38 U.S.C. § 1720A: Treatment and rehabilitative services for persons with drug or alcohol dependency

The Secretary, in consultation with the Secretary of Labor and the Director of the Office of Personnel Management, may take appropriate steps to (1) urge all Federal agencies and appropriate private and public firms, organizations, agencies, and persons to provide appropriate employment and training opportunities for veterans who have been provided treatment and rehabilitative services under this title for alcohol or drug dependence or abuse disabilities and have been determined by competent medical authority to be sufficiently rehabilitated to be employable, and (2) provide all possible assistance to the Secretary of Labor in placing such veterans in such opportunities. provide referral services to assist such individual, to the maximum extent practicable, in obtaining treatment and rehabilitative services from sources outside the Department; and if pertinent, advise such individual of such individual’s rights to apply to the appropriate military, naval, air, or space service and the Department for review of such individual’s discharge or release from such service. Any person serving in the active military, naval, air, or space service who is determined by the Secretary concerned to have an alcohol or drug dependence or abuse disability may be transferred to any facility in order for the Secretary to furnish care or treatment and rehabilitative services for such disability. Care and services provided to a member so transferred shall be provided as if such member were a veteran. Any transfer of any such member for such care and services shall be made pursuant to such terms as may be agreed upon by the Secretary concerned and the Secretary, subject to the provisions of sections 1535 and 1536 of title 31. No person serving in the active military, naval, air, or space service may be transferred pursuant to an agreement made under paragraph (1) of this subsection unless such person requests such transfer in writing for a specified period of time. No such person transferred pursuant to such a request may be furnished such care and services by the Secretary beyond the period of time specified in such request unless such person requests in writing an extension for a further specified period of time and such request is approved by the Secretary. The Secretary shall ensure that each medical center of the Department develops and carries out a plan to provide treatment for substance use disorders, either through referral or direct provision of services, to veterans who require such treatment. Each plan under paragraph (1) shall make available clinically proven substance abuse treatment methods, including opioid substitution therapy, to veterans with respect to whom a qualified medical professional has determined such treatment methods to be appropriate. Not later than 270 days after the date of the enactment of this Act [ Dec. 29, 2022 ], the Secretary of Veterans Affairs shall commence carrying out a pilot program under which the Secretary shall award grants to eligible entities for the provision or coordination of services for recovery from substance use disorder for veterans who are homeless, were previously homeless and are transitioning to permanent housing, or are at risk of becoming homeless. The Secretary shall carry out the pilot program during the five-year period beginning on the date of the commencement of the pilot program. The Secretary shall carry out the pilot program at not fewer than five locations selected by the Secretary for purposes of the pilot program. In carrying out the pilot program, the Secretary shall award a grant to an eligible entity for each veteran with substance use disorder participating in the pilot program for which the eligible entity is providing or coordinating the provision of recovery services for substance use disorder under the pilot program. The Secretary may establish intervals of payment for the administration of grants under this section and a maximum amount to be awarded, in accordance with the services being provided and the duration of such services. In awarding grants under paragraph (1), the Secretary shall give preference to eligible entities providing or coordinating the provision of recovery services for substance use disorder for veterans with substance-use dependency who face barriers in accessing substance-use recovery services from the Department of Veterans Affairs. The Secretary shall ensure that, to the extent practicable, grant amounts awarded under paragraph (1) are equitably distributed across geographic regions, including rural and Tribal communities. The Secretary shall require each eligible entity awarded a grant under paragraph (1) to submit to the Secretary a report that describes the services provided or coordinated with amounts under such grant. Each entity receiving a grant under this section shall notify the recipients of services provided pursuant to grant amounts that such services are being paid for, in whole or in part, by the Department. coordinate with the Secretary with respect to the provision of clinical services to eligible individuals or any other provisions of law regarding the delivery of health care by the Secretary; inform each veteran who receives assistance under this section from the entity of the ability of the veteran to apply for enrollment in the patient enrollment system of the Department under section 1705(a) of title 38 , United States Code; and if such a veteran wishes to so enroll, inform the veteran of a point of contact at the Department who can assist the veteran in such enrollment. An eligible entity seeking the award of a grant under this section shall submit to the Secretary an application therefor in such form, in such manner, and containing such commitments and information as the Secretary considers necessary to carry out this section. A description of the recovery services for substance use disorder proposed to be provided by the eligible entity under the pilot program and the identified need for those services. A description of the types of veterans with substance use disorder proposed to be provided such recovery services. An estimate of the number of veterans with substance use disorder proposed to be provided such recovery services. Evidence of the experience of the eligible entity in providing such recovery services to veterans with substance use disorder. to assess continually the needs of veterans with substance use disorder for such recovery services; to coordinate the provision of such recovery services with services provided by the Department; and to tailor such recovery services to the needs of veterans with substance use disorder. The Secretary shall establish criteria for the selection of eligible entities to be awarded grants under this section. Relevant accreditation as may be required by each State in which the eligible entity operates. Experience coordinating care or providing treatment for veterans or members of the Armed Forces. Participation by a veteran in the pilot program shall not affect any eligibility status or requirements for such veteran with respect to other benefits or services provided by the Department. The Secretary shall provide training and technical assistance to eligible entities awarded grants under this section regarding the planning, development, and provision of recovery services for substance use disorder under this section. The Secretary may provide the training required under paragraph (1) directly or through grants or contracts with such public or nonprofit private entities as the Secretary considers appropriate for purposes of this section, including through grants awarded under section 2064 of title 38 , United States Code. To the extent practicable, the Secretary may collect information from an eligible entity awarded a grant under this section relating to a substance use disorder of a veteran participating in the pilot program for inclusion in the electronic health record of the Department for such veteran for the sole purpose of improving care provided to such veteran. The Secretary shall conduct a study on the effectiveness of the pilot program in meeting the needs of veterans with substance use disorder. In conducting the study required by paragraph (1), the Secretary shall compare the results of the pilot program with other programs of the Department dedicated to the delivery to veterans of recovery services for substance use disorder. The satisfaction of veterans targeted by the programs described in paragraph (2). The health status of such veterans, including mental health. The degree to which such programs encourage such veterans to engage in productive activity. veterans who have received health care provided by the Department during the two-year period preceding the conduct of the study; veterans who have not received health care provided by the Department during such period; veterans eligible for services from the Department similar to services provided under the pilot program; and veterans not eligible for such services from the Department; and veterans ineligible for health care provided by the Department. The number of veterans who are still homeless or at risk of becoming homeless one year after completion of receipt of recovery services under such programs. The number of veterans who still have a substance use disorder that negatively impacts their daily living and ability to maintain independent housing 180 days after discharge from receipt of services provided under this section. The status of the discharge from the Armed Forces of veterans covered under this paragraph. Not later than one year after the date on which the first grant is awarded under 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 on the results of the study required by paragraph (1). no part of the net earnings of which inures to the benefit of any member, founder, contributor, or individual; that has a governing board that is responsible for the operation of the recovery services for substance use disorder provided under this section; and that is approved by the Secretary with respect to financial responsibility. A for-profit limited partnership, the sole general partner of which is an organization meeting the requirements of subparagraph (A). A corporation wholly owned and controlled by an organization meeting the requirements of subparagraph (A). A tribally designated housing entity (as defined in section 4 of the Native American Housing Assistance and Self-Determination Act of 1996 ( 25 U.S.C. 4103 )). The term ‘substance use disorder’, with respect to a veteran, means the veteran has been diagnosed with, or is seeking treatment for, substance use disorder, as determined by the Secretary.” More than 1,500,000 members of the Armed Forces have been deployed in Operation Iraqi Freedom and Operation Enduring Freedom. The 2005 Department of Defense Survey of Health Related Behaviors Among Active Duty Personnel reports that 23 percent of members of the Armed Forces on active duty acknowledge a significant problem with alcohol use disorder, with similar rates of acknowledged problems with alcohol use disorder among members of the National Guard. The effects of substance use disorder are wide ranging, including significantly increased risk of suicide, exacerbation of mental and physical health disorders, breakdown of family support, and increased risk of unemployment and homelessness. While veterans suffering from mental health conditions, chronic physical illness, and polytrauma may be at increased risk for development of a substance use disorder, treatment for these veterans is complicated by the need to address adequately the physical and mental symptoms associated with these conditions through appropriate medical intervention. While the Veterans Health Administration has dramatically increased health services for veterans from 1996 through 2006, the number of veterans receiving specialized substance use disorder treatment services decreased 18 percent during that time. No comparable decrease in the national rate of substance use disorder has been observed during that time. While some facilities of the Veterans Health Administration provide exemplary substance use disorder treatment services, the availability of such treatment services throughout the health care system of the Veterans Health Administration is inconsistent. According to a 2006 report by the Government Accountability Office, the Department of Veterans Affairs significantly reduced its substance use disorder treatment and rehabilitation services between 1996 and 2006, and the Fiscal Year 2007 National Mental Health Program Monitoring System report shows that little progress has been made in restoring these services to their pre-1996 levels. Screening for substance use disorder in all settings, including primary care settings. Short term motivational counseling services. Marital and family counseling. Intensive outpatient or residential care services. Relapse prevention services. Ongoing aftercare and outpatient counseling services. Opiate substitution therapy services. Pharmacological treatments aimed at reducing craving for drugs and alcohol. Detoxification and stabilization services. Coordination with groups providing peer to peer counseling. Such other services as the Secretary considers appropriate. The Secretary shall ensure that amounts made available for care, treatment, and services provided under this section are allocated in such a manner that a full continuum of care, treatment, and services described in subsection (a) is available to veterans seeking such care, treatment, or services, without regard to the location of the residence of any such veterans. at Department of Veterans Affairs medical centers or clinics; by referral to other facilities of the Department that are accessible to such veteran; or by contract or fee-for-service payments with community-based organizations for the provision of such services and treatments. If the Secretary denies the provision to a veteran of services or treatment for a substance use disorder due to clinical necessity, the Secretary shall provide the veteran such other services or treatment as are medically appropriate. through a service provided by a clinician or health professional who has training and expertise in treatment of substance use disorders and mental health disorders; by separate substance use disorder and mental health disorder treatment services when there is appropriate coordination, collaboration, and care management between such treatment services; or by a team of clinicians with appropriate expertise. Clinicians and health professionals with expertise in treatment of substance use disorders and mental health disorders who act in coordination and collaboration with each other. Such other professionals as the Secretary considers appropriate for the provision of treatment to veterans for substance use and mental health disorders. Stigma associated with seeking treatment for mental health disorders has been demonstrated to prevent some veterans from seeking such treatment at a medical facility operated by the Department of Defense or the Department of Veterans Affairs. There is a significant incidence among veterans of post-deployment mental health problems, especially among members of a reserve component who return as veterans to civilian life. Computer-based self-guided training has been demonstrated to be an effective strategy for supplementing the care of psychological conditions. Younger veterans, especially those who served in Operation Enduring Freedom or Operation Iraqi Freedom, are comfortable with and proficient at computer-based technology. Veterans living in rural areas may find access to treatment for substance use disorder limited. Self-assessment and treatment options for substance use disorders through an Internet website may reduce stigma and provides additional access for individuals seeking care and treatment for such disorders. Not later than October 1, 2009 , the Secretary of Veterans Affairs shall carry out a pilot program to assess the feasibility and advisability of providing veterans who seek treatment for substance use disorders access to a computer-based self-assessment, education, and specified treatment program through a secure Internet website operated by the Secretary. Participation in the pilot program shall be available on a voluntary basis for those veterans who have served in Operation Enduring Freedom or Operation Iraqi Freedom. access to the Internet website and the programs available on the website by a veteran (or family member) does not involuntarily generate an identifiable medical record of that access by that veteran in any medical database maintained by the Department of Veterans Affairs; the Internet website is accessible from remote locations, especially rural areas; and the Internet website includes a self-assessment tool for substance use disorders, self-guided treatment and educational materials for such disorders, and appropriate information and materials for family members of veterans. In designing the pilot program under this section, the Secretary shall consider similar pilot projects of the Department of Defense for the early diagnosis and treatment of post-traumatic stress disorder and other mental health conditions established under section 741 of the John Warner National Defense Authorization Act of [for] Fiscal Year 2007 ( Public Law 109–364 ; 120 Stat. 2304 ) [ 10 U.S.C. 1074 note]. The Secretary shall carry out the pilot program through those medical centers of the Department of Veterans Affairs that have established Centers for Excellence for Substance Abuse Treatment and Education or that have established a Substance Abuse Program Evaluation and Research Center. The Secretary may enter into contracts with qualified entities or organizations to carry out the pilot program required under this section. The pilot program required by subsection (a) shall be carried out during the two-year period beginning on the date of the commencement of the pilot program. Not later than six months after the completion of the pilot program, the Secretary shall submit to Congress a report on the pilot program, and shall include in that report—an assessment of the feasibility and advisability of continuing or expanding the pilot program, of any cost savings or other benefits associated with the pilot program, and any other recommendations. There are authorized to be appropriated to the Secretary of Veterans Affairs $1,500,000 for each of fiscal years 2010 and 2011 to carry out the pilot program under this section.” The alcohol and drug abuse contract care program under section 1720A of title 38 , United States Code. The program to provide community-based residential care to homeless chronically mentally ill veterans under section 115 of the Veterans’ Benefits and Services Act of 1988 [ Pub. L. 100–322 ] ( 38 U.S.C. 1712 note). The demonstration program under section 7 of Public Law 102–54 ( 38 U.S.C. 1718 note).” The Secretary of Veterans Affairs may make loans in accordance with this section to assist in the provision of transitional housing exclusively to veterans who are in (or who recently have been in) a program for the treatment of substance abuse. each loan is repaid within two years after the date on which the loan is made; each loan is repaid through monthly installments and that a reasonable penalty is assessed for each failure to pay an installment by the date specified in the loan agreement involved; and the use of alcohol or any illegal drug in the residence will be prohibited; any resident who violates the prohibition in subclause (A) of this clause will be expelled from the residence; the costs of maintaining the residence, including fees for rent and utilities, will be paid by the residents; the residents will, through a majority vote of the residents, otherwise establish policies governing the conditions of residence, including the manner in which applications for residence are approved; and the residence will be operated solely as a residence for not less than six veterans. Loans under this section shall be made from the special account of the General Post Fund of the Department of Veterans Affairs established for purposes of this section. The amount of such loans outstanding at any time may not exceed $100,000. Amounts received as payment of principal and interest on such loans shall be deposited in that account. The operation of the loan program under this section shall be separately accounted for, and shall be separately stated in the documents accompanying the President’s budget for each fiscal year. Loans under this section shall be made on such terms and conditions, including interest, as the Secretary prescribes. The default rate on loans extended under this section. The manner in which loan payments are collected. The number of facilities at which loans have been extended. The adequacy of the amount of funds in the special account referred to in subsection (c).”