[Congressional Record Volume 166, Number 165 (Wednesday, September 23, 2020)]
[House]
[Pages H4734-H4752]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




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

  Mr. TAKANO. Madam Speaker, I move to suspend the rules and pass the 
bill (S. 785) to improve mental health care provided by the Department 
of Veterans Affairs, and for other purposes.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                                 S. 785

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

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``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.

[[Page H4735]]

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.
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,

[[Page H4736]]

     were not included even though they show a similar rate of 
     risk for suicide as other conditions that were included.
       (4) An assessment of the feasibility of incorporating 
     certain economic data held by the Veterans Benefits 
     Administration into the model used by the REACH VET program, 
     including financial data and employment status, which 
     research indicates may have an impact on risk for suicide.
       (c) REACH VET Program Defined.--In this section, the term 
     ``REACH VET program'' means the Recovery Engagement and 
     Coordination for Health--Veterans Enhanced Treatment program 
     of the Department of Veterans Affairs.

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

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

                      TITLE II--SUICIDE PREVENTION

     SEC. 201. FINANCIAL ASSISTANCE TO CERTAIN ENTITIES TO PROVIDE 
                   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;

[[Page H4737]]

       (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.
       (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.

[[Page H4738]]

       (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 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:

[[Page H4739]]

       (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.
       (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.

[[Page H4740]]

       (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 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.

[[Page H4741]]

       (B) The most effective treatment or intervention for 
     reducing the risk of developing depression or dying by 
     suicide associated with living at high altitude.
       (2) Report.--Not later than 150 days after completing the 
     study conducted under paragraph (1), the Secretary shall 
     submit to the Committee on Veterans' Affairs of the Senate 
     and the Committee on Veterans' Affairs of the House of 
     Representatives a report on the results of the study.

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

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

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

       (a) In General.--In the first publication of the Department 
     of Veterans Affairs and Department of Defense Clinical 
     Practice Guideline for Assessment and Management of Patients 
     at Risk for Suicide published after the date of the enactment 
     of this Act, the Secretary of Veterans Affairs and the 
     Secretary of Defense, through the Assessment and Management 
     of Patients at Risk for Suicide Work Group (in this section 
     referred to as the ``Work Group''), shall ensure the 
     publication includes the following:
       (1) Enhanced guidance with respect to 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

[[Page H4742]]

     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.
       (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.--

[[Page H4743]]

       (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.
       (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

[[Page H4744]]

     Veterans' Affairs of the House of Representatives a report on 
     the efforts of the Department to integrate community-based 
     mental health care into the Veterans Health Administration.
       (2) Elements.--The report required by paragraph (1) shall 
     include the following:
       (A) An assessment of the efforts of the Department to 
     integrate community-based mental health care into the 
     Veterans Health Administration.
       (B) An assessment of the effectiveness of such efforts.
       (C) An assessment of how the health care of veterans is 
     impacted by such integration.
       (D) A description of how care is coordinated between 
     providers of community-based mental health care and the 
     Veterans Health Administration, including a description of 
     how documents and patient information are transferred and the 
     effectiveness of those transfers between--
       (i) the Veterans Health Administration and providers of 
     community-based mental health care; and
       (ii) providers of community-based mental health care and 
     the Veterans Health Administration.
       (E) An assessment of any disparities in the coordination of 
     community-based mental health care into the Veterans Health 
     Administration by location and type of facility.
       (F) An assessment of the military cultural competency of 
     health care providers providing community-based mental health 
     care to veterans.
       (G) Such recommendations on how the Department can better 
     integrate community-based mental health care into the 
     Veterans Health Administration as the Comptroller General 
     considers appropriate.
       (H) An assessment of such other areas as the Comptroller 
     General considers appropriate to study.
       (3) Community-based mental health care defined.--In this 
     subsection, the term ``community-based mental health care'' 
     means mental health care paid for by the Department but 
     provided by a non-Department health care provider at a non-
     Department facility, including care furnished under section 
     1703 of title 38, United States Code (as in effect on the 
     date specified in section 101(b) of the Caring for Our 
     Veterans Act of 2018 (title I of Public Law 115-182)).

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

       (a) Report on Mental Health Programs.--
       (1) In general.--Not later than 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

[[Page H4745]]

     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:

  ``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

[[Page H4746]]

     services provided at Vet Centers, including recommendations 
     on whether and how such treatment, counseling, and other 
     services can be expanded.
       (2) An assessment of the efficacy of outreach efforts by 
     the Readjustment Counseling Service, including 
     recommendations for how outreach efforts can be improved.
       (3) An assessment of barriers to care at Vet Centers, 
     including recommendations for overcoming those barriers.
       (4) An assessment of the efficacy and frequency of the use 
     of telehealth by counselors of the Readjustment Counseling 
     Service to provide mental health services, including 
     recommendations for how the use of telehealth can be 
     improved.
       (5) An assessment of the feasibility and advisability of 
     expanding eligibility for services from the Readjustment 
     Counseling Service, including--
       (A) recommendations on what eligibility criteria could be 
     expanded; and
       (B) an assessment of potential costs and increased 
     infrastructure requirements if eligibility is expanded.
       (6) An assessment of the use of Vet Centers by members of 
     the reserve components of the Armed Forces who were never 
     activated and recommendations on how to better reach those 
     members.
       (7) An assessment of the use of Vet Centers by eligible 
     family members of former members of the Armed Forces and 
     recommendations on how to better reach those family members.
       (8) An assessment of the efficacy of group therapy and the 
     level of training of providers at Vet Centers in 
     administering group therapy.
       (9) An assessment of the efficiency and effectiveness of 
     the task organization structure of Vet Centers.
       (10) An assessment of the use of Vet Centers by Native 
     American veterans, as defined in section 3765 of title 38, 
     United States Code, and recommendations on how to better 
     reach those veterans.
       (c) Vet Center Defined.--In this section, the term ``Vet 
     Center'' has the meaning given that term in section 1712A(h) 
     of title 38, United States Code.

     SEC. 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

[[Page H4747]]

     to be discharged home, including a safety plan and post-
     discharge outreach for veterans to facilitate engagement in 
     outpatient mental health care.
       (2) Elements.--The report required by paragraph (1) shall 
     include the following:
       (A) An assessment of the implementation of the current 
     operational policies and procedures of the SPED program at 
     each medical center of the Department of Veterans Affairs, 
     including an assessment of the following:
       (i) Training provided to clinicians or other personnel 
     administering protocols under the SPED program.
       (ii) Any disparities in implementation of such protocols 
     between medical centers.
       (iii) Current criteria used to measure the quality of such 
     protocols including--

       (I) methodology used to assess the quality of a safety plan 
     and post-discharge outreach for veterans; or
       (II) in the absence of such methodology, a proposed 
     timeline and guidelines for creating a methodology to ensure 
     compliance with the evidence-based model used under the 
     Suicide Assessment and Follow-up Engagement: Veteran 
     Emergency Treatment (SAFE VET) program of the Department.

       (B) An assessment of the implementation of the policies and 
     procedures described in subparagraph (A), including the 
     following:
       (i) An assessment of the quality and quantity of safety 
     plans issued to veterans.
       (ii) An assessment of the quality and quantity of post-
     discharge outreach provided to veterans.
       (iii) The post-discharge rate of veteran engagement in 
     outpatient mental health care, including attendance at not 
     fewer than one individual mental health clinic appointment or 
     admission to an inpatient or residential unit.
       (iv) The number of veterans who decline safety planning 
     efforts during protocols under the SPED program.
       (v) The number of veterans who decline to participate in 
     follow-up efforts within the SPED program.
       (C) A description of how SPED primary coordinators are 
     deployed to support such efforts, including the following:
       (i) A description of the duties and responsibilities of 
     such coordinators.
       (ii) The number and location of such coordinators.
       (iii) A description of training provided to such 
     coordinators.
       (iv) An assessment of the other responsibilities for such 
     coordinators and, if applicable, differences in patient 
     outcomes when such responsibilities are full-time duties as 
     opposed to secondary duties.
       (D) An assessment of the feasibility and advisability of 
     expanding the total number and geographic distribution of 
     SPED primary coordinators.
       (E) An assessment of the feasibility and advisability of 
     providing services under the SPED program via telehealth 
     channels, including an analysis of opportunities to leverage 
     telehealth to better serve veterans in rural areas.
       (F) A description of the status of current capabilities and 
     utilization of tracking mechanisms to monitor compliance, 
     quality, and patient outcomes under the SPED program.
       (G) Such recommendations, including specific action items, 
     as the Secretary considers appropriate with respect to how 
     the Department can better implement the SPED program, 
     including recommendations with respect to the following:
       (i) A process to standardize training under such program.
       (ii) Any resourcing requirements necessary to implement the 
     SPED program throughout Veterans Health Administration, 
     including by having a dedicated clinician responsible for 
     administration of such program at each medical center.
       (iii) An analysis of current statutory authority and any 
     changes necessary to fully implement the SPED program 
     throughout the Veterans Health Administration.
       (iv) A timeline for the implementation of the SPED program 
     through the Veterans Health Administration once full 
     resourcing and an approved training plan are in place.
       (H) Such other matters as the Secretary considers 
     appropriate.
       (c) Definitions.--In this section:
       (1) Appropriate committees of congress.--The term 
     ``appropriate committees of Congress'' means--
       (A) the Committee on Veterans' Affairs and the Subcommittee 
     on Military Construction, Veterans Affairs, and Related 
     Agencies of the Committee on Appropriations of the Senate; 
     and
       (B) the Committee on Veterans' Affairs and the Subcommittee 
     on Military Construction, Veterans Affairs, and Related 
     Agencies of the Committee on Appropriations of the House of 
     Representatives.
       (2) SPED primary coordinator.--The term ``SPED primary 
     coordinator'' means the main point of contact responsible for 
     administering the SPED program at a medical center of the 
     Department.
       (3) SPED program.--The term ``SPED program'' means the 
     Safety Planning in Emergency Departments program of the 
     Department of Veterans Affairs established in September 2018 
     for veterans presenting to the emergency department who are 
     assessed to be at risk for suicide and are safe to be 
     discharged home, which extends the evidence-based 
     intervention for suicide prevention to all emergency 
     departments of the Veterans Health Administration.

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

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

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

     SEC. 602. 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.

[[Page H4748]]

       (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 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

[[Page H4749]]

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

     SEC. 705. CREATION OF OFFICE OF RESEARCH REVIEWS WITHIN THE 
                   OFFICE OF INFORMATION AND TECHNOLOGY OF THE 
                   DEPARTMENT OF VETERANS AFFAIRS.

       (a) In General.--Not later than one year after the date of 
     the enactment of this Act, the Secretary of Veterans Affairs 
     shall establish within the Office of Information and 
     Technology of the Department of Veterans Affairs an Office of 
     Research Reviews (in this section referred to as the 
     ``Office'').
       (b) Elements.--The Office shall do the following:
       (1) Perform centralized security reviews and complete 
     security processes for approved research sponsored outside 
     the Department, with a focus on multi-site clinical trials.
       (2) Develop and maintain a list of commercially available 
     software preferred for use in sponsored clinical trials of 
     the Department and ensure such list is maintained as part of 
     the official approved software products list of the 
     Department.
       (3) Develop benchmarks for appropriate timelines for 
     security reviews conducted by the Office.
       (c) Report.--
       (1) In general.--Not later than one year after the 
     establishment of the Office, the Office shall submit to the 
     Committee on Veterans' Affairs of the Senate and the 
     Committee on Veterans' Affairs of the House of 
     Representatives a report on the activity of the Office.
       (2) Elements.--The report required by paragraph (1) shall 
     include, at a minimum, the following:
       (A) The number of security reviews completed.
       (B) The number of personnel assigned for performing the 
     functions described in subsection (b).

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
California (Mr. Takano) and the gentleman from Tennessee (Mr. David P. 
Roe) each will control 20 minutes.
  The Chair recognizes the gentleman from California.


                             General Leave

  Mr. TAKANO. Madam Speaker, I ask unanimous consent that all Members 
may have 5 legislative days in which to revise and extend their remarks 
and to insert extraneous material on S. 785.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from California?
  There was no objection.
  Mr. TAKANO. Madam Speaker, I yield myself such time as I may consume.
  Madam Speaker, I rise in support of S. 785, the Commander John Scott 
Hannon Veterans Mental Health Care Improvement Act.
  Madam Speaker, throughout the 116th Congress, the House Committee on 
Veterans' Affairs has committed significant resources and energy with 
one goal in mind, addressing and helping reduce veteran suicide.
  As a result, our committee has passed no less than 15 pieces of 
legislation that would address many of the upstream challenges that 
veterans confront, which can exacerbate mental health conditions and 
often lead veterans into crisis.
  While we are not discussing all of these proposals today, I am 
hopeful that one bill, and the subject of today's debate, S. 785, will 
provide additional tools and will lead to additional reporting that 
will inform our continued efforts to address this multifaceted and 
complex challenge.
  There is no one solution to this issue, but I know that by working 
together we can continue to make meaningful progress.
  I also thank the members of my committee and other Members of this 
Chamber who offered legislation in the House to address gaps, enhance 
upstream prevention, and create additional resources to help veterans 
access care. Many of these components are included in S. 785.
  Congressman Sablan's legislation included in S. 785 extends VA 
healthcare to veterans for a 1-year period following discharge or 
release from active service. We know this is a crucial period for 
veterans to be enrolled in and receive high-quality healthcare.
  Two provisions from Congressman Cisneros's bill are included in S. 
785; one, directing VA to update its clinical practice guidelines for 
treating veterans at risk of suicide, and the other mandating that VA 
develop clinical practice guidelines to standardize best practices for 
treating co-occurring substance use disorders, chronic pain, PTSD and/
or traumatic brain injuries.

                              {time}  1230

  Other members of my committee introduced House companion legislation 
for key components of S. 785.
  Congresswoman Lee's bill supported further telehealth expansion at 
the VA to capitalize on the use of technology and meeting veterans 
where they are.
  Congressman Lamb introduced legislation to bring the VA's 
complementary and integrated health services to even more veterans and 
also pushed the scientific enterprise to seek biomarkers and more 
tailored treatments for mental health problems through a new VA 
precision medicine initiative.
  Congressman Brindisi's bill will bring more resources to VA's suicide 
prevention coordinators and more staffing in this critical area to VA 
medical centers.
  Madam Speaker, I want to say thanks to them and all our Members who 
introduced companion legislation to S. 785, and I now encourage my 
colleagues to join me in supporting S. 785.
  Madam Speaker, I reserve the balance of my time.
  Mr. DAVID P. ROE of Tennessee. Madam Speaker, I yield myself such 
time as I may consume.
  Madam Speaker, I rise today in strong support of S. 785, the 
Commander John Scott Hannon Veterans Mental Health Care Improvement Act 
of 2019.
  Today, and every day, approximately 20 of our Nation's veteran 
servicemembers and members of the National Guard and Reserve will die 
by suicide. This bill is named after one of those veterans, Commander 
John Scott Hannon.
  One of its most important provisions is named after another, Staff 
Sergeant Parker Gordon Fox, who grew up in my district in east 
Tennessee.
  While we cannot bring back Commander Hannon, Staff Sergeant Fox, or 
countless veterans like them, we can act by passing this bill today to 
help save the lives of the brothers and sisters in arms they left 
behind.
  This Congress, both the House and Senate Veterans' Affairs Committees 
have made it our priority to prevent veteran suicide. This bill 
represents the culmination of our work.
  We would not be here without the unwavering efforts of many 
individuals: Senators and Members of Congress from both sides of the 
aisle who have worked hard on the various components of this bill; 
Secretary Wilkie and his team in VA and in the White House who have 
worked with us on a bipartisan, bicameral basis to make sure we get it 
right; and our veterans service organization partners that have 
provided their input, expertise, and encouragement every step of the 
way.
  I would be remiss if I did not say a particular thank you to my 
friends and esteemed Senate colleagues, Chairman Jerry Moran of Kansas 
and Ranking Member Jon Tester of Montana, the chairman and ranking 
member of the Senate Veterans' Affairs Committee.
  I have had the honor and the privilege of working with Senators Moran 
and Tester for many years, and I know that America's veterans have no 
greater champions in the United States Senate than them. I am grateful 
for their

[[Page H4750]]

hard work and steadfast leadership shepherding this bill to the 
President's desk over the last year and a half.
  And, of course, I am also grateful to my friend and fellow leader of 
the House Veterans' Affairs Committee, Congressman Mark Takano of 
California. Since he took over the gavel last year, Chairman Takano has 
focused our committee's work on veteran suicide prevention. I am proud 
to stand with him in pursuit of that goal.
  Veterans are 1.5 times more likely to die by suicide than 
nonveterans, in general, and veteran women are 2.2 times more likely to 
die by suicide than nonveteran women. It is certainly not for lack of 
attention, effort, or desire that the veteran suicide rate remains as 
high as it has for as long as it has.
  When I came to Congress in 2009, the VA's mental health budget was 
approximately $4 billion per year. When I leave Congress at the end of 
this year, the VA's mental health budget will total approximately $10 
billion. Over that nearly 12-year period, the veteran suicide rate has 
remained essentially the same, with approximately 20 lives lost per 
day.
  Finally lowering that number and eventually stopping veteran suicide 
altogether will not be easy, but S. 785 takes a number of different 
approaches that I believe will make a real difference to veterans in 
need.
  It includes provisions that would improve access to care for veterans 
at risk of suicide; strengthening VA's mental health workforce; 
expanding the availability of complementary and alternative techniques 
to improve veteran quality of life; advancing important research into 
diagnosis and treatment of conditions like post-traumatic stress 
disorder, depression, anxiety, bipolar disorder, suicide ideation, and 
the connection between suicide and certain prescription medications; 
and support for servicemembers as they transition to civilian life, a 
time in which we know they are uniquely vulnerable to stresses and 
suicidal thoughts.
  S. 785 would also establish the Staff Sergeant Parker Gordon Fox 
Suicide Prevention Grant Program to support community-based 
organizations that provide needed care and other services to at-risk 
veterans in their neighborhoods and backyards.
  The care and support that the VA offers to veterans is second to 
none. Under President Trump's direction these last 3\1/2\ years, 
excellent strides have been made to increase access to care, expand 
veteran choice, strengthen the veterans' trust that they have in the VA 
healthcare system, and more.
  Only 6 of the 20 servicemembers and veterans who die by suicide each 
day had used VA care in the last 2 years prior to their death. Not all 
of those who have served are eligible for VA care. Even those who are 
eligible may sometimes find the barrier to entry to a VA medical center 
too high, especially when they already are stressed and struggling.
  If we truly want to prevent veteran suicide, I believe that we must 
expand the VA's reach by partnering with well-respected community 
organizations that are meeting military families where they are, 
developing long-lasting and meaningful relationships to help them heal, 
and connecting them with the VA and other sources of support that best 
suit their individual and family needs.

  The Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program 
would create the mechanism to do that most effectively. It is based on 
the bipartisan IMPROVE Act, which is sponsored in the House by my good 
friend and ranking member of the Subcommittee on Oversight and 
Investigations, Lieutenant General Jack Bergman of Michigan, and 
Congresswoman Chrissy Houlahan of Pennsylvania.
  Both General Bergman and Congresswoman Houlahan are veterans 
themselves, and I know their commitment to supporting their fellow 
veterans is deeply and strongly felt. I am grateful to both of them for 
their hard work and leadership on this bill and for their ongoing 
service to this country, first in uniform and now in Congress.
  As I mentioned in my opening, this grant program is named after one 
of east Tennessee's own, Staff Sergeant Parker Gordon Fox. Parker grew 
up in Kingsport, Tennessee, very near to where I live, and joined the 
Army after high school graduation. He was only 25 years old when he 
died this summer.
  I did not know Parker personally, but I have been touched by the 
loving legacy he left behind and the many wonderful comments I have 
heard from friends and family.
  My heart is with his family and friends today, and I hope that they 
take some comfort in knowing that Parker will forever be memorialized 
through this program that will help veterans like him across the 
country and, hopefully, save others from the deep grief they are now 
experiencing.
  It is Parker I will be thinking of when I vote in support of this 
bill today, and I hope that every one of my colleagues will join me.
  In closing, I would like any veteran listening today who may be 
struggling with their own thoughts of suicide to know that you do not 
have to struggle alone. These are trying times, but free and 
confidential support is available to you any time of the day or night 
by calling 1-800-273-8255 and pressing 1, texting 838255, or visiting 
veteranscrisisline.net. It is okay not to be okay. Please reach out for 
help, if you need it, please.
  Madam Speaker, I reserve the balance of my time.
  Mr. TAKANO. Madam Speaker, I thank Ranking Member Roe for his kind 
words, and it is a pleasure to be here today to present this package of 
legislation on veteran suicide prevention.
  I do appreciate his mentioning the veteran hotline, and I do want to 
also encourage veterans to know that it is okay to not be okay and to 
please call the number that Dr. Roe just announced. I will try to make 
sure I repeat that later on during our session today.
  Madam Speaker, I yield 3 minutes to the gentleman from Pennsylvania 
(Mr. Lamb), my good friend and vice chairman of the Veterans' Affairs 
Committee.
  Mr. LAMB. Madam Speaker, I thank the chairman for his hard work 
bringing us this bipartisan, bicameral compromise that will get things 
done for our Nation's veterans.
  Madam Speaker, my contributions to today's bill are sort of a mix of 
old and new. We are dramatically increasing the investments and 
availability of age-old practices like acupuncture, meditation, yoga, 
nutritional counseling, things that, when you talk to the veterans 
themselves, whether younger millennial-age veterans or grizzled Vietnam 
war veterans, they will tell you these are some of their favorite 
offerings at the local VA and some of the practices that make the 
biggest differences for people with chronic pain, stress, and anxiety.
  I have heard my Republican colleagues make the point many times that 
we have increased the VA's budget without seeing much progress on the 
suicide rate. I agree. That is unacceptable.
  These are some of the least costly offerings that the VA has to make: 
acupuncture and chiropractor. They come up again and again, and they 
are a minuscule part of the VA's budget. We can make a small increase 
and make an enormous difference.
  We are also investing in another great opportunity to do research for 
biomarkers, precision medicine that will tell us how we can better 
treat the invisible wounds of war with new technologies; again, a small 
down payment today for the possibility of much more effective and much 
more cost-effective treatment going forward.
  The other important mix of old and new that we see today, Madam 
Speaker, is that we are making new investments--investing in new 
technology, offering new services to veterans--but we have done it in 
an old-fashioned way, which is that both sides work together.
  This will probably be my last chance to recognize our ranking member, 
Dr. Roe, before he leaves us at the end of this Congress. I just want 
to say, when I came to this Congress 2\1/2\ years ago, my first 
committee assignment was on the Veterans' Affairs Committee when he was 
chairman. Dr. Roe was kind to me from beginning to end, taught me a lot 
about the needs of our Nation's veterans from the standpoint of a 
practicing physician, always with an eye on cost, but, above all, on 
veterans' well-being.

[[Page H4751]]

  We thank Dr. Roe for his service, and our Nation's veterans are 
better off for it.
  Mr. DAVID P. ROE of Tennessee. Madam Speaker, I yield 3 minutes to 
the gentleman from Florida (Mr. Bilirakis), my good friend, who has 
served together with me for 12 years on the Veterans' Affairs Committee 
and vice chairs the committee. There is no greater advocate for 
veterans in this country than Gus Bilirakis.
  Mr. BILIRAKIS. Madam Speaker, I thank the chairman for putting forth 
this bill, and I also thank my good friend Ranking Member Roe, who does 
an outstanding job. He has really done excellent work. It has been an 
honor to serve with him on behalf of our veterans. I thank him so much 
for his service, his continuing service to our country and our true 
American heroes.
  Madam Speaker, I rise today in strong support of S. 785, the 
Commander John Scott Hannon Veterans Mental Health Care Improvement 
Act.
  This bill will help prevent veteran suicide by expanding access to 
care, services, and support for at-risk individuals within the VA 
healthcare system and their local communities. It contains the IMPROVE 
Act, a bill by my friend General Bergman that I was proud to support as 
one of the first cosponsors.
  This section creates a grant program for community providers to 
collaborate and assist in suicide prevention services and is modeled 
after the bipartisan SSVF program, which has been very successful in 
reducing veteran homelessness. We need new and innovative ways to 
tackle this tragic problem that our veterans are facing today.
  Tragically, 20 servicemembers and veterans take their own lives each 
day, not in combat, not by violent crime, but due to suicide. We must 
do everything to stop this, Madam Speaker.
  We know, too, that many of those 20 per day are not currently using 
VA services. That is why this grant program may be particularly 
helpful, since it specifically targets to reach those veterans who are 
actively suicidal or at risk of suicide who are not current users of 
the VA health system.
  Madam Speaker, the status quo is unacceptable, and none of us should 
stand idly by and allow this epidemic of veteran suicide to continue. 
When we called on them, our heroes, these servicemembers and veterans 
answered the call to serve. It is time for us to answer the call and 
support our heroes and get them the help that they have earned and 
deserve.

                              {time}  1245

  Mr. TAKANO. Madam Speaker, I yield 3 minutes to the gentlewoman from 
Nevada (Mrs. Lee), my good friend and the chairwoman of the 
Subcommittee on Technology Modernization, and also the author of this 
important piece of legislation.
  Mrs. LEE of Nevada. Madam Speaker, I want to thank the chairman for 
bringing this bill in front of the House. And I stand today in support 
of S. 785, the Commander John Scott Hannon Veterans Mental Health Care 
Improvement Act.
  In addition to making critical updates related to VA transition 
assistance, mental healthcare, and care for women veterans, this bill 
also includes an important provision that I championed here in the 
House in the form of the VA Telehealth Expansion Act, which would 
provide entities with grants expanding telehealth capabilities to serve 
veterans throughout the VA.
  We know the stat that over 20 veterans take their life by suicide 
every day, and not one suicide is acceptable. And many of those 
veterans are not accessing VA care. We know that telehealth is another 
venue to allow those veterans increased access, whether a veteran is 
homebound, in a rural community, in a community without access to a VA 
clinic or a hospital, or as we have seen now during this pandemic, at 
high risk of dying if they catch COVID-19. This pandemic has shown us 
just how critical it is for our veterans to be able to access 
healthcare through telehealth.
  In my home State of Nevada, on the week that southern Nevada began 
responding to the COVID-19 pandemic, the number of veterans in the 
southern Nevada healthcare system who had telehealth visits, the number 
was just under 150. Fast forward to just the week of July 19, we were 
providing over 2,000 video visits to veterans in their homes via the VA 
Video Connect. That means that the telehealth video visits increased by 
over 1,000 percent.
  It is abundantly clear that telehealth has provided improved access 
in healthcare for so many veterans, and we must continue to invest in 
the VA's telehealth capacity, and S. 785 does just that.
  Madam Speaker, finally, I want to give a special thank you also to 
Congressman Roe, the ranking member, for his leadership on this 
committee. I have only been working with him for one term, but without 
a doubt, I want to thank him for his commitment to our veterans.
  Mr. DAVID P. ROE of Tennessee. Madam Speaker, I appreciate the kind 
words and those of Congressman Lamb also. It is very much appreciated.
  Madam Speaker, I yield 4 minutes to the gentleman from Michigan (Mr. 
Bergman), from the Upper Peninsula where there are more deer than there 
are people. General Bergman has served our country as a marine, in 
private business as a pilot, and now as a Congressman, and I am indeed 
fortunate to call him my friend.
  Mr. BERGMAN. Madam Speaker, Dr. Roe is right, November 15 is fast 
approaching here where it is the opening of deer season in Michigan, so 
we anxiously await that.
  Madam Speaker, S. 785, the Commander John Scott Hannon Veterans 
Mental Health Improvement Act of 2019, will save veterans' lives, and I 
rise in unequivocal support of this legislation.
  The flame of my passion to end veteran suicide was lit long before I 
was elected to Congress, starting with Vietnam to the global war on 
terror.
  I would like to just take one extra opportunity to, again, welcome 
home my fellow veterans from Vietnam. You served your country in tough 
times, and we owe you that again and again for waiting so long to thank 
you.
  Because of that, in June 2019, I proudly introduced the Improve Well-
Being for Veterans Act, which proposed a grant program that would allow 
the VA to support the nationwide network of community organizations 
already providing lifesaving services to local veterans and their 
families. And it would be effective in reaching the 60-plus percent of 
veterans who die by suicide but are not within the VA system of care. 
The goal was to try something different when the status quo was not 
working. That was the driver here among all of us who chose to 
cosponsor the Improve Act.
  Within a 6-month period we gained over 250 bipartisan cosponsors, 
gained VSO support, and welcomed VA Secretary Wilkie to testify before 
our committee.
  Now, the best possible version of this legislation lies at the heart 
of S. 785, which I strongly urge all of my colleagues to support.
  For over a decade, and despite billions of dollars spent within the 
VA trying their hardest, we have heard the same statistic over and over 
again, 20 veterans die by their own hand every day. That is why this 
new approach and innovative approach and a different way of looking at 
things, maybe from the outside in, as opposed to the inside out, is 
long overdue. And I am excited to stay engaged and work with the 
administration to ensure that it makes a difference, especially for the 
veterans in our rural and remote communities that are so vulnerable.
  You know, when you come in as a freshman--and I love to say that, 
being a freshman at the age of 70 a few years ago. I learned as a 
marine early on, you look for good leadership, and I will tell you, I 
found it in Dr. Roe as the Chairman of Veterans' Affairs in my first 
term.
  Madam Speaker, I just wanted to say thank you to Dr. Roe for his 
leadership and for dropping the gavel on time every committee hearing, 
because that was one of his first bits of guidance to us as a 
committee, and he walked the talk. I thank him for his leadership. We 
are going to miss him, but he is not far away, and I have his phone 
number.
  Madam Speaker, I would also like to thank the 250-plus bipartisan 
cosponsors, and also both the majority and the minority staffs for 
working so hard to make this happen, and the VSOs. I thank my co-lead 
Chrissy Houlahan, Senator Boozman, Chairman Moran,

[[Page H4752]]

Ranking Member Tester, Chairman Takano, and, once again, to Dr. Roe.
  Mr. TAKANO. Madam Speaker, I yield 3 minutes to the gentleman from 
California (Mr. Cisneros), my good friend and member of the House 
Veterans' Affairs Committee.
  Mr. CISNEROS. Madam Speaker, I rise today in support of the Commander 
John Scott Hannon Veterans Mental Health Care Improvement Act.
  As this month marks National Suicide Prevention Awareness Month, I am 
grateful the House and Senate Veterans' Affairs Committees are working 
across the aisle to improve mental health services for our veterans. I 
am proud that this package includes my bipartisan bill, the STOP 
Veteran Suicide and Substance Abuse Act.
  We know that too many veterans struggling with mental health 
challenges, like PTSD, are often also dealing with substance misuse 
issues and the impact of various traumas, including military sexual 
assault.
  Given how common these co-occurring problems are, VA healthcare 
providers need evidence-based guidance for working with multiple issues 
all at once. My bill ensures that the VA will develop and disseminate 
this clinical practice guideline to share best practices VA-wide.
  Madam Speaker, I want to thank Representative Mast for working with 
me on this bill, and Chairman Takano for his tireless leadership on 
this issue.
  And I also want to thank Dr. Roe for his years of service to the 
country, both as a doctor, a soldier, and as a member of this committee 
and service in the House of Representatives. I thank him very much for 
his friendship, always stopping to say hello. We are going to miss him 
here. But I know he will continue his service back in civilian life, 
and so I thank him very much for his years of service.
  Mr. DAVID P. ROE of Tennessee. Madam Speaker, I reserve the balance 
of my time.
  Mr. TAKANO. Madam Speaker, I yield 3 minutes to the gentlewoman from 
Pennsylvania (Ms. Houlahan), my good friend.
  Ms. HOULAHAN. Madam Speaker, I want to thank the chairman for 
bringing this bill to the House.
  Madam Speaker, I rise as well to speak in favor of S. 785.
  This comprehensive package of legislation complements the other VA 
bills we considered yesterday and today. I want to highlight two pieces 
of this bill, in particular.
  This bill aims to improve the mental health medical workforce at the 
VA. The vast majority of veterans who get their care at the VA love 
their experience, and that is because of the dedicated VA workforce.
  However, we do need to address head-on the issue of staffing 
shortages. According to the most recent VA report, there are roughly 
50,000 vacant positions at the VA at any given time, many of which are 
slots for healthcare providers.
  This bill would require the VA to create a plan to address the 
staffing of mental healthcare providers at its facilities, and ensure 
that each medical center, like the one in Coatesville in my district, 
is staffed with a suicide prevention coordinator.
  This bill also includes the Staff Sergeant Parker Gordon Fox Suicide 
Prevention Grant Program, which would push funding for suicide 
prevention services out to vetted community organizations. This is a 
similar one that was proposed in the Improve Act, which I was proud to 
help lead with my colleague across the aisle, General Bergman.
  This will really help us reach the millions of veterans who do not 
use the VA for healthcare, or who are more comfortable talking about 
their mental health concerns in a nongovernmental setting. It will also 
ensure that these organizations can refer veterans to the VA when 
needed, ensuring that there is a warm hand-off, which is so critical 
when someone is in crisis.
  Madam Speaker, I do want to take this opportunity to thank Chairman 
Takano for his leadership on this critically important issue. The fact 
that the House is poised to pass not only S. 785, but also the 
chairman's Veterans COMPACT Act, and a variety of other related bills, 
is truly a testament to his laser-like focus on this issue.
  Representative Brownley, who leads the Women Veterans Task Force, 
also has been especially attentive to the barriers that women veterans 
face as well. VA research recently found that the share of women 
veterans using the VA has grown nearly 15 percent in 10 years, and we 
need to ensure that this VA is adapting and continuing to be the 
veterans' first choice for quality mental healthcare regardless of 
gender.
  Madam Speaker, it has been a pleasure to work with General Bergman on 
the Improve Act, given our common background in service. General 
Bergman and I quickly connected last year over the importance of 
ensuring that we use all of the tools in our toolkit, the VA, community 
organizations, peer support groups, and more, to reach veterans in 
mental health crisis where they are and where they feel comfortable.
  Madam Speaker, I thank General Bergman and Ranking Member Dr. Roe for 
their leadership in getting to this moment as well.
  I would like to end by saying, it is okay to not be okay. If you are 
experiencing a crisis or know someone who is, please dial 1-800-273-
8255, and press 1. Again, 1-800-273-8255, and press 1.
  Mr. DAVID P. ROE of Tennessee. Madam Speaker, first of all, we have 
heard numerous speakers today speak eloquently about the problems we 
have with veteran suicide in this country and active duty 
servicemembers, I mean, a horrific number of 20, which we have not 
changed at all in the last 20 years.

                              {time}  1300

  Two decades and we are still having this problem, no matter how much 
money, so it was time to think outside the box, which I believe this 
did. No one bill, Madam Speaker, is going to solve this problem.
  We have read numbers to call. Look, reach out to a friend. If you 
have a friend or a pastor or someone who you trust, reach out to them 
if you are in a dark place, and then we will get you the help you need. 
We will get you the resources you need because most of these decisions, 
many of these, are impulsive decisions that once they are avoided, that 
person can lead a fruitful, bountiful life.
  That is what we want. We want you to reach out, and we will get you 
the help you need to get you from the place you are to a place of a 
productive, helpful life.
  I thank all the Members, especially the chairman, who made this his 
primary goal, suicide prevention. I thank him for that.
  Madam Speaker, I urge my colleagues to support this bill, and I yield 
back the balance of my time.
  Mr. TAKANO. Madam Speaker, I urge all of my colleagues to join me in 
passing S. 785. I thank all of my colleagues who worked on this bill on 
both sides of the aisle, and I yield back the balance of my time.
  The SPEAKER pro tempore (Ms. Dean). The question is on the motion 
offered by the gentleman from California (Mr. Takano) that the House 
suspend the rules and pass the bill, S. 785.
  The question was taken; and (two-thirds being in the affirmative) the 
rules were suspended and the bill was passed.
  A motion to reconsider was laid on the table.

                          ____________________