Public Law 116–171: To improve mental health care provided by the Department of Veterans Affairs, and for other purposes.

Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs, in consultation with the Secretary of Defense, shall submit to the appropriate committees of Congress and publish on a 134 STAT. 780 website of the Department of Veterans Affairs a strategic plan for the provision by the Department of health care to any veteran during the one-year period following the discharge or release of the veteran from active military, naval, or air service.

The plan submitted under paragraph (1) shall include the following:

(B)

The term “” has the meaning given that term in section 101(24) of title 38, United States Code.

The term “” means—

The Secretary of Defense and the Secretary of Veterans Affairs shall jointly review the records of 134 STAT. 781 each former member of the Armed Forces who died by suicide, as determined by the Secretary of Defense or the Secretary of Veterans Affairs, within one year following the discharge or release of the former member from active military, naval, or air service during the five-year period preceding the date of the enactment of this Act.

In completing the review required under paragraph (1), the Secretary of Defense and the Secretary of Veterans Affairs shall review the following records maintained by the Department of Defense:

Whether the Department of Defense had identified the former member as being at elevated risk during the 365-day period before separation of the member from the Armed Forces.

In the case that the member was identified as being at elevated risk as described in paragraph (1), whether that identification had been communicated to the Department of Veterans Affairs via the Solid Start initiative of the Department pursuant to Executive Order 13822 (83 Fed. Reg. 1513; relating to supporting our veterans during their transition from uniformed service to civilian life), or any other means.

The presence of evidence-based and empirically-supported contextual and individual risk factors specified in subsection (c) with respect to the former member and how those risk factors correlated to the circumstances of the death of the former member.

Demographic variables, including the following:

Support or medical services furnished to the former member through the Department of Defense, specified by the type of service or care provided.

Support or medical services furnished to the former member through the Department of Veterans Affairs, specified by the type of service or care provided.

Exposure to violence.

Exposure to suicide.

Housing instability.134 STAT. 782

Financial instability.

Vocational problems or insecurity.

Legal problems.

Highly acute or significantly chronic relational problems.

Limited access to health care.

The term “” has the meaning given that term in section 101(24) of title 38, United States Code.

The term “” means—

An assessment of the impact of the REACH VET program on rates of suicide among veterans.

An assessment of how limits within the REACH VET program, such as caps on the number of veterans who may be flagged as high risk, are adjusted for differing rates of suicide across the country.

A detailed explanation, with evidence, for why the conditions included in the model used by the REACH VET program were chosen, including an explanation as to why certain conditions, such as bipolar disorder II, were not included even though they show a similar rate of risk for suicide as other conditions that were included.

An assessment of the feasibility of incorporating certain economic data held by the Veterans Benefits Administration into the model used by the REACH VET program, including financial data and employment status, which research indicates may have an impact on risk for suicide.

REACH VET program

striking

inserting

by subparagraph (C) as subparagraph (F); and

by after subsection (B) the following new subparagraphs:.

The purpose of this section is to reduce veteran suicide through a community-based grant program to award grants to eligible entities to provide or coordinate suicide prevention services to eligible individuals and their families.

The grant program under this section shall be known as the “Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program”.

The Secretary shall award a grant to each eligible entity for which the Secretary has approved an application under subsection (f) to provide or coordinate the provision of suicide prevention services under this section.

In accordance with the services being provided under a grant under this section and the duration of those services, the Secretary shall establish—

(A)

Priority.—

(B)

Areas with need.—

The Secretary shall give preference to eligible entities that have demonstrated the ability to provide or coordinate suicide prevention services.

Each entity receiving a grant under this section to provide or coordinate suicide prevention services to eligible individuals and their families shall notify the recipients of such services that such services are being paid for, in whole or in part, by the Department.

Any plan developed with respect to the provision of suicide prevention services for an eligible individual or their family shall be developed in consultation with the eligible individual and their family.

An entity receiving a grant under this section shall—

An entity receiving a grant under this section shall submit to the Secretary a 134 STAT. 785 description of such tools and assessments the entity uses or will use to determine the effectiveness of the services furnished by the entity, which shall include the measures developed under subsection (h)(2) and may include—

The Secretary—

An eligible entity seeking a grant under this section shall submit to the Secretary an application therefor in such form, in such manner, and containing such commitments and information as the Secretary considers necessary to carry out this section.

Each application submitted by an eligible entity under paragraph (1) shall contain the following:

(B)

Plan.

(F)

The Secretary shall provide training and technical assistance, in coordination with the Centers for Disease Control and Prevention, to eligible entities in receipt of grants under this section regarding—

The Secretary may provide the training and technical assistance described in paragraph (1) directly or through grants or contracts with appropriate public or nonprofit entities.

The Secretary, in consultation with entities specified in paragraph (3), shall establish criteria for the selection of eligible entities that have submitted applications under subsection (f).

The Secretary shall develop, in consultation with entities specified in paragraph (3), the following:

In developing a plan for the design and implementation of the provision of grants under this section, including criteria for the award of grants, the Secretary shall consult with the following:

(B)

Not later than 30 days before notifying eligible entities of the availability of funding under this section, the Secretary shall submit to the appropriate committees of Congress a report containing—

The Secretary may make available to recipients of grants under this section certain information regarding potential eligible individuals who may receive services for which such grant is provided.

The information made available under paragraph (1) with respect to potential eligible individuals may include the following:

The Secretary shall allow an eligible individual to opt out of having their information shared under this subsection with recipients of grants under this section.134 STAT. 789

(B)

Elements.—

Not later than three years after the date on which the first grant is awarded under this section, and annually thereafter for each year in which the program is in effect, the Secretary shall submit to the appropriate committees of Congress—

(B)

(B)

Elements of study.—

An appropriate entity described in this paragraph is a nongovernment entity with experience optimizing and assessing organizations that deliver services and assessing the effectiveness of suicide prevention programs.

If an eligible entity in receipt of a grant under this section determines that an eligible individual is at-risk of suicide or other mental or behavioral health condition pursuant to a baseline mental health screening conducted under subsection (q)(11)(A)(ii) with respect to the individual, the entity shall refer the eligible individual to the Department for additional care under subsection (n) or any other provision of law.

If an eligible entity in receipt of a grant under this section determines that an eligible individual furnished clinical services for emergency treatment under subsection (q)(11)(A)(iv) requires ongoing services, the entity shall refer the eligible individual to the Department for additional care under subsection (n) or any other provision of law.134 STAT. 792

If an eligible individual refuses a referral by an entity under paragraph (1) or (2), any ongoing clinical services provided to the eligible individual by the entity shall be at the expense of the entity.

Subject to paragraph (2), an eligible entity may use grant funds to enter into an agreement with a community partner under which the eligible entity may provide funds to the community partner for the provision of suicide prevention services to eligible individuals and their families.

The ability of a recipient of a grant under this section to provide grant funds to a community partner shall be limited to grant recipients that are a State or local government or an Indian tribe.

The term “” means—

The term “” means the Department of Veterans Affairs.

The term “” means—

(A)

The term “” includes a person at risk of suicide who is—

Medical services, professional services, ambulance services, ancillary care and medication (including a short course of medication related to and necessary for the treatment of the emergency condition that is provided directly to or prescribed for the patient for use after the emergency condition is stabilized and the patient is discharged) was rendered in a medical emergency of such nature that a prudent layperson would have reasonably expected that delay in seeking immediate medical attention would have been hazardous to life or health. This standard is met by an emergency medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) that a prudent layperson who possesses an average knowledge of health and medicine could reasonably expect the absence of immediate medical attention to result in placing the health of the individual in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.

The term “” means, with respect to an eligible individual, any of the following:

The term “” has the meaning given that term in section 4 of the Native American Housing Assistance and Self-Determination Act of 1996 (25 U.S.C. 4103).

(A)

In general.—

The term “”, with respect to a community, has the meaning given that term in the Rural-Urban Commuting Areas coding system of the Department of Agriculture.

The term “” means the Secretary of Veterans Affairs.

(A)

In general.—

The term “” means the toll-free hotline for veterans established under section 1720F(h) of title 38, United States Code.

The term “” means any organization recognized by the Secretary for the representation of veterans under section 5902 of title 38, United States Code.

Yoga.

Meditation.

Acupuncture.

Chiropractic care.

Other treatments that show sufficient evidence of efficacy at treating mental or physical health conditions, as determined by the Secretary.

the results of such analysis; and

such recommendations regarding the furnishing of complementary and integrative health treatments described in subsection (c) as the Secretary considers appropriate.134 STAT. 796

Equine therapy.

Other animal therapy.

Agritherapy.

Sports and recreation therapy.

Art therapy.

Posttraumatic growth programs.

is enrolled in the system of patient enrollment of the Department under section 1705(a) of title 38, United States Code; and

has received health care under the laws administered by the Secretary during the two-year period preceding the initial participation of the veteran in the pilot program.

The Secretary shall carry out the pilot program under this section for a three-year period beginning on the commencement of the pilot program.

The Secretary may extend the duration of the pilot program under this section if the Secretary, based on the results of the interim report submitted under subsection (f)(1), determines that it is appropriate to do so.

The Secretary shall select not fewer than five facilities of the Department at which to carry out the pilot program under this section.

In selecting facilities under paragraph (1), the Secretary shall ensure that—

(B)

Elements.—

Not later than 90 days after the termination of the pilot program under this section, the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a final report on the pilot program.

The Secretary of Veterans Affairs shall seek to enter into an agreement with the National Academies of Sciences, Engineering, and Medicine under which the Secretary shall collaborate and coordinate with the National Academies on a revised study design to fulfill the goals of the 2019 study design of the National Academies described in the explanatory statement accompanying the Further Consolidated Appropriations Act, 2020 (Public Law 116–94), as part of current and additional research priorities of the Department of Veterans Affairs, to evaluate the effects of opioids and benzodiazepine on all-cause mortality of veterans, including suicide, regardless of whether information relating to such deaths has been reported by the Centers for Disease Control and Prevention.

In carrying out the collaboration and coordination under paragraph (1), the Secretary shall seek as much as possible to achieve the same advancement of useful knowledge as the 2019 study design described in such paragraph.

Not later than 90 days after the date of the enactment of this Act, the Comptroller General of the United States shall conduct a review of the staffing levels for mental health professionals of the Department.

The review required by paragraph (1) shall include a description of the efforts of the Department to maintain appropriate staffing levels for mental health professionals, such as mental health counselors, marriage and family therapists, and other appropriate counselors, including the following:

(B)

(D)

with respect to the study under subsection (a)(1), not later than 24 months after entering into the agreement under such subsection; and

with respect to the review under subsection (b)(1), not later than 18 months after the date of the enactment of this Act.

Not later than 90 days after the completion by the Secretary of Veterans Affairs in coordination with the National Academies of Sciences, Engineering, and Medicine of the study required under subsection (a)(1), the Secretary shall—

Not later than 90 days after the completion by the Comptroller General of the United States of the review required under subsection (b)(1), the Comptroller General shall—

A description of how the Department identifies patients as high risk for suicide, with particular consideration to the efficacy of inputs into the Recovery Engagement and Coordination for Health – Veterans Enhanced Treatment program (commonly referred to as the “REACH VET” program) of the Department, including an assessment of the efficacy of such identifications disaggregated by—

A description of how the Department intervenes when a patient is identified as high risk, including an assessment of the efficacy of such interventions disaggregated by—

A description of how the Department monitors patients who have been identified as high risk, including an assessment of the efficacy of such monitoring and any follow-ups disaggregated by—

A review of staffing levels of suicide prevention coordinators across the Veterans Health Administration.

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 recovery.

An assessment of such other areas as the Comptroller General considers appropriate to study.

If the Secretary determines through the study conducted under subsection (a) that living at high altitude is a risk factor for developing depression or dying by suicide, 134 STAT. 801 the Secretary shall conduct an additional study to identify the following:

Not later than 150 days after completing the study conducted under paragraph (1), 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.

The treatment of patients with post-traumatic stress disorder who are also experiencing an additional mental health condition, a substance use disorder, or chronic pain.

The treatment of patients experiencing a mental health condition, including anxiety, depression, or bipolar disorder, who are also experiencing a substance use disorder or chronic pain.

The treatment of patients with traumatic brain injury who are also experiencing—

Enhanced guidance with respect to gender-specific—

Guidance with respect to the efficacy of alternative therapies, other than psychotherapy and pharmacotherapy, including the following:

Guidance with respect to the findings of the Creating Options for Veterans’ Expedited Recovery Commission (commonly referred to as the “COVER Commission”) established under section 931 of the Jason Simcakoski Memorial and Promise Act (title IX of Public Law 114–198; 38 U.S.C. 1701 note).

Schizophrenia.

Schizoaffective disorder.

Persistent mood disorder, including bipolar disorder I and II.

Any other mental, behavioral, or emotional disorder resulting in serious functional impairment that substantially interferes with major life activities as the Secretary of Veterans Affairs, in consultation with the Secretary of Defense and the Secretary of Health and Human Services, considers appropriate.

Guidance contained in the 2016 Clinical Practice Guidelines for the Management of Major Depressive Disorders of the Department of Veterans Affairs and the Department of Defense.

Guidance with respect to the treatment of patients with a condition described in subsection (a).

A list of evidence-based therapies for the treatment of conditions described in subsection (a).

An appropriate guideline for the administration of pharmacological therapy, psychological or behavioral therapy, or other therapy for the management of conditions described in subsection (a).

The Secretary of Veterans Affairs, the Secretary of Defense, and the Secretary of Health and Human Services shall create a work group to develop the clinical practice guideline or guidelines under subsection (a) to be known as the “Serious Mental Illness Work Group” (in this subsection referred to as the “Work Group”).

The Work Group created under paragraph (1) shall be comprised of individuals that represent Federal Government entities and non-Federal Government entities with expertise in the areas covered by the Work Group, including the following entities:

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 Defense.

In carrying out the initiative under subsection (a), the Secretary shall develop robust data privacy and security measures, consistent with section 552a of title 5, United States Code (commonly known as the “Privacy Act of 1974”), and regulations promulgated pursuant to the Health Insurance Portability and Accountability Act of 1996 (parts 160, 162, and 164 of title 45, Code of Federal Regulations, or successor regulations) to ensure that information of veterans participating in the initiative is kept private and secure.

The Secretary may consult with the National Institute of Science and Technology in developing the data privacy and security measures described in paragraph (1).

The Secretary shall provide access to information under the initiative consistent with the standards described in section 552a(d)(1) of title 5, United States Code, and section 164.524 of title 45, Code of Federal Regulations, or successor regulations.

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 Administration.

In this subsection, the term “” means, with respect to data held by the Department of Veterans Affairs, that the Department—

is amended

adding

is amended

adding

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 (a).

Focus groups convened under paragraph (1) shall be held in geographically diverse areas as follows:

Focus groups convened under paragraph (1) shall be held at a variety of dates and times to ensure an adequate representation of veterans with different work schedules.

Each focus group convened under paragraph (1) shall include not fewer than five and not more than 12 participants.

Each focus group convened under paragraph (1) shall, to the extent practicable, include veterans of diverse backgrounds, including—

Not later than 90 days after the last focus group meeting under subsection (b), 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 groups.

The report required by paragraph (1) shall include the following:134 STAT. 807

Not later than one year after the last focus group meeting under subsection (b), the Secretary shall complete a representative survey of the veteran population that is informed by the focus group data in order to collect information about the effectiveness of the mental health and suicide prevention materials and campaigns conducted by the Department.

(B)

Time period.

Disaggregation of data.—

(B)

Representation.—

The Secretary of Veterans Affairs shall establish goals for the mental health and suicide prevention media outreach campaigns of the Department of Veterans Affairs, which shall include the establishment of targets, metrics, and action plans to describe and assess those campaigns.

(B)

Determination.

Factors to consider.—

The Secretary shall establish targets to track the metrics used under paragraph (2).

In establishing goals under paragraph (1), the Secretary shall consult with the following:

Not later than 180 days after the date of the enactment of this Act, 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 (1) for the mental health and suicide prevention media outreach campaigns of the Department, including the metrics and targets for such metrics by which those goals are to be measured under paragraphs (2) and (3).

Not later than one year after the submittal of the report under paragraph (5), and annually thereafter, 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—

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 Prevention.

A description of the management and organizational structure of the Office of Mental Health and Suicide Prevention, including roles and responsibilities for each position.

A description of the operational policies and processes of the Office of Mental Health and Suicide Prevention.

An assessment of suicide prevention practices and initiatives available from the Department and through community partnerships.

An assessment of the staffing levels at the Office of Mental Health and Suicide Prevention, disaggregated by type of position, and including the location of any staffing deficiencies.

An assessment of the Nurse Advice Line pilot program conducted by the Department.

An assessment of recruitment initiatives in rural areas for mental health professionals of the Department.

An assessment of strategic planning conducted by the Office of Mental Health and Suicide Prevention.

An assessment of the communication, and the effectiveness of such communication—

An assessment of how effectively the Office of Mental Health and Suicide Prevention implements operational policies and procedures.

An assessment of how the Department of Veterans Affairs and the Department of Defense coordinate suicide prevention efforts, and recommendations on how the Department of Veterans Affairs and Department of Defense can more effectively coordinate those efforts.

An assessment of such other areas as the Comptroller General considers appropriate to study.134 STAT. 811

Not later than two years after the date of the enactment of this Act, 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 Department.

The report required by subsection (a) shall include the following:

(D)

Not later than two years after the date on which the Comptroller General submits the report required under subsection (a)(1), 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 Administration.

The report required by paragraph (1) shall include the following:

(D)

In this subsection, the term “” means mental health care paid for by the Department but provided by a non-Department health care provider at a non-Department facility, including care furnished under section 1703 of title 38, United States Code (as in effect on the date specified in section 101(b) of the Caring for Our Veterans Act of 2018 (title I of Public Law 115–182)).

Not later than one year after the date of the enactment of this Act, and annually thereafter, the Secretary of Veterans Affairs and the Secretary of Defense shall submit to the Committee on Veterans’ Affairs and the Committee on Armed Services of the Senate and the Committee on Veterans’ Affairs and the Committee on Armed Services of the House of Representatives a report on mental health programs of the Department of Veterans Affairs and the Department of Defense and joint programs of the Departments.

The report required by paragraph (1) shall include the following:

(A)

(B)

(C)

The Secretary of Veterans Affairs, in coordination with the Secretary of Defense, shall evaluate the current ongoing collaborative efforts of the Department of Veterans Affairs and the Department of Defense related to post-traumatic stress disorder and traumatic brain injury care, research, and education to improve the quality of and access to such care and seek potential new collaborative efforts to improve and expand such care for veterans and members of the Armed Forces in a joint Department of Veterans Affairs/Department of Defense Intrepid Spirit Center that serves active duty members of the Armed Forces, members of the reserve 134 STAT. 814 components of the Armed Forces, and veterans for mutual benefit and growth in treatment and care.

(B)

Recommenda-

tions.

Elements.—

Not later than 270 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report that includes—

In this subsection, with respect to an area, the terms “rural” and “highly rural” have the meanings given those terms in the Rural-Urban Commuting Areas coding system of the Department of Agriculture.

Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs, in consultation with the Inspector General of the Department of Veterans Affairs, shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a plan to address staffing 134 STAT. 815 of mental health providers of the Department of Veterans Affairs, including filling any open positions.

The plan required by paragraph (1) shall include the following:

Not later than one year after the submittal of the plan required by paragraph (1), the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report setting forth the number of mental health providers hired by the Department during the one-year period preceding the submittal of the report.

is amended

inserting

(A)

Establishment of program.—

(B)

38 USC 7602.

Eligibility.—

(E)

Annual report.—

The table of sections at the beginning of chapter 76 of such title

38 USC 7601 prec.

by after the items relating to subchapter VIII the following:

An assessment of the adequacy and types of treatment, counseling, and other services provided at Vet Centers, including recommendations on whether and how such treatment, counseling, and other services can be expanded.

An assessment of the efficacy of outreach efforts by the Readjustment Counseling Service, including recommendations for how outreach efforts can be improved.

An assessment of barriers to care at Vet Centers, including recommendations for overcoming those barriers.

An assessment of the efficacy and frequency of the use of telehealth by counselors of the Readjustment Counseling Service to provide mental health services, including recommendations for how the use of telehealth can be improved.

An assessment of the feasibility and advisability of expanding eligibility for services from the Readjustment Counseling Service, including—

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 members.

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 members.

An assessment of the efficacy of group therapy and the level of training of providers at Vet Centers in administering group therapy.

An assessment of the efficiency and effectiveness of the task organization structure of Vet Centers.

An assessment of the use of Vet Centers by Native American veterans, as defined in section 3765 of title 38, United States Code, and recommendations on how to better reach those veterans.

Vet Center

is amended

inserting

is amended

adding

Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall conduct a survey on the attitudes of eligible veterans toward the Department of Veterans Affairs offering appointments outside the usual operating hours of facilities of the Department, including through the use of telehealth appointments.

In this subsection, the term “” means a veteran who—

Not later than 270 days after the date of the enactment of this Act, the Secretary shall brief the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives on the—

The briefing required by paragraph (1) shall include the following:

Not later than one year after the date of the enactment of this Act, the Secretary, in consultation with the Office of Mental Health and Suicide Prevention of the Department, shall commence the conduct of a study to determine the feasibility and advisability of—

In conducting the study under paragraph (1), the Secretary shall assess the feasibility of advisability of, within the suicide prevention coordinator program office described in paragraph (1)(B), aligning suicide prevention coordinators and suicide prevention case managers within the organizational structure and chart of the Suicide Prevention Program of the Department, with the Director of the Suicide Prevention program having ultimate supervisory oversight and responsibility over the suicide prevention coordinator program office.

An assessment of the feasibility and advisability of creating a suicide prevention coordinator program office to oversee and monitor suicide prevention coordinators and suicide prevention case managers across all medical centers of the Department.

A review of current staffing ratios for suicide prevention coordinators and suicide prevention case managers in comparison with current staffing ratios for mental health providers within each medical center of the Department.

A description of the duties and responsibilities for suicide prevention coordinators across the Department to better define, delineate, and standardize qualifications, performance goals, performance duties, and performance outcomes for suicide prevention coordinators and suicide prevention case managers.

The Department of Veterans Affairs must be more effective in its approach to reducing the burden of veteran suicide connected to mental health diagnoses, to include expansion of treatment delivered via telehealth methods and in rural areas.

An innovative project, known as Suicide Assessment and Follow-up Engagement: Veteran Emergency Treatment (in this subsection referred to as “SAFE VET”), was designed to help suicidal veterans seen at emergency departments within 134 STAT. 822 the Veterans Health Administration and was successfully implemented in five intervention sites beginning in 2010.

A 2018 study found that safety planning intervention under SAFE VET was associated with 45 percent fewer suicidal behaviors in the six-month period following emergency department care and more than double the odds of a veteran engaging in outpatient behavioral health care.

SAFE VET is a promising alternative and acceptable delivery of care system that augments the treatment of suicidal veterans in emergency departments of the Veterans Health Administration and helps ensure that those veterans have appropriate follow-up care.

Beginning in September 2018, the Veterans Health Administration implemented a suicide prevention program, known as the SPED program, for veterans presenting to the emergency department who are assessed to be at risk for suicide and are safe to be discharged home.

The SPED program includes issuance and update of a safety plan and post-discharge follow-up outreach for veterans to facilitate engagement in outpatient mental health care.

Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to the appropriate committees of Congress a report on the efforts of the Secretary to implement a suicide prevention program for veterans presenting to an emergency department or urgent care center of the Veterans Health Administration who are assessed to be at risk for suicide and are safe to be discharged home, including a safety plan and post-discharge outreach for veterans to facilitate engagement in outpatient mental health care.

The report required by paragraph (1) shall include the following:

(A)

(B) 134 STAT. 823

(C)

(G)

Recommenda-

tions.

The term “” means—

The term “” means the main point of contact responsible for administering the SPED program at a medical center of the Department.

The term “” means the Safety Planning in Emergency Departments program of the Department of Veterans Affairs established in September 2018 for veterans presenting to the emergency department who are assessed to be at risk for suicide and are safe to be discharged home, which extends the evidence-based intervention for suicide prevention to all emergency departments of the Veterans Health Administration.

the name and contact information of each women’s health coordinator;134 STAT. 825

a list of appropriate staff for other benefits available from the Veterans Benefits Administration, the National Cemetery Administration, and such other entities as the Secretary considers appropriate; and

such other information as the Secretary considers appropriate.

In carrying out agreements entered into or expanded under this section with entities described in subsection (a), the Secretary shall award grants to those entities.

To the extent practicable, the Secretary shall ensure that grants are awarded to entities that serve veterans in rural and highly rural areas (as determined through the use of the Rural-Urban Commuting Areas coding system of the Department of Agriculture) or areas determined to be medically underserved.

(A)

In general.—

An entity described in subsection (a) that seeks to establish a telehealth access point for veterans but does not require grant funding under this section to do so may enter into an agreement with the Department for the establishment of such an access point.

An entity described in paragraph (1) shall be responsible for ensuring that any access point is adequately private, secure, clean, and accessible for veterans before the access point is established.

Not later than 18 months after the date of the enactment of this Act, the Secretary shall complete an assessment of barriers faced by veterans in accessing telehealth services.

The assessment required by paragraph (1) shall include the following:

Not later than 120 days after the completion of the assessment required by paragraph (1), 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 assessment, including any recommendations for legislative or administrative action based on the results of the assessment.

The Secretary of Veterans Affairs, in consultation with the Center for Compassionate Innovation within the Office of Community Engagement of the Department of Veterans Affairs, may enter into partnerships with non-Federal Government entities to provide hyperbaric oxygen treatment to veterans to research the effectiveness of such therapy.

Partnerships entered into under paragraph (1) may include the following:

Federal Government funding may be used to coordinate and administer the partnerships under this subsection but may not be used to carry out activities conducted under such partnerships.

Not later than 90 days after the date of the enactment of this Act, the Secretary, in consultation with the Center for Compassionate Innovation, shall commence the conduct of a systematic review of published research literature on off-label use of hyperbaric oxygen therapy to treat 134 STAT. 828 post-traumatic stress disorder and traumatic brain injury among veterans and nonveterans.

The review conducted under paragraph (1) shall include the following:

(A)

Assessment.

The review conducted under paragraph (1) shall be completed not later than 180 days after the date of the commencement of the review.

Not later than 90 days after the completion of the review conducted under paragraph (1), 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 review.

Not later than 120 days after the completion of the review conducted under subsection (c), the Secretary, in consultation with the Center for Compassionate Innovation, shall commence the conduct of a study on all individuals receiving hyperbaric oxygen therapy through the current pilot program of the Department for the provision of hyperbaric oxygen therapy to veterans to determine the efficacy and effectiveness of hyperbaric oxygen therapy for the treatment of post-traumatic stress disorder and traumatic brain injury.

The study conducted under paragraph (1) shall include the review and publication of any data and conclusions resulting from research conducted by an authorized provider of hyperbaric oxygen therapy for veterans through the pilot program described in such paragraph.

The study conducted under paragraph (1) shall be completed not later than three years after the date of the commencement of the study.

Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall prescribe the technical qualifications required under section 7402(b)(14) of title 38, United States Code, to be appointed as a licensed hearing aid specialist under section 7401(3) of such title.

In prescribing the qualifications for licensed hearing aid specialists under paragraph (1), the Secretary shall, at a minimum, ensure that such qualifications are consistent with—

assessing the progress of the Secretary in appointing licensed hearing aid specialists under subsection (c);

assessing potential conflicts or obstacles that prevent the appointment of licensed hearing aid specialists;

assessing the factors that led to such conflicts or obstacles;

assessing access of patients to comprehensive hearing health care services from the Department consistent with the requirements under section 4(b) of the Veterans Mobility Safety Act of 2016 (Public Law 114–256; 38 U.S.C. 7401 note), including an assessment of the impact of infrastructure and equipment limitations on wait times for audiologic care; and

indicating the medical centers of the Department with vacancies for audiologists or licensed hearing aid specialists.

identify accredited commercial institutional review boards for use in connection with sponsored clinical research of the Department; and

establish a process to modify existing approvals in the event that a commercial institutional review board loses its accreditation during an ongoing clinical trial.

Not later than 90 days after the completion of the policy revisions under subsection (a), and annually thereafter, the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on all approvals of institutional review boards used by the Department, including central institutional review boards and commercial institutional review boards.

The report required by paragraph (1) shall include, at a minimum, the following:

Perform centralized security reviews and complete security processes for approved research sponsored outside the Department, with a focus on multi-site clinical trials.

Develop and maintain a list of commercially available software preferred for use in sponsored clinical trials of the Department and ensure such list is maintained as part of the official approved software products list of the Department.

Develop benchmarks for appropriate timelines for security reviews conducted by the Office.

Not later than one year after the establishment of the Office, the Office shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on the activity of the Office.134 STAT. 831

The report required by paragraph (1) shall include, at a minimum, the following: