,,ii  #aaeth ,,congress  #ast ,session  
,s4 #iib  ,,in ,,the ,,senate ,,of ,,the
 ,,united ,,states  ,may #a1 #bjag,mr4  
,mc,cain 7for himself1 ,ms4 ,baldwin1   
,mr4 ,van ,hollen1 ,mr4 ,tillis1 and    
,mr4 ,sullivan7 introduced the following
 bill2 which was read twice and referred
 to the ,committee on ,veterans'        
,affairs  ,a ,,bill  ,to direct the     
,secretary of ,veterans ,affairs to     
conduct an independent review of the    
deaths of certain veterans by suicide1  
and for other purposes4  #a4 ,short     
title ,this ,act may be cited as the    
,veteran ,overmedication ,prevention    
,act of #bjag4  #b4 ,department of      
,veterans ,affairs independent review of
 certain deaths of veterans by suicide  
7a7 ,review required  7#a7 ,in general  
,not later than #ij days after the date 
of the enactment of this ,act1 the      
,secretary of ,veterans ,affairs shall  
seek to enter into an agreement with the
 ,national ,academies of ,sciences1     
,engineering1 and ,medicine under which 

the ,national ,academies shall conduct a
 review of the deaths of all covered    
veterans who died by suicide during the 
five-year period ending on the date of  
the enactment of this ,act1 regardless  
of whether information relating to such 
deaths has been reported by the ,centers
 for ,disease ,control and ,prevention4 
7#b7 ,elements ,the review required by  
paragraph 7#a7 shall include the        
following3 7,a7 ,the total number of    
covered veterans who died by suicide    
during the five-year period ending on   
the date of the enactment of this ,act4 
7,b7 ,the total number of covered       
veterans who died by a violent death    
during such five-year period4  7,c7 ,the
 total number of covered veterans who   
died by an accidental death during such 
five-year period4  7,d7 ,a description  
of each covered veteran described in    
subparagraphs 7,a7 through 7,c71        
including age1 gender1 race1 and        
ethnicity4  7,e7 ,a comprehensive list  
of prescribed medications and legal or  

illegal substances as annotated on      
toxicology reports of covered veterans  
described in subparagraphs 7,a7 through 
7,c71 specifically listing any          
medications that carried a black box    
warning1 were prescribed for off-label  
use1 were psychotropic1 or carried      
warnings that included suicidal         
ideation4  7,f7 ,a summary of medical   
diagnoses by physicians of the          
,department of ,veterans ,affairs or    
physicians providing services to covered
 veterans through programs of the       
,department that led to the prescribing 
of medications referred to in           
subparagraph 7,e7 in cases of           
post-traumatic stress disorder1         
traumatic brain injury1 military sexual 
trauma1 and other anxiety and depressive
 disorders4  7,g7 ,the number of        
instances in which a covered veteran    
described in subparagraph 7,a71 7,b71 or
 7,c7 was concurrently on multiple      
medications prescribed by physicians of 
the ,department or physicians providing 

services to veterans through programs of
 the ,department to treat post-traumatic
 stress disorder1 traumatic brain       
injury1 military sexual trauma1 other   
anxiety and depressive disorders1 or    
instances of comorbidity4  7,h7 ,the    
number of covered veterans described in 
subparagraphs 7,a7 through 7,c7 who were
 not taking any medication prescribed by
 a physician of the ,department or a    
physician providing services to veterans
 through a program of the ,department4  
7,i7 ,with respect to the treatment of  
post-traumatic stress disorder1         
traumatic brain injury1 military sexual 
trauma1 or other anxiety and depressive 
disorders1 the percentage of covered    
veterans described in subparagraphs 7,a7
 through 7,c7 who received a            
non-medication first-line treatment     
compared to the percentage of such      
veterans who received medication only4  
7,j7 ,with respect to the treatment of  
covered veterans described in           
subparagraphs 7,a7 through 7,c7 for     

post-traumatic stress disorder1         
traumatic brain injury1 military sexual 
trauma1 or other anxiety and depressive 
disorders1 the number of instances in   
which a non-medication first-line       
treatment 7such as cognitive behavioral 
therapy7 was attempted and determined to
 be ineffective for such a veteran1     
which subsequently led to the           
prescribing of a medication referred to 
in subparagraph 7,e74  7,k7 ,a          
description and example of how the      
,department determines and continually  
updates the clinical practice guidelines
 governing the prescribing of           
medications4  7,l7 ,an analysis of the  
use by the ,department1 including       
protocols or practices at medical       
facilities of the ,department1 of       
systematically measuring pain scores    
during clinical encounters under the    
,pain as the #eth ,vital ,sign ,toolkit 
of the ,department and an evaluation of 
the relationship between the use of such
 measurements and the number of veterans

 concurrently on multiple medications   
prescribed by physicians of the         
,department4  7,m7 ,a description of the
 efforts of the ,department to maintain 
appropriate staffing levels for mental  
health professionals1 such as mental    
health counselors1 marriage and family  
therapists1 and other appropriate       
counselors1 including--  7i7 a          
description of any impediments to carry 
out the education1 training1 and hiring 
of mental health counselors and marriage
 and family therapists under section    
#gcjb7;a7 of title #ch1 ,united ,states 
,code1 and strategies for addressing    
those impediments2  7ii7 a description  
of the objectives1 goals1 and timing of 
the ,department with respect to         
increasing the representation of such   
counselors and therapists in the        
behavioral health workforce of the      
,department1 including--  7,i7 a review 
of eligibility criteria for such        
counselors and therapists and a         
comparison of such criteria to that of  

other behavioral health professions in  
the ,department2 and  7,,ii7 an         
assessment of the participation of such 
counselors and therapists in the mental 
health professionals trainee program of 
the ,department and any impediments to  
such participation2  7iii7 an assessment
 of the development by the ,department  
of hiring guidelines for mental health  
counselors1 marriage and family         
therapists1 and other appropriate       
counselors2  7iv7 a description of how  
the ,department--  7,i7 identifies gaps 
in the supply of mental health          
professionals2 and  7,,ii7 determines   
successful staffing ratios for mental   
health professionals of the ,department2
  7v7 a description of actions taken by 
the ,secretary1 in consultation with the
 ,director of the ,office of ,personnel 
,management1 to create an occupational  
series for mental health counselors and 
marriage and family therapists of the   
,department and a timeline for the      
creation of such an occupational series2

 and  7vi7 a description of actions     
taken by the ,secretary to ensure that  
the national1 regional1 and local       
professional standards boards for mental
 health counselors and marriage and     
family therapists are comprised of only 
mental health counselors and marriage   
and family therapists and that the      
liaison from the ,department to such    
boards is a mental health counselor or  
marriage and family therapist4  7,n7    
,the percentage of covered veterans     
described in subparagraphs 7,a7 through 
7,c7 with combat experience or trauma   
related to combat experience 7including 
military sexual trauma1 traumatic brain 
injury1 and post-traumatic stress74     
7,o7 ,an identification of the medical  
facilities of the ,department with      
markedly high prescription rates and    
suicide rates for veterans receiving    
treatment at those facilities4  7,p7 ,an
 analysis1 by ,state1 of programs of the
 ,department that collaborate with      
,state ,medicaid agencies and the       

,centers for ,medicare and ,medicaid    
,services1 including the following3  7i7
 ,an analysis of the sharing of         
prescription and behavioral health data 
for veterans4  7ii7 ,an analysis of     
whether ,department staff check with    
,state prescription drug monitoring     
programs before prescribing medications 
to veterans4  7iii7 ,a description of   
the procedures of the ,department for   
coordinating with prescribers outside of
 the ,department to ensure that veterans
 are not overprescribed4  7iv7 ,a       
description of actions that the         
,department takes when a veteran is     
determined to be overprescribed4  7,q7  
,an analysis of the collaboration of    
medical centers of the ,department with 
medical examiners' offices or local     
jurisdictions to determine veteran      
mortality and cause of death4  7,r7 ,an 
identification and determination of a   
best practice model to collect and share
 veteran death certificate data between 
the ,department of ,veterans ,affairs1  

the ,department of ,defense1 ,states1   
and tribal entities4  7,s7 ,a           
description of how data relating to     
death certificates of veterans is       
collected1 determined1 and reported by  
the ,department of ,veterans ,affairs4  
7,t7 ,an assessment of any patterns     
apparent to the ,national ,academies of 
,sciences1 ,engineering1 and ,medicine  
based on the review conducted under     
paragraph 7#a74  7,u7 ,such             
recommendations for further action that 
would improve the safety and well-being 
of veterans as the ,national ,academies 
of ,sciences1 ,engineering1 and         
,medicine determine appropriate4  7#c7  
,compilation of data  7,a7 ,form of     
compilation ,the ,secretary of ,veterans
 ,affairs shall ensure that data        
compiled under paragraph 7#b7 is        
compiled in a manner that allows it to  
be analyzed across all data fields for  
purposes of informing and updating      
clinical practice guidelines of the     
,department of ,veterans ,affairs4  7,b7

 ,compilation of data regarding covered 
veterans ,in compiling data under       
paragraph 7#b7 regarding covered        
veterans described in subparagraphs 7,a7
 through 7,c7 of such paragraph1 data   
regarding veterans described in each    
such subparagraph shall be compiled     
separately and disaggregated by year4   
7#d7 ,completion of review and report   
,the agreement entered into under       
paragraph 7#a7 shall require that the   
,national ,academies of ,sciences1      
,engineering1 and ,medicine complete the
 review under such paragraph and submit 
to the ,secretary of ,veterans ,affairs 
a report containing the results of the  
review not later than #ahj days after   
entering into the agreement4  7b7       
,report ,not later than #cj days after  
the completion by the ,national         
,academies of ,sciences1 ,engineering1  
and ,medicine of the review required    
under subsection 7a71 the ,secretary of 
,veterans ,affairs shall--  7#a7 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 results
 of the review2 and  7#b7 make such     
report publicly available4  7c7         
,definitions ,in this section3  7#a7    
,the term black box warning means a     
warning displayed on the label of a     
prescription drug that is designed to   
call attention to the serious or        
life-threatening risk of the            
prescription drug4  7#b7 ,the term      
covered veteran means a veteran who     
received hospital care or medical       
services furnished by the ,department of
 ,veterans ,affairs during the five-year
 period preceding the death of the      
veteran4  7#c7 ,the term first-line     
treatment means a potential intervention
 that has been evaluated and assigned a 
high score within clinical practice     
guidelines4  7#d7 ,the term ,state means
 each of the ,states1 territories1 and  
possessions of the ,united ,states1 the 
,district of ,columbia1 and the         

,commonwealth of ,puerto ,rico4