Defense Women's Health Improvement Act of 1993

SECTION 1. SHORT TITLE.

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

                      TITLE I--WOMEN'S HEALTH CARE

SEC. 101. PRIMARY AND PREVENTIVE HEALTH-CARE SERVICES FOR WOMEN.

    (a) Female Members and Retirees of the Uniformed Services.--(1) 
Chapter 55 of title 10, United States Code, is amended by inserting 
after section 1074c the following new section:
``Sec. 1074d. Primary and preventive health-care services for women
    ``Female members and former members of the uniformed services who 
are entitled to medical care under section 1074 or 1074a of this title 
shall be furnished with primary and preventive health-care services for 
women as part of such medical care.''.
    (2) The table of sections at the beginning of such chapter is 
amended by inserting after the item relating to section 1074c the 
following new item:

``1074d. Primary and preventive health-care services for women.''.
    (b) Female Dependents.--Section 1077(a) of such title is amended by 
adding at the end the following new paragraph:
            ``(13) Primary and preventive health-care services for 
        women.''.
    (c) Definition.--Section 1072 of such title is amended by adding at 
the end the following new paragraph:
            ``(6) The term `primary and preventive health-care services 
        for women' means health-care services provided to women, 
        including counseling, relating to the following:
                    ``(A) Papanicolaou tests (pap smear).
                    ``(B) Breast examinations and mammography.
                    ``(C) Comprehensive reproductive health care, 
                including care related to pregnancy.
                    ``(D) Infertility and sexually transmitted 
                diseases, including prevention.
                    ``(E) Menopause.
                    ``(F) Physical or psychological conditions arising 
                out of acts of sexual violence.''.

SEC. 102. REPORT ON THE PROVISION OF HEALTH-CARE SERVICES TO WOMEN.

    (a) Report Required.--The Secretary of Defense shall prepare a 
report evaluating the provision of health-care services through 
military medical treatment facilities and the Civilian Health and 
Medical Program of the Uniformed Services to female members of the 
uniformed services and female covered beneficiaries eligible for health 
care under chapter 55 of title 10, United States Code.
    (b) Contents.--The report required by subsection (a) shall contain 
the following:
            (1) A description of the medical personnel of the 
        Department of Defense who provided health-care services during 
        fiscal year 1993 to female members and covered beneficiaries, 
        including--
                    (A) the number of such personnel (including both 
                the number of individual employees and the number of 
                full-time employee equivalents);
                    (B) the professional qualifications or specialty 
                training of such personnel; and
                    (C) the medical facilities to which such personnel 
                were assigned.
            (2) A description of any actions, including the use of 
        special pays and incentives, taken by the Secretary during 
        fiscal year 1993--
                    (A) to ensure the retention of the medical 
                personnel described in paragraph (1);
                    (B) to recruit additional personnel to provide 
                health-care services to female members and female 
                covered beneficiaries; and
                    (C) to replace departing personnel who provided 
                such services.
            (3) A description of any existing or proposed programs to 
        encourage specialization of health care professionals in fields 
        related to primary and preventive health-care services for 
        women.
            (4) An assessment of any difficulties experienced by 
        military medical treatment facilities or the Civilian Health 
        and Medical Program of the Uniformed Services in furnishing 
        primary and preventive health-care services for women and a 
        description of those actions taken by the Secretary to resolve 
        such difficulties.
            (5) An assessment of the extent to which gender-related 
        factors impede or complicate diagnoses (such as inappropriate 
        psychiatric referrals and admissions) made by medical personnel 
        described in paragraph (1).
            (6) A description of the actions taken by the Secretary to 
        foster and encourage the expansion of research relating to 
        health care issues of concern to female members of the 
        uniformed services and female covered beneficiaries.
    (c) Population Study of the Need of Female Members and Female 
Covered Beneficiaries for Health-Care Services.--(1) As part of the 
report required by subsection (a), the Secretary shall conduct a study 
to determine the needs of female members of the uniformed services and 
female covered beneficiaries for health-care services, including 
primary and preventive health-care services for women.
    (2) The study shall examine the health needs of current members and 
covered beneficiaries and future members and covered beneficiaries 
based upon the anticipated size and composition of the Armed Forces in 
the year 2000 and should be based on the demographics of society as a 
whole.
    (d) Submission and Revision.--The Secretary of Defense shall submit 
the report required by subsection (a) to Congress not later than April 
1, 1994. The Secretary shall revise and resubmit the report to Congress 
not later than April 1, 1999.
    (e) Definitions.--For purposes of this section:
            (1) The term ``primary and preventive health care services 
        for women'' has the meaning given such term in paragraph (6) of 
        section 1072 of title 10, United States Code, as added by 
        section 101(c)).
            (2) The term ``covered beneficiary'' has the meaning given 
        such term in paragraph (5) of such section.

                   TITLE II--WOMEN'S HEALTH RESEARCH

SEC. 201. DEFENSE WOMEN'S HEALTH RESEARCH CENTER.

    (a) Establishment of the Center.--The Secretary of Defense shall 
establish a Defense Women's Health Research Center (hereinafter in this 
section referred to as the ``Center'') in the Department of the Army. 
The Center shall be under the authority of the Army Health Services 
Command.
    (b) Purposes.--(1) The Center shall be the coordinating agent for 
multidisciplinary and multiinstitutional research within the Department 
of Defense on women's health issues related to service in the Armed 
Forces. The Center shall be dedicated to development and application of 
new knowledge, procedures, techniques, training, and equipment for the 
improvement of the health of women in the Armed Forces.
    (2) In carrying out or sponsoring research studies, the Center 
shall provide that the cohort of women in the Armed Forces shall be 
considered as a control groups.
    (3) The Center shall support the goals and objectives recognized by 
the Department of Defense under the plan of the Department of Health 
and Human Services designated as ``Healthy People 2000''.
    (4) The Center shall support initiation and expansion of research 
into matters relating to women's health in the military, including the 
following matters as they relate to women in the military:
            (A) Combat stress and trauma.
            (B) Exposure to toxins and other environmental hazards 
        associated with military hardware.
            (C) Psychology related stresses in warfare situations.
            (D) Breast cancer.
            (E) Reproductive health, including pregnancy.
            (F) Gynecological cancers.
            (G) Infertility and sexually transmitted diseases.
            (H) HIV and AIDS.
            (I) Mental health, including post-traumatic stress disorder 
        and depression.
            (J) Menopause, osteoporosis, Alzheimer's disease, and other 
        conditions and diseases related to aging.
            (K) Substance abuse.
            (L) Sexual violence and related trauma.
            (M) Human factor studies related to women in combat.
    (c) Preparation of a Plan.--The Secretary of Defense, acting 
through the Secretary of the Army and in coordination with the other 
military departments, shall prepare a plan for the implementation of 
this section. The plan shall be submitted to the Committees on Armed 
Services of the Senate and House of Representatives before May 1, 1994.
    (d) Requirements Relating to Establishment of Center.--(1) The 
Secretary shall provide for the establishment of the Center at an 
existing Army facility.
    (2) The Center may be established only at a facility having the 
following characteristics:
            (A) A physical plant immediately available to serve as 
        headquarters for the medical activities to be carried out by 
        the Center.
            (B) Ongoing fellowship and residency programs colocated 
        with ongoing collaborative health-related and interdisciplinary 
        research of (i) a facility of the Department of Veterans 
        Affairs, (ii) an accredited university with specialties in 
        medical research and clinical diagnostics, and (iii) a hospital 
        owned and operated by a municipality.
            (C) A technologically modern laboratory capability at the 
        site and at the affiliated sites referred to in subparagraph 
        (B), with the capability to include state-of-the-art clinical 
        diagnostic instrumentation, data processing, telecommunication, 
        and data storage systems.
            (D) Compatibility with and capability to effectively expand 
        its existing mission in accordance with the mission of the 
        Center under this section.
            (E) Maximum multi-State geographic jurisdiction to permit 
        regional health-related issues to be researched and integrated 
        into national military databases.
            (F) An existing relationship for the provision of services 
        to Native Americans through the Indian Health Service.
    (e) Activities for Fiscal Year 1994.--During fiscal year 1994, the 
Center shall address the following:
            (1) Program planning, infrastructure development, baseline 
        information gathering, technology infusion, and connectivity.
            (2) Management and technical staffing.
            (3) Data base development of health issues related to 
        service on active duty as compared to service in the National 
        Guard or Reserves.
            (4) Research protocols, cohort development, health 
        surveillance and epidemiologic studies.

SEC. 202. CONTINUATION OF ARMY BREAST CANCER RESEARCH PROGRAM.

    During fiscal year 1994, the Secretary of the Army shall continue 
the breast cancer research program established in the second and third 
provisos in the paragraph in title IV of the Department of Defense 
Appropriations Act, 1993 (Public Law 102-396; 106 Stat. 1890) under the 
heading ``Research, Development, Test, and Evaluation, Army'' .

SEC. 203. INCLUSION OF WOMEN AND MINORITIES IN CLINICAL RESEARCH 
              PROJECTS.

    (a) General Rule.--In conducting or supporting clinical research, 
the Secretary of Defense shall ensure that--
            (1) women who are members of the Armed Forces are included 
        as subjects in each project of such research; and
            (2) members of minority groups who are members of the Armed 
        Forces are included as subjects of such research.
    (b) Waiver Authority.--The requirement in subsection (a) regarding 
women and members of minority groups who are members of the Armed 
Forces may be waived by the Secretary of Defense 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--
            (1) is inappropriate with respect to the health of the 
        subjects;
            (2) is inappropriate with respect to the purpose of the 
        research; or
            (3) is inappropriate under such other circumstances as the 
        Secretary of Defense may designate.
    (c) Requirement for Analysis of Research.--In the case of a project 
of clinical research in which women or members of minority groups will 
under subsection (a) be included as subjects of the research, the 
Secretary of Defense 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.

SEC. 204. REPORT ON RESEARCH RELATING TO FEMALE MEMBERS OF THE 
              UNIFORMED SERVICES AND FEMALE COVERED BENEFICIARIES.

    Not later than July 1 of each of 1995, 1996, and 1997, the 
Secretary of Defense shall submit to Congress a report containing--
            (1) a description (as of May 31 of the year in which the 
        report is submitted) of the status of any health research that 
        is being carried out by or under the jurisdiction of the 
        Secretary relating to female members of the uniformed services 
        and female covered beneficiaries under chapter 55 of title 10, 
        United States Code; and
            (2) recommendations of the Secretary as to future health 
        research (including a proposal for any legislation relating to 
        such research) relating to such female members and covered 
        beneficiaries.

                  TITLE III--WOMEN'S HEALTH EDUCATION

SEC. 301. WOMEN'S HEALTH CURRICULUM ADVISORY COMMITTEE.

    The Secretary of Defense shall establish at the F. Edward Hebert 
School of Medicine of the Uniformed Services University of the Health 
Sciences a women's health curriculum advisory committee to promote the 
comprehensive integration of women's health issues into the curriculum 
at the University. The committee shall include the surgeon general of 
each of the military departments and the dean of the School of 
Medicine. The committee shall be established by April 1, 1994.

Summary: TABLE OF CONTENTS: Title I: Women's Health Care Title II: Women's Health Research Title III: Women's Health Education Defense Women's Health Improvement Act of 1993 - Title I: Women's Health Care - Requires female members and former members of the armed forces who are entitled to medical care under the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) to be furnished primary and preventive health care services for women as part of such care. Provides the same coverage for female dependents of members and former members of the armed forces. Directs the Secretary of Defense to prepare and submit to the Congress a report evaluating the provision of health care services through military medical treatment facilities and CHAMPUS to female members of the armed forces and female covered beneficiaries. Requires the Secretary to include a study to determine the needs of female members and dependents for health care services, including primary and preventive health care services for women. Title II: Women's Health Research - Directs the Secretary to establish a Defense Women's Health Research Center within the Department of the Army to be the coordinating agent for multidisciplinary and multiinstitutional research within the Department of Defense on women's health issues related to service in the armed forces. Directs the Secretary of the Army, during FY 1994, to continue the breast cancer research program as established under prior law. Directs the Secretary of Defense, in conducting or supporting clinical research, to ensure that women and minority group members of the armed forces are included as research subjects. Provides a waiver of such requirement. Directs the Secretary to submit three annual reports on research relating to female members and dependents within the armed forces. Title III: Women's Health Education - Directs the Secretary to establish at the F. Edward Hebert School of Medicine of the Uniformed Services University of the Health Sciences a women's health curriculum advisory committee to promote the comprehensive integration of women's health issues into the curriculum.