| 1 | 1 | | I |
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| 2 | 2 | | 119THCONGRESS |
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| 3 | 3 | | 1 |
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| 4 | 4 | | STSESSION H. R. 136 |
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| 5 | 5 | | To direct the Secretary of Veterans Affairs to conduct an independent review |
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| 6 | 6 | | of the deaths of certain veterans by suicide, and for other purposes. |
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| 7 | 7 | | IN THE HOUSE OF REPRESENTATIVES |
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| 8 | 8 | | JANUARY3, 2025 |
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| 9 | 9 | | Mr. B |
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| 10 | 10 | | UCHANAN(for himself and Mr. CONNOLLY) introduced the following bill; |
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| 11 | 11 | | which was referred to the Committee on Veterans’ Affairs |
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| 12 | 12 | | A BILL |
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| 13 | 13 | | To direct the Secretary of Veterans Affairs to conduct an |
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| 14 | 14 | | independent review of the deaths of certain veterans by |
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| 15 | 15 | | suicide, and for other purposes. |
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| 16 | 16 | | Be it enacted by the Senate and House of Representa-1 |
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| 17 | 17 | | tives of the United States of America in Congress assembled, 2 |
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| 18 | 18 | | SECTION 1. SHORT TITLE. 3 |
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| 19 | 19 | | This Act may be cited as the ‘‘Veteran Overmedica-4 |
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| 20 | 20 | | tion and Suicide Prevention Act of 2025’’. 5 |
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| 21 | 21 | | SEC. 2. DEPARTMENT OF VETERANS AFFAIRS INDE-6 |
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| 22 | 22 | | PENDENT REVIEW OF CERTAIN DEATHS OF 7 |
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| 23 | 23 | | VETERANS BY SUICIDE. 8 |
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| 24 | 24 | | (a) R |
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| 25 | 25 | | EVIEWREQUIRED.— 9 |
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| 29 | 29 | | (1) IN GENERAL.—Not later than 90 days after 1 |
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| 30 | 30 | | the date of the enactment of this Act, the Secretary 2 |
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| 31 | 31 | | of Veterans Affairs shall seek to enter into an agree-3 |
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| 32 | 32 | | ment with the National Academies of Sciences, En-4 |
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| 33 | 33 | | gineering, and Medicine under which the National 5 |
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| 34 | 34 | | Academies shall conduct a review of the deaths of all 6 |
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| 35 | 35 | | covered veterans who died by suicide during the five- 7 |
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| 36 | 36 | | year period ending on the date of the enactment of 8 |
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| 37 | 37 | | this Act, regardless of whether information relating 9 |
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| 38 | 38 | | to such deaths has been reported by the Centers for 10 |
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| 39 | 39 | | Disease Control and Prevention. 11 |
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| 40 | 40 | | (2) E |
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| 41 | 41 | | LEMENTS.—The review required by para-12 |
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| 42 | 42 | | graph (1) shall include the following: 13 |
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| 43 | 43 | | (A) The total number of covered veterans 14 |
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| 44 | 44 | | who died by suicide during the five-year period 15 |
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| 45 | 45 | | ending on the date of the enactment of this Act. 16 |
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| 46 | 46 | | (B) The total number of covered veterans 17 |
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| 47 | 47 | | who died by a violent death during such five- 18 |
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| 48 | 48 | | year period. 19 |
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| 49 | 49 | | (C) The total number of covered veterans 20 |
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| 50 | 50 | | who died by an accidental death during such 21 |
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| 51 | 51 | | five-year period. 22 |
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| 52 | 52 | | (D) A description of each covered veteran 23 |
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| 53 | 53 | | described in subparagraphs (A) through (C), in-24 |
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| 54 | 54 | | cluding age, gender, race, and ethnicity. 25 |
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| 57 | 57 | | •HR 136 IH |
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| 58 | 58 | | (E) A comprehensive list of prescribed 1 |
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| 59 | 59 | | medications and legal or illegal substances as 2 |
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| 60 | 60 | | annotated on toxicology reports of covered vet-3 |
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| 61 | 61 | | erans described in subparagraphs (A) through 4 |
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| 62 | 62 | | (C), specifically listing any medications that 5 |
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| 63 | 63 | | carried a black box warning, were prescribed for 6 |
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| 64 | 64 | | off-label use, were psychotropic, or carried 7 |
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| 65 | 65 | | warnings that included suicidal ideation. 8 |
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| 66 | 66 | | (F) A summary of medical diagnoses by 9 |
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| 67 | 67 | | physicians of the Department of Veterans Af-10 |
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| 68 | 68 | | fairs or physicians providing services to covered 11 |
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| 69 | 69 | | veterans through programs of the Department 12 |
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| 70 | 70 | | that led to the prescribing of medications re-13 |
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| 71 | 71 | | ferred to in subparagraph (E) in cases of post- 14 |
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| 72 | 72 | | traumatic stress disorder, traumatic brain in-15 |
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| 73 | 73 | | jury, military sexual trauma, and other anxiety 16 |
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| 74 | 74 | | and depressive disorders. 17 |
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| 75 | 75 | | (G) The number of instances in which a 18 |
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| 76 | 76 | | covered veteran described in subparagraph (A), 19 |
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| 77 | 77 | | (B), or (C) was concurrently on multiple medi-20 |
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| 78 | 78 | | cations prescribed by physicians of the Depart-21 |
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| 79 | 79 | | ment or physicians providing services to vet-22 |
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| 80 | 80 | | erans through programs of the Department to 23 |
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| 81 | 81 | | treat post-traumatic stress disorder, traumatic 24 |
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| 82 | 82 | | brain injury, military sexual trauma, other anx-25 |
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| 85 | 85 | | •HR 136 IH |
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| 86 | 86 | | iety and depressive disorders, or instances of 1 |
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| 87 | 87 | | comorbidity. 2 |
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| 88 | 88 | | (H) The number of covered veterans de-3 |
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| 89 | 89 | | scribed in subparagraphs (A) through (C) who 4 |
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| 90 | 90 | | were not taking any medication prescribed by a 5 |
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| 91 | 91 | | physician of the Department or a physician pro-6 |
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| 92 | 92 | | viding services to veterans through a program 7 |
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| 93 | 93 | | of the Department. 8 |
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| 94 | 94 | | (I) With respect to the treatment of post- 9 |
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| 95 | 95 | | traumatic stress disorder, traumatic brain in-10 |
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| 96 | 96 | | jury, military sexual trauma, or other anxiety 11 |
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| 97 | 97 | | and depressive disorders, the percentage of cov-12 |
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| 98 | 98 | | ered veterans described in subparagraphs (A) 13 |
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| 99 | 99 | | through (C) who received a non-medication 14 |
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| 100 | 100 | | first-line treatment compared to the percentage 15 |
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| 101 | 101 | | of such veterans who received medication only. 16 |
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| 102 | 102 | | (J) With respect to the treatment of cov-17 |
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| 103 | 103 | | ered veterans described in subparagraphs (A) 18 |
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| 104 | 104 | | through (C) for post-traumatic stress disorder, 19 |
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| 105 | 105 | | traumatic brain injury, military sexual trauma, 20 |
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| 106 | 106 | | or other anxiety and depressive disorders, the 21 |
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| 107 | 107 | | number of instances in which a non-medication 22 |
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| 108 | 108 | | first-line treatment (such as cognitive behav-23 |
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| 109 | 109 | | ioral therapy) was attempted and determined to 24 |
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| 110 | 110 | | be ineffective for such a veteran, which subse-25 |
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| 113 | 113 | | •HR 136 IH |
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| 114 | 114 | | quently led to the prescribing of a medication 1 |
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| 115 | 115 | | referred to in subparagraph (E). 2 |
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| 116 | 116 | | (K) A description and example of how the 3 |
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| 117 | 117 | | Department determines and continually updates 4 |
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| 118 | 118 | | the clinical practice guidelines governing the 5 |
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| 119 | 119 | | prescribing of medications. 6 |
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| 120 | 120 | | (L) An analysis of the use by the Depart-7 |
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| 121 | 121 | | ment, including protocols or practices at med-8 |
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| 122 | 122 | | ical facilities of the Department, of systemati-9 |
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| 123 | 123 | | cally measuring pain scores during clinical en-10 |
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| 124 | 124 | | counters under the Pain as the 5th Vital Sign 11 |
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| 125 | 125 | | Toolkit of the Department and an evaluation of 12 |
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| 126 | 126 | | the relationship between the use of such meas-13 |
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| 127 | 127 | | urements and the number of veterans concur-14 |
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| 128 | 128 | | rently on multiple medications prescribed by 15 |
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| 129 | 129 | | physicians of the Department. 16 |
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| 130 | 130 | | (M) A description of the efforts of the De-17 |
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| 131 | 131 | | partment to maintain appropriate staffing levels 18 |
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| 132 | 132 | | for mental health professionals, such as mental 19 |
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| 133 | 133 | | health counselors, marriage and family thera-20 |
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| 134 | 134 | | pists, and other appropriate counselors, includ-21 |
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| 135 | 135 | | ing— 22 |
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| 136 | 136 | | (i) a description of any impediments 23 |
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| 137 | 137 | | to carry out the education, training, and 24 |
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| 138 | 138 | | hiring of mental health counselors and 25 |
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| 141 | 141 | | •HR 136 IH |
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| 142 | 142 | | marriage and family therapists under sec-1 |
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| 143 | 143 | | tion 7302(a) of title 38, United States 2 |
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| 144 | 144 | | Code, and strategies for addressing those 3 |
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| 145 | 145 | | impediments; 4 |
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| 146 | 146 | | (ii) a description of the objectives, 5 |
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| 147 | 147 | | goals, and timing of the Department with 6 |
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| 148 | 148 | | respect to increasing the representation of 7 |
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| 149 | 149 | | such counselors and therapists in the be-8 |
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| 150 | 150 | | havioral health workforce of the Depart-9 |
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| 151 | 151 | | ment, including— 10 |
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| 152 | 152 | | (I) a review of eligibility criteria 11 |
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| 153 | 153 | | for such counselors and therapists and 12 |
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| 154 | 154 | | a comparison of such criteria to that 13 |
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| 155 | 155 | | of other behavioral health professions 14 |
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| 156 | 156 | | in the Department; and 15 |
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| 157 | 157 | | (II) an assessment of the partici-16 |
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| 158 | 158 | | pation of such counselors and thera-17 |
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| 159 | 159 | | pists in the mental health profes-18 |
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| 160 | 160 | | sionals trainee program of the De-19 |
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| 161 | 161 | | partment and any impediments to 20 |
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| 162 | 162 | | such participation; 21 |
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| 163 | 163 | | (iii) an assessment of the development 22 |
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| 164 | 164 | | by the Department of hiring guidelines for 23 |
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| 165 | 165 | | mental health counselors, marriage and 24 |
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| 168 | 168 | | •HR 136 IH |
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| 169 | 169 | | family therapists, and other appropriate 1 |
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| 170 | 170 | | counselors; 2 |
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| 171 | 171 | | (iv) a description of how the Depart-3 |
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| 172 | 172 | | ment— 4 |
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| 173 | 173 | | (I) identifies gaps in the supply 5 |
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| 174 | 174 | | of mental health professionals; and 6 |
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| 175 | 175 | | (II) determines successful staff-7 |
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| 176 | 176 | | ing ratios for mental health profes-8 |
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| 177 | 177 | | sionals of the Department; 9 |
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| 178 | 178 | | (v) a description of actions taken by 10 |
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| 179 | 179 | | the Secretary, in consultation with the Di-11 |
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| 180 | 180 | | rector of the Office of Personnel Manage-12 |
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| 181 | 181 | | ment, to create an occupational series for 13 |
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| 182 | 182 | | mental health counselors and marriage and 14 |
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| 183 | 183 | | family therapists of the Department and a 15 |
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| 184 | 184 | | timeline for the creation of such an occu-16 |
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| 185 | 185 | | pational series; and 17 |
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| 186 | 186 | | (vi) a description of actions taken by 18 |
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| 187 | 187 | | the Secretary to ensure that the national, 19 |
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| 188 | 188 | | regional, and local professional standards 20 |
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| 189 | 189 | | boards for mental health counselors and 21 |
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| 190 | 190 | | marriage and family therapists are com-22 |
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| 191 | 191 | | prised of only mental health counselors and 23 |
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| 192 | 192 | | marriage and family therapists and that 24 |
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| 193 | 193 | | the liaison from the Department to such 25 |
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| 196 | 196 | | •HR 136 IH |
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| 197 | 197 | | boards is a mental health counselor or 1 |
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| 198 | 198 | | marriage and family therapist. 2 |
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| 199 | 199 | | (N) The percentage of covered veterans de-3 |
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| 200 | 200 | | scribed in subparagraphs (A) through (C) with 4 |
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| 201 | 201 | | combat experience or trauma related to combat 5 |
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| 202 | 202 | | experience (including military sexual trauma, 6 |
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| 203 | 203 | | traumatic brain injury, and post-traumatic 7 |
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| 204 | 204 | | stress). 8 |
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| 205 | 205 | | (O) An identification of the medical facili-9 |
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| 206 | 206 | | ties of the Department with markedly high pre-10 |
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| 207 | 207 | | scription rates and suicide rates for veterans re-11 |
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| 208 | 208 | | ceiving treatment at those facilities. 12 |
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| 209 | 209 | | (P) An analysis, by State, of programs of 13 |
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| 210 | 210 | | the Department that collaborate with State 14 |
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| 211 | 211 | | Medicaid agencies and the Centers for Medicare 15 |
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| 212 | 212 | | and Medicaid Services, including the following: 16 |
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| 213 | 213 | | (i) An analysis of the sharing of pre-17 |
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| 214 | 214 | | scription and behavioral health data for 18 |
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| 215 | 215 | | veterans. 19 |
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| 216 | 216 | | (ii) An analysis of whether Depart-20 |
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| 217 | 217 | | ment staff check with State prescription 21 |
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| 218 | 218 | | drug monitoring programs before pre-22 |
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| 219 | 219 | | scribing medications to veterans. 23 |
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| 220 | 220 | | (iii) A description of the procedures of 24 |
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| 221 | 221 | | the Department for coordinating with pre-25 |
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| 224 | 224 | | •HR 136 IH |
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| 225 | 225 | | scribers outside of the Department to en-1 |
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| 226 | 226 | | sure that veterans are not overprescribed. 2 |
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| 227 | 227 | | (iv) A description of actions that the 3 |
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| 228 | 228 | | Department takes when a veteran is deter-4 |
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| 229 | 229 | | mined to be overprescribed. 5 |
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| 230 | 230 | | (Q) An analysis of the collaboration of 6 |
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| 231 | 231 | | medical centers of the Department with medical 7 |
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| 232 | 232 | | examiners’ offices or local jurisdictions to deter-8 |
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| 233 | 233 | | mine veteran mortality and cause of death. 9 |
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| 234 | 234 | | (R) An identification and determination of 10 |
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| 235 | 235 | | a best practice model to collect and share vet-11 |
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| 236 | 236 | | eran death certificate data between the Depart-12 |
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| 237 | 237 | | ment of Veterans Affairs, the Department of 13 |
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| 238 | 238 | | Defense, States, and tribal entities. 14 |
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| 239 | 239 | | (S) A description of how data relating to 15 |
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| 240 | 240 | | death certificates of veterans is collected, deter-16 |
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| 241 | 241 | | mined, and reported by the Department of Vet-17 |
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| 242 | 242 | | erans Affairs. 18 |
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| 243 | 243 | | (T) An assessment of any patterns appar-19 |
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| 244 | 244 | | ent to the National Academies of Sciences, En-20 |
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| 245 | 245 | | gineering, and Medicine based on the review 21 |
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| 246 | 246 | | conducted under paragraph (1). 22 |
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| 247 | 247 | | (U) Such recommendations for further ac-23 |
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| 248 | 248 | | tion that would improve the safety and well- 24 |
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| 249 | 249 | | being of veterans as the National Academies of 25 |
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| 252 | 252 | | •HR 136 IH |
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| 253 | 253 | | Sciences, Engineering, and Medicine determine 1 |
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| 254 | 254 | | appropriate. 2 |
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| 255 | 255 | | (3) C |
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| 256 | 256 | | OMPILATION OF DATA.— 3 |
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| 257 | 257 | | (A) F |
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| 258 | 258 | | ORM OF COMPILATION .—The Sec-4 |
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| 259 | 259 | | retary of Veterans Affairs shall ensure that 5 |
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| 260 | 260 | | data compiled under paragraph (2) is compiled 6 |
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| 261 | 261 | | in a manner that allows it to be analyzed across 7 |
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| 262 | 262 | | all data fields for purposes of informing and 8 |
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| 263 | 263 | | updating clinical practice guidelines of the De-9 |
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| 264 | 264 | | partment of Veterans Affairs. 10 |
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| 265 | 265 | | (B) C |
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| 266 | 266 | | OMPILATION OF DATA REGARDING 11 |
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| 267 | 267 | | COVERED VETERANS .—In compiling data under 12 |
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| 268 | 268 | | paragraph (2) regarding covered veterans de-13 |
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| 269 | 269 | | scribed in subparagraphs (A) through (C) of 14 |
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| 270 | 270 | | such paragraph, data regarding veterans de-15 |
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| 271 | 271 | | scribed in each such subparagraph shall be 16 |
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| 272 | 272 | | compiled separately and disaggregated by year. 17 |
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| 273 | 273 | | (4) C |
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| 274 | 274 | | OMPLETION OF REVIEW AND REPORT .— 18 |
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| 275 | 275 | | The agreement entered into under paragraph (1) 19 |
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| 276 | 276 | | shall require that the National Academies of 20 |
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| 277 | 277 | | Sciences, Engineering, and Medicine complete the 21 |
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| 278 | 278 | | review under such paragraph and submit to the Sec-22 |
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| 279 | 279 | | retary of Veterans Affairs a report containing the 23 |
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| 280 | 280 | | results of the review not later than 180 days after 24 |
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| 281 | 281 | | entering into the agreement. 25 |
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| 284 | 284 | | •HR 136 IH |
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| 285 | 285 | | (b) REPORT.—Not later than 30 days after the com-1 |
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| 286 | 286 | | pletion by the National Academies of Sciences, Engineer-2 |
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| 287 | 287 | | ing, and Medicine of the review required under subsection 3 |
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| 288 | 288 | | (a), the Secretary of Veterans Affairs shall— 4 |
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| 289 | 289 | | (1) submit to the Committee on Veterans’ Af-5 |
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| 290 | 290 | | fairs of the Senate and the Committee on Veterans’ 6 |
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| 291 | 291 | | Affairs of the House of Representatives a report on 7 |
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| 292 | 292 | | the results of the review; and 8 |
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| 293 | 293 | | (2) make such report publicly available. 9 |
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| 294 | 294 | | (c) D |
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| 295 | 295 | | EFINITIONS.—In this section: 10 |
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| 296 | 296 | | (1) The term ‘‘black box warning’’ means a 11 |
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| 297 | 297 | | warning displayed on the label of a prescription drug 12 |
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| 298 | 298 | | that is designed to call attention to the serious or 13 |
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| 299 | 299 | | life-threatening risk of the prescription drug. 14 |
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| 300 | 300 | | (2) The term ‘‘covered veteran’’ means a vet-15 |
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| 301 | 301 | | eran who received hospital care or medical services 16 |
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| 302 | 302 | | furnished by the Department of Veterans Affairs 17 |
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| 303 | 303 | | during the five-year period preceding the death of 18 |
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| 304 | 304 | | the veteran. 19 |
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| 305 | 305 | | (3) The term ‘‘first-line treatment’’ means a po-20 |
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| 306 | 306 | | tential intervention that has been evaluated and as-21 |
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| 307 | 307 | | signed a high score within clinical practice guide-22 |
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| 308 | 308 | | lines. 23 |
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| 309 | 309 | | (4) The term ‘‘State’’ means each of the States, 24 |
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| 310 | 310 | | territories, and possessions of the United States, the 25 |
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| 313 | 313 | | •HR 136 IH |
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| 314 | 314 | | District of Columbia, and the Commonwealth of 1 |
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| 315 | 315 | | Puerto Rico. 2 |
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| 316 | 316 | | Æ |
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