Pilot program on doula support for veterans

(a)

Findings

Congress finds the following:(1)There are approximately 2,100,000 women within the veteran population in the United States, the fastest growing demographic group of veterans.(2)By 2020, the proportion of all women veterans using health care from the Department of Veterans Affairs grew to 28 percent from 17 percent in 2010.(3)During the period of 2010 through 2020, the number of women veterans using health care from the Department nearly doubled, from 316,961 to 556,135.(4)In 2025, there are more than 600,000 women receiving health care from the Department.(5)Although prenatal care and delivery is not provided in facilities of the Department, 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.(6)The number of women veteran patients with obstetric deliveries paid for by the Department increased to more than 5,500 in fiscal year 2019, triple the number of such patients in fiscal year 2009, and 22 times the number from fiscal year 1999. (7) Notably, a quarter of the deliveries specified in paragraph (5) from fiscal year 2019 were among veterans of advanced maternal age (35 years old or older) and a quarter were among Black or African-American veterans, both groups known to experience higher risk of severe maternal morbidity. (8)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.(9)The number of women veterans of reproductive age seeking care from the Department continues to grow (more than 228,000 as of fiscal year 2020).(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 posttraumatic 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 2027 through 2032, 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.