    [United States Statutes at Large, Volume 134, 116th Congress, 2nd Session]
    [From the U.S. Government Publishing Office, www.gpo.gov]

    Public Law 116-171
    116th Congress

    An Act

    To improve mental health care provided by the Department of Veterans
    Affairs, and for other purposes. <>

    Be it enacted by the Senate and House of Representatives of the
    United States of America in Congress assembled, <>
    SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Commander John
    Scott Hannon Veterans Mental Health Care Improvement Act of 2019''.
    (b) Table of Contents.--The table of contents for this Act is as
    follows:

    Sec. 1. Short title; table of contents.

    TITLE I--IMPROVEMENT OF TRANSITION OF INDIVIDUALS TO SERVICES FROM
    DEPARTMENT OF VETERANS AFFAIRS

    Sec. 101. Strategic plan on expansion of health care coverage for
    veterans transitioning from service in the Armed Forces.
    Sec. 102. Review of records of former members of the Armed Forces who
    die by suicide within one year of separation from the Armed
    Forces.
    Sec. 103. Report on REACH VET program of Department of Veterans Affairs.
    Sec. 104. Report on care for former members of the Armed Forces with
    other than honorable discharge.

    TITLE II--SUICIDE PREVENTION

    Sec. 201. Financial assistance to certain entities to provide or
    coordinate the provision of suicide prevention services for
    eligible individuals and their families.
    Sec. 202. Analysis on feasibility and advisability of the Department of
    Veterans Affairs providing certain complementary and
    integrative health services.
    Sec. 203. Pilot program to provide veterans access to complementary and
    integrative health programs through animal therapy,
    agritherapy, sports and recreation therapy, art therapy, and
    posttraumatic growth programs.
    Sec. 204. Department of Veterans Affairs study of all-cause mortality of
    veterans, including by suicide, and review of staffing levels
    of mental health professionals.
    Sec. 205. Comptroller General report on management by Department of
    Veterans Affairs of veterans at high risk for suicide.

    TITLE III--PROGRAMS, STUDIES, AND GUIDELINES ON MENTAL HEALTH

    Sec. 301. Study on connection between living at high altitude and
    suicide risk factors among veterans.
    Sec. 302. Establishment by Department of Veterans Affairs and Department
    of Defense of a clinical provider treatment toolkit and
    accompanying training materials for comorbidities.
    Sec. 303. Update of clinical practice guidelines for assessment and
    management of patients at risk for suicide.
    Sec. 304. Establishment by Department of Veterans Affairs and Department
    of Defense of clinical practice guidelines for the treatment
    of serious mental illness.
    Sec. 305. Precision medicine initiative of Department of Veterans
    Affairs to identify and validate brain and mental health
    biomarkers.

    [[Page 779]]

    Sec. 306. Statistical analyses and data evaluation by Department of
    Veterans Affairs.

    TITLE IV--OVERSIGHT OF MENTAL HEALTH CARE AND RELATED SERVICES

    Sec. 401. Study on effectiveness of suicide prevention and mental health
    outreach programs of Department of Veterans Affairs.
    Sec. 402. Oversight of mental health and suicide prevention media
    outreach conducted by Department of Veterans Affairs.
    Sec. 403. Comptroller General management review of mental health and
    suicide prevention services of Department of Veterans
    Affairs.
    Sec. 404. Comptroller General report on efforts of Department of
    Veterans Affairs to integrate mental health care into primary
    care clinics.
    Sec. 405. Joint mental health programs by Department of Veterans Affairs
    and Department of Defense.

    TITLE V--IMPROVEMENT OF MENTAL HEALTH MEDICAL WORKFORCE

    Sec. 501. Staffing improvement plan for mental health providers of
    Department of Veterans Affairs.
    Sec. 502. Establishment of Department of Veterans Affairs Readjustment
    Counseling Service Scholarship Program.
    Sec. 503. Comptroller General report on Readjustment Counseling Service
    of Department of Veterans Affairs.
    Sec. 504. Expansion of reporting requirements on Readjustment Counseling
    Service of Department of Veterans Affairs.
    Sec. 505. Briefing on alternative work schedules for employees of
    Veterans Health Administration.
    Sec. 506. Suicide prevention coordinators.
    Sec. 507. Report on efforts by Department of Veterans Affairs to
    implement safety planning in emergency departments.

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

    Sec. 601. Expansion of capabilities of Women Veterans Call Center to
    include text messaging.
    Sec. 602. Requirement for Department of Veterans Affairs internet
    website to provide information on services available to women
    veterans.

    TITLE VII--OTHER MATTERS

    Sec. 701. Expanded telehealth from Department of Veterans Affairs.
    Sec. 702. Partnerships with non-Federal Government entities to provide
    hyperbaric oxygen therapy to veterans and studies on the use
    of such therapy for treatment of post-traumatic stress
    disorder and traumatic brain injury.
    Sec. 703. Prescription of technical qualifications for licensed hearing
    aid specialists and requirement for appointment of such
    specialists.
    Sec. 704. Use by Department of Veterans Affairs of commercial
    institutional review boards in sponsored research trials.
    Sec. 705. Creation of Office of Research Reviews within the Office of
    Information and Technology of the Department of Veterans
    Affairs.

    TITLE I--IMPROVEMENT OF TRANSITION OF INDIVIDUALS TO SERVICES FROM
    DEPARTMENT OF VETERANS AFFAIRS

    SEC. 101. STRATEGIC PLAN ON EXPANSION OF HEALTH CARE COVERAGE FOR
    VETERANS TRANSITIONING FROM SERVICE IN THE
    ARMED FORCES.

    (a) Strategic Plan.--
    (1) <>  In general.--Not later than one year after the date
    of the enactment of this Act, the Secretary of Veterans Affairs,
    in consultation with the Secretary of Defense, shall submit to
    the appropriate committees of Congress and publish on a

    [[Page 780]]

    website of the Department of Veterans Affairs a strategic plan
    for the provision by the Department of health care to any
    veteran during the one-year period following the discharge or
    release of the veteran from active military, naval, or air
    service.
    (2) Elements.--The plan submitted under paragraph (1) shall
    include the following:
    (A) An identification of general goals and
    objectives for the provision of health care to veterans
    described in such paragraph.
    (B) A description of how such goals and objectives
    are to be achieved, including--
    (i) a description of the use of existing
    personnel, information, technology, facilities,
    public and private partnerships, and other
    resources of the Department of Veterans Affairs;
    (ii) a description of the anticipated need for
    additional resources for the Department; and
    (iii) an assessment of cost.
    (C) <>  An analysis of the
    anticipated health care needs, including mental health
    care, for such veterans, disaggregated by geographic
    area.
    (D) <>  An analysis of whether such
    veterans are eligible for enrollment in the system of
    annual patient enrollment of the Department under
    section 1705(a) of title 38, United States Code.
    (E) A description of activities designed to promote
    the availability of health care from the Department for
    such veterans, including outreach to members of the
    Armed Forces though the Transition Assistance Program
    under sections 1142 and 1144 of title 10, United States
    Code.
    (F) A description of legislative or administrative
    action required to carry out the plan.
    (G) A description of how the plan would further the
    ongoing initiatives under Executive Order 13822 (83 Fed.
    Reg. 1513; relating to supporting our veterans during
    their transition from uniformed service to civilian
    life) to provide seamless access to high-quality mental
    health care and suicide prevention resources to veterans
    as they transition, with an emphasis on the one-year
    period following separation.

    (b) Definitions.--In this section:
    (1) Active military, naval, or air service.--The term
    ``active military, naval, or air service'' has the meaning given
    that term in section 101(24) of title 38, United States Code.
    (2) Appropriate committees of congress.--The term
    ``appropriate committees of Congress'' means--
    (A) the Committee on Veterans' Affairs and the
    Committee on Appropriations of the Senate; and
    (B) the Committee on Veterans' Affairs and the
    Committee on Appropriations of the House of
    Representatives.
    SEC. 102. REVIEW OF RECORDS OF FORMER MEMBERS OF THE ARMED FORCES
    WHO DIE BY SUICIDE WITHIN ONE YEAR OF
    SEPARATION FROM THE ARMED FORCES.

    (a) Review.--
    (1) <>  In general.--The
    Secretary of Defense and the Secretary of Veterans Affairs shall
    jointly review the records of

    [[Page 781]]

    each former member of the Armed Forces who died by suicide, as
    determined by the Secretary of Defense or the Secretary of
    Veterans Affairs, within one year following the discharge or
    release of the former member from active military, naval, or air
    service during the five-year period preceding the date of the
    enactment of this Act.
    (2) Records to be reviewed.--In completing the review
    required under paragraph (1), the Secretary of Defense and the
    Secretary of Veterans Affairs shall review the following records
    maintained by the Department of Defense:
    (A) Health treatment records.
    (B) Fitness, medical, and dental records.
    (C) Ancillary training records.
    (D) Safety forms and additional duties sections of
    the personnel information files.

    (b) Elements.--The review required by subsection (a) with respect to
    a former member of the Armed Forces shall include consideration of the
    following:
    (1) <>  Whether the Department of
    Defense had identified the former member as being at elevated
    risk during the 365-day period before separation of the member
    from the Armed Forces.
    (2) In the case that the member was identified as being at
    elevated risk as described in paragraph (1), whether that
    identification had been communicated to the Department of
    Veterans Affairs via the Solid Start initiative of the
    Department pursuant to Executive Order 13822 (83 Fed. Reg. 1513;
    relating to supporting our veterans during their transition from
    uniformed service to civilian life), or any other means.
    (3) The presence of evidence-based and empirically-supported
    contextual and individual risk factors specified in subsection
    (c) with respect to the former member and how those risk factors
    correlated to the circumstances of the death of the former
    member.
    (4) Demographic variables, including the following:
    (A) Sex.
    (B) Age.
    (C) Rank at separation from the Armed Forces.
    (D) Career field after separation from the Armed
    Forces.
    (E) State and county of residence one month prior to
    death.
    (F) Branch of service in the Armed Forces.
    (G) Marital status.
    (H) Reason for separation from the Armed Forces.
    (5) Support or medical services furnished to the former
    member through the Department of Defense, specified by the type
    of service or care provided.
    (6) Support or medical services furnished to the former
    member through the Department of Veterans Affairs, specified by
    the type of service or care provided.

    (c) Evidence-based and Empirically-supported Contextual and
    Individual Risk Factors.--Evidence-based and empirically-supported
    contextual and individual risk factors specified in this subsection
    include the following:
    (1) Exposure to violence.
    (2) Exposure to suicide.
    (3) Housing instability.

    [[Page 782]]

    (4) Financial instability.
    (5) Vocational problems or insecurity.
    (6) Legal problems.
    (7) Highly acute or significantly chronic relational
    problems.
    (8) Limited access to health care.

    (d) Report.--Not later than three years after the date of the
    enactment of this Act, the Secretary of Defense and the Secretary of
    Veterans Affairs shall jointly submit to the appropriate committees of
    Congress an aggregated report on the results of the review conducted
    under subsection (a) with respect to the year-one cohort of former
    members of the Armed Forces covered by the review.
    (e) Definitions.--In this section:
    (1) Active military, naval, or air service.--The term
    ``active military, naval, or air service'' has the meaning given
    that term in section 101(24) of title 38, United States Code.
    (2) Appropriate committees of congress defined.--The term
    ``appropriate committees of Congress'' means--
    (A) the Committee on Armed Services and the
    Committee on Veterans' Affairs of the Senate; and
    (B) the Committee on Armed Services and the
    Committee on Veterans' Affairs of the House of
    Representatives.
    SEC. 103. REPORT ON REACH VET PROGRAM OF DEPARTMENT OF VETERANS
    AFFAIRS.

    (a) In General.--Not later than 180 days after the date of the
    enactment of this Act, the Secretary of Veterans Affairs shall submit to
    the Committee on Veterans' Affairs of the Senate and the Committee on
    Veterans' Affairs of the House of Representatives a report on the REACH
    VET program.
    (b) <>  Elements.--The report required by
    subsection (a) shall include the following:
    (1) An assessment of the impact of the REACH VET program on
    rates of suicide among veterans.
    (2) An assessment of how limits within the REACH VET
    program, such as caps on the number of veterans who may be
    flagged as high risk, are adjusted for differing rates of
    suicide across the country.
    (3) A detailed explanation, with evidence, for why the
    conditions included in the model used by the REACH VET program
    were chosen, including an explanation as to why certain
    conditions, such as bipolar disorder II, were not included even
    though they show a similar rate of risk for suicide as other
    conditions that were included.
    (4) An assessment of the feasibility of incorporating
    certain economic data held by the Veterans Benefits
    Administration into the model used by the REACH VET program,
    including financial data and employment status, which research
    indicates may have an impact on risk for suicide.

    (c) REACH VET Program Defined.--In this section, the term ``REACH
    VET program'' means the Recovery Engagement and Coordination for
    Health--Veterans Enhanced Treatment program of the Department of
    Veterans Affairs.
    SEC. 104. REPORT ON CARE FOR FORMER MEMBERS OF THE ARMED FORCES
    WITH OTHER THAN HONORABLE DISCHARGE.

    Section 1720I(f) of title 38, United States Code, is amended--

    [[Page 783]]

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

    TITLE II--SUICIDE PREVENTION

    SEC. 201. <>  FINANCIAL ASSISTANCE TO
    CERTAIN ENTITIES TO PROVIDE OR COORDINATE
    THE PROVISION OF SUICIDE PREVENTION
    SERVICES FOR ELIGIBLE INDIVIDUALS AND
    THEIR FAMILIES.

    (a) Purpose; Designation.--
    (1) Purpose.--The purpose of this section is to reduce
    veteran suicide through a community-based grant program to award
    grants to eligible entities to provide or coordinate suicide
    prevention services to eligible individuals and their families.
    (2) Designation.--The grant program under this section shall
    be known as the ``Staff Sergeant Parker Gordon Fox Suicide
    Prevention Grant Program''.

    (b) <>  Financial Assistance and Coordination.--The
    Secretary shall provide financial assistance to eligible entities
    approved under this section through the award of grants to such entities
    to provide or coordinate the provision of services to eligible
    individuals and their families to reduce the risk of
    suicide. <>  The Secretary shall carry out this
    section in coordination with the President's Roadmap to Empower Veterans
    and End a National Tragedy of Suicide Task Force and in consultation
    with the Office of Mental Health and Suicide Prevention of the
    Department, to the extent practicable.

    (c) Award of Grants.--
    (1) In general.--The Secretary shall award a grant to each
    eligible entity for which the Secretary has approved an
    application under subsection (f) to provide or coordinate the
    provision of suicide prevention services under this section.
    (2) Grant amounts, intervals of payment, and matching
    funds.--In accordance with the services being provided under a
    grant under this section and the duration of those services, the
    Secretary shall establish--
    (A) a maximum amount to be awarded under the grant
    of not more than $750,000 per grantee per fiscal year;
    and
    (B) intervals of payment for the administration of
    the grant.

    (d) Distribution of Grants and Preference.--

    [[Page 784]]

    (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

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    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.

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    (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.--

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    (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

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    (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.

    [[Page 789]]

    (j) Duration.--The authority of the Secretary to provide grants
    under this section shall terminate on the date that is three years after
    the date on which the first grant is awarded under this section.
    (k) Reporting.--
    (1) Interim report.--
    (A) In general.--Not later than 18 months after the
    date on which the first grant is awarded under this
    section, the Secretary shall submit to the appropriate
    committees of Congress a report on the provision of
    grants to eligible entities under this section.
    (B) Elements.--The report submitted under
    subparagraph (A) shall include the following:
    (i) <>  An assessment of
    the effectiveness of the grant program under this
    section, including--
    (I) the effectiveness of grant
    recipients and their community partners,
    if any, in conducting outreach to
    eligible individuals;
    (II) the effectiveness of increasing
    eligible individuals engagement in
    suicide prevention services; and
    (III) such other validated
    instruments and additional measures as
    determined by the Secretary and as
    described in subsection (h)(2).
    (ii) <>  A list of grant
    recipients and their partner organizations, if
    any, that delivered services funded by the grant
    and the amount of such grant received by each
    recipient and partner organization.
    (iii) The number of eligible individuals
    supported by each grant recipient, including
    through services provided to family members,
    disaggregated by--

    (I) <>
    all demographic characteristics as
    determined necessary and appropriate by
    the Secretary in coordination with the
    Centers for Disease Control and
    Prevention;
    (II) whether each such eligible
    individual is enrolled in the patient
    enrollment system of the Department
    under section 1705(a) of title 38,
    United States Code;
    (III) branch of service in the Armed
    Forces;
    (IV) era of service in the Armed
    Forces;
    (V) type of service received by the
    eligible individual; and
    (VI) whether each such eligible
    individual was referred to the
    Department for care.
    (iv) The number of eligible individuals
    supported by grants under this section, including
    through services provided to family members.
    (v) The number of eligible individuals
    described in clause (iv) who were not previously
    receiving care furnished by the Department, with
    specific numbers for the population of eligible
    individuals described in subsection (q)(4)(B).
    (vi) The number of eligible individuals whose
    mental health status, wellbeing, and suicide risk
    received a baseline measurement assessment under
    this section and the number of such eligible
    individuals

    [[Page 790]]

    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,

    [[Page 791]]

    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.

    [[Page 792]]

    (3) Refusal.--If an eligible individual refuses a referral
    by an entity under paragraph (1) or (2), any ongoing clinical
    services provided to the eligible individual by the entity shall
    be at the expense of the entity.

    (n) <>  Provision of Care to
    Eligible Individuals.--When the Secretary determines it is clinically
    appropriate, the Secretary shall furnish to eligible individuals who are
    receiving or have received suicide prevention services through grants
    provided under this section an initial mental health assessment and
    mental health or behavioral health care services authorized under
    chapter 17 of title 38, United States Code, that are required to treat
    the mental or behavioral health care needs of the eligible individual,
    including risk of suicide.

    (o) <>  Agreements With Community Partners.--
    (1) In general.--Subject to paragraph (2), an eligible
    entity may use grant funds to enter into an agreement with a
    community partner under which the eligible entity may provide
    funds to the community partner for the provision of suicide
    prevention services to eligible individuals and their families.
    (2) Limitation.--The ability of a recipient of a grant under
    this section to provide grant funds to a community partner shall
    be limited to grant recipients that are a State or local
    government or an Indian tribe.

    (p) <>  Authorization of Appropriations.--There
    is authorized to be appropriated to the Secretary to carry out this
    section a total of $174,000,000 for fiscal years 2021 through 2025.

    (q) Definitions.--In this section:
    (1) Appropriate committees of congress.--The term
    ``appropriate committees of Congress'' means--
    (A) the Committee on Veterans' Affairs and the
    Subcommittee on Military Construction, Veterans Affairs,
    and Related Agencies of the Committee on Appropriations
    of the Senate; and
    (B) the Committee on Veterans' Affairs and the
    Subcommittee on Military Construction, Veterans Affairs,
    and Related Agencies of the Committee on Appropriations
    of the House of Representatives.
    (2) Department.--The term ``Department'' means the
    Department of Veterans Affairs.
    (3) Eligible entity.--The term ``eligible entity'' means--
    (A) an incorporated private institution or
    foundation--
    (i) no part of the net earnings of which
    incurs to the benefit of any member, founder,
    contributor, or individual; and
    (ii) that has a governing board that would be
    responsible for the operation of the suicide
    prevention services provided under this section;
    (B) a corporation wholly owned and controlled by an
    organization meeting the requirements of clauses (i) and
    (ii) of subparagraph (A);
    (C) an Indian tribe;
    (D) a community-based organization that can
    effectively network with local civic organizations,
    regional health systems, and other settings where
    eligible individuals and their families are likely to
    have contact; or
    (E) A State or local government.

    [[Page 793]]

    (4) Eligible individual.--The term ``eligible individual''
    includes a person at risk of suicide who is--
    (A) a veteran as defined in section 101 of title 38,
    United States Code;
    (B) an individual described in section 1720I(b) of
    such title; or
    (C) an individual described in any of clauses (i)
    through (iv) of section 1712A(a)(1)(C) of such title.
    (5) Emergency treatment.--Medical services, professional
    services, ambulance services, ancillary care and medication
    (including a short course of medication related to and necessary
    for the treatment of the emergency condition that is provided
    directly to or prescribed for the patient for use after the
    emergency condition is stabilized and the patient is discharged)
    was rendered in a medical emergency of such nature that a
    prudent layperson would have reasonably expected that delay in
    seeking immediate medical attention would have been hazardous to
    life or health. This standard is met by an emergency medical
    condition manifesting itself by acute symptoms of sufficient
    severity (including severe pain) that a prudent layperson who
    possesses an average knowledge of health and medicine could
    reasonably expect the absence of immediate medical attention to
    result in placing the health of the individual in serious
    jeopardy, serious impairment to bodily functions, or serious
    dysfunction of any bodily organ or part.
    (6) Family.--The term ``family'' means, with respect to an
    eligible individual, any of the following:
    (A) A parent.
    (B) A spouse.
    (C) A child.
    (D) A sibling.
    (E) A step-family member.
    (F) An extended family member.
    (G) Any other individual who lives with the eligible
    individual.
    (7) Indian tribe.--The term ``Indian tribe'' has the meaning
    given that term in section 4 of the Native American Housing
    Assistance and Self-Determination Act of 1996 (25 U.S.C. 4103).
    (8) Risk of suicide.--
    (A) In general.--The term ``risk of suicide'' means
    exposure to, or the existence of, any of the following
    (to a degree determined by the Secretary pursuant to
    regulations):
    (i) Health risk factors, including the
    following:
    (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.

    [[Page 794]]

    (iii) Historical risk factors, including the
    following:
    (I) Previous suicide attempts.
    (II) Family history of suicide.
    (III) History of abuse, neglect, or
    trauma.
    (B) <>  Degree of
    risk.--The Secretary may, by regulation, establish a
    process for determining degrees of risk of suicide for
    use by grant recipients to focus the delivery of
    services using grant funds.
    (9) Rural.--The term ``rural'', with respect to a community,
    has the meaning given that term in the Rural-Urban Commuting
    Areas coding system of the Department of Agriculture.
    (10) Secretary.--The term ``Secretary'' means the Secretary
    of Veterans Affairs.
    (11) Suicide prevention services.--
    (A) In general.--The term ``suicide prevention
    services'' means services to address the needs of
    eligible individuals and their families and includes the
    following:
    (i) Outreach to identify those at risk of
    suicide with an emphasis on eligible individuals
    who are at highest risk or who are not receiving
    health care or other services furnished by the
    Department.
    (ii) A baseline mental health screening for
    risk.
    (iii) Education on suicide risk and prevention
    to families and communities.
    (iv) Provision of clinical services for
    emergency treatment.
    (v) Case management services.
    (vi) Peer support services.
    (vii) Assistance in obtaining any benefits
    from the Department that the eligible individual
    and their family may be eligible to receive,
    including--
    (I) vocational and rehabilitation
    counseling;
    (II) supportive services for
    homeless veterans;
    (III) employment and training
    services;
    (IV) educational assistance; and
    (V) health care services.
    (viii) <>  Assistance in
    obtaining and coordinating the provision of other
    benefits provided by the Federal Government, a
    State or local government, or an eligible entity.
    (ix) Assistance with emergent needs relating
    to--
    (I) health care services;
    (II) daily living services;
    (III) personal financial planning
    and counseling;
    (IV) transportation services;
    (V) temporary income support
    services;
    (VI) fiduciary and representative
    payee services;
    (VII) legal services to assist the
    eligible individual with issues that may
    contribute to the risk of suicide; and
    (VIII) child care (not to exceed
    $5,000 per family of an eligible
    individual per fiscal year).
    (x) <>
    Nontraditional and innovative approaches and
    treatment practices, as determined appropriate by
    the Secretary, in consultation with appropriate
    entities.

    [[Page 795]]

    (xi) Such other services necessary for
    improving the mental health status and wellbeing
    and reducing the suicide risk of eligible
    individuals and their families as the Secretary
    considers appropriate, which may include--
    (I) adaptive sports, equine assisted
    therapy, or in-place or outdoor
    recreational therapy;
    (II) substance use reduction
    programming;
    (III) individual, group, or family
    counseling; and
    (IV) relationship coaching.
    (B) Exclusion.--The term ``suicide prevention
    services'' does not include direct cash assistance to
    eligible individuals or their families.
    (12) Veterans crisis line.--The term ``Veterans Crisis
    Line'' means the toll-free hotline for veterans established
    under section 1720F(h) of title 38, United States Code.
    (13) Veterans service organization.--The term ``veterans
    service organization'' means any organization recognized by the
    Secretary for the representation of veterans under section 5902
    of title 38, United States Code.
    SEC. 202. ANALYSIS ON FEASIBILITY AND ADVISABILITY OF THE
    DEPARTMENT OF VETERANS AFFAIRS PROVIDING
    CERTAIN COMPLEMENTARY AND INTEGRATIVE
    HEALTH SERVICES.

    (a) <>  In General.--Not later than 180 days after
    the date of the enactment of this Act, the Secretary of Veterans Affairs
    shall complete an analysis on the feasibility and advisability of
    providing complementary and integrative health treatments described in
    subsection (c) at all medical facilities of the Department of Veterans
    Affairs.

    (b) Inclusion of Assessment of Report.--The analysis conducted under
    subsection (a) shall include an assessment of the final report of the
    Creating Options for Veterans' Expedited Recovery Commission (commonly
    referred to as the ``COVER Commission'') established under section 931
    of the Jason Simcakoski Memorial and Promise Act (title IX of Public Law
    114-198; 38 U.S.C. 1701 note) submitted under subsection (e)(2) of such
    section.
    (c) Treatments Described.--Complementary and integrative health
    treatments described in this subsection shall consist of the following:
    (1) Yoga.
    (2) Meditation.
    (3) Acupuncture.
    (4) Chiropractic care.
    (5) <>  Other treatments that show
    sufficient evidence of efficacy at treating mental or physical
    health conditions, as determined by the Secretary.

    (d) Report.--The Secretary shall submit to the Committee on
    Veterans' Affairs of the Senate and the Committee on Veterans' Affairs
    of the House of Representatives a report on the analysis completed under
    subsection (a), including--
    (1) the results of such analysis; and
    (2) <>  such recommendations
    regarding the furnishing of complementary and integrative health
    treatments described in subsection (c) as the Secretary
    considers appropriate.

    [[Page 796]]

    SEC. 203. <>  PILOT PROGRAM TO PROVIDE
    VETERANS ACCESS TO COMPLEMENTARY AND
    INTEGRATIVE HEALTH PROGRAMS THROUGH ANIMAL
    THERAPY, AGRITHERAPY, SPORTS AND
    RECREATION THERAPY, ART THERAPY, AND
    POSTTRAUMATIC GROWTH PROGRAMS.

    (a) <>  In General.--Not later than
    180 days after the date on which the Creating Options for Veterans'
    Expedited Recovery Commission (commonly referred to as the ``COVER
    Commission'') established under section 931 of the Jason Simcakoski
    Memorial and Promise Act (title IX of Public Law 114-198; 38 U.S.C. 1701
    note) submits its final report under subsection (e)(2) of such section,
    the Secretary of Veterans Affairs shall commence the conduct of a pilot
    program to provide complementary and integrative health programs
    described in subsection (b) to eligible veterans from the Department of
    Veterans Affairs or through the use of non-Department entities for the
    treatment of post-traumatic stress disorder, depression, anxiety, or
    other conditions as determined by the Secretary.
    (b) Programs Described.--Complementary and integrative health
    programs described in this subsection may, taking into consideration the
    report described in subsection (a), consist of the following:
    (1) Equine therapy.
    (2) Other animal therapy.
    (3) Agritherapy.
    (4) Sports and recreation therapy.
    (5) Art therapy.
    (6) Posttraumatic growth programs.

    (c) Eligible Veterans.--A veteran is eligible to participate in the
    pilot program under this section if the veteran--
    (1) is enrolled in the system of patient enrollment of the
    Department under section 1705(a) of title 38, United States
    Code; and
    (2) <>  has received health care under
    the laws administered by the Secretary during the two-year
    period preceding the initial participation of the veteran in the
    pilot program.

    (d) Duration.--
    (1) In general.--The Secretary shall carry out the pilot
    program under this section for a three-year period beginning on
    the commencement of the pilot program.
    (2) Extension.--The Secretary may extend the duration of the
    pilot program under this section if the Secretary, based on the
    results of the interim report submitted under subsection (f)(1),
    determines that it is appropriate to do so.

    (e) Locations.--
    (1) In general.--The Secretary shall select not fewer than
    five facilities of the Department at which to carry out the
    pilot program under this section.
    (2) Selection criteria.--In selecting facilities under
    paragraph (1), the Secretary shall ensure that--
    (A) the locations are in geographically diverse
    areas; and
    (B) not fewer than three facilities serve veterans
    in rural or highly rural areas (as determined through
    the use of the Rural-Urban Commuting Areas coding system
    of the Department of Agriculture).

    (f) Reports.--

    [[Page 797]]

    (1) Interim report.--
    (A) In general.--Not later than one year after the
    commencement of the pilot program under this section,
    the Secretary shall submit to the Committee on Veterans'
    Affairs of the Senate and the Committee on Veterans'
    Affairs of the House of Representatives a report on the
    progress of the pilot program.
    (B) Elements.--The report required by subparagraph
    (A) shall include the following:
    (i) The number of participants in the pilot
    program.
    (ii) The type or types of therapy offered at
    each facility at which the pilot program is being
    carried out.
    (iii) <>  An assessment of
    whether participation by a veteran in the pilot
    program resulted in any changes in clinically
    relevant endpoints for the veteran with respect to
    the conditions specified in subsection (a).
    (iv) <>  An assessment of
    the quality of life of veterans participating in
    the pilot program, including the results of a
    satisfaction survey of the participants in the
    pilot program, disaggregated by program under
    subsection (b).
    (v) <>  The
    determination of the Secretary with respect to
    extending the pilot program under subsection
    (d)(2).
    (vi) <>  Any
    recommendations of the Secretary with respect to
    expanding the pilot program.
    (2) Final report.--Not later than 90 days after the
    termination of the pilot program under this section, the
    Secretary shall submit to the Committee on Veterans' Affairs of
    the Senate and the Committee on Veterans' Affairs of the House
    of Representatives a final report on the pilot program.
    SEC. 204. DEPARTMENT OF VETERANS AFFAIRS STUDY OF ALL-CAUSE
    MORTALITY OF VETERANS, INCLUDING BY
    SUICIDE, AND REVIEW OF STAFFING LEVELS OF
    MENTAL HEALTH PROFESSIONALS.

    (a) Study of Deaths of Veterans by Suicide.--
    (1) <>  In
    general.--The Secretary of Veterans Affairs shall seek to enter
    into an agreement with the National Academies of Sciences,
    Engineering, and Medicine under which the Secretary shall
    collaborate and coordinate with the National Academies on a
    revised study design to fulfill the goals of the 2019 study
    design of the National Academies described in the explanatory
    statement accompanying the Further Consolidated Appropriations
    Act, 2020 (Public Law 116-94), as part of current and additional
    research priorities of the Department of Veterans Affairs, to
    evaluate the effects of opioids and benzodiazepine on all-cause
    mortality of veterans, including suicide, regardless of whether
    information relating to such deaths has been reported by the
    Centers for Disease Control and Prevention.
    (2) Goals.--In carrying out the collaboration and
    coordination under paragraph (1), the Secretary shall seek as
    much as possible to achieve the same advancement of useful
    knowledge as the 2019 study design described in such paragraph.

    (b) Review of Staffing Levels for Mental Health Professionals.--

    [[Page 798]]

    (1) <>  In general.--Not later than 90 days
    after the date of the enactment of this Act, the Comptroller
    General of the United States shall conduct a review of the
    staffing levels for mental health professionals of the
    Department.
    (2) Elements.--The review required by paragraph (1) shall
    include a description of the efforts of the Department to
    maintain appropriate staffing levels for mental health
    professionals, such as mental health counselors, marriage and
    family therapists, and other appropriate counselors, including
    the following:
    (A) A description of any impediments to carry out
    the education, training, and hiring of mental health
    counselors and marriage and family therapists under
    section 7302(a) of title 38, United States Code, and
    strategies for addressing those impediments.
    (B) A description of the objectives, goals, and
    timing of the Department with respect to increasing the
    representation of such counselors and therapists in the
    behavioral health workforce of the Department,
    including--
    (i) a review of qualification criteria for
    such counselors and therapists and a comparison of
    such criteria to that of other behavioral health
    professions in the Department; and
    (ii) <>  an assessment of
    the participation of such counselors and
    therapists in the mental health professionals
    trainee program of the Department and any
    impediments to such participation.
    (C) <>  An assessment of the
    development by the Department of hiring guidelines for
    mental health counselors, marriage and family
    therapists, and other appropriate counselors.
    (D) A description of how the Department--
    (i) identifies gaps in the supply of mental
    health professionals; and
    (ii) determines successful staffing ratios for
    mental health professionals of the Department.
    (E) <>  A description
    of actions taken by the Secretary, in consultation with
    the Director of the Office of Personnel Management, to
    create an occupational series for mental health
    counselors and marriage and family therapists of the
    Department and a timeline for the creation of such an
    occupational series.
    (F) A description of actions taken by the Secretary
    to ensure that the national, regional, and local
    professional standards boards for mental health
    counselors and marriage and family therapists are
    comprised of only mental health counselors and marriage
    and family therapists and that the liaison from the
    Department to such boards is a mental health counselor
    or marriage and family therapist.

    (c) Compilation of Data.--The Secretary of Veterans Affairs shall
    ensure that data under subsections (a) and (b) is compiled separately
    and disaggregated by year and compiled in a manner that allows it to be
    analyzed across all data fields for purposes of informing and updating
    clinical practice guidelines of the Department of Veterans Affairs.

    [[Page 799]]

    (d) <>  Briefings.--The Secretary of Veterans
    Affairs shall brief the Committee on Veterans' Affairs of the Senate and
    the Committee on Veterans' Affairs of the House of Representatives
    containing the interim results--
    (1) with respect to the study under subsection (a)(1), not
    later than 24 months after entering into the agreement under
    such subsection; and
    (2) with respect to the review under subsection (b)(1), not
    later than 18 months after the date of the enactment of this
    Act.

    (e) <>  Reports.--
    (1) Report on study.--Not later than 90 days after the
    completion by the Secretary of Veterans Affairs in coordination
    with the National Academies of Sciences, Engineering, and
    Medicine of the study required under subsection (a)(1), the
    Secretary shall--
    (A) submit to the Committee on Veterans' Affairs of
    the Senate and the Committee on Veterans' Affairs of the
    House of Representatives a report on the results of the
    study; and
    (B) make such report publicly available.
    (2) Report on review.--Not later than 90 days after the
    completion by the Comptroller General of the United States of
    the review required under subsection (b)(1), the Comptroller
    General shall--
    (A) submit to the Committee on Veterans' Affairs of
    the Senate and the Committee on Veterans' Affairs of the
    House of Representatives a report on the results of the
    review; and
    (B) make such report publicly available.
    SEC. 205. COMPTROLLER GENERAL REPORT ON MANAGEMENT BY DEPARTMENT
    OF VETERANS AFFAIRS OF VETERANS AT HIGH
    RISK FOR SUICIDE.

    (a) In General.--Not later than 18 months after the date of the
    enactment of this Act, the Comptroller General of the United States
    shall submit to the Committee on Veterans' Affairs of the Senate and the
    Committee on Veterans' Affairs of the House of Representatives a report
    on the efforts of the Department of Veterans Affairs to manage veterans
    at high risk for suicide.
    (b) <>  Elements.--
    The report required by subsection (a) shall include the following:
    (1) A description of how the Department identifies patients
    as high risk for suicide, with particular consideration to the
    efficacy of inputs into the Recovery Engagement and Coordination
    for Health - Veterans Enhanced Treatment program (commonly
    referred to as the ``REACH VET'' program) of the Department,
    including an assessment of the efficacy of such identifications
    disaggregated by--
    (A) all demographic characteristics as determined
    necessary and appropriate by the Secretary of Veterans
    Affairs in coordination with the Centers for Disease
    Control and Prevention;
    (B) Veterans Integrated Service Network; and
    (C) to the extent practicable, medical center of the
    Department.

    [[Page 800]]

    (2) A description of how the Department intervenes when a
    patient is identified as high risk, including an assessment of
    the efficacy of such interventions disaggregated by--
    (A) all demographic characteristics as determined
    necessary and appropriate by the Secretary in
    coordination with the Centers for Disease Control and
    Prevention;
    (B) Veterans Integrated Service Network; and
    (C) to the extent practicable, medical center of the
    Department.
    (3) A description of how the Department monitors patients
    who have been identified as high risk, including an assessment
    of the efficacy of such monitoring and any follow-ups
    disaggregated by--
    (A) all demographic characteristics as determined
    necessary and appropriate by the Secretary in
    coordination with the Centers for Disease Control and
    Prevention;
    (B) Veterans Integrated Service Network; and
    (C) to the extent practicable, medical center of the
    Department.
    (4) <>  A review of staffing levels of
    suicide prevention coordinators across the Veterans Health
    Administration.
    (5) <>  A review of the resources and
    programming offered to family members and friends of veterans
    who have a mental health condition in order to assist that
    veteran in treatment and recovery.
    (6) An assessment of such other areas as the Comptroller
    General considers appropriate to study.

    TITLE III--PROGRAMS, STUDIES, AND GUIDELINES ON MENTAL HEALTH

    SEC. 301. <>  STUDY ON CONNECTION BETWEEN LIVING
    AT HIGH ALTITUDE AND SUICIDE RISK FACTORS
    AMONG VETERANS.

    (a) <>  In General.--Not later than 180 days
    after the date of the enactment of this Act, the Secretary of Veterans
    Affairs, in consultation with Rural Health Resource Centers of the
    Office of Rural Health of the Department of Veterans Affairs, shall
    commence the conduct of a study on the connection between living at high
    altitude and the risk of developing depression or dying by suicide among
    veterans.

    (b) Completion of Study.--The study conducted under subsection (a)
    shall be completed not later than three years after the date of the
    commencement of the study.
    (c) Individual Impact.--The study conducted under subsection (a)
    shall be conducted so as to determine the effect of high altitude on
    suicide risk at the individual level, not at the State or county level.
    (d) Report.--Not later than 150 days after the completion of the
    study conducted under subsection (a), the Secretary shall submit to the
    Committee on Veterans' Affairs of the Senate and the Committee on
    Veterans' Affairs of the House of Representatives a report on the
    results of the study.
    (e) Follow-up Study.--
    (1) <>  In general.--If the Secretary
    determines through the study conducted under subsection (a) that
    living at high altitude is a risk factor for developing
    depression or dying by suicide,

    [[Page 801]]

    the Secretary shall conduct an additional study to identify the
    following:
    (A) The most likely biological mechanism that makes
    living at high altitude a risk factor for developing
    depression or dying by suicide.
    (B) The most effective treatment or intervention for
    reducing the risk of developing depression or dying by
    suicide associated with living at high altitude.
    (2) Report.--Not later than 150 days after completing the
    study conducted under paragraph (1), the Secretary shall submit
    to the Committee on Veterans' Affairs of the Senate and the
    Committee on Veterans' Affairs of the House of Representatives a
    report on the results of the study.
    SEC. 302. <>  ESTABLISHMENT BY
    DEPARTMENT OF VETERANS AFFAIRS AND
    DEPARTMENT OF DEFENSE OF A CLINICAL
    PROVIDER TREATMENT TOOLKIT AND
    ACCOMPANYING TRAINING MATERIALS FOR
    COMORBIDITIES.

    (a) <>  In General.--Not later than
    two years after the date of the enactment of this Act, the Secretary of
    Veterans Affairs, in consultation with the Secretary of Defense, shall
    develop a clinical provider treatment toolkit and accompanying training
    materials for the evidence-based management of comorbid mental health
    conditions, comorbid mental health and substance use disorders, and a
    comorbid mental health condition and chronic pain.

    (b) Matters Included.--In developing the clinical provider treatment
    toolkit and accompanying training materials under subsection (a), the
    Secretary of Veterans Affairs and the Secretary of Defense shall ensure
    that the toolkit and training materials include guidance with respect to
    the following:
    (1) The treatment of patients with post-traumatic stress
    disorder who are also experiencing an additional mental health
    condition, a substance use disorder, or chronic pain.
    (2) The treatment of patients experiencing a mental health
    condition, including anxiety, depression, or bipolar disorder,
    who are also experiencing a substance use disorder or chronic
    pain.
    (3) The treatment of patients with traumatic brain injury
    who are also experiencing--
    (A) a mental health condition, including post-
    traumatic stress disorder, anxiety, depression, or
    bipolar disorder;
    (B) a substance use disorder; or
    (C) chronic pain.
    SEC. 303. <>  UPDATE OF CLINICAL
    PRACTICE GUIDELINES FOR ASSESSMENT AND
    MANAGEMENT OF PATIENTS AT RISK FOR
    SUICIDE.

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

    [[Page 802]]

    (B) treatment efficacy for depression and suicide
    prevention;
    (C) pharmacotherapy efficacy; and
    (D) psychotherapy efficacy.
    (2) Guidance with respect to the efficacy of alternative
    therapies, other than psychotherapy and pharmacotherapy,
    including the following:
    (A) Yoga therapy.
    (B) Meditation therapy.
    (C) Equine therapy.
    (D) Other animal therapy.
    (E) Training and caring for service dogs.
    (F) Agritherapy.
    (G) Art therapy.
    (H) Outdoor sports therapy.
    (I) Music therapy.
    (J) Any other alternative therapy that the Work
    Group considers appropriate.
    (3) Guidance with respect to the findings of the Creating
    Options for Veterans' Expedited Recovery Commission (commonly
    referred to as the ``COVER Commission'') established under
    section 931 of the Jason Simcakoski Memorial and Promise Act
    (title IX of Public Law 114-198; 38 U.S.C. 1701 note).

    (b) Rule of Construction.--Nothing in this section shall be
    construed to prevent the Secretary of Veterans Affairs and the Secretary
    of Defense from considering all relevant evidence, as appropriate, in
    updating the Department of Veterans Affairs and Department of Defense
    Clinical Practice Guideline for Assessment and Management of Patients at
    Risk for Suicide, as required under subsection (a), or from ensuring
    that the final clinical practice guidelines updated under such
    subsection remain applicable to the patient populations of the
    Department of Veterans Affairs and the Department of Defense.
    SEC. 304. <>  ESTABLISHMENT BY
    DEPARTMENT OF VETERANS AFFAIRS AND
    DEPARTMENT OF DEFENSE OF CLINICAL PRACTICE
    GUIDELINES FOR THE TREATMENT OF SERIOUS
    MENTAL ILLNESS.

    (a) <>  In General.--Not later than
    two years after the date of the enactment of this Act, the Secretary of
    Veterans Affairs, in consultation with the Secretary of Defense and the
    Secretary of Health and Human Services, shall complete the development
    of a clinical practice guideline or guidelines for the treatment of
    serious mental illness, to include the following conditions:
    (1) Schizophrenia.
    (2) Schizoaffective disorder.
    (3) Persistent mood disorder, including bipolar disorder I
    and II.
    (4) Any other mental, behavioral, or emotional disorder
    resulting in serious functional impairment that substantially
    interferes with major life activities as the Secretary of
    Veterans Affairs, in consultation with the Secretary of Defense
    and the Secretary of Health and Human Services, considers
    appropriate.

    (b) Matters Included in Guidelines.--The clinical practice guideline
    or guidelines developed under subsection (a) shall include the
    following:

    [[Page 803]]

    (1) Guidance contained in the 2016 Clinical Practice
    Guidelines for the Management of Major Depressive Disorders of
    the Department of Veterans Affairs and the Department of
    Defense.
    (2) Guidance with respect to the treatment of patients with
    a condition described in subsection (a).
    (3) <>  A list of evidence-based therapies for
    the treatment of conditions described in subsection (a).
    (4) An appropriate guideline for the administration of
    pharmacological therapy, psychological or behavioral therapy, or
    other therapy for the management of conditions described in
    subsection (a).

    (c) <>  Assessment of Existing
    Guidelines.--Not later than two years after the date of the enactment of
    this Act, the Secretary of Veterans Affairs, in consultation with the
    Secretary of Defense and the Secretary of Health and Human Services,
    shall complete an assessment of the 2016 Clinical Practice Guidelines
    for the Management of Major Depressive Disorders to determine whether an
    update to such guidelines is necessary.

    (d) Work Group.--
    (1) Establishment.--The Secretary of Veterans Affairs, the
    Secretary of Defense, and the Secretary of Health and Human
    Services shall create a work group to develop the clinical
    practice guideline or guidelines under subsection (a) to be
    known as the ``Serious Mental Illness Work Group'' (in this
    subsection referred to as the ``Work Group'').
    (2) Membership.--The Work Group created under paragraph (1)
    shall be comprised of individuals that represent Federal
    Government entities and non-Federal Government entities with
    expertise in the areas covered by the Work Group, including the
    following entities:
    (A) Academic institutions that specialize in
    research for the treatment of conditions described in
    subsection (a).
    (B) The Health Services Research and Development
    Service of the Department of Veterans Affairs.
    (C) The Office of the Assistant Secretary for Mental
    Health and Substance Use of the Department of Health and
    Human Services.
    (D) The National Institute of Mental Health.
    (E) The Indian Health Service.
    (F) Relevant organizations with expertise in
    researching, diagnosing, or treating conditions
    described in subsection (a).
    (3) Relation to other work groups.--The Work Group shall be
    created and conducted in the same manner as other work groups
    for the development of clinical practice guidelines for the
    Department of Veterans Affairs and the Department of Defense.

    (e) Rule of Construction.--Nothing in this section shall be
    construed to prevent the Secretary of Veterans Affairs and the Secretary
    of Defense from considering all relevant evidence, as appropriate, in
    creating the clinical practice guideline or guidelines required under
    subsection (a) or from ensuring that the final clinical practice
    guideline or guidelines developed under such subsection and subsequently
    updated, as appropriate, remain applicable to the patient populations of
    the Department of Veterans Affairs and the Department of Defense.

    [[Page 804]]

    SEC. 305. <>  PRECISION MEDICINE
    INITIATIVE OF DEPARTMENT OF VETERANS
    AFFAIRS TO IDENTIFY AND VALIDATE BRAIN AND
    MENTAL HEALTH BIOMARKERS.

    (a) <>  In General.--Beginning not later than 18
    months after the date of the enactment of this Act, the Secretary of
    Veterans Affairs shall develop and implement an initiative of the
    Department of Veterans Affairs to identify and validate brain and mental
    health biomarkers among veterans, with specific consideration for
    depression, anxiety, post-traumatic stress disorder, bipolar disorder,
    traumatic brain injury, and such other mental health conditions as the
    Secretary considers appropriate. Such initiative may be referred to as
    the ``Precision Medicine for Veterans Initiative''.

    (b) Model of Initiative.--The initiative under subsection (a) shall
    be modeled on the All of Us Precision Medicine Initiative administered
    by the National Institutes of Health with respect to large-scale
    collection of standardized data and open data sharing.
    (c) Methods.--The initiative under subsection (a) shall include
    brain structure and function measurements, such as functional magnetic
    resonance imaging and electroencephalogram, and shall coordinate with
    additional biological methods of analysis utilized in the Million
    Veterans Program of the Department of Veterans Affairs.
    (d) Use of Data.--
    (1) Privacy and security.--In carrying out the initiative
    under subsection (a), the Secretary shall develop robust data
    privacy and security measures, consistent with section 552a of
    title 5, United States Code (commonly known as the ``Privacy Act
    of 1974''), and regulations promulgated pursuant to the Health
    Insurance Portability and Accountability Act of 1996 (parts 160,
    162, and 164 of title 45, Code of Federal Regulations, or
    successor regulations) to ensure that information of veterans
    participating in the initiative is kept private and secure.
    (2) Consultation with the national institutes of science and
    technology.--The Secretary may consult with the National
    Institute of Science and Technology in developing the data
    privacy and security measures described in paragraph (1).
    (3) Access standards.--The Secretary shall provide access to
    information under the initiative consistent with the standards
    described in section 552a(d)(1) of title 5, United States Code,
    and section 164.524 of title 45, Code of Federal Regulations, or
    successor regulations.
    (4) Open platform.--
    (A) Availability of data.--The Secretary shall make
    de-identified data collected under the initiative
    available for research purposes to Federal agencies.
    (B) Contract.--The Secretary shall contract with
    nongovernment entities that comply with requisite data
    security measures to make available for research
    purposes de-identified data collected under the
    initiative.
    (C) Assistance.--The Secretary shall provide
    assistance to a Federal agency conducting research using
    data collected under the initiative at the request of
    that agency.
    (D) Prohibition on transfer of data.--Federal
    agencies may not disclose, transmit, share, sell,
    license, or otherwise transfer data collected under the
    initiative to any

    [[Page 805]]

    nongovernment entity other than as allowed under
    subparagraph (B).
    (5) Standardization.--
    (A) In general.--The Secretary shall ensure that
    data collected under the initiative is standardized.
    (B) Consultation.--The Secretary shall consult with
    the National Institutes of Health and the Food and Drug
    Administration to determine the most effective,
    efficient, and cost-effective way of standardizing data
    collected under the initiative.
    (C) <>  Manner of
    standardization.--In consultation with the National
    Institute for Science and Technology, data collected
    under the initiative shall be standardized in the manner
    in which it is collected, entered into the database,
    extracted, and recorded.
    (6) Measures of brain function or structure.--Any measures
    of brain function or structure collected under the initiative
    shall be collected with a device that is approved by the Food
    and Drug Administration.
    (7) De-identified data defined.--In this subsection, the
    term ``de-identified data'' means, with respect to data held by
    the Department of Veterans Affairs, that the Department--
    (A) alters, anonymizes, or aggregates the data so
    that there is a reasonable basis for expecting that the
    data could not be linked as a practical matter to a
    specific individual;
    (B) publicly commits to refrain from attempting to
    re-identify the data with a specific individual, and
    adopts controls to prevent such identification; and
    (C) causes the data to be covered by a contractual
    or other legally enforceable prohibition on each entity
    to which the Department discloses the data from
    attempting to use the data to identify a specific
    individual and requires the same of all onward
    disclosures.

    (e) Inclusion of Initiative in Program.--The Secretary shall
    coordinate efforts of the initiative under subsection (a) with the
    Million Veterans Program of the Department.
    SEC. 306. STATISTICAL ANALYSES AND DATA EVALUATION BY DEPARTMENT
    OF VETERANS AFFAIRS.

    (a) In General.--Chapter 1 of title 38, United States Code, is
    amended by adding at the end the following new section:
    ``Sec. 119. <>  Contracting for statistical
    analyses and data evaluation

    ``(a) <>  In General.--The Secretary may enter
    into a contract or other agreement with an academic institution or other
    qualified entity, as determined by the Secretary, to carry out
    statistical analyses and data evaluation as required of the Secretary by
    law.''.

    ``(b) Rule of Construction.--Nothing in this section may be
    construed to limit the authority of the Secretary to enter into
    contracts or other agreements for statistical analyses and data
    evaluation under any other provision of law.''.
    (b) Clerical Amendment.--The table of sections at the beginning of
    chapter 1 of such title <>  is amended by
    adding at the end the following new item:

    ``119. Contracting for statistical analyses and data evaluation.''.

    [[Page 806]]

    TITLE IV--OVERSIGHT OF MENTAL HEALTH CARE AND RELATED SERVICES

    SEC. 401. STUDY ON EFFECTIVENESS OF SUICIDE PREVENTION AND MENTAL
    HEALTH OUTREACH PROGRAMS OF DEPARTMENT OF
    VETERANS AFFAIRS.

    (a) <>  In General.--Not later than 180
    days after the date of the enactment of this Act, the Secretary of
    Veterans Affairs shall enter into an agreement with a non-Federal
    Government entity with expertise in conducting and evaluating research-
    based studies to conduct a study on the effectiveness of the suicide
    prevention and mental health outreach materials prepared by the
    Department of Veterans Affairs and the suicide prevention and mental
    health outreach campaigns conducted by the Department.

    (b) Use of Focus Groups.--
    (1) In general.--The Secretary shall convene not fewer than
    eight different focus groups to evaluate the effectiveness of
    the suicide prevention and mental health materials and campaigns
    as required under subsection (a).
    (2) Location of focus groups.--Focus groups convened under
    paragraph (1) shall be held in geographically diverse areas as
    follows:
    (A) Not fewer than two in rural or highly rural
    areas.
    (B) Not fewer than one in each of the four districts
    of the Veterans Benefits Administration.
    (3) Timing of focus groups.--Focus groups convened under
    paragraph (1) shall be held at a variety of dates and times to
    ensure an adequate representation of veterans with different
    work schedules.
    (4) Number of participants.--Each focus group convened under
    paragraph (1) shall include not fewer than five and not more
    than 12 participants.
    (5) Representation.--Each focus group convened under
    paragraph (1) shall, to the extent practicable, include veterans
    of diverse backgrounds, including--
    (A) veterans of all eras, as determined by the
    Secretary;
    (B) women veterans;
    (C) minority veterans;
    (D) Native American veterans, as defined in section
    3765 of title 38, United States Code;
    (E) veterans who identify as lesbian, gay, bisexual,
    transgender, or queer (commonly referred to as
    ``LGBTQ'');
    (F) veterans who live in rural or highly rural
    areas;
    (G) individuals transitioning from active duty in
    the Armed Forces to civilian life; and
    (H) other high-risk groups of veterans, as
    determined by the Secretary.

    (c) Report.--
    (1) In general.--Not later than 90 days after the last focus
    group meeting under subsection (b), the Secretary shall submit
    to the Committee on Veterans' Affairs of the Senate and the
    Committee on Veterans' Affairs of the House of Representatives a
    report on the findings of the focus groups.
    (2) Elements.--The report required by paragraph (1) shall
    include the following:

    [[Page 807]]

    (A) <>  Based on the findings of
    the focus groups, an assessment of the effectiveness of
    current suicide prevention and mental health materials
    and campaigns of the Department in reaching veterans as
    a whole as well as specific groups of veterans (for
    example, women veterans).
    (B) <>  Based on the
    findings of the focus groups, recommendations for future
    suicide prevention and mental health materials and
    campaigns of the Department to target specific groups of
    veterans.
    (C) <>  A plan to change the current
    suicide prevention and mental health materials and
    campaigns of the Department or, if the Secretary decides
    not to change the current materials and campaigns, an
    explanation of the reason for maintaining the current
    materials and campaigns.
    (D) A description of any dissenting or opposing
    viewpoints raised by participants in the focus group.
    (E) Such other issues as the Secretary considers
    necessary.

    (d) Representative Survey.--
    (1) <>  In general.--Not later than one
    year after the last focus group meeting under subsection (b),
    the Secretary shall complete a representative survey of the
    veteran population that is informed by the focus group data in
    order to collect information about the effectiveness of the
    mental health and suicide prevention materials and campaigns
    conducted by the Department.
    (2) Veterans surveyed.--
    (A) In general.--Veterans surveyed under paragraph
    (1) shall include veterans described in subsection
    (b)(5).
    (B) <>  Disaggregation of
    data.--Data of veterans surveyed under paragraph (1)
    shall be disaggregated by--
    (i) veterans who have received care from the
    Department during the two-year period preceding
    the survey; and
    (ii) veterans who have not received care from
    the Department during the two-year period
    preceding the survey.

    (e) <>  Treatment of Contracts for Suicide
    Prevention and Mental Health Outreach Media.--
    (1) Focus groups.--
    (A) <>  In general.--The
    Secretary shall include in each contract to develop
    media relating to suicide prevention and mental health
    materials and campaigns a requirement that the
    contractor convene focus groups of veterans to assess
    the effectiveness of suicide prevention and mental
    health outreach.
    (B) Representation.--Each focus group required under
    subparagraph (A) shall, to the extent practicable,
    include veterans of diverse backgrounds, including--
    (i) veterans of all eras, as determined by the
    Secretary;
    (ii) women veterans;
    (iii) minority veterans;
    (iv) Native American veterans, as defined in
    section 3765 of title 38, United States Code;

    [[Page 808]]

    (v) veterans who identify as lesbian, gay,
    bisexual, transgender, or queer (commonly referred
    to as ``LGBTQ'');
    (vi) veterans who live in rural or highly
    rural areas;
    (vii) individuals transitioning from active
    duty in the Armed Forces to civilian life; and
    (viii) other high-risk groups of veterans, as
    determined by the Secretary.
    (2) Subcontracting.--
    (A) <>  In general.--The
    Secretary shall include in each contract described in
    paragraph (1)(A) a requirement that, if the contractor
    subcontracts for the development of media, the
    contractor shall subcontract with a subcontractor that
    has experience creating impactful media campaigns that
    target individuals age 18 to 34.
    (B) Budget limitation.--Not more than two percent of
    the budget of the Office of Mental Health and Suicide
    Prevention of the Department for contractors for suicide
    prevention and mental health media outreach shall go to
    subcontractors described in subparagraph (A).

    (f) Paperwork Reduction Act Exemption.--Chapter 35 of title 44,
    United States Code (commonly known as the ``Paperwork Reduction Act'')
    shall not apply to any rulemaking or information collection required
    under this section.
    (g) Rural and Highly Rural Defined.--In this section, with respect
    to an area, the terms ``rural'' and ``highly rural'' have the meanings
    given those terms in the Rural-Urban Commuting Areas coding system of
    the Department of Agriculture.
    SEC. 402. <>  OVERSIGHT OF MENTAL HEALTH
    AND SUICIDE PREVENTION MEDIA OUTREACH
    CONDUCTED BY DEPARTMENT OF VETERANS
    AFFAIRS.

    (a) Establishment of Goals.--
    (1) <>  In general.--The Secretary of
    Veterans Affairs shall establish goals for the mental health and
    suicide prevention media outreach campaigns of the Department of
    Veterans Affairs, which shall include the establishment of
    targets, metrics, and action plans to describe and assess those
    campaigns.
    (2) Use of metrics.--
    (A) In general.--The goals established under
    paragraph (1) shall be measured by metrics specific to
    different media types.
    (B) <>  Factors to consider.--
    In using metrics under subparagraph (A), the Secretary
    shall determine the best methodological approach for
    each media type and shall consider the following:
    (i) Metrics relating to social media, which
    may include the following:
    (I) Impressions.
    (II) Reach.
    (III) Engagement rate.
    (IV) Such other metrics as the
    Secretary considers necessary.
    (ii) Metrics relating to television, which may
    include the following:

    [[Page 809]]

    (I) Nielsen ratings.
    (II) Such other metrics as the
    Secretary considers necessary.
    (iii) Metrics relating to email, which may
    include the following:
    (I) Open rate.
    (II) Response rate.
    (III) Click rate.
    (IV) Such other metrics as the
    Secretary considers necessary.
    (C) Update.--The Secretary shall periodically update
    the metrics under subparagraph (B) as more accurate
    metrics become available.
    (3) Targets.--The Secretary shall establish targets to track
    the metrics used under paragraph (2).
    (4) Consultation.--In establishing goals under paragraph
    (1), the Secretary shall consult with the following:
    (A) <>  Relevant stakeholders,
    such as organizations that represent veterans, as
    determined by the Secretary.
    (B) Mental health and suicide prevention experts.
    (C) Such other persons as the Secretary considers
    appropriate.
    (5) Initial report.--Not later than 180 days after the date
    of the enactment of this Act, the Secretary shall submit to the
    Committee on Veterans' Affairs of the Senate and the Committee
    on Veterans' Affairs of the House of Representatives a report
    detailing the goals established under paragraph (1) for the
    mental health and suicide prevention media outreach campaigns of
    the Department, including the metrics and targets for such
    metrics by which those goals are to be measured under paragraphs
    (2) and (3).
    (6) Annual report.--Not later than one year after the
    submittal of the report under paragraph (5), and annually
    thereafter, the Secretary shall submit to the Committee on
    Veterans' Affairs of the Senate and the Committee on Veterans'
    Affairs of the House of Representatives a report detailing--
    (A) the progress of the Department in meeting the
    goals established under paragraph (1) and the targets
    established under paragraph (3); and
    (B) a description of action to be taken by the
    Department to modify mental health and suicide
    prevention media outreach campaigns if those goals and
    targets are not being met.

    (b) Report on Use of Funds by Office of Mental Health and Suicide
    Prevention.--Not later than 180 days after the date of the enactment of
    this Act, and semiannually thereafter, the Secretary shall submit to the
    Committee on Appropriations and the Committee on Veterans' Affairs of
    the Senate and the Committee on Appropriations and the Committee on
    Veterans' Affairs of the House of Representatives a report containing
    the expenditures and obligations of the Office of Mental Health and
    Suicide Prevention of the Veterans Health Administration during the
    period covered by the report.

    [[Page 810]]

    SEC. 403. COMPTROLLER GENERAL MANAGEMENT REVIEW OF MENTAL HEALTH
    AND SUICIDE PREVENTION SERVICES OF
    DEPARTMENT OF VETERANS AFFAIRS.

    (a) <>  In General.--Not later than three years
    after the date of the enactment of this Act, the Comptroller General of
    the United States shall submit to the Committee on Veterans' Affairs of
    the Senate and the Committee on Veterans' Affairs of the House of
    Representatives a management review of the mental health and suicide
    prevention services provided by the Department of Veterans Affairs.

    (b) <>  Elements.--The management review
    required by subsection (a) shall include the following:
    (1) An assessment of the infrastructure under the control of
    or available to the Office of Mental Health and Suicide
    Prevention of the Department of Veterans Affairs or available to
    the Department of Veterans Affairs for suicide prevention
    efforts not operated by the Office of Mental Health and Suicide
    Prevention.
    (2) A description of the management and organizational
    structure of the Office of Mental Health and Suicide Prevention,
    including roles and responsibilities for each position.
    (3) A description of the operational policies and processes
    of the Office of Mental Health and Suicide Prevention.
    (4) An assessment of suicide prevention practices and
    initiatives available from the Department and through community
    partnerships.
    (5) An assessment of the staffing levels at the Office of
    Mental Health and Suicide Prevention, disaggregated by type of
    position, and including the location of any staffing
    deficiencies.
    (6) An assessment of the Nurse Advice Line pilot program
    conducted by the Department.
    (7) An assessment of recruitment initiatives in rural areas
    for mental health professionals of the Department.
    (8) An assessment of strategic planning conducted by the
    Office of Mental Health and Suicide Prevention.
    (9) An assessment of the communication, and the
    effectiveness of such communication--
    (A) within the central office of the Office of
    Mental Health and Suicide Prevention;
    (B) between that central office and any staff member
    or office in the field, including chaplains, attorneys,
    law enforcement personnel, and volunteers; and
    (C) between that central office, local facilities of
    the Department, and community partners of the
    Department, including first responders, community
    support groups, and health care industry partners.
    (10) An assessment of how effectively the Office of Mental
    Health and Suicide Prevention implements operational policies
    and procedures.
    (11) <>  An assessment of how the
    Department of Veterans Affairs and the Department of Defense
    coordinate suicide prevention efforts, and recommendations on
    how the Department of Veterans Affairs and Department of Defense
    can more effectively coordinate those efforts.
    (12) An assessment of such other areas as the Comptroller
    General considers appropriate to study.

    [[Page 811]]

    SEC. 404. COMPTROLLER GENERAL REPORT ON EFFORTS OF DEPARTMENT OF
    VETERANS AFFAIRS TO INTEGRATE MENTAL
    HEALTH CARE INTO PRIMARY CARE CLINICS.

    (a) Initial Report.--
    (1) In general.--Not later than two years after the date of
    the enactment of this Act, the Comptroller General of the United
    States shall submit to the Committee on Veterans' Affairs of the
    Senate and the Committee on Veterans' Affairs of the House of
    Representatives a report on the efforts of the Department of
    Veterans Affairs to integrate mental health care into primary
    care clinics of the Department.
    (2) <>  Elements.--The report required
    by subsection (a) shall include the following:
    (A) An assessment of the efforts of the Department
    to integrate mental health care into primary care
    clinics of the Department.
    (B) An assessment of the effectiveness of such
    efforts.
    (C) An assessment of how the health care of veterans
    is impacted by such integration.
    (D) A description of how care is coordinated by the
    Department between specialty mental health care and
    primary care, including a description of the following:
    (i) How documents and patient information are
    transferred and the effectiveness of those
    transfers.
    (ii) How care is coordinated when veterans
    must travel to different facilities of the
    Department.
    (iii) How a veteran is reintegrated into
    primary care after receiving in-patient mental
    health care.
    (E) An assessment of how the integration of mental
    health care into primary care clinics is implemented at
    different types of facilities of the Department.
    (F) <>  Such
    recommendations on how the Department can better
    integrate mental health care into primary care clinics
    as the Comptroller General considers appropriate.
    (G) An assessment of such other areas as the
    Comptroller General considers appropriate to study.

    (b) Community Care Integration Report.--
    (1) In general.--Not later than two years after the date on
    which the Comptroller General submits the report required under
    subsection (a)(1), the Comptroller General shall submit to the
    Committee on Veterans' Affairs of the Senate and the Committee
    on Veterans' Affairs of the House of Representatives a report on
    the efforts of the Department to integrate community-based
    mental health care into the Veterans Health Administration.
    (2) <>  Elements.--The report required
    by paragraph (1) shall include the following:
    (A) An assessment of the efforts of the Department
    to integrate community-based mental health care into the
    Veterans Health Administration.
    (B) An assessment of the effectiveness of such
    efforts.
    (C) An assessment of how the health care of veterans
    is impacted by such integration.
    (D) A description of how care is coordinated between
    providers of community-based mental health care and the
    Veterans Health Administration, including a description

    [[Page 812]]

    of how documents and patient information are transferred
    and the effectiveness of those transfers between--
    (i) the Veterans Health Administration and
    providers of community-based mental health care;
    and
    (ii) providers of community-based mental
    health care and the Veterans Health
    Administration.
    (E) An assessment of any disparities in the
    coordination of community-based mental health care into
    the Veterans Health Administration by location and type
    of facility.
    (F) An assessment of the military cultural
    competency of health care providers providing community-
    based mental health care to veterans.
    (G) <>  Such
    recommendations on how the Department can better
    integrate community-based mental health care into the
    Veterans Health Administration as the Comptroller
    General considers appropriate.
    (H) An assessment of such other areas as the
    Comptroller General considers appropriate to study.
    (3) Community-based mental health care defined.--In this
    subsection, the term ``community-based mental health care''
    means mental health care paid for by the Department but provided
    by a non-Department health care provider at a non-Department
    facility, including care furnished under section 1703 of title
    38, United States Code (as in effect on the date specified in
    section 101(b) of the Caring for Our Veterans Act of 2018 (title
    I of Public Law 115-182)).
    SEC. 405. JOINT MENTAL HEALTH PROGRAMS BY DEPARTMENT OF VETERANS
    AFFAIRS AND DEPARTMENT OF DEFENSE.

    (a) <>  Report on Mental Health Programs.--
    (1) In general.--Not later than one year after the date of
    the enactment of this Act, and annually thereafter, the
    Secretary of Veterans Affairs and the Secretary of Defense shall
    submit to the Committee on Veterans' Affairs and the Committee
    on Armed Services of the Senate and the Committee on Veterans'
    Affairs and the Committee on Armed Services of the House of
    Representatives a report on mental health programs of the
    Department of Veterans Affairs and the Department of Defense and
    joint programs of the Departments.
    (2) Elements.--The report required by paragraph (1) shall
    include the following:
    (A) A description of mental health programs operated
    by the Department of Veterans Affairs, including the
    following:
    (i) Transition assistance programs.
    (ii) Clinical and non-clinical mental health
    initiatives, including centers of excellence of
    the Department of Veterans Affairs for traumatic
    brain injury and post-traumatic stress disorder.
    (iii) Programs that may secondarily improve
    mental health, including employment, housing
    assistance, and financial literacy programs.
    (iv) Research into mental health issues and
    conditions, to include post-traumatic stress
    disorder, depression, anxiety, bipolar disorder,
    traumatic brain injury, suicidal ideation, and any
    other issues or conditions

    [[Page 813]]

    as the Secretary of Veterans Affairs considers
    necessary.
    (B) A description of mental health programs operated
    by the Department of Defense, including the following:
    (i) Transition assistance programs.
    (ii) Clinical and non-clinical mental health
    initiatives, including the National Intrepid
    Center of Excellence and the Intrepid Spirit
    Centers.
    (iii) Programs that may secondarily improve
    mental health, including employment, housing
    assistance, and financial literacy programs.
    (iv) Research into mental health issues and
    conditions, to include post-traumatic stress
    disorder, depression, anxiety, bipolar disorder,
    traumatic brain injury, suicidal ideation, and any
    other issues or conditions as the Secretary of
    Defense considers necessary.
    (C) A description of mental health programs jointly
    operated by the Department of Veterans Affairs and the
    Department of Defense, including the following:
    (i) Transition assistance programs.
    (ii) Clinical and non-clinical mental health
    initiatives.
    (iii) Programs that may secondarily improve
    mental health, including employment, housing
    assistance, and financial literacy programs.
    (iv) Research into mental health issues and
    conditions, to include post-traumatic stress
    disorder, depression, anxiety, bipolar disorder,
    traumatic brain injury, suicidal ideation, and
    completed suicides, including through the use of
    the joint suicide data repository of the
    Department of Veterans Affairs and the Department
    of Defense, and any other issues or conditions as
    the Secretary of Veterans Affairs and the
    Secretary of Defense consider necessary.
    (D) <>  Recommendations
    for coordinating mental health programs of the
    Department of Veterans Affairs and the Department of
    Defense to improve the effectiveness of those programs.
    (E) <>  Recommendations
    for novel joint programming of the Department of
    Veterans Affairs and the Department of Defense to
    improve the mental health of members of the Armed Forces
    and veterans.

    (b) Evaluation of Collaborative Efforts of Department of Veterans
    Affairs and Department of Defense and Alternatives of Analysis to
    Establish a Joint VA/DOD Intrepid Spirit Center.--
    (1) <>  In general.--The Secretary of
    Veterans Affairs, in coordination with the Secretary of Defense,
    shall evaluate the current ongoing collaborative efforts of the
    Department of Veterans Affairs and the Department of Defense
    related to post-traumatic stress disorder and traumatic brain
    injury care, research, and education to improve the quality of
    and access to such care and seek potential new collaborative
    efforts to improve and expand such care for veterans and members
    of the Armed Forces in a joint Department of Veterans Affairs/
    Department of Defense Intrepid Spirit Center that serves active
    duty members of the Armed Forces, members of the reserve

    [[Page 814]]

    components of the Armed Forces, and veterans for mutual benefit
    and growth in treatment and care.
    (2) Alternatives of analysis.--
    (A) In general.--The evaluation required under
    paragraph (1) shall include an alternatives of analysis
    to establish the joint Department of Veterans Affairs/
    Department of Defense Intrepid Spirit Center described
    in paragraph (1).
    (B) <>  Elements.--The
    alternatives of analysis required under subparagraph (A)
    with respect to the establishment of the joint
    Department of Veterans Affairs/Department of Defense
    Intrepid Spirit Center described in paragraph (1) shall
    provide alternatives and recommendations that consider
    information including--
    (i) colocation of the center on an
    installation of the Department of Defense or
    property of a medical center of the Department of
    Veterans Affairs;
    (ii) consideration of a rural or highly rural
    area to establish the center that may include
    colocation described in clause (i);
    (iii) geographic distance from existing or
    planned Intrepid Spirit Centers of the Department
    of Defense or other such facilities of the
    Department of Veterans Affairs or the Department
    of Defense that furnish care for post-traumatic
    stress disorder or traumatic brain injury; and
    (iv) the potential role for private entities
    and philanthropic organizations in carrying out
    the activities of the center.
    (3) Report to congress.--Not later than 270 days after the
    date of the enactment of this Act, the Secretary of Veterans
    Affairs shall submit to the Committee on Veterans' Affairs of
    the Senate and the Committee on Veterans' Affairs of the House
    of Representatives a report that includes--
    (A) <>  a summary of the evaluation
    required under paragraph (1); and
    (B) the alternatives of analysis required under
    paragraph (2).
    (4) Rural and highly rural defined.--In this subsection,
    with respect to an area, the terms ``rural'' and ``highly
    rural'' have the meanings given those terms in the Rural-Urban
    Commuting Areas coding system of the Department of Agriculture.

    TITLE V--IMPROVEMENT OF MENTAL HEALTH MEDICAL WORKFORCE

    SEC. 501. STAFFING IMPROVEMENT PLAN FOR MENTAL HEALTH PROVIDERS OF
    DEPARTMENT OF VETERANS AFFAIRS.

    (a) Staffing Plan.--
    (1) <>  In general.--Not
    later than one year after the date of the enactment of this Act,
    the Secretary of Veterans Affairs, in consultation with the
    Inspector General of the Department of Veterans Affairs, shall
    submit to the Committee on Veterans' Affairs of the Senate and
    the Committee on Veterans' Affairs of the House of
    Representatives a plan to address staffing

    [[Page 815]]

    of mental health providers of the Department of Veterans
    Affairs, including filling any open positions.
    (2) Elements.--The plan required by paragraph (1) shall
    include the following:
    (A) <>  An estimate of the number
    of positions for mental health providers of the
    Department that need to be filled to meet demand.
    (B) An identification of the steps that the
    Secretary will take to address mental health staffing
    for the Department.
    (C) A description of any region-specific hiring
    incentives to be used by the Secretary in consultation
    with the directors of Veterans Integrated Service
    Networks and medical centers of the Department.
    (D) A description of any local retention or
    engagement incentives to be used by directors of
    Veterans Integrated Service Networks.
    (E) <>  Such
    recommendations for legislative or administrative action
    as the Secretary considers necessary to aid in
    addressing mental health staffing for the Department.
    (3) <>  Report.--Not later than one year
    after the submittal of the plan required by paragraph (1), the
    Secretary shall submit to the Committee on Veterans' Affairs of
    the Senate and the Committee on Veterans' Affairs of the House
    of Representatives a report setting forth the number of mental
    health providers hired by the Department during the one-year
    period preceding the submittal of the report.

    (b) Occupational Series for Certain Mental Health Providers.--Not
    later <> than one year
    after the date of the enactment of this Act, the Secretary of Veterans
    Affairs, in consultation with the Office of Personnel Management, shall
    develop an occupational series for licensed professional mental health
    counselors and marriage and family therapists of the Department of
    Veterans Affairs.
    SEC. 502. ESTABLISHMENT OF DEPARTMENT OF VETERANS AFFAIRS
    READJUSTMENT COUNSELING SERVICE
    SCHOLARSHIP PROGRAM.

    (a) In General.--Chapter 76 of title 38, United States Code, is
    amended by inserting after subchapter VIII the following new subchapter:

    ``SUBCHAPTER <>  IX--READJUSTMENT COUNSELING
    SERVICE SCHOLARSHIP PROGRAM
    ``Sec. 7698. <>  Requirement for program

    ``As part of the Educational Assistance Program, the Secretary shall
    carry out a scholarship program under this subchapter. The program shall
    be known as the Department of Veterans Affairs Readjustment Counseling
    Service Scholarship Program (in this subchapter referred to as the
    `Program').
    ``Sec. 7699. <>
    Eligibility; agreement

    ``(a) In General.--An individual is eligible to participate in the
    Program, as determined by the Readjustment Counseling Service of the
    Department, if the individual--
    ``(1) is accepted for enrollment or enrolled (as described
    in section 7602 of this title) in a program of study at an

    [[Page 816]]

    accredited educational institution, school, or training program
    leading to a terminal degree in psychology, social work,
    marriage and family therapy, or mental health counseling that
    would meet the education requirements for appointment to a
    position under section 7402(b) of this title; and
    ``(2) enters into an agreement with the Secretary under
    subsection (c).

    ``(b) Priority.--In selecting individuals to participate in the
    Program, the Secretary shall give priority to the following individuals:
    ``(1) An individual who agrees to be employed by a Vet
    Center located in a community that is--
    ``(A) designated as a medically underserved
    population under section 330(b)(3) of the Public Health
    Service Act (42 U.S.C. 254b(b)(3)); and
    ``(B) in a State with a per capita population of
    veterans of more than five percent according to the
    National Center for Veterans Analysis and Statistics and
    the Bureau of the Census.
    ``(2) An individual who is a veteran.

    ``(c) Agreement.--An agreement between the Secretary and a
    participant in the Program shall (in addition to the requirements set
    forth in section 7604 of this title) include the following:
    ``(1) An agreement by the Secretary to provide the
    participant with a scholarship under the Program for a specified
    number of school years during which the participant pursues a
    program of study described in subsection (a)(1) that meets the
    requirements set forth in section 7602(a) of this title.
    ``(2) <>  An agreement by the
    participant to serve as a full-time employee of the Department
    at a Vet Center for a six-year period following the completion
    by the participant of such program of study (in this subchapter
    referred to as the `period of obligated service').

    ``(d) Vet Center Defined.--In this section, the term `Vet Center'
    has the meaning given that term in section 1712A(h) of this title.
    ``Sec. 7699A. <>  Obligated service

    ``(a) In General.--Each participant in the Program shall provide
    service as a full-time employee of the Department at a Vet Center (as
    defined in section 7699(d) of this title) for the period of obligated
    service set forth in the agreement of the participant entered into under
    section 7604 of this title.
    ``(b) <>  Determination of Service
    Commencement Date.--(1) Not later than 60 days before the service
    commencement date of a participant, the Secretary shall notify the
    participant of that service commencement date.

    ``(2) The date specified in paragraph (1) with respect to a
    participant is the date for the beginning of the period of obligated
    service of the participant.
    ``Sec. 7699B. <>  Breach of
    agreement: liability

    ``(a) Liquidated Damages.--(1) A participant in the Program (other
    than a participant described in subsection (b)) who fails to accept
    payment, or instructs the educational institution in which the
    participant is enrolled not to accept payment, in whole or in part, of a
    scholarship under the agreement entered into under

    [[Page 817]]

    section 7604 of this title shall be liable to the United States for
    liquidated damages in the amount of $1,500.
    ``(2) Liability under paragraph (1) is in addition to any period of
    obligated service or other obligation or liability under such agreement.
    ``(b) Liability During Program of Study.--(1) Except as provided in
    subsection (d), a participant in the Program shall be liable to the
    United States for the amount which has been paid to or on behalf of the
    participant under the agreement if any of the following occurs:
    ``(A) <>  The participant
    fails to maintain an acceptable level of academic standing in
    the educational institution in which the participant is enrolled
    (as determined by the educational institution under regulations
    prescribed by the Secretary).
    ``(B) The participant is dismissed from such educational
    institution for disciplinary reasons.
    ``(C) The participant voluntarily terminates the program of
    study in such educational institution before the completion of
    such program of study.

    ``(2) Liability under this subsection is in lieu of any service
    obligation arising under the agreement.
    ``(c) <>  Liability During Period of
    Obligated Service.--(1) Except as provided in subsection (d), if a
    participant in the Program does not complete the period of obligated
    service of the participant, the United States shall be entitled to
    recover from the participant an amount determined in accordance with the
    following formula: A = 3F(t-s/t).

    ``(2) In the formula in paragraph (1):
    ``(A) `A' is the amount the United States is entitled to
    recover.
    ``(B) `F' is the sum of--
    ``(i) the amounts paid under this subchapter to or
    on behalf of the participant; and
    ``(ii) the interest on such amounts which would be
    payable if at the time the amounts were paid they were
    loans bearing interest at the maximum legal prevailing
    rate, as determined by the Treasurer of the United
    States.
    ``(C) `t' is the total number of months in the period of
    obligated service of the participant.
    ``(D) `s' is the number of months of such period served by
    the participant.

    ``(d) Limitation on Liability for Reductions-in-force.--Liability
    shall not arise under subsection (c) if the participant fails to
    maintain employment as a Department employee due to a staffing
    adjustment.
    ``(e) Period for Payment of Damages.--Any amount of damages that the
    United States is entitled to recover under this section shall be paid to
    the United States within the one-year period beginning on the date of
    the breach of the agreement.''.
    (b) Conforming and Technical Amendments.--
    (1) Conforming amendments.--
    (A) Establishment of program.--Section 7601(a) of
    such title <>  is amended--
    (i) in paragraph (5), by striking ``and'';
    (ii) in paragraph (6), by striking the period
    and inserting ``; and''; and

    [[Page 818]]

    (iii) by adding at the end the following new
    paragraph:
    ``(7) the readjustment counseling service scholarship
    program provided for in subchapter IX of this chapter.''.
    (B) <>  Eligibility.--Section
    7602 of such title is amended--
    (i) in subsection (a)(1)--
    (I) by striking ``or VI'' and
    inserting ``VI, or IX''; and
    (II) by striking ``subchapter VI''
    and inserting ``subchapter VI or IX'';
    and
    (ii) in subsection (b), by striking ``or VI''
    and inserting ``VI, or IX''.
    (C) Application.--Section 7603(a)(1) of such title
    is amended by striking ``or VIII'' and inserting ``VIII,
    or IX''.
    (D) Terms of agreement.--Section 7604 of such title
    is amended by striking ``or VIII'' each place it appears
    and inserting ``VIII, or IX''.
    (E) Annual report.--Section 7632 of such title is
    amended--
    (i) in paragraph (1), by striking ``and the
    Specialty Education Loan Repayment Program'' and
    inserting ``the Specialty Education Loan Repayment
    Program, and the Readjustment Counseling Service
    Scholarship Program''; and
    (ii) in paragraph (4), by striking ``and per
    participant in the Specialty Education Loan
    Repayment Program'' and inserting ``per
    participant in the Specialty Education Loan
    Repayment Program, and per participant in the
    Readjustment Counseling Service Scholarship
    Program''.
    (2) Table of sections.--The table of sections at the
    beginning of chapter 76 of such title <>  is amended by inserting after the items relating to
    subchapter VIII the following:

    ``subchapter ix--readjustment counseling service scholarship program

    ``Sec.
    ``7698. Requirement for program.
    ``7699. Eligibility; agreement.
    ``7699A. Obligated service.
    ``7699B. Breach of agreement: liability.''.

    (c) <>  Effective Date.--The Secretary of
    Veterans Affairs shall begin awarding scholarships under subchapter IX
    of chapter 76 of title 38, United States Code, as added by subsection
    (a), for programs of study beginning not later than one year after the
    date of the enactment of this Act.
    SEC. 503. COMPTROLLER GENERAL REPORT ON READJUSTMENT COUNSELING
    SERVICE OF DEPARTMENT OF VETERANS AFFAIRS.

    (a) In General.--Not later than one year after the date of the
    enactment of this Act, the Comptroller General of the United States
    shall submit to the Committee on Veterans' Affairs of the Senate and the
    Committee on Veterans' Affairs of the House of Representatives a report
    on the Readjustment Counseling Service of the Department of Veterans
    Affairs.
    (b) <>  Elements.--The report
    required by subsection (a) shall include the following:

    [[Page 819]]

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

    (c) Vet Center Defined.--In this section, the term ``Vet Center''
    has the meaning given that term in section 1712A(h) of title 38, United
    States Code.
    SEC. 504. EXPANSION OF REPORTING REQUIREMENTS ON READJUSTMENT
    COUNSELING SERVICE OF DEPARTMENT OF
    VETERANS AFFAIRS.

    (a) Expansion of Annual Report.--Paragraph (2)(C) of section 7309(e)
    of title 38, United States Code, <>  is amended by
    inserting before the period at the end the following: ``, including the
    resources required to meet such unmet need, such as additional staff,
    additional locations, additional infrastructure, infrastructure
    improvements, and additional mobile Vet Centers''.

    (b) Biennial Report.--Such section is amended by adding at the end
    the following new paragraph:
    ``(3) For each even numbered year in which the report required by
    paragraph (1) is submitted, the Secretary shall include in such report a
    prediction of--
    ``(A) trends in demand for care;
    ``(B) long-term investments required with respect to the
    provision of care;

    [[Page 820]]

    ``(C) requirements relating to maintenance of
    infrastructure; and
    ``(D) other capital investment requirements with respect to
    the Readjustment Counseling Service, including Vet Centers,
    mobile Vet Centers, and community access points.''.
    SEC. 505. BRIEFING ON ALTERNATIVE WORK SCHEDULES FOR EMPLOYEES OF
    VETERANS HEALTH ADMINISTRATION.

    (a) Survey of Veterans.--
    (1) <>  In general.--Not later than 180
    days after the date of the enactment of this Act, the Secretary
    of Veterans Affairs shall conduct a survey on the attitudes of
    eligible veterans toward the Department of Veterans Affairs
    offering appointments outside the usual operating hours of
    facilities of the Department, including through the use of
    telehealth appointments.
    (2) Eligible veteran defined.--In this subsection, the term
    ``eligible veteran'' means a veteran who--
    (A) is enrolled in the patient enrollment system of
    the Department under section 1705(a) of title 38, United
    States Code; and
    (B) <>  received health care
    from the Department at least once during the two-year
    period ending on the date of the commencement of the
    survey under paragraph (1).

    (b) Congressional Briefing.--
    (1) <>  In general.--Not later than 270
    days after the date of the enactment of this Act, the Secretary
    shall brief the Committee on Veterans' Affairs of the Senate and
    the Committee on Veterans' Affairs of the House of
    Representatives on the--
    (A) feasibility and advisability of offering
    appointments outside the usual operating hours of
    facilities of the Department that do not offer such
    appointments; and
    (B) effectiveness of offering appointments outside
    the usual operating hours of facilities of the
    Department for those facilities that offer such
    appointments.
    (2) Elements.--The briefing required by paragraph (1) shall
    include the following:
    (A) The findings of the survey conducted under
    subsection (a);
    (B) Feedback from employees of the Veterans Health
    Administration, including clinical, nonclinical, and
    support staff, with respect to offering appointments
    outside the usual operating hours of facilities of the
    Department, including through the use of telehealth
    appointments; and
    (C) Any other matters the Secretary considers
    relevant to a full understanding of the feasibility and
    advisability of offering appointments outside the usual
    operating hours of facilities of the Department.

    (c) Paperwork Reduction Act Exemption.--Chapter 35 of title 44,
    United States Code (commonly known as the ``Paperwork Reduction Act'')
    shall not apply to any rulemaking or information collection required
    under this section.
    SEC. 506. SUICIDE PREVENTION COORDINATORS.

    (a) <>  Staffing Requirement.--
    Beginning not later than one year after the date of the enactment of
    this Act, the Secretary of Veterans Affairs shall ensure that each
    medical center of the Department

    [[Page 821]]

    of Veterans Affairs has not less than one suicide prevention
    coordinator.

    (b) Study on Reorganization.--
    (1) <>  In
    general.--Not later than one year after the date of the
    enactment of this Act, the Secretary, in consultation with the
    Office of Mental Health and Suicide Prevention of the
    Department, shall commence the conduct of a study to determine
    the feasibility and advisability of--
    (A) the realignment and reorganization of suicide
    prevention coordinators within the Office of Mental
    Health and Suicide Prevention; and
    (B) the creation of a suicide prevention coordinator
    program office.
    (2) <>  Program office realignment.--In
    conducting the study under paragraph (1), the Secretary shall
    assess the feasibility of advisability of, within the suicide
    prevention coordinator program office described in paragraph
    (1)(B), aligning suicide prevention coordinators and suicide
    prevention case managers within the organizational structure and
    chart of the Suicide Prevention Program of the Department, with
    the Director of the Suicide Prevention program having ultimate
    supervisory oversight and responsibility over the suicide
    prevention coordinator program office.

    (c) Report.--Not later than 90 days after the completion of the
    study under subsection (b), the Secretary shall submit to the Committee
    on Veterans' Affairs of the Senate and the Committee on Veterans'
    Affairs of the House of Representatives a report on such study,
    including the following:
    (1) <>  An assessment of the feasibility
    and advisability of creating a suicide prevention coordinator
    program office to oversee and monitor suicide prevention
    coordinators and suicide prevention case managers across all
    medical centers of the Department.
    (2) <>  A review of current staffing ratios
    for suicide prevention coordinators and suicide prevention case
    managers in comparison with current staffing ratios for mental
    health providers within each medical center of the Department.
    (3) A description of the duties and responsibilities for
    suicide prevention coordinators across the Department to better
    define, delineate, and standardize qualifications, performance
    goals, performance duties, and performance outcomes for suicide
    prevention coordinators and suicide prevention case managers.
    SEC. 507. REPORT ON EFFORTS BY DEPARTMENT OF VETERANS AFFAIRS TO
    IMPLEMENT SAFETY PLANNING IN EMERGENCY
    DEPARTMENTS.

    (a) Findings.--Congress makes the following findings:
    (1) The Department of Veterans Affairs must be more
    effective in its approach to reducing the burden of veteran
    suicide connected to mental health diagnoses, to include
    expansion of treatment delivered via telehealth methods and in
    rural areas.
    (2) An innovative project, known as Suicide Assessment and
    Follow-up Engagement: Veteran Emergency Treatment (in this
    subsection referred to as ``SAFE VET''), was designed to help
    suicidal veterans seen at emergency departments within

    [[Page 822]]

    the Veterans Health Administration and was successfully
    implemented in five intervention sites beginning in 2010.
    (3) A 2018 study found that safety planning intervention
    under SAFE VET was associated with 45 percent fewer suicidal
    behaviors in the six-month period following emergency department
    care and more than double the odds of a veteran engaging in
    outpatient behavioral health care.
    (4) SAFE VET is a promising alternative and acceptable
    delivery of care system that augments the treatment of suicidal
    veterans in emergency departments of the Veterans Health
    Administration and helps ensure that those veterans have
    appropriate follow-up care.
    (5) Beginning in September 2018, the Veterans Health
    Administration implemented a suicide prevention program, known
    as the SPED program, for veterans presenting to the emergency
    department who are assessed to be at risk for suicide and are
    safe to be discharged home.
    (6) The SPED program includes issuance and update of a
    safety plan and post-discharge follow-up outreach for veterans
    to facilitate engagement in outpatient mental health care.

    (b) Report.--
    (1) In general.--Not later than 180 days after the date of
    the enactment of this Act, the Secretary of Veterans Affairs
    shall submit to the appropriate committees of Congress a report
    on the efforts of the Secretary to implement a suicide
    prevention program for veterans presenting to an emergency
    department or urgent care center of the Veterans Health
    Administration who are assessed to be at risk for suicide and
    are safe to be discharged home, including a safety plan and
    post-discharge outreach for veterans to facilitate engagement in
    outpatient mental health care.
    (2) <>  Elements.--The report required
    by paragraph (1) shall include the following:
    (A) An assessment of the implementation of the
    current operational policies and procedures of the SPED
    program at each medical center of the Department of
    Veterans Affairs, including an assessment of the
    following:
    (i) Training provided to clinicians or other
    personnel administering protocols under the SPED
    program.
    (ii) Any disparities in implementation of such
    protocols between medical centers.
    (iii) <>  Current criteria
    used to measure the quality of such protocols
    including--
    (I) methodology used to assess the
    quality of a safety plan and post-
    discharge outreach for veterans; or

    (II) <>  in
    the absence of such methodology, a
    proposed timeline and guidelines for
    creating a methodology to ensure
    compliance with the evidence-based model
    used under the Suicide Assessment and
    Follow-up Engagement: Veteran Emergency
    Treatment (SAFE VET) program of the
    Department.
    (B) An assessment of the implementation of the
    policies and procedures described in subparagraph (A),
    including the following:

    [[Page 823]]

    (i) An assessment of the quality and quantity
    of safety plans issued to veterans.
    (ii) An assessment of the quality and quantity
    of post-discharge outreach provided to veterans.
    (iii) The post-discharge rate of veteran
    engagement in outpatient mental health care,
    including attendance at not fewer than one
    individual mental health clinic appointment or
    admission to an inpatient or residential unit.
    (iv) The number of veterans who decline safety
    planning efforts during protocols under the SPED
    program.
    (v) The number of veterans who decline to
    participate in follow-up efforts within the SPED
    program.
    (C) A description of how SPED primary coordinators
    are deployed to support such efforts, including the
    following:
    (i) A description of the duties and
    responsibilities of such coordinators.
    (ii) The number and location of such
    coordinators.
    (iii) A description of training provided to
    such coordinators.
    (iv) An assessment of the other
    responsibilities for such coordinators and, if
    applicable, differences in patient outcomes when
    such responsibilities are full-time duties as
    opposed to secondary duties.
    (D) An assessment of the feasibility and
    advisability of expanding the total number and
    geographic distribution of SPED primary coordinators.
    (E) <>  An assessment of the
    feasibility and advisability of providing services under
    the SPED program via telehealth channels, including an
    analysis of opportunities to leverage telehealth to
    better serve veterans in rural areas.
    (F) A description of the status of current
    capabilities and utilization of tracking mechanisms to
    monitor compliance, quality, and patient outcomes under
    the SPED program.
    (G) <>  Such
    recommendations, including specific action items, as the
    Secretary considers appropriate with respect to how the
    Department can better implement the SPED program,
    including recommendations with respect to the following:
    (i) A process to standardize training under
    such program.
    (ii) Any resourcing requirements necessary to
    implement the SPED program throughout Veterans
    Health Administration, including by having a
    dedicated clinician responsible for administration
    of such program at each medical center.
    (iii) <>  An analysis of
    current statutory authority and any changes
    necessary to fully implement the SPED program
    throughout the Veterans Health Administration.
    (iv) <>  A timeline for the
    implementation of the SPED program through the
    Veterans Health Administration once full
    resourcing and an approved training plan are in
    place.

    [[Page 824]]

    (H) Such other matters as the Secretary considers
    appropriate.

    (c) Definitions.--In this section:
    (1) Appropriate committees of congress.--The term
    ``appropriate committees of Congress'' means--
    (A) the Committee on Veterans' Affairs and the
    Subcommittee on Military Construction, Veterans Affairs,
    and Related Agencies of the Committee on Appropriations
    of the Senate; and
    (B) the Committee on Veterans' Affairs and the
    Subcommittee on Military Construction, Veterans Affairs,
    and Related Agencies of the Committee on Appropriations
    of the House of Representatives.
    (2) SPED primary coordinator.--The term ``SPED primary
    coordinator'' means the main point of contact responsible for
    administering the SPED program at a medical center of the
    Department.
    (3) SPED program.--The term ``SPED program'' means the
    Safety Planning in Emergency Departments program of the
    Department of Veterans Affairs established in September 2018 for
    veterans presenting to the emergency department who are assessed
    to be at risk for suicide and are safe to be discharged home,
    which extends the evidence-based intervention for suicide
    prevention to all emergency departments of the Veterans Health
    Administration.

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

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

    The Secretary of Veterans Affairs shall expand the capabilities of
    the Women Veterans Call Center of the Department of Veterans Affairs to
    include a text messaging capability.
    SEC. 602. <>  REQUIREMENT FOR DEPARTMENT
    OF VETERANS AFFAIRS INTERNET WEBSITE TO
    PROVIDE INFORMATION ON SERVICES AVAILABLE
    TO WOMEN VETERANS.

    (a) <>  In General.--The Secretary of Veterans
    Affairs shall survey the internet websites and information resources of
    the Department of Veterans Affairs in effect on the day before the date
    of the enactment of this Act and publish an internet website that serves
    as a centralized source for the provision to women veterans of
    information about the benefits and services available to them under laws
    administered by the Secretary.

    (b) Elements.--The internet website published under subsection (a)
    shall provide to women veterans information regarding all services
    available in the district in which the veteran is seeking such services,
    including, with respect to each medical center and community-based
    outpatient clinic in the applicable Veterans Integrated Service
    Network--
    (1) the name and contact information of each women's health
    coordinator;

    [[Page 825]]

    (2) <>  a list of appropriate staff for other
    benefits available from the Veterans Benefits Administration,
    the National Cemetery Administration, and such other entities as
    the Secretary considers appropriate; and
    (3) such other information as the Secretary considers
    appropriate.

    (c) <>  Updated Information.--The Secretary
    shall ensure that the information described in subsection (b) that is
    published on the internet website required by subsection (a) is updated
    not less frequently than once every 90 days.

    (d) Outreach.--In carrying out this section, the Secretary shall
    ensure that the outreach conducted under section 1720F(i) of title 38,
    United States Code, includes information regarding the internet website
    required by subsection (a).
    (e) Derivation of Funds.--Amounts used by the Secretary to carry out
    this section shall be derived from amounts made available to the
    Secretary to publish internet websites of the Department.

    TITLE VII--OTHER MATTERS

    SEC. 701. <>  EXPANDED TELEHEALTH FROM
    DEPARTMENT OF VETERANS AFFAIRS.

    (a) <>  In General.--The Secretary of Veterans
    Affairs shall enter into agreements, and expand existing agreements,
    with organizations that represent or serve veterans, nonprofit
    organizations, private businesses, and other interested parties for the
    expansion of telehealth capabilities and the provision of telehealth
    services to veterans through the award of grants under subsection (b).

    (b) Award of Grants.--
    (1) In general.--In carrying out agreements entered into or
    expanded under this section with entities described in
    subsection (a), the Secretary shall award grants to those
    entities.
    (2) Locations.--To the extent practicable, the Secretary
    shall ensure that grants are awarded to entities that serve
    veterans in rural and highly rural areas (as determined through
    the use of the Rural-Urban Commuting Areas coding system of the
    Department of Agriculture) or areas determined to be medically
    underserved.
    (3) Use of grants.--
    (A) In general.--Grants awarded to an entity under
    this subsection may be used for one or more of the
    following:
    (i) Purchasing, replacing or upgrading
    hardware or software necessary for the provision
    of secure and private telehealth services.
    (ii) Upgrading security protocols for
    consistency with the security requirements of the
    Department of Veterans Affairs.
    (iii) Training of site attendants, including
    payment of those attendants for completing that
    training, with respect to--
    (I) military and veteran cultural
    competence, if the entity is not an
    organization that represents veterans;

    [[Page 826]]

    (II) equipment required to provide
    telehealth services;
    (III) privacy, including the Health
    Insurance Portability and Accountability
    Act of 1996 privacy rule under part 160
    and subparts A and E of part 164 of
    title 45, Code of Federal Regulations,
    or successor regulations, as it relates
    to health care for veterans;
    (IV) scheduling for telehealth
    services for veterans; or
    (V) any other unique training needs
    for the provision of telehealth services
    to veterans.
    (iv) Upgrading existing infrastructure owned
    or leased by the entity to make rooms more
    conducive to telehealth care, including--
    (I) additions or modifications to
    windows or walls in an existing room, or
    other alterations as needed to create a
    new, private room, including permits or
    inspections required in association with
    space modifications;
    (II) soundproofing of an existing
    room;
    (III) new electrical, telephone, or
    internet outlets in an existing room; or
    (IV) aesthetic enhancements to
    establish a more suitable therapeutic
    environment.
    (v) Upgrading existing infrastructure to
    comply with the Americans with Disabilities Act of
    1990 (42 U.S.C. 12101 et seq.).
    (vi) Upgrading internet infrastructure and
    sustainment of internet services.
    (vii) Sustainment of telephone services.
    (B) <>  Exclusion.--Grants may
    not be used for the purchase of new property or for
    major construction projects, as determined by the
    Secretary.

    (c) <>  Agreement on Telehealth Access Points.--
    (1) In general.--An entity described in subsection (a) that
    seeks to establish a telehealth access point for veterans but
    does not require grant funding under this section to do so may
    enter into an agreement with the Department for the
    establishment of such an access point.
    (2) Adequacy of facilities.--An entity described in
    paragraph (1) shall be responsible for ensuring that any access
    point is adequately private, secure, clean, and accessible for
    veterans before the access point is established.

    (d) Assessment of Barriers to Access.--
    (1) <>  In general.--Not later than 18
    months after the date of the enactment of this Act, the
    Secretary shall complete an assessment of barriers faced by
    veterans in accessing telehealth services.
    (2) Elements.--The assessment required by paragraph (1)
    shall include the following:
    (A) A description of the barriers veterans face in
    using telehealth while not on property of the
    Department.
    (B) A description of how the Department plans to
    address the barriers described in subparagraph (A).

    [[Page 827]]

    (C) Such other matters related to access by veterans
    to telehealth while not on property of the Department as
    the Secretary considers relevant.
    (3) <>  Report.--Not later than
    120 days after the completion of the assessment required by
    paragraph (1), the Secretary shall submit to the Committee on
    Veterans' Affairs of the Senate and the Committee on Veterans'
    Affairs of the House of Representatives a report on the
    assessment, including any recommendations for legislative or
    administrative action based on the results of the assessment.
    SEC. 702. <>  PARTNERSHIPS WITH NON-FEDERAL
    GOVERNMENT ENTITIES TO PROVIDE HYPERBARIC
    OXYGEN THERAPY TO VETERANS AND STUDIES ON
    THE USE OF SUCH THERAPY FOR TREATMENT OF
    POST-TRAUMATIC STRESS DISORDER AND
    TRAUMATIC BRAIN INJURY.

    (a) <>  Partnerships to Provide Hyperbaric
    Oxygen Therapy to Veterans.--
    (1) <>  Use of partnerships.--The
    Secretary of Veterans Affairs, in consultation with the Center
    for Compassionate Innovation within the Office of Community
    Engagement of the Department of Veterans Affairs, may enter into
    partnerships with non-Federal Government entities to provide
    hyperbaric oxygen treatment to veterans to research the
    effectiveness of such therapy.
    (2) Types of partnerships.--Partnerships entered into under
    paragraph (1) may include the following:
    (A) Partnerships to conduct research on hyperbaric
    oxygen therapy.
    (B) Partnerships to review research on hyperbaric
    oxygen therapy provided to nonveterans.
    (C) Partnerships to create industry working groups
    to determine standards for research on hyperbaric oxygen
    therapy.
    (D) Partnerships to provide to veterans hyperbaric
    oxygen therapy for the purposes of conducting research
    on the effectiveness of such therapy.
    (3) Limitation on federal funding.--Federal Government
    funding may be used to coordinate and administer the
    partnerships under this subsection but may not be used to carry
    out activities conducted under such partnerships.

    (b) Review of Effectiveness of Hyperbaric Oxygen Therapy.--Not
    later <> than 90 days after the
    date of the enactment of this Act, the Secretary, in consultation with
    the Center for Compassionate Innovation, shall begin using an objective
    and quantifiable method to review the effectiveness and applicability of
    hyperbaric oxygen therapy, such as through the use of a device approved
    or cleared by the Food and Drug Administration that assesses traumatic
    brain injury by tracking eye movement.

    (c) Systematic Review of Use of Hyperbaric Oxygen Therapy to Treat
    Certain Conditions.--
    (1) <>  In general.--Not later than 90
    days after the date of the enactment of this Act, the Secretary,
    in consultation with the Center for Compassionate Innovation,
    shall commence the conduct of a systematic review of published
    research literature on off-label use of hyperbaric oxygen
    therapy to treat

    [[Page 828]]

    post-traumatic stress disorder and traumatic brain injury among
    veterans and nonveterans.
    (2) Elements.--The review conducted under paragraph (1)
    shall include the following:
    (A) <>  An assessment of the
    current parameters for research on the use by the
    Department of Veterans Affairs of hyperbaric oxygen
    therapy, including--
    (i) tests and questionnaires used to determine
    the efficacy of such therapy; and
    (ii) metrics for determining the success of
    such therapy.
    (B) <>  A comparative analysis of
    tests and questionnaires used to study post-traumatic
    stress disorder and traumatic brain injury in other
    research conducted by the Department of Veterans
    Affairs, other Federal agencies, and entities outside
    the Federal Government.
    (3) Completion of review.--The review conducted under
    paragraph (1) shall be completed not later than 180 days after
    the date of the commencement of the review.
    (4) Report.--Not later than 90 days after the completion of
    the review conducted under paragraph (1), the Secretary shall
    submit to the Committee on Veterans' Affairs of the Senate and
    the Committee on Veterans' Affairs of the House of
    Representatives a report on the results of the review.

    (d) Follow-up Study.--
    (1) <>  In general.--Not later than 120
    days after the completion of the review conducted under
    subsection (c), the Secretary, in consultation with the Center
    for Compassionate Innovation, shall commence the conduct of a
    study on all individuals receiving hyperbaric oxygen therapy
    through the current pilot program of the Department for the
    provision of hyperbaric oxygen therapy to veterans to determine
    the efficacy and effectiveness of hyperbaric oxygen therapy for
    the treatment of post-traumatic stress disorder and traumatic
    brain injury.
    (2) <>  Elements.--The study
    conducted under paragraph (1) shall include the review and
    publication of any data and conclusions resulting from research
    conducted by an authorized provider of hyperbaric oxygen therapy
    for veterans through the pilot program described in such
    paragraph.
    (3) Completion of study.--The study conducted under
    paragraph (1) shall be completed not later than three years
    after the date of the commencement of the study.
    (4) Report.--
    (A) In general.--Not later than 90 days after
    completing the study conducted under paragraph (1), the
    Secretary shall submit to the Committee on Veterans'
    Affairs of the Senate and the Committee on Veterans'
    Affairs of the House of Representatives a report on the
    results of the study.
    (B) <>  Elements.--The
    report required under subparagraph (A) shall include the
    recommendation of the Secretary with respect to whether
    or not hyperbaric oxygen therapy should be made
    available to all veterans with traumatic brain injury or
    post-traumatic stress disorder.

    [[Page 829]]

    SEC. 703. <>  PRESCRIPTION OF TECHNICAL
    QUALIFICATIONS FOR LICENSED HEARING AID
    SPECIALISTS AND REQUIREMENT FOR
    APPOINTMENT OF SUCH SPECIALISTS.

    (a) Technical Qualifications.--
    (1) <>  In general.--Not later than 180
    days after the date of the enactment of this Act, the Secretary
    of Veterans Affairs shall prescribe the technical qualifications
    required under section 7402(b)(14) of title 38, United States
    Code, to be appointed as a licensed hearing aid specialist under
    section 7401(3) of such title.
    (2) Elements for qualifications.--In prescribing the
    qualifications for licensed hearing aid specialists under
    paragraph (1), the Secretary shall, at a minimum, ensure that
    such qualifications are consistent with--
    (A) the standards for licensure of hearing aid
    specialists that are required by a majority of States;
    (B) any competencies needed to perform tasks and
    services commonly performed by hearing aid specialists
    pursuant to such standards; and
    (C) any competencies needed to perform tasks
    specific to providing care to individuals under the laws
    administered by the Secretary.

    (b) Authority to Set and Maintain Duties.--The Secretary shall
    retain the authority to set and maintain the duties for licensed hearing
    aid specialists appointed under section 7401(3) of title 38, United
    States Code, for the purposes of the employment of such specialists with
    the Department of Veterans Affairs.
    (c) <>  Appointment.--Not later than September 30,
    2022, the Secretary shall appoint not fewer than one licensed hearing
    aid specialist at each medical center of the Department.

    (d) <>  Report.--Not later than September 30,
    2022, and annually thereafter, the Secretary shall submit to the
    Committee on Veterans' Affairs of the Senate and the Committee on
    Veterans' Affairs of the House of Representatives a report--
    (1) assessing the progress of the Secretary in appointing
    licensed hearing aid specialists under subsection (c);
    (2) assessing potential conflicts or obstacles that prevent
    the appointment of licensed hearing aid specialists;
    (3) assessing the factors that led to such conflicts or
    obstacles;
    (4) assessing access of patients to comprehensive hearing
    health care services from the Department consistent with the
    requirements under section 4(b) of the Veterans Mobility Safety
    Act of 2016 (Public Law 114-256; 38 U.S.C. 7401 note), including
    an assessment of the impact of infrastructure and equipment
    limitations on wait times for audiologic care; and
    (5) indicating the medical centers of the Department with
    vacancies for audiologists or licensed hearing aid specialists.
    SEC. 704. <>  USE BY
    DEPARTMENT OF VETERANS AFFAIRS OF
    COMMERCIAL INSTITUTIONAL REVIEW BOARDS IN
    SPONSORED RESEARCH TRIALS.

    (a) In General.--Not later than 90 days after the date of the
    enactment of this Act, the Secretary of Veterans Affairs shall complete
    all necessary policy revisions within the directive of the Veterans
    Health Administration numbered 1200.05 and titled ``Requirements for the
    Protection of Human Subjects in Research'',

    [[Page 830]]

    to allow sponsored clinical research of the Department of Veterans
    Affairs to use accredited commercial institutional review boards to
    review research proposal protocols of the Department.
    (b) Identification of Review Boards.--Not later than 90 days after
    the completion of the policy revisions under subsection (a), the
    Secretary shall--
    (1) identify accredited commercial institutional review
    boards for use in connection with sponsored clinical research of
    the Department; and
    (2) establish a process to modify existing approvals in the
    event that a commercial institutional review board loses its
    accreditation during an ongoing clinical trial.

    (c) Report.--
    (1) In general.--Not later than 90 days after the completion
    of the policy revisions under subsection (a), and annually
    thereafter, the Secretary shall submit to the Committee on
    Veterans' Affairs of the Senate and the Committee on Veterans'
    Affairs of the House of Representatives a report on all
    approvals of institutional review boards used by the Department,
    including central institutional review boards and commercial
    institutional review boards.
    (2) Elements.--The report required by paragraph (1) shall
    include, at a minimum, the following:
    (A) The name of each clinical trial with respect to
    which the use of an institutional review board has been
    approved.
    (B) The institutional review board or institutional
    review boards used in the approval process for each
    clinical trial.
    (C) The amount of time between submission and
    approval.
    SEC. 705. <>  CREATION OF OFFICE OF
    RESEARCH REVIEWS WITHIN THE OFFICE OF
    INFORMATION AND TECHNOLOGY OF THE
    DEPARTMENT OF VETERANS AFFAIRS.

    (a) <>  In General.--Not later than one year after
    the date of the enactment of this Act, the Secretary of Veterans Affairs
    shall establish within the Office of Information and Technology of the
    Department of Veterans Affairs an Office of Research Reviews (in this
    section referred to as the ``Office'').

    (b) Elements.--The Office shall do the following:
    (1) Perform centralized security reviews and complete
    security processes for approved research sponsored outside the
    Department, with a focus on multi-site clinical trials.
    (2) <>  Develop and maintain a list of
    commercially available software preferred for use in sponsored
    clinical trials of the Department and ensure such list is
    maintained as part of the official approved software products
    list of the Department.
    (3) Develop benchmarks for appropriate timelines for
    security reviews conducted by the Office.

    (c) Report.--
    (1) In general.--Not later than one year after the
    establishment of the Office, the Office shall submit to the
    Committee on Veterans' Affairs of the Senate and the Committee
    on Veterans' Affairs of the House of Representatives a report on
    the activity of the Office.

    [[Page 831]]

    (2) Elements.--The report required by paragraph (1) shall
    include, at a minimum, the following:
    (A) The number of security reviews completed.
    (B) The number of personnel assigned for performing
    the functions described in subsection (b).

    Approved October 17, 2020.

    LEGISLATIVE HISTORY--S. 785:
    ---------------------------------------------------------------------------

    CONGRESSIONAL RECORD, Vol. 166 (2020):
    Aug. 5, considered and passed Senate.
    Sept. 23, considered and passed House.