II 

Calendar No. 185 

113TH CONGRESS 

1ST SESSION S. 131 

[Report No. 113–106] 

To amend title 38, United States Code, to improve the reproductive assistance 

provided by the Department of Veterans Affairs to severely wounded, 

ill, or injured veterans and their spouses, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

JANUARY 24 (legislative day, JANUARY 3), 2013 

Mrs. MURRAY (for herself, Mr. BEGICH, Mr. TESTER, and Mr. BLUMENTHAL) 

introduced the following bill; which was read twice and referred to the 

Committee on Veterans’ Affairs 

SEPTEMBER 17, 2013 

Reported by Mr. SANDERS, with an amendment 

[Strike out all after the enacting clause and insert the part printed in italic] 

A BILL 

To amend title 38, United States Code, to improve the 

reproductive assistance provided by the Department of 

Veterans Affairs to severely wounded, ill, or injured veterans and their spouses, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Women Veterans and 

3 Other Health Care Improvements Act of 2013’’. 

4 SEC. 2. CLARIFICATION THAT FERTILITY COUNSELING AND 

5 TREATMENT ARE MEDICAL SERVICES WHICH 

6 THE SECRETARY MAY FURNISH TO VET7 ERANS LIKE OTHER MEDICAL SERVICES. 

8 Section 1701(6) of title 38, United States Code, is 

9 amended by adding at the end the following new subpara10 graph: 

11 ‘‘(H) Fertility counseling and treatment, 

12 including treatment using assisted reproductive 

13 technology.’’. 

14 SEC. 3. REPRODUCTIVE TREATMENT AND CARE FOR 

15 SPOUSES AND SURROGATES OF VETERANS. 

16 (a) IN GENERAL.—Subchapter VIII of chapter 17 of 

17 title 38, United States Code, is amended by adding at the 

18 end the following new section: 

19 ‘‘§ 1788. Reproductive treatment and care for spouses 

20 and surrogates of veterans 

21 ‘‘(a) IN GENERAL.—The Secretary shall furnish fer22 tility counseling and treatment, including through the use 

23 of assisted reproductive technology, to a spouse or surro24 gate of a severely wounded, ill, or injured veteran who has 

25 an infertility condition incurred or aggravated in line of 

26 duty in the active military, naval, or air service and who 


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1 is enrolled in the system of annual patient enrollment es2 tablished under section 1705(a) of this title if the spouse 

3 or surrogate and the veteran apply jointly for such coun4 seling and treatment through a process prescribed by the 

5 Secretary. 

6 ‘‘(b) COORDINATION OF CARE FOR OTHER SPOUSES

7 AND SURROGATES.—In the case of a spouse or surrogate 

8 of a veteran not described in subsection (a) who is seeking 

9 fertility counseling and treatment, the Secretary may co10 ordinate fertility counseling and treatment for such spouse 

11 or surrogate. 

12 ‘‘(c) CONSTRUCTION.—Nothing in this section shall 

13 be construed to require the Secretary— 

14 ‘‘(1) to find or certify a surrogate for a veteran 

15 or to connect a surrogate with a veteran; or 

16 ‘‘(2) to furnish maternity care to a spouse or 

17 surrogate of a veteran. 

18 ‘‘(d) ASSISTED REPRODUCTIVE TECHNOLOGY DE19 FINED.—In this section, the term ‘assisted reproductive 

20 technology’ includes in vitro fertilization and other fertility 

21 treatments in which both eggs and sperm are handled 

22 when clinically appropriate.’’. 

23 (b) CLERICAL AMENDMENT.—The table of sections 

24 at the beginning of chapter 17 of such title is amended 


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1 by inserting after the item relating to section 1787 the 

2 following new item: 

‘‘1788. Reproductive treatment and care for spouses and surrogates of veterans.’’. 

3 SEC. 4. ADOPTION ASSISTANCE FOR SEVERELY WOUNDED 

4 VETERANS. 

5 (a) IN GENERAL.—Subchapter VIII of chapter 17 of 

6 title 38, United States Code, as amended by section 3, 

7 is further amended by adding at the end the following new 

8 section: 

9 ‘‘§ 1789. Adoption assistance 

10 ‘‘(a) IN GENERAL.—The Secretary may pay an 

11 amount, not to exceed the limitation amount, to assist a 

12 covered veteran in the adoption of one or more children. 

13 ‘‘(b) COVERED VETERAN.—For purposes of this sec14 tion, a covered veteran is any severely wounded, ill, or in15 jured veteran who— 

16 ‘‘(1) has an infertility condition incurred or ag17 gravated in line of duty in the active military, naval, 

18 or air service; and 

19 ‘‘(2) is enrolled in the system of annual patient 

20 enrollment established under section 1705(a) of this 

21 title. 

22 ‘‘(c) LIMITATION AMOUNT.—For purposes of this 

23 section, the limitation amount is the amount equal to the 

24 lesser of— 


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1 ‘‘(1) the cost the Department would incur if the 

2 Secretary were to provide a covered veteran with one 

3 cycle of in vitro fertilization, as determined by the 

4 Secretary; and 

5 ‘‘(2) the cost the Department would incur by 

6 paying the expenses of three adoptions by covered 

7 veterans, as determined by the Secretary.’’. 

8 (b) CLERICAL AMENDMENT.—The table of sections 

9 at the beginning of chapter 17 of such title, as amended 

10 by section 3, is further amended by inserting after the 

11 item relating to section 1788 the following new item: 

‘‘1789. Adoption assistance.’’. 

12 SEC. 5. ANNUAL REPORT ON PROVISION OF FERTILITY 

13 COUNSELING AND TREATMENT FURNISHED 

14 BY DEPARTMENT OF VETERANS AFFAIRS. 

15 (a) IN GENERAL.—Not later than one year after the 

16 date of the enactment of this Act and not less frequently 

17 than once each year thereafter, the Secretary of Veterans 

18 Affairs shall submit to the Committee on Veterans’ Affairs 

19 of the Senate and the Committee on Veterans’ Affairs of 

20 the House of Representatives a report on the fertility 

21 counseling and treatment furnished by the Department of 

22 Veterans Affairs during the year preceding the submittal 

23 of the report. 


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1 (b) ELEMENTS.—Each report submitted under sub2 section (a) shall include, for the period covered by the re3 port, the following: 

4 (1) The number of veterans who received fer5 tility counseling or treatment furnished by the De6 partment of Veterans Affairs, disaggregated by era 

7 of military service of such veterans. 

8 (2) The number of spouses and surrogates of 

9 veterans who received fertility counseling or treat10 ment furnished by the Department. 

11 (3) The cost to the Department of furnishing 

12 fertility counseling and treatment, disaggregated by 

13 cost of services and administration. 

14 (4) The average cost to the Department per re15 cipient of such counseling and treatment. 

16 (5) In cases in which the Department furnished 

17 fertility treatment through the use of assisted repro18 ductive technology, the average number of cycles per 

19 person furnished. 

20 (6) A description of how fertility counseling and 

21 treatment services of the Department are coordi22 nated with similar services of the Department of De23 fense. 


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1 SEC. 6. REGULATIONS ON FURNISHING OF FERTILITY 

2 COUNSELING AND TREATMENT AND ADOP3 TION ASSISTANCE BY DEPARTMENT OF VET4 ERANS AFFAIRS. 

5 (a) IN GENERAL.—Not later than 540 days after the 

6 date of the enactment of this Act, the Secretary of Vet7 erans Affairs shall prescribe regulations— 

8 (1) on the furnishing of fertility treatment to 

9 veterans using assisted reproductive technology; 

10 (2) to carry out section 1788 of title 38, United 

11 States Code, as added by section 3; and 

12 (3) to carry out section 1789 of such title, as 

13 added by section 4. 

14 (b) LIMITATION.—Notwithstanding any other provi15 sion of law, during the period beginning on the date of 

16 the enactment of this Act and ending on the date on which 

17 the Secretary prescribes regulations under subsection (a), 

18 the Secretary may not furnish— 

19 (1) to a veteran any fertility treatment that 

20 uses an assisted reproductive technology that the 

21 Secretary has not used in the provision of a fertility 

22 treatment to a veteran before the date of the enact23 ment of this Act; 

24 (2) any fertility counseling or treatment under 

25 section 1788 of title 38, United States Code, as 

26 added by section 3; or 


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1 (3) any assistance under section 1789 of such 

2 title, as added by section 4. 

3 (c) ASSISTED REPRODUCTIVE TECHNOLOGY DE4 FINED.—In this section, the term ‘‘assisted reproductive 

5 technology’’ has the meaning given the term in section 

6 1788 of such title, as added by section 3. 

7 SEC. 7. COORDINATION BETWEEN DEPARTMENT OF VET8 ERANS AFFAIRS AND DEPARTMENT OF DE9 FENSE ON FURNISHING OF FERTILITY COUN10 SELING AND TREATMENT. 

11 The Secretary of Veterans Affairs and the Secretary 

12 of Defense shall share best practices and facilitate refer13 rals, as they consider appropriate, on the furnishing of fer14 tility counseling and treatment. 

15 SEC. 8. FACILITATION OF REPRODUCTION AND INFER16 TILITY RESEARCH. 

17 (a) IN GENERAL.—Subchapter II of chapter 73 of 

18 title 38, United States Code, is amended by adding at the 

19 end the following new section: 

20 ‘‘§ 7330B. Facilitation of reproduction and infertility 

21 research 

22 ‘‘(a) FACILITATION OF RESEARCH REQUIRED.—The 

23 Secretary shall facilitate research conducted collabo24 ratively by the Secretary of Defense and the Secretary of 

25 Health and Human Services to improve the ability of the 


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1 Department of Veterans Affairs to meet the long-term re2 productive health care needs of veterans who have a geni3 tourinary service-connected disability or a condition that 

4 was incurred or aggravated in line of duty in the active 

5 military, naval, or air service, such as spinal cord injury, 

6 that affects the veterans’ ability to reproduce. 

7 ‘‘(b) DISSEMINATION OF INFORMATION.—The Sec8 retary shall ensure that information produced by the re9 search facilitated under this section that may be useful 

10 for other activities of the Veterans Health Administration 

11 is disseminated throughout the Veterans Health Adminis12 tration.’’. 

13 (b) CLERICAL AMENDMENT.—The table of sections 

14 at the beginning of chapter 73 of such title is amended 

15 by inserting after the item relating to section 7330A the 

16 following new item: 

‘‘7330B. Facilitation of reproduction and infertility research.’’. 

17 (c) REPORT.—Not later than three years after the 

18 date of the enactment of this Act, the Secretary of Vet19 erans Affairs shall submit to Congress a report on the re20 search activities conducted by the Secretary under section 

21 7330B of title 38, United States Code, as added by sub22 section (a). 


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1 SEC. 9. REQUIREMENT TO IMPROVE DEPARTMENT OF VET2 ERANS AFFAIRS WOMEN VETERANS CONTACT 

3 CENTER. 

4 The Secretary of Veterans Affairs shall enhance the 

5 capabilities of the Department of Veterans Affairs women 

6 veterans contact center— 

7 (1) to respond to requests by women veterans 

8 for assistance with accessing health care and bene9 fits furnished under laws administered by the Sec10 retary; and 

11 (2) for referral of such veterans to community 

12 resources to obtain assistance with services not fur13 nished by the Department. 

14 SEC. 10. MODIFICATION OF PILOT PROGRAM ON COUN15 SELING IN RETREAT SETTINGS FOR WOMEN 

16 VETERANS NEWLY SEPARATED FROM SERV17 ICE IN THE ARMED FORCES. 

18 (a) INCREASE IN NUMBER OF LOCATIONS.—Sub19 section (c) of section 203 of the Caregivers and Veterans 

20 Omnibus Health Services Act of 2010 (Public Law 111– 

21 163; 38 U.S.C. 1712A note) is amended by striking ‘‘three 

22 locations’’ and inserting ‘‘14 locations’’. 

23 (b) EXTENSION OF DURATION.—Subsection (d) of 

24 such section is amended by striking ‘‘2-year’’ and insert25 ing ‘‘four-year’’. 


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1 (c) AUTHORIZATION OF APPROPRIATIONS.—Sub2 section (f) of such section is amended— 

3 (1) by striking ‘‘Secretary of Veterans Affairs 

4 for each’’ and inserting the following: ‘‘Secretary of 

5 Veterans Affairs— 

6 ‘‘(1) for each’’; 

7 (2) in paragraph (1), as designated by para8 graph (1), by striking the period at the end and in9 serting ‘‘; and’’; and 

10 (3) by adding at the end the following new 

11 paragraph: 

12 ‘‘(2) for each of fiscal years 2013 and 2014, 

13 $400,000 to carry out the pilot program.’’. 

14 SEC. 11. PROGRAM ON ASSISTANCE FOR CHILD CARE FOR 

15 CERTAIN VETERANS. 

16 (a) ASSISTANCE FOR CHILD CARE FOR CERTAIN

17 VETERANS RECEIVING HEALTH CARE.— 

18 (1) IN GENERAL.—Subchapter I of chapter 17 

19 of title 38, United States Code, is amended by add20 ing at the end the following new section: 

21 ‘‘§ 1709B. Assistance for child care for certain vet22 erans receiving health care 

23 ‘‘(a) PROGRAM REQUIRED.—The Secretary shall 

24 carry out a program to provide, subject to subsection (b), 

25 assistance to qualified veterans described in subsection (c) 


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1 to obtain child care so that such veterans can receive 

2 health care services described in subsection (c). 

3 ‘‘(b) LIMITATION ON PERIOD OF PAYMENTS.—As4 sistance may only be provided to a qualified veteran under 

5 this section for receipt of child care during the period that 

6 the qualified veteran— 

7 ‘‘(1) receives the types of health care services 

8 described in subsection (c) at a facility of the De9 partment; and 

10 ‘‘(2) requires travel to and return from such fa11 cility for the receipt of such health care services. 

12 ‘‘(c) QUALIFIED VETERANS.—For purposes of this 

13 section, a qualified veteran is a veteran who is— 

14 ‘‘(1) the primary caretaker of a child or chil15 dren; and 

16 ‘‘(2)(A) receiving from the Department— 

17 ‘‘(i) regular mental health care services; 

18 ‘‘(ii) intensive mental health care services; 

19 or 

20 ‘‘(iii) such other intensive health care serv21 ices that the Secretary determines that provi22 sion of assistance to the veteran to obtain child 

23 care would improve access to such health care 

24 services by the veteran; or 


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1 ‘‘(B) in need of regular or intensive mental 

2 health care services from the Department, and but 

3 for lack of child care services, would receive such 

4 health care services from the Department. 

5 ‘‘(d) LOCATIONS.—The Secretary shall carry out the 

6 program in no fewer than three Veterans Integrated Serv7 ice Networks selected by the Secretary for purposes of the 

8 program. 

9 ‘‘(e) FORMS OF CHILD CARE ASSISTANCE.—(1) 

10 Child care assistance under this section may include the 

11 following: 

12 ‘‘(A) Stipends for the payment of child care of13 fered by licensed child care centers (either directly 

14 or through a voucher program) which shall be, to 

15 the extent practicable, modeled after the Depart16 ment of Veterans Affairs Child Care Subsidy Pro17 gram established pursuant to section 630 of the 

18 Treasury and General Government Appropriations 

19 Act, 2002 (Public Law 107–67; 115 Stat. 552). 

20 ‘‘(B) Direct provision of child care at an on-site 

21 facility of the Department of Veterans Affairs. 

22 ‘‘(C) Payments to private child care agencies. 

23 ‘‘(D) Collaboration with facilities or programs 

24 of other Federal departments or agencies. 


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1 ‘‘(E) Such other forms of assistance as the Sec2 retary considers appropriate. 

3 ‘‘(2) In the case that child care assistance under this 

4 section is provided as a stipend under paragraph (1)(A), 

5 such stipend shall cover the full cost of such child care.’’. 

6 (2) CONFORMING AMENDMENT.—Section 

7 205(e) of the Caregivers and Veterans Omnibus 

8 Health Services Act of 2010 (Public Law 111–163; 

9 38 U.S.C. 1710 note) is amended by inserting ‘‘but 

10 not after the date of the enactment of the Women 

11 Veterans and Other Health Care Improvements Act 

12 of 2013’’ before the period at the end. 

13 (3) CLERICAL AMENDMENT.—The table of sec14 tions at the beginning of such chapter is amended 

15 by inserting after the item relating to section 1709A 

16 the following new item: 

‘‘1709B. Assistance for child care for certain veterans receiving health care.’’. 

17 (b) ASSISTANCE FOR CHILD CARE FOR CERTAIN

18 VETERANS RECEIVING READJUSTMENT COUNSELING

19 AND RELATED MENTAL HEALTH SERVICES.— 

20 (1) IN GENERAL.—Subchapter I of chapter 17 

21 of such title, as amended by subsection (a)(1), is 

22 further amended by adding at the end the following 

23 new section: 


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1 ‘‘§ 1709C. Assistance for child care for certain vet2 erans receiving readjustment counseling 

3 and related mental health services 

4 ‘‘(a) PROGRAM REQUIRED.—The Secretary shall 

5 carry out a program to provide, subject to subsection (b), 

6 assistance to qualified veterans described in subsection (c) 

7 to obtain child care so that such veterans can receive read8 justment counseling and related mental health services. 

9 ‘‘(b) LIMITATION ON PERIOD OF PAYMENTS.—As10 sistance may only be provided to a qualified veteran under 

11 this section for receipt of child care during the period that 

12 the qualified veteran receives readjustment counseling and 

13 related health care services at a Vet Center. 

14 ‘‘(c) QUALIFIED VETERANS.—For purposes of this 

15 section, a qualified veteran is a veteran who is— 

16 ‘‘(1) the primary caretaker of a child; and 

17 ‘‘(2)(A) receiving from the Department regular 

18 readjustment counseling and related mental health 

19 services; or 

20 ‘‘(B) in need of readjustment counseling and 

21 related mental health services from the Department, 

22 and but for lack of child care services, would receive 

23 such counseling and services from the Department. 

24 ‘‘(d) LOCATIONS.—The Secretary shall carry out the 

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1 justment Counseling Service Regions selected by the Sec2 retary for purposes of the program. 

3 ‘‘(e) FORMS OF CHILD CARE ASSISTANCE.—(1) 

4 Child care assistance under this section may include the 

5 following: 

6 ‘‘(A) Stipends for the payment of child care of7 fered by licensed child care centers (either directly 

8 or through a voucher program) which shall be, to 

9 the extent practicable, modeled after the Depart10 ment of Veterans Affairs Child Care Subsidy Pro11 gram established pursuant to section 630 of the 

12 Treasury and General Government Appropriations 

13 Act, 2002 (Public Law 107–67; 115 Stat. 552). 

14 ‘‘(B) Payments to private child care agencies. 

15 ‘‘(C) Collaboration with facilities or programs 

16 of other Federal departments or agencies. 

17 ‘‘(D) Such other forms of assistance as the Sec18 retary considers appropriate. 

19 ‘‘(2) In the case that child care assistance under this 

20 subsection is provided as a stipend under paragraph 

21 (1)(A), such stipend shall cover the full cost of such child 

22 care. 

23 ‘‘(f) VET CENTER DEFINED.—In this section, the 

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1 seling and related mental health services for veterans 

2 under section 1712A of this title.’’. 

3 (2) CLERICAL AMENDMENT.—The table of sec4 tions at the beginning of such chapter, as amended 

5 by subsection (a)(3), is further amended by inserting 

6 after the item relating to section 1709B the fol7 lowing new item: 

‘‘1709C. Assistance for child care for certain veterans receiving readjustment 

counseling and related mental health services.’’. 

8 SEC. 12. CONTRACTOR USER FEES. 

9 (a) IN GENERAL.—Chapter 3 of title 38, United 

10 States Code, is amended by adding at the end the fol11 lowing new section: 

12 ‘‘§ 323. Contractor user fees 

13 ‘‘(a) FEE REQUIREMENT.—Except as provided in 

14 subsection (c) and subject to subsection (d), the Secretary 

15 shall impose a fee upon each person with whom the Sec16 retary engages in a contract for a good or service as a 

17 condition of the contract. 

18 ‘‘(b) FEE AMOUNT.—(1) The amount of a fee im19 posed upon a person under subsection (a) with respect to 

20 a contract shall be equal to the lesser of— 

21 ‘‘(A) the amount which is equal to seven per22 cent of the total value of the contract; and 


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1 ‘‘(B) the amount which is equal to the total 

2 value of the contract multiplied by the applicable 

3 percentage for such fiscal year. 

4 ‘‘(2) The applicable percentage for a fiscal year shall 

5 be equal to the percentage by which— 

6 ‘‘(A) the annual estimate of the total value of 

7 contracts for such fiscal year, exceeds 

8 ‘‘(B) the annual estimate of the total cost of 

9 fertility counseling and treatment for such fiscal 

10 year. 

11 ‘‘(3) Before each fiscal year, the Secretary shall es12 tablish, for purposes of this section, the annual estimate 

13 of the total value of contracts for the next fiscal year, 

14 which shall be the Secretary’s estimate of what the aggre15 gate value will be of all contracts in which the Secretary 

16 will engage in the next fiscal year. 

17 ‘‘(4) Before each fiscal year, the Secretary shall es18 tablish, for purposes of this section, the annual estimate 

19 of the total cost of fertility counseling and treatment for 

20 the next fiscal year, which shall be the Secretary’s esti21 mate of what the total cost to the Department will be in 

22 the next fiscal year of— 

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1 ductive technology, to individuals under laws admin2 istered by the Secretary in the next fiscal year; and 

3 ‘‘(B) making payments under section 1789 of 

4 this title in the next fiscal year. 

5 ‘‘(c) WAIVER.—The Secretary may waive the fee re6 quired by subsection (a) for a person as the Secretary con7 siders appropriate if the person is an individual or a small 

8 business concern. 

9 ‘‘(d) LIMITATION ON COLLECTION.—No fee may be 

10 collected under subsection (a) except to the extent that 

11 the expenditure of the fee to pay the costs of activities 

12 and services for which the fee is imposed is provided for 

13 in advance in an appropriations Act. 

14 ‘‘(e) DEPARTMENT OF VETERANS AFFAIRS FER15 TILITY COUNSELING AND TREATMENT FUND.—(1) There 

16 is in the Treasury a fund to be known as the Department 

17 of Veterans Affairs Fertility Counseling and Treatment 

18 Fund. 

19 ‘‘(2) All amounts received by the Secretary under 

20 subsection (a) shall be deposited in the fund. 

21 ‘‘(3)(A) Subject to the provisions of appropriations 

22 Acts, amounts in the fund shall be available, without fiscal 

23 year limitation, to the Secretary for the following pur24 poses: 


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1 ‘‘(i) To furnish fertility counseling and treat2 ment, including through the use of assisted repro3 ductive technology, to individuals under laws admin4 istered by the Secretary. 

5 ‘‘(ii) To make payments under section 1789 of 

6 this title. 

7 ‘‘(B) Amounts available under subparagraph (A) may 

8 not be used for any purposes other than a purpose set 

9 forth in clause (i) or (ii) of that subparagraph. 

10 ‘‘(4) Amounts received by the Secretary under sub11 section (a) shall be treated for the purposes of sections 

12 251 and 252 of the Balanced Budget and Emergency Def13 icit Control Act of 1985 (2 U.S.C. 901, 902) as offsets 

14 to discretionary appropriations (rather than as offsets to 

15 direct spending) to the extent that such amounts are made 

16 available for expenditure in appropriations Acts for the 

17 purposes specified in paragraph (3) of this subsection. 

18 ‘‘(f) SMALL BUSINESS CONCERN DEFINED.—In this 

19 section, the term ‘small business concern’ has the meaning 

20 given such term under section 3 of the Small Business 

21 Act (15 U.S.C. 632).’’. 

22 (b) CLERICAL AMENDMENT.—The table of sections 

23 at the beginning of chapter 3 of such title is amended by 

24 adding after the item relating to section 322 the following 

25 new item: 

‘‘323. Contractor user fees.’’. 


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1 SECTION 1. SHORT TITLE; REFERENCES TO TITLE 38, 

2 UNITED STATES CODE. 

3 (a) SHORT TITLE.—This Act may be cited as the 

4 ‘‘Women Veterans and Other Health Care Improvements 

5 Act of 2013’’. 

6 (b) REFERENCES TO TITLE 38, UNITED STATES

7 CODE.—Except as otherwise expressly provided, whenever 

8 in this Act an amendment or repeal is expressed in terms 

9 of an amendment to, or repeal of, a section or other provi10 sion, the reference shall be considered to be made to a section 

11 or other provision of title 38, United States Code. 

12 SEC. 2. CLARIFICATION THAT FERTILITY COUNSELING AND 

13 TREATMENT ARE MEDICAL SERVICES WHICH 

14 THE SECRETARY MAY FURNISH TO VETERANS 

15 LIKE OTHER MEDICAL SERVICES. 

16 Section 1701(6) is amended by adding at the end the 

17 following new subparagraph: 

18 ‘‘(H) Fertility counseling and treatment, 

19 including treatment using assisted reproductive 

20 technology.’’. 

21 SEC. 3. REPRODUCTIVE TREATMENT AND CARE FOR 

22 SPOUSES AND SURROGATES OF VETERANS. 

23 (a) IN GENERAL.—Subchapter VIII of chapter 17 is 

24 amended by adding at the end the following new section: 


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1 ‘‘§ 1788. Reproductive treatment and care for spouses 

2 and surrogates of veterans 

3 ‘‘(a) IN GENERAL.—The Secretary shall furnish fer4 tility counseling and treatment, including through the use 

5 of assisted reproductive technology, to a spouse or surrogate 

6 of a severely wounded, ill, or injured veteran who has an 

7 infertility condition incurred or aggravated in line of duty 

8 in the active military, naval, or air service and who is en9 rolled in the system of annual patient enrollment estab10 lished under section 1705(a) of this title if the spouse or 

11 surrogate and the veteran apply jointly for such counseling 

12 and treatment through a process prescribed by the Sec13 retary. 

14 ‘‘(b) COORDINATION OF CARE FOR OTHER SPOUSES

15 AND SURROGATES.—In the case of a spouse or surrogate 

16 of a veteran not described in subsection (a) who is seeking 

17 fertility counseling and treatment, the Secretary may co18 ordinate fertility counseling and treatment for such spouse 

19 or surrogate. 

20 ‘‘(c) CONSTRUCTION.—Nothing in this section shall be 

21 construed to require the Secretary— 

22 ‘‘(1) to find or certify a surrogate for a veteran 

23 or to connect a surrogate with a veteran; or 

24 ‘‘(2) to furnish maternity care to a spouse or 

25 surrogate of a veteran. 


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1 ‘‘(d) ASSISTED REPRODUCTIVE TECHNOLOGY DE2 FINED.—In this section, the term ‘assisted reproductive 

3 technology’ includes in vitro fertilization and other fertility 

4 treatments in which both eggs and sperm are handled when 

5 clinically appropriate.’’. 

6 (b) CLERICAL AMENDMENT.—The table of sections at 

7 the beginning of chapter 17 is amended by inserting after 

8 the item relating to section 1787 the following new item: 

‘‘1788. Reproductive treatment and care for spouses and surrogates of veterans.’’. 

9 SEC. 4. ADOPTION ASSISTANCE FOR SEVERELY WOUNDED 

10 VETERANS. 

11 (a) IN GENERAL.—Subchapter VIII of chapter 17, as 

12 amended by section 3 of this Act, is further amended by 

13 adding at the end the following new section: 

14 ‘‘§ 1789. Adoption assistance 

15 ‘‘(a) IN GENERAL.—The Secretary may pay an 

16 amount, not to exceed the limitation amount, to assist a 

17 covered veteran in the adoption of one or more children. 

18 ‘‘(b) COVERED VETERAN.—For purposes of this sec19 tion, a covered veteran is any severely wounded, ill, or in20 jured veteran who— 

21 ‘‘(1) has an infertility condition incurred or ag22 gravated in line of duty in the active military, naval, 

23 or air service; and 


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1 ‘‘(2) is enrolled in the system of annual patient 

2 enrollment established under section 1705(a) of this 

3 title. 

4 ‘‘(c) LIMITATION AMOUNT.—For purposes of this sec5 tion, the limitation amount is the amount equal to the lesser 

6 of— 

7 ‘‘(1) the cost the Department would incur if the 

8 Secretary were to provide a covered veteran with one 

9 cycle of fertility treatment through the use of assisted 

10 reproductive technology under section 1788 of this 

11 title, as determined by the Secretary; or 

12 ‘‘(2) the cost the Department would incur by 

13 paying the expenses of three adoptions by covered vet14 erans, as determined by the Secretary. 

15 ‘‘(d) ASSISTED REPRODUCTIVE TECHNOLOGY DE16 FINED.—In this section, the term ‘assisted reproductive 

17 technology’ has the meaning given that term in section 1788 

18 of this title.’’. 

19 (b) CLERICAL AMENDMENT.—The table of sections at 

20 the beginning of chapter 17, as amended by section 3(b) 

21 of this Act, is further amended by inserting after the item 

22 relating to section 1788 the following new item: 

‘‘1789. Adoption assistance.’’. 


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1 SEC. 5. REGULATIONS ON FURNISHING OF FERTILITY 

2 COUNSELING AND TREATMENT AND ADOP3 TION ASSISTANCE BY DEPARTMENT OF VET4 ERANS AFFAIRS. 

5 (a) IN GENERAL.—Not later than 540 days after the 

6 date of the enactment of this Act, the Secretary of Veterans 

7 Affairs shall prescribe regulations— 

8 (1) on the furnishing of fertility treatment to 

9 veterans using assisted reproductive technology; 

10 (2) to carry out section 1788 of title 38, United 

11 States Code, as added by section 3 of this Act; and 

12 (3) to carry out section 1789 of such title, as 

13 added by section 4 of this Act. 

14 (b) LIMITATION.—Notwithstanding any other provi15 sion of law, during the period beginning on the date of the 

16 enactment of this Act and ending on the date on which the 

17 Secretary prescribes regulations under subsection (a), the 

18 Secretary may not furnish— 

19 (1) to a veteran any fertility treatment that uses 

20 an assisted reproductive technology that the Secretary 

21 has not used in the provision of a fertility treatment 

22 to a veteran before the date of the enactment of this 

23 Act; 

24 (2) any fertility counseling or treatment under 

25 section 1788 of such title, as added by section 3 of 

26 this Act; or 


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1 (3) any assistance under section 1789 of such 

2 title, as added by section 4 of this Act. 

3 (c) ASSISTED REPRODUCTIVE TECHNOLOGY DE4 FINED.—In this section, the term ‘‘assisted reproductive 

5 technology’’ has the meaning given the term in section 1788 

6 of such title, as added by section 3 of this Act. 

7 SEC. 6. COORDINATION BETWEEN DEPARTMENT OF VET8 ERANS AFFAIRS AND DEPARTMENT OF DE9 FENSE ON FURNISHING OF FERTILITY COUN10 SELING AND TREATMENT. 

11 The Secretary of Veterans Affairs and the Secretary 

12 of Defense shall share best practices and facilitate referrals, 

13 as they consider appropriate, on the furnishing of fertility 

14 counseling and treatment. 

15 SEC. 7. FACILITATION OF REPRODUCTION AND INFER16 TILITY RESEARCH. 

17 (a) IN GENERAL.—Subchapter II of chapter 73 is 

18 amended by adding at the end the following new section: 

19 ‘‘§ 7330B. Facilitation of reproduction and infertility 

20 research 

21 ‘‘(a) FACILITATION OF RESEARCH REQUIRED.—The 

22 Secretary shall facilitate research conducted collaboratively 

23 by the Secretary of Defense and the Secretary of Health and 

24 Human Services to improve the ability of the Department 

25 of Veterans Affairs to meet the long-term reproductive 


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1 health care needs of veterans who have a genitourinary serv2 ice-connected disability or a condition that was incurred 

3 or aggravated in line of duty in the active military, naval, 

4 or air service, such as a spinal cord injury, that affects the 

5 veterans’ ability to reproduce. 

6 ‘‘(b) DISSEMINATION OF INFORMATION.—The Sec7 retary shall ensure that information produced by the re8 search facilitated under this section that may be useful for 

9 other activities of the Veterans Health Administration is 

10 disseminated throughout the Veterans Health Administra11 tion.’’. 

12 (b) CLERICAL AMENDMENT.—The table of sections at 

13 the beginning of chapter 73 is amended by inserting after 

14 the item relating to section 7330A the following new item: 

‘‘7330B. Facilitation of reproduction and infertility research.’’. 

15 (c) REPORT.—Not later than three years after the date 

16 of the enactment of this Act, the Secretary of Veterans Af17 fairs shall submit to Congress a report on the research ac18 tivities conducted by the Secretary under section 7330B of 

19 title 38, United States Code, as added by subsection (a). 

20 SEC. 8. ANNUAL REPORT ON PROVISION OF FERTILITY 

21 COUNSELING AND TREATMENT FURNISHED 

22 BY DEPARTMENT OF VETERANS AFFAIRS. 

23 (a) IN GENERAL.—Not later than one year after the 

24 date of the enactment of this Act and not less frequently 

25 than annually thereafter, the Secretary of Veterans Affairs 


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1 shall submit to the Committee on Veterans’ Affairs of the 

2 Senate and the Committee on Veterans’ Affairs of the House 

3 of Representatives a report on the fertility counseling and 

4 treatment furnished by the Department of Veterans Affairs 

5 during the year preceding the submittal of the report. 

6 (b) ELEMENTS.—Each report submitted under sub7 section (a) shall include, for the period covered by the re8 port, the following: 

9 (1) The number of veterans who received fertility 

10 counseling or treatment furnished by the Department 

11 of Veterans Affairs, disaggregated by era of military 

12 service of such veterans. 

13 (2) The number of spouses and surrogates of vet14 erans who received fertility counseling or treatment 

15 furnished by the Department. 

16 (3) The cost to the Department of furnishing fer17 tility counseling and treatment, disaggregated by cost 

18 of services and administration. 

19 (4) The average cost to the Department per re20 cipient of such counseling and treatment. 

21 (5) In cases in which the Department furnished 

22 fertility treatment through the use of assisted repro23 ductive technology, the average number of cycles per 

24 person furnished. 


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1 (6) A description of how fertility counseling and 

2 treatment services of the Department are coordinated 

3 with similar services of the Department of Defense. 

4 SEC. 9. PROGRAM ON ASSISTANCE FOR CHILD CARE FOR 

5 CERTAIN VETERANS. 

6 (a) ASSISTANCE FOR CHILD CARE FOR CERTAIN VET7 ERANS RECEIVING HEALTH CARE.— 

8 (1) IN GENERAL.—Subchapter I of chapter 17 is 

9 amended by adding at the end the following new sec10 tion: 

11 ‘‘§ 1709B. Assistance for child care for certain vet12 erans receiving health care 

13 ‘‘(a) PROGRAM REQUIRED.—The Secretary shall carry 

14 out a program to provide, subject to subsection (b), assist15 ance to qualified veterans described in subsection (c) to ob16 tain child care so that such veterans can receive health care 

17 services described in subsection (c). 

18 ‘‘(b) LIMITATION ON PERIOD OF PAYMENTS.—Assist19 ance may only be provided to a qualified veteran under 

20 this section for receipt of child care during the period that 

21 the qualified veteran— 

22 ‘‘(1) receives health care services described in 

23 subsection (c) at a facility of the Department; and 

24 ‘‘(2) requires travel to and from such facility for 

25 the receipt of such health care services. 


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1 ‘‘(c) QUALIFIED VETERANS.—For purposes of this sec2 tion, a qualified veteran is a veteran who is— 

3 ‘‘(1) the primary caretaker of a child or children; 

4 and 

5 ‘‘(2)(A) receiving from the Department— 

6 ‘‘(i) regular mental health care services; 

7 ‘‘(ii) intensive mental health care services; 

8 or 

9 ‘‘(iii) such other intensive health care serv10 ices that the Secretary determines that provision 

11 of assistance to the veteran to obtain child care 

12 would improve access to such health care services 

13 by the veteran; or 

14 ‘‘(B) in need of regular or intensive mental 

15 health care services from the Department, and but for 

16 lack of child care services, would receive such health 

17 care services from the Department. 

18 ‘‘(d) LOCATIONS.—The Secretary shall carry out the 

19 program in no fewer than three Veterans Integrated Service 

20 Networks selected by the Secretary for purposes of the pro21 gram. 

22 ‘‘(e) FORMS OF CHILD CARE ASSISTANCE.—(1) Child 

23 care assistance under this section may include the fol24 lowing: 


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1 ‘‘(A) Stipends for the payment of child care of2 fered by licensed child care centers (either directly or 

3 through a voucher program) which shall be, to the ex4 tent practicable, modeled after the Department of Vet5 erans Affairs Child Care Subsidy Program established 

6 pursuant to section 630 of the Treasury and General 

7 Government Appropriations Act, 2002 (Public Law 

8 107–67; 115 Stat. 552). 

9 ‘‘(B) Direct provision of child care at an on-site 

10 facility of the Department. 

11 ‘‘(C) Payments to private child care agencies. 

12 ‘‘(D) Collaboration with facilities or programs of 

13 other Federal departments or agencies. 

14 ‘‘(E) Such other forms of assistance as the Sec15 retary considers appropriate. 

16 ‘‘(2) In the case that child care assistance under this 

17 section is provided as a stipend under paragraph (1)(A), 

18 such stipend shall cover the full cost of such child care.’’. 

19 (2) CLERICAL AMENDMENT.—The table of sec20 tions at the beginning of chapter 17 is amended by 

21 inserting after the item relating to section 1709A the 

22 following new item: 

‘‘1709B. Assistance for child care for certain veterans receiving health care.’’. 

23 (3) CONFORMING AMENDMENT.—Section 205(e) 

24 of the Caregivers and Veterans Omnibus Health Serv25 ices Act of 2010 (Public Law 111–163; 38 U.S.C. 


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1 1710 note) is amended by inserting ‘‘but not after the 

2 date of the enactment of the Women Veterans and 

3 Other Health Care Improvements Act of 2013’’ before 

4 the period at the end. 

5 (b) ASSISTANCE FOR CHILD CARE FOR INDIVIDUALS

6 RECEIVING READJUSTMENT COUNSELING AND RELATED

7 MENTAL HEALTH SERVICES.— 

8 (1) IN GENERAL.—Subchapter I of chapter 17, as 

9 amended by subsection (a)(1) of this section, is fur10 ther amended by adding at the end the following new 

11 section: 

12 ‘‘§ 1709C. Assistance for child care for individuals re13 ceiving readjustment counseling and re14 lated mental health services 

15 ‘‘(a) PROGRAM REQUIRED.—The Secretary shall carry 

16 out a program to provide, subject to subsection (b), assist17 ance to qualified individuals described in subsection (c) to 

18 obtain child care so that such individuals can receive read19 justment counseling and related mental health services. 

20 ‘‘(b) LIMITATION ON PERIOD OF PAYMENTS.—Assist21 ance may only be provided to a qualified individual under 

22 this section for receipt of child care during the period that 

23 the qualified individual receives readjustment counseling 

24 and related health care services at a Vet Center. 


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1 ‘‘(c) QUALIFIED INDIVIDUALS.—For purposes of this 

2 section, a qualified individual is an individual who is— 

3 ‘‘(1) the primary caretaker of a child or children; 

4 and 

5 ‘‘(2)(A) receiving from the Department regular 

6 readjustment counseling and related mental health 

7 services; or 

8 ‘‘(B) in need of readjustment counseling and re9 lated mental health services from the Department, 

10 and but for lack of child care services, would receive 

11 such counseling and services from the Department. 

12 ‘‘(d) LOCATIONS.—The Secretary shall carry out the 

13 program under this section in no fewer than three Readjust14 ment Counseling Service Regions selected by the Secretary 

15 for purposes of the program. 

16 ‘‘(e) FORMS OF CHILD CARE ASSISTANCE.—(1) Child 

17 care assistance under this section may include the fol18 lowing: 

19 ‘‘(A) Stipends for the payment of child care of20 fered by licensed child care centers (either directly or 

21 through a voucher program) which shall be, to the ex22 tent practicable, modeled after the Department of Vet23 erans Affairs Child Care Subsidy Program established 

24 pursuant to section 630 of the Treasury and General 


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1 Government Appropriations Act, 2002 (Public Law 

2 107–67; 115 Stat. 552). 

3 ‘‘(B) Payments to private child care agencies. 

4 ‘‘(C) Collaboration with facilities or programs of 

5 other Federal departments or agencies. 

6 ‘‘(D) Such other forms of assistance as the Sec7 retary considers appropriate. 

8 ‘‘(2) In the case that child care assistance under this 

9 subsection is provided as a stipend under paragraph (1)(A), 

10 such stipend shall cover the full cost of such child care. 

11 ‘‘(f) VET CENTER DEFINED.—In this section, the term 

12 ‘Vet Center’ means a center for readjustment counseling and 

13 related mental health services for individuals under section 

14 1712A of this title.’’. 

15 (2) CLERICAL AMENDMENT.—The table of sec16 tions at the beginning of chapter 17, as amended by 

17 subsection (a)(2) of this section, is further amended 

18 by inserting after the item relating to section 1709B 

19 the following new item: 

‘‘1709C. Assistance for child care for individuals receiving readjustment counseling and related mental health services.’’. 

20 SEC. 10. COUNSELING IN RETREAT SETTINGS FOR WOMEN 

21 VETERANS NEWLY SEPARATED FROM SERV22 ICE IN THE ARMED FORCES. 

23 (a) COUNSELING IN RETREAT SETTINGS.— 


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1 (1) IN GENERAL.—Subchapter II of chapter 17 is 

2 amended by adding at the end the following new sec3 tion: 

4 ‘‘§ 1720H. Counseling in retreat settings for women 

5 veterans newly separated from service in 

6 the Armed Forces 

7 ‘‘(a) IN GENERAL.—The Secretary shall provide, 

8 through the Readjustment Counseling Service of the Vet9 erans Health Administration, reintegration and readjust10 ment services described in subsection (c) in group retreat 

11 settings to women veterans who are recently separated from 

12 service in the Armed Forces after a prolonged deployment. 

13 ‘‘(b) ELECTION OF VETERAN.—The receipt of services 

14 under this section by a woman veteran shall be at the elec15 tion of the veteran. 

16 ‘‘(c) COVERED SERVICES.—The services provided to a 

17 woman veteran under this section shall include the fol18 lowing: 

19 ‘‘(1) Information on reintegration into the vet20 eran’s family, employment, and community. 

21 ‘‘(2) Financial counseling. 

22 ‘‘(3) Occupational counseling. 

23 ‘‘(4) Information and counseling on stress reduc24 tion. 


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1 ‘‘(5) Information and counseling on conflict reso2 lution. 

3 ‘‘(6) Such other information and counseling as 

4 the Secretary considers appropriate to assist the vet5 eran in reintegration into the veteran’s family, em6 ployment, and community.’’. 

7 (2) CLERICAL AMENDMENT.—The table of sec8 tions at the beginning of chapter 17 is amended by 

9 inserting after the item relating to section 1720G the 

10 following new item: 

‘‘1720H. Counseling in retreat settings for women veterans newly separated from 

service in the Armed Forces.’’. 

11 (b) REPEAL OF SUPERSEDED PILOT PROGRAM AU12 THORITY.—Section 203 of the Caregivers and Veterans Om13 nibus Health Services Act of 2010 (Public Law 111–163; 

14 38 U.S.C. 1712A note) is hereby repealed. 


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Calendar No. 185 

113TH CONGRESS 

1ST SESSION S. 131 

[Report No. 113–106] 

A BILL 

To amend title 38, United States Code, to improve 

for other purposes. ed, ill, or injured veterans and their spouses, and partment of Veterans Affairs to severely woundthe reproductive assistance provided by the DeSEPTEMBER 17, 2013 

Reported with an amendment 


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