I 

114TH CONGRESS 

1ST SESSION H. R. 4063 

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 

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. 

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


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1 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

3 ‘‘Promoting Responsible Opioid Management and Incor4 porating Scientific Expertise Act’’ or the ‘‘Jason 

5 Simcakoski PROMISE Act’’. 

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

7 this Act is as follows: 

Sec. 1. Short title; table of contents. 

TITLE I—OPIOID THERAPY AND PAIN MANAGEMENT 

Sec. 101. Guidelines on management of opioid therapy by Department of Veterans Affairs and Department of Defense and implementation 

of such guidelines by Department of Veterans Affairs. 

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. 

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. 

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 


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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. GUIDELINES ON MANAGEMENT OF OPIOID THER4 APY BY DEPARTMENT OF VETERANS AFFAIRS 

5 AND DEPARTMENT OF DEFENSE AND IMPLE6 MENTATION OF SUCH GUIDELINES BY DE7 PARTMENT OF VETERANS AFFAIRS. 

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

9 date of the enactment of this Act, the Secretary of Vet10 erans Affairs and the Secretary of Defense shall jointly 

11 update the VA/DOD Clinical Practice Guideline for Man12 agement of Opioid Therapy for Chronic Pain to include 

13 the following: 

14 (1) In accordance with subsection (b), common 

15 recommended guidelines for safely prescribing 

16 opioids for the treatment of chronic, non-cancer pain 

17 in outpatient settings as compiled by the Director of 

18 the Centers for Disease Control and Prevention. 

19 (2) Enhanced guidance with respect to— 

20 (A) the administration of two or more 

21 drugs that may result in a life-limiting drug-to22 drug interaction, including benzodiazepines; 


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1 (B) the treatment of patients with current 

2 acute psychiatric instability or substance use 

3 disorder or patients at risk of suicide; and 

4 (C) the use of opioid therapy to treat men5 tal health disorders other than opioid use dis6 order. 

7 (3) Enhanced guidance with respect to the 

8 treatment of patients with behaviors or 

9 comorbidities, such as post-traumatic stress dis10 order, psychiatric disorders, or a history of sub11 stance abuse or addiction, that requires a consulta12 tion or comanagement of opioid therapy with one or 

13 more specialists in pain management, mental health, 

14 or addictions. 

15 (4) Enhanced guidance with respect to the con16 duct by health care providers of an effective assess17 ment for patients receiving opioid therapy, including 

18 patients on long-term opioid therapy, to determine— 

19 (A) whether opioid therapy is meeting the 

20 expected goals of the patient and health care 

21 provider of relieving pain, improving function, 

22 and providing patient satisfaction; and 

23 (B) whether opioid therapy should be con24 tinued. 


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1 (5) Guidance that each health care provider of 

2 the Department of Veterans Affairs and the Depart3 ment of Defense, before initiating opioid therapy to 

4 treat a patient as part of the comprehensive assess5 ment conducted by the health care provider, use the 

6 Opioid Therapy Risk Report tool of the Department 

7 of Veterans Affairs (or successor tool), which shall 

8 include the ability to access the most recent patient 

9 information from the prescription drug monitoring 

10 program of each State that has such a program to 

11 assess the risk for adverse outcomes of opioid ther12 apy for the patient, including with respect to the 

13 concurrent use of controlled substances, including 

14 benzodiazepines. 

15 (6) Guidelines to govern the methodologies used 

16 by health care providers of the Department of Vet17 erans Affairs and the Department of Defense to 

18 safely titrate and taper opioid therapy when adjust19 ing or discriminating the use of opioid therapy, in20 cluding with respect to— 

21 (A) prescription of the lowest effective dose 

22 based on patient need; 

23 (B) use of opioid only for a limited period 

24 of time; and 


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1 (C) augmentation of opioid therapy with 

2 other pain management therapies and modali3 ties. 

4 (7) 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 (8) Guidelines with respect to appropriate 

10 transfer of case management responsibility for pa11 tients receiving opioid therapy who transition from 

12 receiving care furnished by the Secretary of Defense 

13 to receiving care furnished by other health care pro14 viders after the patient has been discharged or sepa15 rated from the Armed Forces. 

16 (9) Enhanced standards with respect to the use 

17 of routine and random urine drug tests for all pa18 tients before and during opioid therapy to help pre19 vent substance abuse, dependence, and diversion, in20 cluding— 

21 (A) that such tests occur not less fre22 quently than once each year; and 

23 (B) that health care providers appro24 priately interpret and respond to the results 

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1 guards, and risk management strategies to each 

2 patient. 

3 (10) Guidance that health care providers dis4 cuss with patients, before initiating opioid therapy, 

5 options for pain management therapies without the 

6 use of opioids and options to augment opioid therapy 

7 with other clinical and complementary and integra8 tive health services to minimize opioid dependence. 

9 (b) TREATMENT OF CERTAIN GUIDELINES DEVEL10 OPED AFTER DEADLINE.—If the Director of the Centers 

11 for Disease Control and Prevention issues the guidelines 

12 described in paragraph (1) of subsection (a) after the date 

13 on which the Secretary of Veterans Affairs and the Sec14 retary of Defense jointly update the VA/DOD Clinical 

15 Practice Guideline for Management of Opioid Therapy for 

16 Chronic Pain pursuant to such subsection, the Secretaries 

17 shall jointly modify the VA/DOD Clinical Practice Guide18 line for Management of Opioid Therapy for Chronic Pain 

19 to incorporate such guidelines of the Director. 

20 (c) CONSULTATION BEFORE UPDATE.—Before up21 dating the guideline under subsection (a), the Secretary 

22 of Veterans Affairs and the Secretary of Defense shall 

23 jointly consult with the Pain Management Working Group 

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1 fense Joint Executive Committee established by section 

2 320 of title 38, United States Code. 

3 (d) DEFINITIONS.—In this section: 

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

5 meaning given that term in section 102 of the Con6 trolled Substances Act (21 U.S.C. 802). 

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

8 States, territories, and possessions of the United 

9 States, the District of Columbia, and the Common10 wealth of Puerto Rico. 

11 SEC. 102. IMPROVEMENT OF OPIOID SAFETY MEASURES BY 

12 DEPARTMENT OF VETERANS AFFAIRS. 

13 (a) EXPANSION OF OPIOID SAFETY INITIATIVE.— 

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

15 of this Act, the Secretary of Veterans Affairs shall expand 

16 the Opioid Safety Initiative of the Department of Veterans 

17 Affairs to include all medical facilities of the Department. 

18 (b) PAIN MANAGEMENT EDUCATION AND TRAIN19 ING.— 

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

21 Safety Initiative of the Department, the Secretary 

22 shall require all employees of the Department re23 sponsible for prescribing opioids to receive education 

24 and training described in paragraph (2). 


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1 (2) EDUCATION AND TRAINING.—Education 

2 and training described in this paragraph is edu3 cation and training on pain management and safe 

4 opioid prescribing practices for purposes of safely 

5 and effectively managing patients with chronic pain, 

6 including education 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 man13 agement therapies, including cognitive-behav14 ioral therapy, non-opioid alternatives, and non15 drug methods and procedures to managing pain 

16 and related health conditions including com17 plementary alternative medicines. 

18 (C) Screening and identification of patients 

19 with substance use disorder, including drug20 seeking behavior, before prescribing opioids, as21 sessment of risk potential for patients devel22 oping an addiction, and referral of patients to 

23 appropriate addiction treatment professionals if 

24 addiction is identified or strongly suspected. 


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1 (D) Communication with patients on the 

2 potential harm associated with the use of 

3 opioids and other controlled substances, includ4 ing the need to safely store and dispose of sup5 plies relating to the use of opioids and other 

6 controlled substances. 

7 (E) Such other education and training as 

8 the Secretary considers appropriate to ensure 

9 that veterans receive safe and high-quality pain 

10 management care from the Department. 

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

12 education and training described in paragraph (2), 

13 the Secretary shall use the Interdisciplinary Chronic 

14 Pain Management Training Team Program of the 

15 Department (or success program). 

16 (c) PAIN MANAGEMENT TEAMS.— 

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

18 Safety Initiative of the Department, the director of 

19 each medical facility of the Department shall iden20 tify and designate a pain management team of 

21 health care professionals, which may include board 

22 certified pain medicine specialists, responsible for co23 ordinating and overseeing pain management therapy 

24 at such facility for patients experiencing acute and 

25 chronic pain that is non-cancer related. 


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1 (2) ESTABLISHMENT OF PROTOCOLS.— 

2 (A) IN GENERAL.—In consultation with 

3 the Directors of each Veterans Integrated Serv4 ice Network, the Secretary shall establish 

5 standard protocols for the designation of pain 

6 management teams at each medical facility 

7 within the Department. 

8 (B) CONSULTATION ON PRESCRIPTION OF

9 OPIOIDS.—Each protocol established under sub10 paragraph (A) shall ensure that any health care 

11 provider without expertise in prescribing anal12 gesics or who has not completed the education 

13 and training under subsection (b), including a 

14 mental health care provider, does not prescribe 

15 opioids to a patient unless that health care pro16 vider— 

17 (i) consults with a health care pro18 vider with pain management expertise or 

19 who is on the pain management team of 

20 the medical facility; and 

21 (ii) refers the patient to the pain man22 agement team for any subsequent prescrip23 tions and related therapy. 

24 (3) REPORT.— 


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

2 after the date of enactment of this Act, the di3 rector of each medical facility of the Depart4 ment shall submit to the Under Secretary for 

5 Health and the director of the Veterans Inte6 grated Service Network in which the medical fa7 cility is located a report identifying the health 

8 care professionals that have been designated as 

9 members of the pain management team at the 

10 medical facility pursuant to paragraph (1). 

11 (B) ELEMENTS.—Each report submitted 

12 under subparagraph (A) with respect to a med13 ical facility of the Department shall include— 

14 (i) a certification as to whether all 

15 members of the pain management team at 

16 the medical facility have completed the 

17 education and training required under sub18 section (b); and 

19 (ii) a plan for the management and 

20 referral of patients to such pain manage21 ment team if health care providers without 

22 expertise in prescribing analgesics pre23 scribe opioid medications to treat acute 

24 and chronic pain that is non-cancer re25 lated. 


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

2 (1) PRESCRIPTION DRUG MONITORING PRO3 GRAMS OF STATES.—In carrying out the Opioid 

4 Safety Initiative and the Opioid Therapy Risk Re5 port tool of the Department, the Secretary shall— 

6 (A) ensure access by health care providers 

7 of the Department to information on controlled 

8 substances, including opioids and 

9 benzodiazepines, prescribed to veterans who re10 ceive care outside the Department through the 

11 prescription drug monitoring program of each 

12 State with such a program, including by seek13 ing to enter into memoranda of understanding 

14 with States to allow shared access of such infor15 mation between States and the Department; 

16 (B) include such information in the Opioid 

17 Therapy Risk Report; and 

18 (C) require health care providers of the 

19 Department to submit to the prescription drug 

20 monitoring program of each State information 

21 on prescriptions of controlled substances re22 ceived by veterans in that State under the laws 

23 administered by the Secretary. 

24 (2) REPORT ON TRACKING OF DATA ON OPIOID

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


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1 the enactment of this Act, the Secretary shall submit 

2 to the Committee on Veterans’ Affairs of the Senate 

3 and the Committee on Veterans’ Affairs of the 

4 House of Representatives a report on the feasibility 

5 and advisability of improving the Opioid Therapy 

6 Risk Report tool of the Department to allow for 

7 more advanced real-time tracking of and access to 

8 data on— 

9 (A) the key clinical indicators with respect 

10 to the totality of opioid use by veterans; 

11 (B) concurrent prescribing by health care 

12 providers of the Department of opioids in dif13 ferent health care settings, including data on 

14 concurrent prescribing of opioids to treat men15 tal health disorders other than opioid use dis16 order; and 

17 (C) mail-order prescriptions of opioid pre18 scribed to veterans under the laws administered 

19 by the Secretary. 

20 (e) AVAILABILITY OF OPIOID RECEPTOR ANTAGO21 NISTS.— 

22 (1) INCREASED AVAILABILITY AND USE.— 

23 (A) IN GENERAL.—The Secretary shall 

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1 tagonists approved by the Food and Drug Ad2 ministration, including naloxone, to veterans. 

3 (B) AVAILABILITY, TRAINING, AND DIS4 TRIBUTING.—In carrying out subparagraph 

5 (A), not later than 90 days after the date of the 

6 enactment of this Act, the Secretary shall— 

7 (i) equip each pharmacy of the De8 partment with opioid receptor antagonists 

9 approved by the Food and Drug Adminis10 tration to be dispensed to outpatients as 

11 needed; and 

12 (ii) expand the Overdose Education 

13 and Naloxone Distribution program of the 

14 Department to ensure that all veterans in 

15 receipt of health care under laws adminis16 tered by the Secretary who are at risk of 

17 opioid overdose may access such opioid re18 ceptor antagonists and training on the 

19 proper administration of such opioid recep20 tor antagonists. 

21 (C) VETERANS WHO ARE AT RISK.—For 

22 purposes of subparagraph (B), veterans who are 

23 at risk of opioid overdose include— 

24 (i) veterans receiving long-term opioid 

25 therapy; 


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1 (ii) veterans receiving opioid therapy 

2 who have a history of substance use dis3 order or prior instances of overdose; and 

4 (iii) veterans who are at risk as deter5 mined by a health care provider who is 

6 treating the veteran. 

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

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

9 shall submit to the Committee on Veterans’ Affairs 

10 of the Senate and the Committee on Veterans’ Af11 fairs of the House of Representatives a report on 

12 carrying out paragraph (1), including an assessment 

13 of any remaining steps to be carried out by the Sec14 retary to carry out such paragraph. 

15 (f) INCLUSION OF CERTAIN INFORMATION AND CA16 PABILITIES IN OPIOID THERAPY RISK REPORT TOOL OF

17 THE DEPARTMENT.— 

18 (1) INFORMATION.—The Secretary shall include 

19 in the Opioid Therapy Risk Report tool of the De20 partment— 

21 (A) information on the most recent time 

22 the tool was accessed by a health care provider 

23 of the Department with respect to each veteran; 

24 and 


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1 (B) information on the results of the most 

2 recent urine drug test for each veteran. 

3 (2) CAPABILITIES.—The Secretary shall include 

4 in the Opioid Therapy Risk Report tool the ability 

5 of the health care providers of the Department to 

6 determine whether a health care provider of the De7 partment prescribed opioids to a veteran without 

8 checking the information in the tool with respect to 

9 the veteran. 

10 (g) NOTIFICATIONS OF RISK IN COMPUTERIZED

11 HEALTH RECORD.—The Secretary shall modify the com12 puterized patient record system of the Department to en13 sure that any health care provider that accesses the record 

14 of a veteran, regardless of the reason the veteran seeks 

15 care from the health care provider, will be immediately no16 tified whether the veteran— 

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

18 of substance use disorder or prior instances of over19 dose; 

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

21 (3) is at risk of becoming an opioid abuser as 

22 determined by a health care provider who is treating 

23 the veteran. 

24 (h) DEFINITIONS.—In this section: 


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

2 meaning given that term in section 102 of the Con3 trolled Substances Act (21 U.S.C. 802). 

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

5 States, territories, and possessions of the United 

6 States, the District of Columbia, and the Common7 wealth of Puerto Rico. 

8 SEC. 103. STRENGTHENING OF JOINT WORKING GROUP ON 

9 PAIN MANAGEMENT OF THE DEPARTMENT 

10 OF VETERANS AFFAIRS AND THE DEPART11 MENT OF DEFENSE. 

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

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

14 Affairs and the Secretary of Defense shall ensure that the 

15 Pain Management Working Group of the Health Execu16 tive Committee of the Department of Veterans Affairs– 

17 Department of Defense Joint Executive Committee estab18 lished under section 320 of title 38, United States Code, 

19 includes a focus on the following: 

20 (1) The opioid prescribing practices of health 

21 care providers of each Department. 

22 (2) The ability of each Department to manage 

23 acute and chronic pain among individuals receiving 

24 health care from the Department, including training 


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1 health care providers with respect to pain manage2 ment. 

3 (3) The use by each Department of complemen4 tary and integrative health and complementary alter5 native medicines in treating such individuals. 

6 (4) The concurrent use by health care providers 

7 of each Department of opioids and prescription 

8 drugs to treat mental health disorders, including 

9 benzodiazepines. 

10 (5) The practice by health care providers of 

11 each Department of prescribing opioids to treat 

12 mental health disorders. 

13 (6) The coordination in coverage of and con14 sistent access to medications prescribed for patients 

15 transitioning from receiving health care from the 

16 Department of Defense to receiving health care from 

17 the Department of Veterans Affairs. 

18 (7) The ability of each Department to identify 

19 and treat substance use disorders among individuals 

20 receiving health care from that Department. 

21 (b) COORDINATION AND CONSULTATION.—The Sec22 retary of Veterans Affairs and the Secretary of Defense 

23 shall ensure that the working group described in sub24 section (a)— 


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1 (1) coordinates the activities of the working 

2 group with other relevant working groups estab3 lished under section 320 of title 38, United States 

4 Code, including the working groups on evidence5 based practice, patient safety, pharmacy, psycho6 logical health, and psychological health; 

7 (2) consults with other relevant Federal agen8 cies, including the Centers for Disease Control and 

9 Prevention, with respect to the activities of the 

10 working group; and 

11 (3) consults with the Department of Veterans 

12 Affairs and the Department of Defense with respect 

13 to, reviews, and comments on the VA/DOD Clinical 

14 Practice Guideline for Management of Opioid Ther15 apy for Chronic Pain, or any successor guideline, be16 fore any update to the guideline is released. 

17 (c) CONSULTATIONS.—The Secretary of Veterans Af18 fairs and the Secretary of Defense shall ensure that the 

19 working group described in subsection (a) is able to mean20 ingfully consult with respect to the updated guideline re21 quired under subsection (a) of section 101, as required 

22 by subsection (b) of such section, not later than 1 year 

23 after the date of enactment of this Act. 


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

2 OF OPIOIDS IN TREATMENT BY DEPARTMENT 

3 OF VETERANS AFFAIRS. 

4 (a) COMPTROLLER GENERAL REPORT.— 

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

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

7 Comptroller General of the United States shall sub8 mit to the Committee on Veterans’ Affairs of the 

9 Senate and the Committee on Veterans’ Affairs of 

10 the House of Representatives a report on the Opioid 

11 Safety Initiative of the Department of Veterans Af12 fairs and the opioid prescribing practices of health 

13 care providers of the Department. 

14 (2) ELEMENTS.—The report submitted under 

15 paragraph (1) shall include the following: 

16 (A) Recommendations on such improve17 ments to the Opioid Safety Initiative of the De18 partment as the Comptroller General considers 

19 appropriate. 

20 (B) Information with respect to— 

21 (i) deaths resulting from sentinel 

22 events involving veterans prescribed opioids 

23 by a health care provider of the Depart24 ment; 

25 (ii) overall prescription rates and pre26 scriptions indications of opioids to treat 


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1 non-cancer, non-palliative, and non-hospice 

2 care patients; 

3 (iii) the prescription rates and pre4 scriptions indications of benzodiazepines 

5 and opioids concomitantly by health care 

6 providers of the Department; 

7 (iv) the practice by health care pro8 viders of the Department of prescribing 

9 opioids to treat patients without any pain, 

10 including to treat patients with mental 

11 health disorders other than opioid use dis12 order; and 

13 (v) the effectiveness of opioid therapy 

14 for patients receiving such therapy, includ15 ing the effectiveness of long-term opioid 

16 therapy. 

17 (C) An evaluation of processes of the De18 partment in place to oversee opioid use among 

19 veterans, including procedures to identify and 

20 remedy potential over-prescribing of opioids by 

21 health care providers of the Department. 

22 (D) An assessment of the implementation 

23 by the Secretary of the VA/DOD Clinical Prac24 tice Guideline for Management of Opioid Ther25 apy for Chronic Pain. 


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1 (b) QUARTERLY PROGRESS REPORT ON IMPLEMEN2 TATION OF COMPTROLLER GENERAL RECOMMENDA3 TIONS.—Not later than two years after the date of the 

4 enactment of this Act, and not later than 30 days after 

5 the end of each quarter thereafter, the Secretary of Vet6 erans Affairs shall submit to the Committee on Veterans’ 

7 Affairs of the Senate and the Committee on Veterans’ Af8 fairs of the House of Representatives a progress report 

9 detailing the actions by the Secretary during the period 

10 covered by the report to address any outstanding findings 

11 and recommendations by the Comptroller General of the 

12 United States under subsection (a) with respect to the 

13 Veterans Health Administration. 

14 (c) ANNUAL REVIEW OF PRESCRIPTION RATES.— 

15 Not later than one year after the date of the enactment 

16 of this Act, and not less frequently than annually for the 

17 following five years, the Secretary shall submit to the 

18 Committee on Veterans’ Affairs of the Senate and the 

19 Committee on Veterans’ Affairs of the House of Rep20 resentatives a report, with respect to each medical facility 

21 of the Department of Veterans Affairs, to collect and re22 view information on opioids prescribed by health care pro23 viders at the facility to treat non-cancer, non-palliative, 

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1 year period preceding the submission of the report, the 

2 following: 

3 (1) The number of patients and the percentage 

4 of the patient population of the Department who 

5 were prescribed benzodiazepines and opioids concur6 rently by a health care provider of the Department. 

7 (2) The number of patients and the percentage 

8 of the patient population of the Department without 

9 any pain who were prescribed opioids by a health 

10 care provider of the Department, including those 

11 who were prescribed benzodiazepines and opioids 

12 concurrently. 

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

14 and non-hospice care patients and the percentage of 

15 such patients who were treated with opioids by a 

16 health care provider of the Department on an inpa17 tient-basis and who also received prescription opioids 

18 by mail from the Department while being treated on 

19 an inpatient-basis. 

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

21 and non-hospice care patients and the percentage of 

22 such patients who were prescribed opioids concur23 rently by a health care provider of the Department 

24 and a health care provider that is not health care 

25 provider of the Department. 


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

2 Department, information on opioids prescribed by 

3 health care providers at the facility to treat non-can4 cer, non-palliative, and non-hospice care patients, in5 cluding information on— 

6 (A) the prescription rate at which each 

7 health care provider at the facility prescribed 

8 benzodiazepines and opioids concurrently to 

9 such patients and the aggregate such prescrip10 tion rate for all health care providers at the fa11 cility; 

12 (B) the prescription rate at which each 

13 health care provider at the facility prescribed 

14 benzodiazepines or opioids to such patients to 

15 treat conditions for which benzodiazepines or 

16 opioids are not approved treatment and the ag17 gregate such prescription rate for all health 

18 care providers at the facility; 

19 (C) the prescription rate at which each 

20 health care provider at the facility prescribed or 

21 dispensed mail-order prescriptions of opioids to 

22 such patients while such patients were being 

23 treated with opioids on an inpatient-basis and 

24 the aggregate of such prescription rate for all 

25 health care providers at the facility; and 


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1 (D) the prescription rate at which each 

2 health care provider at the facility prescribed 

3 opioids to such patients who were also concur4 rently prescribed opioids by a health care pro5 vider that is not a health care provider of the 

6 Department and the aggregate of such prescrip7 tion rates for all health care providers at the fa8 cility. 

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

10 Department, the number of times a pharmacist at 

11 the facility overrode a critical drug interaction warn12 ing with respect to an interaction between opioids 

13 and another medication before dispensing such medi14 cation to a veteran. 

15 (d) INVESTIGATION OF PRESCRIPTION RATES.—If 

16 the Secretary determines that a prescription rate with re17 spect to a health care provider or medical facility of the 

18 Department conflicts with or is otherwise inconsistent 

19 with the standards of appropriate and safe care, the Sec20 retary shall— 

21 (1) immediately notify the Committee on Vet22 erans’ Affairs of the Senate and the Committee on 

23 Veterans’ Affairs of the House of Representatives of 

24 such determination, including information relating to 

25 such determination, prescription rate, and health 


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1 care provider or medical facility, as the case may be; 

2 and 

3 (2) through the Office of the Medical Inspector 

4 of the Veterans Health Administration, conduct a 

5 full investigation of the health care provider or med6 ical facility, as the case may be. 

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

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

9 health care provider or medical facility of the Department, 

10 each of the following: 

11 (1) The number of patients treated with opioids 

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

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

14 pharmacy users of that health care provider or med15 ical facility. 

16 (2) The average number of morphine equiva17 lents per day prescribed by the health care provider 

18 or at the medical facility, as the case may be, to pa19 tients being treated with opioids. 

20 (3) Of the patients being treated with opioids 

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

22 as the case may be, the average number of prescrip23 tions of opioids per patient. 


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1 TITLE II—PATIENT ADVOCACY 

2 SEC. 201. COMMUNITY MEETINGS ON IMPROVING CARE 

3 FURNISHED BY DEPARTMENT OF VETERANS 

4 AFFAIRS. 

5 (a) COMMUNITY MEETINGS.— 

6 (1) MEDICAL CENTERS.—Not later than 90 

7 days after the date of the enactment of this Act, and 

8 not less frequently than once every 90 days there9 after, the Secretary shall ensure that each medical 

10 facility of the Department of Veterans Affairs hosts 

11 a community meeting open to the public on improv12 ing health care furnished by the Secretary. 

13 (2) COMMUNITY BASED OUTPATIENT CLIN14 ICS.—Not later than one year after the date of the 

15 enactment of this Act, and not less frequently than 

16 annually thereafter, the Secretary shall ensure that 

17 each community based outpatient clinic of the De18 partment hosts a community meeting open to the 

19 public on improving health care furnished by the 

20 Secretary. 

21 (b) ATTENDANCE BY DIRECTOR OF VETERANS INTE22 GRATED SERVICE NETWORK OR DESIGNEE.— 

23 (1) IN GENERAL.—Each community meeting 

24 hosted by a medical facility or community based out25 patient clinic under subsection (a) shall be attended 


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1 by the Director of the Veterans Integrated Service 

2 Network in which the medical facility or community 

3 based outpatient clinic, as the case may be, is lo4 cated. Subject to paragraph (2), the Director may 

5 delegate such attendance only to an employee who 

6 works in the Office of the Director. 

7 (2) ATTENDANCE BY DIRECTOR.—Each Direc8 tor of a Veterans Integrated Service Network shall 

9 personally attend not less than one community meet10 ing under subsection (a) hosted by each medical fa11 cility located in the Veterans Integrated Service Net12 work each year. 

13 (c) NOTICE.—The Secretary shall notify the Com14 mittee on Veterans’ Affairs of the Senate, the Committee 

15 on Veterans’ Affairs of the House of Representatives, and 

16 each Member of Congress (as defined in section 104) who 

17 represents the area in which the medical facility is located 

18 of a community meeting under subsection (a) by not later 

19 than 10 days before such community meeting occurs. 

20 SEC. 202. IMPROVEMENT OF AWARENESS OF PATIENT AD21 VOCACY PROGRAM AND PATIENT BILL OF 

22 RIGHTS OF DEPARTMENT OF VETERANS AF23 FAIRS. 

24 Not later than 90 days after the date of the enact25 ment of this Act, the Secretary of Veterans Affairs shall, 


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1 in as many prominent locations as the Secretary deter2 mines appropriate to be seen by the largest percentage of 

3 patients and family members of patients at each medical 

4 facility of the Department of Veterans Affairs— 

5 (1) display the purposes of the Patient Advo6 cacy Program of the Department and the contact in7 formation for the patient advocate at such medical 

8 facility; and 

9 (2) display the rights and responsibilities of— 

10 (A) patients and family members and pa11 tients at such medical facility; and 

12 (B) with respect to community living cen13 ters and other residential facilities of the De14 partment, residents and family members of resi15 dents at such medical facility. 

16 SEC. 203. COMPTROLLER GENERAL REPORT ON PATIENT 

17 ADVOCACY PROGRAM OF DEPARTMENT OF 

18 VETERANS AFFAIRS. 

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

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

21 of the United States shall submit to the Committee on 

22 Veterans’ Affairs of the Senate and the Committee on Vet23 erans’ Affairs of the House of Representatives a report 

24 on the Patient Advocacy Program of the Department of 


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1 Veterans Affairs (in this section referred to as the ‘‘Pro2 gram’’). 

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

4 (a) shall include the following: 

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

6 (A) the purpose of the Program; 

7 (B) the activities carried out under the 

8 Program; and 

9 (C) the sufficiency of the Program in 

10 achieving the purpose of the Program. 

11 (2) An assessment of the sufficiency of staffing 

12 of employees of the Department responsible for car13 rying out the Program. 

14 (3) An assessment of the sufficiency of the 

15 training of such employees. 

16 (4) An assessment of— 

17 (A) the awareness of the Program among 

18 veterans and family members of veterans; and 

19 (B) the use of the Program by veterans 

20 and family members of veterans. 

21 (5) Such recommendations and proposals for 

22 improving or modifying the Program as the Comp23 troller General considers appropriate. 


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1 (6) Such other information with respect to the 

2 Program as the Comptroller General considers ap3 propriate. 

4 TITLE III—COMPLEMENTARY 

5 AND INTEGRATIVE HEALTH 

6 SEC. 301. EXPANSION OF RESEARCH AND EDUCATION ON 

7 AND DELIVERY OF COMPLEMENTARY AND IN8 TEGRATIVE HEALTH TO VETERANS. 

9 (a) ESTABLISHMENT.—There is established a com10 mission to be known as the ‘‘Creating Options for Vet11 erans’ Expedited Recovery’’ or the ‘‘COVER Commission’’ 

12 (in this Act referred to as the ‘‘Commission’’). The Com13 mission shall examine the evidence-based therapy treat14 ment model used by the Secretary of Veterans Affairs for 

15 treating mental health conditions of veterans and the po16 tential benefits of incorporating complementary alter17 native treatments available in non-Department facilities 

18 (as defined in section 1701 of title 38, United States 

19 Code). 

20 (b) DUTIES.—The Commission shall perform the fol21 lowing duties: 

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

23 therapy model used by the Secretary for treating 

24 mental health illnesses of veterans and identify areas 

25 to improve wellness-based outcomes. 


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1 (2) Conduct a patient-centered survey within 

2 each of the Veterans Integrated Service Networks to 

3 examine— 

4 (A) the experience of veterans with the De5 partment of Veterans Affairs when seeking 

6 medical assistance for mental health issues 

7 through the health care system of the Depart8 ment; 

9 (B) the experience of veterans with non10 Department facilities and health professionals 

11 for treating mental health issues; 

12 (C) the preference of veterans regarding 

13 available treatment for mental health issues and 

14 which methods the veterans believe to be most 

15 effective; 

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

17 respect to the complementary alternative treat18 ment therapies described in paragraph (3); 

19 (E) the prevalence of prescribing prescrip20 tion medication among veterans seeking treat21 ment through the health care system of the De22 partment as remedies for addressing mental 

23 health issues; and 

24 (F) the outreach efforts of the Secretary 

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1 ments for veterans for addressing mental health 

2 issues, including by identifying ways to reduce 

3 barriers to gaps in such benefits and treat4 ments. 

5 (3) Examine available research on complemen6 tary alternative treatment therapies for mental 

7 health issues and identify what benefits could be 

8 made with the inclusion of such treatments for vet9 erans, including with respect to— 

10 (A) music therapy; 

11 (B) equine therapy; 

12 (C) training and caring for service dogs; 

13 (D) yoga therapy; 

14 (E) acupuncture therapy; 

15 (F) meditation therapy; 

16 (G) outdoor sports therapy; 

17 (H) hyperbaric oxygen therapy; 

18 (I) accelerated resolution therapy; 

19 (J) art therapy; 

20 (K) magnetic resonance therapy; and 

21 (L) other therapies the Commission deter22 mines appropriate. 

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

24 Department to ensure the delivery of quality health 


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1 care for mental health issues among veterans seek2 ing treatment within the Department. 

3 (5) Study the current treatments and resources 

4 available within the Department and assess— 

5 (A) the effectiveness of such treatments 

6 and resources in decreasing the number of sui7 cides per day by veterans; 

8 (B) the number of veterans who have been 

9 diagnosed with mental health issues; 

10 (C) the percentage of veterans using the 

11 resources of the Department who have been di12 agnosed with mental health issues; 

13 (D) the percentage of veterans who have 

14 completed counseling sessions offered by the 

15 Department; and 

16 (E) the efforts of the Department to ex17 pand complementary alternative treatments via18 ble to the recovery of veterans with mental 

19 health issues as determined by the Secretary to 

20 improve the effectiveness of treatments offered 

21 with the Department. 

22 (c) MEMBERSHIP.— 

23 (1) IN GENERAL.—The Commission shall be 

24 composed of 10 members, appointed as follows: 


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1 (A) Two members appointed by the Speak2 er of the House of Representatives, at least one 

3 of whom shall be a veteran. 

4 (B) Two members appointed by the Minor5 ity Leader of the House of Representatives, at 

6 least one of whom shall be a veteran. 

7 (C) Two members appointed by the Major8 ity Leader of the Senate, at least one of whom 

9 shall be a veteran. 

10 (D) Two members appointed by the Minor11 ity Leader of the Senate, at least one of whom 

12 shall be a veteran. 

13 (E) Two members appointed by the Presi14 dent, at least one of whom shall be a veteran. 

15 (2) QUALIFICATIONS.—Members of the Com16 mission shall be— 

17 (A) individuals who are of recognized 

18 standing and distinction within the medical 

19 community with a background in treating men20 tal health; 

21 (B) individuals with experience working 

22 with the military and veteran population; and 

23 (C) individuals who do not have a financial 

24 interest in any of the complementary alternative 

25 treatments reviewed by the Commission. 


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1 (3) CHAIRMAN.—The President shall designate 

2 a member of the Commission to be the Chairman. 

3 (4) PERIOD OF APPOINTMENT.—Members of 

4 the Commission shall be appointed for the life of the 

5 Commission. 

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

7 shall be filled in the manner in which the original 

8 appointment was made. 

9 (6) APPOINTMENT DEADLINE.—The appoint10 ment of members of the Commission in this section 

11 shall be made not later than 90 days after the date 

12 of the enactment of this Act. 

13 (d) POWERS OF COMMISSION.— 

14 (1) MEETINGS.— 

15 (A) INITIAL MEETING.—The Commission 

16 shall hold its first meeting not later than 30 

17 days after a majority of members are appointed 

18 to the Commission. 

19 (B) MEETING.—The Commission shall reg20 ularly meet at the call of the Chairman. Such 

21 meetings may be carried out through the use of 

22 telephonic or other appropriate telecommuni23 cation technology if the Commission determines 

24 that such technology will allow the members to 

25 communicate simultaneously. 


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1 (2) HEARINGS.—The Commission may hold 

2 such hearings, sit and act at such times and places, 

3 take such testimony, and receive evidence as the 

4 Commission considers advisable to carry out the re5 sponsibilities of the Commission. 

6 (3) INFORMATION FROM FEDERAL AGENCIES.— 

7 The Commission may secure directly from any de8 partment or agency of the Federal Government such 

9 information as the Commission considers necessary 

10 to carry out the duties of the Commission. 

11 (4) INFORMATION FROM NONGOVERNMENTAL

12 ORGANIZATIONS.—In carrying out its duties, the 

13 Commission may seek guidance through consultation 

14 with foundations, veteran service organizations, non15 profit groups, faith-based organizations, private and 

16 public institutions of higher education, and other or17 ganizations as the Commission determines appro18 priate. 

19 (5) COMMISSION RECORDS.—The Commission 

20 shall keep an accurate and complete record of the 

21 actions and meeting of the Commission. Such record 

22 shall be made available for public inspection and the 

23 Comptroller General of the United States may audit 

24 and examine such record. 


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1 (6) PERSONNEL RECORDS.—The Commission 

2 shall keep an accurate and complete record of the 

3 actions and meetings of the Commission. Such 

4 record shall be made available for public inspection 

5 and the Comptroller General of the United States 

6 may audit and examine such records. 

7 (7) COMPENSATION OF MEMBERS; TRAVEL EX8 PENSES.—Each member shall serve without pay but 

9 shall receive travel expenses to perform the duties of 

10 the Commission, including per diem in lieu of sub11 stances, at rates authorized under subchapter I of 

12 chapter 57 of title 5, United States Code. 

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

14 rules agreed upon the Commission, may appoint fix 

15 the compensation of a staff director and such other 

16 personnel as may be necessary to enable the Com17 mission to carry out its functions, without regard to 

18 the provisions of title 5, United States Code, gov19 erning appointments in the competitive service, with20 out regard to the provision of chapter 51 and sub21 chapter III of chapter 53 of such title relating to 

22 classification and General Schedule pay rates, except 

23 that no rate of pay fixed under this paragraph may 

24 exceed the equivalent of that payable for a position 


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1 at a level IV of the Executive Schedule under section 

2 5316 of title 5, United States Code. 

3 (9) PERSONNEL AS FEDERAL EMPLOYEES.— 

4 (A) IN GENERAL.—The executive director 

5 and any personnel of the Commission are em6 ployees under section 2105 of title 5, United 

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

8 84, 85, 87, 89, and 90 of such title. 

9 (B) MEMBERS OF THE COMMISSION.— 

10 Subparagraph (A) shall not be construed to 

11 apply to members of the Commission. 

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

13 such extent and in such amounts as are provided in 

14 appropriations Acts, enter into contracts to enable 

15 the Commission to discharge the duties of the Com16 mission under this Act. 

17 (11) EXPERT AND CONSULTANT SERVICE.—The 

18 Commission may procure the services of experts and 

19 consultants in accordance with section 3109 or title 

20 5, United States Code, at rates not to exceed the 

21 daily rate paid to a person occupying a position at 

22 level IV of the Executive Schedule under section 

23 3109 of title 5, United States Code. 

24 (12) POSTAL SERVICE.—The Commission may 

25 use the United States mails in the same manner and 


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1 under the same conditions as departments and agen2 cies of the United States. 

3 (13) PHYSICAL FACILITIES AND EQUIPMENT.— 

4 Upon the request of the Commission, the Adminis5 trator of General Services shall provide to the Com6 mission, on a reimbursable basis, the administrative 

7 support services necessary for the Commission to 

8 carry out its responsibilities under this Act. These 

9 administrative services may include human resource 

10 management, budget, leasing accounting, and payroll 

11 services. 

12 (e) REPORT.— 

13 (1) INTERIM REPORTS.— 

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

15 after the date on which the Commission first 

16 meets, and each 30-day period thereafter end17 ing on the date on which the Commission sub18 mits the final report under paragraph (2), the 

19 Commission shall submit to the Committees on 

20 Veterans’ Affairs of the House of Representa21 tives and the Senate and the President a report 

22 detailing the level of cooperation the Secretary 

23 of Veterans Affairs (and the heads of other de24 partments or agencies of the Federal Govern25 ment) has provided to the Commission. 


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

2 duties, at times that the Commission deter3 mines appropriate, the Commission shall submit 

4 to the Committee on Veterans’ Affairs of the 

5 House of Representatives and the Senate and 

6 any other appropriate entities an interim report 

7 with respect to the findings identified by the 

8 Commission. 

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

10 after the first meeting of the Commission, the Com11 mission shall submit to the Committee on Veterans’ 

12 Affairs of the House of Representatives and the Sen13 ate, the President, and the Secretary of Veterans Af14 fairs a final report on the findings of the Commis15 sion. Such report shall include the following: 

16 (A) Recommendations to implement in a 

17 feasible, timely, and cost efficient manner the 

18 solutions and remedies identified within the 

19 findings of the Commission pursuant to sub20 section (b). 

21 (B) An analysis of the evidence-based ther22 apy model used by the Secretary of Veterans 

23 Affairs for treating veterans with mental health 

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1 lence and efficacy of prescription drugs as a 

2 means for treatment. 

3 (C) The findings of the patient-centered 

4 survey conducted within each of the Veterans 

5 Integrated Service Networks pursuant to sub6 section (b)(2). 

7 (D) An examination of complementary al8 ternative treatments described in subsection 

9 (b)(3) and the potential benefits of incor10 porating such treatments in the therapy models 

11 used by the Secretary for treating veterans with 

12 mental health issues. 

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

14 date on which the Commission submits the final re15 port under paragraph (2), the Secretary of Veterans 

16 Affairs shall submit to the Committee on Veterans’ 

17 Affairs of the House of Representatives and the Sen18 ate a report on the following: 

19 (A) An action plan for implementing the 

20 recommendations established by the Commis21 sion on such solutions and remedies for improv22 ing wellness-based outcomes for veterans with 

23 mental health care issues. 

24 (B) A feasible timeframe on when the com25 plementary alternative treatments described in 


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1 subsection (b)(3) can be implemented Depart2 mentwide. 

3 (C) With respect to each recommendation 

4 established by the Commission, including any 

5 complementary alternative treatment, that the 

6 Secretary determines is not appropriate or fea7 sible to implement, a justification for such de8 termination and an alternative solution to im9 prove the efficacy of the therapy models used by 

10 the Secretary for treating veterans with mental 

11 health issues. 

12 (f) TERMINATION OF COMMISSION.—The Commis13 sion shall terminate 30 days after the Commission submits 

14 the final report under subsection (e)(2). 

15 SEC. 302. PILOT PROGRAM ON INTEGRATION OF COM16 PLEMENTARY ALTERNATIVE MEDICINES AND 

17 RELATED ISSUES FOR VETERANS AND FAM18 ILY MEMBERS OF VETERANS. 

19 (a) PILOT PROGRAM.— 

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

21 after the date on which the Secretary of Veterans 

22 Affairs receives the final report under section 

23 301(e), the Secretary shall commence a pilot pro24 gram to assess the feasibility and advisability of 

25 using wellness-based programs (as defined by the 


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1 Secretary) to complement the provision of pain man2 agement and related health care services, including 

3 mental health care services, to veterans. 

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

5 pilot program, the Secretary shall assess the fol6 lowing: 

7 (A) Means of improving coordination be8 tween Federal, State, local, and community pro9 viders of health care in the provision of pain 

10 management and related health care services to 

11 veterans. 

12 (B) Means of enhancing outreach, and co13 ordination of outreach, by and among providers 

14 of health care referred to in subparagraph (A) 

15 on the pain management and related health 

16 care services available to veterans. 

17 (C) Means of using wellness-based pro18 grams of providers of health care referred to in 

19 subparagraph (A) as complements to the provi20 sion by the Department of pain management 

21 and related health care services to veterans. 

22 (D) Whether wellness-based programs de23 scribed in subparagraph (C)— 

24 (i) are effective in enhancing the qual25 ity of life and well-being of veterans; 


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1 (ii) are effective in increasing the ad2 herence of veterans to the primary pain 

3 management and related health care serv4 ices provided such veterans by the Depart5 ment; 

6 (iii) have an effect on the sense of 

7 well-being of veterans who receive primary 

8 pain management and related health care 

9 services from the Department; and 

10 (iv) are effective in encouraging vet11 erans receiving health care from the De12 partment to adopt a more healthy lifestyle. 

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

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

15 years. 

16 (c) LOCATIONS.— 

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

18 the pilot program under subsection (a)(1) at facili19 ties of the Department providing pain management 

20 and related health care services, including mental 

21 health care services, to veterans. In selecting such 

22 facilities to carry out the pilot program, the Sec23 retary shall select not fewer than 15 medical centers 

24 of the Department, of which not fewer than two 


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1 shall be polytrauma rehabilitation centers of the De2 partment. 

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 

9 is otherwise inconsistent with the standards of ap10 propriate 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 


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

2 (3) and requests to participate in the pilot program 

3 or is referred by a clinician of the Department who 

4 is treating the veteran. 

5 (f) COVERED SERVICES.— 

6 (1) IN GENERAL.—For purposes of the pilot 

7 program, covered services are services consisting of 

8 complementary and integrative health services as se9 lected 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 ap15 propriate training and expertise in complemen16 tary and integrative health services who are em17 ployees of the Department or with whom the 

18 Department enters into an agreement to pro19 vide such 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 Cul25 tural Transformation. 


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1 (C) Covered services shall be made avail2 able 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 in7 tegrative health services under the pilot 

8 program; and 

9 (ii) covered veterans who have not re10 ceived conventional treatments from the 

11 Department 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 

17 of the Senate and the Committee on Veterans’ Af18 fairs of the House of Representatives a report on the 

19 pilot program. 

20 (2) ELEMENTS.—The report under paragraph 

21 (1) shall include the following: 

22 (A) The findings and conclusions of the 

23 Secretary with respect to the pilot program 

24 under subsection (a)(1), including with respect 

25 to— 


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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 

5 Secretary to inform veterans and commu6 nity organizations about the pilot program; 

7 and 

8 (iii) an assessment of the benefit of 

9 the pilot program to covered veterans in 

10 mental health diagnoses, pain manage11 ment, and treatment of chronic illness. 

12 (B) Identification of any unresolved bar13 riers that impede the ability of the Secretary to 

14 incorporate complementary and integrative 

15 health services with other health care services 

16 provided by the Department. 

17 (C) Such recommendations for the continu18 ation or expansion of the pilot program as the 

19 Secretary considers appropriate. 

20 (h) COMPLEMENTARY AND INTEGRATIVE HEALTH

21 DEFINED.—In this section, the term ‘‘complementary and 

22 integrative health’’ shall have the meaning given that term 

23 by the National Institutes of Health. 


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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, 

9 the Secretary of Veterans Affairs shall require from the 

10 medical board of each State in which the health care pro11 vider has 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 con15 sideration of the health care provider by the Depart16 ment; 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 

25 States Code, with respect to each health care provider of 


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1 the Department of Veterans Affairs who has violated a 

2 requirement of the medical license of the health care pro3 vider, the Secretary of Veterans Affairs shall provide to 

4 the medical board of each State in which the health care 

5 provider is licensed detailed information with respect to 

6 such violation, regardless of whether such board has for7 mally requested such 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 

12 FACILITIES. 

13 Not later than two years after the date of the enact14 ment of this Act, the Secretary of Veterans Affairs shall 

15 submit to the Committee on Veterans’ Affairs of the Sen16 ate and the Committee on Veterans’ Affairs of the House 

17 of Representatives a report on the compliance by the De18 partment of Veterans Affairs with the policy of the De19 partment— 

20 (1) to conduct a review of each health care pro21 vider of the Department who transfers to another 

22 medical facility of the Department, retires, or is ter23 minated to determine whether there are any con24 cerns, complaints, or allegations of violations relatVerDate Sep 11 2014 22:10 Nov 21, 2015 Jkt 059200 PO 00000 Frm 00052 Fmt 6652 Sfmt 6201 E:\BILLS\H4063.IH H4063

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1 ing to the medical practice of the health care pro2 vider; and 

3 (2) to take appropriate action with respect to 

4 any such concern, complaint, or allegation. 

5 TITLE V—OTHER VETERANS 

6 MATTERS 

7 SEC. 501. AUDIT OF VETERANS HEALTH ADMINISTRATION 

8 PROGRAMS OF DEPARTMENT OF VETERANS 

9 AFFAIRS. 

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

11 seek to enter into a contract with a nongovernmental enti12 ty under which the entity shall conduct a audits of the 

13 programs of the Veterans Health Administration of the 

14 Department of Veterans Affairs to identify ways to im15 prove the furnishing of benefits and health care adminis16 tered by the Veterans Health Administration to veterans 

17 and families of veterans. 

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

19 audit under subsection (a), the entity shall perform the 

20 following: 

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

22 functions, staff organizations, and staff offices of the 

23 Veterans Health Administration that would lead to24 wards the greatest improvement in furnishing of 


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1 benefits and health care to veterans and families of 

2 veterans. 

3 (2) Development of plans that are informed by 

4 the risk assessment under paragraph (1) to conduct 

5 audits of the functions, staff organizations, and staff 

6 offices identified under paragraph (1). 

7 (3) Conduct audits in accordance with the plans 

8 developed pursuant to paragraph (2). 

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

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

11 the Secretary shall submit to the Committees on Veterans’ 

12 Affairs of the House of Representatives and the Senate 

13 a report that includes— 

14 (1) a summary of the audit; 

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

16 audit with respect to the audit; and 

17 (3) such recommendations as the Secretary de18 termines appropriate for legislative or administrative 

19 action to improve the furnishing of benefits and 

20 health care to veterans and families of veterans. 

Æ 


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