,i  #aafth ,,congress  #b;d ,session    
,h4 ,r4 #ehfg  ,,in ,,the ,,house ,,of  
,,representatives  ,february #ab1       
#bjbj,mr4 ,cisneros 7for himself and    
,mr4 ,mast7 introduced the following    
bill2 which was referred to the         
,committee on ,veterans' ,affairs1 and  
in addition to the ,committees on ,armed
 ,services1 and ,energy and ,commerce1  
for a period to be subsequently         
determined by the ,speaker1 in each case
 for consideration of such provisions as
 fall within the jurisdiction of the    
committee concerned  ,a ,,bill  ,to     
direct the ,secretary of ,veterans      
,affairs to establish or update certain 
clinical practice guidelines of the     
,department of ,veterans ,affairs1 and  
for other purposes4  #a4 ,short title   
,this ,act may be cited as the ,setting 
,treatment ,options and ,practices for  
,veteran ,suicide and ,substance ,abuse 
,act or the ,,stop ,veteran ,suicide and
 ,substance ,abuse ,act4  #b4           
,establishment by ,department of        

,veterans ,affairs and ,department of   
,defense of clinical practice guidelines
 for comorbid mental health conditions  
such as ,,ptsd1 ,,mst1 and_/or ,,tbi    
7a7 ,in general ,not later than two     
years after the date of the enactment of
 this ,act1 the ,secretary of ,veterans 
,affairs1 in consultation with the      
,secretary of ,defense and the          
,secretary of ,health and ,human        
,services1 shall complete the           
development of clinical practice        
guidelines for the treatment of         
post-traumatic stress disorder1 military
 sexual trauma1 and traumatic brain     
injury that is comorbid with substance  
use disorder or chronic pain4  7b7 ,work
 group  7#a7 ,establishment ,in carrying
 out subsection 7a71 the ,secretary of  
,veterans ,affairs1 the ,secretary of   
,defense1 and the ,secretary of ,health 
and ,human ,services shall create a     
,trauma and ,comorbid ,substance ,use   
,disorder or ,chronic ,pain ,work ,group
 7in this section referred to as the    

,work ,group74  7#b7 ,membership ,the   
work group created under paragraph 7#a7 
shall be comprised of individuals that  
represent ,federal ,government entities 
and non-,federal ,government entities   
with expertise in the areas covered by  
the work group1 including the following3
 7,a7 ,academic institutions that       
specialize in research for the treatment
 of conditions described in subsection  
7a74  7,b7 ,the ,national ,center for   
,posttraumatic ,stress ,disorder of the 
,department of ,veterans ,affairs4  7,c7
 ,the ,office of the ,assistant         
,secretary for ,mental ,health and      
,substance ,use of the ,department of   
,health and ,human ,services4  7#c7     
,relation to other work groups ,the     
,work ,group shall be created and       
conducted in the same manner as other   
work groups for the development of      
clinical practice guidelines for the    
,department of ,veterans ,affairs and   
the ,department of ,defense4  7c7       
,matters included ,in developing the    

clinical practice guidelines under      
subsection 7a71 the ,work ,group1 in    
consultation with the ,post ,traumatic  
,stress ,disorder ,work ,group1         
,concussion-m,t,b,i ,work ,group1       
,opioid ,therapy for ,chronic ,pain     
,work ,group1 and ,substance ,use ,work 
,group1 shall ensure that the clinical  
practice guidelines include the         
following3 7#a7 ,guidance with respect  
to the following3 7,a7 ,the treatment of
 patients with post-traumatic stress    
disorder who are also experiencing a    
substance use disorder or chronic pain4 
7,b7 ,the treatment of patients         
experiencing a mental health condition1 
including anxiety1 depression1 or       
post-traumatic stress disorder as a     
result of military sexual trauma who are
 also experiencing a substance use      
disorder or chronic pain4  7,c7 ,the    
treatment of patients with traumatic    
brain injury who are also experiencing a
 substance use disorder or chronic pain4
  7#b7 ,guidance with respect to the    

following3 7,a7 ,appropriate case       
management for patients experiencing    
post-traumatic stress disorder that is  
comorbid with substance use disorder or 
chronic pain who transition from        
receiving care while on active duty in  
the ,armed ,forces to care from health  
care networks outside of the ,department
 of ,defense4  7,b7 ,appropriate case   
management for patients experiencing a  
mental health condition1 including      
anxiety1 depression1 or post-traumatic  
stress disorder as a result of military 
sexual trauma that is comorbid with     
substance use disorder or chronic pain  
who transition from receiving care while
 on active duty in the ,armed ,forces to
 care from health care networks outside 
of the ,department of ,defense4  7,c7   
,appropriate case management for        
patients experiencing traumatic brain   
injury that is comorbid with substance  
use disorder or chronic pain who        
transition from receiving care while on 
active duty in the ,armed ,forces to    

care from health care networks outside  
of the ,department of ,defense4  7#c7   
,guidance with respect to the treatment 
of patients who are still members of the
 ,armed ,forces and are experiencing a  
mental health condition1 including      
anxiety1 depression1 or post-traumatic  
stress disorder as a result of military 
sexual trauma that is comorbid with     
substance use disorder or chronic pain4 
7#d7 ,guidance with respect to the      
assessment by the ,national ,academies  
of ,sciences1 ,engineering1 and         
,medicine of the potential              
overmedication of veterans1 as required 
pursuant to the ,senate report          
accompanying ,s4 #aeeg1 #aaeth ,congress
 7,senate ,report #aae-acj71 under the  
heading ,overprescription ,prevention   
,report under the heading ,,committee   
,,recommendation4  7d7 ,rule of         
construction ,nothing in this section   
shall be construed to prevent the       
,secretary of ,veterans ,affairs and the
 ,secretary of ,defense from considering

 all relevant evidence1 as appropriate1 
in creating the clinical practice       
guidelines required under subsection 7a7
 or from ensuring that the final        
clinical practice guidelines developed  
under such subsection and subsequently  
updated1 as appropriate1 remain         
applicable to the patient populations of
 the ,department of ,veterans ,affairs  
and the ,department of ,defense4  #c4   
,update of clinical practice guidelines 
for assessment and management of        
patients at risk for suicide by taking  
into consideration gender- and          
age-specific risk factors and gender-   
and age-specific treatment efficacy of  
pharmacotherapy and psychotherapy  7a7  
,in general ,not later than two years   
after the date of the enactment of this 
,act1 the ,secretary of ,veterans       
,affairs and the ,secretary of ,defense1
 through the ,assessment and ,management
 of ,patients at ,risk for ,suicide     
,work ,group 7in this section referred  
to as the ,work ,group71 shall issue an 

update to the ,,va_/,,dod ,clinical     
,practice ,guideline for ,assessment and
 ,management of ,patients at ,risk for  
,suicide4  7b7 ,matters included ,in    
carrying out the update under subsection
 7a71 the ,work ,group shall ensure that
 the clinical practice guidelines       
updated under such subsection includes  
the following3 7#a7 ,enhanced guidance  
with respect to the following3 7,a7     
,gender- and age-specific risk factors  
for suicide and suicidal ideation4  7,b7
 ,gender- and age-specific treatment    
efficacy for depression and suicide     
prevention4  7,c7 ,gender- and          
age-specific pharmacotherapy efficacy4  
7,d7 ,gender- and age-specific          
psychotherapy efficacy4  7#b7 ,guidance 
with respect to the efficacy of         
alternative therapies1 other than       
psychotherapy and pharmacotherapy1      
including the following3 7,a7 ,yoga     
therapy4  7,b7 ,meditation therapy4     
7,c7 ,equine therapy4  7,d7 ,other      
animal therapy4  7,e7 ,training and     

caring for service dogs4  7,f7          
,agri-therapy4  7,g7 ,art therapy4  7,h7
 ,outdoor sports therapy4  7,i7 ,music  
therapy4  7,j7 ,any other alternative   
therapy that the ,work ,group considers 
appropriate4  7#c7 ,guidance with       
respect to the findings of the ,creating
 ,options for ,veterans' ,expedited     
,recovery ,commission 7commonly referred
 to as the ,,cover ,commission7         
established under section #ica of the   
,jason ,simcakoski ,memorial and        
,promise ,act 7title ,,ix of ,public    
,law #aad-aih2 #ch ,u4,s4,c4 #agja      
note74  7c7 ,rule of construction       
,nothing in this section shall be       
construed to prevent the ,secretary of  
,veterans ,affairs and the ,secretary of
 ,defense from considering all relevant 
evidence1 as appropriate1 in updating   
the ,,va_/,,dod ,clinical ,practice     
,guideline for ,assessment and          
,management of ,patients at ,risk for   
,suicide1 as required under subsection  
7a71 or from ensuring that the final    

clinical practice guidelines updated    
under such subsection remain applicable 
to the patient populations of the       
,department of ,veterans ,affairs and   
the ,department of ,defense4