I 

113TH CONGRESS 

2D SESSION H. R. 5059 

To direct the Secretary of Defense and the Secretary of Veterans Affairs 

to provide for the conduct of annual evaluations of mental health care 

and suicide prevention programs of the Department of Defense and 

the Department of Veterans Affairs, to review the terms or characterization of the discharge or separation of certain individuals from the Armed 

Forces, to require a pilot program on loan repayment for psychiatrists 

who agree to serve in the Veterans Health Administration of the Department of Veterans Affairs, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 10, 2014 

Mr. WALZ (for himself, Mr. MILLER of Florida, Ms. DUCKWORTH, Mr. BARBER, Mr. BENISHEK, Mr. BRALEY of Iowa, Mr. FATTAH, Mr. HASTINGS

of Florida, Mr. JOHNSON of Ohio, Ms. KUSTER, Mr. MCNERNEY, Mr. 

MURPHY of Florida, Mr. STIVERS, Mrs. WALORSKI, Mr. FITZPATRICK, 

Mr. DAINES, Mrs. KIRKPATRICK, and Mr. ROONEY) introduced the following bill; which was referred to the Committee on Veterans’ Affairs, 

and in addition to the Committee on Armed Services, for a period to be 

subsequently determined by the Speaker, in each case for consideration 

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

A BILL 

To direct the Secretary of Defense and the Secretary of 

Veterans Affairs to provide for the conduct of annual 

evaluations of mental health care and suicide prevention 

programs of the Department of Defense and the Department of Veterans Affairs, to review the terms or characterization of the discharge or separation of certain individuals from the Armed Forces, to require a pilot proVerDate Mar 15 2010 21:29 Jul 14, 2014 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6652 E:\BILLS\H5059.IH H5059

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gram on loan repayment for psychiatrists who agree to 

serve in the Veterans Health Administration of the Department of Veterans Affairs, and for other purposes. 

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

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Clay Hunt Suicide Pre5 vention for American Veterans Act’’ or the ‘‘Clay Hunt 

6 SAV Act’’. 

7 SEC. 2. EVALUATIONS OF MENTAL HEALTH CARE AND SUI8 CIDE PREVENTION PROGRAMS OF DEPART9 MENT OF VETERANS AFFAIRS AND DEPART10 MENT OF DEFENSE. 

11 (a) EVALUATIONS.— 

12 (1) IN GENERAL.—Not less frequently than 

13 once each year, the Secretary concerned shall pro14 vide for the conduct of an evaluation of the mental 

15 health care and suicide prevention programs carried 

16 out under the laws administered by such Secretary. 

17 (2) ELEMENTS.—Each evaluation conducted 

18 under paragraph (1) shall— 

19 (A) use metrics that are common among 

20 and useful for practitioners in the field of men21 tal health care and suicide prevention; 

22 (B) identify the most effective mental 

23 health care and suicide prevention programs 


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1 conducted by the Secretary concerned, including 

2 such programs conducted at a Center of Excel3 lence; 

4 (C) identify the cost-effectiveness of each 

5 programs identified under subparagraph (B); 

6 and 

7 (D) propose best practices for caring for 

8 individuals who suffer from mental health dis9 orders or are at risk of suicide. 

10 (3) THIRD PARTY.—Each evaluation conducted 

11 under paragraph (1) shall be conducted by an inde12 pendent third party unaffiliated with the Depart13 ment of Veterans Affairs and the Department of De14 fense. Such third party shall submit to the Secretary 

15 concerned each such evaluation as appropriate. 

16 (4) SUBMISSION.—The Secretary concerned 

17 shall annually submit to the Committees on Armed 

18 Services and the Committees on Veterans’ Affairs of 

19 the House of Representatives and the Senate a re20 port that contains the most recent evaluation sub21 mitted to the Secretary under paragraph (3). 

22 (b) SECRETARY CONCERNED DEFINED.—In this sec23 tion, the term ‘‘Secretary concerned’’ means— 


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1 (1) the Secretary of Veterans Affairs with re2 spect to matters concerning the Department of Vet3 erans Affairs; and 

4 (2) the Secretary of Defense with respect to 

5 matters concerning the Department of Defense. 

6 SEC. 3. REVIEW OF CHARACTERIZATION OR TERMS OF DIS7 CHARGE FROM THE ARMED FORCES OF INDI8 VIDUALS WITH MENTAL HEALTH DISORDERS 

9 ALLEGED TO AFFECT TERMS OF DISCHARGE. 

10 (a) IN GENERAL.—Section 1553(d) of title 10, 

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

12 following new paragraph: 

13 ‘‘(3)(A) In addition to the requirements of paragraph 

14 (1) and (2), in the case of a former member described 

15 in subparagraph (B), the Board shall— 

16 ‘‘(i) review medical evidence of the Secretary of 

17 Veterans Affairs or a civilian health care provider 

18 that is presented by the former member; and 

19 ‘‘(ii) review the case with a presumption of ad20 ministrative irregularity and place the burden on the 

21 Secretary concerned to prove, by a preponderance of 

22 the evidence, that no error or injustice occurred. 

23 ‘‘(B) A former member described in this subpara24 graph is a former member described in paragraph (1) or 

25 a former member whose application for relief is based in 


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1 whole or in part on matters relating to post-traumatic 

2 stress disorder or traumatic brain injury as supporting ra3 tionale or as justification for priority consideration whose 

4 post-traumatic stress disorder or traumatic brain injury 

5 is related to combat or military sexual trauma, as deter6 mined by the Secretary concerned.’’. 

7 SEC. 4. PUBLICATION OF INTERNET WEBSITE TO PROVIDE 

8 INFORMATION REGARDING MENTAL HEALTH 

9 CARE SERVICES. 

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

11 shall publish an Internet website that serves as a central12 ized source to provide veterans with information regarding 

13 all of the mental health care services provided by the Sec14 retary. 

15 (b) ELEMENTS.—The Internet website published 

16 under subsection (a) shall provide to veterans information 

17 regarding all of the mental health care services available 

18 in the Veteran Integrated Service Network that the vet19 eran is seeking such services, including, with respect to 

20 each medical center and community-based outpatient cen21 ter in the Veterans Integrated Service Network— 

22 (1) the name and contact information of each 

23 social work office; 

24 (2) the name and contact information of each 

25 mental health clinic; 


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1 (3) a list of appropriate staff; and 

2 (4) any other information the Secretary deter3 mines appropriate. 

4 (c) UPDATED INFORMATION.—The Secretary shall 

5 ensure that the information described in subsection (b) 

6 that is published on the Internet website under subsection 

7 (a) is updated not less than once every 90 days. 

8 (d) OUTREACH.—In carrying out this section, the 

9 Secretary shall ensure that the outreach conducted under 

10 section 1720F(i) of title 38, United States Code, includes 

11 information regarding the Internet website published 

12 under subsection (a). 

13 SEC. 5. IMPROVEMENTS TO HEALTH CARE MATTERS. 

14 (a) RESERVE COMPONENTS AND DEPARTMENT OF

15 VETERANS AFFAIRS.—The Secretary of Veterans Affairs 

16 and the Secretary of Defense, in consultation with the 

17 Chief of the National Guard Bureau, shall enter into for18 mal strategic relationships between the Joint Forces 

19 Headquarters of each State regional commands of the re20 serve components and the Veterans Service Integrated 

21 Network, medical facilities of the Department of Veterans 

22 Affairs, and other local offices of the Department of Vet23 erans Affairs located in the State with respect to facili24 tating— 


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1 (1) the mental health referrals of members of 

2 the reserve components who have a service-connected 

3 disability and are being discharged or released from 

4 the Armed Forces; 

5 (2) timely behavioral health services for such 

6 members; 

7 (3) communication when such members are at 

8 risk for behavioral health reasons; and 

9 (4) the transfer of documentation for line of 

10 duty and fitness for duty determinations. 

11 (b) GAO REPORT ON TRANSITION OF CARE.— 

12 (1) IN GENERAL.—Not later than April 1, 

13 2015, the Comptroller General of the United States 

14 shall submit to the congressional defense committees 

15 (as defined in section 101(a)(16) of title 10, United 

16 States Code) and the Committees on Veterans’ Af17 fairs of the House of Representatives and the Senate 

18 a report that assesses the transition of care for post19 traumatic stress disorder or traumatic brain injury. 

20 (2) MATTERS INCLUDED.—The report under 

21 paragraph (1) shall include the following: 

22 (A) The programs, policies, and regula23 tions that affect the transition of care, particu24 larly with respect to individuals who are taking 

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1 lants, antipsychotics, mood stabilizers, 

2 anxiolytic, depressants, or hallucinogens. 

3 (B) Upon transitioning to care furnished 

4 by the Secretary of Veterans Affairs, the extent 

5 to which the pharmaceutical treatment plan of 

6 an individual changes, and the factors deter7 mining such changes. 

8 (C) The extent to which the Secretary of 

9 Defense and the Secretary of Veterans Affairs 

10 have worked together to identify and apply best 

11 pharmaceutical treatment practices. 

12 (D) A description of the off-formulary 

13 waiver process of the Secretary of Veterans Af14 fairs, and the extent to which the process is ap15 plied efficiently at the treatment level. 

16 (E) The benefits and challenges of com17 bining the formularies across the Department 

18 of Defense and the Department of Veterans Af19 fairs. 

20 (F) Any other issues that the Comptroller 

21 General determines appropriate. 

22 (3) TRANSITION OF CARE DEFINED.—In this 

23 subsection, the term ‘‘transition of care’’ means the 

24 transition of an individual from receiving treatment 


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1 furnished by the Secretary of Defense to treatment 

2 furnished by the Secretary of Veterans Affairs. 

3 SEC. 6. PILOT PROGRAM FOR REPAYMENT OF EDU4 CATIONAL LOANS FOR CERTAIN PSYCHIA5 TRISTS OF VETERANS HEALTH ADMINISTRA6 TION. 

7 (a) ESTABLISHMENT.—The Secretary of Veterans 

8 Affairs shall carry out a pilot program to repay loans of 

9 individuals described in subsection (b) that— 

10 (1) were used by such individuals to finance 

11 education relating to psychiatric medicine, including 

12 education leading to— 

13 (A) an undergraduate degree; 

14 (B) a degree of doctor of medicine; or 

15 (C) a degree of doctor of osteopathy; and 

16 (2) were obtained from any of the following: 

17 (A) A governmental entity. 

18 (B) A private financial institution. 

19 (C) A school. 

20 (D) Any other authorized entity as deter21 mined by the Secretary. 

22 (b) ELIGIBLE INDIVIDUALS.— 

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

24 individual eligible for participation in the pilot pro25 gram is an individual who— 


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1 (A) either— 

2 (i) is licensed or eligible for licensure 

3 to practice psychiatric medicine in the Vet4 erans Health Administration of the De5 partment of Veterans Affairs; or 

6 (ii) is enrolled in the final year of a 

7 residency program leading to a specialty 

8 qualification in psychiatric medicine that is 

9 approved by the Accreditation Council for 

10 Graduate Medical Education; and 

11 (B) demonstrates a commitment to a long12 term career as a psychiatrist in the Veterans 

13 Health Administration, as determined by the 

14 Secretary. 

15 (2) PROHIBITION ON SIMULTANEOUS ELIGI16 BILITY.—An individual who is participating in any 

17 other program of the Federal Government that re18 pays the educational loans of the individual is not el19 igible to participate in the pilot program. 

20 (c) SELECTION.—The Secretary shall select not less 

21 than 10 individuals described in subsection (b) to partici22 pate in the pilot program for each year in which the Sec23 retary carries out the pilot program. 

24 (d) PERIOD OF OBLIGATED SERVICE.—The Sec25 retary shall enter into an agreement with each individual 


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1 selected under subsection (c) in which such individual 

2 agrees to serve a period of obligated service for the Vet3 erans Health Administration in the field of psychiatric 

4 medicine, as determined by the Secretary. 

5 (e) LOAN REPAYMENTS.— 

6 (1) AMOUNTS.—Subject to paragraph (2), a 

7 loan repayment under this section may consist of 

8 payment of the principal, interest, and related ex9 penses of a loan obtained by an individual who is 

10 participating in the pilot program for all educational 

11 expenses (including tuition, fees, books, and labora12 tory expenses) of such individual relating to edu13 cation described in subsection (a)(1). 

14 (2) LIMIT.—For each year of obligated service 

15 that an individual who is participating in the pilot 

16 program agrees to serve under subsection (d), the 

17 Secretary may pay not more than $60,000 in loan 

18 repayment on behalf of such individual. 

19 (f) BREACH.— 

20 (1) LIABILITY.—An individual who participates 

21 in the pilot program and fails to satisfy the period 

22 of obligated service under subsection (d) shall be lia23 ble to the United States, in lieu of such obligated 

24 service, for the amount that has been paid or is pay25 able to or on behalf of the individual under the pilot 


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1 program, reduced by the proportion that the number 

2 of days served for completion of the period of obli3 gated service bears to the total number of days in 

4 the period of obligated service of such individual. 

5 (2) REPAYMENT PERIOD.—Any amount of dam6 ages that the United States is entitled to recover 

7 under this subsection shall be paid to the United 

8 States not later than one year after the date of the 

9 breach of the agreement. 

10 (g) REPORT.— 

11 (1) INITIAL REPORT.—Not later than two years 

12 after the date on which the pilot program under sub13 section (a) commences, the Secretary shall submit to 

14 the Committee on Veterans’ Affairs of the Senate 

15 and the Committee on Veterans’ Affairs of the 

16 House of Representatives a report on the pilot pro17 gram. 

18 (2) ELEMENTS.—The report required by para19 graph (1) shall include the following: 

20 (A) The number of individuals who partici21 pated in the pilot program. 

22 (B) The locations in which such individuals 

23 were employed by the Department, including 

24 how many such locations were rural or urban 

25 locations. 


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1 (C) An assessment of the quality of the 

2 work performed by such individuals in the 

3 course of such employment. 

4 (D) The number of psychiatrists the Sec5 retary determines is needed by the Department 

6 in the future. 

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

8 after the date on which the pilot program terminates 

9 under subsection (i), the Secretary shall submit to 

10 the Committee on Veterans’ Affairs of the Senate 

11 and the Committee on Veterans’ Affairs of the 

12 House of Representatives an update to the report 

13 submitted under paragraph (1). 

14 (h) REGULATIONS.—The Secretary shall prescribe 

15 regulations to carry out this section, including standards 

16 for qualified loans and authorized payees and other terms 

17 and conditions for the making of loan repayments. 

18 (i) TERMINATION.—The authority to carry out the 

19 pilot program shall expire on the date that is three years 

20 after the date on which the Secretary commences the pilot 

21 program. 


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1 SEC. 7. PUBLIC-PRIVATE CONTRIBUTIONS FOR ADDI2 TIONAL EDUCATIONAL ASSISTANCE FOR 

3 GRADUATE DEGREES RELATING TO MENTAL 

4 HEALTH. 

5 (a) IN GENERAL.—Section 3317 of title 38, United 

6 States Code, is amended by adding at the end the fol7 lowing new subsection: 

8 ‘‘(f) GRADUATE DEGREE IN MENTAL HEALTH.—(1) 

9 As part of the Yellow Ribbon G.I. Education Enhance10 ment Program carried out under this section, the Sec11 retary shall carry out a program under which the Sec12 retary and a college or university that enters into an 

13 agreement described in subsection (a) may make contribu14 tions pursuant to this subsection with respect to the full 

15 cost of established charges of a veteran described in para16 graph (2). 

17 ‘‘(2) A veteran described in this paragraph is a vet18 eran who— 

19 ‘‘(A) is eligible for the program under sub20 section (a); 

21 ‘‘(B) holds a bachelor’s degree; 

22 ‘‘(C) is pursuing an advanced degree in mental 

23 health at an institution of higher learning that par24 ticipates in the program under subsection (a); and 


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1 ‘‘(D) is pursuing such a degree with the inten2 tion of seeking employment as a mental health pro3 fessional in the Department of Veterans Affairs. 

4 ‘‘(3) In determining the intention of a veteran under 

5 paragraph (2)(D), the Secretary may not require the vet6 eran to enter into any binding agreement with respect to 

7 such intention. 

8 ‘‘(4) In determining the amount of matching con9 tributions pursuant to subsection (d)(1) for assistance 

10 provided under paragraph (1), the Secretary shall— 

11 ‘‘(A) substitute ‘66 percent’ for ‘up to 50 per12 cent’; and 

13 ‘‘(B) substitute ‘34 percent’ for ‘an equal per14 centage’. 

15 ‘‘(5) In accordance with section 7406 of this title, the 

16 Secretary may establish residencies and internships at 

17 medical facilities of the Department for veterans partici18 pating in the program under subsection (a). 

19 ‘‘(6) If the Secretary employs a veteran who partici20 pates in the program under subsection (a) as a mental 

21 health professional following such participation, to the 

22 maximum extent practicable, the Secretary shall ensure 

23 that— 


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1 ‘‘(A) the veteran is employed in a rural area or 

2 an area that the Secretary determines is in greatest 

3 need of mental health professionals; and 

4 ‘‘(B) the veteran is employed in a position that 

5 directly relates to the treatment of veterans rather 

6 than a research position. 

7 ‘‘(7) In this subsection, the term ‘advanced degree 

8 in mental health’ means a master’s degree, doctoral de9 gree, or other graduate or professional degree that the 

10 Secretary determines would lead an individual to be em11 ployed as any of the following positions: 

12 ‘‘(A) Psychiatrist. 

13 ‘‘(B) Psychologist. 

14 ‘‘(C) Mental health nurse. 

15 ‘‘(D) Nurse assistant. 

16 ‘‘(E) Physician assistant. 

17 ‘‘(F) Pharmacist. 

18 ‘‘(G) Social worker. 

19 ‘‘(H) Licensed professional mental health coun20 selor. 

21 ‘‘(I) Licensed marriage and family therapist. 

22 ‘‘(J) Addiction therapist. 

23 ‘‘(K) Occupational therapist. 

24 ‘‘(L) Recreational therapist. 

25 ‘‘(M) Vocational rehabilitation therapist. 


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1 ‘‘(N) Health science specialist. 

2 ‘‘(O) Health technician. 

3 ‘‘(P) Any other position the Secretary deter4 mines appropriate.’’. 

5 (b) PROHIBITION ON TRANSFER OF ELIGIBILITY.— 

6 Section 3319(h) of such title is amended by adding at the 

7 end the following new paragraph: 

8 ‘‘(8) PROHIBITION ON CERTAIN CONTRIBU9 TIONS.—Entitlement transferred under this section 

10 may not include eligibility for contributions under 

11 section 3317(f) of this title.’’. 

12 (c) EFFECTIVE DATE.—The amendments made by 

13 this section shall apply with respect to a quarter, semester, 

14 or term that begins on or after July 1, 2015. 

15 SEC. 8. REVIEW OF STAFFING REQUIREMENTS FOR STATE 

16 DIRECTORS OF PSYCHOLOGICAL HEALTH. 

17 Not later than 18 months after the date of the enact18 ment of this Act, the Secretary of Defense shall submit 

19 to the Committees on Armed Services and the Committees 

20 on Veterans’ Affairs of the House of Representatives and 

21 the Senate a zero-based review, conducted in coordination 

22 with the Chief of the National Guard Bureau, of the staff23 ing requirements for individual State National Guard 

24 Commands with respect to Directors of Psychological 

25 Health. 


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1 SEC. 9. PILOT PROGRAM ON COMMUNITY OUTREACH. 

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

3 shall establish a pilot program to assist veterans 

4 transitioning from serving on active duty and to improve 

5 the access of veterans to mental health services. 

6 (b) LOCATIONS.—The Secretary shall carry out the 

7 pilot program under subsection (a) at not less than five 

8 Veterans Integrated Service Networks that have a large 

9 population of veterans who— 

10 (1) served in the reserve components of the 

11 Armed Forces; or 

12 (2) are transitioning into communities with an 

13 established population of veterans after having re14 cently separated from the Armed Forces. 

15 (c) FUNCTIONS.—The pilot program at each Vet16 erans Integrated Service Network described in subsection 

17 (b) shall include the following: 

18 (1) A community oriented veteran peer support 

19 network, carried out in partnership with an appro20 priate entity with experience in peer support pro21 grams, that— 

22 (A) establishes peer support training 

23 guidelines; 

24 (B) develops a network of veteran peer 

25 support counselors to meet the demands of the 


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1 communities in the Veterans Integrated Service 

2 Network; 

3 (C) conducts training of veteran peer sup4 port counselors; 

5 (D) with respect to each medical center in 

6 such Veterans Integrated Service Network, 

7 has— 

8 (i) a designated peer support spe9 cialist who acts as a liaison to the commu10 nity oriented veteran peer network; and 

11 (ii) a certified mental health profes12 sional designated as the community ori13 ented veteran peer network mentor; and 

14 (E) is readily available to veterans, includ15 ing pursuant to the Veterans Integrated Service 

16 Network cooperating and working with State 

17 and local governments and appropriate entities. 

18 (2) A community outreach team for each med19 ical center in such Veterans Integrated Service Net20 work that— 

21 (A) assists veterans transitioning into com22 munities; 

23 (B) establishes a veteran transition advi24 sory group to facilitate outreach activities; 


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1 (C) includes the participation of appro2 priate community organizations, State and local 

3 governments, colleges and universities, and or4 ganizations that provide legal aid or advice; and 

5 (D) coordinates with the Veterans Inte6 grated Service Network regarding the Veterans 

7 Integrated Service Network carrying out an an8 nual mental health summit to assess the status 

9 of veteran mental health care in the community 

10 and to develop new or innovative means to pro11 vide mental health services to veterans. 

12 (d) REPORTS.— 

13 (1) INITIAL REPORT.—Not later than 18 

14 months after the date on which the pilot program 

15 under subsection (a) commences, the Secretary shall 

16 submit to the Committee on Veterans’ Affairs of the 

17 Senate and the Committee on Veterans’ Affairs of 

18 the House of Representatives a report on the pilot 

19 program. With respect to each Veterans Integrated 

20 Service Network described in subsection (b), the re21 port shall include— 

22 (A) a full description of the peer support 

23 model implemented under the pilot program, 

24 participation data, and data pertaining to past 


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1 and current mental health related hospitaliza2 tions and fatalities; 

3 (B) recommendations on implementing 

4 peer support networks throughout the Depart5 ment; 

6 (C) whether the mental health resources 

7 made available under the pilot program for 

8 members of the reserve components of the 

9 Armed Forces is effective; and 

10 (D) a full description of the activities and 

11 effectiveness of community outreach coordi12 nating teams under the pilot program, including 

13 partnerships that have been established with 

14 appropriate entities. 

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

16 after the date on which the pilot program terminates 

17 under subsection (e), the Secretary shall submit to 

18 the Committee on Veterans’ Affairs of the Senate 

19 and the Committee on Veterans’ Affairs of the 

20 House of Representatives an update to the report 

21 submitted under paragraph (1). 

22 (e) TERMINATION.—The authority of the Secretary 

23 to carry out the pilot program under subsection (a) shall 


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1 terminate on the date that is three years after the date 

2 on which the pilot program commences. 

Æ 


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