Commander John Scott Hannon Veterans Mental Health Care Improvement Act of 2019 (P.L. 116-171) and Veterans COMPACT Act of 2020 (P.L. 116-214)

Commander John Scott Hannon Veterans Mental Health Care Improvement Act of 2019 (P.L. 116-171) and Veterans COMPACT Act of 2020 (P.L. 116-214)

Commander John Scott Hannon Veterans
July 19, 2021
Mental Health Care Improvement Act of 2019
Victoria R. Green,
(P.L. 116-171) and Veterans COMPACT Act of
Coordinator
Analyst in Health Policy
2020 (P.L. 116-214)

Sidath Viranga Panangala
Suicide is the 10th leading cause of death in the United States and is a significant contributor to
Specialist in Veterans
premature mortality. Although suicide rates have increased among the U.S. general population
Policy
over the past two decades, veterans are disproportionately affected by suicide. According to the

Department of Veterans Affairs (VA), in 2018—the most recent year for which data are
Jared S. Sussman
available—the suicide rate for veterans was 1.5 times greater than among nonveteran adults
Analyst in Health Policy
(adjusting for age and sex), and an average of 17.6 veterans died by suicide per day.

VA has named suicide as its top clinical priority for FY2018 to FY2024. In response, the
Amanda K. Sarata
department has implemented numerous initiatives to address veteran suicide and related mental
Specialist in Health Policy
health concerns. In addition, Congress has expressed sustained interest in reducing veteran

suicide and has aimed to reduce such suicides through appropriations and authorizing legislation.
Bryce H. P. Mendez
Despite these efforts, Congress, VA, and stakeholders continue to express interest in efforts to
Analyst in Defense Health
further reduce veteran suicide and concern over seemingly limited progress made to date to
Care Policy
reduce veteran suicide.

Isaac A. Nicchitta
In the 116th Congress, the House and Senate Committees on Veterans’ Affairs (HVAC and
Research Assistant
SVAC, respectively) focused much of their efforts on veteran suicide prevention, holding several

hearings and introducing and enacting legislation on the topic. The Commander John Scott
Hannon Veterans Mental Health Care Improvement Act of 2019 (Hannon Act; P.L. 116-171) and
For a copy of the ful report,
the Veterans Comprehensive Prevention, Access to Care, and Treatment Act of 2020 (Veterans
please cal 7-5700 or visit
COMPACT Act; P.L. 116-214) were enacted at the end of the 116th Congress and were
www.crs.gov.
developed out of SVAC and HVAC, respectively. Both bills were enacted as part of a
compromise between the two committees. Although they are separate, the bills complement each other in their efforts to
increase access to and quality of the Veterans Health Administration (VHA) mental health and suicide prevention services.
Summary of Commander John Scott Hannon Veterans Mental Health Care Improvement Act of 2019
(P.L. 116-171)
The Hannon Act was enacted on October 17, 2020. The bill was named after Commander John Scott Hannon, a Navy SEALs
member who served in the U.S. Navy for 23 years and died by suicide. Divided into seven titles, the bill addresses five key
areas:
1. Providing more assistance for servicemembers transitioning from the military .
2. Increasing access to mental health care and suicide prevention services for all veterans, and in particular, veterans
living in rural areas.
3. Strengthening VHA’s mental health workforce.
4. Providing oversight of VHA’s mental health and suicide prevention services.
5. Investing in and studying mental health treatment, including alternative and complementary treatment approaches.

Summary of Veterans COMPACT Act of 2020 (P.L. 116-214)
The Veterans COMPACT Act was enacted on December 5, 2020. The bill is divided into three titles and features nine
provisions adapted from different committee members to help prevent veteran suicide. The three key themes, as organized by
title, include
1. Improving the transition to VHA services by helping veterans build networks of support and tracking VA’s outreach
to transitioning servicemembers.
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link to page 67 The Hannon Act (P.L. 116-171) and the Veterans COMPACT Act (P.L. 116-214)

2. Improving VA’s response to veteran suicide by providing acute crisis care for emergent suicide symptoms and
outreach to certain at-risk veterans, creating new programs, and requiring annual VA police crisis intervention
training.
3. Improving care and services for women veterans by conducting a gap analysis of VA programs providing assistance
to homeless women veterans and requiring a report on locations where women veterans are using VHA care.
Scope of Report
This report summarizes the provisions of the Hannon Act and the Veterans COMPACT Act. The report is not intended to
provide a comprehensive analysis of every provision in these acts; rather, it provides a brie f background and summary of
such provisions. The report is organized by each respective law, starting with the Hannon Act , with each summarized by title
and subsequent provisions within the titles. The Appendix of the report includes tables of relevant provisions for the Hannon
Act and the Veterans COMPACT Act, respectively, that include an effective date, a required report, or an explicit sunset
date. The report reflects the Hannon Act and the Veterans COMPACT Act at enactment and will not track actions pursuant to
required deadlines, nor will this report be updated.
SVAC and HVAC did not produce written reports or release an explanatory statement in the Congressional Record to
accompany the Hannon Act or the Veterans COMPACT Act at the time of passage. Therefore, for some provisions in which
committees’ legislative background was not clear, CRS, where applicable, approximates legislative background b y providing
contextual information based on testimony at committee hearings, hearing transcripts, or earlier or alternative versions of the
bills, with identical provisions, among other sources. This background should not be used as the official legislative intent of
those provisions.

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Contents
Background.................................................................................................................... 1
Brief Legislative History............................................................................................. 2
Brief Overview of the Commander John Scott Hannon Veterans Mental Health Care
Improvement Act of 2019 (Hannon Act; P.L. 116-171).................................................. 5
Brief Overview of the Veterans Comprehensive Prevention, Access to Care, and
Treatment Act of 2020 (Veterans COMPACT Act; P.L. 116-214) .................................... 5
Scope of Report......................................................................................................... 6
Provisions in the Commander John Scott Hannon Veterans Mental Health Care
Improvement Act of 2019 .............................................................................................. 9
Title I: Improvement of Transition of Individuals to Services from Department of
Veterans Affairs ...................................................................................................... 9
Title II: Suicide Prevention ....................................................................................... 13
Title III: Programs, Studies, and Guidelines on Mental Health ........................................ 26
Title IV: Oversight of Mental Health Care and Related Services...................................... 31
Title V: Improvement of Mental Health Medical Workforce ........................................... 37
Title VI: Improvement of Care and Services for Women Veterans ................................... 44
Title VII: Other Matters ............................................................................................ 46
Provisions in Veterans COMPACT Act of 2020.................................................................. 51
Title I: Improvement of Transition of Individuals to Services from Department of
Veterans Affairs .................................................................................................... 51
Title II: Suicide Prevention ....................................................................................... 53
Title III: Improvement of Care and Services for Women Veterans.................................... 61

Tables
Table 1. Acronyms Used in This Report .............................................................................. 6

Table A-1. Hannon Act Implementation Dates, Reporting Requirements, and Deadlines........... 63
Table A-2. Veterans COMPACT Act Implementation Dates, Reporting Requirements, and
Deadlines .................................................................................................................. 72

Appendixes
Appendix. Implementation Dates, Reporting Requirements, and Deadlines ............................ 63

Contacts
Author Information ....................................................................................................... 74

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Background
Suicide is the 10th leading cause of death in the United States and is a significant contributor to
premature mortality. There is no single cause of suicide. Rather, it results from a complex
interaction between risk factors (e.g., a mental health disorder) and protective factors (e.g.,
community engagement). The interaction of these factors can occur at the individual,
interpersonal, community, and societal level. Although suicide rates have increased among the
U.S. general population over the past two decades,1 veterans are disproportionately affected by
suicide. According to the Department of Veterans Affairs (VA), in the period of 2005-2018,
suicide rates increased more quickly among veterans compared with nonveteran U.S. adults,
adjusting for age and sex.2 In 2018—the most recent year for which data are available—the
suicide rate for veterans was 1.5 times greater than among nonveteran adults (adjusting for age
and sex), and an average of 17.6 veterans died by suicide per day.3
VA has named suicide as its top clinical priority for FY2018 to FY2024.4 In response, the
department has implemented numerous initiatives to address veteran suicide and related mental
health concerns. VA has described in its national strategy for preventing veteran suicide how these
different interventions are to be implemented to reach al veterans, from the lowest risk to the
highest risk for suicide. This public health approach, which aims to prevent suicide before it
occurs by focusing on population-level initiatives, uses multidisciplinary strategies to help diverse
veteran communities, among other things.5 For example, the Veteran Health Administration’s
(VHA’s) recently implemented universal annual screening initiative evaluates al veterans
receiving VHA services for suicidal risk and subsequently assesses suicidal risk among those who
screened positive during the initial screening.6 In the national strategy, VA also emphasizes the
need to develop public-private partnerships to advance targeted suicide prevention strategies in
different geographic areas, such as health care provider training and community-specific
activities.
Congress has expressed sustained interest in reducing veteran suicide and has aimed to reduce
such suicides through appropriations and authorizing legislation. In FY2021 appropriations,
Congress provided $1.94 bil ion to VHA for suicide prevention and treatment services,7 an

1 Holly Hedegaard, Sally C. Curtin, and Margaret Warner, “Increase in Suicide Mortality in the United States, 1999 -
2018,” National Center for Health Statistics (NCHS) Data Brief, vol. 362 (April 2020).
2 Office of Mental Health and Suicide Prevention, 2020 National Veteran Suicide Prevention Annual Report,
Department of Veterans Affairs, November 2020, p. 17, https://www.mentalhealth.va.gov/docs/data-sheets/2020/2020-
National-Veteran-Suicide-Prevention-Annual-Report-11-2020-508.pdf.
3 Office of Mental Health and Suicide Prevention, 2020 National Veteran Suicide Prevention Annual Report,
Department of Veterans Affairs, November 2020, p. 5, https://www.mentalhealth.va.gov/docs/data-sheets/2020/2020-
National-Veteran-Suicide-Prevention-Annual-Report-11-2020-508.pdf. Previous VA reports on the suicides per-day
statistic included veterans, current servicemembers, and never federally activated former Guard and Reserve members.
T he 2018 statistic does not include current servicemembers or never federally activated former servicemembers.
4 Department of Veterans Affairs, FY2018 - 2024 Strategic Plan, May 31, 2019, https://www.va.gov/oei/docs/va2018-
2024strategicplan.pdf.
5 Office of Mental Health and Suicide Prevention, National Strategy for Preventing Veteran Suicide, 2018-2028,
Department of Veterans Affairs, p. 8, https://www.mentalhealth.va.gov/suicide_prevention/docs/Office-of-Mental-
Health-and-Suicide-Prevention-National-Strategy-for-Preventing-Veterans-Suicide.pdf.
6 U.S. Government Accountability Office, VA Needs Accurate Data and Comprehensive Analyses to Better Understand
On-Cam pus Suicides, GAO-20-664, September 2020, p. 8, https://www.gao.gov/assets/710/709243.pdf.
7 U.S. Congress, House Committee on Appropriations, Subcommittee on Military Construction, Veterans Affairs, and
Related Agencies, Military Construction, Veterans Affairs, And Related Agencies Appropriations Bill, 2021 , report to
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increase of over $40 mil ion from the prior fiscal year.8 Of that amount, $312.6 mil ion was
provided for suicide prevention outreach, which includes VHA prevention-focused activities such
as the Veterans Crisis Line (VCL),9 among other things. Previous Congresses have enacted
several bil s to help address veteran suicide, including the Joshua Omvig Veterans Suicide
Prevention Act of 2007 (P.L. 110-110) and the Clay Hunt Suicide Prevention for American
Veterans Act (Clay Hunt SAV Act; P.L. 114-2). Each of these bil s included provisions designed
to improve VHA’s offering of mental health and suicide prevention services. Despite these
efforts, Congress, VA, and stakeholders continue to express interest in efforts to further reduce
veteran suicide and concern over seemingly limited progress made to date to reduce veteran
suicide.
Brief Legislative History
In the 116th Congress, the House and Senate Committees on Veterans’ Affairs (hereinafter
referred to as HVAC and SVAC, respectively) continued to focus on veteran suicide prevention,
holding hearings and introducing and enacting legislation on the topic.10 On March 13, 2019, the
Commander John Scott Hannon Veterans Mental Health Care Improvement Act of 2019 (S. 785)
was introduced by then ranking member of SVAC Senator Jon Tester and then chairman of SVAC
Senator Jerry Moran. A key feature of the bil was the authorization of a grant program that
requires VA to award grants to certain community-based organizations to provide veteran suicide
prevention services.11 During a hearing on the legislation, in May 2019, SVAC heard several
views on S. 785. VA testified,
There is much in S. 785 that keys in on what we believe are the right elements, including
suicide prevention coordinators at every medical center, a grant program that taps into the
resources of the local community, focused research projects and deployment of promising
clinical approaches to suicide prevention, the use of complementary and integrative health
care, outreach efforts to reach those veterans that are not in our system of care, and the use
of joint clinical practice guidelines, among other features.12
In June 2019, SVAC held another hearing on engaging communities in preventing veteran
suicide.13 By January 29, 2020, SVAC reported an amended version of S. 785. That version was

accompany H.R. 7609, 116th Cong., 2nd sess., July 13, 2020; H.Rept. 116-445, p. 46.
8 U.S. Congress, House Committee on Appropriations, Subcommittee on Military Construction, Veterans Affairs, and
Related Agencies, Military Construction, Veterans Affairs, And Related Agencies Appropriations Bill, 2020 , Report to
accompany H.R. 2745, 116th Cong., 1st sess., May 15, 2019, H.Rept. 116-63, p. 36.
9 In 2007, VHA established a suicide crisis hotline. It was initially called the National Veterans Suicide Prevention
Hotline. In 2011, its name was changed to the Veterans Crisis Line (VCL). In addition to calling, veterans can chat and
text and connect with a counselor. See https://www.veteranscrisisline.net/Default.aspx.
10 See for example, U.S. Congress, House Committee on Vet erans’ Affairs, “Suicide Prevention,”
https://veterans.house.gov/suicide-prevention, and House Committee on Veterans Affairs, “ T akano, Roe Issue
Bipartisan Statement on Veteran Suicide Prevention,” press release, March 7, 2019, https://veterans.house.gov/news/
press-releases/takano-roe-issue-bipartisan-statement-veteran-suicide-prevention.
11 38 U.S.C. §1720F note, as added by section 201 of P.L. 116-171.
12 U.S. Congress, Senate Committee on Veterans’ Affairs, Hearing on Pending Legislation, 116th Cong., 1st sess., May
22, 2019, S. HRG. 116-179 (Washington: GPO, 2020), p. 8.
13 U.S. Congress, Senate Committee on Veterans’ Affairs, Harnessing the Power Of Community: Leveraging Veteran
Networks To Tackle Suicide, 116th Cong., 1st sess., June 19, 2019, S. HRG. 116-209 (Washington: GPO, 2020).
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then withdrawn and Senators Jerry Moran and Jon Tester proposed an amended version14 to S.
785 , which passed the Senate on August 5, 2020.
In the House, on June 26, 2019, Representatives Jack Bergman and Chrissy Houlahan introduced
the Improve Wel -Being for Veterans Act (H.R. 3495), which would have required VA to award
grants to eligible community-based organizations to provide suicide prevention services. This
program was substantively similar to the suicide prevention grant program included in S. 785. In
September 2019, HVAC held a hearing on H.R. 3495 and other bil s. Regarding the grant
program that would be established by H.R. 3495, VA stated that “VA’s efforts to reduce the
incidence of suicidal ideations and behavior (and suicide completions) among al Veterans could
be complemented by partnering with community-based providers who are able to replicate VA’s
suicide prevention programs in the community and to connect with Veterans that are currently
beyond VA’s reach.”15
In November 2019, HVAC held another hearing on both H.R. 3495 and a discussion draft bil to
establish a pilot program for the issuance of grants to eligible entities for suicide prevention
activities, for which the department stated it would provide its views in a separate letter to the
committee.16 While some HVAC Members supported the grant program as outlined in H.R. 3495
and the discussion draft bil ,17 in his opening remarks, Chairman Mark Takano of HVAC,
addressed several concerns he had regarding the grant program as outlined in H.R. 3495:
While I agree with the underlying intent of H.R. 3495, I do have significant concerns. First,
this bill would allow VA grants to fund community-based clinical care and would clearly
circumvent the MISSION Act that streamlined clinical care under one program. Instead
this legislation creates a separate lane for care in the community without critical safeguards
and accountability measures in place…. Second, H.R. 3495, as introduced would provide
direct temporary cash assistance to veterans, their families, and anyone else who may live
with them. My understanding is that cash assistance to veterans needs further, careful
consideration and should be taken up in separate legislation.... H.R. 3495 as introduced
authorizes the VA Secretary to award grants to organizations unbound to any performance
criteria and irrespective of whether there is demonstrated local need for the services
provided by these organizations. Funding decisions should be driven by local coordinating
organizations who have the pulse on their communities and regions. The coordination
should be as local as possible.... Without local need and metrics tied to the award of grant
funding, this is not consistent with the policy goal of reaching the 60 percent of veterans at
risk for suicide who are not connected with VA.18

14 SA 25940.
15 U.S. Congress, House Committee on Veterans’ Affairs, Subcommittee on Health, Statement of Teresa Boyd,
Assistant Deputy Under Secretary For Health For Clinical Operations, Veterans H ealth Adm inistration (VHA)
Departm ent Of Veterans Affairs (VA), legislative hearing on H.R. 3636; H.R. 2972; H.R. 3036; H.R. 2798; H.R. 2645;
H.R. 2681; H.R. 3224; H.R. 2982; H.R. 2752; H.R. 2628; H.R. 2816; H.R. 1527; H.R. 1163; H.R. 3798; H.R. 3867;
H.R. 4096; and a draft bill, to establish in the Department of Veterans Affairs the Office of Women’s Health, and for
other purposes, 116th Cong., 1st sess., September 11, 2019.
16 U.S. Congress, House Committee on Veterans’ Affairs, Statement of Robert L. Wilkie Secretary Department Of
Veterans Affairs (VA), legislative hearing on H.R. 3495, and a draft bill, to establish a pilot program for the issuance of
grants to eligible entities, 116th Cong., 1st sess., November 20, 2019.
17 See for example, U.S. Congress, House Committee on Veterans’ Affairs, Opening Statement of Ranking Member
Roe, legislative hearing on H.R. 3495, and a draft bill, to establish a pilot program for the issuance of grants to eligible
entities, 116th Cong., 1st sess., November 20, 2019. See House Committee on Veterans’ Affairs Republicans, “ Press
Releases,” November 20, 2019, https://republicans-veterans.house.gov/news/documentsingle.aspx?DocumentID=5550.
18 U.S. Congress, House Committee on Veterans’ Affairs, Opening Statement of Chairman Takano, legislative hearing
on H.R. 3495, and a draft bill, to establish a pilot program for the issuance of grants to eligible entities, 116 th Cong., 1st
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On September 10, 2020, HVAC held a legislative hearing on numerous measures related to
suicide prevention and veterans’ behavioral health, not including H.R. 3495.19 At the hearing, VA
submitted written testimony and strongly opposed the bil s under consideration by HVAC, stating
that many of the bil s and their provisions were very similar to provisions in S. 785:
We note that twelve of the bills on the agenda have provisions with elements that appear
very similar to (or have significant commonality with) those in S. 785, the Commander
John Scott Hannon Veterans Mental Health Care Improvement Act of 2019, which passed
the Senate unanimously by voice vote on August 5, 2020…. VA testified on the introduced
version of S. 785 on May 22, 2019. Through a substantial, wide-ranging effort involving
technical assistance exchanges and discussions over more than a year and a half, VA has
brought clinical, programmatic, and legal expertise to bear with SVAC staff to effect
improvements to the Senate-passed version of S. 785. Many of the bills ... do not reflect
that technical assistance. We ... instead urge the House of Representatives to pass S. 785,
the Commander John Scott Hannon Veterans Mental Health Care Improvement Act of
2019.20
During the 116th Congress, HVAC Chairman Takano adopted a strategy of suicide prevention
general y consistent with the Centers for Disease Control and Prevention’s (CDC’s) Seven Core
Strategies for Suicide Prevention.21 Legislation advanced through the committee by Chairman
Takano largely followed the tenets of this public health approach. On September 14, 2020, the
Veterans Comprehensive Prevention, Access to Care, and Treatment (COMPACT) Act of 2020
(H.R. 8247) was introduced by Chairman Takano. Within H.R. 8247, a significant provision was
the authorization of VA to provide emergent suicide care to eligible veterans without requiring
payment.22 This new requirement expanded upon existing VHA policy that would al ow for
emergent mental health care, but such care was limited to certain individuals and may have
required payment under some circumstances.23 H.R. 8247 did not include any provisions

sess., November 20, 2019. See House Committee on Veterans’ Affairs, “ Chairman T akano: ‘In order to mitigate
veteran suicide, we need new solutions,’” press release, November 20, 2019, https://veterans.house.gov/news/press-
releases/chairman-takano-in-order-to-mitigate-veteran-suicide-we-need-new-solutions.
19 U.S. Congress, House Committee on Veterans’ Affairs, Full Committee Legislative Hearing on H.R.7541; H.R.
7504; H.R. 7784; H.R. 7879; H.R. 7747; H.R. 7888; H.R. 7964; H.R. 3450; H.R. 3788; H.R. 3826; H.R. 6092; H.R.
7469; H.R. 8005; H.R. 8033; H.R. 8084; H.R. 8068; H.R. 8149; H.R. 8148; H.R. 8108; H.R. 8144; H.R. 8145; H.R.
8130; H.R. 8107; H.R. 8147; Discussion Draft - ANS for Veterans’ ACCESS Act; Discussion Draft – Veterans
Com prehensive Prevention, Access to Care, and Treatm ent Act of 2020; Discussion Draft - Ensuring Veterans’ Sm ooth
Transition Act; Discussion Draft - VA Research Technology Act; Discussion Draft - VA High Altitude and Suicide
Research Act; Discussion Draft - VA Expanded Care Hours Act, and Discussion Draft - Veterans Burn Pits Exposure
Recognition Act of 2020, 116th Cong., 2nd sess., September 10, 2020.
20 Statement for the Record Department of Veterans Affairs, U.S. Congress, House Committee on Veterans’ Affairs,
Full Com m ittee Legislative Hearing on H.R.7541; H.R. 7504; H.R. 7784; H.R. 7879; H.R. 7747; H.R. 7888; H.R.
7964; H.R. 3450; H.R. 3788; H.R. 3826; H.R. 6092; H.R. 7469; H.R. 8005; H.R. 8033; H.R. 8084; H.R. 8068; H.R.
8149; H.R. 8148; H.R. 8108; H.R. 8144; H.R. 8145; H.R. 8130; H.R. 8107; H.R. 8147 ; Discussion Draft - ANS for
Veterans’ ACCESS Act; Discussion Draft – Veterans Comprehensive Prevention, Access to Care, and Treatment Act of
2020; Discussion Draft - Ensuring Veterans’ Sm ooth Transition Act; Discussion Draft - VA Research Technology Act;
Discussion Draft - VA High Altitude and Suicide Research Act; Discussion Draft - VA Expanded Care Hours Act, and
Discussion Draft - Veterans Burn Pits Exposure Recognition Act of 2020, 116th Cong., 2nd sess., September 10, 2020.
21 Deb Stone, Kristin Holland, Brad Bartholow, et al., Preventing Suicide: A Technical Package of Policy, Programs,
and Practices, Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease
Control and Prevention (CDC), Atlanta, GA, 2017, https://www.cdc.gov/violenceprevention/pdf/
suicideT echnicalPackage.pdf.
22 38 U.S.C. §1720J.
23 For more information, see CRS Report R42747, Health Care for Veterans: Answers to Frequently Asked Questions.
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authorizing a suicide prevention grant program or provisions related to the suicide prevention
grant program included in H.R. 3495 and S. 785.
In a compromise between SVAC and HVAC,24 the Commander John Scott Hannon Veterans
Mental Health Care Improvement Act of 2019 (Hannon Act; P.L. 116-171) and the Veterans
Comprehensive Prevention, Access to Care, and Treatment Act of 2020 (Veterans COMPACT
Act; P.L. 116-214) were enacted at the end of the 116th Congress. Although the bil s are separate,
they complement each other in their efforts to increase access to and the quality of VHA mental
health and suicide prevention services.
Brief Overview of the Commander John Scott Hannon Veterans
Mental Health Care Improvement Act of 2019 (Hannon Act; P.L.
116-171)
The Hannon Act, enacted on October 17, 2020, was named after Commander John Scott Hannon,
a Navy SEALs member who served in the U.S. Navy for 23 years and died by suicide.25 Divided
into seven titles, this legislation addresses five key areas, as stated by its co-sponsors, Senators
Jon Tester and Jerry Moran.26 These areas include the following:
1. Providing more assistance for servicemembers transitioning from the military
(Title I: Improvement of Transition of Individuals to Services from Department
of Veterans Affairs).
2. Increasing access to mental health care and suicide prevention services for al
veterans, and in particular, veterans living in rural areas (Title II: Suicide
Prevention; Title VI: Improvement of Care and Services for Women Veterans;
Title VII: Other Matters).
3. Strengthening VHA’s mental health workforce (Title V: Improvement of Mental
Health Medical Workforce; Title VII: Other Matters).
4. Oversight of VHA’s mental health and suicide prevention services (Title IV:
Oversight of Mental Health Care and Related Services).
5. Investment and study into mental health treatment, including alternative and
complementary treatment approaches (Title II: Suicide Prevention; Title III:
Programs, Studies, and Guidelines on Mental Health; Title VII: Other Matters).
Brief Overview of the Veterans Comprehensive Prevention, Access
to Care, and Treatment Act of 2020 (Veterans COMPACT Act; P.L.
116-214)
The Veterans COMPACT Act was enacted on December 5, 2020. The bil is divided into three
titles and features nine provisions adapted from bil s original y introduced by different committee

24 U.S. Congress, Senate Committee on Veterans’ Affairs, “ Senator Moran Applauds Deal to Pass Landmark Veteran
Mental Health & Suicide Prevention Legislation ,” September 22, 2020, https://www.veterans.senate.gov/newsroom/
news/senator-moran-applauds-deal-to-pass-landmark-veteran-mental-health-and-suicide-prevention-legislation.
25 U.S. Senator Jon T ester, “T ester’s Groundbreaking Commander John Scott Hannon Veterans Mental Health and
Suicide Prevention Bill Signed into Law,” October 17, 2020, https://www.tester.senate.gov/?p=press_release&id=7817.
26 U.S. Senator Jon T ester, “ T ester, Moran Introduce Landmark Veterans Mental Health and Suicide Prevention Bill,”
March 13, 2019, https://www.veterans.senate.gov/newsroom/minority-news/tester-moran-introduce-landmark-veterans-
mental-health-and-suicide-prevention-bill.
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members to help prevent veteran suicide. The three key themes, as organized by title, include the
following:
1. Improving the transition to VHA services by helping veterans build networks of
support and tracking VA’s outreach to transitioning servicemembers (Title I:
Improvement of Transition of Individuals to Services from the Department of
Veterans Affairs).
2. Improving VA’s response to veteran suicide by providing acute crisis care for
emergent suicide symptoms and outreach to certain at-risk veterans, creating new
programs, and requiring annual VA police crisis intervention training (Title II:
Suicide Prevention).
3. Improving care and services for women veterans by conducting a gap analysis of
VA programs providing assistance to homeless women veterans and requiring a
report on locations where women veterans are using VHA care (Title III:
Improvement of Care and Services for Women Veterans).
Scope of Report
This CRS report summarizes the provisions of the Hannon Act and the Veterans COMPACT Act.
The report does not provide a comprehensive analysis of every provision in these acts; rather, it
provides a brief background and summary of such provisions. The report is organized by each
respective law, starting with the Hannon Act. Each bil is summarized by title and subsequent
provisions within the titles. The report reflects the Hannon Act and the Veterans COMPACT Act
at enactment and wil not track actions pursuant to required deadlines, nor wil this report be
updated.
SVAC and HVAC did not produce written reports or release an explanatory statement in the
Congressional Record to accompany the Hannon Act or the Veterans COMPACT Act at the time
of passage. Therefore, for some provisions in which either committees’ legislative background
was not clear, CRS, where applicable, approximates legislative background by providing
contextual information based on testimony at committee hearings, hearing transcripts, or earlier
or alternative versions of the bil s with identical provisions, among other sources. The
background provided for provisions described in this report should not be used as the official
legislative intent of those provisions.
Throughout this report, unless otherwise stated, “the Secretary” refers to the Secretary of Veterans
Affairs, and “department” or “VA” means the U.S. Department of Veterans Affairs. Other
commonly used acronyms in this report are listed in Table 1. In addition, “this section” refers to
matters addressed under that specific action of the act, unless otherwise noted.
Table 1. Acronyms Used in This Report
CBO
Congressional Budget Office
CBOC
Community-Based Outpatient Clinic
CCI
Center for Compassionate Innovation
CDC
Centers for Disease Control and Prevention
C.F.R.
Code of Federal Regulations
CIH
Complementary and Integrative Health
COVER
Creating Options for Veterans’ Expedited Recovery Commission
CPG
Clinical Practice Guideline
DOD
Department of Defense
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DHS
Department of Homeland Security
FDA
Food and Drug Administration
GAO
Government Accountability Office
HBOT
Hyperbaric Oxygen Therapy
HHS
Department of Health and Human Services
HIPAA
Health Insurance Portability and Accountability Act of 1996
HVAC
House Committee on Veterans’ Affairs
LGBTQ
Lesbian, Gay, Bisexual, Transgender, or Queer
LPMHC
Licensed Professional Mental Health Counselor
MILCON-VA
Senate and House Committees on Appropriations, Subcommittees on Military
Construction, Veterans Affairs, and Related Agencies
MFT
Marriage and Family Therapist
NAMI
National Al iance on Mental Il ness
NAL
Nurse Advice Line
NASEM
National Academies of Sciences, Engineering, and Medicine
NCA
National Cemetery Administration
NIMH
National Institute of Mental Health
NIST
National Institute of Science and Technology
OMHSP
Office of Mental Health and Suicide Prevention
OPM
U.S. Office of Personnel Management
OTH
Other Than Honorable
PACT
Patient-Aligned Care Team
PREVENTS
President’s Roadmap to Empower Veterans and End a National Tragedy of Suicide
PTSD
Posttraumatic Stress Disorder
REACH VET
Recovery Engagement and Coordination for Health—Veterans Enhanced Treatment
RCS
Readjustment Counseling Service
SAFE VET
Suicide Assessment and Fol ow-up Engagement: Veteran Emergency Treatment
SAMHSA
Substance Abuse and Mental Health Services Administration
SMI
Serious Mental Il ness
SPC
Suicide Prevention Coordinator
SPED
Safety Planning in Emergency Departments
SVAC
Senate Committee on Veterans’ Affairs
TBI
Traumatic Brain Injury
U.S.C.
United States Code
VA
Department of Veterans Affairs
VAMC
Veterans Affairs Medical Center
VBA
Veterans Benefits Administration
VCCP
Veterans Community Care Program
VCL
Veterans Crisis Line
VHA
Veterans Health Administration
VISN
Veterans Integrated Service Network
VSO
Veterans Service Organization
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Budgetary Impact
This report does not discuss cost estimates for al provisions; however, the Congressional Budget
Office (CBO) provided a cost estimate of the Hannon Act.27 Overal , the Hannon Act is expected
to increase federal deficits by $277 mil ion over the 2020-2025 year period. The estimate breaks
down outlays into the following categories:
 mental health research,
 suicide prevention,
 hearing aid specialists,
 telehealth,
 treatment guidelines,
 scholarships for readjustment counselors,
 mental health programs,
 pilot program on nontraditional therapy, and
 reports and studies.
The most significant spending would result from the mental health research and suicide
prevention categories. Regarding mental health research, Section 305 of the Hannon Act requires
VA to collect medical information from veterans receiving VHA care and to make anonymized
data available to VA and non-VA researchers. CBO estimates that this effort would cost $94
mil ion from 2020 to 2025. Regarding suicide prevention, Section 201 of the Hannon Act requires
VA to award grants to certain community-based organizations that wil provide suicide prevention
services for veterans and their families. CBO estimates that implementing this effort, including
program expenses beyond awarding of the grants, would cost $80 mil ion from 2020 to 2025.
At the time of this report’s publication, CBO has not yet provided a cost estimate for the Veterans
COMPACT Act. However, CBO has provided cost estimates for legislation with similar intent.
For example, the Sergeant Daniel Somers Veterans Network Support Act of 2019 was introduced
and passed by the Senate in the 116th Congress.28 The bil is identical to Section 101 of the
Veterans COMPACT Act, which requires the Secretary to establish a pilot program that would
al ow veterans, before separating from service, to select up to 10 people, to whom VA would
provide information regarding VA services and benefits. CBO estimates that implementing this
pilot program would cost $2 mil ion over the 2020 to 2025 period.29

27 Congressional Budget Office (CBO), “At a Glance: S. 785, Commander John Scott Hannon Veterans Mental Health
Care Improvement Act of 2019,” March 23, 2020, https://www.cbo.gov/system/files/2020-03/s0785.pdf.
28 S. 2864 (116th Congress).
29 Congressional Budget Office, “ S. 2864, Sergeant Daniel Somers Veterans Network Support Act of 2019 ,” February
19, 2020, https://www.cbo.gov/system/files/2020-02/s2864.pdf.
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Provisions in the Commander John Scott Hannon
Veterans Mental Health Care Improvement Act of
2019
Title I: Improvement of Transition of Individuals to Services from
Department of Veterans Affairs
The period of transition from active duty military service to veteran status is a time of heightened
risk for suicide.30 Studies have shown that “most suicide attempts by those who are or wil
become veterans occur following separation from military service.”31 This title includes
provisions to address the risk associated with this period. Such provisions include requiring VA to
(1) develop and make public a strategic plan on the provision of VA health care to any veteran
during a one-year period following the discharge or release of the veteran from active duty; (2)
review records of former servicemembers who have died by suicide within the year following
separation; and (3) submit and develop reports on relevant VHA suicide prevention programs.
Section 101: Strategic Plan on Expansion of Health Care Coverage for Veterans
Transitioning from Service in the Armed Forces
Background
VA reports that “veterans are most vulnerable in the first three months following separation from
military service, although suicide risk remains elevated for years after the transition.”32
Furthermore, VA has stated that the first 12 months after separation from service is a period
marked by a high risk for suicide.33 On January 9, 2018, President Trump signed Executive Order
(EO) 13822, “Supporting our Veterans During Their Transition from Uniformed Service to
Civilian Life,” which mandated the creation of a Joint Action Plan by VA, DOD, and the
Department of Homeland Security (DHS) to provide transitioning servicemembers with seamless
access to mental health treatment and suicide prevention resources for at least one year following
their discharge, separation, or retirement. Based on this mandate, VA began to implement
programs to assist newly discharged veterans to enroll in the VA health care system.34 However,

30 Department of Veterans Affairs, 2019 Annual Report: VA Mental Health Program and Suicide Prevention Services
Independent Evaluation, October 2019, p. 188.
31 Department of Veterans Affairs, Help with Readjustment and Social Support Needed for Veterans Transitioning from
Military Service, From Science to Practice, Using Research to Promote Safety and Prevent Suicide, 2019,
https://www.mentalhealth.va.gov/suicide_prevention/docs/Literature_Review_Military_Separation_508_FINAL_05 -
24-2019.pdf.
32 Department of Veterans Affairs, Help with Readjustment and Social Support Needed for Veterans Transitioning from
Military Service, From Science to Practice, Using Research to Promote Safety and Prevent Suicide, 2019,
https://www.mentalhealth.va.gov/suicide_prevention/docs/Literature_Review_Military_Separation_508_FINAL_05 -
24-2019.pdf.
33 U.S. Congress, House Committee on Veterans’ Affairs, Caring for Veterans in Crisis: Ensuring a Comprehensive
Health System Approach, Statement of Ms. Renee Oshinski, Deputy Under Secretary for Health for Operations and
Management, Department of Veterans Affairs, Veterans Health Administration, 116 th Cong., 2nd sess., January 29,
2020.
34 U.S. Congress, House Committee on Veterans;’ Affairs, Caring for Veterans in Crisis: Ensuring a Comprehensive
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veterans would stil need to meet the basic eligibility criteria for enrollment, such as (1) meeting
the statutory definition of a “veteran,” meaning an “individual who served in the active military,
naval, or air service and who was discharged or released under conditions other than
dishonorable”;35 (2) meeting the statutory definition of “active duty,” meaning full-time duty in
the Armed Forces, other than active duty for training;36 and (3) having served a minimum period
of 24 months of continuous active duty, among other factors.37 There are several exceptions and
special rules to these basic eligibility criteria.38
Provision
Section 101(a) requires the Secretary, no later than one year after the date of the enactment (i.e.,
October 17, 2021), to submit a strategic plan to SVAC and HVAC on the provision of VA health
care to any veteran during a one-year period following the discharge or release of the veteran
from active duty. The strategic plan must also be published on the VA website. In developing this
strategic plan, the Secretary is required to consult with the Secretary of Defense. The strategic
plan must include the following elements:
 an identification of general goals and objectives for the provision of health care
to recently discharged or released veterans;
 a description of how such goals and objectives could be achieved, including,
among other things, a description of the use of existing personnel, information,
technology, facilities, public and private partnerships; a description of the
anticipated need for additional resources; and associated costs;
 an analysis of the anticipated health care needs, including mental health care, for
such veterans, separated by geographic area;
 an analysis of whether recently discharged or released veterans are eligible to
enroll in the VA health care system;
 a description of activities designed to promote the availability VA health care,
including outreach to members of the Armed Forces though the Transition
Assistance Program (TAP);39
 a description of legislative or administrative action required to implement the
strategic plan; and
 a description of how the strategic plan would further the ongoing initiatives of
EO 13822, “Supporting our Veterans During Their Transition from Uniformed
Service to Civilian Life,” signed by President Trump on January 9, 2018.

Health System Approach, Statement of Ms. Renee Oshinski, 116th Cong., 2nd sess., January 29, 2020.
35 38 U.S.C. §101(2). Section 926 of the William M. (Mac) T hornberry National Defense Authorization Act for Fiscal
Year 2021 (P.L. 116-283) amended the term “ veteran” to include “ space service.” T he Office of the Law Revision
Counsel of the U.S. House of Representatives has not codified this change as of the date of this report.
36 38 U.S.C. §101(21).
37 38 U.S.C. §5303A or exceptions at 38 U.S.C. §5303A(b)(3).
38 For more information on current eligibility and enrollment in the VA health care system, see CRS Report R42747,
Health Care for Veterans: Answers to Frequently Asked Questions.
39 For more information about the T ransition Assistance Program, see CRS In Focus IF10347, Military Transition
Assistance Program (TAP): An Overview.
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Section 102: Review of Records of Former Members of the Armed Forces Who
Die by Suicide Within One Year of Separation from the Armed Forces
Background
Since at least 2005, suicide rates among military and veteran populations have consistently been
higher than those among U.S. general population. During calendar year 2018, the Department of
Defense (DOD) recorded the following suicide rates among different military populations: 24.9
per 100,000 for active duty servicemembers, 22.9 per 100,000 for reservists,40 and 30.8 per
100,000 for members of the National Guard.41 During calendar year 2018, VA recorded a suicide
rate of 27.5 per 100,000 among veterans.42 In comparison, the suicide rate for the (nonveteran)
U.S. general population was 18.2 per 100,000 during the same time period.43 Suicide and suicidal
ideation has remained a top issue of concern for both DOD and VA. 44 In recent years, Congress
has authorized numerous provisions to enhance DOD and VA suicide prevention efforts, improve
data collection and reporting, and expand access to mental health care.
Provision
Section 102 directs the Secretary and Secretary of Defense to review certain military records of
former servicemembers. Section 102(a) defines these servicemembers as those who separated
from the military between October 2015 and October 2020 (i.e., the “five-year period preceding
the date of enactment”) and who died by suicide within one year after separating. The Secretaries
are required to review DOD service treatment records, military training records, and personnel
records to identify and consider certain demographic information and potential or known risk
factors for suicide or suicidal ideation. Risk factors include exposure to violence or suicide,
housing or financial instability, legal or vocational problems, and limited access to health care. In
addition, the review is to identify whether such individuals were referred to the VA’s transition
assistance program (i.e., Solid Start).45 DOD and VA are to submit a report to the House and
Senate Committees on Armed Services, SVAC, and HVAC, no later than three years after
enactment (i.e., October 17, 2023), providing aggregated results of their review of former
servicemember records.

40 Excludes members of the National Guard.
41 Department of Defense, Annual Suicide Report, Calendar Year 2019, August 20, 2020, p. 10, https://www.dspo.mil/
Portals/113/Documents/CY2019%20Suicide%20Report/
DoD%20Calendar%20Year%20CY%202019%20Annual%20Suicide%20Report.pdf .
42 Department of Veterans Affairs, National Veteran Suicide Prevention Annual Report, 2020, p. 5,
https://www.mentalhealth.va.gov/docs/data-sheets/2020/2020-National-Veteran-Suicide-Prevention-Annual-Report-11-
2020-508.pdf.
43 Department of Veterans Affairs, National Veteran Suicide Prevention Annual Report, 2020, p. 5.
44 VA and DOD define suicidal ideation as “thoughts of engaging in suicide-related behavior.” Department of Veterans
Affairs, “VA/DoD Clinical Practice Guideline for Assessment and Management of Patients at Risk for Suicide,” May
2019, p. 63, https://www.healthquality.va.gov/guidelines/MH/srb/VADoDSuicide RiskFullCP GFinal5088212019.pdf.
For more on DOD suicide prevention and response, see CRS In Focus IF10876, Military Suicide Prevention and
Response.
45 Solid Start is a VA-administered transition assistance program that conducts outreach to newly separated
servicemembers. T he program offers new veterans education and assistance with accessing certain VA benefits. For
more on Solid Start, see https://benefits.va.gov/transition/solid-start.asp.
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Section 103: Report on REACH VET Program of Department of
Veterans Affairs
Background
The Recovery Engagement and Coordination for Health—Veterans Enhanced Treatment
(REACH VET) program was launched across VA Medical Centers (VAMCs) in April 2017 and is
run by the Office of Mental Health and Suicide Prevention (OMHSP).46 The program is intended
to help VHA predict which veterans may be at the highest risk for suicide or other related adverse
outcomes. Using a statistical algorithm, REACH VET analyzes existing data such as
demographics, use of VA services, and medications to identify veterans at the highest risk of
suicide in the next month.47 If a veteran is identified, a REACH VET coordinator subsequently
identifies the clinician closest to the veteran who wil then check on the veteran and review the
treatment plan to determine if additional care is needed.
Preliminary VA analyses regarding the impact of REACH VET suggest that the program is
associated with fewer inpatient mental health admissions and lower al -cause mortality, among
other outcomes.48 According to VA, REACH VET has identified more than 65,000 veterans since
it began in 2017.49 However, many of these data are preliminary, as evaluation studies are stil
underway.50 In addition, the methods used to generate such data are not always made publicly
available.
Provision
Section 103 requires the Secretary, no later than 180 days after enactment (i.e., April 15, 2021), to
submit to SVAC and HVAC a report on the REACH VET program. The report is required to
include an assessment of the impact of the REACH VET program on rates of suicide among
veterans and a detailed explanation, with evidence, for why conditions included in the REACH
VET were chosen, among other information.
Section 104: Report on Care for Former Members of the Armed Forces with
Other than Honorable Discharge
Background
Section 258 of the Military Construction, Veterans Affairs, and Related Agencies Appropriations
Act, 2018 (P.L. 115-141, as amended by P.L. 115-182 and P.L. 115-251; 38 U.S.C. §1720I),

46 Department of Veterans Affairs, “ Study evaluates VA program that identifies Vets at highest risk for suicide,”
https://www.research.va.gov/currents/0918-Study-evaluates-VA-program-that-identifies-Vets-at-highest-risk-for-
suicide.cfm.
47 Department of Veterans Affairs, FY2021 Congressional Budget Submission, Volume II: Medical Programs and
Inform ation Technology Programs, p. VHA-68, https://www.va.gov/budget/docs/summary/
fy2021VAbudgetVolumeIImedicalProgramsAndInformationT echnology.pdf .
48 Department of Veterans Affairs, “ Study evaluates VA program that identifies Vets at highest risk for suicide,”
https://www.research.va.gov/currents/0918-Study-evaluates-VA-program-that-identifies-Vets-at-highest-risk-for-
suicide.cfm.
49 Department of Veterans Affairs, FY2021 Congressional Budget Submission, Volume II: Medical Programs and
Inform ation Technology Programs, p. VHA-68, https://www.va.gov/budget/docs/summary/
fy2021VAbudgetVolumeIImedicalProgramsAndInformationT echnology.pdf .
50 U.S. National Library of Medicine, “ REACH VET Program Evaluation (REACH VET ),” https://clinicaltrials.gov/
ct2/show/NCT 03280225.
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authorized VA to provide an initial mental health care assessment and subsequent mental or
behavioral health care services to certain former servicemembers, including those who served in
the Reserve components and who meet each of the following criteria:
 Conditions of discharge: the veteran served on active duty and was discharged
or released under a condition that is not honorable (but not a dishonorable
discharge), or was discharged by court-martial (i.e., those with a dishonorable
discharge or a discharge by court-martial would not be eligible for mental health
care services from VA).
 Duration of service: the veteran served for a period of more than 100
cumulative days.
 Conditions of service: the veteran (1) was deployed in a theater of combat
operations, in support of a contingency operation, or in an area at a time during
which hostilities occurred, including by controlling an unmanned aerial vehicle
(UAV) from a location other than such theater or area; or (2) was the victim of a
physical assault of a sexual nature, a battery of a sexual nature, or sexual
harassment.
 Not currently enrolled in VA’s health care system.51
Those veterans with an other than honorable (OTH) administrative discharge and who meet the
above criteria are not required to enroll in VA’s health care system, to meet the minimum active
duty service requirements, or to pay any copayments for mental and behavioral health care
services included under VA’s standard medical benefits package.52
The Secretary is required to submit a report at least once annual y to SVAC and HVAC on the
services provided under this authority.53
Provision
Section 104 amends the reporting requirements under 38 U.S.C. §1720I to specify that the annual
report be submitted no later than February 15. In addition, the section prescribes three additional
requirements for the annual report, which must specify (1) the types of mental or behavioral
health care needs treated; (2) the demographics of individuals treated including age, era of service
in the Armed Forces, branch of service in the Armed Forces, and geographic location; and (3) the
average number of visits of individuals who were provided mental or behavioral health care.
Title II: Suicide Prevention
In 2018, the suicide rate for veterans was 1.5 times greater than among nonveteran adults
(adjusting for age and sex), and an average of 17.6 veterans died by suicide per day.54 VA has

51 38 U.S.C. §1720I.
52 Department of Veterans Affairs, Veterans Health Administration, “Eligibility Determination,” VHA Directive
1601A.02, amended October 15, 2020.
53 38 U.S.C. §1720I(f).
54 Office of Mental Health and Suicide Prevention, 2020 National Veteran Suicide Prevention Annual Report,
Department of Veterans Affairs, November 2020, p. 5, https://www.mentalhealth.va.gov/docs/data-sheets/2020/2020-
National-Veteran-Suicide-Prevention-Annual-Report-11-2020-508.pdf. Previous VA reports on the suicides per-day
statistic included veterans, current servicemembers, and never federally activated former Guard and Reserve membe rs.
T he 2018 statistic does not include current servicemembers or never federally activated former servicemembers.
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named suicide as its top clinical priority for FY2018 to FY2024,55 while recognizing that
coordinated efforts from different stakeholders and across settings can increase the reach of
veteran suicide prevention activities.56 This title includes provisions to address veteran suicide
through a multifactorial approach. Such provisions include requiring VA to (1) award grants to
certain community-based organizations to provide veteran suicide prevention services to eligible
veterans; (2) examine the feasibility of and increase access to complementary and integrative
health programs; and (3) examine factors potential y related to veteran suicide. In addition, GAO
is required to conduct oversight of VA’s management of veterans at high risk for suicide.
Section 201: Financial Assistance to Certain Entities to Provide or Coordinate
the Provision of Suicide Prevention Services for Eligible Individuals and Their
Families57
Background
As stated elsewhere in this report, the need for community-based engagement to prevent veteran
suicide led to a grant program to address this issue. In its FY2021 budget request to Congress, the
Trump Administration proposed legislation that would al ow VA to provide grants to community-
based organizations to “replicate and/or expand VA suicide prevention services.”58 In addition, the
President’s Roadmap to Empower Veterans and End a National Tragedy of Suicide
(PREVENTS)59 found that
funding initiatives that support a public health approach are vital to empowering Veterans
and preventing suicide at the local level. As existing community -based grants to do this are
limited, additional funding in the short and long term would expand opportunities to
identify new effective strategies and ensure that all communities are provided with
opportunities to create environments where Veterans will thrive. An expanded, Federal
grant program can also assist in meeting the needs of the community by ensuring that
critical data, training, and technical assistance are available and accessible at the program
level.60
PREVENTS recommended developing “a coordinated, interagency Federal funding mechanism
to support, provide resources for, and facilitate the implementation of successful evidence-
informed mental health and suicide prevention programs focused on Veterans and their
communities at the State and local levels.”61

55 Department of Veterans Affairs, FY2018 - 2024 Strategic Plan, May 31, 2019, https://www.va.gov/oei/docs/va2018-
2024strategicplan.pdf.
56 Department of Veterans Affairs, “National Strategy for Preventing Veteran Suicide, 2018 -2028,” p. 13,
https://www.mentalhealth.va.gov/suicide_prevention/docs/Office-of-Mental-Health-and-Suicide-Prevention-National-
Strategy-for-Preventing-Veterans-Suicide.pdf.
57 38 U.S.C. §1720F note.
58 Department of Veterans Affairs, FY2021 Congressional Budget Submission, Volume I: Supplemental Information
and Appendices, Legislative Summary, p. 10.
59 On March 5, 2019, President T rump signed Executive Order (EO) 13861 “ T he President’s Roadmap to Empower
Veterans and End a National T ragedy of Suicide (PREVENT S)” to address veteran suicide in the United States. For
more information, see https://www.va.gov/PREVENT S/EO-13861.asp.
60 Department of Veterans Affairs, President’s Roadmap to Empower Veterans and End a National Tragedy of Suicide
(PREVENTS), June 17, 2020, p. 46.
61 Department of Veterans Affairs, PREVENTS, p. 46.
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Provision
Section 201(a) establishes a new grant program, the Staff Sergeant Parker Gordon Fox Suicide
Prevention Grant Program. The purpose of the grant program 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.”
Financial Assistance and Coordination
Section 201(b) requires the Secretary to award grants to eligible entities to provide or coordinate
the provision of services to eligible individuals and their families to reduce the risk of suicide.
The Secretary is required to implement this grant program, to the extent practicable, in
coordination with PREVENTS and in consultation with VA’s OMHSP.
Award of Grants, Grant Amounts, Intervals of Payment, and Matching Funds
Section 201(c) stipulates that based on the suicide prevention services to be provided by an
eligible entity, and the duration of such services, the Secretary must establish a maximum amount
to be awarded under the grant program and intervals of payment for the administration of the
grant. The maximum amount awarded is limited to no more than $750,000 per grantee per fiscal
year.
Distribution of Grants and Preference
Section 201(d) stipulates criteria the Secretary is required to consider and follow when
distributing grants. The Secretary may prioritize grants to (1) rural communities; (2) tribal lands;
(3) territories of the United States; (4) medical y underserved areas; (5) areas with a high number
or percentage of minority veterans or women veterans; and (6) areas with a high number or
percentage of cal s to the Veterans Crisis Line (VCL). The Secretary is required to ensure that, to
the extent practicable, grants are distributed to (1) areas of the United States that have
experienced high rates of suicide and suicide attempts by eligible individuals, and (2) eligible
entities that can assist eligible individuals at risk of suicide who are not currently receiving health
care furnished by VA. The Secretary may provide grants to eligible entities that furnish services to
eligible individuals and their families in geographical y dispersed areas. Lastly, the Secretary is
required to give preference to eligible entities that have demonstrated the ability to provide or
coordinate suicide prevention services.
Requirements for Receipt of Grants
Section 201(e) requires that each grantee for the provision of suicide prevention services must
notify eligible recipients that such services are being paid for, in whole or in part, by VA. The
section also requires that any suicide prevention plan be developed in consultation with the
eligible recipients and their families. Section 201(e)(3) requires that any grantee coordinate with
the Secretary regarding the provision of clinical services, and inform every veteran who receives
assistance through the grant of the ability to apply for enrollment in the VA health care system. If
a veteran wishes to enroll, the grantee must inform the veteran of a VA point of contact who can
assist with enrollment.62 Section 201(e)(4) stipulates that a grantee must submit to the Secretary a
description of such tools and assessments the entity uses or wil use to determine the effectiveness
of the suicide prevention services furnished. The description must also include measures and
metrics on the effectiveness of the programming being provided, and may include the effect of
the services furnished on the financial stability of the individual; the mental health status,

62 For more information on current eligibility and enrollment in the VA health care system, see CRS Report R42747,
Health Care for Veterans: Answers to Frequently Asked Questions.
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wel being, and suicide risk of the individual; and the social support of the individuals receiving
those services. Under Section 201(e)(5), the Secretary shal require each grantee to submit an
annual report to the Secretary that describes the grant projects carried out during the year covered
by the report. The report must include evaluation criteria and data, as specified by the Secretary,
and the Secretary may require additional reports, as appropriate.
Application for Grants
Section 201(f) stipulates that an entity seeking a grant is required to submit to the Secretary an
application in such form and manner as prescribed by Secretary. Each application submitted by an
eligible applicant must include the following:
 a description of proposed suicide prevention services, and the need for those
services;
 a detailed plan describing how the applicant proposes to coordinate or deliver
suicide prevention services, including
 identification of the community partners, if any, with which the applicant
proposes to work in delivering suicide prevention services;
 a description of the arrangements currently in place between the
applicant and community partners with regard to the provision or
coordination of suicide prevention services;
 identification of the duration of those partnerships, and a description of
the suicide prevention services provided by community partners, if any;
and
 identification of local VA suicide prevention coordinators (SPCs) and a
description of how the applicant wil communicate with VA SPCs;
 a description of the number of eligible individuals and their families that would
be provided suicide prevention services;
 an estimate of the number of eligible individuals at risk of suicide and their
families that wil be provided suicide prevention services, including the
percentage of those eligible individuals who are not currently receiving care
provided by VA;
 evidence of measurable outcomes related to reductions in suicide risk and mood-
related symptoms using validated instruments by the applicant (the applicant’s
community partners, if any);
 a description of the managerial and technological capacity of the applicant,
including the following:
 to coordinate the provision of suicide prevention services;
 to assess on an ongoing basis the needs of eligible individuals and their
families for suicide prevention services;
 to coordinate the provision of suicide prevention services with the
services provided by VA;
 to adapt suicide prevention services to the needs of eligible individuals
and their families;
 to seek continuously new sources of assistance to ensure the continuity
of suicide prevention services for eligible individuals and their families
as long as they are determined to be at risk of suicide; and
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 to measure the effects of suicide prevention services provided by the
applicant or partner organization, on the lives of eligible individuals and
their families who receive such services provided by the organization
using pre- and post-evaluations on validated measures of suicide risk and
mood-related symptoms;
 clearly defined objectives for the provision of suicide prevention services;
 a description and physical address of the primary location of the applicant;
 a description of the geographic area the applicant plans to serve during the grant
award period for which the application applies;
 if the applicant is a state or local government or an Indian tribe, the amount of
grant funds proposed to be made available to community partners, if any, through
agreements;
 a description of how the applicant wil assess the effectiveness of the provision of
grant funds;
 an agreement that the applicant would use the measures and metrics provided by
VA; and
 any additional application criteria as prescribed the Secretary.
Training and Technical Assistance
Section 201(g) requires the Secretary to provide technical assistance and training in coordination
with the Centers for Disease Control and Prevention (CDC) to grantees (or eligible entities in
receipt of a grant). The technical assistance and training is to involve suicide risk identification
and management, required data collection and sharing, familiarization with appropriate data
collection tools, and assistance with data collections for annual reporting requirements, among
other things. The Secretary may provide this technical assistance and training directly or by
entering into contracts with public or nonprofit entities.
Administration of Grant Program
Section 201(h) requires the Secretary to establish criteria for the selection of grantees, in
consultation with numerous entities such as veteran service organizations (VSOs), tribal al iances,
state departments of veterans affairs, the National Al iance on Mental Il ness (NAMI), certain
federal agencies, and institutions of higher education that have expertise in creating measurement
criteria, among other entities and organizations. The section also requires the Secretary to
develop, in consultation with those same entities, a framework for collecting and sharing
information about grantees to improve the services available for eligible individuals and their
families based on service type, locality, and eligibility criteria, as wel as measures and metrics to
be used by the grantees to determine the effectiveness of the services they are providing. Section
201(h)(4) requires the Secretary, no later than 30 days before the notification of the availability of
grant funding, to provide a report to SVAC, HVAC, and MILCON-VA on the criteria for the
award of a grants.
Information on Potential Eligible Individuals
Section 201(i) al ows the Secretary to provide eligible grantees information about potential
eligible individuals. This information may include veteran status and enrollment status in the VA
health care system, including whether they are currently receiving care through VA. The
Secretary must al ow veterans to opt out of having their information shared with eligible grantees.
Duration of the Grant Program
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Section 201(j) stipulates that the Secretary is not authorized to award grants on the date that is
three years after the date on which the first grant is awarded.
Reporting
Section 201(k) requires the Secretary to submit an interim report to SVAC, HVAC, and
MILCON-VA no later than 18 months after the date on which the first grant is awarded. This
report must include the following information:
 an assessment of the effectiveness of the grant program;
 a list of grantees, and the amount of each grant awarded;
 the number of eligible individuals supported by each grantee, including services
provided to family members;
 the number of eligible individuals not receiving VA care;
 the number of eligible individuals who received a baseline assessment about their
mental health status, wel -being, and suicide risk, and who wil be measured for
any improvements over time;
 the types of data VA was able to collect;
 the number and percentage of eligible individuals referred for enrollment in the
VA health care system;
 the number of eligible individuals newly enrolled in the VA health care system
based on such referral;
 a detailed account of grant expenditures, including executive compensation,
overhead costs, and other indirect costs;
 a description of any outreach activities conducted by the grantees; and
 the number of ineligible individuals who seek services under the grant program.
Furthermore, Section 201(k)(2) stipulates that the Secretary is required to submit a final report to
SVAC, HVAC, and MILCON-VA no later than three years after the award of the first grant and
then annual y for the duration of the grant program. The final report would be a follow-up to the
interim report submitted previously, and would include additional information regarding the
effectiveness of the grant program, an assessment of VA’s capacity to provide services to eligible
individuals, feasibility and advisability of extending or expanding the grant program, and any
other relevant information.
Third-Party Assessment
Section 201(l) requires the Secretary, no later than 180 days after the start of the grant program, to
enter into a contract with a nongovernment entity with experience in evaluating organizations that
deliver suicide prevention programs. The contracted entity must evaluate the effectiveness of the
grant program and compare the results of the grant program to other national programs. The
contracted entity must provide this assessment to the Secretary no later than 24 months after the
start of the grant program. Upon receipt of the assessment the Secretary is required to provide a
copy to SVAC, HVAC, and MILCON-VA.
Referral for Care
Section 201(m) stipulates that if a grantee determines that an eligible individual is at risk of
suicide or another mental or behavioral health condition, that individual must be referred to VA
for additional care. The section also stipulates that if a grantee determines that an eligible
individual is provided emergency care and that individual needs further care and services, that
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individual must also be referred to VA for further treatment. If the individual declines the referral
to VA, any ongoing clinical care provided wil be at the expense of the grantee.
Provision of Care to Eligible Individuals
Section 201(n) requires the Secretary, if clinical y appropriate, to provide an initial mental health
assessment and mental health or behavioral health care services through the VA health care
system for individuals who are receiving services through the grant program and are referred for
care.
Agreements with Community Partners
Section 201(o) al ows state or local government or Indian tribe grantees to use grant funds to
enter into contracts with community partners for the provision of suicide prevention services.
Authorization of Appropriations
Section 201(p) authorizes a total of $174 mil ion to be appropriated for FY2021 through FY2025.
Definitions
Section 201(q) defines the following terms applicable to the Staff Sergeant Parker Gordon Fox
Suicide Prevention Grant Program.
Appropriate committees of Congress. SVAC, HVAC, MILCON-VA.
Eligible Entity. (1) “an incorporated private institution or foundation in which no part of the net
earnings of which incurs to the benefit of any member, founder, contributor, or individual; and
that has a governing board that would be responsible for the operation of the suicide prevention
services”, (2) a corporation wholly owned and controlled by an organization in which no part of
the net earnings incurs to the benefit of any member, founder, contributor, or individual, and that
has a governing board that would be responsible for the operation of the suicide prevention
services, (3) an “Indian tribe”, (4) “a community-based organization that can effectively network
with local civic organizations, regional health systems, and other settings where eligible
individuals and their families are likely to have contact”, or (5) a “State or local government.”
Eligible Individual. A person at risk of suicide “who served in the active military, naval, or air
service, and who was discharged or released therefrom under conditions other than
dishonorable”;63 or former servicemembers, including those who served in the Reserve
components and who meet each of the following criteria:64
 Conditions of discharge: the veteran served on active duty and was discharged or
released under a condition that is not honorable (but not a dishonorable
discharge), or was discharged by court-martial (i.e., those with a dishonorable
discharge or a discharge by court-martial would not be eligible for mental health
care services from VA).
 Duration of service: the veteran served for a period of more than 100 cumulative
days.
 Conditions of service: the veteran (1) was deployed in a theater of combat
operations, in support of a contingency operation, or in an area at a time during
which hostilities occurred, including by controlling an unmanned aerial vehicle

63 38 U.S.C. §101(2). Section 926 of the William M. (Mac) T hornberry National Defense Authorization Act for Fiscal
Year 2021 (P.L. 116-283) amended the term “ veteran” to include “ space service.” T he Office of the Law Revision
Counsel of the U.S. House of Representatives has not codified this change as of the date of this report.
64 38 U.S.C. §1720I(b).
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(UAV) from a location other than such theater or area, or (2) was the victim of a
physical assault of a sexual nature, a battery of a sexual nature, or sexual
harassment.
 Not currently enrolled in VA’s health care system.
Additional criteria include the following:
Any individual who is a veteran or member of the Armed Forces, including a member of a
reserve component of the Armed Forces, who served on active duty in a theater of combat
operations or an area at a time during which hostilities occurred in that area.65
Any individual who is a veteran or member of the Armed Forces, including a member of a
reserve component of the Armed Forces, who provided direct emergency medical or mental
health care, or mortuary services to the causalities of combat operations or hostilities, but
who at the time was located outside the theater of combat operations or area of hostilities.66
Any individual who is a veteran or member of the Armed Forces, including a member of a
reserve component of the Armed Forces, who engaged in combat with an enemy of the
United States or against an opposing military force in a theater of combat operations or an
area at a time during which hostilities occurred in that area by remotely controlling an
unmanned aerial vehicle, notwithstanding whether the physical location of such veteran or
member during such combat was within such theater of combat operations or area.67
Any individual who is a veteran or member of the Armed Forces, including a member of a
reserve component of the Armed Forces, who served
 on active service in response to a national emergency or major disaster declared
by the President; or
 in the National Guard of a State under orders of the chief executive of that State
in response to a disaster or civil disorder in such State.”68
Emergency Treatment. Medical services, professional services, ambulance services, ancil ary
care and medication rendered in a medical emergency in which it could be reasonably expected
that absence of immediate medical attention would result in serious health consequences.
Family. Family includes a parent, a spouse, a child, a sibling, a step-family member, an extended
family member, or any other individual who lives with the eligible individual.
Indian Tribe. “Any Indian tribe, band, nation, or other organized group or community of Indians,
including any Alaska Native vil age or regional or vil age corporation as defined in or established
pursuant to the Alaska Native Claims Settlement Act, that is recognized as eligible for the special
programs and services provided by the United States to Indians because of their status as Indians
pursuant to the Indian Self-Determination and Education Assistance Act of 1975.”69
Risk of Suicide. Exposure to, or the existence of, any of the following risk factors: mental health
chal enges; substance abuse; serious or chronic health conditions or pain; traumatic brain injury;
prolonged stress; stressful life events; unemployment; homelessness; recent loss; legal or
financial chal enges; previous suicide attempts; family history of suicide; history of abuse,

65 38 U.S.C. §1712A(a)(1)(C)(i).
66 38 U.S.C. §1712A(a)(1)(C)(ii).
67 38 U.S.C. §1712A(a)(1)(C)(iii).
68 38 U.S.C. §1712A(a)(1)(C)(iv).
69 Section 4 of the Native American Housing Assistance and Self-Determination Act (NAHASDA, P.L. 104-330); 25
U.S.C. §4103.
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neglect, or trauma. The Secretary may establish a process for determining degrees of suicide risk
through regulation.
Rural. Rurality as defined by the Rural-Urban Commuting Areas (RUCA) system.70
Suicide Prevention Services. Suicide prevention services are those that address the needs of
eligible individuals and their families and include, among other things, outreach to identify those
at risk, a baseline mental health screening for risk, peer support services, and other services
necessary for improving mental health status and wel -being of eligible individuals and their
families, including adaptive sports and family counseling.
Veterans Crisis Line (VCL). The VCL is “a toll-free hotline for veterans to be staffed by
appropriately trained mental health personnel and available at al times.”71
Veterans Service Organization (VSO). Organizations recognized by VA to prepare, present, and
prosecute claims.72
Sections 202 and 203: Analysis on Feasibility and Advisability of the
Department of Veterans Affairs Providing Certain Complementary and
Integrative Health Services; Pilot Program to Provide Veterans Access to
Complementary and Integrative Health Programs through Animal Therapy,
Agritherapy, Sports and Recreation Therapy, Art Therapy, and Posttraumatic
Growth Programs
Background
VA has broad authority to offer health services through the standard medical benefits package if it
is determined by appropriate health care professionals that the care is needed to promote,
preserve, or restore the health of the individual and is in accord with general y accepted standards
of medical practice.73 Under this authority, VA has established a vetting process for including
complementary and integrative health (CIH) services in the standard medical benefits process.74
The vetting process considers the following criteria:
 licensing and credentialing;
 clinical practice guidelines, current evidence, community standards, and potential
for harm;
 veteran demand; and
 supports transformation of health care delivery.

70 For more information, see https://www.ers.usda.gov/data-products/rural-urban-commuting-area-codes/.
71 38 U.S.C. §1720F(h).
72 For more information on VSOs, see CRS Report R46412, Veterans Service Organizations (VSOs): Frequently Asked
Questions; and CRS Report R46428, Veterans Accredited Representatives: Frequently Asked Questions.
73 38 C.F.R. §17.38(b).
74 Department of Veterans Affairs, Veterans Health Administration, “Provision of Complementary and Integrative
Health (CIH),” VHA Directive 1137, p. B-1, May 18, 2017.
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Under these criteria, VA has approved a number of CIH approaches for coverage under the VHA
standard medical benefits package (38 C.F.R. §17.38). These include acupuncture, biofeedback,
clinical hypnosis, guided imagery, massage therapy, meditation, Tai Chi/Qi Gong, and yoga.75
Section 931 of the Jason Simcakoski Memorial and Promise Act (Title IX of P.L. 114-198)
established the Creating Options for Veterans’ Expedited Recovery (COVER) Commission,
which was required to examine the evidence-based therapy treatment model used by the Secretary
for treating mental health conditions of veterans and the potential benefits of incorporating CIH
treatments available in nondepartment facilities.76 The COVER Commission published a final
report on February 6, 2020.77
The final report of the COVER Commission made a recommendation to “establish an ongoing
research program focused on testing and implementation of promising adjunctive CIH modalities
associated with positive mental health, functional outcomes, and wel ness that support whole
health and the VA Health Care Transformation Model.”78 This model is the overarching
recommendation of the COVER Commission, and it is intended to transform VA health care
delivery from a reductionist to a whole health person-centered approach.79
Provisions
Section 202 requires the Secretary to complete an analysis on the feasibility and advisability of
providing specified CIH treatments. The Secretary is required to complete the analysis no later
than 180 days from enactment of this act (i.e., April 15, 2021). In addition, this section requires
the Secretary to include an assessment of the COVER Commission final report in the
aforementioned analysis. The Secretary is required to submit a report to SVAC and HVAC on the
analysis that includes recommendations regarding the furnishing of CIH treatments.
Section 203 requires the Secretary to create a pilot program to provide access to specified CIH
programs no later than 180 days after the date on which the COVER Commission submitted its
final report (i.e., July 24, 2020).80 This section specifies that the pilot program provide equine
therapy, other animal therapy, agritherapy, sports and recreation therapy, art therapy, and
posttraumatic growth programs. The pilot program must be conducted at no fewer than five VA
facilities that meet specified criteria. To be eligible for services, veterans must be enrolled in the
VA health care system and have received services within the two-year period preceding the
initiation of the pilot program.81 The Secretary is required to carry out the pilot program for at
least three years and must submit an interim report on program progress to SVAC and HVAC no
later than one year after commencement of the pilot program. The Secretary may extend the
duration of the pilot program beyond three years based on the results of the interim report
indicating that it is appropriate to do so. The interim report is required to include, among other

75 Department of Veterans Affairs, Veterans Health Administration, Office of Patient Centered Care and Cultural
T ransformation, Integrative Health Coordinating Center (IHCC) Fact Sheet, https://www.va.gov/WHOLEHEALT H/
docs/IHCC_FactSheet_508.pdf.
76 38 U.S.C. §1701 note.
77 Creating Options for Veterans Expedited Recovery (COVER) Commission, Final Report, January 24, 2020,
https://www.va.gov/COVER/docs/CO VER-Commission-Final-Report -2020-01-24.PDF. (Hereinafter referred to as
“T he COVER Commission Final Report.”
78 T he COVER Commission Final Report, p. 42.
79 COVER Commission Final Report, p. 71.
80 T he implementation deadline took place prior to enactment of the Hannon Act (October 17, 2020).
81 For information on eligibility and enrollment in VA health care, see CRS Report R42747, Health Care for Veterans:
Answers to Frequently Asked Questions.
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things, the number of participants, the types of therapy offered, an assessment of effectiveness,
and the determination of whether the program wil be extended beyond three years. The Secretary
is required to submit a final report to SVAC and HVAC no later than 90 days after termination of
the pilot program.
Section 204: Department of Veterans Affairs Study of All-Cause Mortality of
Veterans, Including by Suicide, and Review of Staffing Levels of Mental
Health Professionals
Background
Due to combat-related injuries, among other factors, veterans have higher rates of chronic pain,
traumatic brain injury (TBI), posttraumatic stress disorder (PTSD), and other mental health
conditions compared with the civilian population. Opioids are primarily prescribed for acute and
chronic pain treatment. Coupled with the addictive properties of opioids and potential subsequent
transition to other types of harmful opioids (e.g., heroin), increases in prescribing and use from
the late 1990s until approximately 2012—prompted by a desire to improve pain management—
have resulted in high levels of morbidity and mortality among both veteran and civilian
populations. Benzodiazepines are typical y prescribed for anxiety or insomnia, but severe adverse
effects have been associated with chronic use of this medication. Similar to opioids,
benzodiazepine prescribing increased from the late 1990s to approximately 2012, but, unlike for
opioids, prescribing stil remains at high levels. Further, concomitant opioid and benzodiazepine
use is associated with increased rates of unintentional overdose and death, as wel as suicide.82
In a 2013 HVAC hearing on narcotic overprescribing within VHA, Dr. Claudia Bahorik—at the
time, a VHA provider—in her testimony recommended ways to address this issue. Among other
things, she suggested addressing insufficient staffing to more closely monitor veterans receiving
narcotic prescriptions.83 To help monitor narcotic prescriptions, VHA implemented the Opioid
Safety Initiative (OSI) and the Psychotropic Drug Safety Initiative (PDSI) in 2013.84 However,
even with these initiatives, it is not clear to what extent opioid and benzodiazepine co-prescribing
in VHA may have contributed to adverse outcomes among veterans. In response to concerns
regarding overprescribing of these medications within VHA, Congress provided funds to
NASEM in FY2018 “to conduct an assessment of the potential overmedication of veterans during
fiscal years 2010 to 2017 that led to suicides, deaths, mental disorders, and combat-related
traumas.”85 NASEM subsequently published a 2019 assessment that, among other things,
included examples of observational study protocols to estimate the causal effects of opioid and

82 National Academies of Sciences, Engineering, and Medicine, An Approach to Evaluate the Effects of Concomitant
Prescribing of Opioids and Benzodiazepines on Veteran Deaths and Suicides, Washington, DC, 2019, p. 1,
https://www.nap.edu/read/25532/chapter/2.
83 U.S. Congress, House Committee on Veterans’ Affairs, Subcommittee on Health, Between Peril and Promise:
Facing the Dangers of VA’s Skyrocketing Use of Prescription Painkillers to Treat Veterans, 113th Cong., 1st sess.,
October 10, 2013 (Washington: GPO, 2014).
84 National Academies of Sciences, Engineering, and Medicine, An Approach to Evaluate the Effects of Concomitant
Prescribing of Opioids and Benzodiazepines on Veteran Deaths and Suicides, 2019, p. 2, and VA Office of Inspector
General (OIG), Healthcare Inspection Patient Mental Health Care Issues at a Veterans Integrated Service Network 16
Facility, Department of Veterans Affairs, Washington , DC, January 4, 2018, p. 4, https://www.va.gov/oig/pubs/
VAOIG-16-03576-53.pdf.
85 U.S. Congress, House Committee on Appropriations, Subcommittee on Military Construction, Veterans Affairs, and
Related Agencies, Book 2 of 2; Divisions G-L, committee print, 115th Cong., 2nd sess., 2018, p. 1575.
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benzodiazepine co-prescribing on veteran suicides.86 In FY2020 appropriations report language,
Congress directed VA to work with NASEM to implement the study design specified in the 2019
assessment.87
Prior to enactment of the Hannon Act, Congress introduced other legislation in the 116th Congress
to address this issue.88 Among other things, the proposed legislation would have required VA to
review the number of veterans who died by suicide and were prescribed multiple medications in a
five-year period, and provide a description of the efforts of VHA to maintain appropriate mental
health staffing levels.
Provision
Section 204(a) requires the Secretary to enter into an agreement w ith NASEM under which the
Secretary shal collaborate with the National Academies on a revised study design to fulfil the
goals of the 2019 study design, evaluating the effects of opioids and benzodiazepines on al -cause
mortality of veterans, including suicide, among other things. As required by Section 204(d), the
Secretary shal brief SVAC and HVAC on the interim results no later than two years after entering
into the agreement with NASEM. Section 204(e)(1) requires the Secretary, in coordination with
NASEM, to submit a report on the results of the study to SVAC and HVAC no later than 90 days
after completion of the study.
Section 204(b) requires GAO, no later than 90 days after enactment (i.e., January 15, 2021), to
conduct a review of staffing levels for mental health professionals within VA, including mental
health counselors, marriage and family therapists, and other appropriate counselors. The review is
required to include
 a description of barriers to carry out education, training, and hiring of mental
health professionals, as required by 38 U.S.C. §7302(a), and strategies to address
those barriers;
 a description of the objective, goals, and timing to increase representation of
counselors and therapists in the VA behavioral health workforce;
 an assessment of VA’s development of hiring guidelines for mental health
professionals;
 a description of how VA identifies gaps in mental health professional staffing and
determines successful staffing ratios for mental health professionals;
 a description of actions taken by the Secretary, in coordination with the Office of
Personnel Management (OPM), to create an occupational series for mental health
professionals; and
 a description of actions taken by the Secretary to ensure that the national,
regional, and local professional standards boards for mental health professionals
are composed of only mental health professionals, and that the VA liaison to such
boards is a mental health professional.
As required by Section 204(d), the Secretary shal brief SVAC and HVAC on the interim results
of the review no later than 18 months after enactment (i.e., April 17, 2022). Section 204(e)(2)

86 National Academies of Sciences, Engineering, and Medicine, An Approach to Evaluate the Effects of Concomitant
Prescribing of Opioids and Benzodiazepines on Veteran Deaths and Suicides, 2019.
87 U.S. Congress, House Committee on Appropriations, Subcommittee on Military Construction, Veterans Affai rs, and
Related Agencies, committee print, 116th Cong., 2nd sess., 2020, p. 849.
88 See for example, S. 2991 (116th Congress).
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requires GAO to submit a report on the results of the review and make the report publicly
available no later than 90 days after completion of the review.
Section 204(c) requires the data compiled under subsections (a) and (b) to be separated and
disaggregated by year so that such data can be analyzed across al data fields to potential y inform
and update VA clinical practice guidelines.
Section 205: Comptroller General Report on Management by Department of
Veterans Affairs of Veterans at High Risk for Suicide
Background
Suicide is difficult to predict for many reasons—one reason being that there is no one cause of
suicide. A 2016 meta-analysis of national and international longitudinal studies examining suicide
risk among psychiatric patients concluded that “a statistical y strong and reliable method to
usefully distinguish patients with a high-risk of suicide remains elusive.”89 However, recent
research suggests that data from health care records can be used to predict suicide risk, and such
research was used in development of VHA’s REACH VET program.90
In addition, VHA launched a new, standardized suicide screening initiative in 2018 for al
veterans receiving VHA care.91 The suicide risk screening was fully implemented in October
2019 and occurs in three phases, with the first phase comprising an annual initial screening.92
Veterans who receive positive screenings from the first phase or who are receiving mental health
care are administered the second phase, which includes six questions from the Columbia-Suicide
Severity Rating Scale (C-SSRS), an evidence-based screener used by both national and
international institutions.93 The third and final phase is administered to veterans who receive a
positive screening from the second phase or who have demonstrated suicidal behavior. This third
phase, VA’s Comprehensive Suicide Risk Evaluation, is a more in-depth evaluation that assesses
warning signs and history of attempts, among other things. This final phase is intended to form a
mental health treatment plan specific to the needs of the veteran.94 Suicide prevention

89 Matthew Large, Muthusamy Kaneson, Nicholas Myles, et al., “Meta-Analysis of Longitudinal Cohort Studies of
Suicide Risk Assessment among Psychiatric Patients: Heterogeneity in Results and Lack of Improvement over Time,”
PLoS ONE, vol. 11, no. 6 (June 10, 2016), p. https://doi.org/10.1371/journal.pone.0156322.
90 U.S. Congress, House Committee on Veterans’ Affairs, Testimony before the House Committee on Veteran’s Affairs,
Tragic Trends: Suicide Prevention Am ong Veterans, prepared by Shelli Avenevoli, Ph.D., 116th Cong., 1st sess., April
29, 2019, p. 3.
91 Department of Veterans Affairs, “ VA sets standards in suicide risk assessment, offers support to community
providers,” January 2, 2019, https://blogs.va.gov/VAntage/55281/va-sets-standards-in-suicide-risk-assessment -offers-
support -to-community-providers/.
92 U.S. Government Accountability Office, VA Needs Accurate Data and Comprehensive Analyses to Better
Understand On-Cam pus Suicides, GAO-20-664, September 2020, p. 8, https://www.gao.gov/assets/710/709243.pdf.
93 National Suicide Prevention Lifeline, “Columbia-Suicide Severity Rating Scale (C-SSRS),”
https://suicidepreventionlifeline.org/wp-content/uploads/2016/09/Suicide-Risk-Assessment -C-SSRS-Lifeline-Version-
2014.pdf.
94 Department of Veterans Affairs, “ VA sets standards in suicide risk assessment, offers support to community
providers,” January 2, 2019, https://blogs.va.gov/VAntage/55281/va-sets-standards-in-suicide-risk-assessment -offers-
support -to-community-providers/.
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coordinators (SPCs) coordinate the mental health care of at-risk veterans,95 and family and friends
play an important role in supporting at-risk veterans.96
Provision
Section 205 requires GAO to conduct a study, no later than 18 months after enactment (i.e., April
17, 2022), on VA’s efforts to manage veterans at high risk for suicide. The report is required to
include, among other things (1) a description of how VA identifies patients at high risk for
suicide; (2) a description of how VA intervenes when a patient is identified as high risk; (3) a
description of how VA monitors patients who have been identified as high risk; (4) a review of
staffing levels of SPCs across VHA; (5) a review of the resources and programming offered to
family members and friends of veterans with a mental health condition; and (6) any other areas
GAO considers appropriate.
Title III: Programs, Studies, and Guidelines on Mental Health
An understanding of mental health disorders is strengthened through research; likewise, treatment
informed by such research is evolving. This title includes provisions to require research on certain
suicide risk factors among veterans; to implement an initiative to identify and validate brain and
mental health biomarkers—measurable characteristics of body functions (e.g., blood pressure)—
among veterans; to provide VA with additional authority to use data collected from electronic
health systems to analyze mental health outcomes; and to establish and update VA and DOD
mental health and suicide treatment resources.
Section 301: Study on Connection Between Living at High Altitude and
Suicide Risk Factors Among Veterans
Background
Both international and domestic studies have found that individuals who live at higher altitudes
are at increased risk for suicide. In one study conducted using U.S. data, this correlation held even
when accounting for other factors, such as gender, poverty, access to health care, and population
density.97 Furthermore, the correlation between altitude and suicide was stronger among veterans
than nonveterans. Among veterans, the correlation was not significant among veterans aged 18-
34, but it was significant in al other age groups above age 35, with the greatest correlation among
veterans who were older than 75.98
Hypoxia is a condition that causes decreased oxygenation in the body tissues. One study found
that chronic hypoxic markers—living at high altitude, smoking, and chronic obstructive

95 Department of Veterans Affairs, Veterans Health Administration, “Uniform Mental Health Services in VA Medical
Centers and Clinics,” VHA Handbook 1160.01, amended November 16, 2015.
96 Department of Veterans Affairs, “National Strategy for P reventing Veteran Suicide, 2018-2028,” p. 28,
https://www.mentalhealth.va.gov/suicide_prevention/docs/Office-of-Mental-Health-and-Suicide-Prevention-National-
Strategy-for-Preventing-Veterans-Suicide.pdf.
97 Hana Sabic, Brent Kious, Danielle Boxer, et al., “Effect of Altitude on Veteran Suicide Rates,” High Altitude
Medicine & Biology, vol. 20, no. 2 (June 1, 2019), pp. 171 -177.
98 Hana Sabic, Brent Kious, and Danielle Boxer, et al., “Effect of Altitude on Veteran Suicide Rates,” High Altitude
Medicine & Biology, pp. 171-177.
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pulmonary disease (COPD)—may increase suicide risk in veterans.99 As noted by VA, although
chronic hypoxia appears to play a role in the correlation between altitude and suicide, more
research is needed to understand the role that demographic, social, and environmental factors may
play. Understanding if and how altitude contributes to suicide could help to determine appropriate
prevention and treatment options.100
Provision
Section 301 requires the Secretary, no later than 180 days after enactment (i.e., April 15, 2021), to
conduct a study on the connection between living at high altitude and the risk of developing
depression or dying by suicide among veterans on an individual level (rather than at the state or
county level). The study is to be completed no later than three years after it commences, and, the
Secretary shal submit a report on the findings of the study to SVAC and HVAC no later than 150
days after its completion.
Section 301(e) requires the Secretary to conduct a follow-up study if the study conducted under
this section shows high altitude to be a risk factor for developing depression or dying by suicide.
The follow-up study shal focus on likely biological mechanisms underlying this association, and
the most effective treatment or intervention for reducing risk of adverse outcomes associated with
living at high altitude. No later than 150 days after completing a follow-up study, the Secretary
would be required to submit a report on the results of the study to SVAC and HVAC.
Sections 302, 303, and 304: Establishment by Department of Veterans Affairs
and Department of Defense of a Clinical Provider Treatment Toolkit and
Accompanying Training Materials for Comorbidities; Update of Clinical
Practice Guidelines for Assessment and Management of Patients at Risk for
Suicide; and Establishment by Department of Veteran Affairs and Department
of Defense of Clinical Practice Guidelines for the Treatment of Serious Mental
Illness
Background
VA and DOD often collaborate to jointly develop and publish selected clinical practice guidelines
(CPGs) to help health care providers deliver evidenced-based treatment for certain health issues
prevalent in military and veteran populations.101 Although VA and DOD do not require their
health care providers to use the CPGs, the documents typical y provide insight on “best practices”
when developing patient treatment plans.102 Current VA/DOD CPGs include treatment pathways

99 Natalie B. Riblet, Daniel J. Gottlieb, Bradley V. Watts, et al., “Hypoxia-related risk factors for death by suicide in a
national clinical sample,” Psychiatry Res., vol. 273 (March 2019), pp. 247-251.
100 Office of Mental Health and Suicide Prevention, Veterans Health Administration, Understanding the Relationship
Between Altitude and Suicide Risk, U.S. Department of Veterans Affairs, January 31, 2020,
https://www.mentalhealth.va.gov/suicide_prevention/docs/Literature_Review_FST P_Altitude_CLEARED_508_1 -31-
20.pdf.
101 T he National Academy of Medicine (formerly the Institute of Medicine) describes clinical practice guidelines
(CPGs) as “statements that include recommendations intended to optimize patient care. T hey are informed by a
systematic review of evidence and an assessment of the benefits and harms of alternative care options.” For more on
CPGs, see Institute of Medicine, Clinical Practice Guidelines We Can Trust, Washington, DC, 2011, pp. 25-26,
https://www.nap.edu/catalog/13058/clinical-practice-guidelines-we-can-trust.
102 Department of Veterans Affairs, “VA/DoD Clinical Practice Guidelines,” accessed December 15, 2020,
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for pain management, women’s health, trauma rehabilitation, and certain chronic diseases or
conditions (e.g., hypertension, dyslipidemia, and obstructive sleep apnea).103 Four VA/DOD
CPGs are specific to mental health:
 assessment and management of patients at risk for suicide,
 major depressive disorder,
 posttraumatic stress disorder (PTSD), and
 substance use disorder.104
The VA/DOD Health Executive Committee’s Evidence Based Practice Work Group oversees the
collaboration process used to develop, adopt, or update VA/DOD CPGs.105
Provisions
Section 302 directs the Secretary to develop a “clinical provider treatment toolkit and
accompanying training materials” for (1) comorbid mental health conditions, (2) comorbid mental
health and substance use disorders, and (3) comorbid mental health and chronic pain. The
Secretary is required to consult with the Secretary of Defense in developing the toolkit, which
would include elements similar to those in existing VA/DOD CPGs. The toolkit is to include
additional guidance on treating patients with
 PTSD and additional mental health, substance use, or chronic pain issues;
 mental health conditions (e.g., anxiety, depression, bipolar disorder) and
substance use or chronic pain issues; and
 traumatic brain injury (TBI) and mental health, substance use, or chronic pain
issues.
The Secretary is required to develop this toolkit no later than two years from the date of
enactment (i.e., October 17, 2022).
Section 303 requires VA and DOD to add new or enhanced guidance in the next published update
of the VA/DOD CPG on Assessment and Management of Patients at Risk for Suicide. The revised
CPG is to include guidance on (1) gender-specific risk factors, prevention, and treatments for
suicide and suicidal ideation; (2) the efficacy of alternative therapies (e.g., yoga, meditation, art
therapy, equine therapy, music therapy); and (3) the findings from the COVER Commission.106

https://www.healthquality.va.gov; and Department of Defense (DOD) Psychological Health Center of Excellence,
“VA/DoD Clinical Practice Guidelines and Clinical Support T ools,” accessed December 18, 2020,
https://www.pdhealth.mil/clinical-guidance/clinical-practice-guidelines-and-clinical-support -tools.
103 Department of Veterans Affairs, “VA/DoD Clinical Practice Guidelines,” and Department of Defense Psychological
Health Center of Excellence, “VA/DoD Clinical Practice Guidelines and Clinical Support T ools.”
104 Department of Veterans Affairs, “VA/DoD Clinical Practice Guidelines,” and Department of Defense Psychological
Health Center of Excellence, “VA/DoD Clinical Practice Guidelines and Clinical Support T ools.”
105 T he Health Executive Committee (HEC) is a joint VA/DOD entity responsible for “sharing and collaboration efforts
to ensure the effective and efficient use of health services and resources.” T he HEC also oversees numerous work
groups and “business lines,” including the Evidence Based Practice Work Group (EBPWG). For more on the HEC, see
https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/Access-to-Healthcare/DoD-VA-
Sharing-Initiatives/Joint -Oversight/HEC. For more on the EBPWG, see https://www.healthquality.va.gov/documents/
EvidenceBasedPracticeWGCharter123020161.pdf. For more on the CPG development process, see
https://www.qmo.amedd.army.mil/general_documents/GuidelinesforGuidelines.pdf.
106 Section 931 of the Jason Simcakoski Memorial and Promise Act, as incorporated in the Comprehensive Addiction
and Recovery Act of 2016 (P.L. 114-198), directed the establishment of the COVER Commission to “ examine the
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Section 304 directs VA, DOD, and the Department of Health and Human Services (HHS) to
establish a Serious Mental Health Il ness Work Group composed of representatives from federal
entities, including VA’s Health Services Research and Development office, the National Institute
of Mental Health, and the Indian Health Service; nonfederal entities (e.g., academic institutions
specializing in mental health treatments); and other organizations with relevant mental health
expertise. No later than two years after enactment (i.e., October 17, 2022), the Secretary and the
work group are required to develop new CPGs on the following mental health conditions:
 schizophrenia;
 schizoaffective disorder;
 persistent mood disorder, including bipolar disorders; and
 other mental health issues that result in “serious functional impairment that
substantial y interferes with major life activities.”
In addition, the Secretary is required to consult with the Secretary of Defense and the HHS
Secretary no later than two years from enactment (i.e., October 17, 2022), to assess the VA/DOD
CPG on Management of Major Depressive Disorder for any necessary updates.107
Section 305: Precision Medicine Initiative of Department of Veterans Affairs to
Identify and Validate Brain and Mental Health Biomarkers
Background
Precision medicine is defined as “an approach to disease treatment and prevention that seeks to
maximize effectiveness by taking into account individual variability in genes, environment, and
lifestyle.”108 In January 2015, President Obama announced the launch of the Precision Medicine
Initiative (PMI); this effort was codified by the 21st Century Cures Act (P.L. 114-255) in
December 2016.109 Since 2015, the PMI has been undertaken and led by the National Institutes of
Health (NIH), in collaboration with other federal agencies, primarily through the All of Us
Research Program,110 a mil ion-person national research cohort program. The program has
focused intensively on areas such as governance, recruitment strategies, privacy and security of
data, diversity, and data access policies.
Precision medicine research efforts rely on the collection and storage of large amounts of health
and other data; therefore, privacy and security of, and access to, this data may be a concern in the
context of this type of research. Specifical y, the All of Us Research Program is carried out
consistent with applicable requirements in the HIPAA Privacy and Security Rules,111 which

evidence-based therapy treatment model used by the Secretary for treating mental health conditions of veterans and the
potential benefits of incorporating complementary and integrative health treatments in non -Department facilities.”
107 For more on the VA/DOD CPG on the Management of Major Depressive Disorder, see
https://www.healthquality.va.gov/guidelines/MH/mdd/.
108 Precision Medicine Init iative (PMI) Working Group Report to the Advisory Committee to the Director, NIH, “T he
Precision Medicine Initiative Cohort Program – Building a Research Foundation for 21st Century Medicine,”
September 17, 2015, p. 6, https://www.nih.gov/sites/default/files/research-training/initiatives/pmi/pmi-working-group-
report -20150917-2.pdf.
109 PHSA §498E; 42 U.S.C. §289g-5.
110 For more information, see https://allofus.nih.gov/.
111 45 C.F.R. Part 164, Subparts C and E.
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govern the use and disclosure of protected health information (PHI), as wel as the Common
Rule,112 which governs human research subject protection in federal y funded research.
Provision
Section 305 requires the Secretary, no later than 18 months after enactment (i.e., April 17, 2022),
to develop and implement an initiative to identify brain and mental health biomarkers113 among
veterans for specified conditions (e.g., depression, anxiety, PTSD, among others). The initiative
must be modeled on NIH’s All of Us Precision Medicine Initiative and coordinated with the VA’s
Mil ion Veterans Program. Data collected under this initiative must be standardized, as specified,
and the Secretary is required to develop robust data privacy and security measures consistent with
the Privacy Act of 1974,114 as wel as the HIPAA Rules,115 with access to the data required to be
similarly governed. The Secretary is required to make de-identified data, as defined, available as
specified to both federal agencies and nongovernmental entities for research purposes.
Section 306: Statistical Analyses and Data Evaluation by Department of
Veterans Affairs
Background
This section was derived from the VA Data Analytics and Technology Assistance Act, introduced
in the 116th Congress (H.R. 8148). In a congressional hearing on this legislation, the bil ’s
sponsor, Representative Conor Lamb, explained that the intent of the language is to provide the
Secretary with authority to use artificial intel igence and other means of examining data to
determine if there is a link between data collected by VA’s electronic health records system or
other data and mental health outcomes.116
Provision
This section adds a new section 119 to Chapter 1 of title 38 of U.S.C., which authorizes the
Secretary to enter into a contract or other agreement with an academic institution or other
qualified entity, as determined by the Secretary, to carry out statistical analyses and data
evaluation as required of the Secretary under current law.

112 45 C.F.R. Part 46.
113 According to the Food and Drug Administration, a biomarker is “a defined characteristic that is measured as an
indicator of normal biological processes, pathogenic processes, or responses to an exposure or intervention, including
therapeutic interventions.” See https://www.fda.gov/media/99221/download.
114 5 U.S.C. §552a.
115 Defined in the section as “rules 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)”; 45 C.F.R. Parts 1 60,
162, and 164.
116 U.S. Congress, House Committee on Veterans’ Affairs, Full Committee Legislative Hearing, 116th Cong., 2nd sess.,
September 10, 2020.
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Title IV: Oversight of Mental Health Care and Related Services
VA health care is considered a “high-risk area” by the GAO.117 Recent GAO reports suggest that
certain aspects of VHA’s suicide prevention efforts could be improved.118 This title includes
provisions that require GAO to conduct oversight of VA’s mental health and suicide prevention
services, and to provide additional reporting to Congress on select suicide prevention and mental
health programs within VHA and those jointly administered by VA and DOD.
Section 401: Study on Effectiveness of Suicide Prevention and Mental Health
Outreach of Department of Veterans Affairs
Background
As specified by VA in its national strategy to prevent veteran suicide, public awareness and other
outreach efforts are a key component of necessary prevention efforts.119 Developing evidence-
based consistent messaging requires many steps, including conducting research to ensure that the
target audience understands both the problem and desired behavior to address it. Research
methods can include literature reviews, surveys, and focus groups.120 These methods can be
useful for evaluating the effectiveness of public awareness campaigns once they have been
disseminated.
Although VA has conducted its own evaluations of suicide prevention activities,121 few
independent evaluations have examined VHA’s suicide prevention outreach materials and
campaigns. Congress has previously required VA to enter into third-party contracts to evaluate
VHA’s mental health and suicide prevention programs, but these evaluations are not specific to
mental health and suicide prevention outreach conducted by VHA.122
Provision
Section 401(a) requires the Secretary, no later than 180 days after enactment (i.e., April 15, 2021),
to enter into an agreement with an entity outside the federal government to evaluate suicide
prevention and mental health outreach materials and campaigns prepared and conducted by VA.
Section 401(b) requires the Secretary to convene focus groups as part of the evaluation required
under subsection (a). At minimum, the Secretary is required to convene at least eight different
focus groups. Such focus groups must meet specified requirements in timing, number of

117 GAO, “ Managing Risks and Improving VA Health Care,” https://www.gao.gov/highrisk/managing-risks-and-
improving-va-health-care.
118 See, for example, U.S. Government Accountability Office, VA Health Care: Improvements Needed in Suicide
Prevention Media Outreach Cam paign Oversight and Evaluation , GAO-19-66, November 15, 2018,
https://www.gao.gov/assets/700/695485.pdf, and U.S. Government Accountability Office, VA Needs Accurate Data
and Com prehensive Analyses to Better Understand On -Cam pus Suicides, GAO-20-664, September 2020, p. 6,
https://www.gao.gov/assets/710/709243.pdf.
119 Department of Veterans Affairs, “National Strategy for Preventing Veteran Suicide, 2018-2028,” p. 9,
https://www.mentalhealth.va.gov/suicide_prevention/docs/Office-of-Mental-Health-and-Suicide-Prevention-National-
Strategy-for-Preventing-Veterans-Suicide.pdf.
120 Linda Langford, David Litts, and Jane L. Pearson, “Using Science to Improve Communications About Suicide
Among Military and Veteran Populations: Looking for a Few Good Messages,” American Journal of Public Health,
vol. 103 (January 2013), p. 33.
121 Department of Veterans Affairs, Office of Inspector General, Evaluation of Suicide Prevention Programs in
Veterans Health Adm inistration Facilities, May 18, 2017, https://www.va.gov/oig/pubs/VAOIG-16-03808-215.pdf.
122 38 U.S.C. §1709B, as added by Section 2 of the Clay Hunt SAV Act (P.L. 114-2).
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participants, and representation of participants (e.g., minority veterans). Section 401(c) requires
the Secretary, no later than 90 days after the last focus group meeting under subsection (b), to
submit a report to SVAC and HVAC on the focus group findings. The report must include, among
other things, recommendations for future suicide prevention and mental health materials and
campaigns, and a description of any dissenting or opposing viewpoints raised by participants in
the focus group.
Section 401(d) requires the Secretary, no later than one year after the last focus group meeting
under subsection (b), to complete a survey on the effectiveness of mental health and suicide
prevention materials and campaigns. The survey must be informed by the focus group findings
and be representative of the veteran population, among other things. Section 401(e) requires that,
for each contract regarding the development of suicide prevention and mental health materials
and campaigns, the contractor must include representative veteran focus groups as part of
effectiveness assessments. Per Section 401(e)(2), such contracts must include a requirement that
subcontractors have experience creating influential media campaigns targeting individuals aged
18 to 34. Not more than 2% of VHA OMHSP’s contractor budget for suicide prevention and
mental health media outreach can be al ocated to these subcontractors. Section 401(f) exempts
information collection required under this section from the Paperwork Reduction Act (PRA) of
1995.123
Section 402: Oversight of Mental Health and Suicide Prevention Media
Outreach Conducted by Department of Veterans Affairs
Background
In response to a 2018 request from then HVAC ranking member Representative Tim Walz, GAO
conducted a review of VHA’s suicide prevention media outreach activities and related
oversight.124 Specifical y, the report examined the activities conducted by VHA for its suicide
prevention media outreach campaign, and to what extent VHA evaluates the effectiveness of
those activities. GAO examined VHA’s contract to develop suicide prevention outreach from
FY2013 to FY2016 and its contract to develop suicide prevention and mental health outreach
from FY2017 to FY2018.
GAO found that VHA’s suicide prevention media outreach activities declined in FY2017 and
FY2018, and that, accordingly, VHA had spent significantly less than its obligated suicide
prevention paid media budget. Media outreach activities include the development of social media
content, public service announcements (PSAs), paid media (e.g., VHA pays a fee to more broadly
disseminate social media posts), and Suicide Prevention Month activities. According to VHA, this
reduction was due to leadership turnover and reorganization of the offices responsible for suicide
prevention activities. GAO noted that by not assigning key leadership responsibilities and direct
lines of reporting on progress, VHA was not able to effectively implement its suicide prevention
media outreach activities and provide proper oversight of progress, including obligations spent
and effectiveness of the campaign. To address these issues, GAO provided specific
recommendations, including, among others, a delineation of roles and responsibilities, and

123 P.L. 104-13. T he PRA requires, among other things, that agencies obtain Office of Management and Budget (OMB)
approval before requesting most information from the public.
124 U.S. Government Accountability Office, VA Health Care: Improvements Needed in Suicide Prevention Media
Outreach Cam paign Oversight and Evaluation , GAO-19-66, November 15, 2018, https://www.gao.gov/assets/700/
695485.pdf.
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establishing targets for its metrics (e.g., goals for how many individuals VHA wishes to view its
outreach content) to improve evaluation efforts.125
Provision
Section 402(a) codifies the aforementioned GAO recommendations. Namely, it requires the
Secretary to establish goals for VA mental health and suicide prevention media outreach
campaigns, including the establishment and tracking of targets, metrics, and action plans to
describe and assess campaigns. In establishing these goals, the Secretary is required to consult
with mental health and suicide prevention experts, as wel as relevant stakeholders and other
persons determined appropriate by the Secretary. These goals are required to be measured by
metrics specific to media types (e.g., engagement rate relating to social media or response rate
relating to email), and these metrics must be periodical y updated as more accurate metrics
become available. Section 402(a)(5) requires the Secretary, no later than 180 days after enactment
(i.e., April 15, 2021), to submit an initial report to SVAC and HVAC on the goals—including
metrics and targets for such metrics—established for the VA mental health suicide prevention
media outreach campaigns. Section 402(a)(6) requires the Secretary, no later than one year after
the report submitted under paragraph (5), to submit a report, and annual y thereafter, to SVAC and
HVAC on the progress of VA meeting the established goals and action to be taken by VA to
modify goals and targets not being met.
Section 402(b) requires the Secretary, no later than 180 days after enactment (i.e., April 15, 2021)
and semiannual y thereafter, to submit a report to the MILCON-VA, SVAC, and HVAC on
OMHSP obligations and expenditures during the period covered by the report.
Section 403: Comptroller General Management Review of Mental Health and
Suicide Prevention Services of Department of Veterans Affairs
Background
Prior to 2017, VHA suicide prevention and mental health activities were organized in different
offices. In May 2017, VHA’s OMHSP was established.126 This reorganization was intended to
improve efficiency, as wel as to encourage better communication and collaboration of related
VHA operations. VHA’s OMHSP issues policy and implementation guidance, and it provides
oversight and management of VHA mental health and suicide prevention initiatives and
services.127 Such initiatives include coordination of suicide prevention efforts with DOD and
oversight of the VCL, among other things. Some VAMCs and outpatient clinics offer a Nurse
Advice Line—similar to the VCL—which al ows veteran patients and their caregivers to speak at
any time with a registered nurse about a health issue, including a mental health-related concern.128

125 U.S. Government Accountability Office, VA Health Care: Improvements Needed in Suicide Prevention Media
Outreach Cam paign Oversight and Evaluation, GAO-19-66, November 15, 2018, p. 21, https://www.gao.gov/assets/
700/695485.pdf.
126 U.S. Government Accountability Office, VA Needs Accurate Data and Comprehensive Analyses to Better
Understand On-Cam pus Suicides, GAO-20-664, September 2020, p. 6, https://www.gao.gov/assets/710/709243.pdf.
127 Department of Veterans Affairs, FY2021 Congressional Budget Submission, Volume II: Medical Prog rams and
Inform ation Technology Programs, p. VHA-66, https://www.va.gov/budget/docs/summary/
fy2021VAbudgetVolumeIImedicalProgramsAn dInformationT echnology.pdf.
128 Department of Veterans Affairs, “VA VISN 12 Nurse Advice Line (T elephone Care Service),”
https://www.madison.va.gov/documents/T elephone-Care.pdf.
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Provision
Section 403 requires GAO to conduct a study, no later than three years after enactment (i.e.,
October 17, 2023), on the management of mental health and suicide prevention services provided
by VA. The management review is required to include, among other things (1) an assessment of
OMHSP infrastructure, as wel as infrastructure of suicide prevention efforts not operated by
OMHSP; (2) a description of OMHSP management, organization, staffing levels, and operations
(including strategic planning); (3) an assessment of suicide prevention practices and initiatives
available through VA and community partnerships; (4) an assessment of the Nurse Advice Line
pilot program; (5) an assessment of VA/DOD coordination of suicide prevention efforts; and (6)
any other areas GAO considers appropriate.
Section 404: Comptroller General Report on Efforts of Department of Veterans
Affairs to Integrate Mental Health Care into Primary Care Clinics
Background
Integrated behavioral health occurs when a team of providers, including physicians, behavioral
health providers, and other health care providers, work together to address a patient’s physical
and mental health/substance use needs.129 Although different models of behavioral health
integration exist, some models emphasize integrating behavioral health services into primary
care. In general, patients with behavioral health concerns interact more frequently with primary
care, and they may not follow through to the behavioral health specialty care sector if referred
from primary care.130
VHA first began primary care-mental health integration (PC-MHI) in 2007, and by 2008, it
required al VAMCs and very large community-based outpatient clinics (CBOCs; those serving
more than 10,000 patients a year) to have integrated mental health services in primary care clinics
on a full-time basis.131 CBOCs serving 10,000 patients or less must also have varying levels of
integrated mental health services. VHA’s PC-MHI comprises two categories: (1) co-located,
collaborative care (CCC) and (2) care management. CCC provides behavioral health services in
short duration as part of routine primary care service, and is not necessarily specific to patients
with behavioral health disorders. CCC providers—mental health staff, including social workers,
psychiatric nurses, psychiatrists, psychologists—are embedded in Patient Aligned Care Teams
(PACTs), a team of health care providers that provides comprehensive primary care in partnership
with the patient.132 Care management is provided in consultation with the PACTs, but is largely
administered by telephone. Care management services are structured toward those with more
severe behavioral health concerns and includes systematic monitoring of symptoms and referral
to specialty behavioral health care if needed.133 Once a patient starts receiving services in

129 Health Resources and Services Administration (HRSA), “Integrated Behavioral Health Resource Library,”
https://www.hrsa.gov/behavioral-health/library.
130 T he Commonwealth Fund, “In Focus: Integrating Behavioral Health and Primary Care,” August 28, 2014,
https://www.commonwealthfund.org/publications/newslett er-article/2014/aug/focus-integrating-behavioral-health-and-
primary-care.
131 Department of Veterans Affairs, Veterans Health Administration, “Uniform Mental Health Services in VA Medical
Centers and Clinics,” VHA Handbook 1160.01, p. 34, amended November 16, 2015.
132 Department of Veterans Affairs, Veterans Health Administration, “Patient Aligned Care T eam (PACT ) Handbook,”
VHA Handbook 1101.10(1), p. 4, amended May 26, 2017.
133 Margaret Dundon, Katherine Dollar, Larry J. Lantinga, et al., Primary Care-Mental Health Integration Co-Located,
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specialty behavioral health care, a behavioral health provider in primary care wil no longer
provide care, except under very specific circumstances.134
The Veterans Community Care Program (VCCP) was launched in June 2019, as established by
the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018
(VA MISSION Act; P.L. 115-182). Under this program, eligible veterans receive care in the
community (through non-VA providers) when specific eligibility criteria are met.135 To implement
VCCP, VA entered into Community Care Network (CCN) contracts with Optum Public Sector
Solutions, Inc., and TriWest Healthcare Al iance Corporation.
Prior to the implementation of VCCP, researchers from the RAND Corporation evaluated the
capacity of providers in New York to deliver care to veterans, finding that
only 20 percent of New York–licensed health care professionals reported routinely
screening their patients for a military or veteran affiliation, with significant differences
across provider types and by region. As a result, many providers are missing an opportunity
to begin a conversation about how having a military history and background might have
contributed to their veteran patients’ current medical condition.136
Furthermore, RAND researchers reported that “private providers were less prepared than VA
providers to deliver high-quality mental health care to veterans.”137 Taking these concerns into
consideration, the VA MISSION Act included Section 123, which requires VA to implement a
program to provide continuing medical education material and training to non-VA medical
providers.138 The department established the VHA Training Finder Real-time Affiliate-Integrated
Network (VHA-TRAIN) and provides courses and training programs such as Military Culture:
Core Competencies for Health Care Professionals Stressors and Resources, Military Culture:
Core Competencies for Health Care Professionals Self-Assessment and Introduction to Military
Ethos, and Addressing Traumatic Guilt in PTSD Treatment, among others.139
Provision
Section 404(a) requires GAO to submit an initial report, no later than two years after enactment
(i.e., October 17, 2022), on the integration of mental health care into VHA primary care clinics.
The report is required to include, among other things (1) an assessment of efforts to integrate
mental health care into VHA primary care clinics, including how effective these efforts have been
and how health care is affected by integration; (2) a description of how care is coordinated under

Collaborative Care: An Operations Manual, Center for Integrated Healthcare, June 2011, p. 5,
https://www.mentalhealth.va.gov/coe/cih-visn2/Documents/Clinical/Operations_Policies_Procedures/MH-
IPC_CCC_Operations_Manual_Version_2_1.pdf.
134 Margaret Dundon, Katherine Dollar, Larry J. Lantinga, et al., Primary Care-Mental Health Integration Co-Located,
Collaborative Care: An Operations Manual, Center for Integrated Healthcare, June 2011, p. 20.
135 For more information, see CRS Report R42747, Health Care for Veterans: Answers to Frequently Asked Questions;
38 C.F.R. §17.4010, and 38 C.F.R. §17.4040.
136 T erri T anielian et al., Ready or Not? Assessing the Capacity of New York State Health Care Providers to Meet the
Needs of Veterans, RAND Corporation, Santa Monica,, CA, 2018, https://www.rand.org/pubs/research_reports/
RR2298.html.
137 RAND Corporation, Improving the Quality of Mental Health Care for Veterans: Lessons from RAND Research,
2019, https://www.rand.org/pubs/research_briefs/RB10087.html.
138 CRS Report R45390, VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018
(VA MISSION Act; P.L.115-182).
139 Department of Veterans Affairs, Report on Section 123 of the VA Maintaining Internal Systems and Strengthening
Integrated Outside Networks (MISSION) Act of 2018: Continuing Medical Education for Non -Departm ent Medical
Professionals, June 2020, p. 6.
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specified circumstances; (3) an assessment of how integration is implemented at different types of
VHA facilities (e.g., VAMCs, CBOCs); (4) recommendations on how integration can be better
implemented; and (5) any other areas GAO considers appropriate.
Section 404(b) requires GAO to submit, no later than two years after submission of the report
required under section 404(a), a report on the integration of community-based mental health care
into VHA. The report is required to include, among other things, (1) an assessment of VA’s
efforts to integrate community-based mental health care into VHA, including effectiveness of
such efforts and how health care of veterans is affected by integration; (2) a description of how
care is coordinated between community-based mental health care providers and VHA; (3) an
assessment of any disparities in coordination of community-based mental health care integration
into VHA by location and type of facility; (4) an assessment of military cultural competency of
community-based mental health care providers; (5) recommendations on how community-based
health care integration into VHA can be better implemented; and (6) any other areas GAO
considers appropriate. Section 404(b)(3) defines “community-based mental health care” as mental
health care paid for by VA but provided at a non-VHA health care site, including care provided
under the VCCP.
Section 405: Joint Mental Health Programs by Department of Veterans Affairs
and Department of Defense
Background
Congress has a long history of funding and authorizing numerous DOD and VA mental health
programs and services that support servicemembers, veterans, and their families. DOD and VA
deliver mental health services in wide ranges of clinical and nonclinical settings (e.g., military
treatment facilities, military units, VA hospitals and clinics, community-based programs, and
virtual modalities). Both departments administer a number of mental health programs, typical y in
accordance with various VA and DOD strategy documents on interagency collaboration and
resource sharing (e.g., the Joint Strategic Plan or the Integrated Mental Health Strategy).140 These
programs aim to prevent, evaluate, diagnose, treat, or discover new mental health issues and
expand new science on broad or condition-specific issues.
In 2010, DOD established the National Intrepid Center of Excel ence (NICoE) to “advance
treatment, research, and education in the areas of TBI and neurological and psychological
health.”141 NICoE coordinates with the VA’s Polytrauma Centers to synchronize specialized
outpatient treatments and emerging rehabilitative therapies for servicemembers and veterans
diagnosed with TBI and other mental health conditions.142 To extend NICoE’s reach, DOD

140 Section 8111 of T itle 38, U.S. Code, requires DOD and VA to coordinate and share certain health care resources.
T he statute also requires both departments to develop a Joint Strategic Plan (JSP) to “ shape, focus, and prioritize the
coordination and sharing efforts among appropriate elements of the two Departments.” For more on the JSP, see
https://prhome.defense.gov/Portals/52/Documents/VA-DoD%20FY%202019-
2021%20JSP%20(signed%20March%2018%202019).pdf. In 2011, DOD and VA developed an Integrated Mental
Health Strategy (IMHS) to implement a “ coordinated public health model to improve the access, quality, effectiveness,
and efficiency of mental health services” for servicemembers, veterans, and their families. For more on the IMHS, see
https://www.mentalhealth.va.gov/docs/VA-DoD_IMHS_Action_Summaries_040814.pdf.
141 Department of Defense, National Intrepid Center of Excellence Satellite Strategic Basing , June 2020, p. 3,
https://go.usa.gov/xAgDg. For more information on NICoE, see https://walterreed.tricare.mil/Health-Services/
Specialty-Care/National-Intrepid-Center-of-Excellence-NICoE.
142 Department of Defense, National Intrepid Center of Excellence Satellite Strategic Basing , June 2020, pp. 3-5. VA
Polytrauma Centers are part of an “integrated network of specialized rehabilitative programs” that serves
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established satel ite sites, known as Intrepid Spirit Centers, offering similar TBI treatment and
therapy services. DOD maintains eight Intrepid Spirit Centers in the United States, with two
additional locations planned.143 In 2019, the Senate Appropriations Committee report
accompanying the DOD Appropriations Act, 2020, directed DOD and VA to describe the “value
and merit of establishing a Joint NICoE Intrepid Spirit Center that serves both active duty and
veteran populations for their mutual benefit and growth in treatment and care.”144 In the
subsequent report to Congress, issued in June 2020, DOD and VA asserted that there was “neither
value nor merit that supports establishment of a joint NICoE Intrepid Spirit Center at this
time.”145
Provision
Section 405 establishes two reporting requirements for DOD and VA. The first reporting
requirement is the submission of an annual report to Congress, beginning in October 2021, on
mental health programs individual y and jointly administered by each department. The report is to
be submitted to the House and Senate Armed Services, SVAC, and HVAC, and to include a
description of various VA and DOD mental health or related programs, such as
 a transition assistance program;
 clinical and nonclinical mental health initiatives;
 certain quality-of-life programs (e.g., financial literacy, housing assistance, and
employee assistance programs);
 mental health research on PTSD, depression, anxiety, bipolar disorder, TBI,
suicide or suicidal ideation; and
 other issues or conditions as the Secretary or the Secretary of Defense consider
necessary.
The report is to also include recommendations to “improve the effectiveness” of such programs
and on “novel joint programming” to improve the mental health of servicemembers and veterans.
The second reporting requirement is an evaluation and report to Congress on DOD and VA
collaboration on PTSD and TBI care, research, and education. The evaluation is to include an
analysis of alternatives and recommendations on the establishment of a joint DOD and VA
Intrepid Spirit Center. The report on DOD and VA’s findings is to be submitted to the House and
Senate Committees on Armed Services, SVAC, and HVAC no later than 270 days after enactment
(i.e., July 14, 2021).
Title V: Improvement of Mental Health Medical Workforce
The Health Resources and Services Administration (HRSA) projects that national demand for
physician services, including mental health services, wil exceed supply by 2025. Further, HRSA
has reported that these projected shortages wil be exacerbated in rural areas, a situation that
poses a particular chal enge for VHA because at least 26% percent of its VAMCs are located in

servicemembers and veterans with combat - or civilian-related T BI and polytrauma. For more on VA Polytrauma
Centers, see https://www.polytrauma.va.gov.
143 Department of Defense, National Intrepid Center of Excellence Satellite Strategic Basing, June 2020, p. 3.
144 S.Rept. 116-103, p. 241.
145 Department of Defense, National Intrepid Center of Excellence Satellite Strategic Basing , June 2020, p. 6.
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rural areas.146 This title includes provisions that address VHA mental health provider staffing;
authorize a scholarship program for readjustment counselors at Vet Centers; and require
additional reporting and oversight on Vet Centers and other VHA suicide prevention services.
Section 501: Staffing Improvement Plan for Mental Health Providers of
Department of Veterans Affairs
Background
As of April 2020, VHA recommended that al VAMCs have an overal staffing level of at least
1.22 full time equivalent (FTE) psychiatrists and 7.72 FTE outpatient clinical mental health staff
for every 1,000 mental health patients.147 However, difficulties with recruitment, retention, and
lengthy hiring procedures have contributed to vacancies throughout the department. As of May
2019, HVAC reported that the current rate of vacancies in VHA mental health provider staffing
was 10%.148 According to NASEM, these vacancies vary by profession (e.g., psychiatrist,
psychologist) and by VISN.149 In particular, psychiatry was the top-ranked clinical occupation
determined to be in shortage by VHA facilities in FY2020.150 To address these concerns, VHA has
implemented a number of mechanisms to assist with recruitment and the retention of mental
health providers.151
Section 201 of the Veteran Benefits, Health Care, and Information Act of 2006 (P.L. 109-461)
first authorized licensed professional mental health counselors (LPMHCs) and marriage and
family therapists (MFTs) as mental health professionals that could be hired by VHA.152 Further, in
2012, VA began a mental health education expansion (MHEE) program to assist in recruitment
and hiring of VA-trained mental health providers. Through this program, four new professions
were al otted VA training opportunities, including internships for LPMHCs and MFTs.153
However, these two occupations did not have an associated occupational series, a classification
standard issued by the U.S. Office of Personnel Management (OPM) for federal hiring purposes.
In FY2019 appropriations report language, Congress encouraged VA to work with OPM to
develop the occupational series. In addition, Congress directed VA to develop a staffing plan for
LPMHCs and MFTs to fil open positions and address any shortages.154

146 U.S. Government Accountability Office, Veterans Health Administration: Better Data and Evaluation Could Help
Im prove Physician Staffing, Recruitm ent, and Retention Strategies, GAO-18-124, October 2017, p. 6,
https://www.gao.gov/assets/690/687853.pdf.
147 Department of Veterans Affairs, Veterans Health Administration, “Productivity and Staffing in Clinical Encounters
for Mental Health Providers,” VHA Directive 1161, p. A-3, April 28, 2020.
148 H.Rept. 116-70. T his statistic defined mental health provider staffing as including psychiatrists, psychologists, and
social workers.
149 National Academies of Sciences, Engineering, and Medicine, Evaluation of the Department of Veterans Affairs
Mental Health Services, Washington, DC, January 31, 2018, p. 176, https://www.ncbi.nlm.nih.gov/books/NBK499503/
pdf/Bookshelf_NBK499503.pdf.
150 Department of Veterans Affairs, Office of Inspector General, OIG Determination of Veterans Health
Administration’s Occupational Staffing Shortages Fiscal Year 2020 , Department of Veterans Affairs, September 23,
2020, p. 7, https://www.va.gov/oig/pubs/VAOIG-20-01249-259.pdf.
151 For more information, see National Academies of Sciences, Engineering, and Medicine, Evaluation of the
Departm ent of Veterans Affairs Mental Health Services, 2018, p. 180.
152 38 U.S.C. §§7401-7402.
153 National Academies of Sciences, Engineering, and Medicine, Evaluation of the Department of Veterans Affairs
Mental Health Services, 2018, p. 180.
154 S.Rept. 115-269.
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Provision
Section 501(a)(1) requires, no later than one year after enactment (i.e., October 17, 2021), VA to
submit to SVAC and HVAC a plan to address mental health provider staffing within VA. The plan
is required to include (1) an estimate of the number of mental health provider positions that need
to be fil ed, (2) steps VA wil take to address mental health staffing, (3) a description of region-
specific hiring incentives, (4) a description of local retention or engagement incentives to be used
by VISN directors, and (5) recommendations for legislative or administrative action to address
mental health staffing. Section 501(a)(2) requires, no later than one year after submitting the plan
required under section 501(a)(1), that VA submit to SVAC and HVAC a report on the number of
mental health providers hired within VA during the one-year period preceding the report
submission.
Section 501(b) requires VA, no later than one year after enactment (i.e., October 17, 2021), to
develop an occupational series for LPMHCs and MFTs working for VA.
Section 502: Establishment of Department of Veterans Affairs Readjustment
Counseling Service Scholarship Program
Background
To assist VHA with recruitment and retention of both clinical and nonclinical staff, Congress has
authorized scholarships and student loan repayment programs under the umbrel a of the Health
Professional Educational Assistance Program (HPEAP).155 These include, among others, the
Health Professional Scholarship Program (HPSP),156 the Department of Veterans Affairs
Employee Incentive Scholarship Program (EISP),157 and the Visual Impairment Education
Assistance Program (VIOMPSP).158 However, no specific scholarship program was authorized to
recruit and retain Readjustment Counselors serving at Vet Centers in the Readjustment
Counseling Service (RCS).
Provision
Section 502(a) amends current law and adds a new subchapter IX, Readjustment Counseling
Service Scholarship Program. In the following paragraphs, “this section” refers to this new
subchapter IX of chapter 76 of Title 38, and its subdivisions.
Requirement for program
This section requires the Secretary to implement a new Department of Veterans Affairs
Readjustment Counseling Service Scholarship Program under the HPEAP.
Eligibility
This section stipulates that, to be eligible for the scholarship program, an individual must be
accepted for enrollment or enrolled in a course of education leading to a terminal degree in
psychology, social work, marriage and family therapy, or mental health counseling, at an
accredited educational institution or training program that is approved by the Secretary. An

155 38 U.S.C. §§7601 et seq.
156 38 U.S.C. §§ 7611 et seq.
157 38 U.S.C. §§ 7671 et seq.
158 38 U.S.C. §§7501 et seq.
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individual would need to meet VHA qualification standards for employment, and would need to
agree to the requirements stipulated under the scholarship program.
Priority in Selecting Individuals
This section requires the Secretary to prioritize individuals who are veterans, or who agree to be
employed by a Vet Center located in a medical y underserved area, as designated by the Public
Health Service Act, and in a state with a per capita population of veterans of more than 5%, as
defined by the National Center for Veterans Analysis and Statistics and the Census Bureau.
Agreement
This section stipulates that a participant in the scholarship program must agree to enter into an
agreement with the Secretary. The agreement would describe the number of school years during
which the scholarship funds would be provided to the participant, and would require the
participant to commit to a six-year period of obligated service at a Vet Center following the
completion studies.
Obligated service
This section requires that each participant in the scholarship program provide service as a full-
time employee at a Vet Center for a period of six years following the completion studies. The
Secretary is required to provide 60 days advance notice regarding the service commencement
date.
Breach of agreement
This section stipulates that a participant in the scholarship program who has entered into an
agreement with the Secretary, and who does not accept scholarship payments, wil have to pay
$1,500 in damages. This penalty is in addition to any liabilities related to the obligated period of
service. In addition, this section stipulates that the participant wil be liable if the participant fails
to complete course of study or does not obtain a required degree certificate. Penalties pertaining
to the obligated period of service do not apply in a situation where VA is required to use
Reduction in Force (RIF) procedures. Penalties are required to be paid within one year following
the breach of the agreement.
Effective Date
Section 502(c) requires the Secretary to begin awarding Readjustment Counseling Service
Scholarships no later than one year after the date of the enactment of this act (i.e., October 17,
2021).
Section 503: Comptroller General Report on Readjustment Counseling Service
of Department of Veterans Affairs
Background
VA provides readjustment counseling services to veterans, servicemembers, and their families in
community settings through Vet Centers.159 Services provided at Vet Centers address
bereavement, PTSD, military sexual trauma, and substance use assessment and referral, among
other topics. Individuals do not have be enrolled in VA health care to qualify for readjustment
counseling at Vet Centers. To qualify for readjustment services, a veteran or servicemember must
have either (1) served on active duty in a combat theater of operations, (2) provided direct

159 38 U.S.C. §1712A.
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emergency medical or mental health care or mortuary services to the causalities of combat
operations or hostilities, or (3) engaged in combat in a theater of combat operations by remotely
controlling an unmanned aerial vehicle.160 Certain family members are also eligible for
readjustment counseling services if they live with an eligible veteran or servicemember. This
differs from qualification for enrollment in VA health care, which requires a veteran to meet
specific criteria (e.g., means tests or disability status) to qualify for enrollment.161
Provision
Section 503 requires GAO to submit a report, no later than one year after enactment (i.e., October
17, 2021), to SVAC and HVAC on readjustment counseling services provided through VA. The
report must include an assessment of (1) the adequacy of Vet Center treatment, counseling, and
other services; (2) the efficacy of outreach efforts; (3) barriers to care; (4) the efficacy and
frequency of the use of telehealth by the RCS to provide mental health services; (5) the feasibility
and advisability of expanding eligibility for services; (6) the use of Vet Centers by members of
the reserve components of the Armed Forces who were never activated; (7) the use of Vet Centers
by eligible family members of former members of the Armed Forces; (8) the efficacy of group
therapy and the level of training of providers; (9) the efficiency and effectiveness of the task
organization structure of Vet Centers; and (10) the use of Vet Centers by Native American
veterans.162 This section requires GAO to make recommendations for most of the required
assessments.
Section 504: Expansion of Reporting Requirements on Readjustment
Counseling Services of Department of Veterans Affairs
Background
The National Defense Authorization Act for Fiscal Year 2013 (P.L. 112-239) established the
organizational structure, authority, and funding source of Readjustment Counseling Services
within VA.163 This act included an annual reporting requirement on the activities of the
Readjustment Counseling Service during the preceding calendar year.
Provision
Section 504 amends reporting requirements for Readjustment Counseling Services. First, this
section requires that the annual report identify resources required to meet demand for unmet
needs such as additional staff, locations, infrastructure, infrastructure improvements, and
additional mobile Vet Centers. Second, this section adds additional requirements for reports
submitted in even-numbered years. Such reports must additional y include a prediction of (1)
trends in demand for care, (2) long-term investments required with respect to the provision of
care, (3) requirements relating to maintenance of infrastructure, and (4) other capital investment
requirements.

160 Department of Veterans Affairs, Veterans Health Administration, “Readjustment Counseling Services,” VHA
Directive 1500, January 26, 2021, pp. 2 -3. Veterans who accessed readjustment services prior to January 2, 2013, are
eligible regardless of combat experience.
161 For more information on enrollment and eligibility for VA health care, see CRS Report R42747, Health Care for
Veterans: Answers to Frequently Asked Questions.
162 As defined in 38 U.S.C. §3765.
163 38 U.S.C. §7309.
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Section 505: Briefing on Alternative Work Schedules for Employees of
Veterans Health Administration
Background
This section was derived from the VA ECHO Act (H.R. 8212), introduced by Representatives Joe
Cunningham and Jim Banks in the 116th Congress. Current VHA policy requires that VAMCs and
CBOCs treating 10,000 or more unique primary care veteran patients in a fiscal year must provide
individuals with access to appointments for a minimum of four extended hours per week in both a
primary care clinic and a mental health clinic, and a minimum of one extended hour per month in
a women veteran’s clinic.164
Provision
Section 505 codifies existing policy of providing extended hours and requires the Secretary to
conduct, no later than 180 days from enactment of this act (i.e., April 15, 2021), a survey of
veterans on their attitudes toward offering appointments outside usual operating hours. In
addition, this section requires that the Secretary brief SVAC and HVAC no later than 270 days
from enactment (i.e., July 14, 2021) on the (1) feasibility and advisability of offering
appointments outside of normal operating hours and (2) the effectiveness of offering these
appointments. The briefing is required to include, among other things, the findings of the survey
and feedback from specified employees.
Section 506: Suicide Prevention Coordinators
Background
Suicide prevention coordinators (SPCs) are VHA employees tasked with coordinating care for
veterans at high risk for suicide who are receiving care within VHA. As part of this care
coordination, SPCs can be assigned referrals from the VCL to ensure continuity of care with a
veteran’s local VHA provider. Among other responsibilities, SPCs also conduct outreach and
disseminate best practices related to suicide prevention. As of April 2019, VA had employed
approximately 444 SPCs—with at least one SPC at each VAMC and very large CBOC165—
responsible for managing care for nearly 30,000 high-risk veterans, equating to the care
coordination of nearly 90 veterans per SPC.166 According to an internal 2018 analysis, VHA
determined a need for 246 additional SPCs to meet demand.167
In response to concerns that SPCs were being overworked and were understaffed, Congress
enacted legislation in the 116th Congress requiring GAO to look further into the issue.168 Among

164 Department of Veterans Affairs, Veterans Health Administration, “ Outpatient Clinic Practice Management,” VHA
Directive 1231(1) October 18, 2019, amended March 10, 2020. p.3.
165 Department of Veterans Affairs, Veterans Health Administratio n, “Uniform Mental Health Services in VA Medical
Centers and Clinics,” VHA Handbook 1160.01, amended November 16, 2015. Very large CBOC are those that serve
more than 10,000 unique veterans each year.
166 H.Rept. 116-70.
167 U.S. Congress, House Committee on Veterans’ Affairs, Testimony before the House Committee on Veteran’s
Affairs, Tragic Trends: Suicide Prevention Am ong Veterans, prepared by Keita Franklin, Ph.D. on behalf of Dr.
Richard Stone, Veterans Health Administration, 116 th Cong., 1st sess., April 29, 2019.
168 P.L. 116-96.
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other things, GAO was required to examine the responsibilities and workload, training, and
vacancy rates of SPCs, and the extent to which the Secretary provides oversight of SPCs. In its
April 2021 report, GAO noted that SPCs are vulnerable to burnout and turnover, given the
increasing number of suicide initiatives offered by VHA and the resulting increasing volume of
veterans identified at high risk for suicide. Further, GAO found that VHA had not evaluated
staffing needs considering effects of program growth on workload, leaving facilities susceptible
to understaffing.169
Provision
Section 506(a) requires the Secretary, no later than one year after enactment (i.e., October 17,
2021), to ensure that each VAMC has at least one SPC. Section 506(b) requires the Secretary, in
consultation with OMHSP, to conduct a study, no later than one year after enactment (i.e.,
October 17, 2021), on the feasibility of creating a SPC program office. Among other things, this
feasibility assessment would examine whether the Director of the Suicide Prevention program
could have ultimate supervision over the SPC program office. Section 506(c) requires the
Secretary, no later than 90 days after completion of the study under subsection (b), to submit a
report to SVAC and HVAC. This report shal include (1) an assessment of the feasibility and
advisability of the SPC program office; (2) a review of current staffing ratios for SPCs and
suicide prevention case managers in comparison to current staffing ratios for mental health
providers within each VAMC; and (3) a description of the duties of SPCs to better define,
delineate, and standardize specified qualifications and performance objectives.
Section 507: Report on Efforts by Department of Veterans Affairs to Implement
Safety Planning in Emergency Departments
Background
In 2010, VA implemented a clinical demonstration project at five sites known as the Suicide
Assessment and Follow-up Engagement: Veteran Emergency Treatment (SAFE VET) program.
The program was designed to help suicidal veterans seen at VA emergency departments or mental
health urgent care settings through administration of a veteran-focused, clinical safety plan
intervention, including an outreach protocol following discharge.170 The program was associated
with positive outcomes, and based on those findings, VA launched a second, larger program in
September 2018, the Safety Planning in Emergency Departments program of the Department of
Veterans Affairs (SPED). SPED is a program for veterans presenting to emergency departments
who are determined to be at risk for suicide and are safe to be discharged home. The program
combines safety planning interventions with follow-up phone cal s after discharge from
emergency departments or urgent care centers to transition veterans to outpatient mental health
care. SPED primary coordinators are the point of contact responsible for administering the
program at a VAMC. As of FY2020, VA had implemented safety plans in over 60% of emergency
departments, with a goal of 90% by FY2021.171

169 U.S. Government Accountability Office, VA Health Care: Efforts Needed to Ensure Effective Use and Appropriate
Staffing of Suicide Prevention Team s, GAO-21-326, April 2021, https://www.gao.gov/assets/gao-21-326.pdf.
170 Kerry L. Knox, Barbara Stanley, Glenn W. Currier, et al., “An Emergency Department -Based Brief Intervention for
Veterans at Risk for Suicide (SAFE VET ),” American Journal of Public Health, vol. 102, no. suppl. 1 (2012), pp. S33-
37.
171 Department of Veterans Affairs, Agency Priority Goal Action Plan, Suicide Prevention, FY 2020 Q4 Update,
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Provision
Section 507 requires the Secretary to submit a report to HVAC and SVAC no later than 180 days
from enactment (i.e., April 15, 2021) on the efforts to implement the SPED program for veterans
presenting to a VHA emergency department or urgent care center who are assessed to be at risk
for suicide but are safe to be discharged home. The report is required to include, among other
things (1) an assessment of implementation of policies and procedures of the SPED program at
each VA medical center; (2) a description of how SPED primary coordinators are deployed; (3) an
assessment of the feasibility and advisability of expanding SPED coordinator deployment; (4) an
assessment of the feasibility and advisability of providing services under the SPED program via
telehealth; (5) a description of the status of current capabilities and use of tracking mechanisms to
monitor compliance, quality, and patient outcomes; and (6) recommendations regarding how VA
can better implement the SPED program.
Title VI: Improvement of Care and Services for Women Veterans
Women veterans are one of the fastest-growing veteran demographics, and the number of women
using VHA care approximately tripled from 2000 to 2019.172 However, women veterans can
experience certain gender-specific barriers to accessing and receiving VHA care.173 The Veterans
Health Care Act of 1992 (P.L. 102-285) first authorized VA to provide gender-specific services.
Subsequent legislation has expanded services available to women veterans.174 This title includes
two provisions that would (1) expand the capabilities of the Women Veterans Cal Center (a
hotline for women veterans) and (2) require VHA to publicly post relevant information for
women veterans.
Section 601: Expansion of Capabilities of Women Veterans Call Center to
Include Text Messaging
Background
VA administers a hotline for women veterans, the Women Veterans Cal Center (WVCC). In
addition to responding to incoming cal s, the WVCC conducts outreach to women veterans
through outgoing cal s. The WVCC provides women veterans with information about available
benefits, eligibility for VHA services, and resources. As of August 31, 2019, the WVCC had
received 79,692 cal s and made 1,213,639 cal s, with 632,000 of those cal s resulting in speaking
with a veteran or leaving a voicemail.175

January 2021, p. 8, https://trumpadministration.archives.performance.gov/veterans_affairs/
FY2021_january_Suicide_Prevention.pdf.
172 Department of Veterans Affairs, “New text feature available through VA’s Women Veterans Call Center,” blog
post, April 23, 2019, https://www.blogs.va.gov/VAntage/59278/new-text-feature-available-vas-women-veterans-call-
center/.
173 Department of Veterans Affairs, Study of Barriers for Women Veterans to VA Health Care, April 2015,
https://www.womenshealth.va.gov/docs/
Womens%20Health%20Services_Barriers%20to%20Care%20Final%20Report_April2015.pdf .
174 P.L. 103-452 provided authority for counseling and treatment for military sexual trauma. Since 2017, appropriations
acts have authorized the use of assisted reproductive technology, such as in -vitro fertilization for certain veterans. For
more information on gender-specific services for veterans, see CRS In Focus IF11082, Veterans Health
Adm inistration: Gender-Specific Health Care Services for Wom en Veterans.
175 Department of Veterans Affairs, FY2021 Congressional Budget Submission, Volume II: Medical Programs and
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The WVCC connects with women veterans though a cal , text message, or online chat.176 The
WVCC added the online chat feature in May 2016 and added text messaging capabilities in April
2019.177
Provision
Section 601 codifies existing practice by requiring the Secretary to expand the capabilities of the
WVCC to include text messaging.
Section 602: Requirement for Department of Veterans Affairs Internet Website
to Provide Information on Services Available to Women Veterans
Background
VHA administers a program for women veterans that includes preventive care, acute care, and
reproductive health services.178 VHA operates a website that directs women veterans to available
services, provides outreach materials, and relevant news, among other things.179
Provision
Section 602(a) requires the Secretary to survey VA websites and information resources in effect
on the date before enactment of this act (i.e., October 16, 2020) and to publish a website that
serves as a centralized source of information about benefits and services available to veterans.
Section 602(b) requires, among other things, that the website provide women veterans with
information regarding services available in their district and a list of appropriate staff for benefits
available through the Veterans Benefits Administration (VBA), the National Cemetery
Administration (NCA), and other entities. The Secretary is also required to ensure that the
information is updated at least once every 90 days. In addition, the Secretary must ensure that
outreach conducted under the comprehensive program for suicide prevention among veterans180
includes information regarding the website. Section 602(e) specifies that funds needed to carry
out this section shal be derived from available funds used to publish VA websites.

Inform ation Technology Programs, p. VHA-180, https://www.va.gov/budget/docs/summary/
fy2021VAbudgetVolumeIImedicalProgramsAndInformationT echnology.pdf .
176 T he call center is available Monday through Friday 8:00 a.m. to 10:00 p.m. ET , and Saturday from 8:00 a.m. to
6:30 p.m. ET . For more information, see https://www.womenshealth.va.gov/WOMENSHEALT H/ProgramOverview/
wvcc.asp.
177 Department of Veterans Affairs, “New text feature available through VA’s Women Veterans Call Center,” blog
post, April 23, 2019, https://www.blogs.va.gov/VAntage/59278/new-text-feature-available-vas-women-veterans-call-
center/.
178 Department of Veterans Affairs, Veterans Health Administration, “Healthcare Services for Women Veterans,” VHA
Directive 1330.01(3), June 19, 2020.
179 T he website is available at https://www.womenshealth.va.gov/WOMENSHEALT H/index.asp.
180 38 U.S.C. §1720F(i).
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Title VII: Other Matters
Section 701: Expanded Telehealth from Department of Veterans Affairs
Background
On July 12, 2016, VA established the Office of Connected Care (OCC) within VHA. The goal of
OCC is to “deliver [information technology (IT)] health solutions that increase a [v]eteran’s
access to care and supports a [v]eteran’s participation in their health care.”181 OCC administers
the following four VA telehealth programs:182
 VA Telehealth Services, according to VA, “[improve] convenience to [v]eterans
by providing access to care from their homes or local communities when they
need it”;
 My HealtheVet is the web-based electronic health record (EHR) for veteran
patients through which veterans can view and download electronic protected
health information (ePHI);
 VHA Innovation Program is an annual competitive program that al ows VA
staff and key stakeholders in the private sector to submit innovative ideas on
enhancing VA care; and
 VA Mobile Health (VA Mobile) develops mobile apps.183
Provision
Section 701 requires the Secretary to establish a new grant program for the expansion of
telehealth capabilities and the provision of telehealth services. The Secretary is required to ensure,
to the extent practicable, that the grant program gives preference to entities in rural areas. Grants
may be awarded for a large variety of specified purposes. In addition, the section authorizes the
Secretary to enter into agreements with entities that seek to establish telehealth access points but
do not require grant funding. The Secretary is required to complete an assessment of barriers to
accessing telehealth services no later than 18 months from enactment (i.e., April 17, 2022). No
later than 120 days after completion of the assessment, the Secretary is required to submit a report
to SVAC and HVAC on the assessment, including any recommendations for legislative or
administrative action.

181 Department of Veterans Affairs, “T elehealth Services and Connected Care,” VHA Telehealth Quarterly, January
2016, p. 2, winter edition.
182 T his list was adapted from VA, Connected Care, https://connectedcare.va.gov/terms/connected-health/single/About.
183 For more information on VA telehealth services, see CRS Report R45834, Department of Veterans Affairs (VA): A
Prim er on Telehealth.
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Section 702: Partnerships with Non-Federal Government Entitles to Provide
Hyperbaric Oxygen Therapy to Veterans and Studies on the Use of Such
Therapy for Treatment of Posttraumatic Stress Disorder and Traumatic Brain
Injury
Background
Hyperbaric oxygen therapy (HBOT) is intended to increase the supply of oxygen to the blood for
certain types of injuries that can cause a deficiency in the amount of oxygen reaching the tissues
(i.e., hypoxia). HBOT works by having an individual intermittently breathe near 100% oxygen in
a hyperbaric chamber where the air pressure is at least 1.4 times greater than normal.184 This
enhanced oxygen availability has been associated with healing processes that require large
amounts of oxygen (e.g., reducing swel ing).185 Hyperbaric chambers are considered medical
devices and require clearance from the Food and Drug Administration (FDA) to be marketed.
FDA has cleared HBOT for specific uses, including burns, necrotizing infections, and carbon
monoxide poisoning, among others. FDA has not yet cleared HBOT to treat traumatic brain injury
(TBI) and posttraumatic stress disorder (PTSD), which are considered signature wounds
experienced by servicemembers and veterans of the conflicts in Iraq and Afghanistan.
There has been interest in the use of HBOT to treat these often co-occurring conditions, given the
potential effects of these conditions on the white matter of the brain. However, separate reviews
conducted by GAO in 2015186 and VA in 2018 suggest that the evidence regarding the
effectiveness of these treatments for both TBI and PTSD is mixed. This led VA to conclude, “In
summary, the large treatment benefits demonstrated for HBOT in uncontrolled case series have
not been easily replicated in wel -controlled [randomized controlled trials] RCTs. Potential
explanations for this include that the potential benefits are subtle and demonstration requires
larger RCTs, HBOT is in fact ineffective, and/or the sham [control group] design has indeed been
problematic. We are unconvinced that the current evidence clearly points to one explanation over
another. We simply stil don’t know.”187
In 2017, VA, through its Center of Compassionate Innovation (CCI) within the Office of
Community Engagement, started a pilot program that offers HBOT as a treatment option for
certain veterans. Specifical y, these veterans have persistent PTSD and tried two evidence-based
treatments that provided no decrease in symptoms.188 In a recent press release, the Eastern
Oklahoma VA Health Care System and the VA Northern California Health Care System were
mentioned as VAMCs that would initial y provide this care. Since that time, other VAMCs have
been added to the pilot program. In a 2019 update on its website, VA noted that four VAMCs were

184 Richard E. Moon et al., Hyperbaric Oxygen Therapy Indications, Undersea and Hyperbaric Medical Society, 14th
Edition, North Palm Beach, FL, 2019, https://www.uhms.org/images/UHMS-Reference-Material.pdf.
185 Kim Peterson, Donald Bourne, Johanna Anderson, et al., Evidence Brief: Hyperbaric Oxygen Therapy (HBOT) for
Traum atic Brain Injury and/or Post-traum atic Stress Disorder, Department of Veterans Affairs, Portland, OR,
February 2018, https://www.ncbi.nlm.nih.gov/books/NBK499535/pdf/Bookshelf_NBK499535.pdf.
186 U.S. Government Accountability Office, Research on Hyperbaric Oxygen Therapy to Treat Traumatic Brain Injury
and Post-Traum atic Stress Disorder, GAO-16-154, December 2015, https://www.gao.gov/assets/680/674334.pdf.
187 Kim Peterson, Donald Bourne, Johanna Anderson, et al., Evidence Brief: Hyperbaric Oxygen Therapy (HBOT) for
Traum atic Brain Injury and/or Post-traum atic Stress Disorder, 2018, p. 19.
188 Department of Veterans Affairs, “ VA to Provide Hyperbaric Oxygen T herapy to Some Veterans with Chronic
PT SD,” November 2017, https://www.va.gov/opa/pressrel/pressrelease.cfm?id=3978.
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currently participating in the pilot program (although did not specify which sites).189 According to
the North Dakota Department of Veterans Affairs, the Fargo VAMC was the fifth site added to the
pilot program.190 Each of these VAMCs partners with local providers to provide HBOT.
Provision
Section 702(a) al ows the Secretary, in consultation with CCI, to enter into partnerships with
nonfederal government entities to provide HBOT to veterans as part of research into the
effectiveness of this therapy. Such partnerships may include those that focus on conducting
research, reviewing research, creating industry working groups to determine standards for
research, or providing HBOT to veterans for the purpose of conducting research on the
effectiveness of the therapy. Federal funds may be used only to coordinate and administer
partnerships under subsection (a).
Section 702(b) requires the Secretary, no later than 90 days after enactment (i.e., January 15,
2021) and in consultation with CCI, to review the effectiveness of HBOT using an objective and
quantifiable method (e.g., an FDA-approved or cleared device that assesses traumatic brain injury
(TBI) by tracking eye movement). Section 702(c) requires the Secretary, no later than 90 days
after enactment (i.e., January 15, 2021) and in consultation with CCI, to conduct a systematic
review of literature on the off-label use of HBOT to treat PTSD and TBI among veteran and
nonveteran populations. The review is required to include, among other things, an assessment of
current parameters for research on VA use of HBOT and a comparative analysis of tests and
questionnaires used to study PTSD and TBI in research conducted by VA, as wel as other federal
and nonfederal organizations. It is required to be completed no later than 180 days after it is
started, and the Secretary is required to submit a report on the results of the review to SVAC and
HVAC no later than 90 days after completion of the review.
Section 702(d) requires the Secretary, no later than 120 days after completion of the review
conducted under subsection (c) and in consultation with CCI, to conduct a study on the efficacy
and effectiveness of HBOT for PTSD and TBI, as is currently being offered through VA’s pilot
program. This study is required to be completed no later than three years after commencement.
No later than 90 days after the study is completed, the Secretary is require to submit to SVAC and
HVAC a report on the results of the study. The report shal include the Secretary’s
recommendation as to whether HBOT should be made available to al veterans with PTSD and
TBI.
Section 703: Prescription of Technical Qualifications for Licensed Hearing Aid
Specialists and Requirement for Appointment of Such Specialists
Background
The Veterans Mobility Safety Act of 2016 (P.L. 114-256) amended VHA’s appointment authority
to include licensed hearing aid specialists and those whose qualifications can be prescribed by the
Secretary. This provision was derived from the Veterans Hearing Aid Access and Assistance Act

189 Department of Veterans Affairs, “ T he Center for Compassionate Care Innovation supports treatments that may help
Veterans with PT SD: Hyperbaric Oxygen T herapy (HBOT ),” August 9, 2019, https://www.va.gov/healthpartnerships/
updates/cci/08092019.asp.
190 North Dakota Department of Veterans Affairs, “Hoeven, Cramer, Armstrong: VA Extends Fargo VA HBOT
Demonstration Program, Expands Program to Include Jamestown Regio nal Medical Center and Increases T reatment
Referrals for Veterans,” October 15, 2020, https://www.nd.gov/veterans/news/va-extends-fargo-va-hbot-
demonstration-program.
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(S. 564; 114th Congress). However, VHA did not develop basic qualification standards and work
assignments for this occupation and did not exercise this discretionary authority provided in the
act to hire hearing aid specialists. In reports to Congress, VHA stated that
there are technical barriers to establishing qualification standards for hearing aid
specialists.... To be eligible for appointment to the title 38 positions in VA, a profession
must have established qualifications that include standards for education and professional
training that are applicable for all states. Presently, the hearing aid specialist occupation
has no consistent national education requirements and no standardized professional
training, resulting in highly variable skill sets from state to state. Most states (33) require
only a high school education for hearing aid specialists to receive a license. Nine states
have no educational requirement and eight states require an associate degree for state
licensure…. When this profession establishes a functional national standard for hearing aid
specialists that addresses the necessary education, training and licensure requirements, VA
will use the authority to revise the standards when national standards are in place.191
Provision
Section 703 requires the Secretary to prescribe technical qualifications and appointment
requirements for licensed hearing aid specialists.
Technical Qualifications
Section 703(a)(1) requires the Secretary to prescribe the technical qualifications that are required
for appointment as licensed hearing aid specialists in VHA. These qualification standards are to
be prescribed no later than 180 days after the date of the enactment of this act (i.e. April 15,
2021).
Elements for Qualifications
Section 703(a)(2) stipulates that when prescribing qualifications, the Secretary must ensure that
the qualifications for hearing aid specialists are in keeping with licensure standards of a majority
of states, have the competencies needed as hearing aid specialists, and include any other
competencies required by the Secretary to provide care.
Authority to Set and Maintain Duties
Section 703(b) requires the Secretary to retain the authority to set and maintain the duties for
licensed hearing aid specialists.
Appointment
Section 703(c) requires the Secretary to appoint at least one licensed hearing aid specialist at each
VAMC no later than September 30, 2022.
Reporting Requirements
Section 703(d) requires the Secretary to submit an annual report to SVAC and HVAC on the
appointment of licensed hearing aid specialists. The first such report must be submitted no later
than September 30, 2022. The annual report must include, among other things, the following
elements: assessing the progress of appointments of licensed hearing aid specialists in VAMCs,
potential challenges facing appointments, and assessing access of patients to comprehensive VA
hearing health services.

191 Department of Veterans Affairs, Report on Timely Access of Veterans to Hearing Health Services Through the
Departm ent of Veterans Affairs, Report to Congress, December 2020, p. 2.
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Section 704: Use by Department of Veterans Affairs of Commercial
Institutional Review Boards in Sponsored Research Trials
Background
The HHS Human Subject Regulations are a core set of federal standards for protecting human
subjects in HHS-sponsored research.192 These regulations are commonly referred to as the
“Common Rule” because the same requirements have been adopted by many non-HHS federal
departments and agencies, including VA, which apply the regulations to the research they fund.
Under the Common Rule, research protocols must be approved by an Institutional Review Board
(IRB) to ensure that the rights and welfare of research subjects are protected.193 The rule lists
several criteria for IRB approval, including the requirement that researchers obtain the informed
consent of their research subjects.194 HHS has promulgated additional protections for certain
vulnerable populations involved in research. Those groups include pregnant women, human
fetuses, and neonates; prisoners; and children.195
VHA Directive 1200.05 (“Requirements for the Protection of Human Subjects in Research”)
“defines the procedures for implementing the Federal Policy for the Protection of Human
Subjects, known as the Common Rule, and other applicable Federal requirements for the
protection of human subjects in research.”196
Provision
Section 704 requires the Secretary, no later than 90 days after enactment (i.e., January 15, 2021),
to al ow sponsored clinical research of VA to use accredited commercial IRBs to review research
proposal protocols. This must be carried out through revision of VHA Directive 1200.05, titled
‘‘Requirements for the Protection of Human Subjects in Research.” Further, the Secretary is
required to identify accredited commercial IRBs and to establish a process to modify existing
approvals in the case that a commercial IRB loses its accreditation. Final y, the Secretary is
required, no later than 90 days after the revisions of Directive 1200.05 are complete and annual y
thereafter, to submit to SVAC and HVAC a report on al IRB approvals used by VA, including
central IRBs and commercial IRBs, as specified.
Section 705: Creation of Office of Research Reviews Within the Office of
Information and Technology of the Department of Veterans Affairs
Background
Conducting medical research is one of VA’s statutory missions.197 As required by law, the medical
and prosthetic research program (medical research) focuses on research into the special health

192 45 C.F.R. Part 46, Subpart A.
193 45 C.F.R. §46.109.
194 45 C.F.R. §46.111.
195 45 C.F.R. Part 46, Subparts B (pregnant women, fetuses, neonates), C (prisoners), and D (children).
196 Department of Veterans Affairs, VHA Directive 1200.05 “Requirements for the Protection of Human Subjects in
Research,” amended March 3, 2020, p. 1.
197 38 U.S.C. §7303.
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care needs of veterans.198 Although VHA’s medical research program is an intramural program,
industry-funded research studies, as wel as collaborative research studies with private and/or
nonprofit entities, could be performed at VAMCs. VHA has a long history of nongovernmental-
financed studies and private sector collaboration in its medical research program.199
Provision
Section 705 requires the Secretary to establish a new Office of Research Reviews within the
Office of Information and Technology within one year of enactment of this act (i.e. October 17,
2021). The Office of Research Reviews wil be responsible for conducting centralized security
reviews and completing security processes for approved research projects, including multisite
clinical trials, funded by non-VA sources. In addition, the office is required to develop and
maintain a list of official y approved commercial software used in clinical trials, and to develop
appropriate timelines for security reviews. One year after the establishment of the Office of
Research Reviews, the Secretary is required to submit a report to SVAC and HVAC on activities
of the office.
Provisions in Veterans COMPACT Act of 2020
Title I: Improvement of Transition of Individuals to Services from
Department of Veterans Affairs
Transitioning from the military to civilian life can be a time of increased risk for suicide. One
research study found that this risk may be elevated for years after the transition.200 This title
includes provisions that assist with this transition by (1) authorizing a pilot program that
designates relatives and friends to receive information about assistance and benefits available to
veterans, and (2) requires VA to report to specified committees of Congress on the status of Solid
Start, a transition assistance program that conducts outreach to veterans at certain points during
the first year of separation from the military.
Section 101: Pilot Program on Information Sharing Betw een Department of
Veterans Affairs and Designated Relatives and Friends of Veterans Regarding
Assistance and Benefits Available to the Veterans
Background
As VA notes in its national strategy for preventing veteran suicide, “family members, friends, co-
workers, and others can play an important role in recognizing when a Veteran is in crisis and

198 38 U.S.C. §7303(a)(3).
199 Marguerite T . Hays, A Historical Look at the Department of Veterans Affairs Research and Development Program ,
Department of Veterans Affairs, p. 98, https://www.research.va.gov/pubs/ord-history.cfm.
200 Department of Veterans Affairs, “Help With Readjustment and Social Support Needed for Veterans T ransitioning
From Military Service,” https://www.mentalhealth.va.gov/suicide_prevention/docs/
Literature_Review_Military_Separation_508_FINAL_05 -24-2019.pdf.
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connecting the Veteran with sources of help. However, many of these people may not know the
warning signs of suicidal behavior or where a distressed person can go for help.”201
Senator Kyrsten Sinema introduced the Sergeant Daniel Somers Veterans Network of Support Act
of 2019 in November 2019, which requires the Secretary to carry out a two-year pilot program on
information sharing between VA and designated persons regarding assistance and benefits
available to veterans. 202 The act was subsequently passed in the Senate in June 2020 and was
included as Section 101 of the Veterans COMPACT Act. The bil was named after Sergeant
Daniel Somers, who was diagnosed with PTSD and traumatic brain injuries following his return
home from two tours in Iraq, and who died by suicide in 2013.203
Provision
Section 101(a) requires the Secretary to start a pilot program, no later than one year after
enactment (i.e., December 5, 2021), for a duration of at least two years, that encourages Armed
Forces members, before transitioning to civilian life, to designate up to 10 people to whom VA
may disseminate specified information regarding assistance and benefits available to veterans.
When making such a designation, the veteran is required to provide necessary contact information
for the designees, including an email address. The pilot program would also provide the
designees, within 30 days after being designated, the option to elect to receive information
regarding assistance and benefits, and such information would be distributed at least quarterly to
the designees. Among other things, the specified information would include VA services and
benefits offered to veterans and their families, services available through community partner
organizations to support veterans and their families, and a toll-free telephone number through
which designees may request information. Disclosure of such information may not violate
privacy requirements of the Armed Forces specified in statute or regulation.204 Veterans may
participate in the pilot program only if they voluntarily elect to do so. Designees may participate
only if they elect to receive the specified information, and they may opt out of the program upon
request.
Section 101(b)(1) requires the Secretary, no later than one year after the start of the pilot program
and annual y thereafter, to administer a survey to designees in the pilot program regarding the
quality of information disseminated. Among other things, the survey would solicit feedback on
satisfaction with the pilot program, recommendations for improving the pilot program, and
reasons for opting in or out of the pilot program. Section 101(b)(2) requires the Secretary, no later
than three years after the start of the pilot program, to submit a final report on the program to the
HVAC and SVAC. The report is required to include, among other things, the number of
participants enrolled in the pilot program who are veterans, the number of persons who opted in
or out of the pilot program, and identification of necessary legislative or administrative action if
the pilot program is made permanent.

201 Office of Mental Health and Suicide Prevention, National Strategy for Preventing Veteran Suicide, 2018-2028,
Department of Veterans Affairs, p. 17, https://www.mentalhealth.va.gov/suicide_prevention/docs/Office-of-Mental-
Health-and-Suicide-Prevention-National-Strategy-for-Preventing-Veterans-Suicide.pdf.
202 S. 2864 (116th Congress).
203 U.S. Senator Krysten Sinema, “Breaking: Sinema’s Sgt. Daniel Somers Veterans Network of Suppo rt Act Signed
Into Law,” December 7, 2020, https://www.sinema.senate.gov/breaking-sinemas-sgt-daniel-somers-veterans-network-
support -act-signed-law.
204 As specified in Section 101(a)(5), such statutory requirements include 5 U.S.C. §552a (T he Privacy Act of 1974)
and P.L. 104-191 (the Health Insurance Portability and Accountability Act of 1996, HIPAA).
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Section 102: Annual Report on Solid Start Program of Department of
Veterans Affairs
Background
To address requirements associated with the January 2018 EO 13822 “Supporting our Veterans
During Their Transition from Uniformed Service to Civilian Life,” VA, in collaboration with
DOD and DHS, launched Solid Start in December 2019. Solid Start is a transition assistance
program that conducts outreach to newly separated servicemembers, regardless of separation type
or characterization of service. Such outreach general y occurs at the 90-, 180-, and 365-day mark
during the first year after separation, and the cal s provide new veterans education about and
assistance with accessing certain VA benefits. According to VA, VBA successfully connected with
70,000 newly separated servicemembers during the first year of the program (2020).205
Provision
Section 102 requires the Secretary to submit to SVAC and HVAC an annual report on VA’s Solid
Start program no later than 180 days after enactment (i.e., June 3, 2021) and every five years
thereafter. The report is required to include specified information with respect to each veteran
cal ed or emailed under the program, including the Armed Force in which the veteran served and
whether the cal or email resulted in a cal to the VCL, and any change to the Solid Start program
implemented since the date of the previous such report, among other things. The report may not
contain any of the veteran’s personal y identifiable information.
Title II: Suicide Prevention
As VHA continues to expand suicide prevention initiatives and create new programs, more
veterans at risk for suicide are able to be identified.206 However, as these veterans are identified,
need for services also increases. Further, as suicide can arise from numerous factors, a
multifactorial approach is needed to reach as many at-risk veterans as possible. This title includes
provisions that address suicide prevention by (1) requiring the Secretary to provide acute crisis
care for emergent suicide symptoms; (2) requiring the Secretary to create an education pilot
program for family members and caregivers on matters related to coping with mental health
disorders in veterans; (3) requiring the Secretary to establish a task force on outdoor recreation;
(4) requiring VHA to contact al enrolled veterans who have not received care in the past two
years to encourage them to receive a comprehensive medical examination, including a mental
health evaluation; and (5) requiring annual VA police crisis intervention training.
Section 201: Department of Veteran Affair s Provision of Emergent
Suicide Care
Background
The Department of Veterans Affairs Health Care Programs Enhancement Act of 2001 (P.L. 107-
135) provided the Secretary broad authority to furnish hospital care or medical services in

205 Department of Veterans Affairs, “ VA Solid Start program makes strides in first year,” December 2, 2020,
https://www.va.gov/opa/pressrel/pressrelease.cfm?id=5577.
206 U.S. Government Accountability Office, Efforts Needed to Ensure Effective Use and Appropriate Staffing of Suicide
Prevention Team s, GAO-21-326, April 2021, https://www.gao.gov/assets/gao-21-326.pdf.
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emergency situations to any individual regardless of veteran status. This authority is general y
referred to as the humanitarian care authority. Furthermore, the Jeff Mil er and Richard
Blumenthal Veterans Health Care and Benefits Improvement Act of 2016 (P.L. 114-315) requires
VA emergency departments to, at a minimum, screen an individual for a medical emergency. If
the facility determines that a medical emergency exists, the facility wil provide care to stabilize
the individual’s emergency condition.207 The individual is general y bil ed for any emergency
services provided.208
A former servicemember with a bad conduct or dishonorable discharge who is in distress and in
need of emergency mental health services may be provided services under humanitarian care
provisions.209 Former servicemembers can access the VA system by cal ing the VCL or by visiting
a VA emergency room, urgent care center, or VAMC.
Descriptions of Military Character of Discharge

Honorable discharge applies when the quality of a servicemember’s service general y has met the
standards of acceptable conduct and performance of duty for military personnel, or is otherwise so
meritorious that any other characterization would be clearly inappropriate.

General (under honorable) discharge applies when a servicemember’s service has been honest and
faithful. Characterization of service as general (under honorable conditions) is warranted when the positive
aspects of a servicemember’s conduct or performance of duty outweigh negative aspects of the
servicemember’s conduct or performance of duty as documented in their service record.

Other-than-honorable discharge applies when separation is based on a pattern of behavior that
constitutes a significant departure from the conduct expected of servicemembers, or when separation is
based on one or more acts or omissions that constitute a significant departure from the conduct expected of
servicemembers. Factors that may lead to such a discharge include the use of force or violence to produce
serious bodily injury or death; abuse of a special position of trust; disregard by a superior of customary
superior-subordinate relationships; acts or omissions that endanger the security of the United States or the
health and welfare of other servicemembers; and deliberate acts or omissions that seriously endanger the
health and safety of other persons.

Bad-conduct discharge applies only to enlisted persons and may be adjudged by a general court-martial
and by a special court-martial. A bad-conduct discharge is less severe than a dishonorable discharge and is
designed as a punishment for bad conduct rather than as a punishment for serious offenses of either a civilian
or military nature. It is also appropriate for an accused servicemember who has been repeatedly convicted of
minor offenses and whose punitive separation appears to be necessary.

Dishonorable discharge applies only to enlisted persons and warrant officers who are not commissioned
and may be adjudged only by a general court-martial. A dishonorable discharge may be adjudged for any
offense in which a warrant officer who is not commissioned has been found guilty. It is reserved for those
who should be separated under conditions of dishonor, after having been convicted of offenses typical y
recognized in civil jurisdictions as felonies, or of offenses of a military nature requiring severe punishment.
Source: CRS, adapted from the Department of Defense, Enlisted Administrative Separations, DOD Instruction
1332.14, effective April 12, 2019, and the Manual for Courts-Martial United States (2019 edition).
In FY2017, VHA started providing emergent mental health services to former servicemembers
with OTH administrative discharges. Eligible servicemembers were provided emergency
stabilization if they presented at a VAMC with an emergent mental health need. Those with an
OTH administrative discharge were able to receive care for their mental health emergency for an

207 Department of Veterans Affairs, Veterans Health Administration, Eligibility Determination, VHA Directive
1601A.02, amended October 15, 2020, and 38 U.S.C. §1784A.
208 38 U.S.C. §1784.
209 Department of Veterans Affairs, Veterans Health Administration, “Eligibility Determination,” VHA Directive
1601A.02, amended October 15, 2020.
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initial period of up to 90 days, which included inpatient, residential, or outpatient care.210 These
services are not provided to former servicemembers with bad-conduct or dishonorable discharges.
Provision
Section 201(a) amends current law and adds a new Section 1720J to title 38 of the U.S. Code. In
the following paragraphs, “this section” refers to the newly added Section 1720J and its
subdivisions.
Emergent Suicide Care
This section would require the Secretary to provide emergent suicide care to those with an acute
suicidal crisis, in a VA facility, or to pay for care in a non-VA facility, or to reimburse for such
care.
Eligibility
This section stipulates that individuals are eligible for emergent suicide care if they meet the
statutory definition of a “veteran,” meaning an “individual who served in the active military,
naval, or air service and who was discharged or released under conditions other than
dishonorable”;211 or a former servicemember, including those who served in the Reserve
components and who meet each of the following criteria:212
 Conditions of discharge: the veteran served on active duty and was discharged or
released under a condition that is not honorable (but not a dishonorable
discharge), or was discharged by court-martial (i.e., those with a dishonorable
discharge or a discharge by court-martial would not be eligible for mental health
care services from VA).
 Duration of service: the veteran served for a period of more than 100 cumulative
days.
 Conditions of service: the veteran (1) was deployed in a theater of combat
operations, in support of a contingency operation, or in an area at a time during
which hostilities occurred, including by controlling an unmanned aerial vehicle
(UAV) from a location other than such theater or area; or (2) was the victim of a
physical assault of a sexual nature, a battery of a sexual nature, or sexual
harassment.
 Not currently enrolled in VA’s health care system.
Period of Care
This section requires that care be provided for a period not to exceed 30 days as an inpatient or in
a crisis residential care facility; if such care is unavailable or not clinical y appropriate, then care
must be provided on an outpatient basis for a period of no more than 90 days. After such time, if

210 Department of Veterans Affairs, “VA Secretary Formalizes Expansion of Emergency Mental Health Care to Former
Service Members With Other-Than-Honorable Discharges,” press release, June 27, 2017. Also see Memorandum from
Deputy Under Secretary for Health for Operations and Management (1ON) to Network Directors (10N1 -23) and
Network Mental Health Leads (10N1-23), Elim inating Veteran Suicide: Em ergency Services for Other Than
Honorable, June 26, 2017.
211 38 U.S.C. §101(2). Section 926 of the William M. (Mac) T hornberry National Defense Authorization Act for Fiscal
Year 2021 (P.L. 116-283) amended the term “ veteran” to include “ space service.’’ T he Office of the Law Revision
Counsel of the U.S. House of Representatives has not codified this change as of the date of this report.
212 38 U.S.C. §1720I(b).
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the Secretary determines that such individual remains in an acute suicidal crisis, the Secretary
could extend the period of care as appropriate.
Outreach and Notification Requirements
This section stipulates that an eligible individual, or someone else on behalf of the individual,
must notify the Secretary within seven days if such an individual receives emergent suicide care
at a non-VA facility. It also requires the following during the period when an eligible individual is
receiving emergent suicide care:
 If emergent suicide care is recommended by the VCL at a VAMC, then the VCL
must notify the SPC at the VAMC.
 If the eligible individual receives emergent suicide care at a VAMC without the
VCL recommendation, then the SPC at the VAMC must be notified.
 If emergent suicide care is recommended by the VCL at a non-VA facility, then
the VCL must notify the SPC and the Office of Community Care at the nearest
VAMC.
 If the eligible individual receives emergent suicide care at a non-VA facility,
without the VCL recommendation, then the Secretary must notify the SPC and
the Office of Community Care at the nearest VAMC regarding the eligible
individual, or someone else must notify the Secretary on behalf of the individual
within seven days of receiving the emergent suicide care.
 After emergent suicide care is provided, as soon as practicable, the Secretary
must make referrals to other VA benefits and services as appropriate and
determine the eligibility for those benefits and services.
Prohibition on Charges
This section provides that the Secretary may not impose any charges for emergent suicide care
(i.e., no “cost sharing” or “out-of-pocket” costs), and must pay for any costs of emergency
transportation. The Secretary may not impose any charges, even if the eligible individual, or
someone else on behalf of the individual, did not notify the Secretary within the seven day
notification period.
Reimbursement and Other Health Insurance
This section stipulates that the Secretary could establish payment rates for care in non-VA
facilities or from non-VA providers in a similar manner to the manner in which the Secretary
determines reimbursement amounts for that nondepartment facility for medical care and services
provided under another provision of this chapter. If the eligible individual has a health plan
contract that would pay for the emergent suicide care treatment, the Secretary may recover the
costs for nonservice-connected emergent suicide care from such third party.
Annual Report to Congress
This section requires the Secretary to submit and report annual y to SVAC and HVAC. The report
must include the number of eligible individuals who received emergent suicide care and related
demographic information, the types of care provided, and the total cost of emergent suicide care.
Definitions
This section defines the following terms applicable to the new “Emergent suicide care” section.
Acute suicidal crisis. An individual who is determined by a trained crisis responder or health
care provider to be at imminent risk of self-harm.
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Crisis residential care. Care provided in a residential setting, and in a nonhospital facility.
Crisis stabilization care. Care provided to an individual in acute suicidal crisis, which would
provide immediate safety and reduce the severity of the distress.
Emergent suicide care. Crisis stabilization care provided based on recommendations from the
VCL or when presented at a medical facility with acute suicidal crisis.
Health-plan contract. A private health insurance policy or contract, Medicare, Medicaid, or
workers’ compensation law or plan.
Effective Date
This new section wil be effective 270 days after the date of the enactment of this act (i.e.,
September 1, 2021).
Section 202: Education Program for Family Members and Caregivers of
Veterans with Mental Health Disorders
Background
The Department of Veterans Affairs Health Care Programs Enhancement Act of 2001 (P.L. 107-
135) first authorized VHA to provide services such as counseling, training, and mental health
services to family members of veterans receiving treatment through VA. Eligibility for these
services was later expanded to caregivers by the Caregivers and Veterans Omnibus Health
Services Act of 2010 (P.L. 111-163). Under these authorities, VHA established policies for
providing services to family members and caregivers as they pertain to a veteran’s mental health
goals.213 Such services include, at a minimum, family education, veteran-centered brief family
consultation, and marital and family counseling, including family psychoeducation.
Provision
Section 202 requires the Secretary to establish an education pilot program for family members
and caregivers on matters related to coping with mental health disorders in veterans. The
Secretary is required to establish the program no later than 270 days after enactment (i.e.,
September 1, 2021), and the program is required to continue for four years from the date of
commencement. The component of the program that relates to education and training of
noncaregiver family members must be carried out in at least five medical centers, at least five
clinics, and at least five vet centers.
This section requires that the Secretary contract with nonprofit entities experienced in the relevant
field to carry out the education program as specified. In addition, the Secretary is required to
select department mental health care providers to monitor the progress of instruction under the
program. The curriculum must consist of, among other things (1) general education on different
mental health disorders, (2) techniques for handling crisis situations and administering mental
health first aid, (3) techniques for coping with the stress of living with an individual suffering
from a mental health disorder, and (4) information on additional services available.
The Secretary is required to survey participants for satisfaction, perceived effectiveness, and
applicability of the program to issues faced. In addition, the Secretary is required to submit an
annual report to HVAC and SVAC no later than one year after commencement of the program and

213 Department of Veterans Affairs, Veterans Health Administration, Family Services in Mental Health, VHA Directive
1163.04, June 17, 2019.
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no later than September 30 each year thereafter until 2024. The section specifies information to
include in the annual report, which includes results of the surveys. Furthermore, the Secretary is
required to submit a final report to HVAC and SVAC no later than one year after the completion
of the program.
Section 203: Interagency Task Force on Outdoor Recreation for Veterans
Background
Some research suggests that outdoor recreation, such as camping or kayaking, may prove
beneficial for veterans with mental health problems.214 Further, group-based outdoor recreation
programs may help veterans who are transitioning back to civilian life.215
In May 2019, legislation was jointly introduced in the House and Senate that would have created
a federal interagency task force on outdoor recreation for veterans.216 In July 2020, HVAC held a
legislative hearing on the House-passed version of the bil .217 VA supported the passage of the bil
but had a few suggestions for technical corrections.218 Organizations such as the Paralyzed
Veterans of America and the Iraq and Afghanistan Veterans of America also supported the passage
of the legislation.219
Provision
Section 203 requires the Secretary to establish the Task Force on Outdoor Recreation for Veterans
(Task Force) no later than 18 months after the President’s national emergency declaration
pertaining to Coronavirus Disease 2019 (COVID-19) expires.220 The Task Force must include
representatives from the Departments of the Interior, Health and Human Services, Agriculture,
Defense, and Homeland Security, as wel as the Army Corps of Engineers, at least two
representatives from VSOs, and any other member the Secretary deems appropriate. The
Secretary and Secretary of the Interior are required to serve as co-chairpersons of the Task Force.

214 Department of Veterans Affairs, “ Outdoor activities improve mental health in Veterans, study finds,” February 19,
2014, https://www.research.va.gov/currents/winter2013-14/winter2013-14-25.cfm.
215 Jason Duvall and Rachel Kaplan, Exploring the Benefits of Outdoor Experiences on Veterans, University of
Michigan and Sierra Club, Washington, DC, June 2013, p. 23, https://content.sierraclub.org/outings/sites/
content.sierraclub.org.outings/files/
SIERRA_REPORT _6_13_Exploring%20the%20benefits%20of%20outdoor%20expereinces%20on%20veterans%20 (1
).pdf.
216 S. 1263 (116th Congress) and H.R. 2435 (116th Congress).
217 U.S. Congress, House Committee on Veterans’ Affairs, Legislative Hearing on: H.R. 6039; H.R. 6082 ;H.R.
4908;H.R. 2791; H.R. 4526; H.R. 3582 ; H.R. 96 ; H.R. 4281; H.R. 3010 ; H.R. 7163; H.R. 7111; H.R. 2435; H.R.
7287; H.R. 3228; H.R. 6141; H.R. 6493 ; H.R. 7445; Discussion Draft –Burial Equity for Guards and Reserves Act of
2020; Discussion Draft – To am end title 38, United States Code, to extend certain em ploym ent and reem ployment
rights to m em bers of the National Guard who perform State active duty, and Discussion Draft – To am end title 38,
United States Code, to clarify the scope of procedural rights of m em bers of the uniform ed services with respect to their
em ploym ent and reem ployment rights, and for other purposes, 116th Cong., 2nd sess., July 23, 2020.
218 U.S. Congress, House Committee on Veterans’ Affairs, Testimony for the House Committee on Veteran’s Affairs,
prepared by Dr. Maria Llorente, Veterans Health Administration, 116 th Cong., 2nd sess., July 23, 2020.
219 See for example U.S. Congress, House Committee on Veterans’ Affairs, Statement for the Record for the House
Committee on Veteran’s Affairs, prepared by Ryan Britch, Iraq and Afghanistan Veterans of America, 116 th Cong., 2nd
sess., July 23, 2020, and U.S. Congress, House Committee on Veterans’ Affairs, Statement for the Record for the
House Committee on Veteran’s Affairs, prepared by Paralyzed Veterans of America, 116th Cong., 2nd sess., July 23,
2020.
220 50 U.S.C. §§1601 et seq.
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Section 203(g) states that the Federal Advisory Committee Act (FACA; P.L. 92-463) is not
applicable to the Task Force.
Section 203(d) stipulates the duties of the Task Force, which must be carried out in consultation
with appropriate veteran outdoor recreation groups. Among other things, the Task Force is
required to identify barriers that exist to providing veterans with health and wel ness services
through use of outdoor recreation on public lands and to develop recommendations to better
accommodate the use of public lands for this purpose. Section 203(h) defines public lands as any
recreational lands under federal, state, or local government jurisdiction.
Section 203(e) requires submission of reports to Congress on the findings of the Task Force. A
preliminary report on initial findings of the Task Force is due no later than one year after the date
on which the Task Force is established. The final report, which is required to include
recommendations developed under subsection (d), must be submitted no later than one year after
the submission of the preliminary report. Pursuant to section 203(f), the Task Force is required to
end one year after the submission of the final report under subsection (e).
Section 204: Contact of Certain Veterans to Encourage Receipt of
Comprehensive Medical Examinations
Background
In general, a veteran must be enrolled in the VA health care system as a condition for receiving
care. Once a veteran is enrolled, the veteran remains in the system and does not have to reapply
for enrollment annual y. However, in a given year not al enrolled veterans receive care through
the VA health care system, either because they are not sick or have other sources of health care
coverage such as private health insurance or public sources such as Medicare.221
Provision
Section 204 requires the Under Secretary of Health to contact al enrolled veterans who have not
received care from the VA health care system in the past two years and encourage them to receive
a comprehensive medical examination, including mental health evaluations and specified vision
and hearing tests. The veteran could receive this examination in a VAMC or in the community
under the VCCP.222 When care is provided in a VAMC, the Secretary must seek to schedule al
examinations on the same day. Eligible veterans are to be contacted by mail, telephone, or email
no later than 90 days after enactment of this act (i.e., March 5, 2021). This section al ows the
Secretary to pay for travel for rural covered veterans who avail themselves of this comprehensive
medical examination, as wel as to enter into contracts for shuttle services to transport veterans in
rural areas to receive the examination. This section requires a report to Congress no later than 18
months after enactment (i.e., June 5, 2022) on how many eligible veterans scheduled
comprehensive medical examinations.

221 For more information, see CRS In Focus IF10418, Do Veterans Have Choices in How They Access Health Care?
222 For more information on VCCP, see CRS Report R45390, VA Maintaining Internal Systems and Strengthening
Integrated Outside Networks Act of 2018 (VA MISSION Act; P.L.115 -182).
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Section 205: Police Crisis Intervention Training of Department of
Veterans Affairs
Background
VA police officers are federal law enforcement officers who provide security and law
enforcement services at VHA facilities, VBA offices co-located with VHA facilities, and for VA
national cemeteries under certain circumstances.223 There are approximately 4,000 police officers
working at 139 of the 141 VAMCs, and VHA shares responsibility for the police program with
the VA Office of Operations, Security, and Preparedness (OSP).224 Al VA police officers receive
specialized training at the Law Enforcement Training Center (LETC), accredited by the Federal
Law Enforcement Training Accreditation Board. This training entails
a 10-week basic training course where they receive 30.5 hours of classroom training
specific to de-escalation and conflict management techniques with a new special focus on
suicide awareness and prevention. Officers also complete nearly 24 hours of practical based
scenarios in which they are expected to successfully employ and utilize de-escalation skils
to affect positive outcomes in real-life scenarios.225
In light of incidents involving veterans with mental health conditions being mistreated and
injured by VA police,226 among other reasons, the HVAC Subcommittee on Oversight and
Investigations held a June 2019 hearing on current VA police policies and procedures.227 A bil
was subsequently introduced in the House that would, among other things, amend current law228
to require VA police officers to receive annual training on preventing suicide among the
population served (i.e., veterans).229
Provision
Section 205(a) requires the Secretary to provide department police officers with an annual
training on veteran suicide prevention. Section 205(f) defines department police officers as
employees of VA under 38 U.S.C. §902(a). Section 205(b) requires that the Secretary update any
training already provided before enactment to include, at minimum, (1) effective behavioral
procedures of suicide prevention and risk mitigation; (2) crisis intervention and de-escalation
skil s through the use of interactive training; (3) information about mental health and substance
use disorders; and (4) information about local law enforcement teams and other resources for
veterans experiencing mental health crises. Section 205(c) requires that the training occur at a

223 38 U.S.C. §902(a), and VA OIG, VA Police Management System Needs Improvement, Department of Veterans
Affairs, June 17, 2020, https://www.va.gov/oig/pubs/VAOIG-19-05798-107.pdf.
224 U.S. Congress, House Committee on Veterans’ Affairs, Testimony before the House Committee on Veteran’s
Affairs, Subcom m ittee on Oversight and Investigations, Exam ining the Departm ent of Veterans Affairs Police Program,
prepared by Michael J. Missal, Department of Veterans Affairs Inspector General, 116th Cong., 1st sess., June 11, 2019,
p. 2.
225 U.S. Congress, House Committee on Veterans’ Affairs, Testimony before the House Committee on Veteran’s
Affairs, Subcom m ittee on Oversight and Investigations, Exam ining the Departm ent of Veterans Affa irs Police Program,
prepared by Renee Oshinski, Deputy Under Secretary for Health for Operations and Management (Acting), Veterans
Health Administration, 116th Cong., 1st sess., June 11, 2019, p. 4.
226 U.S. Representative Kathleen Rice, “ Rice, Pappas Introduce VA Police Reform Legislation,” July 24, 2020,
https://kathleenrice.house.gov/news/documentsingle.aspx?DocumentID=1548.
227 U.S. Congress, House Committee on Veterans’ Affairs, Subcommittee on Oversight and Investigations, Examining
the Departm ent of Veterans Affairs Police Program , 116th Cong., 1st sess., June 11, 2019.
228 38 U.S.C. §902.
229 H.R. 7784 (116th Congress).
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VAMC in consultation with the mental health experts at the VAMC, as wel as law enforcement
training accreditation organizations. Section 205(d) requires that each VA facility police force
develop a plan to enter into partnerships with relevant local community organizations and local
police departments.
Section 205(e) requires the Secretary to submit to HVAC and SVAC, no later than one year after
enactment (i.e., December 5, 2021), a report with specified information on the annual training and
partnerships required under this section.
Title III: Improvement of Care and Services for Women Veterans
Section 301: Gap Analysis of Department of Veterans Affairs Programs That
Provide Assistance to Women Veterans Who Are Homeless
Background
Based on a single day count in January 2020, approximately 8.4% of veterans experiencing
homelessness were women.230 Programs to assist homeless veterans are funded through three
agencies: VA, Department of Labor (DOL), and Department of Housing and Urban Development
(HUD). Although not necessarily specific to women veterans, a number of VA-administered
programs conduct outreach to homeless veterans, provide work experience, issue grants for
housing, and provide supportive services for low-income families.231
Provision
Section 301 requires the Secretary to complete a gap analysis232 of the programs available
through VA that provide assistance to women veterans who are experiencing homelessness or
who are precariously housed. The Secretary is required to submit a report on the analysis to
HVAC and SVAC no later than 270 days after enactment (i.e., September 1, 2021).
Section 302: Report on Locations Where Women Veterans Are Using Health
Care from Department of Veterans Affair s
Background
VA administers a women’s health care program that, among other things, offers outreach and
support to women veterans to put them in touch with available VHA health services. VHA offers
enrolled veterans a standard medical benefits package, which includes a full range of health care,
gender-specific medical services, prescription drugs, long-term care, and social support
services.233 Gender-specific health care services include primary health care, intimate partner

230 Department of Housing and Urban Development, The 2020 Annual Homeless Assessment Report (AHAR) to
Congress, January 2021, p. 54, https://www.huduser.gov/portal/sites/default/files/pdf/2020-AHAR-Part -1.pdf.
231 For more information on veteran homelessness programs, see CRS In Focus IF10167, Veterans and Homelessness.
232 For the purposes of this section, gap analysis is intended to identify the areas in which the relevant programs are
failing to meet the needs of women veterans who are experiencing homelessness or who are precariously housed.
233 38 C.F.R. §17.38.
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violence services, military sexual trauma services, and maternity health care services, among
others.234
Provision
Section 302 requires the Secretary to submit a report no later than 90 days after enactment (i.e.,
March 5, 2021), and annual y thereafter, to HVAC and SVAC on the use of VHA care by women
veterans. This report must include (1) the number of women veterans who reside in each state; (2)
the number of women veterans enrolled in the VA health care system in each state; (3) the number
of enrolled women veterans who received care at least during the one-year period; (4) the number
of women veterans who were seen at each VA medical facility; (5) the number of appointments
for women veterans disaggregated by facility and appointment type; (6) the number of
appointments completed in person and through telehealth; (7) identification of the medical facility
in each VISN with the largest rate of increase in women veteran patient population; and (8)
identification of the medical facility in each VISN with the largest rate of decrease in women
veteran patient population.

234 For more information on gender-specific health care for women veterans, see CRS In Focus IF11082, Veterans
Health Adm inistration: Gender-Specific Health Care Services for Wom en Veterans.
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Appendix. Implementation Dates, Reporting
Requirements, and Deadlines
The tables below include relevant provisions for the Hannon Act and the Veterans COMPACT
Act, respectively, which include an effective date, a required report, or an explicit sunset date.
The tables include only reports that must be made public or be delivered to Congress. This CRS
report reflects the Hannon Act and the Veterans COMPACT Act at enactment and wil not track
actions pursuant to these deadlines, nor wil this report be updated.
Table A-1. Hannon Act Implementation Dates, Reporting Requirements,
and Deadlines
Effective Date/Reporting
Section Number
Brief Description
Deadline
Title I. Improvement of Transition of Individuals to Services from Department of Veterans Affairs
Section 101
Requires the Secretary, in
No later than one year after
consultation with the Secretary of
enactment (i.e., by October 17,
Defense, to develop a strategic plan
2021).
for providing health care to
veterans transitioning from service,
to be submitted to specified
congressional committees and
published on the VA website.
Section 102
Requires the Secretary of Defense
No later than three years after
and the Secretary to submit a joint
enactment (i.e., by October 17,
report, to specified congressional
2023).
committees, on their review of the
records of al members of the
Armed Forces who died by suicide
within one year of discharge/release
during the five-year period
preceding enactment (i.e., October
17, 2015 to October 17, 2020).
Section 103
Requires the Secretary to submit a
No later than 180 days after
report, to specified congressional
enactment (i.e., by April 15, 2021).
committees, on the REACH VET
program.
Section 104
Requires the Secretary to annual y
No later than February 15 each
submit a report, to specified
year.
congressional committees, on the
mental and behavioral health care
services provided to
servicemembers who were
discharged or released with an
OTH discharge.
Title II. Suicide Prevention
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Effective Date/Reporting
Section Number
Brief Description
Deadline
Section 201
Requires the Secretary to submit a
No later than 30 days before
report, to specified congressional
notifying eligible entities of the
committees, on the grant criteria,
availability of grant funding.
measures and metrics, and
information sharing framework of
the Staff Sergeant Parker Gordon
Fox Suicide Prevention Grant
Program.
Requires the Secretary to submit an No later than 18 months after the
interim report, to specified
date on which the first grant is
congressional committees, on the
awarded.
provision of grants under the Staff
Sergeant Parker Gordon Fox
Suicide Prevention Grant Program.
Requires the Secretary to submit a
No later than three years after the
final report, to specified
date on which the first grant is
congressional committees, on the
awarded, and annual y thereafter for
provision, effectiveness, and
each year in which the program is in
potential extension or expansion of
effect.
grants under the Staff Sergeant
Parker Gordon Fox Suicide
Prevention Grant Program.
Requires the Secretary to seek to
No later than 180 days after
enter into a contract with a
commencement of the grant
nongovernment entity to conduct a
program.
third-party assessment of the Staff
Sergeant Parker Gordon Fox
Suicide Prevention Grant Program.
Requires the Secretary to submit
No later than 24 months after the
the third-party assessment to
date on which the first grant is
specified congressional committees.
awarded.
Sunset of the Staff Sergeant Parker
Three years after the date on which
Gordon Fox Suicide Prevention
the first grant is awarded.
Grant Program.
Section 202
Requires the Secretary to complete
No later than 180 days after
an analysis and submit a report, to
enactment (i.e., by April 15, 2021).
specified congressional committees,
on the feasibility and advisability of
providing select complementary and
integrative health treatments at al
VA medical facilities.
Section 203
Requires the Secretary to
No later than 180 days after the
commence a pilot program to
COVER Commission submits its
provide select complementary and
final report (i.e., by July 24, 2020).
integrative health programs to
eligible veterans.
Requires the Secretary to submit an No later than one year after the
interim report, to specified
commencement of the pilot
congressional committees, on the
program.
pilot program.
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Effective Date/Reporting
Section Number
Brief Description
Deadline
Requires the Secretary to submit a
No later than 90 days after the
final report, to specified
termination of the pilot program.
congressional committees, on the
pilot program.
Sunset of the pilot program.
Three years after the
commencement of the pilot
program.a
Section 204
Requires the Secretary to brief
No later than 24 months after VA
specified congressional committees
enters into an agreement with
on the interim results of a VA and
NASEM for the study.
NASEM study on the effects of
opioids and benzodiazepine on al -
cause mortality of veterans,
including suicide.
Requires GAO to conduct a review
No later than 90 days after
of the staffing levels for mental
enactment (i.e., January 15, 2021).
health professionals at VA.
Requires the Secretary to brief
No later than 18 months after
specified congressional committees
enactment (i.e., by April 17, 2022).
on the interim results of the GAO
review of the staffing levels for
mental health professionals at VA.
Requires the Secretary to submit a
No later than 90 days after the
publical y available report, to
completion of the study.
specified congressional committees,
on the results of a VA and NASEM
study on the effects of opioids and
benzodiazepine on al -cause
mortality of veterans, including
suicide.
Requires the Secretary to submit a
No later than 90 days after the
publical y available report, to
completion of the GAO review.
specified congressional committees,
on the results of the GAO review
of the staffing levels for mental
health professionals at VA.
Section 205
Requires a GAO report, submitted
No later than 18 months after
to specified congressional
enactment (i.e., by April 17, 2022).
committees, on the efforts of VA to
manage veterans at high risk for
suicide.
Title III. Programs, Studies, and Guidelines on Mental Health
Section 301
Requires the Secretary, in
No later than 180 days after
consultation with Rural Health
enactment (i.e., by April 15, 2021).
Resource Centers of the Office of
Rural Health of VA, to commence a
study on the connection between
living at high altitude and the risk of
depression or suicide among
veterans.
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Effective Date/Reporting
Section Number
Brief Description
Deadline
Deadline for the completion of the
No later than three years after the
study.
commencement of the study.
Requires the Secretary to submit a
No later than 150 days after the
report, to specified congressional
completion of the study.
committees, on the results of the
study.
If the Secretary determines, through Report due no later than 150 days
the study, that living at high altitude
after the completion of the fol ow-
is a risk factor for depression or
up study.
suicide, the Secretary is required to
conduct a fol ow-up study on (1)
the most likely biological mechanism
that makes living at high altitude a
risk factor for depression or suicide
and (2) the most effective treatment
or intervention for reducing the risk
of depression or suicide associated
with high altitude.
If the fol ow-up study is conducted,
the Secretary is required to submit
a report, to specified congressional
committees, on the results of that
study.
Section 302
Requires the Secretary, in
No later than two years after
consultation with the Secretary of
enactment (i.e., by October 17,
Defense, to develop a clinical
2022).
provider treatment toolkit and
accompanying training materials for
comorbidities of mental health
conditions, substance use disorders,
and chronic pain.
Section 303
Requires the Secretary and the
Update required in the first
Secretary of Defense to update
publication after enactment.b
guidance in VA and Department of

Defense Clinical Practice Guideline
for Assessment and Management of
Patients at Risk for Suicide.
Section 304
Requires the Secretary, in
No later than two years after
consultation with the Secretary of
enactment (i.e., by October 17,
Defense and the Secretary of Health 2022).
and Human Services, to develop
clinical practice guidelines for the
treatment of serious mental il ness.
Requires the Secretary, in
No later than two years after
consultation with the Secretary of
enactment (i.e., by October 17,
Defense and the Secretary of Health 2022).
and Human Services, to assess the
2016 Clinical Practice Guidelines for
the Management of Major
Depressive Disorders and
determine if updates are necessary.
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Effective Date/Reporting
Section Number
Brief Description
Deadline
Section 305
Requires the Secretary to develop
No later than 18 months after
and implement an initiative to
enactment (i.e., by April 17, 2022).
identify and validate brain and
mental health biomarkers among
veterans.
Title IV. Oversight of Mental Health Care and Related Services
Section 401
Requires the Secretary to contract
No later than 180 days after
with a nonfederal government entity enactment (i.e., by April 15, 2021).
to complete a study using focus
groups on the effectiveness of the
mental health and suicide
prevention outreach materials and
campaigns conducted by VA.
Requires the Secretary to submit a
No later than 90 days after the last
report, to specified congressional
focus group meeting of the study.
committees, on the findings of the
study.
Requires the Secretary to complete
No later than one year after the last
a representative survey of veterans
focus group meeting of the study on
to col ect information about the
effectiveness of mental health and
effectiveness of the mental health
suicide prevention outreach
and suicide prevention outreach
materials and campaigns conducted
materials and campaigns conducted
by VA.
by VA.
Section 402
Requires the Secretary to submit an No later than 180 days after
initial report, to specified
enactment (i.e., by April 15, 2021).
congressional committees, on the
established goals, metrics, and
targets of the mental health and
suicide prevention media outreach
campaigns conducted by VA.
Requires the Secretary to submit an No later than one year after the
annual report, to specified
submittal of the initial report, and
congressional committees, on the
annual y thereafter.
progress of VA in meeting the goals
of its mental health and suicide
prevention media outreach
campaigns, as wel as actions to be
taken to better meet those goals.
Requires the Secretary to submit a
No later than 180 days after
report, to specified congressional
enactment (i.e., by April 15, 2021),
committees, containing the
and semiannual y thereafter.
expenditures and obligations of the
Office of Mental Health and Suicide
Prevention of the Veterans Health
Administration during the period
covered by the report.
Section 403
Requires GAO to submit a
No later than three years after
management review, to specified
enactment (i.e., by October 17,
congressional committees, of the
2023).
mental health and suicide
prevention services provided by VA.
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Effective Date/Reporting
Section Number
Brief Description
Deadline
Section 404
Requires a GAO report, submitted
No later than two years after
to specified congressional
enactment (i.e., by October 17,
committees, on the efforts of VA to
2022).
integrate mental health care into
primary clinics of the Department.
Requires a GAO report, submitted
No later than two years after the
to specified congressional
submittal of the GAO report on
committees, on the efforts of VA to
integrating mental health care into
integrate community-based mental
primary care clinics.
health care into the Veterans Health
Administration.
Section 405
Requires the Secretary and
No later than one year after
Secretary of Defense to submit an
enactment (i.e., by October 17,
annual report, to specified
2021), and annual y thereafter.
congressional committees, on the
mental health programs and joint
mental health programs conducted
by VA and the Department of
Defense.
Requires the Secretary to submit a
No later than 270 days after
report, to specified congressional
enactment (i.e., by July 14, 2021).
committees, on (1) the evaluation of
col aborative efforts by VA and the
Department of Defense related to
PTSD and traumatic brain injuries;
(2) the potential for new
col aborative efforts to improve
such care through a joint
VA/Department of Defense Intrepid
Spirit Center; and (3) an alternatives
of analysis to establish the joint
VA/Department of Defense Intrepid
Spirit Center.
Title V. Improvement of Mental Health Medical Workforce
Section 501
Requires the Secretary, in
No later than one year after
consultation with the Inspector
enactment (i.e., by October 17,
General of VA, to submit a plan, to
2021).
specified congressional committees,
to address staffing of mental health
providers at VA.
Requires the Secretary to submit a
No later than one year after the
report, to specified congressional
submittal of the plan.
committees, that contains the
number of mental health providers
hired by VA during the one-year
period preceding the report.
Requires the Secretary, in
No later than one year after
consultation with the Office of
enactment (i.e., by October 17,
Personnel Management, to develop
2021).
an occupational series for licensed
professional mental health
counselors and marriage and family
therapists of VA.
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Effective Date/Reporting
Section Number
Brief Description
Deadline
Section 502
Effective period for the VA
Scholarships are to begin being
Readjustment Counseling Service
awarded no later than one year
Scholarship Program.
after enactment (i.e., by October
17, 2021).
Section 503
Requires a GAO report, submitted
No later than one year after
to specified congressional
enactment (i.e., by October 17,
committees, on VA Readjustment
2021).
Counseling Service.
Section 504
Requires the Secretary to submit, to Each even-numbered year in which
specified congressional committees,
the annual report on the
a biennial supplement to the annual
Readjustment Counseling Service is
report on the Readjustment
submitted (i.e., no later than March
Counseling Service.
15 of each even numbered year).
Section 505
Requires the Secretary to conduct a No later than 180 days after
survey on the attitudes of eligible
enactment (i.e., by April 15, 2021).
veterans toward VA offering
appointments outside the usual
operating hours of facilities of the
department.
Requires the Secretary to brief
No later than 270 days after
specified congressional committees
enactment (i.e., by July 14, 2021).
on the feasibility, advisability, and
effectiveness of offering
appointments outside the usual
operating hours of facilities of VA.
Section 506
Requires that every medical center
Beginning no later than one year
of VA has at least one suicide
after enactment (i.e., by October
prevention coordinator.
17, 2021).
Requires the Secretary, in
No later than one year after
consultation with the Office of
enactment (i.e., by October 17,
Mental Health and Suicide
2021).
Prevention, to commence a study
on the feasibility and advisability of
(1) the reorganization of suicide
prevention coordinators within the
Office of Mental Health and Suicide
Prevention and (2) the creation of a
suicide prevention coordinator
program office.
Requires the Secretary to submit a
No later than 90 days after the
report, to specified congressional
completion of the study on suicide
committees, on (1) the results of
prevention coordinators.
the study, (2) the staffing ratios for
suicide prevention coordinators and
case managers at VA, and (3) the
responsibilities of suicide prevention
coordinators across the
department.
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Effective Date/Reporting
Section Number
Brief Description
Deadline
Section 507
Requires the Secretary to submit a
No later than 180 days after
report, to specified congressional
enactment (i.e., by April 15, 2021).
committees, on the efforts of the
Secretary to implement a suicide
prevention program for veterans
presenting to a Veterans Health
Administration emergency
department/urgent care center who
are assessed to be at risk for suicide
but are safe to be discharged home.
Title VII. Other Matters
Section 701
Requires the Secretary to complete
No later than 18 months after
an assessment of barriers faced by
enactment (i.e., by April 17, 2022).
veterans in accessing telehealth
services.
Requires the Secretary to submit a
No later than 120 days after the
report, to specified congressional
completion of the assessment.
committees, on the results of the
assessment, as wel as any
recommendations for legislative or
administrative action.
Section 702
Requires the Secretary, in
No later than 90 days after
consultation with the Center for
enactment (i.e., by January 15,
Compassionate Innovation, to begin
2021).
reviewing the effectiveness and
applicability of hyperbaric oxygen
therapy.
Requires the Secretary, in
Review must commence no later
consultation with the Center for
than 90 days after enactment (i.e.,
Compassionate Innovation, to
by January 15, 2021).
conduct a systematic review of

published research literature on off-
label use of hyperbaric oxygen
Review must be completed no later
therapy to treat PTSD and
than 180 days after commencement.
traumatic brain injury among
veterans and nonveterans.
Requires the Secretary to submit a
No later than 90 days after the
report, to specified congressional
completion of the review.
committees, on the results of the
review.
Requires the Secretary, in
Study must commence no later than
consultation with the Center for
120 days after the completion of the
Compassionate Innovation, to
review.
conduct a fol ow-up study on al

individuals receiving hyperbaric
oxygen therapy for the treatment of Study must be completed no later
PTSD and traumatic brain injury
than three years after
through the current VA pilot
commencement.
program.
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Effective Date/Reporting
Section Number
Brief Description
Deadline
Requires the Secretary to submit a
No later than 90 days after the
report, to specified congressional
completion of the fol ow-up study.
committees, on the results of the
fol ow-up study.
Section 703
Requires the Secretary to prescribe
No later than 180 days after
technical qualifications for the
enactment (i.e., by April 15, 2021).
appointment of licensed hearing aid
specialists in the Veterans Health
Administration.
Requires the Secretary to appoint at No later than September 30, 2022.
least one licensed hearing aid
specialist at each VA medical center.
Requires the Secretary to submit an No later than September 30, 2022,
annual report, to specified
and annual y thereafter.
committees, on (1) progress and
conflicts/obstacles in appointing
licensed hearing aid specialists at
VA, (2) patient access to
comprehensive hearing health care
services at VA, and (3) vacancies for
audiologists or licensed hearing aid
specialists at VA medical centers.
Section 704
Requires the Secretary to complete
No later than 90 days after
al necessary policy revisions to
enactment (i.e., by January 15,
al ow VA-sponsored clinical
2021).
research to use accredited
commercial institutional review
boards to review VA research
proposal protocols.
Requires the Secretary to (1)
No later than 90 days after the
identify accredited commercial
completion of the policy revisions.
institutional review boards for use
in connection with VA-sponsored
clinical research and (2) establish a
process to modify existing approvals
in the event that a commercial
institutional review board loses its
accreditation during an ongoing
clinical trial.
Requires the Secretary to submit an No later than 90 days after the
annual report, to specified
completion of the policy revisions,
congressional committees, on al
and annual y thereafter.
approvals of institutional review
boards used by VA.
Section 705
Requires the Secretary to establish
No later than one year after
an Office of Research Reviews
enactment (i.e., by October 17,
within the VA Office of Information
2021).
and Technology.
Requires the Office of Research
No later than one year after the
Reviews to submit a report, to
establishment of the Office.
specified congressional committees,
on the activity of the office.
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Source: CRS analysis of the Commander John Scott Hannon Veterans Mental Health Care Improvement Act of
2019 (P.L. 116-171).
Notes: Effective dates are not included for reporting deadlines that are based on the date of completion of
another reporting deadline.
COVER = Creating Options for Veterans’ Expedited Recovery; GAO = U.S. Government Accountability Office;
NASEM = National Academies of Sciences, Engineering, and Medicine; OTH = Other Than Honorable; PTSD =
Posttraumatic Stress Disorder; REACH VET = Recovery Engagement and Coordination for Health – Veterans
Enhanced Treatment; Secretary = Secretary of the Department of Veterans Affairs; VA = Department of
Veterans Affairs.
a. The Secretary may extend the pilot program beyond three years if the Secretary, based on the results of
the interim report submitted to the House and Senate Veterans Affairs Committees, determines it is
appropriate to do so.
b. The most recent update to the VA and Department of Defense Clinical Practice Guideline for Assessment
and Management of Patients at Risk for Suicide was published in May 2019 and based on evidence reviewed
through April 2018. Department of Veterans Affairs, “VA/DoD Clinical Practice Guideline for Assessment
and Management of Patients at Risk for Suicide,” May 2019, at https://www.healthquality.va.gov/guidelines/
MH/srb/VADoDSuicideRiskFul CPGFinal5088212019.pdf.
Table A-2. Veterans COMPACT Act Implementation Dates, Reporting Requirements,
and Deadlines
Effective Date/Reporting
Section Number
Brief Description
Deadlines
Title I. Improvement of Transition of Individuals to Services from Department of Veterans Affairs
Section 101
Requires the Secretary to
No later than one year after
commence a voluntary pilot
enactment (i.e., by December 5,
program that connects veterans
2021).
transitioning from service with
designated individuals to help share
information regarding assistance and
benefits available to those veterans.
Requires the Secretary to
No later than one year after the
administer surveys in order to
commencement of the pilot
receive feedback from individuals
program, and not less frequently
who elected to receive information
than annual y thereafter for the
under the pilot program.
duration of the pilot program.
Requires the Secretary to submit a
No later than three years after the
final report, to specified
commencement of the pilot
congressional committees, on the
program.
pilot program.
Duration of the pilot program.
The pilot program must be carried
out for a period not less than two
years.
Section 102
Requires the Secretary to submit an No later than 180 days after
annual report, to specified
enactment (i.e., by June 3, 2021),
congressional committees, on the
and annual y thereafter for five
VA Solid Start program.
years.
Title II. Suicide Prevention
Section 201
Requires the Secretary to submit an Not less than once each year.
annual report, to specified
congressional committees, on
emergent suicide care provided by
VA.
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Effective Date/Reporting
Section Number
Brief Description
Deadlines
Effective date for the furnishing
Begins 270 days after enactment
and/or payment of emergent suicide
(i.e., on September 1, 2021).
care by VA.
Section 202
Requires the Secretary to establish
Not less than 270 days after
an education program for the
enactment (i.e., by September 1,
education and training of caregivers
2021).
and family members of eligible
veterans with mental health
disorders.
Requires the Secretary to submit an No later than one year after the
annual report, to specified
commencement of the education
congressional committees, on the
program and no later than
education program and the
September 30 each year thereafter
feasibility and advisability of
until 2024.
expanding the education program to
include a peer support program.
Requires the Secretary to submit a
No later than one year after the
final report, to specified
completion of the education
congressional committees, on the
program.
feasibility and advisability of
continuing the education program.
Duration of education program.
Four-year period fol owing the
commencement of the education
program.
Section 203
Requires the Secretary to establish
No later than 18 months after the
an interagency task force on
expiration of the national
outdoor recreation for veterans.
emergency pertaining to COVID-
19.a
Requires the chairpersons of the
No later than one year after the
Task Force to submit a report to
Task Force is established.
Congress on the preliminary
findings of the Task Force.
Requires the chairpersons of the
No later than one year after the
Task Force to submit a report to
submittal of the preliminary report.
Congress on the final findings and
recommendations of the Task
Force.
Sunset of Task Force.
One year after the submittal of the
final report.
Section 204
Requires the VA Under Secretary of No later than 90 days after
Health to seek to contact al
enactment (i.e., by March 5, 2021).
covered veterans in order to
encourage them to receive
comprehensive medical
examinations.
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Effective Date/Reporting
Section Number
Brief Description
Deadlines
Requires the Secretary to submit a
No later than 18 months after
report to Congress regarding how
enactment (i.e., by June 5, 2022).
many covered veterans scheduled
comprehensive medical
examinations after receiving the
communication described in this
section.
Section 205
Requires the Secretary to submit a
No later than one year after
report, to specified congressional
enactment (i.e., by December 5,
committees, regarding the annual
2021).
training of VA police officers on the
prevention of suicide among their
served population.
Title III. Improvement of Care and Services for Women Veterans
Section 301
Requires the Secretary to submit a
No later than 270 days after
report, to specified congressional
enactment (i.e., by September 1,
committees, on the analysis of VA
2021).
programs that provide assistance to
women veterans who are homeless
or precariously housed.
Section 302
Requires the Secretary to submit an No later than 90 days after
annual report, to specified
enactment (i.e., by March 5, 2021).
congressional committees, on
women veterans’ use of health care
from VA.
Source: CRS analysis of the Veterans COMPACT Act of 2020 (P.L. 116-214).
Notes: Effective dates are not included for reporting deadlines that are based on the date of completion of
another reporting deadline.
COVID-19 = Coronavirus Disease 2019; Secretary = Secretary of the Department of Veterans Affairs; VA =
Department of Veterans Affairs.
a. 50 U.S.C. §§1601 et seq.

Author Information

Victoria R. Green, Coordinator
Amanda K. Sarata
Analyst in Health Policy
Specialist in Health Policy

Sidath Viranga Panangala
Bryce H. P. Mendez
Specialist in Veterans Policy
Analyst in Defense Health Care Policy

Jared S. Sussman
Isaac A. Nicchitta
Analyst in Health Policy
Research Assistant

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Disclaimer
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under the direction of Congress. Information in a CRS Report should n ot be relied upon for purposes other
than public understanding of information that has been provided by CRS to Members of Congress in
connection with CRS’s institutional role. CRS Reports, as a work of the United States Government, are not
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