I 

116TH CONGRESS 

2D SESSION H. R. 9016 

To require the Secretary of Veterans Affairs to establish a pilot program 

to furnish doula services to veterans. 

IN THE HOUSE OF REPRESENTATIVES 

DECEMBER 17, 2020 

Mrs. LAWRENCE (for herself, Mrs. LESKO, Ms. DEAN, and Miss GONZA ́LEZCOLO ́N of Puerto Rico) introduced the following bill; which was referred 

to the Committee on Veterans’ Affairs 

A BILL 

To require the Secretary of Veterans Affairs to establish 

a pilot program to furnish doula services to veterans. 

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 ‘‘Delivering Optimally 

5 Urgent Labor Access for Veterans Affairs Act of 2020’’ 

6 or the ‘‘DOULA for VA Act of 2020’’. 

7 SEC. 2. PILOT PROGRAM ON DOULA SUPPORT FOR VET8 ERANS. 

9 (a) FINDINGS.—Congress finds the following: 


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1 (1) There are approximately 2,300,000 women 

2 within the veteran population in the United States. 

3 (2) The number of women veterans using serv4 ices from the Veterans Health Administration has 

5 increased by 28.8 percent from 423,642 in 2014 to 

6 545,670 in 2019. 

7 (3) During the period of 2010 through 2015, 

8 the use of maternity services from the Veterans 

9 Health Administration increased by 44 percent. 

10 (4) Although prenatal care and delivery is not 

11 provided in facilities of the Department of Veterans 

12 Affairs, pregnant women seek care from the Depart13 ment for other conditions may also need emergency 

14 care and require coordination of services through the 

15 Veterans Community Care Program under section 

16 1703 of title 38, United States Code. 

17 (5) The number of unique women veteran pa18 tients with an obstetric delivery paid for by the De19 partment increased by 1,778 percent from 200 deliv20 eries in 2000 to 3,756 deliveries in 2015. 

21 (6) The number of women age 35 years or older 

22 with an obstetric delivery paid for by the Depart23 ment increased 16-fold from fiscal year 2000 to fis24 cal year 2015. 


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1 (7) A study in 2010 found that veterans return2 ing from Operation Enduring Freedom and Oper3 ation Iraqi Freedom who experienced pregnancy 

4 were twice as likely to have a diagnosis of depres5 sion, anxiety, posttraumatic stress disorder, bipolar 

6 disorder, or schizophrenia as those who had not ex7 perienced a pregnancy. 

8 (8) The number of women veterans of reproduc9 tive age seeking care from the Veterans Health Ad10 ministration continues to grow (more than 185,000 

11 as of fiscal year 2015). 

12 (b) PROGRAM.— 

13 (1) IN GENERAL.—Not later than one year 

14 after the date of the enactment of this Act, the Sec15 retary of Veterans Affairs shall establish a pilot pro16 gram to furnish doula services to covered veterans 

17 through eligible entities by expanding the Whole 

18 Health model of the Department of Veterans Af19 fairs, or successor model, to measure the impact 

20 that doula support services have on birth and mental 

21 health outcomes of pregnant veterans (in this section 

22 referred to as the ‘‘pilot program’’). 

23 (2) CONSIDERATION.—In carrying out the pilot 

24 program, the Secretary shall consider all types of 


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1 doulas, including traditional and community-based 

2 doulas. 

3 (3) CONSULTATION.—In designing and imple4 menting the pilot program the Secretary shall con5 sult with stakeholders, including— 

6 (A) organizations representing veterans, 

7 including veterans that are disproportionately 

8 impacted by poor maternal health outcomes; 

9 (B) community-based health care profes10 sionals, including doulas, and other stake11 holders; and 

12 (C) experts in promoting health equity and 

13 combating racial bias in health care settings. 

14 (4) GOALS.—The goals of the pilot program are 

15 the following: 

16 (A) To improve— 

17 (i) maternal, mental health, and in18 fant care outcomes; 

19 (ii) integration of doula support serv20 ices into the Whole Health model of the 

21 Department, or successor model; and 

22 (iii) the experience of women receiving 

23 maternity care from the Department, in24 cluding by increasing the ability of a 


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1 woman to develop and follow her own 

2 birthing plan. 

3 (B) To reengage veterans with the Depart4 ment after giving birth. 

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

6 pilot program in— 

7 (1) the three Veterans Integrated Service Net8 works of the Department that have the highest per9 centage of female veterans enrolled in the patient 

10 enrollment system of the Department established 

11 and operated under section 1705(a) of title 38, 

12 United States Code, compared to the total number 

13 of enrolled veterans in such Network; and 

14 (2) the three Veterans Integrated Service Net15 works that have the lowest percentage of female vet16 erans enrolled in the patient enrollment system com17 pared to the total number of enrolled veterans in 

18 such Network. 

19 (d) OPEN PARTICIPATION.—The Secretary shall 

20 allow any eligible entity or covered veteran interested in 

21 participating in the pilot program to participate in the 

22 pilot program. 

23 (e) SERVICES PROVIDED.— 

24 (1) IN GENERAL.—Under the pilot program, a 

25 covered veteran shall receive not more than 10 sesVerDate Sep 11 2014 23:54 Jan 02, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H9016.IH H9016

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1 sions of care from a doula under the Whole Health 

2 model of the Department, or successor model, under 

3 which a doula works as an advocate for the veteran 

4 alongside the medical team for the veteran. 

5 (2) SESSIONS.—Sessions covered under para6 graph (1) shall be as follows: 

7 (A) Three or four sessions before labor and 

8 delivery. 

9 (B) One session during labor and delivery. 

10 (C) Three or four sessions after post11 partum, which may be conducted via the mobile 

12 application for VA Video Connect. 

13 (f) ADMINISTRATION OF PILOT PROGRAM.— 

14 (1) IN GENERAL.—The Office of Women’s 

15 Health of the Department of Veterans Affairs, or 

16 successor office, shall— 

17 (A) coordinate services and activities under 

18 the pilot program; 

19 (B) oversee the administration of the pilot 

20 program; and 

21 (C) conduct onsite assessments of medical 

22 facilities of the Department that are partici23 pating in the pilot program. 

24 (2) GUIDELINES FOR VETERAN-SPECIFIC

25 CARE.—The Office shall establish guidelines under 


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1 the pilot program for training doulas on military 

2 sexual trauma and post traumatic stress disorder. 

3 (3) AMOUNTS FOR CARE.—The Office may rec4 ommend to the Secretary appropriate payment 

5 amounts for care and services provided under the 

6 pilot program, which shall not exceed $3,500 per 

7 doula per veteran. 

8 (g) DOULA SERVICE COORDINATOR.— 

9 (1) IN GENERAL.—The Secretary, in consulta10 tion with the Office of Women’s Health, or successor 

11 office, shall establish a Doula Service Coordinator 

12 within the functions of the Maternity Care Coordi13 nator at each medical facility of the Department 

14 that is participating in the pilot program. 

15 (2) DUTIES.—A Doula Service Coordinator es16 tablished under paragraph (1) at a medical facility 

17 shall be responsible for— 

18 (A) working with eligible entities, doulas, 

19 and covered veterans participating in the pilot 

20 program; and 

21 (B) managing payment between eligible en22 tities and the Department under the pilot pro23 gram. 

24 (3) TRACKING OF INFORMATION.—A doula pro25 viding services under the pilot program shall report 


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1 to the applicable Doula Service Coordinator after 

2 each session conducted under the pilot program. 

3 (4) COORDINATION WITH WOMEN’S PROGRAM

4 MANAGER.—A Doula Service Coordinator for a med5 ical facility of the Department shall coordinate with 

6 the women’s program manager for that facility in 

7 carrying out the duties of the Doula Service Coordi8 nator under the pilot program. 

9 (h) TERM OF PILOT PROGRAM.—The Secretary shall 

10 conduct the pilot program for a period of 5 years. 

11 (i) TECHNICAL ASSISTANCE.—The Secretary shall 

12 establish a process to provide technical assistance to eligi13 ble entities and doulas participating in the pilot program. 

14 (j) REPORT.— 

15 (1) IN GENERAL.—Not later than one year 

16 after the date of the enactment of this Act, and an17 nually thereafter for each year in which the pilot 

18 program is carried out, the Secretary shall submit to 

19 the Committee on Veterans’ Affairs of the Senate 

20 and the Committee on Veterans’ Affairs of the 

21 House of Representatives a report on the pilot pro22 gram. 

23 (2) FINAL REPORT.—As part of the final report 

24 submitted under paragraph (1), the Secretary shall 

25 include recommendations on whether the model 


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1 studied in the pilot program should be continued or 

2 more widely adopted by the Department. 

3 (k) AUTHORIZATION OF APPROPRIATIONS.—There 

4 are authorized to be appropriated to the Secretary, for 

5 each of fiscal years 2021 through 2026, such sums as may 

6 be necessary to carry out this section. 

7 (l) DEFINITIONS.—In this section: 

8 (1) The term ‘‘covered veteran’’ means a preg9 nant veteran or a formerly pregnant veteran (with 

10 respect to sessions post-partum) who is enrolled in 

11 the patient enrollment system of the Department of 

12 Veterans Affairs under section 1705 of title 38, 

13 United States Code. 

14 (2) The term ‘‘eligible entity’’ means an entity 

15 that provides medically accurate, comprehensive ma16 ternity services to covered veterans under the laws 

17 administered by the Secretary, including under the 

18 Veterans Community Care Program under section 

19 1703 of title 38, United States Code. 

20 (3) The term ‘‘VA Video Connect’’ means the 

21 program of the Department of Veterans Affairs to 

22 connect veterans with their health care team from 

23 anywhere, using encryption to ensure a secure and 

24 private session. 

Æ 


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