[House Report 108-200]
[From the U.S. Government Publishing Office]
108th Congress Report
HOUSE OF REPRESENTATIVES
1st Session 108-200
======================================================================
NEW FITZSIMONS REGIONAL FEDERAL MEDICAL CENTER ACT OF 2003
_______
July 14, 2003.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Smith of New Jersey, from the Committee on Veterans' Affairs,
submitted the following
R E P O R T
[To accompany H.R. 116]
[Including cost estimate of the Congressional Budget Office]
The Committee on Veterans' Affairs, to whom was referred the
bill (H.R. 116) to authorize the Secretary of Veterans Affairs
to construct, lease or modify major medical facilities at the
site of the former Fitzsimons Army Medical Center, Aurora,
Colorado, having considered the same, reports favorably thereon
with an amendment and recommends that the bill as amended do
pass.
The amendment is as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``New Fitzsimons Regional Federal
Medical Center Act of 2003''.
SEC. 2. AUTHORIZATION OF MAJOR MEDICAL FACILITY PROJECTS, FORMER
FITZSIMONS ARMY MEDICAL CENTER, AURORA, COLORADO.
(a) Authorization.--The Secretary of Veterans Affairs may carry out
major medical facility projects under section 8104 of title 38, United
States Code, at the site of the former Fitzsimons Army Medical Center,
Aurora, Colorado. Projects to be carried out at such site shall be
selected by the Secretary and may include inpatient and outpatient
facilities providing acute, sub-acute, primary, and long-term care
services. Project costs shall be limited to an amount not to exceed a
total of $300,000,000 if a combination of direct construction by the
Department of Veterans Affairs and capital leasing is selected under
subsection (b) and no more than $30,000,000 per year in capital leasing
costs if a leasing option is selected as the sole option under
subsection (b).
(b) Selection of Capital Option.--The Secretary of Veterans shall
select the capital option to carry out the authority provided in
subsection (a) of either--
(1) direct construction by the Department of Veterans Affairs
or a combination of direct construction and capital leasing; or
(2) capital leasing alone.
(c) Consultation With Secretary of Defense.--The Secretary of
Veterans Affairs shall consult with the Secretary of Defense in
carrying out this section. Such consultation shall include
consideration of establishing a Department of Veterans Affairs-
Department of Defense joint health-care venture at the site of the
project or projects under subsection (a).
(d) Authorization of Appropriations.--There is authorized to be
appropriated to the Secretary of Veterans Affairs for fiscal years
2004, 2005, and 2006 for ``Construction, Major Projects'' for the
purposes authorized in subsection (a)--
(1) a total of $300,000,000, if direct construction, or a
combination of direct construction and capital leasing, is
chosen pursuant to subsection (b) for purposes of the projects
authorized in subsection (a); and
(2) $30,000,000 for each such fiscal year, if capital leasing
alone is chosen pursuant to subsection (b) for purposes of the
projects authorized in subsection (a).
(e) Limitation.--The projects authorized in subsection (a) may only
be carried out using--
(1) funds appropriated for fiscal year 2004, 2005, or 2006
pursuant to the authorization of appropriations in subsection
(a);
(2) funds appropriated for Construction, Major Projects, for
a fiscal year before fiscal year 2004 that remain available for
obligation; and
(3) funds appropriated for Construction, Major Projects, for
fiscal year 2004, 2005, or 2006 for a category of activity not
specific to a project.
(f) Report to Congressional Committees.--Not later than 120 days
after the date of the enactment of this Act, the Secretary shall submit
to the Committees on Appropriations and the Committees on Veterans'
Affairs of the Senate and House of Representatives a report on this
section. The report shall include the following:
(1) Notice of the option selected by the Secretary pursuant
to subsection (b) to carry out the authority provided by
subsection (a).
(2) Information on any further planning required to carry out
the authority provided in subsection (a).
(3) Other information of assistance to the committees with
respect to such authority.
Introduction
On January 7, 2003, Honorable Joel Hefley, Honorable Mark
Udall, Honorable Scott McInnis, Honorable Marilyn N. Musgrave,
Honorable Thomas G. Tancredo, Honorable Bob Beauprez, and
Honorable Diana DeGette introduced H.R. 116, the Veterans' New
Fitzsimons Health Care Facilities Act of 2003.
On June 11, 2003, the Subcommittee on Health held a hearing
on several bills, among them H.R. 116, the Veterans' New
Fitzsimons Health Care Facilities Act of 2003. Witnesses who
appeared before the Subcommittee included Ms. Cathleen C.
Wiblemo, Deputy Director, Health Care, Veterans Affairs and
Rehabilitation Division, The American Legion; Mr. Richard
Jones, National Legislative Director, AMVETS; Mr. Adrian M.
Atizado, Associate National Legislative Director, Disabled
American Veterans; Mr. Carl Blake, Associate Legislative
Director, Paralyzed Veterans of America; Mr. Paul A. Hayden,
Deputy Director, National Legislative Service, Veterans of
Foreign Wars; Honorable Robert H. Roswell, M.D., Under
Secretary for Health, Department of Veterans Affairs, who was
accompanied by Mr. D. Mark Catlett, Principal Deputy Assistant
Secretary for Management, and Mr. Robert L. Neary, Jr.,
Associate Chief Facilities Management Officer for Service
Delivery. Written testimonies were received from Honorable Joel
Hefley, Member of Congress from the State of Colorado;
Honorable David L. Hobson, Member of Congress from the State of
Ohio; Honorable Solomon P. Ortiz, Member of Congress from the
State of Texas; and Honorable Deborah Pryce, Member of Congress
from the State of Ohio.
On June 24, 2003, the Subcommittee on Health met and
unanimously ordered H.R. 116, as amended, reported favorably to
the full Committee.
On June 26, 2003, the full Committee met and ordered H.R.
116 reported favorably to the House with an amendment in the
nature of a substitute by unanimous voice vote.
Summary of the Reported Bill
H.R. 116, as amended, would:
1. LAuthorize the Secretary of Veterans Affairs to carry
out a major medical facility project at the site of the former
Fitzsimons Army Medical Center in Aurora, Colorado, in
consultation with the Secretary of Defense.
2. LAllow the Secretary to determine the types of care,
including inpatient, outpatient, acute, sub-acute, primary and/
or long-term care services, and to determine the type of
capital project delivery, whether through construction or a
capital lease arrangement.
3. LRequire the Secretary after consulting with the
Secretary of Defense to select a capital option for carrying
out the authority between direct construction, capital leasing
or a combination of the two.
4. LLimit the amount appropriated for direct construction
to no more than $300,000,000; and limit the amount spent each
year for the capital leasing option to no more than $30,000,000
in annual rental costs.
5. LAuthorize the project to be carried out using a total
appropriation of $300 million, if direct construction or a
combination of direct construction and capital leasing is
chosen by the Secretary; and $30 million for each fiscal year
of a capital lease.
6. LLimit the project authorization to be carried out using
funds appropriated for fiscal year 2004, 2005 and 2006 for the
purposes of providing a new Fitzsimons Health Care Facility;
using available fiscal year 2004 major construction funds; or
using major construction funds appropriated for fiscal year
2004, 2005 or 2006 not specific to a project.
7. LRequire the Secretary to report no later than 120 days
after enactment to the Committees on Veterans' Affairs and on
Appropriations of the Senate and House of Representatives the
option the Secretary chooses to carry out the authority
provided in this bill, and any further planning required or
assistance from the Committees needed to carry out this
project.
Background and Discussion
Since the end of World War II, the Denver Department of
Veterans Affairs (VA) Medical Center and the University of
Colorado have been in partnership to provide care to veterans.
This partnership has included the significant sharing of health
care resources, including physician faculty, house staff,
facilities, equipment, supplies, services, as well as the long-
term shared mission of health-professions education and
biomedical research.
Today, nearly all the physicians caring for veterans at the
Denver VA Medical Center also practice medicine at the
University of Colorado Health Sciences Center and are faculty
members of its medical school. From the inception of their
relationship, the two institutions have shared expensive and
specialized medical equipment and facilities, such as surgical
suites and imaging equipment. For example, veterans under care
at the VA facility who are candidates for organ transplantation
receive those specialized services at the University of
Colorado Hospital by surgical staffs in dual appointment at
both institutions, governed by a sharing agreement between the
two.
Due to the lack of space, inability to renovate or
construct newer facilities and the prohibitive cost associated
with continuing to develop its downtown site, the university
determined in 1995 that the Denver campus was no longer
compatible with its mission. The closure of the Fitzsimons Army
Medical Center in Aurora, Colorado, provided the university an
opportunity to relocate to a new site with over four times the
acreage of the existing campus, and to build a new complex.
To date, the development of the 217-acre Fitzsimons campus
includes an outpatient and cancer pavilion, an eye institute, a
library, and a power plant. Construction is underway on the
first phase of the university hospital, biomedical and cancer
research towers, and the Native American building. Other
development is planned or already programmed.
While the move to Fitzsimons solved existing problems and
provided future advantages for the university, it will be
separated from its sharing partner and health-professions
affiliate, the VA facility. A separation of more than eight
miles would create new barriers and challenges to continued
quality care for veterans who receive their care at the VA.
A study commissioned by the Department concluded health
care demand by Colorado veterans will continue unabated for the
next 20 years. The cost of maintaining the VA facility in its
current location, a medical center that opened in 1955, was
estimated to be over $200 million, and the study estimated
rebuilding the facility in 2020 could cost as much as $377
million in today's dollars.
The basic elements of a relocated VA medical center at
Fitzsimons would include a free-standing inpatient care
hospital building for veterans and Department of Defense (DOD)
beneficiaries, as well as facilities for ambulatory care.
Consolidated and improved VA research facilities could also be
included in this plan, as well as long-term care facilities
coordinated with a new Colorado State veterans home currently
operating on the Fitzsimons campus.
This project could offer vital services to DOD
beneficiaries. The Air Force plans to develop a new military
medical treatment facility at Buckley Air Force Base near
Aurora. A significant population of active duty, reserve and
retiree beneficiaries resides in the Denver area. The Air Force
has initiated a study to determine whether joint location and
construction of health facilities with the VA at the Fitzsimons
site is the best option.
In the report accompanying the House-passed National
Defense Authorization Act for Fiscal Year 2004, H.R. 1588, an
amount of $4 million was included for DOD to contribute to the
design and plan of a new Air Force-VA joint venture health care
facility at the former Fitzsimons Army Medical Center site in
Aurora. Additionally, recognizing the importance of cost
savings and other efficiencies that such a joint venture might
produce, the H.R. 1588 bill report directed DOD and VA to make
every effort to share health care facilities.
The Committee welcomes these developments that could bring
this community of federal beneficiaries a modern
intergovernmental health care resource able to meet their needs
comprehensively, while conserving Federal funds.
The bill was amended to require the Secretary of Veterans
Affairs to consult with the Secretary of Defense, principally
respecting the concerns and needs of the United States Air
Force, in selecting an option to move forward with a new
medical center at the Fitzsimons site. It is the intent of the
Committee that the Secretary of Veterans Affairs, in carrying
out this required consultation, consider the opportunities for
the achievement of the goals restated in Title VII, Subtitle C,
sections 722-725 of the Bob Stump National Defense
Authorization Act for Fiscal Year 2003.
Section by Section Analysis
Section 1 of the bill would name the Act the ``New
Fitzsimons Regional Federal Medical Center Act of 2003''.
Section 2(a) of the bill would provide authority to the
Secretary of Veterans Affairs to carry out major medical
facility projects at the site of the former Fitzsimons Army
Medical Center in Aurora, Colorado; projects chosen by the
Secretary at this site may include inpatient and outpatient
facilities that provide acute, sub-acute, primary, and long-
term care services. The costs of these projects would be
limited to $300,000,000 for new construction, and $30,000,000
in annual rent if the Secretary elected a capital lease option.
Section 2(b) of the bill would require the Secretary to
select from two capital options: (1) direct construction by VA
or a combination of direct construction and capital leasing, or
(2) capital leasing alone to fund the major medical facility
projects at the site of the former Fitzsimons Army Medical
Center in Aurora, Colorado.
Section 2(c) of the bill would require the Secretary to
consult with the Secretary of Defense to consider establishing
a VA-DOD joint health-care venture at the site of the project
or projects at the former Fitzsimons Army Medical Center in
Aurora, Colorado.
Section 2(d) of the bill would authorize funds to be
appropriated to the Secretary for fiscal years 2004, 2005, and
2006 for major construction projects at the site of the former
Fitzsimons Army Medical Center in Aurora, Colorado.
Section 2(d)(1) of the bill would provide $300,000,000 in
funding authorization for major construction projects at the
site of the former Fitzsimons Army Medical Center in Aurora,
Colorado, if the Secretary chooses to fund this construction
through direct construction or a combination of direct
construction and capital leasing.
Section 2(d)(2) of the bill would authorize $30,000,000 for
each fiscal year (2004-2006) for major construction projects at
the site of the former Fitzsimons Army Medical Center in
Aurora, Colorado, if the Secretary chooses to fund this
construction through capital leasing alone.
Section 2(e) of the bill would limit funds used for major
construction projects at the site of the former Fitzsimons Army
Medical Center in Aurora, Colorado, so that the projects may be
completed by using funds: (1) appropriated for fiscal year
2004, 2005, or 2006; (2) appropriated for major construction
projects prior to fiscal year 2004 which are still available;
or (3) appropriated for major construction projects for fiscal
year 2004, 2005, or 2006 for any activity not specified for any
particular project.
Section 2(f) of the bill would require the Secretary to
submit a report to the Committees on Appropriations and
Veterans' Affairs of the Senate and House of Representatives
120 days after enactment of this Act that would include: (1)
the funding option chosen by the Secretary to complete major
construction projects at the site of the former Fitzsimons Army
Medical Center in Aurora, Colorado; (2) information on any
further planning for those projects; and (3) additional
information on those projects which might be of assistance to
the Committees.
Performance Goals and Objectives
The performance goals and objectives of VA programs dealing
with major medical facility construction and the activity of
the Department in sharing health care resources with the
Department of Defense are established in the Department's
annual performance plans and budget formulation processes, and
are subject to the Committee's regular oversight.
Statement of the Views of the Administration
Testimony of Honorable Robert H. Roswell, M.D., Under Secretary for
Health, Health Subcommittee Hearing on H.R. 1720, Veterans Health Care
Facilities Capital Improvement Act; H.R. 116, Veterans' New Fitzsimons
Health Care Facilities Act of 2003; H.R. 2307, to provide for the
establishment of new VA medical facilities for veterans in the area of
Columbus, Ohio, and in south Texas; and H.R. 2349, to authorize certain
major medical facility projects for VA, June 11, 2003
* * * * * * *
VA also supports the intent of H.R. 116, the Veterans' New
Fitzsimmons Health Care Facilities Act of 2003, to authorize the
Secretary to carry out major medical facility projects at the former
Fitzsimons Army Medical Center in Aurora, Colorado. The bill provides
the Secretary flexibility in selecting the projects by providing that
they may include acute, sub-acute, primary, and long-term care
services. H.R. 116 limits project costs to an amount not to exceed
$300,000,000 if a combination of direct construction and capital
leasing is selected and no more that $30,000,000 per year in capital
leasing costs if a leasing option is selected. In addition, the bill
places certain limitations on the fiscal years from which appropriated
funds can come.
We have been involved in evaluating and planning for a facility for
the Fitzsimons site and there is a potential for a joint venture with
DoD to provide health care to both veterans and DoD beneficiaries. Many
issues still remain including the availability of land, but VA would be
able to provide the report to Congress as required if the bill is
enacted.
* * * * * * *
Congressional Budget Office Cost Estimate
The following letter was received from the Congressional
Budget Office concerning the cost of the reported bill:
U.S. Congress,
Congressional Budget Office,
Washington, DC, June 27, 2003
Hon. Christopher H. Smith
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. 116, the New
Fitzsimons Regional Federal Medical Center Act of 2003.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Sam
Papenfuss, who can be reached at 226-2840.
Sincerely,
Douglas Holtz-Eakin,
Director
Enclosure.
Congressional Budget Office Cost Estimate
H.R. 116, New Fitzsimons Regional Federal Medical Center Act of 2003
As ordered reported by the House Committee on Veterans' Affairs on June
26, 2003
H.R. 116 would authorize three different options for the
Department of Veterans Affairs (VA) to carry out major
construction projects at the site of the former Fitzsimons Army
Medical Center in Aurora, Colorado. Under the bill, and at the
discretion of the Secretary of Veterans Affairs, VA could opt
to engage in major construction, engage in major construction
with leasing of some facilities, or forgo major construction in
favor of leasing. If the Secretary chooses either option
entailing major construction, the bill would authorize the
appropriation of $300 million over the 2004-2006 period.
However, if the Secretary chooses to forgo major construction,
the bill would authorize funding of only $90 million over the
same period.
Absent information from VA, CBO assumes that VA would opt
to carry out these projects solely through major construction.
Under that assumption, CBO estimates--as shown in the following
table-that implementing H.R. 116 would cost $13 million in 2004
and $291 million over the 2004-2008 period, assuming
appropriation of the authorized amount.
By Fiscal Year, in Millions of Dollars
--------------------------------------------
2004 2005 2006 2007 2008
----------------------------------------------------------------------------------------------------------------
CHANGES IN SPENDING SUBJECT TO APPROPRIATION
Authorization Level................................................ 300 0 0 0 0
Estimated Outlays.................................................. 13 81 98 72 27
----------------------------------------------------------------------------------------------------------------
If VA were to choose to carry out these projects through
both major construction and some leasing, CBO estimates that
the total costs over the 2004-2008 period would be roughly the
same, but estimated outlays in 2004 would be $23 million
higher. If, on the other hand, VA were to choose to forgo major
construction and lease facilities for only three years, CBO
estimates that costs over the 2004-2006 period would total $90
million. While total costs over the first three years would be
lower under the leasing-only option, that course of action
would only provide services for the three-year period, while
the major construction option would provide services over a
much longer period of time.
H.R. 116 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act and
would not affect the budgets of state, local, or tribal
governments.
The CBO staff contact is Sam Papenfuss, who can be reached
at 226-2840. This estimate was approved by Peter H. Fontaine,
Deputy Assistant Director for Budget Analysis.
Statement of Federal Mandates
The preceding Congressional Budget Office cost estimate
states that the bill contains no intergovernmental or private
sector mandates as defined in the Unfunded Mandates Reform Act.
Statement of Constitutional Authority
Pursuant to Article I, section 8 of the United States
Constitution, the reported bill is authorized by Congress'
power to ``provide for the common Defense and general Welfare
of the United States.''