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[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 785 Enrolled Bill (ENR)]

        S.785

                     One Hundred Sixteenth Congress

                                 of the

                        United States of America

                          AT THE SECOND SESSION

           Begun and held at the City of Washington on Friday,
            the third day of January, two thousand and twenty

                                 An Act

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

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
    (a) Short Title.--This Act may be cited as the ``Commander John 
Scott Hannon Veterans Mental Health Care Improvement Act of 2019''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.

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

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

                      TITLE II--SUICIDE PREVENTION

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

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

Sec. 301. Study on connection between living at high altitude and 
          suicide risk factors among veterans.
Sec. 302. Establishment by Department of Veterans Affairs and Department 
          of Defense of a clinical provider treatment toolkit and 
          accompanying training materials for comorbidities.
Sec. 303. Update of clinical practice guidelines for assessment and 
          management of patients at risk for suicide.
Sec. 304. Establishment by Department of Veterans Affairs and Department 
          of Defense of clinical practice guidelines for the treatment 
          of serious mental illness.
Sec. 305. Precision medicine initiative of Department of Veterans 
          Affairs to identify and validate brain and mental health 
          biomarkers.
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).

                               Speaker of the House of Representatives.

                            Vice President of the United States and    
                                               President of the Senate.
```