Veteran Women's Health Improvement Act of 1993

Summary: Veteran Women's Health Improvement Act of 1993 - Includes women's health services within the definition of medical services authorized to be furnished to eligible veterans.  Includes as women's health services pap smears, breast examinations, and reproductive health care.  Authorizes the Secretary of Veterans to contract with non-Department of Veterans facilities for outpatient women's health services when Department facilities are inadequate or inaccessible.  Requires information on the provision of women's health services to be included in a report from the Secretary to the Congress concerning women veterans. 
Amends the Veterans Health Care Act of 1992 to:  (1) require consultation by the Secretary with various officials, advisory committees, and task forces with regard to appropriate women's health research; (2) expand the research related to women to include specified topics; (3) include certain appropriate personnel of the Department in conducting such research, including women veterans and veteran members of minority groups; and (4) direct that a women veterans population study report required under such Act include an examination of the medical and demographic histories of women veterans comprising the study sample. 
Makes applicable to Department medical facilities provisions of the Public Health Service Act regarding mammography quality standards. Requires all Department facilities to meet such standards within two years.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Veteran Women's Health Improvement 
Act of 1993''.

SEC. 2. WOMEN'S HEALTH SERVICES.

    (a) Women's Health Services.--Section 1701 of title 38, United 
States Code, is amended--
            (1) in paragraph (6)(A)(i), by inserting ``women's health 
        services,'' after ``preventive health services,''; and
            (2) by adding at the end the following:
    ``(10) The term `women's health services' means health care 
services provided to women, including counseling and services relating 
to the following:
            ``(A) Papanicolaou tests (pap smear).
            ``(B) Breast examinations and mammography.
            ``(C) Comprehensive reproductive health care, including 
        pregnancy-related care.
            ``(D) The management of infertility.
            ``(E) The management and prevention of sexually-transmitted 
        diseases.
            ``(F) Menopause, osteoporosis, and other conditions 
        relating to aging.
            ``(G) Physical or psychological conditions arising out of 
        acts of sexual violence.''.
    (b) Contracts for Women's Health Services.--Section 1703(a) of such 
title is amended by adding at the end the following:
            ``(9) Women's health services for veterans on an ambulatory 
        or outpatient basis.''.
    (c) Repeal of Superseded Authority.--Section 106 of the Veterans 
Health Care Act of 1992 (Public Law 102-585; 38 U.S.C. 1710 note) is 
amended--
            (1) by striking out subsection (a); and
            (2) by striking out ``(b) Responsibilities of Directors of 
        Facilities.--'' before ``The Secretary''.
    (d) Report on Health Care and Research.--Section 107(b) of such Act 
(38 U.S.C. 1710 note) is amended--
            (1) in paragraph (1), by inserting ``and women's health 
        services (as such term is defined in section 1701(10) of title 
        38, United States Code)'' after ``section 106 of this Act'';
            (2) in paragraph (2), by striking out ``and (B)'' and 
        inserting in lieu thereof ``(B) the type and amount of services 
        provided by such personnel, including information on the 
        numbers of inpatient stays and the number of outpatient visits 
        through which such services were provided, and (C)'';
            (3) by redesignating paragraph (4) as paragraph (7);
            (4) by adding after paragraph (3) the following new 
        paragraphs:
            ``(4) A description of the personnel of the Department who 
        provided such services to women veterans, including the number 
        of employees (including both the number of individual employees 
        and the number of full-time employee equivalents) and the 
        professional qualifications or specialty training of such 
        employees and the Department facilities to which such personnel 
        were assigned.
            ``(5) A description of any actions taken by the Secretary 
        to ensure the retention of the personnel described in paragraph 
        (4) and any actions undertaken to recruit additional such 
        personnel or personnel to replace such personnel.
            ``(6) An assessment by the Secretary of any difficulties 
        experienced by the Secretary in the furnishing of such services 
        and the actions taken by the Secretary to resolve such 
        difficulties.''; and
            (5) by adding after paragraph (7), as redesignated by 
        paragraph (3) of this subsection, the following:
            ``(8) A description of the actions taken by the Secretary 
        to foster and encourage the expansion of such research.''.

SEC. 3. EXPANSION OF RESEARCH RELATING TO WOMEN VETERANS.

    (a) Health Research.--Section 109(a) of the Veterans Health Care 
Act of 1992 (Public Law 102-585; 38 U.S.C. 7303 note) is amended--
            (1) by inserting ``(1)'' before ``The Secretary'';
            (2) in paragraph (1), as so designated, by striking out 
        ``veterans who are women'' and inserting in lieu thereof 
        ``women veterans''; and
            (3) by adding at the end the following:
    ``(2) In carrying out this section, the Secretary shall consult 
with the following:
            ``(A) The Director of the Nursing Service.
            ``(B) Officials of the Central Office assigned 
        responsibility for women's health programs and sexual trauma 
        services.
            ``(C) The members of the Advisory Committee on Women 
        Veterans established under section 542 of title 38, United 
        States Code.
            ``(D) Members of appropriate task forces and working groups 
        within the Department of Veterans Affairs (including the Women 
        Veterans Working Group and the Task Force on Treatment of Women 
        Who Suffer Sexual Abuse).
    ``(3) The Secretary shall foster and encourage research under this 
section on the following matters as they relate to women:
            ``(A) Breast cancer.
            ``(B) Gynecological and reproductive health, including 
        gynecological cancer, infertility, sexually-transmitted 
        diseases, and pregnancy.
            ``(C) Human Immunodeficiency Virus and Acquired Immune 
        Deficiency Syndrome.
            ``(D) Mental health, including post-traumatic stress 
        disorder, depression, combat related stress, and trauma.
            ``(E) Diseases related to aging, including menopause, 
        osteoporosis, and Alzheimer's Disease.
            ``(F) Substance abuse.
            ``(G) Sexual violence and related trauma.
            ``(H) Exposure to toxic chemicals and other environmental 
        hazards.
    ``(4) The Secretary shall, to the maximum extent practicable, 
ensure that personnel of the Department of Veterans Affairs engaged in 
the research referred to in paragraph (1) include the following:
            ``(A) Personnel of the geriatric research, education, and 
        clinical centers designated pursuant to section 7314 of title 
        38, United States Code.
            ``(B) Personnel of the National Center for Post-Traumatic 
        Stress Disorder established pursuant to section 110(c) of the 
        Veterans Health Care Act of 1984 (Public Law 98-528; 98 Stat. 
        2692).
    ``(5) The Secretary shall ensure that personnel of the Department 
engaged in research relating to the health of women veterans are 
advised and informed of such research engaged in by other personnel of 
the Department.''.
    (b) Inclusion of Women and Minorities in Clinical Research 
Projects.--(1) In conducting or supporting clinical research, the 
Secretary of Veterans Affairs shall ensure that--
            (A) women who are veterans are included as subjects in each 
        project of such research; and
            (B) members of minority groups who are veterans are 
        included as subjects of such research.
    (2) The requirement in paragraph (1) regarding women and members of 
minority groups who are veterans may be waived by the Secretary of 
Veterans Affairs with respect to a project of clinical research if the 
Secretary determines that the inclusion, as subjects in the project, of 
women and members of minority groups, respectively--
            (A) is inappropriate with respect to the health of the 
        subjects;
            (B) is inappropriate with respect to the purpose of the 
        research; or
            (C) is inappropriate under such other circumstances as the 
        Secretary of Veterans Affairs may designate.
    (3) In the case of a project of clinical research in which women or 
members of minority groups will under paragraph (1) be included as 
subjects of the research, the Secretary of Veterans Affairs shall 
ensure that the project is designed and carried out so as to provide 
for a valid analysis of whether the variables being tested in the 
research affect women or members of minority groups, as the case may 
be, differently than other persons who are subjects of the research.
    (c) Population Study.--Section 110(a) of such Act (38 U.S.C. 1710 
note) is amended--
            (1) in paragraph (1), by striking out the second sentence; 
        and
            (2) by amending paragraph (3) to read as follows:
    ``(3)(A) Subject to subparagraph (B), the study shall be based on--
            ``(i) an appropriate sample of veterans who are women; and
            ``(ii) an examination of the medical and demographic 
        histories of the women comprising such sample.
    ``(B) The sample referred to in subparagraph (A) shall constitute a 
representative sampling (as determined by the Secretary) of the ages, 
the ethnic, social and economic backgrounds, the enlisted and officer 
grades, and the branches of service of all veterans who are women.
    ``(C) In carrying out the examination referred to in subparagraph 
(A)(ii), the Secretary shall determine the number of women of the 
sample who have used medical facilities of the Department, nursing home 
facilities of or under the jurisdiction of the Department, and 
outpatient care facilities of or under the jurisdiction of the 
Department.''.

SEC. 4. MAMMOGRAPHY QUALITY STANDARDS.

    (a) Applicability to Department of Veterans Affairs of Mammography 
Quality Standards Act of 1992.--Subsections (a) through (k) of section 
354 of the Public Health Service Act (42 U.S.C. 263b) shall apply with 
respect to facilities of the Department of Veterans Affairs without 
regard to the last sentence of subparagraph (A) of subsection (a)(3) of 
such section.
    (b) Extension of Deadlines.--Any deadline for the completion of any 
action prescribed under any provision referred to in subsection (a) 
shall be applied with respect to facilities of the Department of 
Veterans Affairs by extending such deadline so as to be two years after 
the date of the enactment of this Act or two years after the date which 
would otherwise be applicable under such provision, whichever is later.
    (c) Interagency Cooperation.--The Secretary of Veterans Affairs 
shall take appropriate steps to cooperate with the Secretary of Health 
and Human Services in the implementation of this section.