[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5492 Introduced in House (IH)]

<DOC>






118th CONGRESS
  1st Session
                                H. R. 5492

 To improve the reproductive assistance provided by the Department of 
 Defense and the Department of Veterans Affairs to certain members of 
  the Armed Forces, veterans, and their spouses or partners, and for 
                            other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 14, 2023

  Mr. Larsen of Washington (for himself, Ms. Jacobs, Ms. Norton, Mrs. 
Dingell, Ms. Houlahan, Ms. Omar, Mr. McGovern, Mr. Krishnamoorthi, Mr. 
   Connolly, and Ms. Titus) introduced the following bill; which was 
referred to the Committee on Veterans' Affairs, and in addition to the 
Committee on Armed Services, for a period to be subsequently determined 
 by the Speaker, in each case for consideration of such provisions as 
        fall within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
 To improve the reproductive assistance provided by the Department of 
 Defense and the Department of Veterans Affairs to certain members of 
  the Armed Forces, veterans, and their spouses or partners, and for 
                            other purposes.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Veteran Families 
Health Services Act of 2023''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
TITLE I--REPRODUCTIVE AND FERTILITY PRESERVATION ASSISTANCE FOR MEMBERS 
                          OF THE ARMED FORCES

Sec. 101. Definitions.
Sec. 102. Provision of fertility treatment and counseling to certain 
                            members of the Armed Forces and spouses, 
                            partners, and gestational surrogates of 
                            such members.
Sec. 103. Establishment of fertility preservation procedures after an 
                            injury or illness.
Sec. 104. Cryopreservation and storage of reproductive genetic material 
                            of members of the Armed Forces on active 
                            duty.
Sec. 105. Assistance with and continuity of care regarding reproductive 
                            and fertility preservation services.
Sec. 106. Coordination between Department of Defense and Department of 
                            Veterans Affairs on furnishing of fertility 
                            treatment and counseling.
      TITLE II--REPRODUCTIVE AND ADOPTION ASSISTANCE FOR VETERANS

Sec. 201. Inclusion of fertility treatment and counseling under the 
                            definition of medical services in title 38.
Sec. 202. Fertility treatment and counseling for certain veterans and 
                            spouses, partners, and gestational 
                            surrogates of such veterans.
Sec. 203. Adoption assistance for certain veterans.
Sec. 204. Assistance with and continuity of care regarding reproductive 
                            and fertility preservation services.
Sec. 205. Facilitation of reproduction and infertility research.
Sec. 206. Regulations on furnishing of fertility treatment and 
                            counseling and adoption assistance by 
                            Department of Veterans Affairs.

TITLE I--REPRODUCTIVE AND FERTILITY PRESERVATION ASSISTANCE FOR MEMBERS 
                          OF THE ARMED FORCES

SEC. 101. DEFINITIONS.

    In this title:
            (1) Active duty.--The term ``active duty'' has the meaning 
        given that term in section 101(d)(1) of title 10, United States 
        Code.
            (2) Armed forces.--The term ``Armed Forces'' has the 
        meaning given the term ``armed forces'' in section 101(a)(4) of 
        such title.

SEC. 102. PROVISION OF FERTILITY TREATMENT AND COUNSELING TO CERTAIN 
              MEMBERS OF THE ARMED FORCES AND SPOUSES, PARTNERS, AND 
              GESTATIONAL SURROGATES OF SUCH MEMBERS.

    (a) Fertility Treatment and Counseling.--
            (1) In general.--The Secretary of Defense shall furnish 
        fertility treatment and counseling, including through the use 
        of assisted reproductive technology, to a covered member of the 
        Armed Forces or a spouse, partner, or gestational surrogate of 
        such a member.
            (2) Eligibility for treatment and counseling.--Fertility 
        treatment and counseling shall be furnished under paragraph (1) 
        without regard to the sex, gender identity, sexual orientation, 
        or marital status of the covered member of the Armed Forces.
            (3) In vitro fertilization.--In the case of in vitro 
        fertilization treatment furnished under paragraph (1), the 
        Secretary may furnish to an individual under such paragraph--
                    (A) not more than three completed oocyte 
                retrievals; and
                    (B) unlimited embryo transfers in accordance with 
                the guidelines of the American Society for Reproductive 
                Medicine.
    (b) Procurement of Reproductive Genetic Material.--If a covered 
member of the Armed Forces is unable to provide their reproductive 
genetic material for purposes of fertility treatment under subsection 
(a), the Secretary shall, at the election of such member, allow such 
member to receive such treatment with donated reproductive genetic 
material and pay or reimburse such member the reasonable costs of 
procuring such material from a donor.
    (c) Rule of Construction.--Nothing in this section shall be 
construed to require the Secretary--
            (1) to find or certify a gestational surrogate for a 
        covered member of the Armed Forces or to connect a gestational 
        surrogate with such a member; or
            (2) to find or certify reproductive genetic material from a 
        donor for a covered member of the Armed Forces or to connect 
        such a member with reproductive genetic material from a donor.
    (d) Definitions.--In this section:
            (1) Assisted reproductive technology.--The term ``assisted 
        reproductive technology'' includes in vitro fertilization and 
        other fertility treatments in which both eggs and sperm are 
        handled when clinically appropriate.
            (2) Covered member of the armed forces.--The term ``covered 
        member of the Armed Forces'' means a member of the Armed Forces 
        who has an infertility condition, unless the Secretary can show 
        that the member was completely infertile before service on 
        active duty in the Armed Forces.
            (3) Fertility treatment.--The term ``fertility treatment'' 
        includes the following:
                    (A) Procedures that use assisted reproductive 
                technology.
                    (B) Sperm retrieval.
                    (C) Egg retrieval.
                    (D) Artificial insemination.
                    (E) Transfer of reproductive genetic material.
                    (F) Medications as prescribed or necessary for 
                fertility.
                    (G) Such other treatments as the Secretary of 
                Defense considers appropriate.
            (4) Infertility condition.--The term ``infertility 
        condition'' includes--
                    (A) a diagnosis of infertility; or
                    (B) the inability to reproduce or safely carry a 
                pregnancy to term, including as a result of treatment 
                for another condition.
            (5) Partner.--The term ``partner'', with respect to a 
        member of the Armed Forces, means an individual selected by the 
        member who agrees to share with the member the parental 
        responsibilities with respect to any child born as a result of 
        the use of any fertility treatment under this section.

SEC. 103. ESTABLISHMENT OF FERTILITY PRESERVATION PROCEDURES AFTER AN 
              INJURY OR ILLNESS.

    (a) In General.--The Secretary of Defense, acting through the 
Assistant Secretary of Defense for Health Affairs, shall establish 
procedures for the retrieval of reproductive genetic material, as soon 
as medically appropriate, from a member of the Armed Forces in cases in 
which the fertility of such member is potentially jeopardized as a 
result of an injury or illness incurred or aggravated while serving on 
active duty in the Armed Forces in order to preserve the medical 
options of such member.
    (b) Consent for Retrieval of Reproductive Genetic Material.--
Reproductive genetic material may be retrieved from a member of the 
Armed Forces under subsection (a) only--
            (1) with the specific consent of the member; or
            (2) if the member is unable to consent, if a medical 
        professional determines that--
                    (A) the future fertility of the member is 
                potentially jeopardized as a result of an injury or 
                illness described in subsection (a) or will be 
                potentially jeopardized as a result of treating such 
                injury or illness;
                    (B) the member lacks the capacity to consent to the 
                retrieval of reproductive genetic material and is 
                likely to regain such capacity; and
                    (C) the retrieval of reproductive genetic material 
                under this section is in the medical interest of the 
                member.
    (c) Consent for Use of Retrieved Reproductive Genetic Material.--
Reproductive genetic material retrieved from a member of the Armed 
Forces under subsection (a) may be used only--
            (1) with the specific consent of the member; or
            (2) if the member has lost the ability to consent 
        permanently, as determined by a medical professional, as 
        specified in an advance directive or testamentary instrument 
        executed by the member.
    (d) Disposal of Reproductive Genetic Material.--In accordance with 
regulations prescribed by the Secretary for purpose of this subsection, 
the Secretary shall dispose of reproductive genetic material retrieved 
from a member of the Armed Forces under subsection (a)--
            (1) with the specific consent of the member; or
            (2) if the member--
                    (A) has lost the ability to consent permanently, as 
                determined by a medical professional; and
                    (B) has not specified the use of their reproductive 
                genetic material in an advance directive or 
                testamentary instrument executed by the member.

SEC. 104. CRYOPRESERVATION AND STORAGE OF REPRODUCTIVE GENETIC MATERIAL 
              OF MEMBERS OF THE ARMED FORCES ON ACTIVE DUTY.

    (a) In General.--The Secretary of Defense shall provide members of 
the Armed Forces on active duty in the Armed Forces with the 
opportunity to cryopreserve and store their reproductive genetic 
material prior to--
            (1) deployment to a combat zone; or
            (2) a duty assignment that includes a hazardous assignment, 
        including--
                    (A) assignments resulting in exposure to 
                perfluoroalkyl or polyfluoroalkyl substances; and
                    (B) such other assignments as determined by the 
                Secretary.
    (b) Period of Time.--
            (1) In general.--The Secretary shall provide for the 
        cryopreservation and storage of reproductive genetic material 
        of any member of the Armed Forces under subsection (a) in a 
        facility of the Department of Defense or of a private entity 
        and the transportation of such material, at no cost to the 
        member, until the date that is one year after the retirement, 
        separation, or release of the member from the Armed Forces.
            (2) Continued cryopreservation and storage.--At the end of 
        the one-year period specified in paragraph (1), the Secretary 
        shall permit an individual whose reproductive genetic material 
        was cryopreserved and stored in a facility of the Department as 
        described in that paragraph to select, including pursuant to an 
        advance medical directive or military testamentary instrument 
        completed under subsection (c), one of the following options:
                    (A) To continue such cryopreservation and storage 
                in such facility with the cost of such cryopreservation 
                and storage borne by the individual.
                    (B) To transfer the material to a private 
                cryopreservation and storage facility selected by the 
                individual.
                    (C) To transfer the material to a facility of the 
                Department of Veterans Affairs if cryopreservation and 
                storage is available to the individual at such 
                facility.
            (3) Disposal of reproductive genetic material.--If an 
        individual described in paragraph (2) does not make a selection 
        under subparagraph (A), (B), or (C) of such paragraph, the 
        Secretary may dispose of the reproductive genetic material of 
        the individual not earlier than the date that is 90 days after 
        the end of the one-year period specified in paragraph (1) with 
        respect to the individual.
    (c) Advance Medical Directive and Military Testamentary 
Instrument.--A member of the Armed Forces who elects to cryopreserve 
and store their reproductive genetic material under this section must 
complete an advance medical directive, as defined in section 1044c(b) 
of title 10, United States Code, and a military testamentary 
instrument, as defined in section 1044d(b) of such title, that 
explicitly specifies the use of their cryopreserved and stored 
reproductive genetic material if such member dies or otherwise loses 
the capacity to consent to the use of their cryopreserved and stored 
reproductive genetic material.
    (d) Agreements.--To carry out this section, the Secretary may enter 
into agreements with private entities that provide cryopreservation, 
transportation, and storage services for reproductive genetic material.

SEC. 105. ASSISTANCE WITH AND CONTINUITY OF CARE REGARDING REPRODUCTIVE 
              AND FERTILITY PRESERVATION SERVICES.

    The Secretary of Defense shall ensure that employees of the 
Department of Defense assist members of the Armed Forces--
            (1) in navigating the services provided under this title;
            (2) in finding a provider that meets the needs of such 
        members with respect to such services; and
            (3) in continuing the receipt of such services without 
        interruption during a permanent change of station for such 
        members.

SEC. 106. COORDINATION BETWEEN DEPARTMENT OF DEFENSE AND DEPARTMENT OF 
              VETERANS AFFAIRS ON FURNISHING OF FERTILITY TREATMENT AND 
              COUNSELING.

    (a) In General.--The Secretary of Defense and the Secretary of 
Veterans Affairs shall share best practices and facilitate referrals, 
as they consider appropriate, on the furnishing of fertility treatment 
and counseling to individuals eligible for the receipt of such 
counseling and treatment from the Secretaries.
    (b) Memorandum of Understanding.--The Secretary of Defense and the 
Secretary of Veterans Affairs shall enter into a memorandum of 
understanding--
            (1) providing that the Secretary of Defense will ensure 
        access by the Secretary of Veterans Affairs to reproductive 
        genetic material of veterans stored by the Department of 
        Defense for purposes of furnishing fertility treatment under 
        section 1720K of title 38, United States Code, as added by 
        section 202(a); and
            (2) authorizing the Department of Veterans Affairs to 
        compensate the Department of Defense for the cryopreservation, 
        transportation, and storage of reproductive genetic material of 
        veterans under section 104.

      TITLE II--REPRODUCTIVE AND ADOPTION ASSISTANCE FOR VETERANS

SEC. 201. INCLUSION OF FERTILITY TREATMENT AND COUNSELING UNDER THE 
              DEFINITION OF MEDICAL SERVICES IN TITLE 38.

    Section 1701(6) of title 38, United States Code, is amended by 
adding at the end the following new subparagraph:
                    ``(J) Fertility treatment and counseling, including 
                treatment using assisted reproductive technology.''.

SEC. 202. FERTILITY TREATMENT AND COUNSELING FOR CERTAIN VETERANS AND 
              SPOUSES, PARTNERS, AND GESTATIONAL SURROGATES OF SUCH 
              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. 1720K. Fertility treatment and counseling for certain veterans 
              and spouses, partners, and gestational surrogates of such 
              veterans
    ``(a) Requirement.--
            ``(1) In general.--Notwithstanding any other provision of 
        law, the Secretary shall furnish fertility treatment and 
        counseling, including through the use of assisted reproductive 
        technology, to a covered veteran and the spouse, partner, or 
        gestational surrogate of the veteran if the veteran, and the 
        spouse, partner, or gestational surrogate of the veteran, as 
        applicable, each provide informed consent for such treatment 
        and counseling, including for each cycle of treatment 
        authorized under this section, through a process prescribed by 
        the Secretary.
            ``(2) Provision of treatment and counseling.--Fertility 
        treatment and counseling shall be furnished under paragraph (1) 
        without regard to the sex, gender identity, sexual orientation, 
        or marital status of the covered veteran.
            ``(3) In vitro fertilization.--In the case of in vitro 
        fertilization treatment furnished under paragraph (1), the 
        Secretary may furnish to an individual under such paragraph--
                    ``(A) not more than three completed oocyte 
                retrievals; and
                    ``(B) unlimited embryo transfers in accordance with 
                the guidelines of the American Society for Reproductive 
                Medicine.
    ``(b) Procurement of Reproductive Genetic Material.--If a covered 
veteran is unable to provide their reproductive genetic material for 
purposes of fertility treatment under subsection (a), the Secretary 
shall, at the election of such member, allow such veteran to receive 
such treatment with donated reproductive genetic material and pay or 
reimburse such veteran the reasonable costs of procuring such material 
from a donor.
    ``(c) Outreach and Training.--The Secretary shall carry out an 
outreach and training program to ensure veterans and health care 
providers of the Department are aware of--
            ``(1) the availability of and eligibility requirements for 
        fertility treatment and counseling under this section; and
            ``(2) any changes to fertility treatment and counseling 
        covered under this section.
    ``(d) Ownership, Use, Disposition, or Destruction of Reproductive 
Genetic Material.--
            ``(1) In general.--Issues or disputes regarding ownership 
        of reproductive genetic material, future use of such material, 
        disposition of such material, or destruction of such material 
        shall be the sole responsibility of the covered veteran, the 
        spouse, partner, or gestational surrogate of the veteran, and 
        the private facility storing such material.
            ``(2) Role of department.--The role of the Department under 
        this section is limited to furnishing the treatment and 
        counseling required under this section when requested by a 
        covered veteran.
            ``(3) Ownership and custody of reproductive genetic 
        material.--The Department will not have ownership or custody of 
        any reproductive genetic material obtained pursuant to 
        treatment under this section and will not be involved in the 
        ultimate disposition of such material or disputes between or 
        among any parties with respect to such material.
    ``(e) Rule of Construction.--Nothing in this section shall be 
construed to require the Secretary--
            ``(1) to find or certify a gestational surrogate for a 
        covered veteran or to connect a gestational surrogate with a 
        covered veteran; or
            ``(2) to furnish maternity care to a covered veteran or 
        spouse, partner, or gestational surrogate of a covered veteran 
        in addition to what is otherwise required by law.
    ``(f) Definitions.--In this section:
            ``(1) The term `assisted reproductive technology' includes 
        in vitro fertilization and other fertility treatments in which 
        both eggs and sperm are handled when clinically appropriate.
            ``(2) The term `covered veteran' means a veteran who--
                    ``(A) has an infertility condition, unless the 
                Secretary can show that the veteran was completely 
                infertile before service in the active military, naval, 
                or air service; and
                    ``(B) is enrolled in the system of annual patient 
                enrollment established under section 1705(a) of this 
                title.
            ``(3) The term `fertility treatment' includes the 
        following:
                    ``(A) Procedures that use assisted reproductive 
                technology.
                    ``(B) Sperm retrieval.
                    ``(C) Egg retrieval.
                    ``(D) Artificial insemination.
                    ``(E) Transfer of reproductive genetic material.
                    ``(F) Medications as prescribed or necessary for 
                fertility.
                    ``(G) Such other treatments as the Secretary 
                considers appropriate.
            ``(4) The term `gestational surrogate' means an individual 
        who carries a fetus through pregnancy and gives birth to a baby 
        for another individual or couple.
            ``(5) The term `infertility condition' includes--
                    ``(A) a diagnosis of infertility; or
                    ``(B) the inability to reproduce or safely carry a 
                pregnancy to term, including as a result of treatment 
                for another condition.
            ``(6) The term `partner', with respect to a covered 
        veteran, means an individual--
                    ``(A) selected by the veteran who agrees to share 
                with the veteran the parental responsibilities with 
                respect to any child born as a result of the use of any 
                fertility treatment under this section; and
                    ``(B) whom the veteran certifies to the Department 
                is the partner of the veteran and therefore, based on 
                that certification, is eligible for treatment and 
                counseling under this section.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
subchapter II of chapter 17 of such title is amended by inserting after 
the item relating to section 1720J the following new item:

``1720K. Fertility treatment and counseling for certain veterans and 
                            spouses, partners, and gestational 
                            surrogates of such veterans.''.

SEC. 203. ADOPTION ASSISTANCE FOR CERTAIN VETERANS.

    (a) In General.--Subchapter VIII of chapter 17 of title 38, United 
States Code, is amended by adding at the end the following new section:
``Sec. 1790. Adoption assistance
    ``(a) In General.--The Secretary may pay an amount, not to exceed 
the limitation amount, to assist a covered veteran in the adoption of 
one or more children, without regard to the sex, gender identity, 
sexual orientation, or marital status of the covered veteran.
    ``(b) Limitation Amount.--For purposes of this section, the 
limitation amount is the amount equal to the cost the Department would 
incur by paying the expenses of three adoptions by covered veterans, as 
determined by the Secretary.
    ``(c) Covered Veteran Defined.--In this section, the term `covered 
veteran' has the meaning given that term in section 1720K(f) of this 
title.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
subchapter VIII of chapter 17 of such title is amended by inserting 
after the item relating to section 1789 the following new item:

``1790. Adoption assistance.''.

SEC. 204. ASSISTANCE WITH AND CONTINUITY OF CARE REGARDING REPRODUCTIVE 
              AND FERTILITY PRESERVATION SERVICES.

    The Secretary of Veterans Affairs shall ensure that employees of 
the Department of Veterans Affairs assist veterans--
            (1) in navigating the services provided under this title 
        and the amendments made by this title;
            (2) in finding a provider that meets the needs of such 
        veterans with respect to such services; and
            (3) in continuing the receipt of such services without 
        interruption if such veterans move to a different geographic 
        location.

SEC. 205. FACILITATION OF REPRODUCTION AND INFERTILITY RESEARCH.

    (a) In General.--Subchapter II of chapter 73 of title 38, United 
States Code, is amended by adding at the end the following new section:
``Sec. 7330E. Facilitation of reproduction and infertility research
    ``(a) Facilitation of Research Required.--The Secretary shall 
facilitate research conducted collaboratively by the Secretary of 
Defense and the Secretary of Health and Human Services to improve the 
ability of the Department of Veterans Affairs to meet the long-term 
reproductive health care needs of veterans who have a genitourinary 
service-connected disability or a condition that was incurred or 
aggravated in line of duty in the active military, naval, or air 
service, such as a spinal cord injury, military sexual trauma, or a 
mental health condition, that affects the ability of the veteran to 
reproduce.
    ``(b) Dissemination of Information.--The Secretary shall ensure 
that information produced by the research facilitated under this 
section that may be useful for other activities of the Veterans Health 
Administration is disseminated throughout the Veterans Health 
Administration.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
subchapter II of chapter 73 of such title is amended by inserting after 
the item relating to section 7330D the following new item:

``7330E. Facilitation of reproduction and infertility research.''.

SEC. 206. REGULATIONS ON FURNISHING OF FERTILITY TREATMENT AND 
              COUNSELING AND ADOPTION ASSISTANCE BY DEPARTMENT OF 
              VETERANS AFFAIRS.

    Not later than two years after the date of the enactment of this 
Act, the Secretary of Veterans Affairs shall prescribe regulations--
            (1) to carry out section 1720K of title 38, United States 
        Code, as added by section 202(a); and
            (2) to carry out section 1790 of such title, as added by 
        section 203(a).
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