IB 

Union Calendar No. 422 

114TH CONGRESS 

2D SESSION H. R. 4063 

[Report No. 114–546, Part I] 

To improve the use by the Secretary of Veterans Affairs of opioids in treating 

veterans, to improve patient advocacy by the Secretary, and to expand 

the availability of complementary and integrative health, and for other 

purposes. 

IN THE HOUSE OF REPRESENTATIVES 

NOVEMBER 18, 2015 

Mr. BILIRAKIS (for himself, Mr. KIND, Miss RICE of New York, Mrs. 

WALORSKI, Mr. MCKINLEY, Mr. BOST, Mr. COFFMAN, Mr. ROSS, Mr. 

RYAN of Ohio, Mrs. RADEWAGEN, Mr. CRAWFORD, Mr. MICA, Ms. 

FRANKEL of Florida, Ms. KUSTER, Mr. MCCAUL, and Mr. WALZ) introduced the following bill; which was referred to the Committee on Veterans’ Affairs, and in addition to the Committee on Armed Services, for 

a period to be subsequently determined by the Speaker, in each case for 

consideration of such provisions as fall within the jurisdiction of the committee concerned 

MAY 10, 2016 

Additional sponsors: Mr. POCAN, Mr. RIBBLE, Mr. SENSENBRENNER, Mr. 

ASHFORD, Mr. CARNEY, Mr. JONES, Ms. DUCKWORTH, Ms. MCSALLY, 

Mrs. BLACK, Mr. YOUNG of Iowa, Ms. LOFGREN, Mrs. NAPOLITANO, Mr. 

BUCSHON, Mr. BLUMENAUER, Mrs. HARTZLER, Mr. MOULTON, Mr. 

GUINTA, Mr. KILMER, Mr. CICILLINE, and Mr. TIPTON

MAY 10, 2016 

Reported from the Committee on Veterans’ Affairs with an amendment 

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

MAY 10, 2016 

The Committee on Armed Services discharged; committed to the Committee 

of the Whole House on the State of the Union and ordered to be printed 

[For text of introduced bill, see copy of bill as introduced on November 18, 2015] 


rfrederick on DSK6VPTVN1PROD with BILLS
2 

•HR 4063 RH

A BILL 

To improve the use by the Secretary of Veterans Affairs 

of opioids in treating veterans, to improve patient advocacy by the Secretary, and to expand the availability 

of complementary and integrative health, and for other 

purposes. 


rfrederick on DSK6VPTVN1PROD with BILLS
3 

•HR 4063 RH

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 ‘‘Pro5 moting Responsible Opioid Management and Incorporating 

6 Scientific Expertise Act’’ or the ‘‘Jason Simcakoski PROM7 ISE Act’’. 

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

9 this Act is as follows: 

Sec. 1. Short title; table of contents. 

TITLE I—OPIOID THERAPY AND PAIN MANAGEMENT 

Sec. 101. Establishment of Advisory Committee to review guidelines on management of opioid therapy by Department of Veterans Affairs and 

Department of Defense. 

Sec. 102. Improvement of opioid safety measures by Department of Veterans Affairs. 

Sec. 103. Strengthening of joint working group on pain management of the Department of Veterans Affairs and the Department of Defense. 

Sec. 104. Review, investigation, and report on use of opioids in treatment by Department of Veterans Affairs. 

Sec. 105. Mandatory disclosure of certain veteran information to State controlled 

substance monitoring programs. 

TITLE II—PATIENT ADVOCACY 

Sec. 201. Community meetings on improving care furnished by Department of 

Veterans Affairs. 

Sec. 202. Improvement of awareness of patient advocacy program and patient bill 

of rights of Department of Veterans Affairs. 

Sec. 203. Comptroller general report on patient advocacy program of Department 

of Veterans Affairs. 

TITLE III—COMPLEMENTARY AND INTEGRATIVE HEALTH 

Sec. 301. Expansion of research and education on and delivery of complementary 

and integrative health to veterans. 

Sec. 302. Pilot program on integration of complementary alternative medicines 

and related issues for veterans and family members of veterans. 

TITLE IV—FITNESS OF HEALTH CARE PROVIDERS 

Sec. 401. Additional requirements for hiring of health care providers by Department of Veterans Affairs. 


rfrederick on DSK6VPTVN1PROD with BILLS
4 

•HR 4063 RH

Sec. 402. Provision of information on health care providers of Department of Veterans Affairs to State Medical Boards. 

Sec. 403. Report on compliance by Department of Veterans Affairs with reviews 

of health care providers leaving the Department or transferring 

to other facilities. 

TITLE V—OTHER VETERANS MATTERS 

Sec. 501. Audit of Veterans Health Administration programs of Department of 

Veterans Affairs. 

1 TITLE I—OPIOID THERAPY AND 

2 PAIN MANAGEMENT 

3 SEC. 101. ESTABLISHMENT OF ADVISORY COMMITTEE TO 

4 REVIEW GUIDELINES ON MANAGEMENT OF 

5 OPIOID THERAPY BY DEPARTMENT OF VET6 ERANS AFFAIRS AND DEPARTMENT OF DE7 FENSE. 

8 (a) ADVISORY COMMITTEE.—Not later than 120 days 

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

10 of Veterans Affairs and the Secretary of Defense shall joint11 ly convene an advisory committee to— 

12 (1) conduct a thorough review of the most recent 

13 VA/DOD Clinical Practice Guideline for Management 

14 of Opioid Therapy for Chronic Pain; and 

15 (2) make recommendations to the Secretaries 

16 with respect to updating the Clinical Practice Guide17 line. 

18 (b) MATTERS INCLUDED.—In conducting the review 

19 under subsection (a)(1), the Advisory Committee shall ex20 amine whether the Clinical Practical Guideline should in21 clude the following: 


rfrederick on DSK6VPTVN1PROD with BILLS
5 

•HR 4063 RH

1 (1) Enhanced guidance with respect to— 

2 (A) the coadministration of an opioid and 

3 other drugs, including benzodiazepines, that may 

4 result in life-limiting drug interactions; 

5 (B) the treatment of patients with current 

6 acute psychiatric instability or substance use 

7 disorder or patients at risk of suicide; and 

8 (C) the use of opioid therapy to treat men9 tal health disorders other than opioid use dis10 order. 

11 (2) Enhanced guidance with respect to the treat12 ment of patients with behaviors or comorbidities, such 

13 as post-traumatic stress disorder or other psychiatric 

14 disorders, or a history of substance abuse or addic15 tion, that requires a consultation or comanagement of 

16 opioid therapy with one or more specialists in pain 

17 management, mental health, or addictions. 

18 (3) Enhanced guidance with respect to health 

19 care providers— 

20 (A) conducting an effective assessment for 

21 patients beginning or continuing opioid therapy, 

22 including understanding and setting realistic 

23 goals with respect to achieving and maintaining 

24 an expected level of pain relief, improved funcVerDate Sep 11 2014 02:43 May 11, 2016 Jkt 059200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6203 E:\BILLS\H4063.RH H4063

rfrederick on DSK6VPTVN1PROD with BILLS
6 

•HR 4063 RH

1 tion, or a clinically appropriate combination of 

2 both; and 

3 (B) effectively assessing whether opioid ther4 apy is achieving or maintaining the established 

5 treatment goals of the patient or whether the pa6 tient and health care provider should discuss ad7 justing, augmenting , or discontinuing the opioid 

8 therapy. 

9 (4) Guidance that each health care provider of 

10 the Department of Veterans Affairs and the Depart11 ment of Defense, before initiating opioid therapy to 

12 treat a patient as part of the comprehensive assess13 ment conducted by the health care provider, use the 

14 Opioid Therapy Risk Report tool of the Department 

15 of Veterans Affairs (or similar monitoring tool), 

16 which shall include information from the prescription 

17 drug monitoring program of each State that includes 

18 the most recent information to date relating to the 

19 patient that accessed such program to assess the risk 

20 for adverse outcomes of opioid therapy for the patient, 

21 including the concurrent use of controlled substances 

22 such as benzodiazepines, as part of the comprehensive 

23 assessment conducted by the health care provider. 

24 (5) Guidelines to govern the methodologies used 

25 by health care providers of the Department of VetVerDate Sep 11 2014 02:43 May 11, 2016 Jkt 059200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6203 E:\BILLS\H4063.RH H4063

rfrederick on DSK6VPTVN1PROD with BILLS
7 

•HR 4063 RH

1 erans Affairs and the Department of Defense to taper 

2 opioid therapy when adjusting or discontinuing the 

3 use of opioid therapy. 

4 (6) Guidelines with respect to appropriate case 

5 management for patients receiving opioid therapy 

6 who transition between inpatient and outpatient 

7 health care settings, which may include the use of 

8 care transition plans. 

9 (7) Guidelines with respect to appropriate case 

10 management for patients receiving opioid therapy 

11 who transition from receiving care during active duty 

12 to post-military health care networks. 

13 (8) Enhanced standards with respect to the use 

14 of routine and random urine drug tests for all pa15 tients before and during opioid therapy to help pre16 vent substance abuse, dependence, and diversion, in17 cluding— 

18 (A) that such tests occur not less frequently 

19 than once each year; and 

20 (B) that health care providers appropriately 

21 order, interpret and respond to the results from 

22 such tests to tailor pain therapy, safeguards, and 

23 risk management strategies to each patient. 

24 (9) Guidance that health care providers discuss 

25 with patients, before initiating opioid therapy, opVerDate Sep 11 2014 02:43 May 11, 2016 Jkt 059200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6203 E:\BILLS\H4063.RH H4063

rfrederick on DSK6VPTVN1PROD with BILLS
8 

•HR 4063 RH

1 tions for pain management therapies without the use 

2 of opioids and options to augment opioid therapy 

3 with other clinical and complementary and integra4 tive health services to minimize opioid dependence. 

5 (10) Guidance for health care providers with re6 spect to evidence-based non-opioid treatments within 

7 the Department of Veterans Affairs and the Depart8 ment of Defense, including medical devices and other 

9 therapies approved or cleared by the Food and Drug 

10 Administration for the treatment of chronic pain as 

11 an alternative to or to augment opioid therapy. 

12 (c) CONSULTATION.—In carrying out the review under 

13 paragraph (1) of subsection (a), and before making the rec14 ommendations under paragraph (2) of such subsection, the 

15 Advisory Committee shall consult with the VA/DOD Man16 agement of Opioid Therapy for Chronic Pain Working 

17 Group. 

18 (d) SUBMISSION.—Not later than one year after the 

19 date of the enactment of this Act, the Advisory Committee 

20 shall submit to the Secretaries the review and recommenda21 tions described in subsection (a)(1). 

22 (e) APPLICATION OF FEDERAL ADVISORY COMMITTEE

23 ACT.—The provisions of the Federal Advisory Committee 

24 Act (5 U.S.C. App.) shall apply to the Advisory Committee. 

25 (f) DEFINITIONS.—In this section: 


rfrederick on DSK6VPTVN1PROD with BILLS
9 

•HR 4063 RH

1 (1) The term ‘‘Advisory Committee’’ means the 

2 advisory committee established under subsection (a). 

3 (2) The term ‘‘Clinical Practice Guideline’’ 

4 means the VA/DOD Clinical Practice Guideline for 

5 Management of Opioid Therapy for Chronic Pain. 

6 (3) The term ‘‘controlled substance’’ has the 

7 meaning given that term in section 102 of the Con8 trolled Substances Act (21 U.S.C. 802). 

9 (4) The term ‘‘State’’ means each of the several 

10 States, territories, and possessions of the United 

11 States, the District of Columbia, and the Common12 wealth of Puerto Rico. 

13 SEC. 102. IMPROVEMENT OF OPIOID SAFETY MEASURES BY 

14 DEPARTMENT OF VETERANS AFFAIRS. 

15 (a) EXPANSION OF OPIOID SAFETY INITIATIVE.—Not 

16 later than 180 days after the date of the enactment of this 

17 Act, the Secretary of Veterans Affairs shall expand the 

18 Opioid Safety Initiative of the Department of Veterans Af19 fairs to include all medical facilities of the Department. 

20 (b) PAIN MANAGEMENT EDUCATION AND TRAINING.— 

21 (1) IN GENERAL.—In carrying out the Opioid 

22 Safety Initiative of the Department, the Secretary 

23 shall require all employees of the Department respon24 sible for prescribing opioids to receive education and 

25 training described in paragraph (2). 


rfrederick on DSK6VPTVN1PROD with BILLS
10 

•HR 4063 RH

1 (2) EDUCATION AND TRAINING.—Education and 

2 training described in this paragraph is education and 

3 training on pain management and safe opioid pre4 scribing practices for purposes of safely and effectively 

5 managing patients with chronic pain, including edu6 cation and training on the following: 

7 (A) The implementation of and full compli8 ance with the VA/DOD Clinical Practice Guide9 line for Management of Opioid Therapy for 

10 Chronic Pain, including any update to such 

11 guideline. 

12 (B) The use of evidence-based pain manage13 ment therapies, including cognitive-behavioral 

14 therapy, non-opioid alternatives, and non-drug 

15 methods and procedures to managing pain and 

16 related health conditions including medical de17 vices approved or cleared by the Food and Drug 

18 Administration for the treatment of patients 

19 with chronic pain and complementary alter20 native medicines. 

21 (C) Screening and identification of patients 

22 with substance use disorder, including drug-seek23 ing behavior, before prescribing opioids, assess24 ment of risk potential for patients developing an 

25 addiction, and referral of patients to appropriate 


rfrederick on DSK6VPTVN1PROD with BILLS
11 

•HR 4063 RH

1 addiction treatment professionals if addiction is 

2 identified or strongly suspected. 

3 (D) Communication with patients on the 

4 potential harm associated with the use of opioids 

5 and other controlled substances, including the 

6 need to safely store and dispose of supplies relat7 ing to the use of opioids and other controlled 

8 substances. 

9 (E) Such other education and training as 

10 the Secretary considers appropriate to ensure 

11 that veterans receive safe and high-quality pain 

12 management care from the Department. 

13 (3) USE OF EXISTING PROGRAM.—In providing 

14 education and training described in paragraph (2), 

15 the Secretary shall use the Interdisciplinary Chronic 

16 Pain Management Training Team Program of the 

17 Department (or success program). 

18 (c) PAIN MANAGEMENT TEAMS.— 

19 (1) IN GENERAL.—In carrying out the Opioid 

20 Safety Initiative of the Department, the director of 

21 each medical facility of the Department shall identify 

22 and designate a pain management team of health 

23 care professionals, which may include board certified 

24 pain medicine specialists, responsible for coordinating 

25 and overseeing pain management therapy at such faVerDate Sep 11 2014 02:43 May 11, 2016 Jkt 059200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6203 E:\BILLS\H4063.RH H4063

rfrederick on DSK6VPTVN1PROD with BILLS
12 

•HR 4063 RH

1 cility for patients experiencing acute and chronic 

2 pain that is non-cancer related. 

3 (2) ESTABLISHMENT OF PROTOCOLS.— 

4 (A) IN GENERAL.—In consultation with the 

5 Directors of each Veterans Integrated Service 

6 Network, the Secretary shall establish standard 

7 protocols for the designation of pain manage8 ment teams at each medical facility within the 

9 Department. 

10 (B) CONSULTATION ON PRESCRIPTION OF

11 OPIOIDS.—Each protocol established under sub12 paragraph (A) shall ensure that any health care 

13 provider without expertise in prescribing analge14 sics or who has not completed the education and 

15 training under subsection (b), including a men16 tal health care provider, does not prescribe 

17 opioids to a patient unless that health care pro18 vider— 

19 (i) consults with a health care provider 

20 with pain management expertise or who is 

21 on the pain management team of the med22 ical facility; and 

23 (ii) refers the patient to the pain man24 agement team for any subsequent prescrip25 tions and related therapy. 


rfrederick on DSK6VPTVN1PROD with BILLS
13 

•HR 4063 RH

1 (3) REPORT.— 

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

3 after the date of enactment of this Act, the direc4 tor of each medical facility of the Department 

5 shall submit to the Under Secretary for Health 

6 and the director of the Veterans Integrated Serv7 ice Network in which the medical facility is lo8 cated a report identifying the health care profes9 sionals that have been designated as members of 

10 the pain management team at the medical facil11 ity pursuant to paragraph (1). 

12 (B) ELEMENTS.—Each report submitted 

13 under subparagraph (A) with respect to a med14 ical facility of the Department shall include— 

15 (i) a certification as to whether all 

16 members of the pain management team at 

17 the medical facility have completed the edu18 cation and training required under sub19 section (b); 

20 (ii) a plan for the management and re21 ferral of patients to such pain management 

22 team if health care providers without exper23 tise in prescribing analgesics prescribe 

24 opioid medications to treat acute and 

25 chronic pain that is non-cancer related; and 


rfrederick on DSK6VPTVN1PROD with BILLS
14 

•HR 4063 RH

1 (iii) a certification as to whether the 

2 medical facility— 

3 (I) fully complies with the 

4 stepped-care model of pain manage5 ment and other pain management poli6 cies contained in Directive 2009-053 of 

7 the Veterans Health Administration, or 

8 successor directive; or 

9 (II) does not fully comply with 

10 such stepped-care model of pain man11 agement and other pain management 

12 policies but is carrying out a corrective 

13 plan of action to ensure such full com14 pliance. 

15 (d) TRACKING AND MONITORING OF OPIOID USE.— 

16 (1) PRESCRIPTION DRUG MONITORING PROGRAMS

17 OF STATES.—In carrying out the Opioid Safety Ini18 tiative and the Opioid Therapy Risk Report tool of 

19 the Department, the Secretary shall— 

20 (A) ensure access by health care providers of 

21 the Department to information on controlled sub22 stances, including opioids and benzodiazepines, 

23 prescribed to veterans who receive care outside 

24 the Department through the prescription drug 

25 monitoring program of each State with such a 


rfrederick on DSK6VPTVN1PROD with BILLS
15 

•HR 4063 RH

1 program, including by seeking to enter into 

2 memoranda of understanding with States to 

3 allow shared access of such information between 

4 States and the Department; 

5 (B) include such information in the Opioid 

6 Therapy Risk Report; and 

7 (C) require health care providers of the De8 partment to submit to the prescription drug 

9 monitoring program of each State information 

10 on prescriptions of controlled substances received 

11 by veterans in that State under the laws admin12 istered by the Secretary. 

13 (2) REPORT ON TRACKING OF DATA ON OPIOID

14 USE.—Not later than 18 months after the date of the 

15 enactment of this Act, the Secretary shall submit to 

16 the Committee on Veterans’ Affairs of the Senate and 

17 the Committee on Veterans’ Affairs of the House of 

18 Representatives a report on the feasibility and advis19 ability of improving the Opioid Therapy Risk Report 

20 tool of the Department to allow for more advanced 

21 real-time tracking of and access to data on— 

22 (A) the key clinical indicators with respect 

23 to the totality of opioid use by veterans; 

24 (B) concurrent prescribing by health care 

25 providers of the Department of opioids in difVerDate Sep 11 2014 02:43 May 11, 2016 Jkt 059200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6203 E:\BILLS\H4063.RH H4063

rfrederick on DSK6VPTVN1PROD with BILLS
16 

•HR 4063 RH

1 ferent health care settings, including data on 

2 concurrent prescribing of opioids to treat mental 

3 health disorders other than opioid use disorder; 

4 and 

5 (C) mail-order prescriptions of opioid pre6 scribed to veterans under the laws administered 

7 by the Secretary. 

8 (e) AVAILABILITY OF OPIOID RECEPTOR ANTAGO9 NISTS.— 

10 (1) INCREASED AVAILABILITY AND USE.— 

11 (A) IN GENERAL.—The Secretary shall 

12 maximize the availability of opioid receptor an13 tagonists approved by the Food and Drug Ad14 ministration, including naloxone, to veterans. 

15 (B) AVAILABILITY, TRAINING, AND DISTRIB16 UTING.—In carrying out subparagraph (A), not 

17 later than 90 days after the date of the enact18 ment of this Act, the Secretary shall— 

19 (i) equip each pharmacy of the Depart20 ment with opioid receptor antagonists ap21 proved by the Food and Drug Administra22 tion to be dispensed to outpatients as need23 ed; and 

24 (ii) expand the Overdose Education 

25 and Naloxone Distribution program of the 


rfrederick on DSK6VPTVN1PROD with BILLS
17 

•HR 4063 RH

1 Department to ensure that all veterans in 

2 receipt of health care under laws adminis3 tered by the Secretary who are at risk of 

4 opioid overdose may access such opioid re5 ceptor antagonists and training on the 

6 proper administration of such opioid recep7 tor antagonists. 

8 (C) VETERANS WHO ARE AT RISK.—For 

9 purposes of subparagraph (B), veterans who are 

10 at risk of opioid overdose include— 

11 (i) veterans receiving long-term opioid 

12 therapy; 

13 (ii) veterans receiving opioid therapy 

14 who have a history of substance use disorder 

15 or prior instances of overdose; and 

16 (iii) veterans who are at risk as deter17 mined by a health care provider who is 

18 treating the veteran. 

19 (2) REPORT.—Not later than 120 days after the 

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

21 submit to the Committee on Veterans’ Affairs of the 

22 Senate and the Committee on Veterans’ Affairs of the 

23 House of Representatives a report on carrying out 

24 paragraph (1), including an assessment of any reVerDate Sep 11 2014 02:43 May 11, 2016 Jkt 059200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6203 E:\BILLS\H4063.RH H4063

rfrederick on DSK6VPTVN1PROD with BILLS
18 

•HR 4063 RH

1 maining steps to be carried out by the Secretary to 

2 carry out such paragraph. 

3 (f) INCLUSION OF CERTAIN INFORMATION AND CAPA4 BILITIES IN OPIOID THERAPY RISK REPORT TOOL OF THE

5 DEPARTMENT.— 

6 (1) INFORMATION.—The Secretary shall include 

7 in the Opioid Therapy Risk Report tool of the De8 partment— 

9 (A) information on the most recent time the 

10 tool was accessed by a health care provider of the 

11 Department with respect to each veteran; and 

12 (B) information on the results of the most 

13 recent urine drug test for each veteran. 

14 (2) CAPABILITIES.—The Secretary shall include 

15 in the Opioid Therapy Risk Report tool the ability of 

16 the health care providers of the Department to deter17 mine whether a health care provider of the Depart18 ment prescribed opioids to a veteran without checking 

19 the information in the tool with respect to the vet20 eran. 

21 (g) NOTIFICATIONS OF RISK IN COMPUTERIZED

22 HEALTH RECORD.—The Secretary shall modify the com23 puterized patient record system of the Department to ensure 

24 that any health care provider that accesses the record of 

25 a veteran, regardless of the reason the veteran seeks care 


rfrederick on DSK6VPTVN1PROD with BILLS
19 

•HR 4063 RH

1 from the health care provider, will be immediately notified 

2 whether the veteran— 

3 (1) is receiving opioid therapy and has a history 

4 of substance use disorder or prior instances of over5 dose; 

6 (2) has a history of opioid abuse; or 

7 (3) is at risk of becoming an opioid abuser as de8 termined by a health care provider who is treating 

9 the veteran. 

10 (h) DEFINITIONS.—In this section: 

11 (1) The term ‘‘controlled substance’’ has the 

12 meaning given that term in section 102 of the Con13 trolled Substances Act (21 U.S.C. 802). 

14 (2) The term ‘‘State’’ means each of the several 

15 States, territories, and possessions of the United 

16 States, the District of Columbia, and the Common17 wealth of Puerto Rico. 

18 SEC. 103. STRENGTHENING OF JOINT WORKING GROUP ON 

19 PAIN MANAGEMENT OF THE DEPARTMENT OF 

20 VETERANS AFFAIRS AND THE DEPARTMENT 

21 OF DEFENSE. 

22 (a) IN GENERAL.—Not later than 90 days after the 

23 date of enactment of this Act, the Secretary of Veterans Af24 fairs and the Secretary of Defense shall ensure that the Pain 

25 Management Working Group of the Health Executive ComVerDate Sep 11 2014 02:43 May 11, 2016 Jkt 059200 PO 00000 Frm 00019 Fmt 6652 Sfmt 6203 E:\BILLS\H4063.RH H4063

rfrederick on DSK6VPTVN1PROD with BILLS
20 

•HR 4063 RH

1 mittee of the Department of Veterans Affairs–Department 

2 of Defense Joint Executive Committee established under sec3 tion 320 of title 38, United States Code, includes a focus 

4 on the following: 

5 (1) The opioid prescribing practices of health 

6 care providers of each Department. 

7 (2) The ability of each Department to manage 

8 acute and chronic pain among individuals receiving 

9 health care from the Department, including training 

10 health care providers with respect to pain manage11 ment. 

12 (3) The use by each Department of complemen13 tary and integrative health and complementary alter14 native medicines in treating such individuals. 

15 (4) The concurrent use by health care providers 

16 of each Department of opioids and prescription drugs 

17 to treat mental health disorders, including 

18 benzodiazepines. 

19 (5) The practice by health care providers of each 

20 Department of prescribing opioids to treat mental 

21 health disorders. 

22 (6) The coordination in coverage of and con23 sistent access to medications prescribed for patients 

24 transitioning from receiving health care from the DeVerDate Sep 11 2014 02:43 May 11, 2016 Jkt 059200 PO 00000 Frm 00020 Fmt 6652 Sfmt 6203 E:\BILLS\H4063.RH H4063

rfrederick on DSK6VPTVN1PROD with BILLS
21 

•HR 4063 RH

1 partment of Defense to receiving health care from the 

2 Department of Veterans Affairs. 

3 (7) The ability of each Department to identify 

4 and treat substance use disorders among individuals 

5 receiving health care from that Department. 

6 (b) COORDINATION AND CONSULTATION.—The Sec7 retary of Veterans Affairs and the Secretary of Defense shall 

8 ensure that the working group described in subsection (a)— 

9 (1) coordinates the activities of the working 

10 group with other relevant working groups established 

11 under section 320 of title 38, United States Code, in12 cluding the working groups on evidence-based prac13 tice, patient safety, pharmacy, psychological health, 

14 and psychological health; 

15 (2) consults with other relevant Federal agencies, 

16 including the Centers for Disease Control and Preven17 tion, with respect to the activities of the working 

18 group; and 

19 (3) consults with the Department of Veterans Af20 fairs and the Department of Defense with respect to, 

21 reviews, and comments on the VA/DOD Clinical 

22 Practice Guideline for Management of Opioid Ther23 apy for Chronic Pain, or any successor guideline, be24 fore any update to the guideline is released. 


rfrederick on DSK6VPTVN1PROD with BILLS
22 

•HR 4063 RH

1 (c) CONSULTATIONS.—The Secretary of Veterans Af2 fairs and the Secretary of Defense shall ensure that the 

3 working group described in subsection (a) is able to mean4 ingfully consult with respect to the updated guideline re5 quired under subsection (a) of section 101, as required by 

6 subsection (b) of such section, not later than 1 year after 

7 the date of enactment of this Act. 

8 SEC. 104. REVIEW, INVESTIGATION, AND REPORT ON USE 

9 OF OPIOIDS IN TREATMENT BY DEPARTMENT 

10 OF VETERANS AFFAIRS. 

11 (a) COMPTROLLER GENERAL REPORT.— 

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

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

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

16 Committee on Veterans’ Affairs of the House of Rep17 resentatives a report on the Opioid Safety Initiative 

18 of the Department of Veterans Affairs and the opioid 

19 prescribing practices of health care providers of the 

20 Department. 

21 (2) ELEMENTS.—The report submitted under 

22 paragraph (1) shall include the following: 

23 (A) Recommendations on such improve24 ments to the Opioid Safety Initiative of the DeVerDate Sep 11 2014 02:43 May 11, 2016 Jkt 059200 PO 00000 Frm 00022 Fmt 6652 Sfmt 6203 E:\BILLS\H4063.RH H4063

rfrederick on DSK6VPTVN1PROD with BILLS
23 

•HR 4063 RH

1 partment as the Comptroller General considers 

2 appropriate. 

3 (B) Information with respect to— 

4 (i) deaths resulting from sentinel 

5 events involving veterans prescribed opioids 

6 by a health care provider of the Depart7 ment; 

8 (ii) overall prescription rates and pre9 scriptions indications of opioids to treat 

10 non-cancer, non-palliative, and non-hospice 

11 care patients; 

12 (iii) the prescription rates and pre13 scriptions indications of benzodiazepines 

14 and opioids concomitantly by health care 

15 providers of the Department; 

16 (iv) the practice by health care pro17 viders of the Department of prescribing 

18 opioids to treat patients without any pain, 

19 including to treat patients with mental 

20 health disorders other than opioid use dis21 order; and 

22 (v) the effectiveness of opioid therapy 

23 for patients receiving such therapy, includ24 ing the effectiveness of long-term opioid 

25 therapy. 


rfrederick on DSK6VPTVN1PROD with BILLS
24 

•HR 4063 RH

1 (C) An evaluation of processes of the De2 partment in place to oversee opioid use among 

3 veterans, including procedures to identify and 

4 remedy potential over-prescribing of opioids by 

5 health care providers of the Department. 

6 (D) An assessment of the implementation by 

7 the Secretary of the VA/DOD Clinical Practice 

8 Guideline for Management of Opioid Therapy 

9 for Chronic Pain. 

10 (b) QUARTERLY PROGRESS REPORT ON IMPLEMENTA11 TION OF COMPTROLLER GENERAL RECOMMENDATIONS.— 

12 Not later than two years after the date of the enactment 

13 of this Act, and not later than 30 days after the end of 

14 each quarter thereafter, the Secretary of Veterans Affairs 

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

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

17 of Representatives a progress report detailing the actions 

18 by the Secretary during the period covered by the report 

19 to address any outstanding findings and recommendations 

20 by the Comptroller General of the United States under sub21 section (a) with respect to the Veterans Health Administra22 tion. 

23 (c) ANNUAL REVIEW OF PRESCRIPTION RATES.—Not 

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

25 Act, and not less frequently than annually for the following 


rfrederick on DSK6VPTVN1PROD with BILLS
25 

•HR 4063 RH

1 five years, the Secretary shall submit to the Committee on 

2 Veterans’ Affairs of the Senate and the Committee on Vet3 erans’ Affairs of the House of Representatives a report, with 

4 respect to each medical facility of the Department of Vet5 erans Affairs, to collect and review information on opioids 

6 prescribed by health care providers at the facility to treat 

7 non-cancer, non-palliative, and non-hospice care patients 

8 that contains, for the one-year period preceding the submis9 sion of the report, the following: 

10 (1) The number of patients and the percentage of 

11 the patient population of the Department who were 

12 prescribed benzodiazepines and opioids concurrently 

13 by a health care provider of the Department. 

14 (2) The number of patients and the percentage of 

15 the patient population of the Department without any 

16 pain who were prescribed opioids by a health care 

17 provider of the Department, including those who were 

18 prescribed benzodiazepines and opioids concurrently. 

19 (3) The number of non-cancer, non-palliative, 

20 and non-hospice care patients and the percentage of 

21 such patients who were treated with opioids by a 

22 health care provider of the Department on an inpa23 tient-basis and who also received prescription opioids 

24 by mail from the Department while being treated on 

25 an inpatient-basis. 


rfrederick on DSK6VPTVN1PROD with BILLS
26 

•HR 4063 RH

1 (4) The number of non-cancer, non-palliative, 

2 and non-hospice care patients and the percentage of 

3 such patients who were prescribed opioids concur4 rently by a health care provider of the Department 

5 and a health care provider that is not health care 

6 provider of the Department. 

7 (5) With respect to each medical facility of the 

8 Department, information on opioids prescribed by 

9 health care providers at the facility to treat non-can10 cer, non-palliative, and non-hospice care patients, in11 cluding information on— 

12 (A) the prescription rate at which each 

13 health care provider at the facility prescribed 

14 benzodiazepines and opioids concurrently to such 

15 patients and the aggregate such prescription rate 

16 for all health care providers at the facility; 

17 (B) the prescription rate at which each 

18 health care provider at the facility prescribed 

19 benzodiazepines or opioids to such patients to 

20 treat conditions for which benzodiazepines or 

21 opioids are not approved treatment and the ag22 gregate such prescription rate for all health care 

23 providers at the facility; 

24 (C) the prescription rate at which each 

25 health care provider at the facility prescribed or 


rfrederick on DSK6VPTVN1PROD with BILLS
27 

•HR 4063 RH

1 dispensed mail-order prescriptions of opioids to 

2 such patients while such patients were being 

3 treated with opioids on an inpatient-basis and 

4 the aggregate of such prescription rate for all 

5 health care providers at the facility; and 

6 (D) the prescription rate at which each 

7 health care provider at the facility prescribed 

8 opioids to such patients who were also concur9 rently prescribed opioids by a health care pro10 vider that is not a health care provider of the 

11 Department and the aggregate of such prescrip12 tion rates for all health care providers at the fa13 cility. 

14 (6) With respect to each medical facility of the 

15 Department, the number of times a pharmacist at the 

16 facility overrode a critical drug interaction warning 

17 with respect to an interaction between opioids and 

18 another medication before dispensing such medication 

19 to a veteran. 

20 (d) INVESTIGATION OF PRESCRIPTION RATES.—If the 

21 Secretary determines that a prescription rate with respect 

22 to a health care provider or medical facility of the Depart23 ment conflicts with or is otherwise inconsistent with the 

24 standards of appropriate and safe care, the Secretary 

25 shall— 


rfrederick on DSK6VPTVN1PROD with BILLS
28 

•HR 4063 RH

1 (1) immediately notify the Committee on Vet2 erans’ Affairs of the Senate and the Committee on 

3 Veterans’ Affairs of the House of Representatives of 

4 such determination, including information relating to 

5 such determination, prescription rate, and health care 

6 provider or medical facility, as the case may be; and 

7 (2) through the Office of the Medical Inspector of 

8 the Veterans Health Administration, conduct a full 

9 investigation of the health care provider or medical 

10 facility, as the case may be. 

11 (e) PRESCRIPTION RATE DEFINED.—In this section, 

12 the term ‘‘prescription rate’’ means, with respect to a health 

13 care provider or medical facility of the Department, each 

14 of the following: 

15 (1) The number of patients treated with opioids 

16 by the health care provider or at the medical facility, 

17 as the case may be, divided by the total number of 

18 pharmacy users of that health care provider or med19 ical facility. 

20 (2) The average number of morphine equivalents 

21 per day prescribed by the health care provider or at 

22 the medical facility, as the case may be, to patients 

23 being treated with opioids. 

24 (3) Of the patients being treated with opioids by 

25 the health care provider or at the medical facility, as 


rfrederick on DSK6VPTVN1PROD with BILLS
29 

•HR 4063 RH

1 the case may be, the average number of prescriptions 

2 of opioids per patient. 

3 SEC. 105. MANDATORY DISCLOSURE OF CERTAIN VETERAN 

4 INFORMATION TO STATE CONTROLLED SUB5 STANCE MONITORING PROGRAMS. 

6 Section 5701(l) of title 38, United States Code, is 

7 amended by striking ‘‘may’’ and inserting ‘‘shall’’. 

8 TITLE II—PATIENT ADVOCACY 

9 SEC. 201. COMMUNITY MEETINGS ON IMPROVING CARE 

10 FURNISHED BY DEPARTMENT OF VETERANS 

11 AFFAIRS. 

12 (a) COMMUNITY MEETINGS.— 

13 (1) MEDICAL CENTERS.—Not later than 90 days 

14 after the date of the enactment of this Act, and not 

15 less frequently than once every 90 days thereafter, the 

16 Secretary shall ensure that each medical facility of 

17 the Department of Veterans Affairs hosts a commu18 nity meeting open to the public on improving health 

19 care furnished by the Secretary. 

20 (2) COMMUNITY BASED OUTPATIENT CLINICS.— 

21 Not later than one year after the date of the enact22 ment of this Act, and not less frequently than annu23 ally thereafter, the Secretary shall ensure that each 

24 community based outpatient clinic of the Department 


rfrederick on DSK6VPTVN1PROD with BILLS
30 

•HR 4063 RH

1 hosts a community meeting open to the public on im2 proving health care furnished by the Secretary. 

3 (b) ATTENDANCE BY DIRECTOR OF VETERANS INTE4 GRATED SERVICE NETWORK OR DESIGNEE.— 

5 (1) IN GENERAL.—Each community meeting 

6 hosted by a medical facility or community based out7 patient clinic under subsection (a) shall be attended 

8 by the Director of the Veterans Integrated Service 

9 Network in which the medical facility or community 

10 based outpatient clinic, as the case may be, is located. 

11 Subject to paragraph (2), the Director may delegate 

12 such attendance only to an employee who works in the 

13 Office of the Director. 

14 (2) ATTENDANCE BY DIRECTOR.—Each Director 

15 of a Veterans Integrated Service Network shall person16 ally attend not less than one community meeting 

17 under subsection (a) hosted by each medical facility 

18 located in the Veterans Integrated Service Network 

19 each year. 

20 (c) NOTICE.—The Secretary shall notify the Committee 

21 on Veterans’ Affairs of the Senate, the Committee on Vet22 erans’ Affairs of the House of Representatives, and each 

23 Member of Congress (as defined in section 104) who rep24 resents the area in which the medical facility is located of 


rfrederick on DSK6VPTVN1PROD with BILLS
31 

•HR 4063 RH

1 a community meeting under subsection (a) by not later 

2 than 10 days before such community meeting occurs. 

3 SEC. 202. IMPROVEMENT OF AWARENESS OF PATIENT AD4 VOCACY PROGRAM AND PATIENT BILL OF 

5 RIGHTS OF DEPARTMENT OF VETERANS AF6 FAIRS. 

7 Not later than 90 days after the date of the enactment 

8 of this Act, the Secretary of Veterans Affairs shall, in as 

9 many prominent locations as the Secretary determines ap10 propriate to be seen by the largest percentage of patients 

11 and family members of patients at each medical facility 

12 of the Department of Veterans Affairs— 

13 (1) display the purposes of the Patient Advocacy 

14 Program of the Department and the contact informa15 tion for the patient advocate at such medical facility; 

16 and 

17 (2) display the rights and responsibilities of— 

18 (A) patients and family members and pa19 tients at such medical facility; and 

20 (B) with respect to community living cen21 ters and other residential facilities of the Depart22 ment, residents and family members of residents 

23 at such medical facility. 


rfrederick on DSK6VPTVN1PROD with BILLS
32 

•HR 4063 RH

1 SEC. 203. COMPTROLLER GENERAL REPORT ON PATIENT 

2 ADVOCACY PROGRAM OF DEPARTMENT OF 

3 VETERANS AFFAIRS. 

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

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

6 of the United States shall submit to the Committee on Vet7 erans’ Affairs of the Senate and the Committee on Veterans’ 

8 Affairs of the House of Representatives a report on the Pa9 tient Advocacy Program of the Department of Veterans Af10 fairs (in this section referred to as the ‘‘Program’’). 

11 (b) ELEMENTS.—The report required by subsection (a) 

12 shall include the following: 

13 (1) A description of the Program, including— 

14 (A) the purpose of the Program; 

15 (B) the activities carried out under the Pro16 gram; and 

17 (C) the sufficiency of the Program in 

18 achieving the purpose of the Program. 

19 (2) An assessment of the sufficiency of staffing of 

20 employees of the Department responsible for carrying 

21 out the Program. 

22 (3) An assessment of the sufficiency of the train23 ing of such employees. 

24 (4) An assessment of— 

25 (A) the awareness of the Program among 

26 veterans and family members of veterans; and 


rfrederick on DSK6VPTVN1PROD with BILLS
33 

•HR 4063 RH

1 (B) the use of the Program by veterans and 

2 family members of veterans. 

3 (5) Such recommendations and proposals for im4 proving or modifying the Program as the Comptroller 

5 General considers appropriate. 

6 (6) Such other information with respect to the 

7 Program as the Comptroller General considers appro8 priate. 

9 TITLE III—COMPLEMENTARY 

10 AND INTEGRATIVE HEALTH 

11 SEC. 301. EXPANSION OF RESEARCH AND EDUCATION ON 

12 AND DELIVERY OF COMPLEMENTARY AND IN13 TEGRATIVE HEALTH TO VETERANS. 

14 (a) ESTABLISHMENT.—There is established a commis15 sion to be known as the ‘‘Creating Options for Veterans’ 

16 Expedited Recovery’’ or the ‘‘COVER Commission’’ (in this 

17 Act referred to as the ‘‘Commission’’). The Commission shall 

18 examine the evidence-based therapy treatment model used 

19 by the Secretary of Veterans Affairs for treating mental 

20 health conditions of veterans and the potential benefits of 

21 incorporating complementary alternative treatments avail22 able in non-Department facilities (as defined in section 

23 1701 of title 38, United States Code). 

24 (b) DUTIES.—The Commission shall perform the fol25 lowing duties: 


rfrederick on DSK6VPTVN1PROD with BILLS
34 

•HR 4063 RH

1 (1) Examine the efficacy of the evidence-based 

2 therapy model used by the Secretary for treating men3 tal health illnesses of veterans and identify areas to 

4 improve wellness-based outcomes. 

5 (2) Conduct a patient-centered survey within 

6 each of the Veterans Integrated Service Networks to 

7 examine— 

8 (A) the experience of veterans with the De9 partment of Veterans Affairs when seeking med10 ical assistance for mental health issues through 

11 the health care system of the Department; 

12 (B) the experience of veterans with non-De13 partment facilities and health professionals for 

14 treating mental health issues; 

15 (C) the preference of veterans regarding 

16 available treatment for mental health issues and 

17 which methods the veterans believe to be most ef18 fective; 

19 (D) the experience, if any, of veterans with 

20 respect to the complementary alternative treat21 ment therapies described in paragraph (3); 

22 (E) the prevalence of prescribing prescrip23 tion medication among veterans seeking treat24 ment through the health care system of the DeVerDate Sep 11 2014 02:43 May 11, 2016 Jkt 059200 PO 00000 Frm 00034 Fmt 6652 Sfmt 6203 E:\BILLS\H4063.RH H4063

rfrederick on DSK6VPTVN1PROD with BILLS
35 

•HR 4063 RH

1 partment as remedies for addressing mental 

2 health issues; and 

3 (F) the outreach efforts of the Secretary re4 garding the availability of benefits and treat5 ments for veterans for addressing mental health 

6 issues, including by identifying ways to reduce 

7 barriers to gaps in such benefits and treatments. 

8 (3) Examine available research on complemen9 tary alternative treatment therapies for mental health 

10 issues and identify what benefits could be made with 

11 the inclusion of such treatments for veterans, includ12 ing with respect to— 

13 (A) music therapy; 

14 (B) equine therapy; 

15 (C) training and caring for service dogs; 

16 (D) yoga therapy; 

17 (E) acupuncture therapy; 

18 (F) meditation therapy; 

19 (G) outdoor sports therapy; 

20 (H) hyperbaric oxygen therapy; 

21 (I) accelerated resolution therapy; 

22 (J) art therapy; 

23 (K) magnetic resonance therapy; and 

24 (L) other therapies the Commission deter25 mines appropriate. 


rfrederick on DSK6VPTVN1PROD with BILLS
36 

•HR 4063 RH

1 (4) Study the sufficiency of the resources of the 

2 Department to ensure the delivery of quality health 

3 care for mental health issues among veterans seeking 

4 treatment within the Department. 

5 (5) Study the current treatments and resources 

6 available within the Department and assess— 

7 (A) the effectiveness of such treatments and 

8 resources in decreasing the number of suicides 

9 per day by veterans; 

10 (B) the number of veterans who have been 

11 diagnosed with mental health issues; 

12 (C) the percentage of veterans using the re13 sources of the Department who have been diag14 nosed with mental health issues; 

15 (D) the percentage of veterans who have 

16 completed counseling sessions offered by the De17 partment; and 

18 (E) the efforts of the Department to expand 

19 complementary alternative treatments viable to 

20 the recovery of veterans with mental health issues 

21 as determined by the Secretary to improve the ef22 fectiveness of treatments offered with the Depart23 ment. 

24 (c) MEMBERSHIP.— 


rfrederick on DSK6VPTVN1PROD with BILLS
37 

•HR 4063 RH

1 (1) IN GENERAL.—The Commission shall be com2 posed of 10 members, appointed as follows: 

3 (A) Two members appointed by the Speaker 

4 of the House of Representatives, at least one of 

5 whom shall be a veteran. 

6 (B) Two members appointed by the Minor7 ity Leader of the House of Representatives, at 

8 least one of whom shall be a veteran. 

9 (C) Two members appointed by the Major10 ity Leader of the Senate, at least one of whom 

11 shall be a veteran. 

12 (D) Two members appointed by the Minor13 ity Leader of the Senate, at least one of whom 

14 shall be a veteran. 

15 (E) Two members appointed by the Presi16 dent, at least one of whom shall be a veteran. 

17 (2) QUALIFICATIONS.—Members of the Commis18 sion shall be— 

19 (A) individuals who are of recognized 

20 standing and distinction within the medical 

21 community with a background in treating men22 tal health; 

23 (B) individuals with experience working 

24 with the military and veteran population; and 


rfrederick on DSK6VPTVN1PROD with BILLS
38 

•HR 4063 RH

1 (C) individuals who do not have a financial 

2 interest in any of the complementary alternative 

3 treatments reviewed by the Commission. 

4 (3) CHAIRMAN.—The President shall designate a 

5 member of the Commission to be the Chairman. 

6 (4) PERIOD OF APPOINTMENT.—Members of the 

7 Commission shall be appointed for the life of the 

8 Commission. 

9 (5) VACANCY.—A vacancy in the Commission 

10 shall be filled in the manner in which the original 

11 appointment was made. 

12 (6) APPOINTMENT DEADLINE.—The appointment 

13 of members of the Commission in this section shall be 

14 made not later than 90 days after the date of the en15 actment of this Act. 

16 (d) POWERS OF COMMISSION.— 

17 (1) MEETINGS.— 

18 (A) INITIAL MEETING.—The Commission 

19 shall hold its first meeting not later than 30 

20 days after a majority of members are appointed 

21 to the Commission. 

22 (B) MEETING.—The Commission shall regu23 larly meet at the call of the Chairman. Such 

24 meetings may be carried out through the use of 

25 telephonic or other appropriate telecommuniVerDate Sep 11 2014 02:43 May 11, 2016 Jkt 059200 PO 00000 Frm 00038 Fmt 6652 Sfmt 6203 E:\BILLS\H4063.RH H4063

rfrederick on DSK6VPTVN1PROD with BILLS
39 

•HR 4063 RH

1 cation technology if the Commission determines 

2 that such technology will allow the members to 

3 communicate simultaneously. 

4 (2) HEARINGS.—The Commission may hold such 

5 hearings, sit and act at such times and places, take 

6 such testimony, and receive evidence as the Commis7 sion considers advisable to carry out the responsibil8 ities of the Commission. 

9 (3) INFORMATION FROM FEDERAL AGENCIES.— 

10 The Commission may secure directly from any de11 partment or agency of the Federal Government such 

12 information as the Commission considers necessary to 

13 carry out the duties of the Commission. 

14 (4) INFORMATION FROM NONGOVERNMENTAL OR15 GANIZATIONS.—In carrying out its duties, the Com16 mission may seek guidance through consultation with 

17 foundations, veteran service organizations, nonprofit 

18 groups, faith-based organizations, private and public 

19 institutions of higher education, and other organiza20 tions as the Commission determines appropriate. 

21 (5) COMMISSION RECORDS.—The Commission 

22 shall keep an accurate and complete record of the ac23 tions and meeting of the Commission. Such record 

24 shall be made available for public inspection and the 


rfrederick on DSK6VPTVN1PROD with BILLS
40 

•HR 4063 RH

1 Comptroller General of the United States may audit 

2 and examine such record. 

3 (6) PERSONNEL RECORDS.—The Commission 

4 shall keep an accurate and complete record of the ac5 tions and meetings of the Commission. Such record 

6 shall be made available for public inspection and the 

7 Comptroller General of the United States may audit 

8 and examine such records. 

9 (7) COMPENSATION OF MEMBERS; TRAVEL EX10 PENSES.—Each member shall serve without pay but 

11 shall receive travel expenses to perform the duties of 

12 the Commission, including per diem in lieu of sub13 stances, at rates authorized under subchapter I of 

14 chapter 57 of title 5, United States Code. 

15 (8) STAFF.—The Chairman, in accordance with 

16 rules agreed upon the Commission, may appoint fix 

17 the compensation of a staff director and such other 

18 personnel as may be necessary to enable the Commis19 sion to carry out its functions, without regard to the 

20 provisions of title 5, United States Code, governing 

21 appointments in the competitive service, without re22 gard to the provision of chapter 51 and subchapter 

23 III of chapter 53 of such title relating to classification 

24 and General Schedule pay rates, except that no rate 

25 of pay fixed under this paragraph may exceed the 


rfrederick on DSK6VPTVN1PROD with BILLS
41 

•HR 4063 RH

1 equivalent of that payable for a position at a level IV 

2 of the Executive Schedule under section 5316 of title 

3 5, United States Code. 

4 (9) PERSONNEL AS FEDERAL EMPLOYEES.— 

5 (A) IN GENERAL.—The executive director 

6 and any personnel of the Commission are em7 ployees under section 2105 of title 5, United 

8 States Code, for purpose of chapters 63, 81, 83, 

9 84, 85, 87, 89, and 90 of such title. 

10 (B) MEMBERS OF THE COMMISSION.—Sub11 paragraph (A) shall not be construed to apply to 

12 members of the Commission. 

13 (10) CONTRACTING.—The Commission may, to 

14 such extent and in such amounts as are provided in 

15 appropriations Acts, enter into contracts to enable the 

16 Commission to discharge the duties of the Commission 

17 under this Act. 

18 (11) EXPERT AND CONSULTANT SERVICE.—The 

19 Commission may procure the services of experts and 

20 consultants in accordance with section 3109 or title 

21 5, United States Code, at rates not to exceed the daily 

22 rate paid to a person occupying a position at level IV 

23 of the Executive Schedule under section 3109 of title 

24 5, United States Code. 


rfrederick on DSK6VPTVN1PROD with BILLS
42 

•HR 4063 RH

1 (12) POSTAL SERVICE.—The Commission may 

2 use the United States mails in the same manner and 

3 under the same conditions as departments and agen4 cies of the United States. 

5 (13) PHYSICAL FACILITIES AND EQUIPMENT.— 

6 Upon the request of the Commission, the Adminis7 trator of General Services shall provide to the Com8 mission, on a reimbursable basis, the administrative 

9 support services necessary for the Commission to 

10 carry out its responsibilities under this Act. These ad11 ministrative services may include human resource 

12 management, budget, leasing accounting, and payroll 

13 services. 

14 (e) REPORT.— 

15 (1) INTERIM REPORTS.— 

16 (A) IN GENERAL.—Not later than 60 days 

17 after the date on which the Commission first 

18 meets, and each 30-day period thereafter ending 

19 on the date on which the Commission submits 

20 the final report under paragraph (2), the Com21 mission shall submit to the Committees on Vet22 erans’ Affairs of the House of Representatives 

23 and the Senate and the President a report detail24 ing the level of cooperation the Secretary of Vet25 erans Affairs (and the heads of other departVerDate Sep 11 2014 02:43 May 11, 2016 Jkt 059200 PO 00000 Frm 00042 Fmt 6652 Sfmt 6203 E:\BILLS\H4063.RH H4063

rfrederick on DSK6VPTVN1PROD with BILLS
43 

•HR 4063 RH

1 ments or agencies of the Federal Government) 

2 has provided to the Commission. 

3 (B) OTHER REPORTS.—In carrying out its 

4 duties, at times that the Commission determines 

5 appropriate, the Commission shall submit to the 

6 Committee on Veterans’ Affairs of the House of 

7 Representatives and the Senate and any other 

8 appropriate entities an interim report with re9 spect to the findings identified by the Commis10 sion. 

11 (2) FINAL REPORT.—Not later than 18 months 

12 after the first meeting of the Commission, the Com13 mission shall submit to the Committee on Veterans’ 

14 Affairs of the House of Representatives and the Sen15 ate, the President, and the Secretary of Veterans Af16 fairs a final report on the findings of the Commis17 sion. Such report shall include the following: 

18 (A) Recommendations to implement in a 

19 feasible, timely, and cost efficient manner the so20 lutions and remedies identified within the find21 ings of the Commission pursuant to subsection 

22 (b). 

23 (B) An analysis of the evidence-based ther24 apy model used by the Secretary of Veterans Af25 fairs for treating veterans with mental health 


rfrederick on DSK6VPTVN1PROD with BILLS
44 

•HR 4063 RH

1 care issues, and an examination of the preva2 lence and efficacy of prescription drugs as a 

3 means for treatment. 

4 (C) The findings of the patient-centered sur5 vey conducted within each of the Veterans Inte6 grated Service Networks pursuant to subsection 

7 (b)(2). 

8 (D) An examination of complementary al9 ternative treatments described in subsection 

10 (b)(3) and the potential benefits of incorporating 

11 such treatments in the therapy models used by 

12 the Secretary for treating veterans with mental 

13 health issues. 

14 (3) PLAN.—Not later than 90 days after the date 

15 on which the Commission submits the final report 

16 under paragraph (2), the Secretary of Veterans Af17 fairs shall submit to the Committee on Veterans’ Af18 fairs of the House of Representatives and the Senate 

19 a report on the following: 

20 (A) An action plan for implementing the 

21 recommendations established by the Commission 

22 on such solutions and remedies for improving 

23 wellness-based outcomes for veterans with mental 

24 health care issues. 


rfrederick on DSK6VPTVN1PROD with BILLS
45 

•HR 4063 RH

1 (B) A feasible timeframe on when the com2 plementary alternative treatments described in 

3 subsection (b)(3) can be implemented Depart4 ment-wide. 

5 (C) With respect to each recommendation 

6 established by the Commission, including any 

7 complementary alternative treatment, that the 

8 Secretary determines is not appropriate or fea9 sible to implement, a justification for such deter10 mination and an alternative solution to improve 

11 the efficacy of the therapy models used by the 

12 Secretary for treating veterans with mental 

13 health issues. 

14 (f) TERMINATION OF COMMISSION.—The Commission 

15 shall terminate 30 days after the Commission submits the 

16 final report under subsection (e)(2). 

17 SEC. 302. PILOT PROGRAM ON INTEGRATION OF COM18 PLEMENTARY ALTERNATIVE MEDICINES AND 

19 RELATED ISSUES FOR VETERANS AND FAM20 ILY MEMBERS OF VETERANS. 

21 (a) PILOT PROGRAM.— 

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

23 the date on which the Secretary of Veterans Affairs 

24 receives the final report under section 301(e), the Sec25 retary shall commence a pilot program to assess the 


rfrederick on DSK6VPTVN1PROD with BILLS
46 

•HR 4063 RH

1 feasibility and advisability of using wellness-based 

2 programs (as defined by the Secretary) to complement 

3 the provision of pain management and related health 

4 care services, including mental health care services, to 

5 veterans. 

6 (2) MATTERS ADDRESSED.—In carrying out the 

7 pilot program, the Secretary shall assess the fol8 lowing: 

9 (A) Means of improving coordination be10 tween Federal, State, local, and community pro11 viders of health care in the provision of pain 

12 management and related health care services to 

13 veterans. 

14 (B) Means of enhancing outreach, and co15 ordination of outreach, by and among providers 

16 of health care referred to in subparagraph (A) on 

17 the pain management and related health care 

18 services available to veterans. 

19 (C) Means of using wellness-based programs 

20 of providers of health care referred to in sub21 paragraph (A) as complements to the provision 

22 by the Department of pain management and re23 lated health care services to veterans. 

24 (D) Whether wellness-based programs de25 scribed in subparagraph (C)— 


rfrederick on DSK6VPTVN1PROD with BILLS
47 

•HR 4063 RH

1 (i) are effective in enhancing the qual2 ity of life and well-being of veterans; 

3 (ii) are effective in increasing the ad4 herence of veterans to the primary pain 

5 management and related health care serv6 ices provided such veterans by the Depart7 ment; 

8 (iii) have an effect on the sense of well9 being of veterans who receive primary pain 

10 management and related health care serv11 ices from the Department; and 

12 (iv) are effective in encouraging vet13 erans receiving health care from the Depart14 ment to adopt a more healthy lifestyle. 

15 (b) DURATION.—The Secretary shall carry out the 

16 pilot program under subsection (a)(1) for a period of three 

17 years. 

18 (c) LOCATIONS.— 

19 (1) FACILITIES.—The Secretary shall carry out 

20 the pilot program under subsection (a)(1) at facilities 

21 of the Department providing pain management and 

22 related health care services, including mental health 

23 care services, to veterans. In selecting such facilities 

24 to carry out the pilot program, the Secretary shall se25 lect not fewer than 15 medical centers of the DepartVerDate Sep 11 2014 02:43 May 11, 2016 Jkt 059200 PO 00000 Frm 00047 Fmt 6652 Sfmt 6203 E:\BILLS\H4063.RH H4063

rfrederick on DSK6VPTVN1PROD with BILLS
48 

•HR 4063 RH

1 ment, of which not fewer than two shall be 

2 polytrauma rehabilitation centers of the Department. 

3 (2) MEDICAL CENTERS WITH PRESCRIPTION

4 RATES OF OPIOIDS THAT CONFLICT WITH CARE

5 STANDARDS.—In selecting the medical centers under 

6 paragraph (1), the Secretary shall give priority to 

7 medical centers of the Department at which there is 

8 a prescription rate of opioids that conflicts with or is 

9 otherwise inconsistent with the standards of appro10 priate and safe care. 

11 (d) PROVISION OF SERVICES.—Under the pilot pro12 gram under subsection (a)(1), the Secretary shall provide 

13 covered services to covered veterans by integrating com14 plementary and alternative medicines and integrative 

15 health services with other services provided by the Depart16 ment at the medical centers selected under subsection (c). 

17 (e) COVERED VETERANS.—For purposes of the pilot 

18 program under subsection (a)(1), a covered veteran is any 

19 veteran who— 

20 (1) has a mental health condition diagnosed by 

21 a clinician of the Department; 

22 (2) experiences chronic pain; 

23 (3) has a chronic condition being treated by a 

24 clinician of the Department; or 


rfrederick on DSK6VPTVN1PROD with BILLS
49 

•HR 4063 RH

1 (4) is not described in paragraph (1), (2), or (3) 

2 and requests to participate in the pilot program or is 

3 referred by a clinician of the Department who is 

4 treating the veteran. 

5 (f) COVERED SERVICES.— 

6 (1) IN GENERAL.—For purposes of the pilot pro7 gram, covered services are services consisting of com8 plementary and integrative health services as selected 

9 by the Secretary. 

10 (2) ADMINISTRATION OF SERVICES.—Covered 

11 services shall be administered under the pilot pro12 gram as follows: 

13 (A) Covered services shall be administered 

14 by professionals or other instructors with appro15 priate training and expertise in complementary 

16 and integrative health services who are employ17 ees of the Department or with whom the Depart18 ment enters into an agreement to provide such 

19 services. 

20 (B) Covered services shall be included as 

21 part of the Patient Aligned Care Teams initia22 tive of the Office of Patient Care Services, Pri23 mary Care Program Office, in coordination with 

24 the Office of Patient Centered Care and Cultural 

25 Transformation. 


rfrederick on DSK6VPTVN1PROD with BILLS
50 

•HR 4063 RH

1 (C) Covered services shall be made available 

2 to— 

3 (i) covered veterans who have received 

4 conventional treatments from the Depart5 ment for the conditions for which the cov6 ered veteran seeks complementary and inte7 grative health services under the pilot pro8 gram; and 

9 (ii) covered veterans who have not re10 ceived conventional treatments from the De11 partment for such conditions. 

12 (g) REPORTS.— 

13 (1) IN GENERAL.—Not later than 30 months 

14 after the date on which the Secretary commences the 

15 pilot program under subsection (a)(1), the Secretary 

16 shall submit to the Committee on Veterans’ Affairs of 

17 the Senate and the Committee on Veterans’ Affairs of 

18 the House of Representatives a report on the pilot 

19 program. 

20 (2) ELEMENTS.—The report under paragraph 

21 (1) shall include the following: 

22 (A) The findings and conclusions of the Sec23 retary with respect to the pilot program under 

24 subsection (a)(1), including with respect to— 


rfrederick on DSK6VPTVN1PROD with BILLS
51 

•HR 4063 RH

1 (i) the use and efficacy of the com2 plementary and integrative health services 

3 established under the pilot program; 

4 (ii) the outreach conducted by the Sec5 retary to inform veterans and community 

6 organizations about the pilot program; and 

7 (iii) an assessment of the benefit of the 

8 pilot program to covered veterans in mental 

9 health diagnoses, pain management, and 

10 treatment of chronic illness. 

11 (B) Identification of any unresolved bar12 riers that impede the ability of the Secretary to 

13 incorporate complementary and integrative 

14 health services with other health care services 

15 provided by the Department. 

16 (C) Such recommendations for the continu17 ation or expansion of the pilot program as the 

18 Secretary considers appropriate. 

19 (h) COMPLEMENTARY AND INTEGRATIVE HEALTH DE20 FINED.—In this section, the term ‘‘complementary and inte21 grative health’’ shall have the meaning given that term by 

22 the National Institutes of Health. 


rfrederick on DSK6VPTVN1PROD with BILLS
52 

•HR 4063 RH

1 TITLE IV—FITNESS OF HEALTH 

2 CARE PROVIDERS 

3 SEC. 401. ADDITIONAL REQUIREMENTS FOR HIRING OF 

4 HEALTH CARE PROVIDERS BY DEPARTMENT 

5 OF VETERANS AFFAIRS. 

6 As part of the hiring process for each health care pro7 vider considered for a position at the Department of Vet8 erans Affairs after the date of the enactment of the Act, the 

9 Secretary of Veterans Affairs shall require from the medical 

10 board of each State in which the health care provider has 

11 a medical license— 

12 (1) information on any violation of the require13 ments of the medical license of the health care pro14 vider during the 20-year period preceding the consid15 eration of the health care provider by the Department; 

16 and 

17 (2) information on whether the health care pro18 vider has entered into any settlement agreement for 

19 the disciplinary charge relating to the practice of 

20 medicine by the health care provider. 

21 SEC. 402. PROVISION OF INFORMATION ON HEALTH CARE 

22 PROVIDERS OF DEPARTMENT OF VETERANS 

23 AFFAIRS TO STATE MEDICAL BOARDS. 

24 Notwithstanding section 552a of title 5, United States 

25 Code, with respect to each health care provider of the DeVerDate Sep 11 2014 02:43 May 11, 2016 Jkt 059200 PO 00000 Frm 00052 Fmt 6652 Sfmt 6203 E:\BILLS\H4063.RH H4063

rfrederick on DSK6VPTVN1PROD with BILLS
53 

•HR 4063 RH

1 partment of Veterans Affairs who has violated a require2 ment of the medical license of the health care provider, the 

3 Secretary of Veterans Affairs shall provide to the medical 

4 board of each State in which the health care provider is 

5 licensed detailed information with respect to such violation, 

6 regardless of whether such board has formally requested such 

7 information. 

8 SEC. 403. REPORT ON COMPLIANCE BY DEPARTMENT OF 

9 VETERANS AFFAIRS WITH REVIEWS OF 

10 HEALTH CARE PROVIDERS LEAVING THE DE11 PARTMENT OR TRANSFERRING TO OTHER FA12 CILITIES. 

13 Not later than 180 days after the date of the enactment 

14 of this Act, the Secretary of Veterans Affairs shall submit 

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

16 the Committee on Veterans’ Affairs of the House of Rep17 resentatives a report on the compliance by the Department 

18 of Veterans Affairs with the policy of the Department— 

19 (1) to conduct a review of each health care pro20 vider of the Department who transfers to another 

21 medical facility of the Department, retires, or is ter22 minated to determine whether there are any concerns, 

23 complaints, or allegations of violations relating to the 

24 medical practice of the health care provider; and 


rfrederick on DSK6VPTVN1PROD with BILLS
54 

•HR 4063 RH

1 (2) to take appropriate action with respect to 

2 any such concern, complaint, or allegation. 

3 TITLE V—OTHER VETERANS 

4 MATTERS 

5 SEC. 501. AUDIT OF VETERANS HEALTH ADMINISTRATION 

6 PROGRAMS OF DEPARTMENT OF VETERANS 

7 AFFAIRS. 

8 (a) AUDIT.—The Secretary of Veterans Affairs shall 

9 seek to enter into a contract with a nongovernmental entity 

10 under which the entity shall conduct a audits of the pro11 grams of the Veterans Health Administration of the Depart12 ment of Veterans Affairs to identify ways to improve the 

13 furnishing of benefits and health care administered by the 

14 Veterans Health Administration to veterans and families 

15 of veterans. 

16 (b) AUDIT REQUIREMENTS.—In carrying out each 

17 audit under subsection (a), the entity shall perform the fol18 lowing: 

19 (1) Five-year risk assessments to identify the 

20 functions, staff organizations, and staff offices of the 

21 Veterans Health Administration that would lead to22 wards the greatest improvement in furnishing of bene23 fits and health care to veterans and families of vet24 erans. 


rfrederick on DSK6VPTVN1PROD with BILLS
55 

•HR 4063 RH

1 (2) Development of plans that are informed by 

2 the risk assessment under paragraph (1) to conduct 

3 audits of the functions, staff organizations, and staff 

4 offices identified under paragraph (1). 

5 (3) Conduct audits in accordance with the plans 

6 developed pursuant to paragraph (2). 

7 (c) REPORTS.—Not later than 90 days after the date 

8 on which each audit is completed under subsection (a), the 

9 Secretary shall submit to the Committees on Veterans’ Af10 fairs of the House of Representatives and the Senate a re11 port that includes— 

12 (1) a summary of the audit; 

13 (2) the findings of the entity that conducted the 

14 audit with respect to the audit; and 

15 (3) such recommendations as the Secretary deter16 mines appropriate for legislative or administrative 

17 action to improve the furnishing of benefits and 

18 health care to veterans and families of veterans. 


rfrederick on DSK6VPTVN1PROD with BILLS
Union Calendar No. 422 

114TH CONGRESS 

2D SESSION H. R. 4063 

[Report No. 114–546, Part I] 

A BILL 

To improve the use by the Secretary of Veterans 

health, and for other purposes. the availability of complementary and integrative patient advocacy by the Secretary, and to expand Affairs of opioids in treating veterans, to improve 

MAY 10, 2016 

Reported from the Committee on Veterans’ Affairs with 

M

an amendment 

AY 10, 2016 

The Committee on Armed Services discharged; committed 

the Union and ordered to be printed to the Committee of the Whole House on the State of 


rfrederick on DSK6VPTVN1PROD with BILLS