[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[S. 1641 Introduced in Senate (IS)]

114th CONGRESS
  1st Session
                                S. 1641

To improve the use by the Department of Veterans Affairs of opioids in 
 treating veterans, to improve patient advocacy by the Department, and 
to expand availability of complementary and integrative health, and for 
                            other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             June 22, 2015

 Ms. Baldwin (for herself, Mrs. Capito, Mr. Blumenthal, Mr. Brown, Ms. 
  Hirono, Mr. Johnson, Mr. Kaine, Mr. Manchin, Mr. Markey, Mr. Moran, 
  Mrs. Murray, Mr. Sanders, and Mr. Tester) introduced the following 
 bill; which was read twice and referred to the Committee on Veterans' 
                                Affairs

_______________________________________________________________________

                                 A BILL


 
To improve the use by the Department of Veterans Affairs of opioids in 
 treating veterans, to improve patient advocacy by the Department, and 
to expand availability of complementary and integrative health, 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; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Jason Simcakoski 
Memorial Opioid Safety Act''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
              TITLE I--OPIOID THERAPY AND PAIN MANAGEMENT

Sec. 101. Guidelines on management of opioid therapy by Department of 
                            Veterans Affairs and Department of Defense 
                            and implementation of such guidelines by 
                            Department of Veterans Affairs.
Sec. 102. Improvement of opioid safety measures by Department of 
                            Veterans Affairs.
Sec. 103. Establishment of working group on pain management and opioid 
                            therapy within the Department of Veterans 
                            Affairs-Department of Defense Joint 
                            Executive Committee.
Sec. 104. Establishment of pain management boards of Department of 
                            Veterans Affairs.
Sec. 105. Study on feasibility and advisability of carrying out 
                            pharmacy lock-in program by Department of 
                            Veterans Affairs.
Sec. 106. Reports and investigation on use of opioids in treatment by 
                            Department of Veterans Affairs.
                       TITLE II--PATIENT ADVOCACY

Sec. 201. Establishment of Office of Patient Advocacy of the Department 
                            of Veterans Affairs.
Sec. 202. Community meetings on improving care from Department of 
                            Veterans Affairs.
Sec. 203. Improvement of awareness of patient advocacy program and 
                            patient bill of rights of Department of 
                            Veterans Affairs.
Sec. 204. Comptroller General Report on Patient Advocacy Program of 
                            Department of Veterans Affairs.
Sec. 205. Report on transition by veterans between different health 
                            care settings.
            TITLE III--COMPLEMENTARY AND INTEGRATIVE HEALTH

Sec. 301. Expansion of research and education on and delivery of 
                            complementary and integrative health to 
                            veterans.
Sec. 302. Program on integration of complementary and integrative 
                            health within Department of Veterans 
                            Affairs medical centers.
Sec. 303. Program on use of wellness programs as complementary approach 
                            to pain management and related issues for 
                            veterans and family members of veterans.
              TITLE IV--OTHER VETERANS HEALTH CARE MATTERS

Sec. 401. Additional requirements for hiring of health care providers 
                            by Department of Veterans Affairs.
Sec. 402. Provision of information on health care providers of 
                            Department of Veterans Affairs to State 
                            medical boards.
Sec. 403. Report on compliance by Department of Veterans Affairs with 
                            reviews of health care providers leaving 
                            the Department or transferring to other 
                            facilities.
                    TITLE V--OTHER VETERANS MATTERS

Sec. 501. Department of Veterans Affairs program of internal audits.

              TITLE I--OPIOID THERAPY AND PAIN MANAGEMENT

SEC. 101. GUIDELINES ON MANAGEMENT OF OPIOID THERAPY BY DEPARTMENT OF 
              VETERANS AFFAIRS AND DEPARTMENT OF DEFENSE AND 
              IMPLEMENTATION OF SUCH GUIDELINES BY DEPARTMENT OF 
              VETERANS AFFAIRS.

    (a) In General.--Not later than one year after the date of the 
enactment of this Act, the Secretary of Veterans Affairs and the 
Secretary of Defense shall jointly update the VA/DOD Clinical Practice 
Guideline for Management of Opioid Therapy for Chronic Pain to include 
the following:
            (1) Guidelines for safely prescribing opioids for the 
        treatment of chronic, non-cancer pain in outpatient settings as 
        developed and released by the Centers for Disease Control and 
        Prevention.
            (2) Enhanced guidance with respect to absolute 
        contraindications for opioid therapy, including guidance with 
        respect to the following:
                    (A) The coadministration of drugs that are capable 
                of inducing a life-limiting drug-drug interaction, 
                including benzodiazepines.
                    (B) The treatment of patients with current acute 
                psychiatric instability or substance use disorder or 
                patients at risk of suicide.
                    (C) The use of opioid therapy to treat patients 
                without any pain, including to treat mental health 
                disorders other than opioid use disorder.
            (3) Enhanced guidance with respect to the treatment of 
        patients with behaviors or comorbidities, such as post-
        traumatic stress disorder, psychiatric disorders, or a history 
        of substance abuse or addiction, that require consultation or 
        comanagement of opioid therapy with one or more specialists in 
        pain management, mental health, or addictions.
            (4) Enhanced guidance with respect to the conduct by health 
        care providers of an effectiveness assessment for patients 
        receiving opioid therapy, including patients on long-term 
        opioid therapy, to determine--
                    (A) whether opioid therapy is meeting the expected 
                goals of the patient and health care provider of 
                relieving pain, improving function, and providing 
                patient satisfaction; and
                    (B) whether opioid therapy should be continued.
            (5) Requirements that each health care provider of the 
        Department of Veterans Affairs and the Department of Defense, 
        before initiating opioid therapy to treat a patient, use the 
        Opioid Therapy Risk Report tool of the Department of Veterans 
        Affairs, including information from the prescription drug 
        monitoring program of each State that includes the most recent 
        date information relating to the patient was accessed through 
        such program, as required to be included in such tool under 
        section 102(d)(2), to assess the risk for adverse outcomes of 
        opioid therapy for the patient, including the concurrent use of 
        controlled substances such as benzodiazepines, as part of the 
        comprehensive assessment conducted by the health care provider.
            (6) Guidelines to govern the methodologies used by health 
        care providers of the Department of Veterans Affairs and the 
        Department of Defense to taper opioid therapy when adjusting or 
        discontinuing the use of opioid therapy.
            (7) Guidelines with respect to appropriate case management 
        for patients receiving opioid therapy who transition between 
        inpatient and outpatient health care settings, which may 
        include the use of care transition plans.
            (8) Enhanced recommendations with respect to the use of 
        routine and random urine drug tests for all patients before and 
        during opioid therapy to help prevent substance abuse, 
        dependence, and diversion, including requirements--
                    (A) that such tests occur not less frequently than 
                once each year; and
                    (B) that health care providers appropriately 
                interpret and respond to the results from such tests to 
                tailor pain therapy, safeguards, and risk management 
                strategies to each patient.
            (9) Guidance that health care providers discuss with 
        patients, before initiating opioid therapy, options for pain 
        management therapies without the use of opioids and options to 
        augment opioid therapy with other clinical and complementary 
        and integrative health services to minimize opioid dependence.
    (b) Consultation Before Update.--Before updating the guideline 
under subsection (a), the Secretary of Veterans Affairs and the 
Secretary of Defense shall jointly consult with the working group on 
pain management and opioid therapy established in section 103.
    (c) Comptroller General Report on Implementation by Department of 
Veterans Affairs.--Not later than one year after the Secretary of 
Veterans Affairs updates the guideline under subsection (a), and not 
less frequently than annually thereafter, the Comptroller General of 
the United States 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--
            (1) the implementation by each medical facility of the 
        Department of Veterans Affairs of such guideline; and
            (2) the compliance by each such medical facility with such 
        guideline.
    (d) Controlled Substance Defined.--In this section, the term 
``controlled substance'' has the meaning given that term in section 102 
of the Controlled Substances Act (21 U.S.C. 802).

SEC. 102. IMPROVEMENT OF OPIOID SAFETY MEASURES BY DEPARTMENT OF 
              VETERANS AFFAIRS.

    (a) Expansion of Opioid Safety Initiative.--Not later than 180 days 
after the date of the enactment of this Act, the Secretary of Veterans 
Affairs shall expand the Opioid Safety Initiative of the Department of 
Veterans Affairs to include all medical facilities of the Department.
    (b) Pain Management Education and Training.--
            (1) In general.--In carrying out the Opioid Safety 
        Initiative of the Department, the Secretary shall require all 
        employees of the Department responsible for prescribing opioids 
        to receive education and training described in paragraph (2) in 
        order to appropriately implement and comply with the VA/DOD 
        Clinical Practice Guideline for Management of Opioid Therapy 
        for Chronic Pain, including any updates to such guideline.
            (2) Education and training.--Education and training 
        described in this paragraph is education and training on pain 
        management and safe opioid prescribing practices for purposes 
        of safely and effectively managing patients with chronic pain 
        and includes education and training on the following:
                    (A) The safe and effective use of opioid therapy to 
                treat chronic pain that is non-cancer related.
                    (B) The use of evidence-based pain management 
                therapies, including cognitive-behavioral therapy, non-
                opioid alternatives, and non-drug approaches to 
                managing pain and related health conditions including 
                complementary and integrative health services.
                    (C) Screening and identification of patients with 
                substance use disorder, including drug-seeking 
                behavior, before prescribing opioids, assessment of the 
                risk potential for patients developing an addiction, 
                and referral of patients to appropriate addiction 
                treatment professionals if addiction is identified or 
                strongly suspected.
                    (D) The safe and effective use of urine drug tests.
                    (E) Prescription of the lowest effective dose of 
                opioids based on patient need, use of opioids only for 
                a limited period of time, and augmentation of opioid 
                therapy with other pain management therapies and 
                modalities.
                    (F) The use of safe and effective tapering programs 
                for patients taking opioids and other controlled 
                substances, such as benzodiazepines, concurrently and 
                patients taking high-risk opioids.
                    (G) Communication with patients on the potential 
                harm associated with the use of opioids and other 
                controlled substances, including the need to safely 
                store and dispose of supplies relating to the use of 
                opioids and other controlled substances.
                    (H) Such other education and training as the 
                Secretary considers appropriate to ensure that veterans 
                receive safe, high-quality pain management care from 
                the Department.
            (3) Use of existing program.--In providing education and 
        training described in paragraph (2), the Secretary shall use 
        the Interdisciplinary Chronic Pain Management Training Team 
        Program of the Department.
    (c) Pain Management Teams.--
            (1) In general.--In carrying out the Opioid Safety 
        Initiative of the Department, each medical facility of the 
        Department shall identify and designate a pain management team 
        of health care professionals responsible for coordinating and 
        overseeing therapy at such facility for patients experiencing 
        acute and chronic pain that is non-cancer related.
            (2) Establishment of protocols.--
                    (A) In general.--The director of each Veterans 
                Integrated Service Network shall establish protocols 
                for the designation of pain management teams at each 
                medical facility within that Veterans Integrated 
                Service Network.
                    (B) Consultation on prescription of opioids.--Each 
                protocol established for a medical facility under 
                subparagraph (A) shall ensure that any health care 
                provider without expertise in prescribing analgesics or 
                who has not completed the education and training under 
                subsection (b), such as a mental health care provider, 
                does not prescribe opioids to a patient unless that 
                health care provider--
                            (i) consults with a health care provider 
                        with pain management expertise or who is on the 
                        pain management team of the medical facility; 
                        and
                            (ii) refers the patient to that pain 
                        management team for any subsequent 
                        prescriptions and related therapy.
            (3) Report.--
                    (A) In general.--Not later than one year after the 
                date of the enactment of this Act, the head of each 
                medical facility of the Department shall submit to the 
                director of the Veterans Integrated Service Network in 
                which the medical facility is located a report 
                identifying the health care professionals that have 
                been designated as members of the pain management team 
                at the medical facility.
                    (B) Elements.--Each report submitted under 
                subparagraph (A) with respect to a medical facility of 
                the Department shall include--
                            (i) a certification as to whether all 
                        members of the pain management team at the 
                        medical facility have completed the education 
                        and training required under subsection (b); and
                            (ii) a plan for the management and referral 
                        of patients to such pain management team if 
                        health care providers without expertise in 
                        prescribing analgesics prescribe opioid 
                        medications to treat acute and chronic pain 
                        that is non-cancer related.
    (d) Tracking and Monitoring of Opioid Use.--
            (1) Tracking of data on opioid use.--Not later than 18 
        months after the date of the enactment of this Act, in carrying 
        out the Opioid Safety Initiative and the Opioid Therapy Risk 
        Report tool of the Department, the Secretary shall, through the 
        Computerized Patient Record System of the Department, allow for 
        real-time tracking of and access to data on--
                    (A) the key clinical indicators with respect to the 
                totality of opioid use by veterans;
                    (B) concurrent prescribing by health care providers 
                of the Department of opioids in different health care 
                settings, include data on concurrent prescribing of 
                opioids to treat mental health disorders other than 
                opioid use disorder; and
                    (C) mail-order prescriptions of opioids prescribed 
                to veterans under the laws administered by the 
                Secretary.
            (2) Prescription drug monitoring programs of states.--In 
        carrying out the Opioid Safety Initiative and the Opioid 
        Therapy Risk Report tool of the Department, the Secretary 
        shall--
                    (A) ensure access by health care providers of the 
                Department to information on controlled substances, 
                including opioids and benzodiazepines, prescribed to 
                veterans who receive care outside the Department 
                through the prescription drug monitoring program of 
                each State, including by seeking to enter into 
                memoranda of understanding with States to allow such 
                access;
                    (B) include such information in the Opioid Therapy 
                Risk Report; and
                    (C) require health care providers of the Department 
                to submit to the prescription drug monitoring program 
                of each State information on prescriptions of 
                controlled substances received by veterans in that 
                State under the laws administered by the Secretary.
            (3) Report on implementation.--Not later than 180 days 
        after the date of the enactment of this Act, the Secretary 
        shall submit to Congress a report on the progress of the 
        Department in implementing the improvements to the Opioid 
        Therapy Risk Report tool of the Department required under 
        paragraphs (1) and (2).
    (e) Availability of Opioid Receptor Antagonists.--
            (1) Increased availability and use.--
                    (A) In general.--The Secretary shall increase the 
                availability of opioid receptor antagonists approved by 
                the Food and Drug Administration, such as naloxone, to 
                veterans and increase the availability of opioid 
                receptor antagonists for use by health care providers 
                of the Department in treating veterans.
                    (B) Availability, training, and distribution.--In 
                carrying out subparagraph (A), the Secretary shall, not 
                later than 90 days after the date of the enactment of 
                this Act--
                            (i) equip each medical facility of the 
                        Department with opioid receptor antagonists 
                        approved by the Food and Drug Administration;
                            (ii) enhance training for health care 
                        providers of the Department on distributing 
                        such opioid receptor antagonists; and
                            (iii) expand the Overdose Education and 
                        Naloxone Distribution program of the Department 
                        to ensure that all veterans in receipt of 
                        health care under the laws administered by the 
                        Secretary who are at risk of opioid overdose 
                        have access to such opioid receptor antagonists 
                        and training on the proper administration of 
                        such opioid receptor antagonists.
                    (C) Veterans who are at risk.--For purposes of 
                subparagraph (B), veterans who are at risk of opioid 
                overdose include--
                            (i) veterans receiving long-term opioid 
                        therapy;
                            (ii) veterans receiving opioid therapy who 
                        have a history of substance use disorder or 
                        prior instances of overdose; and
                            (iii) veterans who are at risk as 
                        determined by a health care provider who is 
                        treating the veteran.
            (2) Report.--Not later than 120 days after the date of the 
        enactment of this Act, 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 compliance with paragraph (1) that includes an assessment of 
        the following:
                    (A) Whether all medical facilities of the 
                Department are equipped with opioid receptor 
                antagonists approved by the Food and Drug 
                Administration.
                    (B) The progress of the Department in ensuring that 
                any such facilities that are not equipped with such 
                opioid receptor antagonists obtain such opioid receptor 
                antagonists.
                    (C) Whether all veterans at risk of opioid overdose 
                have access to such opioid receptor antagonists and 
                training on the proper administration of such opioid 
                receptor antagonists.
                    (D) The progress of the Department in ensuring that 
                all veterans at risk of opioid overdose have access to 
                such opioid receptor antagonists and training on the 
                proper administration of such opioid receptor 
                antagonists.
    (f) Inclusion of Certain Information and Capabilities in Opioid 
Therapy Risk Report Tool.--
            (1) Information.--The Secretary shall include in the Opioid 
        Therapy Risk Report tool of the Department--
                    (A) information on the most recent time the tool 
                was accessed by a health care provider of the 
                Department with respect to each veteran; and
                    (B) information on the results of the most recent 
                urine drug test for each veteran.
            (2) Capabilities.--The Secretary shall include in the 
        Opioid Therapy Risk Report tool the ability of health care 
        providers of the Department to determine whether a health care 
        provider of the Department prescribed opioids to a veteran 
        without checking the information in the tool with respect to 
        the veteran.
    (g) Notification of Risk in Computerized Health Record.--The 
Secretary shall modify the Computerized Patient Record System of the 
Department to ensure that any health care provider that accesses the 
record of a veteran, regardless of the reason the veteran seeks care 
from the health care provider, will be immediately notified whether the 
veteran--
            (1) is receiving opioid therapy and has a history of 
        substance use disorder or prior instances of overdose;
            (2) has a history of opioid abuse; or
            (3) is at risk of becoming an opioid abuser as determined 
        by a health care provider who is treating the veteran.
    (h) Controlled Substance Defined.--In this section, the term 
``controlled substance'' has the meaning given that term in section 102 
of the Controlled Substances Act (21 U.S.C. 802).

SEC. 103. ESTABLISHMENT OF WORKING GROUP ON PAIN MANAGEMENT AND OPIOID 
              THERAPY WITHIN THE DEPARTMENT OF VETERANS AFFAIRS-
              DEPARTMENT OF DEFENSE JOINT EXECUTIVE COMMITTEE.

    (a) Working Group on Pain Management and Opioid Therapy.--There is 
established within the Health Executive Committee of the Department of 
Veterans Affairs-Department of Defense Joint Executive Committee 
established under section 320 of title 38, United States Code, a 
working group on pain management and opioid therapy for individuals 
receiving health care from either the Department of Veterans Affairs or 
the Department of Defense that shall cover, at a minimum, the 
following:
            (1) The opioid prescribing practices of health care 
        providers of each Department.
            (2) The ability of each Department to manage acute and 
        chronic pain among individuals receiving health care from that 
        Department, including training health care providers with 
        respect to pain management.
            (3) The use by each Department of complementary and 
        integrative health in treating such individuals.
            (4) The concurrent use by health care providers of each 
        Department of opioids and prescription drugs to treat mental 
        health disorders, including benzodiazepines.
            (5) The practice by health care providers of each 
        Department of prescribing opioids to treat mental health 
        disorders.
            (6) The coordination in coverage of and consistent access 
        to medications prescribed for patients transitioning from 
        receiving health care from the Department of Defense to 
        receiving health care from the Department of Veterans Affairs.
            (7) The ability of each Department to identify and treat 
        substance use disorders among individuals receiving health care 
        from that Department.
    (b) Coordination and Consultation.--The working group established 
under subsection (a) shall--
            (1) coordinate the activities of the working group with 
        other relevant working groups established under section 320 of 
        title 38, United States Code, including the working groups on 
        evidence based practice, patient safety, pharmacy, 
        psychological health, and pain management;
            (2) consult with other relevant Federal agencies, including 
        the Centers for Disease Control and Prevention, with respect to 
        the activities of the working group; and
            (3) consult with the Department of Veterans Affairs and the 
        Department of Defense with respect to, review, and comment on 
        the VA/DOD Clinical Practice Guideline for Management of Opioid 
        Therapy for Chronic Pain, or any successor guideline, before 
        any update to the guideline is released.
    (c) Consultation.--The Secretary of Veterans Affairs and the 
Secretary of Defense shall jointly ensure that the working group 
established under subsection (a) is able to meaningfully consult with 
respect to the updated guideline required under subsection (a) of 
section 101, as required by subsection (b) of such section, not later 
than one year after the date of the enactment of this Act.

SEC. 104. ESTABLISHMENT OF PAIN MANAGEMENT BOARDS OF DEPARTMENT OF 
              VETERANS AFFAIRS.

    (a) In General.--Subchapter I of chapter 73 of title 38, United 
States Code, is amended by adding at the end the following new section:
``Sec. 7309A. Pain management boards
    ``(a) Establishment.--The Secretary shall establish in each 
Veterans Integrated Service Network a Pain Management Board (in this 
section referred to as a `Board').
    ``(b) Duties.--(1) Each Board shall--
            ``(A) consult with health care professionals and other 
        employees of the Department located in the Veterans Integrated 
        Service Network covered by the Board, patients who are being 
        treated at medical facilities of the Department located in such 
        Veterans Integrated Service Network, and family members of such 
        patients with respect to the pain management resources and best 
        practices of the Department;
            ``(B) oversee compliance by the health care professionals 
        and other employees of the Department with the best practices 
        of the Department, including by issuing such recommendations to 
        improve compliance with such best practices as the Board 
        considers appropriate;
            ``(C) provide oversight of the pain management practices of 
        the pain management committees of each medical facility of the 
        Department and the health care professionals and other 
        employees of the Department that are located in the Veterans 
        Integrated Service Network covered by the Board;
            ``(D) carry out educational forums, as the Board considers 
        appropriate, for individuals specified in subparagraph (A) on 
        pain management and treatment that may include the sharing of 
        updated research and best practices from medical experts, other 
        health care systems, and such other Federal agencies as the 
        Board considers necessary to carry out this subparagraph; and
            ``(E) carry out public hearings, symposiums, or other 
        events, as the Board considers appropriate, during which health 
        care professionals discuss and share best practices on pain 
        management and complementary and integrative health.
    ``(2)(A) Each Board may provide treatment recommendations for 
patients with complex clinical pain who are being treated at a medical 
facility of the Department located in the Veterans Integrated Service 
Network covered by the Board, and assist in facilitating communication 
between such patients and their health care providers, regardless of 
whether such treatment is on an in-patient or out-patient basis, and 
for whom a request for such recommendations, subject to subparagraph 
(C), has been made by an individual described in subparagraph (B).
    ``(B) An individual described in this subparagraph is one of the 
following individuals:
            ``(i) The patient.
            ``(ii) The spouse of the patient.
            ``(iii) A family member of the patient or another 
        individual if such family member or individual has been 
        designated by the patient to make health care decisions for the 
        patient or to receive health care information with respect to 
        the patient.
            ``(iv) A physician of the patient.
            ``(v) An employee of the medical facility of the Department 
        described in subparagraph (A).
    ``(C) An individual described in subparagraph (B) may not request 
treatment recommendations under subparagraph (A) unless the 
individual--
            ``(i) has requested treatment recommendations from the pain 
        management committee of the medical facility of the Department 
        at which the patient is receiving treatment; and
            ``(ii) has received treatment recommendations from such 
        committee and is not satisfied with those treatment 
        recommendations.
    ``(3) Based on treatment recommendations developed under paragraph 
(2)(A), consultations conducted under paragraph (1)(A), and educational 
forums and public events carried out under subparagraphs (C) and (D) of 
paragraph (1), each Board shall provide to health care professionals of 
the Department located in the Veterans Integrated Service Network 
covered by the Board recommendations on the best practices regarding 
pain management in cases of complex clinical pain.
    ``(4)(A) Each Board shall annually submit to the Secretary and the 
Under Secretary for Health a report (with all personally identifiable 
information of patients redacted) on pain management practices carried 
out in the Veterans Integrated Service Network covered by the Board. 
Each such report shall include, for the year covered by the report, the 
following:
            ``(i) The treatment recommendations provided under 
        paragraph (2)(A), including--
                    ``(I) a summary of such recommendations; and
                    ``(II) an explanation of the merits of each such 
                recommendation.
            ``(ii) The recommendations for best practices provided 
        under paragraph (3), including--
                    ``(I) a summary of such recommendations; and
                    ``(II) an explanation of the merits of each such 
                recommendation.
            ``(iii) Such other information as the Board considers 
        appropriate.
    ``(B) Not later than January 31 of each year, 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 
that contains comprehensive information from each report submitted to 
the Secretary under subparagraph (A) during the year preceding the 
submittal of the report by the Secretary, disaggregated by Board.
    ``(5) The Federal Advisory Committee Act (5 U.S.C. App.) shall not 
apply to any Board.
    ``(c) Membership.--(1) Each Board shall include the following 
individuals appointed by the Secretary:
            ``(A) A board certified pain medicine specialist.
            ``(B) A trained and qualified member of the primary care 
        team of a medical facility of the Department with experience in 
        pain care, such as a nurse practitioner.
            ``(C) A pain psychologist.
            ``(D) A pain social worker.
            ``(E) A clinical pharmacist.
            ``(F) A pain point of contact for a Veterans Integrated 
        Service Network.
            ``(G) A physician with addiction and psychopharmacology 
        expertise and experience.
            ``(H) An allied health care professional.
            ``(I) A clinician with expertise in complementary and 
        integrative health.
            ``(J) A clinical behavioral therapist.
            ``(K) A patient advocate.
            ``(L) A representative of the labor interests of employees 
        of the Department who are responsible for prescribing drugs.
            ``(M) A current or former clinical patient.
            ``(N) A family member of a current or former clinical 
        patient.
    ``(2) Of the members appointed under paragraph (1), not less than 
three shall be representative of the demographic of patients served by 
the Veterans Integrated Service Network covered by the Board, 
including--
            ``(A) not less than two current or former patients treated 
        at a medical facility of the Department for complex clinical 
        pain; and
            ``(B) not less than one family member of such a current or 
        former patient.
    ``(3) The Secretary shall determine the terms of service of the 
members of each Board.
    ``(4)(A) Members of each Board shall serve without pay and, except 
as provided in subparagraph (B), members who are full-time officers or 
employees of the United States may not receive additional pay, 
allowances, or benefits by reason of their service on the Board.
    ``(B) Members may receive travel expenses, including per diem in 
lieu of subsistence, for travel in connection with their duties as 
members of the Board.
    ``(C) Any member who has clinical duties as an officer or employee 
of the United States shall be relieved of such duties during periods in 
which such relief is necessary for the member to carry out the duties 
of the Board.
    ``(d) Availability of Information.--In carrying out the duties of a 
Board under subsection (b), specific information identifying a patient 
and other confidential information relating to a patient may not be 
made available to any member appointed under subsection (c)(1) solely 
based on qualifications under subparagraph (M) or (N) of such 
subsection.
    ``(e) Employment Protections.--No adverse personnel action may be 
made against an employee of the Department in connection with a 
communication by the employee with a member of a Board relating to the 
duties of the Board under subsection (b) and any such communication 
shall be covered by the employment and whistleblower protections 
otherwise applicable to communications by employees of the Department.
    ``(f) Resources of Department.--The Secretary shall make available 
to each Board the resources and personnel of the Department necessary 
for the Board to carry out the duties of the Board under subsection 
(b), including resources and personnel of the General Counsel of the 
Department.
    ``(g) Powers.--(1) Each Board may, for the purpose of carrying out 
this section, hold hearings, sit and act at times and places, take 
testimony, and receive evidence as the Board determines appropriate.
    ``(2) Each Board may conduct site visits of medical facilities of 
the Department to collect information that the Board considers 
necessary to carry out this section.
    ``(3) The Secretary shall provide to each Board such administrative 
support services as the Secretary considers necessary for the Board to 
carry out this section.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 73 of such title is amended by inserting after the item 
relating to section 7309 the following new item:

``7309A. Pain management boards.''.

SEC. 105. STUDY ON FEASIBILITY AND ADVISABILITY OF CARRYING OUT 
              PHARMACY LOCK-IN PROGRAM BY DEPARTMENT OF VETERANS 
              AFFAIRS.

    (a) In General.--The Secretary of Veterans Affairs shall conduct a 
study on the feasibility and advisability of carrying out a pharmacy 
lock-in program under which veterans at risk for abuse of prescription 
drugs are permitted to receive prescription drugs only from certain 
specified pharmacies of the Department of Veterans Affairs.
    (b) Report.--Not later than one year after the date of the 
enactment of this Act, 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 study conducted under 
subsection (a).

SEC. 106. REPORTS AND INVESTIGATION ON USE OF OPIOIDS IN TREATMENT BY 
              DEPARTMENT OF VETERANS AFFAIRS.

    (a) Comptroller General Report.--
            (1) In general.--Not later than two years after the date of 
        the enactment of this Act, the Comptroller General of the 
        United States 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 Opioid Safety 
        Initiative of the Department of Veterans Affairs and the opioid 
        prescribing practices of health care providers of the 
        Department.
            (2) Elements.--The report submitted under paragraph (1) 
        shall include the following:
                    (A) Recommendations on such improvements to the 
                Opioid Safety Initiative of the Department as the 
                Comptroller General considers appropriate.
                    (B) Information with respect to--
                            (i) deaths resulting from sentinel events 
                        involving veterans prescribed opioids by a 
                        health care provider of the Department;
                            (ii) overall prescription rates and 
                        prescriptions indications of opioids at all 
                        medical facilities of the Department to treat 
                        non-cancer, non-palliative, and non-hospice 
                        care patients, including whether each medical 
                        facility or health care provider of the 
                        Department is among the top ten percent of 
                        medical facilities or health care providers of 
                        the Department with respect to such 
                        prescription rates;
                            (iii) the prescription rates and 
                        prescriptions indications of benzodiazepines 
                        and opioids concomitantly by health care 
                        providers of the Department, including whether 
                        each medical facility or health care provider 
                        of the Department is among the top ten percent 
                        of medical facilities or health care providers 
                        of the Department with respect to such 
                        prescription rates;
                            (iv) the practice by health care providers 
                        of the Department of prescribing opioids to 
                        treat patients without any pain, including to 
                        treat patients with mental health disorders 
                        other than opioid use disorder; and
                            (v) the effectiveness of opioid therapy for 
                        patients receiving such therapy, including the 
                        effectiveness of long-term opioid therapy.
                    (C) Recommendations with respect to whether 
                sanctions are needed, such as written warnings or 
                performance improvement plans, for health care 
                providers of the Department that are--
                            (i) not practicing at a level meeting or 
                        exceeding the minimum level standard of care 
                        established by the Department; and
                            (ii) not following the enhanced guidance 
                        with respect to absolute contraindications for 
                        opioid therapy set forth in the VA/DOD Clinical 
                        Practice Guideline for Management of Opioid 
                        Therapy for Chronic Pain, as updated under 
                        section 101.
    (b) Quarterly Progress Report on Implementation of Comptroller 
General Recommendations.--Not later than 180 days after the date of the 
enactment of this Act, and not later than 30 days after the end of each 
quarter thereafter, the Secretary of Veterans Affairs shall submit to 
the Committee on Veterans Affairs' of the Senate and the Committee on 
Veterans Affairs' of the House of Representatives a progress report 
detailing the actions by the Department of Veterans Affairs during the 
period covered by the report to address any outstanding findings and 
recommendations by the Comptroller General of the United States with 
respect to the Veterans Health Administration.
    (c) Annual Report and Investigation on Opioid Therapy.--
            (1) Report.--Not later than one year after the date of the 
        enactment of this Act, and not less frequently than annually 
        thereafter, the Secretary of Veterans Affairs shall submit to 
        the Committee on Veterans' Affairs of the Senate and the 
        Committee on Veterans' Affairs of the House of Representatives 
        a report that contains, for the one year period preceding the 
        submittal of the report, the following:
                    (A) The number of patients and the percentage of 
                the patient population of the Department of Veterans 
                Affairs who were prescribed benzodiazepines and opioids 
                concurrently by a health care provider of the 
                Department.
                    (B) The number of patients and the percentage of 
                the patient population of the Department without any 
                pain who were prescribed opioids by a health care 
                provider of the Department, including those who were 
                prescribed benzodiazepines and opioids concurrently.
                    (C) The number of non-cancer, non-palliative, and 
                non-hospice care patients and the percentage of such 
                patients who were treated with opioids by a health care 
                provider of the Department on an inpatient-basis and 
                who also received prescription opioids by mail from the 
                Department while being treated on an inpatient-basis.
                    (D) The number of non-cancer, non-palliative, and 
                non-hospice care patients and the percentage of such 
                patients who were prescribed opioids concurrently by a 
                health care provider of the Department and a health 
                care provider that is not a health care provider of the 
                Department.
                    (E) With respect to each medical facility of the 
                Department, information on opioids prescribed by health 
                care providers at the facility to treat non-cancer, 
                non-palliative, and non-hospice care patients, 
                including information on--
                            (i) the prescription rate at which each 
                        health care provider at the facility prescribed 
                        benzodiazepines and opioids concurrently to 
                        such patients and the aggregate such 
                        prescription rate for all health care providers 
                        at the facility;
                            (ii) the prescription rate at which each 
                        health care provider at the facility prescribed 
                        benzodiazepines or opioids to such patients to 
                        treat conditions for which opioids or 
                        benzodiazepines are not an approved treatment 
                        and the aggregate such prescription rate for 
                        all health care providers at the facility;
                            (iii) the prescription rate at which each 
                        health care provider at the facility prescribed 
                        or dispensed mail-order prescriptions of 
                        opioids to such patients while such patients 
                        were being treated with opioids on an 
                        inpatient-basis and the aggregate such 
                        prescription rate for all health care providers 
                        at the facility; and
                            (iv) the prescription rate at which each 
                        health care provider at the facility prescribed 
                        opioids to such patients who were also 
                        concurrently prescribed opioids by a health 
                        care provider that is not a health care 
                        provider of the Department and the aggregate 
                        such prescription rate for all health care 
                        providers at the facility.
                    (F) With respect to each medical facility of the 
                Department, the number of times a pharmacist at the 
                facility overrode a critical drug interaction warning 
                with respect to an interaction between opioids and 
                another medication before dispensing a medication to a 
                veteran.
            (2) Investigation.--If a report submitted under paragraph 
        (1) indicates that a prescription rate described in 
        subparagraph (E) of such paragraph at a medical facility of the 
        Department is among the top ten percent of medical facilities 
        of the Department with respect to such prescription rate, the 
        Secretary shall--
                    (A) through the Office of the Medical Inspector of 
                the Veterans Health Administration, conduct a full 
                investigation of the medical facility; and
                    (B) immediately notify the Committee on Veterans 
                Affairs' of the Senate, the Committee on Veterans 
                Affairs' of the House of Representatives, and each 
                Member of the Senate and the House of Representatives 
                who represents the area in which the medical facility 
                is located.
    (d) Prescription Rate Defined.--In this section, the term 
``prescription rate'' means, with respect to a health care provider or 
medical facility of the Department, each of the following:
            (1) The number of patients treated with opioids by the 
        health care provider or at the medical facility, as the case 
        may be, divided by the total patient population of that health 
        care provider or medical facility.
            (2) The average number of morphine equivalents per day 
        prescribed by the health care provider or at the medical 
        facility, as the case may be, to patients being treated with 
        opioids.
            (3) Of the patients being treated with opioids by the 
        health care provider or at the medical facility, as the case 
        may be, the average number of prescriptions of opioids per 
        patient.

                       TITLE II--PATIENT ADVOCACY

SEC. 201. ESTABLISHMENT OF OFFICE OF PATIENT ADVOCACY OF THE DEPARTMENT 
              OF VETERANS AFFAIRS.

    (a) In General.--Subchapter I of chapter 73 of title 38, United 
States Code, is amended by adding at the end the following new section:
``Sec. 7309A. Office of Patient Advocacy
    ``(a) Establishment.--There is established in the Department within 
the Office of the Under Secretary for Health an office to be known as 
the `Office of Patient Advocacy' (in this section referred to as the 
`Office').
    ``(b) Head.--(1) The Director of the Office of Patient Advocacy 
shall be the head of the Office.
    ``(2) The Director of the Office of Patient Advocacy shall be 
appointed by the Under Secretary for Health from among individuals 
qualified to perform the duties of the position and shall report 
directly to the Under Secretary for Health.
    ``(c) Function.--(1) The function of the Office is to carry out the 
Patient Advocacy Program of the Department.
    ``(2) In carrying out the Patient Advocacy Program of the 
Department, the Director shall ensure that patient advocates of the 
Department--
            ``(A) advocate on behalf of veterans with respect to health 
        care received and sought by veterans under the laws 
        administered by the Secretary;
            ``(B) carry out the responsibilities specified in 
        subsection (d); and
            ``(C) receive training in patient advocacy.
    ``(d) Patient Advocacy Responsibilities.--The responsibilities of 
each patient advocate at a medical facility of the Department are the 
following:
            ``(1) To resolve complaints by veterans with respect to 
        health care furnished under the laws administered by the 
        Secretary that cannot be resolved at the point of service or at 
        a higher level easily accessible to the veteran.
            ``(2) To present at various meetings and to various 
        committees the issues experienced by veterans in receiving such 
        health care at such medical facility.
            ``(3) To express to veterans their rights and 
        responsibilities as patients in receiving such health care.
            ``(4) To manage the Patient Advocate Tracking System of the 
        Department at such medical facility.
            ``(5) To compile data at such medical facility of 
        complaints made by veterans with respect to the receipt of such 
        health care at such medical facility and the satisfaction of 
        veterans with such health care at such medical facility to 
        determine whether there are trends in such data.
            ``(6) To ensure that a process is in place for the 
        distribution of the data compiled under paragraph (5) to 
        appropriate leaders, committees, services, and staff of the 
        Department.
            ``(7) To identify, not less frequently than quarterly, 
        opportunities for improvements in the furnishing of such health 
        care to veterans at such medical facility based on complaints 
        by veterans.
            ``(8) To ensure that any significant complaint by a veteran 
        with respect to such health care is brought to the attention of 
        appropriate staff of the Department to trigger an assessment of 
        whether there needs to be a further analysis of the problem at 
        the facility-wide level.
            ``(9) To support any patient advocacy programs carried out 
        by the Department.
            ``(10) To ensure that all appeals and final decisions with 
        respect to the receipt of such health care are entered into the 
        Patient Advocate Tracking System of the Department.
            ``(11) To understand all laws, directives, and other rules 
        with respect to the rights and responsibilities of veterans in 
        receiving such health care, including the appeals processes 
        available to veterans.
            ``(12) To ensure that veterans receiving mental health 
        care, or the surrogate decisionmakers for such veterans, are 
        aware of the rights of veterans to seek representation from 
        systems established under section 103 of the Protection and 
        Advocacy for Mentally Ill Individuals Act of 1986 (42 U.S.C. 
        10803) to protect and advocate the rights of individuals with 
        mental illness and to investigate incidents of abuse and 
        neglect of such individuals.
            ``(13) To fulfill requirements established by the Secretary 
        with respect to the inspection of controlled substances.
            ``(14) To document potentially threatening behavior and 
        report such behavior to appropriate authorities.
    ``(e) Training.--In providing training to patient advocates under 
subsection (c)(2)(C), the Director shall ensure that such training is 
consistent throughout the Department.
    ``(f) Annual Report.--Not later than two years after the date of 
the enactment of the Jason Simcakoski Memorial Opioid Safety Act, and 
not less frequently than annually 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 the activities conducted by the Office during the period covered by 
the report.
    ``(g) Controlled Substance Defined.--In this section, the term 
`controlled substance' has the meaning given that term in section 102 
of the Controlled Substances Act (21 U.S.C. 802).''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 73 of such title is amended by adding after the item relating 
to section 7309 the following new item:

``7309A. Office of Patient Advocacy.''.
    (c) Date Fully Operational.--The Secretary of Veterans Affairs 
shall ensure that the Office of Patient Advocacy established in section 
7309A of title 38, United States Code, as added by subsection (a), is 
fully operational not later than the date that is one year after the 
date of the enactment of this Act.

SEC. 202. COMMUNITY MEETINGS ON IMPROVING CARE FROM DEPARTMENT OF 
              VETERANS AFFAIRS.

    (a) Community Meetings.--
            (1) Medical centers.--Not later than 90 days after the date 
        of the enactment of this Act, and not less frequently than once 
        every 90 days thereafter, each medical center of the Department 
        of Veterans Affairs shall host a community meeting open to the 
        public on improving health care from the Department.
            (2) Community based outpatient clinics.--Not later than one 
        year after the date of the enactment of this Act, and not less 
        frequently than annually thereafter, each community based 
        outpatient clinic of the Department shall host a community 
        meeting open to the public on improving health care from the 
        Department.
    (b) Attendance by Director of Veterans Integrated Service Network 
or Designee.--
            (1) In general.--Subject to paragraph (2), each community 
        meeting hosted by a medical center or community based 
        outpatient clinic under subsection (a) shall be attended by the 
        Director of the Veterans Integrated Service Network in which 
        the medical center or community based outpatient clinic, as the 
        case may be, is located, or an employee designated by the 
        Director who works in the office of the Director.
            (2) Attendance by director.--Each Director of a Veterans 
        Integrated Service Network shall attend not less than one 
        community meeting under subsection (a) hosted by each medical 
        center located in the Veterans Integrated Service Network each 
        year.
    (c) Notice.--Each medical center or community based outpatient 
clinic hosting a community meeting shall send timely notice of the 
community meeting to the Committee on Veterans Affairs' of the Senate, 
the Committee on Veterans Affairs' of the House of Representatives, and 
each Member of the Senate and the House of Representatives who 
represents the area in which the medical facility is located.

SEC. 203. IMPROVEMENT OF AWARENESS OF PATIENT ADVOCACY PROGRAM AND 
              PATIENT BILL OF RIGHTS OF DEPARTMENT OF VETERANS AFFAIRS.

    Not later than 90 days after the date of the enactment of this Act, 
the Secretary of Veterans Affairs shall, in as many prominent locations 
as appropriate to be seen by the largest percentage of patients and 
family members of patients at each medical facility of the Department 
of Veterans Affairs--
            (1) display the purposes of the Patient Advocacy Program of 
        the Department and the contact information for the patient 
        advocate at such medical facility; and
            (2) display the rights and responsibilities of--
                    (A) patients and family members of patients at such 
                medical facility; and
                    (B) with respect to community living centers and 
                other residential facilities of the Department, 
                residents and family members of residents at such 
                medical facility.

SEC. 204. COMPTROLLER GENERAL REPORT ON PATIENT ADVOCACY PROGRAM OF 
              DEPARTMENT OF VETERANS AFFAIRS.

    (a) In General.--Not later than three years after the date of the 
enactment of this Act, the Comptroller General of the United States 
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 Patient Advocacy Program of the Department of Veterans 
Affairs (in this section referred to as the ``Program'') as carried out 
under the Office of Patient Advocacy of the Department established in 
section 7309A of title 38, United States Code, as added by section 
201(a).
    (b) Elements.--The report required by subsection (a)--
            (1) shall include--
                    (A) such recommendations and proposals for 
                improving or modifying the Program as the Comptroller 
                General considers appropriate; and
                    (B) such other information with respect to the 
                Program as the Comptroller General considers 
                appropriate; and
            (2) may include--
                    (A) a description of the Program, including--
                            (i) the purposes of the Program;
                            (ii) the activities carried out under the 
                        Program; and
                            (iii) the sufficiency of the Program in 
                        achieving the purposes of the Program;
                    (B) an assessment of the sufficiency of staffing of 
                employees of the Department responsible for carrying 
                out the Program;
                    (C) an assessment of the sufficiency of the 
                training of such employees; and
                    (D) an assessment of--
                            (i) awareness of the Program among veterans 
                        and their family members; and
                            (ii) the use of the Program by veterans and 
                        their family members.

SEC. 205. REPORT ON TRANSITION BY VETERANS BETWEEN DIFFERENT HEALTH 
              CARE SETTINGS.

    (a) In General.--Not later than 180 days after the date of the 
enactment of this Act, the Secretary of Veterans Affairs 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 
transitions undergone by veterans in receiving health care in different 
health care settings.
    (b) Elements.--The report required by subsection (a) shall include 
the following:
            (1) An evaluation of the standards of the Department for 
        facilitating and managing the transitions undergone by veterans 
        in receiving health care in different health care settings.
            (2) An assessment of the case management services of the 
        Department that are available for veterans who are undergoing a 
        transition in health care settings.
            (3) An assessment of the coordination in coverage of and 
        consistent access to medications prescribed for patients 
        transitioning from receiving health care from the Department of 
        Defense to receiving health care from the Department of 
        Veterans Affairs.
            (4) Such recommendations to improve transitions in health 
        care settings among veterans as the Secretary considers 
        appropriate, including the coordination of drug formularies 
        between the Department of Defense and the Department of 
        Veterans Affairs and the development of care transition plans 
        for patients with complex medical issues.

            TITLE III--COMPLEMENTARY AND INTEGRATIVE HEALTH

SEC. 301. EXPANSION OF RESEARCH AND EDUCATION ON AND DELIVERY OF 
              COMPLEMENTARY AND INTEGRATIVE HEALTH TO VETERANS.

    (a) Development of Plan To Expand Research, Education, and 
Delivery.--Not later than 180 days after the date of the enactment of 
this Act, the Secretary of Veterans Affairs shall develop a plan to 
expand materially and substantially the scope of the effectiveness of 
research and education on, and delivery and integration of, 
complementary and integrative health 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 effectiveness of various complementary and 
                integrative health services, including the 
                effectiveness of such services integrated with clinical 
                therapies.
                    (B) Approaches to integrating complementary and 
                integrative health 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 integrative health 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 integrative health at centers of innovation 
        at medical centers of the Department.
            (4) Identification or development of metrics and outcome 
        measures to evaluate the effectiveness of the provision and 
        integration of complementary and integrative health services 
        into the delivery of health care to veterans.
            (5) Integration and delivery of complementary and 
        integrative health 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 for 
                Complementary and Integrative Health 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 integrative 
                health and the integration of complementary and 
                integrative health practices into the delivery of 
                health care.
                    (D) Nationally recognized providers of 
                complementary and integrative health.
                    (E) Such other officials, entities, and individuals 
                with expertise on complementary and integrative health 
                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 
                integrative health 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 integrative health 
                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 Integrative Health Defined.--In this section, 
the term ``complementary and integrative health'' has the meaning given 
that term by the National Institutes of Health.

SEC. 302. PROGRAM ON INTEGRATION OF COMPLEMENTARY AND INTEGRATIVE 
              HEALTH WITHIN DEPARTMENT OF VETERANS AFFAIRS MEDICAL 
              CENTERS.

    (a) Program Required.--Not later than the completion of the 
development of the plan under section 301, 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 integrative 
        health 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--
                    (A) use the plan developed under section 301; and
                    (B) identify and, to the extent practicable, 
                resolve barriers to the provision of complementary and 
                integrative health services selected by the Secretary 
                and the integration of those services with other health 
                care services provided by the Department.
    (b) Locations.--
            (1) In general.--The Secretary shall carry out the program 
        at not fewer than 15 medical centers of the Department.
            (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) Medical centers with high prescription rate of 
        opioids.--
                    (A) In general.--In selecting medical centers under 
                paragraph (1), the Secretary shall give priority to 
                medical centers of the Department at which there is a 
                prescription rate of opioids that is among the top ten 
                percent of medical centers of the Department with 
                respect to such prescription rate.
                    (B) Prescription rate defined.--In this paragraph, 
                the term ``prescription rate'' means, with respect to a 
                medical center of the Department, each of the 
                following:
                            (i) The number of patients treated with 
                        opioids at the medical center divided by the 
                        total patient population of that medical 
                        center.
                            (ii) The average number of morphine 
                        equivalents per day prescribed at the medical 
                        center to patients being treated with opioids.
                            (iii) Of the patients being treated with 
                        opioids at the medical center, the average 
                        number of prescriptions of opioids per patient.
            (4) 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.
    (c) Provision of Services.--Under the program, the Secretary shall 
provide covered services to covered veterans by integrating 
complementary and integrative health services with other services 
provided by the Department at the medical centers designated under 
subsection (b)(1).
    (d) 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;
            (3) has a chronic condition being treated by a clinician of 
        the Department; or
            (4) is not described in paragraph (1), (2), or (3) and 
        requests to participate in the program or is referred by a 
        clinician of the Department who is treating the veteran.
    (e) Covered Services.--
            (1) In general.--For purposes of the program, covered 
        services are services consisting of complementary and 
        integrative health services 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 
                professionals or other instructors with appropriate 
                training and expertise in complementary and integrative 
                health services who are employees of the Department or 
                with whom the Department enters into an agreement to 
                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--
                            (i) covered veterans who have received 
                        conventional treatments from the Department for 
                        the conditions for which the covered veteran 
                        seeks complementary and integrative health 
                        services under the program; and
                            (ii) covered veterans who have not received 
                        conventional treatments from the Department for 
                        such conditions.
    (f) 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.
    (g) 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 three years after 
                the date of the commencement 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 use and efficacy of the 
                                complementary and integrative health 
                                services established under the program; 
                                and
                                    (II) an assessment of the benefit 
                                of the program to covered veterans in 
                                mental health diagnoses, pain 
                                management, and treatment of chronic 
                                illness.
                            (ii) Barriers identified under subsection 
                        (a)(2)(B) that were not resolved.
                            (iii) Such recommendations for the 
                        continuation or expansion of the program as the 
                        Secretary considers appropriate.
    (h) Complementary and Integrative Health Defined.--In this section, 
the term ``complementary and integrative health'' shall have the 
meaning given that term in section 301(e).

SEC. 303. PROGRAM ON USE OF WELLNESS PROGRAMS AS COMPLEMENTARY APPROACH 
              TO PAIN MANAGEMENT AND RELATED ISSUES 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 pain management and related health care services, 
        such as mental health care services, to veterans and family 
        members of veterans.
            (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 pain management and 
                related health care services to veterans and family 
                members of veterans.
                    (B) Means of enhancing outreach, and coordination 
                of outreach, by and among providers of health care 
                referred to in subparagraph (A) on the pain management 
                and related health care services available to veterans 
                and family members of veterans.
                    (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 pain management and related health 
                care services to veterans and family members of 
                veterans.
                    (D) Whether wellness programs described in 
                subparagraph (C) are effective in enhancing the quality 
                of life and well-being of veterans and family members 
                of veterans.
                    (E) Whether wellness programs described in 
                subparagraph (C) are effective in increasing the 
                adherence of veterans to the primary pain management 
                and related health care services provided such veterans 
                by the Department.
                    (F) Whether wellness programs described in 
                subparagraph (C) have an impact on the sense of well-
                being of veterans who receive primary pain management 
                and related health care 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 pain management and related 
health care services, such as mental health care services, to veterans 
and family members of veterans.
    (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) Such other requirements as 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 individuals.--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 veterans and 
        family members of veterans.
    (f) Reports.--
            (1) Periodic reports.--
                    (A) In general.--Not later than 180 days after the 
                date of the commencement of the program, and not less 
                frequently than 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 
        feasibility and 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 
for purposes of this section.

              TITLE IV--OTHER VETERANS HEALTH CARE MATTERS

SEC. 401. ADDITIONAL REQUIREMENTS FOR HIRING OF HEALTH CARE PROVIDERS 
              BY DEPARTMENT OF VETERANS AFFAIRS.

    The Secretary of Veterans Affairs shall, as part of the hiring 
process for each health care provider considered for a position at the 
Department of Veterans Affairs after the date of the enactment of this 
Act, request from the medical board of each State in which the health 
care provider has a medical license--
            (1) information on any violation of the requirements of the 
        medical license of the health care provider during the 20-year 
        period preceding the consideration of the health care provider 
        by the Department; and
            (2) information on whether the health care provider has 
        entered into any settlement agreement for a disciplinary charge 
        relating to the practice of medicine by the health care 
        provider.

SEC. 402. PROVISION OF INFORMATION ON HEALTH CARE PROVIDERS OF 
              DEPARTMENT OF VETERANS AFFAIRS TO STATE MEDICAL BOARDS.

    Notwithstanding section 552a of title 5, United States Code, the 
Secretary of Veterans Affairs shall, with respect to any health care 
provider of the Department of Veterans Affairs that has violated a 
requirement of their medical license, provide to the medical board of 
each State in which the health care provider is licensed detailed 
information with respect to such violation.

SEC. 403. REPORT ON COMPLIANCE BY DEPARTMENT OF VETERANS AFFAIRS WITH 
              REVIEWS OF HEALTH CARE PROVIDERS LEAVING THE DEPARTMENT 
              OR TRANSFERRING TO OTHER FACILITIES.

    Not later than two years after the date of the enactment of this 
Act, the Secretary of Veterans Affairs 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 compliance by the 
Department of Veterans Affairs with the policy of the Department--
            (1) to conduct a review of each health care provider of the 
        Department who transfers to another medical facility of the 
        Department or leaves the Department to determine whether there 
        are any concerns, complaints, or allegations of violations 
        relating to the medical practice of the health care provider; 
        and
            (2) to take appropriate action with respect to any such 
        concern, complaint, or allegation.

                    TITLE V--OTHER VETERANS MATTERS

SEC. 501. DEPARTMENT OF VETERANS AFFAIRS PROGRAM OF INTERNAL AUDITS.

    (a) In General.--Subchapter II of chapter 5 of title 38, United 
States Code, is amended by inserting after section 527 the following 
new section:
``Sec. 527A. Program of internal audits
    ``(a) Program Required.--(1) The Secretary shall carry out a 
program of internal audits and self-analysis to improve the furnishing 
of benefits and health care to veterans and their families.
    ``(2) The Secretary shall carry out the program required by 
paragraph (1) through an office the Secretary shall establish for 
purposes of the program within the office of the Secretary that is 
interdisciplinary and independent of--
            ``(A) the other offices within the office of the Secretary; 
        and
            ``(B) the covered administrations (or functions of such 
        administrations), staff organizations, and staff offices 
        identified under subsection (b)(1)(A).
    ``(b) Program Requirements.--(1) In carrying out the program 
required by subsection (a), the Secretary shall--
            ``(A) conduct periodic risk assessments of the Department 
        to identify those covered administrations (or functions of such 
        administrations), staff organizations, and staff offices of the 
        Department the audit of which would lead towards the greatest 
        improvement in the furnishing of benefits and health care to 
        veterans and their families;
            ``(B) develop plans that are informed by the risk 
        assessments conducted under paragraph (1) to conduct internal 
        audits of the covered administrations (or functions of such 
        administrations), staff organizations, and staff offices 
        identified under subparagraph (A); and
            ``(C) conduct internal audits in accordance with the plans 
        developed pursuant to subparagraph (B).
    ``(2) The Secretary shall carry out under the program required by 
subsection (a) an audit of not fewer than five covered administrations 
(or functions of such administrations), staff organizations, or staff 
offices of the Department each year.
    ``(3) In identifying covered administrations (or functions of such 
administrations), staff organizations, and staff offices of the 
Department under paragraph (1)(A), the Secretary shall accord priority 
to the covered administrations and functions of such administrations.
    ``(4)(A) For purposes of this subsection, the covered 
administrations of the Department are the following:
            ``(i) The National Cemetery Administration.
            ``(ii) The Veterans Benefits Administration.
            ``(iii) The Veterans Health Administration.
    ``(B) For purposes this subsection, the covered staff organizations 
of the Department are the following:
            ``(i) The Office of Acquisition, Logistics, and 
        Construction.
            ``(ii) The Advisory Committee Management Office.
            ``(iii) The Board of Veterans' Appeals.
            ``(iv) The Center for Faith-Based and Neighborhood 
        Partnerships.
            ``(v) The Center for Minority Veterans.
            ``(vi) The Center for Women Veterans.
            ``(vii) The Office of General Counsel.
            ``(viii) The Office of Regulation Policy and Management.
            ``(ix) The Office of Employment Discrimination Complaint 
        Adjudication.
            ``(x) The Office of Interagency Care and Benefits 
        Coordination.
            ``(xi) The Office of Small and Disadvantaged Business 
        Utilization.
            ``(xii) The Office of Survivors Assistance.
            ``(xiii) The Veterans' Service Organizations Liaison.
    ``(C) For purposes of this subsection, the covered staff offices of 
the Department are the following:
            ``(i) The office of the Assistant Secretary for 
        Congressional and Legislative Affairs.
            ``(ii) The office of the Assistant Secretary for Human 
        Resources and Administration.
            ``(iii) The office of the Assistant Secretary for 
        Information and Technology.
            ``(iv) The Office of Management.
            ``(v) The office of the Assistant Secretary for Operations, 
        Security, and Preparedness.
            ``(vi) The office of the Assistant Secretary for Policy and 
        Planning.
            ``(vii) The office of the Assistant Secretary for Public 
        and Intergovernmental Affairs.
    ``(c) Reports.--(1) Not later than 90 days after completing an 
audit under the program required by subsection (a), the Secretary shall 
submit to the appropriate committees of Congress a report on the audit.
    ``(2) Each report submitted under paragraph (1) with respect to an 
audit shall include the following:
            ``(A) A summary of the audit.
            ``(B) The findings of the Secretary with respect to the 
        audit.
            ``(C) Such recommendations as the Secretary may have for 
        legislative or administrative action to improve the furnishing 
        of benefits and health care to veterans and their families.
    ``(3) In this subsection, the term `appropriate committees of 
Congress' includes--
            ``(A) the Committee on Veterans' Affairs, the Committee on 
        Appropriations, and the Committee on Homeland Security and 
        Governmental Affairs of the Senate; and
            ``(B) the Committee on Veterans' Affairs, the Committee on 
        Appropriations, and the Committee on Oversight and Government 
        Reform of the House of Representatives.''.
    (b) First Risk Assessment.--The Secretary of Veterans Affairs shall 
complete the first risk assessment required by section 527A(b)(1)(A) of 
such title, as added by subsection (a), by not later than 180 days 
after the date of the enactment of this Act.
    (c) Clerical Amendment.--The table of sections at the beginning of 
chapter 5 of such title is amended by inserting after the item relating 
to section 527 the following new item:

``527A. Program of internal audits.''.
                                 <all>