I 
113TH CONGRESS 
1ST SESSION H. R. 3516 
To improve health care furnished by the Department of Veterans Affairs 
and the Department of Defense by increasing access to complementary 
and alternative medicine and other approaches to wellness and preventive 
care, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
NOVEMBER 15, 2013 
Mr. RYAN of Ohio (for himself, Mr. NUGENT, and Mr. RUIZ) 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 con-
cerned 
A BILL 
To improve health care furnished by the Department of 
Veterans Affairs and the Department of Defense by in-
creasing access to complementary and alternative medi-
cine and other approaches to wellness and preventive 
care, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Veterans and Armed 
Forces Health Promotion Act of 2013’’. 
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SEC. 2. DEPARTMENT OF VETERANS AFFAIRS AND DEPART-
MENT 
OF 
DEFENSE 
EXPANSION 
OF 
RE-
SEARCH AND EDUCATION INTO INTEGRA-
TION 
OF 
COMPLEMENTARY 
AND 
ALTER-
NATIVE MEDICINE INTERVENTIONS. 
(a) DEVELOPMENT AND IMPLEMENTATION OF EX-
PANSION PLAN.—Not later than 270 days after the date 
of the enactment of this Act, the Secretary of Veterans 
Affairs and the Secretary of Defense shall jointly develop 
and implement a plan to expand materially and substan-
tially the scope of research and education on, and delivery 
of holistic care that includes, the integration of appro-
priate complementary and alternative medicine interven-
tions in the delivery of health care to veterans under chap-
ter 17 of title 38, United States Code, and members of 
the Armed Forces at military medical treatment facilities 
under title 10, United States Code. Such plan shall pro-
vide for— 
(1) the conduct of research on— 
(A) integrating proven or promising com-
plementary and alternative medicine interven-
tions into the delivery of health care to veterans 
and members of the Armed Forces; and 
(B) models and systems for providing ho-
listic care that includes complementary and al-
ternative medicine interventions; 
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(2) education and training for health care pro-
fessionals on— 
(A) proven and promising complementary 
and alternative medicine interventions; 
(B) appropriate uses of such interventions 
therapeutic options; and 
(C) holistic integration of such interven-
tions into the delivery of health care to vet-
erans; 
(3) carrying out the research, education, and 
clinical activities described in paragraphs (1) and (2) 
at centers of innovation at geographically dispersed 
medical centers operated jointly by the Secretary of 
Veterans Affairs and the Secretary of Defense; and 
(4) the development of joint metrics and out-
come measures to evaluate the provision (and cost 
effectiveness) of complementary and alternative med-
icine interventions in the care of patients of both the 
Department of Veterans Affairs and the Department 
of Defense. 
(b) CONSULTATION WITH EXPERTS.— 
(1) CONSULTATION REQUIRED.—For the pur-
poses described in paragraph (2), the Secretary of 
Veterans Affairs and the Secretary of Defense shall 
consult with the following: 
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(A) The Director of the Center on Com-
plementary and Alternative Medicine at the Na-
tional Institute of Health. 
(B) The Director of the Food and Drug 
Administration. 
(C) Academic centers, private research in-
stitutes, and individual researchers that have 
extensive experience in studying complementary 
and alternative medicine and the integration of 
such interventions in the delivery of conven-
tional medical care. 
(D) Nationally recognized providers of 
complementary and alternative medicine. 
(E) Such other sources of expertise as the 
Secretary deems appropriate. 
(2) PURPOSE
OF
CONSULTATION.—The Sec-
retary of Veterans Affairs and the Secretary of De-
fense shall undertake the consultation described in 
paragraph (1)— 
(A) in developing the plan required under 
subsection (a); 
(B) to identify specific proven or promising 
complementary and alternative medicine inter-
ventions that, on the basis of research findings 
or promising clinical interventions, are appro-
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priate to include as covered services under sec-
tion 3; and 
(C) to identify barriers to the effective pro-
vision and integration of complementary and al-
ternative medicine interventions (and means of 
circumventing such barriers). 
(c) FUNDING.—None of the amounts authorized to 
be appropriated to carry out this section may be obligated 
or expended except for a joint effort of the Department 
of Defense and the Department of Veterans Affairs. 
SEC. 3. MEDICAL TREATMENT AND RESEARCH FACILITIES 
JOINTLY OPERATED BY THE DEPARTMENT 
OF VETERANS AFFAIRS AND THE DEPART-
MENT OF DEFENSE. 
(a) PILOT PROGRAM REQUIRED.—Commencing not 
later than 270 days after the date of the enactment of 
this Act, the Secretary of Veterans Affairs and the Sec-
retary of Defense shall jointly develop and implement a 
plan to establish jointly-operated medical treatment and 
research facilities. Such facilities shall— 
(1) be staffed by employees of the Department 
of Veterans Affairs and the Department of Defense 
and members of the Armed Forces; 
(2) be operated by dividing the operation and 
maintenance expenses between both the Department 
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of Veterans Affairs and the Department of Defense 
by a ratio determined in a memorandum of under-
standing between the Secretaries; and 
(3) bill to each Department the cost of certain 
specialty medical services, including radiology, lab-
oratory, and surgery, as such services are used. 
(b) DURATION OF PROGRAM.—The pilot program 
shall be carried out during the three-year period beginning 
on the date of the commencement of the pilot program. 
(c) LOCATIONS.— 
(1) IN GENERAL.—The Secretaries shall carry 
out the pilot program by establishing not fewer than 
5 joint medical treatment and research facilities. 
(2) CONSIDERATIONS.—In selecting locations 
for the pilot program, the Secretaries shall consider 
the feasibility and advisability of selecting loca-
tions— 
(A) in areas with a high concentration of 
veterans and members of the Armed Forces; 
(B) that present a reasonable probability 
of cost savings to the taxpayer by consolidation 
of services and facilities currently administered 
separately as determined jointly by the Secre-
taries; and 
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(C) where collaboration of research and 
treatment will be most beneficial to the common 
needs of the patients under the care of both De-
partments, as determined jointly by the Secre-
taries. 
(d) FUNDING.—None of the amounts authorized to 
be appropriated to carry out this section may be obligated 
or expended except for a joint effort of the Department 
of Defense and the Department of Veterans Affairs. 
SEC. 4. PILOT PROGRAM ON ESTABLISHMENT OF COM-
PLEMENTARY AND ALTERNATIVE MEDICINE 
CENTERS WITHIN DEPARTMENT OF VET-
ERANS AFFAIRS MEDICAL CENTERS. 
(a) PILOT PROGRAM REQUIRED.—Commencing not 
later than 180 days after the date of the enactment of 
this Act, the Secretary of Veterans Affairs shall carry out, 
through the Office of Patient Centered Care and Cultural 
Transformation of the Department of Veterans Affairs, a 
pilot program to assess the feasibility and advisability of 
establishing complementary and alternative medicine cen-
ters within Department of Veterans Affairs medical cen-
ters to promote the use and integration of complementary 
and alternative medicine services for mental health diag-
noses and pain management. 
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(b) DURATION OF PROGRAM.—The pilot program 
shall be carried out during the three-year period beginning 
on the date of the commencement of the pilot program. 
(c) LOCATIONS.— 
(1) IN
GENERAL.—The Secretary shall carry 
out the pilot program by establishing not fewer than 
10 complementary and alternative medicine centers 
in 10 separate Department medical centers as fol-
lows: 
(A) Three Department medical centers 
designated by the Secretary as polytrauma cen-
ters. 
(B) Seven Department medical centers not 
designated by Secretary as polytrauma centers. 
(2) CONSIDERATIONS.—In selecting locations 
for the pilot program, the Secretary shall consider 
the feasibility and advisability of selecting locations 
in— 
(A) rural areas; 
(B) areas that are not in close proximity to 
an active duty military installation; and 
(C) areas representing different geographic 
locations, such as census tracts established by 
the Bureau of the Census. 
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(d) PROVISION OF SERVICES.—Under the pilot pro-
gram, the Secretary shall provide covered services to cov-
ered patients through the complementary and alternative 
medicine centers established under subsection (c)(1). 
(e) COVERED PATIENTS.—For purposes of the pilot 
program, a covered patient is any patient who is a veteran 
or member of the Armed Forces who has— 
(1) a mental health condition diagnosed by a 
clinician of the Department of Veterans Affairs, in 
the case of a patient who is a veteran, or a clinician 
of the Department of Defense, in the case of a pa-
tient who is a member of the Armed Forces; or 
(2) a pain condition for which the veteran has 
received a pain management plan from a clinician of 
the Department of Veterans Affairs, in the case of 
a patient who is a veteran, or a clinician of the De-
partment of Defense, in the case of a patient who 
is a member of the Armed Forces. 
(f) COVERED SERVICES.— 
(1) IN GENERAL.—For purposes of the pilot 
program, covered services are services consisting of 
complementary or alternative medicine. 
(2) ADMINISTRATION
OF
SERVICES.—Covered 
services shall be administered under the pilot pro-
gram as follows: 
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(A) Covered services shall be administered 
by clinicians who exclusively provide services 
consisting of complementary or alternative med-
icine. 
(B) Covered services shall be included as 
part of the Patient Aligned Care Teams initia-
tive of the Office of Patient Care Services, Pri-
mary Care Program Office. 
(C) Covered services shall be made avail-
able to both— 
(i) covered patients with mental 
health conditions or pain conditions de-
scribed in subsection (e) who have received 
traditional treatments from the Depart-
ment for such conditions; and 
(ii) covered patients with mental 
health conditions or pain conditions de-
scribed in subsection (e) who have not re-
ceived traditional treatments from the De-
partment for such conditions. 
(g) VOLUNTARY PARTICIPATION.—The participation 
of a patient in the pilot program shall be at the election 
of the patient and in consultation with a clinician of the 
Department of Veterans Affairs, in the case of a patient 
who is a veteran, and in consultation with a clinician of 
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the Department of Defense, in the case of a patient who 
is member of the Armed Forces. 
(h) REPORTS TO CONGRESS.— 
(1) QUARTERLY REPORTS.—Not later than 90 
days after the date of the commencement of the pilot 
program and not less frequently than once every 90 
days thereafter for the duration of the pilot pro-
gram, the Secretary shall submit to the Committee 
on Veterans’ Affairs of the Senate and the Com-
mittee on Veterans’ Affairs of the House of Rep-
resentatives a report on the efforts of the Secretary 
to carry out the pilot program, including a descrip-
tion of the outreach conducted by the Secretary to 
veterans and community organizations to inform 
such organizations about the pilot program. 
(2) FINAL REPORT.— 
(A) IN
GENERAL.—Not later than 180 
days after the completion of the pilot program, 
the Secretary shall submit to the Committee on 
Veterans’ Affairs of the Senate and the Com-
mittee on Veterans’ Affairs of the House of 
Representatives a report on the pilot program. 
(B) CONTENTS.—The report submitted 
under subparagraph (A) shall include the fol-
lowing: 
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(i) The findings and conclusions of 
the Secretary with respect to the pilot pro-
gram, including with respect to the utiliza-
tion and efficacy of the complementary and 
alternative medicine centers established 
under the pilot program. 
(ii) Such recommendations for the 
continuation or expansion of the pilot pro-
gram as the Secretary considers appro-
priate. 
(i) FUNDING.—There is authorized to be appro-
priated to the Secretary such sums as may be necessary 
to carry out this section. 
SEC. 5. PILOT PROGRAM ON USE OF WELLNESS PROGRAMS 
AS COMPLEMENTARY APPROACH TO MENTAL 
HEALTH CARE FOR VETERANS AND FAMILY 
MEMBERS OF VETERANS. 
(a) PILOT PROGRAM REQUIRED.— 
(1) IN GENERAL.—The Secretary of Veterans 
Affairs shall carry out a pilot program through the 
award of grants to public or private nonprofit enti-
ties to assess the feasibility and advisability of using 
wellness programs to complement the provision of 
mental health care to veterans and family members 
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eligible for counseling under section 1712A(a)(1)(C) 
of title 38, United States Code. 
(2) MATTERS TO BE ADDRESSED.—The pilot 
program shall be carried out so as to assess the fol-
lowing: 
(A) Means of improving coordination be-
tween Federal, State, local, and community pro-
viders of health care in the provision of mental 
health care to veterans and family members de-
scribed in paragraph (1). 
(B) Means of enhancing outreach, and co-
ordination of outreach, by and among providers 
of health care referred to in subparagraph (A) 
on the mental health care services available to 
veterans and family members described in para-
graph (1). 
(C) Means of using wellness programs of 
providers of health care referred to in subpara-
graph (A) as complements to the provision by 
the Department of Veterans Affairs of mental 
health care to veterans and family members de-
scribed in paragraph (1). 
(D) Whether wellness programs described 
in subparagraph (C) are effective in enhancing 
the quality of life and well-being of veterans 
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and family members described in paragraph 
(1). 
(E) Whether wellness programs described 
in subparagraph (C) are effective in increasing 
the adherence of veterans described in para-
graph (1) to the primary mental health services 
provided such veterans by the Department. 
(F) Whether wellness programs described 
in subparagraph (C) have an impact on the 
sense of wellbeing of veterans described in para-
graph (1) who receive primary mental health 
services from the Department. 
(G) Whether wellness programs described 
in subparagraph (C) are effective in encour-
aging veterans receiving health care from the 
Department to adopt a more healthy lifestyle. 
(b) DURATION.—The Secretary shall carry out the 
pilot program for a period of three years beginning on the 
date that is 90 days after the date of the enactment of 
this Act. 
(c) LOCATIONS.—The Secretary shall carry out the 
pilot program at facilities of the Department providing 
mental health care services to veterans and family mem-
bers described in subsection (a)(1). 
(d) GRANT PROPOSALS.— 
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(1) IN GENERAL.—A public or private nonprofit 
entity seeking the award of a grant under this sec-
tion shall submit an application therefor to the Sec-
retary in such form and in such manner as the Sec-
retary may require. 
(2) APPLICATION CONTENTS.—Each application 
submitted under paragraph (1) shall include the fol-
lowing: 
(A) A plan to coordinate activities under 
the pilot program, to the extent possible, with 
the Federal, State, and local providers of serv-
ices for veterans to enhance the following: 
(i) Awareness by veterans of benefits 
and health care services provided by the 
Department. 
(ii) Outreach efforts to increase the 
use by veterans of services provided by the 
Department. 
(iii) Educational efforts to inform vet-
erans of the benefits of a healthy and ac-
tive lifestyle. 
(B) A statement of understanding from 
the entity submitting the application that, if se-
lected, such entity will be required to report to 
the Secretary periodically on standardized data 
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and other performance data necessary to evalu-
ate individual outcomes and to facilitate evalua-
tions among entities participating in the pilot 
program. 
(C) Other requirements that the Secretary 
may prescribe. 
(e) GRANT USES.— 
(1) IN GENERAL.—A public or private nonprofit 
entity awarded a grant under this section shall use 
the award for purposes prescribed by the Secretary. 
(2) ELIGIBLE VETERANS AND FAMILY.—In car-
rying out the purposes prescribed by the Secretary 
in paragraph (1), a public or private nonprofit entity 
awarded a grant under this section shall use the 
award to furnish services only to individuals speci-
fied in section 1712A(a)(1)(C) of title 38, United 
States Code. 
(f) REPORTS.— 
(1) PERIODIC REPORTS.— 
(A) IN
GENERAL.—Not later than 180 
days after the date of the enactment of this 
Act, and every 180 days thereafter, the Sec-
retary shall submit to Congress a report on the 
pilot program. 
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(B) REPORT ELEMENTS.—Each report re-
quired by subparagraph (A) shall include the 
following: 
(i) The findings and conclusions of 
the Secretary with respect to the pilot pro-
gram during the 180-day period preceding 
the report. 
(ii) An assessment of the benefits of 
the pilot program to veterans and their 
family members during the 180-day period 
preceding the report. 
(2) FINAL REPORT.—Not later than 180 days 
after the end of the pilot program, the Secretary 
shall submit to Congress a report detailing the rec-
ommendations of the Secretary as to the advisability 
of continuing or expanding the pilot program. 
(g) WELLNESS DEFINED.—In this section, the term 
‘‘wellness’’ shall have the meaning given that term in regu-
lations prescribed by the Secretary. 
(h) FUNDING.—There is authorized to be appro-
priated to the Secretary such sums as may be necessary 
to carry out this section. 
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SEC. 6. PILOT PROGRAM ON FITNESS AND NUTRITION IM-
PROVEMENT FOR OVERWEIGHT AND OBESE 
VETERANS. 
(a) PILOT PROGRAM REQUIRED.—Commencing not 
later than 180 days after the date of the enactment of 
this Act, the Secretary of Veterans Affairs shall, through 
the National Center for Preventive Health, carry out a 
pilot program to assess the feasibility and advisability of 
promoting health in covered veterans, including achieving 
a healthy weight and reducing risks of chronic disease, 
through support for fitness center membership. 
(b) COVERED VETERANS.—For purposes of this sec-
tion, a covered veteran is any veteran who— 
(1) is determined by a clinician of the Depart-
ment of Veterans Affairs to be overweight or obese 
as of the date of the commencement of the pilot pro-
gram; and 
(2) resides in a location that is more than 15 
miles from a fitness center at a facility of the De-
partment that would otherwise be available to the 
veteran for at least eight hours per day during five 
or more days per week. 
(c) DURATION OF PILOT PROGRAM.—The pilot pro-
gram shall be carried out during the three-year period be-
ginning on the date of the commencement of the pilot pro-
gram. 
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(d) LOCATIONS.— 
(1) IN
GENERAL.—In carrying out the pilot 
program, the Secretary shall select— 
(A) not less than five medical centers of 
the Department at which the Secretary shall 
cover the full reasonable cost of a fitness center 
membership for covered veterans within the 
catchment area of such centers; 
(B) not less than five medical centers of 
the Department at which the Secretary shall 
cover half the reasonable cost of a fitness center 
membership for covered veterans within the 
catchment area of such centers; and 
(C) not less than five medical centers of 
the Department at which the Secretary shall 
provide comprehensive medical nutrition ther-
apy for covered veterans. 
(2) CONSIDERATIONS.—In selecting locations 
for the pilot program, the Secretary shall consider 
the feasibility and advisability of selecting locations 
in the following areas: 
(A) Areas that are not in close proximity 
to an active duty military installation. 
(B) Areas in different geographic locations. 
(e) PARTICIPATION.— 
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(1) MAXIMUM
NUMBER
OF
PARTICIPANTS.— 
The number of covered veterans who may participate 
in the pilot program at a location selected under 
subsection (d) may not exceed 100. 
(2) VOLUNTARY PARTICIPATION.—The partici-
pation of a covered veteran in the pilot program 
shall be at the election of the covered veteran in con-
sultation with a clinician of the Department. 
(f) FITNESS CENTER MEMBERSHIP PAYMENT.— 
(1) IN GENERAL.—Except as provided in para-
graph (2), in carrying out the pilot program, the 
Secretary shall pay the following: 
(A) The full reasonable cost of a fitness 
center membership for covered veterans within 
the catchment area of centers selected under 
subsection (b)(1)(A) who are participating in 
the pilot program. 
(B) Half the reasonable cost of a fitness 
center membership for covered veterans within 
the catchment area of centers selected under 
subsection (b)(1)(B) who are participating in 
the pilot program. 
(2) LIMITATION.—Payment for a fitness center 
membership of a covered veteran may not exceed 
$50 per month of membership. 
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(g) REPORTS.— 
(1) PERIODIC
REPORTS.—Not later than 90 
days after the date of the commencement of the pilot 
program and not less frequently than once every 90 
days thereafter, the Secretary shall submit to the 
Committee on Veterans’ Affairs of the Senate and 
the Committee on Veterans’ Affairs of the House of 
Representatives a report on activities carried out to 
implement the pilot program, including outreach ac-
tivities to veterans and community organizations. 
(2) FINAL REPORT.—Not later than 180 days 
after the date of the completion of the pilot pro-
gram, the Secretary shall submit to the Committee 
on Veterans’ Affairs of the Senate and the Com-
mittee on Veterans’ Affairs of the House of Rep-
resentatives a report on the pilot program detail-
ing— 
(A) the findings and conclusions of the 
Secretary as a result of the pilot program; and 
(B) recommendations for the continuation 
or expansion of the pilot program. 
(h) FUNDING.—There is authorized to be appro-
priated to the Secretary such sums as may be necessary 
to carry out this section. 
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