[Congressional Record Volume 168, Number 157 (Wednesday, September 28, 2022)]
[Senate]
[Pages S5270-S5273]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
SA 5799. Mrs. MURRAY submitted an amendment intended to be proposed
to amendment SA 5499 submitted by Mr. Reed (for himself and Mr. Inhofe)
and intended to be proposed to the bill H.R. 7900, to authorize
appropriations for fiscal year 2023 for military activities of the
Department of Defense, for military construction, and for defense
activities of the Department of Energy, to prescribe military personnel
strengths for such fiscal year, and for other purposes; which was
ordered to lie on the table; as follows:
At the end of title X, add the following:
Subtitle H--Reproductive and Fertility Preservation Assistance
SEC. 1081. SHORT TITLE.
This subtitle may be cited as the ``Veteran Families
Health Services Act of 2022''.
CHAPTER 1--REPRODUCTIVE AND FERTILITY PRESERVATION ASSISTANCE FOR
MEMBERS OF THE ARMED FORCES
SEC. 1082. DEFINITIONS.
In this chapter:
(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. 1083. 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 not more than three completed cycles or
six attempted cycles of in vitro fertilization, whichever
occurs first, to an individual under such paragraph.
(b) Procurement of Gametes.--If a covered member of the
Armed Forces is unable to provide their gametes 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 gametes and pay or
reimburse such member the reasonable costs of procuring
gametes 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 gametes from a donor for a covered
member of the Armed Forces or to connect such a member with
gametes 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
[[Page S5271]]
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) Embryo transfer.
(F) 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 conceive 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. 1084. 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 gametes, 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 Gametes.--Gametes 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 gametes and is likely to regain such capacity;
and
(C) the retrieval of gametes under this section is in the
medical interest of the member.
(c) Consent for Use of Retrieved Gametes.--Gametes
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 Gametes.--In accordance with regulations
prescribed by the Secretary for purpose of this subsection,
the Secretary shall dispose of gametes 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 gametes in an
advance directive or testamentary instrument executed by the
member.
SEC. 1085. CRYOPRESERVATION AND STORAGE OF GAMETES 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
gametes prior to--
(1) deployment to a combat zone; or
(2) a duty assignment that includes a hazardous assignment,
as determined by the Secretary.
(b) Period of Time.--
(1) In general.--The Secretary shall provide for the
cryopreservation and storage of gametes 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 gametes, 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 gametes were 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 gametes to a private cryopreservation
and storage facility selected by the individual.
(C) To transfer the gametes to a facility of the Department
of Veterans Affairs if cryopreservation and storage is
available to the individual at such facility.
(3) Disposal of gametes.--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 gametes 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 gametes 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 gametes if such member dies or
otherwise loses the capacity to consent to the use of their
cryopreserved and stored gametes.
(d) Agreements.--To carry out this section, the Secretary
may enter into agreements with private entities that provide
cryopreservation, transportation, and storage services for
gametes.
SEC. 1086. 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 chapter;
(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. 1087. 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 gametes 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 1089(a); and
(2) authorizing the Department of Veterans Affairs to
compensate the Department of Defense for the
cryopreservation, transportation, and storage of gametes of
veterans under section 1085.
CHAPTER 2--REPRODUCTIVE AND ADOPTION ASSISTANCE FOR VETERANS
SEC. 1088. 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:
``(I) Fertility treatment and counseling, including
treatment using assisted reproductive technology.''.
SEC. 1089. 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) In General.--(1) The Secretary shall furnish
fertility treatment and counseling, including through the use
of assisted reproductive technology, to a covered veteran or
a spouse, partner, or gestational surrogate of a covered
veteran if the veteran, and the spouse, partner, or
gestational surrogate of the veteran, as applicable, apply
jointly for such treatment and counseling through a process
prescribed by the Secretary.
``(2) 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 the case of in vitro fertilization treatment
furnished under paragraph (1), the Secretary may furnish not
more than three completed cycles or six attempted cycles of
in vitro fertilization, whichever occurs first, to an
individual under such paragraph.
``(b) Procurement of Gametes.--If a covered veteran is
unable to provide their gametes 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 gametes and pay or reimburse such
veteran the reasonable costs of procuring gametes from a
donor.
``(c) Coordination of Care for Other Individuals.--In the
case of a veteran or a spouse, partner, or gestational
surrogate of a veteran not described in subsection (a) who
[[Page S5272]]
is seeking fertility treatment and counseling, the Secretary
may coordinate fertility treatment and counseling for such
veteran, spouse, partner, or gestational surrogate.
``(d) 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.
``(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) Embryo transfer.
``(F) Such other treatments as the Secretary considers
appropriate.
``(4) The term `infertility condition' includes--
``(A) a diagnosis of infertility; or
``(B) the inability to conceive or safely carry a pregnancy
to term, including as a result of treatment for another
condition.
``(5) The term `partner', with respect to a veteran, means
an individual 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.''.
(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. 1090. 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. 1091. 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. 1092. 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. 7330D. 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 7330C
the following new item:
``7330D. Facilitation of reproduction and infertility research.''.
(c) Report.--
(1) In general.--Not later than three years after the date
of the enactment of this Act, the Secretary of Veterans
Affairs shall submit to Congress a report on the research
activities conducted by the Secretary under section 7330D of
title 38, United States Code, as added by subsection (a).
(2) Elements.--The report submitted under paragraph (1)
shall include demographic data on veterans included in the
research conducted under section 7330D of title 38, United
States Code, as added by subsection (a), disaggregated by
age, race, ethnicity, sex, gender identity, sexual
orientation, marital status, type of disability (if
applicable), and geographic location of such veterans.
SEC. 1093. ANNUAL REPORT ON FERTILITY TREATMENT AND
COUNSELING FURNISHED BY DEPARTMENT OF VETERANS
AFFAIRS.
(a) In General.--Not later than one year after the date of
the enactment of this Act, and not less frequently than
annually thereafter, 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 fertility treatment and
counseling furnished by the Department of Veterans Affairs,
including through non-Department providers, during the year
preceding the submittal of the report.
(b) Elements.--Each report submitted under subsection (a)
shall include, for the period covered by the report, the
following:
(1) The number of veterans who were diagnosed with clinical
infertility, disaggregated by age, race, ethnicity, sex,
gender identity, sexual orientation, marital status, type of
disability (if applicable), geographic location, era of
military service, and, to the extent possible to determine,
the cause of infertility of such veterans.
(2) The number of veterans who received fertility treatment
or counseling furnished by the Department of Veterans
Affairs, including through non-Department providers,
disaggregated by age, race, ethnicity, sex, gender identity,
sexual orientation, marital status, type of disability (if
applicable), geographic location, era of military service,
and, to the extent possible to determine, the cause of
infertility of such veterans.
(3) The number of veterans who self-reported difficulty
becoming pregnant or successfully carrying a pregnancy to
term to a health care provider of the Department or a non-
Department provider, disaggregated by age, race, ethnicity,
sex, gender identity, sexual orientation, marital status,
type of disability (if applicable), and geographic location
of such veterans.
(4) The number of veterans who were exposed to hazardous
chemical or biological agents during service in the Armed
Forces who--
(A) received a clinical diagnosis of infertility; or
(B) self-reported difficulty becoming pregnant or
successfully carrying a pregnancy to term.
(5) The number of spouses, partners, and gestational
surrogates of veterans who received fertility treatment or
counseling furnished by the Department, including through
non-Department providers.
(6) The cost to the Department of furnishing fertility
treatment and counseling, including through non-Department
providers, disaggregated by cost of services and
administration.
(7) The average cost to the Department per recipient of
fertility treatment and counseling.
(8) In cases in which the Department furnished fertility
treatment through the use of assisted reproductive
technology, including through non-Department providers, the
average number of cycles per person furnished, disaggregated
by type of treatment.
(9) A description of how fertility treatment and counseling
services of the Department, including those services provided
through non-Department providers, are coordinated with
similar services of the Department of Defense, including the
average wait time for veterans to transfer from the health
system of the Department of Defense to the Veterans Health
Administration.
(c) Definitions.--In this section, the terms ``assisted
reproductive technology'' and ``partner'' have the meanings
given those terms in section 1720K(f) of title 38, United
States Code, as added by section 1089(a).
[[Page S5273]]
SEC. 1094. REPORT ON TIMELINESS AND ADEQUACY OF ACCESS BY
VETERANS TO FERTILITY TREATMENT AND COUNSELING
SERVICES FURNISHED BY DEPARTMENT OF VETERANS
AFFAIRS.
(a) In General.--Not later than 180 days after the date of
the enactment of this Act, and not less frequently than every
180 days thereafter, the Secretary of Veterans Affairs shall
submit to Congress a report containing data on the timeliness
and adequacy of access by veterans to fertility treatment and
counseling services furnished by the Department of Veterans
Affairs, including through non-Department providers.
(b) Elements.--Each report submitted under subsection (a)
shall include, for the period covered by the report, the
following:
(1) The average number of days from when a veteran first
seeks fertility treatment to when a referral for such
treatment is made and the average number of days from when
such referral is made to when an appointment for such
treatment occurs, disaggregated by facility of the Department
or non-Department provider.
(2) The average number of days from when a veteran first
seeks fertility counseling to when a referral for such
counseling is made and the average number of days from when
such referral is made to when an appointment for such
counseling occurs, disaggregated by facility of the
Department or non-Department provider.
(3) The number of available providers of the Department and
non-Department providers for fertility treatment and
counseling in each State or territory, disaggregated by
facility.
(4) The average number of days it takes for the Secretary
to pay claims for fertility treatment and counseling services
from non-Department providers under section 1703D of title
38, United States Code.
SEC. 1095. REGULATIONS ON FURNISHING OF FERTILITY TREATMENT
AND COUNSELING AND ADOPTION ASSISTANCE BY
DEPARTMENT OF VETERANS AFFAIRS.
Not later than 18 months 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 1089(a); and
(2) to carry out section 1790 of such title, as added by
section 1090(a).
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