[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3224 Referred in Senate (RFS)]
<DOC>
116th CONGRESS
1st Session
H. R. 3224
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
November 13, 2019
Received; read twice and referred to the Committee on Veterans' Affairs
_______________________________________________________________________
AN ACT
To amend title 38, United States Code, to provide for increased access
to Department of Veterans Affairs medical care for women veterans.
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 ``Deborah Sampson
Act''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--VETERANS HEALTH ADMINISTRATION
Sec. 101. Office of Women's Health in the Department of Veterans
Affairs.
Sec. 102. Expansion of capabilities of women veterans call center to
include text messaging.
Sec. 103. Requirement for Department of Veterans Affairs internet
website to provide information on services
available to women veterans.
Sec. 104. Report on Women Veterans Retrofit Initiative.
Sec. 105. Establishment of environment of care standards and
inspections at Department of Veterans
Affairs medical centers.
Sec. 106. Additional funding for primary care and emergency care
clinicians in Women Veterans Health Care
Mini-Residency Program.
Sec. 107. Establishment of women veteran training module for non-
Department of Veterans Affairs health care
providers.
TITLE II--MEDICAL CARE
Sec. 201. Improved access to Department of Veterans Affairs medical
care for women veterans.
Sec. 202. Counseling and treatment for sexual trauma.
Sec. 203. Counseling in retreat settings for women veterans and other
individuals.
Sec. 204. Improvement of health care services provided to newborn
children by Department of Veterans Affairs.
TITLE III--REPORTS AND OTHER MATTERS
Subtitle A--Reports
Sec. 301. Assessment of effects of intimate partner violence on women
veterans by Advisory Committee on Women
Veterans.
Sec. 302. Study on staffing of Women Veteran Program Manager program at
medical centers of the Department of
Veterans Affairs and training of staff.
Sec. 303. Report on availability of prosthetic items for women veterans
from the Department of Veterans Affairs.
Sec. 304. Study of barriers for women veterans to health care from the
Department of Veterans Affairs.
Sec. 305. Report regarding veterans who receive benefits under laws
administered by the Secretary of Veterans
Affairs.
Sec. 306. Study on Women Veteran Coordinator program.
Subtitle B--Other Matters
Sec. 321. Anti-harassment and anti-sexual assault policy of the
Department of Veterans Affairs.
Sec. 322. Support for organizations that have a focus on providing
assistance to women veterans and their
families.
Sec. 323. Gap analysis of Department of Veterans Affairs programs that
provide assistance to women veterans who
are homeless.
Sec. 324. Department of Veterans Affairs public-private partnership on
legal services for women veterans.
Sec. 325. Program to assist veterans who experience intimate partner
violence or sexual assault.
Sec. 326. Study and task force on veterans experiencing intimate
partner violence or sexual assault.
TITLE I--VETERANS HEALTH ADMINISTRATION
SEC. 101. OFFICE OF WOMEN'S HEALTH IN THE DEPARTMENT OF VETERANS
AFFAIRS.
(a) Director of Women's Health.--Subsection (a) of section 7306 of
title 38, United States Code, is amended--
(1) by redesignating paragraph (10) as paragraph (11); and
(2) by inserting after paragraph (9) the following new
paragraph:
``(10) The Director of Women's Health.''.
(b) Organization of Office.--
(1) In general.--Subchapter I of chapter 73 of title 38,
United States Code, is amended by adding at the end of the
following new sections:
``Sec. 7310. Office of Women's Health
``(a) Establishment.--(1) The Under Secretary for Health shall
establish and operate in the Veterans Health Administration the Office
of Women's Health (hereinafter in this section referred to as the
`Office'). The Office shall be located at the Central Office of the
Department of Veterans Affairs.
``(2) The head of the Office is the Director of Women's Health
(hereinafter in this section referred to as the `Director'). The
Director shall report to the Under Secretary for Health.
``(3) The Under Secretary for Health shall provide the Office with
such staff and other support as may be necessary for the Office to
carry out effectively its functions under this section.
``(4) The Under Secretary for Health may reorganize existing
offices within the Veterans Health Administration as of the date of the
enactment of this section in order to avoid duplication with the
functions of the Office.
``(b) Purpose.--The functions of the Office include the following:
``(1) To provide a central office for monitoring and
encouraging the activities of the Veterans Health
Administration with respect to the provision, evaluation, and
improvement of women veterans' health care services in the
Department.
``(2) To develop and implement standards of care for the
provision of health care for women veterans in the Department.
``(3) To monitor and identify deficiencies in standards of
care for the provision of health care for women veterans in the
Department, to provide technical assistance to medical
facilities of the Department to address and remedy
deficiencies, and to perform oversight of implementation of
standards of care for women veterans' health care in the
Department.
``(4) To monitor and identify deficiencies in standards of
care for the provision of health care for women veterans
provided through the community pursuant to this title, and to
provide recommendations to the appropriate office to address
and remedy any deficiencies.
``(5) To oversee distribution of resources and information
related to women veterans' health programming under this title.
``(6) To promote the expansion and improvement of clinical,
research, and educational activities of the Veterans Health
Administration with respect the health care of women veterans.
``(7) To provide, as part of the annual budgeting process,
recommendations with respect to the amount of funds to be
requested for furnishing hospital care and medical services to
women veterans pursuant to chapter 17 of this title, including,
at a minimum, recommendations that ensure that such amount of
funds either reflect or exceed the proportion of veterans
enrolled in the patient enrollment system under section 1705 of
this title who are women.
``(8) To provide recommendations to the Under Secretary for
Health with respect to modifying the Veterans Equitable
Resource Allocation system to ensure that resource allocations
under such system reflect the health care needs of women
veterans.
``(9) To carry out such other duties as the Under Secretary
for Health may require.
``(c) Recommendations.--If the Under Secretary for Health
determines not to implement any recommendation made by the Director
with respect to the allocation of resources to address the health care
needs of women veterans, the Secretary shall notify the appropriate
congressional committees of such determination by not later than 30
days after the date on which the Under Secretary for Health receives
the recommendation. Each such notification shall include the following:
``(1) The reasoning of the Under Secretary for Health in
making such determination.
``(2) An alternative, if one is selected, to such
recommendation that the Under Secretary for Health will carry
out to fulfill the health care needs of women veterans.
``(d) Standards of Care.--In this section, the standards of care
for the provision of health care for women veterans in the Department
shall include, at a minimum, the following:
``(1) Requirement for--
``(A) at least one designated women's health
primary care provider at each medical center whose
duties include, to the extent practicable, providing
training to other health care providers of the
Department with respect to the needs of women veterans;
and
``(B) at least one designated women's health
primary care provider at each community-based
outpatient clinic of the Department who may serve
female patients as a percentage of the total duties of
the provider.
``(2) Other requirements as determined by the Under
Secretary for Health.
``(e) Outreach.--The Director shall ensure that--
``(1) not less frequently than biannually, each medical
facility of the Department holds a public forum for women
veterans that occurs outside of regular business hours; and
``(2) not less frequently than quarterly, each medical
facility of the Department convenes a focus group of women
veterans that includes a discussion of harassment occurring at
such facility.
``(f) Definitions.--In this section:
``(1) The term `appropriate congressional committees' has
the meaning given that term in section 7310A of this title.
``(2) The term `facility of the Department' has the meaning
given the term in section 1701(3).
``(3) The term `Veterans Equitable Resource Allocation
system' means the resource allocation system established
pursuant to section 429 of the Departments of Veterans Affairs
and Housing and Urban Development, and Independent Agencies
Appropriations Act, 1997 (Public Law 104-204; 110 Stat. 2929).
``Sec. 7310A. Annual reports on women's Health
``(a) Annual Reports.--Not later than December 1 of each year, the
Director of Women's Health shall submit to the appropriate
congressional committees a report containing the matters under
subsections (b) through (g).
``(b) Office of Women's Health.--Each report under subsection (a)
shall include a description of--
``(1) actions taken by the Office of Women's Health in the
preceding fiscal year to improve the Department's provision of
health care to women veterans;
``(2) any identified deficiencies related to the
Department's provision of health care to women veterans and the
standards of care established in section 7310 of this title,
and the Department's plan to address such deficiencies;
``(3) the funding and personnel provided to the Office and
whether additional funding or personnel are needed to meet the
requirements of such section; and
``(4) other information that would be of interest to the
appropriate congressional committees with respect to oversight
of the Department's provision of health care to women veterans.
``(c) Access to Gender-Specific Services.--Each report under
subsection (a) shall include an analysis of the access of women
veterans to gender-specific services under contracts, agreements, or
other arrangements with non-Department medical providers entered into
by the Secretary for the provision of hospital care or medical services
to veterans. Such analysis shall include data and performance measures
for the availability of gender specific services, including--
``(1) the average wait time between the veteran's preferred
appointment date and the date on which the appointment is
completed;
``(2) the average driving time required for veterans to
attend appointments; and
``(3) reasons why appointments could not be scheduled with
non-Department medical providers.
``(d) Locations Where Women Veterans Are Using Health Care.--Each
report under subsection (a) shall include an analysis of the use by
women veterans of health care from the Department, including the
following information:
``(1) The number of women veterans who reside in each
State.
``(2) The number of women veterans in each State who are
enrolled in the system of patient enrollment of the Department
established and operated under section 1705(a) this title.
``(3) Of the women veterans who are so enrolled, the number
who have received health care under the laws administered by
the Secretary at least one time during the 1-year period
preceding the submittal of the report.
``(4) The number of women veterans who have been seen at
each medical facility of the Department during such year.
``(5) The number of appointments that women veterans have
had at each such facility during such year.
``(6) If known, an identification of the medical facility
of the Department in each Veterans Integrated Service Network
with the largest rate of increase in patient population of
women veterans as measured by the increase in unique women
veteran patient use.
``(7) If known, an identification of the medical facility
of the Department in each Veterans Integrated Service Network
with the largest rate of decrease in patient population of
women veterans as measured by the decrease in unique women
veterans patient use.
``(e) Models of Care.--Each report under subsection (a) shall
include an analysis of the use by the Department of general primary
care clinics, separate but shared spaces, and women's health centers as
models of providing health care to women veterans. Such analysis shall
include the following:
``(1) The number of facilities of the Department that fall
into each such model, disaggregated by Veterans Integrated
Service Network and State.
``(2) A description of the criteria used by the Department
to determine which such model is most appropriate for each
facility of the Department.
``(3) An assessment of how the Department decides to make
investments to modify facilities to a different model.
``(4) A description of what, if any, plans the Department
has to modify facilities from general primary care clinics to
another model.
``(5) An assessment of whether any facilities could be
modified to a separate but shared space for a women's health
center within planned investments under the strategic capital
investment planning process of the Department.
``(6) An assessment of whether any facilities could be
modified to a separate or shared space, or women's health
center with minor modifications to existing plans under the
strategic capital investment planning process of the
Department.
``(7) An assessment of whether the Department has a goal
for how many facilities should fall into each such model.
``(f) Staffing.--Each report under subsection (a) shall include an
analysis of the staffing of the Department relating to the treatment of
women, including the following, disaggregated by Veterans Integrated
Service Network and State (except with respect to paragraph (4)):
``(1) The number of women's health centers.
``(2) The number of patient aligned care teams of the
Department relating to women's health.
``(3) The number of full- and part-time gynecologists of
the Department.
``(4) The number of designated women's health care
providers of the Department, disaggregated by facility of the
Department.
``(5) The number of health care providers of the Department
who have completed a mini-residency for women's health care
through Women Veterans Health Care Mini-Residency Program of
the Department during the 1-year period preceding the submittal
of the report, and the number that plan to participate in such
a mini-residency during the 1-year period following such date.
``(6) The number of designated women's health care
providers of the Department who have sufficient female patients
to retain their competencies and proficiencies.
``(g) Accessibility and Treatment Options.--Each report under
subsection (a) shall include an analysis of the accessibility and
treatment options for women veterans, including the following:
``(1) An assessment of wheelchair accessibility of women's
health centers of the Department, including, with respect to
each such facility, an assessment of such accessibility for
each kind of treatment provided at the center, including with
respect to radiology and mammography, that addresses all
relevant factors, including door sizes, hoists, and equipment.
``(2) The options for women veterans to access female
mental health providers and primary care providers.
``(3) The options for women veterans at medical facilities
of the Department with respect to clothing sizes, including for
gowns, drawstring pants, and pajamas.
``(h) Definitions.--In this section:
``(1) The term `appropriate congressional committees'
means--
``(A) the Committees on Veterans' Affairs of the
House of Representatives and the Senate; and
``(B) the Committees on Appropriations of the House
of Representatives and the Senate.
``(2) The term `gender-specific services' means
mammography, obstetric care, gynecological care, and such other
services as the Secretary determines appropriate.''.
(2) Clerical amendment.--The table of sections for such
chapter is amended by inserting after the item relating to
section 7309A the following new items:
``7310. Office of Women's Health.
``7310A. Annual reports on women's Health.''.
(c) Initial Report.--The Secretary of Veterans Affairs shall submit
the initial report under section 7310A of title 38, United States Code,
as added by subsection (b), by not later than 180 days after the date
of the enactment of this Act.
SEC. 102. EXPANSION OF CAPABILITIES OF WOMEN VETERANS CALL CENTER TO
INCLUDE TEXT MESSAGING.
The Secretary of Veterans Affairs shall expand the capabilities of
the Women Veterans Call Center of the Department of Veterans Affairs to
include a text messaging capability.
SEC. 103. REQUIREMENT FOR DEPARTMENT OF VETERANS AFFAIRS INTERNET
WEBSITE TO PROVIDE INFORMATION ON SERVICES AVAILABLE TO
WOMEN VETERANS.
(a) In General.--The Secretary of Veterans Affairs shall survey the
internet websites and information resources of the Department of
Veterans Affairs in effect on the day before the date of the enactment
of this Act and publish an internet website that serves as a
centralized source for the provision to women veterans of information
about the benefits and services available to them under laws
administered by the Secretary.
(b) Elements.--The internet website published under subsection (a)
shall provide to women veterans information regarding all of the
services available in the district in which the veteran is seeking such
services, including, with respect to each medical center and community-
based outpatient clinic in the applicable Veterans Integrated Service
Network--
(1) the name and contact information of each women veterans
program manager;
(2) a list of appropriate staff for other benefits
available from the Veterans Benefits Administration, the
National Cemetery Administration, and such other entities as
the Secretary considers appropriate; and
(3) such other information as the Secretary considers
appropriate.
(c) Updated Information.--The Secretary shall ensure that the
information described in subsection (b) that is published on the
internet website required by subsection (a) is updated not less
frequently than once every 90 days.
(d) Outreach.--In carrying out this section, the Secretary shall
ensure that the outreach conducted under section 1720F(i) of title 38,
United States Code, includes information regarding the internet website
required by subsection (a).
(e) Derivation of Funds.--Amounts used by the Secretary to carry
out this section shall be derived from amounts made available to the
Secretary to publish internet websites of the Department.
SEC. 104. REPORT ON WOMEN VETERANS RETROFIT INITIATIVE.
(a) Report.--Not later than 180 days after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall submit
to the Committees on Veterans' Affairs and the Committees on
Appropriations of the Senate and the House of Representatives a report
on requirements to retrofit existing medical facilities of the
Department of Veterans Affairs with fixtures, materials, and other
outfitting measures to support the provision of care to women veterans
at such facilities.
(b) Elements.--The report under subsection (a) shall include the
following:
(1) An assessment of how the Secretary prioritizes
retrofitting existing medical facilities to support provision
of care to women veterans in comparison to other requirements.
(2) A 5-year plan for retrofitting medical facilities of
the Department to support the provision of care to women
veterans.
SEC. 105. ESTABLISHMENT OF ENVIRONMENT OF CARE STANDARDS AND
INSPECTIONS AT DEPARTMENT OF VETERANS AFFAIRS MEDICAL
CENTERS.
(a) In General.--The Secretary of Veterans Affairs shall establish
a policy under which the environment of care standards and inspections
at medical centers of the Department of Veterans Affairs include--
(1) an alignment of the requirements for such standards and
inspections with the women's health handbook of the Veterans
Health Administration;
(2) a requirement for the frequency of such inspections;
(3) delineation of the roles and responsibilities of staff
at the medical center who are responsible for compliance;
(4) the requirement that each medical center submit to the
Secretary and make publicly available a report on the
compliance of the medical center with the standards; and
(5) a remediation plan.
(b) Report.--Not later than 180 days after the date of the
enactment of this Act, the Secretary shall submit to the Committees on
Veterans' Affairs of the Senate and House of Representatives
certification in writing that the policy required by subsection (a) has
been finalized and disseminated to Department all medical centers.
SEC. 106. ADDITIONAL FUNDING FOR PRIMARY CARE AND EMERGENCY CARE
CLINICIANS IN WOMEN VETERANS HEALTH CARE MINI-RESIDENCY
PROGRAM.
(a) In General.--There is authorized to be appropriated to the
Secretary of Veterans Affairs $1,000,000 for each fiscal year for the
Women Veterans Health Care Mini-Residency Program of the Department of
Veterans Affairs to provide opportunities for participation in such
program for primary care and emergency care clinicians.
(b) Treatment of Amounts.--The amounts authorized to be
appropriated under subsection (a) shall be in addition to amounts
otherwise made available to the Secretary for the purposes set forth in
such subsection.
SEC. 107. ESTABLISHMENT OF WOMEN VETERAN TRAINING MODULE FOR NON-
DEPARTMENT OF VETERANS AFFAIRS HEALTH CARE PROVIDERS.
(a) In General.--Not later than 1 year after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall
establish and make available to community providers a training module
that is specific to women veterans.
(b) Community Provider Defined.--In this section, the term
``community provider'' means a non-Department of Veterans Affairs
health care provider who provides health care to veterans under the
laws administered by the Secretary of Veterans Affairs.
TITLE II--MEDICAL CARE
SEC. 201. IMPROVED ACCESS TO DEPARTMENT OF VETERANS AFFAIRS MEDICAL
CARE FOR WOMEN VETERANS.
(a) In General.--Subchapter II of chapter 17 of title 38, United
States Code, is amended by adding at the end the following new section:
``Sec. 1720J. Medical services for women veterans
``(a) Access to Care.--The Secretary shall ensure that women's
health primary care services are available during regular business
hours at every medical center and community based outpatient clinic of
the Department.
``(b) Study on Extended Hours of Care.--The Secretary shall conduct
a study to assess--
``(1) the use of extended hours as a means of reducing
barriers to care;
``(2) the need for extended hours based on interviews with
women veterans and employees; and
``(3) the best practices and resources required to
implement use of extended hours.
``(c) Annual Report to Congress.--Not later than September 30 of
each year, 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 compliance with subsection (a).''.
(b) Clerical Amendment.--The table of sections at the beginning of
such chapter is amended by inserting after the item relating to section
1720I the following new item:
``1720J. Medical services for women veterans.''.
SEC. 202. COUNSELING AND TREATMENT FOR SEXUAL TRAUMA.
Section 1720D of title 38, United States Code, is amended--
(1) in subsection (a)--
(A) in paragraph (1), by striking ``active duty,
active duty for training, or inactive duty training''
and inserting ``duty, regardless of duty status or line
of duty determination (as that term is used in section
12323 of title 10)''; and
(B) in paragraph (2)(A), by striking ``active duty,
active duty for training, or inactive duty training''
and inserting ``duty, regardless of duty status or line
of duty determination (as that term is used in section
12323 of title 10)'';
(2) by striking ``veteran'' each place it appears and
inserting ``former member of the Armed Forces'';
(3) by striking ``veterans'' each place it appears and
inserting ``former members of the Armed Forces''; and
(4) by adding at the end the following new subsection:
``(g) In this section, the term `former member of the Armed Forces'
includes the following:
``(1) A veteran described in section 101(2) of this title.
``(2) An individual not described in paragraph (1) who was
discharged or released from the Armed Forces under a condition
that is not honorable but not--
``(A) a dishonorable discharge; or
``(B) a discharge by court-martial.''.
SEC. 203. COUNSELING IN RETREAT SETTINGS FOR WOMEN VETERANS AND OTHER
INDIVIDUALS.
(a) In General.--Chapter 17 of title 38, United States Code, is
amended by inserting after section 1712C the following new section:
``Sec. 1712D. Counseling in retreat settings for women veterans and
other individuals
``(a) Program.--(1) Commencing not later than January 1, 2021, the
Secretary shall carry out, through the Readjustment Counseling Service
of the Veterans Health Administration, a program to provide
reintegration and readjustment services described in subsection (b) in
group retreat settings to covered individuals, including cohorts of
women veterans who are eligible for readjustment counseling services
under section 1712A of this title.
``(2) The participation of a covered individual in the program
under paragraph (1) shall be at the election of the individual.
``(b) Covered Services.--The services provided to a covered
individual under the program under subsection (a)(1) shall include the
following:
``(1) Information on reintegration into the family,
employment, and community of the individual.
``(2) Financial counseling.
``(3) Occupational counseling.
``(4) Information and counseling on stress reduction.
``(5) Information and counseling on conflict resolution.
``(6) Such other information and counseling as the
Secretary considers appropriate to assist the individual in
reintegration into the family, employment, and community of the
veteran.
``(c) Biennial Reports.--Not later than December 31, 2022, and each
even-numbered year thereafter, the Secretary shall submit to the
Committees on Veterans' Affairs of the House of Representatives and the
Senate a report on the program under subsection (a)(1).
``(d) Covered Individual Defined.--In this section, the term
`covered individual' means--
``(1) Any veteran who is enrolled in the system of annual
patient enrollment under section 1705 of this title.
``(2) Any survivor or dependent of a veteran who is
eligible for medical care under section 1781 of this title.''.
(b) Clerical Amendment.--The table of sections at the beginning of
such chapter is amended by inserting after the item relating to section
1712C the following new item:
``1712D. Counseling in retreat settings for women veterans and other
individuals.''.
SEC. 204. IMPROVEMENT OF HEALTH CARE SERVICES PROVIDED TO NEWBORN
CHILDREN BY DEPARTMENT OF VETERANS AFFAIRS.
(a) Expansion.--Section 1786 of title 38, United States Code, is
amended--
(1) in subsection (a), in the matter preceding paragraph
(1), by striking ``seven days'' and inserting ``14 days''; and
(2) by adding at the end the following new subsection:
``(f) Annual Report.--Not later than 60 days after the end of each
fiscal year, 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 health care services provided
under subsection (a) during such fiscal year, including the number of
newborn children who received such services during such fiscal year.''.
(b) Authority To Furnish Medically Necessary Transportation for
Newborn Children of Certain Women Veterans.--Such section is further
amended--
(1) in subsection (a)--
(A) in the matter before paragraph (1)--
(i) by inserting ``and transportation
necessary to receive such services'' after
``described in subsection (b)''; and
(ii) by inserting ``, except as provided in
subsection (e),'' after ``14 days'';
(B) in paragraph (1), by striking ``or'';
(C) in paragraph (2), by striking the period at the
end and inserting ``; or''; and
(D) by adding at the end the following new
paragraph:
``(3) another location, including a health care facility,
if the veteran delivers the child before arriving at a facility
described in paragraph (1) or (2).'';
(2) in subsection (b), by inserting before the period at
the end the following: ``, including necessary health care
services provided by a facility other than the facility where
the newborn child was delivered (including a specialty
pediatric hospital) that accepts transfer of the newborn child
and responsibility for treatment of the newborn child''; and
(3) by inserting before subsection (f), as added by
subsection (a), the following new subsections:
``(c) Transportation.--(1) Transportation furnished under
subsection (a) to, from, or between care settings to meet the needs of
a newborn child includes costs for either or both the newborn child and
parents.
``(2) Transportation furnished under subsection (a) is
transportation by ambulance, including air ambulance, or other
appropriate medically staffed modes of transportation--
``(A) to another health care facility (including a
specialty pediatric hospital) that accepts transfer of the
newborn child or otherwise provides post-delivery care services
when the treating facility is not capable of furnishing the
care or services required; or
``(B) to a health care facility in a medical emergency of
such nature that a prudent layperson reasonably expects that
delay in seeking immediate medical attention would be hazardous
to life or health.
``(3) Amounts paid by the Department for transportation under this
section shall be derived from the Medical Services appropriations
account of the Department.
``(d) Reimbursement or Payment for Health Care Services or
Transportation.--(1) Pursuant to regulations the Secretary shall
prescribe to establish rates of reimbursement and any limitations
thereto under this section, the Secretary shall directly reimburse a
covered entity for health care services or transportation services
provided under this section, unless the cost of the services or
transportation is covered by an established agreement or contract. If
such an agreement or contract exists, its negotiated payment terms
shall apply.
``(2)(A) Reimbursement or payment by the Secretary under this
section on behalf of an individual to a covered entity shall, unless
rejected and refunded by the covered entity within 30 days of receipt,
extinguish any liability on the part of the individual for the health
care services or transportation covered by such payment.
``(B) Neither the absence of a contract or agreement between the
Secretary and a covered entity nor any provision of a contract,
agreement, or assignment to the contrary shall operate to modify,
limit, or negate the requirements of subparagraph (A).
``(3) In this subsection, the term `covered entity' means any
individual, transportation carrier, organization, or other entity that
furnished or paid for health care services or transportation under this
section.
``(e) Exception.--Pursuant to such regulations as the Secretary
shall prescribe to carry out this section, the Secretary may furnish
more than 14 days of health care services described in subsection (b),
and transportation necessary to receive such services, to a newborn
child based on medical necessity if the child is in need of additional
care, including a case in which the newborn child has been discharged
or released from a hospital and requires readmittance to ensure the
health and welfare of the newborn child.''.
(c) Treatment of Certain Expenses Already Incurred.--Pursuant to
such regulations as the Secretary of Veterans Affairs shall prescribe,
the Secretary may provide reimbursement under section 1786 of title 38,
United States Code, as amended by subsection (a), health care services
or transportation services furnished to a newborn child during the
period beginning on May 5, 2010, and ending on the date of the
enactment of this Act, if the Secretary determines that, under the
circumstances applicable with respect to the newborn, such
reimbursement appropriate.
TITLE III--REPORTS AND OTHER MATTERS
Subtitle A--Reports
SEC. 301. ASSESSMENT OF EFFECTS OF INTIMATE PARTNER VIOLENCE ON WOMEN
VETERANS BY ADVISORY COMMITTEE ON WOMEN VETERANS.
Section 542(c)(1) of title 38, United States Code, is amended--
(1) in subparagraph (B), by striking ``and'' at the end;
(2) by redesignating subparagraph (C) as subparagraph (D);
and
(3) by inserting after subparagraph (B) the following new
subparagraph (C):
``(C) an assessment of the effects of intimate
partner violence on women veterans; and''.
SEC. 302. STUDY ON STAFFING OF WOMEN VETERAN PROGRAM MANAGER PROGRAM AT
MEDICAL CENTERS OF THE DEPARTMENT OF VETERANS AFFAIRS AND
TRAINING OF STAFF.
(a) Study.--The Secretary of Veterans Affairs shall conduct a study
on the use of the Women Veteran Program Manager program of the
Department of Veterans Affairs to determine--
(1) if the program is appropriately staffed at each medical
center of the Department;
(2) whether each medical center of the Department is
staffed with a Women Veteran Program Manager; and
(3) whether it would be feasible and advisable to have a
Women Veteran Program Ombudsman at each medical center of the
Department.
(b) Report.--Not later than 270 days after the date of the
enactment of this Act, 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 study conducted under
subsection (a).
(c) Training.--The Secretary shall ensure that all Women Veteran
Program Managers and Women Veteran Program Ombudsmen receive the proper
training to carry out their duties.
SEC. 303. REPORT ON AVAILABILITY OF PROSTHETIC ITEMS FOR WOMEN VETERANS
FROM THE DEPARTMENT OF VETERANS AFFAIRS.
Not later than 1 year after the date of the enactment of this Act,
the Secretary of Veterans Affairs 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 availability from the
Department of Veterans Affairs of prosthetic items made for women
veterans, including an assessment of the availability of such
prosthetic items at each medical facility of the Department. The report
shall--
(1) address efforts on research, development, and
employment of additive manufacture technology (commonly
referred to as ``3D printing'') to provide prosthetic items for
women veterans; and
(2) include a survey with a representative sample of 50,000
veterans (of which women shall be overrrepresented) in amputee
care program on satisfaction with prosthetics furnished or
procured by the Department that replace appendages or their
function.
SEC. 304. STUDY OF BARRIERS FOR WOMEN VETERANS TO HEALTH CARE FROM THE
DEPARTMENT OF VETERANS AFFAIRS.
(a) Study Required.--The Secretary of Veterans Affairs shall
conduct a comprehensive study of the barriers to the provision of
comprehensive health care by the Department of Veterans Affairs
encountered by women who are veterans. In conducting the study, the
Secretary shall--
(1) survey women veterans who seek or receive hospital care
or medical services provided by the Department of Veterans
Affairs as well as women veterans who do not seek or receive
such care or services;
(2) administer the survey to a representative sample of
women veterans from each Veterans Integrated Service Network;
and
(3) ensure that the sample of women veterans surveyed is of
sufficient size for the study results to be statistically
significant and is a larger sample than that of the study
referred to in subsection (b)(1).
(b) Use of Previous Studies.--In conducting the study required by
subsection (a), the Secretary shall build on the work of the studies of
the Department of Veterans Affairs titled--
(1) ``National Survey of Women Veterans in Fiscal Year
2007-2008''; and
(2) ``Study of Barriers for Women Veterans to VA Health
Care 2015''.
(c) Elements of Study.--In conducting the study required by
subsection (a), the Secretary shall conduct research on the effects of
the following on the women veterans surveyed in the study:
(1) The barriers associated with seeking mental health care
services, including with respect to provider availability,
telehealth access, and family, work, and school obligations.
(2) The effect of driving distance or availability of other
forms of transportation to the nearest medical facility on
access to care.
(3) The effect of access to care in the community.
(4) The availability of child care.
(5) The acceptability of integrated primary care, women's
health clinics, or both.
(6) The comprehension of eligibility requirements for, and
the scope of services available under, hospital care and
medical services.
(7) The perception of personal safety and comfort in
inpatient, outpatient, and behavioral health facilities.
(8) The gender sensitivity of health care providers and
staff to issues that particularly affect women.
(9) The effectiveness of outreach for health care services
available to women veterans.
(10) The location and operating hours of health care
facilities that provide services to women veterans.
(11) The perception of women veterans regarding the motto
of the Department of Veterans Affairs.
(12) Such other significant barriers as the Secretary
considers appropriate.
(d) Discharge by Contract.--The Secretary shall enter into a
contract with a qualified independent entity or organization to carry
out the study and research required under this section.
(e) Mandatory Review of Data by Certain Department Divisions.--
(1) In general.--The Secretary shall ensure that the head
of each division of the Department of Veterans Affairs
specified in paragraph (2) reviews the results of the study
conducted under this section. The head of each such division
shall submit findings with respect to the study to the Under
Secretary for responsibilities relating to health care services
for women veterans.
(2) Specified divisions.--The divisions of the Department
of Veterans Affairs specified in this paragraph are the
following:
(A) The Under Secretary for Health.
(B) The Office of Women's Health.
(C) The Center for Women Veterans established under
section 318 of title 38, United States Code.
(D) The Advisory Committee on Women Veterans
established under section 542 of such title.
(f) Report.--Not later than 30 months after the date of the
enactment of this Act, the Secretary 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 considers appropriate. The report shall also include the
findings of the head of each division of the Department specified under
subsection (e)(2) and of the Under Secretary for Health.
SEC. 305. REPORT REGARDING VETERANS WHO RECEIVE BENEFITS UNDER LAWS
ADMINISTERED BY THE SECRETARY OF VETERANS AFFAIRS.
(a) Report.--Not later than 180 days after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall publish
a report regarding veterans who receive benefits under laws
administered by the Secretary, including the Transition Assistance
Program under sections 1142 and 1144 of title 10, United States Code.
(b) Data.--The data regarding veterans published in the report
under subsection (a)--
(1) shall be disaggregated by--
(A) sex;
(B) minority group member status; and
(C) minority group member status listed by sex.
(2) may not include any personally identifiable
information.
(c) Matters Included.--The report under subsection (a) shall
include--
(1) identification of any disparities in the use of
benefits under laws administered by the Secretary; and
(2) an analysis of the cause of such disparities and
recommendations to address such disparities.
(d) Minority Group Member Defined.--In this section, the term
``minority group member'' has the meaning given that term in section
544 of title 38, United States Code.
SEC. 306. STUDY ON WOMEN VETERAN COORDINATOR PROGRAM.
Not later than 180 days after the date of the enactment of this
Act, the Secretary of Veterans Affairs shall submit to the Committees
on Veterans' Affairs of the House of Representatives and the Senate a
report containing a study on the Women Veteran Coordinator program of
the Veterans Benefits Administration of the Department of Veterans
Affairs. Such study shall identify the following:
(1) If the program is appropriately staffed at each
regional benefits office of the Department.
(2) Whether each regional benefits office of the Department
is staffed with a Women Veteran Coordinator.
(3) The position description of the Women Veteran
Coordinator.
(4) Whether an individual serving in the Women Veteran
Coordinator position concurrently serves in any other position,
and if so, the allocation of time the individual spends in each
such position.
(5) A description of the metrics the Secretary uses to
determine the success and performance of the Women Veteran
Coordinator.
Subtitle B--Other Matters
SEC. 321. ANTI-HARASSMENT AND ANTI-SEXUAL ASSAULT POLICY OF THE
DEPARTMENT OF VETERANS AFFAIRS.
(a) In General.--Subchapter II of chapter 5 of title 38, United
States Code, is amended by adding at the end the following new section:
``Sec. 533. Anti-harassment and anti-sexual assault policy
``(a) Establishment.--The Secretary of Veterans Affairs shall
establish a comprehensive policy to end harassment and sexual assault,
including sexual harassment and gender-based harassment, throughout the
Department of Veterans Affairs. This policy shall include the
following:
``(1) A process for employees and contractors of the
Department to respond to reported incidents of harassment and
sexual assault committed by any non-Department individual
within a facility of the Department, including with respect to
accountability or disciplinary measures.
``(2) A process for employees and contractors of the
Department to respond to reported incidents of harassment and
sexual assault of any non-Department individual within a
facility of the Department.
``(3) A process for any non-Department individual to report
harassment and sexual assault described in paragraph (1),
including an option for confidential reporting, and for the
Secretary to respond to and address such reports.
``(4) Clear mechanisms for non-Department individuals to
readily identify to whom and how to report incidents of
harassment and sexual assault committed by another non-
Department individual.
``(5) Clear mechanisms for employees and contractors of the
Department to readily identify to whom and how to report
incidents of harassment and sexual assault and how to refer
non-Department individuals with respect to reporting an
incident of harassment or sexual assault.
``(6) A process for, and mandatory reporting requirement
applicable to, any employee or contractor of the Department who
witnesses harassment or sexual assault described in paragraph
(1) or (2) within a facility of the Department, regardless of
whether the individual affected by such harassment or sexual
assault wants to report such harassment or sexual assault.
``(7) The actions possible, including disciplinary actions,
for employees or contractors of the Department who fail to
report incidents of harassment and sexual assault described in
paragraph (1) or (2) that the employees or contractors witness.
``(8) On an annual or more frequent basis, mandatory
training for employees and contractors of the Department
regarding how to report and address harassment and sexual
assault described in paragraphs (1) and (2), including
bystander intervention training.
``(9) On an annual or more frequent basis, the distribution
of the policy under this subsection and anti-harassment and
anti-sexual assault educational materials by mail or email to
each individual receiving a benefit under a law administered by
the Secretary.
``(10) The prominent display of anti-harassment and anti-
sexual assault messages in each facility of the Department,
including how non-Department individuals may report harassment
and sexual assault described in paragraphs (1) and (2) at such
facility and the points of contact under subsection (b).
``(11) The posting on internet websites of the Department,
including the main internet website regarding benefits of the
Department and the main internet website regarding health care
of the Department, of anti-harassment and anti-sexual assault
banners specifically addressing harassment and sexual assault
described in paragraphs (1) and (2).
``(b) Points of Contact.--The Secretary shall designate, as a point
of contact to receive reports of harassment and sexual assault
described in paragraphs (1) and (2) of subsection (a)--
``(1) at least one individual, in addition to law
enforcement, at each facility of the Department (including Vet
Centers under section 1712A of this title), with regard to that
facility;
``(2) at least one individual employed in each Veterans
Integrated Service Network, with regards to facilities in that
Veterans Integrated Service Network;
``(3) at least one individual employed in each regional
benefits office;
``(4) at least one individual employed at each location of
the National Cemetery Administration; and
``(5) at least one individual employed at the Central
Office of the Department to track reports of such harassment
and sexual assault across the Department, disaggregated by
facility.
``(c) Accountability.--The Secretary shall establish a policy to
ensure that each facility of the Department and each director of a
Veterans Integrated Service Network is responsible for addressing
harassment and sexual assault at the facility and the Network. Such
policy shall include--
``(1) a remediation plan for facilities that experience
five or more incidents of sexual harassment, sexual assault, or
combination thereof, during any single fiscal year; and
``(2) taking appropriate actions under chapter 7 or
subchapter V of chapter 74 of this title.
``(d) Data.--The Secretary shall ensure that the in-take process
for veterans at medical facilities of the Department includes a survey
to collect the following information:
``(1) Whether the veteran feels safe at the facility and
whether any events occurred at the facility that affect such
feeling.
``(2) Whether the veteran wants to be contacted later by
the Department with respect to such safety issues.
``(e) Working Group.--(1) The Secretary shall establish a working
group to assist the Secretary in implementing policies to carry out
this section.
``(2) The working group established under paragraph (1) shall
consist of representatives from--
``(A) veterans service organizations;
``(B) State, local, and Tribal veterans agencies; and
``(C) other persons the Secretary determines appropriate.
``(3) The working group established under paragraph (1) shall
develop, and the Secretary shall carry out--
``(A) an action plan for addressing changes at the local
level to reduce instances of harassment and sexual assault;
``(B) standardized media for veterans service organizations
and other persons to use in print and on the internet with
respect to reducing harassment and sexual assault; and
``(C) bystander intervention training for veterans.
``(f) Reports.--The Secretary shall submit to the Committees on
Veterans' Affairs of the Senate and the House of Representatives an
annual report on harassment and sexual assault described in paragraphs
(1) and (2) of subsection (a) in facilities of the Department. Each
such report shall include the following:
``(1) Results of harassment and sexual assault programming,
including the End Harassment program.
``(2) Results of studies from the Women's Health Practice-
Based Research Network of the Department relating to harassment
and sexual assault.
``(3) Data collected on incidents of sexual harassment and
sexual assault.
``(4) A description of any actions taken by the Secretary
during the year preceding the date of the report to stop
harassment and sexual assault at facilities of the Department.
``(5) An assessment of the implementation of the training
required in subsection (a)(7).
``(6) A list of resources the Secretary determines
necessary to prevent harassment and sexual assault at
facilities of the Department.
``(g) Definitions.--In this section:
``(1) The term `non-Department individual' means any
individual present at a facility of the Department who is not
an employee or contractor of the Department.
``(2) The term `sexual harassment' has the meaning given
that term in section 1720D of this title.''.
(b) Clerical Amendment.--The table of sections at the beginning of
such chapter is amended by adding after the item relating to section
532 the following new item:
``533. Anti-harassment and anti-sexual assault policy.''.
(c) Definition of Sexual Harassment.--Section 1720D(f) of such
title is amended by striking ``repeated,''.
(d) Deadline.--The Secretary shall commence carrying out section
533 of such title, as added by subsection (a), not later than 180 days
after the date of enactment of this Act.
SEC. 322. SUPPORT FOR ORGANIZATIONS THAT HAVE A FOCUS ON PROVIDING
ASSISTANCE TO WOMEN VETERANS AND THEIR FAMILIES.
Section 2044(e) of title 38, United States Code, is amended by
adding at the end the following new paragraph:
``(4) There is authorized to be appropriated $20,000,000
for fiscal year 2020 to provide, under subsection (a),
financial assistance to organizations that have a focus on
providing assistance to women veterans and their families.''.
SEC. 323. GAP ANALYSIS OF DEPARTMENT OF VETERANS AFFAIRS PROGRAMS THAT
PROVIDE ASSISTANCE TO WOMEN VETERANS WHO ARE HOMELESS.
(a) In General.--The Secretary of Veterans Affairs shall complete
an analysis of programs of the Department of Veterans Affairs that
provide assistance to women veterans who are homeless or precariously
housed to identify the areas in which such programs are failing to meet
the needs of such women.
(b) Report.--Not later than 270 days after the date of the
enactment of this Act, 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 analysis completed
under subsection (a).
SEC. 324. DEPARTMENT OF VETERANS AFFAIRS PUBLIC-PRIVATE PARTNERSHIP ON
LEGAL SERVICES FOR WOMEN VETERANS.
(a) Partnership Required.--The Secretary of Veterans Affairs shall
establish a partnership with at least one nongovernmental organization
to provide legal services to women veterans.
(b) Focus.--The focus of the partnership established under
subsection (a) shall be on the 10 highest unmet needs of women veterans
as set forth in the most recently completed Community Homelessness
Assessment, Local Education and Networking Groups for Veterans (CHALENG
for Veterans) survey.
SEC. 325. PROGRAM TO ASSIST VETERANS WHO EXPERIENCE INTIMATE PARTNER
VIOLENCE OR SEXUAL ASSAULT.
(a) Program Required.--The Secretary of Veterans Affairs shall
carry out a program to assist former members of the armed forces who
have experienced or are experiencing intimate partner violence or
sexual assault in accessing benefits from the Department of Veterans
Affairs, including coordinating access to medical treatment centers,
housing assistance, and other benefits from the Department.
(b) Collaboration.--The Secretary shall carry out the program under
subsection (a) in collaboration with--
(1) intimate partner violence shelters and programs;
(2) rape crisis centers;
(3) State intimate partner violence and sexual assault
coalitions; and
(4) such other health care or other service providers that
serve intimate partner violence or sexual assault victims as
determined by the Secretary, particularly those providing
emergency services or housing assistance.
(c) Authorized Activities.--In carrying out the program under
subsection (a), the Secretary may conduct the following activities:
(1) Training for community-based intimate partner violence
or sexual assault service providers on--
(A) identifying former members of the Armed Forces
who have been victims of intimate partner violence or
sexual assault;
(B) coordinating with local service providers of
the Department; and
(C) connecting former members of the Armed Forces
with appropriate housing, mental health, medical, and
other financial assistance or benefits from the
Department.
(2) Assistance to service providers to ensure access of
veterans to intimate partner violence and sexual assault
emergency services, particularly in underserved areas,
including services for Native American veterans (as defined in
section 3765 of title 38, United States Code).
(3) Such other outreach and assistance as the Secretary
determines necessary for the provision of assistance under
subsection (a).
(d) Intimate Partner Violence and Sexual Assault Outreach
Coordinators.--
(1) In general.--In order to effectively assist veterans
who have experienced intimate partner violence or sexual
assault, the Secretary may establish local coordinators to
provide outreach under the program required by subsection (a).
(2) Local coordinator knowledge.--The Secretary shall
ensure that each coordinator established under paragraph (1) is
knowledgeable about--
(A) the dynamics of intimate partner violence and
sexual assault, including safety concerns, legal
protections, and the need for the provision of
confidential services;
(B) the eligibility of veterans for services and
benefits from the Department that are relevant to
recovery from intimate partner violence and sexual
assault, particularly emergency housing assistance,
mental health care, other health care, and disability
benefits; and
(C) local community resources addressing intimate
partner violence and sexual assault.
(3) Local coordinator assistance.--Each coordinator
established under paragraph (1) shall assist intimate partner
violence shelters and rape crisis centers in providing services
to veterans.
SEC. 326. STUDY AND TASK FORCE ON VETERANS EXPERIENCING INTIMATE
PARTNER VIOLENCE OR SEXUAL ASSAULT.
(a) National Baseline Study.--
(1) In general.--Not later than 1 year after the date of
the enactment of this Act, the Secretary of Veterans Affairs,
in consultation with the Attorney General, shall conduct a
national baseline study to examine the scope of the problem of
intimate partner violence and sexual assault among veterans and
spouses and intimate partners of veterans.
(2) Matters included.--The study under paragraph (1)
shall--
(A) include a literature review of all relevant
research on intimate partner violence and sexual
assault among veterans and spouses and intimate
partners of veterans;
(B) examine the prevalence of the experience of
intimate partner violence among--
(i) women veterans;
(ii) veterans who are minority group
members (as defined in section 544 of title 38,
United States Code, and including other
minority populations as the Secretary
determines appropriate);
(iii) urban and rural veterans;
(iv) veterans who are enrolled in a program
under section 1720G of title 38, United States
Code;
(v) veterans who are in intimate
relationships with other veterans; and
(vi) veterans who are described in more
than one clause of this subparagraph;
(C) examine the prevalence of the perpetration of
intimate partner violence by veterans; and
(D) include recommendations to address the findings
of the study.
(3) Report.--Not later than 30 days after the date on which
the Secretary completes the study under paragraph (1), the
Secretary shall submit to the Committees on Veterans' Affairs
of the House of Representatives and the Senate a report on such
study.
(b) Task Force.--Not later than 90 days after the date on which the
Secretary completes the study under subsection (a), the Secretary, in
consultation with the Attorney General and the Secretary of Health and
Human Services, shall establish a national task force (in this section
referred to as the ``Task Force'') to develop a comprehensive national
program, including by integrating facilities, services, and benefits of
the Department of Veterans Affairs into existing networks of community-
based intimate partner violence and sexual assault services, to address
intimate partner violence and sexual assault among veterans.
(c) Consultation With Stakeholders.--In carrying out this section,
the Task Force shall consult with--
(1) representatives from veteran service organizations and
military service organizations;
(2) representatives from not fewer than three national
organizations or State coalitions with demonstrated expertise
in intimate partner violence prevention, response, or advocacy;
and
(3) representatives from not fewer than three national
organizations or State coalitions, particularly those
representing underserved and ethnic minority communities, with
demonstrated expertise in sexual assault prevention, response,
or advocacy.
(d) Duties.--The duties of the Task Force shall include the
following:
(1) To review existing services and policies of the
Department and develop a comprehensive national program to
address intimate partner violence and sexual assault
prevention, response, and treatment.
(2) To review the feasibility and advisability of
establishing an expedited process to secure emergency,
temporary benefits, including housing or other benefits, for
veterans who are experiencing intimate partner violence or
sexual assault.
(3) To review and make recommendations regarding the
feasibility and advisability of establishing dedicated,
temporary housing assistance for veterans experiencing intimate
partner violence or sexual assault.
(4) To identify any requirements regarding intimate partner
violence assistance or sexual assault response and services
that are not being met by the Department and make
recommendations on how the Department can meet such
requirements.
(5) To review and make recommendations regarding the
feasibility and advisability of providing direct services or
contracting for community-based services for veterans in
response to a sexual assault, including through the use of
sexual assault nurse examiners, particularly in underserved or
remote areas, including services for Native American veterans.
(6) To review the availability of counseling services
provided by the Department and through peer network support,
and to provide recommendations for the enhancement of such
services, to address--
(A) the perpetration of intimate partner violence
and sexual assault; and
(B) the recovery of veterans, particularly women
veterans, from intimate partner violence and sexual
assault.
(7) To review and make recommendations to expand services
available for veterans at risk of perpetrating intimate partner
violence.
(e) Report.--Not later than 1 year after the date of the enactment
of this Act, and not less frequently than annually thereafter by
October 1 of each year, the Task Force shall submit to the Secretary of
Veterans Affairs and Congress a report on the activities of the Task
Force, including any recommendations for legislative or administrative
action.
(f) Definitions.--In this section:
(1) The term ``Native American veteran'' has the meaning
given that term in section 3765 of title 38, United States
Code.
(2) The term ``State'' has the meaning given that term in
section 101 of title 38, United States Code.
Passed the House of Representatives November 12, 2019.
Attest:
CHERYL L. JOHNSON,
Clerk.