Take Care of America’s Veterans Act

Section 307 of the Caregivers and Veterans Omnibus Health Services Act of 2010 (Public Law 111–163; 38 U.S.C. 1710 note) is amended—

(1) in subsection (a)—

(A) in paragraph (2), by adding at the end the following new subparagraphs:

“(C) Indian tribes.

(D) Tribal organizations.

(E) Native Hawaiian organizations.

(F) County veterans service organizations.”;

(B) in paragraph (3), in the matter preceding subparagraph (A), by striking “State veterans service agency or veterans service organization awarded” and inserting “recipient of”; and

(C) by amending paragraph (4) to read as follows:

“(4) Maximum amount.—

(A) In general.— Except as provided in subparagraphs (B) and (C), the amount of a grant under this section may not exceed $50,000.

(B) Off-road communities.— In the case of a county that has more than five communities that are off the road system, the amount of a grant awarded with respect to that county under this section may be increased by an amount not to exceed 50 percent of the amount specified in subparagraph (A).

(C) Purchasing a vehicle.—

(i) Amount.— The amount of a grant awarded under this section to a recipient may be increased by not more than $80,000 if the recipient is purchasing a vehicle to comply with requirements under the Americans with Disabilities Act of 1990 (42 U.S.C. 12101 et seq.) in carrying out this section.

(ii) Limitations.— The Secretary may prescribe limitations on the number of vehicles purchased by each recipient under this section.”;

(2) by striking subsection (d);

(3) by redesignating subsections (b) and (c) as subsections (d) and (e), respectively;

(4) by inserting after subsection (a) the following new subsections:

“(b) Additional services.—

(1) Nearby rural areas.— In addition to providing innovative transportation options to veterans in highly rural areas, a recipient of a grant under this section may use amounts provided under the grant to provide innovative transportation options to veterans in nearby rural areas.

(2) Priority.— A recipient of a grant under this section shall prioritize the provision of innovative transportation options to veterans in highly rural areas, and shall demonstrate to the Secretary such priority, and may only provide services under paragraph (1) to veterans in nearby rural areas if—

(A) it does not impede the services provided to veterans in highly rural areas; and

(B) the grantee has excess capacity and resources available to provide such services to veterans in nearby rural areas.

(c) Eligibility of previous areas.— Areas eligible for assistance under the grant program under this section on the day before the date of the enactment of the Supporting Rural Veterans Access to Healthcare Services Act shall remain eligible for such assistance on and after such date of enactment.”; and

(5) in subsection (e), as redesignated by paragraph (2)—

(A) by redesignating paragraph (2) as paragraph (5); and

(B) by striking paragraph (1) and inserting the following:

“(1) Indian tribe; Tribal organization.— The terms Indian tribe and Tribal organization have the meanings given those terms in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304).

(2) Native Hawaiian organization.— The term Native Hawaiian organization has the meaning given that term in section 6207 of the Elementary and Secondary Education Act f 1965 (20 U.S.C. 7517).

(3) Nearby.— The term nearby, with respect to a rural area, includes rural areas adjacent to a highly rural area and rural areas geographically between the highly rural area and the nearest Department of Veterans Affairs medical center.

(4) Rural; highly rural.— The terms rural and highly rural have the meanings given those terms under the Rural-Urban Commuting Areas (RUCA) coding system of the Department of Agriculture.”.

(a) Extension of period of medical care coverage for caregivers designated as primary providers of personal care services for veterans.— Section 1781(a)(4) of title 38, United States Code, is amended by inserting before the comma at the end the following: “, including during the 180-day period following discharge from the program under section 1720G(a) of this title unless the designation of the individual was revoked due to fraud, abuse, mistreatment, or other misconduct”.

(b) Employment and other benefits for caregivers designated as primary providers of personal care services for veterans.—

(1) Employment assistance.— Section 1720G of title 38, United States Code, is amended by adding at the end the following new subsection:

“(e) Employment assistance.—

(1) The Secretary shall, subject to paragraph (2), provide to an individual designated as a primary provider of personal care services under subsection (a)(7)(A) employment assistance as follows:

(A) Reimbursement of fees associated with certifications or relicensure necessary for such employment.

(B) For purposes of gaining credit for continuing professional education requirements, access to training modules of the Department at no cost.

(C) In consultation with the Secretary of Defense and the Secretary of Labor, access to existing employment assistance resources and programs as considered appropriate.

(2) An individual described in paragraph (1) shall have access to assistance described in such paragraph—

(A) while participating in the program established under subsection (a)(1); and

(B) during the 180-day period following the date on which the individual is no longer participating in such program unless the designation of such individual under subsection (a)(7)(A) was revoked for fraud, abuse, mistreatment, or other misconduct.

(3) The maximum lifetime amount that may be reimbursed for an individual under paragraph (1)(A) is $1,000.”.

(2) Expansion of available services.— Subsection (a)(3)(A)(ii) of such section is amended—

(A) in subclause (V), by striking “; and” and inserting a semicolon;

(B) in subclause (VI)—

(i) in the matter preceding item (aa), by inserting “or agreements” after “contracts”;

(ii) in item (aa), by inserting “, including retirement planning services,” after “services”; and

(iii) in item (bb), by striking the period at the end and inserting “; and”; and

(C) by adding at the end the following new subclause:

“(VII) such instruction, preparation, training, and support as the Secretary considers appropriate to assist in transitioning away from caregiving during the 180-day period following the date on which the family caregiver is no longer participating in the program required by paragraph (1), unless such designation was revoked for fraud, abuse, or mistreatment, or other misconduct.”.

(3) Assistance returning to workforce.— Subclause (VI) of such subsection is further amended—

(A) in item (aa), by striking “; and” and inserting a semicolon; and

(B) by adding at the end the following new item:

“(cc) assistance returning to the workforce upon discharge or dismissal from the program required by paragraph (1) unless such designation was revoked for fraud, abuse, mistreatment, or other misconduct; and”.

(4) Bereavement counseling and support.— Subsection (a)(3)(A)(i)(III) of such section is amended by inserting before the semicolon the following: “, including bereavement counseling and support following the death of the eligible veteran”.

(5) Study on provision of returnship program.—

(A) In general.— Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs, in partnership with the Secretary of Labor, shall complete a study on the feasibility and advisability of conducting a returnship program to assist individuals who are designated as a primary provider of personal care services under section 1720G(a)(7)(A) of title 38, United States Code, or who were discharged from such program, in returning to the workforce.

(B) Report.— Not later than 180 days after completion of the study under subparagraph (A), the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on the study.

(6) Study on incorporating former caregivers into workforce of Department of Veterans Affairs.—

(A) In general.— Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall complete a study on barriers and incentives to hiring individuals who were designated as a primary provider of personal care services under section 1720G(a)(7)(A) of title 38, United States Code, at facilities of the Department of Veterans Affairs to address staffing needs.

(B) Report.— Not later than 180 days after completion of the study under subparagraph (A), the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on the study, which shall include—

(i) a plan for increasing employment opportunities at facilities of the Department for individuals who were designated as a primary provider of personal care services under section 1720G(a)(7)(A) of title 38, United States Code; and

(ii) such recommendations for legislative or administrative action as the Secretary considers appropriate.

(c) Comptroller General report on efforts of Department of Veterans Affairs in supporting family caregivers transitioning away from caregiving.— Not later than two years after the date of the enactment of this Act, the Comptroller General of the United States shall submit to Congress a report assessing the efforts of the Secretary of Veterans Affairs to support individuals serving as family caregivers under section 1720G(a) of title 38, United States Code, in transitioning away from caregiving, either by assisting those individuals with retirement planning or returning to work.

(d) Report on feasibility and advisability of establishing a retirement plan or retirement savings for family caregivers of certain veterans.— Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs, in consultation with the Secretary of the Treasury and the heads of such other relevant entities as the Secretary of Veterans Affairs determines necessary, shall submit to Congress a report on the feasibility and advisability of, for individuals serving as family caregivers under section 1720G(a) of title 38, United States Code—

(1) establishing an individual retirement plan (as defined in section 7701(a)(37) of the Internal Revenue Code of 1986 (26 U.S.C. 7701(a)(37))) or similar retirement plan; or

(2) permitting such individuals to join an already established pathway to retirement savings.

(a) Department of Veterans Affairs grant program for supplemental neurorehabilitation approaches to chronic mild TBI treatment.—

(1) Grant program.—

(A) In general.— The Secretary of Veterans Affairs shall carry out a three-year program (to be known as the “TBI Innovation Grant Program”) under which the Secretary shall award grants to eligible entities described in paragraph (2) for the development, implementation, and evaluation of approaches and methodologies for prospective randomized control trials for neurorehabilitation treatments for the treatment of chronic mild traumatic brain injury (in this Act referred to as “mTBI”) in veterans.

(B) Relationship to other Department activities.— The grant program required under subparagraph (A) shall be carried out in a manner that—

(i) supplements, and does not supplant, other clinical care and research of the Department of Veterans Affairs relating to mTBI; and

(ii) facilitates, as practicable, coordination with Veterans Health Administration facilities for referral, continuity of care, and dissemination of findings.

(2) Eligible entities described.— An eligible entity described in this paragraph is any of the following:

(A) A nonprofit organization with demonstrated capability to conduct clinical trials and to deliver or research effective neurorehabilitation treatments for mTBI, including through patient care delivery.

(B) An academic institution that conducts significant research on mTBI and has demonstrated capability to conduct clinical trials relating to neurorehabilitation treatments.

(C) A non-Department health care provider with expertise in neurorehabilitative therapies and demonstrated capability to conduct clinical trials and to evaluate mTBI treatments through patient care delivery.

(D) A partnership or consortium of two or more entities described in subparagraphs (A) through (C).

(3) Use of funds.— An eligible entity in receipt of a grant under this subsection shall use such grant to support activities that include—

(A) designing and testing novel or integrative treatments for mTBI that prioritize patient-centered care, including non-pharmacological therapies;

(B) conducting clinical studies and assessments to measure the effectiveness of funded approaches to—

(i) improve mental health outcomes among veterans;

(ii) reduce suicidality, and common risk factors for completing suicide, including depression and substance use disorders among veterans; and

(iii) mitigate long-term effects of mTBI and, to the extent outcomes are collected under the applicable clinical protocol, measure durability of outcomes at approximately six months following completion of treatment;

(C) providing training for clinicians and outreach to veterans and their families to improve awareness and accessibility of innovative mTBI treatments, including information on available Department resources and pathways to access such resources; and

(D) establishing partnerships with community organizations, academic institutions, and health care facilities, including, as practicable, coordination with Veterans Health Administration facilities to facilitate referral of eligible veterans, continuity of care, and dissemination of aggregate findings.

(4) Limitation on grant amount.— The Secretary may not award an eligible entity a grant under this section in an amount that exceeds $5,000,000 for any fiscal year.

(5) Program administration.—

(A) Applications.— An eligible entity desiring a grant under this subsection shall submit to the Secretary an application in such form, at such time, and containing such information and assurances as the Secretary determines appropriate, including a detailed description of—

(i) activities proposed to be conducted using the grant;

(ii) expected outcomes of such activities;

(iii) plans for evaluating the effectiveness of such activities;

(iv) how the eligible entity will coordinate, as practicable, with Veterans Health Administration facilities for referral and continuity of care for veterans who participate in activities carried out using grant funds, and for dissemination of aggregate findings;

(v) the budget of the entity for the use of the grant, including a narrative justification and an identification of the estimated amount of grant funds to be used for administrative or overhead costs; and

(vi) assurances of compliance with applicable Federal laws and regulations relating to human subjects protections and patient safety.

(B) Priority.— In awarding grants under this subsection, the Secretary shall give priority to eligible entities that have demonstrated the capacity to coordinate with the Department to facilitate referral and continuity of care for veterans who participate in activities carried out using grant funds.

(C) Periodic reports.— As a condition of receiving a grant under this section, an eligible entity shall, not less frequently than annually during the grant period and not later than 180 days after the end of the grant period, submit to the Secretary a report that includes, with respect to the period covered by the report—

(i) a description of how the eligible entity used such grant;

(ii) a summary of the progress of activities funded with amounts from such grant;

(iii) measured outcomes relating to such activities;

(iv) a detailed accounting of expenditures of grant funds, including administrative or overhead costs;

(v) to the extent collected under the applicable clinical protocol or in the ordinary course of care, a description of any adverse events and serious adverse events, including self-harm or suicide-related events; and

(vi) a description of actions taken pursuant to the coordination plan described in subparagraph (A)(iv).

(D) Oversight; annual evaluations.— The Secretary shall—

(i) ensure rigorous oversight of the grant program under this section, including by monitoring financial compliance and timely receipt of the reports required under subparagraph (B); and

(ii) on an annual basis until the termination date specified in paragraph (9)(A), evaluate the efficacy of activities carried out using grant funds based on the reports submitted under subparagraph (B) and other appropriate information.

(E) Rule of construction.— Nothing in this section shall be construed to authorize the Secretary to require prior approval of, or changes to, any clinical protocol, study design, outcome measures, or follow-up schedule of an eligible entity that receives a grant under this section, except as necessary to ensure compliance with applicable Federal laws and regulations relating to human subjects protections and patient safety.

(F) Enforcement authority.— The Secretary may suspend, modify, or terminate a grant awarded under this section, if the Secretary determines that the recipient of such grant has failed to comply with reporting requirements under subparagraph (B) or other applicable terms and conditions of the grant.

(6) Available amounts; authorization of appropriations.—

(A) Available amounts.— The Secretary may carry out the program under this section using amounts available to the Secretary for general mental health care programs, if the use of such amounts supplements, and does not supplant, amounts otherwise available for Department mental health and traumatic brain injury programs.

(B) Authorization of appropriations.— There is authorized to be appropriated to the Secretary $10,000,000 for each of fiscal years 2026 through 2028 to carry out this section.

(7) Duration; annual review.—

(A) Duration.— The authority of the Secretary to carry out the grant program under this section shall terminate on the date that is three years after the date of the enactment of this Act, except that the Secretary may continue to use amounts made available to carry out this section after such date solely for the purpose of administering activities and obligations incurred before such termination date.

(B) Annual review.— During such three-year period, the Secretary shall, on an annual basis, review the effectiveness of the grant program to determine the potential of such grant program for continuation or expansion.

(b) Department of Veterans Affairs grant program for independent third-party research studies and treatment with respect to supplemental neurorehabilitation treatments for mTBI.—

(1) Establishment.— The Secretary of Veterans Affairs shall establish and carry out a research grant program to award grants to eligible entities described in paragraph (2) to be used to carry out studies and applied programs on approaches and methodologies for the treatment of mTBI in veterans.

(2) Eligible entities described.— An eligible entity described in this paragraph is any of the following:

(A) A nonprofit organization that has demonstrated the capability to conduct clinical trials and to evaluate traumatic brain injury treatments through patient care delivery.

(B) An academic institution that conducts significant research on traumatic brain injury and has demonstrated the capability to conduct clinical trials relating to neurorehabilitation treatments.

(C) A partnership or consortium of two or more entities described in subparagraphs (A) and (B).

(3) Applications.— An eligible entity desiring a grant under this section shall submit to the Secretary an application in such form, at such time, and containing such information and assurances as the Secretary determines appropriate, including a summary of—

(A) the research and treatment activities proposed to be carried out using grant funds;

(B) the methodology to be used for such activities;

(C) the expected outcomes of such activities;

(D) how the eligible entity will coordinate, as practicable, with Veterans Health Administration facilities for referral and continuity of care for veterans who participate in activities carried out using grant funds, and for dissemination of aggregate findings;

(E) the budget of the entity for the use of the grant, including a narrative justification and an identification of the estimated amount of grant funds to be used for administrative or overhead costs; and

(F) assurances of compliance with applicable Federal laws and regulations relating to human subjects protections and patient safety.

(4) Administration.—

(A) Grant categories.— In carrying out the grant program under this subsection, each fiscal year the Secretary shall—

(i) subject to the requirement under subparagraph (B), award four grants for exploratory or pilot research and treatment projects, each of which shall be in an amount of not more than $625,000; and

(ii) award five grants for collaborative or multidisciplinary research and treatment initiatives, each of which shall be in an amount of not more than $1,500,000.

(B) Priority.— Of the grants awarded under subparagraph (A)(i), the Secretary shall award not fewer than three to nonprofit organizations.

(C) Enforcement authority.— The Secretary may suspend, modify, or terminate a grant awarded under this subsection, if the Secretary determines that the recipient of such grant has failed to comply with the applicable terms and conditions of the grant.

(5) Agreement with independent organization.—

(A) In general.— The Secretary shall seek to enter into an agreement with an independent organization that is not a component of the Department and that has demonstrated expertise in randomized controlled trials, neurorehabilitation outcomes evaluation, and research integrity, under which the organization agrees to—

(i) administer the research grant program under this subsection;

(ii) carry out studies and implement efforts that include—

(I) analyzing data from mTBI treatment methodologies developed pursuant to the research grant program to assess the effect, among veterans, of such methodologies on enhanced brain health outcomes, mental health, and long-term recovery, including, to the extent outcomes are collected under the applicable clinical protocol, durability of outcomes at approximately six months following completion of treatment;

(II) identifying data-driven best practices and providing recommendations for further research or clinical application, including recommendations for dissemination to Veterans Health Administration clinicians and facilities (as appropriate); and

(III) randomized, controlled clinical trials to—

(aa) validate and deliver treatments;

(bb) establish a standard of care; and

(cc) improve access to such treatments for veterans;

(iii) submit to the Secretary not less frequently than annually a report describing activities carried out under this section, including outcome data and methodology; and

(iv) make available to the Secretary all data and findings from the grants made under this section, consistent with applicable Federal law, regulation, and Department policies relating to patient protections, data security, and privacy.

(B) Rule of construction.— Nothing in this section shall be construed to authorize the Secretary, or an independent organization that enters into an agreement with the Secretary under subparagraph (A), to require prior approval of, or changes to, any clinical protocol, study design, outcome measures, or follow-up schedule established by an eligible entity that receives a grant under this section, except as necessary to ensure compliance with applicable Federal laws and regulations relating to human subjects protections and patient safety.

(C) Report.— An agreement under subparagraph (A) shall include a requirement that the independent organization submits to Congress and the Secretary a comprehensive report that includes—

(i) the findings of the studies required under such agreement;

(ii) recommendations with respect to the expansion of successful TBI treatment methodologies and standard of care recommendations, if any, developed pursuant to the research grant program; and

(iii) to the extent available from the reports and study materials of grant recipients, a summary of—

(I) the durability of outcomes at approximately six months following completion of treatment, if collected under the applicable clinical protocol;

(II) adverse events and serious adverse events, including self-harm or suicide-related events, if collected under the applicable clinical protocol or in the ordinary course of care; and

(III) aggregate expenditures of grant funds, including administrative or overhead costs.

(D) Surveys.— The Secretary may conduct surveys of any independent organization that enters into an agreement with the Secretary under subparagraph (A) in order to assess the effectiveness of such organization in administering the research grant program under this subsection.

(6) Available amounts; authorization of appropriations.—

(A) Available amounts.— The Secretary may use amounts available to the Secretary for the operating budget of the National Center for Posttraumatic Stress Disorder to carry out the research grant program under this subsection, if the use of such amounts supplements, and does not supplant, amounts otherwise available for Department programs and services.

(B) Authorization of appropriations.— There is authorized to be appropriated to the Secretary $10,000,000 for each of fiscal years 2026 through 2028 to carry out this subsection.

(7) Termination date.— The authority of the Secretary to carry out the research grant program under this section shall terminate on the date that is three years after the date of the enactment of this Act.

(c) Reports to Congress.— Not later than two years after the date on which the Secretary commences the research grant program under subsection (a), and on an annual basis thereafter until the termination date specified in paragraph (8) of such subsection, the Secretary shall submit to Congress a report on the grant programs under subsections (a) and (b). Each such report shall include—

(1) the findings of the studies under subsection (a)(6)(B);

(2) a description of any agreement entered into by the Secretary under subsection (b)(5)(A);

(3) recommendations of the Secretary with respect to policy and programmatic improvements to services of the Department to treat mTBI among veterans;

(4) any findings derived from surveys conducted under subsection (b)(5)(D), including any recommendations of the Secretary for improvements to the structure, oversight, administration, or performance of the independent organization that enters into an agreement with the Secretary under subsection (b)(5)(A); and

(5) such other matters as the Secretary determines appropriate.

(d) Definitions.— In this section:

(1) The terms “chronic mild traumatic brain injury” and “mTBI” mean a mild traumatic brain injury with symptoms that persist for not fewer than six months after the inciting injury, as determined using validated clinical criteria.

(2) The term “nonprofit organization”—

(A) means an organization described in section 501(c)(3) of the Internal Revenue Code of 1986 and exempt from taxation under section 501(a) of such Code; and

(B) includes such an organization that is a hospital, nonprofit health system, academic medical center, or clinic that delivers neurorehabilitation care or conducts clinical research relating to mTBI.

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

(a) In general.— Subchapter I of chapter 74 of title 38, United States Code, is amended by adding at the end the following new section:

“7415. Traveling physicians.—

(a) In general.—

(1) The Secretary may assign a physician appointed under section 7401 or section 7431 of this title to serve as a traveling physician for a period of not more than one year at a time. A physician assigned to serve as a traveling physician under this section may be assigned to provide health care to veterans residing in American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, the Commonwealth of Puerto Rico, the Virgin Islands of the United States, the Freely Associated States (as defined in section 1724(f) of this title), or any other territory or possession of the United States at Department facilities or other approved facilities located in such territory, possession, or Freely Associated State.

(2) The Secretary may assign multiple physicians to serve as traveling physicians under this section and may assign each such physician to serve in a specific territory, possession, or Freely Associated State.

(b) Coordination of care.— In providing care under this section, traveling physicians shall coordinate with non-Department medical providers to the extent practicable and necessary to ensure high quality and coordinated care for veterans receiving hospital care and medical services.

(c) Pay.— In addition to pay under section 7431 of this title, the Secretary shall provide a relocation or retention bonus to traveling physicians under this section. Such relocation or retention bonus shall be substantially similar to a relocation or retention bonus offered under section 7410(a) of this title, as the Secretary considers appropriate.”.

(b) Clerical amendment.— The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 7414 the following new item:

(c) Technical and conforming amendments.— Title 38, United States Code, is further amended as follows:

(1) In section 7410(a)(1), by—

(A) by striking “retention allowances” and inserting “retention bonuses”; and

(B) by striking the second comma after “section 7401(1) of this title”; and

(2) In section 7431(e)(5)(B), by striking “retention allowances” and inserting “retention bonuses”.

Section 1701 of title 38, United States Code, is amended, in paragraph (6)(F)(i), by inserting “(including adaptive prostheses and terminal devices for sports and other recreational activities that are determined to be clinically appropriate by the Secretary)” after “artificial limbs”.

(a) Coordination by Secretary.— Subsection (b) of section 201 of the Commander John Scott Hannon Veterans Mental Health Care Improvement Act of 2019 (Public Law 116–171; 38 U.S.C. 1720F note) is amended by striking the second sentence.

(b) Use of grant funds.— Subsection (c) of such section is amended—

(1) in the subsection heading, by inserting “; Use of Grant Funds” after “Grants”; and

(2) by adding at the end the following new paragraphs:

“(3) Renewal of grant amounts.—

(A) In general.— In determining whether to renew a grant awarded under this section to an eligible entity, the Secretary shall consider, among such other factors as the Secretary may consider appropriate—

(i) the compliance by the eligible entity in administering pre- and post-intervention assessments required under subsection (e)(6); and

(ii) any demonstrated improvements in participant outcomes.

(B) Additional amounts.— Based on a consideration of the factors described in subparagraph (A), the Secretary may award amounts, not to exceed $250,000 per grantee per fiscal year, to a grantee in addition to the maximum amount under paragraph (2)(A) based on a performance-based metric established by the Secretary.”.

(c) Priority for new recipients.— Subsection (d) of such section is amended—

(1) in the subsection heading, by striking “and Preference” and inserting “, Preference, and Priority”;

(2) in paragraph (1)(A)—

(A) in clause (iv), by striking the semi-colon at the end and inserting “; and”;

(B) by striking clause (v); and

(C) by redesignating clause (vi) as clause (v); and

(3) by adding at the end the following new paragraph:

“(3) Priority for new recipients.— To the maximum extent practicable, the Secretary shall prioritize grants for eligible entities that have satisfied the requirements provided under subsection (f) and are located in States in which a grant has not been awarded under this section.”.

(d) Requirements for receipt of grants.— Subsection (e) of such section is amended—

(1) in paragraph (3)—

(A) by redesignating subparagraphs (B) and (C) as subparagraphs (C) and (D), respectively; and

(B) by inserting after subparagraph (A) the following new subparagraph (B):

“(B) coordinate with the Secretary to develop a plan for communication between the entity and local mental health providers of the Department regarding whether veterans receiving assistance under this section from the entity are attending appointments to ensure continuity of care;”; and

(2) by adding at the end the following new paragraph:

“(6) Assessments.— An eligible entity receiving a grant under this section shall conduct a pre- and post-intervention assessment with respect to each eligible individual who receives suicide prevention services pursuant to such grant across all relevant metrics, as determined by the Secretary.

(7) Metrics and outcomes.— An eligible entity receiving a grant under this section shall collect and submit to the Secretary such metrics and outcome data as the Secretary may require, including—

(A) throughput measures, including the number of veterans screened, referred, connected to care, and retained in services under the grant program;

(B) reductions in severity scale measurements, including reductions in suicidality identified through applicable inventories or assessments; and

(C) such other quantifiable metrics as the Secretary determines appropriate.”.

(e) Training and technical assistance.— Subsection (g) of such section is amended—

(1) in paragraph (1)—

(A) in the matter preceding subparagraph (A), by inserting “, or interested in receiving such grants,” after “this section”; and

(B) in subparagraph (A), by inserting “, including training on how to properly use the Columbia Protocol (also known as the Columbia-Suicide Severity Rating Scale (C–SSRS)) and other screening tools selected by the Secretary” after “management”; and

(2) by adding at the end the following new paragraphs:

“(3) Training for department employees.— The Secretary shall provide training to employees of the Department as the Secretary considers appropriate on the grant program under this section.”.

(f) Briefing for local VAMCS.— Subsection (h) of such section is amended by adding at the end the following new paragraph:

“(5) Briefing for local VAMCS.— Not less frequently than once per year, unless the Secretary determines that such frequency is not advisable, the Secretary shall provide, to the appropriate personnel of each medical center of the Department identified on the grantee’s application under this section, a briefing about the grant program under this section in order to improve coordination between such recipient and personnel.”.

(g) Duration.— Subsection (j) of such section is amended by striking “September 30, 2026” and inserting “September 30, 2029”.

(h) Reports.— Subsection (k)(2) is amended—

(1) in the paragraph heading, by striking “Final report” and inserting “Annual reports”; and

(2) in subparagraph (B)—

(A) by redesignating clauses (iii) and (iv) as (v) and (vi), respectively; and

(B) by adding the following new clauses (iii) and (iv):

“(iii) A description of the Secretary’s compliance with the requirement to train employees of the Department under subsection (g)(3).

(iv) An optional description and inclusion of subjective or narrative stories of community or individual impact to allow grant recipients to share meaningful accomplishments.”.

(i) Referral for care.— Subsection (m) of such section is amended by adding at the end the following new paragraph:

“(4) Required response or action.—

(A) If the Secretary receives a referral under paragraph (1) for additional care, the Secretary shall review such referral and contact the veteran not later than 72-hours following the referral.

(B) If the Secretary receives a referral under paragraph (2) for emergent suicide care, the Secretary shall review such referral and contact the veteran not later than 24 hours following the referral by such entity under subsection (m)(1).”.

(j) Reauthorization.— Subsection (p) of such section is amended—

(1) by striking “section a total” and inserting

“(1) a total”;

(2) by striking the period at the end and inserting “; and”; and

(3) by adding at the end the following new paragraph:

“(2) a total of $200,000,000 for fiscal years 2027 through 2029.”.

(k) Technical correction to definitions.— Subsection (q)(5) of such section is amended, in the first sentence—

(1) by striking “Medical services” and inserting “The term “emergency treatment” means medical services”; and

(2) by striking “was rendered” and inserting “rendered”.

(l) Identification of demand for other services and support.— Subsection (e) of such section, as amended, is further amended—

(1) by redesignating paragraphs (5) and (6) as (6) and (7), respectively; and

(2) by adding after paragraph (4) the following new paragraph:

“(5) Demand for other services and support.— An entity receiving a grant under this section shall submit to the Secretary information concerning—

(A) the number of individuals seeking services from the entity who are not eligible individuals and the most common reason such individuals are not eligible individuals;

(B) a description of the types of services that eligible individuals or individuals described in subparagraph (A) require based on any screening conducted by the entity; and

(C) any actions taken by the entity to provide the services described in subparagraph (B) or to refer the individual or eligible individual to another entity for the receipt of such services.”.

(m) Suicide prevention services.—

(1) Required use of certain screening protocol.— Subsection (q)(11)(A)(ii) of such section is amended by adding at the end the following new sentence: “In the case of a recipient of a grant awarded under this section on or after the date of the enactment of the Take Care of America’s Veterans Act, such screening shall be Columbia Protocol (also known as the Columbia-Suicide Severity Rating Scale (C–SSRS)) or the Patient Health Questionnaire–9 (PHQ9), or a successor screening tool selected by the Secretary.”;

(2) Transportation.— Subsection (q)(11)(A) of such section is amended—

(A) by redesignating clause (xi) as clause (xii); and

(B) by inserting after clause (x) the following new clause:

“(xi) Transportation and rideshare services for eligible individuals to use for appointments.”.

(n) Eligible individuals.— Subsection (q)(4)(C) of such section is amended by striking “clauses (i) through (iv)” and inserting “clauses (i) through (vi)”.

(o) Effective date.— The amendments made by this section shall take effect on—

(1) the effective date of award following the date the Secretary publishes a notice of funding opportunity for the program required by section 201(a) of the Commander John Scott Hannon Veterans Mental Health Care Improvement Act of 2019 (Public Law 116–171; (38 U.S.C. 1720F)), if the Secretary determines such amendments do not require rulemaking; or

(2) the effective date of award following the date the Secretary publishes a notice of funding opportunity following the effective date of subsequent rulemaking, if the Secretary determines such amendments do require rulemaking.

(a) GAO report on the use of hyperbaric oxygen therapy to treat traumatic brain injury and post-traumatic stress disorder.— Not later than one year after the date of the enactment of this Act, the Comptroller General of the United States shall submit to the Committees on Veterans’ Affairs of the Senate and House of Representatives an update to the report titled “Research on Hyperbaric Oxygen Therapy to Treat Traumatic Brain Injury and Post-Traumatic Stress Disorder” (GAO-16-154). Such report shall include the assessment of the Comptroller General of clinical trials conducted, since the publication of such report—

(1) regarding the use of hyperbaric oxygen therapy to treat traumatic brain injury and post-traumatic stress disorder; and

(2) by—

(A) the Secretary of Veterans Affairs;

(B) the Secretary of Defense; and

(C) private entities.

(b) Follow-up study.—

(1) In general.— Not later than 180 days after the date of the enactment of this Act, the Secretary shall conduct a systematic review of published research literature on the off-label use of hyperbaric oxygen therapy to treat post-traumatic stress disorder and traumatic brain injury among veterans and nonveterans.

(2) Elements.— The review conducted under paragraph (1) shall include the following:

(A) An analysis of available research literature published after the review completed pursuant to section 702 of the Commander John Scott Hannon Veterans Mental Health Care Improvement Act (Public Law 116–171);

(B) An assessment of the current parameters for research on the use by the Department of Veterans Affairs of hyperbaric oxygen therapy, including—

(i) tests and questionnaires used to determine the efficacy of such therapy; and

(ii) metrics for determining the success of such therapy.

(C) A comparative analysis of tests and questionnaires used to study post-traumatic stress disorder and traumatic brain injury in other research conducted by the Department of Veterans Affairs, other Federal agencies, and entities outside the Federal Government.

(D) A market assessment of available hyperbaric oxygen therapy facilities or units within facilities to assess the most effective locations and practices, including—

(i) an analysis of whether multi-person chambers could reduce per-veteran costs;

(ii) an analysis of areas with lower prices compared to a national average; and

(iii) an identification of not fewer than two VISNs in which the provision or furnishing of hyperbaric oxygen therapy would benefit the most number of veterans at the lowest cost to the Department.

(a) Establishment.— The Secretary of Veterans Affairs shall carry out a three-year pilot program under which the Secretary shall make grants to eligible mental health care providers for the provision of mental health care, including evidence-based mental health care delivered in person or via telehealth.

(b) Eligibility.— To be eligible to receive a grant under the pilot program, a mental health care provider shall—

(1) be a non-profit organization;

(2) have operated at least one outpatient mental health facility in the United States for a continuous period of at least three years;

(3) be licensed or certified under applicable state law to provide outpatient mental health services;

(4) be accredited by—

(A) the Joint Commission on Accreditation of Healthcare Organizations;

(B) the Commission on Accreditation of Rehabilitation Facilities; or

(C) any other nationally recognized accrediting body the Secretary determines appropriate; and

(5) submit to the Secretary an application that includes such information and assurances as the Secretary may require, including—

(A) an identification of the outpatient facility or facilities where the mental health care services will be provided;

(B) a plan for providing clinicians at each facility in receipt of grant funds with units of continuing education with respect to veterans issues; and

(C) an identification of the percentage of the operating budget for each such facility that was provided through Federal grants during the fiscal year preceding the year during which the application is submitted.

(c) Use of funds.—

(1) In general.— The recipient of a grant under the pilot program shall use the grant—

(A) to deliver evidence-based mental health care for veterans in person or via telehealth.

(B) to operate or expand an existing outpatient mental health facility or establish a new outpatient mental health facility for the purpose of providing such care;

(C) to encourage veterans who are eligible for enrollment in the patient enrollment system under section 1705 of title 38, United States Code, to enroll in such system and to receive medical services furnished by the Department of Veterans Affairs;

(D) to support activities necessary to deliver or sustain care, including—

(i) outreach;

(ii) care coordination;

(iii) veteran engagement;

(iv) clinician training;

(v) implementation support; and

(vi) program evaluation; and

(E) to support continuous quality improvement and outcomes measurement activities, including the collection and reporting of clinical outcomes and operational metrics; and

(F) to support activities of the program that are not billable, reimbursable, or otherwise authorized by law, including—

(i) outreach;

(ii) care coordination;

(iii) engagement;

(iv) implementation support; and

(v) program evaluation; and

(G) to provide services to individuals for which reimbursement is not otherwise available, including such individuals who are—

(i) uninsured;

(ii) ineligible for health care furnished by the Department of Veterans Affairs; or

(iii) in receipt of health care that is not reimbursable as of the date of the enactment of this Act.

(2) Limitations on use of grant funds.— The recipient of a grant under the pilot program may not—

(A) charge an eligible veteran a fee associated with the receipt of mental health care funded by such grant;

(B) refuse to provide mental health care to an eligible veteran on the basis that the veteran is not eligible for reimbursement for such care under another payer source; or

(C) use grant funds to—

(i) duplicate payments made under any contract or agreement to which the Department is a party as of the date of the enactment of this Act; or

(ii) pay for the same clinical services or service units that are otherwise billable to a Federal payer, including the Veterans Community Care Program under section 1703 of title 38, United States Code, or any other public or private health plan.

(3) Rules of construction.— Nothing in this subsection may be construed to—

(A) prohibit a grant recipient from seeking reimbursement from non-Department payers for mental health services provided by the grant recipient, except that grant funds shall not be used to supplant or duplicate a reimbursement otherwise available under Federal law; or

(B) authorize double billing or duplicate payments for the same clinical service or unit of service.

(4) Spouse and dependent care.— A recipient may use grant funds to provide care to spouses and dependent children of a veteran when such services are integral to achieving a successful clinical outcome. Permissible services include—

(A) family therapy;

(B) couples therapy;

(C) group therapy;

(D) family psychoeducation; and

(E) other counseling services the Secretary determines are clinically necessary.

(d) Selection of facilities.— In awarding grants under the pilot program, the Secretary—

(1) shall ensure that grants are distributed geographically evenly among rural and urban areas;

(2) may consider the proportion of veterans historically served by the grant recipient; and

(3) may prioritize outpatient mental health facilities located in areas that the Secretary determines—

(A) are medically underserved;

(B) have large veteran populations;

(C) are located near military installations; or

(D) have large numbers of veterans at high risk of suicide.

(e) Amount of grant.—

(1) In general.—

(A) In general.— Except as provided in subparagraph (B), no grant under the pilot program for a facility for any fiscal year may exceed $1,500,000.

(B) Limitation.— In the case of an outpatient mental health facility for which at least 50 percent of the operating budget of the facility for the preceding fiscal year was provided through Federal grants, no grant under the pilot program for the facility for any fiscal year may exceed the lesser of—

(i) 50 percent of the operating budget of the facility; or

(ii) $1,500,000.

(2) Multiple grants.— The recipient of a grant under the pilot program—

(A) may apply for, and receive, grants for more than one facility of the recipient for any fiscal year; and

(B) may apply for, and receive, a grant for a facility that has already received a grant under the pilot program.

(f) Regulations; accountability.— The Secretary shall prescribe regulations to carry out this section, which shall include a requirement that each recipient of a grant under the pilot program shall—

(1) demonstrate the capacity to provide accountability;

(2) demonstrate clinical outcomes;

(3) justify the effective use of any private investment funds or Federal grant funds through data collection and reporting metrics; and

(4) collect standardized outcome measures including symptom improvement and program completion.

(g) Continuity of care.— A recipient of a grant under the pilot program shall adhere to the continuity of care model established by the Secretary to the Veterans Community Care Program.

(h) Report.— Not later than 180 days after the completion of the pilot program under this section, the Secretary shall submit to Congress a report on the pilot program that includes the following:

(1) The number of veterans who received mental health care under the program.

(2) An identification of the types of mental health care provided and the time period for which such care was provided.

(3) An identification and summary of program outcomes.

(4) The number of veterans who received mental health care under the program and subsequently enrolled in the patient enrollment system under section 1705 of title 38, United States Code.

(5) An identification of any obstacles faced by grant recipients in providing mental health care under the program.

(6) A summary of clinical outcomes based on pre- and post-client functioning—

(A) the number of veterans who improved clinically based on relevant clinical evaluation metrics that the Secretary determines appropriate;

(B) the degree of clinical improvement based on such relevant clinical evaluation metrics;

(C) the total number of veterans participating in the program; and

(D) any other outcome metrics as the Secretary determines appropriate.

(7) Findings with respect to the sustainability of the program.

(i) Authorization of appropriations.— There is authorized to be appropriated to the Secretary to carry out the pilot program under this section $20,000,000 for each of fiscal years 2027 through 2029.

(a) Agreements required.— Consistent with section 1724(f) of title 38, United States Code, and section 209(a)(4)(A) of the Compact of Free Association Amendments Act of 2024 (48 U.S.C. 1988(a)(4)(A)), the Secretary of Veterans Affairs shall work expeditiously with the governments of the Freely Associated States to enter into the agreements described in such sections.

(b) Inclusion of telehealth and mail order pharmacy services required.— Consistent with such sections and with the agreements required by subsection (a), the Secretary shall furnish to veterans in the Freely Associated States services that include, at a minimum—

(1) medical services authorized to be provided under chapter 17 of title 38, United States Code, which can be administered through telehealth; and

(2) pharmaceutical products authorized to be provided under such chapter, delivered by mail.

(c) Implementation dates.— In carrying out subsections (a) and (b), the Secretary shall—

(1) initiate outreach to each such government not later than 30 days after the date of the enactment of this Act;

(2) enter into each agreement required by subsection (a) not later than one year after the date of the enactment of this Act; and

(3) begin furnishing the services required by paragraphs (1) and (2) of subsection (b) not later than one year after the date of the enactment of this Act.

(d) Beneficiary travel.— Section 111(h)(1) of title 38, United States Code, is amended by striking “the Secretary may make payments” and inserting “beginning not later than one year after the date of the enactment of the Take Care of America’s Veterans Act, the Secretary shall make payments”.

(e) Reports.— Not less frequently than quarterly, the Secretary shall submit to the appropriate committees of Congress a report on the implementation of this section and the cost of such implementation. Until the Secretary has entered into the agreements required by paragraph (1) and begun furnishing the services required by subparagraphs (A) and (B) of paragraph (2), the report shall also describe the technical and logistical factors that have prevented or impeded the Secretary from doing so.

(f) Definitions.— In this subsection:

(1) Appropriate committees of Congress.— The term appropriate committees of Congress means—

(A) the Committee on Veterans’ Affairs and the Committee on Appropriations of the Senate; and

(B) the Committee on Veterans’ Affairs and the Committee on Appropriations of the House of Representatives.

(2) Freely Associated States.— The term Freely Associated States has the meaning given such term in section 1724(f) of title 38, United States Code.

(a) Modification of Precision Medicine for Veterans Initiative.— Section 305 of the Commander John Scott Hannon Veterans Mental Health Care Improvement Act of 2019 (Public Law 116–171; 38 U.S.C. 1712A note) is amended—

(1) in subsection (a), by striking “and such other mental health conditions” and inserting “repetitive low-level blast exposure, dementia, and such other brain and mental health conditions”;

(2) in subsection (d)(4), by adding at the end the following new subparagraph:

“(E) Data-sharing partnership.—

(i) In general.— The Secretary shall work with the Secretary of Defense to establish a data-sharing partnership between the Department of Veterans Affairs and the Department of Defense.

(ii) Storage.— The partnership established under clause (i) shall be stored in the open platform made available under this paragraph.

(iii) Data.— The data supplied by the Secretary of Defense under the partnership established under clause (i) shall include relevant data throughout the Department of Defense relating to low-level repetitive blast exposure and traumatic brain injury collected by the Armed Forces and other appropriate entities, as determined jointly by the Secretary of Defense and the Secretary of Veterans Affairs.”; and

(3) by adding at the end the following new subsections:

“(f) Repetitive low-level blast exposure research.— In carrying out the initiative under subsection (a), the Secretary shall prioritize research—

(1) to identify and validate biomarkers associated with repetitive low-level blast exposure and traumatic brain injury;

(2) to evaluate clinical and non-clinical interventions that improve cognitive function, quality of life, and mental health outcomes among veterans with symptoms associated with repetitive low-level blast exposure;

(3) to improve the diagnosis, treatment, and care coordination for veterans with a history of low-level repetitive blast exposure or traumatic brain injury, including veterans who performed duties or tasks associated with increased risk of low-level repetitive blast exposure; and

(4) to develop evidence-based strategies to reduce suicide risk among veterans with a history of low-level repetitive blast exposure or traumatic brain injury.

(g) Assistance and report by national academies of sciences, engineering, and medicine.— Not later than 180 days after the date of the enactment of the Take Care of America’s Veterans Act, the Secretary of Veterans Affairs shall seek to enter into a contract with the National Academies of Sciences, Engineering, and Medicine under which the National Academies shall—

(1) work in tandem with the initiative under subsection (a) on validation of brain and mental health biomarkers among veterans; and

(2) not less frequently than once every two years, submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on the work completed under paragraph (1).

(h) Assessment.—

(1) In general.— The Secretary of Veterans Affairs shall conduct an assessment of all translational research studies in progress and planned under the initiative under subsection (a), including research under subsection (f).

(2) Report.— Not later than 60 days after completion of the assessment conducted under paragraph (1), the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on the assessment.

(i) Reports.—

(1) In general.— Not less frequently than once every two years, the Secretary of Veterans Affairs shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on the initiative under subsection (a).

(2) Recommendations.— Each report required by paragraph (1) may include recommendations for immediate administrative and legislative action to improve the initiative under subsection (a).

(j) Authorization of appropriations.— There is authorized to be appropriated to the Secretary of Veterans Affairs $5,000,000 to carry out the initiative under subsection (a) for each of fiscal years 2027 through 2032.”.

(b) Inclusion of information in reports on suicide prevention among veterans and members of the Armed Forces.—

(1) Inclusion of information in national veteran suicide prevention annual report.— Section 149(a)(4)(B) of the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act (Public Law 118–210; 38 U.S.C. 1709B note) is amended by adding at the end the following:

“(iv) Military occupation data of veterans who attempt or commit suicide.”.

(2) Inclusion of information in Department of Defense annual report.— The Secretary of Defense shall include in the annual report of the Defense Suicide Prevention Office, or successor office, information on—

(A) occupational data of members of the Armed Forces who attempt suicide; and

(B) outcomes of suicide prevention interventions among members of the Armed Forces.

(a) Establishment.— Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall appoint, through the Department of Veterans Affairs-Department of Defense Joint Executive Committee under section 320 of title 38, United States Code, the Blast Overpressure Task Force of the Department of Veterans Affairs (in this section referred to as the “Task Force”).

(b) Membership.— Each member of the Task Force appointed under subsection (a) shall be a member of the Health Executive Committee under subsection (b)(2) of such section who, at the time of appointment, is involved in research regarding the mitigation and treatment of blast overpressure or blast exposure.

(c) Duties.— The duties of the Task Force are the following:

(1) To improve how the Secretary of Veterans Affairs, in consultation with the Secretary of Defense, provides health care and other benefits to veterans or members of the Armed Forces diagnosed with traumatic brain injury, post-traumatic stress disorder, or other symptoms, from blast overpressure or blast exposure.

(2) To align research agendas and acquisition strategies of the Department regarding such health care.

(3) To establish physiological and cognitive performance baselines for such veterans and members.

(4) To prioritize translational research regarding such veterans and members, including research regarding—

(A) sleep therapy;

(B) blast-related gut health;

(C) mobile diagnostics;

(D) vestibular dysfunction and balance impairment;

(E) autonomic nervous system dysregulation;

(F) cumulative mild traumatic brain injury;

(G) neuroinflammation and glial activation; and

(H) any other issue determined appropriate by the Secretary.

(5) To monitor sensory decline (including with regards to vision, hearing, and vestibular function) and stress-related impairments among such veterans and members.

(6) To support continuity of such care by integrating mobile and longitudinal diagnostic tools.

(d) Reports.— The Task Force shall issue annual reports to the Committees on Veterans’ Affairs and on Armed Services of the Senate and House of Representatives. Each such report shall include the following elements:

(1) Details of research initiatives, coordination outcomes, and clinical advancements of the Task Force.

(2) Recommendations of the Task Force regarding—

(A) how claims processors of the Department of Veterans Affairs should evaluate evidence that links such conditions to active military, naval, air, or space service; and

(B) best practices regarding the evaluation of neurological injuries in examinations for benefits under chapters 11 or 15 of title 38, United States Code.

(e) Sunset.— The Task Force shall terminate on September 30, 2029.

(a) Extension.— Section 8111(d)(3) of title 38, United States Code, is amended by striking “September 30, 2026” and inserting “September 30, 2027”.

(b) Oversight.—

(1) Justification.— Such section is further amended in subsection (a)—

(A) by inserting “(1)” before “To the maximum extent practicable, the Secretary”; and

(B) by adding at the end the following new paragraph:

“(2) If the Secretary of Veterans Affairs elects not to enter into such an agreement or contract, notwithstanding paragraph (1), the Secretary and the Department of Veterans Affairs-Department of Defense Joint Executive Committee shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a written justification for such election.”.

(2) Form of information.— If the Committee on Veterans’ Affairs of the House of Representatives or the Senate requests information from the Secretary of Veterans Affairs regarding section 8111 of title 38, United States Code, the Secretary shall provide such information in the form requested by such committee, including underlying records, datasets, methodologies, contracts, and communications, and may not be limited to summaries or briefing materials in lieu of original source documents unless authorized by the requesting committee.

(3) Interference with transmission of information.— In response to such a request, no official or employee of the Department of Veterans Affairs shall—

(A) withhold, screen, or alter responsive information;

(B) delay or condition production on initial clearance or political review;

(C) require a nondisclosure agreement unless required by law;

(D) substitute summaries for requested 2 records; or

(E) otherwise impede or interfere with direct transmission of information to the Committee on Veterans’ Affairs of the House of Representatives or the Senate.

(4) Classified information.— If the Secretary of Veterans’ Affairs determines that any information regarding such section requested by the Committee on Veterans’ Affairs of the House of Representatives or the Senate is classified, the Secretary shall make arrangements to present such information to the Chair and Ranking Member of the such committee using appropriate security measures.

(c) Implementation plan and report.—

(1) Joint resource sharing implementation plan.— Not later than 90 days after the date of the enactment of this Act, the Secretary of Veterans Affairs, in coordination with the Secretary of Defense, shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a Joint Resource Sharing Implementation Plan. Such plan shall include—

(A) a comprehensive inventory of all agreements under section 8111 of title 38, United States Code;

(B) a standardized reimbursement methodology;

(C) capacity assessments of Department of Veterans Affairs and Department of Defense facilities; and

(D) identification of priority regions for expansion.

(2) Report.— Not later than 2 years after date of the enactment of this Act, the Comptroller General shall submit a report to Congress on the implementation of section 8111 of title 38, United States Code. Such report shall include—

(A) a description of use and effectiveness of agreements under such section;

(B) a description of the role and output of the Joint Executive Committee under such section;

(C) an evaluation of the effectiveness of coordination of care and sharing of resources by the Department of Veterans Affairs and the Department of Defense under such section; and

(D) a description of any statutory, operational, or cultural barriers to the implementation of such section.

(a) Findings.— Congress finds the following:

(1) States and counties have reported significant delays in the signing of death certificates for veterans who pass away from natural causes.

(2) Such delays, caused by the refusal of, or postponement by, physicians of the Department of Veterans Affairs have, in some cases, lasted as long as eight weeks.

(3) Such delays prevent the timely burial of deceased veterans and access to survivor benefits.

(b) Timely certification of the death of a veteran.—

(1) In general.—

(A) VA physician, nurse practitioner, or physician assistant.— Subject to subparagraph (B), a physician, nurse practitioner, or physician assistant employed by the Secretary of Veterans Affairs who is the primary care provider of a veteran who dies of natural causes shall certify the death of such veteran not later than two business days after such physician, nurse practitioner, or physician assistant learns of such death.

(B) Coroner or medical examiner.— If a physician, nurse practitioner, or physician assistant described in subparagraph (A) cannot comply with such paragraph with respect to a death described in such paragraph, a coroner or medical examiner in the jurisdiction where such death occurred may certify such death.

(2) Report.—

(A) In general.— Not later than one year after the date of the enactment of this Act, and annually thereafter for the following five years, the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report regarding compliance with paragraph (1).

(B) Elements.— Each report required under subparagraph (A) shall include, with respect to the year preceding the date of the report, the following elements:

(i) The percentage of cases in which a physician, nurse practitioner, or physician assistant employed by the Secretary complied with paragraph (1)(A).

(ii) The number of cases in which such a physician, nurse practitioner, or physician assistant could not so comply.

(iii) An identification of the most common reasons why such a physician, nurse practitioner, or physician assistant could not so comply.

(3) Rule of construction.— Nothing in this section shall be construed to authorize a physician assistant or nurse practitioner to certify a death in any State in which such authority is not permitted under State or local law.

(a) Pilot program to improve care coordination for veterans from critical access hospitals and affiliated clinics.—

(1) In general.— Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall commence a five-year pilot program to improve care coordination for eligible veterans who receive care from a critical access hospital or a provider-based rural health clinic affiliated with such hospital (in this section referred to as the “pilot program”).

(2) Contracts, agreements, or other arrangements.—

(A) In general.— In carrying out the pilot program, the Secretary shall enter into contracts, agreements, or other arrangements with facilities participating in the pilot program to reimburse critical access hospitals and affiliated clinics for outpatient health care and medical services provided to eligible veterans.

(B) Elements.— The Secretary, in coordination with participating critical access hospitals, shall ensure that any contract, agreement, or other arrangement entered into under subparagraph (A) establishes criteria, as the Secretary considers appropriate, to ensure—

(i) the provision of timely, safe, and high-quality health care services to participants in the pilot program, including through timely sharing of pertinent medical record and other information between medical facilities participating in the pilot program and medical facilities of the Department of Veterans Affairs;

(ii) the provision of health care services through the pilot program is in accordance with the medical benefits package of the Department;

(iii) no additional charges are imposed on veterans participating in the pilot program or the health care insurer of such veterans for any medical service for which payment is made by the Secretary;

(iv) appropriate reimbursement rates, including through the consideration of cost-based reimbursements; and

(v) such other considerations as the Secretary considers appropriate.

(3) Locations.— The Secretary shall ensure participation in the pilot program is open to all qualified facilities located in States that are designated by the Centers for Medicare & Medicaid Services as frontier States.

(4) Authorization for care.— The Secretary shall provide eligible veterans opting to participate in the pilot program a one-year authorization from the Department to receive outpatient services at facilities participating in the pilot program.

(5) Outreach.—

(A) Eligible veterans.— Not less frequently than annually during each year in which the pilot program is carried out, the Secretary shall conduct direct outreach to eligible veterans in areas in which the pilot program is carried out to notify such veterans of their ability to participate in the pilot program.

(B) Hospitals.— The Secretary shall conduct direct outreach to critical access hospitals in areas in which the pilot program is carried out to notify those hospitals of their ability to participate in the pilot program.

(6) Staff.— The Secretary shall ensure that each medical facility of the Department within the catchment area of a location in which the pilot program is carried out has sufficient dedicated staff to handle—

(A) administrative and technical challenges that arise from the pilot program;

(B) care coordination and follow up with the veteran and the facility participating in the pilot program after an episode of care; and

(C) timely records return following an episode of care.

(7) Limitation.— The Secretary may not extend the pilot program beyond the five-year period specified under subsection (a) or expand the pilot program to additional States or convert the pilot program into a permanent authority unless expressly authorized by a subsequent Act of Congress.

(8) Report.—

(A) In general.— Not later than one year after the date of the enactment of this Act, and annually thereafter for the duration of the pilot program, the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans Affairs of the House of Representatives a report on the pilot program.

(B) Elements.—

(i) In general.— Each report required under subparagraph (A) shall contain the recommendation of the Secretary for the expansion or continuation of the pilot program.

(ii) Initial report.— The initial report required under clause (i) shall contain—

(I) a description of the outreach conducted to critical access hospitals concerning the pilot program;

(II) a list of facilities that have opted to participate in the pilot program;

(III) information, by facility, regarding total obligations and expenditures, utilization average time from authorization to care, timeliness regarding medical records return and claim payment, emergency department utilization, veteran satisfaction, and any effect on care furnished by Department facilities; and

(IV) a list of the barriers, if any, cited by facilities that opted not to participate in the pilot program.

(iii) Subsequent reports.— Each report required under clause (i) after the initial report shall contain—

(I) an updated list of facilities participating in the pilot program;

(II) the number of veterans participating in the pilot program, disaggregated by facility;

(III) an overview of the types of care received through the pilot program;

(IV) feedback from the facilities participating in the pilot program, with identifying information removed, regarding the status of the pilot program, challenges in participating in the pilot program, and the interest of the facility in continued participation in such a program; and

(V) any additional information that the Secretary determines relevant or necessary.

(9) Definitions.— In this subsection:

(A) Critical access hospital.— The term critical access hospital has the meaning given that term in section 1861(mm) of the Social Security Act (42 U.S.C. 1395x(mm)).

(B) Eligible veteran.— The term eligible veteran means a veteran—

(i) enrolled in the patient enrollment system of the Department of Veterans Affairs established and operated under section 1705(a) of title 38, United States Code;

(ii) who has received care at a facility of the Department or in-network provider under the Veterans Community Care Program under section 1703 of such title during the previous two-year period;

(iii) who lives within 35 miles of a critical access hospital; and

(iv) who would be eligible for care or services under the Veterans Community Care Program.

(b) Action plan to address barriers to care for veterans living in rural areas.—

(1) In general.— Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall develop and submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a comprehensive action plan to identify, address, and eliminate barriers to accessing care for veterans residing in rural, highly rural, and frontier areas.

(2) Elements.— In developing the action plan required under paragraph (1), the Secretary shall—

(A) consult with health care providers that provide care in the community under the laws administered by the Secretary, State Offices of Rural Health, Tribal health authorities, and other relevant stakeholders in rural, highly rural, and frontier areas as the Secretary determines appropriate;

(B) assess barriers to care in the community for veterans residing in rural and highly rural areas, including challenges with respect to—

(i) network adequacy;

(ii) provider participation;

(iii) geographic distance;

(iv) transportation;

(v) information technology;

(vi) physical infrastructure;

(vii) outreach and understanding of eligibility for such care;

(viii) timeliness of referrals, authorization, and medical documentation exchange; and

(ix) any other matter the Secretary determines appropriate;

(C) list specific and measurable strategies and actions to address the barriers and challenges assessed under subparagraph (B), to include the consideration of—

(i) expanding participation in the Veterans Community Care Program under section 1703 of title 38, United States Code, among providers in rural, highly rural, and frontier areas;

(ii) physically locating health care facilities of the Department of Veterans Affairs within the same building or on the campuses of other health care facilities located in rural, highly rural, or frontier areas;

(iii) enhancing transportation assistance;

(iv) increasing reimbursement rates, including through cost-based reimbursements; and

(v) improving coordination with State, Tribal, and local partners; and

(D) assess legislative and regulatory barriers, if any, to addressing the barriers assessed under subparagraph (B).

(3) Implementation.— Not later than 90 days after submitting the action plan under paragraph (1), the Secretary shall begin implementation of the plan and shall ensure full implementation not later than two years after the date of the enactment of this Act.

(c) Outreach.—

(1) Outreach to veterans.— Not later than one year after the date of the enactment of this Act, and annually thereafter, the Secretary of Veterans Affairs, through the Office of Rural Health (or successor office) and the Office of Integrated Veteran Care (or successor office), shall conduct outreach to veterans residing in rural, highly rural, and frontier areas regarding—

(A) opportunities to seek care through facilities and programs of the Department of Veterans Affairs, including via telehealth, existing programs provided through grantees or contractors of the Department, Vet Centers (as defined in section 1712A of title 38, United States Code), and volunteer programs and services for transportation;

(B) opportunities to seek care though the Veterans Community Care Program under section 1703 of title 38, United States Code;

(C) opportunities to seek care at critical access hospitals with contracts, partnerships, or agreements with the Department of Veterans Affairs; and

(D) any other matters the Secretary considers appropriate.

(2) Outreach to providers.— Not later than one year after the date of the enactment of this Act, and annually thereafter, the Secretary of Veterans Affairs, through the Office of Rural Health (or successor office) and the Office of Integrated Veteran Care (or successor office), shall—

(A) conduct outreach to health care facilities and critical access hospitals in rural areas regarding—

(i) the Veterans Community Care program under section 1703 of title 38, United States Code, and the pilot program under subsection (a) of this section; and

(ii) any other matters the Secretary considers appropriate; and

(B) seek to enter into contracts, partnerships, agreements, or other arrangements with health care facilities and critical access hospitals in rural areas.

(3) Critical access hospital defined.— In this section, the term critical access hospital has the meaning given that term in section 1861(mm) of the Social Security Act (42 U.S.C. 1395x(mm)).

(a) Pilot program on establishment or enhancement of community integration platform for veterans.—

(1) In general.— Commencing not later than 18 months after the date of the enactment of this Act, the Secretary, acting through the Center for Innovation for Care and Payment of the Department of Veterans Affairs, shall carry out a pilot program under which the Secretary shall establish a new, or enhance an existing, interoperable community integration platform to coordinate local support services for veterans through other governmental and nongovernmental organizations (in this section referred to as the “pilot program”).

(2) Elements of pilot program.— In carrying out the pilot program, the Secretary shall ensure that the community integration platform established or enhanced under the pilot program—

(A) permits veterans to identify and connect with covered entities that furnish covered services;

(B) permits covered entities to identify and connect with veterans in need of covered services;

(C) utilizes, to the extent practicable, existing interoperable technology networks;

(D) prioritizes connectivity with appropriate existing technology networks developed by public or private organizations that comply with, as applicable, standards adopted by the Secretary of Health and Human Services under section 3004 of the Public Health Service Act (42 U.S.C. 300jj–14), for the provision of covered services;

(E) ensures that—

(i) reasonable measures are taken to promote connectivity and interoperable exchange among covered entities and between covered entities and veterans; and

(ii) appropriate privacy and security protections are in place, in accordance with applicable Federal and State privacy law;

(F) is accessible by employees of the Department, covered entities, and veterans;

(G) connects covered entities and veterans for purposes of communication, service coordination, and consumer assistance, referral and capacity management, outcome tracking and reporting, and related services; and

(H) is accessible via a web-based platform for all veterans and via a non-web-based alternative platform or process for veterans who are unable to easily and reliably access the web-based platform.

(3) Locations.—

(A) Initial locations.— The Secretary shall carry out the pilot program at not fewer than five medical facilities of the Department of Veterans Affairs selected by the Secretary for purposes of the pilot program.

(B) Expansion.— The Secretary may expand beyond initial sites for the pilot program selected under paragraph (1) not before two years after the date of enactment, not before thirty days after briefing the Committees on Veterans’ Affairs of the Senate and the House of the expansion plan, and after demonstrated success.

(C) Variety of facilities.— In selecting facilities under subparagraph (A), the Secretary shall ensure the selection of a variety of different types of facilities, including—

(i) frontier facilities;

(ii) under-resourced facilities;

(iii) facilities at which there are existing efforts to coordinate with community resources; and

(iv) facilities located in communities with an established community-based veteran service coordination network capable of integration with the pilot program.

(4) Procurement of technology.— In carrying out the pilot program, the Secretary shall ensure full and open competition in the procurement of any services or technology and shall not enter into an exclusive national contract for the operation of the community integration platform under the pilot program. In procuring technology under this section, the Secretary may prioritize, to the maximum extent practicable, technologies, platforms, or capabilities that are already deployed, validated, interoperable, or otherwise in operational use within medical centers or other components of the Department, unless the Secretary determines and documents that an alternative solution would better achieve the purposes of this section.

(5) Application process.—

(A) In general.— The Secretary may require covered entities that seek to participate in the pilot program to submit to the Secretary an application therefore in such form, in such manner, and containing such commitments and information as the Secretary considers necessary to carry out this section.

(B) Review.—

(i) In general.— The Secretary shall review the applications of covered entities submitted under subparagraph (A) to ensure that the participation of such entities would be safe and appropriate for veterans participating in the pilot program.

(ii) Due diligence.— In reviewing applications under clause (i), the Secretary shall conduct due diligence consistent with how the Secretary conducts due diligence for public-private partnerships under other laws administered by the Secretary.

(6) Screening and tracking of participants.—

(A) In general.— The Secretary shall require veterans participating in the community integration platform under the pilot program to provide information regarding social determinants of health using the ICD–10 diagnostic codes Z55 through Z63 and Z75 (as in effect on the date of the enactment of this Act) in a standardized risk assessment or screening tool and such other information as the Secretary considers necessary to administer the pilot program.

(B) Informed consent.— Information collected under the pilot program with respect to a veteran shall be obtained with the informed consent of the veteran and used solely for purposes of care coordination, service delivery, or program evaluation under the pilot program.

(C) Tracking of information.—

(i) In general.— The Secretary shall track—

(I) the number of referrals of veterans to covered entities through the community integration platform under the pilot program;

(II) the response time of covered entities to which such veterans are referred; and

(III) the outcome of the initial meeting by a veteran and a covered entity to which the veteran is referred, including a description of the services that are provided to the veteran by such entity.

(ii) Tracking by entities.— The Secretary may require covered entities participating in the pilot program to track the information required under clause (i) in a medium determined appropriate by the Secretary.

(7) Coordination and integration of programs.—

(A) Coordination with existing networks.— In carrying out the pilot program, the Secretary shall coordinate with existing community networks.

(B) Coordination and integration with State medicaid programs.— The Secretary may consult and coordinate with the Secretary of Health and Human Services and with States regarding existing Federal and State programs, but nothing in this section shall be construed to authorize the Secretary of Veterans Affairs to administer, direct, or modify a State Medicaid program or waiver.

(8) Performance benchmarks.— The Secretary shall establish performance benchmarks for the pilot program, including measures of referral completion, timeliness of service connection, and veteran-reported satisfaction.

(9) Report and briefings.—

(A) Report.— Not later than three years after the commencement of the pilot program, the Secretary shall submit to the appropriate committees of Congress a report analyzing the needs of veterans for covered services reflected by the use of such services under the community integration platform under the pilot program, including an assessment of—

(i) the need for such services that is being met through such platform; and

(ii) the need for such services that is not being met through such platform.

(B) Briefing on entities not selected.— Not later than 180 days after the commencement of the pilot program, and not less frequently than once every 180 days thereafter until the conclusion of the pilot program, the Secretary shall brief the appropriate committees of Congress on the covered entities that submitted an application to participate in the pilot program but were not selected for participation and the reason those entities were not selected.

(10) Comptroller General evaluation, report, and recommendations.—

(A) Evaluation.— The Comptroller General of the United States shall conduct an evaluation that measures the overall impact of the community integration platform established or enhanced under the pilot program with respect to—

(i) changes in individual and population health outcomes among veterans;

(ii) changes in access to health care or social services among veterans; and

(iii) such other factors as the Comptroller General considers appropriate.

(B) Report and recommendations.—

(i) In general.— Not later than four years after the commencement of the pilot program, the Comptroller General shall—

(I) submit to Congress a report on the evaluation conducted under subparagraph (A);

(II) make such report publicly available; and

(III) based on such evaluation, make recommendations to the Secretary on how to improve and sustain the community integration platform established or enhanced under the pilot program.

(ii) Elements of report.— The report under clause (i)(I) shall include data on—

(I) what covered sources under the pilot program are being utilized the most;

(II) what requests for services under the pilot program cannot be met; and

(III) the impact of the provision of services under the pilot program on health outcomes of veterans.

(11) Limitations.—

(A) The Secretary may not use the pilot program established under subsection (a) to supplant services otherwise required to be furnished by the Department under title 38, United States Code.

(B) No covered entity participating in the pilot program established under subsection (a) may receive access to personally identifiable information, protected health information, or social determinants information of a veteran without the veteran’s informed written consent, and such information may be used only for the specific referral or service authorized by the veteran.

(12) Definitions.— In this subsection:

(A) Appropriate committees of Congress.— The term appropriate committees of Congress means the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives.

(B) Community integration platform.— The term community integration platform means an interoperable platform or network of interoperable systems used to enable the coordination, alignment, and connection of covered entities and veterans at the local level for purposes of communication, service coordination, and referral management of covered services.

(C) Covered entity.— The term covered entity means any of the following entities or providers that have entered into an agreement with the Secretary to participate in the pilot program:

(i) A community-based organization that—

(I) accepts referrals from health care organizations; and

(II) provides covered services.

(ii) A public or private health care provider organization.

(iii) A public or private funded payor of health care services, including home- or community-based services.

(iv) A State, local, territorial, or Tribal health or social services agency.

(v) A State public housing authority or housing finance agency.

(vi) A public health information exchange or public health information network, as defined by the Secretary.

(vii) A faith-based service provider.

(viii) Any other similar entity, as determined by the Secretary.

(D) Covered services.— The term covered services means any of the following:

(i) Nutritional assistance.

(ii) Housing.

(iii) Health care, including preventive health intervention, chronic disease management, and behavioral health care.

(iv) Transportation.

(v) Job training and employment.

(vi) Child development or care.

(vii) Caregiving and respite care.

(viii) Disability assistance.

(ix) Suicide prevention.

(x) Sexual assault services.

(xi) Legal aid.

(xii) Transition assistance for veterans newly separated or discharged from active military, naval, air, or space service (as defined in section 101(24) of title 38, United States Code).

(xiii) Assistance with utilities necessary for safe habitation.

(xiv) Other services directly related to health care access, suicide prevention, homelessness prevention, food insecurity, transportation to health care, or assistance separating from military service and reentering civilian life, as expressly authorized under laws administered by the Secretary.

(E) Secretary.— The term Secretary means the Secretary of Veterans Affairs.

(F) State.— The term State has the meaning given that term in section 101 of title 38, United States Code.

(b) Collection of information from veterans related to social determinants of health.—

(1) In general.— The Secretary of Veterans Affairs shall collect from veterans enrolled in the system of annual patient enrollment of the Department of Veterans Affairs established and operated under section 1705(a) of title 38, United States Code, as part of routine screenings of such veterans under the laws administered by the Secretary, information related to social determinants that may factor into the health of such veterans.

(2) Social determinants of health.—

(A) In general.— The information collected under subsection (a) shall include standardized definitions for identifying social determinants of health needs identified in the ICD–10 diagnostic codes Z55 through Z63 and Z75 (as in effect on the date of enactment of this Act).

(B) Incorporation of measures.— Definitions included under subparagraph (A) with respect to identifying social determinants of health needs shall incorporate measures for quantifying the relative severity of any such social determinant of health need identified in an individual.

(a) Prosthetic and Rehabilitative Items and Services Formulary.—

(1) In general.— Chapter 17 of title 38, United States Code, is amended by inserting after section 1709C the following new section:

“1709D. Prosthetic and Rehabilitative Items and Services Formulary.—

(a) In general.— The Secretary shall establish a list of prosthetic and rehabilitative items and services, which may be referred to as the “Prosthetic and Rehabilitative Items and Services Formulary” or the “Formulary”, for purposes of furnishing medical services under section 1701(6)(F) of this title pursuant to section 1710 of this title.

(b) Requirements.—

(1) Input.— In developing the Formulary, the Secretary shall solicit input from veterans and the public.

(2) Availability of items.— The Secretary shall ensure that all items and services included in the Formulary are available at or through all facilities of the Department.

(3) Items To be included.— In developing the Formulary, the Secretary shall rely on the best available evidence to identify which items and services should be included on the Formulary.

(c) Publication and communication.—

(1) Publication and update.— The Secretary shall publish the Formulary on a website of the Department and shall update the Formulary periodically.

(2) Communication.— The Secretary shall communicate to veterans the contents of the Formulary and information about how to appeal decisions regarding the provision of items and services on the Formulary.

(d) Contracts.— The Secretary shall enter into such contracts as the Secretary considers necessary to support the availability of items and services included in the Formulary.

(e) Training.— The Secretary shall ensure the availability of training on the Formulary for clinicians and other staff of the Department.

(f) Exceptions.—

(1) In general.— The Secretary shall establish a process for clinicians of the Department to request, prescribe, and furnish prosthetic and rehabilitative items and services that are not included on the Formulary when medically necessary.

(2) Monitoring of non-Formulary items and services.— The Secretary shall monitor requests and prescriptions for and the furnishing of prosthetic and rehabilitative items and services under paragraph (1)—

(A) to ensure that such items and services are being consistently and appropriately prescribed at all facilities of the Department; and

(B) to determine whether such items or services should be added to the Formulary.

(3) Prior authorization for non-formulary procurement.— The Secretary shall establish a prior authorization process for the procurement of prosthetic and rehabilitative items that are not included on the Formulary or available through a national contract.

(4) Open market procurement.— The Secretary shall ensure that procurement of items that are not included on the Formulary or available through a national contract is permitted only if a clinician determines the item is medically necessary.

(g) Consideration.— In developing the Formulary, the Secretary shall consider how the approach of the Pharmacy Benefits Management Services of the Department for formulary management and medication safety can be adapted to support the efficient and effective administration of the Formulary.

(h) Enterprise procurement and ordering system.—

(1) In general.— The Secretary shall implement an enterprise electronic ordering system for prosthetic and rehabilitative items and services furnished under this section.

(2) Systems elements.— The system required under paragraph (1) shall—

(A) enable the automated ordering of items included on the Formulary;

(B) provide visibility of contract pricing and availability across all facilities of the Department;

(C) allow enterprise loading of nationally contracted products;

(D) provide procurement analytics to monitor compliance with national contracts and reduce open market purchasing; and

(E) contain all data elements required for the Federal Electronic Healthcare Record in a searchable format.

(3) Implementation.— The Secretary shall ensure that the system required under paragraph (1) is implemented across all medical centers of the Department by not later than three years after the date of the enactment of this section.

(i) Program management.—

(1) In general.— The Secretary shall ensure that the Prosthetic and Sensory Aids Service of the Department maintains adequate staffing to administer the Formulary and associated procurement programs.

(2) Staffing included.— Staffing required under paragraph (1) shall include—

(A) dedicated program managers for major prosthetic product categories; and

(B) full-time clinical staff responsible for clinical evaluations and practice recommendations.

(j) Report to Congress.— Not later than two years after the date of the enactment of this section, and annually thereafter, the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report describing—

(1) rates of compliance by the Department with national prosthetic contracts;

(2) open market purchasing trends of the Department;

(3) utilization of the Formulary across facilities of the Department; and

(4) steps taken by the Department to improve enterprise procurement efficiency.”.

(2) Clerical amendment.— The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 1709C the following new item:

(b) Report.—

(1) In general.— Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report containing a comprehensive operational and technology assessment of the Prosthetic and Rehabilitative Items and Services Formulary established under section 1709D of title 38, United States Code, as added by subsection (a).

(2) Elements.— The report required by paragraph (1) shall identify potential impacts of the Prosthetic and Rehabilitative Items and Services Formulary on—

(A) access by veterans to prosthetic and rehabilitative items and services;

(B) clinician workload;

(C) procurement timelines; and

(D) innovation adoption.

(a) In general.— The Secretary of Veterans Affairs shall ensure that each contract, agreement, or other arrangement through which the Secretary furnishes hospital care, medical services, or extended care services to eligible veterans through non-Department of Veterans Affairs entities or providers includes clear requirements, including requirements regarding timeliness, regarding the submission of medical documentation to the Secretary after a veteran receives such care or services from the non-Department entity or provider.

(b) Internal Measures.— The Secretary shall establish such goals and related performance measures for medical centers of the Department as the Secretary determines appropriate in obtaining medical documentation from non-Department entities or providers under subsection (a).

(c) Training.— The Secretary may establish goals and related performance measures for the completion by non-Department entities or providers of core training related to the submission to the Secretary of medical documentation under subsection (a) and may monitor the completion of such training.

(d) Outreach.— The Secretary shall ensure that communications by the Secretary with non-Department entities or providers contain clear and accurate information regarding requirements for submitting medical documentation under subsection (a) and completing the core training described in subsection (c).

(e) Submission of goals, measures, and materials.— Not later than one year after the date of the enactment of this Act, and not less frequently than annually thereafter for the following five years, the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives copies of any goals, performance measures, training materials, or outreach materials pertaining to the submission of medical documentation under this section.

(a) In general.— Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to the appropriate committees of Congress a plan to improve the process for scheduling appointments for health care from the Department of Veterans Affairs, including improvements for both patients and employees of the Department responsible for scheduling such appointments.

(b) Elements of plan.—

(1) In general.— The plan required by subsection (a) shall include—

(A) such actions, resources, technology, and process improvements as the Secretary determines necessary to ensure the Department achieves, in a timely manner, improved delivery of health care, access to health care, customer experience and service relating to the receipt of health care, and efficiency with respect to the delivery of health care; and

(B) a proposed schedule and timeline to carry out such plan.

(2) Objectives.—

(A) In general.— The Secretary shall ensure that the plan required by subsection (a) addresses the following objectives:

(i) To develop or continue the development of a scheduling system that enables both personnel and patients of the Department to view available appointments for care furnished by the Department, including primary care, mental health care, and all forms of specialty care.

(ii) To develop or continue the development of a self-service scheduling platform, available for use by all patients of the Department, which shall—

(I) enable such patients to view available appointments and, subject to the process described in clause (iii), fully schedule appointments for all care furnished by the Department;

(II) if a referral is required for an appointment, provide a method for the patient to request a referral and subsequently book an appointment if the referral is approved; and

(III) provide such patients with the ability to cancel or reschedule appointments.

(iii) To create a process through which all patients of the Department can telephonically speak with a scheduler who can assist the patient to determine appointment availability and can fully schedule appointments on behalf of the patient for all care furnished by the Department.

(iv) To carry out such other functions, oversight, metric development and tracking, change management, cross-Department coordination, and other related matters, including improvements to employee-facing information technology, training, and processes, as the Secretary determines appropriate as it relates to scheduling tools, functions, and operations with respect to health care appointments furnished by the Department.

(B) Explanation of inability to implement certain objectives, features, or services.— If the Secretary determines that an objective under subparagraph (A), or any feature or service in connection with that objective, cannot be implemented or otherwise incorporated into a final product pursuant to the plan required by subsection (a), the Secretary shall include with the plan submitted under such subsection a report containing—

(i) an explanation as to why that objective, feature, or service cannot be implemented or incorporated, as the case may be; and

(ii) a plan for implementing the plan required by subsection (a) without that objective, feature, or service.

(c) Implementation.— Not later than two years after submitting to the appropriate committees of Congress the plan required by subsection (a), the Secretary shall fully implement the plan.

(d) Coordination with Electronic Health Record Modernization Program.— In developing the plan required by subsection (a), the Secretary shall ensure that the elements and objectives of such plan set forth under subsection (b) are developed in consideration of the deployment schedule and capabilities of the Electronic Health Record Modernization Program of the Department to ensure a smooth transition to using the tools and features under such plan as relevant and appropriate.

(e) Implementation reports.— Not later than each of one year and two years after the date on which the Secretary submits the plan required by subsection (a), the Secretary shall submit to the appropriate committees of Congress a report on the progress of the Secretary in implementing such plan, including—

(1) the costs incurred to implement the plan as of the date of the report;

(2) the expected costs to complete implementation of the plan (including costs for management and technology);

(3) the schedule for deployment of any capabilities developed pursuant to the plan; and

(4) the goals and metrics achieved, challenges, and lessons learned in implementing the plan.

(f) Rule of construction.— Nothing in this section shall be construed to require the Secretary to include in the plan required by subsection (a) any technology or process that would preclude or impede the ability of a veteran to contact or schedule an appointment directly with a facility or provider through a non-online scheduling process, should the veteran choose to do so.

(g) Definitions.— In this section:

(1) Appropriate committees of Congress.— The term appropriate committees of Congress means the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives.

(2) Fully schedule.— The term fully schedule, with respect to an appointment for health care, means that the appointment booking is completed, rather than simply requested.

(a) In general.— The Secretary, in consultation with the Secretary of Health and Human Services, shall carry out a pilot program (in this section referred to as the “pilot program”) to coordinate, navigate, and manage care and benefits for covered veterans.

(b) Purposes of pilot program.— The purposes of the pilot program are as follows:

(1) To improve access to health care services for covered veterans from the Department of Veterans Affairs and under the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.).

(2) To improve satisfaction with care received by covered veterans.

(3) To improve quality of care received by covered veterans.

(4) To lower costs to the Federal Government for care received by covered veterans.

(5) To reduce gaps in care and duplication of services and expenses for covered veterans.

(6) To improve care coordination for covered veterans, including coordination of patient information and medical records between providers and between the Department and the Centers for Medicare & Medicaid Services.

(c) Locations.— The Secretary shall carry out the pilot program in not fewer than three but not more than five Veterans Integrated Service Networks with a significant number of covered veterans and geographic diversity, including—

(1) locations that are in rural or highly rural areas, as determined through the use of the Rural-Urban Continuum codes of the Department of Agriculture; and

(2) locations that are in medically underserved communities (as defined in section 799B of the Public Health Service Act (42 U.S.C. 295p)).

(d) Case manager.— In carrying out the pilot program, the Secretary shall assign each covered veteran participating in the pilot program a case manager responsible for—

(1) coordinating with the veteran, the primary care team of the veteran, and any relevant care coordinators already assisting the veteran to develop an individualized needs assessment for the veteran and, based on such assessment, a care coordination plan with defined treatment goals; and

(2) navigating the systems of care under the laws administered by the Secretary and under the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.).

(e) Use of existing models.— In designing the pilot program, the Secretary may use existing models used by commercial health care programs to improve access, health outcomes, quality, and customer experience and lower per capita costs.

(f) Contracting with private sector entities.—

(1) In general.— The Secretary, to the extent practicable, shall consider entering into contracts or agreements with private sector entities carrying out commercial health care programs for assistance in designing, implementing, and managing care and benefits under the pilot program, to include providing care coordination.

(2) Notification.— If the Secretary determines that entering into contracts or agreements with private sector entities under paragraph (1) is not necessary or practicable, the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives—

(A) a notification of that determination;

(B) a description of the steps, if any, the Secretary has taken to attempt to enter into a contract or an agreement with a private sector entity;

(C) a justification for why the Secretary has determined that such contract or agreement is not necessary or practicable; and

(D) a plan for how the Secretary will carry out the pilot program without entering into a contract or an agreement with a private sector entity, including through the use of employees of the Department of Veterans Affairs or other government agencies, nonprofit organizations, or other entities.

(g) Metrics.—

(1) In general.— The Secretary shall track metrics under the pilot program, including the following:

(A) The number of veterans participating in the pilot program, disaggregated by Veterans Integrated Service Network.

(B) Reliance on health care services administered by the Secretary.

(C) Reliance on health care services administered under the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.).

(D) Quality of care, including patient outcomes.

(E) Cost of care.

(F) Access to care, including under the designated access standards developed by the Secretary under section 1703B of title 38, United States Code.

(G) Patient satisfaction.

(H) Provider satisfaction.

(I) Care coordination, including timely information sharing and medical documentation return.

(2) Elements.— In tracking metrics under paragraph (1), the Secretary shall track information relating to—

(A) whether care received by a covered veteran is related to a service-connected disability (as defined in section 101 of title 38, United States Code);

(B) the priority group under section 1705(a) of title 38, United States Code, through which each covered veteran was enrolled in the system of annual patient enrollment of the Department of Veterans Affairs under such section;

(C) the type of care and services provided to covered veterans; and

(D) the demographics of covered veterans participating in the pilot program, including age.

(h) Supplement not supplant.— The services provided under the pilot program shall supplement, not supplant, the services provided under the education program under section 121 of the VA MISSION Act of 2018 (Public Law 115–182; 38 U.S.C. 1701 note).

(i) Duration.— The Secretary shall carry out the pilot program for a three-year period beginning on the commencement of the pilot program.

(j) Reports.—

(1) Development, implementation, results, and design of pilot program.—

(A) In general.— Not less frequently than biannually during the two-year period beginning on the date of the enactment of this Act, the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on the development, implementation, results, and design of the pilot program, including information on the metrics tracked under subsection (g).

(B) Final design.— One of the reports required under subparagraph (A) shall contain a description of the final design of the pilot program.

(2) Results of pilot program.—

(A) In general.— Not later than one year after the submission of the final report under paragraph (1), and not less frequently than annually thereafter during the duration of the pilot program, the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on the results of the pilot program.

(B) Final report.— In the final report submitted under subparagraph (A), the Secretary shall include the recommendation of the Secretary for whether the pilot program should be extended or made permanent.

(k) Definitions.— In this section:

(1) Covered veteran.— The term covered veteran means a veteran who is enrolled in both the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) and the system of annual patient enrollment of the Department of Veterans Affairs under section 1705(a) of title 38, United States Code.

(2) Secretary.— The term Secretary means the Secretary of Veterans Affairs.

Section 1708 of title 38, United States Code, is amended—

(1) in subsection (a), by striking “in connection with” and all that follows through the period at the end and inserting “in accordance with this section.”;

(2) in subsection (b)—

(A) in paragraph (2)—

(i) by inserting “described in paragraph (1)” after “family of a veteran”; and

(ii) by inserting “such” after “accompany”; and

(B) by adding at the end the following new paragraphs:

“(3) On a space-available basis, a covered beneficiary who must travel a significant distance to receive care or services at a Department or non-Department facility.

(4) On a space-available basis, a member of the family of a covered beneficiary described in paragraph (3) and others who accompany such a covered beneficiary who is receiving care or services and provide the equivalent of familial support for such beneficiary when the covered beneficiary or the family member is traveling to receive care or services at a Department or non-Department facility.

(5) On a space-available basis, a veteran and a member of the family of a veteran and others who must travel a significant distance for a member of the veteran’s family to receive care or services at a Department or non-Department facility.

(6) On a space available basis, a covered beneficiary and a member of the family of a covered beneficiary and others who must travel a significant distance for a member of the covered beneficiary’s family to receive care or services at a Department or non-Department facility.”;

(3) by striking subsection (c) and redesignating subsections (d) and (e) as subsections (c) and (d), respectively;

(4) in subsection (d), as so redesignated—

(A) in paragraph (2), by striking “subsection (d)” and inserting “subsection (c)”;

(B) in paragraph (3), by striking “under subsection (b)(2)” and inserting “or a covered beneficiary under subsection (b)”;

(C) in paragraph (4), by striking “and” after the semicolon;

(D) by redesignating paragraph (5) as paragraph (6); and

(E) by inserting after paragraph (4) the following new paragraph (5):

“(5) establishing criteria for providing access to temporary lodging facilities on a space-available basis under paragraphs (3) through (6) of subsection (b); and”; and

(5) by adding at the end the following new subsection:

“(e) In this section:

(1) The term “covered beneficiary” means a member of the uniformed services, including members of the armed services regardless of duty status.

(2) The term “Fisher house” means a housing facility that—

(A) is located at, or in proximity to, a Department medical facility;

(B) is available for residential use on a temporary basis by patients of that facility and others described in subsection (b); and

(C) is constructed by, and donated to the Secretary by, the Zachary and Elizabeth M. Fisher Armed Services Foundation or the Fisher House Foundation, Inc.”.

(a) In general.— Not later than one year after the date of enactment of this Act, the Secretary of Veterans Affairs shall commence a 5-year pilot program to provide greater access to care for eligible veterans in rural areas and reduce the initial or long-term costs to the Department or the eligible entity of providing such care for eligible veterans.

(b) Pilot program.— In carrying out the pilot program, the Secretary shall ensure that each medical center of the Department participating in the pilot enters into or provides material support to an agreement with an eligible entity related to one or more of the following:

(1) Co-location of Department and non- Department health care resources.

(2) The provision of telehealth to eligible veterans by health care providers of the Department.

(3) Leasing of space or equipment by or from the Department.

(4) Training by health care providers of the Department of non-Department health care providers, subject to paragraph (4).

(5) Care coordination for authorized care furnished by the eligible entity for eligible veterans.

(6) Care coordination, including transportation coordination, for emergency treatment (as defined in section 1725(h) of title 38, United States Code.

(7) The provision by the eligible entity of hospital care, medical services, or extended care services under section 1703 of this title.

(8) Such other conditions or services directly related to health care as expressly authorized under laws administered by the Secretary.

(c) Types of arrangements.— An agreement under subsection (b) may include a lease or co-location agreement, a memorandum of understanding, a partnership agreement, a contract or agreement for the mutual use or exchange of use of health-care resources, or any other similar agreement or arrangement.

(d) Report.— For each year of the pilot, the Secretary shall submit to the appropriate committees of Congress a report on the operation and performance of agreements entered into under subsection (a) including—

(1) new agreements entered into, in the case of the initial report, since the date of the enactment of the Take Care of America’s Veterans Act, and, in the case of any subsequent report, during the period following the previous report;

(2) an assessment of the success of all agreements entered into pursuant to this Act in delivering services to eligible veterans, including—

(A) the number of eligible veterans, by region, who received services under an agreement compared to the previous five-year period;

(B) an evaluation of accessibility to services for eligible veterans as compared to the accessibility of services for those veterans prior to the implementation of such agreements;

(C) an overview of best practices, including new best practices, developed for such agreements and the Department more broadly;

(D) the number of veterans receiving compensation from the Department for a service-connected disability, disaggregated by region, compared to the previous 5-year period; and

(E) such other factors considered appropriate by the Secretary of Veterans Affairs.

(e) Definitions.— In this section:

(1) Appropriate committees of congress.— The term “appropriate committees of Congress” means—

(A) the Committee on Veterans’ Affairs and the Committee on Appropriations of the Senate; and

(B) the Committee on Veterans’ Affairs and the Committee on Appropriations of the House of Representatives.

(2) Eligible entity.— The term “eligible entity” means a non-Department entity or provider furnishing health care or health care services in a rural area.

(3) Eligible veteran.— The term “eligible veteran” means a covered veteran under section 1703(b)16 of this title.

(4) Material support.— The term “material support” means support provided by a health care provider or other staff of the Department to further the purpose or purposes of an agreement under subsection (a)(1) and may include—

(A) the use of time or resources of health care providers of the Department;

(B) the obligation or receipt of funds; and

(C) such other support as the Secretary determines appropriate.

(5) Rural.— The term “rural”, with respect to an area, means the area has a code other than 1 or 1.1 in the Rural-Urban Commuting Areas (RUCA) coding system of the Department of Agriculture.

(a) In general.— Not later than 90 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall seek to enter into an agreement with an independent and objective organization outside the Department of Veterans Affairs under which that organization shall—

(1) conduct a study on the quality of care difference between mental health and addiction therapy care under the laws administered by the Secretary provided by health care providers of the Department compared to non-Department providers across various modalities, such as telehealth, in-patient, intensive out-patient, out-patient, and residential treatment; and

(2) submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives and publish on a publicly available website a report containing the final results of such study.

(b) Timing.— The Secretary shall ensure that the organization with which the Secretary enters into an agreement pursuant to subsection (a) is able to complete the requirements under such subsection by not later than 18 months after the date on which the agreement is entered into.

(c) Elements.— The report submitted pursuant to subsection (a)(2) shall include an assessment of the following:

(1) The amount of improvement in health outcomes from start of treatment to completion, including symptom scores and suicide risk using evidence-based scales, including the Columbia-Suicide Severity Rating Scale.

(2) Whether providers of the Department and non-Department providers are using evidence-based practices in the treatment of mental health and addiction therapy care, including criteria set forth by the American Society of Addiction Medicine.

(3) Potential gaps in coordination between providers of the Department and non-Department providers in responding to individuals seeking mental health or addiction therapy care, including the sharing of patient health records.

(4) Implementation of veteran-centric care, including the level of satisfaction of patients with care and the competency of providers with the unique experiences and needs of the military and veteran population.

(5) Whether veterans with co-occurring conditions receive integrated care to holistically address their needs.

(6) Whether providers monitor health outcomes continually throughout treatment and at regular intervals for up to three years after treatment.

(7) The average length of time to initiate services, which shall include a comparison of the average length of time between the initial point of contact after patient outreach to the point of initial service, as measured or determined by the Secretary.

(a) In general.— Subchapter II of chapter 17 of title 38, United States Code, is amended by adding at the end the following new section:

“1720M. Lactation spaces in medical centers of the Department.—

(a) Lactation space required.— The Secretary shall ensure that each medical center of the Department contains a lactation space.

(b) No unauthorized entry.— Nothing in this section shall be construed to authorize an individual to enter a medical center of the Department or portion thereof that the individual is not otherwise authorized to enter.

(c) Lactation space defined.— In this section, the term lactation space means a hygienic place, other than a bathroom, that—

(1) is shielded from view;

(2) is free from intrusion;

(3) is accessible to disabled individuals (including such individuals who use wheelchairs);

(4) contains a chair and a working surface;

(5) is easy to locate;

(6) is clearly identified with signage; and

(7) is available for use by women veterans and members of the public to express breast milk.”.

(b) Clerical amendment.— The table of sections at the beginning of such chapter is amended by inserting after the item related to section 1720L the following new item:

(c) Implementation.— The Secretary of Veterans Affairs shall ensure that—

(1) not later than two years after the date of the enactment of this Act, not fewer than 80 percent of medical centers of the Department of Veterans Affairs are in compliance with section 1720M of title 38, United States Code, as added by subsection (a); and

(2) not later than three years after such date of enactment, all medical centers of the Department are in compliance with such section.

(d) Report.—

(1) In general.— Not later than one year after the date of the enactment of this Act, and annually thereafter, the Secretary of Veterans Affairs shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on the progress of the Secretary in meeting the requirements under section 1720M of title 38, United States Code, as added by subsection (a), including—

(A) a list of which medical centers of the Department of Veterans Affairs currently have a lactation space;

(B) a list of which medical centers of the Department do not have a lactation space; and

(C) for each medical center listed under subparagraph (B), a description of actions the Department has taken to design and plan a lactation space and a timeline for such lactation space to be fully functional and open for use within the time periods specified under subsection (c).

(2) Termination.— The Secretary is not required to submit a report under paragraph (1) on or after the date on which the Secretary confirms in a report submitted under such paragraph that each medical center of the Department contains a lactation space.

(a) Definitions.— In this section:

(1) Covered provider.— The term covered provider means a health care provider employed by the Department of Veterans Affairs.

(2) Menopause.— The term menopause means the stage of a woman’s life—

(A) when menstrual periods stop permanently and she can no longer get pregnant; and

(B) that is not a disease state, but a normal part of aging for women.

(3) Mid-life.— The term mid-life means a life stage that—

(A) coincides with the menopausal transition in women, which may be physical or emotional;

(B) encompasses the late reproductive age, which can begin at approximately 35 years of age, to the late postmenopausal stages of reproductive aging, which can extend to approximately 65 years of age; and

(C) often marks the onset of many chronic diseases.

(4) Perimenopause.— The term perimenopause means the time during a woman's life when levels of the hormone estrogen fall unevenly in a woman’s body and is also called the menopausal transition.

(5) Postmenopausal.— The term postmenopausal means the stage of a woman's life after a woman has been without a menstrual period for 12 months that lasts for the rest of a woman’s life and reflects a time when women are at increased risk for osteoporosis and heart disease.

(b) Evaluation of certain research related to menopause, perimenopause, or mid-life women’s health.—

(1) In general.— The Secretary of Veterans Affairs, shall evaluate—

(A) the results of completed research related to menopause, perimenopause, or mid-life women’s health among women who are members of the uniformed services or veterans;

(B) the status of such research that is ongoing;

(C) any gaps in knowledge and research on—

(i) treatments for menopause-related symptoms, including hormone and non-hormone treatments;

(ii) the safety and effectiveness of treatments for menopause-related symptoms;

(iii) the impact of perimenopause and menopause on the mental health of women who are members of the uniformed services or veterans;

(D) the availability of and uptake of professional training resources for covered providers relating to mid-life women’s health with respect to the care, treatment, and management of perimenopause and menopausal symptoms, and related support services; and

(E) the availability of and uptake of treatments for women who are members of the uniformed services or veterans who are experiencing perimenopause or menopause.

(2) Report; strategic plan.— Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to Congress a report containing—

(A) the findings of the evaluation conducted under paragraph (1);

(B) recommendations for improving professional training resources described in paragraph (1)(D) for covered providers; and

(C) a strategic plan that—

(i) resolves the gaps in knowledge and research identified in the report; and

(ii) identifies topics in need of further research relating to potential treatments for menopause-related symptoms of women who are members of the uniformed services or veterans.

(3) Nonduplication and supplementation of efforts.— In carrying out activities under this section, the Secretary of Veterans Affairs shall ensure that such activities minimize duplication and supplement, not supplant, existing information-sharing efforts of the Department of Health and Human Services.

(c) Sense of Congress on additional research related to menopause, perimenopause, or mid-life women’s health.— It is the sense of Congress that the Secretary of Defense and the Secretary of Veterans Affairs should each conduct research related to menopause, perimenopause, or mid-life health regarding women who are members of the uniformed services or veterans.

(a) In general.— Commencing not later than 120 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall carry out a one-year pilot program under which the Secretary shall make covered medications available to any veteran at no charge (in this section referred to as the “pilot program”).

(b) Provision of medication prior to confirmation of status.— The Secretary may provide covered medication to an individual under the pilot program prior to confirming the status of the individual as a veteran if the individual provides contact information for the individual and a written self-attestation of veteran status.

(c) Site selection.— The Secretary shall prioritize carrying out the pilot program in geographical areas where data indicates a disproportionately high risk of overdose among the veteran population.

(d) Limitation on use of information.—

(1) In general.— In carrying out this section, the Secretary may only collect the personally identifiable information needed for prescribing covered medication under the pilot program, and any personally identifiable information collected under this section may be used solely for the purpose of delivering, evaluating, and enhancing the quality of health care.

(2) Exclusion.— The Secretary may not use any personally identifiable information collected under this section—

(A) for the purpose of preventing a veteran from employment;

(B) as evidence of a history of drug use; or

(C) as evidence that an individual is an unlawful user of or addicted to any controlled substance.

(e) Provision of information.— The Secretary shall ensure that any individual who receives covered medication under the pilot program also receives—

(1) information about addiction services, suicide prevention services, mental health services, and other related services provided by the Department of Veterans Affairs; and

(2) information on the use and application of covered medications.

(f) Report.—

(1) In general.— Not later than 30 days before the completion of the pilot program under this section, the Secretary shall submit to Congress a report on the pilot program.

(2) Elements.— The report required by paragraph (1) shall include the following:

(A) The number of veterans who received a covered medication under the pilot program, disaggregated by those enrolled in the system of annual patient enrollment of the Department of Veterans Affairs under section 1705(a) of title 38, United States Code, and those not enrolled in such system.

(B) An assessment of the feasibility of expanding the pilot program to provide covered medications to immediate family members of veterans.

(C) Any considerations associated with continuing, expanding, or making permanent the pilot program.

(D) Any other recommendations of the Secretary with respect to modifying or continuing the pilot program.

(g) Definitions.— In this section:

(1) Covered medication.— The term covered medication means any opioid overdose rescue medication, such as naloxone.

(2) Veteran.— The term veteran has the meaning given that term in section 101 of title 38, United States Code.

(a) In general.— Chapter 1 of title 38, United States Code, is amended by adding at the end the following new section:

“120. Veterans Health Administration Policy Advisory Commission.—

(a) Establishment.— There is established the Veterans Health Administration Policy Advisory Commission (in this section referred to as the “Commission”).

(b) Membership.—

(1) Composition.— The Commission shall be composed of 17 members appointed by the Comptroller General of the United States, of which not fewer than 2 shall be veterans.

(2) Qualifications.—

(A) In general.— An individual is eligible for appointment to the Commission under paragraph (1) if the individual has significant expertise in operating or advising large medical systems, including expertise in quality of care, staffing issues, health information technology, artificial intelligence in health care, medical research, and managed care plans and networks.

(B) Experience of members.— In appointing members under paragraph (1), the Comptroller General shall select individuals from backgrounds that reflect the broad diversity of health care received by veterans, including nonprofit health systems, public and private health systems, care furnished by the Veterans Health Administration, and care furnished by the Department of Defense.

(3) Ethical disclosure.— A member of the Commission shall be considered an employee of Congress whose compensation is disbursed by the Secretary of the Senate for purposes of applying subchapter I of chapter 131 of title 5, United States Code, except that a member of the Commission is required to file public financial disclosure reports without regard to their number of days of service or rate of pay.

(c) Period of appointment; vacancies.—

(1) Vacancies.—

(A) In general.— A vacancy on the Commission shall be filled in the manner in which the original appointment was made and shall be subject to any conditions that applied with respect to the original appointment.

(B) Filling unexpired term.— An individual chosen to fill a vacancy shall be appointed for the unexpired term of the member replaced.

(2) Expiration of terms.— The term of any member shall not expire before the date on which the member’s successor takes office.

(d) Meetings.—

(1) Frequency.— The Commission shall meet at the call of the Chairman, but not less frequently than once per year.

(2) Quorum.— A majority of the members of the Commission shall constitute a quorum, but a lesser number of members may hold meetings.

(e) Chairman and Vice Chairman.— The Comptroller General shall designate one member of the Commission as Chairman and one member of the Commission as Vice Chairman, at the time of appointment of such member and for the term of appointment of such member, except that in the case of vacancy of the Chairmanship or Vice Chairmanship, the Comptroller General may designate another member for the remainder of that member’s term.

(f) Duties of the Commission.—

(1) Review.— The Commission shall—

(A) review operations at the Veterans Health Administration; and

(B) prepare reports for Congress based on such review, including recommendations to Congress.

(2) Topics to be reviewed.— In conducting a review under paragraph (1)(A), the Commission shall include periodic reviews of the following, taking into consideration other independent assessments in selecting topics to limit duplicative efforts:

(A) Information technology infrastructure at medical facilities of the Department, including with respect to electronic health record systems.

(B) Referrals to care at facilities of the Department and under the Veterans Community Care Program under section 1703 of this title, and factors impacting those referrals.

(C) Access and wait times at medical facilities of the Department and under the Veterans Community Care Program, including both primary and specialty care, and factors impacting those wait times.

(D) The quality of health care furnished by the Department and through the Veterans Community Care Program.

(E) Workforce issues, including workforce performance, recruitment, and retention factors.

(F) Patient satisfaction and customer service at medical facilities of the Department and through the Veterans Community Care Program.

(G) The training of health care providers and the standards of care at facilities of the Department and in the Veterans Community Care Program.

(H) The long-term budgetary outlook of the Veterans Health Administration, as well as key components driving budgetary changes over time.

(I) The research program of the Department, including both internal and external research.

(J) The interaction of care under the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.), the Medicaid program under title XIX of such Act (42 U.S.C. 1396 et seq.), the TRICARE program under chapter 55 of title 10, and commercial health care plans with care furnished by the Veterans Health Administration.

(3) Use of existing data.— In carrying out the requirements of this subsection, the Commission, to the extent practicable, shall use existing data that has been compiled by the Department, compiled for the Department, or purchased by the Department, including—

(A) data described in subsection (c)(1) of section 1704A of this title; and

(B) the results of the independent assessments conducted under such section.

(4) Issues regarding veteran health care delivery generally.— In carrying out the requirements of this subsection, the Commission shall review the effect of policies under this title on the delivery of health care services to veterans and assess the implications of changes in health care delivery for veterans under the laws administered by the Secretary.

(5) Transmittal of certain reports.— If the Secretary or the Inspector General of the Department of Veterans Affairs submits to Congress (or a committee of Congress) a report that is required by law and that relates to policies for health care furnished under the laws administered by the Secretary, the Secretary shall transmit a copy of that report to the Commission.

(6) Consultation and additional reviews and studies.—

(A) Consultation.— In carrying out the requirements of this subsection, the Commission shall consult periodically with the chairmen and ranking members of the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives regarding the agenda of the Commission and progress towards achieving that agenda.

(B) Additional reviews and reports.— The Commission may conduct additional reviews, and may submit additional reports to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives, from time to time on such topics relating to the activities of the Commission as may be requested by the Chairman and members and as the Commission determines appropriate.

(C) Special studies.— The Commission may conduct special studies requested by the chairman or ranking member of the Committee on Veterans’ Affairs of the Senate or the Committee on Veterans’ Affairs of the House of Representatives and as the Commission determines appropriate.

(7) Coordination.— In carrying out reviews, preparing reports, and conducting studies under this section, the Commission shall, to the extent practicable, coordinate with the Inspector General of the Department to ensure the work of the Commission does not interfere with investigations or remediations underway by the Inspector General.

(8) Budgetary considerations.— Before making any recommendations to Congress, the Commission shall examine the budget consequences of such recommendations, directly or through consultation with appropriate expert entities.

(9) Report.—

(A) In general.— By not later than March 15 of each year, the Commission shall submit to Congress a report containing the results and recommendations from the review conducted under paragraph (1).

(B) Inclusion of recommendations.— A recommendation may be included in a report under subparagraph (A) if a simple majority of the members of the Commission vote to include the recommendation in the report.

(10) Limitation.— Nothing in this section shall be construed to authorize the Commission to direct, control, approve, suspend, delay, or administer any program, policy, contract, personnel action, budgetary decision, clinical decision, or operational activity of the Department. The Commission shall serve solely in an advisory capacity to Congress and to the Department on matters expressly authorized under laws administered by the Secretary.

(g) Powers of Commission.—

(1) In general.— The Commission may—

(A) employ and fix the compensation:

(i) of an Executive Director (at a rate of pay not greater than that provided for level III of the Executive Schedule under section 5314 of title 5) who is confirmed by two thirds vote by members of the Commission; and

(ii) other such personnel as may be necessary to carry out the duties of the Commission, without regard to the provisions of title 5 governing appointments in the competitive service;

(B) seek such assistance and support as may be required in the performance of its duties from appropriate departments and agencies of the United States or departments or agencies of a State;

(C) enter into a contract or conduct original research only upon a written determination by the Chair and Vice Chair that comparable information is unavailable, insufficient, or outdated;

(D) make advance, progress, and other payments that relate to the work of the Commission;

(E) provide transportation and subsistence for individuals serving the Commission without compensation; and

(F) prescribe such rules and regulations as the Commission determines necessary with respect to the internal organization and operation of the Commission.

(2) Data collection.— In order to carry out its functions, the Commission shall—

(A) utilize existing information, both published and unpublished, if possible, collected and assessed either by its own staff or under other arrangements made in accordance with this section;

(B) to the maximum extent practicable, rely on existing data, reports, audits, evaluations, and assessments prepared by the Department, the Inspector General of the Department, the Government Accountability Office, the Congressional Research Service, the Congressional Budget Office, and other relevant Federal entities before entering into any contract or conducting original research; and

(C) adopt procedures allowing any interested party to submit information for use by the Commission in making reports and recommendations.

(3) Information from Federal agencies.—

(A) In general.— The Commission may secure directly from any relevant department or agency of the United States health care information the Chairman determines would be helpful to enable the Commission to carry out this section.

(B) Timing.— Upon request of the Chairman, the head of a department or agency of the United States shall furnish information requested under subparagraph (A) to the Commission on an agreed upon schedule or not later than 180 days after the date of the request.

(h) Compensation.—

(1) Members.—

(A) In general.— While conducting the business of the Commission (including travel time), a member of the Commission shall be entitled to compensation at the per diem equivalent of the rate provided for level IV of the Executive Schedule under section 5315 of title 5.

(B) Travel expenses.— While conducting the business of the Commission away from home and the regular place of business of the member, a member may be allowed travel expenses, as authorized by the Chairman.

(2) Physician comparability allowance for personnel.— The Commission may provide a physician comparability allowance to physicians serving as personnel of the Commission in the same manner as physicians of the Federal Government may be provided such an allowance by an agency under section 5948 of title 5, and for such purpose, subsection (i) of such section shall apply to the Commission in the same manner as it applies to the Tennessee Valley Authority.

(3) Treatment of personnel.— For purposes of pay (other than pay of members of the Commission) and employment benefits, rights, and privileges, all personnel of the Commission shall be treated as if they were employees of the United States Senate.

(i) Detail of Federal employees.— An employee of the Federal Government may be detailed to the Commission without reimbursement and without interruption or loss of civil service status or privileges.

(j) Access of congressional support agencies to information.— The Commission shall provide to the Comptroller General, the Congressional Research Service, and the Congressional Budget Office unrestricted access to all deliberations, records, and nonproprietary data of the Commission not later than 30 days after such access is requested.

(k) Authorization of appropriations.— The Commission shall submit requests for appropriations in the same manner as the Comptroller General submits requests for appropriations, but amounts appropriated for the Commission shall be separate from amounts appropriated for the Comptroller General.

(l) Termination.—

(1) The Commission shall terminate on September 30, 2032.

(2) Not later than 1 year before the date of termination under paragraph (1), the Commission shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a final assessment on whether the Commission should be continued, modified, or allowed to terminate.

(3) A member of the Commission shall be appointed under subsection (b)(1) for a term of 5 years, except that the Comptroller General shall designate staggered terms for the members first appointed.

(4) No funds may be obligated by the Commission after the date of termination under paragraph (1), except for activities necessary to close out the operations of the Commission.”.

(b) Clerical amendment.— The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 119 the following new item:

(c) Initial appointment.— Not later than 280 days after the date on which amounts are first appropriated to the Veterans Health Administration Policy Advisory Commission established under section 120 of title 38, United States Code, as added by subsection (a), the Comptroller General of the United States shall make initial appointments of members to the Commission under subsection (b)(1) of such section.

(a) Connection to Veterans Health Administration when a disability claim related to military sexual trauma is submitted to Veterans Benefits Administration.— Section 2 of the MST Claims Coordination Act (Public Law 117–303; 38 U.S.C. 1166 note) is amended—

(1) in subsection (a)(1)—

(A) in subparagraph (C), by striking “; and” and inserting a semicolon; and

(B) by striking subparagraph (D) and inserting the following:

“(D) the contact information for the nearest military sexual trauma coordinator for the veteran at the Veterans Benefits Administration and a description of the assistance such coordinator can provide;

(E) the contact information for the nearest military sexual trauma coordinator for the veteran at the Veterans Health Administration and a description of the assistance such coordinator can provide;

(F) the types of services that individuals who have experienced military sexual trauma are eligible to receive from the Department of Veterans Affairs, such as mental health counseling from providers trained in military sexual trauma issues and peer support services, including the nearest locations where such services are furnished, including the nearest Readjustment Counseling Service location, and the contact information for the providers of such services; and

(G) such other information on services, care, or resources for military sexual trauma as the Secretary determines appropriate.”; and

(2) in subsection (d)—

(A) in paragraph (3)—

(i) in subparagraph (B), by striking “; and” and inserting a semicolon;

(ii) in subparagraph (C), by striking the period and inserting “; and”; and

(iii) by adding at the end the following:

“(D) submitting a claim for disability compensation to the Veterans Benefits Administration for a disability relating to military sexual trauma.”; and

(B) by amending paragraph (5) to read as follows:

“(5) The term “military sexual trauma” with respect to eligibility for health care, has the meaning given such term in section 1166(d)(2) of title 38, United States Code.”.

(b) Care relating to military sexual trauma for individuals who withdraw from or otherwise do not complete service at service academies.—

(1) In general.— The Secretary of Veterans Affairs, in coordination with the Secretary of Defense, the Secretary of Homeland Security, and the Secretary of Transportation, shall ensure that each individual who withdraws from, or otherwise does not complete service at, a service academy is provided—

(A) information on the potential eligibility of such individual for care and counseling relating to military sexual trauma provided through the Department of Veterans Affairs; and

(B) the option to receive copies of—

(i) the individual’s service treatment records or military personnel records that document military sexual trauma;

(ii) reporting forms of the Department of Defense, the Department of Homeland Security, or the Department of Transportation on sexual assault or sexual harassment for which the individual was the victim; and

(iii) any investigative reports into military sexual trauma that occurred during the individual’s service in the Armed Forces and for which the individual was the victim, which are in the possession of the Department of Defense, the Department of Homeland Security, or the Department of Transportation.

(2) Definitions.— In this subsection:

(A) Military sexual trauma.— The term “military sexual trauma” has the meaning given such term in section 1166(d)(2) of title 38, United States Code.—

(B) Service academy.— The term “service academy” means any of the following:

(i) The United States Military Academy.

(ii) The United States Naval Academy.

(iii) The United States Air Force Academy.

(iv) The United States Coast Guard Academy.

(v) The United States Merchant Marine Academy.

(a) Research on diagnosis and treatment of health conditions of descendants of individuals exposed to toxic substances while serving in Armed Forces.—

(1) Contract or agreement.— The Secretary of Veterans Affairs shall enter into a contract or interagency agreement with the Agency for Toxic Substances and Disease Registry (in this section referred to as the “Agency”) to perform the services covered by this section.

(2) Services.— Under a contract or agreement between the Secretary and the Agency under this section, the Agency shall—

(A) conduct a literature review on the health effects on descendants of toxic-exposed veterans and toxic-exposed members of the Armed Forces from their toxic exposure and identify any gaps in knowledge or research on such topic;

(B) not later than 180 days after completing the literature review under subparagraph (A) establish and maintain a publicly available report with information on—

(i) the findings of the Agency with respect to such literature review; and

(ii) the ongoing research and activities directed by the Agency, including a review of all relevant data to determine the strength of evidence for a positive association between a health condition researched and a toxic exposure based on the categories set forth under section 1173(c)(2) of title 38, United States Code; and

(C) not later than 30 days after the date on which the first review is published under subparagraph (B) and not less frequently than once every year thereafter, publish a new report containing the information made available under clause (ii) of such subparagraph.

(3) Sunset.— On the date that is 7 years after the date of enactment of this Act.

(4) Literature review.—

(A) In general.— In carrying out the literature review under paragraph (2)(A), the Agency shall review available literature to determine the association between military toxic exposures and the incidence or prevalence of birth defects among the descendants of toxic-exposed veterans and toxic-exposed members of the Armed Forces.

(B) Report.— Not later than one year after the date of the enactment of this Act, the Agency shall submit to the Secretary, the Committee on Veterans’ Affairs of the Senate, and the Committee on Veterans’ Affairs of the House of Representatives a report containing the findings of the Agency with respect to the activities of the Agency under paragraph (2)(A).

(C) Plan.—

(i) In general.— Not later than 180 days after the date of the enactment of this Act, the Agency shall submit to the Secretary and to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a plan describing the Agency’s proposed approach to carrying out the literature review under paragraph (2)(A).

(ii) Contents.— The plan submitted pursuant to clause (i) shall include—

(I) the scope and key research questions to be addressed; and

(II) the methodology to be used in identifying, evaluating, and synthesizing relevant scientific and medical literature.

(5) Consultation.— The Agency shall carry out the services covered by this subsection in consultation with such Federal, State, and research partners as the Agency and the Secretary jointly consider appropriate.

(6) Prohibition on expansion of services.— Nothing in this section shall be construed to authorize the expansion of compensation or healthcare benefits furnished by the Department to the descendants of members of the Armed Forces.

(b) Program for monitoring health of descendants of veterans and members of the Armed Forces subjected to toxic exposure in the Armed Forces.—

(1) In general.— The Secretary of Veterans Affairs shall use the results of the literature review conducted under subsection (a)(2)(A) to establish a health monitoring or screening program for descendants of toxic-exposed veterans and toxic-exposed members of the Armed Forces, to assist in identifying potential patterns or signals, supporting public health surveillance, and facilitating epidemiologic and clinical research related to birth defects.

(2) Requirements.— In carrying out the program required by paragraph (1), the Secretary shall—

(A) leverage Government data sets to improve the program;

(B) recruit additional descendants;

(C) consult with relevant stakeholders to develop a strategy to coordinate collection of information under the program; and

(D) ensure data from the program is used to inform basic research, translational research, and epidemiological studies to help address data and knowledge gaps identified in the literature review conducted under subsection (a)(2)(A).

(3) Mechanisms for administration.— The Secretary may administer the program required by paragraph (1) either directly or through such mechanisms as the Secretary considers appropriate, such as through the award of a grant or cooperative agreement.

(4) Collection of information.— In administering the health monitoring program required by paragraph (1), the Secretary may collect, process, maintain, and consolidate information on birth defects among descendants of toxic-exposed veterans and toxic-exposed members of the Armed Forces, including biological samples, environmental factors, and personal and social factors.

(5) Consultation.— The Secretary shall carry out the services covered by this section in consultation with such Federal, State, and research partners as the Department considers appropriate.

(6) Sunset.— On the date that is 7 years after the date of enactment of this Act.

(7) Prohibition on expansion of services.— No information collected by this program shall be used to inform the expansion of compensation or healthcare benefits furnished by the Department to the descendants of members of the Armed Forces, unless otherwise authorized by another Act of Congress on a date after the passage of this legislation.

(c) Definitions.— In this subsection:

(1) Active military, naval, air, or space service.— The term active military, naval, air, or space service has the meaning given such term in section 101 of title 38, United States Code.

(2) Relevant stakeholders.— The term relevant stakeholders means—

(A) public health experts with experience in developing and maintaining registries;

(B) epidemiologists with experience in studying health effects of toxic exposure on the descendants of toxic-exposed veterans;

(C) descendants of toxic-exposed veterans; and

(D) veterans service organizations.

(3) Toxic-exposed member of the Armed Forces.— The term toxic-exposed member of the Armed Forces means a member of the Armed Forces who was subject to a toxic exposure in line of duty in the active military, naval, air, or space service.

(4) Toxic-exposed veteran.— The term toxic-exposed veteran means a veteran who was subject to a toxic exposure in line of duty in the active military, naval, air, or space service.

(5) Toxic exposure.— The terms toxic exposure and toxic-exposed veteran have the meanings given such terms in section 101 of title 38, United States Code.

Section 1706 of title 38, United States Code, is amended by adding at the end the following new subsection:

“(d)

(1) In managing the provision of hospital care and medical services under section 1710(a) of this title, the Secretary shall furnish (through direct provision of service, referral, or a telehealth program operated by the Department) a preventative health evaluation annually to any veteran with a spinal cord injury or disorder who elects to undergo the evaluation.

(2) The evaluation described in paragraph (1) shall include the following:

(A) An assessment of any circumstance or condition the veteran is experiencing that indicates a risk for any health complication related to the spinal cord injury or disorder, including a risk of comorbidities.

(B) An assessment regarding chronic pain and, if applicable, the management of chronic pain.

(C) An assessment regarding dietary management and weight management.

(D) An assessment regarding prosthetic equipment, including which prosthetic equipment the veteran needs, how well any existing prosthetic equipment is functioning considering the needs of the veteran, and any safety concerns regarding the prosthetic equipment in use by or recommended to the veteran.

(E) An assessment with respect to the provision of assistive technology, including spinal cord neuromodulation technology (such as non-invasive transcutaneous spinal stimulation), that could help maximize the veteran’s voluntary motor or autonomic function, independence, or mobility, including suitability for home use and need for training, programming, and remote follow-up.

(3)

(A) In maintaining, prescribing, or amending any guidance, rules, or regulations issued by the Department regarding the requirements set out in this subsection, the Secretary shall consult with—

(i) the spinal cord injury and disorder program managers of the Department;

(ii) clinicians employed by the Department as specialists in spinal cord injuries and disorders;

(iii) clinicians and technologists with demonstrated expertise in spinal cord neuromodulation therapies, including non-invasive transcutaneous approaches; and

(iv) representatives of organizations recognzied under section 5902 of this title.

(B) Before issuing any guidance, rules, or regulations regarding the requirements set out in this subsection, the Secretary shall consult with manufacturers of assistive technologies and other entities relevant to the provision of assistive technologies if the guidance, rules, or regulations would directly affect such manufacturers or entities.

(C) The Secretary shall ensure, to the extent possible, that any veteran known by the Secretary to have a spinal cord injury or disorder receives information annually about the evaluation available under this subsection and the benefits to the veteran of choosing to undergo the evaluation.

(4) As the Secretary determines clinically appropriate, the Secretary may provide training, programming, remote monitoring, and follow-up for assistive technologies through telehealth.

(5) Not later than one year after the date of the enactment of the Take Care of America’s Veterans Act, and every two years thereafter, the Secretary shall submit to the Committees on Veterans’ Affairs of the Senate and the House of Representatives a report that includes the following:

(A) For the period covered by the report—

(i) the number of veterans who—

(I) received medical care or hospital services from the Department and used an assistive technology;

(II) received medical care or hospital services from the Department and were assessed for the provision of an assistive technology; and

(III) received medical care or hospital services from the Department and were prescribed an assistive technology.

(ii) for any assistive technology prescribed, an identification of the category of such technology, including spinal cord neuromodulation, and a summary of functional outcomes associated with the prescription of such technology, if available.

(B) The year-to-year change (for the period covered by the report, including the two years immediately prior to year the report is submitted) in the percent of veterans with a spinal cord injury or disorder who received an evaluation under this subsection.

(6) In reviewing the performance metrics of a Veterans Integrated Service Network for any year beginning after the date that is one year after the date of the enactment of the Veterans Spinal Trauma Access to New Devices Act, the Secretary shall consider the provision of evaluations under paragraph (1).

(7) In this subsection, the term assistive technology means a powered medical device or electronic tool used to treat or alleviate symptoms or conditions caused by a spinal cord injury or disorder, including the following:

(A) A personal mobility device, including a powered exoskeleton device.

(B) A speech generating device.

(C) A spinal cord neuromodulation technology, including non-invasive transcutaneous spinal stimulation using sensory (afferent) pathways, intended to improve voluntary motor function, autonomic function, independence, or quality of life.

(D) Where clinically appropriate, and consistent with the prosthetic and sensory aids policies of the Department, an implantable spinal cord stimulation system that is approved by the Food and Drug Administration.”.

(a) In general.—

(1) Pilot program required.— Not later than 24 months after the date of the enactment of this Act, the Secretary of Veterans Affairs shall establish a pilot program under which the Secretary shall award grants, on a competitive basis based on the application elements listed in subsection (b)(2), to nonprofit entities to provide service dogs to eligible veterans.

(2) Duration.— The Secretary shall carry out the pilot program during the three-year period beginning on the date on which the first grant is awarded under this section.

(b) Applications.—

(1) In general.— To be eligible to receive a grant under this section, a nonprofit entity shall submit an application to the Secretary at such time and in such manner as the Secretary may require.

(2) Elements.— An application submitted by a nonprofit entity under paragraph (1) shall include the following:

(A) A proposal for the provision of service dogs to eligible veterans, including how the nonprofit entity will communicate with the Secretary to ensure an increasing number of service dogs are provided to veterans.

(B) A description of the following services or commitments to be provided by the nonprofit entity:

(i) The training that will be provided to eligible veterans.

(ii) The training of dogs that will serve as service dogs.

(iii) Any additional support or services that will be provided for such dogs and eligible veterans.

(iv) The plan for publicizing the availability of such service dogs through a marketing campaign that targets eligible veterans.

(v) The commitment to have humane standards for animals.

(vi) The demonstrated experience of the nonprofit entity in training service dogs in compliance with the requirements of the Americans with Disabilities Act of 1990 (42 U.S.C. 12101 et seq.).

(c) Award of grants.—

(1) In general.— The Secretary shall award a grant to each nonprofit entity for which the Secretary has approved an application submitted under subsection (b)(1).

(2) Agreement required.— Before the provision of any grant amounts to a nonprofit entity selected to receive a grant under this section, the Secretary shall enter into an agreement, containing such terms, conditions, and limitations as the Secretary determines appropriate, with such entity.

(3) Maximum grant amount.— Except as provided in subparagraph (B), a grant awarded to a nonprofit entity under this section may not exceed $2,000,000 in a fiscal year.

(4) Payments.— The Secretary shall establish intervals of payment for the administration of each grant awarded under this section.

(d) Use of funds.—

(1) In general.—

(A) Requirement.— A recipient of a grant under this section shall use the grant amounts to plan, develop, implement, and manage one or more covered programs.

(B) Covered program defined.— In this paragraph, the term “covered program” means a program under which—

(i) service dogs are provided to participants in the program; and

(ii) only eligible veterans are allowed to participate in the program.

(2) Administrative expenses.— The Secretary may establish a maximum amount for each grant awarded under this section that may be used by the recipient of the grant to cover administrative expenses.

(3) Other conditions and limitations.— The Secretary may establish other conditions or limitations on the use of grant amounts under this section.

(e) Requirements for grant recipients.—

(1) Notifications and information.— A recipient of a grant under this section shall—

(A) notify each veteran who receives a service dog through such grant that the service dog is being paid for, in whole or in part, by the Department of Veterans Affairs; and

(B) inform each such veteran of the benefits and services available from the Secretary for the veteran and the service dog.

(2) Prohibition on certain fees.— A recipient of a grant under this section may not charge a fee to a veteran receiving a service dog through such grant.

(f) Veterinary insurance.—

(1) In general.— The Secretary shall provide to each veteran who receives a service dog through a grant under this section a commercially available veterinary insurance policy for the service dog.

(2) Continuation.— If the Secretary provides a veterinary insurance policy to a veteran under paragraph (1), the Secretary shall continue to provide the policy to the veteran without regard to the continuation or termination of the pilot program.

(g) Training and technical assistance.— The Secretary may provide training and technical assistance regarding grant application and administration to recipients of grants under this section.

(h) Oversight and monitoring.— The Secretary—

(1) may require each recipient of a grant under this section to provide, in such form as may be prescribed by the Secretary, such reports or answers in writing to specific questions, surveys, or questionnaires as the Secretary determines necessary to carry out the pilot program;

(2) shall establish such oversight and monitoring requirement as the Secretary determines appropriate to ensure that grant amounts awarded under this section are used appropriately; and

(3) may take such actions as the Secretary determines necessary and according to the terms of the grant agreement to address any issues identified through the enforcement of such requirements.

(i) Definitions.— In this section:

(1) Eligible veteran.— The term eligible veteran means a veteran (as defined in section 101 of title 38, United States Code) who—

(A) as determined by a physician, has one or more disabilities, conditions, or diagnoses described in paragraph (2); and

(B) is enrolled in the system of annual patient enrollment of the Department of Veterans Affairs established and operated under section 1705(a) of title 38, United States Code, or is otherwise entitled to receive such care and services under subsection (c)(2) of such section.

(2) Disability, condition, diagnosis described.— A disability, condition, or diagnosis described in this subparagraph is any of the following:

(A) Blindness or visual impairment.

(B) Loss of use of a limb, paralysis, or other significant mobility issue.

(C) Loss of hearing.

(D) Post-traumatic stress disorder.

(E) Traumatic brain injury.

(F) Any other disability, condition, or diagnosis for which the Secretary determines, based on medical judgment, that it is optimal for the veteran to manage the disability, condition, or diagnosis and live independently through the assistance of a service dog.

(3) Pilot program.— The term pilot program means the pilot program required by subsection (a)(1).

(4) Service dog.— The term service dog means any dog that is individually trained to do work or perform tasks that are—

(A) for the benefit of a veteran with a disability, condition, or diagnosis described in paragraph (2); and

(B) directly related to the disability, condition, or diagnosis of the veteran.

(j) Authorization of appropriations.— There is authorized to be appropriated to carry out this section $10,000,000 for each of the three consecutive fiscal years beginning the fiscal year in which the pilot program is established under subsection (a).

(k) Termination.—

(1) The authority to carry out a pilot program under this section shall terminate on September 30, 2029.

(2) No funds may be obligated by the Secretary to carry out a pilot program under this section after the date of termination in paragraph (1), except for activities necessary to close operations of such pilot program.

(a) Authorization of major medical facility project of Department of Veterans Affairs for fiscal year 2027 in Manchester, New Hampshire.—

(1) In general.— The Secretary of Veterans Affairs shall carry out a major medical facility project for the replacement of a medical center, a new central utility plant, a community living center, a residential rehabilitation treatment facility, associated parking, and demolition of existing buildings in Manchester, New Hampshire.

(2) Non-Department Federal entity waiver.— In order to reduce cost and expedite timelines, the Secretary may waive the requirements under section 8103(e) of title 38, United States Code, and section 1096 of the National Defense Authorization Act for Fiscal Year 2016 (Public Law 114–92; 38 U.S.C. 8103 note) for a non-Department Federal entity to be engaged in project management and other activities for the project under paragraph (1).

(3) Notification.— Not later than 60 days after making a waiver, modification, or substitution relating to the project under subsection (a), including a waiver under paragraph (2), the Secretary shall submit to the appropriate committees of Congress a notification describing the waiver, modification, or substitution and the reason for such waiver, modification, or substitution.

(4) Authorization of appropriations.— There is authorized to be appropriated to the Secretary of Veterans Affairs for the Construction, Major Projects account $1,180,000,000 for the project under paragraph (1), to remain available until expended.

(5) Appropriate committees of Congress defined.— In this section the term appropriate committees of Congress means—

(A) the Committee on Veterans’ Affairs and the Committee on Appropriations of the Senate; and

(B) the Committee on Veterans’ Affairs and the Committee on Appropriations of the House of Representatives.

(b) Access to information for medical facility construction projects and leases.—

(1) In general.— Subchapter I of chapter 81 of title 38, United States Code, is amended by inserting after section 8106 the following:

“8107. Access to information for medical facility construction projects and leases.—

(a) In general.— For any major construction project, lease, or enhanced-use lease for a medical facility of the Department, the Secretary shall ensure that the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives are provided timely access to all information, records, documents, data, analyses, communications, contracts, agreements, project schedules, cost estimates, memoranda, briefings, reports, and other materials relating to the project or lease.

(b) Prohibition on withholding information.— The Secretary may not withhold information under subsection (a) from the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives solely on the basis that the information is predecisional, deliberative, advisory, procurement-sensitive, or subject to an internal policy or directive of the Department.”.

(2) Clerical amendment.— The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 8106 the following new item:

(a) Findings; Sense of Congress.—

(1) Findings.— Congress finds the following:

(A) Bowel care and bladder care are supportive and necessary medical services for veterans with spinal cord injuries and disorders when they are unable to manage their bowel and bladder functions independently.

(B) Inadequate care will lead to complications and problems such as autonomic dysreflexia that can be potentially life-threatening and result in illness and hospitalization.

(C) Bowel care and bladder care are essential to support veterans with spinal cord injuries and disorders in non-institutional settings, improve quality of life, optimize health, and prevent complications from neurogenic bowel and bladder.

(D) Family caregivers and individually employed caregivers provide life-sustaining care for the bowel and bladder care needs of veterans that allow them to live in their communities.

(2) Sense of Congress.— It is the sense of Congress that—

(A) family caregivers and individually employed caregivers should not be subjected to self-employment taxes and treated as vendors or contractors for the veterans to whom they provide care;

(B) veterans should not be forced to finish their bowel and bladder care needs in a set period of time that does not consider their individual needs; and

(C) veterans should not be subjected to ongoing clinical determinations regarding their bowel and bladder care needs absent a decision by their medical care provider that such care is no longer needed.

(b) In general.— The Secretary of Veterans Affairs shall establish a program to address the bowel and bladder care needs of covered veterans (in this section referred to as the “program”).

(c) Provision of care.—

(1) Clinical need.— The Secretary shall provide bowel and bladder care under the program to covered veterans based on clinical need, which may include covered veterans receiving aid and attendance benefits from the Department of Veterans Affairs.

(2) Caregiver or agency.— A covered veteran may receive bowel and bladder care under the program through a qualified family member, an individually employed caregiver, or a contracted home health agency.

(3) Individualized assessment.— The Secretary shall conduct an individualized assessment with respect to a covered veteran to determine the number of hours of bowel and bladder care needed by such veteran under the program.

(4) Denial of care.— Before denying bowel and bladder care for any covered veteran under the program, the Secretary shall first obtain review of and concurrence with respect to such denial from a designated Spinal Cord Injuries and Disorders Center of the Department.

(d) Coordination of care and benefits.— The Secretary shall ensure the program is coordinated with other programs and benefits of the Department for which the covered veteran is eligible to ensure that covered veterans and caregivers receive appropriate support without duplicating benefits or services.

(e) Supportive medical training and qualifications.—

(1) In general.— The Secretary shall provide to each family member or individually employed caregiver providing care to a covered veteran under the program necessary supportive medical training to participate in and receive payment by the Secretary for the provision of such care.

(2) Qualifications.— The Secretary shall establish such requirements, conditions, and qualifications for providers of care under the program as necessary to provide clinically appropriate bowel and bladder care to covered veterans and to ensure the financial and administrative integrity of the program.

(f) Payment.—

(1) In general.— The Secretary shall provide a monthly stipend to family members and individually employed caregivers and payment to contracted home health agencies for care provided to covered veterans under the program.

(2) Limitation.—

(A) Family members and individually employed caregivers.— The stipend for a family member or individually employed caregiver for care provided to a covered veteran under the program—

(i) shall be determined by the Secretary;

(ii) shall be based on the amount and degree of assistance provided; and

(iii) may not exceed the fifth step of the applicable grade of the General Schedule hourly rate paid to nursing assistants who provide such care at the medical facility of the Department that is nearest to the residence of such veteran.

(B) Home health agencies.— Payment to a home health agency for care provided to a covered veteran under the program may not exceed the payment rates of the Department under section 17.4035 of title 38, Code of Federal Regulations (relating to payment rates and methodologies), or successor regulations.