[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.

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