[Congressional Record Volume 169, Number 70 (Wednesday, April 26, 2023)]
[Senate]
[Pages S1392-S1401]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           TEXT OF AMENDMENTS

  SA 88. Mr. TESTER submitted an amendment intended to be proposed by 
him to the bill S. 326, to direct the Secretary of Veterans Affairs to 
carry out a study and clinical trials on the effects of cannabis on 
certain health outcomes of veterans with chronic pain and post-
traumatic stress disorder, and for other purposes; which was ordered to 
lie on the table; as follows:

        Strike all after the enacting clause and insert the 
     following:

[[Page S1393]]

  


     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Elizabeth 
     Dole Veterans Programs Improvement Act of 2023''.
       (b) Table of Contents.--The table of contents for this Act 
     is as follows:

Sec. 1. Short title; table of contents.

       TITLE I--IMPROVEMENTS TO HOME AND COMMUNITY BASED SERVICES

Sec. 101. Short title.
Sec. 102. Definitions.
Sec. 103. Coordination with Program of All-Inclusive Care for the 
              Elderly.
Sec. 104. Home and community based services: programs.
Sec. 105. Coordination with assistance and support services for 
              caregivers.
Sec. 106. Development of centralized website for program information.
Sec. 107. Improvements relating to Home Maker and Home Health Aide 
              program.
Sec. 108. Reviews and other improvements relating to home and community 
              based services.

           TITLE II--IMPROVEMENTS TO FAMILY CAREGIVER PROGRAM

Sec. 201. Modification of family caregiver program of Department of 
              Veterans Affairs to include services related to mental 
              health and neurological disorders.
Sec. 202. Requirements relating to evaluations, assessments, and 
              reassessments relating to eligibility of veterans and 
              caregivers for family caregiver program.
Sec. 203. Authority for Secretary of Veterans Affairs to award grants 
              to entities to improve provision of mental health support 
              to family caregivers of veterans.
Sec. 204. Comptroller General report on mental health support for 
              caregivers.

                 TITLE III--MEDICINAL CANNABIS RESEARCH

Sec. 301. Definitions.
Sec. 302. Department of Veterans Affairs large-scale, mixed methods, 
              retrospective qualitative study on the effects of 
              cannabis on certain health outcomes of veterans with 
              chronic pain and post-traumatic stress disorder.
Sec. 303. Department of Veterans Affairs clinical trials on the effects 
              of cannabis on certain health outcomes of veterans with 
              chronic pain and post-traumatic stress disorder.
Sec. 304. Administration of study and clinical trials.

                       TITLE IV--HOUSING MATTERS

Sec. 401. Improvements to program for direct housing loans made to 
              Native American veterans by the Secretary of Veterans 
              Affairs.
Sec. 402. Native community development financial institution relending 
              program.
Sec. 403. Department of Veterans Affairs housing loan fees.

                         TITLE V--OTHER MATTERS

Sec. 501. Authority for Secretary of Veterans Affairs to award grants 
              to States to improve outreach to veterans.
Sec. 502. Oversight of Cost of War Toxic Exposures Fund.

       TITLE I--IMPROVEMENTS TO HOME AND COMMUNITY BASED SERVICES

     SEC. 101. SHORT TITLE.

       This title may be cited as the ``Elizabeth Dole Home Care 
     Act''.

     SEC. 102. DEFINITIONS.

       In this title:
       (1) Caregiver; family caregiver.--The terms ``caregiver'' 
     and ``family caregiver'' have the meanings given those terms 
     under section 1720K(g) of title 38, United States Code (as 
     added by section 104(a)(1)).
       (2) Covered program.--The term ``covered program''--
       (A) means any program of the Department for home and 
     community based services; and
       (B) includes the programs specified in section 1720K of 
     title 38, United States Code (as added by section 104(a)(1)).
       (3) Department.--The term ``Department'' means the 
     Department of Veterans Affairs.
       (4) Home and community based services.--The term ``home and 
     community based services''--
       (A) means the services referred to in section 1701(6)(E) of 
     title 38, United States Code; and
       (B) includes services furnished under a program specified 
     in section 1720K of such title (as added by section 
     104(a)(1)).
       (5) Home based primary care program; home maker and home 
     health aide program; veteran directed care program.--The 
     terms ``Home Based Primary Care program'', ``Home Maker and 
     Home Health Aide program'', and ``Veteran Directed Care 
     program'' mean the programs of the Department specified in 
     subsections (d), (c), and (b) of such section 1720K, 
     respectively.
       (6) Home health aide; native american veteran, tribal 
     health program; urban indian organization.--The terms ``home 
     health aide'', ``Native American veteran'', ``tribal health 
     program'', and ``Urban Indian organization'' have the 
     meanings given those terms in subsection (g) of such section 
     1720K.
       (7) Secretary.--The term ``Secretary'' means the Secretary 
     of Veterans Affairs.
       (8) Veterans service organization.--The term ``veterans 
     service organization'' means any organization recognized by 
     the Secretary under section 5902 of title 38, United States 
     Code.

     SEC. 103. COORDINATION WITH PROGRAM OF ALL-INCLUSIVE CARE FOR 
                   THE ELDERLY.

       Section 1720C of title 38, United States Code, is amended 
     by adding at the end the following new subsection:
       ``(f) In furnishing services to a veteran under the program 
     conducted pursuant to subsection (a), if a medical center of 
     the Department through which such program is administered is 
     located in a geographic area in which services are available 
     to the veteran under a PACE program (as such term is defined 
     in sections 1894(a)(2) and 1934(a)(2) of the Social Security 
     Act (42 U.S.C. 1395eee(a)(2); 1396u-4(a)(2))), the Secretary 
     shall establish a partnership with the PACE program operating 
     in that area for the furnishing of such services.''.

     SEC. 104. HOME AND COMMUNITY BASED SERVICES: PROGRAMS.

       (a) Programs.--
       (1) In general.--Subchapter II of chapter 17 of title 38, 
     United States Code, is amended by inserting after section 
     1720J the following new section:

     ``Sec. 1720K. Home and community based services: programs

       ``(a) In General.--In furnishing noninstitutional 
     alternatives to nursing home care under the authority of 
     section 1720C of this title (or any other authority under 
     this chapter or other provision of law administered by the 
     Secretary of Veterans Affairs), the Secretary shall carry out 
     each of the programs specified in this section in accordance 
     with such relevant authorities except as otherwise provided 
     in this section.
       ``(b) Veteran Directed Care Program.--(1) The Secretary of 
     Veterans Affairs, in collaboration with the Secretary of 
     Health and Human Services, shall carry out a program to be 
     known as the `Veteran Directed Care program' under which the 
     Secretary of Veterans Affairs may enter into agreements with 
     the providers described in paragraph (2) to provide to 
     eligible veterans funds to obtain such in-home care services 
     and related items that support clinical need and improve 
     quality of life as determined appropriate by the Secretary of 
     Veterans Affairs and selected by the veteran, including 
     through the veteran hiring individuals to provide such 
     services and items or directly purchasing such services and 
     items.
       ``(2) The providers described in this paragraph are the 
     following:
       ``(A) An Aging and Disability Resource Center, an area 
     agency on aging, or a State agency.
       ``(B) A center for independent living.
       ``(C) Any other entity as determined appropriate by the 
     Secretary of Veterans Affairs, in consultation with the 
     Secretary of Health and Human Services.
       ``(3) In carrying out the Veteran Directed Care program, 
     the Secretary of Veterans Affairs shall--
       ``(A) administer such program through each medical center 
     of the Department of Veterans Affairs;
       ``(B) ensure the availability of such program in American 
     Samoa, Guam, the Commonwealth of the Northern Mariana 
     Islands, the Commonwealth of Puerto Rico, the Virgin Islands 
     of the United States, and any other territory or possession 
     of the United States; and
       ``(C) ensure the availability of such program for eligible 
     veterans who are Native American veterans receiving care and 
     services furnished by the Indian Health Service, a tribal 
     health program, an Urban Indian organization, or (in the case 
     of a Native Hawaiian veteran) a Native Hawaiian health care 
     system.
       ``(4) If a veteran participating in the Veteran Directed 
     Care program is hospitalized, the veteran may continue to use 
     funds under the program during a period of hospitalization in 
     the same manner that the veteran would be authorized to use 
     such funds under the program if the veteran were not 
     hospitalized, as determined appropriate by the Secretary.
       ``(c) Home Maker and Home Health Aide Program.--(1) The 
     Secretary shall carry out a program to be known as the `Home 
     Maker and Home Health Aide program' under which the Secretary 
     may enter into agreements with home health agencies to 
     provide to eligible veterans such home health aide services 
     as may be determined appropriate by the Secretary.
       ``(2) In carrying out the Home Maker and Home Health Aide 
     program, the Secretary shall ensure the availability of such 
     program--
       ``(A) in the locations specified in subparagraph (B) of 
     subsection (b)(3); and
       ``(B) for the veteran populations specified in subparagraph 
     (C) of such subsection.

[[Page 2]]

       ``(d) Home Based Primary Care Program.--The Secretary shall 
     carry out a program to be known as the `Home Based Primary 
     Care program' under which the Secretary may furnish to 
     eligible veterans in-home health care, the provision of which 
     is overseen by a health care provider of the Department.
       ``(e) Purchased Skilled Home Care Program.--The Secretary 
     shall carry out a program to be known as the `Purchased 
     Skilled Home Care program' under which the Secretary may 
     furnish to eligible veterans such in-home care services as 
     may be determined appropriate and selected by the Secretary 
     for the veteran.

[[Page S1394]]

       ``(f) Caregiver Support.--(1) With respect to a caregiver 
     of a veteran participating in a program under this section 
     who is a family caregiver, the Secretary shall--
       ``(A) if the veteran meets the requirements of a covered 
     veteran under section 1720G(b) of this title, provide to such 
     caregiver the option of enrolling in the program of general 
     caregiver support services under such section;
       ``(B) subject to paragraph (2), provide to such caregiver 
     not fewer than 14 days of covered respite care each year; and
       ``(C) conduct on an annual basis (and, to the extent 
     practicable, in connection with in-person services provided 
     under the program in which the veteran is participating), a 
     wellness check of such caregiver.
       ``(2) The Secretary shall provide not fewer than 30 days of 
     covered respite care each year to any caregiver who provides 
     services funded under the Veteran Directed Care program under 
     subsection (b).
       ``(3) Covered respite care provided to a caregiver of a 
     veteran under paragraph (1) or (2), as the case may be, may 
     exceed 14 days annually or 30 days annually, respectively, if 
     an extension is requested by the caregiver or veteran and 
     determined medically appropriate by the Secretary.
       ``(g) Definitions.--In this section:
       ``(1) The terms `Aging and Disability Resource Center', 
     `area agency on aging', and `State agency' have the meanings 
     given those terms in section 102 of the Older Americans Act 
     of 1965 (42 U.S.C. 3002).
       ``(2) The terms `caregiver' and `family caregiver', with 
     respect to a veteran, have the meanings given those terms, 
     respectively, under subsection (d) of section 1720G of this 
     title with respect to an eligible veteran under subsection 
     (a) of such section or a covered veteran under subsection (b) 
     of such section, as the case may be.
       ``(3) The term `center for independent living' has the 
     meaning given that term in section 702 of the Rehabilitation 
     Act of 1973 (29 U.S.C. 796a).
       ``(4) The term `covered respite care' means, with respect 
     to a caregiver of a veteran, respite care that--
       ``(A) includes 24-hour per day care of the veteran 
     commensurate with the care provided by the caregiver;
       ``(B) is medically and age-appropriate; and
       ``(C) includes in-home care services.
       ``(5) The term `eligible veteran' means any veteran--
       ``(A) for whom the Secretary determines participation in a 
     specific program under this section is medically necessary to 
     promote, preserve, or restore the health of the veteran; and
       ``(B) who absent such participation would be at increased 
     risk for hospitalization, placement in a nursing home, or 
     emergency room care.
       ``(6) The term `home health aide' means an individual 
     employed by a home health agency to provide in-home care 
     services.
       ``(7) The term `in-home care service' means any service, 
     including a personal care service, provided to enable the 
     recipient of such service to live at home.
       ``(8) The term `Native American veteran' has the meaning 
     given that term in section 3765 of this title.
       ``(9) The terms `Native Hawaiian' and `Native Hawaiian 
     health care system' have the meanings given those terms in 
     section 12 of the Native Hawaiian Health Care Improvement Act 
     (42 U.S.C. 11711).
       ``(10) The terms `tribal health program' and `Urban Indian 
     organization' have the meanings given those terms in section 
     4 of the Indian Health Care Improvement Act (25 U.S.C. 
     1603).''.
       (2) Clerical amendment.--The table of sections at the 
     beginning of such subchapter is amended by inserting after 
     the item relating to section 1720J the following new item:

``1720K. Home and community based services: programs.''.
       (b) Deadline for Improved Administration.--The Secretary 
     shall ensure that the Veteran Directed Care program and the 
     Home Maker and Home Health Aide program are administered 
     through each medical center of the Department in accordance 
     with section 1720K of title 38, United States Code (as added 
     by subsection (a)(1)), by not later than two years after the 
     date of the enactment of this Act.
       (c) Administration of Veteran Directed Care Program.--
       (1) Procedures.--The Secretary shall establish procedures 
     to identify staffing needs for the Program and define the 
     roles and responsibilities of personnel of the Program at the 
     national, Veterans Integrated Service Network, and facility 
     levels, including responsibilities for engagement with 
     veterans participating in the Program, veterans interested in 
     the Program, and providers described in section 1720K(b)(2), 
     as added by subsection (a)(1).
       (2) Staffing model.--
       (A) In general.--The Secretary shall establish a staffing 
     model for the administration of the Program at each medical 
     center of the Department.
       (B) Staffing ratio.--The Secretary shall establish a 
     staffing ratio for administration of the Program at each 
     facility of the Department at which the Program is carried 
     out, which shall include a specified number of full-time 
     equivalent employees, with no collateral duties, per number 
     of veterans served by the Program.
       (3) Funding for program.--
       (A) Cost estimates.--The Secretary shall develop methods 
     for tracking and reporting demand by veterans for and use by 
     veterans of services under the Program to inform yearly cost 
     estimates for the Program.
       (B) Specific request.--In the budget justification 
     materials submitted to Congress in support of the budget of 
     the Department for any fiscal year (as submitted with the 
     budget of the President under section 1105(a) of title 31, 
     United States Code), the Secretary shall include a separate 
     statement of the amount requested for the Program.
       (4) Program defined.--In this subsection, the term 
     ``Program'' means the Veteran Directed Care program.

     SEC. 105. COORDINATION WITH ASSISTANCE AND SUPPORT SERVICES 
                   FOR CAREGIVERS.

       (a) Coordination With Program of Comprehensive Assistance 
     for Family Caregivers.--
       (1) Coordination.--Section 1720G(a) of title 38, United 
     States Code, is amended by adding at the end the following 
     new paragraph:
       ``(14)(A) In the case of a veteran or caregiver who seeks 
     services under this subsection and is denied such services, 
     or a veteran or the family caregiver of a veteran who is 
     discharged from the program under this subsection, the 
     Secretary shall--
       ``(i) if the veteran meets the requirements of a covered 
     veteran under subsection (b), provide to such caregiver the 
     option of enrolling in the program of general caregiver 
     support services under such subsection;
       ``(ii) assess the veteran or caregiver for participation in 
     any other available program of the Department for home and 
     community based services (including the programs specified in 
     section 1720K of this title) for which the veteran or 
     caregiver may be eligible and, with respect to the veteran, 
     store (and make accessible to the veteran) the results of 
     such assessment in the electronic medical record of the 
     veteran; and
       ``(iii) provide to the veteran or caregiver written 
     information on any such program identified pursuant to the 
     assessment under clause (ii), including information about 
     facilities, eligibility requirements, and relevant contact 
     information for each such program.
       ``(B)(i) Subject to clause (ii), for each veteran or family 
     caregiver who is discharged from the program under this 
     subsection, a caregiver support coordinator shall provide for 
     a smooth and personalized transition from such program to an 
     appropriate program of the Department for home and community 
     based services (including the programs specified in section 
     1720K of this title), including by integrating caregiver 
     support across programs.
       ``(ii) To the extent practicable, the Secretary shall not 
     discharge a veteran or family caregiver from the program 
     under this subsection until appropriate home and community 
     based services are selected by the veteran or caregiver and 
     are being provided to the veteran and caregiver pursuant to 
     clause (i).''.
       (2) Applicability.--The amendment made by paragraph (1) 
     shall apply with respect to denials and discharges described 
     in paragraph (14) of such section, as added by paragraph (1), 
     occurring on or after the date of the enactment of this Act.
       (b) Technical and Conforming Amendments.--Section 1720G(d) 
     of such title is amended--
       (1) by striking ``or a covered veteran'' each place it 
     appears and inserting ``, a veteran denied or discharged as 
     specified in paragraph (14) of such subsection, or a covered 
     veteran''; and
       (2) by striking ``under subsection (a), means'' each place 
     it appears and inserting ``under subsection (a) or a veteran 
     denied or discharged as specified in paragraph (14) of such 
     subsection, means''.
       (c) Review Relating to Caregiver Contact.--The Secretary 
     shall conduct a review of the capacity of the Department to 
     establish a streamlined system for contacting all caregivers 
     enrolled in the program of general caregiver support services 
     under section 1720G(b) of title 38, United States Code, to 
     provide to such caregivers program updates and alerts 
     relating to emerging services for which such caregivers or 
     the veterans for which they provide care may be eligible.

     SEC. 106. DEVELOPMENT OF CENTRALIZED WEBSITE FOR PROGRAM 
                   INFORMATION.

       (a) Centralized Website.--The Secretary shall develop and 
     maintain a centralized and publicly accessible internet 
     website of the Department as a clearinghouse for information 
     and resources relating to covered programs.
       (b) Contents.--The website under subsection (a) shall 
     contain the following:
       (1) A description of each covered program.
       (2) An informational assessment tool that enables users 
     to--

[[Page 3]]

       (A) assess the eligibility of a veteran, or a caregiver of 
     a veteran, for any covered program; and
       (B) receive information, as a result of such assessment, on 
     any covered program for which the veteran or caregiver (as 
     the case may be) may be eligible.
       (3) A list of required procedures for the directors of 
     medical facilities of the Department to follow in determining 
     the eligibility and suitability of veterans for participation 
     in a covered program, including procedures applicable to 
     instances in which the resource constraints of a facility (or 
     of a community in which a facility is located) may result in 
     the inability to address the health needs of a

[[Page S1395]]

     veteran under a covered program in a timely manner.
       (c) Updates.--The Secretary shall ensure the website under 
     subsection (a) is updated on a periodic basis.

     SEC. 107. IMPROVEMENTS RELATING TO HOME MAKER AND HOME HEALTH 
                   AIDE PROGRAM.

       (a) Pilot Program for Communities With Shortage of Home 
     Health Aides.--
       (1) Program.--Not later than two years after the date of 
     the enactment of this Act, the Secretary shall carry out a 
     pilot program under which the Secretary shall provide home 
     maker and home health aide services to veterans who reside in 
     communities with a shortage of home health aides.
       (2) Locations.--The Secretary shall select 10 geographic 
     locations in which the Secretary determines there is a 
     shortage of home health aides at which to carry out the pilot 
     program under paragraph (1).
       (3) Nursing assistants.--
       (A) In general.--In carrying out the pilot program under 
     paragraph (1), the Secretary may hire nursing assistants as 
     new employees of the Department, or reassign nursing 
     assistants who are existing employees of the Department, to 
     provide to veterans in-home care services (including basic 
     tasks authorized by the State certification of the nursing 
     assistant) under the pilot program, in lieu of or in addition 
     to the provision of such services through non-Department home 
     health aides.
       (B) Relationship to existing programs.--Nursing assistants 
     hired or reassigned under subparagraph (A) may provide 
     services to a veteran under the pilot program under paragraph 
     (1) while serving as part of a health care team for the 
     veteran under the Home Based Primary Care program or any 
     other program as determined appropriate by the Secretary.
       (4) Duration.--The pilot program under paragraph (1) shall 
     be for a duration of three years.
       (5) Report to congress.--Not later than one year prior to 
     the termination of the pilot program 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 pilot 
     program as of the date of the report and the feasibility and 
     advisability of extending the pilot program or making the 
     pilot program permanent.
       (b) Report on Use of Funds.--Not later than one year after 
     the date of the enactment of this Act, the Secretary shall 
     submit to the Committee on Veterans' Affairs of the Senate 
     and the Committee on Veterans' Affairs of the House of 
     Representatives a report containing, with respect to the 
     period beginning in fiscal year 2011 and ending in fiscal 
     year 2022, the following:
       (1) An identification of the amount of funds that were 
     included in a budget of the Department during such period for 
     the provision of in-home care to veterans under the Home 
     Maker and Home Health Aide program in effect during such 
     period but were not expended for the provision of such care, 
     disaggregated by medical center of the Department for which 
     such unexpended funds were budgeted.
       (2) An identification of the number of veterans for whom, 
     during such period, the hours during which a home health aide 
     was authorized to provide services to the veteran under such 
     program were reduced, including a detailed description of why 
     such reduction occurred, such as clinical need or provider 
     availability.
       (c) Updated Guidance on Program.--
       (1) In general.--Not later than one year after the date of 
     the enactment of this Act, the Secretary shall issue updated 
     guidance for the Home Maker and Home Health Aide program.
       (2) Matters to include.--Guidance updated under paragraph 
     (1) shall include the following:
       (A) A process for the transition of veterans from the Home 
     Maker and Home Health Aide program to other covered programs.
       (B) A requirement for the directors of the medical 
     facilities of the Department to complete such process 
     whenever a veteran with care needs has been denied services 
     from home health agencies under the Home Maker and Home 
     Health Aide program as a result of the clinical needs or 
     behavioral issues of the veteran.

     SEC. 108. REVIEWS AND OTHER IMPROVEMENTS RELATING TO HOME AND 
                   COMMUNITY BASED SERVICES.

       (a) Office of Geriatric and Extended Care.--
       (1) Review of programs.--The Under Secretary for Health of 
     the Department shall conduct a review of each program 
     administered through the Office of Geriatric and Extended 
     Care of the Department or the Caregiver Support Program 
     Office of the Department, or any successor office, to--
       (A) ensure consistency in program management;
       (B) eliminate service gaps at the medical center level;
       (C) ensure the clinical needs of veterans are being met;
       (D) ensure the availability of, and the access by veterans 
     to, home and community based services, including for veterans 
     living in rural areas; and
       (E) ensure proper coordination between covered programs.
       (2) Assessment of staffing needs.--The Secretary shall 
     conduct an assessment of the staffing needs of the Office of 
     Geriatric and Extended Care of the Department and the 
     Caregiver Support Program Office of the Department, or any 
     successor office.
       (3) Goals for geographic alignment of care.--
       (A) Establishment of goals.--The Director of the Office of 
     Geriatric and Extended Care and the head of the Caregiver 
     Support Program Office, or the head of any successor office, 
     shall establish quantitative goals to enable aging or 
     disabled veterans who are not located near medical centers of 
     the Department to access extended care services (including by 
     improving access to home and community based services for 
     such veterans).
       (B) Implementation timeline.--Each goal established under 
     subparagraph (A) shall include a timeline for the 
     implementation of the goal at each medical center of the 
     Department.
       (4) Goals for in-home specialty care.--The Director of the 
     Office of Geriatric and Extended Care and the head of the 
     Caregiver Support Program Office, or the head of any 
     successor office, shall establish quantitative goals to 
     address the specialty care needs of veterans through in-home 
     care, including by ensuring the education of home health 
     aides and caregivers of veterans in the following areas:
       (A) Dementia care.
       (B) Care for spinal cord injuries and diseases.
       (C) Ventilator care.
       (D) Other specialty care areas as determined by the 
     Secretary.
       (5) Report to congress.--Not later than one year after the 
     date of the enactment of this Act, the Secretary shall submit 
     to the Committee on Veterans' Affairs of the Senate and the 
     Committee on Veterans' Affairs of the House of 
     Representatives a report containing the findings of the 
     review under paragraph (1), the results of the assessment 
     under paragraph (2), and the goals established under 
     paragraphs (3) and (4).
       (b) Review of Incentives and Efforts Relating to Home and 
     Community Based Services.--
       (1) Review.--The Secretary shall conduct a review of the 
     following:
       (A) The financial and organizational incentives and 
     disincentives for the directors of medical centers of the 
     Department to establish or expand covered programs at such 
     medical centers.
       (B) Any incentives or disincentives for such directors to 
     provide to veterans home and community based services in lieu 
     of institutional care.
       (C) The efforts taken by the Secretary to enhance spending 
     of the Department for extended care by balancing spending 
     between institutional care and home and community based 
     services.
       (D) The plan of the Under Secretary for Health of the 
     Department to accelerate efforts to enhance spending as 
     specified in subparagraph (C), to match the progress of 
     similar efforts taken by the Administrator of the Centers for 
     Medicare & Medicaid Services with respect to spending of the 
     Centers for Medicare & Medicaid Services for extended care.
       (2) Report to congress.--Not later than one year after the 
     date of the enactment of this Act, the Secretary shall submit 
     to the Committee on Veterans' Affairs of the Senate and the 
     Committee on Veterans' Affairs of the House of 
     Representatives a report on the findings of the review under 
     paragraph (1).
       (c) Review of Respite Care Services.--Not later than two 
     years after the date of the enactment of this Act, the 
     Secretary shall conduct a review of the use, availability, 
     cost, and effectiveness of the respite care services 
     furnished by the Secretary under chapter 17 of title 38, 
     United States Code, to include--
       (1) the frequency in which Department is unable to meet the 
     need for such services;
       (2) a detailed description of why the Department is unable 
     to meet the need for such services; and
       (3) a detailed description of the actions the Department 
     has taken or plans to take to ensure that the need for such 
     services is met.
       (d) Collaboration To Improve Home and Community Based 
     Services.--
       (1) Feedback and recommendations on caregiver support.--
       (A) Feedback and recommendations.--The Secretary shall 
     solicit from the entities described in subparagraph (B) 
     feedback and recommendations regarding opportunities for the 
     Secretary to enhance home and community based services for 
     veterans and caregivers of veterans, including through the 
     potential provision by the entity of care and respite 
     services to veterans and caregivers who may not be eligible 
     for any program under section 1720G of title 38, United 
     States Code, or section 1720K of such title (as added by 
     section 104(a)(1)), but have a need for assistance.

[[Page 4]]

       (B) Covered entities.--The entities described in this 
     subparagraph are veterans service organizations and nonprofit 
     organizations with a focus on caregiver support or long-term 
     care (as determined by the Secretary).
       (2) Collaboration for native american veterans.--The 
     Secretary shall collaborate with the Director of the Indian 
     Health Service and representatives from tribal health 
     programs and Urban Indian organizations to ensure the 
     availability of home and community based services for Native 
     American veterans, including Native American veterans 
     receiving health care and medical services under multiple 
     health care systems.

[[Page S1396]]

  


           TITLE II--IMPROVEMENTS TO FAMILY CAREGIVER PROGRAM

     SEC. 201. MODIFICATION OF FAMILY CAREGIVER PROGRAM OF 
                   DEPARTMENT OF VETERANS AFFAIRS TO INCLUDE 
                   SERVICES RELATED TO MENTAL HEALTH AND 
                   NEUROLOGICAL DISORDERS.

       (a) In General.--Section 1720G of title 38, United States 
     Code, as amended by section 105, is further amended--
       (1) in subsection (a)--
       (A) in paragraph (2)(C)(ii), by striking ``neurological'' 
     and inserting ``a neurological disorder'';
       (B) in paragraph (3)--
       (i) in subparagraph (A)(ii)(II), by inserting ``, including 
     through public or private entities'' before the semicolon; 
     and
       (ii) in subparagraph (C), by adding at the end the 
     following new clause:
       ``(v)(I) For purposes of determining the amount and degree 
     of personal care services provided under clause (i) with 
     respect to a veteran described in subclause (II), the 
     Secretary shall take into account relevant documentation 
     evidencing the provision of personal care services with 
     respect to the veteran during the preceding three-year 
     period.
       ``(II) A veteran described in this subclause is a veteran 
     whose need for personal care services as described in 
     paragraph (2)(C) is based in whole or in part on--
       ``(aa) a diagnosis of mental illness or history of suicidal 
     ideation that puts the veteran at risk of self-harm; or
       ``(bb) a neurological disorder.''; and
       (C) by adding at the end the following new paragraph:
       ``(15) The Secretary shall establish a process and 
     requirements for clinicians of facilities of the Department--
       ``(A) to document incidents in which an eligible veteran 
     participating in the program established under paragraph 
     (1)--
       ``(i) presents at such a facility for treatment for an 
     emergent or urgent mental health crisis; or
       ``(ii) is assessed by such a clinician to be at risk for 
     suicide; and
       ``(B) to provide such documentation, including any safety 
     plans developed and referrals made to a suicide prevention 
     coordinator of the Department, to such program.'';
       (2) in subsection (b)(2)(B), by striking ``neurological'' 
     and inserting ``a neurological disorder''; and
       (3) in subsection (d)--
       (A) by redesignating paragraph (4) as paragraph (5);
       (B) by inserting after paragraph (3) the following new 
     paragraph (4):
       ``(4) the term `neurological disorder' means a disease of 
     the brain, spinal cord, nerves, or neuromuscular system.''; 
     and
       (C) in paragraph (5)(B), as redesignated by subparagraph 
     (A), by striking ``neurological'' and inserting ``a 
     neurological disorder''.
       (b) Timing for Establishment of Requirements and 
     Processes.--
       (1) Report.--Not later than one year after the date of the 
     enactment of this Act, the Secretary of Veterans Affairs 
     shall--
       (A) establish the process and requirements required under 
     paragraph (15) of section 1720G(a) of title 38, United States 
     Code, as added by subsection (a)(1)(B); and
       (B) submit to the Committee on Veterans' Affairs of the 
     Senate and the Committee on Veterans' Affairs of the House of 
     Representatives a description of such process and 
     requirements.
       (2) Certification.--
       (A) In general.--Not later than one year after the date of 
     the enactment of this Act, the Secretary of Veterans Affairs 
     shall require all clinicians of facilities of the Department 
     to certify to the Secretary that the clinician understands 
     the process and requirements established under paragraph 
     (1)(A).
       (B) Facilities of the department defined.--In this 
     paragraph, the term ``facilities of the Department'' has the 
     meaning given that term in section 1701 of title 38, United 
     States Code.

     SEC. 202. REQUIREMENTS RELATING TO EVALUATIONS, ASSESSMENTS, 
                   AND REASSESSMENTS RELATING TO ELIGIBILITY OF 
                   VETERANS AND CAREGIVERS FOR FAMILY CAREGIVER 
                   PROGRAM.

       (a) In General.--Subsection (a) of section 1720G of title 
     38, United States Code, as amended by section 201(a)(1), is 
     further amended by adding at the end the following new 
     paragraphs:
       ``(16)(A) For purposes of conducting evaluations and 
     assessments to determine eligibility of a veteran and 
     caregiver for the program established under paragraph (1) or 
     conducting reassessments to determine continued eligibility 
     for such program, the Secretary shall--
       ``(i) take into account relevant documentation and medical 
     records generated by Department and non-Department health 
     care providers, including qualified mental health 
     professionals and neurological specialists;
       ``(ii) if the caregiver of the veteran claims that the 
     serious injury or need for personal care services of the 
     veteran as described in paragraph (2) is based in whole or in 
     part on psychological trauma or another mental disorder, 
     ensure--
       ``(I) a qualified mental health professional that treats 
     the veteran participates in the evaluation process; and
       ``(II) a qualified mental health professional participates 
     in the assessment or reassessment process; and
       ``(iii) if the caregiver of the veteran claims that the 
     serious injury or need for personal care services of the 
     veteran as described in paragraph (2) is based in whole or in 
     part on a neurological disorder, ensure--
       ``(I) a neurological specialist that treats the veteran 
     participates in the evaluation process; and
       ``(II) a neurological specialist participates in the 
     assessment or reassessment process.
       ``(B)(i) The Secretary shall establish an appropriate time 
     limit during a 24-hour period for the active participation of 
     a veteran in an evaluation, assessment, or reassessment to 
     determine eligibility of the veteran for the program 
     established under paragraph (1).
       ``(ii) In determining an appropriate time limit for a 
     veteran under clause (i), the Secretary shall--
       ``(I) take into consideration necessary accommodations for 
     the veteran stemming from the disability or medical condition 
     of the veteran; and
       ``(II) consult with the primary care provider, neurological 
     specialist, or qualified mental health professional that is 
     treating the veteran.
       ``(C) The Secretary shall not require the presence of a 
     veteran during portions of an evaluation, assessment, or 
     reassessment to determine eligibility of the veteran for the 
     program established under paragraph (1) that only require the 
     active participation of the caregiver.
       ``(D)(i) The Secretary shall make reasonable efforts to 
     assist a caregiver and veteran in obtaining evidence 
     necessary to substantiate the claims of the caregiver and 
     veteran in the application process for evaluation, 
     assessment, or reassessment for the program established under 
     paragraph (1).
       ``(ii)(I) As part of the assistance provided to a caregiver 
     or veteran under clause (i), the Secretary shall make 
     reasonable efforts to obtain relevant private records that 
     the caregiver or veteran adequately identifies to the 
     Secretary.
       ``(II) Whenever the Secretary, after making reasonable 
     efforts under subclause (I), is unable to obtain all of the 
     relevant records sought, the Secretary shall notify the 
     caregiver and veteran that the Secretary is unable to obtain 
     records with respect to the claim, which shall include--
       ``(aa) an identification of the records the Secretary is 
     unable to obtain;
       ``(bb) a brief explanation of the efforts that the 
     Secretary made to obtain such records; and
       ``(cc) an explanation that the Secretary will make a 
     determination based on the evidence of record and that this 
     clause does not prohibit the submission of records at a later 
     date if such submission is otherwise allowed.
       ``(III) The Secretary shall make not fewer than two 
     requests to a custodian of a private record in order for an 
     effort to obtain such record to be treated as reasonable 
     under subclause (I), unless it is made evident by the first 
     request that a second request would be futile in obtaining 
     such record.
       ``(iii) Under regulations prescribed by the Secretary, the 
     Secretary--
       ``(I) shall encourage a caregiver and veteran to submit 
     relevant private medical records of the veteran to the 
     Secretary to substantiate the claims of the caregiver and 
     veteran in the application process for evaluation, 
     assessment, or reassessment for the program established under 
     paragraph (1) if such submission does not burden the 
     caregiver or veteran; and
       ``(II) may require the caregiver or veteran to authorize 
     the Secretary to obtain such relevant private medical records 
     if such authorization is required to comply with Federal, 
     State, or local law.
       ``(17)(A) The Secretary, in consultation with a health care 
     provider, neurological specialist, or qualified mental health 
     professional that is treating a veteran, shall waive the 
     reassessment requirement for the veteran for participation in 
     the program established under paragraph (1) if--
       ``(i) the serious injury of the veteran under paragraph (2) 
     is significantly caused by a degenerative or chronic 
     condition; and
       ``(ii) such condition is unlikely to improve the dependency 
     of the veteran for personal care services.
       ``(B) The Secretary shall require a health care provider, 
     neurological specialist, or qualified mental health 
     professional that is treating a veteran to certify at 
     appropriate intervals determined by the Secretary the 
     clinical decision of the provider, specialist, or 
     professional under subparagraph (A).
       ``(C) The Secretary may rescind a waiver under subparagraph 
     (A) with respect to a veteran and require a reassessment of 
     the veteran if a health care provider, neurological 
     specialist, or qualified mental health professional that is 
     treating the veteran makes a clinical determination that the 
     level of dependency of the veteran for personal care services 
     has diminished since the last certification of the clinical 
     decision of

[[Page 5]]

     the provider, specialist, or professional under subparagraph 
     (B).''.
       (b) Definitions.--Subsection (d) of such section, as 
     amended by section 201(a)(3), is further amended--
       (1) by redesignating paragraph (5) as paragraph (6);
       (2) by inserting after paragraph (4) the following new 
     paragraph (5):
       ``(5) The term `neurological specialist' means a 
     neurologist, neuropsychiatrist, physiatrist, geriatrician, 
     certified brain injury specialist, neurology nurse, neurology

[[Page S1397]]

     nurse practitioner, neurology physician assistant, or such 
     other licensed medical professional as the Secretary 
     considers appropriate.''; and
       (3) by adding at the end the following new paragraph:
       ``(7) The term `qualified mental health professional' means 
     a psychiatrist, psychologist, licensed clinical social 
     worker, psychiatric nurse, licensed professional mental 
     health counselor, or other licensed mental health 
     professional as the Secretary considers appropriate.''.

     SEC. 203. AUTHORITY FOR SECRETARY OF VETERANS AFFAIRS TO 
                   AWARD GRANTS TO ENTITIES TO IMPROVE PROVISION 
                   OF MENTAL HEALTH SUPPORT TO FAMILY CAREGIVERS 
                   OF VETERANS.

       (a) In General.--Subchapter II of chapter 17 of title 38, 
     United States Code, as amended by section 104(a)(1), is 
     further amended by adding at the end the following new 
     section:

     ``Sec. 1720L. Grants to provide mental health support to 
       family caregivers of veterans

       ``(a) Purpose.--It is the purpose of this section to 
     provide for assistance by the Secretary to entities to carry 
     out programs that improve the provision of mental health 
     support to the family caregivers of veterans participating in 
     the family caregiver program.
       ``(b) Authority.--The Secretary may award grants to carry 
     out, coordinate, improve, or otherwise enhance mental health 
     counseling, treatment, or support to the family caregivers of 
     veterans participating in the family caregiver program.
       ``(c) Application.--(1) To be eligible for a grant under 
     this section, an entity shall submit to the Secretary an 
     application therefor at such time, in such manner, and 
     containing such information as the Secretary may require.
       ``(2) Each application submitted under paragraph (1) shall 
     include the following:
       ``(A) A detailed plan for the use of the grant.
       ``(B) A description of the programs or efforts through 
     which the entity will meet the outcome measures developed by 
     the Secretary under subsection (g).
       ``(C) A description of how the entity will distribute grant 
     amounts equitably among areas with varying levels of 
     urbanization.
       ``(d) Distribution.--The Secretary shall seek to ensure 
     that grants awarded under this section are equitably 
     distributed among entities located in States with varying 
     levels of urbanization.
       ``(e) Priority.--The Secretary shall prioritize awarding 
     grants under this section that will serve the following 
     areas:
       ``(1) Areas with high rates of veterans enrolled in the 
     family caregiver program.
       ``(2) Areas with high rates of--
       ``(A) suicide among veterans; or
       ``(B) referrals to the Veterans Crisis Line.
       ``(f) Required Activities.--Any grant awarded under this 
     section shall be used--
       ``(1) to expand existing programs, activities, and 
     services;
       ``(2) to establish new or additional programs, activities, 
     and services; or
       ``(3) for travel and transportation to facilitate carrying 
     out paragraph (1) or (2).
       ``(g) Outcome Measures.--(1) The Secretary shall develop 
     and provide to each entity that receives a grant under this 
     section written guidance on the following:
       ``(A) Outcome measures.
       ``(B) Policies of the Department.
       ``(2) In developing outcome measures under paragraph (1), 
     the Secretary shall consider the following goals:
       ``(A) Increasing the utilization of mental health services 
     among family caregivers of veterans participating in the 
     family caregiver program.
       ``(B) Reducing barriers to mental health services among 
     family caregivers of veterans participating in such program.
       ``(h) Tracking Requirements.--(1) The Secretary shall 
     establish appropriate tracking requirements with respect to 
     the entities receiving a grant under this section.
       ``(2) Not less frequently than annually, the Secretary 
     shall submit to Congress a report on such tracking 
     requirements.
       ``(i) Performance Review.--The Secretary shall--
       ``(1) review the performance of each entity that receives a 
     grant under this section; and
       ``(2) make information regarding such performance publicly 
     available.
       ``(j) Remediation Plan.--(1) In the case of an entity that 
     receives a grant under this section and does not meet the 
     outcome measures developed by the Secretary under subsection 
     (g), the Secretary shall require the entity to submit to the 
     Secretary a remediation plan under which the entity shall 
     describe how and when it plans to meet such outcome measures.
       ``(2) The Secretary may not award a subsequent grant under 
     this section to an entity described in paragraph (1) unless 
     the Secretary approves the remediation plan submitted by the 
     entity under such paragraph.
       ``(k) Funding Request.--In the budget justification 
     materials submitted to Congress in support of the budget of 
     the Department for any fiscal year (as submitted with the 
     budget of the President under section 1105(a) of title 31), 
     the Secretary shall include a separate statement of the 
     amount requested to be appropriated for that fiscal year to 
     carry out this section.
       ``(l) Authorization of Appropriations.--There is authorized 
     to be appropriated to the Secretary for each of fiscal years 
     2023 through 2025 $50,000,000 to carry out this section.
       ``(m) Definitions.--In this section:
       ``(1) The terms `caregiver' and `family caregiver' have the 
     meanings given those terms in section 1720G(d) of this title.
       ``(2) The term `family caregiver program' means the program 
     of comprehensive assistance for family caregivers under 
     section 1720G(a) of this title.
       ``(3) The term `Veterans Crisis Line' means the toll-free 
     hotline for veterans established under section 1720F(h) of 
     this title.''.
       (b) Clerical Amendment.--The table of sections at the 
     beginning of such subchapter, as amended by section 
     104(a)(2), is further amended by adding at the end the 
     following new item:

``1720L. Grants to provide mental health support to family caregivers 
              of veterans.''.

     SEC. 204. COMPTROLLER GENERAL REPORT ON MENTAL HEALTH SUPPORT 
                   FOR CAREGIVERS.

       (a) Report Required.--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 provision of 
     mental health support to caregivers of veterans.
       (b) Contents.--The report submitted under subsection (a) 
     shall include the following:
       (1) An assessment of the need for mental health support 
     among caregivers participating in the caregiver programs.
       (2) An assessment of options for mental health support in 
     facilities of the Department of Veterans Affairs and in the 
     community for caregivers participating in the caregiver 
     programs.
       (3) An assessment of the availability and accessibility of 
     mental health support in facilities of the Department and in 
     the community for caregivers participating in the caregiver 
     programs.
       (4) An assessment of the awareness among caregivers of the 
     availability of mental health support in facilities of the 
     Department and in the community for caregivers participating 
     in the caregiver programs.
       (5) An assessment of barriers to mental health support in 
     facilities of the Department and in the community for 
     caregivers participating in the caregiver programs.
       (c) Definitions.--In this section:
       (1) Caregiver.--The term ``caregiver'' has the meaning 
     given that term in section 1720G(d) of title 38, United 
     States Code.
       (2) Caregiver programs.--The term ``caregiver programs'' 
     means--
       (A) the program of comprehensive assistance for family 
     caregivers under subsection (a) of section 1720G of title 38, 
     United States Code; and
       (B) the program of support services for caregivers under 
     subsection (b) of such section.

                 TITLE III--MEDICINAL CANNABIS RESEARCH

     SEC. 301. DEFINITIONS.

       In this title:
       (1) Covered veteran.--The term ``covered veteran'' means a 
     veteran who is enrolled in the patient enrollment system of 
     the Department of Veterans Affairs established and operated 
     under section 1705(a) of title 38, United States Code.
       (2) Secretary.-- The term ``Secretary'' means the Secretary 
     of Veterans Affairs.

     SEC. 302. DEPARTMENT OF VETERANS AFFAIRS LARGE-SCALE, MIXED 
                   METHODS, RETROSPECTIVE QUALITATIVE STUDY ON THE 
                   EFFECTS OF CANNABIS ON CERTAIN HEALTH OUTCOMES 
                   OF VETERANS WITH CHRONIC PAIN AND POST-
                   TRAUMATIC STRESS DISORDER.

       (a) Study Required.--
       (1) In general.--The Secretary, through the Office of 
     Research and Development of the Department of Veterans 
     Affairs, shall carry out a large-scale, mixed methods, 
     retrospective, and qualitative study on the effects of 
     cannabis on the health outcomes of covered veterans diagnosed 
     with chronic pain and covered veterans diagnosed with post-
     traumatic stress disorder.
       (2) Observational study.--The study required by paragraph 
     (1) shall be conducted as an observational study on the 
     effects of cannabis use on the health of covered veterans.
       (3) Elements.--
       (A) In general.--The study required by paragraph (1) 
     shall--
       (i) triangulate a range of data sources;
       (ii) compare the positive and negative health outcomes of 
     covered veterans who use cannabis, utilizing outcomes that 
     can be measured in an electronic health record of the 
     Department and through data sets of the Department relating 
     to claims for benefits under the laws administered by the 
     Secretary;
       (iii) elicit the positive and negative outcomes of cannabis 
     use for covered veterans through semi-structured interviews;

[[Page 6]]

       (iv) estimate current and future health system needs to 
     address positive and negative outcomes of cannabis use for 
     covered veterans;
       (v) include a qualitative, open-ended survey provided to 
     covered veterans who have sought care from the Department for 
     chronic pain or post-traumatic stress disorder during the 
     five-year period preceding the survey; and
       (vi) include an assessment of--

       (I) all records within the Veterans Health Administration 
     for covered veterans participating in the study; and

[[Page S1398]]

       (II) all records within the Veterans Benefits 
     Administration for covered veterans participating in the 
     study.

       (B) Health outcomes.--A comparison of health outcomes under 
     subparagraph (A)(ii) shall include an assessment of the 
     following:
       (i) The reduction or increase in opiate use or dosage.
       (ii) The reduction or increase in benzodiazepine use or 
     dosage.
       (iii) The reduction or change in use of other types of 
     medication.
       (iv) The reduction or increase in alcohol use.
       (v) The reduction or increase in the prevalence of 
     substance abuse disorders.
       (vi) Sleep quality.
       (vii) Osteopathic pain (including pain intensity and pain-
     related outcomes).
       (viii) Agitation.
       (ix) Quality of life.
       (x) Mortality and morbidity.
       (xi) Hospital readmissions.
       (xii) Any newly developed or exacerbated health conditions, 
     including mental health conditions.
       (b) Implementation.--Not later than 180 days after the date 
     of the enactment of this Act, the Secretary shall commence 
     the implementation of the study required by subsection 
     (a)(1).
       (c) Duration of Study.--The study required by subsection 
     (a)(1) shall be carried out for an 18-month period.
       (d) Report.--
       (1) In general.--Not later than 90 days after the 
     completion of the study required by subsection (a)(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 study.
       (2) Ability to conduct clinical trials.--The Secretary 
     shall include in the report required by paragraph (1) an 
     assessment of whether the Secretary is able to meet the 
     criteria necessary to conduct the clinical trials required 
     under section 303, including consideration of subsection 
     (e)(1) of such section.

     SEC. 303. DEPARTMENT OF VETERANS AFFAIRS CLINICAL TRIALS ON 
                   THE EFFECTS OF CANNABIS ON CERTAIN HEALTH 
                   OUTCOMES OF VETERANS WITH CHRONIC PAIN AND 
                   POST-TRAUMATIC STRESS DISORDER.

       (a) Clinical Trials Required.--
       (1) In general.--If the Secretary indicates in the report 
     required by section 302(d) that the Secretary is able to meet 
     the criteria necessary to proceed to clinical trials, 
     commencing not later than 180 days after the submittal of 
     that report, the Secretary shall carry out a series of 
     clinical trials on the effects of cannabis appropriate for 
     investigational use, as determined by the Food and Drug 
     Administration under section 505(i) of the Federal Food, 
     Drug, and Cosmetic Act (21 U.S.C. 355(i)), on the health 
     outcomes of covered veterans diagnosed with chronic pain and 
     covered veterans diagnosed with post-traumatic stress 
     disorder.
       (2) Considerations.--The clinical trials required by 
     paragraph (1) shall include, as appropriate, an evaluation of 
     key symptoms, clinical outcomes, and conditions associated 
     with chronic pain and post-traumatic stress disorder, which 
     may include--
       (A) with respect to covered veterans diagnosed with chronic 
     pain, an evaluation of the effects of the use of cannabis 
     on--
       (i) osteopathic pain (including pain intensity and pain-
     related outcomes);
       (ii) the reduction or increase in opioid use or dosage;
       (iii) the reduction or increase in benzodiazepine use or 
     dosage;
       (iv) the reduction or increase in alcohol use;
       (v) the reduction or increase in the prevalence of 
     substance use disorders;
       (vi) inflammation;
       (vii) sleep quality;
       (viii) agitation;
       (ix) quality of life;
       (x) exacerbated or new mental health conditions; and
       (xi) suicidal ideation.
       (B) with respect to covered veterans diagnosed with post-
     traumatic stress disorder, an evaluation of the effects of 
     the use of cannabis on--
       (i) the symptoms of post-traumatic stress disorder (PTSD) 
     as established by or derived from the clinician administered 
     PTSD scale, the PTSD checklist, the PTSD symptom scale, the 
     post-traumatic diagnostic scale, and other applicable methods 
     of evaluating symptoms of post-traumatic stress disorder;
       (ii) the reduction or increase in benzodiazepine use or 
     dosage;
       (iii) the reduction or increase in alcohol use;
       (iv) the reduction or increase in the prevalence of 
     substance use disorders;
       (v) mood;
       (vi) anxiety;
       (vii) social functioning;
       (viii) agitation;
       (ix) suicidal ideation; and
       (x) sleep quality, including frequency of nightmares and 
     night terrors.
       (3) Optional elements.--The clinical trials required by 
     paragraph (1) may include, as appropriate, an evaluation of 
     the effects of the use of cannabis to treat chronic pain and 
     post-traumatic stress disorder on other symptoms, clinical 
     outcomes, and conditions not covered by paragraph (2), which 
     may include--
       (A) pulmonary function;
       (B) cardiovascular events;
       (C) head, neck, and oral cancer;
       (D) testicular cancer;
       (E) ovarian cancer;
       (F) transitional cell cancer;
       (G) intestinal inflammation;
       (H) motor vehicle accidents; or
       (I) spasticity.
       (b) Long-term Observational Study.--The Secretary may carry 
     out a long-term observational study of the participants in 
     the clinical trials required by subsection (a).
       (c) Type of Cannabis.--
       (1) In general.--In carrying out the clinical trials 
     required by subsection (a), the Secretary shall study varying 
     forms of cannabis, including whole plant raw material and 
     extracts, and may study varying routes of administration.
       (2) Plant cultivars.--Of the varying forms of cannabis 
     required under paragraph (1), the Secretary shall study plant 
     cultivars with varying ratios of tetrahydrocannabinol to 
     cannabidiol.
       (d) Implementation.--Not later than 18 months after the 
     date of the enactment of this Act, the Secretary shall--
       (1) develop a plan to implement this section and submit 
     such plan to the Committee on Veterans' Affairs of the Senate 
     and the Committee on Veterans' Affairs of the House of 
     Representatives; and
       (2) issue any requests for proposals the Secretary 
     determines appropriate for such implementation.
       (e) Termination of Clinical Trials.--
       (1) Clinical guideline requirements or excessive risk.--The 
     Secretary may terminate the clinical trials required by 
     subsection (a) if the Secretary determines that the 
     Department of Veterans Affairs is unable to meet clinical 
     guideline requirements necessary to conduct such trials or 
     the clinical trials would create excessive risk to 
     participants.
       (2) Completion upon submittal of final report.--The 
     Secretary may terminate the clinical trials required by 
     subsection (a) upon submittal of the final report required 
     under subsection (f)(2).
       (f) Reports.--
       (1) Periodic reports.--During the five-year period 
     beginning on the date of the commencement of clinical trials 
     required by subsection (a), the Secretary shall submit 
     periodically, but not less frequently than annually, to the 
     Committee on Veterans' Affairs of the Senate and the 
     Committee on Veterans' Affairs of the House of 
     Representatives reports on the implementation of this 
     section.
       (2) Final report.--Not later than one year after the 
     completion of the five-year period specified in 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 final report on the 
     implementation of this section.

     SEC. 304. ADMINISTRATION OF STUDY AND CLINICAL TRIALS.

       (a) Demographic Representation.--In carrying out the study 
     required by section 302 and the clinical trials required by 
     section 303, the Secretary shall ensure representation in 
     such study and trials of demographics that represent the 
     population of veterans in the United States, as determined by 
     the most recently available data from the American Community 
     Survey of the Bureau of the Census.
       (b) Data Preservation.--The Secretary shall ensure that the 
     study required by section 302 and the clinical trials 
     required by section 303 include a mechanism to ensure--
       (1) the preservation of all data, including all data sets 
     and survey results, collected or used for purposes of such 
     study and trials in a manner that will facilitate further 
     research; and
       (2) registration of such data in the database of privately 
     and publicly funded clinical studies maintained by the 
     National Library of Medicine (or successor database).
       (c) Anonymous Data.--The Secretary shall ensure that data 
     relating to any study or clinical trial conducted under this 
     Act is anonymized and cannot be traced back to an individual 
     patient.
       (d) Effect on Other Benefits.--The eligibility or 
     entitlement of a covered veteran to any other benefit under 
     the laws administered by the Secretary or any other provision 
     of law shall not be affected by the participation of the 
     covered veteran in the study under section 302, a clinical 
     trial under section 303(a), or a study under section 303(b).
       (e) Effect on Other Laws.--Nothing in this Act shall affect 
     or modify--
       (1) the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 301 
     et seq.);
       (2) section 351 of the Public Health Service Act (42 U.S.C. 
     262); or
       (3) the authority of the Commissioner of Food and Drugs and 
     the Secretary of Health and Human Services--
       (A) under--

[[Page 7]]

       (i) the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 301 
     et seq.); or
       (ii) section 351 of the Public Health Service Act (42 
     U.S.C. 262); or
       (B) to promulgate Federal regulations and guidelines 
     pertaining to cannabidiol, marijuana, or other subject matter 
     addressed in this title.

                       TITLE IV--HOUSING MATTERS

     SEC. 401. IMPROVEMENTS TO PROGRAM FOR DIRECT HOUSING LOANS 
                   MADE TO NATIVE AMERICAN VETERANS BY THE 
                   SECRETARY OF VETERANS AFFAIRS.

       (a) General Authorities and Requirements.--

[[Page S1399]]

       (1) Direct housing loans to native american veterans.--
     Section 3762(a) of title 38, United States Code, is amended 
     to read as follows:
       ``(a) The Secretary may make a direct housing loan to a 
     Native American veteran under this subchapter if the 
     Secretary ensures the following:
       ``(1) That each Native American veteran to whom the 
     Secretary makes a direct housing loan under this subchapter--
       ``(A) holds, possesses, or purchases using the proceeds of 
     the loan a meaningful interest in a lot or dwelling (or both) 
     that is located on trust land; and
       ``(B) will purchase, construct, or improve (as the case may 
     be) a dwelling on the lot using the proceeds of the loan.
       ``(2) That each such Native American veteran will convey to 
     the Secretary by an appropriate instrument the interest 
     referred to in paragraph (1)(A) as security for a direct 
     housing loan under this subchapter.
       ``(3) That the Secretary, including the Secretary's 
     employees or agents, may enter upon the trust land for the 
     purposes of carrying out such actions as the Secretary 
     determines are necessary, including--
       ``(A) to evaluate the advisability of the loan;
       ``(B) to monitor any purchase, construction, or 
     improvements carried out using the proceeds of the loan; and
       ``(C) to manage any servicing or post-foreclosure 
     activities, including acquisition, property inspections, and 
     property management.
       ``(4) That there are established standards and procedures 
     that apply to the foreclosure of the interest conveyed by a 
     Native American veteran pursuant to paragraph (2), 
     including--
       ``(A) procedures for foreclosing the interest; and
       ``(B) procedures for the resale of the lot or dwelling (or 
     both) purchased, constructed, or improved using the proceeds 
     of the loan.
       ``(5) That the loan is made in a responsible and prudent 
     manner, subject to standards and procedures as are necessary 
     for the reasonable protection of the financial interests of 
     the United States.''.
       (2) Memorandums of understanding, agreements, and 
     determinations.--Section 3762(b) of such title is amended to 
     read as follows:
       ``(b)(1) To carry out the purpose of subsection (a), the 
     Secretary may--
       ``(A) enter into a memorandum of understanding with a 
     tribal organization, other entity, or individual;
       ``(B) rely on agreements or determinations of other Federal 
     agencies to guarantee, insure, or make loans on trust land; 
     and
       ``(C) enter into other agreements or take such other 
     actions as the Secretary determines necessary.
       ``(2) If the Secretary determines that the requirements 
     under subsection (a) are not being enforced by a tribal 
     organization, other entity, or individual that is a party to 
     any memorandum of understanding, agreement, or determination 
     described in paragraph (1), the Secretary may cease making 
     new direct housing loans to Native Americans veterans under 
     this subchapter within the area of the authority of the 
     tribal organization, other entity, or individual (as the case 
     may be).''.
       (b) Direct Loans to Native American Veterans to Refinance 
     Existing Mortgage Loans.--Section 3762(h) of such title is 
     amended to read as follows:
       ``(h) The Secretary may make direct loans to Native 
     American veterans in order to enable such veterans to 
     refinance existing mortgage loans for any of the following 
     purposes:
       ``(1) To refinance an existing loan made under this 
     section, if the loan--
       ``(A) meets the requirements set forth in subparagraphs 
     (B), (C), and (E) of paragraph (1) of section 3710(e) of this 
     title;
       ``(B) will bear an interest rate at least one percentage 
     point less than the interest rate borne by the loan being 
     refinanced; and
       ``(C) complies with paragraphs (2) and (3) of section 
     3710(e) of this title, except that for the purposes of this 
     subsection the reference to subsection (a)(8) of section 3710 
     of this title in such paragraphs (2) and (3) shall be deemed 
     to be a reference to this subsection.
       ``(2) To refinance an existing mortgage loan not made under 
     this section on a dwelling owned and occupied by the veteran 
     as the veteran's home, if all of the following requirements 
     are met:
       ``(A) The loan will be secured by the same dwelling as was 
     the loan being refinanced.
       ``(B) The loan will provide the veteran with a net tangible 
     benefit.
       ``(C) The nature and condition of the property is such as 
     to be suitable for dwelling purposes.
       ``(D) The amount of the loan does not exceed either of the 
     following:
       ``(i) 100 percent of the reasonable value of the dwelling, 
     with such reasonable value determined under the procedures 
     established by the Secretary under subsection (d)(2).
       ``(ii) An amount equal to the sum of the balance of the 
     loan being refinanced and such closing costs (including any 
     discount points) as may be authorized by the Secretary to be 
     included in the loan.
       ``(E) Notwithstanding subparagraph (D), if a loan is made 
     for both the purpose of this paragraph and to make energy 
     efficiency improvements, the loan must not exceed either of 
     the following:
       ``(i) 100 percent of the reasonable value of the dwelling 
     as improved for energy efficiency, with such reasonable value 
     determined under the procedures established by the Secretary 
     under subsection (d)(2).
       ``(ii) The amount referred to under subparagraph (D)(ii), 
     plus the applicable amount specified under section 3710(d)(2) 
     of this title.
       ``(F) The loan meets all other requirements the Secretary 
     may establish under this subchapter.
       ``(G) The existing mortgage being refinanced is a first 
     lien on the property and secured of record.
       ``(3) To refinance an existing mortgage loan to repair, 
     alter, or improve a dwelling owned by the veteran and 
     occupied by the veteran as the veteran's home, if all of the 
     following requirements are met:
       ``(A) The loan will be secured by the same dwelling as was 
     the loan being refinanced.
       ``(B) The nature and condition of the property is such as 
     to be suitable for dwelling purposes, and the repair, 
     alteration, or improvement substantially protects or improves 
     the basic livability or utility of such property.
       ``(C) The amount of the loan, including the costs of 
     repairs, alterations, and improvements, does not exceed 
     either of the following:
       ``(i) 100 percent of the reasonable value of the dwelling 
     as repaired, altered, or improved, with such reasonable value 
     determined under the procedures established by the Secretary 
     under subsection (d)(2).
       ``(ii) An amount equal to the sum of--

       ``(I) the balance of the loan being refinanced;
       ``(II) the actual cost of repairs, alterations, or 
     improvements; and
       ``(III) such closing costs (including any discount points) 
     as may be authorized by the Secretary to be included in the 
     loan.

       ``(D) The loan meets all other requirements the Secretary 
     may establish under this subchapter.
       ``(E) The existing mortgage loan being refinanced is a 
     first lien on the property and secured of record.''.
       (c) Expansion of Outreach Program on Availability of Direct 
     Housing Loans for Native American Veterans.--Section 
     3762(i)(2) of such title is amended by adding at the end the 
     following new subparagraph:
       ``(G) Pursuant to subsection (g)(4), assisting Native 
     American veterans in qualifying for mortgage financing by--
       ``(i) partnering with local service providers, such as 
     tribal organizations, tribally designated housing entities, 
     Native community development financial institutions, and 
     nonprofit organizations, for conducting outreach, homebuyer 
     education, housing counseling, and post-purchase education; 
     and
       ``(ii) providing other technical assistance as needed.
       ``(H) Attending conferences and conventions conducted by 
     the network of Native community development financial 
     institutions and other Native American homeownership 
     organizations to provide information and training to Native 
     community development financial institutions about the 
     availability of the relending program under section 3762A of 
     this title.''.
       (d) Adequate Personnel.--Section 3762 of such title is 
     amended by adding at the end the following new subsection:
       ``(k) The Secretary shall assign a sufficient number of 
     personnel of the Department dedicated to carrying out the 
     authority of the Secretary under this subchapter, including 
     construction and valuation specialists to assist with issues 
     unique to new construction and renovations on trust land.''.
       (e) Definitions.--Section 3765 of such title is amended--
       (1) in paragraph (1)--
       (A) by amending subparagraph (C) to read as follows:
       ``(C) is located in the State of Alaska within a region 
     established under section 7(a) of the Alaska Native Claims 
     Settlement Act (43 U.S.C. 1606(a));'';
       (B) in subparagraph (D), by striking the period at the end 
     and inserting a semicolon; and
       (C) by adding at the end the following new subparagraphs:
       ``(E) is defined by the Secretary of the Interior and 
     recognized by the United States as land over which an Indian 
     Tribe has governmental dominion; or
       ``(F) is on any land that the Secretary determines is 
     provided to Native American veterans because of their status 
     as Native Americans.''; and
       (2) by adding at the end the following new paragraphs:
       ``(6) The term `community development financial 
     institution' has the meaning given that term in section 103 
     of the Community Development Banking and Financial 
     Institutions Act of 1994 (12 U.S.C. 4702).
       ``(7) The term `Indian Tribe' means any Indian tribe, band, 
     nation, or other organized

[[Page 8]]

     group or community, including any Alaska Native village or 
     regional or village corporation as defined in or established 
     pursuant to the Alaska Native Claims Settlement Act (43 
     U.S.C. 1601 et seq.), which is recognized as eligible for the 
     special programs and services provided by the United States 
     to Indians because of their status as Indians.
       ``(8) The term `Native community development financial 
     institution' means any entity--
       ``(A) that has been certified as a community development 
     financial institution by the Secretary of the Treasury;

[[Page S1400]]

       ``(B) that is not less than 51 percent owned or controlled 
     by Native Americans; and
       ``(C) for which not less than 51 percent of the activities 
     of the entity serve Native Americans.
       ``(9) The term `net tangible benefit' shall have such 
     meaning as the Secretary determines appropriate, but shall 
     include the refinance of an interim construction loan.
       ``(10) The term `other technical assistance' means services 
     to assist a Native American veteran to navigate the steps 
     necessary for securing a mortgage loan on trust land, 
     including pre-development activities related to utilities, 
     identifying appropriate residential construction services, 
     and obtaining lease clearances and title status reports from 
     the applicable tribal organization or the Bureau of Indian 
     Affairs.
       ``(11) The term `tribally designated housing entity' 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).''.
       (f) Interest Rate Reduction Financing Loan.--Section 
     3729(b)(4)(F) of such title is amended by striking 
     ``3762(h)'' and inserting ``3762(h)(1)''.
       (g) Regulations.--Section 3761 of such title is amended by 
     adding at the end the following new subsection:
       ``(c) The Secretary shall prescribe such regulations as may 
     be necessary to carry out this subchapter.''.

     SEC. 402. NATIVE COMMUNITY DEVELOPMENT FINANCIAL INSTITUTION 
                   RELENDING PROGRAM.

       (a) In General.--Subchapter V of chapter 37 of title 38, 
     United States Code, is amended by inserting after section 
     3762 the following new section:

     ``Sec. 3762A. Native community development financial 
       institution relending program

       ``(a) Purpose.--The Secretary may make a loan to a Native 
     community development financial institution for the purpose 
     of allowing the institution to relend loan amounts to 
     qualified Native American veterans, subject to the 
     requirements of this section.
       ``(b) Standards.--
       ``(1) In general.--The Secretary shall establish standards 
     to be used in evaluating whether to make a loan to a Native 
     community development financial institution under this 
     section.
       ``(2) Requirements.--In establishing standards under 
     paragraph (1), the Secretary shall ensure that a Native 
     community development financial institution--
       ``(A) is able to originate and service loans for single-
     family homes;
       ``(B) is able to operate the relending program in a manner 
     consistent with the mission of the Department to serve 
     veterans; and
       ``(C) uses loan amounts received under this section only 
     for the purpose of relending, as described in subsection (c), 
     to Native American veterans.
       ``(c) Relending Requirements.--
       ``(1) In general.--A Native community development financial 
     institution that receives a loan under this section shall use 
     the loan amounts to make loans to Native American veterans 
     residing on trust land.
       ``(2) Requirements.--A loan to a Native American veteran 
     made by a Native community development financial institution 
     under paragraph (1) shall--
       ``(A) be limited either to the purpose of purchase, 
     construction, or improvement of a dwelling located on trust 
     land or to the refinance of an existing mortgage loan for a 
     dwelling on trust land, consistent with the requirements of 
     section 3762(h) of this title; and
       ``(B) comply with such terms and conditions as the 
     Secretary determines are necessary to protect against 
     predatory lending, including the interest rate charged on a 
     loan to a Native American veteran.
       ``(d) Repayment.--A loan made to a Native community 
     development financial institution under this section shall--
       ``(1) be payable to the Secretary upon such terms and 
     conditions as are prescribed in regulations pursuant to this 
     subchapter; and
       ``(2) bear interest at a rate of one percent.
       ``(e) Oversight.--Subject to notice and opportunity for a 
     hearing, whenever the Secretary finds with respect to loans 
     made under subsections (a) or (c) that any Native community 
     development financial institution has failed to maintain 
     adequate loan accounting records, to demonstrate proper 
     ability to service loans adequately, or to exercise proper 
     credit judgment, or that such Native community development 
     financial institution has willfully or negligently engaged in 
     practices otherwise detrimental to the interest of veterans 
     or of the Government, the Secretary may take such actions as 
     the Secretary determines necessary to protect veterans or the 
     Government, such as requiring immediate repayment of any 
     loans made under subsection (a) and the assignment to the 
     Secretary of loans made under subsection (c).''.
       (b) Clerical Amendment.--The table of sections at the 
     beginning of chapter 37 of such title is amended by inserting 
     after the item relating to section 3762 the following new 
     item:

``3762A. Native community development financial institution relending 
              program.''.
       (c) Native American Veteran Housing Loan Program Account.--
     Section 3763 of such title is amended by adding at the end 
     the following new subsection:
       ``(c) Of amounts available in the Account, the Secretary 
     may use for loans made under section 3762A of this title--
       ``(1) in fiscal year 2024, not more than $5,000,000; and
       ``(2) in any fiscal year after fiscal year 2024, an amount 
     as determined necessary by the Secretary to meet the demand 
     for such loans.''.

     SEC. 403. DEPARTMENT OF VETERANS AFFAIRS HOUSING LOAN FEES.

       The loan fee table in section 3729(b)(2) of title 38, 
     United States Code, as most recently amended by section 204 
     of the Joseph Maxwell Cleland and Robert Joseph Dole Memorial 
     Veterans Benefits and Health Care Improvement Act of 2022 
     (division U of Public Law 117-328), is further amended by 
     striking ``November 14, 2031'' each place it appears and 
     inserting ``March 14, 2032''.

                         TITLE V--OTHER MATTERS

     SEC. 501. AUTHORITY FOR SECRETARY OF VETERANS AFFAIRS TO 
                   AWARD GRANTS TO STATES TO IMPROVE OUTREACH TO 
                   VETERANS.

       (a) In General.--Chapter 63 of title 38, United States 
     Code, is amended--
       (1) by redesignating sections 6307 and 6308 and sections 
     6308 and 6309, respectively; and
       (2) by inserting after section 6306 the following new 
     section 6307:

     ``Sec. 6307. Grants to States to improve outreach to veterans

       ``(a) Purpose.--It is the purpose of this section to 
     provide for assistance by the Secretary to States to carry 
     out programs that improve outreach and assistance to veterans 
     and the spouses, children, and parents of veterans, to ensure 
     that such individuals are fully informed about, and assisted 
     in applying for, any veterans and veterans-related benefits 
     and programs (including State veterans programs) for which 
     they may be eligible.
       ``(b) Authority.--The Secretary may award grants to 
     States--
       ``(1) to carry out, coordinate, improve, or otherwise 
     enhance--
       ``(A) outreach activities; or
       ``(B) activities to assist in the development and submittal 
     of claims for veterans and veterans-related benefits; or
       ``(2) to increase the number of county or tribal veterans 
     service officers serving in the State by hiring new, 
     additional such officers.
       ``(c) Application.--(1) To be eligible for a grant under 
     this section, a State shall submit to the Secretary an 
     application therefor at such time, in such manner, and 
     containing such information as the Secretary may require.
       ``(2) Each application submitted under paragraph (1) shall 
     include the following:
       ``(A) A detailed plan for the use of the grant.
       ``(B) A description of the programs through which the State 
     will meet the outcome measures developed by the Secretary 
     under subsection (i).
       ``(C) A description of how the State will distribute grant 
     amounts equitably among counties with varying levels of 
     urbanization.
       ``(D) A plan for how the grant will be used to meet the 
     unique needs of American Indian veterans, Alaska Native 
     veterans, or Native Hawaiian veterans, elderly veterans, and 
     veterans from other underserved communities.
       ``(d) Distribution.--The Secretary shall seek to ensure 
     that grants awarded under this section are equitably 
     distributed among States with varying levels of urbanization.
       ``(e) Priority.--The Secretary shall prioritize awarding 
     grants under this section that will serve the following 
     areas:
       ``(1) Areas with a critical shortage of county or tribal 
     veterans service officers.
       ``(2) Areas with high rates of--
       ``(A) suicide among veterans; or
       ``(B) referrals to the Veterans Crisis Line.
       ``(f) Use of County or Tribal Veterans Service Officers.--A 
     State that receives a grant under this section to carry out 
     an activity described in subsection (b)(1) shall carry out 
     the activity through--
       ``(1) a county or tribal veterans service officer of the 
     State; or
       ``(2) if the State does not have a county or tribal 
     veterans service officer, or if the county or tribal veterans 
     service officers of the State cover only a portion of that 
     State, an appropriate entity of a State, local, or tribal 
     government, or another publicly funded entity, as determined 
     by the Secretary.
       ``(g) Required Activities.--Any grant awarded under this 
     section shall be used--
       ``(1) to expand existing programs, activities, and 
     services;
       ``(2) to hire new, additional county or tribal veterans 
     service officers; or
       ``(3) for travel and transportation to facilitate carrying 
     out paragraph (1) or (2).
       ``(h) Authorized Activities.--A grant under this section 
     may be used to provide education and training, including on-
     the-job training, for State, county, local, and tribal 
     government employees who provide (or when trained will 
     provide) veterans outreach services in order for those 
     employees to obtain

[[Page 9]]

     accreditation in accordance with procedures approved by the 
     Secretary.
       ``(i) Outcome Measures.--(1) The Secretary shall develop 
     and provide to each State that receives a grant under this 
     section written guidance on the following:
       ``(A) Outcome measures.
       ``(B) Policies of the Department.
       ``(2) In developing outcome measures under paragraph (1), 
     the Secretary shall consider the following goals:
       ``(A) Increasing the use of veterans and veterans-related 
     benefits, particularly among vulnerable populations.
       ``(B) Increasing the number of county and tribal veterans 
     service officers recognized by

[[Page S1401]]

     the Secretary for the representation of veterans under 
     chapter 59 of this title.
       ``(j) Tracking Requirements.--(1) With respect to each 
     grant awarded under this section, the Secretary shall track 
     the use of veterans and veterans-related benefits among the 
     population served by the grant, including the average period 
     of time between the date on which a veteran applies for such 
     a benefit and the date on which the veteran receives the 
     benefit, disaggregated by type of benefit.
       ``(2) Not less frequently than annually, the Secretary 
     shall submit to Congress a report on the information tracked 
     under paragraph (1).
       ``(k) Performance Review.--(1) The Secretary shall--
       ``(A) review the performance of each State that receives a 
     grant under this section; and
       ``(B) make information regarding such performance publicly 
     available.
       ``(l) Remediation Plan.--(1) In the case of a State that 
     receives a grant under this section and does not meet the 
     outcome measures developed by the Secretary under subsection 
     (i), the Secretary shall require the State to submit a 
     remediation plan under which the State shall describe how and 
     when it plans to meet such outcome measures.
       ``(2) The Secretary may not award a subsequent grant under 
     this section to a State described in paragraph (1) unless the 
     Secretary approves the remediation plan submitted by the 
     State.
       ``(m) Definitions.--In this section:
       ``(1) The term `county or tribal veterans service officer' 
     includes a local equivalent veterans service officer.
       ``(2) The term `Veterans Crisis Line' means the toll-free 
     hotline for veterans established under section 1720F(h) of 
     this title.
       ``(n) Funding Request.--In the budget justification 
     materials submitted to Congress in support of the Department 
     budget for any fiscal year (as submitted with the budget of 
     the President under section 1105(a) of title 31), the 
     Secretary shall include a separate statement of the amount 
     requested to be appropriated for that fiscal year to carry 
     out this section.
       ``(o) Authorization of Appropriations.--There is authorized 
     to be appropriated to the Secretary for each of fiscal years 
     2023, 2024, and 2025, $50,000,000 to carry out this 
     section.''.
       (b) Clerical Amendment.--The table of sections at the 
     beginning of chapter 63 of such title is amended by striking 
     the items relating to sections 6307 and 6308 and inserting 
     the following new items:

``6307. Grants to States to improve outreach to veterans.
``6308. Outreach for eligible dependents.
``6309. Biennial report to Congress.''.

     SEC. 502. OVERSIGHT OF COST OF WAR TOXIC EXPOSURES FUND.

       (a) Plan Required.--Not later July 1, 2023, 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 plan for 
     obligating and expending amounts in the Cost of War Toxic 
     Exposures Fund established by section 324(a) of title 38, 
     United States Code.
       (b) Contents.--The plan submitted pursuant to subsection 
     (a) shall include the following:
       (1) A detailed explanation for how the Secretary interprets 
     ``the delivery of veterans' health care associated with 
     exposure to environmental hazards'' for purposes of section 
     324(c)(1) of title 38, United States Code.
       (2) A list of the medical services most commonly sought 
     from the Department in connection with exposure to 
     environmental hazards in the active military, naval, air, or 
     space service.
       (3) A list of the medical conditions for which services 
     described in paragraph (2) of this subsection are most 
     commonly sought from the Department.
       (4) A detailed explanation of how the Secretary interprets 
     ``expenses incident to the delivery of veterans' health care 
     and benefits associated with exposure to environmental 
     hazards'' for purposes of paragraph (2) of such section.
       (5) A list of the expenses described in paragraph (4) of 
     this subsection.
       (6) A detailed description of how the Secretary interprets 
     ``medical and other research relating to exposure to 
     environmental hazards'' for purposes of paragraph (3) of such 
     section.
       (7) A list of the research described by such paragraph.
       (8) A detailed plan for tracking the following:
       (A) The health care furnished to individuals who became 
     eligible for or entitled to such heath care because of a 
     provision of or amendment made by the Honoring our PACT Act 
     of 2022 (Public Law 117-168; 136 Stat. 1759).
       (B) Reliance by toxic-exposed veterans on health care 
     provided to such veterans pursuant to the Honoring our PACT 
     Act of 2022 (Public Law 117-168; 136 Stat. 1759).
       (C) The costs incurred by the Department for the furnishing 
     of health care to toxic exposed veterans for conditions that 
     can be reasonably attributed to toxic exposure.
       (c) Monthly Reports.--
       (1) In general.--Not later than two weeks after the date of 
     the enactment of this Act, and not less frequently than once 
     every month thereafter, the Secretary shall submit to the 
     appropriate committees of Congress a report detailing the 
     obligations and expenditures by the Secretary with respect to 
     the amounts in the Cost of War Toxic Exposures Fund, 
     disaggregated by obligations and expenditures of the Veterans 
     Benefits Administration and the Veterans Health 
     Administration, including with respect to information 
     technology, general administration, operating expenses, and 
     research.
       (2) Appropriate committees of congress defined.--In this 
     subsection, the term ``appropriate committees of Congress'' 
     means--
       (A) the Committee on Veterans' Affairs, the Committee on 
     the Budget, and the Committee on Appropriations of the 
     Senate; and
       (B) the Committee on Veterans' Affairs, the Committee on 
     the Budget, and the Committee on Appropriations of the House 
     of Representatives.
       (d) Annual Audits.--Not later than one year after the date 
     of the enactment of this Act and not less frequently than 
     once each year thereafter, the Inspector General of the 
     Department of Veterans Affairs shall conduct an audit of the 
     obligation and expenditure of amounts in the Cost of War 
     Toxic Exposures Fund.
       (e) Comptroller General of the United States Reports.--
       (1) In general.--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 an interim report and a final report 
     on the degree to which the Secretary follows and executes the 
     plan submitted pursuant to subsection (a).
       (2) Contents.--Each report submitted under paragraph (1) 
     shall include the following:
       (A) An assessment of the methodology the Secretary uses to 
     create an annual budget for the Cost of War Toxic Exposures 
     Fund for inclusion in each budget of the President submitted 
     to Congress for a fiscal year pursuant to section 1105(a) of 
     title 31, United States Code.
       (B) Identification of such adverse consequences to programs 
     of the Department as the Comptroller General may find is 
     created by the implementation of such Fund.
       (C) An assessment of the long-term viability of the Cost of 
     War Toxic Exposures Fund, including budgetary implications on 
     future authorizing and appropriations legislation.
       (D) Recommendations for such legislative or administrative 
     action as may resolve or mitigate the adverse consequences 
     identified pursuant to subparagraph (B) or any long-term 
     viability issues that may be identified pursuant to the 
     assessment required by subparagraph (C).
       (f) Definitions of Toxic Exposure and Toxic-exposed 
     Veteran.--In this section, the terms ``toxic exposure'' and 
     ``toxic-exposed veteran'' have the meanings given such terms 
     in section 101 of title 38, United States Code.

                          ____________________