II 113th CONGRESS 1st Session S. 852 IN THE SENATE OF THE UNITED STATES April 25, 2013 Mr. Sanders introduced the following bill; which was read twice and referred to the Committee on Veterans' Affairs A BILL To improve health care furnished by the Department of Veterans Affairs by increasing access to complementary and alternative medicine and other approaches to wellness and preventive care, and for other purposes.

1. Short title This Act may be cited as the Veterans' Health Promotion Act of 2013 . 2. Designation and operation of centers of Innovation for complementary and alternative medicine in health care research, education, and clinical activities (a) Designation and operation of centers of innovation Subchapter II of chapter 73 of title 38, United States Code, is amended by adding at the end the following new section: 7330B. Centers of innovation for complementary and alternative medicine in health care research, education, and clinical activities (a) Designation and operation The Secretary, acting through the Director of the Office of Patient Centered Care for Cultural Transformation, shall designate and operate at least one center of innovation for complementary and alternative medicine in health research, education, and clinical activities in each Veterans Integrated Service Networks. (b) Functions The functions of the centers of innovation designated and operated under subsection (a) are as follows: (1) To conduct research on the furnishing of complementary and alternative medicine in health care. (2) To develop specific models to be used by the Department in furnishing services to veterans consisting of complementary and alternative medicine. (3) To provide education and training for health care professionals of the Department on— (A) the furnishing of services consisting of complementary and alternative medicine to veterans; or (B) providing referrals to veterans for the receipt of such services. (4) To develop and implement innovative clinical activities and systems of care for the Department for the furnishing of services consisting of complementary and alternative medicine to veterans. (c) Geographic dispersion The Secretary shall ensure that the centers designated and operated under this section are located at health care facilities that are geographically dispersed throughout the United States. (d) Funding (1) There is authorized to be appropriated to the Secretary such sums as may be necessary for the support of the research and education activities of the centers operated under this section. (2) Activities of clinical and scientific investigation at each center operated under this section— (A) shall be eligible to compete for the award of funding from funds appropriated for the Medical and Prosthetics Research Account; and (B) shall receive priority in the award of funding from such account to the extent that funds are awarded to projects for research on the care of rural veterans. (e) Complimentary and alternative medicine defined In this section, the term complimentary and alternative medicine shall have the meaning given that term in regulations the Secretary shall prescribe for purposes of this section, which shall, to the degree practicable, be consistent with the meaning given such term by the Secretary of Health and Human Services. . (b) Clerical amendment The table of sections at the beginning of chapter 73 of such title is amended by inserting after the item relating to section 7330A the following new item: 7330B. Centers of Innovation for complementary and alternative medicine in health care research, education, and clinical activities. . 3. Pilot program on establishment of complementary and alternative medicine centers within Department of Veterans Affairs medical centers (a) Pilot program required Commencing not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall carry out, through the Office of Patient Centered Care and Cultural Transformation of the Department of Veterans Affairs, a pilot program to assess the feasibility and advisability of establishing complementary and alternative medicine centers within Department medical centers to promote the use and integration of complementary and alternative medicine services for mental health diagnoses and pain management. (b) Duration of program The pilot program shall be carried out during the three-year period beginning on the date of the commencement of the pilot program. (c) Locations (1) In general The Secretary shall carry out the pilot program by establishing not fewer than 15 complementary and alternative medicine centers in 15 separate Department medical centers as follows: (A) Five Department medical centers designated by the Secretary as polytrauma centers. (B) Ten Department medical centers not designated by Secretary as polytrauma centers. (2) Considerations In selecting locations for the pilot program, the Secretary shall consider the feasibility and advisability of selecting locations in— (A) rural areas; (B) areas that are not in close proximity to an active duty military installation; and (C) areas representing different geographic locations, such as census tracts established by the Bureau of the Census. (d) Provision of services Under the pilot program, the Secretary shall provide covered services to covered veterans through the complementary and alternative medicine centers established under subsection (c)(1). (e) Covered veterans For purposes of the pilot program, a covered veteran is any veteran who has— (1) a mental health condition diagnosed by a clinician of the Department; or (2) a pain condition for which the veteran has received a pain management plan from a clinician of the Department. (f) Covered services (1) In general For purposes of the pilot program, covered services are services consisting of complementary or alternative medicine. (2) Administration of services Covered services shall be administered under the pilot program as follows: (A) Covered services shall be administered by clinicians who exclusively provide services consisting of complementary or alternative medicine. (B) Covered services shall be included as part of the Patient Aligned Care Teams initiative of the Office of Patient Care Services, Primary Care Program Office. (C) Covered services shall be made available to both— (i) covered veterans with mental health conditions or pain conditions described in subsection (e) who have received traditional treatments from the Department for such conditions; and (ii) covered veterans with mental health conditions or pain conditions described in subsection (e) who have not received traditional treatments from the Department for such conditions. (g) Voluntary participation The participation of a veteran in the pilot program shall be at the election of the veteran and in consultation with a clinician of the Department. (h) Reports to Congress (1) Quarterly reports Not later than 90 days after the date of the commencement of the pilot program and not less frequently than once every 90 days thereafter for the duration of the pilot program, 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 efforts of the Secretary to carry out the pilot program, including a description of the outreach conducted by the Secretary to veterans and community organizations to inform such organizations about the pilot program. (2) Final report (A) In general Not later than 180 days after the completion of the pilot program, the Secretary shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a report on the pilot program. (B) Contents The report submitted under subparagraph (A) shall include the following: (i) The findings and conclusions of the Secretary with respect to the pilot program, including with respect to the utilization and efficacy of the complementary and alternative medicine centers established under the pilot program. (ii) Such recommendations for the continuation or expansion of the pilot program as the Secretary considers appropriate. 4. Pilot program on use of wellness programs as complementary approach to mental health care for veterans and family members of veterans (a) Pilot program required (1) In general The Secretary of Veterans Affairs shall carry out a pilot program through the award of grants to public or private nonprofit entities to assess the feasibility and advisability of using wellness programs to complement the provision of mental health care to veterans and family members eligible for counseling under section 1712A(a)(1)(C) of title 38, United States Code. (2) Matters to be addressed The pilot program shall be carried out so as to assess the following: (A) Means of improving coordination between Federal, State, local, and community providers of health care in the provision of mental health care to veterans and family members described in paragraph (1). (B) Means of enhancing outreach, and coordination of outreach, by and among providers of health care referred to in subparagraph (A) on the mental health care services available to veterans and family members described in paragraph (1). (C) Means of using wellness programs of providers of health care referred to in subparagraph (A) as complements to the provision by the Department of Veterans Affairs of mental health care to veterans and family members described in paragraph (1). (D) Whether wellness programs described in subparagraph (C) are effective in enhancing the quality of life and well-being of veterans and family members described in paragraph (1). (E) Whether wellness programs described in subparagraph (C) are effective in increasing the adherence of veterans described in paragraph (1) to the primary mental health services provided such veterans by the Department. (F) Whether wellness programs described in subparagraph (C) have an impact on the sense of wellbeing of veterans described in paragraph (1) who receive primary mental health services from the Department. (G) Whether wellness programs described in subparagraph (C) are effective in encouraging veterans receiving health care from the Department to adopt a more healthy lifestyle. (b) Duration The Secretary shall carry out the pilot program for a period of three years beginning on the date that is 90 days after the date of the enactment of this Act. (c) Locations The Secretary shall carry out the pilot program at facilities of the Department providing mental health care services to veterans and family members described in subsection (a)(1). (d) Grant proposals (1) In general A public or private nonprofit entity seeking the award of a grant under this section shall submit an application therefor to the Secretary in such form and in such manner as the Secretary may require. (2) Application contents Each application submitted under paragraph (1) shall include the following: (A) A plan to coordinate activities under the pilot program, to the extent possible, with the Federal, State, and local providers of services for veterans to enhance the following: (i) Awareness by veterans of benefits and health care services provided by the Department. (ii) Outreach efforts to increase the use by veterans of services provided by the Department. (iii) Educational efforts to inform veterans of the benefits of a healthy and active lifestyle. (B) A statement of understanding from the entity submitting the application that, if selected, such entity will be required to report to the Secretary periodically on standardized data and other performance data necessary to evaluate individual outcomes and to facilitate evaluations among entities participating in the pilot program. (C) Other requirements that the Secretary may prescribe. (e) Grant uses (1) In general A public or private nonprofit entity awarded a grant under this section shall use the award for purposes prescribed by the Secretary. (2) Eligible veterans and family In carrying out the purposes prescribed by the Secretary in paragraph (1), a public or private nonprofit entity awarded a grant under this section shall use the award to furnish services only to individuals specified in section 1712A(a)(1)(C) of title 38, United States Code. (f) Reports (1) Periodic reports (A) In general Not later than 180 days after the date of the enactment of this Act, and every 180 days thereafter, the Secretary shall submit to Congress a report on the pilot program. (B) Report elements Each report required by subparagraph (A) shall include the following: (i) The findings and conclusions of the Secretary with respect to the pilot program during the 180-day period preceding the report. (ii) An assessment of the benefits of the pilot program to veterans and their family members during the 180-day period preceding the report. (2) Final report Not later than 180 days after the end of the pilot program, the Secretary shall submit to Congress a report detailing the recommendations of the Secretary as to the advisability of continuing or expanding the pilot program. (g) Wellness defined In this section, the term wellness shall have the meaning given that term in regulations prescribed by the Secretary. 5. Pilot program on health promotion for overweight and obese veterans through support of fitness center membership (a) Pilot program required Commencing not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall, through the National Center for Preventive Health, carry out a pilot program to assess the feasibility and advisability of promoting health in covered veterans, including achieving a healthy weight and reducing risks of chronic disease, through support for fitness center membership. (b) Covered veterans For purposes of this section, a covered veteran is any veteran who— (1) is determined by a clinician of the Department of Veterans Affairs to be overweight or obese as of the date of the commencement of the pilot program; and (2) resides in a location that is more than 15 minutes driving distance from a fitness center at a facility of the Department that would otherwise be available to the veteran for at least eight hours per day during five or more days per week. (c) Duration of pilot program The pilot program shall be carried out during the two-year period beginning on the date of the commencement of the pilot program. (d) Locations (1) In general In carrying out the pilot program, the Secretary shall select— (A) not less than five medical centers of the Department at which the Secretary shall cover the full reasonable cost of a fitness center membership for covered veterans within the catchment area of such centers; and (B) not less than five medical centers of the Department at which the Secretary shall cover half the reasonable cost of a fitness center membership for covered veterans within the catchment area of such centers. (2) Considerations In selecting locations for the pilot program, the Secretary shall consider the feasibility and advisability of selecting locations in the following areas: (A) Rural areas. (B) Areas that are not in close proximity to an active duty military installation. (C) Areas in different geographic locations. (e) Participation (1) Maximum number of participants The number of covered veterans who may participate in the pilot program at a location selected under subsection (d) may not exceed 100. (2) Voluntary participation The participation of a covered veteran in the pilot program shall be at the election of the covered veteran in consultation with a clinician of the Department. (f) Membership payment (1) In general Except as provided in paragraph (2), in carrying out the pilot program, the Secretary shall pay the following: (A) The full reasonable cost of a fitness center membership for covered veterans within the catchment area of centers selected under subsection (b)(1)(A) who are participating in the pilot program. (B) Half the reasonable cost of a fitness center membership for covered veterans within the catchment area of centers selected under subsection (b)(1)(B) who are participating in the pilot program. (2) Limitation Payment for a fitness center membership of a covered veteran may not exceed $50 per month of membership. (g) Reports (1) Periodic reports Not later than 90 days after the date of the commencement of the pilot program and not less frequently than once every 90 days thereafter, the Secretary shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a report on activities carried out to implement the pilot program, including outreach activities to veterans and community organizations. (2) Final report Not later than 180 days after the date of the completion of the pilot program, 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 detailing— (A) the findings and conclusions of the Secretary as a result of the pilot program; and (B) recommendations for the continuation or expansion of the pilot program. 6. Pilot program on health promotion for veterans through establishment of Department of Veterans Affairs fitness facilities (a) Pilot program required Commencing not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall carry out a pilot program to assess the feasibility and advisability of promoting health in covered veterans, including achieving a healthy weight, through establishment of Department of Veterans Affairs fitness facilities. (b) Covered veterans For purposes of this section, a covered veteran is any veteran who is enrolled in the system of annual patient enrollment established and operated by the Secretary under section 1705 of title 38, United States Code. (c) Duration of pilot program The pilot program shall be carried out during the three-year period beginning on the date of the commencement of the pilot program. (d) Locations (1) In general The Secretary shall carry out the pilot program by establishing fitness facilities in Department facilities as follows: (A) In not fewer than five Department of Veterans Affairs medical centers selected by the Secretary for purposes of the pilot program. (B) In not fewer than five outpatient clinics of the Department selected by the Secretary for purposes of the pilot program. (2) Considerations In selecting locations for the pilot program, the Secretary shall consider the feasibility and advisability of selecting locations in the following areas: (A) Rural areas. (B) Areas that are not in close proximity to an active duty military installation. (C) Areas in different geographic locations. (e) Limitation on expenses In establishing and supporting a fitness facility in a facility of the Department under the pilot program, the Secretary may expend amounts as follows: (1) For establishment and support of a fitness facility in a Department of Veterans Affairs medical center, not more than $60,000. (2) For establishment and support of a fitness facility in an outpatient clinic of the Department, not more than $40,000. (f) Renovations and purchases Subject to subsection (e), the Secretary may, in carrying out the pilot program, make such renovations to physical facilities of the Department and purchase such fitness equipment and supplies as the Secretary considers appropriate for purposes of the pilot program. (g) Prohibition on assessment of user fees The Secretary may not assess a fee upon a covered veteran for use of a fitness facility established under the pilot program. (h) Voluntary participation The participation of a covered veteran in the pilot program shall be at the election of the covered veteran. (i) Reports (1) Periodic reports Not later than 90 days after the date of the commencement of the pilot program and not less frequently than once every 90 days thereafter, the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on activities carried out to implement the pilot program, including outreach activities to veterans and community organizations. (2) Final report Not later than 180 days after the date of the completion of the pilot program, 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 detailing— (A) the findings and conclusions of the Secretary as a result of the pilot program; and (B) recommendations for the continuation or expansion of the pilot program. 7. Study of barriers encountered by veterans in receiving complementary and alternative medicine from Department of Veterans Affairs (a) Study required The Secretary of Veterans Affairs shall conduct a comprehensive study of the barriers encountered by veterans in receiving complementary and alternative medicine from the Department of Veterans Affairs. In conducting the study, the Secretary shall— (1) survey veterans who seek or receive hospital care or medical services furnished by the Department, as well as veterans who do not seek or receive such care or services; (2) administer the survey to a representative sample of veterans from each Veterans Integrated Service Network; and (3) ensure that the sample of veterans surveyed is of sufficient size for the study results to be statistically significant. (b) Elements of study In conducting the study required by subsection (a), the Secretary shall study the following: (1) The perceived barriers associated with obtaining complementary and alternative medicine services from the Department. (2) The satisfaction of veterans with complementary and alternative medicine in primary care. (3) The degree to which veterans are aware of eligibility requirements for, and the scope of services available under, complementary and alternative medicine furnished by the Department. (4) The effectiveness of outreach to veterans on the availability of complementary and alternative medicine for veterans. (5) Such other barriers as the Secretary considers appropriate. (c) Discharge by contract The Secretary shall enter into a contract with a qualified independent entity or organization to carry out the study required by this section. (d) Mandatory review of data by certain Department divisions (1) In general The Secretary shall ensure that the head of each division of the Department specified in paragraph (2) reviews the results of the study conducted under this section. The head of each such division shall submit findings with respect to the study to the Under Secretary for Health and to other pertinent program offices within the Department with responsibilities relating to health care services for veterans. (2) Specified divisions The divisions of the Department specified in this paragraph are the following: (A) The centers for innovation established under section 7330B of title 38, United States Code, as added by section 2. (B) The Health Services Research and Development Service Scientific Merit Review Board. (e) Reports (1) Report on implementation Not later than 180 days after the date of the enactment of this Act, the Secretary shall submit to Congress a report on the status of the implementation of this section. (2) Report on study (A) In general Not later than 45 days after the date of the completion of the study, the Secretary shall submit to Congress a report on the study required by subsection (a). (B) Contents The report required by subparagraph (A) shall include the following: (i) Recommendations for such administrative and legislative proposals and actions as the Secretary considers appropriate. (ii) The findings of the head of each division of the Department specified under subsection (d)(2) and of the Under Secretary for Health. (f) Authorization of appropriations There is authorized to be appropriated to the Secretary $2,000,000 to carry out this section. 8. Complimentary and alternative medicine defined In this Act, the term complimentary and alternative medicine shall have the meaning given such term under section 7330B of title 38, United States Code, as added by section 2.