[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 2465 Introduced in Senate (IS)]

<DOC>






118th CONGRESS
  1st Session
                                S. 2465

   To require the Secretary of Veterans Affairs to establish a pilot 
             program to furnish doula services to veterans.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             July 25, 2023

  Mr. Booker (for himself and Ms. Murkowski) introduced the following 
 bill; which was read twice and referred to the Committee on Veterans' 
                                Affairs

_______________________________________________________________________

                                 A BILL


 
   To require the Secretary of Veterans Affairs to establish a pilot 
             program to furnish doula services to veterans.

    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 ``Delivering Optimally Urgent Labor 
Access for Veterans Affairs Act of 2023'' or the ``DOULA for VA Act of 
2023''.

SEC. 2. PILOT PROGRAM ON DOULA SUPPORT FOR VETERANS.

    (a) Findings.--Congress finds the following:
            (1) There are approximately 2,300,000 women within the 
        veteran population in the United States.
            (2) The number of women veterans using services from the 
        Veterans Health Administration has increased by 28.8 percent 
        from 423,642 in 2014 to 545,670 in 2019.
            (3) During the period of 2010 through 2015, the use of 
        maternity services from the Veterans Health Administration 
        increased by 44 percent.
            (4) Although prenatal care and delivery is not provided in 
        facilities of the Department of Veterans Affairs, pregnant 
        women seeking care from the Department for other conditions may 
        also need emergency care and require coordination of services 
        through the Veterans Community Care Program under section 1703 
        of title 38, United States Code.
            (5) The number of unique women veteran patients with an 
        obstetric delivery paid for by the Department increased by 
        1,778 percent from 200 deliveries in 2000 to 3,756 deliveries 
        in 2015.
            (6) The number of women age 35 years or older with an 
        obstetric delivery paid for by the Department increased 16-fold 
        from fiscal year 2000 to fiscal year 2015.
            (7) A study in 2010 found that veterans returning from 
        Operation Enduring Freedom and Operation Iraqi Freedom who 
        experienced pregnancy were twice as likely to have a diagnosis 
        of depression, anxiety, posttraumatic stress disorder, bipolar 
        disorder, or schizophrenia as those who had not experienced a 
        pregnancy.
            (8) The number of women veterans of reproductive age 
        seeking care from the Veterans Health Administration continues 
        to grow (more than 185,000 as of fiscal year 2015).
    (b) Program.--
            (1) In general.--Not later than one year after the date of 
        the enactment of this Act, the Secretary of Veterans Affairs 
        shall establish a pilot program to furnish doula services to 
        covered veterans through eligible entities by expanding the 
        Whole Health model of the Department of Veterans Affairs, or 
        successor model, to measure the impact that doula support 
        services have on birth and mental health outcomes of pregnant 
        veterans (in this section referred to as the ``pilot 
        program'').
            (2) Consideration.--In carrying out the pilot program, the 
        Secretary shall consider all types of doulas, including 
        traditional and community-based doulas.
            (3) Consultation.--In designing and implementing the pilot 
        program, the Secretary shall consult with stakeholders, 
        including--
                    (A) organizations representing veterans, including 
                veterans that are disproportionately impacted by poor 
                maternal health outcomes;
                    (B) community-based health care professionals, 
                including doulas, and other stakeholders; and
                    (C) experts in promoting health equity and 
                combating racial bias in health care settings.
            (4) Goals.--The goals of the pilot program are the 
        following:
                    (A) To improve--
                            (i) maternal, mental health, and infant 
                        care outcomes;
                            (ii) integration of doula support services 
                        into the Whole Health model of the Department, 
                        or successor model; and
                            (iii) the experience of women receiving 
                        maternity care from the Department, including 
                        by increasing the ability of a woman to develop 
                        and follow her own birthing plan.
                    (B) To reengage veterans with the Department after 
                giving birth.
    (c) Locations.--The Secretary shall carry out the pilot program 
in--
            (1) the three Veterans Integrated Service Networks of the 
        Department that have the highest percentage of female veterans 
        enrolled in the patient enrollment system of the Department 
        established and operated under section 1705(a) of title 38, 
        United States Code, compared to the total number of enrolled 
        veterans in such Network;
            (2) the three Veterans Integrated Service Networks that 
        have the lowest percentage of female veterans enrolled in the 
        patient enrollment system compared to the total number of 
        enrolled veterans in such Network; and
            (3) at least one Veterans Integrated Services Network--
                    (A) located in or serving a Frontier State (as 
                defined in section 1886(d)(3)(E)(iii)(II) of the Social 
                Security Act (42 U.S.C. 1395ww(d)(3)(E)(iii)(II))) 
                where more than \1/3\ of the population lives in 
                frontier land; and
                    (B) serving populations experiencing higher average 
                risk and prevalence for maternal mental health 
                disorders, including American Indian or Alaska Native 
                veterans.
    (d) Open Participation.--The Secretary shall allow any eligible 
entity or covered veteran interested in participating in the pilot 
program to participate in the pilot program.
    (e) Services Provided.--
            (1) In general.--Under the pilot program, a covered veteran 
        shall receive not more than 10 sessions of care from a doula 
        under the Whole Health model of the Department, or successor 
        model, under which a doula works as an advocate for the veteran 
        alongside the medical team for the veteran.
            (2) Sessions.--Sessions covered under paragraph (1) shall 
        be as follows:
                    (A) Three or four sessions before labor and 
                delivery.
                    (B) One session during labor and delivery.
                    (C) Three or four sessions after post-partum, which 
                may be conducted via the mobile application for VA 
                Video Connect.
    (f) Administration of Pilot Program.--
            (1) In general.--The Office of Women's Health of the 
        Department of Veterans Affairs, or successor office (in this 
        section referred to as the ``Office''), shall--
                    (A) coordinate services and activities under the 
                pilot program;
                    (B) oversee the administration of the pilot 
                program; and
                    (C) conduct onsite assessments of medical 
                facilities of the Department that are participating in 
                the pilot program.
            (2) Guidelines for veteran-specific care.--The Office shall 
        establish guidelines under the pilot program for training 
        doulas on military sexual trauma and post traumatic stress 
        disorder.
            (3) Amounts for care.--The Office may recommend to the 
        Secretary appropriate payment amounts for care and services 
        provided under the pilot program, which shall not exceed $3,500 
        per doula per veteran.
    (g) Doula Service Coordinator.--
            (1) In general.--The Secretary, in consultation with the 
        Office, shall establish a Doula Service Coordinator within the 
        functions of the Maternity Care Coordinator at each medical 
        facility of the Department that is participating in the pilot 
        program.
            (2) Duties.--A Doula Service Coordinator established under 
        paragraph (1) at a medical facility shall be responsible for--
                    (A) working with eligible entities, doulas, and 
                covered veterans participating in the pilot program; 
                and
                    (B) managing payment between eligible entities and 
                the Department under the pilot program.
            (3) Tracking of information.--A doula providing services 
        under the pilot program shall report to the applicable Doula 
        Service Coordinator after each session conducted under the 
        pilot program.
            (4) Coordination with women's program manager.--A Doula 
        Service Coordinator for a medical facility of the Department 
        shall coordinate with the women's program manager for that 
        facility in carrying out the duties of the Doula Service 
        Coordinator under the pilot program.
    (h) Term of Pilot Program.--The Secretary shall conduct the pilot 
program for a period of five years.
    (i) Technical Assistance.--The Secretary shall establish a process 
to provide technical assistance to eligible entities and doulas 
participating in the pilot program.
    (j) Report.--
            (1) In general.--Not later than one year after the date of 
        the enactment of this Act, and annually thereafter for each 
        year in which the pilot program is carried out, 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 pilot program.
            (2) Final report.--As part of the final report submitted 
        under paragraph (1), the Secretary shall include 
        recommendations on whether the model studied in the pilot 
        program should be continued or more widely adopted by the 
        Department.
    (k) Authorization of Appropriations.--There are authorized to be 
appropriated to the Secretary, for each of fiscal years 2024 through 
2029, such sums as may be necessary to carry out this section.
    (l) Definitions.--In this section:
            (1) Covered veteran.--The term ``covered veteran'' means a 
        pregnant veteran or a formerly pregnant veteran (with respect 
        to sessions post-partum) who is enrolled in the patient 
        enrollment system of the Department of Veterans Affairs 
        established and operated under section 1705(a) of title 38, 
        United States Code.
            (2) Eligible entity.--The term ``eligible entity'' means an 
        entity that provides medically accurate, comprehensive 
        maternity services to covered veterans under the laws 
        administered by the Secretary, including under the Veterans 
        Community Care Program under section 1703 of title 38, United 
        States Code.
            (3) VA video connect.--The term ``VA Video Connect'' means 
        the program of the Department of Veterans Affairs to connect 
        veterans with their health care team from anywhere, using 
        encryption to ensure a secure and private session.
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