[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3516 Introduced in House (IH)]

113th CONGRESS
  1st Session
                                H. R. 3516

To improve health care furnished by the Department of Veterans Affairs 
and the Department of Defense by increasing access to complementary and 
 alternative medicine and other approaches to wellness and preventive 
                     care, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           November 15, 2013

Mr. Ryan of Ohio (for himself, Mr. Nugent, and Mr. Ruiz) introduced the 
   following bill; which was referred to the Committee on Veterans' 
  Affairs, and in addition to the Committee on Armed Services, for a 
 period to be subsequently determined by the Speaker, in each case for 
consideration of such provisions as fall within the jurisdiction of the 
                          committee concerned

_______________________________________________________________________

                                 A BILL


 
To improve health care furnished by the Department of Veterans Affairs 
and the Department of Defense by increasing access to complementary and 
 alternative medicine and other approaches to wellness and preventive 
                     care, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Veterans and Armed Forces Health 
Promotion Act of 2013''.

SEC. 2. DEPARTMENT OF VETERANS AFFAIRS AND DEPARTMENT OF DEFENSE 
              EXPANSION OF RESEARCH AND EDUCATION INTO INTEGRATION OF 
              COMPLEMENTARY AND ALTERNATIVE MEDICINE INTERVENTIONS.

    (a) Development and Implementation of Expansion Plan.--Not later 
than 270 days after the date of the enactment of this Act, the 
Secretary of Veterans Affairs and the Secretary of Defense shall 
jointly develop and implement a plan to expand materially and 
substantially the scope of research and education on, and delivery of 
holistic care that includes, the integration of appropriate 
complementary and alternative medicine interventions in the delivery of 
health care to veterans under chapter 17 of title 38, United States 
Code, and members of the Armed Forces at military medical treatment 
facilities under title 10, United States Code. Such plan shall provide 
for--
            (1) the conduct of research on--
                    (A) integrating proven or promising complementary 
                and alternative medicine interventions into the 
                delivery of health care to veterans and members of the 
                Armed Forces; and
                    (B) models and systems for providing holistic care 
                that includes complementary and alternative medicine 
                interventions;
            (2) education and training for health care professionals 
        on--
                    (A) proven and promising complementary and 
                alternative medicine interventions;
                    (B) appropriate uses of such interventions 
                therapeutic options; and
                    (C) holistic integration of such interventions into 
                the delivery of health care to veterans;
            (3) carrying out the research, education, and clinical 
        activities described in paragraphs (1) and (2) at centers of 
        innovation at geographically dispersed medical centers operated 
        jointly by the Secretary of Veterans Affairs and the Secretary 
        of Defense; and
            (4) the development of joint metrics and outcome measures 
        to evaluate the provision (and cost effectiveness) of 
        complementary and alternative medicine interventions in the 
        care of patients of both the Department of Veterans Affairs and 
        the Department of Defense.
    (b) Consultation With Experts.--
            (1) Consultation required.--For the purposes described in 
        paragraph (2), the Secretary of Veterans Affairs and the 
        Secretary of Defense shall consult with the following:
                    (A) The Director of the Center on Complementary and 
                Alternative Medicine at the National Institute of 
                Health.
                    (B) The Director of the Food and Drug 
                Administration.
                    (C) Academic centers, private research institutes, 
                and individual researchers that have extensive 
                experience in studying complementary and alternative 
                medicine and the integration of such interventions in 
                the delivery of conventional medical care.
                    (D) Nationally recognized providers of 
                complementary and alternative medicine.
                    (E) Such other sources of expertise as the 
                Secretary deems appropriate.
            (2) Purpose of consultation.--The Secretary of Veterans 
        Affairs and the Secretary of Defense shall undertake the 
        consultation described in paragraph (1)--
                    (A) in developing the plan required under 
                subsection (a);
                    (B) to identify specific proven or promising 
                complementary and alternative medicine interventions 
                that, on the basis of research findings or promising 
                clinical interventions, are appropriate to include as 
                covered services under section 3; and
                    (C) to identify barriers to the effective provision 
                and integration of complementary and alternative 
                medicine interventions (and means of circumventing such 
                barriers).
    (c) Funding.--None of the amounts authorized to be appropriated to 
carry out this section may be obligated or expended except for a joint 
effort of the Department of Defense and the Department of Veterans 
Affairs.

SEC. 3. MEDICAL TREATMENT AND RESEARCH FACILITIES JOINTLY OPERATED BY 
              THE DEPARTMENT OF VETERANS AFFAIRS AND THE DEPARTMENT OF 
              DEFENSE.

    (a) Pilot Program Required.--Commencing not later than 270 days 
after the date of the enactment of this Act, the Secretary of Veterans 
Affairs and the Secretary of Defense shall jointly develop and 
implement a plan to establish jointly-operated medical treatment and 
research facilities. Such facilities shall--
            (1) be staffed by employees of the Department of Veterans 
        Affairs and the Department of Defense and members of the Armed 
        Forces;
            (2) be operated by dividing the operation and maintenance 
        expenses between both the Department of Veterans Affairs and 
        the Department of Defense by a ratio determined in a memorandum 
        of understanding between the Secretaries; and
            (3) bill to each Department the cost of certain specialty 
        medical services, including radiology, laboratory, and surgery, 
        as such services are used.
    (b) Duration of Program.--The pilot program shall be carried out 
during the three-year period beginning on the date of the commencement 
of the pilot program.
    (c) Locations.--
            (1) In general.--The Secretaries shall carry out the pilot 
        program by establishing not fewer than 5 joint medical 
        treatment and research facilities.
            (2) Considerations.--In selecting locations for the pilot 
        program, the Secretaries shall consider the feasibility and 
        advisability of selecting locations--
                    (A) in areas with a high concentration of veterans 
                and members of the Armed Forces;
                    (B) that present a reasonable probability of cost 
                savings to the taxpayer by consolidation of services 
                and facilities currently administered separately as 
                determined jointly by the Secretaries; and
                    (C) where collaboration of research and treatment 
                will be most beneficial to the common needs of the 
                patients under the care of both Departments, as 
                determined jointly by the Secretaries.
    (d) Funding.--None of the amounts authorized to be appropriated to 
carry out this section may be obligated or expended except for a joint 
effort of the Department of Defense and the Department of Veterans 
Affairs.

SEC. 4. PILOT PROGRAM ON ESTABLISHMENT OF COMPLEMENTARY AND ALTERNATIVE 
              MEDICINE CENTERS WITHIN DEPARTMENT OF VETERANS AFFAIRS 
              MEDICAL CENTERS.

    (a) Pilot Program Required.--Commencing not later than 180 days 
after the date of the enactment of this Act, the Secretary of Veterans 
Affairs shall carry out, through the Office of Patient Centered Care 
and Cultural Transformation of the Department of Veterans Affairs, a 
pilot program to assess the feasibility and advisability of 
establishing complementary and alternative medicine centers within 
Department of Veterans Affairs medical centers to promote the use and 
integration of complementary and alternative medicine services for 
mental health diagnoses and pain management.
    (b) Duration of Program.--The pilot program shall be carried out 
during the three-year period beginning on the date of the commencement 
of the pilot program.
    (c) Locations.--
            (1) In general.--The Secretary shall carry out the pilot 
        program by establishing not fewer than 10 complementary and 
        alternative medicine centers in 10 separate Department medical 
        centers as follows:
                    (A) Three Department medical centers designated by 
                the Secretary as polytrauma centers.
                    (B) Seven Department medical centers not designated 
                by Secretary as polytrauma centers.
            (2) Considerations.--In selecting locations for the pilot 
        program, the Secretary shall consider the feasibility and 
        advisability of selecting locations in--
                    (A) rural areas;
                    (B) areas that are not in close proximity to an 
                active duty military installation; and
                    (C) areas representing different geographic 
                locations, such as census tracts established by the 
                Bureau of the Census.
    (d) Provision of Services.--Under the pilot program, the Secretary 
shall provide covered services to covered patients through the 
complementary and alternative medicine centers established under 
subsection (c)(1).
    (e) Covered Patients.--For purposes of the pilot program, a covered 
patient is any patient who is a veteran or member of the Armed Forces 
who has--
            (1) a mental health condition diagnosed by a clinician of 
        the Department of Veterans Affairs, in the case of a patient 
        who is a veteran, or a clinician of the Department of Defense, 
        in the case of a patient who is a member of the Armed Forces; 
        or
            (2) a pain condition for which the veteran has received a 
        pain management plan from a clinician of the Department of 
        Veterans Affairs, in the case of a patient who is a veteran, or 
        a clinician of the Department of Defense, in the case of a 
        patient who is a member of the Armed Forces.
    (f) Covered Services.--
            (1) In general.--For purposes of the pilot program, covered 
        services are services consisting of complementary or 
        alternative medicine.
            (2) Administration of services.--Covered services shall be 
        administered under the pilot program as follows:
                    (A) Covered services shall be administered by 
                clinicians who exclusively provide services consisting 
                of complementary or alternative medicine.
                    (B) Covered services shall be included as part of 
                the Patient Aligned Care Teams initiative of the Office 
                of Patient Care Services, Primary Care Program Office.
                    (C) Covered services shall be made available to 
                both--
                            (i) covered patients with mental health 
                        conditions or pain conditions described in 
                        subsection (e) who have received traditional 
                        treatments from the Department for such 
                        conditions; and
                            (ii) covered patients with mental health 
                        conditions or pain conditions described in 
                        subsection (e) who have not received 
                        traditional treatments from the Department for 
                        such conditions.
    (g) Voluntary Participation.--The participation of a patient in the 
pilot program shall be at the election of the patient and in 
consultation with a clinician of the Department of Veterans Affairs, in 
the case of a patient who is a veteran, and in consultation with a 
clinician of the Department of Defense, in the case of a patient who is 
member of the Armed Forces.
    (h) Reports to Congress.--
            (1) Quarterly reports.--Not later than 90 days after the 
        date of the commencement of the pilot program and not less 
        frequently than once every 90 days thereafter for the duration 
        of the pilot program, the Secretary shall submit to the 
        Committee on Veterans' Affairs of the Senate and the Committee 
        on Veterans' Affairs of the House of Representatives a report 
        on the efforts of the Secretary to carry out the pilot program, 
        including a description of the outreach conducted by the 
        Secretary to veterans and community organizations to inform 
        such organizations about the pilot program.
            (2) Final report.--
                    (A) In general.--Not later than 180 days after the 
                completion of the pilot program, the Secretary shall 
                submit to the Committee on Veterans' Affairs of the 
                Senate and the Committee on Veterans' Affairs of the 
                House of Representatives a report on the pilot program.
                    (B) Contents.--The report submitted under 
                subparagraph (A) shall include the following:
                            (i) The findings and conclusions of the 
                        Secretary with respect to the pilot program, 
                        including with respect to the utilization and 
                        efficacy of the complementary and alternative 
                        medicine centers established under the pilot 
                        program.
                            (ii) Such recommendations for the 
                        continuation or expansion of the pilot program 
                        as the Secretary considers appropriate.
    (i) Funding.--There is authorized to be appropriated to the 
Secretary such sums as may be necessary to carry out this section.

SEC. 5. PILOT PROGRAM ON USE OF WELLNESS PROGRAMS AS COMPLEMENTARY 
              APPROACH TO MENTAL HEALTH CARE FOR VETERANS AND FAMILY 
              MEMBERS OF VETERANS.

    (a) Pilot Program Required.--
            (1) In general.--The Secretary of Veterans Affairs shall 
        carry out a pilot program through the award of grants to public 
        or private nonprofit entities to assess the feasibility and 
        advisability of using wellness programs to complement the 
        provision of mental health care to veterans and family members 
        eligible for counseling under section 1712A(a)(1)(C) of title 
        38, United States Code.
            (2) Matters to be addressed.--The pilot program shall be 
        carried out so as to assess the following:
                    (A) Means of improving coordination between 
                Federal, State, local, and community providers of 
                health care in the provision of mental health care to 
                veterans and family members described in paragraph (1).
                    (B) Means of enhancing outreach, and coordination 
                of outreach, by and among providers of health care 
                referred to in subparagraph (A) on the mental health 
                care services available to veterans and family members 
                described in paragraph (1).
                    (C) Means of using wellness programs of providers 
                of health care referred to in subparagraph (A) as 
                complements to the provision by the Department of 
                Veterans Affairs of mental health care to veterans and 
                family members described in paragraph (1).
                    (D) Whether wellness programs described in 
                subparagraph (C) are effective in enhancing the quality 
                of life and well-being of veterans and family members 
                described in paragraph (1).
                    (E) Whether wellness programs described in 
                subparagraph (C) are effective in increasing the 
                adherence of veterans described in paragraph (1) to the 
                primary mental health services provided such veterans 
                by the Department.
                    (F) Whether wellness programs described in 
                subparagraph (C) have an impact on the sense of 
                wellbeing of veterans described in paragraph (1) who 
                receive primary mental health services from the 
                Department.
                    (G) Whether wellness programs described in 
                subparagraph (C) are effective in encouraging veterans 
                receiving health care from the Department to adopt a 
                more healthy lifestyle.
    (b) Duration.--The Secretary shall carry out the pilot program for 
a period of three years beginning on the date that is 90 days after the 
date of the enactment of this Act.
    (c) Locations.--The Secretary shall carry out the pilot program at 
facilities of the Department providing mental health care services to 
veterans and family members described in subsection (a)(1).
    (d) Grant Proposals.--
            (1) In general.--A public or private nonprofit entity 
        seeking the award of a grant under this section shall submit an 
        application therefor to the Secretary in such form and in such 
        manner as the Secretary may require.
            (2) Application contents.--Each application submitted under 
        paragraph (1) shall include the following:
                    (A) A plan to coordinate activities under the pilot 
                program, to the extent possible, with the Federal, 
                State, and local providers of services for veterans to 
                enhance the following:
                            (i) Awareness by veterans of benefits and 
                        health care services provided by the 
                        Department.
                            (ii) Outreach efforts to increase the use 
                        by veterans of services provided by the 
                        Department.
                            (iii) Educational efforts to inform 
                        veterans of the benefits of a healthy and 
                        active lifestyle.
                    (B) A statement of understanding from the entity 
                submitting the application that, if selected, such 
                entity will be required to report to the Secretary 
                periodically on standardized data and other performance 
                data necessary to evaluate individual outcomes and to 
                facilitate evaluations among entities participating in 
                the pilot program.
                    (C) Other requirements that the Secretary may 
                prescribe.
    (e) Grant Uses.--
            (1) In general.--A public or private nonprofit entity 
        awarded a grant under this section shall use the award for 
        purposes prescribed by the Secretary.
            (2) Eligible veterans and family.--In carrying out the 
        purposes prescribed by the Secretary in paragraph (1), a public 
        or private nonprofit entity awarded a grant under this section 
        shall use the award to furnish services only to individuals 
        specified in section 1712A(a)(1)(C) of title 38, United States 
        Code.
    (f) Reports.--
            (1) Periodic reports.--
                    (A) In general.--Not later than 180 days after the 
                date of the enactment of this Act, and every 180 days 
                thereafter, the Secretary shall submit to Congress a 
                report on the pilot program.
                    (B) Report elements.--Each report required by 
                subparagraph (A) shall include the following:
                            (i) The findings and conclusions of the 
                        Secretary with respect to the pilot program 
                        during the 180-day period preceding the report.
                            (ii) An assessment of the benefits of the 
                        pilot program to veterans and their family 
                        members during the 180-day period preceding the 
                        report.
            (2) Final report.--Not later than 180 days after the end of 
        the pilot program, the Secretary shall submit to Congress a 
        report detailing the recommendations of the Secretary as to the 
        advisability of continuing or expanding the pilot program.
    (g) Wellness Defined.--In this section, the term ``wellness'' shall 
have the meaning given that term in regulations prescribed by the 
Secretary.
    (h) Funding.--There is authorized to be appropriated to the 
Secretary such sums as may be necessary to carry out this section.

SEC. 6. PILOT PROGRAM ON FITNESS AND NUTRITION IMPROVEMENT FOR 
              OVERWEIGHT AND OBESE VETERANS.

    (a) Pilot Program Required.--Commencing not later than 180 days 
after the date of the enactment of this Act, the Secretary of Veterans 
Affairs shall, through the National Center for Preventive Health, carry 
out a pilot program to assess the feasibility and advisability of 
promoting health in covered veterans, including achieving a healthy 
weight and reducing risks of chronic disease, through support for 
fitness center membership.
    (b) Covered Veterans.--For purposes of this section, a covered 
veteran is any veteran who--
            (1) is determined by a clinician of the Department of 
        Veterans Affairs to be overweight or obese as of the date of 
        the commencement of the pilot program; and
            (2) resides in a location that is more than 15 miles from a 
        fitness center at a facility of the Department that would 
        otherwise be available to the veteran for at least eight hours 
        per day during five or more days per week.
    (c) Duration of Pilot Program.--The pilot program shall be carried 
out during the three-year period beginning on the date of the 
commencement of the pilot program.
    (d) Locations.--
            (1) In general.--In carrying out the pilot program, the 
        Secretary shall select--
                    (A) not less than five medical centers of the 
                Department at which the Secretary shall cover the full 
                reasonable cost of a fitness center membership for 
                covered veterans within the catchment area of such 
                centers;
                    (B) not less than five medical centers of the 
                Department at which the Secretary shall cover half the 
                reasonable cost of a fitness center membership for 
                covered veterans within the catchment area of such 
                centers; and
                    (C) not less than five medical centers of the 
                Department at which the Secretary shall provide 
                comprehensive medical nutrition therapy for covered 
                veterans.
            (2) Considerations.--In selecting locations for the pilot 
        program, the Secretary shall consider the feasibility and 
        advisability of selecting locations in the following areas:
                    (A) Areas that are not in close proximity to an 
                active duty military installation.
                    (B) Areas in different geographic locations.
    (e) Participation.--
            (1) Maximum number of participants.--The number of covered 
        veterans who may participate in the pilot program at a location 
        selected under subsection (d) may not exceed 100.
            (2) Voluntary participation.--The participation of a 
        covered veteran in the pilot program shall be at the election 
        of the covered veteran in consultation with a clinician of the 
        Department.
    (f) Fitness Center Membership Payment.--
            (1) In general.--Except as provided in paragraph (2), in 
        carrying out the pilot program, the Secretary shall pay the 
        following:
                    (A) The full reasonable cost of a fitness center 
                membership for covered veterans within the catchment 
                area of centers selected under subsection (b)(1)(A) who 
                are participating in the pilot program.
                    (B) Half the reasonable cost of a fitness center 
                membership for covered veterans within the catchment 
                area of centers selected under subsection (b)(1)(B) who 
                are participating in the pilot program.
            (2) Limitation.--Payment for a fitness center membership of 
        a covered veteran may not exceed $50 per month of membership.
    (g) Reports.--
            (1)  Periodic reports.--Not later than 90 days after the 
        date of the commencement of the pilot program and not less 
        frequently than once every 90 days thereafter, the Secretary 
        shall submit to the Committee on Veterans' Affairs of the 
        Senate and the Committee on Veterans' Affairs of the House of 
        Representatives a report on activities carried out to implement 
        the pilot program, including outreach activities to veterans 
        and community organizations.
            (2) Final report.--Not later than 180 days after the date 
        of the completion of the pilot program, the Secretary shall 
        submit to the Committee on Veterans' Affairs of the Senate and 
        the Committee on Veterans' Affairs of the House of 
        Representatives a report on the pilot program detailing--
                    (A) the findings and conclusions of the Secretary 
                as a result of the pilot program; and
                    (B) recommendations for the continuation or 
                expansion of the pilot program.
    (h) Funding.--There is authorized to be appropriated to the 
Secretary such sums as may be necessary to carry out this section.

SEC. 7. PILOT PROGRAM ON TRANSFORMATION OF VETERANS SERVICES 
              ORGANIZATIONS FACILITIES INTO VETERAN HEALTH AND WELLNESS 
              CENTERS.

    (a) Pilot Program Required.--
            (1) In general.--The Secretary of Veterans Affairs shall 
        carry out a pilot program under which the Secretary makes 
        grants to nonprofit veterans services organizations 
        (hereinafter in this section referred to as ``VSOs'') 
        recognized by the Secretary in accordance with section 5902 of 
        title 38, United States Code, to upgrade, through construction 
        and repair, VSO community facilities into health and wellness 
        centers.
            (2) Use of funds.--The recipient of a grant under this 
        section shall use the grant to carry out the repair of a 
        facility owned by the recipient or to construct a facility on 
        property owned by the recipient. Such funds may not be used to 
        purchase real estate or to carry out repair of facilities 
        leased by the recipient or to construct facilities on property 
        leased by the recipient. Any facility repaired or constructed 
        using grant funds shall be used to provide alternative medical 
        care, or wellness programs, to veterans and family members as 
        such term is defined in section 1712A(h)(3) of title 38, United 
        States Code.
            (3) Facility operation.--As a condition of the receipt of a 
        grant under this section, a VSO shall agree to carry out the 
        operation and maintenance of the facility that is repaired or 
        constructed using grant funds for the three-year period 
        beginning on the date of the completion of the repair or 
        construction.
    (b) Duration of Pilot Program.--The pilot program shall be carried 
out during the two-year period beginning on the date of the 
commencement of the pilot program.
    (c) Locations.--In selecting the recipients of grants under this 
section, the Secretary shall ensure that the grant recipients use grant 
funds to construct or repair facilities located in at least ten 
different geographic locations. The Secretary shall give priority to 
locations in economically depressed areas that are not in close 
proximity to Department of Veterans Affairs medical centers.
    (d) Eligibility.--To be eligible to receive a grant under this 
section, a VSO shall submit to the Secretary an application in such 
form and in such manner as the Secretary may require.
    (e) Reports.--
            (1) Periodic reports.--
                    (A) In general.--Not later than 180 days after the 
                date of the enactment of this Act, and every 180 days 
                thereafter for the duration of the pilot program, the 
                Secretary shall submit to Congress a report on the 
                pilot program.
                    (B) Report elements.--Each report required by 
                subparagraph (A) shall include the following:
                            (i) The findings and conclusions of the 
                        Secretary with respect to the pilot program 
                        during the 180-day period covered by the 
                        report.
                            (ii) An assessment of the benefits of the 
                        pilot program to veterans and either family 
                        members during the 180-day period covered by 
                        the report.
            (2) Final report.--Not later than 180 days after the 
        conclusion of the pilot program, the Secretary shall submit to 
        Congress a report detailing the recommendations of the 
        Secretary as to the advisability of continuing or expanding the 
        pilot program.
    (f) Funding.--There is authorized to be appropriated to the 
Secretary such sums as may be necessary to carry out this section.

SEC. 8. DEFINITION OF COMPLEMENTARY AND ALTERNATIVE MEDICINE.

    In this Act, the term ``complementary and alternative medicine'' 
shall--
            (1) have the meaning given that term in regulations the 
        Secretary shall prescribe for purposes of this Act, which 
        shall, to the degree practicable, be consistent with the 
        meaning given such term by the Secretary of Health and Human 
        Services; and
            (2) include integrative health care, adjunctive health 
        care, and functional medicine.
                                 <all>