[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 785 Reported in Senate (RS)]

<DOC>





                                                       Calendar No. 498
116th CONGRESS
  2d Session
                                 S. 785

 To improve mental health care provided by the Department of Veterans 
                    Affairs, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 13, 2019

  Mr. Tester (for himself, Mr. Moran, Ms. Baldwin, Ms. Stabenow, Mr. 
 Kaine, Mr. Markey, Ms. Sinema, Ms. Hirono, Mr. Durbin, Mr. Casey, Ms. 
Harris, Mr. Udall, Mr. Blumenthal, Mr. Murphy, Mr. Warner, Mrs. Murray, 
 Mrs. Feinstein, Mr. Menendez, Mr. Booker, Ms. Smith, Mr. Manchin, Ms. 
Klobuchar, Mr. Sanders, Ms. Duckworth, Mr. Peters, Mrs. Gillibrand, Mr. 
Merkley, Mr. Sullivan, Mr. Bennet, Ms. Hassan, Mr. Coons, Mr. Roberts, 
Mrs. Shaheen, Mr. Daines, Mr. Crapo, Mr. Boozman, Ms. Cortez Masto, Mr. 
  Cramer, Ms. McSally, Mr. Cornyn, Ms. Rosen, Mr. Jones, Ms. Collins, 
   Mrs. Blackburn, Mr. Rounds, Mr. Hoeven, Mr. Risch, Mr. Wyden, Ms. 
 Murkowski, Mr. Wicker, Mr. Portman, and Mr. Heinrich) introduced the 
 following bill; which was read twice and referred to the Committee on 
                           Veterans' Affairs

                             July 27, 2020

                Reported by Mr. Moran, with an amendment
 [Strike out all after the enacting clause and insert the part printed 
                               in italic]

_______________________________________________________________________

                                 A BILL


 
 To improve mental health care provided by the Department of Veterans 
                    Affairs, and for other purposes.

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

<DELETED>SECTION 1. SHORT TITLE; TABLE OF CONTENTS.</DELETED>

<DELETED>    (a) Short Title.--This Act may be cited as the ``Commander 
John Scott Hannon Veterans Mental Health Care Improvement Act of 
2019''.</DELETED>
<DELETED>    (b) Table of Contents.--The table of contents for this Act 
is as follows:</DELETED>

<DELETED>Sec. 1. Short title; table of contents.
<DELETED>TITLE I--IMPROVEMENT OF TRANSITION OF INDIVIDUALS TO SERVICES 
                  FROM DEPARTMENT OF VETERANS AFFAIRS

<DELETED>Sec. 101. Expansion of health care coverage for veterans.
<DELETED>Sec. 102. Grants for provision of transition assistance to 
                            former members of the Armed Forces 
                            transitioning to civilian life.
<DELETED>Sec. 103. Study of community-based transition assistance 
                            programs for former members of the Armed 
                            Forces.
<DELETED>Sec. 104. Modification of eligibility for care from Department 
                            of Veterans Affairs for former members of 
                            the Armed Forces with other than honorable 
                            discharges and report on such care.
                 <DELETED>TITLE II--SUICIDE PREVENTION

<DELETED>Sec. 201. Grants for organizations providing mental health 
                            wellness services to veterans.
<DELETED>Sec. 202. Designation of buddy check week by Department of 
                            Veterans Affairs.
<DELETED>Sec. 203. Post-traumatic growth partnerships.
<DELETED>Sec. 204. Progress of Department of Veterans Affairs in 
                            meeting goals and objectives of National 
                            Strategy for Preventing Veteran Suicide.
<DELETED>Sec. 205. Study on feasibility and advisability of providing 
                            certain complementary and integrative 
                            health services.
<DELETED>Sec. 206. Program to provide veterans access to complementary 
                            and integrative health services through 
                            animal therapy, agri-therapy, and outdoor 
                            sports therapy.
<DELETED>Sec. 207. Comptroller General report on management by 
                            Department of Veterans Affairs of veterans 
                            at high risk for suicide.
 <DELETED>TITLE III--PROGRAMS, STUDIES, AND GUIDELINES ON MENTAL HEALTH

<DELETED>Sec. 301. Program to provide veterans access to computerized 
                            cognitive behavioral therapy.
<DELETED>Sec. 302. Study on connection between living at high altitude 
                            and suicide risk factors among veterans.
<DELETED>Sec. 303. Establishment by Department of Veterans Affairs and 
                            Department of Defense of clinical practice 
                            guidelines for comorbid mental health 
                            conditions.
<DELETED>Sec. 304. Update of clinical practice guidelines for 
                            assessment and management of patients at 
                            risk for suicide.
<DELETED>Sec. 305. Precision medicine initiative of Department of 
                            Veterans Affairs to identify and validate 
                            brain and mental health biomarkers.
<DELETED>Sec. 306. Preventative and complex data analysis by Department 
                            of Veterans Affairs.
<DELETED>TITLE IV--OVERSIGHT OF MENTAL HEALTH CARE AND RELATED SERVICES

<DELETED>Sec. 401. Study on effectiveness of suicide prevention and 
                            mental health outreach programs of 
                            Department of Veterans Affairs.
<DELETED>Sec. 402. Oversight of mental health and suicide prevention 
                            media outreach conducted by Department of 
                            Veterans Affairs.
<DELETED>Sec. 403. Annual report on progress of Department of Veterans 
                            Affairs in meeting goals and objectives of 
                            Executive Order 13822.
<DELETED>Sec. 404. Comptroller General management review of mental 
                            health and suicide prevention services of 
                            Department of Veterans Affairs.
<DELETED>Sec. 405. Comptroller General report on efforts of Department 
                            of Veterans Affairs to integrate mental 
                            health care into primary care clinics.
<DELETED>Sec. 406. Joint mental health programs by Department of 
                            Veterans Affairs and Department of Defense.
                  <DELETED>TITLE V--MEDICAL WORKFORCE

  <DELETED>Subtitle A--Improvement of Mental Health Medical Workforce

<DELETED>Sec. 501. Treatment of psychologists.
<DELETED>Sec. 502. Staffing improvement plan for psychiatrists and 
                            psychologists of Department of Veterans 
                            Affairs.
<DELETED>Sec. 503. Occupational series and staffing improvement plan 
                            for licensed professional mental health 
                            counselors and marriage and family 
                            therapists of Department of Veterans 
                            Affairs.
<DELETED>Sec. 504. Staffing improvement plan for peer specialists of 
                            Department of Veterans Affairs who are 
                            women.
<DELETED>Sec. 505. Establishment of Department of Veterans Affairs 
                            Readjustment Counseling Service Scholarship 
                            Program.
<DELETED>Sec. 506. Comptroller General report on Readjustment 
                            Counseling Service of Department of 
                            Veterans Affairs.
<DELETED>Sec. 507. Expansion of reporting requirements on Readjustment 
                            Counseling Service of Department of 
                            Veterans Affairs.
<DELETED>Sec. 508. Studies on alternative work schedules for employees 
                            of Veterans Health Administration.
<DELETED>Sec. 509. Suicide prevention coordinators.
<DELETED>Subtitle B--Direct Hiring Authorities for Certain Health Care 
                               Positions

<DELETED>Sec. 521. Direct hiring authorities for certain health care 
                            positions.
         <DELETED>TITLE VI--IMPROVEMENT OF TELEHEALTH SERVICES

<DELETED>Sec. 601. Expanded telehealth from Department of Veterans 
                            Affairs.
<DELETED>Sec. 602. Implementation of national protocol for telehealth 
                            security and interfacing instructions.

<DELETED>TITLE I--IMPROVEMENT OF TRANSITION OF INDIVIDUALS TO SERVICES 
             FROM DEPARTMENT OF VETERANS AFFAIRS</DELETED>

<DELETED>SEC. 101. EXPANSION OF HEALTH CARE COVERAGE FOR 
              VETERANS.</DELETED>

<DELETED>    (a) In General.--Section 1710(a)(1) of title 38, United 
States Code, is amended--</DELETED>
        <DELETED>    (1) in subparagraph (A), by striking ``and'' at 
        the end;</DELETED>
        <DELETED>    (2) by redesignating subparagraph (B) as 
        subparagraph (C); and</DELETED>
        <DELETED>    (3) by inserting after subparagraph (A) the 
        following new subparagraph (B):</DELETED>
        <DELETED>    ``(B) to any veteran during the one-year period 
        following the discharge or release of the veteran from active 
        military, naval, or air service; and''.</DELETED>
<DELETED>    (b) Patient Enrollment System.--Section 1705(c) of such 
title is amended by adding at the end the following new 
paragraph:</DELETED>
<DELETED>    ``(3) Nothing in this section shall be construed to 
prevent the Secretary from providing hospital care and medical services 
to a veteran under section 1710(a)(1)(B) of this title during the 
period specified in such section notwithstanding the failure of the 
veteran to enroll in the system of patient enrollment established by 
the Secretary under subsection (a).''.</DELETED>
<DELETED>    (c) Promotion of Expanded Eligibility.--</DELETED>
        <DELETED>    (1) Transition assistance program.--</DELETED>
                <DELETED>    (A) In general.--The Secretary of Labor, 
                in consultation with the Secretary of Defense and the 
                Secretary of Veterans Affairs, shall promote to members 
                of the Armed Forces transitioning from service in the 
                Armed Forces to civilian life through the Transition 
                Assistance Program the expanded eligibility of veterans 
                for health care under the laws administered by the 
                Secretary of Veterans Affairs pursuant to the 
                amendments made by this section.</DELETED>
                <DELETED>    (B) Transition assistance program 
                defined.--In this paragraph, the term ``Transition 
                Assistance Program'' means the Transition Assistance 
                Program under sections 1142 and 1144 of title 10, 
                United States Code.</DELETED>
        <DELETED>    (2) Publication by department of veterans 
        affairs.--Not later than 30 days after the date of the 
        enactment of this Act, the Secretary of Veterans Affairs shall 
        publish on a website of the Department of Veterans Affairs 
        notification of the expanded eligibility of veterans for health 
        care under the laws administered by the Secretary pursuant to 
        the amendments made by this section.</DELETED>

<DELETED>SEC. 102. GRANTS FOR PROVISION OF TRANSITION ASSISTANCE TO 
              FORMER MEMBERS OF THE ARMED FORCES TRANSITIONING TO 
              CIVILIAN LIFE.</DELETED>

<DELETED>    (a) Program Required.--Commencing not later than 180 days 
after the date of the enactment of this Act, the Secretary of Labor 
shall, in coordination with the Secretary of Veterans Affairs, carry 
out a program on the provision of assistance to former members of the 
Armed Forces, and spouses of such members, transitioning from service 
in the Armed Forces to civilian life.</DELETED>
<DELETED>    (b) Duration of Program.--The Secretary of Labor shall 
carry out the program during the five-year period beginning on the date 
of the commencement of the program.</DELETED>
<DELETED>    (c) Grants.--</DELETED>
        <DELETED>    (1) In general.--The Secretary shall carry out the 
        program through the award of grants to eligible organizations 
        for the provision of assistance described in subsection 
        (a).</DELETED>
        <DELETED>    (2) Matching funds required.--A grant under this 
        section shall be in an amount that does not exceed 50 percent 
        of the amount required by the organization to provide the 
        services described in subsection (f).</DELETED>
<DELETED>    (d) Eligible Organizations.--For purposes of this section, 
an eligible organization is any nonprofit organization that the 
Secretary of Labor determines, in consultation with the Secretary of 
Veterans Affairs and State entities that serve veterans, is suitable 
for receipt of a grant under the program pursuant to receipt by the 
Secretary of Labor of an application submitted under subsection 
(e)(1).</DELETED>
<DELETED>    (e) Selection of Grant Recipients.--</DELETED>
        <DELETED>    (1) Applications.--An organization seeking a grant 
        under the program shall submit to the Secretary of Labor an 
        application therefor at such time, in such manner, and 
        containing such information and assurances as the Secretary, in 
        consultation with the Secretary of Veterans Affairs and State 
        entities that serve veterans, may require.</DELETED>
        <DELETED>    (2) Priority for hubs of services.--In awarding 
        grants under the program, the Secretary of Labor shall give 
        priority to an organization that provides multiple forms of 
        services described in subsection (f).</DELETED>
<DELETED>    (f) Use of Grant Funds.--Each organization receiving a 
grant under the program shall use the grant to provide to former 
members of the Armed Forces and spouses described in subsection (a) the 
following:</DELETED>
        <DELETED>    (1) Resume assistance.</DELETED>
        <DELETED>    (2) Interview training.</DELETED>
        <DELETED>    (3) Job recruitment training.</DELETED>
        <DELETED>    (4) Entrepreneurship training.</DELETED>
        <DELETED>    (5) Financial services.</DELETED>
        <DELETED>    (6) Legal assistance.</DELETED>
        <DELETED>    (7) Educational supportive services.</DELETED>
        <DELETED>    (8) Assistance with accessing benefits provided 
        under laws administered by the Secretary of Veterans Affairs, 
        including home loan benefits, education benefits, adaptive 
        housing grants, and all other benefits.</DELETED>
        <DELETED>    (9) Nonclinical case management.</DELETED>
        <DELETED>    (10) Other related services leading directly to 
        successful transition, as determined by the Secretary of Labor 
        in consultation with the Secretary of Veterans 
        Affairs.</DELETED>
<DELETED>    (g) Annual Reports.--</DELETED>
        <DELETED>    (1) In general.--Not later than one year after the 
        date of the commencement of the program and not less frequently 
        than once each year thereafter until the termination of the 
        program, the Secretary of Labor shall, in consultation with the 
        Secretary of Veterans Affairs, submit to the appropriate 
        committees of Congress a report on the program carried out 
        under this section.</DELETED>
        <DELETED>    (2) Contents.--Each report submitted under 
        paragraph (1) shall include the following:</DELETED>
                <DELETED>    (A) A list of the organizations that have 
                received grants under the program, including the 
                geographic location of the organization and the types 
                of services outlined in subsection (f) that each 
                organization provides.</DELETED>
                <DELETED>    (B) The number of veterans served by each 
                organization.</DELETED>
                <DELETED>    (C) An assessment of the effectiveness of 
                the services provided under the program at improving 
                the transition process for former members of the Armed 
                Forces and spouses described in subsection (a), based 
                on metrics determined by the Secretary of Labor in 
                consultation with the Secretary of Veterans 
                Affairs.</DELETED>
                <DELETED>    (D) The amount of each grant awarded to 
                each organization under the program.</DELETED>
                <DELETED>    (E) Such other matters as the Secretary of 
                Labor, in consultation with the Secretary of Veterans 
                Affairs, considers appropriate.</DELETED>
        <DELETED>    (3) Appropriate committees of congress.--In this 
        subsection, the term ``appropriate committees of Congress'' 
        means--</DELETED>
                <DELETED>    (A) the Committee on Veterans' Affairs and 
                the Committee on Appropriations of the Senate; 
                and</DELETED>
                <DELETED>    (B) the Committee on Veterans' Affairs and 
                the Committee on Appropriations of the House of 
                Representatives.</DELETED>
<DELETED>    (h) Authorization of Appropriations.--There is authorized 
to be appropriated $10,000,000 to carry out this section.</DELETED>

<DELETED>SEC. 103. STUDY OF COMMUNITY-BASED TRANSITION ASSISTANCE 
              PROGRAMS FOR FORMER MEMBERS OF THE ARMED 
              FORCES.</DELETED>

<DELETED>    (a) Study.--</DELETED>
        <DELETED>    (1) In general.--The Secretary of Veterans Affairs 
        shall, in consultation with the Secretary of Labor and State 
        entities that serve former members of the Armed Forces, enter 
        into an agreement with a Federal or non-Federal entity to 
        develop or access a comprehensive list of community-based 
        programs that--</DELETED>
                <DELETED>    (A) provide transition assistance to such 
                former members that lead directly to successful 
                transition to civilian life, such as--</DELETED>
                        <DELETED>    (i) resume assistance;</DELETED>
                        <DELETED>    (ii) interview training;</DELETED>
                        <DELETED>    (iii) job recruitment 
                        training;</DELETED>
                        <DELETED>    (iv) entrepreneurship 
                        training;</DELETED>
                        <DELETED>    (v) financial services;</DELETED>
                        <DELETED>    (vi) legal assistance;</DELETED>
                        <DELETED>    (vii) educational supportive 
                        services;</DELETED>
                        <DELETED>    (viii) assistance with accessing 
                        benefits provided under laws administered by 
                        the Secretary of Veterans Affairs, including 
                        home loan benefits, education benefits, 
                        adaptive housing grants, and other benefits; 
                        and</DELETED>
                        <DELETED>    (ix) nonclinical case management; 
                        and</DELETED>
                <DELETED>    (B) are operated by nonprofit 
                organizations.</DELETED>
        <DELETED>    (2) Updates.--</DELETED>
                <DELETED>    (A) Periodic.--Not less frequently than 
                once every five years, the Secretary shall update the 
                list created under paragraph (1).</DELETED>
                <DELETED>    (B) Upon request.--In addition to periodic 
                updates under subparagraph (A), the Secretary shall 
                update the list created under paragraph (1) upon 
                request of an organization with a program included in 
                the list.</DELETED>
                <DELETED>    (C) Verification.--The Secretary shall, in 
                consultation with State entities that serve former 
                members of the Armed Forces and to the degree 
                practicable, verify changes to the list made under this 
                paragraph.</DELETED>
<DELETED>    (b) Transmission to Members.--The Secretary shall transmit 
the list created, and revised as the case may be, under subsection (a) 
to the Secretary of Labor and the Secretary of Defense so the 
Secretaries of the military departments may provide information in the 
list to members of the Armed Forces who participate in the Transition 
Assistance Program under sections 1142 and 1144 of title 10, United 
States Code.</DELETED>
<DELETED>    (c) Online Publication.--The Secretary of Veterans Affairs 
shall publish the list created, and revised as the case may be, under 
subsection (a) on a public website of the Department of Veterans 
Affairs.</DELETED>

<DELETED>SEC. 104. MODIFICATION OF ELIGIBILITY FOR CARE FROM DEPARTMENT 
              OF VETERANS AFFAIRS FOR FORMER MEMBERS OF THE ARMED 
              FORCES WITH OTHER THAN HONORABLE DISCHARGES AND REPORT ON 
              SUCH CARE.</DELETED>

<DELETED>    (a) Eligibility.--Subsection (b)(2)(B) of section 1720I of 
title 38, United States Code, is amended by striking ``a discharge by 
court martial'' and inserting ``a dismissal''.</DELETED>
<DELETED>    (b) Information.--Subsection (e) of such section is 
amended--</DELETED>
        <DELETED>    (1) in paragraph (3)--</DELETED>
                <DELETED>    (A) in subparagraph (B), by striking 
                ``and'' at the end;</DELETED>
                <DELETED>    (B) in subparagraph (C), by striking 
                ``and'' at the end;</DELETED>
                <DELETED>    (C) by redesignating subparagraph (C) as 
                subparagraph (D); and</DELETED>
                <DELETED>    (D) by inserting after subparagraph (B) 
                the following new subparagraph (C):</DELETED>
                <DELETED>    ``(C) is displayed prominently on a 
                website of the Department; and'';</DELETED>
        <DELETED>    (2) by redesignating paragraph (4) as paragraph 
        (5); and</DELETED>
        <DELETED>    (3) by inserting after paragraph (3) the following 
        new paragraph (4):</DELETED>
        <DELETED>    ``(4) shall include outreach on Internet search 
        engines; and''.</DELETED>
<DELETED>    (c) Annual Report.--Subsection (f) of such section is 
amended--</DELETED>
        <DELETED>    (1) in paragraph (1), by striking ``Not less 
        frequently than once'' and inserting ``Not later than February 
        15''; and</DELETED>
        <DELETED>    (2) in paragraph (2)--</DELETED>
                <DELETED>    (A) by redesignating subparagraph (C) as 
                subparagraph (F); and</DELETED>
                <DELETED>    (B) by inserting after subsection (B) the 
                following new subparagraphs:</DELETED>
                <DELETED>    ``(C) The types of mental or behavioral 
                health care needs treated under this section.</DELETED>
                <DELETED>    ``(D) The demographics of individuals 
                being treated under this section, including--</DELETED>
                        <DELETED>    ``(i) age;</DELETED>
                        <DELETED>    ``(ii) era of service in the Armed 
                        Forces;</DELETED>
                        <DELETED>    ``(iii) branch of service in the 
                        Armed Forces; and</DELETED>
                        <DELETED>    ``(iv) geographic 
                        location.</DELETED>
                <DELETED>    ``(E) The average number of visits for an 
                individual for mental or behavioral health care under 
                this section.''.</DELETED>

            <DELETED>TITLE II--SUICIDE PREVENTION</DELETED>

<DELETED>SEC. 201. GRANTS FOR ORGANIZATIONS PROVIDING MENTAL HEALTH 
              WELLNESS SERVICES TO VETERANS.</DELETED>

<DELETED>    (a) Purpose.--The purpose of this section is to facilitate 
the provision of mental health services for veterans with mental health 
conditions who are receiving care outside of the Department of Veterans 
Affairs.</DELETED>
<DELETED>    (b) Grants.--</DELETED>
        <DELETED>    (1) In general.--Subchapter II of chapter 17 of 
        title 38, United States Code, is amended by adding at the end 
        the following new section:</DELETED>
<DELETED>``Sec. 1720J. Financial assistance for mental health 
              supportive services for veterans seeking mental health 
              treatment</DELETED>
<DELETED>    ``(a) Distribution of Financial Assistance.--(1) The 
Secretary shall provide financial assistance to eligible entities 
approved under this section to provide or coordinate the provision of 
mental health supportive services described in subsection (b) for a 
veteran with a mental health condition who is seeking mental health 
treatment.</DELETED>
<DELETED>    ``(2) Financial assistance under paragraph (1) shall 
consist of the award of a grant to an approved eligible entity for each 
veteran described in paragraph (1) for which the approved eligible 
entity is providing or coordinating the provision of mental health 
supportive services.</DELETED>
<DELETED>    ``(3)(A) The Secretary shall award grants under this 
section to each approved eligible entity that is providing or 
coordinating the provision of mental health supportive services under 
this section.</DELETED>
<DELETED>    ``(B) The Secretary may establish intervals of payment for 
the administration of grants under this section and establish a maximum 
amount to be awarded, in accordance with the services being provided 
and the duration of such services.</DELETED>
<DELETED>    ``(4) In providing financial assistance under paragraph 
(1), the Secretary shall give preference to entities providing or 
coordinating the provision of supportive mental health services for 
veterans with mental health conditions who face barriers in accessing 
mental health care services from the Department.</DELETED>
<DELETED>    ``(5) The Secretary shall ensure that, to the extent 
practicable, financial assistance under this subsection is equitably 
distributed across geographic regions, including rural communities and 
tribal lands.</DELETED>
<DELETED>    ``(6) Each entity receiving financial assistance under 
this section to provide mental health supportive services to a veteran 
with a mental health condition shall notify that veteran that such 
services are being paid for, in whole or in part, by the 
Department.</DELETED>
<DELETED>    ``(7) The Secretary shall require entities receiving 
financial assistance under this section to submit a report to the 
Secretary that describes the services provided or coordinated with such 
financial assistance.</DELETED>
<DELETED>    ``(b) Mental Health Supportive Services.--The mental 
health supportive services described in this subsection are services 
provided by an eligible entity or a subcontractor of an eligible entity 
that address the needs of veterans with mental health conditions, 
including--</DELETED>
        <DELETED>    ``(1) outreach services;</DELETED>
        <DELETED>    ``(2) case management services;</DELETED>
        <DELETED>    ``(3) assistance in obtaining any benefits from 
        the Department that the veteran may be eligible to receive, 
        including health care services, vocational and rehabilitation 
        counseling, employment and training services, and educational 
        assistance; and</DELETED>
        <DELETED>    ``(4) assistance in obtaining and coordinating the 
        provision of other public benefits provided by any Federal, 
        State, or local agency, or any other eligible entity, 
        including--</DELETED>
                <DELETED>    ``(A) health care services (including 
                obtaining health insurance);</DELETED>
                <DELETED>    ``(B) daily living services;</DELETED>
                <DELETED>    ``(C) personal financial planning 
                services;</DELETED>
                <DELETED>    ``(D) transportation services;</DELETED>
                <DELETED>    ``(E) income support services;</DELETED>
                <DELETED>    ``(F) fiduciary and representative payee 
                services;</DELETED>
                <DELETED>    ``(G) legal services to assist the veteran 
                with issues that interfere with the ability of the 
                veteran to find and retain meaningful employment, 
                housing, or benefits to which the veteran may be 
                entitled;</DELETED>
                <DELETED>    ``(H) child care services;</DELETED>
                <DELETED>    ``(I) housing counseling; and</DELETED>
                <DELETED>    ``(J) other services necessary for 
                maintaining independent living.</DELETED>
<DELETED>    ``(c) Application for Financial Assistance.--(1) An 
eligible entity seeking financial assistance under subsection (a) shall 
submit to the Secretary an application therefor in such form, in such 
manner, and containing such commitments and information as the 
Secretary determines to be necessary to carry out this 
section.</DELETED>
<DELETED>    ``(2) Each application submitted by an eligible entity 
under paragraph (1) shall contain--</DELETED>
        <DELETED>    ``(A) a description of the mental health 
        supportive services described in subsection (b) proposed to be 
        provided by the eligible entity under this section and the 
        identified needs for those services;</DELETED>
        <DELETED>    ``(B) a description of the types of veterans with 
        a mental health condition proposed to be provided such 
        services;</DELETED>
        <DELETED>    ``(C) an estimate of the number of veterans with a 
        mental health condition proposed to be provided such 
        services;</DELETED>
        <DELETED>    ``(D) evidence of the experience of the eligible 
        entity in providing mental health supportive services to 
        veterans with a mental health condition; and</DELETED>
        <DELETED>    ``(E) a description of the managerial capacity of 
        the eligible entity--</DELETED>
                <DELETED>    ``(i) to coordinate the provision of 
                mental health supportive services with the provision of 
                mental health services by the eligible entity or 
                another organization;</DELETED>
                <DELETED>    ``(ii) to assess continually the needs of 
                veterans with a mental health condition for mental 
                health supportive services;</DELETED>
                <DELETED>    ``(iii) to coordinate the provision of 
                mental health supportive services with the services of 
                the Department; and</DELETED>
                <DELETED>    ``(iv) to tailor supportive mental health 
                services to the needs of veterans with a mental health 
                condition.</DELETED>
<DELETED>    ``(3)(A) The Secretary shall establish criteria for the 
selection of eligible entities to be provided financial assistance 
under this section.</DELETED>
<DELETED>    ``(B) Criteria established under subparagraph (A) with 
respect to an eligible entity shall include the following:</DELETED>
        <DELETED>    ``(i) Relevant accreditation as may be required by 
        each State in which the eligible entity operates.</DELETED>
        <DELETED>    ``(ii) Experience coordinating care or providing 
        treatment for veterans or members of the Armed 
        Forces.</DELETED>
<DELETED>    ``(d) Technical Assistance.--(1) The Secretary shall 
provide training and technical assistance to eligible entities provided 
financial assistance under this section regarding the planning, 
development, and provision of mental health supportive services under 
this section.</DELETED>
<DELETED>    ``(2) The Secretary may provide the training described in 
paragraph (1) directly or through grants or contracts with appropriate 
public or nonprofit private entities, including through grants awarded 
under section 2064 of this title.</DELETED>
<DELETED>    ``(e) Collection of Information.--To the extent 
practicable, the Secretary may collect information from an eligibility 
entity awarded a grant under this section relating to a mental health 
condition of a veteran for inclusion in the electronic health record of 
the Department for such veteran for the sole purpose of improving care 
provided to such veteran.</DELETED>
<DELETED>    ``(f) Funding.--From amounts appropriated to the 
Department for medical services, there shall be available to carry out 
subsections (a), (b), and (c) the following:</DELETED>
        <DELETED>    ``(1) $5,000,000 for fiscal year 2021.</DELETED>
        <DELETED>    ``(2) $10,000,000 for fiscal year 2022.</DELETED>
        <DELETED>    ``(3) $15,000,000 for fiscal year 2023.</DELETED>
<DELETED>    ``(g) Definitions.--In this section:</DELETED>
        <DELETED>    ``(1) The term `eligible entity' means any of the 
        following:</DELETED>
                <DELETED>    ``(A) An incorporated private institution 
                or foundation--</DELETED>
                        <DELETED>    ``(i) no part of the net earnings 
                        of which inures to the benefit of any member, 
                        founder, contributor, or individual;</DELETED>
                        <DELETED>    ``(ii) that has a governing board 
                        that is responsible for the operation of the 
                        mental health supportive services provided 
                        under this section; and</DELETED>
                        <DELETED>    ``(iii) that is approved by the 
                        Secretary with respect to financial 
                        responsibility.</DELETED>
                <DELETED>    ``(B) A for-profit limited partnership, 
                the sole general partner of which is an organization 
                meeting the requirements of clauses (i), (ii), and 
                (iii) of subparagraph (A).</DELETED>
                <DELETED>    ``(C) A corporation wholly owned and 
                controlled by an organization meeting the requirements 
                of clauses (i), (ii), and (iii) of subparagraph 
                (A).</DELETED>
                <DELETED>    ``(D) A tribally designated housing entity 
                (as defined in section 4 of the Native American Housing 
                Assistance and Self-Determination Act of 1996 (25 
                U.S.C. 4103)).</DELETED>
        <DELETED>    ``(2) The term `veteran with a mental health 
        condition' means a veteran who has been diagnosed with, or who 
        is seeking treatment for, one or more mental health conditions, 
        as determined by the Secretary.''.</DELETED>
        <DELETED>    (2) Clerical amendment.--The table of sections at 
        the beginning of chapter 17 is amended by inserting after the 
        item relating to section 1720I the following new 
        item:</DELETED>

<DELETED>``1720J. Financial assistance for mental health supportive 
                            services for veterans seeking mental health 
                            treatment.''.
<DELETED>    (c) Study on Effectiveness of Program.--</DELETED>
        <DELETED>    (1) In general.--The Secretary of Veterans Affairs 
        shall conduct a study on the effectiveness of the program of 
        financial assistance under section 1720J of title 38, United 
        States Code, as added by subsection (b), in meeting the needs 
        of veterans with a mental health condition, as that term is 
        defined in that section.</DELETED>
        <DELETED>    (2) Comparison.--In conducting the study required 
        by paragraph (1), the Secretary shall compare the results of 
        the program described in that paragraph with other programs of 
        the Department of Veterans Affairs dedicated to the delivery of 
        mental health services to veterans.</DELETED>
        <DELETED>    (3) Criteria.--In making the comparison required 
        by paragraph (2), the Secretary shall examine the 
        following:</DELETED>
                <DELETED>    (A) The satisfaction of veterans targeted 
                by the programs described in paragraph (2).</DELETED>
                <DELETED>    (B) The health status of such 
                veterans.</DELETED>
                <DELETED>    (C) The mental wellness of such 
                veterans.</DELETED>
                <DELETED>    (D) The degree to which such veterans are 
                encouraged to engage in productive activity by such 
                programs.</DELETED>
                <DELETED>    (E) The number of veterans using such 
                programs, disaggregated by--</DELETED>
                        <DELETED>    (i) veterans who have received 
                        care from the Department in the previous two 
                        years; and</DELETED>
                        <DELETED>    (ii) veterans who have not 
                        received care from the Department in the 
                        previous two years.</DELETED>
                <DELETED>    (F) The number of veterans who die by 
                suicide while receiving services from an entity in 
                receipt of a grant under the program of financial 
                assistance under section 1720J of title 38, United 
                States Code, as added by subsection (b), or who die by 
                suicide during the 180-day period after receiving such 
                services.</DELETED>
        <DELETED>    (4) Report.--Not later than December 31, 2021, and 
        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 results of the study required by paragraph 
        (1).</DELETED>
<DELETED>    (d) Effective Date.--The Secretary shall begin providing 
financial assistance under section 1720J of title 38, United States 
Code, as added by subsection (b), not later than one year after the 
date of the enactment of this Act.</DELETED>

<DELETED>SEC. 202. DESIGNATION OF BUDDY CHECK WEEK BY DEPARTMENT OF 
              VETERANS AFFAIRS.</DELETED>

<DELETED>    (a) In General.--The Secretary of Veterans Affairs shall 
designate one week per year to organize outreach events and educate 
veterans on how to conduct peer wellness checks, which shall be known 
as ``Buddy Check Week''.</DELETED>
<DELETED>    (b) Events and Education.--</DELETED>
        <DELETED>    (1) In general.--During Buddy Check Week, the 
        Secretary, in consultation with organizations that represent 
        veterans, non-profits that serve veterans, mental health 
        experts, members of the Armed Forces, and such other entities 
        and individuals as the Secretary considers appropriate, shall 
        collaborate with organizations that represent veterans to 
        provide educational opportunities for veterans to learn how to 
        conduct peer wellness checks.</DELETED>
        <DELETED>    (2) Training matters.--As part of the educational 
        opportunities provided under paragraph (1), the Secretary shall 
        provide the following:</DELETED>
                <DELETED>    (A) A script for veterans to use to 
                conduct peer wellness checks that includes information 
                on appropriate referrals to resources veterans might 
                need.</DELETED>
                <DELETED>    (B) Online and in-person training, as 
                appropriate, on how to conduct a peer wellness 
                check.</DELETED>
                <DELETED>    (C) Opportunities for members of 
                organizations that represent veterans to learn how to 
                train individuals to conduct peer wellness 
                checks.</DELETED>
                <DELETED>    (D) Training for veterans participating in 
                Buddy Check Week on how to transfer a phone call 
                directly to the Veterans Crisis Line.</DELETED>
                <DELETED>    (E) Resiliency training for veterans 
                participating in Buddy Check Week on handling a veteran 
                in crisis.</DELETED>
        <DELETED>    (3) Online materials.--All training materials 
        provided under the educational opportunities under paragraph 
        (1) shall be made available on a website of the 
        Department.</DELETED>
<DELETED>    (c) Outreach.--The Secretary, in collaboration with 
organizations that represent veterans, may conduct outreach regarding 
educational opportunities under subsection (b) at--</DELETED>
        <DELETED>    (1) public events where many veterans are expected 
        to congregate;</DELETED>
        <DELETED>    (2) meetings of organizations that represent 
        veterans;</DELETED>
        <DELETED>    (3) facilities of the Department of Veterans 
        Affairs; and</DELETED>
        <DELETED>    (4) such other locations as the Secretary, in 
        collaboration with organizations that represent veterans, 
        considers appropriate.</DELETED>
<DELETED>    (d) Veterans Crisis Line Plan.--</DELETED>
        <DELETED>    (1) In general.--The Secretary shall ensure that 
        the Veterans Crisis Line has a plan for handling the potential 
        increase of calls that may occur during Buddy Check 
        Week.</DELETED>
        <DELETED>    (2) Submittal of plan.--The head of the Veterans 
        Crisis Line shall submit to the Secretary a plan for how to 
        handle excess calls during Buddy Check Week, which may include 
        the following:</DELETED>
                <DELETED>    (A) Additional hours for staff.</DELETED>
                <DELETED>    (B) The use of a backup call 
                center.</DELETED>
                <DELETED>    (C) Any other plan to ensure that calls 
                from veterans in crisis are being answered in a timely 
                manner by an individual trained at the same level as a 
                Veterans Crisis Line responder.</DELETED>
<DELETED>    (e) Veterans Crisis Line Defined.--In this section, the 
term ``Veterans Crisis Line'' means the toll-free hotline for veterans 
established under section 1720F(h) of title 38, United States 
Code.</DELETED>

<DELETED>SEC. 203. POST-TRAUMATIC GROWTH PARTNERSHIPS.</DELETED>

<DELETED>    (a) In General.--The Secretary of Veterans Affairs, in 
consultation with the Secretary of Defense and the Secretary of 
Homeland Security, shall enter into partnerships with nonprofit mental 
health organizations to facilitate post-traumatic growth among veterans 
who have experienced trauma.</DELETED>
<DELETED>    (b) Consultation.--Before entering into a partnership 
under subsection (a), the Secretary of Veterans Affairs shall consult 
with the National Institute of Mental Health, the National Alliance on 
Mental Illness, the American Psychological Association, the 
Posttraumatic Growth Research Group, and organizations that represent 
veterans.</DELETED>
<DELETED>    (c) Selection of Partners.--The Secretary of Veterans 
Affairs shall ensure that each organization with which the Secretary 
enters into a partnership under subsection (a) has a demonstrated 
history of success with programs to facilitate post-traumatic growth, 
including--</DELETED>
        <DELETED>    (1) long-term follow-up with veterans who have 
        participated in such a program for not less than one year after 
        completion of the program; and</DELETED>
        <DELETED>    (2) sustained positive, clinically significant 
        outcomes for veterans who have participated in such a program 
        for not less than 180 days after completion of the 
        program.</DELETED>
<DELETED>    (d) Outcomes From Partners.--The Secretary of Veterans 
Affairs shall require each nonprofit mental health organization that 
enters into a partnership with the Secretary under subsection (a) to 
submit to the Secretary a description of the outcomes from such 
partnership, including the following:</DELETED>
        <DELETED>    (1) The number of veterans who participate in 
        programs of the organization to facilitate post-traumatic 
        growth, including the number of veterans who drop out before 
        completion of the program.</DELETED>
        <DELETED>    (2) The types of mental or behavioral health 
        conditions of veterans who participate in such 
        programs.</DELETED>
        <DELETED>    (3) The percentage of veterans who experience 
        significant post-traumatic growth.</DELETED>
        <DELETED>    (4) Such other topics as the Secretary may require 
        to track post-traumatic growth.</DELETED>
<DELETED>    (e) Post-Traumatic Growth.--</DELETED>
        <DELETED>    (1) In general.--For purposes of this section, 
        ``post-traumatic growth'' means positive responses described in 
        paragraph (3) experienced after, and often as a result of, a 
        traumatic event or a major life crisis.</DELETED>
        <DELETED>    (2) Measurement of growth.--Post-traumatic growth 
        under this section shall be measured through self-reported 
        scales, use of the post-traumatic stress disorder checklist set 
        forth in the most recent edition of the Diagnostic and 
        Statistical Manual of Mental Disorders published by the 
        American Psychiatric Association, and such other metrics as the 
        Secretary considers necessary.</DELETED>
        <DELETED>    (3) Positive responses described.--Positive 
        responses described in this paragraph are positive responses in 
        one or more areas of life, including the following:</DELETED>
                <DELETED>    (A) An appreciation of and for 
                life.</DELETED>
                <DELETED>    (B) Improved relationships with 
                others.</DELETED>
                <DELETED>    (C) Realization of new possibilities in 
                life.</DELETED>
                <DELETED>    (D) Realization of personal 
                strength.</DELETED>
                <DELETED>    (E) Spiritual change.</DELETED>
                <DELETED>    (F) Such other areas that the Secretary, 
                in consultation with organizations specified in 
                subsection (b), considers necessary.</DELETED>

<DELETED>SEC. 204. PROGRESS OF DEPARTMENT OF VETERANS AFFAIRS IN 
              MEETING GOALS AND OBJECTIVES OF NATIONAL STRATEGY FOR 
              PREVENTING VETERAN SUICIDE.</DELETED>

<DELETED>    (a) In General.--The Secretary of Veterans Affairs shall 
develop metrics to track progress on each of the 14 goals and 43 
objectives outlined in the National Strategy for Preventing Veteran 
Suicide, 2018-2028 prepared by the Office of Mental Health and Suicide 
Prevention of the Department of Veterans Affairs.</DELETED>
<DELETED>    (b) Metrics.--The metrics developed under subsection (a) 
shall include measures of both performance and effectiveness.</DELETED>
<DELETED>    (c) Initial Report.--</DELETED>
        <DELETED>    (1) In general.--Not later than 180 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 that contains the metrics developed under subsection 
        (a).</DELETED>
        <DELETED>    (2) Elements.--The report submitted under 
        paragraph (1) shall include the following:</DELETED>
                <DELETED>    (A) An explanation of why the metrics 
                developed under subsection (a) were chosen.</DELETED>
                <DELETED>    (B) An assessment of how accurately those 
                metrics will reflect the goals and objectives specified 
                in such subsection.</DELETED>
<DELETED>    (d) Annual Report.--Not later than one year after the 
submittal of the report under subsection (b), and 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 that contains--</DELETED>
        <DELETED>    (1) an assessment of the progress of the 
        Department in meeting the goals and objectives specified in 
        subsection (a);</DELETED>
        <DELETED>    (2) a description of any action to be taken by the 
        Department if those goals and objectives are not being 
        met;</DELETED>
        <DELETED>    (3) a description of any changes to those goals 
        and objectives;</DELETED>
        <DELETED>    (4) an identification of any new programs or 
        partnerships that have resulted from the implementation of the 
        National Strategy for Preventing Veteran Suicide, 2018-
        2028;</DELETED>
        <DELETED>    (5) an assessment of the effectiveness of the 
        National Strategy for Preventing Veterans Suicide, 2018-2028 at 
        reducing veteran suicide; and</DELETED>
        <DELETED>    (6) such other topics as the Secretary considers 
        necessary.</DELETED>

<DELETED>SEC. 205. STUDY ON FEASIBILITY AND ADVISABILITY OF PROVIDING 
              CERTAIN COMPLEMENTARY AND INTEGRATIVE HEALTH 
              SERVICES.</DELETED>

<DELETED>    (a) In General.--Not later than 180 days after the date of 
the enactment of this Act, the Secretary of Veterans Affairs shall 
complete a study on the feasibility and advisability of providing 
complementary and integrative health treatments described in subsection 
(b) at all facilities of the Department of Veterans Affairs.</DELETED>
<DELETED>    (b) Treatments Described.--Complementary and integrative 
health treatments described in this subsection shall consist of the 
following:</DELETED>
        <DELETED>    (1) Yoga.</DELETED>
        <DELETED>    (2) Meditation.</DELETED>
        <DELETED>    (3) Acupuncture.</DELETED>
        <DELETED>    (4) Chiropractic care.</DELETED>
        <DELETED>    (5) Other treatments that show sufficient evidence 
        of efficacy at treating mental or physical health conditions, 
        as determined by the Secretary.</DELETED>
<DELETED>    (c) Provision of Treatment.--The Secretary may provide 
complementary and integrative health treatments under this section at a 
facility of the Department in person or by telehealth.</DELETED>
<DELETED>    (d) Report.--Not later than 90 days after the completion 
of the study under subsection (a), 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 such 
study, including--</DELETED>
        <DELETED>    (1) the results of such study; and</DELETED>
        <DELETED>    (2) such recommendations regarding the furnishing 
        of complementary and integrative health treatments described in 
        subsection (b) as the Secretary considers 
        appropriate.</DELETED>

<DELETED>SEC. 206. PROGRAM TO PROVIDE VETERANS ACCESS TO COMPLEMENTARY 
              AND INTEGRATIVE HEALTH SERVICES THROUGH ANIMAL THERAPY, 
              AGRI-THERAPY, AND OUTDOOR SPORTS THERAPY.</DELETED>

<DELETED>    (a) In General.--Not later than 180 days after the date of 
the enactment of this Act, the Secretary of Veterans Affairs shall 
commence the conduct of a program to provide complementary and 
integrative health services described in subsection (b) to veterans 
from the Department of Veterans Affairs or through the use of non-
Department entities for the treatment of post-traumatic stress 
disorder, depression, anxiety, or other conditions as determined by the 
Secretary.</DELETED>
<DELETED>    (b) Treatments Described.--Complementary and integrative 
health treatments described in this subsection shall consist of the 
following:</DELETED>
        <DELETED>    (1) Equine therapy.</DELETED>
        <DELETED>    (2) Other animal therapy.</DELETED>
        <DELETED>    (3) Agri-therapy.</DELETED>
        <DELETED>    (4) Outdoor sports therapy.</DELETED>
<DELETED>    (c) Eligible Veterans.--A veteran is eligible to 
participate in the program under this section if the veteran--
</DELETED>
        <DELETED>    (1) is enrolled in the system of patient 
        enrollment of the Department established and operated under 
        section 1705(a) of title 38, United States Code; and</DELETED>
        <DELETED>    (2) has received health care under the laws 
        administered by the Secretary during the two-year period 
        preceding the initial participation of the veteran in the 
        program.</DELETED>
<DELETED>    (d) Duration.--</DELETED>
        <DELETED>    (1) In general.--The Secretary shall carry out the 
        program under this section for a two-year period beginning on 
        the commencement of the program.</DELETED>
        <DELETED>    (2) Extension.--The Secretary may extend the 
        duration of the program under this section if the Secretary, 
        based on the results of the interim report submitted under 
        subsection (e)(1), determines that it is appropriate to do 
        so.</DELETED>
<DELETED>    (e) Locations.--</DELETED>
        <DELETED>    (1) In general.--The Secretary shall select not 
        fewer than five facilities of the Department at which to carry 
        out the program under this section.</DELETED>
        <DELETED>    (2) Selection criteria.--In selecting facilities 
        under paragraph (1), the Secretary shall ensure that--
        </DELETED>
                <DELETED>    (A) the locations are in geographically 
                diverse areas; and</DELETED>
                <DELETED>    (B) not fewer than three facilities serve 
                veterans in rural or highly rural areas (as determined 
                through the use of the Rural-Urban Commuting Areas 
                coding system of the Department of 
                Agriculture).</DELETED>
<DELETED>    (f) Reports.--</DELETED>
        <DELETED>    (1) Interim report.--</DELETED>
                <DELETED>    (A) In general.--Not later than one year 
                after the commencement of the program under this 
                section, 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 progress of the program.</DELETED>
                <DELETED>    (B) Elements.--The report required by 
                subparagraph (A) shall include the following:</DELETED>
                        <DELETED>    (i) The number of participants in 
                        the program.</DELETED>
                        <DELETED>    (ii) The types of therapy offered 
                        at each facility at which the program is being 
                        carried out.</DELETED>
                        <DELETED>    (iii) An assessment of whether 
                        participation by a veteran in the program 
                        resulted in any changes in clinically relevant 
                        endpoints for the veteran with respect to the 
                        conditions specified in subsection 
                        (a).</DELETED>
                        <DELETED>    (iv) An assessment of the quality 
                        of life of veterans participating in the 
                        program, including the results of a 
                        satisfaction survey of the participants in the 
                        program, disaggregated by treatment under 
                        subsection (b).</DELETED>
                        <DELETED>    (v) The determination of the 
                        Secretary with respect to extending the program 
                        under subsection (c)(2).</DELETED>
                        <DELETED>    (vi) Any recommendations of the 
                        Secretary with respect to expanding the 
                        program.</DELETED>
        <DELETED>    (2) Final report.--Not later than 90 days after 
        the termination of the program under this section, 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 final report on the program.</DELETED>

<DELETED>SEC. 207. COMPTROLLER GENERAL REPORT ON MANAGEMENT BY 
              DEPARTMENT OF VETERANS AFFAIRS OF VETERANS AT HIGH RISK 
              FOR SUICIDE.</DELETED>

<DELETED>    (a) In General.--Not later than 18 months 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 efforts of the Department of Veterans Affairs to manage 
veterans at high risk for suicide.</DELETED>
<DELETED>    (b) Elements.--The report required by subsection (a) shall 
include the following:</DELETED>
        <DELETED>    (1) A description of how the Department identifies 
        patients as high risk for suicide, with particular 
        consideration to the efficacy of inputs into the Recovery 
        Engagement and Coordination for Health - Veterans Enhanced 
        Treatment program (commonly referred to as the ``REACH VET'' 
        program) of the Department, including an assessment of the 
        efficacy of such identifications disaggregated by age, gender, 
        Veterans Integrated Service Network, and, to the extent 
        practicable, medical center of the Department.</DELETED>
        <DELETED>    (2) A description of how the Department intervenes 
        when a patient is identified as high risk, including an 
        assessment of the efficacy of such interventions disaggregated 
        by age, gender, Veterans Integrated Service Network, and, to 
        the extent practicable, medical center of the 
        Department.</DELETED>
        <DELETED>    (3) A description of how the Department monitors 
        patients who have been identified as high risk, including an 
        assessment of the efficacy of such monitoring and any follow-
        ups disaggregated by age, gender, Veterans Integrated Service 
        Network, and, to the extent practicable, medical center of the 
        Department.</DELETED>
        <DELETED>    (4) A review of staffing levels of suicide 
        prevention coordinators across the Veterans Health 
        Administration.</DELETED>
        <DELETED>    (5) A review of the resources and programming 
        offered to family members and friends of veterans who have a 
        mental health condition in order to assist that veteran in 
        treatment and recovery.</DELETED>
        <DELETED>    (6) An assessment of such other areas as the 
        Comptroller General considers appropriate to study.</DELETED>

    <DELETED>TITLE III--PROGRAMS, STUDIES, AND GUIDELINES ON MENTAL 
                            HEALTH</DELETED>

<DELETED>SEC. 301. PROGRAM TO PROVIDE VETERANS ACCESS TO COMPUTERIZED 
              COGNITIVE BEHAVIORAL THERAPY.</DELETED>

<DELETED>    (a) In General.--Not later than 210 days after the date of 
the enactment of this Act, the Secretary of Veterans Affairs shall 
commence the conduct of a program to assess the feasibility and 
advisability of using computerized cognitive behavioral therapy to 
treat eligible veterans suffering from depression, anxiety, post-
traumatic stress disorder, military sexual trauma, or substance use 
disorder who are already receiving evidence-based therapy from the 
Department of Veterans Affairs.</DELETED>
<DELETED>    (b) Eligible Veterans.--A veteran is eligible to 
participate in the program under this section if the veteran--
</DELETED>
        <DELETED>    (1) is enrolled in the system of patient 
        enrollment of the Department of Veterans Affairs established 
        and operated under section 1705(a) of title 38, United States 
        Code; and</DELETED>
        <DELETED>    (2) has received health care under the laws 
        administered by the Secretary during the two-year period 
        preceding the initial participation of the veteran in the 
        program.</DELETED>
<DELETED>    (c) Duration.--The Secretary shall carry out the program 
under this section for a two-year period beginning on the commencement 
of the program.</DELETED>
<DELETED>    (d) Locations.--</DELETED>
        <DELETED>    (1) In general.--The Secretary shall select not 
        fewer than three facilities of the Department of Veterans 
        Affairs at which to carry out the program under this 
        section.</DELETED>
        <DELETED>    (2) Selection criteria.--In selecting facilities 
        under paragraph (1), the Secretary shall ensure that--
        </DELETED>
                <DELETED>    (A) the locations are in geographically 
                diverse areas; and</DELETED>
                <DELETED>    (B) not fewer than two facilities serve 
                veterans in rural or highly rural areas (as determined 
                through the use of the Rural-Urban Commuting Areas 
                coding system of the Department of 
                Agriculture).</DELETED>
<DELETED>    (e) Access to Chat.--In carrying out the program under 
this section, the Secretary shall ensure that veterans participating in 
the program have access via chat to a mental health provider 24 hours 
per day, seven days per week.</DELETED>
<DELETED>    (f) Promotion of Veterans Crisis Line.--The Secretary 
shall promote the availability of the Veterans Crisis Line to veterans 
participating in the program under this section.</DELETED>
<DELETED>    (g) Department Website.--In implementing the program under 
this section, the Secretary, to the extent feasible, shall use a 
website of the Department of Veterans Affairs to host the 
program.</DELETED>
<DELETED>    (h) Reports.--</DELETED>
        <DELETED>    (1) Interim report.--</DELETED>
                <DELETED>    (A) In general.--Not later than one year 
                after the commencement of the program under this 
                section, 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 progress of the program.</DELETED>
                <DELETED>    (B) Elements.--The report required by 
                subparagraph (A) shall include the following:</DELETED>
                        <DELETED>    (i) The number of participants in 
                        the program.</DELETED>
                        <DELETED>    (ii) An assessment of whether 
                        participation by a veteran in the program 
                        resulted in any changes in clinically relevant 
                        endpoints for the veteran with respect to the 
                        conditions specified in subsection 
                        (a).</DELETED>
                        <DELETED>    (iii) Any recommendations of the 
                        Secretary with respect to extending or 
                        expanding the program.</DELETED>
        <DELETED>    (2) Final report.--Not later than 90 days after 
        the termination of the program under this section, 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 final report on the program.</DELETED>
<DELETED>    (i) Veterans Crisis Line Defined.--In this section, the 
term ``Veterans Crisis Line'' means the toll-free hotline for veterans 
established under section 1720F(h) of title 38, United States 
Code.</DELETED>

<DELETED>SEC. 302. STUDY ON CONNECTION BETWEEN LIVING AT HIGH ALTITUDE 
              AND SUICIDE RISK FACTORS AMONG VETERANS.</DELETED>

<DELETED>    (a) In General.--Not later than 180 days after the date of 
the enactment of this Act, the Secretary of Veterans Affairs, in 
consultation with Rural Health Resource Centers of the Office of Rural 
Health of the Department of Veterans Affairs, shall commence the 
conduct of a study on the connection between living at high altitude 
and the risk of developing depression or dying by suicide among 
veterans.</DELETED>
<DELETED>    (b) Completion of Study.--The study conducted under 
subsection (a) shall be completed not later than three years after the 
date of the commencement of the study.</DELETED>
<DELETED>    (c) Individual Impact.--The study conducted under 
subsection (a) shall be conducted so as to determine the effect of high 
altitude on suicide risk at the individual level, not at the State or 
county level.</DELETED>
<DELETED>    (d) Report.--Not later than 150 days after the completion 
of the study conducted under subsection (a), 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 
results of the study.</DELETED>
<DELETED>    (e) Follow-Up Study.--</DELETED>
        <DELETED>    (1) In general.--If the Secretary determines 
        through the study conducted under subsection (a) that living at 
        high altitude is a risk factor for developing depression or 
        dying by suicide, the Secretary shall conduct an additional 
        study to identify the following:</DELETED>
                <DELETED>    (A) The most likely biological mechanism 
                that makes living at high altitude a risk factor for 
                developing depression or dying by suicide.</DELETED>
                <DELETED>    (B) The most effective treatment or 
                intervention for reducing the risk of developing 
                depression or dying by suicide associated with living 
                at high altitude.</DELETED>
        <DELETED>    (2) Report.--Not later than 150 days after 
        completing the study conducted under paragraph (1), 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 results of the 
        study.</DELETED>

<DELETED>SEC. 303. ESTABLISHMENT BY DEPARTMENT OF VETERANS AFFAIRS AND 
              DEPARTMENT OF DEFENSE OF CLINICAL PRACTICE GUIDELINES FOR 
              COMORBID MENTAL HEALTH CONDITIONS.</DELETED>

<DELETED>    (a) In General.--Not later than two years after the date 
of the enactment of this Act, the Secretary of Veterans Affairs, in 
consultation with the Secretary of Defense and the Secretary of Health 
and Human Services, shall complete the development of clinical practice 
guidelines for the treatment of post-traumatic stress disorder, 
military sexual trauma, and traumatic brain injury that is comorbid 
with substance use disorder or chronic pain.</DELETED>
<DELETED>    (b) Work Group.--</DELETED>
        <DELETED>    (1) Establishment.--In carrying out subsection 
        (a), the Secretary of Veterans Affairs, the Secretary of 
        Defense, and the Secretary of Health and Human Services shall 
        create a Trauma and Comorbid Substance Use Disorder or Chronic 
        Pain Work Group (in this section referred to as the ``Work 
        Group'').</DELETED>
        <DELETED>    (2) Membership.--The work group created under 
        paragraph (1) shall be comprised of individuals that represent 
        Federal Government entities and non-Federal Government entities 
        with expertise in the areas covered by the work group, 
        including the following:</DELETED>
                <DELETED>    (A) Academic institutions that specialize 
                in research for the treatment of conditions described 
                in subsection (a).</DELETED>
                <DELETED>    (B) The National Center for Posttraumatic 
                Stress Disorder of the Department of Veterans 
                Affairs.</DELETED>
                <DELETED>    (C) The Office of the Assistant Secretary 
                for Mental Health and Substance Use of the Department 
                of Health and Human Services.</DELETED>
        <DELETED>    (3) Relation to other work groups.--The Work Group 
        shall be created and conducted in the same manner as other work 
        groups for the development of clinical practice guidelines for 
        the Department of Veterans Affairs and the Department of 
        Defense.</DELETED>
<DELETED>    (c) Matters Included.--In developing the clinical practice 
guidelines under subsection (a), the Work Group, in consultation with 
the Post Traumatic Stress Disorder Work Group, Concussion-mTBI Work 
Group, Opioid Therapy for Chronic Pain Work Group, and Substance Use 
Work Group, shall ensure that the clinical practice guidelines include 
the following:</DELETED>
        <DELETED>    (1) Guidance with respect to the 
        following:</DELETED>
                <DELETED>    (A) The treatment of patients with post-
                traumatic stress disorder who are also experiencing a 
                substance use disorder or chronic pain.</DELETED>
                <DELETED>    (B) The treatment of patients experiencing 
                a mental health condition, including anxiety, 
                depression, or post-traumatic stress disorder as a 
                result of military sexual trauma who are also 
                experiencing a substance use disorder or chronic 
                pain.</DELETED>
                <DELETED>    (C) The treatment of patients with 
                traumatic brain injury who are also experiencing a 
                substance use disorder or chronic pain.</DELETED>
        <DELETED>    (2) Guidance with respect to the 
        following:</DELETED>
                <DELETED>    (A) Appropriate case management for 
                patients experiencing post-traumatic stress disorder 
                that is comorbid with substance use disorder or chronic 
                pain who transition from receiving care while on active 
                duty in the Armed Forces to care from health care 
                networks outside of the Department of 
                Defense.</DELETED>
                <DELETED>    (B) Appropriate case management for 
                patients experiencing a mental health condition, 
                including anxiety, depression, or post-traumatic stress 
                disorder as a result of military sexual trauma that is 
                comorbid with substance use disorder or chronic pain 
                who transition from receiving care while on active duty 
                in the Armed Forces to care from health care networks 
                outside of the Department of Defense.</DELETED>
                <DELETED>    (C) Appropriate case management for 
                patients experiencing traumatic brain injury that is 
                comorbid with substance use disorder or chronic pain 
                who transition from receiving care while on active duty 
                in the Armed Forces to care from health care networks 
                outside of the Department of Defense.</DELETED>
        <DELETED>    (3) Guidance with respect to the treatment of 
        patients who are still members of the Armed Forces and are 
        experiencing a mental health condition, including anxiety, 
        depression, or post-traumatic stress disorder as a result of 
        military sexual trauma that is comorbid with substance use 
        disorder or chronic pain.</DELETED>
        <DELETED>    (4) Guidance with respect to the assessment by the 
        National Academies of Sciences, Engineering, and Medicine of 
        the potential overmedication of veterans, as required pursuant 
        to the Senate report accompanying S. 1557, 115th Congress 
        (Senate Report 115-130), under the heading ``Overprescription 
        Prevention Report'' under the heading ``committee 
        recommendation''.</DELETED>
<DELETED>    (d) Rule of Construction.--Nothing in this section shall 
be construed to prevent the Secretary of Veterans Affairs and the 
Secretary of Defense from considering all relevant evidence, as 
appropriate, in creating the clinical practice guidelines required 
under subsection (a) or from ensuring that the final clinical practice 
guidelines developed under such subsection and subsequently updated, as 
appropriate, remain applicable to the patient populations of the 
Department of Veterans Affairs and the Department of Defense.</DELETED>

<DELETED>SEC. 304. UPDATE OF CLINICAL PRACTICE GUIDELINES FOR 
              ASSESSMENT AND MANAGEMENT OF PATIENTS AT RISK FOR 
              SUICIDE.</DELETED>

<DELETED>    (a) In General.--Not later than two years after the date 
of the enactment of this Act, the Secretary of Veterans Affairs and the 
Secretary of Defense, through the Assessment and Management of Patients 
at Risk for Suicide Work Group (in this section referred to as the 
``Work Group''), shall issue an update to the VA/DOD Clinical Practice 
Guideline for Assessment and Management of Patients at Risk for 
Suicide.</DELETED>
<DELETED>    (b) Matters Included.--In carrying out the update under 
subsection (a), the Work Group shall ensure that the clinical practice 
guidelines updated under such subsection includes the 
following:</DELETED>
        <DELETED>    (1) Enhanced guidance with respect to the 
        following:</DELETED>
                <DELETED>    (A) Gender-specific risk factors for 
                suicide and suicidal ideation.</DELETED>
                <DELETED>    (B) Gender-specific treatment efficacy for 
                depression and suicide prevention.</DELETED>
                <DELETED>    (C) Gender-specific pharmacotherapy 
                efficacy.</DELETED>
                <DELETED>    (D) Gender-specific psychotherapy 
                efficacy.</DELETED>
        <DELETED>    (2) Guidance with respect to the 
        following:</DELETED>
                <DELETED>    (A) The efficacy of alternative therapies, 
                other than psychotherapy and pharmacotherapy, including 
                the following:</DELETED>
                        <DELETED>    (i) Yoga therapy.</DELETED>
                        <DELETED>    (ii) Meditation therapy.</DELETED>
                        <DELETED>    (iii) Equine therapy.</DELETED>
                        <DELETED>    (iv) Other animal 
                        therapy.</DELETED>
                        <DELETED>    (v) Training and caring for 
                        service dogs.</DELETED>
                        <DELETED>    (vi) Agri-therapy.</DELETED>
                        <DELETED>    (vii) Art therapy.</DELETED>
                        <DELETED>    (viii) Outdoor sports 
                        therapy.</DELETED>
                        <DELETED>    (ix) Music therapy.</DELETED>
                        <DELETED>    (x) Any other alternative therapy 
                        that the Work Group considers 
                        appropriate.</DELETED>
        <DELETED>    (3) Guidance with respect to the findings of the 
        Creating Options for Veterans' Expedited Recovery Commission 
        (commonly referred to as the ``COVER Commission'') established 
        under section 931 of the Jason Simcakoski Memorial and Promise 
        Act (title IX of Public Law 114-198; 38 U.S.C. 1701 
        note).</DELETED>
<DELETED>    (c) Rule of Construction.--Nothing in this section shall 
be construed to prevent the Secretary of Veterans Affairs and the 
Secretary of Defense from considering all relevant evidence, as 
appropriate, in updating the VA/DOD Clinical Practice Guideline for 
Assessment and Management of Patients at Risk for Suicide, as required 
under subsection (a), or from ensuring that the final clinical practice 
guidelines updated under such subsection remain applicable to the 
patient populations of the Department of Veterans Affairs and the 
Department of Defense.</DELETED>

<DELETED>SEC. 305. PRECISION MEDICINE INITIATIVE OF DEPARTMENT OF 
              VETERANS AFFAIRS TO IDENTIFY AND VALIDATE BRAIN AND 
              MENTAL HEALTH BIOMARKERS.</DELETED>

<DELETED>    (a) In General.--Beginning not later than 18 months after 
the date of the enactment of this Act, the Secretary of Veterans 
Affairs shall develop and implement an initiative of the Department of 
Veterans Affairs to identify and validate brain and mental health 
biomarkers among veterans, with specific consideration for depression, 
anxiety, post-traumatic stress disorder, traumatic brain injury, and 
such other mental health conditions as the Secretary considers 
appropriate. Such initiative may be referred to as the ``Precision 
Medicine for Veterans Initiative''.</DELETED>
<DELETED>    (b) Model of Initiative.--The initiative under subsection 
(a) shall be modeled on the All of Us Precision Medicine Initiative 
administered by the National Institutes of Health with respect to 
large-scale collection of standardized data and open data 
sharing.</DELETED>
<DELETED>    (c) Use of Data.--</DELETED>
        <DELETED>    (1) Privacy and security.--In carrying out the 
        initiative under subsection (a), the Secretary shall develop 
        robust data privacy and security measures to ensure that 
        information of veterans participating in the initiative is kept 
        private and secure.</DELETED>
        <DELETED>    (2) Open platform.--</DELETED>
                <DELETED>    (A) Research purposes.--The Secretary 
                shall make de-identified data collected under the 
                initiative available for research purposes both within 
                and outside of the Department of Veterans 
                Affairs.</DELETED>
                <DELETED>    (B) Data may not be sold.--Data collected 
                under the initiative may not be sold.</DELETED>
        <DELETED>    (3) Standardization.--</DELETED>
                <DELETED>    (A) In general.--The Secretary shall 
                ensure that data collected under the initiative is 
                standardized.</DELETED>
                <DELETED>    (B) Consultation.--The Secretary shall 
                consult with the National Institutes of Health and the 
                Food and Drug Administration to determine the most 
                effective, efficient, and cost-effective way of 
                standardizing data collected under the 
                initiative.</DELETED>
                <DELETED>    (C) Manner of standardization.--Data 
                collected under the initiative shall be standardized in 
                the manner in which it is collected, entered into the 
                database, extracted, and recorded.</DELETED>
        <DELETED>    (4) Measures of brain function or structure.--Any 
        measures of brain function or structure collected under the 
        initiative shall be collected with a device that is approved by 
        the Food and Drug Administration.</DELETED>
<DELETED>    (d) Inclusion of Initiative in Program.--The Secretary 
shall assess the feasibility and advisability of coordinating efforts 
of the initiative under subsection (a) with the Million Veterans 
Program of the Department.</DELETED>

<DELETED>SEC. 306. PREVENTATIVE AND COMPLEX DATA ANALYSIS BY DEPARTMENT 
              OF VETERANS AFFAIRS.</DELETED>

<DELETED>    (a) In General.--Chapter 1 of title 38, United States 
Code, is amended by adding at the end the following new 
section:</DELETED>
<DELETED>``Sec. 119. Contracting for preventative or complex 
              statistical analysis</DELETED>
<DELETED>    ``In order to carry out statistical analysis required 
under section 302 of the Commander John Scott Hannon Veterans Mental 
Health Care Improvement Act of 2019, or any other preventative or 
complex statistical analysis required under this title or any other 
provision of law, the Secretary may contract with academic institutions 
or other qualified entities, as determined by the Secretary, to carry 
out the statistical analysis.''.</DELETED>
<DELETED>    (b) Clerical Amendment.--The table of sections at the 
beginning of chapter 1 of such title is amended by inserting after the 
item relating to section 118 the following new item:</DELETED>

<DELETED>``119. Contracting for preventative or complex statistical 
                            analysis.''.

    <DELETED>TITLE IV--OVERSIGHT OF MENTAL HEALTH CARE AND RELATED 
                           SERVICES</DELETED>

<DELETED>SEC. 401. STUDY ON EFFECTIVENESS OF SUICIDE PREVENTION AND 
              MENTAL HEALTH OUTREACH PROGRAMS OF DEPARTMENT OF VETERANS 
              AFFAIRS.</DELETED>

<DELETED>    (a) In General.--Not later than 180 days after the date of 
the enactment of this Act, the Secretary of Veterans Affairs shall 
enter into an agreement with a non-Federal Government entity to conduct 
a study on the effectiveness of the suicide prevention and mental 
health outreach materials prepared by the Department of Veterans 
Affairs and the suicide prevention and mental health outreach campaigns 
conducted by the Department.</DELETED>
<DELETED>    (b) Use of Focus Groups.--</DELETED>
        <DELETED>    (1) In general.--The Secretary shall convene not 
        fewer than eight different focus groups to evaluate the 
        effectiveness of the suicide prevention and mental health 
        materials and campaigns as required under subsection 
        (a).</DELETED>
        <DELETED>    (2) Location of focus groups.--Focus groups 
        convened under paragraph (1) shall be held in geographically 
        diverse areas as follows:</DELETED>
                <DELETED>    (A) Not fewer than two in rural or highly 
                rural areas.</DELETED>
                <DELETED>    (B) Not fewer than one in each of the four 
                districts of the Veterans Benefits 
                Administration.</DELETED>
        <DELETED>    (3) Timing of focus groups.--Focus groups convened 
        under paragraph (1) shall be held at a variety of dates and 
        times to ensure an adequate representation of veterans with 
        different work schedules.</DELETED>
        <DELETED>    (4) Number of participants.--Each focus group 
        convened under paragraph (1) shall include not fewer than five 
        and not more than 12 participants.</DELETED>
        <DELETED>    (5) Representation.--Each focus group convened 
        under paragraph (1) shall, to the extent practicable, include 
        veterans of diverse backgrounds, including--</DELETED>
                <DELETED>    (A) veterans of all eras, as determined by 
                the Secretary;</DELETED>
                <DELETED>    (B) women veterans;</DELETED>
                <DELETED>    (C) minority veterans;</DELETED>
                <DELETED>    (D) Native American veterans, as defined 
                in section 3765 of title 38, United States 
                Code;</DELETED>
                <DELETED>    (E) veterans who identify as lesbian, gay, 
                bisexual, transgender, or queer (commonly referred to 
                as ``LGBTQ'');</DELETED>
                <DELETED>    (F) veterans who live in rural or highly 
                rural areas; and</DELETED>
                <DELETED>    (G) individuals transitioning from active 
                duty in the Armed Forces to civilian life.</DELETED>
<DELETED>    (c) Report.--</DELETED>
        <DELETED>    (1) In general.--Not later than 90 days after the 
        last focus group meeting under subsection (b), 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 findings of the focus 
        groups.</DELETED>
        <DELETED>    (2) Elements.--The report required by paragraph 
        (1) shall include the following:</DELETED>
                <DELETED>    (A) Based on the findings of the focus 
                groups, an assessment of the effectiveness of current 
                suicide prevention and mental health outreach efforts 
                of the Department in reaching veterans as a whole as 
                well as specific groups of veterans (for example, women 
                veterans).</DELETED>
                <DELETED>    (B) Based on the findings of the focus 
                groups, recommendations for future suicide prevention 
                and mental health outreach efforts by the Department to 
                target specific groups of veterans.</DELETED>
                <DELETED>    (C) A plan to change the current approach 
                by the Department to suicide prevention and mental 
                health outreach or, if the Secretary decides not to 
                change the current approach, an explanation of the 
                reason for maintaining the current approach.</DELETED>
                <DELETED>    (D) Such other issues as the Secretary 
                considers necessary.</DELETED>
<DELETED>    (d) Representative Survey.--</DELETED>
        <DELETED>    (1) In general.--Not later than one year after the 
        last focus group meeting under subsection (b), the Secretary 
        shall complete a representative survey of the veteran 
        population that is informed by the focus group data in order to 
        collect information about the effectiveness of the mental 
        health and suicide prevention outreach campaigns conducted by 
        the Department.</DELETED>
        <DELETED>    (2) Veterans surveyed.--</DELETED>
                <DELETED>    (A) In general.--Veterans surveyed under 
                paragraph (1) shall include veterans described in 
                subsection (b)(5).</DELETED>
                <DELETED>    (B) Disaggregation of data.--Data of 
                veterans surveyed under paragraph (1) shall be 
                disaggregated by--</DELETED>
                        <DELETED>    (i) veterans who have received 
                        care from the Department during the two-year 
                        period preceding the survey; and</DELETED>
                        <DELETED>    (ii) veterans who have not 
                        received care from the Department during the 
                        two-year period preceding the survey.</DELETED>
<DELETED>    (e) Treatment of Contracts for Suicide Prevention and 
Mental Health Outreach Media.--</DELETED>
        <DELETED>    (1) Focus groups.--</DELETED>
                <DELETED>    (A) In general.--The Secretary shall 
                include in each contract to develop media relating to 
                suicide prevention and mental health outreach a 
                requirement that the contractor convene focus groups of 
                veterans to assess the effectiveness of suicide 
                prevention and mental health outreach.</DELETED>
                <DELETED>    (B) Representation.--Each focus group 
                required under subparagraph (A) shall, to the extent 
                practicable, include veterans of diverse backgrounds, 
                including--</DELETED>
                        <DELETED>    (i) veterans of all eras, as 
                        determined by the Secretary;</DELETED>
                        <DELETED>    (ii) women veterans;</DELETED>
                        <DELETED>    (iii) minority veterans;</DELETED>
                        <DELETED>    (iv) Native American veterans, as 
                        defined in section 3765 of title 38, United 
                        States Code;</DELETED>
                        <DELETED>    (v) veterans who identify as 
                        lesbian, gay, bisexual, transgender, or queer 
                        (commonly referred to as ``LGBTQ'');</DELETED>
                        <DELETED>    (vi) veterans who live in rural or 
                        highly rural areas; and</DELETED>
                        <DELETED>    (vii) individuals transitioning 
                        from active duty in the Armed Forces to 
                        civilian life.</DELETED>
        <DELETED>    (2) Subcontracting.--</DELETED>
                <DELETED>    (A) In general.--The Secretary shall 
                include in each contract described in paragraph (1)(A) 
                a requirement that, if the contractor subcontracts for 
                the development of media, the contractor shall 
                subcontract with a subcontractor that has experience 
                creating impactful media campaigns that target 
                individuals age 18 to 34.</DELETED>
                <DELETED>    (B) Budget limitation.--Not more than two 
                percent of the budget of the Office of Mental Health 
                and Suicide Prevention of the Department for 
                contractors for suicide prevention and mental health 
                media outreach shall go to subcontractors described in 
                subparagraph (A).</DELETED>
<DELETED>    (f) Rural and Highly Rural Defined.--In this section, with 
respect to an area, the terms ``rural'' and ``highly rural'' have the 
meanings given those terms in the Rural-Urban Commuting Areas coding 
system of the Department of Agriculture.</DELETED>

<DELETED>SEC. 402. OVERSIGHT OF MENTAL HEALTH AND SUICIDE PREVENTION 
              MEDIA OUTREACH CONDUCTED BY DEPARTMENT OF VETERANS 
              AFFAIRS.</DELETED>

<DELETED>    (a) Establishment of Goals.--</DELETED>
        <DELETED>    (1) In general.--The Secretary of Veterans Affairs 
        shall establish goals for the mental health and suicide 
        prevention media outreach campaigns of the Department of 
        Veterans Affairs in raising awareness about mental health and 
        suicide prevention.</DELETED>
        <DELETED>    (2) Use of metrics.--</DELETED>
                <DELETED>    (A) In general.--The goals established 
                under paragraph (1) shall be measured by metrics 
                specific to different media types as follows:</DELETED>
                        <DELETED>    (i) Metrics relating to social 
                        media shall include the following:</DELETED>
                                <DELETED>    (I) Impressions.</DELETED>
                                <DELETED>    (II) Reach.</DELETED>
                                <DELETED>    (III) Engagement 
                                rate.</DELETED>
                                <DELETED>    (IV) Such other metrics as 
                                the Secretary considers 
                                necessary.</DELETED>
                        <DELETED>    (ii) Metrics relating to 
                        television shall include the 
                        following:</DELETED>
                                <DELETED>    (I) Nielsen 
                                ratings.</DELETED>
                                <DELETED>    (II) Such other metrics as 
                                the Secretary considers 
                                necessary.</DELETED>
                        <DELETED>    (iii) Metrics relating to email 
                        shall include the following:</DELETED>
                                <DELETED>    (I) Open rate.</DELETED>
                                <DELETED>    (II) Response 
                                rate</DELETED>
                                <DELETED>    (III) Click 
                                rate.</DELETED>
                                <DELETED>    (IV) Such other metrics as 
                                the Secretary considers 
                                necessary.</DELETED>
                <DELETED>    (B) Update.--The Secretary shall 
                periodically update the metrics under subparagraph (A) 
                as more accurate metrics become available.</DELETED>
        <DELETED>    (3) Targets.--The Secretary shall develop targets 
        to track the metrics used under paragraph (2).</DELETED>
        <DELETED>    (4) Consultation.--In establishing goals under 
        paragraph (1), the Secretary shall consult with the 
        following:</DELETED>
                <DELETED>    (A) Relevant stakeholders, such as 
                organizations that represent veterans, as determined by 
                the Secretary.</DELETED>
                <DELETED>    (B) Mental health and suicide prevention 
                experts.</DELETED>
                <DELETED>    (C) Such other persons as the Secretary 
                considers appropriate.</DELETED>
        <DELETED>    (5) Initial report.--Not later than 180 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 detailing the goals established under 
        paragraph (1) for the mental health and suicide prevention 
        media outreach campaigns of the Department in raising awareness 
        about mental health and suicide prevention, including the 
        metrics and targets for such metrics by which those goals are 
        to be measured under paragraph (2).</DELETED>
        <DELETED>    (6) Annual report.--Not later than one year after 
        the submittal of the report under paragraph (3), and 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 detailing--
        </DELETED>
                <DELETED>    (A) the progress of the Department in 
                meeting the goals established under paragraph (1) and 
                targets developed under paragraph (3); and</DELETED>
                <DELETED>    (B) a description of action to be taken by 
                the Department to modify mental health and suicide 
                prevention media outreach campaigns if those goals and 
                targets are not being met.</DELETED>
<DELETED>    (b) Establishment of Oversight Process.--</DELETED>
        <DELETED>    (1) In general.--Not later than 90 days after the 
        date of the enactment of this Act, the Secretary shall 
        establish a process to oversee the mental health and suicide 
        prevention media outreach campaigns of the 
        Department.</DELETED>
        <DELETED>    (2) Components of oversight process.--The process 
        established under paragraph (1) shall include the following 
        components:</DELETED>
                <DELETED>    (A) A delineation of the roles and 
                responsibilities of all suicide prevention officials 
                within the Office of Mental Health and Suicide 
                Prevention of the Veterans Health 
                Administration.</DELETED>
                <DELETED>    (B) A schedule for creating, approving, 
                implementing, and evaluating all unpaid media and paid 
                media content relating to mental health and suicide 
                prevention.</DELETED>
                <DELETED>    (C) Lines of reporting, as the Secretary 
                considers necessary, to report to management 
                information relating to the mental health and suicide 
                prevention media outreach campaigns of the 
                Department.</DELETED>
<DELETED>    (c) Contract Requirements.--The Secretary shall ensure 
that each contract into which the Secretary enters to develop mental 
health and suicide prevention outreach media includes requirements that 
the contractor--</DELETED>
        <DELETED>    (1) track metrics used by the Secretary under 
        subsection (a)(2); and</DELETED>
        <DELETED>    (2) not less frequently than quarterly, report 
        such metrics to the Office of Mental Health and Suicide 
        Prevention of the Veterans Health Administration.</DELETED>
<DELETED>    (d) Report on Use of Funds by Office of Mental Health and 
Suicide Prevention.--Not later than 180 days after the date of the 
enactment of this Act, and semiannually thereafter, the Secretary shall 
submit to the Committee on Appropriations and the Committee on 
Veterans' Affairs of the Senate and the Committee on Appropriations and 
the Committee on Veterans' Affairs of the House of Representatives a 
report containing the expenditures and obligations of the Office of 
Mental Health and Suicide Prevention of the Veterans Health 
Administration during the period covered by the report.</DELETED>

<DELETED>SEC. 403. ANNUAL REPORT ON PROGRESS OF DEPARTMENT OF VETERANS 
              AFFAIRS IN MEETING GOALS AND OBJECTIVES OF EXECUTIVE 
              ORDER 13822.</DELETED>

<DELETED>    (a) In General.--Not later than 120 days after the date of 
the enactment of this Act, and annually thereafter, the Secretary of 
Veterans Affairs, in consultation with the Secretary of Defense and the 
Secretary of Homeland Security, 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 the 
following:</DELETED>
        <DELETED>    (1) An assessment of the progress of the 
        Department of Veterans Affairs, the Department of Defense, and 
        the Department of Homeland Security in meeting the goals and 
        objectives outlined in the report required under section 2(c) 
        of Executive Order 13822 (83 Fed. Reg. 1513; relating to 
        supporting our veterans during their transition from uniformed 
        service to civilian life) with respect to the implementation by 
        the Department of Veterans Affairs of the Joint Action Plan 
        required under section 2(b) of such Executive order.</DELETED>
        <DELETED>    (2) A description of action to be taken by the 
        Department of Veterans Affairs, the Department of Defense, and 
        the Department of Homeland Security if those goals and 
        objectives are not being met.</DELETED>
        <DELETED>    (3) An assessment of the effectiveness of 
        Executive Order 13822 at improving the transition process for 
        members of the Armed Forces and veterans.</DELETED>
        <DELETED>    (4) Such other topics as the Secretary of Veterans 
        Affairs, the Secretary of Defense, or the Secretary of Homeland 
        Security consider necessary.</DELETED>
<DELETED>    (b) Submittal by Secretary of Veterans Affairs.--The 
Secretary of Veterans Affairs shall submit each report required under 
paragraph (1) with respect to the Department of Veterans Affairs 
regardless of whether the Secretary of Defense or the Secretary of 
Homeland Security provides any information for the report.</DELETED>

<DELETED>SEC. 404. COMPTROLLER GENERAL MANAGEMENT REVIEW OF MENTAL 
              HEALTH AND SUICIDE PREVENTION SERVICES OF DEPARTMENT OF 
              VETERANS AFFAIRS.</DELETED>

<DELETED>    (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 management review of the mental health and suicide prevention 
services provided by the Department of Veterans Affairs.</DELETED>
<DELETED>    (b) Elements.--The management review required by 
subsection (a) shall include the following:</DELETED>
        <DELETED>    (1) An assessment of the infrastructure under the 
        control of or available to the Office of Mental Health and 
        Suicide Prevention of the Department of Veterans Affairs or 
        available to the Department of Veterans Affairs for suicide 
        prevention efforts not operated by the Office of Mental Health 
        and Suicide Prevention.</DELETED>
        <DELETED>    (2) A description of the management and 
        organizational structure of the Office of Mental Health and 
        Suicide Prevention, including roles and responsibilities for 
        each position.</DELETED>
        <DELETED>    (3) A description of the operational policies and 
        processes of the Office of Mental Health and Suicide 
        Prevention.</DELETED>
        <DELETED>    (4) An assessment of suicide prevention practices 
        and initiatives available from the Department and through 
        community partnerships.</DELETED>
        <DELETED>    (5) An assessment of the staffing levels at the 
        Office of Mental Health and Suicide Prevention, dissaggregated 
        by type of position, and including the location of any staffing 
        deficiencies.</DELETED>
        <DELETED>    (6) An assessment of the Nurse Advice Line pilot 
        program conducted by the Department.</DELETED>
        <DELETED>    (7) An assessment of recruitment initiatives in 
        rural areas for mental health professionals of the 
        Department.</DELETED>
        <DELETED>    (8) An assessment of strategic planning conducted 
        by the Office of Mental Health and Suicide 
        Prevention.</DELETED>
        <DELETED>    (9) An assessment of the communication, and the 
        effectiveness of such communication--</DELETED>
                <DELETED>    (A) within the central office of the 
                Office of Mental Health and Suicide 
                Prevention;</DELETED>
                <DELETED>    (B) between that central office and any 
                staff member or office in the field, including 
                chaplains, attorneys, law enforcement personnel, and 
                volunteers; and</DELETED>
                <DELETED>    (C) between that central office, local 
                facilities of the Department, and community partners of 
                the Department, including first responders, community 
                support groups, and health care industry 
                partners.</DELETED>
        <DELETED>    (10) An assessment of how effectively the Office 
        of Mental Health and Suicide Prevention implements operational 
        policies and procedures.</DELETED>
        <DELETED>    (11) An assessment of how the Department of 
        Veterans Affairs and the Department of Defense coordinate 
        suicide prevention efforts, and recommendations on how the 
        Department of Veterans Affairs and Department of Defense can 
        more effectively coordinate those efforts.</DELETED>
        <DELETED>    (12) An assessment of such other areas as the 
        Comptroller General considers appropriate to study.</DELETED>

<DELETED>SEC. 405. COMPTROLLER GENERAL REPORT ON EFFORTS OF DEPARTMENT 
              OF VETERANS AFFAIRS TO INTEGRATE MENTAL HEALTH CARE INTO 
              PRIMARY CARE CLINICS.</DELETED>

<DELETED>    (a) Initial Report.--</DELETED>
        <DELETED>    (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 efforts of the 
        Department of Veterans Affairs to integrate mental health care 
        into primary care clinics of the Department.</DELETED>
        <DELETED>    (2) Elements.--The report required by subsection 
        (a) shall include the following:</DELETED>
                <DELETED>    (A) An assessment of the efforts of the 
                Department to integrate mental health care into primary 
                care clinics of the Department.</DELETED>
                <DELETED>    (B) An assessment of the effectiveness of 
                such efforts.</DELETED>
                <DELETED>    (C) An assessment of how the health care 
                of veterans is impacted by such integration.</DELETED>
                <DELETED>    (D) A description of how care is 
                coordinated by the Department between specialty mental 
                health care and primary care, including a description 
                of the following:</DELETED>
                        <DELETED>    (i) How documents and patient 
                        information are transferred and the 
                        effectiveness of those transfers.</DELETED>
                        <DELETED>    (ii) How care is coordinated when 
                        veterans must travel to different facilities of 
                        the Department.</DELETED>
                        <DELETED>    (iii) How a veteran is 
                        reintegrated into primary care after receiving 
                        in-patient mental health care.</DELETED>
                <DELETED>    (E) An assessment of how the integration 
                of mental health care into primary care clinics is 
                implemented at different types of facilities of the 
                Department.</DELETED>
                <DELETED>    (F) Such recommendations on how the 
                Department can better integrate mental health care into 
                primary care clinics as the Comptroller General 
                considers appropriate.</DELETED>
                <DELETED>    (G) An assessment of such other areas as 
                the Comptroller General considers appropriate to 
                study.</DELETED>
<DELETED>    (b) Community Care Integration Report.--</DELETED>
        <DELETED>    (1) In general.--Not later than two years after 
        the date on which the Comptroller General submits the report 
        required under subsection (a)(1), the Comptroller General 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 Department to 
        integrate community-based mental health care into the Veterans 
        Health Administration.</DELETED>
        <DELETED>    (2) Elements.--The report required by paragraph 
        (1) shall include the following:</DELETED>
                <DELETED>    (A) An assessment of the efforts of the 
                Department to integrate community-based mental health 
                care into the Veterans Health Administration.</DELETED>
                <DELETED>    (B) An assessment of the effectiveness of 
                such efforts.</DELETED>
                <DELETED>    (C) An assessment of how the health care 
                of veterans is impacted by such integration.</DELETED>
                <DELETED>    (D) A description of how care is 
                coordinated between providers of community-based mental 
                health care and the Veterans Health Administration, 
                including a description of how documents and patient 
                information are transferred and the effectiveness of 
                those transfers between--</DELETED>
                        <DELETED>    (i) the Veterans Health 
                        Administration and providers of community-based 
                        mental health care; and</DELETED>
                        <DELETED>    (ii) providers of community-based 
                        mental health care and the Veterans Health 
                        Administration.</DELETED>
                <DELETED>    (E) An assessment of any disparities in 
                the coordination of community-based mental health care 
                into the Veterans Health Administration by location and 
                type of facility.</DELETED>
                <DELETED>    (F) An assessment of the military cultural 
                competency of health care providers providing 
                community-based mental health care to 
                veterans.</DELETED>
                <DELETED>    (G) Such recommendations on how the 
                Department can better integrate community-based mental 
                health care into the Veterans Health Administration as 
                the Comptroller General considers 
                appropriate.</DELETED>
                <DELETED>    (H) An assessment of such other areas as 
                the Comptroller General considers appropriate to 
                study.</DELETED>
        <DELETED>    (3) Community-based mental health care defined.--
        In this subsection, the term ``community-based mental health 
        care'' means mental health care paid for by the Department but 
        provided by a non-Department health care provider at a non-
        Department facility, including care furnished under section 
        1703 of title 38, United States Code (as in effect on the date 
        specified in section 101(b) of the Caring for Our Veterans Act 
        of 2018 (title I of Public Law 115-182)).</DELETED>

<DELETED>SEC. 406. JOINT MENTAL HEALTH PROGRAMS BY DEPARTMENT OF 
              VETERANS AFFAIRS AND DEPARTMENT OF DEFENSE.</DELETED>

<DELETED>    (a) Report on Mental Health Programs.--</DELETED>
        <DELETED>    (1) In general.--Not later than 180 days after the 
        date of the enactment of this Act, and annually thereafter, the 
        Secretary of Veterans Affairs and the Secretary of Defense 
        shall submit to the Committee on Armed Services and the 
        Committee on Veterans' Affairs of the Senate and the Committee 
        on Armed Services and the Committee on Veterans' Affairs of the 
        House of Representatives a report on mental health programs of 
        the Department of Veterans Affairs and the Department of 
        Defense and joint programs of the Departments.</DELETED>
        <DELETED>    (2) Elements.--The report required by paragraph 
        (1) shall include the following:</DELETED>
                <DELETED>    (A) A description of mental health 
                programs operated by the Department of Veterans 
                Affairs, including the following:</DELETED>
                        <DELETED>    (i) Transition assistance 
                        programs.</DELETED>
                        <DELETED>    (ii) Clinical mental health 
                        initiatives, including--</DELETED>
                                <DELETED>    (I) the Million Veterans 
                                Program; and</DELETED>
                                <DELETED>    (II) centers of excellence 
                                of the Department of Veterans Affairs 
                                for traumatic brain injury and post-
                                traumatic stress disorder.</DELETED>
                        <DELETED>    (iii) Programs that may 
                        secondarily improve mental health, including 
                        employment, housing assistance, and financial 
                        literacy programs.</DELETED>
                        <DELETED>    (iv) Research into mental health 
                        issues and conditions.</DELETED>
                <DELETED>    (B) A description of mental health 
                programs operated by the Department of Defense, 
                including the following:</DELETED>
                        <DELETED>    (i) Transition assistance 
                        programs.</DELETED>
                        <DELETED>    (ii) Clinical mental health 
                        initiatives, including the National Intrepid 
                        Center of Excellence.</DELETED>
                        <DELETED>    (iii) Programs that may 
                        secondarily improve mental health, including 
                        employment, housing assistance, and financial 
                        literacy programs.</DELETED>
                        <DELETED>    (iv) Research into mental health 
                        issues and conditions.</DELETED>
                <DELETED>    (C) A description of mental health 
                programs jointly operated by the Department of Veterans 
                Affairs and the Department of Defense, including the 
                following:</DELETED>
                        <DELETED>    (i) Transition assistance 
                        programs.</DELETED>
                        <DELETED>    (ii) Clinical mental health 
                        initiatives.</DELETED>
                        <DELETED>    (iii) Programs that may 
                        secondarily improve mental health, including 
                        employment, housing assistance, and financial 
                        literacy programs.</DELETED>
                        <DELETED>    (iv) Research into mental health 
                        issues and conditions.</DELETED>
                <DELETED>    (D) Recommendations for coordinating 
                mental health programs of the Department of Veterans 
                Affairs and the Department of Defense to improve the 
                effectiveness of those programs.</DELETED>
                <DELETED>    (E) Recommendations for novel joint 
                programming of the Department of Veterans Affairs and 
                the Department of Defense to improve the mental health 
                of members of the Armed Forces and veterans.</DELETED>
<DELETED>    (b) Establishment of Joint Center of Excellence.--
</DELETED>
        <DELETED>    (1) In general.--Not later than two years after 
        the date of the enactment of this Act, the Secretary of 
        Defense, in consultation with the Secretary of Veterans 
        Affairs, shall establish a center of excellence to be known as 
        the ``Joint DOD/VA National Intrepid Center of Excellence 
        Intrepid Spirit Center'' (in this subsection referred to as the 
        ``Center'').</DELETED>
        <DELETED>    (2) Duties.--The Center shall conduct joint mental 
        health programs of the Department of Veterans Affairs and the 
        Department of Defense.</DELETED>
        <DELETED>    (3) Location.--The Center shall be established in 
        a location that--</DELETED>
                <DELETED>    (A) is geographically distant from already 
                existing and planned Intrepid Spirit Centers of the 
                Department of Defense; and</DELETED>
                <DELETED>    (B) is in a rural or highly rural area (as 
                determined through the use of the Rural-Urban Commuting 
                Areas coding system of the Department of 
                Agriculture).</DELETED>

             <DELETED>TITLE V--MEDICAL WORKFORCE</DELETED>

       <DELETED>Subtitle A--Improvement of Mental Health Medical 
                          Workforce</DELETED>

<DELETED>SEC. 501. TREATMENT OF PSYCHOLOGISTS.</DELETED>

<DELETED>    (a) Treatment as Title 38 Employees.--Section 7401 of 
title 38, United States Code, is amended--</DELETED>
        <DELETED>    (1) in paragraph (1) by inserting 
        ``psychologists,'' after ``chiropractors,''; and</DELETED>
        <DELETED>    (2) in paragraph (3), by striking 
        ``psychologists,''.</DELETED>
<DELETED>    (b) Inclusion in Contracts for Scarce Medical Specialist 
Services.--Section 7409(a) of title 38, United States Code, is amended 
by inserting ``psychologists,'' after ``chiropractors,''.</DELETED>

<DELETED>SEC. 502. STAFFING IMPROVEMENT PLAN FOR PSYCHIATRISTS AND 
              PSYCHOLOGISTS OF DEPARTMENT OF VETERANS 
              AFFAIRS.</DELETED>

<DELETED>    (a) Staffing Plan.--Not later than 270 days after the date 
of the enactment of this Act, the Secretary of Veterans Affairs, in 
consultation with the Inspector General of the Department 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 plan to address staffing shortages of psychiatrists 
and psychologists of the Department of Veterans Affairs, including 
filling any open positions.</DELETED>
<DELETED>    (b) Elements.--The plan required by subsection (a) shall 
include the following:</DELETED>
        <DELETED>    (1) The number of positions for psychiatrists and 
        psychologists of the Department that need to be filled to meet 
        demand, disaggregated by Veterans Integrated Service Network 
        and medical center.</DELETED>
        <DELETED>    (2) An identification of the steps that the 
        Secretary will take in each Veterans Integrated Service Network 
        to address such shortages, include the following:</DELETED>
                <DELETED>    (A) A description of any region-specific 
                hiring incentives to be used by the Secretary in 
                consultation with the directors of Veterans Integrated 
                Service Networks and medical centers of the 
                Department.</DELETED>
                <DELETED>    (B) A description of any local retention 
                or engagement incentives to be used by directors of 
                Veterans Integrated Service Networks.</DELETED>
        <DELETED>    (3) Such recommendations for legislative or 
        administrative action as the Secretary considers necessary to 
        aid in addressing staffing shortages of psychiatrists and 
        psychologists of the Department.</DELETED>

<DELETED>SEC. 503. OCCUPATIONAL SERIES AND STAFFING IMPROVEMENT PLAN 
              FOR LICENSED PROFESSIONAL MENTAL HEALTH COUNSELORS AND 
              MARRIAGE AND FAMILY THERAPISTS OF DEPARTMENT OF VETERANS 
              AFFAIRS.</DELETED>

<DELETED>    (a) Occupational Series.--Not later than one year after 
the date of the enactment of this Act, the Secretary of Veterans 
Affairs, in consultation with the Office of Personnel Management, shall 
develop an occupational series for licensed professional mental health 
counselors and marriage and family therapists of the Department of 
Veterans Affairs.</DELETED>
<DELETED>    (b) Staffing Plan.--</DELETED>
        <DELETED>    (1) In general.--Not later than 270 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 plan to address staffing shortages of licensed professional 
        mental health counselors and marriage and family therapists of 
        the Department of Veterans Affairs.</DELETED>
        <DELETED>    (2) Elements.--The plan required by paragraph (1) 
        shall include the following:</DELETED>
                <DELETED>    (A) The number of positions for licensed 
                professional mental health counselors and marriage and 
                family therapists of the Department that need to be 
                filled to meet demand, disaggregated by Veterans 
                Integrated Service Network and medical 
                center.</DELETED>
                <DELETED>    (B) An identification of the steps that 
                the Secretary will take in each Veterans Integrated 
                Service Network to address such shortages, include the 
                following:</DELETED>
                        <DELETED>    (i) A description of any region-
                        specific hiring incentives to be used by the 
                        Secretary in consultation with the directors of 
                        Veterans Integrated Service Networks and 
                        medical centers of the Department.</DELETED>
                        <DELETED>    (ii) A description of any local 
                        retention or engagement incentives to be used 
                        by directors of Veterans Integrated Service 
                        Networks.</DELETED>
                <DELETED>    (C) Such recommendations for legislative 
                or administrative action as the Secretary, in 
                consultation with the Inspector General of the 
                Department of Veterans Affairs, considers necessary to 
                aid in addressing staffing shortages of licensed 
                professional mental health counselors and marriage and 
                family therapists of the Department.</DELETED>
<DELETED>    (c) Report.--Not later than one year after the submittal 
of the plan required by subsection (b), 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 setting 
forth the number of licensed professional mental health counselors and 
marriage and family therapists hired by the Department during the one-
year period preceding the submittal of the report, disaggregated by 
Veterans Integrated Service Network and medical center.</DELETED>

<DELETED>SEC. 504. STAFFING IMPROVEMENT PLAN FOR PEER SPECIALISTS OF 
              DEPARTMENT OF VETERANS AFFAIRS WHO ARE WOMEN.</DELETED>

<DELETED>    (a) Assessment of Capacity.--</DELETED>
        <DELETED>    (1) In general.--Not later than 90 days after the 
        date of the enactment of this Act, the Secretary of Veterans 
        Affairs, in consultation with the Inspector General of the 
        Department of Veterans Affairs, shall commence an assessment of 
        the capacity of peer specialists of the Department of Veterans 
        Affairs who are women.</DELETED>
        <DELETED>    (2) Elements.--The assessment required by 
        paragraph (1) shall include an assessment of the 
        following:</DELETED>
                <DELETED>    (A) The geographical distribution of peer 
                specialists of the Department who are women.</DELETED>
                <DELETED>    (B) The geographical distribution of women 
                veterans.</DELETED>
                <DELETED>    (C) The number and proportion of women 
                peer specialists who specialize in peer counseling on 
                mental health or suicide prevention.</DELETED>
                <DELETED>    (D) The number and proportion of women 
                peer specialists who specialize in peer counseling on 
                non-mental health related matters.</DELETED>
<DELETED>    (b) Report.--Not later than one year after the assessment 
required by subsection (a) has commenced, 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 detailing 
the findings of the assessment.</DELETED>
<DELETED>    (c) Staffing Improvement Plan.--</DELETED>
        <DELETED>    (1) In general.--Not later than 180 days after 
        submitting the report under subsection (b), the Secretary, in 
        consultation with the Inspector General, shall submit to the 
        Committee on Veterans' Affairs of the Senate and the Committee 
        on Veterans' Affairs of the House of Representatives a plan, 
        based on the results of the assessment required by subsection 
        (a), to hire additional qualified peer specialists who are 
        women, with special consideration for areas that lack peer 
        specialists who are women.</DELETED>
        <DELETED>    (2) Elements.--The peer specialist positions 
        included in the plan required by paragraph (1)--</DELETED>
                <DELETED>    (A) shall be non-volunteer, paid 
                positions; and</DELETED>
                <DELETED>    (B) may be part-time positions.</DELETED>

<DELETED>SEC. 505. ESTABLISHMENT OF DEPARTMENT OF VETERANS AFFAIRS 
              READJUSTMENT COUNSELING SERVICE SCHOLARSHIP 
              PROGRAM.</DELETED>

<DELETED>    (a) In General.--Chapter 76 of title 38, United States 
Code, is amended by inserting after subchapter VIII the following new 
subchapter:</DELETED>

 <DELETED>``SUBCHAPTER IX--READJUSTMENT COUNSELING SERVICE SCHOLARSHIP 
                           PROGRAM</DELETED>

<DELETED>``Sec. 7698. Requirement for program</DELETED>
<DELETED>    ``As part of the Educational Assistance Program, the 
Secretary shall carry out a scholarship program under this subchapter. 
The program shall be known as the Department of Veterans Affairs 
Readjustment Counseling Service Scholarship Program (in this subchapter 
referred to as the `Program').</DELETED>
<DELETED>``Sec. 7699. Eligibility; agreement</DELETED>
<DELETED>    ``(a) In General.--An individual is eligible to 
participate in the Program, as determined by the Readjustment 
Counseling Service of the Department, if the individual--</DELETED>
        <DELETED>    ``(1) is accepted for enrollment or enrolled (as 
        described in section 7602 of this title) in, a program of study 
        at an accredited educational institution, school, or training 
        program leading to--</DELETED>
                <DELETED>    ``(A) a bachelor's, master's, or doctoral 
                degree in psychology, social work, or marriage and 
                family therapy; or</DELETED>
                <DELETED>    ``(B) a master's degree in mental health 
                counseling; and</DELETED>
        <DELETED>    ``(2) enters into an agreement with the Secretary 
        under subsection (c).</DELETED>
<DELETED>    ``(b) Priority.--In selecting individuals to participate 
in the Program, the Secretary shall give priority to the following 
individuals:</DELETED>
        <DELETED>    ``(1) An individual who agrees to be employed by a 
        Vet Center located in a community that is--</DELETED>
                <DELETED>    ``(A) designated as a medically 
                underserved population under section 330(b)(3) of the 
                Public Health Service Act (42 U.S.C. 254b(b)(3)); 
                and</DELETED>
                <DELETED>    ``(B) in a state with a per capita 
                population of veterans of more than five percent 
                according to the National Center for Veterans Analysis 
                and Statistics and the Bureau of the Census.</DELETED>
        <DELETED>    ``(2) An individual who is a veteran.</DELETED>
<DELETED>    ``(c) Agreement.--An agreement between the Secretary and a 
participant in the Program shall (in addition to the requirements set 
forth in section 7604 of this title) include the following:</DELETED>
        <DELETED>    ``(1) An agreement by the Secretary to provide the 
        participant with a scholarship under the Program for a 
        specified number of school years during which the participant 
        pursues a program of study described in subsection (a)(1) that 
        meets the requirements set forth in section 7602(a) of this 
        title.</DELETED>
        <DELETED>    ``(2) An agreement by the participant to serve as 
        a full-time employee of the Department at a Vet Center for a 
        three-year period during the six-year period following the 
        completion by the participant of such program of study (in this 
        subchapter referred to as the `period of obligated 
        service').</DELETED>
<DELETED>    ``(d) Vet Center Defined.--In this section, the term `Vet 
Center' has the meaning given that term in section 1712A(h) of this 
title.</DELETED>
<DELETED>``Sec. 7699A. Obligated service</DELETED>
<DELETED>    ``(a) In General.--Each participant in the Program shall 
provide service as a full-time employee of the Department at a Vet 
Center (as defined in section 7699(c) of this title) for the period of 
obligated service set forth in the agreement of the participant entered 
into under section 7604 of this title.</DELETED>
<DELETED>    ``(b) Determination of Service Commencement Date.--(1) Not 
later than 60 days before the service commencement date of a 
participant, the Secretary shall notify the participant of that service 
commencement date.</DELETED>
<DELETED>    ``(2) The date specified in paragraph (1) with respect to 
a participant is the date for the beginning of the period of obligated 
service of the participant.</DELETED>
<DELETED>``Sec. 7699B. Breach of agreement: liability</DELETED>
<DELETED>    ``(a) Liquidated Damages.--(1) A participant in the 
Program (other than a participant described in subsection (b)) who 
fails to accept payment, or instructs the educational institution in 
which the participant is enrolled not to accept payment, in whole or in 
part, of a scholarship under the agreement entered into under section 
7604 of this title shall be liable to the United States for liquidated 
damages in the amount of $1,500.</DELETED>
<DELETED>    ``(2) Liability under paragraph (1) is in addition to any 
period of obligated service or other obligation or liability under such 
agreement.</DELETED>
<DELETED>    ``(b) Liability During Program of Study.--(1) Except as 
provided in subsection (d), a participant in the Program shall be 
liable to the United States for the amount which has been paid to or on 
behalf of the participant under the agreement if any of the following 
occurs:</DELETED>
        <DELETED>    ``(A) The participant fails to maintain an 
        acceptable level of academic standing in the educational 
        institution in which the participant is enrolled (as determined 
        by the educational institution under regulations prescribed by 
        the Secretary).</DELETED>
        <DELETED>    ``(B) The participant is dismissed from such 
        educational institution for disciplinary reasons.</DELETED>
        <DELETED>    ``(C) The participant voluntarily terminates the 
        program of study in such educational institution before the 
        completion of such program of study.</DELETED>
<DELETED>    ``(2) Liability under this subsection is in lieu of any 
service obligation arising under the agreement.</DELETED>
<DELETED>    ``(c) Liability During Period of Obligated Service.--(1) 
Except as provided in subsection (d), if a participant in the Program 
does not complete the period of obligated service of the participant, 
the United States shall be entitled to recover from the participant an 
amount determined in accordance with the following formula: A=3F(t-s/
t).</DELETED>
<DELETED>    ``(2) In the formula in paragraph (1):</DELETED>
        <DELETED>    ``(A) `A' is the amount the United States is 
        entitled to recover.</DELETED>
        <DELETED>    ``(B) `F' is the sum of--</DELETED>
                <DELETED>    ``(i) the amounts paid under this 
                subchapter to or on behalf of the participant; 
                and</DELETED>
                <DELETED>    ``(ii) the interest on such amounts which 
                would be payable if at the time the amounts were paid 
                they were loans bearing interest at the maximum legal 
                prevailing rate, as determined by the Treasurer of the 
                United States.</DELETED>
        <DELETED>    ``(C) `t' is the total number of months in the 
        period of obligated service of the participant.</DELETED>
        <DELETED>    ``(D) `s' is the number of months of such period 
        served by the participant.</DELETED>
<DELETED>    ``(d) Limitation on Liability for Reductions-in-Force.--
Liability shall not arise under subsection (c) if the participant fails 
to maintain employment as a Department employee due to a staffing 
adjustment.</DELETED>
<DELETED>    ``(e) Period for Payment of Damages.--Any amount of 
damages that the United States is entitled to recover under this 
section shall be paid to the United States within the one-year period 
beginning on the date of the breach of the agreement.''.</DELETED>
<DELETED>    (b) Conforming and Technical Amendments.--</DELETED>
        <DELETED>    (1) Conforming amendments.--</DELETED>
                <DELETED>    (A) Establishment of program.--Section 
                7601(a) of such title is amended--</DELETED>
                        <DELETED>    (i) in paragraph (5), by striking 
                        ``and'';</DELETED>
                        <DELETED>    (ii) in paragraph (6), by striking 
                        the period and inserting ``; and''; 
                        and</DELETED>
                        <DELETED>    (iii) by adding at the end the 
                        following new paragraph:</DELETED>
        <DELETED>    ``(7) the readjustment counseling service 
        scholarship program provided for in subchapter IX of this 
        chapter.''.</DELETED>
                <DELETED>    (B) Eligibility.--Section 7602 of such 
                title is amended--</DELETED>
                        <DELETED>    (i) in subsection (a)(1)--
                        </DELETED>
                                <DELETED>    (I) by striking ``or VI'' 
                                and inserting ``VI, or IX''; 
                                and</DELETED>
                                <DELETED>    (II) by striking 
                                ``subchapter VI'' and inserting 
                                ``subchapter VI or IX''; and</DELETED>
                        <DELETED>    (ii) in subsection (b), by 
                        striking ``or VI'' and inserting ``VI, or 
                        IX''.</DELETED>
                <DELETED>    (C) Application.--Section 7603(a)(1) of 
                such title is amended by striking ``or VIII'' and 
                inserting ``VIII, or IX''.</DELETED>
                <DELETED>    (D) Terms of agreement.--Section 7604 of 
                such title is amended by striking ``or VIII'' each 
                place it appears and inserting ``VIII, or 
                IX''.</DELETED>
                <DELETED>    (E) Annual report.--Section 7632 of such 
                title is amended--</DELETED>
                        <DELETED>    (i) in paragraph (1), by striking 
                        ``and the Specialty Education Loan Repayment 
                        Program'' and inserting ``the Specialty 
                        Education Loan Repayment Program, and the 
                        Readjustment Counseling Service Scholarship 
                        Program''; and</DELETED>
                        <DELETED>    (ii) in paragraph (4), by striking 
                        ``and per participant in the Specialty 
                        Education Loan Repayment Program'' and 
                        inserting ``per participant in the Specialty 
                        Education Loan Repayment Program, and per 
                        participant in the Readjustment Counseling 
                        Service Scholarship Program''.</DELETED>
        <DELETED>    (2) Table of sections.--The table of sections at 
        the beginning of chapter 76 of such title is amended by 
        inserting after the items relating to subchapter VIII the 
        following:</DELETED>

<DELETED> ``subchapter ix--readjustment counseling service scholarship 
                                program

<DELETED>``Sec.
<DELETED>``7698. Requirement for program.
<DELETED>``7699. Eligibility; agreement.
<DELETED>``7699A. Obligated service.
<DELETED>``7699B. Breach of agreement: liability.''.
<DELETED>    (c) Effective Date.--The Secretary of Veterans Affairs 
shall begin awarding scholarships under subchapter IX of chapter 76 of 
title 38, United States Code, as added by subsection (a), for programs 
of study beginning not later than one year after the date of the 
enactment of this Act.</DELETED>

<DELETED>SEC. 506. COMPTROLLER GENERAL REPORT ON READJUSTMENT 
              COUNSELING SERVICE OF DEPARTMENT OF VETERANS 
              AFFAIRS.</DELETED>

<DELETED>    (a) In General.--Not later than one year 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 Readjustment Counseling Service of the Department of 
Veterans Affairs.</DELETED>
<DELETED>    (b) Elements.--The report required by subsection (a) shall 
include the following:</DELETED>
        <DELETED>    (1) An assessment of the adequacy and types of 
        treatment, counseling, and other services provided at Vet 
        Centers, including recommendations on whether and how such 
        treatment, counseling, and other services can be 
        expanded.</DELETED>
        <DELETED>    (2) An assessment of the efficacy of outreach 
        efforts by the Readjustment Counseling Service, including 
        recommendations for how outreach efforts can be 
        improved.</DELETED>
        <DELETED>    (3) An assessment of barriers to care at Vet 
        Centers, including recommendations for overcoming those 
        barriers.</DELETED>
        <DELETED>    (4) An assessment of the efficacy and frequency of 
        the use of telehealth by counselors of the Readjustment 
        Counseling Service to provide mental health services, including 
        recommendations for how the use of telehealth can be 
        improved.</DELETED>
        <DELETED>    (5) An assessment of the feasibility and 
        advisability of expanding eligibility for services from the 
        Readjustment Counseling Service, including--</DELETED>
                <DELETED>    (A) recommendations on what eligibility 
                criteria could be expanded; and</DELETED>
                <DELETED>    (B) an assessment of potential costs and 
                increased infrastructure requirements if eligibility is 
                expanded.</DELETED>
        <DELETED>    (6) An assessment of the use of Vet Centers by 
        members of the reserve components of the Armed Forces who were 
        never activated and recommendations on how to better reach 
        those members.</DELETED>
        <DELETED>    (7) An assessment of the use of Vet Centers by 
        eligible family members of former members of the Armed Forces 
        and recommendations on how to better reach those family 
        members.</DELETED>
        <DELETED>    (8) An assessment of the efficacy of group therapy 
        and the level of training of providers at Vet Centers in 
        administering group therapy.</DELETED>
<DELETED>    (c) Vet Center Defined.--In this section, the term ``Vet 
Center'' has the meaning given that term in section 1712A(h) of title 
38, United States Code.</DELETED>

<DELETED>SEC. 507. EXPANSION OF REPORTING REQUIREMENTS ON READJUSTMENT 
              COUNSELING SERVICE OF DEPARTMENT OF VETERANS 
              AFFAIRS.</DELETED>

<DELETED>    (a) Expansion of Annual Report.--Paragraph (2)(C) of 
section 7309(e) of title 38, United States Code, is amended by 
inserting before the period at the end the following: ``, including the 
resources required to meet such unmet need, such as additional staff, 
additional locations, additional infrastructure, infrastructure 
improvements, and additional mobile Vet Centers''.</DELETED>
<DELETED>    (b) Biennial Report.--Such section is amended by adding at 
the end the following new paragraph:</DELETED>
<DELETED>    ``(3) For each even numbered year in which the report 
required by paragraph (1) is submitted, the Secretary shall include in 
such report a prediction of trends in demand for care, long-term 
investments required with respect to the provision of care, maintenance 
of infrastructure, and other capital investments with respect to the 
Readjustment Counseling Service, including Vet Centers, Mobile Vet 
Centers, and community access points.''.</DELETED>

<DELETED>SEC. 508. STUDIES ON ALTERNATIVE WORK SCHEDULES FOR EMPLOYEES 
              OF VETERANS HEALTH ADMINISTRATION.</DELETED>

<DELETED>    (a) Study of Veterans.--</DELETED>
        <DELETED>    (1) In general.--Not later than 180 days after the 
        date of the enactment of this Act, the Secretary of Veterans 
        Affairs shall conduct a study on the attitudes of eligible 
        veterans toward the Department of Veterans Affairs offering 
        appointments outside the usual operating hours of facilities of 
        the Department, including through the use of telehealth 
        appointments.</DELETED>
        <DELETED>    (2) Eligible veteran defined.--In this subsection, 
        the term ``eligible veteran'' means a veteran who--</DELETED>
                <DELETED>    (A) is enrolled in the patient enrollment 
                system of the Department under section 1705(a) of title 
                38, United States Code; and</DELETED>
                <DELETED>    (B) received health care from the 
                Department at least once during the two-year period 
                ending on the date of the commencement of the study 
                under paragraph (1).</DELETED>
<DELETED>    (b) Department Study.--</DELETED>
        <DELETED>    (1) In general.--Not later than 180 days after the 
        date of the enactment of this Act, the Secretary shall conduct 
        a study on the feasibility and advisability of offering 
        appointments outside the usual operating hours of facilities of 
        the Department.</DELETED>
        <DELETED>    (2) Study of employees.--The study required by 
        paragraph (1) shall include a study of the opinions of 
        employees of the Veterans Health Administration, including 
        clinical, nonclinical, and support staff, with respect to 
        offering appointments outside the usual operating hours of 
        facilities of the Department, including through the use of 
        telehealth appointments.</DELETED>

<DELETED>SEC. 509. SUICIDE PREVENTION COORDINATORS.</DELETED>

<DELETED>    The Secretary of Veterans Affairs shall ensure that each 
medical center of the Department of Veterans Affairs is staffed with 
not fewer than one suicide prevention coordinator.</DELETED>

<DELETED>Subtitle B--Direct Hiring Authorities for Certain Health Care 
                          Positions</DELETED>

<DELETED>SEC. 521. DIRECT HIRING AUTHORITIES FOR CERTAIN HEALTH CARE 
              POSITIONS.</DELETED>

<DELETED>    (a) In General.--Subpart I of part III of title 5, United 
States Code, is amended by adding at the end the following:</DELETED>

     <DELETED>``CHAPTER 103--DEPARTMENT OF VETERANS AFFAIRS HIRING 
                         AUTHORITIES</DELETED>

<DELETED>``Sec.
<DELETED>``10301. Department of Veterans Affairs personnel authorities.
<DELETED>``Sec. 10301. Department of Veterans Affairs personnel 
              authorities</DELETED>
<DELETED>    ``(a) Flexibilities Relating to Appointments.--</DELETED>
        <DELETED>    ``(1) In general.--The Secretary of Veterans 
        Affairs (referred to in this section as the `Secretary') shall 
        promulgate regulations to redesign the procedures that are 
        applied by the Department of Veterans Affairs in making 
        appointments to positions described in paragraphs (1) and (3) 
        of section 7401 of title 38 in order to--</DELETED>
                <DELETED>    ``(A) better meet mission needs;</DELETED>
                <DELETED>    ``(B) respond to managers' needs and the 
                needs of applicants;</DELETED>
                <DELETED>    ``(C) produce high-quality 
                applicants;</DELETED>
                <DELETED>    ``(D) support timely decisions; 
                and</DELETED>
                <DELETED>    ``(E) promote competitive job 
                offers.</DELETED>
        <DELETED>    ``(2) Waived requirements.--In redesigning the 
        process by which the appointments described in paragraph (1) 
        shall be made, the Secretary may waive the requirements of 
        chapter 33, and the regulations implementing that chapter, to 
        the extent necessary to achieve the objectives of this section, 
        while providing for the following:</DELETED>
                <DELETED>    ``(A) Fair, credible, and transparent 
                methods of establishing qualification requirements for, 
                recruitment for, and appointments to 
                positions.</DELETED>
                <DELETED>    ``(B) Fair and open competition and 
                equitable treatment in the consideration and selection 
                of individuals to positions.</DELETED>
                <DELETED>    ``(C) Fair, credible, and transparent 
                methods of assigning, reassigning, detailing, 
                transferring, or promoting employees.</DELETED>
        <DELETED>    ``(3) Implementation requirements.--In 
        implementing this subsection, the Secretary shall comply with 
        the provisions of section 2302(b)(11), regarding veterans' 
        preference requirements, in a manner consistent with that in 
        which such provisions are applied under chapter 33.</DELETED>
        <DELETED>    ``(4) Training program.--The Secretary shall 
        develop a training program for Department of Veterans Affairs 
        human resource professionals to implement the requirements of 
        this subsection.</DELETED>
        <DELETED>    ``(5) Indicators of effectiveness.--The Secretary 
        shall develop indicators of effectiveness to determine whether 
        appointment flexibilities under this subsection have achieved 
        the objectives described in paragraph (1).</DELETED>
<DELETED>    ``(b) Criteria for Use of New Personnel Authorities.--In 
the redesign of appointment procedures, as described in subsection (a), 
and with respect to the system of appointment flexibilities established 
under that subsection, the Secretary shall--</DELETED>
        <DELETED>    ``(1) include a means for ensuring employee 
        involvement (for bargaining unit employees, through their 
        exclusive representatives) in that redesign and in the 
        implementation of that system;</DELETED>
        <DELETED>    ``(2) provide for adequate training and retraining 
        for supervisors, managers, and employees in the implementation 
        and operation of that redesign and that system;</DELETED>
        <DELETED>    ``(3) develop--</DELETED>
                <DELETED>    ``(A) a comprehensive management 
                succession program to provide training to employees to 
                develop managers for the agency; and</DELETED>
                <DELETED>    ``(B) a program to provide training to 
                supervisors on actions, options, and strategies that a 
                supervisor may use in administering that 
                system;</DELETED>
        <DELETED>    ``(4) include effective transparency and 
        accountability measures and safeguards to ensure that the 
        management of that system is fair, credible, and equitable, 
        including appropriate independent reasonableness reviews, 
        internal assessments, and employee surveys;</DELETED>
        <DELETED>    ``(5) provide mentors to advise individuals on 
        their career paths and opportunities to advance and excel 
        within their fields;</DELETED>
        <DELETED>    ``(6) develop appropriate procedures for warnings 
        during performance evaluations for employees who fail to meet 
        performance standards;</DELETED>
        <DELETED>    ``(7) utilize the quadrennial strategic plan 
        required under section 7330C(b) of title 38; and</DELETED>
        <DELETED>    ``(8) ensure that adequate agency resources are 
        allocated for the design, implementation, and administration of 
        that system.''.</DELETED>
<DELETED>    (b) Technical and Conforming Amendment.--The table of 
chapters for part III of title 5, United States Code, is amended by 
inserting after the item relating to chapter 102 the 
following:</DELETED>

<DELETED>``103. Department of Veterans Affairs Hiring         10301.''.
                            Authorities.

    <DELETED>TITLE VI--IMPROVEMENT OF TELEHEALTH SERVICES</DELETED>

<DELETED>SEC. 601. EXPANDED TELEHEALTH FROM DEPARTMENT OF VETERANS 
              AFFAIRS.</DELETED>

<DELETED>    (a) In General.--The Secretary of Veterans Affairs shall 
enter into partnerships, and expand existing partnerships, between the 
Department of Veterans Affairs, organizations that represent or serve 
veterans, nonprofit organizations, private businesses, and other 
interested parties for the expansion of telehealth capabilities and the 
provision of telehealth services to veterans through the award of 
grants under subsection (c).</DELETED>
<DELETED>    (b) Preference for Partnerships.--The Secretary shall give 
preference to entering into or expanding partnerships under subsection 
(a) with organizations that--</DELETED>
        <DELETED>    (1) represent veterans in rural or highly rural 
        areas (as determined through the use of the Rural-Urban 
        Commuting Areas coding system of the Department of 
        Agriculture); or</DELETED>
        <DELETED>    (2) operate in a medically underserved community 
        (as defined in section 799B of the Public Health Service Act 
        (42 U.S.C. 295p)).</DELETED>
<DELETED>    (c) Award of Grants.--</DELETED>
        <DELETED>    (1) In general.--In carrying out partnerships 
        entered into or expanded under this section with entities 
        described in subsection (a), the Secretary shall award grants 
        to those entities.</DELETED>
        <DELETED>    (2) Maximum amount of grants.--The amount of a 
        grant awarded under this subsection may not exceed $75,000 per 
        site per year.</DELETED>
        <DELETED>    (3) Use of grants.--</DELETED>
                <DELETED>    (A) In general.--Grants awarded to an 
                entity under this subsection shall be used for the 
                following:</DELETED>
                        <DELETED>    (i) Purchasing or upgrading 
                        hardware or software necessary for the 
                        provision of secure and private telehealth 
                        services.</DELETED>
                        <DELETED>    (ii) Upgrading security protocols 
                        for consistency with the standardized 
                        telehealth security protocol implemented under 
                        section 602(a)(2), or any other security 
                        requirements of the Department.</DELETED>
                        <DELETED>    (iii) Training of employees, 
                        including payment of those employees for 
                        completing that training, with respect to--
                        </DELETED>
                                <DELETED>    (I) military and veteran 
                                cultural competence, if the entity is 
                                not an organization that represents 
                                veterans; and</DELETED>
                                <DELETED>    (II) equipment required to 
                                provide telehealth services.</DELETED>
                        <DELETED>    (iv) Upgrading existing 
                        infrastructure owned or leased by the entity to 
                        make rooms more conducive to telehealth care, 
                        including--</DELETED>
                                <DELETED>    (I) additional walls to 
                                create a new, private room;</DELETED>
                                <DELETED>    (II) soundproofing of 
                                existing rooms; or</DELETED>
                                <DELETED>    (III) new electrical or 
                                internet outlets in an existing 
                                room.</DELETED>
                        <DELETED>    (v) Upgrading existing 
                        infrastructure to comply with the Americans 
                        with Disabilities Act of 1990 (42 U.S.C. 12101 
                        et seq.).</DELETED>
                        <DELETED>    (vi) Upgrading internet 
                        infrastructure.</DELETED>
                <DELETED>    (B) Exclusion.--Grants may not be used for 
                the purchase of new property or for major construction 
                projects, as determined by the Secretary.</DELETED>
<DELETED>    (d) Memoranda of Understanding or Agreement on Telehealth 
Access Points.--</DELETED>
        <DELETED>    (1) In general.--An entity described in subsection 
        (a) that seeks to establish a telehealth access point for 
        veterans but does not require grant funding under this section 
        to do so may enter into a memorandum of understanding or 
        memorandum of agreement with the Department for the 
        establishment of such an access point.</DELETED>
        <DELETED>    (2) Inspection.--The Secretary shall inspect the 
        access point proposed to be established under paragraph (1) to 
        ensure that it is adequately private, secure, and accessible 
        for veterans before the access point is established.</DELETED>
<DELETED>    (e) Assessment of Barriers to Access.--</DELETED>
        <DELETED>    (1) In general.--Not later than 18 months after 
        the date of the enactment of this Act, the Secretary shall 
        complete an assessment of barriers faced by veterans in 
        accessing telehealth services from home.</DELETED>
        <DELETED>    (2) Elements.--The assessment required by 
        paragraph (1) shall include the following:</DELETED>
                <DELETED>    (A) An assessment of current and potential 
                future cost barriers to veterans having internet access 
                at home.</DELETED>
                <DELETED>    (B) An assessment of current and potential 
                future barriers to veterans accessing broadband 
                services at home.</DELETED>
                <DELETED>    (C) A description of how the Department 
                plans to address the current and potential future cost 
                and access barriers described in subparagraphs (A) and 
                (B).</DELETED>
                <DELETED>    (D) Such other matters related to internet 
                access for veterans in their homes as the Secretary 
                considers relevant.</DELETED>
        <DELETED>    (3) Report.--Not later than 120 days after the 
        completion of the assessment required by paragraph (1), 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 assessment, including any 
        recommendations for legislative or administrative action based 
        on the results of the assessment.</DELETED>
<DELETED>    (f) Authorization of Appropriations.--There is authorized 
to be appropriated to the Secretary of Veterans Affairs $10,000,000 to 
carry out this section.</DELETED>

<DELETED>SEC. 602. IMPLEMENTATION OF NATIONAL PROTOCOL FOR TELEHEALTH 
              SECURITY AND INTERFACING INSTRUCTIONS.</DELETED>

<DELETED>    (a) National Telehealth Security Protocol.--</DELETED>
        <DELETED>    (1) Assessment.--</DELETED>
                <DELETED>    (A) In general.--The Secretary of Veterans 
                Affairs, in consultation with industry experts, the 
                Chairman of the Federal Trade Commission, the Assistant 
                Secretary of Veterans Affairs for Information and 
                Technology and Chief Information Officer, and 
                stakeholders, shall conduct an assessment of current 
                telehealth security protocols.</DELETED>
                <DELETED>    (B) Elements.--The assessment conducted 
                under subparagraph (A) shall include the 
                following:</DELETED>
                        <DELETED>    (i) An assessment of current 
                        telehealth security protocols, including 
                        protocols used by--</DELETED>
                                <DELETED>    (I) the Department of 
                                Veterans Affairs;</DELETED>
                                <DELETED>    (II) other Federal 
                                agencies;</DELETED>
                                <DELETED>    (III) other health care 
                                providers; and</DELETED>
                                <DELETED>    (IV) such other 
                                organizations as the Secretary 
                                considers necessary to assess under 
                                such subparagraph.</DELETED>
                        <DELETED>    (ii) A study of any current or 
                        future security risks--</DELETED>
                                <DELETED>    (I) faced by veterans 
                                using telehealth services; or</DELETED>
                                <DELETED>    (II) faced by the 
                                Department in furnishing those 
                                services.</DELETED>
                <DELETED>    (C) Timeline.--The Secretary shall 
                complete the assessment conducted under subparagraph 
                (A) not later than one year after the date of the 
                enactment of this Act.</DELETED>
        <DELETED>    (2) Implementation.--Not later than 18 months 
        after the completion of the assessment under paragraph (1), the 
        Secretary shall, using guidance from the assessment, fully 
        implement a standardized telehealth security protocol at all 
        facilities of the Department.</DELETED>
        <DELETED>    (3) Privacy and security.--The Secretary shall 
        ensure that the security protocol implemented under this 
        subsection protects the privacy and security of veterans, the 
        health data of veterans, and data from the 
        Department.</DELETED>
<DELETED>    (b) National Telehealth Interfacing Instructions.--
</DELETED>
        <DELETED>    (1) Assessment.--</DELETED>
                <DELETED>    (A) In general.--The Secretary of Veterans 
                Affairs, in consultation with industry experts, 
                organizations that represent veterans, the Chief 
                Veterans Experience Officer, the Assistant Secretary of 
                Veterans Affairs for Information and Technology and 
                Chief Information Officer, and stakeholders, shall 
                conduct an assessment of current telehealth interfacing 
                instructions.</DELETED>
                <DELETED>    (B) Elements.--The assessment conducted 
                under subparagraph (A) shall include an assessment of 
                interfacing instructions used by--</DELETED>
                        <DELETED>    (i) the Department of Veterans 
                        Affairs;</DELETED>
                        <DELETED>    (ii) other Federal 
                        agencies;</DELETED>
                        <DELETED>    (iii) other health care providers; 
                        and</DELETED>
                        <DELETED>    (iv) such other organizations as 
                        the Secretary considers necessary to assess 
                        under such subparagraph.</DELETED>
                <DELETED>    (C) Timeline.--The Secretary shall 
                complete the assessment conducted under subparagraph 
                (A) not later than one year after the date of the 
                enactment of this Act.</DELETED>
        <DELETED>    (2) Implementation.--Not later than 18 months 
        after the completion of the assessment under paragraph (1), the 
        Secretary shall, using guidance from the assessment, fully 
        implement standardized telehealth interfacing instructions at 
        all facilities of the Department.</DELETED>
        <DELETED>    (3) Navigation.--The Secretary shall ensure that 
        the telehealth interfacing instructions implemented under this 
        subsection are those that are easiest to navigate for veterans 
        and health care providers.</DELETED>

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Commander John 
Scott Hannon Veterans Mental Health Care Improvement Act of 2019''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.

  TITLE I--IMPROVEMENT OF TRANSITION OF INDIVIDUALS TO SERVICES FROM 
                     DEPARTMENT OF VETERANS AFFAIRS

Sec. 101. Expansion of health care coverage for veterans.
Sec. 102. Review of records of former members of the Armed Forces who 
                            die by suicide within one year of 
                            separation from the Armed Forces.
Sec. 103. Report on REACH VET program of Department of Veterans 
                            Affairs.
Sec. 104. Report on care for former members of the Armed Forces with 
                            other than honorable discharge.

                      TITLE II--SUICIDE PREVENTION

Sec. 201. Financial assistance to certain entities to provide and 
                            coordinate the provision of suicide 
                            prevention services for eligible 
                            individuals and their families.
Sec. 202. Study on feasibility and advisability of the Department of 
                            Veterans Affairs providing certain 
                            complementary and integrative health 
                            services.
Sec. 203. Pilot program to provide veterans access to complementary and 
                            integrative health services through animal 
                            therapy, agritherapy, post-traumatic growth 
                            therapy, and outdoor sports and recreation 
                            therapy.
Sec. 204. Department of Veterans Affairs independent reviews of certain 
                            deaths of veterans by suicide and staffing 
                            levels of mental health professionals.
Sec. 205. Comptroller General report on management by Department of 
                            Veterans Affairs of veterans at high risk 
                            for suicide.

     TITLE III--PROGRAMS, STUDIES, AND GUIDELINES ON MENTAL HEALTH

Sec. 301. Study on connection between living at high altitude and 
                            suicide risk factors among veterans.
Sec. 302. Establishment by Department of Veterans Affairs and 
                            Department of Defense of a clinical 
                            provider treatment toolkit and accompanying 
                            training materials for comorbidities.
Sec. 303. Update of clinical practice guidelines for assessment and 
                            management of patients at risk for suicide.
Sec. 304. Establishment by Department of Veterans Affairs and 
                            Department of Defense of clinical practice 
                            guidelines for the treatment of serious 
                            mental illness.
Sec. 305. Precision medicine initiative of Department of Veterans 
                            Affairs to identify and validate brain and 
                            mental health biomarkers.
Sec. 306. Statistical analyses and data evaluation by Department of 
                            Veterans Affairs.

     TITLE IV--OVERSIGHT OF MENTAL HEALTH CARE AND RELATED SERVICES

Sec. 401. Study on effectiveness of suicide prevention and mental 
                            health outreach programs of Department of 
                            Veterans Affairs.
Sec. 402. Oversight of mental health and suicide prevention media 
                            outreach conducted by Department of 
                            Veterans Affairs.
Sec. 403. Comptroller General management review of mental health and 
                            suicide prevention services of Department 
                            of Veterans Affairs.
Sec. 404. Comptroller General report on efforts of Department of 
                            Veterans Affairs to integrate mental health 
                            care into primary care clinics.
Sec. 405. Joint mental health programs by Department of Veterans 
                            Affairs and Department of Defense.

        TITLE V--IMPROVEMENT OF MENTAL HEALTH MEDICAL WORKFORCE

Sec. 501. Staffing improvement plan for mental health providers of 
                            Department of Veterans Affairs.
Sec. 502. Staffing improvement plan for peer specialists of Department 
                            of Veterans Affairs who are women.
Sec. 503. Establishment of Department of Veterans Affairs Readjustment 
                            Counseling Service Scholarship Program.
Sec. 504. Comptroller General report on Readjustment Counseling Service 
                            of Department of Veterans Affairs.
Sec. 505. Expansion of reporting requirements on Readjustment 
                            Counseling Service of Department of 
                            Veterans Affairs.
Sec. 506. Studies on alternative work schedules for employees of 
                            Veterans Health Administration.
Sec. 507. Suicide prevention coordinators.
Sec. 508. Report on efforts by Department of Veterans Affairs to 
                            implement safety planning in emergency 
                            departments.

     TITLE VI--IMPROVEMENT OF CARE AND SERVICES FOR WOMEN VETERANS

Sec. 601. Expansion of capabilities of Women Veterans Call Center to 
                            include text messaging.
Sec. 602. Gap analysis of Department of Veterans Affairs programs that 
                            provide assistance to women veterans who 
                            are homeless.
Sec. 603. Requirement for Department of Veterans Affairs internet 
                            website to provide information on services 
                            available to women veterans.
Sec. 604. Report on locations where women veterans are using health 
                            care from Department of Veterans Affairs.

                        TITLE VII--OTHER MATTERS

Sec. 701. Expanded telehealth from Department of Veterans Affairs.
Sec. 702. Partnerships with non-Federal Government entities to provide 
                            hyperbaric oxygen therapy to veterans and 
                            studies on the use of such therapy for 
                            treatment of post-traumatic stress disorder 
                            and traumatic brain injury.
Sec. 703. Prescription of technical qualifications for licensed hearing 
                            aid specialists and requirement for 
                            appointment of such specialists.
Sec. 704. Use by Department of Veterans Affairs of commercial 
                            institutional review boards in sponsored 
                            research trials.
Sec. 705. Creation of Office of Research Reviews within the Office of 
                            Information and Technology of the 
                            Department of Veterans Affairs.

  TITLE I--IMPROVEMENT OF TRANSITION OF INDIVIDUALS TO SERVICES FROM 
                     DEPARTMENT OF VETERANS AFFAIRS

SEC. 101. EXPANSION OF HEALTH CARE COVERAGE FOR VETERANS.

    (a) In General.--Section 1710(a)(1) of title 38, United States 
Code, is amended--
            (1) in subparagraph (A), by striking ``and'' at the end;
            (2) by redesignating subparagraph (B) as subparagraph (C); 
        and
            (3) by inserting after subparagraph (A) the following new 
        subparagraph (B):
            ``(B) to any veteran during the one-year period following 
        the discharge or release of the veteran from active military, 
        naval, or air service; and''.
    (b) Patient Enrollment System.--Section 1705(c) of such title is 
amended by adding at the end the following new paragraph:
    ``(3) Nothing in this section shall be construed to prevent the 
Secretary from providing hospital care and medical services to a 
veteran under section 1710(a)(1)(B) of this title during the period 
specified in such section notwithstanding the failure of the veteran to 
enroll in the system of patient enrollment established by the Secretary 
under subsection (a).''.
    (c) Promotion of Expanded Eligibility.--
            (1) Transition assistance program.--
                    (A) In general.--The Secretary of Labor, in 
                consultation with the Secretary of Defense and the 
                Secretary of Veterans Affairs, shall promote to members 
                of the Armed Forces transitioning from service in the 
                Armed Forces to civilian life through the Transition 
                Assistance Program the expanded eligibility of veterans 
                for health care under the laws administered by the 
                Secretary of Veterans Affairs pursuant to the 
                amendments made by this section.
                    (B) Transition assistance program defined.--In this 
                paragraph, the term ``Transition Assistance Program'' 
                means the Transition Assistance Program under sections 
                1142 and 1144 of title 10, United States Code.
            (2) Publication by department of veterans affairs.--Not 
        later than 30 days after the date of the enactment of this Act, 
        the Secretary of Veterans Affairs shall publish on a website of 
        the Department of Veterans Affairs notification of the expanded 
        eligibility of veterans for health care under the laws 
        administered by the Secretary pursuant to the amendments made 
        by this section.

SEC. 102. REVIEW OF RECORDS OF FORMER MEMBERS OF THE ARMED FORCES WHO 
              DIE BY SUICIDE WITHIN ONE YEAR OF SEPARATION FROM THE 
              ARMED FORCES.

    (a) In General.--The Secretary of Defense and the Secretary of 
Veterans Affairs shall jointly review the records of each former member 
of the Armed Forces who died by suicide within one year of separation 
from the Armed Forces during the five-year period preceding the date of 
the enactment of this Act.
    (b) Elements.--The review required by subsection (a) with respect 
to a former member of the Armed Forces shall include consideration of 
the following:
            (1) If the Department of Defense had previously identified 
        the former member as being at risk for suicide and if that 
        identification had been communicated to the Department of 
        Veterans Affairs.
            (2) What risk factors were present with respect to the 
        former member and how those risk factors correlated to the 
        circumstances of the death of the former member.
            (3) If the former member was eligible to receive health 
        care services from the Department of Veterans Affairs.
            (4) If the former member received health care services, 
        including mental health care services, from a facility of the 
        Department of Veterans Affairs, including readjustment 
        counseling services, following separation from the Armed 
        Forces.
            (5) If the former member had received a mental health 
        waiver during service in the Armed Forces.
            (6) The employment status, housing status, marital status, 
        age, rank within the Armed Forces (such as enlisted or 
        officer), and branch of service within the Armed Forces of the 
        former member.
            (7) If support services, specified by the type of service 
        (such as employment, mental health, etc.), were provided to the 
        former member during their period of separation from the Armed 
        Forces, disaggregated by--
                    (A) services furnished by the Department of 
                Defense, including through contracts;
                    (B) services furnished by the Department of 
                Veterans Affairs, including through contracts; and
                    (C) services not covered under subparagraph (A) or 
                (B).
    (c) Report.--
            (1) In general.--Not later than one year after the date of 
        the enactment of this Act, the Secretary of Defense and the 
        Secretary of Veterans Affairs shall jointly submit to the 
        appropriate committees of Congress an aggregated report on the 
        results of the review conducted under subsection (a).
            (2) Appropriate committees of congress defined.--In this 
        subsection, the term ``appropriate committees of Congress'' 
        means--
                    (A) The Committee on Armed Services and the 
                Committee on Veterans' Affairs of the Senate; and
                    (B) The Committee on Armed Services and the 
                Committee on Veterans' Affairs of the House of 
                Representatives.

SEC. 103. REPORT ON REACH VET PROGRAM OF DEPARTMENT OF VETERANS 
              AFFAIRS.

    (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 
REACH VET program.
    (b) Elements.--The report required by subsection (a) shall include 
the following:
            (1) An assessment of the impact of the REACH VET program on 
        rates of suicide among veterans.
            (2) An assessment of how limits within the REACH VET 
        program, such as caps on the number of veterans who may be 
        flagged as high risk, are adjusted for differing rates of 
        suicide across the country.
            (3) A detailed explanation, with evidence, for why the 
        conditions included in the model used by the REACH VET program 
        were chosen, including an explanation as to why certain 
        conditions, such as bipolar disorder II, were not included even 
        though they show a similar rate of risk for suicide as other 
        conditions that were included.
            (4) An assessment of the feasibility of incorporating 
        certain economic data held by the Veterans Benefits 
        Administration into the model used by the REACH VET program, 
        including financial data and employment status, which research 
        indicates may have an impact on risk for suicide.
    (c) REACH VET Program Defined.--In this section, the term ``REACH 
VET program'' means the Recovery Engagement and Coordination for 
Health--Veterans Enhanced Treatment program of the Department of 
Veterans Affairs.

SEC. 104. REPORT ON CARE FOR FORMER MEMBERS OF THE ARMED FORCES WITH 
              OTHER THAN HONORABLE DISCHARGE.

    Section 1720I(f) of title 38, United States Code, is amended--
            (1) in paragraph (1) by striking ``Not less frequently than 
        once'' and inserting ``Not later than February 15''; and
            (2) in paragraph (2)--
                    (A) by redesignating subparagraph (C) as 
                subparagraph (F); and
                    (B) by inserting after subsection (B) the following 
                new subparagraphs:
            ``(C) The types of mental or behavioral health care needs 
        treated under this section.
            ``(D) The demographics of individuals being treated under 
        this section, including--
                    ``(i) age;
                    ``(ii) era of service in the Armed Forces;
                    ``(iii) branch of service in the Armed Forces; and
                    ``(iv) geographic location.
            ``(E) The average number of visits for an individual for 
        mental or behavioral health care under this section.''.

                      TITLE II--SUICIDE PREVENTION

SEC. 201. FINANCIAL ASSISTANCE TO CERTAIN ENTITIES TO PROVIDE AND 
              COORDINATE THE PROVISION OF SUICIDE PREVENTION SERVICES 
              FOR ELIGIBLE INDIVIDUALS AND THEIR FAMILIES.

    (a) Purpose.--The purpose of this section is to reduce veteran 
suicide through a community-based grant program to award grants to 
eligible entities to provide suicide prevention services to eligible 
individuals and their family.
    (b) Distribution of Financial Assistance.--
            (1) In general.--The Secretary of Veterans Affairs shall 
        provide financial assistance to eligible entities approved 
        under this section through the award of grants each fiscal year 
        to such entities to provide and coordinate the provision of 
        suicide prevention services to eligible individuals and their 
        family to reduce the risk of suicide.
            (2) Coordination with task force.--The Secretary shall 
        carry out this section in coordination with the President's 
        Roadmap to Empower Veterans and End the National Tragedy of 
        Suicide Task Force, to the extent practicable.
    (c) Award of Grants.--
            (1) In general.--The Secretary shall award a grant to each 
        eligible entity for which the Secretary has approved an 
        application under subsection (f) to provide or coordinate the 
        provision of suicide prevention services under this section.
            (2) Grant amounts, intervals of payment, and matching 
        funds.--In accordance with the services being provided under a 
        grant under this section and the duration of those services, 
        the Secretary shall establish--
                    (A) a maximum amount to be awarded under the grant 
                that is not greater than $750,000 per grantee per 
                fiscal year;
                    (B) intervals of payment for the administration of 
                the grant; and
                    (C) a requirement for the recipient of the grant to 
                provide matching funds in a specified percentage.
    (d) Distribution of Financial Assistance and Preference.--
            (1) Distribution.--
                    (A) Priority.--Subject to subparagraphs (B) and 
                (C), in determining how to distribute grants under this 
                section, the Secretary may prioritize the award of 
                grants in--
                            (i) rural communities;
                            (ii) Tribal lands;
                            (iii) territories of the United States;
                            (iv) medically underserved areas;
                            (v) areas with a high number or percentage 
                        of minority veterans or women veterans; and
                            (vi) areas with a high number or percentage 
                        of calls to the Veterans Crisis Line.
                    (B) Areas with need.--The Secretary shall ensure 
                that, to the extent practicable, financial assistance 
                under this section is distributed--
                            (i) to provide services in areas of the 
                        United States, including territories of the 
                        United States, that have experienced high rates 
                        or a high burden of veteran suicide; and
                            (ii) to eligible entities that can assist 
                        eligible individuals at risk of suicide who are 
                        not currently receiving health care furnished 
                        by the Department of Veterans Affairs.
                    (C) Geography.--In distributing financial 
                assistance under subparagraph (B), the Secretary may 
                provide grants to eligible entities that furnish 
                services to eligible individuals in geographically 
                dispersed areas.
            (2) Preference.--
                    (A) In general.--The Secretary shall give 
                preference in the provision of financial assistance 
                under this section to eligible entities that have 
                demonstrated the ability to provide or coordinate 
                multiple suicide prevention services using a collective 
                impact model.
                    (B) Rule of construction.--Nothing in this 
                paragraph shall be construed to limit the award of 
                grants under this section only to organizations that 
                provide or coordinate multiple suicide prevention 
                services through a collective impact model.
    (e) Requirements for Receipt of Financial Assistance.--
            (1) Notification that services are from department.--Each 
        entity receiving financial assistance under this section to 
        provide suicide prevention services to eligible individuals and 
        their family shall notify the recipients of such services that 
        such services are being paid for, in whole or in part, by the 
        Department.
            (2) Coordination with other services from department.--Each 
        entity receiving a grant under this section shall--
                    (A) coordinate with the Secretary with respect to 
                the provision of clinical services to eligible 
                individuals in accordance with any other provision of 
                law regarding the delivery of health care under the 
                laws administered by the Secretary;
                    (B) inform a veteran in receipt of assistance under 
                this section of the eligibility of the veteran to 
                enroll in the patient enrollment system of the 
                Department under section 1705 of title 38, United 
                States Code; and
                    (C) if such veteran wishes to so enroll, inform the 
                veteran of the point of contact at the nearest medical 
                center of the Department who can assist the veteran in 
                such enrollment.
            (3) Measurement and monitoring.--Each entity receiving a 
        grant under this section shall submit to the Secretary a 
        description of the tools and assessments the entity uses or 
        will use to determine the effectiveness of the services 
        furnished by the entity under this section, including the 
        effect of those services on--
                    (A) the financial stability of eligible individuals 
                receiving those services;
                    (B) the mental resiliency and mental outlook of 
                those eligible individuals; and
                    (C) the social support of those eligible 
                individuals.
            (4) Reports.--The Secretary--
                    (A) shall require each entity receiving financial 
                assistance under this section to submit to the 
                Secretary an annual report that describes the projects 
                carried out with such financial assistance during the 
                year covered by the report, including the number of 
                eligible individuals served;
                    (B) shall specify to each such entity the 
                evaluation criteria and data and information, which 
                shall include a mental health measurement of each 
                eligible individual served, to be submitted in such 
                report; and
                    (C) may require such entities to submit to the 
                Secretary such additional reports as the Secretary 
                considers appropriate.
    (f) Application for Financial Assistance.--
            (1) In general.--An eligible entity seeking financial 
        assistance under this section shall submit to the Secretary an 
        application therefor in such form, in such manner, and 
        containing such commitments and information as the Secretary 
        considers necessary to carry out this section.
            (2) Matters to be included.--Each application submitted by 
        an eligible entity under paragraph (1) shall contain the 
        following:
                    (A) A description of the suicide prevention 
                services proposed to be provided by the eligible entity 
                and the identified need for those services.
                    (B) A detailed plan describing how the eligible 
                entity proposes to coordinate and deliver suicide 
                prevention services (including by providing 
                opportunities for mental wellness and personal growth) 
                to eligible individuals not currently receiving care 
                furnished by the Department, including--
                            (i) an identification of the community 
                        partners, if any, with which the eligible 
                        entity proposes to work in delivering such 
                        services;
                            (ii) a description of the arrangements 
                        currently in place between the eligible entity 
                        and such partners; and
                            (iii) an identification of how long such 
                        arrangements have been in place.
                    (C) Clearly defined objectives for the provision of 
                suicide prevention services.
                    (D) A description of the services the eligible 
                entity proposes to deliver directly and a description 
                of any services the eligible entity proposes to deliver 
                through an agreement with a community partner, if any.
                    (E) A description of the types of eligible 
                individuals at risk of suicide and their family 
                proposed to be provided suicide prevention services.
                    (F) An estimate of the number of eligible 
                individuals at risk of suicide and their family 
                proposed to be provided suicide prevention services and 
                the basis for such estimate, including the percentage 
                of those individuals who are not currently receiving 
                care furnished by the Department.
                    (G) The physical address of the primary location of 
                the eligible entity.
                    (H) A description of the geographic area and 
                boundaries the eligible entity plans to serve during 
                the year for which the application applies.
                    (I) Evidence of the experience of the eligible 
                entity (and the proposed partners of the entity) in 
                providing suicide prevention services to individuals at 
                risk of suicide, particularly to eligible individuals 
                at risk of suicide and their family.
                    (J) A description of the managerial and 
                technological capacity of the eligible entity--
                            (i) to coordinate the provision of suicide 
                        prevention services with the provision of other 
                        services;
                            (ii) to assess continuously the needs of 
                        eligible individuals at risk of suicide and 
                        their family for suicide prevention services;
                            (iii) to coordinate the provision of 
                        suicide prevention services with the services 
                        of the Department for which the beneficiaries 
                        are eligible;
                            (iv) to continuously seek new sources of 
                        assistance to ensure the continuity of suicide 
                        prevention services for eligible individuals at 
                        risk of suicide and their family as long as the 
                        individual is determined to be at risk of 
                        suicide; and
                            (v) to measure, over a long-term period, 
                        the improved mental resiliency and mental 
                        outlook of the eligible individual served.
                    (K) An agreement to use the measurement tool 
                provided by the Department for purposes of measuring 
                effectiveness of the programming as described in 
                paragraph (2) of subsection (h).
                    (L) A description of how the eligible entity plans 
                to assess the effectiveness of the provision of suicide 
                prevention services under this section.
                    (M) Such additional application criteria as the 
                Secretary considers appropriate.
    (g) Technical Assistance.--
            (1) In general.--The Secretary shall provide training and 
        technical assistance to eligible entities in receipt of 
        financial assistance under this section regarding--
                    (A) the data required to be collected and shared 
                with the Department;
                    (B) the means of data collection and sharing;
                    (C) familiarization with and appropriate use of any 
                tool to be used to measure the effectiveness of the use 
                of the financial assistance provided; and
                    (D) the requirements for reporting under subsection 
                (e)(4) on services provided via such financial 
                assistance.
            (2) Provision of training and technical assistance.--The 
        Secretary may provide the training and technical assistance 
        described in paragraph (1) directly or through grants or 
        contracts with appropriate public or nonprofit entities.
    (h) Administration of Grant Program.--
            (1) Selection criteria.--The Secretary, in consultation 
        with entities specified in paragraph (3), shall establish 
        criteria for the selection of eligible entities that have 
        submitted applications under subsection (f).
            (2) Development of measures and metrics.--The Secretary 
        shall develop, in consultation with entities specified in 
        paragraph (3), the following:
                    (A) A framework for collecting and sharing 
                information about entities in receipt of financial 
                assistance under this section for purposes of improving 
                the discovery of services available for eligible 
                individuals at risk of suicide and their family, set 
                forth by service type, locality, and eligibility 
                criteria.
                    (B) The measures to be used by each entity in 
                receipt of financial assistance under this section to 
                determine the effectiveness of the programming being 
                provided by such entity in improving mental resiliency 
                and mental outlook of eligible individuals at risk of 
                suicide and their family.
                    (C) Metrics for measuring the effectiveness of the 
                provision of financial assistance under this section, 
                including reducing suicide risk among eligible 
                individuals.
            (3) Coordination.--In developing a plan for the design and 
        implementation of the provision of financial assistance under 
        this section, including criteria for the award of grants, the 
        Secretary shall consult with the following:
                    (A) Veterans service organizations.
                    (B) National organizations representing potential 
                community partners of eligible entities in providing 
                supportive services to address the needs of eligible 
                individuals at risk of suicide and their family, 
                including national organizations that--
                            (i) advocate for the needs of individuals 
                        with or at risk of behavioral health 
                        conditions;
                            (ii) represent mayors;
                            (iii) represent first responders;
                            (iv) represent chiefs of police and 
                        sheriffs;
                            (v) represent governors;
                            (vi) represent a territory of the United 
                        States; or
                            (vii) represent a Tribal alliance.
                    (C) National organizations that represent counties.
                    (D) Organizations with which the Department has a 
                current memorandum of agreement or understanding 
                related to mental health or suicide prevention.
                    (E) State departments of veterans affairs.
                    (F) National organizations representing members of 
                the reserve components of the Armed Forces.
                    (G) Vet Centers.
                    (H) Organizations, including institutions of higher 
                education, with experience in creating measurement 
                tools for purposes of determining programmatic 
                effectiveness.
                    (I) The National Alliance on Mental Illness.
                    (J) The Centers for Disease Control and Prevention.
                    (K) The Substance Abuse and Mental Health Services 
                Administration of the Department of Health and Human 
                Services.
                    (L) A labor organization (as such term is defined 
                in section 7103(a)(4) of title 5, United States Code).
                    (M) The PREVENTS task force established under 
                Executive Order 13861 (84 Fed. Reg. 8585; relating to 
                the national roadmap to empower veterans and end 
                suicide) .
                    (N) Such other organizations as the Secretary 
                considers appropriate.
            (4) Report on grant criteria.--Not later than 30 days 
        before notifying eligible entities of the availability of 
        funding under this section, the Secretary shall submit to the 
        appropriate committees of Congress a report containing--
                    (A) criteria for the award of a grant under this 
                section;
                    (B) the tool or tools and metrics to be used by the 
                Department to measure the effectiveness of the use of 
                financial assistance provided under this section;
                    (C) a framework for the sharing of information 
                about entities in receipt of financial assistance under 
                this section; and
                    (D) the method by which the Secretary determines 
                financial responsibility for purposes of paragraph (3) 
                of subsection (m).
    (i) Information on Potential Beneficiaries.--
            (1) In general.--The Secretary may make available to 
        recipients of financial assistance under this section certain 
        information regarding potential beneficiaries of services for 
        which such financial assistance is provided.
            (2) Information included.--The information made available 
        under paragraph (1) with respect to potential beneficiaries may 
        include the following:
                    (A) Confirmation of the status of a potential 
                beneficiary as a veteran.
                    (B) Confirmation of whether the potential 
                beneficiary is enrolled in the patient enrollment 
                system of the Department under section 1705 of title 
                38, United States Code.
                    (C) Confirmation of whether a potential beneficiary 
                is currently receiving care furnished by the Department 
                or has recently received such care.
            (3) Opt-out.--The Secretary shall allow an eligible 
        individual to opt out of having their information shared under 
        this subsection with recipients of financial assistance under 
        this section.
    (j) Duration.--The authority of the Secretary to provide financial 
assistance under this section shall terminate on the date that is three 
years after the date on which the first grant is awarded under this 
section.
    (k) Reporting and Assessment.--
            (1) Interim report.--
                    (A) In general.--Not later than 18 months after the 
                date on which the first grant is awarded under this 
                section, the Secretary shall submit to the appropriate 
                committees of Congress a report on the provision of 
                financial assistance under this section.
                    (B) Elements.--The report submitted under 
                subparagraph (A) shall include the following:
                            (i) An assessment of the effectiveness of 
                        the provision of financial assistance under 
                        this section, including--
                                    (I) the effectiveness of community 
                                partners in conducting outreach to 
                                eligible individuals at risk of suicide 
                                and their family and reducing suicide 
                                rates for eligible individuals; and
                                    (II) the effectiveness of the 
                                measures and metrics developed under 
                                subsection (h)(2) at improving 
                                coordination of suicide prevention 
                                services.
                            (ii) A list of grant recipients and their 
                        partner organizations that delivered services 
                        funded by the grant and the amount of such 
                        grant received by each recipient and partner 
                        organization.
                            (iii) The number of eligible individuals 
                        supported by each grant recipient, including 
                        through services provided to family members.
                            (iv) The types of suicide prevention 
                        services provided by each grant recipient and 
                        partner organization.
                            (v) The number of eligible individuals 
                        supported by each grant recipient under this 
                        section, including through services provided to 
                        family members, who were not previously 
                        receiving care furnished by the Department.
                            (vi) The number of eligible individuals 
                        whose mental resiliency and mental outlook 
                        received a baseline measurement assessment 
                        under this section and the number of such 
                        individuals whose mental resiliency and mental 
                        outlook will be measured by the Department or a 
                        community partner over a period of time.
                            (vii) The types of data the Department was 
                        able to collect and share with partners, 
                        including a characterization of the benefits of 
                        that data.
                            (viii) The number of eligible individuals 
                        newly enrolled in the Veterans Health 
                        Administration by grant recipients, set forth 
                        by grant recipient.
            (2) Final report.--Not later than three years after the 
        date on which the first grant is awarded under this section, 
        the Secretary shall submit to the appropriate committees of 
        Congress--
                    (A) a follow-up on the interim report submitted 
                under paragraph (1) containing the elements set forth 
                in subparagraph (B) of such paragraph; and
                    (B) a report on--
                            (i) the effectiveness of the provision of 
                        financial assistance under this section, 
                        including the effectiveness of community 
                        partners in conducting outreach to eligible 
                        individuals at risk of suicide and their family 
                        and reducing suicide rates for eligible 
                        individuals;
                            (ii) an assessment of the increased 
                        capacity of the Department to provide services 
                        to eligible individuals at risk of suicide and 
                        their family, set forth by State, as a result 
                        of the provision of financial assistance under 
                        this section; and
                            (iii) the feasibility and advisability of 
                        extending or expanding the provision of 
                        financial assistance under this section.
            (3) Third party assessment.--
                    (A) Study of grant program.--
                            (i) In general.--Not later than 180 days 
                        after the date on which the first grant is 
                        awarded under this section, the Secretary shall 
                        seek to enter into a contract with an 
                        appropriate entity described in subparagraph 
                        (C) to conduct a study on the provision of 
                        grants under this section.
                            (ii) Elements.--In conducting the study 
                        under clause (i), the appropriate entity 
                        shall--
                                    (I) evaluate the effectiveness of 
                                grants under this section in addressing 
                                the factors that contribute to suicide 
                                through the provision of services by 
                                eligible entities located in the 
                                communities where the eligible 
                                individuals receiving those services 
                                live; and
                                    (II) compare the results of the 
                                provision of grants under this section 
                                with other national programs in 
                                delivering resources to eligible 
                                individuals in the communities where 
                                they live that address the factors that 
                                contribute to suicide.
                    (B) Assessment.--
                            (i) In general.--The contract under 
                        subparagraph (A) shall require that not later 
                        than two years after the date on which the 
                        first grant is awarded under this section, the 
                        appropriate entity shall submit to the 
                        Secretary an assessment of the provision of 
                        grants under this section based on the study 
                        conducted pursuant to such contract.
                            (ii) Submittal to congress.--Upon receipt 
                        of the assessment under clause (i), the 
                        Secretary shall submit to the appropriate 
                        committees of Congress a copy of the 
                        assessment.
                    (C) Appropriate entity.--An appropriate entity 
                described in this subparagraph is a nongovernment 
                entity with experience optimizing and assessing 
                organizations that deliver services.
    (l) Provision of Care to Eligible Individuals.--
            (1) In general.--When the Secretary determines it is 
        clinically appropriate, the Secretary shall furnish to an 
        eligible individual receiving suicide prevention services 
        through a grant provided under this section an initial mental 
        health assessment and mental health or behavioral health care 
        services authorized under chapter 17 of title 38, United States 
        Code, that are required to treat the mental or behavioral 
        health care needs of the eligible individual, including risk of 
        suicide.
            (2) Ineligible.--If an eligible individual refuses to 
        receive services under paragraph (1) or is ineligible for such 
        services, any ongoing clinical services provided by an eligible 
        entity receiving a grant under this section, or a community 
        partner of such entity, shall be at the expense of the entity.
    (m) Definitions.--In this section:
            (1) Appropriate committees of congress.--The term 
        ``appropriate committees of Congress'' means--
                    (A) the Committee on Veterans' Affairs and the 
                Subcommittee on Military Construction, Veterans 
                Affairs, and Related Agencies of the Committee on 
                Appropriations of the Senate; and
                    (B) the Committee on Veterans' Affairs and the 
                Subcommittee on Military Construction, Veterans 
                Affairs, and Related Agencies of the Committee on 
                Appropriations of the House of Representatives.
            (2) Collective impact model.--The term ``collective impact 
        model'' means a partnership between several entities that--
                    (A) collectively provides multiple suicide 
                prevention services;
                    (B) shares the common goal of reducing the risk of 
                suicide among eligible individuals;
                    (C) has a shared measurement system;
                    (D) engages in continuous communication; and
                    (E) includes an organization that acts as the 
                supporting infrastructure of the model by creating a 
                structured process for--
                            (i) strategic planning;
                            (ii) project management; and
                            (iii) supporting partner entities through 
                        ongoing--
                                    (I) facilitation;
                                    (II) technology and communications 
                                support;
                                    (III) data collection and 
                                reporting; and
                                    (IV) administrative support.
            (3) Eligible entity.--The term ``eligible entity'' means--
                    (A) an incorporated private institution or 
                foundation--
                            (i) no part of the net earnings of which 
                        incurs to the benefit of any member, founder, 
                        contributor, or individual;
                            (ii) that has a governing board that would 
                        be responsible for the operation of the suicide 
                        prevention services provided under this 
                        section; and
                            (iii) that is approved by the Secretary as 
                        to financial responsibility;
                    (B) a corporation wholly owned and controlled by an 
                organization meeting the requirements of clauses (i), 
                (ii), and (iii) of subparagraph (A);
                    (C) a tribally designated housing entity (as 
                defined in section 4 of the Native American Housing 
                Assistance and Self-Determination Act of 1996 (25 
                U.S.C. 4103));
                    (D) a community-based organization--
                            (i) that is physically based in the 
                        targeted community;
                            (ii) that can effectively network with 
                        local civic organizations, regional health 
                        systems, and other settings where eligible 
                        individuals at risk of suicide and their family 
                        are likely to have contact; and
                            (iii) that is approved by the Secretary as 
                        to financial responsibility;
                    (E) a community-based organization--
                            (i) that is physically based in the 
                        targeted community;
                            (ii) that has demonstrated the potential to 
                        use a collective impact model to effectively 
                        network and partner with community partners 
                        that offer suicide prevention services to 
                        reduce the risk of suicide for eligible 
                        individuals; and
                            (iii) that is approved by the Secretary as 
                        to financial responsibility; or
                    (F) a State or local government that is approved by 
                the Secretary as to financial responsibility.
            (4) Eligible individual.--The term ``eligible individual'' 
        means--
                    (A) a veteran, as defined in section 101 of title 
                38, United States Code;
                    (B) an eligible individual described in section 
                1720I(b) of such title;
                    (C) an individual described in any of clauses (i) 
                through (iv) of section 1712A(a)(1)(C) of such title; 
                or
                    (D) such other individual as the Secretary 
                considers appropriate.
            (5) Emergency medical condition defined.--The term 
        ``emergency medical condition'' means a medical or behavioral 
        condition manifesting itself by acute symptoms of sufficient 
        severity, including severe pain, such that the absence of 
        immediate medical attention could reasonably be expected to 
        result in--
                    (A) placing the health of the individual in serious 
                jeopardy;
                    (B) serious impairment to bodily functions; or
                    (C) serious dysfunction of bodily organs.
            (6) Family.--The term ``family'' means, with respect to an 
        eligible individual at risk of suicide, any of the following:
                    (A) A parent.
                    (B) A spouse.
                    (C) A child.
                    (D) A sibling.
                    (E) A step-family member.
                    (F) An extended family member.
                    (G) Any other individual who lives with the 
                eligible individual.
            (7) Necessary stabilizing treatment defined.--The term 
        ``necessary stabilizing treatment'' means, with respect to an 
        emergency medical condition, to provide, for not greater than 
        72 hours, such medical treatment for the condition necessary to 
        assure, within reasonable medical probability, that no material 
        deterioration of the condition is likely to result from or 
        occur during the transfer of the individual from a facility.
            (8) Peer specialist.--The term ``peer specialist'' means a 
        person eligible to be appointed as a peer specialist under 
        section 7402(b)(13) of title 38, United States Code.
            (9) Risk of suicide.--The term ``risk of suicide'' means 
        exposure to or the existence of any of the following:
                    (A) Health risk factors, including the following:
                            (i) Mental health challenges.
                            (ii) Substance abuse.
                            (iii) Serious or chronic health conditions 
                        or pain.
                            (iv) Traumatic brain injury.
                    (B) Environmental risk factors, including the 
                following:
                            (i) Access to lethal means (such as drugs, 
                        firearms, etc.).
                            (ii) Prolonged stress.
                            (iii) Stressful life events.
                            (iv) Exposure to the suicide of another 
                        person or to graphic or sensationalized 
                        accounts of suicide.
                            (v) Unemployment.
                            (vi) Homelessness.
                            (vii) Recent loss.
                            (viii) Legal or financial challenges.
                    (C) Historical risk factors, including the 
                following:
                            (i) Previous suicide attempts.
                            (ii) Family history of suicide.
                            (iii) History of abuse, neglect, or trauma.
            (10) Rural.--With respect to an area or community, the term 
        ``rural'' has the meaning given that term in the Rural-Urban 
        Commuting Areas coding system of the Department of Agriculture.
            (11) State.--The term ``State'' means each of several 
        States, the District of Columbia, the Northern Mariana Islands, 
        American Samoa, Guam, Puerto Rico, and the United States Virgin 
        Islands.
            (12) Suicide prevention services.--
                    (A) In general.--The term ``suicide prevention 
                services'' means services to address the needs of 
                eligible individuals at risk of suicide and their 
                family and includes the following:
                            (i) Outreach to identify eligible 
                        individuals at risk of suicide, with an 
                        emphasis on eligible individuals who are at 
                        highest risk or who are not receiving health 
                        care or other services furnished by the 
                        Department.
                            (ii) A baseline mental health assessment 
                        for risk screening and referral to care at--
                                    (I) a medical facility of the 
                                Department;
                                    (II) a Vet Center; or
                                    (III) a non-Department facility if 
                                the eligible individual refuses to or 
                                is ineligible for care from the 
                                Department or a Vet Center.
                            (iii) Education on suicide risk and 
                        prevention to families and communities.
                            (iv) Individual and group therapy.
                            (v) Case management services.
                            (vi) Peer support services provided by peer 
                        specialists.
                            (vii) Assistance in obtaining any benefit 
                        from the Department that the eligible 
                        individual at risk of suicide or their family 
                        may be eligible to receive, including--
                                    (I) vocational and rehabilitation 
                                counseling;
                                    (II) supportive services for 
                                homeless veterans;
                                    (III) employment and training 
                                services;
                                    (IV) educational assistance; and
                                    (V) health care services.
                            (viii) Assistance in obtaining and 
                        coordinating the provision of other benefits 
                        provided by the Federal Government, a State or 
                        local government, or an eligible entity.
                            (ix) The provision of emergency mental 
                        health treatment to an eligible individual, 
                        which may include--
                                    (I) assessing the eligible 
                                individual for immediate suicide risk;
                                    (II) connecting the eligible 
                                individual to the Veterans Crisis Line; 
                                and
                                    (III) in the case of an eligible 
                                individual who is experiencing an 
                                emergency medical condition--
                                            (aa) paying for the 
                                        provision of necessary 
                                        stabilizing treatment provided 
                                        in a hospital or other medical 
                                        facility; and
                                            (bb) transporting the 
                                        individual--

                                                    (AA) if the 
                                                individual is eligible 
                                                for care from the 
                                                Department, to a 
                                                medical facility of the 
                                                Department; or

                                                    (BB) if the 
                                                individual is not 
                                                eligible for care from 
                                                the Department, to a 
                                                medical facility not 
                                                operated by the 
                                                Department.

                            (x) Such other services necessary for 
                        improving the resiliency of eligible 
                        individuals at risk of suicide and their family 
                        as the Secretary considers appropriate, which 
                        may include--
                                    (I) assistance with emergent needs 
                                relating to--
                                            (aa) daily living services;
                                            (bb) personal financial 
                                        planning;
                                            (cc) transportation 
                                        services;
                                            (dd) legal services to 
                                        assist the eligible individual 
                                        with issues that may contribute 
                                        to risk of suicide; and
                                            (ee) child care (not to 
                                        exceed $5,000 per family of the 
                                        eligible individual per fiscal 
                                        year);
                                    (II) adaptive sports, equine 
                                assisted therapy, or in-place or 
                                outdoor recreational therapy;
                                    (III) substance use reduction 
                                programming;
                                    (IV) individual, group, or family 
                                counseling; and
                                    (V) relationship coaching.
                    (B) Exclusion.--The term ``suicide prevention 
                services'' does not include direct cash assistance to 
                eligible individuals or their family.
            (13) Vet center.--The term ``Vet Center'' has the meaning 
        given that term in section 1712A(h)(1) of title 38, United 
        States Code.
            (14) Veterans crisis line.--The term ``Veterans Crisis 
        Line'' means the toll-free hotline for veterans established 
        under section 1720F(h) of such title.
            (15) Veterans service organization.--The term ``veterans 
        service organization'' means any organization recognized by the 
        Secretary of Veterans Affairs for the representation of 
        veterans included as part of the annually updated list at 
        https://www.va.gov/vso/ or a successor website.

SEC. 202. STUDY ON FEASIBILITY AND ADVISABILITY OF THE DEPARTMENT OF 
              VETERANS AFFAIRS PROVIDING CERTAIN COMPLEMENTARY AND 
              INTEGRATIVE HEALTH SERVICES.

    (a) In General.--Not later than 90 days after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall complete 
a study on the feasibility and advisability of providing complementary 
and integrative health treatments described in subsection (c) at all 
medical facilities of the Department of Veterans Affairs.
    (b) Inclusion of Assessment of Report.--The study conducted under 
subsection (a) shall include an assessment of the final report of the 
Creating Options for Veterans' Expedited Recovery Commission (commonly 
referred to as the ``COVER Commission'') established under section 931 
of the Jason Simcakoski Memorial and Promise Act (title IX of Public 
Law 114-198; 38 U.S.C. 1701 note).
    (c) Treatments Described.--Complementary and integrative health 
treatments described in this subjection shall consist of the following:
            (1) Yoga.
            (2) Meditation.
            (3) Acupuncture.
            (4) Chiropractic care.
            (5) Other treatments that show sufficient evidence of 
        efficacy at treating mental or physical health conditions, as 
        determined by the Secretary.
    (d) Report.--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 completed under 
subsection (a), including--
            (1) the results of such study; and
            (2) such recommendations regarding the furnishing of 
        complementary and integrative health treatments described in 
        subsection (c) as the Secretary considers appropriate.

SEC. 203. PILOT PROGRAM TO PROVIDE VETERANS ACCESS TO COMPLEMENTARY AND 
              INTEGRATIVE HEALTH SERVICES THROUGH ANIMAL THERAPY, 
              AGRITHERAPY, POST-TRAUMATIC GROWTH THERAPY, AND OUTDOOR 
              SPORTS AND RECREATION THERAPY.

    (a) In General.--Not later than 180 days after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall commence 
the conduct of a pilot program to provide complementary and integrative 
health services described in subsection (b) to eligible veterans from 
the Department of Veterans Affairs or through the use of non-Department 
entities for the treatment of post-traumatic stress disorder, 
depression, anxiety, or other conditions as determined by the 
Secretary.
    (b) Treatments Described.--Complementary and integrative health 
treatments described in this subsection shall consist of the following:
            (1) Equine therapy.
            (2) Other animal therapy.
            (3) Agritherapy.
            (4) Post-traumatic growth therapy.
            (5) Outdoor sports and recreation therapy.
    (c) Eligible Veterans.--A veteran is eligible to participate in the 
pilot program under this section if the veteran--
            (1) is enrolled in the system of patient enrollment of the 
        Department under section 1705(a) of title 38, United States 
        Code; and
            (2) has received health care under the laws administered by 
        the Secretary during the two-year period preceding the initial 
        participation of the veteran in the pilot program.
    (d) Duration.--
            (1) In general.--The Secretary shall carry out the pilot 
        program under this section for a three-year period beginning on 
        the commencement of the pilot program.
            (2) Extension.--The Secretary may extend the duration of 
        the pilot program under this section if the Secretary, based on 
        the results of the interim report submitted under subsection 
        (f)(1), determines that it is appropriate to do so.
    (e) Locations.--
            (1) In general.--The Secretary shall select not fewer than 
        five facilities of the Department at which to carry out the 
        pilot program under this section.
            (2) Selection criteria.--In selecting facilities under 
        paragraph (1), the Secretary shall ensure that--
                    (A) the locations are in geographically diverse 
                areas; and
                    (B) not fewer than three facilities serve veterans 
                in rural or highly rural areas (as determined through 
                the use of the Rural-Urban Commuting Areas coding 
                system of the Department of Agriculture).
    (f) Research on Effectiveness of Treatment.--
            (1) In general.--The Secretary shall carry out the pilot 
        program in conjunction with academic researchers affiliated 
        with the Department of Veterans Affairs, including through 
        agreements under paragraph (2), in order for those researchers 
        to research the effectiveness of the treatments described in 
        subsection (b).
            (2) Agreements.--Before commencing the pilot program, the 
        Secretary shall seek to enter into agreements with academic 
        researchers to ensure robust data collection and gathering 
        procedures are in place under the pilot program in order to 
        produce peer-reviewed journal articles.
    (g) Reports.--
            (1) Interim report.--
                    (A) In general.--Not later than one year after the 
                commencement of the pilot program under this section, 
                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 progress of the pilot program.
                    (B) Elements.--The report required by subparagraph 
                (A) shall include the following:
                            (i) The number of participants in the pilot 
                        program.
                            (ii) The type or types of therapy offered 
                        at each facility at which the pilot program is 
                        being carried out.
                            (iii) An assessment of whether 
                        participation by a veteran in the pilot program 
                        resulted in any changes in clinically relevant 
                        endpoints for the veteran with respect to the 
                        conditions specified in subsection (a).
                            (iv) An assessment of the quality of life 
                        of veterans participating in the pilot program, 
                        including the results of a satisfaction survey 
                        of the participants in the pilot program, 
                        disaggregated by treatment under subsection 
                        (b).
                            (v) The determination of the Secretary with 
                        respect to extending the pilot program under 
                        subsection (d)(2).
                            (vi) Any recommendations of the Secretary 
                        with respect to expanding the pilot program.
            (2) Final report.--Not later than 90 days after the 
        termination of the pilot program under this section, 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 final report on the pilot program.

SEC. 204. DEPARTMENT OF VETERANS AFFAIRS INDEPENDENT REVIEWS OF CERTAIN 
              DEATHS OF VETERANS BY SUICIDE AND STAFFING LEVELS OF 
              MENTAL HEALTH PROFESSIONALS.

    (a) Review of Deaths of Veterans by Suicide.--
            (1) In general.--Not later than 90 days after the date of 
        the enactment of this Act, the Secretary of Veterans Affairs 
        shall seek to enter into an agreement with the National 
        Academies of Sciences, Engineering, and Medicine under which 
        the National Academies shall conduct a review of the deaths of 
        all covered veterans who died by suicide during the five-year 
        period ending on the date of the enactment of this Act, 
        regardless of whether information relating to such deaths has 
        been reported by the Centers for Disease Control and 
        Prevention.
            (2) Elements.--The review required by paragraph (1) shall 
        include the following:
                    (A) The total number of covered veterans who died 
                by suicide during the five-year period ending on the 
                date of the enactment of this Act.
                    (B) The total number of covered veterans who died 
                by a violent death during such five-year period.
                    (C) The total number of covered veterans who died 
                by an accidental death during such five-year period.
                    (D) A description of each covered veteran described 
                in subparagraphs (A) through (C), including age, 
                gender, race, and ethnicity.
                    (E) A comprehensive list of prescribed medications 
                and legal or illegal substances as annotated on 
                toxicology reports of covered veterans described in 
                subparagraphs (A) through (C), specifically listing any 
                medications that carried a black box warning, were 
                prescribed for off-label use, were psychotropic, or 
                carried warnings that included suicidal ideation.
                    (F) A summary of medical diagnoses by physicians of 
                the Department of Veterans Affairs or physicians 
                providing services to covered veterans through programs 
                of the Department that led to the prescribing of 
                medications referred to in subparagraph (E) in cases of 
                post-traumatic stress disorder, traumatic brain injury, 
                military sexual trauma, and other anxiety and 
                depressive disorders.
                    (G) The number of instances in which a covered 
                veteran described in subparagraph (A), (B), or (C) was 
                concurrently on multiple medications prescribed by 
                physicians of the Department or physicians providing 
                services to veterans through programs of the Department 
                to treat post-traumatic stress disorder, traumatic 
                brain injury, military sexual trauma, other anxiety and 
                depressive disorders, or instances of comorbidity.
                    (H) The number of covered veterans described in 
                subparagraphs (A) through (C) who were not taking any 
                medication prescribed by a physician of the Department 
                or a physician providing services to veterans through a 
                program of the Department.
                    (I) With respect to the treatment of post-traumatic 
                stress disorder, traumatic brain injury, military 
                sexual trauma, or other anxiety and depressive 
                disorders, the percentage of covered veterans described 
                in subparagraphs (A) through (C) who received a non-
                medication first-line treatment compared to the 
                percentage of such veterans who received medication 
                only.
                    (J) With respect to the treatment of covered 
                veterans described in subparagraphs (A) through (C) for 
                post-traumatic stress disorder, traumatic brain injury, 
                military sexual trauma, or other anxiety and depressive 
                disorders, the number of instances in which a non-
                medication first-line treatment (such as cognitive 
                behavioral therapy) was attempted and determined to be 
                ineffective for such a veteran, which subsequently led 
                to the prescribing of a medication referred to in 
                subparagraph (E).
                    (K) A description and example of how the Department 
                determines and continually updates the clinical 
                practice guidelines governing the prescribing of 
                medications.
                    (L) An analysis of the use by the Department, 
                including protocols or practices at medical facilities 
                of the Department, of systematically measuring pain 
                scores during clinical encounters under the Pain as the 
                5th Vital Sign Toolkit of the Department and an 
                evaluation of the relationship between the use of such 
                measurements and the number of veterans concurrently on 
                multiple medications prescribed by physicians of the 
                Department.
                    (M) The percentage of covered veterans described in 
                subparagraphs (A) through (C) with combat experience or 
                trauma related to combat experience (including military 
                sexual trauma, traumatic brain injury, and post-
                traumatic stress).
                    (N) An identification of the medical facilities of 
                the Department with markedly high prescription rates 
                and suicide rates for veterans receiving treatment at 
                those facilities.
                    (O) An analysis, by State, of programs of the 
                Department that collaborate with State Medicaid 
                agencies and the Centers for Medicare and Medicaid 
                Services, including the following:
                            (i) An analysis of the sharing of 
                        prescription and behavioral health data for 
                        veterans.
                            (ii) An analysis of whether Department 
                        staff check with State prescription drug 
                        monitoring programs before prescribing 
                        medications to veterans.
                            (iii) A description of the procedures of 
                        the Department for coordinating with 
                        prescribers outside of the Department to ensure 
                        that veterans are not overprescribed.
                            (iv) A description of actions that the 
                        Department takes when a veteran is determined 
                        to be overprescribed.
                    (P) An analysis of the collaboration of medical 
                centers of the Department with medical examiners' 
                offices or local jurisdictions to determine veteran 
                mortality and cause of death.
                    (Q) An identification and determination of a best 
                practice model to collect and share veteran death 
                certificate data between the Department of Veterans 
                Affairs, the Department of Defense, States, and tribal 
                entities.
                    (R) A description of how data relating to death 
                certificates of veterans is collected, determined, and 
                reported by the Department of Veterans Affairs.
                    (S) An assessment of any patterns apparent to the 
                National Academies of Sciences, Engineering, and 
                Medicine based on the review conducted under paragraph 
                (1).
                    (T) Such recommendations for further action that 
                would improve the safety and well-being of veterans as 
                the National Academies of Sciences, Engineering, and 
                Medicine determine appropriate.
    (b) Review of Staffing Levels for Mental Health Professionals.--
            (1) In general.--Not later than 90 days after the date of 
        the enactment of this Act, the Secretary shall seek to enter 
        into an agreement with the National Academies of Sciences, 
        Engineering, and Medicine under which the National Academies 
        shall conduct a review of the staffing levels for mental health 
        professionals of the Department.
            (2) Elements.--The review required by paragraph (1) shall 
        include a description of the efforts of the Department to 
        maintain appropriate staffing levels for mental health 
        professionals, such as mental health counselors, marriage and 
        family therapists, and other appropriate counselors, including 
        the following:
                    (A) a description of any impediments to carry out 
                the education, training, and hiring of mental health 
                counselors and marriage and family therapists under 
                section 7302(a) of title 38, United States Code, and 
                strategies for addressing those impediments;
                    (B) a description of the objectives, goals, and 
                timing of the Department with respect to increasing the 
                representation of such counselors and therapists in the 
                behavioral health workforce of the Department, 
                including--
                            (i) a review of eligibility criteria for 
                        such counselors and therapists and a comparison 
                        of such criteria to that of other behavioral 
                        health professions in the Department; and
                            (ii) an assessment of the participation of 
                        such counselors and therapists in the mental 
                        health professionals trainee program of the 
                        Department and any impediments to such 
                        participation;
                    (C) an assessment of the development by the 
                Department of hiring guidelines for mental health 
                counselors, marriage and family therapists, and other 
                appropriate counselors;
                    (D) a description of how the Department--
                            (i) identifies gaps in the supply of mental 
                        health professionals; and
                            (ii) determines successful staffing ratios 
                        for mental health professionals of the 
                        Department;
                    (E) a description of actions taken by the 
                Secretary, in consultation with the Director of the 
                Office of Personnel Management, to create an 
                occupational series for mental health counselors and 
                marriage and family therapists of the Department and a 
                timeline for the creation of such an occupational 
                series; and
                    (F) a description of actions taken by the Secretary 
                to ensure that the national, regional, and local 
                professional standards boards for mental health 
                counselors and marriage and family therapists are 
                comprised of only mental health counselors and marriage 
                and family therapists and that the liaison from the 
                Department to such boards is a mental health counselor 
                or marriage and family therapist.
    (c) Compilation of Data.--
            (1) Form of compilation.--The Secretary of Veterans Affairs 
        shall ensure that data compiled under subsections (a) and (b) 
        is compiled in a manner that allows it to be analyzed across 
        all data fields for purposes of informing and updating clinical 
        practice guidelines of the Department of Veterans Affairs.
            (2) Compilation of data regarding covered veterans.--In 
        compiling data under subsection (a)(2) regarding covered 
        veterans described in subparagraphs (A) through (C) of such 
        subsection, data regarding veterans described in each such 
        subparagraph shall be compiled separately and disaggregated by 
        year.
    (d) Completion of Reviews and Reports.--Each agreement entered into 
under subsections (a)(1) and (b)(1) shall require that the National 
Academies of Sciences, Engineering, and Medicine complete the review 
under each such subsection and submit to the Secretary of Veterans 
Affairs a report containing the results of the review--
            (1) with respect to the review under subsection (a)(1), not 
        later than 24 months after entering into the agreement; and
            (2) with respect to the review under subsection (b)(1), not 
        later than 18 months after entering into the agreement.
    (e) Reports.--Not later than 90 days after the completion by the 
National Academies of Sciences, Engineering, and Medicine of each of 
the reviews required under subsections (a) and (b), the Secretary of 
Veterans Affairs shall--
            (1) 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 results of the review; and
            (2) make such report publicly available.
    (f) Definitions.--In this section:
            (1) The term ``black box warning'' means a warning 
        displayed on the label of a prescription drug that is designed 
        to call attention to the serious or life-threatening risk of 
        the prescription drug.
            (2) The term ``covered veteran'' means a veteran who 
        received hospital care or medical services furnished by the 
        Department of Veterans Affairs during the five-year period 
        preceding the death of the veteran.
            (3) The term ``first-line treatment'' means a potential 
        intervention that has been evaluated and assigned a high score 
        within clinical practice guidelines.
            (4) The term ``State'' means each of the States, 
        territories, and possessions of the United States, the District 
        of Columbia, and the Commonwealth of Puerto Rico.

SEC. 205. COMPTROLLER GENERAL REPORT ON MANAGEMENT BY DEPARTMENT OF 
              VETERANS AFFAIRS OF VETERANS AT HIGH RISK FOR SUICIDE.

    (a) In General.--Not later than 18 months 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 efforts of the Department of Veterans Affairs to manage 
veterans at high risk for suicide.
    (b) Elements.--The report required by subsection (a) shall include 
the following:
            (1) A description of how the Department identifies patients 
        as high risk for suicide, with particular consideration to the 
        efficacy of inputs into the Recovery Engagement and 
        Coordination for Health - Veterans Enhanced Treatment program 
        (commonly referred to as the ``REACH VET'' program) of the 
        Department, including an assessment of the efficacy of such 
        identifications disaggregated by age, gender, Veterans 
        Integrated Service Network, and, to the extent practicable, 
        medical center of the Department.
            (2) A description of how the Department intervenes when a 
        patient is identified as high risk, including an assessment of 
        the efficacy of such interventions disaggregated by age, 
        gender, Veterans Integrated Service Network, and, to the extent 
        practicable, medical center of the Department.
            (3) A description of how the Department monitors patients 
        who have been identified as high risk, including an assessment 
        of the efficacy of such monitoring and any follow-ups 
        disaggregated by age, gender, Veterans Integrated Service 
        Network, and, to the extent practicable, medical center of the 
        Department.
            (4) A review of staffing levels of suicide prevention 
        coordinators across the Veterans Health Administration.
            (5) A review of the resources and programming offered to 
        family members and friends of veterans who have a mental health 
        condition in order to assist that veteran in treatment and 
        recovery.
            (6) An assessment of such other areas as the Comptroller 
        General considers appropriate to study.

     TITLE III--PROGRAMS, STUDIES, AND GUIDELINES ON MENTAL HEALTH

SEC. 301. STUDY ON CONNECTION BETWEEN LIVING AT HIGH ALTITUDE AND 
              SUICIDE RISK FACTORS AMONG VETERANS.

    (a) In General.--Not later than 180 days after the date of the 
enactment of this Act, the Secretary of Veterans Affairs, in 
consultation with Rural Health Resource Centers of the Office of Rural 
Health of the Department of Veterans Affairs, shall commence the 
conduct of a study on the connection between living at high altitude 
and the risk of developing depression or dying by suicide among 
veterans.
    (b) Completion of Study.--The study conducted under subsection (a) 
shall be completed not later than three years after the date of the 
commencement of the study.
    (c) Individual Impact.--The study conducted under subsection (a) 
shall be conducted so as to determine the effect of high altitude on 
suicide risk at the individual level, not at the State or county level.
    (d) Report.--Not later than 150 days after the completion of the 
study conducted under subsection (a), 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 
results of the study.
    (e) Follow-up Study.--
            (1) In general.--If the Secretary determines through the 
        study conducted under subsection (a) that living at high 
        altitude is a risk factor for developing depression or dying by 
        suicide, the Secretary shall conduct an additional study to 
        identify the following:
                    (A) The most likely biological mechanism that makes 
                living at high altitude a risk factor for developing 
                depression or dying by suicide.
                    (B) The most effective treatment or intervention 
                for reducing the risk of developing depression or dying 
                by suicide associated with living at high altitude.
            (2) Report.--Not later than 150 days after completing the 
        study conducted under paragraph (1), 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 results of the study.

SEC. 302. ESTABLISHMENT BY DEPARTMENT OF VETERANS AFFAIRS AND 
              DEPARTMENT OF DEFENSE OF A CLINICAL PROVIDER TREATMENT 
              TOOLKIT AND ACCOMPANYING TRAINING MATERIALS FOR 
              COMORBIDITIES.

    (a) In General.--Not later than two years after the date of the 
enactment of this Act, the Secretary of Veterans Affairs, in 
consultation with the Secretary of Defense, shall develop a clinical 
provider treatment toolkit and accompanying training materials for the 
evidence-based management of comorbid mental health conditions, 
comorbid mental health and substance use disorders, and a comorbid 
mental health condition and chronic pain.
    (b) Matters Included.--In developing the clinical provider 
treatment toolkit and accompanying training materials under subsection 
(a), the Secretary of Veterans Affairs and the Secretary of Defense 
shall ensure that the toolkit and training materials include guidance 
with respect to the following:
            (1) The treatment of patients with post-traumatic stress 
        disorder who are also experiencing an additional mental health 
        condition, a substance use disorder, or chronic pain.
            (2) The treatment of patients experiencing a mental health 
        condition, including anxiety, depression, or bipolar disorder, 
        who are also experiencing a substance use disorder or chronic 
        pain.
            (3) The treatment of patients with traumatic brain injury 
        who are also experiencing--
                    (A) a mental health condition, including post-
                traumatic stress disorder, anxiety, depression, or 
                bipolar disorder;
                    (B) a substance use disorder; or
                    (C) chronic pain.

SEC. 303. UPDATE OF CLINICAL PRACTICE GUIDELINES FOR ASSESSMENT AND 
              MANAGEMENT OF PATIENTS AT RISK FOR SUICIDE.

    (a) In General.--In the first publication of the Department of 
Veterans Affairs and Department of Defense Clinical Practice Guideline 
for Assessment and Management of Patients at Risk for Suicide published 
after the date of the enactment of this Act, the Secretary of Veterans 
Affairs and the Secretary of Defense, through the Assessment and 
Management of Patients at Risk for Suicide Work Group (in this section 
referred to as the ``Work Group''), shall ensure the publication 
includes the following:
            (1) Enhanced guidance with respect to the following:
                    (A) Gender-specific risk factors for suicide and 
                suicidal ideation.
                    (B) Gender-specific treatment efficacy for 
                depression and suicide prevention.
                    (C) Gender-specific pharmacotherapy efficacy.
                    (D) Gender-specific psychotherapy efficacy.
            (2) Guidance with respect to the efficacy of alternative 
        therapies, other than psychotherapy and pharmacotherapy, 
        including the following:
                    (A) Yoga therapy.
                    (B) Meditation therapy.
                    (C) Equine therapy.
                    (D) Other animal therapy.
                    (E) Training and caring for service dogs.
                    (F) Agritherapy.
                    (G) Art therapy.
                    (H) Outdoor sports therapy.
                    (I) Music therapy.
                    (J) Any other alternative therapy that the Work 
                Group considers appropriate.
            (3) Guidance with respect to the findings of the Creating 
        Options for Veterans' Expedited Recovery Commission (commonly 
        referred to as the ``COVER Commission'') established under 
        section 931 of the Jason Simcakoski Memorial and Promise Act 
        (title IX of Public Law 114-198; 38 U.S.C. 1701 note).
    (b) Rule of Construction.--Nothing in this section shall be 
construed to prevent the Secretary of Veterans Affairs and the 
Secretary of Defense from considering all relevant evidence, as 
appropriate, in updating the Department of Veterans Affairs and 
Department of Defense Clinical Practice Guideline for Assessment and 
Management of Patients at Risk for Suicide, as required under 
subsection (a), or from ensuring that the final clinical practice 
guidelines updated under such subsection remain applicable to the 
patient populations of the Department of Veterans Affairs and the 
Department of Defense.

SEC. 304. ESTABLISHMENT BY DEPARTMENT OF VETERANS AFFAIRS AND 
              DEPARTMENT OF DEFENSE OF CLINICAL PRACTICE GUIDELINES FOR 
              THE TREATMENT OF SERIOUS MENTAL ILLNESS.

    (a) In General.--Not later than two years after the date of the 
enactment of this Act, the Secretary of Veterans Affairs, in 
consultation with the Secretary of Defense and the Secretary of Health 
and Human Services, shall complete the development of a clinical 
practice guideline or guidelines for the treatment of serious mental 
illness, to include the following conditions:
            (1) Schizophrenia.
            (2) Schizoaffective disorder.
            (3) Persistent mood disorder, including bipolar disorder I 
        and II.
            (4) Any other mental, behavioral, or emotional disorder 
        resulting in serious functional impairment that substantially 
        interferes with major life activities as the Secretary of 
        Veterans Affairs, in consultation with the Secretary of Defense 
        and the Secretary of Health and Human Services, considers 
        appropriate.
    (b) Matters Included in Guidelines.--The clinical practice 
guideline or guidelines developed under subsection (a) shall include 
the following:
            (1) Guidance contained in the 2016 Clinical Practice 
        Guidelines for the Management of Major Depressive Disorders of 
        the Department of Veterans Affairs and the Department of 
        Defense.
            (2) Guidance with respect to the treatment of patients with 
        a condition described in subsection (a).
            (3) A list of evidence-based therapies for the treatment of 
        conditions described in subsection (a).
            (4) An appropriate guideline for the administration of 
        pharmacological therapy, psychological or behavioral therapy, 
        or other therapy for the management of conditions described in 
        subsection (a).
    (c) Assessment of Existing Guidelines.--Not later than two years 
after the date of the enactment of this Act, the Secretary of Veterans 
Affairs, in consultation with the Secretary of Defense and the 
Secretary of Health and Human Services, shall complete an assessment of 
the 2016 Clinical Practice Guidelines for the Management of Major 
Depressive Disorders to determine whether an update to such guidelines 
is necessary.
    (d) Work Group.--
            (1) Establishment.--The Secretary of Veterans Affairs, the 
        Secretary of Defense, and the Secretary of Health and Human 
        Services shall create a work group to develop the clinical 
        practice guideline or guidelines under subsection (a) to be 
        known as the ``Serious Mental Illness Work Group'' (in this 
        subsection referred to as the ``Work Group'').
            (2) Membership.--The Work Group created under paragraph (1) 
        shall be comprised of individuals that represent Federal 
        Government entities and non-Federal Government entities with 
        expertise in the areas covered by the Work Group, including the 
        following entities:
                    (A) Academic institutions that specialize in 
                research for the treatment of conditions described in 
                subsection (a).
                    (B) The Health Services Research and Development 
                Service of the Department of Veterans Affairs.
                    (C) The Office of the Assistant Secretary for 
                Mental Health and Substance Use of the Department of 
                Health and Human Services.
                    (D) The National Institute of Mental Health.
                    (E) The Indian Health Service.
                    (F) Relevant organizations with expertise in 
                researching, diagnosing, or treating conditions 
                described in subsection (a).
            (3) Relation to other work groups.--The Work Group shall be 
        created and conducted in the same manner as other work groups 
        for the development of clinical practice guidelines for the 
        Department of Veterans Affairs and the Department of Defense.
    (e) Rule of Construction.--Nothing in this section shall be 
construed to prevent the Secretary of Veterans Affairs and the 
Secretary of Defense from considering all relevant evidence, as 
appropriate, in creating the clinical practice guideline or guidelines 
required under subsection (a) or from ensuring that the final clinical 
practice guideline or guidelines developed under such subsection and 
subsequently updated, as appropriate, remain applicable to the patient 
populations of the Department of Veterans Affairs and the Department of 
Defense.

SEC. 305. PRECISION MEDICINE INITIATIVE OF DEPARTMENT OF VETERANS 
              AFFAIRS TO IDENTIFY AND VALIDATE BRAIN AND MENTAL HEALTH 
              BIOMARKERS.

    (a) In General.--Beginning not later than 18 months after the date 
of the enactment of this Act, the Secretary of Veterans Affairs shall 
develop and implement an initiative of the Department of Veterans 
Affairs to identify and validate brain and mental health biomarkers 
among veterans, with specific consideration for depression, anxiety, 
post-traumatic stress disorder, bipolar disorder, traumatic brain 
injury, and such other mental health conditions as the Secretary 
considers appropriate. Such initiative may be referred to as the 
``Precision Medicine for Veterans Initiative''.
    (b) Model of Initiative.--The initiative under subsection (a) shall 
be modeled on the All of Us Precision Medicine Initiative administered 
by the National Institutes of Health with respect to large-scale 
collection of standardized data and open data sharing.
    (c) Use of Data.--
            (1) Privacy and security.--In carrying out the initiative 
        under subsection (a), the Secretary shall develop robust data 
        privacy and security measures to ensure that information of 
        veterans participating in the initiative is kept private and 
        secure.
            (2) Open platform.--
                    (A) Research purposes.--
                            (i) In general.--The Secretary shall make 
                        de-identified data collected under the 
                        initiative available for research purposes both 
                        within and outside of the Department of 
                        Veterans Affairs.
                            (ii) Research.--The Secretary shall assist 
                        the National Institutes of Health and the 
                        Department of Energy in the use by the National 
                        Institutes of Health or the Department of 
                        Energy of data collected under the initiative 
                        for research purposes under clause (i).
                    (B) Data may not be sold.--Data collected under the 
                initiative may not be sold.
            (3) Standardization.--
                    (A) In general.--The Secretary shall ensure that 
                data collected under the initiative is standardized.
                    (B) Consultation.--The Secretary shall consult with 
                the National Institutes of Health and the Food and Drug 
                Administration to determine the most effective, 
                efficient, and cost-effective way of standardizing data 
                collected under the initiative.
                    (C) Manner of standardization.--Data collected 
                under the initiative shall be standardized in the 
                manner in which it is collected, entered into the 
                database, extracted, and recorded.
            (4) Measures of brain function or structure.--Any measures 
        of brain function or structure collected under the initiative 
        shall be collected with a device that is approved by the Food 
        and Drug Administration.
    (d) Inclusion of Initiative in Program.--The Secretary shall assess 
the feasibility and advisability of coordinating efforts of the 
initiative under subsection (a) with the Million Veterans Program of 
the Department.

SEC. 306. STATISTICAL ANALYSES AND DATA EVALUATION BY DEPARTMENT OF 
              VETERANS AFFAIRS.

    (a) In General.--Chapter 1 of title 38, United States Code, is 
amended by adding at the end the following new section:
``Sec. 119. Contracting for statistical analyses and data evaluation
    ``(a) In General.--The Secretary may enter into a contract or other 
agreement with an academic institution or other qualified entity, as 
determined by the Secretary, to carry out statistical analyses and data 
evaluation as required of the Secretary by law.''.
    ``(b) Rule of Construction.--Nothing in this section may be 
construed to limit the authority of the Secretary to enter into 
contracts or other agreements for statistical analyses and data 
evaluation under any other provision of law.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 1 of such title is amended by adding at the end the following 
new item:

``119. Contracting for statistical analyses and data evaluation.''.

     TITLE IV--OVERSIGHT OF MENTAL HEALTH CARE AND RELATED SERVICES

SEC. 401. STUDY ON EFFECTIVENESS OF SUICIDE PREVENTION AND MENTAL 
              HEALTH OUTREACH PROGRAMS OF DEPARTMENT OF VETERANS 
              AFFAIRS.

    (a) In General.--Not later than 180 days after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall enter 
into an agreement with a non-Federal Government entity to conduct a 
study on the effectiveness of the suicide prevention and mental health 
outreach materials prepared by the Department of Veterans Affairs and 
the suicide prevention and mental health outreach campaigns conducted 
by the Department.
    (b) Use of Focus Groups.--
            (1) In general.--The Secretary shall convene not fewer than 
        eight different focus groups to evaluate the effectiveness of 
        the suicide prevention and mental health materials and 
        campaigns as required under subsection (a).
            (2) Location of focus groups.--Focus groups convened under 
        paragraph (1) shall be held in geographically diverse areas as 
        follows:
                    (A) Not fewer than two in rural or highly rural 
                areas.
                    (B) Not fewer than one in each of the four 
                districts of the Veterans Benefits Administration.
            (3) Timing of focus groups.--Focus groups convened under 
        paragraph (1) shall be held at a variety of dates and times to 
        ensure an adequate representation of veterans with different 
        work schedules.
            (4) Number of participants.--Each focus group convened 
        under paragraph (1) shall include not fewer than five and not 
        more than 12 participants.
            (5) Representation.--Each focus group convened under 
        paragraph (1) shall, to the extent practicable, include 
        veterans of diverse backgrounds, including--
                    (A) veterans of all eras, as determined by the 
                Secretary;
                    (B) women veterans;
                    (C) minority veterans;
                    (D) Native American veterans, as defined in section 
                3765 of title 38, United States Code;
                    (E) veterans who identify as lesbian, gay, 
                bisexual, transgender, or queer (commonly referred to 
                as ``LGBTQ'');
                    (F) veterans who live in rural or highly rural 
                areas; and
                    (G) individuals transitioning from active duty in 
                the Armed Forces to civilian life.
    (c) Report.--
            (1) In general.--Not later than 90 days after the last 
        focus group meeting under subsection (b), 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 findings of the focus groups.
            (2) Elements.--The report required by paragraph (1) shall 
        include the following:
                    (A) Based on the findings of the focus groups, an 
                assessment of the effectiveness of current suicide 
                prevention and mental health outreach efforts of the 
                Department in reaching veterans as a whole as well as 
                specific groups of veterans (for example, women 
                veterans).
                    (B) Based on the findings of the focus groups, 
                recommendations for future suicide prevention and 
                mental health outreach efforts by the Department to 
                target specific groups of veterans.
                    (C) A plan to change the current approach by the 
                Department to suicide prevention and mental health 
                outreach or, if the Secretary decides not to change the 
                current approach, an explanation of the reason for 
                maintaining the current approach.
                    (D) Such other issues as the Secretary considers 
                necessary.
    (d) Representative Survey.--
            (1) In general.--Not later than one year after the last 
        focus group meeting under subsection (b), the Secretary shall 
        complete a representative survey of the veteran population that 
        is informed by the focus group data in order to collect 
        information about the effectiveness of the mental health and 
        suicide prevention outreach campaigns conducted by the 
        Department.
            (2) Veterans surveyed.--
                    (A) In general.--Veterans surveyed under paragraph 
                (1) shall include veterans described in subsection 
                (b)(5).
                    (B) Disaggregation of data.--Data of veterans 
                surveyed under paragraph (1) shall be disaggregated 
                by--
                            (i) veterans who have received care from 
                        the Department during the two-year period 
                        preceding the survey; and
                            (ii) veterans who have not received care 
                        from the Department during the two-year period 
                        preceding the survey.
    (e) Treatment of Contracts for Suicide Prevention and Mental Health 
Outreach Media.--
            (1) Focus groups.--
                    (A) In general.--The Secretary shall include in 
                each contract to develop media relating to suicide 
                prevention and mental health outreach a requirement 
                that the contractor convene focus groups of veterans to 
                assess the effectiveness of suicide prevention and 
                mental health outreach.
                    (B) Representation.--Each focus group required 
                under subparagraph (A) shall, to the extent 
                practicable, include veterans of diverse backgrounds, 
                including--
                            (i) veterans of all eras, as determined by 
                        the Secretary;
                            (ii) women veterans;
                            (iii) minority veterans;
                            (iv) Native American veterans, as defined 
                        in section 3765 of title 38, United States 
                        Code;
                            (v) veterans who identify as lesbian, gay, 
                        bisexual, transgender, or queer (commonly 
                        referred to as ``LGBTQ'');
                            (vi) veterans who live in rural or highly 
                        rural areas; and
                            (vii) individuals transitioning from active 
                        duty in the Armed Forces to civilian life.
            (2) Subcontracting.--
                    (A) In general.--The Secretary shall include in 
                each contract described in paragraph (1)(A) a 
                requirement that, if the contractor subcontracts for 
                the development of media, the contractor shall 
                subcontract with a subcontractor that has experience 
                creating impactful media campaigns that target 
                individuals age 18 to 34.
                    (B) Budget limitation.--Not more than two percent 
                of the budget of the Office of Mental Health and 
                Suicide Prevention of the Department for contractors 
                for suicide prevention and mental health media outreach 
                shall go to subcontractors described in subparagraph 
                (A).
    (f) Rural and Highly Rural Defined.--In this section, with respect 
to an area, the terms ``rural'' and ``highly rural'' have the meanings 
given those terms in the Rural-Urban Commuting Areas coding system of 
the Department of Agriculture.

SEC. 402. OVERSIGHT OF MENTAL HEALTH AND SUICIDE PREVENTION MEDIA 
              OUTREACH CONDUCTED BY DEPARTMENT OF VETERANS AFFAIRS.

    (a) Establishment of Goals.--
            (1) In general.--The Secretary of Veterans Affairs shall 
        establish goals for the mental health and suicide prevention 
        media outreach campaigns of the Department of Veterans Affairs, 
        which shall include the establishment of targets, metrics, and 
        action plans to describe and assess those campaigns.
            (2) Use of metrics.--
                    (A) In general.--The goals established under 
                paragraph (1) shall be measured by metrics specific to 
                different media types.
                    (B) Factors to consider.--In using metrics under 
                subparagraph (A), the Secretary shall determine the 
                best methodological approach for each media type and 
                shall consider the following:
                            (i) Metrics relating to social media, which 
                        may include the following:
                                    (I) Impressions.
                                    (II) Reach.
                                    (III) Engagement rate.
                                    (IV) Such other metrics as the 
                                Secretary considers necessary.
                            (ii) Metrics relating to television, which 
                        may include the following:
                                    (I) Nielsen ratings.
                                    (II) Such other metrics as the 
                                Secretary considers necessary.
                            (iii) Metrics relating to email, which may 
                        include the following:
                                    (I) Open rate.
                                    (II) Response rate.
                                    (III) Click rate.
                                    (IV) Such other metrics as the 
                                Secretary considers necessary.
                    (C) Update.--The Secretary shall periodically 
                update the metrics under subparagraph (B) as more 
                accurate metrics become available.
            (3) Targets.--The Secretary shall establish targets to 
        track the metrics used under paragraph (2).
            (4) Consultation.--In establishing goals under paragraph 
        (1), the Secretary shall consult with the following:
                    (A) Relevant stakeholders, such as organizations 
                that represent veterans, as determined by the 
                Secretary.
                    (B) Mental health and suicide prevention experts.
                    (C) Such other persons as the Secretary considers 
                appropriate.
            (5) Initial report.--Not later than 180 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 
        detailing the goals established under paragraph (1) for the 
        mental health and suicide prevention media outreach campaigns 
        of the Department, including the metrics and targets for such 
        metrics by which those goals are to be measured under 
        paragraphs (2) and (3).
            (6) Annual report.--Not later than one year after the 
        submittal of the report under paragraph (5), and 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 detailing--
                    (A) the progress of the Department in meeting the 
                goals established under paragraph (1) and the targets 
                established under paragraph (3); and
                    (B) a description of action to be taken by the 
                Department to modify mental health and suicide 
                prevention media outreach campaigns if those goals and 
                targets are not being met.
    (b) Report on Use of Funds by Office of Mental Health and Suicide 
Prevention.--Not later than 180 days after the date of the enactment of 
this Act, and semiannually thereafter, the Secretary shall submit to 
the Committee on Appropriations and the Committee on Veterans' Affairs 
of the Senate and the Committee on Appropriations and the Committee on 
Veterans' Affairs of the House of Representatives a report containing 
the expenditures and obligations of the Office of Mental Health and 
Suicide Prevention of the Veterans Health Administration during the 
period covered by the report.

SEC. 403. COMPTROLLER GENERAL MANAGEMENT REVIEW OF MENTAL HEALTH AND 
              SUICIDE PREVENTION SERVICES 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 
management review of the mental health and suicide prevention services 
provided by the Department of Veterans Affairs.
    (b) Elements.--The management review required by subsection (a) 
shall include the following:
            (1) An assessment of the infrastructure under the control 
        of or available to the Office of Mental Health and Suicide 
        Prevention of the Department of Veterans Affairs or available 
        to the Department of Veterans Affairs for suicide prevention 
        efforts not operated by the Office of Mental Health and Suicide 
        Prevention.
            (2) A description of the management and organizational 
        structure of the Office of Mental Health and Suicide 
        Prevention, including roles and responsibilities for each 
        position.
            (3) A description of the operational policies and processes 
        of the Office of Mental Health and Suicide Prevention.
            (4) An assessment of suicide prevention practices and 
        initiatives available from the Department and through community 
        partnerships.
            (5) An assessment of the staffing levels at the Office of 
        Mental Health and Suicide Prevention, disaggregated by type of 
        position, and including the location of any staffing 
        deficiencies.
            (6) An assessment of the Nurse Advice Line pilot program 
        conducted by the Department.
            (7) An assessment of recruitment initiatives in rural areas 
        for mental health professionals of the Department.
            (8) An assessment of strategic planning conducted by the 
        Office of Mental Health and Suicide Prevention.
            (9) An assessment of the communication, and the 
        effectiveness of such communication--
                    (A) within the central office of the Office of 
                Mental Health and Suicide Prevention;
                    (B) between that central office and any staff 
                member or office in the field, including chaplains, 
                attorneys, law enforcement personnel, and volunteers; 
                and
                    (C) between that central office, local facilities 
                of the Department, and community partners of the 
                Department, including first responders, community 
                support groups, and health care industry partners.
            (10) An assessment of how effectively the Office of Mental 
        Health and Suicide Prevention implements operational policies 
        and procedures.
            (11) An assessment of how the Department of Veterans 
        Affairs and the Department of Defense coordinate suicide 
        prevention efforts, and recommendations on how the Department 
        of Veterans Affairs and Department of Defense can more 
        effectively coordinate those efforts.
            (12) An assessment of such other areas as the Comptroller 
        General considers appropriate to study.

SEC. 404. COMPTROLLER GENERAL REPORT ON EFFORTS OF DEPARTMENT OF 
              VETERANS AFFAIRS TO INTEGRATE MENTAL HEALTH CARE INTO 
              PRIMARY CARE CLINICS.

    (a) Initial 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 efforts of the 
        Department of Veterans Affairs to integrate mental health care 
        into primary care clinics of the Department.
            (2) Elements.--The report required by subsection (a) shall 
        include the following:
                    (A) An assessment of the efforts of the Department 
                to integrate mental health care into primary care 
                clinics of the Department.
                    (B) An assessment of the effectiveness of such 
                efforts.
                    (C) An assessment of how the health care of 
                veterans is impacted by such integration.
                    (D) A description of how care is coordinated by the 
                Department between specialty mental health care and 
                primary care, including a description of the following:
                            (i) How documents and patient information 
                        are transferred and the effectiveness of those 
                        transfers.
                            (ii) How care is coordinated when veterans 
                        must travel to different facilities of the 
                        Department.
                            (iii) How a veteran is reintegrated into 
                        primary care after receiving in-patient mental 
                        health care.
                    (E) An assessment of how the integration of mental 
                health care into primary care clinics is implemented at 
                different types of facilities of the Department.
                    (F) Such recommendations on how the Department can 
                better integrate mental health care into primary care 
                clinics as the Comptroller General considers 
                appropriate.
                    (G) An assessment of such other areas as the 
                Comptroller General considers appropriate to study.
    (b) Community Care Integration Report.--
            (1) In general.--Not later than two years after the date on 
        which the Comptroller General submits the report required under 
        subsection (a)(1), the Comptroller General 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 Department to integrate community-based 
        mental health care into the Veterans Health Administration.
            (2) Elements.--The report required by paragraph (1) shall 
        include the following:
                    (A) An assessment of the efforts of the Department 
                to integrate community-based mental health care into 
                the Veterans Health Administration.
                    (B) An assessment of the effectiveness of such 
                efforts.
                    (C) An assessment of how the health care of 
                veterans is impacted by such integration.
                    (D) A description of how care is coordinated 
                between providers of community-based mental health care 
                and the Veterans Health Administration, including a 
                description of how documents and patient information 
                are transferred and the effectiveness of those 
                transfers between--
                            (i) the Veterans Health Administration and 
                        providers of community-based mental health 
                        care; and
                            (ii) providers of community-based mental 
                        health care and the Veterans Health 
                        Administration.
                    (E) An assessment of any disparities in the 
                coordination of community-based mental health care into 
                the Veterans Health Administration by location and type 
                of facility.
                    (F) An assessment of the military cultural 
                competency of health care providers providing 
                community-based mental health care to veterans.
                    (G) Such recommendations on how the Department can 
                better integrate community-based mental health care 
                into the Veterans Health Administration as the 
                Comptroller General considers appropriate.
                    (H) An assessment of such other areas as the 
                Comptroller General considers appropriate to study.
            (3) Community-based mental health care defined.--In this 
        subsection, the term ``community-based mental health care'' 
        means mental health care paid for by the Department but 
        provided by a non-Department health care provider at a non-
        Department facility, including care furnished under section 
        1703 of title 38, United States Code (as in effect on the date 
        specified in section 101(b) of the Caring for Our Veterans Act 
        of 2018 (title I of Public Law 115-182)).

SEC. 405. JOINT MENTAL HEALTH PROGRAMS BY DEPARTMENT OF VETERANS 
              AFFAIRS AND DEPARTMENT OF DEFENSE.

    (a) Report on Mental Health Programs.--
            (1) In general.--Not later than 180 days after the date of 
        the enactment of this Act, and annually thereafter, the 
        Secretary of Veterans Affairs and the Secretary of Defense 
        shall submit to the Committee on Veterans' Affairs and the 
        Committee on Armed Services of the Senate and the Committee on 
        Veterans' Affairs and the Committee on Armed Services of the 
        House of Representatives a report on mental health programs of 
        the Department of Veterans Affairs and the Department of 
        Defense and joint programs of the Departments.
            (2) Elements.--The report required by paragraph (1) shall 
        include the following:
                    (A) A description of mental health programs 
                operated by the Department of Veterans Affairs, 
                including the following:
                            (i) Transition assistance programs.
                            (ii) Clinical and non-clinical mental 
                        health initiatives, including centers of 
                        excellence of the Department of Veterans 
                        Affairs for traumatic brain injury and post-
                        traumatic stress disorder.
                            (iii) Programs that may secondarily improve 
                        mental health, including employment, housing 
                        assistance, and financial literacy programs.
                            (iv) Research into mental health issues and 
                        conditions, to include post-traumatic stress 
                        disorder, depression, anxiety, bipolar 
                        disorder, traumatic brain injury, suicidal 
                        ideation, and any other issues or conditions as 
                        the Secretary of Veterans Affairs considers 
                        necessary.
                    (B) A description of mental health programs 
                operated by the Department of Defense, including the 
                following:
                            (i) Transition assistance programs.
                            (ii) Clinical and non-clinical mental 
                        health initiatives, including the National 
                        Intrepid Center of Excellence and the Intrepid 
                        Spirit Centers.
                            (iii) Programs that may secondarily improve 
                        mental health, including employment, housing 
                        assistance, and financial literacy programs.
                            (iv) Research into mental health issues and 
                        conditions, to include post-traumatic stress 
                        disorder, depression, anxiety, bipolar 
                        disorder, traumatic brain injury, suicidal 
                        ideation, and any other issues or conditions as 
                        the Secretary of Defense considers necessary.
                    (C) A description of mental health programs jointly 
                operated by the Department of Veterans Affairs and the 
                Department of Defense, including the following:
                            (i) Transition assistance programs.
                            (ii) Clinical and non-clinical mental 
                        health initiatives.
                            (iii) Programs that may secondarily improve 
                        mental health, including employment, housing 
                        assistance, and financial literacy programs.
                            (iv) Research into mental health issues and 
                        conditions, to include post-traumatic stress 
                        disorder, depression, anxiety, bipolar 
                        disorder, traumatic brain injury, suicidal 
                        ideation, and completed suicides, including 
                        through the use of the joint suicide data 
                        repository of the Department of Veterans 
                        Affairs and the Department of Defense, and any 
                        other issues or conditions as the Secretary of 
                        Veterans Affairs and the Secretary of Defense 
                        consider necessary.
                    (D) Recommendations for coordinating mental health 
                programs of the Department of Veterans Affairs and the 
                Department of Defense to improve the effectiveness of 
                those programs.
                    (E) Recommendations for novel joint programming of 
                the Department of Veterans Affairs and the Department 
                of Defense to improve the mental health of members of 
                the Armed Forces and veterans.
    (b) Authorization of a Public-private Partnership to Establish a 
Joint Center of Excellence.--
            (1) In general.--Not later than two years after the date of 
        the enactment of this Act, the Secretary of Veterans Affairs, 
        in consultation with the Secretary of Defense, shall enter into 
        agreements with private entities and philanthropic 
        organizations to establish a center of excellence to be known 
        as the ``Joint VA/DOD National Intrepid Center of Excellence 
        Intrepid Spirit Center'' (in this subsection referred to as the 
        ``Center'').
            (2) Duties.--The Center shall conduct the following:
                    (A) Joint mental health care delivery programs of 
                the Department of Veterans Affairs and the Department 
                of Defense for veterans and members of the Armed 
                Forces, including members of the reserve components, 
                who reside in rural and highly rural areas.
                    (B) Mental health and suicide prevention research 
                focused on veterans and members of the Armed Forces, 
                including members of the reserve components, to inform 
                treatment and care delivery programs.
            (3) Location.--The Center shall be established in a 
        location that--
                    (A) is geographically distant from existing and 
                planned Intrepid Spirit Centers of the Department of 
                Defense;
                    (B) is in close proximity to rural and highly rural 
                areas and able to serve veterans in those areas who, as 
                of the date of the enactment of this Act, are 
                underserved by the Department of Veterans Affairs; and
                    (C) is in close proximity to a medical school of an 
                institution of higher education.
    (c) Rural and Highly Rural Defined.--In this section, with respect 
to an area, the terms ``rural'' and ``highly rural'' have the meanings 
given those terms in the Rural-Urban Commuting Areas coding system of 
the Department of Agriculture.

        TITLE V--IMPROVEMENT OF MENTAL HEALTH MEDICAL WORKFORCE

SEC. 501. STAFFING IMPROVEMENT PLAN FOR MENTAL HEALTH PROVIDERS OF 
              DEPARTMENT OF VETERANS AFFAIRS.

    (a) Staffing Plan.--
            (1) In general.--Not later than one year after the date of 
        the enactment of this Act, the Secretary of Veterans Affairs, 
        in consultation with the Inspector General of the Department 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 plan to address staffing of 
        mental health providers of the Department of Veterans Affairs, 
        including filling any open positions.
            (2) Elements.--The plan required by paragraph (1) shall 
        include the following:
                    (A) An estimate of the number of positions for 
                mental health providers of the Department that need to 
                be filled to meet demand.
                    (B) An identification of the steps that the 
                Secretary will take to address mental health staffing 
                for the Department.
                    (C) A description of any region-specific hiring 
                incentives to be used by the Secretary in consultation 
                with the directors of Veterans Integrated Service 
                Networks and medical centers of the Department.
                    (D) A description of any local retention or 
                engagement incentives to be used by directors of 
                Veterans Integrated Service Networks.
                    (E) Such recommendations for legislative or 
                administrative action as the Secretary considers 
                necessary to aid in addressing mental health staffing 
                for the Department.
            (3) Report.--Not later than one year after the submittal of 
        the plan required by paragraph (1), 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 setting forth the number of mental health providers 
        hired by the Department during the one-year period preceding 
        the submittal of the report.
    (b) Occupational Series for Certain Mental Health Providers.--Not 
later than one year after the date of the enactment of this Act, the 
Secretary of Veterans Affairs, in consultation with the Office of 
Personnel Management, shall develop an occupational series for licensed 
professional mental health counselors and marriage and family 
therapists of the Department of Veterans Affairs.

SEC. 502. STAFFING IMPROVEMENT PLAN FOR PEER SPECIALISTS OF DEPARTMENT 
              OF VETERANS AFFAIRS WHO ARE WOMEN.

    (a) Assessment of Capacity.--
            (1) In general.--Not later than 90 days after the date of 
        the enactment of this Act, the Secretary of Veterans Affairs, 
        in consultation with the Inspector General of the Department of 
        Veterans Affairs, shall commence an assessment of the capacity 
        of peer specialists of the Department of Veterans Affairs who 
        are women.
            (2) Elements.--The assessment required by paragraph (1) 
        shall include an assessment of the following:
                    (A) The geographical distribution of peer 
                specialists of the Department who are women.
                    (B) The geographical distribution of women 
                veterans.
                    (C) The number and proportion of women peer 
                specialists who specialize in peer counseling on mental 
                health or suicide prevention.
                    (D) The number and proportion of women peer 
                specialists who specialize in peer counseling on non-
                mental health related matters.
    (b) Report.--Not later than one year after the assessment required 
by subsection (a) has commenced, 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 detailing 
the findings of the assessment.
    (c) Staffing Improvement Plan.--
            (1) In general.--Not later than 180 days after submitting 
        the report under subsection (b), the Secretary, in consultation 
        with the Inspector General, shall submit to the Committee on 
        Veterans' Affairs of the Senate and the Committee on Veterans' 
        Affairs of the House of Representatives a plan, based on the 
        results of the assessment required by subsection (a), to hire 
        additional qualified peer specialists who are women, with 
        special consideration for areas that lack peer specialists who 
        are women.
            (2) Elements.--The peer specialist positions included in 
        the plan required by paragraph (1)--
                    (A) shall be non-volunteer, paid positions; and
                    (B) may be part-time positions.

SEC. 503. ESTABLISHMENT OF DEPARTMENT OF VETERANS AFFAIRS READJUSTMENT 
              COUNSELING SERVICE SCHOLARSHIP PROGRAM.

    (a) In General.--Chapter 76 of title 38, United States Code, is 
amended by inserting after subchapter VIII the following new 
subchapter:

  ``SUBCHAPTER IX--READJUSTMENT COUNSELING SERVICE SCHOLARSHIP PROGRAM

``Sec. 7698. Requirement for program
    ``As part of the Educational Assistance Program, the Secretary 
shall carry out a scholarship program under this subchapter. The 
program shall be known as the Department of Veterans Affairs 
Readjustment Counseling Service Scholarship Program (in this subchapter 
referred to as the `Program').
``Sec. 7699. Eligibility; agreement
    ``(a) In General.--An individual is eligible to participate in the 
Program, as determined by the Readjustment Counseling Service of the 
Department, if the individual--
            ``(1) is accepted for enrollment or enrolled (as described 
        in section 7602 of this title) in a program of study at an 
        accredited educational institution, school, or training program 
        leading to a terminal degree in psychology, social work, 
        marriage and family therapy, or mental health counseling that 
        would meet the education requirements for appointment to a 
        position under section 7402(b) of this title; and
            ``(2) enters into an agreement with the Secretary under 
        subsection (c).
    ``(b) Priority.--In selecting individuals to participate in the 
Program, the Secretary shall give priority to the following 
individuals:
            ``(1) An individual who agrees to be employed by a Vet 
        Center located in a community that is--
                    ``(A) designated as a medically underserved 
                population under section 330(b)(3) of the Public Health 
                Service Act (42 U.S.C. 254b(b)(3)); and
                    ``(B) in a State with a per capita population of 
                veterans of more than five percent according to the 
                National Center for Veterans Analysis and Statistics 
                and the Bureau of the Census.
            ``(2) An individual who is a veteran.
    ``(c) Agreement.--An agreement between the Secretary and a 
participant in the Program shall (in addition to the requirements set 
forth in section 7604 of this title) include the following:
            ``(1) An agreement by the Secretary to provide the 
        participant with a scholarship under the Program for a 
        specified number of school years during which the participant 
        pursues a program of study described in subsection (a)(1) that 
        meets the requirements set forth in section 7602(a) of this 
        title.
            ``(2) An agreement by the participant to serve as a full-
        time employee of the Department at a Vet Center for a six-year 
        period following the completion by the participant of such 
        program of study (in this subchapter referred to as the `period 
        of obligated service').
    ``(d) Vet Center Defined.--In this section, the term `Vet Center' 
has the meaning given that term in section 1712A(h) of this title.
``Sec. 7699A. Obligated service
    ``(a) In General.--Each participant in the Program shall provide 
service as a full-time employee of the Department at a Vet Center (as 
defined in section 7699(d) of this title) for the period of obligated 
service set forth in the agreement of the participant entered into 
under section 7604 of this title.
    ``(b) Determination of Service Commencement Date.--(1) Not later 
than 60 days before the service commencement date of a participant, the 
Secretary shall notify the participant of that service commencement 
date.
    ``(2) The date specified in paragraph (1) with respect to a 
participant is the date for the beginning of the period of obligated 
service of the participant.
``Sec. 7699B. Breach of agreement: liability
    ``(a) Liquidated Damages.--(1) A participant in the Program (other 
than a participant described in subsection (b)) who fails to accept 
payment, or instructs the educational institution in which the 
participant is enrolled not to accept payment, in whole or in part, of 
a scholarship under the agreement entered into under section 7604 of 
this title shall be liable to the United States for liquidated damages 
in the amount of $1,500.
    ``(2) Liability under paragraph (1) is in addition to any period of 
obligated service or other obligation or liability under such 
agreement.
    ``(b) Liability During Program of Study.--(1) Except as provided in 
subsection (d), a participant in the Program shall be liable to the 
United States for the amount which has been paid to or on behalf of the 
participant under the agreement if any of the following occurs:
            ``(A) The participant fails to maintain an acceptable level 
        of academic standing in the educational institution in which 
        the participant is enrolled (as determined by the educational 
        institution under regulations prescribed by the Secretary).
            ``(B) The participant is dismissed from such educational 
        institution for disciplinary reasons.
            ``(C) The participant voluntarily terminates the program of 
        study in such educational institution before the completion of 
        such program of study.
    ``(2) Liability under this subsection is in lieu of any service 
obligation arising under the agreement.
    ``(c) Liability During Period of Obligated Service.--(1) Except as 
provided in subsection (d), if a participant in the Program does not 
complete the period of obligated service of the participant, the United 
States shall be entitled to recover from the participant an amount 
determined in accordance with the following formula: A = 3F(t-s/t).
    ``(2) In the formula in paragraph (1):
            ``(A) `A' is the amount the United States is entitled to 
        recover.
            ``(B) `F' is the sum of--
                    ``(i) the amounts paid under this subchapter to or 
                on behalf of the participant; and
                    ``(ii) the interest on such amounts which would be 
                payable if at the time the amounts were paid they were 
                loans bearing interest at the maximum legal prevailing 
                rate, as determined by the Treasurer of the United 
                States.
            ``(C) `t' is the total number of months in the period of 
        obligated service of the participant.
            ``(D) `s' is the number of months of such period served by 
        the participant.
    ``(d) Limitation on Liability for Reductions-in-force.--Liability 
shall not arise under subsection (c) if the participant fails to 
maintain employment as a Department employee due to a staffing 
adjustment.
    ``(e) Period for Payment of Damages.--Any amount of damages that 
the United States is entitled to recover under this section shall be 
paid to the United States within the one-year period beginning on the 
date of the breach of the agreement.''.
    (b) Conforming and Technical Amendments.--
            (1) Conforming amendments.--
                    (A) Establishment of program.--Section 7601(a) of 
                such title is amended--
                            (i) in paragraph (5), by striking ``and'';
                            (ii) in paragraph (6), by striking the 
                        period and inserting ``; and''; and
                            (iii) by adding at the end the following 
                        new paragraph:
            ``(7) the readjustment counseling service scholarship 
        program provided for in subchapter IX of this chapter.''.
                    (B) Eligibility.--Section 7602 of such title is 
                amended--
                            (i) in subsection (a)(1)--
                                    (I) by striking ``or VI'' and 
                                inserting ``VI, or IX''; and
                                    (II) by striking ``subchapter VI'' 
                                and inserting ``subchapter VI or IX''; 
                                and
                            (ii) in subsection (b), by striking ``or 
                        VI'' and inserting ``VI, or IX''.
                    (C) Application.--Section 7603(a)(1) of such title 
                is amended by striking ``or VIII'' and inserting 
                ``VIII, or IX''.
                    (D) Terms of agreement.--Section 7604 of such title 
                is amended by striking ``or VIII'' each place it 
                appears and inserting ``VIII, or IX''.
                    (E) Annual report.--Section 7632 of such title is 
                amended--
                            (i) in paragraph (1), by striking ``and the 
                        Specialty Education Loan Repayment Program'' 
                        and inserting ``the Specialty Education Loan 
                        Repayment Program, and the Readjustment 
                        Counseling Service Scholarship Program''; and
                            (ii) in paragraph (4), by striking ``and 
                        per participant in the Specialty Education Loan 
                        Repayment Program'' and inserting ``per 
                        participant in the Specialty Education Loan 
                        Repayment Program, and per participant in the 
                        Readjustment Counseling Service Scholarship 
                        Program''.
            (2) Table of sections.--The table of sections at the 
        beginning of chapter 76 of such title is amended by inserting 
        after the items relating to subchapter VIII the following:

  ``subchapter ix--readjustment counseling service scholarship program

``Sec.
``7698. Requirement for program.
``7699. Eligibility; agreement.
``7699A. Obligated service.
``7699B. Breach of agreement: liability.''.
    (c) Effective Date.--The Secretary of Veterans Affairs shall begin 
awarding scholarships under subchapter IX of chapter 76 of title 38, 
United States Code, as added by subsection (a), for programs of study 
beginning not later than one year after the date of the enactment of 
this Act.

SEC. 504. COMPTROLLER GENERAL REPORT ON READJUSTMENT COUNSELING SERVICE 
              OF DEPARTMENT OF VETERANS AFFAIRS.

    (a) In General.--Not later than one year 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 Readjustment Counseling Service of the Department of 
Veterans Affairs.
    (b) Elements.--The report required by subsection (a) shall include 
the following:
            (1) An assessment of the adequacy and types of treatment, 
        counseling, and other services provided at Vet Centers, 
        including recommendations on whether and how such treatment, 
        counseling, and other services can be expanded.
            (2) An assessment of the efficacy of outreach efforts by 
        the Readjustment Counseling Service, including recommendations 
        for how outreach efforts can be improved.
            (3) An assessment of barriers to care at Vet Centers, 
        including recommendations for overcoming those barriers.
            (4) An assessment of the efficacy and frequency of the use 
        of telehealth by counselors of the Readjustment Counseling 
        Service to provide mental health services, including 
        recommendations for how the use of telehealth can be improved.
            (5) An assessment of the feasibility and advisability of 
        expanding eligibility for services from the Readjustment 
        Counseling Service, including--
                    (A) recommendations on what eligibility criteria 
                could be expanded; and
                    (B) an assessment of potential costs and increased 
                infrastructure requirements if eligibility is expanded.
            (6) An assessment of the use of Vet Centers by members of 
        the reserve components of the Armed Forces who were never 
        activated and recommendations on how to better reach those 
        members.
            (7) An assessment of the use of Vet Centers by eligible 
        family members of former members of the Armed Forces and 
        recommendations on how to better reach those family members.
            (8) An assessment of the efficacy of group therapy and the 
        level of training of providers at Vet Centers in administering 
        group therapy.
            (9) An assessment of the efficiency and effectiveness of 
        the task organization structure of Vet Centers.
            (10) An assessment of the use of Vet Centers by Native 
        American veterans, as defined in section 3765 of title 38, 
        United States Code, and recommendations on how to better reach 
        those veterans.
    (c) Vet Center Defined.--In this section, the term ``Vet Center'' 
has the meaning given that term in section 1712A(h) of title 38, United 
States Code.

SEC. 505. EXPANSION OF REPORTING REQUIREMENTS ON READJUSTMENT 
              COUNSELING SERVICE OF DEPARTMENT OF VETERANS AFFAIRS.

    (a) Expansion of Annual Report.--Paragraph (2)(C) of section 
7309(e) of title 38, United States Code, is amended by inserting before 
the period at the end the following: ``, including the resources 
required to meet such unmet need, such as additional staff, additional 
locations, additional infrastructure, infrastructure improvements, and 
additional mobile Vet Centers''.
    (b) Biennial Report.--Such section is amended by adding at the end 
the following new paragraph:
    ``(3) For each even numbered year in which the report required by 
paragraph (1) is submitted, the Secretary shall include in such report 
a prediction of--
            ``(A) trends in demand for care;
            ``(B) long-term investments required with respect to the 
        provision of care;
            ``(C) requirements relating to maintenance of 
        infrastructure; and
            ``(D) other capital investment requirements with respect to 
        the Readjustment Counseling Service, including Vet Centers, 
        mobile Vet Centers, and community access points.''.

SEC. 506. STUDIES ON ALTERNATIVE WORK SCHEDULES FOR EMPLOYEES OF 
              VETERANS HEALTH ADMINISTRATION.

    (a) Study of Veterans.--
            (1) In general.--Not later than 180 days after the date of 
        the enactment of this Act, the Secretary of Veterans Affairs 
        shall conduct a study on the attitudes of eligible veterans 
        toward the Department of Veterans Affairs offering appointments 
        outside the usual operating hours of facilities of the 
        Department, including through the use of telehealth 
        appointments.
            (2) Eligible veteran defined.--In this subsection, the term 
        ``eligible veteran'' means a veteran who--
                    (A) is enrolled in the patient enrollment system of 
                the Department under section 1705(a) of title 38, 
                United States Code; and
                    (B) received health care from the Department at 
                least once during the two-year period ending on the 
                date of the commencement of the study under paragraph 
                (1).
    (b) Department Study.--
            (1) In general.--Not later than 180 days after the date of 
        the enactment of this Act, the Secretary shall conduct a study 
        on the feasibility and advisability of offering appointments 
        outside the usual operating hours of facilities of the 
        Department.
            (2) Study of employees.--The study required by paragraph 
        (1) shall include a study of the opinions of employees of the 
        Veterans Health Administration, including clinical, 
        nonclinical, and support staff, with respect to offering 
        appointments outside the usual operating hours of facilities of 
        the Department, including through the use of telehealth 
        appointments.

SEC. 507. SUICIDE PREVENTION COORDINATORS.

    (a) Staffing Requirement.--Beginning not later than one year after 
the date of the enactment of this Act, the Secretary of Veterans 
Affairs shall ensure that each medical center of the Department of 
Veterans Affairs has not less than one suicide prevention coordinator.
    (b) Study on Reorganization.--
            (1) In general.--Not later than one year after the date of 
        the enactment of this Act, the Secretary, in consultation with 
        the Office of Mental Health and Suicide Prevention of the 
        Department, shall commence the conduct of a study to determine 
        the feasibility and advisability of--
                    (A) the realignment and reorganization of suicide 
                prevention coordinators within the Office of Mental 
                Health and Suicide Prevention; and
                    (B) the creation of a suicide prevention 
                coordinator program office.
            (2) Program office realignment.--In conducting the study 
        under paragraph (1), the Secretary shall assess the feasibility 
        of advisability of, within the suicide prevention coordinator 
        program office described in paragraph (1)(B), aligning suicide 
        prevention coordinators and suicide prevention case managers 
        within the organizational structure and chart of the Suicide 
        Prevention Program of the Department, with the Director of the 
        Suicide Prevention program having ultimate supervisory 
        oversight and responsibility over the suicide prevention 
        coordinator program office.
    (c) Report.--Not later than 90 days after the completion of the 
study under subsection (b), 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 such study, 
including the following:
            (1) An assessment of the feasibility and advisability of 
        creating a suicide prevention coordinator program office to 
        oversee and monitor suicide prevention coordinators and suicide 
        prevention case managers across all medical centers of the 
        Department.
            (2) A review of current staffing ratios for suicide 
        prevention coordinators and suicide prevention case managers in 
        comparison with current staffing ratios for mental health 
        providers within each medical center of the Department.
            (3) A description of the duties and responsibilities for 
        suicide prevention coordinators across the Department to better 
        define, delineate, and standardize qualifications, performance 
        goals, performance duties, and performance outcomes for suicide 
        prevention coordinators and suicide prevention case managers.

SEC. 508. REPORT ON EFFORTS BY DEPARTMENT OF VETERANS AFFAIRS TO 
              IMPLEMENT SAFETY PLANNING IN EMERGENCY DEPARTMENTS.

    (a) Findings.--Congress makes the following findings:
            (1) The Department of Veterans Affairs must be more 
        effective in its approach to reducing the burden of veteran 
        suicide connected to mental health diagnoses, to include 
        expansion of treatment delivered via telehealth methods and in 
        rural areas.
            (2) An innovative project, known as Suicide Assessment and 
        Follow-up Engagement: Veteran Emergency Treatment (in this 
        subsection referred to as ``SAFE VET''), was designed to help 
        suicidal veterans seen at emergency departments within the 
        Veterans Health Administration and was successfully implemented 
        in five intervention sites beginning in 2010.
            (3) A 2018 study found that safety planning intervention 
        under SAFE VET was associated with 45 percent fewer suicidal 
        behaviors in the six-month period following emergency 
        department care and more than double the odds of a veteran 
        engaging in outpatient behavioral health care.
            (4) SAFE VET is a promising alternative and acceptable 
        delivery of care system that augments the treatment of suicidal 
        veterans in emergency departments of the Veterans Health 
        Administration and helps ensure that those veterans have 
        appropriate follow-up care.
            (5) Beginning in September 2018, the Veterans Health 
        Administration implemented a suicide prevention program, known 
        as the SPED program, for veterans presenting to the emergency 
        department who are assessed to be at risk for suicide and are 
        safe to be discharged home.
            (6) The SPED program includes issuance and update of a 
        safety plan and post-discharge follow-up outreach for veterans 
        to facilitate engagement in outpatient mental health care.
    (b) Report.--
            (1) 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 appropriate committees of Congress a report 
        on the efforts of the Secretary to implement a suicide 
        prevention program for veterans presenting to an emergency 
        department or urgent care center of the Veterans Health 
        Administration who are assessed to be at risk for suicide and 
        are safe to be discharged home, including a safety plan and 
        post-discharge outreach for veterans to facilitate engagement 
        in outpatient mental health care.
            (2) Elements.--The report required by paragraph (1) shall 
        include the following:
                    (A) An assessment of the implementation of the 
                current operational policies and procedures of the SPED 
                program at each medical center of the Department of 
                Veterans Affairs, including an assessment of the 
                following:
                            (i) Training provided to clinicians or 
                        other personnel administering protocols under 
                        the SPED program.
                            (ii) Any disparities in implementation of 
                        such protocols between medical centers.
                            (iii) Current criteria used to measure the 
                        quality of such protocols including--
                                    (I) methodology used to assess the 
                                quality of a safety plan and post-
                                discharge outreach for veterans; or
                                    (II) in the absence of such 
                                methodology, a proposed timeline and 
                                guidelines for creating a methodology 
                                to ensure compliance with the evidence-
                                based model used under the Suicide 
                                Assessment and Follow-up Engagement: 
                                Veteran Emergency Treatment (SAFE VET) 
                                program of the Department.
                    (B) An assessment of the implementation of the 
                policies and procedures described in subparagraph (A), 
                including the following:
                            (i) An assessment of the quality and 
                        quantity of safety plans issued to veterans.
                            (ii) An assessment of the quality and 
                        quantity of post-discharge outreach provided to 
                        veterans.
                            (iii) The post-discharge rate of veteran 
                        engagement in outpatient mental health care, 
                        including attendance at not fewer than one 
                        individual mental health clinic appointment or 
                        admission to an inpatient or residential unit.
                            (iv) The number of veterans who decline 
                        safety planning efforts during protocols under 
                        the SPED program.
                            (v) The number of veterans who decline to 
                        participate in follow-up efforts within the 
                        SPED program.
                    (C) A description of how SPED primary coordinators 
                are deployed to support such efforts, including the 
                following:
                            (i) A description of the duties and 
                        responsibilities of such coordinators.
                            (ii) The number and location of such 
                        coordinators.
                            (iii) A description of training provided to 
                        such coordinators.
                            (iv) An assessment of the other 
                        responsibilities for such coordinators and, if 
                        applicable, differences in patient outcomes 
                        when such responsibilities are full-time duties 
                        as opposed to secondary duties.
                    (D) An assessment of the feasibility and 
                advisability of expanding the total number and 
                geographic distribution of SPED primary coordinators.
                    (E) An assessment of the feasibility and 
                advisability of providing services under the SPED 
                program via telehealth channels, including an analysis 
                of opportunities to leverage telehealth to better serve 
                veterans in rural areas.
                    (F) A description of the status of current 
                capabilities and utilization of tracking mechanisms to 
                monitor compliance, quality, and patient outcomes under 
                the SPED program.
                    (G) Such recommendations, including specific action 
                items, as the Secretary considers appropriate with 
                respect to how the Department can better implement the 
                SPED program, including recommendations with respect to 
                the following:
                            (i) A process to standardize training under 
                        such program.
                            (ii) Any resourcing requirements necessary 
                        to implement the SPED program throughout 
                        Veterans Health Administration, including by 
                        having a dedicated clinician responsible for 
                        administration of such program at each medical 
                        center.
                            (iii) An analysis of current statutory 
                        authority and any changes necessary to fully 
                        implement the SPED program throughout the 
                        Veterans Health Administration.
                            (iv) A timeline for the implementation of 
                        the SPED program through the Veterans Health 
                        Administration once full resourcing and an 
                        approved training plan are in place.
                    (H) Such other matters as the Secretary considers 
                appropriate.
    (c) Definitions.--In this section:
            (1) Appropriate committees of congress.--The term 
        ``appropriate committees of Congress'' means--
                    (A) the Committee on Veterans' Affairs and the 
                Subcommittee on Military Construction, Veterans 
                Affairs, and Related Agencies of the Committee on 
                Appropriations of the Senate; and
                    (B) the Committee on Veterans' Affairs and the 
                Subcommittee on Military Construction, Veterans 
                Affairs, and Related Agencies of the Committee on 
                Appropriations of the House of Representatives.
            (2) SPED primary coordinator.--The term ``SPED primary 
        coordinator'' means the main point of contact responsible for 
        administering the SPED program at a medical center of the 
        Department.
            (3) SPED program.--The term ``SPED program'' means the 
        Safety Planning in Emergency Departments program of the 
        Department of Veterans Affairs established in September 2018 
        for veterans presenting to the emergency department who are 
        assessed to be at risk for suicide and are safe to be 
        discharged home, which extends the evidence-based intervention 
        for suicide prevention to all emergency departments of the 
        Veterans Health Administration.

     TITLE VI--IMPROVEMENT OF CARE AND SERVICES FOR WOMEN VETERANS

SEC. 601. EXPANSION OF CAPABILITIES OF WOMEN VETERANS CALL CENTER TO 
              INCLUDE TEXT MESSAGING.

    The Secretary of Veterans Affairs shall expand the capabilities of 
the Women Veterans Call Center of the Department of Veterans Affairs to 
include a text messaging capability.

SEC. 602. GAP ANALYSIS OF DEPARTMENT OF VETERANS AFFAIRS PROGRAMS THAT 
              PROVIDE ASSISTANCE TO WOMEN VETERANS WHO ARE HOMELESS.

    (a) In General.--The Secretary of Veterans Affairs shall complete 
an analysis of programs of the Department of Veterans Affairs that 
provide assistance to women veterans who are homeless or precariously 
housed to identify the areas in which such programs are failing to meet 
the needs of such women.
    (b) Report.--Not later than 270 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 the analysis completed 
under subsection (a).

SEC. 603. REQUIREMENT FOR DEPARTMENT OF VETERANS AFFAIRS INTERNET 
              WEBSITE TO PROVIDE INFORMATION ON SERVICES AVAILABLE TO 
              WOMEN VETERANS.

    (a) In General.--The Secretary of Veterans Affairs shall survey the 
internet websites and information resources of the Department of 
Veterans Affairs in effect on the day before the date of the enactment 
of this Act and publish an internet website that serves as a 
centralized source for the provision to women veterans of information 
about the benefits and services available to them under laws 
administered by the Secretary.
    (b) Elements.--The internet website published under subsection (a) 
shall provide to women veterans information regarding all services 
available in the district in which the veteran is seeking such 
services, including, with respect to each medical center and community-
based outpatient clinic in the applicable Veterans Integrated Service 
Network--
            (1) the name and contact information of each women's health 
        coordinator;
            (2) a list of appropriate staff for other benefits 
        available from the Veterans Benefits Administration, the 
        National Cemetery Administration, and such other entities as 
        the Secretary considers appropriate; and
            (3) such other information as the Secretary considers 
        appropriate.
    (c) Updated Information.--The Secretary shall ensure that the 
information described in subsection (b) that is published on the 
internet website required by subsection (a) is updated not less 
frequently than once every 90 days.
    (d) Outreach.--In carrying out this section, the Secretary shall 
ensure that the outreach conducted under section 1720F(i) of title 38, 
United States Code, includes information regarding the internet website 
required by subsection (a).
    (e) Derivation of Funds.--Amounts used by the Secretary to carry 
out this section shall be derived from amounts made available to the 
Secretary to publish internet websites of the Department.

SEC. 604. REPORT ON LOCATIONS WHERE WOMEN VETERANS ARE USING HEALTH 
              CARE FROM DEPARTMENT OF VETERANS AFFAIRS.

    (a) In General.--Not later than 90 days after the date of the 
enactment of this Act, and 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 on the use by women veterans of health care 
from the Department of Veterans Affairs.
    (b) Elements.--Each report required by subsection (a) shall include 
the following information:
            (1) The number of women veterans who reside in each State.
            (2) The number of women veterans in each State who are 
        enrolled in the system of patient enrollment of the Department 
        established and operated under section 1705(a) of title 38, 
        United States Code.
            (3) Of the women veterans who are so enrolled, the number 
        who have received health care under the laws administered by 
        the Secretary at least one time during the one-year period 
        preceding the submittal of the report.
            (4) The number of women veterans who have been seen at each 
        medical facility of the Department during such year.
            (5) The number of appointments that women veterans have had 
        at each such facility during such year.
            (6) If known, an identification of the medical facility of 
        the Department in each Veterans Integrated Service Network with 
        the largest rate of increase in patient population of women 
        veterans as measured by the increase in unique women veteran 
        patient use.
            (7) If known, an identification of the medical facility of 
        the Department in each Veterans Integrated Service Network with 
        the largest rate of decrease in patient population of women 
        veterans as measured by the decrease in unique women veterans 
        patient use.

                        TITLE VII--OTHER MATTERS

SEC. 701. EXPANDED TELEHEALTH FROM DEPARTMENT OF VETERANS AFFAIRS.

    (a) In General.--The Secretary of Veterans Affairs shall enter into 
partnerships, and expand existing partnerships, with organizations that 
represent or serve veterans, nonprofit organizations, private 
businesses, and other interested parties for the expansion of 
telehealth capabilities and the provision of telehealth services to 
veterans through the award of grants under subsection (b).
    (b) Award of Grants.--
            (1) In general.--In carrying out partnerships entered into 
        or expanded under this section with entities described in 
        subsection (a), the Secretary shall award grants to those 
        entities.
            (2) Locations.--To the extent practicable, the Secretary 
        shall ensure that grants are awarded to entities that serve 
        veterans in rural and highly rural areas (as determined through 
        the use of the Rural-Urban Commuting Areas coding system of the 
        Department of Agriculture).
            (3) Use of grants.--
                    (A) In general.--Grants awarded to an entity under 
                this subsection may be used for one or more of the 
                following:
                            (i) Purchasing or upgrading hardware or 
                        software necessary for the provision of secure 
                        and private telehealth services.
                            (ii) Upgrading security protocols for 
                        consistency with the security requirements of 
                        the Department.
                            (iii) Training of employees, including 
                        payment of those employees for completing that 
                        training, with respect to--
                                    (I) military and veteran cultural 
                                competence, if the entity is not an 
                                organization that represents veterans;
                                    (II) equipment required to provide 
                                telehealth services; or
                                    (III) any other unique training 
                                needs for the provision of telehealth 
                                services to veterans.
                            (iv) Upgrading existing infrastructure 
                        owned or leased by the entity to make rooms 
                        more conducive to telehealth care, including--
                                    (I) additions or modifications to 
                                windows or walls in an existing room, 
                                or other alterations as needed to 
                                create a new, private room;
                                    (II) soundproofing of an existing 
                                room;
                                    (III) new electrical or internet 
                                outlets in an existing room; or
                                    (IV) aesthetic enhancements to 
                                establish a more suitable therapeutic 
                                environment.
                            (v) Upgrading existing infrastructure to 
                        comply with the Americans with Disabilities Act 
                        of 1990 (42 U.S.C. 12101 et seq.).
                            (vi) Upgrading internet infrastructure and 
                        sustainment of internet services.
                    (B) Exclusion.--Grants may not be used for the 
                purchase of new property or for major construction 
                projects, as determined by the Secretary.
    (c) Agreement on Telehealth Access Points.--
            (1) In general.--An entity described in subsection (a) that 
        seeks to establish a telehealth access point for veterans but 
        does not require grant funding under this section to do so may 
        enter into an agreement with the Department for the 
        establishment of such an access point.
            (2) Adequacy of facilities.--An entity described in 
        paragraph (1) shall be responsible for ensuring that any access 
        point is adequately private, secure, and accessible for 
        veterans before the access point is established.
    (d) Assessment of Barriers to Access.--
            (1) In general.--Not later than 18 months after the date of 
        the enactment of this Act, the Secretary shall complete an 
        assessment of barriers faced by veterans in accessing 
        telehealth services.
            (2) Elements.--The assessment required by paragraph (1) 
        shall include the following:
                    (A) A description of the barriers veterans face in 
                using telehealth while not on property of the 
                Department.
                    (B) A description of how the Department plans to 
                address the barriers described in subparagraph (A).
                    (C) Such other matters related access by veterans 
                to telehealth while not on property of the Department 
                as the Secretary considers relevant.
            (3) Report.--Not later than 120 days after the completion 
        of the assessment required by paragraph (1), 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 assessment, including any 
        recommendations for legislative or administrative action based 
        on the results of the assessment.

SEC. 702. PARTNERSHIPS WITH NON-FEDERAL GOVERNMENT ENTITIES TO PROVIDE 
              HYPERBARIC OXYGEN THERAPY TO VETERANS AND STUDIES ON THE 
              USE OF SUCH THERAPY FOR TREATMENT OF POST-TRAUMATIC 
              STRESS DISORDER AND TRAUMATIC BRAIN INJURY.

    (a) Partnerships to Provide Hyperbaric Oxygen Therapy to 
Veterans.--
            (1) Use of partnerships.--The Secretary of Veterans 
        Affairs, in consultation with the Center for Compassionate 
        Innovation within the Office of Community Engagement of the 
        Department of Veterans Affairs, may enter into partnerships 
        with non-Federal Government entities to provide hyperbaric 
        oxygen treatment to veterans to research the effectiveness of 
        such therapy.
            (2) Types of partnerships.--Partnerships entered into under 
        paragraph (1) may include the following:
                    (A) Partnerships to conduct research on hyperbaric 
                oxygen therapy.
                    (B) Partnerships to review research on hyperbaric 
                oxygen therapy provided to nonveterans.
                    (C) Partnerships to create industry working groups 
                to determine standards for research on hyperbaric 
                oxygen therapy.
                    (D) Partnerships to provide to veterans hyperbaric 
                oxygen therapy for the purposes of conducting research 
                on the effectiveness of such therapy.
            (3) Limitation on federal funding.--Federal Government 
        funding may be used to coordinate and administer the 
        partnerships under this subsection but may not be used to carry 
        out activities conducted under such partnerships.
    (b) Review of Effectiveness of Hyperbaric Oxygen Therapy.--Not 
later than 90 days after the date of the enactment of this Act, the 
Secretary, in consultation with the Center for Compassionate 
Innovation, shall begin using an objective and quantifiable method to 
review the effectiveness and applicability of hyperbaric oxygen 
therapy, such as through the use of a device approved or cleared by the 
Food and Drug Administration that assesses traumatic brain injury by 
tracking eye movement.
    (c) Systematic Review of Use of Hyperbaric Oxygen Therapy to Treat 
Certain Conditions.--
            (1) In general.--Not later than 90 days after the date of 
        the enactment of this Act, the Secretary, in consultation with 
        the Center for Compassionate Innovation, shall commence the 
        conduct of a systematic review of published research literature 
        on off-label use of hyperbaric oxygen therapy to treat post-
        traumatic stress disorder and traumatic brain injury among 
        veterans and nonveterans.
            (2) Elements.--The review conducted under paragraph (1) 
        shall include the following:
                    (A) An assessment of the current parameters for 
                research on the use by the Department of Veterans 
                Affairs of hyperbaric oxygen therapy, including--
                            (i) tests and questionnaires used to 
                        determine the efficacy of such therapy; and
                            (ii) metrics for determining the success of 
                        such therapy.
                    (B) A comparative analysis of tests and 
                questionnaires used to study post-traumatic stress 
                disorder and traumatic brain injury in other research 
                conducted by the Department of Veterans Affairs, other 
                Federal agencies, and entities outside the Federal 
                Government.
            (3) Completion of review.--The review conducted under 
        paragraph (1) shall be completed not later than 180 days after 
        the date of the commencement of the review.
            (4) Report.--Not later than 90 days after the completion of 
        the review conducted under paragraph (1), 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 results of the review.
    (d) Follow-up Study.--
            (1) In general.--Not later than 120 days after the 
        completion of the review conducted under subsection (c), the 
        Secretary, in consultation with the Center for Compassionate 
        Innovation, shall commence the conduct of a study on all 
        individuals receiving hyperbaric oxygen therapy through the 
        current pilot program of the Department for the provision of 
        hyperbaric oxygen therapy to veterans to determine the efficacy 
        and effectiveness of hyperbaric oxygen therapy for the 
        treatment of post-traumatic stress disorder and traumatic brain 
        injury.
            (2) Elements.--The study conducted under paragraph (1) 
        shall include the review and publication of any data and 
        conclusions resulting from research conducted by an authorized 
        provider of hyperbaric oxygen therapy for veterans through the 
        pilot program described in such paragraph.
            (3) Completion of study.--The study conducted under 
        paragraph (1) shall be completed not later than three years 
        after the date of the commencement of the study.
            (4) Report.--
                    (A) In general.--Not later than 90 days after 
                completing the study conducted under paragraph (1), 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 
                results of the study.
                    (B) Elements.--The report required under 
                subparagraph (A) shall include the recommendation of 
                the Secretary with respect to whether or not hyperbaric 
                oxygen therapy should be made available to all veterans 
                with traumatic brain injury or post-traumatic stress 
                disorder.

SEC. 703. PRESCRIPTION OF TECHNICAL QUALIFICATIONS FOR LICENSED HEARING 
              AID SPECIALISTS AND REQUIREMENT FOR APPOINTMENT OF SUCH 
              SPECIALISTS.

    (a) In General.--Not later than 180 days after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall 
prescribe the technical qualifications required under section 
7402(a)(14) of title 38, United States Code, to be appointed as a 
licensed hearing aid specialist under section 7401(3) of such title.
    (b) Elements for Qualifications.--In prescribing the qualifications 
for licensed hearing aid specialists under subsection (a), the 
Secretary shall ensure such qualifications are consistent with the 
following:
            (1) Standards of registered apprenticeship programs for the 
        occupation of hearing aid specialists approved by the 
        Department of Labor in accordance with the Act of August 16, 
        1937 (commonly known as the ``National Apprenticeship Act'') 
        (50 Stat. 664, chapter 663; 29 U.S.C. 50 et seq.).
            (2) Standards for licensure of hearing aid specialists that 
        are required by a majority of States.
            (3) Competency in completing core tasks for the occupation 
        of hearing aid specialist as determined by the Occupational 
        Information Network Database (commonly known as ``O*NET'').
    (c) Appointment.--Not later than September 30, 2022, the Secretary 
shall appoint not fewer than one licensed hearing aid specialist at 
each medical center of the Department.
    (d) Report.--Not later than September 30, 2022, and 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--
            (1) assessing the progress of the Secretary in appointing 
        licensed hearing aid specialists under subsection (c);
            (2) assessing potential conflicts or obstacles that prevent 
        the appointment of licensed hearing aid specialists;
            (3) assessing the factors that led to such conflicts or 
        obstacles; and
            (4) indicating the medical centers of the Department with 
        vacancies for licensed hearing aid specialists.

SEC. 704. USE BY DEPARTMENT OF VETERANS AFFAIRS OF COMMERCIAL 
              INSTITUTIONAL REVIEW BOARDS IN SPONSORED RESEARCH TRIALS.

    (a) In General.--Not later than 90 days after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall complete 
all necessary policy revisions within the directive of the Veterans 
Health Administration numbered 1200.05 and titled ``Requirements for 
the Protection of Human Subjects in Research'', to allow sponsored 
clinical research of the Department of Veterans Affairs to use 
accredited commercial institutional review boards to review research 
proposal protocols of the Department.
    (b) Identification of Review Boards.--Not later than 90 days after 
the completion of the policy revisions under subsection (a), the 
Secretary shall--
            (1) identify accredited commercial institutional review 
        boards for use in connection with sponsored clinical research 
        of the Department; and
            (2) establish a process to modify existing approvals in the 
        event that a commercial institutional review board loses its 
        accreditation during an ongoing clinical trial.
    (c) Report.--
            (1) In general.--Not later than 90 days after the 
        completion of the policy revisions under subsection (a), and 
        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 all approvals of institutional review boards used by the 
        Department, including central institutional review boards and 
        commercial institutional review boards.
            (2) Elements.--The report required by paragraph (1) shall 
        include, at a minimum, the following:
                    (A) The name of each clinical trial with respect to 
                which the use of an institutional review board has been 
                approved.
                    (B) The institutional review board or institutional 
                review boards used in the approval process for each 
                clinical trial.
                    (C) The amount of time between submission and 
                approval.

SEC. 705. CREATION OF OFFICE OF RESEARCH REVIEWS WITHIN THE OFFICE OF 
              INFORMATION AND TECHNOLOGY OF THE 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 shall 
establish within the Office of Information and Technology of the 
Department of Veterans Affairs an Office of Research Reviews (in this 
section referred to as the ``Office'').
    (b) Elements.--The Office shall do the following:
            (1) Perform centralized security reviews and complete 
        security processes for approved research sponsored outside the 
        Department, with a focus on multi-site clinical trials.
            (2) Develop and maintain a list of commercially available 
        software preferred for use in sponsored clinical trials of the 
        Department and ensure such list is maintained as part of the 
        official approved software products list of the Department.
            (3) Develop benchmarks for appropriate timelines for 
        security reviews conducted by the Office.
    (c) Report.--
            (1) In general.--Not later than one year after the 
        establishment of the Office, the Office 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 activity of the Office.
            (2) Elements.--The report required by paragraph (1) shall 
        include, at a minimum, the following:
                    (A) The number of security reviews completed.
                    (B) The number of personnel assigned for performing 
                the functions described in subsection (b).
                                                       Calendar No. 498

116th CONGRESS

  2d Session

                                 S. 785

_______________________________________________________________________

                                 A BILL

 To improve mental health care provided by the Department of Veterans 
                    Affairs, and for other purposes.

_______________________________________________________________________

                             July 27, 2020

                       Reported with an amendment