,i  #aai? ,,congress  #a/ ,session  ,h4 
,r4 #feii  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,decemb] #aj1         
#bjbe,mr4 ,smi? ( ,miss\ri introduc$ !  
foll[+ bill2 :i* 0 ref]r$ to !          
,committee on ,vet]ans' ,affairs  ,a    
,,bill  ,to am5d title #ch1 ,unit$      
,/ates ,code1 to e/abli% an indep5d5t   
au?ority ( ! ,secret>y ( ,vet]ans       
,affairs to ent] into leases = major    
m$ical facilities1 & = o!r purposes4    
#a4 ,%ort title ,?is ,act may be cit$ z 
! ,leas+ & ,infra/ructure ,act ( #bjbe4 
#b4 ,indep5d5t au?ority ( ! ,secret>y ( 
,vet]ans ,affairs to ent] into leases = 
major m$ical facilities2 e/abli%m5t (   
,vet]ans ,leas+ ,fund  7a7 ,indep5d5t   
au?ority ,section #hajc ( title #ch1    
,unit$ ,/ates ,code1 is am5d$ by add+ at
 ! end ! foll[+ new subsections3  7i7   
,indep5d5t leas+ au?ority  7#a7 ,not)/&+
 section #ccjg ( title #dj1 ! ,secret>y 
may ent] into a lease = any major m$ical
 facility 7z def9$ 9 section #hajd ( ?is
 title7 )\t delegation f ! ,adm9i/rator 

( ,g5]al ,s]vices1 if ! prospectus = su*
 a lease has be5-- 7,a7 approv$ by !    
,committees on ,vet]ans' ,affairs ( !   
,h\se ( ,repres5tatives & ! ,s5ate2 &   
7,b7 transmitt$ concurr5tly to-- 7i7 !  
,committee on ,transportation &         
,infra/ructure ( ! ,h\se (              
,repres5tatives2 &  7ii7 ! ,committee on
 ,environm5t & ,public ,works ( !       
,s5ate4  7#b7 7,a7 ,! firm t]m ( a lease
 "u ?is subsection may n exce$ #bj ye>s4
 ,no lease "u ?is subsection may be     
ext5d$ beyond ! firm t]m unless-- 7i7   
su* ext5sion is au?oriz$ 9 ! prospectus2
 or  7ii7 ,congress approves su*        
ext5sion4  7,b7 ,= purposes ( ?is       
p>agraph1 ! t]m firm t]m means !        
initial1 non-cancellable lease p]iod    
approv$ 9 ! prospectus4  7#c7 ,a lease  
"u ?is subsection-- 7,a7 may be execut$ 
only to ! ext5t & 9 ! am\nt provid$ 9   
advance 9 ! ,vet]ans ,leas+ ,fund       
e/abli%$ by subsection 7j72 &  7,b7 %all
 be scor$ & fund$ 9 accordance ) ,(fice 
( ,managem5t & ,budget ,circul> ,a-#aa4 

7#d7 7,a7 ,9 ex]cis+ ! au?ority "u ?is  
subsection1 ! ,secret>y %all1 = ea*     
purpose-built m$ical facility con/ruct$ 
pursuant to a lease aw>d$ "u ?is        
subsection 9 ea* locality1 submit to    
,congress accurate1 m>ket-bas$ co/      
e/imates4 ,su* e/imates %all-- 7i7      
acc\nt = con/ruction co/s1 mat]ial co/s1
 & l& acquisition co/s2 &  7ii7 be in=m$
 by qualifi$ s\rces1 includ+ lic5s$     
apprais]s1 valuation exp]ts1 pr(essional
 e/imat+ firms1 or comm]cial real e/ate 
firms4  7,b7 ,! ,secret>y may also      
reque/ te*nical assi/ance f !           
,adm9i/rator ( ,g5]al ,s]vices ) respect
 to m>ket surveys1 co/ e/imation1 or    
lease scor+4  7,c7 ,if1 at any po9t 9 ! 
procurem5t process 7includ+ dur+ co/    
e/imation1 ! expression ( int]e/ phase1 
or ^u receipt ( pric+ f (f]ors7 project$
 co/s exce$ approv$ e/imates by m ?an t5
 p]c5t1 or exce$ any congressional      
budget au?ority1 ! ,secret>y %all1 n    
lat] ?an #cj days aft] ! date on :i* !  
,secret>y is notifi$ ( su* project$     

co/s1 submit to ! ,committees on        
,vet]ans' ,affairs ( ! ,h\se (          
,repres5tatives & ! ,s5ate1 ! ,committee
 on ,transportation & ,infra/ructure ( !
 ,h\se ( ,repres5tatives1 & ! ,committee
 on ,environm5t & ,public ,works a      
notification t su* project$ co/s exce$  
approv$ e/imates or congressional budget
 au?ority1 z ! case may be4  7j7        
,vet]ans leas+ fund  7#a7 ,!re is       
e/abli%$ 9 ! ,treasury a revolv+ fund to
 be kn[n z ! ,vet]ans ,leas+ ,fund 79   
?is subsection ref]r$ to z ! ,fund74    
7#b7 ,!re %all be deposit$ 9 ! ,fund--  
7,a7 am\nts appropriat$ = ! purpose (   
c>ry+ out ! indep5d5t leas+ au?ority "u 
subsection 7i72 &  7,b7 am\nts          
transf]r$1 on a reimbursable or         
nonreimbursable basis1 f ! ,m$ical      
,facilities acc\nt ( ! ,dep>tm5t 7or any
 successor acc\nt7 = ! paym5t ( annual  
r5t1 taxes1 or op]at+ co/s = leases     
execut$ "u subsection 7i74  7#c7 ,am\nts
 9 ! ,fund are h]eby made available z   
contract au?ority to ent] into          

obligations to c>ry out subsection 7i71 
includ+ obligations 9 advance (         
receipts4  7#d7 ,! ,secret>y may        
obligate am\nts 9 ! ,fund = r5tal       
paym5ts1 t5ant improvem5ts1 real-e/ate  
taxes1 op]at+ exp5ses1 & pre-aw>d due   
dilig5ce co/s1 includ+ design1          
environm5tal1 & pr(essional s]vice fees 
associat$ ) leases ent]$ into pursuant  
to subsection 7i74  7#e7 ,! ,secret>y   
%all include1 9 ! annual budget         
ju/ification mat]ials submitt$ to       
,congress 9 support ( ! ,dep>tm5t-- 7,a7
 ! project$ unobligat$ balance ( !      
,fund2  7,b7 new obligations2 &  7,c7   
collections = ! ye> cov]$ by su* budget 
ju/ification mat]ials & ! f\r fiscal    
ye>s succe$+ su* ye>4  7k7 ,"o-,ye>     
t>get = lease aw>ds2 annual report  7#a7
 ,! ,secret>y %all1 to ! maximum ext5t  
practicable1 aw>d a lease = a major     
m$ical facility n lat] ?an n lat] ?an ! 
end ( ! "o ye> p]iod beg9n+ on ! date on
 :i* ! ,secret>y issues a solicitation =
 ! lease agreem5t4  7#b7 ,! ,secret>y   

%all revise int]nal guidance1 mile/one  
reviews1 & approval workfl[s to-- 7,a7  
support ! requirem5t "u p>agraph 7#a72 &
  7,b7 elim9ate duplicative or sequ5tial
 reviews t delay procurem5t4  7#c7 ,a   
contract+ (fic] may n issue a           
solicitation describ$ 9 p>agraph 7#a7   
unless1 be=e ! date ( issuance1 ! (fic] 
has plac$ 9 ! (ficial contract file a   
writt5 c]tification t-- 7,a7 suffici5t  
funds are obligat$ to cov] all due      
dilig5ce & pre-aw>d pr(essional s]vices 
reasonably anticipat$ = ! project1      
includ+ environm5tal1 geote*nical1      
title1 survey1 appraisal1 brok]age1 &   
ar*itectural-eng9e]+ s]vices2 &  7,b7   
ea* su* s]vice is available = task-ord] 
issuance )9 #cj days "u an exi/+        
indef9ite-deliv]y1 indef9ite-quantity   
contract or o!r competitively-aw>d$     
vehicle4  7#d7 ,obligations "u p>agraph 
7#c7 may be made f ! ,vet]ans ,leas+    
,fund e/abli%$ 9 subsection 7j7 or f o!r
 appropriations = m$ical facilities t   
are available = ! applicable fiscal ye>4

  7#e7 7,a7 ,z "p ( ! public notice dur+
 ! expression ( int]e/ phase ( !        
acquisition process1 ! ,secret>y %all   
require ea* prospective develop] to     
provide price e/imates1 includ+ ! co/ ( 
l&1 to enable ! ,dep>tm5t to evaluate   
:e!r project$ co/s are at or bel[ !     
uns]vic$ %ell r5t au?oriz$ 9 ! approv$  
prospectus4  7,b7 7i7 ,if su* e/imates  
exce$ su* am\nt au?oriz$1 ! ,secret>y   
%all1 n lat] ?an #ad days aft] ! date on
 :i* ! ,secret>y completes su*          
evaluation1 submit to ,congress a       
notification t su* e/imates exce$ su*   
au?oriz$ am\nt4  7ii7 ,n lat] ?an #de   
days aft] ! date on :i* ! ,secret>y     
submits ! notification "u clause 7i71 ! 
,dep>tm5t %all f9alize a plan to address
 ! discrepancy betwe5 su* e/imates & su*
 au?oriz$ am\nt1 :i* may include-- 7,i7 
r$uc+ ! scope ( ! project2  7,,ii7      
reque/+ additional budget au?ority2 or  
7,,iii7 po/pon+1 or cancel+ ! project1 z
 appropriate4  7,c7 ,to ! maximum ext5t 
practicable1 ! ,secret>y %all1 n lat]   

?an #fj days aft] ! date on :i* !       
,secret>y submits ! notification "u     
subp>agraph 7,b71 notify prospective    
(f]ors ( ! pot5tial effect to procurem5t
 timel9es1 includ+ ! e/imat$ release    
date ( ! reque/ = lease proposals4  7#f7
 ,! ,secret>y %all include1 9 any reque/
 = a lease proposal made pursuant to !  
leas+ au?ority "u subsection 7i7-- 7,a7 
a summ>y ( ! procurem5t mile/ones       
applicable to su* reque/2 &  7,b7 a     
/atem5t t a reimbursem5t "u p>agraph    
7#g7 w\ld become effective on ! date t  
is "o ye> aft] ! date on :i* ! ,secret>y
 issu$ su* reque/4  7#g7 7,a7 ,if !     
,secret>y does n aw>d a lease pursuant  
to a reque/ = a lease proposal be=e !   
date t is "o ye> aft] ! date on :i* !   
,secret>y issu$ su* reque/1 ! ,secret>y 
%all be requir$ to reimburse ea*        
prospective lessor 9 ! competitive range
 = co/s directly associat$ ) ! delay 9  
aw>d+ ! lease4  7,b7 ,any reimbursem5t  
"u subp>agraph 7,a7 %all be calculat$   
bas$ on "o p]c5t annually 7paid 9 equal 

mon?ly in/allm5ts ( "o-twelf? ( "o      
p]c5t7 ( ! av]age l& acquisition co/1 z 
propos$ by all (f]ors rema9+ 9 !        
competitive range "u ! reque/4  7,c7    
,paym5t ( su* reimbursem5ts "u ?is      
p>agraph %all cease-- 7i7 imm$iately ^u 
! aw>d ( ! lease2 or  7ii7 ! date on :i*
 ! project is cancell$1 if applicable4  
7,d7 ,! ,secret>y %all issue guidance   
e/abli%+ docum5tation requirem5ts &     
proc$ures = adm9i/]+ reimbursem5ts "u   
?is p>agraph4  7#h7 ,n lat] ?an ,m>* #a 
( ea* ye>1 ! ,secret>y %all submit to ! 
,committees on ,vet]ans' ,affairs ( !   
,h\se ( ,repres5tatives & ! ,s5ate a    
report t includes-- 7,a7 a li/ ( ea*    
major m$ical facility lease = :i* a     
reque/ 0 issu$ dur+ ! prec$+ cal5d> ye>2
  7,b7 a /atem5t ( :e!r ! lease 0 aw>d$ 
)9 ! "o ye> p]iod describ$ 9 p>agraph   
7#a72 &  7,c7 = any lease n aw>d$ )9 su*
 p]iod1 an explanation ( ! reasons !    
lease 0 n aw>d$ dur+ su* p]iod4  7#i7 ,n
 lat] ?an #ij days aft] ! date ( !      
enactm5t ( ?is subsection1 ! ,secret>y  

%all issue int]nal guidance t e/abli%es 
! policies & ?re%olds ! ,secret>y       
det]m9es necess>y to adm9i/] !          
requirem5ts ( ?is subsection4  7l7      
,revisions ,to design guides  7#a7 ,n   
lat] ?an #ahj days aft] ! date (        
enactm5t ( ?is subsection1 & n less     
frequ5tly ?an once e five ye>s !reaft]1 
! ,secret>y %all revise ! design guides 
( ! ,dep>tm5t applicable to outpati5t   
cl9ics & o!r leas$ m$ical facilities4   
7#b7 ,9 c>ry+ out p>agraph 7#a71 !      
,secret>y %all consult ) subject matt]  
exp]ts1 includ+ heal? c>e pr(essionals &
 repres5tatives ( ! private heal? c>e   
indu/ry4  7#c7 ,any revision to design  
guides conduct$ pursuant to ?is section 
%all n be ov]-eng9e]$ or unnecess>ily   
prescriptive specifications unless      
requir$ = cl9ical safety1 functional    
p]=mance1 or applicable build+ codes4   
7m7 ,mitigation ( risk premiums  7#a7 ,!
 ,secret>y may include 9 a lease        
agreem5t "u ?is *apt] t]ms t mitigate   
risk premiums to ! ,dep>tm5t1 includ+-- 

7,a7 po/-occupancy self-insurance       
arrangem5ts by ! ,dep>tm5t2  7,b7       
reimbursem5t to a prospective lessor =  
reasonable hold+ co/s incurr$ z a result
 ( delays attributable to ! ,dep>tm5t 9 
excess ( e/abli%$ procurem5t mile/ones2 
7,c7 au?orization to /ructure major     
m$ical facility leases z triple-net     
leases 7,,nnn7 or modifi$-gross leases1 
z appropriate1 to align ) prevail+      
comm]cial m>ket practices2 &  7,d7      
def9itions ( ! t]ms %ell "w & t5ant     
improvem5ts to ensure co/ allocation is 
consi/5t ) prevail+ comm]cial m>ket     
/&>ds4  7#b7 ,n lat] ?an #ahj days aft] 
! date ( enactm5t ( ?is subsection1 !   
,secret>y %all issue guidance ) respect 
to ! use ( su* t]ms 9 lease agreem5ts "u
 ?is *apt]4 ,9 su* guidance1 ! ,secret>y
 %all ensure-- 7,a7 heat+1 v5tilation1 &
 air condition+ sy/em capacity is       
includ$ 9 ! def9ition ( %ell "w2 &  7,b7
 heat+1 v5tilation1 & air condition+    
di/ribution & controls requir$ to meet  
t5ant-specific ne$s are includ$ 9 !     

def9ition ( t5ant improvem5ts1 unless   
o!rwise negotiat$4  7#c7 ,= purposes (  
?is subsection1 ! t]m triple-net lease  
means a lease "u :i* ! lessee is        
responsible = paym5t ( real e/ate taxes1
 insurance1 utilities1 janitorial       
s]vices1 & r\t9e op]at+ co/s4  7n7      
,consolidation ( docum5tation ,!        
,secret>y %all consolidate int]nal      
docum5tation requir$ to support lease   
decisions "u ?is *apt] into a s+le      
decision memor&um1 to ! maximum ext5t   
practicable4 ,su* memor&um %all include 
project ju/ification1 site selection    
rationale1 e/imat$ co/s1 design summ>y1 
& o!r in=mation necess>y = int]nal      
approval & submission to ,congress4  4  
7b7 ,con=m+ am5dm5t ,section            
#hajd7;a77#c77;,b77i7 ( title #ch1      
,unit$ ,/ates ,code1 is am5d$ by /rik+  
?r\gh ! ,g5]al ,s]vices ,adm9i/ration "u
 section #ccjg7;a7 ( title #dj4  7c7    
,au?orization ( appropriations  7#a7 ,9 
g5]al ,!re are au?oriz$ to be           
appropriat$ to ! ,vet]ans ,leas+ ,fund  

e/abli%$ "u section #hajc ( title #ch1  
,unit$ ,/ates ,code1 7z am5d$ by ?is    
,act71 su* am\nts z may be specifically 
au?oriz$ = lease obligations "u         
subsection 7i7 ( su* section 7z add$ by 
?is ,act74  7#b7 ,deposit ( future      
appropriations ,any am\nts appropriat$ =
 lease obligations = a fiscal ye> %all  
be deposit$ 9 ! ,vet]ans ,leas+ ,fund4  
#c4 ,co/ e/imation requirem5ts = major  
m$ical facility leases ,section         
#hajd7;b77#b7 ( su* title is am5d$--    
7#a7 by /rik+ ,:5ev] & ins]t+ 7,a7      
,:5ev]2  7#b7 by r$esignat+ subp>agraphs
 7,a7 ?r\gh 7,e7 z clauses 7i7 ?r\gh    
7v71 respectively2  7#c7 9 subp>agraph  
7,a71 z designat$ by p>agraph 7#a7--    
7,a7 9 clause 7v71 z s r$esignat$-- 7i7 
by r$esignat+ clauses 7i7 ?r\gh 7iii7 z 
subclauses 7,i7 ?r\gh 7,,iii71          
respectively2 &  7ii7 by /rik+ ! p]iod  
at ! end & ins]t+ 2 &2 &  7,b7 by add+  
at ! end ! foll[+ new clause3  7vi7 ,a  
m>ket-bas$ co/ e/imate = ! facility to  
be leas$ t includes an evaluation (--   

7,i7 local l& values2  7,,ii7 applicable
 con/ruction co/s2 &  7,,iii7 o!r co/   
factors ! ,secret>y det]m9es relevant to
 build-to-suit facilities4  2 &  7#d7 by
 add+ at ! end ! foll[+ new subp>agraph3
  7,b7 7i7 ,! ,secret>y %all adopt &    
apply a /&>diz$ me?odology = e/imat+ !  
full life-cycle co/ ( major m$ical      
facility leases & prospectus-level      
leases4  7ii7 ,su* me?odology %all      
include1 at a m9imum-- 7,i7 base r5t    
projections ov] ! full lease t]m2       
7,,ii7 t5ant improvem5t & build\t co/s  
bas$ on curr5t m$ical facility /&>ds2   
7,,iii7 e/imat$ op]at+ exp5ses1 includ+ 
utilities1 ma9t5ance1 & security2       
7,,iv7 annual escalation factors ti$ to 
con/ruction co/ indices1 labor rates1 & 
m>ket tr5ds2  7,v7 co/ assumptions =    
option p]iods or pot5tial r5ewal t]ms2 &
  7,,vi7 geographic adju/m5ts us+ curr5t
 regional m>ket data to reflect         
location-specific con/ruction & leas+   
conditions4  7iii7 ,to reflect inflation
 & m>ket escalation1 ! ,secret>y %all   

annually adju/ ea* co/ e/imate = a lease
 submitt$ to ,congress = au?orization or
 prospectus approval dur+ ! p]iod beg9n+
 on ! date on :i* ! ,secret>y submits ! 
fir/ co/ e/imate = ! lease & end+ on !  
project$ aw>d date = ! lease4 ,9 adju/+ 
a co/ e/imate pursuant to ?is           
subp>agraph1 ! ,secret>y %all use su*   
m$ical con/ruction or real e/ate indices
 z ! ,secret>y det]m9es appropriate4    
7iv7 ,if ! ,secret>y does n aw>d a lease
 dur+ ! "o ye> p]iod beg9n+ on ! date on
 :i* ! ,secret>y completes a co/ e/imate
 = ! lease pursuant to ?is p>agraph1 !  
,secret>y %all update & revalidate su*  
co/ e/imate prior to obligat+ any funds 
= ! lease or submitt+ su* co/ e/imate to
 ,congress4  4  #d4 ,developm5t (       
/reaml9$ procurem5t model2 report ,n    
lat] ?an #ahj days aft] ! date (        
enactm5t ( ?is ,act1 ! ,secret>y (      
,vet]ans ,affairs1 9 consultation ) !   
,comptroll] ,g5]al ( ! ,unit$ ,/ates1 ! 
,director ( ! ,(fice ( ,managem5t &     
,budget1 & private sector /akehold]s1   

%all develop a revis$ process = !       
procurem5t ( major m$ical facility      
leases "u *apt] #ha ( title #ch1 ,unit$ 
,/ates ,code1 & submit to ! ,committees 
on ,vet]ans' ,affairs ( ! ,h\se (       
,repres5tatives & ! ,s5ate a report t   
includes a description ( su* revis$     
process4