[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 785 Engrossed in Senate (ES)]
<DOC>
116th CONGRESS
2d Session
S. 785
_______________________________________________________________________
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).
Passed the Senate August 5, 2020.
Attest:
Secretary.
116th CONGRESS
2d Session
S. 785
_______________________________________________________________________
AN ACT
To improve mental health care provided by the Department of Veterans
Affairs, and for other purposes.