,,ii  #aafth ,,congress  #ast ,session  
,s4 #ghe  ,,in ,,the ,,senate ,,of ,,the
 ,,united ,,states  ,march #ac1 #bjai   
,mr4 ,tester 7for himself1 ,mr4 ,moran1 
,ms4 ,baldwin1 ,ms4 ,stabenow1 ,mr4     
,kaine1 ,mr4 ,markey1 ,ms4 ,sinema1 ,ms4
 ,hirono1 ,mr4 ,durbin1 ,mr4 ,casey1    
,ms4 ,harris1 ,mr4 ,udall1 ,mr4         
,blumenthal1 ,mr4 ,murphy1 ,mr4 ,warner1
 ,mrs4 ,murray1 ,mrs4 ,feinstein1 ,mr4  
,menendez1 ,mr4 ,booker1 ,ms4 ,smith1   
,mr4 ,manchin1 ,ms4 ,klobuchar1 ,mr4    
,sanders1 and ,ms4 ,duckworth7          
introduced the following bill2 which was
 read twice and referred to the         
,committee on ,veterans' ,affairs  ,a   
,,bill  ,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      
,expansion of health care coverage for  
veterans4 ,sec4 #ajb4 ,grants for       
provision of transition assistance to   
former members of the ,armed ,forces    
transitioning to civilian life4 ,sec4   
#ajc4 ,study of community-based         
transition assistance programs for      
former members of the ,armed ,forces4   
,sec4 #ajd4 ,modification of eligibility
 for care from ,department of ,veterans 
,affairs for former members of the      
,armed ,forces with other than honorable
 discharges and report on such care4    
,,title ,,ii--,suicide prevention ,sec4 
#bja4 ,grants for organizations         
providing mental health wellness        
services to veterans4 ,sec4 #bjb4       
,designation of buddy check week by     
,department of ,veterans ,affairs4 ,sec4
 #bjc4 ,post-traumatic growth           

partnerships4 ,sec4 #bjd4 ,progress of  
,department of ,veterans ,affairs in    
meeting goals and objectives of         
,national ,strategy for ,preventing     
,veteran ,suicide4 ,sec4 #bje4 ,study on
 feasibility and advisability of        
providing certain complementary and     
integrative health services4 ,sec4 #bjf4
 ,program to provide veterans access to 
complementary and integrative health    
services through animal therapy1        
agri-therapy1 and outdoor sports        
therapy4 ,sec4 #bjg4 ,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 
,program to provide veterans access to  
computerized cognitive behavioral       
therapy4 ,sec4 #cjb4 ,study on          
connection between living at high       
altitude and suicide risk factors among 
veterans4 ,sec4 #cjc4 ,establishment by 
,department of ,veterans ,affairs and   

,department of ,defense of clinical     
practice guidelines for comorbid mental 
health conditions4 ,sec4 #cjd4 ,update  
of clinical practice guidelines for     
assessment and management of patients at
 risk for suicide4 ,sec4 #cje4          
,precision medicine initiative of       
,department of ,veterans ,affairs to    
identify and validate brain and mental  
health biomarkers4 ,sec4 #cjf4          
,preventative and complex data analysis 
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      
,annual report on progress of           
,department of ,veterans ,affairs in    
meeting goals and objectives of         
,executive ,order #achbb4 ,sec4 #djd4   

,comptroller ,general management review 
of mental health and suicide prevention 
services of ,department of ,veterans    
,affairs4 ,sec4 #dje4 ,comptroller      
,general report on efforts of           
,department of ,veterans ,affairs to    
integrate mental health care into       
primary care clinics4 ,sec4 #djf4 ,joint
 mental health programs by ,department  
of ,veterans ,affairs and ,department of
 ,defense4 ,,title ,v--,medical         
workforce ,subtitle ,a--,improvement of 
mental health medical workforce ,sec4   
#eja4 ,treatment of psychologists4 ,sec4
 #ejb4 ,staffing improvement plan for   
psychiatrists and psychologists of      
,department of ,veterans ,affairs4 ,sec4
 #ejc4 ,occupational series and staffing
 improvement plan for licensed          
professional mental health counselors   
and marriage and family therapists of   
,department of ,veterans ,affairs4 ,sec4
 #ejd4 ,staffing improvement plan for   
peer specialists of ,department of      
,veterans ,affairs who are women4 ,sec4 

#eje4 ,establishment of ,department of  
,veterans ,affairs ,readjustment        
,counseling ,service ,scholarship       
,program4 ,sec4 #ejf4 ,comptroller      
,general report on ,readjustment        
,counseling ,service of ,department of  
,veterans ,affairs4 ,sec4 #ejg4         
,expansion of reporting requirements on 
,readjustment ,counseling ,service of   
,department of ,veterans ,affairs4 ,sec4
 #ejh4 ,studies on alternative work     
schedules for employees of ,veterans    
,health ,administration4 ,sec4 #eji4    
,suicide prevention coordinators4       
,subtitle ,b--,direct hiring authorities
 for certain health care positions ,sec4
 #eba4 ,direct hiring authorities for   
certain health care positions4 ,,title  
,,vi--,improvement of telehealth        
services ,sec4 #fja4 ,expanded          
telehealth from ,department of ,veterans
 ,affairs4 ,sec4 #fjb4 ,implementation  
of national protocol for telehealth     
security and interfacing instructions4  
,i ,improvement of transition of        

individuals to services from ,department
 of ,veterans ,affairs  #aja4 ,expansion
 of health care coverage for veterans   
7a7 ,in general ,section #agaj7;a77#a7  
of title #ch1 ,united ,states ,code1 is 
amended--  7#a7 in subparagraph 7,a71 by
 striking and at the end2  7#b7 by      
redesignating subparagraph 7,b7 as      
subparagraph 7,c72 and  7#c7 by         
inserting after subparagraph 7,a7 the   
following new subparagraph 7,b73  7,b7  
to any veteran during the one-year      
period following the discharge or       
release of the veteran from active      
military1 naval1 or air service2 and  4 
7b7 ,patient enrollment system ,section 
#agje7;c7 of such title is amended by   
adding at the end the following new     
paragraph3  7#c7 ,nothing in this       
section shall be construed to prevent   
the ,secretary from providing hospital  
care and medical services to a veteran  
under section #agaj7;a77#a77;,b7 of this
 title during the period specified in   
such section notwithstanding the failure

 of the veteran to enroll in the system 
of patient enrollment established by the
 ,secretary under subsection 7a74  4    
7c7 ,promotion of expanded eligibility  
7#a7 ,transition ,assistance ,program   
7,a7 ,in general ,the ,secretary of     
,labor1 in consultation with the        
,secretary of ,defense and the          
,secretary of ,veterans ,affairs1 shall 
promote to members of the ,armed ,forces
 transitioning from service in the      
,armed ,forces to civilian life through 
the ,transition ,assistance ,program the
 expanded eligibility of veterans for   
health care under the laws administered 
by the ,secretary of ,veterans ,affairs 
pursuant to the amendments made by this 
section4  7,b7 ,transition ,assistance  
,program defined ,in this paragraph1 the
 term ,transition ,assistance ,program  
means the ,transition ,assistance       
,program under sections #aadb and #aadd 
of title #aj1 ,united ,states ,code4    
7#b7 ,publication by ,department of     
,veterans ,affairs ,not later than #cj  

days after the date of the enactment of 
this ,act1 the ,secretary of ,veterans  
,affairs shall publish on a website of  
the ,department of ,veterans ,affairs   
notification of the expanded eligibility
 of veterans for health care under the  
laws administered by the ,secretary     
pursuant to the amendments made by this 
section4  #ajb4 ,grants for provision of
 transition assistance to former members
 of the ,armed ,forces transitioning to 
civilian life  7a7 ,program required    
,commencing not later than #ahj days    
after the date of the enactment of this 
,act1 the ,secretary of ,labor shall1 in
 coordination with the ,secretary of    
,veterans ,affairs1 carry out a program 
on the provision of assistance to former
 members of the ,armed ,forces1 and     
spouses of such members1 transitioning  
from service in the ,armed ,forces to   
civilian life4  7b7 ,duration of program
 ,the ,secretary of ,labor shall carry  
out the program during the five-year    
period beginning on the date of the     

commencement of the program4  7c7       
,grants  7#a7 ,in general ,the          
,secretary shall carry out the program  
through the award of grants to eligible 
organizations for the provision of      
assistance described in subsection 7a74 
7#b7 ,matching funds required ,a grant  
under this section shall be in an amount
 that does not exceed #ej percent of the
 amount required by the organization to 
provide the services described in       
subsection 7f74  7d7 ,eligible          
organizations ,for purposes of this     
section1 an eligible organization is any
 nonprofit organization that the        
,secretary of ,labor determines1 in     
consultation with the ,secretary of     
,veterans ,affairs and ,state entities  
that serve veterans1 is suitable for    
receipt of a grant under the program    
pursuant to receipt by the ,secretary of
 ,labor of an application submitted     
under subsection 7e77#a74  7e7          
,selection of grant recipients  7#a7    
,applications ,an organization seeking a

 grant under the program shall submit to
 the ,secretary of ,labor an application
 therefor at such time1 in such manner1 
and containing such information and     
assurances as the ,secretary1 in        
consultation with the ,secretary of     
,veterans ,affairs and ,state entities  
that serve veterans1 may require4  7#b7 
,priority for hubs of services ,in      
awarding grants under the program1 the  
,secretary of ,labor shall give priority
 to an organization that provides       
multiple forms of services described in 
subsection 7f74  7f7 ,use of grant funds
 ,each organization receiving a grant   
under the program shall use the grant to
 provide to former members of the ,armed
 ,forces and spouses described in       
subsection 7a7 the following3  7#a7     
,rsum assistance4  7#b7 ,interview      
training4  7#c7 ,job recruitment        
training4  7#d7 ,entrepreneurship       
training4  7#e7 ,financial services4    
7#f7 ,legal assistance4  7#g7           
,educational supportive services4  7#h7 

,assistance with accessing benefits     
provided under laws administered by the 
,secretary of ,veterans ,affairs1       
including home loan benefits1 education 
benefits1 adaptive housing grants1 and  
all other benefits4  7#i7 ,nonclinical  
case management4  7#aj7 ,other related  
services leading directly to successful 
transition1 as determined by the        
,secretary of ,labor in consultation    
with the ,secretary of ,veterans        
,affairs4  7g7 ,annual reports  7#a7 ,in
 general ,not later than one year after 
the date of the commencement of the     
program and not less frequently than    
once each year thereafter until the     
termination of the program1 the         
,secretary of ,labor shall1 in          
consultation with the ,secretary of     
,veterans ,affairs1 submit to the       
appropriate committees of ,congress a   
report on the program carried out under 
this section4  7#b7 ,contents ,each     
report submitted under paragraph 7#a7   
shall include the following3 7,a7 ,a    

list of the organizations that have     
received grants under the program1      
including the geographic location of the
 organization and the types of services 
outlined in subsection 7f7 that each    
organization provides4  7,b7 ,the number
 of veterans served by each             
organization4  7,c7 ,an assessment of   
the effectiveness of the services       
provided under the program at improving 
the transition process for former       
members of the ,armed ,forces and       
spouses described in subsection 7a71    
based on metrics determined by the      
,secretary of ,labor in consultation    
with the ,secretary of ,veterans        
,affairs4  7,d7 ,the amount of each     
grant awarded to each organization under
 the program4  7,e7 ,such other matters 
as the ,secretary of ,labor1 in         
consultation with the ,secretary of     
,veterans ,affairs1 considers           
appropriate4  7#c7 ,appropriate         
committees of ,congress ,in this        
subsection1 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  7h7 ,authorization of
 appropriations ,there is authorized to 
be appropriated #aj1jjj1jjj to carry out
 this section4  #ajc4 ,study of         
community-based transition assistance   
programs for former members of the      
,armed ,forces  7a7 ,study  7#a7 ,in    
general ,the ,secretary of ,veterans    
,affairs shall1 in consultation with the
 ,secretary of ,labor and ,state        
entities that serve former members of   
the ,armed ,forces1 enter into an       
agreement with a ,federal or            
non-,federal entity to develop or access
 a comprehensive list of community-based
 programs that--  7,a7 provide          
transition assistance to such former    
members that lead directly to successful
 transition to civilian life1 such as-- 

7i7 rsum assistance2  7ii7 interview    
training2  7iii7 job recruitment        
training2  7iv7 entrepreneurship        
training2  7v7 financial services2  7vi7
 legal assistance2  7vii7 educational   
supportive services2  7viii7 assistance 
with accessing benefits provided under  
laws administered by the ,secretary of  
,veterans ,affairs1 including home loan 
benefits1 education benefits1 adaptive  
housing grants1 and other benefits2 and 
7ix7 nonclinical case management2 and   
7,b7 are operated by nonprofit          
organizations4  7#b7 ,updates  7,a7     
,periodic ,not less frequently than once
 every five years1 the ,secretary shall 
update the list created under paragraph 
7#a74  7,b7 ,upon request ,in addition  
to periodic updates under subparagraph  
7,a71 the ,secretary shall update the   
list created under paragraph 7#a7 upon  
request of an organization with a       
program included in the list4  7,c7     
,verification ,the ,secretary shall1 in 
consultation with ,state entities that  

serve former members of the ,armed      
,forces and to the degree practicable1  
verify changes to the list made under   
this paragraph4  7b7 ,transmission to   
members ,the ,secretary shall transmit  
the list created1 and revised as the    
case may be1 under subsection 7a7 to the
 ,secretary of ,labor and the ,secretary
 of ,defense so the ,secretaries of the 
military departments may provide        
information in the list to members of   
the ,armed ,forces who participate in   
the ,transition ,assistance ,program    
under sections #aadb and #aadd of title 
#aj1 ,united ,states ,code4  7c7 ,online
 publication ,the ,secretary of         
,veterans ,affairs shall publish the    
list created1 and revised as the case   
may be1 under subsection 7a7 on a public
 website of the ,department of ,veterans
 ,affairs4  #ajd4 ,modification of      
eligibility for care from ,department of
 ,veterans ,affairs for former members  
of the ,armed ,forces with other than   
honorable discharges and report on such 

care  7a7 ,eligibility ,subsection      
7b77#b77;,b7 of section #agbj;,i of     
title #ch1 ,united ,states ,code1 is    
amended by striking a discharge by court
 martial and inserting a dismissal4  7b7
 ,information ,subsection 7e7 of such   
section is amended--  7#a7 in paragraph 
7#c7-- 7,a7 in subparagraph 7,b71 by    
striking and at the end2  7,b7 in       
subparagraph 7,c71 by striking and at   
the end2  7,c7 by redesignating         
subparagraph 7,c7 as subparagraph 7,d72 
and  7,d7 by inserting after            
subparagraph 7,b7 the following new     
subparagraph 7,c73  7,c7 is displayed   
prominently on a website of the         
,department2 and  2  7#b7 by            
redesignating paragraph 7#d7 as         
paragraph 7#e72 and  7#c7 by inserting  
after paragraph 7#c7 the following new  
paragraph 7#d73  7#d7 shall include     
outreach on ,internet search engines2   
and  4  7c7 ,annual report ,subsection  
7f7 of such section is amended--  7#a7  
in paragraph 7#a71 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 ,grants for 
organizations providing mental health   
wellness services to veterans  7a7      
,purpose ,the purpose of this section is
 to facilitate the provision of mental  
health services for veterans with mental
 health conditions who are receiving    
care outside of the ,department of      

,veterans ,affairs4  7b7 ,grants  7#a7  
,in general ,subchapter ,,ii of chapter 
#ag of title #ch1 ,united ,states ,code1
 is amended by adding at the end the    
following new section3  #agbj;,j4       
,financial assistance for mental health 
supportive services for veterans seeking
 mental health treatment  7a7           
,distribution of financial assistance   
7#a7 ,the ,secretary shall provide      
financial assistance to eligible        
entities approved under this section to 
provide or coordinate the provision of  
mental health supportive services       
described in subsection 7b7 for a       
veteran with a mental health condition  
who is seeking mental health treatment4 
7#b7 ,financial assistance under        
paragraph 7#a7 shall consist of the     
award of a grant to an approved eligible
 entity for each veteran described in   
paragraph 7#a7 for which the approved   
eligible entity is providing or         
coordinating the provision of mental    
health supportive services4  7#c7 7,a7  

,the ,secretary shall award grants under
 this section to each approved eligible 
entity that is providing or coordinating
 the provision of mental health         
supportive services under this section4 
7,b7 ,the ,secretary may establish      
intervals of payment for the            
administration of grants under this     
section and establish a maximum amount  
to be awarded1 in accordance with the   
services being provided and the duration
 of such services4  7#d7 ,in providing  
financial assistance under paragraph    
7#a71 the ,secretary shall give         
preference to entities providing or     
coordinating the provision of supportive
 mental health services for veterans    
with mental health conditions who face  
barriers in accessing mental health care
 services from the ,department4  7#e7   
,the ,secretary shall ensure that1 to   
the extent practicable1 financial       
assistance under this subsection is     
equitably distributed across geographic 
regions1 including rural communities and

 tribal lands4  7#f7 ,each entity       
receiving financial assistance under    
this section to provide mental health   
supportive services to a veteran with a 
mental health condition shall notify    
that veteran that such services are     
being paid for1 in whole or in part1 by 
the ,department4  7#g7 ,the ,secretary  
shall require entities receiving        
financial assistance under this section 
to submit a report to the ,secretary    
that describes the services provided or 
coordinated with such financial         
assistance4  7b7 ,mental health         
supportive services ,the mental health  
supportive services described in this   
subsection are services provided by an  
eligible entity or a subcontractor of an
 eligible entity that address the needs 
of veterans with mental health          
conditions1 including--  7#a7 outreach  
services2  7#b7 case management         
services2  7#c7 assistance in obtaining 
any benefits from the ,department that  
the veteran may be eligible to receive1 

including health care services1         
vocational and rehabilitation           
counseling1 employment and training     
services1 and educational assistance2   
and  7#d7 assistance in obtaining and   
coordinating the provision of other     
public benefits provided by any         
,federal1 ,state1 or local agency1 or   
any other eligible entity1 including--  
7,a7 health care services 7including    
obtaining health insurance72  7,b7 daily
 living services2  7,c7 personal        
financial planning services2  7,d7      
transportation services2  7,e7 income   
support services2  7,f7 fiduciary and   
representative payee services2  7,g7    
legal services to assist the veteran    
with issues that interfere with the     
ability of the veteran to find and      
retain meaningful employment1 housing1  
or benefits to which the veteran may be 
entitled2  7,h7 child care services2    
7,i7 housing counseling2 and  7,j7 other
 services necessary for maintaining     
independent living4  7c7 ,application   

for financial assistance  7#a7 ,an      
eligible entity seeking financial       
assistance under subsection 7a7 shall   
submit to the ,secretary an application 
therefor in such form1 in such manner1  
and containing such commitments and     
information as the ,secretary determines
 to be necessary to carry out this      
section4  7#b7 ,each application        
submitted by an eligible entity under   
paragraph 7#a7 shall contain-- 7,a7 a   
description of the mental health        
supportive services described in        
subsection 7b7 proposed to be provided  
by the eligible entity under this       
section and the identified needs for    
those services2  7,b7 a description of  
the types of veterans with a mental     
health condition proposed to be provided
 such services2  7,c7 an estimate of the
 number of veterans with a mental health
 condition proposed to be provided such 
services2  7,d7 evidence of the         
experience of the eligible entity in    
providing mental health supportive      

services to veterans with a mental      
health condition2 and  7,e7 a           
description of the managerial capacity  
of the eligible entity-- 7i7 to         
coordinate the provision of mental      
health supportive services with the     
provision of mental health services by  
the eligible entity or another          
organization2  7ii7 to assess           
continually the needs of veterans with a
 mental health condition for mental     
health supportive services2  7iii7 to   
coordinate the provision of mental      
health supportive services with the     
services of the ,department2 and  7iv7  
to tailor supportive mental health      
services to the needs of veterans with a
 mental health condition4  7#c7 7,a7    
,the ,secretary shall establish criteria
 for the selection of eligible entities 
to be provided financial assistance     
under this section4  7,b7 ,criteria     
established under subparagraph 7,a7 with
 respect to an eligible entity shall    
include the following3  7i7 ,relevant   

accreditation as may be required by each
 ,state in which the eligible entity    
operates4  7ii7 ,experience coordinating
 care or providing treatment for        
veterans or members of the ,armed       
,forces4  7d7 ,technical assistance     
7#a7 ,the ,secretary shall provide      
training and technical assistance to    
eligible entities provided financial    
assistance under this section regarding 
the planning1 development1 and provision
 of mental health supportive services   
under this section4  7#b7 ,the          
,secretary may provide the training     
described in paragraph 7#a7 directly or 
through grants or contracts with        
appropriate public or nonprofit private 
entities1 including through grants      
awarded under section #bjfd of this     
title4  7e7 ,collection of information  
,to the extent practicable1 the         
,secretary may collect information from 
an eligibility entity awarded a grant   
under this section relating to a mental 
health condition of a veteran for       

inclusion in the electronic health      
record of the ,department for such      
veteran for the sole purpose of         
improving care provided to such veteran4
  7f7 ,funding ,from amounts            
appropriated to the ,department for     
medical services1 there shall be        
available to carry out subsections 7a71 
7b71 and 7c7 the following3  7#a7       
#e1jjj1jjj for fiscal year #bjba4  7#b7 
#aj1jjj1jjj for fiscal year #bjbb4  7#c7
 #ae1jjj1jjj for fiscal year #bjbc4  7g7
 ,definitions ,in this section3  7#a7   
,the term eligible entity means any of  
the following3 7,a7 ,an incorporated    
private institution or foundation--  7i7
 no part of the net earnings of which   
inures to the benefit of any member1    
founder1 contributor1 or individual2    
7ii7 that has a governing board that is 
responsible for the operation of the    
mental health supportive services       
provided under this section2 and  7iii7 
that is approved by the ,secretary with 
respect to financial responsibility4    

7,b7 ,a for-profit limited partnership1 
the sole general partner of which is an 
organization meeting the requirements of
 clauses 7i71 7ii71 and 7iii7 of        
subparagraph 7,a74  7,c7 ,a corporation 
wholly owned and controlled by an       
organization meeting the requirements of
 clauses 7i71 7ii71 and 7iii7 of        
subparagraph 7,a74  7,d7 ,a tribally    
designated housing entity 7as defined in
 section #d of the ,native ,american    
,housing ,assistance and                
,self-,determination ,act of #aiif 7#be 
,u4,s4,c4 #dajc774  7#b7 ,the term      
veteran with a mental health condition  
means a veteran who has been diagnosed  
with1 or who is seeking treatment for1  
one or more mental health conditions1 as
 determined by the ,secretary4  4  7#b7 
,clerical amendment ,the table of       
sections at the beginning of chapter #ag
 is amended by inserting after the item 
relating to section #agbj;,i the        
following new item3  #agbj;,j4          
,financial assistance for mental health 

supportive services for veterans seeking
 mental health treatment4  4  7c7 ,study
 on effectiveness of program  7#a7 ,in  
general ,the ,secretary of ,veterans    
,affairs shall conduct a study on the   
effectiveness of the program of         
financial assistance under section      
#agbj;,j of title #ch1 ,united ,states  
,code1 as added by subsection 7b71 in   
meeting the needs of veterans with a    
mental health condition1 as that term is
 defined in that section4  7#b7         
,comparison ,in conducting the study    
required by paragraph 7#a71 the         
,secretary shall compare the results of 
the program described in that paragraph 
with other programs of the ,department  
of ,veterans ,affairs dedicated to the  
delivery of mental health services to   
veterans4  7#c7 ,criteria ,in making the
 comparison required by paragraph 7#b71 
the ,secretary shall examine the        
following3 7,a7 ,the satisfaction of    
veterans targeted by the programs       
described in paragraph 7#b74  7,b7 ,the 

health status of such veterans4  7,c7   
,the mental wellness of such veterans4  
7,d7 ,the degree to which such veterans 
are encouraged to engage in productive  
activity by such programs4  7,e7 ,the   
number of veterans using such programs1 
disaggregated by--  7i7 veterans who    
have received care from the ,department 
in the previous two years2 and  7ii7    
veterans who have not received care from
 the ,department in the previous two    
years4  7,f7 ,the number of veterans who
 die by suicide while receiving services
 from an entity in receipt of a grant   
under the program of financial          
assistance under section #agbj;,j of    
title #ch1 ,united ,states ,code1 as    
added by subsection 7b71 or who die by  
suicide during the #ahj-;day period     
after receiving such services4  7#d7    
,report ,not later than ,december #ca1  
#bjba1 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 the results
 of the study required by paragraph     
7#a74  7d7 ,effective date ,the         
,secretary shall begin providing        
financial assistance under section      
#agbj;,j of title #ch1 ,united ,states  
,code1 as added by subsection 7b71 not  
later than one year after the date of   
the enactment of this ,act4  #bjb4      
,designation of buddy check week by     
,department of ,veterans ,affairs  7a7  
,in general ,the ,secretary of ,veterans
 ,affairs shall designate one week per  
year to organize outreach events and    
educate veterans on how to conduct peer 
wellness checks1 which shall be known as
 ,buddy ,check ,week4  7b7 ,events and  
education  7#a7 ,in general ,during     
,buddy ,check ,week1 the ,secretary1 in 
consultation with organizations that    
represent veterans1 non-profits that    
serve veterans1 mental health experts1  
members of the ,armed ,forces1 and such 
other entities and individuals as the   

,secretary considers appropriate1 shall 
collaborate with organizations that     
represent veterans to provide           
educational opportunities for veterans  
to learn how to conduct peer wellness   
checks4  7#b7 ,training matters ,as part
 of the educational opportunities       
provided under paragraph 7#a71 the      
,secretary shall provide the following3 
7,a7 ,a script for veterans to use to   
conduct peer wellness checks that       
includes information on appropriate     
referrals to resources veterans might   
need4  7,b7 ,online and in-person       
training1 as appropriate1 on how to     
conduct a peer wellness check4  7,c7    
,opportunities for members of           
organizations that represent veterans to
 learn how to train individuals to      
conduct peer wellness checks4  7,d7     
,training for veterans participating in 
,buddy ,check ,week on how to transfer a
 phone call directly to the ,veterans   
,crisis ,line4  7,e7 ,resiliency        
training for veterans participating in  

,buddy ,check ,week on handling a       
veteran in crisis4  7#c7 ,online        
materials ,all training materials       
provided under the educational          
opportunities under paragraph 7#a7 shall
 be made available on a website of the  
,department4  7c7 ,outreach ,the        
,secretary1 in collaboration with       
organizations that represent veterans1  
may conduct outreach regarding          
educational opportunities under         
subsection 7b7 at--  7#a7 public events 
where many veterans are expected to     
congregate2  7#b7 meetings of           
organizations that represent veterans2  
7#c7 facilities of the ,department of   
,veterans ,affairs2 and  7#d7 such other
 locations as the ,secretary1 in        
collaboration with organizations that   
represent veterans1 considers           
appropriate4  7d7 ,veterans ,crisis     
,line plan  7#a7 ,in general ,the       
,secretary shall ensure that the        
,veterans ,crisis ,line has a plan for  
handling the potential increase of calls

 that may occur during ,buddy ,check    
,week4  7#b7 ,submittal of plan ,the    
head of the ,veterans ,crisis ,line     
shall submit to the ,secretary a plan   
for how to handle excess calls during   
,buddy ,check ,week1 which may include  
the following3  7,a7 ,additional hours  
for staff4  7,b7 ,the use of a backup   
call center4  7,c7 ,any other plan to   
ensure that calls from veterans in      
crisis are being answered in a timely   
manner by an individual trained at the  
same level as a ,veterans ,crisis ,line 
responder4  7e7 ,veterans crisis line   
defined ,in this section1 the term      
,veterans ,crisis ,line means the       
toll-free hotline for veterans          
established under section #agbj;,f7h7 of
 title #ch1 ,united ,states ,code4      
#bjc4 ,post-traumatic growth            
partnerships  7a7 ,in general ,the      
,secretary of ,veterans ,affairs1 in    
consultation with the ,secretary of     
,defense and the ,secretary of ,homeland
 ,security1 shall enter into            

partnerships with nonprofit mental      
health organizations to facilitate      
post-traumatic growth among veterans who
 have experienced trauma4  7b7          
,consultation ,before entering into a   
partnership under subsection 7a71 the   
,secretary of ,veterans ,affairs shall  
consult with the ,national ,institute of
 ,mental ,health1 the ,national         
,alliance on ,mental ,illness1 the      
,american ,psychological ,association1  
the ,posttraumatic ,growth ,research    
,group1 and organizations that represent
 veterans4  7c7 ,selection of partners  
,the ,secretary of ,veterans ,affairs   
shall ensure that each organization with
 which the ,secretary enters into a     
partnership under subsection 7a7 has a  
demonstrated history of success with    
programs to facilitate post-traumatic   
growth1 including--  7#a7 long-term     
follow-up with veterans who have        
participated in such a program for not  
less than one year after completion of  
the program2 and  7#b7 sustained        

positive1 clinically significant        
outcomes for veterans who have          
participated in such a program for not  
less than #ahj days after completion of 
the program4  7d7 ,outcomes from        
partners ,the ,secretary of ,veterans   
,affairs shall require each nonprofit   
mental health organization that enters  
into a partnership with the ,secretary  
under subsection 7a7 to submit to the   
,secretary a description of the outcomes
 from such partnership1 including the   
following3  7#a7 ,the number of veterans
 who participate in programs of the     
organization to facilitate              
post-traumatic growth1 including the    
number of veterans who drop out before  
completion of the program4  7#b7 ,the   
types of mental or behavioral health    
conditions of veterans who participate  
in such programs4  7#c7 ,the percentage 
of veterans who experience significant  
post-traumatic growth4  7#d7 ,such other
 topics as the ,secretary may require to
 track post-traumatic growth4  7e7      

,post-,traumatic growth  7#a7 ,in       
general ,for purposes of this section1  
post-traumatic growth means positive    
responses described in paragraph 7#c7   
experienced after1 and often as a result
 of1 a traumatic event or a major life  
crisis4  7#b7 ,measurement of growth    
,post-traumatic growth under this       
section shall be measured through       
self-reported scales1 use of the        
post-traumatic stress disorder checklist
 set forth in the most recent edition of
 the ,diagnostic and ,statistical       
,manual of ,mental ,disorders published 
by the ,american ,psychiatric           
,association1 and such other metrics as 
the ,secretary considers necessary4     
7#c7 ,positive responses described      
,positive responses described in this   
paragraph are positive responses in one 
or more areas of life1 including the    
following3  7,a7 ,an appreciation of and
 for life4  7,b7 ,improved relationships
 with others4  7,c7 ,realization of new 
possibilities in life4  7,d7            

,realization of personal strength4  7,e7
 ,spiritual change4  7,f7 ,such other   
areas that the ,secretary1 in           
consultation with organizations         
specified in subsection 7b71 considers  
necessary4  #bjd4 ,progress of          
,department of ,veterans ,affairs in    
meeting goals and objectives of         
,national ,strategy for ,preventing     
,veteran ,suicide  7a7 ,in general ,the 
,secretary of ,veterans ,affairs shall  
develop metrics to track progress on    
each of the #ad goals and #dc objectives
 outlined in the ,national ,strategy for
 ,preventing ,veteran ,suicide1         
#bjah-bjbh prepared by the ,office of   
,mental ,health and ,suicide ,prevention
 of the ,department of ,veterans        
,affairs4  7b7 ,metrics ,the metrics    
developed under subsection 7a7 shall    
include measures of both performance and
 effectiveness4  7c7 ,initial report    
7#a7 ,in general ,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 that contains 
the metrics developed under subsection  
7a74  7#b7 ,elements ,the report        
submitted under paragraph 7#a7 shall    
include the following3 7,a7 ,an         
explanation of why the metrics developed
 under subsection 7a7 were chosen4  7,b7
 ,an assessment of how accurately those 
metrics will reflect the goals and      
objectives specified in such subsection4
  7d7 ,annual report ,not later than one
 year after the submittal of the report 
under subsection 7b71 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 that          
contains--  7#a7 an assessment of the   
progress of the ,department in meeting  
the goals and objectives specified in   
subsection 7a72  7#b7 a description of  

any action to be taken by the           
,department if those goals and          
objectives are not being met2  7#c7 a   
description of any changes to those     
goals and objectives2  7#d7 an          
identification of any new programs or   
partnerships that have resulted from the
 implementation of the ,national        
,strategy for ,preventing ,veteran      
,suicide1 #bjah-bjbh2  7#e7 an          
assessment of the effectiveness of the  
,national ,strategy for ,preventing     
,veterans ,suicide1 #bjah-bjbh at       
reducing veteran suicide2 and  7#f7 such
 other topics as the ,secretary         
considers necessary4  #bje4 ,study on   
feasibility and advisability of         
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 a study on the           
feasibility and advisability of         
providing complementary and integrative 

health treatments described in          
subsection 7b7 at all facilities of the 
,department of ,veterans ,affairs4  7b7 
,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  7c7      
,provision of treatment ,the ,secretary 
may provide complementary and           
integrative health treatments under this
 section at a facility of the           
,department in person or by telehealth4 
7d7 ,report ,not later than #ij days    
after the completion of the study 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 

such study1 including--  7#a7 the       
results of such study2 and  7#b7 such   
recommendations regarding the furnishing
 of complementary and integrative health
 treatments described in subsection 7b7 
as the ,secretary considers appropriate4
  #bjf4 ,program to provide veterans    
access to complementary and integrative 
health services through animal therapy1 
agri-therapy1 and outdoor sports therapy
  7a7 ,in general ,not later than #ahj  
days after the date of the enactment of 
this ,act1 the ,secretary of ,veterans  
,affairs shall commence the conduct of a
 program to provide complementary and   
integrative health services described in
 subsection 7b7 to 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  
,treatments described ,complementary and
 integrative health treatments described

 in this subsection shall consist of the
 following3  7#a7 ,equine therapy4  7#b7
 ,other animal therapy4  7#c7           
,agri-therapy4  7#d7 ,outdoor sports    
therapy4  7c7 ,eligible veterans ,a     
veteran is eligible to participate in   
the program under this section if the   
veteran-- 7#a7 is enrolled in the system
 of patient enrollment of the           
,department established and operated    
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 program4  7d7 ,duration  7#a7 ,in   
general ,the ,secretary shall carry out 
the program under this section for a    
two-year period beginning on the        
commencement of the program4  7#b7      
,extension ,the ,secretary may extend   
the duration of the program under this  
section if the ,secretary1 based on the 
results of the interim report submitted 

under subsection 7e77#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 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 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 program4  7,b7 ,elements
 ,the report required by subparagraph   
7,a7 shall include the following3 7i7   
,the number of participants in the      
program4  7ii7 ,the types of therapy    
offered at each facility at which the   
program is being carried out4  7iii7 ,an
 assessment of whether participation by 
a veteran in the 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 program1 including 
the results of a satisfaction survey of 
the participants in the program1        
disaggregated by treatment under        
subsection 7b74  7v7 ,the determination 
of the ,secretary with respect to       
extending the program under subsection  
7c77#b74  7vi7 ,any recommendations of  
the ,secretary with respect to expanding
 the program4  7#b7 ,final report ,not  
later than #ij days after the           

termination of the 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  
program4  #bjg4 ,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 age1 gender1 ,veterans 
,integrated ,service ,network1 and1 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  
age1 gender1 ,veterans ,integrated      
,service ,network1 and1 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 age1 gender1 ,veterans 

,integrated ,service ,network1 and1 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 ,program to provide veterans    
access to computerized cognitive        
behavioral therapy  7a7 ,in general ,not
 later than #baj days after the date of 
the enactment of this ,act1 the         
,secretary of ,veterans ,affairs shall  
commence the conduct of a program to    
assess the feasibility and advisability 
of using computerized cognitive         
behavioral therapy to treat eligible    

veterans suffering from depression1     
anxiety1 post-traumatic stress disorder1
 military sexual trauma1 or substance   
use disorder who are already receiving  
evidence-based therapy from the         
,department of ,veterans ,affairs4  7b7 
,eligible veterans ,a veteran is        
eligible to participate in the program  
under this section if the veteran-- 7#a7
 is enrolled in the system of patient   
enrollment of the ,department of        
,veterans ,affairs established and      
operated 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 program4  7c7 ,duration ,the       
,secretary shall carry out the program  
under this section for a two-year period
 beginning on the commencement of the   
program4  7d7 ,locations  7#a7 ,in      
general ,the ,secretary shall select not
 fewer than three facilities of the     

,department of ,veterans ,affairs at    
which to carry out the 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 two 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  7e7 ,access to chat ,in 
carrying out the program under this     
section1 the ,secretary shall ensure    
that veterans participating in the      
program have access via chat to a mental
 health provider #bd hours per day1     
seven days per week4  7f7 ,promotion of 
,veterans ,crisis ,line ,the ,secretary 
shall promote the availability of the   
,veterans ,crisis ,line to veterans     
participating in the program under this 
section4  7g7 ,department website ,in   
implementing the program under this     

section1 the ,secretary1 to the extent  
feasible1 shall use a website of the    
,department of ,veterans ,affairs to    
host the program4  7h7 ,reports  7#a7   
,interim report  7,a7 ,in general ,not  
later than one year after the           
commencement of the 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 program4  7,b7 ,elements
 ,the report required by subparagraph   
7,a7 shall include the following3 7i7   
,the number of participants in the      
program4  7ii7 ,an assessment of whether
 participation by a veteran in the      
program resulted in any changes in      
clinically relevant endpoints for the   
veteran with respect to the conditions  
specified in subsection 7a74  7iii7 ,any
 recommendations of the ,secretary with 
respect to extending or expanding the   
program4  7#b7 ,final report ,not later 

than #ij days after the termination of  
the 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  
program4  7i7 ,veterans crisis line     
defined ,in this section1 the term      
,veterans ,crisis ,line means the       
toll-free hotline for veterans          
established under section #agbj;,f7h7 of
 title #ch1 ,united ,states ,code4      
#cjb4 ,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  #cjc4 ,establishment by 
,department of ,veterans ,affairs and   
,department of ,defense of clinical     
practice guidelines for comorbid mental 
health conditions  7a7 ,in general ,not 
later than two years after the date of  
the enactment of this ,act1 the         

,secretary of ,veterans ,affairs1 in    
consultation with the ,secretary of     
,defense and the ,secretary of ,health  
and ,human ,services1 shall complete the
 development of clinical practice       
guidelines for the treatment of         
post-traumatic stress disorder1 military
 sexual trauma1 and traumatic brain     
injury that is comorbid with substance  
use disorder or chronic pain4  7b7 ,work
 group  7#a7 ,establishment ,in carrying
 out subsection 7a71 the ,secretary of  
,veterans ,affairs1 the ,secretary of   
,defense1 and the ,secretary of ,health 
and ,human ,services shall create a     
,trauma and ,comorbid ,substance ,use   
,disorder or ,chronic ,pain ,work ,group
 7in this section referred to as the    
,work ,group74  7#b7 ,membership ,the   
work group created under paragraph 7#a7 
shall be comprised of individuals that  
represent ,federal ,government entities 
and non-,federal ,government entities   
with expertise in the areas covered by  
the work group1 including the following3

  7,a7 ,academic institutions that      
specialize in research for the treatment
 of conditions described in subsection  
7a74  7,b7 ,the ,national ,center for   
,posttraumatic ,stress ,disorder of the 
,department of ,veterans ,affairs4  7,c7
 ,the ,office of the ,assistant         
,secretary for ,mental ,health and      
,substance ,use of the ,department of   
,health and ,human ,services4  7#c7     
,relation to other work groups ,the     
,work ,group shall be created and       
conducted in the same manner as other   
work groups for the development of      
clinical practice guidelines for the    
,department of ,veterans ,affairs and   
the ,department of ,defense4  7c7       
,matters included ,in developing the    
clinical practice guidelines under      
subsection 7a71 the ,work ,group1 in    
consultation with the ,post ,traumatic  
,stress ,disorder ,work ,group1         
,concussion-m,t,b,i ,work ,group1       
,opioid ,therapy for ,chronic ,pain     
,work ,group1 and ,substance ,use ,work 

,group1 shall ensure that the clinical  
practice guidelines include the         
following3  7#a7 ,guidance with respect 
to the following3 7,a7 ,the treatment of
 patients with post-traumatic stress    
disorder who are also experiencing a    
substance use disorder or chronic pain4 
7,b7 ,the treatment of patients         
experiencing a mental health condition1 
including anxiety1 depression1 or       
post-traumatic stress disorder as a     
result of military sexual trauma who are
 also experiencing a substance use      
disorder or chronic pain4  7,c7 ,the    
treatment of patients with traumatic    
brain injury who are also experiencing a
 substance use disorder or chronic pain4
  7#b7 ,guidance with respect to the    
following3 7,a7 ,appropriate case       
management for patients experiencing    
post-traumatic stress disorder that is  
comorbid with substance use disorder or 
chronic pain who transition from        
receiving care while on active duty in  
the ,armed ,forces to care from health  

care networks outside of the ,department
 of ,defense4  7,b7 ,appropriate case   
management for patients experiencing a  
mental health condition1 including      
anxiety1 depression1 or post-traumatic  
stress disorder as a result of military 
sexual trauma that is comorbid with     
substance use disorder or chronic pain  
who transition from receiving care while
 on active duty in the ,armed ,forces to
 care from health care networks outside 
of the ,department of ,defense4  7,c7   
,appropriate case management for        
patients experiencing traumatic brain   
injury that is comorbid with substance  
use disorder or chronic pain who        
transition from receiving care while on 
active duty in the ,armed ,forces to    
care from health care networks outside  
of the ,department of ,defense4  7#c7   
,guidance with respect to the treatment 
of patients who are still members of the
 ,armed ,forces and are experiencing a  
mental health condition1 including      
anxiety1 depression1 or post-traumatic  

stress disorder as a result of military 
sexual trauma that is comorbid with     
substance use disorder or chronic pain4 
7#d7 ,guidance with respect to the      
assessment by the ,national ,academies  
of ,sciences1 ,engineering1 and         
,medicine of the potential              
overmedication of veterans1 as required 
pursuant to the ,senate report          
accompanying ,s4 #aeeg1 #aaeth ,congress
 7,senate ,report #aae-acj71 under the  
heading ,overprescription ,prevention   
,report under the heading ,,committee   
,,recommendation4  7d7 ,rule of         
construction ,nothing in this section   
shall be construed to prevent the       
,secretary of ,veterans ,affairs and the
 ,secretary of ,defense from considering
 all relevant evidence1 as appropriate1 
in creating the clinical practice       
guidelines required under subsection 7a7
 or from ensuring that the final        
clinical practice guidelines developed  
under such subsection and subsequently  
updated1 as appropriate1 remain         

applicable to the patient populations of
 the ,department of ,veterans ,affairs  
and the ,department of ,defense4  #cjd4 
,update of clinical practice guidelines 
for assessment and management of        
patients at risk for suicide  7a7 ,in   
general ,not later than two years after 
the date of the enactment of this ,act1 
the ,secretary of ,veterans ,affairs and
 the ,secretary of ,defense1 through the
 ,assessment and ,management of         
,patients at ,risk for ,suicide ,work   
,group 7in this section referred to as  
the ,work ,group71 shall issue an update
 to the ,,va_/,,dod ,clinical ,practice 
,guideline for ,assessment and          
,management of ,patients at ,risk for   
,suicide4  7b7 ,matters included ,in    
carrying out the update under subsection
 7a71 the ,work ,group shall ensure that
 the clinical practice guidelines       
updated under such subsection includes  
the following3  7#a7 ,enhanced guidance 
with respect to the following3  7,a7    
,gender-specific risk factors for       

suicide and suicidal ideation4  7,b7    
,gender-specific treatment efficacy for 
depression and suicide prevention4  7,c7
 ,gender-specific pharmacotherapy       
efficacy4  7,d7 ,gender-specific        
psychotherapy efficacy4  7#b7 ,guidance 
with respect to the following3 7,a7 ,the
 efficacy of alternative therapies1     
other than psychotherapy and            
pharmacotherapy1 including the          
following3  7i7 ,yoga therapy4  7ii7    
,meditation therapy4  7iii7 ,equine     
therapy4  7iv7 ,other animal therapy4   
7v7 ,training and caring for service    
dogs4  7vi7 ,agri-therapy4  7vii7 ,art  
therapy4  7viii7 ,outdoor sports        
therapy4  7ix7 ,music therapy4  7x7 ,any
 other alternative therapy that the     
,work ,group considers appropriate4     
7#c7 ,guidance with respect to the      
findings of the ,creating ,options for  
,veterans' ,expedited ,recovery         
,commission 7commonly referred to as the
 ,,cover ,commission7 established under 
section #ica of the ,jason ,simcakoski  

,memorial and ,promise ,act 7title ,,ix 
of ,public ,law #aad-aih2 #ch ,u4,s4,c4 
#agja note74  7c7 ,rule of construction 
,nothing in this section shall be       
construed to prevent the ,secretary of  
,veterans ,affairs and the ,secretary of
 ,defense from considering all relevant 
evidence1 as appropriate1 in updating   
the ,,va_/,,dod ,clinical ,practice     
,guideline for ,assessment and          
,management of ,patients at ,risk for   
,suicide1 as required under subsection  
7a71 or from ensuring that the final    
clinical practice guidelines updated    
under such subsection remain applicable 
to the patient populations of the       
,department of ,veterans ,affairs and   
the ,department of ,defense4  #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         
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 ,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
 measures to ensure that information of 

veterans participating in the initiative
 is kept private and secure4  7#b7 ,open
 platform  7,a7 ,research purposes ,the 
,secretary shall make de-identified data
 collected under the initiative         
available for research purposes both    
within and outside of the ,department of
 ,veterans ,affairs4  7,b7 ,data may not
 be sold ,data collected under the      
initiative may not be sold4  7#c7       
,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 ,data   
collected under the initiative shall be 
standardized in the manner in which it  
is collected1 entered into the database1
 extracted1 and recorded4  7#d7         

,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  7d7 ,inclusion of     
initiative in program ,the ,secretary   
shall assess the feasibility and        
advisability of coordinating efforts of 
the initiative under subsection 7a7 with
 the ,million ,veterans ,program of the 
,department4  #cjf4 ,preventative and   
complex data analysis 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 preventative or  
complex statistical analysis ,in order  
to carry out statistical analysis       
required under section #cjb of the      
,commander ,john ,scott ,hannon         
,veterans ,mental ,health ,care         
,improvement ,act of #bjai1 or any other
 preventative or complex statistical    

analysis required under this title or   
any other provision of law1 the         
,secretary may contract with academic   
institutions or other qualified         
entities1 as determined by the          
,secretary1 to carry out the statistical
 analysis4  4  7b7 ,clerical amendment  
,the table of sections at the beginning 
of chapter #a of such title is amended  
by inserting after the item relating to 
section #aah the following new item3    
#aai4 ,contracting for preventative or  
complex statistical analysis4  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  
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 and    
7,g7 individuals transitioning from     
active duty in the ,armed ,forces to    
civilian life4  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 outreach   
efforts 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 outreach efforts by the          
,department to target specific groups of
 veterans4  7,c7 ,a plan to change the  
current approach by the ,department to  
suicide prevention and mental health    
outreach or1 if the ,secretary decides  
not to change the current approach1 an  
explanation of the reason for           
maintaining the current approach4  7,d7 
,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
 outreach 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
 outreach 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 and  7vii7 individuals     
transitioning from active duty in the   

,armed ,forces to civilian life4  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    
,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 ,affairs in    
raising awareness about mental health   
and suicide prevention4  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 types as follows3  7i7  
,metrics relating to social media shall 
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   
television shall include the following3 
7,i7 ,nielsen ratings4  7,,ii7 ,such    
other metrics as the ,secretary         
considers necessary4  7iii7 ,metrics    

relating to email shall include the     
following3 7,i7 ,open rate4  7,,ii7     
,response rate  7,,iii7 ,click rate4    
7,,iv7 ,such other metrics as the       
,secretary considers necessary4  7,b7   
,update ,the ,secretary shall           
periodically update the metrics under   
subparagraph 7,a7 as more accurate      
metrics become available4  7#c7 ,targets
 ,the ,secretary shall develop 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 ,department in raising awareness    
about mental health and suicide         
prevention1 including the metrics and   
targets for such metrics by which those 
goals are to be measured under paragraph
 7#b74  7#f7 ,annual report ,not later  
than one year after the submittal of the
 report under paragraph 7#c71 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    
targets developed 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     
,establishment of oversight process     
7#a7 ,in general ,not later than #ij    
days after the date of the enactment of 
this ,act1 the ,secretary shall         
establish a process to oversee the      
mental health and suicide prevention    
media outreach campaigns of the         
,department4  7#b7 ,components of       
oversight process ,the process          
established under paragraph 7#a7 shall  
include the following components3 7,a7  
,a delineation of the roles and         
responsibilities of all suicide         
prevention officials within the ,office 
of ,mental ,health and ,suicide         
,prevention of the ,veterans ,health    
,administration4  7,b7 ,a schedule for  
creating1 approving1 implementing1 and  
evaluating all unpaid media and paid    
media content relating to mental health 
and suicide prevention4  7,c7 ,lines of 
reporting1 as the ,secretary considers  

necessary1 to report to management      
information relating to the mental      
health and suicide prevention media     
outreach campaigns of the ,department4  
7c7 ,contract requirements ,the         
,secretary shall ensure that each       
contract into which the ,secretary      
enters to develop mental health and     
suicide prevention outreach media       
includes requirements that the          
contractor--  7#a7 track metrics used by
 the ,secretary under subsection        
7a77#b72 and  7#b7 not less frequently  
than quarterly1 report such metrics to  
the ,office of ,mental ,health and      
,suicide ,prevention of the ,veterans   
,health ,administration4  7d7 ,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 ,annual report on progress of     
,department of ,veterans ,affairs in    
meeting goals and objectives of         
,executive ,order #achbb  7a7 ,in       
general ,not later than #abj days after 
the date of the enactment of this ,act1 
and annually thereafter1 the ,secretary 
of ,veterans ,affairs1 in consultation  
with the ,secretary of ,defense and the 
,secretary of ,homeland ,security1 shall
 submit to the ,committee on ,veterans' 
,affairs of the ,senate and the         
,committee on ,veterans' ,affairs of the
 ,house of ,representatives a report    
that contains the following3  7#a7 ,an  
assessment of the progress of the       
,department of ,veterans ,affairs1 the  

,department of ,defense1 and the        
,department of ,homeland ,security in   
meeting the goals and objectives        
outlined in the report required under   
section #b7;c7 of ,executive ,order     
#achbb 7#hc ,fed4 ,reg4 #aeac2 relating 
to supporting our veterans during their 
transition from uniformed service to    
civilian life7 with respect to the      
implementation by the ,department of    
,veterans ,affairs of the ,joint ,action
 ,plan required under section #b7;b7 of 
such ,executive order4  7#b7 ,a         
description of action to be taken by the
 ,department of ,veterans ,affairs1 the 
,department of ,defense1 and the        
,department of ,homeland ,security if   
those goals and objectives are not being
 met4  7#c7 ,an assessment of the       
effectiveness of ,executive ,order      
#achbb at improving the transition      
process for members of the ,armed       
,forces and veterans4  7#d7 ,such other 
topics as the ,secretary of ,veterans   
,affairs1 the ,secretary of ,defense1 or

 the ,secretary of ,homeland ,security  
consider necessary4  7b7 ,submittal by  
,secretary of ,veterans ,affairs ,the   
,secretary of ,veterans ,affairs shall  
submit each report required under       
paragraph 7#a7 with respect to the      
,department of ,veterans ,affairs       
regardless of whether the ,secretary of 
,defense or the ,secretary of ,homeland 
,security provides any information for  
the report4  #djd4 ,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 dissaggregated 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  #dje4            
,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  #djf4 ,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 #ahj days 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 ,armed
 ,services and the ,committee on        
,veterans' ,affairs of the ,senate and  
the ,committee on ,armed ,services and  
the ,committee on ,veterans' ,affairs 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 mental health initiatives1    
including--  7,i7 the ,million ,veterans
 ,program2 and  7,,ii7 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 conditions4  7,b7 ,a  
description of mental health programs   
operated by the ,department of ,defense1
 including the following3  7i7          
,transition assistance programs4  7ii7  
,clinical mental health initiatives1    
including the ,national ,intrepid       
,center of ,excellence4  7iii7 ,programs

 that may secondarily improve mental    
health1 including employment1 housing   
assistance1 and financial literacy      
programs4  7iv7 ,research into mental   
health issues and conditions4  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 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 conditions4  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 ,establishment of joint  
center of excellence  7#a7 ,in general  
,not later than two years after the date
 of the enactment of this ,act1 the     
,secretary of ,defense1 in consultation 
with the ,secretary of ,veterans        
,affairs1 shall establish a center of   
excellence to be known as the ,joint    
,,dod_/,,va ,national ,intrepid ,center 
of ,excellence ,intrepid ,spirit ,center
 7in this subsection referred to as the 
,center74  7#b7 ,duties ,the ,center    
shall conduct joint mental health       
programs of the ,department of ,veterans
 ,affairs and the ,department of        
,defense4  7#c7 ,location ,the ,center  
shall be established in a location      
that-- 7,a7 is geographically distant   
from already existing and planned       
,intrepid ,spirit ,centers of the       
,department of ,defense2 and  7,b7 is in
 a rural or highly rural area 7as       
determined through the use of the       

,rural-,urban ,commuting ,areas coding  
system of the ,department of            
,agriculture74  ,v ,medical workforce   
,a ,improvement of mental health medical
 workforce  #eja4 ,treatment of         
psychologists  7a7 ,treatment as title  
#ch employees ,section #gdja of title   
#ch1 ,united ,states ,code1 is amended--
 7#a7 in paragraph 7#a7 by inserting    
psychologists1 after chiropractors12 and
  7#b7 in paragraph 7#c71 by striking   
psychologists14  7b7 ,inclusion in      
contracts for scarce medical specialist 
services ,section #gdji7;a7 of title    
#ch1 ,united ,states ,code1 is amended  
by inserting psychologists1 after       
chiropractors14  #ejb4 ,staffing        
improvement plan for psychiatrists and  
psychologists of ,department of         
,veterans ,affairs  7a7 ,staffing plan  
,not later than #bgj days 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 shortages of psychiatrists and 
psychologists of the ,department of     
,veterans ,affairs1 including filling   
any open positions4  7b7 ,elements ,the 
plan required by subsection 7a7 shall   
include the following3 7#a7 ,the number 
of positions for psychiatrists and      
psychologists of the ,department that   
need to be filled to meet demand1       
disaggregated by ,veterans ,integrated  
,service ,network and medical center4   
7#b7 ,an identification of the steps    
that the ,secretary will take in each   
,veterans ,integrated ,service ,network 
to address such shortages1 include the  
following3  7,a7 ,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,b7 ,a description of any local        
retention or engagement incentives to be
 used by directors of ,veterans         
,integrated ,service ,networks4  7#c7   
,such recommendations for legislative or
 administrative action as the ,secretary
 considers necessary to aid in          
addressing staffing shortages of        
psychiatrists and psychologists of the  
,department4  #ejc4 ,occupational series
 and staffing improvement plan for      
licensed professional mental health     
counselors and marriage and family      
therapists of ,department of ,veterans  
,affairs  7a7 ,occupational series ,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  

7b7 ,staffing plan  7#a7 ,in general    
,not later than #bgj 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 plan to address      
staffing shortages of licensed          
professional mental health counselors   
and marriage and family therapists of   
the ,department of ,veterans ,affairs4  
7#b7 ,elements ,the plan required by    
paragraph 7#a7 shall include the        
following3 7,a7 ,the number of positions
 for licensed professional mental health
 counselors and marriage and family     
therapists of the ,department that need 
to be filled to meet demand1            
disaggregated by ,veterans ,integrated  
,service ,network and medical center4   
7,b7 ,an identification of the steps    
that the ,secretary will take in each   
,veterans ,integrated ,service ,network 
to address such shortages1 include the  

following3  7i7 ,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     
7ii7 ,a description of any local        
retention or engagement incentives to be
 used by directors of ,veterans         
,integrated ,service ,networks4  7,c7   
,such recommendations for legislative or
 administrative action as the           
,secretary1 in consultation with the    
,inspector ,general of the ,department  
of ,veterans ,affairs1 considers        
necessary to aid in addressing staffing 
shortages of licensed professional      
mental health counselors and marriage   
and family therapists of the            
,department4  7c7 ,report ,not later    
than one year after the submittal of the
 plan required by 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 setting forth 
the number of licensed professional     
mental health counselors and marriage   
and family therapists hired by the      
,department during the one-year period  
preceding the submittal of the report1  
disaggregated by ,veterans ,integrated  
,service ,network and medical center4   
#ejd4 ,staffing improvement plan for    
peer specialists of ,department of      
,veterans ,affairs who are women  7a7   
,assessment of capacity  7#a7 ,in       
general ,not later than #ij days 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 commence an assessment 
of the capacity of peer specialists of  
the ,department of ,veterans ,affairs   
who are women4  7#b7 ,elements ,the     
assessment required by paragraph 7#a7   
shall include an assessment of the      
following3 7,a7 ,the geographical       

distribution of peer specialists of the 
,department who are women4  7,b7 ,the   
geographical distribution of women      
veterans4  7,c7 ,the number and         
proportion of women peer specialists who
 specialize in peer counseling on mental
 health or suicide prevention4  7,d7    
,the number and proportion of women peer
 specialists who specialize in peer     
counseling on non-mental health related 
matters4  7b7 ,report ,not later than   
one year after the assessment required  
by subsection 7a7 has commenced1 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 
findings of the assessment4  7c7        
,staffing improvement plan  7#a7 ,in    
general ,not later than #ahj days after 
submitting the report under subsection  
7b71 the ,secretary1 in consultation    
with the ,inspector ,general1 shall     
submit to the ,committee on ,veterans'  

,affairs of the ,senate and the         
,committee on ,veterans' ,affairs of the
 ,house of ,representatives a plan1     
based on the results of the assessment  
required by subsection 7a71 to hire     
additional qualified peer specialists   
who are women1 with special             
consideration for areas that lack peer  
specialists who are women4  7#b7        
,elements ,the peer specialist positions
 included in the plan required by       
paragraph 7#a7-- 7,a7 shall be          
non-volunteer1 paid positions2 and  7,b7
 may be part-time positions4  #eje4     
,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 in1 a  
program of study at an accredited       
educational institution1 school1 or     
training program leading to--  7,a7 a   
bachelor's1 master's1 or doctoral degree
 in psychology1 social work1 or marriage
 and family therapy2 or  7,b7 a master's
 degree in mental health counseling2 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     
three-year period during the 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;c7 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  #ejf4      
,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  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  #ejg4
 ,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 trends in
 demand for care1 long-term investments 
required with respect to the provision  
of care1 maintenance of infrastructure1 
and other capital investments with      
respect to the ,readjustment ,counseling
 ,service1 including ,vet ,centers1     
,mobile ,vet ,centers1 and community    
access points4  4  #ejh4 ,studies on    
alternative work schedules for employees
 of ,veterans ,health ,administration   
7a7 ,study 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 study 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 study under     
paragraph 7#a74  7b7 ,department study  
7#a7 ,in general ,not later than #ahj   
days after the date of the enactment of 
this ,act1 the ,secretary shall conduct 
a study on the feasibility and          
advisability of offering appointments   
outside the usual operating hours of    
facilities of the ,department4  7#b7    
,study of employees ,the study required 
by paragraph 7#a7 shall include a study 
of the opinions of 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
 appointments4  #eji4 ,suicide          
prevention coordinators ,the ,secretary 
of ,veterans ,affairs shall ensure that 
each medical center of the ,department  
of ,veterans ,affairs is staffed with   
not fewer than one suicide prevention   
coordinator4  ,b ,direct hiring         
authorities for certain health care     
positions  #eba4 ,direct hiring         
authorities for certain health care     
positions  7a7 ,in general ,subpart ,i  
of part ,,iii of title #e1 ,united      
,states ,code1 is amended by adding at  
the end the following3  #ajc ,department
 of ,veterans ,affairs hiring           
authorities  ,sec4#ajcja4 ,department of
 ,veterans ,affairs personnel           
authorities4  #ajcja4 ,department of    
,veterans ,affairs personnel authorities
  7a7 ,flexibilities relating to        
appointments  7#a7 ,in general ,the     
,secretary of ,veterans ,affairs        

7referred to in this section as the     
,secretary7 shall promulgate regulations
 to redesign the procedures that are    
applied by the ,department of ,veterans 
,affairs in making appointments to      
positions described in paragraphs 7#a7  
and 7#c7 of section #gdja of title #ch  
in order to--  7,a7 better meet mission 
needs2  7,b7 respond to managers' needs 
and the needs of applicants2  7,c7      
produce high-quality applicants2  7,d7  
support timely decisions2 and  7,e7     
promote competitive job offers4  7#b7   
,waived requirements ,in redesigning the
 process by which the appointments      
described in paragraph 7#a7 shall be    
made1 the ,secretary may waive the      
requirements of chapter #cc1 and the    
regulations implementing that chapter1  
to the extent necessary to achieve the  
objectives of this section1 while       
providing for the following3  7,a7      
,fair1 credible1 and transparent methods
 of establishing qualification          
requirements for1 recruitment for1 and  

appointments to positions4  7,b7 ,fair  
and open competition and equitable      
treatment in the consideration and      
selection of individuals to positions4  
7,c7 ,fair1 credible1 and transparent   
methods of assigning1 reassigning1      
detailing1 transferring1 or promoting   
employees4  7#c7 ,implementation        
requirements ,in implementing this      
subsection1 the ,secretary shall comply 
with the provisions of section          
#bcjb7;b77#aa71 regarding veterans'     
preference requirements1 in a manner    
consistent with that in which such      
provisions are applied under chapter    
#cc4  7#d7 ,training program ,the       
,secretary shall develop a training     
program for ,department of ,veterans    
,affairs human resource professionals to
 implement the requirements of this     
subsection4  7#e7 ,indicators of        
effectiveness ,the ,secretary shall     
develop indicators of effectiveness to  
determine whether appointment           
flexibilities under this subsection have

 achieved the objectives described in   
paragraph 7#a74  7b7 ,criteria for use  
of new personnel authorities ,in the    
redesign of appointment procedures1 as  
described in subsection 7a71 and with   
respect to the system of appointment    
flexibilities established under that    
subsection1 the ,secretary shall--  7#a7
 include a means for ensuring employee  
involvement 7for bargaining unit        
employees1 through their exclusive      
representatives7 in that redesign and in
 the implementation of that system2     
7#b7 provide for adequate training and  
retraining for supervisors1 managers1   
and employees in the implementation and 
operation of that redesign and that     
system2  7#c7 develop-- 7,a7 a          
comprehensive management succession     
program to provide training to employees
 to develop managers for the agency2 and
  7,b7 a program to provide training to 
supervisors on actions1 options1 and    
strategies that a supervisor may use in 
administering that system2  7#d7 include

 effective transparency and             
accountability measures and safeguards  
to ensure that the management of that   
system is fair1 credible1 and equitable1
 including appropriate independent      
reasonableness reviews1 internal        
assessments1 and employee surveys2  7#e7
 provide mentors to advise individuals  
on their career paths and opportunities 
to advance and excel within their       
fields2  7#f7 develop appropriate       
procedures for warnings during          
performance evaluations for employees   
who fail to meet performance standards2 
7#g7 utilize the quadrennial strategic  
plan required under section #gccj;,c7b7 
of title #ch2 and  7#h7 ensure that     
adequate agency resources are allocated 
for the design1 implementation1 and     
administration of that system4  4  7b7  
,technical and conforming amendment ,the
 table of chapters for part ,,iii of    
title #e1 ,united ,states ,code1 is     
amended by inserting after the item     
relating to chapter #ajb the following3 

#ajc4;,department of ,veterans ,affairs 
,hiring ,authorities#ajcja4  4  ,,vi    
,improvement of telehealth services     
#fja4 ,expanded telehealth from         
,department of ,veterans ,affairs  7a7  
,in general ,the ,secretary of ,veterans
 ,affairs shall enter into partnerships1
 and expand existing partnerships1      
between the ,department of ,veterans    
,affairs1 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 7c74  7b7 ,preference  
for partnerships ,the ,secretary shall  
give preference to entering into or     
expanding partnerships under subsection 
7a7 with organizations that--  7#a7     
represent veterans in rural or highly   
rural areas 7as determined through the  
use of the ,rural-,urban ,commuting     
,areas coding system of the ,department 

of ,agriculture72 or  7#b7 operate in a 
medically underserved community 7as     
defined in section #gii;,b of the       
,public ,health ,service ,act 7#db      
,u4,s4,c4 #biep774  7c7 ,award of grants
  7#a7 ,in general ,in carrying out     
partnerships entered into or expanded   
under this section with entities        
described in subsection 7a71 the        
,secretary shall award grants to those  
entities4  7#b7 ,maximum amount of      
grants ,the amount of a grant awarded   
under this subsection may not exceed    
#ge1jjj per site per year4  7#c7 ,use of
 grants  7,a7 ,in general ,grants       
awarded to an entity under this         
subsection shall be used for the        
following3  7i7 ,purchasing or upgrading
 hardware or software necessary for the 
provision of secure and private         
telehealth services4  7ii7 ,upgrading   
security protocols for consistency with 
the standardized telehealth security    
protocol implemented under section      
#fjb7;a77#b71 or any other security     

requirements of the ,department4  7iii7 
,training of employees1 including       
payment of those employees for          
completing that training1 with respect  
to--  7,i7 military and veteran cultural
 competence1 if the entity is not an    
organization that represents veterans2  
and  7,,ii7 equipment required to       
provide telehealth services4  7iv7      
,upgrading existing infrastructure owned
 or leased by the entity to make rooms  
more conducive to telehealth care1      
including--  7,i7 additional walls to   
create a new1 private room2  7,,ii7     
soundproofing of existing rooms2 or     
7,,iii7 new electrical or internet      
outlets in an existing room4  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 infrastructure4     
7,b7 ,exclusion ,grants may not be used 
for the purchase of new property or for 
major construction projects1 as         

determined by the ,secretary4  7d7      
,memoranda of understanding or 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 a 
memorandum of understanding or          
memorandum of agreement with the        
,department for the establishment of    
such an access point4  7#b7 ,inspection 
,the ,secretary shall inspect the access
 point proposed to be established under 
paragraph 7#a7 to ensure that it is     
adequately private1 secure1 and         
accessible for veterans before the      
access point is established4  7e7       
,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 services from  
home4  7#b7 ,elements ,the assessment   

required by paragraph 7#a7 shall include
 the following3 7,a7 ,an assessment of  
current and potential future cost       
barriers to veterans having internet    
access at home4  7,b7 ,an assessment of 
current and potential future barriers to
 veterans accessing broadband services  
at home4  7,c7 ,a description of how the
 ,department plans to address the       
current and potential future cost and   
access barriers described in            
subparagraphs 7,a7 and 7,b74  7,d7 ,such
 other matters related to internet      
access for veterans in their homes 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  7f7         
,authorization of appropriations ,there 
is authorized to be appropriated to the 
,secretary of ,veterans ,affairs        
#aj1jjj1jjj to carry out this section4  
#fjb4 ,implementation of national       
protocol for telehealth security and    
interfacing instructions  7a7 ,national 
telehealth security protocol  7#a7      
,assessment  7,a7 ,in general ,the      
,secretary of ,veterans ,affairs1 in    
consultation with industry experts1 the 
,chairman of the ,federal ,trade        
,commission1 the ,assistant ,secretary  
of ,veterans ,affairs for ,information  
and ,technology and ,chief ,information 
,officer1 and stakeholders1 shall       
conduct an assessment of current        
telehealth security protocols4  7,b7    
,elements ,the assessment conducted     
under subparagraph 7,a7 shall include   
the following3 7i7 ,an assessment of    
current telehealth security protocols1  
including protocols used by--  7,i7 the 

,department of ,veterans ,affairs2      
7,,ii7 other ,federal agencies2  7,,iii7
 other health care providers2 and       
7,,iv7 such other organizations as the  
,secretary considers necessary to assess
 under such subparagraph4  7ii7 ,a study
 of any current or future security      
risks-- 7,i7 faced by veterans using    
telehealth services2 or  7,,ii7 faced by
 the ,department in furnishing those    
services4  7,c7 ,timeline ,the          
,secretary shall complete the assessment
 conducted under subparagraph 7,a7 not  
later than one year after the date of   
the enactment of this ,act4  7#b7       
,implementation ,not later than #ah     
months after the completion of the      
assessment under paragraph 7#a71 the    
,secretary shall1 using guidance from   
the assessment1 fully implement a       
standardized telehealth security        
protocol at all facilities of the       
,department4  7#c7 ,privacy and security
 ,the ,secretary shall ensure that the  
security protocol implemented under this

 subsection protects the privacy and    
security of veterans1 the health data of
 veterans1 and data from the            
,department4  7b7 ,national telehealth  
interfacing instructions  7#a7          
,assessment  7,a7 ,in general ,the      
,secretary of ,veterans ,affairs1 in    
consultation with industry experts1     
organizations that represent veterans1  
the ,chief ,veterans ,experience        
,officer1 the ,assistant ,secretary of  
,veterans ,affairs for ,information and 
,technology and ,chief ,information     
,officer1 and stakeholders1 shall       
conduct an assessment of current        
telehealth interfacing instructions4    
7,b7 ,elements ,the assessment conducted
 under subparagraph 7,a7 shall include  
an assessment of interfacing            
instructions used by--  7i7 the         
,department of ,veterans ,affairs2  7ii7
 other ,federal agencies2  7iii7 other  
health care providers2 and  7iv7 such   
other organizations as the ,secretary   
considers necessary to assess under such

 subparagraph4  7,c7 ,timeline ,the     
,secretary shall complete the assessment
 conducted under subparagraph 7,a7 not  
later than one year after the date of   
the enactment of this ,act4  7#b7       
,implementation ,not later than #ah     
months after the completion of the      
assessment under paragraph 7#a71 the    
,secretary shall1 using guidance from   
the assessment1 fully implement         
standardized telehealth interfacing     
instructions at all facilities of the   
,department4  7#c7 ,navigation ,the     
,secretary shall ensure that the        
telehealth interfacing instructions     
implemented under this subsection are   
those that are easiest to navigate for  
veterans and health care providers4