO RICO
                                                                                   ARMY NATIONAL GUARD
                                                                                     FORT ALLEN
                                                                                       NATIONAL GUARD READINESS CENTER                                   37, 000       37, 000
                                                                                         TOTAL, PUERTO RICO                                              37, 000       37, 000
                                                                                                           QATAR
                                                                                   AIR FORCE
                                                                                     AL UDEID
                                                                                       CARGO MARSHALLING YARD                                            26, 000       26, 000
                                                                                         TOTAL, QATAR                                                    26, 000       26, 000




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                                                                                                                       MILITARY CONSTRUCTION
                                                                                                                       (AMOUNTS IN THOUSANDS)

                                                                                                                                                         BUDGET
                                                                                                                                                        REQUEST            HOUSE



                                                                                                            SPAIN
                                                                                   NAVY
                                                                                     ROTA
                                                                                        MH-60R SQUADRON SUPPORT FACILITIES                              60,110        60,110
                                                                                        TOTAL, SPAIN                                                    60,110        60,110

                                                                                                       VIRGIN ISLANDS
                                                                                   ARMY NATIONAL GUARD
                                                                                     ST CROIX
                                                                                       ARMY AVIATION SUPPORT FACILITY (AASF)                            28, 000       28, 000
                                                                                       CTS READY BUILDING                                               11 ,400       11 , 400
                                                                                         TOTAL, VIRGIN ISLANDS                                          39, 400       39, 400

                                                                                     NATO SECURITY INVESTMENT PROGRAM                                  173, 030      173, 030

                                                                                                     WORLDWIDE UNSPECIFIED
                                                                                   ARMY
                                                                                     HOST NATION SUPPORT                                                39, 000       39, 000
                                                                                     PLANNING AND DESIGN                                               129, 436       69, 436
                                                                                     SOUTHCOM PLANNING AND DESIGN                                                      8, 000
                                                                                     OTHER PLANNING AND DESIGN                                                        10, 000
                                                                                     MINOR CONSTRUCTION                                                 50, 900       50, 900
                                                                                          SUBTOTAL, ARMY.                                              219, 336      177, 336
                                                                                   NAVY
                                                                                     PLANNING AND DESIGN                                               165, 710      160, 710
                                                                                     MINOR CONSTRUCTION                                                 38, 983       38, 983
                                                                                          SUBTOTAL, NAVY.                                              204, 693      199, 693
                                                                                   AIR FORCE
                                                                                     PLANNING AND DESIGN                                               296, 532      166, 192
                                                                                     MINOR CONSTRUCTION                                                 68, 600       68, 600
                                                                                          SUBTOTAL, AIR FORCE                                          365, 132      234, 792
                                                                                   DEFENSE-WIDE
                                                                                     ENERGY RESILIENCE AND CONSERVATION INVESTMENT
                                                                                        PROGRAM                                                        142, 500      439, 497
                                                                                     PLANNING AND DESIGN
                                                                                        DEFENSE-WIDE                                                    24, 897       10, 647
                                                                                        DEFENSE-WIDE ERCIP                                                            24, 250
                                                                                        INDOPACOM PLANNING AND DESIGN                                                 10, 000
                                                                                        DEFENSE HEALTH AGENCY.                                          64, 406       64, 406
                                                                                        DEPARTMENT OF DEFENSE EDUCATION AGENCY.                         27, 746       27, 746
                                                                                        NATIONAL SECURITY AGENCY                                        10, 303       10, 303
                                                                                        SPECIAL OPERATIONS COMMAND                                      32, 624       32, 624
                                                                                          SUBTOTAL, DEFENSE-WIDE                                       302, 476      619, 473
                                                                                     UNSPECIFIED MINOR CONSTRUCTION
                                                                                        DEFENSE-WIDE                                                     3, 000        3, 000
                                                                                        DEFENSE HEALTH AGENCY.                                          20, 000       20, 000
                                                                                        DEFENSE LOGISTICS AGENCY                                         9, 726        9, 726
                                                                                        DEPARTMENT OF DEFENSE EDUCATION AGENCY.                          8, 000        8, 000
                                                                                        MISSILE DEFENSE AGENCY                                           4, 922        4, 922
                                                                                        SPECIAL OPERATIONS COMMAND                                      17, 698       17, 698
                                                                                        THE JOINT STAFF                                                  5, 840        5, 840
                                                                                          SUBTOTAL, UNSPECIFIED MINOR CONSTRUCTION                      69, 186       69, 186
                                                                                   ARMY NATIONAL GUARD
                                                                                     PLANNING AND DESIGN                                                29, 593       44, 593
                                                                                     MINOR CONSTRUCTION                                                 32, 744       45, 744
                                                                                   AIR NATIONAL GUARD
                                                                                     PLANNING AND DESIGN                                                 3, 414        3, 414
                                                                                     MINOR CONSTRUCTION                                                  9, 000        9, 000
                                                                                   ARMY RESERVE
                                                                                     PLANNING AND DESIGN                                                 1 ,218        1 , 218
                                                                                     MINOR CONSTRUCTION                                                  3, 819        3, 819
                                                                                   NAVY RESERVE




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                                                                                                                               155

                                                                                                                       MILITARY CONSTRUCTION
                                                                                                                       (AMOUNTS IN THOUSANDS)


                                                                                                                                                         BUDGET
                                                                                                                                                        REQUEST            HOUSE


                                                                                     PLANNING AND DESIGN                                                 3, 485         3, 485
                                                                                     MINOR CONSTRUCTION                                                  3, 000         3, 000
                                                                                   AIR FORCE RESERVE
                                                                                     PLANNING AND DESIGN                                                 3, 270         3, 270
                                                                                     MINOR CONSTRUCTION                                                  5, 647         5, 647
                                                                                     SUBTOTAL, WORLDWIDE UNSPECIFIED                                  ,729, 490    2, 177, 147

                                                                                                     FAMILY HOUSING, ARMY
                                                                                   ITALY
                                                                                     VICENZA
                                                                                       FAMILY HOUSING NEW CONSTRUCTION (130 UNITS)                      84, 100       84, 100
                                                                                   KWAJALEIN
                                                                                       REPLACEMENT CONSTRUCTION (24 UNITS)                              32, 000       32, 000
                                                                                   PLANNING AND DESIGN                                                   3, 300        3, 300
                                                                                                                                                   ------------ ------------
                                                                                         SUBTOTAL, CONSTRUCT! ON                                       119,400       119,400

                                                                                   OPERATION AND MAINTENANCE
                                                                                     UTILITES ACCOUNT                                                   41 ,183       41 , 183
                                                                                     SERVICES ACCOUNT                                                    8, 135        8, 135
                                                                                     MANAGEMENT ACCOUNT                                                 39, 716       39, 716
                                                                                     MISCELLANEOUS ACCOUNT                                                  526            526
                                                                                     FURNISHINGS ACCOUNT                                                18, 004       18, 004
                                                                                     LEASING                                                           123, 841      123, 841
                                                                                     MAINTENANCE OF REAL PROPERTY                                       97, 789       97, 789
                                                                                     PRIVATIZATION SUPPORT COSTS                                        37, 948       37, 948
                                                                                         SUBTOTAL, OPERATIONS AND MAINTENANCE                          367, 142      367, 142

                                                                                             FAMILY HOUSING, NAVY AND MARINE CORPS
                                                                                   JAPAN
                                                                                     YOKO SU KA
                                                                                       CONSTRUCTION PLANNING AND DESIGN (66 UNITS)                      37, 043       37, 043
                                                                                   PLANNING AND DESIGN                                                   3, 128        3, 128
                                                                                   PLANNING AND DESIGN FOR USMC/DPRI GUAM                                2, 726        2, 726
                                                                                          SUBTOTAL, CONSTRUCT! ON                                       42, 897       42, 897
                                                                                   OPERATION AND MAINTENANCE
                                                                                     UTILITES ACCOUNT                                                   58, 429       58, 429
                                                                                     SERVICES ACCOUNT                                                   16, 743       16, 743
                                                                                     MANAGEMENT ACCOUNT                                                 51 ,006       51 , 006
                                                                                     MISCELLANEOUS ACCOUNT                                                  350            350
                                                                                     FURNISHINGS ACCOUNT                                                17, 977       17, 977
                                                                                     LEASING                                                            62, 658       62, 658
                                                                                     MAINTENANCE OF REAL PROPERTY                                       85, 630       85, 630
                                                                                     PRIVATIZATION SUPPORT COSTS                                        53, 700       53, 700
                                                                                           SUBTOTAL, OPERA TI ON AND MAINTENANCE                       346, 493      346, 493

                                                                                                 FAMILY HOUSING, AIR FORCE
                                                                                   JAPAN
                                                                                     KADENA
                                                                                       CONSTRUCTION IMPROVEMENTS (117 UNITS)                            94,245        94,245
                                                                                   PLANNING AND DESIGN                                                   2,969         2,969
                                                                                                                                                   ------------ ------------
                                                                                         SUBTOTAL, CONSTRUCTION                                         97,214        97,214

                                                                                   OPERATION AND MAINTENANCE
                                                                                     UTILITIES ACCOUNT                                                  43, 173       43, 173
                                                                                     MANAGEMENT ACCOUNT                                                 64, 732       64, 732
                                                                                     SERVICES ACCOUNT                                                    7, 968        7, 968
                                                                                     FURNISHINGS ACCOUNT                                                25, 805       25, 805
                                                                                     MISCELLANEOUS ACCOUNT                                               2, 184        2, 184
                                                                                     LEASING                                                             9, 318        9, 318
                                                                                     MAINTENANCE OF REAL PROPERTY                                      140, 666      140, 666
                                                                                     PRIVATIZATION SUPPORT COSTS                                        23, 175       23, 175
                                                                                         SUBTOTAL, OPERATION AND MAINTENANCE                           317, 021      317, 021




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                                                                                                                       MILITARY CONSTRUCTION
                                                                                                                       (AMOUNTS IN THOUSANDS)

                                                                                                                                                         BUDGET
                                                                                                                                                        REQUEST            HOUSE

                                                                                                FAMILY HOUSING, DEFENSE-WIDE
                                                                                   OPERATION AND MAINTENANCE
                                                                                     NATIONAL SECURITY AGENCY
                                                                                       UTILITIES ACCOUNT                                                     13             13
                                                                                       FURNISHINGS ACCOUNT                                                   82             82
                                                                                       LEASING                                                          12, 996        12, 996
                                                                                     MAINTENANCE OF REAL PROPERTY                                            32             32
                                                                                     DEFENSE INTELLIGENCE AGENCY
                                                                                       UTILITIES ACCOUNT                                                 4, 100         4, 100
                                                                                       FURNISHINGS ACCOUNT                                                  645            645
                                                                                       LEASING                                                          36, 860        36, 860
                                                                                                                                                   ------------ ------------
                                                                                         SUBTOTAL, OPERATION AND MAINTENANCE                            54, 728        54, 728

                                                                                   DOD MILITARY UNACCOMPANIED HOUSING IMPROVEMENT FUND                      600            600
                                                                                   DOD FAMILY HOUSING IMPROVEMENT FUND                                   5, 897         5, 897
                                                                                                BASE REALIGNMENT AND CLOSURE
                                                                                   BASE REALIGNMENT AND CLOSURE ACCOUNT                                300, 447       580, 447
                                                                                        TOTAL, BASE REALIGNMENT AND CLOSURE                            300, 447       580, 447

                                                                                                 ADMINISTRATIVE PROVISIONS
                                                                                   UNFUNDED REQUIREMENTS - SERVICES
                                                                                   MILITARY CONSTRUCTION, ARMY (Sec 123)                                              342,600
                                                                                   MILITARY CONSTRUCTION, NAVY AND MARINE CORPS (Sec
                                                                                     123)                                                                             765,937
                                                                                   MILITARY CONSTRUCTION, AIR FORCE (Sec 123)                                         428,000
                                                                                   MILITARY CONSTRUCTION, ARMY NATIONAL GUARD (Sec 123)                                34,835
                                                                                   MILITARY CONSTRUCTION, AIR NATIONAL GUARD (Sec 123)                                 54,700
                                                                                   MILITARY CONSTRUCTION, ARMY RESERVE (Sec 123)                                       48,900
                                                                                   FAMILY HOUSING SUPPORT AND MANANGEMENT COSTS (Sec
                                                                                     131)                                                                             135,000
                                                                                   SUBTOTAL, UNFUNDED REQUIREMENTS -        SERVICES                                1,809,972
                                                                                   COST TO COMPLETE PROJECTS - SERVICES
                                                                                   MILITARY CONSTRUCTION, ARMY (Sec 126)                                              224,900
                                                                                   MILITARY CONSTRUCTION, NAVY AND MARINE CORPS (Sec
                                                                                     126)                                                                             144,900
                                                                                   MILITARY CONSTRUCTION, AIR FORCE (Sec 126)                                         166,500
                                                                                   MILITARY CONSTRUCTION, ARMY RESERVE (Sec 126)                                       10,200
                                                                                   MILITARY CONSTRUCTION, NAVY RESERVE (Sec 126)                                        3,500
                                                                                   FAMILY HOUSING CONSTRUCTION, ARMY (Sec 126)                                          4,500

                                                                                   SUBTOTAL, COST TO COMPLETE PROJECT                                                 554,500


                                                                                   ADMINISTRATIVE TOTAL                                                             2,364,472



                                                                                         GRAND TOTAL                                                 7,813,563     10,090,000




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                                                                                                                                157

                                                                                                                  OVERSEAS CONTINGENCY OPERATIONS
                                                                                                                      (AMOUNTS IN THOUSANDS)

                                                                                                                                                           BUDGET
                                                                                                                                                          REQUEST            HOUSE



                                                                                                          GERMANY
                                                                                   AIR FORCE
                                                                                     RAMSTEIN
                                                                                       EDI RAPID AIRFIELD DAMAGE REPAIR STORAGE                           36,345         36,345
                                                                                     SPANGDAHLEM AB
                                                                                       EDI RAPID AIRFIELD DAMAGE REPAIR STORAGE                           25,824         25,824

                                                                                          TOTAL, GERMANY.                                                 62,169         62,169

                                                                                                               ROMANIA
                                                                                   AIR FORCE
                                                                                     CAMPIA TURZII
                                                                                       EDI DANGEROUS CARGO PAD                                            11,000         11,000
                                                                                       EDI ECAOS DABS-FEV STORAGE COMPLEX.                                68,000         68,000
                                                                                       EDI PARKING APRON                                                  19,500         19,500
                                                                                       EDI POL INCREASE CAPACITY                                          32,000         32,000

                                                                                          TOTAL, ROMANIA.                                                130,500        130,500

                                                                                                               SPAIN
                                                                                   NAVY
                                                                                     ROTA
                                                                                        EDI      EOD BOAT SHOP                                            31,760         31,760
                                                                                        EDI      EXPEDITIONARY MAINTENANCE FACILITY.                      27,470         27,470

                                                                                          TOTAL, SPAIN                                                    59,230         59,230




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                                                                                                                 OVERSEAS CONTINGENCY OPERATIONS
                                                                                                                     (AMOUNTS IN THOUSANDS)

                                                                                                                                                          BUDGET
                                                                                                                                                         REQUEST            HOUSE

                                                                                                      WORLDWIDE UNSPECIFIED

                                                                                                        PLANNING AND DESIGN

                                                                                   ARMY                                                                  11,903         12,141
                                                                                   NAVY                                                                  10,790         10,790
                                                                                   AIRFORCE                                                              54,800         54,800

                                                                                         TOTAL, PLANNING AND DESIGN                                      77,493         77,731


                                                                                                        MINOR CONSTRUCTION
                                                                                   ARMY                                                                   3,970          3,970
                                                                                   AIRFORCE                                                              16,400         16,400

                                                                                        TOTAL, MINOR CONSTRUCTION                                        20,370         20,370

                                                                                              GRAND TOTAL                                               349,762        350,000




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

                                                                                                                                  Æ




                                                                                                                              (159)




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