[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[S. 358 Introduced in Senate (IS)]

114th CONGRESS
  1st Session
                                 S. 358

To amend title 10, United States Code, to ensure that women members of 
 the Armed Forces and their families have access to the contraception 
 they need in order to promote the health and readiness of all members 
              of the Armed Forces, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                            February 4, 2015

   Mrs. Shaheen (for herself, Mr. Reid, Mrs. Murray, Mr. Brown, Mr. 
 Bennet, Mr. Blumenthal, Mr. Whitehouse, Mr. Markey, Mrs. Gillibrand, 
  Ms. Baldwin, Mr. Durbin, Mr. Coons, Mr. Sanders, Ms. Stabenow, Mrs. 
  Boxer, Ms. Warren, Mrs. Feinstein, Ms. Cantwell, Mr. Menendez, Mr. 
Tester, Mr. Cardin, Ms. Hirono, Mr. Franken, and Mr. Schatz) introduced 
the following bill; which was read twice and referred to the Committee 
                           on Armed Services

_______________________________________________________________________

                                 A BILL


 
To amend title 10, United States Code, to ensure that women members of 
 the Armed Forces and their families have access to the contraception 
 they need in order to promote the health and readiness of all members 
              of the Armed Forces, 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.

    This Act may be cited as the ``Access to Contraception for Women 
Servicemembers and Dependents Act of 2015''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) Women are serving in the Armed Forces at increasing 
        rates, playing a critical role in the national security of the 
        United States. More than 350,000 women serve on active duty in 
        the Armed Forces or in the Selected Reserve.
            (2) Nearly 10,000,000 members of the Armed Forces 
        (including members of the National Guard and Reserves), 
        military retirees, their families, their survivors, and certain 
        former spouses, including nearly 5,000,000 female 
        beneficiaries, are eligible for health care through the 
        Department of Defense.
            (3) Contraception is critical for women's health and is 
        highly effective at reducing unintended pregnancy. The Centers 
        for Disease Control and Prevention describe contraception as 
        one of the 10 greatest public health achievements of the 
        twentieth century.
            (4) Contraception has played a direct role in the greater 
        participation of women in education and employment. Increased 
        wages and increased control over reproductive decisions provide 
        women with educational and professional opportunities that have 
        increased gender equality over the decades since contraception 
        was introduced.
            (5) Studies have shown that when cost barriers to the full 
        range of methods of contraception are eliminated, and women 
        receive comprehensive counseling on the various methods of 
        contraception (including highly effective Long-Acting 
        Reversible Contraceptives (LARCs)), rates of unintended 
        pregnancy decline dramatically.
            (6) Research has also shown that investments in effective 
        contraception save public and private dollars.
            (7) The 2011 recommendations of the Institute of Medicine 
        on women's preventive health services include recommendations 
        that health insurance plans cover all methods of contraception 
        approved by the Food and Drug Administration, sterilization 
        procedures, and patient education and counseling for all women 
        with reproductive capacity without any cost-sharing 
        requirements.
            (8) The recommendations described in paragraph (7) are 
        reflected in provisions of the Patient Protection and 
        Affordable Care Act (Public Law 111-148), and thus group and 
        individual health insurance plans must provide such coverage. 
        The recommendations have also been adopted by the Office of 
        Personnel Management, and thus all health insurance plans that 
        are part of the Federal Employees Health Benefits Program must 
        provide such coverage.
            (9) Under the TRICARE program, servicewomen on active duty 
        have full coverage of all prescription drugs, including 
        contraception, without cost-sharing requirements. However, 
        servicewomen not on active duty, and female dependents of 
        members of the Armed Forces, who receive health care through 
        the TRICARE program do not have similar coverage of all 
        prescription methods of contraception approved by the Food and 
        Drug Administration without cost-sharing.
            (10) Studies indicate that servicewomen need comprehensive 
        counseling for pregnancy prevention, particularly in their 
        predeployment preparations, and the lack thereof is 
        contributing to unintended pregnancies among servicewomen.
            (11) Research studies based on the Department of Defense 
        Survey of Health Related Behaviors Among Active Duty Military 
        Personnel found a high unintended rate of pregnancy among 
        servicewomen. Adjusting for the difference between age 
        distributions in the Armed Forces and the general population, 
        the rate of unintended pregnancy among servicewomen is higher 
        than among the general population.
            (12) With the integrated use of electronic medical records 
        throughout the Department of Defense, the technological 
        infrastructure exists to develop clinical decision support 
        tools. These tools, which are incorporated into the electronic 
        medical record, allow for a point-of-care feedback loop that 
        can be used to enhance patient decisionmaking, case and patient 
        management, and care coordination. Benefits of clinical 
        decision support tools include increased quality of care and 
        enhanced health outcomes, improved efficiency, and provider and 
        patient satisfaction.
            (13) The Defense Advisory Committee on Women in the 
        Services (DACOWITS) has recommended that all the Armed Forces, 
        to the extent that they have not already, implement initiatives 
        that inform servicemembers of the importance of family 
        planning, educate them on methods of contraception, and make 
        various methods of contraception available, based on the 
        finding that family planning can increase the overall readiness 
        and quality of life of all members of the military.
            (14) Health care, including family planning for survivors 
        of sexual assault in the Armed Forces is a critical issue. 
        Servicewomen on active duty report rates of unwanted sexual 
        contact at approximately 16 times those of the comparable 
        general population of women in the United States. Through 
        regulations, the Department of Defense already supports a 
        policy of ensuring that servicewomen who are sexually assaulted 
        have access to emergency contraception.

SEC. 3. CONTRACEPTION COVERAGE PARITY UNDER THE TRICARE PROGRAM.

    (a) In General.--Section 1074d of title 10, United States Code, is 
amended--
            (1) in subsection (a), by inserting ``for Members and 
        Former Members'' after ``Services Available'';
            (2) by redesignating subsection (b) as subsection (d); and
            (3) by inserting after subsection (a) the following new 
        subsections:
    ``(b) Care Related to Prevention of Pregnancy.--Female covered 
beneficiaries shall be entitled to care related to the prevention of 
pregnancy described by subsection (d)(3).
    ``(c) Prohibition on Cost-Sharing for Certain Services.--
Notwithstanding section 1074g(a)(6) of this title or any other 
provision of law, cost-sharing may not be imposed or collected for care 
related to the prevention of pregnancy provided pursuant to subsection 
(a) or (b), including for any method of contraception provided, whether 
provided through a facility of the uniformed services, the TRICARE 
retail pharmacy program, or the national mail-order pharmacy 
program.''.
    (b) Care Related to Prevention of Pregnancy.--Subsection (d)(3) of 
such section, as redesignated by subsection (a)(2) of this section, is 
further amended by inserting before the period at the end the 
following: ``(including all methods of contraception approved by the 
Food and Drug Administration, sterilization procedures, and patient 
education and counseling in connection therewith)''.
    (c) Conforming Amendment.--Section 1077(a)(13) of such title is 
amended by striking ``section 1074d(b)'' and inserting ``section 
1074d(d)''.

SEC. 4. ACCESS TO BROAD RANGE OF METHODS OF CONTRACEPTION APPROVED BY 
              THE FOOD AND DRUG ADMINISTRATION FOR MEMBERS OF THE ARMED 
              FORCES AND MILITARY DEPENDENTS AT MILITARY TREATMENT 
              FACILITIES.

    (a) In General.--Commencing not later than 180 days after the date 
of the enactment of this Act, the Secretary of Defense shall ensure 
that every military treatment facility has a sufficient stock of a 
broad range of methods of contraception approved by the Food and Drug 
Administration, as recommended by the Centers for Disease Control and 
Prevention and the Office of Population Affairs of the Department of 
Health and Human Services, to be able to dispense at any time any such 
method of contraception to any women members of the Armed Forces and 
female covered beneficiaries who receive care through such facility.
    (b) Covered Beneficiary Defined.--In this section, the term 
``covered beneficiary'' has the meaning given that term in section 
1072(5) of title 10, United States Code.

SEC. 5. COMPREHENSIVE STANDARDS AND ACCESS TO CONTRACEPTION COUNSELING 
              FOR MEMBERS OF THE ARMED FORCES.

    (a) Purpose.--The purpose of this section is to ensure that all 
health care providers employed by the Department of Defense who provide 
care for members of the Armed Forces, including general practitioners, 
are provided, through clinical practice guidelines, the most current 
evidence-based and evidence-informed standards of care with respect to 
methods of contraception and counseling on methods of contraception.
    (b) Clinical Practice Guidelines.--
            (1) In general.--Not later than one year after the date of 
        the enactment of this Act, the Secretary of Defense shall 
        compile clinical practice guidelines for health care providers 
        described in subsection (a) on standards of care with respect 
        to methods of contraception and counseling on methods of 
        contraception for members of the Armed Forces.
            (2) Sources.--The Secretary shall compile clinical practice 
        guidelines under this subsection from among clinical practice 
        guidelines established by appropriate health agencies and 
        professional organizations, including the following:
                    (A) The United States Preventive Services Task 
                Force.
                    (B) The Centers for Disease Control and Prevention.
                    (C) The Office of Population Affairs of the 
                Department of Health and Human Services.
                    (D) The American College of Obstetricians and 
                Gynecologists.
                    (E) The Association of Reproductive Health 
                Professionals.
                    (F) The American Academy of Family Physicians.
                    (G) The Agency for Healthcare Research and Quality.
            (3) Updates.--The Secretary shall from time to time update 
        the list of clinical practice guidelines compiled under this 
        subsection to incorporate into such guidelines new or updated 
        standards of care with respect to methods of contraception and 
        counseling on methods of contraception.
            (4) Dissemination.--
                    (A) Initial dissemination.--As soon as practicable 
                after the compilation of clinical practice guidelines 
                pursuant to paragraph (1), but commencing not later 
                than one year after the date of the enactment of this 
                Act, the Secretary shall provide for rapid 
                dissemination of the clinical practice guidelines to 
                health care providers described in subsection (a).
                    (B) Updates.--As soon as practicable after the 
                adoption under paragraph (3) of any update to the 
                clinical practice guidelines compiled pursuant to this 
                subsection, the Secretary shall provide for the rapid 
                dissemination of such clinical practice guidelines, as 
                so updated, to health care providers described in 
                subsection (a).
                    (C) Protocols.--Clinical practice guidelines, and 
                any updates to such guidelines, shall be disseminated 
                under this paragraph in accordance with administrative 
                protocols developed by the Secretary for that purpose.
    (c) Clinical Decision Support Tools.--
            (1) In general.--Not later than one year after the date of 
        the enactment of this Act, the Secretary shall, in order to 
        assist health care providers described in subsection (a), 
        develop and implement clinical decision support tools that 
        reflect, through the clinical practice guidelines compiled 
        pursuant to subsection (b), the most current evidence-based and 
        evidence-informed standards of care with respect to methods of 
        contraception and counseling on methods of contraception.
            (2) Updates.--The Secretary shall from time to time update 
        the clinical decision support tools developed under this 
        subsection to incorporate into such tools new or updated 
        guidelines on methods of contraception and counseling on 
        methods of contraception.
            (3) Dissemination.--Clinical decision support tools, and 
        any updates to such tools, shall be disseminated under this 
        subsection in accordance with administrative protocols 
        developed by the Secretary for that purpose. Such protocols 
        shall be similar to the administrative protocols developed 
        under subsection (b)(4)(C).
    (d) Access to Contraception Counseling.--As soon as practicable 
after the date of the enactment of this Act, the Secretary shall ensure 
that women members of the Armed Forces have access to comprehensive 
counseling on the full range of methods of contraception provided by 
health care providers described in subsection (a) during health care 
visits, including, but not limited to, visits as follows:
            (1) During predeployment health care visits, including 
        counseling that provides specific information women need 
        regarding the interaction between anticipated deployment 
        conditions and various methods of contraception.
            (2) During health care visits during deployment.
            (3) During annual physical examinations.
    (e) Incorporation Into Surveys of Questions on Servicewomen 
Experiences With Family Planning Services and Counseling.--
            (1) In general.--Not later than 90 days after the date of 
        the enactment of this Act, the Secretary shall integrate into 
        the Department of Defense surveys specified in paragraph (2) 
        questions designed to obtain information on the experiences of 
        women members of the Armed Forces--
                    (A) in accessing family planning services and 
                counseling;
                    (B) in using family planning methods, which method 
                was preferred, and whether deployment conditions 
                affected the decision on which family planning method 
                or methods to be used; and
                    (C) if pregnant, whether the pregnancy was 
                intended.
            (2) Covered surveys.--The surveys into which questions 
        shall be integrated as described in paragraph (1) are the 
        following:
                    (A) The Health Related Behavior Survey of Active 
                Duty Military Personnel.
                    (B) The Health Care Survey of Department of Defense 
                Beneficiaries.

SEC. 6. EDUCATION ON FAMILY PLANNING FOR MEMBERS OF THE ARMED FORCES.

    (a) Education Programs.--
            (1) In general.--Not later than one year after the date of 
        the enactment of this Act, the Secretary of Defense shall 
        establish a uniform standard curriculum that will be used in 
        education programs on family planning for all members of the 
        Armed Forces, including both men and women members.
            (2) Sense of congress.--It is the sense of Congress that 
        the education programs should use the latest technology 
        available to efficiently and effectively deliver information to 
        members of the Armed Forces.
    (b) Elements.--The uniform standard curriculum under subsection (a) 
shall include the following:
            (1) Information for members of the Armed Forces on active 
        duty to make informed decisions regarding family planning.
            (2) Information about the prevention of unintended 
        pregnancy and sexually transmitted infections, including human 
        immunodeficiency virus (HIV).
            (3) Information on the importance of providing 
        comprehensive family planning for members of the Armed Forces, 
        and their commanding officers, and on the positive impact 
        family planning can have on the health and readiness of the 
        Armed Forces.
            (4) Current, medically accurate information.
            (5) Clear, user-friendly information on the full range of 
        methods of contraception and where members of the Armed Forces 
        can access their chosen method of contraception.
            (6) Information on all applicable laws and policies so that 
        members are informed of their rights and obligations.
            (7) Information on patients' rights to confidentiality.
            (8) Information on the unique circumstances encountered by 
        members of the Armed Forces, and the effects of such 
        circumstances on the use of contraception.

SEC. 7. PREGNANCY PREVENTION ASSISTANCE AT MILITARY TREATMENT 
              FACILITIES FOR WOMEN WHO ARE SEXUAL ASSAULT SURVIVORS.

    (a) Purpose.--The purpose of this section is to provide in statute, 
and to enhance, existing regulations that require health care providers 
at military treatment facilities to consult with survivors of sexual 
assault once clinically stable regarding options for emergency 
contraception and any necessary follow-up care, including the provision 
of the emergency contraception.
    (b) In General.--The assistance specified in subsection (c) shall 
be provided at every military treatment facility to the following:
            (1) Any woman who presents at a military treatment facility 
        and states to personnel of the facility that she is a victim of 
        sexual assault or is accompanied by another individual who 
        states that the woman is a victim of sexual assault.
            (2) Any woman who presents at a military treatment facility 
        and is reasonably believed by personnel of such facility to be 
        a survivor of sexual assault.
    (c) Assistance.--
            (1) In general.--The assistance specified in this 
        subsection shall include the following:
                    (A) The prompt provision by appropriate staff of 
                the military treatment facility of comprehensive, 
                medically and factually accurate, and unbiased written 
                and oral information about all methods of emergency 
                contraception approved by the Food and Drug 
                Administration.
                    (B) The prompt provision by such staff of emergency 
                contraception to a woman upon her request.
                    (C) Notification to the woman of her right to 
                confidentiality in the receipt of care and services 
                pursuant to this section.
            (2) Nature of information.--The information provided 
        pursuant to paragraph (1)(A) shall be provided in language that 
        is clear and concise, is readily comprehensible, and meets such 
        conditions (including conditions regarding the provision of 
        information in languages other than English) as the Secretary 
        may provide in the regulations under this section.
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