[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4887 Introduced in House (IH)]

113th CONGRESS
  2d Session
                                H. R. 4887

 To expand the research and education on and delivery of complementary 
     and alternative medicine to veterans, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 18, 2014

  Ms. Brownley of California introduced the following bill; which was 
             referred to the Committee on Veterans' Affairs

_______________________________________________________________________

                                 A BILL


 
 To expand the research and education on and delivery of complementary 
     and alternative medicine to veterans, 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 ``Expanding Care for Veterans Act''.

SEC. 2. EXPANSION OF RESEARCH AND EDUCATION ON AND DELIVERY OF 
              COMPLEMENTARY AND ALTERNATIVE MEDICINE TO VETERANS.

    (a) Development of Plan To Expand Research, Education, and 
Delivery.--Not later than six months after the effective date specified 
in subsection (f), the Secretary of Veterans Affairs shall develop a 
plan to expand materially and substantially the scope of research and 
education on, and delivery and integration of, complementary and 
alternative medicine services into the health care services provided to 
veterans.
    (b) Elements.--The plan required by subsection (a) shall provide 
for the following:
            (1) Research on the following:
                    (A) The comparative effectiveness of various 
                complementary and alternative medicine therapies.
                    (B) Approaches to integrating complementary and 
                alternative medicine services into other health care 
                services provided by the Department.
            (2) Education and training for health care professionals of 
        the Department on the following:
                    (A) Complementary and alternative medicine services 
                selected by the Secretary for purposes of the plan.
                    (B) Appropriate uses of such services.
                    (C) Integration of such services into the delivery 
                of health care to veterans.
            (3) Research, education, and clinical activities on 
        complementary and alternative medicine at centers of innovation 
        at Department medical centers.
            (4) Identification or development of metrics and outcome 
        measures to evaluate the provision and integration of 
        complementary and alternative medicine services into the 
        delivery of health care to veterans.
            (5) Integration and delivery of complementary and 
        alternative medicine services with other health care services 
        provided by the Department.
    (c) Consultation.--
            (1) In general.--In carrying out subsection (a), the 
        Secretary shall consult with the following:
                    (A) The Director of the National Center on 
                Complementary and Alternative Medicine of the National 
                Institutes of Health.
                    (B) The Commissioner of Food and Drugs.
                    (C) Institutions of higher education, private 
                research institutes, and individual researchers with 
                extensive experience in complementary and alternative 
                medicine and the integration of complementary and 
                alternative medicine practices into the delivery of 
                health care.
                    (D) Nationally recognized providers of 
                complementary and alternative medicine.
                    (E) Such other officials, entities, and individuals 
                with expertise on complementary and alternative 
                medicine as the Secretary considers appropriate.
            (2) Scope of consultation.--The Secretary shall undertake 
        consultation under paragraph (1) in carrying out subsection (a) 
        with respect to the following:
                    (A) To develop the plan.
                    (B) To identify specific complementary and 
                alternative medicine practices that, on the basis of 
                research findings or promising clinical interventions, 
                are appropriate to include as services to veterans.
                    (C) To identify barriers to the effective provision 
                and integration of complementary and alternative 
                medicine services into the delivery of health care to 
                veterans, and to identify mechanisms for overcoming 
                such barriers.
    (d) Funding.--There is authorized to be appropriated to the 
Secretary such sums as may be necessary to carry out this section.
    (e) Complementary and Alternative Medicine Defined.--In this 
section, the term ``complementary and alternative medicine'' shall have 
the meaning given that term in regulations the Secretary shall 
prescribe for purposes of this section, which shall, to the degree 
practicable, be consistent with the meaning given such term by the 
Secretary of Health and Human Services.
    (f) Effective Date.--This section shall take effect on the date 
that is one year after the date of the enactment of this Act.

SEC. 3. PROGRAM ON INTEGRATION OF COMPLEMENTARY AND ALTERNATIVE 
              MEDICINE WITHIN DEPARTMENT OF VETERANS AFFAIRS MEDICAL 
              CENTERS.

    (a) Program Required.--The Secretary of Veterans Affairs shall--
            (1) carry out, through the Office of Patient Centered Care 
        and Cultural Transformation of the Department of Veterans 
        Affairs, a program to assess the feasibility and advisability 
        of integrating the delivery of complementary and alternative 
        medicine services selected by the Secretary with other health 
        care services provided by the Department for veterans with 
        mental health conditions, chronic pain conditions, other 
        chronic conditions, and such other conditions as the Secretary 
        determines appropriate; and
            (2) in developing the program, identify and resolve 
        barriers to the provision of complementary and alternative 
        medicine services selected by the Secretary and the integration 
        of those services with other health care services provided by 
        the Department.
    (b) Duration of Program.--The program shall be carried out during 
the three-year period beginning on the effective date specified in 
subsection (j).
    (c) Locations.--
            (1) In general.--The Secretary shall carry out the program 
        at not fewer than 15 separate Department medical centers.
            (2) Polytrauma centers.--Not less than two of the medical 
        centers designated under paragraph (1) shall be located at 
        polytrauma rehabilitation centers of the Department.
            (3) Selection of locations.--In carrying out the program, 
        the Secretary shall select locations that include the following 
        areas:
                    (A) Rural areas.
                    (B) Areas that are not in close proximity to an 
                active duty military installation.
                    (C) Areas representing different geographic 
                locations, such as census tracts established by the 
                Bureau of the Census.
    (d) Provision of Services.--Under the program, the Secretary shall 
provide covered services to covered veterans by integrating 
complementary and alternative medicine services with other services 
provided by the Department at the medical centers designated under 
subsection (c)(1).
    (e) Covered Veterans.--For purposes of the program, a covered 
veteran is any veteran who--
            (1) has a mental health condition diagnosed by a clinician 
        of the Department;
            (2) experiences chronic pain; or
            (3) has a chronic condition being treated by a clinician of 
        the Department.
    (f) Covered Services.--
            (1) In general.--For purposes of the program, covered 
        services are services consisting of complementary and 
        alternative medicine as selected by the Secretary.
            (2) Administration of services.--Covered services shall be 
        administered under the program as follows:
                    (A) Covered services shall be administered by 
                clinicians employed by the Secretary for purposes of 
                this section who, to the extent practicable, shall 
                provide services consisting of complementary and 
                alternative medicine, including those clinicians who 
                solely provide such services.
                    (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, 
                in coordination with the Office of Patient Centered 
                Care and Cultural Transformation.
                    (C) Covered services shall be made available to 
                both--
                            (i) covered veterans with mental health 
                        conditions, pain conditions, or chronic 
                        conditions described in subsection (e) who have 
                        received conventional treatments from the 
                        Department for such conditions; and
                            (ii) covered veterans with mental health 
                        conditions, pain conditions, or chronic 
                        conditions described in subsection (e) who have 
                        not received conventional treatments from the 
                        Department for such conditions.
    (g) Voluntary Participation.--The participation of a veteran in the 
program shall be at the election of the veteran and in consultation 
with a clinician of the Department.
    (h) Reports to Congress.--
            (1) Quarterly reports.--Not later than 90 days after the 
        date of the commencement of the program and not less frequently 
        than once every 90 days thereafter for the duration of the 
        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 program, including a 
        description of the outreach conducted by the Secretary to 
        veterans and community organizations to inform such 
        organizations about the program.
            (2) Final report.--
                    (A) In general.--Not later than 180 days after the 
                completion of the 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 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 program, 
                        including with respect to--
                                    (I) the utilization and efficacy of 
                                the complementary and alternative 
                                medicine services established under the 
                                program;
                                    (II) an assessment of the benefit 
                                of the program to covered veterans in 
                                mental health diagnoses, pain 
                                management, and treatment of chronic 
                                illness; and
                                    (III) the comparative effectiveness 
                                of various complementary and 
                                alternative medicine therapies.
                            (ii) Barriers identified under subsection 
                        (a)(2) that were not resolved.
                            (iii) Such recommendations for the 
                        continuation or expansion of the program as the 
                        Secretary considers appropriate.
    (i) Complementary and Alternative Medicine Defined.--In this 
section, the term ``complementary and alternative medicine'' shall have 
the meaning given that term in section 2(e) of this Act.
    (j) Effective Date.--This section shall take effect on the date 
that is one year after the date of the enactment of this Act.

SEC. 4. STUDIES OF BARRIERS ENCOUNTERED BY VETERANS IN RECEIVING, AND 
              ADMINISTRATORS AND CLINICIANS IN PROVIDING, COMPLEMENTARY 
              AND ALTERNATIVE MEDICINE SERVICES FURNISHED BY THE 
              DEPARTMENT OF VETERANS AFFAIRS.

    (a) Studies Required.--
            (1) In general.--The Secretary of Veterans Affairs shall 
        conduct comprehensive studies of the barriers encountered by 
        veterans in receiving, and administrators and clinicians in 
        providing, complementary and alternative medicine services 
        furnished by the Department of Veterans Affairs.
            (2) Studies conducted.--
                    (A) Veterans.--In conducting the study of veterans, 
                the Secretary shall--
                            (i) survey veterans who seek or receive 
                        hospital care or medical services furnished by 
                        the Department, as well as veterans who do not 
                        seek or receive such care or services;
                            (ii) administer the survey to a 
                        representative sample of veterans from each 
                        Veterans Integrated Service Network; and
                            (iii) ensure that the sample of veterans 
                        surveyed is of sufficient size for the study 
                        results to be statistically significant.
                    (B) Administrators and clinicians.--In conducting 
                the study of clinicians and administrators, the 
                Secretary shall--
                            (i) survey administrators of the Department 
                        who are involved in the provision of health 
                        care services;
                            (ii) survey clinicians that have provided 
                        complementary and alternative medicine services 
                        through the program established under section 3 
                        of this Act, after those clinicians have 
                        provided those services through such program 
                        for at least 90 days; and
                            (iii) administer the survey to 
                        administrators under clause (i)--
                                    (I) before the introduction of 
                                complementary and alternative medicine 
                                services through such program; and
                                    (II) not earlier than 90 days after 
                                the introduction of complementary and 
                                alternative medicine services through 
                                such program.
    (b) Elements of Studies.--
            (1) Veterans.--In conducting the study of veterans required 
        by subsection (a), the Secretary shall study the following:
                    (A) The perceived barriers associated with 
                obtaining complementary and alternative medicine 
                services from the Department.
                    (B) The satisfaction of veterans with complementary 
                and alternative medicine services in primary care.
                    (C) The degree to which veterans are aware of 
                eligibility requirements for, and the scope of services 
                available under, complementary and alternative medicine 
                services furnished by the Department.
                    (D) The effectiveness of outreach to veterans on 
                the availability of complementary and alternative 
                medicine for veterans.
                    (E) Such other barriers as the Secretary considers 
                appropriate.
            (2) Administrators and clinicians.--In conducting the study 
        of administrators and clinicians required by subsection (a), 
        the Secretary shall study the following:
                    (A) The extent of the integration of complementary 
                and alternative medicine services within the services 
                provided by the Department.
                    (B) The perception by administrators and clinicians 
                of the structural and attitudinal barriers to the 
                delivery of high quality complementary and alternative 
                medicine services by the Department.
                    (C) Strategies that have been used to reduce or 
                eliminate such barriers and the results of such 
                strategies.
                    (D) The satisfaction of administrators and 
                clinicians regarding the integration of complementary 
                and alternative medicine services within the services 
                provided by the Department.
                    (E) The perception by administrators and clinicians 
                of the value of specific complementary and alternative 
                medicine services for inpatient and outpatient veteran 
                populations.
    (c) Discharge by Contract.--The Secretary shall enter into a 
contract with a qualified independent entity or organization to carry 
out the studies required by this section.
    (d) Mandatory Review of Data by the National Research Advisory 
Council.--
            (1) In general.--The Secretary shall ensure that the head 
        of the National Research Advisory Council reviews the results 
        of the studies conducted under this section.
            (2) Submittal of findings.--The head of the National 
        Research Advisory Council shall submit findings with respect to 
        the studies to the Under Secretary for Health and to other 
        pertinent program offices within the Department with 
        responsibilities relating to health care services for veterans.
    (e) Reports.--
            (1) Report on implementation.--Not later than one year 
        after the date of the enactment of this Act, the Secretary 
        shall submit to Congress a report on the status of the 
        implementation of this section.
            (2) Report on study.--
                    (A) In general.--Not later than 45 days after the 
                date of the completion of the study, the Secretary 
                shall submit to Congress a report on the study required 
                by subsection (a).
                    (B) Contents.--The report required by subparagraph 
                (A) shall include the following:
                            (i) Recommendations for such administrative 
                        and legislative proposals and actions as the 
                        Secretary considers appropriate.
                            (ii) The findings of the head of the 
                        National Research Advisory Council and of the 
                        Under Secretary for Health.
    (f) Authorization of Appropriations.--There is authorized to be 
appropriated for fiscal year 2015 for the Department of Veterans 
Affairs, $2,000,000 to carry out this section.
    (g) Complementary and Alternative Medicine Defined.--In this 
section, the term ``complementary and alternative medicine'' shall have 
the meaning given that term in section 2(e) of this Act.

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

    (a) Program Required.--
            (1) In general.--The Secretary of Veterans Affairs shall 
        carry out a 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 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 program for a 
period of three years beginning on the date that is one year after the 
date of the enactment of this Act.
    (c) Locations.--The Secretary shall carry out the 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 
                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 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 commencement of the program, and every 180 
                days thereafter, the Secretary shall submit to Congress 
                a report on the 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 program during 
                        the 180-day period preceding the report.
                            (ii) An assessment of the benefits of the 
                        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 program, the Secretary shall submit to Congress a report 
        detailing the recommendations of the Secretary as to the 
        advisability of continuing or expanding the program.
    (g) Wellness Defined.--In this section, the term ``wellness'' has 
the meaning given that term in regulations prescribed by the Secretary.
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