[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4400 Introduced in House (IH)]

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118th CONGRESS
  1st Session
                                H. R. 4400

 To direct the Secretary of Veterans Affairs to conduct an independent 
  review of the deaths of certain veterans by suicide, and for other 
                               purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 30, 2023

 Mr. Buchanan (for himself and Mr. Connolly) introduced the following 
     bill; which was referred to the Committee on Veterans' Affairs

_______________________________________________________________________

                                 A BILL


 
 To direct the Secretary of Veterans Affairs to conduct an independent 
  review of the deaths of certain veterans by suicide, and for other 
                               purposes.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Veteran Overmedication and Suicide 
Prevention Act of 2023''.

SEC. 2. DEPARTMENT OF VETERANS AFFAIRS INDEPENDENT REVIEW OF CERTAIN 
              DEATHS OF VETERANS BY SUICIDE.

    (a) Review Required.--
            (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) 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--
                            (i) 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;
                            (ii) 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;
                            (iii) an assessment of the development by 
                        the Department of hiring guidelines for mental 
                        health counselors, marriage and family 
                        therapists, and other appropriate counselors;
                            (iv) 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;
                            (v) 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
                            (vi) 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.
                    (N) 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).
                    (O) An identification of the medical facilities of 
                the Department with markedly high prescription rates 
                and suicide rates for veterans receiving treatment at 
                those facilities.
                    (P) 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.
                    (Q) 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.
                    (R) 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.
                    (S) A description of how data relating to death 
                certificates of veterans is collected, determined, and 
                reported by the Department of Veterans Affairs.
                    (T) An assessment of any patterns apparent to the 
                National Academies of Sciences, Engineering, and 
                Medicine based on the review conducted under paragraph 
                (1).
                    (U) 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.
            (3) Compilation of data.--
                    (A) Form of compilation.--The Secretary of Veterans 
                Affairs shall ensure that data compiled under paragraph 
                (2) 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.
                    (B) Compilation of data regarding covered 
                veterans.--In compiling data under paragraph (2) 
                regarding covered veterans described in subparagraphs 
                (A) through (C) of such paragraph, data regarding 
                veterans described in each such subparagraph shall be 
                compiled separately and disaggregated by year.
            (4) Completion of review and report.--The agreement entered 
        into under paragraph (1) shall require that the National 
        Academies of Sciences, Engineering, and Medicine complete the 
        review under such paragraph and submit to the Secretary of 
        Veterans Affairs a report containing the results of the review 
        not later than 180 days after entering into the agreement.
    (b) Report.--Not later than 30 days after the completion by the 
National Academies of Sciences, Engineering, and Medicine of the review 
required under subsection (a), 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.
    (c) 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.
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