I 
114TH CONGRESS 
1ST SESSION H. R. 4063 
To improve the use by the Secretary of Veterans Affairs of opioids in treating 
veterans, to improve patient advocacy by the Secretary, and to expand 
the availability of complementary and integrative health, and for other 
purposes. 
IN THE HOUSE OF REPRESENTATIVES 
NOVEMBER 18, 2015 
Mr. BILIRAKIS (for himself, Mr. KIND, Miss RICE of New York, Mrs. 
WALORSKI, Mr. MCKINLEY, Mr. BOST, Mr. COFFMAN, Mr. ROSS, Mr. 
RYAN of Ohio, Mrs. RADEWAGEN, Mr. CRAWFORD, Mr. MICA, Ms. 
FRANKEL of Florida, Ms. KUSTER, Mr. MCCAUL, and Mr. WALZ) intro-
duced the following bill; which was referred to the Committee on Vet-
erans’ 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 com-
mittee concerned 
A BILL 
To improve the use by the Secretary of Veterans Affairs 
of opioids in treating veterans, to improve patient advo-
cacy by the Secretary, and to expand the availability 
of complementary and integrative health, and for other 
purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Promoting Responsible Opioid Management and Incor-
porating Scientific Expertise Act’’ or the ‘‘Jason 
Simcakoski PROMISE Act’’. 
(b) TABLE OF CONTENTS.—The table of contents for 
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 Vet-
erans Affairs and Department of Defense and implementation 
of such guidelines by Department of Veterans Affairs. 
Sec. 102. Improvement of opioid safety measures by Department of Veterans 
Affairs. 
Sec. 103. Strengthening of joint working group on pain management of the De-
partment of Veterans Affairs and the Department of Defense. 
Sec. 104. Review, investigation, and report on use of opioids in treatment by 
Department of Veterans Affairs. 
TITLE II—PATIENT ADVOCACY 
Sec. 201. Community meetings on improving care furnished by Department of 
Veterans Affairs. 
Sec. 202. Improvement of awareness of patient advocacy program and patient 
bill of rights of Department of Veterans Affairs. 
Sec. 203. Comptroller general report on patient advocacy program of Depart-
ment of Veterans Affairs. 
TITLE III—COMPLEMENTARY AND INTEGRATIVE HEALTH 
Sec. 301. Expansion of research and education on and delivery of complemen-
tary and integrative health to veterans. 
Sec. 302. Pilot program on integration of complementary alternative medicines 
and related issues for veterans and family members of vet-
erans. 
TITLE IV—FITNESS OF HEALTH CARE PROVIDERS 
Sec. 401. Additional requirements for hiring of health care providers by De-
partment 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 re-
views of health care providers leaving the Department or trans-
ferring to other facilities. 
TITLE V—OTHER VETERANS MATTERS 
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Sec. 501. Audit of Veterans Health Administration programs of Department of 
Veterans Affairs. 
TITLE I—OPIOID THERAPY AND 
PAIN MANAGEMENT 
SEC. 101. GUIDELINES ON MANAGEMENT OF OPIOID THER-
APY BY DEPARTMENT OF VETERANS AFFAIRS 
AND DEPARTMENT OF DEFENSE AND IMPLE-
MENTATION OF SUCH GUIDELINES BY DE-
PARTMENT OF VETERANS AFFAIRS. 
(a) IN GENERAL.—Not later than one year after the 
date of the enactment of this Act, the Secretary of Vet-
erans Affairs and the Secretary of Defense shall jointly 
update the VA/DOD Clinical Practice Guideline for Man-
agement of Opioid Therapy for Chronic Pain to include 
the following: 
(1) In accordance with subsection (b), common 
recommended 
guidelines 
for 
safely 
prescribing 
opioids for the treatment of chronic, non-cancer pain 
in outpatient settings as compiled by the Director of 
the Centers for Disease Control and Prevention. 
(2) Enhanced guidance with respect to— 
(A) the administration of two or more 
drugs that may result in a life-limiting drug-to- 
drug interaction, including benzodiazepines; 
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(B) the treatment of patients with current 
acute psychiatric instability or substance use 
disorder or patients at risk of suicide; and 
(C) the use of opioid therapy to treat men-
tal health disorders other than opioid use dis-
order. 
(3) Enhanced guidance with respect to the 
treatment 
of 
patients 
with 
behaviors 
or 
comorbidities, such as post-traumatic stress dis-
order, psychiatric disorders, or a history of sub-
stance abuse or addiction, that requires a consulta-
tion or comanagement of opioid therapy with one or 
more specialists in pain management, mental health, 
or addictions. 
(4) Enhanced guidance with respect to the con-
duct by health care providers of an effective assess-
ment for patients receiving opioid therapy, including 
patients on long-term opioid therapy, to determine— 
(A) whether opioid therapy is meeting the 
expected goals of the patient and health care 
provider of relieving pain, improving function, 
and providing patient satisfaction; and 
(B) whether opioid therapy should be con-
tinued. 
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(5) Guidance that each health care provider of 
the Department of Veterans Affairs and the Depart-
ment of Defense, before initiating opioid therapy to 
treat a patient as part of the comprehensive assess-
ment conducted by the health care provider, use the 
Opioid Therapy Risk Report tool of the Department 
of Veterans Affairs (or successor tool), which shall 
include the ability to access the most recent patient 
information from the prescription drug monitoring 
program of each State that has such a program to 
assess the risk for adverse outcomes of opioid ther-
apy for the patient, including with respect to the 
concurrent use of controlled substances, including 
benzodiazepines. 
(6) Guidelines to govern the methodologies used 
by health care providers of the Department of Vet-
erans Affairs and the Department of Defense to 
safely titrate and taper opioid therapy when adjust-
ing or discriminating the use of opioid therapy, in-
cluding with respect to— 
(A) prescription of the lowest effective dose 
based on patient need; 
(B) use of opioid only for a limited period 
of time; and 
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fense Joint Executive Committee established by section 
320 of title 38, United States Code. 
(d) DEFINITIONS.—In this section: 
(1) The term ‘‘controlled substance’’ has the 
meaning given that term in section 102 of the Con-
trolled Substances Act (21 U.S.C. 802). 
(2) The term ‘‘State’’ means each of the several 
States, territories, and possessions of the United 
States, the District of Columbia, and the Common-
wealth of Puerto Rico. 
SEC. 102. IMPROVEMENT OF OPIOID SAFETY MEASURES BY 
DEPARTMENT OF VETERANS AFFAIRS. 
(a) EXPANSION OF OPIOID SAFETY INITIATIVE.— 
Not later than 180 days after the date of the enactment 
of this Act, the Secretary of Veterans Affairs shall expand 
the Opioid Safety Initiative of the Department of Veterans 
Affairs to include all medical facilities of the Department. 
(b) PAIN MANAGEMENT EDUCATION
AND TRAIN-
ING.— 
(1) IN GENERAL.—In carrying out the Opioid 
Safety Initiative of the Department, the Secretary 
shall require all employees of the Department re-
sponsible for prescribing opioids to receive education 
and training described in paragraph (2). 
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(2) EDUCATION
AND
TRAINING.—Education 
and training described in this paragraph is edu-
cation and training on pain management and safe 
opioid prescribing practices for purposes of safely 
and effectively managing patients with chronic pain, 
including education and training on the following: 
(A) The implementation of and full compli-
ance with the VA/DOD Clinical Practice Guide-
line for Management of Opioid Therapy for 
Chronic Pain, including any update to such 
guideline. 
(B) The use of evidence-based pain man-
agement therapies, including cognitive-behav-
ioral therapy, non-opioid alternatives, and non- 
drug methods and procedures to managing pain 
and related health conditions including com-
plementary alternative medicines. 
(C) Screening and identification of patients 
with substance use disorder, including drug- 
seeking behavior, before prescribing opioids, as-
sessment of risk potential for patients devel-
oping an addiction, and referral of patients to 
appropriate addiction treatment professionals if 
addiction is identified or strongly suspected. 
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(D) Communication with patients on the 
potential harm associated with the use of 
opioids and other controlled substances, includ-
ing the need to safely store and dispose of sup-
plies relating to the use of opioids and other 
controlled substances. 
(E) Such other education and training as 
the Secretary considers appropriate to ensure 
that veterans receive safe and high-quality pain 
management care from the Department. 
(3) USE OF EXISTING PROGRAM.—In providing 
education and training described in paragraph (2), 
the Secretary shall use the Interdisciplinary Chronic 
Pain Management Training Team Program of the 
Department (or success program). 
(c) PAIN MANAGEMENT TEAMS.— 
(1) IN GENERAL.—In carrying out the Opioid 
Safety Initiative of the Department, the director of 
each medical facility of the Department shall iden-
tify and designate a pain management team of 
health care professionals, which may include board 
certified pain medicine specialists, responsible for co-
ordinating and overseeing pain management therapy 
at such facility for patients experiencing acute and 
chronic pain that is non-cancer related. 
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(2) ESTABLISHMENT OF PROTOCOLS.— 
(A) IN
GENERAL.—In consultation with 
the Directors of each Veterans Integrated Serv-
ice Network, the Secretary shall establish 
standard protocols for the designation of pain 
management teams at each medical facility 
within the Department. 
(B) CONSULTATION ON PRESCRIPTION OF 
OPIOIDS.—Each protocol established under sub-
paragraph (A) shall ensure that any health care 
provider without expertise in prescribing anal-
gesics or who has not completed the education 
and training under subsection (b), including a 
mental health care provider, does not prescribe 
opioids to a patient unless that health care pro-
vider— 
(i) consults with a health care pro-
vider with pain management expertise or 
who is on the pain management team of 
the medical facility; and 
(ii) refers the patient to the pain man-
agement team for any subsequent prescrip-
tions and related therapy. 
(3) REPORT.— 
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(A) IN GENERAL.—Not later than one year 
after the date of enactment of this Act, the di-
rector of each medical facility of the Depart-
ment shall submit to the Under Secretary for 
Health and the director of the Veterans Inte-
grated Service Network in which the medical fa-
cility is located a report identifying the health 
care professionals that have been designated as 
members of the pain management team at the 
medical facility pursuant to paragraph (1). 
(B) ELEMENTS.—Each report submitted 
under subparagraph (A) with respect to a med-
ical facility of the Department shall include— 
(i) a certification as to whether all 
members of the pain management team at 
the medical facility have completed the 
education and training required under sub-
section (b); and 
(ii) a plan for the management and 
referral of patients to such pain manage-
ment team if health care providers without 
expertise in prescribing analgesics pre-
scribe opioid medications to treat acute 
and chronic pain that is non-cancer re-
lated. 
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(d) TRACKING AND MONITORING OF OPIOID USE.— 
(1) PRESCRIPTION
DRUG
MONITORING
PRO-
GRAMS
OF
STATES.—In carrying out the Opioid 
Safety Initiative and the Opioid Therapy Risk Re-
port tool of the Department, the Secretary shall— 
(A) ensure access by health care providers 
of the Department to information on controlled 
substances, 
including 
opioids 
and 
benzodiazepines, prescribed to veterans who re-
ceive care outside the Department through the 
prescription drug monitoring program of each 
State with such a program, including by seek-
ing to enter into memoranda of understanding 
with States to allow shared access of such infor-
mation between States and the Department; 
(B) include such information in the Opioid 
Therapy Risk Report; and 
(C) require health care providers of the 
Department to submit to the prescription drug 
monitoring program of each State information 
on prescriptions of controlled substances re-
ceived by veterans in that State under the laws 
administered by the Secretary. 
(2) REPORT ON TRACKING OF DATA ON OPIOID 
USE.—Not later than 18 months after the date of 
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the enactment of this Act, 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 the feasibility 
and advisability of improving the Opioid Therapy 
Risk Report tool of the Department to allow for 
more advanced real-time tracking of and access to 
data on— 
(A) the key clinical indicators with respect 
to the totality of opioid use by veterans; 
(B) concurrent prescribing by health care 
providers of the Department of opioids in dif-
ferent health care settings, including data on 
concurrent prescribing of opioids to treat men-
tal health disorders other than opioid use dis-
order; and 
(C) mail-order prescriptions of opioid pre-
scribed to veterans under the laws administered 
by the Secretary. 
(e) AVAILABILITY OF OPIOID RECEPTOR ANTAGO-
NISTS.— 
(1) INCREASED AVAILABILITY AND USE.— 
(A) IN
GENERAL.—The Secretary shall 
maximize the availability of opioid receptor an-
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tagonists approved by the Food and Drug Ad-
ministration, including naloxone, to veterans. 
(B) AVAILABILITY, TRAINING, AND
DIS-
TRIBUTING.—In carrying out subparagraph 
(A), not later than 90 days after the date of the 
enactment of this Act, the Secretary shall— 
(i) equip each pharmacy of the De-
partment with opioid receptor antagonists 
approved by the Food and Drug Adminis-
tration to be dispensed to outpatients as 
needed; and 
(ii) expand the Overdose Education 
and Naloxone Distribution program of the 
Department to ensure that all veterans in 
receipt of health care under laws adminis-
tered by the Secretary who are at risk of 
opioid overdose may access such opioid re-
ceptor antagonists and training on the 
proper administration of such opioid recep-
tor antagonists. 
(C) VETERANS WHO ARE AT RISK.—For 
purposes of subparagraph (B), veterans who are 
at risk of opioid overdose include— 
(i) veterans receiving long-term opioid 
therapy; 
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(ii) veterans receiving opioid therapy 
who have a history of substance use dis-
order or prior instances of overdose; and 
(iii) veterans who are at risk as deter-
mined by a health care provider who is 
treating the veteran. 
(2) REPORT.—Not later than 120 days after 
the date of the enactment of this Act, the Secretary 
shall submit to the Committee on Veterans’ Affairs 
of the Senate and the Committee on Veterans’ Af-
fairs of the House of Representatives a report on 
carrying out paragraph (1), including an assessment 
of any remaining steps to be carried out by the Sec-
retary to carry out such paragraph. 
(f) INCLUSION OF CERTAIN INFORMATION AND CA-
PABILITIES IN OPIOID THERAPY RISK REPORT TOOL OF 
THE DEPARTMENT.— 
(1) INFORMATION.—The Secretary shall include 
in the Opioid Therapy Risk Report tool of the De-
partment— 
(A) information on the most recent time 
the tool was accessed by a health care provider 
of the Department with respect to each veteran; 
and 
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(B) information on the results of the most 
recent urine drug test for each veteran. 
(2) CAPABILITIES.—The Secretary shall include 
in the Opioid Therapy Risk Report tool the ability 
of the health care providers of the Department to 
determine whether a health care provider of the De-
partment prescribed opioids to a veteran without 
checking the information in the tool with respect to 
the veteran. 
(g) NOTIFICATIONS
OF RISK
IN COMPUTERIZED 
HEALTH RECORD.—The Secretary shall modify the com-
puterized patient record system of the Department to en-
sure that any health care provider that accesses the record 
of a veteran, regardless of the reason the veteran seeks 
care from the health care provider, will be immediately no-
tified whether the veteran— 
(1) is receiving opioid therapy and has a history 
of substance use disorder or prior instances of over-
dose; 
(2) has a history of opioid abuse; or 
(3) is at risk of becoming an opioid abuser as 
determined by a health care provider who is treating 
the veteran. 
(h) DEFINITIONS.—In this section: 
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(1) The term ‘‘controlled substance’’ has the 
meaning given that term in section 102 of the Con-
trolled Substances Act (21 U.S.C. 802). 
(2) The term ‘‘State’’ means each of the several 
States, territories, and possessions of the United 
States, the District of Columbia, and the Common-
wealth of Puerto Rico. 
SEC. 103. STRENGTHENING OF JOINT WORKING GROUP ON 
PAIN MANAGEMENT OF THE DEPARTMENT 
OF VETERANS AFFAIRS AND THE DEPART-
MENT OF DEFENSE. 
(a) IN GENERAL.—Not later than 90 days after the 
date of enactment of this Act, the Secretary of Veterans 
Affairs and the Secretary of Defense shall ensure that the 
Pain Management Working Group of the Health Execu-
tive Committee of the Department of Veterans Affairs– 
Department of Defense Joint Executive Committee estab-
lished under section 320 of title 38, United States Code, 
includes a focus on the following: 
(1) The opioid prescribing practices of health 
care providers of each Department. 
(2) The ability of each Department to manage 
acute and chronic pain among individuals receiving 
health care from the Department, including training 
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health care providers with respect to pain manage-
ment. 
(3) The use by each Department of complemen-
tary and integrative health and complementary alter-
native medicines in treating such individuals. 
(4) The concurrent use by health care providers 
of each Department of opioids and prescription 
drugs to treat mental health disorders, including 
benzodiazepines. 
(5) The practice by health care providers of 
each Department of prescribing opioids to treat 
mental health disorders. 
(6) The coordination in coverage of and con-
sistent access to medications prescribed for patients 
transitioning from receiving health care from the 
Department of Defense to receiving health care from 
the Department of Veterans Affairs. 
(7) The ability of each Department to identify 
and treat substance use disorders among individuals 
receiving health care from that Department. 
(b) COORDINATION AND CONSULTATION.—The Sec-
retary of Veterans Affairs and the Secretary of Defense 
shall ensure that the working group described in sub-
section (a)— 
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(1) coordinates the activities of the working 
group with other relevant working groups estab-
lished under section 320 of title 38, United States 
Code, including the working groups on evidence- 
based practice, patient safety, pharmacy, psycho-
logical health, and psychological health; 
(2) consults with other relevant Federal agen-
cies, including the Centers for Disease Control and 
Prevention, with respect to the activities of the 
working group; and 
(3) consults with the Department of Veterans 
Affairs and the Department of Defense with respect 
to, reviews, and comments on the VA/DOD Clinical 
Practice Guideline for Management of Opioid Ther-
apy for Chronic Pain, or any successor guideline, be-
fore any update to the guideline is released. 
(c) CONSULTATIONS.—The Secretary of Veterans Af-
fairs and the Secretary of Defense shall ensure that the 
working group described in subsection (a) is able to mean-
ingfully consult with respect to the updated guideline re-
quired under subsection (a) of section 101, as required 
by subsection (b) of such section, not later than 1 year 
after the date of enactment of this Act. 
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SEC. 104. REVIEW, INVESTIGATION, AND REPORT ON USE 
OF OPIOIDS IN TREATMENT BY DEPARTMENT 
OF VETERANS AFFAIRS. 
(a) COMPTROLLER GENERAL REPORT.— 
(1) IN
GENERAL.—Not later than two years 
after the date of the enactment of this Act, the 
Comptroller General of the United States shall sub-
mit to the Committee on Veterans’ Affairs of the 
Senate and the Committee on Veterans’ Affairs of 
the House of Representatives a report on the Opioid 
Safety Initiative of the Department of Veterans Af-
fairs and the opioid prescribing practices of health 
care providers of the Department. 
(2) ELEMENTS.—The report submitted under 
paragraph (1) shall include the following: 
(A) Recommendations on such improve-
ments to the Opioid Safety Initiative of the De-
partment as the Comptroller General considers 
appropriate. 
(B) Information with respect to— 
(i) deaths resulting from sentinel 
events involving veterans prescribed opioids 
by a health care provider of the Depart-
ment; 
(ii) overall prescription rates and pre-
scriptions indications of opioids to treat 
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non-cancer, non-palliative, and non-hospice 
care patients; 
(iii) the prescription rates and pre-
scriptions indications of benzodiazepines 
and opioids concomitantly by health care 
providers of the Department; 
(iv) the practice by health care pro-
viders of the Department of prescribing 
opioids to treat patients without any pain, 
including to treat patients with mental 
health disorders other than opioid use dis-
order; and 
(v) the effectiveness of opioid therapy 
for patients receiving such therapy, includ-
ing the effectiveness of long-term opioid 
therapy. 
(C) An evaluation of processes of the De-
partment in place to oversee opioid use among 
veterans, including procedures to identify and 
remedy potential over-prescribing of opioids by 
health care providers of the Department. 
(D) An assessment of the implementation 
by the Secretary of the VA/DOD Clinical Prac-
tice Guideline for Management of Opioid Ther-
apy for Chronic Pain. 
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(b) QUARTERLY PROGRESS REPORT ON IMPLEMEN-
TATION
OF
COMPTROLLER
GENERAL
RECOMMENDA-
TIONS.—Not later than two years after the date of the 
enactment of this Act, and not later than 30 days after 
the end of each quarter thereafter, the Secretary of Vet-
erans Affairs shall submit to the Committee on Veterans’ 
Affairs of the Senate and the Committee on Veterans’ Af-
fairs of the House of Representatives a progress report 
detailing the actions by the Secretary during the period 
covered by the report to address any outstanding findings 
and recommendations by the Comptroller General of the 
United States under subsection (a) with respect to the 
Veterans Health Administration. 
(c) ANNUAL REVIEW OF PRESCRIPTION RATES.— 
Not later than one year after the date of the enactment 
of this Act, and not less frequently than annually for the 
following five years, the Secretary shall submit to the 
Committee on Veterans’ Affairs of the Senate and the 
Committee on Veterans’ Affairs of the House of Rep-
resentatives a report, with respect to each medical facility 
of the Department of Veterans Affairs, to collect and re-
view information on opioids prescribed by health care pro-
viders at the facility to treat non-cancer, non-palliative, 
and non-hospice care patients that contains, for the one- 
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year period preceding the submission of the report, the 
following: 
(1) The number of patients and the percentage 
of the patient population of the Department who 
were prescribed benzodiazepines and opioids concur-
rently by a health care provider of the Department. 
(2) The number of patients and the percentage 
of the patient population of the Department without 
any pain who were prescribed opioids by a health 
care provider of the Department, including those 
who were prescribed benzodiazepines and opioids 
concurrently. 
(3) The number of non-cancer, non-palliative, 
and non-hospice care patients and the percentage of 
such patients who were treated with opioids by a 
health care provider of the Department on an inpa-
tient-basis and who also received prescription opioids 
by mail from the Department while being treated on 
an inpatient-basis. 
(4) The number of non-cancer, non-palliative, 
and non-hospice care patients and the percentage of 
such patients who were prescribed opioids concur-
rently by a health care provider of the Department 
and a health care provider that is not health care 
provider of the Department. 
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(5) With respect to each medical facility of the 
Department, information on opioids prescribed by 
health care providers at the facility to treat non-can-
cer, non-palliative, and non-hospice care patients, in-
cluding information on— 
(A) the prescription rate at which each 
health care provider at the facility prescribed 
benzodiazepines and opioids concurrently to 
such patients and the aggregate such prescrip-
tion rate for all health care providers at the fa-
cility; 
(B) the prescription rate at which each 
health care provider at the facility prescribed 
benzodiazepines or opioids to such patients to 
treat conditions for which benzodiazepines or 
opioids are not approved treatment and the ag-
gregate such prescription rate for all health 
care providers at the facility; 
(C) the prescription rate at which each 
health care provider at the facility prescribed or 
dispensed mail-order prescriptions of opioids to 
such patients while such patients were being 
treated with opioids on an inpatient-basis and 
the aggregate of such prescription rate for all 
health care providers at the facility; and 
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(D) the prescription rate at which each 
health care provider at the facility prescribed 
opioids to such patients who were also concur-
rently prescribed opioids by a health care pro-
vider that is not a health care provider of the 
Department and the aggregate of such prescrip-
tion rates for all health care providers at the fa-
cility. 
(6) With respect to each medical facility of the 
Department, the number of times a pharmacist at 
the facility overrode a critical drug interaction warn-
ing with respect to an interaction between opioids 
and another medication before dispensing such medi-
cation to a veteran. 
(d) INVESTIGATION OF PRESCRIPTION RATES.—If 
the Secretary determines that a prescription rate with re-
spect to a health care provider or medical facility of the 
Department conflicts with or is otherwise inconsistent 
with the standards of appropriate and safe care, the Sec-
retary shall— 
(1) immediately notify the Committee on Vet-
erans’ Affairs of the Senate and the Committee on 
Veterans’ Affairs of the House of Representatives of 
such determination, including information relating to 
such determination, prescription rate, and health 
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care provider or medical facility, as the case may be; 
and 
(2) through the Office of the Medical Inspector 
of the Veterans Health Administration, conduct a 
full investigation of the health care provider or med-
ical facility, as the case may be. 
(e) PRESCRIPTION RATE DEFINED.—In this section, 
the term ‘‘prescription rate’’ means, with respect to a 
health care provider or medical facility of the Department, 
each of the following: 
(1) The number of patients treated with opioids 
by the health care provider or at the medical facility, 
as the case may be, divided by the total number of 
pharmacy users of that health care provider or med-
ical facility. 
(2) The average number of morphine equiva-
lents per day prescribed by the health care provider 
or at the medical facility, as the case may be, to pa-
tients being treated with opioids. 
(3) Of the patients being treated with opioids 
by the health care provider or at the medical facility, 
as the case may be, the average number of prescrip-
tions of opioids per patient. 
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TITLE II—PATIENT ADVOCACY 
SEC. 201. COMMUNITY MEETINGS ON IMPROVING CARE 
FURNISHED BY DEPARTMENT OF VETERANS 
AFFAIRS. 
(a) COMMUNITY MEETINGS.— 
(1) MEDICAL
CENTERS.—Not later than 90 
days after the date of the enactment of this Act, and 
not less frequently than once every 90 days there-
after, the Secretary shall ensure that each medical 
facility of the Department of Veterans Affairs hosts 
a community meeting open to the public on improv-
ing health care furnished by the Secretary. 
(2) COMMUNITY
BASED
OUTPATIENT
CLIN-
ICS.—Not later than one year after the date of the 
enactment of this Act, and not less frequently than 
annually thereafter, the Secretary shall ensure that 
each community based outpatient clinic of the De-
partment hosts a community meeting open to the 
public on improving health care furnished by the 
Secretary. 
(b) ATTENDANCE BY DIRECTOR OF VETERANS INTE-
GRATED SERVICE NETWORK OR DESIGNEE.— 
(1) IN
GENERAL.—Each community meeting 
hosted by a medical facility or community based out-
patient clinic under subsection (a) shall be attended 
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by the Director of the Veterans Integrated Service 
Network in which the medical facility or community 
based outpatient clinic, as the case may be, is lo-
cated. Subject to paragraph (2), the Director may 
delegate such attendance only to an employee who 
works in the Office of the Director. 
(2) ATTENDANCE BY DIRECTOR.—Each Direc-
tor of a Veterans Integrated Service Network shall 
personally attend not less than one community meet-
ing under subsection (a) hosted by each medical fa-
cility located in the Veterans Integrated Service Net-
work each year. 
(c) NOTICE.—The Secretary shall notify the Com-
mittee on Veterans’ Affairs of the Senate, the Committee 
on Veterans’ Affairs of the House of Representatives, and 
each Member of Congress (as defined in section 104) who 
represents the area in which the medical facility is located 
of a community meeting under subsection (a) by not later 
than 10 days before such community meeting occurs. 
SEC. 202. IMPROVEMENT OF AWARENESS OF PATIENT AD-
VOCACY PROGRAM AND PATIENT BILL OF 
RIGHTS OF DEPARTMENT OF VETERANS AF-
FAIRS. 
Not later than 90 days after the date of the enact-
ment of this Act, the Secretary of Veterans Affairs shall, 
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in as many prominent locations as the Secretary deter-
mines appropriate to be seen by the largest percentage of 
patients and family members of patients at each medical 
facility of the Department of Veterans Affairs— 
(1) display the purposes of the Patient Advo-
cacy Program of the Department and the contact in-
formation for the patient advocate at such medical 
facility; and 
(2) display the rights and responsibilities of— 
(A) patients and family members and pa-
tients at such medical facility; and 
(B) with respect to community living cen-
ters and other residential facilities of the De-
partment, residents and family members of resi-
dents at such medical facility. 
SEC. 203. COMPTROLLER GENERAL REPORT ON PATIENT 
ADVOCACY PROGRAM OF DEPARTMENT OF 
VETERANS AFFAIRS. 
(a) IN GENERAL.—Not later than two years after the 
date of the enactment of this Act, the Comptroller General 
of the United States shall submit to the Committee on 
Veterans’ Affairs of the Senate and the Committee on Vet-
erans’ Affairs of the House of Representatives a report 
on the Patient Advocacy Program of the Department of 
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Veterans Affairs (in this section referred to as the ‘‘Pro-
gram’’). 
(b) ELEMENTS.—The report required by subsection 
(a) shall include the following: 
(1) A description of the Program, including— 
(A) the purpose of the Program; 
(B) the activities carried out under the 
Program; and 
(C) the sufficiency of the Program in 
achieving the purpose of the Program. 
(2) An assessment of the sufficiency of staffing 
of employees of the Department responsible for car-
rying out the Program. 
(3) An assessment of the sufficiency of the 
training of such employees. 
(4) An assessment of— 
(A) the awareness of the Program among 
veterans and family members of veterans; and 
(B) the use of the Program by veterans 
and family members of veterans. 
(5) Such recommendations and proposals for 
improving or modifying the Program as the Comp-
troller General considers appropriate. 
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(6) Such other information with respect to the 
Program as the Comptroller General considers ap-
propriate. 
TITLE III—COMPLEMENTARY 
AND INTEGRATIVE HEALTH 
SEC. 301. EXPANSION OF RESEARCH AND EDUCATION ON 
AND DELIVERY OF COMPLEMENTARY AND IN-
TEGRATIVE HEALTH TO VETERANS. 
(a) ESTABLISHMENT.—There is established a com-
mission to be known as the ‘‘Creating Options for Vet-
erans’ Expedited Recovery’’ or the ‘‘COVER Commission’’ 
(in this Act referred to as the ‘‘Commission’’). The Com-
mission shall examine the evidence-based therapy treat-
ment model used by the Secretary of Veterans Affairs for 
treating mental health conditions of veterans and the po-
tential benefits of incorporating complementary alter-
native treatments available in non-Department facilities 
(as defined in section 1701 of title 38, United States 
Code). 
(b) DUTIES.—The Commission shall perform the fol-
lowing duties: 
(1) Examine the efficacy of the evidence-based 
therapy model used by the Secretary for treating 
mental health illnesses of veterans and identify areas 
to improve wellness-based outcomes. 
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(2) Conduct a patient-centered survey within 
each of the Veterans Integrated Service Networks to 
examine— 
(A) the experience of veterans with the De-
partment of Veterans Affairs when seeking 
medical assistance for mental health issues 
through the health care system of the Depart-
ment; 
(B) the experience of veterans with non- 
Department facilities and health professionals 
for treating mental health issues; 
(C) the preference of veterans regarding 
available treatment for mental health issues and 
which methods the veterans believe to be most 
effective; 
(D) the experience, if any, of veterans with 
respect to the complementary alternative treat-
ment therapies described in paragraph (3); 
(E) the prevalence of prescribing prescrip-
tion medication among veterans seeking treat-
ment through the health care system of the De-
partment as remedies for addressing mental 
health issues; and 
(F) the outreach efforts of the Secretary 
regarding the availability of benefits and treat-
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ments for veterans for addressing mental health 
issues, including by identifying ways to reduce 
barriers to gaps in such benefits and treat-
ments. 
(3) Examine available research on complemen-
tary alternative treatment therapies for mental 
health issues and identify what benefits could be 
made with the inclusion of such treatments for vet-
erans, including with respect to— 
(A) music therapy; 
(B) equine therapy; 
(C) training and caring for service dogs; 
(D) yoga therapy; 
(E) acupuncture therapy; 
(F) meditation therapy; 
(G) outdoor sports therapy; 
(H) hyperbaric oxygen therapy; 
(I) accelerated resolution therapy; 
(J) art therapy; 
(K) magnetic resonance therapy; and 
(L) other therapies the Commission deter-
mines appropriate. 
(4) Study the sufficiency of the resources of the 
Department to ensure the delivery of quality health 
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care for mental health issues among veterans seek-
ing treatment within the Department. 
(5) Study the current treatments and resources 
available within the Department and assess— 
(A) the effectiveness of such treatments 
and resources in decreasing the number of sui-
cides per day by veterans; 
(B) the number of veterans who have been 
diagnosed with mental health issues; 
(C) the percentage of veterans using the 
resources of the Department who have been di-
agnosed with mental health issues; 
(D) the percentage of veterans who have 
completed counseling sessions offered by the 
Department; and 
(E) the efforts of the Department to ex-
pand complementary alternative treatments via-
ble to the recovery of veterans with mental 
health issues as determined by the Secretary to 
improve the effectiveness of treatments offered 
with the Department. 
(c) MEMBERSHIP.— 
(1) IN
GENERAL.—The Commission shall be 
composed of 10 members, appointed as follows: 
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(A) Two members appointed by the Speak-
er of the House of Representatives, at least one 
of whom shall be a veteran. 
(B) Two members appointed by the Minor-
ity Leader of the House of Representatives, at 
least one of whom shall be a veteran. 
(C) Two members appointed by the Major-
ity Leader of the Senate, at least one of whom 
shall be a veteran. 
(D) Two members appointed by the Minor-
ity Leader of the Senate, at least one of whom 
shall be a veteran. 
(E) Two members appointed by the Presi-
dent, at least one of whom shall be a veteran. 
(2) QUALIFICATIONS.—Members of the Com-
mission shall be— 
(A) individuals who are of recognized 
standing and distinction within the medical 
community with a background in treating men-
tal health; 
(B) individuals with experience working 
with the military and veteran population; and 
(C) individuals who do not have a financial 
interest in any of the complementary alternative 
treatments reviewed by the Commission. 
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(3) CHAIRMAN.—The President shall designate 
a member of the Commission to be the Chairman. 
(4) PERIOD
OF
APPOINTMENT.—Members of 
the Commission shall be appointed for the life of the 
Commission. 
(5) VACANCY.—A vacancy in the Commission 
shall be filled in the manner in which the original 
appointment was made. 
(6) APPOINTMENT
DEADLINE.—The appoint-
ment of members of the Commission in this section 
shall be made not later than 90 days after the date 
of the enactment of this Act. 
(d) POWERS OF COMMISSION.— 
(1) MEETINGS.— 
(A) INITIAL
MEETING.—The Commission 
shall hold its first meeting not later than 30 
days after a majority of members are appointed 
to the Commission. 
(B) MEETING.—The Commission shall reg-
ularly meet at the call of the Chairman. Such 
meetings may be carried out through the use of 
telephonic or other appropriate telecommuni-
cation technology if the Commission determines 
that such technology will allow the members to 
communicate simultaneously. 
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(2) HEARINGS.—The Commission may hold 
such hearings, sit and act at such times and places, 
take such testimony, and receive evidence as the 
Commission considers advisable to carry out the re-
sponsibilities of the Commission. 
(3) INFORMATION FROM FEDERAL AGENCIES.— 
The Commission may secure directly from any de-
partment or agency of the Federal Government such 
information as the Commission considers necessary 
to carry out the duties of the Commission. 
(4) INFORMATION
FROM
NONGOVERNMENTAL 
ORGANIZATIONS.—In carrying out its duties, the 
Commission may seek guidance through consultation 
with foundations, veteran service organizations, non-
profit groups, faith-based organizations, private and 
public institutions of higher education, and other or-
ganizations as the Commission determines appro-
priate. 
(5) COMMISSION
RECORDS.—The Commission 
shall keep an accurate and complete record of the 
actions and meeting of the Commission. Such record 
shall be made available for public inspection and the 
Comptroller General of the United States may audit 
and examine such record. 
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(6) PERSONNEL
RECORDS.—The Commission 
shall keep an accurate and complete record of the 
actions and meetings of the Commission. Such 
record shall be made available for public inspection 
and the Comptroller General of the United States 
may audit and examine such records. 
(7) COMPENSATION OF MEMBERS; TRAVEL EX-
PENSES.—Each member shall serve without pay but 
shall receive travel expenses to perform the duties of 
the Commission, including per diem in lieu of sub-
stances, at rates authorized under subchapter I of 
chapter 57 of title 5, United States Code. 
(8) STAFF.—The Chairman, in accordance with 
rules agreed upon the Commission, may appoint fix 
the compensation of a staff director and such other 
personnel as may be necessary to enable the Com-
mission to carry out its functions, without regard to 
the provisions of title 5, United States Code, gov-
erning appointments in the competitive service, with-
out regard to the provision of chapter 51 and sub-
chapter III of chapter 53 of such title relating to 
classification and General Schedule pay rates, except 
that no rate of pay fixed under this paragraph may 
exceed the equivalent of that payable for a position 
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at a level IV of the Executive Schedule under section 
5316 of title 5, United States Code. 
(9) PERSONNEL AS FEDERAL EMPLOYEES.— 
(A) IN GENERAL.—The executive director 
and any personnel of the Commission are em-
ployees under section 2105 of title 5, United 
States Code, for purpose of chapters 63, 81, 83, 
84, 85, 87, 89, and 90 of such title. 
(B) MEMBERS
OF
THE
COMMISSION.— 
Subparagraph (A) shall not be construed to 
apply to members of the Commission. 
(10) CONTRACTING.—The Commission may, to 
such extent and in such amounts as are provided in 
appropriations Acts, enter into contracts to enable 
the Commission to discharge the duties of the Com-
mission under this Act. 
(11) EXPERT AND CONSULTANT SERVICE.—The 
Commission may procure the services of experts and 
consultants in accordance with section 3109 or title 
5, United States Code, at rates not to exceed the 
daily rate paid to a person occupying a position at 
level IV of the Executive Schedule under section 
3109 of title 5, United States Code. 
(12) POSTAL SERVICE.—The Commission may 
use the United States mails in the same manner and 
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under the same conditions as departments and agen-
cies of the United States. 
(13) PHYSICAL FACILITIES AND EQUIPMENT.— 
Upon the request of the Commission, the Adminis-
trator of General Services shall provide to the Com-
mission, on a reimbursable basis, the administrative 
support services necessary for the Commission to 
carry out its responsibilities under this Act. These 
administrative services may include human resource 
management, budget, leasing accounting, and payroll 
services. 
(e) REPORT.— 
(1) INTERIM REPORTS.— 
(A) IN GENERAL.—Not later than 60 days 
after the date on which the Commission first 
meets, and each 30-day period thereafter end-
ing on the date on which the Commission sub-
mits the final report under paragraph (2), the 
Commission shall submit to the Committees on 
Veterans’ Affairs of the House of Representa-
tives and the Senate and the President a report 
detailing the level of cooperation the Secretary 
of Veterans Affairs (and the heads of other de-
partments or agencies of the Federal Govern-
ment) has provided to the Commission. 
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(B) OTHER REPORTS.—In carrying out its 
duties, at times that the Commission deter-
mines appropriate, the Commission shall submit 
to the Committee on Veterans’ Affairs of the 
House of Representatives and the Senate and 
any other appropriate entities an interim report 
with respect to the findings identified by the 
Commission. 
(2) FINAL REPORT.—Not later than 18 months 
after the first meeting of the Commission, the Com-
mission shall submit to the Committee on Veterans’ 
Affairs of the House of Representatives and the Sen-
ate, the President, and the Secretary of Veterans Af-
fairs a final report on the findings of the Commis-
sion. Such report shall include the following: 
(A) Recommendations to implement in a 
feasible, timely, and cost efficient manner the 
solutions and remedies identified within the 
findings of the Commission pursuant to sub-
section (b). 
(B) An analysis of the evidence-based ther-
apy model used by the Secretary of Veterans 
Affairs for treating veterans with mental health 
care issues, and an examination of the preva-
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lence and efficacy of prescription drugs as a 
means for treatment. 
(C) The findings of the patient-centered 
survey conducted within each of the Veterans 
Integrated Service Networks pursuant to sub-
section (b)(2). 
(D) An examination of complementary al-
ternative treatments described in subsection 
(b)(3) and the potential benefits of incor-
porating such treatments in the therapy models 
used by the Secretary for treating veterans with 
mental health issues. 
(3) PLAN.—Not later than 90 days after the 
date on which the Commission submits the final re-
port under paragraph (2), the Secretary of Veterans 
Affairs shall submit to the Committee on Veterans’ 
Affairs of the House of Representatives and the Sen-
ate a report on the following: 
(A) An action plan for implementing the 
recommendations established by the Commis-
sion on such solutions and remedies for improv-
ing wellness-based outcomes for veterans with 
mental health care issues. 
(B) A feasible timeframe on when the com-
plementary alternative treatments described in 
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subsection (b)(3) can be implemented Depart-
mentwide. 
(C) With respect to each recommendation 
established by the Commission, including any 
complementary alternative treatment, that the 
Secretary determines is not appropriate or fea-
sible to implement, a justification for such de-
termination and an alternative solution to im-
prove the efficacy of the therapy models used by 
the Secretary for treating veterans with mental 
health issues. 
(f) TERMINATION OF COMMISSION.—The Commis-
sion shall terminate 30 days after the Commission submits 
the final report under subsection (e)(2). 
SEC. 302. PILOT PROGRAM ON INTEGRATION OF COM-
PLEMENTARY ALTERNATIVE MEDICINES AND 
RELATED ISSUES FOR VETERANS AND FAM-
ILY MEMBERS OF VETERANS. 
(a) PILOT PROGRAM.— 
(1) IN
GENERAL.—Not later than 180 days 
after the date on which the Secretary of Veterans 
Affairs receives the final report under section 
301(e), the Secretary shall commence a pilot pro-
gram to assess the feasibility and advisability of 
using wellness-based programs (as defined by the 
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Secretary) to complement the provision of pain man-
agement and related health care services, including 
mental health care services, to veterans. 
(2) MATTERS ADDRESSED.—In carrying out the 
pilot program, the Secretary shall 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 pain 
management and related health care services to 
veterans. 
(B) Means of enhancing outreach, and co-
ordination of outreach, by and among providers 
of health care referred to in subparagraph (A) 
on the pain management and related health 
care services available to veterans. 
(C) Means of using wellness-based pro-
grams of providers of health care referred to in 
subparagraph (A) as complements to the provi-
sion by the Department of pain management 
and related health care services to veterans. 
(D) Whether wellness-based programs de-
scribed in subparagraph (C)— 
(i) are effective in enhancing the qual-
ity of life and well-being of veterans; 
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shall be polytrauma rehabilitation centers of the De-
partment. 
(2) MEDICAL
CENTERS
WITH
PRESCRIPTION 
RATES
OF
OPIOIDS
THAT
CONFLICT
WITH
CARE 
STANDARDS.—In selecting the medical centers under 
paragraph (1), the Secretary shall give priority to 
medical centers of the Department at which there is 
a prescription rate of opioids that conflicts with or 
is otherwise inconsistent with the standards of ap-
propriate and safe care. 
(d) PROVISION OF SERVICES.—Under the pilot pro-
gram under subsection (a)(1), the Secretary shall provide 
covered services to covered veterans by integrating com-
plementary and alternative medicines and integrative 
health services with other services provided by the Depart-
ment at the medical centers selected under subsection (c). 
(e) COVERED VETERANS.—For purposes of the pilot 
program under subsection (a)(1), a covered veteran is any 
veteran who— 
(1) has a mental health condition diagnosed by 
a clinician of the Department; 
(2) experiences chronic pain; 
(3) has a chronic condition being treated by a 
clinician of the Department; or 
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(4) is not described in paragraph (1), (2), or 
(3) and requests to participate in the pilot program 
or is referred by a clinician of the Department who 
is treating the veteran. 
(f) COVERED SERVICES.— 
(1) IN GENERAL.—For purposes of the pilot 
program, covered services are services consisting of 
complementary and integrative health services as se-
lected by the Secretary. 
(2) ADMINISTRATION
OF
SERVICES.—Covered 
services shall be administered under the pilot pro-
gram as follows: 
(A) Covered services shall be administered 
by professionals or other instructors with ap-
propriate training and expertise in complemen-
tary and integrative health services who are em-
ployees of the Department or with whom the 
Department enters into an agreement to pro-
vide such services. 
(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, in coordination with 
the Office of Patient Centered Care and Cul-
tural Transformation. 
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(C) Covered services shall be made avail-
able to— 
(i) covered veterans who have received 
conventional treatments from the Depart-
ment for the conditions for which the cov-
ered veteran seeks complementary and in-
tegrative health services under the pilot 
program; and 
(ii) covered veterans who have not re-
ceived conventional treatments from the 
Department for such conditions. 
(g) REPORTS.— 
(1) IN GENERAL.—Not later than 30 months 
after the date on which the Secretary commences the 
pilot program under subsection (a)(1), the Secretary 
shall submit to the Committee on Veterans’ Affairs 
of the Senate and the Committee on Veterans’ Af-
fairs of the House of Representatives a report on the 
pilot program. 
(2) ELEMENTS.—The report under paragraph 
(1) shall include the following: 
(A) The findings and conclusions of the 
Secretary with respect to the pilot program 
under subsection (a)(1), including with respect 
to— 
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(i) the use and efficacy of the com-
plementary and integrative health services 
established under the pilot program; 
(ii) the outreach conducted by the 
Secretary to inform veterans and commu-
nity organizations about the pilot program; 
and 
(iii) an assessment of the benefit of 
the pilot program to covered veterans in 
mental health diagnoses, pain manage-
ment, and treatment of chronic illness. 
(B) Identification of any unresolved bar-
riers that impede the ability of the Secretary to 
incorporate 
complementary 
and 
integrative 
health services with other health care services 
provided by the Department. 
(C) Such recommendations for the continu-
ation or expansion of the pilot program as the 
Secretary considers appropriate. 
(h) COMPLEMENTARY AND INTEGRATIVE HEALTH 
DEFINED.—In this section, the term ‘‘complementary and 
integrative health’’ shall have the meaning given that term 
by the National Institutes of Health. 
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TITLE IV—FITNESS OF HEALTH 
CARE PROVIDERS 
SEC. 401. ADDITIONAL REQUIREMENTS FOR HIRING OF 
HEALTH CARE PROVIDERS BY DEPARTMENT 
OF VETERANS AFFAIRS. 
As part of the hiring process for each health care pro-
vider considered for a position at the Department of Vet-
erans Affairs after the date of the enactment of the Act, 
the Secretary of Veterans Affairs shall require from the 
medical board of each State in which the health care pro-
vider has a medical license— 
(1) information on any violation of the require-
ments of the medical license of the health care pro-
vider during the 20-year period preceding the con-
sideration of the health care provider by the Depart-
ment; and 
(2) information on whether the health care pro-
vider has entered into any settlement agreement for 
the disciplinary charge relating to the practice of 
medicine by the health care provider. 
SEC. 402. PROVISION OF INFORMATION ON HEALTH CARE 
PROVIDERS OF DEPARTMENT OF VETERANS 
AFFAIRS TO STATE MEDICAL BOARDS. 
Notwithstanding section 552a of title 5, United 
States Code, with respect to each health care provider of 
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the Department of Veterans Affairs who has violated a 
requirement of the medical license of the health care pro-
vider, the Secretary of Veterans Affairs shall provide to 
the medical board of each State in which the health care 
provider is licensed detailed information with respect to 
such violation, regardless of whether such board has for-
mally requested such information. 
SEC. 403. REPORT ON COMPLIANCE BY DEPARTMENT OF 
VETERANS 
AFFAIRS 
WITH 
REVIEWS 
OF 
HEALTH CARE PROVIDERS LEAVING THE DE-
PARTMENT OR TRANSFERRING TO OTHER 
FACILITIES. 
Not later than two years after the date of the enact-
ment of this Act, the Secretary of Veterans Affairs shall 
submit to the Committee on Veterans’ Affairs of the Sen-
ate and the Committee on Veterans’ Affairs of the House 
of Representatives a report on the compliance by the De-
partment of Veterans Affairs with the policy of the De-
partment— 
(1) to conduct a review of each health care pro-
vider of the Department who transfers to another 
medical facility of the Department, retires, or is ter-
minated to determine whether there are any con-
cerns, complaints, or allegations of violations relat-
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ing to the medical practice of the health care pro-
vider; and 
(2) to take appropriate action with respect to 
any such concern, complaint, or allegation. 
TITLE V—OTHER VETERANS 
MATTERS 
SEC. 501. AUDIT OF VETERANS HEALTH ADMINISTRATION 
PROGRAMS OF DEPARTMENT OF VETERANS 
AFFAIRS. 
(a) AUDIT.—The Secretary of Veterans Affairs shall 
seek to enter into a contract with a nongovernmental enti-
ty under which the entity shall conduct a audits of the 
programs of the Veterans Health Administration of the 
Department of Veterans Affairs to identify ways to im-
prove the furnishing of benefits and health care adminis-
tered by the Veterans Health Administration to veterans 
and families of veterans. 
(b) AUDIT REQUIREMENTS.—In carrying out each 
audit under subsection (a), the entity shall perform the 
following: 
(1) Five-year risk assessments to identify the 
functions, staff organizations, and staff offices of the 
Veterans Health Administration that would lead to-
wards the greatest improvement in furnishing of 
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benefits and health care to veterans and families of 
veterans. 
(2) Development of plans that are informed by 
the risk assessment under paragraph (1) to conduct 
audits of the functions, staff organizations, and staff 
offices identified under paragraph (1). 
(3) Conduct audits in accordance with the plans 
developed pursuant to paragraph (2). 
(c) REPORTS.—Not later than 90 days after the date 
on which each audit is completed under subsection (a), 
the Secretary shall submit to the Committees on Veterans’ 
Affairs of the House of Representatives and the Senate 
a report that includes— 
(1) a summary of the audit; 
(2) the findings of the entity that conducted the 
audit with respect to the audit; and 
(3) such recommendations as the Secretary de-
termines appropriate for legislative or administrative 
action to improve the furnishing of benefits and 
health care to veterans and families of veterans. 
Æ 
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