US Codex
Pub. L.
Notes

Title V — Improvement of Mental Health Medical Workforce

116th Congress · Approved Oct 17, 2020 · 134 Stat. 778 · Lineage

TITLE V Improvement of Mental Health Medical Workforce

SEC. 501. Staffing Improvement Plan for Mental Health Providers of Department of Veterans Affairs.

(a)
Staffing Plan.—
(1)
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.
(2)
Elements.— The plan required by paragraph (1) shall 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.— Not later than one year after the submittal of the plan required by paragraph (1), the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report setting forth the number of mental health providers hired by the Department during the one-year period preceding the submittal of the report.
(b)
Occupational Series for Certain Mental Health Providers.— Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs, in consultation with the Office of Personnel Management, shall develop an occupational series for licensed professional mental health counselors and marriage and family therapists of the Department of Veterans Affairs.

SEC. 502. Establishment of Department of Veterans Affairs Readjustment Counseling Service Scholarship Program.

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

“SUBCHAPTER IX— READJUSTMENT COUNSELING SERVICE SCHOLARSHIP PROGRAM

Ҥ 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’).

Ҥ 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.

Ҥ 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.

Ҥ 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”.
(2)
Table of sections.— The table of sections at the beginning of chapter 76 of such title is amended by inserting after the items relating to subchapter VIII the following:

“subchapter ix— readjustment counseling service scholarship program

“Sec.

“7698. Requirement for program.

“7699. Eligibility; agreement.

“7699A. Obligated service.

“7699B. Breach of agreement: liability.”.

(c)
Effective Date.— The Secretary of Veterans Affairs shall begin awarding scholarships under subchapter IX of chapter 76 of title 38, United States Code, as added by subsection (a), for programs of study beginning not later than one year after the date of the enactment of this Act.

SEC. 503. Comptroller General Report on Readjustment Counseling Service of Department of Veterans Affairs.

(a)
In General.— Not later than one year after the date of the enactment of this Act, the Comptroller General of the United States shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on the Readjustment Counseling Service of the Department of Veterans Affairs.
(b)
Elements.— The report required by subsection (a) shall include the following:
(1)
An assessment of the adequacy and types of treatment, counseling, and other services provided at Vet Centers, including recommendations on whether and how such treatment, counseling, and other services can be expanded.
(2)
An assessment of the efficacy of outreach efforts by the Readjustment Counseling Service, including recommendations for how outreach efforts can be improved.
(3)
An assessment of barriers to care at Vet Centers, including recommendations for overcoming those barriers.
(4)
An assessment of the efficacy and frequency of the use of telehealth by counselors of the Readjustment Counseling Service to provide mental health services, including recommendations for how the use of telehealth can be improved.
(5)
An assessment of the feasibility and advisability of expanding eligibility for services from the Readjustment Counseling Service, including—
(A)
recommendations on what eligibility criteria could be expanded; and
(B)
an assessment of potential costs and increased infrastructure requirements if eligibility is expanded.
(6)
An assessment of the use of Vet Centers by members of the reserve components of the Armed Forces who were never activated and recommendations on how to better reach those members.
(7)
An assessment of the use of Vet Centers by eligible family members of former members of the Armed Forces and recommendations on how to better reach those family members.
(8)
An assessment of the efficacy of group therapy and the level of training of providers at Vet Centers in administering group therapy.
(9)
An assessment of the efficiency and effectiveness of the task organization structure of Vet Centers.
(10)
An assessment of the use of Vet Centers by Native American veterans, as defined in section 3765 of title 38, United States Code, and recommendations on how to better reach those veterans.
(c)
Vet Center Defined.— In this section, the term “Vet Center” has the meaning given that term in section 1712A(h) of title 38, United States Code.

SEC. 504. Expansion of Reporting Requirements on Readjustment Counseling Service of Department of Veterans Affairs.

(a)
Expansion of Annual Report.— Paragraph (2)(C) of section 7309(e) of title 38, United States Code, is amended by inserting before the period at the end the following: “ , including the resources required to meet such unmet need, such as additional staff, additional locations, additional infrastructure, infrastructure improvements, and additional mobile Vet Centers”.
(b)
Biennial Report.— Such section is amended by adding at the end the following new paragraph:

“(3) For each even numbered year in which the report required by paragraph (1) is submitted, the Secretary shall include in such report a prediction of—

“(A) trends in demand for care;

“(B) long-term investments required with respect to the provision of care;

“(C) requirements relating to maintenance of infrastructure; and

“(D) other capital investment requirements with respect to the Readjustment Counseling Service, including Vet Centers, mobile Vet Centers, and community access points.”

SEC. 505. Briefing on Alternative Work Schedules for Employees of Veterans Health Administration.

(a)
Survey of Veterans.—
(1)
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).
(b)
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—
(A)
feasibility and advisability of offering appointments outside the usual operating hours of facilities of the Department that do not offer such appointments; and
(B)
effectiveness of offering appointments outside the usual operating hours of facilities of the Department for those facilities that offer such appointments.
(2)
Elements.— The briefing required by paragraph (1) shall include the following:
(A)
The findings of the survey conducted under subsection (a);
(B)
Feedback from employees of the Veterans Health Administration, including clinical, nonclinical, and support staff, with respect to offering appointments outside the usual operating hours of facilities of the Department, including through the use of telehealth appointments; and
(C)
Any other matters the Secretary considers relevant to a full understanding of the feasibility and advisability of offering appointments outside the usual operating hours of facilities of the Department.
(c)
Paperwork Reduction Act Exemption.— Chapter 35 of title 44, United States Code (commonly known as the “Paperwork Reduction Act”) shall not apply to any rulemaking or information collection required under this section.

SEC. 506. Suicide Prevention Coordinators.

(a)
Staffing Requirement.— Beginning not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall ensure that each medical center of the Department of Veterans 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.
(2)
Program office realignment.— In conducting the study under paragraph (1), the Secretary shall assess the feasibility of advisability of, within the suicide prevention coordinator program office described in paragraph (1)(B), aligning suicide prevention coordinators and suicide prevention case managers within the organizational structure and chart of the Suicide Prevention Program of the Department, with the Director of the Suicide Prevention program having ultimate supervisory oversight and responsibility over the suicide prevention coordinator program office.
(c)
Report.— Not later than 90 days after the completion of the study under subsection (b), the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on such study, including the following:
(1)
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)
Findings.— Congress makes the following findings:
(1)
The Department of Veterans Affairs must be more effective in its approach to reducing the burden of veteran suicide connected to mental health diagnoses, to include expansion of treatment delivered via telehealth methods and in rural areas.
(2)
An innovative project, known as Suicide Assessment and Follow-up Engagement: Veteran Emergency Treatment (in this subsection referred to as “SAFE VET”), was designed to help suicidal veterans seen at emergency departments within 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.