,,ib  ,union ,calendar ,no4 #dbb  #aadth
 ,,congress  #b;d ,session  ,h4 ,r4     
#djfc  ,report ,no4 #aad-edf1 ,part ,i  
,,in ,,the ,,house ,,of                 
,,representatives  ,november #ah1 #bjae 
,mr4 ,bilirakis 7for himself1 ,mr4      
,kind1 ,miss ,rice of ,new ,york1 ,mrs4 
,walorski1 ,mr4 ,mc,kinley1 ,mr4 ,bost1 
,mr4 ,coffman1 ,mr4 ,ross1 ,mr4 ,ryan of
 ,ohio1 ,mrs4 ,radewagen1 ,mr4          
,crawford1 ,mr4 ,mica1 ,ms4 ,frankel of 
,florida1 ,ms4 ,kuster1 ,mr4 ,mc,caul1  
and ,mr4 ,walz7 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 
,may #aj1 #bjaf ,additional sponsors3   
,mr4 ,pocan1 ,mr4 ,ribble1 ,mr4         
,sensenbrenner1 ,mr4 ,ashford1 ,mr4     
,carney1 ,mr4 ,jones1 ,ms4 ,duckworth1  

,ms4 ,mc,sally1 ,mrs4 ,black1 ,mr4      
,young of ,iowa1 ,ms4 ,lofgren1 ,mrs4   
,napolitano1 ,mr4 ,bucshon1 ,mr4        
,blumenauer1 ,mrs4 ,hartzler1 ,mr4      
,moulton1 ,mr4 ,guinta1 ,mr4 ,kilmer1   
,mr4 ,cicilline1 and ,mr4 ,tipton  ,may 
#aj1 #bjaf ,reported from the ,committee
 on ,veterans' ,affairs with an         
amendment ,strike out all after the     
enacting clause and insert the part     
printed in italic  ,may #aj1 #bjaf ,the 
,committee on ,armed ,services          
discharged2 committed to the ,committee 
of the ,whole ,house on the ,state of   
the ,union and ordered to be printed    
,for text of introduced bill1 see copy  
of bill as introduced on ,november #ah1 
#bjae  ,a ,,bill  ,to improve the use by
 the ,secretary of ,veterans ,affairs of
 opioids in treating veterans1 to       
improve patient advocacy by the         
,secretary1 and to expand the           
availability of complementary and       
integrative health1 and for other       
purposes4  #a4 ,short title2 table of   

contents  7a7 ,short title ,this ,act   
may be cited as the ,promoting          
,responsible ,opioid ,management and    
,incorporating ,scientific ,expertise   
,act or the ,jason ,simcakoski ,,promise
 ,act4  7b7 ,table of contents ,the     
table of contents for this ,act is as   
follows3  ,sec4 #a4 ,short title2 table 
of contents4 ,title ,i--,opioid ,therapy
 and ,pain ,management ,sec4 #aja4      
,establishment of ,advisory ,committee  
to review guidelines on management of   
opioid therapy by ,department of        
,veterans ,affairs and ,department of   
,defense4 ,sec4 #ajb4 ,improvement of   
opioid safety measures by ,department of
 ,veterans ,affairs4 ,sec4 #ajc4        
,strengthening of joint working group on
 pain management of the ,department of  
,veterans ,affairs and the ,department  
of ,defense4 ,sec4 #ajd4 ,review1       
investigation1 and report on use of     
opioids in treatment by ,department of  
,veterans ,affairs4 ,sec4 #aje4         
,mandatory disclosure of certain veteran

 information to ,state controlled       
substance monitoring programs4 ,title   
,,ii--,patient ,advocacy ,sec4 #bja4    
,community meetings on improving care   
furnished by ,department of ,veterans   
,affairs4 ,sec4 #bjb4 ,improvement of   
awareness of patient advocacy program   
and patient bill of rights of           
,department of ,veterans ,affairs4 ,sec4
 #bjc4 ,comptroller general report on   
patient advocacy program of ,department 
of ,veterans ,affairs4 ,title           
,,iii--,complementary and ,integrative  
,health ,sec4 #cja4 ,expansion of       
research and education on and delivery  
of complementary and integrative health 
to veterans4 ,sec4 #cjb4 ,pilot program 
on integration of complementary         
alternative medicines and related issues
 for veterans and family members of     
veterans4 ,title ,,iv--,fitness of      
,health ,care ,providers ,sec4 #dja4    
,additional requirements for hiring of  
health care providers by ,department of 
,veterans ,affairs4 ,sec4 #djb4         

,provision of information on health care
 providers of ,department of ,veterans  
,affairs to ,state ,medical ,boards4    
,sec4 #djc4 ,report on compliance by    
,department of ,veterans ,affairs with  
reviews of health care providers leaving
 the ,department or transferring to     
other facilities4 ,title ,v--,other     
,veterans ,matters ,sec4 #eja4 ,audit of
 ,veterans ,health ,administration      
programs of ,department of ,veterans    
,affairs4  ,i ,opioid ,therapy and ,pain
 ,management  #aja4 ,establishment of   
,advisory ,committee to review          
guidelines on management of opioid      
therapy by ,department of ,veterans     
,affairs and ,department of ,defense    
7a7 ,advisory ,committee ,not later than
 #abj days after the date of the        
enactment of this ,act1 the ,secretary  
of ,veterans ,affairs and the ,secretary
 of ,defense shall jointly convene an   
advisory committee to--  7#a7 conduct a 
thorough review of the most recent      
,,va_/,,dod ,clinical ,practice         

,guideline for ,management of ,opioid   
,therapy for ,chronic ,pain2 and  7#b7  
make recommendations to the ,secretaries
 with respect to updating the ,clinical 
,practice ,guideline4  7b7 ,matters     
included ,in conducting the review under
 subsection 7a77#a71 the ,advisory      
,committee shall examine whether the    
,clinical ,practical ,guideline should  
include the following3  7#a7 ,enhanced  
guidance with respect to-- 7,a7 the     
coadministration of an opioid and other 
drugs1 including benzodiazepines1 that  
may result in life-limiting drug        
interactions2  7,b7 the treatment of    
patients with current acute psychiatric 
instability or substance use disorder or
 patients at risk of suicide2 and  7,c7 
the use of opioid therapy to treat      
mental health disorders other than      
opioid use disorder4  7#b7 ,enhanced    
guidance with respect to the treatment  
of patients with behaviors or           
comorbidities1 such as post-traumatic   
stress disorder or other psychiatric    

disorders1 or a history of substance    
abuse or addiction1 that requires a     
consultation or comanagement of opioid  
therapy with one or more specialists in 
pain management1 mental health1 or      
addictions4  7#c7 ,enhanced guidance    
with respect to health care providers-- 
7,a7 conducting an effective assessment 
for patients beginning or continuing    
opioid therapy1 including understanding 
and setting realistic goals with respect
 to achieving and maintaining an        
expected level of pain relief1 improved 
function1 or a clinically appropriate   
combination of both2 and  7,b7          
effectively assessing whether opioid    
therapy is achieving or maintaining the 
established treatment goals of the      
patient or whether the patient and      
health care provider should discuss     
adjusting1 augmenting 1 or discontinuing
 the opioid therapy4  7#d7 ,guidance    
that each health care provider of the   
,department of ,veterans ,affairs and   
the ,department of ,defense1 before     

initiating opioid therapy to treat a    
patient as part of the comprehensive    
assessment conducted by the health care 
provider1 use the ,opioid ,therapy ,risk
 ,report tool of the ,department of     
,veterans ,affairs 7or similar          
monitoring tool71 which shall include   
information from the prescription drug  
monitoring program of each ,state that  
includes the most recent information to 
date relating to the patient that       
accessed such program to assess the risk
 for adverse outcomes of opioid therapy 
for the patient1 including the          
concurrent use of controlled substances 
such as benzodiazepines1 as part of the 
comprehensive assessment conducted by   
the health care provider4  7#e7         
,guidelines to govern the methodologies 
used by health care providers of the    
,department of ,veterans ,affairs and   
the ,department of ,defense to taper    
opioid therapy when adjusting or        
discontinuing the use of opioid therapy4
  7#f7 ,guidelines with respect to      

appropriate case management for patients
 receiving opioid therapy who transition
 between inpatient and outpatient health
 care settings1 which may include the   
use of care transition plans4  7#g7     
,guidelines with respect to appropriate 
case management for patients receiving  
opioid therapy who transition from      
receiving care during active duty to    
post-military health care networks4     
7#h7 ,enhanced standards with respect to
 the use of routine and random urine    
drug tests for all patients before and  
during opioid therapy to help prevent   
substance abuse1 dependence1 and        
diversion1 including--  7,a7 that such  
tests occur not less frequently than    
once each year2 and  7,b7 that health   
care providers appropriately order1     
interpret and respond to the results    
from such tests to tailor pain therapy1 
safeguards1 and risk management         
strategies to each patient4  7#i7       
,guidance that health care providers    
discuss with patients1 before initiating

 opioid therapy1 options for pain       
management therapies without the use of 
opioids and options to augment opioid   
therapy with other clinical and         
complementary and integrative health    
services to minimize opioid dependence4 
7#aj7 ,guidance for health care         
providers with respect to evidence-based
 non-opioid treatments within the       
,department of ,veterans ,affairs and   
the ,department of ,defense1 including  
medical devices and other therapies     
approved or cleared by the ,food and    
,drug ,administration for the treatment 
of chronic pain as an alternative to or 
to augment opioid therapy4  7c7         
,consultation ,in carrying out the      
review under paragraph 7#a7 of          
subsection 7a71 and before making the   
recommendations under paragraph 7#b7 of 
such subsection1 the ,advisory          
,committee shall consult with the       
,,va_/,,dod ,management of ,opioid      
,therapy for ,chronic ,pain ,working    
,group4  7d7 ,submission ,not later than

 one year after the date of the         
enactment of this ,act1 the ,advisory   
,committee shall submit to the          
,secretaries the review and             
recommendations described in subsection 
7a77#a74  7e7 ,application of ,federal  
,advisory ,committee ,act ,the          
provisions of the ,federal ,advisory    
,committee ,act 7#e ,u4,s4,c4 ,app47    
shall apply to the ,advisory ,committee4
  7f7 ,definitions ,in this section3    
7#a7 ,the term ,advisory ,committee     
means the advisory committee established
 under subsection 7a74  7#b7 ,the term  
,clinical ,practice ,guideline means the
 ,,va_/,,dod ,clinical ,practice        
,guideline for ,management of ,opioid   
,therapy for ,chronic ,pain4  7#c7 ,the 
term controlled substance has the       
meaning given that term in section #ajb 
of the ,controlled ,substances ,act 7#ba
 ,u4,s4,c4 #hjb74  7#d7 ,the term ,state
 means each of the several ,states1     
territories1 and possessions of the     
,united ,states1 the ,district of       

,columbia1 and the ,commonwealth of     
,puerto ,rico4  #ajb4 ,improvement of   
opioid safety measures by ,department of
 ,veterans ,affairs  7a7 ,expansion of  
opioid safety initiative ,not later than
 #ahj days after the date of the        
enactment of this ,act1 the ,secretary  
of ,veterans ,affairs shall expand the  
,opioid ,safety ,initiative of the      
,department of ,veterans ,affairs to    
include all medical facilities of the   
,department4  7b7 ,pain management      
education and training  7#a7 ,in general
 ,in carrying out the ,opioid ,safety   
,initiative of the ,department1 the     
,secretary shall require all employees  
of the ,department responsible for      
prescribing opioids to receive education
 and training described in paragraph    
7#b74  7#b7 ,education and training     
,education and training described in    
this paragraph is education and training
 on pain management and safe opioid     
prescribing practices for purposes of   
safely and effectively managing patients

 with chronic pain1 including education 
and training on the following3  7,a7    
,the implementation of and full         
compliance with the ,,va_/,,dod         
,clinical ,practice ,guideline for      
,management of ,opioid ,therapy for     
,chronic ,pain1 including any update to 
such guideline4  7,b7 ,the use of       
evidence-based pain management          
therapies1 including                    
cognitive-behavioral therapy1 non-opioid
 alternatives1 and non-drug methods and 
procedures to managing pain and related 
health conditions including medical     
devices approved or cleared by the ,food
 and ,drug ,administration for the      
treatment of patients with chronic pain 
and complementary alternative medicines4
  7,c7 ,screening and identification of 
patients with substance use disorder1   
including drug-seeking behavior1 before 
prescribing opioids1 assessment of risk 
potential for patients developing an    
addiction1 and referral of patients to  
appropriate addiction treatment         

professionals if addiction is identified
 or strongly suspected4  7,d7           
,communication with patients on the     
potential harm associated with the use  
of opioids and other controlled         
substances1 including the need to safely
 store and dispose of supplies relating 
to the use of opioids and other         
controlled substances4  7,e7 ,such other
 education and training as the          
,secretary considers appropriate to     
ensure that veterans receive safe and   
high-quality pain management care from  
the ,department4  7#c7 ,use of existing 
program ,in providing education and     
training described in paragraph 7#b71   
the ,secretary shall use the            
,interdisciplinary ,chronic ,pain       
,management ,training ,team ,program of 
the ,department 7or success program74   
7c7 ,pain management teams  7#a7 ,in    
general ,in carrying out the ,opioid    
,safety ,initiative of the ,department1 
the director of each medical facility of
 the ,department shall identify and     

designate a pain management team of     
health care professionals1 which may    
include board certified pain medicine   
specialists1 responsible for            
coordinating and overseeing pain        
management therapy at such facility for 
patients experiencing acute and chronic 
pain that is non-cancer related4  7#b7  
,establishment of protocols  7,a7 ,in   
general ,in consultation with the       
,directors of each ,veterans ,integrated
 ,service ,network1 the ,secretary shall
 establish standard protocols for the   
designation of pain management teams at 
each medical facility within the        
,department4  7,b7 ,consultation on     
prescription of opioids ,each protocol  
established under subparagraph 7,a7     
shall ensure that any health care       
provider without expertise in           
prescribing analgesics or who has not   
completed the education and training    
under subsection 7b71 including a mental
 health care provider1 does not         
prescribe opioids to a patient unless   

that health care provider--  7i7        
consults with a health care provider    
with pain management expertise or who is
 on the pain management team of the     
medical facility2 and  7ii7 refers the  
patient to the pain management team for 
any subsequent prescriptions and related
 therapy4  7#c7 ,report  7,a7 ,in       
general ,not later than one year after  
the date of enactment of this ,act1 the 
director of each medical facility of the
 ,department shall submit to the ,under 
,secretary for ,health and the director 
of the ,veterans ,integrated ,service   
,network in which the medical facility  
is located a report identifying the     
health care professionals that have been
 designated as members of the pain      
management team at the medical facility 
pursuant to paragraph 7#a74  7,b7       
,elements ,each report submitted under  
subparagraph 7,a7 with respect to a     
medical facility of the ,department     
shall include--  7i7 a certification as 
to whether all members of the pain      

management team at the medical facility 
have completed the education and        
training required under subsection 7b72 
7ii7 a plan for the management and      
referral of patients to such pain       
management team if health care providers
 without expertise in prescribing       
analgesics prescribe opioid medications 
to treat acute and chronic pain that is 
non-cancer related2 and  7iii7 a        
certification as to whether the medical 
facility-- 7,i7 fully complies with the 
stepped-care model of pain management   
and other pain management policies      
contained in ,directive #bjji-jec of the
 ,veterans ,health ,administration1 or  
successor directive2 or  7,,ii7 does not
 fully comply with such stepped-care    
model of pain management and other pain 
management policies but is carrying out 
a corrective plan of action to ensure   
such full compliance4  7d7 ,tracking and
 monitoring of opioid use  7#a7         
,prescription drug monitoring programs  
of states ,in carrying out the ,opioid  

,safety ,initiative and the ,opioid     
,therapy ,risk ,report tool of the      
,department1 the ,secretary shall--     
7,a7 ensure access by health care       
providers of the ,department to         
information on controlled substances1   
including opioids and benzodiazepines1  
prescribed to veterans who receive care 
outside the ,department through the     
prescription drug monitoring program of 
each ,state with such a program1        
including by seeking to enter into      
memoranda of understanding with ,states 
to allow shared access of such          
information between ,states and the     
,department2  7,b7 include such         
information in the ,opioid ,therapy     
,risk ,report2 and  7,c7 require health 
care providers of the ,department to    
submit to the prescription drug         
monitoring program of each ,state       
information on prescriptions of         
controlled substances received by       
veterans in that ,state under the laws  
administered by the ,secretary4  7#b7   

,report on tracking of data on opioid   
use ,not later than #ah months after the
 date of the enactment of this ,act1 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        
feasibility and advisability of         
improving the ,opioid ,therapy ,risk    
,report tool of the ,department to allow
 for more advanced real-time tracking of
 and access to data on--  7,a7 the key  
clinical indicators with respect to the 
totality of opioid use by veterans2     
7,b7 concurrent prescribing by health   
care providers of the ,department of    
opioids in different health care        
settings1 including data on concurrent  
prescribing of opioids to treat mental  
health disorders other than opioid use  
disorder2 and  7,c7 mail-order          
prescriptions of opioid prescribed to   
veterans under the laws administered by 
the ,secretary4  7e7 ,availability of   

opioid receptor antagonists  7#a7       
,increased availability and use  7,a7   
,in general ,the ,secretary shall       
maximize the availability of opioid     
receptor antagonists approved by the    
,food and ,drug ,administration1        
including naloxone1 to veterans4  7,b7  
,availability1 training1 and            
distributing ,in carrying out           
subparagraph 7,a71 not later than #ij   
days after the date of the enactment of 
this ,act1 the ,secretary shall--  7i7  
equip each pharmacy of the ,department  
with opioid receptor antagonists        
approved by the ,food and ,drug         
,administration to be dispensed to      
outpatients as needed2 and  7ii7 expand 
the ,overdose ,education and ,naloxone  
,distribution program of the ,department
 to ensure that all veterans in receipt 
of health care under laws administered  
by the ,secretary who are at risk of    
opioid overdose may access such opioid  
receptor antagonists and training on the
 proper administration of such opioid   

receptor antagonists4  7,c7 ,veterans   
who are at risk ,for purposes of        
subparagraph 7,b71 veterans who are at  
risk of opioid overdose include-- 7i7   
veterans receiving long-term opioid     
therapy2  7ii7 veterans receiving opioid
 therapy who have a history of substance
 use disorder or prior instances of     
overdose2 and  7iii7 veterans who are at
 risk as determined by a health care    
provider who is treating the veteran4   
7#b7 ,report ,not later than #abj days  
after the date of the enactment of this 
,act1 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 carrying   
out paragraph 7#a71 including an        
assessment of any remaining steps to be 
carried out by the ,secretary to carry  
out such paragraph4  7f7 ,inclusion of  
certain information and capabilities in 
opioid therapy risk report tool of the  
,department  7#a7 ,information ,the     

,secretary shall include in the ,opioid 
,therapy ,risk ,report tool of the      
,department-- 7,a7 information on the   
most recent time the tool was accessed  
by a health care provider of the        
,department with respect to each        
veteran2 and  7,b7 information on the   
results of the most recent urine drug   
test for each veteran4  7#b7            
,capabilities ,the ,secretary shall     
include in the ,opioid ,therapy ,risk   
,report tool the ability of the health  
care providers of the ,department to    
determine whether a health care provider
 of the ,department prescribed opioids  
to a veteran without checking the       
information in the tool with respect to 
the veteran4  7g7 ,notifications of risk
 in computerized health record ,the     
,secretary shall modify the computerized
 patient record system of the           
,department to ensure that any health   
care provider that accesses the record  
of a veteran1 regardless of the reason  
the veteran seeks care from the health  

care provider1 will be immediately      
notified whether the veteran--  7#a7 is 
receiving opioid therapy and has a      
history of substance use disorder or    
prior instances of overdose2  7#b7 has a
 history of opioid abuse2 or  7#c7 is at
 risk of becoming an opioid abuser as   
determined by a health care provider who
 is treating the veteran4  7h7          
,definitions ,in this section3 7#a7 ,the
 term controlled substance has the      
meaning given that term in section #ajb 
of the ,controlled ,substances ,act 7#ba
 ,u4,s4,c4 #hjb74  7#b7 ,the term ,state
 means each of the several ,states1     
territories1 and possessions of the     
,united ,states1 the ,district of       
,columbia1 and the ,commonwealth of     
,puerto ,rico4  #ajc4 ,strengthening of 
joint working group on pain management  
of the ,department of ,veterans ,affairs
 and the ,department of ,defense  7a7   
,in general ,not later than #ij days    
after the date of enactment of this     
,act1 the ,secretary of ,veterans       

,affairs and the ,secretary of ,defense 
shall ensure that the ,pain ,management 
,working ,group of the ,health          
,executive ,committee of the ,department
 of ,veterans ,affairs-,department of   
,defense ,joint ,executive ,committee   
established under section #cbj of title 
#ch1 ,united ,states ,code1 includes a  
focus on the following3  7#a7 ,the      
opioid prescribing practices of health  
care providers of each ,department4     
7#b7 ,the ability of each ,department to
 manage acute and chronic pain among    
individuals receiving health care from  
the ,department1 including training     
health care providers with respect to   
pain management4  7#c7 ,the use by each 
,department of complementary and        
integrative health and complementary    
alternative medicines in treating such  
individuals4  7#d7 ,the concurrent use  
by health care providers of each        
,department of opioids and prescription 
drugs to treat mental health disorders1 
including benzodiazepines4  7#e7 ,the   

practice by health care providers of    
each ,department of prescribing opioids 
to treat mental health disorders4  7#f7 
,the coordination in coverage of and    
consistent access to medications        
prescribed for patients transitioning   
from receiving health care from the     
,department of ,defense to receiving    
health care from the ,department of     
,veterans ,affairs4  7#g7 ,the ability  
of each ,department to identify and     
treat substance use disorders among     
individuals receiving health care from  
that ,department4  7b7 ,coordination and
 consultation ,the ,secretary of        
,veterans ,affairs and the ,secretary of
 ,defense shall ensure that the working 
group described in subsection 7a7--     
7#a7 coordinates the activities of the  
working group with other relevant       
working groups established under section
 #cbj of title #ch1 ,united ,states     
,code1 including the working groups on  
evidence-based practice1 patient safety1
 pharmacy1 psychological health1 and    

psychological health2  7#b7 consults    
with other relevant ,federal agencies1  
including the ,centers for ,disease     
,control and ,prevention1 with respect  
to the activities of the working group2 
and  7#c7 consults with the ,department 
of ,veterans ,affairs and the           
,department of ,defense with respect to1
 reviews1 and comments on the           
,,va_/,,dod ,clinical ,practice         
,guideline for ,management of ,opioid   
,therapy for ,chronic ,pain1 or any     
successor guideline1 before any update  
to the guideline is released4  7c7      
,consultations ,the ,secretary of       
,veterans ,affairs and the ,secretary of
 ,defense shall ensure that the working 
group described in subsection 7a7 is    
able to meaningfully consult with       
respect to the updated guideline        
required under subsection 7a7 of section
 #aja1 as required by subsection 7b7 of 
such section1 not later than #a year    
after the date of enactment of this     
,act4  #ajd4 ,review1 investigation1 and

 report on use of opioids in treatment  
by ,department of ,veterans ,affairs    
7a7 ,comptroller general report  7#a7   
,in general ,not later than two years   
after the date of the enactment of this 
,act1 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 ,opioid
 ,safety ,initiative of the ,department 
of ,veterans ,affairs and the opioid    
prescribing practices of health care    
providers of the ,department4  7#b7     
,elements ,the report submitted under   
paragraph 7#a7 shall include the        
following3 7,a7 ,recommendations on such
 improvements to the ,opioid ,safety    
,initiative of the ,department as the   
,comptroller ,general considers         
appropriate4  7,b7 ,information with    
respect to-- 7i7 deaths resulting from  
sentinel events involving veterans      
prescribed opioids by a health care     

provider of the ,department2  7ii7      
overall prescription rates and          
prescriptions indications of opioids to 
treat non-cancer1 non-palliative1 and   
non-hospice care patients2  7iii7 the   
prescription rates and prescriptions    
indications of benzodiazepines and      
opioids concomitantly by health care    
providers of the ,department2  7iv7 the 
practice by health care providers of the
 ,department of prescribing opioids to  
treat patients without any pain1        
including to treat patients with mental 
health disorders other than opioid use  
disorder2 and  7v7 the effectiveness of 
opioid therapy for patients receiving   
such therapy1 including the             
effectiveness of long-term opioid       
therapy4  7,c7 ,an evaluation of        
processes of the ,department in place to
 oversee opioid use among veterans1     
including procedures to identify and    
remedy potential over-prescribing of    
opioids by health care providers of the 
,department4  7,d7 ,an assessment of the

 implementation by the ,secretary of the
 ,,va_/,,dod ,clinical ,practice        
,guideline for ,management of ,opioid   
,therapy for ,chronic ,pain4  7b7       
,quarterly progress report on           
implementation of comptroller general   
recommendations ,not later than two     
years after the date of the enactment of
 this ,act1 and not later than #cj days 
after the end of each quarter           
thereafter1 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 progress report      
detailing the actions by the ,secretary 
during the period covered by the report 
to address any outstanding findings and 
recommendations by the ,comptroller     
,general of the ,united ,states under   
subsection 7a7 with respect to the      
,veterans ,health ,administration4  7c7 
,annual review of prescription rates    
,not later than one year after the date 

of the enactment of this ,act1 and not  
less frequently than annually for the   
following five years1 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       
report1 with respect to each medical    
facility of the ,department of ,veterans
 ,affairs1 to collect and review        
information on opioids prescribed by    
health care providers at the facility to
 treat non-cancer1 non-palliative1 and  
non-hospice care patients that contains1
 for the one-year period preceding the  
submission of the report1 the following3
  7#a7 ,the number of patients and the  
percentage of the patient population of 
the ,department who were prescribed     
benzodiazepines and opioids concurrently
 by a health care provider of the       
,department4  7#b7 ,the number of       
patients and the percentage of the      
patient population of the ,department   
without any pain who were prescribed    

opioids by a health care provider of the
 ,department1 including those who were  
prescribed benzodiazepines and opioids  
concurrently4  7#c7 ,the number of      
non-cancer1 non-palliative1 and         
non-hospice care patients and the       
percentage of such patients who were    
treated with opioids by a health care   
provider of the ,department on an       
inpatient-basis and who also received   
prescription opioids by mail from the   
,department while being treated on an   
inpatient-basis4  7#d7 ,the number of   
non-cancer1 non-palliative1 and         
non-hospice care patients and the       
percentage of such patients who were    
prescribed opioids concurrently by a    
health care provider of the ,department 
and a health care provider that is not  
health care provider of the ,department4
  7#e7 ,with respect to each medical    
facility of the ,department1 information
 on opioids prescribed by health care   
providers at the facility to treat      
non-cancer1 non-palliative1 and         

non-hospice care patients1 including    
information on--  7,a7 the prescription 
rate at which each health care provider 
at the facility prescribed              
benzodiazepines and opioids concurrently
 to such patients and the aggregate such
 prescription rate for all health care  
providers at the facility2  7,b7 the    
prescription rate at which each health  
care provider at the facility prescribed
 benzodiazepines or opioids to such     
patients to treat conditions for which  
benzodiazepines or opioids are not      
approved treatment and the aggregate    
such prescription rate for all health   
care providers at the facility2  7,c7   
the prescription rate at which each     
health care provider at the facility    
prescribed or dispensed mail-order      
prescriptions of opioids to such        
patients while such patients were being 
treated with opioids on an              
inpatient-basis and the aggregate of    
such prescription rate for all health   
care providers at the facility2 and     

7,d7 the prescription rate at which each
 health care provider at the facility   
prescribed opioids to such patients who 
were also concurrently prescribed       
opioids by a health care provider that  
is not a health care provider of the    
,department and the aggregate of such   
prescription rates for all health care  
providers at the facility4  7#f7 ,with  
respect to each medical facility of the 
,department1 the number of times a      
pharmacist at the facility overrode a   
critical drug interaction warning with  
respect to an interaction between       
opioids and another medication before   
dispensing such medication to a veteran4
  7d7 ,investigation of prescription    
rates ,if the ,secretary determines that
 a prescription rate with respect to a  
health care provider or medical facility
 of the ,department conflicts with or is
 otherwise inconsistent with the        
standards of appropriate and safe care1 
the ,secretary shall--  7#a7 immediately
 notify the ,committee on ,veterans'    

,affairs of the ,senate and the         
,committee on ,veterans' ,affairs of the
 ,house of ,representatives of such     
determination1 including information    
relating to such determination1         
prescription rate1 and health care      
provider or medical facility1 as the    
case may be2 and  7#b7 through the      
,office of the ,medical ,inspector of   
the ,veterans ,health ,administration1  
conduct a full investigation of the     
health care provider or medical         
facility1 as the case may be4  7e7      
,prescription rate defined ,in this     
section1 the term prescription rate     
means1 with respect to a health care    
provider or medical facility of the     
,department1 each of the following3     
7#a7 ,the number of patients treated    
with opioids by the health care provider
 or at the medical facility1 as the case
 may be1 divided by the total number of 
pharmacy users of that health care      
provider or medical facility4  7#b7 ,the
 average number of morphine equivalents 

per day prescribed by the health care   
provider or at the medical facility1 as 
the case may be1 to patients being      
treated with opioids4  7#c7 ,of the     
patients being treated with opioids by  
the health care provider or at the      
medical facility1 as the case may be1   
the average number of prescriptions of  
opioids per patient4  #aje4 ,mandatory  
disclosure of certain veteran           
information to ,state controlled        
substance monitoring programs ,section  
#egja7l7 of title #ch1 ,united ,states  
,code1 is amended by striking may and   
inserting shall4  ,,ii ,patient         
,advocacy  #bja4 ,community meetings on 
improving care furnished by ,department 
of ,veterans ,affairs  7a7 ,community   
meetings  7#a7 ,medical centers ,not    
later than #ij days after the date of   
the enactment of this ,act1 and not less
 frequently than once every #ij days    
thereafter1 the ,secretary shall ensure 
that each medical facility of the       
,department of ,veterans ,affairs hosts 

a community meeting open to the public  
on improving health care furnished by   
the ,secretary4  7#b7 ,community based  
outpatient clinics ,not later than one  
year after the date of the enactment of 
this ,act1 and not less frequently than 
annually thereafter1 the ,secretary     
shall ensure that each community based  
outpatient clinic of the ,department    
hosts a community meeting open to the   
public on improving health care         
furnished by the ,secretary4  7b7       
,attendance by ,director of veterans    
integrated service network or designee  
7#a7 ,in general ,each community meeting
 hosted by a medical facility or        
community based outpatient clinic under 
subsection 7a7 shall be attended by the 
,director of the ,veterans ,integrated  
,service ,network in which the medical  
facility or community based outpatient  
clinic1 as the case may be1 is located4 
,subject to paragraph 7#b71 the         
,director may delegate such attendance  
only to an employee who works in the    

,office of the ,director4  7#b7         
,attendance by director ,each ,director 
of a ,veterans ,integrated ,service     
,network shall personally attend not    
less than one community meeting under   
subsection 7a7 hosted by each medical   
facility located in the ,veterans       
,integrated ,service ,network each year4
  7c7 ,notice ,the ,secretary shall     
notify the ,committee on ,veterans'     
,affairs of the ,senate1 the ,committee 
on ,veterans' ,affairs of the ,house of 
,representatives1 and each ,member of   
,congress 7as defined in section #ajd7  
who represents the area in which the    
medical facility is located of a        
community meeting under subsection 7a7  
by not later than #aj days before such  
community meeting occurs4  #bjb4        
,improvement of awareness of patient    
advocacy program and patient bill of    
rights of ,department of ,veterans      
,affairs ,not later than #ij days after 
the date of the enactment of this ,act1 
the ,secretary of ,veterans ,affairs    

shall1 in as many prominent locations as
 the ,secretary determines appropriate  
to be seen by the largest percentage of 
patients and family members of patients 
at each medical facility of the         
,department of ,veterans ,affairs--     
7#a7 display the purposes of the        
,patient ,advocacy ,program of the      
,department and the contact information 
for the patient advocate at such medical
 facility2 and  7#b7 display the rights 
and responsibilities of-- 7,a7 patients 
and family members and patients at such 
medical facility2 and  7,b7 with respect
 to community living centers and other  
residential facilities of the           
,department1 residents and family       
members of residents at such medical    
facility4  #bjc4 ,comptroller general   
report on patient advocacy program of   
,department of ,veterans ,affairs  7a7  
,in general ,not later than two years   
after the date of the enactment of this 
,act1 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        
,patient ,advocacy ,program of the      
,department of ,veterans ,affairs 7in   
this section referred to as the         
,program74  7b7 ,elements ,the report   
required by subsection 7a7 shall include
 the following3 7#a7 ,a description of  
the ,program1 including--  7,a7 the     
purpose of the ,program2  7,b7 the      
activities carried out under the        
,program2 and  7,c7 the sufficiency of  
the ,program in achieving the purpose of
 the ,program4  7#b7 ,an assessment of  
the sufficiency of staffing of employees
 of the ,department responsible for     
carrying out the ,program4  7#c7 ,an    
assessment of the sufficiency of the    
training of such employees4  7#d7 ,an   
assessment of--  7,a7 the awareness of  
the ,program among veterans and family  
members of veterans2 and  7,b7 the use  
of the ,program by veterans and family  

members of veterans4  7#e7 ,such        
recommendations and proposals for       
improving or modifying the ,program as  
the ,comptroller ,general considers     
appropriate4  7#f7 ,such other          
information with respect to the ,program
 as the ,comptroller ,general considers 
appropriate4  ,,iii ,complementary and  
,integrative ,health  #cja4 ,expansion  
of research and education on and        
delivery of complementary and           
integrative health to veterans  7a7     
,establishment ,there is established a  
commission to be known as the ,creating 
,options for ,veterans' ,expedited      
,recovery or the ,,cover ,commission 7in
 this ,act referred to as the           
,commission74 ,the ,commission shall    
examine the evidence-based therapy      
treatment model used by the ,secretary  
of ,veterans ,affairs for treating      
mental health conditions of veterans and
 the potential benefits of incorporating
 complementary alternative treatments   
available in non-,department facilities 

7as defined in section #agja of title   
#ch1 ,united ,states ,code74  7b7       
,duties ,the ,commission shall perform  
the following duties3 7#a7 ,examine the 
efficacy of the evidence-based therapy  
model used by the ,secretary for        
treating mental health illnesses of     
veterans and identify areas to improve  
wellness-based outcomes4  7#b7 ,conduct 
a patient-centered survey within each of
 the ,veterans ,integrated ,service     
,networks to examine--  7,a7 the        
experience of veterans with the         
,department of ,veterans ,affairs when  
seeking medical assistance for mental   
health issues through the health care   
system of the ,department2  7,b7 the    
experience of veterans with             
non-,department facilities and health   
professionals for treating mental health
 issues2  7,c7 the preference of        
veterans regarding available treatment  
for mental health issues and which      
methods the veterans believe to be most 
effective2  7,d7 the experience1 if any1

 of veterans with respect to the        
complementary alternative treatment     
therapies described in paragraph 7#c72  
7,e7 the prevalence of prescribing      
prescription medication among veterans  
seeking treatment through the health    
care system of the ,department as       
remedies for addressing mental health   
issues2 and  7,f7 the outreach efforts  
of the ,secretary regarding the         
availability of benefits and treatments 
for veterans for addressing mental      
health issues1 including by identifying 
ways to reduce barriers to gaps in such 
benefits and treatments4  7#c7 ,examine 
available research on complementary     
alternative treatment therapies for     
mental health issues and identify what  
benefits could be made with the         
inclusion of such treatments for        
veterans1 including with respect to--   
7,a7 music therapy2  7,b7 equine        
therapy2  7,c7 training and caring for  
service dogs2  7,d7 yoga therapy2  7,e7 
acupuncture therapy2  7,f7 meditation   

therapy2  7,g7 outdoor sports therapy2  
7,h7 hyperbaric oxygen therapy2  7,i7   
accelerated resolution therapy2  7,j7   
art therapy2  7,k7 magnetic resonance   
therapy2 and  7,l7 other therapies the  
,commission determines appropriate4     
7#d7 ,study the sufficiency of the      
resources of the ,department to ensure  
the delivery of quality health care for 
mental health issues among veterans     
seeking treatment within the            
,department4  7#e7 ,study the current   
treatments and resources available      
within the ,department and assess-- 7,a7
 the effectiveness of such treatments   
and resources in decreasing the number  
of suicides per day by veterans2  7,b7  
the number of veterans who have been    
diagnosed with mental health issues2    
7,c7 the percentage of veterans using   
the resources of the ,department who    
have been diagnosed with mental health  
issues2  7,d7 the percentage of veterans
 who have completed counseling sessions 
offered by the ,department2 and  7,e7   

the efforts of the ,department to expand
 complementary alternative treatments   
viable to the recovery of veterans with 
mental health issues as determined by   
the ,secretary to improve the           
effectiveness of treatments offered with
 the ,department4  7c7 ,membership  7#a7
 ,in general ,the ,commission shall be  
composed of #aj members1 appointed as   
follows3 7,a7 ,two members appointed by 
the ,speaker of the ,house of           
,representatives1 at least one of whom  
shall be a veteran4  7,b7 ,two members  
appointed by the ,minority ,leader of   
the ,house of ,representatives1 at least
 one of whom shall be a veteran4  7,c7  
,two members appointed by the ,majority 
,leader of the ,senate1 at least one of 
whom shall be a veteran4  7,d7 ,two     
members appointed by the ,minority      
,leader of the ,senate1 at least one of 
whom shall be a veteran4  7,e7 ,two     
members appointed by the ,president1 at 
least one of whom shall be a veteran4   
7#b7 ,qualifications ,members of the    

,commission shall be--  7,a7 individuals
 who are of recognized standing and     
distinction within the medical community
 with a background in treating mental   
health2  7,b7 individuals with          
experience working with the military and
 veteran population2 and  7,c7          
individuals who do not have a financial 
interest in any of the complementary    
alternative treatments reviewed by the  
,commission4  7#c7 ,chairman ,the       
,president shall designate a member of  
the ,commission to be the ,chairman4    
7#d7 ,period of appointment ,members of 
the ,commission shall be appointed for  
the life of the ,commission4  7#e7      
,vacancy ,a vacancy in the ,commission  
shall be filled in the manner in which  
the original appointment was made4  7#f7
 ,appointment deadline ,the appointment 
of members of the ,commission in this   
section shall be made not later than #ij
 days after the date of the enactment of
 this ,act4  7d7 ,powers of commission  
7#a7 ,meetings  7,a7 ,initial meeting   

,the ,commission shall hold its first   
meeting not later than #cj days after a 
majority of members are appointed to the
 ,commission4  7,b7 ,meeting ,the       
,commission shall regularly meet at the 
call of the ,chairman4 ,such meetings   
may be carried out through the use of   
telephonic or other appropriate         
telecommunication technology if the     
,commission determines that such        
technology will allow the members to    
communicate simultaneously4  7#b7       
,hearings ,the ,commission may hold such
 hearings1 sit and act at such times and
 places1 take such testimony1 and       
receive evidence as the ,commission     
considers advisable to carry out the    
responsibilities of the ,commission4    
7#c7 ,information from federal agencies 
,the ,commission may secure directly    
from any department or agency of the    
,federal ,government such information as
 the ,commission considers necessary to 
carry out the duties of the ,commission4
  7#d7 ,information from nongovernmental

 organizations ,in carrying out its     
duties1 the ,commission may seek        
guidance through consultation with      
foundations1 veteran service            
organizations1 nonprofit groups1        
faith-based organizations1 private and  
public institutions of higher education1
 and other organizations as the         
,commission determines appropriate4     
7#e7 ,commission records ,the           
,commission shall keep an accurate and  
complete record of the actions and      
meeting of the ,commission4 ,such record
 shall be made available for public     
inspection and the ,comptroller ,general
 of the ,united ,states may audit and   
examine such record4  7#f7 ,personnel   
records ,the ,commission shall keep an  
accurate and complete record of the     
actions and meetings of the ,commission4
 ,such record shall be made available   
for public inspection and the           
,comptroller ,general of the ,united    
,states may audit and examine such      
records4  7#g7 ,compensation of members2

 travel expenses ,each member shall     
serve without pay but shall receive     
travel expenses to perform the duties of
 the ,commission1 including per diem in 
lieu of substances1 at rates authorized 
under subchapter ,i of chapter #eg of   
title #e1 ,united ,states ,code4  7#h7  
,staff ,the ,chairman1 in accordance    
with rules agreed upon the ,commission1 
may appoint fix the compensation of a   
staff director and such other personnel 
as may be necessary to enable the       
,commission to carry out its functions1 
without regard to the provisions of     
title #e1 ,united ,states ,code1        
governing appointments in the           
competitive service1 without regard to  
the provision of chapter #ea and        
subchapter ,,iii of chapter #ec of such 
title relating to classification and    
,general ,schedule pay rates1 except    
that no rate of pay fixed under this    
paragraph may exceed the equivalent of  
that payable for a position at a level  
,,iv of the ,executive ,schedule under  

section #ecaf of title #e1 ,united      
,states ,code4  7#i7 ,personnel as      
federal employees  7,a7 ,in general ,the
 executive director and any personnel of
 the ,commission are employees under    
section #baje of title #e1 ,united      
,states ,code1 for purpose of chapters  
#fc1 #ha1 #hc1 #hd1 #he1 #hg1 #hi1 and  
#ij of such title4  7,b7 ,members of the
 commission ,subparagraph 7,a7 shall not
 be construed to apply to members of the
 ,commission4  7#aj7 ,contracting ,the  
,commission may1 to such extent and in  
such amounts as are provided in         
appropriations ,acts1 enter into        
contracts to enable the ,commission to  
discharge the duties of the ,commission 
under this ,act4  7#aa7 ,expert and     
consultant service ,the ,commission may 
procure the services of experts and     
consultants in accordance with section  
#caji or title #e1 ,united ,states      
,code1 at rates not to exceed the daily 
rate paid to a person occupying a       
position at level ,,iv of the ,executive

 ,schedule under section #caji of title 
#e1 ,united ,states ,code4  7#ab7       
,postal service ,the ,commission may use
 the ,united ,states mails in the same  
manner and under the same conditions as 
departments and agencies of the ,united 
,states4  7#ac7 ,physical facilities and
 equipment ,upon the request of the     
,commission1 the ,administrator of      
,general ,services shall provide to the 
,commission1 on a reimbursable basis1   
the administrative support services     
necessary for the ,commission to carry  
out its responsibilities under this     
,act4 ,these administrative services may
 include human resource management1     
budget1 leasing accounting1 and payroll 
services4  7e7 ,report  7#a7 ,interim   
reports  7,a7 ,in general ,not later    
than #fj days after the date on which   
the ,commission first meets1 and each   
#cj-;day period thereafter ending on the
 date on which the ,commission submits  
the final report under paragraph 7#b71  
the ,commission shall submit to the     

,committees on ,veterans' ,affairs of   
the ,house of ,representatives and the  
,senate and the ,president a report     
detailing the level of cooperation the  
,secretary of ,veterans ,affairs 7and   
the heads of other departments or       
agencies of the ,federal ,government7   
has provided to the ,commission4  7,b7  
,other reports ,in carrying out its     
duties1 at times that the ,commission   
determines appropriate1 the ,commission 
shall submit to the ,committee on       
,veterans' ,affairs of the ,house of    
,representatives and the ,senate and any
 other appropriate entities an interim  
report with respect to the findings     
identified by the ,commission4  7#b7    
,final report ,not later than #ah months
 after the first meeting of the         
,commission1 the ,commission shall      
submit to the ,committee on ,veterans'  
,affairs of the ,house of               
,representatives and the ,senate1 the   
,president1 and the ,secretary of       
,veterans ,affairs a final report on the

 findings of the ,commission4 ,such     
report shall include the following3     
7,a7 ,recommendations to implement in a 
feasible1 timely1 and cost efficient    
manner the solutions and remedies       
identified within the findings of the   
,commission pursuant to subsection 7b74 
7,b7 ,an analysis of the evidence-based 
therapy model used by the ,secretary of 
,veterans ,affairs for treating veterans
 with mental health care issues1 and an 
examination of the prevalence and       
efficacy of prescription drugs as a     
means for treatment4  7,c7 ,the findings
 of the patient-centered survey         
conducted within each of the ,veterans  
,integrated ,service ,networks pursuant 
to subsection 7b77#b74  7,d7 ,an        
examination of complementary alternative
 treatments described in subsection     
7b77#c7 and the potential benefits of   
incorporating such treatments in the    
therapy models used by the ,secretary   
for treating veterans with mental health
 issues4  7#c7 ,plan ,not later than #ij

 days after the date on which the       
,commission submits the final report    
under paragraph 7#b71 the ,secretary of 
,veterans ,affairs shall submit to the  
,committee on ,veterans' ,affairs of the
 ,house of ,representatives and the     
,senate a report on the following3  7,a7
 ,an action plan for implementing the   
recommendations established by the      
,commission on such solutions and       
remedies for improving wellness-based   
outcomes for veterans with mental health
 care issues4  7,b7 ,a feasible         
timeframe on when the complementary     
alternative treatments described in     
subsection 7b77#c7 can be implemented   
,department-wide4  7,c7 ,with respect to
 each recommendation established by the 
,commission1 including any complementary
 alternative treatment1 that the        
,secretary determines is not appropriate
 or feasible to implement1 a            
justification for such determination and
 an alternative solution to improve the 
efficacy of the therapy models used by  

the ,secretary for treating veterans    
with mental health issues4  7f7         
,termination of commission ,the         
,commission shall terminate #cj days    
after the ,commission submits the final 
report under subsection 7e77#b74  #cjb4 
,pilot program on integration of        
complementary alternative medicines and 
related issues for veterans and family  
members of veterans  7a7 ,pilot program 
7#a7 ,in general ,not later than #ahj   
days after the date on which the        
,secretary of ,veterans ,affairs        
receives the final report under section 
#cja7;e71 the ,secretary shall commence 
a pilot program to assess the           
feasibility and advisability of using   
wellness-based programs 7as defined by  
the ,secretary7 to complement the       
provision of pain management and related
 health care services1 including mental 
health care services1 to veterans4  7#b7
 ,matters addressed ,in carrying out the
 pilot program1 the ,secretary shall    
assess the following3 7,a7 ,means of    

improving coordination between ,federal1
 ,state1 local1 and community providers 
of health care in the provision of pain 
management and related health care      
services to veterans4  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 pain management and related 
health care services available to       
veterans4  7,c7 ,means of using         
wellness-based programs of providers of 
health care referred to in subparagraph 
7,a7 as complements to the provision by 
the ,department of pain management and  
related health care services to         
veterans4  7,d7 ,whether wellness-based 
programs described in subparagraph      
7,c7-- 7i7 are effective in enhancing   
the quality of life and well-being of   
veterans2  7ii7 are effective in        
increasing the adherence of veterans to 
the primary pain management and related 
health care services provided such      
veterans by the ,department2  7iii7 have

 an effect on the sense of well-being of
 veterans who receive primary pain      
management and related health care      
services from the ,department2 and  7iv7
 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 under subsection 7a77#a7 for a  
period of three years4  7c7 ,locations  
7#a7 ,facilities ,the ,secretary shall  
carry out the pilot program under       
subsection 7a77#a7 at facilities of the 
,department providing pain management   
and related health care services1       
including mental health care services1  
to veterans4 ,in selecting such         
facilities to carry out the pilot       
program1 the ,secretary shall select not
 fewer than #ae medical centers of the  
,department1 of which not fewer than two
 shall be polytrauma rehabilitation     
centers of the ,department4  7#b7       
,medical centers with prescription rates

 of opioids that conflict with care     
standards ,in selecting the medical     
centers under paragraph 7#a71 the       
,secretary shall give priority to       
medical centers of the ,department at   
which there is a prescription rate of   
opioids that conflicts with or is       
otherwise inconsistent with the         
standards of appropriate and safe care4 
7d7 ,provision of services ,under the   
pilot program under subsection 7a77#a71 
the ,secretary shall provide covered    
services to covered veterans by         
integrating complementary and           
alternative medicines and integrative   
health services with other services     
provided by the ,department at the      
medical centers selected under          
subsection 7c74  7e7 ,covered veterans  
,for purposes of the pilot program under
 subsection 7a77#a71 a covered veteran  
is any veteran who-- 7#a7 has a mental  
health condition diagnosed by a         
clinician of the ,department2  7#b7     
experiences chronic pain2  7#c7 has a   

chronic condition being treated by a    
clinician of the ,department2 or  7#d7  
is not described in paragraph 7#a71     
7#b71 or 7#c7 and requests to           
participate in the pilot program or is  
referred by a clinician of the          
,department who is treating the veteran4
  7f7 ,covered services  7#a7 ,in       
general ,for purposes of the pilot      
program1 covered services are services  
consisting of complementary and         
integrative health services as selected 
by the ,secretary4  7#b7 ,administration
 of services ,covered services shall be 
administered under the pilot program as 
follows3 7,a7 ,covered services shall be
 administered by professionals or other 
instructors with appropriate training   
and expertise in complementary and      
integrative health services who are     
employees of the ,department or with    
whom the ,department enters into an     
agreement to provide such services4     
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 ,office1 in coordination with 
the ,office of ,patient ,centered ,care 
and ,cultural ,transformation4  7,c7    
,covered services shall be made         
available to-- 7i7 covered veterans who 
have received conventional treatments   
from the ,department for the conditions 
for which the covered veteran seeks     
complementary and integrative health    
services under the pilot program2 and   
7ii7 covered veterans who have not      
received conventional treatments from   
the ,department for such conditions4    
7g7 ,reports  7#a7 ,in general ,not     
later than #cj months after the date on 
which the ,secretary commences the pilot
 program under subsection 7a77#a71 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 ,elements ,the report    

under paragraph 7#a7 shall include the  
following3 7,a7 ,the findings and       
conclusions of the ,secretary with      
respect to the pilot program under      
subsection 7a77#a71 including with      
respect to--  7i7 the use and efficacy  
of the complementary and integrative    
health services established under the   
pilot program2  7ii7 the outreach       
conducted by the ,secretary to inform   
veterans and community organizations    
about the pilot program2 and  7iii7 an  
assessment of the benefit of the pilot  
program to covered veterans in mental   
health diagnoses1 pain management1 and  
treatment of chronic illness4  7,b7     
,identification of any unresolved       
barriers that impede the ability of the 
,secretary to incorporate complementary 
and integrative health services with    
other health care services provided by  
the ,department4  7,c7 ,such            
recommendations for the continuation or 
expansion of the pilot program as the   
,secretary considers appropriate4  7h7  

,complementary and integrative health   
defined ,in this section1 the term      
complementary and integrative health    
shall have the meaning given that term  
by the ,national ,institutes of ,health4
  ,,iv ,fitness of ,health ,care        
,providers  #dja4 ,additional           
requirements for hiring of health care  
providers by ,department of ,veterans   
,affairs ,as part of the hiring process 
for each health care provider considered
 for a position at the ,department of   
,veterans ,affairs after the date of the
 enactment of the ,act1 the ,secretary  
of ,veterans ,affairs shall require from
 the medical board of each ,state in    
which the health care provider has a    
medical license--  7#a7 information on  
any violation of the requirements of the
 medical license of the health care     
provider during the #bj-year period     
preceding the consideration of the      
health care provider by the ,department2
 and  7#b7 information on whether the   
health care provider has entered into   

any settlement agreement for the        
disciplinary charge relating to the     
practice of medicine by the health care 
provider4  #djb4 ,provision of          
information on health care providers of 
,department of ,veterans ,affairs to    
,state ,medical ,boards ,notwithstanding
 section #eeb;a of title #e1 ,united    
,states ,code1 with respect to each     
health care provider of the ,department 
of ,veterans ,affairs who has violated a
 requirement of the medical license of  
the health care provider1 the ,secretary
 of ,veterans ,affairs shall provide to 
the medical board of each ,state in     
which the health care provider is       
licensed detailed information with      
respect to such violation1 regardless of
 whether such board has formally        
requested such information4  #djc4      
,report on compliance by ,department of 
,veterans ,affairs with reviews of      
health care providers leaving the       
,department or transferring to other    
facilities ,not later than #ahj days    

after the date of the enactment of this 
,act1 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        
compliance by the ,department of        
,veterans ,affairs with the policy of   
the ,department--  7#a7 to conduct a    
review of each health care provider of  
the ,department who transfers to another
 medical facility of the ,department1   
retires1 or is terminated to determine  
whether there are any concerns1         
complaints1 or allegations of violations
 relating to the medical practice of the
 health care provider2 and  7#b7 to take
 appropriate action with respect to any 
such concern1 complaint1 or allegation4 
,v ,other ,veterans ,matters  #eja4     
,audit of ,veterans ,health             
,administration programs of ,department 
of ,veterans ,affairs  7a7 ,audit ,the  
,secretary of ,veterans ,affairs shall  

seek to enter into a contract with a    
nongovernmental entity under which the  
entity shall conduct a audits of the    
programs of the ,veterans ,health       
,administration of the ,department of   
,veterans ,affairs to identify ways to  
improve the furnishing of benefits and  
health care administered by the         
,veterans ,health ,administration to    
veterans and families of veterans4  7b7 
,audit requirements ,in carrying out    
each audit under subsection 7a71 the    
entity shall perform the following3 7#a7
 ,five-year risk assessments to identify
 the functions1 staff organizations1 and
 staff offices of the ,veterans ,health 
,administration that would lead towards 
the greatest improvement in furnishing  
of benefits and health care to veterans 
and families of veterans4  7#b7         
,development of plans that are informed 
by the risk assessment under paragraph  
7#a7 to conduct audits of the functions1
 staff organizations1 and staff offices 
identified under paragraph 7#a74  7#c7  

,conduct audits in accordance with the  
plans developed pursuant to paragraph   
7#b74  7c7 ,reports ,not later than #ij 
days after the date on which each audit 
is completed under subsection 7a71 the  
,secretary shall submit to the          
,committees on ,veterans' ,affairs of   
the ,house of ,representatives and the  
,senate a report that includes--  7#a7 a
 summary of the audit2  7#b7 the        
findings of the entity that conducted   
the audit with respect to the audit2 and
  7#c7 such recommendations as the      
,secretary determines appropriate for   
legislative or administrative action to 
improve the furnishing of benefits and  
health care to veterans and families of 
veterans4  ,may #aj1 #bjaf ,reported    
from the ,committee on ,veterans'       
,affairs with an amendment ,may #aj1    
#bjaf ,the ,committee on ,armed         
,services discharged2 committed to the  
,committee of the ,whole ,house on the  
,state of the ,union and ordered to be  
printed