Commander John Scott Hannon Veterans Mental Health Care Improvement Act of 2019
PL 116-171 (S.785), enacted 10/17/2020

[116th Congress Public Law 171]
[From the U.S. Government Publishing Office]



[[Page 777]]

COMMANDER JOHN SCOTT HANNON VETERANS MENTAL HEALTH CARE IMPROVEMENT ACT 
                                 OF 2019

[[Page 134 STAT. 778]]

Public Law 116-171
116th Congress

                                 An Act


 
  To improve mental health care provided by the Department of Veterans 
  Affairs, and for other purposes. <<NOTE: Oct. 17, 2020 -  [S. 785]>> 

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled, <<NOTE: Commander John 
Scott Hannon Veterans Mental Health Care Improvement Act of 2019. 38 USC 
101 note.>> 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Commander John 
Scott Hannon Veterans Mental Health Care Improvement Act of 2019''.
    (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 TRANSITION OF INDIVIDUALS TO SERVICES FROM 
                     DEPARTMENT OF VETERANS AFFAIRS

Sec. 101. Strategic plan on expansion of health care coverage for 
           veterans transitioning from service in the Armed Forces.
Sec. 102. Review of records of former members of the Armed Forces who 
           die by suicide within one year of separation from the Armed 
           Forces.
Sec. 103. Report on REACH VET program of Department of Veterans Affairs.
Sec. 104. Report on care for former members of the Armed Forces with 
           other than honorable discharge.

                      TITLE II--SUICIDE PREVENTION

Sec. 201. Financial assistance to certain entities to provide or 
           coordinate the provision of suicide prevention services for 
           eligible individuals and their families.
Sec. 202. Analysis on feasibility and advisability of the Department of 
           Veterans Affairs providing certain complementary and 
           integrative health services.
Sec. 203. Pilot program to provide veterans access to complementary and 
           integrative health programs through animal therapy, 
           agritherapy, sports and recreation therapy, art therapy, and 
           posttraumatic growth programs.
Sec. 204. Department of Veterans Affairs study of all-cause mortality of 
           veterans, including by suicide, and review of staffing levels 
           of mental health professionals.
Sec. 205. Comptroller General report on management by Department of 
           Veterans Affairs of veterans at high risk for suicide.

      TITLE III--PROGRAMS, STUDIES, AND GUIDELINES ON MENTAL HEALTH

Sec. 301. Study on connection between living at high altitude and 
           suicide risk factors among veterans.
Sec. 302. Establishment by Department of Veterans Affairs and Department 
           of Defense of a clinical provider treatment toolkit and 
           accompanying training materials for comorbidities.
Sec. 303. Update of clinical practice guidelines for assessment and 
           management of patients at risk for suicide.
Sec. 304. Establishment by Department of Veterans Affairs and Department 
           of Defense of clinical practice guidelines for the treatment 
           of serious mental illness.
Sec. 305. Precision medicine initiative of Department of Veterans 
           Affairs to identify and validate brain and mental health 
           biomarkers.

[[Page 134 STAT. 779]]

Sec. 306. Statistical analyses and data evaluation by Department of 
           Veterans Affairs.

     TITLE IV--OVERSIGHT OF MENTAL HEALTH CARE AND RELATED SERVICES

Sec. 401. Study on effectiveness of suicide prevention and mental health 
           outreach programs of Department of Veterans Affairs.
Sec. 402. Oversight of mental health and suicide prevention media 
           outreach conducted by Department of Veterans Affairs.
Sec. 403. Comptroller General management review of mental health and 
           suicide prevention services of Department of Veterans 
           Affairs.
Sec. 404. Comptroller General report on efforts of Department of 
           Veterans Affairs to integrate mental health care into primary 
           care clinics.
Sec. 405. Joint mental health programs by Department of Veterans Affairs 
           and Department of Defense.

         TITLE V--IMPROVEMENT OF MENTAL HEALTH MEDICAL WORKFORCE

Sec. 501. Staffing improvement plan for mental health providers of 
           Department of Veterans Affairs.
Sec. 502. Establishment of Department of Veterans Affairs Readjustment 
           Counseling Service Scholarship Program.
Sec. 503. Comptroller General report on Readjustment Counseling Service 
           of Department of Veterans Affairs.
Sec. 504. Expansion of reporting requirements on Readjustment Counseling 
           Service of Department of Veterans Affairs.
Sec. 505. Briefing on alternative work schedules for employees of 
           Veterans Health Administration.
Sec. 506. Suicide prevention coordinators.
Sec. 507. Report on efforts by Department of Veterans Affairs to 
           implement safety planning in emergency departments.

      TITLE VI--IMPROVEMENT OF CARE AND SERVICES FOR WOMEN VETERANS

Sec. 601. Expansion of capabilities of Women Veterans Call Center to 
           include text messaging.
Sec. 602. Requirement for Department of Veterans Affairs internet 
           website to provide information on services available to women 
           veterans.

                        TITLE VII--OTHER MATTERS

Sec. 701. Expanded telehealth from Department of Veterans Affairs.
Sec. 702. Partnerships with non-Federal Government entities to provide 
           hyperbaric oxygen therapy to veterans and studies on the use 
           of such therapy for treatment of post-traumatic stress 
           disorder and traumatic brain injury.
Sec. 703. Prescription of technical qualifications for licensed hearing 
           aid specialists and requirement for appointment of such 
           specialists.
Sec. 704. Use by Department of Veterans Affairs of commercial 
           institutional review boards in sponsored research trials.
Sec. 705. Creation of Office of Research Reviews within the Office of 
           Information and Technology of the Department of Veterans 
           Affairs.

   TITLE I--IMPROVEMENT OF TRANSITION OF INDIVIDUALS TO SERVICES FROM 
                     DEPARTMENT OF VETERANS AFFAIRS

SEC. 101. STRATEGIC PLAN ON EXPANSION OF HEALTH CARE COVERAGE FOR 
                        VETERANS TRANSITIONING FROM SERVICE IN THE 
                        ARMED FORCES.

    (a) Strategic Plan.--
            (1) <<NOTE: Deadline. Consultation. Web posting. Time 
        period.>>  In general.--Not later than one year after the date 
        of the enactment of this Act, the Secretary of Veterans Affairs, 
        in consultation with the Secretary of Defense, shall submit to 
        the appropriate committees of Congress and publish on a

[[Page 134 STAT. 780]]

        website of the Department of Veterans Affairs a strategic plan 
        for the provision by the Department of health care to any 
        veteran during the one-year period following the discharge or 
        release of the veteran from active military, naval, or air 
        service.
            (2) Elements.--The plan submitted under paragraph (1) shall 
        include the following:
                    (A) An identification of general goals and 
                objectives for the provision of health care to veterans 
                described in such paragraph.
                    (B) A description of how such goals and objectives 
                are to be achieved, including--
                          (i) a description of the use of existing 
                      personnel, information, technology, facilities, 
                      public and private partnerships, and other 
                      resources of the Department of Veterans Affairs;
                          (ii) a description of the anticipated need for 
                      additional resources for the Department; and
                          (iii) an assessment of cost.
                    (C) <<NOTE: Analysis.>>  An analysis of the 
                anticipated health care needs, including mental health 
                care, for such veterans, disaggregated by geographic 
                area.
                    (D) <<NOTE: Analysis.>>  An analysis of whether such 
                veterans are eligible for enrollment in the system of 
                annual patient enrollment of the Department under 
                section 1705(a) of title 38, United States Code.
                    (E) A description of activities designed to promote 
                the availability of health care from the Department for 
                such veterans, including outreach to members of the 
                Armed Forces though the Transition Assistance Program 
                under sections 1142 and 1144 of title 10, United States 
                Code.
                    (F) A description of legislative or administrative 
                action required to carry out the plan.
                    (G) A description of how the plan would further the 
                ongoing initiatives under Executive Order 13822 (83 Fed. 
                Reg. 1513; relating to supporting our veterans during 
                their transition from uniformed service to civilian 
                life) to provide seamless access to high-quality mental 
                health care and suicide prevention resources to veterans 
                as they transition, with an emphasis on the one-year 
                period following separation.

    (b) Definitions.--In this section:
            (1) Active military, naval, or air service.--The term 
        ``active military, naval, or air service'' has the meaning given 
        that term in section 101(24) of title 38, United States Code.
            (2) Appropriate committees of congress.--The term 
        ``appropriate committees of Congress'' means--
                    (A) the Committee on Veterans' Affairs and the 
                Committee on Appropriations of the Senate; and
                    (B) the Committee on Veterans' Affairs and the 
                Committee on Appropriations of the House of 
                Representatives.
SEC. 102. REVIEW OF RECORDS OF FORMER MEMBERS OF THE ARMED FORCES 
                        WHO DIE BY SUICIDE WITHIN ONE YEAR OF 
                        SEPARATION FROM THE ARMED FORCES.

    (a) Review.--
            (1) <<NOTE: Determination. Time periods.>>  In general.--The 
        Secretary of Defense and the Secretary of Veterans Affairs shall 
        jointly review the records of

[[Page 134 STAT. 781]]

        each former member of the Armed Forces who died by suicide, as 
        determined by the Secretary of Defense or the Secretary of 
        Veterans Affairs, within one year following the discharge or 
        release of the former member from active military, naval, or air 
        service during the five-year period preceding the date of the 
        enactment of this Act.
            (2) Records to be reviewed.--In completing the review 
        required under paragraph (1), the Secretary of Defense and the 
        Secretary of Veterans Affairs shall review the following records 
        maintained by the Department of Defense:
                    (A) Health treatment records.
                    (B) Fitness, medical, and dental records.
                    (C) Ancillary training records.
                    (D) Safety forms and additional duties sections of 
                the personnel information files.

    (b) Elements.--The review required by subsection (a) with respect to 
a former member of the Armed Forces shall include consideration of the 
following:
            (1) <<NOTE: Time period.>>  Whether the Department of 
        Defense had identified the former member as being at elevated 
        risk during the 365-day period before separation of the member 
        from the Armed Forces.
            (2) In the case that the member was identified as being at 
        elevated risk as described in paragraph (1), whether that 
        identification had been communicated to the Department of 
        Veterans Affairs via the Solid Start initiative of the 
        Department pursuant to Executive Order 13822 (83 Fed. Reg. 1513; 
        relating to supporting our veterans during their transition from 
        uniformed service to civilian life), or any other means.
            (3) The presence of evidence-based and empirically-supported 
        contextual and individual risk factors specified in subsection 
        (c) with respect to the former member and how those risk factors 
        correlated to the circumstances of the death of the former 
        member.
            (4) Demographic variables, including the following:
                    (A) Sex.
                    (B) Age.
                    (C) Rank at separation from the Armed Forces.
                    (D) Career field after separation from the Armed 
                Forces.
                    (E) State and county of residence one month prior to 
                death.
                    (F) Branch of service in the Armed Forces.
                    (G) Marital status.
                    (H) Reason for separation from the Armed Forces.
            (5) Support or medical services furnished to the former 
        member through the Department of Defense, specified by the type 
        of service or care provided.
            (6) Support or medical services furnished to the former 
        member through the Department of Veterans Affairs, specified by 
        the type of service or care provided.

    (c) Evidence-based and Empirically-supported Contextual and 
Individual Risk Factors.--Evidence-based and empirically-supported 
contextual and individual risk factors specified in this subsection 
include the following:
            (1) Exposure to violence.
            (2) Exposure to suicide.
            (3) Housing instability.

[[Page 134 STAT. 782]]

            (4) Financial instability.
            (5) Vocational problems or insecurity.
            (6) Legal problems.
            (7) Highly acute or significantly chronic relational 
        problems.
            (8) Limited access to health care.

    (d) Report.--Not later than three years after the date of the 
enactment of this Act, the Secretary of Defense and the Secretary of 
Veterans Affairs shall jointly submit to the appropriate committees of 
Congress an aggregated report on the results of the review conducted 
under subsection (a) with respect to the year-one cohort of former 
members of the Armed Forces covered by the review.
    (e) Definitions.--In this section:
            (1) Active military, naval, or air service.--The term 
        ``active military, naval, or air service'' has the meaning given 
        that term in section 101(24) of title 38, United States Code.
            (2) Appropriate committees of congress defined.--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.
SEC. 103. REPORT ON REACH VET PROGRAM OF DEPARTMENT OF VETERANS 
                        AFFAIRS.

    (a) In General.--Not later than 180 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 on the REACH 
VET program.
    (b) <<NOTE: Assessments.>>  Elements.--The report required by 
subsection (a) shall include the following:
            (1) An assessment of the impact of the REACH VET program on 
        rates of suicide among veterans.
            (2) An assessment of how limits within the REACH VET 
        program, such as caps on the number of veterans who may be 
        flagged as high risk, are adjusted for differing rates of 
        suicide across the country.
            (3) A detailed explanation, with evidence, for why the 
        conditions included in the model used by the REACH VET program 
        were chosen, including an explanation as to why certain 
        conditions, such as bipolar disorder II, were not included even 
        though they show a similar rate of risk for suicide as other 
        conditions that were included.
            (4) An assessment of the feasibility of incorporating 
        certain economic data held by the Veterans Benefits 
        Administration into the model used by the REACH VET program, 
        including financial data and employment status, which research 
        indicates may have an impact on risk for suicide.

    (c) REACH VET Program Defined.--In this section, the term ``REACH 
VET program'' means the Recovery Engagement and Coordination for 
Health--Veterans Enhanced Treatment program of the Department of 
Veterans Affairs.
SEC. 104. REPORT ON CARE FOR FORMER MEMBERS OF THE ARMED FORCES 
                        WITH OTHER THAN HONORABLE DISCHARGE.

    Section 1720I(f) of title 38, United States Code, is amended--

[[Page 134 STAT. 783]]

            (1) in paragraph (1) by striking ``Not less frequently than 
        once'' and inserting ``Not later than February 15''; and
            (2) in paragraph (2)--
                    (A) by redesignating subparagraph (C) as 
                subparagraph (F); and
                    (B) by inserting after subsection (B) the following 
                new subparagraphs:
            ``(C) The types of mental or behavioral health care needs 
        treated under this section.
            ``(D) The demographics of individuals being treated under 
        this section, including--
                    ``(i) age;
                    ``(ii) era of service in the Armed Forces;
                    ``(iii) branch of service in the Armed Forces; and
                    ``(iv) geographic location.
            ``(E) The average number of visits for an individual for 
        mental or behavioral health care under this section.''.

                      TITLE II--SUICIDE PREVENTION

SEC. 201. <<NOTE: 38 USC 1720F note.>>  FINANCIAL ASSISTANCE TO 
                        CERTAIN ENTITIES TO PROVIDE OR COORDINATE 
                        THE PROVISION OF SUICIDE PREVENTION 
                        SERVICES FOR ELIGIBLE INDIVIDUALS AND 
                        THEIR FAMILIES.

    (a) Purpose; Designation.--
            (1) Purpose.--The purpose of this section is to reduce 
        veteran suicide through a community-based grant program to award 
        grants to eligible entities to provide or coordinate suicide 
        prevention services to eligible individuals and their families.
            (2) Designation.--The grant program under this section shall 
        be known as the ``Staff Sergeant Parker Gordon Fox Suicide 
        Prevention Grant Program''.

    (b) <<NOTE: Grants.>>  Financial Assistance and Coordination.--The 
Secretary shall provide financial assistance to eligible entities 
approved under this section through the award of grants to such entities 
to provide or coordinate the provision of services to eligible 
individuals and their families to reduce the risk of 
suicide. <<NOTE: Consultation.>>  The Secretary shall carry out this 
section in coordination with the President's Roadmap to Empower Veterans 
and End a National Tragedy of Suicide Task Force and in consultation 
with the Office of Mental Health and Suicide Prevention of the 
Department, to the extent practicable.

    (c) Award of Grants.--
            (1) In general.--The Secretary shall award a grant to each 
        eligible entity for which the Secretary has approved an 
        application under subsection (f) to provide or coordinate the 
        provision of suicide prevention services under this section.
            (2) Grant amounts, intervals of payment, and matching 
        funds.--In accordance with the services being provided under a 
        grant under this section and the duration of those services, the 
        Secretary shall establish--
                    (A) a maximum amount to be awarded under the grant 
                of not more than $750,000 per grantee per fiscal year; 
                and
                    (B) intervals of payment for the administration of 
                the grant.

    (d) Distribution of Grants and Preference.--

[[Page 134 STAT. 784]]

            (1) Distribution.--
                    (A) Priority.--In compliance with subparagraphs (B) 
                and (C), in determining how to distribute grants under 
                this section, the Secretary may prioritize--
                          (i) rural communities;
                          (ii) Tribal lands;
                          (iii) territories of the United States;
                          (iv) medically underserved areas;
                          (v) areas with a high number or percentage of 
                      minority veterans or women veterans; and
                          (vi) areas with a high number or percentage of 
                      calls to the Veterans Crisis Line.
                    (B) Areas with need.--The Secretary shall ensure 
                that, to the extent practicable, grants under this 
                section are distributed--
                          (i) to provide services in areas of the United 
                      States that have experienced high rates of suicide 
                      by eligible individuals, including suicide 
                      attempts; and
                          (ii) to eligible entities that can assist 
                      eligible individuals at risk of suicide who are 
                      not currently receiving health care furnished by 
                      the Department.
                    (C) Geography.--In distributing grants under this 
                paragraph, the Secretary may provide grants to eligible 
                entities that furnish services to eligible individuals 
                and their families in geographically dispersed areas.
            (2) Preference.--The Secretary shall give preference to 
        eligible entities that have demonstrated the ability to provide 
        or coordinate suicide prevention services.

    (e) Requirements for Receipt of Grants.--
            (1) Notification that services are from department.--Each 
        entity receiving a grant under this section to provide or 
        coordinate suicide prevention services to eligible individuals 
        and their families shall notify the recipients of such services 
        that such services are being paid for, in whole or in part, by 
        the Department.
            (2) <<NOTE: Consultation.>>  Development of plan with 
        eligible individuals and their family.--Any plan developed with 
        respect to the provision of suicide prevention services for an 
        eligible individual or their family shall be developed in 
        consultation with the eligible individual and their family.
            (3) <<NOTE: Notification.>>  Coordination.--An entity 
        receiving a grant under this section shall--
                    (A) coordinate with the Secretary with respect to 
                the provision of clinical services to eligible 
                individuals in accordance with subsection (n) or any 
                other provisions of the law regarding the delivery of 
                health care by the Secretary;
                    (B) inform every veteran who receives assistance 
                under this section from the entity of the ability of the 
                veteran to apply for enrollment in the patient 
                enrollment system of the Department under section 
                1705(a) of title 38, United States Code; and
                    (C) if such a veteran wishes to so enroll, inform 
                the veteran of a point of contact at the Department who 
                can assist the veteran in such enrollment.
            (4) Measurement and monitoring.--An entity receiving a grant 
        under this section shall submit to the Secretary a

[[Page 134 STAT. 785]]

        description of such tools and assessments the entity uses or 
        will use to determine the effectiveness of the services 
        furnished by the entity, which shall include the measures 
        developed under subsection (h)(2) and may include--
                    (A) the effect of the services furnished by the 
                entity on the financial stability of the eligible 
                individual;
                    (B) the effect of the services furnished by the 
                entity on the mental health status, wellbeing, and 
                suicide risk of the eligible individual; and
                    (C) the effect of the services furnished by the 
                entity on the social support of the eligible individuals 
                receiving those services.
            (5) Reports.--The Secretary--
                    (A) shall require each entity receiving a grant 
                under this section to submit to the Secretary an annual 
                report that describes the projects carried out with such 
                grant during the year covered by the report;
                    (B) <<NOTE: Criteria. Data.>>  shall specify to each 
                such entity the evaluation criteria and data and 
                information to be submitted in such report; and
                    (C) may require each such entity to submit to the 
                Secretary such additional reports as the Secretary 
                considers appropriate.

    (f) Application for Grants.--
            (1) In general.--An eligible entity seeking a grant under 
        this section shall submit to the Secretary an application 
        therefor in such form, in such manner, and containing such 
        commitments and information as the Secretary considers necessary 
        to carry out this section.
            (2) Matters to be included.--Each application submitted by 
        an eligible entity under paragraph (1) shall contain the 
        following:
                    (A) A description of the suicide prevention services 
                proposed to be provided by the eligible entity and the 
                identified need for those services.
                    (B) <<NOTE: Plan.>>  A detailed plan describing how 
                the eligible entity proposes to coordinate or deliver 
                suicide prevention services to eligible individuals, 
                including--
                          (i) an identification of the community 
                      partners, if any, with which the eligible entity 
                      proposes to work in delivering such services;
                          (ii) a description of the arrangements 
                      currently in place between the eligible entity and 
                      such partners with regard to the provision or 
                      coordination of suicide prevention services;
                          (iii) an identification of how long such 
                      arrangements have been in place;
                          (iv) a description of the suicide prevention 
                      services provided by such partners that the 
                      eligible entity shall coordinate, if any; and
                          (v) an identification of local suicide 
                      prevention coordinators of the Department and a 
                      description of how the eligible entity will 
                      communicate with local suicide prevention 
                      coordinators.
                    (C) A description of the population of eligible 
                individuals and their families proposed to be provided 
                suicide prevention services.

[[Page 134 STAT. 786]]

                    (D) <<NOTE: Estimate.>>  Based on information and 
                methods developed by the Secretary for purposes of this 
                subsection, an estimate of the number of eligible 
                individuals at risk of suicide and their families 
                proposed to be provided suicide prevention services, 
                including the percentage of those eligible individuals 
                who are not currently receiving care furnished by the 
                Department.
                    (E) Evidence of measurable outcomes related to 
                reductions in suicide risk and mood-related symptoms 
                utilizing validated instruments by the eligible entity 
                (and the proposed partners of the entity, if any) in 
                providing suicide prevention services to individuals at 
                risk of suicide, particularly to eligible individuals 
                and their families.
                    (F) A description of the managerial and 
                technological capacity of the eligible entity--
                          (i) <<NOTE: Coordination.>>  to coordinate the 
                      provision of suicide prevention services with the 
                      provision of other services;
                          (ii) <<NOTE: Assessment.>>  to assess on an 
                      ongoing basis the needs of eligible individuals 
                      and their families for suicide prevention 
                      services;
                          (iii) <<NOTE: Coordination.>>  to coordinate 
                      the provision of suicide prevention services with 
                      the services of the Department for which eligible 
                      individuals are also eligible;
                          (iv) to tailor suicide prevention services to 
                      the needs of eligible individuals and their 
                      families;
                          (v) to seek continuously new sources of 
                      assistance to ensure the continuity of suicide 
                      prevention services for eligible individuals and 
                      their families as long as they are determined to 
                      be at risk of suicide; and
                          (vi) to measure the effects of suicide 
                      prevention services provided by the eligible 
                      entity or partner organization, in accordance with 
                      subsection (h)(2), on the lives of eligible 
                      individuals and their families who receive such 
                      services provided by the organization using pre- 
                      and post-evaluations on validated measures of 
                      suicide risk and mood-related symptoms.
                    (G) Clearly defined objectives for the provision of 
                suicide prevention services.
                    (H) A description and physical address of the 
                primary location of the eligible entity.
                    (I) A description of the geographic area the 
                eligible entity plans to serve during the grant award 
                period for which the application applies.
                    (J) If the eligible entity is a State or local 
                government or an Indian tribe, the amount of grant funds 
                proposed to be made available to community partners, if 
                any, through agreements.
                    (K) A description of how the eligible entity will 
                assess the effectiveness of the provision of grants 
                under this section.
                    (L) <<NOTE: Contracts.>>  An agreement to use the 
                measures and metrics provided by the Department for the 
                purposes of measuring the effectiveness of the 
                programming as described in subsection (h)(2).
                    (M) Such additional application criteria as the 
                Secretary considers appropriate.

    (g) Training and Technical Assistance.--

[[Page 134 STAT. 787]]

            (1) <<NOTE: Coordination.>>  In general.--The Secretary 
        shall provide training and technical assistance, in coordination 
        with the Centers for Disease Control and Prevention, to eligible 
        entities in receipt of grants under this section regarding--
                    (A) suicide risk identification and management;
                    (B) <<NOTE: Data.>>  the data required to be 
                collected and shared with the Department;
                    (C) <<NOTE: Data.>>  the means of data collection 
                and sharing;
                    (D) familiarization with and appropriate use of any 
                tool to be used to measure the effectiveness of the use 
                of the grants provided; and
                    (E) the requirements for reporting under subsection 
                (e)(5) on services provided via such grants.
            (2) <<NOTE: Grants. Contracts.>>  Provision of training and 
        technical assistance.--The Secretary may provide the training 
        and technical assistance described in paragraph (1) directly or 
        through grants or contracts with appropriate public or nonprofit 
        entities.

    (h) Administration of Grant Program.--
            (1) <<NOTE: Consultation.>>  Selection criteria.--The 
        Secretary, in consultation with entities specified in paragraph 
        (3), shall establish criteria for the selection of eligible 
        entities that have submitted applications under subsection (f).
            (2) <<NOTE: Consultation.>>  Development of measures and 
        metrics.--The Secretary shall develop, in consultation with 
        entities specified in paragraph (3), the following:
                    (A) A framework for collecting and sharing 
                information about entities in receipt of grants under 
                this section for purposes of improving the services 
                available for eligible individuals and their families, 
                set forth by service type, locality, and eligibility 
                criteria.
                    (B) The measures and metrics to be used by each 
                entity in receipt of grants under this section to 
                determine the effectiveness of the programming being 
                provided by such entity in improving mental health 
                status, wellbeing, and reducing suicide risk and 
                completed suicides of eligible individuals and their 
                families, which shall include an existing measurement 
                tool or protocol for the grant recipient to utilize when 
                determining programmatic effectiveness.
            (3) <<NOTE: Consultation.>>  Coordination.--In developing a 
        plan for the design and implementation of the provision of 
        grants under this section, including criteria for the award of 
        grants, the Secretary shall consult with the following:
                    (A) Veterans service organizations.
                    (B) National organizations representing potential 
                community partners of eligible entities in providing 
                supportive services to address the needs of eligible 
                individuals and their families, including national 
                organizations that--
                          (i) advocate for the needs of individuals with 
                      or at risk of behavioral health conditions;
                          (ii) represent mayors;
                          (iii) represent unions;
                          (iv) represent first responders;
                          (v) represent chiefs of police and sheriffs;
                          (vi) represent governors;
                          (vii) represent a territory of the United 
                      States; or

[[Page 134 STAT. 788]]

                          (viii) represent a Tribal alliance.
                    (C) National organizations representing members of 
                the Armed Forces.
                    (D) National organizations that represent counties.
                    (E) Organizations with which the Department has a 
                current memorandum of agreement or understanding related 
                to mental health or suicide prevention.
                    (F) State departments of veterans affairs.
                    (G) National organizations representing members of 
                the reserve components of the Armed Forces.
                    (H) National organizations representing members of 
                the Coast Guard.
                    (I) Organizations, including institutions of higher 
                education, with experience in creating measurement tools 
                for purposes of advising the Secretary on the most 
                appropriate existing measurement tool or protocol for 
                the Department to utilize.
                    (J) The National Alliance on Mental Illness.
                    (K) A labor organization (as such term is defined in 
                section 7103(a)(4) of title 5, United States Code).
                    (L) The Centers for Disease Control and Prevention, 
                the Substance Abuse and Mental Health Services 
                Administration, the President's Roadmap to Empower 
                Veterans and End a National Tragedy of Suicide Task 
                Force, and such other organizations as the Secretary 
                considers appropriate.
            (4) Report on grant criteria.--Not later than 30 days before 
        notifying eligible entities of the availability of funding under 
        this section, the Secretary shall submit to the appropriate 
        committees of Congress a report containing--
                    (A) criteria for the award of a grant under this 
                section;
                    (B) the already developed measures and metrics to be 
                used by the Department to measure the effectiveness of 
                the use of grants provided under this section as 
                described in subsection (h)(2); and
                    (C) a framework for the sharing of information about 
                entities in receipt of grants under this section.

    (i) Information on Potential Eligible Individuals.--
            (1) In general.--The Secretary may make available to 
        recipients of grants under this section certain information 
        regarding potential eligible individuals who may receive 
        services for which such grant is provided.
            (2) Information included.--The information made available 
        under paragraph (1) with respect to potential eligible 
        individuals may include the following:
                    (A) Confirmation of the status of a potential 
                eligible individual as a veteran.
                    (B) Confirmation of whether the potential eligible 
                individual is enrolled in the patient enrollment system 
                of the Department under section 1705(a) of title 38, 
                United States Code.
                    (C) Confirmation of whether a potential eligible 
                individual is currently receiving care furnished by the 
                Department or has recently received such care.
            (3) Opt-out.--The Secretary shall allow an eligible 
        individual to opt out of having their information shared under 
        this subsection with recipients of grants under this section.

[[Page 134 STAT. 789]]

    (j) Duration.--The authority of the Secretary to provide grants 
under this section shall terminate on the date that is three years after 
the date on which the first grant is awarded under this section.
    (k) Reporting.--
            (1) Interim report.--
                    (A) In general.--Not later than 18 months after the 
                date on which the first grant is awarded under this 
                section, the Secretary shall submit to the appropriate 
                committees of Congress a report on the provision of 
                grants to eligible entities under this section.
                    (B) Elements.--The report submitted under 
                subparagraph (A) shall include the following:
                          (i) <<NOTE: Assessment.>>  An assessment of 
                      the effectiveness of the grant program under this 
                      section, including--
                                    (I) the effectiveness of grant 
                                recipients and their community partners, 
                                if any, in conducting outreach to 
                                eligible individuals;
                                    (II) the effectiveness of increasing 
                                eligible individuals engagement in 
                                suicide prevention services; and
                                    (III) such other validated 
                                instruments and additional measures as 
                                determined by the Secretary and as 
                                described in subsection (h)(2).
                          (ii) <<NOTE: List.>>  A list of grant 
                      recipients and their partner organizations, if 
                      any, that delivered services funded by the grant 
                      and the amount of such grant received by each 
                      recipient and partner organization.
                          (iii) The number of eligible individuals 
                      supported by each grant recipient, including 
                      through services provided to family members, 
                      disaggregated by--
                                    
                                (I) <<NOTE: Determination. Coordination.>> 
                                 all demographic characteristics as 
                                determined necessary and appropriate by 
                                the Secretary in coordination with the 
                                Centers for Disease Control and 
                                Prevention;
                                    (II) whether each such eligible 
                                individual is enrolled in the patient 
                                enrollment system of the Department 
                                under section 1705(a) of title 38, 
                                United States Code;
                                    (III) branch of service in the Armed 
                                Forces;
                                    (IV) era of service in the Armed 
                                Forces;
                                    (V) type of service received by the 
                                eligible individual; and
                                    (VI) whether each such eligible 
                                individual was referred to the 
                                Department for care.
                          (iv) The number of eligible individuals 
                      supported by grants under this section, including 
                      through services provided to family members.
                          (v) The number of eligible individuals 
                      described in clause (iv) who were not previously 
                      receiving care furnished by the Department, with 
                      specific numbers for the population of eligible 
                      individuals described in subsection (q)(4)(B).
                          (vi) The number of eligible individuals whose 
                      mental health status, wellbeing, and suicide risk 
                      received a baseline measurement assessment under 
                      this section and the number of such eligible 
                      individuals

[[Page 134 STAT. 790]]

                      whose mental health status, wellbeing, and suicide 
                      risk will be measured by the Department or a 
                      community partner over a period of time for any 
                      improvements.
                          (vii) <<NOTE: Data.>>  The types of data the 
                      Department was able to collect and share with 
                      partners, including a characterization of the 
                      benefits of that data.
                          (viii) The number and percentage of eligible 
                      individuals referred to the point of contact at 
                      the Department under subsection (e)(3)(C).
                          (ix) The number of eligible individuals newly 
                      enrolled in the patient enrollment system of the 
                      Department under section 1705(a) of title 38, 
                      United States Code based on a referral to the 
                      Department from a grant recipient under subsection 
                      (e)(3)(C), disaggregated by grant recipient.
                          (x) A detailed account of how the grant funds 
                      were used, including executive compensation, 
                      overhead costs, and other indirect costs.
                          (xi) A description of any outreach activities 
                      conducted by the eligible entity in receipt of a 
                      grant with respect to services provided using the 
                      grant.
                          (xii) The number of individuals who seek 
                      services from the grant recipient who are not 
                      eligible individuals.
                    (C) <<NOTE: Determination.>>  Submittal of 
                information by grant recipients.--The Secretary may 
                require eligible entities receiving grants under this 
                section to provide to Congress such information as the 
                Secretary determines necessary regarding the elements 
                described in subparagraph (B).
            (2) Final report.--Not later than three years after the date 
        on which the first grant is awarded under this section, and 
        annually thereafter for each year in which the program is in 
        effect, the Secretary shall submit to the appropriate committees 
        of Congress--
                    (A) a follow-up on the interim report submitted 
                under paragraph (1) containing the elements set forth in 
                subparagraph (B) of such paragraph; and
                    (B) a report on--
                          (i) the effectiveness of the provision of 
                      grants under this section, including the 
                      effectiveness of community partners in conducting 
                      outreach to eligible individuals and their 
                      families and reducing the rate of suicide among 
                      eligible individuals;
                          (ii) <<NOTE: Assessment.>>  an assessment of 
                      the increased capacity of the Department to 
                      provide services to eligible individuals and their 
                      families, set forth by State, as a result of the 
                      provision of grants under this section;
                          (iii) the feasibility and advisability of 
                      extending or expanding the provision of grants 
                      consistent with this section; and
                          (iv) such other elements as considered 
                      appropriate by the Secretary.

    (l) Third-party Assessment.--
            (1) Study of grant program.--
                    (A) <<NOTE: Deadline. Contracts.>>  In general.--Not 
                later than 180 days after the commencement of the grant 
                program under this section,

[[Page 134 STAT. 791]]

                the Secretary shall seek to enter into a contract with 
                an appropriate entity described in paragraph (3) to 
                conduct a study of the grant program.
                    (B) Elements of study.--In conducting the study 
                under subparagraph (A), the appropriate entity shall--
                          (i) <<NOTE: Evaluation.>>  evaluate the 
                      effectiveness of the grant program under this 
                      section in--
                                    (I) addressing the factors that 
                                contribute to suicides;
                                    (II) increasing the use of suicide 
                                prevention services;
                                    (III) reducing mood-related symptoms 
                                that increase suicide and suicide risk; 
                                and
                                    (IV) where such information is 
                                available due to the time frame of the 
                                grant program, reducing suicidal 
                                ideation, suicide attempts, self-harm, 
                                and deaths by suicide; and
                                    (V) reducing suicidal ideation, 
                                suicide attempts, self-harm, and deaths 
                                by suicide among eligible individuals 
                                through eligible entities located in 
                                communities; and
                          (ii) compare the results of the grant program 
                      with other national programs in delivering 
                      resources to eligible individuals in the 
                      communities where they live that address the 
                      factors that contribute to suicide.
            (2) Assessment.--
                    (A) <<NOTE: Deadline.>>  In general.--The contract 
                under paragraph (1) shall provide that not later than 24 
                months after the commencement of the grant program under 
                this section, the appropriate entity shall submit to the 
                Secretary an assessment based on the study conducted 
                pursuant to such contract.
                    (B) <<NOTE: Records.>>  Submittal to congress.--Upon 
                receipt of the assessment under subparagraph (A), the 
                Secretary shall transmit to the appropriate committees 
                of Congress a copy of the assessment.
            (3) Appropriate entity.--An appropriate entity described in 
        this paragraph is a nongovernment entity with experience 
        optimizing and assessing organizations that deliver services and 
        assessing the effectiveness of suicide prevention programs.

    (m) <<NOTE: Determinations.>>  Referral for Care.--
            (1) Mental health assessment.--If an eligible entity in 
        receipt of a grant under this section determines that an 
        eligible individual is at-risk of suicide or other mental or 
        behavioral health condition pursuant to a baseline mental health 
        screening conducted under subsection (q)(11)(A)(ii) with respect 
        to the individual, the entity shall refer the eligible 
        individual to the Department for additional care under 
        subsection (n) or any other provision of law.
            (2) Emergency treatment.--If an eligible entity in receipt 
        of a grant under this section determines that an eligible 
        individual furnished clinical services for emergency treatment 
        under subsection (q)(11)(A)(iv) requires ongoing services, the 
        entity shall refer the eligible individual to the Department for 
        additional care under subsection (n) or any other provision of 
        law.

[[Page 134 STAT. 792]]

            (3) Refusal.--If an eligible individual refuses a referral 
        by an entity under paragraph (1) or (2), any ongoing clinical 
        services provided to the eligible individual by the entity shall 
        be at the expense of the entity.

    (n) <<NOTE: Determination. Assessment.>>  Provision of Care to 
Eligible Individuals.--When the Secretary determines it is clinically 
appropriate, the Secretary shall furnish to eligible individuals who are 
receiving or have received suicide prevention services through grants 
provided under this section an initial mental health assessment and 
mental health or behavioral health care services authorized under 
chapter 17 of title 38, United States Code, that are required to treat 
the mental or behavioral health care needs of the eligible individual, 
including risk of suicide.

    (o) <<NOTE: Contracts.>>  Agreements With Community Partners.--
            (1) In general.--Subject to paragraph (2), an eligible 
        entity may use grant funds to enter into an agreement with a 
        community partner under which the eligible entity may provide 
        funds to the community partner for the provision of suicide 
        prevention services to eligible individuals and their families.
            (2) Limitation.--The ability of a recipient of a grant under 
        this section to provide grant funds to a community partner shall 
        be limited to grant recipients that are a State or local 
        government or an Indian tribe.

    (p) <<NOTE: Time period.>>  Authorization of Appropriations.--There 
is authorized to be appropriated to the Secretary to carry out this 
section a total of $174,000,000 for fiscal years 2021 through 2025.

    (q) Definitions.--In this section:
            (1) Appropriate committees of congress.--The term 
        ``appropriate committees of Congress'' means--
                    (A) the Committee on Veterans' Affairs and the 
                Subcommittee on Military Construction, Veterans Affairs, 
                and Related Agencies of the Committee on Appropriations 
                of the Senate; and
                    (B) the Committee on Veterans' Affairs and the 
                Subcommittee on Military Construction, Veterans Affairs, 
                and Related Agencies of the Committee on Appropriations 
                of the House of Representatives.
            (2) Department.--The term ``Department'' means the 
        Department of Veterans Affairs.
            (3) Eligible entity.--The term ``eligible entity'' means--
                    (A) an incorporated private institution or 
                foundation--
                          (i) no part of the net earnings of which 
                      incurs to the benefit of any member, founder, 
                      contributor, or individual; and
                          (ii) that has a governing board that would be 
                      responsible for the operation of the suicide 
                      prevention services provided under this section;
                    (B) a corporation wholly owned and controlled by an 
                organization meeting the requirements of clauses (i) and 
                (ii) of subparagraph (A);
                    (C) an Indian tribe;
                    (D) a community-based organization that can 
                effectively network with local civic organizations, 
                regional health systems, and other settings where 
                eligible individuals and their families are likely to 
                have contact; or
                    (E) A State or local government.

[[Page 134 STAT. 793]]

            (4) Eligible individual.--The term ``eligible individual'' 
        includes a person at risk of suicide who is--
                    (A) a veteran as defined in section 101 of title 38, 
                United States Code;
                    (B) an individual described in section 1720I(b) of 
                such title; or
                    (C) an individual described in any of clauses (i) 
                through (iv) of section 1712A(a)(1)(C) of such title.
            (5) Emergency treatment.--Medical services, professional 
        services, ambulance services, ancillary care and medication 
        (including a short course of medication related to and necessary 
        for the treatment of the emergency condition that is provided 
        directly to or prescribed for the patient for use after the 
        emergency condition is stabilized and the patient is discharged) 
        was rendered in a medical emergency of such nature that a 
        prudent layperson would have reasonably expected that delay in 
        seeking immediate medical attention would have been hazardous to 
        life or health. This standard is met by an emergency medical 
        condition manifesting itself by acute symptoms of sufficient 
        severity (including severe pain) that a prudent layperson who 
        possesses an average knowledge of health and medicine could 
        reasonably expect the absence of immediate medical attention to 
        result in placing the health of the individual in serious 
        jeopardy, serious impairment to bodily functions, or serious 
        dysfunction of any bodily organ or part.
            (6) Family.--The term ``family'' means, with respect to an 
        eligible individual, any of the following:
                    (A) A parent.
                    (B) A spouse.
                    (C) A child.
                    (D) A sibling.
                    (E) A step-family member.
                    (F) An extended family member.
                    (G) Any other individual who lives with the eligible 
                individual.
            (7) Indian tribe.--The term ``Indian tribe'' has the meaning 
        given that term in section 4 of the Native American Housing 
        Assistance and Self-Determination Act of 1996 (25 U.S.C. 4103).
            (8) Risk of suicide.--
                    (A) In general.--The term ``risk of suicide'' means 
                exposure to, or the existence of, any of the following 
                (to a degree determined by the Secretary pursuant to 
                regulations):
                          (i) Health risk factors, including the 
                      following:
                                    (I) Mental health challenges.
                                    (II) Substance abuse.
                                    (III) Serious or chronic health 
                                conditions or pain.
                                    (IV) Traumatic brain injury.
                          (ii) Environmental risk factors, including the 
                      following:
                                    (I) Prolonged stress.
                                    (II) Stressful life events.
                                    (III) Unemployment.
                                    (IV) Homelessness.
                                    (V) Recent loss.
                                    (VI) Legal or financial challenges.

[[Page 134 STAT. 794]]

                          (iii) Historical risk factors, including the 
                      following:
                                    (I) Previous suicide attempts.
                                    (II) Family history of suicide.
                                    (III) History of abuse, neglect, or 
                                trauma.
                    (B) <<NOTE: Regulations. Determination.>>  Degree of 
                risk.--The Secretary may, by regulation, establish a 
                process for determining degrees of risk of suicide for 
                use by grant recipients to focus the delivery of 
                services using grant funds.
            (9) Rural.--The term ``rural'', with respect to a community, 
        has the meaning given that term in the Rural-Urban Commuting 
        Areas coding system of the Department of Agriculture.
            (10) Secretary.--The term ``Secretary'' means the Secretary 
        of Veterans Affairs.
            (11) Suicide prevention services.--
                    (A) In general.--The term ``suicide prevention 
                services'' means services to address the needs of 
                eligible individuals and their families and includes the 
                following:
                          (i) Outreach to identify those at risk of 
                      suicide with an emphasis on eligible individuals 
                      who are at highest risk or who are not receiving 
                      health care or other services furnished by the 
                      Department.
                          (ii) A baseline mental health screening for 
                      risk.
                          (iii) Education on suicide risk and prevention 
                      to families and communities.
                          (iv) Provision of clinical services for 
                      emergency treatment.
                          (v) Case management services.
                          (vi) Peer support services.
                          (vii) Assistance in obtaining any benefits 
                      from the Department that the eligible individual 
                      and their family may be eligible to receive, 
                      including--
                                    (I) vocational and rehabilitation 
                                counseling;
                                    (II) supportive services for 
                                homeless veterans;
                                    (III) employment and training 
                                services;
                                    (IV) educational assistance; and
                                    (V) health care services.
                          (viii) <<NOTE: Coordination.>>  Assistance in 
                      obtaining and coordinating the provision of other 
                      benefits provided by the Federal Government, a 
                      State or local government, or an eligible entity.
                          (ix) Assistance with emergent needs relating 
                      to--
                                    (I) health care services;
                                    (II) daily living services;
                                    (III) personal financial planning 
                                and counseling;
                                    (IV) transportation services;
                                    (V) temporary income support 
                                services;
                                    (VI) fiduciary and representative 
                                payee services;
                                    (VII) legal services to assist the 
                                eligible individual with issues that may 
                                contribute to the risk of suicide; and
                                    (VIII) child care (not to exceed 
                                $5,000 per family of an eligible 
                                individual per fiscal year).
                          (x) <<NOTE: Determination. Consultation.>>  
                      Nontraditional and innovative approaches and 
                      treatment practices, as determined appropriate by 
                      the Secretary, in consultation with appropriate 
                      entities.

[[Page 134 STAT. 795]]

                          (xi) Such other services necessary for 
                      improving the mental health status and wellbeing 
                      and reducing the suicide risk of eligible 
                      individuals and their families as the Secretary 
                      considers appropriate, which may include--
                                    (I) adaptive sports, equine assisted 
                                therapy, or in-place or outdoor 
                                recreational therapy;
                                    (II) substance use reduction 
                                programming;
                                    (III) individual, group, or family 
                                counseling; and
                                    (IV) relationship coaching.
                    (B) Exclusion.--The term ``suicide prevention 
                services'' does not include direct cash assistance to 
                eligible individuals or their families.
            (12) Veterans crisis line.--The term ``Veterans Crisis 
        Line'' means the toll-free hotline for veterans established 
        under section 1720F(h) of title 38, United States Code.
            (13) Veterans service organization.--The term ``veterans 
        service organization'' means any organization recognized by the 
        Secretary for the representation of veterans under section 5902 
        of title 38, United States Code.
SEC. 202. ANALYSIS ON FEASIBILITY AND ADVISABILITY OF THE 
                        DEPARTMENT OF VETERANS AFFAIRS PROVIDING 
                        CERTAIN COMPLEMENTARY AND INTEGRATIVE 
                        HEALTH SERVICES.

    (a) <<NOTE: Deadline.>>  In General.--Not later than 180 days after 
the date of the enactment of this Act, the Secretary of Veterans Affairs 
shall complete an analysis on the feasibility and advisability of 
providing complementary and integrative health treatments described in 
subsection (c) at all medical facilities of the Department of Veterans 
Affairs.

    (b) Inclusion of Assessment of Report.--The analysis conducted under 
subsection (a) shall include an assessment of 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 Law 
114-198; 38 U.S.C. 1701 note) submitted under subsection (e)(2) of such 
section.
    (c) Treatments Described.--Complementary and integrative health 
treatments described in this subsection shall consist of the following:
            (1) Yoga.
            (2) Meditation.
            (3) Acupuncture.
            (4) Chiropractic care.
            (5) <<NOTE: Determination.>>  Other treatments that show 
        sufficient evidence of efficacy at treating mental or physical 
        health conditions, as determined by the Secretary.

    (d) Report.--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 analysis completed under 
subsection (a), including--
            (1) the results of such analysis; and
            (2) <<NOTE: Recommenda- tions.>>  such recommendations 
        regarding the furnishing of complementary and integrative health 
        treatments described in subsection (c) as the Secretary 
        considers appropriate.

[[Page 134 STAT. 796]]

SEC. 203. <<NOTE: 38 USC 1712A note.>>  PILOT PROGRAM TO PROVIDE 
                        VETERANS ACCESS TO COMPLEMENTARY AND 
                        INTEGRATIVE HEALTH PROGRAMS THROUGH ANIMAL 
                        THERAPY, AGRITHERAPY, SPORTS AND 
                        RECREATION THERAPY, ART THERAPY, AND 
                        POSTTRAUMATIC GROWTH PROGRAMS.

    (a) <<NOTE: Deadline. Determination.>>  In General.--Not later than 
180 days after the date on which 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 Law 114-198; 38 U.S.C. 1701 
note) submits its final report under subsection (e)(2) of such section, 
the Secretary of Veterans Affairs shall commence the conduct of a pilot 
program to provide complementary and integrative health programs 
described in subsection (b) to eligible veterans from the Department of 
Veterans Affairs or through the use of non-Department entities for the 
treatment of post-traumatic stress disorder, depression, anxiety, or 
other conditions as determined by the Secretary.
    (b) Programs Described.--Complementary and integrative health 
programs described in this subsection may, taking into consideration the 
report described in subsection (a), consist of the following:
            (1) Equine therapy.
            (2) Other animal therapy.
            (3) Agritherapy.
            (4) Sports and recreation therapy.
            (5) Art therapy.
            (6) Posttraumatic growth programs.

    (c) Eligible Veterans.--A veteran is eligible to participate in the 
pilot program under this section if the veteran--
            (1) is enrolled in the system of patient enrollment of the 
        Department under section 1705(a) of title 38, United States 
        Code; and
            (2) <<NOTE: Time period.>>  has received health care under 
        the laws administered by the Secretary during the two-year 
        period preceding the initial participation of the veteran in the 
        pilot program.

    (d) Duration.--
            (1) In general.--The Secretary shall carry out the pilot 
        program under this section for a three-year period beginning on 
        the commencement of the pilot program.
            (2) Extension.--The Secretary may extend the duration of the 
        pilot program under this section if the Secretary, based on the 
        results of the interim report submitted under subsection (f)(1), 
        determines that it is appropriate to do so.

    (e) Locations.--
            (1) In general.--The Secretary shall select not fewer than 
        five facilities of the Department at which to carry out the 
        pilot program under this section.
            (2) Selection criteria.--In selecting facilities under 
        paragraph (1), the Secretary shall ensure that--
                    (A) the locations are in geographically diverse 
                areas; and
                    (B) not fewer than three facilities serve veterans 
                in rural or highly rural areas (as determined through 
                the use of the Rural-Urban Commuting Areas coding system 
                of the Department of Agriculture).

    (f) Reports.--

[[Page 134 STAT. 797]]

            (1) Interim report.--
                    (A) In general.--Not later than one year after the 
                commencement of the pilot program under this section, 
                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 
                progress of the pilot program.
                    (B) Elements.--The report required by subparagraph 
                (A) shall include the following:
                          (i) The number of participants in the pilot 
                      program.
                          (ii) The type or types of therapy offered at 
                      each facility at which the pilot program is being 
                      carried out.
                          (iii) <<NOTE: Assessment.>>  An assessment of 
                      whether participation by a veteran in the pilot 
                      program resulted in any changes in clinically 
                      relevant endpoints for the veteran with respect to 
                      the conditions specified in subsection (a).
                          (iv) <<NOTE: Assessment.>>  An assessment of 
                      the quality of life of veterans participating in 
                      the pilot program, including the results of a 
                      satisfaction survey of the participants in the 
                      pilot program, disaggregated by program under 
                      subsection (b).
                          (v) <<NOTE: Determination.>>  The 
                      determination of the Secretary with respect to 
                      extending the pilot program under subsection 
                      (d)(2).
                          (vi) <<NOTE: Recommenda- tions.>>  Any 
                      recommendations of the Secretary with respect to 
                      expanding the pilot program.
            (2) Final report.--Not later than 90 days after the 
        termination of the pilot program under this section, 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 final report on the pilot program.
SEC. 204. DEPARTMENT OF VETERANS AFFAIRS STUDY OF ALL-CAUSE 
                        MORTALITY OF VETERANS, INCLUDING BY 
                        SUICIDE, AND REVIEW OF STAFFING LEVELS OF 
                        MENTAL HEALTH PROFESSIONALS.

    (a) Study of Deaths of Veterans by Suicide.--
            (1) <<NOTE: Contracts. Coordination. Evaluation.>>  In 
        general.--The Secretary of Veterans Affairs shall seek to enter 
        into an agreement with the National Academies of Sciences, 
        Engineering, and Medicine under which the Secretary shall 
        collaborate and coordinate with the National Academies on a 
        revised study design to fulfill the goals of the 2019 study 
        design of the National Academies described in the explanatory 
        statement accompanying the Further Consolidated Appropriations 
        Act, 2020 (Public Law 116-94), as part of current and additional 
        research priorities of the Department of Veterans Affairs, to 
        evaluate the effects of opioids and benzodiazepine on all-cause 
        mortality of veterans, including suicide, regardless of whether 
        information relating to such deaths has been reported by the 
        Centers for Disease Control and Prevention.
            (2) Goals.--In carrying out the collaboration and 
        coordination under paragraph (1), the Secretary shall seek as 
        much as possible to achieve the same advancement of useful 
        knowledge as the 2019 study design described in such paragraph.

    (b) Review of Staffing Levels for Mental Health Professionals.--

[[Page 134 STAT. 798]]

            (1) <<NOTE: Deadline.>>  In general.--Not later than 90 days 
        after the date of the enactment of this Act, the Comptroller 
        General of the United States shall conduct a review of the 
        staffing levels for mental health professionals of the 
        Department.
            (2) Elements.--The review required by paragraph (1) shall 
        include a description of the efforts of the Department to 
        maintain appropriate staffing levels for mental health 
        professionals, such as mental health counselors, marriage and 
        family therapists, and other appropriate counselors, including 
        the following:
                    (A) A description of any impediments to carry out 
                the education, training, and hiring of mental health 
                counselors and marriage and family therapists under 
                section 7302(a) of title 38, United States Code, and 
                strategies for addressing those impediments.
                    (B) A description of the objectives, goals, and 
                timing of the Department with respect to increasing the 
                representation of such counselors and therapists in the 
                behavioral health workforce of the Department, 
                including--
                          (i) a review of qualification criteria for 
                      such counselors and therapists and a comparison of 
                      such criteria to that of other behavioral health 
                      professions in the Department; and
                          (ii) <<NOTE: Assessment.>>  an assessment of 
                      the participation of such counselors and 
                      therapists in the mental health professionals 
                      trainee program of the Department and any 
                      impediments to such participation.
                    (C) <<NOTE: Assessment.>>  An assessment of the 
                development by the Department of hiring guidelines for 
                mental health counselors, marriage and family 
                therapists, and other appropriate counselors.
                    (D) A description of how the Department--
                          (i) identifies gaps in the supply of mental 
                      health professionals; and
                          (ii) determines successful staffing ratios for 
                      mental health professionals of the Department.
                    (E) <<NOTE: Consultation. Timeline.>>  A description 
                of actions taken by the Secretary, in consultation with 
                the Director of the Office of Personnel Management, to 
                create an occupational series for mental health 
                counselors and marriage and family therapists of the 
                Department and a timeline for the creation of such an 
                occupational series.
                    (F) A description of actions taken by the Secretary 
                to ensure that the national, regional, and local 
                professional standards boards for mental health 
                counselors and marriage and family therapists are 
                comprised of only mental health counselors and marriage 
                and family therapists and that the liaison from the 
                Department to such boards is a mental health counselor 
                or marriage and family therapist.

    (c) Compilation of Data.--The Secretary of Veterans Affairs shall 
ensure that data under subsections (a) and (b) is compiled separately 
and disaggregated by year and compiled in a manner that allows it to be 
analyzed across all data fields for purposes of informing and updating 
clinical practice guidelines of the Department of Veterans Affairs.

[[Page 134 STAT. 799]]

    (d) <<NOTE: Deadlines.>>  Briefings.--The Secretary of Veterans 
Affairs shall brief the Committee on Veterans' Affairs of the Senate and 
the Committee on Veterans' Affairs of the House of Representatives 
containing the interim results--
            (1) with respect to the study under subsection (a)(1), not 
        later than 24 months after entering into the agreement under 
        such subsection; and
            (2) with respect to the review under subsection (b)(1), not 
        later than 18 months after the date of the enactment of this 
        Act.

    (e) <<NOTE: Public information. Coordination.>>  Reports.--
            (1) Report on study.--Not later than 90 days after the 
        completion by the Secretary of Veterans Affairs in coordination 
        with the National Academies of Sciences, Engineering, and 
        Medicine of the study required under subsection (a)(1), the 
        Secretary shall--
                    (A) 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 results of the 
                study; and
                    (B) make such report publicly available.
            (2) Report on review.--Not later than 90 days after the 
        completion by the Comptroller General of the United States of 
        the review required under subsection (b)(1), the Comptroller 
        General shall--
                    (A) 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 results of the 
                review; and
                    (B) make such report publicly available.
SEC. 205. COMPTROLLER GENERAL REPORT ON MANAGEMENT BY DEPARTMENT 
                        OF VETERANS AFFAIRS OF VETERANS AT HIGH 
                        RISK FOR SUICIDE.

    (a) In General.--Not later than 18 months 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 efforts of the Department of Veterans Affairs to manage veterans 
at high risk for suicide.
    (b) <<NOTE: Assessments. Determination. Coordination.>>  Elements.--
The report required by subsection (a) shall include the following:
            (1) A description of how the Department identifies patients 
        as high risk for suicide, with particular consideration to the 
        efficacy of inputs into the Recovery Engagement and Coordination 
        for Health - Veterans Enhanced Treatment program (commonly 
        referred to as the ``REACH VET'' program) of the Department, 
        including an assessment of the efficacy of such identifications 
        disaggregated by--
                    (A) all demographic characteristics as determined 
                necessary and appropriate by the Secretary of Veterans 
                Affairs in coordination with the Centers for Disease 
                Control and Prevention;
                    (B) Veterans Integrated Service Network; and
                    (C) to the extent practicable, medical center of the 
                Department.

[[Page 134 STAT. 800]]

            (2) A description of how the Department intervenes when a 
        patient is identified as high risk, including an assessment of 
        the efficacy of such interventions disaggregated by--
                    (A) all demographic characteristics as determined 
                necessary and appropriate by the Secretary in 
                coordination with the Centers for Disease Control and 
                Prevention;
                    (B) Veterans Integrated Service Network; and
                    (C) to the extent practicable, medical center of the 
                Department.
            (3) A description of how the Department monitors patients 
        who have been identified as high risk, including an assessment 
        of the efficacy of such monitoring and any follow-ups 
        disaggregated by--
                    (A) all demographic characteristics as determined 
                necessary and appropriate by the Secretary in 
                coordination with the Centers for Disease Control and 
                Prevention;
                    (B) Veterans Integrated Service Network; and
                    (C) to the extent practicable, medical center of the 
                Department.
            (4) <<NOTE: Review.>>  A review of staffing levels of 
        suicide prevention coordinators across the Veterans Health 
        Administration.
            (5) <<NOTE: Review.>>  A review of the resources and 
        programming offered to family members and friends of veterans 
        who have a mental health condition in order to assist that 
        veteran in treatment and recovery.
            (6) An assessment of such other areas as the Comptroller 
        General considers appropriate to study.

      TITLE III--PROGRAMS, STUDIES, AND GUIDELINES ON MENTAL HEALTH

SEC. 301. <<NOTE: Deadlines.>>  STUDY ON CONNECTION BETWEEN LIVING 
                        AT HIGH ALTITUDE AND SUICIDE RISK FACTORS 
                        AMONG VETERANS.

    (a) <<NOTE: Consultation.>>  In General.--Not later than 180 days 
after the date of the enactment of this Act, the Secretary of Veterans 
Affairs, in consultation with Rural Health Resource Centers of the 
Office of Rural Health of the Department of Veterans Affairs, shall 
commence the conduct of a study on the connection between living at high 
altitude and the risk of developing depression or dying by suicide among 
veterans.

    (b) Completion of Study.--The study conducted under subsection (a) 
shall be completed not later than three years after the date of the 
commencement of the study.
    (c) Individual Impact.--The study conducted under subsection (a) 
shall be conducted so as to determine the effect of high altitude on 
suicide risk at the individual level, not at the State or county level.
    (d) Report.--Not later than 150 days after the completion of the 
study conducted 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 Representatives a report on the 
results of the study.
    (e) Follow-up Study.--
            (1) <<NOTE: Determination.>>  In general.--If the Secretary 
        determines through the study conducted under subsection (a) that 
        living at high altitude is a risk factor for developing 
        depression or dying by suicide,

[[Page 134 STAT. 801]]

        the Secretary shall conduct an additional study to identify the 
        following:
                    (A) The most likely biological mechanism that makes 
                living at high altitude a risk factor for developing 
                depression or dying by suicide.
                    (B) The most effective treatment or intervention for 
                reducing the risk of developing depression or dying by 
                suicide associated with living at high altitude.
            (2) Report.--Not later than 150 days after completing the 
        study conducted under paragraph (1), 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 results of the study.
SEC. 302. <<NOTE: 38 USC 1712A note.>>  ESTABLISHMENT BY 
                        DEPARTMENT OF VETERANS AFFAIRS AND 
                        DEPARTMENT OF DEFENSE OF A CLINICAL 
                        PROVIDER TREATMENT TOOLKIT AND 
                        ACCOMPANYING TRAINING MATERIALS FOR 
                        COMORBIDITIES.

    (a) <<NOTE: Deadline. Consultation.>>  In General.--Not later than 
two years after the date of the enactment of this Act, the Secretary of 
Veterans Affairs, in consultation with the Secretary of Defense, shall 
develop a clinical provider treatment toolkit and accompanying training 
materials for the evidence-based management of comorbid mental health 
conditions, comorbid mental health and substance use disorders, and a 
comorbid mental health condition and chronic pain.

    (b) Matters Included.--In developing the clinical provider treatment 
toolkit and accompanying training materials under subsection (a), the 
Secretary of Veterans Affairs and the Secretary of Defense shall ensure 
that the toolkit and training materials include guidance with respect to 
the following:
            (1) The treatment of patients with post-traumatic stress 
        disorder who are also experiencing an additional mental health 
        condition, a substance use disorder, or chronic pain.
            (2) The treatment of patients experiencing a mental health 
        condition, including anxiety, depression, or bipolar disorder, 
        who are also experiencing a substance use disorder or chronic 
        pain.
            (3) The treatment of patients with traumatic brain injury 
        who are also experiencing--
                    (A) a mental health condition, including post-
                traumatic stress disorder, anxiety, depression, or 
                bipolar disorder;
                    (B) a substance use disorder; or
                    (C) chronic pain.
SEC. 303. <<NOTE: 38 USC 1720F note.>>  UPDATE OF CLINICAL 
                        PRACTICE GUIDELINES FOR ASSESSMENT AND 
                        MANAGEMENT OF PATIENTS AT RISK FOR 
                        SUICIDE.

    (a) <<NOTE: Publication.>>  In General.--In the first publication of 
the Department of Veterans Affairs and Department of Defense Clinical 
Practice Guideline for Assessment and Management of Patients at Risk for 
Suicide published after the date of the enactment of this Act, the 
Secretary of Veterans Affairs and the Secretary of Defense, through the 
Assessment and Management of Patients at Risk for Suicide Work Group (in 
this section referred to as the ``Work Group''), shall ensure the 
publication includes the following:
            (1) Enhanced guidance with respect to gender-specific--
                    (A) risk factors for suicide and suicidal ideation;

[[Page 134 STAT. 802]]

                    (B) treatment efficacy for depression and suicide 
                prevention;
                    (C) pharmacotherapy efficacy; and
                    (D) psychotherapy efficacy.
            (2) Guidance with respect to the efficacy of alternative 
        therapies, other than psychotherapy and pharmacotherapy, 
        including the following:
                    (A) Yoga therapy.
                    (B) Meditation therapy.
                    (C) Equine therapy.
                    (D) Other animal therapy.
                    (E) Training and caring for service dogs.
                    (F) Agritherapy.
                    (G) Art therapy.
                    (H) Outdoor sports therapy.
                    (I) Music therapy.
                    (J) Any other alternative therapy that the Work 
                Group considers appropriate.
            (3) Guidance with respect to the findings 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 Law 114-198; 38 U.S.C. 1701 note).

    (b) Rule of Construction.--Nothing in this section shall be 
construed to prevent the Secretary of Veterans Affairs and the Secretary 
of Defense from considering all relevant evidence, as appropriate, in 
updating the Department of Veterans Affairs and Department of Defense 
Clinical Practice Guideline for Assessment and Management of Patients at 
Risk for Suicide, as required under subsection (a), or from ensuring 
that the final clinical practice guidelines updated under such 
subsection remain applicable to the patient populations of the 
Department of Veterans Affairs and the Department of Defense.
SEC. 304. <<NOTE: 38 USC 1712A note.>>  ESTABLISHMENT BY 
                        DEPARTMENT OF VETERANS AFFAIRS AND 
                        DEPARTMENT OF DEFENSE OF CLINICAL PRACTICE 
                        GUIDELINES FOR THE TREATMENT OF SERIOUS 
                        MENTAL ILLNESS.

    (a) <<NOTE: Deadline. Consultations.>>  In General.--Not later than 
two years after the date of the enactment of this Act, the Secretary of 
Veterans Affairs, in consultation with the Secretary of Defense and the 
Secretary of Health and Human Services, shall complete the development 
of a clinical practice guideline or guidelines for the treatment of 
serious mental illness, to include the following conditions:
            (1) Schizophrenia.
            (2) Schizoaffective disorder.
            (3) Persistent mood disorder, including bipolar disorder I 
        and II.
            (4) Any other mental, behavioral, or emotional disorder 
        resulting in serious functional impairment that substantially 
        interferes with major life activities as the Secretary of 
        Veterans Affairs, in consultation with the Secretary of Defense 
        and the Secretary of Health and Human Services, considers 
        appropriate.

    (b) Matters Included in Guidelines.--The clinical practice guideline 
or guidelines developed under subsection (a) shall include the 
following:

[[Page 134 STAT. 803]]

            (1) Guidance contained in the 2016 Clinical Practice 
        Guidelines for the Management of Major Depressive Disorders of 
        the Department of Veterans Affairs and the Department of 
        Defense.
            (2) Guidance with respect to the treatment of patients with 
        a condition described in subsection (a).
            (3) <<NOTE: List.>>  A list of evidence-based therapies for 
        the treatment of conditions described in subsection (a).
            (4) An appropriate guideline for the administration of 
        pharmacological therapy, psychological or behavioral therapy, or 
        other therapy for the management of conditions described in 
        subsection (a).

    (c) <<NOTE: Deadline. Consultation.>>  Assessment of Existing 
Guidelines.--Not later than two years after the date of the enactment of 
this Act, the Secretary of Veterans Affairs, in consultation with the 
Secretary of Defense and the Secretary of Health and Human Services, 
shall complete an assessment of the 2016 Clinical Practice Guidelines 
for the Management of Major Depressive Disorders to determine whether an 
update to such guidelines is necessary.

    (d) Work Group.--
            (1) Establishment.--The Secretary of Veterans Affairs, the 
        Secretary of Defense, and the Secretary of Health and Human 
        Services shall create a work group to develop the clinical 
        practice guideline or guidelines under subsection (a) to be 
        known as the ``Serious Mental Illness Work Group'' (in this 
        subsection referred to as the ``Work Group'').
            (2) Membership.--The Work Group created under paragraph (1) 
        shall be comprised of individuals that represent Federal 
        Government entities and non-Federal Government entities with 
        expertise in the areas covered by the Work Group, including the 
        following entities:
                    (A) Academic institutions that specialize in 
                research for the treatment of conditions described in 
                subsection (a).
                    (B) The Health Services Research and Development 
                Service of the Department of Veterans Affairs.
                    (C) The Office of the Assistant Secretary for Mental 
                Health and Substance Use of the Department of Health and 
                Human Services.
                    (D) The National Institute of Mental Health.
                    (E) The Indian Health Service.
                    (F) Relevant organizations with expertise in 
                researching, diagnosing, or treating conditions 
                described in subsection (a).
            (3) Relation to other work groups.--The Work Group shall be 
        created and conducted in the same manner as other work groups 
        for the development of clinical practice guidelines for the 
        Department of Veterans Affairs and the Department of Defense.

    (e) Rule of Construction.--Nothing in this section shall be 
construed to prevent the Secretary of Veterans Affairs and the Secretary 
of Defense from considering all relevant evidence, as appropriate, in 
creating the clinical practice guideline or guidelines required under 
subsection (a) or from ensuring that the final clinical practice 
guideline or guidelines developed under such subsection and subsequently 
updated, as appropriate, remain applicable to the patient populations of 
the Department of Veterans Affairs and the Department of Defense.

[[Page 134 STAT. 804]]

SEC. 305. <<NOTE: 38 USC 1712A note.>>  PRECISION MEDICINE 
                        INITIATIVE OF DEPARTMENT OF VETERANS 
                        AFFAIRS TO IDENTIFY AND VALIDATE BRAIN AND 
                        MENTAL HEALTH BIOMARKERS.

    (a) <<NOTE: Deadline.>>  In General.--Beginning not later than 18 
months after the date of the enactment of this Act, the Secretary of 
Veterans Affairs shall develop and implement an initiative of the 
Department of Veterans Affairs to identify and validate brain and mental 
health biomarkers among veterans, with specific consideration for 
depression, anxiety, post-traumatic stress disorder, bipolar disorder, 
traumatic brain injury, and such other mental health conditions as the 
Secretary considers appropriate. Such initiative may be referred to as 
the ``Precision Medicine for Veterans Initiative''.

    (b) Model of Initiative.--The initiative under subsection (a) shall 
be modeled on the All of Us Precision Medicine Initiative administered 
by the National Institutes of Health with respect to large-scale 
collection of standardized data and open data sharing.
    (c) Methods.--The initiative under subsection (a) shall include 
brain structure and function measurements, such as functional magnetic 
resonance imaging and electroencephalogram, and shall coordinate with 
additional biological methods of analysis utilized in the Million 
Veterans Program of the Department of Veterans Affairs.
    (d) Use of Data.--
            (1) Privacy and security.--In carrying out the initiative 
        under subsection (a), the Secretary shall develop robust data 
        privacy and security measures, consistent with section 552a of 
        title 5, United States Code (commonly known as the ``Privacy Act 
        of 1974''), and regulations promulgated pursuant to the Health 
        Insurance Portability and Accountability Act of 1996 (parts 160, 
        162, and 164 of title 45, Code of Federal Regulations, or 
        successor regulations) to ensure that information of veterans 
        participating in the initiative is kept private and secure.
            (2) Consultation with the national institutes of science and 
        technology.--The Secretary may consult with the National 
        Institute of Science and Technology in developing the data 
        privacy and security measures described in paragraph (1).
            (3) Access standards.--The Secretary shall provide access to 
        information under the initiative consistent with the standards 
        described in section 552a(d)(1) of title 5, United States Code, 
        and section 164.524 of title 45, Code of Federal Regulations, or 
        successor regulations.
            (4) Open platform.--
                    (A) Availability of data.--The Secretary shall make 
                de-identified data collected under the initiative 
                available for research purposes to Federal agencies.
                    (B) Contract.--The Secretary shall contract with 
                nongovernment entities that comply with requisite data 
                security measures to make available for research 
                purposes de-identified data collected under the 
                initiative.
                    (C) Assistance.--The Secretary shall provide 
                assistance to a Federal agency conducting research using 
                data collected under the initiative at the request of 
                that agency.
                    (D) Prohibition on transfer of data.--Federal 
                agencies may not disclose, transmit, share, sell, 
                license, or otherwise transfer data collected under the 
                initiative to any

[[Page 134 STAT. 805]]

                nongovernment entity other than as allowed under 
                subparagraph (B).
            (5) Standardization.--
                    (A) In general.--The Secretary shall ensure that 
                data collected under the initiative is standardized.
                    (B) Consultation.--The Secretary shall consult with 
                the National Institutes of Health and the Food and Drug 
                Administration to determine the most effective, 
                efficient, and cost-effective way of standardizing data 
                collected under the initiative.
                    (C) <<NOTE: Consultation.>>  Manner of 
                standardization.--In consultation with the National 
                Institute for Science and Technology, data collected 
                under the initiative shall be standardized in the manner 
                in which it is collected, entered into the database, 
                extracted, and recorded.
            (6) Measures of brain function or structure.--Any measures 
        of brain function or structure collected under the initiative 
        shall be collected with a device that is approved by the Food 
        and Drug Administration.
            (7) De-identified data defined.--In this subsection, the 
        term ``de-identified data'' means, with respect to data held by 
        the Department of Veterans Affairs, that the Department--
                    (A) alters, anonymizes, or aggregates the data so 
                that there is a reasonable basis for expecting that the 
                data could not be linked as a practical matter to a 
                specific individual;
                    (B) publicly commits to refrain from attempting to 
                re-identify the data with a specific individual, and 
                adopts controls to prevent such identification; and
                    (C) causes the data to be covered by a contractual 
                or other legally enforceable prohibition on each entity 
                to which the Department discloses the data from 
                attempting to use the data to identify a specific 
                individual and requires the same of all onward 
                disclosures.

    (e) Inclusion of Initiative in Program.--The Secretary shall 
coordinate efforts of the initiative under subsection (a) with the 
Million Veterans Program of the Department.
SEC. 306. STATISTICAL ANALYSES AND DATA EVALUATION BY DEPARTMENT 
                        OF VETERANS AFFAIRS.

    (a) In General.--Chapter 1 of title 38, United States Code, is 
amended by adding at the end the following new section:
``Sec. 119. <<NOTE: 38 USC 119.>>  Contracting for statistical 
                analyses and data evaluation

    ``(a) <<NOTE: Determination.>>  In General.--The Secretary may enter 
into a contract or other agreement with an academic institution or other 
qualified entity, as determined by the Secretary, to carry out 
statistical analyses and data evaluation as required of the Secretary by 
law.''.

    ``(b) Rule of Construction.--Nothing in this section may be 
construed to limit the authority of the Secretary to enter into 
contracts or other agreements for statistical analyses and data 
evaluation under any other provision of law.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 1 of such title <<NOTE: 38 USC 101 prec.>>  is amended by adding 
at the end the following new item:

``119. Contracting for statistical analyses and data evaluation.''.

[[Page 134 STAT. 806]]

     TITLE IV--OVERSIGHT OF MENTAL HEALTH CARE AND RELATED SERVICES

SEC. 401. STUDY ON EFFECTIVENESS OF SUICIDE PREVENTION AND MENTAL 
                        HEALTH OUTREACH PROGRAMS OF DEPARTMENT OF 
                        VETERANS AFFAIRS.

    (a) <<NOTE: Deadline. Contracts.>>  In General.--Not later than 180 
days after the date of the enactment of this Act, the Secretary of 
Veterans Affairs shall enter into an agreement with a non-Federal 
Government entity with expertise in conducting and evaluating research-
based studies to conduct a study on the effectiveness of the suicide 
prevention and mental health outreach materials prepared by the 
Department of Veterans Affairs and the suicide prevention and mental 
health outreach campaigns conducted by the Department.

    (b) Use of Focus Groups.--
            (1) In general.--The Secretary shall convene not fewer than 
        eight different focus groups to evaluate the effectiveness of 
        the suicide prevention and mental health materials and campaigns 
        as required under subsection (a).
            (2) Location of focus groups.--Focus groups convened under 
        paragraph (1) shall be held in geographically diverse areas as 
        follows:
                    (A) Not fewer than two in rural or highly rural 
                areas.
                    (B) Not fewer than one in each of the four districts 
                of the Veterans Benefits Administration.
            (3) Timing of focus groups.--Focus groups convened under 
        paragraph (1) shall be held at a variety of dates and times to 
        ensure an adequate representation of veterans with different 
        work schedules.
            (4) Number of participants.--Each focus group convened under 
        paragraph (1) shall include not fewer than five and not more 
        than 12 participants.
            (5) Representation.--Each focus group convened under 
        paragraph (1) shall, to the extent practicable, include veterans 
        of diverse backgrounds, including--
                    (A) veterans of all eras, as determined by the 
                Secretary;
                    (B) women veterans;
                    (C) minority veterans;
                    (D) Native American veterans, as defined in section 
                3765 of title 38, United States Code;
                    (E) veterans who identify as lesbian, gay, bisexual, 
                transgender, or queer (commonly referred to as 
                ``LGBTQ'');
                    (F) veterans who live in rural or highly rural 
                areas;
                    (G) individuals transitioning from active duty in 
                the Armed Forces to civilian life; and
                    (H) other high-risk groups of veterans, as 
                determined by the Secretary.

    (c) Report.--
            (1) In general.--Not later than 90 days after the last focus 
        group meeting 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 on the findings of the focus groups.
            (2) Elements.--The report required by paragraph (1) shall 
        include the following:

[[Page 134 STAT. 807]]

                    (A) <<NOTE: Assessment.>>  Based on the findings of 
                the focus groups, an assessment of the effectiveness of 
                current suicide prevention and mental health materials 
                and campaigns of the Department in reaching veterans as 
                a whole as well as specific groups of veterans (for 
                example, women veterans).
                    (B) <<NOTE: Recommenda- tions.>>  Based on the 
                findings of the focus groups, recommendations for future 
                suicide prevention and mental health materials and 
                campaigns of the Department to target specific groups of 
                veterans.
                    (C) <<NOTE: Plan.>>  A plan to change the current 
                suicide prevention and mental health materials and 
                campaigns of the Department or, if the Secretary decides 
                not to change the current materials and campaigns, an 
                explanation of the reason for maintaining the current 
                materials and campaigns.
                    (D) A description of any dissenting or opposing 
                viewpoints raised by participants in the focus group.
                    (E) Such other issues as the Secretary considers 
                necessary.

    (d) Representative Survey.--
            (1) <<NOTE: Deadline.>>  In general.--Not later than one 
        year after the last focus group meeting under subsection (b), 
        the Secretary shall complete a representative survey of the 
        veteran population that is informed by the focus group data in 
        order to collect information about the effectiveness of the 
        mental health and suicide prevention materials and campaigns 
        conducted by the Department.
            (2) Veterans surveyed.--
                    (A) In general.--Veterans surveyed under paragraph 
                (1) shall include veterans described in subsection 
                (b)(5).
                    (B) <<NOTE: Time period.>>  Disaggregation of 
                data.--Data of veterans surveyed under paragraph (1) 
                shall be disaggregated by--
                          (i) veterans who have received care from the 
                      Department during the two-year period preceding 
                      the survey; and
                          (ii) veterans who have not received care from 
                      the Department during the two-year period 
                      preceding the survey.

    (e) <<NOTE: 38 USC 1720F note.>>  Treatment of Contracts for Suicide 
Prevention and Mental Health Outreach Media.--
            (1) Focus groups.--
                    (A) <<NOTE: Assessment.>>  In general.--The 
                Secretary shall include in each contract to develop 
                media relating to suicide prevention and mental health 
                materials and campaigns a requirement that the 
                contractor convene focus groups of veterans to assess 
                the effectiveness of suicide prevention and mental 
                health outreach.
                    (B) Representation.--Each focus group required under 
                subparagraph (A) shall, to the extent practicable, 
                include veterans of diverse backgrounds, including--
                          (i) veterans of all eras, as determined by the 
                      Secretary;
                          (ii) women veterans;
                          (iii) minority veterans;
                          (iv) Native American veterans, as defined in 
                      section 3765 of title 38, United States Code;

[[Page 134 STAT. 808]]

                          (v) veterans who identify as lesbian, gay, 
                      bisexual, transgender, or queer (commonly referred 
                      to as ``LGBTQ'');
                          (vi) veterans who live in rural or highly 
                      rural areas;
                          (vii) individuals transitioning from active 
                      duty in the Armed Forces to civilian life; and
                          (viii) other high-risk groups of veterans, as 
                      determined by the Secretary.
            (2) Subcontracting.--
                    (A) <<NOTE: Requirement.>>  In general.--The 
                Secretary shall include in each contract described in 
                paragraph (1)(A) a requirement that, if the contractor 
                subcontracts for the development of media, the 
                contractor shall subcontract with a subcontractor that 
                has experience creating impactful media campaigns that 
                target individuals age 18 to 34.
                    (B) Budget limitation.--Not more than two percent of 
                the budget of the Office of Mental Health and Suicide 
                Prevention of the Department for contractors for suicide 
                prevention and mental health media outreach shall go to 
                subcontractors described in subparagraph (A).

    (f) Paperwork Reduction Act Exemption.--Chapter 35 of title 44, 
United States Code (commonly known as the ``Paperwork Reduction Act'') 
shall not apply to any rulemaking or information collection required 
under this section.
    (g) Rural and Highly Rural Defined.--In this section, with respect 
to an area, the terms ``rural'' and ``highly rural'' have the meanings 
given those terms in the Rural-Urban Commuting Areas coding system of 
the Department of Agriculture.
SEC. 402. <<NOTE: 38 USC 1720F note.>>  OVERSIGHT OF MENTAL HEALTH 
                        AND SUICIDE PREVENTION MEDIA OUTREACH 
                        CONDUCTED BY DEPARTMENT OF VETERANS 
                        AFFAIRS.

    (a) Establishment of Goals.--
            (1) <<NOTE: Action plans.>>  In general.--The Secretary of 
        Veterans Affairs shall establish goals for the mental health and 
        suicide prevention media outreach campaigns of the Department of 
        Veterans Affairs, which shall include the establishment of 
        targets, metrics, and action plans to describe and assess those 
        campaigns.
            (2) Use of metrics.--
                    (A) In general.--The goals established under 
                paragraph (1) shall be measured by metrics specific to 
                different media types.
                    (B) <<NOTE: Determination.>>  Factors to consider.--
                In using metrics under subparagraph (A), the Secretary 
                shall determine the best methodological approach for 
                each media type and shall consider the following:
                          (i) Metrics relating to social media, which 
                      may include the following:
                                    (I) Impressions.
                                    (II) Reach.
                                    (III) Engagement rate.
                                    (IV) Such other metrics as the 
                                Secretary considers necessary.
                          (ii) Metrics relating to television, which may 
                      include the following:

[[Page 134 STAT. 809]]

                                    (I) Nielsen ratings.
                                    (II) Such other metrics as the 
                                Secretary considers necessary.
                          (iii) Metrics relating to email, which may 
                      include the following:
                                    (I) Open rate.
                                    (II) Response rate.
                                    (III) Click rate.
                                    (IV) Such other metrics as the 
                                Secretary considers necessary.
                    (C) Update.--The Secretary shall periodically update 
                the metrics under subparagraph (B) as more accurate 
                metrics become available.
            (3) Targets.--The Secretary shall establish targets to track 
        the metrics used under paragraph (2).
            (4) Consultation.--In establishing goals under paragraph 
        (1), the Secretary shall consult with the following:
                    (A) <<NOTE: Determination.>>  Relevant stakeholders, 
                such as organizations that represent veterans, as 
                determined by the Secretary.
                    (B) Mental health and suicide prevention experts.
                    (C) Such other persons as the Secretary considers 
                appropriate.
            (5) Initial 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 
        detailing the goals established under paragraph (1) for the 
        mental health and suicide prevention media outreach campaigns of 
        the Department, including the metrics and targets for such 
        metrics by which those goals are to be measured under paragraphs 
        (2) and (3).
            (6) Annual report.--Not later than one year after the 
        submittal of the report under paragraph (5), and annually 
        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 detailing--
                    (A) the progress of the Department in meeting the 
                goals established under paragraph (1) and the targets 
                established under paragraph (3); and
                    (B) a description of action to be taken by the 
                Department to modify mental health and suicide 
                prevention media outreach campaigns if those goals and 
                targets are not being met.

    (b) Report on Use of Funds by Office of Mental Health and Suicide 
Prevention.--Not later than 180 days after the date of the enactment of 
this Act, and semiannually thereafter, the Secretary shall submit to the 
Committee on Appropriations and the Committee on Veterans' Affairs of 
the Senate and the Committee on Appropriations and the Committee on 
Veterans' Affairs of the House of Representatives a report containing 
the expenditures and obligations of the Office of Mental Health and 
Suicide Prevention of the Veterans Health Administration during the 
period covered by the report.

[[Page 134 STAT. 810]]

SEC. 403. COMPTROLLER GENERAL MANAGEMENT REVIEW OF MENTAL HEALTH 
                        AND SUICIDE PREVENTION SERVICES OF 
                        DEPARTMENT OF VETERANS AFFAIRS.

    (a) <<NOTE: Deadline.>>  In General.--Not later than three 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 management review of the mental health and suicide 
prevention services provided by the Department of Veterans Affairs.

    (b) <<NOTE: Assessments.>>  Elements.--The management review 
required by subsection (a) shall include the following:
            (1) An assessment of the infrastructure under the control of 
        or available to the Office of Mental Health and Suicide 
        Prevention of the Department of Veterans Affairs or available to 
        the Department of Veterans Affairs for suicide prevention 
        efforts not operated by the Office of Mental Health and Suicide 
        Prevention.
            (2) A description of the management and organizational 
        structure of the Office of Mental Health and Suicide Prevention, 
        including roles and responsibilities for each position.
            (3) A description of the operational policies and processes 
        of the Office of Mental Health and Suicide Prevention.
            (4) An assessment of suicide prevention practices and 
        initiatives available from the Department and through community 
        partnerships.
            (5) An assessment of the staffing levels at the Office of 
        Mental Health and Suicide Prevention, disaggregated by type of 
        position, and including the location of any staffing 
        deficiencies.
            (6) An assessment of the Nurse Advice Line pilot program 
        conducted by the Department.
            (7) An assessment of recruitment initiatives in rural areas 
        for mental health professionals of the Department.
            (8) An assessment of strategic planning conducted by the 
        Office of Mental Health and Suicide Prevention.
            (9) An assessment of the communication, and the 
        effectiveness of such communication--
                    (A) within the central office of the Office of 
                Mental Health and Suicide Prevention;
                    (B) between that central office and any staff member 
                or office in the field, including chaplains, attorneys, 
                law enforcement personnel, and volunteers; and
                    (C) between that central office, local facilities of 
                the Department, and community partners of the 
                Department, including first responders, community 
                support groups, and health care industry partners.
            (10) An assessment of how effectively the Office of Mental 
        Health and Suicide Prevention implements operational policies 
        and procedures.
            (11) <<NOTE: Recommenda- tions.>>  An assessment of how the 
        Department of Veterans Affairs and the Department of Defense 
        coordinate suicide prevention efforts, and recommendations on 
        how the Department of Veterans Affairs and Department of Defense 
        can more effectively coordinate those efforts.
            (12) An assessment of such other areas as the Comptroller 
        General considers appropriate to study.

[[Page 134 STAT. 811]]

SEC. 404. COMPTROLLER GENERAL REPORT ON EFFORTS OF DEPARTMENT OF 
                        VETERANS AFFAIRS TO INTEGRATE MENTAL 
                        HEALTH CARE INTO PRIMARY CARE CLINICS.

    (a) Initial Report.--
            (1) 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 efforts of the Department of 
        Veterans Affairs to integrate mental health care into primary 
        care clinics of the Department.
            (2) <<NOTE: Assessments.>>  Elements.--The report required 
        by subsection (a) shall include the following:
                    (A) An assessment of the efforts of the Department 
                to integrate mental health care into primary care 
                clinics of the Department.
                    (B) An assessment of the effectiveness of such 
                efforts.
                    (C) An assessment of how the health care of veterans 
                is impacted by such integration.
                    (D) A description of how care is coordinated by the 
                Department between specialty mental health care and 
                primary care, including a description of the following:
                          (i) How documents and patient information are 
                      transferred and the effectiveness of those 
                      transfers.
                          (ii) How care is coordinated when veterans 
                      must travel to different facilities of the 
                      Department.
                          (iii) How a veteran is reintegrated into 
                      primary care after receiving in-patient mental 
                      health care.
                    (E) An assessment of how the integration of mental 
                health care into primary care clinics is implemented at 
                different types of facilities of the Department.
                    (F) <<NOTE: Recommenda- tions.>>  Such 
                recommendations on how the Department can better 
                integrate mental health care into primary care clinics 
                as the Comptroller General considers appropriate.
                    (G) An assessment of such other areas as the 
                Comptroller General considers appropriate to study.

    (b) Community Care Integration Report.--
            (1) In general.--Not later than two years after the date on 
        which the Comptroller General submits the report required under 
        subsection (a)(1), 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 on 
        the efforts of the Department to integrate community-based 
        mental health care into the Veterans Health Administration.
            (2) <<NOTE: Assessments.>>  Elements.--The report required 
        by paragraph (1) shall include the following:
                    (A) An assessment of the efforts of the Department 
                to integrate community-based mental health care into the 
                Veterans Health Administration.
                    (B) An assessment of the effectiveness of such 
                efforts.
                    (C) An assessment of how the health care of veterans 
                is impacted by such integration.
                    (D) A description of how care is coordinated between 
                providers of community-based mental health care and the 
                Veterans Health Administration, including a description

[[Page 134 STAT. 812]]

                of how documents and patient information are transferred 
                and the effectiveness of those transfers between--
                          (i) the Veterans Health Administration and 
                      providers of community-based mental health care; 
                      and
                          (ii) providers of community-based mental 
                      health care and the Veterans Health 
                      Administration.
                    (E) An assessment of any disparities in the 
                coordination of community-based mental health care into 
                the Veterans Health Administration by location and type 
                of facility.
                    (F) An assessment of the military cultural 
                competency of health care providers providing community-
                based mental health care to veterans.
                    (G) <<NOTE: Recommenda- tions.>>  Such 
                recommendations on how the Department can better 
                integrate community-based mental health care into the 
                Veterans Health Administration as the Comptroller 
                General considers appropriate.
                    (H) An assessment of such other areas as the 
                Comptroller General considers appropriate to study.
            (3) Community-based mental health care defined.--In this 
        subsection, the term ``community-based mental health care'' 
        means mental health care paid for by the Department but provided 
        by a non-Department health care provider at a non-Department 
        facility, including care furnished under section 1703 of title 
        38, United States Code (as in effect on the date specified in 
        section 101(b) of the Caring for Our Veterans Act of 2018 (title 
        I of Public Law 115-182)).
SEC. 405. JOINT MENTAL HEALTH PROGRAMS BY DEPARTMENT OF VETERANS 
                        AFFAIRS AND DEPARTMENT OF DEFENSE.

    (a) <<NOTE: 38 USC 8111 note.>>  Report on Mental Health Programs.--
            (1) In general.--Not later than one year after the date of 
        the enactment of this Act, and annually thereafter, the 
        Secretary of Veterans Affairs and the Secretary of Defense shall 
        submit to the Committee on Veterans' Affairs and the Committee 
        on Armed Services of the Senate and the Committee on Veterans' 
        Affairs and the Committee on Armed Services of the House of 
        Representatives a report on mental health programs of the 
        Department of Veterans Affairs and the Department of Defense and 
        joint programs of the Departments.
            (2) Elements.--The report required by paragraph (1) shall 
        include the following:
                    (A) A description of mental health programs operated 
                by the Department of Veterans Affairs, including the 
                following:
                          (i) Transition assistance programs.
                          (ii) Clinical and non-clinical mental health 
                      initiatives, including centers of excellence of 
                      the Department of Veterans Affairs for traumatic 
                      brain injury and post-traumatic stress disorder.
                          (iii) Programs that may secondarily improve 
                      mental health, including employment, housing 
                      assistance, and financial literacy programs.
                          (iv) Research into mental health issues and 
                      conditions, to include post-traumatic stress 
                      disorder, depression, anxiety, bipolar disorder, 
                      traumatic brain injury, suicidal ideation, and any 
                      other issues or conditions

[[Page 134 STAT. 813]]

                      as the Secretary of Veterans Affairs considers 
                      necessary.
                    (B) A description of mental health programs operated 
                by the Department of Defense, including the following:
                          (i) Transition assistance programs.
                          (ii) Clinical and non-clinical mental health 
                      initiatives, including the National Intrepid 
                      Center of Excellence and the Intrepid Spirit 
                      Centers.
                          (iii) Programs that may secondarily improve 
                      mental health, including employment, housing 
                      assistance, and financial literacy programs.
                          (iv) Research into mental health issues and 
                      conditions, to include post-traumatic stress 
                      disorder, depression, anxiety, bipolar disorder, 
                      traumatic brain injury, suicidal ideation, and any 
                      other issues or conditions as the Secretary of 
                      Defense considers necessary.
                    (C) A description of mental health programs jointly 
                operated by the Department of Veterans Affairs and the 
                Department of Defense, including the following:
                          (i) Transition assistance programs.
                          (ii) Clinical and non-clinical mental health 
                      initiatives.
                          (iii) Programs that may secondarily improve 
                      mental health, including employment, housing 
                      assistance, and financial literacy programs.
                          (iv) Research into mental health issues and 
                      conditions, to include post-traumatic stress 
                      disorder, depression, anxiety, bipolar disorder, 
                      traumatic brain injury, suicidal ideation, and 
                      completed suicides, including through the use of 
                      the joint suicide data repository of the 
                      Department of Veterans Affairs and the Department 
                      of Defense, and any other issues or conditions as 
                      the Secretary of Veterans Affairs and the 
                      Secretary of Defense consider necessary.
                    (D) <<NOTE: Recommenda- tions.>>  Recommendations 
                for coordinating mental health programs of the 
                Department of Veterans Affairs and the Department of 
                Defense to improve the effectiveness of those programs.
                    (E) <<NOTE: Recommenda- tions.>>  Recommendations 
                for novel joint programming of the Department of 
                Veterans Affairs and the Department of Defense to 
                improve the mental health of members of the Armed Forces 
                and veterans.

    (b) Evaluation of Collaborative Efforts of Department of Veterans 
Affairs and Department of Defense and Alternatives of Analysis to 
Establish a Joint VA/DOD Intrepid Spirit Center.--
            (1) <<NOTE: Coordination.>>  In general.--The Secretary of 
        Veterans Affairs, in coordination with the Secretary of Defense, 
        shall evaluate the current ongoing collaborative efforts of the 
        Department of Veterans Affairs and the Department of Defense 
        related to post-traumatic stress disorder and traumatic brain 
        injury care, research, and education to improve the quality of 
        and access to such care and seek potential new collaborative 
        efforts to improve and expand such care for veterans and members 
        of the Armed Forces in a joint Department of Veterans Affairs/
        Department of Defense Intrepid Spirit Center that serves active 
        duty members of the Armed Forces, members of the reserve

[[Page 134 STAT. 814]]

        components of the Armed Forces, and veterans for mutual benefit 
        and growth in treatment and care.
            (2) Alternatives of analysis.--
                    (A) In general.--The evaluation required under 
                paragraph (1) shall include an alternatives of analysis 
                to establish the joint Department of Veterans Affairs/
                Department of Defense Intrepid Spirit Center described 
                in paragraph (1).
                    (B) <<NOTE: Recommenda- tions.>>  Elements.--The 
                alternatives of analysis required under subparagraph (A) 
                with respect to the establishment of the joint 
                Department of Veterans Affairs/Department of Defense 
                Intrepid Spirit Center described in paragraph (1) shall 
                provide alternatives and recommendations that consider 
                information including--
                          (i) colocation of the center on an 
                      installation of the Department of Defense or 
                      property of a medical center of the Department of 
                      Veterans Affairs;
                          (ii) consideration of a rural or highly rural 
                      area to establish the center that may include 
                      colocation described in clause (i);
                          (iii) geographic distance from existing or 
                      planned Intrepid Spirit Centers of the Department 
                      of Defense or other such facilities of the 
                      Department of Veterans Affairs or the Department 
                      of Defense that furnish care for post-traumatic 
                      stress disorder or traumatic brain injury; and
                          (iv) the potential role for private entities 
                      and philanthropic organizations in carrying out 
                      the activities of the center.
            (3) Report to congress.--Not later than 270 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 that includes--
                    (A) <<NOTE: Summary.>>  a summary of the evaluation 
                required under paragraph (1); and
                    (B) the alternatives of analysis required under 
                paragraph (2).
            (4) Rural and highly rural defined.--In this subsection, 
        with respect to an area, the terms ``rural'' and ``highly 
        rural'' have the meanings given those terms in the Rural-Urban 
        Commuting Areas coding system of the Department of Agriculture.

         TITLE V--IMPROVEMENT OF MENTAL HEALTH MEDICAL WORKFORCE

SEC. 501. STAFFING IMPROVEMENT PLAN FOR MENTAL HEALTH PROVIDERS OF 
                        DEPARTMENT OF VETERANS AFFAIRS.

    (a) Staffing Plan.--
            (1) <<NOTE: Deadline. Consultation.>>  In general.--Not 
        later than one year after the date of the enactment of this Act, 
        the Secretary of Veterans Affairs, in consultation with the 
        Inspector General of the Department 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 address staffing

[[Page 134 STAT. 815]]

        of mental health providers of the Department of Veterans 
        Affairs, including filling any open positions.
            (2) Elements.--The plan required by paragraph (1) shall 
        include the following:
                    (A) <<NOTE: Estimate.>>  An estimate of the number 
                of positions for mental health providers of the 
                Department that need to be filled to meet demand.
                    (B) An identification of the steps that the 
                Secretary will take to address mental health staffing 
                for the Department.
                    (C) A description of any region-specific hiring 
                incentives to be used by the Secretary in consultation 
                with the directors of Veterans Integrated Service 
                Networks and medical centers of the Department.
                    (D) A description of any local retention or 
                engagement incentives to be used by directors of 
                Veterans Integrated Service Networks.
                    (E) <<NOTE: Recommenda- tions.>>  Such 
                recommendations for legislative or administrative action 
                as the Secretary considers necessary to aid in 
                addressing mental health staffing for the Department.
            (3) <<NOTE: Time period.>>  Report.--Not later than one year 
        after the submittal of the plan required by paragraph (1), 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 setting forth the number of mental 
        health providers hired by the Department during the one-year 
        period preceding the submittal of the report.

    (b) <<NOTE: Deadline. Consultation. 38 USC 7401 note.>>  
Occupational Series for Certain Mental Health Providers.--Not later than 
one year after the date of the enactment of this Act, the Secretary of 
Veterans Affairs, in consultation with the Office of Personnel 
Management, shall develop an occupational series for licensed 
professional mental health counselors and marriage and family therapists 
of the Department of Veterans Affairs.
SEC. 502. ESTABLISHMENT OF DEPARTMENT OF VETERANS AFFAIRS 
                        READJUSTMENT COUNSELING SERVICE 
                        SCHOLARSHIP PROGRAM.

    (a) In General.--Chapter 76 of title 38, United States Code, is 
amended by inserting after subchapter VIII the following new subchapter:

 ``SUBCHAPTER <<NOTE: 38 USC 7698 prec.>>  IX--READJUSTMENT COUNSELING 
SERVICE SCHOLARSHIP PROGRAM
``Sec. 7698. <<NOTE: 38 USC 7698.>>  Requirement for program

    ``As part of the Educational Assistance Program, the Secretary shall 
carry out a scholarship program under this subchapter. The program shall 
be known as the Department of Veterans Affairs Readjustment Counseling 
Service Scholarship Program (in this subchapter referred to as the 
`Program').
``Sec. 7699. <<NOTE: Contracts. 38 USC 7699. Determination.>>  
                  Eligibility; agreement

    ``(a) In General.--An individual is eligible to participate in the 
Program, as determined by the Readjustment Counseling Service of the 
Department, if the individual--
            ``(1) is accepted for enrollment or enrolled (as described 
        in section 7602 of this title) in a program of study at an

[[Page 134 STAT. 816]]

        accredited educational institution, school, or training program 
        leading to a terminal degree in psychology, social work, 
        marriage and family therapy, or mental health counseling that 
        would meet the education requirements for appointment to a 
        position under section 7402(b) of this title; and
            ``(2) enters into an agreement with the Secretary under 
        subsection (c).

    ``(b) Priority.--In selecting individuals to participate in the 
Program, the Secretary shall give priority to the following individuals:
            ``(1) An individual who agrees to be employed by a Vet 
        Center located in a community that is--
                    ``(A) designated as a medically underserved 
                population under section 330(b)(3) of the Public Health 
                Service Act (42 U.S.C. 254b(b)(3)); and
                    ``(B) in a State with a per capita population of 
                veterans of more than five percent according to the 
                National Center for Veterans Analysis and Statistics and 
                the Bureau of the Census.
            ``(2) An individual who is a veteran.

    ``(c) Agreement.--An agreement between the Secretary and a 
participant in the Program shall (in addition to the requirements set 
forth in section 7604 of this title) include the following:
            ``(1) An agreement by the Secretary to provide the 
        participant with a scholarship under the Program for a specified 
        number of school years during which the participant pursues a 
        program of study described in subsection (a)(1) that meets the 
        requirements set forth in section 7602(a) of this title.
            ``(2) <<NOTE: Time period.>>  An agreement by the 
        participant to serve as a full-time employee of the Department 
        at a Vet Center for a six-year period following the completion 
        by the participant of such program of study (in this subchapter 
        referred to as the `period of obligated service').

    ``(d) Vet Center Defined.--In this section, the term `Vet Center' 
has the meaning given that term in section 1712A(h) of this title.
``Sec. 7699A. <<NOTE: 38 USC 7699A.>>  Obligated service

    ``(a) In General.--Each participant in the Program shall provide 
service as a full-time employee of the Department at a Vet Center (as 
defined in section 7699(d) of this title) for the period of obligated 
service set forth in the agreement of the participant entered into under 
section 7604 of this title.
    ``(b) <<NOTE: Deadline. Notification.>>  Determination of Service 
Commencement Date.--(1) Not later than 60 days before the service 
commencement date of a participant, the Secretary shall notify the 
participant of that service commencement date.

    ``(2) The date specified in paragraph (1) with respect to a 
participant is the date for the beginning of the period of obligated 
service of the participant.
``Sec. 7699B. <<NOTE: Contracts. 38 USC 7699B.>>  Breach of 
                    agreement: liability

    ``(a) Liquidated Damages.--(1) A participant in the Program (other 
than a participant described in subsection (b)) who fails to accept 
payment, or instructs the educational institution in which the 
participant is enrolled not to accept payment, in whole or in part, of a 
scholarship under the agreement entered into under

[[Page 134 STAT. 817]]

section 7604 of this title shall be liable to the United States for 
liquidated damages in the amount of $1,500.
    ``(2) Liability under paragraph (1) is in addition to any period of 
obligated service or other obligation or liability under such agreement.
    ``(b) Liability During Program of Study.--(1) Except as provided in 
subsection (d), a participant in the Program shall be liable to the 
United States for the amount which has been paid to or on behalf of the 
participant under the agreement if any of the following occurs:
            ``(A) <<NOTE: Determination. Regulations.>>  The participant 
        fails to maintain an acceptable level of academic standing in 
        the educational institution in which the participant is enrolled 
        (as determined by the educational institution under regulations 
        prescribed by the Secretary).
            ``(B) The participant is dismissed from such educational 
        institution for disciplinary reasons.
            ``(C) The participant voluntarily terminates the program of 
        study in such educational institution before the completion of 
        such program of study.

    ``(2) Liability under this subsection is in lieu of any service 
obligation arising under the agreement.
    ``(c) <<NOTE: Determinations.>>  Liability During Period of 
Obligated Service.--(1) Except as provided in subsection (d), if a 
participant in the Program does not complete the period of obligated 
service of the participant, the United States shall be entitled to 
recover from the participant an amount determined in accordance with the 
following formula: A = 3F(t-s/t).

    ``(2) In the formula in paragraph (1):
            ``(A) `A' is the amount the United States is entitled to 
        recover.
            ``(B) `F' is the sum of--
                    ``(i) the amounts paid under this subchapter to or 
                on behalf of the participant; and
                    ``(ii) the interest on such amounts which would be 
                payable if at the time the amounts were paid they were 
                loans bearing interest at the maximum legal prevailing 
                rate, as determined by the Treasurer of the United 
                States.
            ``(C) `t' is the total number of months in the period of 
        obligated service of the participant.
            ``(D) `s' is the number of months of such period served by 
        the participant.

    ``(d) Limitation on Liability for Reductions-in-force.--Liability 
shall not arise under subsection (c) if the participant fails to 
maintain employment as a Department employee due to a staffing 
adjustment.
    ``(e) Period for Payment of Damages.--Any amount of damages that the 
United States is entitled to recover under this section shall be paid to 
the United States within the one-year period beginning on the date of 
the breach of the agreement.''.
    (b) Conforming and Technical Amendments.--
            (1) Conforming amendments.--
                    (A) Establishment of program.--Section 7601(a) of 
                such title <<NOTE: 38 USC 7601.>>  is amended--
                          (i) in paragraph (5), by striking ``and'';
                          (ii) in paragraph (6), by striking the period 
                      and inserting ``; and''; and

[[Page 134 STAT. 818]]

                          (iii) by adding at the end the following new 
                      paragraph:
            ``(7) the readjustment counseling service scholarship 
        program provided for in subchapter IX of this chapter.''.
                    (B) <<NOTE: 38 USC 7602.>>  Eligibility.--Section 
                7602 of such title is amended--
                          (i) in subsection (a)(1)--
                                    (I) by striking ``or VI'' and 
                                inserting ``VI, or IX''; and
                                    (II) by striking ``subchapter VI'' 
                                and inserting ``subchapter VI or IX''; 
                                and
                          (ii) in subsection (b), by striking ``or VI'' 
                      and inserting ``VI, or IX''.
                    (C) Application.--Section 7603(a)(1) of such title 
                is amended by striking ``or VIII'' and inserting ``VIII, 
                or IX''.
                    (D) Terms of agreement.--Section 7604 of such title 
                is amended by striking ``or VIII'' each place it appears 
                and inserting ``VIII, or IX''.
                    (E) Annual report.--Section 7632 of such title is 
                amended--
                          (i) in paragraph (1), by striking ``and the 
                      Specialty Education Loan Repayment Program'' and 
                      inserting ``the Specialty Education Loan Repayment 
                      Program, and the Readjustment Counseling Service 
                      Scholarship Program''; and
                          (ii) in paragraph (4), by striking ``and per 
                      participant in the Specialty Education Loan 
                      Repayment Program'' and inserting ``per 
                      participant in the Specialty Education Loan 
                      Repayment Program, and per participant in the 
                      Readjustment Counseling Service Scholarship 
                      Program''.
            (2) Table of sections.--The table of sections at the 
        beginning of chapter 76 of such title <<NOTE: 38 USC 7601 
        prec.>>  is amended by inserting after the items relating to 
        subchapter VIII the following:

  ``subchapter ix--readjustment counseling service scholarship program

``Sec.
``7698. Requirement for program.
``7699. Eligibility; agreement.
``7699A. Obligated service.
``7699B. Breach of agreement: liability.''.

    (c) <<NOTE: 38 USC 7698 note.>>  Effective Date.--The Secretary of 
Veterans Affairs shall begin awarding scholarships under subchapter IX 
of chapter 76 of title 38, United States Code, as added by subsection 
(a), for programs of study beginning not later than one year after the 
date of the enactment of this Act.
SEC. 503. COMPTROLLER GENERAL REPORT ON READJUSTMENT COUNSELING 
                        SERVICE OF DEPARTMENT OF VETERANS AFFAIRS.

    (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 
on the Readjustment Counseling Service of the Department of Veterans 
Affairs.
    (b) <<NOTE: Assessments. Recommenda- tions.>>  Elements.--The report 
required by subsection (a) shall include the following:

[[Page 134 STAT. 819]]

            (1) An assessment of the adequacy and types of treatment, 
        counseling, and other services provided at Vet Centers, 
        including recommendations on whether and how such treatment, 
        counseling, and other services can be expanded.
            (2) An assessment of the efficacy of outreach efforts by the 
        Readjustment Counseling Service, including recommendations for 
        how outreach efforts can be improved.
            (3) An assessment of barriers to care at Vet Centers, 
        including recommendations for overcoming those barriers.
            (4) An assessment of the efficacy and frequency of the use 
        of telehealth by counselors of the Readjustment Counseling 
        Service to provide mental health services, including 
        recommendations for how the use of telehealth can be improved.
            (5) An assessment of the feasibility and advisability of 
        expanding eligibility for services from the Readjustment 
        Counseling Service, including--
                    (A) recommendations on what eligibility criteria 
                could be expanded; and
                    (B) an assessment of potential costs and increased 
                infrastructure requirements if eligibility is expanded.
            (6) An assessment of the use of Vet Centers by members of 
        the reserve components of the Armed Forces who were never 
        activated and recommendations on how to better reach those 
        members.
            (7) An assessment of the use of Vet Centers by eligible 
        family members of former members of the Armed Forces and 
        recommendations on how to better reach those family members.
            (8) An assessment of the efficacy of group therapy and the 
        level of training of providers at Vet Centers in administering 
        group therapy.
            (9) An assessment of the efficiency and effectiveness of the 
        task organization structure of Vet Centers.
            (10) An assessment of the use of Vet Centers by Native 
        American veterans, as defined in section 3765 of title 38, 
        United States Code, and recommendations on how to better reach 
        those veterans.

    (c) 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.
SEC. 504. EXPANSION OF REPORTING REQUIREMENTS ON READJUSTMENT 
                        COUNSELING SERVICE OF DEPARTMENT OF 
                        VETERANS AFFAIRS.

    (a) Expansion of Annual Report.--Paragraph (2)(C) of section 7309(e) 
of title 38, United States Code, <<NOTE: 38 USC 7309.>>  is amended by 
inserting before the period at the end the following: ``, including the 
resources required to meet such unmet need, such as additional staff, 
additional locations, additional infrastructure, infrastructure 
improvements, and additional mobile Vet Centers''.

    (b) Biennial Report.--Such section is amended by adding at the end 
the following new paragraph:
    ``(3) For each even numbered year in which the report required by 
paragraph (1) is submitted, the Secretary shall include in such report a 
prediction of--
            ``(A) trends in demand for care;
            ``(B) long-term investments required with respect to the 
        provision of care;

[[Page 134 STAT. 820]]

            ``(C) requirements relating to maintenance of 
        infrastructure; and
            ``(D) other capital investment requirements with respect to 
        the Readjustment Counseling Service, including Vet Centers, 
        mobile Vet Centers, and community access points.''.
SEC. 505. BRIEFING ON ALTERNATIVE WORK SCHEDULES FOR EMPLOYEES OF 
                        VETERANS HEALTH ADMINISTRATION.

    (a) Survey of Veterans.--
            (1) <<NOTE: Deadline.>>  In general.--Not later than 180 
        days after the date of the enactment of this Act, the Secretary 
        of Veterans Affairs shall conduct a survey on the attitudes of 
        eligible veterans toward the Department of Veterans Affairs 
        offering appointments outside the usual operating hours of 
        facilities of the Department, including through the use of 
        telehealth appointments.
            (2) Eligible veteran defined.--In this subsection, the term 
        ``eligible veteran'' means a veteran who--
                    (A) is enrolled in the patient enrollment system of 
                the Department under section 1705(a) of title 38, United 
                States Code; and
                    (B) <<NOTE: Time period.>>  received health care 
                from the Department at least once during the two-year 
                period ending on the date of the commencement of the 
                survey under paragraph (1).

    (b) Congressional Briefing.--
            (1) <<NOTE: Deadline.>>  In general.--Not later than 270 
        days after the date of the enactment of this Act, the Secretary 
        shall brief the Committee on Veterans' Affairs of the Senate and 
        the Committee on Veterans' Affairs of the House of 
        Representatives on the--
                    (A) feasibility and advisability of offering 
                appointments outside the usual operating hours of 
                facilities of the Department that do not offer such 
                appointments; and
                    (B) effectiveness of offering appointments outside 
                the usual operating hours of facilities of the 
                Department for those facilities that offer such 
                appointments.
            (2) Elements.--The briefing required by paragraph (1) shall 
        include the following:
                    (A) The findings of the survey conducted under 
                subsection (a);
                    (B) Feedback from employees of the Veterans Health 
                Administration, including clinical, nonclinical, and 
                support staff, with respect to offering appointments 
                outside the usual operating hours of facilities of the 
                Department, including through the use of telehealth 
                appointments; and
                    (C) Any other matters the Secretary considers 
                relevant to a full understanding of the feasibility and 
                advisability of offering appointments outside the usual 
                operating hours of facilities of the Department.

    (c) Paperwork Reduction Act Exemption.--Chapter 35 of title 44, 
United States Code (commonly known as the ``Paperwork Reduction Act'') 
shall not apply to any rulemaking or information collection required 
under this section.
SEC. 506. SUICIDE PREVENTION COORDINATORS.

    (a) <<NOTE: Deadline. 38 USC 1720F note.>>  Staffing Requirement.--
Beginning not later than one year after the date of the enactment of 
this Act, the Secretary of Veterans Affairs shall ensure that each 
medical center of the Department

[[Page 134 STAT. 821]]

of Veterans Affairs has not less than one suicide prevention 
coordinator.

    (b) Study on Reorganization.--
            (1) <<NOTE: Deadline. Consultation. Determination.>>  In 
        general.--Not later than one year after the date of the 
        enactment of this Act, the Secretary, in consultation with the 
        Office of Mental Health and Suicide Prevention of the 
        Department, shall commence the conduct of a study to determine 
        the feasibility and advisability of--
                    (A) the realignment and reorganization of suicide 
                prevention coordinators within the Office of Mental 
                Health and Suicide Prevention; and
                    (B) the creation of a suicide prevention coordinator 
                program office.
            (2) <<NOTE: Assessment.>>  Program office realignment.--In 
        conducting the study under paragraph (1), the Secretary shall 
        assess the feasibility of advisability of, within the suicide 
        prevention coordinator program office described in paragraph 
        (1)(B), aligning suicide prevention coordinators and suicide 
        prevention case managers within the organizational structure and 
        chart of the Suicide Prevention Program of the Department, with 
        the Director of the Suicide Prevention program having ultimate 
        supervisory oversight and responsibility over the suicide 
        prevention coordinator program office.

    (c) Report.--Not later than 90 days after the completion of the 
study 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 on such study, 
including the following:
            (1) <<NOTE: Assessment.>>  An assessment of the feasibility 
        and advisability of creating a suicide prevention coordinator 
        program office to oversee and monitor suicide prevention 
        coordinators and suicide prevention case managers across all 
        medical centers of the Department.
            (2) <<NOTE: Review.>>  A review of current staffing ratios 
        for suicide prevention coordinators and suicide prevention case 
        managers in comparison with current staffing ratios for mental 
        health providers within each medical center of the Department.
            (3) A description of the duties and responsibilities for 
        suicide prevention coordinators across the Department to better 
        define, delineate, and standardize qualifications, performance 
        goals, performance duties, and performance outcomes for suicide 
        prevention coordinators and suicide prevention case managers.
SEC. 507. REPORT ON EFFORTS BY DEPARTMENT OF VETERANS AFFAIRS TO 
                        IMPLEMENT SAFETY PLANNING IN EMERGENCY 
                        DEPARTMENTS.

    (a) Findings.--Congress makes the following findings:
            (1) The Department of Veterans Affairs must be more 
        effective in its approach to reducing the burden of veteran 
        suicide connected to mental health diagnoses, to include 
        expansion of treatment delivered via telehealth methods and in 
        rural areas.
            (2) An innovative project, known as Suicide Assessment and 
        Follow-up Engagement: Veteran Emergency Treatment (in this 
        subsection referred to as ``SAFE VET''), was designed to help 
        suicidal veterans seen at emergency departments within

[[Page 134 STAT. 822]]

        the Veterans Health Administration and was successfully 
        implemented in five intervention sites beginning in 2010.
            (3) A 2018 study found that safety planning intervention 
        under SAFE VET was associated with 45 percent fewer suicidal 
        behaviors in the six-month period following emergency department 
        care and more than double the odds of a veteran engaging in 
        outpatient behavioral health care.
            (4) SAFE VET is a promising alternative and acceptable 
        delivery of care system that augments the treatment of suicidal 
        veterans in emergency departments of the Veterans Health 
        Administration and helps ensure that those veterans have 
        appropriate follow-up care.
            (5) Beginning in September 2018, the Veterans Health 
        Administration implemented a suicide prevention program, known 
        as the SPED program, for veterans presenting to the emergency 
        department who are assessed to be at risk for suicide and are 
        safe to be discharged home.
            (6) The SPED program includes issuance and update of a 
        safety plan and post-discharge follow-up outreach for veterans 
        to facilitate engagement in outpatient mental health care.

    (b) Report.--
            (1) In general.--Not later than 180 days after the date of 
        the enactment of this Act, the Secretary of Veterans Affairs 
        shall submit to the appropriate committees of Congress a report 
        on the efforts of the Secretary to implement a suicide 
        prevention program for veterans presenting to an emergency 
        department or urgent care center of the Veterans Health 
        Administration who are assessed to be at risk for suicide and 
        are safe to be discharged home, including a safety plan and 
        post-discharge outreach for veterans to facilitate engagement in 
        outpatient mental health care.
            (2) <<NOTE: Assessments.>>  Elements.--The report required 
        by paragraph (1) shall include the following:
                    (A) An assessment of the implementation of the 
                current operational policies and procedures of the SPED 
                program at each medical center of the Department of 
                Veterans Affairs, including an assessment of the 
                following:
                          (i) Training provided to clinicians or other 
                      personnel administering protocols under the SPED 
                      program.
                          (ii) Any disparities in implementation of such 
                      protocols between medical centers.
                          (iii) <<NOTE: Criteria.>>  Current criteria 
                      used to measure the quality of such protocols 
                      including--
                                    (I) methodology used to assess the 
                                quality of a safety plan and post-
                                discharge outreach for veterans; or
                                    
                                (II) <<NOTE: Timeline. Guidelines.>>  in 
                                the absence of such methodology, a 
                                proposed timeline and guidelines for 
                                creating a methodology to ensure 
                                compliance with the evidence-based model 
                                used under the Suicide Assessment and 
                                Follow-up Engagement: Veteran Emergency 
                                Treatment (SAFE VET) program of the 
                                Department.
                    (B) An assessment of the implementation of the 
                policies and procedures described in subparagraph (A), 
                including the following:

[[Page 134 STAT. 823]]

                          (i) An assessment of the quality and quantity 
                      of safety plans issued to veterans.
                          (ii) An assessment of the quality and quantity 
                      of post-discharge outreach provided to veterans.
                          (iii) The post-discharge rate of veteran 
                      engagement in outpatient mental health care, 
                      including attendance at not fewer than one 
                      individual mental health clinic appointment or 
                      admission to an inpatient or residential unit.
                          (iv) The number of veterans who decline safety 
                      planning efforts during protocols under the SPED 
                      program.
                          (v) The number of veterans who decline to 
                      participate in follow-up efforts within the SPED 
                      program.
                    (C) A description of how SPED primary coordinators 
                are deployed to support such efforts, including the 
                following:
                          (i) A description of the duties and 
                      responsibilities of such coordinators.
                          (ii) The number and location of such 
                      coordinators.
                          (iii) A description of training provided to 
                      such coordinators.
                          (iv) An assessment of the other 
                      responsibilities for such coordinators and, if 
                      applicable, differences in patient outcomes when 
                      such responsibilities are full-time duties as 
                      opposed to secondary duties.
                    (D) An assessment of the feasibility and 
                advisability of expanding the total number and 
                geographic distribution of SPED primary coordinators.
                    (E) <<NOTE: Analysis.>>  An assessment of the 
                feasibility and advisability of providing services under 
                the SPED program via telehealth channels, including an 
                analysis of opportunities to leverage telehealth to 
                better serve veterans in rural areas.
                    (F) A description of the status of current 
                capabilities and utilization of tracking mechanisms to 
                monitor compliance, quality, and patient outcomes under 
                the SPED program.
                    (G) <<NOTE: Recommenda- tions.>>  Such 
                recommendations, including specific action items, as the 
                Secretary considers appropriate with respect to how the 
                Department can better implement the SPED program, 
                including recommendations with respect to the following:
                          (i) A process to standardize training under 
                      such program.
                          (ii) Any resourcing requirements necessary to 
                      implement the SPED program throughout Veterans 
                      Health Administration, including by having a 
                      dedicated clinician responsible for administration 
                      of such program at each medical center.
                          (iii) <<NOTE: Analysis.>>  An analysis of 
                      current statutory authority and any changes 
                      necessary to fully implement the SPED program 
                      throughout the Veterans Health Administration.
                          (iv) <<NOTE: Timeline.>>  A timeline for the 
                      implementation of the SPED program through the 
                      Veterans Health Administration once full 
                      resourcing and an approved training plan are in 
                      place.

[[Page 134 STAT. 824]]

                    (H) Such other matters as the Secretary considers 
                appropriate.

    (c) Definitions.--In this section:
            (1) Appropriate committees of congress.--The term 
        ``appropriate committees of Congress'' means--
                    (A) the Committee on Veterans' Affairs and the 
                Subcommittee on Military Construction, Veterans Affairs, 
                and Related Agencies of the Committee on Appropriations 
                of the Senate; and
                    (B) the Committee on Veterans' Affairs and the 
                Subcommittee on Military Construction, Veterans Affairs, 
                and Related Agencies of the Committee on Appropriations 
                of the House of Representatives.
            (2) SPED primary coordinator.--The term ``SPED primary 
        coordinator'' means the main point of contact responsible for 
        administering the SPED program at a medical center of the 
        Department.
            (3) SPED program.--The term ``SPED program'' means the 
        Safety Planning in Emergency Departments program of the 
        Department of Veterans Affairs established in September 2018 for 
        veterans presenting to the emergency department who are assessed 
        to be at risk for suicide and are safe to be discharged home, 
        which extends the evidence-based intervention for suicide 
        prevention to all emergency departments of the Veterans Health 
        Administration.

      TITLE VI--IMPROVEMENT OF CARE AND SERVICES FOR WOMEN VETERANS

SEC. 601. <<NOTE: 38 USC 6303 note.>>  EXPANSION OF CAPABILITIES 
                        OF WOMEN VETERANS CALL CENTER TO INCLUDE 
                        TEXT MESSAGING.

    The Secretary of Veterans Affairs shall expand the capabilities of 
the Women Veterans Call Center of the Department of Veterans Affairs to 
include a text messaging capability.
SEC. 602. <<NOTE: 38 USC 6303 note.>>  REQUIREMENT FOR DEPARTMENT 
                        OF VETERANS AFFAIRS INTERNET WEBSITE TO 
                        PROVIDE INFORMATION ON SERVICES AVAILABLE 
                        TO WOMEN VETERANS.

    (a) <<NOTE: Survey.>>  In General.--The Secretary of Veterans 
Affairs shall survey the internet websites and information resources of 
the Department of Veterans Affairs in effect on the day before the date 
of the enactment of this Act and publish an internet website that serves 
as a centralized source for the provision to women veterans of 
information about the benefits and services available to them under laws 
administered by the Secretary.

    (b) Elements.--The internet website published under subsection (a) 
shall provide to women veterans information regarding all services 
available in the district in which the veteran is seeking such services, 
including, with respect to each medical center and community-based 
outpatient clinic in the applicable Veterans Integrated Service 
Network--
            (1) the name and contact information of each women's health 
        coordinator;

[[Page 134 STAT. 825]]

            (2) <<NOTE: List.>>  a list of appropriate staff for other 
        benefits available from the Veterans Benefits Administration, 
        the National Cemetery Administration, and such other entities as 
        the Secretary considers appropriate; and
            (3) such other information as the Secretary considers 
        appropriate.

    (c) <<NOTE: Time period.>>  Updated Information.--The Secretary 
shall ensure that the information described in subsection (b) that is 
published on the internet website required by subsection (a) is updated 
not less frequently 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 
required by subsection (a).
    (e) Derivation of Funds.--Amounts used by the Secretary to carry out 
this section shall be derived from amounts made available to the 
Secretary to publish internet websites of the Department.

                        TITLE VII--OTHER MATTERS

SEC. 701. <<NOTE: 38 USC 1701 note.>>  EXPANDED TELEHEALTH FROM 
                        DEPARTMENT OF VETERANS AFFAIRS.

    (a) <<NOTE: Contracts.>>  In General.--The Secretary of Veterans 
Affairs shall enter into agreements, and expand existing agreements, 
with organizations that represent or serve veterans, nonprofit 
organizations, private businesses, and other interested parties for the 
expansion of telehealth capabilities and the provision of telehealth 
services to veterans through the award of grants under subsection (b).

    (b) Award of Grants.--
            (1) In general.--In carrying out agreements entered into or 
        expanded under this section with entities described in 
        subsection (a), the Secretary shall award grants to those 
        entities.
            (2) Locations.--To the extent practicable, the Secretary 
        shall ensure that grants are awarded to entities that serve 
        veterans in rural and highly rural areas (as determined through 
        the use of the Rural-Urban Commuting Areas coding system of the 
        Department of Agriculture) or areas determined to be medically 
        underserved.
            (3) Use of grants.--
                    (A) In general.--Grants awarded to an entity under 
                this subsection may be used for one or more of the 
                following:
                          (i) Purchasing, replacing or upgrading 
                      hardware or software necessary for the provision 
                      of secure and private telehealth services.
                          (ii) Upgrading security protocols for 
                      consistency with the security requirements of the 
                      Department of Veterans Affairs.
                          (iii) Training of site attendants, including 
                      payment of those attendants for completing that 
                      training, with respect to--
                                    (I) military and veteran cultural 
                                competence, if the entity is not an 
                                organization that represents veterans;

[[Page 134 STAT. 826]]

                                    (II) equipment required to provide 
                                telehealth services;
                                    (III) privacy, including the Health 
                                Insurance Portability and Accountability 
                                Act of 1996 privacy rule under part 160 
                                and subparts A and E of part 164 of 
                                title 45, Code of Federal Regulations, 
                                or successor regulations, as it relates 
                                to health care for veterans;
                                    (IV) scheduling for telehealth 
                                services for veterans; or
                                    (V) any other unique training needs 
                                for the provision of telehealth services 
                                to veterans.
                          (iv) Upgrading existing infrastructure owned 
                      or leased by the entity to make rooms more 
                      conducive to telehealth care, including--
                                    (I) additions or modifications to 
                                windows or walls in an existing room, or 
                                other alterations as needed to create a 
                                new, private room, including permits or 
                                inspections required in association with 
                                space modifications;
                                    (II) soundproofing of an existing 
                                room;
                                    (III) new electrical, telephone, or 
                                internet outlets in an existing room; or
                                    (IV) aesthetic enhancements to 
                                establish a more suitable therapeutic 
                                environment.
                          (v) Upgrading existing infrastructure to 
                      comply with the Americans with Disabilities Act of 
                      1990 (42 U.S.C. 12101 et seq.).
                          (vi) Upgrading internet infrastructure and 
                      sustainment of internet services.
                          (vii) Sustainment of telephone services.
                    (B) <<NOTE: Determination.>>  Exclusion.--Grants may 
                not be used for the purchase of new property or for 
                major construction projects, as determined by the 
                Secretary.

    (c) <<NOTE: Contracts.>>  Agreement on Telehealth Access Points.--
            (1) In general.--An entity described in subsection (a) that 
        seeks to establish a telehealth access point for veterans but 
        does not require grant funding under this section to do so may 
        enter into an agreement with the Department for the 
        establishment of such an access point.
            (2) Adequacy of facilities.--An entity described in 
        paragraph (1) shall be responsible for ensuring that any access 
        point is adequately private, secure, clean, and accessible for 
        veterans before the access point is established.

    (d) Assessment of Barriers to Access.--
            (1) <<NOTE: Deadline.>>  In general.--Not later than 18 
        months after the date of the enactment of this Act, the 
        Secretary shall complete an assessment of barriers faced by 
        veterans in accessing telehealth services.
            (2) Elements.--The assessment required by paragraph (1) 
        shall include the following:
                    (A) A description of the barriers veterans face in 
                using telehealth while not on property of the 
                Department.
                    (B) A description of how the Department plans to 
                address the barriers described in subparagraph (A).

[[Page 134 STAT. 827]]

                    (C) Such other matters related to access by veterans 
                to telehealth while not on property of the Department as 
                the Secretary considers relevant.
            (3) <<NOTE: Recommenda- tions.>>  Report.--Not later than 
        120 days after the completion of the assessment required by 
        paragraph (1), 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 
        assessment, including any recommendations for legislative or 
        administrative action based on the results of the assessment.
SEC. 702. <<NOTE: Deadlines.>>  PARTNERSHIPS WITH NON-FEDERAL 
                        GOVERNMENT ENTITIES TO PROVIDE HYPERBARIC 
                        OXYGEN THERAPY TO VETERANS AND STUDIES ON 
                        THE USE OF SUCH THERAPY FOR TREATMENT OF 
                        POST-TRAUMATIC STRESS DISORDER AND 
                        TRAUMATIC BRAIN INJURY.

    (a) <<NOTE: 38 USC 1701 note.>>  Partnerships to Provide Hyperbaric 
Oxygen Therapy to Veterans.--
            (1) <<NOTE: Consultation.>>  Use of partnerships.--The 
        Secretary of Veterans Affairs, in consultation with the Center 
        for Compassionate Innovation within the Office of Community 
        Engagement of the Department of Veterans Affairs, may enter into 
        partnerships with non-Federal Government entities to provide 
        hyperbaric oxygen treatment to veterans to research the 
        effectiveness of such therapy.
            (2) Types of partnerships.--Partnerships entered into under 
        paragraph (1) may include the following:
                    (A) Partnerships to conduct research on hyperbaric 
                oxygen therapy.
                    (B) Partnerships to review research on hyperbaric 
                oxygen therapy provided to nonveterans.
                    (C) Partnerships to create industry working groups 
                to determine standards for research on hyperbaric oxygen 
                therapy.
                    (D) Partnerships to provide to veterans hyperbaric 
                oxygen therapy for the purposes of conducting research 
                on the effectiveness of such therapy.
            (3) Limitation on federal funding.--Federal Government 
        funding may be used to coordinate and administer the 
        partnerships under this subsection but may not be used to carry 
        out activities conducted under such partnerships.

    (b) <<NOTE: Consultation. 38 USC 1701 note.>>  Review of 
Effectiveness of Hyperbaric Oxygen Therapy.--Not later than 90 days 
after the date of the enactment of this Act, the Secretary, in 
consultation with the Center for Compassionate Innovation, shall begin 
using an objective and quantifiable method to review the effectiveness 
and applicability of hyperbaric oxygen therapy, such as through the use 
of a device approved or cleared by the Food and Drug Administration that 
assesses traumatic brain injury by tracking eye movement.

    (c) Systematic Review of Use of Hyperbaric Oxygen Therapy to Treat 
Certain Conditions.--
            (1) <<NOTE: Consultation.>>  In general.--Not later than 90 
        days after the date of the enactment of this Act, the Secretary, 
        in consultation with the Center for Compassionate Innovation, 
        shall commence the conduct of a systematic review of published 
        research literature on off-label use of hyperbaric oxygen 
        therapy to treat

[[Page 134 STAT. 828]]

        post-traumatic stress disorder and traumatic brain injury among 
        veterans and nonveterans.
            (2) Elements.--The review conducted under paragraph (1) 
        shall include the following:
                    (A) <<NOTE: Assessment.>>  An assessment of the 
                current parameters for research on the use by the 
                Department of Veterans Affairs of hyperbaric oxygen 
                therapy, including--
                          (i) tests and questionnaires used to determine 
                      the efficacy of such therapy; and
                          (ii) metrics for determining the success of 
                      such therapy.
                    (B) <<NOTE: Analysis.>>  A comparative analysis of 
                tests and questionnaires used to study post-traumatic 
                stress disorder and traumatic brain injury in other 
                research conducted by the Department of Veterans 
                Affairs, other Federal agencies, and entities outside 
                the Federal Government.
            (3) Completion of review.--The review conducted under 
        paragraph (1) shall be completed not later than 180 days after 
        the date of the commencement of the review.
            (4) Report.--Not later than 90 days after the completion of 
        the review conducted under paragraph (1), 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 results of the review.

    (d) Follow-up Study.--
            (1) <<NOTE: Consultation.>>  In general.--Not later than 120 
        days after the completion of the review conducted under 
        subsection (c), the Secretary, in consultation with the Center 
        for Compassionate Innovation, shall commence the conduct of a 
        study on all individuals receiving hyperbaric oxygen therapy 
        through the current pilot program of the Department for the 
        provision of hyperbaric oxygen therapy to veterans to determine 
        the efficacy and effectiveness of hyperbaric oxygen therapy for 
        the treatment of post-traumatic stress disorder and traumatic 
        brain injury.
            (2) <<NOTE: Review. Publication.>>  Elements.--The study 
        conducted under paragraph (1) shall include the review and 
        publication of any data and conclusions resulting from research 
        conducted by an authorized provider of hyperbaric oxygen therapy 
        for veterans through the pilot program described in such 
        paragraph.
            (3) Completion of study.--The study conducted under 
        paragraph (1) shall be completed not later than three years 
        after the date of the commencement of the study.
            (4) Report.--
                    (A) In general.--Not later than 90 days after 
                completing the study conducted under paragraph (1), 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 
                results of the study.
                    (B) <<NOTE: Recommenda- tions.>>  Elements.--The 
                report required under subparagraph (A) shall include the 
                recommendation of the Secretary with respect to whether 
                or not hyperbaric oxygen therapy should be made 
                available to all veterans with traumatic brain injury or 
                post-traumatic stress disorder.

[[Page 134 STAT. 829]]

SEC. 703. <<NOTE: 38 USC 7402 note.>>  PRESCRIPTION OF TECHNICAL 
                        QUALIFICATIONS FOR LICENSED HEARING AID 
                        SPECIALISTS AND REQUIREMENT FOR 
                        APPOINTMENT OF SUCH SPECIALISTS.

    (a) Technical Qualifications.--
            (1) <<NOTE: Deadline.>>  In general.--Not later than 180 
        days after the date of the enactment of this Act, the Secretary 
        of Veterans Affairs shall prescribe the technical qualifications 
        required under section 7402(b)(14) of title 38, United States 
        Code, to be appointed as a licensed hearing aid specialist under 
        section 7401(3) of such title.
            (2) Elements for qualifications.--In prescribing the 
        qualifications for licensed hearing aid specialists under 
        paragraph (1), the Secretary shall, at a minimum, ensure that 
        such qualifications are consistent with--
                    (A) the standards for licensure of hearing aid 
                specialists that are required by a majority of States;
                    (B) any competencies needed to perform tasks and 
                services commonly performed by hearing aid specialists 
                pursuant to such standards; and
                    (C) any competencies needed to perform tasks 
                specific to providing care to individuals under the laws 
                administered by the Secretary.

    (b) Authority to Set and Maintain Duties.--The Secretary shall 
retain the authority to set and maintain the duties for licensed hearing 
aid specialists appointed under section 7401(3) of title 38, United 
States Code, for the purposes of the employment of such specialists with 
the Department of Veterans Affairs.
    (c) <<NOTE: Deadline.>>  Appointment.--Not later than September 30, 
2022, the Secretary shall appoint not fewer than one licensed hearing 
aid specialist at each medical center of the Department.

    (d) <<NOTE: Assessments.>>  Report.--Not later than September 30, 
2022, and annually 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--
            (1) assessing the progress of the Secretary in appointing 
        licensed hearing aid specialists under subsection (c);
            (2) assessing potential conflicts or obstacles that prevent 
        the appointment of licensed hearing aid specialists;
            (3) assessing the factors that led to such conflicts or 
        obstacles;
            (4) assessing access of patients to comprehensive hearing 
        health care services from the Department consistent with the 
        requirements under section 4(b) of the Veterans Mobility Safety 
        Act of 2016 (Public Law 114-256; 38 U.S.C. 7401 note), including 
        an assessment of the impact of infrastructure and equipment 
        limitations on wait times for audiologic care; and
            (5) indicating the medical centers of the Department with 
        vacancies for audiologists or licensed hearing aid specialists.
SEC. 704. <<NOTE: Deadlines. 38 USC 7303 note.>>  USE BY 
                        DEPARTMENT OF VETERANS AFFAIRS OF 
                        COMMERCIAL INSTITUTIONAL REVIEW BOARDS IN 
                        SPONSORED RESEARCH TRIALS.

    (a) In General.--Not later than 90 days after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall complete 
all necessary policy revisions within the directive of the Veterans 
Health Administration numbered 1200.05 and titled ``Requirements for the 
Protection of Human Subjects in Research'',

[[Page 134 STAT. 830]]

to allow sponsored clinical research of the Department of Veterans 
Affairs to use accredited commercial institutional review boards to 
review research proposal protocols of the Department.
    (b) Identification of Review Boards.--Not later than 90 days after 
the completion of the policy revisions under subsection (a), the 
Secretary shall--
            (1) identify accredited commercial institutional review 
        boards for use in connection with sponsored clinical research of 
        the Department; and
            (2) establish a process to modify existing approvals in the 
        event that a commercial institutional review board loses its 
        accreditation during an ongoing clinical trial.

    (c) Report.--
            (1) In general.--Not later than 90 days after the completion 
        of the policy revisions under subsection (a), and annually 
        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 all 
        approvals of institutional review boards used by the Department, 
        including central institutional review boards and commercial 
        institutional review boards.
            (2) Elements.--The report required by paragraph (1) shall 
        include, at a minimum, the following:
                    (A) The name of each clinical trial with respect to 
                which the use of an institutional review board has been 
                approved.
                    (B) The institutional review board or institutional 
                review boards used in the approval process for each 
                clinical trial.
                    (C) The amount of time between submission and 
                approval.
SEC. 705. <<NOTE: 38 USC 310 note.>>  CREATION OF OFFICE OF 
                        RESEARCH REVIEWS WITHIN THE OFFICE OF 
                        INFORMATION AND TECHNOLOGY OF THE 
                        DEPARTMENT OF VETERANS AFFAIRS.

    (a) <<NOTE: Deadline.>>  In General.--Not later than one year after 
the date of the enactment of this Act, the Secretary of Veterans Affairs 
shall establish within the Office of Information and Technology of the 
Department of Veterans Affairs an Office of Research Reviews (in this 
section referred to as the ``Office'').

    (b) Elements.--The Office shall do the following:
            (1) Perform centralized security reviews and complete 
        security processes for approved research sponsored outside the 
        Department, with a focus on multi-site clinical trials.
            (2) <<NOTE: List.>>  Develop and maintain a list of 
        commercially available software preferred for use in sponsored 
        clinical trials of the Department and ensure such list is 
        maintained as part of the official approved software products 
        list of the Department.
            (3) Develop benchmarks for appropriate timelines for 
        security reviews conducted by the Office.

    (c) Report.--
            (1) In general.--Not later than one year after the 
        establishment of the Office, the Office 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 activity of the Office.

[[Page 134 STAT. 831]]

            (2) Elements.--The report required by paragraph (1) shall 
        include, at a minimum, the following:
                    (A) The number of security reviews completed.
                    (B) The number of personnel assigned for performing 
                the functions described in subsection (b).

    Approved October 17, 2020.

LEGISLATIVE HISTORY--S. 785:
---------------------------------------------------------------------------

CONGRESSIONAL RECORD, Vol. 166 (2020):
            Aug. 5, considered and passed Senate.
            Sept. 23, considered and passed House.

                                  <all>