S. 785 

One Hundred Sixteenth Congress 

of the 

United States of America 

AT THE SECOND SESSION 

Begun and held at the City of Washington on Friday, 

the third day of January, two thousand and twenty 

An Act 

To improve mental health care provided by the Department of Veterans Affairs, 

and for other purposes. 

Be it enacted by the Senate and House of Representatives of 

the United States of America in Congress assembled, 

SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

(a) SHORT TITLE.—This Act may be cited as the ‘‘Commander 

John Scott Hannon Veterans Mental Health Care Improvement 

Act of 2019’’. 

(b) TABLE OF CONTENTS.—The table of contents for this Act 

is as follows: 

Sec. 1. Short title; table of contents. 

TITLE I—IMPROVEMENT OF TRANSITION OF INDIVIDUALS TO SERVICES 

FROM DEPARTMENT OF VETERANS AFFAIRS 

Sec. 101. 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. 
S. 785—2 

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) 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 
S. 785—3 

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) An analysis of the anticipated health care needs, 

including mental health care, for such veterans, 

disaggregated by geographic area. 

(D) 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) IN GENERAL.—The Secretary of Defense and the Secretary of Veterans Affairs shall jointly review the records of 
S. 785—4 

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) 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 empiricallysupported contextual and individual risk factors specified in this 

subsection include the following: 

(1) Exposure to violence. 

(2) Exposure to suicide. 

(3) Housing instability. 
S. 785—5 

(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) 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— 
S. 785—6 

(1) in paragraph (1) by striking ‘‘Not less frequently than 

once’’ and inserting ‘‘Not later than February 15’’; and 

(2) in paragraph (2)— 

(A) by redesignating subparagraph (C) as subparagraph (F); and 

(B) by inserting after subsection (B) the following new 

subparagraphs: 

‘‘(C) The types of mental or behavioral health care needs 

treated under this section. 

‘‘(D) The demographics of individuals being treated under 

this section, including— 

‘‘(i) age; 

‘‘(ii) era of service in the Armed Forces; 

‘‘(iii) branch of service in the Armed Forces; and 

‘‘(iv) geographic location. 

‘‘(E) The average number of visits for an individual for 

mental or behavioral health care under this section.’’. 

TITLE II—SUICIDE PREVENTION 

SEC. 201. FINANCIAL ASSISTANCE TO CERTAIN ENTITIES TO PROVIDE 

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) 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. 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.— 
S. 785—7 

(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) 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) 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 
S. 785—8 

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) 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) 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. 
S. 785—9 

(D) 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) to coordinate the provision of suicide prevention 

services with the provision of other services; 

(ii) to assess on an ongoing basis the needs of 

eligible individuals and their families for suicide 

prevention services; 

(iii) 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) 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.— 
S. 785—10 

(1) 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) the data required to be collected and shared with 

the Department; 

(C) 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) PROVISION OF TRAINING AND TECHNICAL ASSISTANCE.— 

The Secretary may provide the training and technical assistance described in paragraph (1) directly or through grants 

or contracts with appropriate public or nonprofit entities. 

(h) ADMINISTRATION OF GRANT PROGRAM.— 

(1) SELECTION CRITERIA.—The Secretary, in consultation 

with entities specified in paragraph (3), shall establish criteria 

for the selection of eligible entities that have submitted applications under subsection (f). 

(2) DEVELOPMENT OF MEASURES AND METRICS.—The Secretary shall develop, in consultation with entities specified in 

paragraph (3), the following: 

(A) A framework for collecting and sharing information 

about entities in receipt of 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) 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 
S. 785—11 

(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. 
S. 785—12 

(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) 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) 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) 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 
S. 785—13 

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) 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) 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) 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) IN GENERAL.—Not later than 180 days after the 

commencement of the grant program under this section, 
S. 785—14 

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) 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) 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) 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) 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. 
S. 785—15 

(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) 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) 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) 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. 
S. 785—16 

(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. 
S. 785—17 

(iii) Historical risk factors, including the following: 

(I) Previous suicide attempts. 

(II) Family history of suicide. 

(III) History of abuse, neglect, or trauma. 

(B) 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) 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) Nontraditional and innovative approaches and 

treatment practices, as determined appropriate by the 

Secretary, in consultation with appropriate entities. 
S. 785—18 

(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) 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) 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) such recommendations regarding the furnishing of complementary and integrative health treatments described in subsection (c) as the Secretary considers appropriate. 
S. 785—19 

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. 

(a) 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) 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.— 
S. 785—20 

(1) INTERIM REPORT.— 

(A) IN GENERAL.—Not later than one year after the 

commencement of the pilot program under this section, 

the Secretary shall submit to the Committee on Veterans’ 

Affairs of the Senate and the Committee on Veterans’ 

Affairs of the House of Representatives a report on the 

progress of the pilot program. 

(B) ELEMENTS.—The report required by subparagraph 

(A) shall include the following: 

(i) The number of participants in the pilot program. 

(ii) The type or types of therapy offered at each 

facility at which the pilot program is being carried 

out. 

(iii) An assessment of whether participation by 

a veteran in the pilot program resulted in any changes 

in clinically relevant endpoints for the veteran with 

respect to the conditions specified in subsection (a). 

(iv) An assessment of the quality of life of veterans 

participating in the pilot program, including the results 

of a satisfaction survey of the participants in the pilot 

program, disaggregated by program under subsection 

(b). 

(v) The determination of the Secretary with respect 

to extending the pilot program under subsection (d)(2). 

(vi) Any recommendations of the Secretary with 

respect to expanding the pilot program. 

(2) FINAL REPORT.—Not later than 90 days after the termination of the pilot program under this section, the Secretary 

shall submit to the Committee on Veterans’ Affairs of the 

Senate and the Committee on Veterans’ Affairs of the House 

of Representatives a final report on the pilot program. 

SEC. 204. DEPARTMENT OF VETERANS AFFAIRS 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) 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.— 
S. 785—21 

(1) 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) an assessment of the participation of such counselors and therapists in the mental health professionals 

trainee program of the Department and any impediments to such participation. 

(C) An assessment of the development by the Department of hiring guidelines for mental health counselors, 

marriage and family therapists, and other appropriate 

counselors. 

(D) A description of how the Department— 

(i) identifies gaps in the supply of mental health 

professionals; and 

(ii) determines successful staffing ratios for mental 

health professionals of the Department. 

(E) A description of actions taken by the Secretary, 

in consultation with the Director of the Office of Personnel 

Management, to create an occupational series for mental 

health counselors and marriage and family therapists of 

the Department and a timeline for the creation of such 

an occupational series. 

(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. 
S. 785—22 

(d) 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) 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) 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. 
S. 785—23 

(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) A review of staffing levels of suicide prevention coordinators across the Veterans Health Administration. 

(5) A review of the resources and programming offered 

to family members and friends of veterans who have a mental 

health condition in order to assist that veteran in treatment 

and recovery. 

(6) An assessment of such other areas as the Comptroller 

General considers appropriate to study. 

TITLE III—PROGRAMS, STUDIES, AND 

GUIDELINES ON MENTAL HEALTH 

SEC. 301. STUDY ON CONNECTION BETWEEN LIVING AT HIGH ALTITUDE AND SUICIDE RISK FACTORS AMONG VETERANS. 

(a) IN GENERAL.—Not later than 180 days after the date of 

the enactment of this Act, the Secretary of Veterans Affairs, in 

consultation with Rural Health Resource Centers of the Office of 

Rural Health of the Department of Veterans Affairs, shall commence 

the conduct of a study on the connection between living at high 

altitude and the risk of developing depression or dying by suicide 

among veterans. 

(b) COMPLETION OF STUDY.—The study conducted under subsection (a) shall be completed not later than three years after 

the date of the commencement of the study. 

(c) INDIVIDUAL IMPACT.—The study conducted under subsection 

(a) shall be conducted so as to determine the effect of high altitude 

on suicide risk at the individual level, not at the State or county 

level. 

(d) REPORT.—Not later than 150 days after the completion 

of the study conducted under subsection (a), the Secretary shall 

submit to the Committee on Veterans’ Affairs of the Senate and 

the Committee on Veterans’ Affairs of the House of Representatives 

a report on the results of the study. 

(e) FOLLOW-UP STUDY.— (1) IN GENERAL.—If the Secretary determines through the 

study conducted under subsection (a) that living at high altitude 

is a risk factor for developing depression or dying by suicide, 
S. 785—24 

the Secretary shall conduct an additional study to identify 

the following: 

(A) The most likely biological mechanism that makes 

living at high altitude a risk factor for developing depression or dying by suicide. 

(B) The most effective treatment or intervention for 

reducing the risk of developing depression or dying by 

suicide associated with living at high altitude. 

(2) REPORT.—Not later than 150 days after completing 

the study conducted under paragraph (1), the Secretary shall 

submit to the Committee on Veterans’ Affairs of the Senate 

and the Committee on Veterans’ Affairs of the House of Representatives a report on the results of the study. 

SEC. 302. ESTABLISHMENT BY DEPARTMENT OF VETERANS AFFAIRS 

AND DEPARTMENT OF DEFENSE OF A CLINICAL PROVIDER 

TREATMENT TOOLKIT AND ACCOMPANYING TRAINING 

MATERIALS FOR COMORBIDITIES. 

(a) IN GENERAL.—Not later than two years after the date of 

the enactment of this Act, the Secretary of Veterans Affairs, in 

consultation with the Secretary of Defense, shall develop a clinical 

provider treatment toolkit and accompanying training materials 

for the evidence-based management of comorbid mental health 

conditions, comorbid mental health and substance use disorders, 

and a comorbid mental health condition and chronic pain. 

(b) MATTERS INCLUDED.—In developing the clinical provider 

treatment toolkit and accompanying training materials under subsection (a), the Secretary of Veterans Affairs and the Secretary 

of Defense shall ensure that the toolkit and training materials 

include guidance with respect to the following: 

(1) The treatment of patients with post-traumatic stress 

disorder who are also experiencing an additional mental health 

condition, a substance use disorder, or chronic pain. 

(2) The treatment of patients experiencing a mental health 

condition, including anxiety, depression, or bipolar disorder, 

who are also experiencing a substance use disorder or chronic 

pain. 

(3) The treatment of patients with traumatic brain injury 

who are also experiencing— 

(A) a mental health condition, including post-traumatic 

stress disorder, anxiety, depression, or bipolar disorder; 

(B) a substance use disorder; or 

(C) chronic pain. 

SEC. 303. UPDATE OF CLINICAL PRACTICE GUIDELINES FOR ASSESSMENT AND MANAGEMENT OF PATIENTS AT RISK FOR SUICIDE. 

(a) IN GENERAL.—In the first publication of the Department 

of Veterans Affairs and Department of Defense Clinical Practice 

Guideline for Assessment and Management of Patients at Risk 

for Suicide published after the date of the enactment of this Act, 

the Secretary of Veterans Affairs and the Secretary of Defense, 

through the Assessment and Management of Patients at Risk for 

Suicide Work Group (in this section referred to as the ‘‘Work 

Group’’), shall ensure the publication includes the following: 

(1) Enhanced guidance with respect to gender-specific— 

(A) risk factors for suicide and suicidal ideation; 
S. 785—25 

(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. ESTABLISHMENT BY DEPARTMENT OF VETERANS AFFAIRS 

AND DEPARTMENT OF DEFENSE OF CLINICAL PRACTICE 

GUIDELINES FOR THE TREATMENT OF SERIOUS MENTAL 

ILLNESS. 

(a) IN GENERAL.—Not later than two years after the date of 

the enactment of this Act, the Secretary of Veterans Affairs, in 

consultation with the Secretary of Defense and the Secretary of 

Health and Human Services, shall complete the development of 

a clinical practice guideline or guidelines for the treatment of 

serious mental illness, to include the following conditions: 

(1) Schizophrenia. 

(2) Schizoaffective disorder. 

(3) Persistent mood disorder, including bipolar disorder 

I and II. 

(4) Any other mental, behavioral, or emotional disorder 

resulting in serious functional impairment that substantially 

interferes with major life activities as the Secretary of Veterans 

Affairs, in consultation with the Secretary of Defense and the 

Secretary of Health and Human Services, considers appropriate. 

(b) MATTERS INCLUDED IN GUIDELINES.—The clinical practice 

guideline or guidelines developed under subsection (a) shall include 

the following: 
S. 785—26 

(1) Guidance contained in the 2016 Clinical Practice Guidelines for the Management of Major Depressive Disorders of 

the Department of Veterans Affairs and the Department of 

Defense. 

(2) Guidance with respect to the treatment of patients 

with a condition described in subsection (a). 

(3) A list of evidence-based therapies for the treatment 

of conditions described in subsection (a). 

(4) An appropriate guideline for the administration of 

pharmacological therapy, psychological or behavioral therapy, 

or other therapy for the management of conditions described 

in subsection (a). 

(c) ASSESSMENT OF EXISTING GUIDELINES.—Not later than two 

years after the date of the enactment of this Act, the Secretary 

of Veterans Affairs, in consultation with the Secretary of Defense 

and the Secretary of Health and Human Services, shall complete 

an assessment of the 2016 Clinical Practice Guidelines for the 

Management of Major Depressive Disorders to determine whether 

an update to such guidelines is necessary. 

(d) WORK GROUP.— 

(1) ESTABLISHMENT.—The Secretary of Veterans Affairs, 

the Secretary of Defense, and the Secretary of Health and 

Human Services shall create a work group to develop the clinical practice guideline or guidelines under subsection (a) to 

be known as the ‘‘Serious Mental Illness Work Group’’ (in 

this subsection referred to as the ‘‘Work Group’’). 

(2) MEMBERSHIP.—The Work Group created under paragraph (1) shall be comprised of individuals that represent Federal Government entities and non-Federal Government entities 

with expertise in the areas covered by the Work Group, 

including the following entities: 

(A) Academic institutions that specialize in research 

for the treatment of conditions described in subsection (a). 

(B) The Health Services Research and Development 

Service of the Department of Veterans Affairs. 

(C) The Office of the Assistant Secretary for Mental 

Health and Substance Use of the Department of Health 

and Human Services. 

(D) The National Institute of Mental Health. 

(E) The Indian Health Service. 

(F) Relevant organizations with expertise in 

researching, diagnosing, or treating conditions described 

in subsection (a). 

(3) RELATION TO OTHER WORK GROUPS.—The Work Group 

shall be created and conducted in the same manner as other 

work groups for the development of clinical practice guidelines 

for the Department of Veterans Affairs and the Department 

of Defense. 

(e) RULE OF CONSTRUCTION.—Nothing in this section shall be 

construed to prevent the Secretary of Veterans Affairs and the 

Secretary of Defense from considering all relevant evidence, as 

appropriate, in creating the clinical practice guideline or guidelines 

required under subsection (a) or from ensuring that the final clinical 

practice guideline or guidelines developed under such subsection 

and subsequently updated, as appropriate, remain applicable to 

the patient populations of the Department of Veterans Affairs and 

the Department of Defense. 
S. 785—27 

SEC. 305. PRECISION MEDICINE INITIATIVE OF DEPARTMENT OF VETERANS AFFAIRS TO IDENTIFY AND VALIDATE BRAIN AND 

MENTAL HEALTH BIOMARKERS. 

(a) IN GENERAL.—Beginning not later than 18 months after 

the date of the enactment of this Act, the Secretary of Veterans 

Affairs shall develop and implement an initiative of the Department 

of Veterans Affairs to identify and validate brain and mental health 

biomarkers among veterans, with specific consideration for depression, anxiety, post-traumatic stress disorder, bipolar disorder, traumatic brain injury, and such other mental health conditions as 

the Secretary considers appropriate. Such initiative may be referred 

to as the ‘‘Precision Medicine for Veterans Initiative’’. 

(b) MODEL OF INITIATIVE.—The initiative under subsection (a) 

shall be modeled on the All of Us Precision Medicine Initiative 

administered by the National Institutes of Health with respect 

to large-scale collection of standardized data and open data sharing. 

(c) 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 deidentified 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 
S. 785—28 

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) 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: 

‘‘§ 119. Contracting for statistical analyses and data evaluation 

‘‘(a) IN GENERAL.—The Secretary may enter into a contract 

or other agreement with an academic institution or other qualified 

entity, as determined by the Secretary, to carry out statistical 

analyses and data evaluation as required of the Secretary by law.’’. 

‘‘(b) RULE OF CONSTRUCTION.—Nothing in this section may 

be construed to limit the authority of the Secretary to enter into 

contracts or other agreements for statistical analyses and data 

evaluation under any other provision of law.’’. 

(b) CLERICAL AMENDMENT.—The table of sections at the beginning of chapter 1 of such title is amended by adding at the end 

the following new item: 

‘‘119. Contracting for statistical analyses and data evaluation.’’. 
S. 785—29 

TITLE IV—OVERSIGHT OF MENTAL 

HEALTH CARE AND RELATED SERVICES 

SEC. 401. STUDY ON EFFECTIVENESS OF SUICIDE PREVENTION AND 

MENTAL HEALTH OUTREACH PROGRAMS OF DEPARTMENT 

OF VETERANS AFFAIRS. 

(a) IN GENERAL.—Not later than 180 days after the date of 

the enactment of this Act, the Secretary of Veterans Affairs shall 

enter into an agreement with a non-Federal Government entity 

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: 
S. 785—30 

(A) 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) 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) 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) 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) DISAGGREGATION OF DATA.—Data of veterans surveyed under paragraph (1) shall be disaggregated by— 

(i) veterans who have received care from the 

Department during the two-year period preceding the 

survey; and 

(ii) veterans who have not received care from the 

Department during the two-year period preceding the 

survey. 

(e) TREATMENT OF CONTRACTS FOR SUICIDE PREVENTION AND

MENTAL HEALTH OUTREACH MEDIA.— 

(1) FOCUS GROUPS.— 

(A) IN GENERAL.—The Secretary shall include in each 

contract to develop media relating to suicide prevention 

and mental health 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; 
S. 785—31 

(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) 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. OVERSIGHT OF MENTAL HEALTH AND SUICIDE PREVENTION 

MEDIA OUTREACH CONDUCTED BY DEPARTMENT OF VETERANS AFFAIRS. 

(a) ESTABLISHMENT OF GOALS.— 

(1) IN GENERAL.—The Secretary of Veterans Affairs shall 

establish goals for the mental health and suicide prevention 

media outreach campaigns of the Department of Veterans 

Affairs, which shall include the establishment of targets, 

metrics, and action plans to describe and assess those campaigns. 

(2) USE OF METRICS.— (A) IN GENERAL.—The goals established under paragraph (1) shall be measured by metrics specific to different 

media types. 

(B) FACTORS TO CONSIDER.—In using metrics under 

subparagraph (A), the Secretary shall determine the best 

methodological approach for each media type and shall 

consider the following: 

(i) Metrics relating to social media, which may 

include the following: 

(I) Impressions. 

(II) Reach. 

(III) Engagement rate. 

(IV) Such other metrics as the Secretary considers necessary. 

(ii) Metrics relating to television, which may 

include the following: 
S. 785—32 

(I) Nielsen ratings. 

(II) Such other metrics as the Secretary considers necessary. 

(iii) Metrics relating to email, which may include 

the following: 

(I) Open rate. 

(II) Response rate. 

(III) Click rate. 

(IV) Such other metrics as the Secretary considers necessary. 

(C) UPDATE.—The Secretary shall periodically update 

the metrics under subparagraph (B) as more accurate 

metrics become available. 

(3) TARGETS.—The Secretary shall establish targets to track 

the metrics used under paragraph (2). 

(4) CONSULTATION.—In establishing goals under paragraph 

(1), the Secretary shall consult with the following: 

(A) Relevant stakeholders, such as organizations that 

represent veterans, as determined by the Secretary. 

(B) Mental health and suicide prevention experts. 

(C) Such other persons as the Secretary considers 

appropriate. 

(5) INITIAL REPORT.—Not later than 180 days after the 

date of the enactment of this Act, the Secretary shall submit 

to the Committee on Veterans’ Affairs of the Senate and the 

Committee on Veterans’ Affairs of the House of Representatives 

a report detailing the goals established under paragraph (1) 

for the mental health and suicide prevention media outreach 

campaigns of the Department, including the metrics and targets 

for such metrics by which those goals are to be measured 

under paragraphs (2) and (3). 

(6) ANNUAL REPORT.—Not later than one year after the 

submittal of the report under paragraph (5), and annually 

thereafter, the Secretary shall submit to the Committee on 

Veterans’ Affairs of the Senate and the Committee on Veterans’ 

Affairs of the House of Representatives a report detailing— 

(A) the progress of the Department in meeting the 

goals established under paragraph (1) and the targets 

established under paragraph (3); and 

(B) a description of action to be taken by the Department to modify mental health and suicide prevention media 

outreach campaigns if those goals and targets are not being 

met. 

(b) REPORT ON USE OF FUNDS BY OFFICE OF MENTAL HEALTH

AND SUICIDE PREVENTION.—Not later than 180 days after the date 

of the enactment of this Act, and semiannually thereafter, the 

Secretary shall submit to the Committee on Appropriations and 

the Committee on Veterans’ Affairs of the Senate and the Committee on Appropriations and the Committee on Veterans’ Affairs 

of the House of Representatives a report containing the expenditures and obligations of the Office of Mental Health and Suicide 

Prevention of the Veterans Health Administration during the period 

covered by the report. 
S. 785—33 

SEC. 403. COMPTROLLER GENERAL MANAGEMENT REVIEW OF MENTAL 

HEALTH AND SUICIDE PREVENTION SERVICES OF DEPARTMENT OF VETERANS AFFAIRS. 

(a) IN GENERAL.—Not later than three years after the date 

of the enactment of this Act, the Comptroller General of the United 

States shall submit to the Committee on Veterans’ Affairs of the 

Senate and the Committee on Veterans’ Affairs of the House of 

Representatives a management review of the mental health and 

suicide prevention services provided by the Department of Veterans 

Affairs. 

(b) ELEMENTS.—The management review required by subsection 

(a) shall include the following: 

(1) An assessment of the infrastructure under the control 

of or available to the Office of Mental Health and Suicide 

Prevention of the Department of Veterans Affairs or available 

to the Department of Veterans Affairs for suicide prevention 

efforts not operated by the Office of Mental Health and Suicide 

Prevention. 

(2) A description of the management and organizational 

structure of the Office of Mental Health and Suicide Prevention, 

including roles and responsibilities for each position. 

(3) A description of the operational policies and processes 

of the Office of Mental Health and Suicide Prevention. 

(4) An assessment of suicide prevention practices and initiatives available from the Department and through community 

partnerships. 

(5) An assessment of the staffing levels at the Office of 

Mental Health and Suicide Prevention, disaggregated by type 

of position, and including the location of any staffing deficiencies. 

(6) An assessment of the Nurse Advice Line pilot program 

conducted by the Department. 

(7) An assessment of recruitment initiatives in rural areas 

for mental health professionals of the Department. 

(8) An assessment of strategic planning conducted by the 

Office of Mental Health and Suicide Prevention. 

(9) An assessment of the communication, and the effectiveness of such communication— 

(A) within the central office of the Office of Mental 

Health and Suicide Prevention; 

(B) between that central office and any staff member 

or office in the field, including chaplains, attorneys, law 

enforcement personnel, and volunteers; and 

(C) between that central office, local facilities of the 

Department, and community partners of the Department, 

including first responders, community support groups, and 

health care industry partners. 

(10) An assessment of how effectively the Office of Mental 

Health and Suicide Prevention implements operational policies 

and procedures. 

(11) An assessment of how the Department of Veterans 

Affairs and the Department of Defense coordinate suicide 

prevention efforts, and recommendations on how the Department of Veterans Affairs and Department of Defense can more 

effectively coordinate those efforts. 

(12) An assessment of such other areas as the Comptroller 

General considers appropriate to study. 
S. 785—34 

SEC. 404. COMPTROLLER GENERAL REPORT ON EFFORTS OF DEPARTMENT OF VETERANS AFFAIRS TO INTEGRATE MENTAL 

HEALTH CARE INTO PRIMARY CARE CLINICS. 

(a) INITIAL REPORT.— 

(1) IN GENERAL.—Not later than two years after the date 

of the enactment of this Act, the Comptroller General of the 

United States shall submit to the Committee on Veterans’ 

Affairs of the Senate and the Committee on Veterans’ Affairs 

of the House of Representatives a report on the efforts of 

the Department of Veterans Affairs to integrate mental health 

care into primary care clinics of the Department. 

(2) ELEMENTS.—The report required by subsection (a) shall 

include the following: 

(A) An assessment of the efforts of the Department 

to integrate mental health care into primary care clinics 

of the Department. 

(B) An assessment of the effectiveness of such efforts. 

(C) An assessment of how the health care of veterans 

is impacted by such integration. 

(D) A description of how care is coordinated by the 

Department between specialty mental health care and primary care, including a description of the following: 

(i) How documents and patient information are 

transferred and the effectiveness of those transfers. 

(ii) How care is coordinated when veterans must 

travel to different facilities of the Department. 

(iii) How a veteran is reintegrated into primary 

care after receiving in-patient mental health care. 

(E) An assessment of how the integration of mental 

health care into primary care clinics is implemented at 

different types of facilities of the Department. 

(F) Such recommendations on how the Department 

can better integrate mental health care into primary care 

clinics as the Comptroller General considers appropriate. 

(G) An assessment of such other areas as the Comptroller General considers appropriate to study. 

(b) COMMUNITY CARE INTEGRATION REPORT.— 

(1) IN GENERAL.—Not later than two years after the date 

on which the Comptroller General submits the report required 

under subsection (a)(1), the Comptroller General shall submit 

to the Committee on Veterans’ Affairs of the Senate and the 

Committee on Veterans’ Affairs of the House of Representatives 

a report on the efforts of the Department to integrate community-based mental health care into the Veterans Health 

Administration. 

(2) ELEMENTS.—The report required by paragraph (1) shall 

include the following: 

(A) An assessment of the efforts of the Department 

to integrate community-based mental health care into the 

Veterans Health Administration. 

(B) An assessment of the effectiveness of such efforts. 

(C) An assessment of how the health care of veterans 

is impacted by such integration. 

(D) A description of how care is coordinated between 

providers of community-based mental health care and the 

Veterans Health Administration, including a description 
S. 785—35 

of how documents and patient information are transferred 

and the effectiveness of those transfers between— 

(i) the Veterans Health Administration and providers of community-based mental health care; and 

(ii) providers of community-based mental health 

care and the Veterans Health Administration. 

(E) An assessment of any disparities in the coordination of community-based mental health care into the Veterans Health Administration by location and type of 

facility. 

(F) An assessment of the military cultural competency 

of health care providers providing community-based mental 

health care to veterans. 

(G) Such recommendations on how the Department 

can better integrate community-based mental health care 

into the Veterans Health Administration as the Comptroller General considers appropriate. 

(H) An assessment of such other areas as the Comptroller General considers appropriate to study. 

(3) COMMUNITY-BASED MENTAL HEALTH CARE DEFINED.— 

In this subsection, the term ‘‘community-based mental health 

care’’ means mental health care paid for by the Department 

but provided by a non-Department health care provider at 

a non-Department facility, including care furnished under section 1703 of title 38, United States Code (as in effect on the 

date specified in section 101(b) of the Caring for Our Veterans 

Act of 2018 (title I of Public Law 115–182)). 

SEC. 405. JOINT MENTAL HEALTH PROGRAMS BY DEPARTMENT OF 

VETERANS AFFAIRS AND DEPARTMENT OF DEFENSE. 

(a) REPORT ON MENTAL HEALTH PROGRAMS.— 

(1) IN GENERAL.—Not later than 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 posttraumatic 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 
S. 785—36 

as the Secretary of Veterans Affairs considers necessary. 

(B) A description of mental health programs operated 

by the Department of Defense, including the following: 

(i) Transition assistance programs. 

(ii) Clinical and non-clinical mental health initiatives, including the National Intrepid Center of Excellence and the Intrepid Spirit Centers. 

(iii) Programs that may secondarily improve 

mental health, including employment, housing assistance, and financial literacy programs. 

(iv) Research into mental health issues and conditions, to include post-traumatic stress disorder, depression, anxiety, bipolar disorder, traumatic brain injury, 

suicidal ideation, and any other issues or conditions 

as the Secretary of Defense considers necessary. 

(C) A description of mental health programs jointly 

operated by the Department of Veterans Affairs and the 

Department of Defense, including the following: 

(i) Transition assistance programs. 

(ii) Clinical and non-clinical mental health initiatives. 

(iii) Programs that may secondarily improve 

mental health, including employment, housing assistance, and financial literacy programs. 

(iv) Research into mental health issues and conditions, to include post-traumatic stress disorder, depression, anxiety, bipolar disorder, traumatic brain injury, 

suicidal ideation, and completed suicides, including 

through the use of the joint suicide data repository 

of the Department of Veterans Affairs and the Department of Defense, and any other issues or conditions 

as the Secretary of Veterans Affairs and the Secretary 

of Defense consider necessary. 

(D) Recommendations for coordinating mental health 

programs of the Department of Veterans Affairs and the 

Department of Defense to improve the effectiveness of those 

programs. 

(E) Recommendations for novel joint programming of 

the Department of Veterans Affairs and the Department 

of Defense to improve the mental health of members of 

the Armed Forces and veterans. 

(b) 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) 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 posttraumatic 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 
S. 785—37 

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) 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) 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) 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 
S. 785—38 

of mental health providers of the Department of Veterans 

Affairs, including filling any open positions. 

(2) ELEMENTS.—The plan required by paragraph (1) shall 

include the following: 

(A) An estimate of the number of positions for mental 

health providers of the Department that need to be filled 

to meet demand. 

(B) An identification of the steps that the Secretary 

will take to address mental health staffing for the Department. 

(C) A description of any region-specific hiring incentives to be used by the Secretary in consultation with 

the directors of Veterans Integrated Service Networks and 

medical centers of the Department. 

(D) A description of any local retention or engagement 

incentives to be used by directors of Veterans Integrated 

Service Networks. 

(E) Such recommendations for legislative or administrative action as the Secretary considers necessary to aid 

in addressing mental health staffing for the Department. 

(3) REPORT.—Not later than one year after the submittal 

of the plan required by paragraph (1), the Secretary shall 

submit to the Committee on Veterans’ Affairs of the Senate 

and the Committee on Veterans’ Affairs of the House of Representatives a report setting forth the number of mental health 

providers hired by the Department during the one-year period 

preceding the submittal of the report. 

(b) OCCUPATIONAL SERIES FOR CERTAIN MENTAL HEALTH PRO- VIDERS.—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 IX—READJUSTMENT COUNSELING SERVICE 

SCHOLARSHIP PROGRAM 

‘‘§ 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’). 

‘‘§ 7699. Eligibility; agreement 

‘‘(a) IN GENERAL.—An individual is eligible to participate in 

the Program, as determined by the Readjustment Counseling 

Service of the Department, if the individual— 

‘‘(1) is accepted for enrollment or enrolled (as described 

in section 7602 of this title) in a program of study at an 
S. 785—39 

accredited educational institution, school, or training program 

leading to a terminal degree in psychology, social work, marriage and family therapy, or mental health counseling that 

would meet the education requirements for appointment to 

a position under section 7402(b) of this title; and 

‘‘(2) enters into an agreement with the Secretary under 

subsection (c). 

‘‘(b) PRIORITY.—In selecting individuals to participate in the 

Program, the Secretary shall give priority to the following individuals: 

‘‘(1) An individual who agrees to be employed by a Vet 

Center located in a community that is— 

‘‘(A) designated as a medically underserved population 

under section 330(b)(3) of the Public Health Service Act 

(42 U.S.C. 254b(b)(3)); and 

‘‘(B) in a State with a per capita population of veterans 

of more than five percent according to the National Center 

for Veterans Analysis and Statistics and the Bureau of 

the Census. 

‘‘(2) An individual who is a veteran. 

‘‘(c) AGREEMENT.—An agreement between the Secretary and 

a participant in the Program shall (in addition to the requirements 

set forth in section 7604 of this title) include the following: 

‘‘(1) An agreement by the Secretary to provide the participant with a scholarship under the Program for a specified 

number of school years during which the participant pursues 

a program of study described in subsection (a)(1) that meets 

the requirements set forth in section 7602(a) of this title. 

‘‘(2) An agreement by the participant to serve as a fulltime employee of the Department at a Vet Center for a sixyear 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. 

‘‘§ 7699A. Obligated service 

‘‘(a) IN GENERAL.—Each participant in the Program shall provide service as a full-time employee of the Department at a Vet 

Center (as defined in section 7699(d) of this title) for the period 

of obligated service set forth in the agreement of the participant 

entered into under section 7604 of this title. 

‘‘(b) DETERMINATION OF SERVICE COMMENCEMENT DATE.—(1) 

Not later than 60 days before the service commencement date 

of a participant, the Secretary shall notify the participant of that 

service commencement date. 

‘‘(2) The date specified in paragraph (1) with respect to a 

participant is the date for the beginning of the period of obligated 

service of the participant. 

‘‘§ 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 
S. 785—40 

section 7604 of this title shall be liable to the United States for 

liquidated damages in the amount of $1,500. 

‘‘(2) Liability under paragraph (1) is in addition to any period 

of obligated service or other obligation or liability under such agreement. 

‘‘(b) LIABILITY DURING PROGRAM OF STUDY.—(1) Except as provided in subsection (d), a participant in the Program shall be 

liable to the United States for the amount which has been paid 

to or on behalf of the participant under the agreement if any 

of the following occurs: 

‘‘(A) The participant fails to maintain an acceptable level 

of academic standing in the educational institution in which 

the participant is enrolled (as determined by the educational 

institution under regulations prescribed by the Secretary). 

‘‘(B) The participant is dismissed from such educational 

institution for disciplinary reasons. 

‘‘(C) The participant voluntarily terminates the program 

of study in such educational institution before the completion 

of such program of study. 

‘‘(2) Liability under this subsection is in lieu of any service 

obligation arising under the agreement. 

‘‘(c) LIABILITY DURING PERIOD OF OBLIGATED SERVICE.—(1) 

Except as provided in subsection (d), if a participant in the Program 

does not complete the period of obligated service of the participant, 

the United States shall be entitled to recover from the participant 

an amount determined in accordance with the following formula: 

A = 3Φ(t¥s/t). 

‘‘(2) In the formula in paragraph (1): 

‘‘(A) ‘A’ is the amount the United States is entitled to 

recover. 

‘‘(B) ‘Φ’ is the sum of— 

‘‘(i) the amounts paid under this subchapter to or on 

behalf of the participant; and 

‘‘(ii) the interest on such amounts which would be 

payable if at the time the amounts were paid they were 

loans bearing interest at the maximum legal prevailing 

rate, as determined by the Treasurer of the United States. 

‘‘(C) ‘t’ is the total number of months in the period of 

obligated service of the participant. 

‘‘(D) ‘s’ is the number of months of such period served 

by the participant. 

‘‘(d) LIMITATION ON LIABILITY FOR REDUCTIONS-IN-FORCE.— 

Liability shall not arise under subsection (c) if the participant 

fails to maintain employment as a Department employee due to 

a staffing adjustment. 

‘‘(e) PERIOD FOR PAYMENT OF DAMAGES.—Any amount of damages that the United States is entitled to recover under this section 

shall be paid to the United States within the one-year period 

beginning on the date of the breach of the agreement.’’. 

(b) CONFORMING AND TECHNICAL AMENDMENTS.— 

(1) CONFORMING AMENDMENTS.— 

(A) ESTABLISHMENT OF PROGRAM.—Section 7601(a) of 

such title is amended— 

(i) in paragraph (5), by striking ‘‘and’’; 

(ii) in paragraph (6), by striking the period and 

inserting ‘‘; and’’; and 
S. 785—41 

(iii) by adding at the end the following new paragraph: 

‘‘(7) the readjustment counseling service scholarship program provided for in subchapter IX of this chapter.’’. 

(B) ELIGIBILITY.—Section 7602 of such title is 

amended— 

(i) in subsection (a)(1)— 

(I) by striking ‘‘or VI’’ and inserting ‘‘VI, or 

IX’’; and 

(II) by striking ‘‘subchapter VI’’ and inserting 

‘‘subchapter VI or IX’’; and 

(ii) in subsection (b), by striking ‘‘or VI’’ and 

inserting ‘‘VI, or IX’’. 

(C) APPLICATION.—Section 7603(a)(1) of such title is 

amended by striking ‘‘or VIII’’ and inserting ‘‘VIII, or IX’’. 

(D) TERMS OF AGREEMENT.—Section 7604 of such title 

is amended by striking ‘‘or VIII’’ each place it appears 

and inserting ‘‘VIII, or IX’’. 

(E) ANNUAL REPORT.—Section 7632 of such title is 

amended— 

(i) in paragraph (1), by striking ‘‘and the Specialty 

Education Loan Repayment Program’’ and inserting 

‘‘the Specialty Education Loan Repayment Program, 

and the Readjustment Counseling Service Scholarship 

Program’’; and 

(ii) in paragraph (4), by striking ‘‘and per participant in the Specialty Education Loan Repayment Program’’ and inserting ‘‘per participant in the Specialty 

Education Loan Repayment Program, and per participant in the Readjustment Counseling Service Scholarship Program’’. 

(2) TABLE OF SECTIONS.—The table of sections at the beginning of chapter 76 of such title is amended by inserting after 

the items relating to subchapter VIII the following: 

‘‘SUBCHAPTER IX—READJUSTMENT COUNSELING SERVICE SCHOLARSHIP PROGRAM

‘‘Sec. 

‘‘7698. Requirement for program. 

‘‘7699. Eligibility; agreement. 

‘‘7699A. Obligated service. 

‘‘7699B. Breach of agreement: liability.’’. 

(c) EFFECTIVE DATE.—The Secretary of Veterans Affairs shall 

begin awarding scholarships under subchapter IX of chapter 76 

of title 38, United States Code, as added by subsection (a), for 

programs of study beginning not later than one year after the 

date of the enactment of this Act. 

SEC. 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) ELEMENTS.—The report required by subsection (a) shall 

include the following: 
S. 785—42 

(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, 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; 
S. 785—43 

‘‘(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) 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) 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) 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) 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 
S. 785—44 

of Veterans Affairs has not less than one suicide prevention coordinator. 

(b) STUDY ON REORGANIZATION.— 

(1) IN GENERAL.—Not later than one year after the date 

of the enactment of this Act, the Secretary, in consultation 

with the Office of Mental Health and Suicide Prevention of 

the Department, shall commence the conduct of a study to 

determine the feasibility and advisability of— 

(A) the realignment and reorganization of suicide 

prevention coordinators within the Office of Mental Health 

and Suicide Prevention; and 

(B) the creation of a suicide prevention coordinator 

program office. 

(2) PROGRAM OFFICE REALIGNMENT.—In conducting the 

study under paragraph (1), the Secretary shall assess the feasibility of advisability of, within the suicide prevention coordinator program office described in paragraph (1)(B), aligning 

suicide prevention coordinators and suicide prevention case 

managers within the organizational structure and chart of the 

Suicide Prevention Program of the Department, with the 

Director of the Suicide Prevention program having ultimate 

supervisory oversight and responsibility over the suicide 

prevention coordinator program office. 

(c) REPORT.—Not later than 90 days after the completion of 

the study under subsection (b), the Secretary shall submit to the 

Committee on Veterans’ Affairs of the Senate and the Committee 

on Veterans’ Affairs of the House of Representatives a report on 

such study, including the following: 

(1) An assessment of the feasibility and advisability of 

creating a suicide prevention coordinator program office to oversee and monitor suicide prevention coordinators and suicide 

prevention case managers across all medical centers of the 

Department. 

(2) A review of current staffing ratios for suicide prevention 

coordinators and suicide prevention case managers in comparison with current staffing ratios for mental health providers 

within each medical center of the Department. 

(3) A description of the duties and responsibilities for suicide prevention coordinators across the Department to better 

define, delineate, and standardize qualifications, performance 

goals, performance duties, and performance outcomes for suicide prevention coordinators and suicide prevention case managers. 

SEC. 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 
S. 785—45 

the Veterans Health Administration and was successfully 

implemented in five intervention sites beginning in 2010. 

(3) A 2018 study found that safety planning intervention 

under SAFE VET was associated with 45 percent fewer suicidal 

behaviors in the six-month period following emergency department care and more than double the odds of a veteran engaging 

in outpatient behavioral health care. 

(4) SAFE VET is a promising alternative and acceptable 

delivery of care system that augments the treatment of suicidal 

veterans in emergency departments of the Veterans Health 

Administration and helps ensure that those veterans have 

appropriate follow-up care. 

(5) Beginning in September 2018, the Veterans Health 

Administration implemented a suicide prevention program, 

known as the SPED program, for veterans presenting to the 

emergency department who are assessed to be at risk for suicide 

and are safe to be discharged home. 

(6) The SPED program includes issuance and update of 

a safety plan and post-discharge follow-up outreach for veterans 

to facilitate engagement in outpatient mental health care. 

(b) REPORT.— 

(1) IN GENERAL.—Not later than 180 days after the date 

of the enactment of this Act, the Secretary of Veterans Affairs 

shall submit to the appropriate committees of Congress a report 

on the efforts of the Secretary to implement a suicide prevention 

program for veterans presenting to an emergency department 

or urgent care center of the Veterans Health Administration 

who are assessed to be at risk for suicide and are safe to 

be discharged home, including a safety plan and post-discharge 

outreach for veterans to facilitate engagement in outpatient 

mental health care. 

(2) ELEMENTS.—The report required by paragraph (1) shall 

include the following: 

(A) An assessment of the implementation of the current 

operational policies and procedures of the SPED program 

at each medical center of the Department of Veterans 

Affairs, including an assessment of the following: 

(i) Training provided to clinicians or other personnel administering protocols under the SPED program. 

(ii) Any disparities in implementation of such 

protocols between medical centers. 

(iii) Current criteria used to measure the quality 

of such protocols including— 

(I) methodology used to assess the quality of 

a safety plan and post-discharge outreach for veterans; or 

(II) in the absence of such methodology, a 

proposed timeline and guidelines for creating a 

methodology to ensure compliance with the evidence-based model used under the Suicide Assessment and Follow-up Engagement: Veteran Emergency Treatment (SAFE VET) program of the 

Department. 

(B) An assessment of the implementation of the policies 

and procedures described in subparagraph (A), including 

the following: 
S. 785—46 

(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 fulltime duties as opposed to secondary duties. 

(D) An assessment of the feasibility and advisability 

of expanding the total number and geographic distribution 

of SPED primary coordinators. 

(E) An assessment of the feasibility and advisability 

of providing services under the SPED program via telehealth channels, including an analysis of opportunities to 

leverage telehealth to better serve veterans in rural areas. 

(F) A description of the status of current capabilities 

and utilization of tracking mechanisms to monitor compliance, quality, and patient outcomes under the SPED program. 

(G) Such recommendations, including specific action 

items, as the Secretary considers appropriate with respect 

to how the Department can better implement the SPED 

program, including recommendations with respect to the 

following: 

(i) A process to standardize training under such 

program. 

(ii) Any resourcing requirements necessary to 

implement the SPED program throughout Veterans 

Health Administration, including by having a dedicated 

clinician responsible for administration of such program at each medical center. 

(iii) An analysis of current statutory authority and 

any changes necessary to fully implement the SPED 

program throughout the Veterans Health Administration. 

(iv) A timeline for the implementation of the SPED 

program through the Veterans Health Administration 

once full resourcing and an approved training plan 

are in place. 
S. 785—47 

(H) Such other matters as the Secretary considers 

appropriate. 

(c) DEFINITIONS.—In this section: 

(1) APPROPRIATE COMMITTEES OF CONGRESS.—The term 

‘‘appropriate committees of Congress’’ means— 

(A) the Committee on Veterans’ Affairs and the Subcommittee on Military Construction, Veterans Affairs, and 

Related Agencies of the Committee on Appropriations of 

the Senate; and 

(B) the Committee on Veterans’ Affairs and the Subcommittee on Military Construction, Veterans Affairs, and 

Related Agencies of the Committee on Appropriations of 

the House of Representatives. 

(2) SPED PRIMARY COORDINATOR.—The term ‘‘SPED primary coordinator’’ means the main point of contact responsible 

for administering the SPED program at a medical center of 

the Department. 

(3) SPED PROGRAM.—The term ‘‘SPED program’’ means 

the Safety Planning in Emergency Departments program of 

the Department of Veterans Affairs established in September 

2018 for veterans presenting to the emergency department 

who are assessed to be at risk for suicide and are safe to 

be discharged home, which extends the evidence-based intervention for suicide prevention to all emergency departments 

of the Veterans Health Administration. 

TITLE VI—IMPROVEMENT OF CARE AND 

SERVICES FOR WOMEN VETERANS 

SEC. 601. EXPANSION OF CAPABILITIES OF WOMEN VETERANS CALL 

CENTER TO INCLUDE TEXT MESSAGING. 

The Secretary of Veterans Affairs shall expand the capabilities 

of the Women Veterans Call Center of the Department of Veterans 

Affairs to include a text messaging capability. 

SEC. 602. REQUIREMENT FOR DEPARTMENT OF VETERANS AFFAIRS 

INTERNET WEBSITE TO PROVIDE INFORMATION ON SERVICES AVAILABLE TO WOMEN VETERANS. 

(a) IN GENERAL.—The Secretary of Veterans Affairs shall survey 

the internet websites and information resources of the Department 

of Veterans Affairs in effect on the day before the date of the 

enactment of this Act and publish an internet website that serves 

as a centralized source for the provision to women veterans of 

information about the benefits and services available to them under 

laws administered by the Secretary. 

(b) ELEMENTS.—The internet website published under subsection (a) shall provide to women veterans information regarding 

all services available in the district in which the veteran is seeking 

such services, including, with respect to each medical center and 

community-based outpatient clinic in the applicable Veterans 

Integrated Service Network— 

(1) the name and contact information of each women’s 

health coordinator; 
S. 785—48 

(2) a list of appropriate staff for other benefits available 

from the Veterans Benefits Administration, the National Cemetery Administration, and such other entities as the Secretary 

considers appropriate; and 

(3) such other information as the Secretary considers appropriate. 

(c) UPDATED INFORMATION.—The Secretary shall ensure that 

the information described in subsection (b) that is published on 

the internet website required by subsection (a) is updated not 

less frequently than once every 90 days. 

(d) OUTREACH.—In carrying out this section, the Secretary shall 

ensure that the outreach conducted under section 1720F(i) of title 

38, United States Code, includes information regarding the internet 

website required by subsection (a). 

(e) DERIVATION OF FUNDS.—Amounts used by the Secretary 

to carry out this section shall be derived from amounts made 

available to the Secretary to publish internet websites of the Department. 

TITLE VII—OTHER MATTERS 

SEC. 701. EXPANDED TELEHEALTH FROM DEPARTMENT OF VETERANS 

AFFAIRS. 

(a) 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; 
S. 785—49 

(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) EXCLUSION.—Grants may not be used for the purchase of new property or for major construction projects, 

as determined by the Secretary. 

(c) AGREEMENT ON TELEHEALTH ACCESS POINTS.— 

(1) IN GENERAL.—An entity described in subsection (a) that 

seeks to establish a telehealth access point for veterans but 

does not require grant funding under this section to do so 

may enter into an agreement with the Department for the 

establishment of such an access point. 

(2) ADEQUACY OF FACILITIES.—An entity described in paragraph (1) shall be responsible for ensuring that any access 

point is adequately private, secure, clean, and accessible for 

veterans before the access point is established. 

(d) ASSESSMENT OF BARRIERS TO ACCESS.— 

(1) IN GENERAL.—Not later than 18 months after the date 

of the enactment of this Act, the Secretary shall complete 

an assessment of barriers faced by veterans in accessing telehealth services. 

(2) ELEMENTS.—The assessment required by paragraph (1) 

shall include the following: 

(A) A description of the barriers veterans face in using 

telehealth while not on property of the Department. 

(B) A description of how the Department plans to 

address the barriers described in subparagraph (A). 
S. 785—50 

(C) Such other matters related to access by veterans 

to telehealth while not on property of the Department 

as the Secretary considers relevant. 

(3) REPORT.—Not later than 120 days after the completion 

of the assessment required by paragraph (1), the Secretary 

shall submit to the Committee on Veterans’ Affairs of the 

Senate and the Committee on Veterans’ Affairs of the House 

of Representatives a report on the assessment, including any 

recommendations for legislative or administrative action based 

on the results of the assessment. 

SEC. 702. PARTNERSHIPS WITH NON-FEDERAL GOVERNMENT ENTITIES 

TO PROVIDE HYPERBARIC OXYGEN THERAPY TO VETERANS AND STUDIES ON THE USE OF SUCH THERAPY FOR 

TREATMENT OF POST-TRAUMATIC STRESS DISORDER AND 

TRAUMATIC BRAIN INJURY. 

(a) PARTNERSHIPS TO PROVIDE HYPERBARIC OXYGEN THERAPY

TO VETERANS.— 

(1) USE OF PARTNERSHIPS.—The Secretary of Veterans 

Affairs, in consultation with the Center for Compassionate 

Innovation within the Office of Community Engagement of 

the Department of Veterans Affairs, may enter into partnerships with non-Federal Government entities to provide 

hyperbaric oxygen treatment to veterans to research the 

effectiveness of such therapy. 

(2) TYPES OF PARTNERSHIPS.—Partnerships entered into 

under paragraph (1) may include the following: 

(A) Partnerships to conduct research on hyperbaric 

oxygen therapy. 

(B) Partnerships to review research on hyperbaric 

oxygen therapy provided to nonveterans. 

(C) Partnerships to create industry working groups 

to determine standards for research on hyperbaric oxygen 

therapy. 

(D) Partnerships to provide to veterans hyperbaric 

oxygen therapy for the purposes of conducting research 

on the effectiveness of such therapy. 

(3) LIMITATION ON FEDERAL FUNDING.—Federal Government funding may be used to coordinate and administer the 

partnerships under this subsection but may not be used to 

carry out activities conducted under such partnerships. 

(b) REVIEW OF EFFECTIVENESS OF HYPERBARIC OXYGEN

THERAPY.—Not later than 90 days after the date of the enactment 

of this Act, the Secretary, in consultation with the Center for 

Compassionate Innovation, shall begin using an objective and quantifiable method to review the effectiveness and applicability of 

hyperbaric oxygen therapy, such as through the use of a device 

approved or cleared by the Food and Drug Administration that 

assesses traumatic brain injury by tracking eye movement. 

(c) SYSTEMATIC REVIEW OF USE OF HYPERBARIC OXYGEN

THERAPY TO TREAT CERTAIN CONDITIONS.— 

(1) IN GENERAL.—Not later than 90 days after the date 

of the enactment of this Act, the Secretary, in consultation 

with the Center for Compassionate Innovation, shall commence 

the conduct of a systematic review of published research literature on off-label use of hyperbaric oxygen therapy to treat 
S. 785—51 

post-traumatic stress disorder and traumatic brain injury 

among veterans and nonveterans. 

(2) ELEMENTS.—The review conducted under paragraph (1) 

shall include the following: 

(A) An assessment of the current parameters for 

research on the use by the Department of Veterans Affairs 

of hyperbaric oxygen therapy, including— 

(i) tests and questionnaires used to determine the 

efficacy of such therapy; and 

(ii) metrics for determining the success of such 

therapy. 

(B) A comparative analysis of tests and questionnaires 

used to study post-traumatic stress disorder and traumatic 

brain injury in other research conducted by the Department 

of Veterans Affairs, other Federal agencies, and entities 

outside the Federal Government. 

(3) COMPLETION OF REVIEW.—The review conducted under 

paragraph (1) shall be completed not later than 180 days after 

the date of the commencement of the review. 

(4) REPORT.—Not later than 90 days after the completion 

of the review conducted under paragraph (1), the Secretary 

shall submit to the Committee on Veterans’ Affairs of the 

Senate and the Committee on Veterans’ Affairs of the House 

of Representatives a report on the results of the review. 

(d) FOLLOW-UP STUDY.— 

(1) IN GENERAL.—Not later than 120 days after the completion of the review conducted under subsection (c), the Secretary, 

in consultation with the Center for Compassionate Innovation, 

shall commence the conduct of a study on all individuals 

receiving hyperbaric oxygen therapy through the current pilot 

program of the Department for the provision of hyperbaric 

oxygen therapy to veterans to determine the efficacy and 

effectiveness of hyperbaric oxygen therapy for the treatment 

of post-traumatic stress disorder and traumatic brain injury. 

(2) ELEMENTS.—The study conducted under paragraph (1) 

shall include the review and publication of any data and conclusions resulting from research conducted by an authorized provider of hyperbaric oxygen therapy for veterans through the 

pilot program described in such paragraph. 

(3) COMPLETION OF STUDY.—The study conducted under 

paragraph (1) shall be completed not later than three years 

after the date of the commencement of the study. 

(4) REPORT.— 

(A) IN GENERAL.—Not later than 90 days after completing the study conducted under paragraph (1), the Secretary shall submit to the Committee on Veterans’ Affairs 

of the Senate and the Committee on Veterans’ Affairs of 

the House of Representatives a report on the results of 

the study. 

(B) ELEMENTS.—The report required under subparagraph (A) shall include the recommendation of the Secretary with respect to whether or not hyperbaric oxygen 

therapy should be made available to all veterans with 

traumatic brain injury or post-traumatic stress disorder. 
S. 785—52 

SEC. 703. PRESCRIPTION OF TECHNICAL QUALIFICATIONS FOR 

LICENSED HEARING AID SPECIALISTS AND REQUIREMENT 

FOR APPOINTMENT OF SUCH SPECIALISTS. 

(a) TECHNICAL QUALIFICATIONS.— (1) 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) APPOINTMENT.—Not later than September 30, 2022, the 

Secretary shall appoint not fewer than one licensed hearing aid 

specialist at each medical center of the Department. 

(d) REPORT.—Not later than September 30, 2022, and annually 

thereafter, the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs 

of the House of Representatives a report— 

(1) assessing the progress of the Secretary in appointing 

licensed hearing aid specialists under subsection (c); 

(2) assessing potential conflicts or obstacles that prevent 

the appointment of licensed hearing aid specialists; 

(3) assessing the factors that led to such conflicts or 

obstacles; 

(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. 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’’, 
S. 785—53 

to allow sponsored clinical research of the Department of Veterans 

Affairs to use accredited commercial institutional review boards 

to review research proposal protocols of the Department. 

(b) IDENTIFICATION OF REVIEW BOARDS.—Not later than 90 

days after the completion of the policy revisions under subsection 

(a), the Secretary shall— 

(1) identify accredited commercial institutional review 

boards for use in connection with sponsored clinical research 

of the Department; and 

(2) establish a process to modify existing approvals in the 

event that a commercial institutional review board loses its 

accreditation during an ongoing clinical trial. 

(c) REPORT.— 

(1) IN GENERAL.—Not later than 90 days after the completion of the policy revisions under subsection (a), and annually 

thereafter, the Secretary shall submit to the Committee on 

Veterans’ Affairs of the Senate and the Committee on Veterans’ 

Affairs of the House of Representatives a report on all approvals 

of institutional review boards used by the Department, 

including central institutional review boards and commercial 

institutional review boards. 

(2) ELEMENTS.—The report required by paragraph (1) shall 

include, at a minimum, the following: 

(A) The name of each clinical trial with respect to 

which the use of an institutional review board has been 

approved. 

(B) The institutional review board or institutional 

review boards used in the approval process for each clinical 

trial. 

(C) The amount of time between submission and 

approval. 

SEC. 705. CREATION OF OFFICE OF RESEARCH REVIEWS WITHIN THE 

OFFICE OF INFORMATION AND TECHNOLOGY OF THE 

DEPARTMENT OF VETERANS AFFAIRS. 

(a) IN GENERAL.—Not later than one year after the date of 

the enactment of this Act, the Secretary of Veterans Affairs shall 

establish within the Office of Information and Technology of the 

Department of Veterans Affairs an Office of Research Reviews 

(in this section referred to as the ‘‘Office’’). 

(b) ELEMENTS.—The Office shall do the following: 

(1) Perform centralized security reviews and complete security processes for approved research sponsored outside the 

Department, with a focus on multi-site clinical trials. 

(2) Develop and maintain a list of commercially available 

software preferred for use in sponsored clinical trials of the 

Department and ensure such list is maintained as part of 

the official approved software products list of the Department. 

(3) Develop benchmarks for appropriate timelines for security reviews conducted by the Office. 

(c) REPORT.— 

(1) IN GENERAL.—Not later than one year after the 

establishment of the Office, the Office shall submit to the 

Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives 

a report on the activity of the Office. 
S. 785—54 

(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). 

Speaker of the House of Representatives. 

Vice President of the United States and

President of the Senate.