[House Report 117-382]
[From the U.S. Government Publishing Office]
117th Congress } { Report
HOUSE OF REPRESENTATIVES
2d Session } { 117-382
======================================================================
SUPPORT THE RESILIENCY OF OUR NATION'S GREAT VETERANS ACT OF 2022
_______
June 22, 2022.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Takano, from the Committee on Veterans' Affairs, submitted the
following
R E P O R T
[To accompany H.R. 6411]
The Committee on Veterans' Affairs, to whom was referred
the bill (H.R. 6411) to amend title 38, United States Code, to
make certain improvements in the mental health care provided by
the Department of Veterans Affairs, and for other purposes,
having considered the same, reports favorably thereon without
amendment and recommends that the bill do pass.
STRONG Veterans Act
The Committee on Veterans' Affairs, to which was referred
the bill (H.R. 6411) to improve mental health care services for
veterans, and for other purposes, having considered the same,
report favorably thereon and recommend that the bill do pass.
CONTENTS
Page
Purpose and Summary.............................................. 2
Background and Need for Legislation.............................. 2
Hearings......................................................... 3
Subcommittee Consideration....................................... 5
Committee Consideration.......................................... 5
Committee Votes..................................................
Section-by-Section Description................................... 5
Congressional Budget Office Cost Estimate........................ 9
Committee Oversight Findings..................................... 10
Constitutional Authority Statement............................... 10
Earmark Statement................................................ 10
Federal Mandates Statement....................................... 10
Advisory Committee Statement..................................... 10
Performance Goals................................................ 10
Supplemental, Additional, Dissenting, and Minority Views......... 10
Applicability to Legislative Branch.............................. 10
Statement on Duplication of Federal Programs..................... 10
Ramseyer Submission.............................................. 11
Purpose and Summary
H.R. 6411, the ``Supporting the Resiliency of Our Nation's
Great Veterans Act'' or ``STRONG Veterans Act,'' was introduced
by Representative Mark Takano, Chairman of the House Committee
on Veterans' Affairs, on January 18, 2022. H.R. 6411 would
improve mental health care and suicide prevention for veterans
through increased provider training, expanded outreach and
service delivery, improvements to the Veterans Crisis Line, and
additional research.
H.R. 6411 incorporates, in whole or in part, text of the
following eleven bills: H.R. 912 introduced by Representative
Brownley of California on February 8, 2021; S. 3293 introduced
by Senator Tester of Montana on December 1, 2021; H.R. 5073
introduced by Representative Delgado of New York on August 23,
2021; H.R. 2819 introduced by Representative Slotkin of
Michigan on April 22, 2021; S. 544 introduced by Senator Ernst
of Iowa on March 2, 2021; H.R. 5529 introduced by
Representative Miller-Meeks of Iowa on October 8, 2021; H.R.
5317 introduced by Representative Takano of California on
September 21, 2021; H.R. 4575 introduced by Representative
Peters of California on July 20, 2021; H.R. 4233 introduced by
Representative Murphy of North Carolina on June 29, 2021; H.R.
5029 introduced by Representative Rouzer of North Carolina on
August 13, 2021; and H.R. 5516 introduced by Representative
Ellzey of Texas on October 8, 2021.
Background and Need for Legislation
The rate of veteran suicide decreased in 2019, the most
recent year for which there are data, but suicide is
preventable and one death is too many. Veteran suicide
prevention remains the number one clinical priority for both
the Department of Veterans Affairs (VA) and this Committee.
Within a public health model of prevention, the Committee's
goal is for VA and its partners to mitigate veterans' suicide
risks (ranging from mental health challenges to interpersonal
stressors, financial problems, housing/food/employment
insecurity, and access to lethal means) and strengthen
protective factors (including access to high-quality,
effective, timely mental health care). This legislation
represents the Committee's intent to support VA in moving
forward with improved mental health workforce staffing and
training, increased outreach to underserved veteran
populations, enhanced delivery of high-quality care, expanded
crisis response capacity, and renewed investment in research
that will guide the next decade of assessment, prevention, and
intervention.
Expanding VA's workforce and ensuring it is well-trained in
evidence-based approaches to veteran suicide prevention and
mental health care provision is critical in meeting the demand
from veterans, who seek these services from VA in ever-
increasing numbers. While the hiring sections in this
legislation are subject to availability of appropriations, it
is the clear intent of Congress that VA meet the metrics and
timelines set forth herein. To this end, the Committee has
included authorizations for VA to expand the number of Vet
Center providers, mental health trainees, health professional
scholars, and peer specialists.
This legislation also seeks to ensure that VA and its
partners meet veterans ``where they live,'' both literally and
figuratively, on issues related to health and wellbeing. This
focus must include proactive efforts to identify and engage
veterans who are not already served by VA in light of the
increased risk for suicide in that veteran subpopulation.
Sections of this bill focus on directing VA to more
consistently and comprehensively seek out, partner with, and
provide care to Native veterans and to open VA's Governors'
Challenge Program to tribes. Other sections expand access to
Vet Centers, close to where veterans live, study, and work. One
section also mandates that VA significantly increase the
staffing and work of its Veterans Justice Outreach program to
better identify and meet the needs of veterans involved with
the criminal justice system. In all of these sections, the
Committee's intent is to expeditiously expand VA's existing
outreach efforts, given the known relationships between these
factors and death by suicide.
The Committee included a section codifying VA's existing
Solid Start program, given early data showing the program's
success in reducing suicide rates during the notoriously high-
risk one-year period following separation from active duty. The
Committee recommends that VA add texting capacity and
recommendations to the Solid Start protocols to potentially
reach more veterans by incorporating multiple outreach formats.
One title of this legislation focuses on assessing and
further strengthening the Veterans Crisis Line (VCL), a
critical component of VA's suicide prevention program providing
crisis care and follow-up to veterans at imminent risk of harm
to self or others via phone/text/chat. With the nationwide
rollout of a new, three-digit crisis hotline number in July of
2022, the Committee will continue rigorous oversight of VA's
planning and implementation to meet likely surges in demand for
VCL services and the need for increased VCL responder and VA
mental health provider capacity.
VA has been a leader in sponsoring research that has led to
dramatic improvements in how we conceive of, prevent, and treat
mental illness and suicidality in veterans and society at
large. Findings from studies funded by VA's Office of Research
and Development and the National Center for PTSD have led to
fundamental changes in how veterans' suffering may be
alleviated and eliminated. The Committee's intent in calling
for more research by VA and its partners is to push the
boundaries of what we know and to discover new and improved
approaches to preventing suicide and helping veterans thrive.
The studies mandated in this bill call for methodologically
rigorous investigations of the interactions between frequently
co-occurring sleep problems, substance use, traumatic brain
injuries, and mental health challenges; VA's capacity to treat
veterans with these co-occurring issues; and the promise of
technology to vastly expand veterans' access to effective
treatments.
Hearings
Components of H.R. 6411 were considered in legislative
hearings. H.R. 912 was previously introduced in the 116th
Congress as H.R. 8068. On September 10, 2020, the Subcommittee
on Health of the House Committee on Veterans' Affairs conducted
a legislative hearing on various bills introduced during the
116th Congress. H.R. 8068 was among the bills considered during
this hearing. The following witnesses testified: Ms. Lindsay
Church, Executive Director, Minority Veterans of America; Ms.
Maureen Elias, Associate Legislative Director, Paralyzed
Veterans of America; Ms. Joy Ilem, National Legislative
Director, Disabled American Veterans; Mr. Patrick Murray,
Director, National Legislative Service, Veterans of Foreign
Wars; Dr. Russell Lemle, Senior Policy Analyst, Veterans
Healthcare Policy Institute; Lieutenant Colonel Jim Lorraine
(Ret.), President & CEO, America's Warrior Partnership.
On July 14, 2021, the Subcommittee on Health of the
House Committee on Veterans' Affairs conducted a
legislative hearing on various bills introduced during
the 117th Congress. One bill considered in this
hearing, H.R. 4233, was incorporated into H.R. 6411.
The following witnesses testified: The Honorable Mark
Takano, U.S. House of Representatives, 41st District of
California; The Honorable Chris Pappas, U.S. House of
Representatives, 1st District of New Hampshire; The
Honorable Conor Lamb, U.S. House of Representatives,
17th District of Pennsylvania; The Honorable Jason
Crow, U.S. House of Representatives, 6th District of
Colorado; The Honorable Lauren Underwood, U.S. House of
Representatives, 14th District of Illinois; The
Honorable Greg Murphy, U.S. House of Representatives,
3rd District of North Carolina; Mr. David Perry, Chief
Officer, Workforce Management and Consulting, Veterans
Health Administration, U.S. Department of Veterans
Affairs; accompanied by Mr. Mike Fisher, MSW, Chief
Officer, Readjustment Counseling Service, Veterans
Health Administration, U.S. Department of Veterans
Affairs; Mr. Marquis Barefield, Assistant National
Legislative Director, Disabled American Veterans (DAV);
Mr. Andy Blevins, Operations & Policy Director,
Minority Veterans of America (MVA); Ms. Tammy Barlet,
Deputy Director, National Legislative Service,Veterans
of Foreign Wars (VFW).
On October 13, 2021, the Subcommittee on Health of
the House Committee on Veterans' Affairs conducted a
legislative hearing on various bills introduced during
the 117th Congress. Of the considered bills, the
following were incorporated into H.R. 6411: H.R. 2819,
H.R. 4575, H.R. 5029, H.R. 5073, H.R. 5317, H.R. 5516,
and H.R. 5529. The following witnesses testified: The
Honorable Mark Takano, U.S. House of Representatives,
41st District of California; The Honorable Elissa
Slotkin, U.S House of Representatives, 8th District of
Michigan; The Honorable Scott Peters, U.S. House of
Representatives, 52nd District of California; The
Honorable David Rouzer, U.S. House of Representatives,
7th District of North Carolina; The Honorable Antonio
Delgado, U.S. House of Representatives, 19th District
of New York; The Honorable Mikie Sherrill, U.S. House
of Representatives, 11th District of New Jersey; The
Honorable Josh Harder, U.S. House of Representatives,
10th District of California; The Honorable Lauren
Underwood, U.S House of Representatives, 14th District
of Illinois; The Honorable Mariannette Miller-Meeks,
U.S. House of Representatives, 2nd District of Iowa;
The Honorable Jake Ellzey, U.S. House of
Representatives, 6th District of Texas; Dr. David
Carroll, Executive Director, Office of Mental Health &
Suicide Prevention, Veterans Health Administration,
U.S. Department of Veterans Affairs; accompanied by Dr.
Robert Sherrier, Executive Director, National
Teleradiology Program, Veterans Health Administration,
U.S. Department of Veterans Affairs; Karen M. Ott, DNP,
RN, Director for Policy, Legislation, and Professional
Standards; Office of Nursing Services, Veterans Health
Administration, U.S. Department of Veterans Affairs;
Mr. Michael Fisher, Chief Readjustment Counseling
Officer, Veterans Health Administration, U.S.
Department of Veterans Affairs; Mr. Marquis Barefield,
Assistant National Legislative Director, Disabled
American Veterans; Ms. Tammy Barlet, Deputy Director,
National Legislative Service, Veterans of Foreign Wars;
Dr. Kaki York-Ward, President, Association of VA
Psychology Leaders.
On June 23, 2021, the Senate Committee on Veterans'
Affairs conducted a hearing on pending legislation. One
bill considered in this hearing, S. 544, was
incorporated into H.R. 6411. The following witnesses
testified: Mark Upton, MD, Acting Assistant Under
Secretary of Health for Community Care, Veterans Health
Administration, Department of Veterans Affairs;
accompanied by Gerard Cox, MD, Assistant Under
Secretary for Health for Quality & Patient Safety;
Clifford Smith, MD, Deputy Director, Office of Mental
Health Operations; Theresa Gleason, PhD, Director,
Clinical Science Research & Development Service; Joy
Ilem, National Legislative Director, Disabled American
Veterans; Kathryn Monet, Chief Executive Officer,
National Coalition for Homeless Veterans; Mario A.
Marquez, Director, Veterans Affairs and Rehabilitation
Division, The American Legion.
Subcommittee Consideration
Component bills of H.R. 6411 were considered before the
full Committee
Committee Consideration
On February 2, 2022, the full Committee met in an open
markup session, a quorum being present, to consider H.R. 6411.
No amendments were offered on H.R. 6411. By a voice vote,
the Committee ordered that H.R. 6411, as introduced, be ordered
favorably reported to the House of Representatives.
Section-by-Section Description
Section 1: Short Title; References to Title 38, United States Code;
Table of Contents.
This section includes a table of contents and specifies
that this Act may be cited as the ``Strengthening the
Resiliency of Our Nation's Great Veterans Act'' or the ``STRONG
Veterans Act.''
TITLE I--TRAINING TO SUPPORT VETERANS' MENTAL HEALTH
Sec. 101. Mental health and suicide prevention outreach to
minority veterans and American Indian and Alaska Native
veterans.--While Native Americans serve in the US military in
disproportionately high rates, Native American veterans die by
suicide at disproportionately high rates, as well. This section
directs VA to ensure that every VA medical center has at least
one minority veteran coordinator, trained by VA in consultation
with tribes and tribal programs in culturally appropriate
mental health promotion and suicide prevention approaches. The
minority veteran coordinators must work with facility suicide
prevention coordinators to document and implement mental health
outreach and services to tribes in their catchment areas.
Sec. 102. Expansion of Vet Center workforce.--This section
increases Vet Center capacity by mandating the hiring of 50
additional full-time equivalent employees for Vet Centers.
Sec. 103. VA Mental Health Training Spots.--Within three
years, this section directs VA to add an additional 250 paid
trainee slots in covered mental health disciplines to the VA
workforce. The term ``covered mental health disciplines''
refers to psychiatry, psychology, advanced practice nursing
(with a focus on mental health or substance use disorder),
social work, licensed professional mental health counseling,
and marriage and family therapy.
Sec. 104. Scholarship Expansion.--This section directs VA
to include not fewer than an additional (as compared to
academic year 2021) 50 awards per academic year under the
Department of Veterans Affairs Health Professional Scholarship
Program under subchapter II of chapter 76 of title 38, United
States Code, for applicants otherwise eligible for such program
who are pursuing degrees or training in mental health
disciplines, including advanced practice nursing (with a focus
on mental health or substance use disorder), psychology, and
social work.
TITLE II--VETERANS CRISIS LINE
Sec. 201 Veterans Crisis Line.
Subtitle A--Veterans Crisis Line
Training and Quality Management
Sec. 211. Staff training.
Sec. 212. Quality review and management.
Sec. 213. Guidance for high-Risk callers.
Sec. 214. Oversight of training of social
service assistants and clarification of job
responsibilities.
Subtitle B--Pilot Programs and Research
on Veterans Crisis Line
Sec. 221. Pilot programs.
Sec. 222. Authorization of appropriations
for research on effectiveness and opportunities
for improvement of Veterans Crisis Line.
Subtitle C--Transition of Crisis Line
Number
Sec. 231. Feedback on transition of
crisis line number.
This section directs a series of actions to improve the
Veterans Crisis Line training and quality management, evaluate
its effectiveness, and ensure enough resources are available as
the new 3-digit crisis line number goes into effect in July,
2022.
TITLE III--OUTREACH TO VETERANS
Sec. 301. Solid Start program of the Department of Veterans
Affairs.--This section authorizes in statute VA's existing
Solid Start program for proactively reaching out to veterans
who have recently separated from military service.
Sec. 302. Designation of Buddy Check Week by Secretary of
Veterans Affairs.--This directs the Secretary of VA to
designate one week each year to organize outreach events and
educate veterans on how to conduct peer wellness checks.
Sec. 303. Improvements to Veterans Justice Outreach
Program.--This provision requires VA to improve its outreach to
justice-involved veterans, Veterans Service Organizations, and
stakeholders in the criminal justice community (including law
enforcement, court officials, and jail administrators), to
improve awareness of VA's Veterans Justice Outreach (VJO)
program. It also requires VA to increase the number of VJO
specialists serving justice-involved veterans in rural, remote,
or underserved areas. In addition, VA is directed to carry out
mandatory annual training for VJO specialists and establish
performance goals, measures, and implementation timelines for
the VJO program and its outreach specialists.
Sec. 304. Department of Veterans Affairs Governors
Challenge Program.--VA's Governors' Challenge program is an
existing, collaborative effort with the Substance Abuse and
Mental Health Services Administration (SAMHSA) to help states
develop veteran suicide prevention proposals. This bill gives
VA two new authorities within its existing Governors' Challenge
veteran suicide prevention program: 1) it directs VA to treat
tribes equal to states for the purpose of inclusion in the
program; and 2) it allows VA to provide not only technical
assistance to states and tribes, but also grants for actual
implementation of state and tribal veteran suicide prevention
proposals.
TITLE IV--MENTAL HEALTH CARE DELIVERY
Sec. 401. Expansion of peer specialist support program of
Department of Veterans Affairs.--Peer specialists at VA are
veterans in recovery from their own challenges with mental
illness and substance use, trained to help other veterans
successfully engage in treatment. They have been both popular
with veterans and effective. This bill gradually expands the
number of VA peer specialists in all VA medical centers.
Sec. 402. Expansion of Vet Center services.--This section
would make certain student veterans eligible for using Vet
Centers even if they would not meet Vet Center eligibility
criteria were they not currently students (for example, through
lack of combat deployments). Transitions--from military to
veteran status, and from non-student to student--are times of
increased stress and suicide risk, and it is crucial to support
increased access to the mental health and other services and
benefits during this time.
Sec. 403. Eligibility for mental health services.--This
section allows Vet Centers to provide readjustment counseling
and related mental health services to family members of
servicemembers or veterans who died by suicide. The definition
of ``family member'' includes individuals who are the parent,
spouse, child, step-family member, or extended family member of
a veteran or servicemember; and someone who lives with the
veteran or servicemember but is not a family member.
Sec. 404. Mental Health Consults.--This section amends the
US Code such that not later than thirty days after the date on
which a veteran submits to the VA Secretary a claim for
compensation under this chapter for service-connected
disability relating to a mental health diagnosis, the Secretary
shall offer the veteran a mental health consultation to assess
the mental health needs of and care options for the veteran.
TITLE V--RESEARCH
Sec. 501. Veterans Integration to Academic Leadership
(VITAL) Assessment Act.--This provision requires VA to submit
to Congress within one year of enactment a report on the
Veterans Integration to Academic Leadership (VITAL) program.
Specifically, VA must assess the number of VA medical centers,
institutions of higher learning, non-college degree programs,
and student veterans supported by the program. In addition, the
report must evaluate relevant trends since the program began,
including the levels of staff and resources allocated to the
program and the outcomes and effectiveness of the program. In
addition, VA's report must examine barriers to expanding the
program and how the Department plans to address these barriers.
Finally, VA's report must assess whether the program should be
expanded outside of VHA's Office of Mental Health and Suicide
Prevention to support student veterans with needs unrelated to
mental health or suicide.
Sec. 502. Improvement of sleep disorder care furnished by
Department of Veterans Affairs.--This section directs the
Secretary of VA to improve the assessment and treatment of
veterans with sleep disorders, including by conducting in home
sleep studies for veterans, following an analysis of the
ability of VA to treat sleep disorders among veterans,
including--(1) assessment and treatment options for such
disorders; (2) barriers to care for such disorders, such as
wait time, travel time, and lack of staffing; (3) the efficacy
of the clinical practice guidelines of VA and the Department of
Defense for such disorders; and (4) the availability of and
efficacy of the use by VA of cognitive behavioral therapy for
insomnia.
Sec. 503. Study on inpatient mental health and substance
use care from Department of Veterans Affairs.--This section
mandates that not later than one year after the date of the
enactment of this Act, the Secretary of VA shall complete the
conduct of a study on access of veterans to care under the
residential rehabilitation treatment programs of the Department
of Veterans Affairs to determine--(1) if there are sufficient
geographic offerings of inpatient mental health care,
especially for veterans in rural and remote communities; (2) if
there are sufficient bed spaces at each location, based on
demand and drive time from the homes of veterans; (3) if there
are any workforce-related capacity limitations at each
location, including if beds are unable to be used because there
are not enough providers to care for additional patients; (4)
if there are diagnosis-specific or sex-specific barriers to
accessing care under such programs; and (5) the average wait
time for a bed in such a program, broken out by--(A) Veterans
Integrated Service Network; (B) rural or urban area; (C) sex;
and (D) specialty (general program, substance use disorder
program, military sexual trauma program, etc.).
Sec. 504. Study on treatment from Department of Veterans
Affairs for co-occurring mental health and substance use
disorders.--This section directs VA to conduct a study
examining the availability of treatment programs for veterans
with co-occurring mental health and substance use disorders
(including both inpatient and outpatient care); any geographic
disparities in access to such programs, such as for rural and
remote veterans; and the average wait times for care under such
programs.
Sec. 505. Study on workload of suicide prevention teams of
Department of Veterans Affairs.--This provision directs VA to
conduct a study evaluating the workload of local suicide
prevention teams of the Department of Veterans Affairs. The
study shall identify the effects of the growth of the suicide
prevention program of the Department on the workload of suicide
prevention teams; incorporate key practices for staffing model
design in determining suicide prevention staffing needs; and
determine which facilities of the Department need increased
suicide prevention coordinator staffing to meet the needs of
veterans, with an emphasis placed on facilities with high
patient volume and facilities located in States with high rates
of veteran suicide.
Sec. 506. Expansion of suicide prevention and mental health
research.--This section authorizes an additional $10,000,000 to
be used by VA's Center of Excellence for Suicide Prevention of
the Department and the Rocky Mountain Mental Illness Research
Education and Clinical Center for the purposes of conducting
research on the factors impacting veteran suicide and best
practices for early intervention and support.
Sec. 507. Study on mental health and suicide prevention
support for military families.--This section directs the
Secretary of VA, in collaboration with the Secretary of
Defense, to conduct a study on secondary post-traumatic stress
disorder and depression and its impact on spouses, children,
and caregivers of members of the Armed Forces.
Sec. 508. Research on brain health.--This section
authorizes an additional $5,000,000 for ongoing and future
research at VA's Translational Research Center for traumatic
brain injury and stress disorders to provide better
understanding of and improved treatment options for post 9/11
veterans with traumatic brain injury or post-traumatic stress
disorder.
Sec. 509. Study on efficacy of clinical and at-home
resources for post-traumatic stress disorder.--This section
mandates that not later than two years after the date of the
enactment of this Act, the Secretary of VA, through VA's Office
of Research and Development, shall conduct a study on the
efficacy of clinical and at-home resources, such as mobile
applications like COVID Coach, for providers, veterans,
caregivers, and family members to use for dealing with
stressors; the feasibility and advisability of developing more
such resources; strategies for improving mental health care and
outcomes for veterans with post-traumatic stress disorder; and
best practices for helping family members of veterans deal with
secondary post-traumatic stress disorder or mental health
concerns.
Congressional Budget Office Cost Estimate
A formal cost estimate was not provided in time for the
filing of this report. The Congressional Budget Office informed
the Committee that this legislation will have no direct
budgetary effects.
Committee Oversight Findings
In compliance with clause 3(c)(1) of rule XIII and clause
(2)(b)(1) of rule X of the Rules of the House of
Representatives, the Committee's oversight findings and
recommendations are reflected in the descriptive portions of
this report.
Constitutional Authority Statement
Pursuant to Article I, section 8 of the United States
Constitution, H.R. 6411 is authorized by Congress' power to
``provide for the common Defense and general Welfare of the
United States.''
Earmark Statement
H.R. 6411 does not contain any Congressional earmarks,
limited tax benefits, or limited tariff benefits as defined in
clause 9 of rule XXI of the Rules of the House of
Representatives.
Federal Mandates Statement
The Committee adopts as its own the estimate of Federal
mandates regarding H.R. 6411, prepared by the Director of the
Congressional Budget Office pursuant to section 423 of the
Unfunded Mandates Reform Act.
Advisory Committee Statement
An advisory committee within the meaning of section 5(b) of
the Federal Advisory Committee Act would not be created by H.R.
6411.
Performance Goals
In accordance with clause 3(c)(4) of rule XIII of the Rules
of the House of Representatives, the Committee's performance
goals and objectives are to increase access to quality and
timely health care and benefits to veterans.
Supplemental, Additional, Dissenting, and Minority Views Applicability
to Legislative Branch
The Committee finds that H.R. 6411 does not relate to the
terms and condition of employment or access to public services
or accommodations within the meaning of section 102(b)(3) of
the Congressional Accountability Act.
Statement on Duplication of Federal Programs
Pursuant to clause 3(c)(5) of rule XIII of the Rules of the
House of Representatives, the Committee finds that no provision
of H.R. 6411 establishes or reauthorizes a program of the
Federal Government known to be duplicative of another Federal
program, a program that was included in any report from the
Government Accountability Office to Congress pursuant to
section 21 of Public Law 111-139, or a program related to a
program identified in the most recent Catalog of Federal
Domestic Assistance.
Ramseyer Submission
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italics, and existing law in which no
change is proposed is shown in roman):
TITLE 38, UNITED STATES CODE
* * * * * * *
PART II--GENERAL BENEFITS
* * * * * * *
CHAPTER 11--COMPENSATION FOR SERVICE-CONNECTED DISABILITY OR DEATH
SUBCHAPTER I--GENERAL
Sec.
* * * * * * *
SUBCHAPTER VI--GENERAL COMPENSATION PROVISIONS
* * * * * * *
1167. Mental health consultations.
* * * * * * *
SUBCHAPTER VI--GENERAL COMPENSATION PROVISIONS
* * * * * * *
Sec. 1167. Mental health consultations
(a) In General.--Not later than 30 days after the date on
which a veteran submits to the Secretary a claim for
compensation under this chapter for a service-connected
disability relating to a mental health diagnosis, the Secretary
shall offer the veteran a mental health consultation to assess
the mental health needs of, and care options for, the veteran.
(b) Availability.--The Secretary shall--
(1) offer a veteran a consultation under subsection
(a) without regard to any previous denial or approval
of a claim of that veteran for a service-connected
disability relating to a mental health diagnosis; and
(2) ensure that a veteran offered a mental health
consultation under subsection (a) may elect to receive
such consultation during the one-year period beginning
on the date on which the consultation is offered or
during such longer period beginning on such date as the
Secretary considers appropriate.
(c) Rule of Construction.--A consultation provided to a
veteran under this section shall not be construed as a
determination that any disability of such veteran is service-
connected for the purposes of any benefit under the laws
administered by the Secretary.
* * * * * * *
CHAPTER 17--HOSPITAL, NURSING HOME, DOMICILIARY, AND MEDICAL CARE
* * * * * * *
SUBCHAPTER II--HOSPITAL, NURSING HOME, OR DOMICILIARY CARE AND MEDICAL
TREATMENT
* * * * * * *
Sec. 1712A. Eligibility for readjustment counseling and related mental
health services
(a)(1)(A) Upon the request of any individual referred to in
subparagraph (C), the Secretary shall furnish counseling,
including by furnishing counseling through a Vet Center, to the
individual--
(i) in the case of an individual referred to in
[clauses (i) through (vi)] clauses (i) through (vii) of
subparagraph (C), to assist the individual in
readjusting to civilian life; and
(ii) in the case of an individual referred to [in
clause (vii)] in clause (viii) of such subparagraph who
is a family member of a veteran or member described in
such clause--
(I) in the case of a member who is deployed
in a theater of combat operations or an area at
a time during which hostilities are occurring
in that area, during such deployment to assist
such individual in coping with such deployment;
[and]
(II) in the case of a veteran or member who
is readjusting to civilian life, to the degree
that counseling furnished to such individual is
found to aid in the readjustment of such
veteran or member to civilian life[.]; and
(III) in the case of a veteran or member who
died by suicide, to the degree that counseling
furnished to such individual is found to aid in
coping with the effects of such suicide.
(B)(i) Counseling furnished to an individual under
subparagraph (A) may include a comprehensive individual
assessment of the individual's psychological, social, and other
characteristics to ascertain whether--
(I) in the case of an individual referred to in
[clauses (i) through (vi)] clauses (i) through (vii) of
subparagraph (C), such individual has difficulties
associated with readjusting to civilian life; and
(II) in the case of an individual referred to [in
clause (vii)] in clause (viii) of such subparagraph,
such individual has difficulties associated with--
(aa) coping with the deployment of a member
described in subclause (I) of such clause; [or]
(bb) readjustment to civilian life of a
veteran or member described in subclause (II)
of such clause[.]; or
(cc) coping with the effects of a
suicide described in subclause (III) of
such clause.
(ii)(I) Except as provided in subclauses (IV) and (V),
counseling furnished to an individual under subparagraph (A)
may include reintegration and readjustment services described
in subclause (II) furnished in group retreat settings.
(II) Reintegration and readjustment services described in
this subclause are the following:
(aa) Information on reintegration of the individual
into family, employment, and community.
(bb) Financial counseling.
(cc) Occupational counseling.
(dd) Information and counseling on stress reduction.
(ee) Information and counseling on conflict
resolution.
(ff) Such other information and counseling as the
Secretary considers appropriate to assist the
individual in reintegration into family, employment,
and community.
(III) In furnishing reintegration and readjustment services
under subclause (I), the Secretary shall offer women the
opportunity to receive such services in group retreat settings
in which the only participants are women.
(IV) An individual described in subparagraph (C)(v) may
receive reintegration and readjustment services under subclause
(I) of this clause only if the individual receives such
services with a family member described in subclause (I) or
(II) of such subparagraph.
(V) In each of fiscal years 2021 through 2025, the maximum
number of individuals to whom integration and readjustment
services may be furnished in group retreat settings under this
subclause (I) shall not exceed 1,200 individuals.
(C) Subparagraph (A) applies to the following individuals:
(i) Any individual who is a veteran or member of the
Armed Forces, including a member of a reserve component
of the Armed Forces, who served on active duty in a
theater of combat operations or an area at a time
during which hostilities occurred in that area.
(ii) Any individual who is a veteran or member of the
Armed Forces, including a member of a reserve component
of the Armed Forces, who provided direct emergency
medical or mental health care, or mortuary services to
the causalities of combat operations or hostilities,
but who at the time was located outside the theater of
combat operations or area of hostilities.
(iii) Any individual who is a veteran or member of
the Armed Forces, including a member of a reserve
component of the Armed Forces, who engaged in combat
with an enemy of the United States or against an
opposing military force in a theater of combat
operations or an area at a time during which
hostilities occurred in that area by remotely
controlling an unmanned aerial vehicle, notwithstanding
whether the physical location of such veteran or member
during such combat was within such theater of combat
operations or area.
(iv) Any individual who is a veteran or member of the
Armed Forces, including a member of a reserve component
of the Armed Forces, who served--
(I) on active service in response to a
national emergency or major disaster declared
by the President; or
(II) in the National Guard of a State under
orders of the chief executive of that State in
response to a disaster or civil disorder in
such State.
(v) Any individual who participated in a drug
interdiction operation as a member of the Coast Guard,
regardless of the location of that operation.
(vi) Any individual who received counseling under
this section before the date of the enactment of the
National Defense Authorization Act for Fiscal Year
2013.
(vii) Any veteran or member of the Armed Forces
pursuing a course of education using covered
educational assistance benefits.
[(vii)] (viii) Any individual who is a family member
of any--
(I) member of the Armed Forces, including a
member of a reserve component of the Armed
Forces, who is serving on active duty in a
theater of combat operations or in an area at a
time during which hostilities are occurring in
that area; [or]
(II) veteran or member of the Armed Forces
described in this subparagraph[.]; or
(III) veteran or member of the Armed Forces
who died by suicide.
(2)(A) Upon request of an individual described in paragraph
(1)(C), the Secretary shall provide the individual a
comprehensive individual assessment as described in paragraph
(1)(B)(i) as soon as practicable after receiving the request,
but not later than 30 days after receiving the request.
(B) Upon the request of an individual described in paragraph
(1)(C), the Secretary shall furnish the individual
reintegration and readjustment services in group retreat
settings under paragraph (1)(B)(ii) if the Secretary determines
the experience will be therapeutically appropriate.
(b)(1) If, on the basis of the assessment furnished under
subsection (a) of this section, a licensed or certified mental
health care provider employed by the Department (or, in areas
where no such licensed or certified mental health care provider
is available, a licensed or certified mental health care
provider carrying out such function under a contract or fee
arrangement with the Secretary) determines that the provision
of mental health services to such veteran is necessary to
facilitate the successful readjustment of the veteran to
civilian life, such veteran shall, within the limits of
Department facilities, be furnished such services on an
outpatient basis. For the purposes of furnishing such mental
health services, the counseling furnished under subsection (a)
of this section shall be considered to have been furnished by
the Department as a part of hospital care. Any hospital care
and other medical services considered necessary on the basis of
the assessment furnished under subsection (a) of this section
shall be furnished only in accordance with the eligibility
criteria otherwise set forth in this chapter (including the
eligibility criteria set forth in section 1784 of this title).
(2) Mental health services furnished under paragraph (1) of
this subsection may, if determined to be essential to the
effective treatment and readjustment of the veteran, include
such consultation, counseling, training, services, and expenses
as are described in sections 1782 and 1783 of this title.
(c) Upon receipt of a request for counseling under this
section from any individual who has been discharged or released
from active military, naval, air, or space service but who is
not otherwise eligible for such counseling, the Secretary
shall--
(1) provide referral services to assist such
individual, to the maximum extent practicable, in
obtaining mental health care and services from sources
outside the Department; and
(2) if pertinent, advise such individual of such
individual's rights to apply to the appropriate
military, naval, air, or space service, and to the
Department, for review of such individual's discharge
or release from such service.
(d) The Under Secretary for Health may provide for such
training of professional, paraprofessional, and lay personnel
as is necessary to carry out this section effectively, and, in
carrying out this section, may utilize the services of
paraprofessionals, individuals who are volunteers working
without compensation, and individuals who are veteran-students
(as described in section 3485 of this title) in initial intake
and screening activities.
(e)(1) In furnishing counseling and related mental health
services under subsections (a) and (b) of this section, the
Secretary shall have available the same authority to enter into
contracts or agreements with private facilities that is
available to the Secretary in furnishing medical services to
veterans suffering from total service-connected disabilities.
(2) Before furnishing counseling or related mental health
services described in subsections (a) and (b) of this section
through a contract facility, as authorized by this subsection,
the Secretary shall approve (in accordance with criteria which
the Secretary shall prescribe by regulation) the quality and
effectiveness of the program operated by such facility for the
purpose for which the counseling or services are to be
furnished.
(3) The authority of the Secretary to enter into contracts
under this subsection shall be effective for any fiscal year
only to such extent or in such amounts as are provided in
appropriation Acts.
(f) The Secretary, in cooperation with the Secretary of
Defense, shall take such action as the Secretary considers
appropriate to notify veterans who may be eligible for
assistance under this section of such potential eligibility.
(g) In carrying out this section and in furtherance of the
Secretary's responsibility to carry out outreach activities
under chapter 63 of this title, the Secretary may provide for
and facilitate the participation of personnel employed by the
Secretary to provide services under this section in
recreational programs that are--
(1) designed to encourage the readjustment of
veterans described in subsection (a)(1)(C); and
(2) operated by any organization named in or approved
under section 5902 of this title.
(h) For the purposes of this section:
(1) The term ``Vet Center'' means a facility which is
operated by the Department for the provision of
services under this section and which is situated apart
from Department general health care facilities.
(2) The term ``Department general health-care
facility'' means a health-care facility which is
operated by the Department for the furnishing of
health-care services under this chapter, not limited to
services provided through the program established under
this section.
(3) The term ``family member'', with respect to a
veteran or member of the Armed Forces, means an
individual who--
(A) is a member of the family of the veteran
or member, including--
(i) a parent;
(ii) a spouse;
(iii) a child;
(iv) a step-family member; and
(v) an extended family member; or
(B) lives with the veteran or member but is
not a member of the family of the veteran or
member.
(4) The term ``active service'' has the meaning given
that term in section 101 of title 10.
(5) The term ``civil disorder'' has the meaning given
that term in section 232 of title 18.
(6) The term ``covered educational assistance
benefits'' means educational assistance benefits
provided pursuant to--
(A) chapter 30, 31, 32, or 33 of this title;
(B) chapter 1606 or 1607 of title 10;
(C) section 116 of the Harry W. Colmery
Veterans Educational Assistance Act of 2017
(Public Law 115-48; 38 U.S.C. 3001 note); or
(D) section 8006 of the American Rescue Plan
Act of 2021 (Public Law 117-2; 38 U.S.C. 3001
note prec.).
* * * * * * *
CHAPTER 20--BENEFITS FOR HOMELESS VETERANS
SUBCHAPTER I--PURPOSE; DEFINITIONS; ADMINISTRATIVE MATTERS
Sec.
* * * * * * *
SUBCHAPTER VII--OTHER PROVISIONS
* * * * * * *
2068. Mental health consultations.
* * * * * * *
SUBCHAPTER VII--OTHER PROVISIONS
* * * * * * *
Sec. 2068. Mental health consultations
(a) In General.--Not later than two weeks after the date on
which a veteran described in subsection (b) enters into a
program administered by the Homeless Programs Office of the
Department, the Secretary shall offer the veteran a mental
health consultation to assess the health needs of, and care
options for, the veteran.
(b) Veteran Described.--A veteran described in this
subsection is a veteran to whom a mental health consultation is
not offered or provided through the case management services of
the program of the Homeless Programs Office into which the
veteran enters.
* * * * * * *
PART IV--GENERAL ADMINISTRATIVE PROVISIONS
* * * * * * *
CHAPTER 63--OUTREACH ACTIVITIES
Sec.
Subchapter I--Outreach services program
* * * * * * *
Subchapter II--Other outreach programs and activities
6320. Solid Start program.
Subchapter I--Outreach Services Program
Sec. 6301. Purpose; definitions
(a) Purpose.--The Congress declares that--
(1) the outreach services program authorized by [this
chapter] this subchapter is for the purpose of ensuring
that all veterans (especially those who have been
recently discharged or released from active military,
naval, air, or space service, or from a reserve
component, and those who are eligible for readjustment
or other benefits and services under laws administered
by the Department) are provided timely and appropriate
assistance to aid and encourage them in applying for
and obtaining such benefits and services in order that
they may achieve a rapid social and economic
readjustment to civilian life and obtain a higher
standard of living for themselves and their dependents;
and
(2) the outreach services program authorized by [this
chapter] this subchapter is for the purpose of charging
the Department with the affirmative duty of seeking out
eligible veterans and eligible dependents and providing
them with such services.
(b) Definitions.--For the purposes of [this chapter] this
subchapter--
(1) the term ``outreach'' means the act or process of
reaching out in a systematic manner to proactively
provide information, services, and benefits counseling
to veterans, and to the spouses, children, and parents
of veterans who may be eligible to receive benefits
under the laws administered by the Secretary, to ensure
that such individuals are fully informed about, and
receive assistance in applying for, such benefits;
(2) the term ``other governmental programs'' includes
all programs under State or local laws as well as all
programs under Federal law other than those authorized
by this title; and
(3) the term ``eligible dependent'' means a spouse,
surviving spouse, child, or dependent parent of a
person who served in the active military, naval, air,
or space service.
* * * * * * *
Sec. 6303. Outreach services
(a) Requirement To Provide Services.--In carrying out the
purposes of [this chapter] this subchapter, the Secretary shall
provide the outreach services specified in subsections (b)
through (d). In areas where a significant number of eligible
veterans and eligible dependents speak a language other than
English as their principal language, such services shall, to
the maximum feasible extent, be provided in the principal
language of such persons.
(b) Individual Notice to New Veterans.--The Secretary shall
by letter advise each veteran at the time of the veteran's
discharge or release from active military, naval, air, or space
service (or as soon as possible after such discharge or
release) of all benefits and services under laws administered
by the Department for which the veteran may be eligible. In
carrying out this subsection, the Secretary shall ensure,
through the use of veteran-student services under section 3485
of this title, that contact, in person or by telephone, is made
with those veterans who, on the basis of their military service
records, do not have a high school education or equivalent at
the time of discharge or release.
(c) Distribution of Information.--(1) The Secretary--
(A) shall distribute full information to eligible
veterans and eligible dependents regarding all benefits
and services to which they may be entitled under laws
administered by the Secretary; and
(B) may, to the extent feasible, distribute
information on other governmental programs (including
manpower and training programs) which the Secretary
determines would be beneficial to veterans.
(2) Whenever a veteran or dependent first applies for any
benefit under laws administered by the Secretary (including a
request for burial or related benefits or an application for
life insurance proceeds), the Secretary shall provide to the
veteran or dependent information concerning benefits and health
care services under programs administered by the Secretary.
Such information shall be provided not later than three months
after the date of such application.
(d) Provision of Aid and Assistance.--The Secretary shall
provide, to the maximum extent possible, aid and assistance
(including personal interviews) to members of the Armed Forces,
veterans, and eligible dependents with respect to subsections
(b) and (c) and in the preparation and presentation of claims
under laws administered by the Department.
(e) Assignment of Employees.--In carrying out this section,
the Secretary shall assign such employees as the Secretary
considers appropriate to conduct outreach programs and provide
outreach services for homeless veterans. Such outreach services
may include site visits through which homeless veterans can be
identified and provided assistance in obtaining benefits and
services that may be available to them.
Sec. 6304. Veterans assistance offices
(a) In General.--The Secretary shall establish and maintain
veterans assistance offices at such places throughout the
United States and its territories and possessions, and in the
Commonwealth of Puerto Rico, as the Secretary determines to be
necessary to carry out the purposes of [this chapter] this
subchapter. The Secretary may maintain such offices on such
military installations located elsewhere as the Secretary,
after consultation with the Secretary of Defense and taking
into account recommendations, if any, of the Secretary of
Labor, determines to be necessary to carry out such purposes.
(b) Location of Offices.--In establishing and maintaining
such offices, the Secretary shall give due regard to--
(1) the geographical distribution of veterans
recently discharged or released from active military,
naval, air, or space service;
(2) the special needs of educationally disadvantaged
veterans (including their need for accessibility of
outreach services); and
(3) the necessity of providing appropriate outreach
services in less populated areas.
Sec. 6305. Outstationing of counseling and outreach personnel
The Secretary may station employees of the Department at
locations other than Department offices, including educational
institutions, to provide--
(1) counseling and other assistance regarding
benefits under this title to veterans and other persons
eligible for benefits under this title; and
(2) outreach services under [this chapter] this
subchapter.
Sec. 6306. Use of other agencies
(a) In carrying out [this chapter] this subchapter, the
Secretary shall arrange with the Secretary of Labor for the
State employment service to match the particular qualifications
of an eligible veteran or eligible dependent with an
appropriate job or job training opportunity, including, where
possible, arrangements for outstationing the State employment
personnel who provide such assistance at appropriate facilities
of the Department.
(b) In carrying out [this chapter] this subchapter, the
Secretary shall, in consultation with the Secretary of Labor,
actively seek to promote the development and establishment of
employment opportunities, training opportunities, and other
opportunities for veterans, with particular emphasis on the
needs of veterans with service-connected disabilities and other
eligible veterans, taking into account applicable rates of
unemployment and the employment emphases set forth in chapter
42 of this title.
(c) In carrying out [this chapter] this subchapter, the
Secretary shall cooperate with and use the services of any
Federal department or agency or any State or local governmental
agency or recognized national or other organization.
(d) In carrying out [this chapter] this subchapter, the
Secretary shall, where appropriate, make referrals to any
Federal department or agency or State or local governmental
unit or recognized national or other organization.
(e) In carrying out [this chapter] this subchapter, the
Secretary may furnish available space and office facilities for
the use of authorized representatives of such governmental unit
or other organization providing services.
(f) In carrying out [this chapter] this subchapter, the
Secretary shall conduct and provide for studies, in
consultation with appropriate Federal departments and agencies,
to determine the most effective program design to carry out the
purposes of [this chapter] this subchapter.
Sec. 6307. Outreach for eligible dependents
(a) Needs of Dependents.--In carrying out [this chapter] this
subchapter, the Secretary shall ensure that the needs of
eligible dependents are fully addressed.
(b) Information as to Availability of Outreach Services for
Dependents.--The Secretary shall ensure that the availability
of outreach services and assistance for eligible dependents
under [this chapter] this subchapter is made known through a
variety of means, including the Internet, announcements in
veterans publications, and announcements to the media.
* * * * * * *
SUBCHAPTER II--OTHER OUTREACH PROGRAMS AND ACTIVITIES
Sec. 6320. Solid Start program
(a) In General.--The Secretary shall carry out a program, to
be known as the ``Solid Start program'', under which the
Secretary shall--
(1) build the capacity of the Department to
efficiently and effectively respond to the queries and
needs of veterans who have recently separated from the
Armed Forces; and
(2) systemically integrate and coordinate efforts to
assist veterans, including efforts--
(A) to proactively reach out to newly
separated veterans to inform them of their
eligibility for programs of and benefits
provided by the Department; and
(B) to connect veterans in crisis to
resources that address their immediate needs.
(b) Activities of the Solid Start Program.--(1) The
Secretary, in coordination with the Secretary of Defense, shall
carry out the Solid Start program of the Department by--
(A) collecting up-to-date contact information during
transition classes or separation counseling for all
members of the Armed Forces who are separating from the
Armed Forces, while explaining the existence and
purpose of the Solid Start program;
(B) calling each veteran, regardless of separation
type or characterization of service, three times within
the first year after separation of the veteran from the
Armed Forces;
(C) providing information about the Solid Start
program on the website of the Department and in
materials of the Department, especially transition
booklets and other resources;
(D) ensuring calls are truly tailored to the needs of
each veteran's unique situation by conducting quality
assurance tests;
(E) prioritizing outreach to veterans who have
accessed mental health resources prior to separation
from the Armed Forces;
(F) providing women veterans with information that is
tailored to their specific health care and benefit
needs;
(G) as feasible, providing information on access to
State and local resources, including Vet Centers and
veterans service organizations; and
(H) gathering and analyzing data assessing the
effectiveness of the Solid Start program.
(2) The Secretary, in coordination with the Secretary of
Defense, may carry out the Solid Start program by--
(A) encouraging members of the Armed Forces who are
transitioning to civilian life to authorize alternate
points of contact who can be reached should the member
be unavailable during the first year following the
separation of the member from the Armed Forces;
(B) following up missed phone calls with tailored
mailings to ensure the veteran still receives similar
information; and
(C) striving to reach out to veterans who separated
prior to the initiation of the Solid Start program to
provide similar services to those veterans, as
feasible.
(3) In this subsection:
(A) The term ``Vet Center'' has the meaning given
that term in section 1712A(h) of this title.
(B) The term ``veterans service organization'' means
an organization recognized by the Secretary for the
representation of veterans under section 5902 of this
title.
(c) Obligations of Amounts.--Subject to the availability of
appropriations, the Secretary may not, in a fiscal year,
obligate an amount to carry out the Solid Start program that is
less than the total amount obligated in the previous fiscal
year to carry out the program, unless the Secretary determines
that increased efficiencies of the program warrant the
obligation of a lesser amount.
* * * * * * *
----------
VA MISSION ACT OF 2018
* * * * * * *
TITLE V--OTHER MATTERS
* * * * * * *
SEC. 506. PROGRAM ON ESTABLISHMENT OF PEER SPECIALISTS IN PATIENT
ALIGNED CARE TEAM SETTINGS WITHIN MEDICAL CENTERS
OF DEPARTMENT OF VETERANS AFFAIRS.
(a) Program Required.--The Secretary of Veterans Affairs
shall carry out a program to establish not fewer than two peer
specialists in patient aligned care teams at medical centers of
the Department of Veterans Affairs to promote the use and
integration of services for mental health, substance use
disorder, and behavioral health in a primary care setting. Each
such peer specialist shall be a full-time employee whose
primary function is to serve as a peer specialist and shall be
in addition to all other employees of such medical center.
(b) [Timeframe] Initial Timeframe for Establishment of
Program.--The Secretary shall carry out the program at medical
centers of the Department as follows:
(1) Not later than May 31, 2019, at not fewer than 15
medical centers of the Department.
(2) Not later than May 31, 2020, at not fewer than 30
medical centers of the Department.
(c) [Selection] Initial Selection of Locations.--
(1) In general.--[The Secretary shall] In
establishing the program at initial locations, the
Secretary shall select medical centers for the program
as follows:
(A) Not fewer than five shall be medical
centers of the Department that are designated
by the Secretary as polytrauma centers.
(B) Not fewer than 10 shall be medical
centers of the Department that are not
designated by the Secretary as polytrauma
centers.
(2) Considerations.--In selecting medical centers for
the program under paragraph (1), the Secretary shall
consider the feasibility and advisability of selecting
medical centers in the following areas:
(A) Rural areas and other areas that are
underserved by the Department.
(B) Areas that are not in close proximity to
an active duty military installation.
(C) Areas representing different geographic
locations, such as census tracts established by
the Bureau of the Census.
(d) Timeframe for Expansion of Program; Selection of
Additional Locations.--
(1) Timeframe for expansion.--The Secretary shall
make permanent and expand the program to additional
medical centers of the Department as follows:
(A) As of the date of the enactment of the
STRONG Veterans Act of 2021, the Secretary
shall make such program permanent at each
medical center participating in the program on
the day before such date of enactment.
(B) During the seven-year period following
such date of enactment, the Secretary shall
expand the program to an additional 25 medical
centers per year until the program is carried
out at each medical center of the Department.
(2) Selection of additional locations.--In selecting
medical centers for the expansion of the program under
paragraph (1)(B), until such time as each medical
center of the Department is participating in the
program by establishing not fewer than two peer
specialists at the medical center, the Secretary shall
prioritize medical centers in the following areas:
(A) Rural areas and other areas that are
underserved by the Department.
(B) Areas that are not in close proximity to
an active duty military installation.
(C) Areas representing different geographic
locations, such as census tracts established by
the Bureau of the Census.
[(d) Gender-Specific Services.--] (e) Considerations for
Hiring Peer Specialists.--In carrying out the program at each
[location selected under subsection (c)] medical center, the
Secretary shall ensure that--
(1) the needs of female veterans are specifically
considered and addressed; [and]
[(2) female peer specialists are made available to
female veterans who are treated at each location.]
(2) female peer specialists are hired and made
available to support female veterans who are treated at
each medical center; and
(3) to the extent practical, peer specialists are
hired in demographic percentages that reflect the
racial and ethnic demographic percentages of the
overall veterans population.
[(e)] (f) Engagement With Community Providers.--At each
location selected under subsection (c), the Secretary shall
consider ways in which peer specialists can conduct outreach to
health care providers in the community who are known to be
serving veterans to engage with those providers and veterans
served by those providers.
[(f) Reports.--
[(1) Periodic reports.--
[(A) In general.--Not later than 180 days
after the date of the enactment of this Act,
and not less frequently than once every 180
days thereafter until the Secretary determines
that the program is being carried out at the
last location to be selected under subsection
(c), the Secretary shall submit to Congress a
report on the program.
[(B) Elements.--Each report required by
subparagraph (A) shall, with respect to the
180-day period preceding the submittal of the
report, include the following:
[(i) The findings and conclusions of
the Secretary with respect to the
program.
[(ii) An assessment of the benefits
of the program to veterans and family
members of veterans.
[(iii) An assessment of the
effectiveness of peer specialists in
engaging under subsection (e) with
health care providers in the community
and veterans served by those providers.
[(2) Final report.--Not later than 180 days after the
Secretary determines that the program is being carried
out at the last location to be selected under
subsection (c), the Secretary shall submit to Congress
a report detailing the recommendations of the Secretary
as to the feasibility and advisability of expanding the
program to additional locations.]
(g) Reports.--
(1) Periodic reports.--
(A) In general.--Not later than one year
after the date of the enactment of the STRONG
Veterans Act of 2021, and annually thereafter
for five years, the Secretary shall submit to
the Committees on Veterans' Affairs of the
House of Representatives and the Senate a
report on the program, including the expansion
of the program under subsection (d)(1).
(B) Elements.--Each report under subparagraph
(A) shall include, with respect to the one-year
period preceding the submission of the report,
the following:
(i) The findings and conclusions of
the Secretary with respect to the
program.
(ii) An assessment of the benefits of
the program to veterans and family
members of veterans.
(iii) An assessment of the
effectiveness of peer specialists in
engaging under subsection (f) with
health care providers in the community
and veterans served by such providers.
(iv) The name and location of each
medical center where new peer
specialists were hired.
(v) The number of new peer
specialists hired at each medical
center pursuant to this section and the
total number of peer specialists within
the Department hired pursuant to this
section.
(vi) An assessment of any barriers
confronting the recruitment, training,
or retention of peer specialists.
(2) Final report.--Not later than one year after the
Secretary determines that the program is being carried
out at each medical center of the Department, the
Secretary shall submit to the Committees on Veterans'
Affairs of the House of Representatives and the Senate
a report notifying such committees of such
determination.
* * * * * * *
[all]