II 118th CONGRESS 2d Session S. 5210 IN THE SENATE OF THE UNITED STATES September 25, 2024 Mr. Tester introduced the following bill; which was read twice and referred to the Committee on Veterans' Affairs A BILL To improve mental health services of the Department of Veterans Affairs, and for other purposes.

1. Short title; table of contents (a) Short title This Act may be cited as the Building Resources and Access for Veterans' Mental Health Engagement Act of 2024 or the BRAVE Act of 2024 . (b) Table of contents The table of contents for this Act is as follows: Sec. 1. Short title; table of contents. TITLE I—Improvement of workforce in support of mental health care Sec. 101. Report on market pay surveys for Readjustment Counseling Service positions. Sec. 102. Qualifications of appointees in occupations that support mental health programs. Sec. 103. Report on coordination of Veterans Health Administration with Readjustment Counseling Service. TITLE II—Improvement of Vet Center infrastructure and technology Sec. 201. Vet Center defined. Sec. 202. Comptroller General report on Readjustment Counseling Service model for expansion of Vet Center footprint. Sec. 203. Improvement of guidance and information to improve veteran outreach efforts by Vet Centers. Sec. 204. Report on information technology system of Readjustment Counseling Service. TITLE III—Women veterans Sec. 301. Study on effectiveness of suicide prevention and mental health outreach programs of Department of Veterans Affairs for women veterans. Sec. 302. Requirement for Department of Veterans Affairs to modify the REACH VET program to incorporate risk factors weighted for women veterans. Sec. 303. Review of and report on reintegration and readjustment services for veterans and family members in group retreat settings. TITLE IV—Other matters Sec. 401. Extension of Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program. Sec. 402. Access to mental health residential rehabilitation treatment programs for veterans with spinal cord injury or disorder. Sec. 403. Mental health consultations and outreach on mental health services for veterans receiving compensation for disabilities relating to mental health diagnoses. Sec. 404. Joint report on effectiveness of programs of Department of Veterans Affairs and Department of Defense that promote access to mental health services for transitioning members of the Armed Forces. I Improvement of workforce in support of mental health care 101. Report on market pay surveys for Readjustment Counseling Service positions (a) Findings Congress finds that the Secretary of Veterans Affairs, through the Chief Readjustment Counseling Officer, reviews market pay surveys in each Readjustment Counseling Service District to compare the salaries of employees in the Readjustment Counseling Service of the Department of Veterans Affairs, including licensed professional mental health counselors, social workers, and marriage and family therapists, to the salaries of similarly situated employees within the Department and the private sector. (b) Report Not later than 180 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’ Affairs of the House of Representatives a report on the findings specified in subsection (a), which shall— (1) include an assessment of pay disparities between employees of the Readjustment Counseling Service of the Department and similarly situated employees within the Department and the private sector; and (2) identify if pay-related staffing challenges exist, and if so, determine if each Readjustment Counseling Service District has initiated a review of third-party survey data for the identified occupations. (c) Districts Each report submitted under subsection (b) shall include reports from all Readjustment Counseling Service Districts of the Department, including— (1) areas that are geographically diverse; (2) rural areas; (3) highly rural areas; (4) urban areas; and (5) areas with health care shortages. (d) Assessment of pay Each report submitted under subsection (b) shall include an assessment of pay based on the following factors: (1) Third-party survey data. (2) Geographic location. (3) Equivalent qualifications (licensure, education level, or experience). (4) Short-term incentives. 102. Qualifications of appointees in occupations that support mental health programs (a) Psychologists Section 7402(b)(8)(C) of title 38, United States Code, is amended by striking for a period not to exceed and all that follows through the period at the end and inserting for a reasonable period of time recommended by the Under Secretary for Health. . (b) Licensed professional mental health counselors Section 7402(b)(11)(B) of title 38, United States Code, is amended by striking the period at the end and inserting , except that the Secretary may waive the requirement of licensure or certification for an individual licensed professional mental health counselor for a reasonable period of time recommended by the Under Secretary for Health. . 103. Report on coordination of Veterans Health Administration with Readjustment Counseling Service (a) In general Not later than 60 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report regarding coordination between the clinical care system of the Veterans Health Administration and the Readjustment Counseling Service of the Department of Veterans Affairs. (b) Assessment The report required by subsection (a) shall include an assessment of the adherence by each Director of a Veterans Integrated Service Network to policies of the Veterans Health Administration, which require each such Director to ensure that a support facility of the Department of Veterans Affairs is aligned laterally with each Vet Center to provide supportive administrative and clinical collaboration to better serve veterans eligible for services from Vet Centers, particularly those at high risk for suicide. (c) Analysis The report required by subsection (a) shall include an analysis of— (1) whether staff at Vet Centers in the local area of a medical facility of the Department have the updated contact information for appropriate staff at the medical facility to ensure proper coordination of care; (2) whether the external clinical consultant and suicide prevention coordinator of a medical facility of the Department are providing counseling staff of each Vet Center in the local area of the medical facility professional consultation not less frequently than monthly through regularly scheduled peer case presentations onsite at the Vet Center or via virtual or telephone consultation as necessary to fully support the coordination of care of patients, particularly those at high risk for suicide; (3) whether the external clinical consultant and suicide prevention coordinator are documenting any consultation conducted under paragraph (2); and (4) whether the Under Secretary for Health is coordinating with the Outreach Specialist at each Vet Center to ensure active duty members of the Armed Forces who are participating in the Transition Assistance Program of the Department of Defense are provided information regarding Vet Centers and the services provided at Vet Centers. (d) Vet Center defined In this section, the term Vet Center has the meaning given that term in section 1712A(h) of title 38, United States Code. II Improvement of Vet Center infrastructure and technology 201. Vet Center defined In this title, the term Vet Center has the meaning given that term in section 1712A(h) of title 38, United States Code. 202. Comptroller General report on Readjustment Counseling Service model for expansion of Vet Center footprint (a) In general Not later than one year 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 assessing the model used by the Readjustment Counseling Service of the Department of Veterans Affairs to guide the expansion of the real property footprint of Vet Centers. (b) Elements The report required by subsection (a) shall assess— (1) whether the model described in such subsection adequately accounts for the demand for Vet Center services in rural areas; (2) whether the frequency with which the Secretary of Veterans Affairs is reassessing areas for potential expansion of Vet Center services is often enough to address any population shifts; (3) whether such model adequately considers the needs of veterans in areas with high rates of calls to the Veterans Crisis Line or high rates of suicide by veterans or members of the Armed Forces; (4) whether such model adequately accounts for trends in usage of mobile Vet Centers in a given area; and (5) whether such model takes into account the unique needs of veterans and members of the Armed Forces in areas being assessed. (c) Veterans Crisis Line In this section, the term Veterans Crisis Line means the toll-free hotline for veterans established under section 1720F(h) of title 38, United States Code. 203. Improvement of guidance and information to improve veteran outreach efforts by Vet Centers Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall— (1) ensure each Vet Center has demographic data, such as age, gender, race, and ethnicity, for individuals eligible for Vet Center services in the service area of such Vet Center to be used to tailor outreach activities, including data on veterans who have recently transitioned from service in the Armed Forces; (2) provide Vet Centers with guidance for assessing the effectiveness of outreach activities, including guidance on metrics for those activities and targets against which to assess those metrics to determine effectiveness; (3) develop and implement a process to periodically assess the extent to which veterans and members of the Armed Forces who are eligible for services from Vet Centers experience barriers to obtaining such services, including a lack of awareness about Vet Centers and challenges accessing Vet Center services; and (4) develop and implement a process to periodically assess the extent to which staff of Vet Centers may encounter barriers to providing services. 204. Report on information technology system of Readjustment Counseling Service Not later than 60 days after the date of the enactment of this Act, the Secretary of Veterans Affairs, through the Chief Readjustment Counseling Officer of the Veterans Health Administration, shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report identifying— (1) whether the Department of Veterans Affairs is retaining or replacing the current information technology platform of the Department, commonly referred to as RCSNet , which is currently used to manage certain parts of the daily work of employees of the Readjustment Counseling Service and operational data and management functions of the Readjustment Counseling Service; (2) if the Department intends to keep RCSNet, the rationale for that decision and an identification of the steps the Department is taking to maintain or improve the functionality of RCSNet and the timeline for those steps; and (3) if the Department intends to replace RCSNet, the rationale for that decision and an identification of the steps the Department is taking to implement that replacement, including a timeline and the estimated cost for that replacement. III Women veterans 301. Study on effectiveness of suicide prevention and mental health outreach programs of Department of Veterans Affairs for women veterans (a) In general Not later than 240 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall conduct surveys and host listening sessions with women veterans to determine the extent to which— (1) suicide prevention, lethal-means safety, and mental health resources and messaging campaigns of the Department of Veterans Affairs are perceived and accepted by women veterans; (2) women veterans find those resources and messaging campaigns effective and sufficiently tailored to women veterans; (3) the integration into those resources and messaging campaigns of information pertaining to military sexual trauma, intimate partner violence, and trauma-informed health care would make those resources and messaging campaigns more effective for women veterans; (4) the Department could make additional improvements to those resources and messaging campaigns, including the Women’s Health Transition Training Program, to make those resources and messaging campaigns more effective for women veterans; and (5) programs and services of the Department are targeted at women veterans of different ages and eras of services, racial and ethnic backgrounds, and geographical areas. (b) Population studied The Secretary shall conduct the surveys and listening sessions required under subsection (a) in urban and rural areas and shall ensure such surveys and listening sessions are targeted at different demographics. (c) Report Not later than one year after the surveys and listening sessions required under subsection (a) are complete, 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 findings of such surveys and listening sessions, which shall document the steps the Secretary intends to take to refine the suicide prevention, lethal-means safety, and mental health resources and messaging campaigns of the Department based on the feedback from such surveys and listening sessions to ensure the Secretary is utilizing the most effective strategies. 302. Requirement for Department of Veterans Affairs to modify the REACH VET program to incorporate risk factors weighted for women veterans Not later than 60 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall initiate efforts to modify the Recovery Engagement and Coordination for Health–Veterans Enhanced Treatment program ( REACH VET ) to incorporate into such program risk factors weighted for women, such as military sexual trauma and intimate partner violence. 303. Review of and report on reintegration and readjustment services for veterans and family members in group retreat settings (a) Review Not later than 60 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall review all requests for reintegration and readjustment services for veterans and family members of veterans in group retreat program settings under section 1712A(a)(1)(B)(ii) of title 38, United States Code, to determine if current retreat programming meets demand, specifically requests for— (1) women only retreats; (2) disabled access retreats, particularly wheelchair accessible retreats; and (3) retreats for veterans with specific medical needs. (b) 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’ Affairs of the House of Representatives a report on whether the provision by the Secretary of reintegration and readjustment services for veterans and family members of veterans in group retreat program settings should be increased and made permanent, including— (1) women only retreats; (2) disabled access retreats, particularly wheelchair accessible retreats; and (3) retreats for veterans with specific medical needs. IV Other matters 401. Extension of Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program Section 201 of the Commander John Scott Hannon Veterans Mental Health Care Improvement Act of 2019 ( Public Law 116–171 ; 38 U.S.C. 1720F note) is amended— (1) in subsection (c)(2)(A), by striking $750,000 and inserting $1,000,000 ; and (2) in subsection (j), by striking three years and inserting six years . 402. Access to mental health residential rehabilitation treatment programs for veterans with spinal cord injury or disorder (a) Plan (1) In general Not later than 60 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a plan to ensure access to mental health residential treatment programs of the Department of Veterans Affairs for veterans with a spinal cord injury or disorder. (2) Elements The plan required under paragraph (1) shall include— (A) a staffing plan, which shall include a plan for how the Department will— (i) incorporate staff from other facilities to support the pilot program required under subsection (b); and (ii) ensure adequate staffing to support the needs of veterans with a spinal cord injury or disorder; (B) an assessment of medical equipment needs; and (C) an assessment of the best location to deliver treatment and health care under the mental health residential treatment programs of the Department, including through the use of spinal cord injury or disorder centers and spinal cord injury or disorder spokes. (b) Pilot program Commencing not later than 120 days after the date of the enactment of this Act, the Secretary shall carry out a pilot program to provide access to mental health residential treatment programs of the Department for veterans with a spinal cord injury or disorder at not fewer than three medical facilities of the Department. (c) Report Not later than one year 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’ Affairs of the House of Representatives a report on— (1) the implementation of the plan required under subsection (a); (2) the initial results from the pilot program under subsection (b); and (3) plans to expand the mental health residential treatment programs of the Department to additional medical facilities of the Department to address demand for the highly specialized treatment provided under such programs for veterans with a spinal cord injury or disorder. 403. Mental health consultations and outreach on mental health services for veterans receiving compensation for disabilities relating to mental health diagnoses (a) Technical corrections (1) In general The section 1167 of title 38, United States Code, relating to mental health consultations, is redesignated as section 1169. (2) Clerical amendments The table of sections at the beginning of chapter 11 is amended— (A) by striking the item relating to the section 1167 relating to mental health consultations; and (B) adding after the item relating to section 1168 the following new item: 1169. Mental health consultations. . (b) Improvements Section 1169 of such title, as redesignated by subsection (a), is amended— (1) in subsection (a), in the subsection heading, by striking In general and inserting Initial mental health consultations ; (2) by redesignating subsection (b) and (c) as subsections (c) and (d), respectively; (3) by inserting after subsection (a) the following new subsection (b): (b) Annual mental health consultations and outreach Not less frequently than once each year, the Secretary shall— (1) offer to each veteran who is receiving compensation under this chapter for a service-connected disability relating to a mental health diagnosis a mental health consultation to assess the mental health needs of, and discuss other mental health care options for, the veteran; and (2) conduct outreach to each veteran described in paragraph (1) regarding the availability of consultations described in such paragraph and other mental health services from the Department. .; (4) in subsection (c), as redesignated by paragraph (2), by inserting or (b) after under subsection (a) both places it appears; and (5) in subsection (d), as redesignated by paragraph (2), by inserting or as requiring reevaluation of any entitlement of the veteran to compensation under this chapter before the period at the end. (c) Biennial reports Such section, as amended by subsection (b), is further amended by adding at the end the following new subsection: (e) Biennial reviews and reports (1) Not later than one year after the date of the enactment of the BRAVE Act of 2024 , and not less frequently than once every two years thereafter, the Secretary shall— (A) review the efficacy of the outreach of the Department with respect to consultations offered under this section; and (B) submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a report on— (i) the findings of the Secretary with respect to the most recent review conducted pursuant to subparagraph (A); and (ii) the plans of the Secretary to address the findings described in clause (i). (2) In order to facilitate reviews conducted under paragraph (1)(A), the Secretary shall— (A) ensure veterans can provide feedback to the Secretary on outreach described in paragraph (1) and the consultations offered under this section; and (B) analyze the feedback described in subparagraph (A) that is provided to the Secretary. (3) Each review conducted pursuant to paragraph (1)(A) shall cover the following: (A) The feedback collected under paragraph (2). (B) Consultations sought pursuant to offers under this section. (C) Matters that deter veterans from seeking consultations offered under this section. . 404. Joint report on effectiveness of programs of Department of Veterans Affairs and Department of Defense that promote access to mental health services for transitioning members of the Armed Forces (a) In general Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs and the Secretary of Defense shall jointly 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 actions taken or that will be taken by each such Secretary, either independently or jointly, to improve the effectiveness of programs of the Department of Veterans Affairs and the Department of Defense that promote access to mental health services for members of the Armed Forces transitioning from service in the Armed Forces to civilian life. (b) Status of response to Comptroller General recommendations The report required under subsection (a) shall include an assessment of the status of the response by the Secretary of Veterans Affairs and the Secretary of Defense to the recommendations of the Comptroller General of the United States set forth in the July 2024 report entitled DOD AND VA HEALTH CARE: Actions Needed to Better Facilitate Access to Mental Health Services During Military to Civilian Transitions (GAO–24–106189). (c) Identification of duplicative efforts The report required under subsection (a) shall identify any duplicative efforts or gaps in services and recommend changes to programs of the Department of Veterans Affairs or the Department of Defense to address such duplicative efforts or gaps, including recommendations for legislative action.