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115th Congress    }                                     {       Report
                        HOUSE OF REPRESENTATIVES
 1st Session      }                                     {      115-400

======================================================================



 
                 VETERANS CRISIS LINE STUDY ACT OF 2017

                                _______
                                

November 7, 2017.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

    Mr. Roe of Tennessee, from the Committee on Veterans' Affairs, 
                        submitted the following

                              R E P O R T

                        [To accompany H.R. 4173]

    The Committee on Veterans' Affairs, to whom was referred 
the bill (H.R. 4173) to direct the Secretary of Veterans 
Affairs to conduct a study on the Veterans Crisis Line, having 
considered the same, report favorably thereon with an amendment 
and recommend that the bill as amended do pass.

                                CONTENTS

                                                                   Page
Purpose and Summary..............................................     3
Background and Need for Legislation..............................     3
Hearings.........................................................     3
Subcommittee Consideration.......................................     4
Committee Consideration..........................................     4
Committee Votes..................................................     4
Committee Oversight Findings.....................................     4
Statement of General Performance Goals and Objectives............     5
New Budget Authority, Entitlement Authority, and Tax Expenditures     5
Earmarks and Tax and Tariff Benefits.............................     5
Committee Cost Estimate..........................................     5
Congressional Budget Office Estimate.............................     5
Federal Mandates Statement.......................................     5
Advisory Committee Statement.....................................     6
Constitutional Authority Statement...............................     6
Applicability to Legislative Branch..............................     6
Statement on Duplication of Federal Programs.....................     6
Disclosure of Directed Rulemaking................................     6
Section-by-Section Analysis of the Legislation...................     6
Changes in Existing Law Made by the Bill as Reported.............     7

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

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Veterans Crisis Line Study Act of 
2017''.

SEC. 2. STUDY ON EFFICACY OF VETERANS CRISIS LINE.

  (a) Study.--The Secretary of Veterans Affairs shall conduct a study 
on the outcomes and the efficacy of the Veterans Crisis Line during the 
five-year period beginning January 1, 2014, based on an analysis of 
national suicide data and data collected from the Veterans Crisis Line.
  (b) Matters Included.--The study under subsection (a) shall address 
the following:
          (1) The efficacy of the Veterans Crisis Line in leading 
        veterans to sustained mental health regimens, by determining--
                  (A) the number of veterans who, after contacting the 
                Veterans Crisis Line and being referred to a suicide 
                prevention specialist, begin and continue mental health 
                care furnished by the Secretary of Veterans Affairs; 
                and
                  (B) the number of veterans who, after contacting the 
                Veterans Crisis Line and being referred to a suicide 
                prevention specialist, either--
                          (i) begin mental health care furnished by the 
                        Secretary but do not continue such care; or
                          (ii) do not begin such care.
          (2) The visibility of the Veterans Crisis Line, by 
        determining--
                  (A) the number of veterans who contact the Veterans 
                Crisis Line and have not previously received hospital 
                care or medical services furnished by the Secretary; 
                and
                  (B) the number of veterans who contact the Veterans 
                Crisis Line and have previously received hospital care 
                or medical services furnished by the Secretary.
          (3) The role of the Veterans Crisis Line as part of the 
        mental health care services of the Department, by determining, 
        of the veterans who are enrolled in the health care system 
        established under section 1705(a) of title 38, United States 
        Code, who contact the Veterans Crisis Line, the number who are 
        under the care of a mental health care provider of the 
        Department at the time of such contact.
          (4) Whether receiving sustained mental health care affects 
        suicidality and whether veterans previously receiving mental 
        health care furnished by the Secretary use the Veterans Crisis 
        Line in times of crisis, with respect to the veterans described 
        in paragraph (3), by determining the time frame between 
        receiving such care and the time of such contact.
          (5) The effectiveness of the Veterans Crisis Line in 
        assisting veterans at risk for suicide when the Veterans Crisis 
        Line is contacted by a non-veteran, by determining, of the 
        number of non-veterans who contact the Veterans Crisis Line 
        looking for support in assisting a veteran, how many of such 
        individuals receive support in having a veteran begin to 
        receive mental health care furnished by the Secretary.
          (6) The overall efficacy of the Veterans Crisis Line in 
        preventing suicides and whether the number of contacts affects 
        the efficacy, by determining--
                  (A) the number of veterans who contact the Veterans 
                Crisis Line who ultimately commit or attempt suicide; 
                and
                  (B) of such veterans, how many times did a veteran 
                contact the Veterans Crisis Line prior to committing or 
                attempting suicide.
          (7) The long-term efficacy of the Veterans Crisis Line in 
        preventing repeated suicide attempts and whether the efficacy 
        is temporary, by determining, of the number of veterans who 
        contacted the Veterans Crisis Line and did not commit or 
        attempt suicide during the following six-month period, the 
        number who contacted the Veterans Crisis Line in crisis at a 
        later time and thereafter did commit or attempt suicide.
          (8) Whether referral to mental health care affects the risk 
        of suicide, by determining--
                  (A) the number of veterans who contact the Veterans 
                Crisis Line who are not referred to, or do not continue 
                receiving, mental health care who commit suicide; and
                  (B) the number of veterans described in paragraph 
                (1)(A) who commit or attempt suicide.
          (9) The efficacy of the Veterans Crisis Line to promote 
        continued mental health care in those veterans who are at high 
        risk for suicide whose suicide was prevented, by determining, 
        of the number of veterans who contacted the Veterans Crisis 
        Line and did not commit or attempt suicide soon thereafter, the 
        number that begin and continue to receive mental health care 
        furnished by the Secretary.
          (10) Such other matters as the Secretary determines 
        appropriate.
  (c) Rule of Construction Regarding Data Collection.--Nothing in this 
section may be construed to modify or affect the manner in which data 
is collected, or the kind or content of data collected, by the 
Secretary under the Veterans Crisis Line.
  (d) Submission.--Not later than March 1, 2020, the Secretary shall 
submit to the Committees on Veterans' Affairs of the House of 
Representatives and the Senate the study under subsection (a).
  (e) Veterans Crisis Line Defined.--In this section, the term 
``Veterans Crisis Line'' means the toll-free hotline for veterans 
established under section 1720F(h) of title 38, United States Code.

                          PURPOSE AND SUMMARY

    H.R. 4173, the ``Veterans Crisis Line Study Act of 2017,'' 
would require the Secretary of the Department of Veterans 
Affairs (VA) conduct a study on the outcomes and the efficacy 
of the Veterans Crisis Line during the five-year period 
beginning January 1, 2014, based on an analysis of national 
suicide data and data collected from the Veterans Crisis Line.

                  BACKGROUND AND NEED FOR LEGISLATION

    In 2007, the Veterans Crisis Line (VCL) was established as 
a partnership between the Department of Veterans Affairs (VA), 
the Substance Abuse and Mental Health Services Administration 
(SAMHSA), and the National Suicide Prevention Lifeline. As of 
May 2016, the VCL has answered over 2.3 million calls, over 
55,000 texts and dispatched emergency services over 61,000 
times.\1\
---------------------------------------------------------------------------
    \1\https://www.gao.gov/assets/690/683918.pdf
---------------------------------------------------------------------------
    While VA does collect valuable, anonymous data points from 
VCL callers, it does not currently process them through any 
meaningful form of data analytics as it relates to the efficacy 
of the program. Instead, VCL statistics are currently evaluated 
for quality and access metrics.
    The Veterans Crisis Line Study Act of 2017 would direct the 
Secretary to evaluate the efficacy of the Veterans Crisis Line, 
with respect to continuity of VA mental health services. 
Research and data analysis would utilize the growing national 
availability of statistics regarding suicides to better 
evaluate the impact of the VCL and potentially highlight 
opportunities for outcome improvements. The Committee believes 
evaluating the VCL effectively requires a focus on the full 
continuum of mental health care provided by VA once a veteran 
first contacts the VCL or establishes a need for mental health 
services.
    It is important to note that the data collected under this 
bill is not to be collected differently than they currently 
are.

                                HEARINGS

    There were no Subcommittee hearings held on H.R. 4173.
    On October 24, 2017, the full Committee conducted a 
legislative hearing on a number of bills including H.R. 4173.
    The following witnesses testified:
          The Honorable Jim Banks, U.S. House of 
        Representatives, 3rd District, Indiana; The Honorable 
        Mike Gallagher, U.S. House of Representatives, 8th 
        District, Wisconsin; The Honorable John R. Carter, U.S. 
        House of Representatives, 31st District, Texas; The 
        Honorable Glenn Thompson, U.S. House of 
        Representatives, 5th District, Pennsylvania; The 
        Honorable Neal P. Dunn, U.S. House of Representatives, 
        2nd District, Florida; The Honorable Andy Barr, U.S. 
        House of Representatives, 6th District, Kentucky; The 
        Honorable David J. Shulkin, M.D., Secretary, U.S. 
        Department of Veterans Affairs, who was accompanied by 
        Carolyn Clancy M.D, the Executive in Charge of the 
        Veterans Health Administration, and Laurie Zephyrin 
        M.D., MPH, MBA, the Acting Deputy Under Secretary for 
        Health for Community Care for the Veterans Health 
        Administration; Adrian M. Atizado, Deputy National 
        Legislative Director, Disabled American Veterans; 
        Roscoe G. Butler, Deputy Director for Health Care, 
        Veterans Affairs and Rehabilitation Division, The 
        American Legion; and, Kayda Keleher, Associate 
        Director, National Legislative Service, Veterans of 
        Foreign Wars of the United States.
    Statements for the record were submitted by:
          American Federation of Government Employees, AFL-CIO; 
        American Health Care Association; American Medical 
        Association; AMVETS; Concerned Veterans of America; 
        Fleet Reserve Association; Got Your 6; Health IT Now; 
        Iraq and Afghanistan Veterans of America; Military 
        Officers Association of America; Military Order of the 
        Purple Heart; National Alliance on Mental Illness; 
        National Guard Association of the United States; Nurses 
        Organization of Veterans Affairs/Association of VA 
        Psychologist Leaders/Association of VA Social Workers/
        Veterans Healthcare Action Campaign; Paralyzed Veterans 
        of America; Reserve Officers Association; University of 
        Pittsburgh; Vietnam Veterans of America; and the 
        Wounded Warrior Project.

                       SUBCOMMITTEE CONSIDERATION

    There was no Subcommittee consideration of H.R. 4173.

                        COMMITTEE CONSIDERATION

    On November 2, 2017, the full Committee met in open markup 
session, a quorum being present, and ordered H.R. 4173 to be 
reported favorably to the House of Representatives by voice 
vote. During consideration of the bill, the following 
amendments were considered and agreed to by voice vote:
    An Amendment to H.R. 4173 was offered by Representative Jim 
Banks 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. 4173 
reported to the House. A motion by Representative Tim Walz of 
Minnesota, Ranking Member of the Committee on Veterans' 
Affairs, to report H.R. 4173 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 are to evaluate the efficacy of the 
Veterans Crisis Line, with respect to the full continuum of VA 
mental health care services.

   NEW BUDGET AUTHORITY, ENTITLEMENT AUTHORITY, AND TAX EXPENDITURES

    With respect to the requirement with respect to clause 
3(c)(2) of rule XIII of the Rules of the House of 
Representatives, the Committee has requested but not received 
from the Director of the Congressional Budget Office an 
estimate of new budget authority, entitlement authority, or tax 
expenditures or revenues.

                  EARMARKS AND TAX AND TARIFF BENEFITS

    H.R. 4173 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

    Clause 3(d)(2) of rule XIII of the Rules of the House of 
Representatives requires an estimate and a comparison by the 
Committee of the costs that would be incurred in carrying out 
this bill. However, clause 3(d)(3)(B) of that Rule provides 
that this requirement does not apply when the Committee has 
included in its report a timely submitted cost estimate of the 
bill prepared by the Director of the Congressional Budget 
Office under section 402 of the Congressional Budget Act of 
1974. The Committee has requested but not received a cost 
estimate for this bill from the Director of the Congressional 
Budget Office. Assuming the appropriation of authorized 
amounts, the Committee estimates, and according to a 
preliminary score from the Congressional Budget Office, that 
the legislation would also have a discretionary cost of $1 
million over the 2018-2022 period.

               CONGRESSIONAL BUDGET OFFICE COST ESTIMATE

    With respect to the requirements of clause 3(c)(2) of rule 
XIII of the Rules of the House of Representatives and section 
308(a) of the Congressional Budget Act of 1974 and with respect 
to requirements of clause (3)(c)(3) of rule XIII of the Rules 
of the House of Representatives and section 402 of the 
Congressional Budget Act of 1974, the Committee has requested 
but not received a cost estimate for this bill from the 
Director of Congressional Budget Office. The Committee has 
requested but not received from the Director of the 
Congressional Budget Office a statement as to whether this bill 
contains any new budget authority, spending authority, credit 
authority, or an increase or decrease in revenues or tax 
expenditures.

                       FEDERAL MANDATES STATEMENT

    With respect to the requirements of Section 423 of the 
Congressional Budget and Impoundment Control Act (as amended by 
Section 101(a)(2) of the Unfunded Mandate Reform Act, P.L. 104-
4), the Committee has requested but not received from the 
Director of the Congressional Budget Office a statement as to 
whether the provisions of the reported bill include unfunded 
mandates.

                      ADVISORY COMMITTEE STATEMENT

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act would be created by H.R. 
4173.

                 STATEMENT OF CONSTITUTIONAL AUTHORITY

    Pursuant to Article I, section 8 of the United States 
Constitution, H.R. 4173 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. 4173 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, 115th Cong. (2017), 
the Committee finds that no provision of H.R. 4173 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, 115th Cong. (2017), 
the Committee estimates that H.R. 4173 contains no directed 
rulemaking that would require the Secretary to prescribe 
regulations.

             SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION

Section 1. Short title

    Section 1 of the bill would provide the short title for 
H.R. 4173 as the ``Veterans Crisis Line Study Act of 2017''.

Section 2. Study on efficacy of Veterans Crisis Line

    Section 2(a) of the bill would direct the Secretary of the 
Department of Veterans Affairs to conduct a study on the 
outcomes and efficacy of the VCL for the five-year period 
starting January 1, 2014.
    Section 2(b) of the bill outlines the metrics to be 
targeted for analysis for the study, to include: 2(b)(1)--the 
efficacy of the VCL, 2(b)(2)--the visibility of the VCL; 
2(b)(3)--the role of the VCL as part of the continuum of care 
provided by VA; 2(b)(4)--whether VA-provided mental health care 
affects suicidality; 2(b)(5)--the effectiveness of a non-
veteran calling to seek assistance for a veteran; 2(b)(6)--the 
overall efficacy of the VCL in preventing suicides and whether 
repeated VCL contacts affect the efficacy; 2(b)(7)--the long-
term efficacy of the VCL in preventing repeated suicide 
attempts; 2(b)(8)--effectiveness of referral patterns; 
2(b)(9)--the efficacy of the VCL to promote continued mental 
healthcare for high-risk veterans.
    Section 2(c) of the bill stipulates that all data collected 
under this bill shall be collected in the same manner as prior 
to the enactment of this legislation, beginning January 1, 
2014.
    Section 2(d) of the bill requires the Secretary to report 
the findings of the study to the Congressional Committees on 
Veterans' Affairs by March 1, 2020.
    Section 2(e) of the bill defines the term ``Veterans Crisis 
Line.''

         CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

    If enacted, this bill would make no changes in existing 
law.

                                  [all]