,,ii  #aad? ,,congress  #a/ ,session    
,s4 #afda  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,june #bb1 #bjae ,ms4  
,baldw9 7= h]self1 ,mrs4 ,capito1 ,mr4  
,blum5?al1 ,mr4 ,br[n1 ,ms4 ,hirono1    
,mr4 ,johnson1 ,mr4 ,ka9e1 ,mr4 ,man*91 
,mr4 ,m>key1 ,mr4 ,moran1 ,mrs4 ,murray1
 ,mr4 ,s&]s1 & ,mr4 ,te/]7 introduc$ !  
foll[+ bill2 :i* 0 read twice & ref]r$  
to ! ,committee on ,vet]ans' ,affairs   
,a ,,bill  ,to improve ! use by !       
,dep>tm5t ( ,vet]ans ,affairs ( opioids 
9 treat+ vet]ans1 to improve pati5t     
advocacy by ! ,dep>tm5t1 & to exp&      
availability ( complem5t>y & integrative
 heal?1 & = o!r purposes4  #a4 ,%ort    
title2 table ( cont5ts  7a7 ,%ort title 
,?is ,act may be cit$ z ! ,jason        
,simcakoski ,memorial ,opioid ,safety   
,act4  7b7 ,table ( cont5ts ,! table (  
cont5ts = ?is ,act is z foll[s3 ,sec4   
#a4 ,%ort title2 table ( cont5ts4       
,,title ,i--,opioid ,!rapy & ,pa9       
,managem5t ,sec4 #aja4 ,guidel9es on    
managem5t ( opioid !rapy by ,dep>tm5t ( 

,vet]ans ,affairs & ,dep>tm5t ( ,def5se 
& implem5tation ( su* guidel9es by      
,dep>tm5t ( ,vet]ans ,affairs4 ,sec4    
#ajb4 ,improvem5t ( opioid safety       
measures by ,dep>tm5t ( ,vet]ans        
,affairs4 ,sec4 #ajc4 ,e/abli%m5t (     
work+ gr\p on pa9 managem5t & opioid    
!rapy )9 ! ,dep>tm5t ( ,vet]ans         
,affairs-,dep>tm5t ( ,def5se ,jo9t      
,executive ,committee4 ,sec4 #ajd4      
,e/abli%m5t ( pa9 managem5t bo>ds (     
,dep>tm5t ( ,vet]ans ,affairs4 ,sec4    
#aje4 ,/udy on feasibility &            
advisability ( c>ry+ out ph>macy lock-9 
program by ,dep>tm5t ( ,vet]ans         
,affairs4 ,sec4 #ajf4 ,reports &        
inve/igation on use ( opioids 9 treatm5t
 by ,dep>tm5t ( ,vet]ans ,affairs4      
,,title ,,ii--,pati5t ,advocacy ,sec4   
#bja4 ,e/abli%m5t ( ,(fice ( ,pati5t    
,advocacy ( ! ,dep>tm5t ( ,vet]ans      
,affairs4 ,sec4 #bjb4 ,community meet+s 
on improv+ c>e f ,dep>tm5t ( ,vet]ans   
,affairs4 ,sec4 #bjc4 ,improvem5t (     
aw>5ess ( pati5t advocacy program &     

pati5t bill ( rights ( ,dep>tm5t (      
,vet]ans ,affairs4 ,sec4 #bjd4          
,comptroll] ,g5]al ,report on ,pati5t   
,advocacy ,program ( ,dep>tm5t (        
,vet]ans ,affairs4 ,sec4 #bje4 ,report  
on transition by vet]ans betwe5 diff]5t 
heal? c>e sett+s4 ,,title               
,,iii--,complem5t>y & ,integrative      
,heal? ,sec4 #cja4 ,expansion ( rese>* &
 education on & deliv]y ( complem5t>y & 
integrative heal? to vet]ans4 ,sec4     
#cjb4 ,program on integration (         
complem5t>y & integrative heal? )9      
,dep>tm5t ( ,vet]ans ,affairs m$ical    
c5t]s4 ,sec4 #cjc4 ,program on use (    
wellness programs z complem5t>y approa* 
to pa9 managem5t & relat$ issues =      
vet]ans & family memb]s ( vet]ans4      
,,title ,,iv--,o!r ,vet]ans ,heal? ,c>e 
,matt]s ,sec4 #dja4 ,additional         
requirem5ts = hir+ ( heal? c>e provid]s 
by ,dep>tm5t ( ,vet]ans ,affairs4 ,sec4 
#djb4 ,provision ( in=mation on heal?   
c>e provid]s ( ,dep>tm5t ( ,vet]ans     
,affairs to ,/ate m$ical bo>ds4 ,sec4   

#djc4 ,report on compliance by ,dep>tm5t
 ( ,vet]ans ,affairs ) reviews ( heal?  
c>e provid]s leav+ ! ,dep>tm5t or       
transf]r+ to o!r facilities4 ,,title    
,v--,o!r ,vet]ans ,matt]s ,sec4 #eja4   
,dep>tm5t ( ,vet]ans ,affairs program ( 
int]nal audits4  ,i ,opioid ,!rapy &    
,pa9 ,managem5t  #aja4 ,guidel9es on    
managem5t ( opioid !rapy by ,dep>tm5t ( 
,vet]ans ,affairs & ,dep>tm5t ( ,def5se 
& implem5tation ( su* guidel9es by      
,dep>tm5t ( ,vet]ans ,affairs  7a7 ,9   
g5]al ,n lat] ?an "o ye> aft] ! date ( !
 enactm5t ( ?is ,act1 ! ,secret>y (     
,vet]ans ,affairs & ! ,secret>y (       
,def5se %all jo9tly update ! ,,va_/,,dod
 ,cl9ical ,practice ,guidel9e =         
,managem5t ( ,opioid ,!rapy = ,*ronic   
,pa9 to include ! foll[+3  7#a7         
,guidel9es = safely prescrib+ opioids = 
! treatm5t ( *ronic1 non-canc] pa9 9    
outpati5t sett+s z develop$ & releas$ by
 ! ,c5t]s = ,disease ,control &         
,prev5tion4  7#b7 ,enhanc$ guidance )   
respect to absolute contra9dications =  

opioid !rapy1 includ+ guidance ) respect
 to ! foll[+3  7,a7 ,! coadm9i/ration ( 
drugs t are capable ( induc+ a          
life-limit+ drug-drug int]action1       
includ+ b5zodiazep9es4  7,b7 ,! treatm5t
 ( pati5ts ) curr5t acute psy*iatric    
in/ability or sub/ance use disord] or   
pati5ts at risk ( suicide4  7,c7 ,! use 
( opioid !rapy to treat pati5ts )\t any 
pa91 includ+ to treat m5tal heal?       
disord]s o!r ?an opioid use disord]4    
7#c7 ,enhanc$ guidance ) respect to !   
treatm5t ( pati5ts ) behaviors or       
comorbidities1 su* z po/-traumatic /ress
 disord]1 psy*iatric disord]s1 or a     
hi/ory ( sub/ance abuse or addiction1 t 
require consultation or comanagem5t (   
opioid !rapy ) "o or m speciali/s 9 pa9 
managem5t1 m5tal heal?1 or addictions4  
7#d7 ,enhanc$ guidance ) respect to !   
conduct by heal? c>e provid]s ( an      
effectiv5ess assessm5t = pati5ts receiv+
 opioid !rapy1 includ+ pati5ts on       
long-t]m opioid !rapy1 to det]m9e--     
7,a7 :e!r opioid !rapy is meet+ !       

expect$ goals ( ! pati5t & heal? c>e    
provid] ( reliev+ pa91 improv+ function1
 & provid+ pati5t satisfaction2 &  7,b7 
:e!r opioid !rapy %\ld be cont9u$4  7#e7
 ,requirem5ts t ea* heal? c>e provid] ( 
! ,dep>tm5t ( ,vet]ans ,affairs & !     
,dep>tm5t ( ,def5se1 be=e initiat+      
opioid !rapy to treat a pati5t1 use !   
,opioid ,!rapy ,risk ,report tool ( !   
,dep>tm5t ( ,vet]ans ,affairs1 includ+  
in=mation f ! prescription drug monitor+
 program ( ea* ,/ate t includes ! mo/   
rec5t date in=mation relat+ to ! pati5t 
0 access$ ?r\gh su* program1 z requir$  
to be includ$ 9 su* tool "u section     
#ajb7;d77#b71 to assess ! risk = adv]se 
outcomes ( opioid !rapy = ! pati5t1     
includ+ ! concurr5t use ( controll$     
sub/ances su* z b5zodiazep9es1 z "p ( ! 
compreh5sive assessm5t conduct$ by !    
heal? c>e provid]4  7#f7 ,guidel9es to  
gov]n ! me?odologies us$ by heal? c>e   
provid]s ( ! ,dep>tm5t ( ,vet]ans       
,affairs & ! ,dep>tm5t ( ,def5se to tap]
 opioid !rapy :5 adju/+ or discont9u+ ! 

use ( opioid !rapy4  7#g7 ,guidel9es )  
respect to appropriate case managem5t = 
pati5ts receiv+ opioid !rapy :o         
transition betwe5 inpati5t & outpati5t  
heal? c>e sett+s1 :i* may include ! use 
( c>e transition plans4  7#h7 ,enhanc$  
recomm5dations ) respect to ! use (     
r\t9e & r&om ur9e drug te/s = all       
pati5ts be=e & dur+ opioid !rapy to help
 prev5t sub/ance abuse1 dep5d5ce1 &     
div]sion1 includ+ requirem5ts--  7,a7 t 
su* te/s occur n less frequ5tly ?an once
 ea* ye>2 &  7,b7 t heal? c>e provid]s  
appropriately int]pret & respond to !   
results f su* te/s to tailor pa9 !rapy1 
safegu>ds1 & risk managem5t /rategies to
 ea* pati5t4  7#i7 ,guidance t heal? c>e
 provid]s discuss ) pati5ts1 be=e       
initiat+ opioid !rapy1 options = pa9    
managem5t !rapies )\t ! use ( opioids & 
options to augm5t opioid !rapy ) o!r    
cl9ical & complem5t>y & integrative     
heal? s]vices to m9imize opioid         
dep5d5ce4  7b7 ,consultation be=e update
 ,be=e updat+ ! guidel9e "u subsection  

7a71 ! ,secret>y ( ,vet]ans ,affairs & !
 ,secret>y ( ,def5se %all jo9tly consult
 ) ! work+ gr\p on pa9 managem5t &      
opioid !rapy e/abli%$ 9 section #ajc4   
7c7 ,comptroll] ,g5]al report on        
implem5tation by ,dep>tm5t ( ,vet]ans   
,affairs ,n lat] ?an "o ye> aft] !      
,secret>y ( ,vet]ans ,affairs updates ! 
guidel9e "u subsection 7a71 & n less    
frequ5tly ?an annually !reaft]1 !       
,comptroll] ,g5]al ( ! ,unit$ ,/ates    
%all submit to ! ,committee on ,vet]ans'
 ,affairs ( ! ,s5ate & ! ,committee on  
,vet]ans' ,affairs ( ! ,h\se (          
,repres5tatives a report on--  7#a7 !   
implem5tation by ea* m$ical facility ( !
 ,dep>tm5t ( ,vet]ans ,affairs ( su*    
guidel9e2 &  7#b7 ! compliance by ea*   
su* m$ical facility ) su* guidel9e4  7d7
 ,controll$ sub/ance def9$ ,9 ?is       
section1 ! t]m controll$ sub/ance has ! 
mean+ giv5 t t]m 9 section #ajb ( !     
,controll$ ,sub/ances ,act 7#ba         
,u4,s4,c4 #hjb74  #ajb4 ,improvem5t (   
opioid safety measures by ,dep>tm5t (   

,vet]ans ,affairs  7a7 ,expansion (     
,opioid ,safety ,initiative ,n lat] ?an 
#ahj days aft] ! date ( ! enactm5t ( ?is
 ,act1 ! ,secret>y ( ,vet]ans ,affairs  
%all exp& ! ,opioid ,safety ,initiative 
( ! ,dep>tm5t ( ,vet]ans ,affairs to    
include all m$ical facilities ( !       
,dep>tm5t4  7b7 ,pa9 managem5t education
 & tra9+  7#a7 ,9 g5]al ,9 c>ry+ out !  
,opioid ,safety ,initiative ( !         
,dep>tm5t1 ! ,secret>y %all require all 
employees ( ! ,dep>tm5t responsible =   
prescrib+ opioids to receive education &
 tra9+ describ$ 9 p>agraph 7#b7 9 ord]  
to appropriately implem5t & comply ) !  
,,va_/,,dod ,cl9ical ,practice ,guidel9e
 = ,managem5t ( ,opioid ,!rapy = ,*ronic
 ,pa91 includ+ any updates to su*       
guidel9e4  7#b7 ,education & tra9+      
,education & tra9+ describ$ 9 ?is       
p>agraph is education & tra9+ on pa9    
managem5t & safe opioid prescrib+       
practices = purposes ( safely &         
effectively manag+ pati5ts ) *ronic pa9 
& includes education & tra9+ on !       

foll[+3  7,a7 ,! safe & effective use ( 
opioid !rapy to treat *ronic pa9 t is   
non-canc] relat$4  7,b7 ,! use (        
evid5ce-bas$ pa9 managem5t !rapies1     
includ+ cognitive-behavioral !rapy1     
non-opioid alt]natives1 & non-drug      
approa*es to manag+ pa9 & relat$ heal?  
conditions includ+ complem5t>y &        
integrative heal? s]vices4  7,c7 ,scre5+
 & id5tification ( pati5ts ) sub/ance   
use disord]1 includ+ drug-seek+         
behavior1 be=e prescrib+ opioids1       
assessm5t ( ! risk pot5tial = pati5ts   
develop+ an addiction1 & ref]ral (      
pati5ts to appropriate addiction        
treatm5t pr(essionals if addiction is   
id5tifi$ or /rongly suspect$4  7,d7 ,!  
safe & effective use ( ur9e drug te/s4  
7,e7 ,prescription ( ! l[e/ effective   
dose ( opioids bas$ on pati5t ne$1 use (
 opioids only = a limit$ p]iod ( "t1 &  
augm5tation ( opioid !rapy ) o!r pa9    
managem5t !rapies & modalities4  7,f7 ,!
 use ( safe & effective tap]+ programs =
 pati5ts tak+ opioids & o!r controll$   

sub/ances1 su* z b5zodiazep9es1         
concurr5tly & pati5ts tak+ high-risk    
opioids4  7,g7 ,communication ) pati5ts 
on ! pot5tial h>m associat$ ) ! use (   
opioids & o!r controll$ sub/ances1      
includ+ ! ne$ to safely /ore & dispose (
 supplies relat+ to ! use ( opioids &   
o!r controll$ sub/ances4  7,h7 ,su* o!r 
education & tra9+ z ! ,secret>y consid]s
 appropriate to ensure t vet]ans receive
 safe1 high-quality pa9 managem5t c>e f 
! ,dep>tm5t4  7#c7 ,use ( exi/+ program 
,9 provid+ education & tra9+ describ$ 9 
p>agraph 7#b71 ! ,secret>y %all use !   
,int]discipl9>y ,*ronic ,pa9 ,managem5t 
,tra9+ ,team ,program ( ! ,dep>tm5t4    
7c7 ,pa9 managem5t teams  7#a7 ,9 g5]al 
,9 c>ry+ out ! ,opioid ,safety          
,initiative ( ! ,dep>tm5t1 ea* m$ical   
facility ( ! ,dep>tm5t %all id5tify &   
designate a pa9 managem5t team ( heal?  
c>e pr(essionals responsible = coord9at+
 & ov]see+ !rapy at su* facility =      
pati5ts exp]i5c+ acute & *ronic pa9 t is
 non-canc] relat$4  7#b7 ,e/abli%m5t (  

protocols  7,a7 ,9 g5]al ,! director (  
ea* ,vet]ans ,integrat$ ,s]vice ,network
 %all e/abli% protocols = ! designation 
( pa9 managem5t teams at ea* m$ical     
facility )9 t ,vet]ans ,integrat$       
,s]vice ,network4  7,b7 ,consultation on
 prescription ( opioids ,ea* protocol   
e/abli%$ = a m$ical facility "u         
subp>agraph 7,a7 %all ensure t any heal?
 c>e provid] )\t exp]tise 9 prescrib+   
analgesics or :o has n complet$ !       
education & tra9+ "u subsection 7b71 su*
 z a m5tal heal? c>e provid]1 does n    
prescribe opioids to a pati5t unless t  
heal? c>e provid]--  7i7 consults ) a   
heal? c>e provid] ) pa9 managem5t       
exp]tise or :o is on ! pa9 managem5t    
team ( ! m$ical facility2 &  7ii7 ref]s 
! pati5t to t pa9 managem5t team = any  
subsequ5t prescriptions & relat$ !rapy4 
7#c7 ,report  7,a7 ,9 g5]al ,n lat] ?an 
"o ye> aft] ! date ( ! enactm5t ( ?is   
,act1 ! head ( ea* m$ical facility ( !  
,dep>tm5t %all submit to ! director ( ! 
,vet]ans ,integrat$ ,s]vice ,network 9  

:i* ! m$ical facility is locat$ a report
 id5tify+ ! heal? c>e pr(essionals t h  
be5 designat$ z memb]s ( ! pa9 managem5t
 team at ! m$ical facility4  7,b7       
,elem5ts ,ea* report submitt$ "u        
subp>agraph 7,a7 ) respect to a m$ical  
facility ( ! ,dep>tm5t %all include--   
7i7 a c]tification z to :e!r all memb]s 
( ! pa9 managem5t team at ! m$ical      
facility h complet$ ! education & tra9+ 
requir$ "u subsection 7b72 &  7ii7 a    
plan = ! managem5t & ref]ral ( pati5ts  
to su* pa9 managem5t team if heal? c>e  
provid]s )\t exp]tise 9 prescrib+       
analgesics prescribe opioid m$ications  
to treat acute & *ronic pa9 t is        
non-canc] relat$4  7d7 ,track+ &        
monitor+ ( opioid use  7#a7 ,track+ (   
data on opioid use ,n lat] ?an #ah mon?s
 aft] ! date ( ! enactm5t ( ?is ,act1 9 
c>ry+ out ! ,opioid ,safety ,initiative 
& ! ,opioid ,!rapy ,risk ,report tool ( 
! ,dep>tm5t1 ! ,secret>y %all1 ?r\gh !  
,comput]iz$ ,pati5t ,record ,sy/em ( !  
,dep>tm5t1 all[ = real-"t track+ ( &    

access to data on--  7,a7 ! key cl9ical 
indicators ) respect to ! totality (    
opioid use by vet]ans2  7,b7 concurr5t  
prescrib+ by heal? c>e provid]s ( !     
,dep>tm5t ( opioids 9 diff]5t heal? c>e 
sett+s1 include data on concurr5t       
prescrib+ ( opioids to treat m5tal heal?
 disord]s o!r ?an opioid use disord]2 & 
7,c7 mail-ord] prescriptions ( opioids  
prescrib$ to vet]ans "u ! laws adm9i/]$ 
by ! ,secret>y4  7#b7 ,prescription drug
 monitor+ programs ( ,/ates ,9 c>ry+ out
 ! ,opioid ,safety ,initiative & !      
,opioid ,!rapy ,risk ,report tool ( !   
,dep>tm5t1 ! ,secret>y %all--  7,a7     
ensure access by heal? c>e provid]s ( ! 
,dep>tm5t to in=mation on controll$     
sub/ances1 includ+ opioids &            
b5zodiazep9es1 prescrib$ to vet]ans :o  
receive c>e outside ! ,dep>tm5t ?r\gh ! 
prescription drug monitor+ program ( ea*
 ,/ate1 includ+ by seek+ to ent] into   
memor&a ( und]/&+ ) ,/ates to all[ su*  
access2  7,b7 include su* in=mation 9 ! 
,opioid ,!rapy ,risk ,report2 &  7,c7   

require heal? c>e provid]s ( ! ,dep>tm5t
 to submit to ! prescription drug       
monitor+ program ( ea* ,/ate in=mation  
on prescriptions ( controll$ sub/ances  
receiv$ by vet]ans 9 t ,/ate "u ! laws  
adm9i/]$ by ! ,secret>y4  7#c7 ,report  
on implem5tation ,n lat] ?an #ahj days  
aft] ! date ( ! enactm5t ( ?is ,act1 !  
,secret>y %all submit to ,congress a    
report on ! progress ( ! ,dep>tm5t 9    
implem5t+ ! improvem5ts to ! ,opioid    
,!rapy ,risk ,report tool ( ! ,dep>tm5t 
requir$ "u p>agraphs 7#a7 & 7#b74  7e7  
,availability ( opioid receptor         
antagoni/s  7#a7 ,increas$ availability 
& use  7,a7 ,9 g5]al ,! ,secret>y %all  
increase ! availability ( opioid        
receptor antagoni/s approv$ by ! ,food &
 ,drug ,adm9i/ration1 su* z naloxone1 to
 vet]ans & increase ! availability (    
opioid receptor antagoni/s = use by     
heal? c>e provid]s ( ! ,dep>tm5t 9      
treat+ vet]ans4  7,b7 ,availability1    
tra9+1 & di/ribution ,9 c>ry+ out       
subp>agraph 7,a71 ! ,secret>y %all1 n   

lat] ?an #ij days aft] ! date ( !       
enactm5t ( ?is ,act--  7i7 equip ea*    
m$ical facility ( ! ,dep>tm5t ) opioid  
receptor antagoni/s approv$ by ! ,food &
 ,drug ,adm9i/ration2  7ii7 enhance     
tra9+ = heal? c>e provid]s ( ! ,dep>tm5t
 on di/ribut+ su* opioid receptor       
antagoni/s2 &  7iii7 exp& ! ,ov]dose    
,education & ,naloxone ,di/ribution     
program ( ! ,dep>tm5t to ensure t all   
vet]ans 9 receipt ( heal? c>e "u ! laws 
adm9i/]$ by ! ,secret>y :o are at risk (
 opioid ov]dose h access to su* opioid  
receptor antagoni/s & tra9+ on ! prop]  
adm9i/ration ( su* opioid receptor      
antagoni/s4  7,c7 ,vet]ans :o are at    
risk ,= purposes ( subp>agraph 7,b71    
vet]ans :o are at risk ( opioid ov]dose 
include-- 7i7 vet]ans receiv+ long-t]m  
opioid !rapy2  7ii7 vet]ans receiv+     
opioid !rapy :o h a hi/ory ( sub/ance   
use disord] or prior in/ances ( ov]dose2
 &  7iii7 vet]ans :o are at risk z      
det]m9$ by a heal? c>e provid] :o is    
treat+ ! vet]an4  7#b7 ,report ,n lat]  

?an #abj days aft] ! date ( ! enactm5t (
 ?is ,act1 ! ,secret>y %all submit to ! 
,committee on ,vet]ans' ,affairs ( !    
,s5ate & ! ,committee on ,vet]ans'      
,affairs ( ! ,h\se ( ,repres5tatives a  
report on compliance ) p>agraph 7#a7 t  
includes an assessm5t ( ! foll[+3  7,a7 
,:e!r all m$ical facilities ( !         
,dep>tm5t are equipp$ ) opioid receptor 
antagoni/s approv$ by ! ,food & ,drug   
,adm9i/ration4  7,b7 ,! progress ( !    
,dep>tm5t 9 ensur+ t any su* facilities 
t are n equipp$ ) su* opioid receptor   
antagoni/s obta9 su* opioid receptor    
antagoni/s4  7,c7 ,:e!r all vet]ans at  
risk ( opioid ov]dose h access to su*   
opioid receptor antagoni/s & tra9+ on ! 
prop] adm9i/ration ( su* opioid receptor
 antagoni/s4  7,d7 ,! progress ( !      
,dep>tm5t 9 ensur+ t all vet]ans at risk
 ( opioid ov]dose h access to su* opioid
 receptor antagoni/s & tra9+ on ! prop] 
adm9i/ration ( su* opioid receptor      
antagoni/s4  7f7 ,inclusion ( c]ta9     
in=mation & capabilities 9 ,opioid      

,!rapy ,risk ,report tool  7#a7         
,in=mation ,! ,secret>y %all include 9 !
 ,opioid ,!rapy ,risk ,report tool ( !  
,dep>tm5t--  7,a7 in=mation on ! mo/    
rec5t "t ! tool 0 access$ by a heal? c>e
 provid] ( ! ,dep>tm5t ) respect to ea* 
vet]an2 &  7,b7 in=mation on ! results (
 ! mo/ rec5t ur9e drug te/ = ea* vet]an4
  7#b7 ,capabilities ,! ,secret>y %all  
include 9 ! ,opioid ,!rapy ,risk ,report
 tool ! ability ( heal? c>e provid]s ( !
 ,dep>tm5t to det]m9e :e!r a heal? c>e  
provid] ( ! ,dep>tm5t prescrib$ opioids 
to a vet]an )\t *eck+ ! in=mation 9 !   
tool ) respect to ! vet]an4  7g7        
,notification ( risk 9 comput]iz$ heal? 
record ,! ,secret>y %all modify !       
,comput]iz$ ,pati5t ,record ,sy/em ( !  
,dep>tm5t to ensure t any heal? c>e     
provid] t accesses ! record ( a vet]an1 
reg>dless ( ! reason ! vet]an seeks c>e 
f ! heal? c>e provid]1 w be imm$iately  
notifi$ :e!r ! vet]an--  7#a7 is receiv+
 opioid !rapy & has a hi/ory ( sub/ance 
use disord] or prior in/ances ( ov]dose2

  7#b7 has a hi/ory ( opioid abuse2 or  
7#c7 is at risk ( becom+ an opioid abus]
 z det]m9$ by a heal? c>e provid] :o is 
treat+ ! vet]an4  7h7 ,controll$        
sub/ance def9$ ,9 ?is section1 ! t]m    
controll$ sub/ance has ! mean+ giv5 t   
t]m 9 section #ajb ( ! ,controll$       
,sub/ances ,act 7#ba ,u4,s4,c4 #hjb74   
#ajc4 ,e/abli%m5t ( work+ gr\p on pa9   
managem5t & opioid !rapy )9 ! ,dep>tm5t 
( ,vet]ans ,affairs-,dep>tm5t ( ,def5se 
,jo9t ,executive ,committee  7a7 ,work+ 
gr\p on pa9 managem5t & opioid !rapy    
,!re is e/abli%$ )9 ! ,heal? ,executive 
,committee ( ! ,dep>tm5t ( ,vet]ans     
,affairs-,dep>tm5t ( ,def5se ,jo9t      
,executive ,committee e/abli%$ "u       
section #cbj ( title #ch1 ,unit$ ,/ates 
,code1 a work+ gr\p on pa9 managem5t &  
opioid !rapy = individuals receiv+ heal?
 c>e f ei!r ! ,dep>tm5t ( ,vet]ans      
,affairs or ! ,dep>tm5t ( ,def5se t %all
 cov]1 at a m9imum1 ! foll[+3  7#a7 ,!  
opioid prescrib+ practices ( heal? c>e  
provid]s ( ea* ,dep>tm5t4  7#b7 ,!      

ability ( ea* ,dep>tm5t to manage acute 
& *ronic pa9 among individuals receiv+  
heal? c>e f t ,dep>tm5t1 includ+ tra9+  
heal? c>e provid]s ) respect to pa9     
managem5t4  7#c7 ,! use by ea* ,dep>tm5t
 ( complem5t>y & integrative heal? 9    
treat+ su* individuals4  7#d7 ,!        
concurr5t use by heal? c>e provid]s (   
ea* ,dep>tm5t ( opioids & prescription  
drugs to treat m5tal heal? disord]s1    
includ+ b5zodiazep9es4  7#e7 ,! practice
 by heal? c>e provid]s ( ea* ,dep>tm5t (
 prescrib+ opioids to treat m5tal heal? 
disord]s4  7#f7 ,! coord9ation 9 cov]age
 ( & consi/5t access to m$ications      
prescrib$ = pati5ts transition+ f       
receiv+ heal? c>e f ! ,dep>tm5t (       
,def5se to receiv+ heal? c>e f !        
,dep>tm5t ( ,vet]ans ,affairs4  7#g7 ,! 
ability ( ea* ,dep>tm5t to id5tify &    
treat sub/ance use disord]s among       
individuals receiv+ heal? c>e f t       
,dep>tm5t4  7b7 ,coord9ation &          
consultation ,! work+ gr\p e/abli%$ "u  
subsection 7a7 %all-- 7#a7 coord9ate !  

activities ( ! work+ gr\p ) o!r relevant
 work+ gr\ps e/abli%$ "u section #cbj ( 
title #ch1 ,unit$ ,/ates ,code1 includ+ 
! work+ gr\ps on evid5ce bas$ practice1 
pati5t safety1 ph>macy1 psy*ological    
heal?1 & pa9 managem5t2  7#b7 consult ) 
o!r relevant ,f$]al ag5cies1 includ+ !  
,c5t]s = ,disease ,control & ,prev5tion1
 ) respect to ! activities ( ! work+    
gr\p2 &  7#c7 consult ) ! ,dep>tm5t (   
,vet]ans ,affairs & ! ,dep>tm5t (       
,def5se ) respect to1 review1 & comm5t  
on ! ,,va_/,,dod ,cl9ical ,practice     
,guidel9e = ,managem5t ( ,opioid ,!rapy 
= ,*ronic ,pa91 or any successor        
guidel9e1 be=e any update to ! guidel9e 
is releas$4  7c7 ,consultation ,!       
,secret>y ( ,vet]ans ,affairs & !       
,secret>y ( ,def5se %all jo9tly ensure t
 ! work+ gr\p e/abli%$ "u subsection 7a7
 is able to mean+fully consult ) respect
 to ! updat$ guidel9e requir$ "u        
subsection 7a7 ( section #aja1 z requir$
 by subsection 7b7 ( su* section1 n lat]
 ?an "o ye> aft] ! date ( ! enactm5t (  

?is ,act4  #ajd4 ,e/abli%m5t ( pa9      
managem5t bo>ds ( ,dep>tm5t ( ,vet]ans  
,affairs  7a7 ,9 g5]al ,sub*apt] ,i (   
*apt] #gc ( title #ch1 ,unit$ ,/ates    
,code1 is am5d$ by add+ at ! end !      
foll[+ new section3  #gcji;,a4 ,pa9     
managem5t bo>ds  7a7 ,e/abli%m5t ,!     
,secret>y %all e/abli% 9 ea* ,vet]ans   
,integrat$ ,s]vice ,network a ,pa9      
,managem5t ,bo>d 79 ?is section ref]r$  
to z a ,bo>d74  7b7 ,duties  7#a7 ,ea*  
,bo>d %all-- 7,a7 consult ) heal? c>e   
pr(essionals & o!r employees ( !        
,dep>tm5t locat$ 9 ! ,vet]ans ,integrat$
 ,s]vice ,network cov]$ by ! ,bo>d1     
pati5ts :o are be+ treat$ at m$ical     
facilities ( ! ,dep>tm5t locat$ 9 su*   
,vet]ans ,integrat$ ,s]vice ,network1 & 
family memb]s ( su* pati5ts ) respect to
 ! pa9 managem5t res\rces & be/         
practices ( ! ,dep>tm5t2  7,b7 ov]see   
compliance by ! heal? c>e pr(essionals &
 o!r employees ( ! ,dep>tm5t ) ! be/    
practices ( ! ,dep>tm5t1 includ+ by     
issu+ su* recomm5dations to improve     

compliance ) su* be/ practices z ! ,bo>d
 consid]s appropriate2  7,c7 provide    
ov]sight ( ! pa9 managem5t practices ( !
 pa9 managem5t committees ( ea* m$ical  
facility ( ! ,dep>tm5t & ! heal? c>e    
pr(essionals & o!r employees ( !        
,dep>tm5t t are locat$ 9 ! ,vet]ans     
,integrat$ ,s]vice ,network cov]$ by !  
,bo>d2  7,d7 c>ry out educational =ums1 
z ! ,bo>d consid]s appropriate1 =       
individuals specifi$ 9 subp>agraph 7,a7 
on pa9 managem5t & treatm5t t may       
include ! %>+ ( updat$ rese>* & be/     
practices f m$ical exp]ts1 o!r heal? c>e
 sy/ems1 & su* o!r ,f$]al ag5cies z !   
,bo>d consid]s necess>y to c>ry out ?is 
subp>agraph2 &  7,e7 c>ry out public    
he>+s1 symposiums1 or o!r ev5ts1 z !    
,bo>d consid]s appropriate1 dur+ :i*    
heal? c>e pr(essionals discuss & %>e be/
 practices on pa9 managem5t &           
complem5t>y & integrative heal?4  7#b7  
7,a7 ,ea* ,bo>d may provide treatm5t    
recomm5dations = pati5ts ) complex      
cl9ical pa9 :o are be+ treat$ at a      

m$ical facility ( ! ,dep>tm5t locat$ 9 !
 ,vet]ans ,integrat$ ,s]vice ,network   
cov]$ by ! ,bo>d1 & assi/ 9 facilitat+  
communication betwe5 su* pati5ts & _!   
heal? c>e provid]s1 reg>dless ( :e!r su*
 treatm5t is on an 9-pati5t or          
out-pati5t basis1 & = :om a reque/ = su*
 recomm5dations1 subject to subp>agraph 
7,c71 has be5 made by an individual     
describ$ 9 subp>agraph 7,b74  7,b7 ,an  
individual describ$ 9 ?is subp>agraph is
 "o ( ! foll[+ individuals3 7i7 ,!      
pati5t4  7ii7 ,! sp\se ( ! pati5t4      
7iii7 ,a family memb] ( ! pati5t or     
ano!r individual if su* family memb] or 
individual has be5 designat$ by ! pati5t
 to make heal? c>e decisions = ! pati5t 
or to receive heal? c>e in=mation )     
respect to ! pati5t4  7iv7 ,a physician 
( ! pati5t4  7v7 ,an employee ( ! m$ical
 facility ( ! ,dep>tm5t describ$ 9      
subp>agraph 7,a74  7,c7 ,an individual  
describ$ 9 subp>agraph 7,b7 may n reque/
 treatm5t recomm5dations "u subp>agraph 
7,a7 unless ! individual--  7i7 has     

reque/$ treatm5t recomm5dations f ! pa9 
managem5t committee ( ! m$ical facility 
( ! ,dep>tm5t at :i* ! pati5t is receiv+
 treatm5t2 &  7ii7 has receiv$ treatm5t 
recomm5dations f su* committee & is n   
satisfi$ ) ^? treatm5t recomm5dations4  
7#c7 ,bas$ on treatm5t recomm5dations   
develop$ "u p>agraph 7#b77;,a71         
consultations conduct$ "u p>agraph      
7#a77;,a71 & educational =ums & public  
ev5ts c>ri$ out "u subp>agraphs 7,c7 &  
7,d7 ( p>agraph 7#a71 ea* ,bo>d %all    
provide to heal? c>e pr(essionals ( !   
,dep>tm5t locat$ 9 ! ,vet]ans ,integrat$
 ,s]vice ,network cov]$ by ! ,bo>d      
recomm5dations on ! be/ practices reg>d+
 pa9 managem5t 9 cases ( complex cl9ical
 pa94  7#d7  7,a7 ,ea* ,bo>d %all       
annually submit to ! ,secret>y & ! ,"u  
,secret>y = ,heal? a report 7) all      
p]sonally id5tifiable in=mation (       
pati5ts r$act$7 on pa9 managem5t        
practices c>ri$ out 9 ! ,vet]ans        
,integrat$ ,s]vice ,network cov]$ by !  
,bo>d4 ,ea* su* report %all include1 = !

 ye> cov]$ by ! report1 ! foll[+3  7i7  
,! treatm5t recomm5dations provid$ "u   
p>agraph 7#b77;,a71 includ+-- 7,i7 a    
summ>y ( su* recomm5dations2 &  7,,ii7  
an explanation ( ! m]its ( ea* su*      
recomm5dation4  7ii7 ,! recomm5dations =
 be/ practices provid$ "u p>agraph 7#c71
 includ+--  7,i7 a summ>y ( su*         
recomm5dations2 &  7,,ii7 an explanation
 ( ! m]its ( ea* su* recomm5dation4     
7iii7 ,su* o!r in=mation z ! ,bo>d      
consid]s appropriate4  7,b7 ,n lat] ?an 
,janu>y #ca ( ea* ye>1 ! ,secret>y %all 
submit to ! ,committee on ,vet]ans'     
,affairs ( ! ,s5ate & ! ,committee on   
,vet]ans' ,affairs ( ! ,h\se (          
,repres5tatives a report t conta9s      
compreh5sive in=mation f ea* report     
submitt$ to ! ,secret>y "u subp>agraph  
7,a7 dur+ ! ye> prec$+ ! submittal ( !  
report by ! ,secret>y1 disaggregat$ by  
,bo>d4  7#e7 ,! ,f$]al ,advisory        
,committee ,act 7#e ,u4,s4,c4 ,app47    
%all n apply to any ,bo>d4  7c7         
,memb]%ip  7#a7 ,ea* ,bo>d %all include 

! foll[+ individuals appo9t$ by !       
,secret>y3  7,a7 ,a bo>d c]tifi$ pa9    
m$ic9e speciali/4  7,b7 ,a tra9$ &      
qualifi$ memb] ( ! prim>y c>e team ( a  
m$ical facility ( ! ,dep>tm5t ) exp]i5ce
 9 pa9 c>e1 su* z a nurse practition]4  
7,c7 ,a pa9 psy*ologi/4  7,d7 ,a pa9    
social work]4  7,e7 ,a cl9ical ph>maci/4
  7,f7 ,a pa9 po9t ( contact = a        
,vet]ans ,integrat$ ,s]vice ,network4   
7,g7 ,a physician ) addiction &         
psy*oph>macology exp]tise & exp]i5ce4   
7,h7 ,an alli$ heal? c>e pr(essional4   
7,i7 ,a cl9ician ) exp]tise 9           
complem5t>y & integrative heal?4  7,j7  
,a cl9ical behavioral !rapi/4  7,k7 ,a  
pati5t advocate4  7,l7 ,a repres5tative 
( ! labor int]e/s ( employees ( !       
,dep>tm5t :o are responsible = prescrib+
 drugs4  7,m7 ,a curr5t or =m] cl9ical  
pati5t4  7,n7 ,a family memb] ( a curr5t
 or =m] cl9ical pati5t4  7#b7 ,( !      
memb]s appo9t$ "u p>agraph 7#a71 n less 
?an ?ree %all be repres5tative ( !      
demographic ( pati5ts s]v$ by ! ,vet]ans

 ,integrat$ ,s]vice ,network cov]$ by ! 
,bo>d1 includ+--  7,a7 n less ?an two   
curr5t or =m] pati5ts treat$ at a m$ical
 facility ( ! ,dep>tm5t = complex       
cl9ical pa92 &  7,b7 n less ?an "o      
family memb] ( su* a curr5t or =m]      
pati5t4  7#c7 ,! ,secret>y %all det]m9e 
! t]ms ( s]vice ( ! memb]s ( ea* ,bo>d4 
7#d7 7,a7 ,memb]s ( ea* ,bo>d %all s]ve 
)\t pay &1 except z provid$ 9           
subp>agraph 7,b71 memb]s :o are full-"t 
(fic]s or employees ( ! ,unit$ ,/ates   
may n receive additional pay1 all[ances1
 or b5efits by reason ( _! s]vice on !  
,bo>d4  7,b7 ,memb]s may receive travel 
exp5ses1 includ+ p] diem 9 lieu (       
subsi/5ce1 = travel 9 connection ) _!   
duties z memb]s ( ! ,bo>d4  7,c7 ,any   
memb] :o has cl9ical duties z an (fic]  
or employee ( ! ,unit$ ,/ates %all be   
reliev$ ( su* duties dur+ p]iods 9 :i*  
su* relief is necess>y = ! memb] to c>ry
 out ! duties ( ! ,bo>d4  7d7           
,availability ( in=mation ,9 c>ry+ out !
 duties ( a ,bo>d "u subsection 7b71    

specific in=mation id5tify+ a pati5t &  
o!r confid5tial in=mation relat+ to a   
pati5t may n be made available to any   
memb] appo9t$ "u subsection 7c77#a7     
solely bas$ on qualifications "u        
subp>agraph 7,m7 or 7,n7 ( su*          
subsection4  7e7 ,employm5t protections 
,no adv]se p]sonnel action may be made  
aga9/ an employee ( ! ,dep>tm5t 9       
connection ) a communication by !       
employee ) a memb] ( a ,bo>d relat+ to !
 duties ( ! ,bo>d "u subsection 7b7 &   
any su* communication %all be cov]$ by !
 employm5t & :i/lebl[] protections      
o!rwise applicable to communications by 
employees ( ! ,dep>tm5t4  7f7 ,res\rces 
( ,dep>tm5t ,! ,secret>y %all make      
available to ea* ,bo>d ! res\rces &     
p]sonnel ( ! ,dep>tm5t necess>y = !     
,bo>d to c>ry out ! duties ( ! ,bo>d "u 
subsection 7b71 includ+ res\rces &      
p]sonnel ( ! ,g5]al ,c\nsel ( !         
,dep>tm5t4  7g7 ,p[]s  7#a7 ,ea* ,bo>d  
may1 = ! purpose ( c>ry+ out ?is        
section1 hold he>+s1 sit & act at times 

& places1 take te/imony1 & receive      
evid5ce z ! ,bo>d det]m9es appropriate4 
7#b7 ,ea* ,bo>d may conduct site visits 
( m$ical facilities ( ! ,dep>tm5t to    
collect in=mation t ! ,bo>d consid]s    
necess>y to c>ry out ?is section4  7#c7 
,! ,secret>y %all provide to ea* ,bo>d  
su* adm9i/rative support s]vices z !    
,secret>y consid]s necess>y = ! ,bo>d to
 c>ry out ?is section4  4  7b7 ,cl]ical 
am5dm5t ,! table ( sections at ! beg9n+ 
( *apt] #gc ( su* title is am5d$ by     
ins]t+ aft] ! item relat+ to section    
#gcji ! foll[+ new item3  #gcji;,a4 ,pa9
 managem5t bo>ds4  4  #aje4 ,/udy on    
feasibility & advisability ( c>ry+ out  
ph>macy lock-9 program by ,dep>tm5t (   
,vet]ans ,affairs  7a7 ,9 g5]al ,!      
,secret>y ( ,vet]ans ,affairs %all      
conduct a /udy on ! feasibility &       
advisability ( c>ry+ out a ph>macy      
lock-9 program "u :i* vet]ans at risk = 
abuse ( prescription drugs are p]mitt$  
to receive prescription drugs only f    
c]ta9 specifi$ ph>macies ( ! ,dep>tm5t (

 ,vet]ans ,affairs4  7b7 ,report ,n lat]
 ?an "o ye> aft] ! date ( ! enactm5t (  
?is ,act1 ! ,secret>y %all submit to !  
,committee on ,vet]ans' ,affairs ( !    
,s5ate & ! ,committee on ,vet]ans'      
,affairs ( ! ,h\se ( ,repres5tatives a  
report on ! /udy conduct$ "u subsection 
7a74  #ajf4 ,reports & inve/igation on  
use ( opioids 9 treatm5t by ,dep>tm5t ( 
,vet]ans ,affairs  7a7 ,comptroll]      
,g5]al report  7#a7 ,9 g5]al ,n lat] ?an
 two ye>s aft] ! date ( ! enactm5t ( ?is
 ,act1 ! ,comptroll] ,g5]al ( ! ,unit$  
,/ates %all submit to ! ,committee on   
,vet]ans' ,affairs ( ! ,s5ate & !       
,committee on ,vet]ans' ,affairs ( !    
,h\se ( ,repres5tatives a report on !   
,opioid ,safety ,initiative ( !         
,dep>tm5t ( ,vet]ans ,affairs & ! opioid
 prescrib+ practices ( heal? c>e        
provid]s ( ! ,dep>tm5t4  7#b7 ,elem5ts  
,! report submitt$ "u p>agraph 7#a7 %all
 include ! foll[+3 7,a7 ,recomm5dations 
on su* improvem5ts to ! ,opioid ,safety 
,initiative ( ! ,dep>tm5t z !           

,comptroll] ,g5]al consid]s appropriate4
  7,b7 ,in=mation ) respect to-- 7i7    
dea?s result+ f s5t9el ev5ts involv+    
vet]ans prescrib$ opioids by a heal? c>e
 provid] ( ! ,dep>tm5t2  7ii7 ov]all    
prescription rates & prescriptions      
indications ( opioids at all m$ical     
facilities ( ! ,dep>tm5t to treat       
non-canc]1 non-palliative1 & non-hospice
 c>e pati5ts1 includ+ :e!r ea* m$ical   
facility or heal? c>e provid] ( !       
,dep>tm5t is among ! top t5 p]c5t (     
m$ical facilities or heal? c>e provid]s 
( ! ,dep>tm5t ) respect to su*          
prescription rates2  7iii7 !            
prescription rates & prescriptions      
indications ( b5zodiazep9es & opioids   
concomitantly by heal? c>e provid]s ( ! 
,dep>tm5t1 includ+ :e!r ea* m$ical      
facility or heal? c>e provid] ( !       
,dep>tm5t is among ! top t5 p]c5t (     
m$ical facilities or heal? c>e provid]s 
( ! ,dep>tm5t ) respect to su*          
prescription rates2  7iv7 ! practice by 
heal? c>e provid]s ( ! ,dep>tm5t (      

prescrib+ opioids to treat pati5ts )\t  
any pa91 includ+ to treat pati5ts )     
m5tal heal? disord]s o!r ?an opioid use 
disord]2 &  7v7 ! effectiv5ess ( opioid 
!rapy = pati5ts receiv+ su* !rapy1      
includ+ ! effectiv5ess ( long-t]m opioid
 !rapy4  7,c7 ,recomm5dations ) respect 
to :e!r sanctions are ne$$1 su* z writt5
 w>n+s or p]=mance improvem5t plans1 =  
heal? c>e provid]s ( ! ,dep>tm5t t are--
  7i7 n practic+ at a level meet+ or    
exce$+ ! m9imum level /&>d ( c>e        
e/abli%$ by ! ,dep>tm5t2 &  7ii7 n      
foll[+ ! enhanc$ guidance ) respect to  
absolute contra9dications = opioid !rapy
 set =? 9 ! ,,va_/,,dod ,cl9ical        
,practice ,guidel9e = ,managem5t (      
,opioid ,!rapy = ,*ronic ,pa91 z updat$ 
"u section #aja4  7b7 ,qu>t]ly progress 
report on implem5tation ( ,comptroll]   
,g5]al recomm5dations ,n lat] ?an #ahj  
days aft] ! date ( ! enactm5t ( ?is     
,act1 & n lat] ?an #cj days aft] ! end (
 ea* qu>t] !reaft]1 ! ,secret>y (       
,vet]ans ,affairs %all submit to !      

,committee on ,vet]ans ,affairs' ( !    
,s5ate & ! ,committee on ,vet]ans       
,affairs' ( ! ,h\se ( ,repres5tatives a 
progress report detail+ ! actions by !  
,dep>tm5t ( ,vet]ans ,affairs dur+ !    
p]iod cov]$ by ! report to address any  
out/&+ f9d+s & recomm5dations by !      
,comptroll] ,g5]al ( ! ,unit$ ,/ates )  
respect to ! ,vet]ans ,heal?            
,adm9i/ration4  7c7 ,annual report &    
inve/igation on opioid !rapy  7#a7      
,report ,n lat] ?an "o ye> aft] ! date (
 ! enactm5t ( ?is ,act1 & n less        
frequ5tly ?an annually !reaft]1 !       
,secret>y ( ,vet]ans ,affairs %all      
submit to ! ,committee on ,vet]ans'     
,affairs ( ! ,s5ate & ! ,committee on   
,vet]ans' ,affairs ( ! ,h\se (          
,repres5tatives a report t conta9s1 = ! 
"o ye> p]iod prec$+ ! submittal ( !     
report1 ! foll[+3  7,a7 ,! numb] (      
pati5ts & ! p]c5tage ( ! pati5t         
population ( ! ,dep>tm5t ( ,vet]ans     
,affairs :o 7 prescrib$ b5zodiazep9es & 
opioids concurr5tly by a heal? c>e      

provid] ( ! ,dep>tm5t4  7,b7 ,! numb] ( 
pati5ts & ! p]c5tage ( ! pati5t         
population ( ! ,dep>tm5t )\t any pa9 :o 
7 prescrib$ opioids by a heal? c>e      
provid] ( ! ,dep>tm5t1 includ+ ^? :o 7  
prescrib$ b5zodiazep9es & opioids       
concurr5tly4  7,c7 ,! numb] ( non-canc]1
 non-palliative1 & non-hospice c>e      
pati5ts & ! p]c5tage ( su* pati5ts :o 7 
treat$ ) opioids by a heal? c>e provid] 
( ! ,dep>tm5t on an inpati5t-basis & :o 
also receiv$ prescription opioids by    
mail f ! ,dep>tm5t :ile be+ treat$ on an
 inpati5t-basis4  7,d7 ,! numb] (       
non-canc]1 non-palliative1 & non-hospice
 c>e pati5ts & ! p]c5tage ( su* pati5ts 
:o 7 prescrib$ opioids concurr5tly by a 
heal? c>e provid] ( ! ,dep>tm5t & a     
heal? c>e provid] t is n a heal? c>e    
provid] ( ! ,dep>tm5t4  7,e7 ,) respect 
to ea* m$ical facility ( ! ,dep>tm5t1   
in=mation on opioids prescrib$ by heal? 
c>e provid]s at ! facility to treat     
non-canc]1 non-palliative1 & non-hospice
 c>e pati5ts1 includ+ in=mation on--    

7i7 ! prescription rate at :i* ea* heal?
 c>e provid] at ! facility prescrib$    
b5zodiazep9es & opioids concurr5tly to  
su* pati5ts & ! aggregate su*           
prescription rate = all heal? c>e       
provid]s at ! facility2  7ii7 !         
prescription rate at :i* ea* heal? c>e  
provid] at ! facility prescrib$         
b5zodiazep9es or opioids to su* pati5ts 
to treat conditions = :i* opioids or    
b5zodiazep9es are n an approv$ treatm5t 
& ! aggregate su* prescription rate =   
all heal? c>e provid]s at ! facility2   
7iii7 ! prescription rate at :i* ea*    
heal? c>e provid] at ! facility         
prescrib$ or disp5s$ mail-ord]          
prescriptions ( opioids to su* pati5ts  
:ile su* pati5ts 7 be+ treat$ ) opioids 
on an inpati5t-basis & ! aggregate su*  
prescription rate = all heal? c>e       
provid]s at ! facility2 &  7iv7 !       
prescription rate at :i* ea* heal? c>e  
provid] at ! facility prescrib$ opioids 
to su* pati5ts :o 7 also concurr5tly    
prescrib$ opioids by a heal? c>e provid]

 t is n a heal? c>e provid] ( !         
,dep>tm5t & ! aggregate su* prescription
 rate = all heal? c>e provid]s at !     
facility4  7,f7 ,) respect to ea* m$ical
 facility ( ! ,dep>tm5t1 ! numb] ( times
 a ph>maci/ at ! facility ov]rode a     
critical drug int]action w>n+ ) respect 
to an int]action betwe5 opioids & ano!r 
m$ication be=e disp5s+ a m$ication to a 
vet]an4  7#b7 ,inve/igation ,if a report
 submitt$ "u p>agraph 7#a7 indicates t a
 prescription rate describ$ 9           
subp>agraph 7,e7 ( su* p>agraph at a    
m$ical facility ( ! ,dep>tm5t is among !
 top t5 p]c5t ( m$ical facilities ( !   
,dep>tm5t ) respect to su* prescription 
rate1 ! ,secret>y %all--  7,a7 ?r\gh !  
,(fice ( ! ,m$ical ,inspector ( !       
,vet]ans ,heal? ,adm9i/ration1 conduct a
 full inve/igation ( ! m$ical facility2 
&  7,b7 imm$iately notify ! ,committee  
on ,vet]ans ,affairs' ( ! ,s5ate1 !     
,committee on ,vet]ans ,affairs' ( !    
,h\se ( ,repres5tatives1 & ea* ,memb] ( 
! ,s5ate & ! ,h\se ( ,repres5tatives :o 

repres5ts ! area 9 :i* ! m$ical facility
 is locat$4  7d7 ,prescription rate     
def9$ ,9 ?is section1 ! t]m prescription
 rate means1 ) respect to a heal? c>e   
provid] or m$ical facility ( !          
,dep>tm5t1 ea* ( ! foll[+3  7#a7 ,!     
numb] ( pati5ts treat$ ) opioids by !   
heal? c>e provid] or at ! m$ical        
facility1 z ! case may be1 divid$ by !  
total pati5t population ( t heal? c>e   
provid] or m$ical facility4  7#b7 ,!    
av]age numb] ( morph9e equival5ts p] day
 prescrib$ by ! heal? c>e provid] or at 
! m$ical facility1 z ! case may be1 to  
pati5ts be+ treat$ ) opioids4  7#c7 ,( !
 pati5ts be+ treat$ ) opioids by ! heal?
 c>e provid] or at ! m$ical facility1 z 
! case may be1 ! av]age numb] (         
prescriptions ( opioids p] pati5t4  ,,ii
 ,pati5t ,advocacy  #bja4 ,e/abli%m5t ( 
,(fice ( ,pati5t ,advocacy ( ! ,dep>tm5t
 ( ,vet]ans ,affairs  7a7 ,9 g5]al      
,sub*apt] ,i ( *apt] #gc ( title #ch1   
,unit$ ,/ates ,code1 is am5d$ by add+ at
 ! end ! foll[+ new section3  #gcji;,a4 

,(fice ( ,pati5t ,advocacy  7a7         
,e/abli%m5t ,!re is e/abli%$ 9 !        
,dep>tm5t )9 ! ,(fice ( ! ,"u ,secret>y 
= ,heal? an (fice to be kn[n z ! ,(fice 
( ,pati5t ,advocacy 79 ?is section      
ref]r$ to z ! ,(fice74  7b7 ,head  7#a7 
,! ,director ( ! ,(fice ( ,pati5t       
,advocacy %all be ! head ( ! ,(fice4    
7#b7 ,! ,director ( ! ,(fice ( ,pati5t  
,advocacy %all be appo9t$ by ! ,"u      
,secret>y = ,heal? f among individuals  
qualifi$ to p]=m ! duties ( ! position &
 %all report directly to ! ,"u ,secret>y
 = ,heal?4  7c7 ,function  7#a7 ,!      
function ( ! ,(fice is to c>ry out !    
,pati5t ,advocacy ,program ( !          
,dep>tm5t4  7#b7 ,9 c>ry+ out ! ,pati5t 
,advocacy ,program ( ! ,dep>tm5t1 !     
,director %all ensure t pati5t advocates
 ( ! ,dep>tm5t--  7,a7 advocate on      
behalf ( vet]ans ) respect to heal? c>e 
receiv$ & s\ght by vet]ans "u ! laws    
adm9i/]$ by ! ,secret>y2  7,b7 c>ry out 
! responsibilities specifi$ 9 subsection
 7d72 &  7,c7 receive tra9+ 9 pati5t    

advocacy4  7d7 ,pati5t advocacy         
responsibilities ,! responsibilities (  
ea* pati5t advocate at a m$ical facility
 ( ! ,dep>tm5t are ! foll[+3  7#a7 ,to  
resolve compla9ts by vet]ans ) respect  
to heal? c>e furni%$ "u ! laws adm9i/]$ 
by ! ,secret>y t _c be resolv$ at ! po9t
 ( s]vice or at a high] level easily    
accessible to ! vet]an4  7#b7 ,to pres5t
 at v>i\s meet+s & to v>i\s committees !
 issues exp]i5c$ by vet]ans 9 receiv+   
su* heal? c>e at su* m$ical facility4   
7#c7 ,to express to vet]ans _! rights & 
responsibilities z pati5ts 9 receiv+ su*
 heal? c>e4  7#d7 ,to manage ! ,pati5t  
,advocate ,track+ ,sy/em ( ! ,dep>tm5t  
at su* m$ical facility4  7#e7 ,to       
compile data at su* m$ical facility (   
compla9ts made by vet]ans ) respect to !
 receipt ( su* heal? c>e at su* m$ical  
facility & ! satisfaction ( vet]ans )   
su* heal? c>e at su* m$ical facility to 
det]m9e :e!r !re are tr5ds 9 su* data4  
7#f7 ,to ensure t a process is 9 place =
 ! di/ribution ( ! data compil$ "u      

p>agraph 7#e7 to appropriate lead]s1    
committees1 s]vices1 & /aff ( !         
,dep>tm5t4  7#g7 ,to id5tify1 n less    
frequ5tly ?an qu>t]ly1 opportunities =  
improvem5ts 9 ! furni%+ ( su* heal? c>e 
to vet]ans at su* m$ical facility bas$  
on compla9ts by vet]ans4  7#h7 ,to      
ensure t any significant compla9t by a  
vet]an ) respect to su* heal? c>e is    
br\ght to ! att5tion ( appropriate /aff 
( ! ,dep>tm5t to trigg] an assessm5t (  
:e!r !re ne$s to be a fur!r analysis ( !
 problem at ! facility-wide level4  7#i7
 ,to support any pati5t advocacy        
programs c>ri$ out by ! ,dep>tm5t4      
7#aj7 ,to ensure t all appeals & f9al   
decisions ) respect to ! receipt ( su*  
heal? c>e are ent]$ into ! ,pati5t      
,advocate ,track+ ,sy/em ( ! ,dep>tm5t4 
7#aa7 ,to und]/& all laws1 directives1 &
 o!r rules ) respect to ! rights &      
responsibilities ( vet]ans 9 receiv+ su*
 heal? c>e1 includ+ ! appeals processes 
available to vet]ans4  7#ab7 ,to ensure 
t vet]ans receiv+ m5tal heal? c>e1 or ! 

surrogate decisionmak]s = su* vet]ans1  
are aw>e ( ! rights ( vet]ans to seek   
repres5tation f sy/ems e/abli%$ "u      
section #ajc ( ! ,protection & ,advocacy
 = ,m5tally ,ill ,individuals ,act (    
#aihf 7#db ,u4,s4,c4 #ajhjc7 to protect 
& advocate ! rights ( individuals )     
m5tal illness & to inve/igate incid5ts (
 abuse & neglect ( su* individuals4     
7#ac7 ,to fulfill requirem5ts e/abli%$  
by ! ,secret>y ) respect to ! inspection
 ( controll$ sub/ances4  7#ad7 ,to      
docum5t pot5tially ?reat5+ behavior &   
report su* behavior to appropriate      
au?orities4  7e7 ,tra9+ ,9 provid+ tra9+
 to pati5t advocates "u subsection      
7c77#b77;,c71 ! ,director %all ensure t 
su* tra9+ is consi/5t ?r\gh\t !         
,dep>tm5t4  7f7 ,annual report ,n lat]  
?an two ye>s aft] ! date ( ! enactm5t ( 
! ,jason ,simcakoski ,memorial ,opioid  
,safety ,act1 & n less frequ5tly ?an    
annually !reaft]1 ! ,secret>y %all      
submit to ! ,committee on ,vet]ans'     
,affairs ( ! ,s5ate & ! ,committee on   

,vet]ans' ,affairs ( ! ,h\se (          
,repres5tatives a report on ! activities
 conduct$ by ! ,(fice dur+ ! p]iod cov]$
 by ! report4  7g7 ,controll$ sub/ance  
def9$ ,9 ?is section1 ! t]m controll$   
sub/ance has ! mean+ giv5 t t]m 9       
section #ajb ( ! ,controll$ ,sub/ances  
,act 7#ba ,u4,s4,c4 #hjb74  4  7b7      
,cl]ical am5dm5t ,! table ( sections at 
! beg9n+ ( *apt] #gc ( su* title is     
am5d$ by add+ aft] ! item relat+ to     
section #gcji ! foll[+ new item3        
#gcji;,a4 ,(fice ( ,pati5t ,advocacy4  4
  7c7 ,date fully op]ational ,!         
,secret>y ( ,vet]ans ,affairs %all      
ensure t ! ,(fice ( ,pati5t ,advocacy   
e/abli%$ 9 section #gcji;,a ( title #ch1
 ,unit$ ,/ates ,code1 z add$ by         
subsection 7a71 is fully op]ational n   
lat] ?an ! date t is "o ye> aft] ! date 
( ! enactm5t ( ?is ,act4  #bjb4         
,community meet+s on improv+ c>e f      
,dep>tm5t ( ,vet]ans ,affairs  7a7      
,community meet+s  7#a7 ,m$ical c5t]s ,n
 lat] ?an #ij days aft] ! date ( !      

enactm5t ( ?is ,act1 & n less frequ5tly 
?an once e #ij days !reaft]1 ea* m$ical 
c5t] ( ! ,dep>tm5t ( ,vet]ans ,affairs  
%all ho/ a community meet+ op5 to !     
public on improv+ heal? c>e f !         
,dep>tm5t4  7#b7 ,community bas$        
outpati5t cl9ics ,n lat] ?an "o ye> aft]
 ! date ( ! enactm5t ( ?is ,act1 & n    
less frequ5tly ?an annually !reaft]1 ea*
 community bas$ outpati5t cl9ic ( !     
,dep>tm5t %all ho/ a community meet+ op5
 to ! public on improv+ heal? c>e f !   
,dep>tm5t4  7b7 ,att5dance by ,director 
( ,vet]ans ,integrat$ ,s]vice ,network  
or designee  7#a7 ,9 g5]al ,subject to  
p>agraph 7#b71 ea* community meet+ ho/$ 
by a m$ical c5t] or community bas$      
outpati5t cl9ic "u subsection 7a7 %all  
be att5d$ by ! ,director ( ! ,vet]ans   
,integrat$ ,s]vice ,network 9 :i* !     
m$ical c5t] or community bas$ outpati5t 
cl9ic1 z ! case may be1 is locat$1 or an
 employee designat$ by ! ,director :o   
works 9 ! (fice ( ! ,director4  7#b7    
,att5dance by ,director ,ea* ,director (

 a ,vet]ans ,integrat$ ,s]vice ,network 
%all att5d n less ?an "o community meet+
 "u subsection 7a7 ho/$ by ea* m$ical   
c5t] locat$ 9 ! ,vet]ans ,integrat$     
,s]vice ,network ea* ye>4  7c7 ,notice  
,ea* m$ical c5t] or community bas$      
outpati5t cl9ic ho/+ a community meet+  
%all s5d timely notice ( ! community    
meet+ to ! ,committee on ,vet]ans       
,affairs' ( ! ,s5ate1 ! ,committee on   
,vet]ans ,affairs' ( ! ,h\se (          
,repres5tatives1 & ea* ,memb] ( ! ,s5ate
 & ! ,h\se ( ,repres5tatives :o         
repres5ts ! area 9 :i* ! m$ical facility
 is locat$4  #bjc4 ,improvem5t ( aw>5ess
 ( pati5t advocacy program & pati5t bill
 ( rights ( ,dep>tm5t ( ,vet]ans        
,affairs ,n lat] ?an #ij days aft] !    
date ( ! enactm5t ( ?is ,act1 !         
,secret>y ( ,vet]ans ,affairs %all1 9 z 
_m prom95t locations z appropriate to be
 se5 by ! l>ge/ p]c5tage ( pati5ts &    
family memb]s ( pati5ts at ea* m$ical   
facility ( ! ,dep>tm5t ( ,vet]ans       
,affairs--  7#a7 display ! purposes ( ! 

,pati5t ,advocacy ,program ( ! ,dep>tm5t
 & ! contact in=mation = ! pati5t       
advocate at su* m$ical facility2 &  7#b7
 display ! rights & responsibilities (--
 7,a7 pati5ts & family memb]s ( pati5ts 
at su* m$ical facility2 &  7,b7 )       
respect to community liv+ c5t]s & o!r   
resid5tial facilities ( ! ,dep>tm5t1    
resid5ts & family memb]s ( resid5ts at  
su* m$ical facility4  #bjd4 ,comptroll] 
,g5]al ,report on ,pati5t ,advocacy     
,program ( ,dep>tm5t ( ,vet]ans ,affairs
  7a7 ,9 g5]al ,n lat] ?an ?ree ye>s    
aft] ! date ( ! enactm5t ( ?is ,act1 !  
,comptroll] ,g5]al ( ! ,unit$ ,/ates    
%all submit to ! ,committee on ,vet]ans'
 ,affairs ( ! ,s5ate & ! ,committee on  
,vet]ans' ,affairs ( ! ,h\se (          
,repres5tatives a report on ! ,pati5t   
,advocacy ,program ( ! ,dep>tm5t (      
,vet]ans ,affairs 79 ?is section ref]r$ 
to z ! ,program7 z c>ri$ out "u ! ,(fice
 ( ,pati5t ,advocacy ( ! ,dep>tm5t      
e/abli%$ 9 section #gcji;,a ( title #ch1
 ,unit$ ,/ates ,code1 z add$ by section 

#bja7;a74  7b7 ,elem5ts ,! report       
requir$ by subsection 7a7-- 7#a7 %all   
include--  7,a7 su* recomm5dations &    
proposals = improv+ or modify+ !        
,program z ! ,comptroll] ,g5]al consid]s
 appropriate2 &  7,b7 su* o!r in=mation 
) respect to ! ,program z ! ,comptroll] 
,g5]al consid]s appropriate2 &  7#b7 may
 include-- 7,a7 a description ( !       
,program1 includ+--  7i7 ! purposes ( ! 
,program2  7ii7 ! activities c>ri$ out  
"u ! ,program2 &  7iii7 ! suffici5cy ( !
 ,program 9 a*iev+ ! purposes ( !       
,program2  7,b7 an assessm5t ( !        
suffici5cy ( /aff+ ( employees ( !      
,dep>tm5t responsible = c>ry+ out !     
,program2  7,c7 an assessm5t ( !        
suffici5cy ( ! tra9+ ( su* employees2 & 
7,d7 an assessm5t (--  7i7 aw>5ess ( !  
,program among vet]ans & _! family      
memb]s2 &  7ii7 ! use ( ! ,program by   
vet]ans & _! family memb]s4  #bje4      
,report on transition by vet]ans betwe5 
diff]5t heal? c>e sett+s  7a7 ,9 g5]al  
,n lat] ?an #ahj days aft] ! date ( !   

enactm5t ( ?is ,act1 ! ,secret>y (      
,vet]ans ,affairs %all submit to !      
,committee on ,vet]ans' ,affairs ( !    
,s5ate & ! ,committee on ,vet]ans'      
,affairs ( ! ,h\se ( ,repres5tatives a  
report on ! transitions und]gone by     
vet]ans 9 receiv+ heal? c>e 9 diff]5t   
heal? c>e sett+s4  7b7 ,elem5ts ,!      
report requir$ by subsection 7a7 %all   
include ! foll[+3 7#a7 ,an evaluation ( 
! /&>ds ( ! ,dep>tm5t = facilitat+ &    
manag+ ! transitions und]gone by vet]ans
 9 receiv+ heal? c>e 9 diff]5t heal? c>e
 sett+s4  7#b7 ,an assessm5t ( ! case   
managem5t s]vices ( ! ,dep>tm5t t are   
available = vet]ans :o are und]go+ a    
transition 9 heal? c>e sett+s4  7#c7 ,an
 assessm5t ( ! coord9ation 9 cov]age ( &
 consi/5t access to m$ications prescrib$
 = pati5ts transition+ f receiv+ heal?  
c>e f ! ,dep>tm5t ( ,def5se to receiv+  
heal? c>e f ! ,dep>tm5t ( ,vet]ans      
,affairs4  7#d7 ,su* recomm5dations to  
improve transitions 9 heal? c>e sett+s  
among vet]ans z ! ,secret>y consid]s    

appropriate1 includ+ ! coord9ation (    
drug =mul>ies betwe5 ! ,dep>tm5t (      
,def5se & ! ,dep>tm5t ( ,vet]ans        
,affairs & ! developm5t ( c>e transition
 plans = pati5ts ) complex m$ical       
issues4  ,,iii ,complem5t>y &           
,integrative ,heal?  #cja4 ,expansion ( 
rese>* & education on & deliv]y (       
complem5t>y & integrative heal? to      
vet]ans  7a7 ,developm5t ( plan ,to exp&
 rese>*1 education1 & deliv]y ,n lat]   
?an #ahj days aft] ! date ( ! enactm5t (
 ?is ,act1 ! ,secret>y ( ,vet]ans       
,affairs %all develop a plan to exp&    
mat]ially & sub/antially ! scope ( !    
effectiv5ess ( rese>* & education on1 & 
deliv]y & integration (1 complem5t>y &  
integrative heal? s]vices into ! heal?  
c>e s]vices provid$ to vet]ans4  7b7    
,elem5ts ,! plan requir$ by subsection  
7a7 %all provide = ! foll[+3 7#a7       
,rese>* on ! foll[+3  7,a7 ,!           
effectiv5ess ( v>i\s complem5t>y &      
integrative heal? s]vices1 includ+ !    
effectiv5ess ( su* s]vices integrat$ )  

cl9ical !rapies4  7,b7 ,approa*es to    
integrat+ complem5t>y & integrative     
heal? s]vices into o!r heal? c>e s]vices
 provid$ by ! ,dep>tm5t4  7#b7          
,education & tra9+ = heal? c>e          
pr(essionals ( ! ,dep>tm5t on ! foll[+3 
7,a7 ,complem5t>y & integrative heal?   
s]vices select$ by ! ,secret>y =        
purposes ( ! plan4  7,b7 ,appropriate   
uses ( su* s]vices4  7,c7 ,integration (
 su* s]vices into ! deliv]y ( heal? c>e 
to vet]ans4  7#c7 ,rese>*1 education1 & 
cl9ical activities on complem5t>y &     
integrative heal? at c5t]s ( innovation 
at m$ical c5t]s ( ! ,dep>tm5t4  7#d7    
,id5tification or developm5t ( metrics &
 outcome measures to evaluate !         
effectiv5ess ( ! provision & integration
 ( complem5t>y & integrative heal?      
s]vices into ! deliv]y ( heal? c>e to   
vet]ans4  7#e7 ,integration & deliv]y ( 
complem5t>y & integrative heal? s]vices 
) o!r heal? c>e s]vices provid$ by !    
,dep>tm5t4  7c7 ,consultation  7#a7 ,9  
g5]al ,9 c>ry+ out subsection 7a71 !    

,secret>y %all consult ) ! foll[+3 7,a7 
,! ,director ( ! ,national ,c5t] =      
,complem5t>y & ,integrative ,heal? ( !  
,national ,in/itutes ( ,heal?4  7,b7 ,! 
,commission] ( ,food & ,drugs4  7,c7    
,in/itutions ( high] education1 private 
rese>* in/itutes1 & individual rese>*]s 
) ext5sive exp]i5ce 9 complem5t>y &     
integrative heal? & ! integration (     
complem5t>y & integrative heal?         
practices into ! deliv]y ( heal? c>e4   
7,d7 ,nationally recogniz$ provid]s (   
complem5t>y & integrative heal?4  7,e7  
,su* o!r (ficials1 entities1 &          
individuals ) exp]tise on complem5t>y & 
integrative heal? z ! ,secret>y consid]s
 appropriate4  7#b7 ,scope (            
consultation ,! ,secret>y %all und]take 
consultation "u p>agraph 7#a7 9 c>ry+   
out subsection 7a7 ) respect to !       
foll[+3  7,a7 ,to develop ! plan4  7,b7 
,to id5tify specific complem5t>y &      
integrative heal? practices t1 on !     
basis ( rese>* f9d+s or promis+ cl9ical 
int]v5tions1 are appropriate to include 

z s]vices to vet]ans4  7,c7 ,to id5tify 
b>ri]s to ! effective provision &       
integration ( complem5t>y & integrative 
heal? s]vices into ! deliv]y ( heal? c>e
 to vet]ans1 & to id5tify me*anisms =   
ov]com+ su* b>ri]s4  7d7 ,fund+ ,!re is 
au?oriz$ to be appropriat$ to !         
,secret>y su* sums z may be necess>y to 
c>ry out ?is section4  7e7 ,complem5t>y 
& integrative heal? def9$ ,9 ?is        
section1 ! t]m complem5t>y & integrative
 heal? has ! mean+ giv5 t t]m by !      
,national ,in/itutes ( ,heal?4  #cjb4   
,program on integration ( complem5t>y & 
integrative heal? )9 ,dep>tm5t (        
,vet]ans ,affairs m$ical c5t]s  7a7     
,program requir$ ,n lat] ?an !          
completion ( ! developm5t ( ! plan "u   
section #cja1 ! ,secret>y ( ,vet]ans    
,affairs %all--  7#a7 c>ry out1 ?r\gh ! 
,(fice ( ,pati5t ,c5t]$ ,c>e & ,cultural
 ,trans=mation ( ! ,dep>tm5t ( ,vet]ans 
,affairs1 a program to assess !         
feasibility & advisability ( integrat+ !
 deliv]y ( complem5t>y & integrative    

heal? s]vices select$ by ! ,secret>y )  
o!r heal? c>e s]vices provid$ by !      
,dep>tm5t = vet]ans ) m5tal heal?       
conditions1 *ronic pa9 conditions1 o!r  
*ronic conditions1 & su* o!r conditions 
z ! ,secret>y det]m9es appropriate2 &   
7#b7 9 develop+ ! program-- 7,a7 use !  
plan develop$ "u section #cja2 &  7,b7  
id5tify &1 to ! ext5t practicable1      
resolve b>ri]s to ! provision (         
complem5t>y & integrative heal? s]vices 
select$ by ! ,secret>y & ! integration (
 ^? s]vices ) o!r heal? c>e s]vices     
provid$ by ! ,dep>tm5t4  7b7 ,locations 
7#a7 ,9 g5]al ,! ,secret>y %all c>ry out
 ! program at n few] ?an #ae m$ical     
c5t]s ( ! ,dep>tm5t4  7#b7 ,polytrauma  
c5t]s ,n less ?an two ( ! m$ical c5t]s  
designat$ "u p>agraph 7#a7 %all be      
locat$ at polytrauma rehabilitation     
c5t]s ( ! ,dep>tm5t4  7#c7 ,m$ical c5t]s
 ) high prescription rate ( opioids     
7,a7 ,9 g5]al ,9 select+ m$ical c5t]s "u
 p>agraph 7#a71 ! ,secret>y %all give   
priority to m$ical c5t]s ( ! ,dep>tm5t  

at :i* !re is a prescription rate (     
opioids t is among ! top t5 p]c5t (     
m$ical c5t]s ( ! ,dep>tm5t ) respect to 
su* prescription rate4  7,b7            
,prescription rate def9$ ,9 ?is         
p>agraph1 ! t]m prescription rate means1
 ) respect to a m$ical c5t] ( !         
,dep>tm5t1 ea* ( ! foll[+3 7i7 ,! numb] 
( pati5ts treat$ ) opioids at ! m$ical  
c5t] divid$ by ! total pati5t population
 ( t m$ical c5t]4  7ii7 ,! av]age numb] 
( morph9e equival5ts p] day prescrib$ at
 ! m$ical c5t] to pati5ts be+ treat$ )  
opioids4  7iii7 ,( ! pati5ts be+ treat$ 
) opioids at ! m$ical c5t]1 ! av]age    
numb] ( prescriptions ( opioids p]      
pati5t4  7#d7 ,selection ( locations ,9 
c>ry+ out ! program1 ! ,secret>y %all   
select locations t include ! foll[+     
areas3 7,a7 ,rural areas4  7,b7 ,areas t
 are n 9 close proximity to an active   
duty milit>y in/allation4  7,c7 ,areas  
repres5t+ diff]5t geographic locations1 
su* z c5sus tracts e/abli%$ by ! ,bureau
 ( ! ,c5sus4  7c7 ,provision ( s]vices  

,"u ! program1 ! ,secret>y %all provide 
cov]$ s]vices to cov]$ vet]ans by       
integrat+ complem5t>y & integrative     
heal? s]vices ) o!r s]vices provid$ by !
 ,dep>tm5t at ! m$ical c5t]s designat$  
"u subsection 7b77#a74  7d7 ,cov]$      
vet]ans ,= purposes ( ! program1 a cov]$
 vet]an is any vet]an :o-- 7#a7 has a   
m5tal heal? condition diagnos$ by a     
cl9ician ( ! ,dep>tm5t2  7#b7 exp]i5ces 
*ronic pa92  7#c7 has a *ronic condition
 be+ treat$ by a cl9ician ( ! ,dep>tm5t2
 or  7#d7 is n describ$ 9 p>agraph 7#a71
 7#b71 or 7#c7 & reque/s to p>ticipate 9
 ! program or is ref]r$ by a cl9ician ( 
! ,dep>tm5t :o is treat+ ! vet]an4  7e7 
,cov]$ s]vices  7#a7 ,9 g5]al ,=        
purposes ( ! program1 cov]$ s]vices are 
s]vices consi/+ ( complem5t>y &         
integrative heal? s]vices z select$ by !
 ,secret>y4  7#b7 ,adm9i/ration (       
s]vices ,cov]$ s]vices %all be adm9i/]$ 
"u ! program z foll[s3 7,a7 ,cov]$      
s]vices %all be adm9i/]$ by pr(essionals
 or o!r in/ructors ) appropriate tra9+ &

 exp]tise 9 complem5t>y & integrative   
heal? s]vices :o are employees ( !      
,dep>tm5t or ) :om ! ,dep>tm5t ent]s    
into an agreem5t to provide su* s]vices4
  7,b7 ,cov]$ s]vices %all be includ$ z 
"p ( ! ,pati5t ,align$ ,c>e ,teams      
initiative ( ! ,(fice ( ,pati5t ,c>e    
,s]vices1 ,prim>y ,c>e ,program ,(fice1 
9 coord9ation ) ! ,(fice ( ,pati5t      
,c5t]$ ,c>e & ,cultural ,trans=mation4  
7,c7 ,cov]$ s]vices %all be made        
available to-- 7i7 cov]$ vet]ans :o h   
receiv$ conv5tional treatm5ts f !       
,dep>tm5t = ! conditions = :i* ! cov]$  
vet]an seeks complem5t>y & integrative  
heal? s]vices "u ! program2 &  7ii7     
cov]$ vet]ans :o h n receiv$ conv5tional
 treatm5ts f ! ,dep>tm5t = su*          
conditions4  7f7 ,volunt>y p>ticipation 
,! p>ticipation ( a vet]an 9 ! program  
%all be at ! election ( ! vet]an & 9    
consultation ) a cl9ician ( ! ,dep>tm5t4
  7g7 ,reports to ,congress  7#a7       
,qu>t]ly reports ,n lat] ?an #ij days   
aft] ! date ( ! comm5cem5t ( ! program &

 n less frequ5tly ?an once e #ij days   
!reaft] = ! duration ( ! program1 !     
,secret>y %all submit to ! ,committee on
 ,vet]ans' ,affairs ( ! ,s5ate & !      
,committee on ,vet]ans' ,affairs ( !    
,h\se ( ,repres5tatives a report on !   
ef=ts ( ! ,secret>y to c>ry out !       
program1 includ+ a description ( !      
outrea* conduct$ by ! ,secret>y to      
vet]ans & community organizations to    
in=m su* organizations ab\t ! program4  
7#b7 ,f9al report  7,a7 ,9 g5]al ,n lat]
 ?an ?ree ye>s aft] ! date ( !          
comm5cem5t ( ! program1 ! ,secret>y %all
 submit to ! ,committee on ,vet]ans'    
,affairs ( ! ,s5ate & ! ,committee on   
,vet]ans' ,affairs ( ! ,h\se (          
,repres5tatives a report on ! program4  
7,b7 ,cont5ts ,! report submitt$ "u     
subp>agraph 7,a7 %all include ! foll[+3 
7i7 ,! f9d+s & conclusions ( ! ,secret>y
 ) respect to ! program1 includ+ )      
respect to--  7,i7 ! use & efficacy ( ! 
complem5t>y & integrative heal? s]vices 
e/abli%$ "u ! program2 &  7,,ii7 an     

assessm5t ( ! b5efit ( ! program to     
cov]$ vet]ans 9 m5tal heal? diagnoses1  
pa9 managem5t1 & treatm5t ( *ronic      
illness4  7ii7 ,b>ri]s id5tifi$ "u      
subsection 7a77#b77;,b7 t 7 n resolv$4  
7iii7 ,su* recomm5dations = !           
cont9uation or expansion ( ! program z !
 ,secret>y consid]s appropriate4  7h7   
,complem5t>y & integrative heal? def9$  
,9 ?is section1 ! t]m complem5t>y &     
integrative heal? %all h ! mean+ giv5 t 
t]m 9 section #cja7;e74  #cjc4 ,program 
on use ( wellness programs z complem5t>y
 approa* to pa9 managem5t & relat$      
issues = vet]ans & family memb]s (      
vet]ans  7a7 ,program requir$  7#a7 ,9  
g5]al ,! ,secret>y ( ,vet]ans ,affairs  
%all c>ry out a program ?r\gh ! aw>d (  
grants to public or private nonpr(it    
entities to assess ! feasibility &      
advisability ( us+ wellness programs to 
complem5t ! provision ( pa9 managem5t & 
relat$ heal? c>e s]vices1 su* z m5tal   
heal? c>e s]vices1 to vet]ans & family  
memb]s ( vet]ans4  7#b7 ,matt]s ,to be  

address$ ,! program %all be c>ri$ out s 
z to assess ! foll[+3 7,a7 ,means (     
improv+ coord9ation betwe5 ,f$]al1      
,/ate1 local1 & community provid]s (    
heal? c>e 9 ! provision ( pa9 managem5t 
& relat$ heal? c>e s]vices to vet]ans & 
family memb]s ( vet]ans4  7,b7 ,means ( 
enhanc+ outrea*1 & coord9ation (        
outrea*1 by & among provid]s ( heal? c>e
 ref]r$ to 9 subp>agraph 7,a7 on ! pa9  
managem5t & relat$ heal? c>e s]vices    
available to vet]ans & family memb]s (  
vet]ans4  7,c7 ,means ( us+ wellness    
programs ( provid]s ( heal? c>e ref]r$  
to 9 subp>agraph 7,a7 z complem5ts to ! 
provision by ! ,dep>tm5t ( ,vet]ans     
,affairs ( pa9 managem5t & relat$ heal? 
c>e s]vices to vet]ans & family memb]s (
 vet]ans4  7,d7 ,:e!r wellness programs 
describ$ 9 subp>agraph 7,c7 are         
effective 9 enhanc+ ! quality ( life &  
well-be+ ( vet]ans & family memb]s (    
vet]ans4  7,e7 ,:e!r wellness programs  
describ$ 9 subp>agraph 7,c7 are         
effective 9 increas+ ! adh]5ce ( vet]ans

 to ! prim>y pa9 managem5t & relat$     
heal? c>e s]vices provid$ su* vet]ans by
 ! ,dep>tm5t4  7,f7 ,:e!r wellness      
programs describ$ 9 subp>agraph 7,c7 h  
an impact on ! s5se ( well-be+ ( vet]ans
 :o receive prim>y pa9 managem5t &      
relat$ heal? c>e s]vices f ! ,dep>tm5t4 
7,g7 ,:e!r wellness programs describ$ 9 
subp>agraph 7,c7 are effective 9        
enc\rag+ vet]ans receiv+ heal? c>e f !  
,dep>tm5t to adopt a m heal?y life/yle4 
7b7 ,duration ,! ,secret>y %all c>ry out
 ! program = a p]iod ( ?ree ye>s beg9n+ 
on ! date t is "o ye> aft] ! date ( !   
enactm5t ( ?is ,act4  7c7 ,locations ,! 
,secret>y %all c>ry out ! program at    
facilities ( ! ,dep>tm5t provid+ pa9    
managem5t & relat$ heal? c>e s]vices1   
su* z m5tal heal? c>e s]vices1 to       
vet]ans & family memb]s ( vet]ans4  7d7 
,grant proposals  7#a7 ,9 g5]al ,a      
public or private nonpr(it entity seek+ 
! aw>d ( a grant "u ?is section %all    
submit an application !re= to !         
,secret>y 9 su* =m & 9 su* mann] z !    

,secret>y may require4  7#b7            
,application cont5ts ,ea* application   
submitt$ "u p>agraph 7#a7 %all include !
 foll[+3 7,a7 ,a plan to coord9ate      
activities "u ! program1 to ! ext5t     
possible1 ) ! ,f$]al1 ,/ate1 & local    
provid]s ( s]vices = vet]ans to enhance 
! foll[+3  7i7 ,aw>5ess by vet]ans (    
b5efits & heal? c>e s]vices provid$ by !
 ,dep>tm5t4  7ii7 ,outrea* ef=ts to     
increase ! use by vet]ans ( s]vices     
provid$ by ! ,dep>tm5t4  7iii7          
,educational ef=ts to in=m vet]ans ( !  
b5efits ( a heal?y & active life/yle4   
7,b7 ,a /atem5t ( und]/&+ f ! entity    
submitt+ ! application t1 if select$1   
su* entity w be requir$ to report to !  
,secret>y p]iodically on /&>diz$ data & 
o!r p]=mance data necess>y to evaluate  
individual outcomes & to facilitate     
evaluations among entities p>ticipat+ 9 
! program4  7,c7 ,su* o!r requirem5ts z 
! ,secret>y may prescribe4  7e7 ,grant  
uses  7#a7 ,9 g5]al ,a public or private
 nonpr(it entity aw>d$ a grant "u ?is   

section %all use ! aw>d = purposes      
prescrib$ by ! ,secret>y4  7#b7         
,eligible individuals ,9 c>ry+ out !    
purposes prescrib$ by ! ,secret>y 9     
p>agraph 7#a71 a public or private      
nonpr(it entity aw>d$ a grant "u ?is    
section %all use ! aw>d to furni%       
s]vices only to vet]ans & family memb]s 
( vet]ans4  7f7 ,reports  7#a7 ,p]iodic 
reports  7,a7 ,9 g5]al ,n lat] ?an #ahj 
days aft] ! date ( ! comm5cem5t ( !     
program1 & n less frequ5tly ?an e #ahj  
days !reaft]1 ! ,secret>y %all submit to
 ,congress a report on ! program4  7,b7 
,report elem5ts ,ea* report requir$ by  
subp>agraph 7,a7 %all include ! foll[+3 
7i7 ,! f9d+s & conclusions ( ! ,secret>y
 ) respect to ! program dur+ ! #ahj-;day
 p]iod prec$+ ! report4  7ii7 ,an       
assessm5t ( ! b5efits ( ! program to    
vet]ans & _! family memb]s dur+ !       
#ahj-;day p]iod prec$+ ! report4  7#b7  
,f9al report ,n lat] ?an #ahj days aft] 
! end ( ! program1 ! ,secret>y %all     
submit to ,congress a report detail+ !  

recomm5dations ( ! ,secret>y z to !     
feasibility & advisability ( cont9u+ or 
exp&+ ! program4  7g7 ,wellness def9$ ,9
 ?is section1 ! t]m wellness has ! mean+
 giv5 t t]m 9 regulations prescrib$ by !
 ,secret>y = purposes ( ?is section4    
,,iv ,o!r ,vet]ans ,heal? ,c>e ,matt]s  
#dja4 ,additional requirem5ts = hir+ (  
heal? c>e provid]s by ,dep>tm5t (       
,vet]ans ,affairs ,! ,secret>y (        
,vet]ans ,affairs %all1 z "p ( ! hir+   
process = ea* heal? c>e provid] consid]$
 = a position at ! ,dep>tm5t ( ,vet]ans 
,affairs aft] ! date ( ! enactm5t ( ?is 
,act1 reque/ f ! m$ical bo>d ( ea* ,/ate
 9 :i* ! heal? c>e provid] has a m$ical 
lic5se--  7#a7 in=mation on any         
violation ( ! requirem5ts ( ! m$ical    
lic5se ( ! heal? c>e provid] dur+ !     
#bj-ye> p]iod prec$+ ! consid]ation ( ! 
heal? c>e provid] by ! ,dep>tm5t2 &     
7#b7 in=mation on :e!r ! heal? c>e      
provid] has ent]$ into any settlem5t    
agreem5t = a discipl9>y *>ge relat+ to !
 practice ( m$ic9e by ! heal? c>e       

provid]4  #djb4 ,provision ( in=mation  
on heal? c>e provid]s ( ,dep>tm5t (     
,vet]ans ,affairs to ,/ate m$ical bo>ds 
,not)/&+ section #eeb;a ( title #e1     
,unit$ ,/ates ,code1 ! ,secret>y (      
,vet]ans ,affairs %all1 ) respect to any
 heal? c>e provid] ( ! ,dep>tm5t (      
,vet]ans ,affairs t has violat$ a       
requirem5t ( _! m$ical lic5se1 provide  
to ! m$ical bo>d ( ea* ,/ate 9 :i* !    
heal? c>e provid] is lic5s$ detail$     
in=mation ) respect to su* violation4   
#djc4 ,report on compliance by ,dep>tm5t
 ( ,vet]ans ,affairs ) reviews ( heal?  
c>e provid]s leav+ ! ,dep>tm5t or       
transf]r+ to o!r facilities ,n lat] ?an 
two ye>s aft] ! date ( ! enactm5t ( ?is 
,act1 ! ,secret>y ( ,vet]ans ,affairs   
%all submit to ! ,committee on ,vet]ans'
 ,affairs ( ! ,s5ate & ! ,committee on  
,vet]ans' ,affairs ( ! ,h\se (          
,repres5tatives a report on ! compliance
 by ! ,dep>tm5t ( ,vet]ans ,affairs ) ! 
policy ( ! ,dep>tm5t--  7#a7 to conduct 
a review ( ea* heal? c>e provid] ( !    

,dep>tm5t :o transf]s to ano!r m$ical   
facility ( ! ,dep>tm5t or leaves !      
,dep>tm5t to det]m9e :e!r !re are any   
conc]ns1 compla9ts1 or allegations (    
violations relat+ to ! m$ical practice (
 ! heal? c>e provid]2 &  7#b7 to take   
appropriate action ) respect to any su* 
conc]n1 compla9t1 or allegation4  ,v    
,o!r ,vet]ans ,matt]s  #eja4 ,dep>tm5t (
 ,vet]ans ,affairs program ( int]nal    
audits  7a7 ,9 g5]al ,sub*apt] ,,ii (   
*apt] #e ( title #ch1 ,unit$ ,/ates     
,code1 is am5d$ by ins]t+ aft] section  
#ebg ! foll[+ new section3  #ebg;,a4    
,program ( int]nal audits  7a7 ,program 
requir$  7#a7 ,! ,secret>y %all c>ry out
 a program ( int]nal audits &           
self-analysis to improve ! furni%+ (    
b5efits & heal? c>e to vet]ans & _!     
families4  7#b7 ,! ,secret>y %all c>ry  
out ! program requir$ by p>agraph 7#a7  
?r\gh an (fice ! ,secret>y %all e/abli% 
= purposes ( ! program )9 ! (fice ( !   
,secret>y t is int]discipl9>y &         
indep5d5t (--  7,a7 ! o!r (fices )9 !   

(fice ( ! ,secret>y2 &  7,b7 ! cov]$    
adm9i/rations 7or functions ( su*       
adm9i/rations71 /aff organizations1 &   
/aff (fices id5tifi$ "u subsection      
7b77#a77;,a74  7b7 ,program requirem5ts 
7#a7 ,9 c>ry+ out ! program requir$ by  
subsection 7a71 ! ,secret>y %all-- 7,a7 
conduct p]iodic risk assessm5ts ( !     
,dep>tm5t to id5tify ^? cov]$           
adm9i/rations 7or functions ( su*       
adm9i/rations71 /aff organizations1 &   
/aff (fices ( ! ,dep>tm5t ! audit ( :i* 
w\ld lead t[>ds ! greate/ improvem5t 9 !
 furni%+ ( b5efits & heal? c>e to       
vet]ans & _! families2  7,b7 develop    
plans t are in=m$ by ! risk assessm5ts  
conduct$ "u p>agraph 7#a7 to conduct    
int]nal audits ( ! cov]$ adm9i/rations  
7or functions ( su* adm9i/rations71 /aff
 organizations1 & /aff (fices id5tifi$  
"u subp>agraph 7,a72 &  7,c7 conduct    
int]nal audits 9 accordance ) ! plans   
develop$ pursuant to subp>agraph 7,b74  
7#b7 ,! ,secret>y %all c>ry out "u !    
program requir$ by subsection 7a7 an    

audit ( n few] ?an five cov]$           
adm9i/rations 7or functions ( su*       
adm9i/rations71 /aff organizations1 or  
/aff (fices ( ! ,dep>tm5t ea* ye>4  7#c7
 ,9 id5tify+ cov]$ adm9i/rations 7or    
functions ( su* adm9i/rations71 /aff    
organizations1 & /aff (fices ( !        
,dep>tm5t "u p>agraph 7#a77;,a71 !      
,secret>y %all accord priority to !     
cov]$ adm9i/rations & functions ( su*   
adm9i/rations4  7#d7 7,a7 ,= purposes ( 
?is subsection1 ! cov]$ adm9i/rations ( 
! ,dep>tm5t are ! foll[+3 7i7 ,!        
,national ,cemet]y ,adm9i/ration4  7ii7 
,! ,vet]ans ,b5efits ,adm9i/ration4     
7iii7 ,! ,vet]ans ,heal? ,adm9i/ration4 
7,b7 ,= purposes ?is subsection1 ! cov]$
 /aff organizations ( ! ,dep>tm5t are ! 
foll[+3 7i7 ,! ,(fice ( ,acquisition1   
,logi/ics1 & ,con/ruction4  7ii7 ,!     
,advisory ,committee ,managem5t ,(fice4 
7iii7 ,! ,bo>d ( ,vet]ans' ,appeals4    
7iv7 ,! ,c5t] = ,fai?-,bas$ &           
,neighborhood ,p>tn]%ips4  7v7 ,! ,c5t] 
= ,m9ority ,vet]ans4  7vi7 ,! ,c5t] =   

,wom5 ,vet]ans4  7vii7 ,! ,(fice (      
,g5]al ,c\nsel4  7viii7 ,! ,(fice (     
,regulation ,policy & ,managem5t4  7ix7 
,! ,(fice ( ,employm5t ,discrim9ation   
,compla9t ,adjudication4  7x7 ,! ,(fice 
( ,int]ag5cy ,c>e & ,b5efits            
,coord9ation4  7xi7 ,! ,(fice ( ,small &
 ,disadvantag$ ,bus9ess ,utilization4   
7xii7 ,! ,(fice ( ,survivors ,assi/ance4
  7xiii7 ,! ,vet]ans' ,s]vice           
,organizations ,liaison4  7,c7 ,=       
purposes ( ?is subsection1 ! cov]$ /aff 
(fices ( ! ,dep>tm5t are ! foll[+3 7i7  
,! (fice ( ! ,assi/ant ,secret>y =      
,congressional & ,legislative ,affairs4 
7ii7 ,! (fice ( ! ,assi/ant ,secret>y = 
,human ,res\rces & ,adm9i/ration4  7iii7
 ,! (fice ( ! ,assi/ant ,secret>y =     
,in=mation & ,te*nology4  7iv7 ,! ,(fice
 ( ,managem5t4  7v7 ,! (fice ( !        
,assi/ant ,secret>y = ,op]ations1       
,security1 & ,prep>$ness4  7vi7 ,! (fice
 ( ! ,assi/ant ,secret>y = ,policy &    
,plann+4  7vii7 ,! (fice ( ! ,assi/ant  
,secret>y = ,public & ,int]gov]nm5tal   

,affairs4  7c7 ,reports  7#a7 ,n lat]   
?an #ij days aft] complet+ an audit "u !
 program requir$ by subsection 7a71 !   
,secret>y %all submit to ! appropriate  
committees ( ,congress a report on !    
audit4  7#b7 ,ea* report submitt$ "u    
p>agraph 7#a7 ) respect to an audit %all
 include ! foll[+3 7,a7 ,a summ>y ( !   
audit4  7,b7 ,! f9d+s ( ! ,secret>y )   
respect to ! audit4  7,c7 ,su*          
recomm5dations z ! ,secret>y may h =    
legislative or adm9i/rative action to   
improve ! furni%+ ( b5efits & heal? c>e 
to vet]ans & _! families4  7#c7 ,9 ?is  
subsection1 ! t]m appropriate committees
 ( ,congress includes-- 7,a7 !          
,committee on ,vet]ans' ,affairs1 !     
,committee on ,appropriations1 & !      
,committee on ,homel& ,security &       
,gov]nm5tal ,affairs ( ! ,s5ate2 &  7,b7
 ! ,committee on ,vet]ans' ,affairs1 !  
,committee on ,appropriations1 & !      
,committee on ,ov]sight & ,gov]nm5t     
,re=m ( ! ,h\se ( ,repres5tatives4  4   
7b7 ,fir/ risk assessm5t ,! ,secret>y ( 

,vet]ans ,affairs %all complete ! fir/  
risk assessm5t requir$ by section       
#ebg;,a7b77#a77;,a7 ( su* title1 z add$ 
by subsection 7a71 by n lat] ?an #ahj   
days aft] ! date ( ! enactm5t ( ?is     
,act4  7c7 ,cl]ical am5dm5t ,! table (  
sections at ! beg9n+ ( *apt] #e ( su*   
title is am5d$ by ins]t+ aft] ! item    
relat+ to section #ebg ! foll[+ new     
item3  #ebg;,a4 ,program ( int]nal      
audits4  4