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114th Congress}                                      { Rept. 114-546
                        HOUSE OF REPRESENTATIVES
 2d Session   }                                      { Part 1

======================================================================
 
 PROMOTING RESPONSIBLE OPIOID MANAGEMENT AND INCORPORATING SCIENTIFIC 
                             EXPERTISE ACT

                                _______
                                

  May 10, 2016.--Committed to the Committee of the Whole House on the 
              state of the Union and ordered to be printed

                                _______
                                

    Mr. Miller of Florida, from the Committee on Veterans' Affairs, 
                        submitted the following

                              R E P O R T

                        [To accompany H.R. 4063]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Veterans' Affairs, to whom was referred 
the bill (H.R. 4063) to improve the use by the Secretary of 
Veterans Affairs of opioids in treating veterans, to improve 
patient advocacy by the Secretary, and to expand the 
availability of complementary and integrative health, and for 
other purposes, having considered the same, report favorably 
thereon with an amendment and recommend that the bill as 
amended do pass.

                                CONTENTS

                                                                   Page
Amendment........................................................     2
Purpose and Summary..............................................    15
Background and Need for Legislation..............................    16
Hearings.........................................................    26
Subcommittee Consideration.......................................    27
Committee Consideration..........................................    27
Committee Votes..................................................    27
Committee Oversight Findings.....................................    27
Statement of General Performance Goals and Objectives............    27
New Budget Authority, Entitlement Authority, and Tax Expenditures    28
Earmarks and Tax and Tariff Benefits.............................    28
Committee Cost Estimate..........................................    28
Congressional Budget Office Estimate.............................    28
Federal Mandates Statement.......................................    32
Advisory Committee Statement.....................................    32
Constitutional Authority Statement...............................    32
Applicability to Legislative Branch..............................    32
Exchange of Committee Correspondence.............................    34
Statement on Duplication of Federal Programs.....................    35
Disclosure of Directed Rulemaking................................    35
Section-by-Section Analysis of the Legislation...................    35
Changes in Existing Law Made by the Bill as Reported.............    45

                               Amendment

    The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

  (a) Short Title.--This Act may be cited as the ``Promoting 
Responsible Opioid Management and Incorporating Scientific Expertise 
Act'' or the ``Jason Simcakoski PROMISE Act''.
  (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.

              TITLE I--OPIOID THERAPY AND PAIN MANAGEMENT

Sec. 101. Establishment of Advisory Committee to review guidelines on 
management of opioid therapy by Department of Veterans Affairs and 
Department of Defense.
Sec. 102. Improvement of opioid safety measures by Department of 
Veterans Affairs.
Sec. 103. Strengthening of joint working group on pain management of 
the Department of Veterans Affairs and the Department of Defense.
Sec. 104. Review, investigation, and report on use of opioids in 
treatment by Department of Veterans Affairs.
Sec. 105. Mandatory disclosure of certain veteran information to State 
controlled substance monitoring programs.

                       TITLE II--PATIENT ADVOCACY

Sec. 201. Community meetings on improving care furnished by Department 
of Veterans Affairs.
Sec. 202. Improvement of awareness of patient advocacy program and 
patient bill of rights of Department of Veterans Affairs.
Sec. 203. Comptroller general report on patient advocacy program of 
Department of Veterans Affairs.

            TITLE III--COMPLEMENTARY AND INTEGRATIVE HEALTH

Sec. 301. Expansion of research and education on and delivery of 
complementary and integrative health to veterans.
Sec. 302. Pilot program on integration of complementary alternative 
medicines and related issues for veterans and family members of 
veterans.

               TITLE IV--FITNESS OF HEALTH CARE PROVIDERS

Sec. 401. Additional requirements for hiring of health care providers 
by Department of Veterans Affairs.
Sec. 402. Provision of information on health care providers of 
Department of Veterans Affairs to State Medical Boards.
Sec. 403. Report on compliance by Department of Veterans Affairs with 
reviews of health care providers leaving the Department or transferring 
to other facilities.

                    TITLE V--OTHER VETERANS MATTERS

Sec. 501. Audit of Veterans Health Administration programs of 
Department of Veterans Affairs.

              TITLE I--OPIOID THERAPY AND PAIN MANAGEMENT

SEC. 101. ESTABLISHMENT OF ADVISORY COMMITTEE TO REVIEW GUIDELINES ON 
                    MANAGEMENT OF OPIOID THERAPY BY DEPARTMENT OF 
                    VETERANS AFFAIRS AND DEPARTMENT OF DEFENSE.

  (a) Advisory Committee.--Not later than 120 days after the date of 
the enactment of this Act, the Secretary of Veterans Affairs and the 
Secretary of Defense shall jointly convene an advisory committee to--
          (1) conduct a thorough review of the most recent VA/DOD 
        Clinical Practice Guideline for Management of Opioid Therapy 
        for Chronic Pain; and
          (2) make recommendations to the Secretaries with respect to 
        updating the Clinical Practice Guideline.
  (b) Matters Included.--In conducting the review under subsection 
(a)(1), the Advisory Committee shall examine whether the Clinical 
Practical Guideline should include the following:
          (1) Enhanced guidance with respect to--
                  (A) the coadministration of an opioid and other 
                drugs, including benzodiazepines, that may result in 
                life-limiting drug interactions;
                  (B) the treatment of patients with current acute 
                psychiatric instability or substance use disorder or 
                patients at risk of suicide; and
                  (C) the use of opioid therapy to treat mental health 
                disorders other than opioid use disorder.
          (2) Enhanced guidance with respect to the treatment of 
        patients with behaviors or comorbidities, such as post-
        traumatic stress disorder or other psychiatric disorders, or a 
        history of substance abuse or addiction, that requires a 
        consultation or comanagement of opioid therapy with one or more 
        specialists in pain management, mental health, or addictions.
          (3) Enhanced guidance with respect to health care providers--
                  (A) conducting an effective assessment for patients 
                beginning or continuing opioid therapy, including 
                understanding and setting realistic goals with respect 
                to achieving and maintaining an expected level of pain 
                relief, improved function, or a clinically appropriate 
                combination of both; and
                  (B) effectively assessing whether opioid therapy is 
                achieving or maintaining the established treatment 
                goals of the patient or whether the patient and health 
                care provider should discuss adjusting, augmenting , or 
                discontinuing the opioid therapy.
          (4) Guidance that each health care provider of the Department 
        of Veterans Affairs and the Department of Defense, before 
        initiating opioid therapy to treat a patient as part of the 
        comprehensive assessment conducted by the health care provider, 
        use the Opioid Therapy Risk Report tool of the Department of 
        Veterans Affairs (or similar monitoring tool), which shall 
        include information from the prescription drug monitoring 
        program of each State that includes the most recent information 
        to date relating to the patient that accessed such program to 
        assess the risk for adverse outcomes of opioid therapy for the 
        patient, including the concurrent use of controlled substances 
        such as benzodiazepines, as part of the comprehensive 
        assessment conducted by the health care provider.
          (5) Guidelines to govern the methodologies used by health 
        care providers of the Department of Veterans Affairs and the 
        Department of Defense to taper opioid therapy when adjusting or 
        discontinuing the use of opioid therapy.
          (6) Guidelines with respect to appropriate case management 
        for patients receiving opioid therapy who transition between 
        inpatient and outpatient health care settings, which may 
        include the use of care transition plans.
          (7) Guidelines with respect to appropriate case management 
        for patients receiving opioid therapy who transition from 
        receiving care during active duty to post-military health care 
        networks.
          (8) Enhanced standards with respect to the use of routine and 
        random urine drug tests for all patients before and during 
        opioid therapy to help prevent substance abuse, dependence, and 
        diversion, including--
                  (A) that such tests occur not less frequently than 
                once each year; and
                  (B) that health care providers appropriately order, 
                interpret and respond to the results from such tests to 
                tailor pain therapy, safeguards, and risk management 
                strategies to each patient.
          (9) Guidance that health care providers discuss with 
        patients, before initiating opioid therapy, options for pain 
        management therapies without the use of opioids and options to 
        augment opioid therapy with other clinical and complementary 
        and integrative health services to minimize opioid dependence.
          (10) Guidance for health care providers with respect to 
        evidence-based non-opioid treatments within the Department of 
        Veterans Affairs and the Department of Defense, including 
        medical devices and other therapies approved or cleared by the 
        Food and Drug Administration for the treatment of chronic pain 
        as an alternative to or to augment opioid therapy.
  (c) Consultation.--In carrying out the review under paragraph (1) of 
subsection (a), and before making the recommendations under paragraph 
(2) of such subsection, the Advisory Committee shall consult with the 
VA/DOD Management of Opioid Therapy for Chronic Pain Working Group.
  (d) Submission.--Not later than one year after the date of the 
enactment of this Act, the Advisory Committee shall submit to the 
Secretaries the review and recommendations described in subsection 
(a)(1).
  (e) Application of Federal Advisory Committee Act.--The provisions of 
the Federal Advisory Committee Act (5 U.S.C. App.) shall apply to the 
Advisory Committee.
  (f) Definitions.--In this section:
          (1) The term ``Advisory Committee'' means the advisory 
        committee established under subsection (a).
          (2) The term ``Clinical Practice Guideline'' means the VA/DOD 
        Clinical Practice Guideline for Management of Opioid Therapy 
        for Chronic Pain.
          (3) The term ``controlled substance'' has the meaning given 
        that term in section 102 of the Controlled Substances Act (21 
        U.S.C. 802).
          (4) The term ``State'' means each of the several States, 
        territories, and possessions of the United States, the District 
        of Columbia, and the Commonwealth of Puerto Rico.

SEC. 102. IMPROVEMENT OF OPIOID SAFETY MEASURES BY DEPARTMENT OF 
                    VETERANS AFFAIRS.

  (a) Expansion of Opioid Safety Initiative.--Not later than 180 days 
after the date of the enactment of this Act, the Secretary of Veterans 
Affairs shall expand the Opioid Safety Initiative of the Department of 
Veterans Affairs to include all medical facilities of the Department.
  (b) Pain Management Education and Training.--
          (1) In general.--In carrying out the Opioid Safety Initiative 
        of the Department, the Secretary shall require all employees of 
        the Department responsible for prescribing opioids to receive 
        education and training described in paragraph (2).
          (2) Education and training.--Education and training described 
        in this paragraph is education and training on pain management 
        and safe opioid prescribing practices for purposes of safely 
        and effectively managing patients with chronic pain, including 
        education and training on the following:
                  (A) The implementation of and full compliance with 
                the VA/DOD Clinical Practice Guideline for Management 
                of Opioid Therapy for Chronic Pain, including any 
                update to such guideline.
                  (B) The use of evidence-based pain management 
                therapies, including cognitive-behavioral therapy, non-
                opioid alternatives, and non-drug methods and 
                procedures to managing pain and related health 
                conditions including medical devices approved or 
                cleared by the Food and Drug Administration for the 
                treatment of patients with chronic pain and 
                complementary alternative medicines.
                  (C) Screening and identification of patients with 
                substance use disorder, including drug-seeking 
                behavior, before prescribing opioids, assessment of 
                risk potential for patients developing an addiction, 
                and referral of patients to appropriate addiction 
                treatment professionals if addiction is identified or 
                strongly suspected.
                  (D) Communication with patients on the potential harm 
                associated with the use of opioids and other controlled 
                substances, including the need to safely store and 
                dispose of supplies relating to the use of opioids and 
                other controlled substances.
                  (E) Such other education and training as the 
                Secretary considers appropriate to ensure that veterans 
                receive safe and high-quality pain management care from 
                the Department.
          (3) Use of existing program.--In providing education and 
        training described in paragraph (2), the Secretary shall use 
        the Interdisciplinary Chronic Pain Management Training Team 
        Program of the Department (or success program).
  (c) Pain Management Teams.--
          (1) In general.--In carrying out the Opioid Safety Initiative 
        of the Department, the director of each medical facility of the 
        Department shall identify and designate a pain management team 
        of health care professionals, which may include board certified 
        pain medicine specialists, responsible for coordinating and 
        overseeing pain management therapy at such facility for 
        patients experiencing acute and chronic pain that is non-cancer 
        related.
          (2) Establishment of protocols.--
                  (A) In general.--In consultation with the Directors 
                of each Veterans Integrated Service Network, the 
                Secretary shall establish standard protocols for the 
                designation of pain management teams at each medical 
                facility within the Department.
                  (B) Consultation on prescription of opioids.--Each 
                protocol established under subparagraph (A) shall 
                ensure that any health care provider without expertise 
                in prescribing analgesics or who has not completed the 
                education and training under subsection (b), including 
                a mental health care provider, does not prescribe 
                opioids to a patient unless that health care provider--
                          (i) consults with a health care provider with 
                        pain management expertise or who is on the pain 
                        management team of the medical facility; and
                          (ii) refers the patient to the pain 
                        management team for any subsequent 
                        prescriptions and related therapy.
          (3) Report.--
                  (A) In general.--Not later than one year after the 
                date of enactment of this Act, the director of each 
                medical facility of the Department shall submit to the 
                Under Secretary for Health and the director of the 
                Veterans Integrated Service Network in which the 
                medical facility is located a report identifying the 
                health care professionals that have been designated as 
                members of the pain management team at the medical 
                facility pursuant to paragraph (1).
                  (B) Elements.--Each report submitted under 
                subparagraph (A) with respect to a medical facility of 
                the Department shall include--
                          (i) a certification as to whether all members 
                        of the pain management team at the medical 
                        facility have completed the education and 
                        training required under subsection (b);
                          (ii) a plan for the management and referral 
                        of patients to such pain management team if 
                        health care providers without expertise in 
                        prescribing analgesics prescribe opioid 
                        medications to treat acute and chronic pain 
                        that is non-cancer related; and
                          (iii) a certification as to whether the 
                        medical facility--
                                  (I) fully complies with the stepped-
                                care model of pain management and other 
                                pain management policies contained in 
                                Directive 2009-053 of the Veterans 
                                Health Administration, or successor 
                                directive; or
                                  (II) does not fully comply with such 
                                stepped-care model of pain management 
                                and other pain management policies but 
                                is carrying out a corrective plan of 
                                action to ensure such full compliance.
  (d) Tracking and Monitoring of Opioid Use.--
          (1) Prescription drug monitoring programs of states.--In 
        carrying out the Opioid Safety Initiative and the Opioid 
        Therapy Risk Report tool of the Department, the Secretary 
        shall--
                  (A) ensure access by health care providers of the 
                Department to information on controlled substances, 
                including opioids and benzodiazepines, prescribed to 
                veterans who receive care outside the Department 
                through the prescription drug monitoring program of 
                each State with such a program, including by seeking to 
                enter into memoranda of understanding with States to 
                allow shared access of such information between States 
                and the Department;
                  (B) include such information in the Opioid Therapy 
                Risk Report; and
                  (C) require health care providers of the Department 
                to submit to the prescription drug monitoring program 
                of each State information on prescriptions of 
                controlled substances received by veterans in that 
                State under the laws administered by the Secretary.
          (2) Report on tracking of data on opioid use.--Not later than 
        18 months 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 feasibility and advisability 
        of improving the Opioid Therapy Risk Report tool of the 
        Department to allow for more advanced real-time tracking of and 
        access to data on--
                  (A) the key clinical indicators with respect to the 
                totality of opioid use by veterans;
                  (B) concurrent prescribing by health care providers 
                of the Department of opioids in different health care 
                settings, including data on concurrent prescribing of 
                opioids to treat mental health disorders other than 
                opioid use disorder; and
                  (C) mail-order prescriptions of opioid prescribed to 
                veterans under the laws administered by the Secretary.
  (e) Availability of Opioid Receptor Antagonists.--
          (1) Increased availability and use.--
                  (A) In general.--The Secretary shall maximize the 
                availability of opioid receptor antagonists approved by 
                the Food and Drug Administration, including naloxone, 
                to veterans.
                  (B) Availability, training, and distributing.--In 
                carrying out subparagraph (A), not later than 90 days 
                after the date of the enactment of this Act, the 
                Secretary shall--
                          (i) equip each pharmacy of the Department 
                        with opioid receptor antagonists approved by 
                        the Food and Drug Administration to be 
                        dispensed to outpatients as needed; and
                          (ii) expand the Overdose Education and 
                        Naloxone Distribution program of the Department 
                        to ensure that all veterans in receipt of 
                        health care under laws administered by the 
                        Secretary who are at risk of opioid overdose 
                        may access such opioid receptor antagonists and 
                        training on the proper administration of such 
                        opioid receptor antagonists.
                  (C) Veterans who are at risk.--For purposes of 
                subparagraph (B), veterans who are at risk of opioid 
                overdose include--
                          (i) veterans receiving long-term opioid 
                        therapy;
                          (ii) veterans receiving opioid therapy who 
                        have a history of substance use disorder or 
                        prior instances of overdose; and
                          (iii) veterans who are at risk as determined 
                        by a health care provider who is treating the 
                        veteran.
          (2) Report.--Not later than 120 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 carrying out paragraph (1), including an assessment of any 
        remaining steps to be carried out by the Secretary to carry out 
        such paragraph.
  (f) Inclusion of Certain Information and Capabilities in Opioid 
Therapy Risk Report Tool of the Department.--
          (1) Information.--The Secretary shall include in the Opioid 
        Therapy Risk Report tool of the Department--
                  (A) information on the most recent time the tool was 
                accessed by a health care provider of the Department 
                with respect to each veteran; and
                  (B) information on the results of the most recent 
                urine drug test for each veteran.
          (2) Capabilities.--The Secretary shall include in the Opioid 
        Therapy Risk Report tool the ability of the health care 
        providers of the Department to determine whether a health care 
        provider of the Department prescribed opioids to a veteran 
        without checking the information in the tool with respect to 
        the veteran.
  (g) Notifications of Risk in Computerized Health Record.--The 
Secretary shall modify the computerized patient record system of the 
Department to ensure that any health care provider that accesses the 
record of a veteran, regardless of the reason the veteran seeks care 
from the health care provider, will be immediately notified whether the 
veteran--
          (1) is receiving opioid therapy and has a history of 
        substance use disorder or prior instances of overdose;
          (2) has a history of opioid abuse; or
          (3) is at risk of becoming an opioid abuser as determined by 
        a health care provider who is treating the veteran.
  (h) Definitions.--In this section:
          (1) The term ``controlled substance'' has the meaning given 
        that term in section 102 of the Controlled Substances Act (21 
        U.S.C. 802).
          (2) The term ``State'' means each of the several States, 
        territories, and possessions of the United States, the District 
        of Columbia, and the Commonwealth of Puerto Rico.

SEC. 103. STRENGTHENING OF JOINT WORKING GROUP ON PAIN MANAGEMENT OF 
                    THE DEPARTMENT OF VETERANS AFFAIRS AND THE 
                    DEPARTMENT OF DEFENSE.

  (a) In General.--Not later than 90 days after the date of enactment 
of this Act, the Secretary of Veterans Affairs and the Secretary of 
Defense shall ensure that the Pain Management Working Group of the 
Health Executive Committee of the Department of Veterans Affairs-
Department of Defense Joint Executive Committee established under 
section 320 of title 38, United States Code, includes a focus on the 
following:
          (1) The opioid prescribing practices of health care providers 
        of each Department.
          (2) The ability of each Department to manage acute and 
        chronic pain among individuals receiving health care from the 
        Department, including training health care providers with 
        respect to pain management.
          (3) The use by each Department of complementary and 
        integrative health and complementary alternative medicines in 
        treating such individuals.
          (4) The concurrent use by health care providers of each 
        Department of opioids and prescription drugs to treat mental 
        health disorders, including benzodiazepines.
          (5) The practice by health care providers of each Department 
        of prescribing opioids to treat mental health disorders.
          (6) The coordination in coverage of and consistent access to 
        medications prescribed for patients transitioning from 
        receiving health care from the Department of Defense to 
        receiving health care from the Department of Veterans Affairs.
          (7) The ability of each Department to identify and treat 
        substance use disorders among individuals receiving health care 
        from that Department.
  (b) Coordination and Consultation.--The Secretary of Veterans Affairs 
and the Secretary of Defense shall ensure that the working group 
described in subsection (a)--
          (1) coordinates the activities of the working group with 
        other relevant working groups established under section 320 of 
        title 38, United States Code, including the working groups on 
        evidence-based practice, patient safety, pharmacy, 
        psychological health, and psychological health;
          (2) consults with other relevant Federal agencies, including 
        the Centers for Disease Control and Prevention, with respect to 
        the activities of the working group; and
          (3) consults with the Department of Veterans Affairs and the 
        Department of Defense with respect to, reviews, and comments on 
        the VA/DOD Clinical Practice Guideline for Management of Opioid 
        Therapy for Chronic Pain, or any successor guideline, before 
        any update to the guideline is released.
  (c) Consultations.--The Secretary of Veterans Affairs and the 
Secretary of Defense shall ensure that the working group described in 
subsection (a) is able to meaningfully consult with respect to the 
updated guideline required under subsection (a) of section 101, as 
required by subsection (b) of such section, not later than 1 year after 
the date of enactment of this Act.

SEC. 104. REVIEW, INVESTIGATION, AND REPORT ON USE OF OPIOIDS IN 
                    TREATMENT BY DEPARTMENT OF VETERANS AFFAIRS.

  (a) Comptroller General 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 Opioid Safety 
        Initiative of the Department of Veterans Affairs and the opioid 
        prescribing practices of health care providers of the 
        Department.
          (2) Elements.--The report submitted under paragraph (1) shall 
        include the following:
                  (A) Recommendations on such improvements to the 
                Opioid Safety Initiative of the Department as the 
                Comptroller General considers appropriate.
                  (B) Information with respect to--
                          (i) deaths resulting from sentinel events 
                        involving veterans prescribed opioids by a 
                        health care provider of the Department;
                          (ii) overall prescription rates and 
                        prescriptions indications of opioids to treat 
                        non-cancer, non-palliative, and non-hospice 
                        care patients;
                          (iii) the prescription rates and 
                        prescriptions indications of benzodiazepines 
                        and opioids concomitantly by health care 
                        providers of the Department;
                          (iv) the practice by health care providers of 
                        the Department of prescribing opioids to treat 
                        patients without any pain, including to treat 
                        patients with mental health disorders other 
                        than opioid use disorder; and
                          (v) the effectiveness of opioid therapy for 
                        patients receiving such therapy, including the 
                        effectiveness of long-term opioid therapy.
                  (C) An evaluation of processes of the Department in 
                place to oversee opioid use among veterans, including 
                procedures to identify and remedy potential over-
                prescribing of opioids by health care providers of the 
                Department.
                  (D) An assessment of the implementation by the 
                Secretary of the VA/DOD Clinical Practice Guideline for 
                Management of Opioid Therapy for Chronic Pain.
  (b) Quarterly Progress Report on Implementation of Comptroller 
General Recommendations.--Not later than two years after the date of 
the enactment of this Act, and not later than 30 days after the end of 
each quarter 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 progress report 
detailing the actions by the Secretary during the period covered by the 
report to address any outstanding findings and recommendations by the 
Comptroller General of the United States under subsection (a) with 
respect to the Veterans Health Administration.
  (c) Annual Review of Prescription Rates.--Not later than one year 
after the date of the enactment of this Act, and not less frequently 
than annually for the following five years, 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, with 
respect to each medical facility of the Department of Veterans Affairs, 
to collect and review information on opioids prescribed by health care 
providers at the facility to treat non-cancer, non-palliative, and non-
hospice care patients that contains, for the one-year period preceding 
the submission of the report, the following:
          (1) The number of patients and the percentage of the patient 
        population of the Department who were prescribed 
        benzodiazepines and opioids concurrently by a health care 
        provider of the Department.
          (2) The number of patients and the percentage of the patient 
        population of the Department without any pain who were 
        prescribed opioids by a health care provider of the Department, 
        including those who were prescribed benzodiazepines and opioids 
        concurrently.
          (3) The number of non-cancer, non-palliative, and non-hospice 
        care patients and the percentage of such patients who were 
        treated with opioids by a health care provider of the 
        Department on an inpatient-basis and who also received 
        prescription opioids by mail from the Department while being 
        treated on an inpatient-basis.
          (4) The number of non-cancer, non-palliative, and non-hospice 
        care patients and the percentage of such patients who were 
        prescribed opioids concurrently by a health care provider of 
        the Department and a health care provider that is not health 
        care provider of the Department.
          (5) With respect to each medical facility of the Department, 
        information on opioids prescribed by health care providers at 
        the facility to treat non-cancer, non-palliative, and non-
        hospice care patients, including information on--
                  (A) the prescription rate at which each health care 
                provider at the facility prescribed benzodiazepines and 
                opioids concurrently to such patients and the aggregate 
                such prescription rate for all health care providers at 
                the facility;
                  (B) the prescription rate at which each health care 
                provider at the facility prescribed benzodiazepines or 
                opioids to such patients to treat conditions for which 
                benzodiazepines or opioids are not approved treatment 
                and the aggregate such prescription rate for all health 
                care providers at the facility;
                  (C) the prescription rate at which each health care 
                provider at the facility prescribed or dispensed mail-
                order prescriptions of opioids to such patients while 
                such patients were being treated with opioids on an 
                inpatient-basis and the aggregate of such prescription 
                rate for all health care providers at the facility; and
                  (D) the prescription rate at which each health care 
                provider at the facility prescribed opioids to such 
                patients who were also concurrently prescribed opioids 
                by a health care provider that is not a health care 
                provider of the Department and the aggregate of such 
                prescription rates for all health care providers at the 
                facility.
          (6) With respect to each medical facility of the Department, 
        the number of times a pharmacist at the facility overrode a 
        critical drug interaction warning with respect to an 
        interaction between opioids and another medication before 
        dispensing such medication to a veteran.
  (d) Investigation of Prescription Rates.--If the Secretary determines 
that a prescription rate with respect to a health care provider or 
medical facility of the Department conflicts with or is otherwise 
inconsistent with the standards of appropriate and safe care, the 
Secretary shall--
          (1) immediately notify the Committee on Veterans' Affairs of 
        the Senate and the Committee on Veterans' Affairs of the House 
        of Representatives of such determination, including information 
        relating to such determination, prescription rate, and health 
        care provider or medical facility, as the case may be; and
          (2) through the Office of the Medical Inspector of the 
        Veterans Health Administration, conduct a full investigation of 
        the health care provider or medical facility, as the case may 
        be.
  (e) Prescription Rate Defined.--In this section, the term 
``prescription rate'' means, with respect to a health care provider or 
medical facility of the Department, each of the following:
          (1) The number of patients treated with opioids by the health 
        care provider or at the medical facility, as the case may be, 
        divided by the total number of pharmacy users of that health 
        care provider or medical facility.
          (2) The average number of morphine equivalents per day 
        prescribed by the health care provider or at the medical 
        facility, as the case may be, to patients being treated with 
        opioids.
          (3) Of the patients being treated with opioids by the health 
        care provider or at the medical facility, as the case may be, 
        the average number of prescriptions of opioids per patient.

SEC. 105. MANDATORY DISCLOSURE OF CERTAIN VETERAN INFORMATION TO STATE 
                    CONTROLLED SUBSTANCE MONITORING PROGRAMS.

  Section 5701(l) of title 38, United States Code, is amended by 
striking ``may'' and inserting ``shall''.

                       TITLE II--PATIENT ADVOCACY

SEC. 201. COMMUNITY MEETINGS ON IMPROVING CARE FURNISHED BY DEPARTMENT 
                    OF VETERANS AFFAIRS.

  (a) Community Meetings.--
          (1) Medical centers.--Not later than 90 days after the date 
        of the enactment of this Act, and not less frequently than once 
        every 90 days thereafter, the Secretary shall ensure that each 
        medical facility of the Department of Veterans Affairs hosts a 
        community meeting open to the public on improving health care 
        furnished by the Secretary.
          (2) Community based outpatient clinics.--Not later than one 
        year after the date of the enactment of this Act, and not less 
        frequently than annually thereafter, the Secretary shall ensure 
        that each community based outpatient clinic of the Department 
        hosts a community meeting open to the public on improving 
        health care furnished by the Secretary.
  (b) Attendance by Director of Veterans Integrated Service Network or 
Designee.--
          (1) In general.--Each community meeting hosted by a medical 
        facility or community based outpatient clinic under subsection 
        (a) shall be attended by the Director of the Veterans 
        Integrated Service Network in which the medical facility or 
        community based outpatient clinic, as the case may be, is 
        located. Subject to paragraph (2), the Director may delegate 
        such attendance only to an employee who works in the Office of 
        the Director.
          (2) Attendance by director.--Each Director of a Veterans 
        Integrated Service Network shall personally attend not less 
        than one community meeting under subsection (a) hosted by each 
        medical facility located in the Veterans Integrated Service 
        Network each year.
  (c) Notice.--The Secretary shall notify the Committee on Veterans' 
Affairs of the Senate, the Committee on Veterans' Affairs of the House 
of Representatives, and each Member of Congress (as defined in section 
104) who represents the area in which the medical facility is located 
of a community meeting under subsection (a) by not later than 10 days 
before such community meeting occurs.

SEC. 202. IMPROVEMENT OF AWARENESS OF PATIENT ADVOCACY PROGRAM AND 
                    PATIENT BILL OF RIGHTS OF DEPARTMENT OF VETERANS 
                    AFFAIRS.

  Not later than 90 days after the date of the enactment of this Act, 
the Secretary of Veterans Affairs shall, in as many prominent locations 
as the Secretary determines appropriate to be seen by the largest 
percentage of patients and family members of patients at each medical 
facility of the Department of Veterans Affairs--
          (1) display the purposes of the Patient Advocacy Program of 
        the Department and the contact information for the patient 
        advocate at such medical facility; and
          (2) display the rights and responsibilities of--
                  (A) patients and family members and patients at such 
                medical facility; and
                  (B) with respect to community living centers and 
                other residential facilities of the Department, 
                residents and family members of residents at such 
                medical facility.

SEC. 203. COMPTROLLER GENERAL REPORT ON PATIENT ADVOCACY PROGRAM OF 
                    DEPARTMENT OF VETERANS AFFAIRS.

  (a) 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 Patient Advocacy Program of the Department of Veterans 
Affairs (in this section referred to as the ``Program'').
  (b) Elements.--The report required by subsection (a) shall include 
the following:
          (1) A description of the Program, including--
                  (A) the purpose of the Program;
                  (B) the activities carried out under the Program; and
                  (C) the sufficiency of the Program in achieving the 
                purpose of the Program.
          (2) An assessment of the sufficiency of staffing of employees 
        of the Department responsible for carrying out the Program.
          (3) An assessment of the sufficiency of the training of such 
        employees.
          (4) An assessment of--
                  (A) the awareness of the Program among veterans and 
                family members of veterans; and
                  (B) the use of the Program by veterans and family 
                members of veterans.
          (5) Such recommendations and proposals for improving or 
        modifying the Program as the Comptroller General considers 
        appropriate.
          (6) Such other information with respect to the Program as the 
        Comptroller General considers appropriate.

            TITLE III--COMPLEMENTARY AND INTEGRATIVE HEALTH

SEC. 301. EXPANSION OF RESEARCH AND EDUCATION ON AND DELIVERY OF 
                    COMPLEMENTARY AND INTEGRATIVE HEALTH TO VETERANS.

  (a) Establishment.--There is established a commission to be known as 
the ``Creating Options for Veterans' Expedited Recovery'' or the 
``COVER Commission'' (in this Act referred to as the ``Commission''). 
The Commission shall examine the evidence-based therapy treatment model 
used by the Secretary of Veterans Affairs for treating mental health 
conditions of veterans and the potential benefits of incorporating 
complementary alternative treatments available in non-Department 
facilities (as defined in section 1701 of title 38, United States 
Code).
  (b) Duties.--The Commission shall perform the following duties:
          (1) Examine the efficacy of the evidence-based therapy model 
        used by the Secretary for treating mental health illnesses of 
        veterans and identify areas to improve wellness-based outcomes.
          (2) Conduct a patient-centered survey within each of the 
        Veterans Integrated Service Networks to examine--
                  (A) the experience of veterans with the Department of 
                Veterans Affairs when seeking medical assistance for 
                mental health issues through the health care system of 
                the Department;
                  (B) the experience of veterans with non-Department 
                facilities and health professionals for treating mental 
                health issues;
                  (C) the preference of veterans regarding available 
                treatment for mental health issues and which methods 
                the veterans believe to be most effective;
                  (D) the experience, if any, of veterans with respect 
                to the complementary alternative treatment therapies 
                described in paragraph (3);
                  (E) the prevalence of prescribing prescription 
                medication among veterans seeking treatment through the 
                health care system of the Department as remedies for 
                addressing mental health issues; and
                  (F) the outreach efforts of the Secretary regarding 
                the availability of benefits and treatments for 
                veterans for addressing mental health issues, including 
                by identifying ways to reduce barriers to gaps in such 
                benefits and treatments.
          (3) Examine available research on complementary alternative 
        treatment therapies for mental health issues and identify what 
        benefits could be made with the inclusion of such treatments 
        for veterans, including with respect to--
                  (A) music therapy;
                  (B) equine therapy;
                  (C) training and caring for service dogs;
                  (D) yoga therapy;
                  (E) acupuncture therapy;
                  (F) meditation therapy;
                  (G) outdoor sports therapy;
                  (H) hyperbaric oxygen therapy;
                  (I) accelerated resolution therapy;
                  (J) art therapy;
                  (K) magnetic resonance therapy; and
                  (L) other therapies the Commission determines 
                appropriate.
          (4) Study the sufficiency of the resources of the Department 
        to ensure the delivery of quality health care for mental health 
        issues among veterans seeking treatment within the Department.
          (5) Study the current treatments and resources available 
        within the Department and assess--
                  (A) the effectiveness of such treatments and 
                resources in decreasing the number of suicides per day 
                by veterans;
                  (B) the number of veterans who have been diagnosed 
                with mental health issues;
                  (C) the percentage of veterans using the resources of 
                the Department who have been diagnosed with mental 
                health issues;
                  (D) the percentage of veterans who have completed 
                counseling sessions offered by the Department; and
                  (E) the efforts of the Department to expand 
                complementary alternative treatments viable to the 
                recovery of veterans with mental health issues as 
                determined by the Secretary to improve the 
                effectiveness of treatments offered with the 
                Department.
  (c) Membership.--
          (1) In general.--The Commission shall be composed of 10 
        members, appointed as follows:
                  (A) Two members appointed by the Speaker of the House 
                of Representatives, at least one of whom shall be a 
                veteran.
                  (B) Two members appointed by the Minority Leader of 
                the House of Representatives, at least one of whom 
                shall be a veteran.
                  (C) Two members appointed by the Majority Leader of 
                the Senate, at least one of whom shall be a veteran.
                  (D) Two members appointed by the Minority Leader of 
                the Senate, at least one of whom shall be a veteran.
                  (E) Two members appointed by the President, at least 
                one of whom shall be a veteran.
          (2) Qualifications.--Members of the Commission shall be--
                  (A) individuals who are of recognized standing and 
                distinction within the medical community with a 
                background in treating mental health;
                  (B) individuals with experience working with the 
                military and veteran population; and
                  (C) individuals who do not have a financial interest 
                in any of the complementary alternative treatments 
                reviewed by the Commission.
          (3) Chairman.--The President shall designate a member of the 
        Commission to be the Chairman.
          (4) Period of appointment.--Members of the Commission shall 
        be appointed for the life of the Commission.
          (5) Vacancy.--A vacancy in the Commission shall be filled in 
        the manner in which the original appointment was made.
          (6) Appointment deadline.--The appointment of members of the 
        Commission in this section shall be made not later than 90 days 
        after the date of the enactment of this Act.
  (d) Powers of Commission.--
          (1) Meetings.--
                  (A) Initial meeting.--The Commission shall hold its 
                first meeting not later than 30 days after a majority 
                of members are appointed to the Commission.
                  (B) Meeting.--The Commission shall regularly meet at 
                the call of the Chairman. Such meetings may be carried 
                out through the use of telephonic or other appropriate 
                telecommunication technology if the Commission 
                determines that such technology will allow the members 
                to communicate simultaneously.
          (2) Hearings.--The Commission may hold such hearings, sit and 
        act at such times and places, take such testimony, and receive 
        evidence as the Commission considers advisable to carry out the 
        responsibilities of the Commission.
          (3) Information from federal agencies.--The Commission may 
        secure directly from any department or agency of the Federal 
        Government such information as the Commission considers 
        necessary to carry out the duties of the Commission.
          (4) Information from nongovernmental organizations.--In 
        carrying out its duties, the Commission may seek guidance 
        through consultation with foundations, veteran service 
        organizations, nonprofit groups, faith-based organizations, 
        private and public institutions of higher education, and other 
        organizations as the Commission determines appropriate.
          (5) Commission records.--The Commission shall keep an 
        accurate and complete record of the actions and meeting of the 
        Commission. Such record shall be made available for public 
        inspection and the Comptroller General of the United States may 
        audit and examine such record.
          (6) Personnel records.--The Commission shall keep an accurate 
        and complete record of the actions and meetings of the 
        Commission. Such record shall be made available for public 
        inspection and the Comptroller General of the United States may 
        audit and examine such records.
          (7) Compensation of members; travel expenses.--Each member 
        shall serve without pay but shall receive travel expenses to 
        perform the duties of the Commission, including per diem in 
        lieu of substances, at rates authorized under subchapter I of 
        chapter 57 of title 5, United States Code.
          (8) Staff.--The Chairman, in accordance with rules agreed 
        upon the Commission, may appoint fix the compensation of a 
        staff director and such other personnel as may be necessary to 
        enable the Commission to carry out its functions, without 
        regard to the provisions of title 5, United States Code, 
        governing appointments in the competitive service, without 
        regard to the provision of chapter 51 and subchapter III of 
        chapter 53 of such title relating to classification and General 
        Schedule pay rates, except that no rate of pay fixed under this 
        paragraph may exceed the equivalent of that payable for a 
        position at a level IV of the Executive Schedule under section 
        5316 of title 5, United States Code.
          (9) Personnel as federal employees.--
                  (A) In general.--The executive director and any 
                personnel of the Commission are employees under section 
                2105 of title 5, United States Code, for purpose of 
                chapters 63, 81, 83, 84, 85, 87, 89, and 90 of such 
                title.
                  (B) Members of the commission.--Subparagraph (A) 
                shall not be construed to apply to members of the 
                Commission.
          (10) Contracting.--The Commission may, to such extent and in 
        such amounts as are provided in appropriations Acts, enter into 
        contracts to enable the Commission to discharge the duties of 
        the Commission under this Act.
          (11) Expert and consultant service.--The Commission may 
        procure the services of experts and consultants in accordance 
        with section 3109 or title 5, United States Code, at rates not 
        to exceed the daily rate paid to a person occupying a position 
        at level IV of the Executive Schedule under section 3109 of 
        title 5, United States Code.
          (12) Postal service.--The Commission may use the United 
        States mails in the same manner and under the same conditions 
        as departments and agencies of the United States.
          (13) Physical facilities and equipment.--Upon the request of 
        the Commission, the Administrator of General Services shall 
        provide to the Commission, on a reimbursable basis, the 
        administrative support services necessary for the Commission to 
        carry out its responsibilities under this Act. These 
        administrative services may include human resource management, 
        budget, leasing accounting, and payroll services.
  (e) Report.--
          (1) Interim reports.--
                  (A) In general.--Not later than 60 days after the 
                date on which the Commission first meets, and each 30-
                day period thereafter ending on the date on which the 
                Commission submits the final report under paragraph 
                (2), the Commission shall submit to the Committees on 
                Veterans' Affairs of the House of Representatives and 
                the Senate and the President a report detailing the 
                level of cooperation the Secretary of Veterans Affairs 
                (and the heads of other departments or agencies of the 
                Federal Government) has provided to the Commission.
                  (B) Other reports.--In carrying out its duties, at 
                times that the Commission determines appropriate, the 
                Commission shall submit to the Committee on Veterans' 
                Affairs of the House of Representatives and the Senate 
                and any other appropriate entities an interim report 
                with respect to the findings identified by the 
                Commission.
          (2) Final report.--Not later than 18 months after the first 
        meeting of the Commission, the Commission shall submit to the 
        Committee on Veterans' Affairs of the House of Representatives 
        and the Senate, the President, and the Secretary of Veterans 
        Affairs a final report on the findings of the Commission. Such 
        report shall include the following:
                  (A) Recommendations to implement in a feasible, 
                timely, and cost efficient manner the solutions and 
                remedies identified within the findings of the 
                Commission pursuant to subsection (b).
                  (B) An analysis of the evidence-based therapy model 
                used by the Secretary of Veterans Affairs for treating 
                veterans with mental health care issues, and an 
                examination of the prevalence and efficacy of 
                prescription drugs as a means for treatment.
                  (C) The findings of the patient-centered survey 
                conducted within each of the Veterans Integrated 
                Service Networks pursuant to subsection (b)(2).
                  (D) An examination of complementary alternative 
                treatments described in subsection (b)(3) and the 
                potential benefits of incorporating such treatments in 
                the therapy models used by the Secretary for treating 
                veterans with mental health issues.
          (3) Plan.--Not later than 90 days after the date on which the 
        Commission submits the final report under paragraph (2), the 
        Secretary of Veterans Affairs shall submit to the Committee on 
        Veterans' Affairs of the House of Representatives and the 
        Senate a report on the following:
                  (A) An action plan for implementing the 
                recommendations established by the Commission on such 
                solutions and remedies for improving wellness-based 
                outcomes for veterans with mental health care issues.
                  (B) A feasible timeframe on when the complementary 
                alternative treatments described in subsection (b)(3) 
                can be implemented Department-wide.
                  (C) With respect to each recommendation established 
                by the Commission, including any complementary 
                alternative treatment, that the Secretary determines is 
                not appropriate or feasible to implement, a 
                justification for such determination and an alternative 
                solution to improve the efficacy of the therapy models 
                used by the Secretary for treating veterans with mental 
                health issues.
  (f) Termination of Commission.--The Commission shall terminate 30 
days after the Commission submits the final report under subsection 
(e)(2).

SEC. 302. PILOT PROGRAM ON INTEGRATION OF COMPLEMENTARY ALTERNATIVE 
                    MEDICINES AND RELATED ISSUES FOR VETERANS AND 
                    FAMILY MEMBERS OF VETERANS.

  (a) Pilot Program.--
          (1) In general.--Not later than 180 days after the date on 
        which the Secretary of Veterans Affairs receives the final 
        report under section 301(e), the Secretary shall commence a 
        pilot program to assess the feasibility and advisability of 
        using wellness-based programs (as defined by the Secretary) to 
        complement the provision of pain management and related health 
        care services, including mental health care services, to 
        veterans.
          (2) Matters addressed.--In carrying out the pilot program, 
        the Secretary shall assess the following:
                  (A) Means of improving coordination between Federal, 
                State, local, and community providers of health care in 
                the provision of pain management and related health 
                care services to veterans.
                  (B) Means of enhancing outreach, and coordination of 
                outreach, by and among providers of health care 
                referred to in subparagraph (A) on the pain management 
                and related health care services available to veterans.
                  (C) Means of using wellness-based programs of 
                providers of health care referred to in subparagraph 
                (A) as complements to the provision by the Department 
                of pain management and related health care services to 
                veterans.
                  (D) Whether wellness-based programs described in 
                subparagraph (C)--
                          (i) are effective in enhancing the quality of 
                        life and well-being of veterans;
                          (ii) are effective in increasing the 
                        adherence of veterans to the primary pain 
                        management and related health care services 
                        provided such veterans by the Department;
                          (iii) have an effect on the sense of well-
                        being of veterans who receive primary pain 
                        management and related health care services 
                        from the Department; and
                          (iv) are effective in encouraging veterans 
                        receiving health care from the Department to 
                        adopt a more healthy lifestyle.
  (b) Duration.--The Secretary shall carry out the pilot program under 
subsection (a)(1) for a period of three years.
  (c) Locations.--
          (1) Facilities.--The Secretary shall carry out the pilot 
        program under subsection (a)(1) at facilities of the Department 
        providing pain management and related health care services, 
        including mental health care services, to veterans. In 
        selecting such facilities to carry out the pilot program, the 
        Secretary shall select not fewer than 15 medical centers of the 
        Department, of which not fewer than two shall be polytrauma 
        rehabilitation centers of the Department.
          (2) Medical centers with prescription rates of opioids that 
        conflict with care standards.--In selecting the medical centers 
        under paragraph (1), the Secretary shall give priority to 
        medical centers of the Department at which there is a 
        prescription rate of opioids that conflicts with or is 
        otherwise inconsistent with the standards of appropriate and 
        safe care.
  (d) Provision of Services.--Under the pilot program under subsection 
(a)(1), the Secretary shall provide covered services to covered 
veterans by integrating complementary and alternative medicines and 
integrative health services with other services provided by the 
Department at the medical centers selected under subsection (c).
  (e) Covered Veterans.--For purposes of the pilot program under 
subsection (a)(1), a covered veteran is any veteran who--
          (1) has a mental health condition diagnosed by a clinician of 
        the Department;
          (2) experiences chronic pain;
          (3) has a chronic condition being treated by a clinician of 
        the Department; or
          (4) is not described in paragraph (1), (2), or (3) and 
        requests to participate in the pilot program or is referred by 
        a clinician of the Department who is treating the veteran.
  (f) Covered Services.--
          (1) In general.--For purposes of the pilot program, covered 
        services are services consisting of complementary and 
        integrative health services as selected by the Secretary.
          (2) Administration of services.--Covered services shall be 
        administered under the pilot program as follows:
                  (A) Covered services shall be administered by 
                professionals or other instructors with appropriate 
                training and expertise in complementary and integrative 
                health services who are employees of the Department or 
                with whom the Department enters into an agreement to 
                provide such services.
                  (B) Covered services shall be included as part of the 
                Patient Aligned Care Teams initiative of the Office of 
                Patient Care Services, Primary Care Program Office, in 
                coordination with the Office of Patient Centered Care 
                and Cultural Transformation.
                  (C) Covered services shall be made available to--
                          (i) covered veterans who have received 
                        conventional treatments from the Department for 
                        the conditions for which the covered veteran 
                        seeks complementary and integrative health 
                        services under the pilot program; and
                          (ii) covered veterans who have not received 
                        conventional treatments from the Department for 
                        such conditions.
  (g) Reports.--
          (1) In general.--Not later than 30 months after the date on 
        which the Secretary commences the pilot program under 
        subsection (a)(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 pilot program.
          (2) Elements.--The report under paragraph (1) shall include 
        the following:
                  (A) The findings and conclusions of the Secretary 
                with respect to the pilot program under subsection 
                (a)(1), including with respect to--
                          (i) the use and efficacy of the complementary 
                        and integrative health services established 
                        under the pilot program;
                          (ii) the outreach conducted by the Secretary 
                        to inform veterans and community organizations 
                        about the pilot program; and
                          (iii) an assessment of the benefit of the 
                        pilot program to covered veterans in mental 
                        health diagnoses, pain management, and 
                        treatment of chronic illness.
                  (B) Identification of any unresolved barriers that 
                impede the ability of the Secretary to incorporate 
                complementary and integrative health services with 
                other health care services provided by the Department.
                  (C) Such recommendations for the continuation or 
                expansion of the pilot program as the Secretary 
                considers appropriate.
  (h) Complementary and Integrative Health Defined.--In this section, 
the term ``complementary and integrative health'' shall have the 
meaning given that term by the National Institutes of Health.

               TITLE IV--FITNESS OF HEALTH CARE PROVIDERS

SEC. 401. ADDITIONAL REQUIREMENTS FOR HIRING OF HEALTH CARE PROVIDERS 
                    BY DEPARTMENT OF VETERANS AFFAIRS.

  As part of the hiring process for each health care provider 
considered for a position at the Department of Veterans Affairs after 
the date of the enactment of the Act, the Secretary of Veterans Affairs 
shall require from the medical board of each State in which the health 
care provider has a medical license--
          (1) information on any violation of the requirements of the 
        medical license of the health care provider during the 20-year 
        period preceding the consideration of the health care provider 
        by the Department; and
          (2) information on whether the health care provider has 
        entered into any settlement agreement for the disciplinary 
        charge relating to the practice of medicine by the health care 
        provider.

SEC. 402. PROVISION OF INFORMATION ON HEALTH CARE PROVIDERS OF 
                    DEPARTMENT OF VETERANS AFFAIRS TO STATE MEDICAL 
                    BOARDS.

  Notwithstanding section 552a of title 5, United States Code, with 
respect to each health care provider of the Department of Veterans 
Affairs who has violated a requirement of the medical license of the 
health care provider, the Secretary of Veterans Affairs shall provide 
to the medical board of each State in which the health care provider is 
licensed detailed information with respect to such violation, 
regardless of whether such board has formally requested such 
information.

SEC. 403. REPORT ON COMPLIANCE BY DEPARTMENT OF VETERANS AFFAIRS WITH 
                    REVIEWS OF HEALTH CARE PROVIDERS LEAVING THE 
                    DEPARTMENT OR TRANSFERRING TO OTHER FACILITIES.

  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 compliance by the 
Department of Veterans Affairs with the policy of the Department--
          (1) to conduct a review of each health care provider of the 
        Department who transfers to another medical facility of the 
        Department, retires, or is terminated to determine whether 
        there are any concerns, complaints, or allegations of 
        violations relating to the medical practice of the health care 
        provider; and
          (2) to take appropriate action with respect to any such 
        concern, complaint, or allegation.

                    TITLE V--OTHER VETERANS MATTERS

SEC. 501. AUDIT OF VETERANS HEALTH ADMINISTRATION PROGRAMS OF 
                    DEPARTMENT OF VETERANS AFFAIRS.

  (a) Audit.--The Secretary of Veterans Affairs shall seek to enter 
into a contract with a nongovernmental entity under which the entity 
shall conduct a audits of the programs of the Veterans Health 
Administration of the Department of Veterans Affairs to identify ways 
to improve the furnishing of benefits and health care administered by 
the Veterans Health Administration to veterans and families of 
veterans.
  (b) Audit Requirements.--In carrying out each audit under subsection 
(a), the entity shall perform the following:
          (1) Five-year risk assessments to identify the functions, 
        staff organizations, and staff offices of the Veterans Health 
        Administration that would lead towards the greatest improvement 
        in furnishing of benefits and health care to veterans and 
        families of veterans.
          (2) Development of plans that are informed by the risk 
        assessment under paragraph (1) to conduct audits of the 
        functions, staff organizations, and staff offices identified 
        under paragraph (1).
          (3) Conduct audits in accordance with the plans developed 
        pursuant to paragraph (2).
  (c) Reports.--Not later than 90 days after the date on which each 
audit is completed under subsection (a), the Secretary shall submit to 
the Committees on Veterans' Affairs of the House of Representatives and 
the Senate a report that includes--
          (1) a summary of the audit;
          (2) the findings of the entity that conducted the audit with 
        respect to the audit; and
          (3) such recommendations as the Secretary determines 
        appropriate for legislative or administrative action to improve 
        the furnishing of benefits and health care to veterans and 
        families of veterans..

                          Purpose and Summary

    H.R. 4063, the ``Jason Simcakoski Promoting Responsible 
Opioid Management and Incorporating Scientific Expertise 
(PROMISE) Act,'' was introduced by Representative Gus Bilirakis 
of Florida, the Vice Chairman of the Committee on Veterans' 
Affairs, on November 18, 2015. H.R. 4063, as amended, was 
ordered to be favorably reported to the full House on February 
25, 2016, by voice vote.
    H.R. 4063, as amended would: (1) Require the Department of 
Veterans Affairs (VA) and the Department of Defense (DOD) to 
jointly establish an advisory committee to review and update 
the VA/DOD Clinical Practice Guideline for Management of Opioid 
Therapy for Chronic Pain; (2) require VA to expand the opioid 
safety initiative; (3) strengthen the VA/DOD Pain Management 
Working Group; (4) require the Government Accountability Office 
(GAO) to report on VA's opioid safety initiative and the opioid 
prescribing practices of VA healthcare providers; (5) require 
VA to disclose information to state controlled substance 
monitoring programs; (6) require VA to ensure that each VA 
medical facility hosts regular community meetings on improving 
the provision of VA health care; (7) require VA to display 
information on the patient advocacy program and the patient 
bill of rights; (8) require GAO to report on VA's patient 
advocacy program; (9) establish a Commission to examine VA's 
evidence-based therapy treatment model and the potential 
benefits of incorporating complementary and alternative 
medicine; (10) establish a pilot program to assess the 
feasibility and advisability of using wellness-based programs 
to complement the provision of pain management to veterans; 
(11) require VA to ensure that State medical boards receive 
information on violations of a provider's medical license; (12) 
require VA to provide State medical boards detailed information 
with respect to a violation of a requirement of a provider's 
medical license; (13) require VA to report on the Department's 
compliance with policies to conduct a review of each healthcare 
provider who transfers to another VA medical facility, retires, 
or is terminated to determine whether there are any concerns, 
complaints, or allegations of violations relating to the 
provider's medical practice and to take appropriate action; 
and, (14) require VA to conduct an audit of Veterans Health 
Administration (VHA) programs and identify ways to improve the 
provision of benefits and healthcare to veterans and their 
families.

                  Background and Need for Legislation


          TITLE I--OPIOID THERAPY AND PAIN MANAGEMENT SECTION

Section 101--Establishment of an Advisory Committee to review 
        guidelines on management of opioid therapy by Department of 
        Veterans Affairs and Department of Defense

    The effective management of pain is an increasingly 
critical issue for the American health care system. Given that 
the veteran population experiences chronic pain at a much 
higher rate than the general adult population, it is also an 
increasingly critical issue for the VA health care system. 
Chronic pain, which is defined as pain that persists beyond 
expected healing time and generally persists longer than three 
to six months, affects veterans of all eras. It is the most 
frequent medical condition facing veterans of Iraq and 
Afghanistan and, as the incidence and severity of pain increase 
with age, it is also common among older generations of 
veterans. Chronic pain is a complex condition, involving 
cognitive, psychosocial, and substance use issues as well as a 
variety of medical and mental health co-morbidities.
    DOD and VA have been increasingly reliant on the use of 
prescription painkillers--and, in particular, opioids--to treat 
servicemembers and veterans experiencing both acute and chronic 
pain. Opioids are a commonly abused medication derived from, or 
synthesized similar to, the opium poppy and used for pain 
relief. Examples of common opioids include: hydrocodone; 
oxycodone, fentanyl, methadone, and codeine. According to a CBS 
News report based on VA data, the number of patients treated by 
VA increased 29%, while the number of opioid prescriptions 
written by VA providers increased 259%, from 2002 to 2013.\1\ 
Additionally, the Center for Investigative Reporting found that 
VA prescriptions for certain opioids--hydrocodone, oxycodone, 
methadone and morphine--rose 270% from 2001 to 2013.\2\
---------------------------------------------------------------------------
    \1\CBS News, ``Veterans Dying from Overmedication,'' Sep. 19, 2013, 
http://www.cbsnews.com/news/veterans-dying-from-overmedication/.
    \2\The Center for Investigative Reporting, ``VA's Opiate Overload 
Feeds Veterans' Additions, Overdose Deaths,'' Sep. 28, 2013, http://
cironline.org/reports/vas-opiate-overload-feeds-veterans-addictions-
overdose-deaths-5261.
---------------------------------------------------------------------------
    To help manage the use of opioid medications for 
servicemembers and veterans experiencing chronic pain, VA and 
DOD published the Clinical Practice Guideline for the 
Management of Opioid Therapy (Guideline) in May 2010.\3\ The 
Guideline recommends opioid therapy for servicemembers and 
veterans with chronic pain that meet several eligibility 
criteria including moderate to severe pain that has failed to 
adequately respond to non-opioid and non-drug therapeutic 
interventions. However, the Guideline notes the existence of, 
``controversy . . . among pain practitioners concerning the use 
of opioids for the treatment of chronic pain'' due, in part to, 
``. . . a paucity of data regarding long-term opioid 
efficacy.''
---------------------------------------------------------------------------
    \3\The Department of Veterans Affairs and Department of Defense, 
``Management of Opioid Therapy for Chronic pain,'' May 2010, http://
www.va.gov/painmanagement/docs/cpg_opioidtherapy_fulltext.pdf.
---------------------------------------------------------------------------
    Research has also noted concerns about the use of opioid 
prescriptions to treat veteran patients. A study conducted by 
VA researchers and published in The Journal of the American 
Medical Association on March 7, 2012,\4\ found that veterans 
with a mental health diagnosis--in particular, post-traumatic 
stress disorder (PTSD)--were significantly more likely than 
their peers to receive prescription opioids for pain. These 
veterans also were ``more likely to have comorbid drug and 
alcohol use disorders; receive higher-dose opioid regimens; 
continue taking opioids longer; receive concurrent 
prescriptions for opioids, sedative hypnotics, or both; and 
obtain early opioid refills,'' which can be a sign of opioid 
abuse. Perhaps most troublingly, the study concluded that, 
``receiving prescription opioids was associated with increased 
risk of adverse clinical outcomes for all veterans returning 
from Iraq and Afghanistan, especially veterans with PTSD who 
were at highest-risk of alcohol-
, drug-, and opioid-related accidents and overdose as well as 
self-inflicted injuries.''\5\
---------------------------------------------------------------------------
    \4\The Journal of the American Medical Association, ``Association 
of Mental Health Disorders With Prescription Opioids and High-Risk 
Opioid Use in US Veterans of Iraq and Afghanistan,'' March 7, 2012, 
http://jama.jamanetwork.com/article.aspx?articleid=1105046.
    \5\The article also noted that ``in a sample of veterans with 
multiple pain problems, those with the highest-risk medical and 
psychiatric comorbidity were the most likely to receive the highest-
dose, highest-risk opioid therapy.''
---------------------------------------------------------------------------
    The Committee is supportive of the Guideline but believes 
that it should be updated to reflect the most current research 
and best practices regarding the use of opioid medications in 
pain care, particularly in light of ongoing concerns regarding 
opioid use among veteran patients. As such, Section 101 would 
require VA and DOD to jointly establish an advisory committee 
to conduct a review of and make recommendations with respect to 
updating the Guideline. The advisory committee would be 
required to report to VA and DOD not later than one year after 
the date of enactment of this Act and to examine whether the 
Guideline should include enhanced guidance on a number of 
metrics, including the coadministration of opioids and other 
medications and the treatment of patients with comorbidities. 
In conducting the review of the Guideline, the advisory 
committee would be also required to consult with the VA/DOD 
Management of Opioid Therapy for Chronic Pain Working Group.

Section 102--Improvement of opioid safety measures by the Department of 
        Veterans Affairs

    VA launched the Opioid Safety Initiative (OSI) in October 
2013, to reduce the use of opioids among veterans using the VA 
health care system and to improve care for veterans with 
chronic pain. According to VA, OSI works by incorporating a 
team-based approach, increasing the use of non-prescription 
pain management treatments and CAM, and emphasizing patient 
education and monitoring. To aid in the effectiveness of OSI, 
VA's National Pain Management Program office convened a 
national task force of pain management experts across multiple 
disciplines to create an accompanying toolkit to help VA 
clinicians better manage pain among--and prescribe appropriate 
medications to--their veteran patients. OSI was first deployed 
in and around Minneapolis, Minnesota, and has since expanded to 
many other VA medical facilities, while the OSI toolkit is 
available on VA's website for both VA providers and the general 
public to access.
    Given the prevalence of chronic pain in the veteran 
population and ongoing concerns about opioid use and pain care 
management throughout VA, the Committee wants to ensure that 
OSI and the OSI toolkit are used uniformly across all VA 
medical facilities, that VA clinicians are trained in 
appropriately managing pain and prescribing opioid medications, 
and that VA leaders are effectively overseeing the provision of 
pain care and opioid use among veteran patients. To accomplish 
these goals, section 102 of the bill would require VA to expand 
OSI to all VA medical facilities. It would also require VA to 
use the Interdisciplinary Chronic Pain Management Training Team 
Program to ensure that all VA employees who are responsible for 
prescribing opioids receive education and training on pain 
management and safe opioid prescribing practices to enable them 
to safely and effectively manage care for patients with chronic 
pain. Such education and training would be required to include 
the Guideline, the use of evidence-based pain management 
therapies, the screening and identification of patients with 
substance use disorder, communication with patients on the use 
of opioids and other controlled substances, and other training 
as the Secretary considers appropriate.
    Section 102 of the bill would further require the Director 
of each VA medical facility to designate a pain management team 
to coordinate and oversee pain management therapy at the 
facility and to consult with the Director of each Veterans 
Integrated Service Network (VISN) to establish standard 
protocols for designating pain management teams. Such protocols 
would be required to include assurances that any health care 
provider without expertise in prescribing analgesics or who has 
not completed education and training on pain management and 
safe opioid prescribing practices does not prescribe opioids to 
a patient unless such provider consults with a provider with 
pain management expertise and refers the patient to the pain 
management team for any subsequent prescriptions and related 
therapy. VA would also be required to regularly report, track, 
and monitor the pain management teams, the use of OSI and other 
tools, opioid use among VA patients, and the availability of 
opioid receptor antagonists.

Section 103--Strengthening of joint working group on pain management of 
        the Department of Veterans Affairs and the Department of 
        Defense

    As explained in the descriptive portion of section 101 of 
the bill above, the use of opioid medications for managing 
chronic pain has been rapidly increasing in recent years. Data 
suggests that veterans are a particularly high-risk population 
for prescription misuse, substance use disorder, accidental 
overdose, accidents, and/or self-inflicted injury and some 
studies have shown that those veterans with the highest-risk 
conditions are also the most likely to receive the highest-
dose, highest-risk opioid therapies. As a result, the Committee 
believes that, along with updating the Guideline, VA and DOD 
must focus their collaborative efforts on improving pain care 
for servicemembers and veterans. The Committee is particularly 
concerned about how VA and DOD manage patients' needs--and, in 
particular, their medication needs--during the transition from 
DOD care to VA care, which is an especially vulnerable time for 
many.
    To assist the Departments in focusing on these specific 
areas of need, section 103 of the bill would require VA and DOD 
to ensure that the Pain Management Working Group of the Health 
Executive Committee of the VA/DOD Joint Executive Committee 
focuses on the following: opioid prescribing practices; the 
ability to manage acute and chronic pain; the use of CAM; the 
concurrent use of opioids and prescription drugs to treat 
mental health disorders; the practice of prescribing opioids to 
treat mental health disorders; access to medications for 
patients transitioning from DOD to VA; and, the ability to 
identify and treat substance use disorder. Section 103 of the 
bill would also require VA and DOD to ensure that the Working 
Group coordinates with other relevant working groups and 
Federal agencies and consults with and comments on the updated 
Guideline or any successor guideline.

Section 104--Review, investigation, and report on use of opioids in 
        treatment by Department of Veterans Affairs

    As explained in the descriptive portions of section 102 of 
the bill above, VA developed and deployed the OSI in October 
2013 in Minneapolis, Minnesota. In February 2014--five months 
after it was first deployed--VA reported that the OSI had 
already demonstrated success in lowering dependency on opioid 
medications. According to VA, the eight sites of care where the 
OSI was deployed in and around Minneapolis decreased high-dose 
opioid prescriptions by more than half. While encouraged by 
those results, the Committee wants to ensure that the OSI is 
continuously updated and improved as research surrounding pain 
management and opioid use is advanced.
    In accordance with that goal, section 104 of the bill would 
require GAO to submit a report to Congress on the OSI and the 
opioid prescribing practices of VA health care providers and 
issue recommendations for improvement. VA would be required to 
report to Congress quarterly on the Department's progress 
implementing GAO's recommendations. VA would also be required 
to report to Congress annually--for five years--on opioid 
prescriptions for non-cancer, non-palliative, and non-hospice 
care patients at each VA medical facility. Section 104 of the 
bill would further require VA to notify Congress and conduct a 
full investigation through the Office of Medical Inspector if 
the Secretary determines that a prescription rate with respect 
to either a medical facility or individual provider conflicts 
with or is otherwise inconsistent with the standards of 
appropriate and safe care.

Section 105--Mandatory disclosure of certain veteran information to 
        State controlled substances monitoring programs

    State prescription drug monitoring programs--which are also 
referred to as state controlled substance monitoring programs--
are tools used by State governments to collect, monitor, and 
analyze prescribing and dispensing data submitted by pharmacies 
and dispensing practitioners to support state efforts in 
education, research, law enforcement and substance abuse 
prevention. Data collected by state prescription drug 
monitoring programs is provided to authorized entities 
including healthcare providers, pharmacists, regulatory boards, 
and law enforcement agencies. According to the Prescription 
Drug Monitoring Program Training and Technical Assistance 
Center, 49 states, the District of Columbia, and Guam have 
legislation that authorizes a prescription drug monitoring 
program, and of those, 49 states and Guam have a prescription 
drug monitoring program that is operational.
    In 2013, VA promulgated a regulation that allowed but did 
not require VA medical facilities to disclose information about 
a veteran or dependent of a veteran to a State controlled 
prescription drug monitoring program in order to prevent the 
misuse and diversion of prescription medicines. Some, but not 
all, VA medical facilities are now communicating with their 
local State prescription drug monitoring program. However, the 
Committee believes that all VA medical facilities should be 
disclosing relevant information to State prescription drug 
monitoring programs. As such, section 105 would require VA to 
disclose information to state controlled substance monitoring 
programs.

                       TITLE II--PATIENT ADVOCACY

Section 201--Community meetings on improving care furnished by 
        Department of Veterans Affairs

    In April 2014, the Committee uncovered the use of 
unauthorized waiting lists at the Phoenix VA Health Care System 
in Phoenix, Arizona. At that time, at least forty veteran 
patients had died while waiting on those lists to receive VA 
care. This finding--and the subsequent investigations that 
resulted from it--led to a widespread access and accountability 
scandal that plagued the entire VA health care system. During 
that scandal--the repercussions of which continue today--it 
became increasingly clear to the Committee that there was a 
disconnect between the leaders responsible for managing the VA 
health care system and the veteran patients and their families 
who relied on that system to meet their needs.
    To correct this disconnect and increase communication 
between local and regional VA leaders, veterans, and other 
stakeholders, section 201 of the bill would require VA to 
ensure that each VA medical facility--to include community-
based outpatient clinics--hosts a community meeting with 
members of the public on improving the provision of health care 
by VA. Each community meeting would be required to be noticed 
at least 10 days in advance to the public and Congress. In 
addition, either the Director of the relevant VISN or an 
employee the Director delegates must attend each meeting, with 
the stipulation that the Director must personally attend at 
least one community meeting each year.

Section 202--Improvement of awareness of patient advocacy program and 
        patient bill of rights of Department of Veterans Affairs

    VA operates a patient advocacy program to assist in the 
timely resolution of patient complaints and concerns. In 
accordance with the patient advocacy program, each VA medical 
facility employs one or more patient advocates. Patient 
advocates work directly with service-line chiefs and, per the 
Patient Advocacy Program Handbook, are responsible for 
facilitating resolution to problems beyond the scope of front-
line staff and participating in the resolution of system 
problems by presenting the patient's perspective and desired 
resolution.\6\ The Handbook also requires that patient rights 
and responsibilities as well as information regarding the 
patient advocacy program be posted in VA medical facilities and 
provided to patients upon admission. Despite this requirement, 
the Committee is concerned that veteran patients are not aware 
of their rights and responsibilities with regard to their 
health care or of their ability to contact a patient advocate 
to assist them in resolving complaints and concerns related to 
their health care.
---------------------------------------------------------------------------
    \6\VHA Handbook 1003.4, VHA Patient Advocacy Program.
---------------------------------------------------------------------------
    To remedy this, section 202 of the bill would require VA to 
display the following information in each VA medical facility: 
The purposes of the patient advocacy program; the contact 
information for the facility's patient advocate; and the rights 
and responsibilities of the patients and family members of the 
patient or--with respect to community living centers or other 
VA residential facilities--the rights and responsibilities of 
residents and family members of residents. Such information 
would be required to be displayed in as many prominent 
locations as the Secretary determines is appropriate in order 
to be seen by the largest percentage of patients or residents 
and family members of patients or residents in each facility.

Section 203--Comptroller general report on patient advocacy program of 
        Department of Veterans Affairs

    The Committee believes that a strong patient advocacy 
program is vital to patient satisfaction and to the success of 
the VA health care system. However, the Committee has heard 
numerous concerns from veterans and their families that VA 
patient advocates are not always responsive to a veteran's 
needs. In light of those concerns, section 203 of the bill 
would require GAO to perform an audit of VA's patient advocacy 
program. The report produced by that audit would be required to 
include the purpose and activities of the patient advocacy 
program, the sufficiency of the patient advocacy program in 
achieving its purpose, an assessment of the staffing of the 
patient advocacy program, an assessment of the training of VA 
patient advocates, an assessment of whether veterans and their 
families are aware of and use the patient advocacy program, and 
such recommendations and proposals for improving or modifying 
the patient advocacy program as GAO considers appropriate.

            TITLE III--COMPLEMENTARY AND INTEGRATIVE HEALTH

Section 301--Expansion of research and education on and delivery of 
        complementary and integrative health to veterans

    The National Center for Complementary and Integrative 
Health of the National Institutes of Health (NIH) defines 
complementary and alternative medicine (CAM) as ``a group of 
diverse medical and health care interventions, practices 
products, or disciplines that are not generally considered part 
of conventional medicine.''\7\ The term ``complementary'' 
refers to the use of CAM together with conventional medicine, 
such as using meditation in addition to traditional 
psychotherapy to treat PTSD. The term ``alternative'' refers to 
use of CAM in place of conventional medicine, such as using 
meditation in place of traditional psychotherapy to treat PTSD. 
According to the VA Office of Research and Development, VA most 
often uses CAM to help veterans manage stress, to promote 
general wellness, or to treat PTSD, depression, back pain, 
headache, arthritis, fibromyalgia, or substance abuse. While 
the use of CAM has grown significantly throughout VA over the 
past decade, the demand for CAM services among veterans 
accessing VA care is increasing, and the Committee would like 
to see CAM provided to veterans more uniformly across the VA 
health care system.
---------------------------------------------------------------------------
    \7\National Center for Complementary and Integrative Health, 
``Exploring the Science of Complementary and Alternative Medicine, 
Third Strategic Plan: 2011-2015,'' https://nccih.nih.gov/sites/
nccam.nih.gov/files/NCCAM_SP_508.pdf.
---------------------------------------------------------------------------
    Accordingly, section 301 of the bill would establish the 
Creating Options for Veterans' Expedited Recovery (or COVER) 
Commission to examine the evidence-based therapy treatment 
model used by VA to treat veterans and the potential benefits 
of incorporating CAM into that treatment model. The Commission 
would have the following duties: To examine the efficacy of 
VA's evidence-based treatment model in treatment mental illness 
in veterans; to identify areas to improve wellness-based 
outcomes; to conduct patient centered surveys within each VISN 
on veterans' experiences and preferences; to examine available 
research on CAM and what benefits could result from the 
inclusion of CAM treatments; to study whether VA's resources 
are sufficient for ensuring the delivery of quality care for 
veterans with mental health issues who are seeking VA 
treatment; and to study and assess the current treatments and 
resources available within VA. The Commission's membership 
would be composed of appointees from the Speaker and Minority 
Leader of the House of Representatives, the Majority Leader and 
Minority Leader of the Senate, and the President who have 
relevant qualifications. The Commission would be required to 
meet and report to Congress regularly. Following the 
Commission's final report, VA would be required to submit an 
action plan for implementing the Commission's recommendations 
and a timeframe for implementing CAM. If VA elects not to 
implement a given recommendation, VA would be required to 
submit a justification for determining that such recommendation 
is not appropriate and an alternative solution to improve the 
efficacy of VA's therapy model.

Section 302--Pilot program on integration of complementary alternative 
        medicines and related issues for veterans and family members

    As explained in the descriptive portion of section 301 of 
the bill, the Committee is interested in increasing the use of 
CAM throughout the VA health care system generally. The 
Committee is also interested in exploring how CAM may benefit 
veterans seeking pain care, specifically. To further this goal, 
section 302 of the bill would establish a three-year pilot 
program in at least 15 VA medical centers to assess the 
feasibility and advisability of using wellness-based programs 
to complement the provision of pain and related care to 
veterans. The pilot program would be required to assess the 
following: the means of improving coordination between Federal, 
State, local, and community health care providers in providing 
pain and related care; the means of enhancing outreach and 
coordination of outreach by and among health care providers 
providing pain and related care; the means of using wellness-
based programs to complement pain and related care; and whether 
wellness-based programs are effective for veterans receiving 
pain and related care. In selecting VA medical centers for the 
pilot program, VA would be required to prioritize facilities 
with the opioid prescription rates that conflict or are 
otherwise inconsistent with usual standards of appropriate and 
safe care. In order to be eligible to participate in the pilot, 
veterans would have to be diagnosed with a mental health 
condition and experience chronic pain that is being treated by 
a VA clinician. During the pilot, participating veterans would 
be provided with CAM as defined by NIH. VA would be required to 
report to Congress not later than 30 months after the beginning 
of the pilot program.

               TITLE IV--FITNESS OF HEALTH CARE PROVIDERS

Section 401--Additional requirements for hiring of health care 
        providers by Department of Veterans Affairs

    In response to complaints made in 2011 and 2012, the VA 
Office of the Inspector General (IG) conducted a review of 
alleged inappropriate prescription of controlled substances and 
alleged abuse of authority at the Tomah VA Medical Center 
(VAMC) in Tomah, Wisconsin. According to the IG, a total of 32 
specific allegations were made before and during the course of 
the IG's review. These allegations concerned the number of 
opioid prescriptions at the facility, in general, and the 
opioid prescribing practices of the facility's Chief of Staff, 
in particular. According to media reports, veterans commonly 
referred to the facility as ``Candy Land'' and to the Chief of 
Staff as the ``Candy Man'' because of the high number of opioid 
prescriptions that were provided.\8\ While the IG did not 
substantiate allegations that opioids were prescribed 
inappropriately to specific individuals or in inappropriate 
doses, the IG did find that the amounts of opioids prescribed 
by the Chief of Staff and select other providers were ``at 
considerable variance compared with most opioid prescribers in 
VISN 12.''\9\ The IG also substantiated that there were, 
``widely held beliefs and concerns among pharmacy staff and 
among some other staff,'' of abuse of authority, intimidation, 
and retaliation on the part of the Chief of Staff when 
controlled substance prescription practices were 
questioned.\10\ In conclusion, the IG stated that, ``our 
inspection raised potentially serious concerns that should be 
brought to the attention of VISN 12 management for further 
review.''\11\
---------------------------------------------------------------------------
    \8\Chicago Tribune, ``Veterans: VA hospital nicknamed `Candy Land' 
because painkillers given out freely,'' January 9, 2015. http://
www.chicagotribune.com/news/ct-tomah-va-hospital-nw-20150109-story.html
    \9\VA Office of the Inspector General, ``Administrative Closure--
Alleged Inappropriate Prescribing of Controlled Substances and Alleged 
Abuse of Authority, Tomah VA Medical Center, Tomah, WI,'' page 7. 
http://www.va.gov/oig/pubs/VAOIG-11-04212-127.pdf.
    \10\Id., at page 5.
    \11\Id., page 9. http://www.va.gov/oig/pubs/VAOIG-11-04212-127.pdf.
---------------------------------------------------------------------------
    Following the public release of the IG's findings in 2015, 
VA began a comprehensive review of medication prescription 
practices at the Tomah VAMC. VA's review substantiated unsafe 
clinical practices in areas such as pain management and 
psychiatric care and found that Tomah VAMC patients were: (1) 
2.5 times more likely than the national average to be 
prescribed opioids greater than 400 morphine equivalents per 
day; (2) more likely than the national average to be prescribed 
opioid doses between 200-300 morphine equivalents per day; and, 
(3) almost double the national average with respect to the use 
of benzodiazepines and opioids together. Higher morphine 
equivalents per day and the concurrent use of benzodiazepines 
and opioids increase the occurrence of complications and 
adverse events.
    The IG's and VA's investigations into the Tomah VAMC, and 
the issues that subsequently came to light regarding the Tomah 
VAMC Chief of Staff, started a national conversation about the 
prevalence of opioid prescriptions in the VA health care 
system, how VA oversees facility's and providers' opioid 
prescribing practices, and whether and how VA communicates with 
State and local medical licensing bodies regarding patient care 
concerns with individual providers.
    To ensure that VA has insight into a prospective provider's 
history to include any findings of negligent patient care 
section 401 of the bill would require that, as part of the 
hiring process for incoming providers, VA solicit information 
from the medical board of each State in which an incoming 
provider is licensed. Information VA would be required to 
solicit from the State medical board would include information 
regarding any violations of such provider's medical license and 
information regarding whether such provider has entered into 
any settlement agreements as a result of disciplinary charges 
relating to the practice of medicine.

Section 402--Provision of information on health care providers of 
        Department of Veterans Affairs to State Medical Boards

    As stated above, the Committee has concerns regarding the 
need for VA to have information regarding allegations or 
findings made against a prospective provider's medical license. 
The Committee recognizes a similar need for VA to share 
information with State and local medical licensing bodies about 
allegations or findings that are made about providers during 
their tenure at VA. As such, section 402 of the bill would 
require VA to provide the medical board of each State in which 
a healthcare provider is licensed detailed information with 
respect to a violation of a requirement of such provider's 
medical license.

Section 403--Report on compliance by Department of Veterans Affairs 
        with reviews of health care providers leaving the Department or 
        transferring to other facilities

    Following the issues described above regarding the Tomah 
VAMC, the Committee heard concerns from many veterans and VA 
employees regarding providers who have had complaints made 
about their medical practice leaving VA employment or 
transferring to another VA facility to avoid negative 
repercussions of such complaints. As such, the Committee has 
also recognized the need for a heightened level of oversight 
regarding VA's policies with respect to outgoing providers and 
providers transferring from one VA facility to another. In 
light of this, section 403 of the bill would require VA to 
submit to Congress a report on the Department's compliance with 
policies to conduct a review of each health care provider who 
transfers to another VA medical facility, retires, or is 
terminated to determine whether there are any concerns, 
complaints, or allegations of violations relating to the 
provider's medical practice and to take appropriate action with 
respect to any such concern, complaint, or allegation.

                    TITLE V--OTHER VETERANS MATTERS

Section 501--Audit of Veterans Health Administration programs of 
        Department of Veterans Affairs

    The Veterans Access, Choice, and Accountability Act of 2014 
(Public Law 113-146; 128 Stat. 1770) required VA to contract 
with a private sector entity to conduct an Independent 
Assessment of the VHA. To complete the Independent Assessment, 
which is composed of twelve individual assessments, VA entered 
into a contract with the Centers for Medicare and Medicaid 
Services Alliance to Modernize Healthcare (CAMH), a private 
federally funded research and development center that is 
operated by the MITRE Corporation. CAMH, in turn, partnered 
with the RAND Corporation, McKinsey and Company, and Grant 
Thornton, to complete eleven of the individual assessments with 
the remaining individual assessment (pertaining to access 
standards) being completed by the Institute of Medicine. CAMH 
and its partners interviewed hundreds of VA, VHA, and private 
sector health care staff; visited 87 VA medical facilities 
across 30 states, Washington, DC, and Puerto Rico; and reviewed 
approximately 500 data sets, reports, and documents from VA. 
The Independent Assessment was delivered to VA and to Congress 
on September 1, 2015, and released publicly on September 18, 
2015.
    Assessment L, which was conducted by McKinsey and Company, 
focused on the competency of leadership across VHA with respect 
to culture, accountability, reform readiness, leadership 
development, physician alignment, employee engagement, 
succession planning, and performance management. Assessment L 
concluded that an expanding scope of activities has led to 
confusion around leadership priorities and strategic direction 
of VHA, and that VHA's organization is unnecessarily complex. 
Assessment L further found that VHA's culture is characterized 
by risk-aversion and distrust, and that VHA leadership oversees 
a workforce that appears to be steadily losing motivation, and 
is consumed by addressing crises that have occurred in the past 
at the expense of preparing for the future. As a result, 
Assessment L concluded that VHA is unable to improve 
performance consistently and fully across the system, is 
unprepared for the future, and lacks a leadership pipeline 
robust enough to meet current and future needs.
    In recognition of the need for further study and 
recommendations on how VHA can better service veterans, section 
501 of the bill would require VA to enter into a contract with 
a non-governmental entity to conduct an audit of VHA's programs 
and identify ways to improve the furnishing of benefits and 
health care administered by VHA to veterans and their families. 
The audit would be required to include five-year risk 
assessments to identify the functions and staff organizations 
and offices that would lead to the greatest improvements in the 
furnishing of health care and benefits to veterans and their 
families through VHA; the development of plans that are 
informed by such assessments; and for audits to be conducted in 
accordance with such plans. VA would be required to submit a 
report to Congress 90 days after the audit is complete with a 
summary of the audit, the findings of the entity that conducted 
the audit, and recommendations as the Secretary determines 
appropriate for legislative and administrative action to 
improve the furnishing of benefits and health care to veterans 
and families of veterans.

                                Hearings

    There were no full Committee hearings held on H.R. 4063, as 
amended. On November 17, 2015, the Subcommittee on Health 
conducted a legislative hearing on: H.R. 1319; H.R. 1603; H.R. 
1904; H.R. 2639; H.R. 3234; H.R. 3471; H.R. 3549; draft 
legislation, the Promoting Responsible Opioid Management and 
Incorporating Scientific Expertise Act; and a VA legislative 
proposal, the VA Purchased Health Care Streamlining and 
Modernization Act.
    The following witnesses testified:
    The Honorable Beto O'Rourke of Texas; the Honorable Andy 
Barr of Kentucky; the Honorable Matt Cartwright of 
Pennsylvania; the Honorable Scott Peters of California; the 
Honorable Martha Roby of Alabama; the Honorable Jackie Walorski 
of Indiana; the Honorable John Kline of Minnesota; the 
Honorable Gus Bilirakis of Florida; Adrian Atizado, the Deputy 
National Legislative Director for the Disabled American 
Veterans; LaRanda D. Holt, the Assistant Director for Women and 
Minority Veterans Outreach for the National Veterans Affairs 
and Rehabilitation Division of the American Legion; Carlos 
Fuentes, the Senior Legislative Associate for the National 
Legislative Service of the Veterans of Foreign Wars of the 
United States; and Janet Murphy, Acting Deputy Under Secretary 
for Health for Operations and Management for the Veterans 
Health Administration of the U.S. Department of Veterans 
Affairs, who was accompanied by Elias Hernandez, Chief Officer 
for Workforce Management and Consulting for the Veterans Health 
Administration, Harold Kudler, Chief Consultant for Mental 
Health Services for the Veterans Health Administration, and 
Susan Blauert, Deputy Assistant General Counsel for the 
Veterans Health Administration.
    Statements for the record were submitted by:
    The American Counseling Association; the American Orthotic 
and Prosthetic Association; AMVETS; the Kentucky Department of 
Veterans Affairs; the National Mobility Equipment Dealers 
Association; the Paralyzed Veterans of America; Heather 
Simcakoski; and Martin Simcakoski.

                       Subcommittee Consideration

    There were no Subcommittee markups involving H.R. 4063, as 
amended.

                        Committee Consideration

    On February 25, 2016, the Full Committee met in open markup 
session, a quorum being present, and ordered H.R. 4063, as 
amended, to be reported favorably to the House of 
Representatives by voice vote.
    During consideration of H.R. 4063, as amended, the 
following amendments were considered and agreed to by voice 
vote:
    An amendment in the nature of a substitute offered by 
Representative Gus Bilirakis of Florida;
    An amendment to the amendment in the nature of a substitute 
offered by Representative Jackie Walorski of Indiana;
    A second amendment to the amendment in the nature of a 
substitute offered by Representative Jackie Walorski of 
Indiana.

                            Committee Votes

    In compliance with clause 3(b) of rule XIII of the Rules of 
the House of Representatives, there were no recorded votes 
taken on amendments or in connection with ordering H.R. 4063, 
as amended, reported to the House. A motion by Ranking Member 
Corrine Brown of Florida to report H.R. 4063, as amended, 
favorably to the House of Representatives was agreed to by 
voice vote.

                      Committee Oversight Findings

    In compliance with clause 3(c)(1) of rule XIII and clause 
(2)(b)(1) of rule X of the Rules of the House of 
Representatives, the Committee's oversight findings and 
recommendations are reflected in the descriptive portions of 
this report.

         Statement of General Performance Goals and Objectives

    In accordance with clause 3(c)(4) of rule XIII of the Rules 
of the House of Representatives, the Committee's performance 
goals and objectives of this legislation are to improve pain 
care, patient advocacy, and the use of opioid therapy across 
the VA health care system and to increase complementary and 
integrative health techniques for veteran patients.

   New Budget Authority, Entitlement Authority, and Tax Expenditures

    In compliance with clause 3(c)(2) of rule XIII of the Rules 
of the House of Representatives, the Committee adopts as its 
own the estimate of new budget authority, entitlement 
authority, or tax expenditures or revenues contained in the 
cost estimate prepared by the Director of the Congressional 
Budget Office pursuant to section 402 of the Congressional 
Budget Act of 1974.

                  Earmarks and Tax and Tariff Benefits

    H.R. 4063, as amended, does not contain any Congressional 
earmarks, limited tax benefits, or limited tariff benefits as 
defined in clause 9 of rule XXI of the Rules of the House of 
Representatives.

                        Committee Cost Estimate

    The Committee adopts as its own the cost estimate on H.R. 
4063, as amended, prepared by the Director of the Congressional 
Budget Office pursuant to section 402 of the Congressional 
Budget Act of 1974.

               Congressional Budget Office Cost Estimate

    Pursuant to clause 3(c)(3) of rule XIII of the Rules of the 
House of Representatives, the following is the cost estimate 
for H.R. 4063, as amended, provided by the Congressional Budget 
Office pursuant to section 402 of the Congressional Budget Act 
of 1974:

                                     U.S. Congress,
                               Congressional Budget Office,
                                       Washington, DC, May 4, 2016.
Hon. Jeff Miller,
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 4063, the 
Promoting Responsible Opioid Management and Incorporating 
Scientific Expertise Act.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Ann E. 
Futrell.
            Sincerely,
                                                        Keith Hall.
    Enclosure.

H.R. 4063--Promoting Responsible Opioid Management and Incorporating 
        Scientific Expertise Act

    Summary: H.R. 4063 would require the Department of Veterans 
Affairs (VA) to update safety measures for opioid therapy, 
expand the use of alternative medicine, and conduct audits of 
the VA health care system through a nongovernment entity. In 
total, CBO estimates that implementing the bill would cost $138 
million over the 2017-2021 period, subject to appropriation of 
the necessary amounts.
    Pay-as-you-go procedures do not apply because enacting the 
legislation would not affect direct spending or revenues. CBO 
estimates that enacting H.R. 4063 would not increase net direct 
spending or on-budget deficits in any of the four consecutive 
10-year periods beginning in 2027.
    H.R. 4063 would impose an intergovernmental mandate by 
requiring state medical boards to report to the VA information 
about medical violations in the past 20 years committed by 
licensed physicians whom the VA is considering for employment. 
Information from state medical boards indicates that many 
boards already provide information that is similar to what the 
bill requires. Consequently, CBO estimates that the incremental 
costs of the mandate would be small and would fall below the 
annual threshold established in the Unfunded Mandates Reform 
Act (UMRA) for intergovernmental mandates ($77 million, 
adjusted annually for inflation).
    This bill contains no private-sector mandates as defined in 
UMRA.
    Estimated Cost to the Federal Government: The estimated 
budgetary effect of H.R. 4063 is shown in the table below. The 
costs of this legislation fall within budget function 700 
(veterans benefits and services).

 
----------------------------------------------------------------------------------------------------------------
                                                                   By fiscal year, in millions of dollars----
                                                              --------------------------------------------------
                                                                2017    2018    2019    2020    2021   2017-2021
----------------------------------------------------------------------------------------------------------------
                                        SPENDING SUBJECT TO APPROPRIATION
 
Opioid Safety Measures
    Estimated Authorization Level............................      18      20      20      21      22       101
    Estimated Outlays........................................      16      20      20      21      22        99
Complementary and Integrative Health
    Estimated Authorization Level............................       0       0       6       7       7        20
    Estimated Outlays........................................       0       0       5       7       7        19
Audits
    Estimated Authorization Level............................       2       2       2       2       2        10
    Estimated Outlays........................................       1       2       2       2       2         9
Community Meetings
    Estimated Authorization Level............................       *       1       1       1       1         4
    Estimated Outlays........................................       *       1       1       1       1         4
Commission on Complementary Health
    Estimated Authorization Level............................       1       2       1       0       0         4
    Estimated Outlays........................................       1       2       1       *       0         4
Reports
    Estimated Authorization Level............................       1       1       *       *       *         3
    Estimated Outlays........................................       1       1       *       *       *         3
    Total changes to Spending Subject to Appropriation
        Estimated Authorization Level........................      22      26      30      31      32       142
        Estimated Outlays....................................      19      26      29      31      32       138
----------------------------------------------------------------------------------------------------------------
Note:* = less than $500,000; details may not add to totals because of rounding.

    Basis of estimate: For this estimate, CBO assumes that H.R. 
4063 will be enacted near the start of fiscal year 2017, that 
the estimated amounts will be appropriated each year, and that 
outlays will follow historical spending patterns for affected 
programs.

Opioid safety measures

    Section 102 would require VA to expand its safety measures 
by improving training on providing pain management and 
prescribing opioids, establishing pain management teams at each 
medical facility, and improving patient tracking through 
electronic reports.
    This provision would create pain management teams 
throughout the VA health care system. According to VA, each 
medical facility currently has its own methods to manage and 
oversee pain therapy; however, they do not have designated pain 
management teams. Under this provision, VA would be required to 
implement a protocol for such teams. Based on information from 
VA, we expect that establishing and implementing such protocols 
at roughly 1,000 medical facilities would require very little 
additional work and would have an annual cost of roughly $6,500 
per facility. On that basis, CBO estimates that establishing 
the pain management teams nationwide would cost $33 million 
over the 2017-2021 period.
    Section 102 also would require VA to expand the nationwide 
availability of certain treatments such as Naloxone kits for 
opioid overdose. According to VA, it currently has roughly 
55,000 patients with opioid-use disorder and roughly 28,000 
Naloxone kits in its inventory. CBO estimates that it would 
cost roughly $14 million each year to ensure the availability 
of kits (at a cost of about $400 per kit) for those 55,000 
patients who have the greatest potential risk of overdose. On 
that basis, CBO estimates it would cost $66 million over the 
2017-2021 period to expand the availability of such treatments.
    This section also would require VA to enhance the ability 
of the electronic Opioid Therapy Risk Report (OTRR) to access 
information on prescribed drugs through the Prescription Drug 
Monitoring Programs. According to VA, such modifications to the 
OTRR would require minimal analyst and programming support. CBO 
estimates that implementing that requirement would cost less 
than $500,000 over the 2017-2021 period.
    In total, CBO estimates that implementing section 102 would 
cost $99 million over the 2017-2021 period.

Complementary and integrative health

    Section 302 would require VA to operate a three-year 
program at 15 VA Medical Centers to assess the feasibility of 
integrating complementary and alternative medicine with 
traditional care. That program would begin after the commission 
established under section 301 publishes their final report on 
complementary health. CBO expects that report would be issued 
near the end of fiscal year 2018 and that the three-year 
program would begin near the beginning of fiscal year 2019. On 
the basis of VA's implementation of other pilot programs of 
similar scope (such as using meditation for veterans with Post 
Traumatic Stress Disorder), CBO expects that developing and 
operating the program would require two additional medical 
practitioners at each of the 15 facilities to provide 
nontraditional care, as well as two additional employees at 
each facility to engage in research, training, and assessment 
of the program.
    The use of complementary and alternative medicine also 
would partially displace the use of traditional care (emergency 
care, primary care, and physical therapy) but would lead to 
greater use of medical services on balance, than under current 
law. Specifically, CBO estimates that the net cost to deliver 
medical services, after adjusting for the expected reduction in 
usage of traditional health care services would be roughly 
$66,000 per medical provider, resulting in costs of roughly $2 
million annually during the three-year pilot program.
    On the basis of information from VA, CBO further estimates 
that the annual cost per person for the research and training 
personnel would be $127,000 in 2015. Thus, in total, 
implementing section 302 would cost $19 million over the 2019-
2021 period, CBO estimates.

Audits

    Section 501 would require VA to enter into a contract with 
a private entity to conduct a series of audits of the VA health 
care system. The audits would include a risk assessment for the 
following five years and provide recommendations to improve the 
delivery of health care and plans for subsequent audits. On the 
basis of costs incurred for previous system-wide assessments of 
the VA by contracted entities, CBO estimates that implementing 
section 501 would cost about $2 million each year. After 
factoring in the time to solicit and select a contractor, CBO 
estimates total costs of $9 million over the 2017-2021 period.

Community meetings

    Section 201 would require VA Medical Centers and Community 
Based Outpatient Clinics to host community meetings on an 
annual and quarterly basis, respectively. Those meetings would 
be open to the public. VA currently hosts town hall meetings to 
get feedback from veterans, their family members and other 
community stakeholders. On the basis of information from VA, 
CBO estimates that VA would need to hold an additional 500 such 
meetings a year to meet the requirements of this provision.
    Based on costs in the private sector, we estimate VA would 
spend roughly $1,500 per meeting for audio visual equipment, 
staff time, and supplies. In total, CBO estimates implementing 
this provision would cost $4 million over the 2017-2021 period.

Commission on complementary health

    Within 90 days of enactment, section 301 would establish 
the Creating Options for Veterans' Expedited Recovery 
Commission to:
           Examine treatment of mental health at the VA 
        through evidence-based therapy;
           Conduct a nationwide survey; and,
           Determine the benefits of incorporating 
        alternative treatments at nonVA facilities.
    The commission would have 10 members plus a paid staff and 
would exist for about 18 months. The commission would be 
required to submit interim reports and a final report within 18 
months of the commission's first meeting. Within 90 days of the 
final report, VA would be required to submit a plan to the 
Congress on implementing the commission's recommendations. 
Based on the costs of similar commissions, CBO estimates that 
implementing section 301 would cost about $4 million over the 
2017-2021 period.

Reports

    The bill would require VA to produce about a dozen reports 
on matters such as opioid therapy, patient advocacy, and 
complementary medicine. Based on the costs of similar reports, 
CBO estimates that meeting those requirements would cost a 
total of $3 million over the 2017-2021 period.
    Pay-As-You-Go considerations: None.
    Increase in long-term direct spending and deficits: CBO 
estimates that enacting H.R. 4063 would not increase net direct 
spending or on-budget deficits in any of the four consecutive 
10-year periods beginning in 2027.
    Estimated impact on state, local, and tribal governments: 
H.R. 4063 would impose an intergovernmental mandate by 
requiring state medical boards to report to the VA information 
about medical violations in the past 20 years committed by 
licensed physicians whom the VA is considering for employment. 
Information from state medical boards indicates that many 
boards already provide information that is similar to what the 
bill requires. Consequently, CBO estimates that the incremental 
costs of the mandate would be small and would fall below the 
annual threshold established in UMRA for intergovernmental 
mandates ($77 million, adjusted annually for inflation).
    Estimated impact on the private sector: This bill contains 
no private-sector mandates as defined in UMRA.
    Estimate prepared by: Federal Costs: Ann E. Futrell; Impact 
on State, Local, and Tribal Governments: Jon Sperl; Impact on 
the Private Sector: Paige Piper/Bach.
    Estimate approved by: H. Samuel Papenfuss, Deputy Assistant 
Director for Budget Analysis.

                       Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates regarding H.R. 4063, as amended, prepared by the 
Director of the Congressional Budget Office pursuant to section 
423 of the Unfunded Mandates Reform Act.

                      Advisory Committee Statement

    Section 101 of H.R. 4063, as amended, would create an 
advisory committee within the meaning of section 5(b) of the 
Federal Advisory Committee Act.

                 Statement of Constitutional Authority

    Pursuant to Article I, section 8 of the United States 
Constitution, H.R. 4063, as amended, is authorized by Congress' 
power to ``provide for the common Defense and general Welfare 
of the United States.''

                  Applicability to Legislative Branch

    The Committee finds that H.R. 4063, as amended, does not 
relate to the terms and conditions of employment or access to 
public services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.


              Statement on Duplication of Federal Programs

    Pursuant to section 3(g) of H. Res. 5, 114th Cong. (2015), 
the Committee finds that no provision of H.R. 4063, as amended, 
establishes or reauthorizes a program of the Federal Government 
known to be duplicative of another Federal program, a program 
that was included in any report from the Government 
Accountability Office to Congress pursuant to section 21 of 
Public Law 111-139, or a program related to a program 
identified in the most recent Catalog of Federal Domestic 
Assistance.

                   Disclosure of Directed Rulemaking

    Pursuant to section 3(i) of H. Res. 5, 114th Cong. (2015), 
the Committee estimates that H.R. 4063, as amended, contains no 
directed rule making that would require the Secretary to 
prescribe regulations.

             Section-by-Section Analysis of the Legislation


              TITLE I--OPIOID THERAPY AND PAIN MANAGEMENT

Section 1. Short title; Table of contents

    Section 1(a) would provide the short title of H.R. 4063, as 
amended, as the ``Promoting Responsible Opioid Management and 
Incorporating Scientific Expertise Act'' or the ``Jason 
Simcakoski PROMISE Act.''
    Section 1(b) would provide a table of contents for the Act.

Section 101. Establishment of advisory committee to review guidelines 
        on management of opioid therapy by Department of Veterans 
        Affairs and Department of Defense

    Section 101(a) would establish an advisory committee to: 
(1) conduct a review of the VA/DOD Clinical Practice Guideline 
for Management of Opioid Therapy for Chronic Pain; and (2) make 
recommendations to the Secretaries for updating the Guideline.
    Section 101(b) would require that the review under 
subsection (a) include enhanced guidance in respect to: (1) 
opioid and other drug prescription practices; (2) treatment of 
patients with behaviors or comorbidities; (3) patient status 
assessments for providers; (4) the use of the Opioid Therapy 
Risk Report tool; (5) governance of the methodologies used by 
VA and DOD providers to taper opioid therapy; (6) appropriate 
case management for opioid patients transitioning from an 
inpatient setting to an outpatient setting; (7) appropriate 
case management for opioid patients transitioning from active 
duty to post-military health care networks; (8) use of routine 
and random urine drug tests to help prevent substance abuse; 
(9) how providers should discuss with patients options for pain 
management therapies before initiating opioid therapy; and (10) 
evidence-based non-opioid treatments within VA and DOD.
    Section 101(c) would require the advisory committee to 
consult with the VA/DOD Management of Opioid Therapy for 
Chronic Pain Working Group during the committee's review.
    Section 101(d) would require the advisory committee to 
submit the review and accompanying recommendations to the VA 
and DOD Secretaries no later than one year after the enactment 
of this act.
    Section 101(e) would require that the provisions of the 
Federal Advisory Committee Act (5 U.S.C. App.) apply to the 
Advisory Committee.
    Section 101(f) would define: (1) the term ``Advisory 
Committee'' to mean the advisory committee established under 
subsection (a); (2) the term ``Clinical Practice Guideline'' to 
mean the VA/DOD Clinical Practice Guideline for Management of 
Opioid Therapy for Chronic Pain; (3) the term ``controlled 
substance'' to have the meaning given in section 102 of the 
Controlled Substance Abuse Act (21 U.S.C. 802); and (4) the 
term ``State'' to mean each of the several states, territories, 
and possessions of the United States, the District of Columbia, 
and the Commonwealth of Puerto Rico.

Section 102. Improvement of opioid safety measures by Department of 
        Veterans Affairs

    Section 102(a) would require the Secretary to expand the 
Opioid Safety Initiative to include all VA medical facilities 
within 180 days of the enactment of this act.
    Section 102(b)(1) would require that all VA employees who 
prescribe opioids receive education and training on pain 
management and safe opioid prescribing practices.
    Section 102(b)(2) would require that this education and 
training include the following: (A) the implementation and full 
compliance with the VA/DOD Clinical Practice Guidelines for 
Management of Opioid Therapy for Chronic Pain; (B) the use of 
evidence-based pain management therapies for the treatment of 
patients with chronic pain; (C) screening and identification of 
patients with substance use disorder before prescribing opioids 
and referral of patients to appropriate addiction treatment 
professionals, if needed; (D) communication with patients on 
the risks of opioid and other controlled substance use; and (E) 
such other education and training as the Secretary considers 
appropriate.
    Section 102(b)(3) would require the Secretary to use the 
Interdisciplinary Chronic Pain Management Training Team Program 
(or success program) in providing this training and education.
    Section 102(c)(1) would require that the director of each 
medical facility designate a pain management team of health 
care professionals responsible for coordinating and overseeing 
pain management therapy at the facility to carry out the Opioid 
Safety Initiative.
    Section 102(c)(2) would require the Secretary to establish 
protocols for designating pain management teams in consultation 
with the VISN directors. Each protocol established under this 
subsection must ensure that any provider without expertise in 
prescribing analgesics or who has not completed the education 
and training in subsection (b) does not prescribe opioids 
except under specified circumstances.
    Section 102(c)(3) would require the director of each 
facility to submit a report within one year of the enactment of 
this act to the Under Secretary for Health and the appropriate 
VISN director identifying the members of the facility's pain 
management team. Each report must include a certification as to 
whether all members of the pain management team at the facility 
have completed the education and training required under 
subsection (b); a plan for the management and referral of 
patients to such pain management team if providers without 
expertise in analgesics prescribe opioid medications to treat 
pain; a certification as to whether the medical facility fully 
complies with the stepped-care model or other pain management 
policies, and if not, whether the facility is carrying out a 
corrective plan of action to ensure such full compliance.
    Section 102(d)(1) would require that in carrying out the 
Opioid Safety Initiative and the Opioid Therapy Risk Report 
tool, the Secretary: (A) ensure that VA health care providers 
have access to information on controlled substances prescribed 
to veterans who receive care outside of VA through States' 
prescription drug monitoring program through measures including 
entering into memoranda of understanding with States to allow 
shared access of such information; (B) include the information 
in the Opioid Therapy Risk Report; and (C) require VA providers 
to submit controlled substance prescription information to the 
relevant State prescription drug monitoring program(s).
    Section 102(d)(2) would require that, no later than 18 
months after the enactment of this act, the Secretary submit to 
the Committees on Veterans' Affairs of the House and the Senate 
a report on the feasibility and advisability of improving the 
VA Opioid Therapy Risk Report tool to allow for a more advanced 
real-time tracking of and access to data on: (A) the key 
clinical indicators with respect to the totality of opioid use 
by veterans; (B) concurrent prescribing by VA health care 
providers of opioids in different health care settings; and (C) 
mail-order prescriptions of opioids prescribed to veterans 
under laws administered by the Secretary.
    Section 102(e)(1) would require the Secretary to maximize 
the availability of FDA approved opioid receptor antagonists to 
veterans. In doing so, not later than 90 days after the 
enactment of this act, the Secretary must equip each VA 
pharmacy with opioid receptor antagonists to be given to 
outpatients as needed, and expand the VA Overdose Education and 
Naloxone Distribution program to ensure that veterans at risk 
of opioid overdose have access to and training on opioid 
receptor antagonists.
    Section 102(e)(2) would require that, no later than 120 
days after the enactment of this act, the Secretary submit a 
report regarding VA's implementation of this subsection to the 
Committees on Veterans' Affairs of the House and of the Senate.
    Section 102(f) would require the Secretary to include in 
the VA Opioid Therapy Risk Report tool: (1) information on when 
the tool was last accessed by a VA provider regarding each 
veteran and the results of each veteran's most recent urine 
drug test; and (2) the ability to determine whether a VA 
provider prescribed opioids to a veteran without checking the 
information in the tool with respect to that veteran.
    Section 102(g) would require the Secretary to modify the VA 
computerized patient record system to ensure that any health 
care provider who accesses a veteran's record is notified 
immediately whether that veteran is: (1) receiving opioid 
therapy and has a history of substance abuse or has previously 
overdosed; (2) has a history of opioid abuse; or (3) is at risk 
for opioid abuse.
    Section 102(h) would define the term ``controlled 
substance'' as having the meaning given to that term in section 
102 of the Controlled Substances Act (21 U.S.C. 802) and the 
term ``State'' to mean each of the several States, territories, 
and possessions of the United States, the District of Columbia, 
and the Commonwealth of Puerto Rico.

Section 103. Strengthening of Joint Working Group on Pain Management of 
        the Department of Veterans Affairs and the Department of 
        Defense

    Sec 103(a) would require that, within 90 days after the 
enactment of this act, the Secretaries of VA and DOD ensure 
that the Pain Management Working Group of the Health Executive 
Committee of VA-DOD Joint Executive Committee focuses on: (1) 
opioid prescribing practices of health care providers of each 
Department; (2) the ability of each Department to manage pain 
of each Department's patients (including employee training on 
pain management); (3) the use of each Department of 
complementary and integrative health and complementary 
alternative medicines in treating those patients; (4) the 
concurrent use by each Department's providers of opioids and 
prescription drugs to treat mental health disorders; (5) the 
practice by each Department's providers of prescribing opioids 
to treat mental health disorders; (6) the coordination in 
coverage of and access to medications as patients transition 
from DOD to VA care; and (7) the ability of each Department to 
identify and treat substance abuse disorders among patients.
    Sec 103(b) would require the Secretaries of VA and DOD to 
ensure that the working group described in subsection (a): (1) 
coordinates its activities with other relevant working groups; 
(2) consults with other relevant Federal agencies with respect 
to its activities; (3) and consults with VA and DOD with 
respect to any proposed updates to the VA/DOD Clinical Practice 
Guideline for Management of Opioid Therapy for Chronic Pain.
    Section 103(c) would require the Secretaries of VA and DOD 
to ensure that the working group described in subsection (a) is 
able to meaningfully consult regarding updates to the Guideline 
for Management of Opioid Therapy no later than one year after 
the enactment of this act.

Section 104. Review, investigation, and report on use of opioids in 
        treatment by Department of Veterans Affairs

    Section 104(a)(1) would require the Comptroller General 
within two years after the enactment of this act to submit to 
the Committees on Veterans' Affairs of the House and of the 
Senate a report on the VA Opioid Safety Initiative and the 
opioid prescribing practices of VA providers.
    Section 104(a)(2) would require that the report include: 
(A) recommendations on improvements to the Opioid Safety 
Initiative; (B) information regarding VA-prescribed opioid-
related deaths, overall opioid prescription rates to treat non-
cancer, non-palliative, and non-hospice care patients, 
concomitant opioid and benzodiazepine prescription rates, the 
prescription of opioids to patients without any pain, and the 
effectiveness of opioid therapy; (C) an evaluation of VA's 
oversight processes regarding veterans' opioid use; and (D) an 
assessment of the Secretary's implementation of the VA/DOD 
Guideline for Management of Opioid Therapy.
    Section 104(b) would require that, within two years of the 
enactment of this act, and no later than 30 days after the end 
of each quarter thereafter, the Secretary submit to the 
Committees on Veterans' Affairs of the House and of the Senate 
a progress report on VA's implementation of GAO's 
recommendations under subsection (a).
    Section 104(c) would require that, within one year of the 
enactment of this act, and at least once a year for the 
following five years, the Secretary submit to the Committees on 
Veterans' Affairs of the House and of the Senate a report 
regarding information about VA providers' prescription of 
opioids with respect to each VA facility to treat non-cancer, 
non-palliative, and non-hospice care patients, including the 
following pertaining to the one-year period preceding the 
submission of the report: (1) the number of patients and 
percentage of VA's patient population concurrently prescribed 
opioids; (2) the number of patients and the percentage of VA's 
patient population; (3) the number of patients and the 
percentage of VA's patient population treated with opioids by a 
VA provider on an in-patient basis who also received 
prescription opioids through VA's Consolidated Mail Order 
Pharmacy; (4) the number of patients and the percentage of VA's 
patient population who were prescribed opioids concurrently by 
a VA provider and a non-VA provider; (5) with respect to each 
VA facility, the concurrent and the aggregate opioid 
prescription rate for all providers; the rate at which each 
facility provider prescribed opioids by mail to patients who 
were being treated with opioids on an in-patient basis, and the 
aggregate of such rate; the number of times a facility 
pharmacist overrode a critical drug interaction warning before 
dispensing opioids to a veteran.
    Section 104(d) would require the Secretary to immediately 
notify the Committees on Veterans' Affairs of the House and of 
the Senate and conduct an investigation through the Office of 
the Medical Inspector if the Secretary determines that an 
identified prescription rate is inconsistent with the standards 
of appropriate and safe care.
    Section 104(e) would define the term ``prescription rate'' 
to mean, with respect to a VA provider or facility, each of the 
following: (1) the number of patients treated with opioids by a 
provider or at a facility, divided by the total number of 
pharmacy users of that provider or facility; (2) the average 
number of morphine equivalents per day prescribed by the 
provider or at the facility to patients being treated with 
opioids; (3) the average number of prescriptions per patient of 
the patients being treated with opioids.

Section 105. Mandatory disclosure of certain veteran information to 
        state controlled substance monitoring programs

    Section 105 would amend Section 5701(l) of title 38, United 
States Code, by striking ``may'' and inserting ``shall.''

                       TITLE II--PATIENT ADVOCACY

Section 201. Community meetings on improving care furnished by 
        Department of Veterans Affairs

    Section 201(a) would require that: (1) within 90 days of 
the enactment of this act, and at least once every 90 days 
thereafter, the Secretary ensure that each VA medical facility 
hosts a public community meeting on improving VA health care; 
and (2) within one year of the enactment of this act, and at 
least annually thereafter, the Secretary will ensure that each 
community-based outpatient clinic (CBOC) hosts such a community 
meeting.
    Section 201(b) would require that each community meeting 
hosted by a facility or CBOC under subsection (a) be attended 
by the VISN director in which the facility or CBOC is located. 
The director may delegate the requirement of attendance to an 
employee of the director, provided the VISN director attends at 
least one community meeting each year.
    Section 201(c) would require that the Secretary notify the 
Committees on Veterans' Affairs of the House and of the Senate 
and the Members of Congress who represent the area in which the 
facility is located of any community meetings under subsection 
(a) at least ten days in advance.

Section 202. Improvement of awareness of Patient Advocacy Program and 
        patient bill of rights of Department of Veterans Affairs

    Section 202 would require that, within 90 days of the 
enactment of this act, the Secretary display in as many 
prominent locations as the Secretary determines appropriate to 
be seen by the largest percentage of patients at each VA 
medical facility: (1) the purposes of the VA Patient Advocacy 
Program and the contact information for the patient advocate at 
each medical facility; and (2) the rights and responsibilities 
of patients and family members and, with respect to community 
living centers and other VA residential facilities, residents 
and family members.

Section 203. Comptroller General report on Patient Advocacy Program of 
        Department of Veterans Affairs

    Section 203(a) would require that, within two years of the 
enactment of this act, the Comptroller General submit a report 
on the VA Patient Advocacy Program to the Committees on 
Veterans' Affairs of the House and of the Senate.
    Section 203(b) would require that the report include: (1) a 
description of the Program, including the Program's purpose, 
activities, and sufficiency in achieving its purpose; (2) an 
assessment of the sufficiency of the Program's staffing; (3) an 
assessment of the Program's employee training; (4) an 
assessment of veterans' and family members' awareness of and 
utilization of the Program; (5) recommendations for improving 
the Program; and (6) any other information the Comptroller 
General considers appropriate.

            TITLE III--COMPLEMENTARY AND INTEGRATIVE HEALTH

Section 301. Expansion of research and education on and delivery of 
        complementary and integrative health to veterans

    Section 301(a) would establish a commission known as the 
``Creating Options for Veterans' Expedited Recovery'' or the 
``COVER Commission,'' which would be required to examine the 
evidence-based therapy treatment model used by VA for treating 
mental health conditions of veterans and the potential benefits 
of incorporating complementary alternative treatments available 
in non-VA facilities.
    Section 301(b) would require that the Commission's duties 
are to: (1) examine the efficacy of the evidence-based therapy 
model used by VA to treat mental health illnesses and identify 
areas of improvement; (2) conduct a patient-centered survey 
within each VISN to examine: (A) the experiences of veterans 
with VA facilities regarding mental health care, (B) the 
experiences of veterans with non-VA facilities regarding mental 
health care, (C) the preferences of veterans regarding 
available treatment for mental health issues and which methods 
the veterans believe to be most effective, (D) the experience, 
if any, of veterans with respect to the complementary 
alternative treatment therapies described in subsection (b)(3), 
(E) the prevalence of prescribing medication to veterans 
seeking treatment for mental health disorders through VA, and 
(F) the outreach efforts of VA regarding the availability of 
benefits and treatments for veterans for addressing mental 
health issues; (3) examine available research on complementary 
alternative treatment therapies for mental health disorders in 
areas of therapy including: music therapy, equine therapy, 
training and caring for service dogs, yoga therapy, acupuncture 
therapy, meditation therapy, outdoor sports therapy, hyperbaric 
oxygen therapy, accelerated resolution therapy, art therapy, 
magnetic resonance therapy, and others; (4) study the 
sufficiency of VA resources to deliver quality mental health 
care; and (5) study the current treatments and resources 
available within VA and assess: (A) the effectiveness of such 
treatments and resources in decreasing the number of suicides 
per day by veterans, (B) the number of veterans who have been 
diagnosed with mental health issues, (C) the number of veterans 
who have been diagnosed with mental health issues, (D) the 
percentage of veterans who have completed VA counseling 
sessions, and (E) the efforts of VA to expand complementary 
alternative treatments viable to the recovery of veterans with 
mental health issues as determined by the Secretary to improve 
the effectiveness of treatments offered by VA.
    Section 301(c)(1) would require that the Commission consist 
of 10 members, with at least one of each of the following pairs 
being a veteran: (A) two appointed by the Speaker of the House; 
(B) two appointed by the House Minority Leader; (C) two 
appointed by the Senate Majority Leader; (D) two appointed by 
the Senate Minority Leader; and (E) two appointed by the 
President.
    Section 301(c)(2) would require that members of the 
Commission be: (A) individuals who have standing and 
distinction within the field of mental health care: (B) 
individuals with experience working with military and former 
military populations; and (C) individuals who have no financial 
interest in any complementary alternative treatments to be 
reviewed by the Commission.
    Section 301(c)(3) would require that the President choose 
the chairman.
    Section 301(c)(4) would require that members be appointed 
for the life of the Commission.
    Section 301(c)(5) would require that any vacancy be filled 
in the same manner as the original appointment.
    Section 301(c)(6) would require that appointments be made 
within 90 days of the enactment of this act.
    Section 301(d)(1) would require that the Commission hold 
its first meeting no later than thirty days after a majority of 
members are appointed and that the Commission meet regularly at 
the chairman's discretion.
    Section 301(d)(2) would allow the Commission to hold 
hearings that it deems advisable to carry out its 
responsibilities.
    Section 301(d)(3) would allow the Commission to secure any 
information it considers necessary to carry out its duties, and 
it may do so directly from any department or Federal agency.
    Section 301(d)(4) would allow the Commission to seek 
guidance through consultation with foundations, veteran service 
organizations, nonprofit groups, faith-based organizations, 
private and public institutions of higher education, and other 
non-governmental organizations as the Commission determines 
appropriate.
    Section 301(d)(5) would require the Commission to keep a 
record of its action and meetings, which would be required to 
be made available to the public for inspection and to the 
Comptroller General for audit.
    Section 301(d)(6) would require the Commission to keep a 
record regarding personnel, which would be required to be made 
available to the public for inspection and to the Comptroller 
General for audit.
    Section 301(d)(7) would require that members serve without 
pay, but allows members to be compensated for travel expenses 
to perform Commission duties at rates authorized under 
subchapter I of chapter 57 of title 5, U.S.C.
    Section 301(d)(8) would allow the Commission to employ a 
staff director and other personnel as needed to perform the 
Commission's function without regard to the provisions of title 
5, U.S.C., governing appointments in the competitive service, 
without regard to the provision of chapter 51 and subchapter 
III of chapter 53 of such title relating to classification and 
General Schedule pay rates, except that no rate of pay fixed 
under this paragraph may exceed the equivalent of that payable 
for a position at a level IV of the Executive Schedule under 
section 5316 of title 5, U.S.C.
    Section 301(d)(9) would require that such personnel be 
employees under section 2105 of title 5, U.S.C., for purposes 
of chapters 63, 81, 83, 84, 85, 87, 89, and 90 of such title. 
This does not apply to the members of the Commission.
    Section 301(d)(10) would allow the Commission to enter into 
contracts to enable it to discharge its duties.
    Section 301(d)(11) would allow the Commission to utilize 
experts and consultants in accordance with section 3109 of 
title 5, U.S.C., at rates not to exceed the daily rate paid to 
a person occupying a position at level IV of the Executive 
Schedule under section 3109 of title 5, U.S.C.
    Section 301(d)(12) would allow the Commission to use the 
postal service in the same manner as other Federal agencies and 
departments.
    Section 301(d)(13) would allow the Commission to be 
provided, on a reimbursable basis, physical facilities, 
equipment, and administrative support services necessary to 
carry out its duties.
    Section 301(e)(1) would require that, within 60 days of the 
Commission's first meeting and every 30 days thereafter until 
the Commission submits its final report under subsection 
(e)(2), the Commission submit to the Committees on Veterans' 
Affairs of the House and the Senate and the President a report 
describing the level of cooperation of the Secretary and the 
heads of other Federal agencies or departments. The Commission 
must also submit an interim report regarding its findings to 
the Committees on Veterans' Affairs of the House and the Senate 
and any other appropriate entities at times it deems 
appropriate.
    Section 301(e)(2) would require that the Commission, within 
18 months of its first meeting, submit to the Committees on 
Veterans' Affairs of the House and the Senate, the President, 
and the Secretary its final report. The final report would be 
required to include: (A) recommendations on improving the areas 
for which it was tasked with exploring; (B) analysis of the 
evidence-based therapy model used by VA for treating mental 
illness; (C) findings of the survey conducted within each VISN 
pursuant to subsection (b)(2); and (D) an examination of 
complementary alternative treatments described in subsection 
(b)(3) and their potential benefits.
    Section 301(e)(3) would require that, within 90 days of the 
submission of the Commission's final report, the Secretary 
submit a report to the Committees on Veterans' Affairs of the 
House and of the Senate containing: (A) an action plan for 
implementing the Commission's recommendations; (B) a feasible 
timeframe for implementation; and (C) justifications for any 
recommendations the Secretary believes are not feasible 
complete with alternative solutions.
    Section 301(f) would require that the Commission be 
terminated within 30 days after the Commission submits its 
final report.

Section 302. Pilot program on integration of complementary alternative 
        medicines and related issues for veterans and family members of 
        veterans

    Section 302(a)(1) would require that, within 180 days after 
the Secretary receives the Commission's final report under 
Section 301(e), the Secretary commence a pilot program to 
assess the feasibility and advisability of using wellness-based 
programs to complement pain management and related health care 
services.
    Section 302(a)(2) would require that, in carrying out the 
pilot program, the Secretary assess: (A) means of improving 
pain management care coordination between Federal, State, and 
community providers; (B) means of enhancing outreach by and 
among such providers; (C) means of using wellness-based 
programs as complements to pain management services by and 
among such providers; and (D) the effectiveness of wellness-
based programs.
    Section 302(b) would require that the pilot program last 
for three years.
    Section 302(c)(1) would require that the pilot program be 
carried out at no fewer than 15 VA facilities providing pain 
management, two of which must be polytrauma centers.
    Section 302(c)(2) would require that the Secretary 
prioritize medical centers at which there is a prescription 
rate that is inconsistent with the standards of appropriate 
care when selecting medical centers under subsection(c)(1).
    Section 302(d) would require the Secretary to provide 
covered veterans covered services by integrating complementary 
and alternative medicine under the pilot program those 
treatments into other services provided by VA.
    Section 302(e) would define the term ``covered veteran'' to 
mean a veteran who: (1) has a mental health condition diagnosed 
by a VA provider; (2) experiences chronic pain; (3) has a 
chronic condition being treated by a VA provider; or (4) is not 
described in paragraph (1), (2), or (3) and requests to 
participate in the pilot program or is referred by a VA 
provider treating that veteran.
    Section 302(f)(1) would define the term ``covered 
services'' to mean services consisting of complementary and 
integrative health services as selected by the Secretary.
    Section 302(f)(2) would require that covered services under 
the pilot program be: (A) administered by VA professionals or 
other instructors with appropriate training and expertise; (B) 
included as part of the Patient Aligned Care Teams initiative 
in coordination with the Offices of Patient Centered Care and 
Cultural Transformation; (C) made available to covered veterans 
who have and have not received conventional treatments from VA 
for the conditions for which the veteran seeks complementary 
and integrative health services.
    Section 302(g)(1) would require that, within 30 months of 
the start of the pilot program, the Secretary submit to the 
Committees on Veterans' Affairs of the House and of the Senate 
a report on the pilot program.
    Section 302(g)(2) would require that the report include: 
(A) the Secretary's findings and conclusions regarding the use 
and efficacy of complementary and alternative health services 
established under the pilot program, the outreach conducted by 
VA about the pilot, and an assessment of the benefit of the 
pilot program to covered veterans; (B) the identification of 
any unresolved barriers to VA's use of complementary and 
integrative medicine; and (C) recommendations for the 
continuation or expansion of the pilot program as the Secretary 
considers appropriate.
    Section 302(h) would define the term ``complementary and 
integrative health'' to have the meaning given to that term by 
the National Institutes of Health.

               TITLE IV--FITNESS OF HEALTH CARE PROVIDERS

Section 401. Additional requirements for hiring of health care 
        providers by Department of Veterans Affairs

    Section 401 would require that, as part of the hiring 
process for all heath care providers considered for a position 
after the date of the enactment of this act, the Secretary 
require from the medical board of the State in which the 
applicant is licensed: (1) information on any violations of the 
requirements of medical license over the previous 20 years; and 
(2) information on whether the provider has entered into any 
settlement agreements for disciplinary charges related to the 
practice of medicine.

Section 402. Provision of information on health care providers of 
        Department of Veterans Affairs to state medical boards

    Section 402 would require that VA provide to the medical 
board of each State in which the provider is licensed 
information regarding violations, regardless of whether the 
board has requested such information.

Section 403. Report on compliance by Department of Veterans Affairs 
        with reviews of health care providers leaving the Department or 
        transferring to other facilities

    Section 403 would require that, within 180 days of the 
enactment of this act, the Secretary submit to the Committees 
on Veterans' Affairs of the House and of the Senate a report on 
VA's compliance with VA policy to conduct a review of each 
provider who transfers from another VA medical facility, 
retires, or is terminated and to take appropriate actions with 
respect to any concerns, complaints, or allegations against the 
provider.

                    TITLE V--OTHER VETERANS MATTERS

Section 501. Audit of Veterans Health Administration programs of 
        Department of Veterans Affairs

    Section 501(a) would require that the Secretary seek to 
enter into a contract with a nongovernmental entity under which 
the entity will conduct audits of VHA programs to identify ways 
to improve the administration of benefits and health care to 
veterans and their families.
    Section 501(b) would require that the entity perform the 
following with regard to each such audit: (1) five-year risk 
assessments to identify the functions, staff organizations, and 
staff offices of the VHA that would lead to the greatest 
improvement in health care and benefits provided; (2) 
development of plans that are informed by those risk 
assessments to conduct audits of the functions, staff 
organizations, and staff offices; (3) conduct audits in 
accordance with the developed plans.
    Section 501(c) would require that, within 90 days of the 
completion of each audit under subsection (a), the Secretary 
submit to the Committees on Veterans' Affairs of the House and 
of the Senate a report including: (1) a summary of the audit; 
(2) the entity's findings; and (3) recommendations as the 
Secretary determines appropriate.

         Changes in Existing Law Made by the Bill, as Reported

    In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italic, existing law in which no change is 
proposed is shown in roman):

         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italic, and existing law in which no 
change is proposed is shown in roman):

                      TITLE 38, UNITED STATES CODE



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PART IV--GENERAL ADMINISTRATIVE PROVISIONS

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CHAPTER 57--RECORDS AND INVESTIGATIONS

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                         SUBCHAPTER I--RECORDS

Sec. 5701. Confidential nature of claims

  (a) All files, records, reports, and other papers and 
documents pertaining to any claim under any of the laws 
administered by the Secretary and the names and addresses of 
present or former members of the Armed Forces, and their 
dependents, in the possession of the Department shall be 
confidential and privileged, and no disclosure thereof shall be 
made except as provided in this section.
  (b) The Secretary shall make disclosure of such files, 
records, reports, and other papers and documents as are 
described in subsection (a) of this section as follows:
          (1) To a claimant or duly authorized agent or 
        representative of a claimant as to matters concerning 
        the claimant alone when, in the judgment of the 
        Secretary, such disclosure would not be injurious to 
        the physical or mental health of the claimant and to an 
        independent medical expert or experts for an advisory 
        opinion pursuant to section 5109 or 7109 of this title.
          (2) When required by process of a United States court 
        to be produced in any suit or proceeding therein 
        pending.
          (3) When required by any department or other agency 
        of the United States Government.
          (4) In all proceedings in the nature of an inquest 
        into the mental competency of a claimant.
          (5) In any suit or other judicial proceeding when in 
        the judgment of the Secretary such disclosure is deemed 
        necessary and proper.
          (6) In connection with any proceeding for the 
        collection of an amount owed to the United States by 
        virtue of a person's participation in any benefit 
        program administered by the Secretary when in the 
        judgment of the Secretary such disclosure is deemed 
        necessary and proper.
  (c)(1) The amount of any payment made by the Secretary to any 
person receiving benefits under a program administered by the 
Secretary shall be made known to any person who applies for 
such information.
  (2) Any appraisal report or certificate of reasonable value 
submitted to or prepared by the Secretary in connection with 
any loan guaranteed, insured, or made under chapter 37 of this 
title shall be made available to any person who applies for 
such report or certificate.
  (3) Subject to the approval of the President, the Secretary 
may publish at any time and in any manner any or all 
information of record pertaining to any claim filed with the 
Secretary if the Secretary determines that the public interest 
warrants or requires such publication.
  (d) The Secretary as a matter of discretion may authorize an 
inspection of Department records by duly authorized 
representatives of recognized organizations.
  (e) Except as otherwise specifically provided in this section 
with respect to certain information, the Secretary may release 
information, statistics, or reports to individuals or 
organizations when in the Secretary's judgment such release 
would serve a useful purpose.
  (f) The Secretary may, pursuant to regulations the Secretary 
shall prescribe, release the name or address, or both, of any 
present or former member of the Armed Forces, or a dependent of 
a present or former member of the Armed Forces, (1) to any 
nonprofit organization if the release is directly connected 
with the conduct of programs and the utilization of benefits 
under this title, or (2) to any criminal or civil law 
enforcement governmental agency or instrumentality charged 
under applicable law with the protection of the public health 
or safety if a qualified representative of such agency or 
instrumentality has made a written request that such name or 
address be provided for a purpose authorized by law. Any 
organization or member thereof or other person who, knowing 
that the use of any name or address released by the Secretary 
pursuant to the preceding sentence is limited to the purpose 
specified in such sentence, willfully uses such name or address 
for a purpose other than those so specified, shall be guilty of 
a misdemeanor and be fined not more than $5,000 in the case of 
a first offense and not more than $20,000 in the case of any 
subsequent offense.
  (g)(1) Subject to the provisions of this subsection, and 
under regulations which the Secretary shall prescribe, the 
Secretary may release the name or address, or both, of any 
person who is a present or former member of the Armed Forces, 
or who is a dependent of a present or former member of the 
Armed Forces, to a consumer reporting agency if the release of 
such information is necessary for a purpose described in 
paragraph (2) of this subsection.
  (2) A release of information under paragraph (1) of this 
subsection concerning a person described in such paragraph may 
be made for the purpose of--
          (A) locating such a person--
                  (i) who has been administratively determined 
                to be indebted to the United States by virtue 
                of the person's participation in a benefits 
                program administered by the Secretary; or
                  (ii) if the Secretary has determined under 
                such regulations that (I) it is necessary to 
                locate such person in order to conduct a study 
                pursuant to section 527 of this title or a 
                study required by any other provision of law, 
                and (II) all reasonable steps have been taken 
                to assure that the release of such information 
                to such reporting agency will not have an 
                adverse effect on such person; or
          (B) Obtaining a consumer report in order to assess 
        the ability of a person described in subparagraph 
        (A)(i) of this paragraph to repay the indebtedness of 
        such person to the United States, but the Secretary may 
        release the name or address of such person for the 
        purpose stated in this clause only if the Secretary 
        determines under such regulations that such person has 
        failed to respond appropriately to administrative 
        efforts to collect such indebtedness.
  (3) The Secretary may also release to a consumer reporting 
agency, for the purposes specified in subparagraph (A) or (B) 
of paragraph (2) of this subsection, such other information as 
the Secretary determines under such regulations is reasonably 
necessary to identify a person described in such paragraph, 
except that the Secretary may not release to a consumer 
reporting agency any information which indicates any 
indebtedness on the part of such person to the United States or 
any information which reflects adversely on such person. Before 
releasing any information under this paragraph, the Secretary 
shall, under such regulations, take reasonable steps to provide 
for the protection of the personal privacy of persons about 
whom information is proposed to be released under this 
paragraph.
  (4)(A) If the Secretary determines, under regulations which 
the Secretary shall prescribe, that a person described in 
paragraph (1) of this subsection has failed to respond 
appropriately to reasonable administrative efforts to collect 
an indebtedness of such person described in paragraph (2)(A)(i) 
of this subsection, the Secretary may release information 
concerning the indebtedness, including the name and address of 
such person, to a consumer reporting agency for the purpose of 
making such information available for inclusion in consumer 
reports regarding such person and, if necessary, for the 
purpose of locating such person, if--
          (i) the Secretary has (I) made reasonable efforts to 
        notify such person of such person's right to dispute 
        through prescribed administrative processes the 
        existence or amount of such indebtedness and of such 
        person's right to request a waiver of such indebtedness 
        under section 5302 of this title, (II) afforded such 
        person a reasonable opportunity to exercise such 
        rights, and (III) made a determination with respect to 
        any such dispute or request; and
          (ii) thirty calendar days have elapsed after the day 
        on which the Secretary has made a determination that 
        reasonable efforts have been made to notify such person 
        (I) that the Secretary intends to release such 
        information for such purpose or purposes, and (II) 
        that, upon the request of such person, the Secretary 
        shall inform such person of whether such information 
        has been so released and of the name and address of 
        each consumer reporting agency to which such 
        information was released by the Secretary and of the 
        specific information so released.
  (B) After release of any information under subparagraph (A) 
of this paragraph concerning the indebtedness of any person, 
the Secretary shall promptly notify--
          (i) each consumer reporting agency to which such 
        information has been released by the Secretary; and
          (ii) each consumer reporting agency described in 
        subsection (i)(3)(B)(i) of this section to which such 
        information has been transmitted by the Secretary 
        through a consumer reporting agency described in 
        subsection (i)(3)(B)(ii)(I) of this section,
of any substantial change in the status or amount of such 
indebtedness and, upon the request of any such consumer 
reporting agency for verification of any or all information so 
released, promptly verify or correct, as appropriate, such 
information. The Secretary shall also, after the release of 
such information, inform such person, upon the request of such 
person, of the name and address of each consumer reporting 
agency described in clause (i) or (ii) of this subparagraph to 
which such information was released or transmitted by the 
Secretary and of the specific information so released or 
transmitted.
  (h)(1) Under regulations which the Secretary shall prescribe, 
the Secretary may release the name or address, or both, of any 
person who is a present or former member of the Armed Forces, 
or who is a dependent of a present or former member of the 
Armed Forces (and other information relating to the identity of 
such person), to any person in a category of persons described 
in such regulations and specified in such regulations as a 
category of persons to whom such information may be released, 
if the release of such information is necessary for a purpose 
described in paragraph (2) of this subsection.
  (2) A release of information under paragraph (1) of this 
subsection may be made for the purpose of--
          (A) determining the creditworthiness, credit 
        capacity, income, or financial resources of a person 
        who has (i) applied for any benefit under chapter 37 of 
        this title, or (ii) submitted an offer to the Secretary 
        for the purchase of property acquired by the Secretary 
        under section 3720(a)(5) of this title;
          (B) verifying, either before or after the Secretary 
        has approved a person's application for assistance in 
        the form of a loan guaranty or loan insurance under 
        chapter 37 of this title, information submitted by a 
        lender to the Secretary regarding the creditworthiness, 
        credit capacity, income, or financial resources of such 
        person;
          (C) offering for sale or other disposition by the 
        Secretary, pursuant to section 3720 of this title, any 
        loan or installment sale contract owned or held by the 
        Secretary; or
          (D) providing assistance to any applicant for 
        benefits under chapter 37 of this title or 
        administering such benefits if the Secretary promptly 
        records the fact of such release in appropriate records 
        pertaining to the person concerning whom such release 
        was made.
  (i)(1) No contract entered into for any of the purposes of 
subsection (g) or (h) of this section, and no action taken 
pursuant to any such contract or either such subsection, shall 
result in the application of section 552a of title 5 to any 
consumer reporting agency or any employee of a consumer 
reporting agency.
  (2) The Secretary shall take reasonable steps to provide for 
the protection of the personal privacy of persons about whom 
information is disclosed under subsection (g) or (h) of this 
section.
  (3) For the purposes of this subsection and of subsection (g) 
of this section--
          (A) The term ``consumer report'' has the meaning 
        provided such term in subsection (d) of section 603 of 
        the Fair Credit Reporting Act (15 U.S.C. 1681a(d)).
          (B) The term ``consumer reporting agency'' means--
                  (i) a consumer reporting agency as such term 
                is defined in subsection (f) of section 603 of 
                the Fair Credit Reporting Act (15 U.S.C. 
                1681a(f)), or
                  (ii) any person who, for monetary fees, dues, 
                or on a cooperative nonprofit basis, regularly 
                engages in whole or in part in the practice of 
                (I) obtaining credit or other information on 
                consumers for the purpose of furnishing such 
                information to consumer reporting agencies (as 
                defined in clause (i) of this paragraph), or 
                (II) serving as a marketing agent under 
                arrangements enabling third parties to obtain 
                such information from such reporting agencies.
  (j) Except as provided in subsection (i)(1) of this section, 
any disclosure made pursuant to this section shall be made in 
accordance with the provisions of section 552a of title 5.
  (k)(1)(A) Under regulations that the Secretary shall 
prescribe, the Secretary may disclose the name and address of 
any individual described in subparagraph (C) to an entity 
described in subparagraph (B) in order to facilitate the 
determination by such entity whether the individual is, or 
after death will be, a suitable organ, tissue, or eye donor 
if--
          (i) the individual is near death (as determined by 
        the Secretary) or is deceased; and
          (ii) the disclosure is permitted under regulations 
        promulgated pursuant to section 264 of the Health 
        Insurance Portability and Accountability Act of 1996 
        (42 U.S.C. 1320d-2 note).
  (B) An entity described in this subparagraph is--
          (i) an organ procurement organization, including eye 
        and tissue banks; or
          (ii) an entity that the Secretary has determined--
                  (I) is substantially similar in function, 
                professionalism, and reliability to an organ 
                procurement organization; and
                  (II) should be treated for purposes of this 
                subsection in the same manner as an organ 
                procurement organization.
  (C) An individual described in this subparagraph is--
          (i) a veteran; or
          (ii) a dependent of veteran.
  (2) In this subsection, the term ``organ procurement 
organization'' has the meaning given the term ``qualified organ 
procurement organization'' in section 371(b) of the Public 
Health Service Act (42 U.S.C. 273(b)).
  (l) Under regulations the Secretary shall prescribe, the 
Secretary [may] shall disclose information about a veteran or 
the dependent of a veteran to a State controlled substance 
monitoring program, including a program approved by the 
Secretary of Health and Human Services under section 399O of 
the Public Health Service Act (42 U.S.C. 280g-3), to the extent 
necessary to prevent misuse and diversion of prescription 
medicines.

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