[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4107 Introduced in House (IH)]







110th CONGRESS
  1st Session
                                H. R. 4107

  To amend title 38, United States Code, to expand and improve health 
care services available to women veterans, especially those serving in 
   Operation Iraqi Freedom and Operation Enduring Freedom, from the 
        Department of Veterans Affairs, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            November 7, 2007

Ms. Herseth Sandlin (for herself and Ms. Ginny Brown-Waite of Florida) 
 introduced the following bill; which was referred to the Committee on 
Veterans' Affairs, and in addition to the Committee on Armed Services, 
for a period to be subsequently determined by the Speaker, in each case 
for consideration of such provisions as fall within the jurisdiction of 
                        the committee concerned

_______________________________________________________________________

                                 A BILL


 
  To amend title 38, United States Code, to expand and improve health 
care services available to women veterans, especially those serving in 
   Operation Iraqi Freedom and Operation Enduring Freedom, from the 
        Department of Veterans Affairs, and for other purposes.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Women Veterans 
Health Care Improvement Act''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
  TITLE I--STUDIES AND ASSESSMENTS OF DEPARTMENT OF VETERANS AFFAIRS 
                   HEALTH SERVICES FOR WOMEN VETERANS

Sec. 101. Long-term study on health of women serving in Operation Iraqi 
                            Freedom and Operation Enduring Freedom.
Sec. 102. Study of barriers for women veterans to health care from the 
                            department of veterans affairs.
Sec. 103. Comprehensive assessment of women's health care programs of 
                            the department of veterans affairs.
  TITLE II--IMPROVEMENT AND EXPANSION OF HEALTH CARE PROGRAMS OF THE 
           DEPARTMENT OF VETERANS AFFAIRS FOR WOMEN VETERANS

Sec. 201. Improvement of sexual trauma care programs of the department 
                            of veterans affairs.
Sec. 202. Dissemination of information on effective treatment, 
                            including evidence-based treatments, for 
                            women veterans with post-traumatic stress 
                            disorder (ptsd).
Sec. 203. Ensuring adequate provision of services for women veterans at 
                            Department of Veterans Affairs vet centers.
Sec. 204. Pilot program for child care for certain women veterans 
                            receiving health care from facilities of 
                            the department.
Sec. 205. Pilot program for women veterans newly separated from service 
                            for counseling in retreat settings.
Sec. 206. Addition of recently separated women veterans to serve on 
                            advisory committees.

  TITLE I--STUDIES AND ASSESSMENTS OF DEPARTMENT OF VETERANS AFFAIRS 
                   HEALTH SERVICES FOR WOMEN VETERANS

SEC. 101. LONG-TERM STUDY ON HEALTH OF WOMEN SERVING IN OPERATION IRAQI 
              FREEDOM AND OPERATION ENDURING FREEDOM.

    (a) Prospective, Population-Based Long-Term Study.--The secretary 
of veterans affairs shall enter in contracts with one or more qualified 
entities or organizations, in collaboration with the war-related injury 
and illness study centers of the veterans health administration, to 
conduct a long-term epidemiologic study on the health of women veterans 
who served on active duty in the combat theatres of Operation Iraqi 
Freedom and Operation Enduring Freedom. the study shall include 
information on general health, mental health, reproductive health, and 
mortality of such women veterans
    (b) Cohort.--The study shall utilize a sufficiently large cohort of 
women, and shall include a minimum follow-up period of ten years.
    (c) Arrangements With the Department of Defense.--The Secretary of 
Defense shall enter into arrangements with the Secretary of Veterans 
Affairs to carry out the requirements of this section. The Secretary of 
Defense shall make available to the Secretary of Veterans Affairs 
health care data in the possession of the Department of Defense with 
respect to such women veterans and shall provide access to the cohort 
of such women while serving in the armed forces. Such health care data 
shall include relevant pre-deployment health and health risk 
assessments with respect to such women veterans.
    (d) Annual Reports.--(1) Not later than 6 months after the date of 
the enactment of this Act, the Secretary of Veterans Affairs shall 
submit to Congress an initial report on the status of the 
implementation of the section.
    (2) Not later one year after the date of the submittal to Congress 
of the initial report required under paragraph (1), and annually 
thereafter through 2018, the Secretary of Veterans Affairs shall submit 
to Congress report on the progress and results of the long-term study 
required under this section. The final report required under this 
paragraph shall include a detailed description of the cumulative 
findings of the study and shall include recommendations for such 
administrative and legislative action as the Secretary of Veterans 
Affairs determines to be appropriate.
    (e) Authorization of Appropriations.--There are authorized to be 
appropriated to the Secretary of Veterans Affairs such sums as are 
necessary to carry out the provisions of this section.

SEC. 102. STUDY OF BARRIERS FOR WOMEN VETERANS TO HEALTH CARE FROM THE 
              DEPARTMENT OF VETERANS AFFAIRS.

    (a) Study.--The Secretary of Veterans Affairs shall conduct a 
comprehensive assessment of the barriers to the provision of 
comprehensive health care by the Department of Veterans Affairs 
encountered by women who are veterans, especially veterans of Operation 
Iraqi Freedom and Operation Enduring Freedom. The study should survey 
women veterans who seek or receive services from the healthcare system 
of the Department of Veterans Affairs as well as women veterans who do 
not seek or receive such services.
    (b) Elements.--(1) In conducting the study required by subsection 
(a), the Secretary of Veterans Affairs shall conduct research on the 
effects of the following:
            (A) Perceived stigma with respect to seeking mental health 
        care services.
            (B) The effect of driving distance or availability of other 
        forms of transportation to the nearest appropriate facility of 
        the Department on access to care.
            (C) Availability of child care.
            (D) Acceptability of integrated primary care, or with 
        women's health clinics, or both.
            (E) Comprehension of eligibility requirements for, and the 
        scope of services available under, such health care.
            (F) The quality and nature of the reception by providers of 
        such health care and their staff of the veteran.
            (G) The perception of personal safety and comfort of women 
        veterans in inpatient, outpatient, and behavioral health 
        facilities of the Department.
            (H) Cultural sensitivity of health care providers and staff 
        to issues that particularly affect women.
            (I) The effectiveness of outreach for health care services 
        available to women veterans.
            (J) Such other significant barriers as the Secretary of 
        Veterans Affairs may identify.
    (2) The Secretary of Veterans Affairs shall enter into contracts 
with qualified independent entities or organizations to carry out of 
the studies and research required under this section.
    (c) Mandatory Review of Data by Certain Divisions Within the 
Department.--The Secretary of Veterans Affairs shall ensure that the 
head of each specified division of the Department (as defined in 
subsection (e)(2)) reviews the results of the study. The head of each 
specified division of the Department shall submit findings with respect 
to the study to the Under Secretary for Health and to other pertinent 
program offices within the Department of Veterans Affairs with duties 
relating to health care services for women veterans.
    (d) Reports.--(1) Not later than 6 months after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall submit 
to Congress a report on the status of the implementation of the 
section.
    (2) Not later than 30 months after the date of the enactment of 
this section, the Secretary of Veterans Affairs shall submit to 
Congress a report on the study required under this section. The report 
shall include recommendations for such administrative and legislative 
action as the Secretary of Veterans Affairs determines to be 
appropriate. The report shall also include the findings of the head of 
each specified division of the Department and of the Under Secretary 
for Health.
    (e) Definition.--In this section--
            (1) the term ``facility of the Department'' has the meaning 
        given that term in section 1701(3) of title 38, United States 
        Code; and
            (2) the term ``specified division of the Department'' 
        means--
                    (A) the Center for Women Veterans, established 
                under section 318 of title 38, United States Code; and
                    (B) the Advisory Committee on Women Veterans, 
                established under section 542 of title 38, United 
                States Code.
    (f) Authorization of Appropriations.--There are authorized to be 
appropriated to the Secretary of Veterans Affairs such sums as are 
necessary to carry out the provisions of this section.

SEC. 103. COMPREHENSIVE ASSESSMENT OF WOMEN'S HEALTH CARE PROGRAMS OF 
              THE DEPARTMENT OF VETERANS AFFAIRS.

    (a) In General.--The Secretary of Veterans Affairs shall conduct a 
comprehensive assessment of all health care services and programs 
provided by the Department of Veterans Affairs for the health care 
needs of women veterans. Such comprehensive assessment shall include 
assessments of specialized programs for women with post-traumatic 
stress disorder, for women who are homeless, for women who require care 
for substance abuse or mental illnesses, and for women who require 
pregnancy care.
    (b) Specific Matters Studied.--(1) The Secretary of Veterans 
Affairs shall identify each of the following programs for women 
veterans provided by the Department and determine whether effective 
health care services, including evidenced-based health care services, 
are readily available to and easily accessed by women veterans:
            (A) Health promotion programs.
            (B) Disease prevention programs.
            (C) Health Care programs.
    (2) In making such determination, the Secretary of Veterans Affairs 
shall identify--
            (A) the frequency with which such services are available 
        and provided,
            (B) the demographics of the women veterans population,
            (C) the sites where such services are available and 
        provided, and
            (D) whether, and to what extent, waiting lists, geographic 
        distance, and other factors obstruct the receipt of any of such 
        services at any such site.
    (c) Development of Plan To Improve Services.--(1) After conducting 
the assessments required by subsection (a), the Secretary of Veterans 
Affairs shall develop a program to improve the provision of health care 
services to women veterans and to project the future health care, 
including mental health care, needs of women serving in the combat 
theatres of Operation Iraqi Freedom and Operation Enduring Freedom. In 
developing the program under this subsection, the Secretary of Veterans 
Affairs shall list the types of services available under each program 
at each Medical Center of the Department and shall indicate projected 
resource and staffing requirements to meet the health care needs of 
women veterans.
    (d) Report.--Not later than one year after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall submit 
to Congress a report on the assessment conducted pursuant to this 
section. The report shall include recommendations for such 
administrative and legislative action as the Secretary of Veterans 
Affairs determines to be appropriate.
    (e) GAO Report.--The Comptroller General of the United States shall 
review the report of the Secretary of Veterans Affairs required under 
subsection (d). Not later than 6 months after the date on which the 
Secretary submits such report, the Comptroller General shall submit to 
Congress a report containing the findings of the Comptroller General 
with respect to the report of the Secretary and may include such 
recommendations for administrative or legislative actions as the 
Comptroller General determines to be appropriate.

  TITLE II--IMPROVEMENT AND EXPANSION OF HEALTH CARE PROGRAMS OF THE 
           DEPARTMENT OF VETERANS AFFAIRS FOR WOMEN VETERANS

SEC. 201. IMPROVEMENT OF SEXUAL TRAUMA CARE PROGRAMS OF THE DEPARTMENT 
              OF VETERANS AFFAIRS.

    (a) Improved Training for Health Care Personnel.--Section 1720D of 
title 38, United States Code, is amended--
            (1) by redesignating subsection (d) as subsection (f); and
            (2) by inserting after subsection (c) the following new 
        subsections:
    ``(d)(1)(A) The Secretary shall provide training for mental health 
professionals who provide counseling and care to veterans eligible for 
services under subsection (a). In carrying out such training, the 
Secretary shall ensure that all such mental health professionals have 
been trained in a consistent manner and that such training includes 
principles of evidence-based treatment and care for sexual trauma.
    ``(B) In the case of primary care providers who provide medical 
care for veterans who may be eligible for services under subsection 
(a), the Secretary shall ensure appropriate training of such primary 
care providers in screening for and recognizing symptoms of sexual 
trauma and procedures for the prompt referral of such veterans to 
mental health professionals described in subparagraph (A).
    ``(2) Counseling, care, and services under subsection (a) should 
include the services of therapists qualified to provide counseling for 
sexual trauma and who demonstrate a comprehension of the burden of 
exposure to both combat and sexual trauma inservicemembers of the Armed 
Forces.
    ``(e) The Secretary shall submit to Congress an annual report on 
the counseling and care and services provided to veterans by reason of 
this section. Each report shall include data for the year involved with 
respect to the following:
            ``(1) The number of mental health professionals and primary 
        care providers who received training under subsection (d).
            ``(2) The number of women veterans who received counseling 
        and care and services under subsection (a) from professionals 
        and providers who received training under subsection (d).
            ``(3) The number of training programs operating by reason 
        of subsection (d).
            ``(4) The number of trained full-time equivalent employees 
        required in each facility of the Department to meet the needs 
        of veterans requiring treatment and care for sexual trauma.
            ``(5) Such other information as the Secretary determines to 
        be appropriate.''.
    (b) Establishment of Staffing Standards.--The Secretary of Veterans 
Affairs shall establish staffing standards used at Department health-
care facilities for full-time equivalent employees who are trained to 
provide treatment and care for sexual trauma to veterans. Such 
standards shall be established in a manner that ensures availability 
and accessibility of such treatment and care for all such veterans 
seeking such treatment and care at such facilities.

SEC. 202. DISSEMINATION OF INFORMATION ON EFFECTIVE TREATMENT, 
              INCLUDING EVIDENCE-BASED TREATMENTS, FOR WOMEN VETERANS 
              WITH POST-TRAUMATIC STRESS DISORDER (PTSD).

    (a) In General.--The Secretary of Veterans Affairs shall develop a 
plan for the identification, development, and dissemination of 
effective treatments, including evidenced-based treatments, for post-
traumatic stress disorder and other co-morbid conditions (attributable 
to combat or sexual trauma) that are proven effective for women 
veterans. The Secretary shall develop and implement the plan through 
the National Center for Post-traumatic Stress Disorder (PTSD) of the 
Department of Veterans Affairs.
    (b) Dissemination of Information on Treatment.--(1) The plan 
required under subsection (a) shall include a proposed timetable for 
the dissemination of such treatments, including evidence-based 
treatments, throughout all facilities of the Department, but in no case 
may such dissemination occur later than one year after the date of the 
enactment of this Act.
    (2) The timetable for the completion of such dissemination shall 
include proposed additional resources for the treatment programs, for 
training of personnel involved in counseling and treatment of women 
veterans suffering from post-traumatic stress disorder attributable to 
combat or sexual trauma.
    (c) Report.--(1) Not later than two years after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall submit 
to Congress a report on the dissemination of effective treatments, 
including evidence-based treatments, for women veterans suffering from 
post-traumatic stress disorder through all facilities of the 
Department.
    (2) The report shall include description of--
            (A) the methodology and results of the training of 
        personnel involved in counseling and treatment of women 
        veterans suffering from post-traumatic stress disorder;
            (B) the effectiveness of the treatments; and
            (C) any recommended improvements with respect to access to 
        and availability of the treatment services.
    (3) In preparing the report under paragraph (1), the Secretary 
shall also include any findings or recommendations of the Director of 
the Center for Women Veterans and the Under Secretary for Health with 
respect to the development and implementation of the strategy and the 
completion of the dissemination of such treatments, including evidence-
based treatments.

SEC. 203. ENSURING ADEQUATE PROVISION OF SERVICES FOR WOMEN VETERANS AT 
              DEPARTMENT OF VETERANS AFFAIRS VET CENTERS.

    (a) In General.--The Secretary of Veterans Affairs shall conduct a 
study on centers for the provision of readjustment counseling and 
related mental health services established under section 1712A of title 
38, United States Code (in this section referred to as a ``vet 
center''). The Secretary shall determine whether such centers have the 
capacity to provide a sufficient scope and intensity of services for 
women veterans.
    (b) Ensuring Sufficient Capacity.--After conducting the study under 
subsection (a), the Secretary of Veterans Affairs shall develop a plan 
to ensure that adequate counseling and mental health services shall be 
available at each vet center for women veterans, taking into account 
the specialized needs of such veterans.

SEC. 204. PILOT PROGRAM FOR CHILD CARE FOR CERTAIN WOMEN VETERANS 
              RECEIVING HEALTH CARE FROM FACILITIES OF THE DEPARTMENT.

    (a) In General.--(1) Not later than six months after the date of 
the enactment of this Act, the Secretary of Veterans Affairs shall 
carry out a pilot program under which, subject to paragraph (2), child 
care is provided, directly or indirectly, for qualified veterans.
    (2) Child care under the pilot program may only be provided for the 
period of time that the qualified veteran--
            (A) receives the types of health care services referred to 
        in paragraph (3) at a facility of the Department; and
            (B) requires to travel to and return from such facility for 
        the receipt of such health care services.
    (3) In this section, the term ``qualified veteran'' means a veteran 
who is a woman, who is the primary caretaker of a child or children, 
and who is receiving from the Department of Veterans Affairs one or 
more of the following health care services:
            (A) Regular mental health care services.
            (B) Intensive mental health care services.
            (C) Such other intensive health care services that the 
        Secretary determines that the provision of child care would 
        improve access to those health care services.
    (4) The Secretary shall carry out the pilot program in no fewer 
than three Veterans Integrated Service Networks (VISNs).
    (b) Duration of Pilot Program.--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.
    (c) Possible Forms of Child Care Assistance.--Under the pilot 
program, the form of child care assistance provided to qualified 
veterans may include stipends for the payment of child care offered by 
child care centers (either directly or through a voucher program), the 
development of partnerships with private agencies, collaboration with 
facilities or programs of other Federal departments or agencies, or the 
arrangement of after school care.
    (d) Authorization of Appropriations.--There are authorized to be 
appropriated to the Secretary of Veterans Affairs $1,500,000 for each 
of fiscal years 2008 and 2009 to carry out the pilot program under this 
section.
    (e) Report.--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 recommendations for the continuation or 
expansion of the pilot program.

SEC. 205. PILOT PROGRAM FOR WOMEN VETERANS NEWLY SEPARATED FROM SERVICE 
              FOR COUNSELING IN RETREAT SETTINGS.

    (a) In General.--(1) Not later than six months after the date of 
the enactment of this Act, the Secretary of Veterans Affairs shall 
carry out a pilot program to evaluate the feasibility and advisability 
of providing counseling and transition adjustment assistance for women 
veterans who are newly separated from active duty service.
    (2) Under the pilot program, such counseling and assistance shall 
be provided in a group retreat setting in which the counseling and 
assistance is made available for consecutive periods of days for such 
duration as the Secretary determines to be effective.
    (3) Participation in a pilot program under this section is at the 
election of the woman veteran, and such election may be made with or 
without a referral from a physician or mental health professional.
    (b) Sites.--The Secretary of Veterans Affairs shall carry out the 
pilot program in no fewer than five sites.
    (c) Duration of Pilot Program.--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.
    (d) Counseling Services.--Under the pilot program, a newly 
separated woman veteran is eligible for a program of counseling 
tailored to her specific needs, based on her active duty experience and 
her family situation in order to assist with the transition from active 
duty to civilian life at home. The program may include some or all of 
the following services:
            (1) Mental health counseling.
            (2) Family and marital counseling.
            (3) Role and relationship counseling.
            (4) Counseling for substance-use disorder.
            (5) Such other counseling services that the Secretary of 
        Veterans Affairs determines is necessary to assist the veteran 
        before final repatriation with her family.
    (e) Authorization of Appropriations.--There are authorized to be 
appropriated to the Secretary of Veterans Affairs $2,000,000 for each 
of fiscal years 2008 and 2009 to carry out the pilot program under this 
section.
    (f) Report.--Not later than six months after the completion of the 
pilot program, the Secretary shall submit to Congress a report on the 
pilot program. The report shall include the following:
            (1) An assessment of the relative feasibility and 
        advisability of the pilot program.
            (2) An assessment of the benefits of the program, including 
        any cost effectiveness associated with the program and any 
        projected cost-savings attributable to early intervention and 
        transition assistance under the pilot program.
            (3) Any recommendation for the continuation or expansion of 
        the pilot program.

SEC. 206. ADDITION OF RECENTLY SEPARATED WOMEN VETERANS TO SERVE ON 
              ADVISORY COMMITTEES.

    (a) Advisory Committee on Women Veterans.--Subsection (a)(2)(a) of 
section 542 of title 38, United States Code, is amended--
            (1) by striking ``and'' at the end of clause (ii);
            (2) by striking the period at the end of clause (iii) and 
        inserting ``; and''; and
            (3) by inserting after clause (iii) the following new 
        clause:
                            ``(iv) women who are recently separated 
                        veterans.''.
    (b) Advisory Committee on Minority Veterans.--Subsection (a)(2)(a) 
of section 542 of title 38, United States Code, is amended
            (1) by striking ``and'' at the end of clause (iii);
            (2) by striking the period at the end of clause (iv) and 
        inserting ``; and''; and
            (3) by inserting after clause (iv) the following new 
        clause:
                            ``(v) recently separated veterans who are 
                        minority group members.''.
    (c) Effective Date.--The amendments made by this section shall 
first apply to appointments made on or after the date of the enactment 
of this Act.
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