[House Report 119-103]
[From the U.S. Government Publishing Office]
119th Congress } { Report
HOUSE OF REPRESENTATIVES
1st Session } { 119-103
======================================================================
NO WRONG DOOR FOR VETERANS ACT
_______
May 19, 2025.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Bost, from the Committee on Veterans' Affairs, submitted the
following
R E P O R T
together with
MINORITY VIEWS
[To accompany H.R. 1969]
[Including cost estimate of the Congressional Budget Office]
The Committee on Veterans' Affairs, to whom was referred
the bill (H.R. 1969) to amend and reauthorize the Staff
Sergeant Parker Gordon Fox Suicide Prevention Grant Program of
the Department of Veterans Affairs, having considered the same,
reports favorably thereon with an amendment and recommends that
the bill as amended do pass.
CONTENTS
Page
Amendment........................................................ 2
Purpose and Summary.............................................. 3
Background and Need for Legislation.............................. 3
Hearings......................................................... 4
Subcommittee Consideration....................................... 5
Committee Consideration.......................................... 5
Committee Votes.................................................. 6
Committee Correspondence
Committee Oversight Findings..................................... 9
Statement of General Performance Goals and Objectives............ 9
Earmarks and Tax and Tariff Benefits............................. 9
Committee Cost Estimate.......................................... 9
Budget Authority and Congressional Budget Office Estimate........ 9
Federal Mandates Statement....................................... 12
Advisory Committee Statement..................................... 12
Applicability to Legislative Branch.............................. 12
Statement on Duplication of Federal Programs..................... 12
Section-by-Section Analysis of the Legislation................... 12
Changes in Existing Law Made by the Bill, as Reported............ 13
Minority Views................................................... 32
The amendment is as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``No Wrong Door for Veterans Act''.
SEC. 2. REAUTHORIZATION AND IMPROVEMENT OF STAFF SERGEANT PARKER GORDON
FOX SUICIDE PREVENTION GRANT PROGRAM OF DEPARTMENT
OF VETERANS AFFAIRS.
(a) Duration.--Section 201 of the Commander John Scott Hannon
Veterans Mental Health Care Improvement Act of 2019 (Public Law 116-
171; 38 U.S.C. 1720F note) is amended, in subsection (j), by striking
``the date that is three years after the date on which the first grant
is awarded under this section'' and inserting ``September 30, 2026''.
(b) Emergent Suicide Care.--Such section is further amended--
(1) in subsection (m)--
(A) by redesignating paragraph (3) as paragraph (4);
(B) by inserting after paragraph (2) the following
new paragraph (3):
``(3) Emergent suicide care.--In the case of an eligible
individual who receives suicide prevention services provided or
coordinated by an eligible entity in receipt of a grant under
this section, the eligible entity shall notify--
``(A) the eligible individual that the individual may
be eligible for emergent suicide care under section
1720J of title 38, United States Code; and
``(B) the Secretary, if an eligible individual
notified under subparagraph (A) elects to receive such
emergent suicide care.''; and
(C) in paragraph (4), as so redesignated, by striking
``(1) or (2)'' and inserting ``(1), (2), or (3)''; and
(2) in subsection (n)--
(A) by inserting ``(1) In general.--'' before
``When'' and adjusting the margins accordingly; and
(B) by adding at the end the following new paragraph:
``(2) Time frame.--If the Secretary does not provide services
under paragraph (1) to an eligible individual during the 72-
hour period following a referral under subsection (m), such
eligible individual shall be treated as eligible for emergent
suicide care under section 1720J of title 38, United States
Code.''.
(c) Reauthorization.--Such section is further amended, in subsection
(p)--
(1) by striking ``section a total of $174,000,000 for fiscal
years 2021 through 2025.'' and inserting ``section--''; and
(2) by adding at the end the following new
paragraphs:
``(1) a total of $174,000,000 for fiscal years 2021 through
2025; and
``(2) $52,500,000 for fiscal year 2026.''.
(d) Requirements for Eligible Entities.--Such section is further
amended, in subsection (q)(3)--
(1) by inserting ``an entity that has continuously provided
mental health care or support services in the United States
during the two-year period before the date on which the entity
applies for a grant under this section and that is'' after
``means'';
(2) in subparagraph (A), by striking ``or foundation'' and
inserting ``, foundation, or health care provider''; and
(3) in subparagraph (E), by striking ``A'' and inserting
``a''.
(e) Technical Correction to Definitions.--Such section is further
amended, in subsection (q)(5), by striking ``Medical services'' and
inserting ``The term `emergency treatment' means medical services''.
(f) Required Use of Certain Screening Protocol.--Such section is
further amended, in subsection (q)(11)(A)(ii), by inserting after
``risk'' the following: ``, which in the case of a grant made on or
after the date of the enactment of the No Wrong Door for Veterans Act,
shall be the Columbia Protocol (also known as the Columbia-Suicide
Severity Rating Scale)''.
SEC. 3. INCLUSION OF ADAPTIVE PROSTHESES AND TERMINAL DEVICES FOR
SPORTS AND OTHER RECREATIONAL ACTIVITIES IN MEDICAL
SERVICES FURNISHED TO ELIGIBLE VETERANS BY THE
SECRETARY OF VETERANS AFFAIRS.
Section 1701 of title 38, United States Code, is amended, in
paragraph (6)(F)(i), by inserting ``(including adaptive prostheses and
terminal devices for sports and other recreational activities)'' after
``artificial limbs''.
SEC. 4. EXTENSION OF CERTAIN LIMITS ON PAYMENTS OF PENSION.
Section 5503(d)(7) of title 38, United States Code, is amended by
striking ``November 30, 2031'' and inserting ``January 30, 2033''.
Purpose and Summary
H.R. 1969, the ``No Wrong Door for Veterans Act,'' was
introduced by Rep. Mariannette Miller-Meeks of Iowa on March
10, 2025. This bill would reauthorize the Department of
Veterans Affairs (VA) Staff Sergeant Parker Gordon Fox Suicide
Prevention Grant Program through fiscal year (FY) 2026 and
authorize $54,500,000 in appropriations to carry out the mental
health care support services grant program and would mandate
the use of the Columbia Suicide Severity Rating Scale, expand
provider eligibility, and require improved coordination between
VA Medical Centers and mental health care organization
grantees. The bill also authorizes emergency community mental
health care support for veterans in crisis if the local VA
facility cannot deliver such services within 72 hours.
Additionally, H.R. 1969, as amended, includes the text of
H.R. 1971, the Veterans Supporting Prosthetics Opportunities
and Recreational Therapy (SPORT) Act, which would expand
prosthetic coverage for veterans who wish to obtain prosthetics
for adaptive athletic use. The bill, as amended, would also
provide an offset for the cost of this bill by extending
current law restricting the amount of pension paid to VA
pension beneficiaries who are admitted to a VA or Medicaid
sponsored nursing facility.
Background and Need for Legislation
Section 1: Short Title
This Act may be cited as the ``No Wrong Door for Veterans
Act.''
Section 2: Amendments to and reauthorization of the Staff Sergeant
Parker Gordon Fox Suicide Prevention Grant Program of the
Department of Veterans Affairs
The Staff Sergeant Parker Gordon Fox Suicide Prevention
Grant Program (Fox Grant Program) was authorized by the passage
of the Commander John Scott Hannon Veterans Mental Health Care
Improvement Act of 2019 [P.L. 116-171]. The program's purpose
is to provide community-based mental health organizations with
grant funding to increase veterans' access to mental health
care, support, and suicide prevention services in their
communities across the United States through public-private
partnerships.
Suicidality among veterans is a serious problem. According
to VA's 2024 National Veteran Suicide Prevention Annual Report,
there were roughly 17.6 veteran suicides per day. The same
report suggests that out of those 17.6 veterans, 6.7 of them
(38%) were being treated through the Veterans Health
Administration (VHA). Among those who used VHA, almost 4 in 10
veterans (39.1%) were not being treated for a mental health or
substance use disorder. This suggests that a considerable
number of veterans lost to suicide had not received care or
been diagnosed with a mental health disorder by VA specifically
prior to their death. This situation can potentially be
remedied by providing easier access to mental health care
through private providers and organizations.
Through the Fox Grant Program, VA's ability to provide
mental health services has expanded, and it has connected
veterans with traditional and non-traditional care and
treatment that meet their needs. As of September 2023, hundreds
of grantees have completed over 20,000 outreach contacts to
veterans. However, under current law, this pilot program will
expire at the end of fiscal year 2025.
The results of the Fox Grant Program are difficult to
quantify, but the 2024 National Veteran Suicide Prevention
Annual Report suggests that suicide rates among veterans who
receive mental health treatment decrease by 39.77%.
Consequently, getting veterans the mental health care they need
must remain a priority.
The Committee staff believes that reauthorizing the Fox
Grant Program through fiscal year 2026 will ensure continued
efforts to secure critical care for at-risk veterans--ensuring
that mental health care needs are met, and that veterans are
able to receive community-based emergency mental health if VA
is unable to provide such care within 72 hours of first
contact.
Section 3: Inclusion of Adaptive Prostheses and Terminal Devices for
Sports and Other Recreational Activities in Medical Services
Furnished to Eligible Veterans by the Secretary of Veterans
Affairs
The bill also includes the text of H.R. 1971, the Veterans
Supporting Prosthetics Opportunities and Recreational Therapy
(SPORT) Act. This bill was introduced in response to how VA
health plans have routinely denied access to O&P care for
physical activities as ``not medically necessary.'' This
section would provide coverage under the Department of Veterans
Affairs benefit for prosthetic limbs that veterans with limb
loss use to participate in sports and other recreational
activities. As studies show, veterans living with limb loss who
engage in organized recreational activities are less likely to
suffer from mental health disorders such as depression,
anxiety, and stress. Committee staff consider this change in
law to be beneficial to veterans' overall mental health care.
Section 4: Extension of Certain Limits on Payments of Pension
Under current law (38 U.S.C. Sec. 5503(d)), the amount of
VA pension paid to veterans having no spouse nor child,
veterans' surviving spouses having no child, and veterans'
children who are admitted to a VA or Medicaid sponsored nursing
facility is capped at $90 a month. This section would cover the
costs of the other sections of this bill by extending this
pension limitation by fourteen months to January 30, 2033.
Because they receive government sponsored care in a nursing
home, these pension beneficiaries do not require the full
amount of pension to cover their cost of living. The Committee
believes this short-term extension of the current limit on
pension payments is a reasonable way to cover the costs
associated with the other sections of this bill.
Hearings
On March 11, 2025, the Subcommittee on Health held a
legislative hearing on H.R. 1969 and other bills that were
pending before the subcommittee.
The following witnesses testified:
The Honorable Jack Bergman, U.S. House of
Representatives, 1st Congressional District, Michigan;
The Honorable Greg Murphy, U.S. House of
Representatives, 3rd Congressional District, North
Carolina; The Honorable Steve Womack, U.S. House of
Representatives, 3rd Congressional District, Arkansas;
The Honorable Don Bacon, U.S. House of Representatives,
1st Congressional District, Nebraska; The Honorable
Sylvia Garcia, U.S. House of Representatives, 29th
Congressional District, Texas; The Honorable Lauren
Underwood, U.S. House of Representatives, 14th
Congressional District, Illinois; The Honorable Chris
Deluzio, U.S. House of Representatives, 17th
Congressional District, Pennsylvania; Dr. Thomas
O'Toole, Deputy Assistant Under Secretary for Health
for Clinical Services, Quality and Field Operations,
Veterans Health Administration, U.S. Department of
Veterans Affairs; Dr. Antoinette Shappell, Deputy
Assistant Under Secretary for Health for Patient
Services, Veterans Health Administration, U.S.
Department of Veterans Affairs; Dr. Thomas Emmendorfer,
Executive Director, Pharmacy Benefits Management,
Veterans Health Administration, U.S. Department of
Veterans Affairs; Dr. Jeffrey Gold, President,
University of Nebraska System; Ms. Sue Morris,
President, Veterans Trust; Mr. Brian Dempsey, Director
of Government Affairs, Wounded Warrior Project; Mr. Ed
Harries, President, National Association of State
Veterans Homes; Mr. Jon Retzer, Deputy National
Legislative Director, Disabled American Veterans;
The following individuals and organizations submitted
statements for the record:
Veterans Healthcare Policy Institute; Paralyzed
Veterans of America; American Federation of Government
Employees; Representative Murphy; Trajector Medical;
American Association for Marriage and Family Therapy.
Subcommittee Consideration
On March 25, 2025, the Subcommittee on Health met in an
open markup session, a quorum being present, to consider H.R.
1969. Representative Miller-Meeks offered an amendment in the
nature of a substitute, which would extend the program through
2026; clarify the interplay with other emergent suicide
prevention authorities; and mandate the use of the Columbia-
Suicide Severity Rating Scale, which is a screening tool. This
amendment was adopted by a recorded vote of 7 yeas, 5 noes. A
motion by Representative Van Orden of Wisconsin to order H.R.
1969, as amended, favorably forwarded to the full Committee on
Veterans Affairs was agreed to by voice vote.
Committee Consideration
On May 6, 2025, the full Committee met in an open markup
session, to consider H.R. 1969, as amended. During
consideration of the bill, the following amendments were
considered:
An amendment to the amendment in the nature of a substitute
to H.R. 1969 was offered by Representative Miller-Meeks, which
would offset the costs of the bill and include the text of H.R.
1971, the Veterans SPORT Act, ensuring the availability of
adaptive sports or recreation prosthetic limbs, including
artificial hand ``terminal devices,'' by recognizing them as
clinically necessary for veterans suffering from limb loss.
This amendment to the amendment in the nature of a substitute
was agreed to by voice vote.
A substitute amendment to the amendment in the nature of a
substitute was offered by Representative Ramirez. This
substitute amendment, in the nature of a substitute, would
strip out Chairwoman Miller-Meeks' ANS entirely, increasing the
maximum grant amount from $750,000 to $1,250,000. This
amendment in the nature of a substitute would also reauthorize
the program to 2028. This substitute amendment to the amendment
in the nature of a substitute failed by a recorded vote of 11
ayes, 13 noes.
An amendment to the amendment in the nature of a substitute
to H.R. 1969 was offered by Representative Budzinski. This
amendment would require grant recipients to prioritize suicide
services for veterans who have experienced job loss or
unemployment due to the economic turmoil occurring since
January 20, 2025. This amendment failed by a recorded vote of
11 ayes, 13 noes.
An amendment to the amendment in the nature of a substitute
to H.R. 1969 was offered by Ranking Member Takano. This
amendment would require grant recipients to ensure that end
users receive a post-intervention mental health assessment
using a mental health screening tool, which tool must be the
same tool used to conduct the baseline mental health screening
for the end user. This amendment failed by voice vote.
A motion by Rep. Bergman of Michigan to report H.R. 1969,
as amended, favorably to the House of Representatives, was
agreed to by voice vote.
Committee Votes
In compliance with clause 3(b) of rule XIII of the Rules of
the House of Representatives, two recorded votes were taken on
amendments or in connection with ordering H.R. 1969, as
amended, reported to the House.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
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.
Statement of General Performance Goals and Objectives
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 of H.R. 1969, as amended, are to ensure
the continued access by veterans to suicide prevention programs
funded by Fox Grants, as well as to ensure access to adaptive
prostheses to veterans for the purposes of participating in
sports and recreation.
Earmarks and Tax and Tariff Benefits
H.R. 1969, as amended, 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.
Committee Cost Estimate
The Committee adopts as its own the cost estimate on H.R.
1969, as amended, prepared by the Director of the Congressional
Budget.
Budget Authority and Congressional Budget Office
Cost Estimate
Pursuant to clause (3)(c)(3) of rule XIII of the Rules of
the House of Representatives, the following is the cost
estimate for H.R. 1969, as amended, provided by the
Congressional Budget Office (CBO) pursuant to section 402 of
the Congressional Budget Act of 1974:
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
The bill would:
Reauthorize the Staff Sergeant Parker Gordon
Fox Suicide Prevention Grant Program through fiscal
year 2026
Extend the reduction of pensions the
Department of Veterans Affairs pays to veterans and
survivors residing in Medicaid nursing homes
Estimated budgetary effects would mainly stem from:
Authorizing appropriations of $53 million
for 2026 for the suicide prevention program
Reducing pension payments
Bill summary: H.R. 1969 would extend the Staff Sergeant
Parker Gordon Fox Suicide Prevention Grant Program administered
by the Department of Veterans Affairs (VA) through fiscal year
2026 and authorize appropriations for that purpose. The bill
also would clarify that VA may provide adaptive prosthetic
devices for sports and recreational activities as a medical
service. Finally, the bill would extend a temporary limitation
on certain pension payments through January 2033.
Estimated Federal cost: The estimated budgetary effects of
H.R. 1969 are shown in Table 1. The costs of the legislation
fall within budget functions 550 (health) and 700 (veterans
benefits and services).
TABLE 1.--ESTIMATED BUDGETARY EFFECTS OF H.R. 1969
--------------------------------------------------------------------------------------------------------------------------------------------------------
By fiscal year, millions of dollars--
-------------------------------------------------------------------------------------------------------------
2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2025-2030 2025-2035
--------------------------------------------------------------------------------------------------------------------------------------------------------
INCREASES OR DECREASES (-) IN DIRECT SPENDING
Estimated Budget Authority................ 0 10 0 0 0 0 0 -40 -16 0 0 10 -46
Estimated Outlays......................... 0 9 1 0 0 0 0 -40 -16 0 0 10 -46
INCREASES IN SPENDING SUBJECT TO APPROPRIATION
Estimated Authorization................... 0 43 0 0 0 0 0 0 0 0 0 43 43
Estimated Outlays......................... 0 39 4 0 0 0 0 0 0 0 0 43 43
--------------------------------------------------------------------------------------------------------------------------------------------------------
Basis of estimate: For this estimate, CBO assumes that H.R.
1969 will be enacted in fiscal year 2025 and that outlays will
follow historical spending patterns for affected programs.
Provisions that affect spending subject to appropriation
and direct spending: Section 2 of the bill would reauthorize
the Staff Sergeant Parker Gordon Fox Suicide Prevention Grant
Program through fiscal year 2026 and authorize the
appropriation of $53 million for that year. The program makes
grants to community organizations that provide suicide
prevention services to at-risk veterans.
CBO expects that some of the costs of implementing the bill
would be paid from the Toxic Exposures Fund (TEF) established
by Public Law 117-168, the Honoring our PACT Act. The TEF is a
mandatory appropriation that VA uses to pay for health care,
disability claims processing, medical research, and IT
modernization that benefit veterans who were exposed to
environmental hazards.
Additional spending from the TEF would occur if legislation
increases the costs of similar activities that benefit veterans
with such exposure. CBO estimates that 19 percent of such
additional funding would come from the TEF in 2026. That
percentage is based on the amount of formerly discretionary
appropriations that CBO projects will be provided through the
mandatory appropriation as specified in the Honoring our PACT
Act.\1\ CBO estimates that over the 2025-2035 period,
implementing section 2 would increase spending subject to
appropriation by $43 million and direct spending by $10
million.
---------------------------------------------------------------------------
\1\For additional information about estimated spending from the
TEF, see CBO's most recent table with details about baseline
projections: https://www.cbo.gov/system/files/2025-01/60044-2025-01-
tef.pdf.
---------------------------------------------------------------------------
Direct spending: In addition to expanding benefits that
would partly be covered by the TEF, CBO estimates that enacting
the bill would affect direct spending by reducing pension
payments to veterans and survivors who reside in Medicaid
nursing homes. In total, the bill would decrease net direct
spending by $46 million over the 2025-2035 period.
Under current law, VA reduces pension payments to veterans
and survivors who reside in Medicaid nursing homes to $90 per
month. That required reduction expires November 30, 2031.
Section 4 would extend that reduction for 14 months, through
January 31, 2033. CBO estimates that extending that requirement
would reduce VA benefits by $10 million per month. (Those
benefits are paid from mandatory appropriations and are
therefore considered direct spending.) As a result of that
reduction in beneficiaries' income, Medicaid would pay more of
the cost of their care, increasing spending for that program by
$6 million per month. Thus, enacting section 4 would reduce net
direct spending by $56 million over the 2025-2035 period.
Spending subject to appropriation: The discussion above in
``Provisions That Affect Spending Subject to Appropriation and
Direct Spending'' describes the authorization of appropriations
for suicide prevention grants. That authorization would
increase spending subject to appropriation by $43 million over
the 2025-2035 period.
Section 3 would clarify that adaptive prostheses and
terminal devices for sports and other recreational activities
are included in the definition of medical services furnished to
veterans. VA currently provides those types of adaptive
devices; thus, CBO estimates that implementing section 3 would
not affect the federal budget.
Pay-As-You-Go considerations: The Statutory Pay-As-You-Go
Act of 2010 establishes budget-reporting and enforcement
procedures for legislation affecting direct spending or
revenues. The net changes in outlays that are subject to those
pay-as-you-go procedures are shown in Table 1.
Increase in long-term net direct spending and deficits: CBO
estimates that enacting H.R. 1969 would not increase net direct
spending or on-budget deficits in any of the four consecutive
10-year periods beginning in 2036.
Mandates: The bill contains no intergovernmental or
private-sector mandates as defined in the Unfunded Mandates
Reform Act.
Estimate prepared by: Federal costs: Noah Callahan (for
veterans health care); Logan Smith (for pensions); Mandates:
Brandon Lever.
Estimate reviewed by: David Newman, Chief, Defense,
International Affairs, and Veterans' Affairs Cost Estimates
Unit; Kathleen FitzGerald, Chief, Public and Private Mandates
Unit; Christina Hawley Anthony, Deputy Director of Budget
Analysis.
Estimate approved by: Phillip L. Swagel, Director,
Congressional Budget Office.
Federal Mandates Statement
Section 423 of the Congressional Budget and Impoundment
Control Act (as amended by Section 101(a)(2) of the Unfunded
Mandate Reform Act, P.L. 104-4), is inapplicable to H.R. 1969,
as amended.
Advisory Committee Statement
No advisory committees within the meaning of section 5(b)
of the Federal Advisory Committee Act would be created by H.R.
1969, as amended.
Applicability to Legislative Branch
The Committee finds that H.R. 1969, as amended, does not
relate to the terms and conditions 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. 1969, as amended, 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.
Section-by-Section Analysis of the Legislation
Section 1: Short title
This section would establish the short title as the ``No
Wrong Door for Veterans Act''.
Section 2: Reauthorization and improvement of the Staff Sergeant Parker
Gordon Fox Suicide Prevention Grant Program of the Department
of Veterans Affairs
Section 2(a) would extend the authorization of the Fox
Suicide Prevention Grant Program through September 30, 2026.
This replaces the original sunset clause, which tied the
program's expiration to a date three years after the first
grant was issued.
Section 2(b) would amend subsection (m) to require grantees
to notify eligible veterans that they may qualify for emergent
suicide care under 38 U.S.C. Sec. 1720J and, if the veteran
elects to receive that care, notify the VA Secretary.
Additionally, this would amend subsection (n) to require VA to
respond within 72 hours of a referral. If VA does not provide
care within that window, the veteran will be automatically
eligible for emergent suicide care under Sec. 1720J.
Section 2(c) would authorize $52,500,000 in appropriations
for fiscal year 2026.
Section 2(d) would modify eligibility criteria for grantees
by requiring that an entity must have provided mental health
care or support services continuously in the United States for
at least two years prior to applying. Additionally, it would
expand eligible entity types to explicitly include health care
providers.
Section 2(e) would clarify the term ``emergency treatment''
by amending the existing language to read: ``The term
`emergency treatment' means medical services''.
Section 2(f) would mandate that all grants awarded after
enactment must use the Columbia Suicide Severity Rating Scale
(C-SSRS) as the standardized screening tool for suicide risk
assessment.
Section 3: Inclusion of adaptive prostheses and terminal devices for
recreational activities
This section would amend 38 U.S.C. Sec. 1701(6)(F)(i) to
authorize VA to provide adaptive prosthetic limbs and terminal
devices used by veterans to participate in sports and other
recreational activities.
Section 4: Extension of certain limits on payments of pension
This section would extend the termination date of
limitations on VA pension payments to institutionalized
beneficiaries by amending 38 U.S.C. Sec. 5503(d)(7), changing
the expiration from November 30, 2031, to January 30, 2033.
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, existing law in which no change
is proposed is shown in roman):
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):
COMMANDER JOHN SCOTT HANNON VETERANS MENTAL HEALTH CARE IMPROVEMENT ACT
OF 2019
* * * * * * *
TITLE II--SUICIDE PREVENTION
SEC. 201. FINANCIAL ASSISTANCE TO CERTAIN ENTITIES TO PROVIDE OR
COORDINATE THE PROVISION OF SUICIDE PREVENTION
SERVICES FOR ELIGIBLE INDIVIDUALS AND THEIR
FAMILIES.
(a) Purpose; Designation.--
(1) Purpose.--The purpose of this section is to
reduce veteran suicide through a community-based grant
program to award grants to eligible entities to provide
or coordinate suicide prevention services to eligible
individuals and their families.
(2) Designation.--The grant program under this
section shall be known as the ``Staff Sergeant Parker
Gordon Fox Suicide Prevention Grant Program''.
(b) Financial Assistance and Coordination.--The Secretary
shall provide financial assistance to eligible entities
approved under this section through the award of grants to such
entities to provide or coordinate the provision of services to
eligible individuals and their families to reduce the risk of
suicide. The Secretary shall carry out this section in
coordination with the President's Roadmap to Empower Veterans
and End a National Tragedy of Suicide Task Force and in
consultation with the Office of Mental Health and Suicide
Prevention of the Department, to the extent practicable.
(c) Award of Grants.--
(1) In general.--The Secretary shall award a grant to
each eligible entity for which the Secretary has
approved an application under subsection (f) to provide
or coordinate the provision of suicide prevention
services under this section.
(2) Grant amounts, intervals of payment, and matching
funds.--In accordance with the services being provided
under a grant under this section and the duration of
those services, the Secretary shall establish--
(A) a maximum amount to be awarded under the
grant of not more than $750,000 per grantee per
fiscal year; and
(B) intervals of payment for the
administration of the grant.
(d) Distribution of Grants and Preference.--
(1) Distribution.--
(A) Priority.--In compliance with
subparagraphs (B) and (C), in determining how
to distribute grants under this section, the
Secretary may prioritize--
(i) rural communities;
(ii) Tribal lands;
(iii) territories of the United
States;
(iv) medically underserved areas;
(v) areas with a high number or
percentage of minority veterans or
women veterans; and
(vi) areas with a high number or
percentage of calls to the Veterans
Crisis Line.
(B) Areas with need.--The Secretary shall
ensure that, to the extent practicable, grants
under this section are distributed--
(i) to provide services in areas of
the United States that have experienced
high rates of suicide by eligible
individuals, including suicide
attempts; and
(ii) to eligible entities that can
assist eligible individuals at risk of
suicide who are not currently receiving
health care furnished by the
Department.
(C) Geography.--In distributing grants under
this paragraph, the Secretary may provide
grants to eligible entities that furnish
services to eligible individuals and their
families in geographically dispersed areas.
(2) Preference.--The Secretary shall give preference
to eligible entities that have demonstrated the ability
to provide or coordinate suicide prevention services.
(e) Requirements for Receipt of Grants.--
(1) Notification that services are from department.--
Each entity receiving a grant under this section to
provide or coordinate suicide prevention services to
eligible individuals and their families shall notify
the recipients of such services that such services are
being paid for, in whole or in part, by the Department.
(2) Development of plan with eligible individuals and
their family.--Any plan developed with respect to the
provision of suicide prevention services for an
eligible individual or their family shall be developed
in consultation with the eligible individual and their
family.
(3) Coordination.--An entity receiving a grant under
this section shall--
(A) coordinate with the Secretary with
respect to the provision of clinical services
to eligible individuals in accordance with
subsection (n) or any other provisions of the
law regarding the delivery of health care by
the Secretary;
(B) inform every veteran who receives
assistance under this section from the entity
of the ability of the veteran to apply for
enrollment in the patient enrollment system of
the Department under section 1705(a) of title
38, United States Code; and
(C) if such a veteran wishes to so enroll,
inform the veteran of a point of contact at the
Department who can assist the veteran in such
enrollment.
(4) Measurement and monitoring.--An entity receiving
a grant under this section shall submit to the
Secretary a description of such tools and assessments
the entity uses or will use to determine the
effectiveness of the services furnished by the entity,
which shall include the measures developed under
subsection (h)(2) and may include--
(A) the effect of the services furnished by
the entity on the financial stability of the
eligible individual;
(B) the effect of the services furnished by
the entity on the mental health status,
wellbeing, and suicide risk of the eligible
individual; and
(C) the effect of the services furnished by
the entity on the social support of the
eligible individuals receiving those services.
(5) Reports.--The Secretary--
(A) shall require each entity receiving a
grant under this section to submit to the
Secretary an annual report that describes the
projects carried out with such grant during the
year covered by the report;
(B) shall specify to each such entity the
evaluation criteria and data and information to
be submitted in such report; and
(C) may require each such entity to submit to
the Secretary such additional reports as the
Secretary considers appropriate.
(f) Application for Grants.--
(1) In general.--An eligible entity seeking a grant
under this section shall submit to the Secretary an
application therefor in such form, in such manner, and
containing such commitments and information as the
Secretary considers necessary to carry out this
section.
(2) Matters to be included.--Each application
submitted by an eligible entity under paragraph (1)
shall contain the following:
(A) A description of the suicide prevention
services proposed to be provided by the
eligible entity and the identified need for
those services.
(B) A detailed plan describing how the
eligible entity proposes to coordinate or
deliver suicide prevention services to eligible
individuals, including--
(i) an identification of the
community partners, if any, with which
the eligible entity proposes to work in
delivering such services;
(ii) a description of the
arrangements currently in place between
the eligible entity and such partners
with regard to the provision or
coordination of suicide prevention
services;
(iii) an identification of how long
such arrangements have been in place;
(iv) a description of the suicide
prevention services provided by such
partners that the eligible entity shall
coordinate, if any; and
(v) an identification of local
suicide prevention coordinators of the
Department and a description of how the
eligible entity will communicate with
local suicide prevention coordinators.
(C) A description of the population of
eligible individuals and their families
proposed to be provided suicide prevention
services.
(D) Based on information and methods
developed by the Secretary for purposes of this
subsection, an estimate of the number of
eligible individuals at risk of suicide and
their families proposed to be provided suicide
prevention services, including the percentage
of those eligible individuals who are not
currently receiving care furnished by the
Department.
(E) Evidence of measurable outcomes related
to reductions in suicide risk and mood-related
symptoms utilizing validated instruments by the
eligible entity (and the proposed partners of
the entity, if any) in providing suicide
prevention services to individuals at risk of
suicide, particularly to eligible individuals
and their families.
(F) A description of the managerial and
technological capacity of the eligible entity--
(i) to coordinate the provision of
suicide prevention services with the
provision of other services;
(ii) to assess on an ongoing basis
the needs of eligible individuals and
their families for suicide prevention
services;
(iii) to coordinate the provision of
suicide prevention services with the
services of the Department for which
eligible individuals are also eligible;
(iv) to tailor suicide prevention
services to the needs of eligible
individuals and their families;
(v) to seek continuously new sources
of assistance to ensure the continuity
of suicide prevention services for
eligible individuals and their families
as long as they are determined to be at
risk of suicide; and
(vi) to measure the effects of
suicide prevention services provided by
the eligible entity or partner
organization, in accordance with
subsection (h)(2), on the lives of
eligible individuals and their families
who receive such services provided by
the organization using pre- and post-
evaluations on validated measures of
suicide risk and mood-related symptoms.
(G) Clearly defined objectives for the
provision of suicide prevention services.
(H) A description and physical address of the
primary location of the eligible entity.
(I) A description of the geographic area the
eligible entity plans to serve during the grant
award period for which the application applies.
(J) If the eligible entity is a State or
local government or an Indian tribe, the amount
of grant funds proposed to be made available to
community partners, if any, through agreements.
(K) A description of how the eligible entity
will assess the effectiveness of the provision
of grants under this section.
(L) An agreement to use the measures and
metrics provided by the Department for the
purposes of measuring the effectiveness of the
programming as described in subsection (h)(2).
(M) Such additional application criteria as
the Secretary considers appropriate.
(g) Training and Technical Assistance.--
(1) In general.--The Secretary shall provide training
and technical assistance, in coordination with the
Centers for Disease Control and Prevention, to eligible
entities in receipt of grants under this section
regarding--
(A) suicide risk identification and
management;
(B) the data required to be collected and
shared with the Department;
(C) the means of data collection and sharing;
(D) familiarization with and appropriate use
of any tool to be used to measure the
effectiveness of the use of the grants
provided; and
(E) the requirements for reporting under
subsection (e)(5) on services provided via such
grants.
(2) Provision of training and technical assistance.--
The Secretary may provide the training and technical
assistance described in paragraph (1) directly or
through grants or contracts with appropriate public or
nonprofit entities.
(h) Administration of Grant Program.--
(1) Selection criteria.--The Secretary, in
consultation with entities specified in paragraph (3),
shall establish criteria for the selection of eligible
entities that have submitted applications under
subsection (f).
(2) Development of measures and metrics.--The
Secretary shall develop, in consultation with entities
specified in paragraph (3), the following:
(A) A framework for collecting and sharing
information about entities in receipt of grants
under this section for purposes of improving
the services available for eligible individuals
and their families, set forth by service type,
locality, and eligibility criteria.
(B) The measures and metrics to be used by
each entity in receipt of grants under this
section to determine the effectiveness of the
programming being provided by such entity in
improving mental health status, wellbeing, and
reducing suicide risk and completed suicides of
eligible individuals and their families, which
shall include an existing measurement tool or
protocol for the grant recipient to utilize
when determining programmatic effectiveness.
(3) Coordination.--In developing a plan for the
design and implementation of the provision of grants
under this section, including criteria for the award of
grants, the Secretary shall consult with the following:
(A) Veterans service organizations.
(B) National organizations representing
potential community partners of eligible
entities in providing supportive services to
address the needs of eligible individuals and
their families, including national
organizations that--
(i) advocate for the needs of
individuals with or at risk of
behavioral health conditions;
(ii) represent mayors;
(iii) represent unions;
(iv) represent first responders;
(v) represent chiefs of police and
sheriffs;
(vi) represent governors;
(vii) represent a territory of the
United States; or
(viii) represent a Tribal alliance.
(C) National organizations representing
members of the Armed Forces.
(D) National organizations that represent
counties.
(E) Organizations with which the Department
has a current memorandum of agreement or
understanding related to mental health or
suicide prevention.
(F) State departments of veterans affairs.
(G) National organizations representing
members of the reserve components of the Armed
Forces.
(H) National organizations representing
members of the Coast Guard.
(I) Organizations, including institutions of
higher education, with experience in creating
measurement tools for purposes of advising the
Secretary on the most appropriate existing
measurement tool or protocol for the Department
to utilize.
(J) The National Alliance on Mental Illness.
(K) A labor organization (as such term is
defined in section 7103(a)(4) of title 5,
United States Code).
(L) The Centers for Disease Control and
Prevention, the Substance Abuse and Mental
Health Services Administration, the President's
Roadmap to Empower Veterans and End a National
Tragedy of Suicide Task Force, and such other
organizations as the Secretary considers
appropriate.
(4) Report on grant criteria.--Not later than 30 days
before notifying eligible entities of the availability
of funding under this section, the Secretary shall
submit to the appropriate committees of Congress a
report containing--
(A) criteria for the award of a grant under
this section;
(B) the already developed measures and
metrics to be used by the Department to measure
the effectiveness of the use of grants provided
under this section as described in subsection
(h)(2); and
(C) a framework for the sharing of
information about entities in receipt of grants
under this section.
(i) Information on Potential Eligible Individuals.--
(1) In general.--The Secretary may make available to
recipients of grants under this section certain
information regarding potential eligible individuals
who may receive services for which such grant is
provided.
(2) Information included.--The information made
available under paragraph (1) with respect to potential
eligible individuals may include the following:
(A) Confirmation of the status of a potential
eligible individual as a veteran.
(B) Confirmation of whether the potential
eligible individual is enrolled in the patient
enrollment system of the Department under
section 1705(a) of title 38, United States
Code.
(C) Confirmation of whether a potential
eligible individual is currently receiving care
furnished by the Department or has recently
received such care.
(3) Opt-out.--The Secretary shall allow an eligible
individual to opt out of having their information
shared under this subsection with recipients of grants
under this section.
(j) Duration.--The authority of the Secretary to provide
grants under this section shall terminate on [the date that is
three years after the date on which the first grant is awarded
under this section] September 30, 2026.
(k) Reporting.--
(1) Interim report.--
(A) In general.--Not later than 18 months
after the date on which the first grant is
awarded under this section, the Secretary shall
submit to the appropriate committees of
Congress a report on the provision of grants to
eligible entities under this section.
(B) Elements.--The report submitted under
subparagraph (A) shall include the following:
(i) An assessment of the
effectiveness of the grant program
under this section, including--
(I) the effectiveness of
grant recipients and their
community partners, if any, in
conducting outreach to eligible
individuals;
(II) the effectiveness of
increasing eligible individuals
engagement in suicide
prevention services; and
(III) such other validated
instruments and additional
measures as determined by the
Secretary and as described in
subsection (h)(2).
(ii) A list of grant recipients and
their partner organizations, if any,
that delivered services funded by the
grant and the amount of such grant
received by each recipient and partner
organization.
(iii) The number of eligible
individuals supported by each grant
recipient, including through services
provided to family members,
disaggregated by--
(I) all demographic
characteristics as determined
necessary and appropriate by
the Secretary in coordination
with the Centers for Disease
Control and Prevention;
(II) whether each such
eligible individual is enrolled
in the patient enrollment
system of the Department under
section 1705(a) of title 38,
United States Code;
(III) branch of service in
the Armed Forces;
(IV) era of service in the
Armed Forces;
(V) type of service received
by the eligible individual; and
(VI) whether each such
eligible individual was
referred to the Department for
care.
(iv) The number of eligible
individuals supported by grants under
this section, including through
services provided to family members.
(v) The number of eligible
individuals described in clause (iv)
who were not previously receiving care
furnished by the Department, with
specific numbers for the population of
eligible individuals described in
subsection (q)(4)(B).
(vi) The number of eligible
individuals whose mental health status,
wellbeing, and suicide risk received a
baseline measurement assessment under
this section and the number of such
eligible individuals whose mental
health status, wellbeing, and suicide
risk will be measured by the Department
or a community partner over a period of
time for any improvements.
(vii) The types of data the
Department was able to collect and
share with partners, including a
characterization of the benefits of
that data.
(viii) The number and percentage of
eligible individuals referred to the
point of contact at the Department
under subsection (e)(3)(C).
(ix) The number of eligible
individuals newly enrolled in the
patient enrollment system of the
Department under section 1705(a) of
title 38, United States Code based on a
referral to the Department from a grant
recipient under subsection (e)(3)(C),
disaggregated by grant recipient.
(x) A detailed account of how the
grant funds were used, including
executive compensation, overhead costs,
and other indirect costs.
(xi) A description of any outreach
activities conducted by the eligible
entity in receipt of a grant with
respect to services provided using the
grant.
(xii) The number of individuals who
seek services from the grant recipient
who are not eligible individuals.
(C) Submittal of information by grant
recipients.--The Secretary may require eligible
entities receiving grants under this section to
provide to Congress such information as the
Secretary determines necessary regarding the
elements described in subparagraph (B).
(2) Final report.--Not later than three years after
the date on which the first grant is awarded under this
section, and annually thereafter for each year in which
the program is in effect, the Secretary shall submit to
the appropriate committees of Congress--
(A) a follow-up on the interim report
submitted under paragraph (1) containing the
elements set forth in subparagraph (B) of such
paragraph; and
(B) a report on--
(i) the effectiveness of the
provision of grants under this section,
including the effectiveness of
community partners in conducting
outreach to eligible individuals and
their families and reducing the rate of
suicide among eligible individuals;
(ii) an assessment of the increased
capacity of the Department to provide
services to eligible individuals and
their families, set forth by State, as
a result of the provision of grants
under this section;
(iii) the feasibility and
advisability of extending or expanding
the provision of grants consistent with
this section; and
(iv) such other elements as
considered appropriate by the
Secretary.
(l) Third-party Assessment.--
(1) Study of grant program.--
(A) In general.--Not later than 180 days
after the commencement of the grant program
under this section, the Secretary shall seek to
enter into a contract with an appropriate
entity described in paragraph (3) to conduct a
study of the grant program.
(B) Elements of study.--In conducting the
study under subparagraph (A), the appropriate
entity shall--
(i) evaluate the effectiveness of the
grant program under this section in--
(I) addressing the factors
that contribute to suicides;
(II) increasing the use of
suicide prevention services;
(III) reducing mood-related
symptoms that increase suicide
and suicide risk; and
(IV) where such information
is available due to the time
frame of the grant program,
reducing suicidal ideation,
suicide attempts, self-harm,
and deaths by suicide; and
(V) reducing suicidal
ideation, suicide attempts,
self-harm, and deaths by
suicide among eligible
individuals through eligible
entities located in
communities; and
(ii) compare the results of the grant
program with other national programs in
delivering resources to eligible
individuals in the communities where
they live that address the factors that
contribute to suicide.
(2) Assessment.--
(A) In general.--The contract under paragraph
(1) shall provide that not later than 24 months
after the commencement of the grant program
under this section, the appropriate entity
shall submit to the Secretary an assessment
based on the study conducted pursuant to such
contract.
(B) Submittal to congress.--Upon receipt of
the assessment under subparagraph (A), the
Secretary shall transmit to the appropriate
committees of Congress a copy of the
assessment.
(3) Appropriate entity.--An appropriate entity
described in this paragraph is a nongovernment entity
with experience optimizing and assessing organizations
that deliver services and assessing the effectiveness
of suicide prevention programs.
(m) Referral for Care.--
(1) Mental health assessment.--If an eligible entity
in receipt of a grant under this section determines
that an eligible individual is at-risk of suicide or
other mental or behavioral health condition pursuant to
a baseline mental health screening conducted under
subsection (q)(11)(A)(ii) with respect to the
individual, the entity shall refer the eligible
individual to the Department for additional care under
subsection (n) or any other provision of law.
(2) Emergency treatment.--If an eligible entity in
receipt of a grant under this section determines that
an eligible individual furnished clinical services for
emergency treatment under subsection (q)(11)(A)(iv)
requires ongoing services, the entity shall refer the
eligible individual to the Department for additional
care under subsection (n) or any other provision of
law.
(3) Emergent suicide care.--In the case of an
eligible individual who receives suicide prevention
services provided or coordinated by an eligible entity
in receipt of a grant under this section, the eligible
entity shall notify--
(A) the eligible individual that the
individual may be eligible for emergent suicide
care under section 1720J of title 38, United
States Code; and
(B) the Secretary, if an eligible individual
notified under subparagraph (A) elects to
receive such emergent suicide care.
[(3)] (4) Refusal.--If an eligible individual refuses
a referral by an entity under paragraph [(1) or (2)]
(1), (2), or (3), any ongoing clinical services
provided to the eligible individual by the entity shall
be at the expense of the entity.
(n) Provision of care to eligible individuals.--
(1) In general.--When the Secretary determines it is
clinically appropriate, the Secretary shall furnish to
eligible individuals who are receiving or have received
suicide prevention services through grants provided
under this section an initial mental health assessment
and mental health or behavioral health care services
authorized under chapter 17 of title 38, United States
Code, that are required to treat the mental or
behavioral health care needs of the eligible
individual, including risk of suicide.
(2) Time frame.--If the Secretary does not provide
services under paragraph (1) to an eligible individual
during the 72-hour period following a referral under
subsection (m), such eligible individual shall be
treated as eligible for emergent suicide care under
section 1720J of title 38, United States Code.
(o) Agreements With Community Partners.--
(1) In general.--Subject to paragraph (2), an
eligible entity may use grant funds to enter into an
agreement with a community partner under which the
eligible entity may provide funds to the community
partner for the provision of suicide prevention
services to eligible individuals and their families.
(2) Limitation.--The ability of a recipient of a
grant under this section to provide grant funds to a
community partner shall be limited to grant recipients
that are a State or local government or an Indian
tribe.
(p) Authorization of Appropriations.--There is authorized to
be appropriated to the Secretary to carry out this [section a
total of $174,000,000 for fiscal years 2021 through 2025.]
section--
(1) a total of $174,000,000 for fiscal years 2021
through 2025; and
(2) $52,500,000 for fiscal year 2026.
(q) Definitions.--In this section:
(1) Appropriate committees of congress.--The term
``appropriate committees of Congress'' means--
(A) the Committee on Veterans' Affairs and
the Subcommittee on Military Construction,
Veterans Affairs, and Related Agencies of the
Committee on Appropriations of the Senate; and
(B) the Committee on Veterans' Affairs and
the Subcommittee on Military Construction,
Veterans Affairs, and Related Agencies of the
Committee on Appropriations of the House of
Representatives.
(2) Department.--The term ``Department'' means the
Department of Veterans Affairs.
(3) Eligible entity.--The term ``eligible entity''
means an entity that has continuously provided mental
health care or support services in the United States
during the two-year period before the date on which the
entity applies for a grant under this section and that
is--
(A) an incorporated private institution [or
foundation], foundation, or health care
provider--
(i) no part of the net earnings of
which incurs to the benefit of any
member, founder, contributor, or
individual; and
(ii) that has a governing board that
would be responsible for the operation
of the suicide prevention services
provided under this section;
(B) a corporation wholly owned and controlled
by an organization meeting the requirements of
clauses (i) and (ii) of subparagraph (A);
(C) an Indian tribe;
(D) a community-based organization that can
effectively network with local civic
organizations, regional health systems, and
other settings where eligible individuals and
their families are likely to have contact; or
(E) [A] a State or local government.
(4) Eligible individual.--The term ``eligible
individual'' includes a person at risk of suicide who
is--
(A) a veteran as defined in section 101 of
title 38, United States Code;
(B) an individual described in section
1720I(b) of such title; or
(C) an individual described in any of clauses
(i) through (iv) of section 1712A(a)(1)(C) of
such title.
(5) Emergency treatment.--[Medical services] The term
``emergency treatment'' means medical services,
professional services, ambulance services, ancillary
care and medication (including a short course of
medication related to and necessary for the treatment
of the emergency condition that is provided directly to
or prescribed for the patient for use after the
emergency condition is stabilized and the patient is
discharged) was rendered in a medical emergency of such
nature that a prudent layperson would have reasonably
expected that delay in seeking immediate medical
attention would have been hazardous to life or health.
This standard is met by an emergency medical condition
manifesting itself by acute symptoms of sufficient
severity (including severe pain) that a prudent
layperson who possesses an average knowledge of health
and medicine could reasonably expect the absence of
immediate medical attention to result in placing the
health of the individual in serious jeopardy, serious
impairment to bodily functions, or serious dysfunction
of any bodily organ or part.
(6) Family.--The term ``family'' means, with respect
to an eligible individual, any of the following:
(A) A parent.
(B) A spouse.
(C) A child.
(D) A sibling.
(E) A step-family member.
(F) An extended family member.
(G) Any other individual who lives with the
eligible individual.
(7) Indian tribe.--The term ``Indian tribe'' has the
meaning given that term in section 4 of the Native
American Housing Assistance and Self-Determination Act
of 1996 (25 U.S.C. 4103).
(8) Risk of suicide.--
(A) In general.--The term ``risk of suicide''
means exposure to, or the existence of, any of
the following (to a degree determined by the
Secretary pursuant to regulations):
(i) Health risk factors, including
the following:
(I) Mental health challenges.
(II) Substance abuse.
(III) Serious or chronic
health conditions or pain.
(IV) Traumatic brain injury.
(ii) Environmental risk factors,
including the following:
(I) Prolonged stress.
(II) Stressful life events.
(III) Unemployment.
(IV) Homelessness.
(V) Recent loss.
(VI) Legal or financial
challenges.
(iii) Historical risk factors,
including the following:
(I) Previous suicide
attempts.
(II) Family history of
suicide.
(III) History of abuse,
neglect, or trauma.
(B) Degree of risk.--The Secretary may, by
regulation, establish a process for determining
degrees of risk of suicide for use by grant
recipients to focus the delivery of services
using grant funds.
(9) Rural.--The term ``rural'', with respect to a
community, has the meaning given that term in the
Rural-Urban Commuting Areas coding system of the
Department of Agriculture.
(10) Secretary.--The term ``Secretary'' means the
Secretary of Veterans Affairs.
(11) Suicide prevention services.--
(A) In general.--The term ``suicide
prevention services'' means services to address
the needs of eligible individuals and their
families and includes the following:
(i) Outreach to identify those at
risk of suicide with an emphasis on
eligible individuals who are at highest
risk or who are not receiving health
care or other services furnished by the
Department.
(ii) A baseline mental health
screening for risk, which in the case
of a grant made on or after the date of
the enactment of the No Wrong Door for
Veterans Act, shall be the Columbia
Protocol (also known as the Columbia-
Suicide Severity Rating Scale).
(iii) Education on suicide risk and
prevention to families and communities.
(iv) Provision of clinical services
for emergency treatment.
(v) Case management services.
(vi) Peer support services.
(vii) Assistance in obtaining any
benefits from the Department that the
eligible individual and their family
may be eligible to receive, including--
(I) vocational and
rehabilitation counseling;
(II) supportive services for
homeless veterans;
(III) employment and training
services;
(IV) educational assistance;
and
(V) health care services.
(viii) Assistance in obtaining and
coordinating the provision of other
benefits provided by the Federal
Government, a State or local
government, or an eligible entity.
(ix) Assistance with emergent needs
relating to--
(I) health care services;
(II) daily living services;
(III) personal financial
planning and counseling;
(IV) transportation services;
(V) temporary income support
services;
(VI) fiduciary and
representative payee services;
(VII) legal services to
assist the eligible individual
with issues that may contribute
to the risk of suicide; and
(VIII) child care (not to
exceed $5,000 per family of an
eligible individual per fiscal
year).
(x) Nontraditional and innovative
approaches and treatment practices, as
determined appropriate by the
Secretary, in consultation with
appropriate entities.
(xi) Such other services necessary
for improving the mental health status
and wellbeing and reducing the suicide
risk of eligible individuals and their
families as the Secretary considers
appropriate, which may include--
(I) adaptive sports, equine
assisted therapy, or in-place
or outdoor recreational
therapy;
(II) substance use reduction
programming;
(III) individual, group, or
family counseling; and
(IV) relationship coaching.
(B) Exclusion.--The term ``suicide prevention
services'' does not include direct cash
assistance to eligible individuals or their
families.
(12) Veterans crisis line.--The term ``Veterans
Crisis Line'' means the toll-free hotline for veterans
established under section 1720F(h) of title 38, United
States Code.
(13) Veterans service organization.--The term
``veterans service organization'' means any
organization recognized by the Secretary for the
representation of veterans under section 5902 of title
38, United States Code.
* * * * * * *
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TITLE 38, UNITED STATES CODE
* * * * * * *
PART II--GENERAL BENEFITS
* * * * * * *
CHAPTER 17--HOSPITAL, NURSING HOME, DOMICILIARY, AND MEDICAL CARE
* * * * * * *
SUBCHAPTER I--GENERAL
Sec. 1701. Definitions
For the purposes of this chapter--
(1) The term ``disability'' means a disease, injury, or other
physical or mental defect.
(2) The term ``veteran of any war'' includes any veteran
awarded the Medal of Honor.
(3) The term ``facilities of the Department'' means--
(A) facilities over which the Secretary has direct
jurisdiction;
(B) Government facilities for which the Secretary
contracts; and
(C) public or private facilities at which the
Secretary provides recreational activities for patients
receiving care under section 1710 of this title.
(4) The term ``non-Department facilities'' means facilities
other than Department facilities.
(5) The term ``hospital care'' includes--
(A)(i) medical services rendered in the course of the
hospitalization of any veteran, and (ii) travel and
incidental expenses pursuant to the provisions of
section 111 of this title;
(B) such mental health services, consultation,
professional counseling, marriage and family
counseling, and training for the members of the
immediate family or legal guardian of a veteran, or the
individual in whose household such veteran certifies an
intention to live, as the Secretary considers
appropriate for the effective treatment and
rehabilitation of a veteran or dependent or survivor of
a veteran receiving care under the last sentence of
section 1781(b) of this title; and
(C)(i) medical services rendered in the course of the
hospitalization of a dependent or survivor of a veteran
receiving care under the last sentence of section
1781(b) of this title, and (ii) travel and incidental
expenses for such dependent or survivor under the terms
and conditions set forth in section 111 of this title.
(6) The term ``medical services'' includes, in addition to
medical examination, treatment, and rehabilitative services,
the following:
(A) Surgical services.
(B) Dental services and appliances as described in
sections 1710 and 1712 of this title.
(C) Optometric and podiatric services.
(D) Preventive health services.
(E) Noninstitutional extended care services,
including alternatives to institutional extended care
that the Secretary may furnish directly, by contract,
or through provision of case management by another
provider or payer.
(F) In the case of a person otherwise receiving care
or services under this chapter--
(i) wheelchairs, artificial limbs (including
adaptive prostheses and terminal devices for
sports and other recreational activities),
trusses, and similar appliances;
(ii) special clothing made necessary by the
wearing of prosthetic appliances; and
(iii) such other supplies or services as the
Secretary determines to be reasonable and
necessary.
(G) Travel and incidental expenses pursuant to
section 111 of this title.
(H) Chiropractic services.
(I) The provision of medically necessary van lifts,
raised doors, raised roofs, air conditioning, and
wheelchair tiedowns for passenger use.
(7) The term ``domiciliary care'' includes necessary medical
services and travel and incidental expenses pursuant to the
provisions of section 111 of this title.
(8) The term ``rehabilitative services'' means such
professional, counseling, chiropractic, and guidance services
and treatment programs as are necessary to restore, to the
maximum extent possible, the physical, mental, and
psychological functioning of an ill or disabled person.
(9) The term ``preventive health services'' means--
(A) periodic medical and dental examinations;
(B) patient health education (including nutrition
education);
(C) maintenance of drug use profiles, patient drug
monitoring, and drug utilization education;
(D) mental health preventive services;
(E) substance abuse prevention measures;
(F) chiropractic examinations and services;
(G) immunizations against infectious diseases,
including each immunization on the recommended adult
immunization schedule at the time such immunization is
indicated on that schedule;
(H) prevention of musculoskeletal deformity or other
gradually developing disabilities of a metabolic or
degenerative nature;
(I) genetic counseling concerning inheritance of
genetically determined diseases;
(J) routine vision testing and eye care services;
(K) periodic reexamination of members of likely
target populations (high-risk groups) for selected
diseases and for functional decline of sensory organs,
together with attendant appropriate remedial
intervention; and
(L) such other health-care services as the Secretary
may determine to be necessary to provide effective and
economical preventive health care.
(10) The term ``recommended adult immunization schedule''
means the schedule established (and periodically reviewed and,
as appropriate, revised) by the Advisory Committee on
Immunization Practices established by the Secretary of Health
and Human Services and delegated to the Centers for Disease
Control and Prevention.
* * * * * * *
PART IV--GENERAL ADMINISTRATIVE PROVISIONS
* * * * * * *
CHAPTER 55--MINORS, INCOMPETENTS, AND OTHER WARDS
* * * * * * *
Sec. 5503. Hospitalized veterans and estates of incompetent
institutionalized veterans
(a)(1)(A) Where any veteran having neither spouse nor child
is being furnished domiciliary care by the Department, no
pension in excess of $90 per month shall be paid to or for the
veteran for any period after the end of the third full calendar
month following the month of admission for such care.
(B) Except as provided in subparagraph (D) of this paragraph,
where any veteran having neither spouse nor child is being
furnished nursing home care by the Department, no pension in
excess of $90 per month shall be paid to or for the veteran for
any period after the end of the third full calendar month
following the month of admission for such care. Any amount in
excess of $90 per month to which the veteran would be entitled
but for the application of the preceding sentence shall be
deposited in a revolving fund at the Department medical
facility which furnished the veteran nursing care, and such
amount shall be available for obligation without fiscal year
limitation to help defray operating expenses of that facility.
(C) No pension in excess of $90 per month shall be paid to or
for a veteran having neither spouse nor child for any period
after the month in which such veteran is readmitted for care
described in subparagraph (A) or (B) of this paragraph and
furnished by the Department if such veteran is readmitted
within six months of a period of care in connection with which
pension was reduced pursuant to subparagraph (A) or (B) of this
paragraph.
(D) In the case of a veteran being furnished nursing home
care by the Department and with respect to whom subparagraph
(B) of this paragraph requires a reduction in pension, such
reduction shall not be made for a period of up to three
additional calendar months after the last day of the third
month referred to in such subparagraph if the Secretary
determines that the primary purpose for the furnishing of such
care during such additional period is for the Department to
provide such veteran with a prescribed program of
rehabilitation services, under chapter 17 of this title,
designed to restore such veteran's ability to function within
such veteran's family and community. If the Secretary
determines that it is necessary, after such period, for the
veteran to continue such program of rehabilitation services in
order to achieve the purposes of such program and that the
primary purpose of furnishing nursing home care to the veteran
continues to be the provision of such program to the veteran,
the reduction in pension required by subparagraph (B) of this
paragraph shall not be made for the number of calendar months
that the Secretary determines is necessary for the veteran to
achieve the purposes of such program.
(2) The provisions of paragraph (1) shall also apply to a
veteran being furnished such care who has a spouse but whose
pension is payable under section 1521(b) of this title. In such
a case, the Secretary may apportion and pay to the spouse, upon
an affirmative showing of hardship, all or any part of the
amounts in excess of the amount payable to the veteran while
being furnished such care which would be payable to the veteran
if pension were payable under section 1521(c) of this title.
(b) Notwithstanding any other provision of this section or
any other provision of law, no reduction shall be made in the
pension of any veteran for any part of the period during which
the veteran is furnished hospital treatment, or institutional
or domiciliary care, for Hansen's disease, by the United States
or any political subdivision thereof.
(c) Where any veteran in receipt of an aid and attendance
allowance described in subsection (r) or (t) of section 1114 of
this title is hospitalized at Government expense, such
allowance shall be discontinued from the first day of the
second calendar month which begins after the date of the
veteran's admission for such hospitalization for so long as
such hospitalization continues. Any discontinuance required by
administrative regulation, during hospitalization of a veteran
by the Department, of increased pension based on need of
regular aid and attendance or additional compensation based on
need of regular aid and attendance as described in subsection
(l) or (m) of section 1114 of this title, shall not be
effective earlier than the first day of the second calendar
month which begins after the date of the veteran's admission
for hospitalization. In case a veteran affected by this
subsection leaves a hospital against medical advice and is
thereafter admitted to hospitalization within six months from
the date of such departure, such allowance, increased pension,
or additional compensation, as the case may be, shall be
discontinued from the date of such readmission for so long as
such hospitalization continues.
(d)(1) For the purposes of this subsection--
(A) the term ``Medicaid plan'' means a State plan for
medical assistance referred to in section 1902(a) of
the Social Security Act (42 U.S.C. 1396a(a)); and
(B) the term ``nursing facility'' means a nursing
facility described in section 1919 of such Act (42
U.S.C. 1396r), other than a facility that is a State
home with respect to which the Secretary makes per diem
payments for nursing home care pursuant to section
1741(a) of this title.
(2) If a veteran having neither spouse nor child is covered
by a Medicaid plan for services furnished such veteran by a
nursing facility, no pension in excess of $90 per month shall
be paid to or for the veteran for any period after the month of
admission to such nursing facility.
(3) Notwithstanding any provision of title XIX of the Social
Security Act, the amount of the payment paid a nursing facility
pursuant to a Medicaid plan for services furnished a veteran
may not be reduced by any amount of pension permitted to be
paid such veteran under paragraph (2) of this subsection.
(4) A veteran is not liable to the United States for any
payment of pension in excess of the amount permitted under this
subsection that is paid to or for the veteran by reason of the
inability or failure of the Secretary to reduce the veteran's
pension under this subsection unless such inability or failure
is the result of a willful concealment by the veteran of
information necessary to make a reduction in pension under this
subsection.
(5)(A) The provisions of this subsection shall apply with
respect to a surviving spouse having no child in the same
manner as they apply to a veteran having neither spouse nor
child.
(B) The provisions of this subsection shall apply with
respect to a child entitled to pension under section 1542 of
this title in the same manner as they apply to a veteran having
neither spouse nor child.
(6) The costs of administering this subsection shall be paid
for from amounts available to the Department of Veterans
Affairs for the payment of compensation and pension.
(7) This subsection expires on [November 30, 2031] January
30, 2033.
* * * * * * *
MINORITY VIEWS
The amendment in the nature of a substitute (A.N.S.) to the
No Wrong Door for Veterans Act (H.R. 1969), as amended,
reauthorizes the Staff Sergeant Parker Gordon Fox Suicide
Prevention Grant Program for one year and makes additional
changes.
While Democratic members appreciate the importance of the
Staff Sergeant Parker Gordon Fox Suicide Prevention grant
program in VA's overall suicide prevention strategy and
generally support reauthorizing the program, we want to ensure
that it is reauthorized a way that ensures it is as effective
and robust as possible. We are concerned that this bill, as
amended and reported by the Committee, will not meet that goal.
First, based on the two congressionally mandated reports
that VA has so far provided to the Committee, the Fox grant
program has not been implemented in a way that enables VA and
Congress to evaluate its overall effectiveness. VA has not
established enough metrics to monitor the success of the
program. Further, grantees are not collecting or reporting
complete data for all participants, which limits Congress's
ability to determine whether this grant program is meeting its
intended purposes. H.R. 1969 does not take steps to address
these concerns, and in fact includes provisions that would
further limit the collection of robust, complete data from
grantees.
This bill would also require grantees to use the Columbia
Suicide Severity Rating Scale (CSSRS) to screen participants
for their baseline mental health when entering the program.
While this tool is a widely accepted, clinically validated
behavioral health screening instrument, its primary use is to
measure a patient's suicidal ideation and the severity of
suicidal risk at a given point in time. As the Fox grant
program is currently implemented, grantees have the option to
screen participants' baseline mental health with the following
screening tools: Patient Health Questionnaire, General Self-
Efficacy Scale, Interpersonal Support Evaluation List, Socio
Economic Status, and the Warwick Edinburgh Mental Well-Being
Scale. These other instruments measure the degree of depression
a patient is experiencing; their levels of emotion, optimism,
and work satisfaction; and their perceptions of social support.
Since the Fox grant program is intended to address ``upstream''
factors of mental health that contribute to veterans' suicide
risk, it seems that the CSSRS would be the least useful tool
for measuring the program's effectiveness, as it assesses acute
suicidality. Limiting grantees to the use of a single screening
instrument that measures suicide risk at a point in time will
further limit our ability to evaluate the overall effectiveness
of the Staff Sergeant Parker Gordon Fox Suicide Prevention
grant program on improving veterans' mental health.
In testimony delivered during the March 11, 2025, Health
Subcommittee legislative hearing, VA addressed its concerns
with the bill as drafted:
``VA is concerned about allowing grantees to use a
different protocol for the baseline mental health
screening for risk besides the protocol furnished by
the Secretary. The current baseline mental health
screening protocol is the collection of five screenings
that assess mental health, well-being, financial
stability, and social support. These inform the
individual's treatment plan and referral needs; they
also are vital to program evaluation because they are
conducted both pre- and post-service delivery. To
determine service and program effectiveness, it is
essential that all grantees use the same protocol for
this. The Columbia-Suicide Severity Rating Scale is
currently a tool used by VA as one component of
eligibility screening, in that it identifies
individuals with suicidal thoughts and behaviors. If
Congress's intent is simply to allow grantees to use a
different protocol to determine the degree of risk for
eligibility, we believe this needs to be clarified,
though this could raise concerns with creating
disparate approaches.''
Committee Democrats agree that we must ensure grantees use
the same protocol to conduct both baseline- and post-service
mental health screenings of program participants to properly
evaluate the effectiveness of this program. However,
artificially restricting VA and grantees to using one tool that
only measures suicide risk through statute will fail to meet
this goal.
In addition, we are concerned about provisions of H.R.
1969, as amended, that would dramatically alter the entities
that would be eligible to receive grants. Specifically, we
oppose language that would add ``health care providers'' as
eligible grantees. The Staff Sergeant Parker Gordon Fox Suicide
Prevention grant program was designed to allow community-based
organizations to help address upstream suicide risk factors and
provide services to support veterans' needs. It was never
intended to directly provide clinical care, particularly mental
health care. H.R. 1969, as amended, would create a loophole for
selected community providers to receive grants of up to
$750,000 to furnish mental healthcare to veterans at VA's
expense, without any requirements to coordinate the veterans'
care with VA. Combined with our existing concerns about the
bill's lack of requirements to strengthen data collection and
demonstration of effective outcomes, we remain extremely
concerned that the lack of guardrails or oversight will weaken
the quality of care provided to veterans.
In its current form, H.R. 1969, as amended, does not
reauthorize this grant program in a way that will meet the
needs of our veterans. Accordingly, Democratic members offered
several amendments to the bill at full Committee markup, all of
which were summarily rejected by the majority. The amendments
included:
1. Substitute amendment offered by Rep. Ramirez:
Would have stricken the underlying language and
replaced it with the text of S. 793, To amend the
Commander John Scott Hannon Veterans Mental Health Care
Improvement Act of 2019 to modify and reauthorize the
Staff Sergeant Parker Gordon Fox Suicide Prevention
Grant Program of the Department of Veterans Affairs. It
is the belief of the Democratic members that any effort
to reauthorize the Fox Grant program should be in
coordination with our Senate counterparts. We also feel
that the Senate bill, as drafted, provides a better
starting point for reauthorization of the Fox grant
program and includes provisions that at least partially
address our concerns; namely, the provision in Section
1(c) that will require VA to collect additional
measures and metrics, to provide better accountability
to Congress and reflect lessons learned from interim
reporting on and evaluation of the grant program.
2. Amendment offered by Rep. Budzinski: Would have
required grantees to prioritize serving veterans who
have experienced job loss or unemployment since January
20, 2025. More than 700,000 veterans are federal
employees, which accounts for about a quarter of the
entire federal workforce. Many of these individuals are
either facing job loss or extreme uncertainty about
their continued employment, in light of President
Trump's efforts to reduce the federal workforce.
Because job loss and job insecurity are both known to
lead to higher suicide risk for both men and women
veterans, we believe grantees should prioritize
providing services to these veterans.
3. Amendment offered by Ranking Member Takano: Would
have helped strengthen the data collection requirements
in this bill by requiring grantees to conduct post-
intervention mental health assessments using the same
validated mental health screening tool used to conduct
the baseline mental health screening. It is critical
for grantees to demonstrate improvements in veterans'
mental health and suicide risk factors, to show that
the program is working as intended. Ensuring the
grantees are using the same screening tools to conduct
pre- and post-intervention screenings will help VA and
Congress conduct more robust oversight of the grant
program.
Committee Democrats support reauthorization of the Staff
Sergeant Parker Gordon Fox Suicide Prevention grant program and
improving veterans' access to programs that help reduce suicide
risk. However, as outlined above, we remain concerned about
numerous provisions in H.R. 1969, as amended, and we would like
to see a number of changes made before reauthorization
legislation is enacted.
Mark Takano,
Ranking Member.
[all]