,,ii  #aadth ,,congress  #ast ,session  
,s4 #afda  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,june #bb1     
#bjae ,ms4 ,baldwin 7for herself1 ,mrs4 
,capito1 ,mr4 ,blumenthal1 ,mr4 ,brown1 
,ms4 ,hirono1 ,mr4 ,johnson1 ,mr4       
,kaine1 ,mr4 ,manchin1 ,mr4 ,markey1    
,mr4 ,moran1 ,mrs4 ,murray1 ,mr4        
,sanders1 and ,mr4 ,tester7 introduced  
the following bill2 which was read twice
 and referred to the ,committee on      
,veterans' ,affairs  ,a ,,bill  ,to     
improve the use by the ,department of   
,veterans ,affairs of opioids in        
treating veterans1 to improve patient   
advocacy by the ,department1 and to     
expand 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 ,jason ,simcakoski  
,memorial ,opioid ,safety ,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       
,guidelines on management of opioid     
therapy by ,department of ,veterans     
,affairs and ,department of ,defense and
 implementation of such guidelines by   
,department of ,veterans ,affairs4 ,sec4
 #ajb4 ,improvement of opioid safety    
measures by ,department of ,veterans    
,affairs4 ,sec4 #ajc4 ,establishment of 
working group on pain management and    
opioid therapy within the ,department of
 ,veterans ,affairs-,department of      
,defense ,joint ,executive ,committee4  
,sec4 #ajd4 ,establishment of pain      
management boards of ,department of     
,veterans ,affairs4 ,sec4 #aje4 ,study  
on feasibility and advisability of      
carrying out pharmacy lock-in program by
 ,department of ,veterans ,affairs4     
,sec4 #ajf4 ,reports and investigation  
on use of opioids in treatment by       
,department of ,veterans ,affairs4      
,,title ,,ii--,patient ,advocacy ,sec4  
#bja4 ,establishment of ,office of      

,patient ,advocacy of the ,department of
 ,veterans ,affairs4 ,sec4 #bjb4        
,community meetings on improving care   
from ,department of ,veterans ,affairs4 
,sec4 #bjc4 ,improvement of awareness of
 patient advocacy program and patient   
bill of rights of ,department of        
,veterans ,affairs4 ,sec4 #bjd4         
,comptroller ,general ,report on        
,patient ,advocacy ,program of          
,department of ,veterans ,affairs4 ,sec4
 #bje4 ,report on transition by veterans
 between different health care settings4
 ,,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 ,program on integration of        
complementary and integrative health    
within ,department of ,veterans ,affairs
 medical centers4 ,sec4 #cjc4 ,program  
on use of wellness programs as          
complementary approach to pain          
management and related issues for       

veterans and family members of veterans4
 ,,title ,,iv--,other ,veterans ,health 
,care ,matters ,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 ,department of    
,veterans ,affairs program of internal  
audits4  ,i ,opioid ,therapy and ,pain  
,management  #aja4 ,guidelines on       
management of opioid therapy by         
,department of ,veterans ,affairs and   
,department of ,defense and             
implementation of such guidelines by    
,department of ,veterans ,affairs  7a7  
,in general ,not later than one year    
after the date of the enactment of this 

,act1 the ,secretary of ,veterans       
,affairs and the ,secretary of ,defense 
shall jointly update the ,,va_/,,dod    
,clinical ,practice ,guideline for      
,management of ,opioid ,therapy for     
,chronic ,pain to include the following3
  7#a7 ,guidelines for safely           
prescribing opioids for the treatment of
 chronic1 non-cancer pain in outpatient 
settings as developed and released by   
the ,centers for ,disease ,control and  
,prevention4  7#b7 ,enhanced guidance   
with respect to absolute                
contraindications for opioid therapy1   
including guidance with respect to the  
following3  7,a7 ,the coadministration  
of drugs that are capable of inducing a 
life-limiting drug-drug interaction1    
including benzodiazepines4  7,b7 ,the   
treatment of patients with current acute
 psychiatric instability or substance   
use disorder or patients at risk of     
suicide4  7,c7 ,the use of opioid       
therapy to treat patients without any   
pain1 including to treat mental health  

disorders other than opioid use         
disorder4  7#c7 ,enhanced guidance with 
respect to the treatment of patients    
with behaviors or comorbidities1 such as
 post-traumatic stress disorder1        
psychiatric disorders1 or a history of  
substance abuse or addiction1 that      
require consultation or comanagement of 
opioid therapy with one or more         
specialists in pain management1 mental  
health1 or addictions4  7#d7 ,enhanced  
guidance with respect to the conduct by 
health care providers of an             
effectiveness assessment for patients   
receiving opioid therapy1 including     
patients on long-term opioid therapy1 to
 determine--  7,a7 whether opioid       
therapy is meeting the expected goals of
 the patient and health care provider of
 relieving pain1 improving function1 and
 providing patient satisfaction2 and    
7,b7 whether opioid therapy should be   
continued4  7#e7 ,requirements that each
 health care provider of the ,department
 of ,veterans ,affairs and the          

,department of ,defense1 before         
initiating opioid therapy to treat a    
patient1 use the ,opioid ,therapy ,risk 
,report tool of the ,department of      
,veterans ,affairs1 including           
information from the prescription drug  
monitoring program of each ,state that  
includes the most recent date           
information relating to the patient was 
accessed through such program1 as       
required to be included in such tool    
under section #ajb7;d77#b71 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#f7         
,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#g7 ,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#h7     
,enhanced recommendations 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 requirements--     
7,a7 that such tests occur not less     
frequently than once each year2 and     
7,b7 that health care providers         
appropriately 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 
7b7 ,consultation before update ,before 
updating the guideline under subsection 
7a71 the ,secretary of ,veterans        
,affairs and the ,secretary of ,defense 
shall jointly consult with the working  
group on pain management and opioid     
therapy established in section #ajc4    
7c7 ,comptroller ,general report on     
implementation by ,department of        
,veterans ,affairs ,not later than one  
year after the ,secretary of ,veterans  
,affairs updates the guideline under    
subsection 7a71 and not less frequently 
than annually thereafter1 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--  7#a7 the
 implementation by each medical facility
 of the ,department of ,veterans        
,affairs of such guideline2 and  7#b7   
the compliance by each such medical     

facility with such guideline4  7d7      
,controlled substance defined ,in this  
section1 the term controlled substance  
has the meaning given that term in      
section #ajb of the ,controlled         
,substances ,act 7#ba ,u4,s4,c4 #hjb74  
#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#b7 in order to          
appropriately implement and comply with 

the ,,va_/,,dod ,clinical ,practice     
,guideline for ,management of ,opioid   
,therapy for ,chronic ,pain1 including  
any updates to such guideline4  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 pain and includes education and 
training on the following3  7,a7 ,the   
safe and effective use of opioid therapy
 to treat chronic pain that is          
non-cancer related4  7,b7 ,the use of   
evidence-based pain management          
therapies1 including                    
cognitive-behavioral therapy1 non-opioid
 alternatives1 and non-drug approaches  
to managing pain and related health     
conditions including complementary and  
integrative health services4  7,c7      
,screening and identification of        
patients with substance use disorder1   
including drug-seeking behavior1 before 

prescribing opioids1 assessment of the  
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 ,the safe 
and effective use of urine drug tests4  
7,e7 ,prescription of the lowest        
effective dose of opioids based on      
patient need1 use of opioids only for a 
limited period of time1 and augmentation
 of opioid therapy with other pain      
management therapies and modalities4    
7,f7 ,the use of safe and effective     
tapering programs for patients taking   
opioids and other controlled substances1
 such as benzodiazepines1 concurrently  
and patients taking high-risk opioids4  
7,g7 ,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,h7 ,such other

 education and training as the          
,secretary considers appropriate to     
ensure that veterans receive safe1      
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 ,department4  7c7 ,pain management  
teams  7#a7 ,in general ,in carrying out
 the ,opioid ,safety ,initiative of the 
,department1 each medical facility of   
the ,department shall identify and      
designate a pain management team of     
health care professionals responsible   
for coordinating and overseeing 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 ,the director of each ,veterans 
,integrated ,service ,network shall     
establish protocols for the designation 

of pain management teams at each medical
 facility within that ,veterans         
,integrated ,service ,network4  7,b7    
,consultation on prescription of opioids
 ,each protocol established for a       
medical facility 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 such as 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 that 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 the enactment of this ,act1 the head
 of each medical facility of the        
,department shall submit to 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 facility4
  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 
and  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 related4  7d7 ,tracking and  
monitoring of opioid use  7#a7 ,tracking
 of data on opioid use ,not later than  
#ah months after the date of the        
enactment of this ,act1 in carrying out 

the ,opioid ,safety ,initiative and the 
,opioid ,therapy ,risk ,report tool of  
the ,department1 the ,secretary shall1  
through the ,computerized ,patient      
,record ,system of the ,department1     
allow for 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 include data on concurrent    
prescribing of opioids to treat mental  
health disorders other than opioid use  
disorder2 and  7,c7 mail-order          
prescriptions of opioids prescribed to  
veterans under the laws administered by 
the ,secretary4  7#b7 ,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 ,state1      
including by seeking to enter into      
memoranda of understanding with ,states 
to allow such access2  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#c7   
,report on implementation ,not later    
than #ahj days after the date of the    
enactment of this ,act1 the ,secretary  
shall submit to ,congress a report on   
the progress of the ,department in      
implementing the improvements to the    
,opioid ,therapy ,risk ,report tool of  

the ,department required under          
paragraphs 7#a7 and 7#b74  7e7          
,availability of opioid receptor        
antagonists  7#a7 ,increased            
availability and use  7,a7 ,in general  
,the ,secretary shall increase the      
availability of opioid receptor         
antagonists approved by the ,food and   
,drug ,administration1 such as naloxone1
 to veterans and increase the           
availability of opioid receptor         
antagonists for use by health care      
providers of the ,department in treating
 veterans4  7,b7 ,availability1         
training1 and distribution ,in carrying 
out subparagraph 7,a71 the ,secretary   
shall1 not later than #ij days after the
 date of the enactment of this ,act--   
7i7 equip each medical facility of the  
,department with opioid receptor        
antagonists approved by the ,food and   
,drug ,administration2  7ii7 enhance    
training for health care providers of   
the ,department on distributing such    
opioid receptor antagonists2 and  7iii7 

expand the ,overdose ,education and     
,naloxone ,distribution program of the  
,department to ensure that all veterans 
in receipt of health care under the laws
 administered by the ,secretary who are 
at risk of opioid overdose have access  
to 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 compliance 
with paragraph 7#a7 that includes an    
assessment of the following3  7,a7      
,whether all medical facilities of the  
,department are equipped with opioid    
receptor antagonists approved by the    
,food and ,drug ,administration4  7,b7  
,the progress of the ,department in     
ensuring that any such facilities that  
are not equipped with such opioid       
receptor antagonists obtain such opioid 
receptor antagonists4  7,c7 ,whether all
 veterans at risk of opioid overdose    
have access to such opioid receptor     
antagonists and training on the proper  
administration of such opioid receptor  
antagonists4  7,d7 ,the progress of the 
,department in ensuring that all        
veterans at risk of opioid overdose have
 access to such opioid receptor         
antagonists and training on the proper  
administration of such opioid receptor  
antagonists4  7f7 ,inclusion of certain 
information and capabilities in ,opioid 
,therapy ,risk ,report tool  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 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 ,notification 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 ,controlled substance    
defined ,in this section1 the term      
controlled substance has the meaning    
given that term in section #ajb of the  
,controlled ,substances ,act 7#ba       
,u4,s4,c4 #hjb74  #ajc4 ,establishment  
of working group on pain management and 
opioid therapy within the ,department of
 ,veterans ,affairs-,department of      
,defense ,joint ,executive ,committee   
7a7 ,working group on pain management   
and opioid therapy ,there is established
 within 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 a working   
group on pain management and opioid     
therapy for individuals receiving health
 care from either the ,department of    
,veterans ,affairs or the ,department of
 ,defense that shall cover1 at a        
minimum1 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  
that ,department1 including training    
health care providers with respect to   
pain management4  7#c7 ,the use by each 
,department of complementary and        
integrative health 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 working group        
established under subsection 7a7 shall--
 7#a7 coordinate 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    
pain management2  7#b7 consult 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 consult with the ,department  
of ,veterans ,affairs and the           
,department of ,defense with respect to1
 review1 and comment 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             
,consultation ,the ,secretary of        
,veterans ,affairs and the ,secretary of
 ,defense shall jointly ensure that the 
working group established under         
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 one year after the date of   
the enactment of this ,act4  #ajd4      
,establishment of pain management boards
 of ,department of ,veterans ,affairs   
7a7 ,in general ,subchapter ,i of       
chapter #gc of title #ch1 ,united       

,states ,code1 is amended by adding at  
the end the following new section3      
#gcji;,a4 ,pain management boards  7a7  
,establishment ,the ,secretary shall    
establish in each ,veterans ,integrated 
,service ,network a ,pain ,management   
,board 7in this section referred to as a
 ,board74  7b7 ,duties  7#a7 ,each      
,board shall-- 7,a7 consult with health 
care professionals and other employees  
of the ,department located in the       
,veterans ,integrated ,service ,network 
covered by the ,board1 patients who are 
being treated at medical facilities of  
the ,department located in such         
,veterans ,integrated ,service ,network1
 and family members of such patients    
with respect to the pain management     
resources and best practices of the     
,department2  7,b7 oversee compliance by
 the health care professionals and other
 employees of the ,department with the  
best practices of the ,department1      
including by issuing such               
recommendations to improve compliance   

with such best practices as the ,board  
considers appropriate2  7,c7 provide    
oversight of the pain management        
practices of the pain management        
committees of each medical facility of  
the ,department and the health care     
professionals and other employees of the
 ,department that are located in the    
,veterans ,integrated ,service ,network 
covered by the ,board2  7,d7 carry out  
educational forums1 as the ,board       
considers appropriate1 for individuals  
specified in subparagraph 7,a7 on pain  
management and treatment that may       
include the sharing of updated research 
and best practices from medical experts1
 other health care systems1 and such    
other ,federal agencies as the ,board   
considers necessary to carry out this   
subparagraph2 and  7,e7 carry out public
 hearings1 symposiums1 or other events1 
as the ,board considers appropriate1    
during which health care professionals  
discuss and share best practices on pain
 management and complementary and       

integrative health4  7#b7 7,a7 ,each    
,board may provide treatment            
recommendations for patients with       
complex clinical pain who are being     
treated at a medical facility of the    
,department located in the ,veterans    
,integrated ,service ,network covered by
 the ,board1 and assist in facilitating 
communication between such patients and 
their health care providers1 regardless 
of whether such treatment is on an      
in-patient or out-patient basis1 and for
 whom a request for such                
recommendations1 subject to subparagraph
 7,c71 has been made by an individual   
described in subparagraph 7,b74  7,b7   
,an individual described in this        
subparagraph is one of the following    
individuals3 7i7 ,the patient4  7ii7    
,the spouse of the patient4  7iii7 ,a   
family member of the patient or another 
individual if such family member or     
individual has been designated by the   
patient to make health care decisions   
for the patient or to receive health    

care information with respect to the    
patient4  7iv7 ,a physician of the      
patient4  7v7 ,an employee of the       
medical facility of the ,department     
described in subparagraph 7,a74  7,c7   
,an individual described in subparagraph
 7,b7 may not request treatment         
recommendations under subparagraph 7,a7 
unless the individual--  7i7 has        
requested treatment recommendations from
 the pain management committee of the   
medical facility of the ,department at  
which the patient is receiving          
treatment2 and  7ii7 has received       
treatment recommendations from such     
committee and is not satisfied with     
those treatment recommendations4  7#c7  
,based on treatment recommendations     
developed under paragraph 7#b77;,a71    
consultations conducted under paragraph 
7#a77;,a71 and educational forums and   
public events carried out under         
subparagraphs 7,c7 and 7,d7 of paragraph
 7#a71 each ,board shall provide to     
health care professionals of the        

,department located in the ,veterans    
,integrated ,service ,network covered by
 the ,board recommendations on the best 
practices regarding pain management in  
cases of complex clinical pain4  7#d7   
7,a7 ,each ,board shall annually submit 
to the ,secretary and the ,under        
,secretary for ,health a report 7with   
all personally identifiable information 
of patients redacted7 on pain management
 practices carried out in the ,veterans 
,integrated ,service ,network covered by
 the ,board4 ,each such report shall    
include1 for the year covered by the    
report1 the following3  7i7 ,the        
treatment recommendations provided under
 paragraph 7#b77;,a71 including-- 7,i7 a
 summary of such recommendations2 and   
7,,ii7 an explanation of the merits of  
each such recommendation4  7ii7 ,the    
recommendations for best practices      
provided under paragraph 7#c71          
including--  7,i7 a summary of such     
recommendations2 and  7,,ii7 an         
explanation of the merits of each such  

recommendation4  7iii7 ,such other      
information as the ,board considers     
appropriate4  7,b7 ,not later than      
,january #ca of each year1 the          
,secretary shall submit to the          
,committee on ,veterans' ,affairs of the
 ,senate and the ,committee on          
,veterans' ,affairs of the ,house of    
,representatives a report that contains 
comprehensive information from each     
report submitted to the ,secretary under
 subparagraph 7,a7 during the year      
preceding the submittal of the report by
 the ,secretary1 disaggregated by       
,board4  7#e7 ,the ,federal ,advisory   
,committee ,act 7#e ,u4,s4,c4 ,app47    
shall not apply to any ,board4  7c7     
,membership  7#a7 ,each ,board shall    
include the following individuals       
appointed by the ,secretary3  7,a7 ,a   
board certified pain medicine           
specialist4  7,b7 ,a trained and        
qualified member of the primary care    
team of a medical facility of the       
,department with experience in pain     

care1 such as a nurse practitioner4     
7,c7 ,a pain psychologist4  7,d7 ,a pain
 social worker4  7,e7 ,a clinical       
pharmacist4  7,f7 ,a pain point of      
contact for a ,veterans ,integrated     
,service ,network4  7,g7 ,a physician   
with addiction and psychopharmacology   
expertise and experience4  7,h7 ,an     
allied health care professional4  7,i7  
,a clinician with expertise in          
complementary and integrative health4   
7,j7 ,a clinical behavioral therapist4  
7,k7 ,a patient advocate4  7,l7 ,a      
representative of the labor interests of
 employees of the ,department who are   
responsible for prescribing drugs4  7,m7
 ,a current or former clinical patient4 
7,n7 ,a family member of a current or   
former clinical patient4  7#b7 ,of the  
members appointed under paragraph 7#a71 
not less than three shall be            
representative of the demographic of    
patients served by the ,veterans        
,integrated ,service ,network covered by
 the ,board1 including--  7,a7 not less 

than two current or former patients     
treated at a medical facility of the    
,department for complex clinical pain2  
and  7,b7 not less than one family      
member of such a current or former      
patient4  7#c7 ,the ,secretary shall    
determine the terms of service of the   
members of each ,board4  7#d7 7,a7      
,members of each ,board shall serve     
without pay and1 except as provided in  
subparagraph 7,b71 members who are      
full-time officers or employees of the  
,united ,states may not receive         
additional pay1 allowances1 or benefits 
by reason of their service on the       
,board4  7,b7 ,members may receive      
travel expenses1 including per diem in  
lieu of subsistence1 for travel in      
connection with their duties as members 
of the ,board4  7,c7 ,any member who has
 clinical duties as an officer or       
employee of the ,united ,states shall be
 relieved of such duties during periods 
in which such relief is necessary for   
the member to carry out the duties of   

the ,board4  7d7 ,availability of       
information ,in carrying out the duties 
of a ,board under subsection 7b71       
specific information identifying a      
patient and other confidential          
information relating to a patient may   
not be made available to any member     
appointed under subsection 7c77#a7      
solely based on qualifications under    
subparagraph 7,m7 or 7,n7 of such       
subsection4  7e7 ,employment protections
 ,no adverse personnel action may be    
made against an employee of the         
,department in connection with a        
communication by the employee with a    
member of a ,board relating to the      
duties of the ,board under subsection   
7b7 and any such communication shall be 
covered by the employment and           
whistleblower protections otherwise     
applicable to communications by         
employees of the ,department4  7f7      
,resources of ,department ,the          
,secretary shall make available to each 
,board the resources and personnel of   

the ,department necessary for the ,board
 to carry out the duties of the ,board  
under subsection 7b71 including         
resources and personnel of the ,general 
,counsel of the ,department4  7g7       
,powers  7#a7 ,each ,board may1 for the 
purpose of carrying out this section1   
hold hearings1 sit and act at times and 
places1 take testimony1 and receive     
evidence as the ,board determines       
appropriate4  7#b7 ,each ,board may     
conduct site visits of medical          
facilities of the ,department to collect
 information that the ,board considers  
necessary to carry out this section4    
7#c7 ,the ,secretary shall provide to   
each ,board such administrative support 
services as the ,secretary considers    
necessary for the ,board to carry out   
this section4  4  7b7 ,clerical         
amendment ,the table of sections at the 
beginning of chapter #gc of such title  
is amended by inserting after the item  
relating to section #gcji the following 
new item3  #gcji;,a4 ,pain management   

boards4  4  #aje4 ,study on feasibility 
and advisability of carrying out        
pharmacy lock-in program by ,department 
of ,veterans ,affairs  7a7 ,in general  
,the ,secretary of ,veterans ,affairs   
shall conduct a study on the feasibility
 and advisability of carrying out a     
pharmacy lock-in program under which    
veterans at risk for abuse of           
prescription drugs are permitted to     
receive prescription drugs only from    
certain specified pharmacies of the     
,department of ,veterans ,affairs4  7b7 
,report ,not later than one year 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 study  
conducted under subsection 7a74  #ajf4  
,reports and investigation 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 at 

all medical facilities of the           
,department to treat non-cancer1        
non-palliative1 and non-hospice care    
patients1 including whether each medical
 facility or health care provider of the
 ,department is among the top ten       
percent of medical facilities or health 
care providers of the ,department with  
respect to such prescription rates2     
7iii7 the prescription rates and        
prescriptions indications of            
benzodiazepines and opioids             
concomitantly by health care providers  
of the ,department1 including whether   
each medical facility or health care    
provider of the ,department is among the
 top ten percent of medical facilities  
or health care providers of the         
,department with respect to such        
prescription rates2  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 ,recommendations with    
respect to whether sanctions are needed1
 such as written warnings or performance
 improvement plans1 for health care     
providers of the ,department that are-- 
7i7 not practicing at a level meeting or
 exceeding the minimum level standard of
 care established by the ,department2   
and  7ii7 not following the enhanced    
guidance with respect to absolute       
contraindications for opioid therapy set
 forth in the ,,va_/,,dod ,clinical     
,practice ,guideline for ,management of 
,opioid ,therapy for ,chronic ,pain1 as 
updated under section #aja4  7b7        
,quarterly progress report on           
implementation of ,comptroller ,general 
recommendations ,not later than #ahj    
days 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 ,department
 of ,veterans ,affairs during the period
 covered by the report to address any   
outstanding findings and recommendations
 by the ,comptroller ,general of the    
,united ,states with respect to the     
,veterans ,health ,administration4  7c7 
,annual report and investigation on     
opioid therapy  7#a7 ,report ,not later 
than one year after the date of the     
enactment of this ,act1 and not less    
frequently than annually 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 report    
that contains1 for the one year period  
preceding the submittal of the report1  

the following3  7,a7 ,the number of     
patients and the percentage of the      
patient population of the ,department of
 ,veterans ,affairs 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 a
 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--  7i7 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  7ii7 the    
prescription rate at which each health  
care provider at the facility prescribed
 benzodiazepines or opioids to such     
patients to treat conditions for which  
opioids or benzodiazepines are not an   
approved treatment and the aggregate    
such prescription rate for all health   

care providers at the facility2  7iii7  
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 such  
prescription rate for all health care   
providers at the facility2 and  7iv7 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 such prescription rate
 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 a          

medication to a veteran4  7#b7          
,investigation ,if a report submitted   
under paragraph 7#a7 indicates that a   
prescription rate described in          
subparagraph 7,e7 of such paragraph at a
 medical facility of the ,department is 
among the top ten percent of medical    
facilities of the ,department with      
respect to such prescription rate1 the  
,secretary shall--  7,a7 through the    
,office of the ,medical ,inspector of   
the ,veterans ,health ,administration1  
conduct a full investigation of the     
medical facility2 and  7,b7 immediately 
notify the ,committee on ,veterans      
,affairs' of the ,senate1 the ,committee
 on ,veterans ,affairs' of the ,house of
 ,representatives1 and each ,member of  
the ,senate and the ,house of           
,representatives who represents the area
 in which the medical facility is       
located4  7d7 ,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 patient   
population 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   
,,ii ,patient ,advocacy  #bja4          
,establishment of ,office of ,patient   
,advocacy of the ,department of         
,veterans ,affairs  7a7 ,in general     
,subchapter ,i of chapter #gc of title  
#ch1 ,united ,states ,code1 is amended  
by adding at the end the following new  
section3  #gcji;,a4 ,office of ,patient 
,advocacy  7a7 ,establishment ,there is 

established in the ,department within   
the ,office of the ,under ,secretary for
 ,health an office to be known as the   
,office of ,patient ,advocacy 7in this  
section referred to as the ,office74    
7b7 ,head  7#a7 ,the ,director of the   
,office of ,patient ,advocacy shall be  
the head of the ,office4  7#b7 ,the     
,director of the ,office of ,patient    
,advocacy shall be appointed by the     
,under ,secretary for ,health from among
 individuals qualified to perform the   
duties of the position and shall report 
directly to the ,under ,secretary for   
,health4  7c7 ,function  7#a7 ,the      
function of the ,office is to carry out 
the ,patient ,advocacy ,program of the  
,department4  7#b7 ,in carrying out the 
,patient ,advocacy ,program of the      
,department1 the ,director shall ensure 
that patient advocates of the           
,department--  7,a7 advocate on behalf  
of veterans with respect to health care 
received and sought by veterans under   
the laws administered by the ,secretary2

  7,b7 carry out the responsibilities   
specified in subsection 7d72 and  7,c7  
receive training in patient advocacy4   
7d7 ,patient advocacy responsibilities  
,the responsibilities of each patient   
advocate at a medical facility of the   
,department are the following3  7#a7 ,to
 resolve complaints by veterans with    
respect to health care furnished under  
the laws administered by the ,secretary 
that cannot be resolved at the point of 
service or at a higher level easily     
accessible to the veteran4  7#b7 ,to    
present at various meetings and to      
various committees the issues           
experienced by veterans in receiving    
such health care at such medical        
facility4  7#c7 ,to express to veterans 
their rights and responsibilities as    
patients in receiving such health care4 
7#d7 ,to manage the ,patient ,advocate  
,tracking ,system of the ,department at 
such medical facility4  7#e7 ,to compile
 data at such medical facility of       
complaints made by veterans with respect

 to the receipt of such health care at  
such medical facility and the           
satisfaction of veterans with such      
health care at such medical facility to 
determine whether there are trends in   
such data4  7#f7 ,to ensure that a      
process is in place for the distribution
 of the data compiled under paragraph   
7#e7 to appropriate leaders1 committees1
 services1 and staff of the ,department4
  7#g7 ,to identify1 not less frequently
 than quarterly1 opportunities for      
improvements in the furnishing of such  
health care to veterans at such medical 
facility based on complaints by         
veterans4  7#h7 ,to ensure that any     
significant complaint by a veteran with 
respect to such health care is brought  
to the attention of appropriate staff of
 the ,department to trigger an          
assessment of whether there needs to be 
a further analysis of the problem at the
 facility-wide level4  7#i7 ,to support 
any patient advocacy programs carried   
out by the ,department4  7#aj7 ,to      

ensure that all appeals and final       
decisions with respect to the receipt of
 such health care are entered into the  
,patient ,advocate ,tracking ,system of 
the ,department4  7#aa7 ,to understand  
all laws1 directives1 and other rules   
with respect to the rights and          
responsibilities of veterans in         
receiving such health care1 including   
the appeals processes available to      
veterans4  7#ab7 ,to ensure that        
veterans receiving mental health care1  
or the surrogate decisionmakers for such
 veterans1 are aware of the rights of   
veterans to seek representation from    
systems established under section #ajc  
of the ,protection and ,advocacy for    
,mentally ,ill ,individuals ,act of     
#aihf 7#db ,u4,s4,c4 #ajhjc7 to protect 
and advocate the rights of individuals  
with mental illness and to investigate  
incidents of abuse and neglect of such  
individuals4  7#ac7 ,to fulfill         
requirements established by the         
,secretary with respect to the          

inspection of controlled substances4    
7#ad7 ,to document potentially          
threatening behavior and report such    
behavior to appropriate authorities4    
7e7 ,training ,in providing training to 
patient advocates under subsection      
7c77#b77;,c71 the ,director shall ensure
 that such training is consistent       
throughout the ,department4  7f7 ,annual
 report ,not later than two years after 
the date of the enactment of the ,jason 
,simcakoski ,memorial ,opioid ,safety   
,act1 and not less frequently than      
annually 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 the activities conducted by the     
,office during the period covered by the
 report4  7g7 ,controlled substance     
defined ,in this section1 the term      
controlled substance has the meaning    
given that term in section #ajb of the  
,controlled ,substances ,act 7#ba       

,u4,s4,c4 #hjb74  4  7b7 ,clerical      
amendment ,the table of sections at the 
beginning of chapter #gc of such title  
is amended by adding after the item     
relating to section #gcji the following 
new item3  #gcji;,a4 ,office of ,patient
 ,advocacy4  4  7c7 ,date fully         
operational ,the ,secretary of ,veterans
 ,affairs shall ensure that the ,office 
of ,patient ,advocacy established in    
section #gcji;,a of title #ch1 ,united  
,states ,code1 as added by subsection   
7a71 is fully operational not later than
 the date that is one year after the    
date of the enactment of this ,act4     
#bjb4 ,community meetings on improving  
care from ,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 each    
medical center of the ,department of    
,veterans ,affairs shall host a         
community meeting open to the public on 

improving health care from the          
,department4  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 each community     
based outpatient clinic of the          
,department shall host a community      
meeting open to the public on improving 
health care from the ,department4  7b7  
,attendance by ,director of ,veterans   
,integrated ,service ,network or        
designee  7#a7 ,in general ,subject to  
paragraph 7#b71 each community meeting  
hosted by a medical center or community 
based outpatient clinic under subsection
 7a7 shall be attended by the ,director 
of the ,veterans ,integrated ,service   
,network in which the medical center or 
community based outpatient clinic1 as   
the case may be1 is located1 or an      
employee designated by the ,director who
 works in the office of the ,director4  
7#b7 ,attendance by ,director ,each     
,director of a ,veterans ,integrated    

,service ,network shall attend not less 
than one community meeting under        
subsection 7a7 hosted by each medical   
center located in the ,veterans         
,integrated ,service ,network each year4
  7c7 ,notice ,each medical center or   
community based outpatient clinic       
hosting a community meeting shall send  
timely notice of the community meeting  
to the ,committee on ,veterans ,affairs'
 of the ,senate1 the ,committee on      
,veterans ,affairs' of the ,house of    
,representatives1 and each ,member of   
the ,senate and the ,house of           
,representatives who represents the area
 in which the medical facility is       
located4  #bjc4 ,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       
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 of     
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  #bjd4 ,comptroller   
,general ,report on ,patient ,advocacy  
,program of ,department of ,veterans    
,affairs  7a7 ,in general ,not later    
than three 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         
,program7 as carried out under the      
,office of ,patient ,advocacy of the    
,department established in section      
#gcji;,a of title #ch1 ,united ,states  
,code1 as added by section #bja7;a74    
7b7 ,elements ,the report required by   
subsection 7a7-- 7#a7 shall include--   
7,a7 such recommendations and proposals 
for improving or modifying the ,program 
as the ,comptroller ,general considers  
appropriate2 and  7,b7 such other       
information with respect to the ,program
 as the ,comptroller ,general considers 
appropriate2 and  7#b7 may include--    
7,a7 a description of the ,program1     
including--  7i7 the purposes of the    
,program2  7ii7 the activities carried  
out under the ,program2 and  7iii7 the  
sufficiency of the ,program in achieving
 the purposes of the ,program2  7,b7 an 
assessment of the sufficiency of        

staffing of employees of the ,department
 responsible for carrying out the       
,program2  7,c7 an assessment of the    
sufficiency of the training of such     
employees2 and  7,d7 an assessment of-- 
7i7 awareness of the ,program among     
veterans and their family members2 and  
7ii7 the use of the ,program by veterans
 and their family members4  #bje4       
,report on transition by veterans       
between different health care settings  
7a7 ,in general ,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        
transitions undergone by veterans in    
receiving health care in different      
health care settings4  7b7 ,elements    
,the report required by subsection 7a7  
shall include the following3 7#a7 ,an   
evaluation of the standards of the      

,department for facilitating and        
managing the transitions undergone by   
veterans in receiving health care in    
different health care settings4  7#b7   
,an assessment of the case management   
services of the ,department that are    
available for veterans who are          
undergoing a transition in health care  
settings4  7#c7 ,an assessment of 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#d7 ,such         
recommendations to improve transitions  
in health care settings among veterans  
as the ,secretary considers appropriate1
 including the coordination of drug     
formularies between the ,department of  
,defense and the ,department of         
,veterans ,affairs and the development  
of care transition plans for patients   
with complex medical issues4  ,,iii     

,complementary and ,integrative ,health 
#cja4 ,expansion of research and        
education on and delivery of            
complementary and integrative health to 
veterans  7a7 ,development of plan ,to  
expand research1 education1 and delivery
 ,not later than #ahj days after the    
date of the enactment of this ,act1 the 
,secretary of ,veterans ,affairs shall  
develop a plan to expand materially and 
substantially the scope of the          
effectiveness of research and education 
on1 and delivery and integration of1    
complementary and integrative health    
services into the health care services  
provided to veterans4  7b7 ,elements    
,the plan required by subsection 7a7    
shall provide for the following3 7#a7   
,research on the following3  7,a7 ,the  
effectiveness of various complementary  
and integrative health services1        
including the effectiveness of such     
services integrated with clinical       
therapies4  7,b7 ,approaches to         
integrating complementary and           

integrative health services into other  
health care services provided by the    
,department4  7#b7 ,education and       
training for health care professionals  
of the ,department on the following3    
7,a7 ,complementary and integrative     
health services selected by the         
,secretary for purposes of the plan4    
7,b7 ,appropriate uses of such services4
  7,c7 ,integration of such services    
into the delivery of health care to     
veterans4  7#c7 ,research1 education1   
and clinical activities on complementary
 and integrative health at centers of   
innovation at medical centers of the    
,department4  7#d7 ,identification or   
development of metrics and outcome      
measures to evaluate the effectiveness  
of the provision and integration of     
complementary and integrative health    
services into the delivery of health    
care to veterans4  7#e7 ,integration and
 delivery of complementary and          
integrative health services with other  
health care services provided by the    

,department4  7c7 ,consultation  7#a7   
,in general ,in carrying out subsection 
7a71 the ,secretary shall consult with  
the following3 7,a7 ,the ,director of   
the ,national ,center for ,complementary
 and ,integrative ,health of the        
,national ,institutes of ,health4  7,b7 
,the ,commissioner of ,food and ,drugs4 
7,c7 ,institutions of higher education1 
private research institutes1 and        
individual researchers with extensive   
experience in complementary and         
integrative health and the integration  
of complementary and integrative health 
practices into the delivery of health   
care4  7,d7 ,nationally recognized      
providers of complementary and          
integrative health4  7,e7 ,such other   
officials1 entities1 and individuals    
with expertise on complementary and     
integrative health as the ,secretary    
considers appropriate4  7#b7 ,scope of  
consultation ,the ,secretary shall      
undertake consultation under paragraph  
7#a7 in carrying out subsection 7a7 with

 respect to the following3  7,a7 ,to    
develop the plan4  7,b7 ,to identify    
specific complementary and integrative  
health practices that1 on the basis of  
research findings or promising clinical 
interventions1 are appropriate to       
include as services to veterans4  7,c7  
,to identify barriers to the effective  
provision and integration of            
complementary and integrative health    
services into the delivery of health    
care to veterans1 and to identify       
mechanisms for overcoming such barriers4
  7d7 ,funding ,there is authorized to  
be appropriated to the ,secretary such  
sums as may be necessary to carry out   
this section4  7e7 ,complementary and   
integrative health defined ,in this     
section1 the term complementary and     
integrative health has the meaning given
 that term by the ,national ,institutes 
of ,health4  #cjb4 ,program on          
integration of complementary and        
integrative health within ,department of
 ,veterans ,affairs medical centers  7a7

 ,program required ,not later than the  
completion of the development of the    
plan under section #cja1 the ,secretary 
of ,veterans ,affairs shall--  7#a7     
carry out1 through the ,office of       
,patient ,centered ,care and ,cultural  
,transformation of the ,department of   
,veterans ,affairs1 a program to assess 
the feasibility and advisability of     
integrating the delivery of             
complementary and integrative health    
services selected by the ,secretary with
 other health care services provided by 
the ,department for veterans with mental
 health conditions1 chronic pain        
conditions1 other chronic conditions1   
and such other conditions as the        
,secretary determines appropriate2 and  
7#b7 in developing the program-- 7,a7   
use the plan developed under section    
#cja2 and  7,b7 identify and1 to the    
extent practicable1 resolve barriers to 
the provision of complementary and      
integrative health services selected by 
the ,secretary and the integration of   

those services with other health care   
services provided by the ,department4   
7b7 ,locations  7#a7 ,in general ,the   
,secretary shall carry out the program  
at not fewer than #ae medical centers of
 the ,department4  7#b7 ,polytrauma     
centers ,not less than two of the       
medical centers designated under        
paragraph 7#a7 shall be located at      
polytrauma rehabilitation centers of the
 ,department4  7#c7 ,medical centers    
with high prescription rate of opioids  
7,a7 ,in general ,in selecting 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 is among the top ten       
percent of medical centers of the       
,department with respect to such        
prescription rate4  7,b7 ,prescription  
rate defined ,in this paragraph1 the    
term prescription rate means1 with      
respect to a medical center of the      
,department1 each of the following3 7i7 

,the number of patients treated with    
opioids at the medical center divided by
 the total patient population of that   
medical center4  7ii7 ,the average      
number of morphine equivalents per day  
prescribed at the medical center to     
patients being treated with opioids4    
7iii7 ,of the patients being treated    
with opioids at the medical center1 the 
average number of prescriptions of      
opioids per patient4  7#d7 ,selection of
 locations ,in carrying out the program1
 the ,secretary shall select locations  
that include the following areas3 7,a7  
,rural areas4  7,b7 ,areas that are not 
in close proximity to an active duty    
military installation4  7,c7 ,areas     
representing different geographic       
locations1 such as census tracts        
established by the ,bureau of the       
,census4  7c7 ,provision of services    
,under the program1 the ,secretary shall
 provide covered services to covered    
veterans by integrating complementary   
and integrative health services with    

other services provided by the          
,department at the medical centers      
designated under subsection 7b77#a74    
7d7 ,covered veterans ,for purposes of  
the program1 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 
program or is referred by a clinician of
 the ,department who is treating the    
veteran4  7e7 ,covered services  7#a7   
,in general ,for purposes of the        
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 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 program2 and  7ii7   
covered veterans who have not received  
conventional treatments from the        
,department for such conditions4  7f7   
,voluntary participation ,the           
participation of a veteran in the       

program shall be at the election of the 
veteran and in consultation with a      
clinician of the ,department4  7g7      
,reports to ,congress  7#a7 ,quarterly  
reports ,not later than #ij days after  
the date of the commencement of the     
program and not less frequently than    
once every #ij days thereafter for the  
duration of the 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 program1 including a      
description of the outreach conducted by
 the ,secretary to veterans and         
community organizations to inform such  
organizations about the program4  7#b7  
,final report  7,a7 ,in general ,not    
later than three years after the date of
 the commencement of the 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        
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 program1 including with  
respect to--  7,i7 the use and efficacy 
of the complementary and integrative    
health services established under the   
program2 and  7,,ii7 an assessment of   
the benefit of the program to covered   
veterans in mental health diagnoses1    
pain management1 and treatment of       
chronic illness4  7ii7 ,barriers        
identified under subsection 7a77#b77;,b7
 that were not resolved4  7iii7 ,such   
recommendations for the continuation or 
expansion of the 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  
in section #cja7;e74  #cjc4 ,program on 

use of wellness programs as             
complementary approach to pain          
management and related issues for       
veterans and family members of veterans 
7a7 ,program required  7#a7 ,in general 
,the ,secretary of ,veterans ,affairs   
shall carry out a 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 pain management and related
 health care services1 such as mental   
health care services1 to veterans and   
family members of veterans4  7#b7       
,matters ,to be addressed ,the 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 pain          
management and related health care      
services to veterans and family members 
of 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 veterans and      
family members of veterans4  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 pain management   
and related health care services to     
veterans and family members of veterans4
  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 of veterans4  7,e7       
,whether wellness programs described in 
subparagraph 7,c7 are effective in      
increasing the adherence of veterans to 
the primary pain management and related 
health care services provided such      
veterans by the ,department4  7,f7      
,whether wellness programs described in 
subparagraph 7,c7 have an impact on the 

sense of well-being of veterans who     
receive primary pain management and     
related health care 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 program  
for a period of three years beginning on
 the date that is one year after the    
date of the enactment of this ,act4  7c7
 ,locations ,the ,secretary shall carry 
out the program at facilities of the    
,department providing pain management   
and related health care services1 such  
as mental health care services1 to      
veterans and family members of veterans4
  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 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 program4  7,c7 ,such other      

requirements as 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 individuals ,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       
veterans and family members of veterans4
  7f7 ,reports  7#a7 ,periodic reports  
7,a7 ,in general ,not later than #ahj   
days after the date of the commencement 
of the program1 and not less frequently 
than every #ahj days thereafter1 the    
,secretary shall submit to ,congress a  
report on the 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 program during the       

#ahj-;day period preceding the report4  
7ii7 ,an assessment of the benefits of  
the 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 program1 the ,secretary  
shall submit to ,congress a report      
detailing the recommendations of the    
,secretary as to the feasibility and    
advisability of continuing or expanding 
the program4  7g7 ,wellness defined ,in 
this section1 the term wellness has the 
meaning given that term in regulations  
prescribed by the ,secretary for        
purposes of this section4  ,,iv ,other  
,veterans ,health ,care ,matters  #dja4 
,additional requirements for hiring of  
health care providers by ,department of 
,veterans ,affairs ,the ,secretary of   
,veterans ,affairs shall1 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 this 

,act1 request 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 a 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 the         
,secretary of ,veterans ,affairs shall1 
with respect to any health care provider
 of the ,department of ,veterans        
,affairs that has violated a requirement
 of their medical license1 provide to   
the medical board of each ,state in     

which the health care provider is       
licensed detailed information with      
respect to such violation4  #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 two years    
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 ,department or 
leaves the ,department 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     
,department of ,veterans ,affairs       
program of internal audits  7a7 ,in     
general ,subchapter ,,ii of chapter #e  
of title #ch1 ,united ,states ,code1 is 
amended by inserting after section #ebg 
the following new section3  #ebg;,a4    
,program of internal audits  7a7        
,program required  7#a7 ,the ,secretary 
shall carry out a program of internal   
audits and self-analysis to improve the 
furnishing of benefits and health care  
to veterans and their families4  7#b7   
,the ,secretary shall carry out the     
program required by paragraph 7#a7      
through an office the ,secretary shall  
establish for purposes of the program   
within the office of the ,secretary that
 is interdisciplinary and independent   
of--  7,a7 the other offices within the 
office of the ,secretary2 and  7,b7 the 
covered administrations 7or functions of

 such administrations71 staff           
organizations1 and staff offices        
identified under subsection             
7b77#a77;,a74  7b7 ,program requirements
  7#a7 ,in carrying out the program     
required by subsection 7a71 the         
,secretary shall-- 7,a7 conduct periodic
 risk assessments of the ,department to 
identify those covered administrations  
7or functions of such administrations71 
staff organizations1 and staff offices  
of the ,department the audit of which   
would lead towards the greatest         
improvement in the furnishing of        
benefits and health care to veterans and
 their families2  7,b7 develop plans    
that are informed by the risk           
assessments conducted under paragraph   
7#a7 to conduct internal audits of the  
covered administrations 7or functions of
 such administrations71 staff           
organizations1 and staff offices        
identified under subparagraph 7,a72 and 
7,c7 conduct internal audits in         
accordance with the plans developed     

pursuant to subparagraph 7,b74  7#b7    
,the ,secretary shall carry out under   
the program required by subsection 7a7  
an audit of not fewer than five covered 
administrations 7or functions of such   
administrations71 staff organizations1  
or staff offices of the ,department each
 year4  7#c7 ,in identifying covered    
administrations 7or functions of such   
administrations71 staff organizations1  
and staff offices of the ,department    
under paragraph 7#a77;,a71 the          
,secretary shall accord priority to the 
covered administrations and functions of
 such administrations4  7#d7 7,a7 ,for  
purposes of this subsection1 the covered
 administrations of the ,department are 
the following3 7i7 ,the ,national       
,cemetery ,administration4  7ii7 ,the   
,veterans ,benefits ,administration4    
7iii7 ,the ,veterans ,health            
,administration4  7,b7 ,for purposes    
this subsection1 the covered staff      
organizations of the ,department are the
 following3 7i7 ,the ,office of         

,acquisition1 ,logistics1 and           
,construction4  7ii7 ,the ,advisory     
,committee ,management ,office4  7iii7  
,the ,board of ,veterans' ,appeals4     
7iv7 ,the ,center for ,faith-,based and 
,neighborhood ,partnerships4  7v7 ,the  
,center for ,minority ,veterans4  7vi7  
,the ,center for ,women ,veterans4      
7vii7 ,the ,office of ,general ,counsel4
  7viii7 ,the ,office of ,regulation    
,policy and ,management4  7ix7 ,the     
,office of ,employment ,discrimination  
,complaint ,adjudication4  7x7 ,the     
,office of ,interagency ,care and       
,benefits ,coordination4  7xi7 ,the     
,office of ,small and ,disadvantaged    
,business ,utilization4  7xii7 ,the     
,office of ,survivors ,assistance4      
7xiii7 ,the ,veterans' ,service         
,organizations ,liaison4  7,c7 ,for     
purposes of this subsection1 the covered
 staff offices of the ,department are   
the following3 7i7 ,the office of the   
,assistant ,secretary for ,congressional
 and ,legislative ,affairs4  7ii7 ,the  

office of the ,assistant ,secretary for 
,human ,resources and ,administration4  
7iii7 ,the office of the ,assistant     
,secretary for ,information and         
,technology4  7iv7 ,the ,office of      
,management4  7v7 ,the office of the    
,assistant ,secretary for ,operations1  
,security1 and ,preparedness4  7vi7 ,the
 office of the ,assistant ,secretary for
 ,policy and ,planning4  7vii7 ,the     
office of the ,assistant ,secretary for 
,public and ,intergovernmental ,affairs4
  7c7 ,reports  7#a7 ,not later than #ij
 days after completing an audit under   
the program required by subsection 7a71 
the ,secretary shall submit to the      
appropriate committees of ,congress a   
report on the audit4  7#b7 ,each report 
submitted under paragraph 7#a7 with     
respect to an audit shall include the   
following3 7,a7 ,a summary of the audit4
  7,b7 ,the findings of the ,secretary  
with respect to the audit4  7,c7 ,such  
recommendations as the ,secretary may   
have for legislative or administrative  

action to improve the furnishing of     
benefits and health care to veterans and
 their families4  7#c7 ,in this         
subsection1 the term appropriate        
committees of ,congress includes-- 7,a7 
the ,committee on ,veterans' ,affairs1  
the ,committee on ,appropriations1 and  
the ,committee on ,homeland ,security   
and ,governmental ,affairs of the       
,senate2 and  7,b7 the ,committee on    
,veterans' ,affairs1 the ,committee on  
,appropriations1 and the ,committee on  
,oversight and ,government ,reform of   
the ,house of ,representatives4  4  7b7 
,first risk assessment ,the ,secretary  
of ,veterans ,affairs shall complete the
 first risk assessment required by      
section #ebg;,a7b77#a77;,a7 of such     
title1 as added by subsection 7a71 by   
not later than #ahj days after the date 
of the enactment of this ,act4  7c7     
,clerical amendment ,the table of       
sections at the beginning of chapter #e 
of such title is amended by inserting   
after the item relating to section #ebg 

the following new item3  #ebg;,a4       
,program of internal audits4  4