,i  #aacth ,,congress  #ast ,session    
,h4 ,r4 #ceaf  ,,in ,,the ,,house ,,of  
,,representatives  ,november #ae1 #bjac 
,mr4 ,ryan of ,ohio 7for himself1 ,mr4  
,nugent1 and ,mr4 ,ruiz7 introduced the 
following bill2 which was referred to   
the ,committee on ,veterans' ,affairs1  
and in addition to the ,committee on    
,armed ,services1 for a period to be    
subsequently determined by the ,speaker1
 in each case for consideration of such 
provisions as fall within the           
jurisdiction of the committee concerned 
,a ,,bill  ,to improve health care      
furnished by the ,department of         
,veterans ,affairs and the ,department  
of ,defense by increasing access to     
complementary and alternative medicine  
and other approaches to wellness and    
preventive care1 and for other purposes4
  #a4 ,short title ,this ,act may be    
cited as the ,veterans and ,armed       
,forces ,health ,promotion ,act of      
#bjac4  #b4 ,department of ,veterans    
,affairs and ,department of ,defense    

expansion of research and education into
 integration of complementary and       
alternative medicine interventions  7a7 
,development and implementation of      
expansion plan ,not later than #bgj days
 after the date of the enactment of this
 ,act1 the ,secretary of ,veterans      
,affairs and the ,secretary of ,defense 
shall jointly develop and implement a   
plan to expand materially and           
substantially the scope of research and 
education on1 and delivery of holistic  
care that includes1 the integration of  
appropriate complementary and           
alternative medicine interventions in   
the delivery of health care to veterans 
under chapter #ag of title #ch1 ,united 
,states ,code1 and members of the ,armed
 ,forces at military medical treatment  
facilities under title #aj1 ,united     
,states ,code4 ,such plan shall provide 
for--  7#a7 the conduct of research on--
  7,a7 integrating proven or promising  
complementary and alternative medicine  
interventions into the delivery of      

health care to veterans and members of  
the ,armed ,forces2 and  7,b7 models and
 systems for providing holistic care    
that includes complementary and         
alternative medicine interventions2     
7#b7 education and training for health  
care professionals on--  7,a7 proven and
 promising complementary and alternative
 medicine interventions2  7,b7          
appropriate uses of such interventions  
therapeutic options2 and  7,c7 holistic 
integration of such interventions into  
the delivery of health care to veterans2
  7#c7 carrying out the research1       
education1 and clinical activities      
described in paragraphs 7#a7 and 7#b7 at
 centers of innovation at geographically
 dispersed medical centers operated     
jointly by the ,secretary of ,veterans  
,affairs and the ,secretary of ,defense2
 and  7#d7 the development of joint     
metrics and outcome measures to evaluate
 the provision 7and cost effectiveness7 
of complementary and alternative        
medicine interventions in the care of   

patients of both the ,department of     
,veterans ,affairs and the ,department  
of ,defense4  7b7 ,consultation with    
experts  7#a7 ,consultation required    
,for the purposes described in paragraph
 7#b71 the ,secretary of ,veterans      
,affairs and the ,secretary of ,defense 
shall consult with the following3  7,a7 
,the ,director of the ,center on        
,complementary and ,alternative         
,medicine at the ,national ,institute of
 ,health4  7,b7 ,the ,director of the   
,food and ,drug ,administration4  7,c7  
,academic centers1 private research     
institutes1 and individual researchers  
that have extensive experience in       
studying complementary and alternative  
medicine and the integration of such    
interventions in the delivery of        
conventional medical care4  7,d7        
,nationally recognized providers of     
complementary and alternative medicine4 
7,e7 ,such other sources of expertise as
 the ,secretary deems appropriate4  7#b7
 ,purpose of consultation ,the          

,secretary of ,veterans ,affairs and the
 ,secretary of ,defense shall undertake 
the consultation described in paragraph 
7#a7--  7,a7 in developing the plan     
required under subsection 7a72  7,b7 to 
identify specific proven or promising   
complementary and alternative medicine  
interventions that1 on the basis of     
research findings or promising clinical 
interventions1 are appropriate to       
include as covered services under       
section #c2 and  7,c7 to identify       
barriers to the effective provision and 
integration of complementary and        
alternative medicine interventions 7and 
means of circumventing such barriers74  
7c7 ,funding ,none of the amounts       
authorized to be appropriated to carry  
out this section may be obligated or    
expended except for a joint effort of   
the ,department of ,defense and the     
,department of ,veterans ,affairs4  #c4 
,medical treatment and research         
facilities jointly operated by the      
department of veterans affairs and the  

department of defense  7a7 ,pilot       
program required ,commencing not later  
than #bgj days after the date of the    
enactment of this ,act1 the ,secretary  
of ,veterans ,affairs and the ,secretary
 of ,defense shall jointly develop and  
implement a plan to establish           
jointly-operated medical treatment and  
research facilities4 ,such facilities   
shall--  7#a7 be staffed by employees of
 the ,department of ,veterans ,affairs  
and the ,department of ,defense and     
members of the ,armed ,forces2  7#b7 be 
operated by dividing the operation and  
maintenance expenses between both the   
,department of ,veterans ,affairs and   
the ,department of ,defense by a ratio  
determined in a memorandum of           
understanding between the ,secretaries2 
and  7#c7 bill to each ,department the  
cost of certain specialty medical       
services1 including radiology1          
laboratory1 and surgery1 as such        
services are used4  7b7 ,duration of    
program ,the pilot program shall be     

carried out during the three-year period
 beginning on the date of the           
commencement of the pilot program4  7c7 
,locations  7#a7 ,in general ,the       
,secretaries shall carry out the pilot  
program by establishing not fewer than  
#e joint medical treatment and research 
facilities4  7#b7 ,considerations ,in   
selecting locations for the pilot       
program1 the ,secretaries shall consider
 the feasibility and advisability of    
selecting locations--  7,a7 in areas    
with a high concentration of veterans   
and members of the ,armed ,forces2  7,b7
 that present a reasonable probability  
of cost savings to the taxpayer by      
consolidation of services and facilities
 currently administered separately as   
determined jointly by the ,secretaries2 
and  7,c7 where collaboration of        
research and treatment will be most     
beneficial to the common needs of the   
patients under the care of both         
,departments1 as determined jointly by  
the ,secretaries4  7d7 ,funding ,none of

 the amounts authorized to be           
appropriated to carry out this section  
may be obligated or expended except for 
a joint effort of the ,department of    
,defense and the ,department of         
,veterans ,affairs4  #d4 ,pilot program 
on establishment of complementary and   
alternative medicine centers within     
,department of ,veterans ,affairs       
medical centers  7a7 ,pilot program     
required ,commencing not later than #ahj
 days after the date of the enactment of
 this ,act1 the ,secretary of ,veterans 
,affairs shall carry out1 through the   
,office of ,patient ,centered ,care and 
,cultural ,transformation of the        
,department of ,veterans ,affairs1 a    
pilot program to assess the feasibility 
and advisability of establishing        
complementary and alternative medicine  
centers within ,department of ,veterans 
,affairs medical centers to promote the 
use and integration of complementary and
 alternative medicine services for      
mental health diagnoses and pain        

management4  7b7 ,duration of program   
,the pilot program shall be carried out 
during the three-year period beginning  
on the date of the commencement of the  
pilot program4  7c7 ,locations  7#a7 ,in
 general ,the ,secretary shall carry out
 the pilot program by establishing not  
fewer than #aj complementary and        
alternative medicine centers in #aj     
separate ,department medical centers as 
follows3  7,a7 ,three ,department       
medical centers designated by the       
,secretary as polytrauma centers4  7,b7 
,seven ,department medical centers not  
designated by ,secretary as polytrauma  
centers4  7#b7 ,considerations ,in      
selecting locations for the pilot       
program1 the ,secretary shall consider  
the feasibility and advisability of     
selecting locations in--  7,a7 rural    
areas2  7,b7 areas that are not in close
 proximity to an active duty military   
installation2 and  7,c7 areas           
representing different geographic       
locations1 such as census tracts        

established by the ,bureau of the       
,census4  7d7 ,provision of services    
,under the pilot program1 the ,secretary
 shall provide covered services to      
covered patients through the            
complementary and alternative medicine  
centers established under subsection    
7c77#a74  7e7 ,covered patients ,for    
purposes of the pilot program1 a covered
 patient is any patient who is a veteran
 or member of the ,armed ,forces who    
has--  7#a7 a mental health condition   
diagnosed by a clinician of the         
,department of ,veterans ,affairs1 in   
the case of a patient who is a veteran1 
or a clinician of the ,department of    
,defense1 in the case of a patient who  
is a member of the ,armed ,forces2 or   
7#b7 a pain condition for which the     
veteran has received a pain management  
plan from a clinician of the ,department
 of ,veterans ,affairs1 in the case of a
 patient who is a veteran1 or a         
clinician of the ,department of         
,defense1 in the case of a patient who  

is a member of the ,armed ,forces4  7f7 
,covered services  7#a7 ,in general ,for
 purposes of the pilot program1 covered 
services are services consisting of     
complementary or alternative medicine4  
7#b7 ,administration of services        
,covered services shall be administered 
under the pilot program as follows3     
7,a7 ,covered services shall be         
administered by clinicians who          
exclusively provide services consisting 
of complementary or alternative         
medicine4  7,b7 ,covered services shall 
be included as part of the ,patient     
,aligned ,care ,teams initiative of the 
,office of ,patient ,care ,services1    
,primary ,care ,program ,office4  7,c7  
,covered services shall be made         
available to both--  7i7 covered        
patients with mental health conditions  
or pain conditions described in         
subsection 7e7 who have received        
traditional treatments from the         
,department for such conditions2 and    
7ii7 covered patients with mental health

 conditions or pain conditions described
 in subsection 7e7 who have not received
 traditional treatments from the        
,department for such conditions4  7g7   
,voluntary participation ,the           
participation of a patient in the pilot 
program shall be at the election of the 
patient and in consultation with a      
clinician of the ,department of         
,veterans ,affairs1 in the case of a    
patient who is a veteran1 and in        
consultation with a clinician of the    
,department of ,defense1 in the case of 
a patient who is member of the ,armed   
,forces4  7h7 ,reports to ,congress     
7#a7 ,quarterly reports ,not later than 
#ij days after the date of the          
commencement of the pilot program and   
not less frequently than once every #ij 
days thereafter for the duration of the 
pilot program1 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 efforts of the ,secretary to carry  
out the pilot program1 including a      
description of the outreach conducted by
 the ,secretary to veterans and         
community organizations to inform such  
organizations about the pilot program4  
7#b7 ,final report  7,a7 ,in general    
,not later than #ahj days after the     
completion of the pilot program1 the    
,secretary shall submit to the          
,committee on ,veterans' ,affairs of the
 ,senate and the ,committee on          
,veterans' ,affairs of the ,house of    
,representatives a report on the pilot  
program4  7,b7 ,contents ,the report    
submitted under subparagraph 7,a7 shall 
include the following3  7i7 ,the        
findings and conclusions of the         
,secretary with respect to the pilot    
program1 including with respect to the  
utilization and efficacy of the         
complementary and alternative medicine  
centers established under the pilot     
program4  7ii7 ,such recommendations for
 the continuation or expansion of the   

pilot program as the ,secretary         
considers appropriate4  7i7 ,funding    
,there is authorized to be appropriated 
to the ,secretary such sums as may be   
necessary to carry out this section4    
#e4 ,pilot program on use of wellness   
programs as complementary approach to   
mental health care for veterans and     
family members of veterans  7a7 ,pilot  
program required  7#a7 ,in general ,the 
,secretary of ,veterans ,affairs shall  
carry out a pilot program through the   
award of grants to public or private    
nonprofit entities to assess the        
feasibility and advisability of using   
wellness programs to complement the     
provision of mental health care to      
veterans and family members eligible for
 counseling under section               
#agab;,a7a77#a77;,c7 of title #ch1      
,united ,states ,code4  7#b7 ,matters to
 be addressed ,the pilot program shall  
be carried out so as to assess the      
following3  7,a7 ,means of improving    
coordination between ,federal1 ,state1  

local1 and community providers of health
 care in the provision of mental health 
care to veterans and family members     
described in paragraph 7#a74  7,b7      
,means of enhancing outreach1 and       
coordination of outreach1 by and among  
providers of health care referred to in 
subparagraph 7,a7 on the mental health  
care services available to veterans and 
family members described in paragraph   
7#a74  7,c7 ,means of using wellness    
programs of providers of health care    
referred to in subparagraph 7,a7 as     
complements to the provision by the     
,department of ,veterans ,affairs of    
mental health care to veterans and      
family members described in paragraph   
7#a74  7,d7 ,whether wellness programs  
described in subparagraph 7,c7 are      
effective in enhancing the quality of   
life and well-being of veterans and     
family members described in paragraph   
7#a74  7,e7 ,whether wellness programs  
described in subparagraph 7,c7 are      
effective in increasing the adherence of

 veterans described in paragraph 7#a7 to
 the primary mental health services     
provided such veterans by the           
,department4  7,f7 ,whether wellness    
programs described in subparagraph 7,c7 
have an impact on the sense of wellbeing
 of veterans described in paragraph 7#a7
 who receive primary mental health      
services from the ,department4  7,g7    
,whether wellness programs described in 
subparagraph 7,c7 are effective in      
encouraging veterans receiving health   
care from the ,department to adopt a    
more healthy lifestyle4  7b7 ,duration  
,the ,secretary shall carry out the     
pilot program for a period of three     
years beginning on the date that is #ij 
days after the date of the enactment of 
this ,act4  7c7 ,locations ,the         
,secretary shall carry out the pilot    
program at facilities of the ,department
 providing mental health care services  
to veterans and family members described
 in subsection 7a77#a74  7d7 ,grant     
proposals  7#a7 ,in general ,a public or

 private nonprofit entity seeking the   
award of a grant under this section     
shall submit an application therefor to 
the ,secretary in such form and in such 
manner as the ,secretary may require4   
7#b7 ,application contents ,each        
application submitted under paragraph   
7#a7 shall include the following3  7,a7 
,a plan to coordinate activities under  
the pilot program1 to the extent        
possible1 with the ,federal1 ,state1 and
 local providers of services for        
veterans to enhance the following3  7i7 
,awareness by veterans of benefits and  
health care services provided by the    
,department4  7ii7 ,outreach efforts to 
increase the use by veterans of services
 provided by the ,department4  7iii7    
,educational efforts to inform veterans 
of the benefits of a healthy and active 
lifestyle4  7,b7 ,a statement of        
understanding from the entity submitting
 the application that1 if selected1 such
 entity will be required to report to   
the ,secretary periodically on          

standardized data and other performance 
data necessary to evaluate individual   
outcomes and to facilitate evaluations  
among entities participating in the     
pilot program4  7,c7 ,other requirements
 that the ,secretary may prescribe4  7e7
 ,grant uses  7#a7 ,in general ,a public
 or private nonprofit entity awarded a  
grant under this section shall use the  
award for purposes prescribed by the    
,secretary4  7#b7 ,eligible veterans and
 family ,in carrying out the purposes   
prescribed by the ,secretary in         
paragraph 7#a71 a public or private     
nonprofit entity awarded a grant under  
this section shall use the award to     
furnish services only to individuals    
specified in section                    
#agab;,a7a77#a77;,c7 of title #ch1      
,united ,states ,code4  7f7 ,reports    
7#a7 ,periodic reports  7,a7 ,in general
 ,not later than #ahj days after the    
date of the enactment of this ,act1 and 
every #ahj days thereafter1 the         
,secretary shall submit to ,congress a  

report on the pilot program4  7,b7      
,report elements ,each report required  
by subparagraph 7,a7 shall include the  
following3  7i7 ,the findings and       
conclusions of the ,secretary with      
respect to the pilot program during the 
#ahj-;day period preceding the report4  
7ii7 ,an assessment of the benefits of  
the pilot program to veterans and their 
family members during the #ahj-;day     
period preceding the report4  7#b7      
,final report ,not later than #ahj days 
after the end of the pilot program1 the 
,secretary shall submit to ,congress a  
report detailing the recommendations of 
the ,secretary as to the advisability of
 continuing or expanding the pilot      
program4  7g7 ,wellness defined ,in this
 section1 the term wellness shall have  
the meaning given that term in          
regulations prescribed by the           
,secretary4  7h7 ,funding ,there is     
authorized to be appropriated to the    
,secretary such sums as may be necessary
 to carry out this section4  #f4 ,pilot 

program on fitness and nutrition        
improvement for overweight and obese    
veterans  7a7 ,pilot program required   
,commencing not later than #ahj days    
after the date of the enactment of this 
,act1 the ,secretary of ,veterans       
,affairs shall1 through the ,national   
,center for ,preventive ,health1 carry  
out a pilot program to assess the       
feasibility and advisability of         
promoting health in covered veterans1   
including achieving a healthy weight and
 reducing risks of chronic disease1     
through support for fitness center      
membership4  7b7 ,covered veterans ,for 
purposes of this section1 a covered     
veteran is any veteran who--  7#a7 is   
determined by a clinician of the        
,department of ,veterans ,affairs to be 
overweight or obese as of the date of   
the commencement of the pilot program2  
and  7#b7 resides in a location that is 
more than #ae miles from a fitness      
center at a facility of the ,department 
that would otherwise be available to the

 veteran for at least eight hours per   
day during five or more days per week4  
7c7 ,duration of pilot program ,the     
pilot program shall be carried out      
during the three-year period beginning  
on the date of the commencement of the  
pilot program4  7d7 ,locations  7#a7 ,in
 general ,in carrying out the pilot     
program1 the ,secretary shall select--  
7,a7 not less than five medical centers 
of the ,department at which the         
,secretary shall cover the full         
reasonable cost of a fitness center     
membership for covered veterans within  
the catchment area of such centers2     
7,b7 not less than five medical centers 
of the ,department at which the         
,secretary shall cover half the         
reasonable cost of a fitness center     
membership for covered veterans within  
the catchment area of such centers2 and 
7,c7 not less than five medical centers 
of the ,department at which the         
,secretary shall provide comprehensive  
medical nutrition therapy for covered   

veterans4  7#b7 ,considerations ,in     
selecting locations for the pilot       
program1 the ,secretary shall consider  
the feasibility and advisability of     
selecting locations in the following    
areas3  7,a7 ,areas that are not in     
close proximity to an active duty       
military installation4  7,b7 ,areas in  
different geographic locations4  7e7    
,participation  7#a7 ,maximum number of 
participants ,the number of covered     
veterans who may participate in the     
pilot program at a location selected    
under subsection 7d7 may not exceed     
#ajj4  7#b7 ,voluntary participation    
,the participation of a covered veteran 
in the pilot program shall be at the    
election of the covered veteran in      
consultation with a clinician of the    
,department4  7f7 ,fitness center       
membership payment  7#a7 ,in general    
,except as provided in paragraph 7#b71  
in carrying out the pilot program1 the  
,secretary shall pay the following3     
7,a7 ,the full reasonable cost of a     

fitness center membership for covered   
veterans within the catchment area of   
centers selected under subsection       
7b77#a77;,a7 who are participating in   
the pilot program4  7,b7 ,half the      
reasonable cost of a fitness center     
membership for covered veterans within  
the catchment area of centers selected  
under subsection 7b77#a77;,b7 who are   
participating in the pilot program4     
7#b7 ,limitation ,payment for a fitness 
center membership of a covered veteran  
may not exceed #ej per month of         
membership4  7g7 ,reports  7#a7         
,periodic reports ,not later than #ij   
days after the date of the commencement 
of the pilot program and not less       
frequently than once every #ij days     
thereafter1 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 activities 
carried out to implement the pilot      
program1 including outreach activities  

to veterans and community organizations4
  7#b7 ,final report ,not later than    
#ahj days after the date of the         
completion of the pilot program1 the    
,secretary shall submit to the          
,committee on ,veterans' ,affairs of the
 ,senate and the ,committee on          
,veterans' ,affairs of the ,house of    
,representatives a report on the pilot  
program detailing--  7,a7 the findings  
and conclusions of the ,secretary as a  
result of the pilot program2 and  7,b7  
recommendations for the continuation or 
expansion of the pilot program4  7h7    
,funding ,there is authorized to be     
appropriated to the ,secretary such sums
 as may be necessary to carry out this  
section4  #g4 ,pilot program on         
transformation of veterans services     
organizations facilities into veteran   
health and wellness centers  7a7 ,pilot 
program required  7#a7 ,in general ,the 
,secretary of ,veterans ,affairs shall  
carry out a pilot program under which   
the ,secretary makes grants to nonprofit

 veterans services organizations        
7hereinafter in this section referred to
 as ,v,s,os7 recognized by the          
,secretary in accordance with section   
#eijb of title #ch1 ,united ,states     
,code1 to upgrade1 through construction 
and repair1 ,,vso community facilities  
into health and wellness centers4  7#b7 
,use of funds ,the recipient of a grant 
under this section shall use the grant  
to carry out the repair of a facility   
owned by the recipient or to construct a
 facility on property owned by the      
recipient4 ,such funds may not be used  
to purchase real estate or to carry out 
repair of facilities leased by the      
recipient or to construct facilities on 
property leased by the recipient4 ,any  
facility repaired or constructed using  
grant funds shall be used to provide    
alternative medical care1 or wellness   
programs1 to veterans and family members
 as such term is defined in section     
#agab;,a7h77#c7 of title #ch1 ,united   
,states ,code4  7#c7 ,facility operation

 ,as a condition of the receipt of a    
grant under this section1 a ,,vso shall 
agree to carry out the operation and    
maintenance of the facility that is     
repaired or constructed using grant     
funds for the three-year period         
beginning on the date of the completion 
of the repair or construction4  7b7     
,duration of pilot program ,the pilot   
program shall be carried out during the 
two-year period beginning on the date of
 the commencement of the pilot program4 
7c7 ,locations ,in selecting the        
recipients of grants under this section1
 the ,secretary shall ensure that the   
grant recipients use grant funds to     
construct or repair facilities located  
in at least ten different geographic    
locations4 ,the ,secretary shall give   
priority to locations in economically   
depressed areas that are not in close   
proximity to ,department of ,veterans   
,affairs medical centers4  7d7          
,eligibility ,to be eligible to receive 
a grant under this section1 a ,,vso     

shall submit to the ,secretary an       
application in such form and in such    
manner as the ,secretary may require4   
7e7 ,reports  7#a7 ,periodic reports    
7,a7 ,in general ,not later than #ahj   
days after the date of the enactment of 
this ,act1 and every #ahj days          
thereafter for the duration of the pilot
 program1 the ,secretary shall submit to
 ,congress a report on the pilot        
program4  7,b7 ,report elements ,each   
report required by subparagraph 7,a7    
shall include the following3  7i7 ,the  
findings and conclusions of the         
,secretary with respect to the pilot    
program during the #ahj-;day period     
covered by the report4  7ii7 ,an        
assessment of the benefits of the pilot 
program to veterans and either family   
members during the #ahj-;day period     
covered by the report4  7#b7 ,final     
report ,not later than #ahj days after  
the conclusion of the pilot program1 the
 ,secretary shall submit to ,congress a 
report detailing the recommendations of 

the ,secretary as to the advisability of
 continuing or expanding the pilot      
program4  7f7 ,funding ,there is        
authorized to be appropriated to the    
,secretary such sums as may be necessary
 to carry out this section4  #h4        
,definition of complementary and        
alternative medicine ,in this ,act1 the 
term complementary and alternative      
medicine shall--  7#a7 have the meaning 
given that term in regulations the      
,secretary shall prescribe for purposes 
of this ,act1 which shall1 to the degree
 practicable1 be consistent with the    
meaning given such term by the          
,secretary of ,health and ,human        
,services2 and  7#b7 include integrative
 health care1 adjunctive health care1   
and functional medicine4