II 113th CONGRESS 2d Session S. 2930 IN THE SENATE OF THE UNITED STATES November 17, 2014 Mr. McCain (for himself, Mr. Burr , Mr. Blumenthal , Mr. Blunt , Mr. Manchin , and Ms. Murkowski ) introduced the following bill; which was read twice and referred to the Committee on Veterans' Affairs A BILL To direct the Secretary of Defense and the Secretary of Veterans Affairs to provide for the conduct of an evaluation of mental health care and suicide prevention programs of the Department of Defense and the Department of Veterans Affairs, 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 Clay Hunt Suicide Prevention for American Veterans Act or the Clay Hunt SAV Act . 2. Evaluation of mental health care and suicide prevention programs of Department of Veterans Affairs and Department of Defense (a) Evaluation (1) In general 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) evaluate the effectiveness of each mental health care and suicide prevention program conducted by the Secretary concerned, including such programs conducted at a Center of Excellence; (C) identify the most effective and least effective of the programs evaluated under subparagraph (B); (D) include recommendations on which programs evaluated under subparagraph (B) can be eliminated or consolidated and which programs can benefit from additional resources; and (E) propose best practices for caring for individuals who suffer from mental health disorders or are at risk of suicide. (3) Third party (A) In general Each evaluation provided for under paragraph (1) shall be conducted by an independent third party unaffiliated with the Department of Veterans Affairs and the Department of Defense. (B) Submittal of evaluation An independent third party that conducts an evaluation provided for under paragraph (1) shall submit to the Secretary concerned the evaluation of the mental health care and suicide prevention programs carried out under the laws administered by such Secretary. (4) Report Not later than one year after the date of the enactment of this Act, the Secretary concerned shall submit to the appropriate committees of Congress a report that contains the evaluation submitted to the Secretary under paragraph (3)(B). (b) Definitions In this section: (1) Appropriate committees of Congress The term appropriate committees of Congress means— (A) the Committee on Armed Services and the Committee on Veterans’ Affairs of the Senate; and (B) the Committee on Armed Services and the Committee on Veterans’ Affairs of the House of Representatives. (2) Secretary concerned The term Secretary concerned means— (A) the Secretary of Veterans Affairs with respect to matters concerning the Department of Veterans Affairs; and (B) the Secretary of Defense with respect to matters concerning the Department of Defense. 3. Publication of Internet website to provide information regarding mental health care services (a) In general The Secretary of Veterans Affairs shall publish an Internet website that serves as a centralized source to provide veterans with information regarding all of the mental health care services provided by the Secretary. (b) Elements The Internet website published under subsection (a) shall provide to veterans information regarding all of the mental health care services available under the laws administered by the Secretary, dis­ag­gre­gat­ed by Veterans Integrated Service Network, including, with respect to each medical center and community-based outpatient center— (1) the name and contact information of each social work office; (2) the name and contact information of each mental health clinic; (3) a list of all staff who carry out tasks related to the provision of mental health care services; and (4) any other information the Secretary determines appropriate. (c) Updated information The Secretary shall ensure that the information described in subsection (b) that is published on the Internet website under subsection (a) is updated not less than once every 90 days. (d) Outreach In carrying out this section, the Secretary shall ensure that the outreach conducted under section 1720F(i) of title 38, United States Code, includes information regarding the Internet website published under subsection (a). 4. Improvements to health care matters (a) Reserve components and Department of Veterans Affairs The Secretary of Veterans Affairs and the Secretary of Defense, in consultation with the Chief of the National Guard Bureau, shall enter into formal strategic relationships between the Joint Forces Headquarters of each State regional commands of the reserve components of the Armed Forces and the Veterans Service Integrated Network, medical facilities of the Department of Veterans Affairs, and other local offices of the Department of Veterans Affairs located in or serving the State with respect to facilitating— (1) the mental health referrals of members of the reserve components of the Armed Forces who have a service-connected disability and are being discharged or released from the Armed Forces; (2) timely behavioral health services for such members; (3) communication between the various entities when such members are at risk for behavioral health reasons; and (4) the transfer of documentation for line of duty and fitness for duty determinations. (b) Comptroller General report on transition of care (1) In general Not later than April 1, 2015, the Comptroller General of the United States shall submit to the congressional defense committees (as defined in section 101(a)(16) of title 10, United States Code), the Committee on Veterans’ Affairs of the Senate, and the Committee on Veterans’ Affairs of the House of Representatives a report that assesses the transition of care for post-traumatic stress disorder or traumatic brain injury. (2) Matters included The report under paragraph (1) shall include the following: (A) The programs, policies, and regulations that affect the transition of care for post-traumatic stress disorder or traumatic brain injury, particularly with respect to individuals who are taking or have been prescribed an­ti­de­pres­sants, stimulants, antipsychotics, mood stabilizers, anxiolytics, depressants, or hal­lu­ci­no­gens. (B) Upon transitioning to care furnished by the Secretary of Veterans Affairs, the extent to which the pharmaceutical treatment plan of an individual changes and the factors determining such changes. (C) The extent to which the Secretary of Defense and the Secretary of Veterans Affairs have worked together to identify and apply best pharmaceutical treatment practices. (D) A description of the off-formulary waiver process of the Secretary of Veterans Affairs, and the extent to which the process is applied efficiently at the treatment level. (E) The benefits and challenges of combining the formularies across the Department of Defense and the Department of Veterans Affairs. (F) Such other issues as the Comptroller General considers appropriate. (3) Transition of care defined In this subsection, the term transition of care means the transition of an individual from receiving treatment furnished by the Secretary of Defense to treatment furnished by the Secretary of Veterans Affairs. 5. Pilot program for repayment of educational loans for certain psychiatrists of Veterans Health Administration (a) In general 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 the educational expenses of such individuals 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) An institution of higher education. (D) Any other entity as specified the Secretary for purposes of the pilot program. (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 for purposes of the pilot program, in exchange for the repayment of the loan or loans of such individual under the pilot program. (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 $120,000 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) Reports (1) Initial report (A) In general Not later than two years after the date on which the pilot program under subsection (a) commences, 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) Elements The report required by subparagraph (A) shall include the following: (i) The number of individuals who participated in the pilot program. (ii) The locations in which such individuals were employed by the Department, including how many such locations were rural or urban locations. (iii) An assessment of the quality of the work performed by such individuals in the course of such employment. (iv) The number of psychiatrists the Secretary determines is needed by the Department in the future. (2) Interim report 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 an update to the report submitted under paragraph (1). (3) Final report Not later than one year 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 specifying the number of individuals who participated in the pilot who are still employed by the Department as of the date of submittal of the report. (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. 6. Review of staffing requirements for State Directors of Psychological Health (a) In general Not later than 540 days after the date of the enactment of this Act, the Secretary of Defense shall submit to the appropriate committees of Congress a report detailing the results of a review, conducted in coordination with the Chief of the National Guard Bureau, of the staffing requirements for individual State National Guard Commands with respect to Directors of Psychological Health. (b) Appropriate committees of Congress defined In this section, the term appropriate committees of Congress means— (1) the Committee on Armed Services and the Committee on Veterans’ Affairs of the Senate; and (2) the Committee on Armed Services and the Committee on Veterans’ Affairs of the House of Representatives. 7. Collaboration on suicide prevention efforts between the Department of Veterans Affairs and non-profit mental health organizations (a) Collaboration The Secretary of Veterans Affairs may collaborate with non-profit mental health organizations to prevent suicide among veterans as follows: (1) To improve the efficiency and effectiveness of suicide prevention efforts carried out by the Department of Veterans Affairs and non-profit mental health organizations. (2) To assist non-profit mental health organizations with the suicide prevention efforts of those organizations through the use of the expertise of employees of the Department. (3) To jointly carry out suicide prevention efforts. (b) Exchange of resources In carrying out any collaboration under subsection (a), the Secretary and any non-profit mental health organization with which the Secretary is collaborating under such subsection shall exchange training sessions, best practices, and other resources to help with the suicide prevention efforts of the Department and such organization. (c) Director of Suicide Prevention Coordination The Secretary shall select within the Department a Director of Suicide Prevention Coordination to undertake any collaboration with non-profit mental health organizations under this section or any other provision of law.