[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 785 Introduced in Senate (IS)]
<DOC>
116th CONGRESS
1st Session
S. 785
To improve mental health care provided by the Department of Veterans
Affairs, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
March 13, 2019
Mr. Tester (for himself, Mr. Moran, Ms. Baldwin, Ms. Stabenow, Mr.
Kaine, Mr. Markey, Ms. Sinema, Ms. Hirono, Mr. Durbin, Mr. Casey, Ms.
Harris, Mr. Udall, Mr. Blumenthal, Mr. Murphy, Mr. Warner, Mrs. Murray,
Mrs. Feinstein, Mr. Menendez, Mr. Booker, Ms. Smith, Mr. Manchin, Ms.
Klobuchar, Mr. Sanders, and Ms. Duckworth) introduced the following
bill; which was read twice and referred to the Committee on Veterans'
Affairs
_______________________________________________________________________
A BILL
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. Expansion of health care coverage for veterans.
Sec. 102. Grants for provision of transition assistance to former
members of the Armed Forces transitioning
to civilian life.
Sec. 103. Study of community-based transition assistance programs for
former members of the Armed Forces.
Sec. 104. Modification of eligibility for care from Department of
Veterans Affairs for former members of the
Armed Forces with other than honorable
discharges and report on such care.
TITLE II--SUICIDE PREVENTION
Sec. 201. Grants for organizations providing mental health wellness
services to veterans.
Sec. 202. Designation of buddy check week by Department of Veterans
Affairs.
Sec. 203. Post-traumatic growth partnerships.
Sec. 204. Progress of Department of Veterans Affairs in meeting goals
and objectives of National Strategy for
Preventing Veteran Suicide.
Sec. 205. Study on feasibility and advisability of providing certain
complementary and integrative health
services.
Sec. 206. Program to provide veterans access to complementary and
integrative health services through animal
therapy, agri-therapy, and outdoor sports
therapy.
Sec. 207. 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. Program to provide veterans access to computerized cognitive
behavioral therapy.
Sec. 302. Study on connection between living at high altitude and
suicide risk factors among veterans.
Sec. 303. Establishment by Department of Veterans Affairs and
Department of Defense of clinical practice
guidelines for comorbid mental health
conditions.
Sec. 304. Update of clinical practice guidelines for assessment and
management of patients at risk for suicide.
Sec. 305. Precision medicine initiative of Department of Veterans
Affairs to identify and validate brain and
mental health biomarkers.
Sec. 306. Preventative and complex data analysis 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. Annual report on progress of Department of Veterans Affairs
in meeting goals and objectives of
Executive Order 13822.
Sec. 404. Comptroller General management review of mental health and
suicide prevention services of Department
of Veterans Affairs.
Sec. 405. Comptroller General report on efforts of Department of
Veterans Affairs to integrate mental health
care into primary care clinics.
Sec. 406. Joint mental health programs by Department of Veterans
Affairs and Department of Defense.
TITLE V--MEDICAL WORKFORCE
Subtitle A--Improvement of Mental Health Medical Workforce
Sec. 501. Treatment of psychologists.
Sec. 502. Staffing improvement plan for psychiatrists and psychologists
of Department of Veterans Affairs.
Sec. 503. Occupational series and staffing improvement plan for
licensed professional mental health
counselors and marriage and family
therapists of Department of Veterans
Affairs.
Sec. 504. Staffing improvement plan for peer specialists of Department
of Veterans Affairs who are women.
Sec. 505. Establishment of Department of Veterans Affairs Readjustment
Counseling Service Scholarship Program.
Sec. 506. Comptroller General report on Readjustment Counseling Service
of Department of Veterans Affairs.
Sec. 507. Expansion of reporting requirements on Readjustment
Counseling Service of Department of
Veterans Affairs.
Sec. 508. Studies on alternative work schedules for employees of
Veterans Health Administration.
Sec. 509. Suicide prevention coordinators.
Subtitle B--Direct Hiring Authorities for Certain Health Care Positions
Sec. 521. Direct hiring authorities for certain health care positions.
TITLE VI--IMPROVEMENT OF TELEHEALTH SERVICES
Sec. 601. Expanded telehealth from Department of Veterans Affairs.
Sec. 602. Implementation of national protocol for telehealth security
and interfacing instructions.
TITLE I--IMPROVEMENT OF TRANSITION OF INDIVIDUALS TO SERVICES FROM
DEPARTMENT OF VETERANS AFFAIRS
SEC. 101. EXPANSION OF HEALTH CARE COVERAGE FOR VETERANS.
(a) In General.--Section 1710(a)(1) of title 38, United States
Code, is amended--
(1) in subparagraph (A), by striking ``and'' at the end;
(2) by redesignating subparagraph (B) as subparagraph (C);
and
(3) by inserting after subparagraph (A) the following new
subparagraph (B):
``(B) to any veteran during the one-year period following
the discharge or release of the veteran from active military,
naval, or air service; and''.
(b) Patient Enrollment System.--Section 1705(c) of such title is
amended by adding at the end the following new paragraph:
``(3) Nothing in this section shall be construed to prevent the
Secretary from providing hospital care and medical services to a
veteran under section 1710(a)(1)(B) of this title during the period
specified in such section notwithstanding the failure of the veteran to
enroll in the system of patient enrollment established by the Secretary
under subsection (a).''.
(c) Promotion of Expanded Eligibility.--
(1) Transition assistance program.--
(A) In general.--The Secretary of Labor, in
consultation with the Secretary of Defense and the
Secretary of Veterans Affairs, shall promote to members
of the Armed Forces transitioning from service in the
Armed Forces to civilian life through the Transition
Assistance Program the expanded eligibility of veterans
for health care under the laws administered by the
Secretary of Veterans Affairs pursuant to the
amendments made by this section.
(B) Transition assistance program defined.--In this
paragraph, the term ``Transition Assistance Program''
means the Transition Assistance Program under sections
1142 and 1144 of title 10, United States Code.
(2) Publication by department of veterans affairs.--Not
later than 30 days after the date of the enactment of this Act,
the Secretary of Veterans Affairs shall publish on a website of
the Department of Veterans Affairs notification of the expanded
eligibility of veterans for health care under the laws
administered by the Secretary pursuant to the amendments made
by this section.
SEC. 102. GRANTS FOR PROVISION OF TRANSITION ASSISTANCE TO FORMER
MEMBERS OF THE ARMED FORCES TRANSITIONING TO CIVILIAN
LIFE.
(a) Program Required.--Commencing not later than 180 days after the
date of the enactment of this Act, the Secretary of Labor shall, in
coordination with the Secretary of Veterans Affairs, carry out a
program on the provision of assistance to former members of the Armed
Forces, and spouses of such members, transitioning from service in the
Armed Forces to civilian life.
(b) Duration of Program.--The Secretary of Labor shall carry out
the program during the five-year period beginning on the date of the
commencement of the program.
(c) Grants.--
(1) In general.--The Secretary shall carry out the program
through the award of grants to eligible organizations for the
provision of assistance described in subsection (a).
(2) Matching funds required.--A grant under this section
shall be in an amount that does not exceed 50 percent of the
amount required by the organization to provide the services
described in subsection (f).
(d) Eligible Organizations.--For purposes of this section, an
eligible organization is any nonprofit organization that the Secretary
of Labor determines, in consultation with the Secretary of Veterans
Affairs and State entities that serve veterans, is suitable for receipt
of a grant under the program pursuant to receipt by the Secretary of
Labor of an application submitted under subsection (e)(1).
(e) Selection of Grant Recipients.--
(1) Applications.--An organization seeking a grant under
the program shall submit to the Secretary of Labor an
application therefor at such time, in such manner, and
containing such information and assurances as the Secretary, in
consultation with the Secretary of Veterans Affairs and State
entities that serve veterans, may require.
(2) Priority for hubs of services.--In awarding grants
under the program, the Secretary of Labor shall give priority
to an organization that provides multiple forms of services
described in subsection (f).
(f) Use of Grant Funds.--Each organization receiving a grant under
the program shall use the grant to provide to former members of the
Armed Forces and spouses described in subsection (a) the following:
(1) Resume assistance.
(2) Interview training.
(3) Job recruitment training.
(4) Entrepreneurship training.
(5) Financial services.
(6) Legal assistance.
(7) Educational supportive services.
(8) Assistance with accessing benefits provided under laws
administered by the Secretary of Veterans Affairs, including
home loan benefits, education benefits, adaptive housing
grants, and all other benefits.
(9) Nonclinical case management.
(10) Other related services leading directly to successful
transition, as determined by the Secretary of Labor in
consultation with the Secretary of Veterans Affairs.
(g) Annual Reports.--
(1) In general.--Not later than one year after the date of
the commencement of the program and not less frequently than
once each year thereafter until the termination of the program,
the Secretary of Labor shall, in consultation with the
Secretary of Veterans Affairs, submit to the appropriate
committees of Congress a report on the program carried out
under this section.
(2) Contents.--Each report submitted under paragraph (1)
shall include the following:
(A) A list of the organizations that have received
grants under the program, including the geographic
location of the organization and the types of services
outlined in subsection (f) that each organization
provides.
(B) The number of veterans served by each
organization.
(C) An assessment of the effectiveness of the
services provided under the program at improving the
transition process for former members of the Armed
Forces and spouses described in subsection (a), based
on metrics determined by the Secretary of Labor in
consultation with the Secretary of Veterans Affairs.
(D) The amount of each grant awarded to each
organization under the program.
(E) Such other matters as the Secretary of Labor,
in consultation with the Secretary of Veterans Affairs,
considers appropriate.
(3) Appropriate committees of congress.--In this
subsection, 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.
(h) Authorization of Appropriations.--There is authorized to be
appropriated $10,000,000 to carry out this section.
SEC. 103. STUDY OF COMMUNITY-BASED TRANSITION ASSISTANCE PROGRAMS FOR
FORMER MEMBERS OF THE ARMED FORCES.
(a) Study.--
(1) In general.--The Secretary of Veterans Affairs shall,
in consultation with the Secretary of Labor and State entities
that serve former members of the Armed Forces, enter into an
agreement with a Federal or non-Federal entity to develop or
access a comprehensive list of community-based programs that--
(A) provide transition assistance to such former
members that lead directly to successful transition to
civilian life, such as--
(i) resume assistance;
(ii) interview training;
(iii) job recruitment training;
(iv) entrepreneurship training;
(v) financial services;
(vi) legal assistance;
(vii) educational supportive services;
(viii) assistance with accessing benefits
provided under laws administered by the
Secretary of Veterans Affairs, including home
loan benefits, education benefits, adaptive
housing grants, and other benefits; and
(ix) nonclinical case management; and
(B) are operated by nonprofit organizations.
(2) Updates.--
(A) Periodic.--Not less frequently than once every
five years, the Secretary shall update the list created
under paragraph (1).
(B) Upon request.--In addition to periodic updates
under subparagraph (A), the Secretary shall update the
list created under paragraph (1) upon request of an
organization with a program included in the list.
(C) Verification.--The Secretary shall, in
consultation with State entities that serve former
members of the Armed Forces and to the degree
practicable, verify changes to the list made under this
paragraph.
(b) Transmission to Members.--The Secretary shall transmit the list
created, and revised as the case may be, under subsection (a) to the
Secretary of Labor and the Secretary of Defense so the Secretaries of
the military departments may provide information in the list to members
of the Armed Forces who participate in the Transition Assistance
Program under sections 1142 and 1144 of title 10, United States Code.
(c) Online Publication.--The Secretary of Veterans Affairs shall
publish the list created, and revised as the case may be, under
subsection (a) on a public website of the Department of Veterans
Affairs.
SEC. 104. MODIFICATION OF ELIGIBILITY FOR CARE FROM DEPARTMENT OF
VETERANS AFFAIRS FOR FORMER MEMBERS OF THE ARMED FORCES
WITH OTHER THAN HONORABLE DISCHARGES AND REPORT ON SUCH
CARE.
(a) Eligibility.--Subsection (b)(2)(B) of section 1720I of title
38, United States Code, is amended by striking ``a discharge by court
martial'' and inserting ``a dismissal''.
(b) Information.--Subsection (e) of such section is amended--
(1) in paragraph (3)--
(A) in subparagraph (B), by striking ``and'' at the
end;
(B) in subparagraph (C), by striking ``and'' at the
end;
(C) by redesignating subparagraph (C) as
subparagraph (D); and
(D) by inserting after subparagraph (B) the
following new subparagraph (C):
``(C) is displayed prominently on a website of the
Department; and'';
(2) by redesignating paragraph (4) as paragraph (5); and
(3) by inserting after paragraph (3) the following new
paragraph (4):
``(4) shall include outreach on Internet search engines;
and''.
(c) Annual Report.--Subsection (f) of such section 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. GRANTS FOR ORGANIZATIONS PROVIDING MENTAL HEALTH WELLNESS
SERVICES TO VETERANS.
(a) Purpose.--The purpose of this section is to facilitate the
provision of mental health services for veterans with mental health
conditions who are receiving care outside of the Department of Veterans
Affairs.
(b) Grants.--
(1) In general.--Subchapter II of chapter 17 of title 38,
United States Code, is amended by adding at the end the
following new section:
``Sec. 1720J. Financial assistance for mental health supportive
services for veterans seeking mental health treatment
``(a) Distribution of Financial Assistance.--(1) The Secretary
shall provide financial assistance to eligible entities approved under
this section to provide or coordinate the provision of mental health
supportive services described in subsection (b) for a veteran with a
mental health condition who is seeking mental health treatment.
``(2) Financial assistance under paragraph (1) shall consist of the
award of a grant to an approved eligible entity for each veteran
described in paragraph (1) for which the approved eligible entity is
providing or coordinating the provision of mental health supportive
services.
``(3)(A) The Secretary shall award grants under this section to
each approved eligible entity that is providing or coordinating the
provision of mental health supportive services under this section.
``(B) The Secretary may establish intervals of payment for the
administration of grants under this section and establish a maximum
amount to be awarded, in accordance with the services being provided
and the duration of such services.
``(4) In providing financial assistance under paragraph (1), the
Secretary shall give preference to entities providing or coordinating
the provision of supportive mental health services for veterans with
mental health conditions who face barriers in accessing mental health
care services from the Department.
``(5) The Secretary shall ensure that, to the extent practicable,
financial assistance under this subsection is equitably distributed
across geographic regions, including rural communities and tribal
lands.
``(6) Each entity receiving financial assistance under this section
to provide mental health supportive services to a veteran with a mental
health condition shall notify that veteran that such services are being
paid for, in whole or in part, by the Department.
``(7) The Secretary shall require entities receiving financial
assistance under this section to submit a report to the Secretary that
describes the services provided or coordinated with such financial
assistance.
``(b) Mental Health Supportive Services.--The mental health
supportive services described in this subsection are services provided
by an eligible entity or a subcontractor of an eligible entity that
address the needs of veterans with mental health conditions,
including--
``(1) outreach services;
``(2) case management services;
``(3) assistance in obtaining any benefits from the
Department that the veteran may be eligible to receive,
including health care services, vocational and rehabilitation
counseling, employment and training services, and educational
assistance; and
``(4) assistance in obtaining and coordinating the
provision of other public benefits provided by any Federal,
State, or local agency, or any other eligible entity,
including--
``(A) health care services (including obtaining
health insurance);
``(B) daily living services;
``(C) personal financial planning services;
``(D) transportation services;
``(E) income support services;
``(F) fiduciary and representative payee services;
``(G) legal services to assist the veteran with
issues that interfere with the ability of the veteran
to find and retain meaningful employment, housing, or
benefits to which the veteran may be entitled;
``(H) child care services;
``(I) housing counseling; and
``(J) other services necessary for maintaining
independent living.
``(c) Application for Financial Assistance.--(1) An eligible entity
seeking financial assistance under subsection (a) shall submit to the
Secretary an application therefor in such form, in such manner, and
containing such commitments and information as the Secretary determines
to be necessary to carry out this section.
``(2) Each application submitted by an eligible entity under
paragraph (1) shall contain--
``(A) a description of the mental health supportive
services described in subsection (b) proposed to be provided by
the eligible entity under this section and the identified needs
for those services;
``(B) a description of the types of veterans with a mental
health condition proposed to be provided such services;
``(C) an estimate of the number of veterans with a mental
health condition proposed to be provided such services;
``(D) evidence of the experience of the eligible entity in
providing mental health supportive services to veterans with a
mental health condition; and
``(E) a description of the managerial capacity of the
eligible entity--
``(i) to coordinate the provision of mental health
supportive services with the provision of mental health
services by the eligible entity or another
organization;
``(ii) to assess continually the needs of veterans
with a mental health condition for mental health
supportive services;
``(iii) to coordinate the provision of mental
health supportive services with the services of the
Department; and
``(iv) to tailor supportive mental health services
to the needs of veterans with a mental health
condition.
``(3)(A) The Secretary shall establish criteria for the selection
of eligible entities to be provided financial assistance under this
section.
``(B) Criteria established under subparagraph (A) with respect to
an eligible entity shall include the following:
``(i) Relevant accreditation as may be required by each
State in which the eligible entity operates.
``(ii) Experience coordinating care or providing treatment
for veterans or members of the Armed Forces.
``(d) Technical Assistance.--(1) The Secretary shall provide
training and technical assistance to eligible entities provided
financial assistance under this section regarding the planning,
development, and provision of mental health supportive services under
this section.
``(2) The Secretary may provide the training described in paragraph
(1) directly or through grants or contracts with appropriate public or
nonprofit private entities, including through grants awarded under
section 2064 of this title.
``(e) Collection of Information.--To the extent practicable, the
Secretary may collect information from an eligibility entity awarded a
grant under this section relating to a mental health condition of a
veteran for inclusion in the electronic health record of the Department
for such veteran for the sole purpose of improving care provided to
such veteran.
``(f) Funding.--From amounts appropriated to the Department for
medical services, there shall be available to carry out subsections
(a), (b), and (c) the following:
``(1) $5,000,000 for fiscal year 2021.
``(2) $10,000,000 for fiscal year 2022.
``(3) $15,000,000 for fiscal year 2023.
``(g) Definitions.--In this section:
``(1) The term `eligible entity' means any of the
following:
``(A) An incorporated private institution or
foundation--
``(i) no part of the net earnings of which
inures to the benefit of any member, founder,
contributor, or individual;
``(ii) that has a governing board that is
responsible for the operation of the mental
health supportive services provided under this
section; and
``(iii) that is approved by the Secretary
with respect to financial responsibility.
``(B) A for-profit limited partnership, the sole
general partner of which is an organization meeting the
requirements of clauses (i), (ii), and (iii) of
subparagraph (A).
``(C) A corporation wholly owned and controlled by
an organization meeting the requirements of clauses
(i), (ii), and (iii) of subparagraph (A).
``(D) A tribally designated housing entity (as
defined in section 4 of the Native American Housing
Assistance and Self-Determination Act of 1996 (25
U.S.C. 4103)).
``(2) The term `veteran with a mental health condition'
means a veteran who has been diagnosed with, or who is seeking
treatment for, one or more mental health conditions, as
determined by the Secretary.''.
(2) Clerical amendment.--The table of sections at the
beginning of chapter 17 is amended by inserting after the item
relating to section 1720I the following new item:
``1720J. Financial assistance for mental health supportive services for
veterans seeking mental health
treatment.''.
(c) Study on Effectiveness of Program.--
(1) In general.--The Secretary of Veterans Affairs shall
conduct a study on the effectiveness of the program of
financial assistance under section 1720J of title 38, United
States Code, as added by subsection (b), in meeting the needs
of veterans with a mental health condition, as that term is
defined in that section.
(2) Comparison.--In conducting the study required by
paragraph (1), the Secretary shall compare the results of the
program described in that paragraph with other programs of the
Department of Veterans Affairs dedicated to the delivery of
mental health services to veterans.
(3) Criteria.--In making the comparison required by
paragraph (2), the Secretary shall examine the following:
(A) The satisfaction of veterans targeted by the
programs described in paragraph (2).
(B) The health status of such veterans.
(C) The mental wellness of such veterans.
(D) The degree to which such veterans are
encouraged to engage in productive activity by such
programs.
(E) The number of veterans using such programs,
disaggregated by--
(i) veterans who have received care from
the Department in the previous two years; and
(ii) veterans who have not received care
from the Department in the previous two years.
(F) The number of veterans who die by suicide while
receiving services from an entity in receipt of a grant
under the program of financial assistance under section
1720J of title 38, United States Code, as added by
subsection (b), or who die by suicide during the 180-
day period after receiving such services.
(4) Report.--Not later than December 31, 2021, 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 the results
of the study required by paragraph (1).
(d) Effective Date.--The Secretary shall begin providing financial
assistance under section 1720J of title 38, United States Code, as
added by subsection (b), not later than one year after the date of the
enactment of this Act.
SEC. 202. DESIGNATION OF BUDDY CHECK WEEK BY DEPARTMENT OF VETERANS
AFFAIRS.
(a) In General.--The Secretary of Veterans Affairs shall designate
one week per year to organize outreach events and educate veterans on
how to conduct peer wellness checks, which shall be known as ``Buddy
Check Week''.
(b) Events and Education.--
(1) In general.--During Buddy Check Week, the Secretary, in
consultation with organizations that represent veterans, non-
profits that serve veterans, mental health experts, members of
the Armed Forces, and such other entities and individuals as
the Secretary considers appropriate, shall collaborate with
organizations that represent veterans to provide educational
opportunities for veterans to learn how to conduct peer
wellness checks.
(2) Training matters.--As part of the educational
opportunities provided under paragraph (1), the Secretary shall
provide the following:
(A) A script for veterans to use to conduct peer
wellness checks that includes information on
appropriate referrals to resources veterans might need.
(B) Online and in-person training, as appropriate,
on how to conduct a peer wellness check.
(C) Opportunities for members of organizations that
represent veterans to learn how to train individuals to
conduct peer wellness checks.
(D) Training for veterans participating in Buddy
Check Week on how to transfer a phone call directly to
the Veterans Crisis Line.
(E) Resiliency training for veterans participating
in Buddy Check Week on handling a veteran in crisis.
(3) Online materials.--All training materials provided
under the educational opportunities under paragraph (1) shall
be made available on a website of the Department.
(c) Outreach.--The Secretary, in collaboration with organizations
that represent veterans, may conduct outreach regarding educational
opportunities under subsection (b) at--
(1) public events where many veterans are expected to
congregate;
(2) meetings of organizations that represent veterans;
(3) facilities of the Department of Veterans Affairs; and
(4) such other locations as the Secretary, in collaboration
with organizations that represent veterans, considers
appropriate.
(d) Veterans Crisis Line Plan.--
(1) In general.--The Secretary shall ensure that the
Veterans Crisis Line has a plan for handling the potential
increase of calls that may occur during Buddy Check Week.
(2) Submittal of plan.--The head of the Veterans Crisis
Line shall submit to the Secretary a plan for how to handle
excess calls during Buddy Check Week, which may include the
following:
(A) Additional hours for staff.
(B) The use of a backup call center.
(C) Any other plan to ensure that calls from
veterans in crisis are being answered in a timely
manner by an individual trained at the same level as a
Veterans Crisis Line responder.
(e) Veterans Crisis Line Defined.--In this section, the term
``Veterans Crisis Line'' means the toll-free hotline for veterans
established under section 1720F(h) of title 38, United States Code.
SEC. 203. POST-TRAUMATIC GROWTH PARTNERSHIPS.
(a) In General.--The Secretary of Veterans Affairs, in consultation
with the Secretary of Defense and the Secretary of Homeland Security,
shall enter into partnerships with nonprofit mental health
organizations to facilitate post-traumatic growth among veterans who
have experienced trauma.
(b) Consultation.--Before entering into a partnership under
subsection (a), the Secretary of Veterans Affairs shall consult with
the National Institute of Mental Health, the National Alliance on
Mental Illness, the American Psychological Association, the
Posttraumatic Growth Research Group, and organizations that represent
veterans.
(c) Selection of Partners.--The Secretary of Veterans Affairs shall
ensure that each organization with which the Secretary enters into a
partnership under subsection (a) has a demonstrated history of success
with programs to facilitate post-traumatic growth, including--
(1) long-term follow-up with veterans who have participated
in such a program for not less than one year after completion
of the program; and
(2) sustained positive, clinically significant outcomes for
veterans who have participated in such a program for not less
than 180 days after completion of the program.
(d) Outcomes From Partners.--The Secretary of Veterans Affairs
shall require each nonprofit mental health organization that enters
into a partnership with the Secretary under subsection (a) to submit to
the Secretary a description of the outcomes from such partnership,
including the following:
(1) The number of veterans who participate in programs of
the organization to facilitate post-traumatic growth, including
the number of veterans who drop out before completion of the
program.
(2) The types of mental or behavioral health conditions of
veterans who participate in such programs.
(3) The percentage of veterans who experience significant
post-traumatic growth.
(4) Such other topics as the Secretary may require to track
post-traumatic growth.
(e) Post-Traumatic Growth.--
(1) In general.--For purposes of this section, ``post-
traumatic growth'' means positive responses described in
paragraph (3) experienced after, and often as a result of, a
traumatic event or a major life crisis.
(2) Measurement of growth.--Post-traumatic growth under
this section shall be measured through self-reported scales,
use of the post-traumatic stress disorder checklist set forth
in the most recent edition of the Diagnostic and Statistical
Manual of Mental Disorders published by the American
Psychiatric Association, and such other metrics as the
Secretary considers necessary.
(3) Positive responses described.--Positive responses
described in this paragraph are positive responses in one or
more areas of life, including the following:
(A) An appreciation of and for life.
(B) Improved relationships with others.
(C) Realization of new possibilities in life.
(D) Realization of personal strength.
(E) Spiritual change.
(F) Such other areas that the Secretary, in
consultation with organizations specified in subsection
(b), considers necessary.
SEC. 204. PROGRESS OF DEPARTMENT OF VETERANS AFFAIRS IN MEETING GOALS
AND OBJECTIVES OF NATIONAL STRATEGY FOR PREVENTING
VETERAN SUICIDE.
(a) In General.--The Secretary of Veterans Affairs shall develop
metrics to track progress on each of the 14 goals and 43 objectives
outlined in the National Strategy for Preventing Veteran Suicide, 2018-
2028 prepared by the Office of Mental Health and Suicide Prevention of
the Department of Veterans Affairs.
(b) Metrics.--The metrics developed under subsection (a) shall
include measures of both performance and effectiveness.
(c) Initial Report.--
(1) In general.--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
that contains the metrics developed under subsection (a).
(2) Elements.--The report submitted under paragraph (1)
shall include the following:
(A) An explanation of why the metrics developed
under subsection (a) were chosen.
(B) An assessment of how accurately those metrics
will reflect the goals and objectives specified in such
subsection.
(d) Annual Report.--Not later than one year after the submittal of
the report under subsection (b), 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 that contains--
(1) an assessment of the progress of the Department in
meeting the goals and objectives specified in subsection (a);
(2) a description of any action to be taken by the
Department if those goals and objectives are not being met;
(3) a description of any changes to those goals and
objectives;
(4) an identification of any new programs or partnerships
that have resulted from the implementation of the National
Strategy for Preventing Veteran Suicide, 2018-2028;
(5) an assessment of the effectiveness of the National
Strategy for Preventing Veterans Suicide, 2018-2028 at reducing
veteran suicide; and
(6) such other topics as the Secretary considers necessary.
SEC. 205. STUDY ON FEASIBILITY AND ADVISABILITY OF 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
a study on the feasibility and advisability of providing complementary
and integrative health treatments described in subsection (b) at all
facilities of the Department of Veterans Affairs.
(b) 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.
(c) Provision of Treatment.--The Secretary may provide
complementary and integrative health treatments under this section at a
facility of the Department in person or by telehealth.
(d) Report.--Not later than 90 days after the completion of the
study 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 such study,
including--
(1) the results of such study; and
(2) such recommendations regarding the furnishing of
complementary and integrative health treatments described in
subsection (b) as the Secretary considers appropriate.
SEC. 206. PROGRAM TO PROVIDE VETERANS ACCESS TO COMPLEMENTARY AND
INTEGRATIVE HEALTH SERVICES THROUGH ANIMAL THERAPY, AGRI-
THERAPY, AND OUTDOOR SPORTS THERAPY.
(a) In General.--Not later than 180 days after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall commence
the conduct of a program to provide complementary and integrative
health services described in subsection (b) to 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) Treatments Described.--Complementary and integrative health
treatments described in this subsection shall consist of the following:
(1) Equine therapy.
(2) Other animal therapy.
(3) Agri-therapy.
(4) Outdoor sports therapy.
(c) Eligible Veterans.--A veteran is eligible to participate in the
program under this section if the veteran--
(1) is enrolled in the system of patient enrollment of the
Department established and operated 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 program.
(d) Duration.--
(1) In general.--The Secretary shall carry out the program
under this section for a two-year period beginning on the
commencement of the program.
(2) Extension.--The Secretary may extend the duration of
the program under this section if the Secretary, based on the
results of the interim report submitted under subsection
(e)(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
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 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 program.
(B) Elements.--The report required by subparagraph
(A) shall include the following:
(i) The number of participants in the
program.
(ii) The types of therapy offered at each
facility at which the program is being carried
out.
(iii) An assessment of whether
participation by a veteran in the 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 program,
including the results of a satisfaction survey
of the participants in the program,
disaggregated by treatment under subsection
(b).
(v) The determination of the Secretary with
respect to extending the program under
subsection (c)(2).
(vi) Any recommendations of the Secretary
with respect to expanding the program.
(2) Final report.--Not later than 90 days after the
termination of the 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 program.
SEC. 207. 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 age, gender, Veterans
Integrated Service Network, and, 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 age,
gender, Veterans Integrated Service Network, and, 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 age, gender, Veterans Integrated Service
Network, and, 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. PROGRAM TO PROVIDE VETERANS ACCESS TO COMPUTERIZED COGNITIVE
BEHAVIORAL THERAPY.
(a) In General.--Not later than 210 days after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall commence
the conduct of a program to assess the feasibility and advisability of
using computerized cognitive behavioral therapy to treat eligible
veterans suffering from depression, anxiety, post-traumatic stress
disorder, military sexual trauma, or substance use disorder who are
already receiving evidence-based therapy from the Department of
Veterans Affairs.
(b) Eligible Veterans.--A veteran is eligible to participate in the
program under this section if the veteran--
(1) is enrolled in the system of patient enrollment of the
Department of Veterans Affairs established and operated 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 program.
(c) Duration.--The Secretary shall carry out the program under this
section for a two-year period beginning on the commencement of the
program.
(d) Locations.--
(1) In general.--The Secretary shall select not fewer than
three facilities of the Department of Veterans Affairs at which
to carry out the 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 two 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).
(e) Access to Chat.--In carrying out the program under this
section, the Secretary shall ensure that veterans participating in the
program have access via chat to a mental health provider 24 hours per
day, seven days per week.
(f) Promotion of Veterans Crisis Line.--The Secretary shall promote
the availability of the Veterans Crisis Line to veterans participating
in the program under this section.
(g) Department Website.--In implementing the program under this
section, the Secretary, to the extent feasible, shall use a website of
the Department of Veterans Affairs to host the program.
(h) Reports.--
(1) Interim report.--
(A) In general.--Not later than one year after the
commencement of the 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 program.
(B) Elements.--The report required by subparagraph
(A) shall include the following:
(i) The number of participants in the
program.
(ii) An assessment of whether participation
by a veteran in the program resulted in any
changes in clinically relevant endpoints for
the veteran with respect to the conditions
specified in subsection (a).
(iii) Any recommendations of the Secretary
with respect to extending or expanding the
program.
(2) Final report.--Not later than 90 days after the
termination of the 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 program.
(i) Veterans Crisis Line Defined.--In this section, the term
``Veterans Crisis Line'' means the toll-free hotline for veterans
established under section 1720F(h) of title 38, United States Code.
SEC. 302. 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. 303. ESTABLISHMENT BY DEPARTMENT OF VETERANS AFFAIRS AND
DEPARTMENT OF DEFENSE OF CLINICAL PRACTICE GUIDELINES FOR
COMORBID MENTAL HEALTH CONDITIONS.
(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 clinical practice
guidelines for the treatment of post-traumatic stress disorder,
military sexual trauma, and traumatic brain injury that is comorbid
with substance use disorder or chronic pain.
(b) Work Group.--
(1) Establishment.--In carrying out subsection (a), the
Secretary of Veterans Affairs, the Secretary of Defense, and
the Secretary of Health and Human Services shall create a
Trauma and Comorbid Substance Use Disorder or Chronic Pain Work
Group (in this section 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:
(A) Academic institutions that specialize in
research for the treatment of conditions described in
subsection (a).
(B) The National Center for Posttraumatic Stress
Disorder 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.
(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.
(c) Matters Included.--In developing the clinical practice
guidelines under subsection (a), the Work Group, in consultation with
the Post Traumatic Stress Disorder Work Group, Concussion-mTBI Work
Group, Opioid Therapy for Chronic Pain Work Group, and Substance Use
Work Group, shall ensure that the clinical practice guidelines include
the following:
(1) Guidance with respect to the following:
(A) The treatment of patients with post-traumatic
stress disorder who are also experiencing a substance
use disorder or chronic pain.
(B) The treatment of patients experiencing a mental
health condition, including anxiety, depression, or
post-traumatic stress disorder as a result of military
sexual trauma who are also experiencing a substance use
disorder or chronic pain.
(C) The treatment of patients with traumatic brain
injury who are also experiencing a substance use
disorder or chronic pain.
(2) Guidance with respect to the following:
(A) Appropriate case management for patients
experiencing post-traumatic stress disorder that is
comorbid with substance use disorder or chronic pain
who transition from receiving care while on active duty
in the Armed Forces to care from health care networks
outside of the Department of Defense.
(B) Appropriate case management for patients
experiencing a mental health condition, including
anxiety, depression, or post-traumatic stress disorder
as a result of military sexual trauma that is comorbid
with substance use disorder or chronic pain who
transition from receiving care while on active duty in
the Armed Forces to care from health care networks
outside of the Department of Defense.
(C) Appropriate case management for patients
experiencing traumatic brain injury that is comorbid
with substance use disorder or chronic pain who
transition from receiving care while on active duty in
the Armed Forces to care from health care networks
outside of the Department of Defense.
(3) Guidance with respect to the treatment of patients who
are still members of the Armed Forces and are experiencing a
mental health condition, including anxiety, depression, or
post-traumatic stress disorder as a result of military sexual
trauma that is comorbid with substance use disorder or chronic
pain.
(4) Guidance with respect to the assessment by the National
Academies of Sciences, Engineering, and Medicine of the
potential overmedication of veterans, as required pursuant to
the Senate report accompanying S. 1557, 115th Congress (Senate
Report 115-130), under the heading ``Overprescription
Prevention Report'' under the heading ``committee
recommendation''.
(d) 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 guidelines required
under subsection (a) or from ensuring that the final clinical practice
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. 304. UPDATE OF CLINICAL PRACTICE GUIDELINES FOR ASSESSMENT AND
MANAGEMENT OF PATIENTS AT RISK FOR SUICIDE.
(a) In General.--Not later than two years 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 issue an update to the VA/DOD Clinical Practice
Guideline for Assessment and Management of Patients at Risk for
Suicide.
(b) Matters Included.--In carrying out the update under subsection
(a), the Work Group shall ensure that the clinical practice guidelines
updated under such subsection includes the following:
(1) Enhanced guidance with respect to the following:
(A) Gender-specific risk factors for suicide and
suicidal ideation.
(B) Gender-specific treatment efficacy for
depression and suicide prevention.
(C) Gender-specific pharmacotherapy efficacy.
(D) Gender-specific psychotherapy efficacy.
(2) Guidance with respect to the following:
(A) The efficacy of alternative therapies, other
than psychotherapy and pharmacotherapy, including the
following:
(i) Yoga therapy.
(ii) Meditation therapy.
(iii) Equine therapy.
(iv) Other animal therapy.
(v) Training and caring for service dogs.
(vi) Agri-therapy.
(vii) Art therapy.
(viii) Outdoor sports therapy.
(ix) Music therapy.
(x) 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).
(c) 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 VA/DOD 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. 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, 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) 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 to ensure that information of
veterans participating in the initiative is kept private and
secure.
(2) Open platform.--
(A) Research purposes.--The Secretary shall make
de-identified data collected under the initiative
available for research purposes both within and outside
of the Department of Veterans Affairs.
(B) Data may not be sold.--Data collected under the
initiative may not be sold.
(3) 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.--Data collected
under the initiative shall be standardized in the
manner in which it is collected, entered into the
database, extracted, and recorded.
(4) 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.
(d) Inclusion of Initiative in Program.--The Secretary shall assess
the feasibility and advisability of coordinating efforts of the
initiative under subsection (a) with the Million Veterans Program of
the Department.
SEC. 306. PREVENTATIVE AND COMPLEX DATA ANALYSIS 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 preventative or complex statistical
analysis
``In order to carry out statistical analysis required under section
302 of the Commander John Scott Hannon Veterans Mental Health Care
Improvement Act of 2019, or any other preventative or complex
statistical analysis required under this title or any other provision
of law, the Secretary may contract with academic institutions or other
qualified entities, as determined by the Secretary, to carry out the
statistical analysis.''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 1 of such title is amended by inserting after the item relating
to section 118 the following new item:
``119. Contracting for preventative or complex statistical analysis.''.
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 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; and
(G) individuals transitioning from active duty in
the Armed Forces to civilian life.
(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 outreach efforts 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 outreach efforts by the Department to
target specific groups of veterans.
(C) A plan to change the current approach by the
Department to suicide prevention and mental health
outreach or, if the Secretary decides not to change the
current approach, an explanation of the reason for
maintaining the current approach.
(D) 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 outreach 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 outreach 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; and
(vii) individuals transitioning from active
duty in the Armed Forces to civilian life.
(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) 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
in raising awareness about mental health and suicide
prevention.
(2) Use of metrics.--
(A) In general.--The goals established under
paragraph (1) shall be measured by metrics specific to
different media types as follows:
(i) Metrics relating to social media shall
include the following:
(I) Impressions.
(II) Reach.
(III) Engagement rate.
(IV) Such other metrics as the
Secretary considers necessary.
(ii) Metrics relating to television shall
include the following:
(I) Nielsen ratings.
(II) Such other metrics as the
Secretary considers necessary.
(iii) Metrics relating to email shall
include the following:
(I) Open rate.
(II) Response rate
(III) Click rate.
(IV) Such other metrics as the
Secretary considers necessary.
(B) Update.--The Secretary shall periodically
update the metrics under subparagraph (A) as more
accurate metrics become available.
(3) Targets.--The Secretary shall develop 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 in raising awareness about mental health and
suicide prevention, including the metrics and targets for such
metrics by which those goals are to be measured under paragraph
(2).
(6) Annual report.--Not later than one year after the
submittal of the report under paragraph (3), 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 targets
developed 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) Establishment of Oversight Process.--
(1) In general.--Not later than 90 days after the date of
the enactment of this Act, the Secretary shall establish a
process to oversee the mental health and suicide prevention
media outreach campaigns of the Department.
(2) Components of oversight process.--The process
established under paragraph (1) shall include the following
components:
(A) A delineation of the roles and responsibilities
of all suicide prevention officials within the Office
of Mental Health and Suicide Prevention of the Veterans
Health Administration.
(B) A schedule for creating, approving,
implementing, and evaluating all unpaid media and paid
media content relating to mental health and suicide
prevention.
(C) Lines of reporting, as the Secretary considers
necessary, to report to management information relating
to the mental health and suicide prevention media
outreach campaigns of the Department.
(c) Contract Requirements.--The Secretary shall ensure that each
contract into which the Secretary enters to develop mental health and
suicide prevention outreach media includes requirements that the
contractor--
(1) track metrics used by the Secretary under subsection
(a)(2); and
(2) not less frequently than quarterly, report such metrics
to the Office of Mental Health and Suicide Prevention of the
Veterans Health Administration.
(d) 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. ANNUAL REPORT ON PROGRESS OF DEPARTMENT OF VETERANS AFFAIRS
IN MEETING GOALS AND OBJECTIVES OF EXECUTIVE ORDER 13822.
(a) In General.--Not later than 120 days after the date of the
enactment of this Act, and annually thereafter, the Secretary of
Veterans Affairs, in consultation with the Secretary of Defense and the
Secretary of Homeland Security, 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 contains the following:
(1) An assessment of the progress of the Department of
Veterans Affairs, the Department of Defense, and the Department
of Homeland Security in meeting the goals and objectives
outlined in the report required under section 2(c) of Executive
Order 13822 (83 Fed. Reg. 1513; relating to supporting our
veterans during their transition from uniformed service to
civilian life) with respect to the implementation by the
Department of Veterans Affairs of the Joint Action Plan
required under section 2(b) of such Executive order.
(2) A description of action to be taken by the Department
of Veterans Affairs, the Department of Defense, and the
Department of Homeland Security if those goals and objectives
are not being met.
(3) An assessment of the effectiveness of Executive Order
13822 at improving the transition process for members of the
Armed Forces and veterans.
(4) Such other topics as the Secretary of Veterans Affairs,
the Secretary of Defense, or the Secretary of Homeland Security
consider necessary.
(b) Submittal by Secretary of Veterans Affairs.--The Secretary of
Veterans Affairs shall submit each report required under paragraph (1)
with respect to the Department of Veterans Affairs regardless of
whether the Secretary of Defense or the Secretary of Homeland Security
provides any information for the report.
SEC. 404. 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, dissaggregated 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. 405. 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. 406. 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 180 days 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 Armed Services and the
Committee on Veterans' Affairs of the Senate and the Committee
on Armed Services and the Committee on Veterans' Affairs 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 mental health initiatives,
including--
(I) the Million Veterans Program;
and
(II) 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.
(B) A description of mental health programs
operated by the Department of Defense, including the
following:
(i) Transition assistance programs.
(ii) Clinical mental health initiatives,
including the National Intrepid Center of
Excellence.
(iii) Programs that may secondarily improve
mental health, including employment, housing
assistance, and financial literacy programs.
(iv) Research into mental health issues and
conditions.
(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 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.
(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) Establishment of Joint Center of Excellence.--
(1) In general.--Not later than two years after the date of
the enactment of this Act, the Secretary of Defense, in
consultation with the Secretary of Veterans Affairs, shall
establish a center of excellence to be known as the ``Joint
DOD/VA National Intrepid Center of Excellence Intrepid Spirit
Center'' (in this subsection referred to as the ``Center'').
(2) Duties.--The Center shall conduct joint mental health
programs of the Department of Veterans Affairs and the
Department of Defense.
(3) Location.--The Center shall be established in a
location that--
(A) is geographically distant from already existing
and planned Intrepid Spirit Centers of the Department
of Defense; and
(B) is in a rural or highly rural area (as
determined through the use of the Rural-Urban Commuting
Areas coding system of the Department of Agriculture).
TITLE V--MEDICAL WORKFORCE
Subtitle A--Improvement of Mental Health Medical Workforce
SEC. 501. TREATMENT OF PSYCHOLOGISTS.
(a) Treatment as Title 38 Employees.--Section 7401 of title 38,
United States Code, is amended--
(1) in paragraph (1) by inserting ``psychologists,'' after
``chiropractors,''; and
(2) in paragraph (3), by striking ``psychologists,''.
(b) Inclusion in Contracts for Scarce Medical Specialist
Services.--Section 7409(a) of title 38, United States Code, is amended
by inserting ``psychologists,'' after ``chiropractors,''.
SEC. 502. STAFFING IMPROVEMENT PLAN FOR PSYCHIATRISTS AND PSYCHOLOGISTS
OF DEPARTMENT OF VETERANS AFFAIRS.
(a) Staffing Plan.--Not later than 270 days 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 shortages of psychiatrists
and psychologists of the Department of Veterans Affairs, including
filling any open positions.
(b) Elements.--The plan required by subsection (a) shall include
the following:
(1) The number of positions for psychiatrists and
psychologists of the Department that need to be filled to meet
demand, disaggregated by Veterans Integrated Service Network
and medical center.
(2) An identification of the steps that the Secretary will
take in each Veterans Integrated Service Network to address
such shortages, include the following:
(A) 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.
(B) A description of any local retention or
engagement incentives to be used by directors of
Veterans Integrated Service Networks.
(3) Such recommendations for legislative or administrative
action as the Secretary considers necessary to aid in
addressing staffing shortages of psychiatrists and
psychologists of the Department.
SEC. 503. OCCUPATIONAL SERIES AND STAFFING IMPROVEMENT PLAN FOR
LICENSED PROFESSIONAL MENTAL HEALTH COUNSELORS AND
MARRIAGE AND FAMILY THERAPISTS OF DEPARTMENT OF VETERANS
AFFAIRS.
(a) Occupational Series.--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.
(b) Staffing Plan.--
(1) In general.--Not later than 270 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 plan to
address staffing shortages of licensed professional mental
health counselors and marriage and family therapists of the
Department of Veterans Affairs.
(2) Elements.--The plan required by paragraph (1) shall
include the following:
(A) The number of positions for licensed
professional mental health counselors and marriage and
family therapists of the Department that need to be
filled to meet demand, disaggregated by Veterans
Integrated Service Network and medical center.
(B) An identification of the steps that the
Secretary will take in each Veterans Integrated Service
Network to address such shortages, include the
following:
(i) 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.
(ii) A description of any local retention
or engagement incentives to be used by
directors of Veterans Integrated Service
Networks.
(C) Such recommendations for legislative or
administrative action as the Secretary, in consultation
with the Inspector General of the Department of
Veterans Affairs, considers necessary to aid in
addressing staffing shortages of licensed professional
mental health counselors and marriage and family
therapists of the Department.
(c) Report.--Not later than one year after the submittal of the
plan required by 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 setting
forth the number of licensed professional mental health counselors and
marriage and family therapists hired by the Department during the one-
year period preceding the submittal of the report, disaggregated by
Veterans Integrated Service Network and medical center.
SEC. 504. STAFFING IMPROVEMENT PLAN FOR PEER SPECIALISTS OF DEPARTMENT
OF VETERANS AFFAIRS WHO ARE WOMEN.
(a) Assessment of Capacity.--
(1) In general.--Not later than 90 days 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 commence an assessment of the capacity
of peer specialists of the Department of Veterans Affairs who
are women.
(2) Elements.--The assessment required by paragraph (1)
shall include an assessment of the following:
(A) The geographical distribution of peer
specialists of the Department who are women.
(B) The geographical distribution of women
veterans.
(C) The number and proportion of women peer
specialists who specialize in peer counseling on mental
health or suicide prevention.
(D) The number and proportion of women peer
specialists who specialize in peer counseling on non-
mental health related matters.
(b) Report.--Not later than one year after the assessment required
by subsection (a) has commenced, 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 findings of the assessment.
(c) Staffing Improvement Plan.--
(1) In general.--Not later than 180 days after submitting
the report under subsection (b), the Secretary, in consultation
with the Inspector General, shall submit to the Committee on
Veterans' Affairs of the Senate and the Committee on Veterans'
Affairs of the House of Representatives a plan, based on the
results of the assessment required by subsection (a), to hire
additional qualified peer specialists who are women, with
special consideration for areas that lack peer specialists who
are women.
(2) Elements.--The peer specialist positions included in
the plan required by paragraph (1)--
(A) shall be non-volunteer, paid positions; and
(B) may be part-time positions.
SEC. 505. 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) a bachelor's, master's, or doctoral degree in
psychology, social work, or marriage and family
therapy; or
``(B) a master's degree in mental health
counseling; 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 three-
year period during the 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(c) 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. 506. 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.
(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. 507. 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 trends in demand for care, long-term investments
required with respect to the provision of care, maintenance of
infrastructure, and other capital investments with respect to the
Readjustment Counseling Service, including Vet Centers, Mobile Vet
Centers, and community access points.''.
SEC. 508. STUDIES ON ALTERNATIVE WORK SCHEDULES FOR EMPLOYEES OF
VETERANS HEALTH ADMINISTRATION.
(a) Study 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 study 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 study under paragraph
(1).
(b) Department Study.--
(1) In general.--Not later than 180 days after the date of
the enactment of this Act, the Secretary shall conduct a study
on the feasibility and advisability of offering appointments
outside the usual operating hours of facilities of the
Department.
(2) Study of employees.--The study required by paragraph
(1) shall include a study of the opinions of 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.
SEC. 509. SUICIDE PREVENTION COORDINATORS.
The Secretary of Veterans Affairs shall ensure that each medical
center of the Department of Veterans Affairs is staffed with not fewer
than one suicide prevention coordinator.
Subtitle B--Direct Hiring Authorities for Certain Health Care Positions
SEC. 521. DIRECT HIRING AUTHORITIES FOR CERTAIN HEALTH CARE POSITIONS.
(a) In General.--Subpart I of part III of title 5, United States
Code, is amended by adding at the end the following:
``CHAPTER 103--DEPARTMENT OF VETERANS AFFAIRS HIRING AUTHORITIES
``Sec.
``10301. Department of Veterans Affairs personnel authorities.
``Sec. 10301. Department of Veterans Affairs personnel authorities
``(a) Flexibilities Relating to Appointments.--
``(1) In general.--The Secretary of Veterans Affairs
(referred to in this section as the `Secretary') shall
promulgate regulations to redesign the procedures that are
applied by the Department of Veterans Affairs in making
appointments to positions described in paragraphs (1) and (3)
of section 7401 of title 38 in order to--
``(A) better meet mission needs;
``(B) respond to managers' needs and the needs of
applicants;
``(C) produce high-quality applicants;
``(D) support timely decisions; and
``(E) promote competitive job offers.
``(2) Waived requirements.--In redesigning the process by
which the appointments described in paragraph (1) shall be
made, the Secretary may waive the requirements of chapter 33,
and the regulations implementing that chapter, to the extent
necessary to achieve the objectives of this section, while
providing for the following:
``(A) Fair, credible, and transparent methods of
establishing qualification requirements for,
recruitment for, and appointments to positions.
``(B) Fair and open competition and equitable
treatment in the consideration and selection of
individuals to positions.
``(C) Fair, credible, and transparent methods of
assigning, reassigning, detailing, transferring, or
promoting employees.
``(3) Implementation requirements.--In implementing this
subsection, the Secretary shall comply with the provisions of
section 2302(b)(11), regarding veterans' preference
requirements, in a manner consistent with that in which such
provisions are applied under chapter 33.
``(4) Training program.--The Secretary shall develop a
training program for Department of Veterans Affairs human
resource professionals to implement the requirements of this
subsection.
``(5) Indicators of effectiveness.--The Secretary shall
develop indicators of effectiveness to determine whether
appointment flexibilities under this subsection have achieved
the objectives described in paragraph (1).
``(b) Criteria for Use of New Personnel Authorities.--In the
redesign of appointment procedures, as described in subsection (a), and
with respect to the system of appointment flexibilities established
under that subsection, the Secretary shall--
``(1) include a means for ensuring employee involvement
(for bargaining unit employees, through their exclusive
representatives) in that redesign and in the implementation of
that system;
``(2) provide for adequate training and retraining for
supervisors, managers, and employees in the implementation and
operation of that redesign and that system;
``(3) develop--
``(A) a comprehensive management succession program
to provide training to employees to develop managers
for the agency; and
``(B) a program to provide training to supervisors
on actions, options, and strategies that a supervisor
may use in administering that system;
``(4) include effective transparency and accountability
measures and safeguards to ensure that the management of that
system is fair, credible, and equitable, including appropriate
independent reasonableness reviews, internal assessments, and
employee surveys;
``(5) provide mentors to advise individuals on their career
paths and opportunities to advance and excel within their
fields;
``(6) develop appropriate procedures for warnings during
performance evaluations for employees who fail to meet
performance standards;
``(7) utilize the quadrennial strategic plan required under
section 7330C(b) of title 38; and
``(8) ensure that adequate agency resources are allocated
for the design, implementation, and administration of that
system.''.
(b) Technical and Conforming Amendment.--The table of chapters for
part III of title 5, United States Code, is amended by inserting after
the item relating to chapter 102 the following:
``103. Department of Veterans Affairs Hiring Authorities.... 10301.''.
TITLE VI--IMPROVEMENT OF TELEHEALTH SERVICES
SEC. 601. EXPANDED TELEHEALTH FROM DEPARTMENT OF VETERANS AFFAIRS.
(a) In General.--The Secretary of Veterans Affairs shall enter into
partnerships, and expand existing partnerships, between the Department
of Veterans Affairs, 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 (c).
(b) Preference for Partnerships.--The Secretary shall give
preference to entering into or expanding partnerships under subsection
(a) with organizations that--
(1) represent 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); or
(2) operate in a medically underserved community (as
defined in section 799B of the Public Health Service Act (42
U.S.C. 295p)).
(c) Award of Grants.--
(1) In general.--In carrying out partnerships entered into
or expanded under this section with entities described in
subsection (a), the Secretary shall award grants to those
entities.
(2) Maximum amount of grants.--The amount of a grant
awarded under this subsection may not exceed $75,000 per site
per year.
(3) Use of grants.--
(A) In general.--Grants awarded to an entity under
this subsection shall be used for the following:
(i) Purchasing or upgrading hardware or
software necessary for the provision of secure
and private telehealth services.
(ii) Upgrading security protocols for
consistency with the standardized telehealth
security protocol implemented under section
602(a)(2), or any other security requirements
of the Department.
(iii) Training of employees, including
payment of those employees for completing that
training, with respect to--
(I) military and veteran cultural
competence, if the entity is not an
organization that represents veterans;
and
(II) equipment required to provide
telehealth services.
(iv) Upgrading existing infrastructure
owned or leased by the entity to make rooms
more conducive to telehealth care, including--
(I) additional walls to create a
new, private room;
(II) soundproofing of existing
rooms; or
(III) new electrical or internet
outlets in an existing room.
(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.
(B) Exclusion.--Grants may not be used for the
purchase of new property or for major construction
projects, as determined by the Secretary.
(d) Memoranda of Understanding or 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 a memorandum of understanding or memorandum of
agreement with the Department for the establishment of such an
access point.
(2) Inspection.--The Secretary shall inspect the access
point proposed to be established under paragraph (1) to ensure
that it is adequately private, secure, and accessible for
veterans before the access point is established.
(e) 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 from home.
(2) Elements.--The assessment required by paragraph (1)
shall include the following:
(A) An assessment of current and potential future
cost barriers to veterans having internet access at
home.
(B) An assessment of current and potential future
barriers to veterans accessing broadband services at
home.
(C) A description of how the Department plans to
address the current and potential future cost and
access barriers described in subparagraphs (A) and (B).
(D) Such other matters related to internet access
for veterans in their homes 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.
(f) Authorization of Appropriations.--There is authorized to be
appropriated to the Secretary of Veterans Affairs $10,000,000 to carry
out this section.
SEC. 602. IMPLEMENTATION OF NATIONAL PROTOCOL FOR TELEHEALTH SECURITY
AND INTERFACING INSTRUCTIONS.
(a) National Telehealth Security Protocol.--
(1) Assessment.--
(A) In general.--The Secretary of Veterans Affairs,
in consultation with industry experts, the Chairman of
the Federal Trade Commission, the Assistant Secretary
of Veterans Affairs for Information and Technology and
Chief Information Officer, and stakeholders, shall
conduct an assessment of current telehealth security
protocols.
(B) Elements.--The assessment conducted under
subparagraph (A) shall include the following:
(i) An assessment of current telehealth
security protocols, including protocols used
by--
(I) the Department of Veterans
Affairs;
(II) other Federal agencies;
(III) other health care providers;
and
(IV) such other organizations as
the Secretary considers necessary to
assess under such subparagraph.
(ii) A study of any current or future
security risks--
(I) faced by veterans using
telehealth services; or
(II) faced by the Department in
furnishing those services.
(C) Timeline.--The Secretary shall complete the
assessment conducted under subparagraph (A) not later
than one year after the date of the enactment of this
Act.
(2) Implementation.--Not later than 18 months after the
completion of the assessment under paragraph (1), the Secretary
shall, using guidance from the assessment, fully implement a
standardized telehealth security protocol at all facilities of
the Department.
(3) Privacy and security.--The Secretary shall ensure that
the security protocol implemented under this subsection
protects the privacy and security of veterans, the health data
of veterans, and data from the Department.
(b) National Telehealth Interfacing Instructions.--
(1) Assessment.--
(A) In general.--The Secretary of Veterans Affairs,
in consultation with industry experts, organizations
that represent veterans, the Chief Veterans Experience
Officer, the Assistant Secretary of Veterans Affairs
for Information and Technology and Chief Information
Officer, and stakeholders, shall conduct an assessment
of current telehealth interfacing instructions.
(B) Elements.--The assessment conducted under
subparagraph (A) shall include an assessment of
interfacing instructions used by--
(i) the Department of Veterans Affairs;
(ii) other Federal agencies;
(iii) other health care providers; and
(iv) such other organizations as the
Secretary considers necessary to assess under
such subparagraph.
(C) Timeline.--The Secretary shall complete the
assessment conducted under subparagraph (A) not later
than one year after the date of the enactment of this
Act.
(2) Implementation.--Not later than 18 months after the
completion of the assessment under paragraph (1), the Secretary
shall, using guidance from the assessment, fully implement
standardized telehealth interfacing instructions at all
facilities of the Department.
(3) Navigation.--The Secretary shall ensure that the
telehealth interfacing instructions implemented under this
subsection are those that are easiest to navigate for veterans
and health care providers.
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