[House Report 116-281]
[From the U.S. Government Publishing Office]


116th Congress   }                                     {       Report
                        HOUSE OF REPRESENTATIVES
 1st Session     }                                     {      116-281

======================================================================



 
                          DEBORAH SAMPSON ACT

                                _______
                                

 November 12, 2019.--Committed to the Committee of the Whole House on 
            the State of the Union and ordered to be printed

                                _______
                                

  Mr. Takano, from the Committee on Veterans' Affairs, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 3224]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Veterans' Affairs, to whom was referred 
the bill (H.R. 3224) to amend title 38, United States Code, to 
provide for increased access to Department of Veterans Affairs 
medical care for women veterans, having considered the same, 
report favorably thereon with an amendment and recommend that 
the bill as amended do pass.

                                CONTENTS

                                                                   Page
Purpose and Summary..............................................    16
Background and Need for Legislation..............................    16
Hearings.........................................................    27
Subcommittee Consideration.......................................    28
Committee Consideration..........................................    28
Committee Votes..................................................    28
Committee Oversight Findings.....................................    29
Statement of General Performance Goals and Objectives............    29
New Budget Authority, Entitlement Authority, and Tax Expenditures    29
Earmarks and Tax and Tariff Benefits.............................    29
Committee Cost Estimate..........................................    29
Congressional Budget Office Estimate.............................    29
Federal Mandates Statement.......................................    33
Advisory Committee Statement.....................................    34
Constitutional Authority Statement...............................    34
Applicability to Legislative Branch..............................    34
Statement on Duplication of Federal Programs.....................    34
Disclosure of Directed Rulemaking................................    34
Section-by-Section Analysis of the Legislation...................    34
Changes in Existing Law Made by the Bill as Reported.............    39
    The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

  (a) Short Title.--This Act may be cited as the ``Deborah Sampson 
Act''.
  (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.

                TITLE I--VETERANS HEALTH ADMINISTRATION

Sec. 101. Office of Women's Health in the Department of Veterans 
Affairs.
Sec. 102. Expansion of capabilities of women veterans call center to 
include text messaging.
Sec. 103. Requirement for Department of Veterans Affairs internet 
website to provide information on services available to women veterans.
Sec. 104. Report on Women Veterans Retrofit Initiative.
Sec. 105. Establishment of environment of care standards and 
inspections at Department of Veterans Affairs medical centers.
Sec. 106. Additional funding for primary care and emergency care 
clinicians in Women Veterans Health Care Mini-Residency Program.
Sec. 107. Establishment of women veteran training module for non-
Department of Veterans Affairs health care providers.

                         TITLE II--MEDICAL CARE

Sec. 201. Improved access to Department of Veterans Affairs medical 
care for women veterans.
Sec. 202. Counseling and treatment for sexual trauma.
Sec. 203. Counseling in retreat settings for women veterans and other 
individuals.
Sec. 204. Improvement of health care services provided to newborn 
children by Department of Veterans Affairs.

                  TITLE III--REPORTS AND OTHER MATTERS

                          Subtitle A--Reports

Sec. 301. Assessment of effects of intimate partner violence on women 
veterans by Advisory Committee on Women Veterans.
Sec. 302. Study on staffing of Women Veteran Program Manager program at 
medical centers of the Department of Veterans Affairs and training of 
staff.
Sec. 303. Report on availability of prosthetic items for women veterans 
from the Department of Veterans Affairs.
Sec. 304. Study of barriers for women veterans to health care from the 
Department of Veterans Affairs.
Sec. 305. Report regarding veterans who receive benefits under laws 
administered by the Secretary of Veterans Affairs.
Sec. 306. Study on Women Veteran Coordinator program.

                       Subtitle B--Other Matters

Sec. 321. Anti-harassment and anti-sexual assault policy of the 
Department of Veterans Affairs.
Sec. 322. Support for organizations that have a focus on providing 
assistance to women veterans and their families.
Sec. 323. Gap analysis of Department of Veterans Affairs programs that 
provide assistance to women veterans who are homeless.
Sec. 324. Department of Veterans Affairs public-private partnership on 
legal services for women veterans.
Sec. 325. Program to assist veterans who experience intimate partner 
violence or sexual assault.
Sec. 326. Study and task force on veterans experiencing intimate 
partner violence or sexual assault.

                TITLE I--VETERANS HEALTH ADMINISTRATION

SEC. 101. OFFICE OF WOMEN'S HEALTH IN THE DEPARTMENT OF VETERANS 
                    AFFAIRS.

  (a) Director of Women's Health.--Subsection (a) of section 7306 of 
title 38, United States Code, is amended--
          (1) by redesignating paragraph (10) as paragraph (11); and
          (2) by inserting after paragraph (9) the following new 
        paragraph:
          ``(10) The Director of Women's Health.''.
  (b) Organization of Office.--
          (1) In general.--Subchapter I of chapter 73 of title 38, 
        United States Code, is amended by adding at the end of the 
        following new sections:

``Sec. 7310. Office of Women's Health

  ``(a) Establishment.--(1) The Under Secretary for Health shall 
establish and operate in the Veterans Health Administration the Office 
of Women's Health (hereinafter in this section referred to as the 
`Office'). The Office shall be located at the Central Office of the 
Department of Veterans Affairs.
  ``(2) The head of the Office is the Director of Women's Health 
(hereinafter in this section referred to as the `Director'). The 
Director shall report to the Under Secretary for Health.
  ``(3) The Under Secretary for Health shall provide the Office with 
such staff and other support as may be necessary for the Office to 
carry out effectively its functions under this section.
  ``(4) The Under Secretary for Health may reorganize existing offices 
within the Veterans Health Administration as of the date of the 
enactment of this section in order to avoid duplication with the 
functions of the Office.
  ``(b) Purpose.--The functions of the Office include the following:
          ``(1) To provide a central office for monitoring and 
        encouraging the activities of the Veterans Health 
        Administration with respect to the provision, evaluation, and 
        improvement of women veterans' health care services in the 
        Department.
          ``(2) To develop and implement standards of care for the 
        provision of health care for women veterans in the Department.
          ``(3) To monitor and identify deficiencies in standards of 
        care for the provision of health care for women veterans in the 
        Department, to provide technical assistance to medical 
        facilities of the Department to address and remedy 
        deficiencies, and to perform oversight of implementation of 
        standards of care for women veterans' health care in the 
        Department.
          ``(4) To monitor and identify deficiencies in standards of 
        care for the provision of health care for women veterans 
        provided through the community pursuant to this title, and to 
        provide recommendations to the appropriate office to address 
        and remedy any deficiencies.
          ``(5) To oversee distribution of resources and information 
        related to women veterans' health programming under this title.
          ``(6) To promote the expansion and improvement of clinical, 
        research, and educational activities of the Veterans Health 
        Administration with respect the health care of women veterans.
          ``(7) To provide, as part of the annual budgeting process, 
        recommendations with respect to the amount of funds to be 
        requested for furnishing hospital care and medical services to 
        women veterans pursuant to chapter 17 of this title, including, 
        at a minimum, recommendations that ensure that such amount of 
        funds either reflect or exceed the proportion of veterans 
        enrolled in the patient enrollment system under section 1705 of 
        this title who are women.
          ``(8) To provide recommendations to the Under Secretary for 
        Health with respect to modifying the Veterans Equitable 
        Resource Allocation system to ensure that resource allocations 
        under such system reflect the health care needs of women 
        veterans.
          ``(9) To carry out such other duties as the Under Secretary 
        for Health may require.
  ``(c) Recommendations.--If the Under Secretary for Health determines 
not to implement any recommendation made by the Director with respect 
to the allocation of resources to address the health care needs of 
women veterans, the Secretary shall notify the appropriate 
congressional committees of such determination by not later than 30 
days after the date on which the Under Secretary for Health receives 
the recommendation. Each such notification shall include the following:
          ``(1) The reasoning of the Under Secretary for Health in 
        making such determination.
          ``(2) An alternative, if one is selected, to such 
        recommendation that the Under Secretary for Health will carry 
        out to fulfill the health care needs of women veterans.
  ``(d) Standards of Care.--In this section, the standards of care for 
the provision of health care for women veterans in the Department shall 
include, at a minimum, the following:
          ``(1) Requirement for--
                  ``(A) at least one designated women's health primary 
                care provider at each medical center whose duties 
                include, to the extent practicable, providing training 
                to other health care providers of the Department with 
                respect to the needs of women veterans; and
                  ``(B) at least one designated women's health primary 
                care provider at each community-based outpatient clinic 
                of the Department who may serve female patients as a 
                percentage of the total duties of the provider.
          ``(2) Other requirements as determined by the Under Secretary 
        for Health.
  ``(e) Outreach.--The Director shall ensure that--
          ``(1) not less frequently than biannually, each medical 
        facility of the Department holds a public forum for women 
        veterans that occurs outside of regular business hours; and
          ``(2) not less frequently than quarterly, each medical 
        facility of the Department convenes a focus group of women 
        veterans that includes a discussion of harassment occurring at 
        such facility.
  ``(f) Definitions.--In this section:
          ``(1) The term `appropriate congressional committees' has the 
        meaning given that term in section 7310A of this title.
          ``(2) The term `facility of the Department' has the meaning 
        given the term in section 1701(3).
          ``(3) The term `Veterans Equitable Resource Allocation 
        system' means the resource allocation system established 
        pursuant to section 429 of the Departments of Veterans Affairs 
        and Housing and Urban Development, and Independent Agencies 
        Appropriations Act, 1997 (Public Law 104-204; 110 Stat. 2929).

``Sec. 7310A. Annual reports on women's health

  ``(a) Annual Reports.--Not later than December 1 of each year, the 
Director of Women's Health shall submit to the appropriate 
congressional committees a report containing the matters under 
subsections (b) through (g).
  ``(b) Office of Women's Health.--Each report under subsection (a) 
shall include a description of--
          ``(1) actions taken by the Office of Women's Health in the 
        preceding fiscal year to improve the Department's provision of 
        health care to women veterans;
          ``(2) any identified deficiencies related to the Department's 
        provision of health care to women veterans and the standards of 
        care established in section 7310 of this title, and the 
        Department's plan to address such deficiencies;
          ``(3) the funding and personnel provided to the Office and 
        whether additional funding or personnel are needed to meet the 
        requirements of such section; and
          ``(4) other information that would be of interest to the 
        appropriate congressional committees with respect to oversight 
        of the Department's provision of health care to women veterans.
  ``(c) Access to Gender-specific Services.--Each report under 
subsection (a) shall include an analysis of the access of women 
veterans to gender-specific services under contracts, agreements, or 
other arrangements with non-Department medical providers entered into 
by the Secretary for the provision of hospital care or medical services 
to veterans. Such analysis shall include data and performance measures 
for the availability of gender specific services, including--
          ``(1) the average wait time between the veteran's preferred 
        appointment date and the date on which the appointment is 
        completed;
          ``(2) the average driving time required for veterans to 
        attend appointments; and
          ``(3) reasons why appointments could not be scheduled with 
        non-Department medical providers.
  ``(d) Locations Where Women Veterans Are Using Health Care.--Each 
report under subsection (a) shall include an analysis of the use by 
women veterans of health care from the Department, including the 
following information:
          ``(1) The number of women veterans who reside in each State.
          ``(2) The number of women veterans in each State who are 
        enrolled in the system of patient enrollment of the Department 
        established and operated under section 1705(a) this title.
          ``(3) Of the women veterans who are so enrolled, the number 
        who have received health care under the laws administered by 
        the Secretary at least one time during the one-year period 
        preceding the submittal of the report.
          ``(4) The number of women veterans who have been seen at each 
        medical facility of the Department during such year.
          ``(5) The number of appointments that women veterans have had 
        at each such facility during such year.
          ``(6) If known, an identification of the medical facility of 
        the Department in each Veterans Integrated Service Network with 
        the largest rate of increase in patient population of women 
        veterans as measured by the increase in unique women veteran 
        patient use.
          ``(7) If known, an identification of the medical facility of 
        the Department in each Veterans Integrated Service Network with 
        the largest rate of decrease in patient population of women 
        veterans as measured by the decrease in unique women veterans 
        patient use.
  ``(e) Models of Care.--Each report under subsection (a) shall include 
an analysis of the use by the Department of general primary care 
clinics, separate but shared spaces, and women's health centers as 
models of providing health care to women veterans. Such analysis shall 
include the following:
          ``(1) The number of facilities of the Department that fall 
        into each such model, disaggregated by Veterans Integrated 
        Service Network and State.
          ``(2) A description of the criteria used by the Department to 
        determine which such model is most appropriate for each 
        facility of the Department.
          ``(3) An assessment of how the Department decides to make 
        investments to modify facilities to a different model.
          ``(4) A description of what, if any, plans the Department has 
        to modify facilities from general primary care clinics to 
        another model.
          ``(5) An assessment of whether any facilities could be 
        modified to a separate but shared space for a women's health 
        center within planned investments under the strategic capital 
        investment planning process of the Department.
          ``(6) An assessment of whether any facilities could be 
        modified to a separate or shared space, or women's health 
        center with minor modifications to existing plans under the 
        strategic capital investment planning process of the 
        Department.
          ``(7) An assessment of whether the Department has a goal for 
        how many facilities should fall into each such model.
  ``(f) Staffing.--Each report under subsection (a) shall include an 
analysis of the staffing of the Department relating to the treatment of 
women, including the following, disaggregated by Veterans Integrated 
Service Network and State (except with respect to paragraph (4)):
          ``(1) The number of women's health centers.
          ``(2) The number of patient aligned care teams of the 
        Department relating to women's health.
          ``(3) The number of full- and part-time gynecologists of the 
        Department.
          ``(4) The number of designated women's health care providers 
        of the Department, disaggregated by facility of the Department.
          ``(5) The number of health care providers of the Department 
        who have completed a mini-residency for women's health care 
        through Women Veterans Health Care Mini-Residency Program of 
        the Department during the one-year period preceding the 
        submittal of the report, and the number that plan to 
        participate in such a mini-residency during the one-year period 
        following such date.
          ``(6) The number of designated women's health care providers 
        of the Department who have sufficient female patients to retain 
        their competencies and proficiencies.
  ``(g) Accessibility and Treatment Options.--Each report under 
subsection (a) shall include an analysis of the accessibility and 
treatment options for women veterans, including the following:
          ``(1) An assessment of wheelchair accessibility of women's 
        health centers of the Department, including, with respect to 
        each such facility, an assessment of such accessibility for 
        each kind of treatment provided at the center, including with 
        respect to radiology and mammography, that addresses all 
        relevant factors, including door sizes, hoists, and equipment.
          ``(2) The options for women veterans to access female mental 
        health providers and primary care providers.
          ``(3) The options for women veterans at medical facilities of 
        the Department with respect to clothing sizes, including for 
        gowns, drawstring pants, and pajamas.
  ``(h) Definitions.--In this section:
          ``(1) The term `appropriate congressional committees' means--
                  ``(A) the Committees on Veterans' Affairs of the 
                House of Representatives and the Senate; and
                  ``(B) the Committees on Appropriations of the House 
                of Representatives and the Senate.
          ``(2) The term `gender-specific services' means mammography, 
        obstetric care, gynecological care, and such other services as 
        the Secretary determines appropriate.''.
          (2) Clerical amendment.--The table of sections for such 
        chapter is amended by inserting after the item relating to 
        section 7309A the following new items:

``7310. Office of Women's Health.
``7310A. Annual reports on women's health.''.

  (c) Initial Report.--The Secretary of Veterans Affairs shall submit 
the initial report under section 7310A of title 38, United States Code, 
as added by subsection (b), by not later than 180 days after the date 
of the enactment of this Act.

SEC. 102. EXPANSION OF CAPABILITIES OF WOMEN VETERANS CALL CENTER TO 
                    INCLUDE TEXT MESSAGING.

  The Secretary of Veterans Affairs shall expand the capabilities of 
the Women Veterans Call Center of the Department of Veterans Affairs to 
include a text messaging capability.

SEC. 103. REQUIREMENT FOR DEPARTMENT OF VETERANS AFFAIRS INTERNET 
                    WEBSITE TO PROVIDE INFORMATION ON SERVICES 
                    AVAILABLE TO WOMEN VETERANS.

  (a) In General.--The Secretary of Veterans Affairs shall survey the 
internet websites and information resources of the Department of 
Veterans Affairs in effect on the day before the date of the enactment 
of this Act and publish an internet website that serves as a 
centralized source for the provision to women veterans of information 
about the benefits and services available to them under laws 
administered by the Secretary.
  (b) Elements.--The internet website published under subsection (a) 
shall provide to women veterans information regarding all of the 
services available in the district in which the veteran is seeking such 
services, including, with respect to each medical center and community-
based outpatient clinic in the applicable Veterans Integrated Service 
Network--
          (1) the name and contact information of each women veterans 
        program manager;
          (2) a list of appropriate staff for other benefits available 
        from the Veterans Benefits Administration, the National 
        Cemetery Administration, and such other entities as the 
        Secretary considers appropriate; and
          (3) such other information as the Secretary considers 
        appropriate.
  (c) Updated Information.--The Secretary shall ensure that the 
information described in subsection (b) that is published on the 
internet website required by subsection (a) is updated not less 
frequently than once every 90 days.
  (d) Outreach.--In carrying out this section, the Secretary shall 
ensure that the outreach conducted under section 1720F(i) of title 38, 
United States Code, includes information regarding the internet website 
required by subsection (a).
  (e) Derivation of Funds.--Amounts used by the Secretary to carry out 
this section shall be derived from amounts made available to the 
Secretary to publish internet websites of the Department.

SEC. 104. REPORT ON WOMEN VETERANS RETROFIT INITIATIVE.

  (a) Report.--Not later than 180 days after the date of the enactment 
of this Act, the Secretary of Veterans Affairs shall submit to the 
Committees on Veterans' Affairs and the Committees on Appropriations of 
the Senate and the House of Representatives a report on requirements to 
retrofit existing medical facilities of the Department of Veterans 
Affairs with fixtures, materials, and other outfitting measures to 
support the provision of care to women veterans at such facilities.
  (b) Elements.--The report under subsection (a) shall include the 
following:
          (1) An assessment of how the Secretary prioritizes 
        retrofitting existing medical facilities to support provision 
        of care to women veterans in comparison to other requirements.
          (2) A five-year plan for retrofitting medical facilities of 
        the Department to support the provision of care to women 
        veterans.

SEC. 105. ESTABLISHMENT OF ENVIRONMENT OF CARE STANDARDS AND 
                    INSPECTIONS AT DEPARTMENT OF VETERANS AFFAIRS 
                    MEDICAL CENTERS.

  (a) In General.--The Secretary of Veterans Affairs shall establish a 
policy under which the environment of care standards and inspections at 
medical centers of the Department of Veterans Affairs include--
          (1) an alignment of the requirements for such standards and 
        inspections with the women's health handbook of the Veterans 
        Health Administration;
          (2) a requirement for the frequency of such inspections;
          (3) delineation of the roles and responsibilities of staff at 
        the medical center who are responsible for compliance;
          (4) the requirement that each medical center submit to the 
        Secretary and make publicly available a report on the 
        compliance of the medical center with the standards; and
          (5) a remediation plan.
  (b) Report.--Not later than 180 days after the date of the enactment 
of this Act, the Secretary shall submit to the Committees on Veterans' 
Affairs of the Senate and House of Representatives certification in 
writing that the policy required by subsection (a) has been finalized 
and disseminated to Department all medical centers.

SEC. 106. ADDITIONAL FUNDING FOR PRIMARY CARE AND EMERGENCY CARE 
                    CLINICIANS IN WOMEN VETERANS HEALTH CARE MINI-
                    RESIDENCY PROGRAM.

  (a) In General.--There is authorized to be appropriated to the 
Secretary of Veterans Affairs $1,000,000 for each fiscal year for the 
Women Veterans Health Care Mini-Residency Program of the Department of 
Veterans Affairs to provide opportunities for participation in such 
program for primary care and emergency care clinicians.
  (b) Treatment of Amounts.--The amounts authorized to be appropriated 
under subsection (a) shall be in addition to amounts otherwise made 
available to the Secretary for the purposes set forth in such 
subsection.

SEC. 107. ESTABLISHMENT OF WOMEN VETERAN TRAINING MODULE FOR NON-
                    DEPARTMENT OF VETERANS AFFAIRS HEALTH CARE 
                    PROVIDERS.

  (a) In General.--Not later than one year after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall 
establish and make available to community providers a training module 
that is specific to women veterans.
  (b) Community Provider Defined.--In this section, the term 
``community provider'' means a non-Department of Veterans Affairs 
health care provider who provides health care to veterans under the 
laws administered by the Secretary of Veterans Affairs.

                         TITLE II--MEDICAL CARE

SEC. 201. IMPROVED ACCESS TO DEPARTMENT OF VETERANS AFFAIRS MEDICAL 
                    CARE FOR WOMEN 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. 1720J. Medical services for women veterans

  ``(a) Access to Care.--The Secretary shall ensure that women's health 
primary care services are available during regular business hours at 
every medical center and community based outpatient clinic of the 
Department.
  ``(b) Study on Extended Hours of Care.--The Secretary shall conduct a 
study to assess--
          ``(1) the use of extended hours as a means of reducing 
        barriers to care;
          ``(2) the need for extended hours based on interviews with 
        women veterans and employees; and
          ``(3) the best practices and resources required to implement 
        use of extended hours.
  ``(c) Annual Report to Congress.--Not later than September 30 of each 
year, 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 compliance with subsection (a).''.
  (b) Clerical Amendment.--The table of sections at the beginning of 
such chapter is amended by inserting after the item relating to section 
1720I the following new item:

``1720J. Medical services for women veterans.''.

SEC. 202. COUNSELING AND TREATMENT FOR SEXUAL TRAUMA.

  Section 1720D of title 38, United States Code, is amended--
          (1) in subsection (a)--
                  (A) in paragraph (1), by striking ``active duty, 
                active duty for training, or inactive duty training'' 
                and inserting ``duty, regardless of duty status or line 
                of duty determination (as that term is used in section 
                12323 of title 10)''; and
                  (B) in paragraph (2)(A), by striking ``active duty, 
                active duty for training, or inactive duty training'' 
                and inserting ``duty, regardless of duty status or line 
                of duty determination (as that term is used in section 
                12323 of title 10)'';
          (2) by striking ``veteran'' each place it appears and 
        inserting ``former member of the Armed Forces'';
          (3) by striking ``veterans'' each place it appears and 
        inserting ``former members of the Armed Forces''; and
          (4) by adding at the end the following new subsection:
  ``(g) In this section, the term `former member of the Armed Forces' 
includes the following:
          ``(1) A veteran described in section 101(2) of this title.
          ``(2) An individual not described in paragraph (1) who was 
        discharged or released from the Armed Forces under a condition 
        that is not honorable but not--
                  ``(A) a dishonorable discharge; or
                  ``(B) a discharge by court-martial.''.

SEC. 203. COUNSELING IN RETREAT SETTINGS FOR WOMEN VETERANS AND OTHER 
                    INDIVIDUALS.

  (a) In General.--Chapter 17 of title 38, United States Code, is 
amended by inserting after section 1712C the following new section:

``Sec. 1712D. Counseling in retreat settings for women veterans and 
                    other individuals

  ``(a) Program.--(1) Commencing not later than January 1, 2021, the 
Secretary shall carry out, through the Readjustment Counseling Service 
of the Veterans Health Administration, a program to provide 
reintegration and readjustment services described in subsection (b) in 
group retreat settings to covered individuals, including cohorts of 
women veterans who are eligible for readjustment counseling services 
under section 1712A of this title.
  ``(2) The participation of a covered individual in the program under 
paragraph (1) shall be at the election of the individual.
  ``(b) Covered Services.--The services provided to a covered 
individual under the program under subsection (a)(1) shall include the 
following:
          ``(1) Information on reintegration into the family, 
        employment, and community of the individual.
          ``(2) Financial counseling.
          ``(3) Occupational counseling.
          ``(4) Information and counseling on stress reduction.
          ``(5) Information and counseling on conflict resolution.
          ``(6) Such other information and counseling as the Secretary 
        considers appropriate to assist the individual in reintegration 
        into the family, employment, and community of the veteran.
  ``(c) Biennial Reports.--Not later than December 31, 2022, and each 
even-numbered year thereafter, the Secretary shall submit to the 
Committees on Veterans' Affairs of the House of Representatives and the 
Senate a report on the program under subsection (a)(1).
  ``(d) Covered Individual Defined.--In this section, the term `covered 
individual' means--
          ``(1) Any veteran who is enrolled in the system of annual 
        patient enrollment under section 1705 of this title.
          ``(2) Any survivor or dependent of a veteran who is eligible 
        for medical care under section 1781 of this title.''.
  (b) Clerical Amendment.--The table of sections at the beginning of 
such chapter is amended by inserting after the item relating to section 
1712C the following new item:

``1712D. Counseling in retreat settings for women veterans and other 
individuals.''.

SEC. 204. IMPROVEMENT OF HEALTH CARE SERVICES PROVIDED TO NEWBORN 
                    CHILDREN BY DEPARTMENT OF VETERANS AFFAIRS.

  (a) Expansion.--Section 1786 of title 38, United States Code, is 
amended--
          (1) in subsection (a), in the matter preceding paragraph (1), 
        by striking ``seven days'' and inserting ``14 days''; and
          (2) by adding at the end the following new subsection:
  ``(f) Annual Report.--Not later than 60 days after the end of each 
fiscal year, 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 health care services provided 
under subsection (a) during such fiscal year, including the number of 
newborn children who received such services during such fiscal year.''.
  (b) Authority to Furnish Medically Necessary Transportation for 
Newborn Children of Certain Women Veterans.--Such section is further 
amended--
          (1) in subsection (a)--
                  (A) in the matter before paragraph (1)--
                          (i) by inserting ``and transportation 
                        necessary to receive such services'' after 
                        ``described in subsection (b)''; and
                          (ii) by inserting ``, except as provided in 
                        subsection (e),'' after ``14 days'';
                  (B) in paragraph (1), by striking ``or'';
                  (C) in paragraph (2), by striking the period at the 
                end and inserting ``; or''; and
                  (D) by adding at the end the following new paragraph:
          ``(3) another location, including a health care facility, if 
        the veteran delivers the child before arriving at a facility 
        described in paragraph (1) or (2).'';
          (2) in subsection (b), by inserting before the period at the 
        end the following: ``, including necessary health care services 
        provided by a facility other than the facility where the 
        newborn child was delivered (including a specialty pediatric 
        hospital) that accepts transfer of the newborn child and 
        responsibility for treatment of the newborn child''; and
          (3) by inserting before subsection (f), as added by 
        subsection (a), the following new subsections:
  ``(c) Transportation.--(1) Transportation furnished under subsection 
(a) to, from, or between care settings to meet the needs of a newborn 
child includes costs for either or both the newborn child and parents.
  ``(2) Transportation furnished under subsection (a) is transportation 
by ambulance, including air ambulance, or other appropriate medically 
staffed modes of transportation--
          ``(A) to another health care facility (including a specialty 
        pediatric hospital) that accepts transfer of the newborn child 
        or otherwise provides post-delivery care services when the 
        treating facility is not capable of furnishing the care or 
        services required; or
          ``(B) to a health care facility in a medical emergency of 
        such nature that a prudent layperson reasonably expects that 
        delay in seeking immediate medical attention would be hazardous 
        to life or health.
  ``(3) Amounts paid by the Department for transportation under this 
section shall be derived from the Medical Services appropriations 
account of the Department.
  ``(d) Reimbursement or Payment for Health Care Services or 
Transportation.--(1) Pursuant to regulations the Secretary shall 
prescribe to establish rates of reimbursement and any limitations 
thereto under this section, the Secretary shall directly reimburse a 
covered entity for health care services or transportation services 
provided under this section, unless the cost of the services or 
transportation is covered by an established agreement or contract. If 
such an agreement or contract exists, its negotiated payment terms 
shall apply.
  ``(2)(A) Reimbursement or payment by the Secretary under this section 
on behalf of an individual to a covered entity shall, unless rejected 
and refunded by the covered entity within 30 days of receipt, 
extinguish any liability on the part of the individual for the health 
care services or transportation covered by such payment.
  ``(B) Neither the absence of a contract or agreement between the 
Secretary and a covered entity nor any provision of a contract, 
agreement, or assignment to the contrary shall operate to modify, 
limit, or negate the requirements of subparagraph (A).
  ``(3) In this subsection, the term `covered entity' means any 
individual, transportation carrier, organization, or other entity that 
furnished or paid for health care services or transportation under this 
section.
  ``(e) Exception.--Pursuant to such regulations as the Secretary shall 
prescribe to carry out this section, the Secretary may furnish more 
than 14 days of health care services described in subsection (b), and 
transportation necessary to receive such services, to a newborn child 
based on medical necessity if the child is in need of additional care, 
including a case in which the newborn child has been discharged or 
released from a hospital and requires readmittance to ensure the health 
and welfare of the newborn child.''.
  (c) Treatment of Certain Expenses Already Incurred.--Pursuant to such 
regulations as the Secretary of Veterans Affairs shall prescribe, the 
Secretary may provide reimbursement under section 1786 of title 38, 
United States Code, as amended by subsection (a), health care services 
or transportation services furnished to a newborn child during the 
period beginning on May 5, 2010, and ending on the date of the 
enactment of this Act, if the Secretary determines that, under the 
circumstances applicable with respect to the newborn, such 
reimbursement appropriate.

                  TITLE III--REPORTS AND OTHER MATTERS

                          Subtitle A--Reports

SEC. 301. ASSESSMENT OF EFFECTS OF INTIMATE PARTNER VIOLENCE ON WOMEN 
                    VETERANS BY ADVISORY COMMITTEE ON WOMEN VETERANS.

  Section 542(c)(1) of title 38, United States Code, is amended--
          (1) in subparagraph (B), by striking ``and'' at the end;
          (2) by redesignating subparagraph (C) as subparagraph (D); 
        and
          (3) by inserting after subparagraph (B) the following new 
        subparagraph (C):
          ``(C) an assessment of the effects of intimate partner 
        violence on women veterans; and''.

SEC. 302. STUDY ON STAFFING OF WOMEN VETERAN PROGRAM MANAGER PROGRAM AT 
                    MEDICAL CENTERS OF THE DEPARTMENT OF VETERANS 
                    AFFAIRS AND TRAINING OF STAFF.

  (a) Study.--The Secretary of Veterans Affairs shall conduct a study 
on the use of the Women Veteran Program Manager program of the 
Department of Veterans Affairs to determine--
          (1) if the program is appropriately staffed at each medical 
        center of the Department;
          (2) whether each medical center of the Department is staffed 
        with a Women Veteran Program Manager; and
          (3) whether it would be feasible and advisable to have a 
        Women Veteran Program Ombudsman at each medical center of the 
        Department.
  (b) Report.--Not later than 270 days after the date of the enactment 
of this Act, 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 study conducted under 
subsection (a).
  (c) Training.--The Secretary shall ensure that all Women Veteran 
Program Managers and Women Veteran Program Ombudsmen receive the proper 
training to carry out their duties.

SEC. 303. REPORT ON AVAILABILITY OF PROSTHETIC ITEMS FOR WOMEN VETERANS 
                    FROM THE DEPARTMENT OF VETERANS AFFAIRS.

  Not later than one year after the date of the enactment of this Act, 
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 availability from the 
Department of Veterans Affairs of prosthetic items made for women 
veterans, including an assessment of the availability of such 
prosthetic items at each medical facility of the Department. The report 
shall--
          (1) address efforts on research, development, and employment 
        of additive manufacture technology (commonly referred to as 
        ``3D printing'') to provide prosthetic items for women 
        veterans; and
          (2) include a survey with a representative sample of 50,000 
        veterans (of which women shall be overrrepresented) in amputee 
        care program on satisfaction with prosthetics furnished or 
        procured by the Department that replace appendages or their 
        function.

SEC. 304. STUDY OF BARRIERS FOR WOMEN VETERANS TO HEALTH CARE FROM THE 
                    DEPARTMENT OF VETERANS AFFAIRS.

  (a) Study Required.--The Secretary of Veterans Affairs shall conduct 
a comprehensive study of the barriers to the provision of comprehensive 
health care by the Department of Veterans Affairs encountered by women 
who are veterans. In conducting the study, the Secretary shall--
          (1) survey women veterans who seek or receive hospital care 
        or medical services provided by the Department of Veterans 
        Affairs as well as women veterans who do not seek or receive 
        such care or services;
          (2) administer the survey to a representative sample of women 
        veterans from each Veterans Integrated Service Network; and
          (3) ensure that the sample of women veterans surveyed is of 
        sufficient size for the study results to be statistically 
        significant and is a larger sample than that of the study 
        referred to in subsection (b)(1).
  (b) Use of Previous Studies.--In conducting the study required by 
subsection (a), the Secretary shall build on the work of the studies of 
the Department of Veterans Affairs titled--
          (1) ``National Survey of Women Veterans in Fiscal Year 2007-
        2008''; and
          (2) ``Study of Barriers for Women Veterans to VA Health Care 
        2015''.
  (c) Elements of Study.--In conducting the study required by 
subsection (a), the Secretary shall conduct research on the effects of 
the following on the women veterans surveyed in the study:
          (1) The barriers associated with seeking mental health care 
        services, including with respect to provider availability, 
        telehealth access, and family, work, and school obligations.
          (2) The effect of driving distance or availability of other 
        forms of transportation to the nearest medical facility on 
        access to care.
          (3) The effect of access to care in the community.
          (4) The availability of child care.
          (5) The acceptability of integrated primary care, women's 
        health clinics, or both.
          (6) The comprehension of eligibility requirements for, and 
        the scope of services available under, hospital care and 
        medical services.
          (7) The perception of personal safety and comfort in 
        inpatient, outpatient, and behavioral health facilities.
          (8) The gender sensitivity of health care providers and staff 
        to issues that particularly affect women.
          (9) The effectiveness of outreach for health care services 
        available to women veterans.
          (10) The location and operating hours of health care 
        facilities that provide services to women veterans.
          (11) The perception of women veterans regarding the motto of 
        the Department of Veterans Affairs.
          (12) Such other significant barriers as the Secretary 
        considers appropriate.
  (d) Discharge by Contract.--The Secretary shall enter into a contract 
with a qualified independent entity or organization to carry out the 
study and research required under this section.
  (e) Mandatory Review of Data by Certain Department Divisions.--
          (1) In general.--The Secretary shall ensure that the head of 
        each division of the Department of Veterans Affairs specified 
        in paragraph (2) reviews the results of the study conducted 
        under this section. The head of each such division shall submit 
        findings with respect to the study to the Under Secretary for 
        responsibilities relating to health care services for women 
        veterans.
          (2) Specified divisions.--The divisions of the Department of 
        Veterans Affairs specified in this paragraph are the following:
                  (A) The Under Secretary for Health.
                  (B) The Office of Women's Health.
                  (C) The Center for Women Veterans established under 
                section 318 of title 38, United States Code.
                  (D) The Advisory Committee on Women Veterans 
                established under section 542 of such title.
  (f) Report.--Not later than 30 months after the date of the enactment 
of this Act, the Secretary shall submit to Congress a report on the 
study required under this section. The report shall include 
recommendations for such administrative and legislative action as the 
Secretary considers appropriate. The report shall also include the 
findings of the head of each division of the Department specified under 
subsection (e)(2) and of the Under Secretary for Health.

SEC. 305. REPORT REGARDING VETERANS WHO RECEIVE BENEFITS UNDER LAWS 
                    ADMINISTERED BY THE SECRETARY OF VETERANS AFFAIRS.

  (a) Report.--Not later than 180 days after the date of the enactment 
of this Act, the Secretary of Veterans Affairs shall publish a report 
regarding veterans who receive benefits under laws administered by the 
Secretary, including the Transition Assistance Program under sections 
1142 and 1144 of title 10, United States Code.
  (b) Data.--The data regarding veterans published in the report under 
subsection (a)--
          (1) shall be disaggregated by--
                  (A) sex;
                  (B) minority group member status; and
                  (C) minority group member status listed by sex.
          (2) may not include any personally identifiable information.
  (c) Matters Included.--The report under subsection (a) shall 
include--
          (1) identification of any disparities in the use of benefits 
        under laws administered by the Secretary; and
          (2) an analysis of the cause of such disparities and 
        recommendations to address such disparities.
  (d) Minority Group Member Defined.--In this section, the term 
``minority group member'' has the meaning given that term in section 
544 of title 38, United States Code.

SEC. 306. STUDY ON WOMEN VETERAN COORDINATOR PROGRAM.

  Not later than 180 days after the date of the enactment of this Act, 
the Secretary of Veterans Affairs shall submit to the Committees on 
Veterans' Affairs of the House of Representatives and the Senate a 
report containing a study on the Women Veteran Coordinator program of 
the Veterans Benefits Administration of the Department of Veterans 
Affairs. Such study shall identify the following:
          (1) If the program is appropriately staffed at each regional 
        benefits office of the Department.
          (2) Whether each regional benefits office of the Department 
        is staffed with a Women Veteran Coordinator.
          (3) The position description of the Women Veteran 
        Coordinator.
          (4) Whether an individual serving in the Women Veteran 
        Coordinator position concurrently serves in any other position, 
        and if so, the allocation of time the individual spends in each 
        such position.
          (5) A description of the metrics the Secretary uses to 
        determine the success and performance of the Women Veteran 
        Coordinator.

                       Subtitle B--Other Matters

SEC. 321. ANTI-HARASSMENT AND ANTI-SEXUAL ASSAULT POLICY OF THE 
                    DEPARTMENT OF VETERANS AFFAIRS.

  (a) In General.--Subchapter II of chapter 5 of title 38, United 
States Code, is amended by adding at the end the following new section:

``Sec. 533. Anti-harassment and anti-sexual assault policy

  ``(a) Establishment.--The Secretary of Veterans Affairs shall 
establish a comprehensive policy to end harassment and sexual assault, 
including sexual harassment and gender-based harassment, throughout the 
Department of Veterans Affairs. This policy shall include the 
following:
          ``(1) A process for employees and contractors of the 
        Department to respond to reported incidents of harassment and 
        sexual assault committed by any non-Department individual 
        within a facility of the Department, including with respect to 
        accountability or disciplinary measures.
          ``(2) A process for employees and contractors of the 
        Department to respond to reported incidents of harassment and 
        sexual assault of any non-Department individual within a 
        facility of the Department.
          ``(3) A process for any non-Department individual to report 
        harassment and sexual assault described in paragraph (1), 
        including an option for confidential reporting, and for the 
        Secretary to respond to and address such reports.
          ``(4) Clear mechanisms for non-Department individuals to 
        readily identify to whom and how to report incidents of 
        harassment and sexual assault committed by another non-
        Department individual.
          ``(5) Clear mechanisms for employees and contractors of the 
        Department to readily identify to whom and how to report 
        incidents of harassment and sexual assault and how to refer 
        non-Department individuals with respect to reporting an 
        incident of harassment or sexual assault.
          ``(6) A process for, and mandatory reporting requirement 
        applicable to, any employee or contractor of the Department who 
        witnesses harassment or sexual assault described in paragraph 
        (1) or (2) within a facility of the Department, regardless of 
        whether the individual affected by such harassment or sexual 
        assault wants to report such harassment or sexual assault.
          ``(7) The actions possible, including disciplinary actions, 
        for employees or contractors of the Department who fail to 
        report incidents of harassment and sexual assault described in 
        paragraph (1) or (2) that the employees or contractors witness.
          ``(8) On an annual or more frequent basis, mandatory training 
        for employees and contractors of the Department regarding how 
        to report and address harassment and sexual assault described 
        in paragraphs (1) and (2), including bystander intervention 
        training.
          ``(9) On an annual or more frequent basis, the distribution 
        of the policy under this subsection and anti-harassment and 
        anti-sexual assault educational materials by mail or email to 
        each individual receiving a benefit under a law administered by 
        the Secretary.
          ``(10) The prominent display of anti-harassment and anti-
        sexual assault messages in each facility of the Department, 
        including how non-Department individuals may report harassment 
        and sexual assault described in paragraphs (1) and (2) at such 
        facility and the points of contact under subsection (b).
          ``(11) The posting on internet websites of the Department, 
        including the main internet website regarding benefits of the 
        Department and the main internet website regarding health care 
        of the Department, of anti-harassment and anti-sexual assault 
        banners specifically addressing harassment and sexual assault 
        described in paragraphs (1) and (2).
  ``(b) Points of Contact.--The Secretary shall designate, as a point 
of contact to receive reports of harassment and sexual assault 
described in paragraphs (1) and (2) of subsection (a)--
          ``(1) at least one individual, in addition to law 
        enforcement, at each facility of the Department (including Vet 
        Centers under section 1712A of this title), with regard to that 
        facility;
          ``(2) at least one individual employed in each Veterans 
        Integrated Service Network, with regards to facilities in that 
        Veterans Integrated Service Network;
          ``(3) at least one individual employed in each regional 
        benefits office;
          ``(4) at least one individual employed at each location of 
        the National Cemetery Administration; and
          ``(5) at least one individual employed at the Central Office 
        of the Department to track reports of such harassment and 
        sexual assault across the Department, disaggregated by 
        facility.
  ``(c) Accountability.--The Secretary shall establish a policy to 
ensure that each facility of the Department and each director of a 
Veterans Integrated Service Network is responsible for addressing 
harassment and sexual assault at the facility and the Network. Such 
policy shall include--
          ``(1) a remediation plan for facilities that experience five 
        or more incidents of sexual harassment, sexual assault, or 
        combination thereof, during any single fiscal year; and
          ``(2) taking appropriate actions under chapter 7 or 
        subchapter V of chapter 74 of this title.
  ``(d) Data.--The Secretary shall ensure that the in-take process for 
veterans at medical facilities of the Department includes a survey to 
collect the following information:
          ``(1) Whether the veteran feels safe at the facility and 
        whether any events occurred at the facility that affect such 
        feeling.
          ``(2) Whether the veteran wants to be contacted later by the 
        Department with respect to such safety issues.
  ``(e) Working Group.--(1) The Secretary shall establish a working 
group to assist the Secretary in implementing policies to carry out 
this section.
  ``(2) The working group established under paragraph (1) shall consist 
of representatives from--
          ``(A) veterans service organizations;
          ``(B) State, local, and Tribal veterans agencies; and
          ``(C) other persons the Secretary determines appropriate.
  ``(3) The working group established under paragraph (1) shall 
develop, and the Secretary shall carry out--
          ``(A) an action plan for addressing changes at the local 
        level to reduce instances of harassment and sexual assault;
          ``(B) standardized media for veterans service organizations 
        and other persons to use in print and on the internet with 
        respect to reducing harassment and sexual assault; and
          ``(C) bystander intervention training for veterans.
  ``(f) Reports.--The Secretary shall submit to the Committees on 
Veterans' Affairs of the Senate and the House of Representatives an 
annual report on harassment and sexual assault described in paragraphs 
(1) and (2) of subsection (a) in facilities of the Department. Each 
such report shall include the following:
          ``(1) Results of harassment and sexual assault programming, 
        including the End Harassment program.
          ``(2) Results of studies from the Women's Health Practice-
        Based Research Network of the Department relating to harassment 
        and sexual assault.
          ``(3) Data collected on incidents of sexual harassment and 
        sexual assault.
          ``(4) A description of any actions taken by the Secretary 
        during the year preceding the date of the report to stop 
        harassment and sexual assault at facilities of the Department.
          ``(5) An assessment of the implementation of the training 
        required in subsection (a)(7).
          ``(6) A list of resources the Secretary determines necessary 
        to prevent harassment and sexual assault at facilities of the 
        Department.
  ``(g) Definitions.--In this section:
          ``(1) The term `non-Department individual' means any 
        individual present at a facility of the Department who is not 
        an employee or contractor of the Department.
          ``(2) The term `sexual harassment' has the meaning given that 
        term in section 1720D of this title.''.
  (b) Clerical Amendment.--The table of sections at the beginning of 
such chapter is amended by adding after the item relating to section 
532 the following new item:

``533. Anti-harassment and anti-sexual assault policy.''.

  (c) Definition of Sexual Harassment.--Section 1720D(f) of such title 
is amended by striking ``repeated,''.
  (d) Deadline.--The Secretary shall commence carrying out section 533 
of such title, as added by subsection (a), not later than 180 days 
after the date of enactment of this Act.

SEC. 322. SUPPORT FOR ORGANIZATIONS THAT HAVE A FOCUS ON PROVIDING 
                    ASSISTANCE TO WOMEN VETERANS AND THEIR FAMILIES.

  Section 2044(e) of title 38, United States Code, is amended by adding 
at the end the following new paragraph:
  ``(4) Not less than $20,000,000 shall be available under paragraph 
(1)(H) for the provision of financial assistance under subsection (a) 
to organizations that have a focus on providing assistance to women 
veterans and their families.''.

SEC. 323. GAP ANALYSIS OF DEPARTMENT OF VETERANS AFFAIRS PROGRAMS THAT 
                    PROVIDE ASSISTANCE TO WOMEN VETERANS WHO ARE 
                    HOMELESS.

  (a) In General.--The Secretary of Veterans Affairs shall complete an 
analysis of programs of the Department of Veterans Affairs that provide 
assistance to women veterans who are homeless or precariously housed to 
identify the areas in which such programs are failing to meet the needs 
of such women.
  (b) Report.--Not later than 270 days after the date of the enactment 
of this Act, 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 analysis completed under 
subsection (a).

SEC. 324. DEPARTMENT OF VETERANS AFFAIRS PUBLIC-PRIVATE PARTNERSHIP ON 
                    LEGAL SERVICES FOR WOMEN VETERANS.

  (a) Partnership Required.--The Secretary of Veterans Affairs shall 
establish a partnership with at least one nongovernmental organization 
to provide legal services to women veterans.
  (b) Focus.--The focus of the partnership established under subsection 
(a) shall be on the 10 highest unmet needs of women veterans as set 
forth in the most recently completed Community Homelessness Assessment, 
Local Education and Networking Groups for Veterans (CHALENG for 
Veterans) survey.

SEC. 325. PROGRAM TO ASSIST VETERANS WHO EXPERIENCE INTIMATE PARTNER 
                    VIOLENCE OR SEXUAL ASSAULT.

  (a) Program Required.--The Secretary of Veterans Affairs shall carry 
out a program to assist former members of the armed forces who have 
experienced or are experiencing intimate partner violence or sexual 
assault in accessing benefits from the Department of Veterans Affairs, 
including coordinating access to medical treatment centers, housing 
assistance, and other benefits from the Department.
  (b) Collaboration.--The Secretary shall carry out the program under 
subsection (a) in collaboration with--
          (1) intimate partner violence shelters and programs;
          (2) rape crisis centers;
          (3) State intimate partner violence and sexual assault 
        coalitions; and
          (4) such other health care or other service providers that 
        serve intimate partner violence or sexual assault victims as 
        determined by the Secretary, particularly those providing 
        emergency services or housing assistance.
  (c) Authorized Activities.--In carrying out the program under 
subsection (a), the Secretary may conduct the following activities:
          (1) Training for community-based intimate partner violence or 
        sexual assault service providers on--
                  (A) identifying former members of the Armed Forces 
                who have been victims of intimate partner violence or 
                sexual assault;
                  (B) coordinating with local service providers of the 
                Department; and
                  (C) connecting former members of the Armed Forces 
                with appropriate housing, mental health, medical, and 
                other financial assistance or benefits from the 
                Department.
          (2) Assistance to service providers to ensure access of 
        veterans to intimate partner violence and sexual assault 
        emergency services, particularly in underserved areas, 
        including services for Native American veterans (as defined in 
        section 3765 of title 38, United States Code).
          (3) Such other outreach and assistance as the Secretary 
        determines necessary for the provision of assistance under 
        subsection (a).
  (d) Intimate Partner Violence and Sexual Assault Outreach 
Coordinators.--
          (1) In general.--In order to effectively assist veterans who 
        have experienced intimate partner violence or sexual assault, 
        the Secretary may establish local coordinators to provide 
        outreach under the program required by subsection (a).
          (2) Local coordinator knowledge.--The Secretary shall ensure 
        that each coordinator established under paragraph (1) is 
        knowledgeable about--
                  (A) the dynamics of intimate partner violence and 
                sexual assault, including safety concerns, legal 
                protections, and the need for the provision of 
                confidential services;
                  (B) the eligibility of veterans for services and 
                benefits from the Department that are relevant to 
                recovery from intimate partner violence and sexual 
                assault, particularly emergency housing assistance, 
                mental health care, other health care, and disability 
                benefits; and
                  (C) local community resources addressing intimate 
                partner violence and sexual assault.
          (3) Local coordinator assistance.--Each coordinator 
        established under paragraph (1) shall assist intimate partner 
        violence shelters and rape crisis centers in providing services 
        to veterans.

SEC. 326. STUDY AND TASK FORCE ON VETERANS EXPERIENCING INTIMATE 
                    PARTNER VIOLENCE OR SEXUAL ASSAULT.

  (a) National Baseline Study.--
          (1) In general.--Not later than one year after the date of 
        the enactment of this Act, the Secretary of Veterans Affairs, 
        in consultation with the Attorney General, shall conduct a 
        national baseline study to examine the scope of the problem of 
        intimate partner violence and sexual assault among veterans and 
        spouses and intimate partners of veterans.
          (2) Matters included.--The study under paragraph (1) shall--
                  (A) include a literature review of all relevant 
                research on intimate partner violence and sexual 
                assault among veterans and spouses and intimate 
                partners of veterans;
                  (B) examine the prevalence of the experience of 
                intimate partner violence among--
                          (i) women veterans;
                          (ii) veterans who are minority group members 
                        (as defined in section 544 of title 38, United 
                        States Code, and including other minority 
                        populations as the Secretary determines 
                        appropriate);
                          (iii) urban and rural veterans;
                          (iv) veterans who are enrolled in a program 
                        under section 1720G of title 38, United States 
                        Code;
                          (v) veterans who are in intimate 
                        relationships with other veterans; and
                          (vi) veterans who are described in more than 
                        one clause of this subparagraph;
                  (C) examine the prevalence of the perpetration of 
                intimate partner violence by veterans; and
                  (D) include recommendations to address the findings 
                of the study.
          (3) Report.--Not later than 30 days after the date on which 
        the Secretary completes the study under paragraph (1), the 
        Secretary shall submit to the Committees on Veterans' Affairs 
        of the House of Representatives and the Senate a report on such 
        study.
  (b) Task Force.--Not later than 90 days after the date on which the 
Secretary completes the study under subsection (a), the Secretary, in 
consultation with the Attorney General and the Secretary of Health and 
Human Services, shall establish a national task force (in this section 
referred to as the ``Task Force'') to develop a comprehensive national 
program, including by integrating facilities, services, and benefits of 
the Department of Veterans Affairs into existing networks of community-
based intimate partner violence and sexual assault services, to address 
intimate partner violence and sexual assault among veterans.
  (c) Consultation With Stakeholders.--In carrying out this section, 
the Task Force shall consult with--
          (1) representatives from veteran service organizations and 
        military service organizations;
          (2) representatives from not fewer than three national 
        organizations or State coalitions with demonstrated expertise 
        in intimate partner violence prevention, response, or advocacy; 
        and
          (3) representatives from not fewer than three national 
        organizations or State coalitions, particularly those 
        representing underserved and ethnic minority communities, with 
        demonstrated expertise in sexual assault prevention, response, 
        or advocacy.
  (d) Duties.--The duties of the Task Force shall include the 
following:
          (1) To review existing services and policies of the 
        Department and develop a comprehensive national program to 
        address intimate partner violence and sexual assault 
        prevention, response, and treatment.
          (2) To review the feasibility and advisability of 
        establishing an expedited process to secure emergency, 
        temporary benefits, including housing or other benefits, for 
        veterans who are experiencing intimate partner violence or 
        sexual assault.
          (3) To review and make recommendations regarding the 
        feasibility and advisability of establishing dedicated, 
        temporary housing assistance for veterans experiencing intimate 
        partner violence or sexual assault.
          (4) To identify any requirements regarding intimate partner 
        violence assistance or sexual assault response and services 
        that are not being met by the Department and make 
        recommendations on how the Department can meet such 
        requirements.
          (5) To review and make recommendations regarding the 
        feasibility and advisability of providing direct services or 
        contracting for community-based services for veterans in 
        response to a sexual assault, including through the use of 
        sexual assault nurse examiners, particularly in underserved or 
        remote areas, including services for Native American veterans.
          (6) To review the availability of counseling services 
        provided by the Department and through peer network support, 
        and to provide recommendations for the enhancement of such 
        services, to address--
                  (A) the perpetration of intimate partner violence and 
                sexual assault; and
                  (B) the recovery of veterans, particularly women 
                veterans, from intimate partner violence and sexual 
                assault.
          (7) To review and make recommendations to expand services 
        available for veterans at risk of perpetrating intimate partner 
        violence.
  (e) Report.--Not later than one year after the date of the enactment 
of this Act, and not less frequently than annually thereafter by 
October 1 of each year, the Task Force shall submit to the Secretary of 
Veterans Affairs and Congress a report on the activities of the Task 
Force, including any recommendations for legislative or administrative 
action.
  (f) Definitions.--In this section:
          (1) The term ``Native American veteran'' has the meaning 
        given that term in section 3765 of title 38, United States 
        Code.
          (2) The term ``State'' has the meaning given that term in 
        section 101 of title 38, United States Code.

                          Purpose and Summary

    H.R. 3224 was introduced by Representative Julia Brownley 
of California on June 12, 2019. H.R. 3224, as amended, 
establishes comprehensive reforms throughout the Department of 
Veterans Affairs (VA) to address women veterans' access to 
health care, benefits, and other resources, and also includes 
several reports and studies to identify gaps and opportunities 
for improvement. R2019. H.R. 3224, as amended, incorporates the 
text of the following bills: H.R. 2645 introduced by 
Representative Susie Lee of Nevada on May 9, 2019, H.R. 2681 
introduced by Representative Chris Pappas of New Hampshire on 
May 10, 2019, H.R. 2752 introduced by Representative Colin 
Allred on May 15, 2019, H.R. 2798 introduced by Representative 
Julia Brownley of California on May 16, 2019, H.R. 2924 
introduced by Representative Mike Levin of California on May 
22, 2019, H.R. 2972 introduced by Representative Anthony 
Brindisi of New York on May 23, 2019, H.R. 2982 introduced by 
Representative Joe Cunningham on May 23, 2019 H.R. 3036 
introduced by Representative Max Rose of New York on May 28, 
2019, H.R. 3189 introduced by Representative Susan Wild of 
Pennsylvania on June 10, 2019, H.R. 3636 introduced by 
Representative Lauren Underwood on July 9, 2019, H.R. 3867 
introduced by Representative Nydia Velazquez on July 19, 2019, 
H.R. 4096 introduced by Representative Lou Correa of California 
on July 30, 2019, H.R. 4165 introduced by Representative 
Antonio Delgado of New York on August 6, 2019, and H.R. 4554 
introduced by Representative Julia Brownley of California on 
September 26, 2019.

                  Background and Need for Legislation

    Women have served in every American conflict since the 
Revolutionary War; among them, Deborah Sampson and Margaret 
Corbin, who were the first American women known to have served 
in combat, earning pensions for their service during the 
Revolutionary War. There are over two million women veterans in 
the United States, and they are the fastest-growing demographic 
in both the military and veteran population.
    Despite centuries of honorable service, the women who serve 
our country are still often treated as second class 
servicemembers and veterans. A visible minority in the 
military, women experience everyday indignities that make them 
feel like they do not belong. Even more, the VA system remains 
rife with barriers to care.
    Despite representing a rapidly growing veteran population, 
women veterans' needs continue to be under-resourced by VA in a 
manner that does not meet the pace of growth in the population. 
This has led to many systematic deficiencies including longer 
wait times, staffing shortages, and facilities that fail to 
meet basic environment-of-care standards.
    Women are far more likely to use community care than male 
veterans, largely to receive basic preventive services such as 
Pap smears and mammograms, as well as maternity care. While 
community care can provide a more geographically convenient 
alternative to driving a long distance to a VA facility, women 
veterans cite frustration with the lack of cultural competency 
and awareness at non-VA providers.
    In general, women veterans who use VA are largely satisfied 
with their care. However, only 25% of women veterans use VA. 
The women veterans who do not, cite lack of awareness about 
eligibility and gender specific care, or perception that the 
environment will be hostile to women.
    While the quality of health care for women veterans at VA 
is high, numerous barriers remain to accessing it. The greatest 
barrier of all is a culture that condones sexual harassment and 
assault, often by other veterans. A February 2019 VA study 
found that at least 1 in 4 women veterans experience sexual or 
gender-based harassment at VA facilities, primarily from other 
veterans. Currently, VA has no system-wide process to address 
mandatory training, including bystander intervention, clear 
reporting mechanisms, or means of holding perpetrators 
accountable.
    In addition, many of the gaps in resources have not been 
properly identified by evidence-based research and reporting. 
This bill also requires routine reporting on several topics.
    Women veterans are a visible minority while serving in the 
military but become invisible when they become veterans. This 
legislation will raise the profile of the fastest growing, most 
diverse subpopulation within the veteran community, and serve 
their needs.

                TITLE I--VETERANS HEALTH ADMINISTRATION

Sec. 101. Office of Women's Health in the Department of Veterans 
        Affairs

    Women represent the fastest growing subpopulation of 
veterans in the nation, while the population of male veterans 
is growing smaller. While women veterans currently represent 10 
percent of the veteran population and 8 percent of VA users, 
the Veterans Health Administration (VHA) budget for women's 
health is far less than ten percent of the overall budget. 
While there are numerous resources for women veterans within 
VHA, they are not fully aligned under a single office, without 
a direct line to the Undersecretary for Health (USH).
    This section amends section 7306 of title 38, United States 
Code (USC) to establish the Office of Women's Health reporting 
to the USH, to provide a central office for monitoring and 
encouraging the activities of the VHA with respect to the 
provision, evaluation, and improvement of women veterans' 
health care services in the Department. This office will 
develop standards of care, identify deficiencies, and oversee 
distribution of resources and information related to women's 
health, including research and education. This office will 
also, as part of the annual budgeting process, provide 
recommendations to the amount of funds for furnishing health 
care to women veterans, ensuring that these funds either 
reflect or exceed the proportion of women veterans enrolled at 
VA.
    The Committee expects that this would ensure that VHA 
remains prepared to adequately serve a rapidly growing veteran 
population.
    This section allows the USH to reorganize existing 
capabilities and consolidate them within one office that 
reports directly to the USH to avoid duplication of existing 
capabilities. When women veterans have access to high quality, 
gender specific care at VA, they choose and stay at VA. 
Therefore, this section ensures that at least one women's 
health primary care provider is staffed at each VA medical 
facility. This may include either hiring new staff, or training 
existing staff to become women's health primary care providers 
as all or part of their existing duties, as is deemed necessary 
based on the size of the women veteran population in a 
location.
    This section also requires several annual reports, 
including reporting on the use of women veterans of health care 
from VA, on the models of health care facilities for women's 
primary health care, and the staffing of women's primary health 
care in VA medical facilities. These reports, which are 
deliverable to Congress, will ensure VA remains aware of 
changing requirements to best serve women veterans, and that 
Congress can resource these requirements accordingly. As women 
veterans are more likely to be referred to community care than 
male veterans, this section also requires the Secretary of 
Veterans Affairs (Secretary) to submit to Congress an annual 
report on access of women veterans to gender specific services 
under community care contracts.
    This section also includes reporting on accessibility and 
treatment options for women veterans. This report will include 
an assessment of wheelchair accessibility of women's health 
centers; an assessment of accessibility to radiology and 
mammography, including door sizes and hoists; options for women 
veterans to access mental health primary care providers; and 
options for clothing for women at medical centers. In addition 
to annual reports, the Secretary shall submit the initial 
required report within 180 days of enactment.

Sec. 102. Expansion of capabilities of women veterans call center to 
        include text messaging

    This section requires VA include text messaging capability 
at the Women Veterans Call Center.
    The Committee is committed to reducing all barriers to 
accessing information related to benefits and healthcare, and 
that includes expanding methods of communication. Therefore, 
this provision codifies into law a capability that was 
introduced in mid-2019.

Sec. 103. Requirement for Department of Veterans Affairs internet 
        website to provide information on services available to women 
        veterans

    While VA already has several websites with information 
regarding women veterans, including ongoing research, 
initiatives from the Center for Women Veterans, VA Advisory 
Committee on Women Veterans, and facility-specific information, 
this information is not in a centralized location, and is not 
always kept up to date.
    This section requires the Secretary to survey all websites 
of the Department and publish a centralized website where women 
veterans can access the various information, pages, and 
resources throughout VA's online presence. This webpage must 
include all the locations of each VA Medical Center (VAMC) and 
Community-Based Outpatient Clinic (CBOC), as well as the name 
and contact information of each women's health coordinator, as 
well as contact information for staff from the Veterans 
Benefits Administration (VBA) and National Cemetery 
Administration (NCA). This section also requires VA to update 
the webpage at least every 90 days.

Sec. 104. Report on Women Veterans Retrofit Initiative

    Two shortfalls routinely identified regarding provision of 
health care to women veterans are staff shortages and a lack of 
space to accommodate growth in the women veterans population. 
In addition, when VAs expand their capacity to support the 
women veterans population, more women choose VA for their 
healthcare. The Committee intends for VHA to comprehensively 
identify opportunities to retrofit existing facilities. This 
section requires reporting on retrofitting facilities to 
address women veterans' healthcare, including how the Secretary 
prioritizes existing medical facilities to support provision of 
care to women veterans in comparison to other requirements, and 
a five-year plan for retrofitting medical facilities. This 
section will identify all existing needs across the Department 
to upgrade existing facilities in order to best allocate 
resources to meet those demands.

Sec. 105. Establishment of environment of care standards and 
        inspections at Department of Veterans Affairs medical centers

    Too often, VA facilities fail to meet their own established 
environment of care standards to ensure adequate patient safety 
and privacy. The Committee expects VA to both adhere to these 
standards and hold facility directors accountable for meeting 
these standards. These standards include existence of privacy 
curtains, placement of examination tables, and locking doors. 
There is minimal accountability for facility directors who do 
not prioritize meeting these standards. This section requires 
adherence to environment of care standards and accountability 
and transparency for adherence to those standards.

Sec. 106. Additional funding for primary care and emergency care 
        clinicians in Women Veterans Health Care Mini-Residency Program

    The Committee recognizes that one of the most efficient 
means of expanding gender-specific primary care for women 
veterans is to train existing staff in women's primary care. In 
order to address staffing shortfalls in women's primary care, 
VHA created the Women Veterans Health Care Mini-Residency 
Program in order to train existing VA women's providers in 
women's health. Since 2010, VA's Women Veterans Health Care 
Mini Residency Program has trained over 6,000 clinicians. In 
2016, VA held the first mental-health focused Women's Health 
Mini-Residency, and in 2018, partnered with the Department of 
Defense (DoD) for the first time. The Women's Health Mini 
Residency Program reinforces the expertise of VA's primary care 
teams and women's health providers to address the full range of 
women veterans' medical needs. Specifically, the program gives 
VA's women's health providers experience in conducting breast 
and pelvic exams with the help of trained Gynecological 
Teaching Associates. This section ensures additional funding 
for primary care and emergency care clinicians in the Women 
Veterans' Health Care Mini-Residency Program.

Sec. 107. Establishment of women veteran training module for non-
        Department of Veterans Affairs health care providers

    Women veterans are more likely to be referred to community 
care than male veterans because of a lack of gender-specific 
services such as pre- and post-natal care, gynecology and 
mammography. Women veterans who have used both VA and non-VA 
care express a lack of cultural competency in community 
providers, including a lack of trauma-informed care. The 
Committee expects that community care providers who serve women 
veterans should have a basic competency in serving women 
veterans, and should receive the same training that VA 
providers receive regarding this population. This section 
establishes a women veteran training module for non-VA health 
care providers providing health care to veterans under laws 
administered by the Secretary. This training module will 
provide a mechanism for continuing medical education to 
community providers in order to have an understanding of the 
experience, healthcare needs, and cultural competencies 
required to best serve women veterans.

                         TITLE II--MEDICAL CARE

Sec. 201. Improved access to Department of Veterans Affairs medical 
        care for women veterans

    At many facilities, a part-time women's health provider is 
only available for several hours during a certain day of the 
week. This creates a barrier to care for women veterans, who 
are more likely than male veterans to have multiple outside 
commitments, including a combination of work, school, and 
childcare. It also means that the actual wait times for an 
appointment experienced by women veterans may be longer than 
reported by VA as their outside obligations make it challenging 
to find a convenient appointment time. These barriers result in 
delayed care or avoiding care altogether.
    In order to reduce these barriers, this section ensures 
that women's health primary care is available during regular 
business hours; requires a study by the Secretary on the use of 
extended hours as a means of reducing care barriers, and the 
need for extended hours, and requires this study be reported to 
Congress. Under existing law, there is no mandate for women's 
health primary care to be available at every medical facility 
of the Department, whereas primary care is available for men at 
every facility. This section addresses that inequity to ensure 
that women's health primary care is available at the 10% of 
facilities that do not have that capability and serves the 24% 
of women veterans who use VA and do not have an assigned 
women's health primary care provider. In addition, the intent 
behind this section is that those services be available during 
all regular business hours. In order to meet this requirement 
VA may hire new full- or part-time providers or train existing 
providers through the Women Veterans Health Care Mini-Residency 
Program.
    This section also requires that the Secretary conduct a 
study to assess extended hours as a means of reducing barriers 
to care such as increasing appointment availability before or 
after working hours or on weekends.

Sec. 202. Counseling and treatment for sexual trauma

    Under interpretation of current law, members of the 
National Guard and Reserve are being turned away from Vet 
Centers for counseling for Military Sexual Trauma (MST) on the 
grounds that they have not met a minimum amount of time on 
Title 10 orders. Many of these members are then asked to 
produce a Line of Duty determination, which in addition to 
being a lengthy process, eliminates their right to file a 
Restricted Report. This section recognizes that Reservists and 
members of the National Guard who experience MST are among some 
of the most vulnerable servicemembers due to their lack of 
eligibility for other resources that their active duty 
counterparts have access to. This section ensures that those 
current and former members of the Reserve and National Guard 
have access to the most critical of mental health services, 
regardless of their time in service or where they served. 
Recognizing that many former members of the armed forces who 
experienced MST may not otherwise meet the definition of 
veteran as defined of section 101 (2) in Title 38, this section 
also expands MST counseling at Vet Centers to all former 
members of the armed forces, regardless of discharge status, so 
long as they did not receive a Dishonorable Discharge or a 
discharge by court-martial.

Sec. 203. Counseling in retreat settings for women veterans and other 
        individuals

    This section makes permanent a successful pilot program to 
provide readjustment counseling to women veterans, and expands 
it to other populations. Nationwide, the Committee has heard 
from women veterans that having women-only programming has been 
a significant protective factor for mental health. These 
programs reduce isolation and invisibility, two factors that 
are most detrimental to mental health to women veterans.
    During the last 7 years, Readjustment Counseling Service 
(RCS) has provided 15 retreats to approximately 400 recently 
returning women veterans. Pre-retreat assessments and post-
retreat evaluations have shown significant decrease in 
posttraumatic stress symptomology, and excerpts from feedback 
forms illustrate the positive experiences of participants. This 
section not only makes the program permanent, but authorizes VA 
to expand counseling in retreat settings to other veterans, 
former members of the armed forces, and their families, 
including survivors, dependents, spouses, and partners. In 
order to maintain the integrity of the original program, this 
section also requires that women-only cohorts continue in order 
to maintain this impactful resource for women veterans. The 
Committee intends for VA to identify a broad range of 
recreational therapy activities to best serve these 
populations.

Sec. 204. Improvement of health care services provided to newborn 
        children by the Department of Veterans Affairs

    Women veterans often experience complicated pregnancies and 
births, and therefore this section ensures that they will be 
covered should an emergency arise. This section both doubles 
the amount of time of coverage for all newborn children born to 
women veterans covered by VA. In addition, it closes a loophole 
that was impeding coverage for medically necessary emergency 
transportation for veterans and their newborns. Many women 
veterans are experiencing indebtedness due to hospital bills 
arising from these emergency situations, and this section also 
provides retroactive reimbursement for this circumstance dating 
back to May 5, 2010.

                  TITLE III--REPORTS AND OTHER MATTERS

Subtitle A--Reports

Sec. 301. Assessment of effects of intimate partner violence on women 
        veterans by Advisory Committee on Women Veterans

    The VA Advisory Committee on Women Veterans assesses and 
advises the Secretary on the needs of women veterans, with 
respect to VA programs such as compensation, rehabilitation, 
outreach, and health care. Data shows that women veterans are 
more likely to experience intimate partner violence (IPV) than 
women who did not serve in the military. This section adds IPV 
to one of the topics surveyed by the Advisory Committee on 
Women Veterans.

Sec. 302. Study on staffing of Women Veteran Program Manager program at 
        medical centers of the Department of Veterans Affairs and 
        training of staff

    The Women Veteran Program Manager (WVPM) is a largely 
successful program in VHA, however the Committee has learned 
that there are numerous opportunities to improve this program 
to ensure the program has the appropriate impact at each 
location. Each VAMC nationwide is required to employ a WVPM to 
assist women veterans in identifying and coordinating the 
services available to them. This measure requires VA to assess 
the staffing needs of Women Veterans Program Managers at each 
VAMC. The Committee expects VA to identify if the WVPM has 
sufficient access to the Medical Director, whether the position 
is being used as a career milestone for clinical staff, rather 
than the intended purpose of serving women veterans, whether 
the position has or needs a budget, and identifying whether the 
position is at the appropriate seniority to be able to 
meaningfully advocate for women veterans. Additionally, the 
Secretary is to assess the feasibility of providing each VAMC 
with a Women Veterans Program Ombudsman to act as a single 
point for advocating on behalf of women veterans regarding 
patient experience.

Sec. 303. Report on availability of prosthetic items for women veterans 
        from the Department of Veterans Affairs

    Nationwide, women veterans express frustration with the 
lack of availability of suitable prosthetic items to 
specifically meet their needs. Some women in the amputee care 
program have expressed frustration that prostheses cannot fit 
women's shoes (such as high heels). There are a wide range of 
prosthetics provided by VA in addition to artificial limbs. 
This section requires that VA report on the availability of 
prosthetic items for women veterans. This includes the 
availability of preferred prosthetic items, for example, if 
women veterans who require cranial medical units (or wigs) have 
the ability to use their preferred vendor for wigs made from 
human hair. This section also mandates VA report on efforts on 
research, development, and employment of 3D printing to provide 
prosthetic items for women veterans, and survey 50,000 veterans 
in the amputee care program, with an oversampling of women.

Sec. 304. Study of barriers for women veterans to health care from the 
        Department of Veterans Affairs

    In order to identify the future needs of women veterans, it 
is necessary to periodically conduct independent assessments of 
this population. This section mandates that VA build upon past 
studies by using an outside entity to conduct a survey on a 
statistically significant number of women veterans that both 
utilize and decline to utilize VA's health care services, which 
have been conducted with a periodicity of every 5-7 years. This 
survey includes questions from past surveys, and builds upon 
the survey to reflect changes in existing law, such as 
expansion of community care under the MISSION Act, and a 
question regarding the perception of the motto of VA.

Sec. 305. Report regarding veterans who receive benefits under laws 
        administered by the Secretary of Veterans Affairs

    This section requires the Secretary to publish a report 
regarding veterans who are currently receiving benefits, 
including the Transition Assistance Program (TAP). This report 
will include data regarding veterans and their sex, minority 
group member status, and by both categories, excluding 
personally identifiable information. The report will identify 
any disparities in the use of benefits, analysis of the cause 
of those disparities, and proposed recommendations to address 
those disparities so that VA can best tailor outreach efforts 
to reach veterans who are underutilizing benefits.

Sec. 306. Study on Women Veteran Coordinator program

    Women Veterans Coordinators (WVCs) at VBA are currently an 
unfunded position, diminishing the impact of the role. Their 
purpose is to serve as the primary point of contact for women 
veterans and conduct outreach in their communities to connect 
women veterans with their benefits. This section will help 
understand shortfalls in order to adequately resource this 
position. Unlike a number of roles in VHA, such as the WVPM or 
the MST Coordinator, WVCs are neither a full-time nor part-time 
position as a share (i.e. 0.25) of a full-time position. As a 
result, reports from the field reflect that WVCs execute their 
outreach duties on nights and weekends unpaid, or do not 
perform any specific duties at all.

Subtitle B--Other Matters

Sec. 321. Anti-harassment and anti-sexual assault policy of the 
        Department of Veterans Affairs

    Harassment and sexual assault have no place in VA, yet for 
too long these behaviors have been tolerated. Women, 
minorities, Native veterans, and lesbian, gay, bisexual, and 
transgender veterans in particular, experience especially high 
rates of harassment at VA, often by other veterans. In February 
2019, VA released an empirical study that found that at least 
one in four women veterans experienced sexual or gender-based 
harassment at VA facilities. The Committee sent two letters to 
the Secretary addressing the issue of harassment, and the issue 
was raised frequently with the Committee.
    At the Subcommittee on Health oversight hearing on May 2, 
2019, women veterans shared their perspective on the issue:
    Ms. Lindsay Church, Navy Veteran, Executive Director of 
Minority Veterans of America:

          ``Similar to our male counterparts, we as women 
        veterans are immensely proud of our service and what we 
        have done, the service and support we have offered to 
        our nation; however, many of us experienced instances 
        of harassment, degradation, and discrimination based on 
        our gender identities and/or sexual orientations. We 
        withstood and persevered those experiences, and we did 
        so honorably.''

    Ms. BriGette McCoy, Army Veteran, President, Women Veterans 
Social Justice Network:

          ``It is never clear what the outcome will be for 
        women who reports harassment, or for the patient or 
        employee that harasses. My personal experiences of 
        being harassed within the VA and the discussions with 
        other women about the need to change their appearance, 
        come at certain times of day, switch to other 
        hospitals, or stop going to the VA at all is another 
        area of discussion.''

    Through oversight and fact-finding, the Committee learned 
that not only was harassment prevalent in VA, but existing 
bystander intervention training was not mandatory for all 
employees. This meant that frontline employees such as 
information desk staff or custodial employees who were most 
likely to witness harassment in waiting areas or hallways were 
the least likely to receive training on how to address the 
issue. Furthermore, accountability measures for perpetrators 
were unclear. In the course of a two-week period in September 
2019, three incidents made it clear that legislative action 
that was already in process needed to be accelerated and 
strengthened. First, it came to light that multiple veterans 
had been sexually assaulted by an employee at a VA facility in 
West Virginia. Second, a contract physician in San Diego pled 
guilty to sexually assaulting five women veterans. Finally, a 
committee staffer who is a veteran reported being sexually 
assaulted by a fellow veteran at the Washington, D.C. VA 
Medical Center.
    In all three cases, VA employees did not immediately act 
upon receiving a report of a crime, and it was in part because 
these employees had neither received adequate training in how 
to respond, nor was there comprehensive policy to address these 
issues.
    The Committee expects that VA will use all available 
resources to address this critical issue. As this is as much an 
issue of cultural transformation as it is of strengthening 
policy, the Committee encourages VA to include veteran service 
organizations, community-based organizations, and individual 
advocates at every step of the process of reforming VA to 
eliminate harassment and assault at VA.
    This section builds on P.L. 112-154, section 106, which 
required VA to develop a policy regarding reporting on sexual 
assault. This requires the Secretary to establish a 
comprehensive policy to end harassment and sexual assault, 
including gender-based harassment, at any facility of the 
Department, including those of VA Central Office (VACO), VBA, 
VHA, and NCA. The intent is that the Secretary develop a 
standardized process, policy, and toolkit that creates system-
wide standards, while also allowing local leaders to tailor as 
appropriate, necessary, or desired. This section also creates 
accountability measures for employees and contractors who fail 
to report, and for VA leadership who have multiple incidents in 
their facilities. The policy will include a process for 
mandatory reporting by all VA employees and contractors, 
mandatory training for all VA employees and contractors, 
including bystander intervention training, and clear reporting 
procedures for any non-Department individual, including a 
confidential reporting option, and clear reporting procedures 
for employees and contractors to report any witnessed incidents 
of harassment or assault, regardless of whether the individual 
affected by such harassment or sexual assault wished to report. 
The intent is to establish clear reporting guidelines in order 
to best collect data on and respond to incidents of harassment 
and sexual assault. In order to capture this data at multiple 
points, this section also mandates that VA include questions 
about safety at other points where satisfaction information is 
already collected. Recognizing that certain behaviors require 
cultural transformation, this section also mandates a working 
group that incorporates the feedback of community 
organizations, with the intent of ending harassment and sexual 
assault at VA being a whole-of-community effort that requires 
the active participation of veterans and other non-Department 
individuals.

Sec. 322. Support for organizations that have a focus on providing 
        assistance to women veterans and their families

    Women veterans comprise the fastest growing homeless 
population in the United States and often do not get counted as 
homeless because they are more likely to be sheltered with 
friends or family. Women veterans are also more likely to have 
dependent children than male veterans and be single parents. 
This section mandates that $20,000,000 be authorized for 
support for organizations that have a focus on providing 
assistance to women veterans and their families. The intent is 
to ensure VA should--to all practical extent--give preference 
to organizations specifically serving women in order to ensure 
that their needs are met, but if not available, provide the 
funds to organizations that address homeless women and the 
families as well as men.

Sec. 323. Gap analysis of Department of Veterans Affairs programs that 
        provide assistance to women veterans who are homeless

    Women veterans represent the fastest growing population of 
homeless individuals in the United States, yet the actual 
number of women veterans facing homelessness and unstable 
housing is unknown because women veterans are rarely included 
in point-in-time counts. To add to this challenge, women 
veterans are an invisible homeless population because they are 
more likely to be sheltered and living with friends or 
relatives. Women veterans are not able to use all homelessness 
programs because they often have dependent children, children 
of different ages and genders (male children over age 12 are 
often not permitted in women's shelters), because they are not 
comfortable using a coed facility, or because they do not yet 
meet the definition of homelessness, especially if they are 
cohabitating with a violent intimate partner. This section 
instructs the Secretary to complete a gap analysis of VA 
programs that aid women veterans who are homeless and report it 
to Congress. This analysis will identify areas in which these 
programs are successful or where they fail to meet the needs of 
homeless women veterans.

Sec. 324. Department of Veterans Affairs public-private partnership on 
        legal services for women veterans

    The intent is to ensure that public-private partnerships of 
legal services for all veterans include specific attention to 
the needs of women veterans. While women veterans face many 
similar issues in the legal system as male veterans, they are 
more likely to have a bad paper discharge for issues related to 
MST, experience intimate partner violence, and face concerns 
over retaining custody of their children. Many women veterans 
are unaware of their legal rights and therefore may avoid or 
delay care or support for housing instability for fear of 
losing custody of their children. This section establishes a 
partnership between the Secretary and at least one 
nongovernmental organization to provide legal services to women 
veterans, with a focus on meeting the ten highest unmet needs 
of women veterans in the most recently completed Community 
Homelessness Assessment, Local Education and Networking Groups 
for Veterans Survey. This establishes a partnership program 
that did not previously exist at all for veterans but does not 
intend to create a resource that is not available for all 
veterans.

Sec. 325. Program to assist veterans who experience intimate partner 
        violence or sexual assault

    The experience of intimate partner violence and sexual 
assault is especially high among those who have served in the 
military, and therefore additional support is required for this 
population. In many cases, these individuals use local non-VA 
resources before they learn that they are eligible for some VA 
benefits or health care. The Committee learned through 
oversight visits to VA facilities and community organizations 
in Anchorage, AK, Chicago, IL, Boston, MA, Wappingers Falls, 
NY, and Philadelphia, PA that strong partnerships between VA 
and community organizations are one of the most effective ways 
of serving survivors of intimate partner violence and sexual 
assault who have served in the military. These organizations 
connect these survivors with VBA and VHA for housing programs, 
disability benefits, and healthcare, but also provide community 
support that VA may not be able to provide. This section builds 
on the existing Intimate Partner Violence Coordinator program 
authorized by Title 38 United States Code (U.S.C.) 7301(b). 
This program shall assist former members of the armed forces 
who have experienced or are experiencing intimate partner 
violence or sexual assault in accessing benefits from VA. In 
addition to veterans as defined in section 101 (2) in Title 38, 
this program is intended to serve former members of the armed 
forces who may not otherwise meet this definition, such as 
members of the Reserves or National Guard who have not 
completed sufficient time on active duty. In addition, former 
members of the armed forces refers to individuals whose 
eligibility criterion for other veterans' benefits has not yet 
been determined. This program will be in collaboration with 
intimate violence shelters or programs, state coalitions, and 
other health or service providers who may be the first 
responders to former members of the armed forces who experience 
IPV.

Sec. 326. Study and task force on veterans experiencing intimate 
        partner violence or sexual assault

    In order to comprehensively address intimate partner 
violence and sexual assault experienced by former members of 
the armed forces, it's necessary to understand the scope of the 
issue. This section establishes a national baseline study and 
responsive task force. The Committee expects that the national 
baseline study shall comprehensively addresses all the nuances 
of intimate partner violence and sexual assault in this 
population, and build on existing research and programs that 
address both the experience and perpetration of intimate 
partner violence. The Secretary shall conduct a national 
baseline study of the scope of the problem of sexual assault 
and intimate partner violence among veterans, their spouses, or 
their intimate partners. Subsequently, The Secretary--in 
consultation with the Attorney General and Secretary of Health 
and Human Services--shall establish a national task force to 
develop comprehensive national programs that include 
integrating facilities, services, and benefits of the VA. The 
intent is for the national baseline study to establish a road 
map with recommendations for follow on actions for the task 
force.

                                Hearings

    On July 17, 2019, the Subcommittee on Economic Opportunity 
held a legislative hearing on H.R. 2924. The following 
witnesses testified: Ms. Charmain Bogue, Executive Director, 
U.S. Department of Veterans Affairs, Veterans Benefits 
Administration; Mr. Patrick Murray, Deputy Director, National 
Legislative Service, The Veterans of Foreign Wars; Mr. John 
Kamin, Assistant Director, National Veterans Employment and 
Education Division, The American Legion; Colonel Robert F. 
Norton, USA-ret., Senior Advisor, Veterans Education Success; 
Mr. William Hubbard, Chief of Staff, Student Veterans of 
America; Mr. Jeremy M. Villanueva, Association National 
Legislative Director, Disabled Veterans of America; Mr. Timothy 
McMahon, President of Triangle Tech Group, Career Education 
Colleges and Universities & Veterans for Career Education 
Ambassador. Paralyzed Veterans of America and Tragedy 
Assistance Program for Survivors submitted Statements for the 
Record.
    On September 11, 2019, the Subcommittee on Health held a 
legislative hearing on H.R. 2645; H.R. 2681; H.R. 2752; H.R. 
2798; H.R. 2972; H.R. 2982; H.R. 3036; H.R. 3224; H.R. 3636; 
H.R. 3798; H.R. 3867; H.R. 4096; and a Draft bill, to establish 
in the Department of Veterans Affairs the Office of Women's 
Health, and for other purposes. The following witnesses 
testified: Dr. Teresa Boyd, Assistant Deputy Under Secretary 
for Health for Clinical Operations, U.S. Department of Veterans 
Affairs; Mr. Jeremy Butler, CEO, Iraq and Afghanistan Veterans 
of America; Ms. Joy Ilem, Disabled American Veterans, National 
Legislative Director; Mr. Roscoe Butler, Associate Legislative 
Director, Paralyzed Veterans of America. Representative(s) 
Bilirakis, Correa, Hartzler, Lee, Pappas, Rose, Stefanik, 
Velazquez, provided statements for the record. Statements were 
also given by The Veterans of Foreign Wars of the United 
States, National Association of State Women Veteran 
Coordinators, and Service Women's Action Network.
    On October 22, 2019, the Subcommittee on Disability 
Assistance and Memorial Affairs held a legislative hearing on 
H.R. 4165. The Honorable Antonio Delgado, U.S. House of 
Representatives, 19th Congressional District, New York provided 
testimony before the Subcommittee, as well as: M. Ronald Burke, 
Executive Director, Pension & Fiduciary Service, Veterans 
Benefits Administration; Ms. Kimberly McLeod, Deputy Vice 
Chairman, Board of Veterans' Appeals; Mr. Shane L. Liermann, 
Assistant National Legislative Director, Disabled American 
Veterans; Mr. Brian Dempsey, Government Affairs Director, 
Wounded Warrior Project. Paralyzed Veterans of America provided 
a statement for the record.

                       Subcommittee Consideration

    There was no Subcommittee markup of H.R. 3224.

                        Committee Consideration

    On October 29, 2019, the full Committee met in an open 
markup session, a quorum being present, and ordered H.R. 3224, 
as amended, favorably reported to the House of Representatives 
by voice vote. During consideration of the bill, the following 
amendment was considered:
          An amendment in the nature of a substitute offered by 
        Representative Julia Brownley of California. This 
        amendment replaced the underlying limited language that 
        addressed women's health care access with a more 
        comprehensive package of additional bills and 
        provisions that comprehensively improved healthcare and 
        benefits at VA for women veterans, including addressing 
        resource allocation, cultural transformation, outreach, 
        and benefits for former members of the armed forces who 
        may not otherwise meet the definition of veteran.

                            Committee Votes

    In compliance with clause 3(b) of rule XIII of the Rules of 
the House of Representatives, there were no recorded votes 
taken on amendments or in connection with ordering H.R. 3224, 
as amended, reported to the House. A motion by Representative 
Julia Brownley of California to report H.R. 3224, as amended, 
favorably to the House of Representatives was agreed to by 
voice vote.

                      Committee Oversight Findings

    In compliance with clause 3(c)(1) of rule XIII and clause 
(2)(b)(1) of rule X of the Rules of the House of 
Representatives, the Committee's oversight findings and 
recommendations are reflected in the descriptive portions of 
this report.

         Statement of General Performance Goals and Objectives

    In accordance with clause 3(c)(4) of rule XIII of the Rules 
of the House of Representatives, the Committee's performance 
goals and objectives are to improve resources and benefits for 
women veterans and other underserved veterans.

   New Budget Authority, Entitlement Authority, and Tax Expenditures

    In compliance with clause 3(c)(2) of rule XIII of the Rules 
of the House of Representatives, the Committee adopts as its 
own the estimate of new budget authority, entitlement 
authority, or tax expenditures or revenues contained in the 
cost estimate prepared by the Director of the Congressional 
Budget Office pursuant to section 402 of the Congressional 
Budget Act of 1974.

                  Earmarks and Tax and Tariff Benefits

    H.R. 3224, as amended, does not contain any Congressional 
earmarks, limited tax benefits, or limited tariff benefits as 
defined in clause 9 of rule XXI of the Rules of the House of 
Representatives.

                        Committee Cost Estimate

    The Committee adopts as its own the cost estimate on H.R. 
3224, as amended, prepared by the Director of the Congressional 
Budget Office pursuant to section 402 of the Congressional 
Budget Act of 1974.

               Congressional Budget Office Cost Estimate

    Pursuant to clause 3(c)(3) of rule XIII of the Rules of the 
House of Representatives, the following is the cost estimate 
for H.R. 3224, as amended, provided by the Congressional Budget 
Office pursuant to section 402 of the Congressional Budget Act 
of 1974:

                                     U.S. Congress,
                               Congressional Budget Office,
                                  Washington, DC, November 8, 2019.
Hon. Mark Takano,
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 3224, the Deborah 
Sampson Act.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Ann E. 
Futrell.
            Sincerely,
                                         Phillip L. Swagel,
                                                          Director.
    Enclosure.

              [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
    

    Bill summary: H.R. 3224 would expand the medical care 
provided by the Department of Veterans Affairs (VA) to female 
veterans and newborn children. The bill also would require VA 
to operate a counseling program in retreat settings and 
establish a policy to address sexual harassment and sexual 
assault at department facilities. In total, implementing the 
bill would cost $322 million over the 2020-2024 period, CBO 
estimates. Such spending would be subject to the appropriation 
of the estimated amounts.
    Estimated Federal cost: The estimated budgetary effects of 
H.R. 3224 are shown in Table 1. The costs of the legislation 
fall within budget function 700 (veterans benefits and 
services).

               TABLE 1.--ESTIMATED INCREASES IN SPENDING SUBJECT TO APPROPRIATION UNDER H.R. 3224
----------------------------------------------------------------------------------------------------------------
                                                                By fiscal year, millions of dollars--
                                                    ------------------------------------------------------------
                                                       2020      2021      2022      2023      2024    2020-2024
----------------------------------------------------------------------------------------------------------------
Primary Care for Female Veterans:
    Estimated Authorization........................        10        19        40        41        42        152
    Estimated Outlays..............................         9        18        37        40        41        145
Care for Newborns:
    Estimated Authorization........................        23        24        24        25        26        122
    Estimated Outlays..............................        20        23        23        24        25        115
Intimate Partner Violence and Sexual Assault:
    Estimated Authorization........................         5         5         5         5         6         26
    Estimated Outlays..............................         4         5         5         5         6         25
Counseling in Retreat Settings:
    Estimated Authorization........................         0         2         3         3         3         11
    Estimated Outlays..............................         0         2         3         3         3         11
Sexual Harassment and Assault:
    Estimated Authorization........................         1         2         2         2         2          9
    Estimated Outlays..............................         1         2         2         2         2          9
Medical Residency Program:
    Authorization..................................         1         1         1         1         1          5
    Estimated Outlays..............................         1         1         1         1         1          5
Reports, Studies, and Other Administrative
 Requirements:
    Estimated Authorization........................         6         3         1         1         1         12
    Estimated Outlays..............................         6         3         1         1         1         12
    Total Changes:
        Estimated Authorization....................        46        56        76        78        81        337
        Estimated Outlays..........................        41        54        72        76        79        322
----------------------------------------------------------------------------------------------------------------

    Basis of estimate: For this estimate, CBO assumes the 
legislation will be enacted at the beginning of 2020 and that 
the estimated amounts will be appropriated each year. Estimated 
outlays are based on historical spending patterns for the 
affected programs.

Primary Care for Female Veterans

    Section 201 would require VA to provide primary care 
services to female veterans at each of the department's medical 
centers and outpatient clinics. According to VA, the department 
lacks primary care physicians who specialize in health care for 
female veterans at 96 of its outpatient clinics. CBO expects 
that in 2020 VA would hire 110 additional physicians on a full-
time basis to provide primary care services to female veterans. 
At an average compensation of $360,000, CBO estimates that 
employing those additional physicians would cost $144 million 
over the 2020-2024 period.
    In addition, section 201 would require VA to study the 
benefits of extending the hours during which it provides health 
care at VA facilities and to report the results of that study 
to the Congress. Based on similar studies, CBO estimates that 
satisfying that requirement would cost $1 million over the 
2020-2024 period.
    In total, CBO estimates that implementing section 201 would 
cost $145 million over the 2020-2024 period.

Care for Newborns

    Under current law, VA may pay for health care for up to 
seven days after birth for newborn children of female veterans 
who receive maternity care from the department. Section 204 
would authorize VA to provide more than seven days of health 
care to those children. It also would allow VA to reimburse 
those veterans for the cost of emergency transportation of 
those newborn children by ambulance or airlift to receive 
neonatal care.
    Based on data from VA, CBO estimates that 15 percent (or 
580) of the 3,820 births covered by VA each year are 
complicated births (for example, premature delivery, low birth 
weight, and fetal-growth retardation) that require neonatal 
care for more than seven days. According to the Agency for 
Healthcare Research and Quality, complicated births require 
inpatient neonatal care for an average of 18 days. Using 
information from VA, CBO estimates that the average daily cost 
for complicated births is about $3,700. After adjusting for 
anticipated inflation, CBO estimates that removing the seven-
day limit on payments for neonatal care would cost $113 million 
over the 2020-2024 period.
    In addition, based on data from the National Institute of 
Health on the frequency of neonatal transport, CBO estimates 
that VA would pay for about 300 new emergency transportations 
each year at an average cost of $1,500 per trip. As a result, 
CBO estimates that travel for neonatal care would cost $2 
million over the 2020-2024 period.
    In total, CBO estimates that implementing section 204 would 
cost $115 million over the 2020-2024 period.

Intimate Partner Violence and Sexual Assault

    Section 325 would require VA to provide assistance to 
former members of the Armed Forces who have experienced 
intimate partner violence or sexual assault. Intimate partner 
violence is a type of domestic abuse that can include physical 
violence, sexual assaults, stalking, or psychological 
aggression. Since 2014, VA has operated the Intimate Partner 
Violence Assistance Program (IPVAP), which coordinates access 
to benefits such as medical treatment, counseling, and housing 
assistance for veterans who are victims of intimate partner 
violence. In 2018, VA spent $20 million for IPVAP and employed 
143 coordinators at most medical centers to manage the program, 
train staff, and conduct outreach.
    Currently, IPVAP does not serve veterans who are victims of 
sexual assault by someone who is not an intimate partner. The 
bill would require VA to expand the program to do so. Based on 
information from VA and the Centers for Disease Control and 
Prevention, CBO expects that VA would increase staffing by 25 
percent, hiring an additional 35 personnel. At an average 
compensation of $152,000, CBO estimates that employing those 
additional coordinators would cost $25 million over the 2020-
2024 period.

Counseling in Retreat Settings

    Section 203 would require VA to establish a permanent 
program, beginning in 2021, to provide counseling in group 
retreat settings to veterans enrolled in the VA health care 
system and to eligible survivors and dependents of veterans. 
Participants in the program would receive services such as 
financial, occupational, and mental health counseling. The bill 
also would require VA to report to the Congress biennially on 
the outcomes of the program.
    VA will complete the final year of a pilot program that 
provides similar services to female veterans at the end of 
2020. According to VA, each year roughly 70 women participated 
in the program at three retreat settings, at an average cost of 
$3,500 per participant. On the basis of information from VA, 
CBO expects that the department would establish the permanent 
program to serve about 700 veterans and dependents annually who 
are enrolled in the VA health care system. As a result, CBO 
estimates that implementing this program would cost $11 million 
over the 2021-2024 period, after accounting for anticipated 
inflation.

Sexual Harassment and Assault

    Section 321 would require VA to address sexual assaults and 
sexual harassment that occur at department facilities. It would 
require VA to appoint an employee at each facility to monitor 
reports of sexual assault and harassment and to collect data 
from those reports. Under current law, VA is required to 
provide training to its employees on reporting sexual assault. 
Section 321 would require VA to also train employees on the 
need to report incidents of sexual harassment and on methods 
for intervening when they witness sexual harassment. In 
addition, VA would be required to report annually to the 
Congress on incidents of sexual assault and harassment that 
occur at VA facilities.
    Using information from VA and studies regarding the 
prevalence of sexual assault and harassment in the workplace, 
CBO estimates that VA would need to hire the equivalent of 10 
full-time staff at an average compensation of $175,000 to 
monitor incidents at department facilities. CBO estimates that 
updating the training curriculum and preparing the required 
reports would not significantly increase costs. In total, 
implementing section 321 would cost $9 million over the 2020-
2024 period, CBO estimates.

Medical Residency Program

    Section 106 would authorize appropriations of $1 million 
each year for a residency program focused on providing health 
care to female veterans at VA facilities. CBO estimates that 
implementing this section would cost $5 million over the 2020-
2024 period.

Reports, Studies, and Other Administrative Requirements

    The bill would require VA to conduct more than a dozen one-
time and reoccurring reports and studies, and to fulfill 
administrative duties regarding the health care and services 
provided to female veterans at the department. Based on the 
costs of similar activities, CBO estimates that meeting those 
requirements would cost a total of $12 million over the 2020-
2024 period.
    Pay-As-You-Go considerations: None.
    Increase in long-term deficits: None.
    Mandates: None.
    Estimate prepared by: Federal Costs: Ann E. Futrell; 
Mandates: Brandon Lever.
    Estimate reviewed by: David Newman, Chief, Defense, 
International Affairs & Veterans' Affairs Cost Estimates Unit; 
Leo Lex, Deputy Assistant Director for Budget Analysis.

                       Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates regarding H.R. 3224, as amended, prepared by the 
Director of the Congressional Budget Office pursuant to section 
423 of the Unfunded Mandates Reform Act.

                      Advisory Committee Statement

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act would be created by H.R. 
3224, as amended.

                 Statement of Constitutional Authority

    Pursuant to Article I, section 8 of the United States 
Constitution, H.R. 3224, as amended, is authorized by Congress' 
power to ``provide for the common Defense and general Welfare 
of the United States.''

                  Applicability to Legislative Branch

    The Committee finds that H.R. 3224, as amended, does not 
relate to the terms and conditions of employment or access to 
public services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

              Statement on Duplication of Federal Programs

    Pursuant to clause 3(c)(5) of rule XIII of the Rules of the 
House of Representatives, the Committee finds that no provision 
of H.R. 3224, as amended, establishes or reauthorizes a program 
of the Federal Government known to be duplicative of another 
Federal program, a program that was included in any report from 
the Government Accountability Office to Congress pursuant to 
section 21 of Public Law 111-139, or a program related to a 
program identified in the most recent Catalog of Federal 
Domestic Assistance.

                   Disclosure of Directed Rulemaking

    Pursuant to clause 3(c)(5) of rule XIII, the Committee 
estimates that H.R. 3224 contains no directed rule making that 
would require the Secretary to prescribe regulations.

             Section-by-Section Analysis of the Legislation


                TITLE I--VETERANS HEALTH ADMINISTRATION

Sec. 101. Office of Women's Health in the Department of Veterans 
        Affairs

    Section 101 establishes the Office of Women's Health 
reporting to the USH, to identify and address need and 
deficiencies in care, and adequately allocate resources VHA. 
This section allows the USH to reorganize existing capabilities 
and consolidate them within one office that reports directly to 
the USH, and ensures that at least one women's health primary 
care provider is staffed at each VA medical facility. The 
reports section of this section requires reporting on women 
veterans' use of health care from VA, on the use of various 
models for providing primary to women veterans, and the 
staffing of women's primary health care in VA medical 
facilities. This section also requires the Secretary to submit 
to Congress an annual report on access of women veterans to 
gender specific services under community care contracts. This 
section also includes reporting on accessibility and treatment 
options for women veterans. This report will include an 
assessment of wheelchair accessibility of women's health 
centers; an assessment of accessibility to radiology and 
mammography, including door sizes and hoists; options for women 
veterans to access mental health primary care providers; and 
options for clothing for women at medical centers.

Sec. 102. Expansion of capabilities of women veterans call center to 
        include text messaging

    This statutorily requires that the Department of Veterans 
Affairs include text messaging capability at the Women Veterans 
Call Center.

Sec. 103. Requirement for Department of Veterans Affairs internet 
        website to provide information on services available to women 
        veterans

    This section requires expansion and continuous update of VA 
websites to provide services available to women veterans.

Sec. 104. Report on Women Veterans Retrofit Initiative

    This section requires reporting on retrofitting facilities 
to address women veterans' health care, and deficiencies in 
environments of care for women veterans in VA medical 
facilities.

Sec. 105. Establishment of environment of care standards and 
        inspections at Department of Veterans Affairs medical centers

    This section requires adherence to environment of care 
standards and accountability and transparency for adherence to 
those standards.

Sec. 106. Additional funding for primary care and emergency care 
        clinicians in Women Veterans Health Care Mini-Residency Program

    This section ensures additional funding for primary care 
and emergency care clinicians in women veterans' health care 
mini-residency programs.

Sec. 107. Establishment of women veteran training module for non-
        Department of Veterans Affairs health care providers

    This section establishes a women veteran training module 
for non-VA health care providers.

Sec. 201. Improved access to Department of Veterans Affairs medical 
        care for women veterans

    This section ensures that women's health primary care is 
available during regular business hours, requires a study by 
the Secretary on the use of extended hours as a means of 
reducing care barriers, and the need for extended hours, and 
report this study to Congress

Sec. 202. Counseling and treatment for sexual trauma

    This section expands MST counseling to members of the 
Reserve and National Guard.

Sec. 203. Counseling in retreat settings for women veterans and other 
        individuals

    This section expands and makes permanent the Department of 
Veterans Affairs (VA) pilot program on counseling in retreat 
settings for women veterans coping with post-traumatic stress 
disorder and other wounds of war. In addition, this would also 
expand and make permanent counseling in retreat settings for 
all veterans and their families, while ensuring that there 
remain cohorts for only women veterans.

Sec. 204. Improvement of health care services provided to newborn 
        children by the Department of Veterans Affairs

    Section 204 extends coverage of newborn health care for 
children of veterans. Currently, veterans are only eligible to 
receive seven days of newborn care, after which they must find 
and sign up for health insurance for their newborn. This bill 
would double that available time to 14 days of care, providing 
additional time for veterans to find the best health coverage, 
especially during a high-stress period. Additionally, this bill 
requires VA to submit an annual report on the number of newborn 
children that have received such services. This section also 
ensures that qualified newborns get access to VA covered 
medical care including in emergency situations or when the 
newborn is delivered at a non-VA facility. This measure expands 
the fourteen days of VA provided newborn medical care (through 
a waiver process) for a medically necessary extension; allows 
VA to cover the transportation of both newborn and parents 
between medical facilities; streamlines billing process to 
remove unnecessary burdens on veterans; and authorizes the 
Secretary to waive any outstanding debts associated with 
medically-necessary emergency transportation services for a 
newborn incurred by the veterans.

                  TITLE III--REPORTS AND OTHER MATTERS

Subtitle A--Reports

Sec. 301. Assessment of effects of intimate partner violence on women 
        veterans by Advisory Committee on Women Veterans

    This section requires the VA Advisory Committee on Women 
Veterans to conduct assessments pertaining to the impact of IPV 
on women.

Sec. 302. Study on staffing of Women Veteran Program Manager program at 
        medical centers of the Department of Veterans Affairs and 
        training of staff

    This section requires the Secretary to conduct a study on 
the use of the WVPM and the feasibility of creating a Women 
Veterans Ombudsman position.

Sec. 303. Report on availability of prosthetic items for women veterans 
        from the Department of Veterans Affairs

    This section requires VA to assess the availability of 
prosthetics specifically for women veterans and requires VA to 
conduct a study of satisfaction with participants in the 
amputee care program with an oversampling of women veterans.

Sec. 304. Study of barriers for women veterans to health care from the 
        Department of Veterans Affairs

    This section requires the Secretary to conduct a study of 
barriers for women veterans to health care from the Department 
of Veterans Affairs.

Sec. 305. Report regarding veterans who receive benefits under laws 
        administered by the Secretary of Veterans Affairs

    This section requires the Secretary to publish a report 
regarding veterans who receive benefits, including the 
Transition Assistance Program. This report will include data 
regarding veterans and their sex, minority group member status, 
and by both categories, excluding personally identifiable 
information. The report will identify any disparities in the 
use of benefits, analysis of the cause of those disparities, 
and proposed recommendations to address those disparities.

Sec. 306. Study on Women Veteran Coordinator program

    This section requires the Secretary to submit a report on 
the Women Veteran Coordinator Program, identifying if the 
program is appropriately staffed, if regional benefits offices 
have a Women Veteran Coordinator, the position description of 
the coordinator, and a description of metrics to determine the 
success and performance of the coordinator.

Subtitle B--Other Matters

Sec. 321. Anti-harassment and anti-sexual assault policy of the 
        Department of Veterans Affairs

    This section requires the Secretary to establish a 
comprehensive policy to end harassment and sexual assault, 
including gender-based harassment. The policy will include:
          Responses of incidents of harassment and sexual 
        assault by any veteran or other public visitor to VA 
        facility, and following disciplinary measures, a 
        process for reporting and responding to harassment and 
        sexual assault, mandatory reporting requirements 
        applicable to an employee or contractor of the VA who 
        witnesses harassment or sexual assault, disciplinary 
        actions for employees or contractors who fail to report 
        these incidents, mandatory annual training for 
        employees and contractors regarding how to report and 
        address harassment and sexual assault, including 
        bystander intervention training, the distribution of 
        anti-harassment and anti-sexual assault education 
        materials by mail or email to individuals receiving a 
        benefit, the prominent display of anti-harassment and 
        anti-sexual assault messages in each VA facility, 
        including how to report harassment or assault, the 
        posting of these materials on the VA website, and 
        establishes points of contacts for each VA facility, 
        Veterans Integrated Service Network (VISN) facility, 
        regional benefits office, and VACO.

Sec. 322. Support for organizations that have a focus on providing 
        assistance to women veterans and their families

    This section grants not less than $20,000,000 to be 
available for the provision of financial assistance to 
organizations that have a focus on providing assistance to 
women veterans and their families.

Sec. 323. Gap analysis of Department of Veterans Affairs programs that 
        provide assistance to women veterans who are homeless

    This section instructs the Secretary to complete a gap 
analysis of VA programs that provide assistance to women 
veterans who are homeless and report it to Congress. This 
analysis will identify areas in which these programs are 
successful or where they fail to meet the needs of homeless 
women veterans.

Sec. 324. Department of Veterans Affairs public-private partnership on 
        legal services for women veterans

    This section establishes a partnership between the 
Secretary and at least one nongovernmental organization to 
provide legal services to women veterans.

Sec. 325. Program to assist veterans who experience intimate partner 
        violence or sexual assault

    This section necessitates that the Secretary carry out a 
program to assist veterans and former members of the armed 
forces who have experienced or who are experiencing IPV or 
sexual assault. This program will be in collaboration with 
intimate violence shelters or programs, state assault 
coalitions, and other health or service providers. The 
Secretary may include in their program training for community-
based service providers, assistance for service providers to 
ensure emergency services--including for members of Indian 
tribes--and other outreach and assistance deemed necessary. The 
Secretary may appoint local coordinators.

Sec. 326. Study and task force on veterans experiencing intimate 
        partner violence or sexual assault

    This section establishes a national baseline study and 
responsive task force. The Secretary shall conduct a national 
baseline study of the scope of the problem of sexual assault 
and IPV among veterans, their spouses, or their intimate 
partners. Subsequently, the Secretary--in consultation with the 
Attorney General and Secretary of Health and Human Services--
shall establish a national task force to develop comprehensive 
national programs that include integrating facilities, 
services, and benefits of the VA. The task force will consult 
with representatives from not fewer than three national 
organizations and not fewer than three state coalitions. Task 
force duties include: reviewing existing services and policies 
of VA to develop a national program addressing IPV and sexual 
assault prevention, response, and treatment, reviewing 
feasibility of expedited processes regarding housing, temporary 
benefits in case of emergency, identifying requirements 
regarding IPV assistance or sexual assault response services 
that are not being met by VA, making recommendations regarding 
feasibility of providing direct services for veterans in 
response to sexual assault, including through the use of a 
nurse examiner--especially in underserved/remote areas, 
including Native Americans, reviewing availability of 
counseling services, and annual reporting gathered information.

         Changes in Existing Law Made by the Bill, as Reported

    In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italic, and existing law in which no 
change is proposed is shown in roman):

         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italic, and existing law in which no 
change is proposed is shown in roman):

                      TITLE 38, UNITED STATES CODE




           *       *       *       *       *       *       *
PART I--GENERAL PROVISIONS

           *       *       *       *       *       *       *


CHAPTER 5--AUTHORITY AND DUTIES OF THE SECRETARY

           *       *       *       *       *       *       *



                   SUBCHAPTER II--GENERAL AUTHORITIES

521. Assistance to certain rehabilitation activities.
     * * * * * * *
533. Anti-harassment and anti-sexual assault policy.
     * * * * * * *

                   SUBCHAPTER II--SPECIFIED FUNCTIONS

     * * * * * * *

Sec. 533. Anti-harassment and anti-sexual assault policy

  (a) Establishment.--The Secretary of Veterans Affairs shall 
establish a comprehensive policy to end harassment and sexual 
assault, including sexual harassment and gender-based 
harassment, throughout the Department of Veterans Affairs. This 
policy shall include the following:
          (1) A process for employees and contractors of the 
        Department to respond to reported incidents of 
        harassment and sexual assault committed by any non-
        Department individual within a facility of the 
        Department, including with respect to accountability or 
        disciplinary measures.
          (2) A process for employees and contractors of the 
        Department to respond to reported incidents of 
        harassment and sexual assault of any non-Department 
        individual within a facility of the Department.
          (3) A process for any non-Department individual to 
        report harassment and sexual assault described in 
        paragraph (1), including an option for confidential 
        reporting, and for the Secretary to respond to and 
        address such reports.
          (4) Clear mechanisms for non-Department individuals 
        to readily identify to whom and how to report incidents 
        of harassment and sexual assault committed by another 
        non-Department individual.
          (5) Clear mechanisms for employees and contractors of 
        the Department to readily identify to whom and how to 
        report incidents of harassment and sexual assault and 
        how to refer non-Department individuals with respect to 
        reporting an incident of harassment or sexual assault.
          (6) A process for, and mandatory reporting 
        requirement applicable to, any employee or contractor 
        of the Department who witnesses harassment or sexual 
        assault described in paragraph (1) or (2) within a 
        facility of the Department, regardless of whether the 
        individual affected by such harassment or sexual 
        assault wants to report such harassment or sexual 
        assault.
          (7) The actions possible, including disciplinary 
        actions, for employees or contractors of the Department 
        who fail to report incidents of harassment and sexual 
        assault described in paragraph (1) or (2) that the 
        employees or contractors witness.
          (8) On an annual or more frequent basis, mandatory 
        training for employees and contractors of the 
        Department regarding how to report and address 
        harassment and sexual assault described in paragraphs 
        (1) and (2), including bystander intervention training.
          (9) On an annual or more frequent basis, the 
        distribution of the policy under this subsection and 
        anti-harassment and anti-sexual assault educational 
        materials by mail or email to each individual receiving 
        a benefit under a law administered by the Secretary.
          (10) The prominent display of anti-harassment and 
        anti-sexual assault messages in each facility of the 
        Department, including how non-Department individuals 
        may report harassment and sexual assault described in 
        paragraphs (1) and (2) at such facility and the points 
        of contact under subsection (b).
          (11) The posting on internet websites of the 
        Department, including the main internet website 
        regarding benefits of the Department and the main 
        internet website regarding health care of the 
        Department, of anti-harassment and anti-sexual assault 
        banners specifically addressing harassment and sexual 
        assault described in paragraphs (1) and (2).
  (b) Points of Contact.--The Secretary shall designate, as a 
point of contact to receive reports of harassment and sexual 
assault described in paragraphs (1) and (2) of subsection (a)--
          (1) at least one individual, in addition to law 
        enforcement, at each facility of the Department 
        (including Vet Centers under section 1712A of this 
        title), with regard to that facility;
          (2) at least one individual employed in each Veterans 
        Integrated Service Network, with regards to facilities 
        in that Veterans Integrated Service Network;
          (3) at least one individual employed in each regional 
        benefits office;
          (4) at least one individual employed at each location 
        of the National Cemetery Administration; and
          (5) at least one individual employed at the Central 
        Office of the Department to track reports of such 
        harassment and sexual assault across the Department, 
        disaggregated by facility.
  (c) Accountability.--The Secretary shall establish a policy 
to ensure that each facility of the Department and each 
director of a Veterans Integrated Service Network is 
responsible for addressing harassment and sexual assault at the 
facility and the Network. Such policy shall include--
          (1) a remediation plan for facilities that experience 
        five or more incidents of sexual harassment, sexual 
        assault, or combination thereof, during any single 
        fiscal year; and
          (2) taking appropriate actions under chapter 7 or 
        subchapter V of chapter 74 of this title.
  (d) Data.--The Secretary shall ensure that the in-take 
process for veterans at medical facilities of the Department 
includes a survey to collect the following information:
          (1) Whether the veteran feels safe at the facility 
        and whether any events occurred at the facility that 
        affect such feeling.
          (2) Whether the veteran wants to be contacted later 
        by the Department with respect to such safety issues.
  (e) Working Group.--(1) The Secretary shall establish a 
working group to assist the Secretary in implementing policies 
to carry out this section.
  (2) The working group established under paragraph (1) shall 
consist of representatives from--
          (A) veterans service organizations;
          (B) State, local, and Tribal veterans agencies; and
          (C) other persons the Secretary determines 
        appropriate.
  (3) The working group established under paragraph (1) shall 
develop, and the Secretary shall carry out--
          (A) an action plan for addressing changes at the 
        local level to reduce instances of harassment and 
        sexual assault;
          (B) standardized media for veterans service 
        organizations and other persons to use in print and on 
        the internet with respect to reducing harassment and 
        sexual assault; and
          (C) bystander intervention training for veterans.
  (f) Reports.--The Secretary shall submit to the Committees on 
Veterans' Affairs of the Senate and the House of 
Representatives an annual report on harassment and sexual 
assault described in paragraphs (1) and (2) of subsection (a) 
in facilities of the Department. Each such report shall include 
the following:
          (1) Results of harassment and sexual assault 
        programming, including the End Harassment program.
          (2) Results of studies from the Women's Health 
        Practice-Based Research Network of the Department 
        relating to harassment and sexual assault.
          (3) Data collected on incidents of sexual harassment 
        and sexual assault.
          (4) A description of any actions taken by the 
        Secretary during the year preceding the date of the 
        report to stop harassment and sexual assault at 
        facilities of the Department.
          (5) An assessment of the implementation of the 
        training required in subsection (a)(7).
          (6) A list of resources the Secretary determines 
        necessary to prevent harassment and sexual assault at 
        facilities of the Department.
  (g) Definitions.--In this section:
          (1) The term ``non-Department individual'' means any 
        individual present at a facility of the Department who 
        is not an employee or contractor of the Department.
          (2) The term ``sexual harassment'' has the meaning 
        given that term in section 1720D of this title.

SUBCHAPTER III--ADVISORY COMMITTEES

           *       *       *       *       *       *       *


Sec. 542. Advisory Committee on Women Veterans

  (a)(1) The Secretary shall establish an advisory committee to 
be known as the Advisory Committee on Women Veterans 
(hereinafter in this section referred to as ``the Committee'').
  (2)(A) The Committee shall consist of members appointed by 
the Secretary from the general public, including--
          (i) representatives of women veterans;
          (ii) individuals who are recognized authorities in 
        fields pertinent to the needs of women veterans, 
        including the gender-specific health-care needs of 
        women;
          (iii) representatives of both female and male 
        veterans with service-connected disabilities, including 
        at least one female veteran with a service-connected 
        disability and at least one male veteran with a 
        service-connected disability; and
          (iv) women veterans who are recently separated from 
        service in the Armed Forces.
  (B) The Committee shall include, as ex officio members--
          (i) the Secretary of Labor (or a representative of 
        the Secretary of Labor designated by the Secretary 
        after consultation with the Assistant Secretary of 
        Labor for Veterans' Employment);
          (ii) the Secretary of Defense (or a representative of 
        the Secretary of Defense designated by the Secretary of 
        Defense after consultation with the Defense Advisory 
        Committee on Women in the Services); and
          (iii) the Under Secretary for Health and the Under 
        Secretary for Benefits, or their designees.
  (C) The Secretary may invite representatives of other 
departments and agencies of the United States to participate in 
the meetings and other activities of the Committee.
  (3) The Secretary shall determine the number, terms of 
service, and pay and allowances of members of the Committee 
appointed by the Secretary, except that a term of service of 
any such member may not exceed three years. The Secretary may 
reappoint any such member for additional terms of service.
  (b) The Secretary shall, on a regular basis, consult with and 
seek the advice of the Committee with respect to the 
administration of benefits by the Department for women 
veterans, reports and studies pertaining to women veterans and 
the needs of women veterans with respect to compensation, 
health care, rehabilitation, outreach, and other benefits and 
programs administered by the Department, including the Center 
for Women Veterans.
  (c)(1) Not later than July 1 of each even-numbered year, the 
Committee shall submit to the Secretary a report on the 
programs and activities of the Department that pertain to women 
veterans. Each such report shall include--
          (A) an assessment of the needs of women veterans with 
        respect to compensation, health care, rehabilitation, 
        outreach, and other benefits and programs administered 
        by the Department;
          (B) a review of the programs and activities of the 
        Department designed to meet such needs; [and]
          (C) an assessment of the effects of intimate partner 
        violence on women veterans; and
          [(C)] (D) such recommendations (including 
        recommendations for administrative and legislative 
        action) as the Committee considers appropriate.
  (2) The Secretary shall, within 60 days after receiving each 
report under paragraph (1), submit to the Congress a copy of 
the report, together with any comments concerning the report 
that the Secretary considers appropriate.
  (3) The Committee may also submit to the Secretary such other 
reports and recommendations as the Committee considers 
appropriate.
  (4) The Secretary shall submit with each annual report 
submitted to the Congress pursuant to section 529 of this title 
a summary of all reports and recommendations of the Committee 
submitted to the Secretary since the previous annual report of 
the Secretary submitted pursuant to such section.

           *       *       *       *       *       *       *


PART II--GENERAL BENEFITS

           *       *       *       *       *       *       *


   CHAPTER 17--HOSPITAL, NURSING HOME, DOMICILIARY, AND MEDICAL CARE

                         SUBCHAPTER II--GENERAL

1710. Eligibility for hospital, nursing home, and domiciliary care.
     * * * * * * *
1712D. Counseling in retreat settings for women veterans and other 
          individuals.
     * * * * * * *
1720J. Medical services for women veterans.
     * * * * * * *

 SUBCHAPTER II--HOSPITAL, NURSING HOME, OR DOMICILIARY CARE AND MEDICAL 
                                TREATMENT

     * * * * * * *

Sec. 1712D. Counseling in retreat settings for women veterans and other 
                    individuals

  (a) Program.--(1) Commencing not later than January 1, 2021, 
the Secretary shall carry out, through the Readjustment 
Counseling Service of the Veterans Health Administration, a 
program to provide reintegration and readjustment services 
described in subsection (b) in group retreat settings to 
covered individuals, including cohorts of women veterans who 
are eligible for readjustment counseling services under section 
1712A of this title.
  (2) The participation of a covered individual in the program 
under paragraph (1) shall be at the election of the individual.
  (b) Covered Services.--The services provided to a covered 
individual under the program under subsection (a)(1) shall 
include the following:
          (1) Information on reintegration into the family, 
        employment, and community of the individual.
          (2) Financial counseling.
          (3) Occupational counseling.
          (4) Information and counseling on stress reduction.
          (5) Information and counseling on conflict 
        resolution.
          (6) Such other information and counseling as the 
        Secretary considers appropriate to assist the 
        individual in reintegration into the family, 
        employment, and community of the veteran.
  (c) Biennial Reports.--Not later than December 31, 2022, and 
each even-numbered year thereafter, the Secretary shall submit 
to the Committees on Veterans' Affairs of the House of 
Representatives and the Senate a report on the program under 
subsection (a)(1).
  (d) Covered Individual Defined.--In this section, the term 
``covered individual'' means--
          (1) Any veteran who is enrolled in the system of 
        annual patient enrollment under section 1705 of this 
        title.
          (2) Any survivor or dependent of a veteran who is 
        eligible for medical care under section 1781 of this 
        title.

           *       *       *       *       *       *       *


Sec. 1720D. Counseling and treatment for sexual trauma

  (a)(1) The Secretary shall operate a program under which the 
Secretary provides counseling and appropriate care and services 
to [veterans] former members of the Armed Forces who the 
Secretary determines require such counseling and care and 
services to overcome psychological trauma, which in the 
judgment of a mental health professional employed by the 
Department, resulted from a physical assault of a sexual 
nature, battery of a sexual nature, or sexual harassment which 
occurred while the [veteran] former member of the Armed Forces 
was serving on [active duty, active duty for training, or 
inactive duty training] duty, regardless of duty status or line 
of duty determination (as that term is used in section 12323 of 
title 10) .
  (2)(A) In operating the program required by paragraph (1), 
the Secretary may, in consultation with the Secretary of 
Defense, provide counseling and care and services to members of 
the Armed Forces (including members of the National Guard and 
Reserves) to overcome psychological trauma described in that 
paragraph that was suffered by the member while serving on 
[active duty, active duty for training, or inactive duty 
training] duty, regardless of duty status or line of duty 
determination (as that term is used in section 12323 of title 
10) .
  (B) A member described in subparagraph (A) shall not be 
required to obtain a referral before receiving counseling and 
care and services under this paragraph.
  (3) In furnishing counseling to an individual under this 
subsection, the Secretary may provide such counseling pursuant 
to a contract with a qualified mental health professional if 
(A) in the judgment of a mental health professional employed by 
the Department, the receipt of counseling by that individual in 
facilities of the Department would be clinically inadvisable, 
or (B) Department facilities are not capable of furnishing such 
counseling to that individual economically because of 
geographical inaccessibility.
  (b)(1) The Secretary shall give priority to the establishment 
and operation of the program to provide counseling and care and 
services under subsection (a). In the case of a [veteran] 
former member of the Armed Forces eligible for counseling and 
care and services under subsection (a), the Secretary shall 
ensure that the [veteran] former member of the Armed Forces is 
furnished counseling and care and services under this section 
in a way that is coordinated with the furnishing of such care 
and services under this chapter.
  (2) In establishing a program to provide counseling under 
subsection (a), the Secretary shall--
          (A) provide for appropriate training of mental health 
        professionals and such other health care personnel as 
        the Secretary determines necessary to carry out the 
        program effectively;
          (B) seek to ensure that such counseling is furnished 
        in a setting that is therapeutically appropriate, 
        taking into account the circumstances that resulted in 
        the need for such counseling; and
          (C) provide referral services to assist [veterans] 
        former members of the Armed Forces who are not eligible 
        for services under this chapter to obtain those from 
        sources outside the Department.
  (c) The Secretary shall provide information on the counseling 
and treatment available under this section. Efforts by the 
Secretary to provide such information--
          (1) shall include availability of a toll-free 
        telephone number (commonly referred to as an 800 
        number);
          (2) shall ensure that information about the 
        counseling and treatment available under this section--
                  (A) is revised and updated as appropriate;
                  (B) is made available and visibly posted at 
                appropriate facilities of the Department; and
                  (C) is made available through appropriate 
                public information services; and
          (3) shall include coordination with the Secretary of 
        Defense seeking to ensure that members of the Armed 
        Forces and individuals who are being separated from 
        active military, naval, or air service are provided 
        appropriate information about programs, requirements, 
        and procedures for applying for counseling and 
        treatment under this section.
  (d)(1) The Secretary shall carry out a program to provide 
graduate medical education, training, certification, and 
continuing medical education for mental health professionals 
who provide counseling, care, and services under subsection 
(a).
  (2) In carrying out the program required by paragraph (1), 
the Secretary shall ensure that--
          (A) all mental health professionals described in such 
        paragraph have been trained in a consistent manner; and
          (B) training described in such paragraph includes 
        principles of evidence-based treatment and care for 
        sexual trauma and post-traumatic stress disorder.
  (e) Each year, the Secretary shall submit to Congress an 
annual report on the counseling, care, and services provided 
pursuant to this section. Each report shall include data for 
the year covered by the report with respect to each of the 
following:
          (1) The number of mental health professionals, 
        graduate medical education trainees, and primary care 
        providers who have been certified under the program 
        required by subsection (d) and the amount and nature of 
        continuing medical education provided under such 
        program to such professionals, trainees, and providers 
        who are so certified.
          (2) The number of individuals who received counseling 
        and care and services under subsection (a) from 
        professionals and providers who received training under 
        subsection (d), disaggregated by--
                  (A) [veterans] former members of the Armed 
                Forces ;
                  (B) members of the Armed Forces (including 
                members of the National Guard and Reserves) on 
                active duty; and
                  (C) for each of subparagraphs (A) and (B)--
                          (i) men; and
                          (ii) women.
          (3) The number of graduate medical education, 
        training, certification, and continuing medical 
        education courses provided by reason of subsection (d).
          (4) The number of trained full-time equivalent 
        employees required in each facility of the Department 
        to meet the needs of individuals requiring treatment 
        and care for sexual trauma and post-traumatic stress 
        disorder.
          (5) Such recommendations for improvements in the 
        treatment of individuals with sexual trauma and post-
        traumatic stress disorder as the Secretary considers 
        appropriate, including specific recommendations for 
        individuals specified in subparagraphs (A), (B), and 
        (C) of paragraph (2).
          (6) Such other information as the Secretary considers 
        appropriate.
  (f) In this section, the term ``sexual harassment'' means 
[repeated,] unsolicited verbal or physical contact of a sexual 
nature which is threatening in character.
  (g) In this section, the term ``former member of the Armed 
Forces'' includes the following:
          (1) A veteran described in section 101(2) of this 
        title.
          (2) An individual not described in paragraph (1) who 
        was discharged or released from the Armed Forces under 
        a condition that is not honorable but not--
                  (A) a dishonorable discharge; or
                  (B) a discharge by court-martial.

           *       *       *       *       *       *       *


Sec. 1720J. Medical services for women veterans

  (a) Access to Care.--The Secretary shall ensure that women's 
health primary care services are available during regular 
business hours at every medical center and community based 
outpatient clinic of the Department.
  (b) Study on Extended Hours of Care.--The Secretary shall 
conduct a study to assess--
          (1) the use of extended hours as a means of reducing 
        barriers to care;
          (2) the need for extended hours based on interviews 
        with women veterans and employees; and
          (3) the best practices and resources required to 
        implement use of extended hours.
  (c) Annual Report to Congress.--Not later than September 30 
of each year, 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 compliance 
with subsection (a).

           *       *       *       *       *       *       *


SUBCHAPTER VIII--HEALTH CARE OF PERSONS OTHER THAN VETERANS

           *       *       *       *       *       *       *


Sec. 1786. Care for newborn children of women veterans receiving 
                    maternity care

  (a) In General.--The Secretary may furnish health care 
services described in subsection (b) and transportation 
necessary to receive such services to a newborn child of a 
woman veteran who is receiving maternity care furnished by the 
Department for not more than [seven days] 14 days, except as 
provided in subsection (e), after the birth of the child if the 
veteran delivered the child in--
          (1) a facility of the Department; [or]
          (2) another facility pursuant to a Department 
        contract for services relating to such delivery[.]; or
          (3) another location, including a health care 
        facility, if the veteran delivers the child before 
        arriving at a facility described in paragraph (1) or 
        (2).
  (b) Covered Health Care Services.--Health care services 
described in this subsection are all post-delivery care 
services, including routine care services, that a newborn child 
requires, including necessary health care services provided by 
a facility other than the facility where the newborn child was 
delivered (including a specialty pediatric hospital) that 
accepts transfer of the newborn child and responsibility for 
treatment of the newborn child .
  (c) Transportation.--(1) Transportation furnished under 
subsection (a) to, from, or between care settings to meet the 
needs of a newborn child includes costs for either or both the 
newborn child and parents.
  (2) Transportation furnished under subsection (a) is 
transportation by ambulance, including air ambulance, or other 
appropriate medically staffed modes of transportation--
          (A) to another health care facility (including a 
        specialty pediatric hospital) that accepts transfer of 
        the newborn child or otherwise provides post-delivery 
        care services when the treating facility is not capable 
        of furnishing the care or services required; or
          (B) to a health care facility in a medical emergency 
        of such nature that a prudent layperson reasonably 
        expects that delay in seeking immediate medical 
        attention would be hazardous to life or health.
  (3) Amounts paid by the Department for transportation under 
this section shall be derived from the Medical Services 
appropriations account of the Department.
  (d) Reimbursement or Payment for Health Care Services or 
Transportation.--(1) Pursuant to regulations the Secretary 
shall prescribe to establish rates of reimbursement and any 
limitations thereto under this section, the Secretary shall 
directly reimburse a covered entity for health care services or 
transportation services provided under this section, unless the 
cost of the services or transportation is covered by an 
established agreement or contract. If such an agreement or 
contract exists, its negotiated payment terms shall apply.
  (2)(A) Reimbursement or payment by the Secretary under this 
section on behalf of an individual to a covered entity shall, 
unless rejected and refunded by the covered entity within 30 
days of receipt, extinguish any liability on the part of the 
individual for the health care services or transportation 
covered by such payment.
  (B) Neither the absence of a contract or agreement between 
the Secretary and a covered entity nor any provision of a 
contract, agreement, or assignment to the contrary shall 
operate to modify, limit, or negate the requirements of 
subparagraph (A).
  (3) In this subsection, the term ``covered entity'' means any 
individual, transportation carrier, organization, or other 
entity that furnished or paid for health care services or 
transportation under this section.
  (e) Exception.--Pursuant to such regulations as the Secretary 
shall prescribe to carry out this section, the Secretary may 
furnish more than 14 days of health care services described in 
subsection (b), and transportation necessary to receive such 
services, to a newborn child based on medical necessity if the 
child is in need of additional care, including a case in which 
the newborn child has been discharged or released from a 
hospital and requires readmittance to ensure the health and 
welfare of the newborn child.
  (f) Annual Report.--Not later than 60 days after the end of 
each fiscal year, 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 health care services provided under subsection (a) during 
such fiscal year, including the number of newborn children who 
received such services during such fiscal year.

           *       *       *       *       *       *       *


CHAPTER 20--BENEFITS FOR HOMELESS VETERANS

           *       *       *       *       *       *       *


SUBCHAPTER V--HOUSING ASSISTANCE

           *       *       *       *       *       *       *


Sec. 2044. Financial assistance for supportive services for very low-
                    income veteran families in permanent housing

  (a) Distribution of Financial Assistance.--(1) The Secretary 
shall provide financial assistance to eligible entities 
approved under this section to provide and coordinate the 
provision of supportive services described in subsection (b) 
for very low-income veteran families occupying permanent 
housing.
  (2) Financial assistance under this section shall consist of 
grants for each such family for which an approved eligible 
entity is providing or coordinating the provision of supportive 
services.
  (3)(A) The Secretary shall provide such grants to each 
eligible entity that is providing or coordinating the provision 
of supportive services.
  (B) The Secretary is authorized to establish intervals of 
payment for the administration of such grants and establish a 
maximum amount to be awarded, in accordance with the services 
being provided and their duration.
  (4) In providing financial assistance under paragraph (1), 
the Secretary shall give preference to entities providing or 
coordinating the provision of supportive services for very low-
income veteran families who are transitioning from homelessness 
to permanent housing.
  (5) The Secretary shall ensure that, to the extent 
practicable, financial assistance under this subsection is 
equitably distributed across geographic regions, including 
rural communities and tribal lands.
  (6) Each entity receiving financial assistance under this 
section to provide supportive services to a very low-income 
veteran family shall notify that family that such services are 
being paid for, in whole or in part, by the Department.
  (7) The Secretary may require entities receiving financial 
assistance under this section to submit a report to the 
Secretary that describes the projects carried out with such 
financial assistance.
  (b) Supportive Services.--The supportive services referred to 
in subsection (a) are the following:
          (1) Services provided by an eligible entity or a 
        subcontractor of an eligible entity that address the 
        needs of very low-income veteran families occupying 
        permanent housing, including--
                  (A) outreach services;
                  (B) case management services;
                  (C) assistance in obtaining any benefits from 
                the Department which the veteran may be 
                eligible to receive, including, but not limited 
                to, vocational and rehabilitation counseling, 
                employment and training service, educational 
                assistance, and health care services; and
                  (D) assistance in obtaining and coordinating 
                the provision of other public benefits provided 
                in Federal, State, or local agencies, or any 
                organization defined in subsection (f), 
                including--
                          (i) health care services (including 
                        obtaining health insurance);
                          (ii) daily living services;
                          (iii) personal financial planning;
                          (iv) transportation services;
                          (v) income support services;
                          (vi) fiduciary and representative 
                        payee services;
                          (vii) legal services to assist the 
                        veteran family with issues that 
                        interfere with the family's ability to 
                        obtain or retain housing or supportive 
                        services;
                          (viii) child care;
                          (ix) housing counseling; and
                          (x) other services necessary for 
                        maintaining independent living.
          (2) Services described in paragraph (1) that are 
        delivered to very low-income veteran families who are 
        homeless and who are scheduled to become residents of 
        permanent housing within 90 days pending the location 
        or development of housing suitable for permanent 
        housing.
          (3) Services described in paragraph (1) for very low-
        income veteran families who have voluntarily chosen to 
        seek other housing after a period of tenancy in 
        permanent housing, that are provided, for a period of 
        90 days after such families exit permanent housing or 
        until such families commence receipt of other housing 
        services adequate to meet their current needs, but only 
        to the extent that services under this paragraph are 
        designed to support such families in their choice to 
        transition into housing that is responsive to their 
        individual needs and preferences.
  (c) Application for Financial Assistance.--(1) An eligible 
entity seeking financial assistance under subsection (a) shall 
submit to the Secretary an application therefor in such form, 
in such manner, and containing such commitments and information 
as the Secretary determines to be necessary to carry out this 
section.
  (2) Each application submitted by an eligible entity under 
paragraph (1) shall contain--
          (A) a description of the supportive services proposed 
        to be provided by the eligible entity and the 
        identified needs for those services;
          (B) a description of the types of very low-income 
        veteran families proposed to be provided such services;
          (C) an estimate of the number of very low-income 
        veteran families proposed to be provided such services;
          (D) evidence of the experience of the eligible entity 
        in providing supportive services to very low-income 
        veteran families; and
          (E) a description of the managerial capacity of the 
        eligible entity--
                  (i) to coordinate the provision of supportive 
                services with the provision of permanent 
                housing by the eligible entity or by other 
                organizations;
                  (ii) to assess continuously the needs of very 
                low-income veteran families for supportive 
                services;
                  (iii) to coordinate the provision of 
                supportive services with the services of the 
                Department;
                  (iv) to tailor supportive services to the 
                needs of very low-income veteran families; and
                  (v) to seek continuously new sources of 
                assistance to ensure the long-term provision of 
                supportive services to very low-income veteran 
                families.
  (3) The Secretary shall establish criteria for the selection 
of eligible entities to be provided financial assistance under 
this section.
  (d) Technical Assistance.--(1) The Secretary shall provide 
training and technical assistance to participating eligible 
entities regarding the planning, development, and provision of 
supportive services to very low-income veteran families 
occupying permanent housing, through the Technical Assistance 
grants program in section 2064 of this title.
  (2) The Secretary may provide the training described in 
paragraph (1) directly or through grants or contracts with 
appropriate public or nonprofit private entities.
  (e) Funding.--(1) From amounts appropriated to the Department 
for Medical Services, there shall be available to carry out 
subsections (a), (b), and (c) amounts as follows:
          (A) $15,000,000 for fiscal year 2009.
          (B) $20,000,000 for fiscal year 2010.
          (C) $25,000,000 for fiscal year 2011.
          (D) $100,000,000 for fiscal year 2012.
          (E) $320,000,000 for each of fiscal years 2015 
        through 2017.
          (F) $340,000,000 for fiscal year 2018.
          (G) $380,000,000 for each of fiscal years 2019 
        through 2021.
  (2) Not more than $750,000 may be available under paragraph 
(1) in any fiscal year to provide technical assistance under 
subsection (d).
  (3) There is authorized to be appropriated $1,000,000 for 
each of the fiscal years 2009 through 2012 to carry out the 
provisions of subsection (d).
  (4) Not less than $20,000,000 shall be available under 
paragraph (1)(H) for the provision of financial assistance 
under subsection (a) to organizations that have a focus on 
providing assistance to women veterans and their families.
  (f) Definitions.--In this section:
          (1) The term ``consumer cooperative'' has the meaning 
        given such term in section 202 of the Housing Act of 
        1959 (12 U.S.C. 1701q).
          (2) The term ``eligible entity'' means--
                  (A) a private nonprofit organization; or
                  (B) a consumer cooperative.
          (3) The term ``homeless'' has the meaning given that 
        term in section 103 of the McKinney-Vento Homeless 
        Assistance Act (42 U.S.C. 11302).
          (4) The term ``permanent housing'' means community-
        based housing without a designated length of stay.
          (5) The term ``private nonprofit organization'' means 
        any of the following:
                  (A) Any incorporated private institution or 
                foundation--
                          (i) no part of the net earnings of 
                        which inures to the benefit of any 
                        member, founder, contributor, or 
                        individual;
                          (ii) which has a governing board that 
                        is responsible for the operation of the 
                        supportive services provided under this 
                        section; and
                          (iii) which is approved by the 
                        Secretary as to financial 
                        responsibility.
                  (B) A for-profit limited partnership, the 
                sole general partner of which is an 
                organization meeting the requirements of 
                clauses (i), (ii), and (iii) of subparagraph 
                (A).
                  (C) A corporation wholly owned and controlled 
                by an organization meeting the requirements of 
                clauses (i), (ii), and (iii) of subparagraph 
                (A).
                  (D) A tribally designated housing entity (as 
                defined in section 4 of the Native American 
                Housing Assistance and Self-Determination Act 
                of 1996 (25 U.S.C. 4103)).
          (6)(A) Subject to subparagraphs (B) and (C), the term 
        ``very low-income veteran family'' means a veteran 
        family whose income does not exceed 50 percent of the 
        median income for an area specified by the Secretary 
        for purposes of this section, as determined by the 
        Secretary in accordance with this paragraph.
          (B) The Secretary shall make appropriate adjustments 
        to the income requirement under subparagraph (A) based 
        on family size.
          (C) The Secretary may establish an income ceiling 
        higher or lower than 50 percent of the median income 
        for an area if the Secretary determines that such 
        variations are necessary because the area has unusually 
        high or low construction costs, fair market rents (as 
        determined under section 8 of the United States Housing 
        Act of 1937 (42 U.S.C. 1437f)), or family incomes.
          (7) The term ``veteran family'' includes a veteran 
        who is a single person and a family in which the head 
        of household or the spouse of the head of household is 
        a veteran.

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PART V--BOARDS, ADMINISTRATIONS, AND SERVICES

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 CHAPTER 73--VETERANS HEALTH ADMINISTRATION--ORGANIZATION AND FUNCTIONS

                       SUBCHAPTER I--ORGANIZATION

Sec.
7301. Functions of Veterans Health Administration: in general.
     * * * * * * *
7310. Office of Women's Health.
7310A. Annual reports on women's health.

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SUBCHAPTER I--ORGANIZATION

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Sec. 7306. Office of the Under Secretary for Health

  (a) The Office of the Under Secretary for Health shall 
consist of the following:
          (1) The Deputy Under Secretary for Health, who shall 
        be the principal assistant of the Under Secretary for 
        Health and who shall be a qualified doctor of medicine.
          (2) The Associate Deputy Under Secretary for Health, 
        who shall be an assistant to the Under Secretary for 
        Health and the Deputy Under Secretary for Health and 
        who shall be a qualified doctor of medicine.
          (3) Not to exceed eight Assistant Under Secretaries 
        for Health.
          (4) Such Medical Directors as may be appointed to 
        suit the needs of the Department, who shall be either a 
        qualified doctor of medicine or a qualified doctor of 
        dental surgery or dental medicine.
          (5) A Director of Nursing Service, who shall be a 
        qualified registered nurse and who shall be responsible 
        to, and report directly to, the Under Secretary for 
        Health for the operation of the Nursing Service.
          (6) A Director of Pharmacy Service, a Director of 
        Dietetic Service, a Director of Podiatric Service, and 
        a Director of Optometric Service, who shall be 
        responsible to the Under Secretary for Health for the 
        operation of their respective Services.
          (7) Such directors of such other professional or 
        auxiliary services as may be appointed to suit the 
        needs of the Department, who shall be responsible to 
        the Under Secretary for Health for the operation of 
        their respective services.
          (8) The Director of the National Center for 
        Preventive Health, who shall be responsible to the 
        Under Secretary for Health for the operation of the 
        Center.
          (9) The Director of Physician Assistant Services, who 
        shall--
                  (A) serve in a full-time capacity at the 
                Central Office of the Department;
                  (B) be a qualified physician assistant; and
                  (C) be responsible and report directly to the 
                Chief Patient Care Services Officer of the 
                Veterans Health Administration on all matters 
                relating to the education and training, 
                employment, appropriate use, and optimal 
                participation of physician assistants within 
                the programs and initiatives of the 
                Administration.
          (10) The Director of Women's Health.
          [(10)] (11) Such other personnel as may be authorized 
        by this chapter.
  (b) Of the Assistant Under Secretaries for Health appointed 
under subsection (a)(3)--
          (1) not more than two may be persons qualified in the 
        administration of health services who are not doctors 
        of medicine, dental surgery, or dental medicines;
          (2) one shall be a qualified doctor of dental surgery 
        or dental medicine who shall be directly responsible to 
        the Under Secretary for Health for the operation of the 
        Dental Service; and
          (3) one shall be a qualified physician trained in, or 
        having suitable extensive experience in, geriatrics who 
        shall be responsible to the Under Secretary for Health 
        for evaluating all research, educational, and clinical 
        health-care programs carried out in the Administration 
        in the field of geriatrics and who shall serve as the 
        principal advisor to the Under Secretary for Health 
        with respect to such programs.
  (c) Appointments under subsection (a) shall be made by the 
Secretary. In the case of appointments under paragraphs (1), 
(2), (3), (4), and (8) of that subsection, such appointments 
shall be made upon the recommendation of the Under Secretary 
for Health.
  (d) Except as provided in subsection (e)--
          (1) any appointment under this section shall be for a 
        period of four years, with reappointment permissible 
        for successive like periods,
          (2) any such appointment or reappointment may be 
        extended by the Secretary for a period not in excess of 
        three years, and
          (3) any person so appointed or reappointed or whose 
        appointment or reappointment is extended shall be 
        subject to removal by the Secretary for cause.
  (e)(1) The Secretary may designate a member of the Chaplain 
Service of the Department as Director, Chaplain Service, for a 
period of two years, subject to removal by the Secretary for 
cause. Redesignation under this subsection may be made for 
successive like periods or for any period not exceeding two 
years.
  (2) A person designated as Director, Chaplain Service, shall 
at the end of such person's period of service as Director 
revert to the position, grade, and status which such person 
held immediately before being designated Director, Chaplain 
Service, and all service as Director, Chaplain Service, shall 
be creditable as service in the former position.
  (f) In organizing the Office and appointing persons to 
positions in the Office, the Under Secretary shall ensure 
that--
          (1) the Office is staffed so as to provide the Under 
        Secretary, through a designated clinician in the 
        appropriate discipline in each instance, with expertise 
        and direct policy guidance on--
                  (A) unique programs operated by the 
                Administration to provide for the specialized 
                treatment and rehabilitation of disabled 
                veterans (including blind rehabilitation, care 
                of spinal cord dysfunction, mental illness, and 
                long-term care); and
                  (B) the programs established under section 
                1712A of this title; and
          (2) with respect to the programs established under 
        section 1712A of this title, a clinician with 
        appropriate expertise in those programs is responsible 
        to the Under Secretary for the management of those 
        programs.

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Sec. 7310. Office of Women's Health

  (a) Establishment.--(1) The Under Secretary for Health shall 
establish and operate in the Veterans Health Administration the 
Office of Women's Health (hereinafter in this section referred 
to as the ``Office''). The Office shall be located at the 
Central Office of the Department of Veterans Affairs.
  (2) The head of the Office is the Director of Women's Health 
(hereinafter in this section referred to as the ``Director''). 
The Director shall report to the Under Secretary for Health.
  (3) The Under Secretary for Health shall provide the Office 
with such staff and other support as may be necessary for the 
Office to carry out effectively its functions under this 
section.
  (4) The Under Secretary for Health may reorganize existing 
offices within the Veterans Health Administration as of the 
date of the enactment of this section in order to avoid 
duplication with the functions of the Office.
  (b) Purpose.--The functions of the Office include the 
following:
          (1) To provide a central office for monitoring and 
        encouraging the activities of the Veterans Health 
        Administration with respect to the provision, 
        evaluation, and improvement of women veterans' health 
        care services in the Department.
          (2) To develop and implement standards of care for 
        the provision of health care for women veterans in the 
        Department.
          (3) To monitor and identify deficiencies in standards 
        of care for the provision of health care for women 
        veterans in the Department, to provide technical 
        assistance to medical facilities of the Department to 
        address and remedy deficiencies, and to perform 
        oversight of implementation of standards of care for 
        women veterans' health care in the Department.
          (4) To monitor and identify deficiencies in standards 
        of care for the provision of health care for women 
        veterans provided through the community pursuant to 
        this title, and to provide recommendations to the 
        appropriate office to address and remedy any 
        deficiencies.
          (5) To oversee distribution of resources and 
        information related to women veterans' health 
        programming under this title.
          (6) To promote the expansion and improvement of 
        clinical, research, and educational activities of the 
        Veterans Health Administration with respect the health 
        care of women veterans.
          (7) To provide, as part of the annual budgeting 
        process, recommendations with respect to the amount of 
        funds to be requested for furnishing hospital care and 
        medical services to women veterans pursuant to chapter 
        17 of this title, including, at a minimum, 
        recommendations that ensure that such amount of funds 
        either reflect or exceed the proportion of veterans 
        enrolled in the patient enrollment system under section 
        1705 of this title who are women.
          (8) To provide recommendations to the Under Secretary 
        for Health with respect to modifying the Veterans 
        Equitable Resource Allocation system to ensure that 
        resource allocations under such system reflect the 
        health care needs of women veterans.
          (9) To carry out such other duties as the Under 
        Secretary for Health may require.
  (c) Recommendations.--If the Under Secretary for Health 
determines not to implement any recommendation made by the 
Director with respect to the allocation of resources to address 
the health care needs of women veterans, the Secretary shall 
notify the appropriate congressional committees of such 
determination by not later than 30 days after the date on which 
the Under Secretary for Health receives the recommendation. 
Each such notification shall include the following:
          (1) The reasoning of the Under Secretary for Health 
        in making such determination.
          (2) An alternative, if one is selected, to such 
        recommendation that the Under Secretary for Health will 
        carry out to fulfill the health care needs of women 
        veterans.
  (d) Standards of Care.--In this section, the standards of 
care for the provision of health care for women veterans in the 
Department shall include, at a minimum, the following:
          (1) Requirement for--
                  (A) at least one designated women's health 
                primary care provider at each medical center 
                whose duties include, to the extent 
                practicable, providing training to other health 
                care providers of the Department with respect 
                to the needs of women veterans; and
                  (B) at least one designated women's health 
                primary care provider at each community-based 
                outpatient clinic of the Department who may 
                serve female patients as a percentage of the 
                total duties of the provider.
          (2) Other requirements as determined by the Under 
        Secretary for Health.
  (e) Outreach.--The Director shall ensure that--
          (1) not less frequently than biannually, each medical 
        facility of the Department holds a public forum for 
        women veterans that occurs outside of regular business 
        hours; and
          (2) not less frequently than quarterly, each medical 
        facility of the Department convenes a focus group of 
        women veterans that includes a discussion of harassment 
        occurring at such facility.
  (f) Definitions.--In this section:
          (1) The term ``appropriate congressional committees'' 
        has the meaning given that term in section 7310A of 
        this title.
          (2) The term ``facility of the Department'' has the 
        meaning given the term in section 1701(3).
          (3) The term ``Veterans Equitable Resource Allocation 
        system'' means the resource allocation system 
        established pursuant to section 429 of the Departments 
        of Veterans Affairs and Housing and Urban Development, 
        and Independent Agencies Appropriations Act, 1997 
        (Public Law 104-204; 110 Stat. 2929).

Sec. 7310A. Annual reports on women's health

  (a) Annual Reports.--Not later than December 1 of each year, 
the Director of Women's Health shall submit to the appropriate 
congressional committees a report containing the matters under 
subsections (b) through (g).
  (b) Office of Women's Health.--Each report under subsection 
(a) shall include a description of--
          (1) actions taken by the Office of Women's Health in 
        the preceding fiscal year to improve the Department's 
        provision of health care to women veterans;
          (2) any identified deficiencies related to the 
        Department's provision of health care to women veterans 
        and the standards of care established in section 7310 
        of this title, and the Department's plan to address 
        such deficiencies;
          (3) the funding and personnel provided to the Office 
        and whether additional funding or personnel are needed 
        to meet the requirements of such section; and
          (4) other information that would be of interest to 
        the appropriate congressional committees with respect 
        to oversight of the Department's provision of health 
        care to women veterans.
  (c) Access to Gender-specific Services.--Each report under 
subsection (a) shall include an analysis of the access of women 
veterans to gender-specific services under contracts, 
agreements, or other arrangements with non-Department medical 
providers entered into by the Secretary for the provision of 
hospital care or medical services to veterans. Such analysis 
shall include data and performance measures for the 
availability of gender specific services, including--
          (1) the average wait time between the veteran's 
        preferred appointment date and the date on which the 
        appointment is completed;
          (2) the average driving time required for veterans to 
        attend appointments; and
          (3) reasons why appointments could not be scheduled 
        with non-Department medical providers.
  (d) Locations Where Women Veterans are Using Health Care.--
Each report under subsection (a) shall include an analysis of 
the use by women veterans of health care from the Department, 
including the following information:
          (1) The number of women veterans who reside in each 
        State.
          (2) The number of women veterans in each State who 
        are enrolled in the system of patient enrollment of the 
        Department established and operated under section 
        1705(a) this title.
          (3) Of the women veterans who are so enrolled, the 
        number who have received health care under the laws 
        administered by the Secretary at least one time during 
        the one-year period preceding the submittal of the 
        report.
          (4) The number of women veterans who have been seen 
        at each medical facility of the Department during such 
        year.
          (5) The number of appointments that women veterans 
        have had at each such facility during such year.
          (6) If known, an identification of the medical 
        facility of the Department in each Veterans Integrated 
        Service Network with the largest rate of increase in 
        patient population of women veterans as measured by the 
        increase in unique women veteran patient use.
          (7) If known, an identification of the medical 
        facility of the Department in each Veterans Integrated 
        Service Network with the largest rate of decrease in 
        patient population of women veterans as measured by the 
        decrease in unique women veterans patient use.
  (e) Models of Care.--Each report under subsection (a) shall 
include an analysis of the use by the Department of general 
primary care clinics, separate but shared spaces, and women's 
health centers as models of providing health care to women 
veterans. Such analysis shall include the following:
          (1) The number of facilities of the Department that 
        fall into each such model, disaggregated by Veterans 
        Integrated Service Network and State.
          (2) A description of the criteria used by the 
        Department to determine which such model is most 
        appropriate for each facility of the Department.
          (3) An assessment of how the Department decides to 
        make investments to modify facilities to a different 
        model.
          (4) A description of what, if any, plans the 
        Department has to modify facilities from general 
        primary care clinics to another model.
          (5) An assessment of whether any facilities could be 
        modified to a separate but shared space for a women's 
        health center within planned investments under the 
        strategic capital investment planning process of the 
        Department.
          (6) An assessment of whether any facilities could be 
        modified to a separate or shared space, or women's 
        health center with minor modifications to existing 
        plans under the strategic capital investment planning 
        process of the Department.
          (7) An assessment of whether the Department has a 
        goal for how many facilities should fall into each such 
        model.
  (f) Staffing.--Each report under subsection (a) shall include 
an analysis of the staffing of the Department relating to the 
treatment of women, including the following, disaggregated by 
Veterans Integrated Service Network and State (except with 
respect to paragraph (4)):
          (1) The number of women's health centers.
          (2) The number of patient aligned care teams of the 
        Department relating to women's health.
          (3) The number of full- and part-time gynecologists 
        of the Department.
          (4) The number of designated women's health care 
        providers of the Department, disaggregated by facility 
        of the Department.
          (5) The number of health care providers of the 
        Department who have completed a mini-residency for 
        women's health care through Women Veterans Health Care 
        Mini-Residency Program of the Department during the 
        one-year period preceding the submittal of the report, 
        and the number that plan to participate in such a mini-
        residency during the one-year period following such 
        date.
          (6) The number of designated women's health care 
        providers of the Department who have sufficient female 
        patients to retain their competencies and 
        proficiencies.
  (g) Accessibility and Treatment Options.--Each report under 
subsection (a) shall include an analysis of the accessibility 
and treatment options for women veterans, including the 
following:
          (1) An assessment of wheelchair accessibility of 
        women's health centers of the Department, including, 
        with respect to each such facility, an assessment of 
        such accessibility for each kind of treatment provided 
        at the center, including with respect to radiology and 
        mammography, that addresses all relevant factors, 
        including door sizes, hoists, and equipment.
          (2) The options for women veterans to access female 
        mental health providers and primary care providers.
          (3) The options for women veterans at medical 
        facilities of the Department with respect to clothing 
        sizes, including for gowns, drawstring pants, and 
        pajamas.
  (h) Definitions.--In this section:
          (1) The term ``appropriate congressional committees'' 
        means--
                  (A) the Committees on Veterans' Affairs of 
                the House of Representatives and the Senate; 
                and
                  (B) the Committees on Appropriations of the 
                House of Representatives and the Senate.
          (2) The term ``gender-specific services'' means 
        mammography, obstetric care, gynecological care, and 
        such other services as the Secretary determines 
        appropriate.

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