I 116TH CONGRESS 1ST SESSION H. R. 1963 To expand the research and education on and delivery of complementary and integrative medicine to veterans, and for other purposes. IN THE HOUSE OF REPRESENTATIVES MARCH 28, 2019 Ms. BROWNLEY of California introduced the following bill; which was referred to the Committee on Veterans’ Affairs A BILL To expand the research and education on and delivery of complementary and integrative medicine to veterans, 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 ‘‘Expanding Care for 4 Veterans Act’’. 5 SEC. 2. EXPANSION OF RESEARCH AND EDUCATION ON 6 AND DELIVERY OF COMPLEMENTARY AND IN- 7 TEGRATIVE MEDICINE TO VETERANS. 8 (a) DEVELOPMENT OF PLAN TO EXPAND RE- 9 SEARCH, EDUCATION, AND DELIVERY.—Not later than 10 VerDate Sep 11 2014 01:25 Apr 11, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H1963.IH H1963 pamtmann on DSKBFK8HB2PROD with BILLS 2 •HR 1963 IH six months after the effective date specified in subsection 1 (f), the Secretary of Veterans Affairs shall develop a plan 2 to expand materially and substantially the scope of re- 3 search and education on, and delivery and integration of, 4 complementary and integrative medicine services into the 5 health care services provided to veterans. 6 (b) ELEMENTS.—The plan required by subsection (a) 7 shall provide for the following: 8 (1) Research on the following: 9 (A) The comparative effectiveness of var- 10 ious complementary and integrative medicine 11 therapies. 12 (B) Approaches to integrating complemen- 13 tary and integrative medicine services into other 14 health care services provided by the Depart- 15 ment. 16 (2) Education and training for health care pro- 17 fessionals of the Department on the following: 18 (A) Complementary and integrative medi- 19 cine services selected by the Secretary for pur- 20 poses of the plan. 21 (B) Appropriate uses of such services. 22 (C) Integration of such services into the 23 delivery of health care to veterans. 24 VerDate Sep 11 2014 01:25 Apr 11, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H1963.IH H1963 pamtmann on DSKBFK8HB2PROD with BILLS 3 •HR 1963 IH (3) Research, education, and clinical activities 1 on complementary and integrative medicine at cen- 2 ters of innovation at Department medical centers. 3 (4) Identification or development of metrics and 4 outcome measures to evaluate the provision and inte- 5 gration of complementary and integrative medicine 6 services into the delivery of health care to veterans. 7 (5) Integration and delivery of complementary 8 and integrative medicine services with other health 9 care services provided by the Department. 10 (c) CONSULTATION.— 11 (1) IN GENERAL.—In carrying out subsection 12 (a), the Secretary shall consult with the following: 13 (A) The Director of the National Center 14 on Complementary and Integrative Health of 15 the National Institutes of Health. 16 (B) The Commissioner of Food and Drugs. 17 (C) Institutions of higher education, pri- 18 vate research institutes, and individual re- 19 searchers with extensive experience in com- 20 plementary and integrative medicine and the in- 21 tegration of complementary and integrative 22 medicine practices into the delivery of health 23 care. 24 VerDate Sep 11 2014 01:25 Apr 11, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H1963.IH H1963 pamtmann on DSKBFK8HB2PROD with BILLS 4 •HR 1963 IH (D) Nationally recognized providers of 1 complementary and integrative medicine. 2 (E) Such other officials, entities, and indi- 3 viduals with expertise on complementary and 4 integrative medicine as the Secretary considers 5 appropriate. 6 (2) SCOPE OF CONSULTATION.—The Secretary 7 shall undertake consultation under paragraph (1) in 8 carrying out subsection (a) with respect to the fol- 9 lowing: 10 (A) To develop the plan. 11 (B) To identify specific complementary and 12 integrative medicine practices that, on the basis 13 of research findings or promising clinical inter- 14 ventions, are appropriate to include as services 15 to veterans. 16 (C) To identify barriers to the effective 17 provision and integration of complementary and 18 integrative medicine services into the delivery of 19 health care to veterans, and to identify mecha- 20 nisms for overcoming such barriers. 21 (d) FUNDING.—There is authorized to be appro- 22 priated to the Secretary such sums as may be necessary 23 to carry out this section. 24 VerDate Sep 11 2014 01:25 Apr 11, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1963.IH H1963 pamtmann on DSKBFK8HB2PROD with BILLS 5 •HR 1963 IH (e) COMPLEMENTARY AND INTEGRATIVE MEDICINE 1 DEFINED.—In this section, the term ‘‘complementary and 2 integrative medicine’’ shall have the meaning given that 3 term in regulations the Secretary shall prescribe for pur- 4 poses of this section, which shall, to the degree practicable, 5 be consistent with the meaning given such term by the 6 Secretary of Health and Human Services. 7 (f) EFFECTIVE DATE.—This section shall take effect 8 on the date that is one year after the date of the enact- 9 ment of this Act. 10 SEC. 3. PROGRAM ON INTEGRATION OF COMPLEMENTARY 11 AND INTEGRATIVE MEDICINE WITHIN DE- 12 PARTMENT OF VETERANS AFFAIRS MEDICAL 13 CENTERS. 14 (a) PROGRAM REQUIRED.—The Secretary of Vet- 15 erans Affairs shall— 16 (1) carry out, through the Office of Patient 17 Centered Care and Cultural Transformation of the 18 Department of Veterans Affairs, a program to as- 19 sess the feasibility and advisability of integrating the 20 delivery of complementary and integrative medicine 21 services selected by the Secretary with other health 22 care services provided by the Department for vet- 23 erans with mental health conditions, chronic pain 24 conditions, other chronic conditions, and such other 25 VerDate Sep 11 2014 01:25 Apr 11, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H1963.IH H1963 pamtmann on DSKBFK8HB2PROD with BILLS 6 •HR 1963 IH conditions as the Secretary determines appropriate; 1 and 2 (2) in developing the program, identify and re- 3 solve barriers to the provision of complementary and 4 integrative medicine services selected by the Sec- 5 retary and the integration of those services with 6 other health care services provided by the Depart- 7 ment. 8 (b) DURATION OF PROGRAM.—The program shall be 9 carried out during the three-year period beginning on the 10 effective date specified in subsection (j). 11 (c) LOCATIONS.— 12 (1) IN GENERAL.—The Secretary shall carry 13 out the program at not fewer than 15 separate De- 14 partment medical centers. 15 (2) POLYTRAUMA CENTERS.—Not less than two 16 of the medical centers designated under paragraph 17 (1) shall be located at polytrauma rehabilitation cen- 18 ters of the Department. 19 (3) SELECTION OF LOCATIONS.—In carrying 20 out the program, the Secretary shall select locations 21 that include the following areas: 22 (A) Rural areas. 23 (B) Areas that are not in close proximity 24 to an active duty military installation. 25 VerDate Sep 11 2014 01:25 Apr 11, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H1963.IH H1963 pamtmann on DSKBFK8HB2PROD with BILLS 7 •HR 1963 IH (C) Areas representing different geo- 1 graphic locations, such as census tracts estab- 2 lished by the Bureau of the Census. 3 (d) PROVISION OF SERVICES.—Under the program, 4 the Secretary shall provide covered services to covered vet- 5 erans by integrating complementary and integrative medi- 6 cine services with other services provided by the Depart- 7 ment at the medical centers designated under subsection 8 (c)(1). 9 (e) COVERED VETERANS.—For purposes of the pro- 10 gram, a covered veteran is any veteran who— 11 (1) has a mental health condition diagnosed by 12 a clinician of the Department; 13 (2) experiences chronic pain; or 14 (3) has a chronic condition being treated by a 15 clinician of the Department. 16 (f) COVERED SERVICES.— 17 (1) IN GENERAL.—For purposes of the pro- 18 gram, covered services are services consisting of 19 complementary and integrative medicine as selected 20 by the Secretary. 21 (2) ADMINISTRATION OF SERVICES.—Covered 22 services shall be administered under the program as 23 follows: 24 VerDate Sep 11 2014 01:25 Apr 11, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H1963.IH H1963 pamtmann on DSKBFK8HB2PROD with BILLS 8 •HR 1963 IH (A) Covered services shall be administered 1 by clinicians employed by the Secretary for pur- 2 poses of this section who, to the extent prac- 3 ticable, shall provide services consisting of com- 4 plementary and integrative medicine, including 5 those clinicians who solely provide such services. 6 (B) Covered services shall be included as 7 part of the Patient Aligned Care Teams initia- 8 tive of the Office of Patient Care Services, Pri- 9 mary Care Program Office, in coordination with 10 the Office of Patient Centered Care and Cul- 11 tural Transformation. 12 (C) Covered services shall be made avail- 13 able to both— 14 (i) covered veterans with mental 15 health conditions, pain conditions, or 16 chronic conditions described in subsection 17 (e) who have received conventional treat- 18 ments from the Department for such con- 19 ditions; and 20 (ii) covered veterans with mental 21 health conditions, pain conditions, or 22 chronic conditions described in subsection 23 (e) who have not received conventional 24 VerDate Sep 11 2014 01:25 Apr 11, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H1963.IH H1963 pamtmann on DSKBFK8HB2PROD with BILLS 9 •HR 1963 IH treatments from the Department for such 1 conditions. 2 (g) VOLUNTARY PARTICIPATION.—The participation 3 of a veteran in the program shall be at the election of 4 the veteran and in consultation with a clinician of the De- 5 partment. 6 (h) REPORTS TO CONGRESS.— 7 (1) QUARTERLY REPORTS.—Not later than 90 8 days after the date of the commencement of the pro- 9 gram and not less frequently than once every 90 10 days thereafter for the duration of the program, the 11 Secretary shall submit to the Committee on Vet- 12 erans’ Affairs of the Senate and the Committee on 13 Veterans’ Affairs of the House of Representatives a 14 report on the efforts of the Secretary to carry out 15 the program, including a description of the outreach 16 conducted by the Secretary to veterans and commu- 17 nity organizations to inform such organizations 18 about the program. 19 (2) FINAL REPORT.— 20 (A) IN GENERAL.—Not later than 180 21 days after the completion of the program, the 22 Secretary shall submit to the Committee on 23 Veterans’ Affairs of the Senate and the Com- 24 VerDate Sep 11 2014 01:25 Apr 11, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H1963.IH H1963 pamtmann on DSKBFK8HB2PROD with BILLS 10 •HR 1963 IH mittee on Veterans’ Affairs of the House of 1 Representatives a report on the program. 2 (B) CONTENTS.—The report submitted 3 under subparagraph (A) shall include the fol- 4 lowing: 5 (i) The findings and conclusions of 6 the Secretary with respect to the program, 7 including with respect to— 8 (I) the utilization and efficacy of 9 the complementary and integrative 10 medicine services established under 11 the program; 12 (II) an assessment of the benefit 13 of the program to covered veterans in 14 mental health diagnoses, pain man- 15 agement, and treatment of chronic ill- 16 ness; and 17 (III) the comparative effective- 18 ness of various complementary and in- 19 tegrative medicine therapies. 20 (ii) Barriers identified under sub- 21 section (a)(2) that were not resolved. 22 (iii) Such recommendations for the 23 continuation or expansion of the program 24 as the Secretary considers appropriate. 25 VerDate Sep 11 2014 01:25 Apr 11, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H1963.IH H1963 pamtmann on DSKBFK8HB2PROD with BILLS 11 •HR 1963 IH (i) COMPLEMENTARY AND INTEGRATIVE MEDICINE 1 DEFINED.—In this section, the term ‘‘complementary and 2 integrative medicine’’ shall have the meaning given that 3 term in section 2(e) of this Act. 4 (j) EFFECTIVE DATE.—This section shall take effect 5 on the date that is one year after the date of the enact- 6 ment of this Act. 7 SEC. 4. STUDIES OF BARRIERS ENCOUNTERED BY VET- 8 ERANS IN RECEIVING, AND ADMINISTRATORS 9 AND CLINICIANS IN PROVIDING, COM- 10 PLEMENTARY AND INTEGRATIVE MEDICINE 11 SERVICES FURNISHED BY THE DEPARTMENT 12 OF VETERANS AFFAIRS. 13 (a) STUDIES REQUIRED.— 14 (1) IN GENERAL.—The Secretary of Veterans 15 Affairs shall conduct comprehensive studies of the 16 barriers encountered by veterans in receiving, and 17 administrators and clinicians in providing, com- 18 plementary and integrative medicine services fur- 19 nished by the Department of Veterans Affairs. 20 (2) STUDIES CONDUCTED.— 21 (A) VETERANS.—In conducting the study 22 of veterans, the Secretary shall— 23 (i) survey veterans who seek or receive 24 hospital care or medical services furnished 25 VerDate Sep 11 2014 01:25 Apr 11, 2019 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H1963.IH H1963 pamtmann on DSKBFK8HB2PROD with BILLS 12 •HR 1963 IH by the Department, as well as veterans 1 who do not seek or receive such care or 2 services; 3 (ii) administer the survey to a rep- 4 resentative sample of veterans from each 5 Veterans Integrated Service Network; and 6 (iii) ensure that the sample of vet- 7 erans surveyed is of sufficient size for the 8 study results to be statistically significant. 9 (B) ADMINISTRATORS AND CLINICIANS.— 10 In conducting the study of clinicians and ad- 11 ministrators, the Secretary shall— 12 (i) survey administrators of the De- 13 partment who are involved in the provision 14 of health care services; 15 (ii) survey clinicians that have pro- 16 vided complementary and integrative medi- 17 cine services through the program estab- 18 lished under section 3 of this Act, after 19 those clinicians have provided those serv- 20 ices through such program for at least 90 21 days; and 22 (iii) administer the survey to adminis- 23 trators under clause (i)— 24 VerDate Sep 11 2014 01:25 Apr 11, 2019 Jkt 089200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H1963.IH H1963 pamtmann on DSKBFK8HB2PROD with BILLS 13 •HR 1963 IH (I) before the introduction of 1 complementary and integrative medi- 2 cine services through such program; 3 and 4 (II) not earlier than 90 days 5 after the introduction of complemen- 6 tary and integrative medicine services 7 through such program. 8 (b) ELEMENTS OF STUDIES.— 9 (1) VETERANS.—In conducting the stu [Text truncated for display. 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