[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3713 Introduced in House (IH)]







104th CONGRESS
  2d Session
                                H. R. 3713

To amend title 38, United States Code, to improve health care services 
   for women veterans provided by the Department of Veterans Affairs.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 25, 1996

Ms. Brown of Florida introduced the following bill; which was referred 
                 to the Committee on Veterans' Affairs

_______________________________________________________________________

                                 A BILL


 
To amend title 38, United States Code, to improve health care services 
   for women veterans provided by the Department of Veterans Affairs.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Women Veterans Health Equity Act of 
1996''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) Health care for veterans has traditionally been 
        considered in terms of male veterans.
            (2) Women constitute nearly 5 percent of the total veteran 
        population, a percentage that is growing.
            (3) There are currently 1,200,000 female veterans in the 
        United States, a number which is steadily increasing.
            (4) Thirty percent of women using Department of Veterans 
        Affairs facilities report some form of sexual assault or sexual 
        trauma during their military service.

SEC. 3. TIMELY AND APPROPRIATE HEALTH CARE SERVICES FOR WOMEN.

    (a) Ensured Provision of Services.--The Secretary of Veterans 
Affairs shall ensure that each health-care facility under the direct 
jurisdiction of the Secretary is able, through services made available 
either by individuals appointed to positions in the Veterans Health 
Administration or under contracts or other agreements made under 
section 7409, 8111, or 8153 of title 38, United States Code, or title 
II of Public Law 102-585, to provide in a timely and appropriate manner 
women's health services (as defined in section 1701(10) of title 38, 
United States Code (as added by section 4) to any veteran described in 
section 1710(a)(1) of title 38, United States Code, who is eligible for 
such services.
    (b) Health Care Services To Be Provided Directly When Cost 
Effective.--(1) The Secretary shall ensure that each health-care 
facility under the direct jurisdiction of the Secretary shall provide 
women's health services directly (rather than by contract or other 
agreement) when it is cost effective to do so.
    (2) The Secretary shall ensure that each such facility is provided 
appropriate equipment, treatment facilities, and staff to carry out 
paragraph (1) and to ensure that the quality of care provided under 
that paragraph is in accordance with professional standards.
    (c) Conforming Repeal.--Section 302 of the Veterans' Health Care 
Amendments of 1983 (Public Law 98-160; 97 Stat. 1004; 38 U.S.C. 1701 
note) is repealed.

SEC. 4. WOMEN'S HEALTH SERVICES.

    (a) Women's Health Services.--Section 1701 of title 38, United 
States Code, is amended--
            (1) in paragraph (6)(A)(i), by inserting ``women's health 
        services,'' after ``preventive health services,''; and
            (2) by adding at the end the following:
    ``(10) The term `women's health services' means health care 
services provided to women. Such term includes counseling and services 
relating to the following:
            ``(A) Papanicolaou tests (pap smear).
            ``(B) Breast examinations and mammography.
            ``(C) The treatment, management, and prevention of sexually 
        transmitted diseases.
            ``(D) Hormone replacement therapy.
            ``(E) Menopause, osteoporosis, senility, and other 
        conditions relating to aging.
            ``(F) Cardiac care.
            ``(G) Physical and psychological conditions arising out of 
        acts of sexual violence or sexual intimidation.
            ``(H) Well-baby care and pediatrics.
            ``(I) Physical and psychological conditions that result 
        from homelessness.''.
    (b) Contracts for Women's Health Services.--Section 1703(a) of such 
title is amended by adding at the end the following:
            ``(9) Women's health services for veterans on an ambulatory 
        or outpatient basis.''.
    (c) Repeal of Superseded Authority.--Section 106 of the Veterans 
Health Care Act of 1992 (Public Law 102-585; 38 U.S.C. 1710 note) is 
amended--
            (1) by striking out subsection (a); and
            (2) by striking out ``(b) Responsibilities of Directors of 
        Facilities.--'' before ``The Secretary''.

SEC. 5. PRIMARY CARE SERVICES.

    (a) Training of Primary Care Physicians.--The Secretary of Veterans 
Affairs shall ensure that primary care physicians of the Department of 
Veterans Affairs are trained and prepared to ask the appropriate 
questions in regard to the possibility that a patient who is a woman 
veteran may have experienced sexual assault or sexual trauma while in 
active military, naval, or air service.
    (b) Pregnancy Care for Women Veterans With Service-Connected 
Disability.--The Secretary of Veterans Affairs shall make available to 
any pregnant veteran who has a service-connected disability pregnancy 
care services, including pre-natal, delivery, and post-natal care.

SEC. 6. OUTREACH SERVICES FOR HOMELESS WOMEN VETERANS.

    Section 7722(e) of title 38, United States Code, is amended by 
adding at the end the following new sentence: ``In carrying out this 
subsection, the Secretary shall take such steps as may be necessary to 
ensure that homeless women veterans are included in such outreach 
programs and outreach services. Such programs and services for women 
veterans shall include the following:
            ``(1) Crisis counseling and psychological testing for Post-
        Traumatic Stress Disorder and other manic depressive illnesses.
            ``(2) Transportation for outreach assistance.
            ``(3) Priority placement for inpatient services.
            ``(4) Follow-up and after-care treatment.''.

SEC. 7. SAFE AND EFFECTIVE TREATMENT FOR WOMEN PSYCHIATRIC PATIENTS.

    (a) Safe and Effective Treatment.--The Secretary of Veterans 
Affairs shall ensure that women veterans who receive psychiatric 
treatment from the Secretary, particularly in the case of women who are 
sexually traumatized, receive such treatment (on both an inpatient and 
outpatient basis) in a safe and effective manner that recognizes the 
privacy needs of such women. The Secretary shall ensure strict 
confidentiality for women veterans receiving such treatment. Services 
to be provided women veterans who require such treatment shall include 
the following:
            (1) Private counseling.
            (2) A comprehensive medical examination and evaluation.
    (b) Partnerships To Provide Temporary Shelter.--As part of a 
program of treatment under subsection (a), the Secretary shall 
establish partnerships with nonprofit entities to provide temporary 
housing for homeless women veterans until their mental condition is 
stabilized.

SEC. 8. MAMMOGRAPHY QUALITY STANDARDS.

    (a) In General.--(1) Subchapter II of chapter 73 is amended by 
adding at the end the following new section:
``Sec. 7319. Mammography quality standards
    ``(a) A mammogram may not be performed at a Department facility 
unless that facility is accredited for that purpose by a private 
nonprofit organization designated by the Secretary. An organization 
designated by the Secretary under this subsection shall meet the 
standards for accrediting bodies established under section 354(e) of 
the Public Health Service Act (42 U.S.C. 263b(e)).
    ``(b) The Secretary, in consultation with the Secretary of Health 
and Human Services, shall prescribe quality assurance and quality 
control standards relating to the performance and interpretation of 
mammograms and use of mammogram equipment and facilities of the 
Department of Veterans Affairs consistent with the requirements of 
section 354(f)(1) of the Public Health Service Act. Such standards 
shall be no less stringent than the standards prescribed by the 
Secretary of Health and Human Services under section 354(f) of the 
Public Health Service Act.
    ``(c)(1) The Secretary, to ensure compliance with the standards 
prescribed under subsection (b), shall provide for an annual inspection 
of the equipment and facilities used by and in Department health care 
facilities for the performance of mammograms. Such inspections shall be 
carried out in a manner consistent with the inspection of certified 
facilities by the Secretary of Health and Human Services under section 
354(g) of the Public Health Service Act.
    ``(2) The Secretary may not provide for an inspection under 
paragraph (1) to be performed by a State agency.
    ``(d) The Secretary shall ensure that mammograms performed for the 
Department under contract with any non-Department facility or provider 
conform to the quality standards prescribed by the Secretary of Health 
and Human Services under section 354 of the Public Health Service Act.
    ``(e) For the purposes of this section, the term `mammogram' has 
the meaning given such term in paragraph (5) of section 354(a) of the 
Public Health Service Act (42 U.S.C. 263b(a)).''.
    (2) The table of sections at the beginning of such chapter is 
amended by inserting after the item relating to section 7318 the 
following new item:

``7319. Mammography quality standards.''.
    (b) Deadline for Prescribing Standards.--The Secretary of Veterans 
Affairs shall prescribe standards under subsection (b) of section 7319 
of title 38, United States Code, as added by subsection (a), not later 
than the end of the 120-day period beginning on the date of the 
enactment of this Act.
    (c) Implementation Report.--The Secretary of Veterans Affairs shall 
submit to the Committees on Veterans' Affairs of the Senate and House 
of Representatives a report on the Secretary's implementation of 
section 7319 of title 38, United States Code, as added by subsection 
(a). The report shall be submitted not later than 120 days after the 
later of (1) the date on which the Secretary prescribes the quality 
standards required under subsection (b) of that section, or (2) the 
date of the enactment of this Act.

SEC. 9. COORDINATION OF SERVICES.

    Section 108 of the Women Veterans Health Programs Act of 1992 
(title I of Public Law 102-585; 38 U.S.C. 1710) is amended--
            (1) by inserting ``(a)'' at the beginning of the text of 
        the section; and
            (2) by adding at the end the following:
    ``(b)(1) Each coordinator of women's services under subsection (a) 
shall serve in that capacity on a full-time basis, with the duties of 
that position being that official's principal responsibility.
    ``(2) The Secretary shall ensure that (subject to the availability 
of appropriations) sufficient resources are provided to each such 
coordinator to enable that coordinator to carry out the functions of 
the coordinator under this section and shall ensure that each such 
coordinator has direct access to the Chief of Staff of each Department 
medical facility in that coordinator's region.''.

SEC. 10. PATIENT PRIVACY FOR WOMEN PATIENTS.

    (a) Identification of Deficiencies.--The Secretary of Veterans 
Affairs shall conduct a survey of each medical center under the 
jurisdiction of the Secretary to identify deficiencies relating to 
patient privacy afforded to women patients in the clinical areas at 
each such center which may interfere with appropriate treatment of such 
patients.
    (b) Correction of Deficiencies.--The Secretary shall ensure that 
plans and, where appropriate, interim steps, to correct the 
deficiencies identified in the survey conducted under subsection (a) 
are developed and are incorporated into the Department's construction 
planning processes and given a high priority.
    (c) Reports to Congress.--The Secretary shall compile an annual 
inventory, by medical center, of deficiencies identified under 
subsection (a) and of plans and, where appropriate, interim steps, to 
correct such deficiencies. The Secretary shall submit to the Committees 
on Veterans' Affairs of the Senate and House of Representatives, not 
later than October 1, 1997, and not later than October 1 each year 
thereafter through 2000 a report on such deficiencies. The Secretary 
shall include in such report the inventory compiled by the Secretary, 
the proposed corrective plans, and the status of such plans.

SEC. 11. OUTREACH SERVICES.

    The Secretary of Veterans Affairs shall carry out a program of 
advertising in mass media to inform women veterans of the health 
services available to them through the Department of Veterans Affairs.
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