[Congressional Record Volume 166, Number 139 (Wednesday, August 5, 2020)]
[Senate]
[Pages S4961-S4976]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
SA 2594. Mr. MORAN (for himself and Mr. Tester) proposed an amendment
to the bill S. 785, to improve mental health care provided by the
Department of Veterans Affairs, and for other purposes; as follows:
Strike all after the enacting clause and insert 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. Strategic plan on expansion of health care coverage for
veterans transitioning from service in the Armed Forces.
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 or
coordinate the provision of suicide prevention services
for eligible individuals and their families.
Sec. 202. Analysis on feasibility and advisability of the Department of
Veterans Affairs providing certain complementary and
integrative health services.
Sec. 203. Pilot program to provide veterans access to complementary and
integrative health programs through animal therapy,
agritherapy, sports and recreation therapy, art therapy,
and posttraumatic growth programs.
Sec. 204. Department of Veterans Affairs study of all-cause mortality
of veterans, including by suicide, and review of 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. Establishment of Department of Veterans Affairs Readjustment
Counseling Service Scholarship Program.
Sec. 503. Comptroller General report on Readjustment Counseling Service
of Department of Veterans Affairs.
Sec. 504. Expansion of reporting requirements on Readjustment
Counseling Service of Department of Veterans Affairs.
Sec. 505. Briefing on alternative work schedules for employees of
Veterans Health Administration.
Sec. 506. Suicide prevention coordinators.
Sec. 507. 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. Requirement for Department of Veterans Affairs internet
website to provide information on services available to
women veterans.
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.
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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. STRATEGIC PLAN ON EXPANSION OF HEALTH CARE COVERAGE
FOR VETERANS TRANSITIONING FROM SERVICE IN THE
ARMED FORCES.
(a) Strategic 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 Secretary of Defense, shall submit
to the appropriate committees of Congress and publish on a
website of the Department of Veterans Affairs a strategic
plan for the provision by the Department of health care to
any veteran during the one-year period following the
discharge or release of the veteran from active military,
naval, or air service.
(2) Elements.--The plan submitted under paragraph (1) shall
include the following:
(A) An identification of general goals and objectives for
the provision of health care to veterans described in such
paragraph.
(B) A description of how such goals and objectives are to
be achieved, including--
(i) a description of the use of existing personnel,
information, technology, facilities, public and private
partnerships, and other resources of the Department of
Veterans Affairs;
(ii) a description of the anticipated need for additional
resources for the Department; and
(iii) an assessment of cost.
(C) An analysis of the anticipated health care needs,
including mental health care, for such veterans,
disaggregated by geographic area.
(D) An analysis of whether such veterans are eligible for
enrollment in the system of annual patient enrollment of the
Department under section 1705(a) of title 38, United States
Code.
(E) A description of activities designed to promote the
availability of health care from the Department for such
veterans, including outreach to members of the Armed Forces
though the Transition Assistance Program under sections 1142
and 1144 of title 10, United States Code.
(F) A description of legislative or administrative action
required to carry out the plan.
(G) A description of how the plan would further the ongoing
initiatives under Executive Order 13822 (83 Fed. Reg. 1513;
relating to supporting our veterans during their transition
from uniformed service to civilian life) to provide seamless
access to high-quality mental health care and suicide
prevention resources to veterans as they transition, with an
emphasis on the one-year period following separation.
(b) Definitions.--In this section:
(1) Active military, naval, or air service.--The term
``active military, naval, or air service'' has the meaning
given that term in section 101(24) of title 38, United States
Code.
(2) Appropriate committees of congress.--The term
``appropriate committees of Congress'' means--
(A) the Committee on Veterans' Affairs and the Committee on
Appropriations of the Senate; and
(B) the Committee on Veterans' Affairs and the Committee on
Appropriations of the House of Representatives.
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) Review.--
(1) 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, as
determined by the Secretary of Defense or the Secretary of
Veterans Affairs, within one year following the discharge or
release of the former member from active military, naval, or
air service during the five-year period preceding the date of
the enactment of this Act.
(2) Records to be reviewed.--In completing the review
required under paragraph (1), the Secretary of Defense and
the Secretary of Veterans Affairs shall review the following
records maintained by the Department of Defense:
(A) Health treatment records.
(B) Fitness, medical, and dental records.
(C) Ancillary training records.
(D) Safety forms and additional duties sections of the
personnel information files.
(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) Whether the Department of Defense had identified the
former member as being at elevated risk during the 365-day
period before separation of the member from the Armed Forces.
(2) In the case that the member was identified as being at
elevated risk as described in paragraph (1), whether that
identification had been communicated to the Department of
Veterans Affairs via the Solid Start initiative of the
Department pursuant to Executive Order 13822 (83 Fed. Reg.
1513; relating to supporting our veterans during their
transition from uniformed service to civilian life), or any
other means.
(3) The presence of evidence-based and empirically-
supported contextual and individual risk factors specified in
subsection (c) with respect to the former member and how
those risk factors correlated to the circumstances of the
death of the former member.
(4) Demographic variables, including the following:
(A) Sex.
(B) Age.
(C) Rank at separation from the Armed Forces.
(D) Career field after separation from the Armed Forces.
(E) State and county of residence one month prior to death.
(F) Branch of service in the Armed Forces.
(G) Marital status.
(H) Reason for separation from the Armed Forces.
(5) Support or medical services furnished to the former
member through the Department of Defense, specified by the
type of service or care provided.
(6) Support or medical services furnished to the former
member through the Department of Veterans Affairs, specified
by the type of service or care provided.
(c) Evidence-based and Empirically-supported Contextual and
Individual Risk Factors.--Evidence-based and empirically-
supported contextual and individual risk factors specified in
this subsection include the following:
(1) Exposure to violence.
(2) Exposure to suicide.
(3) Housing instability.
(4) Financial instability.
(5) Vocational problems or insecurity.
(6) Legal problems.
(7) Highly acute or significantly chronic relational
problems.
(8) Limited access to health care.
(d) Report.--Not later than three years 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) with
respect to the year-one cohort of former members of the Armed
Forces covered by the review.
(e) Definitions.--In this section:
(1) Active military, naval, or air service.--The term
``active military, naval, or air service'' has the meaning
given that term in section 101(24) of title 38, United States
Code.
(2) Appropriate committees of congress defined.--The term
``appropriate committees of Congress'' means--
(A) the Committee on Armed Services and the Committee on
Veterans' Affairs of the Senate; and
(B) the Committee on Armed Services and the Committee on
Veterans' Affairs of the House of Representatives.
SEC. 103. REPORT ON REACH VET PROGRAM OF DEPARTMENT OF
VETERANS AFFAIRS.
(a) In General.--Not later than 180 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall submit to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives a report on the REACH VET program.
(b) Elements.--The report required by subsection (a) shall
include the following:
(1) An assessment of the impact of the REACH VET program on
rates of suicide among veterans.
(2) An assessment of how limits within the REACH VET
program, such as caps on the number of veterans who may be
flagged as high risk, are adjusted for differing rates of
suicide across the country.
(3) A detailed explanation, with evidence, for why the
conditions included in the model used by the REACH VET
program were chosen, including an explanation as to why
certain conditions, such as bipolar disorder II, were not
included even though they show a similar rate of risk for
suicide as other conditions that were included.
(4) An assessment of the feasibility of incorporating
certain economic data held by the Veterans Benefits
Administration into the model used by the REACH VET program,
including financial data and employment status, which
research indicates may have an impact on risk for suicide.
(c) REACH VET Program Defined.--In this section, the term
``REACH VET program'' means the Recovery Engagement and
Coordination for Health--Veterans Enhanced Treatment program
of the Department of Veterans Affairs.
SEC. 104. REPORT ON CARE FOR FORMER MEMBERS OF THE ARMED
FORCES WITH OTHER THAN HONORABLE DISCHARGE.
Section 1720I(f) of title 38, United States Code, is
amended--
(1) in paragraph (1) by striking ``Not less frequently than
once'' and inserting ``Not later than February 15''; and
(2) in paragraph (2)--
(A) by redesignating subparagraph (C) as subparagraph (F);
and
(B) by inserting after subsection (B) the following new
subparagraphs:
[[Page S4963]]
``(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
OR COORDINATE THE PROVISION OF SUICIDE
PREVENTION SERVICES FOR ELIGIBLE INDIVIDUALS
AND THEIR FAMILIES.
(a) Purpose; Designation.--
(1) 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 or coordinate
suicide prevention services to eligible individuals and their
families.
(2) Designation.--The grant program under this section
shall be known as the ``Staff Sergeant Parker Gordon Fox
Suicide Prevention Grant Program''.
(b) Financial Assistance and Coordination.--The Secretary
shall provide financial assistance to eligible entities
approved under this section through the award of grants to
such entities to provide or coordinate the provision of
services to eligible individuals and their families to reduce
the risk of suicide. The Secretary shall carry out this
section in coordination with the President's Roadmap to
Empower Veterans and End a National Tragedy of Suicide Task
Force and in consultation with the Office of Mental Health
and Suicide Prevention of the Department, 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 of not
more than $750,000 per grantee per fiscal year; and
(B) intervals of payment for the administration of the
grant.
(d) Distribution of Grants and Preference.--
(1) Distribution.--
(A) Priority.--In compliance with subparagraphs (B) and
(C), in determining how to distribute grants under this
section, the Secretary may prioritize--
(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, grants under this section are
distributed--
(i) to provide services in areas of the United States that
have experienced high rates of suicide by eligible
individuals, including suicide attempts; 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.
(C) Geography.--In distributing grants under this
paragraph, the Secretary may provide grants to eligible
entities that furnish services to eligible individuals and
their families in geographically dispersed areas.
(2) Preference.--The Secretary shall give preference to
eligible entities that have demonstrated the ability to
provide or coordinate suicide prevention services.
(e) Requirements for Receipt of Grants.--
(1) Notification that services are from department.--Each
entity receiving a grant under this section to provide or
coordinate suicide prevention services to eligible
individuals and their families shall notify the recipients of
such services that such services are being paid for, in whole
or in part, by the Department.
(2) Development of plan with eligible individuals and their
family.--Any plan developed with respect to the provision of
suicide prevention services for an eligible individual or
their family shall be developed in consultation with the
eligible individual and their family.
(3) Coordination.--An 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 subsection (n) or any other provisions of the
law regarding the delivery of health care by the Secretary;
(B) inform every veteran who receives assistance under this
section from the entity of the ability of the veteran to
apply for enrollment in the patient enrollment system of the
Department under section 1705(a) of title 38, United States
Code; and
(C) if such a veteran wishes to so enroll, inform the
veteran of a point of contact at the Department who can
assist the veteran in such enrollment.
(4) Measurement and monitoring.--An entity receiving a
grant under this section shall submit to the Secretary a
description of such tools and assessments the entity uses or
will use to determine the effectiveness of the services
furnished by the entity, which shall include the measures
developed under subsection (h)(2) and may include--
(A) the effect of the services furnished by the entity on
the financial stability of the eligible individual;
(B) the effect of the services furnished by the entity on
the mental health status, wellbeing, and suicide risk of the
eligible individual; and
(C) the effect of the services furnished by the entity on
the social support of the eligible individuals receiving
those services.
(5) Reports.--The Secretary--
(A) shall require each entity receiving a grant under this
section to submit to the Secretary an annual report that
describes the projects carried out with such grant during the
year covered by the report;
(B) shall specify to each such entity the evaluation
criteria and data and information to be submitted in such
report; and
(C) may require each such entity to submit to the Secretary
such additional reports as the Secretary considers
appropriate.
(f) Application for Grants.--
(1) In general.--An eligible entity seeking a grant 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 or deliver suicide prevention services
to eligible individuals, 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 with regard to
the provision or coordination of suicide prevention services;
(iii) an identification of how long such arrangements have
been in place;
(iv) a description of the suicide prevention services
provided by such partners that the eligible entity shall
coordinate, if any; and
(v) an identification of local suicide prevention
coordinators of the Department and a description of how the
eligible entity will communicate with local suicide
prevention coordinators.
(C) A description of the population of eligible individuals
and their families proposed to be provided suicide prevention
services.
(D) Based on information and methods developed by the
Secretary for purposes of this subsection, an estimate of the
number of eligible individuals at risk of suicide and their
families proposed to be provided suicide prevention services,
including the percentage of those eligible individuals who
are not currently receiving care furnished by the Department.
(E) Evidence of measurable outcomes related to reductions
in suicide risk and mood-related symptoms utilizing validated
instruments by the eligible entity (and the proposed partners
of the entity, if any) in providing suicide prevention
services to individuals at risk of suicide, particularly to
eligible individuals and their families.
(F) 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 on an ongoing basis the needs of eligible
individuals and their families for suicide prevention
services;
(iii) to coordinate the provision of suicide prevention
services with the services of the Department for which
eligible individuals are also eligible;
(iv) to tailor suicide prevention services to the needs of
eligible individuals and their families;
(v) to seek continuously new sources of assistance to
ensure the continuity of suicide prevention services for
eligible individuals and their families as long as they are
determined to be at risk of suicide; and
(vi) to measure the effects of suicide prevention services
provided by the eligible entity or partner organization, in
accordance with subsection (h)(2), on the lives of eligible
individuals and their families who receive such services
provided by the organization using pre- and post-evaluations
on validated measures of suicide risk and mood-related
symptoms.
(G) Clearly defined objectives for the provision of suicide
prevention services.
(H) A description and physical address of the primary
location of the eligible entity.
(I) A description of the geographic area the eligible
entity plans to serve during the grant award period for which
the application applies.
(J) If the eligible entity is a State or local government
or an Indian tribe, the amount of grant funds proposed to be
made available to community partners, if any, through
agreements.
[[Page S4964]]
(K) A description of how the eligible entity will assess
the effectiveness of the provision of grants under this
section.
(L) An agreement to use the measures and metrics provided
by the Department for the purposes of measuring the
effectiveness of the programming as described in subsection
(h)(2).
(M) Such additional application criteria as the Secretary
considers appropriate.
(g) Training and Technical Assistance.--
(1) In general.--The Secretary shall provide training and
technical assistance, in coordination with the Centers for
Disease Control and Prevention, to eligible entities in
receipt of grants under this section regarding--
(A) suicide risk identification and management;
(B) the data required to be collected and shared with the
Department;
(C) the means of data collection and sharing;
(D) familiarization with and appropriate use of any tool to
be used to measure the effectiveness of the use of the grants
provided; and
(E) the requirements for reporting under subsection (e)(5)
on services provided via such grants.
(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 grants under this section for
purposes of improving the services available for eligible
individuals and their families, set forth by service type,
locality, and eligibility criteria.
(B) The measures and metrics to be used by each entity in
receipt of grants under this section to determine the
effectiveness of the programming being provided by such
entity in improving mental health status, wellbeing, and
reducing suicide risk and completed suicides of eligible
individuals and their families, which shall include an
existing measurement tool or protocol for the grant recipient
to utilize when determining programmatic effectiveness.
(3) Coordination.--In developing a plan for the design and
implementation of the provision of grants 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 and
their families, including national organizations that--
(i) advocate for the needs of individuals with or at risk
of behavioral health conditions;
(ii) represent mayors;
(iii) represent unions;
(iv) represent first responders;
(v) represent chiefs of police and sheriffs;
(vi) represent governors;
(vii) represent a territory of the United States; or
(viii) represent a Tribal alliance.
(C) National organizations representing members of the
Armed Forces.
(D) National organizations that represent counties.
(E) Organizations with which the Department has a current
memorandum of agreement or understanding related to mental
health or suicide prevention.
(F) State departments of veterans affairs.
(G) National organizations representing members of the
reserve components of the Armed Forces.
(H) National organizations representing members of the
Coast Guard.
(I) Organizations, including institutions of higher
education, with experience in creating measurement tools for
purposes of advising the Secretary on the most appropriate
existing measurement tool or protocol for the Department to
utilize.
(J) The National Alliance on Mental Illness.
(K) A labor organization (as such term is defined in
section 7103(a)(4) of title 5, United States Code).
(L) The Centers for Disease Control and Prevention, the
Substance Abuse and Mental Health Services Administration,
the President's Roadmap to Empower Veterans and End a
National Tragedy of Suicide Task Force, and 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 already developed measures and metrics to be used
by the Department to measure the effectiveness of the use of
grants provided under this section as described in subsection
(h)(2); and
(C) a framework for the sharing of information about
entities in receipt of grants under this section.
(i) Information on Potential Eligible Individuals.--
(1) In general.--The Secretary may make available to
recipients of grants under this section certain information
regarding potential eligible individuals who may receive
services for which such grant is provided.
(2) Information included.--The information made available
under paragraph (1) with respect to potential eligible
individuals may include the following:
(A) Confirmation of the status of a potential eligible
individual as a veteran.
(B) Confirmation of whether the potential eligible
individual is enrolled in the patient enrollment system of
the Department under section 1705(a) of title 38, United
States Code.
(C) Confirmation of whether a potential eligible individual
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 grants under this
section.
(j) Duration.--The authority of the Secretary to provide
grants 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.--
(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 grants to eligible
entities under this section.
(B) Elements.--The report submitted under subparagraph (A)
shall include the following:
(i) An assessment of the effectiveness of the grant program
under this section, including--
(I) the effectiveness of grant recipients and their
community partners, if any, in conducting outreach to
eligible individuals;
(II) the effectiveness of increasing eligible individuals
engagement in suicide prevention services; and
(III) such other validated instruments and additional
measures as determined by the Secretary and as described in
subsection (h)(2).
(ii) A list of grant recipients and their partner
organizations, if any, 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, disaggregated by--
(I) all demographic characteristics as determined necessary
and appropriate by the Secretary in coordination with the
Centers for Disease Control and Prevention;
(II) whether each such eligible individual is enrolled in
the patient enrollment system of the Department under section
1705(a) of title 38, United States Code;
(III) branch of service in the Armed Forces;
(IV) era of service in the Armed Forces;
(V) type of service received by the eligible individual;
and
(VI) whether each such eligible individual was referred to
the Department for care.
(iv) The number of eligible individuals supported by grants
under this section, including through services provided to
family members.
(v) The number of eligible individuals described in clause
(iv) who were not previously receiving care furnished by the
Department, with specific numbers for the population of
eligible individuals described in subsection (q)(4)(B).
(vi) The number of eligible individuals whose mental health
status, wellbeing, and suicide risk received a baseline
measurement assessment under this section and the number of
such eligible individuals whose mental health status,
wellbeing, and suicide risk will be measured by the
Department or a community partner over a period of time for
any improvements.
(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 and percentage of eligible individuals
referred to the point of contact at the Department under
subsection (e)(3)(C).
(ix) The number of eligible individuals newly enrolled in
the patient enrollment system of the Department under section
1705(a) of title 38, United States Code based on a referral
to the Department from a grant recipient under subsection
(e)(3)(C), disaggregated by grant recipient.
(x) A detailed account of how the grant funds were used,
including executive compensation, overhead costs, and other
indirect costs.
(xi) A description of any outreach activities conducted by
the eligible entity in receipt of a grant with respect to
services provided using the grant.
(xii) The number of individuals who seek services from the
grant recipient who are not eligible individuals.
(C) Submittal of information by grant recipients.--The
Secretary may require eligible entities receiving grants
under this
[[Page S4965]]
section to provide to Congress such information as the
Secretary determines necessary regarding the elements
described in subparagraph (B).
(2) Final report.--Not later than three years after the
date on which the first grant is awarded under this section,
and annually thereafter for each year in which the program is
in effect, 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 grants under this
section, including the effectiveness of community partners in
conducting outreach to eligible individuals and their
families and reducing the rate of suicide among eligible
individuals;
(ii) an assessment of the increased capacity of the
Department to provide services to eligible individuals and
their families, set forth by State, as a result of the
provision of grants under this section;
(iii) the feasibility and advisability of extending or
expanding the provision of grants consistent with this
section; and
(iv) such other elements as considered appropriate by the
Secretary.
(l) Third-party Assessment.--
(1) Study of grant program.--
(A) In general.--Not later than 180 days after the
commencement of the grant program under this section, the
Secretary shall seek to enter into a contract with an
appropriate entity described in paragraph (3) to conduct a
study of the grant program.
(B) Elements of study.--In conducting the study under
subparagraph (A), the appropriate entity shall--
(i) evaluate the effectiveness of the grant program under
this section in--
(I) addressing the factors that contribute to suicides;
(II) increasing the use of suicide prevention services;
(III) reducing mood-related symptoms that increase suicide
and suicide risk; and
(IV) where such information is available due to the time
frame of the grant program, reducing suicidal ideation,
suicide attempts, self-harm, and deaths by suicide; and
(V) reducing suicidal ideation, suicide attempts, self-
harm, and deaths by suicide among eligible individuals
through eligible entities located in communities; and
(ii) compare the results of the grant program with other
national programs in delivering resources to eligible
individuals in the communities where they live that address
the factors that contribute to suicide.
(2) Assessment.--
(A) In general.--The contract under paragraph (1) shall
provide that not later than 24 months after the commencement
of the grant program under this section, the appropriate
entity shall submit to the Secretary an assessment based on
the study conducted pursuant to such contract.
(B) Submittal to congress.--Upon receipt of the assessment
under subparagraph (A), the Secretary shall transmit to the
appropriate committees of Congress a copy of the assessment.
(3) Appropriate entity.--An appropriate entity described in
this paragraph is a nongovernment entity with experience
optimizing and assessing organizations that deliver services
and assessing the effectiveness of suicide prevention
programs.
(m) Referral for Care.--
(1) Mental health assessment.--If an eligible entity in
receipt of a grant under this section determines that an
eligible individual is at-risk of suicide or other mental or
behavioral health condition pursuant to a baseline mental
health screening conducted under subsection (q)(11)(A)(ii)
with respect to the individual, the entity shall refer the
eligible individual to the Department for additional care
under subsection (n) or any other provision of law.
(2) Emergency treatment.--If an eligible entity in receipt
of a grant under this section determines that an eligible
individual furnished clinical services for emergency
treatment under subsection (q)(11)(A)(iv) requires ongoing
services, the entity shall refer the eligible individual to
the Department for additional care under subsection (n) or
any other provision of law.
(3) Refusal.--If an eligible individual refuses a referral
by an entity under paragraph (1) or (2), any ongoing clinical
services provided to the eligible individual by the entity
shall be at the expense of the entity.
(n) Provision of Care to Eligible Individuals.--When the
Secretary determines it is clinically appropriate, the
Secretary shall furnish to eligible individuals who are
receiving or have received suicide prevention services
through grants 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.
(o) Agreements With Community Partners.--
(1) In general.--Subject to paragraph (2), an eligible
entity may use grant funds to enter into an agreement with a
community partner under which the eligible entity may provide
funds to the community partner for the provision of suicide
prevention services to eligible individuals and their
families.
(2) Limitation.--The ability of a recipient of a grant
under this section to provide grant funds to a community
partner shall be limited to grant recipients that are a State
or local government or an Indian tribe.
(p) Authorization of Appropriations.--There is authorized
to be appropriated to the Secretary to carry out this section
a total of $174,000,000 for fiscal years 2021 through 2025.
(q) 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) Department.--The term ``Department'' means the
Department of Veterans Affairs.
(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;
and
(ii) that has a governing board that would be responsible
for the operation of the suicide prevention services provided
under this section;
(B) a corporation wholly owned and controlled by an
organization meeting the requirements of clauses (i) and (ii)
of subparagraph (A);
(C) an Indian tribe;
(D) a community-based organization that can effectively
network with local civic organizations, regional health
systems, and other settings where eligible individuals and
their families are likely to have contact; or
(E) A State or local government.
(4) Eligible individual.--The term ``eligible individual''
includes a person at risk of suicide who is--
(A) a veteran as defined in section 101 of title 38, United
States Code;
(B) an individual described in section 1720I(b) of such
title; or
(C) an individual described in any of clauses (i) through
(iv) of section 1712A(a)(1)(C) of such title.
(5) Emergency treatment.--Medical services, professional
services, ambulance services, ancillary care and medication
(including a short course of medication related to and
necessary for the treatment of the emergency condition that
is provided directly to or prescribed for the patient for use
after the emergency condition is stabilized and the patient
is discharged) was rendered in a medical emergency of such
nature that a prudent layperson would have reasonably
expected that delay in seeking immediate medical attention
would have been hazardous to life or health. This standard is
met by an emergency medical condition manifesting itself by
acute symptoms of sufficient severity (including severe pain)
that a prudent layperson who possesses an average knowledge
of health and medicine could reasonably expect the absence of
immediate medical attention to result in placing the health
of the individual in serious jeopardy, serious impairment to
bodily functions, or serious dysfunction of any bodily organ
or part.
(6) Family.--The term ``family'' means, with respect to an
eligible individual, 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) Indian tribe.--The term ``Indian tribe'' has the
meaning given that term in section 4 of the Native American
Housing Assistance and Self-Determination Act of 1996 (25
U.S.C. 4103).
(8) Risk of suicide.--
(A) In general.--The term ``risk of suicide'' means
exposure to, or the existence of, any of the following (to a
degree determined by the Secretary pursuant to regulations):
(i) 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.
(ii) Environmental risk factors, including the following:
(I) Prolonged stress.
(II) Stressful life events.
(III) Unemployment.
(IV) Homelessness.
(V) Recent loss.
(VI) Legal or financial challenges.
(iii) Historical risk factors, including the following:
(I) Previous suicide attempts.
(II) Family history of suicide.
(III) History of abuse, neglect, or trauma.
(B) Degree of risk.--The Secretary may, by regulation,
establish a process for determining degrees of risk of
suicide for use by grant recipients to focus the delivery of
services using grant funds.
(9) Rural.--The term ``rural'', with respect to a
community, has the meaning given that term in the Rural-Urban
Commuting Areas coding system of the Department of
Agriculture.
(10) Secretary.--The term ``Secretary'' means the Secretary
of Veterans Affairs.
[[Page S4966]]
(11) Suicide prevention services.--
(A) In general.--The term ``suicide prevention services''
means services to address the needs of eligible individuals
and their families and includes the following:
(i) Outreach to identify those 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 screening for risk.
(iii) Education on suicide risk and prevention to families
and communities.
(iv) Provision of clinical services for emergency
treatment.
(v) Case management services.
(vi) Peer support services.
(vii) Assistance in obtaining any benefits from the
Department that the eligible individual and 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) Assistance with emergent needs relating to--
(I) health care services;
(II) daily living services;
(III) personal financial planning and counseling;
(IV) transportation services;
(V) temporary income support services;
(VI) fiduciary and representative payee services;
(VII) legal services to assist the eligible individual with
issues that may contribute to the risk of suicide; and
(VIII) child care (not to exceed $5,000 per family of an
eligible individual per fiscal year).
(x) Nontraditional and innovative approaches and treatment
practices, as determined appropriate by the Secretary, in
consultation with appropriate entities.
(xi) Such other services necessary for improving the mental
health status and wellbeing and reducing the suicide risk of
eligible individuals and their families as the Secretary
considers appropriate, which may include--
(I) adaptive sports, equine assisted therapy, or in-place
or outdoor recreational therapy;
(II) substance use reduction programming;
(III) individual, group, or family counseling; and
(IV) relationship coaching.
(B) Exclusion.--The term ``suicide prevention services''
does not include direct cash assistance to eligible
individuals or their families.
(12) Veterans crisis line.--The term ``Veterans Crisis
Line'' means the toll-free hotline for veterans established
under section 1720F(h) of title 38, United States Code.
(13) Veterans service organization.--The term ``veterans
service organization'' means any organization recognized by
the Secretary for the representation of veterans under
section 5902 of title 38, United States Code.
SEC. 202. ANALYSIS ON FEASIBILITY AND ADVISABILITY OF THE
DEPARTMENT OF VETERANS AFFAIRS PROVIDING
CERTAIN COMPLEMENTARY AND INTEGRATIVE HEALTH
SERVICES.
(a) In General.--Not later than 180 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall complete an analysis 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 analysis
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) submitted under subsection
(e)(2) of such section.
(c) Treatments Described.--Complementary and integrative
health treatments described in this subsection 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 analysis completed under subsection (a), including--
(1) the results of such analysis; 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 PROGRAMS
THROUGH ANIMAL THERAPY, AGRITHERAPY, SPORTS AND
RECREATION THERAPY, ART THERAPY, AND
POSTTRAUMATIC GROWTH PROGRAMS.
(a) In General.--Not later than 180 days after the date on
which 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) submits its final report under subsection
(e)(2) of such section, the Secretary of Veterans Affairs
shall commence the conduct of a pilot program to provide
complementary and integrative health programs 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) Programs Described.--Complementary and integrative
health programs described in this subsection may, taking into
consideration the report described in subsection (a), consist
of the following:
(1) Equine therapy.
(2) Other animal therapy.
(3) Agritherapy.
(4) Sports and recreation therapy.
(5) Art therapy.
(6) Posttraumatic growth programs.
(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) 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 program 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 STUDY OF ALL-CAUSE
MORTALITY OF VETERANS, INCLUDING BY SUICIDE,
AND REVIEW OF STAFFING LEVELS OF MENTAL HEALTH
PROFESSIONALS.
(a) Study of Deaths of Veterans by Suicide.--
(1) In general.--The Secretary of Veterans Affairs shall
seek to enter into an agreement with the National Academies
of Sciences, Engineering, and Medicine under which the
Secretary shall collaborate and coordinate with the National
Academies on a revised study design to fulfill the goals of
the 2019 study design of the National Academies described in
the explanatory statement accompanying the Further
Consolidated Appropriations Act, 2020 (Public Law 116-94), as
part of current and additional research priorities of the
Department of Veterans Affairs, to evaluate the effects of
opioids and
[[Page S4967]]
benzodiazepine on all-cause mortality of veterans, including
suicide, regardless of whether information relating to such
deaths has been reported by the Centers for Disease Control
and Prevention.
(2) Goals.--In carrying out the collaboration and
coordination under paragraph (1), the Secretary shall seek as
much as possible to achieve the same advancement of useful
knowledge as the 2019 study design described in such
paragraph.
(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 Comptroller General of the
United States 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 qualification 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.
(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.--The Secretary of Veterans Affairs
shall ensure that data under subsections (a) and (b) is
compiled separately and disaggregated by year and 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.
(d) Briefings.--The Secretary of Veterans Affairs shall
brief the Committee on Veterans' Affairs of the Senate and
the Committee on Veterans' Affairs of the House of
Representatives containing the interim results--
(1) with respect to the study under subsection (a)(1), not
later than 24 months after entering into the agreement under
such subsection; and
(2) with respect to the review under subsection (b)(1), not
later than 18 months after the date of the enactment of this
Act.
(e) Reports.--
(1) Report on study.--Not later than 90 days after the
completion by the Secretary of Veterans Affairs in
coordination with the National Academies of Sciences,
Engineering, and Medicine of the study required under
subsection (a)(1), the Secretary shall--
(A) 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; and
(B) make such report publicly available.
(2) Report on review.--Not later than 90 days after the
completion by the Comptroller General of the United States of
the review required under subsection (b)(1), the Comptroller
General shall--
(A) 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
(B) make such report publicly available.
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--
(A) all demographic characteristics as determined necessary
and appropriate by the Secretary of Veterans Affairs in
coordination with the Centers for Disease Control and
Prevention;
(B) Veterans Integrated Service Network; and
(C) 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--
(A) all demographic characteristics as determined necessary
and appropriate by the Secretary in coordination with the
Centers for Disease Control and Prevention;
(B) Veterans Integrated Service Network; and
(C) 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--
(A) all demographic characteristics as determined necessary
and appropriate by the Secretary in coordination with the
Centers for Disease Control and Prevention;
(B) Veterans Integrated Service Network; and
(C) to the extent practicable, medical center of the
Department.
(4) A review of staffing levels of suicide prevention
coordinators across the Veterans Health Administration.
(5) A review of the resources and programming offered to
family members and friends of veterans who have a mental
health condition in order to assist that veteran in treatment
and recovery.
(6) An assessment of such other areas as the Comptroller
General considers appropriate to study.
TITLE III--PROGRAMS, STUDIES, AND GUIDELINES ON MENTAL HEALTH
SEC. 301. STUDY ON CONNECTION BETWEEN LIVING AT HIGH ALTITUDE
AND SUICIDE RISK FACTORS AMONG VETERANS.
(a) In General.--Not later than 180 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs,
in consultation with Rural Health Resource Centers of the
Office of Rural Health of the Department of Veterans Affairs,
shall commence the conduct of a study on the connection
between living at high altitude and the risk of developing
depression or dying by suicide among veterans.
(b) Completion of Study.--The study conducted under
subsection (a) shall be completed not later than three years
after the date of the commencement of the study.
(c) Individual Impact.--The study conducted under
subsection (a) shall be conducted so as to determine the
effect of high altitude on suicide risk at the individual
level, not at the State or county level.
(d) Report.--Not later than 150 days after the completion
of the study conducted under subsection (a), the Secretary
shall submit to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives a report on the results of the study.
(e) Follow-up Study.--
(1) In general.--If the Secretary determines through the
study conducted under subsection (a) that living at high
altitude is a risk factor for developing depression or dying
by suicide, the Secretary shall conduct an additional study
to identify the following:
(A) The most likely biological mechanism that makes living
at high altitude a risk factor for developing depression or
dying by suicide.
(B) The most effective treatment or intervention for
reducing the risk of developing depression or dying by
suicide associated with living at high altitude.
(2) Report.--Not later than 150 days after completing the
study conducted under paragraph (1), the Secretary shall
submit to the Committee on Veterans' Affairs of the Senate
and the Committee on Veterans' Affairs of the House of
Representatives a report on the results of the study.
SEC. 302. ESTABLISHMENT BY DEPARTMENT OF VETERANS AFFAIRS AND
DEPARTMENT OF DEFENSE OF A CLINICAL PROVIDER
TREATMENT TOOLKIT AND ACCOMPANYING TRAINING
MATERIALS FOR COMORBIDITIES.
(a) In General.--Not later than two years after the date of
the enactment of this Act, the Secretary of Veterans Affairs,
in consultation with the Secretary of Defense, shall develop
a clinical provider treatment toolkit and accompanying
training materials for the evidence-based management of
comorbid mental health conditions, comorbid mental health and
substance use disorders, and a comorbid mental health
condition and chronic pain.
[[Page S4968]]
(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 gender-specific--
(A) risk factors for suicide and suicidal ideation;
(B) treatment efficacy for depression and suicide
prevention;
(C) pharmacotherapy efficacy; and
(D) 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) Methods.--The initiative under subsection (a) shall
include brain structure and function measurements, such as
functional magnetic resonance imaging and
electroencephalogram, and shall coordinate with additional
biological methods of analysis utilized in the Million
Veterans Program of the Department of Veterans Affairs.
(d) 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, consistent with section 552a
of title 5, United States Code (commonly known as the
``Privacy Act of 1974''), and regulations promulgated
pursuant to the Health Insurance Portability and
Accountability Act of 1996 (parts 160, 162, and 164 of title
45, Code of Federal Regulations, or successor regulations) to
ensure that information of veterans participating in the
initiative is kept private and secure.
(2) Consultation with the national institutes of science
and technology.--The Secretary may consult with the National
Institute of Science and Technology in developing the data
privacy and security measures described in paragraph (1).
(3) Access standards.--The Secretary shall provide access
to information under the initiative consistent with the
standards described in section 552a(d)(1) of title 5, United
States Code, and section 164.524 of title 45, Code of Federal
Regulations, or successor regulations.
(4) Open platform.--
(A) Availability of data.--The Secretary shall make de-
identified data collected under the initiative available for
research purposes to Federal agencies.
(B) Contract.--The Secretary shall contract with
nongovernment entities that comply with requisite data
security measures to make available for research purposes de-
identified data collected under the initiative.
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(C) Assistance.--The Secretary shall provide assistance to
a Federal agency conducting research using data collected
under the initiative at the request of that agency.
(D) Prohibition on transfer of data.--Federal agencies may
not disclose, transmit, share, sell, license, or otherwise
transfer data collected under the initiative to any
nongovernment entity other than as allowed under subparagraph
(B).
(5) 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.--In consultation with the
National Institute for Science and Technology, data collected
under the initiative shall be standardized in the manner in
which it is collected, entered into the database, extracted,
and recorded.
(6) 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.
(7) De-identified data defined.--In this subsection, the
term ``de-identified data'' means, with respect to data held
by the Department of Veterans Affairs, that the Department--
(A) alters, anonymizes, or aggregates the data so that
there is a reasonable basis for expecting that the data could
not be linked as a practical matter to a specific individual;
(B) publicly commits to refrain from attempting to re-
identify the data with a specific individual, and adopts
controls to prevent such identification; and
(C) causes the data to be covered by a contractual or other
legally enforceable prohibition on each entity to which the
Department discloses the data from attempting to use the data
to identify a specific individual and requires the same of
all onward disclosures.
(e) Inclusion of Initiative in Program.--The Secretary
shall coordinate 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 with expertise in conducting and evaluating research-
based studies 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;
(G) individuals transitioning from active duty in the Armed
Forces to civilian life; and
(H) other high-risk groups of veterans, as determined by
the Secretary.
(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 materials and campaigns 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 materials and campaigns of the Department to target
specific groups of veterans.
(C) A plan to change the current suicide prevention and
mental health materials and campaigns of the Department or,
if the Secretary decides not to change the current materials
and campaigns, an explanation of the reason for maintaining
the current materials and campaigns.
(D) A description of any dissenting or opposing viewpoints
raised by participants in the focus group.
(E) 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 materials and 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 materials and campaigns 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;
(vii) individuals transitioning from active duty in the
Armed Forces to civilian life; and
(viii) other high-risk groups of veterans, as determined by
the Secretary.
(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) Paperwork Reduction Act Exemption.--Chapter 35 of title
44, United States Code (commonly known as the ``Paperwork
Reduction Act'') shall not apply to any rulemaking or
information collection required under this section.
[[Page S4970]]
(g) Rural and Highly Rural Defined.--In this section, with
respect to an area, the terms ``rural'' and ``highly rural''
have the meanings given those terms in the Rural-Urban
Commuting Areas coding system of the Department of
Agriculture.
SEC. 402. OVERSIGHT OF MENTAL HEALTH AND SUICIDE PREVENTION
MEDIA OUTREACH CONDUCTED BY DEPARTMENT OF
VETERANS AFFAIRS.
(a) Establishment of Goals.--
(1) In general.--The Secretary of Veterans Affairs shall
establish goals for the mental health and suicide prevention
media outreach campaigns of the Department of Veterans
Affairs, which shall include the establishment of targets,
metrics, and action plans to describe and assess those
campaigns.
(2) Use of metrics.--
(A) In general.--The goals established under paragraph (1)
shall be measured by metrics specific to different media
types.
(B) Factors to consider.--In using metrics under
subparagraph (A), the Secretary shall determine the best
methodological approach for each media type and shall
consider the following:
(i) Metrics relating to social media, which may include the
following:
(I) Impressions.
(II) Reach.
(III) Engagement rate.
(IV) Such other metrics as the Secretary considers
necessary.
(ii) Metrics relating to television, which may include the
following:
(I) Nielsen ratings.
(II) Such other metrics as the Secretary considers
necessary.
(iii) Metrics relating to email, which may include the
following:
(I) Open rate.
(II) Response rate.
(III) Click rate.
(IV) Such other metrics as the Secretary considers
necessary.
(C) Update.--The Secretary shall periodically update the
metrics under subparagraph (B) as more accurate metrics
become available.
(3) Targets.--The Secretary shall establish targets to
track the metrics used under paragraph (2).
(4) Consultation.--In establishing goals under paragraph
(1), the Secretary shall consult with the following:
(A) Relevant stakeholders, such as organizations that
represent veterans, as determined by the Secretary.
(B) Mental health and suicide prevention experts.
(C) Such other persons as the Secretary considers
appropriate.
(5) Initial report.--Not later than 180 days after the date
of the enactment of this Act, the Secretary shall submit to
the Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of
Representatives a report detailing the goals established
under paragraph (1) for the mental health and suicide
prevention media outreach campaigns of the Department,
including the metrics and targets for such metrics by which
those goals are to be measured under paragraphs (2) and (3).
(6) Annual report.--Not later than one year after the
submittal of the report under paragraph (5), and annually
thereafter, the Secretary shall submit to the Committee on
Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives a report
detailing--
(A) the progress of the Department in meeting the goals
established under paragraph (1) and the targets established
under paragraph (3); and
(B) a description of action to be taken by the Department
to modify mental health and suicide prevention media outreach
campaigns if those goals and targets are not being met.
(b) Report on Use of Funds by Office of Mental Health and
Suicide Prevention.--Not later than 180 days after the date
of the enactment of this Act, and semiannually thereafter,
the Secretary shall submit to the Committee on Appropriations
and the Committee on Veterans' Affairs of the Senate and the
Committee on Appropriations and the Committee on Veterans'
Affairs of the House of Representatives a report containing
the expenditures and obligations of the Office of Mental
Health and Suicide Prevention of the Veterans Health
Administration during the period covered by the report.
SEC. 403. COMPTROLLER GENERAL MANAGEMENT REVIEW OF MENTAL
HEALTH AND SUICIDE PREVENTION SERVICES OF
DEPARTMENT OF VETERANS AFFAIRS.
(a) In General.--Not later than three years after the date
of the enactment of this Act, the Comptroller General of the
United States shall submit to the Committee on Veterans'
Affairs of the Senate and the Committee on Veterans' Affairs
of the House of Representatives a management review of the
mental health and suicide prevention services provided by the
Department of Veterans Affairs.
(b) Elements.--The management review required by subsection
(a) shall include the following:
(1) An assessment of the infrastructure under the control
of or available to the Office of Mental Health and Suicide
Prevention of the Department of Veterans Affairs or available
to the Department of Veterans Affairs for suicide prevention
efforts not operated by the Office of Mental Health and
Suicide Prevention.
(2) A description of the management and organizational
structure of the Office of Mental Health and Suicide
Prevention, including roles and responsibilities for each
position.
(3) A description of the operational policies and processes
of the Office of Mental Health and Suicide Prevention.
(4) An assessment of suicide prevention practices and
initiatives available from the Department and through
community partnerships.
(5) An assessment of the staffing levels at the Office of
Mental Health and Suicide Prevention, disaggregated by type
of position, and including the location of any staffing
deficiencies.
(6) An assessment of the Nurse Advice Line pilot program
conducted by the Department.
(7) An assessment of recruitment initiatives in rural areas
for mental health professionals of the Department.
(8) An assessment of strategic planning conducted by the
Office of Mental Health and Suicide Prevention.
(9) An assessment of the communication, and the
effectiveness of such communication--
(A) within the central office of the Office of Mental
Health and Suicide Prevention;
(B) between that central office and any staff member or
office in the field, including chaplains, attorneys, law
enforcement personnel, and volunteers; and
(C) between that central office, local facilities of the
Department, and community partners of the Department,
including first responders, community support groups, and
health care industry partners.
(10) An assessment of how effectively the Office of Mental
Health and Suicide Prevention implements operational policies
and procedures.
(11) An assessment of how the Department of Veterans
Affairs and the Department of Defense coordinate suicide
prevention efforts, and recommendations on how the Department
of Veterans Affairs and Department of Defense can more
effectively coordinate those efforts.
(12) An assessment of such other areas as the Comptroller
General considers appropriate to study.
SEC. 404. COMPTROLLER GENERAL REPORT ON EFFORTS OF DEPARTMENT
OF VETERANS AFFAIRS TO INTEGRATE MENTAL HEALTH
CARE INTO PRIMARY CARE CLINICS.
(a) Initial Report.--
(1) In general.--Not later than two years after the date of
the enactment of this Act, the Comptroller General of the
United States shall submit to the Committee on Veterans'
Affairs of the Senate and the Committee on Veterans' Affairs
of the House of Representatives a report on the efforts of
the Department of Veterans Affairs to integrate mental health
care into primary care clinics of the Department.
(2) Elements.--The report required by subsection (a) shall
include the following:
(A) An assessment of the efforts of the Department to
integrate mental health care into primary care clinics of the
Department.
(B) An assessment of the effectiveness of such efforts.
(C) An assessment of how the health care of veterans is
impacted by such integration.
(D) A description of how care is coordinated by the
Department between specialty mental health care and primary
care, including a description of the following:
(i) How documents and patient information are transferred
and the effectiveness of those transfers.
(ii) How care is coordinated when veterans must travel to
different facilities of the Department.
(iii) How a veteran is reintegrated into primary care after
receiving in-patient mental health care.
(E) An assessment of how the integration of mental health
care into primary care clinics is implemented at different
types of facilities of the Department.
(F) Such recommendations on how the Department can better
integrate mental health care into primary care clinics as the
Comptroller General considers appropriate.
(G) An assessment of such other areas as the Comptroller
General considers appropriate to study.
(b) Community Care Integration Report.--
(1) In general.--Not later than two years after the date on
which the Comptroller General submits the report required
under subsection (a)(1), the Comptroller General shall submit
to the Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of
Representatives a report on the efforts of the Department to
integrate community-based mental health care into the
Veterans Health Administration.
(2) Elements.--The report required by paragraph (1) shall
include the following:
(A) An assessment of the efforts of the Department to
integrate community-based mental health care into the
Veterans Health Administration.
(B) An assessment of the effectiveness of such efforts.
(C) An assessment of how the health care of veterans is
impacted by such integration.
(D) A description of how care is coordinated between
providers of community-based mental health care and the
Veterans Health Administration, including a description of
how documents and patient information are
[[Page S4971]]
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 one year after the date of
the enactment of this Act, and annually thereafter, the
Secretary of Veterans Affairs and the Secretary of Defense
shall submit to the Committee on Veterans' Affairs and the
Committee on Armed Services of the Senate and the Committee
on Veterans' Affairs and the Committee on Armed Services of
the House of Representatives a report on mental health
programs of the Department of Veterans Affairs and the
Department of Defense and joint programs of the Departments.
(2) Elements.--The report required by paragraph (1) shall
include the following:
(A) A description of mental health programs operated by the
Department of Veterans Affairs, including the following:
(i) Transition assistance programs.
(ii) Clinical and non-clinical mental health initiatives,
including centers of excellence of the Department of Veterans
Affairs for traumatic brain injury and post-traumatic stress
disorder.
(iii) Programs that may secondarily improve mental health,
including employment, housing assistance, and financial
literacy programs.
(iv) Research into mental health issues and conditions, to
include post-traumatic stress disorder, depression, anxiety,
bipolar disorder, traumatic brain injury, suicidal ideation,
and any other issues or conditions as the Secretary of
Veterans Affairs considers necessary.
(B) A description of mental health programs operated by the
Department of Defense, including the following:
(i) Transition assistance programs.
(ii) Clinical and non-clinical mental health initiatives,
including the National Intrepid Center of Excellence and the
Intrepid Spirit Centers.
(iii) Programs that may secondarily improve mental health,
including employment, housing assistance, and financial
literacy programs.
(iv) Research into mental health issues and conditions, to
include post-traumatic stress disorder, depression, anxiety,
bipolar disorder, traumatic brain injury, suicidal ideation,
and any other issues or conditions as the Secretary of
Defense considers necessary.
(C) A description of mental health programs jointly
operated by the Department of Veterans Affairs and the
Department of Defense, including the following:
(i) Transition assistance programs.
(ii) Clinical and non-clinical mental health initiatives.
(iii) Programs that may secondarily improve mental health,
including employment, housing assistance, and financial
literacy programs.
(iv) Research into mental health issues and conditions, to
include post-traumatic stress disorder, depression, anxiety,
bipolar disorder, traumatic brain injury, suicidal ideation,
and completed suicides, including through the use of the
joint suicide data repository of the Department of Veterans
Affairs and the Department of Defense, and any other issues
or conditions as the Secretary of Veterans Affairs and the
Secretary of Defense consider necessary.
(D) Recommendations for coordinating mental health programs
of the Department of Veterans Affairs and the Department of
Defense to improve the effectiveness of those programs.
(E) Recommendations for novel joint programming of the
Department of Veterans Affairs and the Department of Defense
to improve the mental health of members of the Armed Forces
and veterans.
(b) Evaluation of Collaborative Efforts of Department of
Veterans Affairs and Department of Defense and Alternatives
of Analysis to Establish a Joint VA/DOD Intrepid Spirit
Center.--
(1) In general.--The Secretary of Veterans Affairs, in
coordination with the Secretary of Defense, shall evaluate
the current ongoing collaborative efforts of the Department
of Veterans Affairs and the Department of Defense related to
post-traumatic stress disorder and traumatic brain injury
care, research, and education to improve the quality of and
access to such care and seek potential new collaborative
efforts to improve and expand such care for veterans and
members of the Armed Forces in a joint Department of Veterans
Affairs/Department of Defense Intrepid Spirit Center that
serves active duty members of the Armed Forces, members of
the reserve components of the Armed Forces, and veterans for
mutual benefit and growth in treatment and care.
(2) Alternatives of analysis.--
(A) In general.--The evaluation required under paragraph
(1) shall include an alternatives of analysis to establish
the joint Department of Veterans Affairs/Department of
Defense Intrepid Spirit Center described in paragraph (1).
(B) Elements.--The alternatives of analysis required under
subparagraph (A) with respect to the establishment of the
joint Department of Veterans Affairs/Department of Defense
Intrepid Spirit Center described in paragraph (1) shall
provide alternatives and recommendations that consider
information including--
(i) colocation of the center on an installation of the
Department of Defense or property of a medical center of the
Department of Veterans Affairs;
(ii) consideration of a rural or highly rural area to
establish the center that may include colocation described in
clause (i);
(iii) geographic distance from existing or planned Intrepid
Spirit Centers of the Department of Defense or other such
facilities of the Department of Veterans Affairs or the
Department of Defense that furnish care for post-traumatic
stress disorder or traumatic brain injury; and
(iv) the potential role for private entities and
philanthropic organizations in carrying out the activities of
the center.
(3) Report to congress.--Not later than 270 days after the
date of the enactment of this Act, the Secretary of Veterans
Affairs shall submit to the Committee on Veterans' Affairs of
the Senate and the Committee on Veterans' Affairs of the
House of Representatives a report that includes--
(A) a summary of the evaluation required under paragraph
(1); and
(B) the alternatives of analysis required under paragraph
(2).
(4) Rural and highly rural defined.--In this subsection,
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. 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:
[[Page S4972]]
``SUBCHAPTER IX--READJUSTMENT COUNSELING SERVICE SCHOLARSHIP PROGRAM
``Sec. 7698. Requirement for program
``As part of the Educational Assistance Program, the
Secretary shall carry out a scholarship program under this
subchapter. The program shall be known as the Department of
Veterans Affairs Readjustment Counseling Service Scholarship
Program (in this subchapter referred to as the `Program').
``Sec. 7699. Eligibility; agreement
``(a) In General.--An individual is eligible to participate
in the Program, as determined by the Readjustment Counseling
Service of the Department, if the individual--
``(1) is accepted for enrollment or enrolled (as described
in section 7602 of this title) in a program of study at an
accredited educational institution, school, or training
program leading to a terminal degree in psychology, social
work, marriage and family therapy, or mental health
counseling that would meet the education requirements for
appointment to a position under section 7402(b) of this
title; and
``(2) enters into an agreement with the Secretary under
subsection (c).
``(b) Priority.--In selecting individuals to participate in
the Program, the Secretary shall give priority to the
following individuals:
``(1) An individual who agrees to be employed by a Vet
Center located in a community that is--
``(A) designated as a medically underserved population
under section 330(b)(3) of the Public Health Service Act (42
U.S.C. 254b(b)(3)); and
``(B) in a State with a per capita population of veterans
of more than five percent according to the National Center
for Veterans Analysis and Statistics and the Bureau of the
Census.
``(2) An individual who is a veteran.
``(c) Agreement.--An agreement between the Secretary and a
participant in the Program shall (in addition to the
requirements set forth in section 7604 of this title) include
the following:
``(1) An agreement by the Secretary to provide the
participant with a scholarship under the Program for a
specified number of school years during which the participant
pursues a program of study described in subsection (a)(1)
that meets the requirements set forth in section 7602(a) of
this title.
``(2) An agreement by the participant to serve as a full-
time employee of the Department at a Vet Center for a six-
year period following the completion by the participant of
such program of study (in this subchapter referred to as the
`period of obligated service').
``(d) Vet Center Defined.--In this section, the term `Vet
Center' has the meaning given that term in section 1712A(h)
of this title.
``Sec. 7699A. Obligated service
``(a) In General.--Each participant in the Program shall
provide service as a full-time employee of the Department at
a Vet Center (as defined in section 7699(d) of this title)
for the period of obligated service set forth in the
agreement of the participant entered into under section 7604
of this title.
``(b) Determination of Service Commencement Date.--(1) Not
later than 60 days before the service commencement date of a
participant, the Secretary shall notify the participant of
that service commencement date.
``(2) The date specified in paragraph (1) with respect to a
participant is the date for the beginning of the period of
obligated service of the participant.
``Sec. 7699B. Breach of agreement: liability
``(a) Liquidated Damages.--(1) A participant in the Program
(other than a participant described in subsection (b)) who
fails to accept payment, or instructs the educational
institution in which the participant is enrolled not to
accept payment, in whole or in part, of a scholarship under
the agreement entered into under section 7604 of this title
shall be liable to the United States for liquidated damages
in the amount of $1,500.
``(2) Liability under paragraph (1) is in addition to any
period of obligated service or other obligation or liability
under such agreement.
``(b) Liability During Program of Study.--(1) Except as
provided in subsection (d), a participant in the Program
shall be liable to the United States for the amount which has
been paid to or on behalf of the participant under the
agreement if any of the following occurs:
``(A) The participant fails to maintain an acceptable level
of academic standing in the educational institution in which
the participant is enrolled (as determined by the educational
institution under regulations prescribed by the Secretary).
``(B) The participant is dismissed from such educational
institution for disciplinary reasons.
``(C) The participant voluntarily terminates the program of
study in such educational institution before the completion
of such program of study.
``(2) Liability under this subsection is in lieu of any
service obligation arising under the agreement.
``(c) Liability During Period of Obligated Service.--(1)
Except as provided in subsection (d), if a participant in the
Program does not complete the period of obligated service of
the participant, the United States shall be entitled to
recover from the participant an amount determined in
accordance with the following formula: A = 3F(t-s/t).
``(2) In the formula in paragraph (1):
``(A) `A' is the amount the United States is entitled to
recover.
``(B) `F' is the sum of--
``(i) the amounts paid under this subchapter to or on
behalf of the participant; and
``(ii) the interest on such amounts which would be payable
if at the time the amounts were paid they were loans bearing
interest at the maximum legal prevailing rate, as determined
by the Treasurer of the United States.
``(C) `t' is the total number of months in the period of
obligated service of the participant.
``(D) `s' is the number of months of such period served by
the participant.
``(d) Limitation on Liability for Reductions-in-force.--
Liability shall not arise under subsection (c) if the
participant fails to maintain employment as a Department
employee due to a staffing adjustment.
``(e) Period for Payment of Damages.--Any amount of damages
that the United States is entitled to recover under this
section shall be paid to the United States within the one-
year period beginning on the date of the breach of the
agreement.''.
(b) Conforming and Technical Amendments.--
(1) Conforming amendments.--
(A) Establishment of program.--Section 7601(a) of such
title is amended--
(i) in paragraph (5), by striking ``and'';
(ii) in paragraph (6), by striking the period and inserting
``; and''; and
(iii) by adding at the end the following new paragraph:
``(7) the readjustment counseling service scholarship
program provided for in subchapter IX of this chapter.''.
(B) Eligibility.--Section 7602 of such title is amended--
(i) in subsection (a)(1)--
(I) by striking ``or VI'' and inserting ``VI, or IX''; and
(II) by striking ``subchapter VI'' and inserting
``subchapter VI or IX''; and
(ii) in subsection (b), by striking ``or VI'' and inserting
``VI, or IX''.
(C) Application.--Section 7603(a)(1) of such title is
amended by striking ``or VIII'' and inserting ``VIII, or
IX''.
(D) Terms of agreement.--Section 7604 of such title is
amended by striking ``or VIII'' each place it appears and
inserting ``VIII, or IX''.
(E) Annual report.--Section 7632 of such title is amended--
(i) in paragraph (1), by striking ``and the Specialty
Education Loan Repayment Program'' and inserting ``the
Specialty Education Loan Repayment Program, and the
Readjustment Counseling Service Scholarship Program''; and
(ii) in paragraph (4), by striking ``and per participant in
the Specialty Education Loan Repayment Program'' and
inserting ``per participant in the Specialty Education Loan
Repayment Program, and per participant in the Readjustment
Counseling Service Scholarship Program''.
(2) Table of sections.--The table of sections at the
beginning of chapter 76 of such title is amended by inserting
after the items relating to subchapter VIII the following:
``subchapter ix--readjustment counseling service scholarship program
``Sec.
``7698. Requirement for program.
``7699. Eligibility; agreement.
``7699A. Obligated service.
``7699B. Breach of agreement: liability.''.
(c) Effective Date.--The Secretary of Veterans Affairs
shall begin awarding scholarships under subchapter IX of
chapter 76 of title 38, United States Code, as added by
subsection (a), for programs of study beginning not later
than one year after the date of the enactment of this Act.
SEC. 503. 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--
[[Page S4973]]
(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. 504. 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. 505. BRIEFING ON ALTERNATIVE WORK SCHEDULES FOR
EMPLOYEES OF VETERANS HEALTH ADMINISTRATION.
(a) Survey 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 survey 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 survey under paragraph (1).
(b) Congressional Briefing.--
(1) In general.--Not later than 270 days after the date of
the enactment of this Act, the Secretary shall brief the
Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of
Representatives on the--
(A) feasibility and advisability of offering appointments
outside the usual operating hours of facilities of the
Department that do not offer such appointments; and
(B) effectiveness of offering appointments outside the
usual operating hours of facilities of the Department for
those facilities that offer such appointments.
(2) Elements.--The briefing required by paragraph (1) shall
include the following:
(A) The findings of the survey conducted under subsection
(a);
(B) Feedback from 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; and
(C) Any other matters the Secretary considers relevant to a
full understanding of the feasibility and advisability of
offering appointments outside the usual operating hours of
facilities of the Department.
(c) Paperwork Reduction Act Exemption.--Chapter 35 of title
44, United States Code (commonly known as the ``Paperwork
Reduction Act'') shall not apply to any rulemaking or
information collection required under this section.
SEC. 506. SUICIDE PREVENTION COORDINATORS.
(a) Staffing Requirement.--Beginning not later than one
year after the date of the enactment of this Act, the
Secretary of Veterans Affairs shall ensure that each medical
center of the Department of Veterans Affairs has not less
than one suicide prevention coordinator.
(b) Study on Reorganization.--
(1) In general.--Not later than one year after the date of
the enactment of this Act, the Secretary, in consultation
with the Office of Mental Health and Suicide Prevention of
the Department, shall commence the conduct of a study to
determine the feasibility and advisability of--
(A) the realignment and reorganization of suicide
prevention coordinators within the Office of Mental Health
and Suicide Prevention; and
(B) the creation of a suicide prevention coordinator
program office.
(2) Program office realignment.--In conducting the study
under paragraph (1), the Secretary shall assess the
feasibility of advisability of, within the suicide prevention
coordinator program office described in paragraph (1)(B),
aligning suicide prevention coordinators and suicide
prevention case managers within the organizational structure
and chart of the Suicide Prevention Program of the
Department, with the Director of the Suicide Prevention
program having ultimate supervisory oversight and
responsibility over the suicide prevention coordinator
program office.
(c) Report.--Not later than 90 days after the completion of
the study under subsection (b), the Secretary shall submit to
the Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of
Representatives a report on such study, including the
following:
(1) An assessment of the feasibility and advisability of
creating a suicide prevention coordinator program office to
oversee and monitor suicide prevention coordinators and
suicide prevention case managers across all medical centers
of the Department.
(2) A review of current staffing ratios for suicide
prevention coordinators and suicide prevention case managers
in comparison with current staffing ratios for mental health
providers within each medical center of the Department.
(3) A description of the duties and responsibilities for
suicide prevention coordinators across the Department to
better define, delineate, and standardize qualifications,
performance goals, performance duties, and performance
outcomes for suicide prevention coordinators and suicide
prevention case managers.
SEC. 507. 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--
[[Page S4974]]
(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. REQUIREMENT FOR DEPARTMENT OF VETERANS AFFAIRS
INTERNET WEBSITE TO PROVIDE INFORMATION ON
SERVICES AVAILABLE TO WOMEN VETERANS.
(a) In General.--The Secretary of Veterans Affairs shall
survey the internet websites and information resources of the
Department of Veterans Affairs in effect on the day before
the date of the enactment of this Act and publish an internet
website that serves as a centralized source for the provision
to women veterans of information about the benefits and
services available to them under laws administered by the
Secretary.
(b) Elements.--The internet website published under
subsection (a) shall provide to women veterans information
regarding all services available in the district in which the
veteran is seeking such services, including, with respect to
each medical center and community-based outpatient clinic in
the applicable Veterans Integrated Service Network--
(1) the name and contact information of each women's health
coordinator;
(2) a list of appropriate staff for other benefits
available from the Veterans Benefits Administration, the
National Cemetery Administration, and such other entities as
the Secretary considers appropriate; and
(3) such other information as the Secretary considers
appropriate.
(c) Updated Information.--The Secretary shall ensure that
the information described in subsection (b) that is published
on the internet website required by subsection (a) is updated
not less frequently than once every 90 days.
(d) Outreach.--In carrying out this section, the Secretary
shall ensure that the outreach conducted under section
1720F(i) of title 38, United States Code, includes
information regarding the internet website required by
subsection (a).
(e) Derivation of Funds.--Amounts used by the Secretary to
carry out this section shall be derived from amounts made
available to the Secretary to publish internet websites of
the Department.
TITLE VII--OTHER MATTERS
SEC. 701. EXPANDED TELEHEALTH FROM DEPARTMENT OF VETERANS
AFFAIRS.
(a) In General.--The Secretary of Veterans Affairs shall
enter into agreements, and expand existing agreements, 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 agreements 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) or areas determined
to be medically underserved.
(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, replacing 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 of Veterans Affairs.
(iii) Training of site attendants, including payment of
those attendants 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;
(III) privacy, including the Health Insurance Portability
and Accountability Act of 1996 privacy rule under part 160
and subparts A and E of part 164 of title 45, Code of Federal
Regulations, or successor regulations, as it relates to
health care for veterans;
(IV) scheduling for telehealth services for veterans; or
(V) 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, including permits or inspections required
in association with space modifications;
(II) soundproofing of an existing room;
(III) new electrical, telephone, 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.
(vii) Sustainment of telephone 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
[[Page S4975]]
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, clean, 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 to access by veterans to
telehealth while not on property of the Department as the
Secretary considers relevant.
(3) Report.--Not later than 120 days after the completion
of the assessment required by paragraph (1), the Secretary
shall submit to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives a report on the assessment, including any
recommendations for legislative or administrative action
based on the results of the assessment.
SEC. 702. PARTNERSHIPS WITH NON-FEDERAL GOVERNMENT ENTITIES
TO PROVIDE HYPERBARIC OXYGEN THERAPY TO
VETERANS AND STUDIES ON THE USE OF SUCH THERAPY
FOR TREATMENT OF POST-TRAUMATIC STRESS DISORDER
AND TRAUMATIC BRAIN INJURY.
(a) Partnerships to Provide Hyperbaric Oxygen Therapy to
Veterans.--
(1) Use of partnerships.--The Secretary of Veterans
Affairs, in consultation with the Center for Compassionate
Innovation within the Office of Community Engagement of the
Department of Veterans Affairs, may enter into partnerships
with non-Federal Government entities to provide hyperbaric
oxygen treatment to veterans to research the effectiveness of
such therapy.
(2) Types of partnerships.--Partnerships entered into under
paragraph (1) may include the following:
(A) Partnerships to conduct research on hyperbaric oxygen
therapy.
(B) Partnerships to review research on hyperbaric oxygen
therapy provided to nonveterans.
(C) Partnerships to create industry working groups to
determine standards for research on hyperbaric oxygen
therapy.
(D) Partnerships to provide to veterans hyperbaric oxygen
therapy for the purposes of conducting research on the
effectiveness of such therapy.
(3) Limitation on federal funding.--Federal Government
funding may be used to coordinate and administer the
partnerships under this subsection but may not be used to
carry out activities conducted under such partnerships.
(b) Review of Effectiveness of Hyperbaric Oxygen Therapy.--
Not later than 90 days after the date of the enactment of
this Act, the Secretary, in consultation with the Center for
Compassionate Innovation, shall begin using an objective and
quantifiable method to review the effectiveness and
applicability of hyperbaric oxygen therapy, such as through
the use of a device approved or cleared by the Food and Drug
Administration that assesses traumatic brain injury by
tracking eye movement.
(c) Systematic Review of Use of Hyperbaric Oxygen Therapy
to Treat Certain Conditions.--
(1) In general.--Not later than 90 days after the date of
the enactment of this Act, the Secretary, in consultation
with the Center for Compassionate Innovation, shall commence
the conduct of a systematic review of published research
literature on off-label use of hyperbaric oxygen therapy to
treat post-traumatic stress disorder and traumatic brain
injury among veterans and nonveterans.
(2) Elements.--The review conducted under paragraph (1)
shall include the following:
(A) An assessment of the current parameters for research on
the use by the Department of Veterans Affairs of hyperbaric
oxygen therapy, including--
(i) tests and questionnaires used to determine the efficacy
of such therapy; and
(ii) metrics for determining the success of such therapy.
(B) A comparative analysis of tests and questionnaires used
to study post-traumatic stress disorder and traumatic brain
injury in other research conducted by the Department of
Veterans Affairs, other Federal agencies, and entities
outside the Federal Government.
(3) Completion of review.--The review conducted under
paragraph (1) shall be completed not later than 180 days
after the date of the commencement of the review.
(4) Report.--Not later than 90 days after the completion of
the review conducted under paragraph (1), the Secretary shall
submit to the Committee on Veterans' Affairs of the Senate
and the Committee on Veterans' Affairs of the House of
Representatives a report on the results of the review.
(d) Follow-up Study.--
(1) In general.--Not later than 120 days after the
completion of the review conducted under subsection (c), the
Secretary, in consultation with the Center for Compassionate
Innovation, shall commence the conduct of a study on all
individuals receiving hyperbaric oxygen therapy through the
current pilot program of the Department for the provision of
hyperbaric oxygen therapy to veterans to determine the
efficacy and effectiveness of hyperbaric oxygen therapy for
the treatment of post-traumatic stress disorder and traumatic
brain injury.
(2) Elements.--The study conducted under paragraph (1)
shall include the review and publication of any data and
conclusions resulting from research conducted by an
authorized provider of hyperbaric oxygen therapy for veterans
through the pilot program described in such paragraph.
(3) Completion of study.--The study conducted under
paragraph (1) shall be completed not later than three years
after the date of the commencement of the study.
(4) Report.--
(A) In general.--Not later than 90 days after completing
the study conducted under paragraph (1), the Secretary shall
submit to the Committee on Veterans' Affairs of the Senate
and the Committee on Veterans' Affairs of the House of
Representatives a report on the results of the study.
(B) Elements.--The report required under subparagraph (A)
shall include the recommendation of the Secretary with
respect to whether or not hyperbaric oxygen therapy should be
made available to all veterans with traumatic brain injury or
post-traumatic stress disorder.
SEC. 703. PRESCRIPTION OF TECHNICAL QUALIFICATIONS FOR
LICENSED HEARING AID SPECIALISTS AND
REQUIREMENT FOR APPOINTMENT OF SUCH
SPECIALISTS.
(a) Technical Qualifications.--
(1) 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(b)(14) of title 38, United States Code, to be
appointed as a licensed hearing aid specialist under section
7401(3) of such title.
(2) Elements for qualifications.--In prescribing the
qualifications for licensed hearing aid specialists under
paragraph (1), the Secretary shall, at a minimum, ensure that
such qualifications are consistent with--
(A) the standards for licensure of hearing aid specialists
that are required by a majority of States;
(B) any competencies needed to perform tasks and services
commonly performed by hearing aid specialists pursuant to
such standards; and
(C) any competencies needed to perform tasks specific to
providing care to individuals under the laws administered by
the Secretary.
(b) Authority to Set and Maintain Duties.--The Secretary
shall retain the authority to set and maintain the duties for
licensed hearing aid specialists appointed under section
7401(3) of title 38, United States Code, for the purposes of
the employment of such specialists with the Department of
Veterans Affairs.
(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;
(4) assessing access of patients to comprehensive hearing
health care services from the Department consistent with the
requirements under section 4(b) of the Veterans Mobility
Safety Act of 2016 (Public Law 114-256; 38 U.S.C. 7401 note),
including an assessment of the impact of infrastructure and
equipment limitations on wait times for audiologic care; and
(5) indicating the medical centers of the Department with
vacancies for audiologists or 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
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(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).
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