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115th Congress } { Rept. 115-1036
HOUSE OF REPRESENTATIVES
2d Session } { Part 1
======================================================================
TO ESTABLISH A COMMISSION FOR THE PURPOSE OF MAKING RECOMMENDATIONS
REGARDING THE MODERNIZATION OR REALIGNMENT OF FACILITIES OF THE
VETERANS HEALTH ADMINISTRATION, TO IMPROVE CONSTRUCTION AND MANAGEMENT
LEASES OF THE DEPARTMENT OF VETERANS AFFAIRS, TO AMEND AND APPROPRIATE
FUNDS FOR THE VETERANS CHOICE PROGRAM, AND FOR OTHER PURPOSES
_______
November 16, 2018.--Ordered to be printed
_______
Mr. Roe of Tennessee, from the Committee on Veterans' Affairs,
submitted the following
R E P O R T
together with
DISSENTING VIEWS
[To accompany H.R. 4243]
[Including cost estimate of the Congressional Budget Office]
The Committee on Veterans' Affairs, to whom was referred
the bill (H.R. 4243) to establish a commission for the purpose
of making recommendations regarding the modernization or
realignment of facilities of the Veterans Health
Administration, to improve construction and management leases
of the Department of Veterans Affairs, to amend and appropriate
funds for the Veterans Choice Program, and for other purposes,
having considered the same, report favorably thereon with an
amendment and recommend that the bill as amended do pass.
CONTENTS
Purpose and Summary.............................................. 17
Background and Need for Legislation.............................. 18
Hearings......................................................... 26
Subcommittee Consideration....................................... 27
Committee Consideration.......................................... 27
Committee Votes.................................................. 28
Committee Correspondence......................................... 30
Committee Oversight Findings..................................... 32
Statement of General Performance Goals and Objectives............ 32
New Budget Authority, Entitlement Authority, and Tax Expenditures 32
Earmarks and Tax and Tariff Benefits............................. 32
Committee Cost Estimate.......................................... 32
Congressional Budget Office Estimate............................. 32
Federal Mandates Statement....................................... 40
Advisory Committee Statement..................................... 40
Constitutional Authority Statement............................... 40
Applicability to Legislative Branch.............................. 40
Statement on Duplication of Federal Programs..................... 40
Disclosure of Directed Rulemaking................................ 40
Section-by-Section Analysis of the Legislation................... 40
Changes in Existing Law Made by the Bill as Reported............. 49
Amendment
The amendment is as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. TABLE OF CONTENTS.
The table of contents for this Act is as follows:
Sec. 1. Table of contents.
TITLE I--ASSET AND INFRASTRUCTURE REVIEW
Sec. 101. Short title.
Sec. 102. The Commission.
Sec. 103. Procedure for making recommendations.
Sec. 104. Actions regarding infrastructure and facilities of the
Veterans Health Administration.
Sec. 105. Implementation.
Sec. 106. Department of Veterans Affairs Asset and Infrastructure
Review Account.
Sec. 107. Congressional consideration of Commission report.
Sec. 108. Other matters.
Sec. 109. Definitions.
TITLE II--IMPROVEMENTS TO CONSTRUCTION MANAGEMENT AND LEASES
Sec. 201. Modification of thresholds for major medical facility
projects and major medical facility leases.
Sec. 202. Submission of prospectuses of proposed minor medical facility
projects.
Sec. 203. Improvement to training of construction personnel.
Sec. 204. Authority to plan, design, construct, or lease shared medical
facilities.
Sec. 205. Enhanced use lease authority.
TITLE III--OTHER MATTERS
Sec. 301. Exception on limitation on awards and bonuses for
recruitment, relocation, and retention.
Sec. 302. Appropriation of amounts.
Sec. 303. Assessment of health care furnished by the Department to
veterans who live in the territories.
TITLE I--ASSET AND INFRASTRUCTURE REVIEW
SEC. 101. SHORT TITLE.
This title may be cited as the ``VA Asset and Infrastructure Review
Act of 2017''.
SEC. 102. THE COMMISSION.
(a) Establishment.--There is established an independent commission to
be known as the ``Asset and Infrastructure Review Commission'' (in this
title referred to as the ``Commission'').
(b) Duties.--The Commission shall carry out the duties specified for
it in this title.
(c) Appointment.--
(1) In general.--
(A) Appointment.--The Commission shall be composed of
9 members appointed by the President, by and with the
advice and consent of the Senate.
(B) Transmission of nominations.--The President shall
transmit to the Senate the nominations for appointment
to the Commission not later than May 31, 2021.
(2) Consultation in selection process.--In selecting
individuals for nominations for appointments to the Commission,
the President shall consult with--
(A) the Speaker of the House of Representatives;
(B) the majority leader of the Senate;
(C) the minority leader of the House of
Representatives;
(D) the minority leader of the Senate; and
(E) congressionally chartered, membership based
veterans service organizations concerning the
appointment of three members.
(3) Designation of chair.--At the time the President
nominates individuals for appointment to the Commission under
paragraph (1)(B), the President shall designate one such
individual who shall serve as Chair of the Commission and one
such individual who shall serve as Vice Chair of the
Commission.
(4) Member representation.--In nominating individuals under
this subsection, the President shall ensure that--
(A) veterans, reflecting current demographics of
veterans enrolled in the system of annual patient
enrollment under section 1705 of title 38, United
States Code, are adequately represented in the
membership of the Commission;
(B) at least one member of the Commission has
experience working for a private integrated health care
system that has annual gross revenues of more than
$50,000,000;
(C) at least one member has experience as a senior
manager for an entity specified in clause (ii), (iii),
or (iv) of section 101(a)(1)(B) of the Veterans Access,
Choice, and Accountability Act of 2014 (Public Law 113-
146; 38 U.S.C. 1701 note);
(D) at least one member--
(i) has experience with capital asset
management for the Federal Government; and
(ii) is familiar with trades related to
building and real property, including
construction, engineering, architecture,
leasing, and strategic partnerships; and
(E) at least three members represent congressionally
chartered, membership-based, veterans service
organizations.
(d) Meetings.--
(1) In general.--The Commission shall meet only during
calendar years 2022 and 2023.
(2) Public nature of meetings and proceedings.--
(A) Public meetings.--Each meeting of the Commission
shall be open to the public.
(B) Open participation.--All the proceedings,
information, and deliberations of the Commission shall
be available for review by the public.
(e) Vacancies.--A vacancy in the Commission shall be filled in the
same manner as the original appointment, but the individual appointed
to fill the vacancy shall serve only for the unexpired portion of the
term for which the individual's predecessor was appointed.
(f) Pay.--
(1) In general.--Members of the Commission shall serve
without pay.
(2) Officers or employees of the united states.--Each member
of the Commission who is an officer or employee of the United
States shall serve without compensation in addition to that
received for service as an officer or employee of the United
States.
(3) Travel expenses.--Members shall receive travel expenses,
including per diem in lieu of subsistence, in accordance with
sections 5702 and 5703 of title 5, United States Code.
(g) Director of Staff.--
(1) Appointment.--The Commission shall appoint a Director
who--
(A) has not served as an employee of the Department
of Veterans Affairs during the one-year period
preceding the date of such appointment; and
(B) is not otherwise barred or prohibited from
serving as Director under Federal ethics laws and
regulations, by reason of post-employment conflict of
interest.
(2) Rate of pay.--The Director shall be paid at the rate of
basic pay payable for level IV of the Executive Schedule under
section 5315 of title 5, United States Code.
(h) Staff.--
(1) Pay of personnel.--Subject to paragraphs (2) and (3), the
Director, with the approval of the Commission, may appoint and
fix the pay of additional personnel.
(2) Exemption from certain requirements.--The Director may
make such appointments without regard to the provisions of
title 5, United States Code, governing appointments in the
competitive service, and any personnel so appointed may be paid
without regard to the provisions of chapter 51 and subchapter
III of chapter 53 of that title relating to classification and
General Schedule pay rates, except that an individual so
appointed may not receive pay in excess of the annual rate of
basic pay payable for GS-15 of the General Schedule.
(3) Detailees.--
(A) Limitation on number.--Not more than two-thirds
of the personnel employed by or detailed to the
Commission may be on detail from the Department of
Veterans Affairs.
(B) Professional analysts.--Not more than half of the
professional analysts of the Commission staff may be
persons detailed from the Department of Veterans
Affairs to the Commission.
(C) Prohibition on detail of certain personnel.--A
person may not be detailed from the Department of
Veterans Affairs to the Commission if, within 6 months
before the detail is to begin, that person participated
personally and substantially in any matter within the
Department of Veterans Affairs concerning the
preparation of recommendations regarding facilities of
the Veterans Health Administration.
(4) Authority to request detailed personnel.--Subject to
paragraph (3), the head of any Federal department or agency,
upon the request of the Director, may detail any of the
personnel of that department or agency to the Commission to
assist the Commission in carrying out its duties under this
title.
(5) Information from federal agencies.--The Commission may
secure directly from any Federal agency such information the
Commission considers necessary to carry out this title. Upon
request of the Chair, the head of such agency shall furnish
such information to the Commission.
(i) Other Authority.--
(1) Temporary and intermittent services.--The Commission may
procure by contract, to the extent funds are available, the
temporary or intermittent services of experts or consultants
pursuant to section 3109 of title 5, United States Code.
(2) Leasing and acquisition of property.--To the extent funds
are available, the Commission may lease real property and
acquire personal property either of its own accord or in
consultation with the General Services Administration.
(j) Termination.--The Commission shall terminate on December 31,
2023.
(k) Prohibition Against Restricting Communications.--
(1) In general.--Except as provided in paragraph (2), no
person may restrict an employee of the Department of Veterans
Affairs in communicating with the Commission.
(2) Unlawful communications.--Paragraph (1) does not apply to
a communication that is unlawful.
SEC. 103. PROCEDURE FOR MAKING RECOMMENDATIONS.
(a) Selection Criteria.--
(1) Publication.--The Secretary shall, not later than
February 1, 2021, and after consulting with veterans service
organizations, publish in the Federal Register and transmit to
the Committees on Veterans' Affairs of the Senate and the House
of Representatives the criteria proposed to be used by the
Department of Veterans Affairs in assessing and making
recommendations regarding the modernization or realignment of
facilities of the Veterans Health Administration under this
title. Such criteria shall include the preferences of veterans
regarding health care furnished by the Department.
(2) Public comment.--The Secretary shall provide an
opportunity for public comment on the proposed criteria under
paragraph (1) for a period of at least 90 days and shall
include notice of that opportunity in the publication required
under such paragraph.
(3) Publication of final criteria.--The Secretary shall, not
later than May 31, 2021, publish in the Federal Register and
transmit to the Committees on Veterans' Affairs of the Senate
and the House of Representatives the final criteria to be used
in making recommendations regarding the closure, modernization,
or realignment of facilities of the Veterans Health
Administration under this title.
(b) Recommendations of the Secretary.--
(1) Publication in federal register.--The Secretary shall,
not later than January 31, 2022, and after consulting with
veterans service organizations, publish in the Federal Register
and transmit to the Committees on Veterans' Affairs of the
Senate and the House of Representatives and to the Commission a
report detailing the recommendations regarding the
modernization or realignment of facilities of the Veterans
Health Administration on the basis of the final criteria
referred to in subsection (a)(2) that are applicable.
(2) Factors for consideration.--In making recommendations
under this subsection, the Secretary shall consider each of the
following factors:
(A) The degree to which any health care delivery or
other site for providing services to veterans reflect
the metrics of the Department of Veterans Affairs
regarding market area health system planning.
(B) The provision of effective and efficient access
to high-quality health care and services for veterans.
(C) The extent to which the real property that no
longer meets the needs of the Federal Government could
be reconfigured, repurposed, consolidated, realigned,
exchanged, outleased, repurposed, replaced, sold, or
disposed.
(D) The need of the Veterans Health Administration to
acquire infrastructure or facilities that will be used
for the provision of health care and services to
veterans.
(E) The extent to which the operating and maintenance
costs are reduced through consolidating, colocating,
and reconfiguring space, and through realizing other
operational efficiencies.
(F) The extent and timing of potential costs and
savings, including the number of years such costs or
savings will be incurred, beginning with the date of
completion of the proposed recommendation.
(G) The extent to which the real property aligns with
the mission of the Department of Veterans Affairs.
(H) The extent to which any action would impact other
missions of the Department (including education,
research, or emergency preparedness).
(I) Local stakeholder inputs and any factors
identified through public field hearings.
(J) The assessments under paragraph (3).
(K) Any other such factors the Secretary determines
appropriate.
(3) Capacity and commercial market assessments.--
(A) Assessments.--The Secretary shall assess the
capacity of each Veterans Integrated Service Network
and medical facility of the Department to furnish
hospital care or medical services to veterans under
chapter 17 of title 38, United States Code. Each such
assessment shall--
(i) identify gaps in furnishing such care or
services at such Veterans Integrated Service
Network or medical facility;
(ii) identify how such gaps can be filled
by--
(I) entering into contracts or
agreements with network providers under
this section or with entities under
other provisions of law;
(II) making changes in the way such
care and services are furnished at such
Veterans Integrated Service Network or
medical facility, including--
(aa) extending hours of
operation;
(bb) adding personnel; or
(cc) expanding space through
the construction, leasing, or
sharing of health care
facilities;
(III) the building or realignment of
Department resources or personnel;
(iii) forecast, based on future projections
and historical trends, both the short- and
long-term demand in furnishing care or services
at such Veterans Integrated Service Network or
medical facility and assess how such demand
affects the needs to use such network
providers;
(iv) include a commercial health care market
assessment of designated catchment areas in the
United States conducted by a non-governmental
entity; and
(v) consider the unique ability of the
Federal Government to retain a presence in an
area otherwise devoid of commercial health care
providers or from which such providers are at
risk of leaving.
(B) Consultation.--In carrying out the assessments
under subparagraph (A), the Secretary shall consult
with veterans service organizations and veterans served
by each such Veterans Integrated Service Network and
medical facility.
(C) Submittal.--The Secretary shall submit such
assessments to the Committees on Veterans' Affairs of
the House of Representatives and the Senate with the
recommendations of the Secretary under this subsection
and make the assessments publicly available.
(4) Summary of selection process.--The Secretary shall
include, with the list of recommendations published and
transmitted pursuant to paragraph (1), a summary of the
selection process that resulted in the recommendation for each
facility of the Veterans Health Administration, including a
justification for each recommendation. The Secretary shall
transmit the matters referred to in the preceding sentence not
later than 7 days after the date of the transmittal to the
Committees on Veterans' Affairs of the Senate and the House of
Representatives and the Commission of the report referred to in
paragraph (1).
(5) Treatment of facilities.--In assessing facilities of the
Veterans Health Administration, the Secretary shall consider
all such facilities equally without regard to whether the
facility has been previously considered or proposed for reuse,
closure, modernization, or realignment by the Department of
Veterans Affairs.
(6) Availability of information to congress.--In addition to
making all information used by the Secretary to prepare the
recommendations under this subsection available to Congress
(including any committee or Member of Congress), the Secretary
shall also make such information available to the Commission
and the Comptroller General of the United States.
(7) Certification of accuracy.--
(A) In general.--Each person referred to in
subparagraph (B), when submitting information to the
Secretary or the Commission concerning the
modernization or realignment of a facility of the
Veterans Health Administration, shall certify that such
information is accurate and complete to the best of
that person's knowledge and belief.
(B) Covered persons.--Subparagraph (A) applies to the
following persons:
(i) Each Under Secretary of the Department of
Veterans Affairs.
(ii) Each director of a Veterans Integrated
Service Network.
(iii) Each director of a medical center of
the Department of Veterans Affairs.
(iv) Each director of a program office of the
Department of Veterans Affairs.
(v) Each person who is in a position the
duties of which include personal and
substantial involvement in the preparation and
submission of information and recommendations
concerning the modernization or realignment of
facilities of the Veterans Health
Administration.
(c) Review and Recommendations by the Commission.--
(1) Public hearings.--
(A) In general.--After receiving the recommendations
from the Secretary pursuant to subsection (b), the
Commission shall conduct public hearings on the
recommendations.
(B) Locations.--The Commission shall conduct public
hearings in regions affected by a recommendation of the
Secretary to close a facility of the Veterans Health
Administration. To the greatest extent practicable, the
Commission shall conduct public hearings in regions
affected by a recommendation of the Secretary to
modernize or realign such a facility.
(C) Required witnesses.--Witnesses at each public
hearing shall include at a minimum--
(i) a veteran--
(I) enrolled under section 1705 of
title 38, United States Code; and
(II) identified by a local veterans
service organization; and
(ii) a local elected official.
(2) Transmittal to president.--
(A) In general.--The Commission shall, not later than
January 31, 2023, transmit to the President a report
containing the Commission's findings and conclusions
based on a review and analysis of the recommendations
made by the Secretary, together with the Commission's
recommendations, for modernizations and realignments of
facilities of the Veterans Health Administration.
(B) Authority to make changes to recommendations.--
Subject to subparagraph (C), in making its
recommendations, the Commission may change any
recommendation made by the Secretary if the
Commission--
(i) determines that the Secretary deviated
substantially from the final criteria referred
to in subsection (a)(2) in making such
recommendation;
(ii) determines that the change is consistent
with the final criteria referred to in
subsection (a)(2);
(iii) publishes a notice of the proposed
change in the Federal Register not less than 45
days before transmitting its recommendations to
the President pursuant to subparagraph (A); and
(iv) conducts public hearings on the proposed
change.
(3) Justification for changes.--The Commission shall explain
and justify in its report submitted to the President pursuant
to paragraph (2) any recommendation made by the Commission that
is different from the recommendations made by the Secretary
pursuant to subsection (b). The Commission shall transmit a
copy of such report to the Committees on Veterans' Affairs of
the Senate and the House of Representatives on the same date on
which it transmits its recommendations to the President under
paragraph (2).
(4) Provision of information to congress.--After January 31,
2023, the Commission shall promptly provide, upon request, to
any Member of Congress information used by the Commission in
making its recommendations.
(d) Review by the President.--
(1) Report.--The President shall, not later than February 15,
2023, transmit to the Commission and to the Congress a report
containing the President's approval or disapproval of the
Commission's recommendations.
(2) Presidential approval.--If the President approves all the
recommendations of the Commission, the President shall transmit
a copy of such recommendations to the Congress, together with a
certification of such approval.
(3) Presidential disapproval.--If the President disapproves
the recommendations of the Commission, in whole or in part, the
President shall transmit to the Commission and the Congress,
not later than March 1, 2023, the reasons for that disapproval.
The Commission shall then transmit to the President, not later
than March 15, 2023, a revised list of recommendations for
closures, modernizations, and realignments of facilities of the
Veterans Health Administration.
(4) Transmittal of recommendations to congress.--If the
President approves all of the revised recommendations of the
Commission transmitted to the President under paragraph (3),
the President shall transmit a copy of such revised
recommendations to the Congress, together with a certification
of such approval.
(5) Failure to transmit.--If the President does not transmit
to the Congress an approval and certification described in
paragraph (2) or (4) by March 30, 2023, the process by which
facilities of the Veterans Health Administration may be
selected for modernization or realignment under this title
shall be terminated.
SEC. 104. ACTIONS REGARDING INFRASTRUCTURE AND FACILITIES OF THE
VETERANS HEALTH ADMINISTRATION.
(a) In General.--Subject to subsection (b), the Secretary shall begin
to implement the recommended modernizations and realignments in the
report under section 103(d) not later than three years after the date
on which the President transmits such report to Congress. Such
implementation includes the planning of modernizations and realignments
of facilities of the Veterans Health Administration as recommended in
such report.
(b) Congressional Disapproval.--
(1) In general.--The Secretary may not carry out any
modernization or realignment recommended by the Commission in a
report transmitted from the President pursuant to section
103(d) if a joint resolution is enacted, in accordance with the
provisions of section 107, disapproving such recommendations of
the Commission before the earlier of--
(A) the end of the 45-day period beginning on the
date on which the President transmits such report; or
(B) the adjournment of Congress sine die for the
session during which such report is transmitted.
(2) Computation of period.--For purposes of paragraph (1) and
subsections (a) and (c) of section 107, the days on which
either House of Congress is not in session because of an
adjournment of more than three days to a day certain shall be
excluded in the computation of a period.
(c) Specific Authorization.--Any obligation or expenditure of funds
for any major medical facility project or any major medical facility
lease under subsection (a) shall be treated as if specifically
authorized by law for purposes of section 8104 of title 38, United
States Code, as amended by sections 201 and 202 of this Act.
SEC. 105. IMPLEMENTATION.
(a) In General.--
(1) Modernizing and realigning facilities.--In modernizing or
realigning any facility of the Veterans Health Administration
under this title, the Secretary may--
(A) take such actions as may be necessary to
modernize or realign any such facility, including the
alteration of such facilities, the acquisition of such
land, the leasing or construction of such replacement
facilities, the disposition of such land or facilities,
the performance of such activities, and the conduct of
such advance planning and design as may be required to
transfer functions from a facility of the Veterans
Health Administration to another such facility, and may
use for such purpose funds in the Account or funds
appropriated to the Department of Veterans Affairs for
such purposes;
(B) carry out activities for the purposes of
environmental mitigation, abatement, or restoration at
any such facility, and shall use for such purposes
funds in the Account;
(C) provide outplacement assistance to employees
employed by the Department of Veterans Affairs at
facilities of the Veterans Health Administration being
closed or realigned, and may use for such purpose funds
in the Account or funds appropriated to the Department
of Veterans Affairs for outplacement assistance to
employees;
(D) reimburse other Federal agencies for actions
performed at the request of the Secretary with respect
to any such closure or realignment, and may use for
such purpose funds in the Account or funds appropriated
to the Department of Veterans Affairs and available for
such purpose; and
(E) exercise the authority of the Secretary under
subchapter V of chapter 81 of title 38, United States
Code.
(2) Environmental restoration; historic preservation.--In
carrying out any closure or realignment under this title, the
Secretary, with regards to any property made excess to the
needs of the Department of Veterans Affairs as a result of such
closure or realignment, shall carry out, as soon as possible
with funds available for such purpose, any of the following for
which the Secretary is responsible:
(A) Environmental mitigation.
(B) Environmental abatement.
(C) Environmental restoration.
(D) Compliance with historic preservation
requirements.
(b) Management and Disposal of Property.--
(1) Existing disposal authorities.--To transfer or dispose of
surplus real property or infrastructure located at any facility
of the Veterans Health Administration that is modernized or
realigned under this Act, the Secretary may exercise the
authorities of the Secretary under subchapters I and II of
chapter 81 of title 38, United States Code, or the authorities
delegated to the Secretary by the Administrator of General
Services under subchapter III of chapter 5 of title 40, United
States Code.
(2) Effects on local communities.--
(A) Consultation with state and local government.--
Before any action may be taken with respect to the
disposal of any surplus real property or infrastructure
located at any facility of the Veterans Health
Administration to be closed or realigned under this
title, the Secretary of Veterans Affairs shall consult
with the Governor of the State and the heads of the
local governments concerned for the purpose of
considering any plan for the use of such property by
the local community concerned.
(B) Treatment of roads.--If infrastructure or a
facility of the Veterans Health Administration to be
closed or realigned under this title includes a road
used for public access through, into, or around the
facility, the Secretary--
(i) shall consult with the Government of the
State and the heads of the local governments
concerned for the purpose of considering the
continued availability of the road for public
use after the recommended action is complete;
and
(ii) may exercise the authority of the
Secretary under section 8108 of title 38,
United States Code.
(3) Leases; cercla.--
(A) Lease authority.--
(i) Transfer to redevelopment authority for
lease.--The Secretary may transfer title to a
facility of the Veterans Health Administration
approved for closure or realignment under this
title (including property at a facility of the
Veterans Health Administration approved for
realignment which will be retained by the
Department of Veterans Affairs or another
Federal agency after realignment) to the
redevelopment authority for the facility if the
redevelopment authority agrees to lease,
directly upon transfer, one or more portions of
the property transferred under this
subparagraph to the Secretary or to the head of
another department or agency of the Federal
Government.
(ii) Term of lease.--A lease under clause (i)
shall be for a term of not to exceed 50 years,
but may provide for options for renewal or
extension of the term by the department or
agency concerned.
(iii) Limitation.--A lease under clause (i)
may not require rental payments by the United
States.
(iv) Treatment of remaindered lease terms.--A
lease under clause (i) shall include a
provision specifying that if the department or
agency concerned ceases requiring the use of
the leased property before the expiration of
the term of the lease, the remainder of the
lease term may be satisfied by the same or
another department or agency of the Federal
Government using the property for a use similar
to the use under the lease. Exercise of the
authority provided by this clause shall be made
in consultation with the redevelopment
authority concerned.
(v) Facility services.--Notwithstanding
clause (iii), if a lease under clause (i)
involves a substantial portion of the facility,
the department or agency concerned may obtain
facility services for the leased property and
common area maintenance from the redevelopment
authority or the redevelopment authority's
assignee as a provision of the lease. The
facility services and common area maintenance
shall be provided at a rate no higher than the
rate charged to non-Federal tenants of the
transferred property. Facility services and
common area maintenance covered by the lease
shall not include--
(I) municipal services that a State
or local government is required by law
to provide to all landowners in its
jurisdiction without direct charge; or
(II) firefighting or security-guard
functions.
(B) Application of cercla.--The provisions of section
120(h) of the Comprehensive Environmental Response,
Compensation, and Liability Act of 1980 (42 U.S.C.
9620(h)) shall apply to any transfer of real property
under this paragraph.
(C) Additional terms and conditions.--The Secretary
may require any additional terms and conditions in
connection with a transfer under this paragraph as such
Secretary considers appropriate to protect the
interests of the United States.
(4) Application of mckinney-vento homeless assistance act.--
Nothing in this title shall limit or otherwise affect the
application of the provisions of the McKinney-Vento Homeless
Assistance Act (42 U.S.C. 11301 et seq.) to facilities of the
Veterans Health Administration closed under this title.
(c) Applicability of National Environmental Policy Act of 1969.--
(1) In general.--The provisions of the National Environmental
Policy Act of 1969 (42 U.S.C. 4321 et seq.) shall not apply to
the actions of the President, the Commission, and, except as
provided in paragraph (2), the Department of Veterans Affairs
in carrying out this title.
(2) Department of veterans affairs.--
(A) Covered activities.--The provisions of the
National Environmental Policy Act of 1969 shall apply
to actions of the Department of Veterans Affairs under
this title--
(i) during the process of property disposal;
and
(ii) during the process of relocating
functions from a facility of the Veterans
Health Administration being closed or realigned
to another facility after the receiving
facility has been selected but before the
functions are relocated.
(B) Other activities.--In applying the provisions of
the National Environmental Policy Act of 1969 to the
processes referred to in subparagraph (A), the
Secretary shall not have to consider--
(i) the need for closing or realigning the
facility of the Veterans Health Administration
as recommended by the Commission;
(ii) the need for transferring functions to
any facility of the Veterans Health
Administration which has been selected as the
receiving facility; or
(iii) facilities of the Veterans Health
Administration alternative to those recommended
or selected.
(d) Waiver.--
(1) Restrictions on use of funds.--The Secretary may close or
realign facilities of the Veterans Health Administration under
this title without regard to any provision of law restricting
the use of funds for closing or realigning facilities of the
Veterans Health Administration included in any appropriation or
authorization Act.
(2) Restrictions on authorities.--The Secretary may close or
realign facilities of the Veterans Health Administration under
this title without regard to the restrictions of section 8110
of title 38, United States Code.
(e) Transfer Authority in Connection With Payment of Environmental
Remediation Costs.--
(1) In general.--
(A) Transfer by deed.--Subject to paragraph (2) of
this subsection and section 120(h) of the Comprehensive
Environmental Response, Compensation, and Liability Act
of 1980 (42 U.S.C. 9620(h)), the Secretary may enter
into an agreement to transfer by deed a facility of the
Veterans Health Administration with any person who
agrees to perform all environmental restoration, waste
management, and environmental compliance activities
that are required for the property or facilities under
Federal and State laws, administrative decisions,
agreements (including schedules and milestones), and
concurrences.
(B) Additional terms or conditions.--The Secretary
may require any additional terms and conditions in
connection with an agreement authorized by subparagraph
(A) as the Secretary considers appropriate to protect
the interests of the United States.
(2) Limitation.--A transfer of a facility of the Veterans
Health Administration may be made under paragraph (1) only if
the Secretary certifies to Congress that--
(A) the costs of all environmental restoration, waste
management, and environmental compliance activities
otherwise to be paid by the Secretary with respect to
the facility of the Veterans Health Administration are
equal to or greater than the fair market value of the
property or facilities to be transferred, as determined
by the Secretary; or
(B) if such costs are lower than the fair market
value of the facility of the Veterans Health
Administration, the recipient of such transfer agrees
to pay the difference between the fair market value and
such costs.
(3) Payment by the secretary for certain transfers.--In the
case of a facility of the Veterans Health Administration
covered by a certification under paragraph (2)(A), the
Secretary may pay the recipient of such facility an amount
equal to the lesser of--
(A) the amount by which the costs incurred by the
recipient of the facility of the Veterans Health
Administration for all environmental restoration,
waste, management, and environmental compliance
activities with respect to such facility exceed the
fair market value of such property as specified in such
certification; or
(B) the amount by which the costs (as determined by
the Secretary) that would otherwise have been incurred
by the Secretary for such restoration, management, and
activities with respect to such facility of the
Veterans Health Administration exceed the fair market
value of property as so specified.
(4) Disclosure.--As part of an agreement under paragraph (1),
the Secretary shall disclose to the person to whom the facility
of the Veterans Health Administration will be transferred any
information of the Secretary regarding the environmental
restoration, waste management, and environmental compliance
activities described in paragraph (1) that relate to the
facility of the Veterans Health Administration. The Secretary
shall provide such information before entering into the
agreement.
(5) Applicability of certain environmental laws.--Nothing in
this subsection shall be construed to modify, alter, or amend
the Comprehensive Environmental Response, Compensation, and
Liability Act of 1980 (42 U.S.C. 9601 et seq.) or the Solid
Waste Disposal Act (42 U.S.C. 6901 et seq.).
SEC. 106. DEPARTMENT OF VETERANS AFFAIRS ASSET AND INFRASTRUCTURE
REVIEW ACCOUNT.
(a) Establishment.--There is hereby established in the ledgers of the
Treasury an account to be known as the ``Department of Veterans Affairs
Asset and Infrastructure Review Account'' which shall be administered
by the Secretary as a single account.
(b) Credits to Account.--There shall be credited to the Account the
following:
(1) Funds authorized for and appropriated to the Account.
(2) Proceeds received from the lease, transfer, or disposal
of any property at a facility of the Veterans Health
Administration closed or realigned under this title.
(c) Use of Account.--The Secretary may use the funds in the Account
only for the following purposes:
(1) To carry out this title.
(2) To cover property management and disposal costs incurred
at facilities of the Veterans Health Administration closed,
modernized, or realigned under this title.
(3) To cover costs associated with supervision, inspection,
overhead, engineering, and design of construction projects
undertaken under this title, and subsequent claims, if any,
related to such activities.
(4) Other purposes that the Secretary determines support the
mission and operations of the Department of Veterans Affairs.
(d) Consolidated Budget Justification Display for Account.--
(1) Consolidated budget information required.--The Secretary
shall establish a consolidated budget justification display in
support of the Account that for each fiscal year--
(A) details the amount and nature of credits to, and
expenditures from, the Account during the preceding
fiscal year;
(B) separately details the environmental remediation
costs associated with facility of the Veterans Health
Administration for which a budget request is made;
(C) specifies the transfers into the Account and the
purposes for which these transferred funds will be
further obligated, to include caretaker and environment
remediation costs associated with each facility of the
Veterans Health Administration; and
(D) details any intra-budget activity transfers
within the Account that exceeded $1,000,000 during the
preceding fiscal year or that are proposed for the next
fiscal year and will exceed $1,000,000.
(2) Submission.--The Secretary shall include the information
required by paragraph (1) in the materials that the Secretary
submits to Congress in support of the budget for a fiscal year
submitted by the President pursuant to section 1105 of title
31, United States Code.
(e) Closure of Account; Treatment of Remaining Funds.--
(1) Closure.--The Account shall be closed at the time and in
the manner provided for appropriation accounts under section
1555 of title 31, United States Code, except that unobligated
funds which remain in the Account upon closure shall be held by
the Secretary of the Treasury until transferred to the
Secretary of Veterans Affairs by law after the Committees on
Veterans' Affairs of the Senate and the House of
Representatives receive the final report transmitted under
paragraph (2).
(2) Final report.--No later than 60 days after the closure of
the Account under paragraph (1), the Secretary shall transmit
to the Committees on Veterans' Affairs of the Senate and the
House of Representatives and the Committees on Appropriations
of the House of Representatives and the Senate a report
containing an accounting of--
(A) all the funds credited to and expended from the
Account or otherwise expended under this title; and
(B) any funds remaining in the Account.
SEC. 107. CONGRESSIONAL CONSIDERATION OF COMMISSION REPORT.
(a) Disapproval Resolution.--For purposes of section 104(b), the term
``joint resolution'' means only a joint resolution which is introduced
within the 5-day period beginning on the date on which the President
transmits the report to the Congress under section 103(d), and--
(1) which does not have a preamble;
(2) the matter after the resolving clause of which is as
follows: ``that Congress disapproves the recommendations of the
VHA Asset and Infrastructure Review Commission as submitted by
the President on ___'', the blank space being filled with the
appropriate date; and
(3) the title of which is as follows: ``Joint resolution
disapproving the recommendations of the VHA Asset and
Infrastructure Review Commission.''.
(b) Consideration in the House of Representatives.--
(1) Reporting and discharge.--Any committee of the House of
Representatives to which a joint resolution is referred shall
report it to the House without amendment not later than 15
legislative days after the date of introduction thereof. If a
committee fails to report the joint resolution within that
period, the committee shall be discharged from further
consideration of the joint resolution.
(2) Proceeding to consideration.--It shall be in order at any
time after the third legislative day after each committee
authorized to consider a joint resolution has reported or has
been discharged from consideration of a joint resolution, to
move to proceed to consider the joint resolution in the House.
All points of order against the motion are waived. Such a
motion shall not be in order after the House has disposed of a
motion to proceed on a joint resolution addressing a particular
submission. The previous question shall be considered as
ordered on the motion to its adoption without intervening
motion. The motion shall not be debatable. A motion to
reconsider the vote by which the motion is disposed of shall
not be in order.
(3) Consideration.--The joint resolution shall be considered
as read. All points of order against the joint resolution and
against its consideration are waived. The previous question
shall be considered as ordered on the joint resolution to its
passage without intervening motion except two hours of debate
equally divided and controlled by the proponent and an
opponent. A motion to reconsider the vote on passage of the
joint resolution shall not be in order.
(c) Consideration in the Senate.--
(1) Referral.--A joint resolution introduced in the Senate
shall be referred to the Committee on Veterans' Affairs.
(2) Reporting and discharge.--Any committee of the Senate to
which a joint resolution is referred shall report it to the
Senate without amendment not later than 15 session days after
the date of introduction of a joint resolution described in
subsection (a). If a committee fails to report the joint
resolution within that period, the committee shall be
discharged from further consideration of the joint resolution
and the joint resolution shall be placed on the calendar.
(3) Floor consideration.--
(A) In general.--Notwithstanding Rule XXII of the
Standing Rules of the Senate, it is in order at any
time after the third session day on which the Committee
on Veterans' Affairs has reported or has been
discharged from consideration of a joint resolution
described in subsection (a) (even though a previous
motion to the same effect has been disagreed to) to
move to proceed to the consideration of the joint
resolution, and all points of order against the joint
resolution (and against consideration of the joint
resolution) are waived. The motion to proceed is not
debatable. The motion is not subject to a motion to
postpone. A motion to reconsider the vote by which the
motion is agreed to or disagreed to shall not be in
order. If a motion to proceed to the consideration of
the resolution is agreed to, the joint resolution shall
remain the unfinished business until disposed of.
(B) Consideration.--Consideration of the joint
resolution, and on all debatable motions and appeals in
connection therewith, shall be limited to not more than
2 hours, which shall be divided equally between the
majority and minority leaders or their designees. A
motion further to limit debate is in order and not
debatable. An amendment to, or a motion to postpone, or
a motion to proceed to the consideration of other
business, or a motion to recommit the joint resolution
is not in order.
(C) Vote on passage.--If the Senate has voted to
proceed to a joint resolution, the vote on passage of
the joint resolution shall occur immediately following
the conclusion of consideration of the joint
resolution, and a single quorum call at the conclusion
of the debate if requested in accordance with the rules
of the Senate.
(D) Rulings of the chair on procedure.--Appeals from
the decisions of the Chair relating to the application
of the rules of the Senate, as the case may be, to the
procedure relating to a joint resolution shall be
decided without debate.
(d) Amendment Not in Order.--A joint resolution of disapproval
considered pursuant to this section shall not be subject to amendment
in either the House of Representatives or the Senate.
(e) Coordination With Action by Other House.--
(1) In general.--If, before passing the joint resolution, one
House receives from the other a joint resolution--
(A) the joint resolution of the other House shall not
be referred to a committee; and
(B) the procedure in the receiving House shall be the
same as if no joint resolution had been received from
the other House until the vote on passage, when the
joint resolution received from the other House shall
supplant the joint resolution of the receiving House.
(2) Treatment of joint resolution of other house.--If the
Senate fails to introduce or consider a joint resolution under
this section, the joint resolution of the House shall be
entitled to expedited floor procedures under this section.
(3) Treatment of companion measures.--If, following passage
of the joint resolution in the Senate, the Senate then receives
the companion measure from the House of Representatives, the
companion measure shall not be debatable.
(f) Rules of the House of Representatives and Senate.--This section
is enacted by Congress--
(1) as an exercise of the rulemaking power of the Senate and
House of Representatives, respectively, and as such it is
deemed a part of the rules of each House, respectively, but
applicable only with respect to the procedure to be followed in
that House in the case of a joint resolution, and it supersedes
other rules only to the extent that it is inconsistent with
such rules; and
(2) with full recognition of the constitutional right of
either House to change the rules (so far as relating to the
procedure of that House) at any time, in the same manner, and
to the same extent as in the case of any other rule of that
House.
SEC. 108. OTHER MATTERS.
(a) Online Publication of Communications.--
(1) In general.--Not later than 24 hours after the
transmission or receipt of any communication under this title
that is transmitted or received by a party specified in
paragraph (2), the Secretary of Veterans Affairs shall publish
such communication online.
(2) Parties specified.--The parties specified under this
paragraph are the following:
(A) The Secretary of Veterans Affairs.
(B) The Commission.
(C) The President.
(b) Continuation of Existing Construction Projects and Planning.--
During activities that the Commission, President, or Congress carry out
under this title, the Secretary of Veterans Affairs may not stop,
solely because of such activities--
(1) a construction or leasing project of the Veterans Health
Administration;
(2) long term planning regarding infrastructure and assets of
the Veterans Health Administration; or
(3) budgetary processes for the Veterans Health
Administration.
(c) Recommendations for Future Asset Reviews.--The Secretary of
Veterans Affairs may, after consulting with veterans service
organizations, include in budget submissions the Secretary submits
after the termination of the Commission recommendations for future such
commissions or other capital asset realignment and management
processes.
SEC. 109. DEFINITIONS.
In this title:
(1) The term ``Account'' means the Department of Veterans
Affairs Asset and Infrastructure Review Account established by
section 106(a).
(2) The term ``Commission'' means the Commission established
by section 102.
(3) The term ``date of approval'', with respect to a
modernization or realignment of a facility of the Veterans
Health Administration, means the date on which the authority of
Congress to disapprove a recommendation of modernization or
realignment, as the case may be, of such facility under this
title expires.
(4) The term ``facility of the Veterans Health
Administration''--
(A) means any land, building, structure, or
infrastructure (including any medical center, nursing
home, domiciliary facility, outpatient clinic, center
that provides readjustment counseling, or leased
facility) that is--
(i) under the jurisdiction of the Department
of Veterans Affairs;
(ii) under the control of the Veterans Health
Administration; and
(iii) not under the control of the General
Services Administration; or
(B) with respect to a colocated facility of the
Department of Veterans Affairs, includes any land,
building, or structure--
(i) under the jurisdiction of the Department
of Veterans Affairs;
(ii) under the control of another
administration of the Department of Veterans
Affairs; and
(iii) not under the control of the General
Services Administration.
(5) The term ``infrastructure'' means improvements to land
other than buildings or structures.
(6) The term ``modernization'' includes--
(A) any action, including closure, required to align
the form and function of a facility of the Veterans
Health Administration to the provision of modern day
health care, including utilities and environmental
control systems;
(B) the construction, purchase, lease, or sharing of
a facility of the Veterans Health Administration; and
(C) realignments, disposals, exchanges,
collaborations between the Department of Veterans
Affairs and other Federal entities, and strategic
collaborations between the Department and non-Federal
entities, including tribal organizations.
(7) The term ``realignment'', with respect to a facility of
the Veterans Health Administration, includes--
(A) any action that changes the numbers of or
relocates services, functions, and personnel positions;
(B) disposals or exchanges between the Department of
Veterans Affairs and other Federal entities, including
the Department of Defense; and
(C) strategic collaborations between the Department
of Veterans Affairs and non-Federal entities, including
tribal organizations.
(8) The term ``redevelopment authority'', in the case of a
facility of the Veterans Health Administration closed or
modernized under this title, means any entity (including an
entity established by a State or local government) recognized
by the Secretary of Veterans Affairs as the entity responsible
for developing the redevelopment plan with respect to the
facility or for directing the implementation of such plan.
(9) The term ``redevelopment plan'' in the case of a facility
of the Veterans Health Administration to be closed or realigned
under this title, means a plan that--
(A) is agreed to by the local redevelopment authority
with respect to the facility; and
(B) provides for the reuse or redevelopment of the
real property and personal property of the facility
that is available for such reuse and redevelopment as a
result of the closure or realignment of the facility.
(10) The term ``Secretary'' means the Secretary of Veterans
Affairs.
(11) The term ``tribal organization'' has the meaning given
such term in section 3765 of title 38, United States Code.
TITLE II--IMPROVEMENTS TO CONSTRUCTION MANAGEMENT AND LEASES
SEC. 201. MODIFICATION OF THRESHOLDS FOR MAJOR MEDICAL FACILITY
PROJECTS AND MAJOR MEDICAL FACILITY LEASES.
(a) Definitions.--Paragraph (3) of section 8104(a) of title 38,
United States Code, is amended to read as follows:
``(3) In this subsection:
``(A)(i) The term `major medical facility project' means--
``(I) a project for the construction, alteration, or
acquisition of a medical facility involving a total
expenditure of more than $20,000,000; or
``(II) the construction, alteration, or acquisition
of a shared medical facility (as defined in section
8111B(d) of this title) for which the estimated share
of the Department of Veterans Affairs for the costs of
such construction, alteration, or acquisition exceeds
$20,000,000.
``(ii) Such term does not include--
``(I) an acquisition by exchange;
``(II) nonrecurring maintenance projects of the
Department; or
``(III) the construction, alteration, or acquisition
of a shared medical facility for which the estimated
share of the Department of Veterans Affairs for the
costs of such construction, alteration, or acquisition
does not exceed $20,000,000.
``(B) The term `major medical facility lease' means--
``(i) a lease for space for use as a new medical
facility at an average annual rent that is equal to or
exceeds the amount specified in subsection (a)(2) of
section 3307 of title 40; or
``(ii) a lease for space for use as a shared medical
facility (as defined in section 8111B(d) of this title)
for which the estimated share of the Department of
Veterans Affairs for the costs of such lease is equal
to or exceeds the amount specified in subsection (a)(2)
of section 3307 of title 40.''.
(b) Application.--The amendment made by subsection (a) shall apply
with respect to major medical facility projects and major medical
facility leases authorized by law on or after the date of the enactment
of this Act.
SEC. 202. SUBMISSION OF PROSPECTUSES OF PROPOSED MINOR MEDICAL FACILITY
PROJECTS.
Section 8104(b) of title 38, United States Code, is amended, in the
matter preceding paragraph (1), by striking ``a major medical facility
project (as defined in subsection (a)(3)(A))'' and inserting the
following: ``a major medical facility project (as defined in subsection
(a)(3)(A)), a medical facility project that would be a major medical
facility project but for the total expenditure (or, with respect to a
shared medical facility, the estimated share of the Department of
Veterans Affairs) being an amount that is more than $10,000,000 and
less than $20,000,000,''.
SEC. 203. IMPROVEMENT TO TRAINING OF CONSTRUCTION PERSONNEL.
Subsection (g) of section 8103 of title 38, United States Code, is
amended to read as follows:
``(g)(1)(A) Not later than September 30 of the fiscal year following
the fiscal year during which this subsection is enacted, the Secretary
shall implement the covered training curriculum and the covered
certification program.
``(B) In designing and implementing the covered training curriculum
and the covered certification program under paragraph (1), the
Secretary shall use as models existing training curricula and
certification programs that have been established under chapter 87 of
title 10, United States Code, as determined relevant by the Secretary.
``(2) The Secretary may develop the training curriculum under
paragraph (1)(A) in a manner that provides such training in any
combination of--
``(A) training provided in person;
``(B) training provided over an internet website; or
``(C) training provided by another department or agency of
the Federal Government.
``(3) The Secretary may develop the certification program under
paragraph (1)(A) in a manner that uses--
``(A) one level of certification; or
``(B) more than one level of certification, as determined
appropriate by the Secretary with respect to the level of
certification for different grades of the General Schedule.
``(4) The Secretary may enter into a contract with an appropriate
entity to provide the covered training curriculum and the covered
certification program under paragraph (1)(A).
``(5)(A) Not later than September 30 of the second fiscal year
following the fiscal year during which this Act is enacted, the
Secretary shall ensure that the majority of employees subject to the
covered certification program achieve the certification or the
appropriate level of certification pursuant to paragraph (3), as the
case may be.
``(B) After carrying out subparagraph (A), the Secretary shall ensure
that each employee subject to the covered certification program
achieves the certification or the appropriate level of certification
pursuant to paragraph (3), as the case may be, as quickly as
practicable.
``(6) In this subsection:
``(A) The term `covered certification program' means, with
respect to employees of the Department of Veterans Affairs who
are members of occupational series relating to construction or
facilities management, or employees of the Department who award
or administer contracts for major construction, minor
construction, or nonrecurring maintenance, including as
contract specialists or contracting officers' representatives,
a program to certify knowledge and skills relating to
construction or facilities management and to ensure that such
employees maintain adequate expertise relating to industry
standards and best practices for the acquisition of design and
construction services.
``(B) The term `covered training curriculum' means, with
respect to employees specified in subparagraph (A), a training
curriculum relating to construction or facilities
management.''.
SEC. 204. AUTHORITY TO PLAN, DESIGN, CONSTRUCT, OR LEASE SHARED MEDICAL
FACILITIES.
(a) Authority.--
(1) In general.--Chapter 81 of title 38, United States Code,
is amended by inserting after section 8111A the following new
section:
``Sec. 8111B. Authority to plan, design, construct or lease a medical
facility shared with other departments or agencies
``(a) Authority.--Subject to sections 8103 and 8104 of this title,
the Secretary of Veterans Affairs may enter into agreements with the
heads of other departments or agencies of the Federal Government for
the planning, designing, constructing, or leasing of medical facilities
to be shared by the Department of Veterans Affairs and that department
or agency to improve the access to, and quality and cost effectiveness
of, the health care provided by the Veterans Health Administration and
that department or agency.
``(b) Transfers of Amounts From Department of Veterans Affairs.--(1)
With respect to a shared medical facility construction project for
which the estimated costs to the Department of Veterans Affairs do not
exceed the amount specified in section 8104(a)(3)(A) of this title, the
Secretary of Veterans Affairs may transfer to the partner agency
amounts appropriated in the Construction, Minor Projects account of the
Department for use for the planning, design, or construction of the
shared medical facility.
``(2) With respect to a shared medical facility construction project
for which the estimated costs to the Department of Veterans Affairs
exceed the amount specified in section 8104(a)(3)(A) of this title, the
Secretary of Veterans Affairs may transfer to the partner agency
amounts appropriated in the Construction, Major Projects account of the
Department for use for the planning, design, or construction of the
shared medical facility.
``(3) With respect to a shared medical facility lease project for
which the estimated costs of the lease to the Department of Veterans
Affairs do not exceed the amount specified in section 8104(a)(3)(B) of
this title, the Secretary of Veterans Affairs may transfer to the
partner agency amounts appropriated in the applicable medical
appropriation account of the Department for such lease.
``(c) Transfers of Amounts to Department of Veterans Affairs.--(1)
With respect to a shared medical facility construction project for
which the estimated costs to the Department of Veterans Affairs do not
exceed the amount specified in section 8104(a)(3)(A) of this title, any
amounts transferred by the partner agency to the Secretary of Veterans
Affairs may be deposited in the Construction, Minor Projects account of
the Department for use for the planning, design, or construction of the
shared medical facility. Amounts so deposited shall be merged with and
available for the same purposes, and for the same period, as such
account.
``(2) With respect to a shared medical facility construction project
for which the estimated costs to the Department of Veterans Affairs
exceed the amount specified in section 8104(a)(3)(A) of this title, any
amounts transferred by the partner agency to the Secretary of Veterans
Affairs may be deposited in the Construction, Major Projects account of
the Department for use for the planning, design, or construction of the
shared medical facility. Amounts so deposited shall be merged with and
available for the same purposes, and for the same period, as such
account.
``(3) With respect to a shared medical facility lease project, any
amounts transferred by the partner agency to the Secretary of Veterans
Affairs may be deposited in the applicable medical appropriation
account of the Department for such lease. Amounts so deposited shall be
available without fiscal year limitation.
``(d) Definitions.--In this section:
``(1) The term `partner agency' means a department or agency
of the Federal Government that has entered into an agreement
with the Secretary of Veterans Affairs under subsection (a).
``(2) The term `shared medical facility' means a medical
facility shared by the Department of Veterans Affairs and a
partner agency pursuant to an agreement entered into under
subsection (a).
``(3) The term `shared medical facility construction project'
means the planning, designing, or constructing of a shared
medical facility pursuant to an agreement entered into under
subsection (a).
``(4) The term `shared medical facility lease project' means
the leasing of a shared medical facility pursuant to an
agreement entered into under subsection (a).''.
(2) Clerical amendment.--The table of sections at the
beginning of such chapter is amended by inserting after the
item relating to section 8111A the following new item:
``8111B. Authority to plan, design, construct, or lease a medical
facility shared with other departments or agencies.''.
(b) Definition of Medical Facility.--Paragraph (3) of section 8101 of
title 38, United States Code, is amended to read as follows:
``(3) The term `medical facility' means any facility or part thereof
which is, or will be, under the jurisdiction of the Secretary,
including with respect to a shared medical facility (as defined in
section 8111B(d) of this title), for the provision of health-care
services (including hospital, outpatient clinic, extended care
services, nursing home, or domiciliary care or medical services),
including any necessary building and auxiliary structure, garage,
parking facility, mechanical equipment, trackage facilities leading
thereto, abutting sidewalks, accommodations for attending personnel,
and recreation facilities associated therewith.''.
SEC. 205. ENHANCED USE LEASE AUTHORITY.
(a) In General.--Section 8162(a)(2) of title 38, United States Code,
is amended--
(1) by striking ``only''; and
(2) by inserting ``, or if the lease will enhance the use of
the property,'' after ``housing''.
(b) Application.--The amendments made by subsection (a) shall apply
with respect to enhanced-use leases entered into on or after the date
of the enactment of this Act.
TITLE III--OTHER MATTERS
SEC. 301. EXCEPTION ON LIMITATION ON AWARDS AND BONUSES FOR
RECRUITMENT, RELOCATION, AND RETENTION.
Section 705(a) of the Veterans Access, Choice, and Accountability Act
of 2014 (Public Law 113-146; 38 U.S.C. 703 note) is amended, in the
matter preceding paragraph (1), by inserting ``other than recruitment,
relocation, or retention incentives,'' after ``title 38, United States
Code,''.
SEC. 302. APPROPRIATION OF AMOUNTS.
(a) Veterans Choice Program.--There is authorized to be appropriated,
and is appropriated, to the Secretary of Veterans Affairs, out of any
funds in the Treasury not otherwise appropriated, $2,100,000,000 to be
deposited in the Veterans Choice Fund under section 802 of the Veterans
Access, Choice, and Accountability Act of 2014 (Public Law 113-146; 38
U.S.C. 1701 note).
(b) Minor Construction and Nonrecurring Maintenance.--
(1) In general.--There is authorized to be appropriated, and
is appropriated, to the Secretary of Veterans Affairs, out of
any funds in the Treasury not otherwise appropriated,
$500,000,000 for ``Medical Facilities'' for minor construction
and nonrecurring maintenance projects, to be prioritized
according to their rankings in the strategic capital investment
planning process.
(2) Notification.--Not later than 30 days before obligating
amounts appropriated under paragraph (1), the Secretary shall
notify the Committees on Veterans' Affairs of the House of
Representatives and the Senate and the Committees on
Appropriations of the House of Representatives and the Senate
of the medical facilities and specifics of the projects for
which such amounts shall be obligated.
(c) Availability of Amounts.--The amounts appropriated under
subsections (a) and (b)(1) shall be available for obligation or
expenditure without fiscal year limitation.
SEC. 303. ASSESSMENT OF HEALTH CARE FURNISHED BY THE DEPARTMENT TO
VETERANS WHO LIVE IN THE TERRITORIES.
(a) In General.--Not later than 180 days after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall submit
to the Committees on Veterans' Affairs of the Senate and the House of
Representatives a report regarding health care furnished by the
Department of Veterans Affairs to veterans who live in the territories.
(b) Elements.--The report under subsection (a) shall include
assessments of the following:
(1) The ability of the Department to furnish to veterans who
live in the territories the following:
(A) Hospital care.
(B) Medical services.
(C) Mental health services.
(D) Geriatric services.
(2) The feasibility of establishing a medical facility of the
Department in any territory that does not contain such a
facility.
(c) Definition.--In this section, the term ``territories'' means
Puerto Rico, the Virgin Islands, American Samoa, Guam, and the Northern
Mariana Islands.
Purpose and Summary
H.R. 4243, as amended, the ``VA Asset and Infrastructure
Review (AIR) Act of 2017,'' would require the Department of
Veterans Affairs (VA) to establish an Asset and Infrastructure
(AIR) Commission to assess and make recommendations regarding
the modernization and realignment of Veterans Health
Administration (VHA) facilities. It would also authorize and
appropriate money for both the Choice program and minor and
non-recurring maintenance projects. Representative David P. Roe
of Tennessee, the Chairman of the Committee on Veterans'
Affairs, introduced H.R. 4243, as amended, on November 3, 2017.
Background and Need for Legislation
TITLE I--ASSET AND INFRASTRUCTURE REVIEW
VA is one of the federal government's largest property-
holding entities with a capital asset portfolio that includes
approximately 155 million square feet across more than 35,000
acres of land.\1\ Unlike many other federal agencies, the
majority--86 percent--of VA's capital asset portfolio is
owned.\2\ VA also controls approximately 24.6 million square
feet of leased space.\3\ In July 2017, VA testified before the
Committee that ``most of VA's infrastructure portfolio is
dated, in need of repair/replacement, and requires considerable
investment.''\4\ VA further testified that ``the majority of VA
facilities have out-lived their useful life-cycle,'' raising
serious questions about VA's continued ability to meet the
needs of veteran patients and beneficiaries.\5\
---------------------------------------------------------------------------
\1\United States Cong. House Committee on Veterans' Affairs
Oversight Hearing--``Care Where it Count: Assessing VA's Capital Asset
Needs.'' July 12, 2017. 115th Cong. 1st sess. Washington: GPO, 2017
(statement from James M. Sullivan, Director of the Office of Asset
Enterprise Management, U.S. Department of Veterans Affairs).
\2\Ibid.
\3\Ibid
\4\Ibid.
\5\Ibid.
---------------------------------------------------------------------------
Most VA facilities are medical facilities that are operated
by VHA. Nationally, VHA's portfolio includes 168 VA medical
centers, 135 community living centers, 48 domiciliary centers,
737 community-based outpatient clinics, 22 health care centers,
and 305 other outpatient facilities such as mobile treatment
spaces.\6\ The average VHA building is approaching 60 years
old, more than five times older than the average building age
of a not-for-profit hospital system in the United States.\7\
These buildings were designed to meet an older, primarily
inpatient, model of care.\8\ Thus, they are not well suited to
provide care in accordance with modern, primarily outpatient,
care models or to meet the contemporary ambulatory care needs
of veteran patients.\9\
---------------------------------------------------------------------------
\6\GAO-17-349, April 2017, ``VA Real Property. VA Should Improve
Its Efforts to Align Facilities with Veterans'' Needs,'' https://
www.gao.gov/assets/690/683938.pdf.
\7\CMS Alliance to Modernize Healthcare Federally Funded Research
and Development Center, September 1, 2015, ``Independent Assessment of
the Health Care Delivery Systems and Management Processes of the
Department of Veterans Affairs,'' https://www.va.gov/opa/choiceact/
documents/assessments/Integrated_Report.pdf.
\8\Commission on Care, June 30, 2016, ``Commission on Care Final
Report,'' https://s3.amazonaws.com/sitesusa/wp-content/uploads/sites/
912/2016/07/Commission-on-Care_Final-Report_063016_FOR-WEB.pdf.
\9\Ibid.
---------------------------------------------------------------------------
VHA's capital asset portfolio also includes a significant
number of vacant properties, which led the Commission on Care
to note in 2016 that ``VHA's principal mission is to provide
health care to veterans, yet over time it has acquired an
ancillary mission: caretaker of an extensive portfolio of
vacant buildings.''\10\ The Commission on Care also found that
``maintaining outdated, vacant, and unused buildings, which
require millions of dollars in maintenance even in mothball
status, diminishes operating funds needed for patient care and
yields no benefit to veteran patients.''\11\ VA announced in
June 2017 that the Department would initiate reuse or disposal
of approximately 430 vacant buildings totaling 5.9 million
gross square feet over the next two years.\12\ VA expects to
save approximately $7 million annually as a result of this
effort.\13\ VA also intends to review approximately 784
underutilized buildings to determine if they can be reused or
disposed of to yield additional savings.\14\
---------------------------------------------------------------------------
\10\Ibid.
\11\Ibid.
\12\United States Cong. House Committee on Veterans' Affairs
Oversight Hearing--``Care Where it Count: Assessing VA's Capital Asset
Needs.'' July 12, 2017. 115th Cong. 1st sess. Washington: GPO, 2017
(statement from James M. Sullivan, Director of the Office of Asset
Enterprise Management, U.S. Department of Veterans Affairs).
\13\Ibid.
\14\id.
---------------------------------------------------------------------------
The amount of empty or underutilized spaces across the VA
health care system has been exacerbated by VHA's struggle to
align VA medical facilities with the veteran patient
population. In 2015, the Independent Assessment of the Health
Care Delivery Systems and Management Processes of VA
(Independent Assessment) found that VA struggles to
consistently allocate capital to projects that represent the
greatest areas of veteran need in the most cost effective and
timely manner.\15\ The Independent Assessment argued that the
misalignment of VA's properties with VA's patients was due, in
part, to lengthy approval and funding timelines that hinder
VA's ability to meet the identified space requirements to keep
up with veteran demand and invest in facility updates that
align with changing models for care.\16\ The Government
Accountability Office (GAO) made a similar judgment in a 2017
report.\17\ According to GAO, significant geographic shifts in
the veteran patient population coupled with changes in the
delivery of care, ``antiquated'' infrastructure, and serious
limitations with VA's capital planning processes created ``an
imperative for VA to better align its medical facilities and
services.''\18\
---------------------------------------------------------------------------
\15\CMS Alliance to Modernize Healthcare Federally Funded Research
and Development Center, September 1, 2015, ``Independent Assessment of
the Health Care Delivery Systems and Management Processes of the
Department of Veterans Affairs,'' https://www.va.gov/opa/choiceact/
documents/assessments/Integrated_Report.pdf.
\16\Ibid.
\17\GA0-17-349, April 2017, ``VA Real Property: VA Should Improve
Its Efforts to Align Facilities with Veterans'' Needs,'' https://
www.gao.gov/assets/690/683938.pdf.
\18\Ibid.
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Even absent a serious realignment effort, VA has identified
more than $50 billion in capital needs over the next decade to
modernize and maintain the Department's infrastructure.\19\
However, the capital requirement for VHA to maintain facilities
and meet projected growth needs over the next decade is two to
three times higher than anticipated funding levels, a gap which
is expected to could continue to widen.\20\ Furthermore, the
Independent Assessment also found that VA's construction costs
are double private industry best practice, that VA time-to-
complete construction projects exceeds both public and private
sector peers, and that VA's facility management costs are two
to three times higher than comparable private medical
facilities, on average.\21\
---------------------------------------------------------------------------
\19\United States Cong. House Committee on Veterans' Affairs
Oversight Hearing--``Care Where it Count: Assessing VA's Capital Asset
Needs.'' July 12, 2017. 115th Cong. 1st sess. Washington: GPO, 2017
(statement from James M. Sullivan, Director of the Office of Asset
Enterprise Management, U.S. Department of Veterans Affairs).
\20\CMS Alliance to Modernize Healthcare Federally Funded Research
and Development Center, September 1, 2015, ``Independent Assessment of
the Health Care Delivery Systems and Management Processes of the
Department of Veterans Affairs,'' https://www.va.gov/opa/choiceact/
documents/assessments/Integrated_Report.pdf.
\21\Ibid.
---------------------------------------------------------------------------
VA has attempted to address the Department's capital asset
challenges previously. In 2003, then Secretary of Veterans
Affairs, Anthony Principi, initiated the Capital Asset
Realignment for Enhanced Services (CARES) process.\22\ As part
of CARES, an independent commission was formed to provide
recommendations for the realignment and allocation of capital
assets to meet veteran health care demand over the next 20
years.\23\ The CARES Commission conducted 38 public hearings
and 10 public meetings around the country, heard from 770
witnesses--including 135 members of Congress and seven
governors--and received written comments from more than 212,000
people.\24\ In February 2004, the CARES Commission released a
report recommending substantial changes to existing VA
facilities and a limited number of facility closures. Yet,
thirteen years after the CARES report was released, its
recommendations have yet to be fully implemented.\25\ Former
Secretary Prinicipi testified before the Committee in July 2017
and stated that, while CARES offered ``sound recommendations
for realignment and allocation of the Department's capital
assets to meet demand for VA's services over the next twenty
years,'' it did not require Congress to adopt or reject the
final CARES recommendations as a package and, thus, failed.\26\
The Commission on Care similarly noted that, ``political
resistance doomed previous attempts to better align VHA's
capital assets and veterans' needs.''\27\ In light of this, the
Commission also recommended that Congress establish a VHA
facility and capital asset realignment process based on the
process established by the Department of Defense (DOD) Base
Realignment and Closure Commission process to be implemented as
soon as practicable.\28\
---------------------------------------------------------------------------
\22\February 12, 2004, VA Office of Public and Intergovernmental
Affairs, ``CARES Commission Announces Recommendations,'' https://
www.va.gov/opa/pressrel/pressrelease.cfm?id=729.
\23\Ibid.
\24\Ibid.
\25\United States Cong. House Committee on Veterans' Affairs
Oversight Hearing--``Care Where it Count: Assessing VA's Capital Asset
Needs.'' July 12, 2017. 115th Cong. 1st sess. Washington: GPO, 2017
(statement from the Honorable Anthony J. Principi).
\26\Ibid.
\27\Commission on Care, June 30, 2016, ``Commission on Care Final
Report,'' https://s3.amazonaws.com/sitesusa/wp-content/uploads/sites/
912/2016/07/Commission-on-Care_Final-Report_063016_FOR-WEB.pdf.
\28\Ibid.
---------------------------------------------------------------------------
The Committee applauds VA's recent efforts to initiate
reuse or disposal of vacant and underutilized properties across
the country and encourages their continuation. However, the
Committee also believes that bold steps are needed to fully
address VHA's significant and increasing capital asset
challenges, to ensure VHA uses taxpayer dollars wisely in
caring for the nation's veterans, and--most importantly--to
ensure a strong VA health care system is available to meet the
needs veteran patients both today and for generations to come.
Accordingly, the Committee concurs with the Commission on
Care's recommendation to establish a robust VHA capital asset
realignment process freed, to the greatest extent possible,
from political constraints.
As such, title I of the bill would require VA to establish
a nine member Asset and Infrastructure Review (AIR) Commission.
The Commissioners would be appointed by the President, with the
advice and consent of the Senate and in consultation with
Congressional leaders and congressionally chartered,
membership-based veterans service organizations (VSOs). The
Commission as a whole would be required to reflect current
demographics of veterans enrolled in the VA health care system
and to have expertise in health care system and federal capital
asset planning and management. In addition, at least three
Commissioners would be required to represent the VSO community.
The Commission would be tasked with considering recommendations
made by VA and submitting a report to the President on VHA
facility modernization and realignment. In addition, the
Commission would only be able to change a recommendation made
by VA for the modernization or realignment of a VHA facility
if: the Commission determines that VA deviated substantially
from VA's criteria in making a given recommendation and a
change would be consistent with the final criteria; the
Commission publishes a notice of the proposed change in the
Federal Register not less than 45 days before transmitting the
Commission's report including the change to the President; and
the Commission conducts public hearings on the proposed change.
Upon the President's approval of the Commission's report, the
report would be transmitted to Congress. Congress would be
required to act under expedited legislative procedures to issue
a resolution of disapproval of the Commission's report and the
full list of recommendations it contains. Absent such a
resolution, VA would be required to take any such action as may
be necessary to carry out the actions recommended by the
Commission.
The Committee recognizes that the implementation of the
Commission's recommended actions would be a substantial task
for VA as it is likely that VA will need to carry out a level
of construction, leasing, environmental compliance, and
property disposition activity that exceeds typical levels. As
VA's existing legal authority to initiate property actions may
be inadequate to accommodate the Commission's recommendations,
title I of the bill would include additional authorities to
allow VA to take such action as may be necessary to modernize
or realign any VHA facility and to transfer or lease properties
to historic preservation organizations. To ensure that VA's
maintenance needs continue to be met while the Commission's
work is ongoing, title I of the bill would prohibit VA from
pausing major or minor construction activities while the
Commission process is ongoing.
The Committee intends for the AIR Commission process to be
data-driven and to incorporate feedback from veterans,
employees, and communities who would be most impacted by VHA
modernization or realignment. As such, title I of the bill
would require VA to consult with VSOs to establish criteria to
use to assess and recommend the modernization or realignment of
VHA facilities and to take certain factors--including local
veteran and stakeholder input--into account to ensure such
recommendations are robust and fair. Title I of the bill would
also require VA to consult with local veterans and VSOs to
conduct periodic assessments of the capacity of each Veterans
Integrated Service Network (VISN) and VA medical facility to
furnish hospital care or medical services to veterans. Each
assessment would be required to: (1) identify existing
deficiencies in the furnishing of care and services to veterans
and how such deficiencies may be filled by entering into
contracts or agreements with community health care providers or
other entities under other provisions of law and changing the
way care and services are furnished at such VISNs or VA medical
facilities (including through extending hours of operation,
adding personnel, and expanding treatment space through
construction, leasing, or sharing of health care facilities);
(2) forecast both the short-term and long-term demand in
furnishing care and services at such VISN or VA medical
facility; (3) consider how demand affects the need to enter
into contracts or agreements; (4) consider the commercial
health care market of designated catchment areas conducted by a
non-governmental entity; and (5) consider the unique ability of
the Federal government to retain a presence in a rural area
otherwise devoid of commercial health care providers or from
which such providers are at risk of leaving.
The Committee also intends the AIR Commission process to be
transparent and veteran-centric. Accordingly, title I of the
bill would: require that each meeting of the Commission to be
open and all proceedings, information, and deliberations of the
Commission to be available for review by the public; require VA
to publish any information transmitted or received by VA, the
Commission, or the President regarding the Commission (or
related activities) to be published online within 24 hours;
prohibit the restriction of lawful communication from a VA
employee to the Commission; require VA to make the local
capacity and commercial market assessments 5 publically
available; and require the Commission to conduct public
hearings and include local veterans and VSOs as witnesses in
those hearings.
The Committee is aware that the ultimate success of the
Commission may be contingent upon ensuring VA has sufficient
time before the Commission begins its work to gather needed
data, establish reasonable criteria, and make initial
recommendations regarding facility actions. Accordingly and
upon consultation with VSOs, title I of the bill would allow VA
five years, until January 31, 2022, before transmitting
recommendations to the Commission for review. The Commission
would then have a year to conduct their work before
transmitting the Commission's report to the President on
January 31, 2023. The Commission would terminate On December
31, 2023.
The Committee is aware of the sensitive political
considerations inherent in the AIR Commission process and the
expedited legislative consideration of the Commission's report
by Congress. However, the Committee also fully concurs with
former Secretary Principi's testimony that:
The department will fail to honor our nation's
commitment to its veterans if VA's medical system does
not evolve with the times . . . While the practice of
VA medicine has evolved, VA's medical infrastructure
has not kept pace. VA facilities are out of step with
changes in the practice of medicine, with demographic
changes in the veteran population, and with statutory
changes in VA's health care benefits packages. If VA
does not realign itself, and close its unneeded
facilities, the current decline in the veteran
population will make many VA medical centers museums of
the past--not the guideposts for the future they should
be.\29\
---------------------------------------------------------------------------
\29\United States Cong. House Committee on Veterans' Affairs
Oversight Hearing--``Care Where it Count: Assessing VA's Capital Asset
Needs.'' July 12, 2017. 115th Cong. 1st sess. Washington: GPO, 2017
(statement from the Honorable Anthony J.Principi).
---------------------------------------------------------------------------
TITLE II--IMPROVEMENTS TO CONSTRUCTION MANAGEMENT AND LEASES
Section 8104 of title 38, United States Code defines a
``major medical facility project'' as a project for the
construction, alteration, or acquisition of a medical facility
involving a total expenditure of more than $10 million and a
``major medical facility lease'' as a lease for space for use
as a new medical facility at an average annual rental of more
than $1 million. Both major medical facility projects and
leases are required to be authorized by law. To obtain such
authorization, VA is required to submit a prospectus containing
detailed information about each proposed project. Each such
prospectus is required to include: a detailed estimate of the
total costs; demographic data; current and projected workload
and utilization data; projected operating costs; and the
priority score assigned to the project under the Department's
prioritization methodology as well as, if the project is being
proposed for funding before a project with a higher score, a
specific explanation of the factors other than the priority
score that were considered and the basis on which the project
is proposed for funding ahead of projects with higher priority
scores.
VA's performance in the areas of leasing and construction
management has been widely cited as inadequate in recent years,
as evidenced by a series of GAO reports from April 2013 through
March 2017.\30\ In response to unprecedented cost overruns
experienced in the Aurora, Colorado, replacement medical center
construction project--which were documented in a 2016 VA Office
of Inspector General report--Congress enacted the Department of
Veterans Affairs Expiring Authorities Act of 2015 (Public Law
114-58; 129 STAT. 530) to require that all VA medical facility
construction projects exceeding $100 million be managed by
another federal agency.\31\
---------------------------------------------------------------------------
\30\GA0-13-302, April 2013, ``VA Construction: Additional Actions
Needed to Decrease Delays and Lower Costs of Major Medical Facility
Projects,'' https://www.gao.gov/assets/660/653585.pdf; GAO-16-619, June
2016, ``VA Real Property: Leasing Can Provide Flexibility to Meet
Needs, but VA Should Demonstrate the Benefits,'' https://www.gao.gov/
assets/680/678746.pdf; GAO-17-70, March 2017, ``VA Construction:
Improved Processes Needed to Monitor Contract Modifcations, Develop
Schedules, and Estimate Costs,'' https://www.gao.gov/assets/690/
683209.pdf.
\31\VA OIG 15-03706-330, September 21, 2016, ``Review of the
Replacement Denver Medical Center, Eastern Colorado Health Care
System,'' https://www.va.gov/oig/pubs/VAOIG-15-03706-330.pdf.
---------------------------------------------------------------------------
In order to increase the effectiveness of VA's construction
management workforce, Congress enacted the Jeff Miller and
Richard Blumenthal Veterans Health Care and Benefits
Improvement Act of 2016 (Public Law 114-315; 130 STAT. 1536) to
require, among other things, that each employee who VA
determines to have construction responsibilities undergo a
program of ongoing professional training and development
including instruction on industry standards and acquisition
best practices. Unfortunately, those provisions do not seem to
have led to significant improvements in VA's construction
management workforce as it appears that VA has determined that
the law should apply to essentially the same employees who were
already participating in construction management continuing
education and to cover training courses which are not
significantly more numerous or wide ranging than the courses
that were offered before the law's enactment.
Despite these efforts, the Committee continues to find that
major construction, minor construction, and leasing remain
challenging areas for VA. As a result, title II of the bill
would include a number of changes to VA's construction and
leasing authorities. In response to concerns that the $10
million and $1 million thresholds on VA major medical facility
projects and leases, respectively, are outdated and impede
efficient and effective VA construction planning and medical
facility improvements, title II of the bill would incorporate
VA legislative proposals to: (1) redefine a VA major medical
facility project as a project involving a total expenditure of
$20 million or, in the case of a shared medical facility, a
project in which VA's estimated costs exceed $20 million; and
(2) amend the definition of a VA major medical facility lease
as a lease for space for use as a new medical facility at an
average annual rent that is equal to or exceeds the amount
specified in subsection (a)(2) of section 3307 of title 40
United States Code or a lease for use as a shared medical
facility in which VA's estimated costs are equal to or would
exceed such amount. As the Committee generally finds the
prospectuses to provide valuable information that aid in the
Committee's oversight of VA facility needs, estimates, and
intentions, the Committee wants to continue receiving the
prospectuses for VA major medical facility projects despite the
threshold increase. Accordingly, title II of the bill would
also require VA to include in the Department's annual budget
submission prospectuses of both proposed major construction
projects and construction projects in which VA's estimated
costs are between $10 million and $20 million. Title II of the
bill further incorporates VA legislative proposals to
facilitate VA's ability to share medical facilities with other
federal agencies and to amend VA's authority to enter into
enhanced use leases.
The Committee recognizes that, in order to successfully
implement the recommended actions regarding facility
modernization and alignment that title I of the bill would
require, VA's construction management workforce will need to be
as well trained, skilled, and effective as possible. The
Committee also recognizes that it is necessary to broaden
training in construction disciplines beyond architects,
engineers, real property specialists, and other such
professionals located in programmatic offices that are
specifically devoted to construction as there is a much wider
universe of personnel involved in construction acquisition,
notably including contracting officers, contract specialists,
and contracting officers' representatives. Relatedly, since the
passage of the National Defense Authorization Act for Fiscal
Year 1991 (Public Law 101-510; 104 STAT. 1485), the accepted
way to deliver such interdisciplinary acquisition training is
through formal certification programs. All civilian agencies
have subsequently been mandated to adopt certification programs
for the fields of contracting and program management, while DOD
continues to offer a wider range of certification programs to
its employees, notably including certification in facilities
engineering. The Committee believes it would be advantageous
for VA to adopt a similar, formal certification program for
construction and facilities management. As such, title II of
the bill would require VA to implement a training and
certification program for construction and facilities
management personnel, to include all VA employees who are
members of occupational series relating to construction or
facilities management or who award or administer contracts for
major construction, minor construction, or non-recurring
maintenance (including contract specialists or contracting
officers' representatives). Title II of the bill would further
require that such training be taken to complete a formal
certification program and be modeled, to the extent
appropriate, after the training and certification program
established by the Defense Acquisition Workforce Improvement
Act.
TITLE III--OTHER MATTERS
Section 301. Exception of limitations on awards and bonuses for
recruitment, relocation, and retention
Chapter 45 and Chapter 53 of title 5 United States Code
authorizes VA to provide awards and bonuses to employees.
Following a nationwide access to care crisis that raised
serious concerns about accountability among VA leaders, the
Veterans Access, Choice, and Accountability Act of 2014 (Public
Law 113-146; 128 STAT. 1754) limited the amount of awards and
bonuses payable to VA employees to no more than $360 million
from fiscal year 2014 through fiscal year 2024. The
Comprehensive Addiction and Recovery Act (Public Law 114-198;
130 STAT 695) further limited the amount of awards and bonuses
payable to VA employees to $230 million for fiscal year 2017
through fiscal year 2018, $225 million for fiscal year 2019
through fiscal year 2021, and $360 million for fiscal year 2022
through fiscal year 2024. The limitations imposed on awards and
bonuses to VA employees included recruitment, relocation, and
retention incentive payments, which has raised concerns about
unintended negative consequences on VA's ability to hire high-
quality clinicians and support staff to effectively serve
veteran patients. As such, section 301 of the bill would exempt
recruitment, relocation, and retention incentives from the
limitations on awards and bonuses.
Section 302. Appropriation of amounts
The Veterans Access, Choice, and Accountability Act of 2014
(Public Law 113-146; 128 STAT. 1754) (the Act) created the
Choice program to expand the availability of community care to
veteran patients by setting specific triggers that would
require VA to give veterans the option of receiving care in the
community rather than in a VA medical facility. In general,
veterans are eligible to receive care through the Choice
program if they are unable to secure an appointment at a VA
medical facility within 30 days or if they reside more than 40
miles from the nearest VA medical facility. To fund Choice, the
Act also created and deposited $10 billion into the Veterans
Choice Fund and stipulated that Choice would sunset either when
the money in the Choice fund was fully expended or three years
after enactment of the Act. Since the law was enacted on August
7, 2014, three years after enactment of the Act would have been
August 7, 2017.
Congress passed a law (Public Law 115-26; 131 STAT. 129) to
amend the Act to modify the termination date for the Choice
program in April 2017 following testimony that VA expected to
have money left in the Choice Fund on August 7, 2017.\32\
However, in June 2017, VA testified that Choice Program funds
would fully obligated sooner than previously expected and, as a
result, VA was requesting additional funds be deposited into
the Choice Fund.\33\ VA also testified that, without such
action, waiting times for veteran patients would increase and
access to care in the community would decrease.\34\ In
response, Congress enacted the VA Choice and Quality Employment
Act of 2017 (Public Law 115-46; 131 STAT. 958) to appropriate
$2.1 billion into the Choice fund to preserve the availability
of Choice care for veterans patients through the end of
calendar year 2017.
---------------------------------------------------------------------------
\32\United States Cong. House Committee on Veterans' Affairs
Oversight Hearing--``Care Where it Count. Assessing VA's Capital Asset
Needs.'' March 7 2017. 115th Cong. 1st sess. Washington: GPO, 2017
(statement from the Honorable David Shulkin M.D, Secretary of Veterans
Affairs).
\33\United States Cong. House Committee on Veterans' Affairs
Oversight Hearing--``FY 2018 Department of Veterans Affairs Budget
Request for the Veterans Health Administration.'' June 22, 2017. 115th
Cong. 1st sess. Washington: GPO, 2017 (statement from Poonam Alaigh
M.D., Acting Under Secretary for Health, U.S. Department of Veterans
Affairs).
\34\Ibid.
---------------------------------------------------------------------------
The Committee continues to work on legislation to
consolidate and improve VA's many care in the community
programs, including Choice. However, section 302 of the law
would authorize and appropriate $2.1 billion to the Choice Fund
to ensure that, while that larger effort is ongoing, veterans
can continue to receive needed care through the Choice program.
Section 302 would also authorize and appropriate $500 million
for minor construction and non-recurring maintenance projects
to improve capacity for care for veteran patients in VA medical
facilities.
Section 303. Assessment of health care furnished by the Department of
Veterans Affairs who live in the territories
Veterans in Puerto Rico, the U.S. Virgin Islands, the
American Samoa, Guam, and the Northern Mariana Islands face a
number of barriers to timely, accessible VA care and benefits.
The principle barrier these veterans face is the lack of VA
care at home, which necessitates lengthy travel to VA medical
centers and clinics in other areas. In light of the unique
challenges that veterans residing in these territories face
accessing VA services, section 303 of the bill would require VA
to report on the care provided to veterans in Puerto Rico, the
U.S. Virgin Islands, the American Samoa, Guam, and the Northern
Mariana Islands and include whether it would be feasible for VA
to establish a medical facility in any territory that does not
contain such a facility.
Hearings
There were no Subcommittee hearings held on H.R. 4243, as
amended.
On October 12, 2017, the full Committee conducted a
legislative hearing on a draft bill that was later introduced
as H.R. 4243.
The following witnesses testified:
The Honorable Mike Coffman, U.S. House of
Representatives, 6th District; Colorado; Joy J. Ilem,
National Legislative Director, Disabled American
Veterans; Louis J. Celli Jr., Director, Veterans
Affairs and Rehabilitation Division, The American
Legion; Carl Blake, Associate Executive Director of
Government Relations, Paralyzed Veterans of America;
Carlos Fuentes, Director, National Legislative Service,
Veterans of Foreign Wars of the United States; Dave
Wise, Director, Physical Infrastructure Team, U.S.
Government Accountability Office; and, Regan L. Crump
MSN, DrPH, Assistant Deputy Under Secretary for Health
for Policy and Planning, Veterans Health
Administration, U.S. Department of Veterans Affairs,
who was accompanied by James M. Sullivan, the Director,
Office of Asset Enterprise Management.
Statements for the record were submitted by:
Concerned Veterans of America.
Subcommittee Consideration
There was no Subcommittee consideration of H.R. 4243, as
amended.
Committee Consideration
On November 8, 2017, the full Committee met in open markup
session, a quorum being present, and ordered H.R. 4243, as
amended, to be reported favorably to the House of
Representatives by recorded vote. During consideration of the
bill, the following amendments were considered:
An amendment offered by Representative Kilili Sablan
of the Northern Mariana Islands to require VA to submit
a report to Congress on the care provided to veterans
in the American Samoa, Guam, and the Northern Mariana
Islands and on whether it would be feasible for VA to
establish a medical facility in any such territory that
does not contain a VA medical facility. During
consideration of the amendment, Representative Sablan
asked unanimous consent to amend the amendment to
include Puerto Rico and the U.S. Virgin Islands. The
amendment, as amended, was agreed to by voice vote.
An amendment offered and then withdrawn by
Representative Ann Kuster from New Hampshire, the
Ranking Member of the Subcommittee on Oversight and
Investigations, to require VA to consider whether a
veteran resides in a state with no VA medical center
when establishing eligibility criteria for any program
that furnishes primary or specialty care through a
community provide.
An amendment offered and then withdrawn by
Representative Julia Brownley of California, the
Ranking Member of the Subcommittee on Health, to remove
the requirement for VA major medical facility leases to
be authorized by law and prohibit funds from being
appropriated for any fiscal year for a major medical
facility lease unless the Committees on Veterans'
Affairs of the U.S. House of Representatives and the
Senate adopt resolutions approving the lease.
Committee Votes
Clause 3(b) of rule XIII of the Rules of the House of
Representatives require the Committee to list the recorded
votes on motions to report legislation and amendments thereto.
During the full Committee markup of H.R. 4243, as amended, on
November 8, 2017, one recorded vote was taken and is described
below.
A motion by Representative Gus Bilirakis of Florida,
the Vice Chairman of the Committee on Veterans'
Affairs, to report H.R. 4243, as amended, favorably to
the House of Representatives was agreed to by a
recorded vote of 13 yeas and 10 nays. The names of the
Members who voted for and against the motion are as
follows:
Committee Oversight Findings
In compliance with clause 3(c)(1) of rule XIII and clause
(2)(b)(1) of rule X of the Rules of the House of
Representatives, the Committee's oversight findings and
recommendations are reflected in the descriptive portions of
this report.
Statement of General Performance Goals and Objectives
In accordance with clause 3(c)(4) of rule XIII of the Rules
of the House of Representatives, the Committee's performance
goals and objectives are to institute a capital asset
realignment process to address the serious and well-documented
deficiencies in VA's capital asset portfolio and ensure VA
medical facilities are properly aligned with the veteran
patient population and the delivery of high quality, modern
medical care.
New Budget Authority, Entitlement Authority, and Tax Expenditures
In compliance with clause 3(c)(2) of rule XIII of the Rules
of the House of Representatives, the Committee adopts as its
own the estimate of new budget authority, entitlement
authority, or tax expenditures or revenues contained in the
cost estimate prepared by the Director of the Congressional
Budget Office pursuant to section 402 of the Congressional
Budget Act of 1974.
Earmarks and Tax and Tariff Benefits
H.R. 4243, as amended, does not contain any Congressional
earmarks, limited tax benefits, or limited tariff benefits as
defined in clause 9 of rule XXI of the Rules of the House of
Representatives.
Committee Cost Estimate
The Committee adopts as its own the cost estimate on H.R.
4243, as amended, prepared by the Director of the Congressional
Budget Office pursuant to section 402 of the Congressional
Budget Act of 1974.
Congressional Budget Office Cost Estimate
Pursuant to clause 3(c)(3) of rule XIII of the Rules of the
House of Representatives, the following is the cost estimate
for H.R. 4243, as amended, provided by the Congressional Budget
Office pursuant to section 402 of the Congressional Budget Act
of 1974:
U.S. Congress,
Congressional Budget Office,
Washington, DC, November 13, 2017.
Hon. Phil Roe, M.D.,
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 4243, the VA Asset
and Infrastructure Review Act of 2017.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Ann E.
Futrell.
Sincerely,
Keith Hall,
Director.
Enclosure.
H.R. 4243--VA Asset and Infrastructure Review Act of 2017
Summary: H.R. 4243 would directly appropriate $2.1 billion
for the Veterans Choice Program (VCP) and $500 million for
infrastructure improvements at the Department of Veterans
Affairs (VA). The bill also would expand VA's authority to
enter into leases for medical facilities and enhanced-use
leases (EULs). In total, CBO estimates that enacting H.R. 4243
would increase direct spending by $3.8 billion over the 2018-
2027 period.
The bill also would increase the amount VA can spend on
awards and bonuses for employees; establish procedures for
realigning, modernizing, or closing medical facilities; and
require training of construction personnel. In total, CBO
estimates that implementing H.R. 4243 would cost $720 million
over the 2018-2022 period, assuming appropriation of the
necessary amounts.
Because enacting H.R. 4243 would affect direct spending,
pay-as-you-go procedures apply. Enacting the bill would not
affect revenues.
CBO estimates that enacting H.R. 4243 would increase direct
spending by more than $2.5 billion and would increase on-budget
deficits by more than $5 billion in at least one of the four
consecutive 10-year periods beginning in 2028.
H.R. 4243 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act (UMRA).
Estimated cost to the Federal Government: The estimated
budgetary effects of H.R. 4243 is shown in Table 1. The costs
of this legislation fall within budget function 700 (veterans
benefits and services).
TABLE 1.--ESTIMATED BUDGETARY EFFECTS OF H.R. 4243, THE VA ASSET AND INFRASTRUCTURE REVIEW ACT OF 2017
--------------------------------------------------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
--------------------------------------------------------------------------------------------
2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2018-2022 2018-2027
--------------------------------------------------------------------------------------------------------------------------------------------------------
INCREASES IN DIRECT SPENDING
Estimated Budget Authority................................. 2,600 90 90 230 230 230 230 230 230 230 3,240 4,390
Estimated Outlays.......................................... 2,220 340 70 76 102 159 192 213 227 227 2,808 3,826
INCREASES IN SPENDING SUBJECT TO APPROPRIATION
Estimated Authorization Level.............................. 131 70 217 260 266 n.a. n.a. n.a. n.a. n.a. 1,044 n.a.
Estimated Outlays.......................................... 20 75 158 220 246 n.a. n.a. n.a. n.a. n.a. 719 n.a.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Note: Components may not sum to totals because of rounding; n.a. = not applicable.
Basis of estimate: For this estimate, CBO assumes that the
bill will be enacted near the beginning of calendar year 2018
and that the estimated amounts will be appropriated each year.
Estimated outlays are based on historical spending patterns for
the affected programs.
Direct Spending
H.R. 4243 would directly appropriate funds for VCP and
construction projects at the department. In addition, the bill
would increase VA's ability to lease medical facilities without
legislative authorization. On that basis, CBO estimates this
bill would increase direct spending by $3.8 billion over the
2018-2027 period (see Table 2).
Direct Appropriations. Section 302 would appropriate $2.1
billion for VCP and $0.5 billion for minor construction and
nonrecurring maintenance. VCP pays for certain veterans to
receive health care from participating providers in the private
sector. At the beginning of fiscal year 2018, VCP had about $2
billion in available funds, which CBO estimates will be
completely committed before the first half of 2018 is over.
Under current law, the program will terminate once its funding
is exhausted. CBO expects that enacting this provision would
extend the life of VCP through the remainder of 2018 and would
provide additional support for minor construction projects. On
that basis, CBO estimates that section 302 would increase
direct spending by $2.2 billion in 2018 and $2.6 billion over
the 2018-2022 period.
TABLE 2.--ESTIMATE OF THE EFFECTS ON DIRECT SPENDING OF H.R. 4243, THE ASSET AND INFRASTRUCTURE REVIEW ACT OF 2017
--------------------------------------------------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
--------------------------------------------------------------------------------------------
2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2018-2022 2018-2027
--------------------------------------------------------------------------------------------------------------------------------------------------------
INCREASES IN DIRECT SPENDING
Direct Appropriations:
Budget Authority....................................... 2,600 0 0 0 0 0 0 0 0 0 2,600 2,600
Estimated Outlays...................................... 2,220 325 40 10 0 0 0 0 0 0 2,595 2,595
Modify Threshold for Major Medical Facilities:
Estimated Budget Authority............................. 0 0 0 100 100 100 100 100 100 100 200 700
Estimated Outlays...................................... 0 0 0 4 19 49 69 84 94 94 23 413
Shared Medical Facilities:
Estimated Budget Authority............................. 0 0 0 40 40 40 40 40 40 40 80 280
Estimated Outlays...................................... 0 0 0 2 8 20 28 34 38 38 10 168
Enhanced-Use Leases:
Estimated Budget Authority............................. 0 90 90 90 90 90 90 90 90 90 360 810
Estimated Outlays...................................... 0 15 30 60 75 90 95 95 95 95 180 650
Total Changes:
Estimated Budget Authority......................... 2,600 90 90 230 230 230 230 230 230 230 3,240 4,390
Estimated Outlays.................................. 2,220 340 70 76 102 159 192 213 227 227 2,808 3,826
--------------------------------------------------------------------------------------------------------------------------------------------------------
Expanded Authority to Lease Medical Facilities. Sections
201 and 204 would expand the authority for VA to enter into
leases for medical facilities. (Those provisions also would
expand the authority to construct medical facilities, discussed
below under the heading Spending Subject to Appropriation.) In
total, CBO estimates enacting those sections would increase
direct spending by $581 million over the 2018-2027 period.
VA classifies its contracts for acquiring such facilities
as operating leases and thus records its obligations for lease
payments on an annual basis over the term of each lease.
However, CBO has reviewed a number of those contracts and has
concluded that they are akin to government purchases of
facilities built specifically for VA's use--but instead of
being financed by the Treasury, they rely on third-party
financing (that is, funds raised by a nonfederal entity), which
is generally more expensive.\1\ That conclusion is based on
those leases having many of the following key features:
---------------------------------------------------------------------------
\1\For more information on the budgetary treatment of third-party
financing, see Congressional Budget Office, Third-Party Financing of
Federal Projects (June 2005), www.cbo.gov/publication/16554.
---------------------------------------------------------------------------
The facilities are designed and constructed
to the unique specifications of the government;
The facilities are constructed at the
request of the federal government;
The leases on the newly constructed
facilities are long term--usually 20 years;
Payments from the federal government are the
only or primary source of income for the facilities;
The term of the contractual agreements
coincides with the term of the private partner's
financing instrument for developing and constructing
the facility (that is, a facility financed with a 20-
year bond will have a 20-year lease term);
The federal government commits to make fixed
annual payments that are sufficient to service the debt
incurred to develop and construct the facility,
regardless of whether the agency continues to occupy
the facility during the guaranteed term of the lease;
and
The fixed payments over the life of the
lease are sufficient to retire the debt for the
facility.\2\
---------------------------------------------------------------------------
\2\See the statement of Robert A. Sunshine, Deputy Director,
Congressional Budget Office, The Budgetary Treatment of Medical
Facility Leases by the Department of Veterans Affairs, before the House
Committee on Veterans' Affairs, (June 27, 2013), www.cbo.gov/
publication/44368.
---------------------------------------------------------------------------
Thus, although those transactions are structured as leases,
they are essentially government purchases. Under the normal
procedures governing the budgetary treatment of the purchase of
capital assets, budget authority should be available and
obligations should be recorded at the time the acquisitions are
initiated and amounts recorded should equal the full
development and construction costs of the medical facilities.
Instead, VA records a small fraction of those costs as
obligations when it awards the contracts for such transactions.
To the extent that the full costs of developing and
constructing the facilities exceeds the relatively small amount
that VA would initially record as obligations against its
appropriation, CBO treats the legislative authorization for
those transactions as contract authority--a type of budget
authority that allows an agency to enter into a contract and
incur an obligation before receiving an appropriation for those
activities. Because the contract authority would be provided in
an authorizing bill, rather than in an appropriation act, the
resulting spending is categorized as direct spending (as
distinguished from discretionary spending, which results from
appropriation acts).
In addition, at the time the contracts are signed, VA
typically obligates some amounts from available appropriations.
Those costs are considered discretionary and are discussed
below under the heading Spending Subject to Appropriation.
Modify Threshold for Major Medical Facilities. Section 201
would allow VA to enter into leases without legislative
authorization for medical facilities with annual lease payments
up to $1.5 million. Under current law, VA is required to
receive legislative authorization to lease medical facilities
with annual rent payments in excess of $1 million.
After reviewing VA's 2018 budget request for leases of
medical facilities, CBO estimates that enacting this provision
would allow VA to enter into six additional leases, on average,
each year. In total, the annual rent payments for those leases
would be about $7 million. CBO expects that the initial
contracts for those facilities would be entered into starting
in 2021 and that contracts of a similar magnitude would occur
each year thereafter. CBO calculated the present value of each
lease over the entire term of the lease agreement.\3\ We
estimate that enacting this provision would increase direct
spending by $413 million over the 2021-2027 period.
---------------------------------------------------------------------------
\3\The costs for the 20-year leases are calculated by discounting
the expected annual rent payments using the rate on Treasury securities
of comparable maturities.
---------------------------------------------------------------------------
Shared Medical Facilities. Section 204 would allow VA to
enter into sharing agreements with other federal agencies to
lease medical facilities. Under this section VA's portion of
the annual rent payments for leased medical facilities could be
lowered by enough that some leases would no longer require
legislative authorization. Based on an analysis of information
from VA, CBO estimates that, on average, this section would
authorize the construction of one medical facility each year at
an average annual rent payment of $3 million. CBO expects that
VA would enter into the first such contract in 2021 and
contracts of similar magnitude each year thereafter. On the
basis of the present value for each lease over the entire term
of the lease agreement, CBO estimates that enacting this
section would increase direct spending by $168 million over the
2021-2027 period.
Enhanced-Use Leases. Section 205 would expand VA's
authority to enter into enhanced-use leases.
Under EULs, federal agencies can lease out underused
property to a nonfederal entity in exchange for cash or in-kind
compensation. Through some of those leases, agencies have
obtained third-party financing for the acquisition,
construction, rehabilitation, operation, and maintenance of
real property used by the agencies. A range of agreements
associated with the leases establish government control over
the projects, protect the government's interests, and ensure
that agencies will receive guaranteed access to whatever
facilities are being developed. The contracts also assure the
nonfederal partners that they will be able to recover their
capital costs for the facilities over time through payments
from the federal government.
CBO has concluded that such facilities are built for
governmental purposes and are effectively under control of the
federal government. Thus, the costs of developing and
constructing facilities in that manner are governmental
transactions that should be recorded in the budget when they
occur, regardless of whether they are financed directly by the
U.S. Treasury or indirectly by a third party. Budget authority
in the amount of the cost of the facility should be recorded
when the lease is signed and outlays should be recorded over
the construction phase. Because agencies instead record
obligations to pay for the facilities one year at a time,
rather than up front, CBO treats the authorization for those
transactions as contract authority--a form of direct spending
that allows agencies to incur obligations in advance of
appropriations.
VA's authority for enhanced-use leases expired in 2011. It
was subsequently authorized to enter EULs only for the purpose
of obtaining supportive housing for homeless veterans. Section
205 would restore VA's authority to enter enhanced-use leases
for any purpose at any of the department's facilities if the
department determines that the lease would enhance the use of
the property.
Before VA's EUL authority expired, the department used that
authority to acquire numerous facilities such as administrative
buildings, utility plants, data centers, hospitals, and parking
garages. On the basis of the number of and the costs to acquire
those facilities, CBO expects that under section 205, VA would
acquire one or two facilities each year beginning in 2019 at an
average cost of $60 million each. In total, enacting section
205 would increase direct spending by $650 million over the
2018-2027 period, CBO estimates.
Realignment, Modernization and Closure of VA Medical
Facilities. As part of a program of modernizing and realigning
medical facilities, section 104 would allow VA to lease such
facilities without legislative authorization. Such actions
would occur after 2027 and therefore CBO does not include those
budgetary effects in the tables for this estimate. However, CBO
estimates that enacting section 104 would increase direct
spending by more than $7.5 billion in the first 10 years after
2027.
Spending subject to appropriation
CBO estimates that implementing H.R. 4243 would increase
the amounts VA pays for awards and bonuses, leases of medical
facilities, and construction projects by a total of $720
million over the 2018-2022 period, subject to appropriation of
the necessary amounts (see Table 3).
Limitation on Bonuses. Section 301 would increase the
amount that VA is authorized to pay its employees for awards
and bonuses. Under current law, the amount VA may spend for
such payments is capped at $230 million in fiscal year 2018,
$225 million a year in 2019 through 2021, and $360 million in
2022. By removing from the list of capped payments those
amounts provided for recruitment, relocation, and retention
incentives (3R incentives), this provision would increase the
amount VA can spend for those incentives as well as make room
under the caps to increase the amounts paid for all other
awards and bonuses.
TABLE 3.--ESTIMATE OF THE EFFECTS ON SPENDING SUBJECT TO APPROPRIATIONS OF H.R. 4243, THE ASSET AND
INFRASTRUCTURE REVIEW ACT OF 2017
----------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
------------------------------------------------------------
2018-
2018 2019 2020 2021 2022 2022
----------------------------------------------------------------------------------------------------------------
INCREASES IN SPENDING SUBJECT TO APPROPRIATION
Limitation on Bonuses:
Estimated Authorization Level................. 15 52 98 114 120 399
Estimated Outlays............................. 15 52 98 114 120 399
Shared Medical Facilities:
Estimated Authorization Level................. 100 100 100 107 107 514
Estimated Outlays............................. 4 19 49 75 91 238
Modify Threshold for Major Medical Facilities:
Estimated Authorization Level................. 16 16 16 36 36 120
Estimated Outlays............................. 1 3 8 28 32 72
Procedures for Recommendations:
Estimated Authorization Level................. * 1 3 3 3 10
Estimated Outlays............................. * 1 3 3 3 10
Training Construction Personnel:
Estimated Authorization Level................. 0 1 * * * 1
Estimated Outlays............................. 0 * * * * 1
Total Changes:
Estimated Authorization Level................. 131 170 217 260 266 1,044
Estimated Outlays............................. 20 75 158 220 246 720
----------------------------------------------------------------------------------------------------------------
Note: Components may not sum to totals because of rounding; * = less than $500,000.
In 2013, before the cap on such payments was first imposed,
VA spent $81 million for 3R incentives. CBO expects that under
this provision, VA would gradually return to that level of
spending, adjusted to account for the increased number of VA
employees and past and future cost-of-living increases. At the
same time, we expect that VA also would take advantage of the
extra room available under the caps to gradually increase the
amount it spends on other awards and bonuses. On that basis,
CBO estimates that implementing section 301 would cost $399
million over the 2018-2022 period.
Expanded Authority to Construct and Lease Medical
Facilities. Sections 201 and 204 would expand the authority of
VA to construct and lease medical facilities. In total, CBO
estimates that implementing those provisions would cost $310
million over the 2018-2022 period for additional construction
and lease projects.
Shared Medical Facilities. Section 204 would allow VA to
enter into sharing agreements with other federal departments to
construct medical facilities. Implementing this section could
reduce VA's share of the cost of some construction projects,
such that some such projects would no longer require
legislative authorization. On the basis of information from VA,
CBO estimates the total cost for such major construction
projects would average about $100 million each year. On that
basis, CBO estimates costs of $225 million over the 2018-2022
period for additional construction projects.
Furthermore, as discussed above under the heading ``Direct
Spending,'' this section also would expand VA's authority to
enter into leases for medical facilities. CBO estimates that VA
would enter into one additional lease each year with a total
annual rent payment of $3 million. For those leases, we expect
that VA would record obligations of $7 million each year as it
enters those contracts, from available appropriations. On that
basis, we estimate costs of $13 million over the 2021-2022
period for additional leases.
In total, CBO estimates implementing section 204 would cost
$238 million over the 2018-2022 period.
Modify Threshold for Major Medical Facilities. Section 201
would allow VA to construct medical facilities with total costs
of up to $20 million without legislative authorization. Under
current law, VA is required to receive legislative
authorization to construct medical facilities with total
expenses above $10 million.
Based on an analysis of information on planned construction
projects in VA's 2018 budget submission, CBO estimates that
implementing this section would authorize one additional
construction project each year with an average cost of $16
million. On that basis, CBO estimates costs of $36 million over
the 2018-2022 period.
In addition, as discussed above under Direct Spending, this
section would also expand VA's authority to enter into leases
for medical facilities. CBO estimates that VA would enter into
6 additional leases each year with a total annual rent payment
of $7 million. For those leases, we expect that VA would record
obligations of $20 million each year as it enters those
contracts, from available appropriations. On that basis, we
estimate costs of $36 million over the 2021-2022 period for
additional leases.
In total, CBO estimates implementing section 201 would cost
$72 million over the 2018-2022 period for additional leases.
Procedures for Recommendations. By February 1, 2021,
section 103 would require VA, in consultation with Veterans
Service Organizations, to publish the criteria for assessing
and making recommendations for modernizing, realigning and
closing VA medical facilities. In making recommendations VA
must hold public field hearings with local stakeholders. The
final criteria must be published by May 1, 2021, after
receiving comments from the public. In addition, VA would be
required to conduct capacity and commercial market assessments.
On the basis of costs for nationwide assessments, CBO estimates
that an equivalent of 20 full time employees (with average
annual compensation of $150,000) would be necessary. Thus, CBO
estimates implementing this provision would cost $10 million
over the 2018-2022 period.
Training for Construction Personnel. Section 203 would
require VA to offer job training (in person, online or by
another federal agency) for all construction employees. CBO
estimates that implementing this section would cost $1 million
to develop the training materials over the 2018-2022 period.
Pay-As-You-Go considerations: The Statutory Pay-As-You-Go
Act of 2010 establishes budget-reporting and enforcement
procedures for legislation affecting direct spending or
revenues. The net changes in outlays that are subject to those
pay-as-you-go procedures are shown in the following table.
CBO ESTIMATE OF PAY-AS-YOU-GO EFFECTS FOR H.R. 4243, AS ORDERED REPORTED BY THE HOUSE COMMITTEE ON VETERANS' AFFAIRS ON NOVEMBER 8, 2017
--------------------------------------------------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
--------------------------------------------------------------------------------------------
2018- 2018-
2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2022 2027
--------------------------------------------------------------------------------------------------------------------------------------------------------
NET INCREASE IN THE ON-BUDGET DEFICIT
Statutory Pay-As-You-Go Impact............................ 2,220 340 70 76 102 159 192 213 227 227 2,808 3,826
--------------------------------------------------------------------------------------------------------------------------------------------------------
Increase in long-term direct spending and deficits: CBO
estimates that enacting H.R. 4243 would increase direct
spending by more than $2.5 billion and would increase on-budget
deficits by more than $5 billion in at least one of the four
consecutive 10-year periods beginning in 2028.
Mandates: H.R. 4243 contains no intergovernmental or
private-sector mandates as defined in UMRA.
Estimate prepared by: Federal costs: Ann E. Futrell;
Mandates: Zach Byrum.
Estimate approved by: H. Samuel Papenfuss, Deputy Assistant
Director for Budget Analysis.
Federal Mandates Statement
The Committee adopts as its own the estimate of Federal
mandates regarding H.R. 4243, as amended, prepared by the
Director of the Congressional Budget Office pursuant to section
423 of the Unfunded Mandates Reform Act.
Advisory Committee Statement
No advisory committees within the meaning of section 5(b)
of the Federal Advisory Committee Act would be created by H.R.
4243, as amended.
Statement of Constitutional Authority
Pursuant to Article I, section 8 of the United States
Constitution, H.R. 4243, as amended, is authorized by Congress'
power to ``provide for the common Defense and general Welfare
of the United States.''
Applicability to Legislative Branch
The Committee finds that H.R. 4243, as amended, does not
relate to the terms and conditions of employment or access to
public services or accommodations within the meaning of section
102(b)(3) of the Congressional Accountability Act.
Statement on Duplication of Federal Programs
Pursuant to section 3(g) of H. Res. 5, 115th Cong. (2017),
the Committee finds that no provision of H.R. 4243, as amended,
establishes or reauthorizes a program of the Federal Government
known to be duplicative of another Federal program, a program
that was included in any report from the Government
Accountability Office to Congress pursuant to section 21 of
Public Law 111-139, or a program related to a program
identified in the most recent Catalog of Federal Domestic
Assistance.
Disclosure of Directed Rulemaking
Pursuant to section 3(i) of H. Res. 5, 115th Cong. (2017),
the Committee estimates that H.R. 4243, as amended, would
require VA to prescribe regulations.
Section-by-Section Analysis of the Legislation
TITLE I--ASSET AND INFRASTRUCTURE REVIEW
Section 101. Short title
Section 101 of the bill would establish a short title of
the ``Department of Veterans Affairs (VA) Asset and
Infrastructure Review (AIR) Act of 2017.''
Section 102. The Commission
Section 102(a) of the bill would establish an independent
``VA Asset and Infrastructure Review (AIR) Commission.''
Section 102(b) of the bill would require the Commission to
carry out the duties described in this title.
Section 102(c)(1) of the bill would require the President,
with the advice and consent of the Senate, to appoint nine AIR
Commissioners and to transmit nominations to the Senate by May
31, 2021.
Section 102(c)(2) of the bill would require the President
to consult with the Speaker and minority leader of the House of
Representatives and the majority and minority leader of the
Senate in selecting individuals for Commission nomination and
congressionally chartered, membership-based veterans service
organizations (VSOs) specifically concerning the appointment of
three members.
Section 102(c)(3) of the bill would require the President
to nominate one person to serve as the Chair of the Commission
and one person to serve as the Vice Chair of the Commission.
Section 102(c)(4) of the bill would require the President,
in nominating individuals for appointment to the Commission, to
ensure: that veterans (reflecting current demographics of
veterans enrolled in the VA health care system) are adequately
represented in the membership of the Commission; that at least
one member of the Commission has experience with a private
integrated health care system that has annual gross revenue of
more than $50 million; that at least one member has experience
as a senior manager for a Federally-qualified health center,
the Department of Defense, or the Indian Health Service; that
at least one member has experience with capital asset
management for the Federal government and is familiar with
trades related to building and real property (including
construction, engineering, architecture, leasing, and strategic
partnerships); and, that at least three members represent
congressionally-chartered, membership-based VSOs.
Section 102(d) of the bill would require the Commission to
meet only during calendar years 2022 and 2023, and requires
that each meeting of the Commission be open and all
proceedings, information, and deliberations of the Commission
to be available for review by the public.
Section 102(e) of the bill would require a vacancy in the
Commission to be filled in the same manner as the original
appointment, but the individual appointed to fill the vacancy
to serve only for the unexpired portion of the term for which
the individual's predecessor was appointed.
Section 102(f) of the bill would require Commissioners to
serve without pay, requires each member of the Commission who
is an officer/employee of the United States to only receive
compensation for their services as an officer/employee of the
U.S, and allows Commissioners to receive travel expenses,
including per diem.
Section 102(g) of the bill would require the Commission to
appoint a staff director who has not served as a VA employee
during the one-year period preceding the date of appointment
and who is not otherwise barred or prohibited from serving as a
Director under Federal ethics law and regulations by reason of
post-employment conflict of interest and requires the Director
to be paid at the rate of basic pay payable for level IV of the
Executive Schedule.
Section 102(h)(1) and (2) of the bill would require the
Director, with the approval of the Commission, to appoint and
fix the pay of additional personnel, to make such appointments
without regard to the provisions of title 5 U.S.C. governing
appointments in the competitive service, and any personnel so
appointed to be paid without regard to provisions relating to
the classification and General Schedule pay rates except that
an individual so appointed may not receive pay in excess of the
annual rate of basic pay payable for GS-15.
Section 102(h)(3) of the bill would allow not more than
two-thirds of the personnel employed by or detailed to the
Commission to be on detail from VA and not more half of the
professional analysts to be detailed from VA. This section also
prohibits a person from being detailed to the Commission from
VA if, within 6 months before the detail is set to begin, the
person participated personally or substantially in any matter
concerning the preparation of recommendations regarding
Veterans Health Administration (VHA) facilities.
Section 102(h)(4) would allow any Federal department or
agency to detail personnel to the Commission upon request.
Section 102(h)(5) of the bill would allow the Commission to
secure necessary information from Federal agencies and Federal
agencies to furnish such information upon request.
Section 102(i) of the bill would allow the Commission to
procure, by contract to the extent funds are available, the
temporary or intermittent services or experts of consultants
and to lease real property and acquire personal property either
of its own accord or in consultation with the General Services
Administration (GSA).
Section 102(j) of the bill would terminate the Commission
on December 31, 2023.
Section 102(k) of the bill would prohibit the restriction
of lawful communication from a VA employee to the Commission.
Section 103. Procedure for making recommendations
Section 103(a)(1) of the bill would require VA--not later
than February 1, 2021, and after consulting with VSOs--to
publish in the Federal Register and transmit to the Committees
on Veterans' Affairs of the House of Representatives and the
Senate (HVAC/SVAC) the criteria proposed by VA to be used in
assessment and making recommendations regarding the
modernization or realignment of VHA facilities and require such
criteria to include the veterans preference regarding access to
VA health care.
Section 103(a)(2) of the bill would require a 90-day public
comment period for VA's proposed criteria.
Section 103(a)(3) of the bill would require VA--not later
than May 31, 2021--to publish in the Federal Register and
transmit to HVAC/SVAC, the final criteria to be used in making
recommendations regarding the modernization or realignment of
VHA facilities.
Section 103(b)(1) of the bill would require VA--not later
than January 31, 2022, and after consulting with VSOs--to
publish in the Federal Register and transmit to HVAC/SVAC a
report detailing recommendations regarding the modernization or
realignment of VHA facilities.
Section 103(b)(2) of the bill would require VA to consider
the following factors in making recommendations regarding the
modernization or realignment of VHA facilities: the degree to
which health care delivery or other site for providing services
to veterans reflect VA's metrics regarding market area health
system planning; the provision of effective and efficient
access to high-quality health care and services to veterans;
the extent to which real property that no longer meets the
needs of the Federal Government could be reconfigured,
repurposed, consolidated, realigned, exchanged, outleased,
repurposed, replaced, sold, or disposed; VHA's need to acquire
infrastructure or facilities that will be used for the
provision of health care and service to veterans; the extent to
which operation and maintenance costs are reduced through
consolidating, collocating, and reconfiguring space and through
realizing other operational efficiencies; the extent and timing
of potential costs and savings, including the number of years
such costs and savings will be incurred, beginning with the
date of completion of the proposed recommendation; the extent
to which the real property aligns with VA's mission; the extent
to which any action would impact other VA missions including
education, research, or emergency preparedness; local
stakeholder inputs and any factors identified through public
field hearings; capacity and commercial market assessments;
and, any other factors VA determines appropriate.
Section 103(b)(3)(A) of the bill would require VA to assess
the capacity of each Veterans Integrated Service Network (VISN)
and VA medical facility to furnish hospital care or medical
services to veterans and require each assessment to:
Identify existing deficiencies in the furnishing of
care and services to veterans and how such deficiencies
may be filled by entering into contracts or agreements
with community health care providers or other entities
under other provisions of law and changing the way care
and services are furnished at such VISNs or VA medical
facilities (including through extending hours of
operation, adding personnel, and expanding treatment
space through construction, leasing, or sharing of
health care facilities);
Forecast, based on future projections and historical
trends, both the short-term and long term demand in
furnishing care and services at such VISN or VA medical
facility;
Consider how demand affects the need to enter into
contracts or agreements;
Consider the commercial health care market of
designated catchment areas conducted by a non-
governmental entity; and,
Consider the unique ability of the Federal government
to retain a presence in a rural area otherwise devoid
of commercial health care providers or from which such
providers are at risk of leaving.
Section 103(b)(3)(B) of the bill would require the
Secretary to consult with VSOs and veterans served by each VISN
and medical facility affected by the assessments.
Section 103(b)(3)(C) of the bill would require VA to submit
the local capacity and commercial market assessments to HVAC/
SVAC with the recommendations regarding the modernization or
realignment of VHA facilities and to make the assessments
publicly available.
Section 103(b)(4) of the bill would require VA to include
with the recommendations regarding the modernization or
realignment of VHA facilities a summary of the selection
process that resulted in the recommendation for each VHA
facility and a justification for each recommendation and to
transmit the summaries and justifications not later than 7 days
after the date of transmittal to HVAC/SVAC.
Section 103(b)(5) of the bill would require VA to consider
all facilities equally without regard to whether the facility
has been previously considered or proposed for reuse,
modernization, or realignment.
Section 103(b)(6) of the bill would require VA to make all
information used by VA to prepare a recommendation available to
Congress, the Commission and the Comptroller General.
Section 103(b)(7) of the bill would require each VA Under
Secretary, VISN director, VA medical center director, VA
program office director, and each person who is in a position
of duties which includes personal and substantial involvement
in the preparation and submission of information and
recommendations concerning the modernization or realignment of
VHA facilities to certify that information submitted to VA or
to the Commission concerning the modernization or realignment
of VHA facilities is accurate and complete to the best of that
person's knowledge and belief.
Section 103(c)(1)(A) and (B) of the bill would require the
Commission to conduct public hearings on the Secretary's
recommendations regarding the modernization or realignment of
VHA facilities, to include required public hearings in regions
affected by a VA recommendation for the closure of a facility
and, to the greatest extent practicable, public hearings in
regions affected by a recommendation for other (non-closure)
action by VA.
Section 103(d)(1)(C) of the bill would require each
Commission public hearing to include, at a minimum, a local
veteran who is enrolled in the VA healthcare system and
identified by a local VSO and a local elected official.
Section 103(c)(2)(A) of the bill would require the
Commission--not later than January 31, 2023--to transmit to the
President a report and analysis of the recommendations made by
VA together with the Commission's recommendations for the
modernization or realignment of VHA facilities.
Section 103(c)(2)(B) of the bill would authorize the
Commission to change a recommendation made by VA for the
modernization or realignment of a VHA facility only if the
Commission: determines that VA deviated substantially from VA's
final criteria in making such recommendation; determines that
the change is consistent with the final criteria; publishes a
notice of the proposed change in the Federal Register not less
than 45 days before transmitting the Commission's
recommendations to the President; and, conducts public hearings
on the proposed change.
Section 103(c)(3) of the bill would require the Commission
to explain and justify any recommendation made by the
Commission that is different from the recommendations made by
VA in the Commission's report that is transmitted to the
President and to transmit the copy of such report to HVAC/SVAC
on the same day that it is transmitted to the President.
Section 103(c)(4) of the bill would require the
Commission--after January 31, 2023--to promptly provide
information used by the Commission in making its
recommendations to any Member of Congress upon request.
Section 103(d) of the bill would require the President--not
later than February 15, 2023--to transmit to the Commission and
to Congress a report containing the President's approval or
disapproval of the Commission's recommendations.
If the President approves of the Commission's
recommendations, requires the President to transmit a
copy of the Commission's recommendations to the
Congress together with a certification of approval.
If the President disapproves of the Commission's
recommendations in whole or in part, requires the
President to transmit to the Commission and the
Congress the reasons for that disapproval and require
the Commission--not later than March 15, 2023--to
transmit a revised list of recommendations to the
President.
If the President approves of the Commission's revised
recommendations, requires the President to transmit a
copy of the revised recommendations to Congress
together with a certification of such approval.
Would require the process for modernization or
realignment of VHA facilities to be terminated, if the
President does not transmit a certification of approval
to Congress, by March 30, 2023.
Section 104. Actions regarding infrastructure and facilities of the
Veterans Health Administration
Section 104(a) and (b) of the bill would require the
Secretary, in the absence of a resolution of Congressional
disapproval having been enacted within 45 days of Presidential
transmission of the report to Congress or the adjournment of
the 117th Congress, to begin implementing the recommendations
made in the report under Section 103(d) within 3 years the
President having transmitted the report to Congress.
Implementation includes the planning of modernizations or
realignments. Days on which either House is not in session
because of adjournment of more than three days shall be
excluded from the computation of the period.
Section 104(c) of the bill would authorize any obligation
or expenditure of funds for major medical facility leases or
projects made by the report.
Section 105. Implementation
Section 105(a) of the bill would allow the Secretary to
take such actions as necessary to implement the modernization
or realignment of any VHA facility, perform environmental
mitigation, abatement or restoration of facilities being closed
or realigned to include compliance with historical preservation
requirements, provide outplacement assistance to employees of
the Department, reimburse Federal agencies for services, and
enter into Enhanced Use Lease contracts.
Section 105(b) of the bill would outline how the Secretary
may dispose or transfer surplus properties slated for disposal
or realignment under this Act, including consultation with
state and local governments for proper disposal of real
property and roads.
The Secretary may transfer title to a redevelopment
authority for a facility for the purposes of a federal
lease for a term not to exceed 50 years. Such lease may
not require rental payments by the government.
If the lease involves a substantial portion of the
facility, the department or agency may obtain facility
services from the redevelopment authority as a
provision of the lease. Such services shall not include
municipal services, firefighting or security guard
functions.
Provisions of the Comprehensive Environmental
Response, Compensation, and Liability Act of 1980
apply. Nothing in this title shall limit or otherwise
affect application of McKinney-Vento Homeless
Assistance Act provisions.
Section 105(c) of the bill would exempt the Secretary from
the National Environmental Policy Act of 1969 in carrying out
the recommendations of this title.
Section 105(d) of the bill would exempt the Secretary from
any legal prohibition of closing or realigning VHA facilities
included in any appropriation or authorization Act.
Section 105(e) of the bill would provide the authority for
the Secretary to transfer a deed of a VHA facility to a party
who agrees to perform the environmental compliance activities
that are required under federal and state laws. Such transfer
may occur if the Secretary certifies to Congress that all costs
to be paid by the Department are equal to or greater than
market value or if such cost are lower than the recipient of
the transfer agrees to pay the difference.
Section 106. Department of Veterans Affairs asset and infrastructure
review account
Section 106(a) of the bill would establish a single account
in the ledgers of the U.S. Treasury with which the Secretary
may carry out this Act.
Section 106(b) of the bill would allow for the credit to
the account any funds authorized and appropriated and any
proceeds from a lease, transfer, or disposal of property.
Section 106(c) of the bill would allow the Secretary to use
the account for the purposes of carrying out this title, to
cover property management and disposal costs, to cover costs of
supervision, inspection, overhead, engineering, and design, or
for any other purposes in support of the Departments mission
and operations.
Section 106(d) of the bill would require the Secretary to
establish a consolidated budget display detailing the amount
and nature of the credits to and expenditures from, separately
details environmental remediation costs, specifies and details
any transfers. This information shall be submitted to Congress
as part of the Presidential budget submission.
Section 106(e) of the bill would require that upon closure
of the account any unobligated funds, upon submission of an
accounting report to HVAC/SVAC and the Committees on
Appropriations of the House of Representatives and the Senate,
shall be transferred to the Secretary.
Section 107. Congressional consideration of commission report
Section 107(a) of the bill would describe the term ``joint
resolution'' as a resolution introduced within the 45-day
period beginning on the date on which the President transmits
the report to congress which does not include a preamble and
contains specific language as to the resolving clause and
title.
Section 107(b) of the bill would outline the means by which
the House of Representatives shall consider such resolution to
include reporting and discharge, proceeding to consideration,
and consideration.
Section 107(c) of the bill outlines the means by which the
Senate shall consider such resolution to include referral,
reporting and discharge, and floor consideration to include
consideration, vote on passage, and ruling of the chair on
procedure.
Section 107(d) of the bill would prohibit any amendment to
a joint resolution of disapproval.
Section 107(e) of the bill would define the coordination
between either House upon receipt of companion measures.
Section 107(f) of the bill would state that this section is
applicable only with respect to the procedure followed in that
House in the case of a joint resolution and supersedes other
rules only to the extent that it is inconsistent with such
rules, with the recognition of the constitutional right of
either House to change the rules.
Section 108. Other matters
Section 108(a) of the bill would require the online
publication of all communications, within 24 hours, between the
Secretary, the Commission and the President with regards to
this title.
Section 108(b) of the bill would prohibit the VA from
pausing or stopping any scheduled construction, leasing, long-
term planning project activities, or budgetary processes with
regards to the construction during the activities of the
Commission, President, or Congress in carrying out this title.
Section 109. Definitions
Section 109 of the bill would define:
``Account'' as the VA AIR Account established by
section 106.
``Commission'' as the AIR Commission established by
section 102.
``date of approval'' with respect to a modernization
or realignment of a VHA facility as the date on which
the authority of Congress to disapprove a
recommendation of under this title expires.
``VHA facility'' as: (1) any land, building,
structure, or infrastructure (including any medical
center, nursing home, domiciliary facility, outpatient
clinic, center that provides readjustment counseling,
or leased facility) that is under VA's jurisdiction,
under VHA's control, and not under GSA's control; and,
(2) with respect to a collocated VA facility, includes
any land, building, or structure that is under VA's
jurisdiction, under control of another VA
administration, and not under GSA's control.
``infrastructure'' as improvements to land other than
buildings or structures.
``modernization'' as any action required to align the
form and function of a VHA facility to the provision of
modern day health care (including utilities and
environmental control systems), the closure,
construction purchase, lease, or sharing of a VHA
facility, and realignments, disposals, exchanges,
collaborations, between VA and other Federal entities
and strategic collaborations between VA and non-Federal
entities.
``realignment'' with respect to a VHA facility to
include any action that changes the number of or
relocates services, functions, and personnel positions;
disposals or exchanges between VA and other Federal
entities including DOD; and, strategic collaborations
between VA and non-Federal entities.
``Secretary'' to mean the Secretary of Veterans
Affairs.
``redevelopment authority'' to mean, in the case of a
VHA facility closed or modernized under this title, any
entity (including an entity established by a State or
local government) recognized by VA as the entity
responsible for developing the redevelopment plan with
respect to the facility or for directing the
implementation of such a plan.
``redevelopment plan'' in the case of a VHA facility
to be closed or realigned to mean a plan that is agreed
to by the local redevelopment authority with respect to
the facility and provides for the reuse or
redevelopment of the real property and personal
property of the facility that is available for such
reuse and redevelopment as a result of the closure or
realignment of a facility.
TITLE II--IMPROVEMENTS TO CONSTRUCTION MANAGEMENT AND LEASES
Section 201. Modification of thresholds for major medical facility
projects and major medical facility leases
Section 201(a) of the bill would change the definition of a
major medical facility project to that of one involving a total
expenditure of more than $20,000,000. The term does not include
acquisitions by exchange, non-recurring maintenance, or in the
case of a shared facility, when the Departments estimated share
is below $200,000,000. The definition of a major medical
facility lease is changed to reflect an average annual rent
that is equal to or greater than the amount specified by GSA.
Section 201(b) of the bill would establish an effective
date on or after enactment of this Act.
Section 202. Submission of prospectuses of proposed minor medical
facility projects
Section 202 of the bill would require the VA to include the
prospectus of facility projects presented to Congress under
Section 8104(b) of Title 38, USC that require a total
expenditure of more than $10,000,000 and less than $20,000,000.
Section 203. Improvement to training of construction personnel
Section 203 of the bill would require that the Secretary
implement a covered training, curriculum and covered
certification program that models existing training curricula
and certification programs as established under Chapter 87 of
Title 10.
Section 204. Authority to plan, design, construct, or lease shared
medical facilities.
Section 204 of the bill would grant the Secretary the
authority to plan, design, construct, or lease a medical
facility with other federal departments or agencies. Funds may
be transferred from Construction, Major or Construction, Minor
accounts based on the amount of the estimated costs to be
shared by the Department.
Section 205. Enhanced use lease authority
Section 205 of the bill would grant the Secretary the
authority to enter into enhanced-use leases for purposes other
than supportive housing.
TITLE III--OTHER MATTERS
Section 301. Exception of limitations on awards and bonuses for
recruitment, relocation, and retention
Section 301 of the bill would amend the restriction imposed
on bonuses and awards included in the Veteran Access, Choice,
and Accountability Act of 2014 by exempting bonuses and awards
for the purposes of incentives for the recruitment, relocation
and retention of VA employees.
Section 302. Appropriation of amounts
Section 302(a) of the bill would authorize and appropriate
$2,100,000,000 for the Veterans Choice Program.
Section 302(b) of the bill would authorize and appropriate
$500,000,000 for minor construction and nonrecurring
maintenance of VHA medical facilities and requires the
Secretary to notify HVAC/SVAC of the projects for which these
funds shall be allocated.
Section 303. Assessment of health care furnished by the Department to
veterans who live in the territories
Section 303 of the bill would require the Secretary to
submit to HVAC/SVAC a report regarding the health care
furnished by VA to veterans who live in the territories of
American Samoa, Guam, Northern Mariana Island, Puerto Rico and
the Virgin Islands. The report shall assess the ability of the
Department to provide hospital care, medical, mental health,
and geriatric services, as well as assess the feasibility of
establishing a medical facility in any territory that does not
contain such a facility.
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italic, and existing law in which no
change is proposed is shown in roman):
TITLE 38, UNITED STATES CODE
* * * * * * *
PART VI--ACQUISITION AND DISPOSITION OF PROPERTY
* * * * * * *
CHAPTER 81--ACQUISITION AND OPERATION OF HOSPITAL AND DOMICILIARY
FACILITIES; PROCUREMENT AND SUPPLY; ENHANCED-USE LEASES OF REAL
PROPERTY
SUBCHAPTER I--ACQUISITION AND OPERATION OF MEDICAL FACILITIES
Sec.
8101. Definitions.
* * * * * * *
8111B. Authority to plan, design, construct, or lease a medical facility
shared with other departments or agencies.
* * * * * * *
SUBCHAPTER I--ACQUISITION AND OPERATION OF MEDICAL FACILITIES
Sec. 8101. Definitions
For the purposes of this subchapter:
(1) The term ``alter'', with respect to a medical facility,
means to repair, remodel, improve, or extend such medical
facility.
(2) The terms ``construct'' and ``alter'', with respect to a
medical facility, include such engineering, architectural,
legal, fiscal, and economic investigations and studies and such
surveys, designs, plans, construction documents,
specifications, procedures, and other similar actions as are
necessary for the construction or alteration, as the case may
be, of such medical facility and as are carried out after the
completion of the advanced planning (including the development
of project requirements and design development) for such
facility.
[(3) The term ``medical facility'' means any facility or part
thereof which is, or will be, under the jurisdiction of the
Secretary for the provision of health-care services (including
hospital, nursing home, or domiciliary care or medical
services), including any necessary building and auxiliary
structure, garage, parking facility, mechanical equipment,
trackage facilities leading thereto, abutting sidewalks,
accommodations for attending personnel, and recreation
facilities associated therewith.]
(3) The term ``medical facility'' means any facility or part
thereof which is, or will be, under the jurisdiction of the
Secretary, including with respect to a shared medical facility
(as defined in section 8111B(d) of this title), for the
provision of health-care services (including hospital,
outpatient clinic, extended care services, nursing home, or
domiciliary care or medical services), including any necessary
building and auxiliary structure, garage, parking facility,
mechanical equipment, trackage facilities leading thereto,
abutting sidewalks, accommodations for attending personnel, and
recreation facilities associated therewith.
(4) The term ``committee'' means the Committee on Veterans'
Affairs of the House of Representatives or the Committee on
Veterans' Affairs of the Senate, and the term ``committees''
means both such committees.
* * * * * * *
Sec. 8103. Authority to construct and alter, and to acquire sites for,
medical facilities
(a) Subject to section 8104 of this title, the Secretary--
(1) may construct or alter any medical facility and
may acquire, by purchase, lease, condemnation,
donation, exchange, or otherwise, such land or
interests in land as the Secretary considers necessary
for use as the site for such construction or
alteration;
(2) may acquire, by purchase, lease, condemnation,
donation, exchange, or otherwise, any facility
(including the site of such facility) that the
Secretary considers necessary for use as a medical
facility; and
(3) in order to assure compliance with section
8110(a)(2) of this title, in the case of any outpatient
medical facility for which it is proposed to lease
space and for which a qualified lessor and an
appropriate leasing arrangement are available, shall
execute a lease for such facility within 12 months
after funds are made available for such purpose.
(b) Whenever the Secretary considers it to be in the interest
of the United States to construct a new medical facility to
replace an existing medical facility, the Secretary (1) may
demolish the existing facility and use the site on which it is
located for the site of the new medical facility, or (2) if in
the judgment of the Secretary it is more advantageous to
construct such medical facility on a different site in the same
locality, may exchange such existing facility and the site of
such existing facility for the different site.
(c) Whenever the Secretary determines that any site acquired
for the construction of a medical facility is not suitable for
that purpose, the Secretary may exchange such site for another
site to be used for that purpose or may sell such site.
(d)(1) The Secretary may provide for the acquisition of not
more than three facilities for the provision of outpatient
services or nursing home care through lease-purchase
arrangements on real property under the jurisdiction of the
Department of Veterans Affairs.
(2)(A) In carrying out this subsection and notwithstanding
any other provision of law, the Secretary may lease, with or
without compensation and for a period of not to exceed 35
years, to another party any of the real property described in
paragraph (1) of this subsection.
(B) Such real property shall be used as the site of a
facility referred to in paragraph (1) of this subsection--
(i) constructed and owned by the lessee of such real
property; and
(ii) leased under paragraph (3)(A) of this subsection
to the Department for such use and for such other
activities as the Secretary determines are appropriate.
(3)(A) The Secretary may enter into a lease for the use of
any facility described in paragraph (2)(B) of this subsection
for not more than 35 years under such terms and conditions as
may be in the best interests of the Department.
(B) Each agreement to lease a facility under subparagraph (A)
of this paragraph shall include a provision that--
(i) the obligation of the United States to make
payments under the agreement is subject to the
availability of appropriations for that purpose; and
(ii) the ownership of such facility shall vest in the
United States at the end of such lease.
(4)(A) The Secretary may sublease any space in such a
facility to another party at a rate not less than--
(i) the rental rate paid by the Secretary for such
space under paragraph (3) of this subsection; plus
(ii) the amount the Secretary pays for the costs of
administering such facility (including operation,
maintenance, utility, and rehabilitation costs) which
are attributable to such space.
(B) In any such sublease, the Secretary shall include such
terms relating to default and nonperformance as the Secretary
considers appropriate to protect the interests of the United
States.
(5) The Secretary shall use the receipts of any payment for
the lease of real property under paragraph (2) for the payment
of the lease of a facility under paragraph (3).
(6) The authority to enter into an agreement under this
subsection--
(A) shall not take effect until the Secretary has
entered into agreements under section 316 of this title
to carry out at least three collocations; and
(B) shall expire on October 1, 1993.
(e)(1) In the case of any super construction project, the
Secretary shall enter into an agreement with an appropriate
non-Department Federal entity to provide full project
management services for the super construction project,
including management over the project design, acquisition,
construction, and contract changes.
(2) An agreement entered into under paragraph (1) with a
Federal entity shall provide that the Secretary shall reimburse
the Federal entity for all costs associated with the provision
of project management services under the agreement.
(3) In this subsection, the term ``super construction
project'' means a project for the construction, alteration, or
acquisition of a medical facility involving a total expenditure
of more than $100,000,000.
(f) To the maximum extent practicable, the Secretary shall
use industry standards, standard designs, and best practices in
carrying out the construction of medical facilities.
[(g) The Secretary shall ensure that each employee of the
Department with responsibilities, as determined by the
Secretary, relating to the infrastructure construction or
alteration of medical facilities, including such construction
or alteration carried out pursuant to contracts or agreements,
undergoes a program of ongoing professional training and
development. Such program shall be designed to ensure that
employees maintain adequate expertise relating to industry
standards and best practices for the acquisition of design and
construction services. The Secretary may provide the program
under this subsection directly or through a contract or
agreement with a non-Federal entity or with a non-Department
Federal entity.]
(g)(1)(A) Not later than September 30 of the fiscal year
following the fiscal year during which this subsection is
enacted, the Secretary shall implement the covered training
curriculum and the covered certification program.
(B) In designing and implementing the covered training
curriculum and the covered certification program under
paragraph (1), the Secretary shall use as models existing
training curricula and certification programs that have been
established under chapter 87 of title 10, United States Code,
as determined relevant by the Secretary.
(2) The Secretary may develop the training curriculum under
paragraph (1)(A) in a manner that provides such training in any
combination of--
(A) training provided in person;
(B) training provided over an internet website; or
(C) training provided by another department or agency
of the Federal Government.
(3) The Secretary may develop the certification program under
paragraph (1)(A) in a manner that uses--
(A) one level of certification; or
(B) more than one level of certification, as
determined appropriate by the Secretary with respect to
the level of certification for different grades of the
General Schedule.
(4) The Secretary may enter into a contract with an
appropriate entity to provide the covered training curriculum
and the covered certification program under paragraph (1)(A).
(5)(A) Not later than September 30 of the second fiscal year
following the fiscal year during which this Act is enacted, the
Secretary shall ensure that the majority of employees subject
to the covered certification program achieve the certification
or the appropriate level of certification pursuant to paragraph
(3), as the case may be.
(B) After carrying out subparagraph (A), the Secretary shall
ensure that each employee subject to the covered certification
program achieves the certification or the appropriate level of
certification pursuant to paragraph (3), as the case may be, as
quickly as practicable.
(6) In this subsection:
(A) The term ``covered certification program'' means,
with respect to employees of the Department of Veterans
Affairs who are members of occupational series relating
to construction or facilities management, or employees
of the Department who award or administer contracts for
major construction, minor construction, or nonrecurring
maintenance, including as contract specialists or
contracting officers' representatives, a program to
certify knowledge and skills relating to construction
or facilities management and to ensure that such
employees maintain adequate expertise relating to
industry standards and best practices for the
acquisition of design and construction services.
(B) The term ``covered training curriculum'' means,
with respect to employees specified in subparagraph
(A), a training curriculum relating to construction or
facilities management.
Sec. 8104. Congressional approval of certain medical facility
acquisitions
(a)(1) The purpose of this subsection is to enable Congress
to ensure the equitable distribution of medical facilities
throughout the United States, taking into consideration the
comparative urgency of the need for the services to be provided
in the case of each particular facility.
(2) No funds may be appropriated for any fiscal year, and the
Secretary may not obligate or expend funds (other than for
advance planning and design), for any major medical facility
project or any major medical facility lease unless funds for
that project or lease have been specifically authorized by law.
[(3) For the purpose of this subsection:
[(A) The term ``major medical facility project''
means a project for the construction, alteration, or
acquisition of a medical facility involving a total
expenditure of more than $10,000,000, but such term
does not include an acquisition by exchange.
[(B) The term ``major medical facility lease'' means
a lease for space for use as a new medical facility at
an average annual rental of more than $1,000,000.]
(3) In this subsection:
(A)(i) The term ``major medical facility project''
means--
(I) a project for the construction,
alteration, or acquisition of a medical
facility involving a total expenditure of more
than $20,000,000; or
(II) the construction, alteration, or
acquisition of a shared medical facility (as
defined in section 8111B(d) of this title) for
which the estimated share of the Department of
Veterans Affairs for the costs of such
construction, alteration, or acquisition
exceeds $20,000,000.
(ii) Such term does not include--
(I) an acquisition by exchange;
(II) nonrecurring maintenance projects of the
Department; or
(III) the construction, alteration, or
acquisition of a shared medical facility for
which the estimated share of the Department of
Veterans Affairs for the costs of such
construction, alteration, or acquisition does
not exceed $20,000,000.
(B) The term ``major medical facility lease'' means--
(i) a lease for space for use as a new
medical facility at an average annual rent that
is equal to or exceeds the amount specified in
subsection (a)(2) of section 3307 of title 40;
or
(ii) a lease for space for use as a shared
medical facility (as defined in section
8111B(d) of this title) for which the estimated
share of the Department of Veterans Affairs for
the costs of such lease is equal to or exceeds
the amount specified in subsection (a)(2) of
section 3307 of title 40.
(b) Whenever the President or the Secretary submit to the
Congress a request for the funding of [a major medical facility
project (as defined in subsection (a)(3)(A))] a major medical
facility project (as defined in subsection (a)(3)(A)), a
medical facility project that would be a major medical facility
project but for the total expenditure (or, with respect to a
shared medical facility, the estimated share of the Department
of Veterans Affairs) being an amount that is more than
$10,000,000 and less than $20,000,000, or a major medical
facility lease (as defined in subsection (a)(3)(B)), the
Secretary shall submit to each committee, on the same day, a
prospectus of the proposed medical facility. Any such
prospectus shall include the following:
(1) A detailed estimate of the total costs of the
medical facility to be constructed, altered, leased, or
otherwise acquired under this subchapter, including a
description of the location of such facility and, in
the case of a prospectus proposing the construction of
a new or replacement medical facility, a detailed
report of the consideration that was given to acquiring
an existing facility by lease or purchase and to the
sharing of health-care resources with the Department of
Defense under section 8111 of this title. Such detailed
estimate shall include an identification of each of the
following:
(A) Total construction costs.
(B) Activation costs.
(C) Special purpose alterations (lump-sum
payment) costs.
(D) Number of personnel.
(E) Total costs of ancillary services,
equipment, and all other items.
(2) Demographic data applicable to such facility,
including information on projected changes in the
population of veterans to be served by the facility
over a five-year period, a ten-year period, and a
twenty-year period.
(3) Current and projected workload and utilization
data regarding the facility, including information on
projected changes in workload and utilization over a
five-year period, a ten-year period, and a twenty-year
period.
(4) Projected operating costs of the facility,
including both recurring and non-recurring costs
(including and identifying both recurring and non-
recurring costs (including activation costs and total
costs of ancillary services, equipment and all other
items)) over a five-year period, a ten-year period, and
a twenty-year period.
(5) The priority score assigned to the project or
lease under the Department's prioritization methodology
and, if the project or lease is being proposed for
funding before a project or lease with a higher score,
a specific explanation of the factors other than the
priority score that were considered and the basis on
which the project or lease is proposed for funding
ahead of projects or leases with higher priority
scores.
(6) In the case of a prospectus proposing the
construction of a new or replacement medical facility,
each of the following:
(A) A detailed estimate of the total costs
(including total construction costs, activation
costs, special purpose alterations (lump-sum
payment) costs, number of personnel and total
costs of ancillary services, equipment and all
other items) for each alternative to
construction of the facility that was
considered.
(B) A comparison of total costs to total
benefits for each such alternative.
(C) An explanation of why the preferred
alternative is the most effective means to
achieve the stated project goals and the most
cost-effective alternative.
(7) In the case of a prospectus proposing funding for
a major medical facility lease, a detailed analysis of
how the lease is expected to comply with Office of
Management and Budget Circular A-11 and section 1341 of
title 31 (commonly referred to as the ``Anti-Deficiency
Act''). Any such analysis shall include--
(A) an analysis of the classification of the
lease as a ``lease-purchase'', ``capital
lease'', or ``operating lease'' as those terms
are defined in Office of Management and Budget
Circular A-11;
(B) an analysis of the obligation of
budgetary resources associated with the lease;
and
(C) an analysis of the methodology used in
determining the asset cost, fair market value,
and cancellation costs of the lease.
(c)(1) Not less than 30 days before obligating funds for a
major medical facility project approved by a law described in
subsection (a)(2) of this section in an amount that would cause
the total amount obligated for that project to exceed the
amount specified in the law for that project (or would add to
total obligations exceeding such specified amount) by more than
10 percent, the Secretary shall provide the committees with
notice of the Secretary's intention to do so and the reasons
for the specified amount being exceeded.
(2) The Secretary shall--
(A) enter into a contract or agreement with an
appropriate non-department Federal entity with the
ability to conduct forensic audits on medical facility
projects for the conduct of an external forensic audit
of the expenditures relating to any major medical
facility or super construction project for which the
total expenditures exceed the amount requested in the
initial budget request for the project submitted to
Congress under section 1105 of title 31 by more than 25
percent; and
(B) enter into a contract or agreement with an
appropriate non-department Federal entity with the
ability to conduct forensic audits on medical facility
projects for the conduct of an external audit of the
medical center construction project in Aurora,
Colorado.
(d)(1) Except as provided in paragraph (2), in any case in
which the Secretary proposes that funds be used for a purpose
other than the purpose for which such funds were appropriated,
the Secretary shall promptly notify each committee, in writing,
of the particulars involved and the reasons why such funds were
not used for the purpose for which appropriated.
(2)(A) In any fiscal year, unobligated amounts in the
Construction, Major Projects account that are a direct result
of bid savings from a major construction project may only be
obligated for major construction projects authorized for that
fiscal year or a previous fiscal year.
(B) Whenever the Secretary obligates amounts for a major
construction project under subparagraph (A), the Secretary
shall submit to the Committee on Veterans' Affairs and the
Committee on Appropriations of the Senate and the Committee on
Veterans' Affairs and the Committee on Appropriations of the
House of Representatives notice of the following:
(i) The major construction project that is the source
of the bid savings.
(ii) If the major construction project that is the
source of the bid savings is not complete--
(I) the amount already obligated by the
Department or available in the project reserve
for such project;
(II) the percentage of such project that has
been completed; and
(III) the amount available to the Department
to complete such project.
(iii) The other major construction project for which
the bid savings amounts are being obligated.
(iv) The bid savings amounts being obligated for such
other major construction project.
(C) The Secretary may not obligate an amount under
subparagraph (A) to expand the purpose of a major construction
project except pursuant to a provision of law enacted after the
date on which the Secretary submits to the committees described
in subparagraph (B) notice of the following:
(i) The major construction project that is the source
of the bid savings.
(ii) The major construction project for which the
Secretary intends to expand the purpose.
(iii) A description of such expansion of purpose.
(iv) The amounts the Secretary intends to obligate to
expand the purpose.
(e) The Secretary may accept gifts or donations for any of
the purposes of this subchapter.
(f) The Secretary may not obligate funds in an amount in
excess of $500,000 from the Advance Planning Fund of the
Department toward design or development of a major medical
facility project (as defined in subsection (a)(3)(A)) until--
(1) the Secretary submits to the committees a report
on the proposed obligation; and
(2) a period of 30 days has passed after the date on
which the report is received by the committees.
(g) The limitation in subsection (f) does not apply to a
project for which funds have been authorized by law in
accordance with subsection (a)(2).
(h)(1) Not less than 30 days before entering into a major
medical facility lease, the Secretary shall submit to the
Committees on Veterans' Affairs of the Senate and the House of
Representatives--
(A) notice of the Secretary's intention to enter into
the lease;
(B) a detailed summary of the proposed lease;
(C) a description and analysis of any differences
between the prospectus submitted pursuant to subsection
(b) and the proposed lease; and
(D) a scoring analysis demonstrating that the
proposed lease fully complies with Office of Management
and Budget Circular A-11.
(2) Each committee described in paragraph (1) shall ensure
that any information submitted to the committee under such
paragraph is treated by the committee with the same level of
confidentiality as is required by law of the Secretary and
subject to the same statutory penalties for unauthorized
disclosure or use as the Secretary.
(3) Not more than 30 days after entering into a major medical
facility lease, the Secretary shall submit to each committee
described in paragraph (1) a report on any material differences
between the lease that was entered into and the proposed lease
described under such paragraph, including how the lease that
was entered into changes the previously submitted scoring
analysis described in subparagraph (D) of such paragraph.
* * * * * * *
Sec. 8111B. Authority to plan, design, construct or lease a medical
facility shared with other departments or agencies
(a) Authority.--Subject to sections 8103 and 8104 of this
title, the Secretary of Veterans Affairs may enter into
agreements with the heads of other departments or agencies of
the Federal Government for the planning, designing,
constructing, or leasing of medical facilities to be shared by
the Department of Veterans Affairs and that department or
agency to improve the access to, and quality and cost
effectiveness of, the health care provided by the Veterans
Health Administration and that department or agency.
(b) Transfers of Amounts From Department of Veterans
Affairs.--(1) With respect to a shared medical facility
construction project for which the estimated costs to the
Department of Veterans Affairs do not exceed the amount
specified in section 8104(a)(3)(A) of this title, the Secretary
of Veterans Affairs may transfer to the partner agency amounts
appropriated in the Construction, Minor Projects account of the
Department for use for the planning, design, or construction of
the shared medical facility.
(2) With respect to a shared medical facility construction
project for which the estimated costs to the Department of
Veterans Affairs exceed the amount specified in section
8104(a)(3)(A) of this title, the Secretary of Veterans Affairs
may transfer to the partner agency amounts appropriated in the
Construction, Major Projects account of the Department for use
for the planning, design, or construction of the shared medical
facility.
(3) With respect to a shared medical facility lease project
for which the estimated costs of the lease to the Department of
Veterans Affairs do not exceed the amount specified in section
8104(a)(3)(B) of this title, the Secretary of Veterans Affairs
may transfer to the partner agency amounts appropriated in the
applicable medical appropriation account of the Department for
such lease.
(c) Transfers of Amounts to Department of Veterans Affairs.--
(1) With respect to a shared medical facility construction
project for which the estimated costs to the Department of
Veterans Affairs do not exceed the amount specified in section
8104(a)(3)(A) of this title, any amounts transferred by the
partner agency to the Secretary of Veterans Affairs may be
deposited in the Construction, Minor Projects account of the
Department for use for the planning, design, or construction of
the shared medical facility. Amounts so deposited shall be
merged with and available for the same purposes, and for the
same period, as such account.
(2) With respect to a shared medical facility construction
project for which the estimated costs to the Department of
Veterans Affairs exceed the amount specified in section
8104(a)(3)(A) of this title, any amounts transferred by the
partner agency to the Secretary of Veterans Affairs may be
deposited in the Construction, Major Projects account of the
Department for use for the planning, design, or construction of
the shared medical facility. Amounts so deposited shall be
merged with and available for the same purposes, and for the
same period, as such account.
(3) With respect to a shared medical facility lease project,
any amounts transferred by the partner agency to the Secretary
of Veterans Affairs may be deposited in the applicable medical
appropriation account of the Department for such lease. Amounts
so deposited shall be available without fiscal year limitation.
(d) Definitions.--In this section:
(1) The term ``partner agency'' means a department or
agency of the Federal Government that has entered into
an agreement with the Secretary of Veterans Affairs
under subsection (a).
(2) The term ``shared medical facility'' means a
medical facility shared by the Department of Veterans
Affairs and a partner agency pursuant to an agreement
entered into under subsection (a).
(3) The term ``shared medical facility construction
project'' means the planning, designing, or
constructing of a shared medical facility pursuant to
an agreement entered into under subsection (a).
(4) The term ``shared medical facility lease
project'' means the leasing of a shared medical
facility pursuant to an agreement entered into under
subsection (a).
* * * * * * *
SUBCHAPTER V--ENHANCED-USE LEASES OF REAL PROPERTY
* * * * * * *
Sec. 8162. Enhanced-use leases
(a)(1) The Secretary may in accordance with this subchapter
enter into leases with respect to real property that is under
the jurisdiction or control of the Secretary. Any such lease
under this subchapter may be referred to as an ``enhanced-use
lease''. The Secretary may dispose of any such property that is
leased to another party under this subchapter in accordance
with section 8164 of this title. The Secretary may exercise the
authority provided by this subchapter notwithstanding section
8122 of this title, subchapter II of chapter 5 of title 40,
sections 541-555 and 1302 of title 40, or any other provision
of law (other than Federal laws relating to environmental and
historic preservation) inconsistent with this section. The
applicability of this subchapter to section 421(b) of the
Veterans' Benefits and Services Act of 1988 (Public Law 100-
322; 102 Stat. 553) is covered by subsection (c).
(2) The Secretary may enter into an enhanced-use lease [only]
for the provision of supportive housing, or if the lease will
enhance the use of the property, and if the lease is not
inconsistent with and will not adversely affect the mission of
the Department.
(3) The provisions of sections 3141-3144, 3146, and 3147 of
title 40 shall not, by reason of this section, become
inapplicable to property that is leased to another party under
an enhanced-use lease.
(4) A property that is leased to another party under an
enhanced-use lease may not be considered to be unutilized or
underutilized for purposes of section 501 of the McKinney-Vento
Homeless Assistance Act (42 U.S.C. 11411).
(b)(1) If the Secretary has determined that a property should
be leased to another party through an enhanced-use lease, the
Secretary shall, at the Secretary's discretion, select the
party with whom the lease will be entered into using such
selection procedures as the Secretary considers appropriate.
(2) The term of an enhanced-use lease may not exceed 75
years.
(3)(A) For any enhanced-use lease entered into by the
Secretary, the lease consideration provided to the Secretary
shall consist solely of cash at fair value as determined by the
Secretary.
(B) The Secretary shall receive no other type of
consideration for an enhanced-use lease besides cash.
(C) The Secretary may enter into an enhanced-use lease
without receiving consideration.
(D) The Secretary may not waive or postpone the obligation of
a lessee to pay any consideration under an enhanced-use lease,
including monthly rent.
(4) The terms of an enhanced-use lease may provide for the
Secretary to use minor construction funds for capital
contribution payments.
(5) The terms of an enhanced-use lease may not provide for
any acquisition, contract, demonstration, exchange, grant,
incentive, procurement, sale, other transaction authority,
service agreement, use agreement, lease, or lease-back by the
Secretary or Federal Government.
(6) The Secretary may not enter into an enhanced-use lease
without certification in advance in writing by the Director of
the Office of Management and Budget that such lease complies
with the requirements of this subchapter.
(c) The entering into an enhanced-use lease covering any land
or improvement described in section 421(b)(2) of the Veterans'
Benefits and Services Act of 1988 (Public Law 100-322; 102
Stat. 553) or section 224(a) of the Military Construction and
Veterans Affairs and Related Agencies Appropriations Act, 2008,
other than an enhanced-use lease under the Los Angeles Homeless
Veterans Leasing Act of 2016, shall be considered to be
prohibited by such sections unless specifically authorized by
law.
(d)(1) Nothing in this subchapter authorizes the Secretary to
enter into an enhanced-use lease that provides for, is
contingent upon, or otherwise authorizes the Federal Government
to guarantee a loan made by a third party to a lessee for
purposes of the enhanced-use lease.
(2) Nothing in this subchapter shall be construed to abrogate
or constitute a waiver of the sovereign immunity of the United
States with respect to any loan, financing, or other financial
agreement entered into by the lessee and a third party relating
to an enhanced-use lease.
* * * * * * *
----------
VETERANS ACCESS, CHOICE, AND ACCOUNTABILITY ACT OF 2014
* * * * * * *
TITLE VII--OTHER VETERANS MATTERS
* * * * * * *
SEC. 705. LIMITATION ON AWARDS AND BONUSES PAID TO EMPLOYEES OF
DEPARTMENT OF VETERANS AFFAIRS.
(a) Limitation.--The Secretary of Veterans Affairs shall
ensure that the aggregate amount of awards and bonuses paid by
the Secretary in a fiscal year under chapter 45 or 53 of title
5, United States Code, or any other awards or bonuses
authorized under such title or title 38, United States Code,
other than recruitment, relocation, or retention incentives,
does not exceed the following amounts:
(1) With respect to each of fiscal years 2017 through
2018, $230,000,000.
(2) With respect to each of fiscal years 2019 through
2021, $225,000,000.
(3) With respect to each of fiscal years 2022 through
2024, $360,000,000.
(b) Sense of Congress.--It is the sense of Congress that the
limitation under subsection (a) should not disproportionately
impact lower-wage employees and that the Department of Veterans
Affairs is encouraged to use bonuses to incentivize high-
performing employees in areas in which retention is
challenging.
* * * * * * *
DISSENTING VIEWS
We have serious concerns about H.R. 4243, the VA Asset and
Infrastructure Review (AIR) Act outlined below in three parts.
Title I of this bill seeks to dramatically alter how and where
the Department of Veterans. Affairs (VA) delivers health care
to veterans before fully understanding not only how a new
consolidated community care program will function but who would
be eligible to use it (Part 1). Moreover, the process laid out
in Title I for how the Commission is selected and operates in
addition to the erosion of Congressional authority causes major
consternation (Part 2). Furthermore, Section 302(a) in Title
III, which provides an additional $2.1 billion in emergency
funding for the Veterans Choice Program (VCP)--a program that
was established as temporary measure to deal with an access to
care crisis--suggests the Majority is happy to continue kicking
the proverbial can down the road (Part 3). Taken together, the
contents of Title I and III, without corresponding legislation
moving out of Committee to address the future of community
care, one might view the Committee's activities as a pathway
towards the privatization of veterans' care--facilities around
the country would potentially be closed while Congress
continues to haphazardly fund a flawed short-term program, the
Veterans Choice Program.
PART I
While the Commission on Care recommended a Base Realignment
and Closure (BRAC)-like review was needed for VA, declaring it
would, ``offer a level of rigor far beyond what currently
exists for repurposing and selling capital assets'',\1\ we are
not convinced such a model is entirely appropriate in the case
of VA. That being said, the Minority is not opposed to the
concept of realigning VA's capital assets to right-size the
agency. To the contrary. We believe that process is long
overdue.
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\1\Commission on Care, page 60, June 30, 2016, ``Commission on Care
Final Report,'' https://s3.amazonaws.com/sitesusa/wp-content/uploads/
sites/912/2016/07/Commission-on-Care_Final-Report_063016_FOR-WEB.pdf.
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We are, however, unequivocally opposed to the BRAC-like
process elements of the Commission on Care outlined in what
became known as the ``Strawman Document.'' In March 2016, seven
Commissioners (Blom, Cosgrove, Hickey, Johnson, Selnick, Steele
and Webster) produced a document which was meant to serve as a
basis for discussions. The document stated:
. . . VA facilities that are under-utilized will be
dispensed with. No new facility construction or major
renovations will occur. A BRAC-like process will begin
to close the other facilities. Over time, the VA will
become primarily a payor . . .\2\
---------------------------------------------------------------------------
\2\Commission on Care, March 18, 2016, ``Strawman Document,''
http://s3.amazonaws.com/sitesusa/wp-content/uploads/sites/912/2016/03/
2016.3.18-Proposed-Strawman-Assessment-and-Recommendation.pdf.
For more than a decade the Committee has heard from The
Independent Budget veterans service organizations (IBVSOs)--
comprised of The Veterans of Foreign Wars (VFW), Disabled
American Veterans (DAV) and Paralyzed Veterans of America
(PVA)--that VA has not been provided the resources it needs to
meet veteran demand for services. In its FY 2018 budget book,
---------------------------------------------------------------------------
the IBVSOs stated:
In 2004, VA's facilities were utilized at about 80
percent of their planned capacity. Today they are
utilized at 109 percent of capacity, even though based
on the actual conditions of the facilities they should
be operating at just under 80 percent. Over the past
few years, the VA budget request and the Congress's VA
construction appropriation has fallen far short of the
actual need . . . A VA budget that does not adequately
fund facility maintenance and construction will
continue to negatively impact the quality and
timeliness of veterans' health care.\3\
---------------------------------------------------------------------------
\3\The Independent Budget, FY 2018: Critical Issues, pg. 26, http:/
/www.independentbudget.org/2018/FY18_ci.pdf.
The IBVSO's long held sentiment was echoed and even
underscored in the Independent Assessment, a congressionally
mandated report to review 12 areas of VA's health care delivery
systems and management processes following the access to care
crisis in 2014. Authors noted, ``The capital requirement for
VHA to maintain facilities and meet projected growth needs over
the next decade is two to three times higher than anticipated
funding levels, and the gap between capital need and resources
could continue to widen.''\4\
---------------------------------------------------------------------------
\4\CMS Alliance to Modernize Healthcare Federally Funded Research
and Development Center, September 1, 2015, ``Independent Assessment of
the Health Care Delivery Systems and Management Processes of the
Department of Veterans Affairs,'' pg K-1, https://www.va.gov/opa/
choiceact/documents/assessments/Integrated_Report.pdf.
---------------------------------------------------------------------------
While the Committee understands the need for VA to realign
its facilities, the Committee believes that this realignment
will likely, and should likely, result in the need for
additional construction and leasing endeavors. In its FY 2018
budget submission, VA data illustrated every VISN across the
country has greater demand for outpatient care than capacity to
provide it.\5\ Providing increased access to care in the
community will not be the answer in all instances. HCA also
explained in testimony to the Subcommittee on Health that a
lack of facility space for use by providers significantly
affected VA provider's ability to meet national standards of
productivity.\6\ The Committee agrees that any realignment of
VA's assets and infrastructure should be based on sound data
and the expected demand of veterans on VA-based services.
However, absent a permanent VA health care program, the future
demand on VA's services is impossible to assess.
---------------------------------------------------------------------------
\5\VA FY 2018 Budget Submission--Vol. 4, Pg. 8.3-3 https://
www.va.gov/budget/docs/summary/
fy2018VAbudgetVolumeIVconstructionLongRangeCapitalPlanAndAppendix.pdf.
\6\United States Cong. House Committee on Veterans' Affairs,
Subcommittee on Health Oversight Hearing--``Clinical Productivity and
Efficiency in the Department of Veterans' Affairs Healthcare System.''
July 13, 2017. 115th Cong. 1st sess. Washington: GPO, 2017 (statement
from Jonathan B. Perlin, President of the Clinical Services Group and
Chief Medical Officer at HCA Heatlhcare, Inc.).
---------------------------------------------------------------------------
As written, H.R. 4243 currently presents a static, one-off
event. If VA is to be successful in delivering health care in
the 21st century, a process that in and of itself is rapidly
changing due to advances in medicine, to an evolving veteran
population, the Department needs a dynamic process to both
assess and address its future capital asset needs. In its 2015
review of veteran demographics as a part of the Independent
Assessment, the RAND Corporation noted while the overall
veteran population would decrease by 19 percent over the next
10 years, it did envision a substantial geographical shift in
where veterans reside.\7\ In addition, in its FY 2018 budget
submission, VA highlighted the fact female veterans are the
fastest growing cohort, expected to grow from 8% in 2016 to 10%
by 2026,\8\ and how it is also expecting a bubble of aging
veterans requiring long-term care and services over the coming
decades (the number of 85-year-old enrollees will almost double
over the next 20 years).\9\
---------------------------------------------------------------------------
\7\CMS Alliance to Modernize Healthcare Federally Funded Research
and Development Center, September 1, 2015, ``Independent Assessment of
the Health Care Delivery Systems and Management Processes of the
Department of Veterans Affairs,'' https://www.va.gov/opa/choiceact/
documents/assessments/Integrated_Report.pdf.
\8\VA FY 2018 Budget Submission--Vol. 2, pg. VHA 373 https://
www.va.gov/budget/docs/summary/
fy2018VAbudgetVolumeIImedicalProgramsAndInformationTechnology.pdf.
\9\Ibid.
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While a commission could help to make some initial
recommendations about realigning capital assets within VA's
system, how are future decisions meant to be made under this
legislation? A one-time event serves only as a brief snapshot
in time and might take upwards of a decade to complete all of
the recommendations. By that point, due to the factors outlined
above, the recommendations made could be obsolete. It is our
belief, H.R. 4243 would be greatly enhanced if it had included
language that would establish a quadrennial veterans review,
modeled after the Defense Department's long-term planning
document that was established in 1997, as a means of better
projecting the needs of veterans programs in the future. Such a
review would not only look at capital infrastructure needs, but
identify gaps in internal capacity within VA and how to address
them in the immediate and long-term, such as offering veterans
access to care in the community and reforming the overly
burdensome hiring process.
The Majority contends the AIR Commission process would be
``data-driven''. Unfortunately, VA's track record on data
integrity and reliability is poor. For years, this Committee
has struggled with this issue as have the other stakeholders
that review the Agency such as the Office of Inspector General
and GAO. In fact, in its October 12, 2017, written testimony to
the Committee, GAO recommended we include the audit community
in the process early on to promote confidence in data accuracy
noting ``DoD Inspector General and military department audit
agencies played key roles in identifying data limitations,
pointing out the need corrections, and improving the accuracy
of the data used in the process,'' adding, ``In their oversight
roles, the audit organizations, which had access to relevant
information and officials as the process evolved, helped to
improve the accuracy of the data used in the BRAC process and
thus strengthened the quality and integrity of the data used to
develop closure and realignment recommendations.''\10\ Once
again, a critical issue that is not addressed in H.R. 4243.
---------------------------------------------------------------------------
\10\United States Cong. House Committee on Veterans' Affairs
Oversight Hearing--``Realignment May Benefit from Adopting Elements of
Defense Base Realignment and Closure Process, Provided Process
Challenges are Addressed'' October 12, 2017. 115th Cong. 1st sess.
Washington: GPO, 2017 (statement from David J. Wise, Director of
Physical Infrastructure Issues, Government Accountability Office).
---------------------------------------------------------------------------
Furthermore, attempting to determine VA's future capital
asset need and/or footprint without fully appreciating the
extent of the new community care network of providers is
futile. During the full committee markup of H.R. 4243, on
November 8, 2017, Mr. Takano reflected the thoughts of other
Minority Members on the Committee when he remarked:
I am afraid we are putting the cart before the horse
by moving this legislation forward today. This
committee is still grappling with a successor for the
Choice program, as I highlighted in my earlier remarks.
A new plan that streamlines the eligibility and
pathways for veterans to get their care in the
community will have a significant effect on the VA's
capacity needs. Considering how to realign VA's
facilities before we have the program up and running,
let alone agreed to in Congress, seems like a recipe
for disaster. I believe we need to complete our work on
the community care legislation before we consider how
best to realign the VA's facilities and
infrastructure.\11\
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\11\United States Cong. House Committee on Veterans' Affairs
Markup- ``H.R. 4243, the VA Asset and Infrastructure Review (AIR) Act''
November 8, 2017. 115th Cong. 1st sess. Washington: GPO, 2017 (comments
by The Honorable Mark Takano, Representative from California's 41st
District, U.S. House of Representatives).
In addition, given H.R. 4243 is proposing to use a static
process, any changes that occur to our Nation's broader health
care system, as that debate regarding the future of the
Affordable Care Act (ACA) has yet has to reach a conclusion,
could have a serious impact on where millions of veterans seek
their care. VA could see an influx of new enrollees around the
country as benefits under the ACA are repealed. For many non-
elderly veterans, VA would become their safety net. In a 2017
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report, the RAND Corporation found:
By increasing non-VA health insurance coverage for VA
patients, the ACA likely reduced demand for VA care;
the authors estimate that, if the gains in insurance
coverage that occurred between 2013 and 2015 had not
occurred, nonelderly veterans would have used about 1
percent more VA health care in 2015: 125,000 more
office visits, 1,500 more inpatient surgeries, and
375,000 more prescriptions. Recent congressional
proposals to repeal and replace the ACA would increase
the number of uninsured nonelderly veterans and further
increase demand for VA health care.\12\
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\12\Dworsky, Michael, Carrie M. Farmer and Mimi Shen. Veterans'
Health Insurance Coverage Under the Affordable Care Act and
Implications of Repeal for the Department of Veterans Affairs. Santa
Monica, CA: RAND Corporation, 2017. https://www.rand.org/pubs/
research_reports/RR1955.html. Also available in print form.
We are concerned VA does not have appropriate staffing or
expertise to carry out both the initial data collection
requirements or ensure recommendations that are approved are
ultimately implemented. Moreover, given the frequent changes in
key leadership positions within VA Central Office (VACO) or the
fact many of these positions are frequently held by interim or
acting figures, ensuring individuals are in place who are
capable of driving the work forward may be a barrier to
success. This legislation does nothing to address this issue.
In its written testimony to the Committee on October 12, 2017,
GAO highlighted not only the importance of establishing an
organizational structure within the agency but the need to
ensure there is continual senior leadership attention.\13\ It
also recognizes the need for an oversight mechanism to improve
accountability for implementation.\14\ GAO suggests DoD's
eventual inclusion of these items improved not only the process
but the overall outcomes.\15\
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\13\United States Cong. House Committee on Veterans' Affairs
Oversight Hearing- ``Realignment May Benefit from Adopting Elements of
Defense Base Realignment and Closure Process, Provided Process
Challenges are Addressed'' October 12, 2017. 115th Cong. 1st sess.
Washington: GPO, 2017 (statement from David J. Wise, Director of
Physical Infrastructure Issues, Government Accountability Office).
\14\Ibid.
\15\Ibid.
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Finally, it is important to note that closing facilities
through a BRAC will not yield immediate results. In fact, in
his testimony before the Committee on October 12, 2017, Mr.
Lepore, the director of Defense Capabilities and Management at
GAO, indicated DoD has still not reached the payback period on
the 2005 BRAC--it cost $35.1 billion to implement those
recommendations.\16\ Only next year will they start to achieve
savings. Congress must not begin this endeavor under the false
notion that billions of dollars will be saved. In fact, given a
number of the points raised above, the process of rightsizing
the Agency could end up costing taxpayers tens of billions of
dollars in order to fulfil the promise this nation made to its
veterans.
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\16\United States Cong. House Committee on Veterans' Affairs
Oversight Hearing--``Realignment May Benefit from Adopting Elements of
Defense Base Realignment and Closure Process, Provided Process
Challenges Are Addressed.'' October 12, 2017. 115th Cong. 1st sess.
Washington: GPO, 2017 (statement by Brian J. Lepore Director of Defense
Capabilities and Management, Government Accountability Office).
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PART II
We remain gravely concerned H.R. 4243 unnecessarily cedes
Congress' oversight powers, power to authorize and appropriate
funds, and the power to decide future VA health care
infrastructure needs to the Executive Branch. As Ranking Member
Walz stated during markup:
[T]his bill gives immense power and authority to the
President, and it affects every single one of our
districts. And I gotta [sic] be honest with you, I
don't trust any President to know what is best for my
district. I do trust you to know what is best for your
district.\17\
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\17\United States Cong. House Committee on Veterans' Affairs
Markup--``HR 4243, the VA Asset and Infrastructure Review (AIR) Act''
November 8, 2017. 115th Cong. lst sess. Washington: GPO, 2017 (comments
by The Honorable Timothy J. Walz, Representative from Minnesota's 1st
District, U.S. House of Representatives).
Specifically, this legislation would grant the President
significant and outsized power to: appoint all commissioners to
the Asset and Infrastructure Review Commission; authorize VA to
make recommendations for the closure or realignment of VHA
medical facilities and permit VA to develop the criteria for
making those recommendations; authorize the President-appointed
Commission to make recommendations to the President regarding
the closure or realignment ofVHA medical facilities; prohibit
Congress from disapproving the President and Commission's
recommendations to close or realign VHA medical facilities
without a veto-proof majority in both chambers, and authorize
the automatic obligation and expenditure of funds for the
construction or lease of a major medical facility based on the
Commission's recommendations.
The legislation authorizes the President to appoint 9
commissioners to serve on the Commission, but only specifies
qualification requirements for 6 of 9 commissioners, and zero
qualification requirements for the Chair and Vice Chair of the
Commission. The qualification requirements provide for
representation from 3 congressionally-chartered veterans
service organizations, but do not require the other 6
commissioners to be veterans. One commissioner must have
experience delivering private-sector health care, one
commissioner must have senior management experience in a
Federally-qualified health center or in the Department of
Defense or Indian Health Service, and one commissioner must
have experience with Federal Government capital asset
management. Without qualification requirements for all
commissioners, it allows the President to potentially appoint
commissioners with no qualifications, expertise, or knowledge
of the specific health care needs of veterans, and
commissioners who lack the experience and perspective of being
veterans and patients receiving health care at VA medical
facilities. Unlike Members of Congress who must represent and
answer to their constituents, these potentially unqualified
commissioners would be given tremendous power to make decisions
regarding the future delivery of veterans' health care with
little oversight or accountability over their decisions.
The ability to develop criteria and make recommendations
for the closing or realignment of VA medical facilities in
every district and state in the U.S. and its Territories would
no longer lie with Congress, but would be vested solely within
the Executive Branch under H.R. 4243. The legislation would
allow VA, not Congress, to determine the criteria for making
recommendations regarding VA's health care infrastructure.
Although VA would be required to receive public comments on its
proposed criteria for 90 days, it would still have the final
authority to determine criteria despite objections from
veterans and stakeholders. Nine months following publication of
its final criteria, VA would make recommendations for the
closure or realignment of VA medical facilities and provide
these recommendations to the Commission to decide the fate of
VA medical facilities throughout the country. During the 1-year
period in which the Commission would hold hearings and make
decisions on the closure or realignment of VA medical
facilities, the Commission would be given the power to withhold
information from Congress it used to make recommendations for
the closure or realignment of of facilities. The Commission
would only be required to provide this information after
reporting its findings to the President, thereby limiting
Congress' oversight and subpoena power and its ability to
understand the information used to inform the decisions made by
the Commission. Within 3 years of the Commission and
President's decision, VA medical facilities would begin to
close, and representatives would have no access to the
information that informed and influenced the Commission's
decision to close medical facilities until after a decision had
been made.
Congress and the states and districts negatively affected
by the President and Commission's recommendations would have
virtually no power to prevent the closing or realignment of
facilities in those states and districts. Congress would have
only 45 days from the date in which the President approved the
Commission's recommendations to pass a joint resolution of
disapproval to prevent the President's decision to close or
realign VA medical facilities. Although a majority of members
in both chambers would be required to pass the joint resolution
of disapproval, the President would likely veto the resolution,
requiring a two-thirds majority in both chambers to override
the President's veto. The short timeframe in which to pass a
joint resolution of disapproval and the veto-proof majority
needed to override a President's decision to close and realign
VA medical facilities would all but guarantee the closure and
realignment of VA medical facilities throughout the country
without Congress' approval. As described by Representative
Takano during markup:
By the time Congress weighs in, the commission has
finalized its recommendations and they have been
approved by the President. If Congress disagrees, we
send a joint resolution of disapproval back to the
President, who by this time has already approved the
proposal. Then all the President needs to do is veto
the joint resolution. We would effectively need a veto
proof two thirds majority of Congress to have a check
on the commission and the President. On such an
important matter that impacts the health of veterans
across the country, I am uncomfortable ceding this
committee's and this Congress' oversight.\18\
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\18\United States Cong. House Committee on Veterans' Affairs
Markup--``H.R. 4243, the VA Asset and Infrastructure Review (AIR) Act''
November 8, 2017. 115th Cong. 1st sess. Washington: GPO, 2017 (comments
by The Honorable Mark Takano, Representative from California's 41st
District, U.S. House of Representatives).
Finally, Congress would be stripped of its power to
specifically authorize the obligation and expenditure of funds
for major medical facility projects or leases. Any
recommendations made by the President and Commission for the
funding or lease of a major medical facility would
automatically be treated as authorized by Congress, removing
its ability to determine whether funds should be authorized.
PART III
Title III of H.R. 4243 would authorize and appropriate an
additional $2.1 billion to continue funding of the current
Veterans Choice Program (VCP) through FY2018. Without a plan to
consider H.R. 4242, the bipartisan VA Care in the Community Act
that would reform the issues with the current VCP or
consolidate VA's community care programs in the near future, we
are concerned that Congress will continue to authorize more
funding for a flawed program that was intended to be a
temporary measure to address the VHA's access crisis. In July
2017, we authorized an additional $2.1 billion for the VCP as a
stop-gap measure to ensure veterans were able to-receive care
under the program, and to give the House and Senate Veterans'
Affairs Committees an opportunity to write legislation that
would reform and consolidate VA's community care authorities
under one program.\19\ H.R. 4242 was the bipartisan solution to
achieving this effort. It was noticed for markup with H.R. 4343
with an understanding that both bills would be marked up and
reported favorably out of committee for consideration by the
House of Representatives as a package. However, due to concerns
over the Congressional Budget Office's estimated cost of almost
$40 billion over 5 years for H.R. 4242, HVAC majority withdrew
the measure from consideration the night before markup. The
majority decided to move forward with markup of H.R. 4243,
instead of withdrawing H.R. 4243 from consideration and
postponing the markup until a solution could be reached to
address the cost of H.R. 4242. These concerns over the failure
to consider H.R. 4242 and H.R. 4243 in tandem and the lack of a
clear path for consideration ofH.R. 4242 were expressed by
Ranking Member Walz during markup:
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\19\VA Choice and Quality Employment Act of 2017, Pub. L. No. 115-
46.
You know there is a sequence. You know that it
requires strategic thinking. And you know the minute
the leverage leaves and this ship sails, it is going to
be much harder to do [H.R.] 4242. They were predicated
on staying together and moving together. So, once it
leaves, now we are going to have to come back.\20\
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\20\United States Cong. House Committee on Veterans' Affairs
Markup--``H.R. 4243, the VA Asset and Infrastructure Review (AIR) Act''
November 8, 2017. 115th Cong. 1st sess. Washington: GPO, 2017 (comments
by The Honorable Timothy J. Walz, Representative from Minnesota's 1st
District, U.S. House of Representatives).
The need for reform of the flawed Veterans Choice Program
is acknowledged by most Members of Congress who have heard from
constituents frustrated by the program's administration, and
who have participated in oversight hearings on the
implementation of the program. VA Inspector General (``VA
OIG'') and Government Accountability Office (GAO) reviews
supported the experience of constituents: Veterans have not
necessarily experienced improved access or lower appointment
wait times through the program\21\ and providers remain
frustrated with either the VA or the third party
administrator's failure to promptly pay for care provided to
veterans.\22\
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\21\VA Office of Inspector General, Report: 15-04673-333, ``Review
of the Implementation of the VCP,'' January 30, 2017, http://
www.va.gov/oig/pubs/VAOIG-15-04673-333.pdf; Government Accountability
Office, Report; GAO-17-397T, ``Veterans' Health Care: Preliminary
Observations on Veterans' Access to Choice Program Care,'' March 7,
2017, https://www.gao.gov/assets/690/683205.pdf.
\22\Government Accountability Office, Report: GA0-16-353,
``Veterans' Health Care: Proper Plan Needed to Modernize System for
Paying Community Providers,'' May 2016, https://www.gao.gov/assets/680/
677051.pdf.
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According to testimony provided by VA Inspector General
Missal in an HVAC Hearing ``Shaping The Future: Consolidating
And Improving VA Community Care'' in March 2017, the OIG
Hotline received over 700 contacts about the VCP from October
1, 2015 through January 31, 2017.\23\ Missal testified that the
complaints fell into 4 categories: ``48% had concerns about
appointments and scheduling; 35% had concerns about referrals,
authorizations, or consults; 12% had concerns about veteran and
provider payments; [and] 5% had concerns about program
eligibility or program enrollment.''\24\ Missal also testified
that in its Audit of Veteran Wait Time Data, Choice Access, and
Consult Management in Veterans Integrated Service Network 6
(VISN 6) ``veterans who were authorized Choice care in VISN 6
did not consistently receive the authorized health care within
30 days as required by Health Net's contract with VA'' and out
of a ``statistical sample of 389 Choice authorizations provided
to Health Net by VISN 6 medical facility staff during the first
quarter of fiscal year (FY) 2016 . . . [it is] estimated that
for the approximately 34,200 veterans who were authorized
Choice care in VISN 6, approximately 22,500 veterans who
received Choice care waited an average of 84 days to get their
care through Health Net . . . [and] it took VA medical facility
staff an average of 42 days to provide the authorization to
Health Net to begin the Choice process and 42 days for Health
Net to provide the service.''\25\ VA OIG also ``identified
delays related to authorizations for primary care, mental
health care, and specialty care.''\26\ In VA OIG's Review of
the Implementation of the VCP, from November 1, 2014 through
September 30, 2015 it found:
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\23\Michael J. Missal, Inspector General Department Of Veterans
Affairs, Statement Before The Committee On Veterans' Affairs United
States House Of Representatives Hearing On ``Shaping The Future:
Consolidating And Improving Va Community Care'' March 7, 2017.
\24\ Ibid.
\25\ Ibid.
\26\ Ibid.
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``Approximately 149,400 (53 percent) were
for veterans who were able to receive care; on average,
these veterans waited 45 days for treatment from the
date they chose to opt into Choice.''
``Approximately 6,000 (13 percent) were
returned to VHA without the veterans receiving care. On
average, authorizations were returned to VHA
approximately 48 days after the veteran decided to opt
into Choice. About half of the returned authorizations
were sent back because Choice was unable to schedule
the appointment with an appropriate provider or the
appointment offered to the veteran was declined. The
other half of returned authorizations were sent back
because they were missing VA data, veterans requested
specific providers outside the network, VHA requested
that the authorizations be returned, or the veterans
did not show up for their appointments.''
``Approximately 98,200 (35 percent) were
still waiting for TPAs to schedule appointments as of
September 30, 2015. On average, for authorizations that
had not been scheduled, veterans were waiting 72 days
to receive an appointment from the TPA.''\27\
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\27\VA Office of lnspector General, Report: 15-04673-333,
``Veterans Health Care: Preliminary Observations on Veterans' Access to
Choice Program January 30, 2017, https://www.va.gov/oig/pubs/VAOIG-15-
04673-333.pdf.
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Additionally, according to a GAO preliminary analysis of
wait times in 2016, ``selected veterans experienced lengthy
overall wait times for Choice Program care in 2016,'' and
veterans could wait up to 81 days for an appointment under the
VCP.\28\
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\28\Government Accountability Office, Report: GA0-17-397T,
``Veterans' Health Care: Preliminary Observations on Veterans' Access
to Choice Program Care,'' March 7, 2017, https://www. gao.gov/assets/
690/683205.pdf.
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Since the implementation of the Veterans Choice Program
(VCP), VA has furnished over 15 million appointments to 1.7
million unique veterans.\29\ While this program got off to a
slow start, utilization of it has continued to grow. Contract
modifications and changes in the law have all helped to make
the program function better. Between March and May 2017, VA
issued nearly 800,000 authorizations for VCP, which represented
a 32% increase over the same time-period in 2016.\30\ The
argument can be made that the steady increase in appointments
being sent to the community through Choice illustrate VA is not
appropriately resourced to meet veteran demand. The continued
near-flat line request for the Medical Services account will
continue the trend of VA being unable to provide the needed
services and forcing veterans into the community for care.
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\29\United States Cong. House Committee on Veterans' Affairs,
Subcommittee on Health Hearing--``Health Programs Budget Request for
Fiscal Year 2018'' June 22, 2017. 115th Cong. 1st sess. Washington:
GPO, 2017 (Statement by Poonam Alaigh, Acting Under Secretary for
Health, Veterans Health Administration, US Department of Veterans
Affairs).
\30\Ibid.
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Without a plan or path identified to consider H.R. 4242,
without legislation and funding to address VHA's access
challenges by hiring providers to fill over 45,000 vacancies or
address VHA's resource gaps, and with consideration of H.R.
4243 being rushed by the majority for consideration in the
House of Representatives next week, H.R. 4243 could be
interpreted as another large step towards the privatization of
VA health care. Without the implementation of H.R. 4242's
reforms and the consolidation of VA's disparate community care
authorities into one program to inform VA's asset and
infrastructure reviews, H.R. 4243 on its own is nothing more
than the authorization of a Base Realignment and Closure
(BRAC)-style commission to close and realign VA medical
facilities and the appropriation of an additional $2.1 billion
for private-sector health care via the flawed Veterans Choice
Program.
Timothy J. Walz,
Ranking Member
[all]
