[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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