II 113th CONGRESS 2d Session S. 2182 IN THE SENATE OF THE UNITED STATES March 27, 2014 Mr. Walsh (for himself and Mr. Tester ) introduced the following bill; which was read twice and referred to the Committee on Veterans' Affairs A BILL To expand and improve care provided to veterans and members of the Armed Forces with mental health disorders or at risk of suicide, to review the terms or characterization of the discharge or separation of certain individuals from the Armed Forces, to require a pilot program on loan repayment for psychiatrists who agree to serve in the Veterans Health Administration of the Department of Veterans Affairs, and for other purposes.

1. Short title This Act may be cited as the Suicide Prevention for American Veterans Act . 2. Extension of eligibility for domiciliary care for certain veterans who served in a theater of combat operations Section 1710(e)(3)(A) of title 38, United States Code, is amended by striking period of five years and inserting period of 15 years . 3. Review of characterization or terms of discharge from the Armed Forces of individuals with mental health disorders alleged to affect terms of discharge (a) In general The Secretaries of the military departments shall each provide for a process by which a covered individual may challenge the terms or characterization of the individual's discharge or separation from the Armed Forces. (b) Covered individuals For purposes of this section, a covered individual is any individual as follows: (1) An individual who was discharged or separated from the Armed Forces for a personality disorder. (2) An individual who— (A) was discharged or separated from the Armed Forces on a punitive basis, or under other than honorable conditions; and (B) who alleges that the basis for such discharge or separation was a mental health injury or disorder incurred or aggravated by the individual during service in the Armed Forces. (c) Discharge of process through boards of corrections of records The Secretary of a military department shall carry out the process required by subsection (a) through boards for the correction of military records of the military department concerned. (d) Considerations on modification of terms of discharge or separation In deciding whether to modify the terms or characterization of an individual's discharge or separation pursuant to the process required by subsection (a), the Secretary of the military department concerned shall instruct boards to give due consideration to any mental health injury or disorder determined to have been incurred or aggravated by the individual during service in the Armed Forces and to what bearing such injury or disorder may have had on the circumstances surrounding the individual's discharge or separation from the Armed Forces. 4. Improvement of mental health care provided by Department of Veterans Affairs and Department of Defense (a) Evaluations of mental health care and suicide prevention programs (1) In general Not less frequently than once each year, the Secretary concerned shall provide for the conduct of an evaluation of the mental health care and suicide prevention programs carried out under the laws administered by such Secretary. (2) Elements Each evaluation conducted under paragraph (1) shall— (A) use metrics that are common among and useful for practitioners in the field of mental health care and suicide prevention; (B) identify the most effective mental health care and suicide prevention programs conducted by the Secretary concerned; and (C) propose best practices for caring for individuals who suffer from mental health disorders or are at risk of suicide. (3) Third party Each evaluation conducted under paragraph (1) shall be conducted by an independent third party unaffiliated with the Department of Veterans Affairs and the Department of Defense. (b) Training of providers (1) In general The Secretary concerned shall train all providers of health care under the laws administered by such Secretary on the following: (A) Recognizing if an individual is at risk of suicide. (B) Treating or referring for treatment an individual who is at risk of suicide. (C) Recognizing the symptoms of posttraumatic stress disorder. (2) Dissemination of best practices The Secretary concerned shall ensure that best practices for identifying individuals at risk of suicide and providing quality mental health care are disseminated to providers of health care under the laws administered by such Secretary. (c) Secretary concerned defined In this section, the term Secretary concerned means— (1) the Secretary of Veterans Affairs with respect to matters concerning the Department of Veterans Affairs; and (2) the Secretary of Defense with respect to matters concerning the Department of Defense. 5. Collaboration between Department of Veterans Affairs and Department of Defense on health care matters (a) Timeline for implementing interoperable electronic health records (1) In general Section 1635 of the Wounded Warrior Act ( 10 U.S.C. 1071 note) is amended by adding at the end the following new subsection: (k) Timeline In carrying out this section, the Secretary of Defense and the Secretary of Veterans Affairs shall ensure that— (1) the creation of a health data authoritative source by the Department of Defense and the Department of Veterans Affairs that can be accessed by multiple providers and standardizes the input of new medical information is achieved not later than 180 days after the date of the enactment of this subsection; (2) the ability of patients of both the Department of Defense and the Department of Veterans Affairs to download the medical records of the patient (commonly referred to as the Blue Button Initiative ) is achieved not later than 180 days after the date of the enactment of this subsection; (3) the full interoperability of personal health care information between the Departments is achieved not later than one year after the date of the enactment of this subsection; (4) the acceleration of the exchange of real-time data between the Departments is achieved not later than one year after the date of the enactment of this subsection; (5) the upgrade of the graphical user interface to display a joint common graphical user interface is achieved not later than one year after the date of the enactment of this subsection; and (6) each current member of the Armed Forces and the dependent of such a member may elect to receive an electronic copy of the health care record of the individual beginning not later than June 30, 2015. . (2) Conforming amendments Section 1635 of such Act is further amended— (A) in subsection (a), by striking The Secretary and inserting In accordance with the timeline described in subsection (k), the Secretary ; and (B) in the matter preceding paragraph (1) of subsection (e), by inserting in accordance with subsection (k) after under this section . (b) Establishment of uniform prescription formulary The Secretary of Veterans Affairs and the Secretary of Defense shall jointly establish a uniform prescription formulary for use in prescribing medication under the laws administered by the Secretary of Veterans Affairs and the laws administered by the Secretary of Defense. 6. Pilot program for repayment of educational loans for certain psychiatrists of Veterans Health Administration (a) Establishment The Secretary of Veterans Affairs shall carry out a pilot program to repay loans of individuals described in subsection (b) that— (1) were used by such individuals to finance education relating to psychiatric medicine, including education leading to— (A) an undergraduate degree; (B) a degree of doctor of medicine; or (C) a degree of doctor of osteopathy; and (2) were obtained from any of the following: (A) A governmental entity. (B) A private financial institution. (C) A school. (D) Any other authorized entity as determined by the Secretary. (b) Eligible individuals (1) In general Subject to paragraph (2), an individual eligible for participation in the pilot program is an individual who— (A) either— (i) is licensed or eligible for licensure to practice psychiatric medicine in the Veterans Health Administration of the Department of Veterans Affairs; or (ii) is enrolled in the final year of a residency program leading to a specialty qualification in psychiatric medicine that is approved by the Accreditation Council for Graduate Medical Education; and (B) demonstrates a commitment to a long-term career as a psychiatrist in the Veterans Health Administration, as determined by the Secretary. (2) Prohibition on simultaneous eligibility An individual who is participating in any other program of the Federal Government that repays the educational loans of the individual is not eligible to participate in the pilot program. (c) Selection The Secretary shall select not less than 10 individuals described in subsection (b) to participate in the pilot program for each year in which the Secretary carries out the pilot program. (d) Period of obligated service The Secretary shall enter into an agreement with each individual selected under subsection (c) in which such individual agrees to serve a period of obligated service for the Veterans Health Administration in the field of psychiatric medicine, as determined by the Secretary. (e) Loan Repayments (1) Amounts Subject to paragraph (2), a loan repayment under this section may consist of payment of the principal, interest, and related expenses of a loan obtained by an individual who is participating in the pilot program for all educational expenses (including tuition, fees, books, and laboratory expenses) of such individual relating to education described in subsection (a)(1). (2) Limit For each year of obligated service that an individual who is participating in the pilot program agrees to serve under subsection (d), the Secretary may pay not more than $60,000 in loan repayment on behalf of such individual. (f) Breach (1) Liability An individual who participates in the pilot program and fails to satisfy the period of obligated service under subsection (d) shall be liable to the United States, in lieu of such obligated service, for the amount that has been paid or is payable to or on behalf of the individual under the pilot program, reduced by the proportion that the number of days served for completion of the period of obligated service bears to the total number of days in the period of obligated service of such individual. (2) Repayment period Any amount of damages that the United States is entitled to recover under this subsection shall be paid to the United States not later than one year after the date of the breach of the agreement. (g) Report (1) In general Not later than 90 days after the date on which the pilot program terminates under subsection (i), 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 pilot program. (2) Elements The report required by paragraph (1) shall include the following: (A) The overall effect of the pilot program on the psychiatric workforce shortage of the Veterans Health Administration. (B) The long-term stability of the psychiatric workforce of the Veterans Health Administration. (C) Strategies of the Veterans Health Administration to improve and increase the ability of the Administration to promote the physical and mental resiliency of all veterans. (h) Regulations The Secretary shall prescribe regulations to carry out this section, including standards for qualified loans and authorized payees and other terms and conditions for the making of loan repayments. (i) Termination The authority to carry out the pilot program shall expire on the date that is three years after the date on which the Secretary commences the pilot program. 7. Comptroller General study on pay disparities of psychiatrists of Veterans Health Administration (a) Study (1) In general Not later than one year after the date of the enactment of this Act, the Comptroller General of the United States shall conduct a study of pay disparities among psychiatrists of the Veterans Health Administration of the Department of Veterans Affairs. (2) Elements The study required by paragraph (1) shall include the following: (A) An examination of laws, regulations, practices, and policies, including salary flexibilities, that contribute to such disparities. (B) Recommendations for legislative or regulatory action to improve equity in pay among such psychiatrists. (b) Report Not later than one year after the date on which the Comptroller General completes the study under subsection (a), the Comptroller General shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report containing the results of the study.