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[House Report 111-165]
[From the U.S. Government Publishing Office]

111th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 1st Session                                                    111-165

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

 
               WOMEN VETERANS HEALTH CARE IMPROVEMENT ACT

                                _______
                                

 June 18, 2009.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

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

                              R E P O R T

                        [To accompany H.R. 1211]

      [Including cost estimate of the Congressional Budget Office]

  The Committee on Veterans' Affairs, to whom was referred the 
bill (H.R. 1211) to amend title 38, United States Code, to 
expand and improve health care services available to women 
veterans, especially those serving in Operation Enduring 
Freedom and Operation Iraqi Freedom, from the Department of 
Veterans Affairs, and for other purposes, having considered the 
same, report favorably thereon with amendments and recommend 
that the bill as amended do pass.

                                CONTENTS

                                                                   Page
Amendment........................................................     2
Purpose and Summary..............................................     2
Background and Need for Legislation..............................     2
Hearings.........................................................     4
Subcommittee Consideration.......................................     4
Committee Consideration..........................................     5
Committee Votes..................................................     5
Committee Oversight Findings.....................................     5
Statement of General Performance Goals and Objectives............     5
New Budget Authority, Entitlement Authority, and Tax Expenditures     5
Earmarks and Tax and Tariff Benefits.............................     5
Committee Cost Estimate..........................................     5
Congressional Budget Office Estimate.............................     6
Federal Mandates Statement.......................................     8
Advisory Committee Statement.....................................     8
Constitutional Authority Statement...............................     8
Applicability to Legislative Branch..............................     8
Section-by-Section Analysis of the Legislation...................     8
Changes in Existing Law Made by the Bill as Reported.............    10

                               Amendment

    The amendment is as follows:
  The amendments (stated in terms of the page and line numbers 
of the introduced bill) are as follows:
  Page 10, strike line 17 and all that follows through the end 
of line 19, and insert the following:

```Sec. 1786. Hospital care and medical services for newborn children 
                    of women veterans receiving maternity care''.

  Page 11, line 1, strike ``14-day'' and insert ``seven-day''.
  Page 15, line 22, strike ``(a)(2)(a)'' and insert 
``(a)(2)(A)''.
  Page 16, line 8, strike ``(a)(2)(a)'' and insert 
``(a)(2)(A)''.

                          Purpose and Summary

    H.R. 1211 was introduced on February 26, 2009, by 
Representative Stephanie Herseth Sandlin of South Dakota, 
Chairwoman of the Subcommittee on Economic Opportunity of the 
Committee on Veterans' Affairs. This legislation would expand 
and improve health care services available to women veterans, 
especially those who served in Operation Enduring Freedom and 
Operation Iraqi Freedom (OEF/OIF). H.R. 1211 would require the 
Department of Veterans Affairs (VA) to implement a study on 
health care barriers and to conduct a comprehensive assessment 
of the VA's health care programs for women veterans. H.R. 1211, 
as amended, would provide medical care for newborn children of 
women veterans receiving maternity care; require training and 
certification for VA mental health care providers who provide 
care for veterans suffering from sexual trauma and post-
traumatic stress disorder; authorize a pilot program for child 
care assistance to certain veterans receiving health care 
services at VA facilities; and, mandate the addition of 
recently separated women and minority veterans to serve on VA 
advisory committees.

                  Background and Need for Legislation

    The VA is facing a growing challenge to provide equal 
access and high quality health care to the ever-increasing 
population of women veterans. Today, there are approximately 
1.7 million women veterans, or seven percent of the nearly 25 
million veterans. Assuming that current enrollment rates remain 
the same, the number of female veterans who use the VA system 
will double in the next five years, making female veterans one 
of the fastest growing subgroups of veterans.
    The Committee recognizes that the VA has made many 
improvements over the past two decades to the services offered 
to women veterans. For example, Public Law 98-160 (97 Stat. 
994) mandated the establishment of the Advisory Committee on 
Women Veterans and over a decade later, Public Law 103-446 (108 
Stat. 4668) established the Center for Women Veterans. These 
two entities have been instrumental in furthering the awareness 
of the needs and challenges women veterans face. While there 
have been some legislative changes, VA remains largely a male-
dominated physical environment.
    Today's women veterans face unique challenges and barriers 
when seeking health care through the VA. For example, many 
physical VA facilities still do not provide proper 
accommodations for women veterans and often lack changing 
tables in the bathrooms or spaces to ensure privacy for women. 
In addition, the lack of child care, newborn care, and gender-
sensitive care for military sexual trauma and post-traumatic 
stress disorder (PTSD) may hinder women veterans from seeking 
VA health care services.
    To better understand the barriers women veterans face when 
accessing health care, the VA has taken steps to initiate 
gender-specific research studies focused on women veterans. The 
VA is currently conducting a study to identify the changing 
health care needs of the growing women veteran population and 
the barriers they experience within the VA health care system. 
The Committee is concerned that the sample size of this study, 
about 3,500 women veterans from a universe of about 1.7 million 
women veterans, may be both insufficient and not entirely 
representative of the overall population of women veterans. 
H.R. 1211 would require the VA to build on this study by 
requiring a larger sample size and ensuring representation of 
women veterans from each Veterans Integrated Service Network 
(VISN). In addition, H.R. 1211 would require the VA to conduct 
a comprehensive assessment of women's health care programs at 
each VA medical facility. This includes an assessment of 
specialized programs for women with PTSD, homeless women, women 
who require care for substance abuse or mental illnesses, and 
women who require obstetric and gynecologic care. With a more 
complete understanding of the health care barriers and the 
current offering of special programs geared toward women 
veterans, the VA will be better equipped to meet the needs of 
the growing women veteran population.
    This growing women veteran population also includes a large 
subpopulation of women who are of childbearing age. In fact, of 
the OEF/OIF women veterans who are enrolled and access the VA 
health care system, almost all are under age 40. In fiscal year 
2008, the VA provided obstetric care to over 1,100 unique 
patients. While the VA provides prenatal and obstetric care to 
women veterans, they do not have the authority to treat or pay 
for the care of newborns. This is an inequity when compared to 
other Federal health care programs, since generous newborn care 
is provided through such programs as TRICARE Prime and CHAMPVA 
(Civilian Health and Medical Program of the Department of 
Veterans Affairs). H.R. 1211 would address this inequity by 
providing short-term newborn care for women veterans who 
receive their maternity care through the VA. Specifically, this 
provision allows for seven days of newborn care. According to 
the VA, 94 percent of mothers and their infants are released 
from VA medical facilities within the first seven days. In 
addition, this far exceeds the 48 to 96 hours of routine 
newborn care provided by private group health insurance 
policies. With this provision, women veterans will have the 
opportunity to make alternate arrangements and secure private 
health insurance for their newborns or enroll the infants in 
public insurance programs such as Medicaid or the State 
Children's Health Insurance Program.
    Related to the issue of newborns, the lack of child care is 
often cited as a key barrier to accessing health care by women 
veterans with young children. This is especially an issue for 
those who receive regular mental health or other intensive 
health care services. Without the assurance of proper child 
care, these women veterans are foregoing important services 
which are crucial to their well-being. To address this problem, 
H.R. 1211 would authorize the VA to implement a two-year pilot 
program providing child care in a minimum of three VISNs. The 
VA would have flexibility in designing the pilot program and 
would be required to provide a report which includes 
recommendations for the continuation or the expansion of this 
demonstration.
    Another issue facing the growing women veteran population 
is sexual trauma and PTSD. This is especially magnified by the 
changing role of women servicemembers in the current conflicts 
in Iraq and Afghanistan, as evidenced by Team Lioness who were 
the first female soldiers in U.S. history to be sent into 
direct ground combat. Because of the historical predominance of 
male veterans in VA health care settings, many VA providers 
have little or no exposure to women veterans. To address this, 
H.R. 1211 would require the VA to provide graduate medical 
education, training, certification, and continuing medical 
education for mental health professionals caring for veterans 
suffering from military sexual trauma and PTSD.
    To ensure that VA is responsive to the needs of OEF/OIF 
women veterans, who are accessing VA health care services at 
rates higher than women who served in previous conflicts, H.R. 
1211 would require the VA to add recently separated women and 
minority veterans to serve on the Advisory Committee on Women 
Veterans and the Advisory Committee on Minority Veterans.

                                Hearings

    On March 3, 2009, the Subcommittee on Health held a 
legislative hearing on several bills introduced during the 
111th Congress, including H.R. 1211.
    The following witnesses testified: The Honorable Niki 
Tsongas of Massachusetts; The Honorable Stephanie Herseth 
Sandlin of South Dakota; Joy J. Ilem, Assistant National 
Legislative Director, Disabled American Veterans; Joseph L. 
Wilson, Deputy Director, Veterans Affairs and Rehabilitation 
Commission, The American Legion; Eric A. Hilleman, Deputy 
Director, National Legislative Service, Veterans of Foreign 
Wars; Todd Bowers, Director of Government Affairs, Iraq and 
Afghanistan Veterans of America; and Gerald M. Cross, M.D., 
FAAFP, Principal Deputy Under Secretary for Health, U.S. 
Department of Veterans Affairs, accompanied by Walter Hall, 
Assistant General Counsel, U.S. Department of Veterans Affairs. 
Those submitting statements for the record included: The 
Honorable Bob Filner of California; Thomas J. Berger, Ph.D., 
Senior Analyst for Veterans' Benefits and Mental Health Issues, 
Vietnam Veterans of America; and, the Paralyzed Veterans of 
America.

                       Subcommittee Consideration

    On June 4, 2009, the Subcommittee on Health met in open 
markup session and ordered H.R. 1211, as amended, favorably 
forwarded to the full Committee by voice vote. During 
consideration of the bill, the following amendment was 
considered:
          An amendment by Mr. Michaud of Maine to amend the 
        number of days of newborn care was agreed to by voice 
        vote.

                        Committee Consideration

    On June 10, 2009, the full Committee met in an open markup 
session, a quorum being present, and ordered H.R. 1211, as 
amended, reported favorably to the House of Representatives by 
voice vote.

                            Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list the record votes 
on the motion to report the legislation and amendments thereto. 
There were no record votes taken on amendments or in connection 
with ordering H.R. 1211 reported to the House. A motion by Mr. 
Stearns of Florida to order H.R. 1211, as amended, reported 
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 reflected in the descriptive portions 
of this report.

   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. 1211 does not contain any congressional earmarks, 
limited tax benefits, or limited tariff benefits as defined in 
clause 9(d), 9(e), or 9(f) 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. 
1211 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. 1211 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, June 16, 2009.
Hon. Bob Filner,
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. 1211, the Women 
Veterans Health Care Improvement Act.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Sunita 
D'Monte.
            Sincerely,
                                              Douglas W. Elmendorf.
    Enclosure.

H.R. 1211--Women Veterans Health Care Improvement Act

    Summary: H.R. 1211 would authorize several programs for 
women veterans. CBO estimates that implementing the bill would 
cost about $160 million over the 2010-2014 period, assuming 
appropriation of the authorized and estimated amounts. Enacting 
the bill would not affect direct spending or revenues.
    H.R. 1211 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act (UMRA).
    Estimated cost to the Federal Government: The estimated 
budgetary impact of H.R. 1211 is shown in the following table. 
The costs of this legislation fall within budget function 700 
(veterans benefits and services).
    Basis of estimate: The bill would authorize the 
appropriation of $10.5 million in 2010 and $1.5 million in 2011 
for a comprehensive assessment of health care programs at the 
Department of Veterans Affairs (VA), a study on women veterans, 
and a pilot program to provide child care. In addition to those 
specified amounts, CBO estimates that other programs authorized 
in the bill would require the appropriation of $152 million 
over the 2010-2014 period for care provided to newborns and 
certain training for mental health providers. In total, CBO 
estimates that implementing the bill would cost $160 million 
over the 2010-2014 period, assuming appropriation of the 
specified and estimated amounts.

----------------------------------------------------------------------------------------------------------------
                                                                 By fiscal year, in millions of dollars.--
                                                         -------------------------------------------------------
                                                            2010     2011     2012     2013     2014   2010-2014
----------------------------------------------------------------------------------------------------------------
                                  CHANGES IN SPENDING SUBJECT TO APPROPRIATION

Care for Newborns:
    Estimated Authorization Level.......................       18       20       21       22       24       105
    Estimated Outlays...................................       16       19       21       22       24       102
Training for Mental Health Providers:
    Estimated Authorization Level.......................       10        9        9        9       10        47
    Estimated Outlays...................................        9        9        9        9       10        46
Assessment of Health Care Programs:
    Authorization Level.................................        5        0        0        0        0         5
    Estimated Outlays...................................        5        *        *        *        0         5
Study on Women Veterans:
    Authorization Level.................................        4        0        0        0        0         4
    Estimated Outlays...................................        4        *        *        0        0         4
Pilot Program on Child Care:
    Authorization Level.................................        2        2        0        0        0         3
    Estimated Outlays...................................        1        2        *        *        0         3
    Total Changes:
        Estimated Authorization Level...................       39       31       30       31       34       165
        Estimated Outlays...............................       35       30       30       31       34      160
----------------------------------------------------------------------------------------------------------------
Note: Components may not sum to totals because of rounding; * = less than $500,000.

    For this estimate, CBO assumes the legislation will be 
enacted near the start of fiscal year 2010, that the specified 
and estimated authorizations will be appropriated near the 
start of each fiscal year, and that outlays will follow 
historical patterns for similar and existing programs.
    Care for Newborns. Section 201 would authorize VA to 
provide care for up to seven days to the newborn children of 
female veterans who receive maternity care through the 
department. Based on data from VA, CBO estimates that about 
6,600 babies would become eligible for such care in 2010 at an 
average cost of $2,770 per baby. After adjusting for inflation 
and population growth--the number of female veterans of 
childbearing age is expected to rise in future years--CBO 
estimates that implementing this provision would cost $102 
million over the 2010-2014 period.
    Training for Mental Health Providers. Section 202 would 
require VA to educate, train, and certify mental health 
professionals who specialize in treating sexual trauma. Based 
on information from VA's Office of Mental Health Services, CBO 
estimates that VA would need 66 employees a year to provide 
training at a cost of about $46 million over the 2010-2014 
period.
    Assessment of Health Care Programs. Section 102 would 
require the Secretary to undertake a comprehensive assessment 
of VA's health care programs for women and would authorize the 
appropriation of $5 million for that purpose.
    Study on Women Veterans. Section 101 would require the 
Secretary to conduct a study on the barriers faced by women 
veterans in receiving VA health care and would authorize the 
appropriation of $4 million for that purpose.
    Pilot Program for Child Care. Section 203 would require VA 
to implement a pilot program providing child care for certain 
female veterans who use VA medical facilities, and would 
authorize annual appropriations of $1.5 million for 2010 and 
2011 for that purpose.
    Intergovernmental and private-sector impact. H.R. 1211 
contains no intergovernmental or private-sector mandates as 
defined in UMRA. Any costs to state or local governments or 
public entities would be incurred voluntarily.
    Estimate prepared by: Federal Costs: Sunita D'Monte; Impact 
on State, Local, and Tribal Governments: Shannon Fairchild; 
Impact on the Private Sector: Elizabeth Bass.
    Estimate approved by: Theresa Gullo, Deputy Assistant 
Director for Budget Analysis.

                       Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates regarding H.R. 1211 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. 
1211.

                   Constitutional Authority Statement

    Pursuant to clause 3(d)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee finds that the 
Constitutional authority for H.R. 1211 is provided by Article 
I, section 8 of the Constitution of the United States.

                  Applicability to Legislative Branch

    The Committee finds that the legislation 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.

             Section-by-Section Analysis of the Legislation

Section 101. Study of barriers for women veterans to health care from 
        the Department of Veterans Affairs

    This section authorizes the VA to conduct a comprehensive 
study, building on the work of the existing VA study (the 
National Survey of Women Veterans in Fiscal Year 2007-2008) on 
the barriers faced by women veterans in accessing care in the 
VA health care system. The Study is to include a survey of 
women veterans who use the VA for their health care and those 
who do not use the VA. This survey is to be administered to a 
representative sample of women veterans from each VISN which is 
of sufficient sample size for the study results to be 
statistically significant. Required elements of the study 
include perceived stigma with seeking mental health care 
services; effect of driving distance or availability of 
transportation to the nearest medical facility; availability of 
child care; acceptability of integrated primary care and 
women's health clinics; understanding of eligibility 
requirements for and scope of services available at the medical 
center; perceptions of personal safety; gender sensitivity of 
health care providers and staff; effectiveness of outreach; 
location and operating hours of health care facilities; and, 
other significant barriers identified by the Secretary of VA.
    This section also requires the VA to submit to Congress an 
implementation report no later than six months after the date 
the VA publishes a final report on its current study and a 
report no later than 30 months after the date of the VA 
publishing a final report on the study.
    This section authorizes appropriations of $4 million to 
carry out the study.

Section 102. Comprehensive assessment of women's health care programs 
        of the Department of Veterans Affairs

    This section requires the VA to conduct a comprehensive 
assessment of the women's health care programs at each VA 
medical center. The assessment is to include information on 
demographics of the women veterans population; frequency with 
which health care services are available and provided for women 
veterans; sites where such services are available and provided; 
and, the impact of waiting lists, geographic distance, and, 
other factors in obstructing the receipt of services. Upon 
conclusion of this comprehensive assessment, the VA is to 
develop a plan to improve services for women veterans at each 
VA medical center.
    This section requires the VA to submit to Congress a report 
no later than one year after the date of the enactment of the 
Act and a GAO report is required no later than six months after 
the VA submits the report, and authorizes $5 million in 
appropriations to carry out the assessment.

Section 201. Medical care for newborn children of women veterans 
        receiving maternity care

    This section authorizes the VA to provide medical care for 
newborn children of women veterans receiving maternity care for 
a period of seven days beginning on the date of the birth of 
the child.

Section 202. Training and certification for mental health care 
        providers of the Department of Veterans Affairs on care for 
        veterans suffering from sexual trauma and post-traumatic stress 
        disorder

    This section mandates the VA to carry out a program to 
provide graduate medical education, training, certification, 
and continuing medical education for mental health 
professionals at the VA caring for veterans suffering from 
military sexual trauma and PTSD.
    This section requires an annual report to Congress covering 
the number of mental health professionals, graduate medical 
education trainees, and primary care providers certified under 
the program required by this provision; number of women 
veterans who received counseling, care, and services; number of 
graduate medical education, training, certification, and 
continuing medical education courses provided; number of 
trained full-time employees required at each VA facility to 
meet the needs of sexual trauma and PTSD; and any recommended 
improvements for treating women veterans with sexual trauma and 
PTSD.

Section 203. Pilot program for provision of child care assistance to 
        certain veterans receiving certain types of health care 
        services at department facilities

    This section authorizes appropriations of $1.5 million 
annually for FY 2010 and FY 2011 for the VA to conduct a child 
care pilot program in at least three VISNs. Covered veterans 
include those receiving regular mental health care services, 
intensive mental health care services, and any other intensive 
health care services deemed appropriate by the Secretary. Child 
care assistance may include stipends for child care offered by 
licensed child care centers either directly to the providers or 
through a voucher program; development of partnerships with 
private agencies; collaboration with facilities or programs of 
other Federal agencies; and, the arrangement of after-school 
care.

Section 204. Addition of recently separated women and minority veterans 
        to serve on advisory committees

    This section requires the VA to add recently-separated 
women and minority veterans to serve on the Advisory Committee 
on Women Veterans and the Advisory Committee on Minority 
Veterans, respectively.

         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, existing law in which no change is 
proposed is shown in roman):

TITLE 38, UNITED STATES CODE

           *       *       *       *       *       *       *

PART I--GENERAL PROVISIONS

           *       *       *       *       *       *       *

CHAPTER 5--AUTHORITY AND DUTIES OF THE SECRETARY

           *       *       *       *       *       *       *

SUBCHAPTER III--ADVISORY COMMITTEES

           *       *       *       *       *       *       *

Sec. 542. Advisory Committee on Women Veterans

  (a)(1) * * *
  (2)(A) The Committee shall consist of members appointed by 
the Secretary from the general public, including--
          (i) * * *
          (ii) individuals who are recognized authorities in 
        fields pertinent to the needs of women veterans, 
        including the gender-specific health-care needs of 
        women; [and]
          (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 who are recently separated veterans.

           *       *       *       *       *       *       *

Sec. 544. Advisory Committee on Minority Veterans

  (a)(1) * * *
  (2)(A) The Committee shall consist of members appointed by 
the Secretary from the general public, including--
          (i) * * *

           *       *       *       *       *       *       *

          (iii) veterans who are minority group members and who 
        have experience in a military theater of operations; 
        [and]
          (iv) veterans who are minority group members and who 
        do not have such experience[.]; and
          (v) recently separated veterans who are minority 
        group members.

           *       *       *       *       *       *       *

PART II--GENERAL BENEFITS

           *       *       *       *       *       *       *

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

Sec.
1701. Definitions.
     * * * * * * *
1786. Hospital care and medical services for newborn children of women 
          veterans receiving maternity care.

           *       *       *       *       *       *       *

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

           *       *       *       *       *       *       *

Sec. 1720D. Counseling and treatment for sexual trauma

  (a) * * *

           *       *       *       *       *       *       *

  (d) 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). In carrying out such program, 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 and 
post-traumatic stress disorder.
  (e) The Secretary shall submit to Congress an annual report 
on the counseling, care, and services provided to veterans 
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 women veterans who received 
        counseling and care and services under subsection (a) 
        from professionals and providers who received training 
        under subsection (d).
          (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 veterans requiring treatment and 
        care for sexual trauma and post-traumatic stress 
        disorder.
          (5) Any recommended improvements for treating women 
        veterans with sexual trauma and post-traumatic stress 
        disorder.
          (6) Such other information as the Secretary 
        determines to be appropriate.
  [(d)] (f) In this section, the term ``sexual harassment'' 
means repeated, unsolicited verbal or physical contact of a 
sexual nature which is threatening in character.

           *       *       *       *       *       *       *

SUBCHAPTER VIII--HEALTH CARE OF PERSONS OTHER THAN VETERANS

           *       *       *       *       *       *       *

Sec. 1786. Hospital care and medical services for newborn children of 
                    women veterans receiving maternity care

  In the case of a child of a woman veteran who is receiving 
hospital care or medical services at a Department facility (or 
in another facility pursuant to a contract entered into by the 
Secretary) relating to the birth of that child, the Secretary 
may furnish hospital care and medical services to that child at 
that facility during the seven-day period beginning on the date 
of the birth of the child.

           *       *       *       *       *       *       *

                                  
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