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[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 785 Engrossed in Senate (ES)]

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116th CONGRESS
  2d Session
                                 S. 785

_______________________________________________________________________

                                 AN ACT

 
 To improve mental health care provided by the Department of Veterans 
                    Affairs, and for other purposes.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Commander John 
Scott Hannon Veterans Mental Health Care Improvement Act of 2019''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
  TITLE I--IMPROVEMENT OF TRANSITION OF INDIVIDUALS TO SERVICES FROM 
                     DEPARTMENT OF VETERANS AFFAIRS

Sec. 101. Strategic plan on expansion of health care coverage for 
                            veterans transitioning from service in the 
                            Armed Forces.
Sec. 102. Review of records of former members of the Armed Forces who 
                            die by suicide within one year of 
                            separation from the Armed Forces.
Sec. 103. Report on REACH VET program of Department of Veterans 
                            Affairs.
Sec. 104. Report on care for former members of the Armed Forces with 
                            other than honorable discharge.
                      TITLE II--SUICIDE PREVENTION

Sec. 201. Financial assistance to certain entities to provide or 
                            coordinate the provision of suicide 
                            prevention services for eligible 
                            individuals and their families.
Sec. 202. Analysis on feasibility and advisability of the Department of 
                            Veterans Affairs providing certain 
                            complementary and integrative health 
                            services.
Sec. 203. Pilot program to provide veterans access to complementary and 
                            integrative health programs through animal 
                            therapy, agritherapy, sports and recreation 
                            therapy, art therapy, and posttraumatic 
                            growth programs.
Sec. 204. Department of Veterans Affairs study of all-cause mortality 
                            of veterans, including by suicide, and 
                            review of staffing levels of mental health 
                            professionals.
Sec. 205. Comptroller General report on management by Department of 
                            Veterans Affairs of veterans at high risk 
                            for suicide.
     TITLE III--PROGRAMS, STUDIES, AND GUIDELINES ON MENTAL HEALTH

Sec. 301. Study on connection between living at high altitude and 
                            suicide risk factors among veterans.
Sec. 302. Establishment by Department of Veterans Affairs and 
                            Department of Defense of a clinical 
                            provider treatment toolkit and accompanying 
                            training materials for comorbidities.
Sec. 303. Update of clinical practice guidelines for assessment and 
                            management of patients at risk for suicide.
Sec. 304. Establishment by Department of Veterans Affairs and 
                            Department of Defense of clinical practice 
                            guidelines for the treatment of serious 
                            mental illness.
Sec. 305. Precision medicine initiative of Department of Veterans 
                            Affairs to identify and validate brain and 
                            mental health biomarkers.
Sec. 306. Statistical analyses and data evaluation by Department of 
                            Veterans Affairs.
     TITLE IV--OVERSIGHT OF MENTAL HEALTH CARE AND RELATED SERVICES

Sec. 401. Study on effectiveness of suicide prevention and mental 
                            health outreach programs of Department of 
                            Veterans Affairs.
Sec. 402. Oversight of mental health and suicide prevention media 
                            outreach conducted by Department of 
                            Veterans Affairs.
Sec. 403. Comptroller General management review of mental health and 
                            suicide prevention services of Department 
                            of Veterans Affairs.
Sec. 404. Comptroller General report on efforts of Department of 
                            Veterans Affairs to integrate mental health 
                            care into primary care clinics.
Sec. 405. Joint mental health programs by Department of Veterans 
                            Affairs and Department of Defense.
        TITLE V--IMPROVEMENT OF MENTAL HEALTH MEDICAL WORKFORCE

Sec. 501. Staffing improvement plan for mental health providers of 
                            Department of Veterans Affairs.
Sec. 502. Establishment of Department of Veterans Affairs Readjustment 
                            Counseling Service Scholarship Program.
Sec. 503. Comptroller General report on Readjustment Counseling Service 
                            of Department of Veterans Affairs.
Sec. 504. Expansion of reporting requirements on Readjustment 
                            Counseling Service of Department of 
                            Veterans Affairs.
Sec. 505. Briefing on alternative work schedules for employees of 
                            Veterans Health Administration.
Sec. 506. Suicide prevention coordinators.
Sec. 507. Report on efforts by Department of Veterans Affairs to 
                            implement safety planning in emergency 
                            departments.
     TITLE VI--IMPROVEMENT OF CARE AND SERVICES FOR WOMEN VETERANS

Sec. 601. Expansion of capabilities of Women Veterans Call Center to 
                            include text messaging.
Sec. 602. Requirement for Department of Veterans Affairs internet 
                            website to provide information on services 
                            available to women veterans.
                        TITLE VII--OTHER MATTERS

Sec. 701. Expanded telehealth from Department of Veterans Affairs.
Sec. 702. Partnerships with non-Federal Government entities to provide 
                            hyperbaric oxygen therapy to veterans and 
                            studies on the use of such therapy for 
                            treatment of post-traumatic stress disorder 
                            and traumatic brain injury.
Sec. 703. Prescription of technical qualifications for licensed hearing 
                            aid specialists and requirement for 
                            appointment of such specialists.
Sec. 704. Use by Department of Veterans Affairs of commercial 
                            institutional review boards in sponsored 
                            research trials.
Sec. 705. Creation of Office of Research Reviews within the Office of 
                            Information and Technology of the 
                            Department of Veterans Affairs.

  TITLE I--IMPROVEMENT OF TRANSITION OF INDIVIDUALS TO SERVICES FROM 
                     DEPARTMENT OF VETERANS AFFAIRS

SEC. 101. STRATEGIC PLAN ON EXPANSION OF HEALTH CARE COVERAGE FOR 
              VETERANS TRANSITIONING FROM SERVICE IN THE ARMED FORCES.

    (a) Strategic Plan.--
            (1) In general.--Not later than one year after the date of 
        the enactment of this Act, the Secretary of Veterans Affairs, 
        in consultation with the Secretary of Defense, shall submit to 
        the appropriate committees of Congress and publish on a website 
        of the Department of Veterans Affairs a strategic plan for the 
        provision by the Department of health care to any veteran 
        during the one-year period following the discharge or release 
        of the veteran from active military, naval, or air service.
            (2) Elements.--The plan submitted under paragraph (1) shall 
        include the following:
                    (A) An identification of general goals and 
                objectives for the provision of health care to veterans 
                described in such paragraph.
                    (B) A description of how such goals and objectives 
                are to be achieved, including--
                            (i) a description of the use of existing 
                        personnel, information, technology, facilities, 
                        public and private partnerships, and other 
                        resources of the Department of Veterans 
                        Affairs;
                            (ii) a description of the anticipated need 
                        for additional resources for the Department; 
                        and
                            (iii) an assessment of cost.
                    (C) An analysis of the anticipated health care 
                needs, including mental health care, for such veterans, 
                disaggregated by geographic area.
                    (D) An analysis of whether such veterans are 
                eligible for enrollment in the system of annual patient 
                enrollment of the Department under section 1705(a) of 
                title 38, United States Code.
                    (E) A description of activities designed to promote 
                the availability of health care from the Department for 
                such veterans, including outreach to members of the 
                Armed Forces though the Transition Assistance Program 
                under sections 1142 and 1144 of title 10, United States 
                Code.
                    (F) A description of legislative or administrative 
                action required to carry out the plan.
                    (G) A description of how the plan would further the 
                ongoing initiatives under Executive Order 13822 (83 
                Fed. Reg. 1513; relating to supporting our veterans 
                during their transition from uniformed service to 
                civilian life) to provide seamless access to high-
                quality mental health care and suicide prevention 
                resources to veterans as they transition, with an 
                emphasis on the one-year period following separation.
    (b) Definitions.--In this section:
            (1) Active military, naval, or air service.--The term 
        ``active military, naval, or air service'' has the meaning 
        given that term in section 101(24) of title 38, United States 
        Code.
            (2) Appropriate committees of congress.--The term 
        ``appropriate committees of Congress'' means--
                    (A) the Committee on Veterans' Affairs and the 
                Committee on Appropriations of the Senate; and
                    (B) the Committee on Veterans' Affairs and the 
                Committee on Appropriations of the House of 
                Representatives.

SEC. 102. REVIEW OF RECORDS OF FORMER MEMBERS OF THE ARMED FORCES WHO 
              DIE BY SUICIDE WITHIN ONE YEAR OF SEPARATION FROM THE 
              ARMED FORCES.

    (a) Review.--
            (1) In general.--The Secretary of Defense and the Secretary 
        of Veterans Affairs shall jointly review the records of each 
        former member of the Armed Forces who died by suicide, as 
        determined by the Secretary of Defense or the Secretary of 
        Veterans Affairs, within one year following the discharge or 
        release of the former member from active military, naval, or 
        air service during the five-year period preceding the date of 
        the enactment of this Act.
            (2) Records to be reviewed.--In completing the review 
        required under paragraph (1), the Secretary of Defense and the 
        Secretary of Veterans Affairs shall review the following 
        records maintained by the Department of Defense:
                    (A) Health treatment records.
                    (B) Fitness, medical, and dental records.
                    (C) Ancillary training records.
                    (D) Safety forms and additional duties sections of 
                the personnel information files.
    (b) Elements.--The review required by subsection (a) with respect 
to a former member of the Armed Forces shall include consideration of 
the following:
            (1) Whether the Department of Defense had identified the 
        former member as being at elevated risk during the 365-day 
        period before separation of the member from the Armed Forces.
            (2) In the case that the member was identified as being at 
        elevated risk as described in paragraph (1), whether that 
        identification had been communicated to the Department of 
        Veterans Affairs via the Solid Start initiative of the 
        Department pursuant to Executive Order 13822 (83 Fed. Reg. 
        1513; relating to supporting our veterans during their 
        transition from uniformed service to civilian life), or any 
        other means.
            (3) The presence of evidence-based and empirically-
        supported contextual and individual risk factors specified in 
        subsection (c) with respect to the former member and how those 
        risk factors correlated to the circumstances of the death of 
        the former member.
            (4) Demographic variables, including the following:
                    (A) Sex.
                    (B) Age.
                    (C) Rank at separation from the Armed Forces.
                    (D) Career field after separation from the Armed 
                Forces.
                    (E) State and county of residence one month prior 
                to death.
                    (F) Branch of service in the Armed Forces.
                    (G) Marital status.
                    (H) Reason for separation from the Armed Forces.
            (5) Support or medical services furnished to the former 
        member through the Department of Defense, specified by the type 
        of service or care provided.
            (6) Support or medical services furnished to the former 
        member through the Department of Veterans Affairs, specified by 
        the type of service or care provided.
    (c) Evidence-based and Empirically-supported Contextual and 
Individual Risk Factors.--Evidence-based and empirically-supported 
contextual and individual risk factors specified in this subsection 
include the following:
            (1) Exposure to violence.
            (2) Exposure to suicide.
            (3) Housing instability.
            (4) Financial instability.
            (5) Vocational problems or insecurity.
            (6) Legal problems.
            (7) Highly acute or significantly chronic relational 
        problems.
            (8) Limited access to health care.
    (d) Report.--Not later than three years after the date of the 
enactment of this Act, the Secretary of Defense and the Secretary of 
Veterans Affairs shall jointly submit to the appropriate committees of 
Congress an aggregated report on the results of the review conducted 
under subsection (a) with respect to the year-one cohort of former 
members of the Armed Forces covered by the review.
    (e) Definitions.--In this section:
            (1) Active military, naval, or air service.--The term 
        ``active military, naval, or air service'' has the meaning 
        given that term in section 101(24) of title 38, United States 
        Code.
            (2) Appropriate committees of congress defined.--The term 
        ``appropriate committees of Congress'' means--
                    (A) the Committee on Armed Services and the 
                Committee on Veterans' Affairs of the Senate; and
                    (B) the Committee on Armed Services and the 
                Committee on Veterans' Affairs of the House of 
                Representatives.

SEC. 103. REPORT ON REACH VET PROGRAM OF DEPARTMENT OF VETERANS 
              AFFAIRS.

    (a) In General.--Not later than 180 days after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall submit 
to the Committee on Veterans' Affairs of the Senate and the Committee 
on Veterans' Affairs of the House of Representatives a report on the 
REACH VET program.
    (b) Elements.--The report required by subsection (a) shall include 
the following:
            (1) An assessment of the impact of the REACH VET program on 
        rates of suicide among veterans.
            (2) An assessment of how limits within the REACH VET 
        program, such as caps on the number of veterans who may be 
        flagged as high risk, are adjusted for differing rates of 
        suicide across the country.
            (3) A detailed explanation, with evidence, for why the 
        conditions included in the model used by the REACH VET program 
        were chosen, including an explanation as to why certain 
        conditions, such as bipolar disorder II, were not included even 
        though they show a similar rate of risk for suicide as other 
        conditions that were included.
            (4) An assessment of the feasibility of incorporating 
        certain economic data held by the Veterans Benefits 
        Administration into the model used by the REACH VET program, 
        including financial data and employment status, which research 
        indicates may have an impact on risk for suicide.
    (c) REACH VET Program Defined.--In this section, the term ``REACH 
VET program'' means the Recovery Engagement and Coordination for 
Health--Veterans Enhanced Treatment program of the Department of 
Veterans Affairs.

SEC. 104. REPORT ON CARE FOR FORMER MEMBERS OF THE ARMED FORCES WITH 
              OTHER THAN HONORABLE DISCHARGE.

    Section 1720I(f) of title 38, United States Code, is amended--
            (1) in paragraph (1) by striking ``Not less frequently than 
        once'' and inserting ``Not later than February 15''; and
            (2) in paragraph (2)--
                    (A) by redesignating subparagraph (C) as 
                subparagraph (F); and
                    (B) by inserting after subsection (B) the following 
                new subparagraphs:
            ``(C) The types of mental or behavioral health care needs 
        treated under this section.
            ``(D) The demographics of individuals being treated under 
        this section, including--
                    ``(i) age;
                    ``(ii) era of service in the Armed Forces;
                    ``(iii) branch of service in the Armed Forces; and
                    ``(iv) geographic location.
            ``(E) The average number of visits for an individual for 
        mental or behavioral health care under this section.''.

                      TITLE II--SUICIDE PREVENTION

SEC. 201. FINANCIAL ASSISTANCE TO CERTAIN ENTITIES TO PROVIDE OR 
              COORDINATE THE PROVISION OF SUICIDE PREVENTION SERVICES 
              FOR ELIGIBLE INDIVIDUALS AND THEIR FAMILIES.

    (a) Purpose; Designation.--
            (1) Purpose.--The purpose of this section is to reduce 
        veteran suicide through a community-based grant program to 
        award grants to eligible entities to provide or coordinate 
        suicide prevention services to eligible individuals and their 
        families.
            (2) Designation.--The grant program under this section 
        shall be known as the ``Staff Sergeant Parker Gordon Fox 
        Suicide Prevention Grant Program''.
    (b) Financial Assistance and Coordination.--The Secretary shall 
provide financial assistance to eligible entities approved under this 
section through the award of grants to such entities to provide or 
coordinate the provision of services to eligible individuals and their 
families to reduce the risk of suicide. The Secretary shall carry out 
this section in coordination with the President's Roadmap to Empower 
Veterans and End a National Tragedy of Suicide Task Force and in 
consultation with the Office of Mental Health and Suicide Prevention of 
the Department, to the extent practicable.
    (c) Award of Grants.--
            (1) In general.--The Secretary shall award a grant to each 
        eligible entity for which the Secretary has approved an 
        application under subsection (f) to provide or coordinate the 
        provision of suicide prevention services under this section.
            (2) Grant amounts, intervals of payment, and matching 
        funds.--In accordance with the services being provided under a 
        grant under this section and the duration of those services, 
        the Secretary shall establish--
                    (A) a maximum amount to be awarded under the grant 
                of not more than $750,000 per grantee per fiscal year; 
                and
                    (B) intervals of payment for the administration of 
                the grant.
    (d) Distribution of Grants and Preference.--
            (1) Distribution.--
                    (A) Priority.--In compliance with subparagraphs (B) 
                and (C), in determining how to distribute grants under 
                this section, the Secretary may prioritize--
                            (i) rural communities;
                            (ii) Tribal lands;
                            (iii) territories of the United States;
                            (iv) medically underserved areas;
                            (v) areas with a high number or percentage 
                        of minority veterans or women veterans; and
                            (vi) areas with a high number or percentage 
                        of calls to the Veterans Crisis Line.
                    (B) Areas with need.--The Secretary shall ensure 
                that, to the extent practicable, grants under this 
                section are distributed--
                            (i) to provide services in areas of the 
                        United States that have experienced high rates 
                        of suicide by eligible individuals, including 
                        suicide attempts; and
                            (ii) to eligible entities that can assist 
                        eligible individuals at risk of suicide who are 
                        not currently receiving health care furnished 
                        by the Department.
                    (C) Geography.--In distributing grants under this 
                paragraph, the Secretary may provide grants to eligible 
                entities that furnish services to eligible individuals 
                and their families in geographically dispersed areas.
            (2) Preference.--The Secretary shall give preference to 
        eligible entities that have demonstrated the ability to provide 
        or coordinate suicide prevention services.
    (e) Requirements for Receipt of Grants.--
            (1) Notification that services are from department.--Each 
        entity receiving a grant under this section to provide or 
        coordinate suicide prevention services to eligible individuals 
        and their families shall notify the recipients of such services 
        that such services are being paid for, in whole or in part, by 
        the Department.
            (2) Development of plan with eligible individuals and their 
        family.--Any plan developed with respect to the provision of 
        suicide prevention services for an eligible individual or their 
        family shall be developed in consultation with the eligible 
        individual and their family.
            (3) Coordination.--An entity receiving a grant under this 
        section shall--
                    (A) coordinate with the Secretary with respect to 
                the provision of clinical services to eligible 
                individuals in accordance with subsection (n) or any 
                other provisions of the law regarding the delivery of 
                health care by the Secretary;
                    (B) inform every veteran who receives assistance 
                under this section from the entity of the ability of 
                the veteran to apply for enrollment in the patient 
                enrollment system of the Department under section 
                1705(a) of title 38, United States Code; and
                    (C) if such a veteran wishes to so enroll, inform 
                the veteran of a point of contact at the Department who 
                can assist the veteran in such enrollment.
            (4) Measurement and monitoring.--An entity receiving a 
        grant under this section shall submit to the Secretary a 
        description of such tools and assessments the entity uses or 
        will use to determine the effectiveness of the services 
        furnished by the entity, which shall include the measures 
        developed under subsection (h)(2) and may include--
                    (A) the effect of the services furnished by the 
                entity on the financial stability of the eligible 
                individual;
                    (B) the effect of the services furnished by the 
                entity on the mental health status, wellbeing, and 
                suicide risk of the eligible individual; and
                    (C) the effect of the services furnished by the 
                entity on the social support of the eligible 
                individuals receiving those services.
            (5) Reports.--The Secretary--
                    (A) shall require each entity receiving a grant 
                under this section to submit to the Secretary an annual 
                report that describes the projects carried out with 
                such grant during the year covered by the report;
                    (B) shall specify to each such entity the 
                evaluation criteria and data and information to be 
                submitted in such report; and
                    (C) may require each such entity to submit to the 
                Secretary such additional reports as the Secretary 
                considers appropriate.
    (f) Application for Grants.--
            (1) In general.--An eligible entity seeking a grant under 
        this section shall submit to the Secretary an application 
        therefor in such form, in such manner, and containing such 
        commitments and information as the Secretary considers 
        necessary to carry out this section.
            (2) Matters to be included.--Each application submitted by 
        an eligible entity under paragraph (1) shall contain the 
        following:
                    (A) A description of the suicide prevention 
                services proposed to be provided by the eligible entity 
                and the identified need for those services.
                    (B) A detailed plan describing how the eligible 
                entity proposes to coordinate or deliver suicide 
                prevention services to eligible individuals, 
                including--
                            (i) an identification of the community 
                        partners, if any, with which the eligible 
                        entity proposes to work in delivering such 
                        services;
                            (ii) a description of the arrangements 
                        currently in place between the eligible entity 
                        and such partners with regard to the provision 
                        or coordination of suicide prevention services;
                            (iii) an identification of how long such 
                        arrangements have been in place;
                            (iv) a description of the suicide 
                        prevention services provided by such partners 
                        that the eligible entity shall coordinate, if 
                        any; and
                            (v) an identification of local suicide 
                        prevention coordinators of the Department and a 
                        description of how the eligible entity will 
                        communicate with local suicide prevention 
                        coordinators.
                    (C) A description of the population of eligible 
                individuals and their families proposed to be provided 
                suicide prevention services.
                    (D) Based on information and methods developed by 
                the Secretary for purposes of this subsection, an 
                estimate of the number of eligible individuals at risk 
                of suicide and their families proposed to be provided 
                suicide prevention services, including the percentage 
                of those eligible individuals who are not currently 
                receiving care furnished by the Department.
                    (E) Evidence of measurable outcomes related to 
                reductions in suicide risk and mood-related symptoms 
                utilizing validated instruments by the eligible entity 
                (and the proposed partners of the entity, if any) in 
                providing suicide prevention services to individuals at 
                risk of suicide, particularly to eligible individuals 
                and their families.
                    (F) A description of the managerial and 
                technological capacity of the eligible entity--
                            (i) to coordinate the provision of suicide 
                        prevention services with the provision of other 
                        services;
                            (ii) to assess on an ongoing basis the 
                        needs of eligible individuals and their 
                        families for suicide prevention services;
                            (iii) to coordinate the provision of 
                        suicide prevention services with the services 
                        of the Department for which eligible 
                        individuals are also eligible;
                            (iv) to tailor suicide prevention services 
                        to the needs of eligible individuals and their 
                        families;
                            (v) to seek continuously new sources of 
                        assistance to ensure the continuity of suicide 
                        prevention services for eligible individuals 
                        and their families as long as they are 
                        determined to be at risk of suicide; and
                            (vi) to measure the effects of suicide 
                        prevention services provided by the eligible 
                        entity or partner organization, in accordance 
                        with subsection (h)(2), on the lives of 
                        eligible individuals and their families who 
                        receive such services provided by the 
                        organization using pre- and post-evaluations on 
                        validated measures of suicide risk and mood-
                        related symptoms.
                    (G) Clearly defined objectives for the provision of 
                suicide prevention services.
                    (H) A description and physical address of the 
                primary location of the eligible entity.
                    (I) A description of the geographic area the 
                eligible entity plans to serve during the grant award 
                period for which the application applies.
                    (J) If the eligible entity is a State or local 
                government or an Indian tribe, the amount of grant 
                funds proposed to be made available to community 
                partners, if any, through agreements.
                    (K) A description of how the eligible entity will 
                assess the effectiveness of the provision of grants 
                under this section.
                    (L) An agreement to use the measures and metrics 
                provided by the Department for the purposes of 
                measuring the effectiveness of the programming as 
                described in subsection (h)(2).
                    (M) Such additional application criteria as the 
                Secretary considers appropriate.
    (g) Training and Technical Assistance.--
            (1) In general.--The Secretary shall provide training and 
        technical assistance, in coordination with the Centers for 
        Disease Control and Prevention, to eligible entities in receipt 
        of grants under this section regarding--
                    (A) suicide risk identification and management;
                    (B) the data required to be collected and shared 
                with the Department;
                    (C) the means of data collection and sharing;
                    (D) familiarization with and appropriate use of any 
                tool to be used to measure the effectiveness of the use 
                of the grants provided; and
                    (E) the requirements for reporting under subsection 
                (e)(5) on services provided via such grants.
            (2) Provision of training and technical assistance.--The 
        Secretary may provide the training and technical assistance 
        described in paragraph (1) directly or through grants or 
        contracts with appropriate public or nonprofit entities.
    (h) Administration of Grant Program.--
            (1) Selection criteria.--The Secretary, in consultation 
        with entities specified in paragraph (3), shall establish 
        criteria for the selection of eligible entities that have 
        submitted applications under subsection (f).
            (2) Development of measures and metrics.--The Secretary 
        shall develop, in consultation with entities specified in 
        paragraph (3), the following:
                    (A) A framework for collecting and sharing 
                information about entities in receipt of grants under 
                this section for purposes of improving the services 
                available for eligible individuals and their families, 
                set forth by service type, locality, and eligibility 
                criteria.
                    (B) The measures and metrics to be used by each 
                entity in receipt of grants under this section to 
                determine the effectiveness of the programming being 
                provided by such entity in improving mental health 
                status, wellbeing, and reducing suicide risk and 
                completed suicides of eligible individuals and their 
                families, which shall include an existing measurement 
                tool or protocol for the grant recipient to utilize 
                when determining programmatic effectiveness.
            (3) Coordination.--In developing a plan for the design and 
        implementation of the provision of grants under this section, 
        including criteria for the award of grants, the Secretary shall 
        consult with the following:
                    (A) Veterans service organizations.
                    (B) National organizations representing potential 
                community partners of eligible entities in providing 
                supportive services to address the needs of eligible 
                individuals and their families, including national 
                organizations that--
                            (i) advocate for the needs of individuals 
                        with or at risk of behavioral health 
                        conditions;
                            (ii) represent mayors;
                            (iii) represent unions;
                            (iv) represent first responders;
                            (v) represent chiefs of police and 
                        sheriffs;
                            (vi) represent governors;
                            (vii) represent a territory of the United 
                        States; or
                            (viii) represent a Tribal alliance.
                    (C) National organizations representing members of 
                the Armed Forces.
                    (D) National organizations that represent counties.
                    (E) Organizations with which the Department has a 
                current memorandum of agreement or understanding 
                related to mental health or suicide prevention.
                    (F) State departments of veterans affairs.
                    (G) National organizations representing members of 
                the reserve components of the Armed Forces.
                    (H) National organizations representing members of 
                the Coast Guard.
                    (I) Organizations, including institutions of higher 
                education, with experience in creating measurement 
                tools for purposes of advising the Secretary on the 
                most appropriate existing measurement tool or protocol 
                for the Department to utilize.
                    (J) The National Alliance on Mental Illness.
                    (K) A labor organization (as such term is defined 
                in section 7103(a)(4) of title 5, United States Code).
                    (L) The Centers for Disease Control and Prevention, 
                the Substance Abuse and Mental Health Services 
                Administration, the President's Roadmap to Empower 
                Veterans and End a National Tragedy of Suicide Task 
                Force, and such other organizations as the Secretary 
                considers appropriate.
            (4) Report on grant criteria.--Not later than 30 days 
        before notifying eligible entities of the availability of 
        funding under this section, the Secretary shall submit to the 
        appropriate committees of Congress a report containing--
                    (A) criteria for the award of a grant under this 
                section;
                    (B) the already developed measures and metrics to 
                be used by the Department to measure the effectiveness 
                of the use of grants provided under this section as 
                described in subsection (h)(2); and
                    (C) a framework for the sharing of information 
                about entities in receipt of grants under this section.
    (i) Information on Potential Eligible Individuals.--
            (1) In general.--The Secretary may make available to 
        recipients of grants under this section certain information 
        regarding potential eligible individuals who may receive 
        services for which such grant is provided.
            (2) Information included.--The information made available 
        under paragraph (1) with respect to potential eligible 
        individuals may include the following:
                    (A) Confirmation of the status of a potential 
                eligible individual as a veteran.
                    (B) Confirmation of whether the potential eligible 
                individual is enrolled in the patient enrollment system 
                of the Department under section 1705(a) of title 38, 
                United States Code.
                    (C) Confirmation of whether a potential eligible 
                individual is currently receiving care furnished by the 
                Department or has recently received such care.
            (3) Opt-out.--The Secretary shall allow an eligible 
        individual to opt out of having their information shared under 
        this subsection with recipients of grants under this section.
    (j) Duration.--The authority of the Secretary to provide grants 
under this section shall terminate on the date that is three years 
after the date on which the first grant is awarded under this section.
    (k) Reporting.--
            (1) Interim report.--
                    (A) In general.--Not later than 18 months after the 
                date on which the first grant is awarded under this 
                section, the Secretary shall submit to the appropriate 
                committees of Congress a report on the provision of 
                grants to eligible entities under this section.
                    (B) Elements.--The report submitted under 
                subparagraph (A) shall include the following:
                            (i) An assessment of the effectiveness of 
                        the grant program under this section, 
                        including--
                                    (I) the effectiveness of grant 
                                recipients and their community 
                                partners, if any, in conducting 
                                outreach to eligible individuals;
                                    (II) the effectiveness of 
                                increasing eligible individuals 
                                engagement in suicide prevention 
                                services; and
                                    (III) such other validated 
                                instruments and additional measures as 
                                determined by the Secretary and as 
                                described in subsection (h)(2).
                            (ii) A list of grant recipients and their 
                        partner organizations, if any, that delivered 
                        services funded by the grant and the amount of 
                        such grant received by each recipient and 
                        partner organization.
                            (iii) The number of eligible individuals 
                        supported by each grant recipient, including 
                        through services provided to family members, 
                        disaggregated by--
                                    (I) all demographic characteristics 
                                as determined necessary and appropriate 
                                by the Secretary in coordination with 
                                the Centers for Disease Control and 
                                Prevention;
                                    (II) whether each such eligible 
                                individual is enrolled in the patient 
                                enrollment system of the Department 
                                under section 1705(a) of title 38, 
                                United States Code;
                                    (III) branch of service in the 
                                Armed Forces;
                                    (IV) era of service in the Armed 
                                Forces;
                                    (V) type of service received by the 
                                eligible individual; and
                                    (VI) whether each such eligible 
                                individual was referred to the 
                                Department for care.
                            (iv) The number of eligible individuals 
                        supported by grants under this section, 
                        including through services provided to family 
                        members.
                            (v) The number of eligible individuals 
                        described in clause (iv) who were not 
                        previously receiving care furnished by the 
                        Department, with specific numbers for the 
                        population of eligible individuals described in 
                        subsection (q)(4)(B).
                            (vi) The number of eligible individuals 
                        whose mental health status, wellbeing, and 
                        suicide risk received a baseline measurement 
                        assessment under this section and the number of 
                        such eligible individuals whose mental health 
                        status, wellbeing, and suicide risk will be 
                        measured by the Department or a community 
                        partner over a period of time for any 
                        improvements.
                            (vii) The types of data the Department was 
                        able to collect and share with partners, 
                        including a characterization of the benefits of 
                        that data.
                            (viii) The number and percentage of 
                        eligible individuals referred to the point of 
                        contact at the Department under subsection 
                        (e)(3)(C).
                            (ix) The number of eligible individuals 
                        newly enrolled in the patient enrollment system 
                        of the Department under section 1705(a) of 
                        title 38, United States Code based on a 
                        referral to the Department from a grant 
                        recipient under subsection (e)(3)(C), 
                        disaggregated by grant recipient.
                            (x) A detailed account of how the grant 
                        funds were used, including executive 
                        compensation, overhead costs, and other 
                        indirect costs.
                            (xi) A description of any outreach 
                        activities conducted by the eligible entity in 
                        receipt of a grant with respect to services 
                        provided using the grant.
                            (xii) The number of individuals who seek 
                        services from the grant recipient who are not 
                        eligible individuals.
                    (C) Submittal of information by grant recipients.--
                The Secretary may require eligible entities receiving 
                grants under this section to provide to Congress such 
                information as the Secretary determines necessary 
                regarding the elements described in subparagraph (B).
            (2) Final report.--Not later than three years after the 
        date on which the first grant is awarded under this section, 
        and annually thereafter for each year in which the program is 
        in effect, the Secretary shall submit to the appropriate 
        committees of Congress--
                    (A) a follow-up on the interim report submitted 
                under paragraph (1) containing the elements set forth 
                in subparagraph (B) of such paragraph; and
                    (B) a report on--
                            (i) the effectiveness of the provision of 
                        grants under this section, including the 
                        effectiveness of community partners in 
                        conducting outreach to eligible individuals and 
                        their families and reducing the rate of suicide 
                        among eligible individuals;
                            (ii) an assessment of the increased 
                        capacity of the Department to provide services 
                        to eligible individuals and their families, set 
                        forth by State, as a result of the provision of 
                        grants under this section;
                            (iii) the feasibility and advisability of 
                        extending or expanding the provision of grants 
                        consistent with this section; and
                            (iv) such other elements as considered 
                        appropriate by the Secretary.
    (l) Third-party Assessment.--
            (1) Study of grant program.--
                    (A) In general.--Not later than 180 days after the 
                commencement of the grant program under this section, 
                the Secretary shall seek to enter into a contract with 
                an appropriate entity described in paragraph (3) to 
                conduct a study of the grant program.
                    (B) Elements of study.--In conducting the study 
                under subparagraph (A), the appropriate entity shall--
                            (i) evaluate the effectiveness of the grant 
                        program under this section in--
                                    (I) addressing the factors that 
                                contribute to suicides;
                                    (II) increasing the use of suicide 
                                prevention services;
                                    (III) reducing mood-related 
                                symptoms that increase suicide and 
                                suicide risk; and
                                    (IV) where such information is 
                                available due to the time frame of the 
                                grant program, reducing suicidal 
                                ideation, suicide attempts, self-harm, 
                                and deaths by suicide; and
                                    (V) reducing suicidal ideation, 
                                suicide attempts, self-harm, and deaths 
                                by suicide among eligible individuals 
                                through eligible entities located in 
                                communities; and
                            (ii) compare the results of the grant 
                        program with other national programs in 
                        delivering resources to eligible individuals in 
                        the communities where they live that address 
                        the factors that contribute to suicide.
            (2) Assessment.--
                    (A) In general.--The contract under paragraph (1) 
                shall provide that not later than 24 months after the 
                commencement of the grant program under this section, 
                the appropriate entity shall submit to the Secretary an 
                assessment based on the study conducted pursuant to 
                such contract.
                    (B) Submittal to congress.--Upon receipt of the 
                assessment under subparagraph (A), the Secretary shall 
                transmit to the appropriate committees of Congress a 
                copy of the assessment.
            (3) Appropriate entity.--An appropriate entity described in 
        this paragraph is a nongovernment entity with experience 
        optimizing and assessing organizations that deliver services 
        and assessing the effectiveness of suicide prevention programs.
    (m) Referral for Care.--
            (1) Mental health assessment.--If an eligible entity in 
        receipt of a grant under this section determines that an 
        eligible individual is at-risk of suicide or other mental or 
        behavioral health condition pursuant to a baseline mental 
        health screening conducted under subsection (q)(11)(A)(ii) with 
        respect to the individual, the entity shall refer the eligible 
        individual to the Department for additional care under 
        subsection (n) or any other provision of law.
            (2) Emergency treatment.--If an eligible entity in receipt 
        of a grant under this section determines that an eligible 
        individual furnished clinical services for emergency treatment 
        under subsection (q)(11)(A)(iv) requires ongoing services, the 
        entity shall refer the eligible individual to the Department 
        for additional care under subsection (n) or any other provision 
        of law.
            (3) Refusal.--If an eligible individual refuses a referral 
        by an entity under paragraph (1) or (2), any ongoing clinical 
        services provided to the eligible individual by the entity 
        shall be at the expense of the entity.
    (n) Provision of Care to Eligible Individuals.--When the Secretary 
determines it is clinically appropriate, the Secretary shall furnish to 
eligible individuals who are receiving or have received suicide 
prevention services through grants provided under this section an 
initial mental health assessment and mental health or behavioral health 
care services authorized under chapter 17 of title 38, United States 
Code, that are required to treat the mental or behavioral health care 
needs of the eligible individual, including risk of suicide.
    (o) Agreements With Community Partners.--
            (1) In general.--Subject to paragraph (2), an eligible 
        entity may use grant funds to enter into an agreement with a 
        community partner under which the eligible entity may provide 
        funds to the community partner for the provision of suicide 
        prevention services to eligible individuals and their families.
            (2) Limitation.--The ability of a recipient of a grant 
        under this section to provide grant funds to a community 
        partner shall be limited to grant recipients that are a State 
        or local government or an Indian tribe.
    (p) Authorization of Appropriations.--There is authorized to be 
appropriated to the Secretary to carry out this section a total of 
$174,000,000 for fiscal years 2021 through 2025.
    (q) Definitions.--In this section:
            (1) Appropriate committees of congress.--The term 
        ``appropriate committees of Congress'' means--
                    (A) the Committee on Veterans' Affairs and the 
                Subcommittee on Military Construction, Veterans 
                Affairs, and Related Agencies of the Committee on 
                Appropriations of the Senate; and
                    (B) the Committee on Veterans' Affairs and the 
                Subcommittee on Military Construction, Veterans 
                Affairs, and Related Agencies of the Committee on 
                Appropriations of the House of Representatives.
            (2) Department.--The term ``Department'' means the 
        Department of Veterans Affairs.
            (3) Eligible entity.--The term ``eligible entity'' means--
                    (A) an incorporated private institution or 
                foundation--
                            (i) no part of the net earnings of which 
                        incurs to the benefit of any member, founder, 
                        contributor, or individual; and
                            (ii) that has a governing board that would 
                        be responsible for the operation of the suicide 
                        prevention services provided under this 
                        section;
                    (B) a corporation wholly owned and controlled by an 
                organization meeting the requirements of clauses (i) 
                and (ii) of subparagraph (A);
                    (C) an Indian tribe;
                    (D) a community-based organization that can 
                effectively network with local civic organizations, 
                regional health systems, and other settings where 
                eligible individuals and their families are likely to 
                have contact; or
                    (E) A State or local government.
            (4) Eligible individual.--The term ``eligible individual'' 
        includes a person at risk of suicide who is--
                    (A) a veteran as defined in section 101 of title 
                38, United States Code;
                    (B) an individual described in section 1720I(b) of 
                such title; or
                    (C) an individual described in any of clauses (i) 
                through (iv) of section 1712A(a)(1)(C) of such title.
            (5) Emergency treatment.--Medical services, professional 
        services, ambulance services, ancillary care and medication 
        (including a short course of medication related to and 
        necessary for the treatment of the emergency condition that is 
        provided directly to or prescribed for the patient for use 
        after the emergency condition is stabilized and the patient is 
        discharged) was rendered in a medical emergency of such nature 
        that a prudent layperson would have reasonably expected that 
        delay in seeking immediate medical attention would have been 
        hazardous to life or health. This standard is met by an 
        emergency medical condition manifesting itself by acute 
        symptoms of sufficient severity (including severe pain) that a 
        prudent layperson who possesses an average knowledge of health 
        and medicine could reasonably expect the absence of immediate 
        medical attention to result in placing the health of the 
        individual in serious jeopardy, serious impairment to bodily 
        functions, or serious dysfunction of any bodily organ or part.
            (6) Family.--The term ``family'' means, with respect to an 
        eligible individual, any of the following:
                    (A) A parent.
                    (B) A spouse.
                    (C) A child.
                    (D) A sibling.
                    (E) A step-family member.
                    (F) An extended family member.
                    (G) Any other individual who lives with the 
                eligible individual.
            (7) Indian tribe.--The term ``Indian tribe'' has the 
        meaning given that term in section 4 of the Native American 
        Housing Assistance and Self-Determination Act of 1996 (25 
        U.S.C. 4103).
            (8) Risk of suicide.--
                    (A) In general.--The term ``risk of suicide'' means 
                exposure to, or the existence of, any of the following 
                (to a degree determined by the Secretary pursuant to 
                regulations):
                            (i) Health risk factors, including the 
                        following:
                                    (I) Mental health challenges.
                                    (II) Substance abuse.
                                    (III) Serious or chronic health 
                                conditions or pain.
                                    (IV) Traumatic brain injury.
                            (ii) Environmental risk factors, including 
                        the following:
                                    (I) Prolonged stress.
                                    (II) Stressful life events.
                                    (III) Unemployment.
                                    (IV) Homelessness.
                                    (V) Recent loss.
                                    (VI) Legal or financial challenges.
                            (iii) Historical risk factors, including 
                        the following:
                                    (I) Previous suicide attempts.
                                    (II) Family history of suicide.
                                    (III) History of abuse, neglect, or 
                                trauma.
                    (B) Degree of risk.--The Secretary may, by 
                regulation, establish a process for determining degrees 
                of risk of suicide for use by grant recipients to focus 
                the delivery of services using grant funds.
            (9) Rural.--The term ``rural'', with respect to a 
        community, has the meaning given that term in the Rural-Urban 
        Commuting Areas coding system of the Department of Agriculture.
            (10) Secretary.--The term ``Secretary'' means the Secretary 
        of Veterans Affairs.
            (11) Suicide prevention services.--
                    (A) In general.--The term ``suicide prevention 
                services'' means services to address the needs of 
                eligible individuals and their families and includes 
                the following:
                            (i) Outreach to identify those at risk of 
                        suicide with an emphasis on eligible 
                        individuals who are at highest risk or who are 
                        not receiving health care or other services 
                        furnished by the Department.
                            (ii) A baseline mental health screening for 
                        risk.
                            (iii) Education on suicide risk and 
                        prevention to families and communities.
                            (iv) Provision of clinical services for 
                        emergency treatment.
                            (v) Case management services.
                            (vi) Peer support services.
                            (vii) Assistance in obtaining any benefits 
                        from the Department that the eligible 
                        individual and their family may be eligible to 
                        receive, including--
                                    (I) vocational and rehabilitation 
                                counseling;
                                    (II) supportive services for 
                                homeless veterans;
                                    (III) employment and training 
                                services;
                                    (IV) educational assistance; and
                                    (V) health care services.
                            (viii) Assistance in obtaining and 
                        coordinating the provision of other benefits 
                        provided by the Federal Government, a State or 
                        local government, or an eligible entity.
                            (ix) Assistance with emergent needs 
                        relating to--
                                    (I) health care services;
                                    (II) daily living services;
                                    (III) personal financial planning 
                                and counseling;
                                    (IV) transportation services;
                                    (V) temporary income support 
                                services;
                                    (VI) fiduciary and representative 
                                payee services;
                                    (VII) legal services to assist the 
                                eligible individual with issues that 
                                may contribute to the risk of suicide; 
                                and
                                    (VIII) child care (not to exceed 
                                $5,000 per family of an eligible 
                                individual per fiscal year).
                            (x) Nontraditional and innovative 
                        approaches and treatment practices, as 
                        determined appropriate by the Secretary, in 
                        consultation with appropriate entities.
                            (xi) Such other services necessary for 
                        improving the mental health status and 
                        wellbeing and reducing the suicide risk of 
                        eligible individuals and their families as the 
                        Secretary considers appropriate, which may 
                        include--
                                    (I) adaptive sports, equine 
                                assisted therapy, or in-place or 
                                outdoor recreational therapy;
                                    (II) substance use reduction 
                                programming;
                                    (III) individual, group, or family 
                                counseling; and
                                    (IV) relationship coaching.
                    (B) Exclusion.--The term ``suicide prevention 
                services'' does not include direct cash assistance to 
                eligible individuals or their families.
            (12) Veterans crisis line.--The term ``Veterans Crisis 
        Line'' means the toll-free hotline for veterans established 
        under section 1720F(h) of title 38, United States Code.
            (13) Veterans service organization.--The term ``veterans 
        service organization'' means any organization recognized by the 
        Secretary for the representation of veterans under section 5902 
        of title 38, United States Code.

SEC. 202. ANALYSIS ON FEASIBILITY AND ADVISABILITY OF THE DEPARTMENT OF 
              VETERANS AFFAIRS PROVIDING CERTAIN COMPLEMENTARY AND 
              INTEGRATIVE HEALTH SERVICES.

    (a) In General.--Not later than 180 days after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall complete 
an analysis on the feasibility and advisability of providing 
complementary and integrative health treatments described in subsection 
(c) at all medical facilities of the Department of Veterans Affairs.
    (b) Inclusion of Assessment of Report.--The analysis conducted 
under subsection (a) shall include an assessment of the final report of 
the Creating Options for Veterans' Expedited Recovery Commission 
(commonly referred to as the ``COVER Commission'') established under 
section 931 of the Jason Simcakoski Memorial and Promise Act (title IX 
of Public Law 114-198; 38 U.S.C. 1701 note) submitted under subsection 
(e)(2) of such section.
    (c) Treatments Described.--Complementary and integrative health 
treatments described in this subsection shall consist of the following:
            (1) Yoga.
            (2) Meditation.
            (3) Acupuncture.
            (4) Chiropractic care.
            (5) Other treatments that show sufficient evidence of 
        efficacy at treating mental or physical health conditions, as 
        determined by the Secretary.
    (d) Report.--The Secretary shall submit to the Committee on 
Veterans' Affairs of the Senate and the Committee on Veterans' Affairs 
of the House of Representatives a report on the analysis completed 
under subsection (a), including--
            (1) the results of such analysis; and
            (2) such recommendations regarding the furnishing of 
        complementary and integrative health treatments described in 
        subsection (c) as the Secretary considers appropriate.

SEC. 203. PILOT PROGRAM TO PROVIDE VETERANS ACCESS TO COMPLEMENTARY AND 
              INTEGRATIVE HEALTH PROGRAMS THROUGH ANIMAL THERAPY, 
              AGRITHERAPY, SPORTS AND RECREATION THERAPY, ART THERAPY, 
              AND POSTTRAUMATIC GROWTH PROGRAMS.

    (a) In General.--Not later than 180 days after the date on which 
the Creating Options for Veterans' Expedited Recovery Commission 
(commonly referred to as the ``COVER Commission'') established under 
section 931 of the Jason Simcakoski Memorial and Promise Act (title IX 
of Public Law 114-198; 38 U.S.C. 1701 note) submits its final report 
under subsection (e)(2) of such section, the Secretary of Veterans 
Affairs shall commence the conduct of a pilot program to provide 
complementary and integrative health programs described in subsection 
(b) to eligible veterans from the Department of Veterans Affairs or 
through the use of non-Department entities for the treatment of post-
traumatic stress disorder, depression, anxiety, or other conditions as 
determined by the Secretary.
    (b) Programs Described.--Complementary and integrative health 
programs described in this subsection may, taking into consideration 
the report described in subsection (a), consist of the following:
            (1) Equine therapy.
            (2) Other animal therapy.
            (3) Agritherapy.
            (4) Sports and recreation therapy.
            (5) Art therapy.
            (6) Posttraumatic growth programs.
    (c) Eligible Veterans.--A veteran is eligible to participate in the 
pilot program under this section if the veteran--
            (1) is enrolled in the system of patient enrollment of the 
        Department under section 1705(a) of title 38, United States 
        Code; and
            (2) has received health care under the laws administered by 
        the Secretary during the two-year period preceding the initial 
        participation of the veteran in the pilot program.
    (d) Duration.--
            (1) In general.--The Secretary shall carry out the pilot 
        program under this section for a three-year period beginning on 
        the commencement of the pilot program.
            (2) Extension.--The Secretary may extend the duration of 
        the pilot program under this section if the Secretary, based on 
        the results of the interim report submitted under subsection 
        (f)(1), determines that it is appropriate to do so.
    (e) Locations.--
            (1) In general.--The Secretary shall select not fewer than 
        five facilities of the Department at which to carry out the 
        pilot program under this section.
            (2) Selection criteria.--In selecting facilities under 
        paragraph (1), the Secretary shall ensure that--
                    (A) the locations are in geographically diverse 
                areas; and
                    (B) not fewer than three facilities serve veterans 
                in rural or highly rural areas (as determined through 
                the use of the Rural-Urban Commuting Areas coding 
                system of the Department of Agriculture).
    (f) Reports.--
            (1) Interim report.--
                    (A) In general.--Not later than one year after the 
                commencement of the pilot program under this section, 
                the Secretary shall submit to the Committee on 
                Veterans' Affairs of the Senate and the Committee on 
                Veterans' Affairs of the House of Representatives a 
                report on the progress of the pilot program.
                    (B) Elements.--The report required by subparagraph 
                (A) shall include the following:
                            (i) The number of participants in the pilot 
                        program.
                            (ii) The type or types of therapy offered 
                        at each facility at which the pilot program is 
                        being carried out.
                            (iii) An assessment of whether 
                        participation by a veteran in the pilot program 
                        resulted in any changes in clinically relevant 
                        endpoints for the veteran with respect to the 
                        conditions specified in subsection (a).
                            (iv) An assessment of the quality of life 
                        of veterans participating in the pilot program, 
                        including the results of a satisfaction survey 
                        of the participants in the pilot program, 
                        disaggregated by program under subsection (b).
                            (v) The determination of the Secretary with 
                        respect to extending the pilot program under 
                        subsection (d)(2).
                            (vi) Any recommendations of the Secretary 
                        with respect to expanding the pilot program.
            (2) Final report.--Not later than 90 days after the 
        termination of the pilot program under this section, the 
        Secretary shall submit to the Committee on Veterans' Affairs of 
        the Senate and the Committee on Veterans' Affairs of the House 
        of Representatives a final report on the pilot program.

SEC. 204. DEPARTMENT OF VETERANS AFFAIRS STUDY OF ALL-CAUSE MORTALITY 
              OF VETERANS, INCLUDING BY SUICIDE, AND REVIEW OF STAFFING 
              LEVELS OF MENTAL HEALTH PROFESSIONALS.

    (a) Study of Deaths of Veterans by Suicide.--
            (1) In general.--The Secretary of Veterans Affairs shall 
        seek to enter into an agreement with the National Academies of 
        Sciences, Engineering, and Medicine under which the Secretary 
        shall collaborate and coordinate with the National Academies on 
        a revised study design to fulfill the goals of the 2019 study 
        design of the National Academies described in the explanatory 
        statement accompanying the Further Consolidated Appropriations 
        Act, 2020 (Public Law 116-94), as part of current and 
        additional research priorities of the Department of Veterans 
        Affairs, to evaluate the effects of opioids and benzodiazepine 
        on all-cause mortality of veterans, including suicide, 
        regardless of whether information relating to such deaths has 
        been reported by the Centers for Disease Control and 
        Prevention.
            (2) Goals.--In carrying out the collaboration and 
        coordination under paragraph (1), the Secretary shall seek as 
        much as possible to achieve the same advancement of useful 
        knowledge as the 2019 study design described in such paragraph.
    (b) Review of Staffing Levels for Mental Health Professionals.--
            (1) In general.--Not later than 90 days after the date of 
        the enactment of this Act, the Comptroller General of the 
        United States shall conduct a review of the staffing levels for 
        mental health professionals of the Department.
            (2) Elements.--The review required by paragraph (1) shall 
        include a description of the efforts of the Department to 
        maintain appropriate staffing levels for mental health 
        professionals, such as mental health counselors, marriage and 
        family therapists, and other appropriate counselors, including 
        the following:
                    (A) A description of any impediments to carry out 
                the education, training, and hiring of mental health 
                counselors and marriage and family therapists under 
                section 7302(a) of title 38, United States Code, and 
                strategies for addressing those impediments.
                    (B) A description of the objectives, goals, and 
                timing of the Department with respect to increasing the 
                representation of such counselors and therapists in the 
                behavioral health workforce of the Department, 
                including--
                            (i) a review of qualification criteria for 
                        such counselors and therapists and a comparison 
                        of such criteria to that of other behavioral 
                        health professions in the Department; and
                            (ii) an assessment of the participation of 
                        such counselors and therapists in the mental 
                        health professionals trainee program of the 
                        Department and any impediments to such 
                        participation.
                    (C) An assessment of the development by the 
                Department of hiring guidelines for mental health 
                counselors, marriage and family therapists, and other 
                appropriate counselors.
                    (D) A description of how the Department--
                            (i) identifies gaps in the supply of mental 
                        health professionals; and
                            (ii) determines successful staffing ratios 
                        for mental health professionals of the 
                        Department.
                    (E) A description of actions taken by the 
                Secretary, in consultation with the Director of the 
                Office of Personnel Management, to create an 
                occupational series for mental health counselors and 
                marriage and family therapists of the Department and a 
                timeline for the creation of such an occupational 
                series.
                    (F) A description of actions taken by the Secretary 
                to ensure that the national, regional, and local 
                professional standards boards for mental health 
                counselors and marriage and family therapists are 
                comprised of only mental health counselors and marriage 
                and family therapists and that the liaison from the 
                Department to such boards is a mental health counselor 
                or marriage and family therapist.
    (c) Compilation of Data.--The Secretary of Veterans Affairs shall 
ensure that data under subsections (a) and (b) is compiled separately 
and disaggregated by year and compiled in a manner that allows it to be 
analyzed across all data fields for purposes of informing and updating 
clinical practice guidelines of the Department of Veterans Affairs.
    (d) Briefings.--The Secretary of Veterans Affairs shall brief the 
Committee on Veterans' Affairs of the Senate and the Committee on 
Veterans' Affairs of the House of Representatives containing the 
interim results--
            (1) with respect to the study under subsection (a)(1), not 
        later than 24 months after entering into the agreement under 
        such subsection; and
            (2) with respect to the review under subsection (b)(1), not 
        later than 18 months after the date of the enactment of this 
        Act.
    (e) Reports.--
            (1) Report on study.--Not later than 90 days after the 
        completion by the Secretary of Veterans Affairs in coordination 
        with the National Academies of Sciences, Engineering, and 
        Medicine of the study required under subsection (a)(1), the 
        Secretary shall--
                    (A) submit to the Committee on Veterans' Affairs of 
                the Senate and the Committee on Veterans' Affairs of 
                the House of Representatives a report on the results of 
                the study; and
                    (B) make such report publicly available.
            (2) Report on review.--Not later than 90 days after the 
        completion by the Comptroller General of the United States of 
        the review required under subsection (b)(1), the Comptroller 
        General shall--
                    (A) submit to the Committee on Veterans' Affairs of 
                the Senate and the Committee on Veterans' Affairs of 
                the House of Representatives a report on the results of 
                the review; and
                    (B) make such report publicly available.

SEC. 205. COMPTROLLER GENERAL REPORT ON MANAGEMENT BY DEPARTMENT OF 
              VETERANS AFFAIRS OF VETERANS AT HIGH RISK FOR SUICIDE.

    (a) In General.--Not later than 18 months after the date of the 
enactment of this Act, the Comptroller General of the United States 
shall submit to the Committee on Veterans' Affairs of the Senate and 
the Committee on Veterans' Affairs of the House of Representatives a 
report on the efforts of the Department of Veterans Affairs to manage 
veterans at high risk for suicide.
    (b) Elements.--The report required by subsection (a) shall include 
the following:
            (1) A description of how the Department identifies patients 
        as high risk for suicide, with particular consideration to the 
        efficacy of inputs into the Recovery Engagement and 
        Coordination for Health - Veterans Enhanced Treatment program 
        (commonly referred to as the ``REACH VET'' program) of the 
        Department, including an assessment of the efficacy of such 
        identifications disaggregated by--
                    (A) all demographic characteristics as determined 
                necessary and appropriate by the Secretary of Veterans 
                Affairs in coordination with the Centers for Disease 
                Control and Prevention;
                    (B) Veterans Integrated Service Network; and
                    (C) to the extent practicable, medical center of 
                the Department.
            (2) A description of how the Department intervenes when a 
        patient is identified as high risk, including an assessment of 
        the efficacy of such interventions disaggregated by--
                    (A) all demographic characteristics as determined 
                necessary and appropriate by the Secretary in 
                coordination with the Centers for Disease Control and 
                Prevention;
                    (B) Veterans Integrated Service Network; and
                    (C) to the extent practicable, medical center of 
                the Department.
            (3) A description of how the Department monitors patients 
        who have been identified as high risk, including an assessment 
        of the efficacy of such monitoring and any follow-ups 
        disaggregated by--
                    (A) all demographic characteristics as determined 
                necessary and appropriate by the Secretary in 
                coordination with the Centers for Disease Control and 
                Prevention;
                    (B) Veterans Integrated Service Network; and
                    (C) to the extent practicable, medical center of 
                the Department.
            (4) A review of staffing levels of suicide prevention 
        coordinators across the Veterans Health Administration.
            (5) A review of the resources and programming offered to 
        family members and friends of veterans who have a mental health 
        condition in order to assist that veteran in treatment and 
        recovery.
            (6) An assessment of such other areas as the Comptroller 
        General considers appropriate to study.

     TITLE III--PROGRAMS, STUDIES, AND GUIDELINES ON MENTAL HEALTH

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

    (a) In General.--Not later than 180 days after the date of the 
enactment of this Act, the Secretary of Veterans Affairs, in 
consultation with Rural Health Resource Centers of the Office of Rural 
Health of the Department of Veterans Affairs, shall commence the 
conduct of a study on the connection between living at high altitude 
and the risk of developing depression or dying by suicide among 
veterans.
    (b) Completion of Study.--The study conducted under subsection (a) 
shall be completed not later than three years after the date of the 
commencement of the study.
    (c) Individual Impact.--The study conducted under subsection (a) 
shall be conducted so as to determine the effect of high altitude on 
suicide risk at the individual level, not at the State or county level.
    (d) Report.--Not later than 150 days after the completion of the 
study conducted under subsection (a), the Secretary shall submit to the 
Committee on Veterans' Affairs of the Senate and the Committee on 
Veterans' Affairs of the House of Representatives a report on the 
results of the study.
    (e) Follow-up Study.--
            (1) In general.--If the Secretary determines through the 
        study conducted under subsection (a) that living at high 
        altitude is a risk factor for developing depression or dying by 
        suicide, the Secretary shall conduct an additional study to 
        identify the following:
                    (A) The most likely biological mechanism that makes 
                living at high altitude a risk factor for developing 
                depression or dying by suicide.
                    (B) The most effective treatment or intervention 
                for reducing the risk of developing depression or dying 
                by suicide associated with living at high altitude.
            (2) Report.--Not later than 150 days after completing the 
        study conducted under paragraph (1), the Secretary shall submit 
        to the Committee on Veterans' Affairs of the Senate and the 
        Committee on Veterans' Affairs of the House of Representatives 
        a report on the results of the study.

SEC. 302. ESTABLISHMENT BY DEPARTMENT OF VETERANS AFFAIRS AND 
              DEPARTMENT OF DEFENSE OF A CLINICAL PROVIDER TREATMENT 
              TOOLKIT AND ACCOMPANYING TRAINING MATERIALS FOR 
              COMORBIDITIES.

    (a) In General.--Not later than two years after the date of the 
enactment of this Act, the Secretary of Veterans Affairs, in 
consultation with the Secretary of Defense, shall develop a clinical 
provider treatment toolkit and accompanying training materials for the 
evidence-based management of comorbid mental health conditions, 
comorbid mental health and substance use disorders, and a comorbid 
mental health condition and chronic pain.
    (b) Matters Included.--In developing the clinical provider 
treatment toolkit and accompanying training materials under subsection 
(a), the Secretary of Veterans Affairs and the Secretary of Defense 
shall ensure that the toolkit and training materials include guidance 
with respect to the following:
            (1) The treatment of patients with post-traumatic stress 
        disorder who are also experiencing an additional mental health 
        condition, a substance use disorder, or chronic pain.
            (2) The treatment of patients experiencing a mental health 
        condition, including anxiety, depression, or bipolar disorder, 
        who are also experiencing a substance use disorder or chronic 
        pain.
            (3) The treatment of patients with traumatic brain injury 
        who are also experiencing--
                    (A) a mental health condition, including post-
                traumatic stress disorder, anxiety, depression, or 
                bipolar disorder;
                    (B) a substance use disorder; or
                    (C) chronic pain.

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

    (a) In General.--In the first publication of the Department of 
Veterans Affairs and Department of Defense Clinical Practice Guideline 
for Assessment and Management of Patients at Risk for Suicide published 
after the date of the enactment of this Act, the Secretary of Veterans 
Affairs and the Secretary of Defense, through the Assessment and 
Management of Patients at Risk for Suicide Work Group (in this section 
referred to as the ``Work Group''), shall ensure the publication 
includes the following:
            (1) Enhanced guidance with respect to gender-specific--
                    (A) risk factors for suicide and suicidal ideation;
                    (B) treatment efficacy for depression and suicide 
                prevention;
                    (C) pharmacotherapy efficacy; and
                    (D) psychotherapy efficacy.
            (2) Guidance with respect to the efficacy of alternative 
        therapies, other than psychotherapy and pharmacotherapy, 
        including the following:
                    (A) Yoga therapy.
                    (B) Meditation therapy.
                    (C) Equine therapy.
                    (D) Other animal therapy.
                    (E) Training and caring for service dogs.
                    (F) Agritherapy.
                    (G) Art therapy.
                    (H) Outdoor sports therapy.
                    (I) Music therapy.
                    (J) Any other alternative therapy that the Work 
                Group considers appropriate.
            (3) Guidance with respect to the findings of the Creating 
        Options for Veterans' Expedited Recovery Commission (commonly 
        referred to as the ``COVER Commission'') established under 
        section 931 of the Jason Simcakoski Memorial and Promise Act 
        (title IX of Public Law 114-198; 38 U.S.C. 1701 note).
    (b) Rule of Construction.--Nothing in this section shall be 
construed to prevent the Secretary of Veterans Affairs and the 
Secretary of Defense from considering all relevant evidence, as 
appropriate, in updating the Department of Veterans Affairs and 
Department of Defense Clinical Practice Guideline for Assessment and 
Management of Patients at Risk for Suicide, as required under 
subsection (a), or from ensuring that the final clinical practice 
guidelines updated under such subsection remain applicable to the 
patient populations of the Department of Veterans Affairs and the 
Department of Defense.

SEC. 304. ESTABLISHMENT BY DEPARTMENT OF VETERANS AFFAIRS AND 
              DEPARTMENT OF DEFENSE OF CLINICAL PRACTICE GUIDELINES FOR 
              THE TREATMENT OF SERIOUS MENTAL ILLNESS.

    (a) In General.--Not later than two years after the date of the 
enactment of this Act, the Secretary of Veterans Affairs, in 
consultation with the Secretary of Defense and the Secretary of Health 
and Human Services, shall complete the development of a clinical 
practice guideline or guidelines for the treatment of serious mental 
illness, to include the following conditions:
            (1) Schizophrenia.
            (2) Schizoaffective disorder.
            (3) Persistent mood disorder, including bipolar disorder I 
        and II.
            (4) Any other mental, behavioral, or emotional disorder 
        resulting in serious functional impairment that substantially 
        interferes with major life activities as the Secretary of 
        Veterans Affairs, in consultation with the Secretary of Defense 
        and the Secretary of Health and Human Services, considers 
        appropriate.
    (b) Matters Included in Guidelines.--The clinical practice 
guideline or guidelines developed under subsection (a) shall include 
the following:
            (1) Guidance contained in the 2016 Clinical Practice 
        Guidelines for the Management of Major Depressive Disorders of 
        the Department of Veterans Affairs and the Department of 
        Defense.
            (2) Guidance with respect to the treatment of patients with 
        a condition described in subsection (a).
            (3) A list of evidence-based therapies for the treatment of 
        conditions described in subsection (a).
            (4) An appropriate guideline for the administration of 
        pharmacological therapy, psychological or behavioral therapy, 
        or other therapy for the management of conditions described in 
        subsection (a).
    (c) Assessment of Existing Guidelines.--Not later than two years 
after the date of the enactment of this Act, the Secretary of Veterans 
Affairs, in consultation with the Secretary of Defense and the 
Secretary of Health and Human Services, shall complete an assessment of 
the 2016 Clinical Practice Guidelines for the Management of Major 
Depressive Disorders to determine whether an update to such guidelines 
is necessary.
    (d) Work Group.--
            (1) Establishment.--The Secretary of Veterans Affairs, the 
        Secretary of Defense, and the Secretary of Health and Human 
        Services shall create a work group to develop the clinical 
        practice guideline or guidelines under subsection (a) to be 
        known as the ``Serious Mental Illness Work Group'' (in this 
        subsection referred to as the ``Work Group'').
            (2) Membership.--The Work Group created under paragraph (1) 
        shall be comprised of individuals that represent Federal 
        Government entities and non-Federal Government entities with 
        expertise in the areas covered by the Work Group, including the 
        following entities:
                    (A) Academic institutions that specialize in 
                research for the treatment of conditions described in 
                subsection (a).
                    (B) The Health Services Research and Development 
                Service of the Department of Veterans Affairs.
                    (C) The Office of the Assistant Secretary for 
                Mental Health and Substance Use of the Department of 
                Health and Human Services.
                    (D) The National Institute of Mental Health.
                    (E) The Indian Health Service.
                    (F) Relevant organizations with expertise in 
                researching, diagnosing, or treating conditions 
                described in subsection (a).
            (3) Relation to other work groups.--The Work Group shall be 
        created and conducted in the same manner as other work groups 
        for the development of clinical practice guidelines for the 
        Department of Veterans Affairs and the Department of Defense.
    (e) Rule of Construction.--Nothing in this section shall be 
construed to prevent the Secretary of Veterans Affairs and the 
Secretary of Defense from considering all relevant evidence, as 
appropriate, in creating the clinical practice guideline or guidelines 
required under subsection (a) or from ensuring that the final clinical 
practice guideline or guidelines developed under such subsection and 
subsequently updated, as appropriate, remain applicable to the patient 
populations of the Department of Veterans Affairs and the Department of 
Defense.

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

    (a) In General.--Beginning not later than 18 months after the date 
of the enactment of this Act, the Secretary of Veterans Affairs shall 
develop and implement an initiative of the Department of Veterans 
Affairs to identify and validate brain and mental health biomarkers 
among veterans, with specific consideration for depression, anxiety, 
post-traumatic stress disorder, bipolar disorder, traumatic brain 
injury, and such other mental health conditions as the Secretary 
considers appropriate. Such initiative may be referred to as the 
``Precision Medicine for Veterans Initiative''.
    (b) Model of Initiative.--The initiative under subsection (a) shall 
be modeled on the All of Us Precision Medicine Initiative administered 
by the National Institutes of Health with respect to large-scale 
collection of standardized data and open data sharing.
    (c) Methods.--The initiative under subsection (a) shall include 
brain structure and function measurements, such as functional magnetic 
resonance imaging and electroencephalogram, and shall coordinate with 
additional biological methods of analysis utilized in the Million 
Veterans Program of the Department of Veterans Affairs.
    (d) Use of Data.--
            (1) Privacy and security.--In carrying out the initiative 
        under subsection (a), the Secretary shall develop robust data 
        privacy and security measures, consistent with section 552a of 
        title 5, United States Code (commonly known as the ``Privacy 
        Act of 1974''), and regulations promulgated pursuant to the 
        Health Insurance Portability and Accountability Act of 1996 
        (parts 160, 162, and 164 of title 45, Code of Federal 
        Regulations, or successor regulations) to ensure that 
        information of veterans participating in the initiative is kept 
        private and secure.
            (2) Consultation with the national institutes of science 
        and technology.--The Secretary may consult with the National 
        Institute of Science and Technology in developing the data 
        privacy and security measures described in paragraph (1).
            (3) Access standards.--The Secretary shall provide access 
        to information under the initiative consistent with the 
        standards described in section 552a(d)(1) of title 5, United 
        States Code, and section 164.524 of title 45, Code of Federal 
        Regulations, or successor regulations.
            (4) Open platform.--
                    (A) Availability of data.--The Secretary shall make 
                de-identified data collected under the initiative 
                available for research purposes to Federal agencies.
                    (B) Contract.--The Secretary shall contract with 
                nongovernment entities that comply with requisite data 
                security measures to make available for research 
                purposes de-identified data collected under the 
                initiative.
                    (C) Assistance.--The Secretary shall provide 
                assistance to a Federal agency conducting research 
                using data collected under the initiative at the 
                request of that agency.
                    (D) Prohibition on transfer of data.--Federal 
                agencies may not disclose, transmit, share, sell, 
                license, or otherwise transfer data collected under the 
                initiative to any nongovernment entity other than as 
                allowed under subparagraph (B).
            (5) Standardization.--
                    (A) In general.--The Secretary shall ensure that 
                data collected under the initiative is standardized.
                    (B) Consultation.--The Secretary shall consult with 
                the National Institutes of Health and the Food and Drug 
                Administration to determine the most effective, 
                efficient, and cost-effective way of standardizing data 
                collected under the initiative.
                    (C) Manner of standardization.--In consultation 
                with the National Institute for Science and Technology, 
                data collected under the initiative shall be 
                standardized in the manner in which it is collected, 
                entered into the database, extracted, and recorded.
            (6) Measures of brain function or structure.--Any measures 
        of brain function or structure collected under the initiative 
        shall be collected with a device that is approved by the Food 
        and Drug Administration.
            (7) De-identified data defined.--In this subsection, the 
        term ``de-identified data'' means, with respect to data held by 
        the Department of Veterans Affairs, that the Department--
                    (A) alters, anonymizes, or aggregates the data so 
                that there is a reasonable basis for expecting that the 
                data could not be linked as a practical matter to a 
                specific individual;
                    (B) publicly commits to refrain from attempting to 
                re-identify the data with a specific individual, and 
                adopts controls to prevent such identification; and
                    (C) causes the data to be covered by a contractual 
                or other legally enforceable prohibition on each entity 
                to which the Department discloses the data from 
                attempting to use the data to identify a specific 
                individual and requires the same of all onward 
                disclosures.
    (e) Inclusion of Initiative in Program.--The Secretary shall 
coordinate efforts of the initiative under subsection (a) with the 
Million Veterans Program of the Department.

SEC. 306. STATISTICAL ANALYSES AND DATA EVALUATION BY DEPARTMENT OF 
              VETERANS AFFAIRS.

    (a) In General.--Chapter 1 of title 38, United States Code, is 
amended by adding at the end the following new section:
``Sec. 119. Contracting for statistical analyses and data evaluation
    ``(a) In General.--The Secretary may enter into a contract or other 
agreement with an academic institution or other qualified entity, as 
determined by the Secretary, to carry out statistical analyses and data 
evaluation as required of the Secretary by law.''.
    ``(b) Rule of Construction.--Nothing in this section may be 
construed to limit the authority of the Secretary to enter into 
contracts or other agreements for statistical analyses and data 
evaluation under any other provision of law.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 1 of such title is amended by adding at the end the following 
new item:

``119. Contracting for statistical analyses and data evaluation.''.

     TITLE IV--OVERSIGHT OF MENTAL HEALTH CARE AND RELATED SERVICES

SEC. 401. STUDY ON EFFECTIVENESS OF SUICIDE PREVENTION AND MENTAL 
              HEALTH OUTREACH PROGRAMS OF DEPARTMENT OF VETERANS 
              AFFAIRS.

    (a) In General.--Not later than 180 days after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall enter 
into an agreement with a non-Federal Government entity with expertise 
in conducting and evaluating research-based studies to conduct a study 
on the effectiveness of the suicide prevention and mental health 
outreach materials prepared by the Department of Veterans Affairs and 
the suicide prevention and mental health outreach campaigns conducted 
by the Department.
    (b) Use of Focus Groups.--
            (1) In general.--The Secretary shall convene not fewer than 
        eight different focus groups to evaluate the effectiveness of 
        the suicide prevention and mental health materials and 
        campaigns as required under subsection (a).
            (2) Location of focus groups.--Focus groups convened under 
        paragraph (1) shall be held in geographically diverse areas as 
        follows:
                    (A) Not fewer than two in rural or highly rural 
                areas.
                    (B) Not fewer than one in each of the four 
                districts of the Veterans Benefits Administration.
            (3) Timing of focus groups.--Focus groups convened under 
        paragraph (1) shall be held at a variety of dates and times to 
        ensure an adequate representation of veterans with different 
        work schedules.
            (4) Number of participants.--Each focus group convened 
        under paragraph (1) shall include not fewer than five and not 
        more than 12 participants.
            (5) Representation.--Each focus group convened under 
        paragraph (1) shall, to the extent practicable, include 
        veterans of diverse backgrounds, including--
                    (A) veterans of all eras, as determined by the 
                Secretary;
                    (B) women veterans;
                    (C) minority veterans;
                    (D) Native American veterans, as defined in section 
                3765 of title 38, United States Code;
                    (E) veterans who identify as lesbian, gay, 
                bisexual, transgender, or queer (commonly referred to 
                as ``LGBTQ'');
                    (F) veterans who live in rural or highly rural 
                areas;
                    (G) individuals transitioning from active duty in 
                the Armed Forces to civilian life; and
                    (H) other high-risk groups of veterans, as 
                determined by the Secretary.
    (c) Report.--
            (1) In general.--Not later than 90 days after the last 
        focus group meeting under subsection (b), the Secretary shall 
        submit to the Committee on Veterans' Affairs of the Senate and 
        the Committee on Veterans' Affairs of the House of 
        Representatives a report on the findings of the focus groups.
            (2) Elements.--The report required by paragraph (1) shall 
        include the following:
                    (A) Based on the findings of the focus groups, an 
                assessment of the effectiveness of current suicide 
                prevention and mental health materials and campaigns of 
                the Department in reaching veterans as a whole as well 
                as specific groups of veterans (for example, women 
                veterans).
                    (B) Based on the findings of the focus groups, 
                recommendations for future suicide prevention and 
                mental health materials and campaigns of the Department 
                to target specific groups of veterans.
                    (C) A plan to change the current suicide prevention 
                and mental health materials and campaigns of the 
                Department or, if the Secretary decides not to change 
                the current materials and campaigns, an explanation of 
                the reason for maintaining the current materials and 
                campaigns.
                    (D) A description of any dissenting or opposing 
                viewpoints raised by participants in the focus group.
                    (E) Such other issues as the Secretary considers 
                necessary.
    (d) Representative Survey.--
            (1) In general.--Not later than one year after the last 
        focus group meeting under subsection (b), the Secretary shall 
        complete a representative survey of the veteran population that 
        is informed by the focus group data in order to collect 
        information about the effectiveness of the mental health and 
        suicide prevention materials and campaigns conducted by the 
        Department.
            (2) Veterans surveyed.--
                    (A) In general.--Veterans surveyed under paragraph 
                (1) shall include veterans described in subsection 
                (b)(5).
                    (B) Disaggregation of data.--Data of veterans 
                surveyed under paragraph (1) shall be disaggregated 
                by--
                            (i) veterans who have received care from 
                        the Department during the two-year period 
                        preceding the survey; and
                            (ii) veterans who have not received care 
                        from the Department during the two-year period 
                        preceding the survey.
    (e) Treatment of Contracts for Suicide Prevention and Mental Health 
Outreach Media.--
            (1) Focus groups.--
                    (A) In general.--The Secretary shall include in 
                each contract to develop media relating to suicide 
                prevention and mental health materials and campaigns a 
                requirement that the contractor convene focus groups of 
                veterans to assess the effectiveness of suicide 
                prevention and mental health outreach.
                    (B) Representation.--Each focus group required 
                under subparagraph (A) shall, to the extent 
                practicable, include veterans of diverse backgrounds, 
                including--
                            (i) veterans of all eras, as determined by 
                        the Secretary;
                            (ii) women veterans;
                            (iii) minority veterans;
                            (iv) Native American veterans, as defined 
                        in section 3765 of title 38, United States 
                        Code;
                            (v) veterans who identify as lesbian, gay, 
                        bisexual, transgender, or queer (commonly 
                        referred to as ``LGBTQ'');
                            (vi) veterans who live in rural or highly 
                        rural areas;
                            (vii) individuals transitioning from active 
                        duty in the Armed Forces to civilian life; and
                            (viii) other high-risk groups of veterans, 
                        as determined by the Secretary.
            (2) Subcontracting.--
                    (A) In general.--The Secretary shall include in 
                each contract described in paragraph (1)(A) a 
                requirement that, if the contractor subcontracts for 
                the development of media, the contractor shall 
                subcontract with a subcontractor that has experience 
                creating impactful media campaigns that target 
                individuals age 18 to 34.
                    (B) Budget limitation.--Not more than two percent 
                of the budget of the Office of Mental Health and 
                Suicide Prevention of the Department for contractors 
                for suicide prevention and mental health media outreach 
                shall go to subcontractors described in subparagraph 
                (A).
    (f) Paperwork Reduction Act Exemption.--Chapter 35 of title 44, 
United States Code (commonly known as the ``Paperwork Reduction Act'') 
shall not apply to any rulemaking or information collection required 
under this section.
    (g) Rural and Highly Rural Defined.--In this section, with respect 
to an area, the terms ``rural'' and ``highly rural'' have the meanings 
given those terms in the Rural-Urban Commuting Areas coding system of 
the Department of Agriculture.

SEC. 402. OVERSIGHT OF MENTAL HEALTH AND SUICIDE PREVENTION MEDIA 
              OUTREACH CONDUCTED BY DEPARTMENT OF VETERANS AFFAIRS.

    (a) Establishment of Goals.--
            (1) In general.--The Secretary of Veterans Affairs shall 
        establish goals for the mental health and suicide prevention 
        media outreach campaigns of the Department of Veterans Affairs, 
        which shall include the establishment of targets, metrics, and 
        action plans to describe and assess those campaigns.
            (2) Use of metrics.--
                    (A) In general.--The goals established under 
                paragraph (1) shall be measured by metrics specific to 
                different media types.
                    (B) Factors to consider.--In using metrics under 
                subparagraph (A), the Secretary shall determine the 
                best methodological approach for each media type and 
                shall consider the following:
                            (i) Metrics relating to social media, which 
                        may include the following:
                                    (I) Impressions.
                                    (II) Reach.
                                    (III) Engagement rate.
                                    (IV) Such other metrics as the 
                                Secretary considers necessary.
                            (ii) Metrics relating to television, which 
                        may include the following:
                                    (I) Nielsen ratings.
                                    (II) Such other metrics as the 
                                Secretary considers necessary.
                            (iii) Metrics relating to email, which may 
                        include the following:
                                    (I) Open rate.
                                    (II) Response rate.
                                    (III) Click rate.
                                    (IV) Such other metrics as the 
                                Secretary considers necessary.
                    (C) Update.--The Secretary shall periodically 
                update the metrics under subparagraph (B) as more 
                accurate metrics become available.
            (3) Targets.--The Secretary shall establish targets to 
        track the metrics used under paragraph (2).
            (4) Consultation.--In establishing goals under paragraph 
        (1), the Secretary shall consult with the following:
                    (A) Relevant stakeholders, such as organizations 
                that represent veterans, as determined by the 
                Secretary.
                    (B) Mental health and suicide prevention experts.
                    (C) Such other persons as the Secretary considers 
                appropriate.
            (5) Initial report.--Not later than 180 days after the date 
        of the enactment of this Act, the Secretary shall submit to the 
        Committee on Veterans' Affairs of the Senate and the Committee 
        on Veterans' Affairs of the House of Representatives a report 
        detailing the goals established under paragraph (1) for the 
        mental health and suicide prevention media outreach campaigns 
        of the Department, including the metrics and targets for such 
        metrics by which those goals are to be measured under 
        paragraphs (2) and (3).
            (6) Annual report.--Not later than one year after the 
        submittal of the report under paragraph (5), and annually 
        thereafter, the Secretary shall submit to the Committee on 
        Veterans' Affairs of the Senate and the Committee on Veterans' 
        Affairs of the House of Representatives a report detailing--
                    (A) the progress of the Department in meeting the 
                goals established under paragraph (1) and the targets 
                established under paragraph (3); and
                    (B) a description of action to be taken by the 
                Department to modify mental health and suicide 
                prevention media outreach campaigns if those goals and 
                targets are not being met.
    (b) Report on Use of Funds by Office of Mental Health and Suicide 
Prevention.--Not later than 180 days after the date of the enactment of 
this Act, and semiannually thereafter, the Secretary shall submit to 
the Committee on Appropriations and the Committee on Veterans' Affairs 
of the Senate and the Committee on Appropriations and the Committee on 
Veterans' Affairs of the House of Representatives a report containing 
the expenditures and obligations of the Office of Mental Health and 
Suicide Prevention of the Veterans Health Administration during the 
period covered by the report.

SEC. 403. COMPTROLLER GENERAL MANAGEMENT REVIEW OF MENTAL HEALTH AND 
              SUICIDE PREVENTION SERVICES OF DEPARTMENT OF VETERANS 
              AFFAIRS.

    (a) In General.--Not later than three years after the date of the 
enactment of this Act, the Comptroller General of the United States 
shall submit to the Committee on Veterans' Affairs of the Senate and 
the Committee on Veterans' Affairs of the House of Representatives a 
management review of the mental health and suicide prevention services 
provided by the Department of Veterans Affairs.
    (b) Elements.--The management review required by subsection (a) 
shall include the following:
            (1) An assessment of the infrastructure under the control 
        of or available to the Office of Mental Health and Suicide 
        Prevention of the Department of Veterans Affairs or available 
        to the Department of Veterans Affairs for suicide prevention 
        efforts not operated by the Office of Mental Health and Suicide 
        Prevention.
            (2) A description of the management and organizational 
        structure of the Office of Mental Health and Suicide 
        Prevention, including roles and responsibilities for each 
        position.
            (3) A description of the operational policies and processes 
        of the Office of Mental Health and Suicide Prevention.
            (4) An assessment of suicide prevention practices and 
        initiatives available from the Department and through community 
        partnerships.
            (5) An assessment of the staffing levels at the Office of 
        Mental Health and Suicide Prevention, disaggregated by type of 
        position, and including the location of any staffing 
        deficiencies.
            (6) An assessment of the Nurse Advice Line pilot program 
        conducted by the Department.
            (7) An assessment of recruitment initiatives in rural areas 
        for mental health professionals of the Department.
            (8) An assessment of strategic planning conducted by the 
        Office of Mental Health and Suicide Prevention.
            (9) An assessment of the communication, and the 
        effectiveness of such communication--
                    (A) within the central office of the Office of 
                Mental Health and Suicide Prevention;
                    (B) between that central office and any staff 
                member or office in the field, including chaplains, 
                attorneys, law enforcement personnel, and volunteers; 
                and
                    (C) between that central office, local facilities 
                of the Department, and community partners of the 
                Department, including first responders, community 
                support groups, and health care industry partners.
            (10) An assessment of how effectively the Office of Mental 
        Health and Suicide Prevention implements operational policies 
        and procedures.
            (11) An assessment of how the Department of Veterans 
        Affairs and the Department of Defense coordinate suicide 
        prevention efforts, and recommendations on how the Department 
        of Veterans Affairs and Department of Defense can more 
        effectively coordinate those efforts.
            (12) An assessment of such other areas as the Comptroller 
        General considers appropriate to study.

SEC. 404. COMPTROLLER GENERAL REPORT ON EFFORTS OF DEPARTMENT OF 
              VETERANS AFFAIRS TO INTEGRATE MENTAL HEALTH CARE INTO 
              PRIMARY CARE CLINICS.

    (a) Initial Report.--
            (1) In general.--Not later than two years after the date of 
        the enactment of this Act, the Comptroller General of the 
        United States shall submit to the Committee on Veterans' 
        Affairs of the Senate and the Committee on Veterans' Affairs of 
        the House of Representatives a report on the efforts of the 
        Department of Veterans Affairs to integrate mental health care 
        into primary care clinics of the Department.
            (2) Elements.--The report required by subsection (a) shall 
        include the following:
                    (A) An assessment of the efforts of the Department 
                to integrate mental health care into primary care 
                clinics of the Department.
                    (B) An assessment of the effectiveness of such 
                efforts.
                    (C) An assessment of how the health care of 
                veterans is impacted by such integration.
                    (D) A description of how care is coordinated by the 
                Department between specialty mental health care and 
                primary care, including a description of the following:
                            (i) How documents and patient information 
                        are transferred and the effectiveness of those 
                        transfers.
                            (ii) How care is coordinated when veterans 
                        must travel to different facilities of the 
                        Department.
                            (iii) How a veteran is reintegrated into 
                        primary care after receiving in-patient mental 
                        health care.
                    (E) An assessment of how the integration of mental 
                health care into primary care clinics is implemented at 
                different types of facilities of the Department.
                    (F) Such recommendations on how the Department can 
                better integrate mental health care into primary care 
                clinics as the Comptroller General considers 
                appropriate.
                    (G) An assessment of such other areas as the 
                Comptroller General considers appropriate to study.
    (b) Community Care Integration Report.--
            (1) In general.--Not later than two years after the date on 
        which the Comptroller General submits the report required under 
        subsection (a)(1), the Comptroller General shall submit to the 
        Committee on Veterans' Affairs of the Senate and the Committee 
        on Veterans' Affairs of the House of Representatives a report 
        on the efforts of the Department to integrate community-based 
        mental health care into the Veterans Health Administration.
            (2) Elements.--The report required by paragraph (1) shall 
        include the following:
                    (A) An assessment of the efforts of the Department 
                to integrate community-based mental health care into 
                the Veterans Health Administration.
                    (B) An assessment of the effectiveness of such 
                efforts.
                    (C) An assessment of how the health care of 
                veterans is impacted by such integration.
                    (D) A description of how care is coordinated 
                between providers of community-based mental health care 
                and the Veterans Health Administration, including a 
                description of how documents and patient information 
                are transferred and the effectiveness of those 
                transfers between--
                            (i) the Veterans Health Administration and 
                        providers of community-based mental health 
                        care; and
                            (ii) providers of community-based mental 
                        health care and the Veterans Health 
                        Administration.
                    (E) An assessment of any disparities in the 
                coordination of community-based mental health care into 
                the Veterans Health Administration by location and type 
                of facility.
                    (F) An assessment of the military cultural 
                competency of health care providers providing 
                community-based mental health care to veterans.
                    (G) Such recommendations on how the Department can 
                better integrate community-based mental health care 
                into the Veterans Health Administration as the 
                Comptroller General considers appropriate.
                    (H) An assessment of such other areas as the 
                Comptroller General considers appropriate to study.
            (3) Community-based mental health care defined.--In this 
        subsection, the term ``community-based mental health care'' 
        means mental health care paid for by the Department but 
        provided by a non-Department health care provider at a non-
        Department facility, including care furnished under section 
        1703 of title 38, United States Code (as in effect on the date 
        specified in section 101(b) of the Caring for Our Veterans Act 
        of 2018 (title I of Public Law 115-182)).

SEC. 405. JOINT MENTAL HEALTH PROGRAMS BY DEPARTMENT OF VETERANS 
              AFFAIRS AND DEPARTMENT OF DEFENSE.

    (a) Report on Mental Health Programs.--
            (1) In general.--Not later than one year after the date of 
        the enactment of this Act, and annually thereafter, the 
        Secretary of Veterans Affairs and the Secretary of Defense 
        shall submit to the Committee on Veterans' Affairs and the 
        Committee on Armed Services of the Senate and the Committee on 
        Veterans' Affairs and the Committee on Armed Services of the 
        House of Representatives a report on mental health programs of 
        the Department of Veterans Affairs and the Department of 
        Defense and joint programs of the Departments.
            (2) Elements.--The report required by paragraph (1) shall 
        include the following:
                    (A) A description of mental health programs 
                operated by the Department of Veterans Affairs, 
                including the following:
                            (i) Transition assistance programs.
                            (ii) Clinical and non-clinical mental 
                        health initiatives, including centers of 
                        excellence of the Department of Veterans 
                        Affairs for traumatic brain injury and post-
                        traumatic stress disorder.
                            (iii) Programs that may secondarily improve 
                        mental health, including employment, housing 
                        assistance, and financial literacy programs.
                            (iv) Research into mental health issues and 
                        conditions, to include post-traumatic stress 
                        disorder, depression, anxiety, bipolar 
                        disorder, traumatic brain injury, suicidal 
                        ideation, and any other issues or conditions as 
                        the Secretary of Veterans Affairs considers 
                        necessary.
                    (B) A description of mental health programs 
                operated by the Department of Defense, including the 
                following:
                            (i) Transition assistance programs.
                            (ii) Clinical and non-clinical mental 
                        health initiatives, including the National 
                        Intrepid Center of Excellence and the Intrepid 
                        Spirit Centers.
                            (iii) Programs that may secondarily improve 
                        mental health, including employment, housing 
                        assistance, and financial literacy programs.
                            (iv) Research into mental health issues and 
                        conditions, to include post-traumatic stress 
                        disorder, depression, anxiety, bipolar 
                        disorder, traumatic brain injury, suicidal 
                        ideation, and any other issues or conditions as 
                        the Secretary of Defense considers necessary.
                    (C) A description of mental health programs jointly 
                operated by the Department of Veterans Affairs and the 
                Department of Defense, including the following:
                            (i) Transition assistance programs.
                            (ii) Clinical and non-clinical mental 
                        health initiatives.
                            (iii) Programs that may secondarily improve 
                        mental health, including employment, housing 
                        assistance, and financial literacy programs.
                            (iv) Research into mental health issues and 
                        conditions, to include post-traumatic stress 
                        disorder, depression, anxiety, bipolar 
                        disorder, traumatic brain injury, suicidal 
                        ideation, and completed suicides, including 
                        through the use of the joint suicide data 
                        repository of the Department of Veterans 
                        Affairs and the Department of Defense, and any 
                        other issues or conditions as the Secretary of 
                        Veterans Affairs and the Secretary of Defense 
                        consider necessary.
                    (D) Recommendations for coordinating mental health 
                programs of the Department of Veterans Affairs and the 
                Department of Defense to improve the effectiveness of 
                those programs.
                    (E) Recommendations for novel joint programming of 
                the Department of Veterans Affairs and the Department 
                of Defense to improve the mental health of members of 
                the Armed Forces and veterans.
    (b) Evaluation of Collaborative Efforts of Department of Veterans 
Affairs and Department of Defense and Alternatives of Analysis to 
Establish a Joint VA/DOD Intrepid Spirit Center.--
            (1) In general.--The Secretary of Veterans Affairs, in 
        coordination with the Secretary of Defense, shall evaluate the 
        current ongoing collaborative efforts of the Department of 
        Veterans Affairs and the Department of Defense related to post-
        traumatic stress disorder and traumatic brain injury care, 
        research, and education to improve the quality of and access to 
        such care and seek potential new collaborative efforts to 
        improve and expand such care for veterans and members of the 
        Armed Forces in a joint Department of Veterans Affairs/
        Department of Defense Intrepid Spirit Center that serves active 
        duty members of the Armed Forces, members of the reserve 
        components of the Armed Forces, and veterans for mutual benefit 
        and growth in treatment and care.
            (2) Alternatives of analysis.--
                    (A) In general.--The evaluation required under 
                paragraph (1) shall include an alternatives of analysis 
                to establish the joint Department of Veterans Affairs/
                Department of Defense Intrepid Spirit Center described 
                in paragraph (1).
                    (B) Elements.--The alternatives of analysis 
                required under subparagraph (A) with respect to the 
                establishment of the joint Department of Veterans 
                Affairs/Department of Defense Intrepid Spirit Center 
                described in paragraph (1) shall provide alternatives 
                and recommendations that consider information 
                including--
                            (i) colocation of the center on an 
                        installation of the Department of Defense or 
                        property of a medical center of the Department 
                        of Veterans Affairs;
                            (ii) consideration of a rural or highly 
                        rural area to establish the center that may 
                        include colocation described in clause (i);
                            (iii) geographic distance from existing or 
                        planned Intrepid Spirit Centers of the 
                        Department of Defense or other such facilities 
                        of the Department of Veterans Affairs or the 
                        Department of Defense that furnish care for 
                        post-traumatic stress disorder or traumatic 
                        brain injury; and
                            (iv) the potential role for private 
                        entities and philanthropic organizations in 
                        carrying out the activities of the center.
            (3) Report to congress.--Not later than 270 days after the 
        date of the enactment of this Act, the Secretary of Veterans 
        Affairs shall submit to the Committee on Veterans' Affairs of 
        the Senate and the Committee on Veterans' Affairs of the House 
        of Representatives a report that includes--
                    (A) a summary of the evaluation required under 
                paragraph (1); and
                    (B) the alternatives of analysis required under 
                paragraph (2).
            (4) Rural and highly rural defined.--In this subsection, 
        with respect to an area, the terms ``rural'' and ``highly 
        rural'' have the meanings given those terms in the Rural-Urban 
        Commuting Areas coding system of the Department of Agriculture.

        TITLE V--IMPROVEMENT OF MENTAL HEALTH MEDICAL WORKFORCE

SEC. 501. STAFFING IMPROVEMENT PLAN FOR MENTAL HEALTH PROVIDERS OF 
              DEPARTMENT OF VETERANS AFFAIRS.

    (a) Staffing Plan.--
            (1) In general.--Not later than one year after the date of 
        the enactment of this Act, the Secretary of Veterans Affairs, 
        in consultation with the Inspector General of the Department of 
        Veterans Affairs, shall submit to the Committee on Veterans' 
        Affairs of the Senate and the Committee on Veterans' Affairs of 
        the House of Representatives a plan to address staffing of 
        mental health providers of the Department of Veterans Affairs, 
        including filling any open positions.
            (2) Elements.--The plan required by paragraph (1) shall 
        include the following:
                    (A) An estimate of the number of positions for 
                mental health providers of the Department that need to 
                be filled to meet demand.
                    (B) An identification of the steps that the 
                Secretary will take to address mental health staffing 
                for the Department.
                    (C) A description of any region-specific hiring 
                incentives to be used by the Secretary in consultation 
                with the directors of Veterans Integrated Service 
                Networks and medical centers of the Department.
                    (D) A description of any local retention or 
                engagement incentives to be used by directors of 
                Veterans Integrated Service Networks.
                    (E) Such recommendations for legislative or 
                administrative action as the Secretary considers 
                necessary to aid in addressing mental health staffing 
                for the Department.
            (3) Report.--Not later than one year after the submittal of 
        the plan required by paragraph (1), the Secretary shall submit 
        to the Committee on Veterans' Affairs of the Senate and the 
        Committee on Veterans' Affairs of the House of Representatives 
        a report setting forth the number of mental health providers 
        hired by the Department during the one-year period preceding 
        the submittal of the report.
    (b) Occupational Series for Certain Mental Health Providers.--Not 
later than one year after the date of the enactment of this Act, the 
Secretary of Veterans Affairs, in consultation with the Office of 
Personnel Management, shall develop an occupational series for licensed 
professional mental health counselors and marriage and family 
therapists of the Department of Veterans Affairs.

SEC. 502. ESTABLISHMENT OF DEPARTMENT OF VETERANS AFFAIRS READJUSTMENT 
              COUNSELING SERVICE SCHOLARSHIP PROGRAM.

    (a) In General.--Chapter 76 of title 38, United States Code, is 
amended by inserting after subchapter VIII the following new 
subchapter:

  ``SUBCHAPTER IX--READJUSTMENT COUNSELING SERVICE SCHOLARSHIP PROGRAM

``Sec. 7698. Requirement for program
    ``As part of the Educational Assistance Program, the Secretary 
shall carry out a scholarship program under this subchapter. The 
program shall be known as the Department of Veterans Affairs 
Readjustment Counseling Service Scholarship Program (in this subchapter 
referred to as the `Program').
``Sec. 7699. Eligibility; agreement
    ``(a) In General.--An individual is eligible to participate in the 
Program, as determined by the Readjustment Counseling Service of the 
Department, if the individual--
            ``(1) is accepted for enrollment or enrolled (as described 
        in section 7602 of this title) in a program of study at an 
        accredited educational institution, school, or training program 
        leading to a terminal degree in psychology, social work, 
        marriage and family therapy, or mental health counseling that 
        would meet the education requirements for appointment to a 
        position under section 7402(b) of this title; and
            ``(2) enters into an agreement with the Secretary under 
        subsection (c).
    ``(b) Priority.--In selecting individuals to participate in the 
Program, the Secretary shall give priority to the following 
individuals:
            ``(1) An individual who agrees to be employed by a Vet 
        Center located in a community that is--
                    ``(A) designated as a medically underserved 
                population under section 330(b)(3) of the Public Health 
                Service Act (42 U.S.C. 254b(b)(3)); and
                    ``(B) in a State with a per capita population of 
                veterans of more than five percent according to the 
                National Center for Veterans Analysis and Statistics 
                and the Bureau of the Census.
            ``(2) An individual who is a veteran.
    ``(c) Agreement.--An agreement between the Secretary and a 
participant in the Program shall (in addition to the requirements set 
forth in section 7604 of this title) include the following:
            ``(1) An agreement by the Secretary to provide the 
        participant with a scholarship under the Program for a 
        specified number of school years during which the participant 
        pursues a program of study described in subsection (a)(1) that 
        meets the requirements set forth in section 7602(a) of this 
        title.
            ``(2) An agreement by the participant to serve as a full-
        time employee of the Department at a Vet Center for a six-year 
        period following the completion by the participant of such 
        program of study (in this subchapter referred to as the `period 
        of obligated service').
    ``(d) Vet Center Defined.--In this section, the term `Vet Center' 
has the meaning given that term in section 1712A(h) of this title.
``Sec. 7699A. Obligated service
    ``(a) In General.--Each participant in the Program shall provide 
service as a full-time employee of the Department at a Vet Center (as 
defined in section 7699(d) of this title) for the period of obligated 
service set forth in the agreement of the participant entered into 
under section 7604 of this title.
    ``(b) Determination of Service Commencement Date.--(1) Not later 
than 60 days before the service commencement date of a participant, the 
Secretary shall notify the participant of that service commencement 
date.
    ``(2) The date specified in paragraph (1) with respect to a 
participant is the date for the beginning of the period of obligated 
service of the participant.
``Sec. 7699B. Breach of agreement: liability
    ``(a) Liquidated Damages.--(1) A participant in the Program (other 
than a participant described in subsection (b)) who fails to accept 
payment, or instructs the educational institution in which the 
participant is enrolled not to accept payment, in whole or in part, of 
a scholarship under the agreement entered into under section 7604 of 
this title shall be liable to the United States for liquidated damages 
in the amount of $1,500.
    ``(2) Liability under paragraph (1) is in addition to any period of 
obligated service or other obligation or liability under such 
agreement.
    ``(b) Liability During Program of Study.--(1) Except as provided in 
subsection (d), a participant in the Program shall be liable to the 
United States for the amount which has been paid to or on behalf of the 
participant under the agreement if any of the following occurs:
            ``(A) The participant fails to maintain an acceptable level 
        of academic standing in the educational institution in which 
        the participant is enrolled (as determined by the educational 
        institution under regulations prescribed by the Secretary).
            ``(B) The participant is dismissed from such educational 
        institution for disciplinary reasons.
            ``(C) The participant voluntarily terminates the program of 
        study in such educational institution before the completion of 
        such program of study.
    ``(2) Liability under this subsection is in lieu of any service 
obligation arising under the agreement.
    ``(c) Liability During Period of Obligated Service.--(1) Except as 
provided in subsection (d), if a participant in the Program does not 
complete the period of obligated service of the participant, the United 
States shall be entitled to recover from the participant an amount 
determined in accordance with the following formula: A = 3F(t-s/t).
    ``(2) In the formula in paragraph (1):
            ``(A) `A' is the amount the United States is entitled to 
        recover.
            ``(B) `F' is the sum of--
                    ``(i) the amounts paid under this subchapter to or 
                on behalf of the participant; and
                    ``(ii) the interest on such amounts which would be 
                payable if at the time the amounts were paid they were 
                loans bearing interest at the maximum legal prevailing 
                rate, as determined by the Treasurer of the United 
                States.
            ``(C) `t' is the total number of months in the period of 
        obligated service of the participant.
            ``(D) `s' is the number of months of such period served by 
        the participant.
    ``(d) Limitation on Liability for Reductions-in-force.--Liability 
shall not arise under subsection (c) if the participant fails to 
maintain employment as a Department employee due to a staffing 
adjustment.
    ``(e) Period for Payment of Damages.--Any amount of damages that 
the United States is entitled to recover under this section shall be 
paid to the United States within the one-year period beginning on the 
date of the breach of the agreement.''.
    (b) Conforming and Technical Amendments.--
            (1) Conforming amendments.--
                    (A) Establishment of program.--Section 7601(a) of 
                such title is amended--
                            (i) in paragraph (5), by striking ``and'';
                            (ii) in paragraph (6), by striking the 
                        period and inserting ``; and''; and
                            (iii) by adding at the end the following 
                        new paragraph:
            ``(7) the readjustment counseling service scholarship 
        program provided for in subchapter IX of this chapter.''.
                    (B) Eligibility.--Section 7602 of such title is 
                amended--
                            (i) in subsection (a)(1)--
                                    (I) by striking ``or VI'' and 
                                inserting ``VI, or IX''; and
                                    (II) by striking ``subchapter VI'' 
                                and inserting ``subchapter VI or IX''; 
                                and
                            (ii) in subsection (b), by striking ``or 
                        VI'' and inserting ``VI, or IX''.
                    (C) Application.--Section 7603(a)(1) of such title 
                is amended by striking ``or VIII'' and inserting 
                ``VIII, or IX''.
                    (D) Terms of agreement.--Section 7604 of such title 
                is amended by striking ``or VIII'' each place it 
                appears and inserting ``VIII, or IX''.
                    (E) Annual report.--Section 7632 of such title is 
                amended--
                            (i) in paragraph (1), by striking ``and the 
                        Specialty Education Loan Repayment Program'' 
                        and inserting ``the Specialty Education Loan 
                        Repayment Program, and the Readjustment 
                        Counseling Service Scholarship Program''; and
                            (ii) in paragraph (4), by striking ``and 
                        per participant in the Specialty Education Loan 
                        Repayment Program'' and inserting ``per 
                        participant in the Specialty Education Loan 
                        Repayment Program, and per participant in the 
                        Readjustment Counseling Service Scholarship 
                        Program''.
            (2) Table of sections.--The table of sections at the 
        beginning of chapter 76 of such title is amended by inserting 
        after the items relating to subchapter VIII the following:

  ``subchapter ix--readjustment counseling service scholarship program

``Sec.
``7698. Requirement for program.
``7699. Eligibility; agreement.
``7699A. Obligated service.
``7699B. Breach of agreement: liability.''.
    (c) Effective Date.--The Secretary of Veterans Affairs shall begin 
awarding scholarships under subchapter IX of chapter 76 of title 38, 
United States Code, as added by subsection (a), for programs of study 
beginning not later than one year after the date of the enactment of 
this Act.

SEC. 503. COMPTROLLER GENERAL REPORT ON READJUSTMENT COUNSELING SERVICE 
              OF DEPARTMENT OF VETERANS AFFAIRS.

    (a) In General.--Not later than one year after the date of the 
enactment of this Act, the Comptroller General of the United States 
shall submit to the Committee on Veterans' Affairs of the Senate and 
the Committee on Veterans' Affairs of the House of Representatives a 
report on the Readjustment Counseling Service of the Department of 
Veterans Affairs.
    (b) Elements.--The report required by subsection (a) shall include 
the following:
            (1) An assessment of the adequacy and types of treatment, 
        counseling, and other services provided at Vet Centers, 
        including recommendations on whether and how such treatment, 
        counseling, and other services can be expanded.
            (2) An assessment of the efficacy of outreach efforts by 
        the Readjustment Counseling Service, including recommendations 
        for how outreach efforts can be improved.
            (3) An assessment of barriers to care at Vet Centers, 
        including recommendations for overcoming those barriers.
            (4) An assessment of the efficacy and frequency of the use 
        of telehealth by counselors of the Readjustment Counseling 
        Service to provide mental health services, including 
        recommendations for how the use of telehealth can be improved.
            (5) An assessment of the feasibility and advisability of 
        expanding eligibility for services from the Readjustment 
        Counseling Service, including--
                    (A) recommendations on what eligibility criteria 
                could be expanded; and
                    (B) an assessment of potential costs and increased 
                infrastructure requirements if eligibility is expanded.
            (6) An assessment of the use of Vet Centers by members of 
        the reserve components of the Armed Forces who were never 
        activated and recommendations on how to better reach those 
        members.
            (7) An assessment of the use of Vet Centers by eligible 
        family members of former members of the Armed Forces and 
        recommendations on how to better reach those family members.
            (8) An assessment of the efficacy of group therapy and the 
        level of training of providers at Vet Centers in administering 
        group therapy.
            (9) An assessment of the efficiency and effectiveness of 
        the task organization structure of Vet Centers.
            (10) An assessment of the use of Vet Centers by Native 
        American veterans, as defined in section 3765 of title 38, 
        United States Code, and recommendations on how to better reach 
        those veterans.
    (c) Vet Center Defined.--In this section, the term ``Vet Center'' 
has the meaning given that term in section 1712A(h) of title 38, United 
States Code.

SEC. 504. EXPANSION OF REPORTING REQUIREMENTS ON READJUSTMENT 
              COUNSELING SERVICE OF DEPARTMENT OF VETERANS AFFAIRS.

    (a) Expansion of Annual Report.--Paragraph (2)(C) of section 
7309(e) of title 38, United States Code, is amended by inserting before 
the period at the end the following: ``, including the resources 
required to meet such unmet need, such as additional staff, additional 
locations, additional infrastructure, infrastructure improvements, and 
additional mobile Vet Centers''.
    (b) Biennial Report.--Such section is amended by adding at the end 
the following new paragraph:
    ``(3) For each even numbered year in which the report required by 
paragraph (1) is submitted, the Secretary shall include in such report 
a prediction of--
            ``(A) trends in demand for care;
            ``(B) long-term investments required with respect to the 
        provision of care;
            ``(C) requirements relating to maintenance of 
        infrastructure; and
            ``(D) other capital investment requirements with respect to 
        the Readjustment Counseling Service, including Vet Centers, 
        mobile Vet Centers, and community access points.''.

SEC. 505. BRIEFING ON ALTERNATIVE WORK SCHEDULES FOR EMPLOYEES OF 
              VETERANS HEALTH ADMINISTRATION.

    (a) Survey of Veterans.--
            (1) In general.--Not later than 180 days after the date of 
        the enactment of this Act, the Secretary of Veterans Affairs 
        shall conduct a survey on the attitudes of eligible veterans 
        toward the Department of Veterans Affairs offering appointments 
        outside the usual operating hours of facilities of the 
        Department, including through the use of telehealth 
        appointments.
            (2) Eligible veteran defined.--In this subsection, the term 
        ``eligible veteran'' means a veteran who--
                    (A) is enrolled in the patient enrollment system of 
                the Department under section 1705(a) of title 38, 
                United States Code; and
                    (B) received health care from the Department at 
                least once during the two-year period ending on the 
                date of the commencement of the survey under paragraph 
                (1).
    (b) Congressional Briefing.--
            (1) In general.--Not later than 270 days after the date of 
        the enactment of this Act, the Secretary shall brief the 
        Committee on Veterans' Affairs of the Senate and the Committee 
        on Veterans' Affairs of the House of Representatives on the--
                    (A) feasibility and advisability of offering 
                appointments outside the usual operating hours of 
                facilities of the Department that do not offer such 
                appointments; and
                    (B) effectiveness of offering appointments outside 
                the usual operating hours of facilities of the 
                Department for those facilities that offer such 
                appointments.
            (2) Elements.--The briefing required by paragraph (1) shall 
        include the following:
                    (A) The findings of the survey conducted under 
                subsection (a);
                    (B) Feedback from employees of the Veterans Health 
                Administration, including clinical, nonclinical, and 
                support staff, with respect to offering appointments 
                outside the usual operating hours of facilities of the 
                Department, including through the use of telehealth 
                appointments; and
                    (C) Any other matters the Secretary considers 
                relevant to a full understanding of the feasibility and 
                advisability of offering appointments outside the usual 
                operating hours of facilities of the Department.
    (c) Paperwork Reduction Act Exemption.--Chapter 35 of title 44, 
United States Code (commonly known as the ``Paperwork Reduction Act'') 
shall not apply to any rulemaking or information collection required 
under this section.

SEC. 506. SUICIDE PREVENTION COORDINATORS.

    (a) Staffing Requirement.--Beginning not later than one year after 
the date of the enactment of this Act, the Secretary of Veterans 
Affairs shall ensure that each medical center of the Department of 
Veterans Affairs has not less than one suicide prevention coordinator.
    (b) Study on Reorganization.--
            (1) In general.--Not later than one year after the date of 
        the enactment of this Act, the Secretary, in consultation with 
        the Office of Mental Health and Suicide Prevention of the 
        Department, shall commence the conduct of a study to determine 
        the feasibility and advisability of--
                    (A) the realignment and reorganization of suicide 
                prevention coordinators within the Office of Mental 
                Health and Suicide Prevention; and
                    (B) the creation of a suicide prevention 
                coordinator program office.
            (2) Program office realignment.--In conducting the study 
        under paragraph (1), the Secretary shall assess the feasibility 
        of advisability of, within the suicide prevention coordinator 
        program office described in paragraph (1)(B), aligning suicide 
        prevention coordinators and suicide prevention case managers 
        within the organizational structure and chart of the Suicide 
        Prevention Program of the Department, with the Director of the 
        Suicide Prevention program having ultimate supervisory 
        oversight and responsibility over the suicide prevention 
        coordinator program office.
    (c) Report.--Not later than 90 days after the completion of the 
study under subsection (b), the Secretary shall submit to the Committee 
on Veterans' Affairs of the Senate and the Committee on Veterans' 
Affairs of the House of Representatives a report on such study, 
including the following:
            (1) An assessment of the feasibility and advisability of 
        creating a suicide prevention coordinator program office to 
        oversee and monitor suicide prevention coordinators and suicide 
        prevention case managers across all medical centers of the 
        Department.
            (2) A review of current staffing ratios for suicide 
        prevention coordinators and suicide prevention case managers in 
        comparison with current staffing ratios for mental health 
        providers within each medical center of the Department.
            (3) A description of the duties and responsibilities for 
        suicide prevention coordinators across the Department to better 
        define, delineate, and standardize qualifications, performance 
        goals, performance duties, and performance outcomes for suicide 
        prevention coordinators and suicide prevention case managers.

SEC. 507. REPORT ON EFFORTS BY DEPARTMENT OF VETERANS AFFAIRS TO 
              IMPLEMENT SAFETY PLANNING IN EMERGENCY DEPARTMENTS.

    (a) Findings.--Congress makes the following findings:
            (1) The Department of Veterans Affairs must be more 
        effective in its approach to reducing the burden of veteran 
        suicide connected to mental health diagnoses, to include 
        expansion of treatment delivered via telehealth methods and in 
        rural areas.
            (2) An innovative project, known as Suicide Assessment and 
        Follow-up Engagement: Veteran Emergency Treatment (in this 
        subsection referred to as ``SAFE VET''), was designed to help 
        suicidal veterans seen at emergency departments within the 
        Veterans Health Administration and was successfully implemented 
        in five intervention sites beginning in 2010.
            (3) A 2018 study found that safety planning intervention 
        under SAFE VET was associated with 45 percent fewer suicidal 
        behaviors in the six-month period following emergency 
        department care and more than double the odds of a veteran 
        engaging in outpatient behavioral health care.
            (4) SAFE VET is a promising alternative and acceptable 
        delivery of care system that augments the treatment of suicidal 
        veterans in emergency departments of the Veterans Health 
        Administration and helps ensure that those veterans have 
        appropriate follow-up care.
            (5) Beginning in September 2018, the Veterans Health 
        Administration implemented a suicide prevention program, known 
        as the SPED program, for veterans presenting to the emergency 
        department who are assessed to be at risk for suicide and are 
        safe to be discharged home.
            (6) The SPED program includes issuance and update of a 
        safety plan and post-discharge follow-up outreach for veterans 
        to facilitate engagement in outpatient mental health care.
    (b) Report.--
            (1) In general.--Not later than 180 days after the date of 
        the enactment of this Act, the Secretary of Veterans Affairs 
        shall submit to the appropriate committees of Congress a report 
        on the efforts of the Secretary to implement a suicide 
        prevention program for veterans presenting to an emergency 
        department or urgent care center of the Veterans Health 
        Administration who are assessed to be at risk for suicide and 
        are safe to be discharged home, including a safety plan and 
        post-discharge outreach for veterans to facilitate engagement 
        in outpatient mental health care.
            (2) Elements.--The report required by paragraph (1) shall 
        include the following:
                    (A) An assessment of the implementation of the 
                current operational policies and procedures of the SPED 
                program at each medical center of the Department of 
                Veterans Affairs, including an assessment of the 
                following:
                            (i) Training provided to clinicians or 
                        other personnel administering protocols under 
                        the SPED program.
                            (ii) Any disparities in implementation of 
                        such protocols between medical centers.
                            (iii) Current criteria used to measure the 
                        quality of such protocols including--
                                    (I) methodology used to assess the 
                                quality of a safety plan and post-
                                discharge outreach for veterans; or
                                    (II) in the absence of such 
                                methodology, a proposed timeline and 
                                guidelines for creating a methodology 
                                to ensure compliance with the evidence-
                                based model used under the Suicide 
                                Assessment and Follow-up Engagement: 
                                Veteran Emergency Treatment (SAFE VET) 
                                program of the Department.
                    (B) An assessment of the implementation of the 
                policies and procedures described in subparagraph (A), 
                including the following:
                            (i) An assessment of the quality and 
                        quantity of safety plans issued to veterans.
                            (ii) An assessment of the quality and 
                        quantity of post-discharge outreach provided to 
                        veterans.
                            (iii) The post-discharge rate of veteran 
                        engagement in outpatient mental health care, 
                        including attendance at not fewer than one 
                        individual mental health clinic appointment or 
                        admission to an inpatient or residential unit.
                            (iv) The number of veterans who decline 
                        safety planning efforts during protocols under 
                        the SPED program.
                            (v) The number of veterans who decline to 
                        participate in follow-up efforts within the 
                        SPED program.
                    (C) A description of how SPED primary coordinators 
                are deployed to support such efforts, including the 
                following:
                            (i) A description of the duties and 
                        responsibilities of such coordinators.
                            (ii) The number and location of such 
                        coordinators.
                            (iii) A description of training provided to 
                        such coordinators.
                            (iv) An assessment of the other 
                        responsibilities for such coordinators and, if 
                        applicable, differences in patient outcomes 
                        when such responsibilities are full-time duties 
                        as opposed to secondary duties.
                    (D) An assessment of the feasibility and 
                advisability of expanding the total number and 
                geographic distribution of SPED primary coordinators.
                    (E) An assessment of the feasibility and 
                advisability of providing services under the SPED 
                program via telehealth channels, including an analysis 
                of opportunities to leverage telehealth to better serve 
                veterans in rural areas.
                    (F) A description of the status of current 
                capabilities and utilization of tracking mechanisms to 
                monitor compliance, quality, and patient outcomes under 
                the SPED program.
                    (G) Such recommendations, including specific action 
                items, as the Secretary considers appropriate with 
                respect to how the Department can better implement the 
                SPED program, including recommendations with respect to 
                the following:
                            (i) A process to standardize training under 
                        such program.
                            (ii) Any resourcing requirements necessary 
                        to implement the SPED program throughout 
                        Veterans Health Administration, including by 
                        having a dedicated clinician responsible for 
                        administration of such program at each medical 
                        center.
                            (iii) An analysis of current statutory 
                        authority and any changes necessary to fully 
                        implement the SPED program throughout the 
                        Veterans Health Administration.
                            (iv) A timeline for the implementation of 
                        the SPED program through the Veterans Health 
                        Administration once full resourcing and an 
                        approved training plan are in place.
                    (H) Such other matters as the Secretary considers 
                appropriate.
    (c) Definitions.--In this section:
            (1) Appropriate committees of congress.--The term 
        ``appropriate committees of Congress'' means--
                    (A) the Committee on Veterans' Affairs and the 
                Subcommittee on Military Construction, Veterans 
                Affairs, and Related Agencies of the Committee on 
                Appropriations of the Senate; and
                    (B) the Committee on Veterans' Affairs and the 
                Subcommittee on Military Construction, Veterans 
                Affairs, and Related Agencies of the Committee on 
                Appropriations of the House of Representatives.
            (2) SPED primary coordinator.--The term ``SPED primary 
        coordinator'' means the main point of contact responsible for 
        administering the SPED program at a medical center of the 
        Department.
            (3) SPED program.--The term ``SPED program'' means the 
        Safety Planning in Emergency Departments program of the 
        Department of Veterans Affairs established in September 2018 
        for veterans presenting to the emergency department who are 
        assessed to be at risk for suicide and are safe to be 
        discharged home, which extends the evidence-based intervention 
        for suicide prevention to all emergency departments of the 
        Veterans Health Administration.

     TITLE VI--IMPROVEMENT OF CARE AND SERVICES FOR WOMEN VETERANS

SEC. 601. EXPANSION OF CAPABILITIES OF WOMEN VETERANS CALL CENTER TO 
              INCLUDE TEXT MESSAGING.

    The Secretary of Veterans Affairs shall expand the capabilities of 
the Women Veterans Call Center of the Department of Veterans Affairs to 
include a text messaging capability.

SEC. 602. REQUIREMENT FOR DEPARTMENT OF VETERANS AFFAIRS INTERNET 
              WEBSITE TO PROVIDE INFORMATION ON SERVICES AVAILABLE TO 
              WOMEN VETERANS.

    (a) In General.--The Secretary of Veterans Affairs shall survey the 
internet websites and information resources of the Department of 
Veterans Affairs in effect on the day before the date of the enactment 
of this Act and publish an internet website that serves as a 
centralized source for the provision to women veterans of information 
about the benefits and services available to them under laws 
administered by the Secretary.
    (b) Elements.--The internet website published under subsection (a) 
shall provide to women veterans information regarding all services 
available in the district in which the veteran is seeking such 
services, including, with respect to each medical center and community-
based outpatient clinic in the applicable Veterans Integrated Service 
Network--
            (1) the name and contact information of each women's health 
        coordinator;
            (2) a list of appropriate staff for other benefits 
        available from the Veterans Benefits Administration, the 
        National Cemetery Administration, and such other entities as 
        the Secretary considers appropriate; and
            (3) such other information as the Secretary considers 
        appropriate.
    (c) Updated Information.--The Secretary shall ensure that the 
information described in subsection (b) that is published on the 
internet website required by subsection (a) is updated not less 
frequently than once every 90 days.
    (d) Outreach.--In carrying out this section, the Secretary shall 
ensure that the outreach conducted under section 1720F(i) of title 38, 
United States Code, includes information regarding the internet website 
required by subsection (a).
    (e) Derivation of Funds.--Amounts used by the Secretary to carry 
out this section shall be derived from amounts made available to the 
Secretary to publish internet websites of the Department.

                        TITLE VII--OTHER MATTERS

SEC. 701. EXPANDED TELEHEALTH FROM DEPARTMENT OF VETERANS AFFAIRS.

    (a) In General.--The Secretary of Veterans Affairs shall enter into 
agreements, and expand existing agreements, with organizations that 
represent or serve veterans, nonprofit organizations, private 
businesses, and other interested parties for the expansion of 
telehealth capabilities and the provision of telehealth services to 
veterans through the award of grants under subsection (b).
    (b) Award of Grants.--
            (1) In general.--In carrying out agreements entered into or 
        expanded under this section with entities described in 
        subsection (a), the Secretary shall award grants to those 
        entities.
            (2) Locations.--To the extent practicable, the Secretary 
        shall ensure that grants are awarded to entities that serve 
        veterans in rural and highly rural areas (as determined through 
        the use of the Rural-Urban Commuting Areas coding system of the 
        Department of Agriculture) or areas determined to be medically 
        underserved.
            (3) Use of grants.--
                    (A) In general.--Grants awarded to an entity under 
                this subsection may be used for one or more of the 
                following:
                            (i) Purchasing, replacing or upgrading 
                        hardware or software necessary for the 
                        provision of secure and private telehealth 
                        services.
                            (ii) Upgrading security protocols for 
                        consistency with the security requirements of 
                        the Department of Veterans Affairs.
                            (iii) Training of site attendants, 
                        including payment of those attendants for 
                        completing that training, with respect to--
                                    (I) military and veteran cultural 
                                competence, if the entity is not an 
                                organization that represents veterans;
                                    (II) equipment required to provide 
                                telehealth services;
                                    (III) privacy, including the Health 
                                Insurance Portability and 
                                Accountability Act of 1996 privacy rule 
                                under part 160 and subparts A and E of 
                                part 164 of title 45, Code of Federal 
                                Regulations, or successor regulations, 
                                as it relates to health care for 
                                veterans;
                                    (IV) scheduling for telehealth 
                                services for veterans; or
                                    (V) any other unique training needs 
                                for the provision of telehealth 
                                services to veterans.
                            (iv) Upgrading existing infrastructure 
                        owned or leased by the entity to make rooms 
                        more conducive to telehealth care, including--
                                    (I) additions or modifications to 
                                windows or walls in an existing room, 
                                or other alterations as needed to 
                                create a new, private room, including 
                                permits or inspections required in 
                                association with space modifications;
                                    (II) soundproofing of an existing 
                                room;
                                    (III) new electrical, telephone, or 
                                internet outlets in an existing room; 
                                or
                                    (IV) aesthetic enhancements to 
                                establish a more suitable therapeutic 
                                environment.
                            (v) Upgrading existing infrastructure to 
                        comply with the Americans with Disabilities Act 
                        of 1990 (42 U.S.C. 12101 et seq.).
                            (vi) Upgrading internet infrastructure and 
                        sustainment of internet services.
                            (vii) Sustainment of telephone services.
                    (B) Exclusion.--Grants may not be used for the 
                purchase of new property or for major construction 
                projects, as determined by the Secretary.
    (c) Agreement on Telehealth Access Points.--
            (1) In general.--An entity described in subsection (a) that 
        seeks to establish a telehealth access point for veterans but 
        does not require grant funding under this section to do so may 
        enter into an agreement with the Department for the 
        establishment of such an access point.
            (2) Adequacy of facilities.--An entity described in 
        paragraph (1) shall be responsible for ensuring that any access 
        point is adequately private, secure, clean, and accessible for 
        veterans before the access point is established.
    (d) Assessment of Barriers to Access.--
            (1) In general.--Not later than 18 months after the date of 
        the enactment of this Act, the Secretary shall complete an 
        assessment of barriers faced by veterans in accessing 
        telehealth services.
            (2) Elements.--The assessment required by paragraph (1) 
        shall include the following:
                    (A) A description of the barriers veterans face in 
                using telehealth while not on property of the 
                Department.
                    (B) A description of how the Department plans to 
                address the barriers described in subparagraph (A).
                    (C) Such other matters related to access by 
                veterans to telehealth while not on property of the 
                Department as the Secretary considers relevant.
            (3) Report.--Not later than 120 days after the completion 
        of the assessment required by paragraph (1), the Secretary 
        shall submit to the Committee on Veterans' Affairs of the 
        Senate and the Committee on Veterans' Affairs of the House of 
        Representatives a report on the assessment, including any 
        recommendations for legislative or administrative action based 
        on the results of the assessment.

SEC. 702. PARTNERSHIPS WITH NON-FEDERAL GOVERNMENT ENTITIES TO PROVIDE 
              HYPERBARIC OXYGEN THERAPY TO VETERANS AND STUDIES ON THE 
              USE OF SUCH THERAPY FOR TREATMENT OF POST-TRAUMATIC 
              STRESS DISORDER AND TRAUMATIC BRAIN INJURY.

    (a) Partnerships to Provide Hyperbaric Oxygen Therapy to 
Veterans.--
            (1) Use of partnerships.--The Secretary of Veterans 
        Affairs, in consultation with the Center for Compassionate 
        Innovation within the Office of Community Engagement of the 
        Department of Veterans Affairs, may enter into partnerships 
        with non-Federal Government entities to provide hyperbaric 
        oxygen treatment to veterans to research the effectiveness of 
        such therapy.
            (2) Types of partnerships.--Partnerships entered into under 
        paragraph (1) may include the following:
                    (A) Partnerships to conduct research on hyperbaric 
                oxygen therapy.
                    (B) Partnerships to review research on hyperbaric 
                oxygen therapy provided to nonveterans.
                    (C) Partnerships to create industry working groups 
                to determine standards for research on hyperbaric 
                oxygen therapy.
                    (D) Partnerships to provide to veterans hyperbaric 
                oxygen therapy for the purposes of conducting research 
                on the effectiveness of such therapy.
            (3) Limitation on federal funding.--Federal Government 
        funding may be used to coordinate and administer the 
        partnerships under this subsection but may not be used to carry 
        out activities conducted under such partnerships.
    (b) Review of Effectiveness of Hyperbaric Oxygen Therapy.--Not 
later than 90 days after the date of the enactment of this Act, the 
Secretary, in consultation with the Center for Compassionate 
Innovation, shall begin using an objective and quantifiable method to 
review the effectiveness and applicability of hyperbaric oxygen 
therapy, such as through the use of a device approved or cleared by the 
Food and Drug Administration that assesses traumatic brain injury by 
tracking eye movement.
    (c) Systematic Review of Use of Hyperbaric Oxygen Therapy to Treat 
Certain Conditions.--
            (1) In general.--Not later than 90 days after the date of 
        the enactment of this Act, the Secretary, in consultation with 
        the Center for Compassionate Innovation, shall commence the 
        conduct of a systematic review of published research literature 
        on off-label use of hyperbaric oxygen therapy to treat post-
        traumatic stress disorder and traumatic brain injury among 
        veterans and nonveterans.
            (2) Elements.--The review conducted under paragraph (1) 
        shall include the following:
                    (A) An assessment of the current parameters for 
                research on the use by the Department of Veterans 
                Affairs of hyperbaric oxygen therapy, including--
                            (i) tests and questionnaires used to 
                        determine the efficacy of such therapy; and
                            (ii) metrics for determining the success of 
                        such therapy.
                    (B) A comparative analysis of tests and 
                questionnaires used to study post-traumatic stress 
                disorder and traumatic brain injury in other research 
                conducted by the Department of Veterans Affairs, other 
                Federal agencies, and entities outside the Federal 
                Government.
            (3) Completion of review.--The review conducted under 
        paragraph (1) shall be completed not later than 180 days after 
        the date of the commencement of the review.
            (4) Report.--Not later than 90 days after the completion of 
        the review conducted under paragraph (1), the Secretary shall 
        submit to the Committee on Veterans' Affairs of the Senate and 
        the Committee on Veterans' Affairs of the House of 
        Representatives a report on the results of the review.
    (d) Follow-up Study.--
            (1) In general.--Not later than 120 days after the 
        completion of the review conducted under subsection (c), the 
        Secretary, in consultation with the Center for Compassionate 
        Innovation, shall commence the conduct of a study on all 
        individuals receiving hyperbaric oxygen therapy through the 
        current pilot program of the Department for the provision of 
        hyperbaric oxygen therapy to veterans to determine the efficacy 
        and effectiveness of hyperbaric oxygen therapy for the 
        treatment of post-traumatic stress disorder and traumatic brain 
        injury.
            (2) Elements.--The study conducted under paragraph (1) 
        shall include the review and publication of any data and 
        conclusions resulting from research conducted by an authorized 
        provider of hyperbaric oxygen therapy for veterans through the 
        pilot program described in such paragraph.
            (3) Completion of study.--The study conducted under 
        paragraph (1) shall be completed not later than three years 
        after the date of the commencement of the study.
            (4) Report.--
                    (A) In general.--Not later than 90 days after 
                completing the study conducted under paragraph (1), the 
                Secretary shall submit to the Committee on Veterans' 
                Affairs of the Senate and the Committee on Veterans' 
                Affairs of the House of Representatives a report on the 
                results of the study.
                    (B) Elements.--The report required under 
                subparagraph (A) shall include the recommendation of 
                the Secretary with respect to whether or not hyperbaric 
                oxygen therapy should be made available to all veterans 
                with traumatic brain injury or post-traumatic stress 
                disorder.

SEC. 703. PRESCRIPTION OF TECHNICAL QUALIFICATIONS FOR LICENSED HEARING 
              AID SPECIALISTS AND REQUIREMENT FOR APPOINTMENT OF SUCH 
              SPECIALISTS.

    (a) Technical Qualifications.--
            (1) In general.--Not later than 180 days after the date of 
        the enactment of this Act, the Secretary of Veterans Affairs 
        shall prescribe the technical qualifications required under 
        section 7402(b)(14) of title 38, United States Code, to be 
        appointed as a licensed hearing aid specialist under section 
        7401(3) of such title.
            (2) Elements for qualifications.--In prescribing the 
        qualifications for licensed hearing aid specialists under 
        paragraph (1), the Secretary shall, at a minimum, ensure that 
        such qualifications are consistent with--
                    (A) the standards for licensure of hearing aid 
                specialists that are required by a majority of States;
                    (B) any competencies needed to perform tasks and 
                services commonly performed by hearing aid specialists 
                pursuant to such standards; and
                    (C) any competencies needed to perform tasks 
                specific to providing care to individuals under the 
                laws administered by the Secretary.
    (b) Authority to Set and Maintain Duties.--The Secretary shall 
retain the authority to set and maintain the duties for licensed 
hearing aid specialists appointed under section 7401(3) of title 38, 
United States Code, for the purposes of the employment of such 
specialists with the Department of Veterans Affairs.
    (c) Appointment.--Not later than September 30, 2022, the Secretary 
shall appoint not fewer than one licensed hearing aid specialist at 
each medical center of the Department.
    (d) Report.--Not later than September 30, 2022, and annually 
thereafter, the Secretary shall submit to the Committee on Veterans' 
Affairs of the Senate and the Committee on Veterans' Affairs of the 
House of Representatives a report--
            (1) assessing the progress of the Secretary in appointing 
        licensed hearing aid specialists under subsection (c);
            (2) assessing potential conflicts or obstacles that prevent 
        the appointment of licensed hearing aid specialists;
            (3) assessing the factors that led to such conflicts or 
        obstacles;
            (4) assessing access of patients to comprehensive hearing 
        health care services from the Department consistent with the 
        requirements under section 4(b) of the Veterans Mobility Safety 
        Act of 2016 (Public Law 114-256; 38 U.S.C. 7401 note), 
        including an assessment of the impact of infrastructure and 
        equipment limitations on wait times for audiologic care; and
            (5) indicating the medical centers of the Department with 
        vacancies for audiologists or licensed hearing aid specialists.

SEC. 704. USE BY DEPARTMENT OF VETERANS AFFAIRS OF COMMERCIAL 
              INSTITUTIONAL REVIEW BOARDS IN SPONSORED RESEARCH TRIALS.

    (a) In General.--Not later than 90 days after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall complete 
all necessary policy revisions within the directive of the Veterans 
Health Administration numbered 1200.05 and titled ``Requirements for 
the Protection of Human Subjects in Research'', to allow sponsored 
clinical research of the Department of Veterans Affairs to use 
accredited commercial institutional review boards to review research 
proposal protocols of the Department.
    (b) Identification of Review Boards.--Not later than 90 days after 
the completion of the policy revisions under subsection (a), the 
Secretary shall--
            (1) identify accredited commercial institutional review 
        boards for use in connection with sponsored clinical research 
        of the Department; and
            (2) establish a process to modify existing approvals in the 
        event that a commercial institutional review board loses its 
        accreditation during an ongoing clinical trial.
    (c) Report.--
            (1) In general.--Not later than 90 days after the 
        completion of the policy revisions under subsection (a), and 
        annually thereafter, the Secretary shall submit to the 
        Committee on Veterans' Affairs of the Senate and the Committee 
        on Veterans' Affairs of the House of Representatives a report 
        on all approvals of institutional review boards used by the 
        Department, including central institutional review boards and 
        commercial institutional review boards.
            (2) Elements.--The report required by paragraph (1) shall 
        include, at a minimum, the following:
                    (A) The name of each clinical trial with respect to 
                which the use of an institutional review board has been 
                approved.
                    (B) The institutional review board or institutional 
                review boards used in the approval process for each 
                clinical trial.
                    (C) The amount of time between submission and 
                approval.

SEC. 705. CREATION OF OFFICE OF RESEARCH REVIEWS WITHIN THE OFFICE OF 
              INFORMATION AND TECHNOLOGY OF THE DEPARTMENT OF VETERANS 
              AFFAIRS.

    (a) In General.--Not later than one year after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall 
establish within the Office of Information and Technology of the 
Department of Veterans Affairs an Office of Research Reviews (in this 
section referred to as the ``Office'').
    (b) Elements.--The Office shall do the following:
            (1) Perform centralized security reviews and complete 
        security processes for approved research sponsored outside the 
        Department, with a focus on multi-site clinical trials.
            (2) Develop and maintain a list of commercially available 
        software preferred for use in sponsored clinical trials of the 
        Department and ensure such list is maintained as part of the 
        official approved software products list of the Department.
            (3) Develop benchmarks for appropriate timelines for 
        security reviews conducted by the Office.
    (c) Report.--
            (1) In general.--Not later than one year after the 
        establishment of the Office, the Office shall submit to the 
        Committee on Veterans' Affairs of the Senate and the Committee 
        on Veterans' Affairs of the House of Representatives a report 
        on the activity of the Office.
            (2) Elements.--The report required by paragraph (1) shall 
        include, at a minimum, the following:
                    (A) The number of security reviews completed.
                    (B) The number of personnel assigned for performing 
                the functions described in subsection (b).

            Passed the Senate August 5, 2020.

            Attest:

                                                             Secretary.
116th CONGRESS

  2d Session

                                 S. 785

_______________________________________________________________________

                                 AN ACT

 To improve mental health care provided by the Department of Veterans 
                    Affairs, and for other purposes.
```