Veteran Overmedication and Suicide Prevention Act of 2021

I 117TH CONGRESS 1ST SESSION H. R. 67 To direct the Secretary of Veterans Affairs to conduct an independent review of the deaths of certain veterans by suicide, and for other purposes. IN THE HOUSE OF REPRESENTATIVES JANUARY 4, 2021 Mr. BUCHANAN (for himself and Mr. CONNOLLY) introduced the following bill; which was referred to the Committee on Veterans’ Affairs A BILL To direct the Secretary of Veterans Affairs to conduct an independent review of the deaths of certain veterans by suicide, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Veteran Overmedica- 4 tion and Suicide Prevention Act of 2021’’. 5 SEC. 2. DEPARTMENT OF VETERANS AFFAIRS INDE- 6 PENDENT REVIEW OF CERTAIN DEATHS OF 7 VETERANS BY SUICIDE. 8 (a) REVIEW REQUIRED.— 9 VerDate Sep 11 2014 23:56 Jan 20, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H67.IH H67 pbinns on DSKJLVW7X2PROD with BILLS 2 •HR 67 IH (1) IN GENERAL.—Not later than 90 days after 1 the date of the enactment of this Act, the Secretary 2 of Veterans Affairs shall seek to enter into an agree- 3 ment with the National Academies of Sciences, En- 4 gineering, and Medicine under which the National 5 Academies shall conduct a review of the deaths of all 6 covered veterans who died by suicide during the five- 7 year period ending on the date of the enactment of 8 this Act, regardless of whether information relating 9 to such deaths has been reported by the Centers for 10 Disease Control and Prevention. 11 (2) ELEMENTS.—The review required by para- 12 graph (1) shall include the following: 13 (A) The total number of covered veterans 14 who died by suicide during the five-year period 15 ending on the date of the enactment of this Act. 16 (B) The total number of covered veterans 17 who died by a violent death during such five- 18 year period. 19 (C) The total number of covered veterans 20 who died by an accidental death during such 21 five-year period. 22 (D) A description of each covered veteran 23 described in subparagraphs (A) through (C), in- 24 cluding age, gender, race, and ethnicity. 25 VerDate Sep 11 2014 23:56 Jan 20, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H67.IH H67 pbinns on DSKJLVW7X2PROD with BILLS 3 •HR 67 IH (E) A comprehensive list of prescribed 1 medications and legal or illegal substances as 2 annotated on toxicology reports of covered vet- 3 erans described in subparagraphs (A) through 4 (C), specifically listing any medications that 5 carried a black box warning, were prescribed for 6 off-label use, were psychotropic, or carried 7 warnings that included suicidal ideation. 8 (F) A summary of medical diagnoses by 9 physicians of the Department of Veterans Af- 10 fairs or physicians providing services to covered 11 veterans through programs of the Department 12 that led to the prescribing of medications re- 13 ferred to in subparagraph (E) in cases of post- 14 traumatic stress disorder, traumatic brain in- 15 jury, military sexual trauma, and other anxiety 16 and depressive disorders. 17 (G) The number of instances in which a 18 covered veteran described in subparagraph (A), 19 (B), or (C) was concurrently on multiple medi- 20 cations prescribed by physicians of the Depart- 21 ment or physicians providing services to vet- 22 erans through programs of the Department to 23 treat post-traumatic stress disorder, traumatic 24 brain injury, military sexual trauma, other anx- 25 VerDate Sep 11 2014 23:56 Jan 20, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H67.IH H67 pbinns on DSKJLVW7X2PROD with BILLS 4 •HR 67 IH iety and depressive disorders, or instances of 1 comorbidity. 2 (H) The number of covered veterans de- 3 scribed in subparagraphs (A) through (C) who 4 were not taking any medication prescribed by a 5 physician of the Department or a physician pro- 6 viding services to veterans through a program 7 of the Department. 8 (I) With respect to the treatment of post- 9 traumatic stress disorder, traumatic brain in- 10 jury, military sexual trauma, or other anxiety 11 and depressive disorders, the percentage of cov- 12 ered veterans described in subparagraphs (A) 13 through (C) who received a non-medication 14 first-line treatment compared to the percentage 15 of such veterans who received medication only. 16 (J) With respect to the treatment of cov- 17 ered veterans described in subparagraphs (A) 18 through (C) for post-traumatic stress disorder, 19 traumatic brain injury, military sexual trauma, 20 or other anxiety and depressive disorders, the 21 number of instances in which a non-medication 22 first-line treatment (such as cognitive behav- 23 ioral therapy) was attempted and determined to 24 be ineffective for such a veteran, which subse- 25 VerDate Sep 11 2014 23:56 Jan 20, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H67.IH H67 pbinns on DSKJLVW7X2PROD with BILLS 5 •HR 67 IH quently led to the prescribing of a medication 1 referred to in subparagraph (E). 2 (K) A description and example of how the 3 Department determines and continually updates 4 the clinical practice guidelines governing the 5 prescribing of medications. 6 (L) An analysis of the use by the Depart- 7 ment, including protocols or practices at med- 8 ical facilities of the Department, of systemati- 9 cally measuring pain scores during clinical en- 10 counters under the Pain as the 5th Vital Sign 11 Toolkit of the Department and an evaluation of 12 the relationship between the use of such meas- 13 urements and the number of veterans concur- 14 rently on multiple medications prescribed by 15 physicians of the Department. 16 (M) A description of the efforts of the De- 17 partment to maintain appropriate staffing levels 18 for mental health professionals, such as mental 19 health counselors, marriage and family thera- 20 pists, and other appropriate counselors, includ- 21 ing— 22 (i) a description of any impediments 23 to carry out the education, training, and 24 hiring of mental health counselors and 25 VerDate Sep 11 2014 23:56 Jan 20, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H67.IH H67 pbinns on DSKJLVW7X2PROD with BILLS 6 •HR 67 IH marriage and family therapists under sec- 1 tion 7302(a) of title 38, United States 2 Code, and strategies for addressing those 3 impediments; 4 (ii) a description of the objectives, 5 goals, and timing of the Department with 6 respect to increasing the representation of 7 such counselors and therapists in the be- 8 havioral health workforce of the Depart- 9 ment, including— 10 (I) a review of eligibility criteria 11 for such counselors and therapists and 12 a comparison of such criteria to that 13 of other behavioral health professions 14 in the Department; and 15 (II) an assessment of the partici- 16 pation of such counselors and thera- 17 pists in the mental health profes- 18 sionals trainee program of the De- 19 partment and any impediments to 20 such participation; 21 (iii) an assessment of the development 22 by the Department of hiring guidelines for 23 mental health counselors, marriage and 24 VerDate Sep 11 2014 23:56 Jan 20, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H67.IH H67 pbinns on DSKJLVW7X2PROD with BILLS 7 •HR 67 IH family therapists, and other appropriate 1 counselors; 2 (iv) a description of how the Depart- 3 ment— 4 (I) identifies gaps in the supply 5 of mental health professionals; and 6 (II) determines successful staff- 7 ing ratios for mental health profes- 8 sionals of the Department; 9 (v) a description of actions taken by 10 the Secretary, in consultation with the Di- 11 rector of the Office of Personnel Manage- 12 ment, to create an occupational series for 13 mental health counselors and marriage and 14 family therapists of the Department and a 15 timeline for the creation of such an occu- 16 pational series; and 17 (vi) a description of actions taken by 18 the Secretary to ensure that the national, 19 regional, and local professional standards 20 boards for mental health counselors and 21 marriage and family therapists are com- 22 prised of only mental health counselors and 23 marriage and family therapists and that 24 the liaison from the Department to such 25 VerDate Sep 11 2014 23:56 Jan 20, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H67.IH H67 pbinns on DSKJLVW7X2PROD with BILLS 8 •HR 67 IH boards is a mental health counselor or 1 marriage and family therapist. 2 (N) The percentage of covered veterans de- 3 scribed in subparagraphs (A) through (C) with 4 combat experience or trauma related to combat 5 experience (including military sexual trauma, 6 traumatic brain injury, and post-traumatic 7 stress). 8 (O) An identification of the medical facili- 9 ties of the Department with markedly high pre- 10 scription rates and suicide rates for veterans re- 11 ceiving treatment at those facilities. 12 (P) An analysis, by State, of programs of 13 the Department that collaborate with State 14 Medicaid agencies and the Centers for Medicare 15 and Medicaid Services, including the following: 16 (i) An analysis of the sharing of pre- 17 scription and behavioral health data for 18 veterans. 19 (ii) An analysis of whether Depart- 20 ment staff check with State prescription 21 drug monitoring programs before pre- 22 scribing medications to veterans. 23 (iii) A description of the procedures of 24 the Department for coordinating with pre- 25 VerDate Sep 11 2014 23:56 Jan 20, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H67.IH H67 pbinns on DSKJLVW7X2PROD with BILLS 9 •HR 67 IH scribers outside of the Department to en- 1 sure that veterans are not overprescribed. 2 (iv) A description of actions that the 3 Department takes when a veteran is deter- 4 mined to be overprescribed. 5 (Q) An analysis of the collaboration of 6 medical centers of the Department with medical 7 examiners’ offices or local jurisdictions to deter- 8 mine veteran mortality and cause of death. 9 (R) An identification and determination of 10 a best practice model to collect and share vet- 11 eran death certificate data between the Depart- 12 ment of Veterans Affairs, the Department of 13 Defense, States, and tribal entities. 14 (S) A description of how data relating to 15 death certificates of veterans is collected, deter- 16 mined, and reported by the Department of Vet- 17 erans Affairs. 18 (T) An assessment of any patterns appar- 19 ent to the National Academies of Sciences, En- 20 gineering, and Medicine based on the review 21 conducted under paragraph (1). 22 (U) Such recommendations for further ac- 23 tion that would improve the safety and well- 24 being of veterans as the National Academies of 25 VerDate Sep 11 2014 23:56 Jan 20, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H67.IH H67 pbinns on DSKJLVW7X2PROD with BILLS 10 •HR 67 IH Sciences, Engineering, and Medicine determine 1 appropriate. 2 (3) COMPILATION OF DATA.— 3 (A) FORM OF COMPILATION.—The Sec- 4 retary of Veterans Affairs shall ensure that 5 data compiled under paragraph (2) is compiled 6 in a manner that allows it to be analyzed across 7 all data fields for purposes of informing and 8 updating clinical practice guidelines of the De- 9 partment of Veterans Affairs. 10 (B) COMPILATION OF DATA REGARDING 11 COVERED VETERANS.—In compiling data under 12 paragraph (2) regarding covered veterans de- 13 scribed in subparagraphs (A) through (C) of 14 such paragraph, data regarding veterans de- 15 scribed in each such subparagraph shall be 16 compiled separately and disaggregated by year. 17 (4) COMPLETION OF REVIEW AND REPORT.— 18 The agreement entered into under paragraph (1) 19 shall require that the National Academies of 20 Sciences, Engineering, and Medicine complete the 21 review under such paragraph and submit to the Sec- 22 retary of Veterans Affairs a report containing the 23 results of the review not later than 180 days after 24 entering into the agreement. 25 VerDate Sep 11 2014 23:56 Jan 20, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H67.IH H67 pbinns on DSKJLVW7X2PROD with BILLS 11 •HR 67 IH (b) REPORT.—Not later than 30 days after the com- 1 pletion by the National Academies of Sciences, Engineer- 2 ing, and Medicine of the review required under subsection 3 (a), the Secretary of Veterans Affairs shall— 4 (1) submit to the Committee on Veterans’ Af- 5 fairs of the Senate and the Committee on Veterans’ 6 Affairs of the House of Representatives a report on 7 the results of the review; and 8 (2) make such report publicly available. 9 (c) DEFINITIONS.—In this section: 10 (1) The term ‘‘black box warning’’ means a 11 warning displayed on the label of a prescription drug 12 that is designed to call attention to the serious or 13 life-threatening risk of the prescription drug. 14 (2) The term ‘‘covered veteran’’ means a vet- 15 eran who received hospital care or medical services 16 furnished by the Department of Veterans Affairs 17 during the five-year period preceding the death of 18 the veteran. 19 (3) The term ‘‘first-line treatment’’ means a po- 20 tential intervention that has been evaluated and as- 21 signed a high score within clinical practice guide- 22 lines. 23 (4) The term ‘‘State’’ means each of the States, 24 territories, and possessions of the United States, the 25 VerDate Sep 11 2014 23:56 Jan 20, 2021 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H67.IH H67 pbinns on DSKJLVW7X2PROD with BILLS 12 •HR 67 IH District of Columbia, and the Commonwealth of 1 Puerto Rico. 2 Æ VerDate Sep 11 2014 23:56 Jan 20, 2021 Jkt 019200 PO 00000 Frm 00012 Fmt 6652 Sfmt 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