House Report 116-281 - DEBORAH SAMPSON ACT

[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

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.

* * * * * * *

PART V--BOARDS, ADMINISTRATIONS, AND SERVICES

* * * * * * *

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.

* * * * * * *

SUBCHAPTER I--ORGANIZATION

* * * * * * *

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.

* * * * * * *

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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