II 

114TH CONGRESS 

1ST SESSION S. 1641 

To improve the use by the Department of Veterans Affairs of opioids in 

treating veterans, to improve patient advocacy by the Department, and 

to expand availability of complementary and integrative health, and for 

other purposes. 

IN THE SENATE OF THE UNITED STATES 

JUNE 22, 2015 

Ms. BALDWIN (for herself, Mrs. CAPITO, Mr. BLUMENTHAL, Mr. BROWN, Ms. 

HIRONO, Mr. JOHNSON, Mr. KAINE, Mr. MANCHIN, Mr. MARKEY, Mr. 

MORAN, Mrs. MURRAY, Mr. SANDERS, and Mr. TESTER) introduced the 

following bill; which was read twice and referred to the Committee on 

Veterans’ Affairs 

A BILL 

To improve the use by the Department of Veterans Affairs 

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

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

5 ‘‘Jason Simcakoski Memorial Opioid Safety Act’’. 


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

2 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. Establishment of working group on pain management and opioid 

therapy within the Department of Veterans Affairs-Department 

of Defense Joint Executive Committee. 

Sec. 104. Establishment of pain management boards of Department of Veterans Affairs. 

Sec. 105. Study on feasibility and advisability of carrying out pharmacy lockin program by Department of Veterans Affairs. 

Sec. 106. Reports and investigation on use of opioids in treatment by Department of Veterans Affairs. 

TITLE II—PATIENT ADVOCACY 

Sec. 201. Establishment of Office of Patient Advocacy of the Department of 

Veterans Affairs. 

Sec. 202. Community meetings on improving care from Department of Veterans Affairs. 

Sec. 203. Improvement of awareness of patient advocacy program and patient 

bill of rights of Department of Veterans Affairs. 

Sec. 204. Comptroller General Report on Patient Advocacy Program of Department of Veterans Affairs. 

Sec. 205. Report on transition by veterans between different health care settings. 

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. Program on integration of complementary and integrative health 

within Department of Veterans Affairs medical centers. 

Sec. 303. Program on use of wellness programs as complementary approach to 

pain management and related issues for veterans and family 

members of veterans. 

TITLE IV—OTHER VETERANS HEALTH CARE MATTERS 

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. 


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TITLE V—OTHER VETERANS MATTERS 

Sec. 501. Department of Veterans Affairs program of internal audits. 

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) Guidelines for safely prescribing opioids for 

15 the treatment of chronic, non-cancer pain in out16 patient settings as developed and released by the 

17 Centers for Disease Control and Prevention. 

18 (2) Enhanced guidance with respect to absolute 

19 contraindications for opioid therapy, including guid20 ance with respect to the following: 

21 (A) The coadministration of drugs that are 

22 capable of inducing a life-limiting drug-drug 

23 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. 

4 (C) The use of opioid therapy to treat pa5 tients without any pain, including to treat men6 tal health disorders other than opioid use dis7 order. 

8 (3) Enhanced guidance with respect to the 

9 treatment of patients with behaviors or 

10 comorbidities, such as post-traumatic stress dis11 order, psychiatric disorders, or a history of sub12 stance abuse or addiction, that require consultation 

13 or comanagement of opioid therapy with one or more 

14 specialists in pain management, mental health, or 

15 addictions. 

16 (4) Enhanced guidance with respect to the con17 duct by health care providers of an effectiveness as18 sessment for patients receiving opioid therapy, in19 cluding patients on long-term opioid therapy, to de20 termine— 

21 (A) whether opioid therapy is meeting the 

22 expected goals of the patient and health care 

23 provider of relieving pain, improving function, 

24 and providing patient satisfaction; and 


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1 (B) whether opioid therapy should be con2 tinued. 

3 (5) Requirements that each health care provider 

4 of the Department of Veterans Affairs and the De5 partment of Defense, before initiating opioid therapy 

6 to treat a patient, use the Opioid Therapy Risk Re7 port tool of the Department of Veterans Affairs, in8 cluding information from the prescription drug mon9 itoring program of each State that includes the most 

10 recent date information relating to the patient was 

11 accessed through such program, as required to be in12 cluded in such tool under section 102(d)(2), to as13 sess the risk for adverse outcomes of opioid therapy 

14 for the patient, including the concurrent use of con15 trolled substances such as benzodiazepines, as part 

16 of the comprehensive assessment conducted by the 

17 health care provider. 

18 (6) Guidelines to govern the methodologies used 

19 by health care providers of the Department of Vet20 erans Affairs and the Department of Defense to 

21 taper opioid therapy when adjusting or discontinuing 

22 the use of opioid therapy. 

23 (7) Guidelines with respect to appropriate case 

24 management for patients receiving opioid therapy 

25 who transition between inpatient and outpatient 


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1 health care settings, which may include the use of 

2 care transition plans. 

3 (8) Enhanced recommendations with respect to 

4 the use of routine and random urine drug tests for 

5 all patients before and during opioid therapy to help 

6 prevent substance abuse, dependence, and diversion, 

7 including requirements— 

8 (A) that such tests occur not less fre9 quently than once each year; and 

10 (B) that health care providers appro11 priately interpret and respond to the results 

12 from such tests to tailor pain therapy, safe13 guards, and risk management strategies to each 

14 patient. 

15 (9) Guidance that health care providers discuss 

16 with patients, before initiating opioid therapy, op17 tions for pain management therapies without the use 

18 of opioids and options to augment opioid therapy 

19 with other clinical and complementary and integra20 tive health services to minimize opioid dependence. 

21 (b) CONSULTATION BEFORE UPDATE.—Before up22 dating the guideline under subsection (a), the Secretary 

23 of Veterans Affairs and the Secretary of Defense shall 

24 jointly consult with the working group on pain manage25 ment and opioid therapy established in section 103. 


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1 (c) COMPTROLLER GENERAL REPORT ON IMPLE2 MENTATION BY DEPARTMENT OF VETERANS AFFAIRS.— 

3 Not later than one year after the Secretary of Veterans 

4 Affairs updates the guideline under subsection (a), and 

5 not less frequently than annually thereafter, the Comp6 troller General of the United States shall submit to the 

7 Committee on Veterans’ Affairs of the Senate and the 

8 Committee on Veterans’ Affairs of the House of Rep9 resentatives a report on— 

10 (1) the implementation by each medical facility 

11 of the Department of Veterans Affairs of such 

12 guideline; and 

13 (2) the compliance by each such medical facility 

14 with such guideline. 

15 (d) CONTROLLED SUBSTANCE DEFINED.—In this 

16 section, the term ‘‘controlled substance’’ has the meaning 

17 given that term in section 102 of the Controlled Sub18 stances Act (21 U.S.C. 802). 

19 SEC. 102. IMPROVEMENT OF OPIOID SAFETY MEASURES BY 

20 DEPARTMENT OF VETERANS AFFAIRS. 

21 (a) EXPANSION OF OPIOID SAFETY INITIATIVE.— 

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

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

24 the Opioid Safety Initiative of the Department of Veterans 

25 Affairs to include all medical facilities of the Department. 


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1 (b) PAIN MANAGEMENT EDUCATION AND TRAIN2 ING.— 

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

4 Safety Initiative of the Department, the Secretary 

5 shall require all employees of the Department re6 sponsible for prescribing opioids to receive education 

7 and training described in paragraph (2) in order to 

8 appropriately implement and comply with the VA/ 

9 DOD Clinical Practice Guideline for Management of 

10 Opioid Therapy for Chronic Pain, including any up11 dates to such guideline. 

12 (2) EDUCATION AND TRAINING.—Education 

13 and training described in this paragraph is edu14 cation and training on pain management and safe 

15 opioid prescribing practices for purposes of safely 

16 and effectively managing patients with chronic pain 

17 and includes education and training on the fol18 lowing: 

19 (A) The safe and effective use of opioid 

20 therapy to treat chronic pain that is non-cancer 

21 related. 

22 (B) The use of evidence-based pain man23 agement therapies, including cognitive-behav24 ioral therapy, non-opioid alternatives, and non25 drug approaches to managing pain and related 


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1 health conditions including complementary and 

2 integrative health services. 

3 (C) Screening and identification of patients 

4 with substance use disorder, including drug5 seeking behavior, before prescribing opioids, as6 sessment of the risk potential for patients devel7 oping an addiction, and referral of patients to 

8 appropriate addiction treatment professionals if 

9 addiction is identified or strongly suspected. 

10 (D) The safe and effective use of urine 

11 drug tests. 

12 (E) Prescription of the lowest effective 

13 dose of opioids based on patient need, use of 

14 opioids only for a limited period of time, and 

15 augmentation of opioid therapy with other pain 

16 management therapies and modalities. 

17 (F) The use of safe and effective tapering 

18 programs for patients taking opioids and other 

19 controlled substances, such as benzodiazepines, 

20 concurrently and patients taking high-risk 

21 opioids. 

22 (G) Communication with patients on the 

23 potential harm associated with the use of 

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1 plies relating to the use of opioids and other 

2 controlled substances. 

3 (H) Such other education and training as 

4 the Secretary considers appropriate to ensure 

5 that veterans receive safe, high-quality pain 

6 management care from the Department. 

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

8 education and training described in paragraph (2), 

9 the Secretary shall use the Interdisciplinary Chronic 

10 Pain Management Training Team Program of the 

11 Department. 

12 (c) PAIN MANAGEMENT TEAMS.— 

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

14 Safety Initiative of the Department, each medical fa15 cility of the Department shall identify and designate 

16 a pain management team of health care profes17 sionals responsible for coordinating and overseeing 

18 therapy at such facility for patients experiencing 

19 acute and chronic pain that is non-cancer related. 

20 (2) ESTABLISHMENT OF PROTOCOLS.— 

21 (A) IN GENERAL.—The director of each 

22 Veterans Integrated Service Network shall es23 tablish protocols for the designation of pain 

24 management teams at each medical facility 


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1 within that Veterans Integrated Service Net2 work. 

3 (B) CONSULTATION ON PRESCRIPTION OF

4 OPIOIDS.—Each protocol established for a med5 ical facility under subparagraph (A) shall en6 sure that any health care provider without ex7 pertise in prescribing analgesics or who has not 

8 completed the education and training under 

9 subsection (b), such as a mental health care 

10 provider, does not prescribe opioids to a patient 

11 unless that health care provider— 

12 (i) consults with a health care pro13 vider with pain management expertise or 

14 who is on the pain management team of 

15 the medical facility; and 

16 (ii) refers the patient to that pain 

17 management team for any subsequent pre18 scriptions and related therapy. 

19 (3) REPORT.— 

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

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

22 head of each medical facility of the Department 

23 shall submit to the director of the Veterans In24 tegrated Service Network in which the medical 

25 facility is located a report identifying the health 


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1 care professionals that have been designated as 

2 members of the pain management team at the 

3 medical facility. 

4 (B) ELEMENTS.—Each report submitted 

5 under subparagraph (A) with respect to a med6 ical facility of the Department shall include— 

7 (i) a certification as to whether all 

8 members of the pain management team at 

9 the medical facility have completed the 

10 education and training required under sub11 section (b); and 

12 (ii) a plan for the management and 

13 referral of patients to such pain manage14 ment team if health care providers without 

15 expertise in prescribing analgesics pre16 scribe opioid medications to treat acute 

17 and chronic pain that is non-cancer re18 lated. 

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

20 (1) TRACKING OF DATA ON OPIOID USE.—Not 

21 later than 18 months after the date of the enact22 ment of this Act, in carrying out the Opioid Safety 

23 Initiative and the Opioid Therapy Risk Report tool 

24 of the Department, the Secretary shall, through the 

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1 ment, allow for real-time tracking of and access to 

2 data on— 

3 (A) the key clinical indicators with respect 

4 to the totality of opioid use by veterans; 

5 (B) concurrent prescribing by health care 

6 providers of the Department of opioids in dif7 ferent health care settings, include data on con8 current prescribing of opioids to treat mental 

9 health disorders other than opioid use disorder; 

10 and 

11 (C) mail-order prescriptions of opioids pre12 scribed to veterans under the laws administered 

13 by the Secretary. 

14 (2) PRESCRIPTION DRUG MONITORING PRO15 GRAMS OF STATES.—In carrying out the Opioid 

16 Safety Initiative and the Opioid Therapy Risk Re17 port tool of the Department, the Secretary shall— 

18 (A) ensure access by health care providers 

19 of the Department to information on controlled 

20 substances, including opioids and 

21 benzodiazepines, prescribed to veterans who re22 ceive care outside the Department through the 

23 prescription drug monitoring program of each 

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1 randa of understanding with States to allow 

2 such access; 

3 (B) include such information in the Opioid 

4 Therapy Risk Report; and 

5 (C) require health care providers of the 

6 Department to submit to the prescription drug 

7 monitoring program of each State information 

8 on prescriptions of controlled substances re9 ceived by veterans in that State under the laws 

10 administered by the Secretary. 

11 (3) REPORT ON IMPLEMENTATION.—Not later 

12 than 180 days after the date of the enactment of 

13 this Act, the Secretary shall submit to Congress a 

14 report on the progress of the Department in imple15 menting the improvements to the Opioid Therapy 

16 Risk Report tool of the Department required under 

17 paragraphs (1) and (2). 

18 (e) AVAILABILITY OF OPIOID RECEPTOR ANTAGO19 NISTS.— 

20 (1) INCREASED AVAILABILITY AND USE.— 

21 (A) IN GENERAL.—The Secretary shall in22 crease the availability of opioid receptor antago23 nists approved by the Food and Drug Adminis24 tration, such as naloxone, to veterans and in25 crease the availability of opioid receptor antagoVerDate Sep 11 2014 22:37 Jun 26, 2015 Jkt 049200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\S1641.IS S1641

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1 nists for use by health care providers of the De2 partment in treating veterans. 

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

5 (A), the Secretary shall, not later than 90 days 

6 after the date of the enactment of this Act— 

7 (i) equip each medical facility of the 

8 Department with opioid receptor antago9 nists approved by the Food and Drug Ad10 ministration; 

11 (ii) enhance training for health care 

12 providers of the Department on distrib13 uting such opioid receptor antagonists; and 

14 (iii) expand the Overdose Education 

15 and Naloxone Distribution program of the 

16 Department to ensure that all veterans in 

17 receipt of health care under the laws ad18 ministered by the Secretary who are at 

19 risk of opioid overdose have access to such 

20 opioid receptor antagonists and training on 

21 the proper administration of such opioid 

22 receptor antagonists. 

23 (C) VETERANS WHO ARE AT RISK.—For 

24 purposes of subparagraph (B), veterans who are 

25 at risk of opioid overdose include— 


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1 (i) veterans receiving long-term opioid 

2 therapy; 

3 (ii) veterans receiving opioid therapy 

4 who have a history of substance use dis5 order or prior instances of overdose; and 

6 (iii) veterans who are at risk as deter7 mined by a health care provider who is 

8 treating the veteran. 

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

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

11 shall submit to the Committee on Veterans’ Affairs 

12 of the Senate and the Committee on Veterans’ Af13 fairs of the House of Representatives a report on 

14 compliance with paragraph (1) that includes an as15 sessment of the following: 

16 (A) Whether all medical facilities of the 

17 Department are equipped with opioid receptor 

18 antagonists approved by the Food and Drug 

19 Administration. 

20 (B) The progress of the Department in en21 suring that any such facilities that are not 

22 equipped with such opioid receptor antagonists 

23 obtain such opioid receptor antagonists. 

24 (C) Whether all veterans at risk of opioid 

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1 tagonists and training on the proper adminis2 tration of such opioid receptor antagonists. 

3 (D) The progress of the Department in en4 suring that all veterans at risk of opioid over5 dose have access to such opioid receptor antago6 nists and training on the proper administration 

7 of such opioid receptor antagonists. 

8 (f) INCLUSION OF CERTAIN INFORMATION AND CA9 PABILITIES IN OPIOID THERAPY RISK REPORT TOOL.— 

10 (1) INFORMATION.—The Secretary shall include 

11 in the Opioid Therapy Risk Report tool of the De12 partment— 

13 (A) information on the most recent time 

14 the tool was accessed by a health care provider 

15 of the Department with respect to each veteran; 

16 and 

17 (B) information on the results of the most 

18 recent urine drug test for each veteran. 

19 (2) CAPABILITIES.—The Secretary shall include 

20 in the Opioid Therapy Risk Report tool the ability 

21 of health care providers of the Department to deter22 mine whether a health care provider of the Depart23 ment prescribed opioids to a veteran without check24 ing the information in the tool with respect to the 

25 veteran. 


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1 (g) NOTIFICATION OF RISK IN COMPUTERIZED

2 HEALTH RECORD.—The Secretary shall modify the Com3 puterized Patient Record System of the Department to en4 sure that any health care provider that accesses the record 

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

6 care from the health care provider, will be immediately no7 tified whether the veteran— 

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

9 of substance use disorder or prior instances of over10 dose; 

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

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

13 determined by a health care provider who is treating 

14 the veteran. 

15 (h) CONTROLLED SUBSTANCE DEFINED.—In this 

16 section, the term ‘‘controlled substance’’ has the meaning 

17 given that term in section 102 of the Controlled Sub18 stances Act (21 U.S.C. 802). 

19 SEC. 103. ESTABLISHMENT OF WORKING GROUP ON PAIN 

20 MANAGEMENT AND OPIOID THERAPY WITHIN 

21 THE DEPARTMENT OF VETERANS AFFAIRS22 DEPARTMENT OF DEFENSE JOINT EXECU23 TIVE COMMITTEE. 

24 (a) WORKING GROUP ON PAIN MANAGEMENT AND

25 OPIOID THERAPY.—There is established within the 


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1 Health Executive Committee of the Department of Vet2 erans Affairs-Department of Defense Joint Executive 

3 Committee established under section 320 of title 38, 

4 United States Code, a working group on pain management 

5 and opioid therapy for individuals receiving health care 

6 from either the Department of Veterans Affairs or the De7 partment of Defense that shall cover, at a minimum, the 

8 following: 

9 (1) The opioid prescribing practices of health 

10 care providers of each Department. 

11 (2) The ability of each Department to manage 

12 acute and chronic pain among individuals receiving 

13 health care from that Department, including train14 ing health care providers with respect to pain man15 agement. 

16 (3) The use by each Department of complemen17 tary and integrative health in treating such individ18 uals. 

19 (4) The concurrent use by health care providers 

20 of each Department of opioids and prescription 

21 drugs to treat mental health disorders, including 

22 benzodiazepines. 

23 (5) The practice by health care providers of 

24 each Department of prescribing opioids to treat 

25 mental health disorders. 


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1 (6) The coordination in coverage of and con2 sistent access to medications prescribed for patients 

3 transitioning from receiving health care from the 

4 Department of Defense to receiving health care from 

5 the Department of Veterans Affairs. 

6 (7) The ability of each Department to identify 

7 and treat substance use disorders among individuals 

8 receiving health care from that Department. 

9 (b) COORDINATION AND CONSULTATION.—The work10 ing group established under subsection (a) shall— 

11 (1) coordinate the activities of the working 

12 group with other relevant working groups estab13 lished under section 320 of title 38, United States 

14 Code, including the working groups on evidence 

15 based practice, patient safety, pharmacy, psycho16 logical health, and pain management; 

17 (2) consult with other relevant Federal agen18 cies, including the Centers for Disease Control and 

19 Prevention, with respect to the activities of the 

20 working group; and 

21 (3) consult with the Department of Veterans 

22 Affairs and the Department of Defense with respect 

23 to, review, and comment on the VA/DOD Clinical 

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1 apy for Chronic Pain, or any successor guideline, be2 fore any update to the guideline is released. 

3 (c) CONSULTATION.—The Secretary of Veterans Af4 fairs and the Secretary of Defense shall jointly ensure that 

5 the working group established under subsection (a) is able 

6 to meaningfully consult with respect to the updated guide7 line required under subsection (a) of section 101, as re8 quired by subsection (b) of such section, not later than 

9 one year after the date of the enactment of this Act. 

10 SEC. 104. ESTABLISHMENT OF PAIN MANAGEMENT BOARDS 

11 OF DEPARTMENT OF VETERANS AFFAIRS. 

12 (a) IN GENERAL.—Subchapter I of chapter 73 of title 

13 38, United States Code, is amended by adding at the end 

14 the following new section: 

15 ‘‘§ 7309A. Pain management boards 

16 ‘‘(a) ESTABLISHMENT.—The Secretary shall estab17 lish in each Veterans Integrated Service Network a Pain 

18 Management Board (in this section referred to as a 

19 ‘Board’). 

20 ‘‘(b) DUTIES.—(1) Each Board shall— 

21 ‘‘(A) consult with health care professionals and 

22 other employees of the Department located in the 

23 Veterans Integrated Service Network covered by the 

24 Board, patients who are being treated at medical fa25 cilities of the Department located in such Veterans 


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1 Integrated Service Network, and family members of 

2 such patients with respect to the pain management 

3 resources and best practices of the Department; 

4 ‘‘(B) oversee compliance by the health care pro5 fessionals and other employees of the Department 

6 with the best practices of the Department, including 

7 by issuing such recommendations to improve compli8 ance with such best practices as the Board considers 

9 appropriate; 

10 ‘‘(C) provide oversight of the pain management 

11 practices of the pain management committees of 

12 each medical facility of the Department and the 

13 health care professionals and other employees of the 

14 Department that are located in the Veterans Inte15 grated Service Network covered by the Board; 

16 ‘‘(D) carry out educational forums, as the 

17 Board considers appropriate, for individuals speci18 fied in subparagraph (A) on pain management and 

19 treatment that may include the sharing of updated 

20 research and best practices from medical experts, 

21 other health care systems, and such other Federal 

22 agencies as the Board considers necessary to carry 

23 out this subparagraph; and 

24 ‘‘(E) carry out public hearings, symposiums, or 

25 other events, as the Board considers appropriate, 


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1 during which health care professionals discuss and 

2 share best practices on pain management and com3 plementary and integrative health. 

4 ‘‘(2)(A) Each Board may provide treatment rec5 ommendations for patients with complex clinical pain who 

6 are being treated at a medical facility of the Department 

7 located in the Veterans Integrated Service Network cov8 ered by the Board, and assist in facilitating communica9 tion between such patients and their health care providers, 

10 regardless of whether such treatment is on an in-patient 

11 or out-patient basis, and for whom a request for such rec12 ommendations, subject to subparagraph (C), has been 

13 made by an individual described in subparagraph (B). 

14 ‘‘(B) An individual described in this subparagraph is 

15 one of the following individuals: 

16 ‘‘(i) The patient. 

17 ‘‘(ii) The spouse of the patient. 

18 ‘‘(iii) A family member of the patient or an19 other individual if such family member or individual 

20 has been designated by the patient to make health 

21 care decisions for the patient or to receive health 

22 care information with respect to the patient. 

23 ‘‘(iv) A physician of the patient. 

24 ‘‘(v) An employee of the medical facility of the 

25 Department described in subparagraph (A). 


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1 ‘‘(C) An individual described in subparagraph (B) 

2 may not request treatment recommendations under sub3 paragraph (A) unless the individual— 

4 ‘‘(i) has requested treatment recommendations 

5 from the pain management committee of the medical 

6 facility of the Department at which the patient is re7 ceiving treatment; and 

8 ‘‘(ii) has received treatment recommendations 

9 from such committee and is not satisfied with those 

10 treatment recommendations. 

11 ‘‘(3) Based on treatment recommendations developed 

12 under paragraph (2)(A), consultations conducted under 

13 paragraph (1)(A), and educational forums and public 

14 events carried out under subparagraphs (C) and (D) of 

15 paragraph (1), each Board shall provide to health care 

16 professionals of the Department located in the Veterans 

17 Integrated Service Network covered by the Board rec18 ommendations on the best practices regarding pain man19 agement in cases of complex clinical pain. 

20 ‘‘(4)(A) Each Board shall annually submit to the Sec21 retary and the Under Secretary for Health a report (with 

22 all personally identifiable information of patients re23 dacted) on pain management practices carried out in the 

24 Veterans Integrated Service Network covered by the 


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1 Board. Each such report shall include, for the year cov2 ered by the report, the following: 

3 ‘‘(i) The treatment recommendations provided 

4 under paragraph (2)(A), including— 

5 ‘‘(I) a summary of such recommendations; 

6 and 

7 ‘‘(II) an explanation of the merits of each 

8 such recommendation. 

9 ‘‘(ii) The recommendations for best practices 

10 provided under paragraph (3), including— 

11 ‘‘(I) a summary of such recommendations; 

12 and 

13 ‘‘(II) an explanation of the merits of each 

14 such recommendation. 

15 ‘‘(iii) Such other information as the Board con16 siders appropriate. 

17 ‘‘(B) Not later than January 31 of each year, the 

18 Secretary shall submit to the Committee on Veterans’ Af19 fairs of the Senate and the Committee on Veterans’ Af20 fairs of the House of Representatives a report that con21 tains comprehensive information from each report sub22 mitted to the Secretary under subparagraph (A) during 

23 the year preceding the submittal of the report by the Sec24 retary, disaggregated by Board. 


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1 ‘‘(5) The Federal Advisory Committee Act (5 U.S.C. 

2 App.) shall not apply to any Board. 

3 ‘‘(c) MEMBERSHIP.—(1) Each Board shall include 

4 the following individuals appointed by the Secretary: 

5 ‘‘(A) A board certified pain medicine specialist. 

6 ‘‘(B) A trained and qualified member of the pri7 mary care team of a medical facility of the Depart8 ment with experience in pain care, such as a nurse 

9 practitioner. 

10 ‘‘(C) A pain psychologist. 

11 ‘‘(D) A pain social worker. 

12 ‘‘(E) A clinical pharmacist. 

13 ‘‘(F) A pain point of contact for a Veterans In14 tegrated Service Network. 

15 ‘‘(G) A physician with addiction and 

16 psychopharmacology expertise and experience. 

17 ‘‘(H) An allied health care professional. 

18 ‘‘(I) A clinician with expertise in complemen19 tary and integrative health. 

20 ‘‘(J) A clinical behavioral therapist. 

21 ‘‘(K) A patient advocate. 

22 ‘‘(L) A representative of the labor interests of 

23 employees of the Department who are responsible 

24 for prescribing drugs. 

25 ‘‘(M) A current or former clinical patient. 


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1 ‘‘(N) A family member of a current or former 

2 clinical patient. 

3 ‘‘(2) Of the members appointed under paragraph (1), 

4 not less than three shall be representative of the demo5 graphic of patients served by the Veterans Integrated 

6 Service Network covered by the Board, including— 

7 ‘‘(A) not less than two current or former pa8 tients treated at a medical facility of the Depart9 ment for complex clinical pain; and 

10 ‘‘(B) not less than one family member of such 

11 a current or former patient. 

12 ‘‘(3) The Secretary shall determine the terms of serv13 ice of the members of each Board. 

14 ‘‘(4)(A) Members of each Board shall serve without 

15 pay and, except as provided in subparagraph (B), mem16 bers who are full-time officers or employees of the United 

17 States may not receive additional pay, allowances, or bene18 fits by reason of their service on the Board. 

19 ‘‘(B) Members may receive travel expenses, including 

20 per diem in lieu of subsistence, for travel in connection 

21 with their duties as members of the Board. 

22 ‘‘(C) Any member who has clinical duties as an offi23 cer or employee of the United States shall be relieved of 

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1 essary for the member to carry out the duties of the 

2 Board. 

3 ‘‘(d) AVAILABILITY OF INFORMATION.—In carrying 

4 out the duties of a Board under subsection (b), specific 

5 information identifying a patient and other confidential in6 formation relating to a patient may not be made available 

7 to any member appointed under subsection (c)(1) solely 

8 based on qualifications under subparagraph (M) or (N) 

9 of such subsection. 

10 ‘‘(e) EMPLOYMENT PROTECTIONS.—No adverse per11 sonnel action may be made against an employee of the 

12 Department in connection with a communication by the 

13 employee with a member of a Board relating to the duties 

14 of the Board under subsection (b) and any such commu15 nication shall be covered by the employment and whistle16 blower protections otherwise applicable to communications 

17 by employees of the Department. 

18 ‘‘(f) RESOURCES OF DEPARTMENT.—The Secretary 

19 shall make available to each Board the resources and per20 sonnel of the Department necessary for the Board to carry 

21 out the duties of the Board under subsection (b), including 

22 resources and personnel of the General Counsel of the De23 partment. 

24 ‘‘(g) POWERS.—(1) Each Board may, for the purpose 

25 of carrying out this section, hold hearings, sit and act at 


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1 times and places, take testimony, and receive evidence as 

2 the Board determines appropriate. 

3 ‘‘(2) Each Board may conduct site visits of medical 

4 facilities of the Department to collect information that the 

5 Board considers necessary to carry out this section. 

6 ‘‘(3) The Secretary shall provide to each Board such 

7 administrative support services as the Secretary considers 

8 necessary for the Board to carry out this section.’’. 

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

10 at the beginning of chapter 73 of such title is amended 

11 by inserting after the item relating to section 7309 the 

12 following new item: 

‘‘7309A. Pain management boards.’’. 

13 SEC. 105. STUDY ON FEASIBILITY AND ADVISABILITY OF 

14 CARRYING OUT PHARMACY LOCK-IN PRO15 GRAM BY DEPARTMENT OF VETERANS AF16 FAIRS. 

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

18 shall conduct a study on the feasibility and advisability 

19 of carrying out a pharmacy lock-in program under which 

20 veterans at risk for abuse of prescription drugs are per21 mitted to receive prescription drugs only from certain 

22 specified pharmacies of the Department of Veterans Af23 fairs. 

24 (b) REPORT.—Not later than one year after the date 

25 of the enactment of this Act, the Secretary shall submit 


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

2 the Committee on Veterans’ Affairs of the House of Rep3 resentatives a report on the study conducted under sub4 section (a). 

5 SEC. 106. REPORTS AND INVESTIGATION ON USE OF 

6 OPIOIDS IN TREATMENT BY DEPARTMENT OF 

7 VETERANS AFFAIRS. 

8 (a) COMPTROLLER GENERAL REPORT.— 

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

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

11 Comptroller General of the United States shall sub12 mit to the Committee on Veterans’ Affairs of the 

13 Senate and the Committee on Veterans’ Affairs of 

14 the House of Representatives a report on the Opioid 

15 Safety Initiative of the Department of Veterans Af16 fairs and the opioid prescribing practices of health 

17 care providers of the Department. 

18 (2) ELEMENTS.—The report submitted under 

19 paragraph (1) shall include the following: 

20 (A) Recommendations on such improve21 ments to the Opioid Safety Initiative of the De22 partment as the Comptroller General considers 

23 appropriate. 

24 (B) Information with respect to— 


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1 (i) deaths resulting from sentinel 

2 events involving veterans prescribed opioids 

3 by a health care provider of the Depart4 ment; 

5 (ii) overall prescription rates and pre6 scriptions indications of opioids at all med7 ical facilities of the Department to treat 

8 non-cancer, non-palliative, and non-hospice 

9 care patients, including whether each med10 ical facility or health care provider of the 

11 Department is among the top ten percent 

12 of medical facilities or health care pro13 viders of the Department with respect to 

14 such prescription rates; 

15 (iii) the prescription rates and pre16 scriptions indications of benzodiazepines 

17 and opioids concomitantly by health care 

18 providers of the Department, including 

19 whether each medical facility or health 

20 care provider of the Department is among 

21 the top ten percent of medical facilities or 

22 health care providers of the Department 

23 with respect to such prescription rates; 

24 (iv) the practice by health care pro25 viders of the Department of prescribing 


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1 opioids to treat patients without any pain, 

2 including to treat patients with mental 

3 health disorders other than opioid use dis4 order; and 

5 (v) the effectiveness of opioid therapy 

6 for patients receiving such therapy, includ7 ing the effectiveness of long-term opioid 

8 therapy. 

9 (C) Recommendations with respect to 

10 whether sanctions are needed, such as written 

11 warnings or performance improvement plans, 

12 for health care providers of the Department 

13 that are— 

14 (i) not practicing at a level meeting or 

15 exceeding the minimum level standard of 

16 care established by the Department; and 

17 (ii) not following the enhanced guid18 ance with respect to absolute contraindica19 tions for opioid therapy set forth in the 

20 VA/DOD Clinical Practice Guideline for 

21 Management of Opioid Therapy for Chron22 ic Pain, as updated under section 101. 

23 (b) QUARTERLY PROGRESS REPORT ON IMPLEMEN24 TATION OF COMPTROLLER GENERAL RECOMMENDA25 TIONS.—Not later than 180 days after the date of the enVerDate Sep 11 2014 22:37 Jun 26, 2015 Jkt 049200 PO 00000 Frm 00032 Fmt 6652 Sfmt 6201 E:\BILLS\S1641.IS S1641

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1 actment of this Act, and not later than 30 days after the 

2 end of each quarter thereafter, the Secretary of Veterans 

3 Affairs shall submit to the Committee on Veterans Affairs’ 

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

5 the House of Representatives a progress report detailing 

6 the actions by the Department of Veterans Affairs during 

7 the period covered by the report to address any out8 standing findings and recommendations by the Comp9 troller General of the United States with respect to the 

10 Veterans Health Administration. 

11 (c) ANNUAL REPORT AND INVESTIGATION ON OPIOID

12 THERAPY.— 

13 (1) REPORT.—Not later than one year after the 

14 date of the enactment of this Act, and not less fre15 quently than annually thereafter, the Secretary of 

16 Veterans Affairs shall submit to the Committee on 

17 Veterans’ Affairs of the Senate and the Committee 

18 on Veterans’ Affairs of the House of Representatives 

19 a report that contains, for the one year period pre20 ceding the submittal of the report, the following: 

21 (A) The number of patients and the per22 centage of the patient population of the Depart23 ment of Veterans Affairs who were prescribed 

24 benzodiazepines and opioids concurrently by a 

25 health care provider of the Department. 


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1 (B) The number of patients and the per2 centage of the patient population of the Depart3 ment without any pain who were prescribed 

4 opioids by a health care provider of the Depart5 ment, including those who were prescribed 

6 benzodiazepines and opioids concurrently. 

7 (C) The number of non-cancer, non-pallia8 tive, and non-hospice care patients and the per9 centage of such patients who were treated with 

10 opioids by a health care provider of the Depart11 ment on an inpatient-basis and who also re12 ceived prescription opioids by mail from the De13 partment while being treated on an inpatient14 basis. 

15 (D) The number of non-cancer, non-pallia16 tive, and non-hospice care patients and the per17 centage of such patients who were prescribed 

18 opioids concurrently by a health care provider 

19 of the Department and a health care provider 

20 that is not a health care provider of the Depart21 ment. 

22 (E) With respect to each medical facility of 

23 the Department, information on opioids pre24 scribed by health care providers at the facility 


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1 to treat non-cancer, non-palliative, and non-hos2 pice care patients, including information on— 

3 (i) the prescription rate at which each 

4 health care provider at the facility pre5 scribed benzodiazepines and opioids con6 currently to such patients and the aggre7 gate such prescription rate for all health 

8 care providers at the facility; 

9 (ii) the prescription rate at which 

10 each health care provider at the facility 

11 prescribed benzodiazepines or opioids to 

12 such patients to treat conditions for which 

13 opioids or benzodiazepines are not an ap14 proved treatment and the aggregate such 

15 prescription rate for all health care pro16 viders at the facility; 

17 (iii) the prescription rate at which 

18 each health care provider at the facility 

19 prescribed or dispensed mail-order pre20 scriptions of opioids to such patients while 

21 such patients were being treated with 

22 opioids on an inpatient-basis and the ag23 gregate such prescription rate for all 

24 health care providers at the facility; and 


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1 (iv) the prescription rate at which 

2 each health care provider at the facility 

3 prescribed opioids to such patients who 

4 were also concurrently prescribed opioids 

5 by a health care provider that is not a 

6 health care provider of the Department 

7 and the aggregate such prescription rate 

8 for all health care providers at the facility. 

9 (F) With respect to each medical facility of 

10 the Department, the number of times a phar11 macist at the facility overrode a critical drug 

12 interaction warning with respect to an inter13 action between opioids and another medication 

14 before dispensing a medication to a veteran. 

15 (2) INVESTIGATION.—If a report submitted 

16 under paragraph (1) indicates that a prescription 

17 rate described in subparagraph (E) of such para18 graph at a medical facility of the Department is 

19 among the top ten percent of medical facilities of the 

20 Department with respect to such prescription rate, 

21 the Secretary shall— 

22 (A) through the Office of the Medical In23 spector of the Veterans Health Administration, 

24 conduct a full investigation of the medical facil25 ity; and 


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1 (B) immediately notify the Committee on 

2 Veterans Affairs’ of the Senate, the Committee 

3 on Veterans Affairs’ of the House of Represent4 atives, and each Member of the Senate and the 

5 House of Representatives who represents the 

6 area in which the medical facility is located. 

7 (d) 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 patient pop14 ulation of that health care provider or medical facil15 ity. 

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. ESTABLISHMENT OF OFFICE OF PATIENT ADVO3 CACY OF THE DEPARTMENT OF VETERANS 

4 AFFAIRS. 

5 (a) IN GENERAL.—Subchapter I of chapter 73 of title 

6 38, United States Code, is amended by adding at the end 

7 the following new section: 

8 ‘‘§ 7309A. Office of Patient Advocacy 

9 ‘‘(a) ESTABLISHMENT.—There is established in the 

10 Department within the Office of the Under Secretary for 

11 Health an office to be known as the ‘Office of Patient Ad12 vocacy’ (in this section referred to as the ‘Office’). 

13 ‘‘(b) HEAD.—(1) The Director of the Office of Pa14 tient Advocacy shall be the head of the Office. 

15 ‘‘(2) The Director of the Office of Patient Advocacy 

16 shall be appointed by the Under Secretary for Health from 

17 among individuals qualified to perform the duties of the 

18 position and shall report directly to the Under Secretary 

19 for Health. 

20 ‘‘(c) FUNCTION.—(1) The function of the Office is 

21 to carry out the Patient Advocacy Program of the Depart22 ment. 

23 ‘‘(2) In carrying out the Patient Advocacy Program 

24 of the Department, the Director shall ensure that patient 

25 advocates of the Department— 


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1 ‘‘(A) advocate on behalf of veterans with re2 spect to health care received and sought by veterans 

3 under the laws administered by the Secretary; 

4 ‘‘(B) carry out the responsibilities specified in 

5 subsection (d); and 

6 ‘‘(C) receive training in patient advocacy. 

7 ‘‘(d) PATIENT ADVOCACY RESPONSIBILITIES.—The 

8 responsibilities of each patient advocate at a medical facil9 ity of the Department are the following: 

10 ‘‘(1) To resolve complaints by veterans with re11 spect to health care furnished under the laws admin12 istered by the Secretary that cannot be resolved at 

13 the point of service or at a higher level easily acces14 sible to the veteran. 

15 ‘‘(2) To present at various meetings and to var16 ious committees the issues experienced by veterans 

17 in receiving such health care at such medical facility. 

18 ‘‘(3) To express to veterans their rights and re19 sponsibilities as patients in receiving such health 

20 care. 

21 ‘‘(4) To manage the Patient Advocate Tracking 

22 System of the Department at such medical facility. 

23 ‘‘(5) To compile data at such medical facility of 

24 complaints made by veterans with respect to the re25 ceipt of such health care at such medical facility and 


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1 the satisfaction of veterans with such health care at 

2 such medical facility to determine whether there are 

3 trends in such data. 

4 ‘‘(6) To ensure that a process is in place for the 

5 distribution of the data compiled under paragraph 

6 (5) to appropriate leaders, committees, services, and 

7 staff of the Department. 

8 ‘‘(7) To identify, not less frequently than quar9 terly, opportunities for improvements in the fur10 nishing of such health care to veterans at such med11 ical facility based on complaints by veterans. 

12 ‘‘(8) To ensure that any significant complaint 

13 by a veteran with respect to such health care is 

14 brought to the attention of appropriate staff of the 

15 Department to trigger an assessment of whether 

16 there needs to be a further analysis of the problem 

17 at the facility-wide level. 

18 ‘‘(9) To support any patient advocacy programs 

19 carried out by the Department. 

20 ‘‘(10) To ensure that all appeals and final deci21 sions with respect to the receipt of such health care 

22 are entered into the Patient Advocate Tracking Sys23 tem of the Department. 

24 ‘‘(11) To understand all laws, directives, and 

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1 sibilities of veterans in receiving such health care, 

2 including the appeals processes available to veterans. 

3 ‘‘(12) To ensure that veterans receiving mental 

4 health care, or the surrogate decisionmakers for 

5 such veterans, are aware of the rights of veterans to 

6 seek representation from systems established under 

7 section 103 of the Protection and Advocacy for Men8 tally Ill Individuals Act of 1986 (42 U.S.C. 10803) 

9 to protect and advocate the rights of individuals with 

10 mental illness and to investigate incidents of abuse 

11 and neglect of such individuals. 

12 ‘‘(13) To fulfill requirements established by the 

13 Secretary with respect to the inspection of controlled 

14 substances. 

15 ‘‘(14) To document potentially threatening be16 havior and report such behavior to appropriate au17 thorities. 

18 ‘‘(e) TRAINING.—In providing training to patient ad19 vocates under subsection (c)(2)(C), the Director shall en20 sure that such training is consistent throughout the De21 partment. 

22 ‘‘(f) ANNUAL REPORT.—Not later than two years 

23 after the date of the enactment of the Jason Simcakoski 

24 Memorial Opioid Safety Act, and not less frequently than 

25 annually thereafter, the Secretary shall submit to the 


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1 Committee on Veterans’ Affairs of the Senate and the 

2 Committee on Veterans’ Affairs of the House of Rep3 resentatives a report on the activities conducted by the Of4 fice during the period covered by the report. 

5 ‘‘(g) CONTROLLED SUBSTANCE DEFINED.—In this 

6 section, the term ‘controlled substance’ has the meaning 

7 given that term in section 102 of the Controlled Sub8 stances Act (21 U.S.C. 802).’’. 

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

10 at the beginning of chapter 73 of such title is amended 

11 by adding after the item relating to section 7309 the fol12 lowing new item: 

‘‘7309A. Office of Patient Advocacy.’’. 

13 (c) DATE FULLY OPERATIONAL.—The Secretary of 

14 Veterans Affairs shall ensure that the Office of Patient 

15 Advocacy established in section 7309A of title 38, United 

16 States Code, as added by subsection (a), is fully oper17 ational not later than the date that is one year after the 

18 date of the enactment of this Act. 

19 SEC. 202. COMMUNITY MEETINGS ON IMPROVING CARE 

20 FROM DEPARTMENT OF VETERANS AFFAIRS. 

21 (a) COMMUNITY MEETINGS.— 

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

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

24 not less frequently than once every 90 days there25 after, each medical center of the Department of VetVerDate Sep 11 2014 22:37 Jun 26, 2015 Jkt 049200 PO 00000 Frm 00042 Fmt 6652 Sfmt 6201 E:\BILLS\S1641.IS S1641

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1 erans Affairs shall host a community meeting open 

2 to the public on improving health care from the De3 partment. 

4 (2) COMMUNITY BASED OUTPATIENT CLIN5 ICS.—Not later than one year after the date of the 

6 enactment of this Act, and not less frequently than 

7 annually thereafter, each community based out8 patient clinic of the Department shall host a commu9 nity meeting open to the public on improving health 

10 care from the Department. 

11 (b) ATTENDANCE BY DIRECTOR OF VETERANS INTE12 GRATED SERVICE NETWORK OR DESIGNEE.— 

13 (1) IN GENERAL.—Subject to paragraph (2), 

14 each community meeting hosted by a medical center 

15 or community based outpatient clinic under sub16 section (a) shall be attended by the Director of the 

17 Veterans Integrated Service Network in which the 

18 medical center or community based outpatient clinic, 

19 as the case may be, is located, or an employee des20 ignated by the Director who works in the office of 

21 the Director. 

22 (2) ATTENDANCE BY DIRECTOR.—Each Direc23 tor of a Veterans Integrated Service Network shall 

24 attend not less than one community meeting under 

25 subsection (a) hosted by each medical center located 


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1 in the Veterans Integrated Service Network each 

2 year. 

3 (c) NOTICE.—Each medical center or community 

4 based outpatient clinic hosting a community meeting shall 

5 send timely notice of the community meeting to the Com6 mittee on Veterans Affairs’ of the Senate, the Committee 

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

8 each Member of the Senate and the House of Representa9 tives who represents the area in which the medical facility 

10 is located. 

11 SEC. 203. IMPROVEMENT OF AWARENESS OF PATIENT AD12 VOCACY PROGRAM AND PATIENT BILL OF 

13 RIGHTS OF DEPARTMENT OF VETERANS AF14 FAIRS. 

15 Not later than 90 days after the date of the enact16 ment of this Act, the Secretary of Veterans Affairs shall, 

17 in as many prominent locations as appropriate to be seen 

18 by the largest percentage of patients and family members 

19 of patients at each medical facility of the Department of 

20 Veterans Affairs— 

21 (1) display the purposes of the Patient Advo22 cacy Program of the Department and the contact in23 formation for the patient advocate at such medical 

24 facility; and 

25 (2) display the rights and responsibilities of— 


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1 (A) patients and family members of pa2 tients at such medical facility; and 

3 (B) with respect to community living cen4 ters and other residential facilities of the De5 partment, residents and family members of resi6 dents at such medical facility. 

7 SEC. 204. COMPTROLLER GENERAL REPORT ON PATIENT 

8 ADVOCACY PROGRAM OF DEPARTMENT OF 

9 VETERANS AFFAIRS. 

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

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

12 General of the United States shall submit to the Com13 mittee on Veterans’ Affairs of the Senate and the Com14 mittee on Veterans’ Affairs of the House of Representa15 tives a report on the Patient Advocacy Program of the 

16 Department of Veterans Affairs (in this section referred 

17 to as the ‘‘Program’’) as carried out under the Office of 

18 Patient Advocacy of the Department established in section 

19 7309A of title 38, United States Code, as added by section 

20 201(a). 

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

22 (a)— 

23 (1) shall include— 


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1 (A) such recommendations and proposals 

2 for improving or modifying the Program as the 

3 Comptroller General considers appropriate; and 

4 (B) such other information with respect to 

5 the Program as the Comptroller General con6 siders appropriate; and 

7 (2) may include— 

8 (A) a description of the Program, includ9 ing— 

10 (i) the purposes of the Program; 

11 (ii) the activities carried out under the 

12 Program; and 

13 (iii) the sufficiency of the Program in 

14 achieving the purposes of the Program; 

15 (B) an assessment of the sufficiency of 

16 staffing of employees of the Department re17 sponsible for carrying out the Program; 

18 (C) an assessment of the sufficiency of the 

19 training of such employees; and 

20 (D) an assessment of— 

21 (i) awareness of the Program among 

22 veterans and their family members; and 

23 (ii) the use of the Program by vet24 erans and their family members. 


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1 SEC. 205. REPORT ON TRANSITION BY VETERANS BETWEEN 

2 DIFFERENT HEALTH CARE SETTINGS. 

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

4 date of the enactment of this Act, the Secretary of Vet5 erans Affairs shall submit to the Committee on Veterans’ 

6 Affairs of the Senate and the Committee on Veterans’ Af7 fairs of the House of Representatives a report on the tran8 sitions undergone by veterans in receiving health care in 

9 different health care settings. 

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

11 (a) shall include the following: 

12 (1) An evaluation of the standards of the De13 partment for facilitating and managing the transi14 tions undergone by veterans in receiving health care 

15 in different health care settings. 

16 (2) An assessment of the case management 

17 services of the Department that are available for vet18 erans who are undergoing a transition in health care 

19 settings. 

20 (3) An assessment of the coordination in cov21 erage of and consistent access to medications pre22 scribed for patients transitioning from receiving 

23 health care from the Department of Defense to re24 ceiving health care from the Department of Veterans 

25 Affairs. 


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1 (4) Such recommendations to improve transi2 tions in health care settings among veterans as the 

3 Secretary considers appropriate, including the co4 ordination of drug formularies between the Depart5 ment of Defense and the Department of Veterans 

6 Affairs and the development of care transition plans 

7 for patients with complex medical issues. 

8 TITLE III—COMPLEMENTARY 

9 AND INTEGRATIVE HEALTH 

10 SEC. 301. EXPANSION OF RESEARCH AND EDUCATION ON 

11 AND DELIVERY OF COMPLEMENTARY AND IN12 TEGRATIVE HEALTH TO VETERANS. 

13 (a) DEVELOPMENT OF PLAN TO EXPAND RE14 SEARCH, EDUCATION, AND DELIVERY.—Not later than 

15 180 days after the date of the enactment of this Act, the 

16 Secretary of Veterans Affairs shall develop a plan to ex17 pand materially and substantially the scope of the effec18 tiveness of research and education on, and delivery and 

19 integration of, complementary and integrative health serv20 ices into the health care services provided to veterans. 

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

22 shall provide for the following: 

23 (1) Research on the following: 

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1 cluding the effectiveness of such services inte2 grated with clinical therapies. 

3 (B) Approaches to integrating complemen4 tary and integrative health services into other 

5 health care services provided by the Depart6 ment. 

7 (2) Education and training for health care pro8 fessionals of the Department on the following: 

9 (A) Complementary and integrative health 

10 services selected by the Secretary for purposes 

11 of the plan. 

12 (B) Appropriate uses of such services. 

13 (C) Integration of such services into the 

14 delivery of health care to veterans. 

15 (3) Research, education, and clinical activities 

16 on complementary and integrative health at centers 

17 of innovation at medical centers of the Department. 

18 (4) Identification or development of metrics and 

19 outcome measures to evaluate the effectiveness of 

20 the provision and integration of complementary and 

21 integrative health services into the delivery of health 

22 care to veterans. 

23 (5) Integration and delivery of complementary 

24 and integrative health services with other health care 

25 services provided by the Department. 


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1 (c) CONSULTATION.— 

2 (1) IN GENERAL.—In carrying out subsection 

3 (a), the Secretary shall consult with the following: 

4 (A) The Director of the National Center 

5 for Complementary and Integrative Health of 

6 the National Institutes of Health. 

7 (B) The Commissioner of Food and Drugs. 

8 (C) Institutions of higher education, pri9 vate research institutes, and individual re10 searchers with extensive experience in com11 plementary and integrative health and the inte12 gration of complementary and integrative health 

13 practices into the delivery of health care. 

14 (D) Nationally recognized providers of 

15 complementary and integrative health. 

16 (E) Such other officials, entities, and indi17 viduals with expertise on complementary and 

18 integrative health as the Secretary considers ap19 propriate. 

20 (2) SCOPE OF CONSULTATION.—The Secretary 

21 shall undertake consultation under paragraph (1) in 

22 carrying out subsection (a) with respect to the fol23 lowing: 

24 (A) To develop the plan. 


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1 (B) To identify specific complementary and 

2 integrative health practices that, on the basis of 

3 research findings or promising clinical interven4 tions, are appropriate to include as services to 

5 veterans. 

6 (C) To identify barriers to the effective 

7 provision and integration of complementary and 

8 integrative health services into the delivery of 

9 health care to veterans, and to identify mecha10 nisms for overcoming such barriers. 

11 (d) FUNDING.—There is authorized to be appro12 priated to the Secretary such sums as may be necessary 

13 to carry out this section. 

14 (e) COMPLEMENTARY AND INTEGRATIVE HEALTH

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

16 integrative health’’ has the meaning given that term by 

17 the National Institutes of Health. 

18 SEC. 302. PROGRAM ON INTEGRATION OF COMPLEMEN19 TARY AND INTEGRATIVE HEALTH WITHIN DE20 PARTMENT OF VETERANS AFFAIRS MEDICAL 

21 CENTERS. 

22 (a) PROGRAM REQUIRED.—Not later than the com23 pletion of the development of the plan under section 301, 

24 the Secretary of Veterans Affairs shall— 


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1 (1) carry out, through the Office of Patient 

2 Centered Care and Cultural Transformation of the 

3 Department of Veterans Affairs, a program to as4 sess the feasibility and advisability of integrating the 

5 delivery of complementary and integrative health 

6 services selected by the Secretary with other health 

7 care services provided by the Department for vet8 erans with mental health conditions, chronic pain 

9 conditions, other chronic conditions, and such other 

10 conditions as the Secretary determines appropriate; 

11 and 

12 (2) in developing the program— 

13 (A) use the plan developed under section 

14 301; and 

15 (B) identify and, to the extent practicable, 

16 resolve barriers to the provision of complemen17 tary and integrative health services selected by 

18 the Secretary and the integration of those serv19 ices with other health care services provided by 

20 the Department. 

21 (b) LOCATIONS.— 

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

23 out the program at not fewer than 15 medical cen24 ters of the Department. 


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1 (2) POLYTRAUMA CENTERS.—Not less than two 

2 of the medical centers designated under paragraph 

3 (1) shall be located at polytrauma rehabilitation cen4 ters of the Department. 

5 (3) MEDICAL CENTERS WITH HIGH PRESCRIP6 TION RATE OF OPIOIDS.— 

7 (A) IN GENERAL.—In selecting medical 

8 centers under paragraph (1), the Secretary 

9 shall give priority to medical centers of the De10 partment at which there is a prescription rate 

11 of opioids that is among the top ten percent of 

12 medical centers of the Department with respect 

13 to such prescription rate. 

14 (B) PRESCRIPTION RATE DEFINED.—In 

15 this paragraph, the term ‘‘prescription rate’’ 

16 means, with respect to a medical center of the 

17 Department, each of the following: 

18 (i) The number of patients treated 

19 with opioids at the medical center divided 

20 by the total patient population of that 

21 medical center. 

22 (ii) The average number of morphine 

23 equivalents per day prescribed at the med24 ical center to patients being treated with 

25 opioids. 


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1 (iii) Of the patients being treated with 

2 opioids at the medical center, the average 

3 number of prescriptions of opioids per pa4 tient. 

5 (4) SELECTION OF LOCATIONS.—In carrying 

6 out the program, the Secretary shall select locations 

7 that include the following areas: 

8 (A) Rural areas. 

9 (B) Areas that are not in close proximity 

10 to an active duty military installation. 

11 (C) Areas representing different geo12 graphic locations, such as census tracts estab13 lished by the Bureau of the Census. 

14 (c) PROVISION OF SERVICES.—Under the program, 

15 the Secretary shall provide covered services to covered vet16 erans by integrating complementary and integrative health 

17 services with other services provided by the Department 

18 at the medical centers designated under subsection (b)(1). 

19 (d) COVERED VETERANS.—For purposes of the pro20 gram, a covered veteran is any veteran who— 

21 (1) has a mental health condition diagnosed by 

22 a clinician of the Department; 

23 (2) experiences chronic pain; 

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

25 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 program or is 

3 referred by a clinician of the Department who is 

4 treating the veteran. 

5 (e) COVERED SERVICES.— 

6 (1) IN GENERAL.—For purposes of the pro7 gram, 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 program as 

12 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 pro8 gram; and 

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

11 Department for such conditions. 

12 (f) VOLUNTARY PARTICIPATION.—The participation 

13 of a veteran in the program shall be at the election of 

14 the veteran and in consultation with a clinician of the De15 partment. 

16 (g) REPORTS TO CONGRESS.— 

17 (1) QUARTERLY REPORTS.—Not later than 90 

18 days after the date of the commencement of the pro19 gram and not less frequently than once every 90 

20 days thereafter for the duration of the program, the 

21 Secretary shall submit to the Committee on Vet22 erans’ Affairs of the Senate and the Committee on 

23 Veterans’ Affairs of the House of Representatives a 

24 report on the efforts of the Secretary to carry out 

25 the program, including a description of the outreach 


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1 conducted by the Secretary to veterans and commu2 nity organizations to inform such organizations 

3 about the program. 

4 (2) FINAL REPORT.— 

5 (A) IN GENERAL.—Not later than three 

6 years after the date of the commencement of 

7 the program, the Secretary shall submit to the 

8 Committee on Veterans’ Affairs of the Senate 

9 and the Committee on Veterans’ Affairs of the 

10 House of Representatives a report on the pro11 gram. 

12 (B) CONTENTS.—The report submitted 

13 under subparagraph (A) shall include the fol14 lowing: 

15 (i) The findings and conclusions of 

16 the Secretary with respect to the program, 

17 including with respect to— 

18 (I) the use and efficacy of the 

19 complementary and integrative health 

20 services established under the pro21 gram; and 

22 (II) an assessment of the benefit 

23 of the program to covered veterans in 

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1 agement, and treatment of chronic ill2 ness. 

3 (ii) Barriers identified under sub4 section (a)(2)(B) that were not resolved. 

5 (iii) Such recommendations for the 

6 continuation or expansion of the program 

7 as the Secretary considers appropriate. 

8 (h) COMPLEMENTARY AND INTEGRATIVE HEALTH

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

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

11 in section 301(e). 

12 SEC. 303. PROGRAM ON USE OF WELLNESS PROGRAMS AS 

13 COMPLEMENTARY APPROACH TO PAIN MAN14 AGEMENT AND RELATED ISSUES FOR VET15 ERANS AND FAMILY MEMBERS OF VETERANS. 

16 (a) PROGRAM REQUIRED.— 

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

18 Affairs shall carry out a program through the award 

19 of grants to public or private nonprofit entities to 

20 assess the feasibility and advisability of using 

21 wellness programs to complement the provision of 

22 pain management and related health care services, 

23 such as mental health care services, to veterans and 

24 family members of veterans. 


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1 (2) MATTERS TO BE ADDRESSED.—The pro2 gram shall be carried out so as to assess the fol3 lowing: 

4 (A) Means of improving coordination be5 tween Federal, State, local, and community pro6 viders of health care in the provision of pain 

7 management and related health care services to 

8 veterans and family members of veterans. 

9 (B) Means of enhancing outreach, and co10 ordination of outreach, by and among providers 

11 of health care referred to in subparagraph (A) 

12 on the pain management and related health 

13 care services available to veterans and family 

14 members of veterans. 

15 (C) Means of using wellness programs of 

16 providers of health care referred to in subpara17 graph (A) as complements to the provision by 

18 the Department of Veterans Affairs of pain 

19 management and related health care services to 

20 veterans and family members of veterans. 

21 (D) Whether wellness programs described 

22 in subparagraph (C) are effective in enhancing 

23 the quality of life and well-being of veterans 

24 and family members of veterans. 


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1 (E) Whether wellness programs described 

2 in subparagraph (C) are effective in increasing 

3 the adherence of veterans to the primary pain 

4 management and related health care services 

5 provided such veterans by the Department. 

6 (F) Whether wellness programs described 

7 in subparagraph (C) have an impact on the 

8 sense of well-being of veterans who receive pri9 mary pain management and related health care 

10 services from the Department. 

11 (G) Whether wellness programs described 

12 in subparagraph (C) are effective in encour13 aging veterans receiving health care from the 

14 Department to adopt a more healthy lifestyle. 

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

16 program for a period of three years beginning on the date 

17 that is one year after the date of the enactment of this 

18 Act. 

19 (c) LOCATIONS.—The Secretary shall carry out the 

20 program at facilities of the Department providing pain 

21 management and related health care services, such as 

22 mental health care services, to veterans and family mem23 bers of veterans. 

24 (d) GRANT PROPOSALS.— 


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1 (1) IN GENERAL.—A public or private nonprofit 

2 entity seeking the award of a grant under this sec3 tion shall submit an application therefor to the Sec4 retary in such form and in such manner as the Sec5 retary may require. 

6 (2) APPLICATION CONTENTS.—Each application 

7 submitted under paragraph (1) shall include the fol8 lowing: 

9 (A) A plan to coordinate activities under 

10 the program, to the extent possible, with the 

11 Federal, State, and local providers of services 

12 for veterans to enhance the following: 

13 (i) Awareness by veterans of benefits 

14 and health care services provided by the 

15 Department. 

16 (ii) Outreach efforts to increase the 

17 use by veterans of services provided by the 

18 Department. 

19 (iii) Educational efforts to inform vet20 erans of the benefits of a healthy and ac21 tive lifestyle. 

22 (B) A statement of understanding from 

23 the entity submitting the application that, if se24 lected, such entity will be required to report to 

25 the Secretary periodically on standardized data 


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1 and other performance data necessary to evalu2 ate individual outcomes and to facilitate evalua3 tions among entities participating in the pro4 gram. 

5 (C) Such other requirements as the Sec6 retary may prescribe. 

7 (e) GRANT USES.— 

8 (1) IN GENERAL.—A public or private nonprofit 

9 entity awarded a grant under this section shall use 

10 the award for purposes prescribed by the Secretary. 

11 (2) ELIGIBLE INDIVIDUALS.—In carrying out 

12 the purposes prescribed by the Secretary in para13 graph (1), a public or private nonprofit entity 

14 awarded a grant under this section shall use the 

15 award to furnish services only to veterans and family 

16 members of veterans. 

17 (f) REPORTS.— 

18 (1) PERIODIC REPORTS.— 

19 (A) IN GENERAL.—Not later than 180 

20 days after the date of the commencement of the 

21 program, and not less frequently than every 

22 180 days thereafter, the Secretary shall submit 

23 to Congress a report on the program. 


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1 (B) REPORT ELEMENTS.—Each report re2 quired by subparagraph (A) shall include the 

3 following: 

4 (i) The findings and conclusions of 

5 the Secretary with respect to the program 

6 during the 180-day period preceding the 

7 report. 

8 (ii) An assessment of the benefits of 

9 the program to veterans and their family 

10 members during the 180-day period pre11 ceding the report. 

12 (2) FINAL REPORT.—Not later than 180 days 

13 after the end of the program, the Secretary shall 

14 submit to Congress a report detailing the rec15 ommendations of the Secretary as to the feasibility 

16 and advisability of continuing or expanding the pro17 gram. 

18 (g) WELLNESS DEFINED.—In this section, the term 

19 ‘‘wellness’’ has the meaning given that term in regulations 

20 prescribed by the Secretary for purposes of this section. 


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1 TITLE IV—OTHER VETERANS 

2 HEALTH CARE MATTERS 

3 SEC. 401. ADDITIONAL REQUIREMENTS FOR HIRING OF 

4 HEALTH CARE PROVIDERS BY DEPARTMENT 

5 OF VETERANS AFFAIRS. 

6 The Secretary of Veterans Affairs shall, as part of 

7 the hiring process for each health care provider considered 

8 for a position at the Department of Veterans Affairs after 

9 the date of the enactment of this Act, request 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 a disciplinary charge relating to the practice of med20 icine 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, the Secretary of Veterans Affairs shall, with 


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1 respect to any health care provider of the Department of 

2 Veterans Affairs that has violated a requirement of their 

3 medical license, provide to the medical board of each State 

4 in which the health care provider is licensed detailed infor5 mation with respect to such violation. 

6 SEC. 403. REPORT ON COMPLIANCE BY DEPARTMENT OF 

7 VETERANS AFFAIRS WITH REVIEWS OF 

8 HEALTH CARE PROVIDERS LEAVING THE DE9 PARTMENT OR TRANSFERRING TO OTHER 

10 FACILITIES. 

11 Not later than two years after the date of the enact12 ment of this Act, the Secretary of Veterans Affairs shall 

13 submit to the Committee on Veterans’ Affairs of the Sen14 ate and the Committee on Veterans’ Affairs of the House 

15 of Representatives a report on the compliance by the De16 partment of Veterans Affairs with the policy of the De17 partment— 

18 (1) to conduct a review of each health care pro19 vider of the Department who transfers to another 

20 medical facility of the Department or leaves the De21 partment to determine whether there are any con22 cerns, complaints, or allegations of violations relat23 ing to the medical practice of the health care pro24 vider; and 


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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. DEPARTMENT OF VETERANS AFFAIRS PROGRAM 

6 OF INTERNAL AUDITS. 

7 (a) IN GENERAL.—Subchapter II of chapter 5 of title 

8 38, United States Code, is amended by inserting after sec9 tion 527 the following new section: 

10 ‘‘§ 527A. Program of internal audits 

11 ‘‘(a) PROGRAM REQUIRED.—(1) The Secretary shall 

12 carry out a program of internal audits and self-analysis 

13 to improve the furnishing of benefits and health care to 

14 veterans and their families. 

15 ‘‘(2) The Secretary shall carry out the program re16 quired by paragraph (1) through an office the Secretary 

17 shall establish for purposes of the program within the of18 fice of the Secretary that is interdisciplinary and inde19 pendent of— 

20 ‘‘(A) the other offices within the office of the 

21 Secretary; and 

22 ‘‘(B) the covered administrations (or functions 

23 of such administrations), staff organizations, and 

24 staff offices identified under subsection (b)(1)(A). 


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1 ‘‘(b) PROGRAM REQUIREMENTS.—(1) In carrying out 

2 the program required by subsection (a), the Secretary 

3 shall— 

4 ‘‘(A) conduct periodic risk assessments of the 

5 Department to identify those covered administra6 tions (or functions of such administrations), staff or7 ganizations, and staff offices of the Department the 

8 audit of which would lead towards the greatest im9 provement in the furnishing of benefits and health 

10 care to veterans and their families; 

11 ‘‘(B) develop plans that are informed by the 

12 risk assessments conducted under paragraph (1) to 

13 conduct internal audits of the covered administra14 tions (or functions of such administrations), staff or15 ganizations, and staff offices identified under sub16 paragraph (A); and 

17 ‘‘(C) conduct internal audits in accordance with 

18 the plans developed pursuant to subparagraph (B). 

19 ‘‘(2) The Secretary shall carry out under the program 

20 required by subsection (a) an audit of not fewer than five 

21 covered administrations (or functions of such administra22 tions), staff organizations, or staff offices of the Depart23 ment each year. 

24 ‘‘(3) In identifying covered administrations (or func25 tions of such administrations), staff organizations, and 


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1 staff offices of the Department under paragraph (1)(A), 

2 the Secretary shall accord priority to the covered adminis3 trations and functions of such administrations. 

4 ‘‘(4)(A) For purposes of this subsection, the covered 

5 administrations of the Department are the following: 

6 ‘‘(i) The National Cemetery Administration. 

7 ‘‘(ii) The Veterans Benefits Administration. 

8 ‘‘(iii) The Veterans Health Administration. 

9 ‘‘(B) For purposes this subsection, the covered staff 

10 organizations of the Department are the following: 

11 ‘‘(i) The Office of Acquisition, Logistics, and 

12 Construction. 

13 ‘‘(ii) The Advisory Committee Management Of14 fice. 

15 ‘‘(iii) The Board of Veterans’ Appeals. 

16 ‘‘(iv) The Center for Faith-Based and Neigh17 borhood Partnerships. 

18 ‘‘(v) The Center for Minority Veterans. 

19 ‘‘(vi) The Center for Women Veterans. 

20 ‘‘(vii) The Office of General Counsel. 

21 ‘‘(viii) The Office of Regulation Policy and 

22 Management. 

23 ‘‘(ix) The Office of Employment Discrimination 

24 Complaint Adjudication. 


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1 ‘‘(x) The Office of Interagency Care and Bene2 fits Coordination. 

3 ‘‘(xi) The Office of Small and Disadvantaged 

4 Business Utilization. 

5 ‘‘(xii) The Office of Survivors Assistance. 

6 ‘‘(xiii) The Veterans’ Service Organizations Li7 aison. 

8 ‘‘(C) For purposes of this subsection, the covered 

9 staff offices of the Department are the following: 

10 ‘‘(i) The office of the Assistant Secretary for 

11 Congressional and Legislative Affairs. 

12 ‘‘(ii) The office of the Assistant Secretary for 

13 Human Resources and Administration. 

14 ‘‘(iii) The office of the Assistant Secretary for 

15 Information and Technology. 

16 ‘‘(iv) The Office of Management. 

17 ‘‘(v) The office of the Assistant Secretary for 

18 Operations, Security, and Preparedness. 

19 ‘‘(vi) The office of the Assistant Secretary for 

20 Policy and Planning. 

21 ‘‘(vii) The office of the Assistant Secretary for 

22 Public and Intergovernmental Affairs. 

23 ‘‘(c) REPORTS.—(1) Not later than 90 days after 

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1 section (a), the Secretary shall submit to the appropriate 

2 committees of Congress a report on the audit. 

3 ‘‘(2) Each report submitted under paragraph (1) with 

4 respect to an audit shall include the following: 

5 ‘‘(A) A summary of the audit. 

6 ‘‘(B) The findings of the Secretary with respect 

7 to the audit. 

8 ‘‘(C) Such recommendations as the Secretary 

9 may have for legislative or administrative action to 

10 improve the furnishing of benefits and health care to 

11 veterans and their families. 

12 ‘‘(3) In this subsection, the term ‘appropriate com13 mittees of Congress’ includes— 

14 ‘‘(A) the Committee on Veterans’ Affairs, the 

15 Committee on Appropriations, and the Committee on 

16 Homeland Security and Governmental Affairs of the 

17 Senate; and 

18 ‘‘(B) the Committee on Veterans’ Affairs, the 

19 Committee on Appropriations, and the Committee on 

20 Oversight and Government Reform of the House of 

21 Representatives.’’. 

22 (b) FIRST RISK ASSESSMENT.—The Secretary of 

23 Veterans Affairs shall complete the first risk assessment 

24 required by section 527A(b)(1)(A) of such title, as added 


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1 by subsection (a), by not later than 180 days after the 

2 date of the enactment of this Act. 

3 (c) CLERICAL AMENDMENT.—The table of sections 

4 at the beginning of chapter 5 of such title is amended by 

5 inserting after the item relating to section 527 the fol6 lowing new item: 

‘‘527A. Program of internal audits.’’. 

Æ 


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