[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 785 Enrolled Bill (ENR)]
S.785
One Hundred Sixteenth Congress
of the
United States of America
AT THE SECOND SESSION
Begun and held at the City of Washington on Friday,
the third day of January, two thousand and twenty
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.
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 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 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.
(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--
(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.--
(1) Distribution.--
(A) Priority.--In compliance with subparagraphs (B) and
(C), in determining how to distribute grants under this
section, the Secretary may prioritize--
(i) rural communities;
(ii) Tribal lands;
(iii) territories of the United States;
(iv) medically underserved areas;
(v) areas with a high number or percentage of minority
veterans or women veterans; and
(vi) areas with a high number or percentage of calls to
the Veterans Crisis Line.
(B) Areas with need.--The Secretary shall ensure that, to
the extent practicable, grants under this section are
distributed--
(i) to provide services in areas of the United States
that have experienced high rates of suicide by eligible
individuals, including suicide attempts; and
(ii) to eligible entities that can assist eligible
individuals at risk of suicide who are not currently
receiving health care furnished by the Department.
(C) Geography.--In distributing grants under this
paragraph, the Secretary may provide grants to eligible
entities that furnish services to eligible individuals and
their families in geographically dispersed areas.
(2) Preference.--The Secretary shall give preference to
eligible entities that have demonstrated the ability to provide or
coordinate suicide prevention services.
(e) Requirements for Receipt of Grants.--
(1) Notification that services are from department.--Each
entity receiving a grant under this section to provide or
coordinate suicide prevention services to eligible individuals and
their families shall notify the recipients of such services that
such services are being paid for, in whole or in part, by the
Department.
(2) Development of plan with eligible individuals and their
family.--Any plan developed with respect to the provision of
suicide prevention services for an eligible individual or their
family shall be developed in consultation with the eligible
individual and their family.
(3) Coordination.--An entity receiving a grant under this
section shall--
(A) coordinate with the Secretary with respect to the
provision of clinical services to eligible individuals in
accordance with subsection (n) or any other provisions of the
law regarding the delivery of health care by the Secretary;
(B) inform every veteran who receives assistance under this
section from the entity of the ability of the veteran to apply
for enrollment in the patient enrollment system of the
Department under section 1705(a) of title 38, United States
Code; and
(C) if such a veteran wishes to so enroll, inform the
veteran of a point of contact at the Department who can assist
the veteran in such enrollment.
(4) Measurement and monitoring.--An entity receiving a grant
under this section shall submit to the Secretary a description of
such tools and assessments the entity uses or will use to determine
the effectiveness of the services furnished by the entity, which
shall include the measures developed under subsection (h)(2) and
may include--
(A) the effect of the services furnished by the entity on
the financial stability of the eligible individual;
(B) the effect of the services furnished by the entity on
the mental health status, wellbeing, and suicide risk of the
eligible individual; and
(C) the effect of the services furnished by the entity on
the social support of the eligible individuals receiving those
services.
(5) Reports.--The Secretary--
(A) shall require each entity receiving a grant under this
section to submit to the Secretary an annual report that
describes the projects carried out with such grant during the
year covered by the report;
(B) shall specify to each such entity the evaluation
criteria and data and information to be submitted in such
report; and
(C) may require each such entity to submit to the Secretary
such additional reports as the Secretary considers appropriate.
(f) Application for Grants.--
(1) In general.--An eligible entity seeking a grant under this
section shall submit to the Secretary an application therefor in
such form, in such manner, and containing such commitments and
information as the Secretary considers necessary to carry out this
section.
(2) Matters to be included.--Each application submitted by an
eligible entity under paragraph (1) shall contain the following:
(A) A description of the suicide prevention services
proposed to be provided by the eligible entity and the
identified need for those services.
(B) A detailed plan describing how the eligible entity
proposes to coordinate or deliver suicide prevention services
to eligible individuals, including--
(i) an identification of the community partners, if
any, with which the eligible entity proposes to work in
delivering such services;
(ii) a description of the arrangements currently in
place between the eligible entity and such partners with
regard to the provision or coordination of suicide
prevention services;
(iii) an identification of how long such arrangements
have been in place;
(iv) a description of the suicide prevention services
provided by such partners that the eligible entity shall
coordinate, if any; and
(v) an identification of local suicide prevention
coordinators of the Department and a description of how the
eligible entity will communicate with local suicide
prevention coordinators.
(C) A description of the population of eligible individuals
and their families proposed to be provided suicide prevention
services.
(D) Based on information and methods developed by the
Secretary for purposes of this subsection, an estimate of the
number of eligible individuals at risk of suicide and their
families proposed to be provided suicide prevention services,
including the percentage of those eligible individuals who are
not currently receiving care furnished by the Department.
(E) Evidence of measurable outcomes related to reductions
in suicide risk and mood-related symptoms utilizing validated
instruments by the eligible entity (and the proposed partners
of the entity, if any) in providing suicide prevention services
to individuals at risk of suicide, particularly to eligible
individuals and their families.
(F) A description of the managerial and technological
capacity of the eligible entity--
(i) to coordinate the provision of suicide prevention
services with the provision of other services;
(ii) to assess on an ongoing basis the needs of
eligible individuals and their families for suicide
prevention services;
(iii) to coordinate the provision of suicide prevention
services with the services of the Department for which
eligible individuals are also eligible;
(iv) to tailor suicide prevention services to the needs
of eligible individuals and their families;
(v) to seek continuously new sources of assistance to
ensure the continuity of suicide prevention services for
eligible individuals and their families as long as they are
determined to be at risk of suicide; and
(vi) to measure the effects of suicide prevention
services provided by the eligible entity or partner
organization, in accordance with subsection (h)(2), on the
lives of eligible individuals and their families who
receive such services provided by the organization using
pre- and post-evaluations on validated measures of suicide
risk and mood-related symptoms.
(G) Clearly defined objectives for the provision of suicide
prevention services.
(H) A description and physical address of the primary
location of the eligible entity.
(I) A description of the geographic area the eligible
entity plans to serve during the grant award period for which
the application applies.
(J) If the eligible entity is a State or local government
or an Indian tribe, the amount of grant funds proposed to be
made available to community partners, if any, through
agreements.
(K) A description of how the eligible entity will assess
the effectiveness of the provision of grants under this
section.
(L) An agreement to use the measures and metrics provided
by the Department for the purposes of measuring the
effectiveness of the programming as described in subsection
(h)(2).
(M) Such additional application criteria as the Secretary
considers appropriate.
(g) Training and Technical Assistance.--
(1) In general.--The Secretary shall provide training and
technical assistance, in coordination with the Centers for Disease
Control and Prevention, to eligible entities in receipt of grants
under this section regarding--
(A) suicide risk identification and management;
(B) the data required to be collected and shared with the
Department;
(C) the means of data collection and sharing;
(D) familiarization with and appropriate use of any tool to
be used to measure the effectiveness of the use of the grants
provided; and
(E) the requirements for reporting under subsection (e)(5)
on services provided via such grants.
(2) Provision of training and technical assistance.--The
Secretary may provide the training and technical assistance
described in paragraph (1) directly or through grants or contracts
with appropriate public or nonprofit entities.
(h) Administration of Grant Program.--
(1) Selection criteria.--The Secretary, in consultation with
entities specified in paragraph (3), shall establish criteria for
the selection of eligible entities that have submitted applications
under subsection (f).
(2) Development of measures and metrics.--The Secretary shall
develop, in consultation with entities specified in paragraph (3),
the following:
(A) A framework for collecting and sharing information
about entities in receipt of grants under this section for
purposes of improving the services available for eligible
individuals and their families, set forth by service type,
locality, and eligibility criteria.
(B) The measures and metrics to be used by each entity in
receipt of grants under this section to determine the
effectiveness of the programming being provided by such entity
in improving mental health status, wellbeing, and reducing
suicide risk and completed suicides of eligible individuals and
their families, which shall include an existing measurement
tool or protocol for the grant recipient to utilize when
determining programmatic effectiveness.
(3) Coordination.--In developing a plan for the design and
implementation of the provision of grants under this section,
including criteria for the award of grants, the Secretary shall
consult with the following:
(A) Veterans service organizations.
(B) National organizations representing potential community
partners of eligible entities in providing supportive services
to address the needs of eligible individuals and their
families, including national organizations that--
(i) advocate for the needs of individuals with or at
risk of behavioral health conditions;
(ii) represent mayors;
(iii) represent unions;
(iv) represent first responders;
(v) represent chiefs of police and sheriffs;
(vi) represent governors;
(vii) represent a territory of the United States; or
(viii) represent a Tribal alliance.
(C) National organizations representing members of the
Armed Forces.
(D) National organizations that represent counties.
(E) Organizations with which the Department has a current
memorandum of agreement or understanding related to mental
health or suicide prevention.
(F) State departments of veterans affairs.
(G) National organizations representing members of the
reserve components of the Armed Forces.
(H) National organizations representing members of the
Coast Guard.
(I) Organizations, including institutions of higher
education, with experience in creating measurement tools for
purposes of advising the Secretary on the most appropriate
existing measurement tool or protocol for the Department to
utilize.
(J) The National Alliance on Mental Illness.
(K) A labor organization (as such term is defined in
section 7103(a)(4) of title 5, United States Code).
(L) The Centers for Disease Control and Prevention, the
Substance Abuse and Mental Health Services Administration, the
President's Roadmap to Empower Veterans and End a National
Tragedy of Suicide Task Force, and such other organizations as
the Secretary considers appropriate.
(4) Report on grant criteria.--Not later than 30 days before
notifying eligible entities of the availability of funding under
this section, the Secretary shall submit to the appropriate
committees of Congress a report containing--
(A) criteria for the award of a grant under this section;
(B) the already developed measures and metrics to be used
by the Department to measure the effectiveness of the use of
grants provided under this section as described in subsection
(h)(2); and
(C) a framework for the sharing of information about
entities in receipt of grants under this section.
(i) Information on Potential Eligible Individuals.--
(1) In general.--The Secretary may make available to recipients
of grants under this section certain information regarding
potential eligible individuals who may receive services for which
such grant is provided.
(2) Information included.--The information made available under
paragraph (1) with respect to potential eligible individuals may
include the following:
(A) Confirmation of the status of a potential eligible
individual as a veteran.
(B) Confirmation of whether the potential eligible
individual is enrolled in the patient enrollment system of the
Department under section 1705(a) of title 38, United States
Code.
(C) Confirmation of whether a potential eligible individual
is currently receiving care furnished by the Department or has
recently received such care.
(3) Opt-out.--The Secretary shall allow an eligible individual
to opt out of having their information shared under this subsection
with recipients of grants under this section.
(j) Duration.--The authority of the Secretary to provide grants
under this section shall terminate on the date that is three years
after the date on which the first grant is awarded under this section.
(k) Reporting.--
(1) Interim report.--
(A) In general.--Not later than 18 months after the date on
which the first grant is awarded under this section, the
Secretary shall submit to the appropriate committees of
Congress a report on the provision of grants to eligible
entities under this section.
(B) Elements.--The report submitted under subparagraph (A)
shall include the following:
(i) An assessment of the effectiveness of the grant
program under this section, including--
(I) the effectiveness of grant recipients and their
community partners, if any, in conducting outreach to
eligible individuals;
(II) the effectiveness of increasing eligible
individuals engagement in suicide prevention services;
and
(III) such other validated instruments and
additional measures as determined by the Secretary and
as described in subsection (h)(2).
(ii) A list of grant recipients and their partner
organizations, if any, that delivered services funded by
the grant and the amount of such grant received by each
recipient and partner organization.
(iii) The number of eligible individuals supported by
each grant recipient, including through services provided
to family members, disaggregated by--
(I) all demographic characteristics as determined
necessary and appropriate by the Secretary in
coordination with the Centers for Disease Control and
Prevention;
(II) whether each such eligible individual is
enrolled in the patient enrollment system of the
Department under section 1705(a) of title 38, United
States Code;
(III) branch of service in the Armed Forces;
(IV) era of service in the Armed Forces;
(V) type of service received by the eligible
individual; and
(VI) whether each such eligible individual was
referred to the Department for care.
(iv) The number of eligible individuals supported by
grants under this section, including through services
provided to family members.
(v) The number of eligible individuals described in
clause (iv) who were not previously receiving care
furnished by the Department, with specific numbers for the
population of eligible individuals described in subsection
(q)(4)(B).
(vi) The number of eligible individuals whose mental
health status, wellbeing, and suicide risk received a
baseline measurement assessment under this section and the
number of such eligible individuals whose mental health
status, wellbeing, and suicide risk will be measured by the
Department or a community partner over a period of time for
any improvements.
(vii) The types of data the Department was able to
collect and share with partners, including a
characterization of the benefits of that data.
(viii) The number and percentage of eligible
individuals referred to the point of contact at the
Department under subsection (e)(3)(C).
(ix) The number of eligible individuals newly enrolled
in the patient enrollment system of the Department under
section 1705(a) of title 38, United States Code based on a
referral to the Department from a grant recipient under
subsection (e)(3)(C), disaggregated by grant recipient.
(x) A detailed account of how the grant funds were
used, including executive compensation, overhead costs, and
other indirect costs.
(xi) A description of any outreach activities conducted
by the eligible entity in receipt of a grant with respect
to services provided using the grant.
(xii) The number of individuals who seek services from
the grant recipient who are not eligible individuals.
(C) Submittal of information by grant recipients.--The
Secretary may require eligible entities receiving grants under
this section to provide to Congress such information as the
Secretary determines necessary regarding the elements described
in subparagraph (B).
(2) Final report.--Not later than three years after the date on
which the first grant is awarded under this section, and annually
thereafter for each year in which the program is in effect, the
Secretary shall submit to the appropriate committees of Congress--
(A) a follow-up on the interim report submitted under
paragraph (1) containing the elements set forth in subparagraph
(B) of such paragraph; and
(B) a report on--
(i) the effectiveness of the provision of grants under
this section, including the effectiveness of community
partners in conducting outreach to eligible individuals and
their families and reducing the rate of suicide among
eligible individuals;
(ii) an assessment of the increased capacity of the
Department to provide services to eligible individuals and
their families, set forth by State, as a result of the
provision of grants under this section;
(iii) the feasibility and advisability of extending or
expanding the provision of grants consistent with this
section; and
(iv) such other elements as considered appropriate by
the Secretary.
(l) Third-party Assessment.--
(1) Study of grant program.--
(A) In general.--Not later than 180 days after the
commencement of the grant program under this section, the
Secretary shall seek to enter into a contract with an
appropriate entity described in paragraph (3) to conduct a
study of the grant program.
(B) Elements of study.--In conducting the study under
subparagraph (A), the appropriate entity shall--
(i) evaluate the effectiveness of the grant program
under this section in--
(I) addressing the factors that contribute to
suicides;
(II) increasing the use of suicide prevention
services;
(III) reducing mood-related symptoms that increase
suicide and suicide risk; and
(IV) where such information is available due to the
time frame of the grant program, reducing suicidal
ideation, suicide attempts, self-harm, and deaths by
suicide; and
(V) reducing suicidal ideation, suicide attempts,
self-harm, and deaths by suicide among eligible
individuals through eligible entities located in
communities; and
(ii) compare the results of the grant program with
other national programs in delivering resources to eligible
individuals in the communities where they live that address
the factors that contribute to suicide.
(2) Assessment.--
(A) In general.--The contract under paragraph (1) shall
provide that not later than 24 months after the commencement of
the grant program under this section, the appropriate entity
shall submit to the Secretary an assessment based on the study
conducted pursuant to such contract.
(B) Submittal to congress.--Upon receipt of the assessment
under subparagraph (A), the Secretary shall transmit to the
appropriate committees of Congress a copy of the assessment.
(3) Appropriate entity.--An appropriate entity described in
this paragraph is a nongovernment entity with experience optimizing
and assessing organizations that deliver services and assessing the
effectiveness of suicide prevention programs.
(m) Referral for Care.--
(1) Mental health assessment.--If an eligible entity in receipt
of a grant under this section determines that an eligible
individual is at-risk of suicide or other mental or behavioral
health condition pursuant to a baseline mental health screening
conducted under subsection (q)(11)(A)(ii) with respect to the
individual, the entity shall refer the eligible individual to the
Department for additional care under subsection (n) or any other
provision of law.
(2) Emergency treatment.--If an eligible entity in receipt of a
grant under this section determines that an eligible individual
furnished clinical services for emergency treatment under
subsection (q)(11)(A)(iv) requires ongoing services, the entity
shall refer the eligible individual to the Department for
additional care under subsection (n) or any other provision of law.
(3) 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.
(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.
(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.
(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.
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.--
(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.--
(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.
(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.
(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, 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;
(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:
(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.
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
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.''.
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:
(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;
(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:
(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.
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.
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 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 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 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 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 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 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
(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:
(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;
``(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 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 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:
(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.
(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;
(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;
(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).
(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 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.
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'', 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.
(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).
Speaker of the House of Representatives.
Vice President of the United States and
President of the Senate.