[DOCID: f:hr648.110]
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110th Congress Report
HOUSE OF REPRESENTATIVES
2d Session 110-648
======================================================================
DEPARTMENT OF VETERANS AFFAIRS MEDICAL FACILITY AUTHORIZATION AND LEASE
ACT OF 2008
_______
May 15, 2008.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Filner, from the Committee on Veterans' Affairs, submitted the
following
R E P O R T
[To accompany H.R. 5856]
[Including cost estimate of the Congressional Budget Office]
The Committee on Veterans' Affairs, to whom was referred the
bill (H.R. 5856) to authorize major medical facility projects
and major medical facility leases for the Department of
Veterans Affairs for fiscal year 2009, and for other purposes,
having considered the same, report favorably thereon without
amendment and recommend that the bill do pass.
CONTENTS
Page
Purpose and Summary.............................................. 2
Background and Discussion........................................ 3
Hearings......................................................... 9
Committee Consideration.......................................... 9
Committee Votes.................................................. 9
Committee Oversight Findings..................................... 9
Statement of General Performance Goals and Objectives............ 9
New Budget Authority, Entitlement Authority, and Tax Expenditures 10
Earmarks and Tax and Tariff Benefits............................. 10
Committee Cost Estimate.......................................... 10
Congressional Budget Office Estimate............................. 10
Federal Mandates Statement....................................... 12
Advisory Committee Statement..................................... 12
Constitutional Authority Statement............................... 12
Applicability to Legislative Branch.............................. 13
Section-by-Section Analysis of the Legislation................... 13
Changes in Existing Law Made by the Bill as Reported............. 15
Purpose and Summary
H.R. 5856 was introduced by Representative Michael H.
Michaud of Maine, the Chairman of the Subcommittee on Health,
on April 22, 2008. This legislation would authorize major
construction projects and medical facility leases for the
Department of Veterans Affairs for fiscal year 2009. This bill
would expand and improve the health care delivery to veterans
throughout the VA health care system. It would also provide for
state-of-the-art facilities and address current gaps in
services.
H.R. 5856 would:
1. Authorize appropriations for:
<bullet> Seismic corrections to building 2 at the VAMC in
Palo Alto, California in the amount of $54 million.
<bullet> Construction of a polytrauma health care and
rehabilitation center at the VAMC in San Antonio, Texas, in the
amount of $66 million.
<bullet> Seismic correction to building 1, at the VAMC in
San Juan, Puerto Rico, in the amount of $225,900 million.
2. Increase authorization amounts for previously authorized
construction projects:
<bullet> Increases the authorization level for the New
Orleans VAMC replacement facility to $625,000,000.
<bullet> Increases the authorization level for the Denver
VAMC, replacement medical facility to $769,200,000.
<bullet> Increases the authorization for the correction of
patient privacy issues at the Gainesville, Florida VAMC to
$136,700,000.
<bullet> Increases the authorization for the construction
of a new medical facility in Las Vegas, Nevada to $600,400,000.
<bullet> Increases the authorization for the construction
of a new outpatient clinic in Lee County, Florida to
$131,800,000 million.
<bullet> Increases the authorization for the construction
of a new medical facility in Orlando, Florida to $656,800,000.
<bullet> Increases the authorization for the consolidation
of campuses at the University Drive and H. John Heinz III
Divisions to $295,600,000.
3. Authorize the Secretary of Veterans Affair to carry out
major medical facility leases in the following twelve
locations:
<bullet> Brandon, Florida outpatient clinic in the amount
of $4,326,000.
<bullet> Colorado Springs, Colorado outpatient clinic in
the amount of $3,995,000.
<bullet> Eugene, Oregon outpatient clinic in the amount of
$5,826,000.
<bullet> Greenville, South Carolina outpatient clinic in
the amount of $3,731,000.
<bullet> Mansfield, Ohio outpatient clinic in the amount of
$2,212,000.
<bullet> Mayaguez, Puerto Rico outpatient clinic in the
amount of $6,276,000.
<bullet> Mesa, Arizona outpatient clinic in the amount of
$5,106,000.
<bullet> Sun City, Arizona outpatient clinic in the amount
of $2,295,000.
<bullet> Expansion of an outpatient clinic in Green Bay,
Wisconsin, in the amount of $5,891,000.
<bullet> Expansion of an outpatient clinic in Savannah,
Georgia in the amount of $3,168,000.
<bullet> Interim research space in Palo Alto, California in
the amount of $8,636,000.
<bullet> Primary care annex in Tampa, Florida in the amount
of $8,652,000.
4. Authorize the Secretary of Veterans Affairs to construct
a new medical facility in Okaloosa County, Florida, in an
amount not to exceed $54,475,000.
5. Authorize $345,900,000 to be appropriated for Major
Medical Facility Projects for Fiscal Year 2009.
6. Authorize $1,694,295,000 to be appropriated for
modifications of major medical facility authorizations for FY
2009 and modifications for certain major medical facility
construction projects previously authorized in connection with
the Capital Asset Realignment for Enhanced Services (CARES).
7. Authorize $54,475,000 to be appropriated for the
construction of a major medical facility in section 5.
8. Require the Secretary to submit a report on the progress
in complying with Section 312A of 38 U.S.C. Section 312A
governs the establishment and responsibilities of the Director
of Construction and Facilities Management which was a position
established in P.L. 109-461.
9. Require Secretary to submit an annual report on
outpatient clinics.
Background and Discussion
VA's medical infrastructure is old and outdated. The
average age of a VA facility is over 50 years old. With the
enactment of eligibility reform in 1996, VA's health care
delivery model has undergone a transformation from inpatient-
centered care to one of outpatient-centered care. The Capital
Asset Realignment for Enhanced Services (CARES) process
initiated in 1998 by VA created a blueprint for the future
construction needs of the Department. CARES is a comprehensive
assessment for identifying the demand for VA care and
projecting future appropriate models of delivery of health care
to veterans throughout the VA's system of health care.
Section 8104(a)(2) of title 38, United States Code,
requires statutory authorization for all major medical facility
construction projects (defined as those which cost more than
$10 million) and all major medical facility leases exceeding
$600,000 (including parking facilities) prior to the
appropriation or expenditure of funds.
MAJOR MEDICAL FACILITY AUTHORIZATIONS
H.R. 5856 provides authorization for 11 major medical
facility projects and 12 major medical facility leases.
Palo Alto, California: The Palo Alto project received $34
million in fiscal year 2005 and an additional $20 million in
fiscal year 2008 budget authority to complete construction,
with a total estimated cost of $54 million. This project would
replace an obsolete, functionally deficient and seismically
unsafe acute psychiatric inpatient building by constructing an
80-bed, 78,000 square-foot replacement facility at VA Palo Alto
Heath Care System's Palo Alto Division. After completion of the
80-bed acute psychiatric inpatient replacement facility,
Building 2 would be decommissioned and razed, with the land
being converted to patient parking.
San Antonio, Texas: The San Antonio project received the
total estimated cost of $66 million in a reprogramming action
in fiscal year 2008 to complete design and construction. This
project would provide a new 84,000 state-of-the-art Polytrauma
Healthcare and Rehabilitation Center. The Center would consist
of a polytrauma ward, transitional housing, Physical Medicine
and Rehabilitation Service, Prosthetics Service, and polytrauma
research and support programs. Additionally, spaces vacated by
programs moving to the new center would be renovated and
parking deficiencies addressed.
San Juan, Puerto Rico: The San Juan project received $14.88
million in fiscal year 2005, which was reduced by $4 million in
a reprogramming action in fiscal year 2006, and received $59
million in fiscal year 2008. This project requires an
additional $64.4 million in fiscal year 2009 budget authority
to construct the administrative building, with a total
estimated cost of approximately $225.9 million. This project
would complete the seismic corrections in the main hospital
building to comply with occupancy standards. The second phase
of approximately 100,000 square feet of new construction would
house administrative functions to meet VA's immediate occupancy
standards.
Okaloosa County, Florida: Okaloosa County, Florida, is home
to one of the largest veteran populations in the nation, yet
veterans have to drive over three hours to receive VA inpatient
care. The area is located in the Eastern Southern Market of
Veterans Integrated Service Network 16, which the CARES
decision identified as ``the only market in the VISN without a
medical center and it. . . is underserved for inpatient care.
The CARES decision further stated that ``[t]he VISN also will
continue to pursue opportunities to expand its current sharing
with Eglin Air Force Base (AFB) to enhance inpatient care
services.''
As of April 2008, veterans in this area were only able to
receive outpatient care at a VA community-based outpatient
clinic located at Eglin AFB in Okaloosa County. On November 1,
2007, Major General David W. Eidsaune, Commander, Air Armament
Center, Eglin AFB, Florida, testified before the Subcommittee
on Health of the Committee on Veterans' Affairs that the VA and
the Department of Defense (DoD) have developed a successful
partnership to provide accessible health care in northwest
Florida.
Based on the CARES recommendations and the existing
cooperative VA/DoD history, section 823 of Public Law 109-461
required that the Secretary of VA conduct a study in
conjunction with the Secretary of DoD and the Secretary of the
Air Force to develop options for the VA on the placement of a
VA Medical Center in Okaloosa County, Florida. Completed in
June 2007, the study identified three options for providing
inpatient care in Okaloosa County, Florida. Implementing Option
2 was identified as the most feasible of the three options.
Option 2 would expand the outpatient specialty care space at
Eglin AFB Hospital through Federal construction, and would
establish a VA/DoD sharing agreement with Eglin AFB Hospital to
provide medical and surgical acute inpatient services to
veterans, and expand specialty outpatient care.
INCREASES IN PRIOR YEAR AUTHORIZATIONS
Authorizations for appropriations were increased for
projects authorized in Public Law 109-461, the ``Veterans
Benefits, Health Care, and Information Technology Act of
2006.'' VA has reported that these projects have increased in
cost and new authorization levels must be obtained to move
forward with the projects. There are six projects that have
increased in cost and require increased authorizations: New
Orleans VA Medical Center (VAMC); Denver VAMC; Gainesville,
Florida, VAMC; new medical facility in Las Vegas; new
outpatient clinic in Lee County, Florida; and new medical
facility in Orlando, Florida.
Denver, Colorado: H.R. 5856 would provide VA an
authorization in the amount not to exceed $769,200,000 for the
replacement of the Denver, Colorado, VAMC. This authorization
was requested by the Administration in February in the fiscal
year 2009 budget submission. However, on April 24, 2008, the
Secretary of Veterans Affairs announced his decision to change
the scope of the project. VA now intends to construct a new bed
tower in partnership with the University of Colorado Denver and
the University of Colorado Hospital (UCH) on University
property at the former Fitzsimons Army Medical Center campus.
The Committee strongly supports the Secretary's decision to
once again move forward with a joint use facility. We recognize
that it may be necessary to amend the authorization as planning
and design for a new shared facility is developed.
There has been a long and detailed history of planning for
a shared facility to replace the existing Denver VAMC.
Discussions between VA and UCH regarding the relocation of the
Denver VAMC to the Fitzsimons campus started in 2000. In 2003,
Congress enacted Public Law 108-170, the ``Veterans Health
Care, Capital Asset, and Business Improvement Act of 2003.''
The law authorized advance planning in an amount not to exceed
$30 million for the contemplated joint use facility.
Additionally, Public Law 108-422, the ``Veterans Health
Programs Improvement Act of 2004,'' authorized VA to enter into
a long-term lease of up to 75 years at UCH. This authority was
necessary for VA to acquire a sufficient land interest for the
construction of a shared facility on the Fitzsimons Campus.
Following enactment of the law, to the disappointment of the
Committee, VA gave notice of its intention not to enter into a
lease and instead purchase land on a separate site at the
Fitzsimons campus for a freestanding VA medical center. On
March 29, 2007, VA acquired 17.8 acres of land that is now
intended to be used for a state-of-the-art VA Ambulatory Health
Care Center, parking garage and administrative offices.
However, the Committee remains concerned that the new plan
for Denver does not reflect the authorization included in this
bill. We expect VA to provide the Committee with a detailed
prospectus and briefing on the announced changes for the major
medical facility project in Denver.
LEASE AUTHORIZATIONS
Twelve leases require authorization for FY 2009: Brandon,
Florida; Colorado Springs, Colorado; Eugene, Oregon;
Greenville, South Carolina; Mansfield, Ohio; Mayaguez, Puerto
Rico; Mesa, Arizona; Sun City, Arizona; Expansion of an
outpatient clinic in Green Bay, Wisconsin; Expansion of an
outpatient clinic in Savannah, Georgia; Interim research space
in Palo Alto, California; and primary care annex in Tampa,
Florida.
Brandon, Florida: The bill would authorize a 50,000 square
foot multi-specialty clinic lease in Brandon, Florida, that
would affect 10,425 unique veterans. Because of the rapidly
expanding population growth, lack of public transportation, and
inadequate highway infrastructure, the Brandon Clinic would
significantly improve access to veterans in Southeastern
Hillsborough County. The lease is fully authorized in the
measure for $4,326,000.
Colorado Springs, Colorado: The existing Colorado Springs
Community Based Outpatient Clinic (CBOC) lease expires on
August 31, 2010. The project would relocate and expand the
current clinic into approximately 47,000 square feet of
outpatient clinic space. This project would allow the VA to
continue to provide timely access to state-of-the-art primary
care, specialty care, and mental health services for veterans
in the area. The lease is fully authorized in the measure for
$3,995,000.
Eugene, Oregon: The existing Eugene CBOC lease expires in
2012. This lease would relocate and expand the current clinic
into approximately 66,000 square feet of outpatient clinic
space. The lease is fully authorized in this measure for
$5,826,000.
Greenville, South Carolina: The lease in Greenville, South
Carolina would relocate and expand the current clinic to
approximately 45,900 square feet of new outpatient clinic space
due to the expiration of the current lease. This expansion
would address the access and capacity issues for primary care
and specialty care services that currently exist. The lease is
fully authorized in this measure for $3,731,000.
Mansfield, Ohio: The lease in Mansfield, Ohio would
construct a new Mansfield CBOC to augment existing services
provided and add new services to the more than 5,800 unique
veterans served. The new clinic would be approximately 27,500
square feet and would eliminate the physical separation between
primary care and mental health services that currently exists.
The lease is fully authorized in this measure for $2,212,000.
Mayaguez, Puerto Rico: The current leased clinic space has
significant infrastructure deficiencies that would be very
costly to repair. Under a new lease contract, the Mayaguez
clinic would continue to provide the same services to its
veteran service area in a structure that measures approximately
70,100 square feet. The lease is fully authorized in this
measure for $6,276,000.
Southeast Mesa, Arizona: The lease for the existing
Southeast Mesa, Arizona CBOC expires on December 30, 2011. This
lease would relocate and expand the current 42,500 square foot
clinic into approximately 60,000 square feet of outpatient
clinic space. The lease is fully authorized in this measure for
$5,106,000.
Sun City, Arizona: The existing Sun City, Arizona Northwest
Extension Clinic lease expires on April 30, 2009. This project
would relocate and expand the current 8,916 square feet clinic
into approximately 25,000 square feet of outpatient clinic
space. This project would allow the VA to continue to provide
timely access to state-of-the-art primary care clinics,
specialty care clinics, mental health and ancillary diagnostic
services in a properly sized clinic to meet increased workload.
Dental care would be introduced as a new service offered after
relocation into the larger space. The lease is fully authorized
in this measure for $2,295,000.
Green Bay, Wisconsin: The lease authorization in Green Bay,
Wisconsin, would provide authority to construct an Ambulatory
Surgery/Outpatient Diagnostic Center and CBOC for the North and
Central submarket of VISN 12. The current clinic has reached
its physical capacity and the expansion is needed to meet the
needs of more than 1,500 patients currently on temporary fee
authorization, and to provide closer access for nearly 4,000
patients from this catchment area currently being seen at the
Appleton and Cleveland CBOC. Additional space would be
necessary to support the ancillary services needed to provide
appropriate services to these patients including laboratory,
radiology, mental health, social work and home based primary
care. The lease is fully authorized in the measure for
$5,891,000.
Savannah, Georgia: The Savannah, Georgia, CBOC is a long
established facility serving southeastern Georgia and the
southern tip of South Carolina. This lease would maintain the
clinic presence in the Savannah area while increasing the net
usable space from 34,760 square feet to 38,900 square feet.
This facility would provide access to primary care, mental
health services, specialty care, diagnostic services and home-
based health care for area veterans and the Fort Stewart and
Fort Hunter Army Airfield communities. The lease is fully
authorized in this measure for $3,168,000.
Palo Alto, California: The Palo Alto lease authorization
would authorize the lease of up to 100,000 square feet of wet
and dry bench research laboratory facilities in the San
Francisco Bay area to house approximately 300 VA researchers
and other miscellaneous programs displaced due to major and
minor construction projects. The lease is fully authorized in
this measure for $8,636,000.
Tampa, Florida: The proposed lease in Tampa, Florida would
move all Primary Care services to a 100,000 square foot off-
site location within close proximity of the parent campus. This
relocation would have the primary benefit of decompressing the
parent facility so that Specialty Clinics can be expanded. The
lease is fully authorized in this measure for $8,652,000.
OTHER MATTERS
Far South Texas: Veterans in far South Texas face an
excessive travel burden to obtain inpatient care at the San
Antonio VA Medical Center. Round trip travel time from
Harlingen is about ten hours and from Corpus Christi, about
five hours. Public Law 108-170 required VA to develop a plan
for meeting the future hospital care needs of veterans who
reside in this region. On April 30, 2004, VA submitted a report
to Congress with a plan consistent with the CARES Decision. The
plan included an expansion of services in Harlingen, Corpus
Christi, and the McAllen Clinic.
In August 2007, Booz Allen Hamilton released a report on
veteran health care needs in South Texas that was requested by
Senator Kay Bailey Hutchison of Texas. The Booz Allen Hamilton
report included options for expanding VA health care services
in the Harlingen and Corpus Christi areas.
As recommended, the Committee supports expanding services
at the McAllen Clinic, Corpus Christi, and Harlingen.
VA is moving forward with an expansion of services in
Harlingen that would be comprehensive in terms of providing
medical care and reduce the rate of travel to San Antonio VAMC
by about at least 90 percent. VA is implementing a plan in
collaboration with the University of Texas Regional Academic
Health Center, to provide a full spectrum of services in
Harlingen with a lease-build out over the next three years. The
Committee expects the new facility to be named the ``Far South
Texas VA Medical Care Center.''
Additionally, the Committee expects that the current Deputy
Director position that has been established for far South Texas
will be transitioned to the title of Health Care System
Director, Coastal Bend/Lower Rio Grande Valley/Laredo Health
Care System starting in fiscal year 2010. This Director will
report directly to the VA Heart of Texas Health Care Network
Director.
We remain committed to ensuring that VA fully funds, and
remains focused on, an aggressive plan to maximize local access
to care for veterans in far South Texas.
Guam: The Committee is concerned about the future provision
of health care services for veterans residing in Guam and the
Pacific Islands that make up the Compact of Free Association.
VA and DoD currently have a memorandum of understanding
(MOU) to provide inpatient and specialty care for veteran
beneficiaries on a space available basis. The MOU is set to
expire on December 31, 2010. Additionally, DoD is anticipating
the relocation of 8,000 to 12,000 Marines from Okinawa to Guam
by 2014 that would nearly double the total patient population
served by the U.S. Naval Hospital Guam. To meet the increased
demand, the Navy will replace the existing facility. Several
sites are being considered. The Secretary of the Navy informed
the Committee that a site location decision will be made by May
31, 2008. The Committee strongly recommends that the new Naval
Hospital be built at the current location. Further, to ensure
continued access to the Naval Hospital by veterans, we
recommend that VA and DoD enter into a joint agreement whereby
veterans are guaranteed access to inpatient and specialty
services at U.S Naval Hospital Guam.
Fort Ord, California: The Committee is aware there is a VA
feasibility study underway to determine the need for a CBOC in
the Ord Military Community. We strongly encourage the
completion of this study as expeditiously as possible and look
forward to the results and recommendations that will address
future health care needs for veterans in the area.
Northeast Iowa: The Committee is concerned that the
Veterans Integrated Service Network 23 has identified rural
Northeast Iowa as an underserved area. Veterans in Northeastern
Iowa do not meet the VA access standard of having VA primary
care community based outpatient clinic located within 30
minutes of 70 percent of veterans living in the area. The VA is
now conducting a more comprehensive analysis to determine what
strategies might improve delivery of VA health care services in
the area. The study is expected to be completed by June 30,
2008. We encourage VA to have a strategy in place that will
meet the access to care needs of veterans residing in Northeast
Iowa in fiscal year 2010. This may include community-based
outpatient or outreach clinics, telemedicine, or contract care
with existing local medical facilities.
Hearings
On February 27, 2008, the Subcommittee on Health held a
hearing entitled ``U.S. Department of Veterans Affairs
Construction Authorization.'' The following witnesses
testified: Mr. Dennis M. Cullinan, Director, National
Legislative Service, Veterans of Foreign Wars of the United
States, On Behalf of The Independent Budget; Mr. Joseph L.
Wilson, Deputy Director, Veterans Affairs and Rehabilitation
Commission, The American Legion; Mr. Richard F. Weidman,
Executive Director for Policy and Government Affairs, Vietnam
Veterans of America; and Mr. Donald H. Orndoff, Director,
Office of Construction and Facilities Management, U.S.
Department of Veterans Affairs, accompanied by Mr. Robert L.
Neary, Director, Service Delivery Office, U.S. Department of
Veterans Affairs; Mr. James M. Sullivan, Deputy Director,
Office of Asset Enterprise Management, Office of Management,
U.S. Department of Veterans Affairs; and, Mr. Joseph Williams,
Assistant Deputy Under Secretary for Health for Operations and
Management, Veterans Health Administration, U.S. Department of
Veterans Affairs.
Committee Consideration
On April 23, 2008, the Subcommittee on Health met in open
markup session and ordered favorably forwarded to the full
Committee H.R. 5856, without amendment, by voice vote.
On April 30, 2008, the full Committee met in open markup
session, a quorum being present, and ordered H.R. 5856
favorably reported to the House of Representatives, by voice
vote.
Committee Votes
Clause 3(b) of rule XIII of the Rules of the House of
Representatives requires the Committee to list the record votes
on the motion to report the legislation and amendments thereto.
There were no record votes taken on amendments or in connection
with ordering H.R. 5856 reported to the House. A motion by Mr.
Buyer of Indiana to order H.R. 5856 reported favorably to the
House of Representatives was agreed to by voice vote.
Committee Oversight Findings
In compliance with clause 3(c)(1) of rule XIII and clause
(2)(b)(1) of rule X of the Rules of the House of
Representatives, the Committee's oversight findings and
recommendations are reflected in the descriptive portions of
this report.
Statement of General Performance Goals and Objectives
In accordance with clause 3(c)(4) of rule XIII of the Rules
of the House of Representatives, the Committee's performance
goals and objectives are reflected in the descriptive portions
of this report.
New Budget Authority, Entitlement Authority, and Tax Expenditures
In compliance with clause 3(c)(2) of rule XIII of the Rules
of the House of Representatives, the Committee adopts as its
own the estimate of new budget authority, entitlement
authority, or tax expenditures or revenues contained in the
cost estimate prepared by the Director of the Congressional
Budget Office pursuant to section 402 of the Congressional
Budget Act of 1974.
Earmarks and Tax and Tariff Benefits
H.R. 5856 contains the following congressional earmark,
limited tax benefit, or limited tariff benefit as defined in
clause 9(d), 9(e), or 9(f) of rule XXI of the Rules of the
House of Representatives:
1. Authorization for the VA to construct a new medical
facility in Okaloosa County, Florida, in an amount not to
exceed $54,455,000, offered by Representative Jeff Miller of
Florida, Ranking Member of the Subcommittee on Health of the
Committee on Veterans' Affairs.
Committee Cost Estimate
The Committee adopts as its own the cost estimate on H.R.
5856 prepared by the Director of the Congressional Budget
Office pursuant to section 402 of the Congressional Budget Act
of 1974.
Congressional Budget Office Cost Estimate
Pursuant to clause 3(c)(3) of rule XIII of the Rules of the
House of Representatives, the following is the cost estimate
for H.R. 5856 provided by the Congressional Budget Office
pursuant to section 402 of the Congressional Budget Act of
1974:
U.S. Congress,
Congressional Budget Office,
Washington, DC, May 12, 2008.
Hon. Bob Filner,
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 5856, the
Department of Veterans Affairs Medical Facility Authorization
and Lease Act of 2008.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Sunita
D'Monte.
Sincerely,
Robert A. Sunshine
(For Peter R. Orszag, Director).
Enclosure.
H.R. 5856--Department of Veterans Affairs Medical Facility
Authorization and Lease Act of 2008
Summary: H.R. 5856 would authorize funding for the
construction, renovation, improvement, or leasing of several
medical facilities by the Department of Veterans Affairs (VA).
The bill would specifically authorize the appropriation of $2.1
billion in 2009 for 11 projects, and $60 million for leasing 12
clinics or other facilities. CBO estimates that implementing
H.R. 5856 would cost $146 million in 2009 and about $2.2
billion over the 2009-2013 period, assuming appropriation of
the authorized and estimated amounts. CBO estimates that
enacting the bill would have no effect on direct spending or
revenues.
H.R. 5856 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act (UMRA)
and would not affect the budgets of state, local, or tribal
governments.
Estimated cost to the Federal Government: The estimated
budgetary impact of H.R. 5856 is shown in the following table.
The costs of this legislation fall within budget function 700
(veterans benefits and services).
----------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
-----------------------------------------------------
2008 2009 2010 2011 2012 2013
----------------------------------------------------------------------------------------------------------------
SPENDING SUBJECT TO APPROPRIATION
Spending Under Current Law for Major Construction of
Veterans Medical Facilities:
Budget Authority\1\................................... 1,135 0 0 0 0 0
Estimated Outlays..................................... 525 680 572 343 119 33
Proposed Changes:
Major Medical Facility Projects:
Authorization Level............................... 0 2,095 0 0 0 0
Estimated Outlays................................. 0 92 563 681 503 191
Leases for Medical Facilities:
Estimated Authorization Level..................... 0 60 22 22 22 22
Estimated Outlays................................. 0 54 25 22 22 22
Total Changes:
Estimated Authorization Level................. 0 2,155 22 22 22 22
Estimated Outlays............................. 0 146 589 702 524 212
Spending Under H.R. 5856:
Estimated Authorization Level\1\...................... 1,135 2,155 22 22 22 22
Estimated Outlays..................................... 525 826 1,161 1,045 643 245
----------------------------------------------------------------------------------------------------------------
\1\The 2008 level is the amount appropriated for that year.
Basis of estimate: For this estimate, CBO assumes that the
legislation will be enacted before the end of fiscal year 2008,
that the authorized and estimated amounts will be appropriated
near the start of each fiscal year, and that outlays will
follow historical spending patterns for similar programs.
H.R. 5856 would authorize appropriations for major
construction and leasing of medical facilities by VA. It also
would require VA to prepare reports addressing specific
construction issues. CBO estimates that implementing H.R. 5856
would cost about $2.2 billion over the 2009-2013 period,
assuming appropriation of the necessary amounts.
Major medical facility projects
Sections 2, 3, and 5 would authorize work on a number of
medical facility projects. CBO estimates that implementing
those three sections would cost $2 billion over the 2009-2013
period, assuming appropriation of the authorized amounts.
Section 3 would authorize the appropriation of about $1.7
billion in 2009 for additional funding for construction,
renovation, repairs, and upgrades to seven major projects that
were previously authorized under Public Law 109-461.
Section 2 would authorize the appropriation of $346 million
in 2009 for three new construction projects including a
polytrauma center in San Antonio, Texas, and seismic
corrections to facilities in Palo Alto, California, and San
Juan, Puerto Rico.
Section 5 would authorize the appropriation of $55 million
in 2009 to construct a new medical facility in Okaloosa County,
Florida.
Leases for medical facilities
Section 4 would authorize the Secretary of VA to lease
facilities for 10 outpatient clinics, a primary care annex, and
a research laboratory. The bill would authorize the
appropriation of $60 million in 2009 for lease payments for the
first year. Based on information from VA's 2009 budget request,
CBO estimates that VA would enter into 20-year lease agreements
for those facilities, and that VA would have additional costs
of about $22 million a year starting in 2010. (Costs are higher
in 2009 than other years because VA would pay the lessors
additional amounts in the first year of the lease for necessary
improvements and upgrades.) Thus, CBO estimates that
implementing this section would cost $145 million over the
2009-2013 period, assuming appropriation of the necessary
amounts.
Other provisions
Section 7 would require VA to prepare a report on its
progress in appointing a Director of Construction and
Facilities Management. Section 8 would require VA to prepare an
annual report on outpatient clinics. CBO estimates that
implementing those provisions would have an insignificant
impact on discretionary spending.
Intergovernmental and private-sector impact: H.R. 5856
contains no intergovernmental or private-sector mandates as
defined in UMRA and would not affect the budgets of state,
local, or tribal governments.
Estimate prepared by: Federal costs: Sunita D'Monte; Impact
on state, local, and tribal governments: Lisa Ramirez-Branum;
Impact on the private sector: Daniel Frisk.
Estimate approved by: Theresa Gullo, Deputy Assistant
Director for Budget Analysis.
Federal Mandates Statement
The Committee adopts as its own the estimate of Federal
mandates regarding H.R. 5856 prepared by the Director of the
Congressional Budget Office pursuant to section 423 of the
Unfunded Mandates Reform Act.
Advisory Committee Statement
No advisory committees within the meaning of section 5(b)
of the Federal Advisory Committee Act would be created by H.R.
5856.
Constitutional Authority Statement
Pursuant to clause 3(d)(1) of rule XIII of the Rules of the
House of Representatives, the Committee finds that the
Constitutional authority for H.R. 5856 is provided by Article
I, section 8 of the Constitution of the United States.
Applicability to Legislative Branch
The Committee finds that the legislation does not relate to
the terms and conditions of employment or access to public
services or accommodations within the meaning of section
102(b)(3) of the Congressional Accountability Act.
Section-by-Section Analysis of the Legislation
Section 1. Short title
This Act may be cited as the ``Department of Veterans
Affairs Medical Facility Authorization and Lease Act of 2008.''
Section 2. Authorization for fiscal year 2009 major medical facility
projects. The authorization total for this section is $345,900
million
This section authorizes appropriations for:
<bullet> Seismic corrections to building 2 at the VAMC in
Palo Alto, California in the amount of $54 million.
<bullet> Construction of a polytrauma healthcare and
rehabilitation center at the VAMC in San Antonio, Texas in the
amount of $66 million.
<bullet> Seismic correction to building 1, at the VAMC in
San Juan, Puerto Rico in the amount of $225,900 million.
Section 3. Modification of authorization amounts for certain major
medical facility construction projects previously authorized.
The authorization total for this section is $1,694,295,000
This section increases previously authorized construction
projects that were included in Public Law 109-461 and since
that time have increased in cost:
<bullet> Raises the authorization level for the New Orleans
VAMC replacement facility to $625 million. An increase of $325
million.
<bullet> Raises the authorization level for the Denver VAMC
replacement medical facility to $769,200 million. An increase
of $671,200 million.
<bullet> Raises the authorization for the correction of
patient privacy issues at the Gainesville, Florida VAMC to
$136,700 million. An increase of $51,500 million.
<bullet> Raises the authorization for the construction of a
new medical facility in Las Vegas, Nevada to $600,400 million.
An increase of $194,400 million.
<bullet> Raises the authorization for the construction of a
new outpatient clinic in Lee County, Florida to $131,800
million. An increase of $66,700 million.
<bullet> Raises the authorization for the construction of a
new medical facility in Orlando, Florida to $656,800. An
increase of $279,100 million.
<bullet> Raises the authorization for the consolidation of
campuses at the University Drive and H. John Heinz III
Divisions to $295,600 million. An increase of $106,395 million.
Section 4. Authorization of fiscal year 2009 major medical facility
leases. The total for this section is $60,114 million
This section authorizes the Secretary of Veterans Affairs
to carry out major medical facility leases in twelve locations.
The following eight leases are for outpatient clinics:
<bullet> Brandon, Florida, in the amount of $4,326 million.
<bullet> Colorado Springs, Colorado, in the amount of
$3,995 million.
<bullet> Eugene, Oregon, in the amount of $5,826 million.
<bullet> Greenville, South Carolina, in the amount of
$3,731 million.
<bullet> Mansfield, Ohio, $2,212 million.
<bullet> Mayaguez, Puerto Rico, $6,276 million.
<bullet> Mesa, Arizona, $5,106 million.
<bullet> Sun City, Arizona, in the amount of $2,295
million.
The other four leases are requested for:
<bullet> Expansion of an outpatient clinic in Green Bay,
Wisconsin, in the amount of $5,891 million.
<bullet> Expansion of an outpatient clinic in Savannah,
Georgia, $3,168 million.
<bullet> Interim research space in Palo Alto, California in
the amount of $8,636 million.
<bullet> Primary care annex in Tampa, Florida, $8,652
million.
Section 5. Authorization of construction of major medical facility,
Okaloosa County, Florida
This section authorizes the Secretary of Veterans Affairs
to construct a new medical facility in Okaloosa County, Florida
in an amount not to exceed $54,475 million.
Section 6. Authorization of appropriation
For Major Medical Facility Projects for fiscal year 2009,
this section authorizes to be appropriated an amount of
$345,900 million.
For modifications of major medical facility authorizations
for fiscal year 2009 and modifications for certain major
medical facility construction projects previously authorized in
connection with the Capital Asset Realignment for Enhanced
Services this section authorizes to be appropriated an amount
of $1,694,295,000.
For the construction of a major medical facility in section
5 in the amount of $54,475 million.
Section 7. Facilities administration
This section requires the Secretary to submit a report on
the progress in complying with section 312A of 38 U.S.C. 312A
governs the establishment and responsibilities of the Director
of Construction and Facilities Management which was a position
established in P.L. 109-461.
Section 8. Annual report on outpatient clinics
This section requires VA to submit an annual report on
outpatient clinics.
Section 9. Technical correction
This section makes a technical correction to P.L. 109-461.
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italic, existing law in which no change is
proposed is shown in roman):
VETERANS BENEFITS, HEALTH CARE, AND INFORMATION TECHNOLOGY ACT OF 2006
* * * * * * *
TITLE VIII--CONSTRUCTION MATTERS
Subtitle A--Construction and Lease Authorities
SEC. 801. AUTHORIZATION OF FISCAL YEAR 2006 MAJOR MEDICAL FACILITY
PROJECTS.
(a) In General.--The Secretary of Veterans Affairs may carry
out the following major medical facility projects in fiscal
year 2006, with each project to be carried out in the amount
specified for that project:
(1) Restoration, new construction or replacement of
the medical center facility for the Department of
Veterans Affairs Medical Center, New Orleans,
Louisiana, due to damage from Hurricane Katrina in an
amount not to exceed [$300,000,000] $625,000,000. [The
Secretary is authorized to carry out the project in or
near New Orleans as a collaborative effort consistent
with the New Orleans Collaborative Opportunities Study
Group Report dated June 12, 2006.]
* * * * * * *
(3) Replacement of the Department of Veterans Affairs
Medical Center, Denver, Colorado, in an amount not to
exceed [$98,000,000] $769,200,000.
* * * * * * *
SEC. 802. EXTENSION OF AUTHORIZATION FOR CERTAIN MAJOR MEDICAL FACILITY
CONSTRUCTION PROJECTS PREVIOUSLY AUTHORIZED IN
CONNECTION WITH CAPITAL ASSET REALIGNMENT
INITIATIVE.
The Secretary of Veterans Affairs may carry out the following
major medical facility projects, with each such project to be
carried out in the amount specified for that project:
(1) * * *
* * * * * * *
(5) Correction of patient privacy deficiencies at the
Department of Veterans Affairs Medical Center,
Gainesville, Florida, in an amount not to exceed
[$85,200,000] $136,700,000.
* * * * * * *
(7) Construction of a new Medical Center Facility at
the Department of Veterans Affairs Medical Center, Las
Vegas, Nevada, in an amount not to exceed
[$406,000,000] $600,400,000.
(8) Construction of an [ambulatory surgery/outpatient
diagnostic support center in the Gulf South Submarket
of Veterans Integrated Service Network (VISN) 8 and
completion of Phase I land purchase,] outpatient clinic
in Lee County, Florida, in an amount not to exceed
[$65,100,000] $131,800,000.
* * * * * * *
(11) Construction of a new medical center facility in
the Orlando, Florida, area in an amount not to exceed
[$377,700,000] $656,800,000.
(12) Consolidation of campuses at the University
Drive and H. John Heinz III divisions, Pittsburgh,
Pennsylvania, in an amount not to exceed [$189,205,000]
$295,600,000.
* * * * * * *
SEC. 807. AUTHORIZATION OF APPROPRIATIONS.
(a) * * *
* * * * * * *
(e) Authorization of Appropriations for Major Medical
Facility Leases.--
(1) Fiscal year 2006 leases.--There is authorized to
be appropriated for the Secretary of Veterans Affairs
for fiscal year 2006 for the [Medical Care] Medical
Facilities account, $24,990,000 for the leases
authorized in section 805.
(2) Fiscal year 2007 leases.--There is authorized to
be appropriated for the Secretary of Veterans Affairs
for fiscal year 2007 for the [Medical Care] Medical
Facilities account, $26,642,000 for the leases
authorized in section 806.
* * * * * * *
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TITLE 38, UNITED STATES CODE
* * * * * * *
PART VI--ACQUISITION AND DISPOSITION OF PROPERTY
* * * * * * *
CHAPTER 81--ACQUISITION AND OPERATION OF HOSPITAL AND DOMICILIARY
FACILITIES; PROCUREMENT AND SUPPLY; ENHANCED-USE LEASES OF REAL
PROPERTY
SUBCHAPTER I--ACQUISITION AND OPERATION OF MEDICAL FACILITIES
Sec.
8101. Definitions.
* * * * * * *
8119. Annual report on outpatient clinics.
* * * * * * *
SUBCHAPTER I--ACQUISITION AND OPERATION OF MEDICAL FACILITIES
* * * * * * *
Sec. 8119. Annual report on outpatient clinics
(a) Annual Report Required.--The Secretary of Veterans
Affairs shall submit to the Committees on Veterans' Affairs of
the Senate and House of Representatives an annual report on
community-based outpatient clinics and other outpatient
clinics. The report shall be submitted each year not later than
the date on which the budget for the next fiscal year is
submitted to the Congress under section 1105 of title 31.
(b) Contents of Report.--Each report required under
subsection (a) shall include the following:
(1) A list of each community-based outpatient clinic
and other outpatient clinic of the Department, and for
each such clinic, the type of clinic, location, size,
number of health professionals employed by the clinic,
workload, whether the clinic is leased or constructed
and operated by the Secretary, and the annual cost of
operating the clinic.
(2) A list of community-based outpatient clinics and
other outpatient clinics that the Secretary opened
during the fiscal year preceding the fiscal year during
which the report is submitted and a list of clinics the
Secretary proposes opening during the fiscal year
during which the report is submitted and the subsequent
fiscal year, together with the cost of activating each
such clinic and the information required to be provided
under paragraph (1) for each such clinic and proposed
clinic.
(3) A list of proposed community-based outpatient
clinics and other outpatient clinics that are, as of
the date of the submission of the report, under review
by the National Review Panel and a list of possible
locations for future clinics identified in the
Department's strategic planning process, including any
identified locations in rural and underserved areas.
(4) A prioritized list of sites of care identified by
the Secretary that the Secretary could establish
without carrying out construction or entering into a
lease, including--
(A) any such sites that could be expanded by
hiring additional staff or allocating staff to
Federal facilities or facilities operating in
collaboration with the Federal Government; and
(B) any sites established, or able to be
established, under sections 8111 and 8153 of
this title.
* * * * * * *
<all>