I 

116TH CONGRESS 

1ST SESSION H. R. 1963 

To expand the research and education on and delivery of complementary 

and integrative medicine to veterans, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 28, 2019 

Ms. BROWNLEY of California introduced the following bill; which was referred 

to the Committee on Veterans’ Affairs 

A BILL 

To expand the research and education on and delivery of 

complementary and integrative medicine to veterans, 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. 

4 This Act may be cited as the ‘‘Expanding Care for 

5 Veterans Act’’. 

6 SEC. 2. EXPANSION OF RESEARCH AND EDUCATION ON 

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

9 (a) DEVELOPMENT OF PLAN TO EXPAND RE10 SEARCH, EDUCATION, AND DELIVERY.—Not later than 


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1 six months after the effective date specified in subsection 

2 (f), the Secretary of Veterans Affairs shall develop a plan 

3 to expand materially and substantially the scope of re4 search and education on, and delivery and integration of, 

5 complementary and integrative medicine services into the 

6 health care services provided to veterans. 

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

8 shall provide for the following: 

9 (1) Research on the following: 

10 (A) The comparative effectiveness of var11 ious complementary and integrative medicine 

12 therapies. 

13 (B) Approaches to integrating complemen14 tary and integrative medicine services into other 

15 health care services provided by the Depart16 ment. 

17 (2) Education and training for health care pro18 fessionals of the Department on the following: 

19 (A) Complementary and integrative medi20 cine services selected by the Secretary for pur21 poses of the plan. 

22 (B) Appropriate uses of such services. 

23 (C) Integration of such services into the 

24 delivery of health care to veterans. 


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1 (3) Research, education, and clinical activities 

2 on complementary and integrative medicine at cen3 ters of innovation at Department medical centers. 

4 (4) Identification or development of metrics and 

5 outcome measures to evaluate the provision and inte6 gration of complementary and integrative medicine 

7 services into the delivery of health care to veterans. 

8 (5) Integration and delivery of complementary 

9 and integrative medicine services with other health 

10 care services provided by the Department. 

11 (c) CONSULTATION.— 

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

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

14 (A) The Director of the National Center 

15 on Complementary and Integrative Health of 

16 the National Institutes of Health. 

17 (B) The Commissioner of Food and Drugs. 

18 (C) Institutions of higher education, pri19 vate research institutes, and individual re20 searchers with extensive experience in com21 plementary and integrative medicine and the in22 tegration of complementary and integrative 

23 medicine practices into the delivery of health 

24 care. 


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1 (D) Nationally recognized providers of 

2 complementary and integrative medicine. 

3 (E) Such other officials, entities, and indi4 viduals with expertise on complementary and 

5 integrative medicine as the Secretary considers 

6 appropriate. 

7 (2) SCOPE OF CONSULTATION.—The Secretary 

8 shall undertake consultation under paragraph (1) in 

9 carrying out subsection (a) with respect to the fol10 lowing: 

11 (A) To develop the plan. 

12 (B) To identify specific complementary and 

13 integrative medicine practices that, on the basis 

14 of research findings or promising clinical inter15 ventions, are appropriate to include as services 

16 to veterans. 

17 (C) To identify barriers to the effective 

18 provision and integration of complementary and 

19 integrative medicine services into the delivery of 

20 health care to veterans, and to identify mecha21 nisms for overcoming such barriers. 

22 (d) FUNDING.—There is authorized to be appro23 priated to the Secretary such sums as may be necessary 

24 to carry out this section. 


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1 (e) COMPLEMENTARY AND INTEGRATIVE MEDICINE

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

3 integrative medicine’’ shall have the meaning given that 

4 term in regulations the Secretary shall prescribe for pur5 poses of this section, which shall, to the degree practicable, 

6 be consistent with the meaning given such term by the 

7 Secretary of Health and Human Services. 

8 (f) EFFECTIVE DATE.—This section shall take effect 

9 on the date that is one year after the date of the enact10 ment of this Act. 

11 SEC. 3. PROGRAM ON INTEGRATION OF COMPLEMENTARY 

12 AND INTEGRATIVE MEDICINE WITHIN DE13 PARTMENT OF VETERANS AFFAIRS MEDICAL 

14 CENTERS. 

15 (a) PROGRAM REQUIRED.—The Secretary of Vet16 erans Affairs shall— 

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

18 Centered Care and Cultural Transformation of the 

19 Department of Veterans Affairs, a program to as20 sess the feasibility and advisability of integrating the 

21 delivery of complementary and integrative medicine 

22 services selected by the Secretary with other health 

23 care services provided by the Department for vet24 erans with mental health conditions, chronic pain 

25 conditions, other chronic conditions, and such other 


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1 conditions as the Secretary determines appropriate; 

2 and 

3 (2) in developing the program, identify and re4 solve barriers to the provision of complementary and 

5 integrative medicine services selected by the Sec6 retary and the integration of those services with 

7 other health care services provided by the Depart8 ment. 

9 (b) DURATION OF PROGRAM.—The program shall be 

10 carried out during the three-year period beginning on the 

11 effective date specified in subsection (j). 

12 (c) LOCATIONS.— 

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

14 out the program at not fewer than 15 separate De15 partment medical centers. 

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

17 of the medical centers designated under paragraph 

18 (1) shall be located at polytrauma rehabilitation cen19 ters of the Department. 

20 (3) SELECTION OF LOCATIONS.—In carrying 

21 out the program, the Secretary shall select locations 

22 that include the following areas: 

23 (A) Rural areas. 

24 (B) Areas that are not in close proximity 

25 to an active duty military installation. 


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1 (C) Areas representing different geo2 graphic locations, such as census tracts estab3 lished by the Bureau of the Census. 

4 (d) PROVISION OF SERVICES.—Under the program, 

5 the Secretary shall provide covered services to covered vet6 erans by integrating complementary and integrative medi7 cine services with other services provided by the Depart8 ment at the medical centers designated under subsection 

9 (c)(1). 

10 (e) COVERED VETERANS.—For purposes of the pro11 gram, a covered veteran is any veteran who— 

12 (1) has a mental health condition diagnosed by 

13 a clinician of the Department; 

14 (2) experiences chronic pain; or 

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

16 clinician of the Department. 

17 (f) COVERED SERVICES.— 

18 (1) IN GENERAL.—For purposes of the pro19 gram, covered services are services consisting of 

20 complementary and integrative medicine as selected 

21 by the Secretary. 

22 (2) ADMINISTRATION OF SERVICES.—Covered 

23 services shall be administered under the program as 

24 follows: 


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1 (A) Covered services shall be administered 

2 by clinicians employed by the Secretary for pur3 poses of this section who, to the extent prac4 ticable, shall provide services consisting of com5 plementary and integrative medicine, including 

6 those clinicians who solely provide such services. 

7 (B) Covered services shall be included as 

8 part of the Patient Aligned Care Teams initia9 tive of the Office of Patient Care Services, Pri10 mary Care Program Office, in coordination with 

11 the Office of Patient Centered Care and Cul12 tural Transformation. 

13 (C) Covered services shall be made avail14 able to both— 

15 (i) covered veterans with mental 

16 health conditions, pain conditions, or 

17 chronic conditions described in subsection 

18 (e) who have received conventional treat19 ments from the Department for such con20 ditions; and 

21 (ii) covered veterans with mental 

22 health conditions, pain conditions, or 

23 chronic conditions described in subsection 

24 (e) who have not received conventional 


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1 treatments from the Department for such 

2 conditions. 

3 (g) VOLUNTARY PARTICIPATION.—The participation 

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

5 the veteran and in consultation with a clinician of the De6 partment. 

7 (h) REPORTS TO CONGRESS.— 

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

9 days after the date of the commencement of the pro10 gram and not less frequently than once every 90 

11 days thereafter for the duration of the program, the 

12 Secretary shall submit to the Committee on Vet13 erans’ Affairs of the Senate and the Committee on 

14 Veterans’ Affairs of the House of Representatives a 

15 report on the efforts of the Secretary to carry out 

16 the program, including a description of the outreach 

17 conducted by the Secretary to veterans and commu18 nity organizations to inform such organizations 

19 about the program. 

20 (2) FINAL REPORT.— 

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

22 days after the completion of the program, the 

23 Secretary shall submit to the Committee on 

24 Veterans’ Affairs of the Senate and the ComVerDate Sep 11 2014 01:25 Apr 11, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H1963.IH H1963

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1 mittee on Veterans’ Affairs of the House of 

2 Representatives a report on the program. 

3 (B) CONTENTS.—The report submitted 

4 under subparagraph (A) shall include the fol5 lowing: 

6 (i) The findings and conclusions of 

7 the Secretary with respect to the program, 

8 including with respect to— 

9 (I) the utilization and efficacy of 

10 the complementary and integrative 

11 medicine services established under 

12 the program; 

13 (II) an assessment of the benefit 

14 of the program to covered veterans in 

15 mental health diagnoses, pain man16 agement, and treatment of chronic ill17 ness; and 

18 (III) the comparative effective19 ness of various complementary and in20 tegrative medicine therapies. 

21 (ii) Barriers identified under sub22 section (a)(2) that were not resolved. 

23 (iii) Such recommendations for the 

24 continuation or expansion of the program 

25 as the Secretary considers appropriate. 


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1 (i) COMPLEMENTARY AND INTEGRATIVE MEDICINE

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

3 integrative medicine’’ shall have the meaning given that 

4 term in section 2(e) of this Act. 

5 (j) EFFECTIVE DATE.—This section shall take effect 

6 on the date that is one year after the date of the enact7 ment of this Act. 

8 SEC. 4. STUDIES OF BARRIERS ENCOUNTERED BY VET9 ERANS IN RECEIVING, AND ADMINISTRATORS 

10 AND CLINICIANS IN PROVIDING, COM11 PLEMENTARY AND INTEGRATIVE MEDICINE 

12 SERVICES FURNISHED BY THE DEPARTMENT 

13 OF VETERANS AFFAIRS. 

14 (a) STUDIES REQUIRED.— 

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

16 Affairs shall conduct comprehensive studies of the 

17 barriers encountered by veterans in receiving, and 

18 administrators and clinicians in providing, com19 plementary and integrative medicine services fur20 nished by the Department of Veterans Affairs. 

21 (2) STUDIES CONDUCTED.— 

22 (A) VETERANS.—In conducting the study 

23 of veterans, the Secretary shall— 

24 (i) survey veterans who seek or receive 

25 hospital care or medical services furnished 


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1 by the Department, as well as veterans 

2 who do not seek or receive such care or 

3 services; 

4 (ii) administer the survey to a rep5 resentative sample of veterans from each 

6 Veterans Integrated Service Network; and 

7 (iii) ensure that the sample of vet8 erans surveyed is of sufficient size for the 

9 study results to be statistically significant. 

10 (B) ADMINISTRATORS AND CLINICIANS.— 

11 In conducting the study of clinicians and ad12 ministrators, the Secretary shall— 

13 (i) survey administrators of the De14 partment who are involved in the provision 

15 of health care services; 

16 (ii) survey clinicians that have pro17 vided complementary and integrative medi18 cine services through the program estab19 lished under section 3 of this Act, after 

20 those clinicians have provided those serv21 ices through such program for at least 90 

22 days; and 

23 (iii) administer the survey to adminis24 trators under clause (i)— 


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1 (I) before the introduction of 

2 complementary and integrative medi3 cine services through such program; 

4 and 

5 (II) not earlier than 90 days 

6 after the introduction of complemen7 tary and integrative medicine services 

8 through such program. 

9 (b) ELEMENTS OF STUDIES.— 

10 (1) VETERANS.—In conducting the study of 

11 veterans required by subsection (a), the Secretary 

12 shall study the following: 

13 (A) The perceived barriers associated with 

14 obtaining complementary and integrative medi15 cine services from the Department. 

16 (B) The satisfaction of veterans with com17 plementary and integrative medicine services in 

18 primary care. 

19 (C) The degree to which veterans are 

20 aware of eligibility requirements for, and the 

21 scope of services available under, complemen22 tary and integrative medicine services furnished 

23 by the Department. 


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1 (D) The effectiveness of outreach to vet2 erans on the availability of complementary and 

3 integrative medicine for veterans. 

4 (E) Such other barriers as the Secretary 

5 considers appropriate. 

6 (2) ADMINISTRATORS AND CLINICIANS.—In 

7 conducting the study of administrators and clini8 cians required by subsection (a), the Secretary shall 

9 study the following: 

10 (A) The extent of the integration of com11 plementary and integrative medicine services 

12 within the services provided by the Department. 

13 (B) The perception by administrators and 

14 clinicians of the structural and attitudinal bar15 riers to the delivery of high quality complemen16 tary and integrative medicine services by the 

17 Department. 

18 (C) Strategies that have been used to re19 duce or eliminate such barriers and the results 

20 of such strategies. 

21 (D) The satisfaction of administrators and 

22 clinicians regarding the integration of com23 plementary and integrative medicine services 

24 within the services provided by the Department. 


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1 (E) The perception by administrators and 

2 clinicians of the value of specific complementary 

3 and integrative medicine services for inpatient 

4 and outpatient veteran populations. 

5 (c) DISCHARGE BY CONTRACT.—The Secretary shall 

6 enter into a contract with a qualified independent entity 

7 or organization to carry out the studies required by this 

8 section. 

9 (d) MANDATORY REVIEW OF DATA BY THE NA10 TIONAL RESEARCH ADVISORY COUNCIL.— 

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

12 that the head of the National Research Advisory 

13 Council reviews the results of the studies conducted 

14 under this section. 

15 (2) SUBMITTAL OF FINDINGS.—The head of the 

16 National Research Advisory Council shall submit 

17 findings with respect to the studies to the Under 

18 Secretary for Health and to other pertinent program 

19 offices within the Department with responsibilities 

20 relating to health care services for veterans. 

21 (e) REPORTS.— 

22 (1) REPORT ON IMPLEMENTATION.—Not later 

23 than one year after the date of the enactment of this 

24 Act, the Secretary shall submit to Congress a report 

25 on the status of the implementation of this section. 


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1 (2) REPORT ON STUDY.— 

2 (A) IN GENERAL.—Not later than 45 days 

3 after the date of the completion of the study, 

4 the Secretary shall submit to Congress a report 

5 on the study required by subsection (a). 

6 (B) CONTENTS.—The report required by 

7 subparagraph (A) shall include the following: 

8 (i) Recommendations for such admin9 istrative and legislative proposals and ac10 tions as the Secretary considers appro11 priate. 

12 (ii) The findings of the head of the 

13 National Research Advisory Council and of 

14 the Under Secretary for Health. 

15 (f) AUTHORIZATION OF APPROPRIATIONS.—There is 

16 authorized to be appropriated for fiscal year 2019 for the 

17 Department of Veterans Affairs, $2,000,000 to carry out 

18 this section. 

19 (g) COMPLEMENTARY AND INTEGRATIVE MEDICINE

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

21 integrative medicine’’ shall have the meaning given that 

22 term in section 2(e) of this Act. 


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1 SEC. 5. PROGRAM ON USE OF WELLNESS PROGRAMS AS 

2 COMPLEMENTARY APPROACH TO MENTAL 

3 HEALTH CARE FOR VETERANS AND FAMILY 

4 MEMBERS OF VETERANS. 

5 (a) PROGRAM REQUIRED.— 

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

7 Affairs shall carry out a program through the award 

8 of grants to public or private nonprofit entities to 

9 assess the feasibility and advisability of using 

10 wellness programs to complement the provision of 

11 mental health care to veterans and family members 

12 eligible for counseling under section 1712A(a)(1)(C) 

13 of title 38, United States Code. 

14 (2) MATTERS TO BE ADDRESSED.—The pro15 gram shall be carried out so as to assess the fol16 lowing: 

17 (A) Means of improving coordination be18 tween Federal, State, local, and community pro19 viders of health care in the provision of mental 

20 health care to veterans and family members de21 scribed in paragraph (1). 

22 (B) Means of enhancing outreach, and co23 ordination of outreach, by and among providers 

24 of health care referred to in subparagraph (A) 

25 on the mental health care services available to 


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1 veterans and family members described in para2 graph (1). 

3 (C) Means of using wellness programs of 

4 providers of health care referred to in subpara5 graph (A) as complements to the provision by 

6 the Department of Veterans Affairs of mental 

7 health care to veterans and family members de8 scribed in paragraph (1). 

9 (D) Whether wellness programs described 

10 in subparagraph (C) are effective in enhancing 

11 the quality of life and well-being of veterans 

12 and family members described in paragraph 

13 (1). 

14 (E) Whether wellness programs described 

15 in subparagraph (C) are effective in increasing 

16 the adherence of veterans described in para17 graph (1) to the primary mental health services 

18 provided such veterans by the Department. 

19 (F) Whether wellness programs described 

20 in subparagraph (C) have an impact on the 

21 sense of well-being of veterans described in 

22 paragraph (1) who receive primary mental 

23 health services from the Department. 

24 (G) Whether wellness programs described 

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1 aging veterans receiving health care from the 

2 Department to adopt a more healthy lifestyle. 

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

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

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

6 Act. 

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

8 program at facilities of the Department providing mental 

9 health care services to veterans and family members de10 scribed in subsection (a)(1). 

11 (d) GRANT PROPOSALS.— 

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

13 entity seeking the award of a grant under this sec14 tion shall submit an application therefor to the Sec15 retary in such form and in such manner as the Sec16 retary may require. 

17 (2) APPLICATION CONTENTS.—Each application 

18 submitted under paragraph (1) shall include the fol19 lowing: 

20 (A) A plan to coordinate activities under 

21 the program, to the extent possible, with the 

22 Federal, State, and local providers of services 

23 for veterans to enhance the following: 


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1 (i) Awareness by veterans of benefits 

2 and health care services provided by the 

3 Department. 

4 (ii) Outreach efforts to increase the 

5 use by veterans of services provided by the 

6 Department. 

7 (iii) Educational efforts to inform vet8 erans of the benefits of a healthy and ac9 tive lifestyle. 

10 (B) A statement of understanding from 

11 the entity submitting the application that, if se12 lected, such entity will be required to report to 

13 the Secretary periodically on standardized data 

14 and other performance data necessary to evalu15 ate individual outcomes and to facilitate evalua16 tions among entities participating in the pro17 gram. 

18 (C) Other requirements that the Secretary 

19 may prescribe. 

20 (e) GRANT USES.— 

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

22 entity awarded a grant under this section shall use 

23 the award for purposes prescribed by the Secretary. 

24 (2) ELIGIBLE VETERANS AND FAMILY.—In car25 rying out the purposes prescribed by the Secretary 


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1 in paragraph (1), a public or private nonprofit entity 

2 awarded a grant under this section shall use the 

3 award to furnish services only to individuals speci4 fied in section 1712A(a)(1)(C) of title 38, United 

5 States Code. 

6 (f) REPORTS.— 

7 (1) PERIODIC REPORTS.— 

8 (A) IN GENERAL.—Not later than 180 

9 days after the date of the commencement of the 

10 program, and every 180 days thereafter, the 

11 Secretary shall submit to Congress a report on 

12 the program. 

13 (B) REPORT ELEMENTS.—Each report re14 quired by subparagraph (A) shall include the 

15 following: 

16 (i) The findings and conclusions of 

17 the Secretary with respect to the program 

18 during the 180-day period preceding the 

19 report. 

20 (ii) An assessment of the benefits of 

21 the program to veterans and their family 

22 members during the 180-day period pre23 ceding the report. 

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

25 after the end of the program, the Secretary shall 


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1 submit to Congress a report detailing the rec2 ommendations of the Secretary as to the advisability 

3 of continuing or expanding the program. 

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

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

6 prescribed by the Secretary. 

Æ 


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