[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 3826 Introduced in Senate (IS)]

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116th CONGRESS
  2d Session
                                S. 3826

 To require the Secretary of Defense to provide additional resources, 
 including doula support, for pregnant beneficiaries under the TRICARE 
                    program, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 21, 2020

    Mr. Blumenthal (for himself and Mrs. Gillibrand) introduced the 
 following bill; which was read twice and referred to the Committee on 
                             Armed Services

_______________________________________________________________________

                                 A BILL


 
 To require the Secretary of Defense to provide additional resources, 
 including doula support, for pregnant beneficiaries under the TRICARE 
                    program, 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 ``TRICARE Coverage for Doula Support 
Act''.

SEC. 2. ADDITIONAL RESOURCES, INCLUDING DOULA SUPPORT, FOR PREGNANT 
              BENEFICIARIES UNDER THE TRICARE PROGRAM.

    (a) Findings.--Congress finds the following:
            (1) In 2018, 52,535 members of the Armed Forces and their 
        dependents gave birth at military medical treatment facilities 
        or civilian hospitals where the Department of Defense purchased 
        care.
            (2) As required pursuant to the House report accompanying 
        H.R. 5515, 115th Congress (House Report 115-874), under the 
        heading ``Report on rate of maternal mortality among members of 
        the Armed Forces'' under the heading ``Legislative Provisions 
        Not Adopted'', the report submitted by the Secretary of Defense 
        titled ``Maternal and Infant Mortality Rates in the Military 
        Health System'' showed that rates of maternal and infant 
        mortality in the military health system are lower than national 
        averages but also recommended expanding available resources for 
        prenatal, childbirth, and postnatal communication, as well as 
        education for pregnant beneficiaries under the TRICARE program.
            (3) Doula support, which includes continuous non-clinical 
        one-to-one emotional, physical, and informational support 
        around the time of birth, as well as support during pregnancy 
        and postpartum, could be one such resource for pregnant 
        beneficiaries.
            (4) Studies have shown that doula support can decrease 
        maternal anxiety and depression that can contribute to 
        postpartum depression, and also that doula support reduces the 
        likelihood of consequential and costly interventions, such as 
        cesarean birth and epidural pain relief.
            (5) Research has also shown that doula support increases 
        the likelihood of a shorter labor, a spontaneous vaginal birth, 
        higher Apgar scores for babies, and a positive childbirth 
        experience, which subsequently lowers the cost of maternity 
        care while improving the health of women and infants.
            (6) The Expert Panel on Improving Maternal and Infant 
        Health Outcomes in Medicaid and the Children's Health Insurance 
        Program of the Centers for Medicare & Medicaid Services 
        recommends providing coverage for continuous doula support 
        during labor.
            (7) Members of the Armed Forces and military spouses are 
        uniquely positioned to maximize the benefits of doula support 
        due to the nature of training, deployments, frequent permanent 
        changes of station, and other mission requirements that can 
        contribute to isolation during pregnancy and birth, or prevent 
        birthing partners from being present during childbirth.
            (8) Members of the Armed Forces who are single, members of 
        the Armed Forces and military spouses with deployed birthing 
        partners, and minority women who face racial bias in access to 
        health care might find doula support particularly beneficial.
            (9) There are currently no specific programs of the 
        Department of Defense for labor support, but the My Career 
        Advancement Account program of the Department provides funding 
        for military spouses to receive training to become doulas.
    (b) Additional Resources for Pregnant TRICARE Beneficiaries.--
            (1) In general.--In providing maternity care for pregnant 
        beneficiaries under the TRICARE program under chapter 55 of 
        title 10, United States Code, the Secretary of Defense shall 
        provide to such beneficiaries additional resources for prenatal 
        and postnatal communication and education, including doula 
        support.
            (2) Prohibition on cost sharing.--The Secretary shall not 
        require a beneficiary under the TRICARE program to pay any fee 
        or other cost-sharing requirement for the receipt of additional 
        resources under paragraph (1).
            (3) Implementation.--Not later than one year after the date 
        of the enactment of this Act, the Secretary shall finalize 
        implementation of the provision of additional resources 
        required under paragraph (1).
    (c) Advisory Committee.--
            (1) In general.--Not later than 180 days after the date of 
        the enactment of this Act, the Secretary of Defense shall 
        establish an advisory committee to assist the Department of 
        Defense in carrying out the requirements under this section.
            (2) Selection of members.--The Secretary shall select the 
        members of the advisory committee required under paragraph (1), 
        which shall include the selection of--
                    (A) members who are racially and ethnically 
                diverse;
                    (B) members who are trained doulas; and
                    (C) members who are members of the Armed Forces or 
                family members of members of the Armed Forces.
            (3) Duties.--The duties of the advisory committee 
        established under paragraph (1) are to guide the Department of 
        Defense through the implementation of the requirements under 
        this section by providing recommendations to the Department on 
        the following items:
                    (A) Expansion of the TRICARE program to cover doula 
                support.
                    (B) Identification of appropriate certifications to 
                qualify an individual to provide doula support under 
                the TRICARE program.
                    (C) Establishment of reimbursement rates for doula 
                support under the TRICARE program.
                    (D) Outreach to beneficiaries under the TRICARE 
                program to educate those beneficiaries on the benefits 
                of doula support and the availability of such support.
    (d) Survey and Report.--
            (1) Survey.--Not later than one year after the date of the 
        enactment of this Act, and annually thereafter, the Secretary 
        shall administer a survey to determine--
                    (A) how many members of the Armed Forces or spouses 
                of such members give birth while their spouse or 
                birthing partner is unable to be present due to 
                deployment, training, or other mission requirements;
                    (B) how many single members of the Armed Forces 
                give birth alone; and
                    (C) how many members of the Armed Forces or spouses 
                of such members use doula support, or are interested in 
                using doula support, during pregnancy and childbirth.
            (2) Matters covered by the survey.--The survey administered 
        under paragraph (1) shall include an identification of the 
        following:
                    (A) The race, ethnicity, age, sex, relationship 
                status, military service, military occupation, and 
                rank, as applicable, of each individual surveyed.
                    (B) The service- or mission-specific reason the 
                member of the Armed Forces was not present during the 
                birth, if applicable.
                    (C) If individuals surveyed were members of the 
                Armed Forces or the spouses of such members, or both.
                    (D) The length of advanced notice received by 
                individuals surveyed that the member of the Armed 
                Forces would be unable to be present during the birth, 
                if applicable.
                    (E) Any resources or support that the individuals 
                surveyed found useful during the pregnancy and birth 
                process, including doula support.
            (3) Report.--The Secretary shall submit to the 
        congressional defense committees an annual report on the 
        results of the survey administered under paragraph (1) for the 
        year covered by the report.
    (e) Definitions.--In this section:
            (1) Congressional defense committees.--The term 
        ``congressional defense committees'' has the meaning given that 
        term in section 101(a)(16) of title 10, United States Code.
            (2) Doula.--
                    (A) In general.--The term ``doula'' means an 
                individual who is trained as described in subparagraph 
                (B) to provide non-medical advice, information, 
                emotional support, and physical comfort to an 
                individual during the individual's pregnancy, 
                childbirth, and postpartum period by an organization 
                that has been established for not less than five years 
                and that requires the completion of continuing 
                education.
                    (B) Training described.--Training described in this 
                subparagraph is training in nationally recognized core 
                doula competencies, which may include competency in 
                reproductive and birth justice frameworks, race equity, 
                cultural humility, home visiting skills, and knowledge 
                of social services.
            (3) TRICARE program.--The term ``TRICARE program'' has the 
        meaning given that term in section 1072 of title 10, United 
        States Code.

SEC. 3. EXPANSION OF EVALUATION ON EFFECTIVENESS OF TRICARE PROGRAM TO 
              INCLUDE DATA ON BIRTHS AT MILITARY MEDICAL TREATMENT 
              FACILITIES AND CIVILIAN HOSPITALS UNDER THE TRICARE 
              PROGRAM.

    Section 717(a) of the National Defense Authorization Act for Fiscal 
Year 1996 (Public Law 104-106; 10 U.S.C. 1073 note) is amended--
            (1) in paragraph (2), by striking ``; and'' and inserting a 
        semicolon;
            (2) in paragraph (3)(B)(v), by striking the period at the 
        end and inserting ``; and''; and
            (3) by adding at the end the following new paragraph:
            ``(4) assess data relating to births at each military 
        medical treatment facility or civilian hospital under the 
        TRICARE program during the one-year period preceding the 
        evaluation, including--
                    ``(A) the number of births, disaggregated by 
                military service and rank of the individual giving 
                birth or their spouse, as appropriate;
                    ``(B) whether the individual giving birth is a 
                member of the Armed Forces, a spouse of such a member, 
                or other dependent of such a member;
                    ``(C) the race, ethnicity, age, and relationship 
                status of the individual giving birth;
                    ``(D) any effects of implicit or explicit bias in 
                maternal health care under the TRICARE program, or 
                evidence of racial or socioeconomic barriers to such 
                care; and
                    ``(E) such other demographic information about the 
                individual giving birth as the Secretary considers 
                appropriate.''.
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