I
104TH CONGRESS
2D SESSION
H. R. 3713
To amend title 38, United States Code, to improve health care services
for women veterans provided by the Department of Veterans Affairs.
IN THE HOUSE OF REPRESENTATIVES
JUNE 25, 1996
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 for women veterans provided by the Depart-
ment of Veterans Affairs.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Women Veterans
Health Equity Act of 1996’’.
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) Health care for veterans has traditionally
been considered in terms of male veterans.
(2) Women constitute nearly 5 percent of the
total veteran population, a percentage that is grow-
ing.
(3) There are currently 1,200,000 female veter-
ans in the United States, a number which is steadily
increasing.
(4) Thirty percent of women using Department
of Veterans Affairs facilities report some form of
sexual assault or sexual trauma during their military
service.
SEC. 3. TIMELY AND APPROPRIATE HEALTH CARE SERV-
ICES FOR WOMEN.
(a) ENSURED PROVISION OF SERVICES.—The Sec-
retary of Veterans Affairs shall ensure that each health-
care facility under the direct jurisdiction of the Secretary
is able, through services made available either by individ-
uals appointed to positions in the Veterans Health Admin-
istration or under contracts or other agreements made
under section 7409, 8111, or 8153 of title 38, United
States Code, or title II of Public Law 102–585, to provide
in a timely and appropriate manner women’s health serv-
ices (as defined in section 1701(10) of title 38, United
States Code (as added by section 4) to any veteran de-
scribed in section 1710(a)(1) of title 38, United States
Code, who is eligible for such services.
(b) HEALTH CARE SERVICES TO BE PROVIDED DI-
RECTLY WHEN COST EFFECTIVE.—(1) The Secretary
shall ensure that each health-care facility under the direct
jurisdiction of the Secretary shall provide women’s health
services directly (rather than by contract or other agree-
ment) when it is cost effective to do so.
(2) The Secretary shall ensure that each such facility
is provided appropriate equipment, treatment facilities,
and staff to carry out paragraph (1) and to ensure that
the quality of care provided under that paragraph is in
accordance with professional standards.
(c) CONFORMING REPEAL.—Section 302 of the Vet-
erans’ Health Care Amendments of 1983 (Public Law 98–
160; 97 Stat. 1004; 38 U.S.C. 1701 note) is repealed.
SEC. 4. WOMEN’S HEALTH SERVICES.
(a) WOMEN’S HEALTH SERVICES.—Section 1701 of
title 38, United States Code, is amended—
(1) in paragraph (6)(A)(i), by inserting ‘‘wom-
en’s health services,’’ after ‘‘preventive health serv-
ices,’’; and
(2) by adding at the end the following:
‘‘(10) The term ‘women’s health services’ means
health care services provided to women. Such term in-
cludes counseling and services relating to the following:
‘‘(A) Papanicolaou tests (pap smear).
‘‘(B) Breast examinations and mammography.
‘‘(C) The treatment, management, and preven-
tion of sexually transmitted diseases.
‘‘(D) Hormone replacement therapy.
‘‘(E) Menopause, osteoporosis, senility, and
other conditions relating to aging.
‘‘(F) Cardiac care.
‘‘(G) Physical and psychological conditions aris-
ing out of acts of sexual violence or sexual intimida-
tion.
‘‘(H) Well-baby care and pediatrics.
‘‘(I) Physical and psychological conditions that
result from homelessness.’’.
(b) CONTRACTS FOR WOMEN’S HEALTH SERVICES.—
Section 1703(a) of such title is amended by adding at the
end the following:
‘‘(9) Women’s health services for veterans on
an ambulatory or outpatient basis.’’.
(c) REPEAL OF SUPERSEDED AUTHORITY.—Section
106 of the Veterans Health Care Act of 1992 (Public Law
102–585; 38 U.S.C. 1710 note) is amended—
(1) by striking out subsection (a); and
(2) by striking out ‘‘(b) RESPONSIBILITIES OF
DIRECTORS
OF FACILITIES.—’’ before ‘‘The Sec-
retary’’.
SEC. 5. PRIMARY CARE SERVICES.
(a) TRAINING OF PRIMARY CARE PHYSICIANS.—The
Secretary of Veterans Affairs shall ensure that primary
care physicians of the Department of Veterans Affairs are
trained and prepared to ask the appropriate questions in
regard to the possibility that a patient who is a woman
veteran may have experienced sexual assault or sexual
trauma while in active military, naval, or air service.
(b) PREGNANCY CARE FOR WOMEN VETERANS WITH
SERVICE-CONNECTED
DISABILITY.—The Secretary of
Veterans Affairs shall make available to any pregnant vet-
eran who has a service-connected disability pregnancy care
services, including pre-natal, delivery, and post-natal care.
SEC. 6. OUTREACH SERVICES FOR HOMELESS WOMEN VET-
ERANS.
Section 7722(e) of title 38, United States Code, is
amended by adding at the end the following new sentence:
‘‘In carrying out this subsection, the Secretary shall take
such steps as may be necessary to ensure that homeless
women veterans are included in such outreach programs
and outreach services. Such programs and services for
women veterans shall include the following:
‘‘(1) Crisis counseling and psychological testing
for Post-Traumatic Stress Disorder and other manic
depressive illnesses.
‘‘(2) Transportation for outreach assistance.
‘‘(3) Priority placement for inpatient services.
‘‘(4) Follow-up and after-care treatment.’’.
SEC. 7. SAFE AND EFFECTIVE TREATMENT FOR WOMEN
PSYCHIATRIC PATIENTS.
(a) SAFE AND EFFECTIVE TREATMENT.—The Sec-
retary of Veterans Affairs shall ensure that women veter-
ans who receive psychiatric treatment from the Secretary,
particularly in the case of women who are sexually trau-
matized, receive such treatment (on both an inpatient and
outpatient basis) in a safe and effective manner that rec-
ognizes the privacy needs of such women. The Secretary
shall ensure strict confidentiality for women veterans re-
ceiving such treatment. Services to be provided women vet-
erans who require such treatment shall include the follow-
ing:
(1) Private counseling.
(2) A comprehensive medical examination and
evaluation.
(b) PARTNERSHIPS TO PROVIDE TEMPORARY SHEL-
TER.—As part of a program of treatment under sub-
section (a), the Secretary shall establish partnerships with
nonprofit entities to provide temporary housing for home-
less women veterans until their mental condition is sta-
bilized.
SEC. 8. MAMMOGRAPHY QUALITY STANDARDS.
(a) IN GENERAL.—(1) Subchapter II of chapter 73
is amended by adding at the end the following new section:
‘‘§ 7319. Mammography quality standards
‘‘(a) A mammogram may not be performed at a De-
partment facility unless that facility is accredited for that
purpose by a private nonprofit organization designated by
the Secretary. An organization designated by the Sec-
retary under this subsection shall meet the standards for
accrediting bodies established under section 354(e) of the
Public Health Service Act (42 U.S.C. 263b(e)).
‘‘(b) The Secretary, in consultation with the Sec-
retary of Health and Human Services, shall prescribe
quality assurance and quality control standards relating
to the performance and interpretation of mammograms
and use of mammogram equipment and facilities of the
Department of Veterans Affairs consistent with the re-
quirements of section 354(f)(1) of the Public Health Serv-
ice Act. Such standards shall be no less stringent than
the standards prescribed by the Secretary of Health and
Human Services under section 354(f) of the Public Health
Service Act.
‘‘(c)(1) The Secretary, to ensure compliance with the
standards prescribed under subsection (b), shall provide
for an annual inspection of the equipment and facilities
used by and in Department health care facilities for the
performance of mammograms. Such inspections shall be
carried out in a manner consistent with the inspection of
certified facilities by the Secretary of Health and Human
Services under section 354(g) of the Public Health Service
Act.
‘‘(2) The Secretary may not provide for an inspection
under paragraph (1) to be performed by a State agency.
‘‘(d) The Secretary shall ensure that mammograms
performed for the Department under contract with any
non-Department facility or provider conform to the quality
standards prescribed by the Secretary of Health and
Human Services under section 354 of the Public Health
Service Act.
‘‘(e) For the purposes of this section, the term ‘mam-
mogram’ has the meaning given such term in paragraph
(5) of section 354(a) of the Public Health Service Act (42
U.S.C. 263b(a)).’’.
(2) The table of sections at the beginning of such
chapter is amended by inserting after the item relating
to section 7318 the following new item:
‘‘7319. Mammography quality standards.’’.
(b) DEADLINE FOR PRESCRIBING STANDARDS.—The
Secretary of Veterans Affairs shall prescribe standards
under subsection (b) of section 7319 of title 38, United
States Code, as added by subsection (a), not later than
the end of the 120-day period beginning on the date of
the enactment of this Act.
(c) IMPLEMENTATION REPORT.—The Secretary of
Veterans Affairs shall submit to the Committees on Veter-
ans’ Affairs of the Senate and House of Representatives
a report on the Secretary’s implementation of section
7319 of title 38, United States Code, as added by sub-
section (a). The report shall be submitted not later than
120 days after the later of (1) the date on which the Sec-
retary prescribes the quality standards required under
subsection (b) of that section, or (2) the date of the enact-
ment of this Act.
SEC. 9. COORDINATION OF SERVICES.
Section 108 of the Women Veterans Health Pro-
grams Act of 1992 (title I of Public Law 102–585; 38
U.S.C. 1710) is amended—
(1) by inserting ‘‘(a)’’ at the beginning of the
text of the section; and
(2) by adding at the end the following:
‘‘(b)(1) Each coordinator of women’s services under
subsection (a) shall serve in that capacity on a full-time
basis, with the duties of that position being that official’s
principal responsibility.
‘‘(2) The Secretary shall ensure that (subject to the
availability of appropriations) sufficient resources are pro-
vided to each such coordinator to enable that coordinator
to carry out the functions of the coordinator under this
section and shall ensure that each such coordinator has
direct access to the Chief of Staff of each Department
medical facility in that coordinator’s region.’’.
SEC. 10. PATIENT PRIVACY FOR WOMEN PATIENTS.
(a) IDENTIFICATION OF DEFICIENCIES.—The Sec-
retary of Veterans Affairs shall conduct a survey of each
medical center under the jurisdiction of the Secretary to
identify deficiencies relating to patient privacy afforded to
women patients in the clinical areas at each such center
which may interfere with appropriate treatment of such
patients.
(b) CORRECTION OF DEFICIENCIES.—The Secretary
shall ensure that plans and, where appropriate, interim
steps, to correct the deficiencies identified in the survey
conducted under subsection (a) are developed and are in-
corporated into the Department’s construction planning
processes and given a high priority.
(c) REPORTS TO CONGRESS.—The Secretary shall
compile an annual inventory, by medical center, of defi-
ciencies identified under subsection (a) and of plans and,
where appropriate, interim steps, to correct such defi-
ciencies. The Secretary shall submit to the Committees on
Veterans’ Affairs of the Senate and House of Representa-
tives, not later than October 1, 1997, and not later than
October 1 each year thereafter through 2000 a report on
such deficiencies. The Secretary shall include in such re-
port the inventory compiled by the Secretary, the proposed
corrective plans, and the status of such plans.
SEC. 11. OUTREACH SERVICES.
The Secretary of Veterans Affairs shall carry out a
program of advertising in mass media to inform women
veterans of the health services available to them through
the Department of Veterans Affairs.
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