[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 3293 Introduced in Senate (IS)]

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117th CONGRESS
  1st Session
                                S. 3293

To expand access of veterans to mental health care from the Department 
              of Veterans Affairs, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                            December 1, 2021

 Mr. Tester (for himself and Mr. Moran) introduced the following bill; 
which was read twice and referred to the Committee on Veterans' Affairs

_______________________________________________________________________

                                 A BILL


 
To expand access of veterans to mental health care from 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,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Post-9/11 
Veterans' Mental Health Care Improvement Act of 2021''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
                        TITLE I--ACCESS TO CARE

Sec. 101. Improvement of sleep disorder care furnished by Department of 
                            Veterans Affairs.
Sec. 102. Mental health consultations.
Sec. 103. Study on inpatient mental health and substance use care from 
                            Department of Veterans Affairs.
Sec. 104. Study on treatment from Department of Veterans Affairs for 
                            co-occurring mental health and substance 
                            use disorders.
                   TITLE II--MENTAL HEALTH WORKFORCE

Sec. 201. Expansion of Vet Center workforce.
Sec. 202. Expansion of mental health training for Department of 
                            Veterans Affairs.
Sec. 203. Expansion of scholarships and loan repayment programs for 
                            mental health providers.
Sec. 204. Study on workload of suicide prevention teams of Department 
                            of Veterans Affairs.
                   TITLE III--MENTAL HEALTH RESEARCH

Sec. 301. Expansion of suicide prevention and mental health research.
Sec. 302. Study on mental health and suicide prevention support for 
                            military families.
Sec. 303. Research on brain health.
Sec. 304. Study on efficacy of clinical and at-home resources for post-
                            traumatic stress disorder.

                        TITLE I--ACCESS TO CARE

SEC. 101. IMPROVEMENT OF SLEEP DISORDER CARE FURNISHED BY DEPARTMENT OF 
              VETERANS AFFAIRS.

    (a) In General.--Pursuant to the analysis conducted under 
subsection (b), the Secretary of Veterans Affairs shall take such 
action as the Secretary considers appropriate to improve the assessment 
and treatment of veterans with sleep disorders, including by conducting 
in-home sleep studies for veterans.
    (b) Analysis.--The Secretary shall conduct an analysis of the 
ability of the Department of Veterans Affairs to treat sleep disorders 
among veterans, including--
            (1) assessment and treatment options for such disorders;
            (2) barriers to care for such disorders, such as wait time, 
        travel time, and lack of staffing;
            (3) the efficacy of the clinical practice guidelines of the 
        Department of Veterans Affairs and the Department of Defense 
        for such disorders; and
            (4) the availability of and efficacy of the use by the 
        Department of Veterans Affairs of cognitive behavioral therapy 
        for insomnia.
    (c) Report.--Not later than two years 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--
            (1) the findings from the analysis conducted under 
        subsection (b); and
            (2) any actions taken under subsection (a) to improve the 
        assessment and treatment of veterans with sleep disorders.
    (d) Authorization of Appropriations for In-Home Sleep Studies.--
There is authorized to be appropriated to the Secretary of Veterans 
Affairs $5,000,000 to be used to conduct in-home sleep studies for 
veterans, as part of sleep disorder assessment and treatment conducted 
by the Department of Veterans Affairs.

SEC. 102. MENTAL HEALTH CONSULTATIONS.

    (a) Mental Health Consultations for Veterans Filing for 
Compensation.--
            (1) In general.--Subchapter VI of chapter 11 of title 38, 
        United States Code, is amended by adding at the end the 
        following new section:
``Sec. 1167. Mental health consultations
    ``(a) In General.--Not later than 30 days after the date on which a 
veteran submits to the Secretary a claim for compensation under this 
chapter for service-connected disability relating to a mental health 
diagnosis, the Secretary shall offer the veteran a mental health 
consultation to assess the mental health needs of and care options for 
the veteran.
    ``(b) Availability.--The Secretary shall ensure that a veteran 
offered a mental health consultation under subsection (a) may elect to 
receive such consultation during the one-year period beginning on the 
date on which the consultation is offered or during such longer period 
beginning on such date as the Secretary considers appropriate.''.
            (2) Clerical amendment.--The table of sections at the 
        beginning of chapter 11 of such title is amended by adding at 
        the end the following new item:

``1167. Mental health consultations.''.
    (b) Mental Health Consultations for Veterans Entering Homeless 
Programs Office Programs.--
            (1) In general.--Subchapter VII of chapter 20 of title 38, 
        United States Code, is amended by adding at the end the 
        following new section:
``Sec. 2068. Mental health consultations
    ``(a) In General.--Not later than two weeks after the date on which 
a veteran described in subsection (b) enters into a program 
administered by the Homeless Programs Office of the Department, the 
Secretary shall offer the veteran a mental health consultation to 
assess the health needs of and care options for the veteran.
    ``(b) Veteran Described.--A veteran described in this subsection is 
a veteran to whom a mental health consultation is not offered or 
provided through the case management services of the program of the 
Homeless Programs Office into which the veteran enters.''.
            (2) Clerical amendment.--The table of sections at the 
        beginning of chapter 20 of such title is amended by adding at 
        the end the following new item:

``2068. Mental health consultations.''.

SEC. 103. STUDY ON INPATIENT MENTAL HEALTH AND SUBSTANCE USE CARE FROM 
              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 complete 
the conduct of a study on access of veterans to care under the 
residential rehabilitation treatment programs of the Department of 
Veterans Affairs to determine--
            (1) if there are sufficient geographic offerings of 
        inpatient mental health care, especially for veterans in rural 
        and remote communities;
            (2) if there are sufficient bed spaces at each location, 
        based on demand and drive time from the homes of veterans;
            (3) if there are any workforce-related capacity limitations 
        at each location, including if beds are unable to be used 
        because there are not enough providers to care for additional 
        patients;
            (4) if there are diagnosis-specific or sex-specific 
        barriers to accessing care under such programs; and
            (5) the average wait time for a bed in such a program, 
        broken out by--
                    (A) Veterans Integrated Service Network;
                    (B) rural or urban area;
                    (C) sex; and
                    (D) specialty (general program, substance use 
                disorder program, military sexual trauma program, 
                etc.).
    (b) Recommendations for Modifications to Treatment Programs.--Using 
the results from the study conducted under subsection (a), the 
Secretary shall make recommendations for--
            (1) new locations for opening facilities to participate in 
        the residential rehabilitation treatment programs of the 
        Department;
            (2) facilities under such programs at which new beds can be 
        added; and
            (3) any additional specialty tracks to be added to such 
        programs, such as substance use disorder or military sexual 
        trauma, in order to meet veteran need and demand.
    (c) Report.--Not later than 180 days after 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 the findings of the study 
conducted under subsection (a) and the recommendations made by the 
Secretary under subsection (b).

SEC. 104. STUDY ON TREATMENT FROM DEPARTMENT OF VETERANS AFFAIRS FOR 
              CO-OCCURRING MENTAL HEALTH AND SUBSTANCE USE DISORDERS.

    (a) In General.--Not later than one year after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall conduct 
a study examining--
            (1) the availability of treatment programs for veterans 
        with co-occurring mental health and substance use disorders 
        (including both inpatient and outpatient care);
            (2) any geographic disparities in access to such programs, 
        such as for rural and remote veterans; and
            (3) the average wait times for care under such programs.
    (b) Report.--
            (1) In general.--Not later than two years 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 findings of the study conducted under subsection (a).
            (2) Elements.--The report required by paragraph (1) shall 
        include--
                    (A) any recommendations resulting from the study 
                conducted under subsection (a) with respect to 
                improving timeliness and quality of care and meeting 
                treatment preferences for veterans with co-occurring 
                mental health and substance use disorders; and
                    (B) a description of any actions taken by the 
                Secretary to improve care for such veterans.

                   TITLE II--MENTAL HEALTH WORKFORCE

SEC. 201. EXPANSION OF VET CENTER WORKFORCE.

    (a) In General.--Not later than one year after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall hire an 
additional 100 full-time equivalent employees for Vet Centers to 
bolster the workforce of Vet Centers and to provide expanded mental 
health care to veterans, members of the Armed Forces, and their 
families through outreach, community access points, outstations, and 
Vet Centers.
    (b) 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. 202. EXPANSION OF MENTAL HEALTH TRAINING FOR DEPARTMENT OF 
              VETERANS AFFAIRS.

    (a) In General.--Not later than three years after the date of the 
enactment of this Act, the Secretary of Veterans Affairs, in 
collaboration with the Office of Mental Health and Suicide Prevention 
and the Office of Academic Affiliations, shall add an additional 500 
paid trainee slots in covered mental health disciplines to the 
workforce of the Department of Veterans Affairs.
    (b) Covered Mental Health Disciplines Defined.--In this section, 
the term ``covered mental health disciplines'' means psychiatry, 
psychology, advanced practice nursing (with a focus on mental health or 
substance use disorder), social work, licensed professional mental 
health counseling, and marriage and family therapy.

SEC. 203. EXPANSION OF SCHOLARSHIPS AND LOAN REPAYMENT PROGRAMS FOR 
              MENTAL HEALTH PROVIDERS.

    (a) Expansion of Health Professional Scholarship Program.--
Beginning in academic year 2022, the Secretary of Veterans Affairs 
shall include not fewer than an additional (as compared to academic 
year 2021) 50 awards per academic year under the Department of Veterans 
Affairs Health Professional Scholarship Program under subchapter II of 
chapter 76 of title 38, United States Code, for applicants otherwise 
eligible for such program who are pursuing degrees or training in 
mental health disciplines, including advanced practice nursing (with a 
focus on mental health or substance use disorder), psychology, and 
social work.
    (b) Expansion of Education Debt Reduction Program.--
            (1) In general.--Beginning in fiscal year 2022, the 
        Secretary shall provide not fewer than an additional (as 
        compared to fiscal year 2021) 200 debt reduction awards per 
        year under the Department of Veterans Affairs Education Debt 
        Reduction Program under subchapter VII of chapter 76 of title 
        38, United States Code, to be used to recruit mental health 
        professionals to the Department of Veterans Affairs in 
        disciplines that include psychiatry, psychology, advanced 
        practice nursing (with a focus on mental health or substance 
        use disorder), and social work.
            (2) Authorization of appropriations.--There is authorized 
        to be appropriated to the Secretary of Veterans Affairs 
        $8,000,000 per year to carry out the additional awards under 
        paragraph (1).
    (c) Outreach.--
            (1) In general.--Not later than one year after the date of 
        the enactment of this Act, the Secretary shall develop a public 
        awareness campaign to encourage veterans and mental health 
        professionals to choose the Department for their mental health 
        career.
            (2) Elements.--The campaign required under paragraph (1)--
                    (A) shall advertise the paid trainee, scholarship, 
                and loan repayment opportunities offered by the 
                Department; and
                    (B) may highlight the new graduate medical 
                education residencies available at the Department for 
                medical students entering residency.

SEC. 204. STUDY ON WORKLOAD OF SUICIDE PREVENTION TEAMS OF DEPARTMENT 
              OF VETERANS AFFAIRS.

    (a) In General.--The Secretary of Veterans Affairs, acting through 
the Under Secretary for Health and the Office of Mental Health and 
Suicide Prevention, shall conduct a study evaluating the workload of 
local suicide prevention teams of the Department of Veterans Affairs.
    (b) Elements.--The study conducted under subsection (a) shall--
            (1) identify the effects of the growth of the suicide 
        prevention program of the Department on the workload of suicide 
        prevention teams;
            (2) incorporate key practices for staffing model design in 
        determining suicide prevention staffing needs; and
            (3) determine which facilities of the Department need 
        increased suicide prevention coordinator staffing to meet the 
        needs of veterans, with an emphasis placed on facilities with 
        high patient volume and facilities located in States with high 
        rates of veteran suicide.
    (c) Report.--Not later than one year after the date of the 
enactment of this Act, the Secretary shall submit to the Committee on 
Veterans' Affairs of the Senate and the Committee on Veterans' Affairs 
of the House of Representatives a report--
            (1) on the findings of the study conducted under subsection 
        (a); and
            (2) indicating any changes made to the staffing of suicide 
        prevention teams of the Department resulting from the 
        determinations made under subsection (b)(3), including a list 
        of facilities of the Department where staffing was adjusted.

                   TITLE III--MENTAL HEALTH RESEARCH

SEC. 301. EXPANSION OF SUICIDE PREVENTION AND MENTAL HEALTH RESEARCH.

    There is authorized to be appropriated to the Department of 
Veterans Affairs an additional $10,000,000 to be used by the Center of 
Excellence for Suicide Prevention of the Department and the Rocky 
Mountain Mental Illness Research Education and Clinical Center for 
purposes of conducting research on the factors impacting veteran 
suicide and best practices for early intervention and support.

SEC. 302. STUDY ON MENTAL HEALTH AND SUICIDE PREVENTION SUPPORT FOR 
              MILITARY FAMILIES.

    (a) In General.--The Secretary of Veterans Affairs, in 
collaboration with the Secretary of Defense, shall conduct a study on 
secondary post-traumatic stress disorder and depression and its impact 
on spouses, children, and caregivers of members of the Armed Forces.
    (b) Report.--
            (1) In general.--Not later than three years after the date 
        of the enactment of this Act, the Secretary of Veterans 
        Affairs, in collaboration with the Secretary of Defense, shall 
        submit to Congress, veterans service organizations, and 
        military support organizations a report on the findings of the 
        study conducted under subsection (a).
            (2) Definitions.--In this subsection:
                    (A) Military support organization.--The term 
                ``military support organization'' has the meaning given 
                that term by the Secretary of Defense.
                    (B) Veterans service organization.--The term 
                ``veterans service organization'' means an organization 
                recognized by the Secretary of Veterans Affairs for the 
                representation of veterans under section 5902 of title 
                38, United States Code.

SEC. 303. RESEARCH ON BRAIN HEALTH.

    There is authorized to be appropriated to the Department of 
Veterans Affairs an additional $5,000,000 for ongoing and future 
research at the Translational Research Center of the Department of 
Veterans Affairs for traumatic brain injury and stress disorders to 
provide better understanding of and improved treatment options for 
post-9/11 veterans with traumatic brain injury or post-traumatic stress 
disorder.

SEC. 304. STUDY ON EFFICACY OF CLINICAL AND AT-HOME RESOURCES FOR POST-
              TRAUMATIC STRESS DISORDER.

    Not later than two years after the date of the enactment of this 
Act, the Secretary of Veterans Affairs, through the Office of Research 
and Development of the Department of Veterans Affairs, shall conduct a 
study on--
            (1) the efficacy of clinical and at-home resources, such as 
        mobile applications like COVID Coach, for providers, veterans, 
        caregivers, and family members to use for dealing with 
        stressors;
            (2) the feasibility and advisability of developing more 
        such resources;
            (3) strategies for improving mental health care and 
        outcomes for veterans with post-traumatic stress disorder; and
            (4) best practices for helping family members of veterans 
        deal with secondary post-traumatic stress disorder or mental 
        health concerns.
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