II 

113TH CONGRESS 

1ST SESSION S. 131 

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, and Mr. TESTER) introduced the following bill; which was read twice and referred to the Committee on Veterans’ Affairs 

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, 

3 SECTION 1. SHORT TITLE. 

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

5 Other Health Care Improvements Act of 2013’’. 


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1 SEC. 2. CLARIFICATION THAT FERTILITY COUNSELING AND 

2 TREATMENT ARE MEDICAL SERVICES WHICH 

3 THE SECRETARY MAY FURNISH TO VET4 ERANS LIKE OTHER MEDICAL SERVICES. 

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

6 amended by adding at the end the following new subpara7 graph: 

8 ‘‘(H) Fertility counseling and treatment, 

9 including treatment using assisted reproductive 

10 technology.’’. 

11 SEC. 3. REPRODUCTIVE TREATMENT AND CARE FOR 

12 SPOUSES AND SURROGATES OF VETERANS. 

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

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

15 end the following new section: 

16 ‘‘§ 1788. Reproductive treatment and care for spouses 

17 and surrogates of veterans 

18 ‘‘(a) IN GENERAL.—The Secretary shall furnish fer19 tility counseling and treatment, including through the use 

20 of assisted reproductive technology, to a spouse or surro21 gate of a severely wounded, ill, or injured veteran who has 

22 an infertility condition incurred or aggravated in line of 

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

24 is enrolled in the system of annual patient enrollment es25 tablished under section 1705(a) of this title if the spouse 

26 or surrogate and the veteran apply jointly for such counVerDate Mar 15 2010 01:31 Jan 30, 2013 Jkt 029200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S131.IS S131

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1 seling and treatment through a process prescribed by the 

2 Secretary. 

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

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

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

6 fertility counseling and treatment, the Secretary may co7 ordinate fertility counseling and treatment for such spouse 

8 or surrogate. 

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

10 be construed to require the Secretary— 

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

12 or to connect a surrogate with a veteran; or 

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

14 surrogate of a veteran. 

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

17 technology’ includes in vitro fertilization and other fertility 

18 treatments in which both eggs and sperm are handled 

19 when clinically appropriate.’’. 

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

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

22 by inserting after the item relating to section 1787 the 

23 following new item: 

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


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1 SEC. 4. ADOPTION ASSISTANCE FOR SEVERELY WOUNDED 

2 VETERANS. 

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

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

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

6 section: 

7 ‘‘§ 1789. Adoption assistance 

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

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

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

11 ‘‘(b) COVERED VETERAN.—For purposes of this sec12 tion, a covered veteran is any severely wounded, ill, or in13 jured veteran who— 

14 ‘‘(1) has an infertility condition incurred or ag15 gravated in line of duty in the active military, naval, 

16 or air service; and 

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

18 enrollment established under section 1705(a) of this 

19 title. 

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

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

22 lesser of— 

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

24 Secretary were to provide a covered veteran with one 

25 cycle of in vitro fertilization, as determined by the 

26 Secretary; and 


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

2 paying the expenses of three adoptions by covered 

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

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

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

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

7 item relating to section 1788 the following new item: 

‘‘1789. Adoption assistance.’’. 

8 SEC. 5. ANNUAL REPORT ON PROVISION OF FERTILITY 

9 COUNSELING AND TREATMENT FURNISHED 

10 BY DEPARTMENT OF VETERANS AFFAIRS. 

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

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

13 than once each year thereafter, the Secretary of Veterans 

14 Affairs shall submit to the Committee on Veterans’ Affairs 

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

16 the House of Representatives a report on the fertility 

17 counseling and treatment furnished by the Department of 

18 Veterans Affairs during the year preceding the submittal 

19 of the report. 

20 (b) ELEMENTS.—Each report submitted under sub21 section (a) shall include, for the period covered by the re22 port, the following: 

23 (1) The number of veterans who received fer24 tility counseling or treatment furnished by the DeVerDate Mar 15 2010 01:31 Jan 30, 2013 Jkt 029200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S131.IS S131

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1 partment of Veterans Affairs, disaggregated by era 

2 of military service of such veterans. 

3 (2) The number of spouses and surrogates of 

4 veterans who received fertility counseling or treat5 ment furnished by the Department. 

6 (3) The cost to the Department of furnishing 

7 fertility counseling and treatment, disaggregated by 

8 cost of services and administration. 

9 (4) The average cost to the Department per re10 cipient of such counseling and treatment. 

11 (5) In cases in which the Department furnished 

12 fertility treatment through the use of assisted repro13 ductive technology, the average number of cycles per 

14 person furnished. 

15 (6) A description of how fertility counseling and 

16 treatment services of the Department are coordi17 nated with similar services of the Department of De18 fense. 

19 SEC. 6. REGULATIONS ON FURNISHING OF FERTILITY 

20 COUNSELING AND TREATMENT AND ADOP21 TION ASSISTANCE BY DEPARTMENT OF VET22 ERANS AFFAIRS. 

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

24 date of the enactment of this Act, the Secretary of Vet25 erans Affairs shall prescribe regulations— 


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1 (1) on the furnishing of fertility treatment to 

2 veterans using assisted reproductive technology; 

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

4 States Code, as added by section 3; and 

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

6 added by section 4. 

7 (b) LIMITATION.—Notwithstanding any other provi8 sion of law, during the period beginning on the date of 

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

10 the Secretary prescribes regulations under subsection (a), 

11 the Secretary may not furnish— 

12 (1) to a veteran any fertility treatment that 

13 uses an assisted reproductive technology that the 

14 Secretary has not used in the provision of a fertility 

15 treatment to a veteran before the date of the enact16 ment of this Act; 

17 (2) any fertility counseling or treatment under 

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

19 added by section 3; or 

20 (3) any assistance under section 1789 of such 

21 title, as added by section 4. 

22 (c) ASSISTED REPRODUCTIVE TECHNOLOGY DE23 FINED.—In this section, the term ‘‘assisted reproductive 

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

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


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1 SEC. 7. COORDINATION BETWEEN DEPARTMENT OF VET2 ERANS AFFAIRS AND DEPARTMENT OF DE3 FENSE ON FURNISHING OF FERTILITY COUN4 SELING AND TREATMENT. 

5 The Secretary of Veterans Affairs and the Secretary 

6 of Defense shall share best practices and facilitate refer7 rals, as they consider appropriate, on the furnishing of fer8 tility counseling and treatment. 

9 SEC. 8. FACILITATION OF REPRODUCTION AND INFER10 TILITY RESEARCH. 

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

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

13 end the following new section: 

14 ‘‘§ 7330B. Facilitation of reproduction and infertility 

15 research 

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

17 Secretary shall facilitate research conducted collabo18 ratively by the Secretary of Defense and the Secretary of 

19 Health and Human Services to improve the ability of the 

20 Department of Veterans Affairs to meet the long-term re21 productive health care needs of veterans who have a geni22 tourinary service-connected disability or a condition that 

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

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

25 that affects the veterans’ ability to reproduce. 


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1 ‘‘(b) DISSEMINATION OF INFORMATION.—The Sec2 retary shall ensure that information produced by the re3 search facilitated under this section that may be useful 

4 for other activities of the Veterans Health Administration 

5 is disseminated throughout the Veterans Health Adminis6 tration.’’. 

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

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

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

10 following new item: 

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

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

12 date of the enactment of this Act, the Secretary of Vet13 erans Affairs shall submit to Congress a report on the re14 search activities conducted by the Secretary under section 

15 7330B of title 38, United States Code, as added by sub16 section (a). 

17 SEC. 9. REQUIREMENT TO IMPROVE DEPARTMENT OF VET18 ERANS AFFAIRS WOMEN VETERANS CONTACT 

19 CENTER. 

20 The Secretary of Veterans Affairs shall enhance the 

21 capabilities of the Department of Veterans Affairs women 

22 veterans contact center— 

23 (1) to respond to requests by women veterans 

24 for assistance with accessing health care and beneVerDate Mar 15 2010 01:31 Jan 30, 2013 Jkt 029200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S131.IS S131

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1 fits furnished under laws administered by the Sec2 retary; and 

3 (2) for referral of such veterans to community 

4 resources to obtain assistance with services not fur5 nished by the Department. 

6 SEC. 10. MODIFICATION OF PILOT PROGRAM ON COUN7 SELING IN RETREAT SETTINGS FOR WOMEN 

8 VETERANS NEWLY SEPARATED FROM SERV9 ICE IN THE ARMED FORCES. 

10 (a) INCREASE IN NUMBER OF LOCATIONS.—Sub11 section (c) of section 203 of the Caregivers and Veterans 

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

13 163; 38 U.S.C. 1712A note) is amended by striking ‘‘three 

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

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

16 such section is amended by striking ‘‘2-year’’ and insert17 ing ‘‘four-year’’. 

18 (c) AUTHORIZATION OF APPROPRIATIONS.—Sub19 section (f) of such section is amended— 

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

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

22 Veterans Affairs— 

23 ‘‘(1) for each’’; 


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1 (2) in paragraph (1), as designated by para2 graph (1), by striking the period at the end and in3 serting ‘‘; and’’; and 

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

5 paragraph: 

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

7 $400,000 to carry out the pilot program.’’. 

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

9 CERTAIN VETERANS. 

10 (a) ASSISTANCE FOR CHILD CARE FOR CERTAIN

11 VETERANS RECEIVING HEALTH CARE.— 

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

13 of title 38, United States Code, is amended by add14 ing at the end the following new section: 

15 ‘‘§ 1709B. Assistance for child care for certain vet16 erans receiving health care 

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

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

19 assistance to qualified veterans described in subsection (c) 

20 to obtain child care so that such veterans can receive 

21 health care services described in subsection (c). 

22 ‘‘(b) LIMITATION ON PERIOD OF PAYMENTS.—As23 sistance may only be provided to a qualified veteran under 

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

25 the qualified veteran— 


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

2 described in subsection (c) at a facility of the De3 partment; and 

4 ‘‘(2) requires travel to and return from such fa5 cility for the receipt of such health care services. 

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

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

8 ‘‘(1) the primary caretaker of a child or chil9 dren; and 

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

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

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

13 or 

14 ‘‘(iii) such other intensive health care serv15 ices that the Secretary determines that provi16 sion of assistance to the veteran to obtain child 

17 care would improve access to such health care 

18 services by the veteran; or 

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

20 health care services from the Department, and but 

21 for lack of child care services, would receive such 

22 health care services from the Department. 

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

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1 ice Networks selected by the Secretary for purposes of the 

2 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) Direct provision of child care at an on-site 

15 facility of the Department of Veterans Affairs. 

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

17 ‘‘(D) Collaboration with facilities or programs 

18 of other Federal departments or agencies. 

19 ‘‘(E) Such other forms of assistance as the Sec20 retary considers appropriate. 

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

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

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

24 (2) CONFORMING AMENDMENT.—Section 

25 205(e) of the Caregivers and Veterans Omnibus 


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

2 38 U.S.C. 1710 note) is amended by inserting ‘‘but 

3 not after the date of the enactment of the Women 

4 Veterans and Other Health Care Improvements Act 

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

6 (3) CLERICAL AMENDMENT.—The table of sec7 tions at the beginning of such chapter is amended 

8 by inserting after the item relating to section 1709A 

9 the following new item: 

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

10 (b) ASSISTANCE FOR CHILD CARE FOR CERTAIN

11 VETERANS RECEIVING READJUSTMENT COUNSELING

12 AND RELATED MENTAL HEALTH SERVICES.— 

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

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

15 further amended by adding at the end the following 

16 new section: 

17 ‘‘§ 1709C. Assistance for child care for certain vet18 erans receiving readjustment counseling 

19 and related mental health services 

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

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

22 assistance to qualified veterans described in subsection (c) 

23 to obtain child care so that such veterans can receive read24 justment counseling and related mental health services. 


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1 ‘‘(b) LIMITATION ON PERIOD OF PAYMENTS.—As2 sistance may only be provided to a qualified veteran under 

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

4 the qualified veteran receives readjustment counseling and 

5 related health care services at a Vet Center. 

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

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

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

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

10 readjustment counseling and related mental health 

11 services; or 

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

13 related mental health services from the Department, 

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

15 such counseling and services from the Department. 

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

17 program under this section in no fewer than three Read18 justment Counseling Service Regions selected by the Sec19 retary for purposes of the program. 

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

21 Child care assistance under this section may include the 

22 following: 

23 ‘‘(A) Stipends for the payment of child care of24 fered by licensed child care centers (either directly 

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


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1 the extent practicable, modeled after the Depart2 ment of Veterans Affairs Child Care Subsidy Pro3 gram established pursuant to section 630 of the 

4 Treasury and General Government Appropriations 

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

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

7 ‘‘(C) Collaboration with facilities or programs 

8 of other Federal departments or agencies. 

9 ‘‘(D) Such other forms of assistance as the Sec10 retary considers appropriate. 

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

12 subsection is provided as a stipend under paragraph 

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

14 care. 

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

16 term ‘Vet Center’ means a center for readjustment coun17 seling and related mental health services for veterans 

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

19 (2) CLERICAL AMENDMENT.—The table of sec20 tions at the beginning of such chapter, as amended 

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

22 after the item relating to section 1709B the fol23 lowing new item: 

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

counseling and related mental health services.’’. 


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1 SEC. 12. CONTRACTOR USER FEES. 

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

3 States Code, is amended by adding at the end the fol4 lowing new section: 

5 ‘‘§ 323. Contractor user fees 

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

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

8 shall impose a fee upon each person with whom the Sec9 retary engages in a contract for a good or service as a 

10 condition of the contract. 

11 ‘‘(b) FEE AMOUNT.—(1) The amount of a fee im12 posed upon a person under subsection (a) with respect to 

13 a contract shall be equal to the lesser of— 

14 ‘‘(A) the amount which is equal to seven per15 cent of the total value of the contract; and 

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

17 value of the contract multiplied by the applicable 

18 percentage for such fiscal year. 

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

20 be equal to the percentage by which— 

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

22 contracts for such fiscal year, exceeds 

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

24 fertility counseling and treatment for such fiscal 

25 year. 


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1 ‘‘(3) Before each fiscal year, the Secretary shall es2 tablish, for purposes of this section, the annual estimate 

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

4 which shall be the Secretary’s estimate of what the aggre5 gate value will be of all contracts in which the Secretary 

6 will engage in the next fiscal year. 

7 ‘‘(4) Before each fiscal year, the Secretary shall es8 tablish, for purposes of this section, the annual estimate 

9 of the total cost of fertility counseling and treatment for 

10 the next fiscal year, which shall be the Secretary’s esti11 mate of what the total cost to the Department will be in 

12 the next fiscal year of— 

13 ‘‘(A) furnishing fertility counseling and treat14 ment, including through the use of assisted repro15 ductive technology, to individuals under laws admin16 istered by the Secretary in the next fiscal year; and 

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

18 this title in the next fiscal year. 

19 ‘‘(c) WAIVER.—The Secretary may waive the fee re20 quired by subsection (a) for a person as the Secretary con21 siders appropriate if the person is an individual or a small 

22 business concern. 

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

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

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


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

2 in advance in an appropriations Act. 

3 ‘‘(e) DEPARTMENT OF VETERANS AFFAIRS FER4 TILITY COUNSELING AND TREATMENT FUND.—(1) There 

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

6 of Veterans Affairs Fertility Counseling and Treatment 

7 Fund. 

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

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

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

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

12 year limitation, to the Secretary for the following pur13 poses: 

14 ‘‘(i) To furnish fertility counseling and treat15 ment, including through the use of assisted repro16 ductive technology, to individuals under laws admin17 istered by the Secretary. 

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

19 this title. 

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

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

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

23 ‘‘(4) Amounts received by the Secretary under sub24 section (a) shall be treated for the purposes of sections 

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1 icit Control Act of 1985 (2 U.S.C. 901, 902) as offsets 

2 to discretionary appropriations (rather than as offsets to 

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

4 available for expenditure in appropriations Acts for the 

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

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

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

8 given such term under section 3 of the Small Business 

9 Act (15 U.S.C. 632).’’. 

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

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

12 adding after the item relating to section 322 the following 

13 new item: 

‘‘323. Contractor user fees.’’. 

Æ 


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