I
110th CONGRESS
1st Session
H. R. 4107
IN THE HOUSE OF REPRESENTATIVES
November 7, 2007
Ms. Herseth Sandlin (for herself and Ms. Ginny Brown-Waite of Florida) introduced the following bill; which was referred to the Committee on Veterans’ Affairs, and in addition to the Committee on Armed Services, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned
A BILL
To amend title 38, United States Code, to expand and improve health care services available to women veterans, especially those serving in Operation Iraqi Freedom and Operation Enduring Freedom, from the Department of Veterans Affairs, and for other purposes.
Short title; table of contents
Short title
This Act may be cited as the Women Veterans Health Care Improvement
Act
.
Table of contents
The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents.
Title I—STUDIES AND ASSESSMENTS OF DEPARTMENT OF VETERANS AFFAIRS HEALTH SERVICES FOR WOMEN VETERANS
Sec. 101. Long-term study on health of women serving in Operation Iraqi Freedom and Operation Enduring Freedom.
Sec. 102. Study of barriers for women veterans to health care from the department of veterans affairs.
Sec. 103. Comprehensive assessment of women’s health care programs of the department of veterans affairs.
Title II—IMPROVEMENT AND EXPANSION OF HEALTH CARE PROGRAMS OF THE DEPARTMENT OF VETERANS AFFAIRS FOR WOMEN VETERANS
Sec. 201. Improvement of sexual trauma care programs of the department of veterans affairs.
Sec. 202. Dissemination of information on effective treatment, including evidence-based treatments, for women veterans with post-traumatic stress disorder (ptsd).
Sec. 203. Ensuring adequate provision of services for women veterans at Department of Veterans Affairs vet centers.
Sec. 204. Pilot program for child care for certain women veterans receiving health care from facilities of the department.
Sec. 205. Pilot program for women veterans newly separated from service for counseling in retreat settings.
Sec. 206. Addition of recently separated women veterans to serve on advisory committees.
STUDIES AND ASSESSMENTS OF DEPARTMENT OF VETERANS AFFAIRS HEALTH SERVICES FOR WOMEN VETERANS
Long-term study on health of women serving in operation iraqi freedom and operation enduring freedom
Prospective, population-based long-term study
The secretary of veterans affairs shall enter in contracts with one or more qualified entities or organizations, in collaboration with the war-related injury and illness study centers of the veterans health administration, to conduct a long-term epidemiologic study on the health of women veterans who served on active duty in the combat theatres of Operation Iraqi Freedom and Operation Enduring Freedom. the study shall include information on general health, mental health, reproductive health, and mortality of such women veterans
Cohort
The study shall utilize a sufficiently large cohort of women, and shall include a minimum follow-up period of ten years.
Arrangements with the department of defense
The Secretary of Defense shall enter into arrangements with the Secretary of Veterans Affairs to carry out the requirements of this section. The Secretary of Defense shall make available to the Secretary of Veterans Affairs health care data in the possession of the Department of Defense with respect to such women veterans and shall provide access to the cohort of such women while serving in the armed forces. Such health care data shall include relevant pre-deployment health and health risk assessments with respect to such women veterans.
Annual reports
(1) Not later than 6 months after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to Congress an initial report on the status of the implementation of the section.
Not later one year after the date of the submittal to Congress of the initial report required under paragraph (1), and annually thereafter through 2018, the Secretary of Veterans Affairs shall submit to Congress report on the progress and results of the long-term study required under this section. The final report required under this paragraph shall include a detailed description of the cumulative findings of the study and shall include recommendations for such administrative and legislative action as the Secretary of Veterans Affairs determines to be appropriate.
Authorization of appropriations
There are authorized to be appropriated to the Secretary of Veterans Affairs such sums as are necessary to carry out the provisions of this section.
Study of barriers for women veterans to health care from the department of veterans affairs
Study
The Secretary of Veterans Affairs shall conduct a comprehensive assessment of the barriers to the provision of comprehensive health care by the Department of Veterans Affairs encountered by women who are veterans, especially veterans of Operation Iraqi Freedom and Operation Enduring Freedom. The study should survey women veterans who seek or receive services from the healthcare system of the Department of Veterans Affairs as well as women veterans who do not seek or receive such services.
Elements
In conducting the study required by subsection (a), the Secretary of Veterans Affairs shall conduct research on the effects of the following:
Perceived stigma with respect to seeking mental health care services.
The effect of driving distance or availability of other forms of transportation to the nearest appropriate facility of the Department on access to care.
Availability of child care.
Acceptability of integrated primary care, or with women’s health clinics, or both.
Comprehension of eligibility requirements for, and the scope of services available under, such health care.
The quality and nature of the reception by providers of such health care and their staff of the veteran.
The perception of personal safety and comfort of women veterans in inpatient, outpatient, and behavioral health facilities of the Department.
Cultural sensitivity of health care providers and staff to issues that particularly affect women.
The effectiveness of outreach for health care services available to women veterans.
Such other significant barriers as the Secretary of Veterans Affairs may identify.
The Secretary of Veterans Affairs shall enter into contracts with qualified independent entities or organizations to carry out of the studies and research required under this section.
Mandatory review of data by certain divisions within the department
The Secretary of Veterans Affairs shall ensure that the head of each specified division of the Department (as defined in subsection (e)(2)) reviews the results of the study. The head of each specified division of the Department shall submit findings with respect to the study to the Under Secretary for Health and to other pertinent program offices within the Department of Veterans Affairs with duties relating to health care services for women veterans.
Reports
Not later than 6 months after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to Congress a report on the status of the implementation of the section.
Not later than 30 months after the date of the enactment of this section, the Secretary of Veterans Affairs 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 of Veterans Affairs determines to be appropriate. The report shall also include the findings of the head of each specified division of the Department and of the Under Secretary for Health.
Definition
In this section—
the term
facility of the Department
has the meaning given that term in
section 1701(3) of title 38, United States Code; and
the term
specified division of the Department
means—
the Center for Women Veterans, established under section 318 of title 38, United States Code; and
the Advisory Committee on Women Veterans, established under section 542 of title 38, United States Code.
Authorization of appropriations
There are authorized to be appropriated to the Secretary of Veterans Affairs such sums as are necessary to carry out the provisions of this section.
Comprehensive assessment of women’s health care programs of the department of veterans affairs
In general
The Secretary of Veterans Affairs shall conduct a comprehensive assessment of all health care services and programs provided by the Department of Veterans Affairs for the health care needs of women veterans. Such comprehensive assessment shall include assessments of specialized programs for women with post-traumatic stress disorder, for women who are homeless, for women who require care for substance abuse or mental illnesses, and for women who require pregnancy care.
Specific matters studied
The Secretary of Veterans Affairs shall identify each of the following programs for women veterans provided by the Department and determine whether effective health care services, including evidenced-based health care services, are readily available to and easily accessed by women veterans:
Health promotion programs.
Disease prevention programs.
Health Care programs.
In making such determination, the Secretary of Veterans Affairs shall identify—
the frequency with which such services are available and provided,
the demographics of the women veterans population,
the sites where such services are available and provided, and
whether, and to what extent, waiting lists, geographic distance, and other factors obstruct the receipt of any of such services at any such site.
Development of plan To improve services
After conducting the assessments required by subsection (a), the Secretary of Veterans Affairs shall develop a program to improve the provision of health care services to women veterans and to project the future health care, including mental health care, needs of women serving in the combat theatres of Operation Iraqi Freedom and Operation Enduring Freedom. In developing the program under this subsection, the Secretary of Veterans Affairs shall list the types of services available under each program at each Medical Center of the Department and shall indicate projected resource and staffing requirements to meet the health care needs of women veterans.
Report
Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to Congress a report on the assessment conducted pursuant to this section. The report shall include recommendations for such administrative and legislative action as the Secretary of Veterans Affairs determines to be appropriate.
GAO report
The Comptroller General of the United States shall review the report of the Secretary of Veterans Affairs required under subsection (d). Not later than 6 months after the date on which the Secretary submits such report, the Comptroller General shall submit to Congress a report containing the findings of the Comptroller General with respect to the report of the Secretary and may include such recommendations for administrative or legislative actions as the Comptroller General determines to be appropriate.
IMPROVEMENT AND EXPANSION OF HEALTH CARE PROGRAMS OF THE DEPARTMENT OF VETERANS AFFAIRS FOR WOMEN VETERANS
Improvement of sexual trauma care programs of the department of veterans affairs
Improved training for health care personnel
Section 1720D of title 38, United States Code, is amended—
by redesignating subsection (d) as subsection (f); and
by inserting after subsection (c) the following new subsections:
The Secretary shall provide training for mental health professionals who provide counseling and care to veterans eligible for services under subsection (a). In carrying out such training, the Secretary shall ensure that all such mental health professionals have been trained in a consistent manner and that such training includes principles of evidence-based treatment and care for sexual trauma.
In the case of primary care providers who provide medical care for veterans who may be eligible for services under subsection (a), the Secretary shall ensure appropriate training of such primary care providers in screening for and recognizing symptoms of sexual trauma and procedures for the prompt referral of such veterans to mental health professionals described in subparagraph (A).
Counseling, care, and services under subsection (a) should include the services of therapists qualified to provide counseling for sexual trauma and who demonstrate a comprehension of the burden of exposure to both combat and sexual trauma inservicemembers of the Armed Forces.
The Secretary shall submit to Congress an annual report on the counseling and care and services provided to veterans by reason of this section. Each report shall include data for the year involved with respect to the following:
The number of mental health professionals and primary care providers who received training under subsection (d).
The number of women veterans who received counseling and care and services under subsection (a) from professionals and providers who received training under subsection (d).
The number of training programs operating by reason of subsection (d).
The number of trained full-time equivalent employees required in each facility of the Department to meet the needs of veterans requiring treatment and care for sexual trauma.
Such other information as the Secretary determines to be appropriate.
.
Establishment of staffing standards
The Secretary of Veterans Affairs shall establish staffing standards used at Department health-care facilities for full-time equivalent employees who are trained to provide treatment and care for sexual trauma to veterans. Such standards shall be established in a manner that ensures availability and accessibility of such treatment and care for all such veterans seeking such treatment and care at such facilities.
Dissemination of information on effective treatment, including evidence-based treatments, for women veterans with post-traumatic stress disorder (ptsd)
In general
The Secretary of Veterans Affairs shall develop a plan for the identification, development, and dissemination of effective treatments, including evidenced-based treatments, for post-traumatic stress disorder and other co-morbid conditions (attributable to combat or sexual trauma) that are proven effective for women veterans. The Secretary shall develop and implement the plan through the National Center for Post-traumatic Stress Disorder (PTSD) of the Department of Veterans Affairs.
Dissemination of information on treatment
The plan required under subsection (a) shall include a proposed timetable for the dissemination of such treatments, including evidence-based treatments, throughout all facilities of the Department, but in no case may such dissemination occur later than one year after the date of the enactment of this Act.
The timetable for the completion of such dissemination shall include proposed additional resources for the treatment programs, for training of personnel involved in counseling and treatment of women veterans suffering from post-traumatic stress disorder attributable to combat or sexual trauma.
Report
Not later than two years after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to Congress a report on the dissemination of effective treatments, including evidence-based treatments, for women veterans suffering from post-traumatic stress disorder through all facilities of the Department.
The report shall include description of—
the methodology and results of the training of personnel involved in counseling and treatment of women veterans suffering from post-traumatic stress disorder;
the effectiveness of the treatments; and
any recommended improvements with respect to access to and availability of the treatment services.
In preparing the report under paragraph (1), the Secretary shall also include any findings or recommendations of the Director of the Center for Women Veterans and the Under Secretary for Health with respect to the development and implementation of the strategy and the completion of the dissemination of such treatments, including evidence-based treatments.
Ensuring adequate provision of services for women veterans at Department of Veterans Affairs vet centers
In general
The Secretary of Veterans Affairs shall conduct a study
on centers for the provision of readjustment counseling and related mental
health services established under section 1712A of title 38, United States Code
(in this section referred to as a vet center
). The Secretary
shall determine whether such centers have the capacity to provide a sufficient
scope and intensity of services for women veterans.
Ensuring sufficient capacity
After conducting the study under subsection (a), the Secretary of Veterans Affairs shall develop a plan to ensure that adequate counseling and mental health services shall be available at each vet center for women veterans, taking into account the specialized needs of such veterans.
Pilot program for child care for certain women veterans receiving health care from facilities of the department
In general
Not later than six months after the date of the enactment of this Act, the Secretary of Veterans Affairs shall carry out a pilot program under which, subject to paragraph (2), child care is provided, directly or indirectly, for qualified veterans.
Child care under the pilot program may only be provided for the period of time that the qualified veteran—
receives the types of health care services referred to in paragraph (3) at a facility of the Department; and
requires to travel to and return from such facility for the receipt of such health care services.
In this section, the term
qualified veteran
means a veteran who is a woman, who is the
primary caretaker of a child or children, and who is receiving from the
Department of Veterans Affairs one or more of the following health care
services:
Regular mental health care services.
Intensive mental health care services.
Such other intensive health care services that the Secretary determines that the provision of child care would improve access to those health care services.
The Secretary shall carry out the pilot program in no fewer than three Veterans Integrated Service Networks (VISNs).
Duration of pilot program
The pilot program required by subsection (a) shall be carried out during the two-year period beginning on the date of the commencement of the pilot program.
Possible forms of child care assistance
Under the pilot program, the form of child care assistance provided to qualified veterans may include stipends for the payment of child care offered by child care centers (either directly or through a voucher program), the development of partnerships with private agencies, collaboration with facilities or programs of other Federal departments or agencies, or the arrangement of after school care.
Authorization of appropriations
There are authorized to be appropriated to the Secretary of Veterans Affairs $1,500,000 for each of fiscal years 2008 and 2009 to carry out the pilot program under this section.
Report
Not later than six months after the completion of the pilot program, the Secretary shall submit to Congress a report on the pilot program and shall include recommendations for the continuation or expansion of the pilot program.
Pilot program for women veterans newly separated from service for counseling in retreat settings
In general
Not later than six months after the date of the enactment of this Act, the Secretary of Veterans Affairs shall carry out a pilot program to evaluate the feasibility and advisability of providing counseling and transition adjustment assistance for women veterans who are newly separated from active duty service.
Under the pilot program, such counseling and assistance shall be provided in a group retreat setting in which the counseling and assistance is made available for consecutive periods of days for such duration as the Secretary determines to be effective.
Participation in a pilot program under this section is at the election of the woman veteran, and such election may be made with or without a referral from a physician or mental health professional.
Sites
The Secretary of Veterans Affairs shall carry out the pilot program in no fewer than five sites.
Duration of pilot program
The pilot program required by subsection (a) shall be carried out during the two-year period beginning on the date of the commencement of the pilot program.
Counseling services
Under the pilot program, a newly separated woman veteran is eligible for a program of counseling tailored to her specific needs, based on her active duty experience and her family situation in order to assist with the transition from active duty to civilian life at home. The program may include some or all of the following services:
Mental health counseling.
Family and marital counseling.
Role and relationship counseling.
Counseling for substance-use disorder.
Such other counseling services that the Secretary of Veterans Affairs determines is necessary to assist the veteran before final repatriation with her family.
Authorization of appropriations
There are authorized to be appropriated to the Secretary of Veterans Affairs $2,000,000 for each of fiscal years 2008 and 2009 to carry out the pilot program under this section.
Report
Not later than six months after the completion of the pilot program, the Secretary shall submit to Congress a report on the pilot program. The report shall include the following:
An assessment of the relative feasibility and advisability of the pilot program.
An assessment of the benefits of the program, including any cost effectiveness associated with the program and any projected cost-savings attributable to early intervention and transition assistance under the pilot program.
Any recommendation for the continuation or expansion of the pilot program.
Addition of recently separated women veterans to serve on advisory committees
Advisory committee on women veterans
Subsection (a)(2)(a) of section 542 of title 38, United States Code, is amended—
by striking
and
at the end of clause (ii);
by
striking the period at the end of clause (iii) and inserting ;
and
; and
by inserting after clause (iii) the following new clause:
women who are recently separated veterans.
.
Advisory committee on minority veterans
Subsection (a)(2)(a) of section 542 of title 38, United States Code, is amended
by striking
and
at the end of clause (iii);
by striking the
period at the end of clause (iv) and inserting ; and
; and
by inserting after clause (iv) the following new clause:
recently separated veterans who are minority group members.
.
Effective date
The amendments made by this section shall first apply to appointments made on or after the date of the enactment of this Act.