--- kind: "diff" citation: "S. 785" bill: "116-s-785" heading: "Commander John Scott Hannon Veterans Mental Health Care Improvement Act of 2019" from: "rs" from_label: "Reported in Senate" to: "es" to_label: "Engrossed in Senate" sections_amended: 29 sections_added: 5 sections_removed: 6 url: "https://uscodex.org/bills/116/s/785/changes/es" --- # S. 785 — what changed S. 785, Commander John Scott Hannon Veterans Mental Health Care Improvement Act of 2019 — 29 sections amended, 5 added, and 6 removed between Reported in Senate and Engrossed in Senate. Edits are marked `struck` and `inserted`. ## Sec. 101 Strategic plan on expansion of health care coverage for veterans transitioning from service in the Armed Forces - (a) Strategic plan— - (1) 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 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. - (a) In general— Section 1710(a)(1) of title 38, United States Code, is amended— - (2) Elements— in subparagraph (A), by striking “and” at The plan submitted under paragraph (1) shall include the end;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) An analysis of the anticipated health care needs, including mental health care, for such veterans, disaggregated by geographic area. - (D) 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. - (2) by redesignating subparagraph (B) as subparagraph (C); and - (3) by inserting after subparagraph (A) the following new subparagraph (B): - “(B) to any veteran during the one-year period following the discharge or release of the veteran from active military, naval, or air service; and” - (b) Patient enrollment system—Definitions— Section 1705(c) of such title is amended by adding at the end the following new paragraph: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. - “(3) Nothing in this section shall be construed to prevent the Secretary from providing hospital care and medical services to a veteran under section 1710(a)(1)(B) of this title during the period specified in such section notwithstanding the failure of the veteran to enroll in the system of patient enrollment established by the Secretary under subsection (a).” - (c) Promotion of expanded eligibility— - (1) Transition Assistance Program— - (A) In general— The Secretary of Labor, in consultation with the Secretary of Defense and the Secretary of Veterans Affairs, shall promote to members of the Armed Forces transitioning from service in the Armed Forces to civilian life through the Transition Assistance Program the expanded eligibility of veterans for health care under the laws administered by the Secretary of Veterans Affairs pursuant to the amendments made by this section. - (B) Transition Assistance Program defined— In this paragraph, the term Transition Assistance Program means the Transition Assistance Program under sections 1142 and 1144 of title 10, United States Code. - (2) Publication by Department of Veterans Affairs— Not later than 30 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall publish on a website of the Department of Veterans Affairs notification of the expanded eligibility of veterans for health care under the laws administered by the Secretary pursuant to the amendments made by this section. ## 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) In general— The Secretary of Defense and the Secretary of Veterans Affairs shall jointly review the records of 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. - (a) Program required— Commencing not later than 180 days after the date of the enactment of this Act, the Secretary of Labor shall, in coordination with the Secretary of Veterans Affairs, carry out a program on the provision of assistance to former members of the Armed Forces, and spouses of such members, transitioning from service in the Armed Forces to civilian life. - (b) Duration of program—Elements— The Secretary of Labor shall carry out the program during the five-year period beginning on the date review required by subsection (a) with respect to a former member of the commencement Armed Forces shall include consideration of the program.following: - (1) 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: - (c) Grants— - (1) In general— The Secretary shall carry out the program through the award of grants to eligible organizations for the provision of assistance described in subsection (a). - (1) Matching funds required— A grant under this section shall be in an amount that does not exceed 50 percent of the amount required by the organization Exposure to provide the services described in subsection (f).violence. - (2) Exposure to suicide. - (3) Housing instability. - (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) Eligible organizations—Report— For purposes Not later than three years after the date of the enactment of this section, an eligible organization is any nonprofit organization that Act, the Secretary of Labor determines, in consultation with Defense and the Secretary of Veterans Affairs and State entities that serve veterans, is suitable for receipt of a grant under the program pursuant shall jointly submit to receipt by the Secretary of Labor appropriate committees of Congress an application submitted aggregated report on the results of the review conducted under subsection (e)(1).(a) with respect to the year-one cohort of former members of the Armed Forces covered by the review. - (e) Definitions— In this section: - (e) Selection of grant recipients— - (1) Applications— An organization seeking a grant under the program shall submit to the Secretary of Labor an application therefor at such time, in such manner, and containing such information and assurances as the Secretary, in consultation with the Secretary of Veterans Affairs and State entities that serve veterans, may require. - (1) Priority for hubs of services—Active military, naval, or air service— In awarding grants under the program, The term active military, naval, or air service has the Secretary of Labor shall give priority to an organization meaning given that provides multiple forms of services described term in subsection (f).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. - (f) Use of grant funds— Each organization receiving a grant under the program shall use the grant to provide to former members of the Armed Forces and spouses described in subsection (a) the following: - (1) Résumé assistance. - (2) Interview training. - (3) Job recruitment training. - (4) Entrepreneurship training. - (5) Financial services. - (6) Legal assistance. - (7) Educational supportive services. - (8) Assistance with accessing benefits provided under laws administered by the Secretary of Veterans Affairs, including home loan benefits, education benefits, adaptive housing grants, and all other benefits. - (9) Nonclinical case management. - (10) Other related services leading directly to successful transition, as determined by the Secretary of Labor in consultation with the Secretary of Veterans Affairs. - (g) Annual reports— - (1) In general— Not later than one year after the date of the commencement of the program and not less frequently than once each year thereafter until the termination of the program, the Secretary of Labor shall, in consultation with the Secretary of Veterans Affairs, submit to the appropriate committees of Congress a report on the program carried out under this section. - (2) Contents— Each report submitted under paragraph (1) shall include the following: - (A) A list of the organizations that have received grants under the program, including the geographic location of the organization and the types of services outlined in subsection (f) that each organization provides. - (B) The number of veterans served by each organization. - (C) An assessment of the effectiveness of the services provided under the program at improving the transition process for former members of the Armed Forces and spouses described in subsection (a), based on metrics determined by the Secretary of Labor in consultation with the Secretary of Veterans Affairs. - (D) The amount of each grant awarded to each organization under the program. - (E) Such other matters as the Secretary of Labor, in consultation with the Secretary of Veterans Affairs, considers appropriate. - (3) Appropriate committees of Congress— In this subsection, 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. - (h) Authorization of appropriations— There is authorized to be appropriated $10,000,000 to carry out this section. ## 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. - (a) Study— - (1) In general— The Secretary of Veterans Affairs shall, in consultation with the Secretary of Labor and State entities that serve former members of the Armed Forces, enter into an agreement with a Federal or non-Federal entity to develop or access a comprehensive list of community-based programs that— - (A) provide transition assistance to such former members that lead directly to successful transition to civilian life, such as— - (i) résumé assistance; - (ii) interview training; - (iii) job recruitment training; - (iv) entrepreneurship training; - (v) financial services; - (vi) legal assistance; - (vii) educational supportive services; - (viii) assistance with accessing benefits provided under laws administered by the Secretary of Veterans Affairs, including home loan benefits, education benefits, adaptive housing grants, and other benefits; and - (ix) nonclinical case management; and - (B) are operated by nonprofit organizations. - (2) Updates— - (A) Periodic— Not less frequently than once every five years, the Secretary shall update the list created under paragraph (1). - (B) Upon request— In addition to periodic updates under subparagraph (A), the Secretary shall update the list created under paragraph (1) upon request of an organization with a program included in the list. - (C) Verification— The Secretary shall, in consultation with State entities that serve former members of the Armed Forces and to the degree practicable, verify changes to the list made under this paragraph. - (b) Transmission to members—Elements— The Secretary shall transmit the list created, and revised as the case may be, under report required by subsection (a) to the Secretary of Labor and the Secretary of Defense so the Secretaries of the military departments may provide information in the list to members of the Armed Forces who participate in shall include the Transition Assistance Program under sections 1142 and 1144 of title 10, United States Code.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) Online publication—REACH VET program defined— The Secretary of Veterans Affairs shall publish In this section, the list created, and revised as term REACH VET program means the case may be, under subsection (a) on a public website 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— - (a) Eligibility— Subsection (b)(2)(B) of section 1720I of title 38, United States Code, is amended by striking “a discharge by court martial” and inserting “a dismissal”. - (1) Information— Subsection (e) of such section is amended—in paragraph (1) by striking “Not less frequently than once” and inserting “Not later than February 15”; and - (1) in paragraph (3)— - (A) in subparagraph (B), by striking “and” at the end; - (B) in subparagraph (C), by striking “and” at the end; - (C) by redesignating subparagraph (C) as subparagraph (D); and - (D) by inserting after subparagraph (B) the following new subparagraph (C): - “(C) is displayed prominently on a website of the Department; and” - (2) by redesignating paragraph (4) as paragraph (5); and - (3) by inserting after paragraph (3) the following new paragraph (4): - “(4) shall include outreach on Internet search engines; and” - (c) Annual report— Subsection (f) of such section is amended— - (1) in paragraph (1), by striking “Not less frequently than once” and inserting “Not later than February 15”; and - (2) [was (4)(4)] in paragraph (2)— - (A) [was (4)(4)(2)] by redesignating subparagraph (C) as subparagraph (F); and - (B) [was (4)(4)(3)] 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.” ## Sec. 201 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) 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. 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. - (a) Purpose— The purpose of this section is to facilitate the provision of mental health services for veterans with mental health conditions who are receiving care outside of the Department of Veterans Affairs. - (b) Grants— - (1) In general— Subchapter II of chapter 17 of title 38, United States Code, is amended by adding at the end the following new section: - “1720J. Financial assistance for mental health supportive services for veterans seeking mental health treatment - “(a) Distribution of financial assistance - “(1) The Secretary shall provide financial assistance to eligible entities approved under this section to provide or coordinate the provision of mental health supportive services described in subsection (b) for a veteran with a mental health condition who is seeking mental health treatment. - “(2) Financial assistance under paragraph (1) shall consist of the award of a grant to an approved eligible entity for each veteran described in paragraph (1) for which the approved eligible entity is providing or coordinating the provision of mental health supportive services. - “(3) - “(A) The Secretary shall award grants under this section to each approved eligible entity that is providing or coordinating the provision of mental health supportive services under this section. - “(B) The Secretary may establish intervals of payment for the administration of grants under this section and establish a maximum amount to be awarded, in accordance with the services being provided and the duration of such services. - “(4) In providing financial assistance under paragraph (1), the Secretary shall give preference to entities providing or coordinating the provision of supportive mental health services for veterans with mental health conditions who face barriers in accessing mental health care services from the Department. - “(5) The Secretary shall ensure that, to the extent practicable, financial assistance under this subsection is equitably distributed across geographic regions, including rural communities and tribal lands. - “(6) Each entity receiving financial assistance under this section to provide mental health supportive services to a veteran with a mental health condition shall notify that veteran that such services are being paid for, in whole or in part, by the Department. - “(7) The Secretary shall require entities receiving financial assistance under this section to submit a report to the Secretary that describes the services provided or coordinated with such financial assistance. - “(b) Mental health supportive services—The mental health supportive services described in this subsection are services provided by an eligible entity or a subcontractor of an eligible entity that address the needs of veterans with mental health conditions, including— - “(1) outreach services; - “(2) case management services; - “(3) assistance in obtaining any benefits from the Department that the veteran may be eligible to receive, including health care services, vocational and rehabilitation counseling, employment and training services, and educational assistance; and - “(4) assistance in obtaining and coordinating the provision of other public benefits provided by any Federal, State, or local agency, or any other eligible entity, including— - “(A) health care services (including obtaining health insurance); - “(B) daily living services; - “(C) personal financial planning services; - “(D) transportation services; - “(E) income support services; - “(F) fiduciary and representative payee services; - “(G) legal services to assist the veteran with issues that interfere with the ability of the veteran to find and retain meaningful employment, housing, or benefits to which the veteran may be entitled; - “(H) child care services; - “(I) housing counseling; and - “(J) other services necessary for maintaining independent living. - “(c) Application for financial assistance - “(1) An eligible entity seeking financial assistance under subsection (a) shall submit to the Secretary an application therefor in such form, in such manner, and containing such commitments and information as the Secretary determines to be necessary to carry out this section. - “(2) Each application submitted by an eligible entity under paragraph (1) shall contain— - “(A) a description of the mental health supportive services described in subsection (b) proposed to be provided by the eligible entity under this section and the identified needs for those services; - “(B) a description of the types of veterans with a mental health condition proposed to be provided such services; - “(C) an estimate of the number of veterans with a mental health condition proposed to be provided such services; - “(D) evidence of the experience of the eligible entity in providing mental health supportive services to veterans with a mental health condition; and - “(E) a description of the managerial capacity of the eligible entity— - “(i) to coordinate the provision of mental health supportive services with the provision of mental health services by the eligible entity or another organization; - “(ii) to assess continually the needs of veterans with a mental health condition for mental health supportive services; - “(iii) to coordinate the provision of mental health supportive services with the services of the Department; and - “(iv) to tailor supportive mental health services to the needs of veterans with a mental health condition. - “(3) - “(A) The Secretary shall establish criteria for the selection of eligible entities to be provided financial assistance under this section. - “(B) Criteria established under subparagraph (A) with respect to an eligible entity shall include the following: - “(i) Relevant accreditation as may be required by each State in which the eligible entity operates. - “(ii) Experience coordinating care or providing treatment for veterans or members of the Armed Forces. - “(d) Technical assistance - “(1) The Secretary shall provide training and technical assistance to eligible entities provided financial assistance under this section regarding the planning, development, and provision of mental health supportive services under this section. - “(2) The Secretary may provide the training described in paragraph (1) directly or through grants or contracts with appropriate public or nonprofit private entities, including through grants awarded under section 2064 of this title. - “(e) Collection of information—To the extent practicable, the Secretary may collect information from an eligibility entity awarded a grant under this section relating to a mental health condition of a veteran for inclusion in the electronic health record of the Department for such veteran for the sole purpose of improving care provided to such veteran. - “(f) Funding—From amounts appropriated to the Department for medical services, there shall be available to carry out subsections (a), (b), and (c) the following: - “(1) $5,000,000 for fiscal year 2021. - “(2) $10,000,000 for fiscal year 2022. - “(3) $15,000,000 for fiscal year 2023. - “(g) Definitions—In this section: - “(1) The term eligible entity means any of the following: - “(A) An incorporated private institution or foundation— - “(i) no part of the net earnings of which inures to the benefit of any member, founder, contributor, or individual; - “(ii) that has a governing board that is responsible for the operation of the mental health supportive services provided under this section; and - “(iii) that is approved by the Secretary with respect to financial responsibility. - “(B) A for-profit limited partnership, the sole general partner of which is an organization meeting the requirements of clauses (i), (ii), and (iii) of subparagraph (A). - “(C) A corporation wholly owned and controlled by an organization meeting the requirements of clauses (i), (ii), and (iii) of subparagraph (A). - “(D) A tribally designated housing entity (as defined in section 4 of the Native American Housing Assistance and Self-Determination Act of 1996 (25 U.S.C. 4103)). - “(2) The term veteran with a mental health condition means a veteran who has been diagnosed with, or who is seeking treatment for, one or more mental health conditions, as determined by the Secretary.” - (2) Clerical amendment— The table of sections at the beginning of chapter 17 is amended by inserting after the item relating to section 1720I the following new item: - (c) Study on effectiveness Award of program—grants— - (1) In general— The Secretary of Veterans Affairs shall conduct award a study on the effectiveness of grant to each eligible entity for which the program of financial assistance Secretary has approved an application under section 1720J of title 38, United States Code, as added by subsection (b), in meeting (f) to provide or coordinate the needs provision of veterans with a mental health condition, as that term is defined in that suicide prevention services under this section. - (2) Comparison—Grant amounts, intervals of payment, and matching funds— In conducting the study required by paragraph (1), the Secretary shall compare the results of the program described in that paragraph accordance with other programs of the Department of Veterans Affairs dedicated to services being provided under a grant under this section and the delivery duration of mental health services to veterans.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— - (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) 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) 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 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) 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) 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. - (D) 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) to coordinate the provision of suicide prevention services with the provision of other services; - (ii) to assess on an ongoing basis the needs of eligible individuals and their families for suicide prevention services; - (iii) 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) 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— - (1) 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) the data required to be collected and shared with the Department; - (C) 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) 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) 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) 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) 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 - (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. - (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) 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) 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) 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 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) 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) 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) 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) In general— Not later than 180 days after the commencement of the grant program under this section, 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) 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) 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) 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) 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. - (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) 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) 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) 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. - (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. - (iii) Historical risk factors, including the following: - (I) Previous suicide attempts. - (II) Family history of suicide. - (III) History of abuse, neglect, or trauma. - (B) 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) 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) Nontraditional and innovative approaches and treatment practices, as determined appropriate by the Secretary, in consultation with appropriate entities. - (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. - (3) Criteria— In making the comparison required by paragraph (2), the Secretary shall examine the following: - (A) The satisfaction of veterans targeted by the programs described in paragraph (2). - (B) The health status of such veterans. - (C) The mental wellness of such veterans. - (D) The degree to which such veterans are encouraged to engage in productive activity by such programs. - (E) The number of veterans using such programs, disaggregated by— - (i) veterans who have received care from the Department in the previous two years; and - (ii) veterans who have not received care from the Department in the previous two years. - (F) The number of veterans who die by suicide while receiving services from an entity in receipt of a grant under the program of financial assistance under section 1720J of title 38, United States Code, as added by subsection (b), or who die by suicide during the 180-day period after receiving such services. - (4) Report— Not later than December 31, 2021, 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 the results of the study required by paragraph (1). - (d) Effective date— The Secretary shall begin providing financial assistance under section 1720J of title 38, United States Code, as added by subsection (b), not later than one year after the date of the enactment of this Act. ## Sec. 202 Analysis on feasibility and advisability of the Department of Veterans Affairs providing certain complementary and integrative health services - (a) In general— The Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall designate one week per year to organize outreach events and educate veterans complete an analysis on how to conduct peer wellness checks, which shall be known as “Buddy Check Week”.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. - (b) Events and education— - (1) In general— During Buddy Check Week, the Secretary, in consultation with organizations that represent veterans, non-profits that serve veterans, mental health experts, members of the Armed Forces, and such other entities and individuals as the Secretary considers appropriate, shall collaborate with organizations that represent veterans to provide educational opportunities for veterans to learn how to conduct peer wellness checks. - (2) Training matters— As part of the educational opportunities provided under paragraph (1), the Secretary shall provide the following: - (A) A script for veterans to use to conduct peer wellness checks that includes information on appropriate referrals to resources veterans might need. - (B) Online and in-person training, as appropriate, on how to conduct a peer wellness check. - (C) Opportunities for members of organizations that represent veterans to learn how to train individuals to conduct peer wellness checks. - (D) Training for veterans participating in Buddy Check Week on how to transfer a phone call directly to the Veterans Crisis Line. - (E) Resiliency training for veterans participating in Buddy Check Week on handling a veteran in crisis. - (3) Online materials— All training materials provided under the educational opportunities under paragraph (1) shall be made available on a website of the Department. - (c) Outreach—Treatments described— The Secretary, Complementary and integrative health treatments described in collaboration with organizations that represent veterans, may conduct outreach regarding educational opportunities under this subsection (b) at—shall consist of the following: - (1) public events where many veterans are expected to congregate;Yoga. - (2) meetings of organizations that represent veterans;Meditation. - (3) facilities of the Department of Veterans Affairs; andAcupuncture. - (4) such other locations as the Secretary, in collaboration with organizations that represent veterans, considers appropriate.Chiropractic care. - (5) 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— - (d) Veterans Crisis Line plan— - (1) In general— The Secretary shall ensure that the Veterans Crisis Line has a plan for handling the potential increase of calls that may occur during Buddy Check Week. - (1) Submittal of plan— The head of the Veterans Crisis Line shall submit to the Secretary a plan for how to handle excess calls during Buddy Check Week, which may include the following:results of such analysis; and - (2) such recommendations regarding the furnishing of complementary and integrative health treatments described in subsection (c) as the Secretary considers appropriate. - (A) Additional hours for staff. - (B) The use of a backup call center. - (C) Any other plan to ensure that calls from veterans in crisis are being answered in a timely manner by an individual trained at the same level as a Veterans Crisis Line responder. - (e) Veterans crisis line defined— In this section, the term Veterans Crisis Line means the toll-free hotline for veterans established under section 1720F(h) of title 38, United States Code. ## 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 - (a) In general— The Secretary of Veterans Affairs, in consultation with Not later than 180 days after the Secretary date on which the Creating Options for Veterans’ Expedited Recovery Commission (commonly referred to as the “COVER Commission”) established under section 931 of Defense 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 Homeland Security, Veterans Affairs shall enter into partnerships with nonprofit mental commence the conduct of a pilot program to provide complementary and integrative health organizations programs described in subsection (b) to facilitate post-traumatic growth among eligible veterans who have experienced trauma.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) Consultation—Programs described— Before entering Complementary and integrative health programs described in this subsection may, taking into a partnership under consideration the report described in subsection (a), the Secretary of Veterans Affairs shall consult with the National Institute consist of Mental Health, the National Alliance on Mental Illness, the American Psychological Association, the Posttraumatic Growth Research Group, and organizations that represent veterans.following: - (1) Equine therapy. - (2) Other animal therapy. - (3) Agritherapy. - (4) Sports and recreation therapy. - (5) Art therapy. - (6) Posttraumatic growth programs. - (c) Selection of partners—Eligible veterans— The Secretary of Veterans Affairs shall ensure that each organization with which A veteran is eligible to participate in the Secretary enters into a partnership pilot program under subsection (a) has a demonstrated history of success with programs to facilitate post-traumatic growth, including—this section if the veteran— - (1) long-term follow-up with veterans who have participated is enrolled in such a program for not less than one year after completion the system of patient enrollment of the program; Department under section 1705(a) of title 38, United States Code; and - (2) sustained positive, clinically significant outcomes for veterans who have participated in such a program for not less than 180 days after completion 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. - (d) Outcomes from partners— The Secretary of Veterans Affairs shall require each nonprofit mental health organization that enters into a partnership with the Secretary under subsection (a) to submit to the Secretary a description of the outcomes from such partnership, including the following: - (2) Extension— The number of veterans who participate in programs Secretary may extend the duration of the organization to facilitate post-traumatic growth, including pilot program under this section if the number of veterans who drop out before completion Secretary, based on the results of the program.interim report submitted under subsection (f)(1), determines that it is appropriate to do so. - (2) The types of mental or behavioral health conditions of veterans who participate in such programs. - (3) The percentage of veterans who experience significant post-traumatic growth. - (4) Such other topics as the Secretary may require to track post-traumatic growth. - (e) Post-Traumatic growth—Locations— - (1) In general— For purposes The Secretary shall select not fewer than five facilities of the Department at which to carry out the pilot program under this section, post-traumatic growth means positive responses described in paragraph (3) experienced after, and often as a result of, a traumatic event or a major life crisis.section. - (2) Measurement of growth—Selection criteria— Post-traumatic growth In selecting facilities under this section shall be measured through self-reported scales, use of the post-traumatic stress disorder checklist set forth in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association, and such other metrics as paragraph (1), the Secretary considers necessary.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— - (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) 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) 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) The determination of the Secretary with respect to extending the pilot program under subsection (d)(2). - (vi) 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. - (3) Positive responses described— Positive responses described in this paragraph are positive responses in one or more areas of life, including the following: - (A) An appreciation of and for life. - (B) Improved relationships with others. - (C) Realization of new possibilities in life. - (D) Realization of personal strength. - (E) Spiritual change. - (F) Such other areas that the Secretary, in consultation with organizations specified in subsection (b), considers necessary. ## 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) 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— - (1) 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) 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) 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) 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. - (a) In general— The Secretary of Veterans Affairs shall develop metrics to track progress on each of the 14 goals and 43 objectives outlined in the National Strategy for Preventing Veteran Suicide, 2018–2028 prepared by the Office of Mental Health and Suicide Prevention of the Department of Veterans Affairs. - (b) Metrics— The metrics developed under subsection (a) shall include measures of both performance and effectiveness. - (c) Initial report— - (1) In general— 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 that contains the metrics developed under subsection (a). - (2) Elements— The report submitted under paragraph (1) shall include the following: - (A) An explanation of why the metrics developed under subsection (a) were chosen. - (B) An assessment of how accurately those metrics will reflect the goals and objectives specified in such subsection. - (d) Annual report—Briefings— Not later than one year after the submittal of the report under subsection (b), and annually thereafter, the The Secretary of Veterans Affairs shall submit to brief the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report that contains—containing the interim results— - (1) an assessment of the progress of the Department in meeting with respect to the goals and objectives specified in study under subsection (a);(a)(1), not later than 24 months after entering into the agreement under such subsection; and - (2) a description of any action with respect to be taken by the Department if those goals and objectives are review under subsection (b)(1), not being met;later than 18 months after the date of the enactment of this Act. - (e) 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. - (3) a description of any changes to those goals and objectives; - (4) an identification of any new programs or partnerships that have resulted from the implementation of the National Strategy for Preventing Veteran Suicide, 2018–2028; - (5) an assessment of the effectiveness of the National Strategy for Preventing Veterans Suicide, 2018–2028 at reducing veteran suicide; and - (6) such other topics as the Secretary considers necessary. ## 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 180 days 18 months after the date of the enactment of this Act, the Secretary Comptroller General of Veterans Affairs the United States shall complete a study submit to the Committee on Veterans’ Affairs of the feasibility Senate and advisability the Committee on Veterans’ Affairs of providing complementary and integrative health treatments described in subsection (b) at all facilities the House of Representatives a report on the efforts of the Department of Veterans Affairs.Affairs to manage veterans at high risk for suicide. - (b) Treatments described—Elements— Complementary and integrative health treatments described in this The report required by subsection (a) shall consist of include the following: - (1) Yoga.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. - (2) Meditation.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) Acupuncture.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) Chiropractic care.A review of staffing levels of suicide prevention coordinators across the Veterans Health Administration. - (5) Other treatments that show sufficient evidence A review of efficacy at treating the resources and programming offered to family members and friends of veterans who have a mental or physical health conditions, as determined by the Secretary.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. - (c) Provision of treatment— The Secretary may provide complementary and integrative health treatments under this section at a facility of the Department in person or by telehealth. - (d) Report— Not later than 90 days after the completion of the study 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 such study, including— - (1) the results of such study; and - (2) such recommendations regarding the furnishing of complementary and integrative health treatments described in subsection (b) as the Secretary considers appropriate. ## Sec. 206 Program to provide veterans access to complementary and integrative health services through animal therapy, agri-therapy, and outdoor sports therapy — removed - (a) In general— Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall commence the conduct of a program to provide complementary and integrative health services described in subsection (b) to 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) Treatments described— Complementary and integrative health treatments described in this subsection shall consist of the following: - (1) Equine therapy. - (2) Other animal therapy. - (3) Agri-therapy. - (4) Outdoor sports therapy. - (c) Eligible veterans— A veteran is eligible to participate in the program under this section if the veteran— - (1) is enrolled in the system of patient enrollment of the Department established and operated under section 1705(a) of title 38, United States Code; and - (2) 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 program. - (d) Duration— - (1) In general— The Secretary shall carry out the program under this section for a two-year period beginning on the commencement of the program. - (2) Extension— The Secretary may extend the duration of the program under this section if the Secretary, based on the results of the interim report submitted under subsection (e)(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 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— - (1) Interim report— - (A) In general— Not later than one year after the commencement of the 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 program. - (B) Elements— The report required by subparagraph (A) shall include the following: - (i) The number of participants in the program. - (ii) The types of therapy offered at each facility at which the program is being carried out. - (iii) An assessment of whether participation by a veteran in the program resulted in any changes in clinically relevant endpoints for the veteran with respect to the conditions specified in subsection (a). - (iv) An assessment of the quality of life of veterans participating in the program, including the results of a satisfaction survey of the participants in the program, disaggregated by treatment under subsection (b). - (v) The determination of the Secretary with respect to extending the program under subsection (c)(2). - (vi) Any recommendations of the Secretary with respect to expanding the program. - (2) Final report— Not later than 90 days after the termination of the 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 program. ## Sec. 207 Comptroller General report on management by Department of Veterans Affairs of veterans at high risk for suicide — removed - (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) 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 age, gender, Veterans Integrated Service Network, and, to the extent practicable, medical center of the Department. - (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 age, gender, Veterans Integrated Service Network, and, 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 age, gender, Veterans Integrated Service Network, and, to the extent practicable, medical center of the Department. - (4) A review of staffing levels of suicide prevention coordinators across the Veterans Health Administration. - (5) 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. ## Sec. 301 Study on connection between living at high altitude and suicide risk factors among veterans - (a) In general— Not later than 210 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs 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 program to assess study on the feasibility connection between living at high altitude and advisability of using computerized cognitive behavioral therapy to treat eligible veterans suffering from depression, anxiety, post-traumatic stress disorder, military sexual trauma, or substance use disorder who are already receiving evidence-based therapy from the Department risk of Veterans Affairs.developing depression or dying by suicide among veterans. - (b) Eligible veterans—Completion of study— A veteran is eligible to participate in the program The study conducted under this section if subsection (a) shall be completed not later than three years after the veteran—date of the commencement of the study. - (1) is enrolled in the system of patient enrollment of the Department of Veterans Affairs established and operated under section 1705(a) of title 38, United States Code; and - (2) 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 program. - (c) Duration—Individual impact— The Secretary study conducted under subsection (a) shall carry out be conducted so as to determine the program under this section for a two-year period beginning effect of high altitude on suicide risk at the commencement of individual level, not at the program.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) 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, 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. - (d) Locations— - (1) In general— The Secretary shall select not fewer than three facilities of the Department of Veterans Affairs at which to carry out the 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 two 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). - (e) Access to chat— In carrying out the program under this section, the Secretary shall ensure that veterans participating in the program have access via chat to a mental health provider 24 hours per day, seven days per week. - (f) Promotion of Veterans Crisis Line— The Secretary shall promote the availability of the Veterans Crisis Line to veterans participating in the program under this section. - (g) Department website— In implementing the program under this section, the Secretary, to the extent feasible, shall use a website of the Department of Veterans Affairs to host the program. - (h) Reports— - (1) Interim report— - (A) In general— Not later than one year after the commencement of the 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 program. - (B) Elements— The report required by subparagraph (A) shall include the following: - (i) The number of participants in the program. - (ii) An assessment of whether participation by a veteran in the program resulted in any changes in clinically relevant endpoints for the veteran with respect to the conditions specified in subsection (a). - (iii) Any recommendations of the Secretary with respect to extending or expanding the program. - (2) Final report— Not later than 90 days after the termination of the 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 program. - (i) Veterans crisis line defined— In this section, the term Veterans Crisis Line means the toll-free hotline for veterans established under section 1720F(h) of title 38, United States Code. ## Sec. 302 Establishment by Department of Veterans Affairs and Department of Defense of a clinical provider treatment toolkit and accompanying training materials for comorbidities - (a) In general— Not later than 180 days two years 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 Secretary of Veterans Affairs, Defense, shall commence the conduct of develop a study on the connection between living at high altitude clinical provider treatment toolkit and accompanying training materials for the risk evidence-based management of developing depression or dying by suicide among veterans.comorbid mental health conditions, comorbid mental health and substance use disorders, and a comorbid mental health condition and chronic pain. - (b) Completion of study—Matters included— The study conducted In developing the clinical provider treatment toolkit and accompanying training materials under subsection (a) shall be completed not later than three years after (a), the date Secretary of Veterans Affairs and the commencement Secretary of Defense shall ensure that the study.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. - (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) 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, 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. 303 Update of clinical practice guidelines for assessment and management of patients at risk for suicide - (a) In general— Not later than two years 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, in consultation with the Secretary of Defense Affairs and the Secretary of Health and Human Services, shall complete Defense, through the development Assessment and Management of clinical practice guidelines Patients at Risk for Suicide Work Group (in this section referred to as the treatment of post-traumatic stress disorder, military sexual trauma, and traumatic brain injury that is comorbid with substance use disorder or chronic pain.“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; - (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. - (b) Work group— - (1) Establishment— In carrying out subsection (a), the Secretary of Veterans Affairs, the Secretary of Defense, and the Secretary of Health and Human Services shall create a Trauma and Comorbid Substance Use Disorder or Chronic Pain Work Group (in this section 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: - (A) Academic institutions that specialize in research for the treatment of conditions described in subsection (a). - (B) The National Center for Posttraumatic Stress Disorder 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. - (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. - (c) Matters included— In developing the clinical practice guidelines under subsection (a), the Work Group, in consultation with the Post Traumatic Stress Disorder Work Group, Concussion-mTBI Work Group, Opioid Therapy for Chronic Pain Work Group, and Substance Use Work Group, shall ensure that the clinical practice guidelines include the following: - (1) Guidance with respect to the following: - (A) The treatment of patients with post-traumatic stress disorder who are also experiencing a substance use disorder or chronic pain. - (B) The treatment of patients experiencing a mental health condition, including anxiety, depression, or post-traumatic stress disorder as a result of military sexual trauma who are also experiencing a substance use disorder or chronic pain. - (C) The treatment of patients with traumatic brain injury who are also experiencing a substance use disorder or chronic pain. - (2) Guidance with respect to the following: - (A) Appropriate case management for patients experiencing post-traumatic stress disorder that is comorbid with substance use disorder or chronic pain who transition from receiving care while on active duty in the Armed Forces to care from health care networks outside of the Department of Defense. - (B) Appropriate case management for patients experiencing a mental health condition, including anxiety, depression, or post-traumatic stress disorder as a result of military sexual trauma that is comorbid with substance use disorder or chronic pain who transition from receiving care while on active duty in the Armed Forces to care from health care networks outside of the Department of Defense. - (C) Appropriate case management for patients experiencing traumatic brain injury that is comorbid with substance use disorder or chronic pain who transition from receiving care while on active duty in the Armed Forces to care from health care networks outside of the Department of Defense. - (3) Guidance with respect to the treatment of patients who are still members of the Armed Forces and are experiencing a mental health condition, including anxiety, depression, or post-traumatic stress disorder as a result of military sexual trauma that is comorbid with substance use disorder or chronic pain. - (4) Guidance with respect to the assessment by the National Academies of Sciences, Engineering, and Medicine of the potential overmedication of veterans, as required pursuant to the Senate report accompanying S. 1557, 115th Congress (Senate Report 115-130), under the heading “Overprescription Prevention Report” under the heading “COMMITTEE RECOMMENDATION”. - (d) 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 guidelines required under subsection (a) or from ensuring that the final clinical practice 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. ## Sec. 304 Establishment by Department of Veterans Affairs and Department of Defense of clinical practice guidelines for the treatment of serious mental illness - (a) In general— Not later than two years after the date of the enactment of this Act, the Secretary of Veterans Affairs and Affairs, in consultation with the Secretary of Defense, through Defense and the Assessment Secretary of Health and Management Human Services, shall complete the development of Patients at Risk a clinical practice guideline or guidelines for Suicide Work Group (in this section referred to as the “Work Group”), shall issue an update treatment of serious mental illness, to include the VA/DOD Clinical Practice Guideline for Assessment and Management of Patients at Risk for Suicide.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—included in guidelines— In carrying out the update under subsection (a), the Work Group shall ensure that the The clinical practice guideline or guidelines updated developed under such subsection includes (a) shall include the following: - (1) Enhanced guidance with respect to Guidance contained in the following:2016 Clinical Practice Guidelines for the Management of Major Depressive Disorders of the Department of Veterans Affairs and the Department of Defense. - (A) Gender-specific risk factors for suicide and suicidal ideation. - (B) Gender-specific treatment efficacy for depression and suicide prevention. - (C) Gender-specific pharmacotherapy efficacy. - (D) Gender-specific psychotherapy efficacy. - (2) Guidance with respect to the following:treatment of patients with a condition described in subsection (a). - (A) The efficacy of alternative therapies, other than psychotherapy and phar­ma­co­ther­a­py, including the following: - (i) Yoga therapy. - (ii) Meditation therapy. - (iii) Equine therapy. - (iv) Other animal therapy. - (v) Training and caring for service dogs. - (vi) Agri-therapy. - (vii) Art therapy. - (viii) Outdoor sports therapy. - (ix) Music therapy. - (x) Any other alternative therapy that the Work Group considers appropriate. - (3) Guidance with respect to the findings A list of the Creating Options evidence-based therapies 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 treatment of Public Law 114–198; 38 U.S.C. 1701 note).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) Rule Assessment of construction—existing guidelines— Nothing in Not later than two years after the date of the enactment of this section shall be construed to prevent Act, the Secretary of Veterans Affairs and Affairs, in consultation with the Secretary of Defense from considering all relevant evidence, as appropriate, in updating and the VA/DOD Secretary of Health and Human Services, shall complete an assessment of the 2016 Clinical Practice Guideline Guidelines for Assessment and the 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 Major Depressive Disorders to the patient populations of the Department of Veterans Affairs and the Department of Defense.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. ## Sec. 305 Precision medicine initiative of Department of Veterans Affairs to identify and validate brain and mental health biomarkers - (a) 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 nongovernment entity other than as allowed under subparagraph (B). - (5) Standardization— - (c) 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 to ensure that information of veterans participating in the initiative is kept private and secure. - (2) Open platform— - (A) Research purposes— The Secretary shall make de-identified data collected under the initiative available for research purposes both within and outside of the Department of Veterans Affairs. - (B) Data may not be sold— Data collected under the initiative may not be sold. - (3) Standardization— - (A) [was (4)(4)(2)] In general— The Secretary shall ensure that data collected under the initiative is standardized. - (B) [was (4)(4)(3)] 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) 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. - (C) Manner of standardization— Data collected under the initiative shall be standardized in the manner in which it is collected, entered into the database, extracted, and recorded. - (6) [was (4)(5)] 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. - (d) Inclusion of initiative in program— The Secretary shall assess the feasibility and advisability of coordinating 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: - “119. Contracting for preventative or complex statistical analysisanalyses and data evaluation - “In order to carry out statistical analysis required under section 302 of the Commander John Scott Hannon Veterans Mental Health Care Improvement Act of 2019, or any other preventative or complex statistical analysis required under this title or any other provision of law, the “(a) In general—The Secretary may enter into a contract or other agreement with an academic institutions institution or other qualified entities, entity, as determined by the Secretary, to carry out the statistical analysis.”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 is amended by inserting after adding at the item relating to section 118 end the following new item: ## Sec. 401 Study on effectiveness of suicide prevention and mental health outreach programs 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 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; andareas; - (G) individuals transitioning from active duty in the Armed Forces to civilian life.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: - (A) Based on the findings of the focus groups, an assessment of the effectiveness of current suicide prevention and mental health outreach efforts materials and campaigns of the Department in reaching veterans as a whole as well as specific groups of veterans (for example, women veterans). - (B) Based on the findings of the focus groups, recommendations for future suicide prevention and mental health outreach efforts by materials and campaigns of the Department to target specific groups of veterans. - (C) A plan to change the current approach by the Department to suicide prevention and mental health outreach materials and campaigns of the Department or, if the Secretary decides not to change the current approach, materials and campaigns, an explanation of the reason for maintaining the current approach.materials and campaigns. - (D) A description of any dissenting or opposing viewpoints raised by participants in the focus group. - (E) [was (4)(3)(6)] Such other issues as the Secretary considers necessary. - (d) Representative survey— - (1) 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 outreach 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) 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) Treatment of contracts for suicide prevention and mental health outreach media— - (1) Focus groups— - (A) In general— The Secretary shall include in each contract to develop media relating to suicide prevention and mental health outreach 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; - (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; andareas; - (vii) individuals transitioning from active duty in the Armed Forces to civilian life.life; and - (viii) other high-risk groups of veterans, as determined by the Secretary. - (2) Subcontracting— - (A) 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) [was (7)] 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 Oversight of mental health and suicide prevention media outreach conducted by Department of Veterans Affairs - (a) Establishment of goals— - (1) 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 in raising awareness about mental health Affairs, which shall include the establishment of targets, metrics, and suicide prevention.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 as follows:types. - (B) 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) Metrics relating to social media shall include the following: - (I) [was (2)(3)(2)(3)(2)] Impressions. - (II) [was (2)(3)(2)(3)(3)] Reach. - (III) [was (2)(3)(2)(3)(4)] Engagement rate. - (IV) [was (2)(3)(2)(3)(5)] Such other metrics as the Secretary considers necessary. - (ii) Metrics relating to television, which may include the following: - (ii) Metrics relating to television shall include the following: - (I) [was (2)(3)(2)(4)(2)] Nielsen ratings. - (II) [was (2)(3)(2)(4)(3)] Such other metrics as the Secretary considers necessary. - (iii) Metrics relating to email, which may include the following: - (iii) Metrics relating to email shall include the following: - (I) [was (2)(3)(2)(5)(2)] Open rate. - (II) Response rate. - (II) Response rate - (III) [was (2)(3)(2)(5)(4)] Click rate. - (IV) [was (2)(3)(2)(5)(5)] 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. - (B) Update— The Secretary shall periodically update the metrics under subparagraph (A) as more accurate metrics become available. - (3) Targets— The Secretary shall develop 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) 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 in raising awareness about mental health and suicide prevention, Department, including the metrics and targets for such metrics by which those goals are to be measured under paragraph (2).paragraphs (2) and (3). - (6) Annual report— Not later than one year after the submittal of the report under paragraph (3), (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 developed 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) Establishment of oversight process— - (1) In general— Not later than 90 days after the date of the enactment of this Act, the Secretary shall establish a process to oversee the mental health and suicide prevention media outreach campaigns of the Department. - (2) Components of oversight process— The process established under paragraph (1) shall include the following components: - (A) A delineation of the roles and responsibilities of all suicide prevention officials within the Office of Mental Health and Suicide Prevention of the Veterans Health Administration. - (B) A schedule for creating, approving, implementing, and evaluating all unpaid media and paid media content relating to mental health and suicide prevention. - (C) Lines of reporting, as the Secretary considers necessary, to report to management information relating to the mental health and suicide prevention media outreach campaigns of the Department. - (c) Contract requirements— The Secretary shall ensure that each contract into which the Secretary enters to develop mental health and suicide prevention outreach media includes requirements that the contractor— - (1) track metrics used by the Secretary under subsection (a)(2); and - (2) not less frequently than quarterly, report such metrics to the Office of Mental Health and Suicide Prevention of the Veterans Health Administration. - (b) [was (5)] 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. ## Sec. 403 Comptroller General management review of mental health and suicide prevention services of Department of Veterans Affairs - (a) In general— Not later than 120 days three years after the date of the enactment of this Act, and annually thereafter, the Secretary of Veterans Affairs, in consultation with the Secretary Comptroller General of Defense and the Secretary of Homeland Security, 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 that contains management review of the following:mental health and suicide prevention services provided by the Department of Veterans Affairs. - (1) An assessment of the progress of the Department of Veterans Affairs, the Department of Defense, and the Department of Homeland Security in meeting the goals and objectives outlined in the report required under section 2(c) of Executive Order 13822 (83 Fed. Reg. 1513; relating to supporting our veterans during their transition from uniformed service to civilian life) with respect to the implementation by the Department of Veterans Affairs of the Joint Action Plan required under section 2(b) of such Executive order. - (2) A description of action to be taken by the Department of Veterans Affairs, the Department of Defense, and the Department of Homeland Security if those goals and objectives are not being met. - (3) An assessment of the effectiveness of Executive Order 13822 at improving the transition process for members of the Armed Forces and veterans. - (4) Such other topics as the Secretary of Veterans Affairs, the Secretary of Defense, or the Secretary of Homeland Security consider necessary. - (b) Submittal by Secretary of Veterans Affairs—Elements— The Secretary of Veterans Affairs shall submit each report management review required under paragraph (1) with respect to the Department of Veterans Affairs regardless of whether the Secretary of Defense or the Secretary of Homeland Security provides any information for by subsection (a) shall include the report.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) 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. ## 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) 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) Such recommendations on how the Department can better integrate mental health care into primary care clinics as the Comptroller General considers appropriate. - (a) 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) 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, dissaggregated 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) 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. - (G) [was (3)(14)] 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) 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 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) 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) Initial Report—Report on mental health programs— - (1) In general— Not later than two years one year after the date of the enactment of this Act, and annually thereafter, the Comptroller General Secretary of Veterans Affairs and the United States 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 the efforts mental health programs of the Department of Veterans Affairs to integrate mental health care into primary care clinics and the Department of Defense and joint programs of the Department.Departments. - (2) 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) 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) [was (3)(3)] 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 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) 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) 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) 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 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) Elements— An assessment The alternatives of analysis required under subparagraph (A) with respect to the efforts establishment of the joint Department to integrate community-based mental health care into the of Veterans Health Administration.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. - (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 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) 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—Report to Congress— In this subsection, the term community-based mental health care means mental health care paid for by Not later than 270 days after the Department but provided by a non-Department health care provider at a non-Department facility, including care furnished under section 1703 date of title 38, United States Code (as in effect on the date specified in section 101(b) enactment of this Act, the Caring for Our Secretary of Veterans Act Affairs shall submit to the Committee on Veterans’ Affairs of 2018 (title I the Senate and the Committee on Veterans’ Affairs of Public Law 115–182)).the House of Representatives a report that includes— - (A) 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. ## Sec. 406 Joint mental health programs by Department of Veterans Affairs and Department of Defense — removed - (a) Report on mental health programs— - (1) In general— Not later than 180 days 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 Armed Services and the Committee on Veterans’ Affairs of the Senate and the Committee on Armed Services and the Committee on Veterans’ Affairs 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 mental health initiatives, including— - (I) the Million Veterans Program; and - (II) 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. - (B) A description of mental health programs operated by the Department of Defense, including the following: - (i) Transition assistance programs. - (ii) Clinical mental health initiatives, including the National Intrepid Center of Excellence. - (iii) Programs that may secondarily improve mental health, including employment, housing assistance, and financial literacy programs. - (iv) Research into mental health issues and conditions. - (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 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. - (D) 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) 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) Establishment of joint center of excellence— - (1) In general— Not later than two years after the date of the enactment of this Act, the Secretary of Defense, in consultation with the Secretary of Veterans Affairs, shall establish a center of excellence to be known as the “Joint DOD/VA National Intrepid Center of Excellence Intrepid Spirit Center” (in this subsection referred to as the “Center”). - (2) Duties— The Center shall conduct joint mental health programs of the Department of Veterans Affairs and the Department of Defense. - (3) Location— The Center shall be established in a location that— - (A) is geographically distant from already existing and planned Intrepid Spirit Centers of the Department of Defense; and - (B) is in a rural or highly rural area (as determined through the use of the Rural-Urban Commuting Areas coding system of the Department of Agriculture). ## Sec. 501 Staffing improvement plan for mental health providers of Department of Veterans Affairs - (a) Staffing plan— - (1) 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 of mental health providers of the Department of Veterans Affairs, including filling any open positions. - (a) Treatment as title 38 employees— Section 7401 of title 38, United States Code, is amended— - (2) Elements— in The plan required by paragraph (1) by inserting “psychologists,” after “chiropractors,”; andshall include the following: - (A) 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) Such recommendations for legislative or administrative action as the Secretary considers necessary to aid in addressing mental health staffing for the Department. - (3) Report— in Not later than one year after the submittal of the plan required by paragraph (3), (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 striking “psychologists,”.the Department during the one-year period preceding the submittal of the report. - (b) Inclusion in contracts Occupational series for scarce medical specialist services—certain mental health providers— Section 7409(a) of title 38, United States Code, is amended by inserting “psychologists,” Not later than one year after “chiropractors,”.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) Staffing plan—In general— Not later than 270 days 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 shortages of psychiatrists and psychologists Chapter 76 of title 38, United States Code, is amended by inserting after subchapter VIII the Department of Veterans Affairs, including filling any open positions.following new subchapter: - “IX Readjustment Counseling Service Scholarship Program - “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”). - “7699. 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 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) 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. - “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) 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. - “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 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) 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) 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 = 3Φ(t−s/t). - “(2) In the formula in paragraph (1): - “(A) “A” is the amount the United States is entitled to recover. - “(B) “Φ” 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 is amended— - (i) in paragraph (5), by striking “and”; - (ii) in paragraph (6), by striking the period and inserting “; and”; and - (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) 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”. - (b) Elements— The plan required by subsection (a) shall include the following: - (2) Table of sections— The number table of positions for psychiatrists and psychologists sections at the beginning of chapter 76 of such title is amended by inserting after the Department that need to be filled items relating to meet demand, disaggregated by Veterans Integrated Service Network and medical center.subchapter VIII the following: - (c) 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. - (2) An identification of the steps that the Secretary will take in each Veterans Integrated Service Network to address such shortages, include the following: - (A) 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. - (B) A description of any local retention or engagement incentives to be used by directors of Veterans Integrated Service Networks. - (3) Such recommendations for legislative or administrative action as the Secretary considers necessary to aid in addressing staffing shortages of psychiatrists and psychologists of the Department. ## Sec. 503 Comptroller General report on Readjustment Counseling Service of Department of Veterans Affairs - (a) Occupational series—In general— Not later than one year after the date of the enactment of this Act, the Secretary Comptroller General of Veterans Affairs, in consultation with the Office of Personnel Management, United States shall develop an occupational series for licensed professional mental health counselors and marriage submit to the Committee on Veterans’ Affairs of the Senate and family therapists the Committee on Veterans’ Affairs of the House of Representatives a report on the Readjustment Counseling Service of the Department of Veterans Affairs. - (b) Elements— The report required by subsection (a) shall include the following: - (b) Staffing plan— - (1) In general— Not later than 270 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 plan to address staffing shortages of licensed professional mental health counselors and marriage and family therapists of the Department of Veterans Affairs. - (1) Elements— The plan required by paragraph (1) shall include An assessment of the following: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. - (A) The number of positions for licensed professional mental health counselors and marriage and family therapists of the Department that need to be filled to meet demand, disaggregated by Veterans Integrated Service Network and medical center. - (B) An identification of the steps that the Secretary will take in each Veterans Integrated Service Network to address such shortages, include the following: - (i) 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. - (ii) A description of any local retention or engagement incentives to be used by directors of Veterans Integrated Service Networks. - (C) Such recommendations for legislative or administrative action as the Secretary, in consultation with the Inspector General of the Department of Veterans Affairs, considers necessary to aid in addressing staffing shortages of licensed professional mental health counselors and marriage and family therapists of the Department. - (c) Report—Vet center defined— Not later than one year after the submittal of the plan required by 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 setting forth the number of licensed professional mental health counselors and marriage and family therapists hired by the Department during In this section, the one-year period preceding term Vet Center has the submittal meaning given that term in section 1712A(h) of the report, disaggregated by Veterans Integrated Service Network and medical center.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, 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”. - (a) Assessment of capacity— - (1) In general— Not later than 90 days 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 commence an assessment of the capacity of peer specialists of the Department of Veterans Affairs who are women. - (2) Elements— The assessment required by paragraph (1) shall include an assessment of the following: - (A) The geographical distribution of peer specialists of the Department who are women. - (B) The geographical distribution of women veterans. - (C) The number and proportion of women peer specialists who specialize in peer counseling on mental health or suicide prevention. - (D) The number and proportion of women peer specialists who specialize in peer counseling on non-mental health related matters. - (b) Report—Biennial report— Not later than one year after the assessment required Such section is amended by subsection (a) has commenced, 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 adding at the findings of end the assessment.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; - “(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.” - (c) Staffing improvement plan— - (1) In general— Not later than 180 days after submitting the report under subsection (b), the Secretary, in consultation with the Inspector General, shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a plan, based on the results of the assessment required by subsection (a), to hire additional qualified peer specialists who are women, with special consideration for areas that lack peer specialists who are women. - (2) Elements— The peer specialist positions included in the plan required by paragraph (1)— - (A) shall be non-volunteer, paid positions; and - (B) may be part-time positions. ## Sec. 505 Briefing on alternative work schedules for employees of Veterans Health Administration - (a) Survey of veterans— - (1) 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) 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). - (a) In general— Chapter 76 of title 38, United States Code, is amended by inserting after subchapter VIII the following new subchapter: - “IX Readjustment Counseling Service Scholarship Program - “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”). - “7699. 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 accredited educational institution, school, or training program leading to— - “(A) a bachelor's, master's, or doctoral degree in psychology, social work, or marriage and family therapy; or - “(B) a master's degree in mental health counseling; 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) An agreement by the participant to serve as a full-time employee of the Department at a Vet Center for a three-year period during the 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. - “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(c) 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) 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. - “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 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) 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) 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 = 3Φ(t−s/t). - “(2) In the formula in paragraph (1): - “(A) “A” is the amount the United States is entitled to recover. - “(B) “Φ” 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—Congressional briefing— - (1) 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— - (1) Conforming amendments— - (A) Establishment of program— Section 7601(a) of such title is amended— - (i) in paragraph (5), by striking “and”; - (ii) in paragraph (6), by striking the period and inserting “; and”; and - (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.” - (A) Eligibility— Section 7602 feasibility and advisability of offering appointments outside the usual operating hours of facilities of the Department that do not offer such title is amended—appointments; and - (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”. - (B) Application— Section 7603(a)(1) effectiveness of offering appointments outside the usual operating hours of facilities of the Department for those facilities that offer such title is amended by striking “or VIII” and inserting “VIII, or IX”.appointments. - (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—Elements— The table of sections at the beginning of chapter 76 of such title is amended briefing required by inserting after the items relating to subchapter VIII 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) Effective date—Paperwork Reduction Act exemption— The Secretary of Veterans Affairs shall begin awarding scholarships under subchapter IX of chapter 76 Chapter 35 of title 38, 44, United States Code, Code (commonly known as added by subsection (a), for programs of study beginning not later than one year after the date of the enactment of “Paperwork Reduction Act”) shall not apply to any rulemaking or information collection required under this Act.section. ## Sec. 506 Suicide prevention coordinators - (a) In general—Staffing requirement— Not Beginning 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 Secretary of the Senate and the Committee on Veterans’ Veterans Affairs of the House of Representatives a report on the Readjustment Counseling Service shall ensure that each medical center of the Department of Veterans Affairs.Affairs has not less than one suicide prevention coordinator. - (b) Study on reorganization— - (1) 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. - (b) Elements— The report required by subsection (a) shall include the following: - (2) Program office realignment— An assessment of In conducting the adequacy and types study under paragraph (1), the Secretary shall assess the feasibility of treatment, counseling, advisability of, within the suicide prevention coordinator program office described in paragraph (1)(B), aligning suicide prevention coordinators and other services provided at Vet Centers, including recommendations on whether suicide prevention case managers within the organizational structure and how such treatment, counseling, chart of the Suicide Prevention Program of the Department, with the Director of the Suicide Prevention program having ultimate supervisory oversight and other services can be expanded.responsibility over the suicide prevention coordinator program office. - (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. - (c) Vet Center defined—Report— In this section, Not later than 90 days after the term Vet Center has completion of the meaning given that term in section 1712A(h) study under subsection (b), the Secretary shall submit to the Committee on Veterans’ Affairs of title 38, United States Code.the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on such study, including the following: - (1) 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) 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) Expansion of annual report—Findings— Paragraph (2)(C) of section 7309(e) of title 38, United States Code, is amended by inserting before the period at the end the following: “, including Congress makes the resources required to meet such unmet need, such as additional staff, additional locations, additional infrastructure, infrastructure improvements, and additional mobile Vet Centers”.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 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) 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) 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) 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: - (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) 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) 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) An analysis of current statutory authority and any changes necessary to fully implement the SPED program throughout the Veterans Health Administration. - (iv) 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. - (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. - (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 trends in demand for care, long-term investments required with respect to the provision of care, maintenance of infrastructure, and other capital investments with respect to the Readjustment Counseling Service, including Vet Centers, Mobile Vet Centers, and community access points.” ## Sec. 508 Studies on alternative work schedules for employees of Veterans Health Administration — removed - (a) Study of veterans— - (1) In general— Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall conduct a study 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) received health care from the Department at least once during the two-year period ending on the date of the commencement of the study under paragraph (1). - (b) Department study— - (1) In general— Not later than 180 days after the date of the enactment of this Act, the Secretary shall conduct a study on the feasibility and advisability of offering appointments outside the usual operating hours of facilities of the Department. - (2) Study of employees— The study required by paragraph (1) shall include a study of the opinions of 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. ## Sec. 509 Suicide prevention coordinators — removed - The Secretary of Veterans Affairs shall ensure that each medical center of the Department of Veterans Affairs is staffed with not fewer than one suicide prevention coordinator. ## Sec. 521 Direct hiring authorities for certain health care positions — removed - (a) In general— Subpart I of part III of title 5, United States Code, is amended by adding at the end the following: - “103 Department of Veterans Affairs hiring authorities - “10301. Department of Veterans Affairs personnel authorities - “(a) Flexibilities relating to appointments - “(1) In general—The Secretary of Veterans Affairs (referred to in this section as the “Secretary”) shall promulgate regulations to redesign the procedures that are applied by the Department of Veterans Affairs in making appointments to positions described in paragraphs (1) and (3) of section 7401 of title 38 in order to— - “(A) better meet mission needs; - “(B) respond to managers’ needs and the needs of applicants; - “(C) produce high-quality applicants; - “(D) support timely decisions; and - “(E) promote competitive job offers. - “(2) Waived requirements—In redesigning the process by which the appointments described in paragraph (1) shall be made, the Secretary may waive the requirements of chapter 33, and the regulations implementing that chapter, to the extent necessary to achieve the objectives of this section, while providing for the following: - “(A) Fair, credible, and transparent methods of establishing qualification requirements for, recruitment for, and appointments to positions. - “(B) Fair and open competition and equitable treatment in the consideration and selection of individuals to positions. - “(C) Fair, credible, and transparent methods of assigning, reassigning, detailing, transferring, or promoting employees. - “(3) Implementation requirements—In implementing this subsection, the Secretary shall comply with the provisions of section 2302(b)(11), regarding veterans’ preference requirements, in a manner consistent with that in which such provisions are applied under chapter 33. - “(4) Training program—The Secretary shall develop a training program for Department of Veterans Affairs human resource professionals to implement the requirements of this subsection. - “(5) Indicators of effectiveness—The Secretary shall develop indicators of effectiveness to determine whether appointment flexibilities under this subsection have achieved the objectives described in paragraph (1). - “(b) Criteria for use of new personnel authorities—In the redesign of appointment procedures, as described in subsection (a), and with respect to the system of appointment flexibilities established under that subsection, the Secretary shall— - “(1) include a means for ensuring employee involvement (for bargaining unit employees, through their exclusive representatives) in that redesign and in the implementation of that system; - “(2) provide for adequate training and retraining for supervisors, managers, and employees in the implementation and operation of that redesign and that system; - “(3) develop— - “(A) a comprehensive management succession program to provide training to employees to develop managers for the agency; and - “(B) a program to provide training to supervisors on actions, options, and strategies that a supervisor may use in administering that system; - “(4) include effective transparency and accountability measures and safeguards to ensure that the management of that system is fair, credible, and equitable, including appropriate independent reasonableness reviews, internal assessments, and employee surveys; - “(5) provide mentors to advise individuals on their career paths and opportunities to advance and excel within their fields; - “(6) develop appropriate procedures for warnings during performance evaluations for employees who fail to meet performance standards; - “(7) utilize the quadrennial strategic plan required under section 7330C(b) of title 38; and - “(8) ensure that adequate agency resources are allocated for the design, implementation, and administration of that system.” - (b) Technical and conforming amendment— The table of chapters for part III of title 5, United States Code, is amended by inserting after the item relating to chapter 102 the following: ## Sec. 601 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. - (a) In general— The Secretary of Veterans Affairs shall enter into partnerships, and expand existing partnerships, between the Department of Veterans Affairs, 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 (c). - (b) Preference for partnerships— The Secretary shall give preference to entering into or expanding partnerships under subsection (a) with organizations that— - (1) represent 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); or - (2) operate in a medically underserved community (as defined in section 799B of the Public Health Service Act (42 U.S.C. 295p)). - (c) Award of grants— - (1) In general— In carrying out partnerships entered into or expanded under this section with entities described in subsection (a), the Secretary shall award grants to those entities. - (2) Maximum amount of grants— The amount of a grant awarded under this subsection may not exceed $75,000 per site per year. - (3) Use of grants— - (A) In general— Grants awarded to an entity under this subsection shall be used for the following: - (i) Purchasing or upgrading hardware or software necessary for the provision of secure and private telehealth services. - (ii) Upgrading security protocols for consistency with the standardized telehealth security protocol implemented under section 602(a)(2), or any other security requirements of the Department. - (iii) Training of employees, including payment of those employees for completing that training, with respect to— - (I) military and veteran cultural competence, if the entity is not an organization that represents veterans; and - (II) equipment required to provide telehealth services. - (iv) Upgrading existing infrastructure owned or leased by the entity to make rooms more conducive to telehealth care, including— - (I) additional walls to create a new, private room; - (II) soundproofing of existing rooms; or - (III) new electrical or internet outlets in an existing room. - (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. - (B) Exclusion— Grants may not be used for the purchase of new property or for major construction projects, as determined by the Secretary. - (d) Memoranda of understanding or 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 a memorandum of understanding or memorandum of agreement with the Department for the establishment of such an access point. - (2) Inspection— The Secretary shall inspect the access point proposed to be established under paragraph (1) to ensure that it is adequately private, secure, and accessible for veterans before the access point is established. - (e) Assessment of barriers to access— - (1) 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 from home. - (2) Elements— The assessment required by paragraph (1) shall include the following: - (A) An assessment of current and potential future cost barriers to veterans having internet access at home. - (B) An assessment of current and potential future barriers to veterans accessing broadband services at home. - (C) A description of how the Department plans to address the current and potential future cost and access barriers described in subparagraphs (A) and (B). - (D) Such other matters related to internet access for veterans in their homes as the Secretary considers relevant. - (3) 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. - (f) Authorization of appropriations— There is authorized to be appropriated to the Secretary of Veterans Affairs $10,000,000 to carry out this section. ## Sec. 602 Requirement for Department of Veterans Affairs internet website to provide information on services available to women veterans - (a) 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— - (a) National telehealth security protocol— - (1) Assessment— - (A) In general— The Secretary of Veterans Affairs, in consultation with industry experts, the Chairman of the Federal Trade Commission, the Assistant Secretary of Veterans Affairs for Information and Technology and Chief Information Officer, and stakeholders, shall conduct an assessment of current telehealth security protocols. - (B) Elements— The assessment conducted under subparagraph (A) shall include the following: - (i) An assessment of current telehealth security protocols, including protocols used by— - (I) the Department of Veterans Affairs; - (II) other Federal agencies; - (III) other health care providers; and - (IV) such other organizations as the Secretary considers necessary to assess under such subparagraph. - (ii) A study of any current or future security risks— - (I) faced by veterans using telehealth services; or - (II) faced by the Department in furnishing those services. - (C) Timeline— The Secretary shall complete the assessment conducted under subparagraph (A) not later than one year after the date of the enactment of this Act. - (2) Implementation— Not later than 18 months after the completion of the assessment under paragraph (1), the Secretary shall, using guidance from the assessment, fully implement a standardized telehealth security protocol at all facilities of the Department. - (3) Privacy and security— The Secretary shall ensure that the security protocol implemented under this subsection protects the privacy and security of veterans, the health data of veterans, and data from the Department. - (b) National telehealth interfacing instructions— - (1) Assessment— - (A) In general— The Secretary of Veterans Affairs, in consultation with industry experts, organizations that represent veterans, the Chief Veterans Experience Officer, the Assistant Secretary of Veterans Affairs for Information and Technology and Chief Information Officer, and stakeholders, shall conduct an assessment of current telehealth interfacing instructions. - (B) Elements— The assessment conducted under subparagraph (A) shall include an assessment of interfacing instructions used by— - (i) the Department of Veterans Affairs; - (ii) other Federal agencies; - (iii) other health care providers; and - (iv) such other organizations as the Secretary considers necessary to assess under such subparagraph. - (C) Timeline— The Secretary shall complete the assessment conducted under subparagraph (A) not later than one year after the date of the enactment of this Act. - (1) Implementation— Not later than 18 months after the completion of the assessment under paragraph (1), the Secretary shall, using guidance from the assessment, fully implement standardized telehealth interfacing instructions at all facilities name and contact information of the Department.each women's health coordinator; - (2) Navigation— The Secretary shall ensure that the telehealth interfacing instructions implemented under this subsection are those that are easiest to navigate a list of appropriate staff for veterans other benefits available from the Veterans Benefits Administration, the National Cemetery Administration, and health care providers.such other entities as the Secretary considers appropriate; and - (3) such other information as the Secretary considers appropriate. - (c) 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. ## Sec. 701 Expanded telehealth from Department of Veterans Affairs — added - (a) 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; - (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) Exclusion— Grants may not be used for the purchase of new property or for major construction projects, as determined by the Secretary. - (c) 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) 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). - (C) Such other matters related to access by veterans to telehealth while not on property of the Department as the Secretary considers relevant. - (3) 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 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 — added - (a) Partnerships to provide hyperbaric oxygen therapy to veterans— - (1) 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) 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) 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 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) 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) 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) 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) 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) 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. ## Sec. 703 Prescription of technical qualifications for licensed hearing aid specialists and requirement for appointment of such specialists — added - (a) Technical qualifications— - (1) 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) 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) 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 Use by Department of Veterans Affairs of commercial institutional review boards in sponsored research trials — added - (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”, 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 Creation of Office of Research Reviews within the Office of Information and Technology of the Department of Veterans Affairs — added - (a) 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) 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. - (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).