[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 785 Reported in Senate (RS)]
<DOC>
Calendar No. 498
116th CONGRESS
2d 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, Ms. Duckworth, Mr. Peters, Mrs. Gillibrand, Mr.
Merkley, Mr. Sullivan, Mr. Bennet, Ms. Hassan, Mr. Coons, Mr. Roberts,
Mrs. Shaheen, Mr. Daines, Mr. Crapo, Mr. Boozman, Ms. Cortez Masto, Mr.
Cramer, Ms. McSally, Mr. Cornyn, Ms. Rosen, Mr. Jones, Ms. Collins,
Mrs. Blackburn, Mr. Rounds, Mr. Hoeven, Mr. Risch, Mr. Wyden, Ms.
Murkowski, Mr. Wicker, Mr. Portman, and Mr. Heinrich) introduced the
following bill; which was read twice and referred to the Committee on
Veterans' Affairs
July 27, 2020
Reported by Mr. Moran, with an amendment
[Strike out all after the enacting clause and insert the part printed
in italic]
_______________________________________________________________________
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,
<DELETED>SECTION 1. SHORT TITLE; TABLE OF CONTENTS.</DELETED>
<DELETED> (a) Short Title.--This Act may be cited as the ``Commander
John Scott Hannon Veterans Mental Health Care Improvement Act of
2019''.</DELETED>
<DELETED> (b) Table of Contents.--The table of contents for this Act
is as follows:</DELETED>
<DELETED>Sec. 1. Short title; table of contents.
<DELETED>TITLE I--IMPROVEMENT OF TRANSITION OF INDIVIDUALS TO SERVICES
FROM DEPARTMENT OF VETERANS AFFAIRS
<DELETED>Sec. 101. Expansion of health care coverage for veterans.
<DELETED>Sec. 102. Grants for provision of transition assistance to
former members of the Armed Forces
transitioning to civilian life.
<DELETED>Sec. 103. Study of community-based transition assistance
programs for former members of the Armed
Forces.
<DELETED>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.
<DELETED>TITLE II--SUICIDE PREVENTION
<DELETED>Sec. 201. Grants for organizations providing mental health
wellness services to veterans.
<DELETED>Sec. 202. Designation of buddy check week by Department of
Veterans Affairs.
<DELETED>Sec. 203. Post-traumatic growth partnerships.
<DELETED>Sec. 204. Progress of Department of Veterans Affairs in
meeting goals and objectives of National
Strategy for Preventing Veteran Suicide.
<DELETED>Sec. 205. Study on feasibility and advisability of providing
certain complementary and integrative
health services.
<DELETED>Sec. 206. Program to provide veterans access to complementary
and integrative health services through
animal therapy, agri-therapy, and outdoor
sports therapy.
<DELETED>Sec. 207. Comptroller General report on management by
Department of Veterans Affairs of veterans
at high risk for suicide.
<DELETED>TITLE III--PROGRAMS, STUDIES, AND GUIDELINES ON MENTAL HEALTH
<DELETED>Sec. 301. Program to provide veterans access to computerized
cognitive behavioral therapy.
<DELETED>Sec. 302. Study on connection between living at high altitude
and suicide risk factors among veterans.
<DELETED>Sec. 303. Establishment by Department of Veterans Affairs and
Department of Defense of clinical practice
guidelines for comorbid mental health
conditions.
<DELETED>Sec. 304. Update of clinical practice guidelines for
assessment and management of patients at
risk for suicide.
<DELETED>Sec. 305. Precision medicine initiative of Department of
Veterans Affairs to identify and validate
brain and mental health biomarkers.
<DELETED>Sec. 306. Preventative and complex data analysis by Department
of Veterans Affairs.
<DELETED>TITLE IV--OVERSIGHT OF MENTAL HEALTH CARE AND RELATED SERVICES
<DELETED>Sec. 401. Study on effectiveness of suicide prevention and
mental health outreach programs of
Department of Veterans Affairs.
<DELETED>Sec. 402. Oversight of mental health and suicide prevention
media outreach conducted by Department of
Veterans Affairs.
<DELETED>Sec. 403. Annual report on progress of Department of Veterans
Affairs in meeting goals and objectives of
Executive Order 13822.
<DELETED>Sec. 404. Comptroller General management review of mental
health and suicide prevention services of
Department of Veterans Affairs.
<DELETED>Sec. 405. Comptroller General report on efforts of Department
of Veterans Affairs to integrate mental
health care into primary care clinics.
<DELETED>Sec. 406. Joint mental health programs by Department of
Veterans Affairs and Department of Defense.
<DELETED>TITLE V--MEDICAL WORKFORCE
<DELETED>Subtitle A--Improvement of Mental Health Medical Workforce
<DELETED>Sec. 501. Treatment of psychologists.
<DELETED>Sec. 502. Staffing improvement plan for psychiatrists and
psychologists of Department of Veterans
Affairs.
<DELETED>Sec. 503. Occupational series and staffing improvement plan
for licensed professional mental health
counselors and marriage and family
therapists of Department of Veterans
Affairs.
<DELETED>Sec. 504. Staffing improvement plan for peer specialists of
Department of Veterans Affairs who are
women.
<DELETED>Sec. 505. Establishment of Department of Veterans Affairs
Readjustment Counseling Service Scholarship
Program.
<DELETED>Sec. 506. Comptroller General report on Readjustment
Counseling Service of Department of
Veterans Affairs.
<DELETED>Sec. 507. Expansion of reporting requirements on Readjustment
Counseling Service of Department of
Veterans Affairs.
<DELETED>Sec. 508. Studies on alternative work schedules for employees
of Veterans Health Administration.
<DELETED>Sec. 509. Suicide prevention coordinators.
<DELETED>Subtitle B--Direct Hiring Authorities for Certain Health Care
Positions
<DELETED>Sec. 521. Direct hiring authorities for certain health care
positions.
<DELETED>TITLE VI--IMPROVEMENT OF TELEHEALTH SERVICES
<DELETED>Sec. 601. Expanded telehealth from Department of Veterans
Affairs.
<DELETED>Sec. 602. Implementation of national protocol for telehealth
security and interfacing instructions.
<DELETED>TITLE I--IMPROVEMENT OF TRANSITION OF INDIVIDUALS TO SERVICES
FROM DEPARTMENT OF VETERANS AFFAIRS</DELETED>
<DELETED>SEC. 101. EXPANSION OF HEALTH CARE COVERAGE FOR
VETERANS.</DELETED>
<DELETED> (a) In General.--Section 1710(a)(1) of title 38, United
States Code, is amended--</DELETED>
<DELETED> (1) in subparagraph (A), by striking ``and'' at
the end;</DELETED>
<DELETED> (2) by redesignating subparagraph (B) as
subparagraph (C); and</DELETED>
<DELETED> (3) by inserting after subparagraph (A) the
following new subparagraph (B):</DELETED>
<DELETED> ``(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''.</DELETED>
<DELETED> (b) Patient Enrollment System.--Section 1705(c) of such
title is amended by adding at the end the following new
paragraph:</DELETED>
<DELETED> ``(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).''.</DELETED>
<DELETED> (c) Promotion of Expanded Eligibility.--</DELETED>
<DELETED> (1) Transition assistance program.--</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (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.</DELETED>
<DELETED>SEC. 102. GRANTS FOR PROVISION OF TRANSITION ASSISTANCE TO
FORMER MEMBERS OF THE ARMED FORCES TRANSITIONING TO
CIVILIAN LIFE.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (c) Grants.--</DELETED>
<DELETED> (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).</DELETED>
<DELETED> (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).</DELETED>
<DELETED> (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).</DELETED>
<DELETED> (e) Selection of Grant Recipients.--</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (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).</DELETED>
<DELETED> (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:</DELETED>
<DELETED> (1) Resume assistance.</DELETED>
<DELETED> (2) Interview training.</DELETED>
<DELETED> (3) Job recruitment training.</DELETED>
<DELETED> (4) Entrepreneurship training.</DELETED>
<DELETED> (5) Financial services.</DELETED>
<DELETED> (6) Legal assistance.</DELETED>
<DELETED> (7) Educational supportive services.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (9) Nonclinical case management.</DELETED>
<DELETED> (10) Other related services leading directly to
successful transition, as determined by the Secretary of Labor
in consultation with the Secretary of Veterans
Affairs.</DELETED>
<DELETED> (g) Annual Reports.--</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (2) Contents.--Each report submitted under
paragraph (1) shall include the following:</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (B) The number of veterans served by each
organization.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (D) The amount of each grant awarded to
each organization under the program.</DELETED>
<DELETED> (E) Such other matters as the Secretary of
Labor, in consultation with the Secretary of Veterans
Affairs, considers appropriate.</DELETED>
<DELETED> (3) Appropriate committees of congress.--In this
subsection, the term ``appropriate committees of Congress''
means--</DELETED>
<DELETED> (A) the Committee on Veterans' Affairs and
the Committee on Appropriations of the Senate;
and</DELETED>
<DELETED> (B) the Committee on Veterans' Affairs and
the Committee on Appropriations of the House of
Representatives.</DELETED>
<DELETED> (h) Authorization of Appropriations.--There is authorized
to be appropriated $10,000,000 to carry out this section.</DELETED>
<DELETED>SEC. 103. STUDY OF COMMUNITY-BASED TRANSITION ASSISTANCE
PROGRAMS FOR FORMER MEMBERS OF THE ARMED
FORCES.</DELETED>
<DELETED> (a) Study.--</DELETED>
<DELETED> (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--</DELETED>
<DELETED> (A) provide transition assistance to such
former members that lead directly to successful
transition to civilian life, such as--</DELETED>
<DELETED> (i) resume assistance;</DELETED>
<DELETED> (ii) interview training;</DELETED>
<DELETED> (iii) job recruitment
training;</DELETED>
<DELETED> (iv) entrepreneurship
training;</DELETED>
<DELETED> (v) financial services;</DELETED>
<DELETED> (vi) legal assistance;</DELETED>
<DELETED> (vii) educational supportive
services;</DELETED>
<DELETED> (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</DELETED>
<DELETED> (ix) nonclinical case management;
and</DELETED>
<DELETED> (B) are operated by nonprofit
organizations.</DELETED>
<DELETED> (2) Updates.--</DELETED>
<DELETED> (A) Periodic.--Not less frequently than
once every five years, the Secretary shall update the
list created under paragraph (1).</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (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.</DELETED>
<DELETED>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.</DELETED>
<DELETED> (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''.</DELETED>
<DELETED> (b) Information.--Subsection (e) of such section is
amended--</DELETED>
<DELETED> (1) in paragraph (3)--</DELETED>
<DELETED> (A) in subparagraph (B), by striking
``and'' at the end;</DELETED>
<DELETED> (B) in subparagraph (C), by striking
``and'' at the end;</DELETED>
<DELETED> (C) by redesignating subparagraph (C) as
subparagraph (D); and</DELETED>
<DELETED> (D) by inserting after subparagraph (B)
the following new subparagraph (C):</DELETED>
<DELETED> ``(C) is displayed prominently on a
website of the Department; and'';</DELETED>
<DELETED> (2) by redesignating paragraph (4) as paragraph
(5); and</DELETED>
<DELETED> (3) by inserting after paragraph (3) the following
new paragraph (4):</DELETED>
<DELETED> ``(4) shall include outreach on Internet search
engines; and''.</DELETED>
<DELETED> (c) Annual Report.--Subsection (f) of such section is
amended--</DELETED>
<DELETED> (1) in paragraph (1), by striking ``Not less
frequently than once'' and inserting ``Not later than February
15''; and</DELETED>
<DELETED> (2) in paragraph (2)--</DELETED>
<DELETED> (A) by redesignating subparagraph (C) as
subparagraph (F); and</DELETED>
<DELETED> (B) by inserting after subsection (B) the
following new subparagraphs:</DELETED>
<DELETED> ``(C) The types of mental or behavioral
health care needs treated under this section.</DELETED>
<DELETED> ``(D) The demographics of individuals
being treated under this section, including--</DELETED>
<DELETED> ``(i) age;</DELETED>
<DELETED> ``(ii) era of service in the Armed
Forces;</DELETED>
<DELETED> ``(iii) branch of service in the
Armed Forces; and</DELETED>
<DELETED> ``(iv) geographic
location.</DELETED>
<DELETED> ``(E) The average number of visits for an
individual for mental or behavioral health care under
this section.''.</DELETED>
<DELETED>TITLE II--SUICIDE PREVENTION</DELETED>
<DELETED>SEC. 201. GRANTS FOR ORGANIZATIONS PROVIDING MENTAL HEALTH
WELLNESS SERVICES TO VETERANS.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (b) Grants.--</DELETED>
<DELETED> (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:</DELETED>
<DELETED>``Sec. 1720J. Financial assistance for mental health
supportive services for veterans seeking mental health
treatment</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(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--</DELETED>
<DELETED> ``(1) outreach services;</DELETED>
<DELETED> ``(2) case management services;</DELETED>
<DELETED> ``(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</DELETED>
<DELETED> ``(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--</DELETED>
<DELETED> ``(A) health care services (including
obtaining health insurance);</DELETED>
<DELETED> ``(B) daily living services;</DELETED>
<DELETED> ``(C) personal financial planning
services;</DELETED>
<DELETED> ``(D) transportation services;</DELETED>
<DELETED> ``(E) income support services;</DELETED>
<DELETED> ``(F) fiduciary and representative payee
services;</DELETED>
<DELETED> ``(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;</DELETED>
<DELETED> ``(H) child care services;</DELETED>
<DELETED> ``(I) housing counseling; and</DELETED>
<DELETED> ``(J) other services necessary for
maintaining independent living.</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(2) Each application submitted by an eligible entity
under paragraph (1) shall contain--</DELETED>
<DELETED> ``(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;</DELETED>
<DELETED> ``(B) a description of the types of veterans with
a mental health condition proposed to be provided such
services;</DELETED>
<DELETED> ``(C) an estimate of the number of veterans with a
mental health condition proposed to be provided such
services;</DELETED>
<DELETED> ``(D) evidence of the experience of the eligible
entity in providing mental health supportive services to
veterans with a mental health condition; and</DELETED>
<DELETED> ``(E) a description of the managerial capacity of
the eligible entity--</DELETED>
<DELETED> ``(i) to coordinate the provision of
mental health supportive services with the provision of
mental health services by the eligible entity or
another organization;</DELETED>
<DELETED> ``(ii) to assess continually the needs of
veterans with a mental health condition for mental
health supportive services;</DELETED>
<DELETED> ``(iii) to coordinate the provision of
mental health supportive services with the services of
the Department; and</DELETED>
<DELETED> ``(iv) to tailor supportive mental health
services to the needs of veterans with a mental health
condition.</DELETED>
<DELETED> ``(3)(A) The Secretary shall establish criteria for the
selection of eligible entities to be provided financial assistance
under this section.</DELETED>
<DELETED> ``(B) Criteria established under subparagraph (A) with
respect to an eligible entity shall include the following:</DELETED>
<DELETED> ``(i) Relevant accreditation as may be required by
each State in which the eligible entity operates.</DELETED>
<DELETED> ``(ii) Experience coordinating care or providing
treatment for veterans or members of the Armed
Forces.</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(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:</DELETED>
<DELETED> ``(1) $5,000,000 for fiscal year 2021.</DELETED>
<DELETED> ``(2) $10,000,000 for fiscal year 2022.</DELETED>
<DELETED> ``(3) $15,000,000 for fiscal year 2023.</DELETED>
<DELETED> ``(g) Definitions.--In this section:</DELETED>
<DELETED> ``(1) The term `eligible entity' means any of the
following:</DELETED>
<DELETED> ``(A) An incorporated private institution
or foundation--</DELETED>
<DELETED> ``(i) no part of the net earnings
of which inures to the benefit of any member,
founder, contributor, or individual;</DELETED>
<DELETED> ``(ii) that has a governing board
that is responsible for the operation of the
mental health supportive services provided
under this section; and</DELETED>
<DELETED> ``(iii) that is approved by the
Secretary with respect to financial
responsibility.</DELETED>
<DELETED> ``(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).</DELETED>
<DELETED> ``(C) A corporation wholly owned and
controlled by an organization meeting the requirements
of clauses (i), (ii), and (iii) of subparagraph
(A).</DELETED>
<DELETED> ``(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)).</DELETED>
<DELETED> ``(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.''.</DELETED>
<DELETED> (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:</DELETED>
<DELETED>``1720J. Financial assistance for mental health supportive
services for veterans seeking mental health
treatment.''.
<DELETED> (c) Study on Effectiveness of Program.--</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (3) Criteria.--In making the comparison required
by paragraph (2), the Secretary shall examine the
following:</DELETED>
<DELETED> (A) The satisfaction of veterans targeted
by the programs described in paragraph (2).</DELETED>
<DELETED> (B) The health status of such
veterans.</DELETED>
<DELETED> (C) The mental wellness of such
veterans.</DELETED>
<DELETED> (D) The degree to which such veterans are
encouraged to engage in productive activity by such
programs.</DELETED>
<DELETED> (E) The number of veterans using such
programs, disaggregated by--</DELETED>
<DELETED> (i) veterans who have received
care from the Department in the previous two
years; and</DELETED>
<DELETED> (ii) veterans who have not
received care from the Department in the
previous two years.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (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).</DELETED>
<DELETED> (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.</DELETED>
<DELETED>SEC. 202. DESIGNATION OF BUDDY CHECK WEEK BY DEPARTMENT OF
VETERANS AFFAIRS.</DELETED>
<DELETED> (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''.</DELETED>
<DELETED> (b) Events and Education.--</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (2) Training matters.--As part of the educational
opportunities provided under paragraph (1), the Secretary shall
provide the following:</DELETED>
<DELETED> (A) A script for veterans to use to
conduct peer wellness checks that includes information
on appropriate referrals to resources veterans might
need.</DELETED>
<DELETED> (B) Online and in-person training, as
appropriate, on how to conduct a peer wellness
check.</DELETED>
<DELETED> (C) Opportunities for members of
organizations that represent veterans to learn how to
train individuals to conduct peer wellness
checks.</DELETED>
<DELETED> (D) Training for veterans participating in
Buddy Check Week on how to transfer a phone call
directly to the Veterans Crisis Line.</DELETED>
<DELETED> (E) Resiliency training for veterans
participating in Buddy Check Week on handling a veteran
in crisis.</DELETED>
<DELETED> (3) Online materials.--All training materials
provided under the educational opportunities under paragraph
(1) shall be made available on a website of the
Department.</DELETED>
<DELETED> (c) Outreach.--The Secretary, in collaboration with
organizations that represent veterans, may conduct outreach regarding
educational opportunities under subsection (b) at--</DELETED>
<DELETED> (1) public events where many veterans are expected
to congregate;</DELETED>
<DELETED> (2) meetings of organizations that represent
veterans;</DELETED>
<DELETED> (3) facilities of the Department of Veterans
Affairs; and</DELETED>
<DELETED> (4) such other locations as the Secretary, in
collaboration with organizations that represent veterans,
considers appropriate.</DELETED>
<DELETED> (d) Veterans Crisis Line Plan.--</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (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:</DELETED>
<DELETED> (A) Additional hours for staff.</DELETED>
<DELETED> (B) The use of a backup call
center.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (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.</DELETED>
<DELETED>SEC. 203. POST-TRAUMATIC GROWTH PARTNERSHIPS.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (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--</DELETED>
<DELETED> (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</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (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:</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (2) The types of mental or behavioral health
conditions of veterans who participate in such
programs.</DELETED>
<DELETED> (3) The percentage of veterans who experience
significant post-traumatic growth.</DELETED>
<DELETED> (4) Such other topics as the Secretary may require
to track post-traumatic growth.</DELETED>
<DELETED> (e) Post-Traumatic Growth.--</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (3) Positive responses described.--Positive
responses described in this paragraph are positive responses in
one or more areas of life, including the following:</DELETED>
<DELETED> (A) An appreciation of and for
life.</DELETED>
<DELETED> (B) Improved relationships with
others.</DELETED>
<DELETED> (C) Realization of new possibilities in
life.</DELETED>
<DELETED> (D) Realization of personal
strength.</DELETED>
<DELETED> (E) Spiritual change.</DELETED>
<DELETED> (F) Such other areas that the Secretary,
in consultation with organizations specified in
subsection (b), considers necessary.</DELETED>
<DELETED>SEC. 204. PROGRESS OF DEPARTMENT OF VETERANS AFFAIRS IN
MEETING GOALS AND OBJECTIVES OF NATIONAL STRATEGY FOR
PREVENTING VETERAN SUICIDE.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (b) Metrics.--The metrics developed under subsection (a)
shall include measures of both performance and effectiveness.</DELETED>
<DELETED> (c) Initial Report.--</DELETED>
<DELETED> (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).</DELETED>
<DELETED> (2) Elements.--The report submitted under
paragraph (1) shall include the following:</DELETED>
<DELETED> (A) An explanation of why the metrics
developed under subsection (a) were chosen.</DELETED>
<DELETED> (B) An assessment of how accurately those
metrics will reflect the goals and objectives specified
in such subsection.</DELETED>
<DELETED> (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--</DELETED>
<DELETED> (1) an assessment of the progress of the
Department in meeting the goals and objectives specified in
subsection (a);</DELETED>
<DELETED> (2) a description of any action to be taken by the
Department if those goals and objectives are not being
met;</DELETED>
<DELETED> (3) a description of any changes to those goals
and objectives;</DELETED>
<DELETED> (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;</DELETED>
<DELETED> (5) an assessment of the effectiveness of the
National Strategy for Preventing Veterans Suicide, 2018-2028 at
reducing veteran suicide; and</DELETED>
<DELETED> (6) such other topics as the Secretary considers
necessary.</DELETED>
<DELETED>SEC. 205. STUDY ON FEASIBILITY AND ADVISABILITY OF PROVIDING
CERTAIN COMPLEMENTARY AND INTEGRATIVE HEALTH
SERVICES.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (b) Treatments Described.--Complementary and integrative
health treatments described in this subsection shall consist of the
following:</DELETED>
<DELETED> (1) Yoga.</DELETED>
<DELETED> (2) Meditation.</DELETED>
<DELETED> (3) Acupuncture.</DELETED>
<DELETED> (4) Chiropractic care.</DELETED>
<DELETED> (5) Other treatments that show sufficient evidence
of efficacy at treating mental or physical health conditions,
as determined by the Secretary.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (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--</DELETED>
<DELETED> (1) the results of such study; and</DELETED>
<DELETED> (2) such recommendations regarding the furnishing
of complementary and integrative health treatments described in
subsection (b) as the Secretary considers
appropriate.</DELETED>
<DELETED>SEC. 206. PROGRAM TO PROVIDE VETERANS ACCESS TO COMPLEMENTARY
AND INTEGRATIVE HEALTH SERVICES THROUGH ANIMAL THERAPY,
AGRI-THERAPY, AND OUTDOOR SPORTS THERAPY.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (b) Treatments Described.--Complementary and integrative
health treatments described in this subsection shall consist of the
following:</DELETED>
<DELETED> (1) Equine therapy.</DELETED>
<DELETED> (2) Other animal therapy.</DELETED>
<DELETED> (3) Agri-therapy.</DELETED>
<DELETED> (4) Outdoor sports therapy.</DELETED>
<DELETED> (c) Eligible Veterans.--A veteran is eligible to
participate in the program under this section if the veteran--
</DELETED>
<DELETED> (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</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (d) Duration.--</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (e) Locations.--</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (2) Selection criteria.--In selecting facilities
under paragraph (1), the Secretary shall ensure that--
</DELETED>
<DELETED> (A) the locations are in geographically
diverse areas; and</DELETED>
<DELETED> (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).</DELETED>
<DELETED> (f) Reports.--</DELETED>
<DELETED> (1) Interim report.--</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (B) Elements.--The report required by
subparagraph (A) shall include the following:</DELETED>
<DELETED> (i) The number of participants in
the program.</DELETED>
<DELETED> (ii) The types of therapy offered
at each facility at which the program is being
carried out.</DELETED>
<DELETED> (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).</DELETED>
<DELETED> (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).</DELETED>
<DELETED> (v) The determination of the
Secretary with respect to extending the program
under subsection (c)(2).</DELETED>
<DELETED> (vi) Any recommendations of the
Secretary with respect to expanding the
program.</DELETED>
<DELETED> (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.</DELETED>
<DELETED>SEC. 207. COMPTROLLER GENERAL REPORT ON MANAGEMENT BY
DEPARTMENT OF VETERANS AFFAIRS OF VETERANS AT HIGH RISK
FOR SUICIDE.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (b) Elements.--The report required by subsection (a) shall
include the following:</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (4) A review of staffing levels of suicide
prevention coordinators across the Veterans Health
Administration.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (6) An assessment of such other areas as the
Comptroller General considers appropriate to study.</DELETED>
<DELETED>TITLE III--PROGRAMS, STUDIES, AND GUIDELINES ON MENTAL
HEALTH</DELETED>
<DELETED>SEC. 301. PROGRAM TO PROVIDE VETERANS ACCESS TO COMPUTERIZED
COGNITIVE BEHAVIORAL THERAPY.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (b) Eligible Veterans.--A veteran is eligible to
participate in the program under this section if the veteran--
</DELETED>
<DELETED> (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</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (c) Duration.--The Secretary shall carry out the program
under this section for a two-year period beginning on the commencement
of the program.</DELETED>
<DELETED> (d) Locations.--</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (2) Selection criteria.--In selecting facilities
under paragraph (1), the Secretary shall ensure that--
</DELETED>
<DELETED> (A) the locations are in geographically
diverse areas; and</DELETED>
<DELETED> (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).</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (h) Reports.--</DELETED>
<DELETED> (1) Interim report.--</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (B) Elements.--The report required by
subparagraph (A) shall include the following:</DELETED>
<DELETED> (i) The number of participants in
the program.</DELETED>
<DELETED> (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).</DELETED>
<DELETED> (iii) Any recommendations of the
Secretary with respect to extending or
expanding the program.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (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.</DELETED>
<DELETED>SEC. 302. STUDY ON CONNECTION BETWEEN LIVING AT HIGH ALTITUDE
AND SUICIDE RISK FACTORS AMONG VETERANS.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (e) Follow-Up Study.--</DELETED>
<DELETED> (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:</DELETED>
<DELETED> (A) The most likely biological mechanism
that makes living at high altitude a risk factor for
developing depression or dying by suicide.</DELETED>
<DELETED> (B) The most effective treatment or
intervention for reducing the risk of developing
depression or dying by suicide associated with living
at high altitude.</DELETED>
<DELETED> (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.</DELETED>
<DELETED>SEC. 303. ESTABLISHMENT BY DEPARTMENT OF VETERANS AFFAIRS AND
DEPARTMENT OF DEFENSE OF CLINICAL PRACTICE GUIDELINES FOR
COMORBID MENTAL HEALTH CONDITIONS.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (b) Work Group.--</DELETED>
<DELETED> (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'').</DELETED>
<DELETED> (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:</DELETED>
<DELETED> (A) Academic institutions that specialize
in research for the treatment of conditions described
in subsection (a).</DELETED>
<DELETED> (B) The National Center for Posttraumatic
Stress Disorder of the Department of Veterans
Affairs.</DELETED>
<DELETED> (C) The Office of the Assistant Secretary
for Mental Health and Substance Use of the Department
of Health and Human Services.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (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:</DELETED>
<DELETED> (1) Guidance with respect to the
following:</DELETED>
<DELETED> (A) The treatment of patients with post-
traumatic stress disorder who are also experiencing a
substance use disorder or chronic pain.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (C) The treatment of patients with
traumatic brain injury who are also experiencing a
substance use disorder or chronic pain.</DELETED>
<DELETED> (2) Guidance with respect to the
following:</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (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''.</DELETED>
<DELETED> (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.</DELETED>
<DELETED>SEC. 304. UPDATE OF CLINICAL PRACTICE GUIDELINES FOR
ASSESSMENT AND MANAGEMENT OF PATIENTS AT RISK FOR
SUICIDE.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (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:</DELETED>
<DELETED> (1) Enhanced guidance with respect to the
following:</DELETED>
<DELETED> (A) Gender-specific risk factors for
suicide and suicidal ideation.</DELETED>
<DELETED> (B) Gender-specific treatment efficacy for
depression and suicide prevention.</DELETED>
<DELETED> (C) Gender-specific pharmacotherapy
efficacy.</DELETED>
<DELETED> (D) Gender-specific psychotherapy
efficacy.</DELETED>
<DELETED> (2) Guidance with respect to the
following:</DELETED>
<DELETED> (A) The efficacy of alternative therapies,
other than psychotherapy and pharmacotherapy, including
the following:</DELETED>
<DELETED> (i) Yoga therapy.</DELETED>
<DELETED> (ii) Meditation therapy.</DELETED>
<DELETED> (iii) Equine therapy.</DELETED>
<DELETED> (iv) Other animal
therapy.</DELETED>
<DELETED> (v) Training and caring for
service dogs.</DELETED>
<DELETED> (vi) Agri-therapy.</DELETED>
<DELETED> (vii) Art therapy.</DELETED>
<DELETED> (viii) Outdoor sports
therapy.</DELETED>
<DELETED> (ix) Music therapy.</DELETED>
<DELETED> (x) Any other alternative therapy
that the Work Group considers
appropriate.</DELETED>
<DELETED> (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).</DELETED>
<DELETED> (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.</DELETED>
<DELETED>SEC. 305. PRECISION MEDICINE INITIATIVE OF DEPARTMENT OF
VETERANS AFFAIRS TO IDENTIFY AND VALIDATE BRAIN AND
MENTAL HEALTH BIOMARKERS.</DELETED>
<DELETED> (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''.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (c) Use of Data.--</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (2) Open platform.--</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (B) Data may not be sold.--Data collected
under the initiative may not be sold.</DELETED>
<DELETED> (3) Standardization.--</DELETED>
<DELETED> (A) In general.--The Secretary shall
ensure that data collected under the initiative is
standardized.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (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.</DELETED>
<DELETED>SEC. 306. PREVENTATIVE AND COMPLEX DATA ANALYSIS BY DEPARTMENT
OF VETERANS AFFAIRS.</DELETED>
<DELETED> (a) In General.--Chapter 1 of title 38, United States
Code, is amended by adding at the end the following new
section:</DELETED>
<DELETED>``Sec. 119. Contracting for preventative or complex
statistical analysis</DELETED>
<DELETED> ``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.''.</DELETED>
<DELETED> (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:</DELETED>
<DELETED>``119. Contracting for preventative or complex statistical
analysis.''.
<DELETED>TITLE IV--OVERSIGHT OF MENTAL HEALTH CARE AND RELATED
SERVICES</DELETED>
<DELETED>SEC. 401. STUDY ON EFFECTIVENESS OF SUICIDE PREVENTION AND
MENTAL HEALTH OUTREACH PROGRAMS OF DEPARTMENT OF VETERANS
AFFAIRS.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (b) Use of Focus Groups.--</DELETED>
<DELETED> (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).</DELETED>
<DELETED> (2) Location of focus groups.--Focus groups
convened under paragraph (1) shall be held in geographically
diverse areas as follows:</DELETED>
<DELETED> (A) Not fewer than two in rural or highly
rural areas.</DELETED>
<DELETED> (B) Not fewer than one in each of the four
districts of the Veterans Benefits
Administration.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (4) Number of participants.--Each focus group
convened under paragraph (1) shall include not fewer than five
and not more than 12 participants.</DELETED>
<DELETED> (5) Representation.--Each focus group convened
under paragraph (1) shall, to the extent practicable, include
veterans of diverse backgrounds, including--</DELETED>
<DELETED> (A) veterans of all eras, as determined by
the Secretary;</DELETED>
<DELETED> (B) women veterans;</DELETED>
<DELETED> (C) minority veterans;</DELETED>
<DELETED> (D) Native American veterans, as defined
in section 3765 of title 38, United States
Code;</DELETED>
<DELETED> (E) veterans who identify as lesbian, gay,
bisexual, transgender, or queer (commonly referred to
as ``LGBTQ'');</DELETED>
<DELETED> (F) veterans who live in rural or highly
rural areas; and</DELETED>
<DELETED> (G) individuals transitioning from active
duty in the Armed Forces to civilian life.</DELETED>
<DELETED> (c) Report.--</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (2) Elements.--The report required by paragraph
(1) shall include the following:</DELETED>
<DELETED> (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).</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (D) Such other issues as the Secretary
considers necessary.</DELETED>
<DELETED> (d) Representative Survey.--</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (2) Veterans surveyed.--</DELETED>
<DELETED> (A) In general.--Veterans surveyed under
paragraph (1) shall include veterans described in
subsection (b)(5).</DELETED>
<DELETED> (B) Disaggregation of data.--Data of
veterans surveyed under paragraph (1) shall be
disaggregated by--</DELETED>
<DELETED> (i) veterans who have received
care from the Department during the two-year
period preceding the survey; and</DELETED>
<DELETED> (ii) veterans who have not
received care from the Department during the
two-year period preceding the survey.</DELETED>
<DELETED> (e) Treatment of Contracts for Suicide Prevention and
Mental Health Outreach Media.--</DELETED>
<DELETED> (1) Focus groups.--</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (B) Representation.--Each focus group
required under subparagraph (A) shall, to the extent
practicable, include veterans of diverse backgrounds,
including--</DELETED>
<DELETED> (i) veterans of all eras, as
determined by the Secretary;</DELETED>
<DELETED> (ii) women veterans;</DELETED>
<DELETED> (iii) minority veterans;</DELETED>
<DELETED> (iv) Native American veterans, as
defined in section 3765 of title 38, United
States Code;</DELETED>
<DELETED> (v) veterans who identify as
lesbian, gay, bisexual, transgender, or queer
(commonly referred to as ``LGBTQ'');</DELETED>
<DELETED> (vi) veterans who live in rural or
highly rural areas; and</DELETED>
<DELETED> (vii) individuals transitioning
from active duty in the Armed Forces to
civilian life.</DELETED>
<DELETED> (2) Subcontracting.--</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (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).</DELETED>
<DELETED> (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.</DELETED>
<DELETED>SEC. 402. OVERSIGHT OF MENTAL HEALTH AND SUICIDE PREVENTION
MEDIA OUTREACH CONDUCTED BY DEPARTMENT OF VETERANS
AFFAIRS.</DELETED>
<DELETED> (a) Establishment of Goals.--</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (2) Use of metrics.--</DELETED>
<DELETED> (A) In general.--The goals established
under paragraph (1) shall be measured by metrics
specific to different media types as follows:</DELETED>
<DELETED> (i) Metrics relating to social
media shall include the following:</DELETED>
<DELETED> (I) Impressions.</DELETED>
<DELETED> (II) Reach.</DELETED>
<DELETED> (III) Engagement
rate.</DELETED>
<DELETED> (IV) Such other metrics as
the Secretary considers
necessary.</DELETED>
<DELETED> (ii) Metrics relating to
television shall include the
following:</DELETED>
<DELETED> (I) Nielsen
ratings.</DELETED>
<DELETED> (II) Such other metrics as
the Secretary considers
necessary.</DELETED>
<DELETED> (iii) Metrics relating to email
shall include the following:</DELETED>
<DELETED> (I) Open rate.</DELETED>
<DELETED> (II) Response
rate</DELETED>
<DELETED> (III) Click
rate.</DELETED>
<DELETED> (IV) Such other metrics as
the Secretary considers
necessary.</DELETED>
<DELETED> (B) Update.--The Secretary shall
periodically update the metrics under subparagraph (A)
as more accurate metrics become available.</DELETED>
<DELETED> (3) Targets.--The Secretary shall develop targets
to track the metrics used under paragraph (2).</DELETED>
<DELETED> (4) Consultation.--In establishing goals under
paragraph (1), the Secretary shall consult with the
following:</DELETED>
<DELETED> (A) Relevant stakeholders, such as
organizations that represent veterans, as determined by
the Secretary.</DELETED>
<DELETED> (B) Mental health and suicide prevention
experts.</DELETED>
<DELETED> (C) Such other persons as the Secretary
considers appropriate.</DELETED>
<DELETED> (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).</DELETED>
<DELETED> (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--
</DELETED>
<DELETED> (A) the progress of the Department in
meeting the goals established under paragraph (1) and
targets developed under paragraph (3); and</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (b) Establishment of Oversight Process.--</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (2) Components of oversight process.--The process
established under paragraph (1) shall include the following
components:</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (B) A schedule for creating, approving,
implementing, and evaluating all unpaid media and paid
media content relating to mental health and suicide
prevention.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (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--</DELETED>
<DELETED> (1) track metrics used by the Secretary under
subsection (a)(2); and</DELETED>
<DELETED> (2) not less frequently than quarterly, report
such metrics to the Office of Mental Health and Suicide
Prevention of the Veterans Health Administration.</DELETED>
<DELETED> (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.</DELETED>
<DELETED>SEC. 403. ANNUAL REPORT ON PROGRESS OF DEPARTMENT OF VETERANS
AFFAIRS IN MEETING GOALS AND OBJECTIVES OF EXECUTIVE
ORDER 13822.</DELETED>
<DELETED> (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:</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (3) An assessment of the effectiveness of
Executive Order 13822 at improving the transition process for
members of the Armed Forces and veterans.</DELETED>
<DELETED> (4) Such other topics as the Secretary of Veterans
Affairs, the Secretary of Defense, or the Secretary of Homeland
Security consider necessary.</DELETED>
<DELETED> (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.</DELETED>
<DELETED>SEC. 404. COMPTROLLER GENERAL MANAGEMENT REVIEW OF MENTAL
HEALTH AND SUICIDE PREVENTION SERVICES OF DEPARTMENT OF
VETERANS AFFAIRS.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (b) Elements.--The management review required by
subsection (a) shall include the following:</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (3) A description of the operational policies and
processes of the Office of Mental Health and Suicide
Prevention.</DELETED>
<DELETED> (4) An assessment of suicide prevention practices
and initiatives available from the Department and through
community partnerships.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (6) An assessment of the Nurse Advice Line pilot
program conducted by the Department.</DELETED>
<DELETED> (7) An assessment of recruitment initiatives in
rural areas for mental health professionals of the
Department.</DELETED>
<DELETED> (8) An assessment of strategic planning conducted
by the Office of Mental Health and Suicide
Prevention.</DELETED>
<DELETED> (9) An assessment of the communication, and the
effectiveness of such communication--</DELETED>
<DELETED> (A) within the central office of the
Office of Mental Health and Suicide
Prevention;</DELETED>
<DELETED> (B) between that central office and any
staff member or office in the field, including
chaplains, attorneys, law enforcement personnel, and
volunteers; and</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (10) An assessment of how effectively the Office
of Mental Health and Suicide Prevention implements operational
policies and procedures.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (12) An assessment of such other areas as the
Comptroller General considers appropriate to study.</DELETED>
<DELETED>SEC. 405. COMPTROLLER GENERAL REPORT ON EFFORTS OF DEPARTMENT
OF VETERANS AFFAIRS TO INTEGRATE MENTAL HEALTH CARE INTO
PRIMARY CARE CLINICS.</DELETED>
<DELETED> (a) Initial Report.--</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (2) Elements.--The report required by subsection
(a) shall include the following:</DELETED>
<DELETED> (A) An assessment of the efforts of the
Department to integrate mental health care into primary
care clinics of the Department.</DELETED>
<DELETED> (B) An assessment of the effectiveness of
such efforts.</DELETED>
<DELETED> (C) An assessment of how the health care
of veterans is impacted by such integration.</DELETED>
<DELETED> (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:</DELETED>
<DELETED> (i) How documents and patient
information are transferred and the
effectiveness of those transfers.</DELETED>
<DELETED> (ii) How care is coordinated when
veterans must travel to different facilities of
the Department.</DELETED>
<DELETED> (iii) How a veteran is
reintegrated into primary care after receiving
in-patient mental health care.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (F) Such recommendations on how the
Department can better integrate mental health care into
primary care clinics as the Comptroller General
considers appropriate.</DELETED>
<DELETED> (G) An assessment of such other areas as
the Comptroller General considers appropriate to
study.</DELETED>
<DELETED> (b) Community Care Integration Report.--</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (2) Elements.--The report required by paragraph
(1) shall include the following:</DELETED>
<DELETED> (A) An assessment of the efforts of the
Department to integrate community-based mental health
care into the Veterans Health Administration.</DELETED>
<DELETED> (B) An assessment of the effectiveness of
such efforts.</DELETED>
<DELETED> (C) An assessment of how the health care
of veterans is impacted by such integration.</DELETED>
<DELETED> (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--</DELETED>
<DELETED> (i) the Veterans Health
Administration and providers of community-based
mental health care; and</DELETED>
<DELETED> (ii) providers of community-based
mental health care and the Veterans Health
Administration.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (F) An assessment of the military cultural
competency of health care providers providing
community-based mental health care to
veterans.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (H) An assessment of such other areas as
the Comptroller General considers appropriate to
study.</DELETED>
<DELETED> (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)).</DELETED>
<DELETED>SEC. 406. JOINT MENTAL HEALTH PROGRAMS BY DEPARTMENT OF
VETERANS AFFAIRS AND DEPARTMENT OF DEFENSE.</DELETED>
<DELETED> (a) Report on Mental Health Programs.--</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (2) Elements.--The report required by paragraph
(1) shall include the following:</DELETED>
<DELETED> (A) A description of mental health
programs operated by the Department of Veterans
Affairs, including the following:</DELETED>
<DELETED> (i) Transition assistance
programs.</DELETED>
<DELETED> (ii) Clinical mental health
initiatives, including--</DELETED>
<DELETED> (I) the Million Veterans
Program; and</DELETED>
<DELETED> (II) centers of excellence
of the Department of Veterans Affairs
for traumatic brain injury and post-
traumatic stress disorder.</DELETED>
<DELETED> (iii) Programs that may
secondarily improve mental health, including
employment, housing assistance, and financial
literacy programs.</DELETED>
<DELETED> (iv) Research into mental health
issues and conditions.</DELETED>
<DELETED> (B) A description of mental health
programs operated by the Department of Defense,
including the following:</DELETED>
<DELETED> (i) Transition assistance
programs.</DELETED>
<DELETED> (ii) Clinical mental health
initiatives, including the National Intrepid
Center of Excellence.</DELETED>
<DELETED> (iii) Programs that may
secondarily improve mental health, including
employment, housing assistance, and financial
literacy programs.</DELETED>
<DELETED> (iv) Research into mental health
issues and conditions.</DELETED>
<DELETED> (C) A description of mental health
programs jointly operated by the Department of Veterans
Affairs and the Department of Defense, including the
following:</DELETED>
<DELETED> (i) Transition assistance
programs.</DELETED>
<DELETED> (ii) Clinical mental health
initiatives.</DELETED>
<DELETED> (iii) Programs that may
secondarily improve mental health, including
employment, housing assistance, and financial
literacy programs.</DELETED>
<DELETED> (iv) Research into mental health
issues and conditions.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (b) Establishment of Joint Center of Excellence.--
</DELETED>
<DELETED> (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'').</DELETED>
<DELETED> (2) Duties.--The Center shall conduct joint mental
health programs of the Department of Veterans Affairs and the
Department of Defense.</DELETED>
<DELETED> (3) Location.--The Center shall be established in
a location that--</DELETED>
<DELETED> (A) is geographically distant from already
existing and planned Intrepid Spirit Centers of the
Department of Defense; and</DELETED>
<DELETED> (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).</DELETED>
<DELETED>TITLE V--MEDICAL WORKFORCE</DELETED>
<DELETED>Subtitle A--Improvement of Mental Health Medical
Workforce</DELETED>
<DELETED>SEC. 501. TREATMENT OF PSYCHOLOGISTS.</DELETED>
<DELETED> (a) Treatment as Title 38 Employees.--Section 7401 of
title 38, United States Code, is amended--</DELETED>
<DELETED> (1) in paragraph (1) by inserting
``psychologists,'' after ``chiropractors,''; and</DELETED>
<DELETED> (2) in paragraph (3), by striking
``psychologists,''.</DELETED>
<DELETED> (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,''.</DELETED>
<DELETED>SEC. 502. STAFFING IMPROVEMENT PLAN FOR PSYCHIATRISTS AND
PSYCHOLOGISTS OF DEPARTMENT OF VETERANS
AFFAIRS.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (b) Elements.--The plan required by subsection (a) shall
include the following:</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (2) An identification of the steps that the
Secretary will take in each Veterans Integrated Service Network
to address such shortages, include the following:</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (B) A description of any local retention
or engagement incentives to be used by directors of
Veterans Integrated Service Networks.</DELETED>
<DELETED> (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.</DELETED>
<DELETED>SEC. 503. OCCUPATIONAL SERIES AND STAFFING IMPROVEMENT PLAN
FOR LICENSED PROFESSIONAL MENTAL HEALTH COUNSELORS AND
MARRIAGE AND FAMILY THERAPISTS OF DEPARTMENT OF VETERANS
AFFAIRS.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (b) Staffing Plan.--</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (2) Elements.--The plan required by paragraph (1)
shall include the following:</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (B) An identification of the steps that
the Secretary will take in each Veterans Integrated
Service Network to address such shortages, include the
following:</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (ii) A description of any local
retention or engagement incentives to be used
by directors of Veterans Integrated Service
Networks.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (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.</DELETED>
<DELETED>SEC. 504. STAFFING IMPROVEMENT PLAN FOR PEER SPECIALISTS OF
DEPARTMENT OF VETERANS AFFAIRS WHO ARE WOMEN.</DELETED>
<DELETED> (a) Assessment of Capacity.--</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (2) Elements.--The assessment required by
paragraph (1) shall include an assessment of the
following:</DELETED>
<DELETED> (A) The geographical distribution of peer
specialists of the Department who are women.</DELETED>
<DELETED> (B) The geographical distribution of women
veterans.</DELETED>
<DELETED> (C) The number and proportion of women
peer specialists who specialize in peer counseling on
mental health or suicide prevention.</DELETED>
<DELETED> (D) The number and proportion of women
peer specialists who specialize in peer counseling on
non-mental health related matters.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (c) Staffing Improvement Plan.--</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (2) Elements.--The peer specialist positions
included in the plan required by paragraph (1)--</DELETED>
<DELETED> (A) shall be non-volunteer, paid
positions; and</DELETED>
<DELETED> (B) may be part-time positions.</DELETED>
<DELETED>SEC. 505. ESTABLISHMENT OF DEPARTMENT OF VETERANS AFFAIRS
READJUSTMENT COUNSELING SERVICE SCHOLARSHIP
PROGRAM.</DELETED>
<DELETED> (a) In General.--Chapter 76 of title 38, United States
Code, is amended by inserting after subchapter VIII the following new
subchapter:</DELETED>
<DELETED>``SUBCHAPTER IX--READJUSTMENT COUNSELING SERVICE SCHOLARSHIP
PROGRAM</DELETED>
<DELETED>``Sec. 7698. Requirement for program</DELETED>
<DELETED> ``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').</DELETED>
<DELETED>``Sec. 7699. Eligibility; agreement</DELETED>
<DELETED> ``(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--</DELETED>
<DELETED> ``(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--</DELETED>
<DELETED> ``(A) a bachelor's, master's, or doctoral
degree in psychology, social work, or marriage and
family therapy; or</DELETED>
<DELETED> ``(B) a master's degree in mental health
counseling; and</DELETED>
<DELETED> ``(2) enters into an agreement with the Secretary
under subsection (c).</DELETED>
<DELETED> ``(b) Priority.--In selecting individuals to participate
in the Program, the Secretary shall give priority to the following
individuals:</DELETED>
<DELETED> ``(1) An individual who agrees to be employed by a
Vet Center located in a community that is--</DELETED>
<DELETED> ``(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</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(2) An individual who is a veteran.</DELETED>
<DELETED> ``(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:</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(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').</DELETED>
<DELETED> ``(d) Vet Center Defined.--In this section, the term `Vet
Center' has the meaning given that term in section 1712A(h) of this
title.</DELETED>
<DELETED>``Sec. 7699A. Obligated service</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED>``Sec. 7699B. Breach of agreement: liability</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(2) Liability under paragraph (1) is in addition to any
period of obligated service or other obligation or liability under such
agreement.</DELETED>
<DELETED> ``(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:</DELETED>
<DELETED> ``(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).</DELETED>
<DELETED> ``(B) The participant is dismissed from such
educational institution for disciplinary reasons.</DELETED>
<DELETED> ``(C) The participant voluntarily terminates the
program of study in such educational institution before the
completion of such program of study.</DELETED>
<DELETED> ``(2) Liability under this subsection is in lieu of any
service obligation arising under the agreement.</DELETED>
<DELETED> ``(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).</DELETED>
<DELETED> ``(2) In the formula in paragraph (1):</DELETED>
<DELETED> ``(A) `A' is the amount the United States is
entitled to recover.</DELETED>
<DELETED> ``(B) `F' is the sum of--</DELETED>
<DELETED> ``(i) the amounts paid under this
subchapter to or on behalf of the participant;
and</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(C) `t' is the total number of months in the
period of obligated service of the participant.</DELETED>
<DELETED> ``(D) `s' is the number of months of such period
served by the participant.</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(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.''.</DELETED>
<DELETED> (b) Conforming and Technical Amendments.--</DELETED>
<DELETED> (1) Conforming amendments.--</DELETED>
<DELETED> (A) Establishment of program.--Section
7601(a) of such title is amended--</DELETED>
<DELETED> (i) in paragraph (5), by striking
``and'';</DELETED>
<DELETED> (ii) in paragraph (6), by striking
the period and inserting ``; and'';
and</DELETED>
<DELETED> (iii) by adding at the end the
following new paragraph:</DELETED>
<DELETED> ``(7) the readjustment counseling service
scholarship program provided for in subchapter IX of this
chapter.''.</DELETED>
<DELETED> (B) Eligibility.--Section 7602 of such
title is amended--</DELETED>
<DELETED> (i) in subsection (a)(1)--
</DELETED>
<DELETED> (I) by striking ``or VI''
and inserting ``VI, or IX'';
and</DELETED>
<DELETED> (II) by striking
``subchapter VI'' and inserting
``subchapter VI or IX''; and</DELETED>
<DELETED> (ii) in subsection (b), by
striking ``or VI'' and inserting ``VI, or
IX''.</DELETED>
<DELETED> (C) Application.--Section 7603(a)(1) of
such title is amended by striking ``or VIII'' and
inserting ``VIII, or IX''.</DELETED>
<DELETED> (D) Terms of agreement.--Section 7604 of
such title is amended by striking ``or VIII'' each
place it appears and inserting ``VIII, or
IX''.</DELETED>
<DELETED> (E) Annual report.--Section 7632 of such
title is amended--</DELETED>
<DELETED> (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</DELETED>
<DELETED> (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''.</DELETED>
<DELETED> (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:</DELETED>
<DELETED> ``subchapter ix--readjustment counseling service scholarship
program
<DELETED>``Sec.
<DELETED>``7698. Requirement for program.
<DELETED>``7699. Eligibility; agreement.
<DELETED>``7699A. Obligated service.
<DELETED>``7699B. Breach of agreement: liability.''.
<DELETED> (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.</DELETED>
<DELETED>SEC. 506. COMPTROLLER GENERAL REPORT ON READJUSTMENT
COUNSELING SERVICE OF DEPARTMENT OF VETERANS
AFFAIRS.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (b) Elements.--The report required by subsection (a) shall
include the following:</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (2) An assessment of the efficacy of outreach
efforts by the Readjustment Counseling Service, including
recommendations for how outreach efforts can be
improved.</DELETED>
<DELETED> (3) An assessment of barriers to care at Vet
Centers, including recommendations for overcoming those
barriers.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (5) An assessment of the feasibility and
advisability of expanding eligibility for services from the
Readjustment Counseling Service, including--</DELETED>
<DELETED> (A) recommendations on what eligibility
criteria could be expanded; and</DELETED>
<DELETED> (B) an assessment of potential costs and
increased infrastructure requirements if eligibility is
expanded.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (8) An assessment of the efficacy of group therapy
and the level of training of providers at Vet Centers in
administering group therapy.</DELETED>
<DELETED> (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.</DELETED>
<DELETED>SEC. 507. EXPANSION OF REPORTING REQUIREMENTS ON READJUSTMENT
COUNSELING SERVICE OF DEPARTMENT OF VETERANS
AFFAIRS.</DELETED>
<DELETED> (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''.</DELETED>
<DELETED> (b) Biennial Report.--Such section is amended by adding at
the end the following new paragraph:</DELETED>
<DELETED> ``(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.''.</DELETED>
<DELETED>SEC. 508. STUDIES ON ALTERNATIVE WORK SCHEDULES FOR EMPLOYEES
OF VETERANS HEALTH ADMINISTRATION.</DELETED>
<DELETED> (a) Study of Veterans.--</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (2) Eligible veteran defined.--In this subsection,
the term ``eligible veteran'' means a veteran who--</DELETED>
<DELETED> (A) is enrolled in the patient enrollment
system of the Department under section 1705(a) of title
38, United States Code; and</DELETED>
<DELETED> (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).</DELETED>
<DELETED> (b) Department Study.--</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (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.</DELETED>
<DELETED>SEC. 509. SUICIDE PREVENTION COORDINATORS.</DELETED>
<DELETED> 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.</DELETED>
<DELETED>Subtitle B--Direct Hiring Authorities for Certain Health Care
Positions</DELETED>
<DELETED>SEC. 521. DIRECT HIRING AUTHORITIES FOR CERTAIN HEALTH CARE
POSITIONS.</DELETED>
<DELETED> (a) In General.--Subpart I of part III of title 5, United
States Code, is amended by adding at the end the following:</DELETED>
<DELETED>``CHAPTER 103--DEPARTMENT OF VETERANS AFFAIRS HIRING
AUTHORITIES</DELETED>
<DELETED>``Sec.
<DELETED>``10301. Department of Veterans Affairs personnel authorities.
<DELETED>``Sec. 10301. Department of Veterans Affairs personnel
authorities</DELETED>
<DELETED> ``(a) Flexibilities Relating to Appointments.--</DELETED>
<DELETED> ``(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--</DELETED>
<DELETED> ``(A) better meet mission needs;</DELETED>
<DELETED> ``(B) respond to managers' needs and the
needs of applicants;</DELETED>
<DELETED> ``(C) produce high-quality
applicants;</DELETED>
<DELETED> ``(D) support timely decisions;
and</DELETED>
<DELETED> ``(E) promote competitive job
offers.</DELETED>
<DELETED> ``(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:</DELETED>
<DELETED> ``(A) Fair, credible, and transparent
methods of establishing qualification requirements for,
recruitment for, and appointments to
positions.</DELETED>
<DELETED> ``(B) Fair and open competition and
equitable treatment in the consideration and selection
of individuals to positions.</DELETED>
<DELETED> ``(C) Fair, credible, and transparent
methods of assigning, reassigning, detailing,
transferring, or promoting employees.</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(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).</DELETED>
<DELETED> ``(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--</DELETED>
<DELETED> ``(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;</DELETED>
<DELETED> ``(2) provide for adequate training and retraining
for supervisors, managers, and employees in the implementation
and operation of that redesign and that system;</DELETED>
<DELETED> ``(3) develop--</DELETED>
<DELETED> ``(A) a comprehensive management
succession program to provide training to employees to
develop managers for the agency; and</DELETED>
<DELETED> ``(B) a program to provide training to
supervisors on actions, options, and strategies that a
supervisor may use in administering that
system;</DELETED>
<DELETED> ``(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;</DELETED>
<DELETED> ``(5) provide mentors to advise individuals on
their career paths and opportunities to advance and excel
within their fields;</DELETED>
<DELETED> ``(6) develop appropriate procedures for warnings
during performance evaluations for employees who fail to meet
performance standards;</DELETED>
<DELETED> ``(7) utilize the quadrennial strategic plan
required under section 7330C(b) of title 38; and</DELETED>
<DELETED> ``(8) ensure that adequate agency resources are
allocated for the design, implementation, and administration of
that system.''.</DELETED>
<DELETED> (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:</DELETED>
<DELETED>``103. Department of Veterans Affairs Hiring 10301.''.
Authorities.
<DELETED>TITLE VI--IMPROVEMENT OF TELEHEALTH SERVICES</DELETED>
<DELETED>SEC. 601. EXPANDED TELEHEALTH FROM DEPARTMENT OF VETERANS
AFFAIRS.</DELETED>
<DELETED> (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).</DELETED>
<DELETED> (b) Preference for Partnerships.--The Secretary shall give
preference to entering into or expanding partnerships under subsection
(a) with organizations that--</DELETED>
<DELETED> (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</DELETED>
<DELETED> (2) operate in a medically underserved community
(as defined in section 799B of the Public Health Service Act
(42 U.S.C. 295p)).</DELETED>
<DELETED> (c) Award of Grants.--</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (2) Maximum amount of grants.--The amount of a
grant awarded under this subsection may not exceed $75,000 per
site per year.</DELETED>
<DELETED> (3) Use of grants.--</DELETED>
<DELETED> (A) In general.--Grants awarded to an
entity under this subsection shall be used for the
following:</DELETED>
<DELETED> (i) Purchasing or upgrading
hardware or software necessary for the
provision of secure and private telehealth
services.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (iii) Training of employees,
including payment of those employees for
completing that training, with respect to--
</DELETED>
<DELETED> (I) military and veteran
cultural competence, if the entity is
not an organization that represents
veterans; and</DELETED>
<DELETED> (II) equipment required to
provide telehealth services.</DELETED>
<DELETED> (iv) Upgrading existing
infrastructure owned or leased by the entity to
make rooms more conducive to telehealth care,
including--</DELETED>
<DELETED> (I) additional walls to
create a new, private room;</DELETED>
<DELETED> (II) soundproofing of
existing rooms; or</DELETED>
<DELETED> (III) new electrical or
internet outlets in an existing
room.</DELETED>
<DELETED> (v) Upgrading existing
infrastructure to comply with the Americans
with Disabilities Act of 1990 (42 U.S.C. 12101
et seq.).</DELETED>
<DELETED> (vi) Upgrading internet
infrastructure.</DELETED>
<DELETED> (B) Exclusion.--Grants may not be used for
the purchase of new property or for major construction
projects, as determined by the Secretary.</DELETED>
<DELETED> (d) Memoranda of Understanding or Agreement on Telehealth
Access Points.--</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (e) Assessment of Barriers to Access.--</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (2) Elements.--The assessment required by
paragraph (1) shall include the following:</DELETED>
<DELETED> (A) An assessment of current and potential
future cost barriers to veterans having internet access
at home.</DELETED>
<DELETED> (B) An assessment of current and potential
future barriers to veterans accessing broadband
services at home.</DELETED>
<DELETED> (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).</DELETED>
<DELETED> (D) Such other matters related to internet
access for veterans in their homes as the Secretary
considers relevant.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (f) Authorization of Appropriations.--There is authorized
to be appropriated to the Secretary of Veterans Affairs $10,000,000 to
carry out this section.</DELETED>
<DELETED>SEC. 602. IMPLEMENTATION OF NATIONAL PROTOCOL FOR TELEHEALTH
SECURITY AND INTERFACING INSTRUCTIONS.</DELETED>
<DELETED> (a) National Telehealth Security Protocol.--</DELETED>
<DELETED> (1) Assessment.--</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (B) Elements.--The assessment conducted
under subparagraph (A) shall include the
following:</DELETED>
<DELETED> (i) An assessment of current
telehealth security protocols, including
protocols used by--</DELETED>
<DELETED> (I) the Department of
Veterans Affairs;</DELETED>
<DELETED> (II) other Federal
agencies;</DELETED>
<DELETED> (III) other health care
providers; and</DELETED>
<DELETED> (IV) such other
organizations as the Secretary
considers necessary to assess under
such subparagraph.</DELETED>
<DELETED> (ii) A study of any current or
future security risks--</DELETED>
<DELETED> (I) faced by veterans
using telehealth services; or</DELETED>
<DELETED> (II) faced by the
Department in furnishing those
services.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (b) National Telehealth Interfacing Instructions.--
</DELETED>
<DELETED> (1) Assessment.--</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (B) Elements.--The assessment conducted
under subparagraph (A) shall include an assessment of
interfacing instructions used by--</DELETED>
<DELETED> (i) the Department of Veterans
Affairs;</DELETED>
<DELETED> (ii) other Federal
agencies;</DELETED>
<DELETED> (iii) other health care providers;
and</DELETED>
<DELETED> (iv) such other organizations as
the Secretary considers necessary to assess
under such subparagraph.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (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.</DELETED>
<DELETED> (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.</DELETED>
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. Review of records of former members of the Armed Forces who
die by suicide within one year of
separation from the Armed Forces.
Sec. 103. Report on REACH VET program of Department of Veterans
Affairs.
Sec. 104. Report on care for former members of the Armed Forces with
other than honorable discharge.
TITLE II--SUICIDE PREVENTION
Sec. 201. Financial assistance to certain entities to provide and
coordinate the provision of suicide
prevention services for eligible
individuals and their families.
Sec. 202. Study on feasibility and advisability of the Department of
Veterans Affairs providing certain
complementary and integrative health
services.
Sec. 203. Pilot program to provide veterans access to complementary and
integrative health services through animal
therapy, agritherapy, post-traumatic growth
therapy, and outdoor sports and recreation
therapy.
Sec. 204. Department of Veterans Affairs independent reviews of certain
deaths of veterans by suicide and staffing
levels of mental health professionals.
Sec. 205. Comptroller General report on management by Department of
Veterans Affairs of veterans at high risk
for suicide.
TITLE III--PROGRAMS, STUDIES, AND GUIDELINES ON MENTAL HEALTH
Sec. 301. Study on connection between living at high altitude and
suicide risk factors among veterans.
Sec. 302. Establishment by Department of Veterans Affairs and
Department of Defense of a clinical
provider treatment toolkit and accompanying
training materials for comorbidities.
Sec. 303. Update of clinical practice guidelines for assessment and
management of patients at risk for suicide.
Sec. 304. Establishment by Department of Veterans Affairs and
Department of Defense of clinical practice
guidelines for the treatment of serious
mental illness.
Sec. 305. Precision medicine initiative of Department of Veterans
Affairs to identify and validate brain and
mental health biomarkers.
Sec. 306. Statistical analyses and data evaluation by Department of
Veterans Affairs.
TITLE IV--OVERSIGHT OF MENTAL HEALTH CARE AND RELATED SERVICES
Sec. 401. Study on effectiveness of suicide prevention and mental
health outreach programs of Department of
Veterans Affairs.
Sec. 402. Oversight of mental health and suicide prevention media
outreach conducted by Department of
Veterans Affairs.
Sec. 403. Comptroller General management review of mental health and
suicide prevention services of Department
of Veterans Affairs.
Sec. 404. Comptroller General report on efforts of Department of
Veterans Affairs to integrate mental health
care into primary care clinics.
Sec. 405. Joint mental health programs by Department of Veterans
Affairs and Department of Defense.
TITLE V--IMPROVEMENT OF MENTAL HEALTH MEDICAL WORKFORCE
Sec. 501. Staffing improvement plan for mental health providers of
Department of Veterans Affairs.
Sec. 502. Staffing improvement plan for peer specialists of Department
of Veterans Affairs who are women.
Sec. 503. Establishment of Department of Veterans Affairs Readjustment
Counseling Service Scholarship Program.
Sec. 504. Comptroller General report on Readjustment Counseling Service
of Department of Veterans Affairs.
Sec. 505. Expansion of reporting requirements on Readjustment
Counseling Service of Department of
Veterans Affairs.
Sec. 506. Studies on alternative work schedules for employees of
Veterans Health Administration.
Sec. 507. Suicide prevention coordinators.
Sec. 508. Report on efforts by Department of Veterans Affairs to
implement safety planning in emergency
departments.
TITLE VI--IMPROVEMENT OF CARE AND SERVICES FOR WOMEN VETERANS
Sec. 601. Expansion of capabilities of Women Veterans Call Center to
include text messaging.
Sec. 602. Gap analysis of Department of Veterans Affairs programs that
provide assistance to women veterans who
are homeless.
Sec. 603. Requirement for Department of Veterans Affairs internet
website to provide information on services
available to women veterans.
Sec. 604. Report on locations where women veterans are using health
care from Department of Veterans Affairs.
TITLE VII--OTHER MATTERS
Sec. 701. Expanded telehealth from Department of Veterans Affairs.
Sec. 702. Partnerships with non-Federal Government entities to provide
hyperbaric oxygen therapy to veterans and
studies on the use of such therapy for
treatment of post-traumatic stress disorder
and traumatic brain injury.
Sec. 703. Prescription of technical qualifications for licensed hearing
aid specialists and requirement for
appointment of such specialists.
Sec. 704. Use by Department of Veterans Affairs of commercial
institutional review boards in sponsored
research trials.
Sec. 705. Creation of Office of Research Reviews within the Office of
Information and Technology of the
Department of Veterans Affairs.
TITLE I--IMPROVEMENT OF TRANSITION OF INDIVIDUALS TO SERVICES FROM
DEPARTMENT OF VETERANS AFFAIRS
SEC. 101. 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. REVIEW OF RECORDS OF FORMER MEMBERS OF THE ARMED FORCES WHO
DIE BY SUICIDE WITHIN ONE YEAR OF SEPARATION FROM THE
ARMED FORCES.
(a) In General.--The Secretary of Defense and the Secretary of
Veterans Affairs shall jointly review the records of each former member
of the Armed Forces who died by suicide within one year of separation
from the Armed Forces during the five-year period preceding the date of
the enactment of this Act.
(b) Elements.--The review required by subsection (a) with respect
to a former member of the Armed Forces shall include consideration of
the following:
(1) If the Department of Defense had previously identified
the former member as being at risk for suicide and if that
identification had been communicated to the Department of
Veterans Affairs.
(2) What risk factors were present with respect to the
former member and how those risk factors correlated to the
circumstances of the death of the former member.
(3) If the former member was eligible to receive health
care services from the Department of Veterans Affairs.
(4) If the former member received health care services,
including mental health care services, from a facility of the
Department of Veterans Affairs, including readjustment
counseling services, following separation from the Armed
Forces.
(5) If the former member had received a mental health
waiver during service in the Armed Forces.
(6) The employment status, housing status, marital status,
age, rank within the Armed Forces (such as enlisted or
officer), and branch of service within the Armed Forces of the
former member.
(7) If support services, specified by the type of service
(such as employment, mental health, etc.), were provided to the
former member during their period of separation from the Armed
Forces, disaggregated by--
(A) services furnished by the Department of
Defense, including through contracts;
(B) services furnished by the Department of
Veterans Affairs, including through contracts; and
(C) services not covered under subparagraph (A) or
(B).
(c) Report.--
(1) In general.--Not later than one year after the date of
the enactment of this Act, the Secretary of Defense and the
Secretary of Veterans Affairs shall jointly submit to the
appropriate committees of Congress an aggregated report on the
results of the review conducted under subsection (a).
(2) Appropriate committees of congress defined.--In this
subsection, the term ``appropriate committees of Congress''
means--
(A) The Committee on Armed Services and the
Committee on Veterans' Affairs of the Senate; and
(B) The Committee on Armed Services and the
Committee on Veterans' Affairs of the House of
Representatives.
SEC. 103. REPORT ON REACH VET PROGRAM OF DEPARTMENT OF VETERANS
AFFAIRS.
(a) In General.--Not later than 180 days after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall submit
to the Committee on Veterans' Affairs of the Senate and the Committee
on Veterans' Affairs of the House of Representatives a report on the
REACH VET program.
(b) Elements.--The report required by subsection (a) shall include
the following:
(1) An assessment of the impact of the REACH VET program on
rates of suicide among veterans.
(2) An assessment of how limits within the REACH VET
program, such as caps on the number of veterans who may be
flagged as high risk, are adjusted for differing rates of
suicide across the country.
(3) A detailed explanation, with evidence, for why the
conditions included in the model used by the REACH VET program
were chosen, including an explanation as to why certain
conditions, such as bipolar disorder II, were not included even
though they show a similar rate of risk for suicide as other
conditions that were included.
(4) An assessment of the feasibility of incorporating
certain economic data held by the Veterans Benefits
Administration into the model used by the REACH VET program,
including financial data and employment status, which research
indicates may have an impact on risk for suicide.
(c) REACH VET Program Defined.--In this section, the term ``REACH
VET program'' means the Recovery Engagement and Coordination for
Health--Veterans Enhanced Treatment program of the Department of
Veterans Affairs.
SEC. 104. REPORT ON CARE FOR FORMER MEMBERS OF THE ARMED FORCES WITH
OTHER THAN HONORABLE DISCHARGE.
Section 1720I(f) of title 38, United States Code, is amended--
(1) in paragraph (1) by striking ``Not less frequently than
once'' and inserting ``Not later than February 15''; and
(2) in paragraph (2)--
(A) by redesignating subparagraph (C) as
subparagraph (F); and
(B) by inserting after subsection (B) the following
new subparagraphs:
``(C) The types of mental or behavioral health care needs
treated under this section.
``(D) The demographics of individuals being treated under
this section, including--
``(i) age;
``(ii) era of service in the Armed Forces;
``(iii) branch of service in the Armed Forces; and
``(iv) geographic location.
``(E) The average number of visits for an individual for
mental or behavioral health care under this section.''.
TITLE II--SUICIDE PREVENTION
SEC. 201. FINANCIAL ASSISTANCE TO CERTAIN ENTITIES TO PROVIDE AND
COORDINATE THE PROVISION OF SUICIDE PREVENTION SERVICES
FOR ELIGIBLE INDIVIDUALS AND THEIR FAMILIES.
(a) Purpose.--The purpose of this section is to reduce veteran
suicide through a community-based grant program to award grants to
eligible entities to provide suicide prevention services to eligible
individuals and their family.
(b) Distribution of Financial Assistance.--
(1) In general.--The Secretary of Veterans Affairs shall
provide financial assistance to eligible entities approved
under this section through the award of grants each fiscal year
to such entities to provide and coordinate the provision of
suicide prevention services to eligible individuals and their
family to reduce the risk of suicide.
(2) Coordination with task force.--The Secretary shall
carry out this section in coordination with the President's
Roadmap to Empower Veterans and End the National Tragedy of
Suicide Task Force, to the extent practicable.
(c) Award of Grants.--
(1) In general.--The Secretary shall award a grant to each
eligible entity for which the Secretary has approved an
application under subsection (f) to provide or coordinate the
provision of suicide prevention services under this section.
(2) Grant amounts, intervals of payment, and matching
funds.--In accordance with the services being provided under a
grant under this section and the duration of those services,
the Secretary shall establish--
(A) a maximum amount to be awarded under the grant
that is not greater than $750,000 per grantee per
fiscal year;
(B) intervals of payment for the administration of
the grant; and
(C) a requirement for the recipient of the grant to
provide matching funds in a specified percentage.
(d) Distribution of Financial Assistance and Preference.--
(1) Distribution.--
(A) Priority.--Subject to subparagraphs (B) and
(C), in determining how to distribute grants under this
section, the Secretary may prioritize the award of
grants in--
(i) rural communities;
(ii) Tribal lands;
(iii) territories of the United States;
(iv) medically underserved areas;
(v) areas with a high number or percentage
of minority veterans or women veterans; and
(vi) areas with a high number or percentage
of calls to the Veterans Crisis Line.
(B) Areas with need.--The Secretary shall ensure
that, to the extent practicable, financial assistance
under this section is distributed--
(i) to provide services in areas of the
United States, including territories of the
United States, that have experienced high rates
or a high burden of veteran suicide; and
(ii) to eligible entities that can assist
eligible individuals at risk of suicide who are
not currently receiving health care furnished
by the Department of Veterans Affairs.
(C) Geography.--In distributing financial
assistance under subparagraph (B), the Secretary may
provide grants to eligible entities that furnish
services to eligible individuals in geographically
dispersed areas.
(2) Preference.--
(A) In general.--The Secretary shall give
preference in the provision of financial assistance
under this section to eligible entities that have
demonstrated the ability to provide or coordinate
multiple suicide prevention services using a collective
impact model.
(B) Rule of construction.--Nothing in this
paragraph shall be construed to limit the award of
grants under this section only to organizations that
provide or coordinate multiple suicide prevention
services through a collective impact model.
(e) Requirements for Receipt of Financial Assistance.--
(1) Notification that services are from department.--Each
entity receiving financial assistance under this section to
provide suicide prevention services to eligible individuals and
their family shall notify the recipients of such services that
such services are being paid for, in whole or in part, by the
Department.
(2) Coordination with other services from department.--Each
entity receiving a grant under this section shall--
(A) coordinate with the Secretary with respect to
the provision of clinical services to eligible
individuals in accordance with any other provision of
law regarding the delivery of health care under the
laws administered by the Secretary;
(B) inform a veteran in receipt of assistance under
this section of the eligibility of the veteran to
enroll in the patient enrollment system of the
Department under section 1705 of title 38, United
States Code; and
(C) if such veteran wishes to so enroll, inform the
veteran of the point of contact at the nearest medical
center of the Department who can assist the veteran in
such enrollment.
(3) Measurement and monitoring.--Each entity receiving a
grant under this section shall submit to the Secretary a
description of the tools and assessments the entity uses or
will use to determine the effectiveness of the services
furnished by the entity under this section, including the
effect of those services on--
(A) the financial stability of eligible individuals
receiving those services;
(B) the mental resiliency and mental outlook of
those eligible individuals; and
(C) the social support of those eligible
individuals.
(4) Reports.--The Secretary--
(A) shall require each entity receiving financial
assistance under this section to submit to the
Secretary an annual report that describes the projects
carried out with such financial assistance during the
year covered by the report, including the number of
eligible individuals served;
(B) shall specify to each such entity the
evaluation criteria and data and information, which
shall include a mental health measurement of each
eligible individual served, to be submitted in such
report; and
(C) may require such entities to submit to the
Secretary such additional reports as the Secretary
considers appropriate.
(f) Application for Financial Assistance.--
(1) In general.--An eligible entity seeking financial
assistance under this section shall submit to the Secretary an
application therefor in such form, in such manner, and
containing such commitments and information as the Secretary
considers necessary to carry out this section.
(2) Matters to be included.--Each application submitted by
an eligible entity under paragraph (1) shall contain the
following:
(A) A description of the suicide prevention
services proposed to be provided by the eligible entity
and the identified need for those services.
(B) A detailed plan describing how the eligible
entity proposes to coordinate and deliver suicide
prevention services (including by providing
opportunities for mental wellness and personal growth)
to eligible individuals not currently receiving care
furnished by the Department, including--
(i) an identification of the community
partners, if any, with which the eligible
entity proposes to work in delivering such
services;
(ii) a description of the arrangements
currently in place between the eligible entity
and such partners; and
(iii) an identification of how long such
arrangements have been in place.
(C) Clearly defined objectives for the provision of
suicide prevention services.
(D) A description of the services the eligible
entity proposes to deliver directly and a description
of any services the eligible entity proposes to deliver
through an agreement with a community partner, if any.
(E) A description of the types of eligible
individuals at risk of suicide and their family
proposed to be provided suicide prevention services.
(F) An estimate of the number of eligible
individuals at risk of suicide and their family
proposed to be provided suicide prevention services and
the basis for such estimate, including the percentage
of those individuals who are not currently receiving
care furnished by the Department.
(G) The physical address of the primary location of
the eligible entity.
(H) A description of the geographic area and
boundaries the eligible entity plans to serve during
the year for which the application applies.
(I) Evidence of the experience of the eligible
entity (and the proposed partners of the entity) in
providing suicide prevention services to individuals at
risk of suicide, particularly to eligible individuals
at risk of suicide and their family.
(J) A description of the managerial and
technological capacity of the eligible entity--
(i) to coordinate the provision of suicide
prevention services with the provision of other
services;
(ii) to assess continuously the needs of
eligible individuals at risk of suicide and
their family for suicide prevention services;
(iii) to coordinate the provision of
suicide prevention services with the services
of the Department for which the beneficiaries
are eligible;
(iv) to continuously seek new sources of
assistance to ensure the continuity of suicide
prevention services for eligible individuals at
risk of suicide and their family as long as the
individual is determined to be at risk of
suicide; and
(v) to measure, over a long-term period,
the improved mental resiliency and mental
outlook of the eligible individual served.
(K) An agreement to use the measurement tool
provided by the Department for purposes of measuring
effectiveness of the programming as described in
paragraph (2) of subsection (h).
(L) A description of how the eligible entity plans
to assess the effectiveness of the provision of suicide
prevention services under this section.
(M) Such additional application criteria as the
Secretary considers appropriate.
(g) Technical Assistance.--
(1) In general.--The Secretary shall provide training and
technical assistance to eligible entities in receipt of
financial assistance under this section regarding--
(A) the data required to be collected and shared
with the Department;
(B) the means of data collection and sharing;
(C) familiarization with and appropriate use of any
tool to be used to measure the effectiveness of the use
of the financial assistance provided; and
(D) the requirements for reporting under subsection
(e)(4) on services provided via such financial
assistance.
(2) Provision of training and technical assistance.--The
Secretary may provide the training and technical assistance
described in paragraph (1) directly or through grants or
contracts with appropriate public or nonprofit entities.
(h) Administration of Grant Program.--
(1) Selection criteria.--The Secretary, in consultation
with entities specified in paragraph (3), shall establish
criteria for the selection of eligible entities that have
submitted applications under subsection (f).
(2) Development of measures and metrics.--The Secretary
shall develop, in consultation with entities specified in
paragraph (3), the following:
(A) A framework for collecting and sharing
information about entities in receipt of financial
assistance under this section for purposes of improving
the discovery of services available for eligible
individuals at risk of suicide and their family, set
forth by service type, locality, and eligibility
criteria.
(B) The measures to be used by each entity in
receipt of financial assistance under this section to
determine the effectiveness of the programming being
provided by such entity in improving mental resiliency
and mental outlook of eligible individuals at risk of
suicide and their family.
(C) Metrics for measuring the effectiveness of the
provision of financial assistance under this section,
including reducing suicide risk among eligible
individuals.
(3) Coordination.--In developing a plan for the design and
implementation of the provision of financial assistance under
this section, including criteria for the award of grants, the
Secretary shall consult with the following:
(A) Veterans service organizations.
(B) National organizations representing potential
community partners of eligible entities in providing
supportive services to address the needs of eligible
individuals at risk of suicide and their family,
including national organizations that--
(i) advocate for the needs of individuals
with or at risk of behavioral health
conditions;
(ii) represent mayors;
(iii) represent first responders;
(iv) represent chiefs of police and
sheriffs;
(v) represent governors;
(vi) represent a territory of the United
States; or
(vii) represent a Tribal alliance.
(C) National organizations that represent counties.
(D) Organizations with which the Department has a
current memorandum of agreement or understanding
related to mental health or suicide prevention.
(E) State departments of veterans affairs.
(F) National organizations representing members of
the reserve components of the Armed Forces.
(G) Vet Centers.
(H) Organizations, including institutions of higher
education, with experience in creating measurement
tools for purposes of determining programmatic
effectiveness.
(I) The National Alliance on Mental Illness.
(J) The Centers for Disease Control and Prevention.
(K) The Substance Abuse and Mental Health Services
Administration of the Department of Health and Human
Services.
(L) A labor organization (as such term is defined
in section 7103(a)(4) of title 5, United States Code).
(M) The PREVENTS task force established under
Executive Order 13861 (84 Fed. Reg. 8585; relating to
the national roadmap to empower veterans and end
suicide) .
(N) Such other organizations as the Secretary
considers appropriate.
(4) Report on grant criteria.--Not later than 30 days
before notifying eligible entities of the availability of
funding under this section, the Secretary shall submit to the
appropriate committees of Congress a report containing--
(A) criteria for the award of a grant under this
section;
(B) the tool or tools and metrics to be used by the
Department to measure the effectiveness of the use of
financial assistance provided under this section;
(C) a framework for the sharing of information
about entities in receipt of financial assistance under
this section; and
(D) the method by which the Secretary determines
financial responsibility for purposes of paragraph (3)
of subsection (m).
(i) Information on Potential Beneficiaries.--
(1) In general.--The Secretary may make available to
recipients of financial assistance under this section certain
information regarding potential beneficiaries of services for
which such financial assistance is provided.
(2) Information included.--The information made available
under paragraph (1) with respect to potential beneficiaries may
include the following:
(A) Confirmation of the status of a potential
beneficiary as a veteran.
(B) Confirmation of whether the potential
beneficiary is enrolled in the patient enrollment
system of the Department under section 1705 of title
38, United States Code.
(C) Confirmation of whether a potential beneficiary
is currently receiving care furnished by the Department
or has recently received such care.
(3) Opt-out.--The Secretary shall allow an eligible
individual to opt out of having their information shared under
this subsection with recipients of financial assistance under
this section.
(j) Duration.--The authority of the Secretary to provide financial
assistance under this section shall terminate on the date that is three
years after the date on which the first grant is awarded under this
section.
(k) Reporting and Assessment.--
(1) Interim report.--
(A) In general.--Not later than 18 months after the
date on which the first grant is awarded under this
section, the Secretary shall submit to the appropriate
committees of Congress a report on the provision of
financial assistance under this section.
(B) Elements.--The report submitted under
subparagraph (A) shall include the following:
(i) An assessment of the effectiveness of
the provision of financial assistance under
this section, including--
(I) the effectiveness of community
partners in conducting outreach to
eligible individuals at risk of suicide
and their family and reducing suicide
rates for eligible individuals; and
(II) the effectiveness of the
measures and metrics developed under
subsection (h)(2) at improving
coordination of suicide prevention
services.
(ii) A list of grant recipients and their
partner organizations that delivered services
funded by the grant and the amount of such
grant received by each recipient and partner
organization.
(iii) The number of eligible individuals
supported by each grant recipient, including
through services provided to family members.
(iv) The types of suicide prevention
services provided by each grant recipient and
partner organization.
(v) The number of eligible individuals
supported by each grant recipient under this
section, including through services provided to
family members, who were not previously
receiving care furnished by the Department.
(vi) The number of eligible individuals
whose mental resiliency and mental outlook
received a baseline measurement assessment
under this section and the number of such
individuals whose mental resiliency and mental
outlook will be measured by the Department or a
community partner over a period of time.
(vii) The types of data the Department was
able to collect and share with partners,
including a characterization of the benefits of
that data.
(viii) The number of eligible individuals
newly enrolled in the Veterans Health
Administration by grant recipients, set forth
by grant recipient.
(2) Final report.--Not later than three years after the
date on which the first grant is awarded under this section,
the Secretary shall submit to the appropriate committees of
Congress--
(A) a follow-up on the interim report submitted
under paragraph (1) containing the elements set forth
in subparagraph (B) of such paragraph; and
(B) a report on--
(i) the effectiveness of the provision of
financial assistance under this section,
including the effectiveness of community
partners in conducting outreach to eligible
individuals at risk of suicide and their family
and reducing suicide rates for eligible
individuals;
(ii) an assessment of the increased
capacity of the Department to provide services
to eligible individuals at risk of suicide and
their family, set forth by State, as a result
of the provision of financial assistance under
this section; and
(iii) the feasibility and advisability of
extending or expanding the provision of
financial assistance under this section.
(3) Third party assessment.--
(A) Study of grant program.--
(i) In general.--Not later than 180 days
after the date on which the first grant is
awarded under this section, the Secretary shall
seek to enter into a contract with an
appropriate entity described in subparagraph
(C) to conduct a study on the provision of
grants under this section.
(ii) Elements.--In conducting the study
under clause (i), the appropriate entity
shall--
(I) evaluate the effectiveness of
grants under this section in addressing
the factors that contribute to suicide
through the provision of services by
eligible entities located in the
communities where the eligible
individuals receiving those services
live; and
(II) compare the results of the
provision of grants under this section
with other national programs in
delivering resources to eligible
individuals in the communities where
they live that address the factors that
contribute to suicide.
(B) Assessment.--
(i) In general.--The contract under
subparagraph (A) shall require that not later
than two years after the date on which the
first grant is awarded under this section, the
appropriate entity shall submit to the
Secretary an assessment of the provision of
grants under this section based on the study
conducted pursuant to such contract.
(ii) Submittal to congress.--Upon receipt
of the assessment under clause (i), the
Secretary shall submit to the appropriate
committees of Congress a copy of the
assessment.
(C) Appropriate entity.--An appropriate entity
described in this subparagraph is a nongovernment
entity with experience optimizing and assessing
organizations that deliver services.
(l) Provision of Care to Eligible Individuals.--
(1) In general.--When the Secretary determines it is
clinically appropriate, the Secretary shall furnish to an
eligible individual receiving suicide prevention services
through a grant provided under this section an initial mental
health assessment and mental health or behavioral health care
services authorized under chapter 17 of title 38, United States
Code, that are required to treat the mental or behavioral
health care needs of the eligible individual, including risk of
suicide.
(2) Ineligible.--If an eligible individual refuses to
receive services under paragraph (1) or is ineligible for such
services, any ongoing clinical services provided by an eligible
entity receiving a grant under this section, or a community
partner of such entity, shall be at the expense of the entity.
(m) Definitions.--In this section:
(1) Appropriate committees of congress.--The term
``appropriate committees of Congress'' means--
(A) the Committee on Veterans' Affairs and the
Subcommittee on Military Construction, Veterans
Affairs, and Related Agencies of the Committee on
Appropriations of the Senate; and
(B) the Committee on Veterans' Affairs and the
Subcommittee on Military Construction, Veterans
Affairs, and Related Agencies of the Committee on
Appropriations of the House of Representatives.
(2) Collective impact model.--The term ``collective impact
model'' means a partnership between several entities that--
(A) collectively provides multiple suicide
prevention services;
(B) shares the common goal of reducing the risk of
suicide among eligible individuals;
(C) has a shared measurement system;
(D) engages in continuous communication; and
(E) includes an organization that acts as the
supporting infrastructure of the model by creating a
structured process for--
(i) strategic planning;
(ii) project management; and
(iii) supporting partner entities through
ongoing--
(I) facilitation;
(II) technology and communications
support;
(III) data collection and
reporting; and
(IV) administrative support.
(3) Eligible entity.--The term ``eligible entity'' means--
(A) an incorporated private institution or
foundation--
(i) no part of the net earnings of which
incurs to the benefit of any member, founder,
contributor, or individual;
(ii) that has a governing board that would
be responsible for the operation of the suicide
prevention services provided under this
section; and
(iii) that is approved by the Secretary as
to financial responsibility;
(B) a corporation wholly owned and controlled by an
organization meeting the requirements of clauses (i),
(ii), and (iii) of subparagraph (A);
(C) 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));
(D) a community-based organization--
(i) that is physically based in the
targeted community;
(ii) that can effectively network with
local civic organizations, regional health
systems, and other settings where eligible
individuals at risk of suicide and their family
are likely to have contact; and
(iii) that is approved by the Secretary as
to financial responsibility;
(E) a community-based organization--
(i) that is physically based in the
targeted community;
(ii) that has demonstrated the potential to
use a collective impact model to effectively
network and partner with community partners
that offer suicide prevention services to
reduce the risk of suicide for eligible
individuals; and
(iii) that is approved by the Secretary as
to financial responsibility; or
(F) a State or local government that is approved by
the Secretary as to financial responsibility.
(4) Eligible individual.--The term ``eligible individual''
means--
(A) a veteran, as defined in section 101 of title
38, United States Code;
(B) an eligible individual described in section
1720I(b) of such title;
(C) an individual described in any of clauses (i)
through (iv) of section 1712A(a)(1)(C) of such title;
or
(D) such other individual as the Secretary
considers appropriate.
(5) Emergency medical condition defined.--The term
``emergency medical condition'' means a medical or behavioral
condition manifesting itself by acute symptoms of sufficient
severity, including severe pain, such that the absence of
immediate medical attention could reasonably be expected to
result in--
(A) placing the health of the individual in serious
jeopardy;
(B) serious impairment to bodily functions; or
(C) serious dysfunction of bodily organs.
(6) Family.--The term ``family'' means, with respect to an
eligible individual at risk of suicide, any of the following:
(A) A parent.
(B) A spouse.
(C) A child.
(D) A sibling.
(E) A step-family member.
(F) An extended family member.
(G) Any other individual who lives with the
eligible individual.
(7) Necessary stabilizing treatment defined.--The term
``necessary stabilizing treatment'' means, with respect to an
emergency medical condition, to provide, for not greater than
72 hours, such medical treatment for the condition necessary to
assure, within reasonable medical probability, that no material
deterioration of the condition is likely to result from or
occur during the transfer of the individual from a facility.
(8) Peer specialist.--The term ``peer specialist'' means a
person eligible to be appointed as a peer specialist under
section 7402(b)(13) of title 38, United States Code.
(9) Risk of suicide.--The term ``risk of suicide'' means
exposure to or the existence of any of the following:
(A) Health risk factors, including the following:
(i) Mental health challenges.
(ii) Substance abuse.
(iii) Serious or chronic health conditions
or pain.
(iv) Traumatic brain injury.
(B) Environmental risk factors, including the
following:
(i) Access to lethal means (such as drugs,
firearms, etc.).
(ii) Prolonged stress.
(iii) Stressful life events.
(iv) Exposure to the suicide of another
person or to graphic or sensationalized
accounts of suicide.
(v) Unemployment.
(vi) Homelessness.
(vii) Recent loss.
(viii) Legal or financial challenges.
(C) Historical risk factors, including the
following:
(i) Previous suicide attempts.
(ii) Family history of suicide.
(iii) History of abuse, neglect, or trauma.
(10) Rural.--With respect to an area or community, the term
``rural'' has the meaning given that term in the Rural-Urban
Commuting Areas coding system of the Department of Agriculture.
(11) State.--The term ``State'' means each of several
States, the District of Columbia, the Northern Mariana Islands,
American Samoa, Guam, Puerto Rico, and the United States Virgin
Islands.
(12) Suicide prevention services.--
(A) In general.--The term ``suicide prevention
services'' means services to address the needs of
eligible individuals at risk of suicide and their
family and includes the following:
(i) Outreach to identify eligible
individuals at risk of suicide, with an
emphasis on eligible individuals who are at
highest risk or who are not receiving health
care or other services furnished by the
Department.
(ii) A baseline mental health assessment
for risk screening and referral to care at--
(I) a medical facility of the
Department;
(II) a Vet Center; or
(III) a non-Department facility if
the eligible individual refuses to or
is ineligible for care from the
Department or a Vet Center.
(iii) Education on suicide risk and
prevention to families and communities.
(iv) Individual and group therapy.
(v) Case management services.
(vi) Peer support services provided by peer
specialists.
(vii) Assistance in obtaining any benefit
from the Department that the eligible
individual at risk of suicide or their family
may be eligible to receive, including--
(I) vocational and rehabilitation
counseling;
(II) supportive services for
homeless veterans;
(III) employment and training
services;
(IV) educational assistance; and
(V) health care services.
(viii) Assistance in obtaining and
coordinating the provision of other benefits
provided by the Federal Government, a State or
local government, or an eligible entity.
(ix) The provision of emergency mental
health treatment to an eligible individual,
which may include--
(I) assessing the eligible
individual for immediate suicide risk;
(II) connecting the eligible
individual to the Veterans Crisis Line;
and
(III) in the case of an eligible
individual who is experiencing an
emergency medical condition--
(aa) paying for the
provision of necessary
stabilizing treatment provided
in a hospital or other medical
facility; and
(bb) transporting the
individual--
(AA) if the
individual is eligible
for care from the
Department, to a
medical facility of the
Department; or
(BB) if the
individual is not
eligible for care from
the Department, to a
medical facility not
operated by the
Department.
(x) Such other services necessary for
improving the resiliency of eligible
individuals at risk of suicide and their family
as the Secretary considers appropriate, which
may include--
(I) assistance with emergent needs
relating to--
(aa) daily living services;
(bb) personal financial
planning;
(cc) transportation
services;
(dd) legal services to
assist the eligible individual
with issues that may contribute
to risk of suicide; and
(ee) child care (not to
exceed $5,000 per family of the
eligible individual per fiscal
year);
(II) adaptive sports, equine
assisted therapy, or in-place or
outdoor recreational therapy;
(III) substance use reduction
programming;
(IV) individual, group, or family
counseling; and
(V) relationship coaching.
(B) Exclusion.--The term ``suicide prevention
services'' does not include direct cash assistance to
eligible individuals or their family.
(13) Vet center.--The term ``Vet Center'' has the meaning
given that term in section 1712A(h)(1) of title 38, United
States Code.
(14) Veterans crisis line.--The term ``Veterans Crisis
Line'' means the toll-free hotline for veterans established
under section 1720F(h) of such title.
(15) Veterans service organization.--The term ``veterans
service organization'' means any organization recognized by the
Secretary of Veterans Affairs for the representation of
veterans included as part of the annually updated list at
https://www.va.gov/vso/ or a successor website.
SEC. 202. STUDY ON FEASIBILITY AND ADVISABILITY OF THE DEPARTMENT OF
VETERANS AFFAIRS PROVIDING CERTAIN COMPLEMENTARY AND
INTEGRATIVE HEALTH SERVICES.
(a) In General.--Not later than 90 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 (c) at all
medical facilities of the Department of Veterans Affairs.
(b) Inclusion of Assessment of Report.--The study conducted under
subsection (a) shall include an assessment of the final report of the
Creating Options for Veterans' Expedited Recovery Commission (commonly
referred to as the ``COVER Commission'') established under section 931
of the Jason Simcakoski Memorial and Promise Act (title IX of Public
Law 114-198; 38 U.S.C. 1701 note).
(c) Treatments Described.--Complementary and integrative health
treatments described in this subjection shall consist of the following:
(1) Yoga.
(2) Meditation.
(3) Acupuncture.
(4) Chiropractic care.
(5) Other treatments that show sufficient evidence of
efficacy at treating mental or physical health conditions, as
determined by the Secretary.
(d) Report.--The Secretary shall submit to the Committee on
Veterans' Affairs of the Senate and the Committee on Veterans' Affairs
of the House of Representatives a report on the study completed under
subsection (a), including--
(1) the results of such study; and
(2) such recommendations regarding the furnishing of
complementary and integrative health treatments described in
subsection (c) as the Secretary considers appropriate.
SEC. 203. PILOT PROGRAM TO PROVIDE VETERANS ACCESS TO COMPLEMENTARY AND
INTEGRATIVE HEALTH SERVICES THROUGH ANIMAL THERAPY,
AGRITHERAPY, POST-TRAUMATIC GROWTH THERAPY, AND OUTDOOR
SPORTS AND RECREATION 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 pilot program to provide complementary and integrative
health services described in subsection (b) to eligible veterans from
the Department of Veterans Affairs or through the use of non-Department
entities for the treatment of post-traumatic stress disorder,
depression, anxiety, or other conditions as determined by the
Secretary.
(b) Treatments Described.--Complementary and integrative health
treatments described in this subsection shall consist of the following:
(1) Equine therapy.
(2) Other animal therapy.
(3) Agritherapy.
(4) Post-traumatic growth therapy.
(5) Outdoor sports and recreation therapy.
(c) Eligible Veterans.--A veteran is eligible to participate in the
pilot program under this section if the veteran--
(1) is enrolled in the system of patient enrollment of the
Department under section 1705(a) of title 38, United States
Code; and
(2) has received health care under the laws administered by
the Secretary during the two-year period preceding the initial
participation of the veteran in the pilot program.
(d) Duration.--
(1) In general.--The Secretary shall carry out the pilot
program under this section for a three-year period beginning on
the commencement of the pilot program.
(2) Extension.--The Secretary may extend the duration of
the pilot program under this section if the Secretary, based on
the results of the interim report submitted under subsection
(f)(1), determines that it is appropriate to do so.
(e) Locations.--
(1) In general.--The Secretary shall select not fewer than
five facilities of the Department at which to carry out the
pilot program under this section.
(2) Selection criteria.--In selecting facilities under
paragraph (1), the Secretary shall ensure that--
(A) the locations are in geographically diverse
areas; and
(B) not fewer than three facilities serve veterans
in rural or highly rural areas (as determined through
the use of the Rural-Urban Commuting Areas coding
system of the Department of Agriculture).
(f) Research on Effectiveness of Treatment.--
(1) In general.--The Secretary shall carry out the pilot
program in conjunction with academic researchers affiliated
with the Department of Veterans Affairs, including through
agreements under paragraph (2), in order for those researchers
to research the effectiveness of the treatments described in
subsection (b).
(2) Agreements.--Before commencing the pilot program, the
Secretary shall seek to enter into agreements with academic
researchers to ensure robust data collection and gathering
procedures are in place under the pilot program in order to
produce peer-reviewed journal articles.
(g) Reports.--
(1) Interim report.--
(A) In general.--Not later than one year after the
commencement of the pilot program under this section,
the Secretary shall submit to the Committee on
Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives a
report on the progress of the pilot program.
(B) Elements.--The report required by subparagraph
(A) shall include the following:
(i) The number of participants in the pilot
program.
(ii) The type or types of therapy offered
at each facility at which the pilot program is
being carried out.
(iii) An assessment of whether
participation by a veteran in the pilot program
resulted in any changes in clinically relevant
endpoints for the veteran with respect to the
conditions specified in subsection (a).
(iv) An assessment of the quality of life
of veterans participating in the pilot program,
including the results of a satisfaction survey
of the participants in the pilot program,
disaggregated by treatment under subsection
(b).
(v) The determination of the Secretary with
respect to extending the pilot program under
subsection (d)(2).
(vi) Any recommendations of the Secretary
with respect to expanding the pilot program.
(2) Final report.--Not later than 90 days after the
termination of the pilot program under this section, the
Secretary shall submit to the Committee on Veterans' Affairs of
the Senate and the Committee on Veterans' Affairs of the House
of Representatives a final report on the pilot program.
SEC. 204. DEPARTMENT OF VETERANS AFFAIRS INDEPENDENT REVIEWS OF CERTAIN
DEATHS OF VETERANS BY SUICIDE AND STAFFING LEVELS OF
MENTAL HEALTH PROFESSIONALS.
(a) Review of Deaths of Veterans by Suicide.--
(1) In general.--Not later than 90 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall seek to enter into an agreement with the National
Academies of Sciences, Engineering, and Medicine under which
the National Academies shall conduct a review of the deaths of
all covered veterans who died by suicide during the five-year
period ending on the date of the enactment of this Act,
regardless of whether information relating to such deaths has
been reported by the Centers for Disease Control and
Prevention.
(2) Elements.--The review required by paragraph (1) shall
include the following:
(A) The total number of covered veterans who died
by suicide during the five-year period ending on the
date of the enactment of this Act.
(B) The total number of covered veterans who died
by a violent death during such five-year period.
(C) The total number of covered veterans who died
by an accidental death during such five-year period.
(D) A description of each covered veteran described
in subparagraphs (A) through (C), including age,
gender, race, and ethnicity.
(E) A comprehensive list of prescribed medications
and legal or illegal substances as annotated on
toxicology reports of covered veterans described in
subparagraphs (A) through (C), specifically listing any
medications that carried a black box warning, were
prescribed for off-label use, were psychotropic, or
carried warnings that included suicidal ideation.
(F) A summary of medical diagnoses by physicians of
the Department of Veterans Affairs or physicians
providing services to covered veterans through programs
of the Department that led to the prescribing of
medications referred to in subparagraph (E) in cases of
post-traumatic stress disorder, traumatic brain injury,
military sexual trauma, and other anxiety and
depressive disorders.
(G) The number of instances in which a covered
veteran described in subparagraph (A), (B), or (C) was
concurrently on multiple medications prescribed by
physicians of the Department or physicians providing
services to veterans through programs of the Department
to treat post-traumatic stress disorder, traumatic
brain injury, military sexual trauma, other anxiety and
depressive disorders, or instances of comorbidity.
(H) The number of covered veterans described in
subparagraphs (A) through (C) who were not taking any
medication prescribed by a physician of the Department
or a physician providing services to veterans through a
program of the Department.
(I) With respect to the treatment of post-traumatic
stress disorder, traumatic brain injury, military
sexual trauma, or other anxiety and depressive
disorders, the percentage of covered veterans described
in subparagraphs (A) through (C) who received a non-
medication first-line treatment compared to the
percentage of such veterans who received medication
only.
(J) With respect to the treatment of covered
veterans described in subparagraphs (A) through (C) for
post-traumatic stress disorder, traumatic brain injury,
military sexual trauma, or other anxiety and depressive
disorders, the number of instances in which a non-
medication first-line treatment (such as cognitive
behavioral therapy) was attempted and determined to be
ineffective for such a veteran, which subsequently led
to the prescribing of a medication referred to in
subparagraph (E).
(K) A description and example of how the Department
determines and continually updates the clinical
practice guidelines governing the prescribing of
medications.
(L) An analysis of the use by the Department,
including protocols or practices at medical facilities
of the Department, of systematically measuring pain
scores during clinical encounters under the Pain as the
5th Vital Sign Toolkit of the Department and an
evaluation of the relationship between the use of such
measurements and the number of veterans concurrently on
multiple medications prescribed by physicians of the
Department.
(M) The percentage of covered veterans described in
subparagraphs (A) through (C) with combat experience or
trauma related to combat experience (including military
sexual trauma, traumatic brain injury, and post-
traumatic stress).
(N) An identification of the medical facilities of
the Department with markedly high prescription rates
and suicide rates for veterans receiving treatment at
those facilities.
(O) An analysis, by State, of programs of the
Department that collaborate with State Medicaid
agencies and the Centers for Medicare and Medicaid
Services, including the following:
(i) An analysis of the sharing of
prescription and behavioral health data for
veterans.
(ii) An analysis of whether Department
staff check with State prescription drug
monitoring programs before prescribing
medications to veterans.
(iii) A description of the procedures of
the Department for coordinating with
prescribers outside of the Department to ensure
that veterans are not overprescribed.
(iv) A description of actions that the
Department takes when a veteran is determined
to be overprescribed.
(P) An analysis of the collaboration of medical
centers of the Department with medical examiners'
offices or local jurisdictions to determine veteran
mortality and cause of death.
(Q) An identification and determination of a best
practice model to collect and share veteran death
certificate data between the Department of Veterans
Affairs, the Department of Defense, States, and tribal
entities.
(R) A description of how data relating to death
certificates of veterans is collected, determined, and
reported by the Department of Veterans Affairs.
(S) An assessment of any patterns apparent to the
National Academies of Sciences, Engineering, and
Medicine based on the review conducted under paragraph
(1).
(T) Such recommendations for further action that
would improve the safety and well-being of veterans as
the National Academies of Sciences, Engineering, and
Medicine determine appropriate.
(b) Review of Staffing Levels for Mental Health Professionals.--
(1) In general.--Not later than 90 days after the date of
the enactment of this Act, the Secretary shall seek to enter
into an agreement with the National Academies of Sciences,
Engineering, and Medicine under which the National Academies
shall conduct a review of the staffing levels for mental health
professionals of the Department.
(2) Elements.--The review required by paragraph (1) shall
include a description of the efforts of the Department to
maintain appropriate staffing levels for mental health
professionals, such as mental health counselors, marriage and
family therapists, and other appropriate counselors, including
the following:
(A) a description of any impediments to carry out
the education, training, and hiring of mental health
counselors and marriage and family therapists under
section 7302(a) of title 38, United States Code, and
strategies for addressing those impediments;
(B) a description of the objectives, goals, and
timing of the Department with respect to increasing the
representation of such counselors and therapists in the
behavioral health workforce of the Department,
including--
(i) a review of eligibility criteria for
such counselors and therapists and a comparison
of such criteria to that of other behavioral
health professions in the Department; and
(ii) an assessment of the participation of
such counselors and therapists in the mental
health professionals trainee program of the
Department and any impediments to such
participation;
(C) an assessment of the development by the
Department of hiring guidelines for mental health
counselors, marriage and family therapists, and other
appropriate counselors;
(D) a description of how the Department--
(i) identifies gaps in the supply of mental
health professionals; and
(ii) determines successful staffing ratios
for mental health professionals of the
Department;
(E) a description of actions taken by the
Secretary, in consultation with the Director of the
Office of Personnel Management, to create an
occupational series for mental health counselors and
marriage and family therapists of the Department and a
timeline for the creation of such an occupational
series; and
(F) a description of actions taken by the Secretary
to ensure that the national, regional, and local
professional standards boards for mental health
counselors and marriage and family therapists are
comprised of only mental health counselors and marriage
and family therapists and that the liaison from the
Department to such boards is a mental health counselor
or marriage and family therapist.
(c) Compilation of Data.--
(1) Form of compilation.--The Secretary of Veterans Affairs
shall ensure that data compiled under subsections (a) and (b)
is compiled in a manner that allows it to be analyzed across
all data fields for purposes of informing and updating clinical
practice guidelines of the Department of Veterans Affairs.
(2) Compilation of data regarding covered veterans.--In
compiling data under subsection (a)(2) regarding covered
veterans described in subparagraphs (A) through (C) of such
subsection, data regarding veterans described in each such
subparagraph shall be compiled separately and disaggregated by
year.
(d) Completion of Reviews and Reports.--Each agreement entered into
under subsections (a)(1) and (b)(1) shall require that the National
Academies of Sciences, Engineering, and Medicine complete the review
under each such subsection and submit to the Secretary of Veterans
Affairs a report containing the results of the review--
(1) with respect to the review under subsection (a)(1), not
later than 24 months after entering into the agreement; and
(2) with respect to the review under subsection (b)(1), not
later than 18 months after entering into the agreement.
(e) Reports.--Not later than 90 days after the completion by the
National Academies of Sciences, Engineering, and Medicine of each of
the reviews required under subsections (a) and (b), the Secretary of
Veterans Affairs shall--
(1) submit to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives a report on the results of the review; and
(2) make such report publicly available.
(f) Definitions.--In this section:
(1) The term ``black box warning'' means a warning
displayed on the label of a prescription drug that is designed
to call attention to the serious or life-threatening risk of
the prescription drug.
(2) The term ``covered veteran'' means a veteran who
received hospital care or medical services furnished by the
Department of Veterans Affairs during the five-year period
preceding the death of the veteran.
(3) The term ``first-line treatment'' means a potential
intervention that has been evaluated and assigned a high score
within clinical practice guidelines.
(4) The term ``State'' means each of the States,
territories, and possessions of the United States, the District
of Columbia, and the Commonwealth of Puerto Rico.
SEC. 205. COMPTROLLER GENERAL REPORT ON MANAGEMENT BY DEPARTMENT OF
VETERANS AFFAIRS OF VETERANS AT HIGH RISK FOR SUICIDE.
(a) In General.--Not later than 18 months after the date of the
enactment of this Act, the Comptroller General of the United States
shall submit to the Committee on Veterans' Affairs of the Senate and
the Committee on Veterans' Affairs of the House of Representatives a
report on the efforts of the Department of Veterans Affairs to manage
veterans at high risk for suicide.
(b) Elements.--The report required by subsection (a) shall include
the following:
(1) A description of how the Department identifies patients
as high risk for suicide, with particular consideration to the
efficacy of inputs into the Recovery Engagement and
Coordination for Health - Veterans Enhanced Treatment program
(commonly referred to as the ``REACH VET'' program) of the
Department, including an assessment of the efficacy of such
identifications disaggregated by 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. STUDY ON CONNECTION BETWEEN LIVING AT HIGH ALTITUDE AND
SUICIDE RISK FACTORS AMONG VETERANS.
(a) In General.--Not later than 180 days after the date of the
enactment of this Act, the Secretary of Veterans Affairs, in
consultation with Rural Health Resource Centers of the Office of Rural
Health of the Department of Veterans Affairs, shall commence the
conduct of a study on the connection between living at high altitude
and the risk of developing depression or dying by suicide among
veterans.
(b) Completion of Study.--The study conducted under subsection (a)
shall be completed not later than three years after the date of the
commencement of the study.
(c) Individual Impact.--The study conducted under subsection (a)
shall be conducted so as to determine the effect of high altitude on
suicide risk at the individual level, not at the State or county level.
(d) Report.--Not later than 150 days after the completion of the
study conducted under subsection (a), the Secretary shall submit to the
Committee on Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives a report on the
results of the study.
(e) Follow-up Study.--
(1) In general.--If the Secretary determines through the
study conducted under subsection (a) that living at high
altitude is a risk factor for developing depression or dying by
suicide, the Secretary shall conduct an additional study to
identify the following:
(A) The most likely biological mechanism that makes
living at high altitude a risk factor for developing
depression or dying by suicide.
(B) The most effective treatment or intervention
for reducing the risk of developing depression or dying
by suicide associated with living at high altitude.
(2) Report.--Not later than 150 days after completing the
study conducted under paragraph (1), the Secretary shall submit
to the Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of Representatives
a report on the results of the study.
SEC. 302. ESTABLISHMENT BY DEPARTMENT OF VETERANS AFFAIRS AND
DEPARTMENT OF DEFENSE OF A CLINICAL PROVIDER TREATMENT
TOOLKIT AND ACCOMPANYING TRAINING MATERIALS FOR
COMORBIDITIES.
(a) In General.--Not later than two years after the date of the
enactment of this Act, the Secretary of Veterans Affairs, in
consultation with the Secretary of Defense, shall develop a clinical
provider treatment toolkit and accompanying training materials for the
evidence-based management of comorbid mental health conditions,
comorbid mental health and substance use disorders, and a comorbid
mental health condition and chronic pain.
(b) Matters Included.--In developing the clinical provider
treatment toolkit and accompanying training materials under subsection
(a), the Secretary of Veterans Affairs and the Secretary of Defense
shall ensure that the toolkit and training materials include guidance
with respect to the following:
(1) The treatment of patients with post-traumatic stress
disorder who are also experiencing an additional mental health
condition, a substance use disorder, or chronic pain.
(2) The treatment of patients experiencing a mental health
condition, including anxiety, depression, or bipolar disorder,
who are also experiencing a substance use disorder or chronic
pain.
(3) The treatment of patients with traumatic brain injury
who are also experiencing--
(A) a mental health condition, including post-
traumatic stress disorder, anxiety, depression, or
bipolar disorder;
(B) a substance use disorder; or
(C) chronic pain.
SEC. 303. UPDATE OF CLINICAL PRACTICE GUIDELINES FOR ASSESSMENT AND
MANAGEMENT OF PATIENTS AT RISK FOR SUICIDE.
(a) In General.--In the first publication of the Department of
Veterans Affairs and Department of Defense Clinical Practice Guideline
for Assessment and Management of Patients at Risk for Suicide published
after the date of the enactment of this Act, the Secretary of Veterans
Affairs and the Secretary of Defense, through the Assessment and
Management of Patients at Risk for Suicide Work Group (in this section
referred to as the ``Work Group''), shall ensure the publication
includes the following:
(1) Enhanced guidance with respect to 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 efficacy of alternative
therapies, other than psychotherapy and pharmacotherapy,
including the following:
(A) Yoga therapy.
(B) Meditation therapy.
(C) Equine therapy.
(D) Other animal therapy.
(E) Training and caring for service dogs.
(F) Agritherapy.
(G) Art therapy.
(H) Outdoor sports therapy.
(I) Music therapy.
(J) Any other alternative therapy that the Work
Group considers appropriate.
(3) Guidance with respect to the findings of the Creating
Options for Veterans' Expedited Recovery Commission (commonly
referred to as the ``COVER Commission'') established under
section 931 of the Jason Simcakoski Memorial and Promise Act
(title IX of Public Law 114-198; 38 U.S.C. 1701 note).
(b) Rule of Construction.--Nothing in this section shall be
construed to prevent the Secretary of Veterans Affairs and the
Secretary of Defense from considering all relevant evidence, as
appropriate, in updating the Department of Veterans Affairs and
Department of Defense Clinical Practice Guideline for Assessment and
Management of Patients at Risk for Suicide, as required under
subsection (a), or from ensuring that the final clinical practice
guidelines updated under such subsection remain applicable to the
patient populations of the Department of Veterans Affairs and the
Department of Defense.
SEC. 304. ESTABLISHMENT BY DEPARTMENT OF VETERANS AFFAIRS AND
DEPARTMENT OF DEFENSE OF CLINICAL PRACTICE GUIDELINES FOR
THE TREATMENT OF SERIOUS MENTAL ILLNESS.
(a) In General.--Not later than two years after the date of the
enactment of this Act, the Secretary of Veterans Affairs, in
consultation with the Secretary of Defense and the Secretary of Health
and Human Services, shall complete the development of a clinical
practice guideline or guidelines for the treatment of serious mental
illness, to include the following conditions:
(1) Schizophrenia.
(2) Schizoaffective disorder.
(3) Persistent mood disorder, including bipolar disorder I
and II.
(4) Any other mental, behavioral, or emotional disorder
resulting in serious functional impairment that substantially
interferes with major life activities as the Secretary of
Veterans Affairs, in consultation with the Secretary of Defense
and the Secretary of Health and Human Services, considers
appropriate.
(b) Matters Included in Guidelines.--The clinical practice
guideline or guidelines developed under subsection (a) shall include
the following:
(1) Guidance contained in the 2016 Clinical Practice
Guidelines for the Management of Major Depressive Disorders of
the Department of Veterans Affairs and the Department of
Defense.
(2) Guidance with respect to the treatment of patients with
a condition described in subsection (a).
(3) A list of evidence-based therapies for the treatment of
conditions described in subsection (a).
(4) An appropriate guideline for the administration of
pharmacological therapy, psychological or behavioral therapy,
or other therapy for the management of conditions described in
subsection (a).
(c) Assessment of Existing Guidelines.--Not later than two years
after the date of the enactment of this Act, the Secretary of Veterans
Affairs, in consultation with the Secretary of Defense and the
Secretary of Health and Human Services, shall complete an assessment of
the 2016 Clinical Practice Guidelines for the Management of Major
Depressive Disorders to determine whether an update to such guidelines
is necessary.
(d) Work Group.--
(1) Establishment.--The Secretary of Veterans Affairs, the
Secretary of Defense, and the Secretary of Health and Human
Services shall create a work group to develop the clinical
practice guideline or guidelines under subsection (a) to be
known as the ``Serious Mental Illness Work Group'' (in this
subsection referred to as the ``Work Group'').
(2) Membership.--The Work Group created under paragraph (1)
shall be comprised of individuals that represent Federal
Government entities and non-Federal Government entities with
expertise in the areas covered by the Work Group, including the
following entities:
(A) Academic institutions that specialize in
research for the treatment of conditions described in
subsection (a).
(B) The Health Services Research and Development
Service of the Department of Veterans Affairs.
(C) The Office of the Assistant Secretary for
Mental Health and Substance Use of the Department of
Health and Human Services.
(D) The National Institute of Mental Health.
(E) The Indian Health Service.
(F) Relevant organizations with expertise in
researching, diagnosing, or treating conditions
described in subsection (a).
(3) Relation to other work groups.--The Work Group shall be
created and conducted in the same manner as other work groups
for the development of clinical practice guidelines for the
Department of Veterans Affairs and the Department of Defense.
(e) Rule of Construction.--Nothing in this section shall be
construed to prevent the Secretary of Veterans Affairs and the
Secretary of Defense from considering all relevant evidence, as
appropriate, in creating the clinical practice guideline or guidelines
required under subsection (a) or from ensuring that the final clinical
practice guideline or guidelines developed under such subsection and
subsequently updated, as appropriate, remain applicable to the patient
populations of the Department of Veterans Affairs and the Department of
Defense.
SEC. 305. PRECISION MEDICINE INITIATIVE OF DEPARTMENT OF VETERANS
AFFAIRS TO IDENTIFY AND VALIDATE BRAIN AND MENTAL HEALTH
BIOMARKERS.
(a) In General.--Beginning not later than 18 months after the date
of the enactment of this Act, the Secretary of Veterans Affairs shall
develop and implement an initiative of the Department of Veterans
Affairs to identify and validate brain and mental health biomarkers
among veterans, with specific consideration for depression, anxiety,
post-traumatic stress disorder, bipolar disorder, traumatic brain
injury, and such other mental health conditions as the Secretary
considers appropriate. Such initiative may be referred to as the
``Precision Medicine for Veterans Initiative''.
(b) Model of Initiative.--The initiative under subsection (a) shall
be modeled on the All of Us Precision Medicine Initiative administered
by the National Institutes of Health with respect to large-scale
collection of standardized data and open data sharing.
(c) 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.--
(i) In general.--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.
(ii) Research.--The Secretary shall assist
the National Institutes of Health and the
Department of Energy in the use by the National
Institutes of Health or the Department of
Energy of data collected under the initiative
for research purposes under clause (i).
(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. STATISTICAL ANALYSES AND DATA EVALUATION BY DEPARTMENT OF
VETERANS AFFAIRS.
(a) In General.--Chapter 1 of title 38, United States Code, is
amended by adding at the end the following new section:
``Sec. 119. Contracting for statistical analyses and data evaluation
``(a) In General.--The Secretary may enter into a contract or other
agreement with an academic institution or other qualified entity, as
determined by the Secretary, to carry out statistical analyses and data
evaluation as required of the Secretary by law.''.
``(b) Rule of Construction.--Nothing in this section may be
construed to limit the authority of the Secretary to enter into
contracts or other agreements for statistical analyses and data
evaluation under any other provision of law.''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 1 of such title is amended by adding at the end the following
new item:
``119. Contracting for statistical analyses and data evaluation.''.
TITLE IV--OVERSIGHT OF MENTAL HEALTH CARE AND RELATED SERVICES
SEC. 401. STUDY ON EFFECTIVENESS OF SUICIDE PREVENTION AND MENTAL
HEALTH OUTREACH PROGRAMS OF DEPARTMENT OF VETERANS
AFFAIRS.
(a) In General.--Not later than 180 days after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall enter
into an agreement with a non-Federal Government entity 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,
which shall include the establishment of targets, metrics, and
action plans to describe and assess those campaigns.
(2) Use of metrics.--
(A) In general.--The goals established under
paragraph (1) shall be measured by metrics specific to
different media types.
(B) Factors to consider.--In using metrics under
subparagraph (A), the Secretary shall determine the
best methodological approach for each media type and
shall consider the following:
(i) Metrics relating to social media, which
may include the following:
(I) Impressions.
(II) Reach.
(III) Engagement rate.
(IV) Such other metrics as the
Secretary considers necessary.
(ii) Metrics relating to television, which
may include the following:
(I) Nielsen ratings.
(II) Such other metrics as the
Secretary considers necessary.
(iii) Metrics relating to email, which may
include the following:
(I) Open rate.
(II) Response rate.
(III) Click rate.
(IV) Such other metrics as the
Secretary considers necessary.
(C) Update.--The Secretary shall periodically
update the metrics under subparagraph (B) as more
accurate metrics become available.
(3) Targets.--The Secretary shall establish targets to
track the metrics used under paragraph (2).
(4) Consultation.--In establishing goals under paragraph
(1), the Secretary shall consult with the following:
(A) Relevant stakeholders, such as organizations
that represent veterans, as determined by the
Secretary.
(B) Mental health and suicide prevention experts.
(C) Such other persons as the Secretary considers
appropriate.
(5) Initial report.--Not later than 180 days after the date
of the enactment of this Act, the Secretary shall submit to the
Committee on Veterans' Affairs of the Senate and the Committee
on Veterans' Affairs of the House of Representatives a report
detailing the goals established under paragraph (1) for the
mental health and suicide prevention media outreach campaigns
of the Department, including the metrics and targets for such
metrics by which those goals are to be measured under
paragraphs (2) and (3).
(6) Annual report.--Not later than one year after the
submittal of the report under paragraph (5), and annually
thereafter, the Secretary shall submit to the Committee on
Veterans' Affairs of the Senate and the Committee on Veterans'
Affairs of the House of Representatives a report detailing--
(A) the progress of the Department in meeting the
goals established under paragraph (1) and the targets
established under paragraph (3); and
(B) a description of action to be taken by the
Department to modify mental health and suicide
prevention media outreach campaigns if those goals and
targets are not being met.
(b) Report on Use of Funds by Office of Mental Health and Suicide
Prevention.--Not later than 180 days after the date of the enactment of
this Act, and semiannually thereafter, the Secretary shall submit to
the Committee on Appropriations and the Committee on Veterans' Affairs
of the Senate and the Committee on Appropriations and the Committee on
Veterans' Affairs of the House of Representatives a report containing
the expenditures and obligations of the Office of Mental Health and
Suicide Prevention of the Veterans Health Administration during the
period covered by the report.
SEC. 403. COMPTROLLER GENERAL MANAGEMENT REVIEW OF MENTAL HEALTH AND
SUICIDE PREVENTION SERVICES OF DEPARTMENT OF VETERANS
AFFAIRS.
(a) In General.--Not later than three years after the date of the
enactment of this Act, the Comptroller General of the United States
shall submit to the Committee on Veterans' Affairs of the Senate and
the Committee on Veterans' Affairs of the House of Representatives a
management review of the mental health and suicide prevention services
provided by the Department of Veterans Affairs.
(b) Elements.--The management review required by subsection (a)
shall include the following:
(1) An assessment of the infrastructure under the control
of or available to the Office of Mental Health and Suicide
Prevention of the Department of Veterans Affairs or available
to the Department of Veterans Affairs for suicide prevention
efforts not operated by the Office of Mental Health and Suicide
Prevention.
(2) A description of the management and organizational
structure of the Office of Mental Health and Suicide
Prevention, including roles and responsibilities for each
position.
(3) A description of the operational policies and processes
of the Office of Mental Health and Suicide Prevention.
(4) An assessment of suicide prevention practices and
initiatives available from the Department and through community
partnerships.
(5) An assessment of the staffing levels at the Office of
Mental Health and Suicide Prevention, disaggregated by type of
position, and including the location of any staffing
deficiencies.
(6) An assessment of the Nurse Advice Line pilot program
conducted by the Department.
(7) An assessment of recruitment initiatives in rural areas
for mental health professionals of the Department.
(8) An assessment of strategic planning conducted by the
Office of Mental Health and Suicide Prevention.
(9) An assessment of the communication, and the
effectiveness of such communication--
(A) within the central office of the Office of
Mental Health and Suicide Prevention;
(B) between that central office and any staff
member or office in the field, including chaplains,
attorneys, law enforcement personnel, and volunteers;
and
(C) between that central office, local facilities
of the Department, and community partners of the
Department, including first responders, community
support groups, and health care industry partners.
(10) An assessment of how effectively the Office of Mental
Health and Suicide Prevention implements operational policies
and procedures.
(11) An assessment of how the Department of Veterans
Affairs and the Department of Defense coordinate suicide
prevention efforts, and recommendations on how the Department
of Veterans Affairs and Department of Defense can more
effectively coordinate those efforts.
(12) An assessment of such other areas as the Comptroller
General considers appropriate to study.
SEC. 404. COMPTROLLER GENERAL REPORT ON EFFORTS OF DEPARTMENT OF
VETERANS AFFAIRS TO INTEGRATE MENTAL HEALTH CARE INTO
PRIMARY CARE CLINICS.
(a) Initial Report.--
(1) In general.--Not later than two years after the date of
the enactment of this Act, the Comptroller General of the
United States shall submit to the Committee on Veterans'
Affairs of the Senate and the Committee on Veterans' Affairs of
the House of Representatives a report on the efforts of the
Department of Veterans Affairs to integrate mental health care
into primary care clinics of the Department.
(2) Elements.--The report required by subsection (a) shall
include the following:
(A) An assessment of the efforts of the Department
to integrate mental health care into primary care
clinics of the Department.
(B) An assessment of the effectiveness of such
efforts.
(C) An assessment of how the health care of
veterans is impacted by such integration.
(D) A description of how care is coordinated by the
Department between specialty mental health care and
primary care, including a description of the following:
(i) How documents and patient information
are transferred and the effectiveness of those
transfers.
(ii) How care is coordinated when veterans
must travel to different facilities of the
Department.
(iii) How a veteran is reintegrated into
primary care after receiving in-patient mental
health care.
(E) An assessment of how the integration of mental
health care into primary care clinics is implemented at
different types of facilities of the Department.
(F) Such recommendations on how the Department can
better integrate mental health care into primary care
clinics as the Comptroller General considers
appropriate.
(G) An assessment of such other areas as the
Comptroller General considers appropriate to study.
(b) Community Care Integration Report.--
(1) In general.--Not later than two years after the date on
which the Comptroller General submits the report required under
subsection (a)(1), the Comptroller General shall submit to the
Committee on Veterans' Affairs of the Senate and the Committee
on Veterans' Affairs of the House of Representatives a report
on the efforts of the Department to integrate community-based
mental health care into the Veterans Health Administration.
(2) Elements.--The report required by paragraph (1) shall
include the following:
(A) An assessment of the efforts of the Department
to integrate community-based mental health care into
the Veterans Health Administration.
(B) An assessment of the effectiveness of such
efforts.
(C) An assessment of how the health care of
veterans is impacted by such integration.
(D) A description of how care is coordinated
between providers of community-based mental health care
and the Veterans Health Administration, including a
description of how documents and patient information
are transferred and the effectiveness of those
transfers between--
(i) the Veterans Health Administration and
providers of community-based mental health
care; and
(ii) providers of community-based mental
health care and the Veterans Health
Administration.
(E) An assessment of any disparities in the
coordination of community-based mental health care into
the Veterans Health Administration by location and type
of facility.
(F) An assessment of the military cultural
competency of health care providers providing
community-based mental health care to veterans.
(G) Such recommendations on how the Department can
better integrate community-based mental health care
into the Veterans Health Administration as the
Comptroller General considers appropriate.
(H) An assessment of such other areas as the
Comptroller General considers appropriate to study.
(3) Community-based mental health care defined.--In this
subsection, the term ``community-based mental health care''
means mental health care paid for by the Department but
provided by a non-Department health care provider at a non-
Department facility, including care furnished under section
1703 of title 38, United States Code (as in effect on the date
specified in section 101(b) of the Caring for Our Veterans Act
of 2018 (title I of Public Law 115-182)).
SEC. 405. JOINT MENTAL HEALTH PROGRAMS BY DEPARTMENT OF VETERANS
AFFAIRS AND DEPARTMENT OF DEFENSE.
(a) Report on Mental Health Programs.--
(1) In general.--Not later than 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 Veterans' Affairs and the
Committee on Armed Services of the Senate and the Committee on
Veterans' Affairs and the Committee on Armed Services of the
House of Representatives a report on mental health programs of
the Department of Veterans Affairs and the Department of
Defense and joint programs of the Departments.
(2) Elements.--The report required by paragraph (1) shall
include the following:
(A) A description of mental health programs
operated by the Department of Veterans Affairs,
including the following:
(i) Transition assistance programs.
(ii) Clinical and non-clinical mental
health initiatives, including centers of
excellence of the Department of Veterans
Affairs for traumatic brain injury and post-
traumatic stress disorder.
(iii) Programs that may secondarily improve
mental health, including employment, housing
assistance, and financial literacy programs.
(iv) Research into mental health issues and
conditions, to include post-traumatic stress
disorder, depression, anxiety, bipolar
disorder, traumatic brain injury, suicidal
ideation, and any other issues or conditions as
the Secretary of Veterans Affairs considers
necessary.
(B) A description of mental health programs
operated by the Department of Defense, including the
following:
(i) Transition assistance programs.
(ii) Clinical and non-clinical mental
health initiatives, including the National
Intrepid Center of Excellence and the Intrepid
Spirit Centers.
(iii) Programs that may secondarily improve
mental health, including employment, housing
assistance, and financial literacy programs.
(iv) Research into mental health issues and
conditions, to include post-traumatic stress
disorder, depression, anxiety, bipolar
disorder, traumatic brain injury, suicidal
ideation, and any other issues or conditions as
the Secretary of Defense considers necessary.
(C) A description of mental health programs jointly
operated by the Department of Veterans Affairs and the
Department of Defense, including the following:
(i) Transition assistance programs.
(ii) Clinical and non-clinical mental
health initiatives.
(iii) Programs that may secondarily improve
mental health, including employment, housing
assistance, and financial literacy programs.
(iv) Research into mental health issues and
conditions, to include post-traumatic stress
disorder, depression, anxiety, bipolar
disorder, traumatic brain injury, suicidal
ideation, and completed suicides, including
through the use of the joint suicide data
repository of the Department of Veterans
Affairs and the Department of Defense, and any
other issues or conditions as the Secretary of
Veterans Affairs and the Secretary of Defense
consider necessary.
(D) Recommendations for coordinating mental health
programs of the Department of Veterans Affairs and the
Department of Defense to improve the effectiveness of
those programs.
(E) Recommendations for novel joint programming of
the Department of Veterans Affairs and the Department
of Defense to improve the mental health of members of
the Armed Forces and veterans.
(b) Authorization of a Public-private Partnership to Establish a
Joint Center of Excellence.--
(1) In general.--Not later than two years after the date of
the enactment of this Act, the Secretary of Veterans Affairs,
in consultation with the Secretary of Defense, shall enter into
agreements with private entities and philanthropic
organizations to establish a center of excellence to be known
as the ``Joint VA/DOD National Intrepid Center of Excellence
Intrepid Spirit Center'' (in this subsection referred to as the
``Center'').
(2) Duties.--The Center shall conduct the following:
(A) Joint mental health care delivery programs of
the Department of Veterans Affairs and the Department
of Defense for veterans and members of the Armed
Forces, including members of the reserve components,
who reside in rural and highly rural areas.
(B) Mental health and suicide prevention research
focused on veterans and members of the Armed Forces,
including members of the reserve components, to inform
treatment and care delivery programs.
(3) Location.--The Center shall be established in a
location that--
(A) is geographically distant from existing and
planned Intrepid Spirit Centers of the Department of
Defense;
(B) is in close proximity to rural and highly rural
areas and able to serve veterans in those areas who, as
of the date of the enactment of this Act, are
underserved by the Department of Veterans Affairs; and
(C) is in close proximity to a medical school of an
institution of higher education.
(c) 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.
TITLE V--IMPROVEMENT OF MENTAL HEALTH MEDICAL WORKFORCE
SEC. 501. STAFFING IMPROVEMENT PLAN FOR MENTAL HEALTH PROVIDERS OF
DEPARTMENT OF VETERANS AFFAIRS.
(a) Staffing Plan.--
(1) In general.--Not later than one year after the date of
the enactment of this Act, the Secretary of Veterans Affairs,
in consultation with the Inspector General of the Department of
Veterans Affairs, shall submit to the Committee on Veterans'
Affairs of the Senate and the Committee on Veterans' Affairs of
the House of Representatives a plan to address staffing of
mental health providers of the Department of Veterans Affairs,
including filling any open positions.
(2) Elements.--The plan required by paragraph (1) shall
include the following:
(A) An estimate of the number of positions for
mental health providers of the Department that need to
be filled to meet demand.
(B) An identification of the steps that the
Secretary will take to address mental health staffing
for the Department.
(C) A description of any region-specific hiring
incentives to be used by the Secretary in consultation
with the directors of Veterans Integrated Service
Networks and medical centers of the Department.
(D) A description of any local retention or
engagement incentives to be used by directors of
Veterans Integrated Service Networks.
(E) Such recommendations for legislative or
administrative action as the Secretary considers
necessary to aid in addressing mental health staffing
for the Department.
(3) Report.--Not later than one year after the submittal of
the plan required by paragraph (1), the Secretary shall submit
to the Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of Representatives
a report setting forth the number of mental health providers
hired by the Department during the one-year period preceding
the submittal of the report.
(b) Occupational Series for Certain Mental Health Providers.--Not
later than one year after the date of the enactment of this Act, the
Secretary of Veterans Affairs, in consultation with the Office of
Personnel Management, shall develop an occupational series for licensed
professional mental health counselors and marriage and family
therapists of the Department of Veterans Affairs.
SEC. 502. 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. 503. ESTABLISHMENT OF DEPARTMENT OF VETERANS AFFAIRS READJUSTMENT
COUNSELING SERVICE SCHOLARSHIP PROGRAM.
(a) In General.--Chapter 76 of title 38, United States Code, is
amended by inserting after subchapter VIII the following new
subchapter:
``SUBCHAPTER IX--READJUSTMENT COUNSELING SERVICE SCHOLARSHIP PROGRAM
``Sec. 7698. Requirement for program
``As part of the Educational Assistance Program, the Secretary
shall carry out a scholarship program under this subchapter. The
program shall be known as the Department of Veterans Affairs
Readjustment Counseling Service Scholarship Program (in this subchapter
referred to as the `Program').
``Sec. 7699. Eligibility; agreement
``(a) In General.--An individual is eligible to participate in the
Program, as determined by the Readjustment Counseling Service of the
Department, if the individual--
``(1) is accepted for enrollment or enrolled (as described
in section 7602 of this title) in a program of study at an
accredited educational institution, school, or training program
leading to a terminal degree in psychology, social work,
marriage and family therapy, or mental health counseling that
would meet the education requirements for appointment to a
position under section 7402(b) of this title; and
``(2) enters into an agreement with the Secretary under
subsection (c).
``(b) Priority.--In selecting individuals to participate in the
Program, the Secretary shall give priority to the following
individuals:
``(1) An individual who agrees to be employed by a Vet
Center located in a community that is--
``(A) designated as a medically underserved
population under section 330(b)(3) of the Public Health
Service Act (42 U.S.C. 254b(b)(3)); and
``(B) in a State with a per capita population of
veterans of more than five percent according to the
National Center for Veterans Analysis and Statistics
and the Bureau of the Census.
``(2) An individual who is a veteran.
``(c) Agreement.--An agreement between the Secretary and a
participant in the Program shall (in addition to the requirements set
forth in section 7604 of this title) include the following:
``(1) An agreement by the Secretary to provide the
participant with a scholarship under the Program for a
specified number of school years during which the participant
pursues a program of study described in subsection (a)(1) that
meets the requirements set forth in section 7602(a) of this
title.
``(2) An agreement by the participant to serve as a full-
time employee of the Department at a Vet Center for a six-year
period following the completion by the participant of such
program of study (in this subchapter referred to as the `period
of obligated service').
``(d) Vet Center Defined.--In this section, the term `Vet Center'
has the meaning given that term in section 1712A(h) of this title.
``Sec. 7699A. Obligated service
``(a) In General.--Each participant in the Program shall provide
service as a full-time employee of the Department at a Vet Center (as
defined in section 7699(d) of this title) for the period of obligated
service set forth in the agreement of the participant entered into
under section 7604 of this title.
``(b) Determination of Service Commencement Date.--(1) Not later
than 60 days before the service commencement date of a participant, the
Secretary shall notify the participant of that service commencement
date.
``(2) The date specified in paragraph (1) with respect to a
participant is the date for the beginning of the period of obligated
service of the participant.
``Sec. 7699B. Breach of agreement: liability
``(a) Liquidated Damages.--(1) A participant in the Program (other
than a participant described in subsection (b)) who fails to accept
payment, or instructs the educational institution in which the
participant is enrolled not to accept payment, in whole or in part, of
a scholarship under the agreement entered into under section 7604 of
this title shall be liable to the United States for liquidated damages
in the amount of $1,500.
``(2) Liability under paragraph (1) is in addition to any period of
obligated service or other obligation or liability under such
agreement.
``(b) Liability During Program of Study.--(1) Except as provided in
subsection (d), a participant in the Program shall be liable to the
United States for the amount which has been paid to or on behalf of the
participant under the agreement if any of the following occurs:
``(A) The participant fails to maintain an acceptable level
of academic standing in the educational institution in which
the participant is enrolled (as determined by the educational
institution under regulations prescribed by the Secretary).
``(B) The participant is dismissed from such educational
institution for disciplinary reasons.
``(C) The participant voluntarily terminates the program of
study in such educational institution before the completion of
such program of study.
``(2) Liability under this subsection is in lieu of any service
obligation arising under the agreement.
``(c) Liability During Period of Obligated Service.--(1) Except as
provided in subsection (d), if a participant in the Program does not
complete the period of obligated service of the participant, the United
States shall be entitled to recover from the participant an amount
determined in accordance with the following formula: A = 3F(t-s/t).
``(2) In the formula in paragraph (1):
``(A) `A' is the amount the United States is entitled to
recover.
``(B) `F' is the sum of--
``(i) the amounts paid under this subchapter to or
on behalf of the participant; and
``(ii) the interest on such amounts which would be
payable if at the time the amounts were paid they were
loans bearing interest at the maximum legal prevailing
rate, as determined by the Treasurer of the United
States.
``(C) `t' is the total number of months in the period of
obligated service of the participant.
``(D) `s' is the number of months of such period served by
the participant.
``(d) Limitation on Liability for Reductions-in-force.--Liability
shall not arise under subsection (c) if the participant fails to
maintain employment as a Department employee due to a staffing
adjustment.
``(e) Period for Payment of Damages.--Any amount of damages that
the United States is entitled to recover under this section shall be
paid to the United States within the one-year period beginning on the
date of the breach of the agreement.''.
(b) Conforming and Technical Amendments.--
(1) Conforming amendments.--
(A) Establishment of program.--Section 7601(a) of
such title is amended--
(i) in paragraph (5), by striking ``and'';
(ii) in paragraph (6), by striking the
period and inserting ``; and''; and
(iii) by adding at the end the following
new paragraph:
``(7) the readjustment counseling service scholarship
program provided for in subchapter IX of this chapter.''.
(B) Eligibility.--Section 7602 of such title is
amended--
(i) in subsection (a)(1)--
(I) by striking ``or VI'' and
inserting ``VI, or IX''; and
(II) by striking ``subchapter VI''
and inserting ``subchapter VI or IX'';
and
(ii) in subsection (b), by striking ``or
VI'' and inserting ``VI, or IX''.
(C) Application.--Section 7603(a)(1) of such title
is amended by striking ``or VIII'' and inserting
``VIII, or IX''.
(D) Terms of agreement.--Section 7604 of such title
is amended by striking ``or VIII'' each place it
appears and inserting ``VIII, or IX''.
(E) Annual report.--Section 7632 of such title is
amended--
(i) in paragraph (1), by striking ``and the
Specialty Education Loan Repayment Program''
and inserting ``the Specialty Education Loan
Repayment Program, and the Readjustment
Counseling Service Scholarship Program''; and
(ii) in paragraph (4), by striking ``and
per participant in the Specialty Education Loan
Repayment Program'' and inserting ``per
participant in the Specialty Education Loan
Repayment Program, and per participant in the
Readjustment Counseling Service Scholarship
Program''.
(2) Table of sections.--The table of sections at the
beginning of chapter 76 of such title is amended by inserting
after the items relating to subchapter VIII the following:
``subchapter ix--readjustment counseling service scholarship program
``Sec.
``7698. Requirement for program.
``7699. Eligibility; agreement.
``7699A. Obligated service.
``7699B. Breach of agreement: liability.''.
(c) Effective Date.--The Secretary of Veterans Affairs shall begin
awarding scholarships under subchapter IX of chapter 76 of title 38,
United States Code, as added by subsection (a), for programs of study
beginning not later than one year after the date of the enactment of
this Act.
SEC. 504. COMPTROLLER GENERAL REPORT ON READJUSTMENT COUNSELING SERVICE
OF DEPARTMENT OF VETERANS AFFAIRS.
(a) In General.--Not later than one year after the date of the
enactment of this Act, the Comptroller General of the United States
shall submit to the Committee on Veterans' Affairs of the Senate and
the Committee on Veterans' Affairs of the House of Representatives a
report on the Readjustment Counseling Service of the Department of
Veterans Affairs.
(b) Elements.--The report required by subsection (a) shall include
the following:
(1) An assessment of the adequacy and types of treatment,
counseling, and other services provided at Vet Centers,
including recommendations on whether and how such treatment,
counseling, and other services can be expanded.
(2) An assessment of the efficacy of outreach efforts by
the Readjustment Counseling Service, including recommendations
for how outreach efforts can be improved.
(3) An assessment of barriers to care at Vet Centers,
including recommendations for overcoming those barriers.
(4) An assessment of the efficacy and frequency of the use
of telehealth by counselors of the Readjustment Counseling
Service to provide mental health services, including
recommendations for how the use of telehealth can be improved.
(5) An assessment of the feasibility and advisability of
expanding eligibility for services from the Readjustment
Counseling Service, including--
(A) recommendations on what eligibility criteria
could be expanded; and
(B) an assessment of potential costs and increased
infrastructure requirements if eligibility is expanded.
(6) An assessment of the use of Vet Centers by members of
the reserve components of the Armed Forces who were never
activated and recommendations on how to better reach those
members.
(7) An assessment of the use of Vet Centers by eligible
family members of former members of the Armed Forces and
recommendations on how to better reach those family members.
(8) An assessment of the efficacy of group therapy and the
level of training of providers at Vet Centers in administering
group therapy.
(9) An assessment of the efficiency and effectiveness of
the task organization structure of Vet Centers.
(10) An assessment of the use of Vet Centers by Native
American veterans, as defined in section 3765 of title 38,
United States Code, and recommendations on how to better reach
those veterans.
(c) Vet Center Defined.--In this section, the term ``Vet Center''
has the meaning given that term in section 1712A(h) of title 38, United
States Code.
SEC. 505. EXPANSION OF REPORTING REQUIREMENTS ON READJUSTMENT
COUNSELING SERVICE OF DEPARTMENT OF VETERANS AFFAIRS.
(a) Expansion of Annual Report.--Paragraph (2)(C) of section
7309(e) of title 38, United States Code, is amended by inserting before
the period at the end the following: ``, including the resources
required to meet such unmet need, such as additional staff, additional
locations, additional infrastructure, infrastructure improvements, and
additional mobile Vet Centers''.
(b) Biennial Report.--Such section is amended by adding at the end
the following new paragraph:
``(3) For each even numbered year in which the report required by
paragraph (1) is submitted, the Secretary shall include in such report
a prediction of--
``(A) trends in demand for care;
``(B) long-term investments required with respect to the
provision of care;
``(C) requirements relating to maintenance of
infrastructure; and
``(D) other capital investment requirements with respect to
the Readjustment Counseling Service, including Vet Centers,
mobile Vet Centers, and community access points.''.
SEC. 506. 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. 507. SUICIDE PREVENTION COORDINATORS.
(a) Staffing Requirement.--Beginning not later than one year after
the date of the enactment of this Act, the Secretary of Veterans
Affairs shall ensure that each medical center of the Department of
Veterans Affairs has not less than one suicide prevention coordinator.
(b) Study on Reorganization.--
(1) In general.--Not later than one year after the date of
the enactment of this Act, the Secretary, in consultation with
the Office of Mental Health and Suicide Prevention of the
Department, shall commence the conduct of a study to determine
the feasibility and advisability of--
(A) the realignment and reorganization of suicide
prevention coordinators within the Office of Mental
Health and Suicide Prevention; and
(B) the creation of a suicide prevention
coordinator program office.
(2) Program office realignment.--In conducting the study
under paragraph (1), the Secretary shall assess the feasibility
of advisability of, within the suicide prevention coordinator
program office described in paragraph (1)(B), aligning suicide
prevention coordinators and suicide prevention case managers
within the organizational structure and chart of the Suicide
Prevention Program of the Department, with the Director of the
Suicide Prevention program having ultimate supervisory
oversight and responsibility over the suicide prevention
coordinator program office.
(c) Report.--Not later than 90 days after the completion of the
study under subsection (b), the Secretary shall submit to the Committee
on Veterans' Affairs of the Senate and the Committee on Veterans'
Affairs of the House of Representatives a report on such study,
including the following:
(1) An assessment of the feasibility and advisability of
creating a suicide prevention coordinator program office to
oversee and monitor suicide prevention coordinators and suicide
prevention case managers across all medical centers of the
Department.
(2) A review of current staffing ratios for suicide
prevention coordinators and suicide prevention case managers in
comparison with current staffing ratios for mental health
providers within each medical center of the Department.
(3) A description of the duties and responsibilities for
suicide prevention coordinators across the Department to better
define, delineate, and standardize qualifications, performance
goals, performance duties, and performance outcomes for suicide
prevention coordinators and suicide prevention case managers.
SEC. 508. REPORT ON EFFORTS BY DEPARTMENT OF VETERANS AFFAIRS TO
IMPLEMENT SAFETY PLANNING IN EMERGENCY DEPARTMENTS.
(a) Findings.--Congress makes the following findings:
(1) The Department of Veterans Affairs must be more
effective in its approach to reducing the burden of veteran
suicide connected to mental health diagnoses, to include
expansion of treatment delivered via telehealth methods and in
rural areas.
(2) An innovative project, known as Suicide Assessment and
Follow-up Engagement: Veteran Emergency Treatment (in this
subsection referred to as ``SAFE VET''), was designed to help
suicidal veterans seen at emergency departments within the
Veterans Health Administration and was successfully implemented
in five intervention sites beginning in 2010.
(3) A 2018 study found that safety planning intervention
under SAFE VET was associated with 45 percent fewer suicidal
behaviors in the six-month period following emergency
department care and more than double the odds of a veteran
engaging in outpatient behavioral health care.
(4) SAFE VET is a promising alternative and acceptable
delivery of care system that augments the treatment of suicidal
veterans in emergency departments of the Veterans Health
Administration and helps ensure that those veterans have
appropriate follow-up care.
(5) Beginning in September 2018, the Veterans Health
Administration implemented a suicide prevention program, known
as the SPED program, for veterans presenting to the emergency
department who are assessed to be at risk for suicide and are
safe to be discharged home.
(6) The SPED program includes issuance and update of a
safety plan and post-discharge follow-up outreach for veterans
to facilitate engagement in outpatient mental health care.
(b) Report.--
(1) In general.--Not later than 180 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall submit to the appropriate committees of Congress a report
on the efforts of the Secretary to implement a suicide
prevention program for veterans presenting to an emergency
department or urgent care center of the Veterans Health
Administration who are assessed to be at risk for suicide and
are safe to be discharged home, including a safety plan and
post-discharge outreach for veterans to facilitate engagement
in outpatient mental health care.
(2) Elements.--The report required by paragraph (1) shall
include the following:
(A) An assessment of the implementation of the
current operational policies and procedures of the SPED
program at each medical center of the Department of
Veterans Affairs, including an assessment of the
following:
(i) Training provided to clinicians or
other personnel administering protocols under
the SPED program.
(ii) Any disparities in implementation of
such protocols between medical centers.
(iii) Current criteria used to measure the
quality of such protocols including--
(I) methodology used to assess the
quality of a safety plan and post-
discharge outreach for veterans; or
(II) in the absence of such
methodology, a proposed timeline and
guidelines for creating a methodology
to ensure compliance with the evidence-
based model used under the Suicide
Assessment and Follow-up Engagement:
Veteran Emergency Treatment (SAFE VET)
program of the Department.
(B) An assessment of the implementation of the
policies and procedures described in subparagraph (A),
including the following:
(i) An assessment of the quality and
quantity of safety plans issued to veterans.
(ii) An assessment of the quality and
quantity of post-discharge outreach provided to
veterans.
(iii) The post-discharge rate of veteran
engagement in outpatient mental health care,
including attendance at not fewer than one
individual mental health clinic appointment or
admission to an inpatient or residential unit.
(iv) The number of veterans who decline
safety planning efforts during protocols under
the SPED program.
(v) The number of veterans who decline to
participate in follow-up efforts within the
SPED program.
(C) A description of how SPED primary coordinators
are deployed to support such efforts, including the
following:
(i) A description of the duties and
responsibilities of such coordinators.
(ii) The number and location of such
coordinators.
(iii) A description of training provided to
such coordinators.
(iv) An assessment of the other
responsibilities for such coordinators and, if
applicable, differences in patient outcomes
when such responsibilities are full-time duties
as opposed to secondary duties.
(D) An assessment of the feasibility and
advisability of expanding the total number and
geographic distribution of SPED primary coordinators.
(E) An assessment of the feasibility and
advisability of providing services under the SPED
program via telehealth channels, including an analysis
of opportunities to leverage telehealth to better serve
veterans in rural areas.
(F) A description of the status of current
capabilities and utilization of tracking mechanisms to
monitor compliance, quality, and patient outcomes under
the SPED program.
(G) Such recommendations, including specific action
items, as the Secretary considers appropriate with
respect to how the Department can better implement the
SPED program, including recommendations with respect to
the following:
(i) A process to standardize training under
such program.
(ii) Any resourcing requirements necessary
to implement the SPED program throughout
Veterans Health Administration, including by
having a dedicated clinician responsible for
administration of such program at each medical
center.
(iii) An analysis of current statutory
authority and any changes necessary to fully
implement the SPED program throughout the
Veterans Health Administration.
(iv) A timeline for the implementation of
the SPED program through the Veterans Health
Administration once full resourcing and an
approved training plan are in place.
(H) Such other matters as the Secretary considers
appropriate.
(c) Definitions.--In this section:
(1) Appropriate committees of congress.--The term
``appropriate committees of Congress'' means--
(A) the Committee on Veterans' Affairs and the
Subcommittee on Military Construction, Veterans
Affairs, and Related Agencies of the Committee on
Appropriations of the Senate; and
(B) the Committee on Veterans' Affairs and the
Subcommittee on Military Construction, Veterans
Affairs, and Related Agencies of the Committee on
Appropriations of the House of Representatives.
(2) SPED primary coordinator.--The term ``SPED primary
coordinator'' means the main point of contact responsible for
administering the SPED program at a medical center of the
Department.
(3) SPED program.--The term ``SPED program'' means the
Safety Planning in Emergency Departments program of the
Department of Veterans Affairs established in September 2018
for veterans presenting to the emergency department who are
assessed to be at risk for suicide and are safe to be
discharged home, which extends the evidence-based intervention
for suicide prevention to all emergency departments of the
Veterans Health Administration.
TITLE VI--IMPROVEMENT OF CARE AND SERVICES FOR WOMEN VETERANS
SEC. 601. EXPANSION OF CAPABILITIES OF WOMEN VETERANS CALL CENTER TO
INCLUDE TEXT MESSAGING.
The Secretary of Veterans Affairs shall expand the capabilities of
the Women Veterans Call Center of the Department of Veterans Affairs to
include a text messaging capability.
SEC. 602. GAP ANALYSIS OF DEPARTMENT OF VETERANS AFFAIRS PROGRAMS THAT
PROVIDE ASSISTANCE TO WOMEN VETERANS WHO ARE HOMELESS.
(a) In General.--The Secretary of Veterans Affairs shall complete
an analysis of programs of the Department of Veterans Affairs that
provide assistance to women veterans who are homeless or precariously
housed to identify the areas in which such programs are failing to meet
the needs of such women.
(b) Report.--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 report on the analysis completed
under subsection (a).
SEC. 603. REQUIREMENT FOR DEPARTMENT OF VETERANS AFFAIRS INTERNET
WEBSITE TO PROVIDE INFORMATION ON SERVICES AVAILABLE TO
WOMEN VETERANS.
(a) In General.--The Secretary of Veterans Affairs shall survey the
internet websites and information resources of the Department of
Veterans Affairs in effect on the day before the date of the enactment
of this Act and publish an internet website that serves as a
centralized source for the provision to women veterans of information
about the benefits and services available to them under laws
administered by the Secretary.
(b) Elements.--The internet website published under subsection (a)
shall provide to women veterans information regarding all services
available in the district in which the veteran is seeking such
services, including, with respect to each medical center and community-
based outpatient clinic in the applicable Veterans Integrated Service
Network--
(1) the name and contact information of each women's health
coordinator;
(2) a list of appropriate staff for other benefits
available from the Veterans Benefits Administration, the
National Cemetery Administration, and such other entities as
the Secretary considers appropriate; and
(3) such other information as the Secretary considers
appropriate.
(c) Updated Information.--The Secretary shall ensure that the
information described in subsection (b) that is published on the
internet website required by subsection (a) is updated not less
frequently than once every 90 days.
(d) Outreach.--In carrying out this section, the Secretary shall
ensure that the outreach conducted under section 1720F(i) of title 38,
United States Code, includes information regarding the internet website
required by subsection (a).
(e) Derivation of Funds.--Amounts used by the Secretary to carry
out this section shall be derived from amounts made available to the
Secretary to publish internet websites of the Department.
SEC. 604. REPORT ON LOCATIONS WHERE WOMEN VETERANS ARE USING HEALTH
CARE FROM DEPARTMENT OF VETERANS AFFAIRS.
(a) In General.--Not later than 90 days after the date of the
enactment of this Act, and annually thereafter, the Secretary of
Veterans Affairs shall submit to the Committee on Veterans' Affairs of
the Senate and the Committee on Veterans' Affairs of the House of
Representatives a report on the use by women veterans of health care
from the Department of Veterans Affairs.
(b) Elements.--Each report required by subsection (a) shall include
the following information:
(1) The number of women veterans who reside in each State.
(2) The number of women veterans in each State who are
enrolled in the system of patient enrollment of the Department
established and operated under section 1705(a) of title 38,
United States Code.
(3) Of the women veterans who are so enrolled, the number
who have received health care under the laws administered by
the Secretary at least one time during the one-year period
preceding the submittal of the report.
(4) The number of women veterans who have been seen at each
medical facility of the Department during such year.
(5) The number of appointments that women veterans have had
at each such facility during such year.
(6) If known, an identification of the medical facility of
the Department in each Veterans Integrated Service Network with
the largest rate of increase in patient population of women
veterans as measured by the increase in unique women veteran
patient use.
(7) If known, an identification of the medical facility of
the Department in each Veterans Integrated Service Network with
the largest rate of decrease in patient population of women
veterans as measured by the decrease in unique women veterans
patient use.
TITLE VII--OTHER MATTERS
SEC. 701. EXPANDED TELEHEALTH FROM DEPARTMENT OF VETERANS AFFAIRS.
(a) In General.--The Secretary of Veterans Affairs shall enter into
partnerships, and expand existing partnerships, with organizations that
represent or serve veterans, nonprofit organizations, private
businesses, and other interested parties for the expansion of
telehealth capabilities and the provision of telehealth services to
veterans through the award of grants under subsection (b).
(b) Award of Grants.--
(1) In general.--In carrying out partnerships entered into
or expanded under this section with entities described in
subsection (a), the Secretary shall award grants to those
entities.
(2) Locations.--To the extent practicable, the Secretary
shall ensure that grants are awarded to entities that serve
veterans in rural and highly rural areas (as determined through
the use of the Rural-Urban Commuting Areas coding system of the
Department of Agriculture).
(3) Use of grants.--
(A) In general.--Grants awarded to an entity under
this subsection may be used for one or more of the
following:
(i) Purchasing or upgrading hardware or
software necessary for the provision of secure
and private telehealth services.
(ii) Upgrading security protocols for
consistency with the security requirements of
the Department.
(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;
(II) equipment required to provide
telehealth services; or
(III) any other unique training
needs for the provision of telehealth
services to veterans.
(iv) Upgrading existing infrastructure
owned or leased by the entity to make rooms
more conducive to telehealth care, including--
(I) additions or modifications to
windows or walls in an existing room,
or other alterations as needed to
create a new, private room;
(II) soundproofing of an existing
room;
(III) new electrical or internet
outlets in an existing room; or
(IV) aesthetic enhancements to
establish a more suitable therapeutic
environment.
(v) Upgrading existing infrastructure to
comply with the Americans with Disabilities Act
of 1990 (42 U.S.C. 12101 et seq.).
(vi) Upgrading internet infrastructure and
sustainment of internet services.
(B) Exclusion.--Grants may not be used for the
purchase of new property or for major construction
projects, as determined by the Secretary.
(c) Agreement on Telehealth Access Points.--
(1) In general.--An entity described in subsection (a) that
seeks to establish a telehealth access point for veterans but
does not require grant funding under this section to do so may
enter into an agreement with the Department for the
establishment of such an access point.
(2) Adequacy of facilities.--An entity described in
paragraph (1) shall be responsible for ensuring that any access
point is adequately private, secure, and accessible for
veterans before the access point is established.
(d) Assessment of Barriers to Access.--
(1) In general.--Not later than 18 months after the date of
the enactment of this Act, the Secretary shall complete an
assessment of barriers faced by veterans in accessing
telehealth services.
(2) Elements.--The assessment required by paragraph (1)
shall include the following:
(A) A description of the barriers veterans face in
using telehealth while not on property of the
Department.
(B) A description of how the Department plans to
address the barriers described in subparagraph (A).
(C) Such other matters related access by veterans
to telehealth while not on property of the Department
as the Secretary considers relevant.
(3) Report.--Not later than 120 days after the completion
of the assessment required by paragraph (1), the Secretary
shall submit to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives a report on the assessment, including any
recommendations for legislative or administrative action based
on the results of the assessment.
SEC. 702. PARTNERSHIPS WITH NON-FEDERAL GOVERNMENT ENTITIES TO PROVIDE
HYPERBARIC OXYGEN THERAPY TO VETERANS AND STUDIES ON THE
USE OF SUCH THERAPY FOR TREATMENT OF POST-TRAUMATIC
STRESS DISORDER AND TRAUMATIC BRAIN INJURY.
(a) Partnerships to Provide Hyperbaric Oxygen Therapy to
Veterans.--
(1) Use of partnerships.--The Secretary of Veterans
Affairs, in consultation with the Center for Compassionate
Innovation within the Office of Community Engagement of the
Department of Veterans Affairs, may enter into partnerships
with non-Federal Government entities to provide hyperbaric
oxygen treatment to veterans to research the effectiveness of
such therapy.
(2) Types of partnerships.--Partnerships entered into under
paragraph (1) may include the following:
(A) Partnerships to conduct research on hyperbaric
oxygen therapy.
(B) Partnerships to review research on hyperbaric
oxygen therapy provided to nonveterans.
(C) Partnerships to create industry working groups
to determine standards for research on hyperbaric
oxygen therapy.
(D) Partnerships to provide to veterans hyperbaric
oxygen therapy for the purposes of conducting research
on the effectiveness of such therapy.
(3) Limitation on federal funding.--Federal Government
funding may be used to coordinate and administer the
partnerships under this subsection but may not be used to carry
out activities conducted under such partnerships.
(b) Review of Effectiveness of Hyperbaric Oxygen Therapy.--Not
later than 90 days after the date of the enactment of this Act, the
Secretary, in consultation with the Center for Compassionate
Innovation, shall begin using an objective and quantifiable method to
review the effectiveness and applicability of hyperbaric oxygen
therapy, such as through the use of a device approved or cleared by the
Food and Drug Administration that assesses traumatic brain injury by
tracking eye movement.
(c) Systematic Review of Use of Hyperbaric Oxygen Therapy to Treat
Certain Conditions.--
(1) In general.--Not later than 90 days after the date of
the enactment of this Act, the Secretary, in consultation with
the Center for Compassionate Innovation, shall commence the
conduct of a systematic review of published research literature
on off-label use of hyperbaric oxygen therapy to treat post-
traumatic stress disorder and traumatic brain injury among
veterans and nonveterans.
(2) Elements.--The review conducted under paragraph (1)
shall include the following:
(A) An assessment of the current parameters for
research on the use by the Department of Veterans
Affairs of hyperbaric oxygen therapy, including--
(i) tests and questionnaires used to
determine the efficacy of such therapy; and
(ii) metrics for determining the success of
such therapy.
(B) A comparative analysis of tests and
questionnaires used to study post-traumatic stress
disorder and traumatic brain injury in other research
conducted by the Department of Veterans Affairs, other
Federal agencies, and entities outside the Federal
Government.
(3) Completion of review.--The review conducted under
paragraph (1) shall be completed not later than 180 days after
the date of the commencement of the review.
(4) Report.--Not later than 90 days after the completion of
the review conducted under paragraph (1), the Secretary shall
submit to the Committee on Veterans' Affairs of the Senate and
the Committee on Veterans' Affairs of the House of
Representatives a report on the results of the review.
(d) Follow-up Study.--
(1) In general.--Not later than 120 days after the
completion of the review conducted under subsection (c), the
Secretary, in consultation with the Center for Compassionate
Innovation, shall commence the conduct of a study on all
individuals receiving hyperbaric oxygen therapy through the
current pilot program of the Department for the provision of
hyperbaric oxygen therapy to veterans to determine the efficacy
and effectiveness of hyperbaric oxygen therapy for the
treatment of post-traumatic stress disorder and traumatic brain
injury.
(2) Elements.--The study conducted under paragraph (1)
shall include the review and publication of any data and
conclusions resulting from research conducted by an authorized
provider of hyperbaric oxygen therapy for veterans through the
pilot program described in such paragraph.
(3) Completion of study.--The study conducted under
paragraph (1) shall be completed not later than three years
after the date of the commencement of the study.
(4) Report.--
(A) In general.--Not later than 90 days after
completing the study conducted under paragraph (1), the
Secretary shall submit to the Committee on Veterans'
Affairs of the Senate and the Committee on Veterans'
Affairs of the House of Representatives a report on the
results of the study.
(B) Elements.--The report required under
subparagraph (A) shall include the recommendation of
the Secretary with respect to whether or not hyperbaric
oxygen therapy should be made available to all veterans
with traumatic brain injury or post-traumatic stress
disorder.
SEC. 703. PRESCRIPTION OF TECHNICAL QUALIFICATIONS FOR LICENSED HEARING
AID SPECIALISTS AND REQUIREMENT FOR APPOINTMENT OF SUCH
SPECIALISTS.
(a) In General.--Not later than 180 days after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall
prescribe the technical qualifications required under section
7402(a)(14) of title 38, United States Code, to be appointed as a
licensed hearing aid specialist under section 7401(3) of such title.
(b) Elements for Qualifications.--In prescribing the qualifications
for licensed hearing aid specialists under subsection (a), the
Secretary shall ensure such qualifications are consistent with the
following:
(1) Standards of registered apprenticeship programs for the
occupation of hearing aid specialists approved by the
Department of Labor in accordance with the Act of August 16,
1937 (commonly known as the ``National Apprenticeship Act'')
(50 Stat. 664, chapter 663; 29 U.S.C. 50 et seq.).
(2) Standards for licensure of hearing aid specialists that
are required by a majority of States.
(3) Competency in completing core tasks for the occupation
of hearing aid specialist as determined by the Occupational
Information Network Database (commonly known as ``O*NET'').
(c) Appointment.--Not later than September 30, 2022, the Secretary
shall appoint not fewer than one licensed hearing aid specialist at
each medical center of the Department.
(d) Report.--Not later than September 30, 2022, and annually
thereafter, the Secretary shall submit to the Committee on Veterans'
Affairs of the Senate and the Committee on Veterans' Affairs of the
House of Representatives a report--
(1) assessing the progress of the Secretary in appointing
licensed hearing aid specialists under subsection (c);
(2) assessing potential conflicts or obstacles that prevent
the appointment of licensed hearing aid specialists;
(3) assessing the factors that led to such conflicts or
obstacles; and
(4) indicating the medical centers of the Department with
vacancies for licensed hearing aid specialists.
SEC. 704. USE BY DEPARTMENT OF VETERANS AFFAIRS OF COMMERCIAL
INSTITUTIONAL REVIEW BOARDS IN SPONSORED RESEARCH TRIALS.
(a) In General.--Not later than 90 days after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall complete
all necessary policy revisions within the directive of the Veterans
Health Administration numbered 1200.05 and titled ``Requirements for
the Protection of Human Subjects in Research'', to allow sponsored
clinical research of the Department of Veterans Affairs to use
accredited commercial institutional review boards to review research
proposal protocols of the Department.
(b) Identification of Review Boards.--Not later than 90 days after
the completion of the policy revisions under subsection (a), the
Secretary shall--
(1) identify accredited commercial institutional review
boards for use in connection with sponsored clinical research
of the Department; and
(2) establish a process to modify existing approvals in the
event that a commercial institutional review board loses its
accreditation during an ongoing clinical trial.
(c) Report.--
(1) In general.--Not later than 90 days after the
completion of the policy revisions under subsection (a), and
annually thereafter, the Secretary shall submit to the
Committee on Veterans' Affairs of the Senate and the Committee
on Veterans' Affairs of the House of Representatives a report
on all approvals of institutional review boards used by the
Department, including central institutional review boards and
commercial institutional review boards.
(2) Elements.--The report required by paragraph (1) shall
include, at a minimum, the following:
(A) The name of each clinical trial with respect to
which the use of an institutional review board has been
approved.
(B) The institutional review board or institutional
review boards used in the approval process for each
clinical trial.
(C) The amount of time between submission and
approval.
SEC. 705. CREATION OF OFFICE OF RESEARCH REVIEWS WITHIN THE OFFICE OF
INFORMATION AND TECHNOLOGY OF THE DEPARTMENT OF VETERANS
AFFAIRS.
(a) In General.--Not later than one year after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall
establish within the Office of Information and Technology of the
Department of Veterans Affairs an Office of Research Reviews (in this
section referred to as the ``Office'').
(b) Elements.--The Office shall do the following:
(1) Perform centralized security reviews and complete
security processes for approved research sponsored outside the
Department, with a focus on multi-site clinical trials.
(2) Develop and maintain a list of commercially available
software preferred for use in sponsored clinical trials of the
Department and ensure such list is maintained as part of the
official approved software products list of the Department.
(3) Develop benchmarks for appropriate timelines for
security reviews conducted by the Office.
(c) Report.--
(1) In general.--Not later than one year after the
establishment of the Office, the Office shall submit to the
Committee on Veterans' Affairs of the Senate and the Committee
on Veterans' Affairs of the House of Representatives a report
on the activity of the Office.
(2) Elements.--The report required by paragraph (1) shall
include, at a minimum, the following:
(A) The number of security reviews completed.
(B) The number of personnel assigned for performing
the functions described in subsection (b).
Calendar No. 498
116th CONGRESS
2d Session
S. 785
_______________________________________________________________________
A BILL
To improve mental health care provided by the Department of Veterans
Affairs, and for other purposes.
_______________________________________________________________________
July 27, 2020
Reported with an amendment