House Report 118-122 - MILITARY CONSTRUCTION, VETERANS AFFAIRS, AND RELATED AGENCIES APPROPRIATIONS BILL, 2024

[House Report 118-122]
[From the U.S. Government Publishing Office]

118th Congress } { Report
HOUSE OF REPRESENTATIVES
1st Session } { 118-122

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

MILITARY CONSTRUCTION, VETERANS AFFAIRS, AND RELATED AGENCIES
APPROPRIATIONS BILL, 2024

_______

June 27, 2023.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed

_______

Mr. Carter of Texas, from the Committee on Appropriations, submitted
the following

R E P O R T

together with

MINORITY VIEWS

[To accompany H.R. 4366]

The Committee on Appropriations submits the following
report in explanation of the accompanying bill making
appropriations for military construction, veterans affairs, and
related agencies for the fiscal year ending September 30, 2024.

INDEX TO BILL AND REPORT

Page Number

Bill Report
Purpose of the Bill........................................
2
Summary of Committee Recommendation........................
2
Title I--Department of Defense: 2
3
Military Construction.............................. 2
3
NATO Security Investment Program................... 9
14
Department of Defense Base Closure Account......... 10
14
Family Housing Construction and Operation and
Maintenance.................................... 10
16
Department of Defense Family Housing Improvement
Fund........................................... 12
16
Department of Defense Military Unaccompanied
Housing Improvement Fund....................... 12
17
Administrative Provisions.......................... 12
17
Title II--Department of Veterans Affairs: 30
19
Veterans Benefits Administration................... 30
22
Veterans Health Administration..................... 34
27
National Cemetery Administration................... 39
49
Departmental Administration........................ 39
50
Administrative Provisions.......................... 48
57
Title III--Related Agencies: 82
62
American Battle Monuments Commission............... 82
62
U.S. Court of Appeals for Veterans Claims.......... 83
63
Cemeterial Expenses, Army.......................... 83
63
Armed Forces Retirement Home....................... 84
64
Administrative Provision........................... 85
64
Title IV--General Provisions: 86
65

Purpose of the Bill

The Military Construction, Veterans Affairs, and Related
Agencies Appropriations bill funds the Department of Defense's
activities related to military construction; family housing
construction, maintenance, and oversight; and environmental
remediation at closed military bases. The bill also funds the
Department of Veterans Affairs, including programs to assist
veterans, such as disability and pension benefits, education,
healthcare, and insurance and loan programs. The bill funds
four related agencies that honor and respect the Nation's
veterans including the American Battle Monuments Commission;
Cemeterial Expenses, Army (including Arlington National
Cemetery); the U.S. Court of Appeals for Veterans Claims; and
the Armed Forces Retirement Home.

Summary of Committee Recommendation

The Committee recommends $317,441,342,000 in total budget
authority for the fiscal year 2024 programs and activities
funded in the bill.
The bill includes $161,740,342,000 for mandatory programs
and $155,701,000,000 for discretionary programs.
The bill provides $17,474,000,000 for military construction
and family housing. This is $1,526,000,000 below the fiscal
year 2023 enacted level and $799,056,000 above the budget
request. It includes $2,095,810,000 to address unfunded
requirements of the Services and Combatant Commanders and
increases investment in infrastructure in the Pacific region,
unaccompanied personnel housing, and child development centers.
The bill provides $299,495,645,000 for fiscal year 2024 for
the Department of Veterans Affairs, which is a decrease of
$3,786,953,000 below the fiscal year 2023 enacted level. Of the
total, $161,740,342,000 is provided for mandatory benefit
programs and $137,755,303,000 is provided for discretionary
programs. Of the total for fiscal year 2024, $128,104,000,000
for veterans' healthcare was advanced in the Consolidated
Appropriations Act, 2023 (P.L 117-328).
For fiscal year 2025, the Committee recommendation includes
$112,582,000,000 in advance appropriations for the four
discretionary veterans' medical care accounts and
$193,048,534,000 in advance appropriations for mandatory
benefits programs.
The Committee recommendation provides a total of
$471,697,000, which is $29,037,000 above the fiscal year 2023
enacted level, for the four Related Agencies: The American
Battle Monuments Commission, the U.S. Court of Appeals for
Veterans Claims, Army Cemeterial Expenses (including Arlington
National Cemetery), and the Armed Forces Retirement Home.

TITLE I

DEPARTMENT OF DEFENSE

Military Construction Overview

Appropriation, fiscal year 2023....................... $19,000,000,000
Budget request, fiscal year 2024...................... 16,674,944,000
Committee recommendation, fiscal year 2024............ 17,474,000,000
Change from enacted level......................... -1,526,000,000
Change from budget request........................ +799,056,000

Military construction accounts provide funds for new
construction, construction improvements, planning and design,
and host nation support. Projects funded by these accounts
include facilities for operations, training, readiness,
maintenance, research and development, supply, medical care,
and force protection as well as unaccompanied housing,
military-owned family housing, utilities infrastructure, and
land acquisition.

COMMITTEE DIRECTIVES

In addition to the notification and reporting requirements
for military construction programs contained in Title 10,
United States Code, the Committee's recommendations include
several provisions requiring the Department of Defense to
report on various aspects of military construction programs and
to provide notification to the Committee when certain actions
are taken. The Committee also retains prior approval authority
for any reprogramming of funds exceeding a specific threshold.
Reprogramming Guidelines.--The following reprogramming
guidelines apply for all military construction and family
housing projects. A project or account (including the sub-
elements of an account) that has been specifically reduced by
Congress in acting on the budget request is considered to be a
Congressional interest item and as such, prior approval is
required. Accordingly, no reprogramming to an item specifically
reduced below the threshold by Congress is permitted, except
that the Department may seek reprogramming for appropriated
increments.
The reprogramming criteria that applies to military
construction projects is 25 percent of the funded amount or
$6,000,000 and includes new housing construction projects and
improvements. To provide the Services the flexibility to
proceed with construction contracts without disruption or
delay, the costs associated with environmental hazard
remediation such as asbestos removal, radon abatement, lead-
based paint removal or abatement, and any other legislated
environmental hazard remediation may be excluded, if such
remediation requirements could not be reasonably anticipated at
the time of the budget submission. Reprogramming is a courtesy
provided to the Department and can be taken away if the
authority is abused. This exclusion applies to projects
authorized in this budget year as well as projects authorized
in prior years for which construction has not been completed.
Planning and design costs associated with military construction
and family housing projects may also be excluded from these
guidelines. In instances where prior approval for a
reprogramming request for a project or account has been
received from the Committees on Appropriations of both Houses
of Congress, the adjusted amount approved becomes the new base
for any future increase or decrease via below-threshold
reprogramming (provided that the project or account is not a
Congressional interest item as defined above).
In addition to these guidelines, the Services are directed
to adhere to the guidance for military construction
reprogramming actions and notifications, including the
pertinent statutory authorities contained in DOD Financial
Management Regulation 7000.14-R and relevant updates and policy
memoranda. The Committee further encourages the Office of the
Director of National Intelligence to use a format similar to
that used by the Office of the Secretary of Defense to submit
reprogramming requests.
Facilities Sustainment, Restoration and Modernization
(FSRM).--The Department is directed to continue describing on
form 1390 the backlog of FSRM requirements at installations
with future construction projects. For troop housing requests,
form 1391 should describe any FSRM conducted in the past two
years. Likewise, future requirements for unaccompanied housing
at the corresponding installation should be included.
Additionally, the forms should include English equivalent
measurements for projects presented in metric measurement.
Rules for funding repairs of facilities under the operation and
maintenance accounts are described below:
(1) components of the facility may be repaired by
replacement. Such replacement can be up to current
standards or codes;
(2) interior arrangements and restorations may be
included as repair;
(3) additions and new facilities, may be done
concurrently with repair projects as long as the final
conjunctively funded project is a complete and usable
facility; and
(4) the appropriate Service Secretary shall notify
the appropriate committees 21 days prior to carrying
out any repair project with an estimated cost in excess
of $7,500,000.
Quarterly Summary of Notifications.--The Committee directs
the Services and the Office of the Secretary of Defense (on
behalf of itself and defense agencies) to continue to submit a
quarterly report listing all notifications that have been
submitted to the Committees during the preceding three-month
period.
Work in Progress or Planned (WIP) Curve.--The Committee
directs the Services and the Office of the Secretary of Defense
(on behalf of itself and defense agencies) to submit a WIP
curve for each project requested in a budget submission above
$90,000,000 with the form 1391 justification to the
congressional defense committees. The Committee also directs
the Secretary of Defense to report to the congressional defense
committees quarterly, beginning in the second quarter of fiscal
year 2024 and each quarter thereafter, of projects that remain
unawarded from the current and prior fiscal years and the
reasons for delay.
Transfer of Funds to and from the Foreign Currency
Fluctuations, Construction, Defense Account.--The Committee
directs the Department of Defense to submit a quarterly report
to the Committees on Appropriations of both Houses of Congress
on the transfer of funds from military construction and family
housing accounts to the Foreign Currency Fluctuations,
Construction, Defense account. The report shall specify the
amount transferred to the Foreign Currency account from each
military construction and/or family housing account, and all
other accounts for which an appropriation is provided in this
Act, during the preceding fiscal quarter, and the amounts
transferred from the Foreign Currency account to the above
accounts during the same period. This report shall be submitted
no later than 30 days after the close of each fiscal quarter.
In addition, the Department shall notify the Committees on
Appropriations of both Houses of Congress within 7 days of
transferring any amount in excess of $10,000,000 to or from the
Foreign Currency account.
Bid Savings.--The Committee directs the Secretary of
Defense to submit 1002 reports on military construction bid
savings not later than 180 days after enactment of this Act,
and biannually thereafter, to the Committees on Appropriations
of both Houses of Congress.
Incremental Funding of Projects.--In general, the Committee
supports full funding for military construction projects if
they are executable. However, it continues to be the practice
of the Committee to provide incremental funding for certain
large projects to enable the Services to more efficiently
allocate military construction dollars among projects that can
be executed in the year of appropriation.
Unfunded Priority List (UPL) and Future Years Defense
Program (FYDP).--The Committee directs the Department of
Defense and Military Services, active and reserve components as
well as Combatant Commanders, as required by law, to submit a
UPL and FYDP to the congressional defense committees for
military construction projects no later than 10 days and 5
days, respectively, after the President's budget is submitted
to Congress.

ITEMS OF INTEREST

Advanced Manufacturing.--The Committee is encouraged by
reports that three-dimensional (3D) construction could provide
military civil engineers with a faster means of building
facilities which could reduce supply lines and the number of
personnel needed for construction and related activities. The
Department of Defense is encouraged to study, develop, and
utilize advanced manufacturing capabilities to the extent
practicable.
Barracks.--The bill provides $362,300,000 for 9
construction projects to ensure that servicemembers who live in
barracks have safe, modern, and secure living facilities. The
Committee also provides $195,000,000 for barracks replacement
planning and design.
Blood Processing Laboratory Infrastructure.--The Committee
continues to recognize the importance of Department of Defense
laboratory infrastructure and the investment needed to
modernize outdated facilities and equipment. While the
Department has taken steps in recent years to upgrade its
laboratory infrastructure, the Committee is concerned that the
Department is not properly prioritizing critical improvements
to blood processing laboratory infrastructure and that this
presents a risk to readiness. Therefore, the Committee directs
the Department to provide a report on the status of blood
processing laboratory infrastructure and its strategy to
modernize such infrastructure within 180 days of enactment of
this Act.
Delivery and Cost of Military Construction Projects.--The
Committee appreciates the U.S. Army Corps of Engineers' March
2023 report titled, ``U.S. Army Corps of Engineers Contracting
Study Response: Recommended Reforms to Reduce Cost and
Accelerate Project Delivery.'' The Committee encourages the
Department to review progressive design-build as a potential
construction contract method as it may provide efficiencies.
Demolition of Excess Infrastructure.--The bill includes
$90,000,000 for unspecified minor military construction for
demolition across the active and reserve components. The
Committee is concerned about the amount of excess and obsolete
infrastructure found on installations. While the Committee
understands the need to balance demolition with other
infrastructure needs, excess infrastructure can be costly to
maintain and diverts resources away from current requirements.
Child Development Centers (CDCs).--The bill includes
$75,000,000 for planning and design and $293,820,000 for
construction of 7 CDC projects.
Infrastructure Needs to Support Alliance with the
Philippines.--The Committee notes the importance of the
recently reinvigorated alliance with the Philippines. To better
understand the Department of Defense's needs to support the
expanded alliance, the Committee directs the Secretary of
Defense to provide a report, not later than 180 days after the
date of the enactment of this Act, summarizing the plans for
military construction and associated infrastructure needs to
maximize the effectiveness of an enhanced posture in and
alliance with the Philippines.
Laboratory Infrastructure.--The Committee is concerned that
aging laboratory infrastructure threatens the ability of
Services to maintain the advanced technology necessary to keep
ahead of U.S. adversaries across all domains. Accordingly, the
Committee provides an additional $90,000,000 for planning and
design for laboratory infrastructure projects. The Services are
directed to provide a spend plan not later than 90 days after
enactment of this Act regarding the use of these funds.
Mass Timber.--The Committee is aware that the use of cross
laminated timber and other mass timber products as a building
material has the potential to reduce costs, limit environmental
impact, and increase functionality of various military
structures. The Committee encourages the Department of Defense
to continue exploring the application of these innovative
technologies in future planning and design for military
construction projects.
Open Air Burn Pans.--The Committee remains concerned about
the burning of hazardous materials, including open air burn
pans, at installations located in the United States and looks
forward to receiving the report on the Department's plans to
address this issue as required by House Report 117-391.
Resilient Military Installations.--The Committee supports
the Department's continued efforts to build lasting and
resilient military installations. These efforts include using
methods that update hurricane-resistant building codes for
bases, barracks, hospitals, and airfields and reviewing the
effect of severe drought and desertification and how these two
hazards effect installations and missions. The Committee
encourages the Department to continue investing in innovative
infrastructure projects to increase infrastructure resiliency
and reduce costs.
Unspecified Minor Military Construction (UMMC).--The bill
includes $414,192,000 for UMMC across the active and reserve
components, which is $80,000,000 above the budget request. The
Committee believes the UMMC authority is a helpful tool as the
Services address their most critical infrastructure needs.
U.S. Indo-Pacific Command (USINDOPACOM).--The
recommendation includes $69,000,000 for planning and design and
$62,000,000 for unspecified minor military construction for
USINDOPACOM.

Military Construction, Army

Appropriation, fiscal year 2023....................... $1,553,825,000
Budget request, fiscal year 2024...................... 1,470,555,000
Committee recommendation, fiscal year 2024............ 1,517,455,000
Change from enacted level......................... -36,370,000
Change from budget request........................ +46,900,000

The Committee recommends $1,517,455,000 for the Army in
fiscal year 2024, of which $162,900,000 is for the following
projects in the following amounts:

----------------------------------------------------------------------------------------------------------------
State Location Project Amount
----------------------------------------------------------------------------------------------------------------
AL..................................... Anniston Army Depot...... Access Control Point..... $5,500,000
AL..................................... Anniston Army Depot...... Component Rebuild Shop... 8,100,000
AL..................................... Anniston Army Depot...... Vehicle Paint Shop....... 2,900,000
FL..................................... Camp Bull Simons......... 7th Special Forces Group 17,000,000
Child Development Center.
HI..................................... Wheeler Army Airfield.... Air Traffic Control Tower 5,400,000
NC..................................... Fort Bragg............... Aircraft Maintenance 61,000,000
Hangar.
NC..................................... Fort Bragg............... Child Development Center. 36,000,000
TX..................................... Fort Bliss............... Collective Training 7,200,000
Barracks.
TX..................................... Fort Hood................ Barracks (PN 100948)..... 9,900,000
TX..................................... Fort Hood................ Barracks (PN 94937)...... 9,900,000
----------------------------------------------------------------------------------------------------------------

Within the total for Military Construction, Army, the
recommendation includes $345,775,000 for planning and design,
which is $48,900,000 above the budget request; and $86,280,000
for unspecified minor construction, which is $10,000,000 above
the budget request.
Further detail of the Committee's recommendation is
provided in the State table at the end of this report.
Army Barracks.--The Committee notes the importance of
providing high-quality barracks on Army bases and recommends
the refurbishment of barracks that have fallen below the Army's
set standards. The Committee believes that adequate housing is
an important quality of life issue that impacts readiness.
Dugway Proving Ground.--The Committee notes the importance
of the chemical and biological testing and evaluation done at
Dugway Proving Ground (DPG) through its laboratories, ranges,
test grids, airfield, and other testing facilities. The
Committee is concerned about the condition of the facilities at
DPG given that several facilities, including all three chemical
surety facilities, are in poor to failing conditions, at or
near their life expectancy.
The Committee hopes that the recent memorandum of agreement
between the Assistant Secretary of Defense for Nuclear,
Biological, and Chemical Defense and the Department of the Army
to transfer certain institutional funding will ensure adequate
facilities are maintained at DPG.
To better understand this issue, the Committee directs the
Secretary of the Army and the Assistant Secretary of Defense
for Nuclear, Chemical, and Biological Defense Programs to
provide a report to the congressional defense committees, not
later than 180 days after the date of the enactment of this
Act, on the facility conditions and requirements at DPG. The
report shall include the following: (1) an outline of military
construction (MILCON) funding responsibilities for mission-
critical facilities at DPG; (2) a list of high-priority MILCON
projects at DPG; (3) an assessment of facilities needed at DPG
to meet current and future requirements; (4) the Department's
plan to address facilities at DPG that are in poor to failing
condition.
Fort Bragg Roadway Infrastructure.--The Committee is
concerned about the roadway infrastructure at Fort Bragg,
especially the 47 miles that were originally constructed to
serve troop training functions but are now being used by
servicemembers, their families, and civilians for commuting
purposes. The Committee is aware that the North Carolina
Department of Transportation (NCDOT) has offered to assume
maintenance of the 47 miles of roadway infrastructure at Fort
Bragg under a proposed intergovernmental support agreement,
which may help the Army mitigate risks associated with the
inadequate road infrastructure. Accordingly, the Committee
directs the Secretary of the Army to provide a report to the
Committee, not later than 120 days after the date of the
enactment of this Act, that details the following: (1) the
Army's plan to bring the 47 miles of roadway infrastructure at
Fort Bragg up to NCDOT's minimum standards; (2) the cost for
such roadway repairs; (3) a timeline for performing such
roadway repairs; and (4) an estimate of the savings by the Army
if it no longer needs to perform annual maintenance on the
relevant roadway infrastructure at Fort Bragg.
Recapitalization of Army Infrastructure in Hawaii.--The
Committee is concerned about the condition of Army
infrastructure in Hawaii. In a November 2022 Congressional
Budget Office (CBO) report titled, ``The Army's Costs to
Eliminate Its Deferred Maintenance Backlog and to Renovate and
Modernize Its Buildings'' the CBO notes that the deferred
maintenance costs for U.S. Army Garrison Hawaii are
approximately $1.4 billion and its modernization costs are
approximately $2.6 billion. To better understand the Army's
efforts to address this problem, the Committee directs the
Assistant Secretary of the Army for Installations, Energy, and
Environment to provide a report on the following: (1) the
Army's plan for addressing its maintenance backlog; (2) the
military construction projects in the future years defense
program for U.S. Army Garrison Hawaii related to the backlog;
and (3) how the Army intends to ensure efforts to address the
backlog do not interfere with planned investments under the
Hawaii Infrastructure Readiness Initiative. The report shall be
provided to the Committees on Appropriations of both Houses of
Congress not later than 180 days after the date of the
enactment of this Act.
Tobyhanna Army Depot.--The Committee views Tobyhanna Army
Depot as an advantageous location for the build-out of physical
space for future Army Materiel Command (AMC) manufacturing of
microelectronics, including semi conductors. As such, the
Committee requests that the Army keep the Committee informed of
AMC construction needs at Tobyhanna Army Depot.

Military Construction, Navy and Marine Corps

Appropriation, fiscal year 2023....................... $4,345,320,000
Budget request fiscal year 2024....................... 6,022,187,000
Committee recommendation, fiscal year 2024............ 4,477,961,000
Change from enacted level......................... +132,641,000
Change from budget request........................ -1,544,226,000

The Committee recommends $4,477,961,000 for the Navy and
Marine Corps in fiscal year 2024, of which $52,683,000 is for
the following projects in the following amounts:

Within the total for Military Construction, Navy and Marine
Corps, the recommendation includes $602,625,000 for planning
and design, which is $2,683,000 above the budget request; and
$44,430,000 for unspecified minor construction, which is
$10,000,000 above the budget request.
Further detail of the Committee's recommendation is
provided in the State table at the end of this report.
Joint Base Pearl Harbor-Hickam (JBPHH) Infrastructure
Investments.--The Committee is concerned about the condition of
the infrastructure at JBPHH, especially given recent issues
with water and wastewater infrastructure that may have deferred
infrastructure improvements in other critical areas. The
Committee directs the Assistant Secretary of the Navy for
Installations, Energy, and Environment to provide a report, no
later than 180 days after enactment of this Act, on the
condition of JBPHH's infrastructure. The report shall include,
at a minimum, the following: (1) the plan for addressing failed
or failing infrastructure; (2) a list of critical
infrastructure projects that must be addressed to meet
operational plan requirements; and (3) how the Navy plans on
meeting current operational plan requirements while addressing
the construction backlog.
Naval Aviation Training Enterprise.--The Committee notes
the importance of the Naval Aviation Training Enterprise and
encourages the Navy to prioritize infrastructure projects
within the coastal Naval Aviation Training Enterprise,
especially those that build, remodel, and restore unaccompanied
and family housing, child and youth development centers, and
quality of life projects for servicemembers and their families.
Public Shipyard Construction Planning for Crisis and
Conflict.--The Committee is concerned about the Navy's ability
to fulfill its battle damage requirements using the current
shipyard infrastructure and urges the Navy to assess how to
best utilize the Shipyard Infrastructure Optimization Program
to better prepare the public shipyards for conflict and to
provide additional resources to develop the Wartime Acquisition
and Sustainment Support Plan, which will require infrastructure
investments.
Shipyard Infrastructure Optimization Program (SIOP).--The
Committee supports efforts to modernize and improve facilities
at the Navy's four public shipyards to equip them to address
the maintenance needs of the Navy's current and future active
fleet and emphasizes the important role military construction
must play in achieving this goal.
Additionally, the Committee expects the Navy to keep it
informed of additional flexibilities or authorizations
necessary to successfully coordinate with tribal governments
for expeditious completion of SIOP. The Committee recognizes
the importance of these critical dry dock construction projects
and the importance of relationships with tribal governments.
The management and oversight of SIOP is key to the
program's success. As such, the Committee directs the
Government Accountability Office to submit a report or reports,
as necessary, not later than 180 days after the date of the
enactment of this Act, on options for improving the management
and oversight of SIOP. The report shall include, at a minimum,
the following: (1) staffing and contracting options for
ensuring the adequate oversight of contracted activities; (2)
support provided to the public shipyards and local shipyard
construction agents; (3) best practices for the management of
large multi-contractor projects; and (4) how the Navy's
policies and procedures for large facility improvements greater
than $500,000,000 compare to those of other Federal agencies.

Military Construction, Air Force

Appropriation, fiscal year 2023....................... $2,614,996,000
Budget request, fiscal year 2024...................... 2,605,314,000
Committee recommendation, fiscal year 2024............ 2,439,614,000
Change from enacted level......................... -175,382,000
Change from budget request........................ -165,700,000

The Committee recommends $2,439,614,000 for the Air Force
in fiscal year 2024, of which $30,300,000 is for the following
projects in the following amounts:

Within the total for Military Construction, Air Force, the
recommendation includes $450,614,000 for planning and design,
which is $15,700,000 above the budget request; and $74,900,000
for unspecified minor construction, which is $10,000,000 above
the budget request.
Further detail of the Committee's recommendation is
provided in the State table at the end of this report.
Air Education and Training Command Facilities (AETC).--The
Committee recognizes the importance of adequate facilities for
basic military training, flying training, and the other
training missions of AETC and believes that outdated and
inadequate AETC facilities, including dormitories, harm the Air
Force's ability to recruit, train, and retain Airmen and
increase operation and maintenance costs. The Committee urges
the Air Force to prioritize funding for AETC facility design,
construction, and refurbishment.
Air Traffic Control Towers.--The Committee is concerned
that some air traffic control towers along the Gulf Coast have
fire safety concerns, lack proper heating and air conditioning,
and are vulnerable to tropical storms and hurricanes. As such,
the Committee directs the Air Force ensure its air traffic
control towers are properly maintained and upgraded, or
replaced as necessary, to meet mission requirements.
Data link infrastructure.--The Committee is aware of the
importance of data link capabilities to national security and
encourages the Air Force to ensure it has the adequate
infrastructure to support its data link requirements.
Ground Based Strategic Deterrent (GBSD) Infrastructure.--
The Committee is encouraged by the Air Force's future years
defense program expectations for military construction related
to the GBSD. The Committee requests that the Air Force continue
engaging with Congress on its infrastructure needs related to
the GBSD.
Hardened Infrastructure in the Pacific.--The Committee
notes the importance of air power in the Pacific and the
infrastructure required to support, maintain, and protect those
requirements. The Committee encourages the Air Force to ensure
U.S. and allied air force facilities are appropriately hardened
to deter aggression and defend U.S. interests.
U.S. Space Command Headquarters.--The Committee is
concerned that the Department has not finalized a permanent
location for the United States Space Command headquarters after
nearly five years of consideration and the impact on national
security. Therefore, the Committee directs the Secretary to
announce a decision expeditiously and directs the Department to
provide a report within 90 days of enactment of this Act
regarding any funds that have been obligated or expended in all
previous fiscal years for the construction, renovation, or
improvement of facilities, including all leases, for Space
Command Headquarters.

Military Construction, Defense-Wide

Appropriation, fiscal year 2023....................... $2,626,078,000
Budget request, fiscal year 2024...................... 2,984,682,000
Committee recommendation, fiscal year 2024............ 2,651,047,000
Change from enacted level......................... +24,969,000
Change from budget request........................ -333,635,000

The Committee recommends $2,651,047,000 for Military
Construction, Defense-Wide, in fiscal year 2024, including
$304,045,000 for planning and design, which is $41,000,000
above the budget request; and $48,618,000 for unspecified minor
construction, which is $10,365,000 above the budget request.
Further detail of the Committee's recommendation is
provided in the State table at the end of this report.
Defense Health Agency (DHA) Hawaii Market Facilities Master
Plan.--The Committee notes the importance of the Tripler Army
Medical Center and is concerned about infrastructure challenges
as DHA works to restructure and realign military medical
facilities. The Hawaii Market Facilities Master Plan Study is
expected to evaluate options to recapitalize the Tripler Army
Medical Center. The Committee looks forward to the DHA
submitting this study in a timely manner.
Energy Resilience and Conservation Investment Program
(ERCIP).--The Committee provides $548,000,000 for ERCIP
construction, which is the same as the budget request; and
$107,250,000 for ERCIP design, which is $21,000,000 above the
budget request.
The Committee supports the Department's efforts to improve
energy resilience, contribute to mission assurance, save
energy, and reduce energy costs through ERCIP. The Committee
encourages the Department to continue using all available tools
and authorities to ensure the timely execution of ERCIP
projects. Additionally, as the Department works to achieve base
energy independence, the Committee encourages the Department to
leverage new energy technologies.
Military Construction at Cold Weather Installations.--The
Committee recognizes that certain installations have unique
challenges due to extreme cold temperatures and significant
snowfall during the fall and winter months. The Committee
believes that the unspecified minor military construction
authority can help with these challenges by ensuring there are
adequate facilities to house and protect property and equipment
at these installations. The Committee encourages the military
services to ensure the proper facilities and structure are in
place to protect property and equipment at cold weather
installations, such as Fort Drum.

Military Construction, Army National Guard

Appropriation, fiscal year 2023....................... $459,018,000
Budget request, fiscal year 2024...................... 340,186,000
Committee recommendation, fiscal year 2024............ 369,261,000
Change from enacted level......................... -89,757,000
Change from budget request........................ +29,075,000

The Committee recommends $369,261,000 for the Army National
Guard in fiscal year 2024, of which $19,075,000 is for the
following projects in the following amounts:

----------------------------------------------------------------------------------------------------------------
State Location Project Amount
----------------------------------------------------------------------------------------------------------------
FL..................................... Camp Blanding............ Automated Multipurpose $11,000,000
Machine Gun Range.
FL..................................... Camp Blanding............ Training Aids Center..... 1,200,000
FL..................................... Camp Blanding............ Infantry Squad Battle 840,000
Course.
OK..................................... Shawnee.................. National Guard Readiness 1,800,000
Center.
PA..................................... Fort Indiantown Gap...... Automated Multipurpose 1,550,000
Machine Gun Range.
TX..................................... Fort Hood................ General Purpose 2,685,000
Instruction Building.
----------------------------------------------------------------------------------------------------------------

Within the total for Military Construction, Army National
Guard, the recommendation includes $42,361,000 for planning and
design, which is $8,075,000 above the budget request; and
$73,000,000 for unspecified minor construction, which is
$10,000,000 above the budget request.
Further detail of the Committee's recommendation is
provided in the State table at the end of this report.

Military Construction, Air National Guard

Appropriation, fiscal year 2023....................... $279,353,000
Budget request, fiscal year 2024...................... 178,722,000
Committee recommendation, fiscal year 2024............ 189,322,000
Change from enacted level......................... -90,031,000
Change from budget request........................ +10,600,000

The Committee recommends $189,322,000 for the Air National
Guard in fiscal year 2024, of which $600,000 is for the
following project in the following amount:

Within the total for Military Construction, Air National
Guard, the recommendation includes $36,200,000 for planning and
design, which is $600,000 above the budget request; and
$73,122,000 for unspecified minor construction, which is
$10,000,000 above the budget request.
Further detail of the Committee's recommendation is
provided in the State table at the end of this report.
Air National Guard Infrastructure.--The Committee
recognizes that some Aviation Support Facilities are not
configured to protect and maintain modern airframes and
encourages the Air National Guard to upgrade these facilities
using unspecified minor military construction funds, as
appropriate, to ensure current facilities are upgraded to
adequately support current airframes.

Military Construction, Army Reserve

Appropriation, fiscal year 2023....................... $193,878,000
Budget request, fiscal year 2024...................... 107,076,000
Committee recommendation, fiscal year 2024............ 117,076,000
Change from enacted level......................... -76,802,000
Change from budget request........................ +10,000,000

The Committee recommends $117,076,000 for the Army Reserve
in fiscal year 2024, including $23,389,000 for planning and
design, which is the same as the budget request; and
$24,687,000 for unspecified minor construction, which is
$10,000,000 above the budget request.
Further detail of the Committee's recommendation is
provided in the State table at the end of this report.

Military Construction, Navy Reserve

Appropriation, fiscal year 2023....................... $36,837,000
Budget request, fiscal year 2024...................... 51,291,000
Committee recommendation, fiscal year 2024............ 61,291,000
Change from enacted level......................... +24,454,000
Change from budget request........................ +10,000,000

The Committee recommends $61,291,000 for the Navy Reserve
in fiscal year 2024, including $6,495,000 for planning and
design, which is the same as the budget request; and
$17,847,000 for unspecified minor construction, which is
$10,000,000 above the budget request.
Further detail of the Committee's recommendation is
provided in the State table at the end of this report.

Military Construction, Air Force Reserve

Appropriation, fiscal year 2023....................... $85,423,000
Budget request, fiscal year 2024...................... 291,572,000
Committee recommendation, fiscal year 2024............ 330,572,000
Change from enacted level......................... +245,149,000
Change from budget request........................ +39,000,000

The Committee recommends $330,572,000 for the Air Force
Reserve in fiscal year 2024, of which $29,000,000 is for the
following projects in the following amounts:

Within the total for Military Construction, Air Force
Reserve, the recommendation includes $12,146,000 for planning
and design, which is the same as the budget request; and
$19,926,000 for unspecified minor construction, which is
$10,000,000 above the budget request.
Further detail of the Committee's recommendation is
provided in the State table at the end of this report.

North Atlantic Treaty Organization Security Investment Program

Appropriation, fiscal year 2023....................... $220,139,000
Budget request, fiscal year 2024...................... 293,434,000
Committee recommendation, fiscal year 2024............ 293,434,000
Change from enacted level......................... +73,295,000
Change from budget request........................ - - -

The North Atlantic Treaty Organization Security Investment
Program (NSIP) consists of annual contributions by North
Atlantic Treaty Organization (NATO) member countries to finance
the costs of construction needed to support the roles of the
major NATO commands.
As requested, the bill provides additional funding above
the fiscal year 2023 enacted level to support efforts to deter
Russian aggression against NATO allies and partners.

Department of Defense Base Closure Account

Appropriation, fiscal year 2023....................... $574,687,000
Budget request, fiscal year 2024...................... 389,174,000
Committee recommendation, fiscal year 2024............ 539,174,000
Change from enacted level......................... -35,513,000
Change from budget request........................ +150,000,000

The Committee recommends $539,174,000 for the Base Closure
account, which is $150,000,000 above the budget request.
The Committee supports the Navy's efforts towards the
demolition and removal of non-historically designated buildings
and structures under Navy control where the sampling or
remediation of radiologically contaminated materials have been
the subject of substantiated allegations of fraud.

Family Housing Overview

Appropriation, fiscal year 2023....................... $1,986,330,000
Budget request, fiscal year 2024...................... 1,940,751,000
Committee recommendation, fiscal year 2024............ 1,970,751,000
Change from enacted level......................... -15,579,000
Change from budget request........................ +30,000,000

Family housing construction accounts provide funds for new
construction, construction improvements, the Federal
government's costs for family housing privatization projects,
and planning and design. The operation and maintenance accounts
provide funds to pay for maintenance and repair, furnishings,
management, services, utilities, leasing, interest, mortgage
insurance, and miscellaneous expenses.
Homeownership Education.--The Committee encourages the
Services to work with privatized housing partners to develop
and provide basic homeownership education programs for
servicemembers and their families. The Committee believes that
the Army's recent counter-mold operation, a holistic, global
effort to reduce the risk of hazardous mold in Army facilities
and housing, is a step in the right direction and commends
these efforts to inform and educate Soldiers and their families
about mold conditions, mitigation, and reporting.
Indoor Air Quality.--The Committee remains concerned that
servicemembers and their families could be subject to unhealthy
living conditions, including potentially dangerous indoor air
quality, in military family housing constructed and managed by
privatized housing providers, as well as in Unaccompanied
Personnel Housing. The Committee has been aware of the poor
quality of service provided by privatized housing partners, as
well as the deteriorating housing conditions. The Department
and housing partners are directed to regularly monitor housing
conditions and adhere to Environmental Protection Agency
guidance and recommended mitigation procedures for those areas
where there is evidence of potential health effects, including
mold and other indoor air health risks.
Kwajalein Atoll.--The Committee commends the Army's
revitalization of family housing on U.S. Army Garrison
Kwajalein Atoll and believes these updates improve the quality
of life for servicemembers and their families as well as
increase force readiness.
Military Housing Privatization Initiative (MHPI).--
Recognizing the importance of adequate and safe housing to the
readiness of the U.S. military and wellbeing of servicemembers
and their families, the Committee continues to direct the
Services to prioritize the oversight of the privatized housing.
While the Department and Services have improved their internal
processes, hired staff, and increased their oversight of
housing partners, the Committee continues to hear reports of
poor housing conditions, slow response times, and indifference
towards requests for assistance. The Committee looks forward to
reviewing the report required by Division J of Public Law 117-
328 regarding the plan to address these issues.
The Committee provides an additional $30,000,000 above the
budget request to expand oversight of the entire housing
portfolio, including government-owned and controlled family
housing and privatized family and unaccompanied housing. The
Committee requests an expenditure plan detailing the planned
use of these funds within 30 days of enactment of this Act,
including the specific, additional oversight activities these
funds above the budget request will allow.
Pacific Northwest Military Housing Enhancements.--The
Committee recognizes the need to address the shortage of
affordable and suitable military family housing units in the
Pacific Northwest and the effect this shortage has on military
readiness and the quality of life of servicemembers and their
families. The Committee supports efforts to address this
shortfall.

Family Housing Construction, Army

Appropriation, fiscal year 2023....................... $169,339,000
Budget request, fiscal year 2024...................... 304,895,000
Committee recommendation, fiscal year 2024............ 304,895,000
Change from enacted level......................... +135,556,000
Change from budget request........................ - - -

Family Housing Operation and Maintenance, Army

Appropriation, fiscal year 2023....................... $446,411,000
Budget request, fiscal year 2024...................... 385,485,000
Committee recommendation, fiscal year 2024............ 395,485,000
Change from enacted level......................... -50,926,000
Change from budget request........................ +10,000,000

Family Housing Construction, Navy and Marine Corps

Appropriation, fiscal year 2023....................... $337,297,000
Budget request, fiscal year 2024...................... 277,142,000
Committee recommendation, fiscal year 2024............ 277,142,000
Change from enacted level......................... -60,155,000
Change from budget request........................ - - -

Family Housing Operation and Maintenance, Navy and Marine Corps

Appropriation, fiscal year 2023....................... $378,224,000
Budget request, fiscal year 2024...................... 363,854,000
Committee recommendation, fiscal year 2024............ 373,854,000
Change from enacted level......................... -4,370,000
Change from budget request........................ +10,000,000

Family Housing Construction, Air Force

Appropriation, fiscal year 2023....................... $232,788,000
Budget request, fiscal year 2024...................... 237,097,000
Committee recommendation, fiscal year 2024............ 237,097,000
Change from enacted level......................... +4,309,000
Change from budget request........................ - - -

Family Housing Operation and Maintenance, Air Force

Appropriation, fiscal year 2023....................... $365,222,000
Budget request, fiscal year 2024...................... 314,386,000
Committee recommendation, fiscal year 2024............ 324,386,000
Change from enacted level......................... -40,836,000
Change from budget request........................ +10,000,000

Family Housing Operation and Maintenance, Defense-Wide

Appropriation, fiscal year 2023....................... $50,113,000
Budget request, fiscal year 2024...................... 50,785,000
Committee recommendation, fiscal year 2024............ 50,785,000
Change from enacted level......................... +672,000
Change from budget request........................ - - -

Department of Defense Family Housing Improvement Fund

Appropriation, fiscal year 2023....................... $6,442,000
Budget request, fiscal year 2024...................... 6,611,000
Committee recommendation, fiscal year 2024............ 6,611,000
Change from enacted level......................... +169,000
Change from budget request........................ - - -

Department of Defense Military Unaccompanied Housing Improvement Fund

Appropriation, fiscal year 2023....................... $494,000
Budget request, fiscal year 2024...................... 496,000
Committee recommendation, fiscal year 2024............ 496,000
Change from enacted level......................... +2,000
Change from budget request........................ - - -

Administrative Provisions

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

(INCLUDING TRANSFER OF FUNDS)

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

(INCLUDING TRANSFER OF FUNDS)

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

(INCLUDING TRANSFER OF FUNDS)

The bill includes section 121 allowing the transfer of
expired funds to the ``Foreign Currency Fluctuations,
Construction, Defense'' account.
The bill includes section 122 allowing the transfer of
funds in accordance with reprogramming guidelines.
The bill includes section 123 prohibiting the use of funds
for projects at Arlington National Cemetery.
The bill includes section 124 providing funds for certain
projects identified in the respective military department's
unfunded priority list for fiscal year 2024.
The bill includes section 125 directing all amounts
appropriated to Military Construction (all accounts) be
immediately available and allotted for the full scope of the
authorized project.
The bill includes section 126 extending the eligibility of
unobligated funding for fiscal year 2017, 2018, and 2019
projects that have not lapsed.
The bill includes section 127 defining the congressional
defense committees.
The bill includes section 128 providing additional funds
for planning and design for construction improvements to
laboratory facilities.
The bill includes section 129 providing additional funds
for the Air Force for expenses incurred as a result of natural
disasters.
The bill includes section 130 providing funds for planning
and design for child development centers.
The bill includes section 131 providing funds for planning
and design for barracks.
The bill includes section 132 providing funds for
unspecified minor construction for demolition.
The bill includes section 133 providing funds for cost to
complete projects identified in the respective military
department's unfunded priority list for fiscal year 2024.
The bill includes section 134 providing funds for planning
and design associated with the Shipyard Infrastructure
Optimization Program.
The bill includes section 135 prohibiting funds from being
used to carry out the closure or realignment of Naval Station
Guantanamo Bay.
The bill includes section 136 regarding U.S. Space Command
Headquarters.

TITLE II

DEPARTMENT OF VETERANS AFFAIRS

Appropriation, fiscal year 2023\1\................... $303,282,598,000
Budget request, fiscal year 2024\1\.................. 319,763,645,000
Committee recommendation, fiscal year 2024\1\........ 299,495,645,000
Change from enacted level........................ -3,786,953,000
Change from budget request....................... -20,268,000,000
Fiscal year 2025 advance budget request.............. 327,085,076,000
Fiscal year 2025 Committee recommendation in the bill 305,633,534,000
Change from budget request....................... -21,454,542,000

\1\All funding cited excludes amounts in the Medical Care Collections
Fund.

The Department of Veterans Affairs (VA) provides health
care for 9,000,000 veteran enrollees; disability compensation
benefits to an estimated 6,094,440 veterans and 562,448
survivors; pension benefits for an estimated 136,678 veterans
and 112,179 survivors; life insurance for more than 5,600,000
veterans, servicemembers and their families; educational
assistance for nearly 820,000 students; and interment of more
than 140,000 veterans and eligible family members in national
cemeteries. To serve adequately the nation's veterans, VA
employs more than 450,000 staff, making it one of the largest
Federal agencies in terms of employment.
Advertising Contracts for Small Business.--The Committee
understands that, as the largest advertiser in the United
States, the Federal government should work to ensure fair
access to its advertising contracts for small, disadvantaged
businesses and businesses owned by minorities and women. The
Committee directs the Department to include the following
information in its fiscal year 2025 budget justification:
Expenditures for fiscal year 2023 and expected expenditures for
fiscal year 2025, respectively, for (1) all contracts for
advertising services; and (2) contracts for the advertising
services of (I) socially and economically disadvantaged small
businesses concerns (as defined in section 8(a)(4) of the Small
Business Act (15 U.S.C. 637(a)(4)); and (II) women-and
minority-owned businesses.
Congressional Oversight of VA's Actions on Abortion.--The
bill prohibits funding to implement, administer, or otherwise
carry out the Department's illegal actions in the interim final
rule published September 9, 2022. The interim final rule
clearly violated Section 106 of the Veterans Health Care Act of
1992 (P.L. 102-585; Title 38 U.S.C. 1710 note). The Committee
directs the Department to provide a report within 30 days of
enactment, and every 180 days thereafter, to the Committee on
Appropriations of the United States House of Representatives
and the Committee on Appropriations of the United States Senate
containing the following information, disaggregated by State:
(1) the number of abortions the Department has provided in VA
facilities since September 9, 2022; (2) the number of abortions
performed elsewhere and funded by the Department since
September 9, 2022; (3) under which exception each abortion
provided or funded by the Department has qualified; (4) the
total amount expended on each abortion; and (5) the criteria
used and documentation required by the Department to determine
when an exception allowing for an abortion applies.
Customer Service Standards and Performance Plan.--The
Committee continues to support efforts to improve customer
service in accordance with Executive Order 13571, Streamlining
Service Delivery and Improving Customer Service, and encourages
the Secretary to continuously improve customer service
standards and incorporate them into the performance plan
required by section 1115 of title 31, United States Code. The
Committee requests that the Department confirm its compliance
with 31 U.S.C. 1115 within 30 days of enactment of the Act.
Former Members of Guard and Reserve Components.--The
Committee notes that since 2020 the National Veteran Suicide
Prevention Annual Reports have not included information
regarding former members of the Guard and Reserve Components
who were not activated for military service. The Committee
encourages the Department to continue to collaborate with the
Department of Defense to monitor and to ensure appropriate
measures are available to reduce suicide in this population.
Protecting Immigrant Veterans.--The Committee supports VA's
role in the Immigrant Military Members and Veterans Initiative
and urges VA to take steps to ensure non-citizen veterans are
aware of their options to naturalize as U.S. citizens and
provide administrative guidance and assistance with relevant
applications and paperwork. The Department is encouraged to
continue to coordinate with the Department of Homeland Security
to develop methods that allow the Department to maintain
contact with immigrant and non-citizen veterans and ensure that
they can access immigration related assistance and other VA
assistance and benefits to which they are entitled by law.
Service-Disabled Veteran Owned Small Business Program.--The
Committee understands that Congress created the Service-
Disabled Veteran Owned Small Business (SDVOSB) program to honor
the service of veterans who incurred disabilities on active
service and to leverage their unique skill sets and
perspectives for the public benefit. However, SDVOSB contract
awards and obligations often fall short of targets, and SDVOSBs
remain an underutilized agency partner. The Committee urges VA
to prioritize meeting SDVOB targets utilizing available
acquisition tools including best-in-class acquisition
solutions, including for new and emerging information
technology requirements.
Sexual Harassment and Sexual Assault Protections for VA
Beneficiaries and Employees.--Eliminating sexual harassment and
assault at VA is critical to creating a safe and welcoming
environment for veterans, their families, caregivers, and
survivors, as well as VA employees. The Committee notes that VA
has published a handbook with comprehensive policy guidance and
instructions addressing harassment and sexual assault and
directs VA to ensure that these policies are fully communicated
and complied with. The Committee appreciates the Department's
efforts to better address harassment and sexual assault and
requests an updated report annually on its approach.
Veterans First Contracting Program.--The Committee
encourages VA to continue to expand and standardize the
training of contracting officers in the requirements of the
Veterans First Contracting Program, with particular attention
being paid to conducting the market research necessary to
ensure service-disabled veteran and veterans-owned small
businesses, including women and minority veteran-led small
businesses, are awarded VA contracts when appropriate.
Veterans Records.--The Committee is aware some veterans are
receiving records through the U.S. Postal Service instead of
electronically, as requested. This is contrary to the 21st
Century Cares Act, unnecessarily increases costs, and causes
delays. The Committee directs the Department to ensure
employees are aware of this requirement and not to send
requested documents through the U.S. Postal Service unless the
veteran has no other means available to receive the records.
Veterans in the Pacific.--The Committee acknowledges and
appreciates the service of Pacific island veterans and
recognizes the challenges they have in securing the benefits
they have earned. As such, the Committee directs the Department
to (1) expand and improve the delivery and services of the
Foreign Medical Program; (2) expand the availability of
preventative and wellness programs, suicide prevention,
military sexual trauma, and women's health to veterans in the
Pacific islands; (3) fully utilize telehealth in the region;
(4) expand the capabilities, including staffing, of the Guam
and/or Manila regional offices to allow quarterly visits to the
territories and Freely Associated States; (5) develop training
programs so that local veterans can become advocates for other
veterans; (6) develop methods to securely provide payments to
veterans and providers, using U.S. embassy resources, as
appropriate; (7) allow for the prescribing and mailing, through
the U.S. Postal Service, of medications by U.S. providers to
veterans in the territories and Freely Associated States,
consistent with Federal law; (8) seek to train local healthcare
providers in the unique needs of veterans; (9) allow healthcare
providers in the territories and Freely Associated States to
directly bill for services provided; (10) ensure beneficiary
travel reimbursement rates are commensurate with travel costs
in the region; and (11) ensure veterans in the territories,
Freely Associated States, other locales, and nations are noted
in expenditure reporting, such as in the appendix to the
Federal Budget. The Committee requests a report within 60 days
of enactment of this Act regarding the status of these efforts.
The report should include a detailed description of the
Department's efforts, identify barriers to implementation, and
provide legislative and funding recommendations. The Committee
continues to support the Center for Native Hawaiians, Pacific
Islanders, and U.S. Affiliated Pacific Islanders.

Veterans Benefits Administration

COMPENSATION AND PENSIONS

(INCLUDING TRANSFER OF FUNDS)

Fiscal year 2023 enacted level....................... $152,016,542,000
Fiscal year 2024 enacted level....................... 146,778,136,000
Fiscal year 2024 budget year request................. 4,655,879,000
Committee 2024 budget year recommendation............ 4,655,879,000
Fiscal year 2025 advance appropriation request....... 181,390,281,000
Committee 2025 advance appropriation recommendation.. 181,390,281,000
Comparison with:
Fiscal year 2024 enacted level................... +34,612,145,000
Fiscal year 2025 advance budget request.......... - - -

This appropriation provides funds for service-connected
compensation payments to an estimated 6,094,446 veterans and
562,448 survivors in fiscal year 2024. In addition, pension
payments will be funded for an estimated 150,678 veterans and
112,179 survivors. The average payment per compensation case
for veterans in fiscal year 2024 is estimated to be $24,307 and
pension payments are projected to be $14,063.
The appropriation includes authority to transfer funding
not to exceed $22,109,000 in fiscal year 2024 to General
Operating Expenses, Veterans Benefits Administration (VBA) and
Information Technology Systems. These funds are for the
administrative expenses of implementing cost-saving provisions
required by the Omnibus Budget Reconciliation Act of 1990 (P.L.
101-508), the Veterans' Benefits Act of 1992 (P.L. 102-568),
and the Veterans' Benefits Improvements Act of 1994 (P.L. 103-
446). The bill also continues to include language permitting
this appropriation to reimburse such sums as may be earned to
the Medical Care Collections Fund to help defray the operating
expenses of individual medical facilities for nursing home care
provided to pensioners.
The Committee recommendation includes $4,655,879,000 in
additional funding for fiscal year 2024 for a total of
$151,434,015,000 for the fiscal year, which includes the
advance appropriation provided in the prior fiscal year. For
fiscal year 2025, the Committee recommendation includes an
advance appropriation of $181,390,281,000.
Disability Claims and Appeals.--Due to the significant
investments Congress has provided in recent years, VA has been
able to hire staff, acquire technology, and modify work
processes necessary to significantly reduce the disability
claims backlog. The Committee encourages VA to continue its
effort to reduce the claims backlog to pre-pandemic levels and
work expeditiously to resolve the oldest and most emergent
claims.

READJUSTMENT BENEFITS

Fiscal year 2023 enacted level........................ $8,906,851,000
Fiscal year 2024 enacted level........................ 8,452,500,000
Fiscal year 2024 budget year request.................. - - -
Committee 2024 budget year recommendation............. - - -
Fiscal year 2025 advance appropriation request........ 11,523,134,000
Committee 2025 advance appropriation recommendation... 11,523,134,000
Comparison with:
Fiscal year 2025 enacted level.................... +3,070,634,000
Fiscal year 2025 advance budget request........... - - -

This appropriation finances the education and training of
veterans and servicemembers through the Post-9/11 GI Bill and
the All-Volunteer Force Educational Assistance Program. In
addition, certain disabled veterans are provided with
vocational rehabilitation, specially adapted housing grants,
and grants for automobiles with approved adaptive equipment.
This account also finances educational assistance allowances
for eligible dependents of veterans who died from service-
connected causes or have a total and permanent service-
connected disability, as well as dependents of servicemembers
who were captured or are missing in action.
The Committee recommendation includes an advance
appropriation of $11,523,134,000 for fiscal year 2025.
GI Bill Comparison Tool.--The Committee emphasizes the
importance of providing veterans with the necessary information
to make informed decisions when selecting institutions of
higher education. The Committee urges the Department to
continue to monitor and assess the effectiveness of the GI
comparison tool, including usage metrics, the frequency that
caution flags are checked and updated, and technical
performance.
Skills and Certifications.--The Committee recognizes the
importance of expanding job opportunities for veterans after
their discharge and encourages VA to work with other Federal
agencies and State licensing bureaus, as appropriate, to
evaluate the transferability of DoD skills and certifications,
including mechanical skills and certifications, to state
certifications to aid in transition to civilian employment.
Technology for Student Veterans.--During the pandemic,
remote learning technologies, such as computers and routers for
internet access, were widely used so students could continue
their studies. Within 180 days of enactment of this Act, the
Department is directed to submit a report on the cost,
feasibility, and advisability of ensuring student veterans have
access to the technologies needed to be successful in school.
Transition Coordination.--The Committee encourages VA, in
consultation with the Departments of Defense and Labor, to
coordinate efforts and resources to ensure veterans have a
successful transition to civilian life. This includes sharing
information on community resources, including nonprofits and
Veterans Service Organizations, that are available to veterans
and their families. The Committee also urges VA to explore
options for veterans to access hands-on job placement services
that connect them directly with employers, including those
offered through successful state and local programs.
VET TEC Pilot Program.--The Committee expects the
Department to fund the program, consistent with current law, at
$45,000,000 for fiscal year 2024, and encourages it to take
steps to expand access by including additional providers,
particularly in areas of the country where the initiative is
not currently available or only allowing access to online
courses, as well as to help train and employ women veterans and
veterans with disabilities.
Veteran Transitional Assistance Grant Program (VTAG).--The
Committee continues to support VTAG and includes an additional
$5,000,000 above the fiscal year 2023 level, as requested.

VETERANS INSURANCE AND INDEMNITIES

Fiscal year 2023 enacted level........................ $109,865,000
Fiscal year 2024 enacted level........................ 121,126,000
Fiscal year 2024 budget year request.................. 12,701,000
Committee 2024 budget year recommendation............. 12,701,000
Fiscal year 2025 advance appropriation request........ 135,119,000
Committee 2025 advance appropriation recommendation... 135,119,000
Comparison with:
Fiscal year 2024 enacted level.................... +13,993,000
Fiscal year 2025 advance budget request........... - - -

The Veterans Insurance and Indemnities appropriation is
made up of the former appropriations for military and naval
insurance, applicable to World War I veterans; national service
life insurance applicable to certain World War II veterans;
servicemember's indemnities, applicable to Korean Conflict
veterans; and veterans mortgage life insurance, applicable to
individuals who have received a grant for specially adapted
housing.
The Committee recommendation includes an additional
$12,701,000 for fiscal year 2024 for a total of $133,827,000
for the fiscal year. This includes the advance appropriation
provided in the prior fiscal year. For fiscal year 2025, the
Committee recommendation includes an advance appropriation of
$135,119,000.

VETERANS HOUSING BENEFIT PROGRAM FUND PROGRAM ACCOUNT

----------------------------------------------------------------------------------------------------------------
Limitation on
direct loans for Administrative
Program Account specially adapted Expenses
housing loans
----------------------------------------------------------------------------------------------------------------
Appropriation, fiscal year 2023.......................... - - - ($500,000) $282,361,131
Budget request est., fiscal year 2024.................... - - - (500,000) 316,742,419
Committee recommendation, fiscal year 2024............... - - - (500,000) 316,742,419
Change from enacted level............................ - - - - - - +34,381,288
Change from budget request........................... - - - - - - - - -
----------------------------------------------------------------------------------------------------------------

The purpose of the home loan guaranty program is to
facilitate the extension of mortgage credit on favorable terms
by private lenders to eligible veterans. This appropriation
provides for all costs, with the exception of the Native
American Veterans Housing Loan Program, of the Department's
direct and guaranteed loans programs.
The Committee recommendation includes $316,742,419 for
fiscal year 2024 for administrative expenses to carry out the
Veterans Housing Loan Program.
Home Loan Income Verification.--The Committee understands
that as directed by House Report 116-63, VA has clarified that
nothing in VA statutes or regulations specifically prohibits a
veteran whose income is derived from state-legalized cannabis
activities from obtaining a certificate of eligibility for VA
home loan benefits. The Committee understands that VA is
working to improve communication with eligible lending
institutions to reduce confusion among lenders and borrowers on
this matter.

VOCATIONAL REHABILITATION LOANS PROGRAM ACCOUNT

----------------------------------------------------------------------------------------------------------------
Limitation on Administrative
Program Account direct loans Expenses
----------------------------------------------------------------------------------------------------------------
Appropriation, fiscal year 2023.......................... $7,171 ($942,330) $445,698
Budget request, fiscal year 2024......................... 78,337 (2,026,000) 460,698
Committee recommendation, fiscal year 2024............... 78,337 (2,206,000) 460,698
Change from enacted level............................ +71,116 (+1,083,670) +15,000
Change from budget request........................... - - - - - - - - -
----------------------------------------------------------------------------------------------------------------

This appropriation covers the subsidy cost of direct loans
for vocational rehabilitation of eligible veterans and includes
administrative expenses necessary to carry out the direct loan
program. Loans of up to $1,300 (based on indexed chapter 31
subsistence allowance rate) are available to service-connected
disabled veterans enrolled in vocational rehabilitation
programs when the veteran is temporarily in need of additional
assistance.
The Committee recommendation includes $460,698 for fiscal
year 2024 for administrative expenses to carry out the
Vocational Rehabilitation Direct Loan program. It is estimated
that the Department will make 1,559 loans in fiscal year 2024.

NATIVE AMERICAN VETERAN HOUSING LOAN PROGRAM ACCOUNT

Administrative expenses:
Appropriation, fiscal year 2023....................... $1,400,000
Budget request, fiscal year 2024...................... 2,718,546
Committee recommendation, fiscal year 2024............ 2,718,546
Change from enacted level......................... +1,318,546
Change from budget request........................ - - -

The Native American Veteran Housing Loan Program, as
authorized by title 38 United States Code, chapter 37,
subchapter V, provides the Secretary authority to make direct
housing loans to Native American veterans for the purpose of
purchasing, constructing, or improving dwellings on trust
lands, including Hawaiian Home Lands. These loans are available
to purchase, construct, or improve homes to be occupied as
veterans' residences.
The Committee recommendation includes $2,718,546 for fiscal
year 2024 for administrative expenses for the Native American
Veteran Housing Loan Program.

GENERAL OPERATING EXPENSES, VETERANS BENEFITS ADMINISTRATION

Appropriation, fiscal year 2023....................... $3,863,000,000
Budget request, fiscal year 2024...................... 3,899,000,000
Committee recommendation, fiscal year 2024............ 3,899,000,000
Change from enacted level......................... +36,000,000
Change from budget request........................ - - -

The General Operating Expenses, Veterans Benefits
Administration (VBA) account provides funding for VBA to
administer entitlement programs such as service-connected
disability compensation, education benefits, and vocational
rehabilitation services.
The Committee recommendation includes $3,899,000,000 for
fiscal year 2024 for General Operating Expenses, VBA. These
resources will fully fund VA's request for fiscal year 2024 and
improve VBA's ability to address compensation and benefit
claims. The bill makes available through September 30, 2025, up
to ten percent of these funds.
Benefits Usage.--The Committee encourages VA to include
veteran benefit usage into its annual suicide prevention
report, including usage of disability compensation, education
and employment, home loan and foreclosure assistance benefits,
as well as participation in housing and food security programs.
Additional data may enable a better understanding of the
correlation between benefit use and suicide and allow for more
effective programs to assist veterans.
Compensation and Pension (C&P) Claims.--The Committee
continues to be concerned about reports of delays that veterans
experience in the resolution of pending C&P claims. The
Committee encourages the Department to work diligently to
reduce the backlog of compensation and benefit claims to pre-
pandemic levels to lessen the burden of excessive wait times.
Compensation and Pension Exams.--The Committee is aware
that the majority of veterans filing claims for disabilities
incurred or aggravated by Military Sexual Trauma (MST) are
referred to a third-party contract provider for the required
C&P exam, and that veterans filing MST-related claims may have
unique needs and safety concerns. The Committee requests a
report, not later than 90 days after enactment of this Act,
describing information related to the required, specialized
training for contracted and VA examiners. The report should
include claim outcome data, by congressional district as
practicable, for veterans referred to a third-party provider as
compared to those evaluated by a VA provider. The Committee
directs VA to allow veterans filing an MST-related claim to
request a VA provider for the required C&P exam.
Digitizing Veteran Records.--The Committee commends the
efforts of VBA, in partnership with the National Archives and
Records Administration, to address the backlog of veterans'
records requests by creating digital copies of records that
currently exist only in hardcopy form at the National Personnel
Records Center (NPRC). The Committee strongly encourages VBA to
continue its efforts to create digital copies of veterans'
records housed at NPRC.
Equitable Relief.--The Committee understands VA is working
to implement new systems and protocols to eliminate instances
of administrative error. However, as VA enacts system-wide
reforms, ending equitable relief for veterans who were deemed
eligible for benefits in error would place an unfair burden on
veterans and their families. The Secretary is directed to
continue to grant or extend equitable relief to eligible
veterans initially deemed eligible in instances of
administrative error. Not later than April 1, 2024, the
Secretary is directed to submit to the Committee a report
containing a statement as to the disposition of each case
recommended to the Secretary for equitable relief under section
503 of title 38, United States Code during the preceding
calendar year.
Filipino Veterans.--There are approximately 1,721 living
WWII Filipino Veterans. The Committee directs the Department to
provide a report within 180 days of the enactment of this Act
describing an outreach plan and required budget to extend the
time limit for accepting initial and revised applications for a
sufficient period of time to ensures all eligible, living WWII
Filipino Veterans can apply for and receive the benefits they
are entitled to.
Hearing Loss Prevention.--Hearing loss and auditory
injuries account for one of the most prevalent service-
connected disabilities for veterans receiving compensation
benefits. The Committee encourages the Department to work with
the Department of Defense to identify options, strategies, and
technologies to reduce the incidence of hearing loss by
military personnel through exposure to excessive auditory
pressure impulses during weapons training.
Information for Toxic-Exposed Veterans.--The Committee
encourages VA to ensure resources and materials provided by VA
to toxic-exposed veterans be made available in the most
commonly spoken languages in the United States, as required by
the Veterans and Family Information Act (P.L. 117-62).
Military Sexual Trauma.--The Committee continues to direct
VA to prioritize specialized MST training for claims processors
and involve MST survivors in the development of specialized
training.
The Committee additionally remains concerned that veterans
suffering from a mental health disorder because of sexual
trauma during service have different standards of evidence
based on their diagnosis. The Committee recognizes that
evidence in personnel files is rare, no matter the resulting
condition following MST. As such, the Committee urges VA to
support the extension of the relaxed evidentiary standard to
all those suffering from mental health disorders as a result of
MST. The Committee also urges VA to continue to report on
information relating to claims for disabilities incurred or
aggravated by MST, as provided by section 113 of the Jeff
Miller and Richard Blumenthal Veterans Health Care and Benefits
Improvement Act of 2016 (P.L. 114-315).
Toxic Exposure Claims.--The Committee recognizes that an
increase in claims and associated workload increases is
expected as a result of enactment of the Honoring our Promise
to Address Comprehensive Toxics Act (PACT Act) and encourages
the Department to implement thorough and special training
protocols to ensure accuracy and efficiency in the claims
adjudication process.

Veterans Health Administration

The Department operates the largest integrated medical care
delivery system in the United States, providing care at nearly
1,300 health care facilities, including 171 medical centers and
more than 1,100 outpatient sites, to more than 9,000,000
veterans enrolled in the VA healthcare program.
The bill includes a total of $121,011,303,000 for veterans'
medical care. The Fiscal Responsibility Act of 2023 (P.L. 118-
5) provided a total of $20,268,000,000 for the Cost of War
Toxic Exposures Fund for fiscal year 2024, including
$17,116,000,000 for veterans' medical care. The combined total
appropriated by this Act and the Fiscal Responsibility Act for
veterans medical care is $138,127,303,000, equal to the
President's Budget request.
In addition, the bill includes a total of $112,582,000,000
in advance appropriations for fiscal year 2025. The Fiscal
Responsibility Act also provided $24,455,000,000 in advance
appropriations for the Toxic Exposures Fund for fiscal year
2025, including $21,454,542,000 for veterans' medical care. The
combined total appropriated by this Act and the Fiscal
Responsibility Act is $134,036,542,000 for medical care for
fiscal year 2025, as requested.
In fiscal year 2024, VA will collect an estimated
$3,991,000,000 in the Medical Care Collections Fund.
The Committee provides $938,000,000 for Medical and
Prosthetic Research for fiscal year 2024, equal to the
requested level.
The Committee provides $112,582,000,000 in advance for
fiscal year 2025, equal to the budget request.
Ambulance Services.--The Committee recognizes the critical
value of Special Modes of Transportation but is concerned the
change in rates that VA pays may jeopardize access to ambulance
services. The Committee directs VA to expeditiously contract
with providers of special modes of transportation at fair and
appropriate reimbursement rates to provide certainty about
payments and ensure the availability of ambulance services.
Beneficiary Travel.--The Committee continues to hear from
veterans frustrated with the system and the inability of VA
staff to assist them. The Department is directed to ensure the
new system is user-friendly and staff are trained and available
to provide the required assistance.
Dispute Resolution.--The Committee urges VA to ensure that
veterans are advised of their rights to contest VA billing
charges and determinations and of the step-by-step process for
disputes. VA should ensure this information is available online
and in publicly accessible areas at each VA medical center, and
that it is made available in English, Spanish, and the eight
other most commonly spoken languages in the United States per
current laws (P.L. 117-62).
Essential Medical Products.--The United States'
manufacturing capacity for essential medical products is at
serious risk due to organized efforts by Chinese manufacturers
to enter the U.S. market in response to inflationary pressures
faced by U.S.-based manufacturers, distributors, and providers.
The current shift toward purchasing Chinese-made health care
supplies is drastic and occurring at a pace that will leave
U.S. hospitals dependent on Chinese supplied products. The
Committee strongly urges the Department to address this issue
and prioritize purchasing decisions that support domestic-based
manufacturing for critical healthcare products required for VA
medical facility operations, such as those that supply medical
supplies like needles and syringes. The Committee strongly
supports efforts to protect national security and vulnerable
domestic supply chains for critical industries, like medical
supplies. The Committee requests the Department provide a
report, no later than 90 days after the enactment of this Act,
on efforts to strengthen the VA's medical facilities supply
chain with U.S. domestically produced products. Specifically,
the Department should report on any cross-agency efforts it is
involved in to shore up the domestic supply of essential
medical products and steps taken to expand VA's use of
domestically produced essential medical products.
Vet Centers.--The Committee directs VA to ensure that Vet
Centers have data on eligible veterans in their service areas
so that they can tailor their outreach activities and veterans
are aware of available services.
Veterans Enrollment in Medicare.--The Committee is aware
that information gaps exist for some veterans related to the
differences between the hospital care and medical services
available in the VA system versus coverage provided under
Medicare. The Committee encourages VA to work with the
Department of Health and Human Services to ensure that veterans
have complete information regarding the differences between the
VA system and Medicare coverage, including for prescription
drugs.
VHA Phone Operations.--The Committee encourages VA to
improve its phone operations to ensure communications between
major regional VA Medical Centers and community based
outpatient clinics (CBOC) route veterans' calls to their local
CBOC, as appropriate.

MEDICAL SERVICES

Fiscal year 2023 enacted level........................ $70,584,116,000
Fiscal year 2024 enacted level........................ 74,004,000,000
Fiscal year 2024 budget year request.................. - - -
Committee 2024 budget year recommendation............. - - -
Fiscal year 2025 advance appropriation request........ 71,000,000,000
Committee 2025 advance appropriation recommendation... 71,000,000,000
Comparison with:
Fiscal year 2024 enacted level.................... -3,004,000,000
Fiscal year 2025 advanced budget request.......... - - -

The bill includes $71,000,000,000 for advance fiscal year
2025 funding. The Committee has included bill language to make
$2,000,000,000 of the Medical Services advance appropriation
for fiscal year 2025 available through September 30, 2026.
Allocation of Health Funding.--The Committee continues to
request a report each year, no later than 30 days after VA
allocates the medical services appropriation to the VISNs, that
identifies: (1) the amount of general purpose funding that is
allocated to each VISN; (2) the amount of funding that is
retained by central headquarters for specific purposes, with
amounts identified for each purpose; and (3) the amount of
funding that is retained by each VISN before allocating it to
the medical centers, identifying separately the amounts
retained for purposes such as network operations, network
initiatives, and emergencies.
Changes in Funding Requirements Due to Modeling.--The
Committee expects VA to continue to include in the sufficiency
letter required by section 117(d) of title 38, United States
Code, which is due to the Congress on July 31 of each year, a
description of any changes exceeding $250,000,000 in funding
requirements for the Medical Services account resulting from
the spring recalculation of the Enrollee Healthcare Projection
Model.

CANCER AND RARE DISEASES

Cancer Screening at Veterans Affairs Medical Centers.--The
Department is encouraged to ensure its healthcare providers
screen for the numerous types of cancers that veterans
experience so they can receive the best possible care.
Creutzfeldt-Jakob Disease (CJD) Monitoring.--The Committee
continues to urge VA to utilize reference data from existing
medical records of veterans to determine the percentage of
veterans who have more frequent or unexplained symptoms
associated with CJD compared to the civilian population. This
data could be helpful in clarifying the extent and specifics of
the medical issues suffered by veterans because of CJD.
Dermatological Care for Veterans.--The Committee recognizes
that veterans may have experienced large amounts of ultraviolet
radiation during their service in the military and have an
increased risk of skin cancer. Recent studies, including those
by the National Institutes of Health and as reported in the
Journal of the American Academy of Dermatology, compared the
rates of skin cancer among military and veteran populations to
nonmilitary populations in the United States, finding members
of the military and veterans may have higher incidence of skin
cancer. As such, the Committee directs the department to
provide a report no later than 180 days after the enactment of
this Act regarding the Department's approach to skin cancer,
its views on recent studies, and on veterans' access to
dermatology screening, dermatologists, and trained Mohs
micrographic surgeons.
Lung Precision Oncology Program.--The Committee notes with
approval the launch of the VA's Lung Precision Oncology Program
and its effort to expand access to lung cancer screening for
veterans and accelerate the science on lung cancer prevention,
detection, and treatment. The Committee provides $14,000,000
for this program, as requested.
Molecular Diagnostics and Precision Oncology.--The
Committee recommendation includes $215,433,000 for Precision
Oncology, an increase of $48,206,000 above the fiscal year 2023
enacted level; as well as $30,300,000 for Molecular
Diagnostics, as requested, to accelerate the adoption of
molecular diagnostics for additional cancers, including rare
cancers and hematopoietic cancers.
VA is encouraged to continue to provide information to
clinicians on the value of using molecular diagnostics for
cancer patients and on how to contribute tissue specimens to a
repository started among the Department, Department of Defense,
and the National Institutes of Health. The Committee requests
an update, no later than 60 days after the enactment of this
Act, describing how these funds will be used to enhance the use
of molecular diagnostics, including information on the use of
specific types of molecular diagnostics, such as microarray,
whole exome, whole genome, and RNA Seq.

CAREGIVER SUPPORT PROGRAM

Caregivers Program.--The Committee provides $2,422,410,000,
as requested, for the caregivers program. The Committee
continues to require quarterly reporting on obligations for
this program.

CENTERS OF EXCELLENCE

Epilepsy Center of Excellence.--The Committee encourages
the Department to ensure that all veterans with epilepsy are
comprehensively evaluated at a VHA Epilepsy Center of
Excellence to identify drug-resistant epilepsy patients who may
be candidates for FDA-approved non-drug therapies.
Neurology Centers of Excellence.--The Committee recognizes
the increasing number of veterans affected by neurologic
conditions, including epilepsy, headache, multiple sclerosis,
and Parkinson's disease. The Neurology Centers of Excellence
provide essential innovative clinical care, education, and
research efforts focused on these conditions. The Committee
encourages further investment and collaboration of the Centers
across disciplines and includes the requested $59,540,000 for
Neurology Centers of Excellence. This includes $23,590,000 for
epilepsy; $21,000,000 for headache; $10,330,000 for
Parkinson's; and $4,620,000 for multiple sclerosis.

COLLABORATIONS AND PARTNERSHIPS

Academic Collaborations at Community Based Outpatient
Clinics (CBOC).--The Committee encourages VA to expand academic
collaborations with CBOCs, as they provide valuable patient
care and access to services that can be strengthened by
collaboration with educational institutions. Through clinical
traineeships and research fellowships, emerging health
professionals can gain a better understanding of veterans'
specific healthcare needs, improve patient outcomes, advance
specialized research, and increase the talented workforce
pipeline. VA is encouraged to consider including public
academic medical centers in CBOC collaborations.
Partnerships.--The Committee commends the efforts of
private organizations to support veterans and recognizes that
they can sometimes provide services, such as counseling and
wellness programs, for the families of veterans that the
Department cannot. Recognizing that Congress, the Department,
and private organizations share the same goal of supporting
veterans, the Committee directs the Department to build upon
its existing partnerships and seek opportunities to establish
new ones and provides up to $5,000,000 for this purpose. The
Committee is specifically interested in partnerships focused on
providing mental health care, including the mental health of
veterans' families, and requests a report on the Department's
current partnership activities within 90 days of enactment of
this Act. The report should identify types of partnerships and
their best practices and the opportunities, barriers, and cost
of expanding them. It also should include an analysis of
potential and innovative options to simplify the process for
veterans seeking mental health care, such as through
modifications to referral requirements, technologies to ease
scheduling, and the use of telemedicine.
Strategic Collaboration.--The Committee encourages the
Department to engage with potential partners, including through
lease agreements, to modernize and provide increased access to
veterans services, especially in areas with many veterans where
VA cannot meet demand.

DENTAL CARE

Dental Care.--The recommendation includes $2,573,291,000,
as requested, to provide dental care for veterans. The
Committee requests that the fiscal year 2025 budget
justification include information on the role, resources, and
staffing required for the Assistant Under Secretary of Health
for Dentistry and the Office of Dentistry.
Dental Care Report.--The Committee understands that
veterans may experience a large oral disease burden, and
therefore an integrated and whole-person approach is needed to
prevent and manage oral disease in this population. The
Committee urges the Department to offer robust dental
healthcare services to veterans and requests a report within
180 days of enactment of this Act assessing the state of the
Department's oral healthcare program and its ability to
adequately meet current and future needs. The report should
include an assessment of the Department's infrastructure
serving the oral health needs of veterans enrolled in VA
healthcare and the additional infrastructure that would be
needed if eligibility were expanded.

DIABETES CARE

Diabetic Foot Ulcers.--The Committee continues to be
concerned about diabetic foot and related limb loss among
veterans. Based upon the September 2022 report entitled
``Report to Congress on Remote Patient Diabetes Foot Ulcer
Monitoring,'' which details disparate outcomes due to disparate
training provided to VA clinicians, within 30 days of enactment
of the Act, the Committee requests the Department provide a
report detailing its plan for ensuring that all VA employees
utilizing remote temperature monitoring are receiving the
training necessary to ensure optimal outcomes.

EMERGING AND NOTABLE HEALTHCARE ISSUES

Air Filtration Equipment and Technologies.--The Committee
appreciates the Department's review of its air filtration
standards; encourages it to exceed industry standards on
single-pass air and levels of air filtration; and urges it to
continue to research, evaluate, and implement new technologies,
including commercial off-the-shelf technologies.
Central Line Associated Blood Stream Infections
(CLABSIs).--The Committee is aware of the reported 31 percent
increase in (CLABSI) rates in acute care facilities during the
coronavirus pandemic. The Department is urged to enhance and
sustain conventional infection prevention and control
strategies to reduce this significant increase in CLASBIs and
any other hospital-associated infections. The Committee
requests the fiscal year 2025 budget request include a detailed
plan that describes the steps accomplished and planned to
reduce the rate of CLASBIs and other hospital-associated
infections.
Dialysis.--Understanding that some dialysis services are
provided through community providers under nation-wide
contracts when the care cannot be provided directly, the
Committee expects the Department to ensure veterans receive the
highest quality care and access to care and looks forward to
receiving the report requested in P.L. 117-328.
Marriage and Family Therapists.--The Committee urges VA to
improve access to marriage and family therapists and to ensure
that there are no unnecessary barriers to increasing the
Department's capacity to serve veterans seeking this care.
Needle Stick Injuries (NSI).--The Committee requests a
report within 90 days of enactment of this Act regarding
options to reduce or eliminate (NSIs) among clinicians,
including the use of electronic digital needle destruction
technology, as well as potential time and cost savings
associated with the options.
Nuclear Medicine Quality Improvements.--The Committee notes
the Nuclear Regulatory Commission's (NRC) commencement of a
rulemaking to require reporting of some nuclear medicine
extravasations and acknowledges that significant nuclear
medicine extravasations can cause patient injury. The Committee
requests a report, not later than 180 days after enactment of
this Act, regarding VA implementation of new NRC regulatory
requirements, including any requirements related to the
monitoring of injection quality, image extravasations,
dosimetry, and patient notification.
Pressure Injuries.--The Committee supports the development
and use of an evidence-based standard of care for pressure
injury prevention and treatment and encourages VA to update
recommendations and guidelines to ensure they are consistent
with current evidence from a variety of relevant sources, such
as the 2019 International Guidelines and the newly revised
SPIPP Checklist (version 2.0).
Produce Prescription Program.--The Committee is concerned
with food insecurity among the veteran population and provides
up to $2,000,000 for the Office of Nutrition & Food Services to
work with clinicians to create and test delivery and coverage
work streams to facilitate integration, such as produce
prescription service delivery. Within one year of enactment of
this Act, the Department is directed to provide a report on
this effort to include metrics that can be used to measure
value, including appropriate health outcomes, and the
feasibility and advisability of expanding produce prescriptions
to all veterans.
Rideshare Program.--The Committee recognizes the success of
VA's temporary rideshare authority and is interested in
expanding transportation services for veterans. As such, the
Committee requests a report not later than 120 days after
enactment of this Act assessing the feasibility of establishing
a national VA Rideshare Program. The report should include the
following: (1) an analysis of the impact of the VA Rideshare
Program on eligible veterans from August 2021 to April 2023;
(2) an assessment of the availability and cost of
transportation required to support stability and health of
eligible veterans, which includes transportation to
appointments with service providers, conducting housing and
employment searches, and obtaining food and supplies; (3) any
plan of the Secretary to expand the ability for veteran
homelessness programs to assist with transportation needs of
eligible veterans; (4) an assessment of the feasibility of
establishing a national VA Rideshare Program; (5) a
determination of the direct or indirect costs to the Department
that would arise from the establishment of such a program; and
(6) any other element the Secretary determines appropriate.
Stellate Ganglion Block Therapy.--The Committee encourages
the Department to make stellate ganglion block therapy
available as a first-line treatment at VA medical facilities,
as appropriate.
Veterans Transportation.--The Committee supports the
Department's programs that provide veterans with transportation
to VA medical facilities and make it easier for veterans to
receive medical care and encourages VA to explore options to
strengthen and sustain the Volunteer Transportation Network,
such as increased funding to recruit and retain drivers and
provide vehicle maintenance.

HEALTHCARE TECHNOLOGIES

Bioelectronic Medicine for Veterans.--The Committee
recognizes that Bioelectronic Medicine has the potential to
harness the body's electrical signaling to advance treatments
that save lives and lower medical expenditures. Accelerating
studies, additional data collection, and the development and
adoption of novel applications for Bioelectronic Medicine
combined with machine learning and artificial intelligence (AI)
can address challenging and expensive diseases by personalizing
treatments and improving therapy delivery. The Committee
encourages the Department to ensure that combined Bioelectronic
Medicine and AI technologies are available to veterans.
Early Detection Diagnostics.--The Committee encourages VA
to consider all options to better incorporate available early
detection diagnostics into veterans' care. The Committee looks
forward to the report required by House Report 117-391 on how
it is incorporating early detection diagnostics into veterans'
care and areas for potential improvement.
Focused Ultrasound Therapy.--The Committee understands
focused ultrasound is a non-invasive, non-pharmacological,
safe, and cost-effective alternative or complement to
conventional surgery, radiation therapy, or drug-based
treatments and encourages the Department to ensure it is
available to veterans to the extent practicable.
Medical Image Exchange.--The Committee supports the use of
modern medical image exchange software and notes that most VA
facilities have deployed a modern software solution that
supports bi-directional exchange of diagnostic quality medical
images between VA facilities and with community providers,
without requiring secondary storage of veterans' images. The
Committee encourages the Department to ensure software
solutions like this are available in the new Electronic Health
Record system and the VA Enterprise Cloud.
Migraine Prevention and Treatment.--The Committee
recognizes approximately one in three servicemembers experience
severe headaches and migraines and encourages the Department to
ensure neuromodulation devices with FDA-indication for migraine
prevention and treatment are available to veterans and to
educate clinicians and veterans on such devices.
Respiratory Illness.--The Committee is aware of emerging
technology that uses existing x-ray imaging equipment to derive
four-dimensional models of lung function, which helps to
identify respiratory illnesses and accompanying loss of lung
function earlier than was previously feasible. The Committee
requests a report, no later than 180 days after enactment of
this Act, on the potential efficacy of using a four-dimensional
functional lung scan to triage veterans with unexplained
shortness of breath following deployment.

HOMELESS ASSISTANCE PROGRAMS

The Committee provides $3,111,148,000 for VA homeless
assistance programs, an increase of $240,589,000 above the
fiscal year 2023 enacted level and equal to the budget request.
An estimated $9,522,772,000 is provided for homeless veterans
treatment costs, an increase of $173,873,000 above the fiscal
year 2023 level.
Programs to assist homeless veterans include the Homeless
Providers Grant and Per Diem (GPD), Health Care for Homeless
Veterans (HCHV), the Domiciliary Care for Homeless Veterans,
the Supportive Services for Low Income Veterans and Families
(SSVF), Veterans Justice Outreach Homeless Prevention (VJO),
Compensated Work Therapy, and the Department of Housing and
Urban Development-Department of Veterans Affairs Supported
Housing (HUD-VASH) programs.
Healthcare for Homeless Veterans.--The Committee notes the
benefits of the Homeless Patient Aligned Care Team (HPACT)
program and encourages VA to expand this program to additional
sites, including rural areas, and to consider additional
services to improve the program. The Committee directs the
Department to explore options to expand this program to
additional sites, including cost estimates, with its fiscal
year 2025 budget request.
Homeless Veterans in the Southwest.--The Committee
continues to direct VA to work with HUD to develop strategies
and recommendations for addressing veteran homelessness in the
Southwest and to take into account undercounted veterans when
awarding HUD-VASH vouchers. The Committee appreciates VA's
efforts to implement strategies to decrease veteran
homelessness in the Southwest and requests an updated report
within 60 days of enactment of this Act on its efforts.
HUD-VASH.--The Committee recognizes the value and positive
effects of HUD-VASH program. Due to the joint nature of HUD-
VASH funding, the Committee recommends that VA's budget for
case managers be increased commensurate with any increases in
HUD's budget for new vouchers and to account for increased
costs in staffing and recent expansions in eligibility.
Legal Assistance for Veterans.--The Committee continues to
support the Veterans Justice Outreach and the Legal Services
for Veterans programs and provides $109,721,000 for these
programs, as requested.
Recovery-Oriented Care.--The Committee notes the National
Center for Homelessness Among Veterans' development of housing
models that promote recovery-oriented care for veterans
experiencing or at risk of homelessness. The Committee requests
that not later than 180 days after enactment of this Act the
Department provide a report on the effectiveness of recovery-
oriented care housing programs, including a review of the
barriers that homeless veterans face when attempting to secure
permanent housing.
Supportive Housing for Veterans with Serious Mental
Illness.--The Committee encourages VA to build upon the
tangible achievements of the HUD-VASH program and explore
whether a new model of vouchers could provide housing
opportunities for low-income veterans experiencing serious
mental illness who seek healthcare services from VA.
Supportive Services for Veterans Families and Inflation.--
To meet the rising costs of goods and help veterans achieve
financial stability and access to services, the Committee
requests a report on cost, feasibility, and advisability of
increasing the cap on Tenant Incentives and allowance for car
repairs, as well as expanding the circumstances in which car
repairs are an eligible program expense. In addition, the
Department is encouraged to ensure it has a consistent and
understandable policy regarding covered costs for pet deposits/
rent, utility deposits, car repairs, and childcare.
Supportive Services for Veteran Families and Legal
Services.--The Committee continues to encourage the SSVF
program to work with grantees to expand their legal service
offerings, particularly in rural areas where access to private
legal assistance can be limited. The Department is encouraged
to partner SSVF grantees with university law schools in rural
areas or within underserved populations to enhance legal
assistance to veterans.
Tiny Homes.--The Committee notes the success of the tiny
home village model by multiple veterans service organizations
(VSOs) and encourages VA, in coordination with the Department
of Housing and Urban Development to support this work and
facilitate the creation of additional villages of tiny homes
villages within VA's existing GPD program. Not later than one
year after the date of the enactment of this Act, the Committee
requests a report comparing the outcomes of grantees under
current GPD programs to the outcomes of existing VSO operated
tiny homes villages that contain individual homes and a
community center with supportive services. This report should
compare: (1) the amount of time a veteran stayed in a tiny home
village compared to a similar GPD facility; (2) the percentage
of veterans who exit a tiny home village compared to a similar
GPD facility; (3) the percentage of veterans who exit the tiny
homes village with competitive employment compared to a similar
GPD facility; (4) the percentage of veterans who have a
negative exit from the tiny homes village compared to a similar
GPD facility; and (5) other matters, as appropriate.

INTIMATE PARTNER VIOLENCE ASSISTANCE PROGRAM

Intimate Partner Violence (IPV) Program.--The Committee
continues to support VA's efforts to expand its IPV program,
which provides a holistic approach that involves understanding,
recognizing and responding to the effects of all types of
trauma, with the ultimate goals to end violence, prevent
further violence, and promote healthy relationships.

MENTAL HEALTH PROGRAMS

The Committee provides $16,587,825,000 for mental health
programs. Of the total, $3,552,888,000 is for suicide
prevention and treatment programs, including $558,794,000 for
suicide prevention outreach, of which $300,500,000 is for the
Veterans Crisis Line.
The Committee continues to direct the Department to focus
on efforts to address parking lot suicides and connect veterans
to care.
The Department is directed to provide a report to the
Committee, no later than 90 days after enactment of this Act,
identifying a detailed expenditure plan for all suicide
outreach and treatment programs and how VA is meeting the
Committee's directives.
AANHPI Veterans.--The Committee understands that Asian
American, Native Hawaiian, and Pacific Islander (AANHPI)
veterans have a lower use of VA and non-VA mental health
services and requests a report Committee not later 180 days
after enactment of this Act on a plan to improve access of
AANHPI veterans to mental health care and increase outreach,
especially for those in harder-to-reach populations, including
rural communities and English-as-a-second-language households.
Agritherapy.--The Committee supports efforts to train
veterans in agricultural vocations, while also tending to
behavioral and mental health needs with behavioral healthcare
services and treatments from licensed providers. The Department
is urged to consider including agritherapy as a Complementary
and Alternative Medicine therapy.
Cognitive Behavioral Therapy Virtual Care.--To meet the
growing demand for telehealth or virtual mental healthcare, the
Committee encourages VA to provide veterans access to virtual
cognitive behavioral therapy. The Committee directs VA to
provide a report, not later than 90 days after enactment of
this Act, on the status of efforts to utilize solutions and
partners in the delivery of mental health services virtually
and how to make these solutions more accessible to patients.
Improving Depression Treatment with Precision Medicine.--
The Committee recognizes that depression is one of the most
common conditions associated with military service and combat
exposure. VA is encouraged to ensure access to pharmacogenomic
tests in the treatment of depression if the tests have been
shown to improve health outcomes of veterans in clinical
trials.
Law Enforcement Liaison.--The Committee appreciates VA's
past efforts to educate the law enforcement community regarding
the unique issues facing veterans, especially those returning
from combat operations. Such education is invaluable in cases
where veterans are determined to be an immediate threat to
themselves or others. In such instances, it is imperative that
the veteran's needs be addressed in an expeditious, humane, and
respectful manner.
Mental Health Screening at Veterans Affairs Medical
Centers.--The Department is encouraged to ensure its healthcare
providers screen for the numerous types of mental health issues
that veterans experience so they can receive the best possible
care.
Military Sexual Assault.--The Committee recommends that all
veterans seeking treatment services are screened for sexual
assault using an evidence-based screening tool in order to
successfully treat those who have experienced assault.
Modeling and Simulation Treatment of PTSD.--The Committee
is aware that modeling and simulation technology has enabled
the development of innovative and immersive therapies, which
can extend trauma management therapy protocol. The Committee
encourages VA to continue its Trauma Management Therapy study
and provide a report within 90 days of enactment of this Act
regarding the results of the study.
Non-Citizen Veteran Outreach.--The Committee is concerned
about the level of awareness regarding mental health services
among at-risk, non-citizen veterans. The Committee urges VA to
conduct outreach targeting this group of veterans to offer
mental health and other early intervention services, drug and
alcohol services, and mental health counseling.
Veterans Crisis Line (VCL).--The Committee provides funding
to support the VCL, as requested, and continues to monitor the
VCL to ensure veterans are receiving appropriate clinical care.
To support this critical care, the Committee encourages VA to
utilize funds provided by the bill to ensure appropriate
staffing for call centers and back-up centers, provide
necessary training for VCL staff, and ensure that staff are
able to appropriately and effectively respond to the needs of
veterans. The Committee maintains bill language requiring the
VCL to: (1) provide to individuals who contact the hotline
immediate assistance from a trained professional; and (2) to
adhere to all requirements of the American Association of
Suicidology.

MILITARY TOXIC EXPOSURE RESEARCH PROGRAM

The bill includes $68,012,000, as requested, for research
on military environmental exposures. The Committee supports
efforts to improve diagnosis and treatment of conditions
resulting from toxic exposures and appreciates the work of the
Health Outcomes Military Exposures (HOME) program, the Office
of Research and Development, and other VA program offices to
increase attention to this issue.
The Committee encourages the Department to continue
research on the effects of and treatments for veterans exposed
to toxins, such as Agent Orange, open burn pits, PFAS,
radiation, and asbestos, during the course of their active-duty
service. The Committee also urges the Department to utilize
reference data from existing medical records to determine how
veterans who served in areas where toxins were dispersed may
have more frequent or unexplained diseases compared to the
civilian population.
Airborne Hazards and Burn Pits Center of Excellence.--The
Committee provides $15,000,000 and continues to support the
Airborne Hazards and Burn Pits Center of Excellence on
diagnoses, mitigation, and treatment of conditions related to
airborne hazards and burn pits.
Use of Burn Pits During the Vietnam War.--The Committee
notes that burn-barrel latrines and burn pits were used in many
base camps, fire bases, and landing zones in Southeast Asia
during the Vietnam War, and that exposure at that time may be
causing or contributing to chronic conditions that adversely
affect the health and wellness today of veterans of that era.
The Committee requests the Government Accountability Office
report on the health outcomes, including an assessment of the
data available, of veterans exposed to burn pits and other
related sites during the Vietnam War.
PFAS Research.--The Committee is concerned about the effect
of PFAS at military bases on servicemembers, their families,
and surrounding communities, and recognizes that the effects of
PFAS exposure may continue for servicemembers once they are
under the care of VA. The Committee continues to direct VA to
collaborate with the Department of Defense PFAS Task Force,
academia, and other health institutions and agencies to monitor
research activities, results, and publications on the health
effects from PFAS.
Service-Connected Colorectal Cancer.--The Committee is
aware that colorectal cancer is a common cancer diagnosis among
veterans and directs the Department to submit a report, no
later than 180 days after enactment of the Act, on colorectal
cancer among veterans and the potential effect of exposures to
burn pits and other environmental hazards during military
service on incidence rates.
War Related Illness and Injury Study Center Expansion.--
Research and clinical trials are needed to develop effective
treatments for veterans exposed to toxic environmental hazards,
and the VA Research Advisory Committee has recommended the
establishment of Centers of Excellence to facilitate the
development and availability of new treatments in clinical
settings. However, the effects of toxic exposure may manifest
differently between men and women. The Committee is encouraged
by the work of the War Related Illness and Injury Study Center
(WRIISC)--Women's Operational Military Exposure Network (WOMEN)
to meet the unique needs of women veterans. However, with only
one physical center in California, the Committee is concerned
that toxic-exposed women veterans who live and seek care in
other regions may not have equal access to the Center's unique
resources. The Committee directs the Department to report on
the feasibility, including cost estimates, of establishing a
new WRIISC-WOMEN within 60 days of enactment of this Act.

OPIOID PREVENTION AND TREATMENT PROGRAM

The bill includes $715,356,000 for opioid treatment and
prevention efforts, which is $26,876,000 above the fiscal year
2023 enacted level. Of the total, $254,478,000 is provided for
activities authorized by the Comprehensive Addiction and
Recovery Act of 2016 (P.L. 114-198).

PHARMACEUTICAL ISSUES

Community Pharmacies.--The Committee requests a report,
within 120 days of enactment of this Act, on the feasibility
and advisability of expanding the use of community pharmacies,
including an assessment of cost, veteran access, and effect on
rural delivery.
Drug Pricing Report.--The Committee remains interested in
information regarding VA drug pricing and appreciates VA
providing a report as requested in previous fiscal years on
VA's spending on prescription drugs. The Committee encourages
VA to conduct this analysis annually and requests robust and
routine updates to Congress, including updated information for
fiscal year 2024 on prescription drug prices (net of rebates)
paid by VA for the ten most frequently prescribed drugs and the
ten highest-cost drugs for VA. In addition, the report should
include total annual costs to VA for all prescription drugs. As
VA has noted that country of origin information on drugs and
active pharmaceutical ingredients is not yet available on a
national level, the Committee urges the VA's National
Acquisition Center to work with the Food and Drug
Administration to track this data and establish a national
database for such information.
Medication Optimization for Veterans.--The Committee
commends VA's work to implement a National Pharmacogenomics
Program to ensure all eligible veterans have access to
appropriate, evidenced-based pharmacogenomic testing, and that
VA has a robust and highly trained healthcare professional
workforce to help veterans who have undergone pharmacogenomic
testing. The Committee provides $35,616,000, as requested, for
this work.
Pharmaceutical On-dose Tracking and Tracing Technologies.--
The Committee is committed to providing veterans safe and
reliable medication. Track and trace systems are increasingly
being implemented as a technological solution to secure
pharmaceutical supply chains. These systems offer the potential
to minimize reimbursement fraud, facilitate fast market
recalls, and help identify medicine shortages. The Committee
looks forward to receiving the report requested in House Report
117-391, especially regarding solutions to prevent counterfeit
medicines from entering the VA supply chain.
Weight Loss and Weight Management Tools.--The Committee is
aware of growing interest in the use of FDA-approved
pharmaceuticals that help veterans lose and manage weight,
which can help them prevent disease, manage chronic and co-
morbid conditions, and improve their quality of life. The
Committee encourages the Department to review its clinical
practice guidelines and other criteria for use to ensure
veterans have access to evidence-based weight management
interventions and provide a report within 60 days of enactment
of this Act regarding its current approach to weight management
and plans to review and update its clinical practice
guidelines.

POST-TRAUMATIC STRESS DISORDER CARE

Hyperbaric Oxygen Therapy.--The Committee encourages the
Department to provide hyperbaric oxygen treatment to veterans
suffering from chronic post-traumatic stress disorder, as
appropriate.
National Center for Post-traumatic Stress Disorder.--
Recognizing the importance of VA's National Center for PTSD in
promoting better prevention, diagnoses and treatment of PTSD,
the Committee provides $42,000,000 for the Center, as
requested.
New Treatments for PTSD.--The Committee is aware of
privately funded research regarding potential new treatments
for PTSD and encourages the Department to monitor these efforts
and review the results of existing and future clinical trials.
The Committee requests a detailed report within 30 days of
enactment of this Act regarding VA activities, including
investigators and facilites, participating in this research
and, within 120 days of enactment of this Act, an assessment of
any potential therapeutic value and potential risk of new
treatments.
Service Dogs for Veterans' Mental Health.--The Committee
recognizes the positive role that service, guide, and hearing
dogs have played in mitigating veterans' disabilities and
providing assistance and rehabilitation. The Committee is
encouraged that a pilot program created by the PAWS Act of 2021
is underway at VA medical centers, which will assess the
potential therapeutic effectiveness of service dogs in the
treatment of PTSD. The Committee encourages VA to expand the
number of pilot sites to include medical centers that primarily
serve veterans in rural areas and in states with few VA medical
facilities.
Women Veterans Network.--The Committee continues to support
the role of Women Veterans Network (WoVeN), a national peer
support network for women veterans managed by the National
Center for PTSD--Women's Health Sciences Division, and provides
up to $3,000,000 for peer support programs for women veterans.

RURAL HEALTH

Office of Rural Health.--The bill includes $337,455,000 for
rural health, which is equal to the budget request, to improve
access and quality of care for the more than 3,000,000 enrolled
veterans residing in rural and highly rural areas.
Office of Rural Health Operating Plan.--The Committee
directs the Office of Rural Health to submit no later than 30
days after enactment of this Act an operating plan for fiscal
year 2024 funding, as well as for the fiscal year 2025 funding
provided in advance by this Act.
Rural Access Network for Growth Enhancement (RANGE).--The
RANGE Program provides case management and treatment services
to mentally ill veterans in rural areas. The bill includes
sufficient funding to maintain the three new centers of the
RANGE Program, as authorized by the Sgt. Ketchum Rural Veterans
Mental Health Act of 2021 (P.L. 117-21).
Transportation Challenges.--The Committee recognizes the
transportation challenges and barriers to care that rural and
remote veterans face and directs the Office of Rural Health to
increase efforts to improve transportation mobility for
veterans and to allocate funding to enhance rural access and
transportation services.

SUBSTANCE USE DISORDER CARE

The bill includes $230,947,000 for Substance-Use Disorder
(SUD) efforts to ensure veterans can receive timely SUD
specialty services.
Jason Simcakoski Memorial and PROMISE Act Implementation.--
The Committee supports the continued implementation of the
Jason Simcakoski Memorial and Promise Act, Title IX of the
Comprehensive Addiction and Recovery Act of 2016 (P.L. 114-
198), including updating therapy and pain management
guidelines, strengthening provider education and training, and
improving patient advocacy.
Medication-Assisted Treatments.--The Committee encourages
VA to increase education among its primary care practitioners
on the diagnosis and treatment of alcohol use disorders with
FDA-approved medication-assisted treatments and counseling, as
clinically indicated.
Substance Use Disorder Screening.--The Committee recommends
that all veterans seeking treatment services in a VA facility
be screened for SUD, using evidence-based assessment tools.
Substance Abuse Education and Outreach.--The Committee
recognizes the importance of intervention and support programs
for at-risk veterans and their families that offer confidential
education information that can reduce substance use, relapse,
hospital visits and suicide, and continues to support internet-
based substance abuse education and outreach.

SUICIDE PREVENTION

Lethal Means Safety Collaboration.--The Committee notes
that VA has been called to partner with the Departments of
Defense, Health and Human Services, Homeland Security, Justice,
and the Office of Emergency Medical Services within the
Department of Transportation to create and implement a
coordinated approach for improving lethal means safety. The
Committee looks forward to the report required by House Report
117-391 on this coordinated approach and VA's plans to
incorporate the coordinated approach into the Department's
existing lethal means safety initiatives.
Lethal Means Safety Training.--To ensure that every
employee who regularly interacts with veterans is prepared to
have a conversation that could save a veteran's life, the
Committee continues to urge VA to implement mandatory lethal
means safety trainings for all VA employees who regularly
interact with veterans in their work, compensation and pension
examiners, employees of Veterans Centers and vocational
rehabilitation facilities, community care providers, and family
caregivers to the extent practicable.
Suicide Prevention Coordinators.--The Committee recognizes
the importance of Suicide Prevention Coordinators, who follow
up with and coordinate care for veterans who have been directly
referred to them by responders at the Veterans Crisis Line, and
directs VA to fully staff suicide prevention coordinator
positions.
Zero Suicide Initiative.--The Committee recognizes the
value of innovative, systems-focused efforts to combat veteran
suicide across the country and notes the use of the Zero
Suicide model across various healthcare systems and through the
Department of Health and Human Services. The Committee directs
VA to evaluate, in consultation with experts and VSOs, the
feasibility and advisability of implementing a Zero Suicide
initiative. Within 180 days of the enactment of this Act, the
Department is directed to submit a report, including
recommendations for incorporating the Zero Suicide model in VA
suicide prevention programming.

TELEHEALTH AND CONNECTED CARE

The bill includes $5,165,336,000 for teleheath and
connected care, which includes home telehealth, home telehealth
prosthetics, and clinic-based telehealth.
The Committee directs VA to continue to expand telehealth
availability, including the facilitation of public private
partnerships, to include additional mental health, primary
care, and rehabilitation services as a means to deliver care in
rural and underserved communities.
VA is encouraged to leverage newly gained telehealth
capacity to address backlogs for disability exams and
healthcare appointments when appropriate. The Committee further
directs VA to continue to implement plans to improve veteran
and provider satisfaction, increase awareness of the telehealth
program, and enhance adoption of telehealth by veterans and
providers.

WHOLE HEALTH

The Committee recommendation includes $107,848,000 for
Whole Health, as requested, which is $21,997,000 above the
fiscal year 2023 enacted level. The Committee supports the
Whole Health model of care and the expansion of Whole Health to
all VA facilities.
Adaptive Sports.--As requested, the bill provides
$30,414,000 for National Veterans Sports Programs, including
$16,000,000 for adaptive sports programs and up to $5,000,000
equine therapy.
Creative Arts Therapies.--The Committee continues to
acknowledge the effective use of creative arts therapies and
arts and humanities partnerships in treating veterans with
traumatic brain injuries and psychological health conditions
and provides up to $5,000,000 to do so.
Nutrition and Food Services.--The Committee encourages the
Department to work with the Centers for Disease Control to
implement the Food Service Guidelines for Federal Facilities
and to expand its plant-based menu options. The Committee
requests within two years of the date of enactment of this Act
a report that includes an assessment of how VA's food
purchasing and food service practices align with the Food
Service Guidelines and recommendations for changes to
procurement or other laws that would facilitate ongoing
implementation of the Food Service Guidelines.

WOMEN VETERANS HEALTH CARE

The recommendation includes a total of $1,279,096,000, as
requested, to meet the estimated need for specific care for
women veterans and support the Office of Women's Health and
programmatic efforts, including the childcare initiative.
Within this amount, VA is encouraged to continue hiring women
primary care providers and increase the number of peer support
specialists for women veterans.
The Committee recognizes women are now the fastest growing
cohort within the veteran community. The number of women
veterans using VHA services has more than tripled since 2001,
growing from 159,810 in 2001 to 627,000 today. The increased
number of women using VHA services necessitates a greater
investment of resources to provide and expand VA's specific
services for women veterans and ensure women veterans' health
needs, which often differ from men, are met. The Committee
supports continued efforts to identify and address the unique
issues experienced by women veterans. VA is directed to
continue redesigning its women's healthcare delivery system and
improving its facilities to ensure women receive equitable,
timely, and high-quality healthcare. The Committee requests an
expenditure plan no later than 45 days after enactment of this
Act.
Breast Cancer Screening Guidelines.--The Committee commends
VA's decision to offer breast cancer screening and mammography
to eligible women veterans beginning at age 40. However, the
Department should offer screening to eligible younger women
veterans before age 40 if a physician determines it necessary
or risk factors warrant it. The Committee supports this effort
to ensure that the care women veterans receive is consistent
with the private sector and will continue to monitor the
Department's implementation of this policy. The Department
should closely follow ongoing debate within the scientific
community on breast cancer screening and mammography coverage
to provide veterans the best care possible. The recommendation
includes bill language to ensure VA maintains this policy
through fiscal year 2024.
Maternal and Infant Health Outcomes for Women Veterans.--
The Committee directs the Department to provide a report within
180 days of enactment of this Act regarding the incidence of
birth defects, miscarriage, stillbirth, and maternal morbidity
and mortality that can be related to military service and
provide recommendations to raise awareness and improve maternal
and infant health outcomes.
Maternity Healthcare and Coordination Programs.--The
Committee is pleased that to coordinate prenatal and postpartum
care provided in the community, the Department has established
maternity healthcare and coordination programs, which have been
successful in ensuring that veterans can receive high-quality
care and robust support during and after pregnancy. The
Committee supports these programs and encourages VA to continue
to ensure veterans have access to high-quality, well-
coordinated care, and robust services and directs VA to
continue to implement and fully resource the Protecting Moms
Who Served Act (P.L. 117-69).

WORKFORCE AND STAFFING ISSUES

Expanding Recruitment.--The Committee recognizes the
challenge VA has in the recruitment and retention of
clinicians. To help VA better keep pace with other providers
and continue to train its workforce to improve their service to
veterans, the Committee urges VA to explore potential options
to enhance recruitment and retention, such as expanding
benefits to relocate to underserved VA medical facilities and
expanding reimbursement to clinicians for Continuing
Professional Education, regardless of individual specialty or
board certification.
Homeless Veterans Caseworkers.--The Committee requests that
the Department evaluate staffing needs for caseworkers for
homeless veterans and veterans at risk of homelessness and
evaluate the potential benefits and effectiveness of
contracting for caseworkers in the annual Staffing Report.
Respiratory Therapists.--The Committee recognizes the
important role respiratory therapists play as part of care
teams treating respiratory conditions in veterans and
encourages the Department to ensure respiratory therapists are
available where needed. The Committee is concerned there may be
gaps in coverage of respiratory therapists in VA for veterans
with certain respiratory conditions, particularly as additional
veterans become eligible under the PACT Act (P.L. 117-168). The
Committee requests that the Department evaluate staffing needs
for respiratory therapists using a validated system and include
the results in the annual Staffing Report.
Staffing Report.--The Committee looks forward to the annual
comprehensive report required by the Joint Explanatory
Statement accompanying the Consolidated Appropriations Act,
2022 (P.L. 117-103) on the Department's plan to address
critical workforce issues.
VA/HHS Collaboration on Health Workforce Shortages.--The
Committee continues to encourage VA to work with the Department
of Health and Human Services (HHS) to explore ways the agencies
can work together, such as by creating a taskforce, to increase
the availability of providers, including in the behavioral
health workforce and among physicians specializing in cancer,
spinal cord, and neuropsychiatric conditions. This
collaboration is urged to examine VA's recruitment challenges,
review programs that could enhance recruitment and retention,
and to think creatively on how other Federal agencies like HHS
can identify and address provider shortages. VA also is
encouraged to consult with the Department of Defense to explore
recruiting those who have left military service.
Primary Care Provider Shortages.--The Committee is
concerned by the growing shortage of primary care providers
across the VA Health Care system, and therefore directs VA to
provide a report to the Committees on Appropriations of both
Houses of Congress within 90 days of enactment of this Act that
(1) describes the current benchmark for patient-to-primary care
physician ratio, including what the standard is and how many
hospitals and clinics fall short of the standard; (2) details
which VA clinics have seen a 50 percent or greater reduction of
full time primary care physicians in the previous 15 months;
and (3) explains how the Department intends to address these
primary care physician shortages while reducing individual
clinic dependence on VISN floating staff. The report should
also include recommendations for legislative or administrative
action that could support efforts to address this primary care
physician shortage.

MEDICAL COMMUNITY CARE

Fiscal year 2023 enacted level...................... $28,456,659,000
Fiscal year 2024 enacted level...................... 33,000,000,000
Fiscal year 2024 budget year request................ - - -
Committee 2024 budget year recommendation........... - - -
Fiscal year 2025 advance appropriation request...... 20,382,000,000
Committee 2025 advance appropriation recommendation. 20,382,000,000
Comparison with:
Fiscal year 2024 enacted level.................. -12,618,000,000
Fiscal year 2025 advance budget request......... - - -

For fiscal year 2025, the Committee recommendation
includes an advance appropriation of $20,382,000,000, of which
$2,000,000,000 is available until September 30, 2026.
Long-Term Care for Veterans with Severe Traumatic Brain
Injury.--The Committee is encouraged by the Department's
progress in using agreements with non-VA providers to ensure
all veterans receive long-term specialty care for severe
traumatic brain injury in their communities and directs the
Department to continue entering into such agreements and to
educate case managers on all tools available to provide
veterans with long-term specialty care in the community.
Third-Party Payments and Reimbursements.--The Committee
continues to direct VA to provide comprehensive reports on a
quarterly basis detailing the amount owed to outside providers
for every state, outstanding payments over six months, the
corrective actions being implemented to address these
outstanding balances, and the average time for repayment.

MEDICAL SUPPORT AND COMPLIANCE

Fiscal year 2023 enacted level........................ $11,073,409,000
Fiscal year 2024 enacted level........................ 12,300,000,000
Fiscal year 2024 budget year request.................. - - -
Committee 2024 budget year recommendation............. - - -

Fiscal year 2025 advance appropriation request........ 11,800,000,000
Committee 2025 advance appropriation recommendation... 11,800,000,000
Comparison with:
Fiscal year 2024 enacted level.................... -500,000,000
Fiscal year 2025 advance budget request........... - - -

The Committee recommendation includes an advance
appropriation of $11,800,000,000 for fiscal year 2025 for
Medical Support and Compliance, of which $350,000,000 shall
remain available through September 30, 2026.

MEDICAL FACILITIES

Fiscal year 2023 enacted level........................ $8,633,816,000
Fiscal year 2024 enacted level........................ 8,800,000,000
Fiscal year 2024 budget year request.................. - - -
Committee 2024 budget year recommendation............. - - -

Fiscal year 2025 advance appropriation request........ 9,400,000,000
Committee 2025 advance appropriation recommendation... 9,400,000,000
Comparison with:
Fiscal year 2024 enacted level.................... +600,000,000
Fiscal year 2025 advance budget request........... - - -

For fiscal year 2025, the Committee recommendation includes
an advance appropriation of $9,400,000,000, of which
$350,000,000 shall remain available until September 30, 2026.
Community-Based Outpatient Clinic in Alameda Point,
California.--The Committee is concerned that the Alameda Point
CBOC remains unbuilt more than a decade after Congress
authorized this facility in fiscal year 2010 through Public Law
111-82; and after this project was fully funded by Congress.
The Committee directs the Department to expeditiously execute
the lease and commence construction of the CBOC by no later
than June 30, 2024. The Committee also directs the Department
to provide monthly reports to the Committees on Appropriations
on the progress until completion and activation. These reports
shall include an action plan and timeline of the project and a
status update on the appropriated funds for the project.
Community-Based Outpatient Clinic in Bakersfield,
California.--The Committee remains disappointed that the new
Bakersfield CBOC remains unbuilt more than a decade after
Congress authorized this facility in fiscal year 2010 through
Public Law 111-82. The Committee directs the Secretary to
expeditiously execute Lease No. 36C10F20L0008 and commence
construction of the CBOC by no later than September 30, 2023,
as provided in the lease. Furthermore, the Committee directs
the Secretary to provide monthly reports to the Committees on
Appropriations of both Houses of Congress on the CBOC 's
progress until completion and activation. The bill includes
section 252 prohibiting the use of funds for monthly payments
under Lease No. VA10112R0032, including section 11 of the
lease, that exceeds $223,166.67 unless required for maintenance
and repairs or improvements related to the form, fit, or
function of the facility that directly enhances the safety of
veterans or improves healthcare services.
Facilities Security and Communication Technology Refresh.--
The Committee encourages the Department to continue security
and communications technology upgrades at VA facilities to
ensure the safety of veterans, visitors, and employees. The
Committee recommends that VA take a holistic approach and
continue efforts to deploy proven technologies that can provide
actionable, real-time data and communications to improve
safety.
Facility Transformations.--The Committee urges VA to
continue efforts to keep up with a growing population of women
veterans who deserve equitable access to medical care. The
Committee directs the Department to prioritize funding for
medical facilities to accommodate women veterans and to make it
safer and easier for women veterans to get care. This includes
correcting environment of care deficiencies, such as adding
doors, curtains, and soundproofing in treatment and check-in
areas.
Medical Center Services.--The Committee reminds the
Department to ensure it consults with a wide variety of
stakeholders regarding any changes to services, hours, and
staffing prior to making changes and to ensure veterans are not
negatively affected.
Richard A. Pittman Community Based Outpatient Clinic, San
Joaquin County, California.--The Committee believes that an
estimated 5,724 added daily traffic trips in a congested area
with key community infrastructure warrants additional traffic
mitigation measures. The Committee directs the Department to
take expeditious actions to complete traffic mitigation
projects associated with this new clinic and encourages it to
implement all traffic mitigation measures in the first phase of
opening. The Committee also directs VA to provide quarterly
reports describing updates and expected timelines for the
completion of the clinic and implementation of these traffic
mitigation measures.
Spend Plan.--The Committee expects VA to provide, no later
than 30 days after enactment of this Act, an expenditure plan
detailing the planned use of the funds provided. The Committee
understands that some of the projects planned for fiscal year
2024 may not be ready within that timeframe, requiring an
adjustment to the spending plan. The Committee requests a
quarterly update of the plan if the funding for any single
project changes by more than $3,000,000 during that time
period.
Use of Autonomous Robots.--The Committee is aware of the
Department's use of autonomous mobile robots at a growing
number of VA hospitals and understands there is a potential to
utilize such technology for certain functions, such as handling
laboratory, pharmacy, food, linen, waste and other materials.
The Committee encourages the VA to consider the future use of
autonomous robots during the planning for new construction or
modernization of VA hospitals and requests the VA report to the
Committee not later than 180 days after the enactment of the
Act on use of robots at VA hospitals, including current use and
potential benefits expanded use in the future.

MEDICAL AND PROSTHETIC RESEARCH

Appropriation, fiscal year 2023....................... $916,000,000
Budget request, fiscal year 2024...................... 938,000,000
Committee recommendation, fiscal year 2024............ 938,000,000
Change from enacted level......................... +22,000,000
Change from budget request........................ - - -

The Committee recommendation includes $938,000,000 for
Medical and Prosthetic Research, available through September
30, 2025, which is $22,000,000 above the fiscal year 2023
level. The Committee appreciates the Department's plans to
focus on critical research areas that include environmental
exposures, traumatic brain injury, cancer and precision
oncology, and mental health.
In addition to this appropriation, resources from other
sources, including appropriations from the medical care
accounts, reimbursements from the Department of Defense, grants
from the National Institutes of Health, private sources, and
voluntary organizations, support the Department's researchers.
The total amount estimated available for fiscal year 2024 is
$1,437,400,000.
Advanced Platform Technology (APT) Center.--The Committee
applauds the Department for progress being made to provide
veterans with new assistive and restorative technologies that
address sensory, motor, or cognitive deficits, as well as limb
loss. The APT Center has effectively utilized a partnership
model to leverage local and national research expertise to
drive progress in diverse areas including artificial lung
development, wound healing, and neurally connected sensory
prosthesis. The Committee continues to support the APT Center's
efforts.
Effects of Toxic Exposures on Women Veterans.--The
Committee recognizes the effects of toxic exposure on women
veterans, and that the effects of toxic exposure may manifest
differently between men and women. To provide full and
effective medical care, it is essential for the Department to
understand the health effects of women veterans exposed to
toxins during their service. The Committee encourages the
Department to continue and expand its research on the effects
of toxic exposure and ensure specific research on women
veterans is included in these efforts. The Committee also
encourages that a commensurate number of women veterans
relative to the total women veteran population are utilized in
research studies, especially in those pertaining to effects of
toxic exposure on veterans. The Committee looks forward to
receiving the report requested in House Report 117-391 on the
metrics of women veterans participating in trials and
strategies.
Endometriosis.--The Committee encourages the Department to
conduct research into the needs and concerns of women veterans
with endometriosis and investigate new diagnostic and treatment
methods.
Gulf War Illness Studies.--The Committee recommends the
Department continue to conduct epidemiological studies
regarding the prevalence of Gulf War Illness, morbidity, and
mortality in Persian Gulf War veterans and the development of
effective treatments, preventions, and cures. The Department is
encouraged to make the findings of all research conducted by or
for the Executive Branch publicly available as soon as possible
and continue to publish disease-specific mortality data related
specifically to Persian Gulf War veterans. The Committee
continues to encourage the Department to utilize the term
``Gulf War Illness,'' as recommended by the Institute of
Medicine. The Committee appreciates the Department's work to
strengthen the training of primary, specialty, and mental
healthcare providers on effective assessment, diagnosis, and
clinical management of Gulf War Illness.
Herbicide-Related Toxic Exposure Research.--To understand
the residual effects of Agent Orange, dioxins, and other
herbicide-related toxic exposures, the Committee urges the
Department to utilize reference data from existing medical
records of veterans who served in Vietnam, Thailand, Guam, the
Northern Mariana Islands, American Samoa, and other geographic
areas where these toxic substances were dispersed to determine
the percentage who have frequent or unexplained diseases
compared to the civilian population.
Metastatic Cancer Research.--While recent research has
revealed that there is a genetic basis for susceptibility to
metastatic cancer or resistance to metastasis, more research is
required to develop a comprehensive understanding of this
complex process. Clinical trials are an important aspect of
that progress, and a diverse representation of patients in
clinical trials is integral to the development of medications
and therapies that effectively treat disease. Demographics and
genetics play a role in the safety and efficacy of a treatment
for an individual. To achieve representation of the
demographics of the U.S. population in these trials, the
Committee directs VA to partner with the Department of Defense
to fully implement the outstanding recommendations made by the
April 2018 Task Force Report to Congress on Metastatic Cancer.
National Intrepid Center of Excellence (NICoE).--The
Committee recognizes the high-quality mental health care and
neurological research being conducted at the NICoE and directs
the Department to expand its work with NICoE to strengthen VA's
research capacity. The Committee continues to encourage the
Department to pursue new collaborative initiatives with NICoE,
consider public academic medical centers as partners in such
efforts, and assist Department of Defense efforts to optimize
research to implement solutions and deliver better health
outcomes for veterans.
Research Using Animals.--The Department is directed to
include in any report to Congress describing animal research
approved under Section 247 in Division J of the Consolidated
Appropriations Act, 2023 (P.L. 117-328), submitted after the
date of filing of this report, details on the specific
alternatives to animals that were considered, why those
alternatives were not chosen, and an explanation for why these
animal subjects were the only viable option for this research.
Also, the Committee looks forward to the Department fully
implementing its plan to eliminate or reduce the research
conducted using canines, felines, or non-human primates in
2024, as directed in Public Law 116-94.
Women Veterans Research.--Women veterans have unique health
needs that are substantially different than civilian women and
men veterans. The Committee directs the Department to ensure
its research program adequately addresses the unique needs and
concerns of women veterans and to prioritize medical and
prosthetic research for women, given that women have different
physical requirements for prosthetics. The Department should
ensure that conditions that affect women are included in VA's
research efforts to better understand the impact of military
service on veterans with these conditions.

Medical Care Collections Fund

The Department of Veterans Affairs Medical Care Collections
Fund (MCCF) was established by the Balanced Budget Act of 1997
(P.L. 105-33). The Department deposits first-party and pharmacy
co-payments, third-party insurance payments and enhanced-use
collections, long-term care co-payments, Compensated Work
Therapy Program collections, Compensation and Pension Living
Expenses Program collections, and Parking Program fees into the
MCCF. The Department uses these funds for medical care and
services to veterans. The estimate of fees that will be
collected in fiscal year 2024 is $3,991,000,000.

National Cemetery Administration

Appropriation, fiscal year 2023....................... $430,000,000
Budget request, fiscal year 2024...................... 480,000,000
Committee recommendation, fiscal year 2024............ 480,000,000
Change from enacted level......................... +50,000,000
Change from budget request........................ - - -

The Committee recommends $480,000,000 for fiscal year 2024,
which is $50,000,000 above the fiscal year 2023 enacted level.
NCA should prioritize maintaining the current level of services
at existing cemeteries and activating new cemeteries to
increase burial access. In addition, the bill includes language
making ten percent of the total available until September 30,
2025.
Geographically Isolated National Cemeteries.--The Committee
looks forward to receiving the report requested in House Report
117-391 regarding the Department's criteria for establishing
new national cemeteries and meeting the needs of veterans and
families in geographically isolated areas.

Departmental Administration

GENERAL ADMINISTRATION

(INCLUDING TRANSFER OF FUNDS)

Appropriation, fiscal year 2023....................... $433,000,000
Budget request, fiscal year 2024...................... 475,000,000
Committee recommendation, fiscal year 2024............ 475,000,000
Change from enacted level......................... +42,000,000
Change from budget request........................ - - -

The General Administration account provides funds for the
Office of the Secretary, the General Counsel, six Assistant
Secretaries, and two Department-level staff offices.
The Committee recommendation includes $475,000,000 for
General Administration, an increase of $42,000,000 above the
fiscal year 2023 enacted level.
The Committee has included bill language to make available
through September 30, 2025, up to ten percent of these funds
and to permit the transfer of funds in this account to the
General Operating Expenses, Veterans Benefits Administration
account.
Additional Budgetary Information.--The Committee continues
its request that items described in previous House reports
continue to be included in the budget justifications submitted
each year. Further, the Committee directs VA to include in its
budget justification materials a table for each account that
shows a five-year funding history for requested and enacted
levels.
Data Strategy.--The Committee recommends $13,575,000 for
the Office of Enterprise Integration's Data Governance, as
requested, which is $608,000 more than the prior fiscal year
and supports the Department's continued efforts to manage VA
data as a strategic asset in order to strengthen the delivery
of services and benefits to veterans, their families,
survivors, and caregivers.
Data on Women and Minority Veterans.--The Committee
recognizes the lack of data specific to women and minority
veterans made available to Congress by the Department. The
Committee continues to recommend that, when applicable, the
Secretary display information in the annual reports submitted
to Congress separately for women veterans and minority
veterans.
Office of Resolution Management, Diversity, and
Inclusion.--The Committee is concerned the Department requests
an increase of 360 full-time equivalent staff with no
justification and, as such, provides no funding for the
increase. The Committee directs the Department to comply with
Section 415 of the bill that prohibits funds to be used to
carry out any program, project, or activity that promotes or
advances Critical Race Theory or any concept associated with
Critical Race Theory.
Quarterly Financial Information Reports.--The bill includes
an administrative provision that extends the requirement for
submission of the quarterly financial information required in
the fiscal year 2017 bill and conference report.
Staff Relocations Within VA.--The bill continues the
administrative provision requiring written notification 15 days
prior to organizational changes that result in the transfer of
25 or more full-time equivalent staff from one organizational
unit of the Department to another.
Supporting Minority and Disadvantaged Contractors.--The
Committee reiterates the reporting requirement included in
House Report 117-81 on this topic and looks forward to
receiving the requested report.
VA Public Affairs.--The Committee is disappointed the
Department issued a news release on April 21, 2023, titled
``Budget Cut Proposals Would Hurt Veterans.'' In addition to
being factually wrong, the news release was intended to
influence the legislative process and negotiations between
Congress and the Executive Branch, which is a violation of
Section 715 of Division E of Public Law 117-328. Appropriated
funds are prohibited from being used by the executive branch
for partisan political purposes, including attempting to
support or defeat legislation pending before Congress. As such,
the bill includes a new general provision to specifically
prohibit this type of activity by the Departments and agencies
funded in this bill. It also provides zero funding for the
Department's Public Affairs office.

BOARD OF VETERANS APPEALS

Appropriation, fiscal year 2023....................... $285,000,000
Budget request, fiscal year 2024...................... 287,000,000
Committee recommendation, fiscal year 2024............ 287,000,000
Change from enacted level......................... +2,000,000
Change from budget level.......................... - - -

The Committee recommendation includes $287,000,000 for the
Board of Veterans Appeals, which is $2,000,000 above the prior
fiscal year. Ten percent of this funding is available through
September 30, 2025.
The Committee recognizes the challenges VA has in
recruitment and retention of attorneys at BVA. To help the
Board retain its attorneys, the Committee supports efforts to
enhance recruitment and retention, such as expanding
reimbursement for bar fees and Continuing Legal Education.

INFORMATION TECHNOLOGY SYSTEMS

(INCLUDING TRANSFER OF FUNDS)

Appropriation, fiscal year 2023....................... $5,782,000,000
Budget request, fiscal year 2024...................... 6,401,000,000
Committee recommendation, fiscal year 2024............ 6,401,000,000
Change from enacted level......................... +619,000,000
Change from budget request........................ - - -

The Committee recommendation includes $6,401,000,000 for
Information Technology Systems, which is $619,000,000 above the
fiscal year 2023 enacted amount. Within the account total, the
Committee allocates $1,606,977,000 for pay and associated
costs; $4,668,373,000 for operations and maintenance; and
$125,650,000 for development.
The bill makes available three percent of pay and
associated costs and five percent of operations and maintenance
funds until September 30, 2025. All development funds are
available until September 30, 2026.
The Committee continues bill language permitting the
transfer of funding among the three subaccounts upon approval
of the Committees on Appropriations of both Houses of Congress.
The bill also continues language allowing for the
reprogramming of funds among development projects upon approval
by the Committees on Appropriations of both Houses of Congress.
The Committee continues to include bill language limiting
the funds available for information technology systems
development to the projects and in the amounts specified in the
report. The bill limits the amount of funds that can be
transferred into the IT account to ten percent of the total of
either the source or destination account. The bill contains
language that permits the reprogramming of funds among
development projects upon prior notification to, and approval
by, the Committees on Appropriations of both Houses of
Congress.
The chart below reflects the Committee's allocation for
development projects. This chart will serve as the Department's
approved list of development projects, and all requested
changes are subject to the reprogramming guidelines as outlined
in the accompanying Act.

INFORMATION TECHNOLOGY DEVELOPMENT PROJECTS
[In thousands of dollars]
------------------------------------------------------------------------
Committee
Project Recommendation
------------------------------------------------------------------------
Clinical Enabling Capabilities....................... $53,656
Health Business Services............................. 14,694
Care Coverage Capabilities........................... 13,608
Clinical Care Capabilities........................... 7,949
Health IT Services................................... 2,000
Patient Management Capabilities...................... 559
Benefit Services..................................... 16,000
Veteran Experience Services.......................... 14,184
Corporate Services................................... 3,000
Total All Development............................ 125,650
------------------------------------------------------------------------

The Committee expects the Office of Information and
Technology to continue to provide an IT expenditure report to
the Committees on Appropriations of both Houses of Congress on
a monthly basis. This report should include a comparison to the
project costs included in the development funding chart above
and provide an explanation for any differences in excess of
$3,000,000.
Small Business IT Security Partners.--The Committee urges
the Office of Information Technology to increase utilization of
small businesses in implementing IT security programs,
including in the areas of secure storage and encryption.

VETERANS ELECTRONIC HEALTH RECORD

Appropriation, fiscal year 2023....................... $1,759,000,000
Budget request, fiscal year 2024...................... 1,863,000,000
Committee recommendation, fiscal year 2024............ 1,863,000,000
Change from enacted level......................... +104,000,000
Change from budget request........................ - - -

The bill includes $1,863,000,000, as requested, for
Veterans Electronic Health Record for activities related to the
development and rollout of VA's Electronic Health Record
Modernization (EHRM) initiative, the associated contractual
costs, and the salaries and expenses of employees hired under
titles 5 and 38, United States Code. Within the total, the bill
includes $1,186,000,000 for the electronic health record
contract; $424,000,000 for infrastructure readiness; and
$253,000,000 for program management. Funding is made available
for three fiscal years.
This account is intended to be the single source of funding
within VA for the electronic health record effort. No authority
is provided for funds from other VA accounts to be transferred
into this account nor for funds from this account to be
transferred out to other accounts.
The bill continues to require quarterly reporting of
obligations, expenditures, and deployment schedule by facility
and the Office of Deputy Secretary to administer the
initiative. It also continues to make 25 percent of funds
contingent upon the Secretary, within specified deadlines: (1)
providing a report detailing the status of outstanding issues
impacting the stability and usability of the new electronic
health record (EHR) system, including those that contributed to
deployment delays, along with a timeline and measurable
metrics; (2) certifying and detailing any changes to the full
deployment schedule; and (3) certifying the status of
outstanding issues impacting the stability and usability of the
system, and whether the system is ready and optimized for
further deployment at VA sites.
The Committee directs the Department to continue monthly
briefings on program implementation, including updates on
progress resolving outstanding issues, and to provide quarterly
updates to review timelines, performance milestones,
implementation, and change management progress. The Government
Accountability Office is directed to continue quarterly
performance reviews of EHRM deployment and to report to the
Committees each quarter.
The Committee notes that the Department is not expected to
request the release of the 25 percent of funds set aside for
fiscal year 2023, and that it plans to pause new deployments in
fiscal year 2024. While this bill provides the full amount
requested for fiscal year 2024, the Committee will work with
the Department and the Senate Appropriations Committee to
determine the appropriate amount to provide in a final
conference agreement.
Contractor Accountability.--The Committee expects the
Department to hold its contractors accountable. The Department
is expected to work closely with Oracle Cerner to resolve
usability problems and dramatically improve training to ensure
that when deployments restart the new system can be adopted
easily by clinicians and healthcare staff.
Cost and Budget Estimates.--The Committee appreciates the
information included in the fiscal year 2024 budget request and
accompanying justifications that better identifies all costs
related to EHRM implementation, including those that would be
incurred in other budget accounts, in meeting the reporting
requirements above and in the justifications accompanying the
President's budget request.
Enterprise Integration and Standardization.--The Committee
is very concerned that little progress has been made to
standardize the processes, products, and workflows associated
with the new system, especially since this is increasing the
cost of implementation. For example, the Committee is aware
that the Department of Defense has fewer than one-third of the
interfaces the Department is considering.
An interoperable, enterprise-wide system presumes a
standardized system and operating structure. As such, the
Department is directed to set enterprise standards, including
readiness criteria and training requirements, and strictly
limit customization. The standards should be in place as soon
as practicable to ensure new deployments are swift and smooth.
The Committee requests a report of each new requirement and
customized interface added in fiscal years 2022 and 2023,
including the cost of each, reasons for inclusion, and whether
they were outside of the scope of the contract within 30 days
of enactment of this Act, as well as a briefing within 45 days
of the filing of this bill on how the Department's plan to set
enterprise standards.
Life-Cycle Cost Estimate.--The Committee anticipates
receiving an updated Life Cycle Cost Estimate for the program
that takes into account the estimate provided by the Institute
for Defense Analyses and continues to require that at least
annually the Department provide a report to the Committees on
Appropriations that compares current estimated costs to the
revised Life Cycle Cost Estimate.
Report.--The Committee looks forward to receiving the
report required in Division J of Public Law 113-328 detailing
steps taken to: (1) revise and enhance the EHR training
program; (2) independently validate the efficacy of the super
user program and the training for such program; (3) ensure
proper medication management and accurate patient data through
such record; (4) demonstrate that patient record flags that
identify veterans who are at high risk for suicide are properly
displayed in such record; and (5) implement a policy for
regular updates to affected employees about progress on and
estimated completion dates for issues arising from trouble
tickets.

OFFICE OF INSPECTOR GENERAL

Appropriation, fiscal year 2023....................... $273,000,000
Budget request, fiscal year 2024...................... 296,000,000
Committee recommendation, fiscal year 2024............ 296,000,000
Change from enacted level......................... +23,000,000
Change from budget request........................ - - -

The Committee recommendation includes $296,000,000 for
fiscal year 2024 for the Office of the Inspector General, which
is $23,000,000 above the prior year level. The bill makes up to
ten percent of this funding available until September 30, 2025.
The Committee continues to request robust oversight of the
Electronic Health Record Modernization initiative.
VA Claims Backlog.--The OIG is encouraged to continue to
review the VA's work to address the claims backlog and report
to the Committee about such efforts. This report should analyze
how VA's partnership with the National Archives and Records
Administration to digitally scan all paper-based military
personnel files has helped address and resolve the backlog as
well as any changes in wait times and size of the claims
backlog.

CONSTRUCTION, MAJOR PROJECTS

Appropriation, fiscal year 2023....................... $1,447,890,000
Budget request, fiscal year 2024...................... 881,000,000
Committee recommendation, fiscal year 2024............ 881,000,000
Change from enacted level......................... -566,890,000
Change from budget request........................ - - -

The Committee recommendation includes $881,000,000 for
Construction, Major Projects for fiscal year 2024, of which
$373,096,000 shall remain available until September 30, 2029,
and $507,904,000 shall remain available until expended. In
addition, the Committee supports the Department's plan to
allocate $600,000,000 to support major construction projects in
American Lake, WA; Dallas, TX; El Paso, TX; Perry Point, MD;
Portland, OR; San Diego, CA; San Francisco, CA; and San Juan,
PR.
As required by language that is in permanent law, all major
construction projects costing more than $100,000,000 must be
managed by a non-VA government entity, such as the Army Corps
of Engineers. While the Committee no longer duplicates this
language, the Committee intends to continue its oversight of
the quality of the outside entity management and expects to
receive quarterly briefings on each of the large construction
projects.
Construction Reports.--The Committee continues to request
that VA provide quarterly briefings on the progress and cost of
each facility managed by an outside entity. Several additional
bill language provisions are included to enhance the
Committee's capacity to conduct oversight of VA's facility
construction efforts including: (1) no funding greater than
$7,000,000 may be reprogrammed between construction projects
unless approved by the Committees on Appropriations of both
Houses of Congress; (2) any change to the scope of a
construction project is prohibited without the approval of the
Committees; and (3) VA must report any bid savings of
$5,000,000 or more on projects as soon as they are identified.
The Committee does not provide $1,930,000,000 in mandatory
funding, as requested, does not support the shift of
discretionary funding to the mandatory side for construction,
and discourages such requests in future fiscal years.
The chart below reflects the Committee's recommendation for
Major Construction projects.

CONSTRUCTION, MAJOR PROJECTS
[In thousands of dollars]
------------------------------------------------------------------------
Project Amount
------------------------------------------------------------------------
Veterans Health Administration (VHA):
West Haven, CT--New Surgical and Clinical Space 153,128
Tower, Renovation of Buildings 1 and 2 and
Demolition..........................................
Advance Planning and Design Fund--Various Stations... 196,872
Construction & Facilities Management Staff--Various 153,000
Stations............................................
Hazardous Waste--Various Stations.................... 1,000
Judgement Fund--Various Stations..................... 25,000
Non-Departmental Federal Entity Project Management 112,000
Support--Various Stations...........................
Seismic Corrections--Various Stations................ 110,00
Total, VHA....................................... 759,000
National Cemetery Administration (NCA):
St. Louis, MO--Phase 1 Gravesite Development (New 28,800
Land)...............................................
Advance Planning and Design Fund--Various Stations... 78,200
NCA Land Acquisition Fund--Various Stations.......... 5,000
Total, NCA....................................... 112,000
General Administration/Staff Offices:
Department Advance Planning and Design Fund for Major 10,000
Construction........................................
Total, Major Construction........................ 881,000
------------------------------------------------------------------------

To enhance the Committee's capacity to conduct oversight on
VA's facility construction efforts, several administrative
provisions are continued in the bill: (1) No funding amount
greater than $7,000,000 may be reprogrammed between
construction projects unless approved by the Committees on
Appropriations of both Houses of Congress; (2) any change to
the scope of a construction project is not permitted without
the approval of the Committees; and (3) VA must report any bid
savings of $5,000,000 or more on projects as soon as they are
identified.

CONSTRUCTION, MINOR PROJECTS

Appropriation, fiscal year 2023....................... $626,110,000
Budget request, fiscal year 2024...................... 680,000,000
Committee recommendation, fiscal year 2024............ 680,000,000
Change from enacted level......................... +53,890,000
Change from budget request........................ - - -

The Committee recommendation includes $680,000,000 for
Construction, Minor Project for fiscal year 2024, of which
$612,000,000 shall remain available until September 30, 2028,
and $68,000,000 shall remain available until expended.
Greater Los Angeles Healthcare System's Master Plan.--The
Committee continues to encourage the VA to engage with the
Principal Developer Team responsible for the Greater Los Angles
Health Care System's Master Plan and support the
operationalization of the Master Plan, as appropriate.

GRANTS FOR CONSTRUCTION OF STATE EXTENDED CARE FACILITIES

Appropriation, fiscal year 2023....................... $150,000,000
Budget request, fiscal year 2024...................... 164,000,000
Committee recommendation, fiscal year 2024............ 164,000,000
Change from enacted level......................... +14,000,000
Change from budget request........................ - - -

The Committee recommendation includes $164,000,000 for
fiscal year 2024 for Grants for Construction of State Extended
Care Facilities, which is $14,000,000 above the fiscal year
2023 level. A grant may not exceed 65 percent of the total cost
of the project. The bill makes this funding available until
expended.
The Committee directs the Department to work with states to
ensure new facilities and expansions are eligible to receive
the full amount of federal funding as authorized under current
law.

GRANTS FOR CONSTRUCTION OF VETERANS CEMETERIES

Appropriation, fiscal year 2023....................... $50,000,000
Budget request, fiscal year 2024...................... 60,000,000
Committee recommendation, fiscal year 2024............ 50,000,000
Change from enacted level......................... +10,000,000
Change from budget request........................ - - -

The Committee recommendation includes $60,000,000 for
Grants for Construction of Veterans Cemeteries, which is
$10,000,000 above the fiscal year 2023 level. The bill makes
this funding available until expended.

COST OF WAR TOXIC EXPOSURES FUND

Fiscal year 2023 enacted level............ $5,000,000,000
Fiscal year 2024 enacted level............ - - -
Fiscal year 2024 budget year request...... 20,268,000,000
Committee 2024 budget year recommendation. - - -
Fiscal year 2025 advance appropriation 21,454,542,000
request..................................
Committee 2025 advance appropriation - - -
recommendation...........................

The recently enacted Fiscal Responsibility Act of 2023
(P.L. 118-5) included $20,268,000,000 for the Cost of War Toxic
Exposures Fund (TEF), as requested by the President's fiscal
year 2024 budget request. The Fiscal Responsibility Act also
included $24,455,000,000 in advance appropriations for fiscal
year 2025 for the TEF.
The Department is directed to provide the Committees on
Appropriations an expenditure plan for funds provided for the
TEF by the Fiscal Responsibility Act within 30 days of the
filing of this report with the Clerk of the U.S. House of
Representatives.
PACT Act Incremental Costs.--The Committee directs the
Department to include in its fiscal year 2025 and all future
budget justification materials a detailed description of the
incremental costs for implementation of the PACT Act for all
requested funds on an account-by-account basis.

Administrative Provisions

The administrative provisions included in the bill are as
follows:

(INCLUDING TRANSFER OF FUNDS)

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

(INCLUDING TRANSFER OF FUNDS)

The bill includes section 202 allowing the Department to
transfer funding among the four medical appropriations accounts
in fiscal year 2024. The Administration proposal to modify this
provision is not adopted.
The bill includes section 203 allowing for salaries and
expenses funds to be used for hire of passenger vehicles, lease
of facilities or land, and purchase of uniforms.
The bill includes section 204 providing that only funding
in ``Construction, Major Projects'' and ``Construction, Minor
Projects'' can be used for the purchase of any site for any new
hospital or home or to construct any new hospital or home.
The bill includes section 205 requiring the Department to
be reimbursed for medical services it provides to any person
not defined as a beneficiary to ensure the Department is
receiving payment for all medical services provided.
The bill includes section 206 allowing for the use of funds
appropriated in fiscal year 2024 for ``Compensation and
Pensions'', ``Readjustment Benefits'', and ``Veterans Insurance
and Indemnities'' for payment of accrued obligations recorded
in the last quarter of fiscal year 2023.
The bill includes section 207 allowing for the use of
fiscal year 2024 funds to pay prior year obligations resulting
from implementation of sections 3328(a), 3334, and 3712(a) of
title 31, United States Code.

(INCLUDING TRANSFER OF FUNDS)

The bill includes section 208 allowing the Department to
use surplus earnings from the national service life insurance,
U.S. Government life insurance, and veterans' special life
insurance program to administer these programs.
The bill includes section 209 allowing enhanced-use lease
proceeds deducted for administrative expenses that were
incurred in a prior fiscal year to be available until expended.

(INCLUDING TRANSFER OF FUNDS)

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

(INCLUDING TRANSFER OF FUNDS)

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

(INCLUDING TRANSFER OF FUNDS)

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

(INCLUDING TRANSFER OF FUNDS)

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

(INCLUDING TRANSFER OF FUNDS)

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

(INCLUDING TRANSFER OF FUNDS)

The bill includes section 219 providing up to $430,532,000
of fiscal year 2024 funds for transfer to the Joint DOD-VA
Medical Facility Demonstration Fund. Additional funding may be
transferred from these accounts upon written notification to
the Committees on Appropriations of both Houses of Congress.

(INCLUDING TRANSFER OF FUNDS)

The bill includes section 220 permitting the transfer of
$456,547,000 of fiscal year 2025 funding appropriated for
medical accounts to the Joint DOD-VA Medical Facility
Demonstration Fund for the operation of facilities designated
as combined Federal medical facilities.

(INCLUDING TRANSFER OF FUNDS)

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

(INCLUDING TRANSFER OF FUNDS)

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

(INCLUDING TRANSFER OF FUNDS)

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

(INCLUDING TRANSFER OF FUNDS)

The bill includes section 229 permitting the transfer of
funds between the ``Board of Veterans Appeals'' and ``General
Operating Expenses, Veterans Benefits Administration'' upon
approval of the Appropriations Committees on Appropriations of
both Houses of Congress. The Administration proposal to modify
this provision is not adopted.
The bill includes section 230 prohibiting the reprogramming
of funds exceeding $7,000,000 among the Major Construction
projects unless the Committees on Appropriations of both Houses
of Congress approve the request. The Administration proposal to
modify this provision is not adopted.
The bill includes section 231 requiring the Secretary to
ensure that the toll-free suicide hotline provides immediate
assistance from a trained professional and adheres to all
requirements of the American Association of Suicidology. The
Administration request to delete this provision is not adopted.
The bill includes section 232 requiring VA to use the
mammography screening guidelines announced by the Secretary on
May 10, 2017, through January 1, 2025. The Administration
request to delete this provision is not adopted.
The bill includes section 233 allowing the use of Medical
Services funding for assisted reproductive technology treatment
and adoption reimbursement for veterans and their spouses.
The bill includes section 234 prohibiting any funds from
being used in a manner that is inconsistent with statutory
limitations on outsourcing.
The bill includes section 235 pertaining to exceptions for
Indian- or Native Hawaiian-owned businesses contracting with
VA.
The bill includes section 236 directing the elimination
over a series of years of the use of Social Security numbers in
VA programs.
The bill includes section 237 referencing the provision in
the Continuing Appropriations and Military Construction,
Veterans Affairs, and Related Agencies Appropriations Act,
2017, and Zika Response and Preparedness Act (P.L. 114-223)
pertaining to certification of marriage and family therapists.
The Administration request to delete this provision is not
adopted.
The bill includes section 238 which prohibits funds from
being used to transfer funding from the Filipino Veterans
Equity Compensation Fund to any other VA account. The
Administration request to delete this provision is not adopted.
The bill includes section 239 permitting funding to be used
in fiscal years 2024 and 2025 to carry out and expand the
childcare pilot program authorized by section 205 of the
Caregivers and Veterans Omnibus Health Services Act of 2010
(P.L. 111-163).
The bill includes section 240 prohibiting VA from using
funds to enter into an agreement to resolve a dispute or claim
with an individual that would restrict the individual from
speaking to Members of Congress or their staff on any topic,
except those required to be kept secret in the interest of
national defense or the conduct of foreign affairs. The
Administration request to delete this provision is not adopted.
The bill includes section 241 referencing language in the
Continuing Appropriations and Military Construction, Veterans
Affairs, and Related Agencies Appropriations Act, 2017, and
Zika Response and Preparedness Act (P.L. 114-223) requiring
certain data to be included in budget justifications for major
construction projects. The Administration request to delete
this provision is not adopted.
The bill includes section 242 prohibiting the use of funds
to deny the Inspector General timely access to information
unless a provision of law expressly refers to the Inspector
General and expressly limits such access.
The bill includes section 243 prohibiting funding from
being used in a manner that would increase wait times for
veterans at medical facilities. The Administration request to
delete this provision is not adopted.
The bill includes section 244 prohibiting the use of funds
in fiscal year 2024 to convert any program that received
specific purpose funds in fiscal year 2023 to a general
purpose-funded program without the approval of the Committees
on Appropriations of both Houses of Congress at least 30 days
prior to any such action. The Administration request to delete
this provision is not adopted.
The bill includes section 245 regarding verification of
service for coastwise merchant seamen.
The bill includes section 246 regarding the use of canines,
felines, and non-human primates in VA research.
The bill includes section 247 regarding staffing ratios.
The bill includes section 248 to allow fiscal year 2024 and
2025 ``Medical Community Care'' funds to be used to cover
obligations that would have otherwise been paid by the Veterans
Choice Fund.
The bill includes section 249 allowing obligations and
expenditures applicable to the ``Medical Services'' account in
fiscal years 2017 through 2019 for aid to state homes to remain
in the ``Medical Community Care'' account for such fiscal
years.
This bill includes section 250 specifying an amount from
the four medical care accounts for specific care for women
veterans. The administration request to delete this provision
is not adopted.
The bill includes section 251 regarding construction of a
community-based outpatient clinic in Bakersfield, California.
The bill includes section 252 regarding the lease of a
community-based outpatient clinic in Bakersfield, California.
The bill includes section 253 requiring quarterly reports
on the status of the ``Veterans Medical Care and Health Fund,''
established to execute section 8002 of the American Rescue Plan
(P.L. 117-2).
The bill includes section 254 establishing a timeline for
construction in accordance with a lease.
The bill includes section 255 regarding the use of
unobligated balances to support construction projects in the
CHIP-IN program.

(INCLUDING RESCISSION OF FUNDS)

The bill includes section 256 rescinding funding from the
Medical Services, Medical Community Care, and Medical
Facilities accounts.
The bill includes section 257 requiring an expenditure plan
for funds made available through the Fiscal Responsibility Act
of 2023 (P.L. 118-5).
The bill includes section 258 prohibiting federal funding
for abortions except in cases of incest, rape, or life of the
mother and prohibiting federal funding to implement the
Department of Veterans Affairs' Interim Final Rule on abortion.
The bill includes section 259 prohibiting federal funding
for hormone therapies or surgeries for gender-affirming care.
The bill includes section 260 permitting certain flags to
be flown over VA facilities.

TITLE III

RELATED AGENCIES

American Battle Monuments Commission

SALARIES AND EXPENSES

Appropriation, fiscal year 2023....................... $87,500,000
Budget request, fiscal year 2024...................... 114,630,000
Committee recommendation, fiscal year 2024............ 114,630,000
Change from enacted level......................... 27,130,000
Change from budget request........................ - - -

The recommendation includes $114,630,000 for Salaries and
Expenses of the American Battle Monuments Commission. The
Committee directs the Commission to provide a spend plan for
the additional funds provided this fiscal year, including
funding for the capital program, within 60 days of enactment of
this Act.

FOREIGN CURRENCY FLUCTUATIONS ACCOUNT

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

CAPITAL PROGRAM

Appropriation, fiscal year 2023....................... $- - -
Budget request, fiscal year 2024...................... 44,000,000
Committee recommendation, fiscal year 2024............ 44,000,000
Change from enacted level......................... +44,000,000
Change from budget request........................ - - -

The recommendation includes $44,000,000, as requested.

United States Court of Appeals for Veterans Claims

SALARIES AND EXPENSES

Appropriation, fiscal year 2023....................... $46,900,000
Budget request, fiscal year 2024...................... 47,200,000
Committee recommendation, fiscal year 2024............ 47,200,000
Change from enacted level......................... +300
Change from budget request........................ - - -

The recommendation includes $47,200,000 for Salaries and
Expenses for the United States Court of Appeals for Veterans
Claims.

Department of Defense--Civil

Cemeterial Expenses, Army

SALARIES AND EXPENSES

Appropriation, fiscal year 2023....................... $93,400,000
Budget request, fiscal year 2024...................... 99,880,000
Committee recommendation, fiscal year 2024............ 100,267,000
Change from enacted level......................... +6,867,000
Change from budget request........................ +387,000

The recommendation includes $100,267,000 for Salaries and
Expenses for Arlington National Cemetery, which is equal to the
fiscal year 2024 budget request.

CONSTRUCTION

Appropriation, fiscal year 2023....................... $62,500,000
Budget request, fiscal year 2024...................... 88,600,000
Committee recommendation, fiscal year 2024............ 88,600,000
Change from enacted level......................... +26,100,000
Change from budget request........................ - - -

The recommendation includes $88,600,000 to complete the
Southern Expansion, to remain available until expended. The
Committee reminds the Army to include status updates in its
required quarterly reports on funds obligated, including
previously appropriated funds, and funds remaining for the
Southern Expansion project, as well as any remaining unfunded
needs to complete the project.

Armed Forces Retirement Home

TRUST FUND

The recommendation includes a total of $77,000,000 for the
Armed Forces Retirement Home (AFRH) Trust Fund, including
$8,940,000 for capital projects and $25,000,000 from the
general fund of the Treasury.
General Fund.--The Committee continues to be concerned
about the use of the General Fund to support the AFRH and
directs it to make progress to increase revenues and stabilize
the Trust Fund for the long term.
Land Redevelopment.--The Committee continues to be
interested in the redevelopment of the 80-acre master planned
parcel on the Washington campus and continues to direct AFRH to
report to the Committee on the progress of the redevelopment
project.

OPERATION AND MAINTENANCE

Appropriation, fiscal year 2023....................... $68,060,000
Budget request, fiscal year 2024...................... 68,060,000
Committee recommendation, fiscal year 2024............ 68,060,000
Change from enacted level......................... - - -
Change from budget request........................ - - -

The Committee makes these operation and maintenance funds
available until September 30, 2025, as requested, to provide
AFRH greater ability to respond to emergency situations and
ensure stable operations.

CAPITAL PROGRAM

Appropriation, fiscal year 2023....................... $7,300,000
Budget request, fiscal year 2024...................... 8,940,000
Committee recommendation, fiscal year 2024............ 8,940,000
Change from enacted level......................... +1,640,000
Change from budget request........................ - - -

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

MAJOR CONSTRUCTION

Appropriation, fiscal year 2023....................... $77,000,000
Budget request, fiscal year 2024...................... - - -
Committee recommendation, fiscal year 2024............ - - -
Change from enacted level......................... -77,000,000
Change from budget request........................ - - -

The Committee reminds AFRH to provide quarterly reports on
the status of this construction project, including obligations
of funds, anticipated timelines, and any changes to the overall
cost of the project.

Administrative Provision

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

TITLE IV

GENERAL PROVISIONS

The bill includes section 401 prohibiting the obligation of
funds beyond the current fiscal year unless expressly so
provided.
The bill includes section 402 prohibiting the use of funds
for programs, projects, or activities not in compliance with
Federal law relating to risk assessment, the protection of
private property rights, or unfunded mandates.
The bill includes section 403 encouraging all departments
and agencies funded in this Act to expand the use of ``E
Commerce'' technologies and procedures.
The bill includes section 404 specifying the Congressional
committees that are to receive all reports and notifications.
The bill includes section 405 prohibiting the transfer of
funds to any instrumentality of the United States Government
without authority from an appropriations Act.
The bill includes section 406 prohibiting any funds in this
Act to be used for a project or program named for an individual
serving as a Member, Delegate, or Resident Commissioner of the
United States House of Representatives.
The bill includes section 407 requiring all reports
submitted to Congress to be posted on official websites of the
submitting agency.
The bill includes section 408 prohibiting the use of funds
to establish or maintain a computer network unless such network
blocks the viewing, downloading, and exchanging of pornography,
except for law enforcement investigation, prosecution, or
adjudication activities.
The bill includes section 409 prohibiting the use of funds
for payment of first-class travel by an employee of the
executive branch.
The bill includes section 410 prohibiting the use of funds
in this Act for any contract where the contractor has not
complied with E-Verify requirements.
The bill includes section 411 prohibiting the use of funds
in this Act to construct facilities on military installations
that do not meet resiliency standards.
The bill includes section 412 prohibiting the use of funds
in this Act for the renovation, expansion, or construction of
any facility in the continental United States for the purposes
of housing any individual who has been detained at the United
States Naval Station, Guantanamo Bay, Cuba.
The bill includes section 413 prohibiting the use of funds
to support or defeat legislation pending before Congress.
The bill includes section 414 prohibiting the use of funds
to implement Executive Order 13985, Executive Order 14035,
Executive Order 14091 regarding diversity, equity, and
inclusion activities.
The bill includes section 415 prohibiting the use of funds
to promote or advance Critical Race Theory or any concept
associated with Critical Race Theory.
The bill includes section 416 prohibiting discrimination
based on religious beliefs related to marriage.
The bill includes section 417 prohibiting federal funding
for Diversity, Equity, and Inclusion training or
implementation.
The bill includes section 418 establishing a ``Spending
Reduction Account'' in the bill.

House of Representatives Reporting Requirements

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

STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES

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

RESCISSION OF FUNDS

Pursuant to clause 3(f)(2) of rule XIII of the Rules of the
House of Representatives, the following statements are
submitted describing the rescissions in the accompanying bill:
In title II, section 256 recinds $4,933,113,000 of
unobligated balances from ``Medical Services''; $1,909,069,000
of unobligated balances from ``Medical Community Care''; and
$250,515,000 of unobligated balances from ``Medical
Facilities''.

TRANSFER OF FUNDS

Pursuant to clause 3(f)(2) of rule XIII of the Rules of the
House of Representatives, the following statements are
submitted describing the transfer of funds provided in the
accompanying bill.
Language is included under Title I to allow for the
transfer of funds from Family Housing, Construction accounts to
the Department of Defense Family Housing Improvement Fund and
funds from Military Construction accounts to the Department of
Defense Military Unaccompanied Housing Improvement Fund.
Language is included under Title I to provide transfer
authority from the BRAC account to the Homeowners Assistance
Program.
Language is included under Title I to allow the transfer of
expired funds to the ``Foreign Currency Fluctuations,
Construction, Defense'' account.
Language is included under Title II to transfer not to
exceed $22,109,000 in fiscal year 2025 from Compensation and
Pensions to General Operating Expenses, Veterans Benefits
Administration and Information Technology Systems. These funds
are for the administrative costs of implementing cost-savings
proposals required by the Omnibus Budget Reconciliation Act of
1990 and the Veterans' Benefits Act of 1992. Language is also
included transferring funds to the Medical Care Collections
Fund to augment funding of medical facilities for nursing home
care provided to pensioners.
Language is included under Title II to permit the transfer
of funds from General Administration to General Operating
Expenses, Veterans Benefits Administration.
Language is included under Title II to permit the transfer
of funds between Information Technology Systems development
projects and among the three sub-accounts identified in bill
language subject to the approval of the Committee.
Language is included under Title II to provide authority
for the Department of Veterans Affairs for any funds
appropriated in 2024 for Compensation and Pensions,
Readjustment Benefits, and Veterans Insurance and Indemnities
to be transferred among those three accounts.
Language is included under Title II to transfer funds among
the Medical Services, Medical Community Care, Medical Support
and Compliance, and Medical Facilities accounts, subject to
approval by the Committee.
Language is included under Title II to permit the funds
from three life insurance funds to be transferred to General
Operating Expenses, Veterans Benefits Administration and
Information Technology Systems for the costs of administering
such programs.
Language is included under Title II to permit funding up to
$101,065,000 to be transferred to General Administration and
Information Technology Systems from any funds appropriated in
fiscal year 2024 to reimburse three headquarters offices for
services provided.
Language is included under Title II to transfer certain
funds derived from enhanced-use leasing activities to the
Construction, Major Projects and Construction, Minor Projects
accounts.
Language is included under Title II to allow the transfer
of funds from the Medical Care Collections Fund to the Medical
Services and Medical Community Care accounts.
Language is included under Title II to allow the transfer
of funds from the Capital Asset Fund to the Construction, Major
Projects and Construction, Minor Projects accounts.
Language is included under Title II to allow the transfer
of funds from various accounts to the Information Technology
Systems account in an aggregate amount not to exceed ten
percent of the account appropriation, subject to approval by
the Committee.
Language is included under Title II to allow the transfer
of funds provided for the Department of Veterans Affairs in
fiscal year 2024 to the Joint Department of Defense-Department
of Veterans Affairs Medical Facility Demonstration Fund.
Language is included under Title II allowing fiscal year
2025 medical care funding to be transferred to the Joint
Department of Defense-Department of Veterans Affairs Medical
Facility Demonstration fund.
Language is included under Title II permitting funds
deposited to the Medical Care Collections Fund for healthcare
provided at a combined Federal medical facility to be
transferred to the Joint Department of Defense-Department of
Veterans Affairs Medical Facility Demonstration Fund.
Language is included under Title II to the Department of
Veterans Affairs that would transfer no less than $15,000,000
for the DOD-VA Health Care Sharing Incentive Fund as authorized
by section 8111(d) of title 38, United States Code.
Language is included under Title II that permits the
transfer from all discretionary accounts except General
Operating Expenses, Veterans Benefits Administration, to
Medical Services, subject to approval by the Committee.
Language is included under Title II that permits transfer
of funds between General Operating Expenses, Veterans Benefits
Administration and the Board of Veterans Appeals, subject to
approval by the Committee.

DISCLOSURE OF EARMARKS AND CONGRESSIONALLY DIRECTED SPENDING ITEMS

The following table is submitted in compliance with clause
9 of rule XXI, and lists the congressional earmarks (as defined
in paragraph (e) of clause 9) contained in the bill or in this
report. Neither the bill nor the report contain any limited tax
benefits or limited tariff benefits as defined in paragraphs
(f) or (g) of clause 9 of rule XXI.

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

In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets):

SECTION 220 OF DIVISION J OF THE CONSOLIDATED APPROPRIATIONS ACT, 2023

(Public Law 117-328)

[(INCLUDING TRANSFER OF FUNDS)

[Sec. 220. Of the amounts appropriated to the Department of
Veterans Affairs which become available on October 1, 2023, for
``Medical Services'', ``Medical Community Care'', ``Medical
Support and Compliance'', and ``Medical Facilities'', up to
$314,825,000, plus reimbursements, may be transferred to the
Joint Department of Defense--Department of Veterans Affairs
Medical Facility Demonstration Fund, established by section
1704 of the National Defense Authorization Act for Fiscal Year
2010 (Public Law 111-84; 123 Stat. 2571) and may be used for
operation of the facilities designated as combined Federal
medical facilities as described by section 706 of the Duncan
Hunter National Defense Authorization Act for Fiscal Year 2009
(Public Law 110-417; 122 Stat. 4500): Provided, That additional
funds may be transferred from accounts designated in this
section to the Joint Department of Defense--Department of
Veterans Affairs Medical Facility Demonstration Fund upon
written notification by the Secretary of Veterans Affairs to
the Committees on Appropriation of both Houses of Congress.]

Changes in the Application of Existing Law

Pursuant to clause 3(f)(1)(A) of rule XIII of the Rules of
the House of Representatives, the following statements are
submitted describing the effect of provisions in the
accompanying bill that directly or indirectly change the
application of existing law.
Language is included in various parts of the bill to
continue on-going activities that require annual authorization
or additional legislation, which to date have not been enacted.
Language is included in various parts of the bill to place
limitations on the use of funds in the bill or change existing
limitations and which might, under some circumstances, be
construed as changing the application of existing law.
Language is included in various parts of the bill to allow
the Secretary of Defense to exceed certain limitations upon
notification to the Committee.
Language is included in various parts of the bill to allow
funding to be used for official reception and representation
expenses.
Language is included in various parts of the bill to enable
various appropriations to remain available for more than one
year for some programs for which the basic authority
legislation does not presently authorize such extended
availability.
Language is included in various parts of the bill to permit
the transfer of funds to other accounts.
Language is included under Title I to prohibit payments for
cost-plus-a-fixed-fee contracts under certain circumstances.
Language is included in various parts of the bill to allow
funds to be used for the hire of passenger motor vehicles.
Language is included under Title I to allow advances to the
Federal Highway Administration, Department of Transportation
under certain circumstances.
Language is included under Title I to prohibit the use of
funds to begin construction of new bases without specific
appropriations.
Language is included under Title I to prohibit the use of
funds for purchase of land or land easements under certain
circumstances.
Language is included under Title I to prohibit the use of
funds for land acquisition, site preparation, and utility
installation for family housing unless funds have been made
available in annual appropriations Acts.
Language is included under Title I to prohibit the use of
minor construction funds to transfer an activity between
installations without prior notification.
Language is included under Title I to prohibit the use of
funds for the procurement of steel for any activity if American
steel producers have been denied the opportunity to compete for
such steel procurements.
Language is included under Title I to prohibit the use of
funds to pay real property taxes in any foreign nation.
Language is included under Title I to prohibit the use of
funds to initiate a new installation overseas without prior
notification.
Language is included under Title I to limit the use of
funds for architect and engineer contracts under certain
circumstances.
Language is included under Title I to limit the use of
funds for awarding contracts to foreign contractors under
certain circumstances.
Language is included under Title I to require the
Department of Defense to notify the appropriate committees of
Congress of any proposed military exercises under certain
circumstances.
Language is included under Title I to allow prior year
construction funding to be available for currently authorized
projects.
Language is included under Title I to allow payment for the
cost associated with supervision, inspection, overhead,
engineering and design on family housing or military
construction projects that are being completed with expired or
lapsed funds.
Language is included under Title I to allow funds to be
expended on military construction projects for four fiscal
years after enactment under certain circumstances.
Language is included under Title I to allow construction
funds to be transferred to Housing Improvement Funds.
Language is included under Title I to allow for the
transfer of BRAC funds to the Homeowners Assistance Program.
Language is included under Title I to limit funds for the
operation and maintenance of family housing to those provided
in this appropriation and to limit amounts expended on repairs
of general and flag officer quarters under certain
circumstances.
Language is included under Title I to allow funds in the
Ford Island Improvement Account to be available until expended
for certain purposes.
Language is included under Title I to allow for the
transfer of expired funding to the Foreign Currency Fluctuation
Account under certain circumstances.
Language is included under Title I to prohibit funds from
being used for projects at Arlington Cemetery.
Language is included under Title I directing all amounts
appropriated to Military Construction (all accounts) be
immediately available and allotted for the full scope of the
authorized project.
Language is included under Title I providing funds for
unfunded requirements requested by the Services and Combatant
Commanders.
Language is included under Title I allowing unobligated
funds from prior appropriations acts for fiscal years 2017,
2018, and 2019 to be obligated under certain circumstances.
Language is included under Title I defining the
congressional defense committees.
Language is included under Title I providing funds for
military laboratory facilities.
Language is included under Title I providing funds for
natural disasters.
Language is included under Title I providing funds for
child development centers planning and design.
Language is included under Title I providing funds for
barracks planning and design.
Language is included under Title I providing funds for
demolition.
Language is included under Title I providing funds for the
Shipyard Infrastructure Optimization Program.
Language is included under Title I prohibiting funds to
close Naval Station Guantanamo Bay, Cuba.
Language is included under Title II providing for the
reimbursement to the Department of Defense for the costs of
overseas employee mail.
Language is included under Title II to require that the
Secretary of Veterans Affairs establish a priority for
treatment of Veterans who are service-connected disabled, lower
income, or have special needs.
Language is included under Title II to require that the
Secretary of Veterans Affairs give priority funding of basic
medical benefits to priority groups 1 through 6.
Language is included under Title II to allow the Secretary
of Veterans Affairs to dispense prescription drugs from VHA
facilities to enrolled Veterans with privately written
prescriptions at no additional cost to the Department.
Language is included under Title II requiring the Secretary
to ensure sufficient funding is available for the acquisition
of prosthetics designed for women Veterans.
Language is included under Title II requiring sufficient
funding is available for prosthetic research specifically for
female Veterans and for toxic exposure research.
Language is included under Title II to require approval of
a transfer between development projects in the Information
Technology Systems account.
Language is included under Title II prohibiting funding in
the Veterans Electronic Health Record account from being
obligated in a manner inconsistent with deployment schedules.
Language is included under Title II establishing time
limitations and reporting requirements concerning the
obligation of Major Construction funds, limiting the use of
funds, allowing the use of funds for program costs, and
allowing for the reimbursement to the ``General
Administration'' account for the salaries and expenses of the
Office of Construction and Facilities Management employees.
Language is included under Title II to allow Minor
Construction funds to be used to repair non-medical facilities
damaged by natural disaster or catastrophe.
Language is included under Title II permitting transfers
between mandatory and discretionary accounts, limiting and
providing for the use of certain funds, funding administrative
expenses associated with life insurance programs from excess
program revenues, allowing reimbursement from enhanced-use
leases and for certain services, requiring notification of
construction bid savings, limiting reprogramming amount of
major construction projects, restricting changes in the scope
of major construction projects, requiring disclosure of
insurance and income information, allowing a recovery audit
collection program, allowing Veterans in the State of Alaska to
use Indian Health Service facilities under certain conditions,
requiring quarterly reports on the Department's financial
status, performance measures, and data, allowing medical
services funds for recreational and funeral expenses, and
requiring notification of organizational changes that transfer
25 or more employees from one VA organizational unit to
another.
Language is included under Title II requiring notification
of any single national outreach and awareness marketing
campaign in which obligations exceed $1,000,000.
Language is included under Title II requiring the Secretary
to maintain certain requirements in operating the toll-free
suicide hotline.
Language is included under Title II prohibiting funds from
being used in contravention of certain breast cancer screening
guidance.
Language is included under Title II to allow covered
veterans and their spouses or partners, under certain
conditions, to receive assisted reproductive technology
services and adoption reimbursement.
Language is included under Title II pertaining to
exceptions for Indian- or Native Hawaiian-owned businesses
contracting with the Department.
Language is included under Title II directing the
elimination of using Social Security account numbers to
identify individuals in all information systems of the
Department.
Language is included under Title II pertaining to
certification of marriage and family therapists.
Language is included under Title II prohibiting funds from
being used to transfer funding from the Filipino Veterans
Equity Compensation Fund to any other VA account.
Language is included under Title II permitting funds to
carry out and expand the childcare program.
Language is included under Title II prohibiting funds to
enter into an agreement to resolve a dispute or claim with an
individual that would restrict the individual from speaking to
Members of Congress or their staff.
Language is included under Title II requiring certain data
to be included in budget justifications for major construction
projects.
Language is included under Title II prohibiting the
Inspector General from being denied timely access to
information.
Language is included under Title II prohibiting funding to
be used in a manner that would increase wait times for Veterans
who seek medical care.
Language is included under Title II prohibiting the use of
funds in fiscal year 2024 to convert any program that received
specific purpose funding in fiscal year 2023 to a general
purpose-funded program.
Language is included under Title II prohibiting the use of
dogs or cats as part of the conduct of any study.
Language is included under Title II allowing for funds
within the Medical Community Care account to be used for
expenses that would have otherwise been payable from the
Veterans Choice Fund.
Language is included under Title II allowing for
obligations and expenditures applicable to the Medical Services
account in fiscal years 2017 through 2019 for aid to state
homes to remain in the Medical Community Care account for such
fiscal years.
Language is included under Title II providing for a certain
amount within the medical care accounts to be made available
for gender-specific care and programmatic efforts to deliver
care for women veterans.
Language is included under Title II rescinding unobligated
balances in the ``Recurring Expenses Transformational Fund.''
Language is included under Title II requiring quarterly
reports on the status of the Veterans Medical Care and Health
Fund.
Language is included under Title II allowing the use of
unobligated balances for CHIP-In construction projects.
Language is included under Title II to require an
expenditure plan for funds made available in the Fiscal
Responsibility Act of 2023 (P.L. 118-5).
Language is included under Title II prohibiting federal
funding for abortions except in cases of incest, rape, or life
of the mother and prohibiting federal funding for implementing
the Department of Veterans Affairs Interim Final Rule on
abortion.
Language is included under Title II regarding funding for
hormone therapies or surgeries for gender-affirming care.
Language is included under Title II permitting certain
flags to be flown at VA facilities.
Language is included under Title III, United States Court
of Appeals for Veterans Claims, Salaries and Expenses, to
permit the use of funds for a pro bono program.
Language is included under Title III, Cemeterial Expenses,
Army, Salaries and Expenses, to permit the use of funds for
parking maintenance and repairs.
Language is included under Title III, Armed Forces
Retirement Home to permit payment from the general fund of the
Treasury to the Trust Fund.
Language is included under Title III to allow for the use
of concession fees.
Language is included under Title IV prohibiting funding
beyond the current fiscal year unless expressly so provided.
Language is included under Title IV to limit the use of
funds for Federal entities when they are not in compliance with
Federal law relating to risk assessment, the protection of
private property rights, or unfunded mandates.
Language is included under Title IV providing funding to
expand the use of ``E Commerce'' technologies and procedures.
Language is included under Title IV specifying the
Congressional committees that are to receive all reports and
notifications.
Language is included under Title IV prohibiting the
transfer of funds to any instrumentality of the United States
Government without authority from an appropriations Act.
Language is included under Title IV prohibiting the use of
funds for a project or program named for an individual serving
as a Member, Delegate, or Resident Commissioner of the United
States House of Representatives.
Language is included under Title IV requiring all reports
submitted to the Congress to be posted on the official public
website of that agency.
Language is included under Title IV prohibiting funds from
being used to maintain or establish a computer network unless
such network blocks the viewing, downloading, and exchanging of
pornography.
Language is included under Title IV prohibiting funds from
being used to pay for first-class travel in violation of
Federal regulations.
Language is included under Title IV prohibiting funds from
being used to execute a contract for goods or services where a
contractor has not complied with Executive Order 12989.
Language is included under Title IV prohibiting the use of
funds in this Act to construct facilities on military
installations that do not meet resiliency standards.
Language is included under Title IV prohibiting funds to
build or house detainees at Naval Station Guantanamo Bay, Cuba.
Language is included under Title IV prohibiting funds for
executive orders related to diversity, equity, and inclusion.
Language is included under Title IV prohibiting funds to
teach or promote Critical Race Theory.
Language is included under Title IV prohibiting
discrimination based on religious beliefs related to marriage.
Language is included under Title IV prohibiting Diversity,
Equity, and Inclusion training or implementation.
Language is included under Title IV regarding a Spending
Reduction Account.

Appropriations Not Authorized By Law

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

BUDGETARY IMPACT OF THE FY 2024 MILITARY CONSTRUCTION, VETERANS
AFFAIRS, AND RELATED AGENCIES APPROPRIATIONS BILL PREPARED IN
CONSULTATION WITH THE CONGRESSIONAL BUDGET OFFICE PURSUANT TO SECTION
308(A) OF THE CONGRESSIONAL BUDGET ACT OF 1974

[In millions of dollars]

COMPARISON WITH BUDGET RESOLUTION

Pursuant to clause 3(c)(2) of rule XIII of the Rules of the
House of Representaties and section 308(a)(1)(A) of the
Congressional Budget Act of 1974, the following table compares
the levels of new budget authority provided in the bill with
the appropriate allocation under section 302(b) of the Budget
Act.

[In millions of dollars]
----------------------------------------------------------------------------------------------------------------
302(b) Allocation This Bill
---------------------------------------------------------------
Budget Budget
Authority Outlays Authority Outlays
----------------------------------------------------------------------------------------------------------------
Comparison of amounts in the bill with Committee
allocations to its subcommittees: Subcommittee
on Military Construction, Veterans Affairs, and
Related Agencies
Discretionary............................... 155,701 152,724 155,701 \1\152,730
Mandatory................................... 204,556 190,242 204,556 \1\188,230
----------------------------------------------------------------------------------------------------------------
\1\Includes outlays from prior-year budget authority.

FIVE-YEAR OUTLAY PROJECTIONS

Pursuant to clause 3(c)(2) of rule XIII and section
308(a)(1)(B) of the Congressional Budget Act of 1974, the
following table contains five-year projections associated with
the budget authority provided in the accompanying bill as
provided to the Committee by the Congressional Budget Office.

[In millions of dollars]
------------------------------------------------------------------------
Outlays
------------------------------------------------------------------------
Projection of outlays associated with the recommendation:
2024................................................... \1\162,986
2025................................................... 104,7220
2026................................................... 18,330
2027................................................... 5,497
2028 and future years.................................. 5,158
------------------------------------------------------------------------
\1\Excludes outlays from prior-year budget authority.

FINANCIAL ASSISTANCE TO STATE AND LOCAL GOVERNMENTS

Pursuant to clause 3(c)(2) of rule XIII and section
308(a)(1)(C) of the Congressional Budget Act of 1974, the
Congressional Budget Office has provided the following
estimates of new budget authority and outlays provided by the
accompanying bill for financial assistance to State and local
governments.

[In millions of dollars]
------------------------------------------------------------------------
Budget Authority Outlays
------------------------------------------------------------------------
Financial assistance to State and 190 \1\189
local governments for 2024.......
------------------------------------------------------------------------
\1\Excludes outlays from prior-year budget authority.

Committee Hearings

Pursuant to clause 3(c)(6) of rule XIII of the Rules of the
House of Representatives, the following hearings were used to
develop or consider the Military Construction, Department of
Veterans Affairs, and Related Agencies Appropriations Act,
2024:
The Subcommittee on Military Construction, Department of
Veterans Affairs, and Related Agencies held a hearing on
February 28, 2023, entitled ``Oversight Hearing--Quality of
Life in the Military''. The Subcommittee received testimony
from:
Sergeant Major Michael A. Grinston, U.S. Army
Master Chief Petty Officer James A. Honea, U.S. Navy
Sergeant Major Troy E. Black, U.S. Marine Corps
Chief Master Sergeant JoAnne S. Bass, U.S. Air Force
Chief Master Sergeant Roger A. Towberman, U.S. Space Force
The Subcommittee on Military Construction, Department of
Veterans Affairs, and Related Agencies held a hearing on April
20, 2023, entitled ``FY 2023 Member Day Hearing''. The
Subcommittee received testimony from:
The Honorable Brian J. Mast, Member of Congress
The Honorable Earl Blumenauer, Member of Congress
The Subcommittee on Military Construction, Department of
Veterans Affairs, and Related Agencies held a hearing on March
23, 2023, entitled ``Budget Hearing--Fiscal Year 2024 Request
for Army Military Construction and Family Housing''. The
Subcommittee received testimony from:
The Honorable Rachel Jacobson, Assistant Secretary of the
Army, Installations, Energy, and Environment Department of
Veterans Affairs
Lieutenant General Kevin Vereen, Deputy Chief of Staff G9,
Installation Management Command
The Subcommittee on Military Construction, Department of
Veterans Affairs, and Related Agencies held a hearing on March
29, 2023, entitled ``Budget Hearing--Fiscal Year 2024 Request
for the Department of Veterans Affairs''. The Subcommittee
received testimony from:
The Honorable Denis McDonough, Secretary, Department of
Veterans Affairs
The Subcommittee on Military Construction, Department of
Veterans Affairs, and Related Agencies held a hearing on April
18, 2023, entitled ``Budget Hearing--Fiscal Year 2024 Request
for Navy and Marine Corps Military Construction and Family
Housing''. The Subcommittee received testimony from:
The Honorable Meredith Berger, Assistant Secretary of the
Navy, Energy, Installations, and Environment
Vice Admiral Ricky Williamson, Deputy Chief of Naval
Operations, Fleet Readiness, and Logistics, N4, Office of the
Chief of Naval Operations
Lieutenant General Edward D. Banta, Deputy Commandant,
Installations and Logistics, United States Marine Corps
The Subcommittee on Military Construction, Department of
Veterans Affairs, and Related Agencies held a hearing on April
20, 2023, entitled ``Budget Hearing--Fiscal Year 2024 Request
for Air Force and Space Force Military Construction and Family
Housing''. The Subcommittee received testimony from:
Dr. Ravi I. Chaudhary, Assistant Secretary of the Air
Force, Energy, Installations, and Environment, Department of
the Air Force
Mr. Bruce Hollywood, Associate Chief Operations Officer,
Office of the Chief Operations Officer, United States Space
Force
Brigadier General Brian S. Hartless, Air Force Director of
Civil Engineers, Deputy Chief of Staff for Logistics,
Engineering and Force Protection, United States Air Force

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY

The following table provides a detailed summary, for each
Department and agency, comparing the amounts recommended in the
bill with amounts enacted for fiscal year 2023 and budget
estimates presented for fiscal year 2024.

MINORITY VIEWS

The fiscal year (FY) 2024 Military Construction, Veterans
Affairs, and Related Agencies (MilCon-VA) bill funds critical
military construction, family housing, and quality of life
improvements and enhancements for our brave men and women in
uniform and their families. The bill also funds a wide variety
of assistance programs for veterans, including disability and
pension benefits, healthcare services, educational assistance,
and home loan and insurance programs they have earned through
their service to our country. It also funds the American Battle
Monuments Commission, Armed Forces Retirement Home, Arlington
National Cemetery, and the Court of Appeals for Veterans
Claims. This bill provides $155.7 billion in total
discretionary funding, which is $1.5 billion above the FY 2023
enacted funding level and $799.4 million above the budget
request.
We thank Chairman Carter and his staff for their work in
keeping a professional process in place and engaging in
respectful debate on difficult issues, in spite of clear policy
differences. While efforts were made to accommodate Democratic
priorities, the funding levels and policy riders in the MilCon-
VA bill are not workable or sustainable.

DEPARTMENT OF VETERANS AFFAIRS

On August 10, 2022, President Biden signed the Sergeant
First Class Heath Robinson Honoring our Promise to Address
Comprehensive Toxics (PACT) Act of 2022 (P.L. 117-168) after
passing the House with overwhelming bipartisan support with a
vote of 342-88. Included in the PACT Act is the Cost of War
Toxic Exposures Fund (TEF)--the dedicated funding source for
care and services for veterans of all wars exposed to Agent
Orange, burn pits, and other toxic substances. As such, the
budget requested $20.3 billion for the TEF in FY 2024 and $21.5
billion in advance appropriations in FY 2025, consistent with
the law and congressional intent to fund all toxic exposures
related care and services out of the TEF.
House Republican's subcommittee mark included only $5.5
billion for the Fund, rejecting the budget request to provide
all required resources for care and services related to toxic
exposures through the dedicated funding source, and
backtracking on our promises made in the PACT Act.
Subsequently, on June 3, 2023, the Fiscal Responsibility Act of
2023 (P.L. 118-5) was signed into law, setting topline spending
levels for defense and domestic spending and providing full
funding for the TEF for FY 2024 and 2025. We are pleased to see
the Managers' amendment incorporate changes to comport to the
Fiscal Responsibility Act.
The current version of the bill funds the Department of
Veterans Affairs at $299.5 billion in total budgetary
resources, which is $3.8 billion below FY 2023 and $20.3
billion below the budget request. However, combined with the
amounts provided for the TEF in the Fiscal Responsibility Act,
the Department of Veterans Affairs is funded at the budget
request level. The bill provides $121 billion for the four
medical care accounts. Combined with the $17.1 billion provided
for medical care through the TEF in the Fiscal Responsibility
Act, a total of $138 billion is available for medical care in
2024, equal to the budget request. The bill further provides
$112.6 billion in advance appropriations for medical care.
Combined with the $21.5 billion provided in advance for 2025
for medical care through the TEF in the Fiscal Responsibility
Act, a total of $134 billion will be available for medical care
in 2025, equal to the budget request.
We are disappointed that the bill rejects the budget
request to provide $2 billion in mandatory funding to start to
whittle down the over $100 billion infrastructure backlog. We
will not be able to make real progress in VA's infrastructure
backlog without dedicated investment in our facilities outside
the normal discretionary funding streams. We need this funding
to improve the quality of care at VA's facilities for our
veterans and VA employees.

MILITARY CONSTRUCTION

The bill funds military construction at $17.5 billion,
which is $1.5 billion below the FY 2023 enacted level. This
amount is $200 million lower than the level marked up in
subcommittee, which only exacerbates the problem of
underfunding military construction. Since 2021, this committee
has built on the progress from the previous year and continued
to increase investments in military construction. This bill
backtracks on that progress. In a time when we have a
recruitment and retention issue, the condition of military
facilities has a direct impact on the quality of life of our
servicemembers and their families. We need to be strongly
investing in infrastructure that supports quality of life--
including child development centers, gyms, barracks, family
housing, among others, to better the lives of our
servicemembers and their families.
We are pleased that the bill includes Ranking Member
Wasserman Schultz's request to provide $30 million in dedicated
funding to expand the oversight of the housing portfolio at the
Department of Defense, including government-owned and
controlled family housing and privatized family and
unaccompanied housing in the Managers' amendment. We appreciate
Chairman Carter's shared commitment to this oversight and
ensuring privatized housing providers are held accountable. The
wellbeing of servicemembers and their families is of utmost
importance, and continuing to hear reports of poor housing
conditions, slow response times, and indifference towards
requests for assistance is unacceptable.
We are disappointed that the bill only provides $539
billion for the Department of Defense Base Closure Account
(BRAC), which is a cut of $35.5 million compared to the current
level and does not include dedicated funding for PFAS
remediation and cleanup, which is a cut of $200 million. It
also does not include additional, dedicated funding for
military installation climate change and resilience projects,
which is a cut of $90 million from the current level.
The bill would have been improved if the amendments offered
by Ranking Member Wasserman Schultz and Congresswoman Lee were
adopted to strike the partisan poison pill riders related to
Guantanamo Bay, Critical Race Theory, and Diversity, Equity,
and Inclusion. There is no funding in this bill related to
housing Guantanamo Bay prisoners and is not germane to the
bill.
Furthermore, the majority added even more partisan poison
pill riders during the full committee markup--prohibiting VA
from implementing its Interim Final Rule on abortion,
prohibiting VA from flying Pride flags at its facilities,
prohibiting VA from providing hormone therapy or surgical
treatment for gender affirming care, further prohibitions on
Diversity, Equity, and Inclusion training or implementation,
and prohibiting the discrimination against people who believe
marriage is between a man and a woman. These riders only
further politicize this bill, and takes away from the focus on
veterans, servicemembers, and their families.
This subcommittee has a long-standing tradition of
bipartisanship, and we will work in good faith with our
colleagues as we proceed through the appropriations process
with the hope of restoring bipartisan priorities in this bill.
By working together, we can best address the needs of our
Nation's military and its veterans and reach an agreement on
the Military Construction, Veterans Affairs, and Related
Agencies bill for FY 2024.

Rosa DeLauro.
Debbie Wasserman Schultz.