I

104TH CONGRESS

2D SESSION H. R. 3972

To amend title 38, United States Code, to improve health care services

provided by the Department of Veterans Affairs to women veterans.

IN THE HOUSE OF REPRESENTATIVES

AUGUST 2, 1996

Ms. WATERS (for herself and Ms. BROWN of Florida) introduced the following

bill; which was referred to the Committee on Veterans’ Affairs

A BILL

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

care services provided by the Department of Veterans

Affairs to women 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 ‘‘Women Veterans’

5 Health Act of 1996’’.

6 SEC. 2. WOMEN’S HEALTH SERVICES.

7 (a) WOMEN’S HEALTH SERVICES.—Section 1701 of

8 title 38, United States Code, is amended—
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1 (1) in paragraph (6)(A)(i), by inserting ‘‘wom2 en’s health services,’’ after ‘‘preventive health serv3 ices,’’; and

4 (2) by adding at the end the following:

5 ‘‘(10) The term ‘women’s health services’ means

6 health care services provided to women. Such term in7 cludes counseling and services relating to the following:

8 ‘‘(A) Papanicolaou tests (pap smear).

9 ‘‘(B) Breast examinations and mammography.

10 ‘‘(C) The management and prevention of sexu11 ally transmitted diseases.

12 ‘‘(D) Menopause, osteoporosis, and other condi13 tions relating to aging.

14 ‘‘(E) Cardiac care.

15 ‘‘(F) Physical and psychological conditions aris16 ing out of acts of sexual violence.

17 ‘‘(G) Physical and psychological conditions that

18 result from homelessness.’’.

19 (b) CONTRACTS FOR WOMEN’S HEALTH SERVICES.—

20 Section 1703(a) of such title is amended by adding at the

21 end the following:

22 ‘‘(9) Women’s health services for veterans on

23 an ambulatory or outpatient basis.’’.
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1 (c) REPEAL OF SUPERSEDED AUTHORITY.—Section

2 106 of the Veterans Health Care Act of 1992 (Public Law

3 102–585; 38 U.S.C. 1710 note) is amended—

4 (1) by striking out subsection (a); and

5 (2) by striking out ‘‘(b) RESPONSIBILITIES OF

6 DIRECTORS OF FACILITIES.—’’ before ‘‘The Sec7 retary’’.

8 SEC. 3. COUNSELING AND TREATMENT FOR SEXUAL TRAU9 MA.

10 (a) COUNSELING.—Subsection (a)(1) of section

11 1720D of title 38, United States Code, is amended by

12 striking out ‘‘During the period through December 31,

13 1998, the Secretary’’ and inserting in lieu thereof ‘‘The

14 Secretary’’.

15 (b) TREATMENT.—Subsection (a)(2) of such section

16 is amended by striking out ‘‘During the period referred

17 to in paragraph (1), the Secretary’’ and inserting in lieu

18 thereof ‘‘The Secretary’’.

19 (c) CONTRACT COUNSELING.—Subsection (a)(3) of

20 such section is amended by striking out ‘‘, during the pe21 riod through December 31, 1998,’’.

22 SEC. 4. REPORT ON WOMEN’S HEALTH CARE AND RE23 SEARCH.

24 (a) IN GENERAL.—Not later than January 1, 1999,

25 the Secretary of Veterans Affairs shall submit to the Com-
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1 mittees on Veterans’ Affairs of the Senate and House of

2 Representatives a report on the provision of health care

3 services and the conduct of research carried out by, or

4 under the jurisdiction of, the Secretary relating to women

5 veterans. The report shall be prepared through the Center

6 for Women Veterans established under section 318 of title

7 38, United States Code, which shall prepare the report

8 in consultation with the Advisory Committee on Women

9 Veterans established under section 542 of that title.

10 (b) CONTENTS.—The report under subsection (a)

11 shall include the following information:

12 (1) The number of women veterans who have

13 received women’s health services (as such term is de14 fined in section 1701(10) of title 38, United States

15 Code) in facilities under the jurisdiction of the Sec16 retary (or the Secretary of Defense), shown by ref17 erence to the Department facility which provided

18 (or, in the case of Department of Defense facilities,

19 arranged for) those services.

20 (2) A description of—

21 (A) the services provided at each such fa22 cility;

23 (B) the type and amount of services pro24 vided by such personnel, including information

25 on the numbers of inpatient stays and the num-
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1 ber of outpatient visits through which such

2 services were provided; and

3 (C) the extent to which each such facility

4 relies on contractual arrangements under sec5 tion 1703 or 8153 of title 38, United States

6 Code, to furnish care to women veterans in fa7 cilities which are not under the jurisdiction of

8 the Secretary where the provision of such care

9 is not furnished in a medical emergency.

10 (3) The steps taken by each such facility to ex11 pand the provision of services at such facility (or

12 under arrangements with the Department of De13 fense facility) to women veterans.

14 (4) A description of the personnel of the De15 partment who provided such services to women vet16 erans, including the number of employees (including

17 both the number of individual employees and the

18 number of full-time employee equivalents) and the

19 professional qualifications or specialty training of

20 such employees and the Department facilities to

21 which such personnel were assigned.

22 (5) A description of any actions taken by the

23 Secretary to ensure the retention of the personnel

24 described in paragraph (4) and any actions under-
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1 taken to recruit such additional personnel or person2 nel to replace such personnel.

3 (6) An assessment by the Secretary of any dif4 ficulties experienced by the Secretary in the furnish5 ing of such services and the actions taken by the

6 Secretary to resolve such difficulties.

7 (7) A description (as of October 1 of the year

8 preceding the year in which the report is submitted)

9 of the status of any research relating to women vet10 erans being carried out by or under the jurisdiction

11 of the Secretary.

12 (8) A description of the actions taken by the

13 Secretary to foster and encourage the expansion of

14 such research.

15 SEC. 5. EXPANSION OF RESEARCH RELATING TO WOMEN

16 VETERANS.

17 (a) INCLUSION OF WOMEN AND MINORITIES IN

18 HEALTH RESEARCH.—Section 7303(c) of title 38, United

19 States Code, is amended—

20 (1) in paragraph (1), by striking out ‘‘that,

21 whenever possible and appropriate—’’ and inserting

22 in lieu thereof ‘‘that—’’; and

23 (2) by adding at the end the following new

24 paragraph:
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1 ‘‘(3) The requirement in paragraph (1) regarding

2 women and members of minority groups who are veterans

3 may be waived by the Secretary of Veterans Affairs with

4 respect to a project of clinical research if the Secretary

5 determines that the inclusion, as subjects in the project,

6 of women and members of minority groups, respectively—

7 ‘‘(A) is inappropriate with respect to the health

8 of the subjects;

9 ‘‘(B) is inappropriate with respect to the pur10 pose of the research; or

11 ‘‘(C) is inappropriate under such other cir12 cumstances as the Secretary may designate.’’.

13 (b) HEALTH RESEARCH RELATING TO WOMEN.—

14 Section 7303(d) of such title is amended by adding at the

15 end the following new paragraphs:

16 ‘‘(3) The Secretary shall foster and encourage re17 search under this section on the following matters as they

18 relate to women:

19 ‘‘(A) Breast cancer.

20 ‘‘(B) Gynecological and reproductive health, in21 cluding gynecological cancer, infertility, sexually22 transmitted diseases, and pregnancy.

23 ‘‘(C) Human Immunodeficiency Virus and Ac24 quired Immune Deficiency Syndrome.
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1 ‘‘(D) Mental health, including post-traumatic

2 stress disorder, depression, combat related stress,

3 and trauma.

4 ‘‘(E) Diseases related to aging, including meno5 pause, osteoporosis, and Alzheimer’s disease.

6 ‘‘(F) Substance abuse.

7 ‘‘(G) Sexual violence and related trauma.

8 ‘‘(H) Exposure to toxic chemicals and other en9 vironmental hazards.

10 ‘‘(I) Cardiac care.

11 ‘‘(4) The Secretary shall, to the maximum extent

12 practicable, ensure that personnel of the Department of

13 Veterans Affairs engaged in the research referred to in

14 paragraph (1) include the following:

15 ‘‘(A) Personnel of the geriatric research, edu16 cation, and clinical centers designated pursuant to

17 section 7314 of this title.

18 ‘‘(B) Personnel of the National Center for Post19 Traumatic Stress Disorder established pursuant to

20 section 110(c) of the Veterans Health Care Act of

21 1984 (Public Law 98–528; 98 Stat. 2692).

22 ‘‘(5) The Secretary shall ensure that personnel of the

23 Department engaged in research relating to the health of

24 women veterans are advised and informed of such research

25 engaged in by other personnel of the Department.’’.
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1 SEC. 6. POPULATION STUDY.

2 (a) STUDY.—The Secretary of Veterans Affairs, sub3 ject to subsection (f), shall conduct a study to determine

4 the needs of veterans who are women for health-care serv5 ices. The study shall be carried out through the Center

6 for Women Veterans.

7 (b) CONSULTATION.—Before carrying out the study,

8 the Secretary shall request the advice of the Advisory

9 Committee on Women Veterans on the conduct of the

10 study.

11 (c) PERSONS TO BE INCLUDED IN SAMPLE OF VET12 ERANS STUDIED.—(1) Subject to paragraph (2), the study

13 shall be based on—

14 (A) an appropriate sample of veterans who are

15 women; and

16 (B) an examination of the medical and demo17 graphic histories of the women comprising such sam18 ple.

19 (2) The sample referred to in paragraph (1) shall

20 constitute a representative sampling (as determined by the

21 Secretary) of the ages, the ethnic, social and economic

22 backgrounds, the enlisted and officer grades, and the

23 branches of service of all veterans who are women. The

24 Secretary shall ensure that homeless Women Veterans are

25 included in the sample.
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1 (3) In carrying out the examination referred to in

2 paragraph (1)(B), the Secretary shall determine the num3 ber of women of the sample who have used medical facili4 ties of the Department, nursing home facilities of or under

5 the jurisdiction of the Department, and outpatient care

6 facilities of or under the jurisdiction of the Department.

7 (d) REPORTS.—The Secretary shall submit to the

8 Committees on Veterans’ Affairs of the Senate and House

9 of Representatives reports relating to the study as follows:

10 (1) Not later than nine months after the date

11 of the enactment of this Act, an interim report de12 scribing (A) the information and advice obtained by

13 the Secretary from the Advisory Committee on

14 Women Veterans, and (B) the status of the study.

15 (2) Not later than December 31, 1999, a final

16 report describing the results of the study.

17 (e) AUTHORIZATION OF APPROPRIATIONS.—There is

18 authorized to be appropriated to the General Operating

19 Expenses account of the Department of Veterans Affairs

20 $2,000,000 to carry out the purposes of this section.

21 Amounts appropriated pursuant to this authorization of

22 appropriations shall be available for obligation without fis23 cal year limitation.
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1 (f) LIMITATION.—No funds may be used to conduct

2 the study described in subsection (a) unless expressly pro3 vided for in an appropriation Act.

4 SEC. 7. OUTREACH SERVICES FOR HOMELESS WOMEN VET5 ERANS.

6 Section 7722(e) of title 38, United States Code, is

7 amended by adding at the end the following new sentence:

8 ‘‘In carrying out this subsection, the Secretary shall take

9 such steps as may be necessary to ensure that homeless

10 women veterans are included in such outreach programs

11 and outreach services.’’.

12 SEC. 8. SAFE AND EFFECTIVE TREATMENT FOR WOMEN

13 PSYCHIATRIC PATIENTS.

14 The Secretary of Veterans Affairs shall ensure that

15 women veterans who receive psychiatric treatment from

16 the Secretary, particularly in the case of women who are

17 sexually traumatized, receive such treatment (on both an

18 inpatient and outpatient basis) in a safe and effective

19 manner that recognizes the privacy needs of such women.

20 SEC. 9. MAMMOGRAPHY QUALITY STANDARDS.

21 (a) APPLICABILITY TO DEPARTMENT OF VETERANS

22 AFFAIRS OF MAMMOGRAPHY QUALITY STANDARDS ACT

23 OF 1992.—Subsections (a) through (k) of section 354 of

24 the Public Health Service Act (42 U.S.C. 263b) shall

25 apply with respect to facilities of the Department of Veter-
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1 ans Affairs without regard to the last sentence of subpara2 graph (A) of subsection (a)(3) of such section.

3 (b) EXTENSION OF DEADLINES.—Any deadline for

4 the completion of any action prescribed under any provi5 sion referred to in subsection (a) shall be applied with re6 spect to facilities of the Department of Veterans Affairs

7 by extending such deadline so as to be two years after

8 the date of the enactment of this Act or two years after

9 the date which would otherwise be applicable under such

10 provision, whichever is later.

11 (c) INTERAGENCY COOPERATION.—The Secretary of

12 Veterans Affairs shall take appropriate steps to cooperate

13 with the Secretary of Health and Human Services in the

14 implementation of this section.

15 SEC. 10. CENTER FOR WOMEN VETERANS.

16 Section 318(e) of title 38, United States Code, is

17 amended—

18 (1) by inserting ‘‘(1)’’ after ‘‘(e)’’;

19 (2) by adding after the period the following:

20 ‘‘Such resources shall include (subject to the avail21 ability of appropriations) adequate clerical support

22 (as determined by the Director) to enable the Direc23 tor to carry out the functions of the Director under

24 this section.’’; and

25 (3) by adding at the end the following:
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1 ‘‘(2) There is in the Center an Associate Director,

2 who shall be appointed from among individuals with ap3 propriate education, experience, and training to assist the

4 Director with the investigative, research, and reporting

5 requirements under this section.’’.

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