[Congressional Record Volume 169, Number 120 (Thursday, July 13, 2023)]
[Senate]
[Pages S2789-S2790]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
SA 681. Mr. BOOKER submitted an amendment intended to be proposed by
him to the bill S. 2226, to authorize appropriations for fiscal year
2024 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 subtitle G of title X, add the following:
SEC. 1083. 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;
[[Page S2790]]
(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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