[Congressional Record Volume 166, Number 139 (Wednesday, August 5, 2020)]
[Senate]
[Pages S4921-S4936]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




COMMANDER JOHN SCOTT HANNON VETERANS MENTAL HEALTH CARE IMPROVEMENT ACT 
                                OF 2019

  Mr. MORAN. Mr. President, I am pleased to be on the floor this 
evening, but I am here to discuss a significantly tragic issue that 
affects way too many Americans all across our country--certainly at 
home in Kansas--and that is the lack of treatment for mental health 
conditions and, in many instances, the consequence that comes from 
that--suicide.
  Sadly, veterans in particular face risks for suicide, and, 
unfortunately, COVID-19 has increased the problem. Veterans have a 
higher rate of suicide and mental health issues than people who have 
not served in our armed services.
  We know there is not a single explanation or reason for suicide, and 
there is no single treatment for prevention strategy. One veteran lost 
to suicide is one too many, and, of course, we all have the obligation 
to help those who have served our Nation--those who fought bravely for 
our country--to help fix this tragedy.
  Every day that we fail to act is another day we lose another 20 
veterans to suicide. They need our help.
  I want to highlight one veteran who fought a battle with his mental 
health condition, CDR John Scott Hannon. Commander Hannon was a 
decorated Navy SEAL. I met his family through the Senator from Montana, 
Mr. Tester. He, like every other veteran, was more than just what his 
service record would show. His family and friends remember him as a 
passionate mental health advocate for veterans. He tried to help other 
veterans who faced the same challenges that he did. They say he had a 
gentle heart and a fierce belief in taking actions to tackle big 
challenges.
  Sadly, Commander Hannon lost his fight with post-traumatic stress, 
bipolar disorder, and the effects of a traumatic brain injury. He lost 
that fight in February 2018. He now lives on in the memories of his 
friends and family, and when S. 785 becomes law--the namesake of the 
Commander John Scott Hannon Veterans Mental Health Care Improvement 
Act--he will be remembered even more--more by other Americans than his 
family and friends.
  I am proud to lead this effort in passage of this legislation, in its 
development, its creation, in the studies and efforts, the 
conversations that went on with my colleagues in the Senate, our 
colleagues in the Veterans' Affairs Committee, the veterans service 
organizations, and his family. I am proud to lead that effort with the 
Senator from Montana, the Senator who represents Commander Hannon's 
family.
  For several months now, our committee has been working closely with 
the Department of Veterans Affairs and the White House to improve upon 
and advance S. 785. This bill will make necessary investments in 
suicide prevention. It will improve and support innovative research. It 
will make improvements and increase the availability of mental health 
care
  This bill establishes a grant program championed by Mr. Boozman, the 
Senator from Arkansas. The VA will be required to better collaborate 
with community organizations across the country, serving veterans.
  Senator Tester, Senator Boozman, and I come from rural States, and it 
is hard to find the services where they are necessary. If we can allow 
the Department of Veterans Affairs to deal with local organizations, we 
have a better chance of fighting suicide.
  This legislation represents a team effort. I appreciate Secretary 
Wilkie, David Ballenger, Cathy Haverstock, and Chris Anderson for their 
help and commitment in addressing mental health services.
  President Trump and his support for veterans is well recognized. The 
Second Lady, Karen Pence, has also been a long-time advocate for 
veterans' mental health, and I appreciate our conversations on this 
important topic. The staff at the White House and at the Domestic 
Policy Council--Joe Grogan, Brooke Rollins, James Baehr, and Virginia 
McMillin--deserve recognition as well.
  The Senate VA committee is known for its spirit of bipartisanship, 
and I want to thank my colleagues on both sides of the aisle for their 
input on this important legislation. Along with the lead sponsor of 
this legislation, Senator Tester, and the efforts I mentioned of 
Senator Boozman, I would recognize Senator Sullivan, Senator Tillis, 
Senator Cassidy, Senator Rounds, Senator Cramer--the Presiding Officer 
this evening--Senator Loeffler, Senator Blackburn, Senator McSally, and 
Senator Kaine for their substantive contributions to several primary 
sections of this bill.
  These contributions by our colleagues range from studies on 
overmedication and suicidality, the effectiveness of hyperbaric oxygen 
therapy on PTSD and TBI, a pilot program for post-traumatic growth, and 
many provisions that will provide more direct oversight of the VA to 
ensure the Department is equipped to better serve veterans.
  As a result, this bipartisan legislation has 51 cosponsors, and it 
received a unanimous 17-to-0 vote in the Senate Committee on Veterans' 
Affairs earlier this year, and today is the time we will pass this 
measure out of the Senate.
  I am calling on my colleagues on both sides of the aisle to do our 
part to make certain that every veteran has access to the lifesaving 
care and support they need. We need to ensure that every VA medical 
center is equipped with the proper personnel, evidence-based treatment 
options, and the best research-informed care to fit the needs of each 
veteran who walks through its doors.
  For veterans and servicemembers like CDR John Scott Hannon, we, in 
Congress, have the opportunity to take action to help them know they 
don't have to struggle alone. Our legislation will help connect these 
veterans and servicemembers to more resources and provide them with the 
tools they need to address the challenges related to their service.
  To my colleagues, we have a significant role and responsibility to 
combat this struggle, and here today we can do our part to make certain 
that, in their struggles, our veterans are equipped with the care and 
services they need to be successful, to win. We must take real and 
urgent action to tackle the challenges together.


                     Additional Cosponsor to S. 785

  Mr. President, I ask unanimous consent that the Senator from Rhode 
Island, Mr. Reed, be added as a cosponsor to S. 785.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. MORAN. Mr. President, I also ask unanimous consent that the 
Senate proceed to the immediate consideration of Calendar No. 498, S. 
785.
  The PRESIDING OFFICER. The clerk will report the bill by title.
  The legislative clerk read as follows:

       A bill (S. 785) to improve mental health care provided by 
     the Department of Veterans Affairs, and for other purposes.

  The PRESIDING OFFICER. Is there objection to proceeding to the 
measure?
  There being no objection, the Senate proceeded to consider the bill, 
which had been reported from the Committee on Veterans' Affairs with an 
amendment to strike all after the enacting clause and insert in lieu 
thereof the following:

     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.

[[Page S4922]]

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

[[Page S4923]]

     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;

[[Page S4924]]

       (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

[[Page S4925]]

     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

[[Page S4926]]

       (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

[[Page S4927]]

     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.

[[Page S4928]]

       (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.

[[Page S4929]]

       (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

[[Page S4930]]

     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

[[Page S4931]]

     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.

[[Page S4932]]

  


     ``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

[[Page S4933]]

     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

[[Page S4934]]

     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

[[Page S4935]]

     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).

  Mr. MORAN. Mr. President, I ask unanimous consent that the committee-
reported substitute be withdrawn; that the Moran substitute amendment 
at the desk be considered and agreed to; and that the bill, as amended, 
be considered read a third time.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  The committee-reported amendment in the nature of a substitute was 
withdrawn.
  The amendment (No. 2594) in the nature of a substitute was agreed to.
  (The amendment is printed in today's Record under ``Text of 
Amendments.'')
  The bill was ordered to be engrossed for a third reading and was read 
the third time.
  Mr. MORAN. I know of no further debate on the bill, as amended.
  The PRESIDING OFFICER. If there is no further debate, the bill having 
been read the third time, the question is, Shall the bill pass, as 
amended?
  The bill (S. 785), as amended, was passed.
  Mr. MORAN. Thank you for that. I now ask unanimous consent that the 
motion to reconsider be considered made and laid upon the table.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. MORAN. I yield to the Senator from Montana for his conversation 
and discussion about this legislation.
  The PRESIDING OFFICER. The Senator from Montana.
  Mr. TESTER. Mr. President, I thank the chairman of the VA Committee, 
Senator Moran, for his leadership.
  What we have done here today is a very, very good thing. I think the 
biggest challenge facing the VA today is that we are losing 20 veterans 
a day to suicide. It has been that way for some time.
  People have been looking for solutions--looking for solutions--and 
the fact is that there is no silver bullet. But what we have done today 
is give the VA more tools in their toolbox to be able to address this 
problem of mental health and veteran suicide amongst our veterans.
  I thank Chairman Moran for his comments about CDR John Scott Hannon, 
after whom this bill is named. As Senator Moran has pointed out,

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this Navy SEAL served our Nation for 23 years. And after combat, Scott 
returned to Helena, MT, but, unfortunately, the invisible wounds of war 
followed him right back home.
  He was open about his journey to recovery, getting involved in the 
Montana chapter of the National Alliance on Mental Illness and using 
animal therapy and programs at Montana Wild. But, unfortunately--and I 
know his family is watching right now--on February 25, 2018, Scott 
succumbed to the wounds of war that caused his mental illness.
  As Chairman Moran has pointed out, this bill honors his legacy by 
supporting the kinds of programs that helped improve Commander Hannon's 
quality of life by expanding our understanding of mental health 
conditions and the treatments that may have made diagnosing the 
conditions easier.
  I am not going to go into everything the bill does because Senator 
Moran did a fine job on that. All I can say is that we have a great VA 
Committee in this U.S. Senate. It is a committee that works to get 
things done in a bipartisan way.
  I have had the honor of serving with Johnny Isakson as chairman and 
now with Chairman Moran, and we haven't missed a step. We continue to 
work together to support our veterans across this country.
  There is no better way of supporting our veterans than to pass this 
bill, which is what we just did in the U.S. Senate about 2 minutes ago.
  The bottom line is this: This isn't the final bill we are going to 
pass out of the U.S. Senate dealing with veterans. We have plenty more. 
In fact, I think we passed a dozen bills in the VA Committee today, 
dealing with a myriad of different issues that impact our veterans in 
this country. The bottom line is that today we can be proud. We can be 
proud of Senators in the U.S. Senate for doing something that needed to 
be done that is going to help our veterans and move this country 
forward.
  I am going to close by going where I started, and that is to say 
thank you, Senator Moran. Thank you for your leadership. Thank you for 
your friendship. Thank you for your trust. It is great working with 
you, and I look forward to doing many more good things before this 
Congress ends.
  Thank you.
  The PRESIDING OFFICER. The Senator from Kansas.
  Mr. MORAN. Mr. President, let me extend the courtesies that were 
extended to me by the Senator from Montana, Mr. Tester.
  It has been a privilege to work with him on this and many other 
issues--many of them related to our Nation's service men and women and 
those who served and are now veterans.
  I appreciate that Senator Tester and I have the ability to work 
together to resolve differences and find common ground for the benefit 
of those who have served.
  Before I conclude my comments this evening, I would use this as a 
moment--on behalf of the Presiding Officer, on behalf of Senator Tester 
and me, and on behalf of all Members of the U.S. Senate--to express our 
gratitude to all who have served our country and express our respects 
and honor for those who are no longer with us, who, because of those 
battle wounds, have lost their lives to suicide.
  We express our condolences and sympathies to their family members and 
to their friends, and, in each and every instance, we recognize what 
sacrifice they have made for the benefit of each and every one of us 
here today and across the country.
  I would say to those family members that this legislation--we hope--
and the example that their loved ones demonstrated in their lives will 
be something that will inspire us to do the right thing and care for 
those who served. So I express my condolence and sympathies to the 
families, and I thank all who served, and I do so on behalf of all 
Members of the U.S. Senate.
  Finally, I would be remiss if I didn't thank the many dedicated staff 
members who helped this legislation through to this point: Emily Blair, 
who is with us on the Senate floor tonight, Tiffanii Woolfolk, Mark 
Crowley, Asher Allman, Scott Nulty, Pat McGuigan, David Shearman, and 
Caroline Canfield.
  In addition, thank you to Senator Tester's staff: Sophie Friedl, 
Dahlia Melendrez, and Tony McClain, the Kansan, as well as the House 
Veterans' Affairs Committee staff members.
  Suicide is preventable, and with the passage of Commander John Scott 
Hannon Veterans Mental Health Care Improvement Act tonight--here, 
moments ago--we take a stand to protect the lives of the people who 
have given us so much in their protection of each and every American.
  I yield the floor

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