Commander John Scott Hannon Veterans Mental Health Care Improvement Act of 2019
This bill makes updates related to Department of Veterans Affairs (VA) transition assistance, mental health care, care for women veterans, and telehealth care.
TITLE I--IMPROVEMENT OF TRANSITION OF INDIVIDUALS TO SERVICES FROM DEPARTMENT OF VETERANS AFFAIRS
(Sec. 101) This section requires the VA to submit a plan for the provision of VA health care to any veteran during the one-year period following the discharge or release from active military, naval, or air service.
(Sec. 102) The Department of Defense (DOD) and the VA must jointly review and report on the records of each former member of the Armed Forces who died by suicide within one year of separation from the Armed Forces during the five-year period preceding the enactment of this bill.
(Sec. 103) The VA must report on the Recovery Engagement and Coordination for Health—Veterans Enhanced Treatment (REACH VET) program to assess, among other elements, the impact of the program on rates of suicide among veterans.
(Sec. 104) This section updates reporting requirements related to the mental and behavioral health care provided by the VA to former members of the Armed Forces with other than honorable discharge.
TITLE II--SUICIDE PREVENTION
(Sec. 201) This section establishes the Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program, under which the VA must award grants for a period of three years to eligible entities for the provision of suicide prevention services to veterans and their families. A nongovernmental entity must conduct a study on the provision of such grants to evaluate the effectiveness.
In certain circumstances, entities receiving grants must refer eligible individuals for additional care at the VA. If it is clinically appropriate, the VA must provide an individual receiving suicide prevention services through a grant with a mental health care assessment or services. If an individual refuses such care, ongoing clinical services provided by a grantee must be at the expense of the grantee.
(Sec. 202) The VA must complete a study and report on the feasibility and advisability of providing complementary and integrative health treatments, such as acupuncture, at all VA medical facilities.
(Sec. 203) After the Creating Options for Veterans' Expedited Recovery Commission submits its final report, the VA must conduct a three-year pilot program to provide complementary and integrative health services (e.g., animal therapy) to certain veterans from the VA or non-VA entities for the treatment of post-traumatic stress disorder (PTSD), depression, or anxiety. The VA is authorized to extend the duration based on the results of the implementation.
(Sec. 204) The VA must seek to enter into an agreement with the National Academies of Sciences, Engineering, and Medicine to study the effects of opioids and benzodiazepine on all-cause mortality of veterans, including suicide, regardless of whether information relating to such deaths has been reported by the Centers for Disease Control and Prevention.
The Government Accountability Office (GAO) must conduct a review of the staffing levels for mental health professionals of the VA.
(Sec. 205) This section requires the GAO to report on the VA's efforts to manage veterans at high risk for suicide.
TITLE III--PROGRAMS, STUDIES, AND GUIDELINES ON MENTAL HEALTH
(Sec. 301) This section requires the VA to conduct a study on the connection between living at high altitude and the risk of developing depression or dying by suicide among veterans. Depending on the results, a follow-up study may be required to identify biological causes and effective treatments.
(Sec. 302) The VA must develop a clinical provider treatment toolkit and training materials for the evidence-based management of comorbid mental health conditions, comorbid mental health and substance use disorders, and a comorbid mental health condition and chronic pain.
(Sec. 303) The VA and DOD (through the Assessment and Management of Patients at Risk for Suicide Work Group) must issue an update to the VA/DOD Clinical Practice Guideline for Assessment and Management of Patients at Risk for Suicide that (1) considers gender-specific factors; and (2) includes guidance with respect to the efficacy of certain alternative therapies, such as meditation and animal therapy.
(Sec. 304) This section requires the VA to complete the development of a clinical practice guideline or guidelines for the treatment of serious mental illness. Under this section, such guidelines must address the treatment of schizophrenia, schizoaffective disorder, and persistent mood disorder (including bipolar disorder I and II).
The VA must establish the Serious Mental Illness Work Group with DOD and the Department of Health and Human Services to develop such clinical practice guideline or guidelines.
Additionally, the VA must complete an assessment of the 2016 Clinical Practice Guidelines for the Management of Major Depressive Disorders to determine if an update is necessary.
(Sec. 305) The VA must implement the Precision Medicine for Veterans Initiative to identify and validate brain and mental health biomarkers among veterans, with specific consideration for depression, anxiety, PTSD, bipolar disorder, and traumatic brain injury. The VA must develop data privacy and security measures to ensure the information of veterans participating in the initiative is kept private and secure. The VA must also coordinate efforts of the initiative with the Million Veterans Program.
(Sec. 306) This section authorizes the VA to contract with academic institutions or other qualified entities to carry out any statistical analyses and data evaluation as required by law.
TITLE IV--OVERSIGHT OF MENTAL HEALTH CARE AND RELATED SERVICES
(Sec. 401) The VA must enter into an agreement with a nonfederal government entity that has expertise in conducting and evaluating research-based studies to conduct a study on the effectiveness of the VA's suicide prevention and mental health outreach materials and campaigns.
(Sec. 402) The VA must establish measurable goals to evaluate the effectiveness of the VA's mental health and suicide prevention media outreach campaigns.
(Sec. 403) This section requires the GAO to conduct a management review of the mental health and suicide prevention services provided by the VA.
(Sec. 404) The GAO must report on the VA's efforts to integrate (1) mental health care into VA primary care clinics, and (2) community-based mental health care (care provided by a non-VA provider but paid for by the VA) into the Veterans Health Administration (VHA).
(Sec. 405) The VA and DOD must report on their mental health programs, including joint programs of the departments. The VA must establish a joint VA/DOD Intrepid Spirit Center to serve active duty members of the Armed Forces, members of the reserve components, and veterans for mutual benefit and growth in treatment and care for PTSD and traumatic brain injury.
TITLE V--IMPROVEMENT OF MENTAL HEALTH MEDICAL WORKFORCE
(Sec. 501) The VA must submit a plan to address the staffing of mental health providers at its facilities. Additionally, the VA must develop an occupational series for its licensed professional mental health counselors and marriage and family therapists.
(Sec. 502) This section requires the VA to carry out the Department of Veterans Affairs Readjustment Counseling Service Scholarship Program under the Educational Assistance Program.
(Sec. 503) The GAO must report on the VA's Readjustment Counseling Service. Such report must include, among other elements, an assessment of barriers to care at Vet Centers.
(Sec. 504) This section expands the annual reporting requirement on the activities of the Readjustment Counseling Service to include additional elements.
(Sec. 505) The VA must conduct a survey on the attitudes of veterans toward the VA offering appointments outside the usual operating hours of VA facilities, including via telehealth appointments. The VA must also study the feasibility and advisability of offering appointments outside the usual operating hours
(Sec. 506) The VA must ensure each of its medical centers is staffed with at least one suicide prevention coordinator. In addition, the VA must conduct a study to determine the feasibility and advisability of the realignment and reorganization of suicide prevention coordinators within the Office of Mental Health and Suicide Prevention and the creation of a suicide prevention coordinator program office.
(Sec. 507) This section requires the VA to report on its efforts to implement a suicide prevention program for veterans presenting to an emergency department or urgent care center of the VHA who are assessed to be at risk for suicide and are safe to be discharged home.
TITLE VI--IMPROVEMENT OF CARE AND SERVICES FOR WOMEN VETERANS
(Sec. 601) This section requires the VA to expand the capabilities of the Women Veterans Call Center by including a text messaging capability.
(Sec. 602) The VA must publish a website providing information for women veterans about the benefits and services available to them.
TITLE VII--OTHER MATTERS
(Sec. 701) This section requires the VA to award grants to entities for the expansion of telehealth capabilities and provision of telehealth services to veterans. An entity seeking to establish a telehealth access point for veterans without grant funding is authorized to enter into an agreement with the VA to establish such access point.
The VA must assess and report on the barriers veterans face in accessing telehealth services.
(Sec. 702) This section authorizes the VA to enter partnerships with nonfederal government entities to provide hyperbaric oxygen treatment to veterans to research the effectiveness of such therapy in treating certain conditions (e.g., PTSD).
The VA must conduct a systematic review of published research literature on off-label use of hyperbaric oxygen therapy to treat PTSD and traumatic brain injury among veterans and nonveterans. Additionally, the VA must conduct a study on all individuals receiving hyperbaric oxygen therapy through the VA's current pilot program to determine the efficacy and effectiveness for treating PTSD and traumatic brain injury.
(Sec. 703) The VA must prescribe specified technical qualifications for appointment as a licensed hearing aid specialist in the VHA. Under this section, at least one licensed hearing aid specialist must be appointed at each VA medical center.
(Sec. 704) This section requires the VA to complete policy revisions within the internal directive titled Requirements for the Protection of Human Subjects in Research to allow sponsored clinical research of the VA to use accredited commercial institutional review boards to review VA research proposal protocols.
The VA must (1) identify accredited commercial institutional review boards for use in connection with sponsored clinical research of the VA, and (2) establish a process to modify existing approvals if a board loses its accreditation during an ongoing clinical trial.
(Sec. 705) This section also requires the VA to establish an Office of Research Reviews within the VA's Office of Information and Technology to perform centralized security reviews and complete security processes for approved research sponsored outside the VA, among other purposes.
[116th Congress Public Law 171]
[From the U.S. Government Publishing Office]
[[Page 777]]
COMMANDER JOHN SCOTT HANNON VETERANS MENTAL HEALTH CARE IMPROVEMENT ACT
OF 2019
[[Page 134 STAT. 778]]
Public Law 116-171
116th Congress
An Act
To improve mental health care provided by the Department of Veterans
Affairs, and for other purposes. <<NOTE: Oct. 17, 2020 - [S. 785]>>
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled, <<NOTE: Commander John
Scott Hannon Veterans Mental Health Care Improvement Act of 2019. 38 USC
101 note.>>
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Commander John
Scott Hannon Veterans Mental Health Care Improvement Act of 2019''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--IMPROVEMENT OF TRANSITION OF INDIVIDUALS TO SERVICES FROM
DEPARTMENT OF VETERANS AFFAIRS
Sec. 101. Strategic plan on expansion of health care coverage for
veterans transitioning from service in the Armed Forces.
Sec. 102. Review of records of former members of the Armed Forces who
die by suicide within one year of separation from the Armed
Forces.
Sec. 103. Report on REACH VET program of Department of Veterans Affairs.
Sec. 104. Report on care for former members of the Armed Forces with
other than honorable discharge.
TITLE II--SUICIDE PREVENTION
Sec. 201. Financial assistance to certain entities to provide or
coordinate the provision of suicide prevention services for
eligible individuals and their families.
Sec. 202. Analysis on feasibility and advisability of the Department of
Veterans Affairs providing certain complementary and
integrative health services.
Sec. 203. Pilot program to provide veterans access to complementary and
integrative health programs through animal therapy,
agritherapy, sports and recreation therapy, art therapy, and
posttraumatic growth programs.
Sec. 204. Department of Veterans Affairs study of all-cause mortality of
veterans, including by suicide, and review of staffing levels
of mental health professionals.
Sec. 205. Comptroller General report on management by Department of
Veterans Affairs of veterans at high risk for suicide.
TITLE III--PROGRAMS, STUDIES, AND GUIDELINES ON MENTAL HEALTH
Sec. 301. Study on connection between living at high altitude and
suicide risk factors among veterans.
Sec. 302. Establishment by Department of Veterans Affairs and Department
of Defense of a clinical provider treatment toolkit and
accompanying training materials for comorbidities.
Sec. 303. Update of clinical practice guidelines for assessment and
management of patients at risk for suicide.
Sec. 304. Establishment by Department of Veterans Affairs and Department
of Defense of clinical practice guidelines for the treatment
of serious mental illness.
Sec. 305. Precision medicine initiative of Department of Veterans
Affairs to identify and validate brain and mental health
biomarkers.
[[Page 134 STAT. 779]]
Sec. 306. Statistical analyses and data evaluation by Department of
Veterans Affairs.
TITLE IV--OVERSIGHT OF MENTAL HEALTH CARE AND RELATED SERVICES
Sec. 401. Study on effectiveness of suicide prevention and mental health
outreach programs of Department of Veterans Affairs.
Sec. 402. Oversight of mental health and suicide prevention media
outreach conducted by Department of Veterans Affairs.
Sec. 403. Comptroller General management review of mental health and
suicide prevention services of Department of Veterans
Affairs.
Sec. 404. Comptroller General report on efforts of Department of
Veterans Affairs to integrate mental health care into primary
care clinics.
Sec. 405. Joint mental health programs by Department of Veterans Affairs
and Department of Defense.
TITLE V--IMPROVEMENT OF MENTAL HEALTH MEDICAL WORKFORCE
Sec. 501. Staffing improvement plan for mental health providers of
Department of Veterans Affairs.
Sec. 502. Establishment of Department of Veterans Affairs Readjustment
Counseling Service Scholarship Program.
Sec. 503. Comptroller General report on Readjustment Counseling Service
of Department of Veterans Affairs.
Sec. 504. Expansion of reporting requirements on Readjustment Counseling
Service of Department of Veterans Affairs.
Sec. 505. Briefing on alternative work schedules for employees of
Veterans Health Administration.
Sec. 506. Suicide prevention coordinators.
Sec. 507. Report on efforts by Department of Veterans Affairs to
implement safety planning in emergency departments.
TITLE VI--IMPROVEMENT OF CARE AND SERVICES FOR WOMEN VETERANS
Sec. 601. Expansion of capabilities of Women Veterans Call Center to
include text messaging.
Sec. 602. Requirement for Department of Veterans Affairs internet
website to provide information on services available to women
veterans.
TITLE VII--OTHER MATTERS
Sec. 701. Expanded telehealth from Department of Veterans Affairs.
Sec. 702. Partnerships with non-Federal Government entities to provide
hyperbaric oxygen therapy to veterans and studies on the use
of such therapy for treatment of post-traumatic stress
disorder and traumatic brain injury.
Sec. 703. Prescription of technical qualifications for licensed hearing
aid specialists and requirement for appointment of such
specialists.
Sec. 704. Use by Department of Veterans Affairs of commercial
institutional review boards in sponsored research trials.
Sec. 705. Creation of Office of Research Reviews within the Office of
Information and Technology of the Department of Veterans
Affairs.
TITLE I--IMPROVEMENT OF TRANSITION OF INDIVIDUALS TO SERVICES FROM
DEPARTMENT OF VETERANS AFFAIRS
SEC. 101. STRATEGIC PLAN ON EXPANSION OF HEALTH CARE COVERAGE FOR
VETERANS TRANSITIONING FROM SERVICE IN THE
ARMED FORCES.
(a) Strategic Plan.--
(1) <<NOTE: Deadline. Consultation. Web posting. Time
period.>> In general.--Not later than one year after the date
of the enactment of this Act, the Secretary of Veterans Affairs,
in consultation with the Secretary of Defense, shall submit to
the appropriate committees of Congress and publish on a
[[Page 134 STAT. 780]]
website of the Department of Veterans Affairs a strategic plan
for the provision by the Department of health care to any
veteran during the one-year period following the discharge or
release of the veteran from active military, naval, or air
service.
(2) Elements.--The plan submitted under paragraph (1) shall
include the following:
(A) An identification of general goals and
objectives for the provision of health care to veterans
described in such paragraph.
(B) A description of how such goals and objectives
are to be achieved, including--
(i) a description of the use of existing
personnel, information, technology, facilities,
public and private partnerships, and other
resources of the Department of Veterans Affairs;
(ii) a description of the anticipated need for
additional resources for the Department; and
(iii) an assessment of cost.
(C) <<NOTE: Analysis.>> An analysis of the
anticipated health care needs, including mental health
care, for such veterans, disaggregated by geographic
area.
(D) <<NOTE: Analysis.>> An analysis of whether such
veterans are eligible for enrollment in the system of
annual patient enrollment of the Department under
section 1705(a) of title 38, United States Code.
(E) A description of activities designed to promote
the availability of health care from the Department for
such veterans, including outreach to members of the
Armed Forces though the Transition Assistance Program
under sections 1142 and 1144 of title 10, United States
Code.
(F) A description of legislative or administrative
action required to carry out the plan.
(G) A description of how the plan would further the
ongoing initiatives under Executive Order 13822 (83 Fed.
Reg. 1513; relating to supporting our veterans during
their transition from uniformed service to civilian
life) to provide seamless access to high-quality mental
health care and suicide prevention resources to veterans
as they transition, with an emphasis on the one-year
period following separation.
(b) Definitions.--In this section:
(1) Active military, naval, or air service.--The term
``active military, naval, or air service'' has the meaning given
that term in section 101(24) of title 38, United States Code.
(2) Appropriate committees of congress.--The term
``appropriate committees of Congress'' means--
(A) the Committee on Veterans' Affairs and the
Committee on Appropriations of the Senate; and
(B) the Committee on Veterans' Affairs and the
Committee on Appropriations of the House of
Representatives.
SEC. 102. REVIEW OF RECORDS OF FORMER MEMBERS OF THE ARMED FORCES
WHO DIE BY SUICIDE WITHIN ONE YEAR OF
SEPARATION FROM THE ARMED FORCES.
(a) Review.--
(1) <<NOTE: Determination. Time periods.>> In general.--The
Secretary of Defense and the Secretary of Veterans Affairs shall
jointly review the records of
[[Page 134 STAT. 781]]
each former member of the Armed Forces who died by suicide, as
determined by the Secretary of Defense or the Secretary of
Veterans Affairs, within one year following the discharge or
release of the former member from active military, naval, or air
service during the five-year period preceding the date of the
enactment of this Act.
(2) Records to be reviewed.--In completing the review
required under paragraph (1), the Secretary of Defense and the
Secretary of Veterans Affairs shall review the following records
maintained by the Department of Defense:
(A) Health treatment records.
(B) Fitness, medical, and dental records.
(C) Ancillary training records.
(D) Safety forms and additional duties sections of
the personnel information files.
(b) Elements.--The review required by subsection (a) with respect to
a former member of the Armed Forces shall include consideration of the
following:
(1) <<NOTE: Time period.>> Whether the Department of
Defense had identified the former member as being at elevated
risk during the 365-day period before separation of the member
from the Armed Forces.
(2) In the case that the member was identified as being at
elevated risk as described in paragraph (1), whether that
identification had been communicated to the Department of
Veterans Affairs via the Solid Start initiative of the
Department pursuant to Executive Order 13822 (83 Fed. Reg. 1513;
relating to supporting our veterans during their transition from
uniformed service to civilian life), or any other means.
(3) The presence of evidence-based and empirically-supported
contextual and individual risk factors specified in subsection
(c) with respect to the former member and how those risk factors
correlated to the circumstances of the death of the former
member.
(4) Demographic variables, including the following:
(A) Sex.
(B) Age.
(C) Rank at separation from the Armed Forces.
(D) Career field after separation from the Armed
Forces.
(E) State and county of residence one month prior to
death.
(F) Branch of service in the Armed Forces.
(G) Marital status.
(H) Reason for separation from the Armed Forces.
(5) Support or medical services furnished to the former
member through the Department of Defense, specified by the type
of service or care provided.
(6) Support or medical services furnished to the former
member through the Department of Veterans Affairs, specified by
the type of service or care provided.
(c) Evidence-based and Empirically-supported Contextual and
Individual Risk Factors.--Evidence-based and empirically-supported
contextual and individual risk factors specified in this subsection
include the following:
(1) Exposure to violence.
(2) Exposure to suicide.
(3) Housing instability.
[[Page 134 STAT. 782]]
(4) Financial instability.
(5) Vocational problems or insecurity.
(6) Legal problems.
(7) Highly acute or significantly chronic relational
problems.
(8) Limited access to health care.
(d) Report.--Not later than three years after the date of the
enactment of this Act, the Secretary of Defense and the Secretary of
Veterans Affairs shall jointly submit to the appropriate committees of
Congress an aggregated report on the results of the review conducted
under subsection (a) with respect to the year-one cohort of former
members of the Armed Forces covered by the review.
(e) Definitions.--In this section:
(1) Active military, naval, or air service.--The term
``active military, naval, or air service'' has the meaning given
that term in section 101(24) of title 38, United States Code.
(2) Appropriate committees of congress defined.--The term
``appropriate committees of Congress'' means--
(A) the Committee on Armed Services and the
Committee on Veterans' Affairs of the Senate; and
(B) the Committee on Armed Services and the
Committee on Veterans' Affairs of the House of
Representatives.
SEC. 103. REPORT ON REACH VET PROGRAM OF DEPARTMENT OF VETERANS
AFFAIRS.
(a) In General.--Not later than 180 days after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall submit to
the Committee on Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives a report on the REACH
VET program.
(b) <<NOTE: Assessments.>> Elements.--The report required by
subsection (a) shall include the following:
(1) An assessment of the impact of the REACH VET program on
rates of suicide among veterans.
(2) An assessment of how limits within the REACH VET
program, such as caps on the number of veterans who may be
flagged as high risk, are adjusted for differing rates of
suicide across the country.
(3) A detailed explanation, with evidence, for why the
conditions included in the model used by the REACH VET program
were chosen, including an explanation as to why certain
conditions, such as bipolar disorder II, were not included even
though they show a similar rate of risk for suicide as other
conditions that were included.
(4) An assessment of the feasibility of incorporating
certain economic data held by the Veterans Benefits
Administration into the model used by the REACH VET program,
including financial data and employment status, which research
indicates may have an impact on risk for suicide.
(c) REACH VET Program Defined.--In this section, the term ``REACH
VET program'' means the Recovery Engagement and Coordination for
Health--Veterans Enhanced Treatment program of the Department of
Veterans Affairs.
SEC. 104. REPORT ON CARE FOR FORMER MEMBERS OF THE ARMED FORCES
WITH OTHER THAN HONORABLE DISCHARGE.
Section 1720I(f) of title 38, United States Code, is amended--
[[Page 134 STAT. 783]]
(1) in paragraph (1) by striking ``Not less frequently than
once'' and inserting ``Not later than February 15''; and
(2) in paragraph (2)--
(A) by redesignating subparagraph (C) as
subparagraph (F); and
(B) by inserting after subsection (B) the following
new subparagraphs:
``(C) The types of mental or behavioral health care needs
treated under this section.
``(D) The demographics of individuals being treated under
this section, including--
``(i) age;
``(ii) era of service in the Armed Forces;
``(iii) branch of service in the Armed Forces; and
``(iv) geographic location.
``(E) The average number of visits for an individual for
mental or behavioral health care under this section.''.
TITLE II--SUICIDE PREVENTION
SEC. 201. <<NOTE: 38 USC 1720F note.>> FINANCIAL ASSISTANCE TO
CERTAIN ENTITIES TO PROVIDE OR COORDINATE
THE PROVISION OF SUICIDE PREVENTION
SERVICES FOR ELIGIBLE INDIVIDUALS AND
THEIR FAMILIES.
(a) Purpose; Designation.--
(1) Purpose.--The purpose of this section is to reduce
veteran suicide through a community-based grant program to award
grants to eligible entities to provide or coordinate suicide
prevention services to eligible individuals and their families.
(2) Designation.--The grant program under this section shall
be known as the ``Staff Sergeant Parker Gordon Fox Suicide
Prevention Grant Program''.
(b) <<NOTE: Grants.>> Financial Assistance and Coordination.--The
Secretary shall provide financial assistance to eligible entities
approved under this section through the award of grants to such entities
to provide or coordinate the provision of services to eligible
individuals and their families to reduce the risk of
suicide. <<NOTE: Consultation.>> The Secretary shall carry out this
section in coordination with the President's Roadmap to Empower Veterans
and End a National Tragedy of Suicide Task Force and in consultation
with the Office of Mental Health and Suicide Prevention of the
Department, to the extent practicable.
(c) Award of Grants.--
(1) In general.--The Secretary shall award a grant to each
eligible entity for which the Secretary has approved an
application under subsection (f) to provide or coordinate the
provision of suicide prevention services under this section.
(2) Grant amounts, intervals of payment, and matching
funds.--In accordance with the services being provided under a
grant under this section and the duration of those services, the
Secretary shall establish--
(A) a maximum amount to be awarded under the grant
of not more than $750,000 per grantee per fiscal year;
and
(B) intervals of payment for the administration of
the grant.
(d) Distribution of Grants and Preference.--
[[Page 134 STAT. 784]]
(1) Distribution.--
(A) Priority.--In compliance with subparagraphs (B)
and (C), in determining how to distribute grants under
this section, the Secretary may prioritize--
(i) rural communities;
(ii) Tribal lands;
(iii) territories of the United States;
(iv) medically underserved areas;
(v) areas with a high number or percentage of
minority veterans or women veterans; and
(vi) areas with a high number or percentage of
calls to the Veterans Crisis Line.
(B) Areas with need.--The Secretary shall ensure
that, to the extent practicable, grants under this
section are distributed--
(i) to provide services in areas of the United
States that have experienced high rates of suicide
by eligible individuals, including suicide
attempts; and
(ii) to eligible entities that can assist
eligible individuals at risk of suicide who are
not currently receiving health care furnished by
the Department.
(C) Geography.--In distributing grants under this
paragraph, the Secretary may provide grants to eligible
entities that furnish services to eligible individuals
and their families in geographically dispersed areas.
(2) Preference.--The Secretary shall give preference to
eligible entities that have demonstrated the ability to provide
or coordinate suicide prevention services.
(e) Requirements for Receipt of Grants.--
(1) Notification that services are from department.--Each
entity receiving a grant under this section to provide or
coordinate suicide prevention services to eligible individuals
and their families shall notify the recipients of such services
that such services are being paid for, in whole or in part, by
the Department.
(2) <<NOTE: Consultation.>> Development of plan with
eligible individuals and their family.--Any plan developed with
respect to the provision of suicide prevention services for an
eligible individual or their family shall be developed in
consultation with the eligible individual and their family.
(3) <<NOTE: Notification.>> Coordination.--An entity
receiving a grant under this section shall--
(A) coordinate with the Secretary with respect to
the provision of clinical services to eligible
individuals in accordance with subsection (n) or any
other provisions of the law regarding the delivery of
health care by the Secretary;
(B) inform every veteran who receives assistance
under this section from the entity of the ability of the
veteran to apply for enrollment in the patient
enrollment system of the Department under section
1705(a) of title 38, United States Code; and
(C) if such a veteran wishes to so enroll, inform
the veteran of a point of contact at the Department who
can assist the veteran in such enrollment.
(4) Measurement and monitoring.--An entity receiving a grant
under this section shall submit to the Secretary a
[[Page 134 STAT. 785]]
description of such tools and assessments the entity uses or
will use to determine the effectiveness of the services
furnished by the entity, which shall include the measures
developed under subsection (h)(2) and may include--
(A) the effect of the services furnished by the
entity on the financial stability of the eligible
individual;
(B) the effect of the services furnished by the
entity on the mental health status, wellbeing, and
suicide risk of the eligible individual; and
(C) the effect of the services furnished by the
entity on the social support of the eligible individuals
receiving those services.
(5) Reports.--The Secretary--
(A) shall require each entity receiving a grant
under this section to submit to the Secretary an annual
report that describes the projects carried out with such
grant during the year covered by the report;
(B) <<NOTE: Criteria. Data.>> shall specify to each
such entity the evaluation criteria and data and
information to be submitted in such report; and
(C) may require each such entity to submit to the
Secretary such additional reports as the Secretary
considers appropriate.
(f) Application for Grants.--
(1) In general.--An eligible entity seeking a grant under
this section shall submit to the Secretary an application
therefor in such form, in such manner, and containing such
commitments and information as the Secretary considers necessary
to carry out this section.
(2) Matters to be included.--Each application submitted by
an eligible entity under paragraph (1) shall contain the
following:
(A) A description of the suicide prevention services
proposed to be provided by the eligible entity and the
identified need for those services.
(B) <<NOTE: Plan.>> A detailed plan describing how
the eligible entity proposes to coordinate or deliver
suicide prevention services to eligible individuals,
including--
(i) an identification of the community
partners, if any, with which the eligible entity
proposes to work in delivering such services;
(ii) a description of the arrangements
currently in place between the eligible entity and
such partners with regard to the provision or
coordination of suicide prevention services;
(iii) an identification of how long such
arrangements have been in place;
(iv) a description of the suicide prevention
services provided by such partners that the
eligible entity shall coordinate, if any; and
(v) an identification of local suicide
prevention coordinators of the Department and a
description of how the eligible entity will
communicate with local suicide prevention
coordinators.
(C) A description of the population of eligible
individuals and their families proposed to be provided
suicide prevention services.
[[Page 134 STAT. 786]]
(D) <<NOTE: Estimate.>> Based on information and
methods developed by the Secretary for purposes of this
subsection, an estimate of the number of eligible
individuals at risk of suicide and their families
proposed to be provided suicide prevention services,
including the percentage of those eligible individuals
who are not currently receiving care furnished by the
Department.
(E) Evidence of measurable outcomes related to
reductions in suicide risk and mood-related symptoms
utilizing validated instruments by the eligible entity
(and the proposed partners of the entity, if any) in
providing suicide prevention services to individuals at
risk of suicide, particularly to eligible individuals
and their families.
(F) A description of the managerial and
technological capacity of the eligible entity--
(i) <<NOTE: Coordination.>> to coordinate the
provision of suicide prevention services with the
provision of other services;
(ii) <<NOTE: Assessment.>> to assess on an
ongoing basis the needs of eligible individuals
and their families for suicide prevention
services;
(iii) <<NOTE: Coordination.>> to coordinate
the provision of suicide prevention services with
the services of the Department for which eligible
individuals are also eligible;
(iv) to tailor suicide prevention services to
the needs of eligible individuals and their
families;
(v) to seek continuously new sources of
assistance to ensure the continuity of suicide
prevention services for eligible individuals and
their families as long as they are determined to
be at risk of suicide; and
(vi) to measure the effects of suicide
prevention services provided by the eligible
entity or partner organization, in accordance with
subsection (h)(2), on the lives of eligible
individuals and their families who receive such
services provided by the organization using pre-
and post-evaluations on validated measures of
suicide risk and mood-related symptoms.
(G) Clearly defined objectives for the provision of
suicide prevention services.
(H) A description and physical address of the
primary location of the eligible entity.
(I) A description of the geographic area the
eligible entity plans to serve during the grant award
period for which the application applies.
(J) If the eligible entity is a State or local
government or an Indian tribe, the amount of grant funds
proposed to be made available to community partners, if
any, through agreements.
(K) A description of how the eligible entity will
assess the effectiveness of the provision of grants
under this section.
(L) <<NOTE: Contracts.>> An agreement to use the
measures and metrics provided by the Department for the
purposes of measuring the effectiveness of the
programming as described in subsection (h)(2).
(M) Such additional application criteria as the
Secretary considers appropriate.
(g) Training and Technical Assistance.--
[[Page 134 STAT. 787]]
(1) <<NOTE: Coordination.>> In general.--The Secretary
shall provide training and technical assistance, in coordination
with the Centers for Disease Control and Prevention, to eligible
entities in receipt of grants under this section regarding--
(A) suicide risk identification and management;
(B) <<NOTE: Data.>> the data required to be
collected and shared with the Department;
(C) <<NOTE: Data.>> the means of data collection
and sharing;
(D) familiarization with and appropriate use of any
tool to be used to measure the effectiveness of the use
of the grants provided; and
(E) the requirements for reporting under subsection
(e)(5) on services provided via such grants.
(2) <<NOTE: Grants. Contracts.>> Provision of training and
technical assistance.--The Secretary may provide the training
and technical assistance described in paragraph (1) directly or
through grants or contracts with appropriate public or nonprofit
entities.
(h) Administration of Grant Program.--
(1) <<NOTE: Consultation.>> Selection criteria.--The
Secretary, in consultation with entities specified in paragraph
(3), shall establish criteria for the selection of eligible
entities that have submitted applications under subsection (f).
(2) <<NOTE: Consultation.>> Development of measures and
metrics.--The Secretary shall develop, in consultation with
entities specified in paragraph (3), the following:
(A) A framework for collecting and sharing
information about entities in receipt of grants under
this section for purposes of improving the services
available for eligible individuals and their families,
set forth by service type, locality, and eligibility
criteria.
(B) The measures and metrics to be used by each
entity in receipt of grants under this section to
determine the effectiveness of the programming being
provided by such entity in improving mental health
status, wellbeing, and reducing suicide risk and
completed suicides of eligible individuals and their
families, which shall include an existing measurement
tool or protocol for the grant recipient to utilize when
determining programmatic effectiveness.
(3) <<NOTE: Consultation.>> Coordination.--In developing a
plan for the design and implementation of the provision of
grants under this section, including criteria for the award of
grants, the Secretary shall consult with the following:
(A) Veterans service organizations.
(B) National organizations representing potential
community partners of eligible entities in providing
supportive services to address the needs of eligible
individuals and their families, including national
organizations that--
(i) advocate for the needs of individuals with
or at risk of behavioral health conditions;
(ii) represent mayors;
(iii) represent unions;
(iv) represent first responders;
(v) represent chiefs of police and sheriffs;
(vi) represent governors;
(vii) represent a territory of the United
States; or
[[Page 134 STAT. 788]]
(viii) represent a Tribal alliance.
(C) National organizations representing members of
the Armed Forces.
(D) National organizations that represent counties.
(E) Organizations with which the Department has a
current memorandum of agreement or understanding related
to mental health or suicide prevention.
(F) State departments of veterans affairs.
(G) National organizations representing members of
the reserve components of the Armed Forces.
(H) National organizations representing members of
the Coast Guard.
(I) Organizations, including institutions of higher
education, with experience in creating measurement tools
for purposes of advising the Secretary on the most
appropriate existing measurement tool or protocol for
the Department to utilize.
(J) The National Alliance on Mental Illness.
(K) A labor organization (as such term is defined in
section 7103(a)(4) of title 5, United States Code).
(L) The Centers for Disease Control and Prevention,
the Substance Abuse and Mental Health Services
Administration, the President's Roadmap to Empower
Veterans and End a National Tragedy of Suicide Task
Force, and such other organizations as the Secretary
considers appropriate.
(4) Report on grant criteria.--Not later than 30 days before
notifying eligible entities of the availability of funding under
this section, the Secretary shall submit to the appropriate
committees of Congress a report containing--
(A) criteria for the award of a grant under this
section;
(B) the already developed measures and metrics to be
used by the Department to measure the effectiveness of
the use of grants provided under this section as
described in subsection (h)(2); and
(C) a framework for the sharing of information about
entities in receipt of grants under this section.
(i) Information on Potential Eligible Individuals.--
(1) In general.--The Secretary may make available to
recipients of grants under this section certain information
regarding potential eligible individuals who may receive
services for which such grant is provided.
(2) Information included.--The information made available
under paragraph (1) with respect to potential eligible
individuals may include the following:
(A) Confirmation of the status of a potential
eligible individual as a veteran.
(B) Confirmation of whether the potential eligible
individual is enrolled in the patient enrollment system
of the Department under section 1705(a) of title 38,
United States Code.
(C) Confirmation of whether a potential eligible
individual is currently receiving care furnished by the
Department or has recently received such care.
(3) Opt-out.--The Secretary shall allow an eligible
individual to opt out of having their information shared under
this subsection with recipients of grants under this section.
[[Page 134 STAT. 789]]
(j) Duration.--The authority of the Secretary to provide grants
under this section shall terminate on the date that is three years after
the date on which the first grant is awarded under this section.
(k) Reporting.--
(1) Interim report.--
(A) In general.--Not later than 18 months after the
date on which the first grant is awarded under this
section, the Secretary shall submit to the appropriate
committees of Congress a report on the provision of
grants to eligible entities under this section.
(B) Elements.--The report submitted under
subparagraph (A) shall include the following:
(i) <<NOTE: Assessment.>> An assessment of
the effectiveness of the grant program under this
section, including--
(I) the effectiveness of grant
recipients and their community partners,
if any, in conducting outreach to
eligible individuals;
(II) the effectiveness of increasing
eligible individuals engagement in
suicide prevention services; and
(III) such other validated
instruments and additional measures as
determined by the Secretary and as
described in subsection (h)(2).
(ii) <<NOTE: List.>> A list of grant
recipients and their partner organizations, if
any, that delivered services funded by the grant
and the amount of such grant received by each
recipient and partner organization.
(iii) The number of eligible individuals
supported by each grant recipient, including
through services provided to family members,
disaggregated by--
(I) <<NOTE: Determination. Coordination.>>
all demographic characteristics as
determined necessary and appropriate by
the Secretary in coordination with the
Centers for Disease Control and
Prevention;
(II) whether each such eligible
individual is enrolled in the patient
enrollment system of the Department
under section 1705(a) of title 38,
United States Code;
(III) branch of service in the Armed
Forces;
(IV) era of service in the Armed
Forces;
(V) type of service received by the
eligible individual; and
(VI) whether each such eligible
individual was referred to the
Department for care.
(iv) The number of eligible individuals
supported by grants under this section, including
through services provided to family members.
(v) The number of eligible individuals
described in clause (iv) who were not previously
receiving care furnished by the Department, with
specific numbers for the population of eligible
individuals described in subsection (q)(4)(B).
(vi) The number of eligible individuals whose
mental health status, wellbeing, and suicide risk
received a baseline measurement assessment under
this section and the number of such eligible
individuals
[[Page 134 STAT. 790]]
whose mental health status, wellbeing, and suicide
risk will be measured by the Department or a
community partner over a period of time for any
improvements.
(vii) <<NOTE: Data.>> The types of data the
Department was able to collect and share with
partners, including a characterization of the
benefits of that data.
(viii) The number and percentage of eligible
individuals referred to the point of contact at
the Department under subsection (e)(3)(C).
(ix) The number of eligible individuals newly
enrolled in the patient enrollment system of the
Department under section 1705(a) of title 38,
United States Code based on a referral to the
Department from a grant recipient under subsection
(e)(3)(C), disaggregated by grant recipient.
(x) A detailed account of how the grant funds
were used, including executive compensation,
overhead costs, and other indirect costs.
(xi) A description of any outreach activities
conducted by the eligible entity in receipt of a
grant with respect to services provided using the
grant.
(xii) The number of individuals who seek
services from the grant recipient who are not
eligible individuals.
(C) <<NOTE: Determination.>> Submittal of
information by grant recipients.--The Secretary may
require eligible entities receiving grants under this
section to provide to Congress such information as the
Secretary determines necessary regarding the elements
described in subparagraph (B).
(2) Final report.--Not later than three years after the date
on which the first grant is awarded under this section, and
annually thereafter for each year in which the program is in
effect, the Secretary shall submit to the appropriate committees
of Congress--
(A) a follow-up on the interim report submitted
under paragraph (1) containing the elements set forth in
subparagraph (B) of such paragraph; and
(B) a report on--
(i) the effectiveness of the provision of
grants under this section, including the
effectiveness of community partners in conducting
outreach to eligible individuals and their
families and reducing the rate of suicide among
eligible individuals;
(ii) <<NOTE: Assessment.>> an assessment of
the increased capacity of the Department to
provide services to eligible individuals and their
families, set forth by State, as a result of the
provision of grants under this section;
(iii) the feasibility and advisability of
extending or expanding the provision of grants
consistent with this section; and
(iv) such other elements as considered
appropriate by the Secretary.
(l) Third-party Assessment.--
(1) Study of grant program.--
(A) <<NOTE: Deadline. Contracts.>> In general.--Not
later than 180 days after the commencement of the grant
program under this section,
[[Page 134 STAT. 791]]
the Secretary shall seek to enter into a contract with
an appropriate entity described in paragraph (3) to
conduct a study of the grant program.
(B) Elements of study.--In conducting the study
under subparagraph (A), the appropriate entity shall--
(i) <<NOTE: Evaluation.>> evaluate the
effectiveness of the grant program under this
section in--
(I) addressing the factors that
contribute to suicides;
(II) increasing the use of suicide
prevention services;
(III) reducing mood-related symptoms
that increase suicide and suicide risk;
and
(IV) where such information is
available due to the time frame of the
grant program, reducing suicidal
ideation, suicide attempts, self-harm,
and deaths by suicide; and
(V) reducing suicidal ideation,
suicide attempts, self-harm, and deaths
by suicide among eligible individuals
through eligible entities located in
communities; and
(ii) compare the results of the grant program
with other national programs in delivering
resources to eligible individuals in the
communities where they live that address the
factors that contribute to suicide.
(2) Assessment.--
(A) <<NOTE: Deadline.>> In general.--The contract
under paragraph (1) shall provide that not later than 24
months after the commencement of the grant program under
this section, the appropriate entity shall submit to the
Secretary an assessment based on the study conducted
pursuant to such contract.
(B) <<NOTE: Records.>> Submittal to congress.--Upon
receipt of the assessment under subparagraph (A), the
Secretary shall transmit to the appropriate committees
of Congress a copy of the assessment.
(3) Appropriate entity.--An appropriate entity described in
this paragraph is a nongovernment entity with experience
optimizing and assessing organizations that deliver services and
assessing the effectiveness of suicide prevention programs.
(m) <<NOTE: Determinations.>> Referral for Care.--
(1) Mental health assessment.--If an eligible entity in
receipt of a grant under this section determines that an
eligible individual is at-risk of suicide or other mental or
behavioral health condition pursuant to a baseline mental health
screening conducted under subsection (q)(11)(A)(ii) with respect
to the individual, the entity shall refer the eligible
individual to the Department for additional care under
subsection (n) or any other provision of law.
(2) Emergency treatment.--If an eligible entity in receipt
of a grant under this section determines that an eligible
individual furnished clinical services for emergency treatment
under subsection (q)(11)(A)(iv) requires ongoing services, the
entity shall refer the eligible individual to the Department for
additional care under subsection (n) or any other provision of
law.
[[Page 134 STAT. 792]]
(3) Refusal.--If an eligible individual refuses a referral
by an entity under paragraph (1) or (2), any ongoing clinical
services provided to the eligible individual by the entity shall
be at the expense of the entity.
(n) <<NOTE: Determination. Assessment.>> Provision of Care to
Eligible Individuals.--When the Secretary determines it is clinically
appropriate, the Secretary shall furnish to eligible individuals who are
receiving or have received suicide prevention services through grants
provided under this section an initial mental health assessment and
mental health or behavioral health care services authorized under
chapter 17 of title 38, United States Code, that are required to treat
the mental or behavioral health care needs of the eligible individual,
including risk of suicide.
(o) <<NOTE: Contracts.>> Agreements With Community Partners.--
(1) In general.--Subject to paragraph (2), an eligible
entity may use grant funds to enter into an agreement with a
community partner under which the eligible entity may provide
funds to the community partner for the provision of suicide
prevention services to eligible individuals and their families.
(2) Limitation.--The ability of a recipient of a grant under
this section to provide grant funds to a community partner shall
be limited to grant recipients that are a State or local
government or an Indian tribe.
(p) <<NOTE: Time period.>> Authorization of Appropriations.--There
is authorized to be appropriated to the Secretary to carry out this
section a total of $174,000,000 for fiscal years 2021 through 2025.
(q) Definitions.--In this section:
(1) Appropriate committees of congress.--The term
``appropriate committees of Congress'' means--
(A) the Committee on Veterans' Affairs and the
Subcommittee on Military Construction, Veterans Affairs,
and Related Agencies of the Committee on Appropriations
of the Senate; and
(B) the Committee on Veterans' Affairs and the
Subcommittee on Military Construction, Veterans Affairs,
and Related Agencies of the Committee on Appropriations
of the House of Representatives.
(2) Department.--The term ``Department'' means the
Department of Veterans Affairs.
(3) Eligible entity.--The term ``eligible entity'' means--
(A) an incorporated private institution or
foundation--
(i) no part of the net earnings of which
incurs to the benefit of any member, founder,
contributor, or individual; and
(ii) that has a governing board that would be
responsible for the operation of the suicide
prevention services provided under this section;
(B) a corporation wholly owned and controlled by an
organization meeting the requirements of clauses (i) and
(ii) of subparagraph (A);
(C) an Indian tribe;
(D) a community-based organization that can
effectively network with local civic organizations,
regional health systems, and other settings where
eligible individuals and their families are likely to
have contact; or
(E) A State or local government.
[[Page 134 STAT. 793]]
(4) Eligible individual.--The term ``eligible individual''
includes a person at risk of suicide who is--
(A) a veteran as defined in section 101 of title 38,
United States Code;
(B) an individual described in section 1720I(b) of
such title; or
(C) an individual described in any of clauses (i)
through (iv) of section 1712A(a)(1)(C) of such title.
(5) Emergency treatment.--Medical services, professional
services, ambulance services, ancillary care and medication
(including a short course of medication related to and necessary
for the treatment of the emergency condition that is provided
directly to or prescribed for the patient for use after the
emergency condition is stabilized and the patient is discharged)
was rendered in a medical emergency of such nature that a
prudent layperson would have reasonably expected that delay in
seeking immediate medical attention would have been hazardous to
life or health. This standard is met by an emergency medical
condition manifesting itself by acute symptoms of sufficient
severity (including severe pain) that a prudent layperson who
possesses an average knowledge of health and medicine could
reasonably expect the absence of immediate medical attention to
result in placing the health of the individual in serious
jeopardy, serious impairment to bodily functions, or serious
dysfunction of any bodily organ or part.
(6) Family.--The term ``family'' means, with respect to an
eligible individual, any of the following:
(A) A parent.
(B) A spouse.
(C) A child.
(D) A sibling.
(E) A step-family member.
(F) An extended family member.
(G) Any other individual who lives with the eligible
individual.
(7) Indian tribe.--The term ``Indian tribe'' has the meaning
given that term in section 4 of the Native American Housing
Assistance and Self-Determination Act of 1996 (25 U.S.C. 4103).
(8) Risk of suicide.--
(A) In general.--The term ``risk of suicide'' means
exposure to, or the existence of, any of the following
(to a degree determined by the Secretary pursuant to
regulations):
(i) Health risk factors, including the
following:
(I) Mental health challenges.
(II) Substance abuse.
(III) Serious or chronic health
conditions or pain.
(IV) Traumatic brain injury.
(ii) Environmental risk factors, including the
following:
(I) Prolonged stress.
(II) Stressful life events.
(III) Unemployment.
(IV) Homelessness.
(V) Recent loss.
(VI) Legal or financial challenges.
[[Page 134 STAT. 794]]
(iii) Historical risk factors, including the
following:
(I) Previous suicide attempts.
(II) Family history of suicide.
(III) History of abuse, neglect, or
trauma.
(B) <<NOTE: Regulations. Determination.>> Degree of
risk.--The Secretary may, by regulation, establish a
process for determining degrees of risk of suicide for
use by grant recipients to focus the delivery of
services using grant funds.
(9) Rural.--The term ``rural'', with respect to a community,
has the meaning given that term in the Rural-Urban Commuting
Areas coding system of the Department of Agriculture.
(10) Secretary.--The term ``Secretary'' means the Secretary
of Veterans Affairs.
(11) Suicide prevention services.--
(A) In general.--The term ``suicide prevention
services'' means services to address the needs of
eligible individuals and their families and includes the
following:
(i) Outreach to identify those at risk of
suicide with an emphasis on eligible individuals
who are at highest risk or who are not receiving
health care or other services furnished by the
Department.
(ii) A baseline mental health screening for
risk.
(iii) Education on suicide risk and prevention
to families and communities.
(iv) Provision of clinical services for
emergency treatment.
(v) Case management services.
(vi) Peer support services.
(vii) Assistance in obtaining any benefits
from the Department that the eligible individual
and their family may be eligible to receive,
including--
(I) vocational and rehabilitation
counseling;
(II) supportive services for
homeless veterans;
(III) employment and training
services;
(IV) educational assistance; and
(V) health care services.
(viii) <<NOTE: Coordination.>> Assistance in
obtaining and coordinating the provision of other
benefits provided by the Federal Government, a
State or local government, or an eligible entity.
(ix) Assistance with emergent needs relating
to--
(I) health care services;
(II) daily living services;
(III) personal financial planning
and counseling;
(IV) transportation services;
(V) temporary income support
services;
(VI) fiduciary and representative
payee services;
(VII) legal services to assist the
eligible individual with issues that may
contribute to the risk of suicide; and
(VIII) child care (not to exceed
$5,000 per family of an eligible
individual per fiscal year).
(x) <<NOTE: Determination. Consultation.>>
Nontraditional and innovative approaches and
treatment practices, as determined appropriate by
the Secretary, in consultation with appropriate
entities.
[[Page 134 STAT. 795]]
(xi) Such other services necessary for
improving the mental health status and wellbeing
and reducing the suicide risk of eligible
individuals and their families as the Secretary
considers appropriate, which may include--
(I) adaptive sports, equine assisted
therapy, or in-place or outdoor
recreational therapy;
(II) substance use reduction
programming;
(III) individual, group, or family
counseling; and
(IV) relationship coaching.
(B) Exclusion.--The term ``suicide prevention
services'' does not include direct cash assistance to
eligible individuals or their families.
(12) Veterans crisis line.--The term ``Veterans Crisis
Line'' means the toll-free hotline for veterans established
under section 1720F(h) of title 38, United States Code.
(13) Veterans service organization.--The term ``veterans
service organization'' means any organization recognized by the
Secretary for the representation of veterans under section 5902
of title 38, United States Code.
SEC. 202. ANALYSIS ON FEASIBILITY AND ADVISABILITY OF THE
DEPARTMENT OF VETERANS AFFAIRS PROVIDING
CERTAIN COMPLEMENTARY AND INTEGRATIVE
HEALTH SERVICES.
(a) <<NOTE: Deadline.>> In General.--Not later than 180 days after
the date of the enactment of this Act, the Secretary of Veterans Affairs
shall complete an analysis on the feasibility and advisability of
providing complementary and integrative health treatments described in
subsection (c) at all medical facilities of the Department of Veterans
Affairs.
(b) Inclusion of Assessment of Report.--The analysis conducted under
subsection (a) shall include an assessment of the final report of the
Creating Options for Veterans' Expedited Recovery Commission (commonly
referred to as the ``COVER Commission'') established under section 931
of the Jason Simcakoski Memorial and Promise Act (title IX of Public Law
114-198; 38 U.S.C. 1701 note) submitted under subsection (e)(2) of such
section.
(c) Treatments Described.--Complementary and integrative health
treatments described in this subsection shall consist of the following:
(1) Yoga.
(2) Meditation.
(3) Acupuncture.
(4) Chiropractic care.
(5) <<NOTE: Determination.>> Other treatments that show
sufficient evidence of efficacy at treating mental or physical
health conditions, as determined by the Secretary.
(d) Report.--The Secretary shall submit to the Committee on
Veterans' Affairs of the Senate and the Committee on Veterans' Affairs
of the House of Representatives a report on the analysis completed under
subsection (a), including--
(1) the results of such analysis; and
(2) <<NOTE: Recommenda- tions.>> such recommendations
regarding the furnishing of complementary and integrative health
treatments described in subsection (c) as the Secretary
considers appropriate.
[[Page 134 STAT. 796]]
SEC. 203. <<NOTE: 38 USC 1712A note.>> PILOT PROGRAM TO PROVIDE
VETERANS ACCESS TO COMPLEMENTARY AND
INTEGRATIVE HEALTH PROGRAMS THROUGH ANIMAL
THERAPY, AGRITHERAPY, SPORTS AND
RECREATION THERAPY, ART THERAPY, AND
POSTTRAUMATIC GROWTH PROGRAMS.
(a) <<NOTE: Deadline. Determination.>> In General.--Not later than
180 days after the date on which the Creating Options for Veterans'
Expedited Recovery Commission (commonly referred to as the ``COVER
Commission'') established under section 931 of the Jason Simcakoski
Memorial and Promise Act (title IX of Public Law 114-198; 38 U.S.C. 1701
note) submits its final report under subsection (e)(2) of such section,
the Secretary of Veterans Affairs shall commence the conduct of a pilot
program to provide complementary and integrative health programs
described in subsection (b) to eligible veterans from the Department of
Veterans Affairs or through the use of non-Department entities for the
treatment of post-traumatic stress disorder, depression, anxiety, or
other conditions as determined by the Secretary.
(b) Programs Described.--Complementary and integrative health
programs described in this subsection may, taking into consideration the
report described in subsection (a), consist of the following:
(1) Equine therapy.
(2) Other animal therapy.
(3) Agritherapy.
(4) Sports and recreation therapy.
(5) Art therapy.
(6) Posttraumatic growth programs.
(c) Eligible Veterans.--A veteran is eligible to participate in the
pilot program under this section if the veteran--
(1) is enrolled in the system of patient enrollment of the
Department under section 1705(a) of title 38, United States
Code; and
(2) <<NOTE: Time period.>> has received health care under
the laws administered by the Secretary during the two-year
period preceding the initial participation of the veteran in the
pilot program.
(d) Duration.--
(1) In general.--The Secretary shall carry out the pilot
program under this section for a three-year period beginning on
the commencement of the pilot program.
(2) Extension.--The Secretary may extend the duration of the
pilot program under this section if the Secretary, based on the
results of the interim report submitted under subsection (f)(1),
determines that it is appropriate to do so.
(e) Locations.--
(1) In general.--The Secretary shall select not fewer than
five facilities of the Department at which to carry out the
pilot program under this section.
(2) Selection criteria.--In selecting facilities under
paragraph (1), the Secretary shall ensure that--
(A) the locations are in geographically diverse
areas; and
(B) not fewer than three facilities serve veterans
in rural or highly rural areas (as determined through
the use of the Rural-Urban Commuting Areas coding system
of the Department of Agriculture).
(f) Reports.--
[[Page 134 STAT. 797]]
(1) Interim report.--
(A) In general.--Not later than one year after the
commencement of the pilot program under this section,
the Secretary shall submit to the Committee on Veterans'
Affairs of the Senate and the Committee on Veterans'
Affairs of the House of Representatives a report on the
progress of the pilot program.
(B) Elements.--The report required by subparagraph
(A) shall include the following:
(i) The number of participants in the pilot
program.
(ii) The type or types of therapy offered at
each facility at which the pilot program is being
carried out.
(iii) <<NOTE: Assessment.>> An assessment of
whether participation by a veteran in the pilot
program resulted in any changes in clinically
relevant endpoints for the veteran with respect to
the conditions specified in subsection (a).
(iv) <<NOTE: Assessment.>> An assessment of
the quality of life of veterans participating in
the pilot program, including the results of a
satisfaction survey of the participants in the
pilot program, disaggregated by program under
subsection (b).
(v) <<NOTE: Determination.>> The
determination of the Secretary with respect to
extending the pilot program under subsection
(d)(2).
(vi) <<NOTE: Recommenda- tions.>> Any
recommendations of the Secretary with respect to
expanding the pilot program.
(2) Final report.--Not later than 90 days after the
termination of the pilot program under this section, the
Secretary shall submit to the Committee on Veterans' Affairs of
the Senate and the Committee on Veterans' Affairs of the House
of Representatives a final report on the pilot program.
SEC. 204. DEPARTMENT OF VETERANS AFFAIRS STUDY OF ALL-CAUSE
MORTALITY OF VETERANS, INCLUDING BY
SUICIDE, AND REVIEW OF STAFFING LEVELS OF
MENTAL HEALTH PROFESSIONALS.
(a) Study of Deaths of Veterans by Suicide.--
(1) <<NOTE: Contracts. Coordination. Evaluation.>> In
general.--The Secretary of Veterans Affairs shall seek to enter
into an agreement with the National Academies of Sciences,
Engineering, and Medicine under which the Secretary shall
collaborate and coordinate with the National Academies on a
revised study design to fulfill the goals of the 2019 study
design of the National Academies described in the explanatory
statement accompanying the Further Consolidated Appropriations
Act, 2020 (Public Law 116-94), as part of current and additional
research priorities of the Department of Veterans Affairs, to
evaluate the effects of opioids and benzodiazepine on all-cause
mortality of veterans, including suicide, regardless of whether
information relating to such deaths has been reported by the
Centers for Disease Control and Prevention.
(2) Goals.--In carrying out the collaboration and
coordination under paragraph (1), the Secretary shall seek as
much as possible to achieve the same advancement of useful
knowledge as the 2019 study design described in such paragraph.
(b) Review of Staffing Levels for Mental Health Professionals.--
[[Page 134 STAT. 798]]
(1) <<NOTE: Deadline.>> In general.--Not later than 90 days
after the date of the enactment of this Act, the Comptroller
General of the United States shall conduct a review of the
staffing levels for mental health professionals of the
Department.
(2) Elements.--The review required by paragraph (1) shall
include a description of the efforts of the Department to
maintain appropriate staffing levels for mental health
professionals, such as mental health counselors, marriage and
family therapists, and other appropriate counselors, including
the following:
(A) A description of any impediments to carry out
the education, training, and hiring of mental health
counselors and marriage and family therapists under
section 7302(a) of title 38, United States Code, and
strategies for addressing those impediments.
(B) A description of the objectives, goals, and
timing of the Department with respect to increasing the
representation of such counselors and therapists in the
behavioral health workforce of the Department,
including--
(i) a review of qualification criteria for
such counselors and therapists and a comparison of
such criteria to that of other behavioral health
professions in the Department; and
(ii) <<NOTE: Assessment.>> an assessment of
the participation of such counselors and
therapists in the mental health professionals
trainee program of the Department and any
impediments to such participation.
(C) <<NOTE: Assessment.>> An assessment of the
development by the Department of hiring guidelines for
mental health counselors, marriage and family
therapists, and other appropriate counselors.
(D) A description of how the Department--
(i) identifies gaps in the supply of mental
health professionals; and
(ii) determines successful staffing ratios for
mental health professionals of the Department.
(E) <<NOTE: Consultation. Timeline.>> A description
of actions taken by the Secretary, in consultation with
the Director of the Office of Personnel Management, to
create an occupational series for mental health
counselors and marriage and family therapists of the
Department and a timeline for the creation of such an
occupational series.
(F) A description of actions taken by the Secretary
to ensure that the national, regional, and local
professional standards boards for mental health
counselors and marriage and family therapists are
comprised of only mental health counselors and marriage
and family therapists and that the liaison from the
Department to such boards is a mental health counselor
or marriage and family therapist.
(c) Compilation of Data.--The Secretary of Veterans Affairs shall
ensure that data under subsections (a) and (b) is compiled separately
and disaggregated by year and compiled in a manner that allows it to be
analyzed across all data fields for purposes of informing and updating
clinical practice guidelines of the Department of Veterans Affairs.
[[Page 134 STAT. 799]]
(d) <<NOTE: Deadlines.>> Briefings.--The Secretary of Veterans
Affairs shall brief the Committee on Veterans' Affairs of the Senate and
the Committee on Veterans' Affairs of the House of Representatives
containing the interim results--
(1) with respect to the study under subsection (a)(1), not
later than 24 months after entering into the agreement under
such subsection; and
(2) with respect to the review under subsection (b)(1), not
later than 18 months after the date of the enactment of this
Act.
(e) <<NOTE: Public information. Coordination.>> Reports.--
(1) Report on study.--Not later than 90 days after the
completion by the Secretary of Veterans Affairs in coordination
with the National Academies of Sciences, Engineering, and
Medicine of the study required under subsection (a)(1), the
Secretary shall--
(A) submit to the Committee on Veterans' Affairs of
the Senate and the Committee on Veterans' Affairs of the
House of Representatives a report on the results of the
study; and
(B) make such report publicly available.
(2) Report on review.--Not later than 90 days after the
completion by the Comptroller General of the United States of
the review required under subsection (b)(1), the Comptroller
General shall--
(A) submit to the Committee on Veterans' Affairs of
the Senate and the Committee on Veterans' Affairs of the
House of Representatives a report on the results of the
review; and
(B) make such report publicly available.
SEC. 205. COMPTROLLER GENERAL REPORT ON MANAGEMENT BY DEPARTMENT
OF VETERANS AFFAIRS OF VETERANS AT HIGH
RISK FOR SUICIDE.
(a) In General.--Not later than 18 months after the date of the
enactment of this Act, the Comptroller General of the United States
shall submit to the Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of Representatives a report
on the efforts of the Department of Veterans Affairs to manage veterans
at high risk for suicide.
(b) <<NOTE: Assessments. Determination. Coordination.>> Elements.--
The report required by subsection (a) shall include the following:
(1) A description of how the Department identifies patients
as high risk for suicide, with particular consideration to the
efficacy of inputs into the Recovery Engagement and Coordination
for Health - Veterans Enhanced Treatment program (commonly
referred to as the ``REACH VET'' program) of the Department,
including an assessment of the efficacy of such identifications
disaggregated by--
(A) all demographic characteristics as determined
necessary and appropriate by the Secretary of Veterans
Affairs in coordination with the Centers for Disease
Control and Prevention;
(B) Veterans Integrated Service Network; and
(C) to the extent practicable, medical center of the
Department.
[[Page 134 STAT. 800]]
(2) A description of how the Department intervenes when a
patient is identified as high risk, including an assessment of
the efficacy of such interventions disaggregated by--
(A) all demographic characteristics as determined
necessary and appropriate by the Secretary in
coordination with the Centers for Disease Control and
Prevention;
(B) Veterans Integrated Service Network; and
(C) to the extent practicable, medical center of the
Department.
(3) A description of how the Department monitors patients
who have been identified as high risk, including an assessment
of the efficacy of such monitoring and any follow-ups
disaggregated by--
(A) all demographic characteristics as determined
necessary and appropriate by the Secretary in
coordination with the Centers for Disease Control and
Prevention;
(B) Veterans Integrated Service Network; and
(C) to the extent practicable, medical center of the
Department.
(4) <<NOTE: Review.>> A review of staffing levels of
suicide prevention coordinators across the Veterans Health
Administration.
(5) <<NOTE: Review.>> A review of the resources and
programming offered to family members and friends of veterans
who have a mental health condition in order to assist that
veteran in treatment and recovery.
(6) An assessment of such other areas as the Comptroller
General considers appropriate to study.
TITLE III--PROGRAMS, STUDIES, AND GUIDELINES ON MENTAL HEALTH
SEC. 301. <<NOTE: Deadlines.>> STUDY ON CONNECTION BETWEEN LIVING
AT HIGH ALTITUDE AND SUICIDE RISK FACTORS
AMONG VETERANS.
(a) <<NOTE: Consultation.>> In General.--Not later than 180 days
after the date of the enactment of this Act, the Secretary of Veterans
Affairs, in consultation with Rural Health Resource Centers of the
Office of Rural Health of the Department of Veterans Affairs, shall
commence the conduct of a study on the connection between living at high
altitude and the risk of developing depression or dying by suicide among
veterans.
(b) Completion of Study.--The study conducted under subsection (a)
shall be completed not later than three years after the date of the
commencement of the study.
(c) Individual Impact.--The study conducted under subsection (a)
shall be conducted so as to determine the effect of high altitude on
suicide risk at the individual level, not at the State or county level.
(d) Report.--Not later than 150 days after the completion of the
study conducted under subsection (a), the Secretary shall submit to the
Committee on Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives a report on the
results of the study.
(e) Follow-up Study.--
(1) <<NOTE: Determination.>> In general.--If the Secretary
determines through the study conducted under subsection (a) that
living at high altitude is a risk factor for developing
depression or dying by suicide,
[[Page 134 STAT. 801]]
the Secretary shall conduct an additional study to identify the
following:
(A) The most likely biological mechanism that makes
living at high altitude a risk factor for developing
depression or dying by suicide.
(B) The most effective treatment or intervention for
reducing the risk of developing depression or dying by
suicide associated with living at high altitude.
(2) Report.--Not later than 150 days after completing the
study conducted under paragraph (1), the Secretary shall submit
to the Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of Representatives a
report on the results of the study.
SEC. 302. <<NOTE: 38 USC 1712A note.>> ESTABLISHMENT BY
DEPARTMENT OF VETERANS AFFAIRS AND
DEPARTMENT OF DEFENSE OF A CLINICAL
PROVIDER TREATMENT TOOLKIT AND
ACCOMPANYING TRAINING MATERIALS FOR
COMORBIDITIES.
(a) <<NOTE: Deadline. Consultation.>> In General.--Not later than
two years after the date of the enactment of this Act, the Secretary of
Veterans Affairs, in consultation with the Secretary of Defense, shall
develop a clinical provider treatment toolkit and accompanying training
materials for the evidence-based management of comorbid mental health
conditions, comorbid mental health and substance use disorders, and a
comorbid mental health condition and chronic pain.
(b) Matters Included.--In developing the clinical provider treatment
toolkit and accompanying training materials under subsection (a), the
Secretary of Veterans Affairs and the Secretary of Defense shall ensure
that the toolkit and training materials include guidance with respect to
the following:
(1) The treatment of patients with post-traumatic stress
disorder who are also experiencing an additional mental health
condition, a substance use disorder, or chronic pain.
(2) The treatment of patients experiencing a mental health
condition, including anxiety, depression, or bipolar disorder,
who are also experiencing a substance use disorder or chronic
pain.
(3) The treatment of patients with traumatic brain injury
who are also experiencing--
(A) a mental health condition, including post-
traumatic stress disorder, anxiety, depression, or
bipolar disorder;
(B) a substance use disorder; or
(C) chronic pain.
SEC. 303. <<NOTE: 38 USC 1720F note.>> UPDATE OF CLINICAL
PRACTICE GUIDELINES FOR ASSESSMENT AND
MANAGEMENT OF PATIENTS AT RISK FOR
SUICIDE.
(a) <<NOTE: Publication.>> In General.--In the first publication of
the Department of Veterans Affairs and Department of Defense Clinical
Practice Guideline for Assessment and Management of Patients at Risk for
Suicide published after the date of the enactment of this Act, the
Secretary of Veterans Affairs and the Secretary of Defense, through the
Assessment and Management of Patients at Risk for Suicide Work Group (in
this section referred to as the ``Work Group''), shall ensure the
publication includes the following:
(1) Enhanced guidance with respect to gender-specific--
(A) risk factors for suicide and suicidal ideation;
[[Page 134 STAT. 802]]
(B) treatment efficacy for depression and suicide
prevention;
(C) pharmacotherapy efficacy; and
(D) psychotherapy efficacy.
(2) Guidance with respect to the efficacy of alternative
therapies, other than psychotherapy and pharmacotherapy,
including the following:
(A) Yoga therapy.
(B) Meditation therapy.
(C) Equine therapy.
(D) Other animal therapy.
(E) Training and caring for service dogs.
(F) Agritherapy.
(G) Art therapy.
(H) Outdoor sports therapy.
(I) Music therapy.
(J) Any other alternative therapy that the Work
Group considers appropriate.
(3) Guidance with respect to the findings of the Creating
Options for Veterans' Expedited Recovery Commission (commonly
referred to as the ``COVER Commission'') established under
section 931 of the Jason Simcakoski Memorial and Promise Act
(title IX of Public Law 114-198; 38 U.S.C. 1701 note).
(b) Rule of Construction.--Nothing in this section shall be
construed to prevent the Secretary of Veterans Affairs and the Secretary
of Defense from considering all relevant evidence, as appropriate, in
updating the Department of Veterans Affairs and Department of Defense
Clinical Practice Guideline for Assessment and Management of Patients at
Risk for Suicide, as required under subsection (a), or from ensuring
that the final clinical practice guidelines updated under such
subsection remain applicable to the patient populations of the
Department of Veterans Affairs and the Department of Defense.
SEC. 304. <<NOTE: 38 USC 1712A note.>> ESTABLISHMENT BY
DEPARTMENT OF VETERANS AFFAIRS AND
DEPARTMENT OF DEFENSE OF CLINICAL PRACTICE
GUIDELINES FOR THE TREATMENT OF SERIOUS
MENTAL ILLNESS.
(a) <<NOTE: Deadline. Consultations.>> In General.--Not later than
two years after the date of the enactment of this Act, the Secretary of
Veterans Affairs, in consultation with the Secretary of Defense and the
Secretary of Health and Human Services, shall complete the development
of a clinical practice guideline or guidelines for the treatment of
serious mental illness, to include the following conditions:
(1) Schizophrenia.
(2) Schizoaffective disorder.
(3) Persistent mood disorder, including bipolar disorder I
and II.
(4) Any other mental, behavioral, or emotional disorder
resulting in serious functional impairment that substantially
interferes with major life activities as the Secretary of
Veterans Affairs, in consultation with the Secretary of Defense
and the Secretary of Health and Human Services, considers
appropriate.
(b) Matters Included in Guidelines.--The clinical practice guideline
or guidelines developed under subsection (a) shall include the
following:
[[Page 134 STAT. 803]]
(1) Guidance contained in the 2016 Clinical Practice
Guidelines for the Management of Major Depressive Disorders of
the Department of Veterans Affairs and the Department of
Defense.
(2) Guidance with respect to the treatment of patients with
a condition described in subsection (a).
(3) <<NOTE: List.>> A list of evidence-based therapies for
the treatment of conditions described in subsection (a).
(4) An appropriate guideline for the administration of
pharmacological therapy, psychological or behavioral therapy, or
other therapy for the management of conditions described in
subsection (a).
(c) <<NOTE: Deadline. Consultation.>> Assessment of Existing
Guidelines.--Not later than two years after the date of the enactment of
this Act, the Secretary of Veterans Affairs, in consultation with the
Secretary of Defense and the Secretary of Health and Human Services,
shall complete an assessment of the 2016 Clinical Practice Guidelines
for the Management of Major Depressive Disorders to determine whether an
update to such guidelines is necessary.
(d) Work Group.--
(1) Establishment.--The Secretary of Veterans Affairs, the
Secretary of Defense, and the Secretary of Health and Human
Services shall create a work group to develop the clinical
practice guideline or guidelines under subsection (a) to be
known as the ``Serious Mental Illness Work Group'' (in this
subsection referred to as the ``Work Group'').
(2) Membership.--The Work Group created under paragraph (1)
shall be comprised of individuals that represent Federal
Government entities and non-Federal Government entities with
expertise in the areas covered by the Work Group, including the
following entities:
(A) Academic institutions that specialize in
research for the treatment of conditions described in
subsection (a).
(B) The Health Services Research and Development
Service of the Department of Veterans Affairs.
(C) The Office of the Assistant Secretary for Mental
Health and Substance Use of the Department of Health and
Human Services.
(D) The National Institute of Mental Health.
(E) The Indian Health Service.
(F) Relevant organizations with expertise in
researching, diagnosing, or treating conditions
described in subsection (a).
(3) Relation to other work groups.--The Work Group shall be
created and conducted in the same manner as other work groups
for the development of clinical practice guidelines for the
Department of Veterans Affairs and the Department of Defense.
(e) Rule of Construction.--Nothing in this section shall be
construed to prevent the Secretary of Veterans Affairs and the Secretary
of Defense from considering all relevant evidence, as appropriate, in
creating the clinical practice guideline or guidelines required under
subsection (a) or from ensuring that the final clinical practice
guideline or guidelines developed under such subsection and subsequently
updated, as appropriate, remain applicable to the patient populations of
the Department of Veterans Affairs and the Department of Defense.
[[Page 134 STAT. 804]]
SEC. 305. <<NOTE: 38 USC 1712A note.>> PRECISION MEDICINE
INITIATIVE OF DEPARTMENT OF VETERANS
AFFAIRS TO IDENTIFY AND VALIDATE BRAIN AND
MENTAL HEALTH BIOMARKERS.
(a) <<NOTE: Deadline.>> In General.--Beginning not later than 18
months after the date of the enactment of this Act, the Secretary of
Veterans Affairs shall develop and implement an initiative of the
Department of Veterans Affairs to identify and validate brain and mental
health biomarkers among veterans, with specific consideration for
depression, anxiety, post-traumatic stress disorder, bipolar disorder,
traumatic brain injury, and such other mental health conditions as the
Secretary considers appropriate. Such initiative may be referred to as
the ``Precision Medicine for Veterans Initiative''.
(b) Model of Initiative.--The initiative under subsection (a) shall
be modeled on the All of Us Precision Medicine Initiative administered
by the National Institutes of Health with respect to large-scale
collection of standardized data and open data sharing.
(c) Methods.--The initiative under subsection (a) shall include
brain structure and function measurements, such as functional magnetic
resonance imaging and electroencephalogram, and shall coordinate with
additional biological methods of analysis utilized in the Million
Veterans Program of the Department of Veterans Affairs.
(d) Use of Data.--
(1) Privacy and security.--In carrying out the initiative
under subsection (a), the Secretary shall develop robust data
privacy and security measures, consistent with section 552a of
title 5, United States Code (commonly known as the ``Privacy Act
of 1974''), and regulations promulgated pursuant to the Health
Insurance Portability and Accountability Act of 1996 (parts 160,
162, and 164 of title 45, Code of Federal Regulations, or
successor regulations) to ensure that information of veterans
participating in the initiative is kept private and secure.
(2) Consultation with the national institutes of science and
technology.--The Secretary may consult with the National
Institute of Science and Technology in developing the data
privacy and security measures described in paragraph (1).
(3) Access standards.--The Secretary shall provide access to
information under the initiative consistent with the standards
described in section 552a(d)(1) of title 5, United States Code,
and section 164.524 of title 45, Code of Federal Regulations, or
successor regulations.
(4) Open platform.--
(A) Availability of data.--The Secretary shall make
de-identified data collected under the initiative
available for research purposes to Federal agencies.
(B) Contract.--The Secretary shall contract with
nongovernment entities that comply with requisite data
security measures to make available for research
purposes de-identified data collected under the
initiative.
(C) Assistance.--The Secretary shall provide
assistance to a Federal agency conducting research using
data collected under the initiative at the request of
that agency.
(D) Prohibition on transfer of data.--Federal
agencies may not disclose, transmit, share, sell,
license, or otherwise transfer data collected under the
initiative to any
[[Page 134 STAT. 805]]
nongovernment entity other than as allowed under
subparagraph (B).
(5) Standardization.--
(A) In general.--The Secretary shall ensure that
data collected under the initiative is standardized.
(B) Consultation.--The Secretary shall consult with
the National Institutes of Health and the Food and Drug
Administration to determine the most effective,
efficient, and cost-effective way of standardizing data
collected under the initiative.
(C) <<NOTE: Consultation.>> Manner of
standardization.--In consultation with the National
Institute for Science and Technology, data collected
under the initiative shall be standardized in the manner
in which it is collected, entered into the database,
extracted, and recorded.
(6) Measures of brain function or structure.--Any measures
of brain function or structure collected under the initiative
shall be collected with a device that is approved by the Food
and Drug Administration.
(7) De-identified data defined.--In this subsection, the
term ``de-identified data'' means, with respect to data held by
the Department of Veterans Affairs, that the Department--
(A) alters, anonymizes, or aggregates the data so
that there is a reasonable basis for expecting that the
data could not be linked as a practical matter to a
specific individual;
(B) publicly commits to refrain from attempting to
re-identify the data with a specific individual, and
adopts controls to prevent such identification; and
(C) causes the data to be covered by a contractual
or other legally enforceable prohibition on each entity
to which the Department discloses the data from
attempting to use the data to identify a specific
individual and requires the same of all onward
disclosures.
(e) Inclusion of Initiative in Program.--The Secretary shall
coordinate efforts of the initiative under subsection (a) with the
Million Veterans Program of the Department.
SEC. 306. STATISTICAL ANALYSES AND DATA EVALUATION BY DEPARTMENT
OF VETERANS AFFAIRS.
(a) In General.--Chapter 1 of title 38, United States Code, is
amended by adding at the end the following new section:
``Sec. 119. <<NOTE: 38 USC 119.>> Contracting for statistical
analyses and data evaluation
``(a) <<NOTE: Determination.>> In General.--The Secretary may enter
into a contract or other agreement with an academic institution or other
qualified entity, as determined by the Secretary, to carry out
statistical analyses and data evaluation as required of the Secretary by
law.''.
``(b) Rule of Construction.--Nothing in this section may be
construed to limit the authority of the Secretary to enter into
contracts or other agreements for statistical analyses and data
evaluation under any other provision of law.''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 1 of such title <<NOTE: 38 USC 101 prec.>> is amended by adding
at the end the following new item:
``119. Contracting for statistical analyses and data evaluation.''.
[[Page 134 STAT. 806]]
TITLE IV--OVERSIGHT OF MENTAL HEALTH CARE AND RELATED SERVICES
SEC. 401. STUDY ON EFFECTIVENESS OF SUICIDE PREVENTION AND MENTAL
HEALTH OUTREACH PROGRAMS OF DEPARTMENT OF
VETERANS AFFAIRS.
(a) <<NOTE: Deadline. Contracts.>> In General.--Not later than 180
days after the date of the enactment of this Act, the Secretary of
Veterans Affairs shall enter into an agreement with a non-Federal
Government entity with expertise in conducting and evaluating research-
based studies to conduct a study on the effectiveness of the suicide
prevention and mental health outreach materials prepared by the
Department of Veterans Affairs and the suicide prevention and mental
health outreach campaigns conducted by the Department.
(b) Use of Focus Groups.--
(1) In general.--The Secretary shall convene not fewer than
eight different focus groups to evaluate the effectiveness of
the suicide prevention and mental health materials and campaigns
as required under subsection (a).
(2) Location of focus groups.--Focus groups convened under
paragraph (1) shall be held in geographically diverse areas as
follows:
(A) Not fewer than two in rural or highly rural
areas.
(B) Not fewer than one in each of the four districts
of the Veterans Benefits Administration.
(3) Timing of focus groups.--Focus groups convened under
paragraph (1) shall be held at a variety of dates and times to
ensure an adequate representation of veterans with different
work schedules.
(4) Number of participants.--Each focus group convened under
paragraph (1) shall include not fewer than five and not more
than 12 participants.
(5) Representation.--Each focus group convened under
paragraph (1) shall, to the extent practicable, include veterans
of diverse backgrounds, including--
(A) veterans of all eras, as determined by the
Secretary;
(B) women veterans;
(C) minority veterans;
(D) Native American veterans, as defined in section
3765 of title 38, United States Code;
(E) veterans who identify as lesbian, gay, bisexual,
transgender, or queer (commonly referred to as
``LGBTQ'');
(F) veterans who live in rural or highly rural
areas;
(G) individuals transitioning from active duty in
the Armed Forces to civilian life; and
(H) other high-risk groups of veterans, as
determined by the Secretary.
(c) Report.--
(1) In general.--Not later than 90 days after the last focus
group meeting under subsection (b), the Secretary shall submit
to the Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of Representatives a
report on the findings of the focus groups.
(2) Elements.--The report required by paragraph (1) shall
include the following:
[[Page 134 STAT. 807]]
(A) <<NOTE: Assessment.>> Based on the findings of
the focus groups, an assessment of the effectiveness of
current suicide prevention and mental health materials
and campaigns of the Department in reaching veterans as
a whole as well as specific groups of veterans (for
example, women veterans).
(B) <<NOTE: Recommenda- tions.>> Based on the
findings of the focus groups, recommendations for future
suicide prevention and mental health materials and
campaigns of the Department to target specific groups of
veterans.
(C) <<NOTE: Plan.>> A plan to change the current
suicide prevention and mental health materials and
campaigns of the Department or, if the Secretary decides
not to change the current materials and campaigns, an
explanation of the reason for maintaining the current
materials and campaigns.
(D) A description of any dissenting or opposing
viewpoints raised by participants in the focus group.
(E) Such other issues as the Secretary considers
necessary.
(d) Representative Survey.--
(1) <<NOTE: Deadline.>> In general.--Not later than one
year after the last focus group meeting under subsection (b),
the Secretary shall complete a representative survey of the
veteran population that is informed by the focus group data in
order to collect information about the effectiveness of the
mental health and suicide prevention materials and campaigns
conducted by the Department.
(2) Veterans surveyed.--
(A) In general.--Veterans surveyed under paragraph
(1) shall include veterans described in subsection
(b)(5).
(B) <<NOTE: Time period.>> Disaggregation of
data.--Data of veterans surveyed under paragraph (1)
shall be disaggregated by--
(i) veterans who have received care from the
Department during the two-year period preceding
the survey; and
(ii) veterans who have not received care from
the Department during the two-year period
preceding the survey.
(e) <<NOTE: 38 USC 1720F note.>> Treatment of Contracts for Suicide
Prevention and Mental Health Outreach Media.--
(1) Focus groups.--
(A) <<NOTE: Assessment.>> In general.--The
Secretary shall include in each contract to develop
media relating to suicide prevention and mental health
materials and campaigns a requirement that the
contractor convene focus groups of veterans to assess
the effectiveness of suicide prevention and mental
health outreach.
(B) Representation.--Each focus group required under
subparagraph (A) shall, to the extent practicable,
include veterans of diverse backgrounds, including--
(i) veterans of all eras, as determined by the
Secretary;
(ii) women veterans;
(iii) minority veterans;
(iv) Native American veterans, as defined in
section 3765 of title 38, United States Code;
[[Page 134 STAT. 808]]
(v) veterans who identify as lesbian, gay,
bisexual, transgender, or queer (commonly referred
to as ``LGBTQ'');
(vi) veterans who live in rural or highly
rural areas;
(vii) individuals transitioning from active
duty in the Armed Forces to civilian life; and
(viii) other high-risk groups of veterans, as
determined by the Secretary.
(2) Subcontracting.--
(A) <<NOTE: Requirement.>> In general.--The
Secretary shall include in each contract described in
paragraph (1)(A) a requirement that, if the contractor
subcontracts for the development of media, the
contractor shall subcontract with a subcontractor that
has experience creating impactful media campaigns that
target individuals age 18 to 34.
(B) Budget limitation.--Not more than two percent of
the budget of the Office of Mental Health and Suicide
Prevention of the Department for contractors for suicide
prevention and mental health media outreach shall go to
subcontractors described in subparagraph (A).
(f) Paperwork Reduction Act Exemption.--Chapter 35 of title 44,
United States Code (commonly known as the ``Paperwork Reduction Act'')
shall not apply to any rulemaking or information collection required
under this section.
(g) Rural and Highly Rural Defined.--In this section, with respect
to an area, the terms ``rural'' and ``highly rural'' have the meanings
given those terms in the Rural-Urban Commuting Areas coding system of
the Department of Agriculture.
SEC. 402. <<NOTE: 38 USC 1720F note.>> OVERSIGHT OF MENTAL HEALTH
AND SUICIDE PREVENTION MEDIA OUTREACH
CONDUCTED BY DEPARTMENT OF VETERANS
AFFAIRS.
(a) Establishment of Goals.--
(1) <<NOTE: Action plans.>> In general.--The Secretary of
Veterans Affairs shall establish goals for the mental health and
suicide prevention media outreach campaigns of the Department of
Veterans Affairs, which shall include the establishment of
targets, metrics, and action plans to describe and assess those
campaigns.
(2) Use of metrics.--
(A) In general.--The goals established under
paragraph (1) shall be measured by metrics specific to
different media types.
(B) <<NOTE: Determination.>> Factors to consider.--
In using metrics under subparagraph (A), the Secretary
shall determine the best methodological approach for
each media type and shall consider the following:
(i) Metrics relating to social media, which
may include the following:
(I) Impressions.
(II) Reach.
(III) Engagement rate.
(IV) Such other metrics as the
Secretary considers necessary.
(ii) Metrics relating to television, which may
include the following:
[[Page 134 STAT. 809]]
(I) Nielsen ratings.
(II) Such other metrics as the
Secretary considers necessary.
(iii) Metrics relating to email, which may
include the following:
(I) Open rate.
(II) Response rate.
(III) Click rate.
(IV) Such other metrics as the
Secretary considers necessary.
(C) Update.--The Secretary shall periodically update
the metrics under subparagraph (B) as more accurate
metrics become available.
(3) Targets.--The Secretary shall establish targets to track
the metrics used under paragraph (2).
(4) Consultation.--In establishing goals under paragraph
(1), the Secretary shall consult with the following:
(A) <<NOTE: Determination.>> Relevant stakeholders,
such as organizations that represent veterans, as
determined by the Secretary.
(B) Mental health and suicide prevention experts.
(C) Such other persons as the Secretary considers
appropriate.
(5) Initial report.--Not later than 180 days after the date
of the enactment of this Act, the Secretary shall submit to the
Committee on Veterans' Affairs of the Senate and the Committee
on Veterans' Affairs of the House of Representatives a report
detailing the goals established under paragraph (1) for the
mental health and suicide prevention media outreach campaigns of
the Department, including the metrics and targets for such
metrics by which those goals are to be measured under paragraphs
(2) and (3).
(6) Annual report.--Not later than one year after the
submittal of the report under paragraph (5), and annually
thereafter, the Secretary shall submit to the Committee on
Veterans' Affairs of the Senate and the Committee on Veterans'
Affairs of the House of Representatives a report detailing--
(A) the progress of the Department in meeting the
goals established under paragraph (1) and the targets
established under paragraph (3); and
(B) a description of action to be taken by the
Department to modify mental health and suicide
prevention media outreach campaigns if those goals and
targets are not being met.
(b) Report on Use of Funds by Office of Mental Health and Suicide
Prevention.--Not later than 180 days after the date of the enactment of
this Act, and semiannually thereafter, the Secretary shall submit to the
Committee on Appropriations and the Committee on Veterans' Affairs of
the Senate and the Committee on Appropriations and the Committee on
Veterans' Affairs of the House of Representatives a report containing
the expenditures and obligations of the Office of Mental Health and
Suicide Prevention of the Veterans Health Administration during the
period covered by the report.
[[Page 134 STAT. 810]]
SEC. 403. COMPTROLLER GENERAL MANAGEMENT REVIEW OF MENTAL HEALTH
AND SUICIDE PREVENTION SERVICES OF
DEPARTMENT OF VETERANS AFFAIRS.
(a) <<NOTE: Deadline.>> In General.--Not later than three years
after the date of the enactment of this Act, the Comptroller General of
the United States shall submit to the Committee on Veterans' Affairs of
the Senate and the Committee on Veterans' Affairs of the House of
Representatives a management review of the mental health and suicide
prevention services provided by the Department of Veterans Affairs.
(b) <<NOTE: Assessments.>> Elements.--The management review
required by subsection (a) shall include the following:
(1) An assessment of the infrastructure under the control of
or available to the Office of Mental Health and Suicide
Prevention of the Department of Veterans Affairs or available to
the Department of Veterans Affairs for suicide prevention
efforts not operated by the Office of Mental Health and Suicide
Prevention.
(2) A description of the management and organizational
structure of the Office of Mental Health and Suicide Prevention,
including roles and responsibilities for each position.
(3) A description of the operational policies and processes
of the Office of Mental Health and Suicide Prevention.
(4) An assessment of suicide prevention practices and
initiatives available from the Department and through community
partnerships.
(5) An assessment of the staffing levels at the Office of
Mental Health and Suicide Prevention, disaggregated by type of
position, and including the location of any staffing
deficiencies.
(6) An assessment of the Nurse Advice Line pilot program
conducted by the Department.
(7) An assessment of recruitment initiatives in rural areas
for mental health professionals of the Department.
(8) An assessment of strategic planning conducted by the
Office of Mental Health and Suicide Prevention.
(9) An assessment of the communication, and the
effectiveness of such communication--
(A) within the central office of the Office of
Mental Health and Suicide Prevention;
(B) between that central office and any staff member
or office in the field, including chaplains, attorneys,
law enforcement personnel, and volunteers; and
(C) between that central office, local facilities of
the Department, and community partners of the
Department, including first responders, community
support groups, and health care industry partners.
(10) An assessment of how effectively the Office of Mental
Health and Suicide Prevention implements operational policies
and procedures.
(11) <<NOTE: Recommenda- tions.>> An assessment of how the
Department of Veterans Affairs and the Department of Defense
coordinate suicide prevention efforts, and recommendations on
how the Department of Veterans Affairs and Department of Defense
can more effectively coordinate those efforts.
(12) An assessment of such other areas as the Comptroller
General considers appropriate to study.
[[Page 134 STAT. 811]]
SEC. 404. COMPTROLLER GENERAL REPORT ON EFFORTS OF DEPARTMENT OF
VETERANS AFFAIRS TO INTEGRATE MENTAL
HEALTH CARE INTO PRIMARY CARE CLINICS.
(a) Initial Report.--
(1) In general.--Not later than two years after the date of
the enactment of this Act, the Comptroller General of the United
States shall submit to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives a report on the efforts of the Department of
Veterans Affairs to integrate mental health care into primary
care clinics of the Department.
(2) <<NOTE: Assessments.>> Elements.--The report required
by subsection (a) shall include the following:
(A) An assessment of the efforts of the Department
to integrate mental health care into primary care
clinics of the Department.
(B) An assessment of the effectiveness of such
efforts.
(C) An assessment of how the health care of veterans
is impacted by such integration.
(D) A description of how care is coordinated by the
Department between specialty mental health care and
primary care, including a description of the following:
(i) How documents and patient information are
transferred and the effectiveness of those
transfers.
(ii) How care is coordinated when veterans
must travel to different facilities of the
Department.
(iii) How a veteran is reintegrated into
primary care after receiving in-patient mental
health care.
(E) An assessment of how the integration of mental
health care into primary care clinics is implemented at
different types of facilities of the Department.
(F) <<NOTE: Recommenda- tions.>> Such
recommendations on how the Department can better
integrate mental health care into primary care clinics
as the Comptroller General considers appropriate.
(G) An assessment of such other areas as the
Comptroller General considers appropriate to study.
(b) Community Care Integration Report.--
(1) In general.--Not later than two years after the date on
which the Comptroller General submits the report required under
subsection (a)(1), the Comptroller General shall submit to the
Committee on Veterans' Affairs of the Senate and the Committee
on Veterans' Affairs of the House of Representatives a report on
the efforts of the Department to integrate community-based
mental health care into the Veterans Health Administration.
(2) <<NOTE: Assessments.>> Elements.--The report required
by paragraph (1) shall include the following:
(A) An assessment of the efforts of the Department
to integrate community-based mental health care into the
Veterans Health Administration.
(B) An assessment of the effectiveness of such
efforts.
(C) An assessment of how the health care of veterans
is impacted by such integration.
(D) A description of how care is coordinated between
providers of community-based mental health care and the
Veterans Health Administration, including a description
[[Page 134 STAT. 812]]
of how documents and patient information are transferred
and the effectiveness of those transfers between--
(i) the Veterans Health Administration and
providers of community-based mental health care;
and
(ii) providers of community-based mental
health care and the Veterans Health
Administration.
(E) An assessment of any disparities in the
coordination of community-based mental health care into
the Veterans Health Administration by location and type
of facility.
(F) An assessment of the military cultural
competency of health care providers providing community-
based mental health care to veterans.
(G) <<NOTE: Recommenda- tions.>> Such
recommendations on how the Department can better
integrate community-based mental health care into the
Veterans Health Administration as the Comptroller
General considers appropriate.
(H) An assessment of such other areas as the
Comptroller General considers appropriate to study.
(3) Community-based mental health care defined.--In this
subsection, the term ``community-based mental health care''
means mental health care paid for by the Department but provided
by a non-Department health care provider at a non-Department
facility, including care furnished under section 1703 of title
38, United States Code (as in effect on the date specified in
section 101(b) of the Caring for Our Veterans Act of 2018 (title
I of Public Law 115-182)).
SEC. 405. JOINT MENTAL HEALTH PROGRAMS BY DEPARTMENT OF VETERANS
AFFAIRS AND DEPARTMENT OF DEFENSE.
(a) <<NOTE: 38 USC 8111 note.>> Report on Mental Health Programs.--
(1) In general.--Not later than one year after the date of
the enactment of this Act, and annually thereafter, the
Secretary of Veterans Affairs and the Secretary of Defense shall
submit to the Committee on Veterans' Affairs and the Committee
on Armed Services of the Senate and the Committee on Veterans'
Affairs and the Committee on Armed Services of the House of
Representatives a report on mental health programs of the
Department of Veterans Affairs and the Department of Defense and
joint programs of the Departments.
(2) Elements.--The report required by paragraph (1) shall
include the following:
(A) A description of mental health programs operated
by the Department of Veterans Affairs, including the
following:
(i) Transition assistance programs.
(ii) Clinical and non-clinical mental health
initiatives, including centers of excellence of
the Department of Veterans Affairs for traumatic
brain injury and post-traumatic stress disorder.
(iii) Programs that may secondarily improve
mental health, including employment, housing
assistance, and financial literacy programs.
(iv) Research into mental health issues and
conditions, to include post-traumatic stress
disorder, depression, anxiety, bipolar disorder,
traumatic brain injury, suicidal ideation, and any
other issues or conditions
[[Page 134 STAT. 813]]
as the Secretary of Veterans Affairs considers
necessary.
(B) A description of mental health programs operated
by the Department of Defense, including the following:
(i) Transition assistance programs.
(ii) Clinical and non-clinical mental health
initiatives, including the National Intrepid
Center of Excellence and the Intrepid Spirit
Centers.
(iii) Programs that may secondarily improve
mental health, including employment, housing
assistance, and financial literacy programs.
(iv) Research into mental health issues and
conditions, to include post-traumatic stress
disorder, depression, anxiety, bipolar disorder,
traumatic brain injury, suicidal ideation, and any
other issues or conditions as the Secretary of
Defense considers necessary.
(C) A description of mental health programs jointly
operated by the Department of Veterans Affairs and the
Department of Defense, including the following:
(i) Transition assistance programs.
(ii) Clinical and non-clinical mental health
initiatives.
(iii) Programs that may secondarily improve
mental health, including employment, housing
assistance, and financial literacy programs.
(iv) Research into mental health issues and
conditions, to include post-traumatic stress
disorder, depression, anxiety, bipolar disorder,
traumatic brain injury, suicidal ideation, and
completed suicides, including through the use of
the joint suicide data repository of the
Department of Veterans Affairs and the Department
of Defense, and any other issues or conditions as
the Secretary of Veterans Affairs and the
Secretary of Defense consider necessary.
(D) <<NOTE: Recommenda- tions.>> Recommendations
for coordinating mental health programs of the
Department of Veterans Affairs and the Department of
Defense to improve the effectiveness of those programs.
(E) <<NOTE: Recommenda- tions.>> Recommendations
for novel joint programming of the Department of
Veterans Affairs and the Department of Defense to
improve the mental health of members of the Armed Forces
and veterans.
(b) Evaluation of Collaborative Efforts of Department of Veterans
Affairs and Department of Defense and Alternatives of Analysis to
Establish a Joint VA/DOD Intrepid Spirit Center.--
(1) <<NOTE: Coordination.>> In general.--The Secretary of
Veterans Affairs, in coordination with the Secretary of Defense,
shall evaluate the current ongoing collaborative efforts of the
Department of Veterans Affairs and the Department of Defense
related to post-traumatic stress disorder and traumatic brain
injury care, research, and education to improve the quality of
and access to such care and seek potential new collaborative
efforts to improve and expand such care for veterans and members
of the Armed Forces in a joint Department of Veterans Affairs/
Department of Defense Intrepid Spirit Center that serves active
duty members of the Armed Forces, members of the reserve
[[Page 134 STAT. 814]]
components of the Armed Forces, and veterans for mutual benefit
and growth in treatment and care.
(2) Alternatives of analysis.--
(A) In general.--The evaluation required under
paragraph (1) shall include an alternatives of analysis
to establish the joint Department of Veterans Affairs/
Department of Defense Intrepid Spirit Center described
in paragraph (1).
(B) <<NOTE: Recommenda- tions.>> Elements.--The
alternatives of analysis required under subparagraph (A)
with respect to the establishment of the joint
Department of Veterans Affairs/Department of Defense
Intrepid Spirit Center described in paragraph (1) shall
provide alternatives and recommendations that consider
information including--
(i) colocation of the center on an
installation of the Department of Defense or
property of a medical center of the Department of
Veterans Affairs;
(ii) consideration of a rural or highly rural
area to establish the center that may include
colocation described in clause (i);
(iii) geographic distance from existing or
planned Intrepid Spirit Centers of the Department
of Defense or other such facilities of the
Department of Veterans Affairs or the Department
of Defense that furnish care for post-traumatic
stress disorder or traumatic brain injury; and
(iv) the potential role for private entities
and philanthropic organizations in carrying out
the activities of the center.
(3) Report to congress.--Not later than 270 days after the
date of the enactment of this Act, the Secretary of Veterans
Affairs shall submit to the Committee on Veterans' Affairs of
the Senate and the Committee on Veterans' Affairs of the House
of Representatives a report that includes--
(A) <<NOTE: Summary.>> a summary of the evaluation
required under paragraph (1); and
(B) the alternatives of analysis required under
paragraph (2).
(4) Rural and highly rural defined.--In this subsection,
with respect to an area, the terms ``rural'' and ``highly
rural'' have the meanings given those terms in the Rural-Urban
Commuting Areas coding system of the Department of Agriculture.
TITLE V--IMPROVEMENT OF MENTAL HEALTH MEDICAL WORKFORCE
SEC. 501. STAFFING IMPROVEMENT PLAN FOR MENTAL HEALTH PROVIDERS OF
DEPARTMENT OF VETERANS AFFAIRS.
(a) Staffing Plan.--
(1) <<NOTE: Deadline. Consultation.>> In general.--Not
later than one year after the date of the enactment of this Act,
the Secretary of Veterans Affairs, in consultation with the
Inspector General of the Department of Veterans Affairs, shall
submit to the Committee on Veterans' Affairs of the Senate and
the Committee on Veterans' Affairs of the House of
Representatives a plan to address staffing
[[Page 134 STAT. 815]]
of mental health providers of the Department of Veterans
Affairs, including filling any open positions.
(2) Elements.--The plan required by paragraph (1) shall
include the following:
(A) <<NOTE: Estimate.>> An estimate of the number
of positions for mental health providers of the
Department that need to be filled to meet demand.
(B) An identification of the steps that the
Secretary will take to address mental health staffing
for the Department.
(C) A description of any region-specific hiring
incentives to be used by the Secretary in consultation
with the directors of Veterans Integrated Service
Networks and medical centers of the Department.
(D) A description of any local retention or
engagement incentives to be used by directors of
Veterans Integrated Service Networks.
(E) <<NOTE: Recommenda- tions.>> Such
recommendations for legislative or administrative action
as the Secretary considers necessary to aid in
addressing mental health staffing for the Department.
(3) <<NOTE: Time period.>> Report.--Not later than one year
after the submittal of the plan required by paragraph (1), the
Secretary shall submit to the Committee on Veterans' Affairs of
the Senate and the Committee on Veterans' Affairs of the House
of Representatives a report setting forth the number of mental
health providers hired by the Department during the one-year
period preceding the submittal of the report.
(b) <<NOTE: Deadline. Consultation. 38 USC 7401 note.>>
Occupational Series for Certain Mental Health Providers.--Not later than
one year after the date of the enactment of this Act, the Secretary of
Veterans Affairs, in consultation with the Office of Personnel
Management, shall develop an occupational series for licensed
professional mental health counselors and marriage and family therapists
of the Department of Veterans Affairs.
SEC. 502. ESTABLISHMENT OF DEPARTMENT OF VETERANS AFFAIRS
READJUSTMENT COUNSELING SERVICE
SCHOLARSHIP PROGRAM.
(a) In General.--Chapter 76 of title 38, United States Code, is
amended by inserting after subchapter VIII the following new subchapter:
``SUBCHAPTER <<NOTE: 38 USC 7698 prec.>> IX--READJUSTMENT COUNSELING
SERVICE SCHOLARSHIP PROGRAM
``Sec. 7698. <<NOTE: 38 USC 7698.>> Requirement for program
``As part of the Educational Assistance Program, the Secretary shall
carry out a scholarship program under this subchapter. The program shall
be known as the Department of Veterans Affairs Readjustment Counseling
Service Scholarship Program (in this subchapter referred to as the
`Program').
``Sec. 7699. <<NOTE: Contracts. 38 USC 7699. Determination.>>
Eligibility; agreement
``(a) In General.--An individual is eligible to participate in the
Program, as determined by the Readjustment Counseling Service of the
Department, if the individual--
``(1) is accepted for enrollment or enrolled (as described
in section 7602 of this title) in a program of study at an
[[Page 134 STAT. 816]]
accredited educational institution, school, or training program
leading to a terminal degree in psychology, social work,
marriage and family therapy, or mental health counseling that
would meet the education requirements for appointment to a
position under section 7402(b) of this title; and
``(2) enters into an agreement with the Secretary under
subsection (c).
``(b) Priority.--In selecting individuals to participate in the
Program, the Secretary shall give priority to the following individuals:
``(1) An individual who agrees to be employed by a Vet
Center located in a community that is--
``(A) designated as a medically underserved
population under section 330(b)(3) of the Public Health
Service Act (42 U.S.C. 254b(b)(3)); and
``(B) in a State with a per capita population of
veterans of more than five percent according to the
National Center for Veterans Analysis and Statistics and
the Bureau of the Census.
``(2) An individual who is a veteran.
``(c) Agreement.--An agreement between the Secretary and a
participant in the Program shall (in addition to the requirements set
forth in section 7604 of this title) include the following:
``(1) An agreement by the Secretary to provide the
participant with a scholarship under the Program for a specified
number of school years during which the participant pursues a
program of study described in subsection (a)(1) that meets the
requirements set forth in section 7602(a) of this title.
``(2) <<NOTE: Time period.>> An agreement by the
participant to serve as a full-time employee of the Department
at a Vet Center for a six-year period following the completion
by the participant of such program of study (in this subchapter
referred to as the `period of obligated service').
``(d) Vet Center Defined.--In this section, the term `Vet Center'
has the meaning given that term in section 1712A(h) of this title.
``Sec. 7699A. <<NOTE: 38 USC 7699A.>> Obligated service
``(a) In General.--Each participant in the Program shall provide
service as a full-time employee of the Department at a Vet Center (as
defined in section 7699(d) of this title) for the period of obligated
service set forth in the agreement of the participant entered into under
section 7604 of this title.
``(b) <<NOTE: Deadline. Notification.>> Determination of Service
Commencement Date.--(1) Not later than 60 days before the service
commencement date of a participant, the Secretary shall notify the
participant of that service commencement date.
``(2) The date specified in paragraph (1) with respect to a
participant is the date for the beginning of the period of obligated
service of the participant.
``Sec. 7699B. <<NOTE: Contracts. 38 USC 7699B.>> Breach of
agreement: liability
``(a) Liquidated Damages.--(1) A participant in the Program (other
than a participant described in subsection (b)) who fails to accept
payment, or instructs the educational institution in which the
participant is enrolled not to accept payment, in whole or in part, of a
scholarship under the agreement entered into under
[[Page 134 STAT. 817]]
section 7604 of this title shall be liable to the United States for
liquidated damages in the amount of $1,500.
``(2) Liability under paragraph (1) is in addition to any period of
obligated service or other obligation or liability under such agreement.
``(b) Liability During Program of Study.--(1) Except as provided in
subsection (d), a participant in the Program shall be liable to the
United States for the amount which has been paid to or on behalf of the
participant under the agreement if any of the following occurs:
``(A) <<NOTE: Determination. Regulations.>> The participant
fails to maintain an acceptable level of academic standing in
the educational institution in which the participant is enrolled
(as determined by the educational institution under regulations
prescribed by the Secretary).
``(B) The participant is dismissed from such educational
institution for disciplinary reasons.
``(C) The participant voluntarily terminates the program of
study in such educational institution before the completion of
such program of study.
``(2) Liability under this subsection is in lieu of any service
obligation arising under the agreement.
``(c) <<NOTE: Determinations.>> Liability During Period of
Obligated Service.--(1) Except as provided in subsection (d), if a
participant in the Program does not complete the period of obligated
service of the participant, the United States shall be entitled to
recover from the participant an amount determined in accordance with the
following formula: A = 3F(t-s/t).
``(2) In the formula in paragraph (1):
``(A) `A' is the amount the United States is entitled to
recover.
``(B) `F' is the sum of--
``(i) the amounts paid under this subchapter to or
on behalf of the participant; and
``(ii) the interest on such amounts which would be
payable if at the time the amounts were paid they were
loans bearing interest at the maximum legal prevailing
rate, as determined by the Treasurer of the United
States.
``(C) `t' is the total number of months in the period of
obligated service of the participant.
``(D) `s' is the number of months of such period served by
the participant.
``(d) Limitation on Liability for Reductions-in-force.--Liability
shall not arise under subsection (c) if the participant fails to
maintain employment as a Department employee due to a staffing
adjustment.
``(e) Period for Payment of Damages.--Any amount of damages that the
United States is entitled to recover under this section shall be paid to
the United States within the one-year period beginning on the date of
the breach of the agreement.''.
(b) Conforming and Technical Amendments.--
(1) Conforming amendments.--
(A) Establishment of program.--Section 7601(a) of
such title <<NOTE: 38 USC 7601.>> is amended--
(i) in paragraph (5), by striking ``and'';
(ii) in paragraph (6), by striking the period
and inserting ``; and''; and
[[Page 134 STAT. 818]]
(iii) by adding at the end the following new
paragraph:
``(7) the readjustment counseling service scholarship
program provided for in subchapter IX of this chapter.''.
(B) <<NOTE: 38 USC 7602.>> Eligibility.--Section
7602 of such title is amended--
(i) in subsection (a)(1)--
(I) by striking ``or VI'' and
inserting ``VI, or IX''; and
(II) by striking ``subchapter VI''
and inserting ``subchapter VI or IX'';
and
(ii) in subsection (b), by striking ``or VI''
and inserting ``VI, or IX''.
(C) Application.--Section 7603(a)(1) of such title
is amended by striking ``or VIII'' and inserting ``VIII,
or IX''.
(D) Terms of agreement.--Section 7604 of such title
is amended by striking ``or VIII'' each place it appears
and inserting ``VIII, or IX''.
(E) Annual report.--Section 7632 of such title is
amended--
(i) in paragraph (1), by striking ``and the
Specialty Education Loan Repayment Program'' and
inserting ``the Specialty Education Loan Repayment
Program, and the Readjustment Counseling Service
Scholarship Program''; and
(ii) in paragraph (4), by striking ``and per
participant in the Specialty Education Loan
Repayment Program'' and inserting ``per
participant in the Specialty Education Loan
Repayment Program, and per participant in the
Readjustment Counseling Service Scholarship
Program''.
(2) Table of sections.--The table of sections at the
beginning of chapter 76 of such title <<NOTE: 38 USC 7601
prec.>> is amended by inserting after the items relating to
subchapter VIII the following:
``subchapter ix--readjustment counseling service scholarship program
``Sec.
``7698. Requirement for program.
``7699. Eligibility; agreement.
``7699A. Obligated service.
``7699B. Breach of agreement: liability.''.
(c) <<NOTE: 38 USC 7698 note.>> Effective Date.--The Secretary of
Veterans Affairs shall begin awarding scholarships under subchapter IX
of chapter 76 of title 38, United States Code, as added by subsection
(a), for programs of study beginning not later than one year after the
date of the enactment of this Act.
SEC. 503. COMPTROLLER GENERAL REPORT ON READJUSTMENT COUNSELING
SERVICE OF DEPARTMENT OF VETERANS AFFAIRS.
(a) In General.--Not later than one year after the date of the
enactment of this Act, the Comptroller General of the United States
shall submit to the Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of Representatives a report
on the Readjustment Counseling Service of the Department of Veterans
Affairs.
(b) <<NOTE: Assessments. Recommenda- tions.>> Elements.--The report
required by subsection (a) shall include the following:
[[Page 134 STAT. 819]]
(1) An assessment of the adequacy and types of treatment,
counseling, and other services provided at Vet Centers,
including recommendations on whether and how such treatment,
counseling, and other services can be expanded.
(2) An assessment of the efficacy of outreach efforts by the
Readjustment Counseling Service, including recommendations for
how outreach efforts can be improved.
(3) An assessment of barriers to care at Vet Centers,
including recommendations for overcoming those barriers.
(4) An assessment of the efficacy and frequency of the use
of telehealth by counselors of the Readjustment Counseling
Service to provide mental health services, including
recommendations for how the use of telehealth can be improved.
(5) An assessment of the feasibility and advisability of
expanding eligibility for services from the Readjustment
Counseling Service, including--
(A) recommendations on what eligibility criteria
could be expanded; and
(B) an assessment of potential costs and increased
infrastructure requirements if eligibility is expanded.
(6) An assessment of the use of Vet Centers by members of
the reserve components of the Armed Forces who were never
activated and recommendations on how to better reach those
members.
(7) An assessment of the use of Vet Centers by eligible
family members of former members of the Armed Forces and
recommendations on how to better reach those family members.
(8) An assessment of the efficacy of group therapy and the
level of training of providers at Vet Centers in administering
group therapy.
(9) An assessment of the efficiency and effectiveness of the
task organization structure of Vet Centers.
(10) An assessment of the use of Vet Centers by Native
American veterans, as defined in section 3765 of title 38,
United States Code, and recommendations on how to better reach
those veterans.
(c) Vet Center Defined.--In this section, the term ``Vet Center''
has the meaning given that term in section 1712A(h) of title 38, United
States Code.
SEC. 504. EXPANSION OF REPORTING REQUIREMENTS ON READJUSTMENT
COUNSELING SERVICE OF DEPARTMENT OF
VETERANS AFFAIRS.
(a) Expansion of Annual Report.--Paragraph (2)(C) of section 7309(e)
of title 38, United States Code, <<NOTE: 38 USC 7309.>> is amended by
inserting before the period at the end the following: ``, including the
resources required to meet such unmet need, such as additional staff,
additional locations, additional infrastructure, infrastructure
improvements, and additional mobile Vet Centers''.
(b) Biennial Report.--Such section is amended by adding at the end
the following new paragraph:
``(3) For each even numbered year in which the report required by
paragraph (1) is submitted, the Secretary shall include in such report a
prediction of--
``(A) trends in demand for care;
``(B) long-term investments required with respect to the
provision of care;
[[Page 134 STAT. 820]]
``(C) requirements relating to maintenance of
infrastructure; and
``(D) other capital investment requirements with respect to
the Readjustment Counseling Service, including Vet Centers,
mobile Vet Centers, and community access points.''.
SEC. 505. BRIEFING ON ALTERNATIVE WORK SCHEDULES FOR EMPLOYEES OF
VETERANS HEALTH ADMINISTRATION.
(a) Survey of Veterans.--
(1) <<NOTE: Deadline.>> In general.--Not later than 180
days after the date of the enactment of this Act, the Secretary
of Veterans Affairs shall conduct a survey on the attitudes of
eligible veterans toward the Department of Veterans Affairs
offering appointments outside the usual operating hours of
facilities of the Department, including through the use of
telehealth appointments.
(2) Eligible veteran defined.--In this subsection, the term
``eligible veteran'' means a veteran who--
(A) is enrolled in the patient enrollment system of
the Department under section 1705(a) of title 38, United
States Code; and
(B) <<NOTE: Time period.>> received health care
from the Department at least once during the two-year
period ending on the date of the commencement of the
survey under paragraph (1).
(b) Congressional Briefing.--
(1) <<NOTE: Deadline.>> In general.--Not later than 270
days after the date of the enactment of this Act, the Secretary
shall brief the Committee on Veterans' Affairs of the Senate and
the Committee on Veterans' Affairs of the House of
Representatives on the--
(A) feasibility and advisability of offering
appointments outside the usual operating hours of
facilities of the Department that do not offer such
appointments; and
(B) effectiveness of offering appointments outside
the usual operating hours of facilities of the
Department for those facilities that offer such
appointments.
(2) Elements.--The briefing required by paragraph (1) shall
include the following:
(A) The findings of the survey conducted under
subsection (a);
(B) Feedback from employees of the Veterans Health
Administration, including clinical, nonclinical, and
support staff, with respect to offering appointments
outside the usual operating hours of facilities of the
Department, including through the use of telehealth
appointments; and
(C) Any other matters the Secretary considers
relevant to a full understanding of the feasibility and
advisability of offering appointments outside the usual
operating hours of facilities of the Department.
(c) Paperwork Reduction Act Exemption.--Chapter 35 of title 44,
United States Code (commonly known as the ``Paperwork Reduction Act'')
shall not apply to any rulemaking or information collection required
under this section.
SEC. 506. SUICIDE PREVENTION COORDINATORS.
(a) <<NOTE: Deadline. 38 USC 1720F note.>> Staffing Requirement.--
Beginning not later than one year after the date of the enactment of
this Act, the Secretary of Veterans Affairs shall ensure that each
medical center of the Department
[[Page 134 STAT. 821]]
of Veterans Affairs has not less than one suicide prevention
coordinator.
(b) Study on Reorganization.--
(1) <<NOTE: Deadline. Consultation. Determination.>> In
general.--Not later than one year after the date of the
enactment of this Act, the Secretary, in consultation with the
Office of Mental Health and Suicide Prevention of the
Department, shall commence the conduct of a study to determine
the feasibility and advisability of--
(A) the realignment and reorganization of suicide
prevention coordinators within the Office of Mental
Health and Suicide Prevention; and
(B) the creation of a suicide prevention coordinator
program office.
(2) <<NOTE: Assessment.>> Program office realignment.--In
conducting the study under paragraph (1), the Secretary shall
assess the feasibility of advisability of, within the suicide
prevention coordinator program office described in paragraph
(1)(B), aligning suicide prevention coordinators and suicide
prevention case managers within the organizational structure and
chart of the Suicide Prevention Program of the Department, with
the Director of the Suicide Prevention program having ultimate
supervisory oversight and responsibility over the suicide
prevention coordinator program office.
(c) Report.--Not later than 90 days after the completion of the
study under subsection (b), the Secretary shall submit to the Committee
on Veterans' Affairs of the Senate and the Committee on Veterans'
Affairs of the House of Representatives a report on such study,
including the following:
(1) <<NOTE: Assessment.>> An assessment of the feasibility
and advisability of creating a suicide prevention coordinator
program office to oversee and monitor suicide prevention
coordinators and suicide prevention case managers across all
medical centers of the Department.
(2) <<NOTE: Review.>> A review of current staffing ratios
for suicide prevention coordinators and suicide prevention case
managers in comparison with current staffing ratios for mental
health providers within each medical center of the Department.
(3) A description of the duties and responsibilities for
suicide prevention coordinators across the Department to better
define, delineate, and standardize qualifications, performance
goals, performance duties, and performance outcomes for suicide
prevention coordinators and suicide prevention case managers.
SEC. 507. REPORT ON EFFORTS BY DEPARTMENT OF VETERANS AFFAIRS TO
IMPLEMENT SAFETY PLANNING IN EMERGENCY
DEPARTMENTS.
(a) Findings.--Congress makes the following findings:
(1) The Department of Veterans Affairs must be more
effective in its approach to reducing the burden of veteran
suicide connected to mental health diagnoses, to include
expansion of treatment delivered via telehealth methods and in
rural areas.
(2) An innovative project, known as Suicide Assessment and
Follow-up Engagement: Veteran Emergency Treatment (in this
subsection referred to as ``SAFE VET''), was designed to help
suicidal veterans seen at emergency departments within
[[Page 134 STAT. 822]]
the Veterans Health Administration and was successfully
implemented in five intervention sites beginning in 2010.
(3) A 2018 study found that safety planning intervention
under SAFE VET was associated with 45 percent fewer suicidal
behaviors in the six-month period following emergency department
care and more than double the odds of a veteran engaging in
outpatient behavioral health care.
(4) SAFE VET is a promising alternative and acceptable
delivery of care system that augments the treatment of suicidal
veterans in emergency departments of the Veterans Health
Administration and helps ensure that those veterans have
appropriate follow-up care.
(5) Beginning in September 2018, the Veterans Health
Administration implemented a suicide prevention program, known
as the SPED program, for veterans presenting to the emergency
department who are assessed to be at risk for suicide and are
safe to be discharged home.
(6) The SPED program includes issuance and update of a
safety plan and post-discharge follow-up outreach for veterans
to facilitate engagement in outpatient mental health care.
(b) Report.--
(1) In general.--Not later than 180 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall submit to the appropriate committees of Congress a report
on the efforts of the Secretary to implement a suicide
prevention program for veterans presenting to an emergency
department or urgent care center of the Veterans Health
Administration who are assessed to be at risk for suicide and
are safe to be discharged home, including a safety plan and
post-discharge outreach for veterans to facilitate engagement in
outpatient mental health care.
(2) <<NOTE: Assessments.>> Elements.--The report required
by paragraph (1) shall include the following:
(A) An assessment of the implementation of the
current operational policies and procedures of the SPED
program at each medical center of the Department of
Veterans Affairs, including an assessment of the
following:
(i) Training provided to clinicians or other
personnel administering protocols under the SPED
program.
(ii) Any disparities in implementation of such
protocols between medical centers.
(iii) <<NOTE: Criteria.>> Current criteria
used to measure the quality of such protocols
including--
(I) methodology used to assess the
quality of a safety plan and post-
discharge outreach for veterans; or
(II) <<NOTE: Timeline. Guidelines.>> in
the absence of such methodology, a
proposed timeline and guidelines for
creating a methodology to ensure
compliance with the evidence-based model
used under the Suicide Assessment and
Follow-up Engagement: Veteran Emergency
Treatment (SAFE VET) program of the
Department.
(B) An assessment of the implementation of the
policies and procedures described in subparagraph (A),
including the following:
[[Page 134 STAT. 823]]
(i) An assessment of the quality and quantity
of safety plans issued to veterans.
(ii) An assessment of the quality and quantity
of post-discharge outreach provided to veterans.
(iii) The post-discharge rate of veteran
engagement in outpatient mental health care,
including attendance at not fewer than one
individual mental health clinic appointment or
admission to an inpatient or residential unit.
(iv) The number of veterans who decline safety
planning efforts during protocols under the SPED
program.
(v) The number of veterans who decline to
participate in follow-up efforts within the SPED
program.
(C) A description of how SPED primary coordinators
are deployed to support such efforts, including the
following:
(i) A description of the duties and
responsibilities of such coordinators.
(ii) The number and location of such
coordinators.
(iii) A description of training provided to
such coordinators.
(iv) An assessment of the other
responsibilities for such coordinators and, if
applicable, differences in patient outcomes when
such responsibilities are full-time duties as
opposed to secondary duties.
(D) An assessment of the feasibility and
advisability of expanding the total number and
geographic distribution of SPED primary coordinators.
(E) <<NOTE: Analysis.>> An assessment of the
feasibility and advisability of providing services under
the SPED program via telehealth channels, including an
analysis of opportunities to leverage telehealth to
better serve veterans in rural areas.
(F) A description of the status of current
capabilities and utilization of tracking mechanisms to
monitor compliance, quality, and patient outcomes under
the SPED program.
(G) <<NOTE: Recommenda- tions.>> Such
recommendations, including specific action items, as the
Secretary considers appropriate with respect to how the
Department can better implement the SPED program,
including recommendations with respect to the following:
(i) A process to standardize training under
such program.
(ii) Any resourcing requirements necessary to
implement the SPED program throughout Veterans
Health Administration, including by having a
dedicated clinician responsible for administration
of such program at each medical center.
(iii) <<NOTE: Analysis.>> An analysis of
current statutory authority and any changes
necessary to fully implement the SPED program
throughout the Veterans Health Administration.
(iv) <<NOTE: Timeline.>> A timeline for the
implementation of the SPED program through the
Veterans Health Administration once full
resourcing and an approved training plan are in
place.
[[Page 134 STAT. 824]]
(H) Such other matters as the Secretary considers
appropriate.
(c) Definitions.--In this section:
(1) Appropriate committees of congress.--The term
``appropriate committees of Congress'' means--
(A) the Committee on Veterans' Affairs and the
Subcommittee on Military Construction, Veterans Affairs,
and Related Agencies of the Committee on Appropriations
of the Senate; and
(B) the Committee on Veterans' Affairs and the
Subcommittee on Military Construction, Veterans Affairs,
and Related Agencies of the Committee on Appropriations
of the House of Representatives.
(2) SPED primary coordinator.--The term ``SPED primary
coordinator'' means the main point of contact responsible for
administering the SPED program at a medical center of the
Department.
(3) SPED program.--The term ``SPED program'' means the
Safety Planning in Emergency Departments program of the
Department of Veterans Affairs established in September 2018 for
veterans presenting to the emergency department who are assessed
to be at risk for suicide and are safe to be discharged home,
which extends the evidence-based intervention for suicide
prevention to all emergency departments of the Veterans Health
Administration.
TITLE VI--IMPROVEMENT OF CARE AND SERVICES FOR WOMEN VETERANS
SEC. 601. <<NOTE: 38 USC 6303 note.>> EXPANSION OF CAPABILITIES
OF WOMEN VETERANS CALL CENTER TO INCLUDE
TEXT MESSAGING.
The Secretary of Veterans Affairs shall expand the capabilities of
the Women Veterans Call Center of the Department of Veterans Affairs to
include a text messaging capability.
SEC. 602. <<NOTE: 38 USC 6303 note.>> REQUIREMENT FOR DEPARTMENT
OF VETERANS AFFAIRS INTERNET WEBSITE TO
PROVIDE INFORMATION ON SERVICES AVAILABLE
TO WOMEN VETERANS.
(a) <<NOTE: Survey.>> In General.--The Secretary of Veterans
Affairs shall survey the internet websites and information resources of
the Department of Veterans Affairs in effect on the day before the date
of the enactment of this Act and publish an internet website that serves
as a centralized source for the provision to women veterans of
information about the benefits and services available to them under laws
administered by the Secretary.
(b) Elements.--The internet website published under subsection (a)
shall provide to women veterans information regarding all services
available in the district in which the veteran is seeking such services,
including, with respect to each medical center and community-based
outpatient clinic in the applicable Veterans Integrated Service
Network--
(1) the name and contact information of each women's health
coordinator;
[[Page 134 STAT. 825]]
(2) <<NOTE: List.>> a list of appropriate staff for other
benefits available from the Veterans Benefits Administration,
the National Cemetery Administration, and such other entities as
the Secretary considers appropriate; and
(3) such other information as the Secretary considers
appropriate.
(c) <<NOTE: Time period.>> Updated Information.--The Secretary
shall ensure that the information described in subsection (b) that is
published on the internet website required by subsection (a) is updated
not less frequently than once every 90 days.
(d) Outreach.--In carrying out this section, the Secretary shall
ensure that the outreach conducted under section 1720F(i) of title 38,
United States Code, includes information regarding the internet website
required by subsection (a).
(e) Derivation of Funds.--Amounts used by the Secretary to carry out
this section shall be derived from amounts made available to the
Secretary to publish internet websites of the Department.
TITLE VII--OTHER MATTERS
SEC. 701. <<NOTE: 38 USC 1701 note.>> EXPANDED TELEHEALTH FROM
DEPARTMENT OF VETERANS AFFAIRS.
(a) <<NOTE: Contracts.>> In General.--The Secretary of Veterans
Affairs shall enter into agreements, and expand existing agreements,
with organizations that represent or serve veterans, nonprofit
organizations, private businesses, and other interested parties for the
expansion of telehealth capabilities and the provision of telehealth
services to veterans through the award of grants under subsection (b).
(b) Award of Grants.--
(1) In general.--In carrying out agreements entered into or
expanded under this section with entities described in
subsection (a), the Secretary shall award grants to those
entities.
(2) Locations.--To the extent practicable, the Secretary
shall ensure that grants are awarded to entities that serve
veterans in rural and highly rural areas (as determined through
the use of the Rural-Urban Commuting Areas coding system of the
Department of Agriculture) or areas determined to be medically
underserved.
(3) Use of grants.--
(A) In general.--Grants awarded to an entity under
this subsection may be used for one or more of the
following:
(i) Purchasing, replacing or upgrading
hardware or software necessary for the provision
of secure and private telehealth services.
(ii) Upgrading security protocols for
consistency with the security requirements of the
Department of Veterans Affairs.
(iii) Training of site attendants, including
payment of those attendants for completing that
training, with respect to--
(I) military and veteran cultural
competence, if the entity is not an
organization that represents veterans;
[[Page 134 STAT. 826]]
(II) equipment required to provide
telehealth services;
(III) privacy, including the Health
Insurance Portability and Accountability
Act of 1996 privacy rule under part 160
and subparts A and E of part 164 of
title 45, Code of Federal Regulations,
or successor regulations, as it relates
to health care for veterans;
(IV) scheduling for telehealth
services for veterans; or
(V) any other unique training needs
for the provision of telehealth services
to veterans.
(iv) Upgrading existing infrastructure owned
or leased by the entity to make rooms more
conducive to telehealth care, including--
(I) additions or modifications to
windows or walls in an existing room, or
other alterations as needed to create a
new, private room, including permits or
inspections required in association with
space modifications;
(II) soundproofing of an existing
room;
(III) new electrical, telephone, or
internet outlets in an existing room; or
(IV) aesthetic enhancements to
establish a more suitable therapeutic
environment.
(v) Upgrading existing infrastructure to
comply with the Americans with Disabilities Act of
1990 (42 U.S.C. 12101 et seq.).
(vi) Upgrading internet infrastructure and
sustainment of internet services.
(vii) Sustainment of telephone services.
(B) <<NOTE: Determination.>> Exclusion.--Grants may
not be used for the purchase of new property or for
major construction projects, as determined by the
Secretary.
(c) <<NOTE: Contracts.>> Agreement on Telehealth Access Points.--
(1) In general.--An entity described in subsection (a) that
seeks to establish a telehealth access point for veterans but
does not require grant funding under this section to do so may
enter into an agreement with the Department for the
establishment of such an access point.
(2) Adequacy of facilities.--An entity described in
paragraph (1) shall be responsible for ensuring that any access
point is adequately private, secure, clean, and accessible for
veterans before the access point is established.
(d) Assessment of Barriers to Access.--
(1) <<NOTE: Deadline.>> In general.--Not later than 18
months after the date of the enactment of this Act, the
Secretary shall complete an assessment of barriers faced by
veterans in accessing telehealth services.
(2) Elements.--The assessment required by paragraph (1)
shall include the following:
(A) A description of the barriers veterans face in
using telehealth while not on property of the
Department.
(B) A description of how the Department plans to
address the barriers described in subparagraph (A).
[[Page 134 STAT. 827]]
(C) Such other matters related to access by veterans
to telehealth while not on property of the Department as
the Secretary considers relevant.
(3) <<NOTE: Recommenda- tions.>> Report.--Not later than
120 days after the completion of the assessment required by
paragraph (1), the Secretary shall submit to the Committee on
Veterans' Affairs of the Senate and the Committee on Veterans'
Affairs of the House of Representatives a report on the
assessment, including any recommendations for legislative or
administrative action based on the results of the assessment.
SEC. 702. <<NOTE: Deadlines.>> PARTNERSHIPS WITH NON-FEDERAL
GOVERNMENT ENTITIES TO PROVIDE HYPERBARIC
OXYGEN THERAPY TO VETERANS AND STUDIES ON
THE USE OF SUCH THERAPY FOR TREATMENT OF
POST-TRAUMATIC STRESS DISORDER AND
TRAUMATIC BRAIN INJURY.
(a) <<NOTE: 38 USC 1701 note.>> Partnerships to Provide Hyperbaric
Oxygen Therapy to Veterans.--
(1) <<NOTE: Consultation.>> Use of partnerships.--The
Secretary of Veterans Affairs, in consultation with the Center
for Compassionate Innovation within the Office of Community
Engagement of the Department of Veterans Affairs, may enter into
partnerships with non-Federal Government entities to provide
hyperbaric oxygen treatment to veterans to research the
effectiveness of such therapy.
(2) Types of partnerships.--Partnerships entered into under
paragraph (1) may include the following:
(A) Partnerships to conduct research on hyperbaric
oxygen therapy.
(B) Partnerships to review research on hyperbaric
oxygen therapy provided to nonveterans.
(C) Partnerships to create industry working groups
to determine standards for research on hyperbaric oxygen
therapy.
(D) Partnerships to provide to veterans hyperbaric
oxygen therapy for the purposes of conducting research
on the effectiveness of such therapy.
(3) Limitation on federal funding.--Federal Government
funding may be used to coordinate and administer the
partnerships under this subsection but may not be used to carry
out activities conducted under such partnerships.
(b) <<NOTE: Consultation. 38 USC 1701 note.>> Review of
Effectiveness of Hyperbaric Oxygen Therapy.--Not later than 90 days
after the date of the enactment of this Act, the Secretary, in
consultation with the Center for Compassionate Innovation, shall begin
using an objective and quantifiable method to review the effectiveness
and applicability of hyperbaric oxygen therapy, such as through the use
of a device approved or cleared by the Food and Drug Administration that
assesses traumatic brain injury by tracking eye movement.
(c) Systematic Review of Use of Hyperbaric Oxygen Therapy to Treat
Certain Conditions.--
(1) <<NOTE: Consultation.>> In general.--Not later than 90
days after the date of the enactment of this Act, the Secretary,
in consultation with the Center for Compassionate Innovation,
shall commence the conduct of a systematic review of published
research literature on off-label use of hyperbaric oxygen
therapy to treat
[[Page 134 STAT. 828]]
post-traumatic stress disorder and traumatic brain injury among
veterans and nonveterans.
(2) Elements.--The review conducted under paragraph (1)
shall include the following:
(A) <<NOTE: Assessment.>> An assessment of the
current parameters for research on the use by the
Department of Veterans Affairs of hyperbaric oxygen
therapy, including--
(i) tests and questionnaires used to determine
the efficacy of such therapy; and
(ii) metrics for determining the success of
such therapy.
(B) <<NOTE: Analysis.>> A comparative analysis of
tests and questionnaires used to study post-traumatic
stress disorder and traumatic brain injury in other
research conducted by the Department of Veterans
Affairs, other Federal agencies, and entities outside
the Federal Government.
(3) Completion of review.--The review conducted under
paragraph (1) shall be completed not later than 180 days after
the date of the commencement of the review.
(4) Report.--Not later than 90 days after the completion of
the review conducted under paragraph (1), the Secretary shall
submit to the Committee on Veterans' Affairs of the Senate and
the Committee on Veterans' Affairs of the House of
Representatives a report on the results of the review.
(d) Follow-up Study.--
(1) <<NOTE: Consultation.>> In general.--Not later than 120
days after the completion of the review conducted under
subsection (c), the Secretary, in consultation with the Center
for Compassionate Innovation, shall commence the conduct of a
study on all individuals receiving hyperbaric oxygen therapy
through the current pilot program of the Department for the
provision of hyperbaric oxygen therapy to veterans to determine
the efficacy and effectiveness of hyperbaric oxygen therapy for
the treatment of post-traumatic stress disorder and traumatic
brain injury.
(2) <<NOTE: Review. Publication.>> Elements.--The study
conducted under paragraph (1) shall include the review and
publication of any data and conclusions resulting from research
conducted by an authorized provider of hyperbaric oxygen therapy
for veterans through the pilot program described in such
paragraph.
(3) Completion of study.--The study conducted under
paragraph (1) shall be completed not later than three years
after the date of the commencement of the study.
(4) Report.--
(A) In general.--Not later than 90 days after
completing the study conducted under paragraph (1), the
Secretary shall submit to the Committee on Veterans'
Affairs of the Senate and the Committee on Veterans'
Affairs of the House of Representatives a report on the
results of the study.
(B) <<NOTE: Recommenda- tions.>> Elements.--The
report required under subparagraph (A) shall include the
recommendation of the Secretary with respect to whether
or not hyperbaric oxygen therapy should be made
available to all veterans with traumatic brain injury or
post-traumatic stress disorder.
[[Page 134 STAT. 829]]
SEC. 703. <<NOTE: 38 USC 7402 note.>> PRESCRIPTION OF TECHNICAL
QUALIFICATIONS FOR LICENSED HEARING AID
SPECIALISTS AND REQUIREMENT FOR
APPOINTMENT OF SUCH SPECIALISTS.
(a) Technical Qualifications.--
(1) <<NOTE: Deadline.>> In general.--Not later than 180
days after the date of the enactment of this Act, the Secretary
of Veterans Affairs shall prescribe the technical qualifications
required under section 7402(b)(14) of title 38, United States
Code, to be appointed as a licensed hearing aid specialist under
section 7401(3) of such title.
(2) Elements for qualifications.--In prescribing the
qualifications for licensed hearing aid specialists under
paragraph (1), the Secretary shall, at a minimum, ensure that
such qualifications are consistent with--
(A) the standards for licensure of hearing aid
specialists that are required by a majority of States;
(B) any competencies needed to perform tasks and
services commonly performed by hearing aid specialists
pursuant to such standards; and
(C) any competencies needed to perform tasks
specific to providing care to individuals under the laws
administered by the Secretary.
(b) Authority to Set and Maintain Duties.--The Secretary shall
retain the authority to set and maintain the duties for licensed hearing
aid specialists appointed under section 7401(3) of title 38, United
States Code, for the purposes of the employment of such specialists with
the Department of Veterans Affairs.
(c) <<NOTE: Deadline.>> Appointment.--Not later than September 30,
2022, the Secretary shall appoint not fewer than one licensed hearing
aid specialist at each medical center of the Department.
(d) <<NOTE: Assessments.>> Report.--Not later than September 30,
2022, and annually thereafter, the Secretary shall submit to the
Committee on Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives a report--
(1) assessing the progress of the Secretary in appointing
licensed hearing aid specialists under subsection (c);
(2) assessing potential conflicts or obstacles that prevent
the appointment of licensed hearing aid specialists;
(3) assessing the factors that led to such conflicts or
obstacles;
(4) assessing access of patients to comprehensive hearing
health care services from the Department consistent with the
requirements under section 4(b) of the Veterans Mobility Safety
Act of 2016 (Public Law 114-256; 38 U.S.C. 7401 note), including
an assessment of the impact of infrastructure and equipment
limitations on wait times for audiologic care; and
(5) indicating the medical centers of the Department with
vacancies for audiologists or licensed hearing aid specialists.
SEC. 704. <<NOTE: Deadlines. 38 USC 7303 note.>> USE BY
DEPARTMENT OF VETERANS AFFAIRS OF
COMMERCIAL INSTITUTIONAL REVIEW BOARDS IN
SPONSORED RESEARCH TRIALS.
(a) In General.--Not later than 90 days after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall complete
all necessary policy revisions within the directive of the Veterans
Health Administration numbered 1200.05 and titled ``Requirements for the
Protection of Human Subjects in Research'',
[[Page 134 STAT. 830]]
to allow sponsored clinical research of the Department of Veterans
Affairs to use accredited commercial institutional review boards to
review research proposal protocols of the Department.
(b) Identification of Review Boards.--Not later than 90 days after
the completion of the policy revisions under subsection (a), the
Secretary shall--
(1) identify accredited commercial institutional review
boards for use in connection with sponsored clinical research of
the Department; and
(2) establish a process to modify existing approvals in the
event that a commercial institutional review board loses its
accreditation during an ongoing clinical trial.
(c) Report.--
(1) In general.--Not later than 90 days after the completion
of the policy revisions under subsection (a), and annually
thereafter, the Secretary shall submit to the Committee on
Veterans' Affairs of the Senate and the Committee on Veterans'
Affairs of the House of Representatives a report on all
approvals of institutional review boards used by the Department,
including central institutional review boards and commercial
institutional review boards.
(2) Elements.--The report required by paragraph (1) shall
include, at a minimum, the following:
(A) The name of each clinical trial with respect to
which the use of an institutional review board has been
approved.
(B) The institutional review board or institutional
review boards used in the approval process for each
clinical trial.
(C) The amount of time between submission and
approval.
SEC. 705. <<NOTE: 38 USC 310 note.>> CREATION OF OFFICE OF
RESEARCH REVIEWS WITHIN THE OFFICE OF
INFORMATION AND TECHNOLOGY OF THE
DEPARTMENT OF VETERANS AFFAIRS.
(a) <<NOTE: Deadline.>> In General.--Not later than one year after
the date of the enactment of this Act, the Secretary of Veterans Affairs
shall establish within the Office of Information and Technology of the
Department of Veterans Affairs an Office of Research Reviews (in this
section referred to as the ``Office'').
(b) Elements.--The Office shall do the following:
(1) Perform centralized security reviews and complete
security processes for approved research sponsored outside the
Department, with a focus on multi-site clinical trials.
(2) <<NOTE: List.>> Develop and maintain a list of
commercially available software preferred for use in sponsored
clinical trials of the Department and ensure such list is
maintained as part of the official approved software products
list of the Department.
(3) Develop benchmarks for appropriate timelines for
security reviews conducted by the Office.
(c) Report.--
(1) In general.--Not later than one year after the
establishment of the Office, the Office shall submit to the
Committee on Veterans' Affairs of the Senate and the Committee
on Veterans' Affairs of the House of Representatives a report on
the activity of the Office.
[[Page 134 STAT. 831]]
(2) Elements.--The report required by paragraph (1) shall
include, at a minimum, the following:
(A) The number of security reviews completed.
(B) The number of personnel assigned for performing
the functions described in subsection (b).
Approved October 17, 2020.
LEGISLATIVE HISTORY--S. 785:
---------------------------------------------------------------------------
CONGRESSIONAL RECORD, Vol. 166 (2020):
Aug. 5, considered and passed Senate.
Sept. 23, considered and passed House.
<all>
Measure laid before Senate by unanimous consent. (consideration: CR S4921-4935)
The committee substitute withdrawn by Unanimous Consent. (CR S4935)
Passed/agreed to in Senate: Passed Senate with an amendment by Voice Vote.(text of amendment in the nature of a substitute: CR S4961-4976)
Passed Senate with an amendment by Voice Vote. (text of amendment in the nature of a substitute: CR S4961-4976)
Message on Senate action sent to the House.
Received in the House.
Held at the desk.
Committee on Veterans' Affairs. Hearings held.
Mr. Takano moved to suspend the rules and pass the bill.
Considered under suspension of the rules. (consideration: CR H4734-4752)
DEBATE - The House proceeded with forty minutes of debate on S. 785.
Passed/agreed to in House: On motion to suspend the rules and pass the bill Agreed to by voice vote.
Enacted as Public Law 116-171
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On motion to suspend the rules and pass the bill Agreed to by voice vote. (text: CR H4734-4749)
Motion to reconsider laid on the table Agreed to without objection.
Presented to President.
Presented to President.
Signed by President.
Signed by President.
Became Public Law No: 116-171.
Became Public Law No: 116-171.