II 

Calendar No. 498 

116TH CONGRESS 

2D SESSION S. 785 

To improve mental health care provided by the Department of Veterans 

Affairs, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

MARCH 13, 2019 

Mr. TESTER (for himself, Mr. MORAN, Ms. BALDWIN, Ms. STABENOW, Mr. 

KAINE, Mr. MARKEY, Ms. SINEMA, Ms. HIRONO, Mr. DURBIN, Mr. 

CASEY, Ms. HARRIS, Mr. UDALL, Mr. BLUMENTHAL, Mr. MURPHY, Mr. 

WARNER, Mrs. MURRAY, Mrs. FEINSTEIN, Mr. MENENDEZ, Mr. BOOKER, Ms. SMITH, Mr. MANCHIN, Ms. KLOBUCHAR, Mr. SANDERS, Ms. 

DUCKWORTH, Mr. PETERS, Mrs. GILLIBRAND, Mr. MERKLEY, Mr. SULLIVAN, Mr. BENNET, Ms. HASSAN, Mr. COONS, Mr. ROBERTS, Mrs. SHAHEEN, Mr. DAINES, Mr. CRAPO, Mr. BOOZMAN, Ms. CORTEZ MASTO, Mr. 

CRAMER, Ms. MCSALLY, Mr. CORNYN, Ms. ROSEN, Mr. JONES, Ms. COLLINS, Mrs. BLACKBURN, Mr. ROUNDS, Mr. HOEVEN, Mr. RISCH, Mr. 

WYDEN, Ms. MURKOWSKI, Mr. WICKER, Mr. PORTMAN, and Mr. HEINRICH) introduced the following bill; which was read twice and referred to 

the Committee on Veterans’ Affairs 

JULY 27, 2020 

Reported by Mr. MORAN, with an amendment 

[Strike out all after the enacting clause and insert the part printed in italic] 

A BILL 

To improve mental health care provided by the Department 

of Veterans Affairs, and for other purposes. 


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1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

5 ‘‘Commander John Scott Hannon Veterans Mental Health 

6 Care Improvement Act of 2019’’. 

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

8 this Act is as follows: 

Sec. 1. Short title; table of contents. 

TITLE I—IMPROVEMENT OF TRANSITION OF INDIVIDUALS TO 

SERVICES FROM DEPARTMENT OF VETERANS AFFAIRS 

Sec. 101. Expansion of health care coverage for veterans. 

Sec. 102. Grants for provision of transition assistance to former members of 

the Armed Forces transitioning to civilian life. 

Sec. 103. Study of community-based transition assistance programs for former 

members of the Armed Forces. 

Sec. 104. Modification of eligibility for care from Department of Veterans Affairs for former members of the Armed Forces with other than 

honorable discharges and report on such care. 

TITLE II—SUICIDE PREVENTION 

Sec. 201. Grants for organizations providing mental health wellness services to 

veterans. 

Sec. 202. Designation of buddy check week by Department of Veterans Affairs. 

Sec. 203. Post-traumatic growth partnerships. 

Sec. 204. Progress of Department of Veterans Affairs in meeting goals and objectives of National Strategy for Preventing Veteran Suicide. 

Sec. 205. Study on feasibility and advisability of providing certain complementary and integrative health services. 

Sec. 206. Program to provide veterans access to complementary and integrative 

health services through animal therapy, agri-therapy, and outdoor sports therapy. 

Sec. 207. 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. Program to provide veterans access to computerized cognitive behavioral therapy. 

Sec. 302. Study on connection between living at high altitude and suicide risk 

factors among veterans. 


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Sec. 303. Establishment by Department of Veterans Affairs and Department of 

Defense of clinical practice guidelines for comorbid mental 

health conditions. 

Sec. 304. Update of clinical practice guidelines for assessment and management 

of patients at risk for suicide. 

Sec. 305. Precision medicine initiative of Department of Veterans Affairs to 

identify and validate brain and mental health biomarkers. 

Sec. 306. Preventative and complex data analysis 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. Annual report on progress of Department of Veterans Affairs in 

meeting goals and objectives of Executive Order 13822. 

Sec. 404. Comptroller General management review of mental health and suicide 

prevention services of Department of Veterans Affairs. 

Sec. 405. Comptroller General report on efforts of Department of Veterans Affairs to integrate mental health care into primary care clinics. 

Sec. 406. Joint mental health programs by Department of Veterans Affairs and 

Department of Defense. 

TITLE V—MEDICAL WORKFORCE 

Subtitle A—Improvement of Mental Health Medical Workforce 

Sec. 501. Treatment of psychologists. 

Sec. 502. Staffing improvement plan for psychiatrists and psychologists of Department of Veterans Affairs. 

Sec. 503. Occupational series and staffing improvement plan for licensed professional mental health counselors and marriage and family 

therapists of Department of Veterans Affairs. 

Sec. 504. Staffing improvement plan for peer specialists of Department of Veterans Affairs who are women. 

Sec. 505. Establishment of Department of Veterans Affairs Readjustment 

Counseling Service Scholarship Program. 

Sec. 506. Comptroller General report on Readjustment Counseling Service of 

Department of Veterans Affairs. 

Sec. 507. Expansion of reporting requirements on Readjustment Counseling 

Service of Department of Veterans Affairs. 

Sec. 508. Studies on alternative work schedules for employees of Veterans 

Health Administration. 

Sec. 509. Suicide prevention coordinators. 

Subtitle B—Direct Hiring Authorities for Certain Health Care Positions 

Sec. 521. Direct hiring authorities for certain health care positions. 

TITLE VI—IMPROVEMENT OF TELEHEALTH SERVICES 

Sec. 601. Expanded telehealth from Department of Veterans Affairs. 

Sec. 602. Implementation of national protocol for telehealth security and interfacing instructions. 


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1 TITLE I—IMPROVEMENT OF 

2 TRANSITION OF INDIVIDUALS 

3 TO SERVICES FROM DEPART4 MENT OF VETERANS AFFAIRS 

5 SEC. 101. EXPANSION OF HEALTH CARE COVERAGE FOR 

6 VETERANS. 

7 (a) IN GENERAL.—Section 1710(a)(1) of title 38, 

8 United States Code, is amended— 

9 (1) in subparagraph (A), by striking ‘‘and’’ at 

10 the end; 

11 (2) by redesignating subparagraph (B) as sub12 paragraph (C); and 

13 (3) by inserting after subparagraph (A) the fol14 lowing new subparagraph (B): 

15 ‘‘(B) to any veteran during the one-year period 

16 following the discharge or release of the veteran 

17 from active military, naval, or air service; and’’. 

18 (b) PATIENT ENROLLMENT SYSTEM.—Section 

19 1705(c) of such title is amended by adding at the end the 

20 following new paragraph: 

21 ‘‘(3) Nothing in this section shall be construed to pre22 vent the Secretary from providing hospital care and med23 ical services to a veteran under section 1710(a)(1)(B) of 

24 this title during the period specified in such section not25 withstanding the failure of the veteran to enroll in the sysVerDate Sep 11 2014 00:32 Jul 28, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6401 E:\BILLS\S785.RS S785

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1 tem of patient enrollment established by the Secretary 

2 under subsection (a).’’. 

3 (c) PROMOTION OF EXPANDED ELIGIBILITY.— 

4 (1) TRANSITION ASSISTANCE PROGRAM.— 

5 (A) IN GENERAL.—The Secretary of 

6 Labor, in consultation with the Secretary of 

7 Defense and the Secretary of Veterans Affairs, 

8 shall promote to members of the Armed Forces 

9 transitioning from service in the Armed Forces 

10 to civilian life through the Transition Assist11 ance Program the expanded eligibility of vet12 erans for health care under the laws adminis13 tered by the Secretary of Veterans Affairs pur14 suant to the amendments made by this section. 

15 (B) TRANSITION ASSISTANCE PROGRAM

16 DEFINED.—In this paragraph, the term ‘‘Tran17 sition Assistance Program’’ means the Transi18 tion Assistance Program under sections 1142 

19 and 1144 of title 10, United States Code. 

20 (2) PUBLICATION BY DEPARTMENT OF VET21 ERANS AFFAIRS.—Not later than 30 days after the 

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

23 Veterans Affairs shall publish on a website of the 

24 Department of Veterans Affairs notification of the 

25 expanded eligibility of veterans for health care under 


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1 the laws administered by the Secretary pursuant to 

2 the amendments made by this section. 

3 SEC. 102. GRANTS FOR PROVISION OF TRANSITION ASSIST4 ANCE TO FORMER MEMBERS OF THE ARMED 

5 FORCES TRANSITIONING TO CIVILIAN LIFE. 

6 (a) PROGRAM REQUIRED.—Commencing not later 

7 than 180 days after the date of the enactment of this Act, 

8 the Secretary of Labor shall, in coordination with the Sec9 retary of Veterans Affairs, carry out a program on the 

10 provision of assistance to former members of the Armed 

11 Forces, and spouses of such members, transitioning from 

12 service in the Armed Forces to civilian life. 

13 (b) DURATION OF PROGRAM.—The Secretary of 

14 Labor shall carry out the program during the five-year 

15 period beginning on the date of the commencement of the 

16 program. 

17 (c) GRANTS.— 

18 (1) IN GENERAL.—The Secretary shall carry 

19 out the program through the award of grants to eli20 gible organizations for the provision of assistance de21 scribed in subsection (a). 

22 (2) MATCHING FUNDS REQUIRED.—A grant 

23 under this section shall be in an amount that does 

24 not exceed 50 percent of the amount required by the 


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1 organization to provide the services described in sub2 section (f). 

3 (d) ELIGIBLE ORGANIZATIONS.—For purposes of 

4 this section, an eligible organization is any nonprofit orga5 nization that the Secretary of Labor determines, in con6 sultation with the Secretary of Veterans Affairs and State 

7 entities that serve veterans, is suitable for receipt of a 

8 grant under the program pursuant to receipt by the Sec9 retary of Labor of an application submitted under sub10 section (e)(1). 

11 (e) SELECTION OF GRANT RECIPIENTS.— 

12 (1) APPLICATIONS.—An organization seeking a 

13 grant under the program shall submit to the Sec14 retary of Labor an application therefor at such time, 

15 in such manner, and containing such information 

16 and assurances as the Secretary, in consultation 

17 with the Secretary of Veterans Affairs and State en18 tities that serve veterans, may require. 

19 (2) PRIORITY FOR HUBS OF SERVICES.—In 

20 awarding grants under the program, the Secretary 

21 of Labor shall give priority to an organization that 

22 provides multiple forms of services described in sub23 section (f). 

24 (f) USE OF GRANT FUNDS.—Each organization re25 ceiving a grant under the program shall use the grant to 


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1 provide to former members of the Armed Forces and 

2 spouses described in subsection (a) the following: 

3 (1) R ́esum ́e assistance. 

4 (2) Interview training. 

5 (3) Job recruitment training. 

6 (4) Entrepreneurship training. 

7 (5) Financial services. 

8 (6) Legal assistance. 

9 (7) Educational supportive services. 

10 (8) Assistance with accessing benefits provided 

11 under laws administered by the Secretary of Vet12 erans Affairs, including home loan benefits, edu13 cation benefits, adaptive housing grants, and all 

14 other benefits. 

15 (9) Nonclinical case management. 

16 (10) Other related services leading directly to 

17 successful transition, as determined by the Secretary 

18 of Labor in consultation with the Secretary of Vet19 erans Affairs. 

20 (g) ANNUAL REPORTS.— 

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

22 after the date of the commencement of the program 

23 and not less frequently than once each year there24 after until the termination of the program, the Sec25 retary of Labor shall, in consultation with the SecVerDate Sep 11 2014 00:32 Jul 28, 2020 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6401 E:\BILLS\S785.RS S785

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1 retary of Veterans Affairs, submit to the appropriate 

2 committees of Congress a report on the program 

3 carried out under this section. 

4 (2) CONTENTS.—Each report submitted under 

5 paragraph (1) shall include the following: 

6 (A) A list of the organizations that have 

7 received grants under the program, including 

8 the geographic location of the organization and 

9 the types of services outlined in subsection (f) 

10 that each organization provides. 

11 (B) The number of veterans served by each 

12 organization. 

13 (C) An assessment of the effectiveness of 

14 the services provided under the program at im15 proving the transition process for former mem16 bers of the Armed Forces and spouses described 

17 in subsection (a), based on metrics determined 

18 by the Secretary of Labor in consultation with 

19 the Secretary of Veterans Affairs. 

20 (D) The amount of each grant awarded to 

21 each organization under the program. 

22 (E) Such other matters as the Secretary of 

23 Labor, in consultation with the Secretary of 

24 Veterans Affairs, considers appropriate. 


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1 (3) APPROPRIATE COMMITTEES OF CON2 GRESS.—In this subsection, the term ‘‘appropriate 

3 committees of Congress’’ means— 

4 (A) the Committee on Veterans’ Affairs 

5 and the Committee on Appropriations of the 

6 Senate; and 

7 (B) the Committee on Veterans’ Affairs 

8 and the Committee on Appropriations of the 

9 House of Representatives. 

10 (h) AUTHORIZATION OF APPROPRIATIONS.—There is 

11 authorized to be appropriated $10,000,000 to carry out 

12 this section. 

13 SEC. 103. STUDY OF COMMUNITY-BASED TRANSITION AS14 SISTANCE PROGRAMS FOR FORMER MEM15 BERS OF THE ARMED FORCES. 

16 (a) STUDY.— 

17 (1) IN GENERAL.—The Secretary of Veterans 

18 Affairs shall, in consultation with the Secretary of 

19 Labor and State entities that serve former members 

20 of the Armed Forces, enter into an agreement with 

21 a Federal or non-Federal entity to develop or access 

22 a comprehensive list of community-based programs 

23 that— 


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1 (A) provide transition assistance to such 

2 former members that lead directly to successful 

3 transition to civilian life, such as— 

4 (i) r ́esum ́e assistance; 

5 (ii) interview training; 

6 (iii) job recruitment training; 

7 (iv) entrepreneurship training; 

8 (v) financial services; 

9 (vi) legal assistance; 

10 (vii) educational supportive services; 

11 (viii) assistance with accessing bene12 fits provided under laws administered by 

13 the Secretary of Veterans Affairs, includ14 ing home loan benefits, education benefits, 

15 adaptive housing grants, and other bene16 fits; and 

17 (ix) nonclinical case management; and 

18 (B) are operated by nonprofit organiza19 tions. 

20 (2) UPDATES.— 

21 (A) PERIODIC.—Not less frequently than 

22 once every five years, the Secretary shall update 

23 the list created under paragraph (1). 

24 (B) UPON REQUEST.—In addition to peri25 odic updates under subparagraph (A), the SecVerDate Sep 11 2014 00:32 Jul 28, 2020 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6401 E:\BILLS\S785.RS S785

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1 retary shall update the list created under para2 graph (1) upon request of an organization with 

3 a program included in the list. 

4 (C) VERIFICATION.—The Secretary shall, 

5 in consultation with State entities that serve 

6 former members of the Armed Forces and to 

7 the degree practicable, verify changes to the list 

8 made under this paragraph. 

9 (b) TRANSMISSION TO MEMBERS.—The Secretary 

10 shall transmit the list created, and revised as the case may 

11 be, under subsection (a) to the Secretary of Labor and 

12 the Secretary of Defense so the Secretaries of the military 

13 departments may provide information in the list to mem14 bers of the Armed Forces who participate in the Transi15 tion Assistance Program under sections 1142 and 1144 

16 of title 10, United States Code. 

17 (c) ONLINE PUBLICATION.—The Secretary of Vet18 erans Affairs shall publish the list created, and revised as 

19 the case may be, under subsection (a) on a public website 

20 of the Department of Veterans Affairs. 


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1 SEC. 104. MODIFICATION OF ELIGIBILITY FOR CARE FROM 

2 DEPARTMENT OF VETERANS AFFAIRS FOR 

3 FORMER MEMBERS OF THE ARMED FORCES 

4 WITH OTHER THAN HONORABLE DIS5 CHARGES AND REPORT ON SUCH CARE. 

6 (a) ELIGIBILITY.—Subsection (b)(2)(B) of section 

7 1720I of title 38, United States Code, is amended by 

8 striking ‘‘a discharge by court martial’’ and inserting ‘‘a 

9 dismissal’’. 

10 (b) INFORMATION.—Subsection (e) of such section is 

11 amended— 

12 (1) in paragraph (3)— 

13 (A) in subparagraph (B), by striking 

14 ‘‘and’’ at the end; 

15 (B) in subparagraph (C), by striking 

16 ‘‘and’’ at the end; 

17 (C) by redesignating subparagraph (C) as 

18 subparagraph (D); and 

19 (D) by inserting after subparagraph (B) 

20 the following new subparagraph (C): 

21 ‘‘(C) is displayed prominently on a website 

22 of the Department; and’’; 

23 (2) by redesignating paragraph (4) as para24 graph (5); and 

25 (3) by inserting after paragraph (3) the fol26 lowing new paragraph (4): 


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1 ‘‘(4) shall include outreach on Internet search 

2 engines; and’’. 

3 (c) ANNUAL REPORT.—Subsection (f) of such section 

4 is amended— 

5 (1) in paragraph (1), by striking ‘‘Not less fre6 quently than once’’ and inserting ‘‘Not later than 

7 February 15’’; and 

8 (2) in paragraph (2)— 

9 (A) by redesignating subparagraph (C) as 

10 subparagraph (F); and 

11 (B) by inserting after subsection (B) the 

12 following new subparagraphs: 

13 ‘‘(C) The types of mental or behavioral 

14 health care needs treated under this section. 

15 ‘‘(D) The demographics of individuals 

16 being treated under this section, including— 

17 ‘‘(i) age; 

18 ‘‘(ii) era of service in the Armed 

19 Forces; 

20 ‘‘(iii) branch of service in the Armed 

21 Forces; and 

22 ‘‘(iv) geographic location. 

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

24 individual for mental or behavioral health care 

25 under this section.’’. 


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1 TITLE II—SUICIDE PREVENTION 

2 SEC. 201. GRANTS FOR ORGANIZATIONS PROVIDING MEN3 TAL HEALTH WELLNESS SERVICES TO VET4 ERANS. 

5 (a) PURPOSE.—The purpose of this section is to fa6 cilitate the provision of mental health services for veterans 

7 with mental health conditions who are receiving care out8 side of the Department of Veterans Affairs. 

9 (b) GRANTS.— 

10 (1) IN GENERAL.—Subchapter II of chapter 17 

11 of title 38, United States Code, is amended by add12 ing at the end the following new section: 

13 ‘‘§ 1720J. Financial assistance for mental health sup14 portive services for veterans seeking 

15 mental health treatment 

16 ‘‘(a) DISTRIBUTION OF FINANCIAL ASSISTANCE.— 

17 (1) The Secretary shall provide financial assistance to eli18 gible entities approved under this section to provide or co19 ordinate the provision of mental health supportive services 

20 described in subsection (b) for a veteran with a mental 

21 health condition who is seeking mental health treatment. 

22 ‘‘(2) Financial assistance under paragraph (1) shall 

23 consist of the award of a grant to an approved eligible 

24 entity for each veteran described in paragraph (1) for 


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1 which the approved eligible entity is providing or coordi2 nating the provision of mental health supportive services. 

3 ‘‘(3)(A) The Secretary shall award grants under this 

4 section to each approved eligible entity that is providing 

5 or coordinating the provision of mental health supportive 

6 services under this section. 

7 ‘‘(B) The Secretary may establish intervals of pay8 ment for the administration of grants under this section 

9 and establish a maximum amount to be awarded, in ac10 cordance with the services being provided and the duration 

11 of such services. 

12 ‘‘(4) In providing financial assistance under para13 graph (1), the Secretary shall give preference to entities 

14 providing or coordinating the provision of supportive men15 tal health services for veterans with mental health condi16 tions who face barriers in accessing mental health care 

17 services from the Department. 

18 ‘‘(5) The Secretary shall ensure that, to the extent 

19 practicable, financial assistance under this subsection is 

20 equitably distributed across geographic regions, including 

21 rural communities and tribal lands. 

22 ‘‘(6) Each entity receiving financial assistance under 

23 this section to provide mental health supportive services 

24 to a veteran with a mental health condition shall notify 


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1 that veteran that such services are being paid for, in whole 

2 or in part, by the Department. 

3 ‘‘(7) The Secretary shall require entities receiving fi4 nancial assistance under this section to submit a report 

5 to the Secretary that describes the services provided or 

6 coordinated with such financial assistance. 

7 ‘‘(b) MENTAL HEALTH SUPPORTIVE SERVICES.— 

8 The mental health supportive services described in this 

9 subsection are services provided by an eligible entity or 

10 a subcontractor of an eligible entity that address the needs 

11 of veterans with mental health conditions, including— 

12 ‘‘(1) outreach services; 

13 ‘‘(2) case management services; 

14 ‘‘(3) assistance in obtaining any benefits from 

15 the Department that the veteran may be eligible to 

16 receive, including health care services, vocational and 

17 rehabilitation counseling, employment and training 

18 services, and educational assistance; and 

19 ‘‘(4) assistance in obtaining and coordinating 

20 the provision of other public benefits provided by 

21 any Federal, State, or local agency, or any other eli22 gible entity, including— 

23 ‘‘(A) health care services (including obtain24 ing health insurance); 

25 ‘‘(B) daily living services; 


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1 ‘‘(C) personal financial planning services; 

2 ‘‘(D) transportation services; 

3 ‘‘(E) income support services; 

4 ‘‘(F) fiduciary and representative payee 

5 services; 

6 ‘‘(G) legal services to assist the veteran 

7 with issues that interfere with the ability of the 

8 veteran to find and retain meaningful employ9 ment, housing, or benefits to which the veteran 

10 may be entitled; 

11 ‘‘(H) child care services; 

12 ‘‘(I) housing counseling; and 

13 ‘‘(J) other services necessary for maintain14 ing independent living. 

15 ‘‘(c) APPLICATION FOR FINANCIAL ASSISTANCE.— 

16 (1) An eligible entity seeking financial assistance under 

17 subsection (a) shall submit to the Secretary an application 

18 therefor in such form, in such manner, and containing 

19 such commitments and information as the Secretary deter20 mines to be necessary to carry out this section. 

21 ‘‘(2) Each application submitted by an eligible entity 

22 under paragraph (1) shall contain— 

23 ‘‘(A) a description of the mental health sup24 portive services described in subsection (b) proposed 


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1 to be provided by the eligible entity under this sec2 tion and the identified needs for those services; 

3 ‘‘(B) a description of the types of veterans with 

4 a mental health condition proposed to be provided 

5 such services; 

6 ‘‘(C) an estimate of the number of veterans 

7 with a mental health condition proposed to be pro8 vided such services; 

9 ‘‘(D) evidence of the experience of the eligible 

10 entity in providing mental health supportive services 

11 to veterans with a mental health condition; and 

12 ‘‘(E) a description of the managerial capacity of 

13 the eligible entity— 

14 ‘‘(i) to coordinate the provision of mental 

15 health supportive services with the provision of 

16 mental health services by the eligible entity or 

17 another organization; 

18 ‘‘(ii) to assess continually the needs of vet19 erans with a mental health condition for mental 

20 health supportive services; 

21 ‘‘(iii) to coordinate the provision of mental 

22 health supportive services with the services of 

23 the Department; and 


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1 ‘‘(iv) to tailor supportive mental health 

2 services to the needs of veterans with a mental 

3 health condition. 

4 ‘‘(3)(A) The Secretary shall establish criteria for the 

5 selection of eligible entities to be provided financial assist6 ance under this section. 

7 ‘‘(B) Criteria established under subparagraph (A) 

8 with respect to an eligible entity shall include the fol9 lowing: 

10 ‘‘(i) Relevant accreditation as may be required 

11 by each State in which the eligible entity operates. 

12 ‘‘(ii) Experience coordinating care or providing 

13 treatment for veterans or members of the Armed 

14 Forces. 

15 ‘‘(d) TECHNICAL ASSISTANCE.—(1) The Secretary 

16 shall provide training and technical assistance to eligible 

17 entities provided financial assistance under this section re18 garding the planning, development, and provision of men19 tal health supportive services under this section. 

20 ‘‘(2) The Secretary may provide the training de21 scribed in paragraph (1) directly or through grants or con22 tracts with appropriate public or nonprofit private entities, 

23 including through grants awarded under section 2064 of 

24 this title. 


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1 ‘‘(e) COLLECTION OF INFORMATION.—To the extent 

2 practicable, the Secretary may collect information from an 

3 eligibility entity awarded a grant under this section relat4 ing to a mental health condition of a veteran for inclusion 

5 in the electronic health record of the Department for such 

6 veteran for the sole purpose of improving care provided 

7 to such veteran. 

8 ‘‘(f) FUNDING.—From amounts appropriated to the 

9 Department for medical services, there shall be available 

10 to carry out subsections (a), (b), and (c) the following: 

11 ‘‘(1) $5,000,000 for fiscal year 2021. 

12 ‘‘(2) $10,000,000 for fiscal year 2022. 

13 ‘‘(3) $15,000,000 for fiscal year 2023. 

14 ‘‘(g) DEFINITIONS.—In this section: 

15 ‘‘(1) The term ‘eligible entity’ means any of the 

16 following: 

17 ‘‘(A) An incorporated private institution or 

18 foundation— 

19 ‘‘(i) no part of the net earnings of 

20 which inures to the benefit of any member, 

21 founder, contributor, or individual; 

22 ‘‘(ii) that has a governing board that 

23 is responsible for the operation of the men24 tal health supportive services provided 

25 under this section; and 


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1 ‘‘(iii) that is approved by the Sec2 retary with respect to financial responsi3 bility. 

4 ‘‘(B) A for-profit limited partnership, the 

5 sole general partner of which is an organization 

6 meeting the requirements of clauses (i), (ii), 

7 and (iii) of subparagraph (A). 

8 ‘‘(C) A corporation wholly owned and con9 trolled by an organization meeting the require10 ments of clauses (i), (ii), and (iii) of subpara11 graph (A). 

12 ‘‘(D) A tribally designated housing entity 

13 (as defined in section 4 of the Native American 

14 Housing Assistance and Self-Determination Act 

15 of 1996 (25 U.S.C. 4103)). 

16 ‘‘(2) The term ‘veteran with a mental health 

17 condition’ means a veteran who has been diagnosed 

18 with, or who is seeking treatment for, one or more 

19 mental health conditions, as determined by the Sec20 retary.’’. 

21 (2) CLERICAL AMENDMENT.—The table of sec22 tions at the beginning of chapter 17 is amended by 

23 inserting after the item relating to section 1720I the 

24 following new item: 

‘‘1720J. Financial assistance for mental health supportive services for veterans 

seeking mental health treatment.’’. 


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1 (c) STUDY ON EFFECTIVENESS OF PROGRAM.— 

2 (1) IN GENERAL.—The Secretary of Veterans 

3 Affairs shall conduct a study on the effectiveness of 

4 the program of financial assistance under section 

5 1720J of title 38, United States Code, as added by 

6 subsection (b), in meeting the needs of veterans with 

7 a mental health condition, as that term is defined in 

8 that section. 

9 (2) COMPARISON.—In conducting the study re10 quired by paragraph (1), the Secretary shall com11 pare the results of the program described in that 

12 paragraph with other programs of the Department 

13 of Veterans Affairs dedicated to the delivery of men14 tal health services to veterans. 

15 (3) CRITERIA.—In making the comparison re16 quired by paragraph (2), the Secretary shall examine 

17 the following: 

18 (A) The satisfaction of veterans targeted 

19 by the programs described in paragraph (2). 

20 (B) The health status of such veterans. 

21 (C) The mental wellness of such veterans. 

22 (D) The degree to which such veterans are 

23 encouraged to engage in productive activity by 

24 such programs. 


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1 (E) The number of veterans using such 

2 programs, disaggregated by— 

3 (i) veterans who have received care 

4 from the Department in the previous two 

5 years; and 

6 (ii) veterans who have not received 

7 care from the Department in the previous 

8 two years. 

9 (F) The number of veterans who die by 

10 suicide while receiving services from an entity 

11 in receipt of a grant under the program of fi12 nancial assistance under section 1720J of title 

13 38, United States Code, as added by subsection 

14 (b), or who die by suicide during the 180-day 

15 period after receiving such services. 

16 (4) REPORT.—Not later than December 31, 

17 2021, and annually thereafter, the Secretary shall 

18 submit to the Committee on Veterans’ Affairs of the 

19 Senate and the Committee on Veterans’ Affairs of 

20 the House of Representatives a report on the results 

21 of the study required by paragraph (1). 

22 (d) EFFECTIVE DATE.—The Secretary shall begin 

23 providing financial assistance under section 1720J of title 

24 38, United States Code, as added by subsection (b), not 


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1 later than one year after the date of the enactment of this 

2 Act. 

3 SEC. 202. DESIGNATION OF BUDDY CHECK WEEK BY DE4 PARTMENT OF VETERANS AFFAIRS. 

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

6 shall designate one week per year to organize outreach 

7 events and educate veterans on how to conduct peer 

8 wellness checks, which shall be known as ‘‘Buddy Check 

9 Week’’. 

10 (b) EVENTS AND EDUCATION.— 

11 (1) IN GENERAL.—During Buddy Check Week, 

12 the Secretary, in consultation with organizations 

13 that represent veterans, non-profits that serve vet14 erans, mental health experts, members of the Armed 

15 Forces, and such other entities and individuals as 

16 the Secretary considers appropriate, shall collaborate 

17 with organizations that represent veterans to provide 

18 educational opportunities for veterans to learn how 

19 to conduct peer wellness checks. 

20 (2) TRAINING MATTERS.—As part of the edu21 cational opportunities provided under paragraph (1), 

22 the Secretary shall provide the following: 

23 (A) A script for veterans to use to conduct 

24 peer wellness checks that includes information 


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1 on appropriate referrals to resources veterans 

2 might need. 

3 (B) Online and in-person training, as ap4 propriate, on how to conduct a peer wellness 

5 check. 

6 (C) Opportunities for members of organi7 zations that represent veterans to learn how to 

8 train individuals to conduct peer wellness 

9 checks. 

10 (D) Training for veterans participating in 

11 Buddy Check Week on how to transfer a phone 

12 call directly to the Veterans Crisis Line. 

13 (E) Resiliency training for veterans partici14 pating in Buddy Check Week on handling a vet15 eran in crisis. 

16 (3) ONLINE MATERIALS.—All training materials 

17 provided under the educational opportunities under 

18 paragraph (1) shall be made available on a website 

19 of the Department. 

20 (c) OUTREACH.—The Secretary, in collaboration with 

21 organizations that represent veterans, may conduct out22 reach regarding educational opportunities under sub23 section (b) at— 

24 (1) public events where many veterans are ex25 pected to congregate; 


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1 (2) meetings of organizations that represent 

2 veterans; 

3 (3) facilities of the Department of Veterans Af4 fairs; and 

5 (4) such other locations as the Secretary, in col6 laboration with organizations that represent vet7 erans, considers appropriate. 

8 (d) VETERANS CRISIS LINE PLAN.— 

9 (1) IN GENERAL.—The Secretary shall ensure 

10 that the Veterans Crisis Line has a plan for han11 dling the potential increase of calls that may occur 

12 during Buddy Check Week. 

13 (2) SUBMITTAL OF PLAN.—The head of the 

14 Veterans Crisis Line shall submit to the Secretary a 

15 plan for how to handle excess calls during Buddy 

16 Check Week, which may include the following: 

17 (A) Additional hours for staff. 

18 (B) The use of a backup call center. 

19 (C) Any other plan to ensure that calls 

20 from veterans in crisis are being answered in a 

21 timely manner by an individual trained at the 

22 same level as a Veterans Crisis Line responder. 

23 (e) VETERANS CRISIS LINE DEFINED.—In this sec24 tion, the term ‘‘Veterans Crisis Line’’ means the toll-free 


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1 hotline for veterans established under section 1720F(h) of 

2 title 38, United States Code. 

3 SEC. 203. POST-TRAUMATIC GROWTH PARTNERSHIPS. 

4 (a) IN GENERAL.—The Secretary of Veterans Af5 fairs, in consultation with the Secretary of Defense and 

6 the Secretary of Homeland Security, shall enter into part7 nerships with nonprofit mental health organizations to fa8 cilitate post-traumatic growth among veterans who have 

9 experienced trauma. 

10 (b) CONSULTATION.—Before entering into a partner11 ship under subsection (a), the Secretary of Veterans Af12 fairs shall consult with the National Institute of Mental 

13 Health, the National Alliance on Mental Illness, the Amer14 ican Psychological Association, the Posttraumatic Growth 

15 Research Group, and organizations that represent vet16 erans. 

17 (c) SELECTION OF PARTNERS.—The Secretary of 

18 Veterans Affairs shall ensure that each organization with 

19 which the Secretary enters into a partnership under sub20 section (a) has a demonstrated history of success with pro21 grams to facilitate post-traumatic growth, including— 

22 (1) long-term follow-up with veterans who have 

23 participated in such a program for not less than one 

24 year after completion of the program; and 


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1 (2) sustained positive, clinically significant out2 comes for veterans who have participated in such a 

3 program for not less than 180 days after completion 

4 of the program. 

5 (d) OUTCOMES FROM PARTNERS.—The Secretary of 

6 Veterans Affairs shall require each nonprofit mental 

7 health organization that enters into a partnership with the 

8 Secretary under subsection (a) to submit to the Secretary 

9 a description of the outcomes from such partnership, in10 cluding the following: 

11 (1) The number of veterans who participate in 

12 programs of the organization to facilitate post-trau13 matic growth, including the number of veterans who 

14 drop out before completion of the program. 

15 (2) The types of mental or behavioral health 

16 conditions of veterans who participate in such pro17 grams. 

18 (3) The percentage of veterans who experience 

19 significant post-traumatic growth. 

20 (4) Such other topics as the Secretary may re21 quire to track post-traumatic growth. 

22 (e) POST-TRAUMATIC GROWTH.— 

23 (1) IN GENERAL.—For purposes of this section, 

24 ‘‘post-traumatic growth’’ means positive responses 

25 described in paragraph (3) experienced after, and 


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1 often as a result of, a traumatic event or a major 

2 life crisis. 

3 (2) MEASUREMENT OF GROWTH.—Post-trau4 matic growth under this section shall be measured 

5 through self-reported scales, use of the post-trau6 matic stress disorder checklist set forth in the most 

7 recent edition of the Diagnostic and Statistical Man8 ual of Mental Disorders published by the American 

9 Psychiatric Association, and such other metrics as 

10 the Secretary considers necessary. 

11 (3) POSITIVE RESPONSES DESCRIBED.—Posi12 tive responses described in this paragraph are posi13 tive responses in one or more areas of life, including 

14 the following: 

15 (A) An appreciation of and for life. 

16 (B) Improved relationships with others. 

17 (C) Realization of new possibilities in life. 

18 (D) Realization of personal strength. 

19 (E) Spiritual change. 

20 (F) Such other areas that the Secretary, in 

21 consultation with organizations specified in sub22 section (b), considers necessary. 


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1 SEC. 204. PROGRESS OF DEPARTMENT OF VETERANS AF2 FAIRS IN MEETING GOALS AND OBJECTIVES 

3 OF NATIONAL STRATEGY FOR PREVENTING 

4 VETERAN SUICIDE. 

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

6 shall develop metrics to track progress on each of the 14 

7 goals and 43 objectives outlined in the National Strategy 

8 for Preventing Veteran Suicide, 2018–2028 prepared by 

9 the Office of Mental Health and Suicide Prevention of the 

10 Department of Veterans Affairs. 

11 (b) METRICS.—The metrics developed under sub12 section (a) shall include measures of both performance and 

13 effectiveness. 

14 (c) INITIAL REPORT.— 

15 (1) IN GENERAL.—Not later than 180 days 

16 after the date of the enactment of this Act, the Sec17 retary shall submit to the Committee on Veterans’ 

18 Affairs of the Senate and the Committee on Vet19 erans’ Affairs of the House of Representatives a re20 port that contains the metrics developed under sub21 section (a). 

22 (2) ELEMENTS.—The report submitted under 

23 paragraph (1) shall include the following: 

24 (A) An explanation of why the metrics de25 veloped under subsection (a) were chosen. 


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1 (B) An assessment of how accurately those 

2 metrics will reflect the goals and objectives 

3 specified in such subsection. 

4 (d) ANNUAL REPORT.—Not later than one year after 

5 the submittal of the report under subsection (b), and an6 nually thereafter, the Secretary shall submit to the Com7 mittee on Veterans’ Affairs of the Senate and the Com8 mittee on Veterans’ Affairs of the House of Representa9 tives a report that contains— 

10 (1) an assessment of the progress of the De11 partment in meeting the goals and objectives speci12 fied in subsection (a); 

13 (2) a description of any action to be taken by 

14 the Department if those goals and objectives are not 

15 being met; 

16 (3) a description of any changes to those goals 

17 and objectives; 

18 (4) an identification of any new programs or 

19 partnerships that have resulted from the implemen20 tation of the National Strategy for Preventing Vet21 eran Suicide, 2018–2028; 

22 (5) an assessment of the effectiveness of the 

23 National Strategy for Preventing Veterans Suicide, 

24 2018–2028 at reducing veteran suicide; and 


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1 (6) such other topics as the Secretary considers 

2 necessary. 

3 SEC. 205. STUDY ON FEASIBILITY AND ADVISABILITY OF 

4 PROVIDING CERTAIN COMPLEMENTARY AND 

5 INTEGRATIVE HEALTH SERVICES. 

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

7 date of the enactment of this Act, the Secretary of Vet8 erans Affairs shall complete a study on the feasibility and 

9 advisability of providing complementary and integrative 

10 health treatments described in subsection (b) at all facili11 ties of the Department of Veterans Affairs. 

12 (b) TREATMENTS DESCRIBED.—Complementary and 

13 integrative health treatments described in this subsection 

14 shall consist of the following: 

15 (1) Yoga. 

16 (2) Meditation. 

17 (3) Acupuncture. 

18 (4) Chiropractic care. 

19 (5) Other treatments that show sufficient evi20 dence of efficacy at treating mental or physical 

21 health conditions, as determined by the Secretary. 

22 (c) PROVISION OF TREATMENT.—The Secretary may 

23 provide complementary and integrative health treatments 

24 under this section at a facility of the Department in per25 son or by telehealth. 


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1 (d) REPORT.—Not later than 90 days after the com2 pletion of the study under subsection (a), the Secretary 

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

4 Senate and the Committee on Veterans’ Affairs of the 

5 House of Representatives a report on such study, includ6 ing— 

7 (1) the results of such study; and 

8 (2) such recommendations regarding the fur9 nishing of complementary and integrative health 

10 treatments described in subsection (b) as the Sec11 retary considers appropriate. 

12 SEC. 206. PROGRAM TO PROVIDE VETERANS ACCESS TO 

13 COMPLEMENTARY AND INTEGRATIVE 

14 HEALTH SERVICES THROUGH ANIMAL THER15 APY, AGRI-THERAPY, AND OUTDOOR SPORTS 

16 THERAPY. 

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

18 date of the enactment of this Act, the Secretary of Vet19 erans Affairs shall commence the conduct of a program 

20 to provide complementary and integrative health services 

21 described in subsection (b) to veterans from the Depart22 ment of Veterans Affairs or through the use of non-De23 partment entities for the treatment of post-traumatic 

24 stress disorder, depression, anxiety, or other conditions as 

25 determined by the Secretary. 


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1 (b) TREATMENTS DESCRIBED.—Complementary and 

2 integrative health treatments described in this subsection 

3 shall consist of the following: 

4 (1) Equine therapy. 

5 (2) Other animal therapy. 

6 (3) Agri-therapy. 

7 (4) Outdoor sports therapy. 

8 (c) ELIGIBLE VETERANS.—A veteran is eligible to 

9 participate in the program under this section if the vet10 eran— 

11 (1) is enrolled in the system of patient enroll12 ment of the Department established and operated 

13 under section 1705(a) of title 38, United States 

14 Code; and 

15 (2) has received health care under the laws ad16 ministered by the Secretary during the two-year pe17 riod preceding the initial participation of the veteran 

18 in the program. 

19 (d) DURATION.— 

20 (1) IN GENERAL.—The Secretary shall carry 

21 out the program under this section for a two-year 

22 period beginning on the commencement of the pro23 gram. 

24 (2) EXTENSION.—The Secretary may extend 

25 the duration of the program under this section if the 


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1 Secretary, based on the results of the interim report 

2 submitted under subsection (e)(1), determines that 

3 it is appropriate to do so. 

4 (e) LOCATIONS.— 

5 (1) IN GENERAL.—The Secretary shall select 

6 not fewer than five facilities of the Department at 

7 which to carry out the program under this section. 

8 (2) SELECTION CRITERIA.—In selecting facili9 ties under paragraph (1), the Secretary shall ensure 

10 that— 

11 (A) the locations are in geographically di12 verse areas; and 

13 (B) not fewer than three facilities serve 

14 veterans in rural or highly rural areas (as de15 termined through the use of the Rural-Urban 

16 Commuting Areas coding system of the Depart17 ment of Agriculture). 

18 (f) REPORTS.— 

19 (1) INTERIM REPORT.— 

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

21 after the commencement of the program under 

22 this section, the Secretary shall submit to the 

23 Committee on Veterans’ Affairs of the Senate 

24 and the Committee on Veterans’ Affairs of the 


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1 House of Representatives a report on the 

2 progress of the program. 

3 (B) ELEMENTS.—The report required by 

4 subparagraph (A) shall include the following: 

5 (i) The number of participants in the 

6 program. 

7 (ii) The types of therapy offered at 

8 each facility at which the program is being 

9 carried out. 

10 (iii) An assessment of whether partici11 pation by a veteran in the program re12 sulted in any changes in clinically relevant 

13 endpoints for the veteran with respect to 

14 the conditions specified in subsection (a). 

15 (iv) An assessment of the quality of 

16 life of veterans participating in the pro17 gram, including the results of a satisfac18 tion survey of the participants in the pro19 gram, disaggregated by treatment under 

20 subsection (b). 

21 (v) The determination of the Sec22 retary with respect to extending the pro23 gram under subsection (c)(2). 


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1 (vi) Any recommendations of the Sec2 retary with respect to expanding the pro3 gram. 

4 (2) FINAL REPORT.—Not later than 90 days 

5 after the termination of the program under this sec6 tion, the Secretary shall submit to the Committee on 

7 Veterans’ Affairs of the Senate and the Committee 

8 on Veterans’ Affairs of the House of Representatives 

9 a final report on the program. 

10 SEC. 207. COMPTROLLER GENERAL REPORT ON MANAGE11 MENT BY DEPARTMENT OF VETERANS AF12 FAIRS OF VETERANS AT HIGH RISK FOR SUI13 CIDE. 

14 (a) IN GENERAL.—Not later than 18 months after 

15 the date of the enactment of this Act, the Comptroller 

16 General of the United States shall submit to the Com17 mittee on Veterans’ Affairs of the Senate and the Com18 mittee on Veterans’ Affairs of the House of Representa19 tives a report on the efforts of the Department of Veterans 

20 Affairs to manage veterans at high risk for suicide. 

21 (b) ELEMENTS.—The report required by subsection 

22 (a) shall include the following: 

23 (1) A description of how the Department identi24 fies patients as high risk for suicide, with particular 

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1 covery Engagement and Coordination for Health – 

2 Veterans Enhanced Treatment program (commonly 

3 referred to as the ‘‘REACH VET’’ program) of the 

4 Department, including an assessment of the efficacy 

5 of such identifications disaggregated by age, gender, 

6 Veterans Integrated Service Network, and, to the ex7 tent practicable, medical center of the Department. 

8 (2) A description of how the Department inter9 venes when a patient is identified as high risk, in10 cluding an assessment of the efficacy of such inter11 ventions disaggregated by age, gender, Veterans In12 tegrated Service Network, and, to the extent prac13 ticable, medical center of the Department. 

14 (3) A description of how the Department mon15 itors patients who have been identified as high risk, 

16 including an assessment of the efficacy of such mon17 itoring and any follow-ups disaggregated by age, 

18 gender, Veterans Integrated Service Network, and, 

19 to the extent practicable, medical center of the De20 partment. 

21 (4) A review of staffing levels of suicide preven22 tion coordinators across the Veterans Health Admin23 istration. 

24 (5) A review of the resources and programming 

25 offered to family members and friends of veterans 


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1 who have a mental health condition in order to as2 sist that veteran in treatment and recovery. 

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

4 Comptroller General considers appropriate to study. 

5 TITLE III—PROGRAMS, STUDIES, 

6 AND GUIDELINES ON MENTAL 

7 HEALTH 

8 SEC. 301. PROGRAM TO PROVIDE VETERANS ACCESS TO 

9 COMPUTERIZED COGNITIVE BEHAVIORAL 

10 THERAPY. 

11 (a) IN GENERAL.—Not later than 210 days after the 

12 date of the enactment of this Act, the Secretary of Vet13 erans Affairs shall commence the conduct of a program 

14 to assess the feasibility and advisability of using computer15 ized cognitive behavioral therapy to treat eligible veterans 

16 suffering from depression, anxiety, post-traumatic stress 

17 disorder, military sexual trauma, or substance use dis18 order who are already receiving evidence-based therapy 

19 from the Department of Veterans Affairs. 

20 (b) ELIGIBLE VETERANS.—A veteran is eligible to 

21 participate in the program under this section if the vet22 eran— 

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1 lished and operated under section 1705(a) of title 

2 38, United States Code; and 

3 (2) has received health care under the laws ad4 ministered by the Secretary during the two-year pe5 riod preceding the initial participation of the veteran 

6 in the program. 

7 (c) DURATION.—The Secretary shall carry out the 

8 program under this section for a two-year period begin9 ning on the commencement of the program. 

10 (d) LOCATIONS.— 

11 (1) IN GENERAL.—The Secretary shall select 

12 not fewer than three facilities of the Department of 

13 Veterans Affairs at which to carry out the program 

14 under this section. 

15 (2) SELECTION CRITERIA.—In selecting facili16 ties under paragraph (1), the Secretary shall ensure 

17 that— 

18 (A) the locations are in geographically di19 verse areas; and 

20 (B) not fewer than two facilities serve vet21 erans in rural or highly rural areas (as deter22 mined through the use of the Rural-Urban 

23 Commuting Areas coding system of the Depart24 ment of Agriculture). 


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1 (e) ACCESS TO CHAT.—In carrying out the program 

2 under this section, the Secretary shall ensure that vet3 erans participating in the program have access via chat 

4 to a mental health provider 24 hours per day, seven days 

5 per week. 

6 (f) PROMOTION OF VETERANS CRISIS LINE.—The 

7 Secretary shall promote the availability of the Veterans 

8 Crisis Line to veterans participating in the program under 

9 this section. 

10 (g) DEPARTMENT WEBSITE.—In implementing the 

11 program under this section, the Secretary, to the extent 

12 feasible, shall use a website of the Department of Veterans 

13 Affairs to host the program. 

14 (h) REPORTS.— 

15 (1) INTERIM REPORT.— 

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

17 after the commencement of the program under 

18 this section, the Secretary shall submit to the 

19 Committee on Veterans’ Affairs of the Senate 

20 and the Committee on Veterans’ Affairs of the 

21 House of Representatives a report on the 

22 progress of the program. 

23 (B) ELEMENTS.—The report required by 

24 subparagraph (A) shall include the following: 


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1 (i) The number of participants in the 

2 program. 

3 (ii) An assessment of whether partici4 pation by a veteran in the program re5 sulted in any changes in clinically relevant 

6 endpoints for the veteran with respect to 

7 the conditions specified in subsection (a). 

8 (iii) Any recommendations of the Sec9 retary with respect to extending or expand10 ing the program. 

11 (2) FINAL REPORT.—Not later than 90 days 

12 after the termination of the program under this sec13 tion, the Secretary shall submit to the Committee on 

14 Veterans’ Affairs of the Senate and the Committee 

15 on Veterans’ Affairs of the House of Representatives 

16 a final report on the program. 

17 (i) VETERANS CRISIS LINE DEFINED.—In this sec18 tion, the term ‘‘Veterans Crisis Line’’ means the toll-free 

19 hotline for veterans established under section 1720F(h) of 

20 title 38, United States Code. 

21 SEC. 302. STUDY ON CONNECTION BETWEEN LIVING AT 

22 HIGH ALTITUDE AND SUICIDE RISK FACTORS 

23 AMONG VETERANS. 

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

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1 erans Affairs, in consultation with Rural Health Resource 

2 Centers of the Office of Rural Health of the Department 

3 of Veterans Affairs, shall commence the conduct of a study 

4 on the connection between living at high altitude and the 

5 risk of developing depression or dying by suicide among 

6 veterans. 

7 (b) COMPLETION OF STUDY.—The study conducted 

8 under subsection (a) shall be completed not later than 

9 three years after the date of the commencement of the 

10 study. 

11 (c) INDIVIDUAL IMPACT.—The study conducted 

12 under subsection (a) shall be conducted so as to determine 

13 the effect of high altitude on suicide risk at the individual 

14 level, not at the State or county level. 

15 (d) REPORT.—Not later than 150 days after the com16 pletion of the study conducted under subsection (a), the 

17 Secretary shall submit to the Committee on Veterans’ Af18 fairs of the Senate and the Committee on Veterans’ Af19 fairs of the House of Representatives a report on the re20 sults of the study. 

21 (e) FOLLOW-UP STUDY.— 

22 (1) IN GENERAL.—If the Secretary determines 

23 through the study conducted under subsection (a) 

24 that living at high altitude is a risk factor for devel25 oping depression or dying by suicide, the Secretary 


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1 shall conduct an additional study to identify the fol2 lowing: 

3 (A) The most likely biological mechanism 

4 that makes living at high altitude a risk factor 

5 for developing depression or dying by suicide. 

6 (B) The most effective treatment or inter7 vention for reducing the risk of developing de8 pression or dying by suicide associated with liv9 ing at high altitude. 

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

11 completing the study conducted under paragraph 

12 (1), the Secretary shall submit to the Committee on 

13 Veterans’ Affairs of the Senate and the Committee 

14 on Veterans’ Affairs of the House of Representatives 

15 a report on the results of the study. 

16 SEC. 303. ESTABLISHMENT BY DEPARTMENT OF VETERANS 

17 AFFAIRS AND DEPARTMENT OF DEFENSE OF 

18 CLINICAL PRACTICE GUIDELINES FOR CO19 MORBID MENTAL HEALTH CONDITIONS. 

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

21 date of the enactment of this Act, the Secretary of Vet22 erans Affairs, in consultation with the Secretary of De23 fense and the Secretary of Health and Human Services, 

24 shall complete the development of clinical practice guide25 lines for the treatment of post-traumatic stress disorder, 


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1 military sexual trauma, and traumatic brain injury that 

2 is comorbid with substance use disorder or chronic pain. 

3 (b) WORK GROUP.— 

4 (1) ESTABLISHMENT.—In carrying out sub5 section (a), the Secretary of Veterans Affairs, the 

6 Secretary of Defense, and the Secretary of Health 

7 and Human Services shall create a Trauma and Co8 morbid Substance Use Disorder or Chronic Pain 

9 Work Group (in this section referred to as the 

10 ‘‘Work Group’’). 

11 (2) MEMBERSHIP.—The work group created 

12 under paragraph (1) shall be comprised of individ13 uals that represent Federal Government entities and 

14 non-Federal Government entities with expertise in 

15 the areas covered by the work group, including the 

16 following: 

17 (A) Academic institutions that specialize in 

18 research for the treatment of conditions de19 scribed in subsection (a). 

20 (B) The National Center for Posttraumatic 

21 Stress Disorder of the Department of Veterans 

22 Affairs. 

23 (C) The Office of the Assistant Secretary 

24 for Mental Health and Substance Use of the 

25 Department of Health and Human Services. 


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1 (3) RELATION TO OTHER WORK GROUPS.—The 

2 Work Group shall be created and conducted in the 

3 same manner as other work groups for the develop4 ment of clinical practice guidelines for the Depart5 ment of Veterans Affairs and the Department of De6 fense. 

7 (c) MATTERS INCLUDED.—In developing the clinical 

8 practice guidelines under subsection (a), the Work Group, 

9 in consultation with the Post Traumatic Stress Disorder 

10 Work Group, Concussion-mTBI Work Group, Opioid 

11 Therapy for Chronic Pain Work Group, and Substance 

12 Use Work Group, shall ensure that the clinical practice 

13 guidelines include the following: 

14 (1) Guidance with respect to the following: 

15 (A) The treatment of patients with post16 traumatic stress disorder who are also experi17 encing a substance use disorder or chronic pain. 

18 (B) The treatment of patients experiencing 

19 a mental health condition, including anxiety, de20 pression, or post-traumatic stress disorder as a 

21 result of military sexual trauma who are also 

22 experiencing a substance use disorder or chron23 ic pain. 


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1 (C) The treatment of patients with trau2 matic brain injury who are also experiencing a 

3 substance use disorder or chronic pain. 

4 (2) Guidance with respect to the following: 

5 (A) Appropriate case management for pa6 tients experiencing post-traumatic stress dis7 order that is comorbid with substance use dis8 order or chronic pain who transition from re9 ceiving care while on active duty in the Armed 

10 Forces to care from health care networks out11 side of the Department of Defense. 

12 (B) Appropriate case management for pa13 tients experiencing a mental health condition, 

14 including anxiety, depression, or post-traumatic 

15 stress disorder as a result of military sexual 

16 trauma that is comorbid with substance use dis17 order or chronic pain who transition from re18 ceiving care while on active duty in the Armed 

19 Forces to care from health care networks out20 side of the Department of Defense. 

21 (C) Appropriate case management for pa22 tients experiencing traumatic brain injury that 

23 is comorbid with substance use disorder or 

24 chronic pain who transition from receiving care 

25 while on active duty in the Armed Forces to 


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1 care from health care networks outside of the 

2 Department of Defense. 

3 (3) Guidance with respect to the treatment of 

4 patients who are still members of the Armed Forces 

5 and are experiencing a mental health condition, in6 cluding anxiety, depression, or post-traumatic stress 

7 disorder as a result of military sexual trauma that 

8 is comorbid with substance use disorder or chronic 

9 pain. 

10 (4) Guidance with respect to the assessment by 

11 the National Academies of Sciences, Engineering, 

12 and Medicine of the potential overmedication of vet13 erans, as required pursuant to the Senate report ac14 companying S. 1557, 115th Congress (Senate Re15 port 115-130), under the heading ‘‘Overprescription 

16 Prevention Report’’ under the heading ‘‘COMMITTEE

17 RECOMMENDATION’’. 

18 (d) RULE OF CONSTRUCTION.—Nothing in this sec19 tion shall be construed to prevent the Secretary of Vet20 erans Affairs and the Secretary of Defense from consid21 ering all relevant evidence, as appropriate, in creating the 

22 clinical practice guidelines required under subsection (a) 

23 or from ensuring that the final clinical practice guidelines 

24 developed under such subsection and subsequently up25 dated, as appropriate, remain applicable to the patient 


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1 populations of the Department of Veterans Affairs and the 

2 Department of Defense. 

3 SEC. 304. UPDATE OF CLINICAL PRACTICE GUIDELINES 

4 FOR ASSESSMENT AND MANAGEMENT OF PA5 TIENTS AT RISK FOR SUICIDE. 

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

7 date of the enactment of this Act, the Secretary of Vet8 erans Affairs and the Secretary of Defense, through the 

9 Assessment and Management of Patients at Risk for Sui10 cide Work Group (in this section referred to as the ‘‘Work 

11 Group’’), shall issue an update to the VA/DOD Clinical 

12 Practice Guideline for Assessment and Management of 

13 Patients at Risk for Suicide. 

14 (b) MATTERS INCLUDED.—In carrying out the up15 date under subsection (a), the Work Group shall ensure 

16 that the clinical practice guidelines updated under such 

17 subsection includes the following: 

18 (1) Enhanced guidance with respect to the fol19 lowing: 

20 (A) Gender-specific risk factors for suicide 

21 and suicidal ideation. 

22 (B) Gender-specific treatment efficacy for 

23 depression and suicide prevention. 

24 (C) Gender-specific pharmacotherapy effi25 cacy. 


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1 (D) Gender-specific psychotherapy efficacy. 

2 (2) Guidance with respect to the following: 

3 (A) The efficacy of alternative therapies, 

4 other than psychotherapy and pharmacothera5 py, including the following: 

6 (i) Yoga therapy. 

7 (ii) Meditation therapy. 

8 (iii) Equine therapy. 

9 (iv) Other animal therapy. 

10 (v) Training and caring for service 

11 dogs. 

12 (vi) Agri-therapy. 

13 (vii) Art therapy. 

14 (viii) Outdoor sports therapy. 

15 (ix) Music therapy. 

16 (x) Any other alternative therapy that 

17 the Work Group considers appropriate. 

18 (3) Guidance with respect to the findings of the 

19 Creating Options for Veterans’ Expedited Recovery 

20 Commission (commonly referred to as the ‘‘COVER 

21 Commission’’) established under section 931 of the 

22 Jason Simcakoski Memorial and Promise Act (title 

23 IX of Public Law 114–198; 38 U.S.C. 1701 note). 

24 (c) RULE OF CONSTRUCTION.—Nothing in this sec25 tion shall be construed to prevent the Secretary of VetVerDate Sep 11 2014 00:32 Jul 28, 2020 Jkt 099200 PO 00000 Frm 00051 Fmt 6652 Sfmt 6401 E:\BILLS\S785.RS S785

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1 erans Affairs and the Secretary of Defense from consid2 ering all relevant evidence, as appropriate, in updating the 

3 VA/DOD Clinical Practice Guideline for Assessment and 

4 Management of Patients at Risk for Suicide, as required 

5 under subsection (a), or from ensuring that the final clin6 ical practice guidelines updated under such subsection re7 main applicable to the patient populations of the Depart8 ment of Veterans Affairs and the Department of Defense. 

9 SEC. 305. PRECISION MEDICINE INITIATIVE OF DEPART10 MENT OF VETERANS AFFAIRS TO IDENTIFY 

11 AND VALIDATE BRAIN AND MENTAL HEALTH 

12 BIOMARKERS. 

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

14 months after the date of the enactment of this Act, the 

15 Secretary of Veterans Affairs shall develop and implement 

16 an initiative of the Department of Veterans Affairs to 

17 identify and validate brain and mental health biomarkers 

18 among veterans, with specific consideration for depression, 

19 anxiety, post-traumatic stress disorder, traumatic brain 

20 injury, and such other mental health conditions as the 

21 Secretary considers appropriate. Such initiative may be re22 ferred to as the ‘‘Precision Medicine for Veterans Initia23 tive’’. 

24 (b) MODEL OF INITIATIVE.—The initiative under 

25 subsection (a) shall be modeled on the All of Us Precision 


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1 Medicine Initiative administered by the National Insti2 tutes of Health with respect to large-scale collection of 

3 standardized data and open data sharing. 

4 (c) USE OF DATA.— 

5 (1) PRIVACY AND SECURITY.—In carrying out 

6 the initiative under subsection (a), the Secretary 

7 shall develop robust data privacy and security meas8 ures to ensure that information of veterans partici9 pating in the initiative is kept private and secure. 

10 (2) OPEN PLATFORM.— 

11 (A) RESEARCH PURPOSES.—The Secretary 

12 shall make de-identified data collected under 

13 the initiative available for research purposes 

14 both within and outside of the Department of 

15 Veterans Affairs. 

16 (B) DATA MAY NOT BE SOLD.—Data col17 lected under the initiative may not be sold. 

18 (3) STANDARDIZATION.— 

19 (A) IN GENERAL.—The Secretary shall en20 sure that data collected under the initiative is 

21 standardized. 

22 (B) CONSULTATION.—The Secretary shall 

23 consult with the National Institutes of Health 

24 and the Food and Drug Administration to de25 termine the most effective, efficient, and costVerDate Sep 11 2014 00:32 Jul 28, 2020 Jkt 099200 PO 00000 Frm 00053 Fmt 6652 Sfmt 6401 E:\BILLS\S785.RS S785

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1 effective way of standardizing data collected 

2 under the initiative. 

3 (C) MANNER OF STANDARDIZATION.— 

4 Data collected under the initiative shall be 

5 standardized in the manner in which it is col6 lected, entered into the database, extracted, and 

7 recorded. 

8 (4) MEASURES OF BRAIN FUNCTION OR STRUC9 TURE.—Any measures of brain function or structure 

10 collected under the initiative shall be collected with 

11 a device that is approved by the Food and Drug Ad12 ministration. 

13 (d) INCLUSION OF INITIATIVE IN PROGRAM.—The 

14 Secretary shall assess the feasibility and advisability of co15 ordinating efforts of the initiative under subsection (a) 

16 with the Million Veterans Program of the Department. 

17 SEC. 306. PREVENTATIVE AND COMPLEX DATA ANALYSIS 

18 BY DEPARTMENT OF VETERANS AFFAIRS. 

19 (a) IN GENERAL.—Chapter 1 of title 38, United 

20 States Code, is amended by adding at the end the fol21 lowing new section: 

22 ‘‘§ 119. Contracting for preventative or complex sta23 tistical analysis 

24 ‘‘In order to carry out statistical analysis required 

25 under section 302 of the Commander John Scott Hannon 


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1 Veterans Mental Health Care Improvement Act of 2019, 

2 or any other preventative or complex statistical analysis 

3 required under this title or any other provision of law, the 

4 Secretary may contract with academic institutions or 

5 other qualified entities, as determined by the Secretary, 

6 to carry out the statistical analysis.’’. 

7 (b) CLERICAL AMENDMENT.—The table of sections 

8 at the beginning of chapter 1 of such title is amended by 

9 inserting after the item relating to section 118 the fol10 lowing new item: 

‘‘119. Contracting for preventative or complex statistical analysis.’’. 

11 TITLE IV—OVERSIGHT OF MEN12 TAL HEALTH CARE AND RE13 LATED SERVICES 

14 SEC. 401. STUDY ON EFFECTIVENESS OF SUICIDE PREVEN15 TION AND MENTAL HEALTH OUTREACH PRO16 GRAMS OF DEPARTMENT OF VETERANS AF17 FAIRS. 

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

19 date of the enactment of this Act, the Secretary of Vet20 erans Affairs shall enter into an agreement with a non21 Federal Government entity to conduct a study on the ef22 fectiveness of the suicide prevention and mental health 

23 outreach materials prepared by the Department of Vet24 erans Affairs and the suicide prevention and mental health 

25 outreach campaigns conducted by the Department. 


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1 (b) USE OF FOCUS GROUPS.— 

2 (1) IN GENERAL.—The Secretary shall convene 

3 not fewer than eight different focus groups to evalu4 ate the effectiveness of the suicide prevention and 

5 mental health materials and campaigns as required 

6 under subsection (a). 

7 (2) LOCATION OF FOCUS GROUPS.—Focus 

8 groups convened under paragraph (1) shall be held 

9 in geographically diverse areas as follows: 

10 (A) Not fewer than two in rural or highly 

11 rural areas. 

12 (B) Not fewer than one in each of the four 

13 districts of the Veterans Benefits Administra14 tion. 

15 (3) TIMING OF FOCUS GROUPS.—Focus groups 

16 convened under paragraph (1) shall be held at a va17 riety of dates and times to ensure an adequate rep18 resentation of veterans with different work sched19 ules. 

20 (4) NUMBER OF PARTICIPANTS.—Each focus 

21 group convened under paragraph (1) shall include 

22 not fewer than five and not more than 12 partici23 pants. 

24 (5) REPRESENTATION.—Each focus group con25 vened under paragraph (1) shall, to the extent pracVerDate Sep 11 2014 00:32 Jul 28, 2020 Jkt 099200 PO 00000 Frm 00056 Fmt 6652 Sfmt 6401 E:\BILLS\S785.RS S785

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1 ticable, include veterans of diverse backgrounds, in2 cluding— 

3 (A) veterans of all eras, as determined by 

4 the Secretary; 

5 (B) women veterans; 

6 (C) minority veterans; 

7 (D) Native American veterans, as defined 

8 in section 3765 of title 38, United States Code; 

9 (E) veterans who identify as lesbian, gay, 

10 bisexual, transgender, or queer (commonly re11 ferred to as ‘‘LGBTQ’’); 

12 (F) veterans who live in rural or highly 

13 rural areas; and 

14 (G) individuals transitioning from active 

15 duty in the Armed Forces to civilian life. 

16 (c) REPORT.— 

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

18 the last focus group meeting under subsection (b), 

19 the Secretary shall submit to the Committee on Vet20 erans’ Affairs of the Senate and the Committee on 

21 Veterans’ Affairs of the House of Representatives a 

22 report on the findings of the focus groups. 

23 (2) ELEMENTS.—The report required by para24 graph (1) shall include the following: 


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1 (A) Based on the findings of the focus 

2 groups, an assessment of the effectiveness of 

3 current suicide prevention and mental health 

4 outreach efforts of the Department in reaching 

5 veterans as a whole as well as specific groups 

6 of veterans (for example, women veterans). 

7 (B) Based on the findings of the focus 

8 groups, recommendations for future suicide pre9 vention and mental health outreach efforts by 

10 the Department to target specific groups of vet11 erans. 

12 (C) A plan to change the current approach 

13 by the Department to suicide prevention and 

14 mental health outreach or, if the Secretary de15 cides not to change the current approach, an 

16 explanation of the reason for maintaining the 

17 current approach. 

18 (D) Such other issues as the Secretary 

19 considers necessary. 

20 (d) REPRESENTATIVE SURVEY.— 

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

22 after the last focus group meeting under subsection 

23 (b), the Secretary shall complete a representative 

24 survey of the veteran population that is informed by 

25 the focus group data in order to collect information 


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1 about the effectiveness of the mental health and sui2 cide prevention outreach campaigns conducted by 

3 the Department. 

4 (2) VETERANS SURVEYED.— 

5 (A) IN GENERAL.—Veterans surveyed 

6 under paragraph (1) shall include veterans de7 scribed in subsection (b)(5). 

8 (B) DISAGGREGATION OF DATA.—Data of 

9 veterans surveyed under paragraph (1) shall be 

10 disaggregated by— 

11 (i) veterans who have received care 

12 from the Department during the two-year 

13 period preceding the survey; and 

14 (ii) veterans who have not received 

15 care from the Department during the two16 year period preceding the survey. 

17 (e) TREATMENT OF CONTRACTS FOR SUICIDE PRE18 VENTION AND MENTAL HEALTH OUTREACH MEDIA.— 

19 (1) FOCUS GROUPS.— 

20 (A) IN GENERAL.—The Secretary shall in21 clude in each contract to develop media relating 

22 to suicide prevention and mental health out23 reach a requirement that the contractor convene 

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1 ness of suicide prevention and mental health 

2 outreach. 

3 (B) REPRESENTATION.—Each focus group 

4 required under subparagraph (A) shall, to the 

5 extent practicable, include veterans of diverse 

6 backgrounds, including— 

7 (i) veterans of all eras, as determined 

8 by the Secretary; 

9 (ii) women veterans; 

10 (iii) minority veterans; 

11 (iv) Native American veterans, as de12 fined in section 3765 of title 38, United 

13 States Code; 

14 (v) veterans who identify as lesbian, 

15 gay, bisexual, transgender, or queer (com16 monly referred to as ‘‘LGBTQ’’); 

17 (vi) veterans who live in rural or high18 ly rural areas; and 

19 (vii) individuals transitioning from ac20 tive duty in the Armed Forces to civilian 

21 life. 

22 (2) SUBCONTRACTING.— 

23 (A) IN GENERAL.—The Secretary shall in24 clude in each contract described in paragraph 

25 (1)(A) a requirement that, if the contractor 


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1 subcontracts for the development of media, the 

2 contractor shall subcontract with a subcon3 tractor that has experience creating impactful 

4 media campaigns that target individuals age 18 

5 to 34. 

6 (B) BUDGET LIMITATION.—Not more than 

7 two percent of the budget of the Office of Men8 tal Health and Suicide Prevention of the De9 partment for contractors for suicide prevention 

10 and mental health media outreach shall go to 

11 subcontractors described in subparagraph (A). 

12 (f) RURAL AND HIGHLY RURAL DEFINED.—In this 

13 section, with respect to an area, the terms ‘‘rural’’ and 

14 ‘‘highly rural’’ have the meanings given those terms in the 

15 Rural-Urban Commuting Areas coding system of the De16 partment of Agriculture. 

17 SEC. 402. OVERSIGHT OF MENTAL HEALTH AND SUICIDE 

18 PREVENTION MEDIA OUTREACH CONDUCTED 

19 BY DEPARTMENT OF VETERANS AFFAIRS. 

20 (a) ESTABLISHMENT OF GOALS.— 

21 (1) IN GENERAL.—The Secretary of Veterans 

22 Affairs shall establish goals for the mental health 

23 and suicide prevention media outreach campaigns of 

24 the Department of Veterans Affairs in raising 


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1 awareness about mental health and suicide preven2 tion. 

3 (2) USE OF METRICS.— 

4 (A) IN GENERAL.—The goals established 

5 under paragraph (1) shall be measured by 

6 metrics specific to different media types as fol7 lows: 

8 (i) Metrics relating to social media 

9 shall include the following: 

10 (I) Impressions. 

11 (II) Reach. 

12 (III) Engagement rate. 

13 (IV) Such other metrics as the 

14 Secretary considers necessary. 

15 (ii) Metrics relating to television shall 

16 include the following: 

17 (I) Nielsen ratings. 

18 (II) Such other metrics as the 

19 Secretary considers necessary. 

20 (iii) Metrics relating to email shall in21 clude the following: 

22 (I) Open rate. 

23 (II) Response rate 

24 (III) Click rate. 


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1 (IV) Such other metrics as the 

2 Secretary considers necessary. 

3 (B) UPDATE.—The Secretary shall periodi4 cally update the metrics under subparagraph 

5 (A) as more accurate metrics become available. 

6 (3) TARGETS.—The Secretary shall develop tar7 gets to track the metrics used under paragraph (2). 

8 (4) CONSULTATION.—In establishing goals 

9 under paragraph (1), the Secretary shall consult 

10 with the following: 

11 (A) Relevant stakeholders, such as organi12 zations that represent veterans, as determined 

13 by the Secretary. 

14 (B) Mental health and suicide prevention 

15 experts. 

16 (C) Such other persons as the Secretary 

17 considers appropriate. 

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

19 after the date of the enactment of this Act, the Sec20 retary shall submit to the Committee on Veterans’ 

21 Affairs of the Senate and the Committee on Vet22 erans’ Affairs of the House of Representatives a re23 port detailing the goals established under paragraph 

24 (1) for the mental health and suicide prevention 

25 media outreach campaigns of the Department in 


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1 raising awareness about mental health and suicide 

2 prevention, including the metrics and targets for 

3 such metrics by which those goals are to be meas4 ured under paragraph (2). 

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

6 after the submittal of the report under paragraph 

7 (3), and annually thereafter, the Secretary shall sub8 mit to the Committee on Veterans’ Affairs of the 

9 Senate and the Committee on Veterans’ Affairs of 

10 the House of Representatives a report detailing— 

11 (A) the progress of the Department in 

12 meeting the goals established under paragraph 

13 (1) and targets developed under paragraph (3); 

14 and 

15 (B) a description of action to be taken by 

16 the Department to modify mental health and 

17 suicide prevention media outreach campaigns if 

18 those goals and targets are not being met. 

19 (b) ESTABLISHMENT OF OVERSIGHT PROCESS.— 

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

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

22 shall establish a process to oversee the mental health 

23 and suicide prevention media outreach campaigns of 

24 the Department. 


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1 (2) COMPONENTS OF OVERSIGHT PROCESS.— 

2 The process established under paragraph (1) shall 

3 include the following components: 

4 (A) A delineation of the roles and respon5 sibilities of all suicide prevention officials within 

6 the Office of Mental Health and Suicide Pre7 vention of the Veterans Health Administration. 

8 (B) A schedule for creating, approving, im9 plementing, and evaluating all unpaid media 

10 and paid media content relating to mental 

11 health and suicide prevention. 

12 (C) Lines of reporting, as the Secretary 

13 considers necessary, to report to management 

14 information relating to the mental health and 

15 suicide prevention media outreach campaigns of 

16 the Department. 

17 (c) CONTRACT REQUIREMENTS.—The Secretary shall 

18 ensure that each contract into which the Secretary enters 

19 to develop mental health and suicide prevention outreach 

20 media includes requirements that the contractor— 

21 (1) track metrics used by the Secretary under 

22 subsection (a)(2); and 

23 (2) not less frequently than quarterly, report 

24 such metrics to the Office of Mental Health and SuiVerDate Sep 11 2014 00:32 Jul 28, 2020 Jkt 099200 PO 00000 Frm 00065 Fmt 6652 Sfmt 6401 E:\BILLS\S785.RS S785

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1 cide Prevention of the Veterans Health Administra2 tion. 

3 (d) REPORT ON USE OF FUNDS BY OFFICE OF MEN4 TAL HEALTH AND SUICIDE PREVENTION.—Not later than 

5 180 days after the date of the enactment of this Act, and 

6 semiannually thereafter, the Secretary shall submit to the 

7 Committee on Appropriations and the Committee on Vet8 erans’ Affairs of the Senate and the Committee on Appro9 priations and the Committee on Veterans’ Affairs of the 

10 House of Representatives a report containing the expendi11 tures and obligations of the Office of Mental Health and 

12 Suicide Prevention of the Veterans Health Administration 

13 during the period covered by the report. 

14 SEC. 403. ANNUAL REPORT ON PROGRESS OF DEPARTMENT 

15 OF VETERANS AFFAIRS IN MEETING GOALS 

16 AND OBJECTIVES OF EXECUTIVE ORDER 

17 13822. 

18 (a) IN GENERAL.—Not later than 120 days after the 

19 date of the enactment of this Act, and annually thereafter, 

20 the Secretary of Veterans Affairs, in consultation with the 

21 Secretary of Defense and the Secretary of Homeland Se22 curity, shall submit to the Committee on Veterans’ Affairs 

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

24 the House of Representatives a report that contains the 

25 following: 


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1 (1) An assessment of the progress of the De2 partment of Veterans Affairs, the Department of 

3 Defense, and the Department of Homeland Security 

4 in meeting the goals and objectives outlined in the 

5 report required under section 2(c) of Executive 

6 Order 13822 (83 Fed. Reg. 1513; relating to sup7 porting our veterans during their transition from 

8 uniformed service to civilian life) with respect to the 

9 implementation by the Department of Veterans Af10 fairs of the Joint Action Plan required under section 

11 2(b) of such Executive order. 

12 (2) A description of action to be taken by the 

13 Department of Veterans Affairs, the Department of 

14 Defense, and the Department of Homeland Security 

15 if those goals and objectives are not being met. 

16 (3) An assessment of the effectiveness of Exec17 utive Order 13822 at improving the transition proc18 ess for members of the Armed Forces and veterans. 

19 (4) Such other topics as the Secretary of Vet20 erans Affairs, the Secretary of Defense, or the Sec21 retary of Homeland Security consider necessary. 

22 (b) SUBMITTAL BY SECRETARY OF VETERANS AF23 FAIRS.—The Secretary of Veterans Affairs shall submit 

24 each report required under paragraph (1) with respect to 

25 the Department of Veterans Affairs regardless of whether 


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1 the Secretary of Defense or the Secretary of Homeland 

2 Security provides any information for the report. 

3 SEC. 404. COMPTROLLER GENERAL MANAGEMENT REVIEW 

4 OF MENTAL HEALTH AND SUICIDE PREVEN5 TION SERVICES OF DEPARTMENT OF VET6 ERANS AFFAIRS. 

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

8 the date of the enactment of this Act, the Comptroller 

9 General of the United States shall submit to the Com10 mittee on Veterans’ Affairs of the Senate and the Com11 mittee on Veterans’ Affairs of the House of Representa12 tives a management review of the mental health and sui13 cide prevention services provided by the Department of 

14 Veterans Affairs. 

15 (b) ELEMENTS.—The management review required 

16 by subsection (a) shall include the following: 

17 (1) An assessment of the infrastructure under 

18 the control of or available to the Office of Mental 

19 Health and Suicide Prevention of the Department of 

20 Veterans Affairs or available to the Department of 

21 Veterans Affairs for suicide prevention efforts not 

22 operated by the Office of Mental Health and Suicide 

23 Prevention. 

24 (2) A description of the management and orga25 nizational structure of the Office of Mental Health 


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1 and Suicide Prevention, including roles and respon2 sibilities for each position. 

3 (3) A description of the operational policies and 

4 processes of the Office of Mental Health and Suicide 

5 Prevention. 

6 (4) An assessment of suicide prevention prac7 tices and initiatives available from the Department 

8 and through community partnerships. 

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

10 Office of Mental Health and Suicide Prevention, 

11 dissaggregated by type of position, and including the 

12 location of any staffing deficiencies. 

13 (6) An assessment of the Nurse Advice Line 

14 pilot program conducted by the Department. 

15 (7) An assessment of recruitment initiatives in 

16 rural areas for mental health professionals of the 

17 Department. 

18 (8) An assessment of strategic planning con19 ducted by the Office of Mental Health and Suicide 

20 Prevention. 

21 (9) An assessment of the communication, and 

22 the effectiveness of such communication— 

23 (A) within the central office of the Office 

24 of Mental Health and Suicide Prevention; 


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1 (B) between that central office and any 

2 staff member or office in the field, including 

3 chaplains, attorneys, law enforcement per4 sonnel, and volunteers; and 

5 (C) between that central office, local facili6 ties of the Department, and community part7 ners of the Department, including first respond8 ers, community support groups, and health care 

9 industry partners. 

10 (10) An assessment of how effectively the Office 

11 of Mental Health and Suicide Prevention implements 

12 operational policies and procedures. 

13 (11) An assessment of how the Department of 

14 Veterans Affairs and the Department of Defense co15 ordinate suicide prevention efforts, and recommenda16 tions on how the Department of Veterans Affairs 

17 and Department of Defense can more effectively co18 ordinate those efforts. 

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

20 Comptroller General considers appropriate to study. 

21 SEC. 405. COMPTROLLER GENERAL REPORT ON EFFORTS 

22 OF DEPARTMENT OF VETERANS AFFAIRS TO 

23 INTEGRATE MENTAL HEALTH CARE INTO 

24 PRIMARY CARE CLINICS. 

25 (a) INITIAL REPORT.— 


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

2 after the date of the enactment of this Act, the 

3 Comptroller General of the United States shall sub4 mit to the Committee on Veterans’ Affairs of the 

5 Senate and the Committee on Veterans’ Affairs of 

6 the House of Representatives a report on the efforts 

7 of the Department of Veterans Affairs to integrate 

8 mental health care into primary care clinics of the 

9 Department. 

10 (2) ELEMENTS.—The report required by sub11 section (a) shall include the following: 

12 (A) An assessment of the efforts of the 

13 Department to integrate mental health care 

14 into primary care clinics of the Department. 

15 (B) An assessment of the effectiveness of 

16 such efforts. 

17 (C) An assessment of how the health care 

18 of veterans is impacted by such integration. 

19 (D) A description of how care is coordi20 nated by the Department between specialty 

21 mental health care and primary care, including 

22 a description of the following: 

23 (i) How documents and patient infor24 mation are transferred and the effective25 ness of those transfers. 


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1 (ii) How care is coordinated when vet2 erans must travel to different facilities of 

3 the Department. 

4 (iii) How a veteran is reintegrated 

5 into primary care after receiving in-patient 

6 mental health care. 

7 (E) An assessment of how the integration 

8 of mental health care into primary care clinics 

9 is implemented at different types of facilities of 

10 the Department. 

11 (F) Such recommendations on how the De12 partment can better integrate mental health 

13 care into primary care clinics as the Comp14 troller General considers appropriate. 

15 (G) An assessment of such other areas as 

16 the Comptroller General considers appropriate 

17 to study. 

18 (b) COMMUNITY CARE INTEGRATION REPORT.— 

19 (1) IN GENERAL.—Not later than two years 

20 after the date on which the Comptroller General 

21 submits the report required under subsection (a)(1), 

22 the Comptroller General shall submit to the Com23 mittee on Veterans’ Affairs of the Senate and the 

24 Committee on Veterans’ Affairs of the House of 

25 Representatives a report on the efforts of the DeVerDate Sep 11 2014 00:32 Jul 28, 2020 Jkt 099200 PO 00000 Frm 00072 Fmt 6652 Sfmt 6401 E:\BILLS\S785.RS S785

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1 partment to integrate community-based mental 

2 health care into the Veterans Health Administration. 

3 (2) ELEMENTS.—The report required by para4 graph (1) shall include the following: 

5 (A) An assessment of the efforts of the 

6 Department to integrate community-based men7 tal health care into the Veterans Health Admin8 istration. 

9 (B) An assessment of the effectiveness of 

10 such efforts. 

11 (C) An assessment of how the health care 

12 of veterans is impacted by such integration. 

13 (D) A description of how care is coordi14 nated between providers of community-based 

15 mental health care and the Veterans Health 

16 Administration, including a description of how 

17 documents and patient information are trans18 ferred and the effectiveness of those transfers 

19 between— 

20 (i) the Veterans Health Administra21 tion and providers of community-based 

22 mental health care; and 

23 (ii) providers of community-based 

24 mental health care and the Veterans 

25 Health Administration. 


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1 (E) An assessment of any disparities in the 

2 coordination of community-based mental health 

3 care into the Veterans Health Administration 

4 by location and type of facility. 

5 (F) An assessment of the military cultural 

6 competency of health care providers providing 

7 community-based mental health care to vet8 erans. 

9 (G) Such recommendations on how the De10 partment can better integrate community-based 

11 mental health care into the Veterans Health 

12 Administration as the Comptroller General con13 siders appropriate. 

14 (H) An assessment of such other areas as 

15 the Comptroller General considers appropriate 

16 to study. 

17 (3) COMMUNITY-BASED MENTAL HEALTH CARE

18 DEFINED.—In this subsection, the term ‘‘commu19 nity-based mental health care’’ means mental health 

20 care paid for by the Department but provided by a 

21 non-Department health care provider at a non-De22 partment facility, including care furnished under 

23 section 1703 of title 38, United States Code (as in 

24 effect on the date specified in section 101(b) of the 


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1 Caring for Our Veterans Act of 2018 (title I of Pub2 lic Law 115–182)). 

3 SEC. 406. JOINT MENTAL HEALTH PROGRAMS BY DEPART4 MENT OF VETERANS AFFAIRS AND DEPART5 MENT OF DEFENSE. 

6 (a) REPORT ON MENTAL HEALTH PROGRAMS.— 

7 (1) IN GENERAL.—Not later than 180 days 

8 after the date of the enactment of this Act, and an9 nually thereafter, the Secretary of Veterans Affairs 

10 and the Secretary of Defense shall submit to the 

11 Committee on Armed Services and the Committee on 

12 Veterans’ Affairs of the Senate and the Committee 

13 on Armed Services and the Committee on Veterans’ 

14 Affairs of the House of Representatives a report on 

15 mental health programs of the Department of Vet16 erans Affairs and the Department of Defense and 

17 joint programs of the Departments. 

18 (2) ELEMENTS.—The report required by para19 graph (1) shall include the following: 

20 (A) A description of mental health pro21 grams operated by the Department of Veterans 

22 Affairs, including the following: 

23 (i) Transition assistance programs. 

24 (ii) Clinical mental health initiatives, 

25 including— 


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1 (I) the Million Veterans Pro2 gram; and 

3 (II) centers of excellence of the 

4 Department of Veterans Affairs for 

5 traumatic brain injury and post-trau6 matic stress disorder. 

7 (iii) Programs that may secondarily 

8 improve mental health, including employ9 ment, housing assistance, and financial lit10 eracy programs. 

11 (iv) Research into mental health 

12 issues and conditions. 

13 (B) A description of mental health pro14 grams operated by the Department of Defense, 

15 including the following: 

16 (i) Transition assistance programs. 

17 (ii) Clinical mental health initiatives, 

18 including the National Intrepid Center of 

19 Excellence. 

20 (iii) Programs that may secondarily 

21 improve mental health, including employ22 ment, housing assistance, and financial lit23 eracy programs. 

24 (iv) Research into mental health 

25 issues and conditions. 


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1 (C) A description of mental health pro2 grams jointly operated by the Department of 

3 Veterans Affairs and the Department of De4 fense, including the following: 

5 (i) Transition assistance programs. 

6 (ii) Clinical mental health initiatives. 

7 (iii) Programs that may secondarily 

8 improve mental health, including employ9 ment, housing assistance, and financial lit10 eracy programs. 

11 (iv) Research into mental health 

12 issues and conditions. 

13 (D) Recommendations for coordinating 

14 mental health programs of the Department of 

15 Veterans Affairs and the Department of De16 fense to improve the effectiveness of those pro17 grams. 

18 (E) Recommendations for novel joint pro19 gramming of the Department of Veterans Af20 fairs and the Department of Defense to improve 

21 the mental health of members of the Armed 

22 Forces and veterans. 

23 (b) ESTABLISHMENT OF JOINT CENTER OF EXCEL24 LENCE.— 


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

2 after the date of the enactment of this Act, the Sec3 retary of Defense, in consultation with the Secretary 

4 of Veterans Affairs, shall establish a center of excel5 lence to be known as the ‘‘Joint DOD/VA National 

6 Intrepid Center of Excellence Intrepid Spirit Cen7 ter’’ (in this subsection referred to as the ‘‘Center’’). 

8 (2) DUTIES.—The Center shall conduct joint 

9 mental health programs of the Department of Vet10 erans Affairs and the Department of Defense. 

11 (3) LOCATION.—The Center shall be estab12 lished in a location that— 

13 (A) is geographically distant from already 

14 existing and planned Intrepid Spirit Centers of 

15 the Department of Defense; and 

16 (B) is in a rural or highly rural area (as 

17 determined through the use of the Rural-Urban 

18 Commuting Areas coding system of the Depart19 ment of Agriculture). 

20 TITLE V—MEDICAL WORKFORCE 

21 Subtitle A—Improvement of Mental 

22 Health Medical Workforce 

23 SEC. 501. TREATMENT OF PSYCHOLOGISTS. 

24 (a) TREATMENT AS TITLE 38 EMPLOYEES.—Section 

25 7401 of title 38, United States Code, is amended— 


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1 (1) in paragraph (1) by inserting ‘‘psycholo2 gists,’’ after ‘‘chiropractors,’’; and 

3 (2) in paragraph (3), by striking ‘‘psycholo4 gists,’’. 

5 (b) INCLUSION IN CONTRACTS FOR SCARCE MEDICAL

6 SPECIALIST SERVICES.—Section 7409(a) of title 38, 

7 United States Code, is amended by inserting ‘‘psycholo8 gists,’’ after ‘‘chiropractors,’’. 

9 SEC. 502. STAFFING IMPROVEMENT PLAN FOR PSYCHIA10 TRISTS AND PSYCHOLOGISTS OF DEPART11 MENT OF VETERANS AFFAIRS. 

12 (a) STAFFING PLAN.—Not later than 270 days after 

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

14 Veterans Affairs, in consultation with the Inspector Gen15 eral of the Department of Veterans Affairs, shall submit 

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

17 the Committee on Veterans’ Affairs of the House of Rep18 resentatives a plan to address staffing shortages of psychi19 atrists and psychologists of the Department of Veterans 

20 Affairs, including filling any open positions. 

21 (b) ELEMENTS.—The plan required by subsection (a) 

22 shall include the following: 

23 (1) The number of positions for psychiatrists 

24 and psychologists of the Department that need to be 


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1 filled to meet demand, disaggregated by Veterans 

2 Integrated Service Network and medical center. 

3 (2) An identification of the steps that the Sec4 retary will take in each Veterans Integrated Service 

5 Network to address such shortages, include the fol6 lowing: 

7 (A) A description of any region-specific 

8 hiring incentives to be used by the Secretary in 

9 consultation with the directors of Veterans Inte10 grated Service Networks and medical centers of 

11 the Department. 

12 (B) A description of any local retention or 

13 engagement incentives to be used by directors 

14 of Veterans Integrated Service Networks. 

15 (3) Such recommendations for legislative or ad16 ministrative action as the Secretary considers nec17 essary to aid in addressing staffing shortages of psy18 chiatrists and psychologists of the Department. 

19 SEC. 503. OCCUPATIONAL SERIES AND STAFFING IMPROVE20 MENT PLAN FOR LICENSED PROFESSIONAL 

21 MENTAL HEALTH COUNSELORS AND MAR22 RIAGE AND FAMILY THERAPISTS OF DEPART23 MENT OF VETERANS AFFAIRS. 

24 (a) OCCUPATIONAL SERIES.—Not later than one year 

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


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1 of Veterans Affairs, in consultation with the Office of Per2 sonnel Management, shall develop an occupational series 

3 for licensed professional mental health counselors and 

4 marriage and family therapists of the Department of Vet5 erans Affairs. 

6 (b) STAFFING PLAN.— 

7 (1) IN GENERAL.—Not later than 270 days 

8 after the date of the enactment of this Act, the Sec9 retary shall submit to the Committee on Veterans’ 

10 Affairs of the Senate and the Committee on Vet11 erans’ Affairs of the House of Representatives a 

12 plan to address staffing shortages of licensed profes13 sional mental health counselors and marriage and 

14 family therapists of the Department of Veterans Af15 fairs. 

16 (2) ELEMENTS.—The plan required by para17 graph (1) shall include the following: 

18 (A) The number of positions for licensed 

19 professional mental health counselors and mar20 riage and family therapists of the Department 

21 that need to be filled to meet demand, 

22 disaggregated by Veterans Integrated Service 

23 Network and medical center. 

24 (B) An identification of the steps that the 

25 Secretary will take in each Veterans Integrated 


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1 Service Network to address such shortages, in2 clude the following: 

3 (i) A description of any region-specific 

4 hiring incentives to be used by the Sec5 retary in consultation with the directors of 

6 Veterans Integrated Service Networks and 

7 medical centers of the Department. 

8 (ii) A description of any local reten9 tion or engagement incentives to be used 

10 by directors of Veterans Integrated Service 

11 Networks. 

12 (C) Such recommendations for legislative 

13 or administrative action as the Secretary, in 

14 consultation with the Inspector General of the 

15 Department of Veterans Affairs, considers nec16 essary to aid in addressing staffing shortages of 

17 licensed professional mental health counselors 

18 and marriage and family therapists of the De19 partment. 

20 (c) REPORT.—Not later than one year after the sub21 mittal of the plan required by subsection (b), the Secretary 

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

23 Senate and the Committee on Veterans’ Affairs of the 

24 House of Representatives a report setting forth the num25 ber of licensed professional mental health counselors and 


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1 marriage and family therapists hired by the Department 

2 during the one-year period preceding the submittal of the 

3 report, disaggregated by Veterans Integrated Service Net4 work and medical center. 

5 SEC. 504. STAFFING IMPROVEMENT PLAN FOR PEER SPE6 CIALISTS OF DEPARTMENT OF VETERANS AF7 FAIRS WHO ARE WOMEN. 

8 (a) ASSESSMENT OF CAPACITY.— 

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

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

11 of Veterans Affairs, in consultation with the Inspec12 tor General of the Department of Veterans Affairs, 

13 shall commence an assessment of the capacity of 

14 peer specialists of the Department of Veterans Af15 fairs who are women. 

16 (2) ELEMENTS.—The assessment required by 

17 paragraph (1) shall include an assessment of the fol18 lowing: 

19 (A) The geographical distribution of peer 

20 specialists of the Department who are women. 

21 (B) The geographical distribution of 

22 women veterans. 

23 (C) The number and proportion of women 

24 peer specialists who specialize in peer coun25 seling on mental health or suicide prevention. 


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1 (D) The number and proportion of women 

2 peer specialists who specialize in peer coun3 seling on non-mental health related matters. 

4 (b) REPORT.—Not later than one year after the as5 sessment required by subsection (a) has commenced, the 

6 Secretary shall submit to the Committee on Veterans’ Af7 fairs of the Senate and the Committee on Veterans’ Af8 fairs of the House of Representatives a report detailing 

9 the findings of the assessment. 

10 (c) STAFFING IMPROVEMENT PLAN.— 

11 (1) IN GENERAL.—Not later than 180 days 

12 after submitting the report under subsection (b), the 

13 Secretary, in consultation with the Inspector Gen14 eral, shall submit to the Committee on Veterans’ Af15 fairs of the Senate and the Committee on Veterans’ 

16 Affairs of the House of Representatives a plan, 

17 based on the results of the assessment required by 

18 subsection (a), to hire additional qualified peer spe19 cialists who are women, with special consideration 

20 for areas that lack peer specialists who are women. 

21 (2) ELEMENTS.—The peer specialist positions 

22 included in the plan required by paragraph (1)— 

23 (A) shall be non-volunteer, paid positions; 

24 and 

25 (B) may be part-time positions. 


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1 SEC. 505. ESTABLISHMENT OF DEPARTMENT OF VETERANS 

2 AFFAIRS READJUSTMENT COUNSELING 

3 SERVICE SCHOLARSHIP PROGRAM. 

4 (a) IN GENERAL.—Chapter 76 of title 38, United 

5 States Code, is amended by inserting after subchapter 

6 VIII the following new subchapter: 

7 ‘‘SUBCHAPTER IX—READJUSTMENT 

8 COUNSELING SERVICE SCHOLARSHIP PROGRAM 

9 ‘‘§ 7698. Requirement for program 

10 ‘‘As part of the Educational Assistance Program, the 

11 Secretary shall carry out a scholarship program under this 

12 subchapter. The program shall be known as the Depart13 ment of Veterans Affairs Readjustment Counseling Serv14 ice Scholarship Program (in this subchapter referred to 

15 as the ‘Program’). 

16 ‘‘§ 7699. Eligibility; agreement 

17 ‘‘(a) IN GENERAL.—An individual is eligible to par18 ticipate in the Program, as determined by the Readjust19 ment Counseling Service of the Department, if the indi20 vidual— 

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

22 described in section 7602 of this title) in, a program 

23 of study at an accredited educational institution, 

24 school, or training program leading to— 


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1 ‘‘(A) a bachelor’s, master’s, or doctoral de2 gree in psychology, social work, or marriage 

3 and family therapy; or 

4 ‘‘(B) a master’s degree in mental health 

5 counseling; and 

6 ‘‘(2) enters into an agreement with the Sec7 retary under subsection (c). 

8 ‘‘(b) PRIORITY.—In selecting individuals to partici9 pate in the Program, the Secretary shall give priority to 

10 the following individuals: 

11 ‘‘(1) An individual who agrees to be employed 

12 by a Vet Center located in a community that is— 

13 ‘‘(A) designated as a medically underserved 

14 population under section 330(b)(3) of the Pub15 lic Health Service Act (42 U.S.C. 254b(b)(3)); 

16 and 

17 ‘‘(B) in a state with a per capita popu18 lation of veterans of more than five percent ac19 cording to the National Center for Veterans 

20 Analysis and Statistics and the Bureau of the 

21 Census. 

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

23 ‘‘(c) AGREEMENT.—An agreement between the Sec24 retary and a participant in the Program shall (in addition 


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1 to the requirements set forth in section 7604 of this title) 

2 include the following: 

3 ‘‘(1) An agreement by the Secretary to provide 

4 the participant with a scholarship under the Pro5 gram for a specified number of school years during 

6 which the participant pursues a program of study 

7 described in subsection (a)(1) that meets the re8 quirements set forth in section 7602(a) of this title. 

9 ‘‘(2) An agreement by the participant to serve 

10 as a full-time employee of the Department at a Vet 

11 Center for a three-year period during the six-year 

12 period following the completion by the participant of 

13 such program of study (in this subchapter referred 

14 to as the ‘period of obligated service’). 

15 ‘‘(d) VET CENTER DEFINED.—In this section, the 

16 term ‘Vet Center’ has the meaning given that term in sec17 tion 1712A(h) of this title. 

18 ‘‘§ 7699A. Obligated service 

19 ‘‘(a) IN GENERAL.—Each participant in the Program 

20 shall provide service as a full-time employee of the Depart21 ment at a Vet Center (as defined in section 7699(c) of 

22 this title) for the period of obligated service set forth in 

23 the agreement of the participant entered into under sec24 tion 7604 of this title. 


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1 ‘‘(b) DETERMINATION OF SERVICE COMMENCEMENT

2 DATE.—(1) Not later than 60 days before the service com3 mencement date of a participant, the Secretary shall no4 tify the participant of that service commencement date. 

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

6 to a participant is the date for the beginning of the period 

7 of obligated service of the participant. 

8 ‘‘§ 7699B. Breach of agreement: liability 

9 ‘‘(a) LIQUIDATED DAMAGES.—(1) A participant in 

10 the Program (other than a participant described in sub11 section (b)) who fails to accept payment, or instructs the 

12 educational institution in which the participant is enrolled 

13 not to accept payment, in whole or in part, of a scholarship 

14 under the agreement entered into under section 7604 of 

15 this title shall be liable to the United States for liquidated 

16 damages in the amount of $1,500. 

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

18 any period of obligated service or other obligation or liabil19 ity under such agreement. 

20 ‘‘(b) LIABILITY DURING PROGRAM OF STUDY.—(1) 

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

22 Program shall be liable to the United States for the 

23 amount which has been paid to or on behalf of the partici24 pant under the agreement if any of the following occurs: 


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1 ‘‘(A) The participant fails to maintain an ac2 ceptable level of academic standing in the edu3 cational institution in which the participant is en4 rolled (as determined by the educational institution 

5 under regulations prescribed by the Secretary). 

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

7 educational institution for disciplinary reasons. 

8 ‘‘(C) The participant voluntarily terminates the 

9 program of study in such educational institution be10 fore the completion of such program of study. 

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

12 service obligation arising under the agreement. 

13 ‘‘(c) LIABILITY DURING PERIOD OF OBLIGATED

14 SERVICE.—(1) Except as provided in subsection (d), if a 

15 participant in the Program does not complete the period 

16 of obligated service of the participant, the United States 

17 shall be entitled to recover from the participant an amount 

18 determined in accordance with the following formula: 

19 A = 3Φ(t−s/t). 

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

21 ‘‘(A) ‘A’ is the amount the United States is en22 titled to recover. 

23 ‘‘(B) ‘Φ’ is the sum of— 

24 ‘‘(i) the amounts paid under this sub25 chapter to or on behalf of the participant; and 


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1 ‘‘(ii) the interest on such amounts which 

2 would be payable if at the time the amounts 

3 were paid they were loans bearing interest at 

4 the maximum legal prevailing rate, as deter5 mined by the Treasurer of the United States. 

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

7 period of obligated service of the participant. 

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

9 served by the participant. 

10 ‘‘(d) LIMITATION ON LIABILITY FOR REDUCTIONS11 IN-FORCE.—Liability shall not arise under subsection (c) 

12 if the participant fails to maintain employment as a De13 partment employee due to a staffing adjustment. 

14 ‘‘(e) PERIOD FOR PAYMENT OF DAMAGES.—Any 

15 amount of damages that the United States is entitled to 

16 recover under this section shall be paid to the United 

17 States within the one-year period beginning on the date 

18 of the breach of the agreement.’’. 

19 (b) CONFORMING AND TECHNICAL AMENDMENTS.— 

20 (1) CONFORMING AMENDMENTS.— 

21 (A) ESTABLISHMENT OF PROGRAM.—Sec22 tion 7601(a) of such title is amended— 

23 (i) in paragraph (5), by striking 

24 ‘‘and’’; 


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1 (ii) in paragraph (6), by striking the 

2 period and inserting ‘‘; and’’; and 

3 (iii) by adding at the end the fol4 lowing new paragraph: 

5 ‘‘(7) the readjustment counseling service schol6 arship program provided for in subchapter IX of this 

7 chapter.’’. 

8 (B) ELIGIBILITY.—Section 7602 of such 

9 title is amended— 

10 (i) in subsection (a)(1)— 

11 (I) by striking ‘‘or VI’’ and in12 serting ‘‘VI, or IX’’; and 

13 (II) by striking ‘‘subchapter VI’’ 

14 and inserting ‘‘subchapter VI or IX’’; 

15 and 

16 (ii) in subsection (b), by striking ‘‘or 

17 VI’’ and inserting ‘‘VI, or IX’’. 

18 (C) APPLICATION.—Section 7603(a)(1) of 

19 such title is amended by striking ‘‘or VIII’’ and 

20 inserting ‘‘VIII, or IX’’. 

21 (D) TERMS OF AGREEMENT.—Section 

22 7604 of such title is amended by striking ‘‘or 

23 VIII’’ each place it appears and inserting 

24 ‘‘VIII, or IX’’. 


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1 (E) ANNUAL REPORT.—Section 7632 of 

2 such title is amended— 

3 (i) in paragraph (1), by striking ‘‘and 

4 the Specialty Education Loan Repayment 

5 Program’’ and inserting ‘‘the Specialty 

6 Education Loan Repayment Program, and 

7 the Readjustment Counseling Service 

8 Scholarship Program’’; and 

9 (ii) in paragraph (4), by striking ‘‘and 

10 per participant in the Specialty Education 

11 Loan Repayment Program’’ and inserting 

12 ‘‘per participant in the Specialty Education 

13 Loan Repayment Program, and per partic14 ipant in the Readjustment Counseling 

15 Service Scholarship Program’’. 

16 (2) TABLE OF SECTIONS.—The table of sections 

17 at the beginning of chapter 76 of such title is 

18 amended by inserting after the items relating to sub19 chapter 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.’’. 

20 (c) EFFECTIVE DATE.—The Secretary of Veterans 

21 Affairs shall begin awarding scholarships under sub22 chapter IX of chapter 76 of title 38, United States Code, 


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1 as added by subsection (a), for programs of study begin2 ning not later than one year after the date of the enact3 ment of this Act. 

4 SEC. 506. COMPTROLLER GENERAL REPORT ON READJUST5 MENT COUNSELING SERVICE OF DEPART6 MENT OF VETERANS AFFAIRS. 

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

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

9 of the United States shall submit to the Committee on 

10 Veterans’ Affairs of the Senate and the Committee on Vet11 erans’ Affairs of the House of Representatives a report 

12 on the Readjustment Counseling Service of the Depart13 ment of Veterans Affairs. 

14 (b) ELEMENTS.—The report required by subsection 

15 (a) shall include the following: 

16 (1) An assessment of the adequacy and types of 

17 treatment, counseling, and other services provided at 

18 Vet Centers, including recommendations on whether 

19 and how such treatment, counseling, and other serv20 ices can be expanded. 

21 (2) An assessment of the efficacy of outreach 

22 efforts by the Readjustment Counseling Service, in23 cluding recommendations for how outreach efforts 

24 can be improved. 


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1 (3) An assessment of barriers to care at Vet 

2 Centers, including recommendations for overcoming 

3 those barriers. 

4 (4) An assessment of the efficacy and frequency 

5 of the use of telehealth by counselors of the Read6 justment Counseling Service to provide mental 

7 health services, including recommendations for how 

8 the use of telehealth can be improved. 

9 (5) An assessment of the feasibility and advis10 ability of expanding eligibility for services from the 

11 Readjustment Counseling Service, including— 

12 (A) recommendations on what eligibility 

13 criteria could be expanded; and 

14 (B) an assessment of potential costs and 

15 increased infrastructure requirements if eligi16 bility is expanded. 

17 (6) An assessment of the use of Vet Centers by 

18 members of the reserve components of the Armed 

19 Forces who were never activated and recommenda20 tions on how to better reach those members. 

21 (7) An assessment of the use of Vet Centers by 

22 eligible family members of former members of the 

23 Armed Forces and recommendations on how to bet24 ter reach those family members. 


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1 (8) An assessment of the efficacy of group ther2 apy and the level of training of providers at Vet 

3 Centers in administering group therapy. 

4 (c) VET CENTER DEFINED.—In this section, the 

5 term ‘‘Vet Center’’ has the meaning given that term in 

6 section 1712A(h) of title 38, United States Code. 

7 SEC. 507. EXPANSION OF REPORTING REQUIREMENTS ON 

8 READJUSTMENT COUNSELING SERVICE OF 

9 DEPARTMENT OF VETERANS AFFAIRS. 

10 (a) EXPANSION OF ANNUAL REPORT.—Paragraph 

11 (2)(C) of section 7309(e) of title 38, United States Code, 

12 is amended by inserting before the period at the end the 

13 following: ‘‘, including the resources required to meet such 

14 unmet need, such as additional staff, additional locations, 

15 additional infrastructure, infrastructure improvements, 

16 and additional mobile Vet Centers’’. 

17 (b) BIENNIAL REPORT.—Such section is amended by 

18 adding at the end the following new paragraph: 

19 ‘‘(3) For each even numbered year in which the re20 port required by paragraph (1) is submitted, the Secretary 

21 shall include in such report a prediction of trends in de22 mand for care, long-term investments required with re23 spect to the provision of care, maintenance of infrastruc24 ture, and other capital investments with respect to the ReVerDate Sep 11 2014 00:32 Jul 28, 2020 Jkt 099200 PO 00000 Frm 00095 Fmt 6652 Sfmt 6401 E:\BILLS\S785.RS S785

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1 adjustment Counseling Service, including Vet Centers, 

2 Mobile Vet Centers, and community access points.’’. 

3 SEC. 508. STUDIES ON ALTERNATIVE WORK SCHEDULES 

4 FOR EMPLOYEES OF VETERANS HEALTH AD5 MINISTRATION. 

6 (a) STUDY OF VETERANS.— 

7 (1) IN GENERAL.—Not later than 180 days 

8 after the date of the enactment of this Act, the Sec9 retary of Veterans Affairs shall conduct a study on 

10 the attitudes of eligible veterans toward the Depart11 ment of Veterans Affairs offering appointments out12 side the usual operating hours of facilities of the De13 partment, including through the use of telehealth 

14 appointments. 

15 (2) ELIGIBLE VETERAN DEFINED.—In this sub16 section, the term ‘‘eligible veteran’’ means a veteran 

17 who— 

18 (A) is enrolled in the patient enrollment 

19 system of the Department under section 

20 1705(a) of title 38, United States Code; and 

21 (B) received health care from the Depart22 ment at least once during the two-year period 

23 ending on the date of the commencement of the 

24 study under paragraph (1). 

25 (b) DEPARTMENT STUDY.— 


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

2 after the date of the enactment of this Act, the Sec3 retary shall conduct a study on the feasibility and 

4 advisability of offering appointments outside the 

5 usual operating hours of facilities of the Depart6 ment. 

7 (2) STUDY OF EMPLOYEES.—The study re8 quired by paragraph (1) shall include a study of the 

9 opinions of employees of the Veterans Health Ad10 ministration, including clinical, nonclinical, and sup11 port staff, with respect to offering appointments out12 side the usual operating hours of facilities of the De13 partment, including through the use of telehealth 

14 appointments. 

15 SEC. 509. SUICIDE PREVENTION COORDINATORS. 

16 The Secretary of Veterans Affairs shall ensure that 

17 each medical center of the Department of Veterans Affairs 

18 is staffed with not fewer than one suicide prevention coor19 dinator. 


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1 Subtitle B—Direct Hiring Authori2 ties for Certain Health Care Po3 sitions 

4 SEC. 521. DIRECT HIRING AUTHORITIES FOR CERTAIN 

5 HEALTH CARE POSITIONS. 

6 (a) IN GENERAL.—Subpart I of part III of title 5, 

7 United States Code, is amended by adding at the end the 

8 following: 

9 ‘‘CHAPTER 103—DEPARTMENT OF VET10 ERANS AFFAIRS HIRING AUTHORITIES 

‘‘Sec. 

‘‘10301. Department of Veterans Affairs personnel authorities. 

11 ‘‘§ 10301. Department of Veterans Affairs personnel 

12 authorities 

13 ‘‘(a) FLEXIBILITIES RELATING TO APPOINT14 MENTS.— 

15 ‘‘(1) IN GENERAL.—The Secretary of Veterans 

16 Affairs (referred to in this section as the ‘Secretary’) 

17 shall promulgate regulations to redesign the proce18 dures that are applied by the Department of Vet19 erans Affairs in making appointments to positions 

20 described in paragraphs (1) and (3) of section 7401 

21 of title 38 in order to— 

22 ‘‘(A) better meet mission needs; 

23 ‘‘(B) respond to managers’ needs and the 

24 needs of applicants; 


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1 ‘‘(C) produce high-quality applicants; 

2 ‘‘(D) support timely decisions; and 

3 ‘‘(E) promote competitive job offers. 

4 ‘‘(2) WAIVED REQUIREMENTS.—In redesigning 

5 the process by which the appointments described in 

6 paragraph (1) shall be made, the Secretary may 

7 waive the requirements of chapter 33, and the regu8 lations implementing that chapter, to the extent nec9 essary to achieve the objectives of this section, while 

10 providing for the following: 

11 ‘‘(A) Fair, credible, and transparent meth12 ods of establishing qualification requirements 

13 for, recruitment for, and appointments to posi14 tions. 

15 ‘‘(B) Fair and open competition and equi16 table treatment in the consideration and selec17 tion of individuals to positions. 

18 ‘‘(C) Fair, credible, and transparent meth19 ods of assigning, reassigning, detailing, trans20 ferring, or promoting employees. 

21 ‘‘(3) IMPLEMENTATION REQUIREMENTS.—In 

22 implementing this subsection, the Secretary shall 

23 comply with the provisions of section 2302(b)(11), 

24 regarding veterans’ preference requirements, in a 


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1 manner consistent with that in which such provi2 sions are applied under chapter 33. 

3 ‘‘(4) TRAINING PROGRAM.—The Secretary shall 

4 develop a training program for Department of Vet5 erans Affairs human resource professionals to imple6 ment the requirements of this subsection. 

7 ‘‘(5) INDICATORS OF EFFECTIVENESS.—The 

8 Secretary shall develop indicators of effectiveness to 

9 determine whether appointment flexibilities under 

10 this subsection have achieved the objectives de11 scribed in paragraph (1). 

12 ‘‘(b) CRITERIA FOR USE OF NEW PERSONNEL AU13 THORITIES.—In the redesign of appointment procedures, 

14 as described in subsection (a), and with respect to the sys15 tem of appointment flexibilities established under that 

16 subsection, the Secretary shall— 

17 ‘‘(1) include a means for ensuring employee in18 volvement (for bargaining unit employees, through 

19 their exclusive representatives) in that redesign and 

20 in the implementation of that system; 

21 ‘‘(2) provide for adequate training and retrain22 ing for supervisors, managers, and employees in the 

23 implementation and operation of that redesign and 

24 that system; 

25 ‘‘(3) develop— 


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1 ‘‘(A) a comprehensive management succes2 sion program to provide training to employees 

3 to develop managers for the agency; and 

4 ‘‘(B) a program to provide training to su5 pervisors on actions, options, and strategies 

6 that a supervisor may use in administering that 

7 system; 

8 ‘‘(4) include effective transparency and account9 ability measures and safeguards to ensure that the 

10 management of that system is fair, credible, and eq11 uitable, including appropriate independent reason12 ableness reviews, internal assessments, and employee 

13 surveys; 

14 ‘‘(5) provide mentors to advise individuals on 

15 their career paths and opportunities to advance and 

16 excel within their fields; 

17 ‘‘(6) develop appropriate procedures for warn18 ings during performance evaluations for employees 

19 who fail to meet performance standards; 

20 ‘‘(7) utilize the quadrennial strategic plan re21 quired under section 7330C(b) of title 38; and 

22 ‘‘(8) ensure that adequate agency resources are 

23 allocated for the design, implementation, and admin24 istration of that system.’’. 


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1 (b) TECHNICAL AND CONFORMING AMENDMENT.— 

2 The table of chapters for part III of title 5, United States 

3 Code, is amended by inserting after the item relating to 

4 chapter 102 the following: 

‘‘103. Department of Veterans Affairs Hiring Authorities .....................10301.’’. 

5 TITLE VI—IMPROVEMENT OF 

6 TELEHEALTH SERVICES 

7 SEC. 601. EXPANDED TELEHEALTH FROM DEPARTMENT OF 

8 VETERANS AFFAIRS. 

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

10 shall enter into partnerships, and expand existing partner11 ships, between the Department of Veterans Affairs, orga12 nizations that represent or serve veterans, nonprofit orga13 nizations, private businesses, and other interested parties 

14 for the expansion of telehealth capabilities and the provi15 sion of telehealth services to veterans through the award 

16 of grants under subsection (c). 

17 (b) PREFERENCE FOR PARTNERSHIPS.—The Sec18 retary shall give preference to entering into or expanding 

19 partnerships under subsection (a) with organizations 

20 that— 

21 (1) represent veterans in rural or highly rural 

22 areas (as determined through the use of the Rural23 Urban Commuting Areas coding system of the De24 partment of Agriculture); or 


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1 (2) operate in a medically underserved commu2 nity (as defined in section 799B of the Public 

3 Health Service Act (42 U.S.C. 295p)). 

4 (c) AWARD OF GRANTS.— 

5 (1) IN GENERAL.—In carrying out partnerships 

6 entered into or expanded under this section with en7 tities described in subsection (a), the Secretary shall 

8 award grants to those entities. 

9 (2) MAXIMUM AMOUNT OF GRANTS.—The 

10 amount of a grant awarded under this subsection 

11 may not exceed $75,000 per site per year. 

12 (3) USE OF GRANTS.— 

13 (A) IN GENERAL.—Grants awarded to an 

14 entity under this subsection shall be used for 

15 the following: 

16 (i) Purchasing or upgrading hardware 

17 or software necessary for the provision of 

18 secure and private telehealth services. 

19 (ii) Upgrading security protocols for 

20 consistency with the standardized tele21 health security protocol implemented under 

22 section 602(a)(2), or any other security re23 quirements of the Department. 


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1 (iii) Training of employees, including 

2 payment of those employees for completing 

3 that training, with respect to— 

4 (I) military and veteran cultural 

5 competence, if the entity is not an or6 ganization that represents veterans; 

7 and 

8 (II) equipment required to pro9 vide telehealth services. 

10 (iv) Upgrading existing infrastructure 

11 owned or leased by the entity to make 

12 rooms more conducive to telehealth care, 

13 including— 

14 (I) additional walls to create a 

15 new, private room; 

16 (II) soundproofing of existing 

17 rooms; or 

18 (III) new electrical or internet 

19 outlets in an existing room. 

20 (v) Upgrading existing infrastructure 

21 to comply with the Americans with Disabil22 ities Act of 1990 (42 U.S.C. 12101 et 

23 seq.). 

24 (vi) Upgrading internet infrastruc25 ture. 


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1 (B) EXCLUSION.—Grants may not be used 

2 for the purchase of new property or for major 

3 construction projects, as determined by the Sec4 retary. 

5 (d) MEMORANDA OF UNDERSTANDING OR AGREE6 MENT ON TELEHEALTH ACCESS POINTS.— 

7 (1) IN GENERAL.—An entity described in sub8 section (a) that seeks to establish a telehealth access 

9 point for veterans but does not require grant fund10 ing under this section to do so may enter into a 

11 memorandum of understanding or memorandum of 

12 agreement with the Department for the establish13 ment of such an access point. 

14 (2) INSPECTION.—The Secretary shall inspect 

15 the access point proposed to be established under 

16 paragraph (1) to ensure that it is adequately pri17 vate, secure, and accessible for veterans before the 

18 access point is established. 

19 (e) ASSESSMENT OF BARRIERS TO ACCESS.— 

20 (1) IN GENERAL.—Not later than 18 months 

21 after the date of the enactment of this Act, the Sec22 retary shall complete an assessment of barriers faced 

23 by veterans in accessing telehealth services from 

24 home. 


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1 (2) ELEMENTS.—The assessment required by 

2 paragraph (1) shall include the following: 

3 (A) An assessment of current and potential 

4 future cost barriers to veterans having internet 

5 access at home. 

6 (B) An assessment of current and poten7 tial future barriers to veterans accessing 

8 broadband services at home. 

9 (C) A description of how the Department 

10 plans to address the current and potential fu11 ture cost and access barriers described in sub12 paragraphs (A) and (B). 

13 (D) Such other matters related to internet 

14 access for veterans in their homes as the Sec15 retary considers relevant. 

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

17 the completion of the assessment required by para18 graph (1), the Secretary shall submit to the Com19 mittee on Veterans’ Affairs of the Senate and the 

20 Committee on Veterans’ Affairs of the House of 

21 Representatives a report on the assessment, includ22 ing any recommendations for legislative or adminis23 trative action based on the results of the assessment. 


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1 (f) AUTHORIZATION OF APPROPRIATIONS.—There is 

2 authorized to be appropriated to the Secretary of Veterans 

3 Affairs $10,000,000 to carry out this section. 

4 SEC. 602. IMPLEMENTATION OF NATIONAL PROTOCOL FOR 

5 TELEHEALTH SECURITY AND INTERFACING 

6 INSTRUCTIONS. 

7 (a) NATIONAL TELEHEALTH SECURITY PRO8 TOCOL.— 

9 (1) ASSESSMENT.— 

10 (A) IN GENERAL.—The Secretary of Vet11 erans Affairs, in consultation with industry ex12 perts, the Chairman of the Federal Trade Com13 mission, the Assistant Secretary of Veterans Af14 fairs for Information and Technology and Chief 

15 Information Officer, and stakeholders, shall 

16 conduct an assessment of current telehealth se17 curity protocols. 

18 (B) ELEMENTS.—The assessment con19 ducted under subparagraph (A) shall include 

20 the following: 

21 (i) An assessment of current tele22 health security protocols, including proto23 cols used by— 

24 (I) the Department of Veterans 

25 Affairs; 


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1 (II) other Federal agencies; 

2 (III) other health care providers; 

3 and 

4 (IV) such other organizations as 

5 the Secretary considers necessary to 

6 assess under such subparagraph. 

7 (ii) A study of any current or future 

8 security risks— 

9 (I) faced by veterans using tele10 health services; or 

11 (II) faced by the Department in 

12 furnishing those services. 

13 (C) TIMELINE.—The Secretary shall com14 plete the assessment conducted under subpara15 graph (A) not later than one year after the date 

16 of the enactment of this Act. 

17 (2) IMPLEMENTATION.—Not later than 18 

18 months after the completion of the assessment under 

19 paragraph (1), the Secretary shall, using guidance 

20 from the assessment, fully implement a standardized 

21 telehealth security protocol at all facilities of the De22 partment. 

23 (3) PRIVACY AND SECURITY.—The Secretary 

24 shall ensure that the security protocol implemented 

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1 rity of veterans, the health data of veterans, and 

2 data from the Department. 

3 (b) NATIONAL TELEHEALTH INTERFACING INSTRUC4 TIONS.— 

5 (1) ASSESSMENT.— 

6 (A) IN GENERAL.—The Secretary of Vet7 erans Affairs, in consultation with industry ex8 perts, organizations that represent veterans, the 

9 Chief Veterans Experience Officer, the Assist10 ant Secretary of Veterans Affairs for Informa11 tion and Technology and Chief Information Of12 ficer, and stakeholders, shall conduct an assess13 ment of current telehealth interfacing instruc14 tions. 

15 (B) ELEMENTS.—The assessment con16 ducted under subparagraph (A) shall include an 

17 assessment of interfacing instructions used 

18 by— 

19 (i) the Department of Veterans Af20 fairs; 

21 (ii) other Federal agencies; 

22 (iii) other health care providers; and 

23 (iv) such other organizations as the 

24 Secretary considers necessary to assess 

25 under such subparagraph. 


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1 (C) TIMELINE.—The Secretary shall com2 plete the assessment conducted under subpara3 graph (A) not later than one year after the date 

4 of the enactment of this Act. 

5 (2) IMPLEMENTATION.—Not later than 18 

6 months after the completion of the assessment under 

7 paragraph (1), the Secretary shall, using guidance 

8 from the assessment, fully implement standardized 

9 telehealth interfacing instructions at all facilities of 

10 the Department. 

11 (3) NAVIGATION.—The Secretary shall ensure 

12 that the telehealth interfacing instructions imple13 mented under this subsection are those that are 

14 easiest to navigate for veterans and health care pro15 viders. 

16 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

18 ‘‘Commander John Scott Hannon Veterans Mental Health 

19 Care Improvement Act of 2019’’. 

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

21 this Act is as follows: 

Sec. 1. Short title; table of contents. 

TITLE I—IMPROVEMENT OF TRANSITION OF INDIVIDUALS TO 

SERVICES FROM DEPARTMENT OF VETERANS AFFAIRS 

Sec. 101. Expansion of health care coverage for veterans. 

Sec. 102. Review of records of former members of the Armed Forces who die by 

suicide within one year of separation from the Armed Forces. 

Sec. 103. Report on REACH VET program of Department of Veterans Affairs. 


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Sec. 104. Report on care for former members of the Armed Forces with other than 

honorable discharge. 

TITLE II—SUICIDE PREVENTION 

Sec. 201. Financial assistance to certain entities to provide and coordinate the 

provision of suicide prevention services for eligible individuals 

and their families. 

Sec. 202. Study on feasibility and advisability of the Department of Veterans Affairs providing certain complementary and integrative health 

services. 

Sec. 203. Pilot program to provide veterans access to complementary and integrative health services through animal therapy, agritherapy, posttraumatic growth therapy, and outdoor sports and recreation 

therapy. 

Sec. 204. Department of Veterans Affairs independent reviews of certain deaths 

of veterans by suicide and staffing levels of mental health professionals. 

Sec. 205. Comptroller General report on management by Department of Veterans 

Affairs of veterans at high risk for suicide. 

TITLE III—PROGRAMS, STUDIES, AND GUIDELINES ON MENTAL 

HEALTH 

Sec. 301. Study on connection between living at high altitude and suicide risk 

factors among veterans. 

Sec. 302. Establishment by Department of Veterans Affairs and Department of 

Defense of a clinical provider treatment toolkit and accompanying training materials for comorbidities. 

Sec. 303. Update of clinical practice guidelines for assessment and management 

of patients at risk for suicide. 

Sec. 304. Establishment by Department of Veterans Affairs and Department of 

Defense of clinical practice guidelines for the treatment of serious mental illness. 

Sec. 305. Precision medicine initiative of Department of Veterans Affairs to identify and validate brain and mental health biomarkers. 

Sec. 306. Statistical analyses and data evaluation by Department of Veterans Affairs. 

TITLE IV—OVERSIGHT OF MENTAL HEALTH CARE AND RELATED 

SERVICES 

Sec. 401. Study on effectiveness of suicide prevention and mental health outreach 

programs of Department of Veterans Affairs. 

Sec. 402. Oversight of mental health and suicide prevention media outreach conducted by Department of Veterans Affairs. 

Sec. 403. Comptroller General management review of mental health and suicide 

prevention services of Department of Veterans Affairs. 

Sec. 404. Comptroller General report on efforts of Department of Veterans Affairs 

to integrate mental health care into primary care clinics. 

Sec. 405. Joint mental health programs by Department of Veterans Affairs and 

Department of Defense. 


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TITLE V—IMPROVEMENT OF MENTAL HEALTH MEDICAL 

WORKFORCE 

Sec. 501. Staffing improvement plan for mental health providers of Department 

of Veterans Affairs. 

Sec. 502. Staffing improvement plan for peer specialists of Department of Veterans Affairs who are women. 

Sec. 503. Establishment of Department of Veterans Affairs Readjustment Counseling Service Scholarship Program. 

Sec. 504. Comptroller General report on Readjustment Counseling Service of Department of Veterans Affairs. 

Sec. 505. Expansion of reporting requirements on Readjustment Counseling Service of Department of Veterans Affairs. 

Sec. 506. Studies on alternative work schedules for employees of Veterans Health 

Administration. 

Sec. 507. Suicide prevention coordinators. 

Sec. 508. Report on efforts by Department of Veterans Affairs to implement safety 

planning in emergency departments. 

TITLE VI—IMPROVEMENT OF CARE AND SERVICES FOR WOMEN 

VETERANS 

Sec. 601. Expansion of capabilities of Women Veterans Call Center to include text 

messaging. 

Sec. 602. Gap analysis of Department of Veterans Affairs programs that provide 

assistance to women veterans who are homeless. 

Sec. 603. Requirement for Department of Veterans Affairs internet website to provide information on services available to women veterans. 

Sec. 604. Report on locations where women veterans are using health care from 

Department of Veterans Affairs. 

TITLE VII—OTHER MATTERS 

Sec. 701. Expanded telehealth from Department of Veterans Affairs. 

Sec. 702. Partnerships with non-Federal Government entities to provide 

hyperbaric oxygen therapy to veterans and studies on the use of 

such therapy for treatment of post-traumatic stress disorder and 

traumatic brain injury. 

Sec. 703. Prescription of technical qualifications for licensed hearing aid specialists and requirement for appointment of such specialists. 

Sec. 704. Use by Department of Veterans Affairs of commercial institutional review boards in sponsored research trials. 

Sec. 705. Creation of Office of Research Reviews within the Office of Information 

and Technology of the Department of Veterans Affairs. 


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1 TITLE I—IMPROVEMENT OF 

2 TRANSITION OF INDIVIDUALS 

3 TO SERVICES FROM DEPART4 MENT OF VETERANS AFFAIRS 

5 SEC. 101. EXPANSION OF HEALTH CARE COVERAGE FOR 

6 VETERANS. 

7 (a) IN GENERAL.—Section 1710(a)(1) of title 38, 

8 United States Code, is amended— 

9 (1) in subparagraph (A), by striking ‘‘and’’ at 

10 the end; 

11 (2) by redesignating subparagraph (B) as sub12 paragraph (C); and 

13 (3) by inserting after subparagraph (A) the fol14 lowing new subparagraph (B): 

15 ‘‘(B) to any veteran during the one-year period 

16 following the discharge or release of the veteran from 

17 active military, naval, or air service; and’’. 

18 (b) PATIENT ENROLLMENT SYSTEM.—Section 1705(c) 

19 of such title is amended by adding at the end the following 

20 new paragraph: 

21 ‘‘(3) Nothing in this section shall be construed to pre22 vent the Secretary from providing hospital care and med23 ical services to a veteran under section 1710(a)(1)(B) of this 

24 title during the period specified in such section notwith25 standing the failure of the veteran to enroll in the system 


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1 of patient enrollment established by the Secretary under 

2 subsection (a).’’. 

3 (c) PROMOTION OF EXPANDED ELIGIBILITY.— 

4 (1) TRANSITION ASSISTANCE PROGRAM.— 

5 (A) IN GENERAL.—The Secretary of Labor, 

6 in consultation with the Secretary of Defense 

7 and the Secretary of Veterans Affairs, shall pro8 mote to members of the Armed Forces 

9 transitioning from service in the Armed Forces 

10 to civilian life through the Transition Assistance 

11 Program the expanded eligibility of veterans for 

12 health care under the laws administered by the 

13 Secretary of Veterans Affairs pursuant to the 

14 amendments made by this section. 

15 (B) TRANSITION ASSISTANCE PROGRAM DE16 FINED.—In this paragraph, the term ‘‘Transi17 tion Assistance Program’’ means the Transition 

18 Assistance Program under sections 1142 and 

19 1144 of title 10, United States Code. 

20 (2) PUBLICATION BY DEPARTMENT OF VETERANS

21 AFFAIRS.—Not later than 30 days after the date of the 

22 enactment of this Act, the Secretary of Veterans Af23 fairs shall publish on a website of the Department of 

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1 ministered by the Secretary pursuant to the amend2 ments made by this section. 

3 SEC. 102. REVIEW OF RECORDS OF FORMER MEMBERS OF 

4 THE ARMED FORCES WHO DIE BY SUICIDE 

5 WITHIN ONE YEAR OF SEPARATION FROM 

6 THE ARMED FORCES. 

7 (a) IN GENERAL.—The Secretary of Defense and the 

8 Secretary of Veterans Affairs shall jointly review the records 

9 of each former member of the Armed Forces who died by 

10 suicide within one year of separation from the Armed 

11 Forces during the five-year period preceding the date of the 

12 enactment of this Act. 

13 (b) ELEMENTS.—The review required by subsection (a) 

14 with respect to a former member of the Armed Forces shall 

15 include consideration of the following: 

16 (1) If the Department of Defense had previously 

17 identified the former member as being at risk for sui18 cide and if that identification had been commu19 nicated to the Department of Veterans Affairs. 

20 (2) What risk factors were present with respect 

21 to the former member and how those risk factors cor22 related to the circumstances of the death of the former 

23 member. 


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1 (3) If the former member was eligible to receive 

2 health care services from the Department of Veterans 

3 Affairs. 

4 (4) If the former member received health care 

5 services, including mental health care services, from a 

6 facility of the Department of Veterans Affairs, includ7 ing readjustment counseling services, following sepa8 ration from the Armed Forces. 

9 (5) If the former member had received a mental 

10 health waiver during service in the Armed Forces. 

11 (6) The employment status, housing status, mar12 ital status, age, rank within the Armed Forces (such 

13 as enlisted or officer), and branch of service within 

14 the Armed Forces of the former member. 

15 (7) If support services, specified by the type of 

16 service (such as employment, mental health, etc.), 

17 were provided to the former member during their pe18 riod of separation from the Armed Forces, 

19 disaggregated by— 

20 (A) services furnished by the Department of 

21 Defense, including through contracts; 

22 (B) services furnished by the Department of 

23 Veterans Affairs, including through contracts; 

24 and 


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1 (C) services not covered under subparagraph 

2 (A) or (B). 

3 (c) REPORT.— 

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

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

6 Defense and the Secretary of Veterans Affairs shall 

7 jointly submit to the appropriate committees of Con8 gress an aggregated report on the results of the review 

9 conducted under subsection (a). 

10 (2) APPROPRIATE COMMITTEES OF CONGRESS

11 DEFINED.—In this subsection, the term ‘‘appropriate 

12 committees of Congress’’ means— 

13 (A) The Committee on Armed Services and 

14 the Committee on Veterans’ Affairs of the Senate; 

15 and 

16 (B) The Committee on Armed Services and 

17 the Committee on Veterans’ Affairs of the House 

18 of Representatives. 

19 SEC. 103. REPORT ON REACH VET PROGRAM OF DEPART20 MENT OF VETERANS AFFAIRS. 

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

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

23 Affairs shall submit to the Committee on Veterans’ Affairs 

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


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1 the House of Representatives a report on the REACH VET 

2 program. 

3 (b) ELEMENTS.—The report required by subsection (a) 

4 shall include the following: 

5 (1) An assessment of the impact of the REACH 

6 VET program on rates of suicide among veterans. 

7 (2) An assessment of how limits within the 

8 REACH VET program, such as caps on the number 

9 of veterans who may be flagged as high risk, are ad10 justed for differing rates of suicide across the country. 

11 (3) A detailed explanation, with evidence, for 

12 why the conditions included in the model used by the 

13 REACH VET program were chosen, including an ex14 planation as to why certain conditions, such as bipo15 lar disorder II, were not included even though they 

16 show a similar rate of risk for suicide as other condi17 tions that were included. 

18 (4) An assessment of the feasibility of incor19 porating certain economic data held by the Veterans 

20 Benefits Administration into the model used by the 

21 REACH VET program, including financial data and 

22 employment status, which research indicates may 

23 have an impact on risk for suicide. 

24 (c) REACH VET PROGRAM DEFINED.—In this sec25 tion, the term ‘‘REACH VET program’’ means the RecovVerDate Sep 11 2014 00:32 Jul 28, 2020 Jkt 099200 PO 00000 Frm 00118 Fmt 6652 Sfmt 6203 E:\BILLS\S785.RS S785

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1 ery Engagement and Coordination for Health—Veterans 

2 Enhanced Treatment program of the Department of Vet3 erans Affairs. 

4 SEC. 104. REPORT ON CARE FOR FORMER MEMBERS OF THE 

5 ARMED FORCES WITH OTHER THAN HONOR6 ABLE DISCHARGE. 

7 Section 1720I(f) of title 38, United States Code, is 

8 amended— 

9 (1) in paragraph (1) by striking ‘‘Not less fre10 quently than once’’ and inserting ‘‘Not later than 

11 February 15’’; and 

12 (2) in paragraph (2)— 

13 (A) by redesignating subparagraph (C) as 

14 subparagraph (F); and 

15 (B) by inserting after subsection (B) the fol16 lowing new subparagraphs: 

17 ‘‘(C) The types of mental or behavioral health 

18 care needs treated under this section. 

19 ‘‘(D) The demographics of individuals being 

20 treated under this section, including— 

21 ‘‘(i) age; 

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

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

24 and 

25 ‘‘(iv) geographic location. 


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1 ‘‘(E) The average number of visits for an indi2 vidual for mental or behavioral health care under this 

3 section.’’. 

4 TITLE II—SUICIDE PREVENTION 

5 SEC. 201. FINANCIAL ASSISTANCE TO CERTAIN ENTITIES TO 

6 PROVIDE AND COORDINATE THE PROVISION 

7 OF SUICIDE PREVENTION SERVICES FOR ELI8 GIBLE INDIVIDUALS AND THEIR FAMILIES. 

9 (a) PURPOSE.—The purpose of this section is to reduce 

10 veteran suicide through a community-based grant program 

11 to award grants to eligible entities to provide suicide pre12 vention services to eligible individuals and their family. 

13 (b) DISTRIBUTION OF FINANCIAL ASSISTANCE.— 

14 (1) IN GENERAL.—The Secretary of Veterans Af15 fairs shall provide financial assistance to eligible en16 tities approved under this section through the award 

17 of grants each fiscal year to such entities to provide 

18 and coordinate the provision of suicide prevention 

19 services to eligible individuals and their family to re20 duce the risk of suicide. 

21 (2) COORDINATION WITH TASK FORCE.—The Sec22 retary shall carry out this section in coordination 

23 with the President’s Roadmap to Empower Veterans 

24 and End the National Tragedy of Suicide Task Force, 

25 to the extent practicable. 


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1 (c) AWARD OF GRANTS.— 

2 (1) IN GENERAL.—The Secretary shall award a 

3 grant to each eligible entity for which the Secretary 

4 has approved an application under subsection (f) to 

5 provide or coordinate the provision of suicide preven6 tion services under this section. 

7 (2) GRANT AMOUNTS, INTERVALS OF PAYMENT, 

8 AND MATCHING FUNDS.—In accordance with the serv9 ices being provided under a grant under this section 

10 and the duration of those services, the Secretary shall 

11 establish— 

12 (A) a maximum amount to be awarded 

13 under the grant that is not greater than 

14 $750,000 per grantee per fiscal year; 

15 (B) intervals of payment for the adminis16 tration of the grant; and 

17 (C) a requirement for the recipient of the 

18 grant to provide matching funds in a specified 

19 percentage. 

20 (d) DISTRIBUTION OF FINANCIAL ASSISTANCE AND

21 PREFERENCE.— 

22 (1) DISTRIBUTION.— 

23 (A) PRIORITY.—Subject to subparagraphs 

24 (B) and (C), in determining how to distribute 


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1 grants under this section, the Secretary may 

2 prioritize the award of grants in— 

3 (i) rural communities; 

4 (ii) Tribal lands; 

5 (iii) territories of the United States; 

6 (iv) medically underserved areas; 

7 (v) areas with a high number or per8 centage of minority veterans or women vet9 erans; and 

10 (vi) areas with a high number or per11 centage of calls to the Veterans Crisis Line. 

12 (B) AREAS WITH NEED.—The Secretary 

13 shall ensure that, to the extent practicable, finan14 cial assistance under this section is distributed— 

15 (i) to provide services in areas of the 

16 United States, including territories of the 

17 United States, that have experienced high 

18 rates or a high burden of veteran suicide; 

19 and 

20 (ii) to eligible entities that can assist 

21 eligible individuals at risk of suicide who 

22 are not currently receiving health care fur23 nished by the Department of Veterans Af24 fairs. 


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1 (C) GEOGRAPHY.—In distributing financial 

2 assistance under subparagraph (B), the Sec3 retary may provide grants to eligible entities 

4 that furnish services to eligible individuals in 

5 geographically dispersed areas. 

6 (2) PREFERENCE.— 

7 (A) IN GENERAL.—The Secretary shall give 

8 preference in the provision of financial assist9 ance under this section to eligible entities that 

10 have demonstrated the ability to provide or co11 ordinate multiple suicide prevention services 

12 using a collective impact model. 

13 (B) RULE OF CONSTRUCTION.—Nothing in 

14 this paragraph shall be construed to limit the 

15 award of grants under this section only to orga16 nizations that provide or coordinate multiple 

17 suicide prevention services through a collective 

18 impact model. 

19 (e) REQUIREMENTS FOR RECEIPT OF FINANCIAL AS20 SISTANCE.— 

21 (1) NOTIFICATION THAT SERVICES ARE FROM

22 DEPARTMENT.—Each entity receiving financial as23 sistance under this section to provide suicide preven24 tion services to eligible individuals and their family 

25 shall notify the recipients of such services that such 


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1 services are being paid for, in whole or in part, by 

2 the Department. 

3 (2) COORDINATION WITH OTHER SERVICES FROM

4 DEPARTMENT.—Each entity receiving a grant under 

5 this section shall— 

6 (A) coordinate with the Secretary with re7 spect to the provision of clinical services to eligi8 ble individuals in accordance with any other 

9 provision of law regarding the delivery of health 

10 care under the laws administered by the Sec11 retary; 

12 (B) inform a veteran in receipt of assist13 ance under this section of the eligibility of the 

14 veteran to enroll in the patient enrollment sys15 tem of the Department under section 1705 of 

16 title 38, United States Code; and 

17 (C) if such veteran wishes to so enroll, in18 form the veteran of the point of contact at the 

19 nearest medical center of the Department who 

20 can assist the veteran in such enrollment. 

21 (3) MEASUREMENT AND MONITORING.—Each en22 tity receiving a grant under this section shall submit 

23 to the Secretary a description of the tools and assess24 ments the entity uses or will use to determine the ef25 fectiveness of the services furnished by the entity 


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1 under this section, including the effect of those services 

2 on— 

3 (A) the financial stability of eligible indi4 viduals receiving those services; 

5 (B) the mental resiliency and mental out6 look of those eligible individuals; and 

7 (C) the social support of those eligible indi8 viduals. 

9 (4) REPORTS.—The Secretary— 

10 (A) shall require each entity receiving fi11 nancial assistance under this section to submit 

12 to the Secretary an annual report that describes 

13 the projects carried out with such financial as14 sistance during the year covered by the report, 

15 including the number of eligible individuals 

16 served; 

17 (B) shall specify to each such entity the 

18 evaluation criteria and data and information, 

19 which shall include a mental health measure20 ment of each eligible individual served, to be sub21 mitted in such report; and 

22 (C) may require such entities to submit to 

23 the Secretary such additional reports as the Sec24 retary considers appropriate. 

25 (f) APPLICATION FOR FINANCIAL ASSISTANCE.— 


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1 (1) IN GENERAL.—An eligible entity seeking fi2 nancial assistance under this section shall submit to 

3 the Secretary an application therefor in such form, in 

4 such manner, and containing such commitments and 

5 information as the Secretary considers necessary to 

6 carry out this section. 

7 (2) MATTERS TO BE INCLUDED.—Each applica8 tion submitted by an eligible entity under paragraph 

9 (1) shall contain the following: 

10 (A) A description of the suicide prevention 

11 services proposed to be provided by the eligible 

12 entity and the identified need for those services. 

13 (B) A detailed plan describing how the eli14 gible entity proposes to coordinate and deliver 

15 suicide prevention services (including by pro16 viding opportunities for mental wellness and 

17 personal growth) to eligible individuals not cur18 rently receiving care furnished by the Depart19 ment, including— 

20 (i) an identification of the community 

21 partners, if any, with which the eligible en22 tity proposes to work in delivering such 

23 services; 


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1 (ii) a description of the arrangements 

2 currently in place between the eligible entity 

3 and such partners; and 

4 (iii) an identification of how long such 

5 arrangements have been in place. 

6 (C) Clearly defined objectives for the provi7 sion of suicide prevention services. 

8 (D) A description of the services the eligible 

9 entity proposes to deliver directly and a descrip10 tion of any services the eligible entity proposes to 

11 deliver through an agreement with a community 

12 partner, if any. 

13 (E) A description of the types of eligible in14 dividuals at risk of suicide and their family pro15 posed to be provided suicide prevention services. 

16 (F) An estimate of the number of eligible 

17 individuals at risk of suicide and their family 

18 proposed to be provided suicide prevention serv19 ices and the basis for such estimate, including 

20 the percentage of those individuals who are not 

21 currently receiving care furnished by the Depart22 ment. 

23 (G) The physical address of the primary lo24 cation of the eligible entity. 


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1 (H) A description of the geographic area 

2 and boundaries the eligible entity plans to serve 

3 during the year for which the application ap4 plies. 

5 (I) Evidence of the experience of the eligible 

6 entity (and the proposed partners of the entity) 

7 in providing suicide prevention services to indi8 viduals at risk of suicide, particularly to eligible 

9 individuals at risk of suicide and their family. 

10 (J) A description of the managerial and 

11 technological capacity of the eligible entity— 

12 (i) to coordinate the provision of sui13 cide prevention services with the provision 

14 of other services; 

15 (ii) to assess continuously the needs of 

16 eligible individuals at risk of suicide and 

17 their family for suicide prevention services; 

18 (iii) to coordinate the provision of sui19 cide prevention services with the services of 

20 the Department for which the beneficiaries 

21 are eligible; 

22 (iv) to continuously seek new sources of 

23 assistance to ensure the continuity of sui24 cide prevention services for eligible individ25 uals at risk of suicide and their family as 


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1 long as the individual is determined to be 

2 at risk of suicide; and 

3 (v) to measure, over a long-term pe4 riod, the improved mental resiliency and 

5 mental outlook of the eligible individual 

6 served. 

7 (K) An agreement to use the measurement 

8 tool provided by the Department for purposes of 

9 measuring effectiveness of the programming as 

10 described in paragraph (2) of subsection (h). 

11 (L) A description of how the eligible entity 

12 plans to assess the effectiveness of the provision 

13 of suicide prevention services under this section. 

14 (M) Such additional application criteria as 

15 the Secretary considers appropriate. 

16 (g) TECHNICAL ASSISTANCE.— 

17 (1) IN GENERAL.—The Secretary shall provide 

18 training and technical assistance to eligible entities 

19 in receipt of financial assistance under this section 

20 regarding— 

21 (A) the data required to be collected and 

22 shared with the Department; 

23 (B) the means of data collection and shar24 ing; 


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1 (C) familiarization with and appropriate 

2 use of any tool to be used to measure the effec3 tiveness of the use of the financial assistance pro4 vided; and 

5 (D) the requirements for reporting under 

6 subsection (e)(4) on services provided via such fi7 nancial assistance. 

8 (2) PROVISION OF TRAINING AND TECHNICAL AS9 SISTANCE.—The Secretary may provide the training 

10 and technical assistance described in paragraph (1) 

11 directly or through grants or contracts with appro12 priate public or nonprofit entities. 

13 (h) ADMINISTRATION OF GRANT PROGRAM.— 

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

15 consultation with entities specified in paragraph (3), 

16 shall establish criteria for the selection of eligible enti17 ties that have submitted applications under subsection 

18 (f). 

19 (2) DEVELOPMENT OF MEASURES AND

20 METRICS.—The Secretary shall develop, in consulta21 tion with entities specified in paragraph (3), the fol22 lowing: 

23 (A) A framework for collecting and sharing 

24 information about entities in receipt of financial 

25 assistance under this section for purposes of imVerDate Sep 11 2014 00:32 Jul 28, 2020 Jkt 099200 PO 00000 Frm 00130 Fmt 6652 Sfmt 6203 E:\BILLS\S785.RS S785

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1 proving the discovery of services available for eli2 gible individuals at risk of suicide and their 

3 family, set forth by service type, locality, and eli4 gibility criteria. 

5 (B) The measures to be used by each entity 

6 in receipt of financial assistance under this sec7 tion to determine the effectiveness of the pro8 gramming being provided by such entity in im9 proving mental resiliency and mental outlook of 

10 eligible individuals at risk of suicide and their 

11 family. 

12 (C) Metrics for measuring the effectiveness 

13 of the provision of financial assistance under 

14 this section, including reducing suicide risk 

15 among eligible individuals. 

16 (3) COORDINATION.—In developing a plan for 

17 the design and implementation of the provision of fi18 nancial assistance under this section, including cri19 teria for the award of grants, the Secretary shall con20 sult with the following: 

21 (A) Veterans service organizations. 

22 (B) National organizations representing po23 tential community partners of eligible entities in 

24 providing supportive services to address the 

25 needs of eligible individuals at risk of suicide 


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1 and their family, including national organiza2 tions that— 

3 (i) advocate for the needs of individ4 uals with or at risk of behavioral health 

5 conditions; 

6 (ii) represent mayors; 

7 (iii) represent first responders; 

8 (iv) represent chiefs of police and sher9 iffs; 

10 (v) represent governors; 

11 (vi) represent a territory of the United 

12 States; or 

13 (vii) represent a Tribal alliance. 

14 (C) National organizations that represent 

15 counties. 

16 (D) Organizations with which the Depart17 ment has a current memorandum of agreement 

18 or understanding related to mental health or sui19 cide prevention. 

20 (E) State departments of veterans affairs. 

21 (F) National organizations representing 

22 members of the reserve components of the Armed 

23 Forces. 

24 (G) Vet Centers. 


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1 (H) Organizations, including institutions of 

2 higher education, with experience in creating 

3 measurement tools for purposes of determining 

4 programmatic effectiveness. 

5 (I) The National Alliance on Mental Illness. 

6 (J) The Centers for Disease Control and 

7 Prevention. 

8 (K) The Substance Abuse and Mental 

9 Health Services Administration of the Depart10 ment of Health and Human Services. 

11 (L) A labor organization (as such term is 

12 defined in section 7103(a)(4) of title 5, United 

13 States Code). 

14 (M) The PREVENTS task force established 

15 under Executive Order 13861 (84 Fed. Reg. 

16 8585; relating to the national roadmap to em17 power veterans and end suicide) . 

18 (N) Such other organizations as the Sec19 retary considers appropriate. 

20 (4) REPORT ON GRANT CRITERIA.—Not later 

21 than 30 days before notifying eligible entities of the 

22 availability of funding under this section, the Sec23 retary shall submit to the appropriate committees of 

24 Congress a report containing— 


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1 (A) criteria for the award of a grant under 

2 this section; 

3 (B) the tool or tools and metrics to be used 

4 by the Department to measure the effectiveness of 

5 the use of financial assistance provided under 

6 this section; 

7 (C) a framework for the sharing of informa8 tion about entities in receipt of financial assist9 ance under this section; and 

10 (D) the method by which the Secretary de11 termines financial responsibility for purposes of 

12 paragraph (3) of subsection (m). 

13 (i) INFORMATION ON POTENTIAL BENEFICIARIES.— 

14 (1) IN GENERAL.—The Secretary may make 

15 available to recipients of financial assistance under 

16 this section certain information regarding potential 

17 beneficiaries of services for which such financial as18 sistance is provided. 

19 (2) INFORMATION INCLUDED.—The information 

20 made available under paragraph (1) with respect to 

21 potential beneficiaries may include the following: 

22 (A) Confirmation of the status of a poten23 tial beneficiary as a veteran. 

24 (B) Confirmation of whether the potential 

25 beneficiary is enrolled in the patient enrollment 


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1 system of the Department under section 1705 of 

2 title 38, United States Code. 

3 (C) Confirmation of whether a potential 

4 beneficiary is currently receiving care furnished 

5 by the Department or has recently received such 

6 care. 

7 (3) OPT-OUT.—The Secretary shall allow an eli8 gible individual to opt out of having their informa9 tion shared under this subsection with recipients of fi10 nancial assistance under this section. 

11 (j) DURATION.—The authority of the Secretary to pro12 vide financial assistance under this section shall terminate 

13 on the date that is three years after the date on which the 

14 first grant is awarded under this section. 

15 (k) REPORTING AND ASSESSMENT.— 

16 (1) INTERIM REPORT.— 

17 (A) IN GENERAL.—Not later than 18 

18 months after the date on which the first grant is 

19 awarded under this section, the Secretary shall 

20 submit to the appropriate committees of Congress 

21 a report on the provision of financial assistance 

22 under this section. 

23 (B) ELEMENTS.—The report submitted 

24 under subparagraph (A) shall include the fol25 lowing: 


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1 (i) An assessment of the effectiveness of 

2 the provision of financial assistance under 

3 this section, including— 

4 (I) the effectiveness of community 

5 partners in conducting outreach to eli6 gible individuals at risk of suicide and 

7 their family and reducing suicide rates 

8 for eligible individuals; and 

9 (II) the effectiveness of the meas10 ures and metrics developed under sub11 section (h)(2) at improving coordina12 tion of suicide prevention services. 

13 (ii) A list of grant recipients and their 

14 partner organizations that delivered services 

15 funded by the grant and the amount of such 

16 grant received by each recipient and part17 ner organization. 

18 (iii) The number of eligible individuals 

19 supported by each grant recipient, includ20 ing through services provided to family 

21 members. 

22 (iv) The types of suicide prevention 

23 services provided by each grant recipient 

24 and partner organization. 


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1 (v) The number of eligible individuals 

2 supported by each grant recipient under 

3 this section, including through services pro4 vided to family members, who were not pre5 viously receiving care furnished by the De6 partment. 

7 (vi) The number of eligible individuals 

8 whose mental resiliency and mental outlook 

9 received a baseline measurement assessment 

10 under this section and the number of such 

11 individuals whose mental resiliency and 

12 mental outlook will be measured by the De13 partment or a community partner over a 

14 period of time. 

15 (vii) The types of data the Department 

16 was able to collect and share with partners, 

17 including a characterization of the benefits 

18 of that data. 

19 (viii) The number of eligible individ20 uals newly enrolled in the Veterans Health 

21 Administration by grant recipients, set 

22 forth by grant recipient. 

23 (2) FINAL REPORT.—Not later than three years 

24 after the date on which the first grant is awarded 


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1 under this section, the Secretary shall submit to the 

2 appropriate committees of Congress— 

3 (A) a follow-up on the interim report sub4 mitted under paragraph (1) containing the ele5 ments set forth in subparagraph (B) of such 

6 paragraph; and 

7 (B) a report on— 

8 (i) the effectiveness of the provision of 

9 financial assistance under this section, in10 cluding the effectiveness of community part11 ners in conducting outreach to eligible indi12 viduals at risk of suicide and their family 

13 and reducing suicide rates for eligible indi14 viduals; 

15 (ii) an assessment of the increased ca16 pacity of the Department to provide services 

17 to eligible individuals at risk of suicide and 

18 their family, set forth by State, as a result 

19 of the provision of financial assistance 

20 under this section; and 

21 (iii) the feasibility and advisability of 

22 extending or expanding the provision of fi23 nancial assistance under this section. 

24 (3) THIRD PARTY ASSESSMENT.— 

25 (A) STUDY OF GRANT PROGRAM.— 


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1 (i) IN GENERAL.—Not later than 180 

2 days after the date on which the first grant 

3 is awarded under this section, the Secretary 

4 shall seek to enter into a contract with an 

5 appropriate entity described in subpara6 graph (C) to conduct a study on the provi7 sion of grants under this section. 

8 (ii) ELEMENTS.—In conducting the 

9 study under clause (i), the appropriate enti10 ty shall— 

11 (I) evaluate the effectiveness of 

12 grants under this section in addressing 

13 the factors that contribute to suicide 

14 through the provision of services by eli15 gible entities located in the commu16 nities where the eligible individuals re17 ceiving those services live; and 

18 (II) compare the results of the 

19 provision of grants under this section 

20 with other national programs in deliv21 ering resources to eligible individuals 

22 in the communities where they live 

23 that address the factors that contribute 

24 to suicide. 

25 (B) ASSESSMENT.— 


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1 (i) IN GENERAL.—The contract under 

2 subparagraph (A) shall require that not 

3 later than two years after the date on which 

4 the first grant is awarded under this sec5 tion, the appropriate entity shall submit to 

6 the Secretary an assessment of the provision 

7 of grants under this section based on the 

8 study conducted pursuant to such contract. 

9 (ii) SUBMITTAL TO CONGRESS.—Upon 

10 receipt of the assessment under clause (i), 

11 the Secretary shall submit to the appro12 priate committees of Congress a copy of the 

13 assessment. 

14 (C) APPROPRIATE ENTITY.—An appropriate 

15 entity described in this subparagraph is a non16 government entity with experience optimizing 

17 and assessing organizations that deliver services. 

18 (l) PROVISION OF CARE TO ELIGIBLE INDIVIDUALS.— 

19 (1) IN GENERAL.—When the Secretary deter20 mines it is clinically appropriate, the Secretary shall 

21 furnish to an eligible individual receiving suicide pre22 vention services through a grant provided under this 

23 section an initial mental health assessment and men24 tal health or behavioral health care services author25 ized under chapter 17 of title 38, United States Code, 


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1 that are required to treat the mental or behavioral 

2 health care needs of the eligible individual, including 

3 risk of suicide. 

4 (2) INELIGIBLE.—If an eligible individual re5 fuses to receive services under paragraph (1) or is in6 eligible for such services, any ongoing clinical services 

7 provided by an eligible entity receiving a grant under 

8 this section, or a community partner of such entity, 

9 shall be at the expense of the entity. 

10 (m) DEFINITIONS.—In this section: 

11 (1) APPROPRIATE COMMITTEES OF CONGRESS.— 

12 The term ‘‘appropriate committees of Congress’’ 

13 means— 

14 (A) the Committee on Veterans’ Affairs and 

15 the Subcommittee on Military Construction, Vet16 erans Affairs, and Related Agencies of the Com17 mittee on Appropriations of the Senate; and 

18 (B) the Committee on Veterans’ Affairs and 

19 the Subcommittee on Military Construction, Vet20 erans Affairs, and Related Agencies of the Com21 mittee on Appropriations of the House of Rep22 resentatives. 

23 (2) COLLECTIVE IMPACT MODEL.—The term ‘‘col24 lective impact model’’ means a partnership between 

25 several entities that— 


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1 (A) collectively provides multiple suicide 

2 prevention services; 

3 (B) shares the common goal of reducing the 

4 risk of suicide among eligible individuals; 

5 (C) has a shared measurement system; 

6 (D) engages in continuous communication; 

7 and 

8 (E) includes an organization that acts as 

9 the supporting infrastructure of the model by 

10 creating a structured process for— 

11 (i) strategic planning; 

12 (ii) project management; and 

13 (iii) supporting partner entities 

14 through ongoing— 

15 (I) facilitation; 

16 (II) technology and communica17 tions support; 

18 (III) data collection and report19 ing; and 

20 (IV) administrative support. 

21 (3) ELIGIBLE ENTITY.—The term ‘‘eligible enti22 ty’’ means— 

23 (A) an incorporated private institution or 

24 foundation— 


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1 (i) no part of the net earnings of which 

2 incurs to the benefit of any member, found3 er, contributor, or individual; 

4 (ii) that has a governing board that 

5 would be responsible for the operation of the 

6 suicide prevention services provided under 

7 this section; and 

8 (iii) that is approved by the Secretary 

9 as to financial responsibility; 

10 (B) a corporation wholly owned and con11 trolled by an organization meeting the require12 ments of clauses (i), (ii), and (iii) of subpara13 graph (A); 

14 (C) a tribally designated housing entity (as 

15 defined in section 4 of the Native American 

16 Housing Assistance and Self-Determination Act 

17 of 1996 (25 U.S.C. 4103)); 

18 (D) a community-based organization— 

19 (i) that is physically based in the tar20 geted community; 

21 (ii) that can effectively network with 

22 local civic organizations, regional health 

23 systems, and other settings where eligible 

24 individuals at risk of suicide and their fam25 ily are likely to have contact; and 


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1 (iii) that is approved by the Secretary 

2 as to financial responsibility; 

3 (E) a community-based organization— 

4 (i) that is physically based in the tar5 geted community; 

6 (ii) that has demonstrated the poten7 tial to use a collective impact model to effec8 tively network and partner with community 

9 partners that offer suicide prevention serv10 ices to reduce the risk of suicide for eligible 

11 individuals; and 

12 (iii) that is approved by the Secretary 

13 as to financial responsibility; or 

14 (F) a State or local government that is ap15 proved by the Secretary as to financial responsi16 bility. 

17 (4) ELIGIBLE INDIVIDUAL.—The term ‘‘eligible 

18 individual’’ means— 

19 (A) a veteran, as defined in section 101 of 

20 title 38, United States Code; 

21 (B) an eligible individual described in sec22 tion 1720I(b) of such title; 

23 (C) an individual described in any of 

24 clauses (i) through (iv) of section 1712A(a)(1)(C) 

25 of such title; or 


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1 (D) such other individual as the Secretary 

2 considers appropriate. 

3 (5) EMERGENCY MEDICAL CONDITION DE4 FINED.—The term ‘‘emergency medical condition’’ 

5 means a medical or behavioral condition manifesting 

6 itself by acute symptoms of sufficient severity, includ7 ing severe pain, such that the absence of immediate 

8 medical attention could reasonably be expected to re9 sult in— 

10 (A) placing the health of the individual in 

11 serious jeopardy; 

12 (B) serious impairment to bodily functions; 

13 or 

14 (C) serious dysfunction of bodily organs. 

15 (6) FAMILY.—The term ‘‘family’’ means, with re16 spect to an eligible individual at risk of suicide, any 

17 of the following: 

18 (A) A parent. 

19 (B) A spouse. 

20 (C) A child. 

21 (D) A sibling. 

22 (E) A step-family member. 

23 (F) An extended family member. 

24 (G) Any other individual who lives with the 

25 eligible individual. 


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1 (7) NECESSARY STABILIZING TREATMENT DE2 FINED.—The term ‘‘necessary stabilizing treatment’’ 

3 means, with respect to an emergency medical condi4 tion, to provide, for not greater than 72 hours, such 

5 medical treatment for the condition necessary to as6 sure, within reasonable medical probability, that no 

7 material deterioration of the condition is likely to re8 sult from or occur during the transfer of the indi9 vidual from a facility. 

10 (8) PEER SPECIALIST.—The term ‘‘peer spe11 cialist’’ means a person eligible to be appointed as a 

12 peer specialist under section 7402(b)(13) of title 38, 

13 United States Code. 

14 (9) RISK OF SUICIDE.—The term ‘‘risk of sui15 cide’’ means exposure to or the existence of any of the 

16 following: 

17 (A) Health risk factors, including the fol18 lowing: 

19 (i) Mental health challenges. 

20 (ii) Substance abuse. 

21 (iii) Serious or chronic health condi22 tions or pain. 

23 (iv) Traumatic brain injury. 

24 (B) Environmental risk factors, including 

25 the following: 


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1 (i) Access to lethal means (such as 

2 drugs, firearms, etc.). 

3 (ii) Prolonged stress. 

4 (iii) Stressful life events. 

5 (iv) Exposure to the suicide of another 

6 person or to graphic or sensationalized ac7 counts of suicide. 

8 (v) Unemployment. 

9 (vi) Homelessness. 

10 (vii) Recent loss. 

11 (viii) Legal or financial challenges. 

12 (C) Historical risk factors, including the 

13 following: 

14 (i) Previous suicide attempts. 

15 (ii) Family history of suicide. 

16 (iii) History of abuse, neglect, or trau17 ma. 

18 (10) RURAL.—With respect to an area or com19 munity, the term ‘‘rural’’ has the meaning given that 

20 term in the Rural-Urban Commuting Areas coding 

21 system of the Department of Agriculture. 

22 (11) STATE.—The term ‘‘State’’ means each of 

23 several States, the District of Columbia, the Northern 

24 Mariana Islands, American Samoa, Guam, Puerto 

25 Rico, and the United States Virgin Islands. 


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1 (12) SUICIDE PREVENTION SERVICES.— 

2 (A) IN GENERAL.—The term ‘‘suicide pre3 vention services’’ means services to address the 

4 needs of eligible individuals at risk of suicide 

5 and their family and includes the following: 

6 (i) Outreach to identify eligible indi7 viduals at risk of suicide, with an emphasis 

8 on eligible individuals who are at highest 

9 risk or who are not receiving health care or 

10 other services furnished by the Department. 

11 (ii) A baseline mental health assess12 ment for risk screening and referral to care 

13 at— 

14 (I) a medical facility of the De15 partment; 

16 (II) a Vet Center; or 

17 (III) a non-Department facility if 

18 the eligible individual refuses to or is 

19 ineligible for care from the Department 

20 or a Vet Center. 

21 (iii) Education on suicide risk and 

22 prevention to families and communities. 

23 (iv) Individual and group therapy. 

24 (v) Case management services. 


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1 (vi) Peer support services provided by 

2 peer specialists. 

3 (vii) Assistance in obtaining any ben4 efit from the Department that the eligible 

5 individual at risk of suicide or their family 

6 may be eligible to receive, including— 

7 (I) vocational and rehabilitation 

8 counseling; 

9 (II) supportive services for home10 less veterans; 

11 (III) employment and training 

12 services; 

13 (IV) educational assistance; and 

14 (V) health care services. 

15 (viii) Assistance in obtaining and co16 ordinating the provision of other benefits 

17 provided by the Federal Government, a 

18 State or local government, or an eligible en19 tity. 

20 (ix) The provision of emergency mental 

21 health treatment to an eligible individual, 

22 which may include— 

23 (I) assessing the eligible indi24 vidual for immediate suicide risk; 


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1 (II) connecting the eligible indi2 vidual to the Veterans Crisis Line; and 

3 (III) in the case of an eligible in4 dividual who is experiencing an emer5 gency medical condition— 

6 (aa) paying for the provision 

7 of necessary stabilizing treatment 

8 provided in a hospital or other 

9 medical facility; and 

10 (bb) transporting the indi11 vidual— 

12 (AA) if the individual is 

13 eligible for care from the De14 partment, to a medical facil15 ity of the Department; or 

16 (BB) if the individual 

17 is not eligible for care from 

18 the Department, to a medical 

19 facility not operated by the 

20 Department. 

21 (x) Such other services necessary for 

22 improving the resiliency of eligible individ23 uals at risk of suicide and their family as 

24 the Secretary considers appropriate, which 

25 may include— 


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1 (I) assistance with emergent needs 

2 relating to— 

3 (aa) daily living services; 

4 (bb) personal financial plan5 ning; 

6 (cc) transportation services; 

7 (dd) legal services to assist 

8 the eligible individual with issues 

9 that may contribute to risk of sui10 cide; and 

11 (ee) child care (not to exceed 

12 $5,000 per family of the eligible 

13 individual per fiscal year); 

14 (II) adaptive sports, equine as15 sisted therapy, or in-place or outdoor 

16 recreational therapy; 

17 (III) substance use reduction pro18 gramming; 

19 (IV) individual, group, or family 

20 counseling; and 

21 (V) relationship coaching. 

22 (B) EXCLUSION.—The term ‘‘suicide pre23 vention services’’ does not include direct cash as24 sistance to eligible individuals or their family. 


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1 (13) VET CENTER.—The term ‘‘Vet Center’’ has 

2 the meaning given that term in section 1712A(h)(1) 

3 of title 38, United States Code. 

4 (14) VETERANS CRISIS LINE.—The term ‘‘Vet5 erans Crisis Line’’ means the toll-free hotline for vet6 erans established under section 1720F(h) of such title. 

7 (15) VETERANS SERVICE ORGANIZATION.—The 

8 term ‘‘veterans service organization’’ means any orga9 nization recognized by the Secretary of Veterans Af10 fairs for the representation of veterans included as 

11 part of the annually updated list at https:// 

12 www.va.gov/vso/ or a successor website. 

13 SEC. 202. STUDY ON FEASIBILITY AND ADVISABILITY OF 

14 THE DEPARTMENT OF VETERANS AFFAIRS 

15 PROVIDING CERTAIN COMPLEMENTARY AND 

16 INTEGRATIVE HEALTH SERVICES. 

17 (a) IN GENERAL.—Not later than 90 days after the 

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

19 Affairs shall complete a study on the feasibility and advis20 ability of providing complementary and integrative health 

21 treatments described in subsection (c) at all medical facili22 ties of the Department of Veterans Affairs. 

23 (b) INCLUSION OF ASSESSMENT OF REPORT.—The 

24 study conducted under subsection (a) shall include an as25 sessment of the final report of the Creating Options for VetVerDate Sep 11 2014 00:32 Jul 28, 2020 Jkt 099200 PO 00000 Frm 00152 Fmt 6652 Sfmt 6203 E:\BILLS\S785.RS S785

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1 erans’ Expedited Recovery Commission (commonly referred 

2 to as the ‘‘COVER Commission’’) established under section 

3 931 of the Jason Simcakoski Memorial and Promise Act 

4 (title IX of Public Law 114-198; 38 U.S.C. 1701 note). 

5 (c) TREATMENTS DESCRIBED.—Complementary and 

6 integrative health treatments described in this subjection 

7 shall consist of the following: 

8 (1) Yoga. 

9 (2) Meditation. 

10 (3) Acupuncture. 

11 (4) Chiropractic care. 

12 (5) Other treatments that show sufficient evi13 dence of efficacy at treating mental or physical health 

14 conditions, as determined by the Secretary. 

15 (d) REPORT.—The Secretary shall submit to the Com16 mittee on Veterans’ Affairs of the Senate and the Committee 

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

18 on the study completed under subsection (a), including— 

19 (1) the results of such study; and 

20 (2) such recommendations regarding the fur21 nishing of complementary and integrative health 

22 treatments described in subsection (c) as the Secretary 

23 considers appropriate. 


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1 SEC. 203. PILOT PROGRAM TO PROVIDE VETERANS ACCESS 

2 TO COMPLEMENTARY AND INTEGRATIVE 

3 HEALTH SERVICES THROUGH ANIMAL THER4 APY, AGRITHERAPY, POST-TRAUMATIC 

5 GROWTH THERAPY, AND OUTDOOR SPORTS 

6 AND RECREATION THERAPY. 

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

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

9 Affairs shall commence the conduct of a pilot program to 

10 provide complementary and integrative health services de11 scribed in subsection (b) to eligible veterans from the De12 partment of Veterans Affairs or through the use of non-De13 partment entities for the treatment of post-traumatic stress 

14 disorder, depression, anxiety, or other conditions as deter15 mined by the Secretary. 

16 (b) TREATMENTS DESCRIBED.—Complementary and 

17 integrative health treatments described in this subsection 

18 shall consist of the following: 

19 (1) Equine therapy. 

20 (2) Other animal therapy. 

21 (3) Agritherapy. 

22 (4) Post-traumatic growth therapy. 

23 (5) Outdoor sports and recreation therapy. 

24 (c) ELIGIBLE VETERANS.—A veteran is eligible to par25 ticipate in the pilot program under this section if the vet26 eran— 


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1 (1) is enrolled in the system of patient enroll2 ment of the Department under section 1705(a) of title 

3 38, United States Code; and 

4 (2) has received health care under the laws ad5 ministered by the Secretary during the two-year pe6 riod preceding the initial participation of the veteran 

7 in the pilot program. 

8 (d) DURATION.— 

9 (1) IN GENERAL.—The Secretary shall carry out 

10 the pilot program under this section for a three-year 

11 period beginning on the commencement of the pilot 

12 program. 

13 (2) EXTENSION.—The Secretary may extend the 

14 duration of the pilot program under this section if the 

15 Secretary, based on the results of the interim report 

16 submitted under subsection (f)(1), determines that it 

17 is appropriate to do so. 

18 (e) LOCATIONS.— 

19 (1) IN GENERAL.—The Secretary shall select not 

20 fewer than five facilities of the Department at which 

21 to carry out the pilot program under this section. 

22 (2) SELECTION CRITERIA.—In selecting facilities 

23 under paragraph (1), the Secretary shall ensure 

24 that— 


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1 (A) the locations are in geographically di2 verse areas; and 

3 (B) not fewer than three facilities serve vet4 erans in rural or highly rural areas (as deter5 mined through the use of the Rural-Urban Com6 muting Areas coding system of the Department 

7 of Agriculture). 

8 (f) RESEARCH ON EFFECTIVENESS OF TREATMENT.— 

9 (1) IN GENERAL.—The Secretary shall carry out 

10 the pilot program in conjunction with academic re11 searchers affiliated with the Department of Veterans 

12 Affairs, including through agreements under para13 graph (2), in order for those researchers to research 

14 the effectiveness of the treatments described in sub15 section (b). 

16 (2) AGREEMENTS.—Before commencing the pilot 

17 program, the Secretary shall seek to enter into agree18 ments with academic researchers to ensure robust 

19 data collection and gathering procedures are in place 

20 under the pilot program in order to produce peer-re21 viewed journal articles. 

22 (g) REPORTS.— 

23 (1) INTERIM REPORT.— 

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

25 after the commencement of the pilot program 


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1 under this section, the Secretary shall submit to 

2 the Committee on Veterans’ Affairs of the Senate 

3 and the Committee on Veterans’ Affairs of the 

4 House of Representatives a report on the progress 

5 of the pilot program. 

6 (B) ELEMENTS.—The report required by 

7 subparagraph (A) shall include the following: 

8 (i) The number of participants in the 

9 pilot program. 

10 (ii) The type or types of therapy of11 fered at each facility at which the pilot pro12 gram is being carried out. 

13 (iii) An assessment of whether partici14 pation by a veteran in the pilot program 

15 resulted in any changes in clinically rel16 evant endpoints for the veteran with respect 

17 to the conditions specified in subsection (a). 

18 (iv) An assessment of the quality of life 

19 of veterans participating in the pilot pro20 gram, including the results of a satisfaction 

21 survey of the participants in the pilot pro22 gram, disaggregated by treatment under 

23 subsection (b). 


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1 (v) The determination of the Secretary 

2 with respect to extending the pilot program 

3 under subsection (d)(2). 

4 (vi) Any recommendations of the Sec5 retary with respect to expanding the pilot 

6 program. 

7 (2) FINAL REPORT.—Not later than 90 days 

8 after the termination of the pilot program under this 

9 section, the Secretary shall submit to the Committee 

10 on Veterans’ Affairs of the Senate and the Committee 

11 on Veterans’ Affairs of the House of Representatives 

12 a final report on the pilot program. 

13 SEC. 204. DEPARTMENT OF VETERANS AFFAIRS INDE14 PENDENT REVIEWS OF CERTAIN DEATHS OF 

15 VETERANS BY SUICIDE AND STAFFING LEV16 ELS OF MENTAL HEALTH PROFESSIONALS. 

17 (a) REVIEW OF DEATHS OF VETERANS BY SUICIDE.— 

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

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

20 Veterans Affairs shall seek to enter into an agreement 

21 with the National Academies of Sciences, Engineer22 ing, and Medicine under which the National Acad23 emies shall conduct a review of the deaths of all cov24 ered veterans who died by suicide during the five-year 

25 period ending on the date of the enactment of this 


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1 Act, regardless of whether information relating to 

2 such deaths has been reported by the Centers for Dis3 ease Control and Prevention. 

4 (2) ELEMENTS.—The review required by para5 graph (1) shall include the following: 

6 (A) The total number of covered veterans 

7 who died by suicide during the five-year period 

8 ending on the date of the enactment of this Act. 

9 (B) The total number of covered veterans 

10 who died by a violent death during such five11 year period. 

12 (C) The total number of covered veterans 

13 who died by an accidental death during such 

14 five-year period. 

15 (D) A description of each covered veteran 

16 described in subparagraphs (A) through (C), in17 cluding age, gender, race, and ethnicity. 

18 (E) A comprehensive list of prescribed medi19 cations and legal or illegal substances as anno20 tated on toxicology reports of covered veterans 

21 described in subparagraphs (A) through (C), spe22 cifically listing any medications that carried a 

23 black box warning, were prescribed for off-label 

24 use, were psychotropic, or carried warnings that 

25 included suicidal ideation. 


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1 (F) A summary of medical diagnoses by 

2 physicians of the Department of Veterans Affairs 

3 or physicians providing services to covered vet4 erans through programs of the Department that 

5 led to the prescribing of medications referred to 

6 in subparagraph (E) in cases of post-traumatic 

7 stress disorder, traumatic brain injury, military 

8 sexual trauma, and other anxiety and depressive 

9 disorders. 

10 (G) The number of instances in which a 

11 covered veteran described in subparagraph (A), 

12 (B), or (C) was concurrently on multiple medi13 cations prescribed by physicians of the Depart14 ment or physicians providing services to veterans 

15 through programs of the Department to treat 

16 post-traumatic stress disorder, traumatic brain 

17 injury, military sexual trauma, other anxiety 

18 and depressive disorders, or instances of comor19 bidity. 

20 (H) The number of covered veterans de21 scribed in subparagraphs (A) through (C) who 

22 were not taking any medication prescribed by a 

23 physician of the Department or a physician pro24 viding services to veterans through a program of 

25 the Department. 


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1 (I) With respect to the treatment of post2 traumatic stress disorder, traumatic brain in3 jury, military sexual trauma, or other anxiety 

4 and depressive disorders, the percentage of cov5 ered veterans described in subparagraphs (A) 

6 through (C) who received a non-medication first7 line treatment compared to the percentage of 

8 such veterans who received medication only. 

9 (J) With respect to the treatment of covered 

10 veterans described in subparagraphs (A) through 

11 (C) for post-traumatic stress disorder, traumatic 

12 brain injury, military sexual trauma, or other 

13 anxiety and depressive disorders, the number of 

14 instances in which a non-medication first-line 

15 treatment (such as cognitive behavioral therapy) 

16 was attempted and determined to be ineffective 

17 for such a veteran, which subsequently led to the 

18 prescribing of a medication referred to in sub19 paragraph (E). 

20 (K) A description and example of how the 

21 Department determines and continually updates 

22 the clinical practice guidelines governing the 

23 prescribing of medications. 

24 (L) An analysis of the use by the Depart25 ment, including protocols or practices at medical 


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1 facilities of the Department, of systematically 

2 measuring pain scores during clinical encounters 

3 under the Pain as the 5th Vital Sign Toolkit of 

4 the Department and an evaluation of the rela5 tionship between the use of such measurements 

6 and the number of veterans concurrently on mul7 tiple medications prescribed by physicians of the 

8 Department. 

9 (M) The percentage of covered veterans de10 scribed in subparagraphs (A) through (C) with 

11 combat experience or trauma related to combat 

12 experience (including military sexual trauma, 

13 traumatic brain injury, and post-traumatic 

14 stress). 

15 (N) An identification of the medical facili16 ties of the Department with markedly high pre17 scription rates and suicide rates for veterans re18 ceiving treatment at those facilities. 

19 (O) An analysis, by State, of programs of 

20 the Department that collaborate with State Med21 icaid agencies and the Centers for Medicare and 

22 Medicaid Services, including the following: 

23 (i) An analysis of the sharing of pre24 scription and behavioral health data for vet25 erans. 


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1 (ii) An analysis of whether Depart2 ment staff check with State prescription 

3 drug monitoring programs before pre4 scribing medications to veterans. 

5 (iii) A description of the procedures of 

6 the Department for coordinating with pre7 scribers outside of the Department to ensure 

8 that veterans are not overprescribed. 

9 (iv) A description of actions that the 

10 Department takes when a veteran is deter11 mined to be overprescribed. 

12 (P) An analysis of the collaboration of med13 ical centers of the Department with medical ex14 aminers’ offices or local jurisdictions to deter15 mine veteran mortality and cause of death. 

16 (Q) An identification and determination of 

17 a best practice model to collect and share veteran 

18 death certificate data between the Department of 

19 Veterans Affairs, the Department of Defense, 

20 States, and tribal entities. 

21 (R) A description of how data relating to 

22 death certificates of veterans is collected, deter23 mined, and reported by the Department of Vet24 erans Affairs. 


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1 (S) An assessment of any patterns apparent 

2 to the National Academies of Sciences, Engineer3 ing, and Medicine based on the review conducted 

4 under paragraph (1). 

5 (T) Such recommendations for further ac6 tion that would improve the safety and well7 being of veterans as the National Academies of 

8 Sciences, Engineering, and Medicine determine 

9 appropriate. 

10 (b) REVIEW OF STAFFING LEVELS FOR MENTAL

11 HEALTH PROFESSIONALS.— 

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

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

14 shall seek to enter into an agreement with the Na15 tional Academies of Sciences, Engineering, and Medi16 cine under which the National Academies shall con17 duct a review of the staffing levels for mental health 

18 professionals of the Department. 

19 (2) ELEMENTS.—The review required by para20 graph (1) shall include a description of the efforts of 

21 the Department to maintain appropriate staffing lev22 els for mental health professionals, such as mental 

23 health counselors, marriage and family therapists, 

24 and other appropriate counselors, including the fol25 lowing: 


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1 (A) a description of any impediments to 

2 carry out the education, training, and hiring of 

3 mental health counselors and marriage and fam4 ily therapists under section 7302(a) of title 38, 

5 United States Code, and strategies for addressing 

6 those impediments; 

7 (B) a description of the objectives, goals, 

8 and timing of the Department with respect to in9 creasing the representation of such counselors 

10 and therapists in the behavioral health workforce 

11 of the Department, including— 

12 (i) a review of eligibility criteria for 

13 such counselors and therapists and a com14 parison of such criteria to that of other be15 havioral health professions in the Depart16 ment; and 

17 (ii) an assessment of the participation 

18 of such counselors and therapists in the 

19 mental health professionals trainee program 

20 of the Department and any impediments to 

21 such participation; 

22 (C) an assessment of the development by the 

23 Department of hiring guidelines for mental 

24 health counselors, marriage and family thera25 pists, and other appropriate counselors; 


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1 (D) a description of how the Department— 

2 (i) identifies gaps in the supply of 

3 mental health professionals; and 

4 (ii) determines successful staffing ra5 tios for mental health professionals of the 

6 Department; 

7 (E) a description of actions taken by the 

8 Secretary, in consultation with the Director of 

9 the Office of Personnel Management, to create an 

10 occupational series for mental health counselors 

11 and marriage and family therapists of the De12 partment and a timeline for the creation of such 

13 an occupational series; and 

14 (F) a description of actions taken by the 

15 Secretary to ensure that the national, regional, 

16 and local professional standards boards for men17 tal health counselors and marriage and family 

18 therapists are comprised of only mental health 

19 counselors and marriage and family therapists 

20 and that the liaison from the Department to such 

21 boards is a mental health counselor or marriage 

22 and family therapist. 

23 (c) COMPILATION OF DATA.— 

24 (1) FORM OF COMPILATION.—The Secretary of 

25 Veterans Affairs shall ensure that data compiled 


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1 under subsections (a) and (b) is compiled in a man2 ner that allows it to be analyzed across all data fields 

3 for purposes of informing and updating clinical prac4 tice guidelines of the Department of Veterans Affairs. 

5 (2) COMPILATION OF DATA REGARDING COVERED

6 VETERANS.—In compiling data under subsection 

7 (a)(2) regarding covered veterans described in sub8 paragraphs (A) through (C) of such subsection, data 

9 regarding veterans described in each such subpara10 graph shall be compiled separately and disaggregated 

11 by year. 

12 (d) COMPLETION OF REVIEWS AND REPORTS.—Each 

13 agreement entered into under subsections (a)(1) and (b)(1) 

14 shall require that the National Academies of Sciences, Engi15 neering, and Medicine complete the review under each such 

16 subsection and submit to the Secretary of Veterans Affairs 

17 a report containing the results of the review— 

18 (1) with respect to the review under subsection 

19 (a)(1), not later than 24 months after entering into 

20 the agreement; and 

21 (2) with respect to the review under subsection 

22 (b)(1), not later than 18 months after entering into 

23 the agreement. 

24 (e) REPORTS.—Not later than 90 days after the com25 pletion by the National Academies of Sciences, Engineering, 


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1 and Medicine of each of the reviews required under sub2 sections (a) and (b), the Secretary of Veterans Affairs 

3 shall— 

4 (1) submit to the Committee on Veterans’ Affairs 

5 of the Senate and the Committee on Veterans’ Affairs 

6 of the House of Representatives a report on the results 

7 of the review; and 

8 (2) make such report publicly available. 

9 (f) DEFINITIONS.—In this section: 

10 (1) The term ‘‘black box warning’’ means a 

11 warning displayed on the label of a prescription drug 

12 that is designed to call attention to the serious or life13 threatening risk of the prescription drug. 

14 (2) The term ‘‘covered veteran’’ means a veteran 

15 who received hospital care or medical services fur16 nished by the Department of Veterans Affairs during 

17 the five-year period preceding the death of the vet18 eran. 

19 (3) The term ‘‘first-line treatment’’ means a po20 tential intervention that has been evaluated and as21 signed a high score within clinical practice guide22 lines. 

23 (4) The term ‘‘State’’ means each of the States, 

24 territories, and possessions of the United States, the 


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1 District of Columbia, and the Commonwealth of Puer2 to Rico. 

3 SEC. 205. COMPTROLLER GENERAL REPORT ON MANAGE4 MENT BY DEPARTMENT OF VETERANS AF5 FAIRS OF VETERANS AT HIGH RISK FOR SUI6 CIDE. 

7 (a) IN GENERAL.—Not later than 18 months after the 

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

9 of the United States shall submit to the Committee on Vet10 erans’ Affairs of the Senate and the Committee on Veterans’ 

11 Affairs of the House of Representatives a report on the ef12 forts of the Department of Veterans Affairs to manage vet13 erans at high risk for suicide. 

14 (b) ELEMENTS.—The report required by subsection (a) 

15 shall include the following: 

16 (1) A description of how the Department identi17 fies patients as high risk for suicide, with particular 

18 consideration to the efficacy of inputs into the Recov19 ery Engagement and Coordination for Health – Vet20 erans Enhanced Treatment program (commonly re21 ferred to as the ‘‘REACH VET’’ program) of the De22 partment, including an assessment of the efficacy of 

23 such identifications disaggregated by age, gender, Vet24 erans Integrated Service Network, and, to the extent 

25 practicable, medical center of the Department. 


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1 (2) A description of how the Department inter2 venes when a patient is identified as high risk, in3 cluding an assessment of the efficacy of such interven4 tions disaggregated by age, gender, Veterans Inte5 grated Service Network, and, to the extent practicable, 

6 medical center of the Department. 

7 (3) A description of how the Department mon8 itors patients who have been identified as high risk, 

9 including an assessment of the efficacy of such moni10 toring and any follow-ups disaggregated by age, gen11 der, Veterans Integrated Service Network, and, to the 

12 extent practicable, medical center of the Department. 

13 (4) A review of staffing levels of suicide preven14 tion coordinators across the Veterans Health Adminis15 tration. 

16 (5) A review of the resources and programming 

17 offered to family members and friends of veterans who 

18 have a mental health condition in order to assist that 

19 veteran in treatment and recovery. 

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

21 Comptroller General considers appropriate to study. 


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1 TITLE III—PROGRAMS, STUDIES, 

2 AND GUIDELINES ON MENTAL 

3 HEALTH 

4 SEC. 301. STUDY ON CONNECTION BETWEEN LIVING AT 

5 HIGH ALTITUDE AND SUICIDE RISK FACTORS 

6 AMONG VETERANS. 

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

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

9 Affairs, in consultation with Rural Health Resource Cen10 ters of the Office of Rural Health of the Department of Vet11 erans Affairs, shall commence the conduct of a study on 

12 the connection between living at high altitude and the risk 

13 of developing depression or dying by suicide among vet14 erans. 

15 (b) COMPLETION OF STUDY.—The study conducted 

16 under subsection (a) shall be completed not later than three 

17 years after the date of the commencement of the study. 

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

19 subsection (a) shall be conducted so as to determine the ef20 fect of high altitude on suicide risk at the individual level, 

21 not at the State or county level. 

22 (d) REPORT.—Not later than 150 days after the com23 pletion of the study conducted under subsection (a), the Sec24 retary shall submit to the Committee on Veterans’ Affairs 

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


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1 the House of Representatives a report on the results of the 

2 study. 

3 (e) FOLLOW-UP STUDY.— 

4 (1) IN GENERAL.—If the Secretary determines 

5 through the study conducted under subsection (a) that 

6 living at high altitude is a risk factor for developing 

7 depression or dying by suicide, the Secretary shall 

8 conduct an additional study to identify the following: 

9 (A) The most likely biological mechanism 

10 that makes living at high altitude a risk factor 

11 for developing depression or dying by suicide. 

12 (B) The most effective treatment or inter13 vention for reducing the risk of developing de14 pression or dying by suicide associated with liv15 ing at high altitude. 

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

17 completing the study conducted under paragraph (1), 

18 the Secretary shall submit to the Committee on Vet19 erans’ Affairs of the Senate and the Committee on 

20 Veterans’ Affairs of the House of Representatives a re21 port on the results of the study. 


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1 SEC. 302. ESTABLISHMENT BY DEPARTMENT OF VETERANS 

2 AFFAIRS AND DEPARTMENT OF DEFENSE OF 

3 A CLINICAL PROVIDER TREATMENT TOOLKIT 

4 AND ACCOMPANYING TRAINING MATERIALS 

5 FOR COMORBIDITIES. 

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

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

8 Affairs, in consultation with the Secretary of Defense, shall 

9 develop a clinical provider treatment toolkit and accom10 panying training materials for the evidence-based manage11 ment of comorbid mental health conditions, comorbid men12 tal health and substance use disorders, and a comorbid men13 tal health condition and chronic pain. 

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

15 provider treatment toolkit and accompanying training ma16 terials under subsection (a), the Secretary of Veterans Af17 fairs and the Secretary of Defense shall ensure that the tool18 kit and training materials include guidance with respect 

19 to the following: 

20 (1) The treatment of patients with post-trau21 matic stress disorder who are also experiencing an 

22 additional mental health condition, a substance use 

23 disorder, or chronic pain. 

24 (2) The treatment of patients experiencing a 

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1 sion, or bipolar disorder, who are also experiencing a 

2 substance use disorder or chronic pain. 

3 (3) The treatment of patients with traumatic 

4 brain injury who are also experiencing— 

5 (A) a mental health condition, including 

6 post-traumatic stress disorder, anxiety, depres7 sion, or bipolar disorder; 

8 (B) a substance use disorder; or 

9 (C) chronic pain. 

10 SEC. 303. UPDATE OF CLINICAL PRACTICE GUIDELINES FOR 

11 ASSESSMENT AND MANAGEMENT OF PA12 TIENTS AT RISK FOR SUICIDE. 

13 (a) IN GENERAL.—In the first publication of the De14 partment of Veterans Affairs and Department of Defense 

15 Clinical Practice Guideline for Assessment and Manage16 ment of Patients at Risk for Suicide published after the date 

17 of the enactment of this Act, the Secretary of Veterans Af18 fairs and the Secretary of Defense, through the Assessment 

19 and Management of Patients at Risk for Suicide Work 

20 Group (in this section referred to as the ‘‘Work Group’’), 

21 shall ensure the publication includes the following: 

22 (1) Enhanced guidance with respect to the fol23 lowing: 

24 (A) Gender-specific risk factors for suicide 

25 and suicidal ideation. 


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1 (B) Gender-specific treatment efficacy for 

2 depression and suicide prevention. 

3 (C) Gender-specific pharmacotherapy effi4 cacy. 

5 (D) Gender-specific psychotherapy efficacy. 

6 (2) Guidance with respect to the efficacy of alter7 native therapies, other than psychotherapy and 

8 pharmacotherapy, including the following: 

9 (A) Yoga therapy. 

10 (B) Meditation therapy. 

11 (C) Equine therapy. 

12 (D) Other animal therapy. 

13 (E) Training and caring for service dogs. 

14 (F) Agritherapy. 

15 (G) Art therapy. 

16 (H) Outdoor sports therapy. 

17 (I) Music therapy. 

18 (J) Any other alternative therapy that the 

19 Work Group considers appropriate. 

20 (3) Guidance with respect to the findings of the 

21 Creating Options for Veterans’ Expedited Recovery 

22 Commission (commonly referred to as the ‘‘COVER 

23 Commission’’) established under section 931 of the 

24 Jason Simcakoski Memorial and Promise Act (title 

25 IX of Public Law 114–198; 38 U.S.C. 1701 note). 


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

2 shall be construed to prevent the Secretary of Veterans Af3 fairs and the Secretary of Defense from considering all rel4 evant evidence, as appropriate, in updating the Department 

5 of Veterans Affairs and Department of Defense Clinical 

6 Practice Guideline for Assessment and Management of Pa7 tients at Risk for Suicide, as required under subsection (a), 

8 or from ensuring that the final clinical practice guidelines 

9 updated under such subsection remain applicable to the pa10 tient populations of the Department of Veterans Affairs and 

11 the Department of Defense. 

12 SEC. 304. ESTABLISHMENT BY DEPARTMENT OF VETERANS 

13 AFFAIRS AND DEPARTMENT OF DEFENSE OF 

14 CLINICAL PRACTICE GUIDELINES FOR THE 

15 TREATMENT OF SERIOUS MENTAL ILLNESS. 

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

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

18 Affairs, in consultation with the Secretary of Defense and 

19 the Secretary of Health and Human Services, shall com20 plete the development of a clinical practice guideline or 

21 guidelines for the treatment of serious mental illness, to in22 clude the following conditions: 

23 (1) Schizophrenia. 

24 (2) Schizoaffective disorder. 


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1 (3) Persistent mood disorder, including bipolar 

2 disorder I and II. 

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

4 disorder resulting in serious functional impairment 

5 that substantially interferes with major life activities 

6 as the Secretary of Veterans Affairs, in consultation 

7 with the Secretary of Defense and the Secretary of 

8 Health and Human Services, considers appropriate. 

9 (b) MATTERS INCLUDED IN GUIDELINES.—The clin10 ical practice guideline or guidelines developed under sub11 section (a) shall include the following: 

12 (1) Guidance contained in the 2016 Clinical 

13 Practice Guidelines for the Management of Major De14 pressive Disorders of the Department of Veterans Af15 fairs and the Department of Defense. 

16 (2) Guidance with respect to the treatment of pa17 tients with a condition described in subsection (a). 

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

19 treatment of conditions described in subsection (a). 

20 (4) An appropriate guideline for the administra21 tion of pharmacological therapy, psychological or be22 havioral therapy, or other therapy for the manage23 ment of conditions described in subsection (a). 

24 (c) ASSESSMENT OF EXISTING GUIDELINES.—Not 

25 later than two years after the date of the enactment of this 


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1 Act, the Secretary of Veterans Affairs, in consultation with 

2 the Secretary of Defense and the Secretary of Health and 

3 Human Services, shall complete an assessment of the 2016 

4 Clinical Practice Guidelines for the Management of Major 

5 Depressive Disorders to determine whether an update to 

6 such guidelines is necessary. 

7 (d) WORK GROUP.— 

8 (1) ESTABLISHMENT.—The Secretary of Veterans 

9 Affairs, the Secretary of Defense, and the Secretary of 

10 Health and Human Services shall create a work 

11 group to develop the clinical practice guideline or 

12 guidelines under subsection (a) to be known as the 

13 ‘‘Serious Mental Illness Work Group’’ (in this sub14 section referred to as the ‘‘Work Group’’). 

15 (2) MEMBERSHIP.—The Work Group created 

16 under paragraph (1) shall be comprised of individ17 uals that represent Federal Government entities and 

18 non-Federal Government entities with expertise in the 

19 areas covered by the Work Group, including the fol20 lowing entities: 

21 (A) Academic institutions that specialize in 

22 research for the treatment of conditions described 

23 in subsection (a). 


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1 (B) The Health Services Research and De2 velopment Service of the Department of Veterans 

3 Affairs. 

4 (C) The Office of the Assistant Secretary for 

5 Mental Health and Substance Use of the Depart6 ment of Health and Human Services. 

7 (D) The National Institute of Mental 

8 Health. 

9 (E) The Indian Health Service. 

10 (F) Relevant organizations with expertise 

11 in researching, diagnosing, or treating condi12 tions described in subsection (a). 

13 (3) RELATION TO OTHER WORK GROUPS.—The 

14 Work Group shall be created and conducted in the 

15 same manner as other work groups for the develop16 ment of clinical practice guidelines for the Depart17 ment of Veterans Affairs and the Department of De18 fense. 

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

20 shall be construed to prevent the Secretary of Veterans Af21 fairs and the Secretary of Defense from considering all rel22 evant evidence, as appropriate, in creating the clinical 

23 practice guideline or guidelines required under subsection 

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1 sequently updated, as appropriate, remain applicable to the 

2 patient populations of the Department of Veterans Affairs 

3 and the Department of Defense. 

4 SEC. 305. PRECISION MEDICINE INITIATIVE OF DEPART5 MENT OF VETERANS AFFAIRS TO IDENTIFY 

6 AND VALIDATE BRAIN AND MENTAL HEALTH 

7 BIOMARKERS. 

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

9 months after the date of the enactment of this Act, the Sec10 retary of Veterans Affairs shall develop and implement an 

11 initiative of the Department of Veterans Affairs to identify 

12 and validate brain and mental health biomarkers among 

13 veterans, with specific consideration for depression, anxiety, 

14 post-traumatic stress disorder, bipolar disorder, traumatic 

15 brain injury, and such other mental health conditions as 

16 the Secretary considers appropriate. Such initiative may 

17 be referred to as the ‘‘Precision Medicine for Veterans Ini18 tiative’’. 

19 (b) MODEL OF INITIATIVE.—The initiative under sub20 section (a) shall be modeled on the All of Us Precision Medi21 cine Initiative administered by the National Institutes of 

22 Health with respect to large-scale collection of standardized 

23 data and open data sharing. 

24 (c) USE OF DATA.— 


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1 (1) PRIVACY AND SECURITY.—In carrying out 

2 the initiative under subsection (a), the Secretary shall 

3 develop robust data privacy and security measures to 

4 ensure that information of veterans participating in 

5 the initiative is kept private and secure. 

6 (2) OPEN PLATFORM.— 

7 (A) RESEARCH PURPOSES.— 

8 (i) IN GENERAL.—The Secretary shall 

9 make de-identified data collected under the 

10 initiative available for research purposes 

11 both within and outside of the Department 

12 of Veterans Affairs. 

13 (ii) RESEARCH.—The Secretary shall 

14 assist the National Institutes of Health and 

15 the Department of Energy in the use by the 

16 National Institutes of Health or the Depart17 ment of Energy of data collected under the 

18 initiative for research purposes under clause 

19 (i). 

20 (B) DATA MAY NOT BE SOLD.—Data col21 lected under the initiative may not be sold. 

22 (3) STANDARDIZATION.— 

23 (A) IN GENERAL.—The Secretary shall en24 sure that data collected under the initiative is 

25 standardized. 


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1 (B) CONSULTATION.—The Secretary shall 

2 consult with the National Institutes of Health 

3 and the Food and Drug Administration to deter4 mine the most effective, efficient, and cost-effec5 tive way of standardizing data collected under 

6 the initiative. 

7 (C) MANNER OF STANDARDIZATION.—Data 

8 collected under the initiative shall be standard9 ized in the manner in which it is collected, en10 tered into the database, extracted, and recorded. 

11 (4) MEASURES OF BRAIN FUNCTION OR STRUC12 TURE.—Any measures of brain function or structure 

13 collected under the initiative shall be collected with a 

14 device that is approved by the Food and Drug Ad15 ministration. 

16 (d) INCLUSION OF INITIATIVE IN PROGRAM.—The Sec17 retary shall assess the feasibility and advisability of coordi18 nating efforts of the initiative under subsection (a) with the 

19 Million Veterans Program of the Department. 

20 SEC. 306. STATISTICAL ANALYSES AND DATA EVALUATION 

21 BY DEPARTMENT OF VETERANS AFFAIRS. 

22 (a) IN GENERAL.—Chapter 1 of title 38, United States 

23 Code, is amended by adding at the end the following new 

24 section: 


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

2 evaluation 

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

4 contract or other agreement with an academic institution 

5 or other qualified entity, as determined by the Secretary, 

6 to carry out statistical analyses and data evaluation as re7 quired of the Secretary by law.’’. 

8 ‘‘(b) RULE OF CONSTRUCTION.—Nothing in this sec9 tion may be construed to limit the authority of the Sec10 retary to enter into contracts or other agreements for statis11 tical analyses and data evaluation under any other provi12 sion of law.’’. 

13 (b) CLERICAL AMENDMENT.—The table of sections at 

14 the beginning of chapter 1 of such title is amended by add15 ing at the end the following new item: 

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

16 TITLE IV—OVERSIGHT OF MEN17 TAL HEALTH CARE AND RE18 LATED SERVICES 

19 SEC. 401. STUDY ON EFFECTIVENESS OF SUICIDE PREVEN20 TION AND MENTAL HEALTH OUTREACH PRO21 GRAMS OF DEPARTMENT OF VETERANS AF22 FAIRS. 

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

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

25 Affairs shall enter into an agreement with a non-Federal 


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1 Government entity to conduct a study on the effectiveness 

2 of the suicide prevention and mental health outreach mate3 rials prepared by the Department of Veterans Affairs and 

4 the suicide prevention and mental health outreach cam5 paigns conducted by the Department. 

6 (b) USE OF FOCUS GROUPS.— 

7 (1) IN GENERAL.—The Secretary shall convene 

8 not fewer than eight different focus groups to evaluate 

9 the effectiveness of the suicide prevention and mental 

10 health materials and campaigns as required under 

11 subsection (a). 

12 (2) LOCATION OF FOCUS GROUPS.—Focus groups 

13 convened under paragraph (1) shall be held in geo14 graphically diverse areas as follows: 

15 (A) Not fewer than two in rural or highly 

16 rural areas. 

17 (B) Not fewer than one in each of the four 

18 districts of the Veterans Benefits Administration. 

19 (3) TIMING OF FOCUS GROUPS.—Focus groups 

20 convened under paragraph (1) shall be held at a vari21 ety of dates and times to ensure an adequate represen22 tation of veterans with different work schedules. 

23 (4) NUMBER OF PARTICIPANTS.—Each focus 

24 group convened under paragraph (1) shall include not 

25 fewer than five and not more than 12 participants. 


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1 (5) REPRESENTATION.—Each focus group con2 vened under paragraph (1) shall, to the extent prac3 ticable, include veterans of diverse backgrounds, in4 cluding— 

5 (A) veterans of all eras, as determined by 

6 the Secretary; 

7 (B) women veterans; 

8 (C) minority veterans; 

9 (D) Native American veterans, as defined in 

10 section 3765 of title 38, United States Code; 

11 (E) veterans who identify as lesbian, gay, 

12 bisexual, transgender, or queer (commonly re13 ferred to as ‘‘LGBTQ’’); 

14 (F) veterans who live in rural or highly 

15 rural areas; and 

16 (G) individuals transitioning from active 

17 duty in the Armed Forces to civilian life. 

18 (c) REPORT.— 

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

20 the last focus group meeting under subsection (b), the 

21 Secretary shall submit to the Committee on Veterans’ 

22 Affairs of the Senate and the Committee on Veterans’ 

23 Affairs of the House of Representatives a report on 

24 the findings of the focus groups. 


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1 (2) ELEMENTS.—The report required by para2 graph (1) shall include the following: 

3 (A) Based on the findings of the focus 

4 groups, an assessment of the effectiveness of cur5 rent suicide prevention and mental health out6 reach efforts of the Department in reaching vet7 erans as a whole as well as specific groups of vet8 erans (for example, women veterans). 

9 (B) Based on the findings of the focus 

10 groups, recommendations for future suicide pre11 vention and mental health outreach efforts by the 

12 Department to target specific groups of veterans. 

13 (C) A plan to change the current approach 

14 by the Department to suicide prevention and 

15 mental health outreach or, if the Secretary de16 cides not to change the current approach, an ex17 planation of the reason for maintaining the cur18 rent approach. 

19 (D) Such other issues as the Secretary con20 siders necessary. 

21 (d) REPRESENTATIVE SURVEY.— 

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

23 the last focus group meeting under subsection (b), the 

24 Secretary shall complete a representative survey of the 

25 veteran population that is informed by the focus 


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1 group data in order to collect information about the 

2 effectiveness of the mental health and suicide preven3 tion outreach campaigns conducted by the Depart4 ment. 

5 (2) VETERANS SURVEYED.— 

6 (A) IN GENERAL.—Veterans surveyed under 

7 paragraph (1) shall include veterans described in 

8 subsection (b)(5). 

9 (B) DISAGGREGATION OF DATA.—Data of 

10 veterans surveyed under paragraph (1) shall be 

11 disaggregated by— 

12 (i) veterans who have received care 

13 from the Department during the two-year 

14 period preceding the survey; and 

15 (ii) veterans who have not received 

16 care from the Department during the two17 year period preceding the survey. 

18 (e) TREATMENT OF CONTRACTS FOR SUICIDE PREVEN19 TION AND MENTAL HEALTH OUTREACH MEDIA.— 

20 (1) FOCUS GROUPS.— 

21 (A) IN GENERAL.—The Secretary shall in22 clude in each contract to develop media relating 

23 to suicide prevention and mental health outreach 

24 a requirement that the contractor convene focus 


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1 groups of veterans to assess the effectiveness of 

2 suicide prevention and mental health outreach. 

3 (B) REPRESENTATION.—Each focus group 

4 required under subparagraph (A) shall, to the ex5 tent practicable, include veterans of diverse back6 grounds, including— 

7 (i) veterans of all eras, as determined 

8 by the Secretary; 

9 (ii) women veterans; 

10 (iii) minority veterans; 

11 (iv) Native American veterans, as de12 fined in section 3765 of title 38, United 

13 States Code; 

14 (v) veterans who identify as lesbian, 

15 gay, bisexual, transgender, or queer (com16 monly referred to as ‘‘LGBTQ’’); 

17 (vi) veterans who live in rural or high18 ly rural areas; and 

19 (vii) individuals transitioning from 

20 active duty in the Armed Forces to civilian 

21 life. 

22 (2) SUBCONTRACTING.— 

23 (A) IN GENERAL.—The Secretary shall in24 clude in each contract described in paragraph 

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1 contracts for the development of media, the con2 tractor shall subcontract with a subcontractor 

3 that has experience creating impactful media 

4 campaigns that target individuals age 18 to 34. 

5 (B) BUDGET LIMITATION.—Not more than 

6 two percent of the budget of the Office of Mental 

7 Health and Suicide Prevention of the Depart8 ment for contractors for suicide prevention and 

9 mental health media outreach shall go to sub10 contractors described in subparagraph (A). 

11 (f) RURAL AND HIGHLY RURAL DEFINED.—In this 

12 section, with respect to an area, the terms ‘‘rural’’ and 

13 ‘‘highly rural’’ have the meanings given those terms in the 

14 Rural-Urban Commuting Areas coding system of the De15 partment of Agriculture. 

16 SEC. 402. OVERSIGHT OF MENTAL HEALTH AND SUICIDE 

17 PREVENTION MEDIA OUTREACH CONDUCTED 

18 BY DEPARTMENT OF VETERANS AFFAIRS. 

19 (a) ESTABLISHMENT OF GOALS.— 

20 (1) IN GENERAL.—The Secretary of Veterans Af21 fairs shall establish goals for the mental health and 

22 suicide prevention media outreach campaigns of the 

23 Department of Veterans Affairs, which shall include 

24 the establishment of targets, metrics, and action plans 

25 to describe and assess those campaigns. 


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1 (2) USE OF METRICS.— 

2 (A) IN GENERAL.—The goals established 

3 under paragraph (1) shall be measured by 

4 metrics specific to different media types. 

5 (B) FACTORS TO CONSIDER.—In using 

6 metrics under subparagraph (A), the Secretary 

7 shall determine the best methodological approach 

8 for each media type and shall consider the fol9 lowing: 

10 (i) Metrics relating to social media, 

11 which may include the following: 

12 (I) Impressions. 

13 (II) Reach. 

14 (III) Engagement rate. 

15 (IV) Such other metrics as the 

16 Secretary considers necessary. 

17 (ii) Metrics relating to television, 

18 which may include the following: 

19 (I) Nielsen ratings. 

20 (II) Such other metrics as the Sec21 retary considers necessary. 

22 (iii) Metrics relating to email, which 

23 may include the following: 

24 (I) Open rate. 

25 (II) Response rate. 


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1 (III) Click rate. 

2 (IV) Such other metrics as the 

3 Secretary considers necessary. 

4 (C) UPDATE.—The Secretary shall periodi5 cally update the metrics under subparagraph (B) 

6 as more accurate metrics become available. 

7 (3) TARGETS.—The Secretary shall establish tar8 gets to track the metrics used under paragraph (2). 

9 (4) CONSULTATION.—In establishing goals under 

10 paragraph (1), the Secretary shall consult with the 

11 following: 

12 (A) Relevant stakeholders, such as organiza13 tions that represent veterans, as determined by 

14 the Secretary. 

15 (B) Mental health and suicide prevention 

16 experts. 

17 (C) Such other persons as the Secretary 

18 considers appropriate. 

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

20 after the date of the enactment of this Act, the Sec21 retary shall submit to the Committee on Veterans’ Af22 fairs of the Senate and the Committee on Veterans’ 

23 Affairs of the House of Representatives a report de24 tailing the goals established under paragraph (1) for 

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1 reach campaigns of the Department, including the 

2 metrics and targets for such metrics by which those 

3 goals are to be measured under paragraphs (2) and 

4 (3). 

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

6 after the submittal of the report under paragraph (5), 

7 and annually thereafter, the Secretary shall submit to 

8 the Committee on Veterans’ Affairs of the Senate and 

9 the Committee on Veterans’ Affairs of the House of 

10 Representatives a report detailing— 

11 (A) the progress of the Department in meet12 ing the goals established under paragraph (1) 

13 and the targets established under paragraph (3); 

14 and 

15 (B) a description of action to be taken by 

16 the Department to modify mental health and 

17 suicide prevention media outreach campaigns if 

18 those goals and targets are not being met. 

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

20 HEALTH AND SUICIDE PREVENTION.—Not later than 180 

21 days after the date of the enactment of this Act, and semi22 annually thereafter, the Secretary shall submit to the Com23 mittee on Appropriations and the Committee on Veterans’ 

24 Affairs of the Senate and the Committee on Appropriations 

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1 resentatives a report containing the expenditures and obli2 gations of the Office of Mental Health and Suicide Preven3 tion of the Veterans Health Administration during the pe4 riod covered by the report. 

5 SEC. 403. COMPTROLLER GENERAL MANAGEMENT REVIEW 

6 OF MENTAL HEALTH AND SUICIDE PREVEN7 TION SERVICES OF DEPARTMENT OF VET8 ERANS AFFAIRS. 

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

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

11 of the United States shall submit to the Committee on Vet12 erans’ Affairs of the Senate and the Committee on Veterans’ 

13 Affairs of the House of Representatives a management re14 view of the mental health and suicide prevention services 

15 provided by the Department of Veterans Affairs. 

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

17 subsection (a) shall include the following: 

18 (1) An assessment of the infrastructure under the 

19 control of or available to the Office of Mental Health 

20 and Suicide Prevention of the Department of Veterans 

21 Affairs or available to the Department of Veterans Af22 fairs for suicide prevention efforts not operated by the 

23 Office of Mental Health and Suicide Prevention. 

24 (2) A description of the management and organi25 zational structure of the Office of Mental Health and 


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1 Suicide Prevention, including roles and responsibil2 ities for each position. 

3 (3) A description of the operational policies and 

4 processes of the Office of Mental Health and Suicide 

5 Prevention. 

6 (4) An assessment of suicide prevention practices 

7 and initiatives available from the Department and 

8 through community partnerships. 

9 (5) An assessment of the staffing levels at the Of10 fice of Mental Health and Suicide Prevention, 

11 disaggregated by type of position, and including the 

12 location of any staffing deficiencies. 

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

14 program conducted by the Department. 

15 (7) An assessment of recruitment initiatives in 

16 rural areas for mental health professionals of the De17 partment. 

18 (8) An assessment of strategic planning con19 ducted by the Office of Mental Health and Suicide 

20 Prevention. 

21 (9) An assessment of the communication, and the 

22 effectiveness of such communication— 

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

24 Mental Health and Suicide Prevention; 


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1 (B) between that central office and any staff 

2 member or office in the field, including chap3 lains, attorneys, law enforcement personnel, and 

4 volunteers; and 

5 (C) between that central office, local facili6 ties of the Department, and community partners 

7 of the Department, including first responders, 

8 community support groups, and health care in9 dustry partners. 

10 (10) An assessment of how effectively the Office 

11 of Mental Health and Suicide Prevention implements 

12 operational policies and procedures. 

13 (11) An assessment of how the Department of 

14 Veterans Affairs and the Department of Defense co15 ordinate suicide prevention efforts, and recommenda16 tions on how the Department of Veterans Affairs and 

17 Department of Defense can more effectively coordinate 

18 those efforts. 

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

20 Comptroller General considers appropriate to study. 

21 SEC. 404. COMPTROLLER GENERAL REPORT ON EFFORTS 

22 OF DEPARTMENT OF VETERANS AFFAIRS TO 

23 INTEGRATE MENTAL HEALTH CARE INTO PRI24 MARY CARE CLINICS. 

25 (a) INITIAL REPORT.— 


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

2 the date of the enactment of this Act, the Comptroller 

3 General of the United States shall submit to the Com4 mittee on Veterans’ Affairs of the Senate and the 

5 Committee on Veterans’ Affairs of the House of Rep6 resentatives a report on the efforts of the Department 

7 of Veterans Affairs to integrate mental health care 

8 into primary care clinics of the Department. 

9 (2) ELEMENTS.—The report required by sub10 section (a) shall include the following: 

11 (A) An assessment of the efforts of the De12 partment to integrate mental health care into 

13 primary care clinics of the Department. 

14 (B) An assessment of the effectiveness of 

15 such efforts. 

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

17 veterans is impacted by such integration. 

18 (D) A description of how care is coordi19 nated by the Department between specialty men20 tal health care and primary care, including a 

21 description of the following: 

22 (i) How documents and patient infor23 mation are transferred and the effectiveness 

24 of those transfers. 


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1 (ii) How care is coordinated when vet2 erans must travel to different facilities of 

3 the Department. 

4 (iii) How a veteran is reintegrated 

5 into primary care after receiving in-patient 

6 mental health care. 

7 (E) An assessment of how the integration of 

8 mental health care into primary care clinics is 

9 implemented at different types of facilities of the 

10 Department. 

11 (F) Such recommendations on how the De12 partment can better integrate mental health care 

13 into primary care clinics as the Comptroller 

14 General considers appropriate. 

15 (G) An assessment of such other areas as the 

16 Comptroller General considers appropriate to 

17 study. 

18 (b) COMMUNITY CARE INTEGRATION REPORT.— 

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

20 the date on which the Comptroller General submits 

21 the report required under subsection (a)(1), the Comp22 troller General shall submit to the Committee on Vet23 erans’ Affairs of the Senate and the Committee on 

24 Veterans’ Affairs of the House of Representatives a re25 port on the efforts of the Department to integrate 


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1 community-based mental health care into the Veterans 

2 Health Administration. 

3 (2) ELEMENTS.—The report required by para4 graph (1) shall include the following: 

5 (A) An assessment of the efforts of the De6 partment to integrate community-based mental 

7 health care into the Veterans Health Administra8 tion. 

9 (B) An assessment of the effectiveness of 

10 such efforts. 

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

12 veterans is impacted by such integration. 

13 (D) A description of how care is coordi14 nated between providers of community-based 

15 mental health care and the Veterans Health Ad16 ministration, including a description of how doc17 uments and patient information are transferred 

18 and the effectiveness of those transfers between— 

19 (i) the Veterans Health Administration 

20 and providers of community-based mental 

21 health care; and 

22 (ii) providers of community-based 

23 mental health care and the Veterans Health 

24 Administration. 


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1 (E) An assessment of any disparities in the 

2 coordination of community-based mental health 

3 care into the Veterans Health Administration by 

4 location and type of facility. 

5 (F) An assessment of the military cultural 

6 competency of health care providers providing 

7 community-based mental health care to veterans. 

8 (G) Such recommendations on how the De9 partment can better integrate community-based 

10 mental health care into the Veterans Health Ad11 ministration as the Comptroller General con12 siders appropriate. 

13 (H) An assessment of such other areas as 

14 the Comptroller General considers appropriate to 

15 study. 

16 (3) COMMUNITY-BASED MENTAL HEALTH CARE

17 DEFINED.—In this subsection, the term ‘‘community18 based mental health care’’ means mental health care 

19 paid for by the Department but provided by a non20 Department health care provider at a non-Depart21 ment facility, including care furnished under section 

22 1703 of title 38, United States Code (as in effect on 

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

24 Our Veterans Act of 2018 (title I of Public Law 115– 

25 182)). 


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1 SEC. 405. JOINT MENTAL HEALTH PROGRAMS BY DEPART2 MENT OF VETERANS AFFAIRS AND DEPART3 MENT OF DEFENSE. 

4 (a) REPORT ON MENTAL HEALTH PROGRAMS.— 

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

6 the date of the enactment of this Act, and annually 

7 thereafter, the Secretary of Veterans Affairs and the 

8 Secretary of Defense shall submit to the Committee on 

9 Veterans’ Affairs and the Committee on Armed Serv10 ices of the Senate and the Committee on Veterans’ Af11 fairs and the Committee on Armed Services of the 

12 House of Representatives a report on mental health 

13 programs of the Department of Veterans Affairs and 

14 the Department of Defense and joint programs of the 

15 Departments. 

16 (2) ELEMENTS.—The report required by para17 graph (1) shall include the following: 

18 (A) A description of mental health pro19 grams operated by the Department of Veterans 

20 Affairs, including the following: 

21 (i) Transition assistance programs. 

22 (ii) Clinical and non-clinical mental 

23 health initiatives, including centers of excel24 lence of the Department of Veterans Affairs 

25 for traumatic brain injury and post-trau26 matic stress disorder. 


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1 (iii) Programs that may secondarily 

2 improve mental health, including employ3 ment, housing assistance, and financial lit4 eracy programs. 

5 (iv) Research into mental health issues 

6 and conditions, to include post-traumatic 

7 stress disorder, depression, anxiety, bipolar 

8 disorder, traumatic brain injury, suicidal 

9 ideation, and any other issues or conditions 

10 as the Secretary of Veterans Affairs con11 siders necessary. 

12 (B) A description of mental health pro13 grams operated by the Department of Defense, 

14 including the following: 

15 (i) Transition assistance programs. 

16 (ii) Clinical and non-clinical mental 

17 health initiatives, including the National 

18 Intrepid Center of Excellence and the In19 trepid Spirit Centers. 

20 (iii) Programs that may secondarily 

21 improve mental health, including employ22 ment, housing assistance, and financial lit23 eracy programs. 

24 (iv) Research into mental health issues 

25 and conditions, to include post-traumatic 


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1 stress disorder, depression, anxiety, bipolar 

2 disorder, traumatic brain injury, suicidal 

3 ideation, and any other issues or conditions 

4 as the Secretary of Defense considers nec5 essary. 

6 (C) A description of mental health pro7 grams jointly operated by the Department of Vet8 erans Affairs and the Department of Defense, in9 cluding the following: 

10 (i) Transition assistance programs. 

11 (ii) Clinical and non-clinical mental 

12 health initiatives. 

13 (iii) Programs that may secondarily 

14 improve mental health, including employ15 ment, housing assistance, and financial lit16 eracy programs. 

17 (iv) Research into mental health issues 

18 and conditions, to include post-traumatic 

19 stress disorder, depression, anxiety, bipolar 

20 disorder, traumatic brain injury, suicidal 

21 ideation, and completed suicides, including 

22 through the use of the joint suicide data re23 pository of the Department of Veterans Af24 fairs and the Department of Defense, and 

25 any other issues or conditions as the SecVerDate Sep 11 2014 00:32 Jul 28, 2020 Jkt 099200 PO 00000 Frm 00202 Fmt 6652 Sfmt 6203 E:\BILLS\S785.RS S785

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1 retary of Veterans Affairs and the Secretary 

2 of Defense consider necessary. 

3 (D) Recommendations for coordinating 

4 mental health programs of the Department of 

5 Veterans Affairs and the Department of Defense 

6 to improve the effectiveness of those programs. 

7 (E) Recommendations for novel joint pro8 gramming of the Department of Veterans Affairs 

9 and the Department of Defense to improve the 

10 mental health of members of the Armed Forces 

11 and veterans. 

12 (b) AUTHORIZATION OF A PUBLIC-PRIVATE PARTNER13 SHIP TO ESTABLISH A JOINT CENTER OF EXCELLENCE.— 

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

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

16 Veterans Affairs, in consultation with the Secretary of 

17 Defense, shall enter into agreements with private enti18 ties and philanthropic organizations to establish a 

19 center of excellence to be known as the ‘‘Joint VA/ 

20 DOD National Intrepid Center of Excellence Intrepid 

21 Spirit Center’’ (in this subsection referred to as the 

22 ‘‘Center’’). 

23 (2) DUTIES.—The Center shall conduct the fol24 lowing: 


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1 (A) Joint mental health care delivery pro2 grams of the Department of Veterans Affairs and 

3 the Department of Defense for veterans and 

4 members of the Armed Forces, including mem5 bers of the reserve components, who reside in 

6 rural and highly rural areas. 

7 (B) Mental health and suicide prevention 

8 research focused on veterans and members of the 

9 Armed Forces, including members of the reserve 

10 components, to inform treatment and care deliv11 ery programs. 

12 (3) LOCATION.—The Center shall be established 

13 in a location that— 

14 (A) is geographically distant from existing 

15 and planned Intrepid Spirit Centers of the De16 partment of Defense; 

17 (B) is in close proximity to rural and high18 ly rural areas and able to serve veterans in those 

19 areas who, as of the date of the enactment of this 

20 Act, are underserved by the Department of Vet21 erans Affairs; and 

22 (C) is in close proximity to a medical school 

23 of an institution of higher education. 

24 (c) RURAL AND HIGHLY RURAL DEFINED.—In this 

25 section, with respect to an area, the terms ‘‘rural’’ and 


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1 ‘‘highly rural’’ have the meanings given those terms in the 

2 Rural-Urban Commuting Areas coding system of the De3 partment of Agriculture. 

4 TITLE V—IMPROVEMENT OF 

5 MENTAL HEALTH MEDICAL 

6 WORKFORCE 

7 SEC. 501. STAFFING IMPROVEMENT PLAN FOR MENTAL 

8 HEALTH PROVIDERS OF DEPARTMENT OF 

9 VETERANS AFFAIRS. 

10 (a) STAFFING PLAN.— 

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

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

13 Veterans Affairs, in consultation with the Inspector 

14 General of the Department of Veterans Affairs, shall 

15 submit to the Committee on Veterans’ Affairs of the 

16 Senate and the Committee on Veterans’ Affairs of the 

17 House of Representatives a plan to address staffing of 

18 mental health providers of the Department of Veterans 

19 Affairs, including filling any open positions. 

20 (2) ELEMENTS.—The plan required by para21 graph (1) shall include the following: 

22 (A) An estimate of the number of positions 

23 for mental health providers of the Department 

24 that need to be filled to meet demand. 


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1 (B) An identification of the steps that the 

2 Secretary will take to address mental health 

3 staffing for the Department. 

4 (C) A description of any region-specific hir5 ing incentives to be used by the Secretary in con6 sultation with the directors of Veterans Inte7 grated Service Networks and medical centers of 

8 the Department. 

9 (D) A description of any local retention or 

10 engagement incentives to be used by directors of 

11 Veterans Integrated Service Networks. 

12 (E) Such recommendations for legislative or 

13 administrative action as the Secretary considers 

14 necessary to aid in addressing mental health 

15 staffing for the Department. 

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

17 submittal of the plan required by paragraph (1), the 

18 Secretary shall submit to the Committee on Veterans’ 

19 Affairs of the Senate and the Committee on Veterans’ 

20 Affairs of the House of Representatives a report set21 ting forth the number of mental health providers 

22 hired by the Department during the one-year period 

23 preceding the submittal of the report. 

24 (b) OCCUPATIONAL SERIES FOR CERTAIN MENTAL

25 HEALTH PROVIDERS.—Not later than one year after the 


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

2 Affairs, in consultation with the Office of Personnel Man3 agement, shall develop an occupational series for licensed 

4 professional mental health counselors and marriage and 

5 family therapists of the Department of Veterans Affairs. 

6 SEC. 502. STAFFING IMPROVEMENT PLAN FOR PEER SPE7 CIALISTS OF DEPARTMENT OF VETERANS AF8 FAIRS WHO ARE WOMEN. 

9 (a) ASSESSMENT OF CAPACITY.— 

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

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

12 Veterans Affairs, in consultation with the Inspector 

13 General of the Department of Veterans Affairs, shall 

14 commence an assessment of the capacity of peer spe15 cialists of the Department of Veterans Affairs who are 

16 women. 

17 (2) ELEMENTS.—The assessment required by 

18 paragraph (1) shall include an assessment of the fol19 lowing: 

20 (A) The geographical distribution of peer 

21 specialists of the Department who are women. 

22 (B) The geographical distribution of women 

23 veterans. 


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1 (C) The number and proportion of women 

2 peer specialists who specialize in peer counseling 

3 on mental health or suicide prevention. 

4 (D) The number and proportion of women 

5 peer specialists who specialize in peer counseling 

6 on non-mental health related matters. 

7 (b) REPORT.—Not later than one year after the assess8 ment required by subsection (a) has commenced, the Sec9 retary shall submit to the Committee on Veterans’ Affairs 

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

11 the House of Representatives a report detailing the findings 

12 of the assessment. 

13 (c) STAFFING IMPROVEMENT PLAN.— 

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

15 submitting the report under subsection (b), the Sec16 retary, in consultation with the Inspector General, 

17 shall submit to the Committee on Veterans’ Affairs of 

18 the Senate and the Committee on Veterans’ Affairs of 

19 the House of Representatives a plan, based on the re20 sults of the assessment required by subsection (a), to 

21 hire additional qualified peer specialists who are 

22 women, with special consideration for areas that lack 

23 peer specialists who are women. 

24 (2) ELEMENTS.—The peer specialist positions 

25 included in the plan required by paragraph (1)— 


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1 (A) shall be non-volunteer, paid positions; 

2 and 

3 (B) may be part-time positions. 

4 SEC. 503. ESTABLISHMENT OF DEPARTMENT OF VETERANS 

5 AFFAIRS READJUSTMENT COUNSELING SERV6 ICE SCHOLARSHIP PROGRAM. 

7 (a) IN GENERAL.—Chapter 76 of title 38, United 

8 States Code, is amended by inserting after subchapter VIII 

9 the following new subchapter: 

10 ‘‘SUBCHAPTER IX—READJUSTMENT 

11 COUNSELING SERVICE SCHOLARSHIP PROGRAM 

12 ‘‘§ 7698. Requirement for program 

13 ‘‘As part of the Educational Assistance Program, the 

14 Secretary shall carry out a scholarship program under this 

15 subchapter. The program shall be known as the Department 

16 of Veterans Affairs Readjustment Counseling Service Schol17 arship Program (in this subchapter referred to as the ‘Pro18 gram’). 

19 ‘‘§ 7699. Eligibility; agreement 

20 ‘‘(a) IN GENERAL.—An individual is eligible to par21 ticipate in the Program, as determined by the Readjustment 

22 Counseling Service of the Department, if the individual— 

23 ‘‘(1) is accepted for enrollment or enrolled (as de24 scribed in section 7602 of this title) in a program of 

25 study at an accredited educational institution, school, 


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1 or training program leading to a terminal degree in 

2 psychology, social work, marriage and family ther3 apy, or mental health counseling that would meet the 

4 education requirements for appointment to a position 

5 under section 7402(b) of this title; and 

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

7 under subsection (c). 

8 ‘‘(b) PRIORITY.—In selecting individuals to partici9 pate in the Program, the Secretary shall give priority to 

10 the following individuals: 

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

12 a Vet Center located in a community that is— 

13 ‘‘(A) designated as a medically underserved 

14 population under section 330(b)(3) of the Public 

15 Health Service Act (42 U.S.C. 254b(b)(3)); and 

16 ‘‘(B) in a State with a per capita popu17 lation of veterans of more than five percent ac18 cording to the National Center for Veterans 

19 Analysis and Statistics and the Bureau of the 

20 Census. 

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

22 ‘‘(c) AGREEMENT.—An agreement between the Sec23 retary and a participant in the Program shall (in addition 

24 to the requirements set forth in section 7604 of this title) 

25 include the following: 


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1 ‘‘(1) An agreement by the Secretary to provide 

2 the participant with a scholarship under the Program 

3 for a specified number of school years during which 

4 the participant pursues a program of study described 

5 in subsection (a)(1) that meets the requirements set 

6 forth in section 7602(a) of this title. 

7 ‘‘(2) An agreement by the participant to serve as 

8 a full-time employee of the Department at a Vet Cen9 ter for a six-year period following the completion by 

10 the participant of such program of study (in this sub11 chapter referred to as the ‘period of obligated service’). 

12 ‘‘(d) VET CENTER DEFINED.—In this section, the term 

13 ‘Vet Center’ has the meaning given that term in section 

14 1712A(h) of this title. 

15 ‘‘§ 7699A. Obligated service 

16 ‘‘(a) IN GENERAL.—Each participant in the Program 

17 shall provide service as a full-time employee of the Depart18 ment at a Vet Center (as defined in section 7699(d) of this 

19 title) for the period of obligated service set forth in the 

20 agreement of the participant entered into under section 

21 7604 of this title. 

22 ‘‘(b) DETERMINATION OF SERVICE COMMENCEMENT

23 DATE.—(1) Not later than 60 days before the service com24 mencement date of a participant, the Secretary shall notify 

25 the participant of that service commencement date. 


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

2 to a participant is the date for the beginning of the period 

3 of obligated service of the participant. 

4 ‘‘§ 7699B. Breach of agreement: liability 

5 ‘‘(a) LIQUIDATED DAMAGES.—(1) A participant in the 

6 Program (other than a participant described in subsection 

7 (b)) who fails to accept payment, or instructs the edu8 cational institution in which the participant is enrolled not 

9 to accept payment, in whole or in part, of a scholarship 

10 under the agreement entered into under section 7604 of this 

11 title shall be liable to the United States for liquidated dam12 ages in the amount of $1,500. 

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

14 any period of obligated service or other obligation or liabil15 ity under such agreement. 

16 ‘‘(b) LIABILITY DURING PROGRAM OF STUDY.—(1) 

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

18 Program shall be liable to the United States for the amount 

19 which has been paid to or on behalf of the participant under 

20 the agreement if any of the following occurs: 

21 ‘‘(A) The participant fails to maintain an ac22 ceptable level of academic standing in the educational 

23 institution in which the participant is enrolled (as 

24 determined by the educational institution under regu25 lations prescribed by the Secretary). 


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

2 educational institution for disciplinary reasons. 

3 ‘‘(C) The participant voluntarily terminates the 

4 program of study in such educational institution be5 fore the completion of such program of study. 

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

7 service obligation arising under the agreement. 

8 ‘‘(c) LIABILITY DURING PERIOD OF OBLIGATED SERV9 ICE.—(1) Except as provided in subsection (d), if a partici10 pant in the Program does not complete the period of obli11 gated service of the participant, the United States shall be 

12 entitled to recover from the participant an amount deter13 mined in accordance with the following formula: A = 

14 3Φ(t¥s/t). 

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

16 ‘‘(A) ‘A’ is the amount the United States is enti17 tled to recover. 

18 ‘‘(B) ‘Φ’ is the sum of— 

19 ‘‘(i) the amounts paid under this subchapter 

20 to or on behalf of the participant; and 

21 ‘‘(ii) the interest on such amounts which 

22 would be payable if at the time the amounts were 

23 paid they were loans bearing interest at the 

24 maximum legal prevailing rate, as determined 

25 by the Treasurer of the United States. 


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1 ‘‘(C) ‘t’ is the total number of months in the pe2 riod of obligated service of the participant. 

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

4 served by the participant. 

5 ‘‘(d) LIMITATION ON LIABILITY FOR REDUCTIONS-IN6 FORCE.—Liability shall not arise under subsection (c) if 

7 the participant fails to maintain employment as a Depart8 ment employee due to a staffing adjustment. 

9 ‘‘(e) PERIOD FOR PAYMENT OF DAMAGES.—Any 

10 amount of damages that the United States is entitled to 

11 recover under this section shall be paid to the United States 

12 within the one-year period beginning on the date of the 

13 breach of the agreement.’’. 

14 (b) CONFORMING AND TECHNICAL AMENDMENTS.— 

15 (1) CONFORMING AMENDMENTS.— 

16 (A) ESTABLISHMENT OF PROGRAM.—Sec17 tion 7601(a) of such title is amended— 

18 (i) in paragraph (5), by striking 

19 ‘‘and’’; 

20 (ii) in paragraph (6), by striking the 

21 period and inserting ‘‘; and’’; and 

22 (iii) by adding at the end the following 

23 new paragraph: 


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1 ‘‘(7) the readjustment counseling service scholar2 ship program provided for in subchapter IX of this 

3 chapter.’’. 

4 (B) ELIGIBILITY.—Section 7602 of such 

5 title is amended— 

6 (i) in subsection (a)(1)— 

7 (I) by striking ‘‘or VI’’ and in8 serting ‘‘VI, or IX’’; and 

9 (II) by striking ‘‘subchapter VI’’ 

10 and inserting ‘‘subchapter VI or IX’’; 

11 and 

12 (ii) in subsection (b), by striking ‘‘or 

13 VI’’ and inserting ‘‘VI, or IX’’. 

14 (C) APPLICATION.—Section 7603(a)(1) of 

15 such title is amended by striking ‘‘or VIII’’ and 

16 inserting ‘‘VIII, or IX’’. 

17 (D) TERMS OF AGREEMENT.—Section 7604 

18 of such title is amended by striking ‘‘or VIII’’ 

19 each place it appears and inserting ‘‘VIII, or 

20 IX’’. 

21 (E) ANNUAL REPORT.—Section 7632 of 

22 such title is amended— 

23 (i) in paragraph (1), by striking ‘‘and 

24 the Specialty Education Loan Repayment 

25 Program’’ and inserting ‘‘the Specialty 


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1 Education Loan Repayment Program, and 

2 the Readjustment Counseling Service Schol3 arship Program’’; and 

4 (ii) in paragraph (4), by striking ‘‘and 

5 per participant in the Specialty Education 

6 Loan Repayment Program’’ and inserting 

7 ‘‘per participant in the Specialty Edu8 cation Loan Repayment Program, and per 

9 participant in the Readjustment Counseling 

10 Service Scholarship Program’’. 

11 (2) TABLE OF SECTIONS.—The table of sections 

12 at the beginning of chapter 76 of such title is amend13 ed by inserting after the items relating to subchapter 

14 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.’’. 

15 (c) EFFECTIVE DATE.—The Secretary of Veterans Af16 fairs shall begin awarding scholarships under subchapter 

17 IX of chapter 76 of title 38, United States Code, as added 

18 by subsection (a), for programs of study beginning not later 

19 than one year after the date of the enactment of this Act. 


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1 SEC. 504. COMPTROLLER GENERAL REPORT ON READJUST2 MENT COUNSELING SERVICE OF DEPART3 MENT OF VETERANS AFFAIRS. 

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

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

6 of the United States shall submit to the Committee on Vet7 erans’ Affairs of the Senate and the Committee on Veterans’ 

8 Affairs of the House of Representatives a report on the Re9 adjustment Counseling Service of the Department of Vet10 erans Affairs. 

11 (b) ELEMENTS.—The report required by subsection (a) 

12 shall include the following: 

13 (1) An assessment of the adequacy and types of 

14 treatment, counseling, and other services provided at 

15 Vet Centers, including recommendations on whether 

16 and how such treatment, counseling, and other serv17 ices can be expanded. 

18 (2) An assessment of the efficacy of outreach ef19 forts by the Readjustment Counseling Service, includ20 ing recommendations for how outreach efforts can be 

21 improved. 

22 (3) An assessment of barriers to care at Vet Cen23 ters, including recommendations for overcoming those 

24 barriers. 

25 (4) An assessment of the efficacy and frequency 

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1 ment Counseling Service to provide mental health 

2 services, including recommendations for how the use 

3 of telehealth can be improved. 

4 (5) An assessment of the feasibility and advis5 ability of expanding eligibility for services from the 

6 Readjustment Counseling Service, including— 

7 (A) recommendations on what eligibility 

8 criteria could be expanded; and 

9 (B) an assessment of potential costs and in10 creased infrastructure requirements if eligibility 

11 is expanded. 

12 (6) An assessment of the use of Vet Centers by 

13 members of the reserve components of the Armed 

14 Forces who were never activated and recommenda15 tions on how to better reach those members. 

16 (7) An assessment of the use of Vet Centers by 

17 eligible family members of former members of the 

18 Armed Forces and recommendations on how to better 

19 reach those family members. 

20 (8) An assessment of the efficacy of group ther21 apy and the level of training of providers at Vet Cen22 ters in administering group therapy. 

23 (9) An assessment of the efficiency and effective24 ness of the task organization structure of Vet Centers. 


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1 (10) An assessment of the use of Vet Centers by 

2 Native American veterans, as defined in section 3765 

3 of title 38, United States Code, and recommendations 

4 on how to better reach those veterans. 

5 (c) VET CENTER DEFINED.—In this section, the term 

6 ‘‘Vet Center’’ has the meaning given that term in section 

7 1712A(h) of title 38, United States Code. 

8 SEC. 505. EXPANSION OF REPORTING REQUIREMENTS ON 

9 READJUSTMENT COUNSELING SERVICE OF 

10 DEPARTMENT OF VETERANS AFFAIRS. 

11 (a) EXPANSION OF ANNUAL REPORT.—Paragraph 

12 (2)(C) of section 7309(e) of title 38, United States Code, 

13 is amended by inserting before the period at the end the 

14 following: ‘‘, including the resources required to meet such 

15 unmet need, such as additional staff, additional locations, 

16 additional infrastructure, infrastructure improvements, 

17 and additional mobile Vet Centers’’. 

18 (b) BIENNIAL REPORT.—Such section is amended by 

19 adding at the end the following new paragraph: 

20 ‘‘(3) For each even numbered year in which the report 

21 required by paragraph (1) is submitted, the Secretary shall 

22 include in such report a prediction of— 

23 ‘‘(A) trends in demand for care; 

24 ‘‘(B) long-term investments required with respect 

25 to the provision of care; 


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1 ‘‘(C) requirements relating to maintenance of in2 frastructure; and 

3 ‘‘(D) other capital investment requirements with 

4 respect to the Readjustment Counseling Service, in5 cluding Vet Centers, mobile Vet Centers, and commu6 nity access points.’’. 

7 SEC. 506. STUDIES ON ALTERNATIVE WORK SCHEDULES 

8 FOR EMPLOYEES OF VETERANS HEALTH AD9 MINISTRATION. 

10 (a) STUDY OF VETERANS.— 

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

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

13 Veterans Affairs shall conduct a study on the atti14 tudes of eligible veterans toward the Department of 

15 Veterans Affairs offering appointments outside the 

16 usual operating hours of facilities of the Department, 

17 including through the use of telehealth appointments. 

18 (2) ELIGIBLE VETERAN DEFINED.—In this sub19 section, the term ‘‘eligible veteran’’ means a veteran 

20 who— 

21 (A) is enrolled in the patient enrollment 

22 system of the Department under section 1705(a) 

23 of title 38, United States Code; and 

24 (B) received health care from the Depart25 ment at least once during the two-year period 


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1 ending on the date of the commencement of the 

2 study under paragraph (1). 

3 (b) DEPARTMENT STUDY.— 

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

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

6 shall conduct a study on the feasibility and advis7 ability of offering appointments outside the usual op8 erating hours of facilities of the Department. 

9 (2) STUDY OF EMPLOYEES.—The study required 

10 by paragraph (1) shall include a study of the opin11 ions of employees of the Veterans Health Administra12 tion, including clinical, nonclinical, and support 

13 staff, with respect to offering appointments outside 

14 the usual operating hours of facilities of the Depart15 ment, including through the use of telehealth appoint16 ments. 

17 SEC. 507. SUICIDE PREVENTION COORDINATORS. 

18 (a) STAFFING REQUIREMENT.—Beginning not later 

19 than one year after the date of the enactment of this Act, 

20 the Secretary of Veterans Affairs shall ensure that each med21 ical center of the Department of Veterans Affairs has not 

22 less than one suicide prevention coordinator. 

23 (b) STUDY ON REORGANIZATION.— 

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

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


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1 in consultation with the Office of Mental Health and 

2 Suicide Prevention of the Department, shall com3 mence the conduct of a study to determine the feasi4 bility and advisability of— 

5 (A) the realignment and reorganization of 

6 suicide prevention coordinators within the Office 

7 of Mental Health and Suicide Prevention; and 

8 (B) the creation of a suicide prevention co9 ordinator program office. 

10 (2) PROGRAM OFFICE REALIGNMENT.—In con11 ducting the study under paragraph (1), the Secretary 

12 shall assess the feasibility of advisability of, within 

13 the suicide prevention coordinator program office de14 scribed in paragraph (1)(B), aligning suicide preven15 tion coordinators and suicide prevention case man16 agers within the organizational structure and chart of 

17 the Suicide Prevention Program of the Department, 

18 with the Director of the Suicide Prevention program 

19 having ultimate supervisory oversight and responsi20 bility over the suicide prevention coordinator pro21 gram office. 

22 (c) REPORT.—Not later than 90 days after the comple23 tion of the study under subsection (b), the Secretary shall 

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


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1 and the Committee on Veterans’ Affairs of the House of Rep2 resentatives a report on such study, including the following: 

3 (1) An assessment of the feasibility and advis4 ability of creating a suicide prevention coordinator 

5 program office to oversee and monitor suicide preven6 tion coordinators and suicide prevention case man7 agers across all medical centers of the Department. 

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

9 prevention coordinators and suicide prevention case 

10 managers in comparison with current staffing ratios 

11 for mental health providers within each medical cen12 ter of the Department. 

13 (3) A description of the duties and responsibil14 ities for suicide prevention coordinators across the 

15 Department to better define, delineate, and stand16 ardize qualifications, performance goals, performance 

17 duties, and performance outcomes for suicide preven18 tion coordinators and suicide prevention case man19 agers. 

20 SEC. 508. REPORT ON EFFORTS BY DEPARTMENT OF VET21 ERANS AFFAIRS TO IMPLEMENT SAFETY 

22 PLANNING IN EMERGENCY DEPARTMENTS. 

23 (a) FINDINGS.—Congress makes the following findings: 

24 (1) The Department of Veterans Affairs must be 

25 more effective in its approach to reducing the burden 


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1 of veteran suicide connected to mental health diag2 noses, to include expansion of treatment delivered via 

3 telehealth methods and in rural areas. 

4 (2) An innovative project, known as Suicide As5 sessment and Follow-up Engagement: Veteran Emer6 gency Treatment (in this subsection referred to as 

7 ‘‘SAFE VET’’), was designed to help suicidal veterans 

8 seen at emergency departments within the Veterans 

9 Health Administration and was successfully imple10 mented in five intervention sites beginning in 2010. 

11 (3) A 2018 study found that safety planning 

12 intervention under SAFE VET was associated with 

13 45 percent fewer suicidal behaviors in the six-month 

14 period following emergency department care and more 

15 than double the odds of a veteran engaging in out16 patient behavioral health care. 

17 (4) SAFE VET is a promising alternative and 

18 acceptable delivery of care system that augments the 

19 treatment of suicidal veterans in emergency depart20 ments of the Veterans Health Administration and 

21 helps ensure that those veterans have appropriate fol22 low-up care. 

23 (5) Beginning in September 2018, the Veterans 

24 Health Administration implemented a suicide preven25 tion program, known as the SPED program, for vetVerDate Sep 11 2014 00:32 Jul 28, 2020 Jkt 099200 PO 00000 Frm 00224 Fmt 6652 Sfmt 6203 E:\BILLS\S785.RS S785

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1 erans presenting to the emergency department who 

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

3 be discharged home. 

4 (6) The SPED program includes issuance and 

5 update of a safety plan and post-discharge follow-up 

6 outreach for veterans to facilitate engagement in out7 patient mental health care. 

8 (b) REPORT.— 

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

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

11 Veterans Affairs shall submit to the appropriate com12 mittees of Congress a report on the efforts of the Sec13 retary to implement a suicide prevention program for 

14 veterans presenting to an emergency department or 

15 urgent care center of the Veterans Health Administra16 tion who are assessed to be at risk for suicide and are 

17 safe to be discharged home, including a safety plan 

18 and post-discharge outreach for veterans to facilitate 

19 engagement in outpatient mental health care. 

20 (2) ELEMENTS.—The report required by para21 graph (1) shall include the following: 

22 (A) An assessment of the implementation of 

23 the current operational policies and procedures 

24 of the SPED program at each medical center of 


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1 the Department of Veterans Affairs, including an 

2 assessment of the following: 

3 (i) Training provided to clinicians or 

4 other personnel administering protocols 

5 under the SPED program. 

6 (ii) Any disparities in implementation 

7 of such protocols between medical centers. 

8 (iii) Current criteria used to measure 

9 the quality of such protocols including— 

10 (I) methodology used to assess the 

11 quality of a safety plan and post-dis12 charge outreach for veterans; or 

13 (II) in the absence of such meth14 odology, a proposed timeline and 

15 guidelines for creating a methodology 

16 to ensure compliance with the evidence17 based model used under the Suicide As18 sessment and Follow-up Engagement: 

19 Veteran Emergency Treatment (SAFE 

20 VET) program of the Department. 

21 (B) An assessment of the implementation of 

22 the policies and procedures described in subpara23 graph (A), including the following: 

24 (i) An assessment of the quality and 

25 quantity of safety plans issued to veterans. 


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1 (ii) An assessment of the quality and 

2 quantity of post-discharge outreach pro3 vided to veterans. 

4 (iii) The post-discharge rate of veteran 

5 engagement in outpatient mental health 

6 care, including attendance at not fewer 

7 than one individual mental health clinic 

8 appointment or admission to an inpatient 

9 or residential unit. 

10 (iv) The number of veterans who de11 cline safety planning efforts during proto12 cols under the SPED program. 

13 (v) The number of veterans who decline 

14 to participate in follow-up efforts within the 

15 SPED program. 

16 (C) A description of how SPED primary 

17 coordinators are deployed to support such efforts, 

18 including the following: 

19 (i) A description of the duties and re20 sponsibilities of such coordinators. 

21 (ii) The number and location of such 

22 coordinators. 

23 (iii) A description of training provided 

24 to such coordinators. 


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1 (iv) An assessment of the other respon2 sibilities for such coordinators and, if appli3 cable, differences in patient outcomes when 

4 such responsibilities are full-time duties as 

5 opposed to secondary duties. 

6 (D) An assessment of the feasibility and ad7 visability of expanding the total number and ge8 ographic distribution of SPED primary coordi9 nators. 

10 (E) An assessment of the feasibility and ad11 visability of providing services under the SPED 

12 program via telehealth channels, including an 

13 analysis of opportunities to leverage telehealth to 

14 better serve veterans in rural areas. 

15 (F) A description of the status of current 

16 capabilities and utilization of tracking mecha17 nisms to monitor compliance, quality, and pa18 tient outcomes under the SPED program. 

19 (G) Such recommendations, including spe20 cific action items, as the Secretary considers ap21 propriate with respect to how the Department 

22 can better implement the SPED program, in23 cluding recommendations with respect to the fol24 lowing: 


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1 (i) A process to standardize training 

2 under such program. 

3 (ii) Any resourcing requirements nec4 essary to implement the SPED program 

5 throughout Veterans Health Administration, 

6 including by having a dedicated clinician 

7 responsible for administration of such pro8 gram at each medical center. 

9 (iii) An analysis of current statutory 

10 authority and any changes necessary to 

11 fully implement the SPED program 

12 throughout the Veterans Health Administra13 tion. 

14 (iv) A timeline for the implementation 

15 of the SPED program through the Veterans 

16 Health Administration once full resourcing 

17 and an approved training plan are in 

18 place. 

19 (H) Such other matters as the Secretary 

20 considers appropriate. 

21 (c) DEFINITIONS.—In this section: 

22 (1) APPROPRIATE COMMITTEES OF CONGRESS.— 

23 The term ‘‘appropriate committees of Congress’’ 

24 means— 


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1 (A) the Committee on Veterans’ Affairs and 

2 the Subcommittee on Military Construction, Vet3 erans Affairs, and Related Agencies of the Com4 mittee on Appropriations of the Senate; and 

5 (B) the Committee on Veterans’ Affairs and 

6 the Subcommittee on Military Construction, Vet7 erans Affairs, and Related Agencies of the Com8 mittee on Appropriations of the House of Rep9 resentatives. 

10 (2) SPED PRIMARY COORDINATOR.—The term 

11 ‘‘SPED primary coordinator’’ means the main point 

12 of contact responsible for administering the SPED 

13 program at a medical center of the Department. 

14 (3) SPED PROGRAM.—The term ‘‘SPED pro15 gram’’ means the Safety Planning in Emergency De16 partments program of the Department of Veterans Af17 fairs established in September 2018 for veterans pre18 senting to the emergency department who are assessed 

19 to be at risk for suicide and are safe to be discharged 

20 home, which extends the evidence-based intervention 

21 for suicide prevention to all emergency departments of 

22 the Veterans Health Administration. 


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1 TITLE VI—IMPROVEMENT OF 

2 CARE AND SERVICES FOR 

3 WOMEN VETERANS 

4 SEC. 601. EXPANSION OF CAPABILITIES OF WOMEN VET5 ERANS CALL CENTER TO INCLUDE TEXT MES6 SAGING. 

7 The Secretary of Veterans Affairs shall expand the ca8 pabilities of the Women Veterans Call Center of the Depart9 ment of Veterans Affairs to include a text messaging capa10 bility. 

11 SEC. 602. GAP ANALYSIS OF DEPARTMENT OF VETERANS 

12 AFFAIRS PROGRAMS THAT PROVIDE ASSIST13 ANCE TO WOMEN VETERANS WHO ARE HOME14 LESS. 

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

16 shall complete an analysis of programs of the Department 

17 of Veterans Affairs that provide assistance to women vet18 erans who are homeless or precariously housed to identify 

19 the areas in which such programs are failing to meet the 

20 needs of such women. 

21 (b) REPORT.—Not later than 270 days after the date 

22 of the enactment of this Act, the Secretary shall submit to 

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

24 Committee on Veterans’ Affairs of the House of RepresentaVerDate Sep 11 2014 00:32 Jul 28, 2020 Jkt 099200 PO 00000 Frm 00231 Fmt 6652 Sfmt 6203 E:\BILLS\S785.RS S785

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1 tives a report on the analysis completed under subsection 

2 (a). 

3 SEC. 603. REQUIREMENT FOR DEPARTMENT OF VETERANS 

4 AFFAIRS INTERNET WEBSITE TO PROVIDE IN5 FORMATION ON SERVICES AVAILABLE TO 

6 WOMEN VETERANS. 

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

8 shall survey the internet websites and information resources 

9 of the Department of Veterans Affairs in effect on the day 

10 before the date of the enactment of this Act and publish an 

11 internet website that serves as a centralized source for the 

12 provision to women veterans of information about the bene13 fits and services available to them under laws administered 

14 by the Secretary. 

15 (b) ELEMENTS.—The internet website published under 

16 subsection (a) shall provide to women veterans information 

17 regarding all services available in the district in which the 

18 veteran is seeking such services, including, with respect to 

19 each medical center and community-based outpatient clinic 

20 in the applicable Veterans Integrated Service Network— 

21 (1) the name and contact information of each 

22 women’s health coordinator; 

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

24 available from the Veterans Benefits Administration, 

25 the National Cemetery Administration, and such 


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1 other entities as the Secretary considers appropriate; 

2 and 

3 (3) such other information as the Secretary con4 siders appropriate. 

5 (c) UPDATED INFORMATION.—The Secretary shall en6 sure that the information described in subsection (b) that 

7 is published on the internet website required by subsection 

8 (a) is updated not less frequently than once every 90 days. 

9 (d) OUTREACH.—In carrying out this section, the Sec10 retary shall ensure that the outreach conducted under sec11 tion 1720F(i) of title 38, United States Code, includes infor12 mation regarding the internet website required by sub13 section (a). 

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

15 Secretary to carry out this section shall be derived from 

16 amounts made available to the Secretary to publish internet 

17 websites of the Department. 

18 SEC. 604. REPORT ON LOCATIONS WHERE WOMEN VET19 ERANS ARE USING HEALTH CARE FROM DE20 PARTMENT OF VETERANS AFFAIRS. 

21 (a) IN GENERAL.—Not later than 90 days after the 

22 date of the enactment of this Act, and annually thereafter, 

23 the Secretary of Veterans Affairs shall submit to the Com24 mittee on Veterans’ Affairs of the Senate and the Committee 

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


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1 on the use by women veterans of health care from the De2 partment of Veterans Affairs. 

3 (b) ELEMENTS.—Each report required by subsection 

4 (a) shall include the following information: 

5 (1) The number of women veterans who reside in 

6 each State. 

7 (2) The number of women veterans in each State 

8 who are enrolled in the system of patient enrollment 

9 of the Department established and operated under sec10 tion 1705(a) of title 38, United States Code. 

11 (3) Of the women veterans who are so enrolled, 

12 the number who have received health care under the 

13 laws administered by the Secretary at least one time 

14 during the one-year period preceding the submittal of 

15 the report. 

16 (4) The number of women veterans who have 

17 been seen at each medical facility of the Department 

18 during such year. 

19 (5) The number of appointments that women vet20 erans have had at each such facility during such year. 

21 (6) If known, an identification of the medical fa22 cility of the Department in each Veterans Integrated 

23 Service Network with the largest rate of increase in 

24 patient population of women veterans as measured by 

25 the increase in unique women veteran patient use. 


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1 (7) If known, an identification of the medical fa2 cility of the Department in each Veterans Integrated 

3 Service Network with the largest rate of decrease in 

4 patient population of women veterans as measured by 

5 the decrease in unique women veterans patient use. 

6 TITLE VII—OTHER MATTERS 

7 SEC. 701. EXPANDED TELEHEALTH FROM DEPARTMENT OF 

8 VETERANS AFFAIRS. 

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

10 shall enter into partnerships, and expand existing partner11 ships, with organizations that represent or serve veterans, 

12 nonprofit organizations, private businesses, and other inter13 ested parties for the expansion of telehealth capabilities and 

14 the provision of telehealth services to veterans through the 

15 award of grants under subsection (b). 

16 (b) AWARD OF GRANTS.— 

17 (1) IN GENERAL.—In carrying out partnerships 

18 entered into or expanded under this section with enti19 ties described in subsection (a), the Secretary shall 

20 award grants to those entities. 

21 (2) LOCATIONS.—To the extent practicable, the 

22 Secretary shall ensure that grants are awarded to en23 tities that serve veterans in rural and highly rural 

24 areas (as determined through the use of the RuralVerDate Sep 11 2014 00:32 Jul 28, 2020 Jkt 099200 PO 00000 Frm 00235 Fmt 6652 Sfmt 6203 E:\BILLS\S785.RS S785

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1 Urban Commuting Areas coding system of the De2 partment of Agriculture). 

3 (3) USE OF GRANTS.— 

4 (A) IN GENERAL.—Grants awarded to an 

5 entity under this subsection may be used for one 

6 or more of the following: 

7 (i) Purchasing or upgrading hardware 

8 or software necessary for the provision of se9 cure and private telehealth services. 

10 (ii) Upgrading security protocols for 

11 consistency with the security requirements 

12 of the Department. 

13 (iii) Training of employees, including 

14 payment of those employees for completing 

15 that training, with respect to— 

16 (I) military and veteran cultural 

17 competence, if the entity is not an or18 ganization that represents veterans; 

19 (II) equipment required to pro20 vide telehealth services; or 

21 (III) any other unique training 

22 needs for the provision of telehealth 

23 services to veterans. 

24 (iv) Upgrading existing infrastructure 

25 owned or leased by the entity to make rooms 


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1 more conducive to telehealth care, includ2 ing— 

3 (I) additions or modifications to 

4 windows or walls in an existing room, 

5 or other alterations as needed to create 

6 a new, private room; 

7 (II) soundproofing of an existing 

8 room; 

9 (III) new electrical or internet 

10 outlets in an existing room; or 

11 (IV) aesthetic enhancements to es12 tablish a more suitable therapeutic en13 vironment. 

14 (v) Upgrading existing infrastructure 

15 to comply with the Americans with Disabil16 ities Act of 1990 (42 U.S.C. 12101 et seq.). 

17 (vi) Upgrading internet infrastructure 

18 and sustainment of internet services. 

19 (B) EXCLUSION.—Grants may not be used 

20 for the purchase of new property or for major 

21 construction projects, as determined by the Sec22 retary. 

23 (c) AGREEMENT ON TELEHEALTH ACCESS POINTS.— 

24 (1) IN GENERAL.—An entity described in sub25 section (a) that seeks to establish a telehealth access 


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1 point for veterans but does not require grant funding 

2 under this section to do so may enter into an agree3 ment with the Department for the establishment of 

4 such an access point. 

5 (2) ADEQUACY OF FACILITIES.—An entity de6 scribed in paragraph (1) shall be responsible for en7 suring that any access point is adequately private, se8 cure, and accessible for veterans before the access 

9 point is established. 

10 (d) ASSESSMENT OF BARRIERS TO ACCESS.— 

11 (1) IN GENERAL.—Not later than 18 months 

12 after the date of the enactment of this Act, the Sec13 retary shall complete an assessment of barriers faced 

14 by veterans in accessing telehealth services. 

15 (2) ELEMENTS.—The assessment required by 

16 paragraph (1) shall include the following: 

17 (A) A description of the barriers veterans 

18 face in using telehealth while not on property of 

19 the Department. 

20 (B) A description of how the Department 

21 plans to address the barriers described in sub22 paragraph (A). 

23 (C) Such other matters related access by 

24 veterans to telehealth while not on property of 


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1 the Department as the Secretary considers rel2 evant. 

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

4 completion of the assessment required by paragraph 

5 (1), the Secretary shall submit to the Committee on 

6 Veterans’ Affairs of the Senate and the Committee on 

7 Veterans’ Affairs of the House of Representatives a re8 port on the assessment, including any recommenda9 tions for legislative or administrative action based on 

10 the results of the assessment. 

11 SEC. 702. PARTNERSHIPS WITH NON-FEDERAL GOVERN12 MENT ENTITIES TO PROVIDE HYPERBARIC 

13 OXYGEN THERAPY TO VETERANS AND STUD14 IES ON THE USE OF SUCH THERAPY FOR 

15 TREATMENT OF POST-TRAUMATIC STRESS 

16 DISORDER AND TRAUMATIC BRAIN INJURY. 

17 (a) PARTNERSHIPS TO PROVIDE HYPERBARIC OXYGEN

18 THERAPY TO VETERANS.— 

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

20 Veterans Affairs, in consultation with the Center for 

21 Compassionate Innovation within the Office of Com22 munity Engagement of the Department of Veterans 

23 Affairs, may enter into partnerships with non-Federal 

24 Government entities to provide hyperbaric oxygen 


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1 treatment to veterans to research the effectiveness of 

2 such therapy. 

3 (2) TYPES OF PARTNERSHIPS.—Partnerships en4 tered into under paragraph (1) may include the fol5 lowing: 

6 (A) Partnerships to conduct research on 

7 hyperbaric oxygen therapy. 

8 (B) Partnerships to review research on 

9 hyperbaric oxygen therapy provided to non10 veterans. 

11 (C) Partnerships to create industry working 

12 groups to determine standards for research on 

13 hyperbaric oxygen therapy. 

14 (D) Partnerships to provide to veterans 

15 hyperbaric oxygen therapy for the purposes of 

16 conducting research on the effectiveness of such 

17 therapy. 

18 (3) LIMITATION ON FEDERAL FUNDING.—Federal 

19 Government funding may be used to coordinate and 

20 administer the partnerships under this subsection but 

21 may not be used to carry out activities conducted 

22 under such partnerships. 

23 (b) REVIEW OF EFFECTIVENESS OF HYPERBARIC OXY24 GEN THERAPY.—Not later than 90 days after the date of 

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


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1 with the Center for Compassionate Innovation, shall begin 

2 using an objective and quantifiable method to review the 

3 effectiveness and applicability of hyperbaric oxygen ther4 apy, such as through the use of a device approved or cleared 

5 by the Food and Drug Administration that assesses trau6 matic brain injury by tracking eye movement. 

7 (c) SYSTEMATIC REVIEW OF USE OF HYPERBARIC OX8 YGEN THERAPY TO TREAT CERTAIN CONDITIONS.— 

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

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

11 in consultation with the Center for Compassionate In12 novation, shall commence the conduct of a systematic 

13 review of published research literature on off-label use 

14 of hyperbaric oxygen therapy to treat post-traumatic 

15 stress disorder and traumatic brain injury among 

16 veterans and nonveterans. 

17 (2) ELEMENTS.—The review conducted under 

18 paragraph (1) shall include the following: 

19 (A) An assessment of the current parameters 

20 for research on the use by the Department of Vet21 erans Affairs of hyperbaric oxygen therapy, in22 cluding— 

23 (i) tests and questionnaires used to de24 termine the efficacy of such therapy; and 


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1 (ii) metrics for determining the success 

2 of such therapy. 

3 (B) A comparative analysis of tests and 

4 questionnaires used to study post-traumatic 

5 stress disorder and traumatic brain injury in 

6 other research conducted by the Department of 

7 Veterans Affairs, other Federal agencies, and en8 tities outside the Federal Government. 

9 (3) COMPLETION OF REVIEW.—The review con10 ducted under paragraph (1) shall be completed not 

11 later than 180 days after the date of the commence12 ment of the review. 

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

14 completion of the review conducted under paragraph 

15 (1), the Secretary shall submit to the Committee on 

16 Veterans’ Affairs of the Senate and the Committee on 

17 Veterans’ Affairs of the House of Representatives a re18 port on the results of the review. 

19 (d) FOLLOW-UP STUDY.— 

20 (1) IN GENERAL.—Not later than 120 days after 

21 the completion of the review conducted under sub22 section (c), the Secretary, in consultation with the 

23 Center for Compassionate Innovation, shall commence 

24 the conduct of a study on all individuals receiving 

25 hyperbaric oxygen therapy through the current pilot 


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1 program of the Department for the provision of 

2 hyperbaric oxygen therapy to veterans to determine 

3 the efficacy and effectiveness of hyperbaric oxygen 

4 therapy for the treatment of post-traumatic stress dis5 order and traumatic brain injury. 

6 (2) ELEMENTS.—The study conducted under 

7 paragraph (1) shall include the review and publica8 tion of any data and conclusions resulting from re9 search conducted by an authorized provider of 

10 hyperbaric oxygen therapy for veterans through the 

11 pilot program described in such paragraph. 

12 (3) COMPLETION OF STUDY.—The study con13 ducted under paragraph (1) shall be completed not 

14 later than three years after the date of the commence15 ment of the study. 

16 (4) REPORT.— 

17 (A) IN GENERAL.—Not later than 90 days 

18 after completing the study conducted under 

19 paragraph (1), the Secretary shall submit to the 

20 Committee on Veterans’ Affairs of the Senate 

21 and the Committee on Veterans’ Affairs of the 

22 House of Representatives a report on the results 

23 of the study. 

24 (B) ELEMENTS.—The report required under 

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1 tion of the Secretary with respect to whether or 

2 not hyperbaric oxygen therapy should be made 

3 available to all veterans with traumatic brain 

4 injury or post-traumatic stress disorder. 

5 SEC. 703. PRESCRIPTION OF TECHNICAL QUALIFICATIONS 

6 FOR LICENSED HEARING AID SPECIALISTS 

7 AND REQUIREMENT FOR APPOINTMENT OF 

8 SUCH SPECIALISTS. 

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

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

11 Affairs shall prescribe the technical qualifications required 

12 under section 7402(a)(14) of title 38, United States Code, 

13 to be appointed as a licensed hearing aid specialist under 

14 section 7401(3) of such title. 

15 (b) ELEMENTS FOR QUALIFICATIONS.—In prescribing 

16 the qualifications for licensed hearing aid specialists under 

17 subsection (a), the Secretary shall ensure such qualifications 

18 are consistent with the following: 

19 (1) Standards of registered apprenticeship pro20 grams for the occupation of hearing aid specialists 

21 approved by the Department of Labor in accordance 

22 with the Act of August 16, 1937 (commonly known as 

23 the ‘‘National Apprenticeship Act’’) (50 Stat. 664, 

24 chapter 663; 29 U.S.C. 50 et seq.). 


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1 (2) Standards for licensure of hearing aid spe2 cialists that are required by a majority of States. 

3 (3) Competency in completing core tasks for the 

4 occupation of hearing aid specialist as determined by 

5 the Occupational Information Network Database 

6 (commonly known as ‘‘O*NET’’). 

7 (c) APPOINTMENT.—Not later than September 30, 

8 2022, the Secretary shall appoint not fewer than one li9 censed hearing aid specialist at each medical center of the 

10 Department. 

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

12 annually thereafter, the Secretary shall submit to the Com13 mittee on Veterans’ Affairs of the Senate and the Committee 

14 on Veterans’ Affairs of the House of Representatives a re15 port— 

16 (1) assessing the progress of the Secretary in ap17 pointing licensed hearing aid specialists under sub18 section (c); 

19 (2) assessing potential conflicts or obstacles that 

20 prevent the appointment of licensed hearing aid spe21 cialists; 

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

23 or obstacles; and 


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1 (4) indicating the medical centers of the Depart2 ment with vacancies for licensed hearing aid special3 ists. 

4 SEC. 704. USE BY DEPARTMENT OF VETERANS AFFAIRS OF 

5 COMMERCIAL INSTITUTIONAL REVIEW 

6 BOARDS IN SPONSORED RESEARCH TRIALS. 

7 (a) IN GENERAL.—Not later than 90 days after the 

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

9 Affairs shall complete all necessary policy revisions within 

10 the directive of the Veterans Health Administration num11 bered 1200.05 and titled ‘‘Requirements for the Protection 

12 of Human Subjects in Research’’, to allow sponsored clin13 ical research of the Department of Veterans Affairs to use 

14 accredited commercial institutional review boards to review 

15 research proposal protocols of the Department. 

16 (b) IDENTIFICATION OF REVIEW BOARDS.—Not later 

17 than 90 days after the completion of the policy revisions 

18 under subsection (a), the Secretary shall— 

19 (1) identify accredited commercial institutional 

20 review boards for use in connection with sponsored 

21 clinical research of the Department; and 

22 (2) establish a process to modify existing approv23 als in the event that a commercial institutional re24 view board loses its accreditation during an ongoing 

25 clinical trial. 


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1 (c) REPORT.— 

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

3 the completion of the policy revisions under subsection 

4 (a), and annually thereafter, the Secretary shall sub5 mit to the Committee on Veterans’ Affairs of the Sen6 ate and the Committee on Veterans’ Affairs of the 

7 House of Representatives a report on all approvals of 

8 institutional review boards used by the Department, 

9 including central institutional review boards and 

10 commercial institutional review boards. 

11 (2) ELEMENTS.—The report required by para12 graph (1) shall include, at a minimum, the following: 

13 (A) The name of each clinical trial with re14 spect to which the use of an institutional review 

15 board has been approved. 

16 (B) The institutional review board or insti17 tutional review boards used in the approval 

18 process for each clinical trial. 

19 (C) The amount of time between submission 

20 and approval. 


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1 SEC. 705. CREATION OF OFFICE OF RESEARCH REVIEWS 

2 WITHIN THE OFFICE OF INFORMATION AND 

3 TECHNOLOGY OF THE DEPARTMENT OF VET4 ERANS AFFAIRS. 

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

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

7 Affairs shall establish within the Office of Information and 

8 Technology of the Department of Veterans Affairs an Office 

9 of Research Reviews (in this section referred to as the ‘‘Of10 fice’’). 

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

12 (1) Perform centralized security reviews and 

13 complete security processes for approved research 

14 sponsored outside the Department, with a focus on 

15 multi-site clinical trials. 

16 (2) Develop and maintain a list of commercially 

17 available software preferred for use in sponsored clin18 ical trials of the Department and ensure such list is 

19 maintained as part of the official approved software 

20 products list of the Department. 

21 (3) Develop benchmarks for appropriate 

22 timelines for security reviews conducted by the Office. 

23 (c) REPORT.— 

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

25 the establishment of the Office, the Office shall submit 

26 to the Committee on Veterans’ Affairs of the Senate 


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1 and the Committee on Veterans’ Affairs of the House 

2 of Representatives a report on the activity of the Of3 fice. 

4 (2) ELEMENTS.—The report required by para5 graph (1) shall include, at a minimum, the following: 

6 (A) The number of security reviews com7 pleted. 

8 (B) The number of personnel assigned for 

9 performing the functions described in subsection 

10 (b). 


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Calendar No. 498 

116TH CONGRESS 

2D SESSION S. 785 

A BILL 

To improve mental health care provided by the Deposes. partment of Veterans Affairs, and for other purJULY 27, 2020 

Reported with an amendment 


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