Comment on FR Doc # 2026-14146

Thank you for the opportunity to comment on HRSA's Request for Information. As a veteran-serving nonprofit in rural Montana, we support evidence-based approaches that safely expand access to innovative mental health treatments. ## Workforce Training ### Pre-Administration Patient screening should occur in two phases. **Phase 1:** Medical evaluation by a licensed provider (physician, nurse practitioner, physician assistant, or registered nurse within scope) to assess medical history, medications, contraindications, and psychiatric risk. **Phase 2:** Preparation by trained behavioral health professionals to evaluate psychological readiness, trauma history, informed consent, expectations, and support systems. Telehealth is appropriate for screening, education, and preparation when clinically appropriate. ### Administration Patients should receive a medical evaluation before dosing, with emergency protocols in place. At least two trained staff members should be available during treatment, including one capable of responding to medical emergencies. Competency standards should emphasize trauma-informed care, crisis intervention, adverse event recognition, ethics, military cultural competency, and integration planning rather than relying solely on professional title. ### Follow-Up Structured follow-up is essential. Licensed behavioral health clinicians, certified peers, veteran mentors, whole health coaches, and community organizations can all contribute within their respective scopes of practice. Telehealth should be encouraged to improve access in rural communities. ### Training HRSA should establish a standardized national certification pathway that includes didactic education, simulation, supervised practicum, continuing education, and periodic competency assessment. ## Ambulatory and Rural Clinics Implementation should prioritize Rural Health Clinics, Federally Qualified Health Centers, Tribal health systems, Community Behavioral Health Clinics, and VA Community Care partners. Essential requirements include emergency protocols, medication security, patient monitoring, trained staff, behavioral health support, referral pathways, and quality assurance. Therapeutic environments should be encouraged but not required if they become barriers for rural implementation. ## Technology Artificial intelligence should support—not replace—clinical judgment. AI may assist with screening, medication review, symptom monitoring, documentation, follow-up, and workforce training, but it should never independently determine eligibility or replace human supervision during treatment. ## Community Partnerships Trusted veteran-serving nonprofits can expand access through education, outreach, peer support, preparation, wellness programming, post-treatment integration, and navigation into VA and community resources. ## Conclusion Successful implementation will require rigorous safety standards while ensuring equitable access for rural and medically underserved populations. HRSA has an opportunity to develop a scalable, multidisciplinary workforce that safely delivers future FDA-approved psychedelic therapies while leveraging partnerships among healthcare providers, researchers, veteran organizations, and community-based programs. This version is substantially shorter, eliminates repetition, and reads more like the type of concise public comment federal agencies typically receive while preserving your core recommendations.