II 

116TH CONGRESS 

1ST SESSION S. 785 

To improve mental health care provided by the Department of Veterans 

Affairs, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

MARCH 13, 2019 

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

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

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

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

DUCKWORTH) introduced the following bill; which was read twice and referred to the Committee on Veterans’ Affairs 

A BILL 

To improve mental health care provided by the Department 

of Veterans Affairs, and for other purposes. 

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

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

5 ‘‘Commander John Scott Hannon Veterans Mental Health 

6 Care Improvement Act of 2019’’. 

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

8 this Act is as follows: 


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Sec. 1. Short title; table of contents. 

TITLE I—IMPROVEMENT OF TRANSITION OF INDIVIDUALS TO 

SERVICES FROM DEPARTMENT OF VETERANS AFFAIRS 

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

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

the Armed Forces transitioning to civilian life. 

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

members of the Armed Forces. 

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

honorable discharges and report on such care. 

TITLE II—SUICIDE PREVENTION 

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

veterans. 

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

Sec. 203. Post-traumatic growth partnerships. 

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

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

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

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

Sec. 207. Comptroller General report on management by Department of Veterans Affairs of veterans at high risk for suicide. 

TITLE III—PROGRAMS, STUDIES, AND GUIDELINES ON MENTAL 

HEALTH 

Sec. 301. Program to provide veterans access to computerized cognitive behavioral therapy. 

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

factors among veterans. 

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

Defense of clinical practice guidelines for comorbid mental 

health conditions. 

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

of patients at risk for suicide. 

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

identify and validate brain and mental health biomarkers. 

Sec. 306. Preventative and complex data analysis by Department of Veterans 

Affairs. 

TITLE IV—OVERSIGHT OF MENTAL HEALTH CARE AND RELATED 

SERVICES 

Sec. 401. Study on effectiveness of suicide prevention and mental health outreach programs of Department of Veterans Affairs. 

Sec. 402. Oversight of mental health and suicide prevention media outreach 

conducted by Department of Veterans Affairs. 

Sec. 403. Annual report on progress of Department of Veterans Affairs in 

meeting goals and objectives of Executive Order 13822. 


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

prevention services of Department of Veterans Affairs. 

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

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

Department of Defense. 

TITLE V—MEDICAL WORKFORCE 

Subtitle A—Improvement of Mental Health Medical Workforce 

Sec. 501. Treatment of psychologists. 

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

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

therapists of Department of Veterans Affairs. 

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

Sec. 505. Establishment of Department of Veterans Affairs Readjustment 

Counseling Service Scholarship Program. 

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

Department of Veterans Affairs. 

Sec. 507. Expansion of reporting requirements on Readjustment Counseling 

Service of Department of Veterans Affairs. 

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

Health Administration. 

Sec. 509. Suicide prevention coordinators. 

Subtitle B—Direct Hiring Authorities for Certain Health Care Positions 

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

TITLE VI—IMPROVEMENT OF TELEHEALTH SERVICES 

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

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

1 TITLE I—IMPROVEMENT OF 

2 TRANSITION OF INDIVIDUALS 

3 TO SERVICES FROM DEPART4 MENT OF VETERANS AFFAIRS 

5 SEC. 101. EXPANSION OF HEALTH CARE COVERAGE FOR 

6 VETERANS. 

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

8 United States Code, is amended— 


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

2 the end; 

3 (2) by redesignating subparagraph (B) as sub4 paragraph (C); and 

5 (3) by inserting after subparagraph (A) the fol6 lowing new subparagraph (B): 

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

8 following the discharge or release of the veteran 

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

10 (b) PATIENT ENROLLMENT SYSTEM.—Section 

11 1705(c) of such title is amended by adding at the end the 

12 following new paragraph: 

13 ‘‘(3) Nothing in this section shall be construed to pre14 vent the Secretary from providing hospital care and med15 ical services to a veteran under section 1710(a)(1)(B) of 

16 this title during the period specified in such section not17 withstanding the failure of the veteran to enroll in the sys18 tem of patient enrollment established by the Secretary 

19 under subsection (a).’’. 

20 (c) PROMOTION OF EXPANDED ELIGIBILITY.— 

21 (1) TRANSITION ASSISTANCE PROGRAM.— 

22 (A) IN GENERAL.—The Secretary of 

23 Labor, in consultation with the Secretary of 

24 Defense and the Secretary of Veterans Affairs, 

25 shall promote to members of the Armed Forces 


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1 transitioning from service in the Armed Forces 

2 to civilian life through the Transition Assist3 ance Program the expanded eligibility of vet4 erans for health care under the laws adminis5 tered by the Secretary of Veterans Affairs pur6 suant to the amendments made by this section. 

7 (B) TRANSITION ASSISTANCE PROGRAM

8 DEFINED.—In this paragraph, the term ‘‘Tran9 sition Assistance Program’’ means the Transi10 tion Assistance Program under sections 1142 

11 and 1144 of title 10, United States Code. 

12 (2) PUBLICATION BY DEPARTMENT OF VET13 ERANS AFFAIRS.—Not later than 30 days after the 

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

15 Veterans Affairs shall publish on a website of the 

16 Department of Veterans Affairs notification of the 

17 expanded eligibility of veterans for health care under 

18 the laws administered by the Secretary pursuant to 

19 the amendments made by this section. 

20 SEC. 102. GRANTS FOR PROVISION OF TRANSITION ASSIST21 ANCE TO FORMER MEMBERS OF THE ARMED 

22 FORCES TRANSITIONING TO CIVILIAN LIFE. 

23 (a) PROGRAM REQUIRED.—Commencing not later 

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

25 the Secretary of Labor shall, in coordination with the SecVerDate Sep 11 2014 22:25 Apr 03, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S785.IS S785

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1 retary of Veterans Affairs, carry out a program on the 

2 provision of assistance to former members of the Armed 

3 Forces, and spouses of such members, transitioning from 

4 service in the Armed Forces to civilian life. 

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

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

7 period beginning on the date of the commencement of the 

8 program. 

9 (c) GRANTS.— 

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

11 out the program through the award of grants to eli12 gible organizations for the provision of assistance de13 scribed in subsection (a). 

14 (2) MATCHING FUNDS REQUIRED.—A grant 

15 under this section shall be in an amount that does 

16 not exceed 50 percent of the amount required by the 

17 organization to provide the services described in sub18 section (f). 

19 (d) ELIGIBLE ORGANIZATIONS.—For purposes of 

20 this section, an eligible organization is any nonprofit orga21 nization that the Secretary of Labor determines, in con22 sultation with the Secretary of Veterans Affairs and State 

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

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1 retary of Labor of an application submitted under sub2 section (e)(1). 

3 (e) SELECTION OF GRANT RECIPIENTS.— 

4 (1) APPLICATIONS.—An organization seeking a 

5 grant under the program shall submit to the Sec6 retary of Labor an application therefor at such time, 

7 in such manner, and containing such information 

8 and assurances as the Secretary, in consultation 

9 with the Secretary of Veterans Affairs and State en10 tities that serve veterans, may require. 

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

12 awarding grants under the program, the Secretary 

13 of Labor shall give priority to an organization that 

14 provides multiple forms of services described in sub15 section (f). 

16 (f) USE OF GRANT FUNDS.—Each organization re17 ceiving a grant under the program shall use the grant to 

18 provide to former members of the Armed Forces and 

19 spouses described in subsection (a) the following: 

20 (1) Re ́sume ́ assistance. 

21 (2) Interview training. 

22 (3) Job recruitment training. 

23 (4) Entrepreneurship training. 

24 (5) Financial services. 

25 (6) Legal assistance. 


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1 (7) Educational supportive services. 

2 (8) Assistance with accessing benefits provided 

3 under laws administered by the Secretary of Vet4 erans Affairs, including home loan benefits, edu5 cation benefits, adaptive housing grants, and all 

6 other benefits. 

7 (9) Nonclinical case management. 

8 (10) Other related services leading directly to 

9 successful transition, as determined by the Secretary 

10 of Labor in consultation with the Secretary of Vet11 erans Affairs. 

12 (g) ANNUAL REPORTS.— 

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

14 after the date of the commencement of the program 

15 and not less frequently than once each year there16 after until the termination of the program, the Sec17 retary of Labor shall, in consultation with the Sec18 retary of Veterans Affairs, submit to the appropriate 

19 committees of Congress a report on the program 

20 carried out under this section. 

21 (2) CONTENTS.—Each report submitted under 

22 paragraph (1) shall include the following: 

23 (A) A list of the organizations that have 

24 received grants under the program, including 

25 the geographic location of the organization and 


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1 the types of services outlined in subsection (f) 

2 that each organization provides. 

3 (B) The number of veterans served by each 

4 organization. 

5 (C) An assessment of the effectiveness of 

6 the services provided under the program at im7 proving the transition process for former mem8 bers of the Armed Forces and spouses described 

9 in subsection (a), based on metrics determined 

10 by the Secretary of Labor in consultation with 

11 the Secretary of Veterans Affairs. 

12 (D) The amount of each grant awarded to 

13 each organization under the program. 

14 (E) Such other matters as the Secretary of 

15 Labor, in consultation with the Secretary of 

16 Veterans Affairs, considers appropriate. 

17 (3) APPROPRIATE COMMITTEES OF CON18 GRESS.—In this subsection, the term ‘‘appropriate 

19 committees of Congress’’ means— 

20 (A) the Committee on Veterans’ Affairs 

21 and the Committee on Appropriations of the 

22 Senate; and 

23 (B) the Committee on Veterans’ Affairs 

24 and the Committee on Appropriations of the 

25 House of Representatives. 


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1 (h) AUTHORIZATION OF APPROPRIATIONS.—There is 

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

3 this section. 

4 SEC. 103. STUDY OF COMMUNITY-BASED TRANSITION AS5 SISTANCE PROGRAMS FOR FORMER MEM6 BERS OF THE ARMED FORCES. 

7 (a) STUDY.— 

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

9 Affairs shall, in consultation with the Secretary of 

10 Labor and State entities that serve former members 

11 of the Armed Forces, enter into an agreement with 

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

13 a comprehensive list of community-based programs 

14 that— 

15 (A) provide transition assistance to such 

16 former members that lead directly to successful 

17 transition to civilian life, such as— 

18 (i) re ́sume ́ assistance; 

19 (ii) interview training; 

20 (iii) job recruitment training; 

21 (iv) entrepreneurship training; 

22 (v) financial services; 

23 (vi) legal assistance; 

24 (vii) educational supportive services; 


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1 (viii) assistance with accessing bene2 fits provided under laws administered by 

3 the Secretary of Veterans Affairs, includ4 ing home loan benefits, education benefits, 

5 adaptive housing grants, and other bene6 fits; and 

7 (ix) nonclinical case management; and 

8 (B) are operated by nonprofit organiza9 tions. 

10 (2) UPDATES.— 

11 (A) PERIODIC.—Not less frequently than 

12 once every five years, the Secretary shall update 

13 the list created under paragraph (1). 

14 (B) UPON REQUEST.—In addition to peri15 odic updates under subparagraph (A), the Sec16 retary shall update the list created under para17 graph (1) upon request of an organization with 

18 a program included in the list. 

19 (C) VERIFICATION.—The Secretary shall, 

20 in consultation with State entities that serve 

21 former members of the Armed Forces and to 

22 the degree practicable, verify changes to the list 

23 made under this paragraph. 

24 (b) TRANSMISSION TO MEMBERS.—The Secretary 

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


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

2 the Secretary of Defense so the Secretaries of the military 

3 departments may provide information in the list to mem4 bers of the Armed Forces who participate in the Transi5 tion Assistance Program under sections 1142 and 1144 

6 of title 10, United States Code. 

7 (c) ONLINE PUBLICATION.—The Secretary of Vet8 erans Affairs shall publish the list created, and revised as 

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

10 of the Department of Veterans Affairs. 

11 SEC. 104. MODIFICATION OF ELIGIBILITY FOR CARE FROM 

12 DEPARTMENT OF VETERANS AFFAIRS FOR 

13 FORMER MEMBERS OF THE ARMED FORCES 

14 WITH OTHER THAN HONORABLE DIS15 CHARGES AND REPORT ON SUCH CARE. 

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

17 1720I of title 38, United States Code, is amended by 

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

19 dismissal’’. 

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

21 amended— 

22 (1) in paragraph (3)— 

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

24 ‘‘and’’ at the end; 


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

2 ‘‘and’’ at the end; 

3 (C) by redesignating subparagraph (C) as 

4 subparagraph (D); and 

5 (D) by inserting after subparagraph (B) 

6 the following new subparagraph (C): 

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

8 of the Department; and’’; 

9 (2) by redesignating paragraph (4) as para10 graph (5); and 

11 (3) by inserting after paragraph (3) the fol12 lowing new paragraph (4): 

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

14 engines; and’’. 

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

16 is amended— 

17 (1) in paragraph (1), by striking ‘‘Not less fre18 quently than once’’ and inserting ‘‘Not later than 

19 February 15’’; and 

20 (2) in paragraph (2)— 

21 (A) by redesignating subparagraph (C) as 

22 subparagraph (F); and 

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

24 following new subparagraphs: 


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

2 health care needs treated under this section. 

3 ‘‘(D) The demographics of individuals 

4 being treated under this section, including— 

5 ‘‘(i) age; 

6 ‘‘(ii) era of service in the Armed 

7 Forces; 

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

9 Forces; and 

10 ‘‘(iv) geographic location. 

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

12 individual for mental or behavioral health care 

13 under this section.’’. 

14 TITLE II—SUICIDE PREVENTION 

15 SEC. 201. GRANTS FOR ORGANIZATIONS PROVIDING MEN16 TAL HEALTH WELLNESS SERVICES TO VET17 ERANS. 

18 (a) PURPOSE.—The purpose of this section is to fa19 cilitate the provision of mental health services for veterans 

20 with mental health conditions who are receiving care out21 side of the Department of Veterans Affairs. 

22 (b) GRANTS.— 

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

24 of title 38, United States Code, is amended by add25 ing at the end the following new section: 


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1 ‘‘§ 1720J. Financial assistance for mental health sup2 portive services for veterans seeking 

3 mental health treatment 

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

5 (1) The Secretary shall provide financial assistance to eli6 gible entities approved under this section to provide or co7 ordinate the provision of mental health supportive services 

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

9 health condition who is seeking mental health treatment. 

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

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

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

13 which the approved eligible entity is providing or coordi14 nating the provision of mental health supportive services. 

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

16 section to each approved eligible entity that is providing 

17 or coordinating the provision of mental health supportive 

18 services under this section. 

19 ‘‘(B) The Secretary may establish intervals of pay20 ment for the administration of grants under this section 

21 and establish a maximum amount to be awarded, in ac22 cordance with the services being provided and the duration 

23 of such services. 

24 ‘‘(4) In providing financial assistance under para25 graph (1), the Secretary shall give preference to entities 

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1 tal health services for veterans with mental health condi2 tions who face barriers in accessing mental health care 

3 services from the Department. 

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

5 practicable, financial assistance under this subsection is 

6 equitably distributed across geographic regions, including 

7 rural communities and tribal lands. 

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

9 this section to provide mental health supportive services 

10 to a veteran with a mental health condition shall notify 

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

12 or in part, by the Department. 

13 ‘‘(7) The Secretary shall require entities receiving fi14 nancial assistance under this section to submit a report 

15 to the Secretary that describes the services provided or 

16 coordinated with such financial assistance. 

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

18 The mental health supportive services described in this 

19 subsection are services provided by an eligible entity or 

20 a subcontractor of an eligible entity that address the needs 

21 of veterans with mental health conditions, including— 

22 ‘‘(1) outreach services; 

23 ‘‘(2) case management services; 

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

25 the Department that the veteran may be eligible to 


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1 receive, including health care services, vocational and 

2 rehabilitation counseling, employment and training 

3 services, and educational assistance; and 

4 ‘‘(4) assistance in obtaining and coordinating 

5 the provision of other public benefits provided by 

6 any Federal, State, or local agency, or any other eli7 gible entity, including— 

8 ‘‘(A) health care services (including obtain9 ing health insurance); 

10 ‘‘(B) daily living services; 

11 ‘‘(C) personal financial planning services; 

12 ‘‘(D) transportation services; 

13 ‘‘(E) income support services; 

14 ‘‘(F) fiduciary and representative payee 

15 services; 

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

17 with issues that interfere with the ability of the 

18 veteran to find and retain meaningful employ19 ment, housing, or benefits to which the veteran 

20 may be entitled; 

21 ‘‘(H) child care services; 

22 ‘‘(I) housing counseling; and 

23 ‘‘(J) other services necessary for maintain24 ing independent living. 


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

2 (1) An eligible entity seeking financial assistance under 

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

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

5 such commitments and information as the Secretary deter6 mines to be necessary to carry out this section. 

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

8 under paragraph (1) shall contain— 

9 ‘‘(A) a description of the mental health sup10 portive services described in subsection (b) proposed 

11 to be provided by the eligible entity under this sec12 tion and the identified needs for those services; 

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

14 a mental health condition proposed to be provided 

15 such services; 

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

17 with a mental health condition proposed to be pro18 vided such services; 

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

20 entity in providing mental health supportive services 

21 to veterans with a mental health condition; and 

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

23 the eligible entity— 

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

25 health supportive services with the provision of 


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1 mental health services by the eligible entity or 

2 another organization; 

3 ‘‘(ii) to assess continually the needs of vet4 erans with a mental health condition for mental 

5 health supportive services; 

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

7 health supportive services with the services of 

8 the Department; and 

9 ‘‘(iv) to tailor supportive mental health 

10 services to the needs of veterans with a mental 

11 health condition. 

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

13 selection of eligible entities to be provided financial assist14 ance under this section. 

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

16 with respect to an eligible entity shall include the fol17 lowing: 

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

19 by each State in which the eligible entity operates. 

20 ‘‘(ii) Experience coordinating care or providing 

21 treatment for veterans or members of the Armed 

22 Forces. 

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

24 shall provide training and technical assistance to eligible 

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1 garding the planning, development, and provision of men2 tal health supportive services under this section. 

3 ‘‘(2) The Secretary may provide the training de4 scribed in paragraph (1) directly or through grants or con5 tracts with appropriate public or nonprofit private entities, 

6 including through grants awarded under section 2064 of 

7 this title. 

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

9 practicable, the Secretary may collect information from an 

10 eligibility entity awarded a grant under this section relat11 ing to a mental health condition of a veteran for inclusion 

12 in the electronic health record of the Department for such 

13 veteran for the sole purpose of improving care provided 

14 to such veteran. 

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

16 Department for medical services, there shall be available 

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

18 ‘‘(1) $5,000,000 for fiscal year 2021. 

19 ‘‘(2) $10,000,000 for fiscal year 2022. 

20 ‘‘(3) $15,000,000 for fiscal year 2023. 

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

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

23 following: 

24 ‘‘(A) An incorporated private institution or 

25 foundation— 


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

2 which inures to the benefit of any member, 

3 founder, contributor, or individual; 

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

5 is responsible for the operation of the men6 tal health supportive services provided 

7 under this section; and 

8 ‘‘(iii) that is approved by the Sec9 retary with respect to financial responsi10 bility. 

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

12 sole general partner of which is an organization 

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

14 and (iii) of subparagraph (A). 

15 ‘‘(C) A corporation wholly owned and con16 trolled by an organization meeting the require17 ments of clauses (i), (ii), and (iii) of subpara18 graph (A). 

19 ‘‘(D) A tribally designated housing entity 

20 (as defined in section 4 of the Native American 

21 Housing Assistance and Self-Determination Act 

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

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

24 condition’ means a veteran who has been diagnosed 

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


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1 mental health conditions, as determined by the Sec2 retary.’’. 

3 (2) CLERICAL AMENDMENT.—The table of sec4 tions at the beginning of chapter 17 is amended by 

5 inserting after the item relating to section 1720I the 

6 following new item: 

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

seeking mental health treatment.’’. 

7 (c) STUDY ON EFFECTIVENESS OF PROGRAM.— 

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

9 Affairs shall conduct a study on the effectiveness of 

10 the program of financial assistance under section 

11 1720J of title 38, United States Code, as added by 

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

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

14 that section. 

15 (2) COMPARISON.—In conducting the study re16 quired by paragraph (1), the Secretary shall com17 pare the results of the program described in that 

18 paragraph with other programs of the Department 

19 of Veterans Affairs dedicated to the delivery of men20 tal health services to veterans. 

21 (3) CRITERIA.—In making the comparison re22 quired by paragraph (2), the Secretary shall examine 

23 the following: 


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1 (A) The satisfaction of veterans targeted 

2 by the programs described in paragraph (2). 

3 (B) The health status of such veterans. 

4 (C) The mental wellness of such veterans. 

5 (D) The degree to which such veterans are 

6 encouraged to engage in productive activity by 

7 such programs. 

8 (E) The number of veterans using such 

9 programs, disaggregated by— 

10 (i) veterans who have received care 

11 from the Department in the previous two 

12 years; and 

13 (ii) veterans who have not received 

14 care from the Department in the previous 

15 two years. 

16 (F) The number of veterans who die by 

17 suicide while receiving services from an entity 

18 in receipt of a grant under the program of fi19 nancial assistance under section 1720J of title 

20 38, United States Code, as added by subsection 

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

22 period after receiving such services. 

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

24 2021, and annually thereafter, the Secretary shall 

25 submit to the Committee on Veterans’ Affairs of the 


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1 Senate and the Committee on Veterans’ Affairs of 

2 the House of Representatives a report on the results 

3 of the study required by paragraph (1). 

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

5 providing financial assistance under section 1720J of title 

6 38, United States Code, as added by subsection (b), not 

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

8 Act. 

9 SEC. 202. DESIGNATION OF BUDDY CHECK WEEK BY DE10 PARTMENT OF VETERANS AFFAIRS. 

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

12 shall designate one week per year to organize outreach 

13 events and educate veterans on how to conduct peer 

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

15 Week’’. 

16 (b) EVENTS AND EDUCATION.— 

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

18 the Secretary, in consultation with organizations 

19 that represent veterans, non-profits that serve vet20 erans, mental health experts, members of the Armed 

21 Forces, and such other entities and individuals as 

22 the Secretary considers appropriate, shall collaborate 

23 with organizations that represent veterans to provide 

24 educational opportunities for veterans to learn how 

25 to conduct peer wellness checks. 


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1 (2) TRAINING MATTERS.—As part of the edu2 cational opportunities provided under paragraph (1), 

3 the Secretary shall provide the following: 

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

5 peer wellness checks that includes information 

6 on appropriate referrals to resources veterans 

7 might need. 

8 (B) Online and in-person training, as ap9 propriate, on how to conduct a peer wellness 

10 check. 

11 (C) Opportunities for members of organi12 zations that represent veterans to learn how to 

13 train individuals to conduct peer wellness 

14 checks. 

15 (D) Training for veterans participating in 

16 Buddy Check Week on how to transfer a phone 

17 call directly to the Veterans Crisis Line. 

18 (E) Resiliency training for veterans partici19 pating in Buddy Check Week on handling a vet20 eran in crisis. 

21 (3) ONLINE MATERIALS.—All training materials 

22 provided under the educational opportunities under 

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

24 of the Department. 


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

2 organizations that represent veterans, may conduct out3 reach regarding educational opportunities under sub4 section (b) at— 

5 (1) public events where many veterans are ex6 pected to congregate; 

7 (2) meetings of organizations that represent 

8 veterans; 

9 (3) facilities of the Department of Veterans Af10 fairs; and 

11 (4) such other locations as the Secretary, in col12 laboration with organizations that represent vet13 erans, considers appropriate. 

14 (d) VETERANS CRISIS LINE PLAN.— 

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

16 that the Veterans Crisis Line has a plan for han17 dling the potential increase of calls that may occur 

18 during Buddy Check Week. 

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

20 Veterans Crisis Line shall submit to the Secretary a 

21 plan for how to handle excess calls during Buddy 

22 Check Week, which may include the following: 

23 (A) Additional hours for staff. 

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


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1 (C) Any other plan to ensure that calls 

2 from veterans in crisis are being answered in a 

3 timely manner by an individual trained at the 

4 same level as a Veterans Crisis Line responder. 

5 (e) VETERANS CRISIS LINE DEFINED.—In this sec6 tion, the term ‘‘Veterans Crisis Line’’ means the toll-free 

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

8 title 38, United States Code. 

9 SEC. 203. POST-TRAUMATIC GROWTH PARTNERSHIPS. 

10 (a) IN GENERAL.—The Secretary of Veterans Af11 fairs, in consultation with the Secretary of Defense and 

12 the Secretary of Homeland Security, shall enter into part13 nerships with nonprofit mental health organizations to fa14 cilitate post-traumatic growth among veterans who have 

15 experienced trauma. 

16 (b) CONSULTATION.—Before entering into a partner17 ship under subsection (a), the Secretary of Veterans Af18 fairs shall consult with the National Institute of Mental 

19 Health, the National Alliance on Mental Illness, the Amer20 ican Psychological Association, the Posttraumatic Growth 

21 Research Group, and organizations that represent vet22 erans. 

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

24 Veterans Affairs shall ensure that each organization with 

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1 section (a) has a demonstrated history of success with pro2 grams to facilitate post-traumatic growth, including— 

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

4 participated in such a program for not less than one 

5 year after completion of the program; and 

6 (2) sustained positive, clinically significant out7 comes for veterans who have participated in such a 

8 program for not less than 180 days after completion 

9 of the program. 

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

11 Veterans Affairs shall require each nonprofit mental 

12 health organization that enters into a partnership with the 

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

14 a description of the outcomes from such partnership, in15 cluding the following: 

16 (1) The number of veterans who participate in 

17 programs of the organization to facilitate post-trau18 matic growth, including the number of veterans who 

19 drop out before completion of the program. 

20 (2) The types of mental or behavioral health 

21 conditions of veterans who participate in such pro22 grams. 

23 (3) The percentage of veterans who experience 

24 significant post-traumatic growth. 


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1 (4) Such other topics as the Secretary may re2 quire to track post-traumatic growth. 

3 (e) POST-TRAUMATIC GROWTH.— 

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

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

6 described in paragraph (3) experienced after, and 

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

8 life crisis. 

9 (2) MEASUREMENT OF GROWTH.—Post-trau10 matic growth under this section shall be measured 

11 through self-reported scales, use of the post-trau12 matic stress disorder checklist set forth in the most 

13 recent edition of the Diagnostic and Statistical Man14 ual of Mental Disorders published by the American 

15 Psychiatric Association, and such other metrics as 

16 the Secretary considers necessary. 

17 (3) POSITIVE RESPONSES DESCRIBED.—Posi18 tive responses described in this paragraph are posi19 tive responses in one or more areas of life, including 

20 the following: 

21 (A) An appreciation of and for life. 

22 (B) Improved relationships with others. 

23 (C) Realization of new possibilities in life. 

24 (D) Realization of personal strength. 

25 (E) Spiritual change. 


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

2 consultation with organizations specified in sub3 section (b), considers necessary. 

4 SEC. 204. PROGRESS OF DEPARTMENT OF VETERANS AF5 FAIRS IN MEETING GOALS AND OBJECTIVES 

6 OF NATIONAL STRATEGY FOR PREVENTING 

7 VETERAN SUICIDE. 

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

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

10 goals and 43 objectives outlined in the National Strategy 

11 for Preventing Veteran Suicide, 2018–2028 prepared by 

12 the Office of Mental Health and Suicide Prevention of the 

13 Department of Veterans Affairs. 

14 (b) METRICS.—The metrics developed under sub15 section (a) shall include measures of both performance and 

16 effectiveness. 

17 (c) INITIAL REPORT.— 

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

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

21 Affairs of the Senate and the Committee on Vet22 erans’ Affairs of the House of Representatives a re23 port that contains the metrics developed under sub24 section (a). 


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1 (2) ELEMENTS.—The report submitted under 

2 paragraph (1) shall include the following: 

3 (A) An explanation of why the metrics de4 veloped under subsection (a) were chosen. 

5 (B) An assessment of how accurately those 

6 metrics will reflect the goals and objectives 

7 specified in such subsection. 

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

9 the submittal of the report under subsection (b), and an10 nually thereafter, the Secretary shall submit to the Com11 mittee on Veterans’ Affairs of the Senate and the Com12 mittee on Veterans’ Affairs of the House of Representa13 tives a report that contains— 

14 (1) an assessment of the progress of the De15 partment in meeting the goals and objectives speci16 fied in subsection (a); 

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

18 the Department if those goals and objectives are not 

19 being met; 

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

21 and objectives; 

22 (4) an identification of any new programs or 

23 partnerships that have resulted from the implemen24 tation of the National Strategy for Preventing Vet25 eran Suicide, 2018–2028; 


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1 (5) an assessment of the effectiveness of the 

2 National Strategy for Preventing Veterans Suicide, 

3 2018–2028 at reducing veteran suicide; and 

4 (6) such other topics as the Secretary considers 

5 necessary. 

6 SEC. 205. STUDY ON FEASIBILITY AND ADVISABILITY OF 

7 PROVIDING CERTAIN COMPLEMENTARY AND 

8 INTEGRATIVE HEALTH SERVICES. 

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

10 date of the enactment of this Act, the Secretary of Vet11 erans Affairs shall complete a study on the feasibility and 

12 advisability of providing complementary and integrative 

13 health treatments described in subsection (b) at all facili14 ties of the Department of Veterans Affairs. 

15 (b) TREATMENTS DESCRIBED.—Complementary and 

16 integrative health treatments described in this subsection 

17 shall consist of the following: 

18 (1) Yoga. 

19 (2) Meditation. 

20 (3) Acupuncture. 

21 (4) Chiropractic care. 

22 (5) Other treatments that show sufficient evi23 dence of efficacy at treating mental or physical 

24 health conditions, as determined by the Secretary. 


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

2 provide complementary and integrative health treatments 

3 under this section at a facility of the Department in per4 son or by telehealth. 

5 (d) REPORT.—Not later than 90 days after the com6 pletion of the study under subsection (a), the Secretary 

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

8 Senate and the Committee on Veterans’ Affairs of the 

9 House of Representatives a report on such study, includ10 ing— 

11 (1) the results of such study; and 

12 (2) such recommendations regarding the fur13 nishing of complementary and integrative health 

14 treatments described in subsection (b) as the Sec15 retary considers appropriate. 

16 SEC. 206. PROGRAM TO PROVIDE VETERANS ACCESS TO 

17 COMPLEMENTARY AND INTEGRATIVE 

18 HEALTH SERVICES THROUGH ANIMAL THER19 APY, AGRI-THERAPY, AND OUTDOOR SPORTS 

20 THERAPY. 

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

22 date of the enactment of this Act, the Secretary of Vet23 erans Affairs shall commence the conduct of a program 

24 to provide complementary and integrative health services 

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1 ment of Veterans Affairs or through the use of non-De2 partment entities for the treatment of post-traumatic 

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

4 determined by the Secretary. 

5 (b) TREATMENTS DESCRIBED.—Complementary and 

6 integrative health treatments described in this subsection 

7 shall consist of the following: 

8 (1) Equine therapy. 

9 (2) Other animal therapy. 

10 (3) Agri-therapy. 

11 (4) Outdoor sports therapy. 

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

13 participate in the program under this section if the vet14 eran— 

15 (1) is enrolled in the system of patient enroll16 ment of the Department established and operated 

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

18 Code; and 

19 (2) has received health care under the laws ad20 ministered by the Secretary during the two-year pe21 riod preceding the initial participation of the veteran 

22 in the program. 

23 (d) DURATION.— 

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

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


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1 period beginning on the commencement of the pro2 gram. 

3 (2) EXTENSION.—The Secretary may extend 

4 the duration of the program under this section if the 

5 Secretary, based on the results of the interim report 

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

7 it is appropriate to do so. 

8 (e) LOCATIONS.— 

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

10 not fewer than five facilities of the Department at 

11 which to carry out the program under this section. 

12 (2) SELECTION CRITERIA.—In selecting facili13 ties under paragraph (1), the Secretary shall ensure 

14 that— 

15 (A) the locations are in geographically di16 verse areas; and 

17 (B) not fewer than three facilities serve 

18 veterans in rural or highly rural areas (as de19 termined through the use of the Rural-Urban 

20 Commuting Areas coding system of the Depart21 ment of Agriculture). 

22 (f) REPORTS.— 

23 (1) INTERIM REPORT.— 

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

25 after the commencement of the program under 


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1 this section, the Secretary shall submit to the 

2 Committee on Veterans’ Affairs of the Senate 

3 and the Committee on Veterans’ Affairs of the 

4 House of Representatives a report on the 

5 progress of the program. 

6 (B) ELEMENTS.—The report required by 

7 subparagraph (A) shall include the following: 

8 (i) The number of participants in the 

9 program. 

10 (ii) The types of therapy offered at 

11 each facility at which the program is being 

12 carried out. 

13 (iii) An assessment of whether partici14 pation by a veteran in the program re15 sulted in any changes in clinically relevant 

16 endpoints for the veteran with respect to 

17 the conditions specified in subsection (a). 

18 (iv) An assessment of the quality of 

19 life of veterans participating in the pro20 gram, including the results of a satisfac21 tion survey of the participants in the pro22 gram, disaggregated by treatment under 

23 subsection (b). 


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1 (v) The determination of the Sec2 retary with respect to extending the pro3 gram under subsection (c)(2). 

4 (vi) Any recommendations of the Sec5 retary with respect to expanding the pro6 gram. 

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

8 after the termination of the program under this sec9 tion, the Secretary shall submit to the Committee on 

10 Veterans’ Affairs of the Senate and the Committee 

11 on Veterans’ Affairs of the House of Representatives 

12 a final report on the program. 

13 SEC. 207. COMPTROLLER GENERAL REPORT ON MANAGE14 MENT BY DEPARTMENT OF VETERANS AF15 FAIRS OF VETERANS AT HIGH RISK FOR SUI16 CIDE. 

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

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

19 General of the United States shall submit to the Com20 mittee on Veterans’ Affairs of the Senate and the Com21 mittee on Veterans’ Affairs of the House of Representa22 tives a report on the efforts of the Department of Veterans 

23 Affairs to manage veterans at high risk for suicide. 

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

25 (a) shall include the following: 


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1 (1) A description of how the Department identi2 fies patients as high risk for suicide, with particular 

3 consideration to the efficacy of inputs into the Re4 covery Engagement and Coordination for Health – 

5 Veterans Enhanced Treatment program (commonly 

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

7 Department, including an assessment of the efficacy 

8 of such identifications disaggregated by age, gender, 

9 Veterans Integrated Service Network, and, to the ex10 tent practicable, medical center of the Department. 

11 (2) A description of how the Department inter12 venes when a patient is identified as high risk, in13 cluding an assessment of the efficacy of such inter14 ventions disaggregated by age, gender, Veterans In15 tegrated Service Network, and, to the extent prac16 ticable, medical center of the Department. 

17 (3) A description of how the Department mon18 itors patients who have been identified as high risk, 

19 including an assessment of the efficacy of such mon20 itoring and any follow-ups disaggregated by age, 

21 gender, Veterans Integrated Service Network, and, 

22 to the extent practicable, medical center of the De23 partment. 


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1 (4) A review of staffing levels of suicide preven2 tion coordinators across the Veterans Health Admin3 istration. 

4 (5) A review of the resources and programming 

5 offered to family members and friends of veterans 

6 who have a mental health condition in order to as7 sist that veteran in treatment and recovery. 

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

9 Comptroller General considers appropriate to study. 

10 TITLE III—PROGRAMS, STUDIES, 

11 AND GUIDELINES ON MENTAL 

12 HEALTH 

13 SEC. 301. PROGRAM TO PROVIDE VETERANS ACCESS TO 

14 COMPUTERIZED COGNITIVE BEHAVIORAL 

15 THERAPY. 

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

17 date of the enactment of this Act, the Secretary of Vet18 erans Affairs shall commence the conduct of a program 

19 to assess the feasibility and advisability of using computer20 ized cognitive behavioral therapy to treat eligible veterans 

21 suffering from depression, anxiety, post-traumatic stress 

22 disorder, military sexual trauma, or substance use dis23 order who are already receiving evidence-based therapy 

24 from the Department of Veterans Affairs. 


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

2 participate in the program under this section if the vet3 eran— 

4 (1) is enrolled in the system of patient enroll5 ment of the Department of Veterans Affairs estab6 lished and operated under section 1705(a) of title 

7 38, United States Code; and 

8 (2) has received health care under the laws ad9 ministered by the Secretary during the two-year pe10 riod preceding the initial participation of the veteran 

11 in the program. 

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

13 program under this section for a two-year period begin14 ning on the commencement of the program. 

15 (d) LOCATIONS.— 

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

17 not fewer than three facilities of the Department of 

18 Veterans Affairs at which to carry out the program 

19 under this section. 

20 (2) SELECTION CRITERIA.—In selecting facili21 ties under paragraph (1), the Secretary shall ensure 

22 that— 

23 (A) the locations are in geographically di24 verse areas; and 


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1 (B) not fewer than two facilities serve vet2 erans in rural or highly rural areas (as deter3 mined through the use of the Rural-Urban 

4 Commuting Areas coding system of the Depart5 ment of Agriculture). 

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

7 under this section, the Secretary shall ensure that vet8 erans participating in the program have access via chat 

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

10 per week. 

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

12 Secretary shall promote the availability of the Veterans 

13 Crisis Line to veterans participating in the program under 

14 this section. 

15 (g) DEPARTMENT WEBSITE.—In implementing the 

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

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

18 Affairs to host the program. 

19 (h) REPORTS.— 

20 (1) INTERIM REPORT.— 

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

22 after the commencement of the program under 

23 this section, the Secretary shall submit to the 

24 Committee on Veterans’ Affairs of the Senate 

25 and the Committee on Veterans’ Affairs of the 


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1 House of Representatives a report on the 

2 progress of the program. 

3 (B) ELEMENTS.—The report required by 

4 subparagraph (A) shall include the following: 

5 (i) The number of participants in the 

6 program. 

7 (ii) An assessment of whether partici8 pation by a veteran in the program re9 sulted in any changes in clinically relevant 

10 endpoints for the veteran with respect to 

11 the conditions specified in subsection (a). 

12 (iii) Any recommendations of the Sec13 retary with respect to extending or expand14 ing the program. 

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

16 after the termination of the program under this sec17 tion, the Secretary shall submit to the Committee on 

18 Veterans’ Affairs of the Senate and the Committee 

19 on Veterans’ Affairs of the House of Representatives 

20 a final report on the program. 

21 (i) VETERANS CRISIS LINE DEFINED.—In this sec22 tion, the term ‘‘Veterans Crisis Line’’ means the toll-free 

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

24 title 38, United States Code. 


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1 SEC. 302. STUDY ON CONNECTION BETWEEN LIVING AT 

2 HIGH ALTITUDE AND SUICIDE RISK FACTORS 

3 AMONG VETERANS. 

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

5 date of the enactment of this Act, the Secretary of Vet6 erans Affairs, in consultation with Rural Health Resource 

7 Centers of the Office of Rural Health of the Department 

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

9 on the connection between living at high altitude and the 

10 risk of developing depression or dying by suicide among 

11 veterans. 

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

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

14 three years after the date of the commencement of the 

15 study. 

16 (c) INDIVIDUAL IMPACT.—The study conducted 

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

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

19 level, not at the State or county level. 

20 (d) REPORT.—Not later than 150 days after the com21 pletion of the study conducted under subsection (a), the 

22 Secretary shall submit to the Committee on Veterans’ Af23 fairs of the Senate and the Committee on Veterans’ Af24 fairs of the House of Representatives a report on the re25 sults of the study. 

26 (e) FOLLOW-UP STUDY.— 


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

2 through the study conducted under subsection (a) 

3 that living at high altitude is a risk factor for devel4 oping depression or dying by suicide, the Secretary 

5 shall conduct an additional study to identify the fol6 lowing: 

7 (A) The most likely biological mechanism 

8 that makes living at high altitude a risk factor 

9 for developing depression or dying by suicide. 

10 (B) The most effective treatment or inter11 vention for reducing the risk of developing de12 pression or dying by suicide associated with liv13 ing at high altitude. 

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

15 completing the study conducted under paragraph 

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

17 Veterans’ Affairs of the Senate and the Committee 

18 on Veterans’ Affairs of the House of Representatives 

19 a report on the results of the study. 

20 SEC. 303. ESTABLISHMENT BY DEPARTMENT OF VETERANS 

21 AFFAIRS AND DEPARTMENT OF DEFENSE OF 

22 CLINICAL PRACTICE GUIDELINES FOR CO23 MORBID MENTAL HEALTH CONDITIONS. 

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

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1 erans Affairs, in consultation with the Secretary of De2 fense and the Secretary of Health and Human Services, 

3 shall complete the development of clinical practice guide4 lines for the treatment of post-traumatic stress disorder, 

5 military sexual trauma, and traumatic brain injury that 

6 is comorbid with substance use disorder or chronic pain. 

7 (b) WORK GROUP.— 

8 (1) ESTABLISHMENT.—In carrying out sub9 section (a), the Secretary of Veterans Affairs, the 

10 Secretary of Defense, and the Secretary of Health 

11 and Human Services shall create a Trauma and Co12 morbid Substance Use Disorder or Chronic Pain 

13 Work Group (in this section referred to as the 

14 ‘‘Work Group’’). 

15 (2) MEMBERSHIP.—The work group created 

16 under paragraph (1) shall be comprised of individ17 uals that represent Federal Government entities and 

18 non-Federal Government entities with expertise in 

19 the areas covered by the work group, including the 

20 following: 

21 (A) Academic institutions that specialize in 

22 research for the treatment of conditions de23 scribed in subsection (a). 


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1 (B) The National Center for Posttraumatic 

2 Stress Disorder of the Department of Veterans 

3 Affairs. 

4 (C) The Office of the Assistant Secretary 

5 for Mental Health and Substance Use of the 

6 Department of Health and Human Services. 

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

8 Work Group shall be created and conducted in the 

9 same manner as other work groups for the develop10 ment of clinical practice guidelines for the Depart11 ment of Veterans Affairs and the Department of De12 fense. 

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

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

15 in consultation with the Post Traumatic Stress Disorder 

16 Work Group, Concussion-mTBI Work Group, Opioid 

17 Therapy for Chronic Pain Work Group, and Substance 

18 Use Work Group, shall ensure that the clinical practice 

19 guidelines include the following: 

20 (1) Guidance with respect to the following: 

21 (A) The treatment of patients with post22 traumatic stress disorder who are also experi23 encing a substance use disorder or chronic pain. 

24 (B) The treatment of patients experiencing 

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1 pression, or post-traumatic stress disorder as a 

2 result of military sexual trauma who are also 

3 experiencing a substance use disorder or chron4 ic pain. 

5 (C) The treatment of patients with trau6 matic brain injury who are also experiencing a 

7 substance use disorder or chronic pain. 

8 (2) Guidance with respect to the following: 

9 (A) Appropriate case management for pa10 tients experiencing post-traumatic stress dis11 order that is comorbid with substance use dis12 order or chronic pain who transition from re13 ceiving care while on active duty in the Armed 

14 Forces to care from health care networks out15 side of the Department of Defense. 

16 (B) Appropriate case management for pa17 tients experiencing a mental health condition, 

18 including anxiety, depression, or post-traumatic 

19 stress disorder as a result of military sexual 

20 trauma that is comorbid with substance use dis21 order or chronic pain who transition from re22 ceiving care while on active duty in the Armed 

23 Forces to care from health care networks out24 side of the Department of Defense. 


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1 (C) Appropriate case management for pa2 tients experiencing traumatic brain injury that 

3 is comorbid with substance use disorder or 

4 chronic pain who transition from receiving care 

5 while on active duty in the Armed Forces to 

6 care from health care networks outside of the 

7 Department of Defense. 

8 (3) Guidance with respect to the treatment of 

9 patients who are still members of the Armed Forces 

10 and are experiencing a mental health condition, in11 cluding anxiety, depression, or post-traumatic stress 

12 disorder as a result of military sexual trauma that 

13 is comorbid with substance use disorder or chronic 

14 pain. 

15 (4) Guidance with respect to the assessment by 

16 the National Academies of Sciences, Engineering, 

17 and Medicine of the potential overmedication of vet18 erans, as required pursuant to the Senate report ac19 companying S. 1557, 115th Congress (Senate Re20 port 115-130), under the heading ‘‘Overprescription 

21 Prevention Report’’ under the heading ‘‘COMMITTEE

22 RECOMMENDATION’’. 

23 (d) RULE OF CONSTRUCTION.—Nothing in this sec24 tion shall be construed to prevent the Secretary of Vet25 erans Affairs and the Secretary of Defense from considVerDate Sep 11 2014 22:25 Apr 03, 2019 Jkt 089200 PO 00000 Frm 00048 Fmt 6652 Sfmt 6201 E:\BILLS\S785.IS S785

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1 ering all relevant evidence, as appropriate, in creating the 

2 clinical practice guidelines required under subsection (a) 

3 or from ensuring that the final clinical practice guidelines 

4 developed under such subsection and subsequently up5 dated, as appropriate, remain applicable to the patient 

6 populations of the Department of Veterans Affairs and the 

7 Department of Defense. 

8 SEC. 304. UPDATE OF CLINICAL PRACTICE GUIDELINES 

9 FOR ASSESSMENT AND MANAGEMENT OF PA10 TIENTS AT RISK FOR SUICIDE. 

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

12 date of the enactment of this Act, the Secretary of Vet13 erans Affairs and the Secretary of Defense, through the 

14 Assessment and Management of Patients at Risk for Sui15 cide Work Group (in this section referred to as the ‘‘Work 

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

17 Practice Guideline for Assessment and Management of 

18 Patients at Risk for Suicide. 

19 (b) MATTERS INCLUDED.—In carrying out the up20 date under subsection (a), the Work Group shall ensure 

21 that the clinical practice guidelines updated under such 

22 subsection includes the following: 

23 (1) Enhanced guidance with respect to the fol24 lowing: 


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1 (A) Gender-specific risk factors for suicide 

2 and suicidal ideation. 

3 (B) Gender-specific treatment efficacy for 

4 depression and suicide prevention. 

5 (C) Gender-specific pharmacotherapy effi6 cacy. 

7 (D) Gender-specific psychotherapy efficacy. 

8 (2) Guidance with respect to the following: 

9 (A) The efficacy of alternative therapies, 

10 other than psychotherapy and pharmacothera11 py, including the following: 

12 (i) Yoga therapy. 

13 (ii) Meditation therapy. 

14 (iii) Equine therapy. 

15 (iv) Other animal therapy. 

16 (v) Training and caring for service 

17 dogs. 

18 (vi) Agri-therapy. 

19 (vii) Art therapy. 

20 (viii) Outdoor sports therapy. 

21 (ix) Music therapy. 

22 (x) Any other alternative therapy that 

23 the Work Group considers appropriate. 

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

25 Creating Options for Veterans’ Expedited Recovery 


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1 Commission (commonly referred to as the ‘‘COVER 

2 Commission’’) established under section 931 of the 

3 Jason Simcakoski Memorial and Promise Act (title 

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

5 (c) RULE OF CONSTRUCTION.—Nothing in this sec6 tion shall be construed to prevent the Secretary of Vet7 erans Affairs and the Secretary of Defense from consid8 ering all relevant evidence, as appropriate, in updating the 

9 VA/DOD Clinical Practice Guideline for Assessment and 

10 Management of Patients at Risk for Suicide, as required 

11 under subsection (a), or from ensuring that the final clin12 ical practice guidelines updated under such subsection re13 main applicable to the patient populations of the Depart14 ment of Veterans Affairs and the Department of Defense. 

15 SEC. 305. PRECISION MEDICINE INITIATIVE OF DEPART16 MENT OF VETERANS AFFAIRS TO IDENTIFY 

17 AND VALIDATE BRAIN AND MENTAL HEALTH 

18 BIOMARKERS. 

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

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

21 Secretary of Veterans Affairs shall develop and implement 

22 an initiative of the Department of Veterans Affairs to 

23 identify and validate brain and mental health biomarkers 

24 among veterans, with specific consideration for depression, 

25 anxiety, post-traumatic stress disorder, traumatic brain 


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1 injury, and such other mental health conditions as the 

2 Secretary considers appropriate. Such initiative may be re3 ferred to as the ‘‘Precision Medicine for Veterans Initia4 tive’’. 

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

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

7 Medicine Initiative administered by the National Insti8 tutes of Health with respect to large-scale collection of 

9 standardized data and open data sharing. 

10 (c) USE OF DATA.— 

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

12 the initiative under subsection (a), the Secretary 

13 shall develop robust data privacy and security meas14 ures to ensure that information of veterans partici15 pating in the initiative is kept private and secure. 

16 (2) OPEN PLATFORM.— 

17 (A) RESEARCH PURPOSES.—The Secretary 

18 shall make de-identified data collected under 

19 the initiative available for research purposes 

20 both within and outside of the Department of 

21 Veterans Affairs. 

22 (B) DATA MAY NOT BE SOLD.—Data col23 lected under the initiative may not be sold. 

24 (3) STANDARDIZATION.— 


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1 (A) IN GENERAL.—The Secretary shall en2 sure that data collected under the initiative is 

3 standardized. 

4 (B) CONSULTATION.—The Secretary shall 

5 consult with the National Institutes of Health 

6 and the Food and Drug Administration to de7 termine the most effective, efficient, and cost8 effective way of standardizing data collected 

9 under the initiative. 

10 (C) MANNER OF STANDARDIZATION.— 

11 Data collected under the initiative shall be 

12 standardized in the manner in which it is col13 lected, entered into the database, extracted, and 

14 recorded. 

15 (4) MEASURES OF BRAIN FUNCTION OR STRUC16 TURE.—Any measures of brain function or structure 

17 collected under the initiative shall be collected with 

18 a device that is approved by the Food and Drug Ad19 ministration. 

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

21 Secretary shall assess the feasibility and advisability of co22 ordinating efforts of the initiative under subsection (a) 

23 with the Million Veterans Program of the Department. 


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1 SEC. 306. PREVENTATIVE AND COMPLEX DATA ANALYSIS 

2 BY DEPARTMENT OF VETERANS AFFAIRS. 

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

4 States Code, is amended by adding at the end the fol5 lowing new section: 

6 ‘‘§ 119. Contracting for preventative or complex sta7 tistical analysis 

8 ‘‘In order to carry out statistical analysis required 

9 under section 302 of the Commander John Scott Hannon 

10 Veterans Mental Health Care Improvement Act of 2019, 

11 or any other preventative or complex statistical analysis 

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

13 Secretary may contract with academic institutions or 

14 other qualified entities, as determined by the Secretary, 

15 to carry out the statistical analysis.’’. 

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

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

18 inserting after the item relating to section 118 the fol19 lowing new item: 

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


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1 TITLE IV—OVERSIGHT OF MEN2 TAL HEALTH CARE AND RE3 LATED SERVICES 

4 SEC. 401. STUDY ON EFFECTIVENESS OF SUICIDE PREVEN5 TION AND MENTAL HEALTH OUTREACH PRO6 GRAMS OF DEPARTMENT OF VETERANS AF7 FAIRS. 

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

9 date of the enactment of this Act, the Secretary of Vet10 erans Affairs shall enter into an agreement with a non11 Federal Government entity to conduct a study on the ef12 fectiveness of the suicide prevention and mental health 

13 outreach materials prepared by the Department of Vet14 erans Affairs and the suicide prevention and mental health 

15 outreach campaigns conducted by the Department. 

16 (b) USE OF FOCUS GROUPS.— 

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

18 not fewer than eight different focus groups to evalu19 ate the effectiveness of the suicide prevention and 

20 mental health materials and campaigns as required 

21 under subsection (a). 

22 (2) LOCATION OF FOCUS GROUPS.—Focus 

23 groups convened under paragraph (1) shall be held 

24 in geographically diverse areas as follows: 


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

2 rural areas. 

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

4 districts of the Veterans Benefits Administra5 tion. 

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

7 convened under paragraph (1) shall be held at a va8 riety of dates and times to ensure an adequate rep9 resentation of veterans with different work sched10 ules. 

11 (4) NUMBER OF PARTICIPANTS.—Each focus 

12 group convened under paragraph (1) shall include 

13 not fewer than five and not more than 12 partici14 pants. 

15 (5) REPRESENTATION.—Each focus group con16 vened under paragraph (1) shall, to the extent prac17 ticable, include veterans of diverse backgrounds, in18 cluding— 

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

20 the Secretary; 

21 (B) women veterans; 

22 (C) minority veterans; 

23 (D) Native American veterans, as defined 

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


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

2 bisexual, transgender, or queer (commonly re3 ferred to as ‘‘LGBTQ’’); 

4 (F) veterans who live in rural or highly 

5 rural areas; and 

6 (G) individuals transitioning from active 

7 duty in the Armed Forces to civilian life. 

8 (c) REPORT.— 

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

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

11 the Secretary shall submit to the Committee on Vet12 erans’ Affairs of the Senate and the Committee on 

13 Veterans’ Affairs of the House of Representatives a 

14 report on the findings of the focus groups. 

15 (2) ELEMENTS.—The report required by para16 graph (1) shall include the following: 

17 (A) Based on the findings of the focus 

18 groups, an assessment of the effectiveness of 

19 current suicide prevention and mental health 

20 outreach efforts of the Department in reaching 

21 veterans as a whole as well as specific groups 

22 of veterans (for example, women veterans). 

23 (B) Based on the findings of the focus 

24 groups, recommendations for future suicide pre25 vention and mental health outreach efforts by 


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1 the Department to target specific groups of vet2 erans. 

3 (C) A plan to change the current approach 

4 by the Department to suicide prevention and 

5 mental health outreach or, if the Secretary de6 cides not to change the current approach, an 

7 explanation of the reason for maintaining the 

8 current approach. 

9 (D) Such other issues as the Secretary 

10 considers necessary. 

11 (d) REPRESENTATIVE SURVEY.— 

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

13 after the last focus group meeting under subsection 

14 (b), the Secretary shall complete a representative 

15 survey of the veteran population that is informed by 

16 the focus group data in order to collect information 

17 about the effectiveness of the mental health and sui18 cide prevention outreach campaigns conducted by 

19 the Department. 

20 (2) VETERANS SURVEYED.— 

21 (A) IN GENERAL.—Veterans surveyed 

22 under paragraph (1) shall include veterans de23 scribed in subsection (b)(5). 


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1 (B) DISAGGREGATION OF DATA.—Data of 

2 veterans surveyed under paragraph (1) shall be 

3 disaggregated by— 

4 (i) veterans who have received care 

5 from the Department during the two-year 

6 period preceding the survey; and 

7 (ii) veterans who have not received 

8 care from the Department during the two9 year period preceding the survey. 

10 (e) TREATMENT OF CONTRACTS FOR SUICIDE PRE11 VENTION AND MENTAL HEALTH OUTREACH MEDIA.— 

12 (1) FOCUS GROUPS.— 

13 (A) IN GENERAL.—The Secretary shall in14 clude in each contract to develop media relating 

15 to suicide prevention and mental health out16 reach a requirement that the contractor convene 

17 focus groups of veterans to assess the effective18 ness of suicide prevention and mental health 

19 outreach. 

20 (B) REPRESENTATION.—Each focus group 

21 required under subparagraph (A) shall, to the 

22 extent practicable, include veterans of diverse 

23 backgrounds, including— 

24 (i) veterans of all eras, as determined 

25 by the Secretary; 


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1 (ii) women veterans; 

2 (iii) minority veterans; 

3 (iv) Native American veterans, as de4 fined in section 3765 of title 38, United 

5 States Code; 

6 (v) veterans who identify as lesbian, 

7 gay, bisexual, transgender, or queer (com8 monly referred to as ‘‘LGBTQ’’); 

9 (vi) veterans who live in rural or high10 ly rural areas; and 

11 (vii) individuals transitioning from ac12 tive duty in the Armed Forces to civilian 

13 life. 

14 (2) SUBCONTRACTING.— 

15 (A) IN GENERAL.—The Secretary shall in16 clude in each contract described in paragraph 

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

18 subcontracts for the development of media, the 

19 contractor shall subcontract with a subcon20 tractor that has experience creating impactful 

21 media campaigns that target individuals age 18 

22 to 34. 

23 (B) BUDGET LIMITATION.—Not more than 

24 two percent of the budget of the Office of Men25 tal Health and Suicide Prevention of the DeVerDate Sep 11 2014 22:25 Apr 03, 2019 Jkt 089200 PO 00000 Frm 00060 Fmt 6652 Sfmt 6201 E:\BILLS\S785.IS S785

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1 partment for contractors for suicide prevention 

2 and mental health media outreach shall go to 

3 subcontractors described in subparagraph (A). 

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

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

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

7 Rural-Urban Commuting Areas coding system of the De8 partment of Agriculture. 

9 SEC. 402. OVERSIGHT OF MENTAL HEALTH AND SUICIDE 

10 PREVENTION MEDIA OUTREACH CONDUCTED 

11 BY DEPARTMENT OF VETERANS AFFAIRS. 

12 (a) ESTABLISHMENT OF GOALS.— 

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

14 Affairs shall establish goals for the mental health 

15 and suicide prevention media outreach campaigns of 

16 the Department of Veterans Affairs in raising 

17 awareness about mental health and suicide preven18 tion. 

19 (2) USE OF METRICS.— 

20 (A) IN GENERAL.—The goals established 

21 under paragraph (1) shall be measured by 

22 metrics specific to different media types as fol23 lows: 

24 (i) Metrics relating to social media 

25 shall include the following: 


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1 (I) Impressions. 

2 (II) Reach. 

3 (III) Engagement rate. 

4 (IV) Such other metrics as the 

5 Secretary considers necessary. 

6 (ii) Metrics relating to television shall 

7 include the following: 

8 (I) Nielsen ratings. 

9 (II) Such other metrics as the 

10 Secretary considers necessary. 

11 (iii) Metrics relating to email shall in12 clude the following: 

13 (I) Open rate. 

14 (II) Response rate 

15 (III) Click rate. 

16 (IV) Such other metrics as the 

17 Secretary considers necessary. 

18 (B) UPDATE.—The Secretary shall periodi19 cally update the metrics under subparagraph 

20 (A) as more accurate metrics become available. 

21 (3) TARGETS.—The Secretary shall develop tar22 gets to track the metrics used under paragraph (2). 

23 (4) CONSULTATION.—In establishing goals 

24 under paragraph (1), the Secretary shall consult 

25 with the following: 


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1 (A) Relevant stakeholders, such as organi2 zations that represent veterans, as determined 

3 by the Secretary. 

4 (B) Mental health and suicide prevention 

5 experts. 

6 (C) Such other persons as the Secretary 

7 considers appropriate. 

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

9 after the date of the enactment of this Act, the Sec10 retary shall submit to the Committee on Veterans’ 

11 Affairs of the Senate and the Committee on Vet12 erans’ Affairs of the House of Representatives a re13 port detailing the goals established under paragraph 

14 (1) for the mental health and suicide prevention 

15 media outreach campaigns of the Department in 

16 raising awareness about mental health and suicide 

17 prevention, including the metrics and targets for 

18 such metrics by which those goals are to be meas19 ured under paragraph (2). 

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

21 after the submittal of the report under paragraph 

22 (3), and annually thereafter, the Secretary shall sub23 mit to the Committee on Veterans’ Affairs of the 

24 Senate and the Committee on Veterans’ Affairs of 

25 the House of Representatives a report detailing— 


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1 (A) the progress of the Department in 

2 meeting the goals established under paragraph 

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

4 and 

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

6 the Department to modify mental health and 

7 suicide prevention media outreach campaigns if 

8 those goals and targets are not being met. 

9 (b) ESTABLISHMENT OF OVERSIGHT PROCESS.— 

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

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

12 shall establish a process to oversee the mental health 

13 and suicide prevention media outreach campaigns of 

14 the Department. 

15 (2) COMPONENTS OF OVERSIGHT PROCESS.— 

16 The process established under paragraph (1) shall 

17 include the following components: 

18 (A) A delineation of the roles and respon19 sibilities of all suicide prevention officials within 

20 the Office of Mental Health and Suicide Pre21 vention of the Veterans Health Administration. 

22 (B) A schedule for creating, approving, im23 plementing, and evaluating all unpaid media 

24 and paid media content relating to mental 

25 health and suicide prevention. 


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1 (C) Lines of reporting, as the Secretary 

2 considers necessary, to report to management 

3 information relating to the mental health and 

4 suicide prevention media outreach campaigns of 

5 the Department. 

6 (c) CONTRACT REQUIREMENTS.—The Secretary shall 

7 ensure that each contract into which the Secretary enters 

8 to develop mental health and suicide prevention outreach 

9 media includes requirements that the contractor— 

10 (1) track metrics used by the Secretary under 

11 subsection (a)(2); and 

12 (2) not less frequently than quarterly, report 

13 such metrics to the Office of Mental Health and Sui14 cide Prevention of the Veterans Health Administra15 tion. 

16 (d) REPORT ON USE OF FUNDS BY OFFICE OF MEN17 TAL HEALTH AND SUICIDE PREVENTION.—Not later than 

18 180 days after the date of the enactment of this Act, and 

19 semiannually thereafter, the Secretary shall submit to the 

20 Committee on Appropriations and the Committee on Vet21 erans’ Affairs of the Senate and the Committee on Appro22 priations and the Committee on Veterans’ Affairs of the 

23 House of Representatives a report containing the expendi24 tures and obligations of the Office of Mental Health and 


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1 Suicide Prevention of the Veterans Health Administration 

2 during the period covered by the report. 

3 SEC. 403. ANNUAL REPORT ON PROGRESS OF DEPARTMENT 

4 OF VETERANS AFFAIRS IN MEETING GOALS 

5 AND OBJECTIVES OF EXECUTIVE ORDER 

6 13822. 

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

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

9 the Secretary of Veterans Affairs, in consultation with the 

10 Secretary of Defense and the Secretary of Homeland Se11 curity, shall submit to the Committee on Veterans’ Affairs 

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

13 the House of Representatives a report that contains the 

14 following: 

15 (1) An assessment of the progress of the De16 partment of Veterans Affairs, the Department of 

17 Defense, and the Department of Homeland Security 

18 in meeting the goals and objectives outlined in the 

19 report required under section 2(c) of Executive 

20 Order 13822 (83 Fed. Reg. 1513; relating to sup21 porting our veterans during their transition from 

22 uniformed service to civilian life) with respect to the 

23 implementation by the Department of Veterans Af24 fairs of the Joint Action Plan required under section 

25 2(b) of such Executive order. 


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

2 Department of Veterans Affairs, the Department of 

3 Defense, and the Department of Homeland Security 

4 if those goals and objectives are not being met. 

5 (3) An assessment of the effectiveness of Exec6 utive Order 13822 at improving the transition proc7 ess for members of the Armed Forces and veterans. 

8 (4) Such other topics as the Secretary of Vet9 erans Affairs, the Secretary of Defense, or the Sec10 retary of Homeland Security consider necessary. 

11 (b) SUBMITTAL BY SECRETARY OF VETERANS AF12 FAIRS.—The Secretary of Veterans Affairs shall submit 

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

14 the Department of Veterans Affairs regardless of whether 

15 the Secretary of Defense or the Secretary of Homeland 

16 Security provides any information for the report. 

17 SEC. 404. COMPTROLLER GENERAL MANAGEMENT REVIEW 

18 OF MENTAL HEALTH AND SUICIDE PREVEN19 TION SERVICES OF DEPARTMENT OF VET20 ERANS AFFAIRS. 

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

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

23 General of the United States shall submit to the Com24 mittee on Veterans’ Affairs of the Senate and the Com25 mittee on Veterans’ Affairs of the House of RepresentaVerDate Sep 11 2014 22:25 Apr 03, 2019 Jkt 089200 PO 00000 Frm 00067 Fmt 6652 Sfmt 6201 E:\BILLS\S785.IS S785

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1 tives a management review of the mental health and sui2 cide prevention services provided by the Department of 

3 Veterans Affairs. 

4 (b) ELEMENTS.—The management review required 

5 by subsection (a) shall include the following: 

6 (1) An assessment of the infrastructure under 

7 the control of or available to the Office of Mental 

8 Health and Suicide Prevention of the Department of 

9 Veterans Affairs or available to the Department of 

10 Veterans Affairs for suicide prevention efforts not 

11 operated by the Office of Mental Health and Suicide 

12 Prevention. 

13 (2) A description of the management and orga14 nizational structure of the Office of Mental Health 

15 and Suicide Prevention, including roles and respon16 sibilities for each position. 

17 (3) A description of the operational policies and 

18 processes of the Office of Mental Health and Suicide 

19 Prevention. 

20 (4) An assessment of suicide prevention prac21 tices and initiatives available from the Department 

22 and through community partnerships. 

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

24 Office of Mental Health and Suicide Prevention, 


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1 dissaggregated by type of position, and including the 

2 location of any staffing deficiencies. 

3 (6) An assessment of the Nurse Advice Line 

4 pilot program conducted by the Department. 

5 (7) An assessment of recruitment initiatives in 

6 rural areas for mental health professionals of the 

7 Department. 

8 (8) An assessment of strategic planning con9 ducted by the Office of Mental Health and Suicide 

10 Prevention. 

11 (9) An assessment of the communication, and 

12 the effectiveness of such communication— 

13 (A) within the central office of the Office 

14 of Mental Health and Suicide Prevention; 

15 (B) between that central office and any 

16 staff member or office in the field, including 

17 chaplains, attorneys, law enforcement per18 sonnel, and volunteers; and 

19 (C) between that central office, local facili20 ties of the Department, and community part21 ners of the Department, including first respond22 ers, community support groups, and health care 

23 industry partners. 


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1 (10) An assessment of how effectively the Office 

2 of Mental Health and Suicide Prevention implements 

3 operational policies and procedures. 

4 (11) An assessment of how the Department of 

5 Veterans Affairs and the Department of Defense co6 ordinate suicide prevention efforts, and recommenda7 tions on how the Department of Veterans Affairs 

8 and Department of Defense can more effectively co9 ordinate those efforts. 

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

11 Comptroller General considers appropriate to study. 

12 SEC. 405. COMPTROLLER GENERAL REPORT ON EFFORTS 

13 OF DEPARTMENT OF VETERANS AFFAIRS TO 

14 INTEGRATE MENTAL HEALTH CARE INTO 

15 PRIMARY CARE CLINICS. 

16 (a) INITIAL REPORT.— 

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

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

19 Comptroller General of the United States shall sub20 mit to the Committee on Veterans’ Affairs of the 

21 Senate and the Committee on Veterans’ Affairs of 

22 the House of Representatives a report on the efforts 

23 of the Department of Veterans Affairs to integrate 

24 mental health care into primary care clinics of the 

25 Department. 


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1 (2) ELEMENTS.—The report required by sub2 section (a) shall include the following: 

3 (A) An assessment of the efforts of the 

4 Department to integrate mental health care 

5 into primary care clinics of the Department. 

6 (B) An assessment of the effectiveness of 

7 such efforts. 

8 (C) An assessment of how the health care 

9 of veterans is impacted by such integration. 

10 (D) A description of how care is coordi11 nated by the Department between specialty 

12 mental health care and primary care, including 

13 a description of the following: 

14 (i) How documents and patient infor15 mation are transferred and the effective16 ness of those transfers. 

17 (ii) How care is coordinated when vet18 erans must travel to different facilities of 

19 the Department. 

20 (iii) How a veteran is reintegrated 

21 into primary care after receiving in-patient 

22 mental health care. 

23 (E) An assessment of how the integration 

24 of mental health care into primary care clinics 


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1 is implemented at different types of facilities of 

2 the Department. 

3 (F) Such recommendations on how the De4 partment can better integrate mental health 

5 care into primary care clinics as the Comp6 troller General considers appropriate. 

7 (G) An assessment of such other areas as 

8 the Comptroller General considers appropriate 

9 to study. 

10 (b) COMMUNITY CARE INTEGRATION REPORT.— 

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

12 after the date on which the Comptroller General 

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

14 the Comptroller General shall submit to the Com15 mittee on Veterans’ Affairs of the Senate and the 

16 Committee on Veterans’ Affairs of the House of 

17 Representatives a report on the efforts of the De18 partment to integrate community-based mental 

19 health care into the Veterans Health Administration. 

20 (2) ELEMENTS.—The report required by para21 graph (1) shall include the following: 

22 (A) An assessment of the efforts of the 

23 Department to integrate community-based men24 tal health care into the Veterans Health Admin25 istration. 


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1 (B) An assessment of the effectiveness of 

2 such efforts. 

3 (C) An assessment of how the health care 

4 of veterans is impacted by such integration. 

5 (D) A description of how care is coordi6 nated between providers of community-based 

7 mental health care and the Veterans Health 

8 Administration, including a description of how 

9 documents and patient information are trans10 ferred and the effectiveness of those transfers 

11 between— 

12 (i) the Veterans Health Administra13 tion and providers of community-based 

14 mental health care; and 

15 (ii) providers of community-based 

16 mental health care and the Veterans 

17 Health Administration. 

18 (E) An assessment of any disparities in the 

19 coordination of community-based mental health 

20 care into the Veterans Health Administration 

21 by location and type of facility. 

22 (F) An assessment of the military cultural 

23 competency of health care providers providing 

24 community-based mental health care to vet25 erans. 


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1 (G) Such recommendations on how the De2 partment can better integrate community-based 

3 mental health care into the Veterans Health 

4 Administration as the Comptroller General con5 siders appropriate. 

6 (H) An assessment of such other areas as 

7 the Comptroller General considers appropriate 

8 to study. 

9 (3) COMMUNITY-BASED MENTAL HEALTH CARE

10 DEFINED.—In this subsection, the term ‘‘commu11 nity-based mental health care’’ means mental health 

12 care paid for by the Department but provided by a 

13 non-Department health care provider at a non-De14 partment facility, including care furnished under 

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

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

17 Caring for Our Veterans Act of 2018 (title I of Pub18 lic Law 115–182)). 

19 SEC. 406. JOINT MENTAL HEALTH PROGRAMS BY DEPART20 MENT OF VETERANS AFFAIRS AND DEPART21 MENT OF DEFENSE. 

22 (a) REPORT ON MENTAL HEALTH PROGRAMS.— 

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

24 after the date of the enactment of this Act, and an25 nually thereafter, the Secretary of Veterans Affairs 


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1 and the Secretary of Defense shall submit to the 

2 Committee on Armed Services and the Committee on 

3 Veterans’ Affairs of the Senate and the Committee 

4 on Armed Services and the Committee on Veterans’ 

5 Affairs of the House of Representatives a report on 

6 mental health programs of the Department of Vet7 erans Affairs and the Department of Defense and 

8 joint programs of the Departments. 

9 (2) ELEMENTS.—The report required by para10 graph (1) shall include the following: 

11 (A) A description of mental health pro12 grams operated by the Department of Veterans 

13 Affairs, including the following: 

14 (i) Transition assistance programs. 

15 (ii) Clinical mental health initiatives, 

16 including— 

17 (I) the Million Veterans Pro18 gram; and 

19 (II) centers of excellence of the 

20 Department of Veterans Affairs for 

21 traumatic brain injury and post-trau22 matic stress disorder. 

23 (iii) Programs that may secondarily 

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1 ment, housing assistance, and financial lit2 eracy programs. 

3 (iv) Research into mental health 

4 issues and conditions. 

5 (B) A description of mental health pro6 grams operated by the Department of Defense, 

7 including the following: 

8 (i) Transition assistance programs. 

9 (ii) Clinical mental health initiatives, 

10 including the National Intrepid Center of 

11 Excellence. 

12 (iii) Programs that may secondarily 

13 improve mental health, including employ14 ment, housing assistance, and financial lit15 eracy programs. 

16 (iv) Research into mental health 

17 issues and conditions. 

18 (C) A description of mental health pro19 grams jointly operated by the Department of 

20 Veterans Affairs and the Department of De21 fense, including the following: 

22 (i) Transition assistance programs. 

23 (ii) Clinical mental health initiatives. 

24 (iii) Programs that may secondarily 

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1 ment, housing assistance, and financial lit2 eracy programs. 

3 (iv) Research into mental health 

4 issues and conditions. 

5 (D) Recommendations for coordinating 

6 mental health programs of the Department of 

7 Veterans Affairs and the Department of De8 fense to improve the effectiveness of those pro9 grams. 

10 (E) Recommendations for novel joint pro11 gramming of the Department of Veterans Af12 fairs and the Department of Defense to improve 

13 the mental health of members of the Armed 

14 Forces and veterans. 

15 (b) ESTABLISHMENT OF JOINT CENTER OF EXCEL16 LENCE.— 

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

18 after the date of the enactment of this Act, the Sec19 retary of Defense, in consultation with the Secretary 

20 of Veterans Affairs, shall establish a center of excel21 lence to be known as the ‘‘Joint DOD/VA National 

22 Intrepid Center of Excellence Intrepid Spirit Cen23 ter’’ (in this subsection referred to as the ‘‘Center’’). 


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

2 mental health programs of the Department of Vet3 erans Affairs and the Department of Defense. 

4 (3) LOCATION.—The Center shall be estab5 lished in a location that— 

6 (A) is geographically distant from already 

7 existing and planned Intrepid Spirit Centers of 

8 the Department of Defense; and 

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

10 determined through the use of the Rural-Urban 

11 Commuting Areas coding system of the Depart12 ment of Agriculture). 

13 TITLE V—MEDICAL WORKFORCE 

14 Subtitle A—Improvement of Mental 

15 Health Medical Workforce 

16 SEC. 501. TREATMENT OF PSYCHOLOGISTS. 

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

18 7401 of title 38, United States Code, is amended— 

19 (1) in paragraph (1) by inserting ‘‘psycholo20 gists,’’ after ‘‘chiropractors,’’; and 

21 (2) in paragraph (3), by striking ‘‘psycholo22 gists,’’. 

23 (b) INCLUSION IN CONTRACTS FOR SCARCE MEDICAL

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


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1 United States Code, is amended by inserting ‘‘psycholo2 gists,’’ after ‘‘chiropractors,’’. 

3 SEC. 502. STAFFING IMPROVEMENT PLAN FOR PSYCHIA4 TRISTS AND PSYCHOLOGISTS OF DEPART5 MENT OF VETERANS AFFAIRS. 

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

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

8 Veterans Affairs, in consultation with the Inspector Gen9 eral of the Department of Veterans Affairs, shall submit 

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

11 the Committee on Veterans’ Affairs of the House of Rep12 resentatives a plan to address staffing shortages of psychi13 atrists and psychologists of the Department of Veterans 

14 Affairs, including filling any open positions. 

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

16 shall include the following: 

17 (1) The number of positions for psychiatrists 

18 and psychologists of the Department that need to be 

19 filled to meet demand, disaggregated by Veterans 

20 Integrated Service Network and medical center. 

21 (2) An identification of the steps that the Sec22 retary will take in each Veterans Integrated Service 

23 Network to address such shortages, include the fol24 lowing: 


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1 (A) A description of any region-specific 

2 hiring incentives to be used by the Secretary in 

3 consultation with the directors of Veterans Inte4 grated Service Networks and medical centers of 

5 the Department. 

6 (B) A description of any local retention or 

7 engagement incentives to be used by directors 

8 of Veterans Integrated Service Networks. 

9 (3) Such recommendations for legislative or ad10 ministrative action as the Secretary considers nec11 essary to aid in addressing staffing shortages of psy12 chiatrists and psychologists of the Department. 

13 SEC. 503. OCCUPATIONAL SERIES AND STAFFING IMPROVE14 MENT PLAN FOR LICENSED PROFESSIONAL 

15 MENTAL HEALTH COUNSELORS AND MAR16 RIAGE AND FAMILY THERAPISTS OF DEPART17 MENT OF VETERANS AFFAIRS. 

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

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

20 of Veterans Affairs, in consultation with the Office of Per21 sonnel Management, shall develop an occupational series 

22 for licensed professional mental health counselors and 

23 marriage and family therapists of the Department of Vet24 erans Affairs. 

25 (b) STAFFING PLAN.— 


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

2 after the date of the enactment of this Act, the Sec3 retary shall submit to the Committee on Veterans’ 

4 Affairs of the Senate and the Committee on Vet5 erans’ Affairs of the House of Representatives a 

6 plan to address staffing shortages of licensed profes7 sional mental health counselors and marriage and 

8 family therapists of the Department of Veterans Af9 fairs. 

10 (2) ELEMENTS.—The plan required by para11 graph (1) shall include the following: 

12 (A) The number of positions for licensed 

13 professional mental health counselors and mar14 riage and family therapists of the Department 

15 that need to be filled to meet demand, 

16 disaggregated by Veterans Integrated Service 

17 Network and medical center. 

18 (B) An identification of the steps that the 

19 Secretary will take in each Veterans Integrated 

20 Service Network to address such shortages, in21 clude the following: 

22 (i) A description of any region-specific 

23 hiring incentives to be used by the Sec24 retary in consultation with the directors of 


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1 Veterans Integrated Service Networks and 

2 medical centers of the Department. 

3 (ii) A description of any local reten4 tion or engagement incentives to be used 

5 by directors of Veterans Integrated Service 

6 Networks. 

7 (C) Such recommendations for legislative 

8 or administrative action as the Secretary, in 

9 consultation with the Inspector General of the 

10 Department of Veterans Affairs, considers nec11 essary to aid in addressing staffing shortages of 

12 licensed professional mental health counselors 

13 and marriage and family therapists of the De14 partment. 

15 (c) REPORT.—Not later than one year after the sub16 mittal of the plan required by subsection (b), the Secretary 

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

18 Senate and the Committee on Veterans’ Affairs of the 

19 House of Representatives a report setting forth the num20 ber of licensed professional mental health counselors and 

21 marriage and family therapists hired by the Department 

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

23 report, disaggregated by Veterans Integrated Service Net24 work and medical center. 


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1 SEC. 504. STAFFING IMPROVEMENT PLAN FOR PEER SPE2 CIALISTS OF DEPARTMENT OF VETERANS AF3 FAIRS WHO ARE WOMEN. 

4 (a) ASSESSMENT OF CAPACITY.— 

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

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

7 of Veterans Affairs, in consultation with the Inspec8 tor General of the Department of Veterans Affairs, 

9 shall commence an assessment of the capacity of 

10 peer specialists of the Department of Veterans Af11 fairs who are women. 

12 (2) ELEMENTS.—The assessment required by 

13 paragraph (1) shall include an assessment of the fol14 lowing: 

15 (A) The geographical distribution of peer 

16 specialists of the Department who are women. 

17 (B) The geographical distribution of 

18 women veterans. 

19 (C) The number and proportion of women 

20 peer specialists who specialize in peer coun21 seling on mental health or suicide prevention. 

22 (D) The number and proportion of women 

23 peer specialists who specialize in peer coun24 seling on non-mental health related matters. 

25 (b) REPORT.—Not later than one year after the as26 sessment required by subsection (a) has commenced, the 


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1 Secretary shall submit to the Committee on Veterans’ Af2 fairs of the Senate and the Committee on Veterans’ Af3 fairs of the House of Representatives a report detailing 

4 the findings of the assessment. 

5 (c) STAFFING IMPROVEMENT PLAN.— 

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

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

8 Secretary, in consultation with the Inspector Gen9 eral, shall submit to the Committee on Veterans’ Af10 fairs of the Senate and the Committee on Veterans’ 

11 Affairs of the House of Representatives a plan, 

12 based on the results of the assessment required by 

13 subsection (a), to hire additional qualified peer spe14 cialists who are women, with special consideration 

15 for areas that lack peer specialists who are women. 

16 (2) ELEMENTS.—The peer specialist positions 

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

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

19 and 

20 (B) may be part-time positions. 


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1 SEC. 505. ESTABLISHMENT OF DEPARTMENT OF VETERANS 

2 AFFAIRS READJUSTMENT COUNSELING 

3 SERVICE SCHOLARSHIP PROGRAM. 

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

5 States Code, is amended by inserting after subchapter 

6 VIII the following new subchapter: 

7 ‘‘SUBCHAPTER IX—READJUSTMENT 

8 COUNSELING SERVICE SCHOLARSHIP PROGRAM 

9 ‘‘§ 7698. Requirement for program 

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

11 Secretary shall carry out a scholarship program under this 

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

15 as the ‘Program’). 

16 ‘‘§ 7699. Eligibility; agreement 

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

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

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

23 of study at an accredited educational institution, 

24 school, or training program leading to— 


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

3 and family therapy; or 

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

5 counseling; and 

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

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

10 the following individuals: 

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

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

13 ‘‘(A) designated as a medically underserved 

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

16 and 

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

20 Analysis and Statistics and the Bureau of the 

21 Census. 

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

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


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

2 include the following: 

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

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

6 which the participant pursues a program of study 

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

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

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

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

12 period following the completion by the participant of 

13 such program of study (in this subchapter referred 

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

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

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

18 ‘‘§ 7699A. Obligated service 

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

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

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

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


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1 ‘‘(b) DETERMINATION OF SERVICE COMMENCEMENT

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

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

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

7 of obligated service of the participant. 

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

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

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

12 educational institution in which the participant is enrolled 

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

14 under the agreement entered into under section 7604 of 

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

16 damages in the amount of $1,500. 

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

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

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

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

22 Program shall be liable to the United States for the 

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


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

5 under regulations prescribed by the Secretary). 

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

7 educational institution for disciplinary reasons. 

8 ‘‘(C) The participant voluntarily terminates the 

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

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

12 service obligation arising under the agreement. 

13 ‘‘(c) LIABILITY DURING PERIOD OF OBLIGATED

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

15 participant in the Program does not complete the period 

16 of obligated service of the participant, the United States 

17 shall be entitled to recover from the participant an amount 

18 determined in accordance with the following formula: 

19 A=3Φ(t¥s/t). 

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

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

23 ‘‘(B) ‘Φ’ is the sum of— 

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


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

2 would be payable if at the time the amounts 

3 were paid they were loans bearing interest at 

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

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

7 period of obligated service of the participant. 

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

9 served by the participant. 

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

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

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

15 amount of damages that the United States is entitled to 

16 recover under this section shall be paid to the United 

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

18 of the breach of the agreement.’’. 

19 (b) CONFORMING AND TECHNICAL AMENDMENTS.— 

20 (1) CONFORMING AMENDMENTS.— 

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

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

24 ‘‘and’’; 


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

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

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

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

7 chapter.’’. 

8 (B) ELIGIBILITY.—Section 7602 of such 

9 title is amended— 

10 (i) in subsection (a)(1)— 

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

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

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

15 and 

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

17 VI’’ and inserting ‘‘VI, or IX’’. 

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

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

20 inserting ‘‘VIII, or IX’’. 

21 (D) TERMS OF AGREEMENT.—Section 

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

23 VIII’’ each place it appears and inserting 

24 ‘‘VIII, or IX’’. 


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1 (E) ANNUAL REPORT.—Section 7632 of 

2 such title is amended— 

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

4 the Specialty Education Loan Repayment 

5 Program’’ and inserting ‘‘the Specialty 

6 Education Loan Repayment Program, and 

7 the Readjustment Counseling Service 

8 Scholarship Program’’; and 

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

10 per participant in the Specialty Education 

11 Loan Repayment Program’’ and inserting 

12 ‘‘per participant in the Specialty Education 

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

15 Service Scholarship Program’’. 

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

17 at the beginning of chapter 76 of such title is 

18 amended by inserting after the items relating to sub19 chapter VIII the following: 

‘‘SUBCHAPTER IX—READJUSTMENT COUNSELING SERVICE SCHOLARSHIP

PROGRAM

‘‘Sec. 

‘‘7698. Requirement for program. 

‘‘7699. Eligibility; agreement. 

‘‘7699A. Obligated service. 

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

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

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


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

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

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

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

9 of the United States shall submit to the Committee on 

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

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

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

15 (a) shall include the following: 

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

17 treatment, counseling, and other services provided at 

18 Vet Centers, including recommendations on whether 

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

21 (2) An assessment of the efficacy of outreach 

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

24 can be improved. 


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

2 Centers, including recommendations for overcoming 

3 those barriers. 

4 (4) An assessment of the efficacy and frequency 

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

7 health services, including recommendations for how 

8 the use of telehealth can be improved. 

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

11 Readjustment Counseling Service, including— 

12 (A) recommendations on what eligibility 

13 criteria could be expanded; and 

14 (B) an assessment of potential costs and 

15 increased infrastructure requirements if eligi16 bility is expanded. 

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

18 members of the reserve components of the Armed 

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

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

22 eligible family members of former members of the 

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


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

3 Centers in administering group therapy. 

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

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

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

7 SEC. 507. EXPANSION OF REPORTING REQUIREMENTS ON 

8 READJUSTMENT COUNSELING SERVICE OF 

9 DEPARTMENT OF VETERANS AFFAIRS. 

10 (a) EXPANSION OF ANNUAL REPORT.—Paragraph 

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

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

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

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

15 additional infrastructure, infrastructure improvements, 

16 and additional mobile Vet Centers’’. 

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

18 adding at the end the following new paragraph: 

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

21 shall include in such report a prediction of trends in de22 mand for care, long-term investments required with re23 spect to the provision of care, maintenance of infrastruc24 ture, and other capital investments with respect to the ReVerDate Sep 11 2014 22:25 Apr 03, 2019 Jkt 089200 PO 00000 Frm 00095 Fmt 6652 Sfmt 6201 E:\BILLS\S785.IS S785

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1 adjustment Counseling Service, including Vet Centers, 

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

3 SEC. 508. STUDIES ON ALTERNATIVE WORK SCHEDULES 

4 FOR EMPLOYEES OF VETERANS HEALTH AD5 MINISTRATION. 

6 (a) STUDY OF VETERANS.— 

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

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

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

14 appointments. 

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

17 who— 

18 (A) is enrolled in the patient enrollment 

19 system of the Department under section 

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

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

23 ending on the date of the commencement of the 

24 study under paragraph (1). 

25 (b) DEPARTMENT STUDY.— 


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

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

4 advisability of offering appointments outside the 

5 usual operating hours of facilities of the Depart6 ment. 

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

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

14 appointments. 

15 SEC. 509. SUICIDE PREVENTION COORDINATORS. 

16 The Secretary of Veterans Affairs shall ensure that 

17 each medical center of the Department of Veterans Affairs 

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


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

4 SEC. 521. DIRECT HIRING AUTHORITIES FOR CERTAIN 

5 HEALTH CARE POSITIONS. 

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

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

8 following: 

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

‘‘Sec. 

‘‘10301. Department of Veterans Affairs personnel authorities. 

11 ‘‘§ 10301. Department of Veterans Affairs personnel 

12 authorities 

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

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

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

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

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

21 of title 38 in order to— 

22 ‘‘(A) better meet mission needs; 

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

24 needs of applicants; 


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

2 ‘‘(D) support timely decisions; and 

3 ‘‘(E) promote competitive job offers. 

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

5 the process by which the appointments described in 

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

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

10 providing for the following: 

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

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

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

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

21 ‘‘(3) IMPLEMENTATION REQUIREMENTS.—In 

22 implementing this subsection, the Secretary shall 

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

24 regarding veterans’ preference requirements, in a 


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

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

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

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

8 Secretary shall develop indicators of effectiveness to 

9 determine whether appointment flexibilities under 

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

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

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

16 subsection, the Secretary shall— 

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

19 their exclusive representatives) in that redesign and 

20 in the implementation of that system; 

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

23 implementation and operation of that redesign and 

24 that system; 

25 ‘‘(3) develop— 


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

3 to develop managers for the agency; and 

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

6 that a supervisor may use in administering that 

7 system; 

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

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

13 surveys; 

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

15 their career paths and opportunities to advance and 

16 excel within their fields; 

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

19 who fail to meet performance standards; 

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

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

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


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1 (b) TECHNICAL AND CONFORMING AMENDMENT.— 

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

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

4 chapter 102 the following: 

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

5 TITLE VI—IMPROVEMENT OF 

6 TELEHEALTH SERVICES 

7 SEC. 601. EXPANDED TELEHEALTH FROM DEPARTMENT OF 

8 VETERANS AFFAIRS. 

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

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

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

16 of grants under subsection (c). 

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

19 partnerships under subsection (a) with organizations 

20 that— 

21 (1) represent veterans in rural or highly rural 

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


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

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

4 (c) AWARD OF GRANTS.— 

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

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

8 award grants to those entities. 

9 (2) MAXIMUM AMOUNT OF GRANTS.—The 

10 amount of a grant awarded under this subsection 

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

12 (3) USE OF GRANTS.— 

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

14 entity under this subsection shall be used for 

15 the following: 

16 (i) Purchasing or upgrading hardware 

17 or software necessary for the provision of 

18 secure and private telehealth services. 

19 (ii) Upgrading security protocols for 

20 consistency with the standardized tele21 health security protocol implemented under 

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


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1 (iii) Training of employees, including 

2 payment of those employees for completing 

3 that training, with respect to— 

4 (I) military and veteran cultural 

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

7 and 

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

10 (iv) Upgrading existing infrastructure 

11 owned or leased by the entity to make 

12 rooms more conducive to telehealth care, 

13 including— 

14 (I) additional walls to create a 

15 new, private room; 

16 (II) soundproofing of existing 

17 rooms; or 

18 (III) new electrical or internet 

19 outlets in an existing room. 

20 (v) Upgrading existing infrastructure 

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

23 seq.). 

24 (vi) Upgrading internet infrastruc25 ture. 


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

2 for the purchase of new property or for major 

3 construction projects, as determined by the Sec4 retary. 

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

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

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

11 memorandum of understanding or memorandum of 

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

14 (2) INSPECTION.—The Secretary shall inspect 

15 the access point proposed to be established under 

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

18 access point is established. 

19 (e) ASSESSMENT OF BARRIERS TO ACCESS.— 

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

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

23 by veterans in accessing telehealth services from 

24 home. 


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1 (2) ELEMENTS.—The assessment required by 

2 paragraph (1) shall include the following: 

3 (A) An assessment of current and potential 

4 future cost barriers to veterans having internet 

5 access at home. 

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

8 broadband services at home. 

9 (C) A description of how the Department 

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

13 (D) Such other matters related to internet 

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

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

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

20 Committee on Veterans’ Affairs of the House of 

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


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1 (f) AUTHORIZATION OF APPROPRIATIONS.—There is 

2 authorized to be appropriated to the Secretary of Veterans 

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

4 SEC. 602. IMPLEMENTATION OF NATIONAL PROTOCOL FOR 

5 TELEHEALTH SECURITY AND INTERFACING 

6 INSTRUCTIONS. 

7 (a) NATIONAL TELEHEALTH SECURITY PRO8 TOCOL.— 

9 (1) ASSESSMENT.— 

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

15 Information Officer, and stakeholders, shall 

16 conduct an assessment of current telehealth se17 curity protocols. 

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

20 the following: 

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

24 (I) the Department of Veterans 

25 Affairs; 


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1 (II) other Federal agencies; 

2 (III) other health care providers; 

3 and 

4 (IV) such other organizations as 

5 the Secretary considers necessary to 

6 assess under such subparagraph. 

7 (ii) A study of any current or future 

8 security risks— 

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

11 (II) faced by the Department in 

12 furnishing those services. 

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

16 of the enactment of this Act. 

17 (2) IMPLEMENTATION.—Not later than 18 

18 months after the completion of the assessment under 

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

20 from the assessment, fully implement a standardized 

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

23 (3) PRIVACY AND SECURITY.—The Secretary 

24 shall ensure that the security protocol implemented 

25 under this subsection protects the privacy and secuVerDate Sep 11 2014 22:25 Apr 03, 2019 Jkt 089200 PO 00000 Frm 00108 Fmt 6652 Sfmt 6201 E:\BILLS\S785.IS S785

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

2 data from the Department. 

3 (b) NATIONAL TELEHEALTH INTERFACING INSTRUC4 TIONS.— 

5 (1) ASSESSMENT.— 

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

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

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

17 assessment of interfacing instructions used 

18 by— 

19 (i) the Department of Veterans Af20 fairs; 

21 (ii) other Federal agencies; 

22 (iii) other health care providers; and 

23 (iv) such other organizations as the 

24 Secretary considers necessary to assess 

25 under such subparagraph. 


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

4 of the enactment of this Act. 

5 (2) IMPLEMENTATION.—Not later than 18 

6 months after the completion of the assessment under 

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

8 from the assessment, fully implement standardized 

9 telehealth interfacing instructions at all facilities of 

10 the Department. 

11 (3) NAVIGATION.—The Secretary shall ensure 

12 that the telehealth interfacing instructions imple13 mented under this subsection are those that are 

14 easiest to navigate for veterans and health care pro15 viders. 

Æ 


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