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116th Congress    }                                   {         Report
                        HOUSE OF REPRESENTATIVES
 1st Session      }                                   {         116-71

======================================================================



 
                           WHOLE VETERAN ACT

                                _______
                                

  May 17, 2019.--Committed to the Committee on the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

          Mr. Takano, from the Committee on Veterans' Affairs,
                        submitted the following

                              R E P O R T

                        [To accompany H.R. 2359]

    The Committee on Veterans' Affairs, to whom was referred 
the bill (H.R. 2359) to direct the Secretary of Veterans 
Affairs to submit to Congress a report on the Department of 
Veterans Affairs advancing of whole health transformation, 
having considered the same, report favorably thereon with an 
amendment and recommend that the bill as amended do pass.

                                CONTENTS

                                                                   Page
Amendment........................................................     1
Purpose and Summary..............................................     2
Background and Need for Legislation..............................     2
Hearings.........................................................     4
Subcommittee Consideration.......................................     4
Committee Consideration..........................................     5
Committee Votes..................................................     5
Committee Oversight Findings.....................................     5
Congressional Budget Office Estimate; Committee Cost Estimate; 
  and New Budget Authority.......................................     5
Statement of General Performance Goals and Objectives............     6
Earmarks and Tax and Tariff Benefits.............................     6
Federal Mandates Statement.......................................     6
Advisory Committee Statement.....................................     6
Constitutional Authority Statement...............................     6
Applicability to Legislative Branch..............................     6
Statement on Duplication of Federal Programs.....................     6
Section-by-Section Analysis of the Legislation...................     6

    The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Whole Veteran Act''.

SEC. 2. REPORT ON DEPARTMENT OF VETERANS AFFAIRS ADVANCING OF WHOLE 
                    HEALTH TRANSFORMATION.

  (a) Report.--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 on the implementation of the Department of Veterans Affairs 
memorandum dated February 1, 2019, on the subject of Advancing Whole 
Health Transformation Across Veterans Health Administration.
  (b) Matters Included.--The report under subsection (a) shall include 
the following:
          (1) An analysis of the accessibility and availability of each 
        of the following services at medical facilities of the 
        Department of Veterans Affairs (including community based 
        outpatient clinics, vet centers, and community living centers):
                  (A) Massage.
                  (B) Chiropractic services.
                  (C) Whole health clinician services.
                  (D) Whole health coaching.
                  (E) Acupuncture.
                  (F) Healing touch.
                  (G) Whole health group services.
                  (H) Guided imagery.
                  (I) Meditation.
                  (J) Hypnosis.
                  (K) Yoga.
                  (L) Tai chi or Qi gong.
                  (M) Equine assisted therapy.
                  (N) Any other service the Secretary determines 
                appropriate.
          (2) An assessment of the health outcomes derived from the 
        services specified in paragraph (1).
          (3) An assessment of the resources required to expand such 
        services to the entire Veterans Health Administration.
          (4) A plan to provide the services referred to in paragraph 
        (1) to veterans who reside in a geographic area where no 
        community-based outpatient clinic, medical center, Vet Center, 
        or community living center is located.

                          PURPOSE AND SUMMARY

    H.R. 2359, as amended, would require the Secretary of the 
Department of Veterans Affairs (VA) to submit to Congress a 
report on the implementation of the February 1, 2019 Whole 
Health Transformation Memorandum. The report would include an 
analysis of the accessibility and availability of relevant 
services with respect to the implementation of such memorandum, 
an assessment of health outcomes, and an assessment of 
resources necessary to expand Whole Health to the VHA 
enterprise. It would also require VA to produce a plan on the 
delivery of VA Whole Health elements to veterans living in 
areas without access to VA facilities.
    Representative Conor Lamb of Pennsylvania introduced H.R. 
2359 on April 25, 2019.

                  BACKGROUND AND NEED FOR LEGISLATION

    America's healthcare systems are grappling with redesigning 
delivery of care to meet healthcare needs in this country. 
Social isolation, economic inequality, and prohibitive health 
care costs have led to increased use of complementary and 
alternative medicine (CAM), or complementary and integrative 
health (CIH), such as health coaching, chiropractic services, 
acupuncture, yoga, meditation, and equine therapy. The Veterans 
Health Administration (VHA) is one of the first to take steps 
to create a system focused on maintaining health, rather than a 
system designed to only treat disease. This redesign will 
appropriately accommodate the veteran population and their 
unique needs while empowering veterans to control their health 
and wellbeing.
    In 2000, the White House Commission on Complementary and 
Alternative Medicine Policy (WHCCAMP) submitted a report to the 
President that included public policy recommendations to 
maximize the benefits of CIH for Americans.\1\ The report 
called on VA to assist in the implementation of its 
recommendations. In 2005, the Institute of Medicine (IOM) (now 
the National Academy of Medicine) suggested (1) health care 
should strive to be both comprehensive and evidence-based; and 
(2) conventional medical treatments and CIH should be held to 
the same standards for validating clinical effectiveness.\2\ A 
report from VHA's Healthcare Analysis and Information Group, 
titled ``FY 2015 VHA Complementary & Integrative Health 
Services (formerly CAM)'' demonstrated the CIH practices in 
greatest use within VHA were acupuncture, animal assisted 
therapy, biofeedback, guided imagery, hypnosis, meditation, 
music therapy, progressive muscle relaxation, stress management 
and relaxation therapy, and yoga.\3\ VA recognizes these 
practices help in developing a patient's personalized and 
patient-centric treatment plan.
---------------------------------------------------------------------------
    \1\VHA Directive 1137, Provision of Complementary and Integrative 
Health (CIH), May 18, 2017, 2c
    \2\VHA Directive 1137, Provision of Complementary and Integrative 
Health (CIH), May 18, 2017, 2e
    \3\VHA Directive 1137, Provision of Complementary and Integrative 
Health (CIH), May 18, 2017, 2h
---------------------------------------------------------------------------
    The Office of Patient Centered Care and Cultural 
Transformation (OPCC&CT) was established in January 2011. The 
OPCC&CT works with

          ``VHA leadership and other program offices to 
        transform the system of health care from the 
        traditional medical model to a whole health system of 
        care, which is personalized, proactive, and patient 
        driven. The mission of OPCC & CT is to catalyze and 
        sustain cultural transformation in healthcare for and 
        with Veterans. Its stated vision is to transform from a 
        problem-based disease care system to a patient centered 
        health care system.''\4\
---------------------------------------------------------------------------
    \4\VHA Directive 1137, Provision of Complementary and Integrative 
Health (CIH), May 18, 2017, 2j

    In 2017, VHA launched the Whole Health Transformation 
Program at 18 flagship sites, with positive early outcomes. 
According to a February 2019 memo, ``Advancing Whole Health 
Transformation Across Veterans Health Administration,'' VHA 
plans to expand the full program to an additional 18 sites by 
summer 2019, though 140 medical centers have elements of the 
program.
    As VA struggles to prevent the tragic reality of 20 veteran 
suicides per day, programs that provide the means for social 
connection and wellness services are crucial.\5\ The pace, 
efficacy, and reach of the Whole Health program are not known 
to Congress. Thus, by requiring the delivery of a report on the 
subject of ``Advancing Whole Health Transformation Across 
Veterans Health Administration,'' with analysis of 
accessibility of critical services, Congress can better inform 
its efforts to ensure veterans are treated as whole people, and 
not episodes of care. This is particularly true for socially 
isolated veterans and veterans living far from a VA facility. 
As such, Congress must understand how VA has rolled out the 
initial expansion, the outcomes, and the resources needed to 
continue the program.
---------------------------------------------------------------------------
    \5\VA National Suicide Data Report 2005-2016, Office of Mental 
Health and Suicide Prevention, U.S. Department of Veterans Affairs, 
September 2018.
---------------------------------------------------------------------------

                                HEARINGS

    For the purposes of section 103(i) of H.Res. 6 of the 116th 
Congress--(1) the following hearings were used to develop or 
consider H.R. 2359.
    On April 29, 2019, the Committee on Veterans' Affairs 
conducted an oversight hearing titled, ``Tragic Trends: Suicide 
Prevention Among Veterans''' to explore actions the Department 
of Veterans Affairs and the House Committee on Veterans' 
Affairs could take to combat the epidemic of suicide within the 
veteran population.
    The following witnesses testified:
          Shelli Avenevoli PhD, the Deputy Director of the 
        National Institute of Mental Health within the National 
        Institute of Health; Richard McKeon PhD, MPH, the Chief 
        of the Suicide Prevention Branch within the Substance 
        Abuse and Mental Health Services Administration; and 
        Richard Stone M.D., the Executive-in-Charge of the 
        Veterans Health Administration within the U.S. 
        Department of Veterans Affairs, who was accompanied by 
        Keita Franklin LCSW, PhD, the National Director of 
        Suicide Prevention of the Office of Mental Health and 
        Suicide Prevention within the U.S. Department of 
        Veterans Affairs.
    Statements for the record were received by American 
Veterans, Disabled American Veterans, Iraq and Afghanistan 
Veterans of America, The American Legion, Vietnam Veterans of 
America, Wounded Warrior Project, Center for Disease Control, 
Veterans of Foreign Wars, and The Independence Fund.
    On April 30, 2019, the Subcommittee on Health conducted a 
legislative hearing on several bills including H.R. 2359.
    The following witnesses testified:
          The Honorable Earl Blumenauer, U.S. House of 
        Representatives; The Honorable J. Louis Correa, U.S. 
        House of Representatives; The Honorable Conor Lamb, 
        U.S. House of Representatives; The Honorable Max Rose, 
        U.S. House of Representatives; Keita Franklin LCSW, 
        PhD, the National Director of Suicide Prevention of the 
        Office of Mental Health and Suicide Prevention within 
        the U.S. Department of Veterans Affairs, who was 
        accompanied by Tracy Gaudet M.D., the Director of the 
        Office of Patient Centered Care within the U.S. 
        Department of Veterans Affairs and Larry Mole PharmD, 
        the Chief Consultant on Population Health of the U.S. 
        Department of Veterans Affairs; Stephanie Mullen, 
        Research Director for Iraq and Afghanistan Veterans of 
        America; Carlos Fuentes, the Director of the National 
        Legislative Service within Veterans of Foreign Wars; 
        and Joy Ilem, the National Legislative Director for 
        Disabled American Veterans.
    No statements for the record were received.

                       SUBCOMMITTEE CONSIDERATION

    H.R. 2359 was not considered before the Subcommittee.

                        COMMITTEE CONSIDERATION

    On May 8, 2019, the Committee on Veterans' Affairs met in 
an open markup session, a quorum being present, and reported 
H.R. 2359, as amended, favorably to the House of 
Representatives by voice vote. During consideration of the 
bill, the following amendments were considered and agreed to by 
voice vote:
    An amendment in the nature of a substitute offered by 
Representative Mark Takano of California that would require the 
Secretary of the Department of Veterans Affairs to submit to 
Congress a report on the implementation of the February 1, 2019 
Whole Health Transformation Memorandum. The report would 
include an analysis of the accessibility and availability of 
relevant services with respect to the implementation of such 
memorandum, an assessment of health outcomes, and an assessment 
of resources necessary to expand Whole Health to the VHA 
enterprise.
    An amendment to the amendment in the nature of substitute 
offered by Representative Gregorio Sablan that would require VA 
to submit a plan to provide the components of Whole Health to 
veterans without access to a VA facility, including a medical 
facility, community-based outpatient center, or Vet Center.
    An amendment to the amendment in the nature of a substitute 
offered by Representative Andy Barr of Kentucky that would 
ensure VA considers the availability of equine therapy as part 
of its assessment.

                            COMMITTEE VOTES

    In compliance with clause 3(b) of rule XIII of the Rules of 
the House of Representatives, there were no recorded votes 
taken on amendments or in connection with ordering H.R. 2359, 
as amended, reported to the House. A motion by Ranking Member 
David P. Roe of Tennessee to report H.R. 2359, as amended, 
favorably to the House of Representatives was adopted by voice 
vote.

                      COMMITTEE OVERSIGHT FINDINGS

    In compliance with clause 3(c)(1) of rule XIII and clause 
(2)(b)(1) of rule X of the Rules of the House of 
Representatives, the Committee's oversight findings and 
recommendations are reflected in the descriptive portions of 
this report.

CONGRESSIONAL BUDGET OFFICE ESTIMATE; COMMITTEE COST ESTIMATE; AND NEW 
                            BUDGET AUTHORITY

    With respect to the requirements of clause 3(c)(2) of rule 
XIII of the Rules of the House of Representatives and section 
308(a) of the Congressional Budget Act of 1974 and with respect 
to requirements of clause (3)(c)(3) of rule XIII of the Rules 
of the House of Representatives and section 402 of the 
Congressional Budget Act of 1974, the Committee has requested 
but not received a cost estimate for this bill from the 
Director of the Congressional Budget Office. The Committee has 
requested but not received from the Director of the 
Congressional Budget Office a statement as to whether this bill 
contains any new budget authority, spending authority, credit 
authority, or an increase or decrease in revenues or tax 
expenditures.

         STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES

    In accordance with clause 3(c)(4) of rule XIII of the Rules 
of the House of Representatives, the Committee's performance 
goals and objectives are to expand access to high quality 
mental healthcare and related resources to curb the prevalence 
of suicide among veterans, servicemembers, Reservists, and 
members of the Coast Guard and National Guard.

                  EARMARKS AND TAX AND TARIFF BENEFITS

    H.R. 2359, as amended, does not contain any Congressional 
earmarks, limited tax benefits, or limited tariff benefits as 
defined in clause 9 of rule XXI of the Rules of the House of 
Representatives.

                       FEDERAL MANDATES STATEMENT

    The Committee adopts as its own the estimate of Federal 
mandates regarding H.R. 2359, as amended, prepared by the 
Director of the Congressional Budget Office pursuant to section 
423 of the Unfunded Mandates Reform Act.

                      ADVISORY COMMITTEE STATEMENT

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act would be created by H.R. 
2359, as amended.

                   CONSTITUTIONAL AUTHORITY STATEMENT

    Pursuant to Article I, section 8 of the United States 
Constitution, H.R. 2359, as amended, is authorized by Congress' 
power to ``provide for the common Defense and general Welfare 
of the United States.''

                  APPLICABILITY TO LEGISLATIVE BRANCH

    The Committee finds that H.R. 2359, as amended, does not 
relate to the terms and conditions of employment or access to 
public services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

              STATEMENT ON DUPLICATION OF FEDERAL PROGRAMS

    Pursuant to clause 3(c)(5) of rule XIII of the Rules of the 
House of Representatives, the Committee finds that no provision 
of H.R. 2359, as amended, establishes or reauthorizes a program 
of the Federal Government known to be duplicative of another 
Federal program, a program that was included in any report from 
the Government Accountability Office to Congress pursuant to 
section 21 of Public Law 111-139, or a program related to a 
program identified in the most recent Catalog of Federal 
Domestic Assistance.

             SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION

Section 1. Short title

    Section 1 of the bill establishes the short title of the 
measure as the ``Whole Veteran Act.''

Section 2. Report on Department of Veterans Affairs Advancing of Whole 
        Health Transformation

    Section 2 of the bill requires, not later than 180 days 
after the date of enactment of this Act, the Secretary of 
Veterans Affairs submit to Congress a report on the 
implementation of the Whole Health Transformation as outlined 
in the Department of Veterans Affairs memorandum dated February 
1, 2019. The report shall include analysis on the accessibility 
and availability of massage, chiropractic services, whole 
health clinician services, whole health coaching, acupuncture, 
healing touch, whole health group services, guided imagery, 
meditation, hypnosis, yoga, Tai chi or Qi gong, equine therapy, 
and any other service the Secretary determines appropriate. The 
report will also include an assessment of the health outcomes 
from these services and an assessment of the resources required 
to expand such services to the entire VHA. Additionally, 
section 2 would require VA to submit a plan to the Committees 
on Veterans Affairs of the Senate and House of Representatives 
to provide the components of Whole Health to veterans without 
access to a VA facility such as a medical facility, community-
based outpatient center, or Vet Center.

                                  [all]