#aafth ,,congress  #b;d ,session  ,s4   
#ghe  ,,an ,,act  ,to improve mental    
health care provided by the ,department 
of ,veterans ,affairs1 and for other    
purposes4  #a4 ,short title2 table of   
contents  7a7 ,short title ,this ,act   
may be cited as the ,commander ,john    
,scott ,hannon ,veterans ,mental ,health
 ,care ,improvement ,act of #bjai4  7b7 
,table of contents ,the table of        
contents for this ,act is as follows3   
,sec4 #a4 ,short title2 table of        
contents4,,title ,i--,improvement of    
transition of individuals to services   
from ,department of ,veterans           
,affairs,sec4 #aja4 ,strategic plan on  
expansion of health care coverage for   
veterans transitioning from service in  
the ,armed ,forces4,sec4 #ajb4 ,review  
of records of former members of the     
,armed ,forces who die by suicide within
 one year of separation from the ,armed 
,forces4,sec4 #ajc4 ,report on ,,reach  
,,vet program of ,department of         
,veterans ,affairs4,sec4 #ajd4 ,report  

on care for former members of the ,armed
 ,forces with other than honorable      
discharge4,,title ,,ii--,suicide        
prevention,sec4 #bja4 ,financial        
assistance to certain entities to       
provide or coordinate the provision of  
suicide prevention services for eligible
 individuals and their families4,sec4   
#bjb4 ,analysis on feasibility and      
advisability of the ,department of      
,veterans ,affairs providing certain    
complementary and integrative health    
services4,sec4 #bjc4 ,pilot program to  
provide veterans access to complementary
 and integrative health programs through
 animal therapy1 agritherapy1 sports and
 recreation therapy1 art therapy1 and   
posttraumatic growth programs4,sec4     
#bjd4 ,department of ,veterans ,affairs 
study of all-cause mortality of         
veterans1 including by suicide1 and     
review of staffing levels of mental     
health professionals4,sec4 #bje4        
,comptroller ,general report on         
management by ,department of ,veterans  

,affairs of veterans at high risk for   
suicide4,,title ,,iii--,programs1       
studies1 and guidelines on mental       
health,sec4 #cja4 ,study on connection  
between living at high altitude and     
suicide risk factors among              
veterans4,sec4 #cjb4 ,establishment by  
,department of ,veterans ,affairs and   
,department of ,defense of a clinical   
provider treatment toolkit and          
accompanying training materials for     
comorbidities4,sec4 #cjc4 ,update of    
clinical practice guidelines for        
assessment and management of patients at
 risk for suicide4,sec4 #cjd4           
,establishment by ,department of        
,veterans ,affairs and ,department of   
,defense of clinical practice guidelines
 for the treatment of serious mental    
illness4,sec4 #cje4 ,precision medicine 
initiative of ,department of ,veterans  
,affairs to identify and validate brain 
and mental health biomarkers4,sec4 #cjf4
 ,statistical analyses and data         
evaluation by ,department of ,veterans  

,affairs4,,title ,,iv--,oversight of    
mental health care and related          
services,sec4 #dja4 ,study on           
effectiveness of suicide prevention and 
mental health outreach programs of      
,department of ,veterans ,affairs4,sec4 
#djb4 ,oversight of mental health and   
suicide prevention media outreach       
conducted by ,department of ,veterans   
,affairs4,sec4 #djc4 ,comptroller       
,general management review of mental    
health and suicide prevention services  
of ,department of ,veterans             
,affairs4,sec4 #djd4 ,comptroller       
,general report on efforts of           
,department of ,veterans ,affairs to    
integrate mental health care into       
primary care clinics4,sec4 #dje4 ,joint 
mental health programs by ,department of
 ,veterans ,affairs and ,department of  
,defense4,,title ,v--,improvement of    
mental health medical workforce,sec4    
#eja4 ,staffing improvement plan for    
mental health providers of ,department  
of ,veterans ,affairs4,sec4 #ejb4       

,establishment of ,department of        
,veterans ,affairs ,readjustment        
,counseling ,service ,scholarship       
,program4,sec4 #ejc4 ,comptroller       
,general report on ,readjustment        
,counseling ,service of ,department of  
,veterans ,affairs4,sec4 #ejd4          
,expansion of reporting requirements on 
,readjustment ,counseling ,service of   
,department of ,veterans ,affairs4,sec4 
#eje4 ,briefing on alternative work     
schedules for employees of ,veterans    
,health ,administration4,sec4 #ejf4     
,suicide prevention coordinators4,sec4  
#ejg4 ,report on efforts by ,department 
of ,veterans ,affairs to implement      
safety planning in emergency            
departments4,,title ,,vi--,improvement  
of care and services for women          
veterans,sec4 #fja4 ,expansion of       
capabilities of ,women ,veterans ,call  
,center to include text messaging4,sec4 
#fjb4 ,requirement for ,department of   
,veterans ,affairs internet website to  
provide information on services         

available to women veterans4,,title     
,,vii--,other matters,sec4 #gja4        
,expanded telehealth from ,department of
 ,veterans ,affairs4,sec4 #gjb4         
,partnerships with non-,federal         
,government entities to provide         
hyperbaric oxygen therapy to veterans   
and studies on the use of such therapy  
for treatment of post-traumatic stress  
disorder and traumatic brain            
injury4,sec4 #gjc4 ,prescription of     
technical qualifications for licensed   
hearing aid specialists and requirement 
for appointment of such                 
specialists4,sec4 #gjd4 ,use by         
,department of ,veterans ,affairs of    
commercial institutional review boards  
in sponsored research trials4,sec4 #gje4
 ,creation of ,office of ,research      
,reviews within the ,office of          
,information and ,technology of the     
,department of ,veterans ,affairs4  ,i  
,improvement of transition of           
individuals to services from ,department
 of ,veterans ,affairs  #aja4 ,strategic

 plan on expansion of health care       
coverage for veterans transitioning from
 service in the ,armed ,forces  7a7     
,strategic plan  7#a7 ,in general ,not  
later than one year after the date of   
the enactment of this ,act1 the         
,secretary of ,veterans ,affairs1 in    
consultation with the ,secretary of     
,defense1 shall submit to the           
appropriate committees of ,congress and 
publish on a website of the ,department 
of ,veterans ,affairs a strategic plan  
for the provision by the ,department of 
health care to any veteran during the   
one-year period following the discharge 
or release of the veteran from active   
military1 naval1 or air service4  7#b7  
,elements ,the plan submitted under     
paragraph 7#a7 shall include the        
following3 7,a7 ,an identification of   
general goals and objectives for the    
provision of health care to veterans    
described in such paragraph4  7,b7 ,a   
description of how such goals and       
objectives are to be achieved1          

including-- 7i7 a description of the use
 of existing personnel1 information1    
technology1 facilities1 public and      
private partnerships1 and other         
resources of the ,department of         
,veterans ,affairs2  7ii7 a description 
of the anticipated need for additional  
resources for the ,department2 and      
7iii7 an assessment of cost4  7,c7 ,an  
analysis of the anticipated health care 
needs1 including mental health care1 for
 such veterans1 disaggregated by        
geographic area4  7,d7 ,an analysis of  
whether such veterans are eligible for  
enrollment in the system of annual      
patient enrollment of the ,department   
under section #agje7;a7 of title #ch1   
,united ,states ,code4  7,e7 ,a         
description of activities designed to   
promote the availability of health care 
from the ,department for such veterans1 
including outreach to members of the    
,armed ,forces though the ,transition   
,assistance ,program under sections     
#aadb and #aadd of title #aj1 ,united   

,states ,code4  7,f7 ,a description of  
legislative or administrative action    
required to carry out the plan4  7,g7 ,a
 description of how the plan would      
further the ongoing initiatives under   
,executive ,order #achbb 7#hc ,fed4     
,reg4 #aeac2 relating to supporting our 
veterans during their transition from   
uniformed service to civilian life7 to  
provide seamless access to high-quality 
mental health care and suicide          
prevention resources to veterans as they
 transition1 with an emphasis on the    
one-year period following separation4   
7b7 ,definitions ,in this section3 7#a7 
,active military1 naval1 or air service 
,the term active military1 naval1 or air
 service has the meaning given that term
 in section #aja7bd7 of title #ch1      
,united ,states ,code4  7#b7            
,appropriate committees of ,congress    
,the term appropriate committees of     
,congress means-- 7,a7 the ,committee on
 ,veterans' ,affairs and the ,committee 
on ,appropriations of the ,senate2 and  

7,b7 the ,committee on ,veterans'       
,affairs and the ,committee on          
,appropriations of the ,house of        
,representatives4  #ajb4 ,review of     
records of former members of the ,armed 
,forces who die by suicide within one   
year of separation from the ,armed      
,forces  7a7 ,review  7#a7 ,in general  
,the ,secretary of ,defense and the     
,secretary of ,veterans ,affairs shall  
jointly review the records of each      
former member of the ,armed ,forces who 
died by suicide1 as determined by the   
,secretary of ,defense or the ,secretary
 of ,veterans ,affairs1 within one year 
following the discharge or release of   
the former member from active military1 
naval1 or air service during the        
five-year period preceding the date of  
the enactment of this ,act4  7#b7       
,records ,to be reviewed ,in completing 
the review required under paragraph     
7#a71 the ,secretary of ,defense and the
 ,secretary of ,veterans ,affairs shall 
review the following records maintained 

by the ,department of ,defense3 7,a7    
,health treatment records4  7,b7        
,fitness1 medical1 and dental records4  
7,c7 ,ancillary training records4  7,d7 
,safety forms and additional duties     
sections of the personnel information   
files4  7b7 ,elements ,the review       
required by subsection 7a7 with respect 
to a former member of the ,armed ,forces
 shall include consideration of the     
following3 7#a7 ,whether the ,department
 of ,defense had identified the former  
member as being at elevated risk during 
the #cfe-;day period before separation  
of the member from the ,armed ,forces4  
7#b7 ,in the case that the member was   
identified as being at elevated risk as 
described in paragraph 7#a71 whether    
that identification had been            
communicated to the ,department of      
,veterans ,affairs via the ,solid ,start
 initiative of the ,department pursuant 
to ,executive ,order #achbb 7#hc ,fed4  
,reg4 #aeac2 relating to supporting our 
veterans during their transition from   

uniformed service to civilian life71 or 
any other means4  7#c7 ,the presence of 
evidence-based and empirically-supported
 contextual and individual risk factors 
specified in subsection 7c7 with respect
 to the former member and how those risk
 factors correlated to the circumstances
 of the death of the former member4     
7#d7 ,demographic variables1 including  
the following3 7,a7 ,sex4  7,b7 ,age4   
7,c7 ,rank at separation from the ,armed
 ,forces4  7,d7 ,career field after     
separation from the ,armed ,forces4     
7,e7 ,state and county of residence one 
month prior to death4  7,f7 ,branch of  
service in the ,armed ,forces4  7,g7    
,marital status4  7,h7 ,reason for      
separation from the ,armed ,forces4     
7#e7 ,support or medical services       
furnished to the former member through  
the ,department of ,defense1 specified  
by the type of service or care provided4
  7#f7 ,support or medical services     
furnished to the former member through  
the ,department of ,veterans ,affairs1  

specified by the type of service or care
 provided4  7c7 ,evidence-based and     
empirically-supported contextual and    
individual risk factors ,evidence-based 
and empirically-supported contextual and
 individual risk factors specified in   
this subsection include the following3  
7#a7 ,exposure to violence4  7#b7       
,exposure to suicide4  7#c7 ,housing    
instability4  7#d7 ,financial           
instability4  7#e7 ,vocational problems 
or insecurity4  7#f7 ,legal problems4   
7#g7 ,highly acute or significantly     
chronic relational problems4  7#h7      
,limited access to health care4  7d7    
,report ,not later than three years     
after the date of the enactment of this 
,act1 the ,secretary of ,defense and the
 ,secretary of ,veterans ,affairs shall 
jointly submit to the appropriate       
committees of ,congress an aggregated   
report on the results of the review     
conducted under subsection 7a7 with     
respect to the year-one cohort of former
 members of the ,armed ,forces covered  

by the review4  7e7 ,definitions ,in    
this section3 7#a7 ,active military1    
naval1 or air service ,the term active  
military1 naval1 or air service has the 
meaning given that term in section      
#aja7bd7 of title #ch1 ,united ,states  
,code4  7#b7 ,appropriate committees of 
,congress defined ,the term appropriate 
committees of ,congress means-- 7,a7 the
 ,committee on ,armed ,services and the 
,committee on ,veterans' ,affairs of the
 ,senate2 and  7,b7 the ,committee on   
,armed ,services and the ,committee on  
,veterans' ,affairs of the ,house of    
,representatives4  #ajc4 ,report on     
,,reach ,,vet program of ,department of 
,veterans ,affairs  7a7 ,in general ,not
 later than #ahj days after the date of 
the enactment of this ,act1 the         
,secretary of ,veterans ,affairs shall  
submit to the ,committee on ,veterans'  
,affairs of the ,senate and the         
,committee on ,veterans' ,affairs of the
 ,house of ,representatives a report on 
the ,,reach ,,vet program4  7b7         

,elements ,the report required by       
subsection 7a7 shall include the        
following3 7#a7 ,an assessment of the   
impact of the ,,reach ,,vet program on  
rates of suicide among veterans4  7#b7  
,an assessment of how limits within the 
,,reach ,,vet program1 such as caps on  
the number of veterans who may be       
flagged as high risk1 are adjusted for  
differing rates of suicide across the   
country4  7#c7 ,a detailed explanation1 
with evidence1 for why the conditions   
included in the model used by the       
,,reach ,,vet program were chosen1      
including an explanation as to why      
certain conditions1 such as bipolar     
disorder ,,ii1 were not included even   
though they show a similar rate of risk 
for suicide as other conditions that    
were included4  7#d7 ,an assessment of  
the feasibility of incorporating certain
 economic data held by the ,veterans    
,benefits ,administration into the model
 used by the ,,reach ,,vet program1     
including financial data and employment 

status1 which research indicates may    
have an impact on risk for suicide4  7c7
 ,,reach ,,vet program defined ,in this 
section1 the term ,,reach ,,vet program 
means the ,recovery ,engagement and     
,coordination for ,health--,veterans    
,enhanced ,treatment program of the     
,department of ,veterans ,affairs4      
#ajd4 ,report on care for former members
 of the ,armed ,forces with other than  
honorable discharge ,section #agbj;,i7f7
 of title #ch1 ,united ,states ,code1 is
 amended-- 7#a7 in paragraph 7#a7 by    
striking ,not less frequently than once 
and inserting ,not later than ,february 
#ae2 and  7#b7 in paragraph 7#b7-- 7,a7 
by redesignating subparagraph 7,c7 as   
subparagraph 7,f72 and  7,b7 by         
inserting after subsection 7,b7 the     
following new subparagraphs3  7,c7 ,the 
types of mental or behavioral health    
care needs treated under this section4  
7,d7 ,the demographics of individuals   
being treated under this section1       
including-- 7i7 age2  7ii7 era of       

service in the ,armed ,forces2  7iii7   
branch of service in the ,armed ,forces2
 and  7iv7 geographic location4  7,e7   
,the average number of visits for an    
individual for mental or behavioral     
health care under this section4  4  ,,ii
 ,suicide prevention  #bja4 ,financial  
assistance to certain entities to       
provide or coordinate the provision of  
suicide prevention services for eligible
 individuals and their families  7a7    
,purpose2 designation  7#a7 ,purpose    
,the purpose of this section is to      
reduce veteran suicide through a        
community-based grant program to award  
grants to eligible entities to provide  
or coordinate suicide prevention        
services to eligible individuals and    
their families4  7#b7 ,designation ,the 
grant program under this section shall  
be known as the ,staff ,sergeant ,parker
 ,gordon ,fox ,suicide ,prevention      
,grant ,program4  7b7 ,financial        
assistance and coordination ,the        
,secretary shall provide financial      

assistance to eligible entities approved
 under this section through the award of
 grants to such entities to provide or  
coordinate the provision of services to 
eligible individuals and their families 
to reduce the risk of suicide4 ,the     
,secretary shall carry out this section 
in coordination with the ,president's   
,roadmap to ,empower ,veterans and ,end 
a ,national ,tragedy of ,suicide ,task  
,force and in consultation with the     
,office of ,mental ,health and ,suicide 
,prevention of the ,department1 to the  
extent practicable4  7c7 ,award of      
grants  7#a7 ,in general ,the ,secretary
 shall award a grant to each eligible   
entity for which the ,secretary has     
approved an application under subsection
 7f7 to provide or coordinate the       
provision of suicide prevention services
 under this section4  7#b7 ,grant       
amounts1 intervals of payment1 and      
matching funds ,in accordance with the  
services being provided under a grant   
under this section and the duration of  

those services1 the ,secretary shall    
establish-- 7,a7 a maximum amount to be 
awarded under the grant of not more than
 #gej1jjj per grantee per fiscal year2  
and  7,b7 intervals of payment for the  
administration of the grant4  7d7       
,distribution of grants and preference  
7#a7 ,distribution  7,a7 ,priority ,in  
compliance with subparagraphs 7,b7 and  
7,c71 in determining how to distribute  
grants under this section1 the          
,secretary may prioritize-- 7i7 rural   
communities2  7ii7 ,tribal lands2  7iii7
 territories of the ,united ,states2    
7iv7 medically underserved areas2  7v7  
areas with a high number or percentage  
of minority veterans or women veterans2 
and  7vi7 areas with a high number or   
percentage of calls to the ,veterans    
,crisis ,line4  7,b7 ,areas with need   
,the ,secretary shall ensure that1 to   
the extent practicable1 grants under    
this section are distributed-- 7i7 to   
provide services in areas of the ,united
 ,states that have experienced high     

rates of suicide by eligible            
individuals1 including suicide attempts2
 and  7ii7 to eligible entities that can
 assist eligible individuals at risk of 
suicide who are not currently receiving 
health care furnished by the            
,department4  7,c7 ,geography ,in       
distributing grants under this          
paragraph1 the ,secretary may provide   
grants to eligible entities that furnish
 services to eligible individuals and   
their families in geographically        
dispersed areas4  7#b7 ,preference ,the 
,secretary shall give preference to     
eligible entities that have demonstrated
 the ability to provide or coordinate   
suicide prevention services4  7e7       
,requirements for receipt of grants     
7#a7 ,notification that services are    
from ,department ,each entity receiving 
a grant under this section to provide or
 coordinate suicide prevention services 
to eligible individuals and their       
families shall notify the recipients of 
such services that such services are    

being paid for1 in whole or in part1 by 
the ,department4  7#b7 ,development of  
plan with eligible individuals and their
 family ,any plan developed with respect
 to the provision of suicide prevention 
services for an eligible individual or  
their family shall be developed in      
consultation with the eligible          
individual and their family4  7#c7      
,coordination ,an entity receiving a    
grant under this section shall-- 7,a7   
coordinate with the ,secretary with     
respect to the provision of clinical    
services to eligible individuals in     
accordance with subsection 7n7 or any   
other provisions of the law regarding   
the delivery of health care by the      
,secretary2  7,b7 inform every veteran  
who receives assistance under this      
section from the entity of the ability  
of the veteran to apply for enrollment  
in the patient enrollment system of the 
,department under section #agje7;a7 of  
title #ch1 ,united ,states ,code2 and   
7,c7 if such a veteran wishes to so     

enroll1 inform the veteran of a point of
 contact at the ,department who can     
assist the veteran in such enrollment4  
7#d7 ,measurement and monitoring ,an    
entity receiving a grant under this     
section shall submit to the ,secretary a
 description of such tools and          
assessments the entity uses or will use 
to determine the effectiveness of the   
services furnished by the entity1 which 
shall include the measures developed    
under subsection 7h77#b7 and may        
include-- 7,a7 the effect of the        
services furnished by the entity on the 
financial stability of the eligible     
individual2  7,b7 the effect of the     
services furnished by the entity on the 
mental health status1 wellbeing1 and    
suicide risk of the eligible individual2
 and  7,c7 the effect of the services   
furnished by the entity on the social   
support of the eligible individuals     
receiving those services4  7#e7 ,reports
 ,the ,secretary-- 7,a7 shall require   
each entity receiving a grant under this

 section to submit to the ,secretary an 
annual report that describes the        
projects carried out with such grant    
during the year covered by the report2  
7,b7 shall specify to each such entity  
the evaluation criteria and data and    
information to be submitted in such     
report2 and  7,c7 may require each such 
entity to submit to the ,secretary such 
additional reports as the ,secretary    
considers appropriate4  7f7 ,application
 for grants  7#a7 ,in general ,an       
eligible entity seeking a grant under   
this section shall submit to the        
,secretary an application therefor in   
such form1 in such manner1 and          
containing such commitments and         
information as the ,secretary considers 
necessary to carry out this section4    
7#b7 ,matters to be included ,each      
application submitted by an eligible    
entity under paragraph 7#a7 shall       
contain the following3 7,a7 ,a          
description of the suicide prevention   
services proposed to be provided by the 

eligible entity and the identified need 
for those services4  7,b7 ,a detailed   
plan describing how the eligible entity 
proposes to coordinate or deliver       
suicide prevention services to eligible 
individuals1 including-- 7i7 an         
identification of the community         
partners1 if any1 with which the        
eligible entity proposes to work in     
delivering such services2  7ii7 a       
description of the arrangements         
currently in place between the eligible 
entity and such partners with regard to 
the provision or coordination of suicide
 prevention services2  7iii7 an         
identification of how long such         
arrangements have been in place2  7iv7 a
 description of the suicide prevention  
services provided by such partners that 
the eligible entity shall coordinate1 if
 any2 and  7v7 an identification of     
local suicide prevention coordinators of
 the ,department and a description of   
how the eligible entity will communicate
 with local suicide prevention          

coordinators4  7,c7 ,a description of   
the population of eligible individuals  
and their families proposed to be       
provided suicide prevention services4   
7,d7 ,based on information and methods  
developed by the ,secretary for purposes
 of this subsection1 an estimate of the 
number of eligible individuals at risk  
of suicide and their families proposed  
to be provided suicide prevention       
services1 including the percentage of   
those eligible individuals who are not  
currently receiving care furnished by   
the ,department4  7,e7 ,evidence of     
measurable outcomes related to          
reductions in suicide risk and          
mood-related symptoms utilizing         
validated instruments by the eligible   
entity 7and the proposed partners of the
 entity1 if any7 in providing suicide   
prevention services to individuals at   
risk of suicide1 particularly to        
eligible individuals and their families4
  7,f7 ,a description of the managerial 
and technological capacity of the       

eligible entity-- 7i7 to coordinate the 
provision of suicide prevention services
 with the provision of other services2  
7ii7 to assess on an ongoing basis the  
needs of eligible individuals and their 
families for suicide prevention         
services2  7iii7 to coordinate the      
provision of suicide prevention services
 with the services of the ,department   
for which eligible individuals are also 
eligible2  7iv7 to tailor suicide       
prevention services to the needs of     
eligible individuals and their families2
  7v7 to seek continuously new sources  
of assistance to ensure the continuity  
of suicide prevention services for      
eligible individuals and their families 
as long as they are determined to be at 
risk of suicide2 and  7vi7 to measure   
the effects of suicide prevention       
services provided by the eligible entity
 or partner organization1 in accordance 
with subsection 7h77#b71 on the lives of
 eligible individuals and their families
 who receive such services provided by  

the organization using pre- and         
post-evaluations on validated measures  
of suicide risk and mood-related        
symptoms4  7,g7 ,clearly defined        
objectives for the provision of suicide 
prevention services4  7,h7 ,a           
description and physical address of the 
primary location of the eligible entity4
  7,i7 ,a description of the geographic 
area the eligible entity plans to serve 
during the grant award period for which 
the application applies4  7,j7 ,if the  
eligible entity is a ,state or local    
government or an ,indian tribe1 the     
amount of grant funds proposed to be    
made available to community partners1 if
 any1 through agreements4  7,k7 ,a      
description of how the eligible entity  
will assess the effectiveness of the    
provision of grants under this section4 
7,l7 ,an agreement to use the measures  
and metrics provided by the ,department 
for the purposes of measuring the       
effectiveness of the programming as     
described in subsection 7h77#b74  7,m7  

,such additional application criteria as
 the ,secretary considers appropriate4  
7g7 ,training and technical assistance  
7#a7 ,in general ,the ,secretary shall  
provide training and technical          
assistance1 in coordination with the    
,centers for ,disease ,control and      
,prevention1 to eligible entities in    
receipt of grants under this section    
regarding-- 7,a7 suicide risk           
identification and management2  7,b7 the
 data required to be collected and      
shared with the ,department2  7,c7 the  
means of data collection and sharing2   
7,d7 familiarization with and           
appropriate use of any tool to be used  
to measure the effectiveness of the use 
of the grants provided2 and  7,e7 the   
requirements for reporting under        
subsection 7e77#e7 on services provided 
via such grants4  7#b7 ,provision of    
training and technical assistance ,the  
,secretary may provide the training and 
technical assistance described in       
paragraph 7#a7 directly or through      

grants or contracts with appropriate    
public or nonprofit entities4  7h7      
,administration of grant program  7#a7  
,selection criteria ,the ,secretary1 in 
consultation with entities specified in 
paragraph 7#c71 shall establish criteria
 for the selection of eligible entities 
that have submitted applications under  
subsection 7f74  7#b7 ,development of   
measures and metrics ,the ,secretary    
shall develop1 in consultation with     
entities specified in paragraph 7#c71   
the following3 7,a7 ,a framework for    
collecting and sharing information about
 entities in receipt of grants under    
this section for purposes of improving  
the services available for eligible     
individuals and their families1 set     
forth by service type1 locality1 and    
eligibility criteria4  7,b7 ,the        
measures and metrics to be used by each 
entity in receipt of grants under this  
section to determine the effectiveness  
of the programming being provided by    
such entity in improving mental health  

status1 wellbeing1 and reducing suicide 
risk and completed suicides of eligible 
individuals and their families1 which   
shall include an existing measurement   
tool or protocol for the grant recipient
 to utilize when determining            
programmatic effectiveness4  7#c7       
,coordination ,in developing a plan for 
the design and implementation of the    
provision of grants under this section1 
including criteria for the award of     
grants1 the ,secretary shall consult    
with the following3 7,a7 ,veterans      
service organizations4  7,b7 ,national  
organizations representing potential    
community partners of eligible entities 
in providing supportive services to     
address the needs of eligible           
individuals and their families1         
including national organizations that-- 
7i7 advocate for the needs of           
individuals with or at risk of          
behavioral health conditions2  7ii7     
represent mayors2  7iii7 represent      
unions2  7iv7 represent first           

responders2  7v7 represent chiefs of    
police and sheriffs2  7vi7 represent    
governors2  7vii7 represent a territory 
of the ,united ,states2 or  7viii7      
represent a ,tribal alliance4  7,c7     
,national organizations representing    
members of the ,armed ,forces4  7,d7    
,national organizations that represent  
counties4  7,e7 ,organizations with     
which the ,department has a current     
memorandum of agreement or understanding
 related to mental health or suicide    
prevention4  7,f7 ,state departments of 
veterans affairs4  7,g7 ,national       
organizations representing members of   
the reserve components of the ,armed    
,forces4  7,h7 ,national organizations  
representing members of the ,coast      
,guard4  7,i7 ,organizations1 including 
institutions of higher education1 with  
experience in creating measurement tools
 for purposes of advising the ,secretary
 on the most appropriate existing       
measurement tool or protocol for the    
,department to utilize4  7,j7 ,the      

,national ,alliance on ,mental ,illness4
  7,k7 ,a labor organization 7as such   
term is defined in section #gajc7;a77#d7
 of title #e1 ,united ,states ,code74   
7,l7 ,the ,centers for ,disease ,control
 and ,prevention1 the ,substance ,abuse 
and ,mental ,health ,services           
,administration1 the ,president's       
,roadmap to ,empower ,veterans and ,end 
a ,national ,tragedy of ,suicide ,task  
,force1 and such other organizations as 
the ,secretary considers appropriate4   
7#d7 ,report on grant criteria ,not     
later than #cj days before notifying    
eligible entities of the availability of
 funding under this section1 the        
,secretary shall submit to the          
appropriate committees of ,congress a   
report containing-- 7,a7 criteria for   
the award of a grant under this section2
  7,b7 the already developed measures   
and metrics to be used by the           
,department to measure the effectiveness
 of the use of grants provided under    
this section as described in subsection 

7h77#b72 and  7,c7 a framework for the  
sharing of information about entities in
 receipt of grants under this section4  
7i7 ,information on potential eligible  
individuals  7#a7 ,in general ,the      
,secretary may make available to        
recipients of grants under this section 
certain information regarding potential 
eligible individuals who may receive    
services for which such grant is        
provided4  7#b7 ,information included   
,the information made available under   
paragraph 7#a7 with respect to potential
 eligible individuals may include the   
following3 7,a7 ,confirmation of the    
status of a potential eligible          
individual as a veteran4  7,b7          
,confirmation of whether the potential  
eligible individual is enrolled in the  
patient enrollment system of the        
,department under section #agje7;a7 of  
title #ch1 ,united ,states ,code4  7,c7 
,confirmation of whether a potential    
eligible individual is currently        
receiving care furnished by the         

,department or has recently received    
such care4  7#c7 ,opt-out ,the          
,secretary shall allow an eligible      
individual to opt out of having their   
information shared under this subsection
 with recipients of grants under this   
section4  7j7 ,duration ,the authority  
of the ,secretary to provide grants     
under this section shall terminate on   
the date that is three years after the  
date on which the first grant is awarded
 under this section4  7k7 ,reporting    
7#a7 ,interim report  7,a7 ,in general  
,not later than #ah months after the    
date on which the first grant is awarded
 under this section1 the ,secretary     
shall submit to the appropriate         
committees of ,congress a report on the 
provision of grants to eligible entities
 under this section4  7,b7 ,elements    
,the report submitted under subparagraph
 7,a7 shall include the following3 7i7  
,an assessment of the effectiveness of  
the grant program under this section1   
including-- 7,i7 the effectiveness of   

grant recipients and their community    
partners1 if any1 in conducting outreach
 to eligible individuals2  7,,ii7 the   
effectiveness of increasing eligible    
individuals engagement in suicide       
prevention services2 and  7,,iii7 such  
other validated instruments and         
additional measures as determined by the
 ,secretary and as described in         
subsection 7h77#b74  7ii7 ,a list of    
grant recipients and their partner      
organizations1 if any1 that delivered   
services funded by the grant and the    
amount of such grant received by each   
recipient and partner organization4     
7iii7 ,the number of eligible           
individuals supported by each grant     
recipient1 including through services   
provided to family members1             
disaggregated by-- 7,i7 all demographic 
characteristics as determined necessary 
and appropriate by the ,secretary in    
coordination with the ,centers for      
,disease ,control and ,prevention2      
7,,ii7 whether each such eligible       

individual is enrolled in the patient   
enrollment system of the ,department    
under section #agje7;a7 of title #ch1   
,united ,states ,code2  7,,iii7 branch  
of service in the ,armed ,forces2       
7,,iv7 era of service in the ,armed     
,forces2  7,v7 type of service received 
by the eligible individual2 and  7,,vi7 
whether each such eligible individual   
was referred to the ,department for     
care4  7iv7 ,the number of eligible     
individuals supported by grants under   
this section1 including through services
 provided to family members4  7v7 ,the  
number of eligible individuals described
 in clause 7iv7 who were not previously 
receiving care furnished by the         
,department1 with specific numbers for  
the population of eligible individuals  
described in subsection 7q77#d77;,b74   
7vi7 ,the number of eligible individuals
 whose mental health status1 wellbeing1 
and suicide risk received a baseline    
measurement assessment under this       
section and the number of such eligible 

individuals whose mental health status1 
wellbeing1 and suicide risk will be     
measured by the ,department or a        
community partner over a period of time 
for any improvements4  7vii7 ,the types 
of data the ,department was able to     
collect and share with partners1        
including a characterization of the     
benefits of that data4  7viii7 ,the     
number and percentage of eligible       
individuals referred to the point of    
contact at the ,department under        
subsection 7e77#c77;,c74  7ix7 ,the     
number of eligible individuals newly    
enrolled in the patient enrollment      
system of the ,department under section 
#agje7;a7 of title #ch1 ,united ,states 
,code based on a referral to the        
,department from a grant recipient under
 subsection 7e77#c77;,c71 disaggregated 
by grant recipient4  7x7 ,a detailed    
account of how the grant funds were     
used1 including executive compensation1 
overhead costs1 and other indirect      
costs4  7xi7 ,a description of any      

outreach activities conducted by the    
eligible entity in receipt of a grant   
with respect to services provided using 
the grant4  7xii7 ,the number of        
individuals who seek services from the  
grant recipient who are not eligible    
individuals4  7,c7 ,submittal of        
information by grant recipients ,the    
,secretary may require eligible entities
 receiving grants under this section to 
provide to ,congress such information as
 the ,secretary determines necessary    
regarding the elements described in     
subparagraph 7,b74  7#b7 ,final report  
,not later than three years after the   
date on which the first grant is awarded
 under this section1 and annually       
thereafter for each year in which the   
program is in effect1 the ,secretary    
shall submit to the appropriate         
committees of ,congress-- 7,a7 a        
follow-up on the interim report         
submitted under paragraph 7#a7          
containing the elements set forth in    
subparagraph 7,b7 of such paragraph2 and

  7,b7 a report on-- 7i7 the            
effectiveness of the provision of grants
 under this section1 including the      
effectiveness of community partners in  
conducting outreach to eligible         
individuals and their families and      
reducing the rate of suicide among      
eligible individuals2  7ii7 an          
assessment of the increased capacity of 
the ,department to provide services to  
eligible individuals and their families1
 set forth by ,state1 as a result of the
 provision of grants under this section2
  7iii7 the feasibility and advisability
 of extending or expanding the provision
 of grants consistent with this section2
 and  7iv7 such other elements as       
considered appropriate by the           
,secretary4  7l7 ,third-party assessment
  7#a7 ,study of grant program  7,a7 ,in
 general ,not later than #ahj days after
 the commencement of the grant program  
under this section1 the ,secretary shall
 seek to enter into a contract with an  
appropriate entity described in         

paragraph 7#c7 to conduct a study of the
 grant program4  7,b7 ,elements of study
 ,in conducting the study under         
subparagraph 7,a71 the appropriate      
entity shall-- 7i7 evaluate the         
effectiveness of the grant program under
 this section in-- 7,i7 addressing the  
factors that contribute to suicides2    
7,,ii7 increasing the use of suicide    
prevention services2  7,,iii7 reducing  
mood-related symptoms that increase     
suicide and suicide risk2 and  7,,iv7   
where such information is available due 
to the time frame of the grant program1 
reducing suicidal ideation1 suicide     
attempts1 self-harm1 and deaths by      
suicide2 and  7,v7 reducing suicidal    
ideation1 suicide attempts1 self-harm1  
and deaths by suicide among eligible    
individuals through eligible entities   
located in communities2 and  7ii7       
compare the results of the grant program
 with other national programs in        
delivering resources to eligible        
individuals in the communities where    

they live that address the factors that 
contribute to suicide4  7#b7 ,assessment
  7,a7 ,in general ,the contract under  
paragraph 7#a7 shall provide that not   
later than #bd months after the         
commencement of the grant program under 
this section1 the appropriate entity    
shall submit to the ,secretary an       
assessment based on the study conducted 
pursuant to such contract4  7,b7        
,submittal to ,congress ,upon receipt of
 the assessment under subparagraph 7,a71
 the ,secretary shall transmit to the   
appropriate committees of ,congress a   
copy of the assessment4  7#c7           
,appropriate entity ,an appropriate     
entity described in this paragraph is a 
nongovernment entity with experience    
optimizing and assessing organizations  
that deliver services and assessing the 
effectiveness of suicide prevention     
programs4  7m7 ,referral for care  7#a7 
,mental health assessment ,if an        
eligible entity in receipt of a grant   
under this section determines that an   

eligible individual is at-risk of       
suicide or other mental or behavioral   
health condition pursuant to a baseline 
mental health screening conducted under 
subsection 7q77#aa77;,a77ii7 with       
respect to the individual1 the entity   
shall refer the eligible individual to  
the ,department for additional care     
under subsection 7n7 or any other       
provision of law4  7#b7 ,emergency      
treatment ,if an eligible entity in     
receipt of a grant under this section   
determines that an eligible individual  
furnished clinical services for         
emergency treatment under subsection    
7q77#aa77;,a77iv7 requires ongoing      
services1 the entity shall refer the    
eligible individual to the ,department  
for additional care under subsection 7n7
 or any other provision of law4  7#c7   
,refusal ,if an eligible individual     
refuses a referral by an entity under   
paragraph 7#a7 or 7#b71 any ongoing     
clinical services provided to the       
eligible individual by the entity shall 

be at the expense of the entity4  7n7   
,provision of care to eligible          
individuals ,when the ,secretary        
determines it is clinically appropriate1
 the ,secretary shall furnish to        
eligible individuals who are receiving  
or have received suicide prevention     
services through grants provided under  
this section an initial mental health   
assessment and mental health or         
behavioral health care services         
authorized under chapter #ag of title   
#ch1 ,united ,states ,code1 that are    
required to treat the mental or         
behavioral health care needs of the     
eligible individual1 including risk of  
suicide4  7o7 ,agreements with community
 partners  7#a7 ,in general ,subject to 
paragraph 7#b71 an eligible entity may  
use grant funds to enter into an        
agreement with a community partner under
 which the eligible entity may provide  
funds to the community partner for the  
provision of suicide prevention services
 to eligible individuals and their      

families4  7#b7 ,limitation ,the ability
 of a recipient of a grant under this   
section to provide grant funds to a     
community partner shall be limited to   
grant recipients that are a ,state or   
local government or an ,indian tribe4   
7p7 ,authorization of appropriations    
,there is authorized to be appropriated 
to the ,secretary to carry out this     
section a total of #agd1jjj1jjj for     
fiscal years #bjba through #bjbe4  7q7  
,definitions ,in this section3 7#a7     
,appropriate committees of ,congress    
,the term appropriate committees of     
,congress means-- 7,a7 the ,committee on
 ,veterans' ,affairs and the            
,subcommittee on ,military              
,construction1 ,veterans ,affairs1 and  
,related ,agencies of the ,committee on 
,appropriations of the ,senate2 and     
7,b7 the ,committee on ,veterans'       
,affairs and the ,subcommittee on       
,military ,construction1 ,veterans      
,affairs1 and ,related ,agencies of the 
,committee on ,appropriations of the    

,house of ,representatives4  7#b7       
,department ,the term ,department means 
the ,department of ,veterans ,affairs4  
7#c7 ,eligible entity ,the term eligible
 entity means-- 7,a7 an incorporated    
private institution or foundation-- 7i7 
no part of the net earnings of which    
incurs to the benefit of any member1    
founder1 contributor1 or individual2 and
  7ii7 that has a governing board that  
would be responsible for the operation  
of the suicide prevention services      
provided under this section2  7,b7 a    
corporation wholly owned and controlled 
by an organization meeting the          
requirements of clauses 7i7 and 7ii7 of 
subparagraph 7,a72  7,c7 an ,indian     
tribe2  7,d7 a community-based          
organization that can effectively       
network with local civic organizations1 
regional health systems1 and other      
settings where eligible individuals and 
their families are likely to have       
contact2 or  7,e7 ,a ,state or local    
government4  7#d7 ,eligible individual  

,the term eligible individual includes a
 person at risk of suicide who is-- 7,a7
 a veteran as defined in section #aja of
 title #ch1 ,united ,states ,code2  7,b7
 an individual described in section     
#agbj;,i7b7 of such title2 or  7,c7 an  
individual described in any of clauses  
7i7 through 7iv7 of section             
#agab;,a7a77#a77;,c7 of such title4     
7#e7 ,emergency treatment ,medical      
services1 professional services1        
ambulance services1 ancillary care and  
medication 7including a short course of 
medication related to and necessary for 
the treatment of the emergency condition
 that is provided directly to or        
prescribed for the patient for use after
 the emergency condition is stabilized  
and the patient is discharged7 was      
rendered in a medical emergency of such 
nature that a prudent layperson would   
have reasonably expected that delay in  
seeking immediate medical attention     
would have been hazardous to life or    
health4 ,this standard is met by an     

emergency medical condition manifesting 
itself by acute symptoms of sufficient  
severity 7including severe pain7 that a 
prudent layperson who possesses an      
average knowledge of health and medicine
 could reasonably expect the absence of 
immediate medical attention to result in
 placing the health of the individual in
 serious jeopardy1 serious impairment to
 bodily functions1 or serious           
dysfunction of any bodily organ or part4
  7#f7 ,family ,the term family means1  
with respect to an eligible individual1 
any of the following3 7,a7 ,a parent4   
7,b7 ,a spouse4  7,c7 ,a child4  7,d7 ,a
 sibling4  7,e7 ,a step-family member4  
7,f7 ,an extended family member4  7,g7  
,any other individual who lives with the
 eligible individual4  7#g7 ,indian     
tribe ,the term ,indian tribe has the   
meaning given that term in section #d of
 the ,native ,american ,housing         
,assistance and ,self-,determination    
,act of #aiif 7#be ,u4,s4,c4 #dajc74    
7#h7 ,risk of suicide  7,a7 ,in general 

,the term risk of suicide means exposure
 to1 or the existence of1 any of the    
following 7to a degree determined by the
 ,secretary pursuant to regulations73   
7i7 ,health risk factors1 including the 
following3 7,i7 ,mental health          
challenges4  7,,ii7 ,substance abuse4   
7,,iii7 ,serious or chronic health      
conditions or pain4  7,,iv7 ,traumatic  
brain injury4  7ii7 ,environmental risk 
factors1 including the following3 7,i7  
,prolonged stress4  7,,ii7 ,stressful   
life events4  7,,iii7 ,unemployment4    
7,,iv7 ,homelessness4  7,v7 ,recent     
loss4  7,,vi7 ,legal or financial       
challenges4  7iii7 ,historical risk     
factors1 including the following3 7,i7  
,previous suicide attempts4  7,,ii7     
,family history of suicide4  7,,iii7    
,history of abuse1 neglect1 or trauma4  
7,b7 ,degree of risk ,the ,secretary    
may1 by regulation1 establish a process 
for determining degrees of risk of      
suicide for use by grant recipients to  
focus the delivery of services using    

grant funds4  7#i7 ,rural ,the term     
rural1 with respect to a community1 has 
the meaning given that term in the      
,rural-,urban ,commuting ,areas coding  
system of the ,department of            
,agriculture4  7#aj7 ,secretary ,the    
term ,secretary means the ,secretary of 
,veterans ,affairs4  7#aa7 ,suicide     
prevention services  7,a7 ,in general   
,the term suicide prevention services   
means services to address the needs of  
eligible individuals and their families 
and includes the following3 7i7         
,outreach to identify those at risk of  
suicide with an emphasis on eligible    
individuals who are at highest risk or  
who are not receiving health care or    
other services furnished by the         
,department4  7ii7 ,a baseline mental   
health screening for risk4  7iii7       
,education on suicide risk and          
prevention to families and communities4 
7iv7 ,provision of clinical services for
 emergency treatment4  7v7 ,case        
management services4  7vi7 ,peer support

 services4  7vii7 ,assistance in        
obtaining any benefits from the         
,department that the eligible individual
 and their family may be eligible to    
receive1 including-- 7,i7 vocational and
 rehabilitation counseling2  7,,ii7     
supportive services for homeless        
veterans2  7,,iii7 employment and       
training services2  7,,iv7 educational  
assistance2 and  7,v7 health care       
services4  7viii7 ,assistance in        
obtaining and coordinating the provision
 of other benefits provided by the      
,federal ,government1 a ,state or local 
government1 or an eligible entity4  7ix7
 ,assistance with emergent needs        
relating to-- 7,i7 health care services2
  7,,ii7 daily living services2  7,,iii7
 personal financial planning and        
counseling2  7,,iv7 transportation      
services2  7,v7 temporary income support
 services2  7,,vi7 fiduciary and        
representative payee services2  7,,vii7 
legal services to assist the eligible   
individual with issues that may         

contribute to the risk of suicide2 and  
7,,viii7 child care 7not to exceed      
#e1jjj per family of an eligible        
individual per fiscal year74  7x7       
,nontraditional and innovative          
approaches and treatment practices1 as  
determined appropriate by the           
,secretary1 in consultation with        
appropriate entities4  7xi7 ,such other 
services necessary for improving the    
mental health status and wellbeing and  
reducing the suicide risk of eligible   
individuals and their families as the   
,secretary considers appropriate1 which 
may include-- 7,i7 adaptive sports1     
equine assisted therapy1 or in-place or 
outdoor recreational therapy2  7,,ii7   
substance use reduction programming2    
7,,iii7 individual1 group1 or family    
counseling2 and  7,,iv7 relationship    
coaching4  7,b7 ,exclusion ,the term    
suicide prevention services does not    
include direct cash assistance to       
eligible individuals or their families4 
7#ab7 ,veterans crisis line ,the term   

,veterans ,crisis ,line means the       
toll-free hotline for veterans          
established under section #agbj;,f7h7 of
 title #ch1 ,united ,states ,code4      
7#ac7 ,veterans service organization    
,the term veterans service organization 
means any organization recognized by the
 ,secretary for the representation of   
veterans under section #eijb of title   
#ch1 ,united ,states ,code4  #bjb4      
,analysis on feasibility and            
advisability of the ,department of      
,veterans ,affairs providing certain    
complementary and integrative health    
services  7a7 ,in general ,not later    
than #ahj days after the date of the    
enactment of this ,act1 the ,secretary  
of ,veterans ,affairs shall complete an 
analysis on the feasibility and         
advisability of providing complementary 
and integrative health treatments       
described in subsection 7c7 at all      
medical facilities of the ,department of
 ,veterans ,affairs4  7b7 ,inclusion of 
assessment of report ,the analysis      

conducted under subsection 7a7 shall    
include an assessment of the final      
report 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 note7 submitted under subsection  
7e77#b7 of such section4  7c7           
,treatments described ,complementary and
 integrative health treatments described
 in this subsection shall consist of the
 following3 7#a7 ,yoga4  7#b7           
,meditation4  7#c7 ,acupuncture4  7#d7  
,chiropractic care4  7#e7 ,other        
treatments that show sufficient evidence
 of efficacy at treating mental or      
physical health conditions1 as          
determined by the ,secretary4  7d7      
,report ,the ,secretary shall submit to 
the ,committee on ,veterans' ,affairs of
 the ,senate and the ,committee on      
,veterans' ,affairs of the ,house of    

,representatives a report on the        
analysis completed under subsection 7a71
 including-- 7#a7 the results of such   
analysis2 and  7#b7 such recommendations
 regarding the furnishing of            
complementary and integrative health    
treatments described in subsection 7c7  
as the ,secretary considers appropriate4
  #bjc4 ,pilot program to provide       
veterans access to complementary and    
integrative health programs through     
animal therapy1 agritherapy1 sports and 
recreation therapy1 art therapy1 and    
posttraumatic growth programs  7a7 ,in  
general ,not later than #ahj days after 
the date on which 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 note7 submits its final report    
under subsection 7e77#b7 of such        
section1 the ,secretary of ,veterans    

,affairs shall commence the conduct of a
 pilot program to provide complementary 
and integrative health programs         
described in subsection 7b7 to eligible 
veterans from the ,department of        
,veterans ,affairs or through the use of
 non-,department entities for the       
treatment of post-traumatic stress      
disorder1 depression1 anxiety1 or other 
conditions as determined by the         
,secretary4  7b7 ,programs described    
,complementary and integrative health   
programs described in this subsection   
may1 taking into consideration the      
report described in subsection 7a71     
consist of the following3 7#a7 ,equine  
therapy4  7#b7 ,other animal therapy4   
7#c7 ,agritherapy4  7#d7 ,sports and    
recreation therapy4  7#e7 ,art therapy4 
7#f7 ,posttraumatic growth programs4    
7c7 ,eligible veterans ,a veteran is    
eligible to participate in the pilot    
program under this section if the       
veteran-- 7#a7 is enrolled in the system
 of patient enrollment of the           

,department under section #agje7;a7 of  
title #ch1 ,united ,states ,code2 and   
7#b7 has received health care under the 
laws administered by the ,secretary     
during the two-year period preceding the
 initial participation of the veteran in
 the pilot program4  7d7 ,duration  7#a7
 ,in general ,the ,secretary shall carry
 out the pilot program under this       
section for a three-year period         
beginning on the commencement of the    
pilot program4  7#b7 ,extension ,the    
,secretary may extend the duration of   
the pilot program under this section if 
the ,secretary1 based on the results of 
the interim report submitted under      
subsection 7f77#a71 determines that it  
is appropriate to do so4  7e7 ,locations
  7#a7 ,in general ,the ,secretary shall
 select not fewer than five facilities  
of the ,department at which to carry out
 the pilot program under this section4  
7#b7 ,selection criteria ,in selecting  
facilities under paragraph 7#a71 the    
,secretary shall ensure that-- 7,a7 the 

locations are in geographically diverse 
areas2 and  7,b7 not fewer than three   
facilities serve veterans in rural or   
highly rural areas 7as determined       
through the use of the ,rural-,urban    
,commuting ,areas coding system of the  
,department of ,agriculture74  7f7      
,reports  7#a7 ,interim report  7,a7 ,in
 general ,not later than one year after 
the commencement of the pilot program   
under this section1 the ,secretary shall
 submit to the ,committee on ,veterans' 
,affairs of the ,senate and the         
,committee on ,veterans' ,affairs of the
 ,house of ,representatives a report on 
the progress of the pilot program4  7,b7
 ,elements ,the report required by      
subparagraph 7,a7 shall include the     
following3 7i7 ,the number of           
participants in the pilot program4  7ii7
 ,the type or types of therapy offered  
at each facility at which the pilot     
program is being carried out4  7iii7 ,an
 assessment of whether participation by 
a veteran in the pilot program resulted 

in any changes in clinically relevant   
endpoints for the veteran with respect  
to the conditions specified in          
subsection 7a74  7iv7 ,an assessment of 
the quality of life of veterans         
participating in the pilot program1     
including the results of a satisfaction 
survey of the participants in the pilot 
program1 disaggregated by program under 
subsection 7b74  7v7 ,the determination 
of the ,secretary with respect to       
extending the pilot program under       
subsection 7d77#b74  7vi7 ,any          
recommendations of the ,secretary with  
respect to expanding the pilot program4 
7#b7 ,final report ,not later than #ij  
days after the termination of the pilot 
program under this section1 the         
,secretary shall submit to the          
,committee on ,veterans' ,affairs of the
 ,senate and the ,committee on          
,veterans' ,affairs of the ,house of    
,representatives a final report on the  
pilot program4  #bjd4 ,department of    
,veterans ,affairs study of all-cause   

mortality of veterans1 including by     
suicide1 and review of staffing levels  
of mental health professionals  7a7     
,study of deaths of veterans by suicide 
7#a7 ,in general ,the ,secretary of     
,veterans ,affairs shall seek to enter  
into an agreement with the ,national    
,academies of ,sciences1 ,engineering1  
and ,medicine under which the ,secretary
 shall collaborate and coordinate with  
the ,national ,academies on a revised   
study design to fulfill the goals of the
 #bjai study design of the ,national    
,academies described in the explanatory 
statement accompanying the ,further     
,consolidated ,appropriations ,act1     
#bjbj 7,public ,law #aaf-id71 as part of
 current and additional research        
priorities of the ,department of        
,veterans ,affairs1 to evaluate the     
effects of opioids and benzodiazepine on
 all-cause mortality of veterans1       
including suicide1 regardless of whether
 information relating to such deaths has
 been reported by the ,centers for      

,disease ,control and ,prevention4  7#b7
 ,goals ,in carrying out the            
collaboration and coordination under    
paragraph 7#a71 the ,secretary shall    
seek as much as possible to achieve the 
same advancement of useful knowledge as 
the #bjai study design described in such
 paragraph4  7b7 ,review of staffing    
levels for mental health professionals  
7#a7 ,in general ,not later than #ij    
days after the date of the enactment of 
this ,act1 the ,comptroller ,general of 
the ,united ,states shall conduct a     
review of the staffing levels for mental
 health professionals of the            
,department4  7#b7 ,elements ,the review
 required by paragraph 7#a7 shall       
include 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 the following3    
7,a7 ,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 impediments4  7,b7 ,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-- 7i7 a review of
 qualification criteria for such        
counselors and therapists and a         
comparison of such criteria to that of  
other behavioral health professions in  
the ,department2 and  7ii7 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 
participation4  7,c7 ,an assessment of  
the development by the ,department of   
hiring guidelines for mental health     
counselors1 marriage and family         

therapists1 and other appropriate       
counselors4  7,d7 ,a description of how 
the ,department-- 7i7 identifies gaps in
 the supply of mental health            
professionals2 and  7ii7 determines     
successful staffing ratios for mental   
health professionals of the ,department4
  7,e7 ,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 series4  7,f7 ,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  7c7 ,compilation of 
data ,the ,secretary of ,veterans       
,affairs shall ensure that data under   
subsections 7a7 and 7b7 is compiled     
separately and disaggregated by year and
 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  7d7 
,briefings ,the ,secretary of ,veterans 
,affairs shall brief the ,committee on  
,veterans' ,affairs of the ,senate and  
the ,committee on ,veterans' ,affairs of
 the ,house of ,representatives         
containing the interim results-- 7#a7   
with respect to the study under         
subsection 7a77#a71 not later than #bd  
months after entering into the agreement
 under such subsection2 and  7#b7 with  
respect to the review under subsection  
7b77#a71 not later than #ah months after
 the date of the enactment of this ,act4
  7e7 ,reports  7#a7 ,report on study   

,not later than #ij days after the      
completion by the ,secretary of         
,veterans ,affairs in coordination with 
the ,national ,academies of ,sciences1  
,engineering1 and ,medicine of the study
 required under subsection 7a77#a71 the 
,secretary 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 study2 and  7,b7 make such      
report publicly available4  7#b7 ,report
 on review ,not later than #ij days     
after the completion by the ,comptroller
 ,general of the ,united ,states of the 
review required under subsection        
7b77#a71 the ,comptroller ,general      
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   
#bje4 ,comptroller ,general report on   

management by ,department of ,veterans  
,affairs of veterans at high risk for   
suicide  7a7 ,in general ,not later than
 #ah months after the date of the       
enactment of this ,act1 the ,comptroller
 ,general of the ,united ,states shall  
submit to the ,committee on ,veterans'  
,affairs of the ,senate and the         
,committee on ,veterans' ,affairs of the
 ,house of ,representatives a report on 
the efforts of the ,department of       
,veterans ,affairs to manage veterans at
 high risk for suicide4  7b7 ,elements  
,the report required by subsection 7a7  
shall include the following3 7#a7 ,a    
description of how the ,department      
identifies patients as high risk for    
suicide1 with particular consideration  
to the efficacy of inputs into the      
,recovery ,engagement and ,coordination 
for ,health - ,veterans ,enhanced       
,treatment program 7commonly referred to
 as the ,,reach ,,vet program7 of the   
,department1 including an assessment of 
the efficacy of such identifications    

disaggregated by-- 7,a7 all demographic 
characteristics as determined necessary 
and appropriate by the ,secretary of    
,veterans ,affairs in coordination with 
the ,centers for ,disease ,control and  
,prevention2  7,b7 ,veterans ,integrated
 ,service ,network2 and  7,c7 to the    
extent practicable1 medical center of   
the ,department4  7#b7 ,a description of
 how the ,department intervenes when a  
patient is identified as high risk1     
including an assessment of the efficacy 
of such interventions disaggregated by--
 7,a7 all demographic characteristics as
 determined necessary and appropriate by
 the ,secretary in coordination with the
 ,centers for ,disease ,control and     
,prevention2  7,b7 ,veterans ,integrated
 ,service ,network2 and  7,c7 to the    
extent practicable1 medical center of   
the ,department4  7#c7 ,a description of
 how the ,department monitors patients  
who have been identified as high risk1  
including an assessment of the efficacy 
of such monitoring and any follow-ups   

disaggregated by-- 7,a7 all demographic 
characteristics as determined necessary 
and appropriate by the ,secretary in    
coordination with the ,centers for      
,disease ,control and ,prevention2  7,b7
 ,veterans ,integrated ,service         
,network2 and  7,c7 to the extent       
practicable1 medical center of the      
,department4  7#d7 ,a review of staffing
 levels of suicide prevention           
coordinators across the ,veterans       
,health ,administration4  7#e7 ,a review
 of the resources and programming       
offered to family members and friends of
 veterans who have a mental health      
condition in order to assist that       
veteran in treatment and recovery4  7#f7
 ,an assessment of such other areas as  
the ,comptroller ,general considers     
appropriate to study4  ,,iii ,programs1 
studies1 and guidelines on mental health
  #cja4 ,study on connection between    
living at high altitude and suicide risk
 factors among veterans  7a7 ,in general
 ,not later than #ahj days after the    

date of the enactment of this ,act1 the 
,secretary of ,veterans ,affairs1 in    
consultation with ,rural ,health        
,resource ,centers of the ,office of    
,rural ,health of the ,department of    
,veterans ,affairs1 shall commence the  
conduct of a study on the connection    
between living at high altitude and the 
risk of developing depression or dying  
by suicide among veterans4  7b7         
,completion of study ,the study         
conducted under subsection 7a7 shall be 
completed not later than three years    
after the date of the commencement of   
the study4  7c7 ,individual impact ,the 
study conducted under subsection 7a7    
shall be conducted so as to determine   
the effect of high altitude on suicide  
risk at the individual level1 not at the
 ,state or county level4  7d7 ,report   
,not later than #aej days after the     
completion of the study conducted under 
subsection 7a71 the ,secretary shall    
submit to the ,committee on ,veterans'  
,affairs of the ,senate and the         

,committee on ,veterans' ,affairs of the
 ,house of ,representatives a report on 
the results of the study4  7e7          
,follow-up study  7#a7 ,in general ,if  
the ,secretary determines through the   
study conducted under subsection 7a7    
that living at high altitude is a risk  
factor for developing depression or     
dying by suicide1 the ,secretary shall  
conduct an additional study to identify 
the following3 7,a7 ,the most likely    
biological mechanism that makes living  
at high altitude a risk factor for      
developing depression or dying by       
suicide4  7,b7 ,the most effective      
treatment or intervention for reducing  
the risk of developing depression or    
dying by suicide associated with living 
at high altitude4  7#b7 ,report ,not    
later than #aej days after completing   
the study conducted under paragraph     
7#a71 the ,secretary shall submit to the
 ,committee on ,veterans' ,affairs of   
the ,senate and the ,committee on       
,veterans' ,affairs of the ,house of    

,representatives a report on the results
 of the study4  #cjb4 ,establishment by 
,department of ,veterans ,affairs and   
,department of ,defense of a clinical   
provider treatment toolkit and          
accompanying training materials for     
comorbidities  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     
,defense1 shall develop a clinical      
provider treatment toolkit and          
accompanying training materials for the 
evidence-based management of comorbid   
mental health conditions1 comorbid      
mental health and substance use         
disorders1 and a comorbid mental health 
condition and chronic pain4  7b7        
,matters included ,in developing the    
clinical provider treatment toolkit and 
accompanying training materials under   
subsection 7a71 the ,secretary of       
,veterans ,affairs and the ,secretary of
 ,defense shall ensure that the toolkit 

and training materials include guidance 
with respect to the following3 7#a7 ,the
 treatment of patients with             
post-traumatic stress disorder who are  
also experiencing an additional mental  
health condition1 a substance use       
disorder1 or chronic pain4  7#b7 ,the   
treatment of patients experiencing a    
mental health condition1 including      
anxiety1 depression1 or bipolar         
disorder1 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-- 7,a7 a mental health     
condition1 including post-traumatic     
stress disorder1 anxiety1 depression1 or
 bipolar disorder2  7,b7 a substance use
 disorder2 or  7,c7 chronic pain4  #cjc4
 ,update of clinical practice guidelines
 for assessment and management of       
patients at risk for suicide  7a7 ,in   
general ,in the first publication of the
 ,department of ,veterans ,affairs and  
,department of ,defense ,clinical       

,practice ,guideline for ,assessment and
 ,management of ,patients at ,risk for  
,suicide published 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 ensure the publication   
includes the following3 7#a7 ,enhanced  
guidance with respect to                
gender-specific-- 7,a7 risk factors for 
suicide and suicidal ideation2  7,b7    
treatment efficacy for depression and   
suicide prevention2  7,c7               
pharmacotherapy efficacy2 and  7,d7     
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          
,agritherapy4  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  7b7 ,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 ,department of ,veterans ,affairs   
and ,department of ,defense ,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  #cjd4     
,establishment by ,department of        
,veterans ,affairs and ,department of   
,defense of clinical practice guidelines
 for the treatment of serious mental    
illness  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 a clinical practice      
guideline or guidelines for the         
treatment of serious mental illness1 to 
include the following conditions3 7#a7  
,schizophrenia4  7#b7 ,schizoaffective  
disorder4  7#c7 ,persistent mood        
disorder1 including bipolar disorder ,i 
and ,,ii4  7#d7 ,any other mental1      

behavioral1 or emotional disorder       
resulting in serious functional         
impairment that substantially interferes
 with major life activities as the      
,secretary of ,veterans ,affairs1 in    
consultation with the ,secretary of     
,defense and the ,secretary of ,health  
and ,human ,services1 considers         
appropriate4  7b7 ,matters included in  
guidelines ,the clinical practice       
guideline or guidelines developed under 
subsection 7a7 shall include the        
following3 7#a7 ,guidance contained in  
the #bjaf ,clinical ,practice           
,guidelines for the ,management of      
,major ,depressive ,disorders of the    
,department of ,veterans ,affairs and   
the ,department of ,defense4  7#b7      
,guidance with respect to the treatment 
of patients with a condition described  
in subsection 7a74  7#c7 ,a list of     
evidence-based therapies for the        
treatment of conditions described in    
subsection 7a74  7#d7 ,an appropriate   
guideline for the administration of     

pharmacological therapy1 psychological  
or behavioral therapy1 or other therapy 
for the management of conditions        
described in subsection 7a74  7c7       
,assessment of existing guidelines ,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 an 
assessment of the #bjaf ,clinical       
,practice ,guidelines for the           
,management of ,major ,depressive       
,disorders to determine whether an      
update to such guidelines is necessary4 
7d7 ,work group  7#a7 ,establishment    
,the ,secretary of ,veterans ,affairs1  
the ,secretary of ,defense1 and the     
,secretary of ,health and ,human        
,services shall create a work group to  
develop the clinical practice guideline 
or guidelines under subsection 7a7 to be
 known as the ,serious ,mental ,illness 
,work ,group 7in this subsection        

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 following entities3 7,a7  
,academic institutions that specialize  
in research for the treatment of        
conditions described in subsection 7a74 
7,b7 ,the ,health ,services ,research   
and ,development ,service 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,d7 ,the
 ,national ,institute of ,mental        
,health4  7,e7 ,the ,indian ,health     
,service4  7,f7 ,relevant organizations 
with expertise in researching1          
diagnosing1 or treating conditions      
described in subsection 7a74  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  7e7 ,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       
guideline or guidelines required under  
subsection 7a7 or from ensuring that the
 final clinical practice guideline or   
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  #cje4         
,precision medicine initiative of       
,department of ,veterans ,affairs to    
identify and validate brain and mental  
health biomarkers  7a7 ,in general      

,beginning not later than #ah months    
after the date of the enactment of this 
,act1 the ,secretary of ,veterans       
,affairs shall develop and implement an 
initiative of the ,department of        
,veterans ,affairs to identify and      
validate brain and mental health        
biomarkers among veterans1 with specific
 consideration for depression1 anxiety1 
post-traumatic stress disorder1 bipolar 
disorder1 traumatic brain injury1 and   
such other mental health conditions as  
the ,secretary considers appropriate4   
,such initiative may be referred to as  
the ,precision ,medicine for ,veterans  
,initiative4  7b7 ,model of initiative  
,the initiative under subsection 7a7    
shall be modeled on the ,all of ,us     
,precision ,medicine ,initiative        
administered by the ,national           
,institutes of ,health with respect to  
large-scale collection of standardized  
data and open data sharing4  7c7        
,methods ,the initiative under          
subsection 7a7 shall include brain      

structure and function measurements1    
such as functional magnetic resonance   
imaging and electroencephalogram1 and   
shall coordinate with additional        
biological methods of analysis utilized 
in the ,million ,veterans ,program of   
the ,department of ,veterans ,affairs4  
7d7 ,use of data  7#a7 ,privacy and     
security ,in carrying out the initiative
 under subsection 7a71 the ,secretary   
shall develop robust data privacy and   
security measures1 consistent with      
section #eeb;a of title #e1 ,united     
,states ,code 7commonly known as the    
,privacy ,act of #aigd71 and regulations
 promulgated pursuant to the ,health    
,insurance ,portability and             
,accountability ,act of #aiif 7parts    
#afj1 #afb1 and #afd of title #de1 ,code
 of ,federal ,regulations1 or successor 
regulations7 to ensure that information 
of veterans participating in the        
initiative is kept private and secure4  
7#b7 ,consultation with the national    
institutes of science and technology    

,the ,secretary may consult with the    
,national ,institute of ,science and    
,technology in developing the data      
privacy and security measures described 
in paragraph 7#a74  7#c7 ,access        
standards ,the ,secretary shall provide 
access to information under the         
initiative consistent with the standards
 described in section #eeb;a7d77#a7 of  
title #e1 ,united ,states ,code1 and    
section #afd4ebd of title #de1 ,code of 
,federal ,regulations1 or successor     
regulations4  7#d7 ,open platform  7,a7 
,availability of data ,the ,secretary   
shall make de-identified data collected 
under the initiative available for      
research purposes to ,federal agencies4 
7,b7 ,contract ,the ,secretary shall    
contract with nongovernment entities    
that comply with requisite data security
 measures to make available for research
 purposes de-identified data collected  
under the initiative4  7,c7 ,assistance 
,the ,secretary shall provide assistance
 to a ,federal agency conducting        

research using data collected under the 
initiative at the request of that       
agency4  7,d7 ,prohibition on transfer  
of data ,federal agencies may not       
disclose1 transmit1 share1 sell1        
license1 or otherwise transfer data     
collected under the initiative to any   
nongovernment entity other than as      
allowed under subparagraph 7,b74  7#e7  
,standardization  7,a7 ,in general ,the 
,secretary shall ensure that data       
collected under the initiative is       
standardized4  7,b7 ,consultation ,the  
,secretary shall consult with the       
,national ,institutes of ,health and the
 ,food and ,drug ,administration to     
determine the most effective1 efficient1
 and cost-effective way of standardizing
 data collected under the initiative4   
7,c7 ,manner of standardization ,in     
consultation with the ,national         
,institute for ,science and ,technology1
 data collected under the initiative    
shall be standardized in the manner in  
which it is collected1 entered into the 

database1 extracted1 and recorded4  7#f7
 ,measures of brain function or         
structure ,any measures of brain        
function or structure collected under   
the initiative shall be collected with a
 device that is approved by the ,food   
and ,drug ,administration4  7#g7        
,de-identified data defined ,in this    
subsection1 the term de-identified data 
means1 with respect to data held by the 
,department of ,veterans ,affairs1 that 
the ,department-- 7,a7 alters1          
anonymizes1 or aggregates the data so   
that there is a reasonable basis for    
expecting that the data could not be    
linked as a practical matter to a       
specific individual2  7,b7 publicly     
commits to refrain from attempting to   
re-identify the data with a specific    
individual1 and adopts controls to      
prevent such identification2 and  7,c7  
causes the data to be covered by a      
contractual or other legally enforceable
 prohibition on each entity to which the
 ,department discloses the data from    

attempting to use the data to identify a
 specific individual and requires the   
same of all onward disclosures4  7e7    
,inclusion of initiative in program ,the
 ,secretary shall coordinate efforts of 
the initiative under subsection 7a7 with
 the ,million ,veterans ,program of the 
,department4  #cjf4 ,statistical        
analyses and data evaluation by         
,department of ,veterans ,affairs  7a7  
,in general ,chapter #a of title #ch1   
,united ,states ,code1 is amended by    
adding at the end the following new     
section3  #aai4 ,contracting for        
statistical analyses and data evaluation
  7a7 ,in general ,the ,secretary may   
enter into a contract or other agreement
 with an academic institution or other  
qualified entity1 as determined by the  
,secretary1 to carry out statistical    
analyses and data evaluation as required
 of the ,secretary by law4  4  7b7 ,rule
 of construction ,nothing in this       
section may be construed to limit the   
authority of the ,secretary to enter    

into contracts or other agreements for  
statistical analyses and data evaluation
 under any other provision of law4  4   
7b7 ,clerical amendment ,the table of   
sections at the beginning of chapter #a 
of such title is amended by adding at   
the end the following new item3  #aai4  
,contracting for statistical analyses   
and data evaluation4  4  ,,iv ,oversight
 of mental health care and related      
services  #dja4 ,study on effectiveness 
of suicide prevention and mental health 
outreach programs of ,department of     
,veterans ,affairs  7a7 ,in general ,not
 later than #ahj days after the date of 
the enactment of this ,act1 the         
,secretary of ,veterans ,affairs shall  
enter into an agreement with a          
non-,federal ,government entity with    
expertise in conducting and evaluating  
research-based studies to conduct a     
study on the effectiveness of the       
suicide prevention and mental health    
outreach materials prepared by the      
,department of ,veterans ,affairs and   

the suicide prevention and mental health
 outreach campaigns conducted by the    
,department4  7b7 ,use of focus groups  
7#a7 ,in general ,the ,secretary shall  
convene not fewer than eight different  
focus groups to evaluate the            
effectiveness of the suicide prevention 
and mental health materials and         
campaigns as required under subsection  
7a74  7#b7 ,location of focus groups    
,focus groups convened under paragraph  
7#a7 shall be held in geographically    
diverse areas as follows3 7,a7 ,not     
fewer than two in rural or highly rural 
areas4  7,b7 ,not fewer than one in each
 of the four districts of the ,veterans 
,benefits ,administration4  7#c7 ,timing
 of focus groups ,focus groups convened 
under paragraph 7#a7 shall be held at a 
variety of dates and times to ensure an 
adequate representation of veterans with
 different work schedules4  7#d7 ,number
 of participants ,each focus group      
convened under paragraph 7#a7 shall     
include not fewer than five and not more

 than #ab participants4  7#e7           
,representation ,each focus group       
convened under paragraph 7#a7 shall1 to 
the extent practicable1 include veterans
 of diverse backgrounds1 including--    
7,a7 veterans of all eras1 as determined
 by the ,secretary2  7,b7 women         
veterans2  7,c7 minority veterans2  7,d7
 ,native ,american veterans1 as defined 
in section #cgfe of title #ch1 ,united  
,states ,code2  7,e7 veterans who       
identify as lesbian1 gay1 bisexual1     
transgender1 or queer 7commonly referred
 to as ,,lgbtq72  7,f7 veterans who live
 in rural or highly rural areas2  7,g7  
individuals transitioning from active   
duty in the ,armed ,forces to civilian  
life2 and  7,h7 other high-risk groups  
of veterans1 as determined by the       
,secretary4  7c7 ,report  7#a7 ,in      
general ,not later than #ij days after  
the last focus group meeting under      
subsection 7b71 the ,secretary shall    
submit to the ,committee on ,veterans'  
,affairs of the ,senate and the         

,committee on ,veterans' ,affairs of the
 ,house of ,representatives a report on 
the findings of the focus groups4  7#b7 
,elements ,the report required by       
paragraph 7#a7 shall include the        
following3 7,a7 ,based on the findings  
of the focus groups1 an assessment of   
the effectiveness of current suicide    
prevention and mental health materials  
and campaigns of the ,department in     
reaching veterans as a whole as well as 
specific groups of veterans 7for        
example1 women veterans74  7,b7 ,based  
on the findings of the focus groups1    
recommendations for future suicide      
prevention and mental health materials  
and campaigns of the ,department to     
target specific groups of veterans4     
7,c7 ,a plan to change the current      
suicide prevention and mental health    
materials and campaigns of the          
,department or1 if the ,secretary       
decides not to change the current       
materials and campaigns1 an explanation 
of the reason for maintaining the       

current materials and campaigns4  7,d7  
,a description of any dissenting or     
opposing viewpoints raised by           
participants in the focus group4  7,e7  
,such other issues as the ,secretary    
considers necessary4  7d7               
,representative survey  7#a7 ,in general
 ,not later than one year after the last
 focus group meeting under subsection   
7b71 the ,secretary shall complete a    
representative survey of the veteran    
population that is informed by the focus
 group data in order to collect         
information about the effectiveness of  
the mental health and suicide prevention
 materials and campaigns conducted by   
the ,department4  7#b7 ,veterans        
surveyed  7,a7 ,in general ,veterans    
surveyed under paragraph 7#a7 shall     
include veterans described in subsection
 7b77#e74  7,b7 ,disaggregation of data 
,data of veterans surveyed under        
paragraph 7#a7 shall be disaggregated   
by-- 7i7 veterans who have received care
 from the ,department during the        

two-year period preceding the survey2   
and  7ii7 veterans who have not received
 care from the ,department during the   
two-year period preceding the survey4   
7e7 ,treatment of contracts for suicide 
prevention and mental health outreach   
media  7#a7 ,focus groups  7,a7 ,in     
general ,the ,secretary shall include in
 each contract to develop media relating
 to suicide prevention and mental health
 materials and campaigns a requirement  
that the contractor convene focus groups
 of veterans to assess the effectiveness
 of suicide prevention and mental health
 outreach4  7,b7 ,representation ,each  
focus group required under subparagraph 
7,a7 shall1 to the extent practicable1  
include veterans of diverse backgrounds1
 including-- 7i7 veterans of all eras1  
as determined by the ,secretary2  7ii7  
women veterans2  7iii7 minority         
veterans2  7iv7 ,native ,american       
veterans1 as defined in section #cgfe of
 title #ch1 ,united ,states ,code2  7v7 
veterans who identify as lesbian1 gay1  

bisexual1 transgender1 or queer         
7commonly referred to as ,,lgbtq72  7vi7
 veterans who live in rural or highly   
rural areas2  7vii7 individuals         
transitioning from active duty in the   
,armed ,forces to civilian life2 and    
7viii7 other high-risk groups of        
veterans1 as determined by the          
,secretary4  7#b7 ,subcontracting  7,a7 
,in general ,the ,secretary shall       
include in each contract described in   
paragraph 7#a77;,a7 a requirement that1 
if the contractor subcontracts for the  
development of media1 the contractor    
shall subcontract with a subcontractor  
that has experience creating impactful  
media campaigns that target individuals 
age #ah to #cd4  7,b7 ,budget limitation
 ,not more than two percent of the      
budget of the ,office of ,mental ,health
 and ,suicide ,prevention of the        
,department for contractors for suicide 
prevention and mental health media      
outreach shall go to subcontractors     
described in subparagraph 7,a74  7f7    

,paperwork ,reduction ,act exemption    
,chapter #ce of title #dd1 ,united      
,states ,code 7commonly known as the    
,paperwork ,reduction ,act7 shall not   
apply to any rulemaking or information  
collection required under this section4 
7g7 ,rural and highly rural defined ,in 
this section1 with respect to an area1  
the terms rural and highly rural have   
the meanings given those terms in the   
,rural-,urban ,commuting ,areas coding  
system of the ,department of            
,agriculture4  #djb4 ,oversight of      
mental health and suicide prevention    
media outreach conducted by ,department 
of ,veterans ,affairs  7a7              
,establishment of goals  7#a7 ,in       
general ,the ,secretary of ,veterans    
,affairs shall establish goals for the  
mental health and suicide prevention    
media outreach campaigns of the         
,department of ,veterans ,affairs1 which
 shall include the establishment of     
targets1 metrics1 and action plans to   
describe and assess those campaigns4    

7#b7 ,use of metrics  7,a7 ,in general  
,the goals established under paragraph  
7#a7 shall be measured by metrics       
specific to different media types4  7,b7
 ,factors to consider ,in using metrics 
under subparagraph 7,a71 the ,secretary 
shall determine the best methodological 
approach for each media type and shall  
consider the following3 7i7 ,metrics    
relating to social media1 which may     
include the following3 7,i7             
,impressions4  7,,ii7 ,reach4  7,,iii7  
,engagement rate4  7,,iv7 ,such other   
metrics as the ,secretary considers     
necessary4  7ii7 ,metrics relating to   
television1 which may include the       
following3 7,i7 ,nielsen ratings4       
7,,ii7 ,such other metrics as the       
,secretary considers necessary4  7iii7  
,metrics relating to email1 which may   
include the following3 7,i7 ,open rate4 
7,,ii7 ,response rate4  7,,iii7 ,click  
rate4  7,,iv7 ,such other metrics as the
 ,secretary considers necessary4  7,c7  
,update ,the ,secretary shall           

periodically update the metrics under   
subparagraph 7,b7 as more accurate      
metrics become available4  7#c7 ,targets
 ,the ,secretary shall establish targets
 to track the metrics used under        
paragraph 7#b74  7#d7 ,consultation ,in 
establishing goals under paragraph 7#a71
 the ,secretary shall consult with the  
following3 7,a7 ,relevant stakeholders1 
such as organizations that represent    
veterans1 as determined by the          
,secretary4  7,b7 ,mental health and    
suicide prevention experts4  7,c7 ,such 
other persons as the ,secretary         
considers appropriate4  7#e7 ,initial   
report ,not later than #ahj days after  
the date of the enactment of this ,act1 
the ,secretary shall submit to the      
,committee on ,veterans' ,affairs of the
 ,senate and the ,committee on          
,veterans' ,affairs of the ,house of    
,representatives a report detailing the 
goals established under paragraph 7#a7  
for the mental health and suicide       
prevention media outreach campaigns of  

the ,department1 including the metrics  
and targets for such metrics by which   
those goals are to be measured under    
paragraphs 7#b7 and 7#c74  7#f7 ,annual 
report ,not later than one year after   
the submittal of the report under       
paragraph 7#e71 and annually thereafter1
 the ,secretary shall submit to the     
,committee on ,veterans' ,affairs of the
 ,senate and the ,committee on          
,veterans' ,affairs of the ,house of    
,representatives a report detailing--   
7,a7 the progress of the ,department in 
meeting the goals established under     
paragraph 7#a7 and the targets          
established under paragraph 7#c72 and   
7,b7 a description of action to be taken
 by the ,department to modify mental    
health and suicide prevention media     
outreach campaigns if those goals and   
targets are not being met4  7b7 ,report 
on use of funds by ,office of ,mental   
,health and ,suicide ,prevention ,not   
later than #ahj days after the date of  
the enactment of this ,act1 and         

semiannually thereafter1 the ,secretary 
shall submit to the ,committee on       
,appropriations and the ,committee on   
,veterans' ,affairs of the ,senate and  
the ,committee on ,appropriations and   
the ,committee on ,veterans' ,affairs of
 the ,house of ,representatives a report
 containing the expenditures and        
obligations of the ,office of ,mental   
,health and ,suicide ,prevention of the 
,veterans ,health ,administration during
 the period covered by the report4      
#djc4 ,comptroller ,general management  
review of mental health and suicide     
prevention services of ,department of   
,veterans ,affairs  7a7 ,in general ,not
 later than three years after the date  
of the enactment of this ,act1 the      
,comptroller ,general of the ,united    
,states shall submit to the ,committee  
on ,veterans' ,affairs of the ,senate   
and the ,committee on ,veterans'        
,affairs of the ,house of               
,representatives a management review of 
the mental health and suicide prevention

 services provided by the ,department of
 ,veterans ,affairs4  7b7 ,elements ,the
 management review required by          
subsection 7a7 shall include the        
following3 7#a7 ,an assessment of the   
infrastructure under the control of or  
available to the ,office of ,mental     
,health and ,suicide ,prevention of the 
,department of ,veterans ,affairs or    
available to the ,department of         
,veterans ,affairs for suicide          
prevention efforts not operated by the  
,office of ,mental ,health and ,suicide 
,prevention4  7#b7 ,a description of the
 management and organizational structure
 of the ,office of ,mental ,health and  
,suicide ,prevention1 including roles   
and responsibilities for each position4 
7#c7 ,a description of the operational  
policies and processes of the ,office of
 ,mental ,health and ,suicide           
,prevention4  7#d7 ,an assessment of    
suicide prevention practices and        
initiatives available from the          
,department and through community       

partnerships4  7#e7 ,an assessment of   
the staffing levels at the ,office of   
,mental ,health and ,suicide            
,prevention1 disaggregated by type of   
position1 and including the location of 
any staffing deficiencies4  7#f7 ,an    
assessment of the ,nurse ,advice ,line  
pilot program conducted by the          
,department4  7#g7 ,an assessment of    
recruitment initiatives in rural areas  
for mental health professionals of the  
,department4  7#h7 ,an assessment of    
strategic planning conducted by the     
,office of ,mental ,health and ,suicide 
,prevention4  7#i7 ,an assessment of the
 communication1 and the effectiveness of
 such communication-- 7,a7 within the   
central office of the ,office of ,mental
 ,health and ,suicide ,prevention2  7,b7
 between that central office and any    
staff member or office in the field1    
including chaplains1 attorneys1 law     
enforcement personnel1 and volunteers2  
and  7,c7 between that central office1  
local facilities of the ,department1 and

 community partners of the ,department1 
including first responders1 community   
support groups1 and health care industry
 partners4  7#aj7 ,an assessment of how 
effectively the ,office of ,mental      
,health and ,suicide ,prevention        
implements operational policies and     
procedures4  7#aa7 ,an assessment of how
 the ,department of ,veterans ,affairs  
and the ,department of ,defense         
coordinate suicide prevention efforts1  
and recommendations on how the          
,department of ,veterans ,affairs and   
,department of ,defense can more        
effectively coordinate those efforts4   
7#ab7 ,an assessment of such other areas
 as the ,comptroller ,general considers 
appropriate to study4  #djd4            
,comptroller ,general report on efforts 
of ,department of ,veterans ,affairs to 
integrate mental health care into       
primary care clinics  7a7 ,initial      
report  7#a7 ,in general ,not later than
 two years after the date of the        
enactment of this ,act1 the ,comptroller

 ,general of the ,united ,states shall  
submit to the ,committee on ,veterans'  
,affairs of the ,senate and the         
,committee on ,veterans' ,affairs of the
 ,house of ,representatives a report on 
the efforts of the ,department of       
,veterans ,affairs to integrate mental  
health care into primary care clinics of
 the ,department4  7#b7 ,elements ,the  
report required by subsection 7a7 shall 
include the following3 7,a7 ,an         
assessment of the efforts of the        
,department to integrate mental health  
care into primary care clinics of the   
,department4  7,b7 ,an assessment of the
 effectiveness of such efforts4  7,c7   
,an assessment of how the health care of
 veterans is impacted by such           
integration4  7,d7 ,a description of how
 care is coordinated by the ,department 
between specialty mental health care and
 primary care1 including a description  
of the following3 7i7 ,how documents and
 patient information are transferred and
 the effectiveness of those transfers4  

7ii7 ,how care is coordinated when      
veterans must travel to different       
facilities of the ,department4  7iii7   
,how a veteran is reintegrated into     
primary care after receiving in-patient 
mental health care4  7,e7 ,an assessment
 of how the integration of mental health
 care into primary care clinics is      
implemented at different types of       
facilities of the ,department4  7,f7    
,such recommendations on how the        
,department can better integrate mental 
health care into primary care clinics as
 the ,comptroller ,general considers    
appropriate4  7,g7 ,an assessment of    
such other areas as the ,comptroller    
,general considers appropriate to study4
  7b7 ,community care integration report
  7#a7 ,in general ,not later than two  
years after the date on which the       
,comptroller ,general submits the report
 required under subsection 7a77#a71 the 
,comptroller ,general shall submit to   
the ,committee on ,veterans' ,affairs of
 the ,senate and the ,committee on      

,veterans' ,affairs of the ,house of    
,representatives a report on the efforts
 of the ,department to integrate        
community-based mental health care into 
the ,veterans ,health ,administration4  
7#b7 ,elements ,the report required by  
paragraph 7#a7 shall include the        
following3 7,a7 ,an assessment of the   
efforts of the ,department to integrate 
community-based mental health care into 
the ,veterans ,health ,administration4  
7,b7 ,an assessment of the effectiveness
 of such efforts4  7,c7 ,an assessment  
of how the health care of veterans is   
impacted by such integration4  7,d7 ,a  
description of how care is coordinated  
between providers of community-based    
mental health care and the ,veterans    
,health ,administration1 including a    
description of how documents and patient
 information are transferred and the    
effectiveness of those transfers        
between-- 7i7 the ,veterans ,health     
,administration and providers of        
community-based mental health care2 and 

7ii7 providers of community-based mental
 health care and the ,veterans ,health  
,administration4  7,e7 ,an assessment of
 any disparities in the coordination of 
community-based mental health care into 
the ,veterans ,health ,administration by
 location and type of facility4  7,f7   
,an assessment of the military cultural 
competency of health care providers     
providing community-based mental health 
care to veterans4  7,g7 ,such           
recommendations on how the ,department  
can better integrate community-based    
mental health care into the ,veterans   
,health ,administration as the          
,comptroller ,general considers         
appropriate4  7,h7 ,an assessment of    
such other areas as the ,comptroller    
,general considers appropriate to study4
  7#c7 ,community-based mental health   
care defined ,in this subsection1 the   
term community-based mental health care 
means mental health care paid for by the
 ,department but provided by a          
non-,department health care provider at 

a non-,department facility1 including   
care furnished under section #agjc of   
title #ch1 ,united ,states ,code 7as in 
effect on the date specified in section 
#aja7;b7 of the ,caring for ,our        
,veterans ,act of #bjah 7title ,i of    
,public ,law #aae-ahb774  #dje4 ,joint  
mental health programs by ,department of
 ,veterans ,affairs and ,department of  
,defense  7a7 ,report on mental health  
programs  7#a7 ,in general ,not later   
than one year after the date of the     
enactment of this ,act1 and annually    
thereafter1 the ,secretary of ,veterans 
,affairs and the ,secretary of ,defense 
shall submit to the ,committee on       
,veterans' ,affairs and the ,committee  
on ,armed ,services of the ,senate and  
the ,committee on ,veterans' ,affairs   
and the ,committee on ,armed ,services  
of the ,house of ,representatives a     
report on mental health programs of the 
,department of ,veterans ,affairs and   
the ,department of ,defense and joint   
programs of the ,departments4  7#b7     

,elements ,the report required by       
paragraph 7#a7 shall include the        
following3 7,a7 ,a description of mental
 health programs operated by the        
,department of ,veterans ,affairs1      
including the following3 7i7 ,transition
 assistance programs4  7ii7 ,clinical   
and non-clinical mental health          
initiatives1 including centers of       
excellence of the ,department of        
,veterans ,affairs for traumatic brain  
injury and post-traumatic stress        
disorder4  7iii7 ,programs that may     
secondarily improve mental health1      
including employment1 housing           
assistance1 and financial literacy      
programs4  7iv7 ,research into mental   
health issues and conditions1 to include
 post-traumatic stress disorder1        
depression1 anxiety1 bipolar disorder1  
traumatic brain injury1 suicidal        
ideation1 and any other issues or       
conditions as the ,secretary of         
,veterans ,affairs considers necessary4 
7,b7 ,a description of mental health    

programs operated by the ,department of 
,defense1 including the following3 7i7  
,transition assistance programs4  7ii7  
,clinical and non-clinical mental health
 initiatives1 including the ,national   
,intrepid ,center of ,excellence and the
 ,intrepid ,spirit ,centers4  7iii7     
,programs that may secondarily improve  
mental health1 including employment1    
housing assistance1 and financial       
literacy programs4  7iv7 ,research into 
mental health issues and conditions1 to 
include post-traumatic stress disorder1 
depression1 anxiety1 bipolar disorder1  
traumatic brain injury1 suicidal        
ideation1 and any other issues or       
conditions as the ,secretary of ,defense
 considers necessary4  7,c7 ,a          
description of mental health programs   
jointly operated by the ,department of  
,veterans ,affairs and the ,department  
of ,defense1 including the following3   
7i7 ,transition assistance programs4    
7ii7 ,clinical and non-clinical mental  
health initiatives4  7iii7 ,programs    

that may secondarily improve mental     
health1 including employment1 housing   
assistance1 and financial literacy      
programs4  7iv7 ,research into mental   
health issues and conditions1 to include
 post-traumatic stress disorder1        
depression1 anxiety1 bipolar disorder1  
traumatic brain injury1 suicidal        
ideation1 and completed suicides1       
including through the use of the joint  
suicide data repository of the          
,department of ,veterans ,affairs and   
the ,department of ,defense1 and any    
other issues or conditions as the       
,secretary of ,veterans ,affairs and the
 ,secretary of ,defense consider        
necessary4  7,d7 ,recommendations for   
coordinating mental health programs of  
the ,department of ,veterans ,affairs   
and the ,department of ,defense to      
improve the effectiveness of those      
programs4  7,e7 ,recommendations for    
novel joint programming of the          
,department of ,veterans ,affairs and   
the ,department of ,defense to improve  

the mental health of members of the     
,armed ,forces and veterans4  7b7       
,evaluation of collaborative efforts of 
,department of ,veterans ,affairs and   
,department of ,defense and alternatives
 of analysis to establish a joint       
,,va_/,do,d ,intrepid ,spirit ,center   
7#a7 ,in general ,the ,secretary of     
,veterans ,affairs1 in coordination with
 the ,secretary of ,defense1 shall      
evaluate the current ongoing            
collaborative efforts of the ,department
 of ,veterans ,affairs and the          
,department of ,defense related to      
post-traumatic stress disorder and      
traumatic brain injury care1 research1  
and education to improve the quality of 
and access to such care and seek        
potential new collaborative efforts to  
improve and expand such care for        
veterans and members of the ,armed      
,forces in a joint ,department of       
,veterans ,affairs_/,department of      
,defense ,intrepid ,spirit ,center that 
serves active duty members of the ,armed

 ,forces1 members of the reserve        
components of the ,armed ,forces1 and   
veterans for mutual benefit and growth  
in treatment and care4  7#b7            
,alternatives of analysis  7,a7 ,in     
general ,the evaluation required under  
paragraph 7#a7 shall include an         
alternatives of analysis to establish   
the joint ,department of ,veterans      
,affairs_/,department of ,defense       
,intrepid ,spirit ,center described in  
paragraph 7#a74  7,b7 ,elements ,the    
alternatives of analysis required under 
subparagraph 7,a7 with respect to the   
establishment of the joint ,department  
of ,veterans ,affairs_/,department of   
,defense ,intrepid ,spirit ,center      
described in paragraph 7#a7 shall       
provide alternatives and recommendations
 that consider information including--  
7i7 colocation of the center on an      
installation of the ,department of      
,defense or property of a medical center
 of the ,department of ,veterans        
,affairs2  7ii7 consideration of a rural

 or highly rural area to establish the  
center that may include colocation      
described in clause 7i72  7iii7         
geographic distance from existing or    
planned ,intrepid ,spirit ,centers of   
the ,department of ,defense or other    
such facilities of the ,department of   
,veterans ,affairs or the ,department of
 ,defense that furnish care for         
post-traumatic stress disorder or       
traumatic brain injury2 and  7iv7 the   
potential role for private entities and 
philanthropic organizations in carrying 
out the activities of the center4  7#c7 
,report to ,congress ,not later than    
#bgj days after the date of the         
enactment of this ,act1 the ,secretary  
of ,veterans ,affairs shall submit to   
the ,committee on ,veterans' ,affairs of
 the ,senate and the ,committee on      
,veterans' ,affairs of the ,house of    
,representatives a report that          
includes-- 7,a7 a summary of the        
evaluation required under paragraph     
7#a72 and  7,b7 the alternatives of     

analysis required under paragraph 7#b74 
7#d7 ,rural and highly rural defined ,in
 this subsection1 with respect to an    
area1 the terms rural and highly rural  
have the meanings given those terms in  
the ,rural-,urban ,commuting ,areas     
coding system of the ,department of     
,agriculture4  ,v ,improvement of mental
 health medical workforce  #eja4        
,staffing improvement plan for mental   
health providers of ,department of      
,veterans ,affairs  7a7 ,staffing plan  
7#a7 ,in general ,not later than one    
year after the date of the enactment of 
this ,act1 the ,secretary of ,veterans  
,affairs1 in consultation with the      
,inspector ,general of the ,department  
of ,veterans ,affairs1 shall submit to  
the ,committee on ,veterans' ,affairs of
 the ,senate and the ,committee on      
,veterans' ,affairs of the ,house of    
,representatives a plan to address      
staffing of mental health providers of  
the ,department of ,veterans ,affairs1  
including filling any open positions4   

7#b7 ,elements ,the plan required by    
paragraph 7#a7 shall include the        
following3 7,a7 ,an estimate of the     
number of positions for mental health   
providers of the ,department that need  
to be filled to meet demand4  7,b7 ,an  
identification of the steps that the    
,secretary will take to address mental  
health staffing for the ,department4    
7,c7 ,a description of any              
region-specific hiring incentives to be 
used by the ,secretary in consultation  
with the directors of ,veterans         
,integrated ,service ,networks and      
medical centers of the ,department4     
7,d7 ,a description of any local        
retention or engagement incentives to be
 used by directors of ,veterans         
,integrated ,service ,networks4  7,e7   
,such recommendations for legislative or
 administrative action as the ,secretary
 considers necessary to aid in          
addressing mental health staffing for   
the ,department4  7#c7 ,report ,not     
later than one year after the submittal 

of the plan required by paragraph 7#a71 
the ,secretary shall submit to the      
,committee on ,veterans' ,affairs of the
 ,senate and the ,committee on          
,veterans' ,affairs of the ,house of    
,representatives a report setting forth 
the number of mental health providers   
hired by the ,department during the     
one-year period preceding the submittal 
of the report4  7b7 ,occupational series
 for certain mental health providers    
,not later than one year after the date 
of the enactment of this ,act1 the      
,secretary of ,veterans ,affairs1 in    
consultation with the ,office of        
,personnel ,management1 shall develop an
 occupational series for licensed       
professional mental health counselors   
and marriage and family therapists of   
the ,department of ,veterans ,affairs4  
#ejb4 ,establishment of ,department of  
,veterans ,affairs ,readjustment        
,counseling ,service ,scholarship       
,program  7a7 ,in general ,chapter #gf  
of title #ch1 ,united ,states ,code1 is 

amended by inserting after subchapter   
,,viii the following new subchapter3    
,,ix ,readjustment ,counseling ,service 
,scholarship ,program  #gfih4           
,requirement for program ,as part of the
 ,educational ,assistance ,program1 the 
,secretary shall carry out a scholarship
 program under this subchapter4 ,the    
program shall be known as the           
,department of ,veterans ,affairs       
,readjustment ,counseling ,service      
,scholarship ,program 7in this          
subchapter referred to as the ,program74
  #gfii4 ,eligibility2 agreement  7a7   
,in general ,an individual is eligible  
to participate in the ,program1 as      
determined by the ,readjustment         
,counseling ,service of the ,department1
 if the individual-- 7#a7 is accepted   
for enrollment or enrolled 7as described
 in section #gfjb of this title7 in a   
program of study at an accredited       
educational institution1 school1 or     
training program leading to a terminal  
degree in psychology1 social work1      

marriage and family therapy1 or mental  
health counseling that would meet the   
education requirements for appointment  
to a position under section #gdjb7;b7 of
 this title2 and  7#b7 enters into an   
agreement with the ,secretary under     
subsection 7c74  7b7 ,priority ,in      
selecting individuals to participate in 
the ,program1 the ,secretary shall give 
priority to the following individuals3  
7#a7 ,an individual who agrees to be    
employed by a ,vet ,center located in a 
community that is-- 7,a7 designated as a
 medically underserved population under 
section #ccj7;b77#c7 of the ,public     
,health ,service ,act 7#db ,u4,s4,c4    
#bed;b7b77#c772 and  7,b7 in a ,state   
with a per capita population of veterans
 of more than five percent according to 
the ,national ,center for ,veterans     
,analysis and ,statistics and the       
,bureau of the ,census4  7#b7 ,an       
individual who is a veteran4  7c7       
,agreement ,an agreement between the    
,secretary and a participant in the     

,program shall 7in addition to the      
requirements set forth in section #gfjd 
of this title7 include the following3   
7#a7 ,an agreement by the ,secretary to 
provide the participant with a          
scholarship under the ,program for a    
specified number of school years during 
which the participant pursues a program 
of study described in subsection 7a77#a7
 that meets the requirements set forth  
in section #gfjb7;a7 of this title4     
7#b7 ,an agreement by the participant to
 serve as a full-time employee of the   
,department at a ,vet ,center for a     
six-year period following the completion
 by the participant of such program of  
study 7in this subchapter referred to as
 the period of obligated service74  7d7 
,vet center defined ,in this section1   
the term ,vet ,center has the meaning   
given that term in section #agab;,a7h7  
of this title4  #gfii;,a4 ,obligated    
service  7a7 ,in general ,each          
participant in the ,program shall       
provide service as a full-time employee 

of the ,department at a ,vet ,center 7as
 defined in section #gfii7;d7 of this   
title7 for the period of obligated      
service set forth in the agreement of   
the participant entered into under      
section #gfjd of this title4  7b7       
,determination of service commencement  
date  7#a7 ,not later than #fj days     
before the service commencement date of 
a participant1 the ,secretary shall     
notify the participant of that service  
commencement date4  7#b7 ,the date      
specified in paragraph 7#a7 with respect
 to a participant is the date for the   
beginning of the period of obligated    
service of the participant4  #gfii;,b4  
,breach of agreement3 liability  7a7    
,liquidated damages  7#a7 ,a participant
 in the ,program 7other than a          
participant described in subsection 7b77
 who fails to accept payment1 or        
instructs the educational institution in
 which the participant is enrolled not  
to accept payment1 in whole or in part1 
of a scholarship under the agreement    

entered into under section #gfjd of this
 title shall be liable to the ,united   
,states for liquidated damages in the   
amount of #a1ejj4  7#b7 ,liability under
 paragraph 7#a7 is in addition to any   
period of obligated service or other    
obligation or liability under such      
agreement4  7b7 ,liability during       
program of study  7#a7 ,except as       
provided in subsection 7d71 a           
participant in the ,program shall be    
liable to the ,united ,states for the   
amount which has been paid to or on     
behalf of the participant under the     
agreement if any of the following       
occurs3 7,a7 ,the participant fails to  
maintain an acceptable level of academic
 standing in the educational institution
 in which the participant is enrolled   
7as determined by the educational       
institution under regulations prescribed
 by the ,secretary74  7,b7 ,the         
participant is dismissed from such      
educational institution for disciplinary
 reasons4  7,c7 ,the participant        

voluntarily terminates the program of   
study in such educational institution   
before the completion of such program of
 study4  7#b7 ,liability under this     
subsection is in lieu of any service    
obligation arising under the agreement4 
7c7 ,liability during period of         
obligated service  7#a7 ,except as      
provided in subsection 7d71 if a        
participant in the ,program does not    
complete the period of obligated service
 of the participant1 the ,united ,states
 shall be entitled to recover from the  
participant an amount determined in     
accordance with the following formula3  
,a  #c7ts_/t74  7#b7 ,in the formula in 
paragraph 7#a73 7,a7 ,a is the amount   
the ,united ,states is entitled to      
recover4  7,b7  is the sum of-- 7i7 the 
amounts paid under this subchapter to or
 on behalf of the participant2 and  7ii7
 the interest on such amounts which     
would be payable if at the time the     
amounts were paid they were loans       
bearing interest at the maximum legal   

prevailing rate1 as determined by the   
,treasurer of the ,united ,states4  7,c7
 t is the total number of months in the 
period of obligated service of the      
participant4  7,d7 s is the number of   
months of such period served by the     
participant4  7d7 ,limitation on        
liability for reductions-in-force       
,liability shall not arise under        
subsection 7c7 if the participant fails 
to maintain employment as a ,department 
employee due to a staffing adjustment4  
7e7 ,period for payment of damages ,any 
amount of damages that the ,united      
,states is entitled to recover under    
this section shall be paid to the       
,united ,states within the one-year     
period beginning on the date of the     
breach of the agreement4  4  7b7        
,conforming and technical amendments    
7#a7 ,conforming amendments  7,a7       
,establishment of program ,section      
#gfja7;a7 of such title is amended-- 7i7
 in paragraph 7#e71 by striking and2    
7ii7 in paragraph 7#f71 by striking the 

period and inserting 2 and2 and  7iii7  
by adding at the end the following new  
paragraph3  7#g7 the readjustment       
counseling service scholarship program  
provided for in subchapter ,,ix of this 
chapter4  4  7,b7 ,eligibility ,section 
#gfjb of such title is amended-- 7i7 in 
subsection 7a77#a7-- 7,i7 by striking or
 ,,vi and inserting ,,vi1 or ,,ix2 and  
7,,ii7 by striking subchapter ,,vi and  
inserting subchapter ,,vi or ,,ix2 and  
7ii7 in subsection 7b71 by striking or  
,,vi and inserting ,,vi1 or ,,ix4  7,c7 
,application ,section #gfjc7;a77#a7 of  
such title is amended by striking or    
,,viii and inserting ,,viii1 or ,,ix4   
7,d7 ,terms of agreement ,section #gfjd 
of such title is amended by striking or 
,,viii each place it appears and        
inserting ,,viii1 or ,,ix4  7,e7 ,annual
 report ,section #gfcb of such title is 
amended-- 7i7 in paragraph 7#a71 by     
striking and the ,specialty ,education  
,loan ,repayment ,program and inserting 
the ,specialty ,education ,loan         

,repayment ,program1 and the            
,readjustment ,counseling ,service      
,scholarship ,program2 and  7ii7 in     
paragraph 7#d71 by striking and per     
participant in the ,specialty ,education
 ,loan ,repayment ,program and inserting
 per participant in the ,specialty      
,education ,loan ,repayment ,program1   
and per participant in the ,readjustment
 ,counseling ,service ,scholarship      
,program4  7#b7 ,table of sections ,the 
table of sections at the beginning of   
chapter #gf of such title is amended by 
inserting after the items relating to   
subchapter ,,viii the following3        
,,subchapter ,,ix--,readjustment        
,counseling ,service ,scholarship       
,program ,sec4 #gfih4 ,requirement for  
program4 #gfii4 ,eligibility2 agreement4
 #gfii;,a4 ,obligated service4 #gfii;,b4
 ,breach of agreement3 liability4  4    
7c7 ,effective date ,the ,secretary of  
,veterans ,affairs shall begin awarding 
scholarships under subchapter ,,ix of   
chapter #gf of title #ch1 ,united       

,states ,code1 as added by subsection   
7a71 for programs of study beginning not
 later than one year after the date of  
the enactment of this ,act4  #ejc4      
,comptroller ,general report on         
,readjustment ,counseling ,service of   
,department of ,veterans ,affairs  7a7  
,in general ,not later than one year    
after the date of the enactment of this 
,act1 the ,comptroller ,general of the  
,united ,states shall submit to the     
,committee on ,veterans' ,affairs of the
 ,senate and the ,committee on          
,veterans' ,affairs of the ,house of    
,representatives a report on the        
,readjustment ,counseling ,service of   
the ,department of ,veterans ,affairs4  
7b7 ,elements ,the report required by   
subsection 7a7 shall include the        
following3 7#a7 ,an assessment of the   
adequacy and types of treatment1        
counseling1 and other services provided 
at ,vet ,centers1 including             
recommendations on whether and how such 
treatment1 counseling1 and other        

services can be expanded4  7#b7 ,an     
assessment of the efficacy of outreach  
efforts by the ,readjustment ,counseling
 ,service1 including recommendations for
 how outreach efforts can be improved4  
7#c7 ,an assessment of barriers to care 
at ,vet ,centers1 including             
recommendations for overcoming those    
barriers4  7#d7 ,an assessment of the   
efficacy and frequency of the use of    
telehealth by counselors of the         
,readjustment ,counseling ,service to   
provide mental health services1         
including recommendations for how the   
use of telehealth can be improved4  7#e7
 ,an assessment of the feasibility and  
advisability of expanding eligibility   
for services from the ,readjustment     
,counseling ,service1 including-- 7,a7  
recommendations on what eligibility     
criteria could be expanded2 and  7,b7 an
 assessment of potential costs and      
increased infrastructure requirements if
 eligibility is expanded4  7#f7 ,an     
assessment of the use of ,vet ,centers  

by members of the reserve components of 
the ,armed ,forces who were never       
activated and recommendations on how to 
better reach those members4  7#g7 ,an   
assessment of the use of ,vet ,centers  
by eligible family members of former    
members of the ,armed ,forces and       
recommendations on how to better reach  
those family members4  7#h7 ,an         
assessment of the efficacy of group     
therapy and the level of training of    
providers at ,vet ,centers in           
administering group therapy4  7#i7 ,an  
assessment of the efficiency and        
effectiveness of the task organization  
structure of ,vet ,centers4  7#aj7 ,an  
assessment of the use of ,vet ,centers  
by ,native ,american veterans1 as       
defined in section #cgfe of title #ch1  
,united ,states ,code1 and              
recommendations on how to better reach  
those veterans4  7c7 ,vet center defined
 ,in this section1 the term ,vet ,center
 has the meaning given that term in     
section #agab;,a7h7 of title #ch1       

,united ,states ,code4  #ejd4 ,expansion
 of reporting requirements on           
,readjustment ,counseling ,service of   
,department of ,veterans ,affairs  7a7  
,expansion of annual report ,paragraph  
7#b77;,c7 of section #gcji7;e7 of title 
#ch1 ,united ,states ,code1 is amended  
by inserting before the period at the   
end the following3 1 including the      
resources required to meet such unmet   
need1 such as additional staff1         
additional locations1 additional        
infrastructure1 infrastructure          
improvements1 and additional mobile ,vet
 ,centers4  7b7 ,biennial report ,such  
section is amended by adding at the end 
the following new paragraph3  7#c7 ,for 
each even numbered year in which the    
report required by paragraph 7#a7 is    
submitted1 the ,secretary shall include 
in such report a prediction of-- 7,a7   
trends in demand for care2  7,b7        
long-term investments required with     
respect to the provision of care2  7,c7 
requirements relating to maintenance of 

infrastructure2 and  7,d7 other capital 
investment requirements with respect to 
the ,readjustment ,counseling ,service1 
including ,vet ,centers1 mobile ,vet    
,centers1 and community access points4  
4  #eje4 ,briefing on alternative work  
schedules for employees of ,veterans    
,health ,administration  7a7 ,survey of 
veterans  7#a7 ,in general ,not later   
than #ahj days after the date of the    
enactment of this ,act1 the ,secretary  
of ,veterans ,affairs shall conduct a   
survey on the attitudes of eligible     
veterans toward the ,department of      
,veterans ,affairs offering appointments
 outside the usual operating hours of   
facilities of the ,department1 including
 through the use of telehealth          
appointments4  7#b7 ,eligible veteran   
defined ,in this subsection1 the term   
eligible veteran means a veteran who--  
7,a7 is enrolled in the patient         
enrollment system of the ,department    
under section #agje7;a7 of title #ch1   
,united ,states ,code2 and  7,b7        

received health care from the           
,department at least once during the    
two-year period ending on the date of   
the commencement of the survey under    
paragraph 7#a74  7b7 ,congressional     
briefing  7#a7 ,in general ,not later   
than #bgj days after the date of the    
enactment of this ,act1 the ,secretary  
shall brief the ,committee on ,veterans'
 ,affairs of the ,senate and the        
,committee on ,veterans' ,affairs of the
 ,house of ,representatives on the--    
7,a7 feasibility and advisability of    
offering appointments outside the usual 
operating hours of facilities of the    
,department that do not offer such      
appointments2 and  7,b7 effectiveness of
 offering appointments outside the usual
 operating hours of facilities of the   
,department for those facilities that   
offer such appointments4  7#b7 ,elements
 ,the briefing required by paragraph    
7#a7 shall include the following3 7,a7  
,the findings of the survey conducted   
under subsection 7a72  7,b7 ,feedback   

from employees of the ,veterans ,health 
,administration1 including clinical1    
nonclinical1 and support staff1 with    
respect to offering appointments outside
 the usual operating hours of facilities
 of the ,department1 including through  
the use of telehealth appointments2 and 
7,c7 ,any other matters the ,secretary  
considers relevant to a full            
understanding of the feasibility and    
advisability of offering appointments   
outside the usual operating hours of    
facilities of the ,department4  7c7     
,paperwork ,reduction ,act exemption    
,chapter #ce of title #dd1 ,united      
,states ,code 7commonly known as the    
,paperwork ,reduction ,act7 shall not   
apply to any rulemaking or information  
collection required under this section4 
#ejf4 ,suicide prevention coordinators  
7a7 ,staffing requirement ,beginning not
 later than one year after the date of  
the enactment of this ,act1 the         
,secretary of ,veterans ,affairs shall  
ensure that each medical center of the  

,department of ,veterans ,affairs has   
not less than one suicide prevention    
coordinator4  7b7 ,study on             
reorganization  7#a7 ,in general ,not   
later than one year after the date of   
the enactment of this ,act1 the         
,secretary1 in consultation with the    
,office of ,mental ,health and ,suicide 
,prevention of the ,department1 shall   
commence the conduct of a study to      
determine the feasibility and           
advisability of-- 7,a7 the realignment  
and reorganization of suicide prevention
 coordinators within the ,office of     
,mental ,health and ,suicide            
,prevention2 and  7,b7 the creation of a
 suicide prevention coordinator program 
office4  7#b7 ,program office           
realignment ,in conducting the study    
under paragraph 7#a71 the ,secretary    
shall assess the feasibility of         
advisability of1 within the suicide     
prevention coordinator program office   
described in paragraph 7#a77;,b71       
aligning suicide prevention coordinators

 and suicide prevention case managers   
within the organizational structure and 
chart of the ,suicide ,prevention       
,program of the ,department1 with the   
,director of the ,suicide ,prevention   
program having ultimate supervisory     
oversight and responsibility over the   
suicide prevention coordinator program  
office4  7c7 ,report ,not later than #ij
 days after the completion of the study 
under subsection 7b71 the ,secretary    
shall submit to the ,committee on       
,veterans' ,affairs of the ,senate and  
the ,committee on ,veterans' ,affairs of
 the ,house of ,representatives a report
 on such study1 including the following3
 7#a7 ,an assessment of the feasibility 
and advisability of creating a suicide  
prevention coordinator program office to
 oversee and monitor suicide prevention 
coordinators and suicide prevention case
 managers across all medical centers of 
the ,department4  7#b7 ,a review of     
current staffing ratios for suicide     
prevention coordinators and suicide     

prevention case managers in comparison  
with current staffing ratios for mental 
health providers within each medical    
center of the ,department4  7#c7 ,a     
description of the duties and           
responsibilities for suicide prevention 
coordinators across the ,department to  
better define1 delineate1 and           
standardize qualifications1 performance 
goals1 performance duties1 and          
performance outcomes for suicide        
prevention coordinators and suicide     
prevention case managers4  #ejg4 ,report
 on efforts by ,department of ,veterans 
,affairs to implement safety planning in
 emergency departments  7a7 ,findings   
,congress makes the following findings3 
7#a7 ,the ,department of ,veterans      
,affairs must be more effective in its  
approach to reducing the burden of      
veteran suicide connected to mental     
health diagnoses1 to include expansion  
of treatment delivered via telehealth   
methods and in rural areas4  7#b7 ,an   
innovative project1 known as ,suicide   

,assessment and ,follow-up ,engagement3 
,veteran ,emergency ,treatment 7in this 
subsection referred to as ,,safe ,,vet71
 was designed to help suicidal veterans 
seen at emergency departments within the
 ,veterans ,health ,administration and  
was successfully implemented in five    
intervention sites beginning in #bjaj4  
7#c7 ,a #bjah study found that safety   
planning intervention under ,,safe ,,vet
 was associated with #de percent fewer  
suicidal behaviors in the six-month     
period following emergency department   
care and more than double the odds of a 
veteran engaging in outpatient          
behavioral health care4  7#d7 ,,safe    
,,vet is a promising alternative and    
acceptable delivery of care system that 
augments the treatment of suicidal      
veterans in emergency departments of the
 ,veterans ,health ,administration and  
helps ensure that those veterans have   
appropriate follow-up care4  7#e7       
,beginning in ,september #bjah1 the     
,veterans ,health ,administration       

implemented a suicide prevention        
program1 known as the ,,sped program1   
for veterans presenting to the emergency
 department who are assessed to be at   
risk for suicide and are safe to be     
discharged home4  7#f7 ,the ,,sped      
program includes issuance and update of 
a safety plan and post-discharge        
follow-up outreach for veterans to      
facilitate engagement in outpatient     
mental health care4  7b7 ,report  7#a7  
,in general ,not later than #ahj days   
after the date of the enactment of this 
,act1 the ,secretary of ,veterans       
,affairs shall submit to the appropriate
 committees of ,congress a report on the
 efforts of the ,secretary to implement 
a suicide prevention program for        
veterans presenting to an emergency     
department or urgent care center of the 
,veterans ,health ,administration who   
are assessed to be at risk for suicide  
and are safe to be discharged home1     
including a safety plan and             
post-discharge outreach for veterans to 

facilitate engagement in outpatient     
mental health care4  7#b7 ,elements ,the
 report required by paragraph 7#a7 shall
 include the following3 7,a7 ,an        
assessment of the implementation of the 
current operational policies and        
procedures of the ,,sped program at each
 medical center of the ,department of   
,veterans ,affairs1 including an        
assessment of the following3 7i7        
,training provided to clinicians or     
other personnel administering protocols 
under the ,,sped program4  7ii7 ,any    
disparities in implementation of such   
protocols between medical centers4      
7iii7 ,current criteria used to measure 
the quality of such protocols           
including-- 7,i7 methodology used to    
assess the quality of a safety plan and 
post-discharge outreach for veterans2 or
  7,,ii7 in the absence of such         
methodology1 a proposed timeline and    
guidelines for creating a methodology to
 ensure compliance with the             
evidence-based model used under the     

,suicide ,assessment and ,follow-up     
,engagement3 ,veteran ,emergency        
,treatment 7,,safe ,,vet7 program of the
 ,department4  7,b7 ,an assessment of   
the implementation of the policies and  
procedures described in subparagraph    
7,a71 including the following3 7i7 ,an  
assessment of the quality and quantity  
of safety plans issued to veterans4     
7ii7 ,an assessment of the quality and  
quantity of post-discharge outreach     
provided to veterans4  7iii7 ,the       
post-discharge rate of veteran          
engagement in outpatient mental health  
care1 including attendance at not fewer 
than one individual mental health clinic
 appointment or admission to an         
inpatient or residential unit4  7iv7    
,the number of veterans who decline     
safety planning efforts during protocols
 under the ,,sped program4  7v7 ,the    
number of veterans who decline to       
participate in follow-up efforts within 
the ,,sped program4  7,c7 ,a description
 of how ,,sped primary coordinators are 

deployed to support such efforts1       
including the following3 7i7 ,a         
description of the duties and           
responsibilities of such coordinators4  
7ii7 ,the number and location of such   
coordinators4  7iii7 ,a description of  
training provided to such coordinators4 
7iv7 ,an assessment of the other        
responsibilities for such coordinators  
and1 if applicable1 differences in      
patient outcomes when such              
responsibilities are full-time duties as
 opposed to secondary duties4  7,d7 ,an 
assessment of the feasibility and       
advisability of expanding the total     
number and geographic distribution of   
,,sped primary coordinators4  7,e7 ,an  
assessment of the feasibility and       
advisability of providing services under
 the ,,sped program via telehealth      
channels1 including an analysis of      
opportunities to leverage telehealth to 
better serve veterans in rural areas4   
7,f7 ,a description of the status of    
current capabilities and utilization of 

tracking mechanisms to monitor          
compliance1 quality1 and patient        
outcomes under the ,,sped program4  7,g7
 ,such recommendations1 including       
specific action items1 as the ,secretary
 considers appropriate with respect to  
how the ,department can better implement
 the ,,sped program1 including          
recommendations with respect to the     
following3 7i7 ,a process to standardize
 training under such program4  7ii7 ,any
 resourcing requirements necessary to   
implement the ,,sped program throughout 
,veterans ,health ,administration1      
including by having a dedicated         
clinician responsible for administration
 of such program at each medical center4
  7iii7 ,an analysis of current         
statutory authority and any changes     
necessary to fully implement the ,,sped 
program throughout the ,veterans ,health
 ,administration4  7iv7 ,a timeline for 
the implementation of the ,,sped program
 through the ,veterans ,health          
,administration once full resourcing and

 an approved training plan are in place4
  7,h7 ,such other matters as the       
,secretary considers appropriate4  7c7  
,definitions ,in this section3 7#a7     
,appropriate committees of congress ,the
 term appropriate committees of         
,congress means-- 7,a7 the ,committee on
 ,veterans' ,affairs and the            
,subcommittee on ,military              
,construction1 ,veterans ,affairs1 and  
,related ,agencies of the ,committee on 
,appropriations of the ,senate2 and     
7,b7 the ,committee on ,veterans'       
,affairs and the ,subcommittee on       
,military ,construction1 ,veterans      
,affairs1 and ,related ,agencies of the 
,committee on ,appropriations of the    
,house of ,representatives4  7#b7 ,,sped
 primary coordinator ,the term ,,sped   
primary coordinator means the main point
 of contact responsible for             
administering the ,,sped program at a   
medical center of the ,department4  7#c7
 ,,sped program ,the term ,,sped program
 means the ,safety ,planning in         

,emergency ,departments program of the  
,department of ,veterans ,affairs       
established in ,september #bjah for     
veterans presenting to the emergency    
department who are assessed to be at    
risk for suicide and are safe to be     
discharged home1 which extends the      
evidence-based intervention for suicide 
prevention to all emergency departments 
of the ,veterans ,health                
,administration4  ,,vi ,improvement of  
care and services for women veterans    
#fja4 ,expansion of capabilities of     
,women ,veterans ,call ,center to       
include text messaging ,the ,secretary  
of ,veterans ,affairs shall expand the  
capabilities of the ,women ,veterans    
,call ,center of the ,department of     
,veterans ,affairs to include a text    
messaging capability4  #fjb4            
,requirement for ,department of         
,veterans ,affairs internet website to  
provide information on services         
available to women veterans  7a7 ,in    
general ,the ,secretary of ,veterans    

,affairs shall survey the internet      
websites and information resources of   
the ,department of ,veterans ,affairs in
 effect on the day before the date of   
the enactment of this ,act and publish  
an internet website that serves as a    
centralized source for the provision to 
women veterans of information about the 
benefits and services available to them 
under laws administered by the          
,secretary4  7b7 ,elements ,the internet
 website published under subsection 7a7 
shall provide to women veterans         
information regarding all services      
available in the district in which the  
veteran is seeking such services1       
including1 with respect to each medical 
center and community-based outpatient   
clinic in the applicable ,veterans      
,integrated ,service ,network-- 7#a7 the
 name and contact information of each   
women's health coordinator2  7#b7 a list
 of appropriate staff for other benefits
 available from the ,veterans ,benefits 
,administration1 the ,national ,cemetery

 ,administration1 and such other        
entities as the ,secretary considers    
appropriate2 and  7#c7 such other       
information as the ,secretary considers 
appropriate4  7c7 ,updated information  
,the ,secretary shall ensure that the   
information described in subsection 7b7 
that is published on the internet       
website required by subsection 7a7 is   
updated not less frequently than once   
every #ij days4  7d7 ,outreach ,in      
carrying out this section1 the          
,secretary shall ensure that the        
outreach conducted under section        
#agbj;,f7i7 of title #ch1 ,united       
,states ,code1 includes information     
regarding the internet website required 
by subsection 7a74  7e7 ,derivation of  
funds ,amounts used by the ,secretary to
 carry out this section shall be derived
 from amounts made available to the     
,secretary to publish internet websites 
of the ,department4  ,,vii ,other       
matters  #gja4 ,expanded telehealth from
 ,department of ,veterans ,affairs  7a7 

,in general ,the ,secretary of ,veterans
 ,affairs shall enter into agreements1  
and expand existing agreements1 with    
organizations that represent or serve   
veterans1 nonprofit organizations1      
private businesses1 and other interested
 parties for the expansion of telehealth
 capabilities and the provision of      
telehealth services to veterans through 
the award of grants under subsection    
7b74  7b7 ,award of grants  7#a7 ,in    
general ,in carrying out agreements     
entered into or expanded under this     
section with entities described in      
subsection 7a71 the ,secretary shall    
award grants to those entities4  7#b7   
,locations ,to the extent practicable1  
the ,secretary shall ensure that grants 
are awarded to entities that serve      
veterans in rural and highly rural areas
 7as determined through the use of the  
,rural-,urban ,commuting ,areas coding  
system of the ,department of            
,agriculture7 or areas determined to be 
medically underserved4  7#c7 ,use of    

grants  7,a7 ,in general ,grants awarded
 to an entity under this subsection may 
be used for one or more of the          
following3 7i7 ,purchasing1 replacing or
 upgrading hardware or software         
necessary for the provision of secure   
and private telehealth services4  7ii7  
,upgrading security protocols for       
consistency with the security           
requirements of the ,department of      
,veterans ,affairs4  7iii7 ,training of 
site attendants1 including payment of   
those attendants for completing that    
training1 with respect to-- 7,i7        
military and veteran cultural           
competence1 if the entity is not an     
organization that represents veterans2  
7,,ii7 equipment required to provide    
telehealth services2  7,,iii7 privacy1  
including the ,health ,insurance        
,portability and ,accountability ,act of
 #aiif privacy rule under part #afj and 
subparts ,a and ,e of part #afd of title
 #de1 ,code of ,federal ,regulations1 or
 successor regulations1 as it relates to

 health care for veterans2  7,,iv7      
scheduling for telehealth services for  
veterans2 or  7,v7 any other unique     
training needs for the provision of     
telehealth services to veterans4  7iv7  
,upgrading existing infrastructure owned
 or leased by the entity to make rooms  
more conducive to telehealth care1      
including-- 7,i7 additions or           
modifications to windows or walls in an 
existing room1 or other alterations as  
needed to create a new1 private room1   
including permits or inspections        
required in association with space      
modifications2  7,,ii7 soundproofing of 
an existing room2  7,,iii7 new          
electrical1 telephone1 or internet      
outlets in an existing room2 or  7,,iv7 
aesthetic enhancements to establish a   
more suitable therapeutic environment4  
7v7 ,upgrading existing infrastructure  
to comply with the ,americans with      
,disabilities ,act of #aiij 7#db        
,u4,s4,c4 #abaja et seq474  7vi7        
,upgrading internet infrastructure and  

sustainment of internet services4  7vii7
 ,sustainment of telephone services4    
7,b7 ,exclusion ,grants may not be used 
for the purchase of new property or for 
major construction projects1 as         
determined by the ,secretary4  7c7      
,agreement on telehealth access points  
7#a7 ,in general ,an entity described in
 subsection 7a7 that seeks to establish 
a telehealth access point for veterans  
but does not require grant funding under
 this section to do so may enter into an
 agreement with the ,department for the 
establishment of such an access point4  
7#b7 ,adequacy of facilities ,an entity 
described in paragraph 7#a7 shall be    
responsible for ensuring that any access
 point is adequately private1 secure1   
clean1 and accessible for veterans      
before the access point is established4 
7d7 ,assessment of barriers to access   
7#a7 ,in general ,not later than #ah    
months after the date of the enactment  
of this ,act1 the ,secretary shall      
complete an assessment of barriers faced

 by veterans in accessing telehealth    
services4  7#b7 ,elements ,the          
assessment required by paragraph 7#a7   
shall include the following3 7,a7 ,a    
description of the barriers veterans    
face in using telehealth while not on   
property of the ,department4  7,b7 ,a   
description of how the ,department plans
 to address the barriers described in   
subparagraph 7,a74  7,c7 ,such other    
matters related to access by veterans to
 telehealth while not on property of the
 ,department as the ,secretary considers
 relevant4  7#c7 ,report ,not later than
 #abj days after the completion of the  
assessment required by paragraph 7#a71  
the ,secretary shall submit to the      
,committee on ,veterans' ,affairs of the
 ,senate and the ,committee on          
,veterans' ,affairs of the ,house of    
,representatives a report on the        
assessment1 including any               
recommendations for legislative or      
administrative action based on the      
results of the assessment4  #gjb4       

,partnerships with non-,federal         
,government entities to provide         
hyperbaric oxygen therapy to veterans   
and studies on the use of such therapy  
for treatment of post-traumatic stress  
disorder and traumatic brain injury  7a7
 ,partnerships to provide hyperbaric    
oxygen therapy to veterans  7#a7 ,use of
 partnerships ,the ,secretary of        
,veterans ,affairs1 in consultation with
 the ,center for ,compassionate         
,innovation within the ,office of       
,community ,engagement of the           
,department of ,veterans ,affairs1 may  
enter into partnerships with            
non-,federal ,government entities to    
provide hyperbaric oxygen treatment to  
veterans to research the effectiveness  
of such therapy4  7#b7 ,types of        
partnerships ,partnerships entered into 
under paragraph 7#a7 may include the    
following3 7,a7 ,partnerships to conduct
 research on hyperbaric oxygen therapy4 
7,b7 ,partnerships to review research on
 hyperbaric oxygen therapy provided to  

nonveterans4  7,c7 ,partnerships to     
create industry working groups to       
determine standards for research on     
hyperbaric oxygen therapy4  7,d7        
,partnerships to provide to veterans    
hyperbaric oxygen therapy for the       
purposes of conducting research on the  
effectiveness of such therapy4  7#c7    
,limitation on ,federal funding ,federal
 ,government funding may be used to     
coordinate and administer the           
partnerships under this subsection but  
may not be used to carry out activities 
conducted under such partnerships4  7b7 
,review of effectiveness of hyperbaric  
oxygen therapy ,not later than #ij days 
after the date of the enactment of this 
,act1 the ,secretary1 in consultation   
with the ,center for ,compassionate     
,innovation1 shall begin using an       
objective and quantifiable method to    
review the effectiveness and            
applicability of hyperbaric oxygen      
therapy1 such as through the use of a   
device approved or cleared by the ,food 

and ,drug ,administration that assesses 
traumatic brain injury by tracking eye  
movement4  7c7 ,systematic review of use
 of hyperbaric oxygen therapy to treat  
certain conditions  7#a7 ,in general    
,not later than #ij days after the date 
of the enactment of this ,act1 the      
,secretary1 in consultation with the    
,center for ,compassionate ,innovation1 
shall commence the conduct of a         
systematic review of published research 
literature on off-label use of          
hyperbaric oxygen therapy to treat      
post-traumatic stress disorder and      
traumatic brain injury among veterans   
and nonveterans4  7#b7 ,elements ,the   
review conducted under paragraph 7#a7   
shall include the following3 7,a7 ,an   
assessment of the current parameters for
 research on the use by the ,department 
of ,veterans ,affairs of hyperbaric     
oxygen therapy1 including-- 7i7 tests   
and questionnaires used to determine the
 efficacy of such therapy2 and  7ii7    
metrics for determining the success of  

such therapy4  7,b7 ,a comparative      
analysis of tests and questionnaires    
used to study post-traumatic stress     
disorder and traumatic brain injury in  
other research conducted by the         
,department of ,veterans ,affairs1 other
 ,federal agencies1 and entities outside
 the ,federal ,government4  7#c7        
,completion of review ,the review       
conducted under paragraph 7#a7 shall be 
completed not later than #ahj days after
 the date of the commencement of the    
review4  7#d7 ,report ,not later than   
#ij days after the completion of the    
review conducted under paragraph 7#a71  
the ,secretary shall submit to the      
,committee on ,veterans' ,affairs of the
 ,senate and the ,committee on          
,veterans' ,affairs of the ,house of    
,representatives a report on the results
 of the review4  7d7 ,follow-up study   
7#a7 ,in general ,not later than #abj   
days after the completion of the review 
conducted under subsection 7c71 the     
,secretary1 in consultation with the    

,center for ,compassionate ,innovation1 
shall commence the conduct of a study on
 all individuals receiving hyperbaric   
oxygen therapy through the current pilot
 program of the ,department for the     
provision of hyperbaric oxygen therapy  
to veterans to determine the efficacy   
and effectiveness of hyperbaric oxygen  
therapy for the treatment of            
post-traumatic stress disorder and      
traumatic brain injury4  7#b7 ,elements 
,the study conducted under paragraph    
7#a7 shall include the review and       
publication of any data and conclusions 
resulting from research conducted by an 
authorized provider of hyperbaric oxygen
 therapy for veterans through the pilot 
program described in such paragraph4    
7#c7 ,completion of study ,the study    
conducted under paragraph 7#a7 shall be 
completed not later than three years    
after the date of the commencement of   
the study4  7#d7 ,report  7,a7 ,in      
general ,not later than #ij days after  
completing the study conducted under    

paragraph 7#a71 the ,secretary shall    
submit to the ,committee on ,veterans'  
,affairs of the ,senate and the         
,committee on ,veterans' ,affairs of the
 ,house of ,representatives a report on 
the results of the study4  7,b7         
,elements ,the report required under    
subparagraph 7,a7 shall include the     
recommendation of the ,secretary with   
respect to whether or not hyperbaric    
oxygen therapy should be made available 
to all veterans with traumatic brain    
injury or post-traumatic stress         
disorder4  #gjc4 ,prescription of       
technical qualifications for licensed   
hearing aid specialists and requirement 
for appointment of such specialists  7a7
 ,technical qualifications  7#a7 ,in    
general ,not later than #ahj days after 
the date of the enactment of this ,act1 
the ,secretary of ,veterans ,affairs    
shall prescribe the technical           
qualifications required under section   
#gdjb7;b77#ad7 of title #ch1 ,united    
,states ,code1 to be appointed as a     

licensed hearing aid specialist under   
section #gdja7c7 of such title4  7#b7   
,elements for qualifications ,in        
prescribing the qualifications for      
licensed hearing aid specialists under  
paragraph 7#a71 the ,secretary shall1 at
 a minimum1 ensure that such            
qualifications are consistent with--    
7,a7 the standards for licensure of     
hearing aid specialists that are        
required by a majority of ,states2  7,b7
 any competencies needed to perform     
tasks and services commonly performed by
 hearing aid specialists pursuant to    
such standards2 and  7,c7 any           
competencies needed to perform tasks    
specific to providing care to           
individuals under the laws administered 
by the ,secretary4  7b7 ,authority to   
set and maintain duties ,the ,secretary 
shall retain the authority to set and   
maintain the duties for licensed hearing
 aid specialists appointed under section
 #gdja7c7 of title #ch1 ,united ,states 
,code1 for the purposes of the          

employment of such specialists with the 
,department of ,veterans ,affairs4  7c7 
,appointment ,not later than ,september 
#cj1 #bjbb1 the ,secretary shall appoint
 not fewer than one licensed hearing aid
 specialist at each medical center of   
the ,department4  7d7 ,report ,not later
 than ,september #cj1 #bjbb1 and        
annually thereafter1 the ,secretary     
shall submit to the ,committee on       
,veterans' ,affairs of the ,senate and  
the ,committee on ,veterans' ,affairs of
 the ,house of ,representatives a       
report-- 7#a7 assessing the progress of 
the ,secretary in appointing licensed   
hearing aid specialists under subsection
 7c72  7#b7 assessing potential         
conflicts or obstacles that prevent the 
appointment of licensed hearing aid     
specialists2  7#c7 assessing the factors
 that led to such conflicts or          
obstacles2  7#d7 assessing access of    
patients to comprehensive hearing health
 care services from the ,department     
consistent with the requirements under  

section #d7;b7 of the ,veterans         
,mobility ,safety ,act of #bjaf 7,public
 ,law #aad-bef2 #ch ,u4,s4,c4 #gdja     
note71 including an assessment of the   
impact of infrastructure and equipment  
limitations on wait times for audiologic
 care2 and  7#e7 indicating the medical 
centers of the ,department with         
vacancies for audiologists or licensed  
hearing aid specialists4  #gjd4 ,use by 
,department of ,veterans ,affairs of    
commercial institutional review boards  
in sponsored research trials  7a7 ,in   
general ,not later than #ij days after  
the date of the enactment of this ,act1 
the ,secretary of ,veterans ,affairs    
shall complete all necessary policy     
revisions within the directive of the   
,veterans ,health ,administration       
numbered #abjj4je and titled            
,requirements for the ,protection of    
,human ,subjects in ,research1 to allow 
sponsored clinical research of the      
,department of ,veterans ,affairs to use
 accredited commercial institutional    

review boards to review research        
proposal protocols of the ,department4  
7b7 ,identification of review boards    
,not later than #ij days after the      
completion of the policy revisions under
 subsection 7a71 the ,secretary shall-- 
7#a7 identify accredited commercial     
institutional review boards for use in  
connection with sponsored clinical      
research of the ,department2 and  7#b7  
establish a process to modify existing  
approvals in the event that a commercial
 institutional review board loses its   
accreditation during an ongoing clinical
 trial4  7c7 ,report  7#a7 ,in general  
,not later than #ij days after the      
completion of the policy revisions under
 subsection 7a71 and annually           
thereafter1 the ,secretary shall submit 
to the ,committee on ,veterans' ,affairs
 of the ,senate and the ,committee on   
,veterans' ,affairs of the ,house of    
,representatives a report on all        
approvals of institutional review boards
 used by the ,department1 including     

central institutional review boards and 
commercial institutional review boards4 
7#b7 ,elements ,the report required by  
paragraph 7#a7 shall include1 at a      
minimum1 the following3 7,a7 ,the name  
of each clinical trial with respect to  
which the use of an institutional review
 board has been approved4  7,b7 ,the    
institutional review board or           
institutional review boards used in the 
approval process for each clinical      
trial4  7,c7 ,the amount of time between
 submission and approval4  #gje4        
,creation of ,office of ,research       
,reviews within the ,office of          
,information and ,technology of the     
,department of ,veterans ,affairs  7a7  
,in general ,not later than one year    
after the date of the enactment of this 
,act1 the ,secretary of ,veterans       
,affairs shall establish within the     
,office of ,information and ,technology 
of the ,department of ,veterans ,affairs
 an ,office of ,research ,reviews 7in   
this section referred to as the         

,office74  7b7 ,elements ,the ,office   
shall do the following3 7#a7 ,perform   
centralized security reviews and        
complete security processes for approved
 research sponsored outside the         
,department1 with a focus on multi-site 
clinical trials4  7#b7 ,develop and     
maintain a list of commercially         
available software preferred for use in 
sponsored clinical trials of the        
,department and ensure such list is     
maintained as part of the official      
approved software products list of the  
,department4  7#c7 ,develop benchmarks  
for appropriate timelines for security  
reviews conducted by the ,office4  7c7  
,report  7#a7 ,in general ,not later    
than one year after the establishment of
 the ,office1 the ,office shall submit  
to the ,committee on ,veterans' ,affairs
 of the ,senate and the ,committee on   
,veterans' ,affairs of the ,house of    
,representatives a report on the        
activity of the ,office4  7#b7 ,elements
 ,the report required by paragraph 7#a7 

shall include1 at a minimum1 the        
following3 7,a7 ,the number of security 
reviews completed4  7,b7 ,the number of 
personnel assigned for performing the   
functions described in subsection 7b74  
,passed the ,senate ,august #e1         
#bjbj4,secretary