Military Construction, Veterans Affairs, and Related Agencies Appropriations Bill, 2023
Summary
House Report 117–391 is the report of the Committee on Appropriations, submitted by Ms. Wasserman Schultz of Florida and ordered to be printed June 27, 2022, with minority views, on H.R. 8238, the bill making appropriations for military construction, veterans affairs and related agencies for the fiscal year ending September 30, 2023. The report states that the purpose of the bill is to support the military and their families and provide the benefits and medical care that veterans have earned, and that it funds four related agencies including the American Battle Monuments Commission and the Armed Forces Retirement Home. It states that the Committee recommends $314,057,258,000 in total budget authority for fiscal year 2023.
Summary drafted by a model from the document's text below and checked by script against that text before publication. It is a navigation aid, not a reading of what the document proves. Where AI is used
- Issuer
- Congressional materials
- Document type
- Crpt Crpt 117Hrpt391 Crpt 117Hrpt391
- Case
- Crpt Crpt 117Hrpt391 Crpt 117Hrpt391
Cite this document
“Military Construction, Veterans Affairs, and Related Agencies Appropriations Bill, 2023.”
Original at www.govinfo.gov. Archived at Pandemic Darlings, https://pandemicdarlings.com/source-documents/crpt-crpt-117hrpt391-crpt-117hrpt391/
, SHA-256 3dfaa6c21393aa4ad139daaf7b79c8044394c8b4a1806a2f9eaf9a53987c7aa4.Full text
117TH CONGRESS REPORT
" HOUSE OF REPRESENTATIVES !
2d Session 117–391
MILITARY CONSTRUCTION, VETERANS AFFAIRS, AND
RELATED AGENCIES APPROPRIATIONS BILL, 2023
JUNE 27, 2022.—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. 8238]
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, 2023.
INDEX TO BILL AND REPORT
Page Number
Bill Report
Purpose of the Bill ...................................................................................... ........ 2
Summary of Committee Recommendation ............................................... ........ 2
Management and Oversight Initiatives .................................................... ........ 3
Department of Defense:
Military Construction ......................................................................... 2 6
NATO Security Investment Program ................................................ 9 21
Department of Defense Base Closure Account ................................. 10 22
Family Housing Construction and Operation and Maintenance .... 10 23
Department of Defense Family Housing Improvement Fund ......... 12 25
Department of Defense Military Unaccompanied Housing Im-
provement Fund .............................................................................. 12 26
Administrative Provisions .................................................................. 13 26
Department of Veterans Affairs:
Veterans Benefits Administration ..................................................... 30 31
Veterans Health Administration ....................................................... 34 38
National Cemetery Administration ................................................... 38 76
Departmental Administration ............................................................ 39 77
rfrederick on DSKB3L4F33PROD with HEARING
Administrative Provisions .................................................................. 47 87
47–868
VerDate Sep 11 2014 08:38 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00001 Fmt 6659 Sfmt 6659 E:\HR\OC\HR391.XXX HR391
2
Page Number
Bill Report
Related Agencies:
American Battle Monuments Commission ........................................ 80 92
U.S. Court of Appeals for Veterans Claims ...................................... 81 93
Cemeterial Expenses, Army ............................................................... 81 93
Armed Forces Retirement Home ....................................................... 82 94
Administrative Provision .................................................................... 83 95
General Provisions ..................................................................................... 84 95
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 veterans have
earned because of their service to our nation. This is accomplished
through the programs funded in the bill, which provide the facili-
ties 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 infra-
structure 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 $314,057,258,000 in total budget au-
thority, for the fiscal year 2023 programs and activities funded in
the bill. The fiscal year 2023 recommendation represents an in-
crease of $29,459,676,000 above the comparable fiscal year 2022
enacted level and $2,850,075,000 above the President’s request. Of
the increase over the fiscal year 2022 enacted level, $6,509,676,000
is in mandatory programs. Included in the total budget authority
is $163,557,258,000 in mandatory budget authority and
$150,500,000,000 in discretionary budget authority.
The Committee recommendation highlights the continued com-
mitment to our servicemembers and their families and to our vet-
erans. In overall discretionary budget authority, the bill is 18 per-
cent above the fiscal year 2022 enacted level. While the Committee
recommendation continues essential support for servicemembers
and veterans, it does not provide funds for projects or activities
that lacked sufficient justification or urgency.
The programs funded in the bill for the Department of Defense
address the priorities of the Department’s agencies and the Serv-
ices for the numerous facility challenges that they face. The funds
provided support readiness improvements with new construction,
family housing, and continued cleanup of military bases closed dur-
rfrederick on DSKB3L4F33PROD with HEARING
ing previous Base Realignment and Closure rounds, support Com-
batant Commanders’ requirements where appropriate, and ensure
VerDate Sep 11 2014 08:38 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00002 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
3
that military personnel and their families’ quality of life is pre-
served.
The total recommended funding level for military construction
and family housing is $15,053,000,000, which is $153,000,000 more
than the fiscal year 2022 enacted level and $2,899,035,000 above
the budget request. The recommendation provides critical invest-
ments in Family Housing and construction on our bases, including
additional resources above the budget request for child develop-
ment centers, unaccompanied housing, the North Atlantic Treaty
Organization Security Investment Program, installation resiliency,
land and water remediation, natural disaster recovery expenses,
laboratory infrastructure, support for critical overseas investments,
and increased oversight of the Department’s privatized housing
portfolio.
The total recommended funding level for fiscal year 2023 for the
Department of Veterans Affairs is $298,563,339,000, an increase of
$29,299,957,000 over the fiscal year 2022 enacted level. Of the
total, $163,557,258,000 is provided for mandatory benefit programs
and $135,006,081,000 is allocated to discretionary programs, such
as medical care and research, claims processing, and construction,
with $118,814,000,000 specifically for medical care. In this bill, dis-
cretionary funding for the Department of Veterans Affairs is rec-
ommended at 20.3 percent over the fiscal year 2022 enacted level.
Of the total for fiscal year 2023, $111,287,000,000 for medical care
has been appropriated in advance.
In addition, the Committee recommendation includes
$128,104,000,000 in advance appropriations for fiscal year 2024 for
the four health care accounts of the Department and
$155,351,762,000 in advance appropriations for mandatory benefits
programs in fiscal year 2024.
The Committee recommendation provides a total of $440,919,000
for the four Related Agencies: The American Battle Monuments
Commission (ABMC), the U.S. Court of Appeals for Veterans
Claims, Army Cemeterial Expenses (including Arlington National
Cemetery), and the Armed Forces Retirement Home. These funds
are provided to ensure that these agencies are able to continue
their missions of honoring the service and sacrifice of our
servicemembers and veterans.
MANAGEMENT AND OVERSIGHT INITIATIVES
The Committee believes the effective stewardship of taxpayer
dollars is of the highest priority. In the interest of eliminating
waste, fraud, and abuse in Federal programs, the Committee has
and will continue to use public hearings, briefings, information 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
the Related Agencies under the jurisdiction of this bill.
The fiscal year 2023 appropriations bill and the accompanying
report address management challenges of the Federal agencies it
funds, including directives to strengthen financial and program
rfrederick on DSKB3L4F33PROD with HEARING
management, eliminate redundancy, and improve implementation
and oversight of initiatives that support the mission of this bill.
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00003 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
4
The Committee will use every means at its disposal to reduce mis-
management that results in waste, fraud, and abuse.
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. Addition-
ally, some housing providers have admitted to incidences of incen-
tive fee fraud. The military housing privatization initiative (MHPI)
was established by Congress in 1996 as a tool to help DOD improve
the quality of life for its servicemembers by improving the condi-
tion of their housing. MHPI is a public/private venture (PPV)
where private sector developers may own, operate, maintain, im-
prove, and assume responsibility for military family housing. The
private entity is responsible for managing the construction, renova-
tion, and day-to-day maintenance and services for the community.
The PPV housing may be located on or off government property
and may be former military family housing. Congress has man-
dated that all military family housing in the United States be even-
tually privatized. The Committee includes report language direct-
ing DOD to submit various reports and maintain a maintenance
database to track any issues that may be prevalent in the future.
The Committee notes that the general welfare of a servicemember’s
family contributes to the overall state of readiness for DOD and
that increased oversight of the MHPI is essential in order to ensure
proper maintenance, quality service, and legal operations.
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 $1,759,000,000 in fiscal year 2023 for EHRM
and continues strict quarterly reporting of timelines, performance
milestones, costs, implementation, and change management. The
bill also continues the requirement for GAO to review EHRM im-
plementation so that Congress can be informed of any problems at
a point where they can be promptly and economically addressed.
Disability Claims and Appeals.—Due to the significant 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. The Committee
recognizes this threat and provides resources within the Veterans
Benefits Administration to support staffing, automation, and other
efforts to respond to claims. The Committee additionally provides
increases to the Board of Veterans Appeals and the Court of Ap-
peals for Veterans Claims to help ensure the prompt resolution of
cases. The Committee hopes that with these additional invest-
ments, Congress will have taken the necessary management action
to prevent veterans from enduring excessive wait times to receive
the disability benefits they deserve.
Information Technology (IT).—The Committee continues to in-
clude bill language indicating that funds for information technology
rfrederick on DSKB3L4F33PROD with HEARING
systems development are available only for the projects and in the
amounts specified in the report. The bill limits the amount of funds
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00004 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
5
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 on Appropriations of both Houses of Congress.
Strict 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.
Army Cemeterial Expenses.—The Committee has provided fund-
ing for Arlington National Cemetery to complete its Southern Ex-
pansion project to sustain the active life of the Cemetery, as well
as additional construction projects to improve the Cemetery. The
Committee requires the Cemetery to provide regular reports on the
status of these funds, and previously appropriated funds, to con-
tinue to provide oversight over these projects.
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 continues to make oper-
ations and maintenance funds available for two years to allow
AFRH to make more effective use of its funds. These efforts will
ensure that AFRH is well-positioned to continue to improve its
standing and increase revenue for the long term. The Committee
notes that efforts are underway to stabilize the AFRH Trust Fund
and reduce reliance on transfers from the General Fund, and di-
rects AFRH to continue making progress toward improving AFRH’s
sustainability. The Committee has also provided funding in a
Major Construction account to support the renovation of the main
resident building at the Washington campus, and directs AFRH to
provide quarterly reports on the status of this construction project,
including obligations of funds, anticipated timelines, and any
changes to the overall cost of the project.
Army Corps of Engineers Updates on VA Projects.—The Com-
mittee directs VA to continue to provide monthly updates on all
current and subsequent VA construction projects worth more than
$100,000,000 and jointly managed by VA and the Army Corps of
Engineers. Regular reports for certain projects may be submitted
on a quarterly basis if the Department and Committee come to an
agreement that more frequent reports are not necessary.
Advertising Contracts for Small Business.—The Committee un-
derstands that, as the largest advertiser in the United States, the
Federal government should work to ensure fair access to its adver-
tising contracts for small disadvantaged businesses and businesses
owned by minorities and women. The Committee directs each de-
rfrederick on DSKB3L4F33PROD with HEARING
partment and agency to include the following information in its fis-
cal year 2024 budget justification: Expenditures for fiscal year 2022
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00005 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
6
and expected expenditures for fiscal year 2024, respectively, for (1)
all contracts for advertising services; and (2) contracts for the ad-
vertising services of (I) socially and economically disadvantaged
small businesses concerns (as defined in section 8(a)(4) of the Small
Business Act (15 U.S.C. 637(a)(4)); and (II) women- and minority-
owned businesses.
Non-disparagement and Non-disclosure Clauses Covering Work-
place Harassment.—The Committee is strongly opposed to con-
tracts with any company that requires employees or independent
contractors to enter into agreements containing a non-disparage-
ment or non-disclosure clause covering workplace harassment, in-
cluding sexual harassment and sexual assault, or retaliation for re-
porting, resisting, opposing, or otherwise participating in a work-
place harassment proceeding, as a condition of employment, pro-
motion, compensation, benefits, or change in employment status.
Federal Law Enforcement.—The explanatory statement that ac-
companied the Commerce, Justice, Science, and Related Agencies
Appropriations Act, 2022 directed the Attorney General to ensure
implementation of evidence-based training programs on de-esca-
lation, the use-of-force, and the protection of civil rights, that are
broadly applicable and scalable to all Federal law enforcement
agencies. Several agencies funded by this Act employ Federal law
enforcement officers and are Federal Law Enforcement Training
Centers partner organizations. These agencies are again directed to
consult with the Attorney General regarding the implementation of
these programs for their law enforcement officers. The Committee
further directs such agencies to submit a report to the Committee
on their efforts relating to such implementation not later than 90
days after consultation with the Attorney General. In addition, the
Committee continues to direct such agencies to the extent that they
are not already participating, to consult with the Attorney General
and the Director of the FBI regarding participation in the National
Use-of-Force Data Collection. The Committee further directs such
agencies to submit a report to the Committee not later than 180
days after enactment of this Act on their efforts to so participate.
TITLE I
DEPARTMENT OF DEFENSE
MILITARY CONSTRUCTION OVERVIEW
Appropriation, fiscal year 2022 ......................................................... $14,900,000,000
Budget request, fiscal year 2023 ....................................................... 12,153,965,000
Committee Recommendation, fiscal year 2023 ................................ 15,053,000,000
Change from enacted level ......................................................... +153,000,000
Change from budget request ...................................................... +2,899,035,000
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.
rfrederick on DSKB3L4F33PROD with HEARING
In addition to the notification and reporting requirements for
military construction programs contained in Title 10, United States
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00006 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
7
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
future increase or decrease via below-threshold reprogramming
(provided that the project or account is not a Congressional interest
item as defined above).
In addition to these guidelines, the Services are directed to 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.
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
rfrederick on DSKB3L4F33PROD with HEARING
metric measurement. Rules for funding repairs of facilities under
the operation and maintenance accounts are described below:
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00007 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
8
(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 2023 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
$10,000,000 to or from the Foreign Currency account.
Bid Savings.—The Committee directs the Secretary of Defense to
submit 1002 reports on military construction bid savings not later
than 180 days after enactment of this Act, and biannually there-
after, to the Committees on Appropriations of both Houses of Con-
gress.
Supporting Resilient Military Installations.—The Committee sup-
ports the military’s continued focus on building lasting and resil-
ient military installations, including methods that update hurri-
cane-resistant building codes for bases, barracks, hospitals, and
rfrederick on DSKB3L4F33PROD with HEARING
airfields. It further considers the impact of severe drought and
desertification as high potential instability areas and how these
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00008 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
9
two hazards impact bases and missions. In addition to Department-
wide initiatives such as revised structure planning, conservation
programs and modeling new installations with the threat of sea-
level rise in mind, the Committee encourages the Department of
Defense to prioritize investing in climate-sustainable infrastructure
projects that have yielded positive results like increased resiliency
and cost-savings. As such, the bill includes section 411 prohibiting
the use of funds to construct facilities that do not meet resiliency
standards.
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.
Federally Recognized Tribes.—The Committee reminds the Serv-
ices that consultations with the Tribes are required by current law
and as such expects the Services to begin tribal consultations on
proposed military construction projects that are likely to affect trib-
al lands, cultural properties, or treaty rights as early as possible
and preferably prior to submission of DD Form 1391 Project Data
Sheet.
Child Development Centers (CDCs).—The bill includes
$274,383,000 for planning and design and construction of child de-
velopment center projects. This investment of resources is nec-
essary to address both insufficient accessibility to childcare facili-
ties, as well as the poor conditions of existing facilities. Such short-
falls in capacity are an unacceptable burden to military families,
leading to thousands of children of servicemembers forced onto
waitlists for childcare. The Committee is disappointed by the lack
of attention paid to this priority in the budget requests and directs
the Department to assign greater priority to CDC construction
projects in future budget requests.
Unaccompanied Personnel Housing.—The Committee provides
$510,443,000 for 10 construction projects to ensure that
servicemembers who live in unaccompanied personnel housing have
safe, modern, and secure living facilities.
New Construction Technologies.—The Committee is encouraged
by reports that three dimensional (3D) construction could provide
military civil engineers with a faster means of building facilities
when deployed and reduce supply lines and the number of per-
sonnel needed for construction and related activities and urges the
Department to study, develop, and utilize 3D construction capabili-
ties as appropriate.
Agile Combat Employment Concept of Operations.—The logistical
burden of operating and sustaining forces under constant threat of
attack is a significant challenge, and the Committee encourages the
Services to thoughtfully consider various initiatives that reduce
their logistical footprints, including rapid repair and additive man-
ufacturing construction capabilities that can exploit locally avail-
able natural resources or native materials in contested logistics en-
vironments.
rfrederick on DSKB3L4F33PROD with HEARING
U.S. Indo-Pacific Command Planning and Design.—The rec-
ommendation includes $50,000,000 for U.S. Indo-Pacific Command
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00009 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
10
Planning and Design, World-Wide Unspecified (Pacific Deterrence
Initiative).
Unfunded Priority Lists (UPL) and Future Years Defense Pro-
gram (FYDP).—The Committee directs the Department of Defense
and all Services, active and reserve components, as well as combat-
ant commanders, as required by law, to submit updated UPL and
FYDP lists to the congressional defense committees for military
construction projects no later than 10 days after the transmission
of the annual President’s Budget.
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, limiting en-
vironmental impact, and increasing functionality of various mili-
tary structures. The Committee encourages the Secretary of De-
fense to expand the application of these innovative technologies in
future planning and design for military construction projects. Fur-
thermore, the Department is directed to provide a report not later
than 180 days after enactment of this Act on how it is currently
using cross laminated timber and other mass timber products, as
well as the feasibility and advisability of expanding their use.
Project Cost Increases.—The Committee provided $230,851,000 in
fiscal year 2022 and provides $698,057,000 in fiscal year 2023 to
supplement discrepancies in outdated cost estimates and current
cost estimates. The Committee is concerned that the Department
is not being proactive in determining future cost increases when
developing and submitting project cost estimates to Congress in the
yearly President’s budget request, Future Years Defense Program
(FYDP), and unfunded priorities lists (UPLs). The Committee rec-
ognizes that market conditions, supply chain issues, and the
COVID–19 pandemic contributed to volatile shifts in cost. However,
the Department has not properly adjusted to incorporate these fac-
tors into its project estimate submissions nor communicated real-
ized cost increases to Congress, thus placing the burden on Con-
gress to supplement the costs of projects in order to meet the ac-
tual needs, which is woefully unacceptable. Therefore, the Com-
mittee directs the Department to implement practices to better ad-
dress future cost increases and submit official project cost adjust-
ments to the Committee every 30 days following the original sub-
mission and until enactment of the next fiscal year appropriations
Act.
Laboratory Infrastructure.—The Committee directs the Depart-
ment to prioritize laboratory infrastructure construction projects in
the fiscal year 2024 submission to Congress. For too long, labs have
been neglected to the detriment of research, development, techno-
logical advancement, and readiness. Therefore, the Committee in-
cludes $100,000,000 for planning and design necessary for labora-
tory infrastructure. The Department is further directed to prioritize
laboratory infrastructure that is needed to address safety and envi-
ronmental concerns on installations and requires a spend plan not
later than 90 days after enactment of this Act on how the Depart-
ment plans to use these funds.
Open Air Burn Pans.—No later than 180 days after enactment
of this Act, the Department is directed to submit a report to the
rfrederick on DSKB3L4F33PROD with HEARING
Committee detailing a plan to eliminate burning of hazardous ma-
terials, including open air burn pans, at installations located in the
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00010 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
11
United States. Such a plan should detail at what installations each
Service is still utilizing open-air burning, including burn pans, and
how the Department will transition away from the use of open-air
burn pans.
Airborne Infectious Diseases.—The COVID–19 pandemic has cre-
ated unique challenges for buildings that were not designed to di-
rectly address the risks posed by bacteria or viruses commonly
transmitted through respiratory droplets. As the current pandemic
unfolded, the Department of Defense made responsive modifica-
tions to existing buildings, such as reopening windows that had
been permanently sealed shut, adding new air filtration systems,
installing plexiglass barriers and mandating social distancing
where possible. Despite these efforts, risks remain to employees in
shared office spaces. To help better understand potential solutions
that can be implemented in a cost-effective manner, the Committee
encourages the Under Secretary of Defense for Acquisition and
Sustainment to consider lessons learned from implementing cost-ef-
fective techniques for reducing airborne infectious diseases in exist-
ing buildings and assess how to incorporate designs in future con-
struction projects that can reduce the spread of airborne infectious
diseases.
MILITARY CONSTRUCTION, ARMY
Appropriation, fiscal year 2022 ......................................................... $1,051,772,000
Budget request, fiscal year 2023 ....................................................... 845,565,000
Committee Recommendation, fiscal year 2023 ................................ 997,425,000
Change from enacted level ......................................................... ¥54,347,000
Change from budget request ...................................................... +151,860,000
The Committee recommends $997,425,000 for the Army in fiscal
year 2023, of which $101,860,000 is for the following projects in the
following amounts:
State Location Project Amount
HI ....................... Fort Shafter ................................ Water System Upgrade ......................................... $2,000,000
HI ....................... Tripler Medical Center ............... Water System Upgrade ......................................... 2,000,000
LA ...................... Fort Polk ..................................... Joint Operations Center ........................................ 61,000,000
MD ..................... Aberdeen Proving Ground .......... Test Maintenance Fabrication Facility ................. 7,600,000
NC ..................... Fort Bragg .................................. Child Development Center ................................... 3,600,000
NY ...................... Fort Drum ................................... Automated Record Fire Plus Range ..................... 3,600,000
TX ...................... Fort Hood ................................... Automated Infantry Battle Squad Course ............ 600,000
TX ...................... Fort Hood ................................... Automated Infantry Platoon Battle Course .......... 1,220,000
TX ...................... Fort Hood ................................... Automated Multipurpose Machine Gun Range .... 1,240,000
TX ...................... Fort Hood ................................... Barracks ............................................................... 19,000,000
Within the total for Military Construction, Army, the rec-
ommendation also includes $240,011,000 for planning and design,
which is $46,860,000 above the budget request; and $105,414,000
for unspecified minor construction, which is $25,000,000 above the
budget request.
Further detail of the Committee’s recommendation is provided in
the State table at the end of this report.
Mobilization Force Generation Installations.—The Committee
continues to be concerned that installations with rapid deployment
requirements, including Mobilization Force Generation Installa-
tions, have insufficient rail and transport logistics infrastructure to
rfrederick on DSKB3L4F33PROD with HEARING
efficiently move equipment in support of deployments, training op-
erations, and evolving Army requirements.
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00011 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
12
Army Barracks.—The Committee understands the importance of
maintaining our servicemembers at the highest level of readiness
as our nation continues to face new threats. A key component of
that readiness is providing high-quality barracks. The Committee
recommends the refurbishment of housing installations where con-
ditions have fallen below the Army’s high standards.
Guantanamo Bay Detention Facility Closure.—The Committee di-
rects the Secretary of Defense to submit a report to the Committees
on Appropriations of both Houses of Congress not later than 60
days after enactment of this Act, and quarterly thereafter, on the
current number of detainees at the Guantanamo Bay detention fa-
cility; their legal status; a description of all Department of Defense
costs associated with the facility during the last two fiscal years by
program, account, and activity; the status of funds for the current
fiscal year; and a description of steps taken to close the facility.
Hawaii Infrastructure Readiness Initiative (HIRI).—HIRI was
created to address critical military construction and readiness
shortfalls because failing and failed infrastructure has put oper-
ational needs at risk in the military’s priority theater. To address
this crisis, HIRI proposed to allocate between $50,000,000 and
$150,000,000 per year through fiscal year 2030 to address major
readiness related infrastructure needs, with a ten-year cost of
$1,100,000,000. These projects were intended to be fully separate
from and supplemental to the Army’s consideration of other mili-
tary construction needs at U.S. Army Garrison Hawaii in the nor-
mal course. While the U.S. Army’s FYDP currently includes var-
ious HIRI projects or projects similar to HIRI projects, it currently
only contains one non-HIRI project. This suggests that HIRI
projects are potentially displacing other projects critical to the re-
capitalization of U.S. Army Garrison Hawaii’s aging infrastructure.
This was not Congress’ intent nor direction. Therefore, the Com-
mittee directs the Secretary of the Army to submit a report no later
than 180 days after the enactment of this Act consisting of: (1) the
strategy for addressing poor or failing infrastructure at U.S. Army
Garrison Hawaii that were not part of HIRI; and (2) an explanation
of how the U.S. Army evaluates non-HIRI projects for Hawaii when
selecting construction projects for the FYDP.
Tobyhanna Army Depot (ARD) Microelectronics Development.—
The Committee views Tobyhanna ARD as an advantageous location
for the build-out of physical space for future Army Materiel Com-
mand (AMC) packaging of ‘‘digital twins’’ or microelectronics for re-
placement in equipment. The Committee requests that the Army
keep the Committee informed regarding AMC construction needs in
this area.
Recycling of Tire Rubber.—The Committee is aware of recent ad-
vances in the use of rubber modified asphalt (RMA), a resilient
pavement technology which incorporates ground tire rubber made
from scrap tires into asphalt. RMA delivers significant, proven ben-
efits in terms of pavement durability, economics, and environ-
mental sustainability. Compared to traditional asphalt, RMA im-
proves fuel economy, provides cost savings over the life of the as-
phalt, extends pavement life, and reduces maintenance activities,
noise pollution, carbon dioxide emissions, and tire and road wear
rfrederick on DSKB3L4F33PROD with HEARING
particles. Therefore, the Army is encouraged to work with its in-
dustry partners and the research community to assess the dura-
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00012 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
13
bility and economic feasibility of widescale deployment of RMA on
domestic military installations.
Army Responsiveness to Congressional Requests.—The Committee
is concerned with the Army’s lack of responsiveness to questions
and requests for technical assistance. Overly bureaucratic proc-
esses among administrative offices, major commands, and program
offices for responding to inquiries from Members and Committees
can negatively affect congressional decisions, which ultimately can
negatively affect the Army. The Committee directs the Department
to immediately and systematically improve these processes and its
communications with Congress.
MILITARY CONSTRUCTION, NAVY AND MARINE CORPS
Appropriation, fiscal year 2022 ......................................................... $2,644,277,000
Budget request fiscal year 2023 ........................................................ 3,752,391,000
Committee Recommendation, fiscal year 2023 ................................ 3,808,340,000
Change from enacted level ......................................................... +1,164,063,000
Change from budget request ...................................................... +55,949,000
The Committee recommends $3,808,340,000 for the Navy and
Marine Corps in fiscal year 2023, of which $5,949,000 is for the fol-
lowing project in the following amount:
State Location Project Amount
FL ...................... MCSF Blount Island ................... Communications Infrastructure Modernization .... $5,949,000
Within the total for Military Construction, Navy and Marine
Corps, the recommendation also includes $428,073,000 for planning
and design, which is $30,949,000 above the budget request; and
$134,994,000 for unspecified minor construction, which is
$25,000,000 above the budget request.
Further detail of the Committee’s recommendation is provided in
the State table at the end of this report.
Shipyard Infrastructure Optimization Plan (SIOP).—The Com-
mittee recognizes the critical strategic and logistics role public
shipyards play in the security of the nation. To address chronically
unmet infrastructure needs at the shipyards, the fiscal year 2018
National Defense Authorization Act included language directing
the Department of Defense to create and implement a Shipyard In-
frastructure Optimization Plan. The Committee strongly supports
efforts to modernize and improve facilities at the Navy’s four public
shipyards to equip them to address the maintenance needs of the
Navy’s current and future active fleet and emphasizes the impor-
tant role military construction must play in achieving this goal.
Additionally, the Committee expects clear communication from
the Navy to the Committee regarding additional flexibilities or au-
thorizations necessary to successfully coordinate with tribal govern-
ments for expeditious completion of SIOP. The Committee remains
concerned that without additional authorities from Congress, the
Navy risks delaying critical dry dock construction projects and
harming their valuable relationships with tribal governments.
Project Labor Agreements (PLAs).—The Committee recognizes
that PLAs promote economy and efficiency in contracting, as well
as foster labor-management stability and ensure compliance with
rfrederick on DSKB3L4F33PROD with HEARING
worker protection laws. The Committee is also aware that the first
military construction project which used a PLA, the Explosive Han-
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00013 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
14
dling Wharf at Naval Base Kitsap, came under budget by over
$250,000,000 when it was completed in 2016. For these reasons,
the Committee encourages the Department of the Navy to follow
Executive Order 14063 and make use of PLAs with essential ele-
ments of Community Workforce Agreements for military construc-
tion projects associated with SIOP.
Naval Air Weapons Station (NAWS) China Lake Earthquake Re-
covery Efforts.—NAWS China Lake is a critical installation that
provides important capabilities to support our national defense.
The Committee appreciates the Navy’s efforts to rebuild NAWS
China Lake in response to the 2019 earthquakes that caused sig-
nificant damage to the installation and applauds the close coordi-
nation with supporting communities to maximize these rebuilding
efforts. The Committee directs the Navy to continue to prioritize
the rebuilding efforts and maintain open communication with the
supporting communities to ensure the projects stay on track for
timely completion.
Defense Support Infrastructure in The Bahamas.—The Com-
mittee is concerned with the state of infrastructure supporting U.S.
Navy installations in the Commonwealth of The Bahamas. The
Committee recognizes that damage inflicted by Hurricane Dorian
has strained local government resources and therefore impedes the
ability to rebuild Bahamian-owned structures integral to the
Navy’s mission in the region. Therefore, the Committee directs the
Department of the Navy to provide a briefing no later than 90 days
after the enactment of this Act on the condition of supporting infra-
structure for Navy installations in The Bahamas, potential infra-
structure projects that may be eligible for the Defense Access
Roads Program, and resources available to assist The Bahamas in
development of Defense-related support infrastructure.
MILITARY CONSTRUCTION, AIR FORCE
Appropriation, fiscal year 2022 ......................................................... $2,204,750,000
Budget request, fiscal year 2023 ....................................................... 2,055,456,000
Committee Recommendation, fiscal year 2023 ................................ 2,291,156,000
Change from enacted level ......................................................... +86,406,000
Change from budget request ...................................................... +235,700,000
The Committee recommends $2,291,156,000 for the Air Force in
fiscal year 2023, of which $185,700,000 is for the following projects
in the following amounts:
State Location Project Amount
AL ...................... Maxwell AFB ............................... Commercial Vehicle Inspection Gate ................... $15,000,000
FL ...................... Eglin AFB ................................... F–35A ADAL Squadron Operations ....................... 2,500,000
FL ...................... Eglin AFB ................................... F–35A Developmental Test 2–Bay Test Hangar .. 3,700,000
FL ...................... Eglin AFB ................................... F–35A Developmental Test 2–Bay MX Hangar .... 4,100,000
FL ...................... Patrick SFB ................................ Consolidated Communications Facility ................ 97,000,000
OH ..................... Wright-Patterson AFB ................ Child Development Center ................................... 29,000,000
TX ...................... JBSA Lackland AFB .................... Basic Military Training Recruit Dormitory 8 ........ 5,400,000
TX ...................... JBSA Randolph AFB ................... Child Development Center ................................... 29,000,000
Within the total for Military Construction, Air Force, the rec-
ommendation also includes $171,094,000 for planning and design,
which is $35,300,000 above the budget request; and $91,162,000 for
rfrederick on DSKB3L4F33PROD with HEARING
unspecified minor construction, which is $25,000,000 above the
budget request.
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00014 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
15
Further detail of the Committee’s recommendation is provided in
the State table at the end of this report.
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 for AETC.
Outdated and inadequate AETC facilities, including dormitories,
harm the Air Force’s ability to recruit, train, and retain Airmen
and increases operations and maintenance costs. The Committee
urges the Air Force to prioritize funding for AETC facility design,
construction, and construction improvements and requests a report
within 90 days of enactment of this Act regarding plans to mod-
ernize, upgrade, and construct new AETC facilities over the next
five years.
Air Traffic Control Towers.—The Committee is aware that some
control towers along the Gulf Coast have fire safety concerns, lack
proper heating and air conditioning, and are vulnerable to tropical
storms and hurricanes and therefore encourages the Air Force to
ensure they are properly maintained and upgraded or replaced as
necessary, to meet mission requirements. The Committee urges the
Department of the Air Force to prioritize replacing their oldest tow-
ers in a timely manner. The Committee believes that these towers
are valuable national security assets that the Department of the
Air Force should maintain in a manner that will ensure their vital
role in protecting U.S. national security interests.
PFAS Water Treatment Demonstration Project.—The Committee
remains concerned about the areas that have been contaminated
with PFAS by the Air Force’s previous use of firefighting foam on
former installations, resulting in PFAS contamination that has
spread beyond the installations and traveled to neighboring private
lands and water sources, including agricultural lands. Therefore,
the Committee encourages the Department to consider the creation
of a water treatment demonstration project for areas impacted by
PFAS contamination from BRAC sites.
MILITARY CONSTRUCTION, DEFENSE-WIDE
(INCLUDING TRANSFER OF FUNDS)
Appropriation, fiscal year 2022 ......................................................... $2,206,051,000
Budget request, fiscal year 2023 ....................................................... 2,416,398,000
Committee Recommendation, fiscal year 2023 ................................ 2,675,128,000
Change from enacted level ......................................................... +469,077,000
Change from budget request ...................................................... +258,730,000
The Committee recommends $2,675,128,000 for Military Con-
struction, Defense-Wide in fiscal year 2023, of which $58,730,000
is for the following projects in the following amounts:
State Location Project Amount
FL ...................... MacDill AFB ............................... SOF Joint MISO Web-Operations Facility .............. $8,730,000
FL ...................... MacDill AFB ............................... SOF Operations Integration Facility ..................... 50,000,000
Within the total, the recommendation provides $144,072,000 for
unspecified minor construction, and $506,107,000 for planning and
design, including $50,000,000 above the budget request for U.S.
Indo-Pacific Command (USINDOPACOM).
rfrederick on DSKB3L4F33PROD with HEARING
Further detail of the Committee’s recommendation is provided in
the State table at the end of this report.
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00015 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
16
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 $653,250,000 for ERCIP construction, an
increase of $100,000,000 above the request.
Leadership in Energy and Environmental Design (LEED).—The
Committee encourages DOD to capitalize on the current energy ef-
ficiency, management, and resiliency momentum and explore op-
portunities to make more significant progress towards reducing en-
ergy costs, increasing the use of renewable energy sources, and re-
ducing carbon emissions. As DOD works to construct new bases
and upgrade facilities, the Committee directs DOD to leverage new
energy technologies and maximize the integration of clean renew-
able and alternative energy sources throughout all military facili-
ties and installations. DOD should brief the Committee with de-
tails on necessary resources to ensure all new construction and ren-
ovations are ‘‘Platinum’’ LEED certified. In addition, climate
change is increasing the frequency and duration of severe weather
events. When these weather events damage military facilities and
installations, they reduce readiness by delaying operations and
training. The briefing should also address how to assess resources
and the strategy necessary to ensure new construction and/or ren-
ovations are designed to withstand severe weather events or are re-
located to lower risk of damage.
Energy Efficiency and Security.—DOD installation energy use ac-
counts for nearly a quarter of all Federal government energy con-
sumption. In fiscal year 2015, according to DOD’s Annual Energy
Management Report, the Department spent $3,900,000,000 on in-
stallation energy. While DOD has made great strides in increasing
installation energy efficiency and reducing overall energy consump-
tion, more needs to be done to bring down the energy costs
throughout the Department. DOD must also increase its efforts to
enhance energy security on its installations through a range of ac-
tions, including investing in renewable energy and smart tech-
nology that can shield mission-critical operations from disruptions
to the power grid. According to a January 2017 report commis-
sioned by the Pew Charitable Trusts, ‘‘Power Begins at Home: As-
sured Energy for U.S. Military Bases’’, DOD could enhance energy
security on installations and save hundreds of millions of dollars
annually by investing in microgrids and renewable energy systems
and by increasing energy efficiency on military bases.
The Committee notes that military installations in Hawaii are
among those at the forefront of DOD’s efforts to increase energy ef-
ficiency and security, including projects to develop net-zero energy
military housing and installation facilities, upgrade and retrofit
systems to improve energy and water efficiency, and demonstrate
microgrid technology. The Committee supports DOD’s investments
in energy efficiency, renewable energy systems, and energy secu-
rity, including through ERCIP. The Committee encourages the De-
partment to prioritize funding for energy-related projects, including
renewable energy projects, to mitigate risk to mission-critical as-
sets and to promote energy security and efficiency at military in-
stallations.
rfrederick on DSKB3L4F33PROD with HEARING
Stormwater Management Projects.—The Committee recognizes
that resilient built and natural infrastructure on and around mili-
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00016 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
17
tary bases are essential in maintaining military readiness. The
Committee also recognizes the increasing variability of the fre-
quency and intensity of precipitation globally and the need to miti-
gate flooding and runoff. The Committee supports the implementa-
tion of stormwater best management practices, but recognizes there
is currently no dedicated, authorized DOD entity that prioritizes
stormwater management projects on and off military installations.
Therefore, the Committee directs the Department to conduct a fea-
sibility study and submit a report no later than 180 days after en-
actment of this Act assessing the potential creation of a program
that prioritizes stormwater management projects in order to en-
hance resilience and improve water quality in stormwater-stressed
ecosystems, where the Department has restoration partnership ob-
ligations, and where land subsidence and the expansion of non-per-
meable surfaces exacerbate flooding on and around military bases.
Additionally, the Committee applauds states and localities that uti-
lize current precipitation data to inform the design of stormwater
management features that are built to address current and future
needs.
Unified Facilities Guide Specifications.—The Committee recog-
nizes the importance of the Unified Facilities Guide Specifications
but remains concerned it references building materials that no
longer exist or no longer reflect high standards of resiliency and re-
duced environmental impact. Therefore, the Committee directs the
Department to update the Unified Facilities Guide Specifications
and directs the Department to ensure lower-carbon materials are
included as appropriate. As steps are being taken to reduce the en-
vironmental footprint of infrastructure projects, the Committee
supports the use of lower-carbon building materials, which will re-
duce the initial embodied carbon of a project over its full life cycle,
and therefore directs the Department to prioritize the use of these
materials.
Homeland Defense Radar—Hawaii and other Missile Defense
Military Construction Requirements.—Providing an updated missile
defense architecture for the State of Hawaii is critical to protecting
the roughly 1.4 million Americans living in Hawaii. It is also need-
ed to properly protect critical military regional headquarters in Ha-
waii (U.S. Indo-Pacific Command, U.S. Pacific Fleet, Pacific Air
Forces, U.S. Army Pacific, Marine Corps Forces Pacific, Special Op-
erations Command Pacific, and National Security Agency Hawaii)
and key military installations in the state (Joint Base Pearl Har-
bor-Hickam, Marine Corps Base Hawaii, Schofield Barracks, Fort
Shafter, the Pacific Missile Range Facility, and Pearl Harbor Naval
Shipyard and Intermediate Maintenance Facility). The Joint Ex-
planatory Statement accompanying the Consolidated Appropria-
tions Act, 2022 (P.L. 117–103) directed the Director of the Missile
Defense Agency, in consultation with the Commander of U.S. Indo-
Pacific Command and the Director of Cost Assessment and Pro-
gram Evaluation, to provide to congressional defense committees a
briefing on the current and evolving threats, the capability that
Homeland Defense Radar-Hawaii provides against these threats,
and other realistic solutions to defend Hawaii from current and
evolving ballistic missile threats. In addition, the Department of
rfrederick on DSKB3L4F33PROD with HEARING
Defense is conducting its own broad review of missile defense op-
tions for Hawaii to address the evolving threat landscape that has
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00017 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
18
changed significantly over the last few years. To better understand
the potential military construction needs for these efforts, the De-
partment is directed to include a list of potential construction
projects associated with enhancing the missile defense of Hawaii
within their upcoming report, which should include a description,
estimated cost, and construction timeline for each project.
Cross-Service Facility Master Planning and Investments for the
Indo-Pacific.—Locations in the Indo-Pacific, such as Wake Island,
face a plethora of logistical, infrastructural, environmental, and fis-
cal challenges that hinder their ability to maintain mission readi-
ness, provide adequate quality of life for inhabitants, and ensure
their ability to support strategic requirements. For example, nearly
all of the facilities on Wake Island, faced with the intense corrosive
nature of the region, are falling into disrepair and the sanitary
sewage system is rapidly trending towards collapse. Despite these
challenges and the potential strategic importance of this location,
project planning and major construction funding requests have not
recently made the Services’ priority lists. To help the Committee
assess the challenges facing locations in the Indo-Pacific, the Com-
mittee directs the Assistant Secretary of Defense for Sustainment,
in conjunction with the INDOPACOM and Services that have ex-
pressed interests in building facilities or stationing personnel in
these locations, to provide a classified briefing within 180 days of
the enactment of this Act on military construction needs at Wake
Island, Midway, Guam, Tinian, the Republic of Marshall Islands,
the Federated States of Micronesia, the Republic of Palau, and any
other location in the Pacific Islands. The briefing should include
the following items: (1) a summary of outdated facilities that must
be modernized or replaced to meet current mission needs; (2) a list
of unfunded construction requirements; (3) a consolidated list of
projects at these locations considered by U.S. Indo-Pacific Com-
mand and the Services that could potentially be built over the next
five years; (4) the ability of these locations to support the power,
water, sewage and other critical life-support needs of future poten-
tial construction projects; (5) the timeline for updating the installa-
tion development plan at each location; and (6) steps taken by the
Services to advance projects supported through INDOPACOM’s
planning and design funding.
Military Facility Resilience Funding.—The Committee recognizes
that the Armed Services must continue to improve efforts to ensure
its military installations are resilient to flooding, sea level rise, and
hurricanes, which are increasing in frequency and scale. The Com-
mittee continues to support efforts to improve the resilience of mili-
tary installations and encourages installations to develop plans
that take into account current and future risks from extreme
weather, including by utilizing modeling technologies that measure
sea-level rise. Therefore, the Committee directs the Services to
prioritize and commit funding to projects that improve the resil-
ience of military installations and their missions and notes the
need to ensure that infrastructure and facilities remain operational
against natural and manmade threats.
Recognizing that such investments are critical to installation
readiness, the bill provides $40,000,000 in planning and design and
rfrederick on DSKB3L4F33PROD with HEARING
construction funding for each of the Services, including the Army,
Navy and Marine Corps, and Air Force, and $15,000,000 for De-
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00018 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
19
fense-Wide, to continue to develop projects, conduct studies and
analyses, and update Unified Facilities Criteria that will directly
enhance military installation resilience. No later than 90 days after
enactment of this Act, the Services are directed to provide a spend
plan on the funds appropriated in this Act.
Alternative Fuel Infrastructure.—The Committee encourages
DOD to prioritize funding for the installation of alternative fuel in-
frastructure at military installations to ensure continuity of oper-
ations as DOD transitions to utilizing alternative fuel vehicles.
United States Southern Command (SOUTHCOM).—The Com-
mittee recognizes there are facilities within the SOUTHCOM enter-
prise, including the Joint Interagency Task Force South (JIATF–S),
located at Naval Air Station Key West, that are severely degraded,
not optimized, and create a continual risk to mission execution.
The Committee also recognizes the installation is critical to
SOUTHCOM’s Congressionally mandated mission, and a new com-
mand and control facility is required to ensure resiliency and en-
able modernization at JIATF–S. Therefore, the Committee directs
the Department to submit a report no later than 120 days after en-
actment of this Act detailing the condition of all facilities sup-
porting the JIATF–S mission, to include adequacy and sufficiency
of military and civilian housing at Naval Air Station Key West, and
the status of construction for the new Command and Control Facil-
ity, to ensure the long-term success of the JIATF–S mission.
MILITARY CONSTRUCTION, ARMY NATIONAL GUARD
Appropriation, fiscal year 2022 ......................................................... $337,893,000
Budget request, fiscal year 2023 ....................................................... 297,278,000
Committee Recommendation ............................................................. 325,658,000
Change from enacted level ......................................................... ¥12,235,000
Change from Budget Request .................................................... +28,380,000
The Committee recommends $325,658,000 for the Army National
Guard in fiscal year 2023, of which $3,380,000 is for the following
projects in the following amounts:
State Location Project Amount
FL ...................... Camp Blanding .......................... Automated Multipurpose Machine Gun Range .... $1,080,000
FL ...................... Camp Blanding .......................... Scout Recce Gunnery Complex ............................. 2,300,000
Within the total for Military Construction, Army National Guard,
the recommendation also includes $43,625,000 for planning and de-
sign, which is $15,380,000 above the budget request; and
$48,933,000 for unspecified minor construction, which is
$13,000,000 above the budget request.
Further detail of the Committee’s recommendation is provided in
the State table at the end of this report.
Army National Guard (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 with the Army. The
operation and maintenance of new aircraft platforms requires sig-
nificant investment in AASFs across the country so that they can
provide the required shelter and support for new airframes, as well
rfrederick on DSKB3L4F33PROD with HEARING
as regular maintenance for the existing airframes. The Committee
urges both the Army and the ARNG to prioritize facilities that sup-
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00019 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
20
port readiness of ARNG aviation units as they prepare to gain new
aircraft platforms.
National Guard Training Center.—The Committee recognizes the
importance of the National Guard Texas Training Center, which
has been in development since 2010 and has had execution delays.
The Committee recognizes that the Texas Training Center remains
a high priority and the Texas Army National Guard is directed to
continue its efforts to establish the Center.
MILITARY CONSTRUCTION, AIR NATIONAL GUARD
Appropriation, fiscal year 2022 ......................................................... $305,050,000
Budget request, fiscal year 2023 ....................................................... 148,883,000
Committee Recommendation ............................................................. 193,983,000
Change from enacted level ......................................................... ¥111,067,000
Change from budget request ...................................................... +45,100,000
The Committee recommends $193,983,000 for the Air National
Guard in fiscal year 2023, of which $20,100,000 is for the following
projects in the following amounts:
State Location Project Amount
AL ...................... Montgomery Regional Airport F–35 Weapons Load Crew Training Facility ........ $6,800,000
ANG Base.
AZ ...................... Morris ANG Base ........................ Base Entry Complex ............................................. 12,000,000
FL ...................... Jacksonville International Airport F–35 Munitions Maintenance & Inspection Facil- 530,000
ity.
FL ...................... Jacksonville International Airport F–35 Construct Munitions Storage Area Admin 770,000
& Pad.
Within the total for Military Construction, Air National Guard,
the recommendation also includes $41,712,000 for planning and de-
sign, which is $13,300,000 above the budget request; and
$57,171,000 for unspecified minor construction, which is
$13,000,000 above the budget request.
Further detail of the Committee’s recommendation is provided in
the State table at the end of this report.
Air National Guard Infrastructure.—The Committee recognizes
that some Aviation Support Facilities are not configured to protect
and maintain modern airframes and encourages the Air National
Guard to upgrade these facilities using unspecified minor military
construction funds as appropriate.
Green Energy Projects.—The Committee is aware of National
Guard green energy projects that are at 35 percent design, shovel-
ready, and are below the unspecified minor military construction
threshold. However, these projects are not receiving priority fund-
ing from the National Guard. The Committee encourages the Air
National Guard to prioritize green energy projects that are ready
and eligible for current unspecified minor military construction
funding.
MILITARY CONSTRUCTION, ARMY RESERVE
Appropriation, fiscal year 2022 ......................................................... $94,111,000
Budget request, fiscal year 2023 ....................................................... 99,878,000
rfrederick on DSKB3L4F33PROD with HEARING
Committee Recommendation, fiscal year 2023 ................................ 119,878,000
Change from enacted level ......................................................... +25,767,000
Change from budget request ...................................................... +20,000,000
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00020 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
21
The Committee recommends $119,878,000 for the Army Reserve
in fiscal year 2023, including $19,829,000 for planning and design,
which is $10,000,000 above the budget request; and $30,049,000 for
unspecified minor construction, which is $10,000,000 above the
budget request.
Further detail of the Committee’s recommendation is provided in
the State table at the end of this report.
MILITARY CONSTRUCTION, NAVY RESERVE
Appropriation, fiscal year 2022 ......................................................... $71,804,000
Budget request, fiscal year 2023 ....................................................... 30,337,000
Committee Recommendation, fiscal year 2023 ................................ 30,337,000
Change from enacted level ......................................................... ¥41,467,000
Change from budget request ...................................................... –––
The Committee recommends $30,337,000 for the Navy Reserve in
fiscal year 2023, including $2,590,000 for planning and design,
which is the same as the budget request; and $27,747,000 for un-
specified minor construction, which is the same as the budget re-
quest.
Further detail of the Committee’s recommendation is provided in
the State table at the end of this report.
MILITARY CONSTRUCTION, AIR FORCE RESERVE
Appropriation, fiscal year 2022 ......................................................... $120,074,000
Budget request, fiscal year 2023 ....................................................... 56,623,000
Committee Recommendation, fiscal year 2023 ................................ 82,123,000
Change from enacted level ......................................................... ¥37,951,000
Change from budget request ...................................................... +25,500,000
The Committee recommends $82,123,000 for the Air Force Re-
serve in fiscal year 2023, of which $5,500,000 is for the following
project in the following amount:
State Location Project Amount
VA ...................... Joint Base Langley-Eustis ......... AFRC Intelligence Group Facility .......................... $5,500,000
Within the total for Military Construction, Air Force Reserve, the
recommendation also includes $21,773,000 for planning and design,
which is $10,000,000 above the budget request; and $21,850,000 for
unspecified minor construction, which is $10,000,000 above the
budget request.
Further detail of the Committee’s recommendation is provided in
the State table at the end of this report.
NORTH ATLANTIC TREATY ORGANIZATION SECURITY INVESTMENT
PROGRAM
Appropriation, fiscal year 2022 ......................................................... $215,853,000
Budget request, fiscal year 2023 ....................................................... 210,139,000
Committee Recommendation, fiscal year 2023 ................................ 220,139,000
Change from enacted level ......................................................... +4,286,000
Change from budget request ...................................................... +10,000,000
The North Atlantic Treaty Organization Security Investment
Program (NSIP) consists of annual contributions by North Atlantic
Treaty Organization (NATO) member countries. The program fi-
rfrederick on DSKB3L4F33PROD with HEARING
nances the costs of construction needed to support the roles of the
major NATO commands. The investments cover facilities such as
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00021 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
22
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.
Russian Aggression.—In response to the unprovoked Russian
Federation invasion of the sovereign state of Ukraine on February
24, 2022, the Committee includes an additional $10,000,000 above
the budget request for the NATO Security Investment Program.
DEPARTMENT OF DEFENSE BASE CLOSURE ACCOUNT
Appropriation, fiscal year 2022 ......................................................... $529,639,000
Budget request, fiscal year 2023 ....................................................... 284,687,000
Committee Recommendation, fiscal year 2023 ................................ 574,687,000
Change from enacted level ......................................................... +45,048,000
Change from budget request ...................................................... +290,000,000
The Committee recommends $574,687,000 for the Base Closure
account, which is $45,048,000 more than fiscal year 2022 and
$290,000,000 above the budget request.
The recommendation includes an additional $90,000,000 above
the budget request for the Navy to accelerate environmental reme-
diation at installations closed under previous Base Closure and Re-
alignment (BRAC) rounds and for the demolition or removal of non-
historically designated buildings and structures under Navy control
where the sampling or remediation of radiologically contaminated
materials have been the subject of substantiated allegations of
fraud. Furthermore, the Navy is directed to provide to the Com-
mittee a spend plan for these additional funds no later than 60
days after enactment of this Act.
Army Ordinance Remediation.—The Committee is concerned that
the Army is not adequately addressing the backlog in ordinance re-
mediation at former installations. Therefore, the Committee directs
the Department to submit to the Committee a report on the cur-
rent backlog of ordinance remediation and the cost estimate of com-
pleting all remediation efforts no later than 90 days after enact-
ment of this Act.
Per- and Polyfluoroalkyl Substances (PFAS).—The Committee
continues to be very concerned about the extent of PFAS contami-
nation at U.S. military installations and how that contamination is
measured. Therefore, the Committee includes an additional
$200,000,000 above the budget request within the Base Closure Ac-
count to increase the pace of cleanup at the military installations
affected by PFAS and directs the Department to provide a spend
plan to the Committees on Appropriations of both Houses of Con-
gress not later than 60 days after enactment of this Act.
PFAS Regulation and Research.—The Committee expects the De-
partment to continue working with the U.S. Environmental Protec-
rfrederick on DSKB3L4F33PROD with HEARING
tion Agency on its regulatory initiatives and engaging Federal
health agencies, including the Agency for Toxic Substances and
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00022 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
23
Disease Registry, to ensure that it is using the best and most up-
to-date science to guide DOD remediation plans and processes.
PFAS Reporting Requirement.—Over the past three fiscal years,
the Committee has directed the Department to keep it apprised of
new findings of PFAS at BRAC sites. The Committee recognizes
that the Services have provided some information. However, the
process for identifying PFAS contamination at BRAC sites and de-
termining the appropriate remediation plan remains unclear.
Therefore, the Deputy Assistant Secretary of Defense for Environ-
ment is directed to prepare an updated comprehensive report for
the congressional defense committees no later than 60 days after
enactment of this Act that establishes a baseline of information re-
garding PFAS at closed military installations. At a minimum, the
report should (1) provide a list of all closed military installations;
(2) indicate whether PFAS has been detected in drinking water and
groundwater; (3) indicate the level of contamination that has been
detected; (4) provide information on the likely sources of contami-
nation; (5) explain current mitigation efforts and proposed remedi-
ation plans; (6) discuss the status of remediation; (7) provide a
timeline for cleanup; and (8) estimate the total cost of detection,
mitigation and remediation.
FAMILY HOUSING OVERVIEW
Appropriation, fiscal year 2022 ......................................................... $1,423,554,000
Budget request, fiscal year 2023 ....................................................... 1,956,330,000
Committee Recommendation, fiscal year 2023 ................................ 1,986,330,000
Change from enacted level ......................................................... +562,776,000
Change from budget request ...................................................... +30,000,000
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-
neous expenses.
Military Housing Privatization Initiative (MHPI).—The Com-
mittee believes that the MHPI management companies have woe-
fully neglected responsibilities outlined in their partnership agree-
ments with the Services. The Committee continues to receive evi-
dence of poor housing conditions, inadequate maintenance response
times, mishandling of claims, indifference towards the wellbeing of
servicemembers and their families, and some incidences of illegal
incentive fee fraud. Therefore, the Committee provides an addi-
tional $30,000,000 for increased oversight of DOD’s housing port-
folio, including government-owned and controlled family housing,
and privatized family and unaccompanied housing. Additionally,
the Committee directs each Service to submit a report no later
than 120 days after enactment of this Act detailing: (1) the current
condition of all MHPI housing, including the current backlog of
maintenance requests; (2) a summary of all MHPI tenant com-
plaints; (3) a performance review of each MHPI management com-
pany; and (4) an update on all known and alleged incidences of in-
rfrederick on DSKB3L4F33PROD with HEARING
centive fee fraud. Furthermore, the Committee directs the Services
to brief the Committee and provide a spend plan on how it will use
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00023 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
24
the additional funding no later than 45 days after enactment of
this Act.
The Committee recognizes the importance of the MHPI and con-
tinues to prioritize the state of homes within the MHPI, as well as
the timeliness and thoroughness of repair and remediation of re-
ported problems, and the Department of Defense and Services’
oversight communications with tenants and the base housing prop-
erty management companies.
Evan’s Law.—The Committee is concerned that the MHPI man-
agement companies are not purchasing and installing the manda-
tory, lifesaving window fall prevention devices in compliance with
International Building Code standards and required by section
2823 of the National Defense Authorization Act for Fiscal Year
2019 (P.L. 115–232), which is commonly referred to as ‘‘Evan’s
Law’’, in a timely manner. The Committee directs the Department
to prioritize the installation of these devices and provide the MHPI
partners with all necessary, authorized resources to do so, if need-
ed. Additionally, the Committee directs the Department to submit
a report no later than 90 days after enactment of this Act on the
progress of window fall prevention device installation, as well as an
estimate of any additional funding and/or authorizations required
to expedite the completion of necessary device installations at all
privatized military housing.
Indoor Air Quality.—The Committee remains concerned that
servicemembers and their families are subject to unhealthy living
conditions, including potentially dangerous indoor air quality, in
military family housing constructed and operated under the MHPI,
as well as Unaccompanied Personnel Housing. The Committee has
been aware of poor quality of service provided by MHPI manage-
ment companies as well as deteriorating conditions of MHPI hous-
ing and Unaccompanied Personnel Housing. The Department and
MHPI partners are directed to regularly monitor housing condi-
tions and adhere to Environmental Protection Agency guidance and
recommended mitigation procedures for those areas where there is
evidence of potential health effects, including mold and other in-
door air health risks. Additionally, the Committee directs the De-
partment to provide a briefing for the Committee within 90 days
of enactment of this Act on how the Department will work with the
MHPI partners to monitor and enhance indoor air quality in MHPI
housing. The briefing should at a minimum include, but not be lim-
ited to: (1) whether and to what extent private housing providers
include air purification in their procedures for mold mitigation; (2)
an evaluation of both commercially and non-commercially available
air purification technology capable of destroying airborne mold and
other harmful substances; and (3) recommendations for the deploy-
ment of air purification technology within the MHPI.
Homeownership Education.—The Committee encourages the
Services to work with privatized housing partners to develop and
provide basic homeownership education programs for
servicemembers and their families.
rfrederick on DSKB3L4F33PROD with HEARING
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00024 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
25
FAMILY HOUSING CONSTRUCTION, ARMY
Appropriation, fiscal year 2022 ......................................................... $99,849,000
Budget request, fiscal year 2023 ....................................................... 169,339,000
Committee Recommendation, fiscal year 2023 ................................ 169,339,000
Change from enacted level ......................................................... +69,490,000
Change from budget request ...................................................... –––
FAMILY HOUSING OPERATION AND MAINTENANCE, ARMY
Appropriation, fiscal year 2022 ......................................................... $391,227,000
Budget request, fiscal year 2023 ....................................................... 436,411,000
Committee Recommendation, fiscal year 2023 ................................ 446,411,000
Change from enacted level ......................................................... +55,184,000
Change from budget request ...................................................... +10,000,000
FAMILY HOUSING CONSTRUCTION, NAVY AND MARINE CORPS
Appropriation, fiscal year 2022 ......................................................... $77,616,000
Budget request, fiscal year 2023 ....................................................... 337,297,000
Committee Recommendation, fiscal year 2023 ................................ 337,297,000
Change from enacted level ......................................................... +259,681,000
Change from budget request ...................................................... –––
FAMILY HOUSING OPERATION AND MAINTENANCE, NAVY AND
MARINE CORPS
Appropriation, fiscal year 2022 ......................................................... $357,341,000
Budget request, fiscal year 2023 ....................................................... 368,224,000
Committee Recommendation, fiscal year 2023 ................................ 378,224,000
Change from enacted level ......................................................... +20,883,000
Change from budget request ...................................................... +10,000,000
FAMILY HOUSING CONSTRUCTION, AIR FORCE
Appropriation, fiscal year 2022 ......................................................... $115,716,000
Budget request, fiscal year 2023 ....................................................... 232,788,000
Committee Recommendation, fiscal year 2023 ................................ 232,788,000
Change from enacted level ......................................................... +117,072,000
Change from budget request ...................................................... –––
FAMILY HOUSING OPERATION AND MAINTENANCE, AIR FORCE
Appropriation, fiscal year 2022 ......................................................... $325,445,000
Budget request, fiscal year 2023 ....................................................... 355,222,000
Committee Recommendation, fiscal year 2023 ................................ 365,222,000
Change from enacted level ......................................................... +39,777,000
Change from budget request ...................................................... +10,000,000
FAMILY HOUSING OPERATION AND MAINTENANCE, DEFENSE WIDE
Appropriation, fiscal year 2022 ......................................................... $49,785,000
Budget request, fiscal year 2023 ....................................................... 50,113,000
Committee Recommendation, fiscal year 2023 ................................ 50,113,000
Change from enacted level ......................................................... +328,000
Change from budget request ...................................................... –––
DEPARTMENT OF DEFENSE FAMILY HOUSING IMPROVEMENT FUND
Appropriation, fiscal year 2022 ......................................................... $6,081,000
Budget request, fiscal year 2023 ....................................................... 6,442,000
rfrederick on DSKB3L4F33PROD with HEARING
Committee Recommendation, fiscal year 2023 ................................ 6,442,000
Change from enacted level ......................................................... +361,000
Change from budget request ...................................................... –––
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00025 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
26
DEPARTMENT OF DEFENSE MILITARY UNACCOMPANIED HOUSING
IMPROVEMENT FUND
Appropriation, fiscal year 2022 ......................................................... $494,000
Budget request, fiscal year 2023 ....................................................... 494,000
Committee Recommendation, fiscal year 2023 ................................ 494,000
Change from enacted level ......................................................... –––
Change from budget request ...................................................... –––
ADMINISTRATIVE PROVISIONS
The bill includes a total of 36 Administrative provisions, 25 of
which are effective in fiscal year 2022.
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
funds for the hire of passenger motor vehicles.
The bill includes section 103 permitting funds to be expended on
the construction of defense access roads under certain 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
rfrederick on DSKB3L4F33PROD with HEARING
years to be used for new projects authorized during the current ses-
sion of Congress.
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00026 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
27
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
Homeowners Assistance Program.
The bill includes section 119 requiring that funds in this title be
the sole source of all operation and maintenance for flag and gen-
eral officer quarter houses and limits the repair on these quarters
to $35,000 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 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 124 extending the eligibility of unobli-
gated funding for fiscal years 2017 and 2018 projects that have not
lapsed.
The bill includes section 125 defining the congressional defense
committees.
The bill includes section 126 providing additional funds for im-
proving resilience and the effects of climate change on military in-
stallations.
The bill includes section 127 providing additional planning and
design funds for child development centers.
The bill includes section 128 providing additional cost to com-
plete funds for the Air Force for expenses incurred as a result of
natural disasters.
The bill includes section 129 providing funds for various military
construction accounts for DOD labs.
The bill includes section 130 providing additional funds for an
Air Force Reserve unfunded priorities project.
The bill includes section 131 providing funds specified to address
rfrederick on DSKB3L4F33PROD with HEARING
cost increases identified subsequent to the fiscal year 2023 budget
request for construction projects across various accounts.
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00027 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
28
The bill includes section 132 providing funds specified to address
cost increases for major construction projects funded by this Act.
The bill includes section 133 providing the Navy with planning
and design funds for water treatment and distribution infrastruc-
ture.
The bill includes section 134 providing the Army National Guard
and Reserve additional funds for barracks and unaccompanied per-
sonnel housing.
The bill includes section 135 providing additional funds for Army
housing cost to complete projects.
The bill includes section 136 providing additional funds for con-
struction of child development centers.
TITLE II
DEPARTMENT OF VETERANS AFFAIRS
Appropriation, fiscal year 20221 ...................................................... $269,263,382,000
Budget request, fiscal year 20231 ................................................... 298,611,258,000
Committee recommendation, fiscal year 20231 .............................. 298,563,339,000
Change from enacted level ....................................................... +29,299,957,000
Change from budget request .................................................... ¥47,919,000
Fiscal year 2024 advance budget request ....................................... 283,455,762,000
Fiscal year 2024 Committee recommendation in the bill ............. 283,455,762,000
Change from budget request .................................................... –––
1All funding cited excludes amounts in the Medical Care Collections Fund.
The Department of Veterans Affairs (VA) provides health care for
9,200,000 veteran enrollees, disability compensation benefits to an
estimated 5,538,958 veterans and 482,949 survivors, pension bene-
fits for an estimated 162,377 veterans and 114,250 survivors, life
insurance for more than 5,500,000 veterans, servicemembers and
their families, educational assistance for nearly 900,000 trainees,
and interment of more than 130,000 veterans and eligible family
members in national cemeteries. To serve adequately the nation’s
veterans, VA employs more than 425,000 people, making it one of
the largest Federal agencies in terms of employment.
The Committee strongly supports the implementation of the
Deborah Sampson Act, enacted into law as part of the Johnny Isak-
son and David P. Roe, M.D. Veterans Health Care and Benefits Im-
provement Act of 2020 (P.L. 116–315), and notes that the funding
level provided for the Department for fiscal year 2023 continues to
fund the implementation of the Deborah Sampson Act. The Com-
mittee believes firmly that the Department should dedicate suffi-
cient resources to support the needs of women veterans in all pro-
gram areas, including hiring and training staff, strategic planning,
health research, eliminating sexual harassment and sexual assault,
and retrofitting existing medical facilities to make it safer and easi-
er for women veterans to get care. The Committee directs VA to
provide an updated plan and timeline for implementation of this
law, including an expenditure plan in each of these areas, to the
Committees on Appropriations of both Houses of Congress, no later
than 90 days after enactment of this Act.
Sexual Harassment and Sexual Assault Protections for VA Bene-
ficiaries and Employees.—Eliminating sexual harassment and as-
sault at VA is critical to creating a safe and welcoming environ-
rfrederick on DSKB3L4F33PROD with HEARING
ment for veterans, their families, caregivers, and survivors, as well
as VA employees. The Committee has previously expressed concern
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00028 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
29
about the lack of centralized reporting mechanisms and resources
for VA beneficiaries who are harassed or assaulted by VA employ-
ees or on VA property, as well as the potential for retaliation from
within the Department. The Committee notes that VA has pub-
lished a handbook with comprehensive policy guidance and instruc-
tions addressing harassment and sexual assault and directs VA to
ensure that these policies are fully communicated and complied
with. The Committee appreciates the Department’s efforts to better
address harassment and sexual assault, and requests an updated
report annually on the Department’s comprehensive approach.
Native Hawaiian, Pacific Islander and United States-Affiliated
Pacific Islander (NHPIUSAPI) Veteran Healthcare.—The Com-
mittee recognizes the significant contributions of NHPIUSAPI
servicemembers in the U.S. military and the disproportionate num-
ber of NHPIUSAPI servicemembers and veterans. These veterans
are more likely to be female, report military sexual trauma, receive
care for conditions such as diabetes, hypertension, post-traumatic
stress disorder and addiction and receive more physical and mental
diagnoses overall than their non-native and NHPIUSAPI counter-
parts. Given the unique clinical and geographic needs of
NHPIUSAPI veterans and recognizing the Department’s support
for creating a new center focused on the NHPIUSAPI community,
the Committee provides $5,000,000 to establish a Center for
NHPIUSAPI Health to focus on research, data collection, and prac-
tice improvement to better serve NHPIUSAPI veterans. The Com-
mittee supports VA’s approach of housing the new center in the VA
Office of Health Equity with a field office in the Pacific, and en-
courages VA to partner with non-government institutions and uni-
versities. The Committee encourages VA to focus on issues specific
to the NHPIUSAPI community, including extending the use of tele-
health and telepharmacy to reach remote and isolated areas; using
multi-disciplinary teams that incorporate community outreach
workers; integrating clinical pharmacists into primary care prac-
tices to improve chronic disease control; incorporating local and in-
digenous cultural practices into VA’s healthcare system; leveraging
data analytics from modernized electronic health records to analyze
gaps, costs, and healthcare disparities due to race and ethnicity;
creating a more diverse healthcare workforce; and improving lan-
guage access.
Combatting Online Misinformation and Extremism.—The Com-
mittee is concerned by foreign and domestic actions to exploit vet-
erans through the use of online misinformation and manipulation.
These efforts to spread extremist views and conspiracy theories
among the veteran community have severely damaging effects,
such as spreading conspiracies that may have motivated participa-
tion in the Capitol insurrection on January 6, 2021. The Committee
feels strongly that VA should engage with the veteran community
to better understand the unique vulnerabilities that veterans face
online, and that the Department should establish a comprehensive,
evidence-based program to educate veterans about malign influ-
ences, transition assistance to include specialized counseling serv-
ices, as well as research into operations and methods to discern
against disinformation. This should include developing evidence-
rfrederick on DSKB3L4F33PROD with HEARING
based social media and internet propaganda literacy programs that
are appropriately targeted to different veteran populations and an
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00029 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
30
understanding of appropriate counseling options. The Committee
encourages the Department to engage with the Departments of
Justice and Homeland Security, as well as civil society partners, in
developing this program, and looks forward to the report required
in House Report 117–81 on VA’s plans to implement this program,
including a cost estimate of additional resources that would assist
in implementation.
Protecting Immigrant Veterans.—The Committee recognizes the
value and service of immigrant veterans and is concerned about the
deportation of veterans, as well as family members, workers, and
other visitors interacting with VA who may also be at risk for de-
portation. The Committee is strongly supportive of VA’s role in the
Immigrant Military Members and Veterans Initiative and looks for-
ward to receiving the plan requested in House Report 117–81. The
Committee continues to direct VA to take steps to ensure that non-
citizen veterans are made aware of their options to naturalize as
U.S. citizens. Finally, the Committee strongly urges VA to take
every step possible to assist detained and previously deported vet-
erans, including by providing administrative guidance and assist-
ance with relevant applications and paperwork. The Department is
encouraged to continue to coordinate with the Department of
Homeland Security to develop methods that allow the Department
to maintain contact with detained and previously deported vet-
erans and ensure that they are able to access this and other VA
assistance and benefits to which they are entitled.
Performance Measures.—The Committee directs the Department
to comply with title 31 of the United States Code, including the de-
velopment of organizational priority goals and outcomes such as
performance outcome measures, output measures, efficiency meas-
ures, and customer service measures. The Secretary is directed to
submit a report to the Committee within 60 days of enactment of
this 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 and encourages the Secretary to continuously im-
prove customer service standards and incorporate them into the
performance plans required under section 1115 of title 31, United
States Code.
The Committee is aware of reports that Members have had chal-
lenges providing casework services to their constituents because
the Department’s local offices are lacking staff and strongly encour-
ages VA to ensure sufficient staff, including in-person employees,
are available.
rfrederick on DSKB3L4F33PROD with HEARING
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00030 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
31
VETERANS BENEFITS ADMINISTRATION
COMPENSATION AND PENSIONS
(INCLUDING TRANSFER OF FUNDS)
Fiscal year 2022 enacted level ......................................................... $139,183,014,000
Fiscal year 2023 enacted level ......................................................... 152,016,542,000
Fiscal year 2023 budget year request ............................................. –––
Committee 2023 budget year recommendation .............................. –––
Fiscal year 2024 advance appropriation request ........................... 146,778,136,000
Committee 2024 advance appropriation recommendation ............ 146,778,136,000
Comparison with:
Fiscal year 2023 enacted level ................................................. ¥5,238,406,000
Fiscal year 2024 advance budget request ............................... –––
This appropriation provides funds for service-connected com-
pensation payments to an estimated 5,538,958 veterans and
482,949 survivors in fiscal year 2023. In addition, pension pay-
ments will be funded for an estimated 162,377 veterans and
114,250 survivors. The average payment per compensation case for
veterans in fiscal year 2023 is estimated at $23,245 and pension
payments are projected at $14,173.
The appropriation includes authority to transfer funding not to
exceed $21,423,000 in fiscal year 2024 to General Operating Ex-
penses, Veterans Benefits Administration (VBA) and Information
Technology Systems. These funds are for the administrative ex-
penses of implementing cost-saving provisions required by the Om-
nibus Budget Reconciliation Act of 1990 (P.L. 101–508), the Vet-
erans’ Benefits Act of 1992 (P.L. 102–568), and the Veterans’ Bene-
fits Improvements Act of 1994 (P.L. 103–446). These cost-saving
provisions include verifying pension income against Internal Rev-
enue Service and Social Security Administration (SSA) data; estab-
lishing a match with SSA to obtain verification of Social Security
numbers; and applying the VA pension cap for Medicaid-eligible
single veterans and surviving spouses alone in Medicaid-covered
nursing homes. The bill also continues to include language permit-
ting this appropriation to reimburse such sums as may be earned
to the Medical Care Collections Fund to help defray the operating
expenses of individual medical facilities for nursing home care pro-
vided to pensioners.
Financial Hardship and Bankruptcy.—The Committee continues
to support VA programs, such as disability-related benefits, that
seek to address the root causes of veteran and dependent financial
hardship, which is a known contributory factor to negative out-
comes such as mental health issues, substance use disorder, and
suicide. For example, disability-related benefits not only honor the
service and sacrifice of the veterans who receive them, but also
help to replace lost wages and provide a critical source of economic
well-being.
rfrederick on DSKB3L4F33PROD with HEARING
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00031 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
32
READJUSTMENT BENEFITS
Fiscal year 2022 enacted level ........................................................... $14,946,618,000
Fiscal year 2023 enacted level ........................................................... 8,906,851,000
Fiscal year 2023 budget year request ............................................... –––
Committee 2023 budget year recommendation ................................ –––
Fiscal year 2024 advance appropriation request ............................. 8,452,500,000
Committee 2024 advance appropriation recommendation .............. 8,452,500,000
Comparison with:
Fiscal year 2023 enacted level ................................................... ¥454,351,000
Fiscal year 2024 advance budget request ................................. –––
This appropriation finances the education and training of vet-
erans and servicemembers through the Post-9/11 GI Bill and the
All-Volunteer Force Educational Assistance Program. Supplemental
education benefits are also provided to certain veteran members of
the Selected Reserve and are funded through transfers from DOD.
In addition, certain disabled veterans are provided with vocational
rehabilitation, specially adapted housing grants, and grants for
automobiles with approved adaptive equipment. This account also
finances educational assistance allowances for eligible dependents
of veterans who died from service-connected causes or have a total
and permanent service-connected disability, as well as dependents
of servicemembers who were captured or are missing in action. Al-
most 80 percent of the funds in the account support the Post-9/11
GI Bill.
For fiscal year 2024, the bill provides $8,452,500,000.
Transition Coordination.—The Committee believes that VA, in
consultation with the Departments of Labor and Defense, should
further coordinate efforts and resources to ensure veterans have a
successful transition to civilian life. This includes sharing informa-
tion on community resources, including nonprofits and Veterans
Service Organizations (VSOs), that are available to the veteran and
their family as they depart the service. The Committee also urges
VA to explore options for veterans to access hands-on job placement
services that connect veterans directly with employers, and encour-
ages VA to look at successful state and local programs in this area.
The Committee requests a report on these efforts not later than
180 days after enactment of this Act.
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. The Committee directs VA to submit a report not later than
60 days after enactment of this Act on the steps VA has taken to
fulfill the directive included in House Report 117–81 on VA’s GI
Bill Comparison Tool requirement.
Technology for Student Veterans.—During the pandemic, remote
learning technology such as computers and routers for internet
rfrederick on DSKB3L4F33PROD with HEARING
were more important than ever for so many veteran students. The
Committee directs VA to explore options for ensuring all veteran
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00032 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
33
students have access to the technology and connectivity they need
to be successful in school.
VetSuccess on Campus.—The Committee recognizes the impor-
tance of the VetSuccess on Campus program and its role in ensur-
ing success in post-secondary education for veterans,
servicemembers, and qualified dependents. The Committee encour-
ages the Department to expand the program, including at institu-
tions that collaborate to provide additional opportunities for stu-
dents.
Training and Upskilling for Veterans.—According to the Syra-
cuse University Institute for Veterans & Military Families, 47 per-
cent of veterans are employed in occupations expected to shrink be-
tween now and 2030, namely, where automation is a threat to the
workforce. Veterans receiving professional coaching and training
are more likely to be promoted in their first job after transitioning
from the military. The Committee encourages the Department to
continue efforts to implement training and upskilling programs,
such as the Veteran Employment Through Technology Education
Courses (VET TEC) and Transition Assistance Grant programs, to
help ensure veterans are not left behind in the new talent economy.
The Committee directs VA to provide a report not later than 90
days after enactment of this Act on efforts to improve training and
upskilling of veterans and their families.
VA Work-Study Program.—The Committee supports VA’s efforts
to provide work-based experiences that could help improve student
veterans’ employment opportunities after graduation and that do
not disadvantage student veterans compared to their non-veteran
peers. Therefore, the Committee directs VA to submit a report, not
later than 180 days after enactment of this Act, consisting of: (1)
an overview of the VA Work-Study program, to include types of
work-study activities undertaken through the program, number
and demographics of beneficiaries, and participating institutions;
(2) an assessment of work-study opportunities available to student
veterans; (3) an analysis of the feasibility and advisability of ex-
panding the scope of eligible work-study opportunities supported
through the VA Work-Study program; and, (4) any recommenda-
tions for improvements to the program, to include legislative pro-
posals, that might better position student veterans for future em-
ployment.
VET TEC Pilot Program.—The VET TEC Pilot Program has en-
abled veterans to use their GI Bill benefits to access non-tradi-
tional, technology-oriented educational courses. The Committee ex-
pects the Department to fully fund the program, consistent with
current law, at $45,000,000 for fiscal year 2023.
VETERANS INSURANCE AND INDEMNITIES
Fiscal year 2022 enacted level ........................................................... $136,950,000
Fiscal year 2023 enacted level ........................................................... 109,865,000
Fiscal year 2023 budget year request ............................................... –––
Committee 2023 budget year recommendation ................................ –––
Fiscal year 2024 advance appropriation request ............................. 121,126,000
Committee 2024 advance appropriation recommendation .............. 121,126,000
rfrederick on DSKB3L4F33PROD with HEARING
Comparison with:
Fiscal year 2023 enacted level ................................................... +11,261,000
Fiscal year 2024 advance budget request ................................. –––
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00033 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
34
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.
For fiscal year 2024, the bill provides $121,126,000.
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 veterans
mortgage life insurance program. These policies are identified
under the Veterans Insurance and Indemnities appropriation since
they provide insurance to service-disabled veterans unable to qual-
ify 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 2022 .................................................... ––– ($500,000) $229,500,000
Budget request est., fiscal year 2023 ......................................... ––– (500,000) 282,361,131
Committee recommendation, fiscal year 2023 ............................ ––– (500,000) 282,361,131
Change from enacted level ................................................. ––– ––– +52,861,131
Change from budget request .............................................. ––– ––– –––
The purpose of the home loan guaranty program is to facilitate
the extension of mortgage credit on favorable terms by private
lenders to eligible veterans. This appropriation provides for all
costs, with the exception of the Native American Veterans Housing
Loan Program, of the Department’s direct and guaranteed loans
programs. The Federal Credit Reform Act of 1990 (P.L. 101–508)
requires budgetary resources to be available prior to incurring a 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 understands
that as directed by House Report 116–63, VA has clarified that
nothing in VA statutes or regulations specifically prohibits a vet-
eran whose income is derived from state-legalized cannabis activi-
ties from obtaining a certificate of eligibility for VA home loan ben-
efits. The Committee understands that VA is working to improve
communication with eligible lending institutions to reduce confu-
sion among lenders and borrowers on this matter and looks for-
rfrederick on DSKB3L4F33PROD with HEARING
ward to receiving the report to the Committee requested in House
Report 117–81.
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00034 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
35
VOCATIONAL REHABILITATION LOANS PROGRAM ACCOUNT
Limitation on Administrative
Program Account direct loans Expenses
Appropriation, fiscal year 2022 .................................................... $2,838 (1,662,758) $429,467
Budget request, fiscal year 2023 ................................................. 7,171 (942,330) 445,698
Committee recommendation, fiscal year 2023 ............................ 7,171 (942,330) 445,698
Change from enacted level ................................................. +4,333 (¥720,428) +16,231
Change from budget request .............................................. ––– ––– –––
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 $1,300 (based on indexed chapter 31 subsistence allowance
rate) are available to service-connected disabled veterans enrolled
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 870 loans in fiscal
year 2023, with an average amount of $1,083.
NATIVE AMERICAN VETERAN HOUSING LOAN PROGRAM ACCOUNT
Administrative expenses:
Appropriation, fiscal year 2022 ......................................................... $1,400,000
Budget request, fiscal year 2023 ....................................................... 1,186,000
Committee recommendation, fiscal year 2023 ................................. 1,400,000
Change from enacted level ......................................................... –––
Change from budget request ...................................................... +214,000
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.
The Committee continues to provide resources above the budget
request in fiscal year 2023 to boost awareness of the program
through improved communication and outreach to veterans eligible
for a loan under this program. The Committee directs the Secretary
to provide a report on efforts to improve outreach to eligible vet-
erans not later than 90 days after the enactment of this Act.
GENERAL OPERATING EXPENSES, VETERANS BENEFITS
ADMINISTRATION
Appropriation, fiscal year 2022 ......................................................... $3,453,813,000
Budget request, fiscal year 2023 ....................................................... 3,863,000,000
rfrederick on DSKB3L4F33PROD with HEARING
Committee recommendation, fiscal year 2023 ................................. 3,863,000,000
Change from enacted level ......................................................... +409,187,000
Change from budget request ...................................................... –––
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00035 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
36
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, 2024, up to ten
percent of these funds.
The Committee provides $3,863,000,000, for the General Oper-
ating Expenses, VBA account, to enable VBA to deliver the benefits
that veterans rely on. These resources will fully fund VA’s request
for fiscal year 2023 and improve VBA’s ability to address com-
pensation and benefit claims in a timely manner by hiring new
claims processors and continued adoption of automation efforts to
deliver fast, accurate, and consistent claim decisions for veterans.
Toxic Exposures.—The Committee remains concerned about serv-
ice-connected exposures to toxic substances among veterans, such
as Agent Orange, per- and polyfluoroalkyl substances (PFAS), radi-
ation, asbestos, and open burn pits. The Committee believes that
VA’s recent rulemaking activities expanding presumptive benefits
for veterans with certain toxic exposures is a step in the right di-
rection. More must be done, both in expanding access to healthcare
for veterans exposed to toxins, as well as ensuring they are receiv-
ing the disability compensation benefits that they have earned.
Disability Claims.—The Committee continues to be concerned
about reports of delays that 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 sup-
port they deserve. The Committee encourages the Department to
work diligently to reduce the backlog of compensation and benefit
claims to pre-pandemic levels to lessen the burden of excessive wait
times. The funding level provided is sufficient to continue programs
that support effective management of claims, including the Vet-
erans Claims Intake Program.
Burn Pits Data Tracking and Reporting.—The Committee con-
tinues to be concerned with the lack of data on veteran exposure
to open burn pits (burn pits) and reiterates the direction provided
in House Report 117–81, requiring a report within 180 days on
burn pit data tracking and reporting. The Committee urges VA to
work with DOD to ensure that VA has information about every lo-
cation in which servicemembers may have been exposed to toxins
in order to appropriately adjudicate claims and make determina-
tions about presumptive eligibility.
Equitable Relief.—The Committee understands VA is working to
implement new systems and protocols to eliminate instances of ad-
ministrative error. However, as VA enacts system-wide reforms,
ending equitable relief for veterans who were deemed eligible for
benefits in error would place an unfair burden on veterans and
their families. The Secretary is directed to continue to grant or ex-
tend equitable relief to eligible veterans initially deemed eligible in
instances of administrative error. Not later than April 1, 2023, the
rfrederick on DSKB3L4F33PROD with HEARING
Secretary is directed to submit to the Committee a report con-
taining a statement as to the disposition of each case recommended
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00036 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
37
to the Secretary for equitable relief under section 503 of title 38,
United States Code during the preceding calendar year.
Military Sexual Trauma (MST) Claims.—The Committee is frus-
trated by the findings of the August 2021 Office of Inspector Gen-
eral (OIG) Report titled ‘‘Improvements Still Needed in Processing
Military Sexual Trauma Claims,’’ which found VBA has failed to
ensure all claims processors handling MST-related claims have re-
ceived specialized MST training. The Committee urges VBA to
prioritize specialized MST training for claims processors, and to
continue to involve MST survivors in the development of special-
ized training. Additionally, the Committee remains concerned that
veterans suffering from a mental health disorder as a result of sex-
ual trauma during service have different standards of evidence
based on their diagnosis. The Committee recognizes that evidence
in personnel files is rare, no matter the resulting condition fol-
lowing MST, and therefore, the Committee urges VA to support the
extension of the relaxed evidentiary standard to all those suffering
from mental health disorders as a result of MST. Further, the
Committee urges VA to continue to report to Congress on informa-
tion relating to claims for disabilities incurred or aggravated by
MST, as provided by section 113 of the Jeff Miller and Richard
Blumenthal Veterans Health Care and Benefits Improvement Act
of 2016 (P.L. 114–315).
Compensation and Pension Exams.—The Committee is aware
that the majority of veterans filing claims for disabilities incurred
or aggravated by MST are referred to a third-party contract pro-
vider for the required Compensation and Pension (C&P) exam, and
is aware that veterans filing MST-related claims may have unique
needs and safety concerns. Therefore, the Committee reiterates the
direction included in House Report 117–81 related to required, spe-
cialized MST training for both contract and VHA examiners and
looks forward to receiving the report expeditiously. The Committee
further directs VA to allow veterans filing an MST-related claim to
request a VHA provider for the required C&P exam.
Hearing Loss Prevention.—Hearing loss and auditory injuries ac-
count for one of the most prevalent service-connected disabilities
for veterans receiving compensation benefits. As such, the Com-
mittee requests a report, not later than 180 days after enactment
of this Act, on the number of veterans affected and amount of com-
pensation benefits provided over the last five fiscal years and di-
rects the Department to work with the Department of Defense to
identify options, strategies, and technologies to reduce the inci-
dence of hearing loss by military personnel through exposure to ex-
cessive auditory pressure impulses during weapons training.
Expand Accessibility for Toxic-Exposed Veterans.—The Com-
mittee encourages VA to ensure resources and materials provided
by VA to toxic-exposed veterans be made available in the most
commonly spoken languages in the United States, as mandated in
the Veterans and Family Information Act (P.L. 117–62).
Transition Assistance Grant Program.—The transition from mili-
tary to civilian life brings significant challenges, which can be exac-
erbated by difficulties navigating a patchwork of different pro-
grams. The Committee believes that centralized community re-
rfrederick on DSKB3L4F33PROD with HEARING
sources are needed to ensure veterans have a successful transition.
The Committee directs VA to work towards timely implementation
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00037 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
38
of the transition assistance grant program established by Section
4304 of the Johnny Isakson and David P. Roe, M.D. Veterans
Health Care and Benefits Improvement Act of 2020 (P.L. 116–315)
and includes $1,300,000 for the initial implementation of this pro-
gram, as requested. The Committee encourages VBA to explore op-
tions to expand these grants in future years. The Committee fur-
ther directs VBA to provide a briefing, not later than 90 days after
awarding the initial grants, on progress and an interim assessment
of effectiveness of these grants to improve veteran transition and
a report on the effectiveness of these grants not later than 90 days
after completion of the grant period.
Digitizing Veteran Records.—The Committee commends the ef-
forts of VBA, in partnership with the National Archives and
Records Administration (NARA), to address the backlog of veterans’
records requests by creating digital copies of records that currently
exist only in hardcopy form at the National Personnel Records Cen-
ter (NPRC). The Committee strongly encourages VBA to continue
its efforts to create digital copies of veterans’ records housed at
NPRC. Therefore, the Committee encourages VBA to allocate with-
in the budgeted amounts any necessary funding to continue to
digitize veterans’ records housed at NPRC. In addition, to assist
with Congressional efforts to properly resource digitization efforts,
the Committee directs VBA to produce an analysis of the resources
needed to digitize all hardcopy veteran records housed at NPRC
not later than 90 days after the enactment of this Act.
VETERANS HEALTH ADMINISTRATION (VHA)
The Department operates the largest Federal medical care deliv-
ery system in the country, with 145 hospitals, 124 residential reha-
bilitation treatment programs, 135 nursing homes, 300 Vet Cen-
ters, 83 Mobile Vet Centers, and 740 Community-Based Outpatient
Clinics (CBOCs). Approximately 7,347,400 patients will be treated
in fiscal year 2023.
The Veterans Health Administration budget comprises five ac-
counts: Medical Services, Medical Community Care, Medical Sup-
port and Compliance, Medical Facilities, and Medical and Pros-
thetic Research. For the first four accounts, which are funded in
advance, the Committee provides an additional $7,527,000,000 for
fiscal year 2023, which is an increase of $66,000,000 over the budg-
et request. In addition, VA will receive an estimated
$3,910,000,000 in the Medical Care Collections Fund in fiscal year
2023. The Administration has requested total resources for fiscal
year 2024 of $128,104,000,000 to fund the four advance appropria-
tions of VHA. The Committee also provides $926,000,000 for Med-
ical and Prosthetic Research, an increase of $10,000,000 over the
budget request.
The Committee supports the efforts of the Office of Care Manage-
ment and Social Work, which provides comprehensive transition
assistance and case management for wounded, ill, and injured
Post-9/11 veterans. The Committee notes the overall trend for re-
cently transitioned servicemembers that pose the highest risk of
suicide during the three years immediately post-discharge. VHA
rfrederick on DSKB3L4F33PROD with HEARING
should continue to support effective initiatives that cover transition
from military service to veteran status.
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00038 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
39
Billing of Private Insurers.—The Committee expresses concerns
with the Department’s challenges in effectively billing private
health insurers, as detailed in the OIG’s May 2022 report, ‘‘VHA
Continues to Face Challenges with Billing Private Insurers for
Community Care’’ (Report No. 21–00846–104). The Inspector Gen-
eral identified inefficient processes, problems with data complete-
ness, and workload and staffing challenges that led to VA being
unable to recover significant amounts of funds. The Committee di-
rects VA to submit a report within 60 days of enactment of this Act
on how it is addressing these identified deficiencies and how it is
responding to the Inspector General’s recommendations to improve
billing processes.
Veterans Transportation.—The Committee continues to support
the Department’s programs to provide veterans across the country
with transportation to VA medical facilities, making it easier for
rural and disabled and impaired veterans to receive medical care.
The Committee directs the Department to allocate robust funding
for these programs, including the Veterans Transportation Pro-
gram and the Volunteer Transportation Network, so that they can
continue to expand access to VA services for veterans across the
country. The Committee further directs VA to explore all options
to strengthen and sustain the Volunteer Transportation Network,
including increased funding to recruit and retain drivers and sup-
port vehicle maintenance.
Dispute Resolution.—The Committee urges VA to ensure that
veterans are clearly advised of their rights to contest VA billing
charges and determinations and of the step-by-step process for dis-
puting billing charges. VA is further urged to ensure this informa-
tion is available both online and in publicly accessible areas at each
VA medical center, and that it is made available in English, Span-
ish, and other languages, as appropriate, in a given geographic re-
gion, with information directing veterans where to find further
translations of the information into the eight other most commonly
spoken languages in the United States.
Healthcare Information Transparency.—The Committee urges VA
to ensure that information that is required to be disclosed by law,
such as wait time and patient safety data, is consolidated and
streamlined onto an easily accessible and usable website. VA is en-
couraged to consult with Veterans Service Organizations, veterans,
and caregivers of veterans from geographically diverse areas and
representing different eras of service to gather insights about po-
tential modifications that could help improve the understanding
and use of such data.
TOXIC EXPOSURE
The Committee strongly supports efforts to improve diagnosis
and treatment of conditions resulting from toxic exposures, and ap-
preciates the work of the Health Outcomes Military Exposures
(HOME) program, the Office of Research and Development, and
other VA program offices to increase attention to this issue.
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
rfrederick on DSKB3L4F33PROD with HEARING
during military service has had on the health of veterans. There-
fore, the Committee continues to support VA’s work through the
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00039 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
40
Airborne Hazards and Burn Pits Center of Excellence on diagnoses,
mitigation, and treatment of conditions related to airborne hazards
and burn pits, and includes $13,000,000, as requested, to carry out
responsibilities and activities of the Airborne Hazards and Burn
Pits Center of Excellence.
Burn Pits Center of Excellence Expansion.—Research and clinical
trials are urgently needed to develop effective treatments for vet-
erans exposed to toxic environmental hazards, and the VA Re-
search Advisory Committee has recommended the establishment of
Centers of Excellence to facilitate the development and availability
of new treatments in clinical settings. However, the effects of toxic
exposure may manifest differently between genders. Therefore, the
Committee directs the Department to provide a report within 120
days of enactment of this Act on the feasibility, including cost esti-
mates, of establishing a new Center of Excellence or expanding the
existing Burn Pits Center of Excellence to focus on gender-based
differences in disease and treatment. The report should include de-
tails on how the Department is including investigations of gender-
based differences in disease and treatment and ways it can expand;
how it is expanding provider education to focus on gender-based
differences; how it is working with outside groups and clinical ex-
perts to inform best practices on including women veterans in clin-
ical trials; and how it is leveraging research funding through part-
nerships, particularly those with experience with research con-
sortia working on Gulf War Illness with funding through the De-
partment of Defense’s Congressionally Directed Medical Research
Programs, partnerships with VA medical centers and minority
serving institutions, and expertise in gender-based differences in
disease diagnosis and treatment.
Toxic Exposure Research.—The Committee is pleased that toxic
exposures will continue to be an area of focus for VA’s research pro-
grams in fiscal year 2023 through the Military Exposure Research
Program. The Committee encourages the Department to continue
to expand its research on the effects of and treatments for veterans
exposed to toxins, such as Agent Orange, open burn pits, per- and
polyfluoroalkyl substances (PFAS), radiation, and asbestos, during
the course of their active duty service. In addition, the Committee
urges the Department to reference data from existing medical
records of veterans to determine how veterans who served in areas
where toxins were dispersed may have more frequent or unex-
plained diseases compared to the civilian population.
Gender-Specific Toxic Exposure Research.—The Committee recog-
nizes the gender-specific impacts of toxic exposure and notes that
in order to provide full and effective medical care, it is essential for
the Department to understand the health effects of women vet-
erans exposed to toxins during their service. The Committee en-
courages the Department to continue and expand its research on
the effects of toxic exposure and ensure gender-specific research on
women veterans is included in these efforts. Further, the Com-
mittee is concerned that a commensurate number of women vet-
erans relative to the total women veteran population are not being
utilized in research studies, especially in those pertaining to effects
of toxic exposure on veterans. The Committee directs VA to provide
rfrederick on DSKB3L4F33PROD with HEARING
a report within 120 days of enactment of this Act on the metrics
of women veterans participating in trials and strategies on how VA
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00040 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
41
is recruiting and designing their studies to be properly inclusive of
women.
PFAS Research.—The Committee is deeply concerned about the
impact of PFAS at military bases on servicemembers, their fami-
lies, and surrounding communities, and recognizes that the effects
of PFAS exposure may continue for servicemembers once they are
under the care of VA. While the Committee directs VA to continue
collaborating with DOD’s PFAS Task Force, academia, and other
health institutions and agencies to monitor research activities, re-
sults, and publications on the health effects from PFAS, the Com-
mittee also believes that VA can and should play an active role in
research on the effects of PFAS exposure and health monitoring as
it relates to veterans.
Burn Pit Population Surveillance.—The Committee continues to
express its concern regarding the devastating effects that toxic par-
ticulate matter from sources such as burn pits, dust storms and
sulphur mine fires have had on veterans who were deployed to
Iraq, Afghanistan, Southwest Asia, and other theaters of operations
in the period after 9/11. While the Department has attempted to
quantify the number of veterans who were exposed to airborne haz-
ards, a full accounting of the scope and severity of the impacts of
these exposures across the affected population has not been under-
taken. The Committee is aware of emerging technology that uses
existing x-ray imaging equipment to derive four-dimensional mod-
els of lung function, to identify respiratory illnesses and accom-
panying loss of lung function earlier than was previously feasible.
The Committee urges the Department to evaluate this technology
for the purposes of conducting population-wide surveillance of vet-
erans who have likely been exposed to airborne hazards, in order
to conduct a full accounting of the health impacts suffered by vet-
erans and to provide full and effective medical care to this popu-
lation.
Early Detection Diagnostics.—The Committee encourages VA to
consider all options to better incorporate available early detection
diagnostics into veterans’ care. Particularly for veterans exposed to
toxic substances, early detection diagnostics can help identify early
onset cancers and other illnesses to ensure that toxic-exposed vet-
erans get the care and help they need from the VA. The Committee
directs the VA to submit a report to the Committee no later than
180 days after enactment of this Act on how it is incorporating
early detection diagnostics into veterans’ care and areas for poten-
tial improvement.
MEDICAL SERVICES
Fiscal year 2022 enacted level ....................................................... $58,897,219,000
Fiscal year 2023 enacted level ....................................................... 70,323,116,000
Fiscal year 2023 budget year request ........................................... 261,000,000
Committee 2023 budget year recommendation ............................ 327,000,000
Fiscal year 2024 advance appropriation request ......................... 74,004,000,000
Committee 2024 advance appropriation recommendation .......... 74,004,000,000
Comparison with:
Fiscal year 2023 enacted level ............................................... +3,680,884,000
Fiscal year 2024 advance budget request ............................. –––
The bill includes an additional $327,000,000 for Medical Services
rfrederick on DSKB3L4F33PROD with HEARING
in fiscal year 2023 as well as $74,004,000,000 for advance fiscal
year 2024 funding. The Committee has included bill language to
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00041 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
42
make $1,500,000,000 of the Medical Services advance appropriation
for fiscal year 2024 available through September 30, 2025.
Of the funds provided for fiscal year 2023, $13,920,415,000 is for
mental health, which is $1,500,000 above the budget request;
$2,685,392,000 is provided for homelessness initiatives;
$307,455,000 is for rural health; $911,119,000 is for gender-specific
care and programmatic efforts to deliver care for women, which is
$10,000,000 above the budget request; $85,851,000 is for Whole
Health initiatives, which is $10,000,000 above the budget request;
$498,098,000 is provided for suicide prevention outreach efforts,
which is $1,500,000 above the budget request; $662,805,000 is pro-
vided for opioid prevention and treatment; and $183,287,000 is pro-
vided for Substance Use Disorder programs, which is $2,000,000
above the budget request.
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.
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.
MENTAL HEALTH
The Committee provides $13,920,415,000 in discretionary fund-
ing for mental health programs. Of the amounts provided for men-
tal health programs in fiscal year 2023, $2,883,874,000 is for sui-
cide prevention and treatment programs. Specifically, $498,098,000
is for suicide prevention outreach, which is $1,500,000 above the
budget request.
The Committee notes that in fiscal year 2023, the three-year
PREVENTS program, which was established by Executive Order
13861 to develop an interagency public health strategy to address
veteran suicide, will come to an end and its suicide prevention
treatment and outreach programs will be absorbed into VA’s ongo-
ing suicide prevention programs. While this will reduce duplication
of efforts and enable more effective programming, the Committee
strongly believes that suicide prevention must continue to be an
rfrederick on DSKB3L4F33PROD with HEARING
area of investment for the Department to make progress on this
issue.
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00042 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
43
The Committee continues to direct the Department to focus on
efforts to address parking lot suicides and connect veterans to care.
The Department is directed to provide a report to the Committee,
no later than 90 days after enactment of this Act, identifying a de-
tailed expenditure plan for all suicide outreach and treatment pro-
grams and how VA is meeting the Committee’s directives.
The Department should continue to work to improve community
outreach and increase access to care regardless of discharge status
or service history. The Department should also continue to engage
with VSOs to help remove the stigma that is associated with seek-
ing mental healthcare. Furthermore, VA is directed to remove bar-
riers that affect a veteran when trying to receive mental healthcare
and to implement a twenty-first century outreach program that in-
corporates social media and other electronic means to reach vet-
erans 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 and ensure that mental health
needs are addressed throughout the transition process.
Improving the Veterans Crisis Line (VCL).—The Committee pro-
vides funding to support the VCL, as requested, and continues to
monitor the VCL to ensure veterans are receiving appropriate clin-
ical care. To support this critical care, the Committee instructs the
Secretary to ensure that Federal funding for the VCL is utilized to
make any necessary improvements to VCL’s operations in order to
best meet the needs of veterans seeking assistance. This includes,
but is not limited to, ensuring appropriate staffing for call centers
and back-up centers, providing necessary training for VCL staff,
and ensuring that staff are able to appropriately and effectively re-
spond to the needs of veterans needing assistance through the
VCL.
The Committee maintains 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.
Peer Specialist Program.—The Committee is encouraged by the
success of VA’s Peer Specialist program. By providing connections
to their peers, this program is ensuring veterans can access mental
health benefits and resources in a supportive context. The Com-
mittee encourages VHA to explore opportunities to add new peers
to support the Substance Use Disorder programs administered by
the Office of Mental Health and Suicide Prevention. The Com-
mittee also encourages the Peer Specialist program to ensure com-
munity-based peer mentoring organizations are activated to direct
candidate veterans to the VHA’s program, and encourages elimi-
nating barriers to participation.
Improving Depression Treatment with Precision Medicine.—The
Committee recognizes that depression is one of the most common
conditions associated with military service and combat exposure.
Further, the risk of suicide increases with this diagnosis and each
time a veteran tries and fails a medication. The Committee is
aware that VA-led studies focusing on precision medicine tests to
treat depression are nearing completion and will be submitted for
rfrederick on DSKB3L4F33PROD with HEARING
peer review and publication. VHA is encouraged to ensure access
to pharmacogenomic tests in the treatment of depression if the
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00043 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
44
tests have been shown to improve health outcomes of veterans in
clinical trials.
Public-Private Partnerships.—The Committee continues to be
concerned by the alarming number of suicides committed by vet-
erans each day. While the Committee appreciates the important
work being done by the Department to combat suicide and improve
mental health among veterans, more can and must be done. The
Committee recommends that the Department continue to seek out
public-private partnerships, in particular with research univer-
sities, teaching hospitals, and other partners, to expand upon its
existing efforts related to suicide prevention, post-traumatic stress
disorder (PTSD), traumatic brain injury (TBI), and substance use
disorders. Of the funds provided for mental health programs in fis-
cal year 2023, up to $5,000,000 is included for expansion of 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. The Committee requests a report on VA’s efforts
to educate law enforcement about the issues facing veterans, in-
cluding mental health needs, no later than 60 days after enactment
of this Act.
Non-Citizen Veteran Outreach.—The Committee is concerned
about the level of awareness regarding mental health services
among 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.
Reporting on Wait Times for Psychiatric Inpatient Care.—The
Committee notes its concern with reports of wait times faced by
veterans for inpatient emergency mental health treatment pro-
grams. As VA prepares for implementation of Section 201 of the
COMPACT Act (P.L. 116–214), it is even more critical to have a
full understanding of limitations and obstacles to veteran access to
inpatient care. Within 180 days of enactment of this Act, the Com-
mittee requests a report outlining whether and how VHA tracks
wait times for psychiatric beds, how any such wait times have im-
pacted health outcomes or possible suicides, remediation efforts un-
dertaken or recommended to be taken, and any resource require-
ments needed to meet such objectives. The report should include
data from the past five years on whether resource limitations, staff
or inpatient unit shortfalls, or wait-lists have kept veterans in
state-managed mental healthcare that wished to transfer to VA
care, as well as data on whether VA’s lack of facilities able to han-
dle veterans with coincident mental and medical conditions and a
broader lack of psychiatric care beds has limited access to care for
veterans.
Military Sexual Assault.—The Committee continues to be aware
of the high prevalence of sexual assault, among both men and
rfrederick on DSKB3L4F33PROD with HEARING
women, during their service. Effects from this assault persist once
servicemembers return home and can manifest in mental health
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00044 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
45
disorders such as depression, PTSD, substance use disorders, eat-
ing disorders, and anxiety. Because sexual trauma is so prevalent,
the Committee recommends that all veterans seeking treatment
services are screened for sexual assault using an evidence-based
screening tool in order to successfully treat those who have experi-
enced assault.
Cancer and Mental Health Screening at Veterans Affairs Medical
Centers.—The Department is encouraged to ensure its healthcare
providers screen for the numerous types of cancers and mental
health issues that veterans experience so they can receive the best
possible care.
National Center for Post-Traumatic Stress Disorder.—Recog-
nizing the importance of VA’s National Center for PTSD in pro-
moting better prevention, diagnoses and treatment of PTSD, the
Committee provides $45,000,000 for the Center, which is
$5,000,000 above the budget request.
The Committee remains concerned that, consistent with findings
from the Center, some groups of veterans, including African Ameri-
cans and Latinos, are more likely to develop PTSD, and less likely
to see improvement from treatment. As such, the Secretary is di-
rected to report to the Committee on Appropriations no later than
90 days after enactment of this Act on efforts to implement rec-
ommendations made by the Office of Health Equity at VHA to im-
prove outcomes for African American and Latino veterans with
PTSD, as well as improving the collection, use and dissemination
of data disaggregated by race and ethnicity.
The Committee also continues to encourage the Center to explore
academic and interagency collaborations that investigate novel and
multifactor approaches, such as dietary interventions and non-
invasive brain stimulations, and investigational trials to test and
develop new methods to treat PTSD, including neuromodulation,
family-inclusive therapies, and alternative treatments, such as
those recommended by the Creating Options for Veterans’ Expe-
dited Recovery (COVER) Commission.
Post-Traumatic Growth Programs.—As the Department con-
tinues to highlight veterans’ mental healthcare and suicide preven-
tion as a key priority, there is an opportunity to explore effective
alternative treatments focused on the area of post-traumatic
growth. The Committee encourages the Department to continue to
collaborate, partner with and support non-profit post-traumatic
growth organizations and programs.
Post-Traumatic Stress Disorder Service Dogs.—The Committee
recognizes the positive role that service, guide, and hearing dogs
have played in mitigating veterans’ disabilities and providing as-
sistance and rehabilitation. The Committee is encouraged that a
pilot program created by the PAWS Act of 2021 (P.L. 117–37) is
underway at five VA medical centers, which will assess the poten-
tial therapeutic effectiveness of service dogs in the treatment of
PTSD, and urges VA to ensure it is properly resourced to achieve
the best possible outcomes. The Committee directs VA to provide
a report on the status of this program within 120 days of enact-
ment of this Act, including the status of agreements with partici-
rfrederick on DSKB3L4F33PROD with HEARING
pating canine training organizations and whether the Department
has identified any barriers to participation of these entities.
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00045 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
46
Hyperbaric Oxygen Therapy.—The Committee encourages the De-
partment to provide hyperbaric oxygen treatment to veterans suf-
fering from chronic post-traumatic stress disorder, as appropriate.
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-
opment of innovative and immersive therapies, which can extend
trauma management therapy protocol. The Committee encourages
VA to continue its Trauma Management Therapy study that ex-
plores exposure therapy involving virtual reality in combination
with group therapy for the treatment of individuals with symptoms
relating to PTSD, and requests a report at the conclusion of the
study.
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.
Cognitive Behavioral Therapy Virtual Care.—The Committee un-
derstands that wounded, ill, and injured veterans and their fami-
lies face complicated and complex challenges, which at times can
lead to attempts at self-medication, other substance use disorders,
and general struggles with mental health, which have been exacer-
bated by the COVID–19 pandemic. The Committee recognizes the
evidence that more veterans will require greater access to mental
healthcare and that the demand for accessible and virtual care is
likely to increase concurrently. As such, the Committee recognizes
the promise of commercially available, virtual programs with thera-
pist-guided cognitive behavioral therapy that can support the VA
in delivering timely and quality care to veterans. To meet the
growing demand for telehealth or virtual mental healthcare, the
Committee encourages VA to provide veterans access to virtual cog-
nitive behavioral therapy, including ensuring that options are
available over low broadband. The Committee directs VA to provide
the Committees on Appropriations of both Houses of Congress a re-
port, not later than 90 days after enactment of this Act, on the sta-
tus of efforts to utilize solutions and partners in the delivery of
mental health services virtually and how to make these solutions
more accessible to patients.
Vet Centers.—The Committee recognizes the importance of Vet
Centers and the role they play in helping veterans readjust to civil-
ian life. The Committee provides funding for VA’s Readjustment
Counseling Service programs and encourages VA to work with local
stakeholders to increase access to the readjustment counseling
services provided by Vet Centers, Mobile Vet Centers, Outstations,
and Community Access Points, and directs the Department to in-
rfrederick on DSKB3L4F33PROD with HEARING
crease outreach to veterans so they are aware of these counseling
centers and services.
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00046 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
47
SUICIDE PREVENTION OUTREACH
Suicide Prevention Coordinators.—The Committee recognizes the
importance of Suicide Prevention Coordinators, who follow up with
and coordinate care for veterans who have been directly referred to
them by responders at the Veterans Crisis Line. Given that VA an-
ticipates an increased volume of calls as the crisis line transitions
to a three-digit number, the Committee directs VA to ensure that
it maintains adequate staffing levels of Suicide Prevention Coordi-
nators to respond to this increase and provides an additional
$1,500,000 above the budget request to help support staffing of Sui-
cide Prevention Coordinators. The Committee further directs VA to
submit a report within 60 days of the transition to the three-digit
number, and quarterly thereafter, on the volume of calls received
by the crisis line and a comparison to the prior year; the number
of callers referred to Suicide Prevention Coordinators; the metrics
that VA is using to measure and ensure adequate staff response by
both crisis line staff and Suicide Prevention Coordinators; and rec-
ommendations, including cost estimates, of any needed adjustments
to staffing levels.
VetsCorps.—The Committee continues to strongly support the
VetsCorps pilot program and urges that it be fully implemented
without further delay. Although VA has other outreach programs,
a key and unique aspect of VetsCorps is that veterans themselves,
working with VA, proactively seek out and connect with veterans
in their communities who have not been served by the Department,
in order to help connect them with available programs and serv-
ices. VA should track veterans brought into the system through
this outreach. The Committee continues to direct the Department
to provide quarterly reports on the status of the implementation of
the VetsCorps pilot program. Furthermore, at the conclusion of the
pilot, the Committee directs the Department to report to the Com-
mittees on Appropriations of both Houses of Congress on the effec-
tiveness of the pilot program at reaching veterans, particularly
those in need, and increasing utilization of VA services and evalu-
ate the cost-effectiveness of the program compared to existing out-
reach efforts.
Governor’s and Mayor’s Challenges to Prevent Suicide Among
Service Members, Veterans, and their Families.—The Committee
applauds the work of the Governor’s and Mayor’s Challenges to
Prevent Suicide Among Service Members, Veterans, and their Fam-
ilies, and the bill includes sufficient funding to support the Depart-
ment’s efforts to extend this program to additional States. The
Committee urges VA to continue to engage with participating
states on technical assistance around implementation of action
plans, and to provide resources to states to assist with efforts to
improve data collection to better inform suicide prevention activi-
ties.
Zero Suicide Initiative.—The Committee recognizes the value of
innovative, systems-focused efforts to combat veteran suicide across
the country and notes the use of the Zero Suicide model across var-
ious healthcare systems and through the Department of Health
and Human Services. The Committee encourages VA to evaluate,
rfrederick on DSKB3L4F33PROD with HEARING
in consultation with experts and VSOs, the feasibility and effective-
ness of implementing a Zero Suicide initiative that provides train-
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00047 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
48
ing and support to VA employees, in order to reduce the rate of vet-
eran suicide.
Suicide Risk Assessment and Training.—The Committee recog-
nizes the ongoing need to support the success of the Clinical Re-
source Hub at the Office of Rural Health. This program is an inno-
vative model that delivers high-quality healthcare services to vet-
erans in underserved locations. The Committee also recognizes the
high risk of suicide among veterans and the need to train addi-
tional behavioral and mental health providers to assist veterans
living in both rural and urban communities. The Committee directs
VA to expand ways for urban and rural academic institutions with
expertise in suicide risk assessment and training, particularly mi-
nority-serving institutions, to engage with Clinical Resource Hubs
to share best practices on meeting the needs of all veterans, as well
as on combining telehealth services with in-person care to train
providers and provide care to veterans in rural communities.
Collaboration on Lethal Means Safety.—The Committee wel-
comes the Administration’s new national strategy, ‘‘Reducing Mili-
tary and Veteran Suicide: Advancing a Comprehensive, Cross-Sec-
tor, Evidence-Informed Approach’’, and commends the Strategy’s
focus on improving Lethal Means Safety education and training for
veterans, including firearms safety. The Committee notes that the
Strategy called for VA to partner with the Departments of Defense,
Health and Human Services, Homeland Security, Justice, and the
Office of Emergency Medical Services within the Department of
Transportation to create and implement a coordinated approach for
improving lethal means safety. The Committee requests a report
within 180 days of enactment of this Act on the development of this
coordinated approach and VA’s plans to incorporate the coordinated
approach into the Department’s existing lethal means safety initia-
tives.
The Committee continues to support collaboration across public
and private sectors to end the national tragedy of suicide, and en-
courages VA medical centers to collaborate with state and local law
enforcement and health officials in states that have adopted ex-
treme risk protection orders, also known as ‘‘red flag’’ laws, and
similar gun safety laws, to adopt programs and protocols on fire-
arm safety and storage to assist veterans who may be struggling
with suicidal thoughts. The Committee additionally supports VA’s
investment in demonstration projects to support innovative and
promising practices to address suicide, in particular VA’s project to
evaluate a novel firearm safety storage and mental health crisis
planning intervention, which will engage veterans and their fami-
lies in conversations about safe firearm storage, identifying warn-
ing signs for mental health symptoms or suicide risk, and how to
create a collaborative safe storage plan.
The Committee is pleased that VA has implemented mandatory
lethal means safety trainings for clinical healthcare providers in
VHA facilities. To ensure that every employee who regularly inter-
acts with veterans is prepared to have a conversation that could
save a veteran’s life, the Committee continues to urge VA to imple-
ment mandatory lethal means safety trainings for all VHA and
rfrederick on DSKB3L4F33PROD with HEARING
VBA employees who regularly interact with veterans in their work,
compensation and pension examiners, employees of Veterans Cen-
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00048 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
49
ters and vocational rehabilitation facilities, community care pro-
viders, and family caregivers to the extent practicable.
Suicide Prevention Technology.—The Committee recognizes the
importance of consistent and timely follow-up care for veterans
identified as at high risk for suicide. Although VA has been an in-
novator in implementing an enterprise-wide suicide screening ini-
tiative, monitoring and management of veterans identified as at-
risk falls on the responsibility of already overworked suicide pre-
vention coordinators and case managers, as documented in an April
2021 Government Accountability Office (GAO) report (21–326: Ef-
forts Needed to Ensure Effective Use and Appropriate Staffing of
Suicide Prevention Teams). To help address this challenge, VA
medical centers need the latest real-time technologies that com-
plement the existing retrospective reporting tools from the VA Cen-
tral Office. Suicide prevention coordinators need real-time case
monitoring and management tools that improve situational aware-
ness, patient safety, and compliance with VA Risk ID policies. The
Committee encourages VA to provide integrated, real-time data,
interactive push notifications, data visualization tools and VA sui-
cide prevention performance measure analytics. The Committee di-
rects the Department to provide a report, no more than 180 days
after enactment of this Act, on the benefits of an enterprise-wide,
real-time, and interactive technology to support suicide prevention
coordinators. The report must include: (1) a list of facilities cur-
rently using this type of technology and the outcomes that have
been seen, (2) the Department’s plans to deploy this type of tech-
nology across all VA medical facilities, and (3) total program cost
and schedule to implement an enterprise-wide solution.
HOMELESS ASSISTANCE
The Committee provides $2,685,392,000 for VA homeless assist-
ance programs, an increase of $530,942,000 above the comparable
fiscal year 2022 enacted level and fully funding the President’s
budget request. An estimated $9,145,900,000 is provided for home-
less veterans treatment costs, an increase of $294,400,000 above
the comparable fiscal year 2022 enacted level.
Programs to assist homeless veterans include the Homeless Pro-
viders Grant and Per Diem (GPD), Health Care for Homeless Vet-
erans (HCHV), the Domiciliary Care for Homeless Veterans, the
Supportive Services for Low Income Veterans and Families (SSVF),
Veterans Justice Outreach Homeless Prevention (VJO), Com-
pensated Work Therapy, 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 notes the
benefits of the Healthcare for Homeless Veterans Program H–
PACT program, and encourages VA to expand this program to ad-
ditional sites, including rural areas, and to consider additional
services to improve the program. The Committee directs the De-
partment to include a plan to expand this program to additional
sites, including cost estimates, with its fiscal year 2024 budget re-
quest.
Ending Veteran Homelessness.—The Committee recognizes the
rfrederick on DSKB3L4F33PROD with HEARING
value and impact of the HUD–VASH program, which serves vet-
erans experiencing homelessness and pairs each HUD affordable
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00049 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
50
housing voucher earmarked for veterans with intensive case man-
agement from VA to assist with benefits and income, mental
healthcare, recovery services, and permanent housing stability.
Case management services are critically important to the function
of the program, and public housing authorities rely on VA Medical
Centers referrals to house veterans. Due to the joint nature of
HUD–VASH funding, the Committee recommends that VA’s budget
for case managers be increased commensurate with any increases
in HUD’s budget for new vouchers and to account for increased
costs in staffing and recent expansions in eligibility.
Tiny Homes.—The Committee notes the Department has made
great efforts to find suitable housing for homeless veterans and
their families, and strongly encourages the Department to continue
its efforts to implement more non-traditional efforts, such as
‘‘Micro’’ or ‘‘Tiny Homes’’ or renovated shipping containers, to elimi-
nate the problem of suitable housing for homeless veterans and
their families. The Committee directs VA to allocate $8,000,000 to
fund a pilot program to build villages of tiny homes for homeless
veterans, with preference given to grant recipients who use energy
efficient building materials. Of the funds provided, the Committee
recommends $2,000,000 to be used for continuing operations and
maintenance costs of these tiny home villages.
Legal Assistance for Veterans.—The Committee notes that the
Department has begun implementing the Legal Services for Vet-
erans Grant Program, which builds upon existing services offered
to veterans through partnerships with legal service providers. The
Department is encouraged to expeditiously finalize the rule and
fully implement this program. Furthermore, the Committee con-
tinues to encourage the SSVF program to work with grantees to ex-
pand their legal service offerings, particularly in rural areas where
access to private legal assistance can be limited, and to establish
one or more pilot projects to partner SSVF grantees with university
law schools in rural areas or within underserved populations to en-
hance legal assistance to veterans. This can result in additional
benefits such as training law students in veteran disability law and
legal skills critical to providing advocacy within the VA system, as
well as inspiring next-generation lawyers to serve veterans in prac-
tice.
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
continues to direct VA to work with HUD to develop strategies and
recommendations for addressing veteran homelessness near the
United States-Mexico border and to take into account these under-
counted veterans when awarding HUD–VASH vouchers. The Com-
mittee appreciates VA’s efforts to implement strategies and make
recommendations to decrease veteran homelessness on the border,
such as the development of a Homelessness Screening Clinical Re-
minder, data sharing, improving the accuracy of data, and con-
tracting case management in rural areas. The Committee requests
an updated report within 60 days of enactment of this Act on its
efforts to serve homeless veterans on the border.
rfrederick on DSKB3L4F33PROD with HEARING
Supportive Housing for Veterans with Serious Mental Illness.—
The Committee applauds the HUD–VASH program for providing
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00050 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
51
housing opportunities for veterans experiencing homelessness and
commends their success in decreasing the rate of homeless vet-
erans by nearly 50 percent since 2010. The Committee understands
not all veterans in need fit the traditional definition of homeless
and that veterans experiencing serious mental illness also experi-
ence difficulties acquiring housing, whether due to a co-occurring
substance use disorder or conditions related to their service, includ-
ing PTSD and TBI. Thus, the Committee encourages VA to build
upon the tangible achievements of the HUD–VASH program and
explore whether a new model of vouchers could provide housing op-
portunities for low-income veterans experiencing serious mental ill-
ness who seek healthcare services from VA.
STAFFING ISSUES
Staffing Shortages.—The Committee has long recognized the
growing shortage of VHA physicians and medical professionals has
negatively affected the delivery of care for veterans at VHA med-
ical 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 the nation’s veterans. The Committee looks for-
ward to the annual comprehensive report required by the Joint Ex-
planatory Statement accompanying the Consolidated Appropria-
tions Act, 2022 (P.L. 117–103) on the Department’s plan to address
critical workforce issues.
VA/HHS Collaboration on Health Workforce Shortages.—The
Committee continues to encourage VA to work with HHS to explore
ways the agencies can work together, such as by creating a
taskforce, to increase the availability of providers, including in the
behavioral health workforce and among physicians specializing in
cancer, spinal cord, and neuropsychiatric conditions. This collabora-
tion is urged to examine VA’s recruitment challenges, review pro-
grams that could enhance recruitment and retention, and to think
creatively on how other Federal agencies like HHS can identify and
address provider shortages. VA is also encouraged to consult with
DOD to explore recruiting those who have left the military.
Enhancing Recruitment.—The Committee recognizes the chal-
lenge VA has in the recruitment and retention of clinicians. To help
VA better keep pace with other providers and continue to train its
workforce to improve their service to veterans, the Committee
urges VA to explore potential options to enhance recruitment and
retention, such as expanding reimbursement to clinicians for Con-
tinuing Professional Education.
Physical Therapists.—The Committee encourages VA to ensure
pain treatment alternatives to opioids, such as physical therapy,
are available to veterans where they are most needed. As part of
these efforts, the Committee encourages VA to examine how more
competitive pay for physical therapists and physical therapist as-
sistants can help hire and retain these professionals. The Com-
mittee further encourages VA to explore how the Health Profes-
sional Scholarship Program can be expanded to include physical
therapists, and to develop a staffing plan on how to utilize physical
rfrederick on DSKB3L4F33PROD with HEARING
therapists and physical therapist assistants within Primary Care,
Rural Health, Women’s Health, and other areas of the Department.
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00051 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
52
ACCESS FOR RURAL VETERANS
Office of Rural Health (ORH).—The bill includes $307,455,000 for
rural health, which is equal to the budget request, to improve ac-
cess and quality of care for the more than 3,000,000 enrolled vet-
erans residing in rural and highly rural areas. ORH improves ac-
cess and quality of care for enrolled veterans residing in geographi-
cally rural areas. In addition to providing healthcare services,
ORH’s important work includes identifying barriers to healthcare
delivery in rural areas and implementing new ways to deliver
healthcare and services to veterans in these locations.
Office of Rural Health Operating Plan.—The Committee directs
the Office of Rural Health to submit to the Committee no later
than 30 days after enactment of this Act an operating plan for fis-
cal year 2023 funding, as well as for the fiscal year 2024 funding
provided in advance by this Act.
Transportation Challenges.—The Committee recognizes the
transportation challenges and barriers to care that rural and re-
mote veterans face, and that the veteran population is dispropor-
tionately both rural and mobility challenged when compared to the
public at large. The Committee directs the Office of Rural Health
to increase efforts to improve transportation mobility for veterans
and to allocate funding to enhance rural access and transportation
services, and continues to encourage VA to consider utilizing acces-
sible autonomous electric vehicles to overcome these challenges.
The Committee appreciates VA’s progress in beginning to study
veterans’ experiences using autonomous transportation, and re-
quests VA report to the Committee no later than 90 days after en-
actment of this Act with a plan for additional expected studies and
detail on the benchmarks and metrics that VA will use to deter-
mine feasibility of this technology.
Rural Transportation Study.—In fiscal year 2021, the Committee
provided funding, as requested, for the Office of Rural Health’s
rural transportation study by the Veterans Rural Health Resource
Center, Iowa City. The Committee directs the Office of Rural
Health to expeditiously conclude the study and provide a report to
the Committee so that it can assess whether there are gaps in the
Department’s comprehensive rural transportation program, how
they should be closed, and if additional funding is needed.
Rural Veteran Transportation.—The Committee acknowledges
continued progress in addressing transportation barriers for vet-
erans, especially those in areas that have limited transportation
services, including rural or highly rural areas. While the Com-
mittee recognizes the important work of VSOs and the existence of
the Veterans Transportation Program, a transportation gap still ex-
ists for many VA service areas, especially predominantly exurban
and rural ones. The Committee notes that as new forms of mobility
are being developed and becoming increasingly available, options
like on-demand shared ride microtransit may help improve accessi-
bility for veterans, and encourages the Veterans Transportation
Program to explore increased adoption of this transit model and
study the use of software technology to enable this transportation
option.
rfrederick on DSKB3L4F33PROD with HEARING
Clinical Resource Hub.—The Committee supports the success of
the Clinical Resource Hub at the Office of Rural Health. This pro-
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00052 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
53
gram is an innovative model that delivers high-quality healthcare
services to veterans in underserved locations. The Committee rec-
ognizes 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 Com-
mittee also recognizes the impact that expanded access to tele-
health services has had on rural veterans that live beyond the
reach of critical care services. The Clinical Resource Hub combines
telehealth services with in-person care to bring access within reach
for veterans across rural America. The Committee will continue
monitoring the progress of this program through the fiscal year.
Rural Access Network for Growth Enhancement (RANGE).—The
RANGE Program provides case management and treatment serv-
ices to mentally ill veterans in rural areas. These centers are es-
sential for providing care to veterans who have served honorably
and are now in crisis and need serious mental healthcare re-
sources. No veteran should be turned away from receiving mental
healthcare services due to a lack of access and availability of ap-
pointments. The Committee provides $1,200,000 to establish and
maintain three new centers of the RANGE Program, as authorized
by the Sgt. Ketchum Rural Veterans Mental Health Act of 2021
(P.L. 117–21).
TELEHEALTH AND CONNECTED CARE
The bill includes $5,174,818,000 for telehealth and connected
care, which includes home telehealth, home telehealth prosthetics,
and clinic-based telehealth.
Telehealth Improvements.—Telehealth services increase veteran
access to care. The Committee directs VA to continue to expand
telehealth availability to include additional mental health, primary
care, and rehabilitation services as a means to deliver care in rural
and underserved communities. The Committee particularly recog-
nizes and appreciates the significant improvements made in Tele-
health Service by VA in the past two years. These timely improve-
ments were critical in meeting the healthcare needs of veterans
during the COVID–19 pandemic. As the pandemic travel restric-
tions are relaxed, the Committee urges the Department to evaluate
current telehealth services to improve and inform a normalized,
sustainable Telehealth Service model and to focus on easing the
burdens of rural veterans with limited travel options. Additionally,
VA is encouraged to leverage newly gained telehealth capacity to
address backlogs for disability exams and healthcare appointments
when appropriate. The Committee further directs VA to continue to
implement plans to improve veteran and provider satisfaction, in-
crease awareness of the telehealth program, and enhance adoption
of telehealth by veterans and providers. The Department’s plans
should include efforts to make telehealth more accessible to pa-
tients in highly rural areas. The Committee requests a report on
these efforts within 90 days of enactment of this Act.
GENDER-SPECIFIC CARE FOR WOMEN
Women are now the fastest growing cohort within the veteran
community. The number of women veterans using VHA services
rfrederick on DSKB3L4F33PROD with HEARING
has more than tripled in the last two decades, growing from
159,810 in 2001 to over 600,000 today. The increased number of
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00053 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
54
women using VHA services necessitates a greater investment of re-
sources in order to provide and expand VA’s gender-specific serv-
ices to women veterans and ensure women veterans’ health needs,
which often differ from men, are met. The bill provides
$911,119,000 for gender-specific care and programmatic efforts to
deliver care for women, which is $70,673,000 above the fiscal year
2022 enacted level and $10,000,000 above the budget request. This
includes funding to support the Office of Women’s Health at VHA
and its efforts to expand programs and strategic planning for
women veterans. The Committee supports continued efforts to
identify and address the unique issues experienced by women vet-
erans. VA is directed to continue redesigning its women’s
healthcare delivery system and improving its facilities to ensure
women receive equitable, timely, and high-quality healthcare.
VA is directed to provide an expenditure plan no later than 90
days after enactment of this Act, detailing how the funding for gen-
der-specific care and for programmatic support will be spent. Fur-
thermore, the Committee requires quarterly briefings on the ex-
penditure of these funds. The Committee continues to direct the de-
livery of care to women veterans be through an organized program
within normal business operations of VA. The women’s health pro-
gram is required to have appropriate staffing levels and executive
support that is operationalized to ensure all aspects of care for
women veterans are available.
Program managers within each VA facility should be equipped,
at a minimum, with at least one designated women’s health pro-
vider, the appropriate number of nurses, administrative support,
care coordinators, and peer navigators. Additionally, the Com-
mittee continues to direct that Women’s Health Program Managers
be full-time jobs and not be tasked with supplemental responsibil-
ities outside of their specified job descriptions.
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 pro-
vide greater resources at the field level to build visible women-spe-
cific health programs, including suicide prevention programs, re-
productive mental health programs, and combined pain and opioid
use programs, and to ensure that these resources are being prop-
erly used at these levels. As such, 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 Committee remains strongly supportive of efforts by the De-
partment to train and hire Women’s Health Primary Care Pro-
viders (WH–PCPs) and notes that women veterans are twice as
likely to choose to stay in VA care over time if they are assigned
a WH–PCP. The Committee appreciates that to reinforce advance-
ments in hiring and purchasing equipment specific for women’s
healthcare, VA launched the Women’s Health Innovations and
Staffing Enhancements Initiative, and therefore directs VA to en-
sure that sufficient resources are made available to hire and train
WH–PCPs, Women’s Health Patient Aligned Care Team staff, and
other essential women’s health personnel.
Peer Support for Women Veterans.—Peer support programs of-
rfrederick on DSKB3L4F33PROD with HEARING
fered at VA have proven effective in improving health outcomes,
and they continue providing vital support to veterans across the
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00054 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
55
nation. The Committee appreciates VA’s continued investments in
hiring additional women peer specialists and in enhancing peer
support services for women veterans, such as through developing
peer support trainings and clinical resources. The Committee pro-
vides increased funding above current levels for VA to hire addi-
tional women peer specialists at all VA medical centers and notes
that VA plans to conduct a staffing assessment to identify further
peer specialist hiring needs. In addition to this funding, the Com-
mittee directs VA to provide no less than $1,300,000 to implement
women-specific peer support interventions like Women Veterans
Network (WoVeN), a national peer support network for women vet-
erans run by researchers from the National Center for PTSD—
Women’s Health Sciences Division. The research component of this
peer support program will drive innovation in addressing PTSD in
women veterans.
Maternity Healthcare and Coordination Programs.—The Com-
mittee notes that the United States has the highest maternal mor-
tality rate among high-income countries and significant racial and
ethnic disparities in maternal health outcomes. Some of the causes
of adverse maternal health outcomes can be even more prevalent
in veterans, such as military sexual trauma, which is linked with
risk factors for pregnancy-related complications. The Committee is
pleased that to coordinate prenatal and postpartum care provided
in the community, VA has established maternity healthcare and co-
ordination programs, which have been successful in ensuring that
veterans can receive high-quality, culturally appropriate care and
robust support during and after pregnancy. The Committee sup-
ports these maternity healthcare and coordination programs and
encourages VA to continue to ensure veterans have access to high-
quality, well-coordinated care and robust services to address social
determinants of maternal health, including access to housing, nu-
trition, and transportation. The Committee directs VA to continue
to implement and fully resource the Protecting Moms Who Served
Act (P.L. 117–69).
Access to Maternity Care.—The Committee notes that studies
have demonstrated that maternity care provided by midwives in
birth centers is high value care that significantly improves out-
comes for mothers and newborns, while resulting in significant cost
savings for every mother-baby pair during the first year of life. The
Committee is aware that VA is working to improve interoperability
of health records and communications between community pro-
viders in the VA Community Care Network and VA facilities in
order to improve access and quality of care for women veterans,
and directs VA to ensure in-network birth centers and their col-
laborating physician practices are included in efforts to improve
interoperability of electronic health information between facilities
and levels of care. The Committee further directs VA to reduce bar-
riers to care, including those relating to obtaining community refer-
rals, for women veterans seeking maternity care at birth centers
and other community care providers. The Committee requests a re-
port on the progress to achieve these goals no later than 180 days
after enactment of this Act.
Breast Cancer Screening Guidelines.—The Committee commends
rfrederick on DSKB3L4F33PROD with HEARING
VA’s decision to offer breast cancer screening and mammography
to eligible women veterans beginning at age 40. However, the De-
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00055 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
56
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.
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 remains in-
terested in information regarding VA drug pricing and appreciates
VA providing a report as requested in previous fiscal years on VA’s
spending on prescription drugs. The Committee encourages VA to
conduct this analysis annually and requests robust and routine up-
dates to Congress, including updated information for fiscal year
2023 on prescription drug prices (net of rebates) paid by VA for the
ten most frequently prescribed drugs and the ten highest-cost
drugs for VA. In addition, the report should include total annual
costs to VA for all prescription drugs. As VA has noted that coun-
try of origin information on drugs and active pharmaceutical ingre-
dients is not yet available on a national level, the Committee urges
the VA’s National Acquisition Center to work with the Food and
Drug Administration to track this data and establish a national
database for such information.
At-Home Drug Disposal for Veterans.—The Committee is aware
that many unused and unwanted prescription opioids and other
powerful medications remain in homes and are subject to diversion.
This is too often the beginning of a pathway to dependence, addic-
tion, and overdose. The Committee is pleased that in response to
the directions in House Report 116–445 and House Report 117–81,
VA has begun a pilot program to evaluate the benefits of co-dis-
pensing at-home drug disposal products for post-surgical patients.
The Committee directs VA to continue to invest in this pilot pro-
gram and appreciates that VA has expanded this pilot to additional
sites. Further, the Committee encourages VA to include patients in
this demonstration from a variety of geographic locations and VA
medical facility types, as well as patients who are prescribed
opioids for chronic pain management or other long-term use. No
later than 60 days upon conclusion of the pilot, VA is directed to
submit a report on the results of this program and a detailed plan,
including cost estimates, of how this program could be expanded
throughout VA.
Safe Medicine.—The Committee recognizes that the nation’s in-
creased reliance on foreign-based sources of medicine and active
pharmaceutical ingredients may present a health security risk to
rfrederick on DSKB3L4F33PROD with HEARING
VA as they provide medicine for veterans. The Committee con-
tinues to encourage VA to examine potential vulnerabilities and
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00056 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
57
safety risks VA faces purchasing medicine from off-shore sources,
including supply chain and dependency issues, and encourages VA
to address strategies to buy American and produce medicine do-
mestically.
Pharmaceutical On-dose Tracking and Tracing Technologies.—
Track and trace systems are increasingly being implemented as a
technological solution to secure pharmaceutical supply chains.
These systems offer the potential to minimize reimbursement
fraud, facilitate fast market recalls, and help identify medicine
shortages. Therefore, the Committee directs VA to submit a report
within 180 days of the enactment of this Act on the Department’s
efforts, including technologies being used, to secure the VA phar-
maceutical supply chain, reduce illegal distribution of opioid prod-
ucts within VA, and eliminate the distribution of counterfeit phar-
maceutical products within VA.
Pharmaceutical Catalog.—The Committee notes the Federal gov-
ernment’s investments in a competitive process to develop domesti-
cally produced radiopharmaceuticals. To reflect the on-shoring of
manufacturing, the Committee encourages VA to strive to procure,
if feasible, 20 percent in fiscal year 2023 (and 35 percent in fiscal
year 2024) of their molybdenum-99 and its daughter, technetium-
99m from domestic producers of sustainable medical radioisotopes.
The Committee requests a report from VA on the availability of do-
mestic sources of sustainable medical radioisotopes available to
them for procurement in fiscal year 2023.
OPIOID SAFETY INITIATIVES AND SUBSTANCE USE DISORDER CARE
The Committee is pleased that VA has taken an aggressive pos-
ture 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 encourages
VA to continue the challenging effort to reduce opioid use among
veterans, half of whom suffer from chronic pain. The bill includes
$662,805,000 for opioid treatment and prevention efforts, which is
$41,471,000 above fiscal year 2022, and of which $245,754,000 is
provided for activities authorized by the Comprehensive Addiction
and Recovery Act of 2016 (P.L. 114–198). With veteran opioid ad-
diction numbers outpacing those for the rest of the U.S. population,
and the full effects of the coronavirus global pandemic on veteran
opioid addiction still unknown, this funding will allow VA to reach
more veterans in need of assistance with their opioid addiction and
lessen the numbers who fall victim to COVID–19.
The bill also includes $183,287,000 for Substance Use Disorder
(SUD) efforts, an increase of $2,000,000 over the budget request, to
ensure veterans can receive timely SUD specialty services. The
Committee is concerned with challenges veterans face in accessing
treatment, including wait times for inpatient admission, and di-
rects the Department to continue to increase investment in this
program to reduce delays and ensure adequate bed availability and
staffing.
Jason Simcakoski Memorial and PROMISE Act Implementa-
tion.—The Committee supports robust funding to facilitate the con-
tinued implementation of the Jason Simcakoski Memorial and
rfrederick on DSKB3L4F33PROD with HEARING
Promise Act, which passed as Title IX of the Comprehensive Addic-
tion and Recovery Act of 2016 (P.L. 114–198), including updating
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00057 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
58
therapy and pain management guidelines, strengthening provider
education and training, and improving patient advocacy.
Behavioral Health and Substance Use Screening.—The Com-
mittee continues to be aware of the high prevalence of mental ill-
ness and substance abuse among veterans, particularly PTSD, de-
pression, anxiety, and alcohol and opioid abuse. The Committee
strongly recommends that all veterans seeking treatment services
in a VA facility be screened for the listed illnesses, at a minimum
annually, using evidence-based assessment tools.
Substance Use Disorder Programs.—The Committee recognizes
the ongoing work of VA to reduce substance use disorder among
veterans. The Committee supports new and innovative solutions to
intervene early with at-risk veterans and supports programs that
provide veterans and their families with the tools they need to
meet these challenges. The Committee encourages VA to increase
education among its primary care practitioners on the diagnosis
and treatment of alcohol use disorders with Federal Drug Adminis-
tration (FDA)-approved medication-assisted treatments and coun-
seling, as clinically indicated. Additionally, the Committee recog-
nizes the importance of programs that utilize harm reduction tech-
niques and offer confidential education information that can reduce
substance use, relapse, hospital visits and suicide, and therefore
continues to direct VA to establish an internet-based substance
abuse education program to expand its efforts related to SUD edu-
cation and outreach. The Committee directs the Department to re-
port to the Committees on Appropriations of both Houses of Con-
gress within 60 days of enactment of this Act on the efforts made
in establishing this program.
WHOLE HEALTH INITIATIVE
Traditionally, medical providers have focused on the physical
symptoms of veterans, zeroing in on their diseases and ailments.
However, VA is continuing to work to expand this focus by incor-
porating a whole health model of care, which is a holistic look at
the many areas of life that can affect a veteran’s health, including
their work environment, relationships, diet, sleep patterns, and
more. Whole Health is an approach to healthcare that empowers
and enables the veteran to take charge of their health and well-
being and live their life to the fullest. The Committee is extremely
pleased with the Whole Health model of care and includes
$85,851,000 in the bill, which is $10,000,000 above the request and
$2,251,000 above the fiscal year 2022 enacted level, to continue to
implement and expand Whole Health to all VA facilities.
Continued Support and Expansion for Whole Health.—The Com-
mittee notes that data shows participation in the Whole Health
system of care resulted in a 24 percent drop in total healthcare
costs among the participating veterans. Additionally, a recent sur-
vey found that 97 percent of veterans are interested in using Whole
Health. The Committee is pleased by this evidence that points to
the ability of the Whole Health System to deliver care efficiently
and effectively to the nation’s veterans, and urges VA to continue
supporting the program and to expand it further in fiscal year
rfrederick on DSKB3L4F33PROD with HEARING
2023. The Committee further directs VA to report to the Committee
within 60 days of enactment of this Act with the details, timeline,
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00058 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
59
and expected year by year costs of its plan to expand the Whole
Health system to all VA facilities.
Creative Arts Therapies.—The Committee continues to acknowl-
edge the effective use of creative arts therapies and arts and hu-
manities partnerships in treating veterans with traumatic brain in-
juries and psychological health conditions. The Committee supports
the ongoing integration of the arts and creative arts therapies pro-
vided by VA’s Office of Patient Centered Care and Cultural Trans-
formation through the Whole Health initiative and encourages VA’s
continued partnerships with healing arts providers. The Committee
strongly supports the Secretary in continuing to expand these inno-
vative programs throughout the Veterans Healthcare Networks,
particularly in areas that are serving rural, isolated or underserved
veteran populations, and includes $5,000,000 to do so.
Health and Wellness Through Digital and At-Home Fitness.—The
Committee continues to believe the health and well-being of vet-
erans and their families is important to maintain. Furthermore,
the Committee is aware of the ways in which new technologies, in-
cluding digital and at-home fitness applications, can further im-
prove and personalize exercising experiences for best results. The
Committee encourages VA to make all available efforts to ensure
veterans and their families can benefit from digital and at-home
fitness programs in its quality-of-life programming. As such, the
Committee requests a report within 180 days of enactment of this
Act identifying the potential benefits of digital and at-home fitness
to promote force readiness, mental health, suicide prevention, and
rehabilitation from injury.
CAREGIVERS PROGRAM
Caregivers Program.—The caregivers program provides an un-
precedented level of benefits to families with veterans seriously in-
jured in the line of duty. These benefits include stipends paid di-
rectly to the family caregiver, enrollment for the family member in
the VA Civilian Health and Medical Program (CHAMPVA), an ex-
panded respite benefit, and mental health treatment. The Com-
mittee provides the request level of $1,846,210,000 for the care-
givers program. The Committee also continues the requirement on
quarterly reporting on obligations for the caregivers program.
Caregiver Support Program.—The Committee strongly encour-
ages VA to ensure parity in the Program of Comprehensive Assist-
ance for Family Caregivers and the Program of General Caregiver
Support Services for all eligible veterans and their families by en-
suring at least one VA Caregiver Support Coordinator is respon-
sible for each state or U.S. territory that does not currently have
a VA Caregiver Support Coordinator located within its jurisdiction,
such as the Commonwealth of the Northern Mariana Islands, with-
in 180 days of enactment of this Act. Such staff should be provided
the necessary support, space, equipment, and funds to facilitate
travel to other areas within such jurisdiction where veterans reside
on a regular basis. The Committee urges VA to ensure veterans in
these areas are notified that a VA Caregiver Support Coordinator
is available to provide services, including enrollment assistance, to
them and their families. Furthermore, no later than 180 days after
rfrederick on DSKB3L4F33PROD with HEARING
the date this report is filed, the Committee directs VA to provide
a report to the Committees on Appropriations of both Houses of
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00059 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
60
Congress on enrollment, services, and outreach relating to the care-
giver program conducted by VA in such areas, an evaluation of
such activities, and an assessment of the need to provide additional
resources and VA caregiver support staff in such areas, which
should include input from veterans residing in these areas.
OTHER HEALTH ISSUES
Neurology Centers of Excellence.—The Committee recognizes the
increasing number of veterans affected by neurologic conditions, in-
cluding but not limited to epilepsy, headache, multiple sclerosis,
and Parkinson’s disease. The Neurology Centers of Excellence pro-
vide essential and innovative clinical care, education, and research
efforts focused on these conditions, and the Department is directed
to continue to increase its investment to maintain and expand
these centers to enhance their ability to serve veterans. The Com-
mittee appreciates VA’s acknowledgment of the additional need for
equitable access to headache care, specialists, and clinical research
through the Headache Centers of Excellence (HCoE) system, and
provides $5,000,000 to begin expansion of the system as described
in the report referenced in the Joint Explanatory Statement accom-
panying the Consolidated Appropriations Act, 2022 (P.L. 117–103).
The Department is directed to submit a report on the use of these
funds, as well as a funding plan for further expansion, within 90
days of enactment of this Act. The Committee also notes that simi-
lar expansion of the Parkinson’s Disease Research Education and
Clinical Centers (PADRECCs) may help to increase access to high
quality neurology care, and directs VA to provide a report within
120 days of enactment of this Act on the feasibility, advisability,
and cost estimates to expand PADRECCs to additional sites and
fund increased staff at each site.
Epilepsy Centers of Excellence.—The bill includes $19,086,000 to-
ward maintaining and expanding the Epilepsy Centers of Excel-
lence within VA.
Central Alabama Veterans Health Care System (CAVHCS).—The
Committee reminds the Department of the urgent need to improve
the management of CAVHCS and directs that the Department
thoroughly and expeditiously implement plans to promote a safe
culture and enhance care to veterans, fill permanent leadership va-
cancies, hire for all levels of permanent staffing, and provide incen-
tives and bonuses. The Committee requests a status update of the
plans within 60 days of enactment of this Act.
Nuclear Medicine Quality Improvements.—The Committee is
aware of the consequence of extravasations in nuclear medicine
procedures, and understands that the Nuclear Regulatory Commis-
sion and Centers for Medicare and Medicaid Services are consid-
ering regulatory actions to improve nuclear medicine injection qual-
ity. The Committee continues to encourage VA to monitor injection
quality, as well as image extravasations, perform dosimetry and
notify patients when they occur, and urges the Department to
adopt any new regulatory requirements.
Hospital-Acquired Pressure Ulcers and Pressure Injuries.—The
Committee reiterates that VA is urged to update VHA Directive
1352 based on the 2019 International Guidelines for the Prevention
rfrederick on DSKB3L4F33PROD with HEARING
and Treatment of Pressure Injuries as VA’s standard of care, and
appreciates that VA has begun to evaluate and update the direc-
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00060 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
61
tive. The Committee requests that VHA expedite the update of the
directive, which should include the Standardized Pressure Injury
Prevention Protocol (SPIPP) Checklist. Furthermore, the Com-
mittee requests the fiscal year 2024 budget request include a de-
tailed timeline with steps accomplished and planned to full adop-
tion.
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. The Committee expects the Department to work with the
Centers for Disease Control to implement the Food Service Guide-
lines for Federal Facilities, and encourages the Department to ex-
pand its plant-based menu options, including offering vegetarian
and vegan meal options at every facility.
Produce Prescription Programs.—The Committee is concerned
with food insecurity among the veteran population and recognizes
the role of access to healthy produce in managing chronic disease
and reducing healthcare utilization. The Committee is further
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 understands that
VA has demonstrated interest in supporting efforts to provide
produce prescriptions to veterans in partnership with community-
based organizations and/or government entities with demonstrated
experience and expertise, and provides up to $2,000,000 for VA to
continue to provide guidance and resources for VA facilities to de-
velop local programs and pursue strategies for patient education
and outreach.
Expanded Access to Noninstitutional Long Term and Extended
Care.—The Committee recognizes that veterans prefer to receive
long-term and extended care services in their local communities.
The Committee continues to encourage VA to increase the number
of Veterans Care Agreements executed at VA Medical Centers lo-
cated within the geographic service areas of Programs of All-Inclu-
sive Care (PACE). These collaborations will enable veterans to ex-
perience improved quality of life, heightened independence, and in-
creased support for their family caregivers, while reducing costs by
preventing or delaying nursing home placement. For these reasons,
the Committee also urges the Department to ascertain if its eligi-
bility criteria for PACE should be expanded to facilitate serving
more veterans with this proven model of care.
Medical School Affiliations.—The Committee continues to be
pleased with VA’s implementation of its collaborative agreements
with academically affiliated minority medical schools. The Com-
mittee encourages VHA and the Office of Academic Affiliations to
further align academic partnerships with training opportunities
and patient needs of veterans in surrounding communities.
Academic Collaborations at Community-Based Outpatient Clin-
ics.—The Committee encourages VA to expand academic collabora-
tions with CBOCs. CBOCs provide valuable patient care and access
to services that can be strengthened by collaboration with edu-
rfrederick on DSKB3L4F33PROD with HEARING
cational institutions. Through clinical traineeships and research
fellowships, emerging health professionals can gain a better under-
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00061 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
62
standing of veterans’ specific healthcare needs, improve patient
outcomes, advance specialized research, and increase the talented
workforce pipeline. VA should look to include wholly public aca-
demic medical centers in CBOC collaborations.
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 that VA will ensure that care is not disrupted or dimin-
ished for the veterans who receive treatment through experienced
providers under the Nationwide Dialysis Services contracts. In ad-
dition, the Committee looks forward to receiving the report ref-
erenced in the Joint Explanatory Statement accompanying the
Consolidated Appropriations Act, 2022 (P.L. 117–103) that will
evaluate the feasibility of a value-based care model.
Reducing Airborne Infections.—The Committee recognizes that
airborne bacteria and viruses remain a significant source of
healthcare-associated infections at healthcare facilities. Although
High Efficiency Particulate Air (HEPA) filters are widely used to
filter the air, airborne transmission still accounts for a significant
portion of healthcare-associated infections. The Committee appre-
ciates that VA has undertaken a review of its air filtration stand-
ards as a result of the coronavirus pandemic, which has increased
the urgency of addressing airborne contaminants. The Committee
continues to encourage VA to review and adopt new commercial,
off-the-shelf technology with the potential to capture and destroy
airborne contaminants to ensure that facilities are not using out-
dated technology and putting veterans at risk. Not later than 90
days after enactment of this Act, the Committee directs the Sec-
retary to submit a report to the Committees on Appropriations of
both Houses of Congress on how the Department evaluates and in-
corporates new technology in its air filtration procedures.
Creutzfeldt-Jakob Disease Monitoring.—The Committee is com-
mitted to understanding the residual impacts of Creutzfeldt-Jakob
Disease (CJD) within the veteran community, particularly among
those who are barred from donating blood due to their potential ex-
posure during their military service to beef that was infected with
bovine spongiform encephalopathy. The Committee continues to
urge the Department to reference data from existing medical
records of veterans to determine the percentage of veterans from
the above referenced subgroup that have more frequent or unex-
plained symptoms associated with CJD compared to the civilian
population. This body of data could be helpful in clarifying the ex-
tent and specifics of the medical issues suffered by veterans from
exposure to CJD.
Molecular Diagnostics and Precision Oncology.—The Committee
believes that every veteran with cancer deserves the highest qual-
ity and most medically advanced diagnosis and treatment avail-
able. Molecular diagnostics and precision oncology, performed at
the first occurrence of cancer, can provide vital information regard-
ing the specific tumor type and its drivers, which can lead to the
most accurate precision medicine for patients. The Committee com-
mends the Department’s Precision Oncology Program and supports
rfrederick on DSKB3L4F33PROD with HEARING
the budget’s requested increase of $67,000,000 over fiscal year 2022
to expand precision oncology clinical services, including molecular
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00062 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
63
diagnostics. The Committee includes up to $15,000,000 to accel-
erate the adoption of molecular diagnostics for additional cancers,
including rare cancers and hematopoietic cancers. VA is further en-
couraged to continue to provide information to clinicians on the
value of using molecular diagnostics to cancer patients and on how
to contribute tissue specimens to a repository started among the
Department, Department of Defense and the National Institute of
Health. The Committee further directs the Department to issue an
updated report no later than 60 days after the enactment of this
Act describing how these funds will be used to enhance the use of
molecular diagnostics, including information on the use of specific
types of molecular diagnostics, such as microarray, whole exome,
whole genome, and RNA-Seq.
Oral Contraceptives.—Given the potential advantages for pa-
tients in receiving a full year’s supply of hormonal contraceptive
products at once that are for regular use, the Committee continues
to urge the Department to encourage prescribers to proactively
offer patients the option to receive a full year’s supply and to en-
sure patients are notified of that option. The Committee is aware
that VA is currently evaluating the results of a demonstration
project for potential enterprise-wide implementation, and requests
a report with the findings of this demonstration within 30 days of
the conclusion of the evaluation.
Intimate Partner Violence Program.—The Committee continues
to support VA’s efforts to expand its Intimate Partner Violence
(IPV) Program, which provides a holistic approach that involves
understanding, recognizing and responding to the effects of all
types of trauma, with the ultimate goals to end violence, prevent
further violence, and promote healthy relationships. The Com-
mittee directs VA to increase funding to this program. Additionally,
the Committee notes that IPV is a leading cause of maternal mor-
tality and morbidity in the United States and can negatively im-
pact fetal outcomes, as well as that research indicates that IPV
rates are of significant concern among U.S. veterans. Therefore, the
Committee urges the Department to develop a Pregnancy IPV
awareness campaign to address the prevalence of IPV among child-
bearing veterans, and further, supports programs designed to ac-
tively engage fathers and partners in an effort to assist in breaking
cycles of abuse.
Adaptive Sports.—The bill provides $27,229,000 for National Vet-
erans Sports Programs, including $16,000,000 for adaptive sports
programs, and recommends that the Department use no less than
$1,500,000 of funding provided for the adaptive sports program for
equine therapy. The Committee recognizes the significant improve-
ments that adaptive sports and recreational therapy have on vet-
erans’ mental and physical health, as well as the efforts of commu-
nity providers, especially in rural areas, who have been able to use
this key program to successfully reintegrate veterans back into
their communities. The Committee acknowledges that community
providers of adaptive sports grants spend considerable time and ef-
fort in planning and implementing their veteran service programs.
Assisted Reproductive Services.—The Committee continues to be-
lieve that the limitations of VA’s current policy for providing as-
rfrederick on DSKB3L4F33PROD with HEARING
sisted reproductive services are completely unacceptable, resulting
in a discriminatory, unjust, and antiquated approach in practice.
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00063 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
64
Such services include in vitro fertilization (IVF) treatment for vet-
erans who have sustained serious or severe illness and/or injury
while on active duty that led to the loss of their natural procreative
ability. It is outrageous that VA infertility services have been de-
nied to a growing number of veterans due to marital status, and
it is similarly unacceptable that veterans who cannot use their own
genetic material or carry their own child to term are being dis-
criminated against with the current barriers to coverage for do-
nated gametes and gestational surrogacy. Additionally, the Com-
mittee notes that veterans have different needs than active duty
servicemembers, and it is vital that VA be able to create a unique
policy that benefits the population it serves. The Committee is fur-
ther concerned by the inequities presented when VA must maintain
different sets of eligibility standards for different types of reproduc-
tive services, such as intrauterine insemination or in vitro fertiliza-
tion. As such, the Committee applauds VA’s inclusion of a proposal
in the fiscal year 2023 budget request to revise the access policy
for assisted reproductive services, as the Committee has requested
in previous years. The Committee has included this proposal in the
bill, which is crucial to ensure a permanent, equitable solution.
Fertility Treatment Data.—The Committee remains concerned by
the Department’s challenges in tracking how many veterans have
been able to access fertility treatment or have been denied these
benefits. The Committee looks forward to the annually required re-
port detailing the number of veterans and spouses who have re-
ceived fertility treatment, and those who are ineligible, and urges
VA to include in future reports information on partners of veterans
who have received fertility treatment or counseling, as well as in-
formation on veterans who are denied these benefits as a result of
their infertility not having been determined to be service-con-
nected. The Department is further urged to develop a system for
better understanding the population of veterans who are denied or
determined to be ineligible for these benefits, as the Committee un-
derstands they currently may not be properly captured in data sys-
tems.
Adoption Reimbursement and Assisted Reproductive Services.—
The Committee remains concerned that many veterans who could
benefit from adoption reimbursement and assisted reproductive
services benefits may not be aware of the full range of services
available to them, and continues to urge the Department to in-
crease its efforts to ensure veterans are informed about these serv-
ices, including during earlier medical visits. The Committee pro-
vides an additional $500,000 above the budget request to support
increased outreach efforts on these benefits, including to veterans
newly eligible under the expanded access policy included in this
bill. The Committee requests an expenditure plan for these funds
within 60 days of enactment of this Act.
Medication Optimization for Veterans.—The Committee recog-
nizes that many veterans have at least one gene variant that im-
pacts medication efficacy or safety and that over half of veterans
are prescribed at least one drug where pharmacogenomic informa-
tion would be critical to drug or dose selection to prevent patient
harm. The Committee commends the work of VHA to implement a
rfrederick on DSKB3L4F33PROD with HEARING
National Pharmacogenomics Program to ensure all eligible vet-
erans have access to appropriate, evidence-based pharmacogenomic
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00064 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
65
testing and that VA has a robust and highly trained healthcare
professional workforce to help interpret and manage veterans who
have undergone pharmacogenomic testing. The Committee provides
$15,610,000, as requested, for this work.
Diabetic Foot Ulcers.—The Consolidated Appropriations Act,
2022 (P.L. 117–103) directed VA to continue, and expand, efforts to
monitor diabetes patients remotely and to provide a report to the
Committees on Appropriations of both Houses of Congress within
180 days of enactment of the Act on the effectiveness of current ef-
forts to prevent foot amputation. The Committee looks forward to
the report and the findings from The Initiative to End Diabetic
Limb Loss in Veterans, which are anticipated to show improved pa-
tient outcomes and significant projected cost avoidance. The Com-
mittee expects the report to, as directed, detail the feasibility, in-
cluding cost estimates, of expanding these programs to reach an
additional 20,000 veterans, as well as expansion to eligible VISNs,
and directs the Department to begin expanding the program to
cover additional veterans at high risk of amputation and expand to
eligible VISNs by the end of fiscal year 2023.
Remote Diabetes Monitoring.—The Committee recognizes that
Type 2 Diabetes can be a serious health concern for veterans and
their family members and that the rate of this condition is more
than doubled among veterans, who are at a higher risk due to serv-
ice-related chronic pain, joint damage, and exposure to herbicides
such as Agent Orange. To address this issue, the Committee en-
courages VA to pursue a Veterans Diabetes Remote Patient Moni-
toring solution that would increase patient access to diabetes care
management and improve health outcomes by connecting to the VA
Electronic Health Record system for participants to push near-real
time testing data into the patient’s record. The Committee recog-
nizes that a Veterans Diabetes Remote Patient Monitoring program
could facilitate data and analytics access and sharing for physi-
cians, specialists, family, and other care team members by
populating the Electronic Health Record of the veteran in the VA
system. The Committee directs the Department to report to the
Committees on Appropriations of both Houses of Congress within
90 days of enactment of this Act on the feasibility, advisability, and
cost of establishing this program to provide real-time patient moni-
toring and care coordination for veterans.
Osteopathic Manipulative Treatment.—The Committee is aware
that doctors of osteopathic medicine receive intensive training in
osteopathic manipulative treatment (OMT) and play an important
role in the treatment of veterans, who experience higher prevalence
of pain and more severe pain than nonveterans. To ensure veterans
have access to effective non-addictive treatments for back and other
pain, the Committee directs VA to provide a report, including out-
comes data, to the Committees on Appropriations of both Houses
of Congress within 120 days of enactment on the VA’s use of OMT
in the treatment of back and other pain in veterans.
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
rfrederick on DSKB3L4F33PROD with HEARING
full-time, dedicated, VA medical and mental health providers in
these areas.
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00065 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
66
Improving Access to Programs and Services.—The Committee
strongly encourages VA to ensure the Veteran Directed Care Pro-
gram and the Homemaker Home Health Aide Care program are
available in each state or U.S. territory where they are currently
not operative, such as the Commonwealth of the Northern Mariana
Islands. VA should promptly identify and address barriers to pro-
viding these programs in these areas. No later than 180 days after
the date this report is filed, the Committee directs VA to provide
a report to the Committees on Appropriations of both Houses of
Congress on enrollment in these two programs, services, and out-
reach conducted by VA in areas where the programs are currently
not operative, an evaluation of such activities, and an assessment
of the need to provide additional resources and VA staff in such
areas that should include input from veterans residing in these
areas.
Improved VA Healthcare for Veterans Living in the Philippines.—
The VA Manila Regional Office and Outpatient Clinic is the only
VA office located outside the United States or its territories. The
Committee notes that the clinic and regional office are located in
Manila, but a large number of veterans reside near the former
Clark Air Base. Given VA’s obligation to help veterans regardless
of where they live, no later than 180 days after the enactment of
this Act, the Committee directs VA to submit a report on how it
is serving veterans in the Philippines who live outside Manila, in-
cluding whether additional physical locations would help to im-
prove access to hospital care, medical services, telehealth services,
and veterans benefits.
Migraine Prevention and Treatment.—The Committee recognizes
approximately one in three servicemembers experience severe
headaches and migraines within the first months of returning from
deployment. Furthermore, 36 percent of U.S. veterans who com-
pleted a 12-month deployment were either diagnosed with or exhib-
ited symptoms of migraines, which is three times higher than the
general population. The Committee is aware that some veterans
with migraines taking prescription headache medication report
poor mental status changes, higher rates of psychiatric symptoms,
and higher rates of traumatic events. Therefore, the Committee di-
rects the Department to ensure neuromodulation devices with
FDA-indication for migraine prevention and treatment are avail-
able to veterans and to educate clinicians and veterans on such de-
vices.
Automated Discharge Planning.—The Committee recognizes that
delays in the discharge process can result in extended stays for vet-
eran patients in VA Medical Centers and increased cost of care for
VA. The Committee understands that VHA seeks to improve pa-
tient satisfaction and productivity through automating the dis-
charge process and eliminating time-consuming fax and phone
processes to refer patients to more appropriate levels of care. VHA
is encouraged to ensure that all VA Medical Centers implement ef-
ficiencies and automation into the discharge process.
Technology to Improve Patient & Staff Safety.—The Committee
encourages VA to explore the use of commercial off-the-shelf sen-
sor-based automated technology platforms to increase the safety of
rfrederick on DSKB3L4F33PROD with HEARING
patient veterans and staff, especially in reducing healthcare-ac-
quired infections through rapid contact tracing and improved hand
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00066 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
67
hygiene. The Department is encouraged to consider integrating
these technologies into its ongoing system-wide patient and staff
safety improvement efforts and to prioritize any necessary informa-
tion technology reviews.
Bioelectronic Medicine for Veterans.—The Committee recognizes
that Bioelectronic Medicine has the potential to harness the body’s
electrical signaling to advance treatments that save lives and lower
medical expenditures across many diseases impacting veterans, in-
cluding arrhythmia, atrial fibrillation, Parkinson’s, major depres-
sive disorder, treatment-resistant epilepsy, incontinence, and
chronic pain, among others. Acceleration of studies, further data
collection, and the development and adoption of novel applications
for Bioelectronic Medicine combined with machine learning and ar-
tificial intelligence (AI) can address the most challenging and ex-
pensive diseases by personalizing treatments and improving ther-
apy delivery. Therefore, the Committee encourages the Department
to ensure that combined Bioelectronic Medicine and AI technologies
are available to veterans and includes $2,000,000 for a Bioelec-
tronic Medicine pilot to further expand access to this technology.
Air Ambulance Services.—The Committee urges the Department
to ensure that any changes to the beneficiary travel reimbursement
for air ambulances do not reduce the availability of emergency
services to veterans or increase mortality and morbidity among vet-
erans needing air ambulance care.
Health Navigator.—The Committee encourages the Department
to continue to investigate the potential benefits of utilizing a health
navigator model of care for veterans.
Marriage and Family Therapists.—The Committee urges VA to
improve access to marriage and family therapists and to ensure
that there are not unnecessary barriers to increasing the Depart-
ment’s capacity to serve veterans seeking this care.
Philanthropic Partnerships.—The Committee encourages VA to
explore philanthropic partnerships with nonprofit and for-profit pa-
tient organizations that help advance patient care and ensure ade-
quate resources for all healthcare providers with a strategic focus
on the critical role of clinician engagement, so long as such part-
nerships do not advance privatization or degrade the core missions
of VA.
Beneficiary Travel.—The Committee recognizes the Department
is currently transitioning to the Beneficiary Travel Self Service
System (BTSSS) to consolidate its reimbursement structure. While
the Committee applauds this effort, it is concerned about avail-
ability for veterans to submit travel pay requests who do not have
access to internet or have limited digital literacy. The Committee
directs the Department to ensure all VA staff involved in the bene-
ficiary travel program understand that veterans have the option to
continue using the paper claim form No. 10–3542 even as VA tran-
sitions to BTSSS and further encourages the Department to ensure
BTSSS does not negatively affect veterans, especially those in rural
areas without reliable internet access.
Acquisition of Personal Protective Equipment.—The Committee
strongly encourages the Department to seek to prioritize acquisi-
tion of American-made personal protective equipment when pos-
rfrederick on DSKB3L4F33PROD with HEARING
sible, including nitrile and vinyl gloves, surgical masks, respirator
masks and powered air purifying respirators and required filters,
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00067 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
68
face shields and protective eyewear, surgical and isolation gowns,
and head and foot coverings or clothing, and the materials and
components thereof, instead of purchasing from countries like Rus-
sia, China, North Korea, or Iran. The Committee notes that in ac-
cordance with the Infrastructure Investment and Jobs Act (P.L.
117–58), VA is working with Federal interagency partners on a
long-term strategy for PPE produced in the United States, and
urges the Department to continue to make progress in this area.
MEDICAL COMMUNITY CARE
Fiscal year 2022 enacted level ........................................................... $23,417,244,000
Fiscal year 2023 enacted level ........................................................... 24,156,659,000
Fiscal year 2023 budget year request ............................................... 4,300,000,000
Committee 2023 budget year recommendation ................................ 4,300,000,000
Fiscal year 2024 advance appropriation request ............................. 33,000,000,000
Committee 2024 advance appropriation recommendation .............. 33,000,000,000
Comparison with:
Fiscal year 2023 enacted level ................................................... +8,843,341,000
Fiscal year 2024 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 2024, the bill provides an advance appropria-
tion of $33,000,000,000, of which $2,000,000,000 is available until
September 30, 2025.
The Committee provides an additional $4,300,000,000 to be avail-
able for fiscal year 2023, as proposed in the budget request, in re-
sponse to readjusted actuarial estimates for medical community
care.
Third-Party Payments and Reimbursements.—The Committee
continues to be concerned about the timeliness of reimbursements
by VA to private healthcare/third-party providers. The Committee
believes VA must prioritize efficient and prompt payment to com-
munity 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 serve the nation’s veterans.
The Committee continues to direct VA to provide comprehensive re-
ports on a quarterly basis detailing the amount owed to outside
providers for every state, outstanding payments over six months
old and the corrective actions being implemented to address these
outstanding balances, and average time for repayment.
Long-Term Care for Veterans with Severe Traumatic Brain In-
jury.—The Committee continues to note the prevalence of deploy-
ment-related traumatic brain injuries. This increase continues to
demonstrate the longstanding need for providing adequate long-
term specialty care for veterans suffering from severe TBIs. The
Committee is encouraged by the Department’s progress in using
agreements with non-VA providers to ensure all veterans receive
such long-term specialty care in their communities and directs the
Department to continue entering into such agreements, to educate
case managers on all tools available to provide veterans with long-
term specialty care outside the VA system, and to provide an up-
date within 270 days of enactment of this Act on the Department’s
rfrederick on DSKB3L4F33PROD with HEARING
progress on providing access to long-term care to veterans with se-
vere TBIs.
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00068 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
69
Shortage of VA Community Care Providers in Rural Areas.—The
Committee is aware that certain rural regions of the country are
experiencing a shortage in private healthcare providers electing to
participate in VA’s Community Care Program, as authorized by the
VA MISSION Act (P.L. 115–182). The Committee notes that a lack
of Community Care Providers, specifically in regions with recent
facility closures, has the potential to compromise veterans’ access
to care. The Committee encourages the Secretary to continue work-
ing with its partners to recruit private healthcare providers in
rural communities to participate in the Community Care Network
System to serve veterans in their local communities. The Com-
mittee directs VA to submit a report on the progress of these ef-
forts within 180 days of enactment of this Act. The report should
include the number of community care providers brought into the
system over the past year, the locations of the providers, and how
much funding VA has allocated for provider recruitment efforts in
fiscal year 2023 and fiscal year 2024. The report should also detail
a three-year plan on how the VA will continue to recruit private
healthcare providers in rural communities to participate in the
Community Care Network System.
State Veterans Homes Reporting of COVID–19 Data.—While VA
has made considerable improvements in its public reporting of data
on COVID–19 infections and deaths in State Veterans Homes, sig-
nificant gaps in this reporting remains. The Committee directs VA
to increase its efforts to publicly report on its website the corrected
numbers, where the current data has been found to be incorrect,
dating back as close as possible to the start of the public health
emergency for all State Veterans Homes. Not later than 90 days
after the enactment of this Act, the VA shall submit to the Com-
mittee a home-by-home breakdown of all reported COVID–19 infec-
tions and deaths in State Veterans Homes as of the earliest date
possible since the start of the public health emergency.
State Veterans Homes.—The Committee notes the challenges that
the COVID–19 pandemic has posed to State Veterans Homes, par-
ticularly with regards to staffing shortages and reduced admis-
sions. The Committee encourages VA to continue to explore ways
to assist State Veterans Homes.
MEDICAL SUPPORT AND COMPLIANCE
Fiscal year 2022 enacted level ........................................................... $8,403,117,000
Fiscal year 2023 enacted level ........................................................... 9,673,409,000
Fiscal year 2023 budget year request ............................................... 1,400,000,000
Committee 2023 budget year recommendation ................................ 1,400,000,000
Fiscal year 2024 advance appropriation request ............................. 12,300,000,000
Committee 2024 advance appropriation recommendation .............. 12,300,000,000
Comparison with:
Fiscal year 2023 enacted level ................................................... +2,626,591,000
Fiscal year 2024 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
rfrederick on DSKB3L4F33PROD with HEARING
and continuing education, security, volunteer operations, and
human resources.
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00069 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
70
The bill provides $12,300,000,000 in advance fiscal year 2024
funding. The Committee has included bill language to make
$200,000,000 of the Medical Support and Compliance appropriation
for fiscal year 2024 available through September 30, 2025.
MEDICAL FACILITIES
Fiscal year 2022 enacted level ........................................................... $6,734,680,000
Fiscal year 2023 enacted level ........................................................... 7,133,816,000
Fiscal year 2023 budget year request ............................................... 1,500,000,000
Committee 2023 budget year recommendation ................................ 1,500,000,000
Fiscal year 2024 advance appropriation request ............................. 8,800,000,000
Committee 2024 advance appropriation recommendation .............. 8,800,000,000
Comparison with:
Fiscal year 2023 enacted level ................................................... +1,666,184,000
Fiscal year 2024 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 $8,800,000,000 in advance fiscal year 2024
funding. The Committee has included bill language to make avail-
able through September 30, 2025, $350,000,000 of the advance
Medical Facilities appropriation for fiscal year 2024.
The Committee provides an additional $1,500,000,000 to be avail-
able for fiscal year 2023 to support non-recurring maintenance
(NRM) projects nationwide, as requested. Of the funds provided for
NRM, the Committee directs VA to prioritize projects that expand
women’s access to gender-specific care and that repurpose vacant
and underutilized space for mental health needs, particularly
projects that 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.
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 2023
may not be ready within that timeframe, requiring an adjustment
to the spending plan. The Committee requests a quarterly update
of the plan if the funding for any single project changes by more
than $3,000,000 during that time period.
Facility Transformations.—The Committee strongly urges VA to
continue efforts 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 and
to make it safer and easier for women veterans to get care. This
rfrederick on DSKB3L4F33PROD with HEARING
includes correcting environment of care deficiencies, such as adding
doors, curtains, and soundproofing in treatment and check-in areas.
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00070 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
71
Community-Based Outpatient Clinic in Bakersfield, California.—
The Committee remains disappointed that the new Bakersfield
CBOC remains unbuilt more than a decade after Congress author-
ized this facility in fiscal year 2010 through Public Law 111–82.
The Committee directs the Secretary to expeditiously execute Lease
No. 36C10F20L0008 and commence construction of the CBOC by
no later than September 30, 2023, as provided in the lease. Fur-
thermore, the Committee directs the Secretary to provide monthly
reports to the Committees on Appropriations of both Houses of
Congress on the CBOC’s progress until completion and activation.
Veteran Affairs Facilities Security and Communication Tech-
nology Refresh.—The Committee encourages the Department to
continue security and communications technology upgrades at VA
facilities to ensure the safety of veterans, visitors, and employees.
The Committee recommends that VA take a holistic approach and
continue efforts to deploy proven technologies that can provide ac-
tionable, real-time data and communications to improve safety.
VA Facility Leases.—The Committee supports the 31 leases pro-
posed in the fiscal year 2023 budget request, but acknowledges the
challenges related to their authorization. Recognizing that the pri-
mary obstacle is not related to appropriations, the Committee con-
tinues to direct the Department to work with the Office of Manage-
ment and Budget and Congress, including the Budget and Veterans
Affairs Committees of the House and Senate, to resolve the issues
that inhibit VA’s ability to execute leases for medical, research and
administrative offices and facilities.
Efficiencies at VA Medical Facilities.—As the largest healthcare
system in the country, the Committee encourages VA to explore po-
tential options to reduce emissions and waste at medical facilities,
including identifying approaches that can improve supply chain re-
silience. The Committee requests a report on VA’s efforts in this
area not later than 90 days of enactment of this Act.
Clinic Closures.—The Committee is concerned about closures of
CBOCs and the effect on veterans’ access to care, especially for vet-
erans living in rural areas. The Committee directs the Secretary to
provide a report on CBOC closures over the past five years and the
effect on care for veterans living in rural areas. The report should
list the locations of clinics that have closed and include an assess-
ment of the time veterans must wait for care after the closure, the
availability of community care provider networks, the availability
of Mobile Medical Units for veterans impacted by clinic closures,
and the effect on the continuity of care for these veterans. The Sec-
retary is directed to provide a report to the Committee within 60
days of enactment of this Act.
MEDICAL AND PROSTHETIC RESEARCH
Appropriation, fiscal year 2022 ......................................................... $882,000,000
Budget request, fiscal year 2023 ....................................................... 916,000,000
Committee recommendation, fiscal year 2023 ................................. 926,000,000
Change from enacted level ......................................................... +44,000,000
Change from budget request ...................................................... +10,000,000
This appropriation provides for medical, rehabilitative, and
health services research. The Committee recognizes the importance
rfrederick on DSKB3L4F33PROD with HEARING
of the research conducted by VA for veterans’ quality of life and
health and provides $926,000,000, available through September 30,
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00071 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
72
2024, which is $44,000,000 above fiscal year 2022 and $10,000,000
above the budget request, for these activities. The Committee ap-
preciates the Department’s plans to focus on critical research areas
that include environmental exposures, traumatic brain injury, can-
cer and precision oncology, and mental health as priorities.
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 2023 research resources in addition to those provided in the
research account are $1,379,600,000.
Women Veterans Research.—Women veterans have unique health
needs that are substantially different than both civilian women and
men veterans. The Committee directs the Department to ensure its
research program adequately addresses the unique needs and con-
cerns of women veterans. Additionally, the Committee continues to
direct VA to prioritize medical and prosthetic research to ade-
quately address prosthetics meant for women, given that women
have different physical requirements for prosthetics compared to
men. The Committee also directs VA to ensure that conditions with
widespread impact on women, such as endometriosis, are included
in VA’s research efforts to better understand the impact of military
service on veterans with these conditions.
Animal Research.—The Committee has included bill language to
prohibit painful research on dogs and cats beginning in fiscal year
2023. Additionally, the Department is directed to include in any re-
port to Congress describing animal research approved under Sec-
tion 247 of the Consolidated Appropriations Act, 2022 (P.L. 117–
103), submitted after the date of filing of this report, detail on what
specific alternatives to animals were considered, why those alter-
natives were not chosen, and therefore supporting why these ani-
mal subjects are the only viable option for this research.
Access to Clinical Oncology Trials.—The Committee continues to
support efforts to expand opportunities for veterans receiving can-
cer care at VA facilities to participate in promising oncology clinical
trials in collaboration with National Cancer Institute (NCI)-des-
ignated cancer centers, but notes the lack of infrastructure for
these clinical trials in other areas of the country. The Committee
urges the Department to continue to focus on States with the larg-
est veteran populations and on securing the participation of NCI-
designated centers in those States that are not already part of the
VA’s NAVIGATE program. The Department is directed to draw
best practices from locations with long-standing partnerships and
NAVIGATE participation and build on those efforts to create simi-
rfrederick on DSKB3L4F33PROD with HEARING
lar, successful partnerships in other locations. The Committee
notes the budget request has highlighted expanding access to oncol-
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00072 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
73
ogy clinical trials as a priority for fiscal year 2023 funds and di-
rects that not less than $10,000,000 be continued to be allocated to-
ward clinical trial partnerships, with an emphasis on expanding to
new sites outside the current NAVIGATE structure. The Com-
mittee directs the Department to submit a report within 60 days
of enactment of this Act with a plan to further expand access to
clinical trials and how staff and resources will be dedicated to this
effort.
Million Veteran Program.—The Committee recognizes and sup-
ports the VA Medical and Prosthetic Research Program’s signifi-
cant investment in the Million Veteran Program (MVP) research
program. The Committee notes with concern that scientific access
to this valuable research tool is severely limited by the computing
infrastructure, and urges VA to provide the funds needed to ensure
appropriate access to the MVP database for the VA research com-
munity. Additionally, the Committee urges VA to enhance this pro-
gram by accelerating the development of risk assessment tools re-
lated to gene/environment interactions as they relate to cancer risk,
with a focus on carcinogens and other environmental pollutants
being potentially important given recent combat areas and stra-
tegic global centers of conflict. Identifying novel gene/environment
interactions based on observations collected during previous mili-
tary engagements could result in target identification and drug de-
velopment in cancer, which could generate a ground-breaking data
set for the understanding of impacts of burn pit emissions and en-
vironmental exposure on cancer and other disease risks.
Monoamine Oxidase A Deficiency.—The Committee encourages
VA to investigate connections between Monoamine Oxidase A Defi-
ciency (MAO/A) and veterans with PTSD, suicidal tendencies, im-
pulse control, aggressive and obsessive behavior, or ADHD using,
if viable, genetic samples taken from the participants of the Million
Veteran Program and to research possible cures and treatments for
MAO/A deficiency.
Gulf War Illness Studies.—The Committee recommends the De-
partment continue to conduct epidemiological studies regarding the
prevalence of Gulf War Illness, morbidity, and mortality in Persian
Gulf War veterans and the development of effective treatments,
preventions, and cures. The Committee continues to encourage the
findings of all research conducted by or for the Executive Branch
relating to the health consequences of military service in the Per-
sian Gulf theater of operations during the Persian Gulf War be
made publicly available as soon as possible, and that the Depart-
ment continue to publish disease-specific mortality data related
specifically to Persian Gulf War veterans. The Committee also con-
tinues to encourage the Department to utilize the term ‘‘Gulf War
Illness’’ for the signature adverse health outcome of the Persian
Gulf War, as recommended by the Institute of Medicine (IOM), and
appreciates the Department’s work to strengthen the training of
primary, specialty, and mental healthcare providers on effective as-
sessment, diagnosis, and clinical management of Gulf War Illness.
Dystonia.—The Committee appreciates VA’s work to examine the
connection between traumatic brain injury and dystonia and con-
rfrederick on DSKB3L4F33PROD with HEARING
tinues to urge VA to pursue collaborative efforts with the dystonia
stakeholder community and related Federal agencies.
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00073 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
74
Cannabis Research.—The Committee notes that VA has made
progress on cannabis research and continues to request updates on
the status of this research, as described in House Report 116–63.
National Intrepid Center of Excellence (NICoE) Collaboration.—
The Committee recognizes the high-quality mental healthcare and
neurological research being conducted at Walter Reed NICoE. As
veterans and servicemembers continue to face higher rates of brain
trauma than civilians, impacting brain function, agencies should
continue to collaborate to study neurological conditions such as
PTSD, bipolar, schizophrenia, depression, suicide and substance
use disorders. The Committee directs VA to expand its work with
NICoE to strengthen VA’s research capacity, streamline
servicemembers’ access to preventive care, and share best practices
so health professionals can learn from NICoE’s important work and
contribution to the health community. The Committee encourages
VA to pursue new collaborative initiatives with NICoE and con-
sider public academic medical centers as partners in such efforts.
Furthermore, the Committee encourages VA to assist DOD with
their efforts to optimize research to implement solutions and de-
liver better health outcomes for veterans.
Advanced Platform Technology (APT) Center.—The Committee
applauds VA for progress being made to provide veterans with new
assistive and restorative technologies that address sensory, motor,
or cognitive deficits, as well as limb loss. The APT Center has effec-
tively utilized a partnership model to leverage local and national
research expertise to drive dramatic progress in diverse areas in-
cluding artificial lung development, wound healing, and neurally-
connected sensory prosthesis. The Committee continues to support
the APT Center’s efforts.
Tinnitus Research.—The Committee encourages the Department
to work with academic partners, as appropriate, to address and im-
prove the outcomes for veterans experiencing problematic tinnitus,
including research to identify contributing factors associated with
tinnitus onset and progression to chronic tinnitus and develop
novel interventional therapies and self-management models.
Metastatic Cancer Research.—While recent research has revealed
that there is a genetic basis for susceptibility to metastatic cancer
or resistance to metastasis, more research is required to develop a
comprehensive understanding of this complex process. Clinical
trials are an important aspect of that progress, and diverse rep-
resentation of patients in clinical trials is integral to the develop-
ment of medications and therapies that effectively treat disease.
Ethnicity, gender, age and genetics all play a role in the safety and
efficacy of a treatment for an individual. Therefore, in order to
achieve representation of the demographics of the United States
population in these trials, the Committee directs VA to partner
with DOD to fully implement the outstanding recommendations in
this area made to the Department by DOD’s April 2018 Task Force
Report to Congress on Metastatic Cancer.
Aviator Cancer Report.—The Department is directed to provide a
report within 90 days of enactment of this Act regarding the inci-
dence and mortality of cancers experienced by veterans who served
as air crew members or support personnel of fixed-wing aircraft. To
rfrederick on DSKB3L4F33PROD with HEARING
the extent possible, the report should identify whether the presence
of certain chemicals and compounds used in fixed-wing aircraft, in-
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00074 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
75
cluding radiofrequency radiation, is linked to cancer incidence or
mortality risk.
Transcendental Meditation.—The Committee looks forward to re-
viewing VA’s report, as directed in Senate Report 117–35, on re-
sources needed to deploy transcendental meditation (TM) across
the VA system. The Committee remains interested in TM’s poten-
tial as an evidence-based, non-invasive treatment for veterans of
all backgrounds in treating acute mental health and pain manage-
ment needs. The Committee also supports the ongoing Phase III
clinical trial and pilot at nine VA Medical Centers and research
hospitals evaluating TM as a first-line treatment for PTSD and
suicidality and offering TM instruction to VA patients and staff,
and urges VA to ensure timely completion of the trial and pilot.
Precision Oncology Platform.—The Committee notes VA’s estab-
lishment of a hub for Computer Vision and Machine Learning in
Precision Oncology (CoMPL), and urges VA to continue efforts to
accelerate machine learning tools and other technologies that en-
hance cancer diagnosis and treatment, including potentially devel-
oping a precision oncology platform that integrates next-generation
sequencing data, bioinformatics, machine learning, and mathe-
matics, including algorithms to help predict the probability of a pa-
tient’s response to a specific drug. This platform could help move
beyond a single target-based approach to drug-patient or cancer
matching, identify which therapy works best for each specific can-
cer or a specific patient, and improve patient outcomes by opti-
mizing clinical trial population selection. VA is directed to submit
a report no later than 180 days after enactment of this Act on the
progress of the CoMPL hub, as well as the feasibility, including
cost estimates, of further developing a precision oncology platform
that has this functionality.
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
fiscal year 2023 is $3,910,000,000.
MCCF Third-Party Billing.—The Committee remains concerned
over potential discrepancies in VA’s billing and collection processes.
Procedures to provide for not only correct billing, but also prompt
collection must continue to be improved at VA. Therefore, the De-
partment is directed to submit quarterly reports to the Committees
on Appropriations of both Houses of Congress identifying the
amount of third-party health billings that were owed to VA in the
previous quarter, and the amount collected, with an explanation of
why amounts were not collected. The report should differentiate
the amount expected to be collected out of the total billings from
the amount actually collected. Additionally, each report should in-
rfrederick on DSKB3L4F33PROD with HEARING
clude VA’s net collections ratio for the quarter, how the net collec-
tions ratio for that quarter compares to industry standards, and
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00075 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
76
how VA plans to improve the collection process. The reports should
include billings and collections data for both large claims (greater
than $1,000) and small claims (equal to or less than $1,000). Last-
ly, each report should also describe current management practices
to provide proper oversight of the billing process, including appeals
(both manual and automated), to eliminate unnecessary and dupli-
cative functions.
NATIONAL CEMETERY ADMINISTRATION
Appropriation, fiscal year 2022 ......................................................... $394,000,000
Budget request, fiscal year 2023 ....................................................... 430,000,000
Committee recommendation, fiscal year 2023 ................................. 430,000,000
Change from enacted level ......................................................... +36,000,000
Change from budget request ...................................................... –––
The National Cemetery Administration (NCA) was established in
accordance with the National Cemeteries Act of 1973 (P.L. 93–43).
It has a fourfold mission: to provide for the interment of, in any
national cemetery with available grave space, the remains of 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 158 national ceme-
teries and 34 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, 2024.
Cemetery Access and Unmet Needs.—The Committee remains
concerned that NCA is not adequately serving the nation’s veterans
in certain areas, particularly rural areas and geographically iso-
lated areas, and that there are pockets in the country which con-
tinue to go unserved. The Committee therefore directs VA to con-
tinue to pursue efforts to ensure that a burial option, including
those utilizing public-private partnerships, within 75 miles of all
veteran homes is available and accessible. Additionally, the Com-
mittee is concerned that the Department’s current criteria for es-
tablishing new national cemeteries may not adequately address the
needs of veterans and their families in geographically isolated
areas and states where state veterans cemeteries do not meet na-
tional shrine standards. The Committee notes that the Department
has previously indicated interest in undertaking a review and con-
sidering potential revisions of the current criteria. Therefore, the
Department is directed to report to the Committee within 180 days
of enactment of this Act on its progress to review and amend the
criteria for establishing new national cemeteries, including changes
to allow for the establishment of new national veterans cemeteries
rfrederick on DSKB3L4F33PROD with HEARING
in geographically isolated areas and states where state veterans
cemeteries do not meet national shrine standards, and how revised
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00076 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
77
criteria will help address the remaining need of unserved veteran
populations.
Cremation.—The Committee is aware of interest in allowing cre-
mation under the Department’s existing burial allowance and re-
quests a report, within 90 days of enactment of this Act, on the es-
timated cost of providing this expanded benefit, including an eval-
uation of the feasibility of directly covering the cost in place of the
existing reimbursement system.
DEPARTMENTAL ADMINISTRATION
GENERAL ADMINISTRATION
(INCLUDING TRANSFER OF FUNDS)
Appropriation, fiscal year 2022 ......................................................... $401,200,000
Budget request, fiscal year 2023 ....................................................... 435,000,000
Committee recommendation, fiscal year 2023 ................................. 435,000,000
Change from enacted level ......................................................... +33,800,000
Change from budget request ...................................................... –––
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,
2024, 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.
VA Five Year Development Plan (VFYDP).—The Committee is
very pleased that the Department has provided a VFYDP in its fis-
cal year 2023 budget and 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
rfrederick on DSKB3L4F33PROD with HEARING
percentage of SES and non-SES employees who received a bonus
and the average dollar amount of the bonuses by grade covering
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00077 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
78
the same time period. The report, however, should not include any
personally identifiable information.
Financial Management Business Transformation (FMBT).—The
Committee provides $20,300,000 for FMBT, as requested. VA’s cur-
rent legacy financial management system is over 30 years old, and
its imminent failure presents significant risks to VA. In the fiscal
year 2018 conference report, VA was directed to provide the Com-
mittee, on a quarterly basis, a report that compares actual progress
on the financial management system to the performance bench-
marks and timeline provided in the first report. The Committee di-
rects the Department to continue this quarterly report throughout
fiscal year 2023.
Supporting Minority and Disadvantaged Contractors.—The Com-
mittee recognizes the need for VA to continue to meet its goals for
contracting 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 reiter-
ates the reporting requirement included in House Report 117–81 on
this topic and looks forward to receiving the requested report.
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
continues to recommend that, when applicable, the Secretary dis-
play information in the annual reports submitted to Congress sepa-
rately for women veterans and minority veterans.
Human Capital Tools.—The Committee is aware the Department
currently uses a product suite to provide cloud-based solutions to
manage various human resource functions such as business align-
ment, people performance, and recruitment. The Committee is sup-
portive of VA’s continued use and implementation of enterprise-
wide solutions.
Data Strategy.—The Committee provides $36,229,000 for the Of-
fice of Enterprise Integration, as requested, and supports the De-
partment’s continued efforts to manage VA data as a strategic
asset in order to strengthen the delivery of services and benefits to
veterans, their families, survivors, and caregivers.
Center for Women Veterans Digital Infrastructure.—The Com-
mittee recognizes and welcomes the Department’s movement to-
wards modernizing the digital infrastructure in the Center for
Women Veterans (CWV). While VA completes and delivers to Con-
gress its report on plans to modernize the CWV website, the Com-
mittee emphasizes the importance of VA swiftly bringing into com-
pliance its websites at the center, and across the full VA. This is
essential for VA’s employees and the veterans who rely on VA serv-
ices, including the women veterans reliant upon the CWV.
BOARD OF VETERANS APPEALS
Appropriation, fiscal year 2022 ......................................................... $228,000,000
Budget request, fiscal year 2023 ....................................................... 285,000,000
rfrederick on DSKB3L4F33PROD with HEARING
Committee recommendation, fiscal year 2023 ................................. 285,000,000
Change from enacted level ......................................................... +57,000,000
Change from budget level ........................................................... –––
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00078 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
79
The bill makes ten percent of this funding available through Sep-
tember 30, 2024.
The Board of Veterans’ Appeals (BVA) is the component of VA
responsible for making final decisions on behalf of the Secretary for
the thousands of claims for veterans’ benefits that are presented to
BVA for appellate review. The majority of BVA’s workload derives
from the benefit claims initiated at VBA regional offices. The appel-
late process has multiple steps, most of which occur at the local re-
gional office level. If a veteran is not satisfied with a regional office
determination, he or she may appeal to BVA for a final agency de-
cision. BVA adjudicates appeals covering all areas of veterans’ ben-
efits, but most of the workload concerns appeals for veterans’ dis-
ability compensation or pension benefits. On February 19, 2019,
VA implemented the new legislative framework that modernized
the claims and appeals process and provided greater choice to vet-
erans by providing them three options for claims and appeals: (1)
a supplemental claim; (2) a higher-level review; or (3) a direct ap-
peal to the Board of Veterans’ Appeals.
Despite the unprecedented challenges presented by the COVID–
19 pandemic, BVA held a record 23,777 hearings in 2021, 96 per-
cent of which were conducted virtually, and issued 99,721 deci-
sions. With increased resources provided by Congress for fiscal year
2023, BVA will be able to adjudicate a higher number of appeals,
with a goal of 40,000 hearings held virtually and in-person.
Reimbursement of BVA Bar Dues.—The Committee recognizes
the challenge VA has in the recruitment and retention of attorneys
at BVA. To help the Board retain its attorneys, the Committee is
supportive of VA’s plans to reimburse bar fees for eligible staff in
fiscal year 2023.
INFORMATION TECHNOLOGY SYSTEMS
(INCLUDING TRANSFER OF FUNDS)
Appropriation, fiscal year 2022 ......................................................... $4,842,800,000
Budget request, fiscal year 2023 ....................................................... 5,782,000,000
Committee recommendation, fiscal year 2023 ................................. 5,782,000,000
Change from enacted level ......................................................... +939,200,000
Change from 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-
erans’ healthcare services and benefits programs.
Within the account total, the Committee allocates $1,494,230,000
for pay and associated costs, $4,145,678,000 for operations and
maintenance, and $142,092,000 for development. The bill makes
available three percent of pay and associated costs and five percent
of operations and maintenance funds until September 30, 2024. All
development funds are available until September 30, 2024.
The Committee directs VA to allocate sufficient resources for IT
improvements that support research and research facilities to en-
sure that computing infrastructure is adequate to facilitate re-
search needs.
The Committee continues bill language permitting the transfer of
rfrederick on DSKB3L4F33PROD with HEARING
funding among the three subaccounts upon approval of the Com-
mittees on Appropriations of both Houses of Congress.
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00079 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
80
The bill also continues language allowing for the reprogramming
of funds among development projects upon approval by the Com-
mittees on Appropriations of both Houses of Congress.
The chart below reflects the Committee’s allocation for develop-
ment projects. This chart will serve as the Department’s approved
list of development projects, and all requested changes are subject
to the reprogramming guidelines as outlined in the accompanying
Act.
INFORMATION TECHNOLOGY DEVELOPMENT PROJECTS
[In thousands of dollars]
Committee
Project Recommendation
Health Management Platform ........................................................................................................................ $70,736
Clinical Applications ...................................................................................................................................... 43,277
Health Research and Development ................................................................................................................ 5,209
Benefits Systems ............................................................................................................................................ 20,727
Other IT Systems ............................................................................................................................................ 2,143
Cybersecurity .................................................................................................................................................. ..............................
Information/Infrastructure Management ........................................................................................................ ..............................
Memorial Affairs ............................................................................................................................................. ..............................
Total All Development ........................................................................................................................... 142,092
The Committee expects the Office of Information and Technology
(OIT) to continue to provide an IT expenditure report to the Com-
mittees on Appropriations of both Houses of Congress on a monthly
basis. This report should include a comparison to the project costs
included in the development funding chart above and provide an
explanation for any differences in excess of $3,000,000.
Cybersecurity.—The Committee appreciates OIT’s implementa-
tion of the Executive Order on Improving the Nation’s Cybersecu-
rity (E.O. 14028) and its use of end-to-end encrypted communica-
tions with zero trust architecture and encourages it to continue to
adhere to development, security, and operations principles to se-
cure the Department’s information systems.
Supply Chain Modernization.—VA has made multiple attempts
to modernize its supply chain yet still lacks an enterprise solution
to effectively purchase and track supplies critical to providing
healthcare for the nation’s veterans. Currently, VA is assessing re-
quirements for an enterprise modernization that includes both the
supply chain and associated support functions. VA is encouraged to
continue to use an innovative approach to the acquisition through
an open competition and a prototyping evaluation phase to identify
an enterprise-wide solution, scheduled to be completed in January
2023. The Committee recommends the Department apply rigorous
vetting standards to ensure that industry partners demonstrate the
ability to deliver modernized supply chain solutions at the scale
and scope VA requires. Finally, the Committee directs the Sec-
retary to submit the final version of VA’s Supply Chain Manage-
ment Strategy and a full cost estimate of the program no later than
90 days after enactment of this Act.
rfrederick on DSKB3L4F33PROD with HEARING
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00080 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
81
VETERANS ELECTRONIC HEALTH RECORD
Appropriation, fiscal year 2022 ......................................................... $2,500,000,000
Budget request, fiscal year 2023 ....................................................... 1,759,000,000
Committee recommendation, fiscal year 2023 ................................. 1,759,000,000
Change from enacted level ......................................................... ¥741,000,000
Change from budget request ...................................................... –––
The Veterans Electronic Health Record (EHR) is a unified ac-
count designed to manage the effort to develop an interoperable
electronic health record system that will access seamlessly the
records of veterans in the VA system and those of DOD and of com-
munity providers. The VA system is the same as the one chosen
by DOD and is planned to be rolled out with the same timeline and
geographic areas as DOD in order to realize cost efficiency savings.
The bill provides funding to support VA’s on-going efforts to de-
ploy the new electronic health record system, consistent with the
budget request. Within the total funding, the bill includes
$1,119,145,000 for the electronic health record contract,
$199,116,000 for program management, and $440,739,000 for infra-
structure 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 prior to each quarterly briefing. Additionally,
the Committee directs the Department to provide updates on plans
and efforts to integrate community care providers into the new
EHR system. Such updates should be submitted concurrently with
the quarterly reports.
In addition, bill language is included that makes 25 percent of
the total funding available contingent upon the Secretary providing
notice to and receiving approval from the Committees on Appro-
priations of both Houses of Congress of any changes to the deploy-
ment schedule, as well as an updated plan outlining benchmarks
and measurable metrics for deployment and an updated plan for
addressing all required infrastructure upgrades. The Committee re-
peats the fiscal year 2019 directive for GAO to perform quarterly
performance reviews of the VA electronic health record deployment.
It is expected that this quarterly reporting will provide the Com-
mittees and VA with timely information to properly oversee this ef-
fort and address important issues.
Patient Harm and Transparency.—The Committee is aware of re-
rfrederick on DSKB3L4F33PROD with HEARING
cent alleged reports of patient harm connected to the rollout of the
new electronic health record system at the Mann-Grandstaff VA
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00081 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
82
Medical Center due to thousands of work orders that were ‘‘lost’’
in the system. This information, which is based on leaked draft
documents, has not been confirmed but includes concerning allega-
tions that VA leadership has known about incidents of patient
harm for many months. The Committee understands that the final
Office of Inspector General report is forthcoming and looks forward
to receiving the report as soon as possible in order to clarify these
issues.
Therefore, the Committee directs VA to provide, no later than 15
days after the filing of this report, a list of any patient harm inci-
dents that were identified at Mann-Grandstaff and any other loca-
tion that has received the new EHR; a timeline on when VA leader-
ship was notified of any patient harm issues and the issue of lost
work orders; and an execution plan and timeline for VA, working
with Oracle Cerner, to identify a solution to any remaining issues
that could impact patient safety, including issues related to system
stability. VA is further directed to provide monthly briefings to the
Committee on the status of these outstanding issues with the sys-
tem, beginning in July 2022, until such time that they have been
sufficiently remediated, as determined by the Committee.
Furthermore, the Committee directs VA to provide a report with-
in 90 days of enactment of this Act on the number of orders made
in the new EHR system for specialty care, lab work, and other
services that did not result in the intended action as well as those
that were lost since October 2020; the number of staff hours spent
by VA employees addressing these lost orders and the resulting de-
creased staff productivity and financial impact on VA; and avail-
able options for VA to recoup costs from Oracle Cerner for the dis-
ruption in patient care.
The Committee strongly urges VA to postpone additional rollouts
of the new EHR system until all issues that could contribute to pa-
tient safety or harm have been fully resolved and staff training on
properly utilizing the system, including any workarounds to pre-
vent lost orders, has been improved. VA is directed to certify to the
Committee that there have been no patient harm issues 7 days
prior to any new deployment. The Committee supports ongoing and
robust oversight of the EHRM program from VA’s Office of Inspec-
tor General and directs VA to be transparent with Congress on all
aspects of the rollout going forward.
Cybersecurity for Electronic Health Records and Blockchain Tech-
nology.—Recognizing the ongoing challenges of sharing data be-
tween DOD’s Military Health System (MHS) GENESIS and the De-
partment’s EHRM initiative, the Committee encourages the De-
partment to continue prioritizing efforts to protect veterans’ sen-
sitive information when implementing EHRM, and recommends the
Department consider emerging technologies, such as blockchain
technology, if future requirements drive a need to modify VA’s se-
curity architecture and technical solutions. The Committee under-
stands that the Department is planning a pilot to study the use of
blockchain technology to share data and looks forward to the re-
sults of the pilot being shared with the Committee.
VA EHRM at VA-Department of Defense Joint Venture Facili-
ties.—The Committee notes the significant potential to improve
rfrederick on DSKB3L4F33PROD with HEARING
data sharing between DOD’s MHS GENESIS and VA’s EHRM. Op-
portunities to identify areas of improvement can be found at the
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00082 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
83
VA-Department of Defense Joint Venture Facilities. The Com-
mittee understands that transition to the new electronic health
records system is planned at two VA-DOD joint venture facilities
in fiscal year 2023. Thus, the Committee directs the Federal Elec-
tronic Health Record Modernization Office, in coordination with
VA, to report to the Committee within 180 days of enactment of
this Act on: (1) how electronic health records coordination currently
functions at these facilities; (2) lessons learned from joint venture
facilities that can be applied to the implementation of the VA
EHRM; and, (3) how lessons learned will be disseminated to other
joint venture facilities to help those sites prepare for transition and
ensure better coordination of systems across the two departments.
Life Cycle Cost Analysis.—The Committee reminds the Depart-
ment of its interest in the life-cycle cost analysis of the EHRM pro-
gram and requests monthly updates on its progress until it is com-
pleted and shared with the Committee.
OFFICE OF INSPECTOR GENERAL
Appropriation, fiscal year 2022 ......................................................... $239,000,000
Budget request, fiscal year 2023 ....................................................... 273,000,000
Committee recommendation, fiscal year 2023 ................................. 273,000,000
Change from enacted level ......................................................... +34,000,000
Change from 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, 2024.
The Committee continues to request robust oversight of MIS-
SION Act and EHRM implementation.
VA Backlog.—OIG is encouraged to review the causes of VA’s
current claims backlog and provide all appropriate feedback on the
work VA is doing to address backlog issues. OIG is directed to re-
port to the Committee on the status of the backlog, how VA is ad-
dressing the backlog, and any changes in the amount of time vet-
erans are waiting to hear back on their claims. This report should
analyze how VA’s partnership with the National Archives and
Records Administration to digitally scan all paper-based military
personnel files has helped address and resolve the backlog.
CONSTRUCTION, MAJOR PROJECTS
Appropriation, fiscal year 2022 ......................................................... $1,611,000,000
Budget request, fiscal year 2023 ....................................................... 1,447,890,000
Committee recommendation, fiscal year 2023 ................................. 1,371,890,000
Change from enacted level ......................................................... ¥239,110,000
Change from budget request ...................................................... ¥76,000,000
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-
rfrederick on DSKB3L4F33PROD with HEARING
chitectural and engineering services, assessments, and site acquisi-
tion where the estimated cost of a project is more than $20,000,000.
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00083 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
84
The Committee recommendation makes $731,722,000 of these
funds available for a five-year period.
The Committee supports robust funding for VA construction
projects in fiscal year 2023. In addition to the $1,371,890,000 pro-
vided to fully support all requested Major Construction projects,
the Committee supports the Department’s plan to allocate
$804,510,000 from the Recurring Expenses Transformational Fund
to support Major Construction projects in Portland, OR,
Canandaigua, NY, Fort Harrison, MT, and for other purposes with-
in the account. In total, this would provide VA with $2,176,400,000
to support Major Construction projects in fiscal year 2023, which
is $565,400,000 above fiscal year 2022.
The Committee does not provide the requested new authority for
VHA land acquisition or the $76,000,000 requested specifically for
that purpose.
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 expects to receive quar-
terly briefings on each of the large construction projects.
The chart below reflects the Committee’s recommendation for
Major Construction projects.
CONSTRUCTION, MAJOR PROJECTS
[In thousands of dollars]
Project Amount
Veterans Health Administration (VHA)
Louisville, KY—New Medical Facility ............................................................................................................. 35,000
Alameda, CA—Community Based Outpatient Clinic and National Cemetery .............................................. 128,800
Livermore, CA—Realignment and Closure, Livermore Campus .................................................................... 35,000
El Paso, TX—Construct New Health Care Center ......................................................................................... 550,000
Advance Planning and Design Fund—Various Stations ............................................................................... 190,378
Claims Analysis—Various Stations ............................................................................................................... 2,500
Construction & Facilities Management Staff—Various Stations .................................................................. 128,122
Hazardous Waste—Various Stations ............................................................................................................. 16,000
Non-Departmental Federal Entity Project Management Support—Various Stations .................................... 134,590
Seismic Corrections—Various Stations ......................................................................................................... 1,500
Total, VHA .............................................................................................................................................. 1,221,890
National Cemetery Administration (NCA)
Elmira, NY—Phase 1 Gravesite Development ............................................................................................... 25,000
Albuquerque, NM—Phase 1 Gravesite Expansion ......................................................................................... 57,000
St. Louis, MO—Phase 1 Gravesite Development (New Land) ....................................................................... 44,000
Advance Planning and Design Fund—Various Stations ............................................................................... 13,000
NCA Land Acquisition Fund—Various Stations ............................................................................................. 1,000
Total, NCA .............................................................................................................................................. 140,000
General Administration/Staff Offices
Department Advance Planning and Design Fund for Major Construction .................................................... 10,000
Total, Major Construction ...................................................................................................................... 1,371,890
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
rfrederick on DSKB3L4F33PROD with HEARING
Houses of Congress; (2) any change to the scope of a construction
project is not permitted without the approval of the Committees;
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00084 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
85
and (3) VA must report any bid savings of $5,000,000 or more on
projects as soon as they are identified.
CONSTRUCTION, MINOR PROJECTS
Appropriation, fiscal year 2022 ......................................................... $553,000,000
Budget request, fiscal year 2023 ....................................................... 626,110,000
Committee recommendation, fiscal year 2023 ................................. 626,110,000
Change from enacted level ......................................................... +73,110,000
Change from budget request ...................................................... –––
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.
The Committee recommendation supports robust funding for VA
construction projects and makes $62,611,000 of the funds provided
available until expended.
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 also encourages VA to allocate sufficient resources for
improvements to research facilities, particularly to address any pri-
ority deficiencies.
Parking Assessment for the Spark M. Matsunaga Veterans Affairs
Medical Center at the Tripler Army Medical Facility.—The Tripler
Army Medical Center and the Spark M. Matsunaga Veterans Af-
fairs Medical Center share a facility on the Island of Oahu. As the
largest military and veterans medical facility in the Pacific Basin,
it is responsible for nearly 450,000 beneficiaries who are eligible to
receive care at the facility.
Due to the constraining geography and parking shortfall, vet-
erans and servicemembers have difficulty finding parking, which is
particularly challenging for elderly veterans, wounded soldiers and
those who have difficulty walking unassisted. The facility is also
not readily accessible to public transit, making ground transpor-
tation with parking the only reliable option for care. To help better
understand the need and potential solutions, the Committee directs
the VA Office of Acquisition, Logistics, and Construction to submit
a report to the Committee not later than 90 days after enactment
of this Act detailing: (1) the current parking requirements and
shortfalls at the facility; (2) the estimated cost of constructing a
new parking facility; and (3) a description of efforts to coordinate
joint solutions to the parking shortfall with the Defense Health
Agency.
Support the Expeditious Enactment of the Greater Los Angeles
Healthcare System’s Master Plan.—The Committee continues to
support the expeditious enactment of the Greater Los Angeles
Healthcare System’s Master Plan, which calls for the delivery of
rfrederick on DSKB3L4F33PROD with HEARING
more than 1,200 units of housing for more than 4,000 veterans in
the area experiencing homelessness. The Committee appreciates
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00085 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
86
VA’s work with the Principal Developer Team at the West Los An-
geles VA to identify opportunities to operationalize the Master
Plan. The Committee encourages VA to continue to engage with the
Principal Developer Team and others on any potential funding op-
portunities, including Capital Contributions.
The Committee supports the Department’s plan to allocate
$163,490,000 from the Recurring Expenses Transformational Fund
to support Minor Construction projects, which would support the
completion of construction projects at VA facilities nationwide as
well as installation of zero-emission vehicle charging infrastructure
on VA campuses. In addition, the Committee encourages VA to use
these resources to support Capital Contributions, as necessary, par-
ticularly for projects that would support housing and supportive
services for homeless veterans.
GRANTS FOR CONSTRUCTION OF STATE EXTENDED CARE FACILITIES
Appropriation, fiscal year 2022 ......................................................... $50,000,000
Budget request, fiscal year 2023 ....................................................... 150,000,000
Committee recommendation, fiscal year 2023 ................................. 150,000,000
Change from enacted level ......................................................... +100,000,000
Change from budget request ...................................................... –––
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 existing
buildings for furnishing domiciliary, nursing home, or hospital care
to veterans in State homes. A grant may not exceed 65 percent of
the total cost of the project. The bill makes this funding available
until expended.
Supporting grants for construction of state extended care facili-
ties has been and will continue to be a priority of the Committee.
As such, in order to ensure that VA has the resources required to
address priority project applications in fiscal year 2023, the bill in-
creases funding over the prior fiscal year by $100,000,000 for fiscal
year 2023, as requested.
GRANTS FOR CONSTRUCTION OF VETERANS CEMETERIES
Appropriation, fiscal year 2022 ......................................................... $48,500,000
Budget request, fiscal year 2023 ....................................................... 50,000,000
Committee recommendation, fiscal year 2023 ................................. 50,000,000
Change from enacted level ......................................................... +1,500,000
Change from budget request ...................................................... –––
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.
rfrederick on DSKB3L4F33PROD with HEARING
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00086 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
87
ASSET AND INFRASTRUCTURE REVIEW
Appropriation, fiscal year 2022 ......................................................... $5,000,000
Budget request, fiscal year 2023 ....................................................... 5,000,000
Committee recommendation, fiscal year 2023 ................................. 5,000,000
Change from enacted level ......................................................... –––
Change from budget request ...................................................... –––
This appropriation funds the work of the ‘‘Asset and Infrastruc-
ture Review Commission’’ (the Commission), an independent com-
mission established in the VA MISSION Act of 2018 (P.L. 115–
182), Title II, section 202. The Commission will review VA’s rec-
ommendations to modernize or realign VHA facilities, including
leased facilities. The Commission will conduct public hearings and
provide a report to the President on VA’s plan along with any addi-
tional recommendations from the Commission. Support staff will
conduct in-depth field hearings to receive input from veterans, Vet-
erans Service Organizations, local VA providers, and local govern-
ment.
The Committee urges VA and the Commission to focus on main-
taining or improving veterans’ access to medical care when final-
izing the recommendations, in both dense urban and rural areas.
The Committee urges VA and the Commission to be transparent
with and responsive to Congress as the recommendations continue
to evolve and encourages the Commission to conduct hearings in
regions affected by the recommendations of the Secretary, including
rural areas.
ADMINISTRATIVE PROVISIONS
The bill includes 52 administrative provisions, of which 50 were
in effect in fiscal year 2022 in some form and two are new provi-
sions. The administrative provisions included in the bill are as fol-
lows:
(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.
(INCLUDING TRANSFER OF FUNDS)
The bill includes section 202 allowing the Department to transfer
funding among the four medical appropriations accounts in fiscal
year 2023. 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
rfrederick on DSKB3L4F33PROD with HEARING
as a beneficiary to ensure the Department is receiving payment for
all medical services provided.
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00087 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
88
The bill includes section 206 allowing for the use of funds appro-
priated in fiscal year 2023 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 2022.
The bill includes section 207 allowing for the use of fiscal year
2023 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 enhanced-use lease pro-
ceeds deducted for administrative expenses that were incurred in
a prior fiscal year to be available until expended.
(INCLUDING TRANSFER OF FUNDS)
The bill includes section 210 limiting the amount of reimburse-
ment the Office of Resolution Management, Diversity and Inclu-
sion, the Office of Employment Discrimination Complaint Adjudica-
tion, and the Alternative Dispute Resolution function within the
Office of Human Resources and Administration can charge other of-
fices 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
facilities.
The bill includes section 213 allowing the Department to use the
Medical Services appropriation for expenses related to the broader
mission of medical care to veterans.
(INCLUDING TRANSFER OF FUNDS)
The bill includes section 214 allowing the Department to transfer
Medical Care Collections to the ‘‘Medical Services’’ and ‘‘Medical
Community Care’’ accounts to be used for veterans’ medical care
and makes those funds available until expended.
The bill includes section 215 allowing veterans who reside in
Alaska to obtain medical services from medical facilities supported
by the Indian Health Service or tribal organizations, and provides
for reimbursement for those services from VA.
(INCLUDING TRANSFER OF FUNDS)
rfrederick on DSKB3L4F33PROD with HEARING
The bill includes section 216 allowing the Department to transfer
the proceeds received from the transfer of real property deposited
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00088 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
89
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 Department of
Veterans Affairs.
(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 $330,140,000 of fis-
cal year 2023 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
$314,825,000 of fiscal year 2024 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
combined Federal medical facilities.
(INCLUDING TRANSFER OF FUNDS)
The bill includes section 222 directing that a minimum of
$15,000,000 shall be transferred from the four medical care 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
rfrederick on DSKB3L4F33PROD with HEARING
the scope specified for that project in the original justification data
provided to Congress unless approved by the Committees on Appro-
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00089 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
90
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
Committees on Appropriations of both Houses of Congress. The Ad-
ministration 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 modify
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 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 233 permanently allowing the use of
rfrederick on DSKB3L4F33PROD with HEARING
Medical Services funding for assisted reproductive technology treat-
ment and adoption reimbursement for veterans and their spouses
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00090 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
91
or partners if the veteran has a service-connected disability that re-
sults in being unable to procreate without such fertility treatment.
The bill includes section 234 prohibiting any funds from being
used in a manner that is inconsistent with statutory limitations on
outsourcing.
The bill includes section 235 pertaining to exceptions for Indian-
or Native Hawaiian-owned businesses contracting with VA.
The bill includes section 236 directing the elimination over a se-
ries of years of the use of Social Security numbers in VA programs.
The bill includes section 237 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 238 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 239 permitting funding to be used in fis-
cal years 2023 and 2024 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 240 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
kept secret in the interest of national defense or the conduct of for-
eign affairs. The Administration request to delete this provision is
not adopted.
The bill includes section 241 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 242 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 bill includes section 243 prohibiting funding from being used
in a manner that would increase wait times for veterans at medical
facilities. The Administration request to delete this provision is not
adopted.
The bill includes section 244 prohibiting the use of funds in fiscal
year 2023 to convert any program that received specific purpose
funds in fiscal year 2022 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.
rfrederick on DSKB3L4F33PROD with HEARING
The bill includes section 245 eliminating category D or E pain
testing on dogs or cats.
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00091 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
92
The bill includes section 246 to allow fiscal year 2023 and 2024
‘‘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 247 allowing obligations and expendi-
tures 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.
This bill includes section 248 specifying an amount from the four
medical care accounts for gender-specific care and programmatic ef-
forts for women. The Administration request to delete this provi-
sion is not adopted.
(INCLUDING TRANSFER OF FUNDS)
The bill includes section 249 permitting the transfer of funds de-
posited in the ‘‘Medical Facilities’’ and ‘‘General Administration’’
accounts to the ‘‘Asset and Infrastructure Review’’ account, under
certain circumstances.
(INCLUDING RESCISSION OF FUNDS)
The bill includes section 250 rescinding funds from the Recurring
Expenses Transformational Fund.
The bill includes section 251 requiring quarterly reports on the
status of the ‘‘Veterans Medical Care and Health Fund,’’ estab-
lished to execute section 8002 of the American Rescue Plan (P.L.
117–2).
The bill includes section 252 establishing a timeline for construc-
tion in accordance with a lease.
TITLE III
RELATED AGENCIES
Funds under Title III support the agencies that honor and re-
spect the service of the nation’s heroes. Though it may be a smaller
title of the bill, the agencies funded under Title III are the public
face of America’s commitment to servicemembers and veterans. The
American Battle Monuments Commission and Arlington Cemetery
commemorate those who made the ultimate sacrifice, while the
Armed Forces Retirement Home and the United States Court of
Appeals for Veterans Claims are critical parts of keeping the prom-
ise to serve those who served the nation.
AMERICAN BATTLE MONUMENTS COMMISSION
SALARIES AND EXPENSES
Appropriation, fiscal year 2022 ......................................................... $87,500,000
Budget request, fiscal year 2023 ....................................................... 86,800,000
Committee recommendation, fiscal year 2023 ................................. 87,500,000
Change from enacted level ......................................................... –––
Change from budget request ...................................................... +700,000
The recommendation includes $87,500,000 for Salaries and Ex-
penses of the American Battle Monuments Commission.
The Committee notes the significant maintenance needs of the
American Battle Monuments around the world, which are specifi-
rfrederick on DSKB3L4F33PROD with HEARING
cally designed to honor fallen servicemembers. The Committee con-
tinues to emphasize that existing monuments and memorials
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00092 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
93
should be maintained and repaired in a proactive and timely man-
ner that honors the service, achievements, and sacrifices of the
United States Armed Forces.
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 2022 ......................................................... $41,700,000
Budget request, fiscal year 2023 ....................................................... 46,900,000
Committee recommendation, fiscal year 2023 ................................. 45,159,000
Change from enacted level ......................................................... +3,459,000
Change from budget request ...................................................... ¥1,741,000
The recommendation includes $45,159,000 for Salaries and Ex-
penses for the United States Court of Appeals for Veterans Claims
(the Court).
The Committee notes that the Court’s current authorization is
for nine judges and provides funding for the current activities of
the Court. The Committee recognizes that caseloads at the Court
continue to grow and notes that future statutory changes may in-
crease the size of the Court. The Committee will continue to closely
follow these developments and their impact on funding needs.
DEPARTMENT OF DEFENSE—CIVIL
CEMETERIAL EXPENSES, ARMY
SALARIES AND EXPENSES
Appropriation, fiscal year 2022 ......................................................... $87,000,000
Budget request, fiscal year 2023 ....................................................... 93,400,000
Committee recommendation, fiscal year 2023 ................................. 93,400,000
Change from enacted level ......................................................... +6,400,000
Change from budget request ...................................................... –––
The recommendation includes $93,400,000 for Salaries and Ex-
penses for Arlington National Cemetery (the Cemetery), which is
equal to the fiscal year 2023 budget request. The Committee is
pleased to see an acknowledgment of its repeated direction that the
Cemetery’s budget requests reflect the funding needed to respond
to increased costs and to maintain the current level of services.
Updated Interment Policy.—The Committee is aware that the
Secretary of the Army is in the process of finalizing revised criteria
for interment at the Cemetery to preserve it as an active burial
ground well into the future, and the Committee notes that it will
continue to follow closely to ensure that the Cemetery can continue
to live up to its mission to honor those who have served.
Protestant Chaplain Memorial.—The Committee strongly be-
lieves that the nation’s deceased military chaplains of all faiths
should be properly honored in Arlington National Cemetery, and
that the monuments located on Chaplains Hill represent a key part
of this commitment. The Committee continues to urge the Ceme-
rfrederick on DSKB3L4F33PROD with HEARING
tery to work productively with stakeholders on proposals to restore
and update the Protestant Chaplain Memorial and ensure that it
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00093 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
94
can continue to honor those who have served without additional
delay.
Military Horses.—The Committee is concerned about reports of
disturbing treatment and malnourishment of the horses that pull
the caissons at Arlington National Cemetery. While the Committee
notes that the oversight of these horses may ultimately fall to other
Army entities, these horses are an integral symbol of the Ceme-
tery’s mission to lay to rest those who have served the nation with
dignity and honor, just as any other employee of the Cemetery. The
Committee directs Cemetery leadership to engage with the 3rd
U.S. Infantry Regiment, Joint Base Myer-Henderson Hall, Fort
Belvoir, and others, and take all possible actions to ensure that the
horses that allow the Cemetery to fulfill its mission are well cared
for and treated with respect.
CONSTRUCTION
Appropriation, fiscal year 2022 ......................................................... $141,000,000
Budget request, fiscal year 2023 ....................................................... 62,500,000
Committee recommendation, fiscal year 2023 ................................. 62,500,000
Change from enacted level ......................................................... ¥78,500,000
Change from budget request ...................................................... –––
The recommendation includes $62,500,000 for construction, in-
cluding $60,000,000 for planning and design and construction of
Southern Expansion, to remain available until expended. This is
expected to complete the Southern Expansion project and road re-
alignments to extend the life of the cemetery. The Committee pro-
vides this funding to ensure that the life of the nation’s most pres-
tigious cemetery is extended into the 2050 timeframe. The Com-
mittee directs the Cemetery to include status updates in its re-
quired quarterly reports on funds obligated, including previously
appropriated funds, and funds remaining for the Southern Expan-
sion project, as well as any remaining unfunded needs to complete
the project.
The Committee also provides $2,500,000 to begin the process of
a project to make improvements to Memorial Avenue. The Com-
mittee directs the Cemetery to provide updates on the status of
this study and project, including obligations of funds.
ARMED FORCES RETIREMENT HOME
TRUST FUND
The recommendation includes $75,360,000 for the Armed Forces
Retirement Home (AFRH) Trust Fund, including $7,300,000 for
capital projects, although $25,000,000 of the total is provided from
the general fund of the Treasury, and not the Trust Fund.
General Fund.—The Committee continues to express concern
about the use of the General Fund to support the work of AFRH.
The Committee directs AFRH to continue to make progress on ef-
forts to increase revenues and stabilize the AFRH Trust Fund for
the long term, and to continue to report to the Committee on its
further initiatives to improve sustainability and maintain the high-
quality services provided to AFRH residents.
rfrederick on DSKB3L4F33PROD with HEARING
Land Redevelopment.—The Committee continues to be interested
in the redevelopment of the 80-acre master planned parcel on the
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00094 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
95
Washington campus and continues to direct AFRH to report to the
Committee on the progress of the redevelopment project.
OPERATION AND MAINTENANCE
Appropriation, fiscal year 2022 ......................................................... $68,000,000
Budget request, fiscal year 2023 ....................................................... 68,060,000
Committee recommendation, fiscal year 2023 ................................. 68,060,000
Change from enacted level ......................................................... +60,000
Change from budget request ...................................................... –––
The Committee makes these operation and maintenance funds
available until September 30, 2024, as requested, to provide AFRH
greater ability to respond to emergency situations and ensure sta-
ble operations.
CAPITAL PROGRAM
Appropriation, fiscal year 2022 ......................................................... $9,000,000
Budget request, fiscal year 2023 ....................................................... 7,300,000
Committee recommendation, fiscal year 2023 ................................. 7,300,000
Change from enacted level ......................................................... ¥1,700,000
Change from budget request ...................................................... –––
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.
MAJOR CONSTRUCTION
Appropriation, fiscal year 2022 ......................................................... $– – –
Budget request, fiscal year 2023 ....................................................... 77,000,000
Committee recommendation, fiscal year 2023 ................................. 77,000,000
Change from enacted level ......................................................... +77,000,000
Change from budget request ...................................................... –––
The Committee provides $77,000,000, as requested, for renova-
tion of the Sheridan Building on the Washington campus, which
will improve resident safety and quality of life, address needed
maintenance projects, and provide additional opportunities for
AFRH to increase occupancy rates. The Committee requests quar-
terly reports on the status of this construction project, including ob-
ligations of funds, anticipated timelines, and any changes to the
overall cost of the project.
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
GENERAL PROVISIONS
The bill includes a total of 11 provisions that were in effect in
fiscal year 2022:
rfrederick on DSKB3L4F33PROD with HEARING
The bill includes section 401 prohibiting the obligation of funds
beyond the current fiscal year unless expressly so provided.
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00095 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
96
The bill includes section 402 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,
or unfunded mandates.
The bill includes section 403 encouraging all departments and
agencies funded in this Act to expand the use of ‘‘E-Commerce’’
technologies and procedures.
The bill includes section 404 specifying the Congressional com-
mittees that are to receive all reports and notifications.
The bill includes section 405 prohibiting the transfer of funds to
any instrumentality of the United States Government without au-
thority from an appropriations Act.
The bill includes section 406 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 407 requiring all reports submitted to
the Congress to be posted on official websites of the submitting
agency.
The bill includes section 408 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 409 prohibiting the use of funds for pay-
ment of first-class travel by an employee of the executive branch.
The bill includes section 410 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 411 prohibiting the use of funds in this
Act to construct facilities on military installations that do not meet
resiliency standards.
HOUSE OF REPRESENTATIVES REPORTING 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-
ance, including a program’s success in developing and attaining
outcome-related goals and objectives, in developing funding rec-
ommendations.
RESCISSION 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 rescissions in the accompanying bill:
In title II Section 250 rescinds $48,132,853 of unobligated bal-
rfrederick on DSKB3L4F33PROD with HEARING
ances in the ‘‘Recurring Expenses Transformational Fund’’ estab-
lished in section 243 of division J of Public Law 114–113.
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00096 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
97
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 $21,423,000 in fis-
cal year 2024 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 2023 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, subject to approval by the Com-
mittee.
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 $97,869,000 to be
transferred to General Administration and Information Technology
Systems from any funds appropriated in fiscal year 2023 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
and Construction, Minor Projects accounts.
Language is included to allow the transfer of 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-
rfrederick on DSKB3L4F33PROD with HEARING
ital Asset Fund to the Construction, Major Projects and Construc-
tion, Minor Projects accounts.
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00097 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
98
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 provided for
the Department of Veterans Affairs in fiscal year 2023 to the Joint
Department of Defense-Department of Veterans Affairs Medical
Facility Demonstration Fund.
Language is included allowing fiscal year 2024 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.
Language is included that permits the transfer of funds from the
Medical Facilities and General Administration accounts to the
Asset and Infrastructure Review account.
DISCLOSURE OF EARMARKS AND CONGRESSIONALLY DIRECTED
SPENDING ITEMS
The following table is submitted in compliance with clause 9 of
rule XXI, and lists the congressional earmarks (as defined in para-
graph (e) of clause 9) contained in the bill or in this report. Neither
the bill nor the report contain any limited tax benefits or limited
tariff benefits as defined in paragraphs (f) or (g) of clause 9 of rule
XXI.
rfrederick on DSKB3L4F33PROD with HEARING
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00098 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
99
rfrederick on DSKB3L4F33PROD with HEARING
Insert offset folio 02 here 46979.001
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00099 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
100
rfrederick on DSKB3L4F33PROD with HEARING
Insert offset folio 3 here 46979.002
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00100 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
101
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):
SECTION 220 OF DIVISION J OF PUBLIC LAW 117–103
øSEC. 220. Of the amounts appropriated to the Department of
Veterans Affairs which become available on October 1, 2022, for
‘‘Medical Services’’, ‘‘Medical Community Care’’, ‘‘Medical Support
and Compliance’’, and ‘‘Medical Facilities’’, up to $323,242,000, plus
reimbursements, may be transferred to the Joint Department of
Defense—Department of Veterans Affairs Medical Facility Dem-
onstration Fund, established by section 1704 of the National De-
fense Authorization Act for Fiscal Year 2010 (Public Law 111–84;
123 Stat. 3571) and may be used for operation of the facilities des-
ignated as combined Federal medical facilities as described by sec-
tion 706 of the Duncan Hunter National Defense Authorization Act
for Fiscal Year 2009 (Public Law 110–417; 122 Stat. 4500): Pro-
vided, That additional funds may be transferred from accounts des-
ignated in this section to the Joint Department of Defense—De-
partment of Veterans Affairs Medical Facility Demonstration Fund
upon written notification by the Secretary of Veterans Affairs to
the Committees on Appropriations of both Houses of Congress.¿
TITLE 38, UNITED STATES CODE
* * * * * * *
PART II—GENERAL BENEFITS
* * * * * * *
CHAPTER 17—HOSPITAL, NURSING HOME,
DOMICILIARY, AND MEDICAL CARE
SUBCHAPTER SUBCHAPTER I—GENERAL
Sec.
1701. Definitions.
* * * * * * *
SUBCHAPTER II—HOSPITAL, NURSING HOME, OR
DOMICILIARY CARE AND MEDICAL TREATMENT
* * * * * * *
1720K. Infertility counseling and treatment; reimbursement of adoption expenses.
* * * * * * *
§ 1720K. Infertility counseling and treatment; reimbursement
of adoption expenses
rfrederick on DSKB3L4F33PROD with HEARING
(a) INFERTILITY COUNSELING AND TREATMENT.—(1) Pursuant to
regulations the Secretary shall prescribe to carry out this subsection,
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00101 Fmt 6659 Sfmt 6603 E:\HR\OC\HR391.XXX HR391
102
the Secretary may provide infertility counseling and treatment,
using assisted reproductive technology, including in vitro fertiliza-
tion, intrauterine insemination, and other advanced reproductive
technologies, to the following:
(A) A veteran—
(i) who is enrolled in the system of annual patient enroll-
ment established and operated under section 1705 of this
title; and
(ii) who, in the judgment of a health care professional of
the Department—
(I) has a service-connected disability or condition
causing or aggravating infertility; or
(II) is infertile as a result of having received medi-
cally necessary treatment pursuant to this chapter.
(B) The spouse of a veteran described in subparagraph (A),
or the partner of a veteran described in subparagraph (A)
whom the veteran designates for purposes of this subsection.
(2)(A) The Secretary may contract with a provider of in vitro fer-
tilization services to obtain donor gametes or embryos from
thirdparty donors.
(B) The Secretary may only obtain third-party donation of
gametes or embryos through a contract.
(C) The Secretary may not provide assisted reproductive tech-
nology services or medical services to third-party donors.
(3)(A) The Secretary may contract with a facility to furnish the
cryopreservation, storage, and transportation of gametes and em-
bryos.
(B) The Secretary may not impose any limitation on the period in
which an embryo or gamete is cryopreserved and stored pursuant to
this subsection.
(4) The legal status, custody, future use, donation, disposition, or
destruction, of gametes or embryos relating to infertility or treat-
ment furnished under this subsection shall be determined in accord-
ance with the law of the State in which the gametes or embryos are
located.
(5)(A) In prescribing regulations to carry out this subsection, the
Secretary shall ensure that any in vitro fertilization (including with
respect to the number of retrieval attempts and completed embryo
transfer cycles) will be—
(i) determined using the best medical evidence available; and
(ii) provided in accordance with applicable standards of care.
(B) In furnishing in vitro fertilization to a covered individual pur-
suant to this subsection, the Secretary is responsible only for pay-
ment of the costs of the in vitro fertilization services.
(C) The Secretary may not furnish an in vitro fertilization cycle
to a covered individual under this subsection unless the Secretary
receives consent for such cycle from each of the following:
(i) The covered individual.
(ii) If the covered individual is a spouse or partner of a vet-
eran as described in subparagraph (l)(B), the veteran.
(iii) If applicable, the third-party donor.
(6) In this subsection:
(A) The term ‘‘covered individual’’ means a veteran, spouse, or
rfrederick on DSKB3L4F33PROD with HEARING
partner who receives infertility counseling and treatment under
paragraph (1).
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00102 Fmt 6659 Sfmt 6603 E:\HR\OC\HR391.XXX HR391
103
(B) The term ‘‘gamete’’ means a mature sperm or an oocyte or
egg germ cell, as applicable.
(C) The term ‘‘infertility’’ means the inability to procreate
without the use of infertility treatment.
(D) The term ‘‘in vitro fertilization’’ means the procedure in
which an oocyte is removed from a mature ovarian follicle and
fertilized by a sperm cell outside the human body and, at the
appropriate time, transferred into the uterus.
(E) The term ‘‘third-party donor’’ means an individual who
consents to donate the gametes or embryo of the individual for
use in treatment furnished pursuant to this subsection.
(b) ADOPTION REIMBURSEMENT.—(1) Pursuant to regulations the
Secretary shall prescribe to carry out this subsection, the Secretary
may reimburse an eligible veteran for qualifying adoption expenses
incurred by the veteran in the adoption of a child.
(2) For purposes of this subsection, an eligible veteran is a veteran
who meets the following criteria:
(A) The veteran is enrolled in the system of annual patient
enrollment established and operated under section 1705 of this
title.
(B) The veteran, in the judgment of the health care profes-
sional of the Department—
(i) has a service-connected disability or condition causing
or aggravating infertility; or
(ii) is infertile as a result of having received medically
necessary treatment pursuant to this chapter.
(3) An adoption for which expenses may be reimbursed under this
subsection includes an adoption by a single person, an infant adop-
tion, an intercountry adoption, or an adoption of a child with spe-
cial needs (as defined in section 473(c) of the Social Security Act (42
U.S.C. 673(c))).
(4) The Secretary may reimburse an eligible veteran for qualifying
adoption expenses under this subsection only after the adoption is
final.
(5) The Secretary may not reimburse an eligible veteran for quali-
fying adoption expenses under this subsection for any expense paid
to or for the veteran under any other adoption benefits program ad-
ministered by the Federal Government or under any such program
administered by a State or local government.
(6)(A)(i) The Secretary may not reimburse an eligible veteran, or
two eligible veterans who are partners, for qualifying adoption ex-
penses under this subsection for more than one adoption.
(ii) The Secretary may not reimburse more than one eligible vet-
eran for the qualifying adoption expenses under this subsection for
the adoption of the same child.
(B) In prescribing regulations to carry out this subsection, the
Secretary shall establish minimum and maximum amounts for the
reimbursement of qualifying adoption expenses.
(7) In this subsection:
(A) Notwithstanding section 101 of this title, the term ‘‘child’’
means an individual who is under the age of eighteen years.
(B) The term ‘‘qualified adoption agency’’ means—
(i) a State or local government agency that has responsi-
rfrederick on DSKB3L4F33PROD with HEARING
bility under State or local law for child placement through
adoption;
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00103 Fmt 6659 Sfmt 6603 E:\HR\OC\HR391.XXX HR391
104
(ii) a nonprofit, voluntary adoption agency that is author-
ized by State or local law to place children for adoption;
(iii) any other source authorized by a State to provide
adoption placement if the adoption is supervised by a court
under State or local law; or
(iv) a foreign government or an agency authorized by a
foreign government to place children for adoption, in any
case in which—
(I) the adopted child is entitled to automatic citizen-
ship under section 320 of the Immigration and Nation-
ality Act (8 U.S.C. 1431); or
(II) a certificate of citizenship has been issued for
such child under section 322 of that Act (8 U.S.C.
1433).
(C) The term ‘‘qualifying adoption expenses’’ means reason-
able and necessary expenses that are directly related to the legal
adoption of a child, but only if such adoption is arranged by
a qualified adoption agency. Such term does not include any ex-
pense incurred—
(i) by an adopting parent for travel; or
(ii) in connection with an adoption arranged in violation
of Federal, State, or local law.
(D) The term ‘‘reasonable and necessary expenses’’ includes—
(i) public and private agency fees, including adoption fees
charged by an agency in a foreign country;
(ii) placement fees, including fees charged adoptive par-
ents for counseling;
(iii) legal fees (including court costs) or notary expenses;
and
(iv) medical expenses, including hospital expenses of the
biological mother of the child to be adopted and of a new-
born infant to be adopted.
* * * * * * *
CHANGES IN THE 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-
islation, which to date have not been enacted.
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.
rfrederick on DSKB3L4F33PROD with HEARING
Language is included in various parts of the bill to enable var-
ious appropriations to remain available for more than one year for
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00104 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
105
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
associated with supervision, inspection, overhead, engineering and
design on family housing or military construction projects that are
being completed with expired or lapsed funds.
Language is included under Title I to allow funds to be expended
on military construction projects for four fiscal years after 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.
rfrederick on DSKB3L4F33PROD with HEARING
Language is included under Title I to limit funds for the oper-
ation and maintenance of family housing to those provided in this
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00105 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
106
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 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 allowing unobligated funds
from prior appropriations acts for fiscal years 2017 and 2018 to be
obligated under certain circumstances.
Language is included under Title I defining the congressional de-
fense committees.
Language is included under Title I for improving military instal-
lation resilience.
Language is included under Title I for child development centers
planning and design.
Language is included under Title I for Natural Disasters.
Language is included under Title I for laboratory facilities.
Language is included under Title I for Air Force Reserve cost to
complete projects.
Language is included under Title I for cost increases identified
subsequent to the fiscal year 2023 budget request.
Language is included under Title I providing additional funds for
Military Construction, Defense-Wide for cost increases for major
construction projects.
Language is included in Title I for planning and design of water
treatment and distribution facilities.
Language is included under Title I for unaccompanied housing.
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 for child development centers
construction.
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 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
rfrederick on DSKB3L4F33PROD with HEARING
ensure sufficient funding is available for the acquisition of pros-
thetics designed for women veterans.
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00106 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
107
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 to require approval of a
transfer between development projects in the Information Tech-
nology Systems account.
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
for program costs, and allowing for the reimbursement to the ‘‘Gen-
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 in contravention of certain breast cancer screening guidance.
Language is included under Title II to allow covered veterans
and their spouses or partners, under certain conditions, to receive
assisted reproductive technology services and adoption reimburse-
ment.
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.
rfrederick on DSKB3L4F33PROD with HEARING
Language is included under Title II pertaining to certification of
marriage and family therapists.
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00107 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
108
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
Congress or their staff.
Language is included under Title II requiring certain data to be
included in budget justifications for major construction projects.
Language is included under Title II prohibiting the Inspector
General from being denied timely access to information.
Language is included under Title II prohibiting funding to be
used in a manner 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 2023 to convert any program that received specific
purpose funding in fiscal year 2022 to a general purpose-funded
program.
Language is included under Title II prohibiting the use of dogs
or cats as part of the conduct of any study.
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 and programmatic efforts to deliver care for
women veterans.
Language is included under Title II rescinding unobligated bal-
ances in the ‘‘Recurring Expenses Transformational Fund.’’
Language is included under Title II requiring quarterly reports
on the status of the Veterans Medical Care and Health Fund.
Language is included under Title II establishing a timeline for
construction in accordance with a lease.
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 park-
ing 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 prohibiting funding beyond
the current fiscal year unless expressly so provided.
rfrederick on DSKB3L4F33PROD with HEARING
Language is included under Title IV to limit the use of funds for
Federal entities when they are not in compliance with Federal law
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00108 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
109
relating to risk assessment, the protection of private property
rights, or unfunded mandates.
Language is included under Title IV providing funding to expand
the use of ‘‘E-Commerce’’ technologies and procedures.
Language is included under Title IV specifying the Congressional
committees that are to receive all reports and notifications.
Language is included under Title IV prohibiting the transfer of
funds to any instrumentality of the United States Government
without authority from an appropriations Act.
Language is included under Title IV 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 IV requiring all reports sub-
mitted to the Congress to be posted on the official public Website
of that agency.
Language is included under Title IV 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 IV prohibiting funds from being
used to pay for first-class travel in violation of Federal regulations.
Language is included under Title IV 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 IV prohibiting the use of funds
in this Act to construct facilities on military installations that do
not meet resiliency standards.
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
the period concerned:
[dollars in thousands]
Agency/program Last year of Authorization level Appropriations in last Appropriations in this
authorization year of authorization bill
Military Construction, Army .......................... 2022 1,727,943 1,051,772 997,425
Military Construction, Navy and Marine
Corps ........................................................ 2022 3,895,117 2,644,277 3,808,340
Military Construction, Air Force .................... 2022 2,485,424 2,204,750 2,291,156
Military Construction, Defense-Wide ............ 2022 2,029,569 2,206,051 2,675,128
Military Construction, Army National Guard 2022 391,993 337,893 325,658
Military Construction, Air National Guard .... 2022 382,250 305,050 193,983
Military Construction, Army Reserve ............ 2022 123,311 94,111 119,878
Military Construction, Navy Reserve ............. 2022 71,804 71,804 30,337
Military Construction, Air Force Reserve ...... 2022 164,074 120,074 82,123
North Atlantic Treaty Organization Security
Investment Program ................................. 2022 205,853 215,853 220,139
Family Housing Construction, Army ............. 2022 161,349 99,849 169,339
Family Housing Operation and Maintenance,
Army ......................................................... 2022 391,227 391,227 446,411
Family Housing Construction, Navy and Ma-
rine Corps ................................................. 2022 77,616 77,616 337,297
rfrederick on DSKB3L4F33PROD with HEARING
Family Housing Operation and Maintenance,
Navy and Marine Corps ........................... 2022 357,341 357,341 378,224
Family Housing Construction, Air Force ....... 2022 115,716 115,716 232,788
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00109 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
110
[dollars in thousands]
Last year of Appropriations in last Appropriations in this
Agency/program Authorization level
authorization year of authorization bill
Family Housing Operation and Maintenance,
Air Force ................................................... 2022 325,445 325,445 365,222
Family Housing Operation and Maintenance,
Defense-Wide ............................................ 2022 49,785 49,785 50,113
Department of Defense Family Housing Im-
provement Fund ....................................... 2022 6,081 6,081 6,442
Department of Defense Military Unaccom-
panied Housing Improvement Fund ......... 2022 494 494 494
Base Realignment and Closure Account ...... 2022 384,639 529,639 574,687
Dept. of Veterans Affairs, Major Construc-
tion ........................................................... done each yr. .......................... 1,611,000 1,371,890
Dept. of Veterans Affairs, Major Leases ...... done each yr. .......................... 283,381 224,075
Armed Forces Retirement Home ................... 2022 75,300 77,000 152,360
PROGRAM DUPLICATION
Pursuant to clause 3(c)(5) of rule XIII of the Rules of the House
of Representatives, no provision of this bill establishes or reauthor-
izes a program of the Federal Government known to be duplicative
of another Federal program, a program that was included in any
report from the Government Accountability Office to Congress pur-
suant to section 21 of Public Law 111–139, or a program related
to a program identified in the most recent Catalog of Federal Do-
mestic Assistance.
BUDGETARY IMPACT OF THE FY 2023 MILITARY CONSTRUCTION, VET-
ERANS AFFAIRS, AND RELATED AGENCIES APPROPRIATIONS BILL
PREPARED IN CONSULTATION WITH THE CONGRESSIONAL BUDGET
OFFICE PURSUANT TO SECTION 308(a) OF THE CONGRESSIONAL
BUDGET ACT OF 1974
[In millions of dollars]
COMPARISON WITH BUDGET RESOLUTION
Pursuant to clause 3(c)(2) of rule XIII of the Rules of the House
of Representatives and section 308(a)(1)(A) of the Congressional
Budget Act of 1974, the following table compares the levels of new
budget authority provided in the bill with the appropriate alloca-
tion under section 302(b) of the Budget Act.
[In millions of dollars]
302(b) Allocation This Bill
Budget Budget
Outlays Outlays
Authority Authority
Comparison of amounts in the bill with Committee al-
locations to its subcommittees: Subcommittee on
Military Construction, Veterans Affairs, and Related
Agencies
Discretionary .......................................................... 150,500 145,000 150,500 1 144,809
Mandatory .............................................................. 147,729 149,341 147,729 1 149,341
1 Includes outlays from prior-year budget authority.
FIVE-YEAR OUTLAY PROJECTIONS
rfrederick on DSKB3L4F33PROD with HEARING
Pursuant to clause 3(c)(2) of rule XIII and section 308(a)(1)(B) of
the Congressional Budget Act of 1974, the following table contains
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00110 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
111
five-year projections associated with the budget authority provided
in the accompanying bill as provided to the Committee by the Con-
gressional Budget Office.
[In millions of dollars]
Outlays
Projection of outlays associated with the recommendation:
2023 ................................................................................................................................................................ 1 168,207
2024 ................................................................................................................................................................ 122,940
2025 ................................................................................................................................................................ 17,411
2026 ................................................................................................................................................................ 5,230
2027 and future years .................................................................................................................................... 4,760
1 Excludes outlays from prior-year budget authority.
FINANCIAL ASSISTANCE TO STATE AND LOCAL GOVERNMENTS
Pursuant to clause 3(c)(2) of rule XIII and section 308(a)(1)(C) of
the Congressional Budget Act of 1974, the Congressional Budget
Office has provided the following estimates of new budget authority
and outlays provided by the accompanying bill for financial assist-
ance to State and local governments.
[In millions of dollars]
Budget Outlays
Authority
Financial assistance to State and local governments for 2023 ................................ 265 1 36
1 Excludes outlays from prior-year budget authority.
rfrederick on DSKB3L4F33PROD with HEARING
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00111 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
112
rfrederick on DSKB3L4F33PROD with HEARING
Insert offset folio 04 here 46979.003
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00112 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
113
rfrederick on DSKB3L4F33PROD with HEARING
Insert offset folio 5 here 46979.004
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00113 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
114
rfrederick on DSKB3L4F33PROD with HEARING
Insert offset folio 6 here 46979.005
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00114 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
115
rfrederick on DSKB3L4F33PROD with HEARING
Insert offset folio 121 here 47868.001
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00115 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
116
rfrederick on DSKB3L4F33PROD with HEARING
Insert offset folio 8 here 46979.007
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00116 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
117
rfrederick on DSKB3L4F33PROD with HEARING
Insert offset folio 9 here 46979.008
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00117 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
118
rfrederick on DSKB3L4F33PROD with HEARING
Insert offset folio 10 here 46979.009
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00118 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
119
rfrederick on DSKB3L4F33PROD with HEARING
Insert offset folio 11 here 46979.010
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00119 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
120
rfrederick on DSKB3L4F33PROD with HEARING
Insert offset folio 12 here 46979.011
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00120 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
121
rfrederick on DSKB3L4F33PROD with HEARING
Insert offset folio 13 here 46979.012
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00121 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
122
rfrederick on DSKB3L4F33PROD with HEARING
Insert offset folio 14 here 46979.013
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00122 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
123
rfrederick on DSKB3L4F33PROD with HEARING
Insert offset folio 15 here 46979.014
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00123 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
124
rfrederick on DSKB3L4F33PROD with HEARING
Insert offset folio 16 here 46979.015
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00124 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
125
COMMITTEE HEARINGS
Pursuant to clause 3(c)(6) of rule XIII of the Rules of the House
of Representatives, the following hearings were used to develop or
consider the Military Construction, Department of Veterans Af-
fairs, and Related Agencies Appropriations Act, 2023:
The Subcommittee on Military Construction, Department of Vet-
erans Affairs, and Related Agencies held a hearing on March 31,
2022, entitled ‘‘Military Privatized Housing Oversight’’. The Sub-
committee received testimony from:
Major General Al Aycock, Military Partnership Executive,
Corvias Military Living
Mr. Cody Calderon, Private First Class, Military Privatized
Housing Resident
Rachel Christian, Founder and Chief Legislative Officer, Armed
Forces Housing Advocates
Patricia Coury, Deputy Assistant Secretary of Defense for Hous-
ing, Department of Defense
Ms. Elizabeth A. Field, Director, Defense Capabilities Manage-
ment, Government Accountability Office (GAO)
Philip Rizzo, CEO/COO, Liberty Military Housing
Brian Stann, President/CEO, Hunt Military Communities
Rick Taylor, President, Facility Operations, Renovation, and Con-
struction, Balfour Beatty Communities
Carolyn Tregarthen, Managing Director, Lendlease Communities
Nikki Wylie, Military Privatized Housing Resident
The Subcommittee on Military Construction, Department of Vet-
erans Affairs, and Related Agencies held a hearing on April 6,
2022, entitled ‘‘FY 2023 Department of Veterans Affairs Budget
Hearing’’. The Subcommittee received testimony from:
The Honorable Denis R. McDonough, Secretary, Department of
Veterans Affairs
The Subcommittee on Military Construction, Department of Vet-
erans Affairs, and Related Agencies held a hearing on April 27,
2022, entitled ‘‘Meeting Veterans’ Full Needs: Update on Women’s
Health, Mental Health, Homelessness and Other Programs’’. The
Subcommittee received testimony from:
Dr. Erica Scavella, Assistant Under Secretary for Health for
Clinical Services, Department of Veterans Affairs, accompanied by:
Dr. David Carroll, Executive Director, Office of Mental Health
and Suicide Prevention, Department of Veterans Affairs
Dr. Patricia Hayes, Chief Officer, Office of Women’s Health, De-
partment of Veterans Affairs
Dr. Benjamin Kligler, Executive Director, Office of Patient Cen-
tered Care and Cultural Transformation, Department of Veterans
Affairs
The Subcommittee on Military Construction, Department of Vet-
erans Affairs, and Related Agencies held a hearing on April 28,
2022, entitled ‘‘Air Force Installations and Quality of Life Update’’.
The Subcommittee received testimony from:
Chief Master Sergeant JoAnne Bass, Chief Master Sergeant of
the Air Force
rfrederick on DSKB3L4F33PROD with HEARING
Mr. Bruce Hollywood, Space Force Associate Chief Operations
Officer
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00125 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
126
Brigadier General William Kale, Air Force Director of Civil Engi-
neers
Mr. Edwin H. Oshiba, Acting Assistant Secretary of the Air
Force for Installations, Environment and Energy
Chief Master Sergeant Roger Towberman, Chief Master Sergeant
of the Space Force
The Subcommittee on Military Construction, Department of Vet-
erans Affairs, and Related Agencies held a hearing on May 11,
2022, entitled ‘‘Impacts of VA’s Research Efforts on Veterans’’. The
Subcommittee received testimony from:
Dr. Rachel Ramoni, Chief Research and Development Officer
(CRADO), accompanied by:
Dr. Patricia Hastings, Chief Consultant, Health Outcomes Mili-
tary Exposures
The Subcommittee on Military Construction, Department of Vet-
erans Affairs, and Related Agencies held a hearing on May 12,
2022, entitled ‘‘Army Quality of Life and Installations Update’’. The
Subcommittee received testimony from:
Lieutenant General Jason T. Evans, Deputy Chief of Staff of the
Army, G9
Sergeant Major Michael A. Grinston, Sergeant Major of the Army
Ms. Rachel Jacobson, Assistant Secretary of the Army for Instal-
lations, Energy and Environment
The Subcommittee on Military Construction, Department of Vet-
erans Affairs, and Related Agencies held a hearing on May 18,
2022, entitled ‘‘Navy and Marine Corps Quality of Life and Instal-
lations Update’’. The Subcommittee received testimony from:
Lt. General Edward Banta, Deputy Commandant of Installations
and Logistics for the Marine Corps
Ms. Meredith Berger, Assistant Secretary of the Navy for Envi-
ronment, Installations and Energy
Sergeant Major Troy Black, Sergeant Major of the Marine Corps
Master Chief Petty Officer Russell Smith, Master Chief Petty Of-
ficer of the Navy
Vice Admiral Ricky Williamson, Deputy Chief of Naval Oper-
ations for Fleet Readiness and Logistics
The Subcommittee on Military Construction, Department of Vet-
erans Affairs, and Related Agencies held a hearing on May 19,
2022, entitled ‘‘FY 2023 Member Day Hearing’’. The Subcommittee
received testimony from:
The Honorable Veronica Escobar, Member of Congress
The Honorable Richard Hudson, Member of Congress
The Honorable Mikie Sherrill, Member of Congress
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 2022 and budget esti-
mates presented for fiscal year 2023.
rfrederick on DSKB3L4F33PROD with HEARING
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00126 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
127
rfrederick on DSKB3L4F33PROD with HEARING
Insert offset folio 017 here 46979.016
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00127 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
128
rfrederick on DSKB3L4F33PROD with HEARING
Insert offset folio 18 here 46979.017
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00128 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
129
rfrederick on DSKB3L4F33PROD with HEARING
Insert offset folio 19 here 46979.018
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00129 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
130
rfrederick on DSKB3L4F33PROD with HEARING
Insert offset folio 20 here 46979.019
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00130 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
131
rfrederick on DSKB3L4F33PROD with HEARING
Insert offset folio 21 here 46979.020
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00131 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
132
rfrederick on DSKB3L4F33PROD with HEARING
Insert offset folio 22 here 46979.021
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00132 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
133
rfrederick on DSKB3L4F33PROD with HEARING
Insert offset folio 23 here 46979.022
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00133 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
134
rfrederick on DSKB3L4F33PROD with HEARING
Insert offset folio 24 here 46979.023
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00134 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
135
rfrederick on DSKB3L4F33PROD with HEARING
Insert offset folio 25 here 46979.024
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00135 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
136
rfrederick on DSKB3L4F33PROD with HEARING
Insert offset folio 26 here 46979.025
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00136 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
137
rfrederick on DSKB3L4F33PROD with HEARING
Insert offset folio 27 here 46979.026
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00137 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
138
rfrederick on DSKB3L4F33PROD with HEARING
Insert offset folio 28 here 46979.027
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00138 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
139
rfrederick on DSKB3L4F33PROD with HEARING
Insert offset folio 29 here 46979.028
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00139 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
140
rfrederick on DSKB3L4F33PROD with HEARING
Insert offset folio 30 here 46979.029
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00140 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
141
rfrederick on DSKB3L4F33PROD with HEARING
Insert offset folio 31 here 46979.030
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00141 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
142
rfrederick on DSKB3L4F33PROD with HEARING
Insert offset folio 32 here 46979.031
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00142 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
143
rfrederick on DSKB3L4F33PROD with HEARING
Insert offset folio 150 here 47868.002
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00143 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
144
rfrederick on DSKB3L4F33PROD with HEARING
Insert offset folio 151 here 47868.003
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00144 Fmt 6659 Sfmt 6602 E:\HR\OC\HR391.XXX HR391
145
MINORITY VIEWS
The Military Construction, Veterans Affairs, and Related Agen-
cies Appropriations Bill for Fiscal Year 2023 includes funding for
veterans’ programs, military construction projects, military family
housing, as well as the American Battle Monuments Commission,
Armed Forces Retirement Home, Arlington National Cemetery, and
the Court of Appeals for Veterans Claims.
We strongly support the funding provided for child development
centers and barracks projects. We also appreciate the funding for
many important military construction, installation resilience, and
environmental remediation projects.
We support the funding provided for veterans’ programs, espe-
cially for mental health, suicide prevention, homelessness, gender-
specific care for women veterans, and research. We also support
funding for the Electronic Health Record Modernization Initiative
and the strong oversight mechanisms included in bill and report
language.
We are concerned the bill does not include previously enacted
provisions prohibiting the closure of Naval Station, Guantanamo
Bay and the use of funds to build or renovate a facility on U.S. soil
to house detainees currently held there. In various forms, these
provisions have been included in the bill since December 2009. We
believe these provisions provide protections to the American people
and support our national security interests in the Caribbean and
Latin America.
We are also concerned this bill is based on a funding framework
that the Majority party developed without Republican support, and
that it does not appropriately allocate funds between defense and
non-defense programs.
If enacted into law, the Committee will need to address the Ser-
geant First Class Heath Robinson Honoring our Promise to Ad-
dress Comprehensive Toxics Act of 2022 (i.e. PACT Act). It would
authorize funds to be appropriated to a new mandatory fund in fis-
cal years 2023 through 2031 to increase funding, over the fiscal
year 2021 level, for veterans’ health care associated with exposure
to environmental hazards and related administrative expenses and
research.
The shift of some veterans’ health care costs from discretionary
spending (counted against the bill’s 302(b) allocation) to mandatory
spending will have significant effects on the annual appropriations
process and topline discretionary funding level. Even though these
funds will move off of our books, this Committee should work with
the House Veterans Affairs Committee to ensure this new author-
ity is used appropriately and the Department of Veterans Affairs
is held accountable.
rfrederick on DSKB3L4F33PROD with HEARING
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00145 Fmt 6659 Sfmt 6604 E:\HR\OC\HR391.XXX HR391
146
Despite our concerns, we appreciate the Majority’s willingness to
address Member priorities in the bill and report. The subcommittee
has a long-standing tradition of bipartisanship, and we will con-
tinue 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 bill for Fiscal Year 2023.
KAY GRANGER.
JOHN R. CARTER.
Æ
rfrederick on DSKB3L4F33PROD with HEARING
VerDate Sep 11 2014 07:18 Jun 28, 2022 Jkt 047868 PO 00000 Frm 00146 Fmt 6659 Sfmt 6611 E:\HR\OC\HR391.XXX HR391
File and source
- File
- CRPT_crpt-117hrpt391_crpt-117hrpt391.pdf
- Size
- 2,151,654 bytes
- SHA-256
- 3dfaa6c21393aa4ad139daaf7b79c8044394c8b4a1806a2f9eaf9a53987c7aa4
- Original
- www.govinfo.gov