[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).
                                 ______