H. R. 2617—974 
‘‘(2) A veteran on whose behalf the Secretary pays for care 
in a medical foster home under paragraph (1) shall agree, as a 
condition of such payment, to accept home health services furnished 
by the Secretary under section 1717 of this title. 
‘‘(3) In any year, not more than a daily average of 900 veterans 
receiving care in a medical foster home, whether placed before, 
on, or after the date of the enactment of the Joseph Maxwell 
Cleland and Robert Joseph Dole Memorial Veterans Benefits and 
Health Care Improvement Act of 2022, may have their care covered 
at the expense of the United States under paragraph (1). 
‘‘(4) The prohibition under section 1730(b)(3) of this title shall 
not apply to a veteran whose care is covered at the expense of 
the United States under paragraph (1). 
‘‘(5) In this subsection, the term ‘medical foster home’ means 
a home designed to provide non-institutional, long-term, supportive 
care for veterans who are unable to live independently and prefer 
a family setting.’’. 
(2) EFFECTIVE DATE.—Subsection (h) of section 1720 of title 
38, United States Code, as added by paragraph (1), shall take 
effect 90 days after the date of the enactment of this Act. 
(b) ONGOING MONITORING
OF MEDICAL FOSTER HOME PRO-
GRAM.— 
(1) IN GENERAL.—The Secretary of Veterans Affairs shall 
create a system to monitor and assess the workload for the 
Department of Veterans Affairs in carrying out the authority 
under section 1720(h) of title 38, United States Code, as added 
by subsection (a)(1), including by tracking— 
(A) requests by veterans to be placed in a medical 
foster home under such section; 
(B) denials of such requests, including the reasons 
for such denials; 
(C) the total number of medical foster homes applying 
to participate under such section, disaggregated by those 
approved and those denied approval by the Department 
to participate; 
(D) veterans receiving care at a medical foster home 
at the expense of the United States; and 
(E) veterans receiving care at a medical foster home 
at their own expense. 
(2) REPORT.—Based on the monitoring and assessments 
conducted under paragraph (1), the Secretary shall identify 
and submit to Congress a report on such modifications to imple-
menting section 1720(h) of title 38, United States Code, as 
added by subsection (a)(1), as the Secretary considers necessary 
to ensure the authority under such section is functioning as 
intended and care is provided to veterans under such section 
as intended. 
(3) MEDICAL FOSTER HOME DEFINED.—In this subsection, 
the term ‘‘medical foster home’’ has the meaning given that 
term in section 1720(h) of title 38, United States Code, as 
added by subsection (a)(1). 
(c) COMPTROLLER GENERAL REPORT.—Not later than each of 
three years and six years after the date of the enactment of this 
Act, the Comptroller General of the United States shall submit 
to Congress a report— 
(1) assessing the implementation of this section and the 
amendments made by this section;
H. R. 2617—975 
(2) assessing the impact of the monitoring and modifica-
tions under subsection (b) on care provided under section 
1720(h) of title 38, United States Code, as added by subsection 
(a)(1); and 
(3) setting forth recommendations for improvements to the 
implementation of such section, as the Comptroller General 
considers appropriate. 
Subtitle F—Foreign Medical Program 
SEC. 
171. 
ANALYSIS 
OF 
FEASIBILITY 
AND 
ADVISABILITY 
OF 
EXPANDING ASSISTANCE AND SUPPORT TO CAREGIVERS 
TO INCLUDE CAREGIVERS OF VETERANS IN THE REPUBLIC 
OF THE PHILIPPINES. 
(a) FINDINGS.—Congress makes the following findings: 
(1) Although section 161 of the VA MISSION Act of 2018 
(Public Law 115–182; 132 Stat. 1438) expanded the program 
of comprehensive assistance for family caregivers of the Depart-
ment of Veterans Affairs under section 1720G(a) of title 38, 
United States Code, to veterans of all eras, it did not expand 
the program to family caregivers for veterans overseas. 
(2) Although caregivers for veterans overseas can access 
online resources as part of the program of support services 
for caregivers of veterans under subsection (b) section 1720G 
of such title, those caregivers are not currently eligible for 
the comprehensive services and benefits provided under sub-
section (a) of such section. 
(3) The Department has an outpatient clinic and a regional 
benefits office in Manila, Republic of the Philippines, and the 
Foreign Medical Program of the Department under section 
1724 of such title is used heavily in the Republic of the Phil-
ippines by veterans who live in that country. 
(4) Due to the presence of facilities of the Department 
in the Republic of the Philippines and the number of veterans 
who reside there, that country is a suitable test case to analyze 
the feasibility and advisability of expanding caregiver support 
to caregivers of veterans overseas. 
(b) ANALYSIS.—Not later than 180 days after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall com-
plete an analysis of the feasibility and advisability of making assist-
ance and support under section 1720G(a) of title 38, United States 
Code, available to caregivers of veterans in the Republic of the 
Philippines. 
(c) REPORT.—Not later than 180 days after the conclusion of 
the analysis conducted under subsection (b), 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 that includes the following: 
(1) The results of such analysis. 
(2) An assessment of the number of veterans who are 
enrolled in the patient enrollment system and reside in the 
Republic of the Philippines. 
(3) An assessment of the number of veterans residing in 
the Republic of the Philippines with a disability rating from 
the Department of not less than 70 percent.
H. R. 2617—976 
(4) An assessment of the number of veterans who are 
enrolled in the patient enrollment system and reside in the 
Republic of the Philippines that have a caregiver to provide 
them personal care services described in section 1720G(a)(C) 
of title 38, United States Code. 
(5) An assessment of the staffing needs and associated 
costs of making assistance and support available to caregivers 
of veterans in the Republic of the Philippines. 
(6) An assessment of the infrastructure needs and associ-
ated costs of making assistance and support available to care-
givers of veterans in the Republic of the Philippines. 
(7) An assessment of the local transportation challenges 
to making assistance and support available to caregivers of 
veterans in the Republic of the Philippines. 
(8) An assessment of how the Secretary would determine 
payment rates for caregivers of veterans in the Republic of 
the Philippines to account for variances in living standards 
in the Republic of the Philippines. 
(9) Such other elements as the Secretary considers appro-
priate. 
(d) DEFINITIONS.—In this section: 
(1) CAREGIVER.—The term ‘‘caregiver’’ has the meaning 
given that term in section 1720G(d) of title 38, United States 
Code. 
(2) PATIENT
ENROLLMENT
SYSTEM.—The term ‘‘patient 
enrollment system’’ means the system of annual patient enroll-
ment of the Department of Veterans Affairs established and 
operated under section 1705(a) of such title. 
(3) VETERAN.—The term ‘‘veteran’’ has the meaning given 
that term in section 101(2) of such title. 
SEC. 172. COMPTROLLER GENERAL REPORT ON FOREIGN MEDICAL 
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 Veterans’ Affairs of the House of 
Representatives a report on the Foreign Medical Program. 
(b) ELEMENTS.—The report required by subsection (a) shall 
include, for the most recent five fiscal years for which data are 
available, an assessment of the following: 
(1) The number of veterans who live overseas and are 
eligible for the Foreign Medical Program. 
(2) The number of veterans who live overseas, are reg-
istered for the Foreign Medical Program, and use such program. 
(3) The number of veterans who live overseas, are reg-
istered for the Foreign Medical Program, and do not use such 
program. 
(4) The number of veterans who are eligible for care fur-
nished by the Department of Veterans Affairs, live in the United 
States, including territories of the United States, and make 
use of such care, including through the Veterans Community 
Care Program under section 1703 of title 38, United States 
Code. 
(5) Any challenges faced by the Department in admin-
istering the Foreign Medical Program, including—
H. R. 2617—977 
(A) outreach to veterans on eligibility for such program 
and ensuring veterans who live overseas are aware of such 
program; 
(B) executing timely reimbursements of claims by vet-
erans under such program; and 
(C) need for and use of translation services. 
(6) Any trends relating to— 
(A) the timeliness of processing by the Department 
of claims under the Foreign Medical Program and 
reimbursement of veterans under such program; 
(B) types of care or treatment sought by veterans who 
live overseas that is reimbursed under such program; and 
(C) types of care or treatment eligible for reimburse-
ment under such program that veterans have difficulty 
accessing overseas. 
(7) Any barriers or obstacles cited by veterans who live 
overseas who are registered for the Foreign Medical Program, 
including any differences between veterans who use the pro-
gram and veterans who do not. 
(8) Satisfaction of veterans who live overseas with the 
Foreign Medical Program. 
(9) Such other areas as the Comptroller General considers 
appropriate. 
(c) FOREIGN MEDICAL PROGRAM DEFINED.—In this section, the 
term ‘‘Foreign Medical Program’’ means the program under with 
the Secretary of Veterans Affairs provides hospital care and medical 
services under section 1724 of title 38, United States Code. 
Subtitle G—Research Matters 
SEC. 181. INAPPLICABILITY OF PAPERWORK REDUCTION ACT. 
(a) IN GENERAL.—Subchapter II of chapter 73 of title 38, United 
States Code, is amended by adding at the end the following new 
section: 
‘‘§ 7330D. Inapplicability of Paperwork Reduction Act to 
research activities 
‘‘Subchapter I of chapter 35 of title 44 (commonly referred 
to as the ‘Paperwork Reduction Act’) shall not apply to the voluntary 
collection of information during the conduct of research by the 
Veterans Health Administration, including the Office of Research 
and Development, or individuals or entities affiliated with the Vet-
erans Health Administration.’’. 
(b) CLERICAL AMENDMENT.—The table of sections at the begin-
ning of such subchapter is amended by inserting after the item 
relating to section 7330C the following new item: 
‘‘(1) ‘‘7330D. Inapplicability of Paperwork Reduction Act 
to research activities.’’. 
SEC. 182. RESEARCH AND DEVELOPMENT. 
(a) OFFICE OF RESEARCH AND DEVELOPMENT.—Chapter 73 of 
title 38, United States Code, is amended by adding at the end 
the following new subchapter:
H. R. 2617—978 
‘‘SUBCHAPTER V—RESEARCH AND DEVELOPMENT 
‘‘§ 7381. Office of Research and Development 
‘‘(a) OFFICE OF RESEARCH AND DEVELOPMENT.—There is in the 
Veterans Health Administration an Office of Research and Develop-
ment (in this section referred to as the ‘Office’). 
‘‘(b) PURPOSES.—The function of the Office is to serve veterans 
through a full spectrum of research (including pre-clinical, clinical, 
and health systems science), technology transfer, and application. 
‘‘(c) CHIEF RESEARCH AND DEVELOPMENT OFFICER.—The head 
of the Office is the Chief Research and Development Officer. 
‘‘(d) ORGANIZATION AND PERSONNEL.—The Office shall be orga-
nized in such manner, and its personnel shall perform such duties 
and have such titles, as the Secretary may prescribe. 
‘‘§ 7382. Research personnel 
‘‘(a) WAIVER OF INTERGOVERNMENTAL PERSONNEL ACT MOBILITY 
PROGRAM LIMITS.—The Secretary may waive the limit on the period 
and number of assignments required under section 3372(a) of title 
5 with respect to an individual who performs research for the 
Department under the mobility program under subchapter VI of 
chapter 33 of such title (commonly referred to as the ‘Intergovern-
mental Personnel Act Mobility Program’). 
‘‘(b) OUTSIDE EARNED INCOME FOR RESEARCH FOR THE DEPART-
MENT.—(1) Compensation from a nonprofit corporation established 
under subchapter IV of this chapter, or a university affiliated with 
the Department, may be paid, without regard to section 209 of 
title 18, to an employee described in paragraph (2), for research 
conducted pursuant to section 7303 of this title if— 
‘‘(A) the research has been approved in accordance with 
procedures prescribed by the Under Secretary for Health; 
‘‘(B) the employee conducts research under the supervision 
of personnel of the Department; and 
‘‘(C) the Secretary agreed to the terms of such compensation 
in writing. 
‘‘(2) An employee described in this subsection is an employee 
who has an appointment within the Department, whether with 
or without compensation, and without regard to the source of such 
compensation.’’. 
(b) CLERICAL AMENDMENT.—The table of sections at the begin-
ning of such chapter is amended by adding at the end the following 
new items: 
‘‘SUBCHAPTER V—RESEARCH AND DEVELOPMENT 
‘‘7381. Office of Research and Development. 
‘‘7382. Research personnel.’’. 
SEC. 183. EXPANSION OF HIRING AUTHORITIES FOR CERTAIN CLASSES 
OF RESEARCH OCCUPATIONS. 
Section 7401(3) of title 38, United States Code, is amended 
by inserting ‘‘statisticians, economists, informaticists, data sci-
entists, and’’ after ‘‘blind rehabilitation outpatient specialists,’’. 
SEC. 184. COMPTROLLER GENERAL STUDY ON DEDICATED RESEARCH 
TIME FOR CERTAIN PERSONNEL OF THE DEPARTMENT OF 
VETERANS AFFAIRS. 
(a) STUDY.—The Comptroller General of the United States shall 
conduct a study on the amount of time dedicated for research
H. R. 2617—979 
for clinician-scientists appointed by the Secretary of Veterans 
Affairs. 
(b) ELEMENTS.—The study under subsection (a) shall include 
the following: 
(1) A review of the policies and practices of the Department 
of Veterans Affairs regarding the time dedicated for research 
for the personnel specified in subsection (a). 
(2) An assessment of the effect of such policies and practices 
on the following: 
(A) The recruitment and retention efforts of the Depart-
ment. 
(B) The productivity of the personnel specified in sub-
section (a) with respect to research. 
(C) The efficient use of resources available for research 
on issues relating to the health of veterans. 
(c) REPORT.—Not later than two years after the date of the 
enactment of this Act, the Comptroller General 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 
detailing the findings of the study conducted under subsection (a). 
Subtitle H—Mental Health Care 
SEC. 191. ANALYSIS OF FEASIBILITY AND ADVISABILITY OF DEPART-
MENT OF VETERANS AFFAIRS PROVIDING EVIDENCE- 
BASED TREATMENTS FOR THE DIAGNOSIS OF TREATMENT- 
RESISTANT DEPRESSION. 
(a) FINDINGS.—Congress makes the following findings: 
(1) A systematic review in 2019 of the economics and 
quality of life relating to treatment-resistant depression 
summarized that major depressive disorder (in this subsection 
referred to as ‘‘MDD’’) is a global public health concern and 
that treatment-resistant depression in particular represents a 
key unmet need. The findings of that review highlighted the 
need for improved therapies for treatment-resistant depression 
to reduce disease burden, lower medical costs, and improve 
the quality of life of patients. 
(2) The Clinical Practice Guideline for the Management 
of MDD (in this subsection referred to as the ‘‘CPG’’) developed 
jointly by the Department of Veterans Affairs and the Depart-
ment of Defense defines treatment-resistant depression as at 
least two adequate treatment trials and lack of full response 
to each. 
(3) The CPG recommends electro-convulsive therapy (in 
this subsection referred to as ‘‘ECT’’) as a treatment strategy 
for patients who have failed multiple other treatment strategies. 
(4) The CPG recommends offering repetitive transcranial 
magnetic stimulation (in this subsection referred to as ‘‘rTMS’’), 
an intervention that is indicated by the Food and Drug Adminis-
tration, for treatment during a major depressive episode in 
patients with treatment-resistant MDD. 
(5) The final report of the Creating Options for Veterans’ 
Expedited Recovery Commission (commonly referred to as the 
‘‘COVER Commission’’) established under section 931 of the 
Jason Simcakoski Memorial and Promise Act (title IX of Public
H. R. 2617—980 
Law 114–198; 38 U.S.C. 1701 note) found that treatment-resist-
ant depression is a major issue throughout the mental health 
treatment system, and that an estimated 50 percent of 
depressed patients are inadequately treated by available inter-
ventions. 
(6) The COVER Commission also reported data collected 
from the Department of Veterans Affairs that found that only 
approximately 1,166 patients throughout the Department were 
referred for ECT in 2018 and only approximately 772 patients 
were referred for rTMS during that year. 
(b) ANALYSIS.—Not later than 180 days after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall com-
plete an analysis of the feasibility and advisability of making repet-
itive transcranial magnetic stimulation available at all medical 
facilities of the Department of Veterans Affairs and electro-convul-
sive therapy available at one medical center located within each 
Veterans Integrated Service Network for the treatment of veterans 
who are enrolled in the patient enrollment system and have a 
diagnosis of treatment-resistant depression. 
(c) INCLUSION OF ASSESSMENT OF REPORT.—The analysis con-
ducted under subsection (b) shall include an assessment of the 
final report of the COVER Commission submitted under section 
931(e)(2) of the Jason Simcakoski Memorial and Promise Act (title 
IX of Public Law 114–198; 38 U.S.C. 1701 note). 
(d) REPORT.—Not later than 180 days after the conclusion of 
the analysis conducted under subsection (b), 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 that includes the following: 
(1) The results of such analysis. 
(2) An assessment of the number of veterans who are 
enrolled in the patient enrollment system and who have a 
diagnosis of treatment-resistant depression per Veterans 
Integrated Service Network during the two-year period pre-
ceding the date of the report. 
(3) An assessment of the number of the veterans who 
are enrolled in the patient enrollment system who have a 
diagnosis of treatment-resistant depression and who have 
received or are currently receiving repetitive transcranial mag-
netic stimulation or electro-convulsive therapy as a treatment 
modality during the two-year period preceding the date of the 
report. 
(4) An assessment of the number and locations of medical 
centers of the Department that currently provide repetitive 
transcranial magnetic stimulation to veterans who are enrolled 
in the patient enrollment system and who have a diagnosis 
of treatment-resistant depression. 
(5) An assessment of the number and locations of medical 
centers of the Department that currently provide electro-convul-
sive therapy to veterans who are enrolled in the patient enroll-
ment system and who have a diagnosis of treatment-resistant 
depression. 
(e) PATIENT ENROLLMENT SYSTEM DEFINED.—In this section, 
the term ‘‘patient enrollment system’’ means the system of annual 
patient enrollment of the Department of Veterans Affairs estab-
lished and operated under section 1705(a) of title 38, United States 
Code.
H. R. 2617—981 
SEC. 192. MODIFICATION OF RESOURCE ALLOCATION SYSTEM TO 
INCLUDE PEER SPECIALISTS. 
(a) IN GENERAL.—Not later than one year after the date of 
the enactment of this Act, the Secretary of Veterans Affairs shall 
modify the Veterans Equitable Resource Allocation system, or suc-
cessor system, to ensure that resource allocations under such 
system, or successor system, include peer specialists appointed 
under section 7402(b)(13) of title 38, United States Code. 
(b) VETERANS
EQUITABLE
RESOURCE
ALLOCATION
SYSTEM 
DEFINED.—In this section, the term ‘‘Veterans Equitable Resource 
Allocation system’’ means the resource allocation system established 
pursuant to section 429 of the Departments of Veterans Affairs 
and House and Urban Development, and Independent Agencies 
Appropriations Act, 1997 (Public Law 104–204; 110 Stat. 2929). 
SEC. 193. GAP ANALYSIS OF PSYCHOTHERAPEUTIC INTERVENTIONS 
OF THE DEPARTMENT OF VETERANS AFFAIRS. 
(a) IN GENERAL.—Not later than 270 days after the date of 
the enactment of this Act, the Secretary of Veterans Affairs shall 
complete a gap analysis throughout the entire health care system 
of the Veterans Health Administration on the use and availability 
of psychotherapeutic interventions recommended in widely used 
clinical practice guidelines as recommended in the final report 
of the COVER Commission submitted under section 931(e)(2) of 
the Jason Simcakoski Memorial and Promise Act (title IX of Public 
Law 114–198; 38 U.S.C. 1701 note). 
(b) ELEMENTS.—The gap analysis required under subsection 
(a) shall include the following: 
(1) An assessment of the psychotherapeutic interventions 
available and routinely delivered to veterans at medical centers 
of the Department of Veterans Affairs within each Veterans 
Integrated Service Network of the Department. 
(2) An assessment of the barriers faced by medical centers 
of the Department in offering certain psychotherapeutic inter-
ventions and why those interventions are not widely imple-
mented or are excluded from implementation throughout the 
entire health care system of the Veterans Health Administra-
tion. 
(c) REPORT AND PLAN.—Not later than 180 days after com-
pleting the gap analysis under subsection (a), the Secretary shall 
submit to the Committee on Veterans’ Affairs of the Senate and 
the Committee on Veterans’ Affairs of the House of Representa-
tives— 
(1) a report on the results of the analysis; and 
(2) a plan with measurable, time-limited steps for the 
Department to implement— 
(A) to address the gaps that limit access of veterans 
to care; and 
(B) to treat various mental health conditions across 
the entire health care system of the Veterans Health 
Administration. 
SEC. 193A. PROHIBITION ON COLLECTION OF COPAYMENTS FOR FIRST 
THREE MENTAL HEALTH CARE OUTPATIENT VISITS OF 
VETERANS. 
(a) PROHIBITION
ON COLLECTION.—Chapter 17 of title 38, 
United States Code, is amended by inserting after section 1722B
H. R. 2617—982 
the following new section (and conforming the table of sections 
at the beginning of such chapter accordingly): 
‘‘§ 1722C. Copayments: prohibition on collection of copay-
ments for first three mental health care out-
patient visits of veterans 
‘‘(a) PROHIBITION.—Except as provided in subsection (b), not-
withstanding section 1710(g) of this title or any other provision 
of law, the Secretary may not impose or collect a copayment for 
the first three mental health care outpatient visits of a veteran 
in a calendar year for which the veteran would otherwise be 
required to pay a copayment under the laws administered by the 
Secretary. 
‘‘(b) COPAYMENT FOR MEDICATIONS.—The prohibition under sub-
section (a) shall not apply with respect to the imposition or collection 
of copayments for medications pursuant to section 1722A of this 
title. 
‘‘(c) MENTAL HEALTH CARE OUTPATIENT VISIT DEFINED.—In 
this section, the term ‘mental health care outpatient visit’ means 
an outpatient visit with a qualified mental health professional 
for the primary purpose of seeking mental health care or treatment 
for substance abuse disorder. 
‘‘(d) SUNSET.—This section shall terminate on the date that 
is five years after the date of the enactment of the Joseph Maxwell 
Cleland and Robert Joseph Dole Memorial Veterans Benefits and 
Health Care Improvement Act of 2022.’’. 
(b) APPLICABILITY.—The amendment made by subsection (a) 
shall apply with respect to mental health care outpatient visits 
occurring on or after the date that is 180 days after the date 
of the enactment of this Act. 
Subtitle I—Other Matters 
SEC. 194. REQUIREMENT FOR ONGOING INDEPENDENT ASSESSMENTS 
OF HEALTH CARE DELIVERY SYSTEMS AND MANAGEMENT 
PROCESSES OF THE DEPARTMENT OF VETERANS AFFAIRS. 
(a) ONGOING ASSESSMENTS.—Subchapter I of chapter 17 of title 
38, United States Code, is amended by inserting after section 1704 
the following new section: 
‘‘§ 1704A. Independent assessments of health care delivery 
systems and management processes 
‘‘(a) INDEPENDENT ASSESSMENTS.—(1) Not less frequently than 
once every 10 years, the Secretary shall enter into one or more 
contracts with a private sector entity or entities described in sub-
section (d) to conduct an independent assessment of the hospital 
care, medical services, and other health care furnished by the 
Department. 
‘‘(2) Each assessment required under paragraph (1) shall 
address each of the following: 
‘‘(A) Current and projected demographics and unique health 
care needs of the patient population served by the Department. 
‘‘(B) The accuracy of models and forecasting methods used 
by the Department to project health care demand, including 
with respect to veteran demographics, rates of use of health 
care furnished by the Department, the inflation of health care