II 113th CONGRESS 1st Session S. 131 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. Short title This Act may be cited as the Women Veterans and Other Health Care Improvements Act of 2013 . 2. Clarification that fertility counseling and treatment are medical services which the Secretary may furnish to veterans like other medical services Section 1701(6) of title 38, United States Code, is amended by adding at the end the following new subparagraph: (H) Fertility counseling and treatment, including treatment using assisted reproductive technology. . 3. Reproductive treatment and care for spouses and surrogates of veterans (a) In general Subchapter VIII of chapter 17 of title 38, United States Code, is amended by adding at the end the following new section: 1788. Reproductive treatment and care for spouses and surrogates of veterans (a) In general The Secretary shall furnish fertility counseling and treatment, including through the use of assisted reproductive technology, to a spouse or surrogate of a severely wounded, ill, or injured veteran who has an infertility condition incurred or aggravated in line of duty in the active military, naval, or air service and who is enrolled in the system of annual patient enrollment established under section 1705(a) of this title if the spouse or surrogate and the veteran apply jointly for such counseling and treatment through a process prescribed by the Secretary. (b) Coordination of care for other spouses and surrogates In the case of a spouse or surrogate of a veteran not described in subsection (a) who is seeking fertility counseling and treatment, the Secretary may coordinate fertility counseling and treatment for such spouse or surrogate. (c) Construction Nothing in this section shall be construed to require the Secretary— (1) to find or certify a surrogate for a veteran or to connect a surrogate with a veteran; or (2) to furnish maternity care to a spouse or surrogate of a veteran. (d) Assisted reproductive technology defined In this section, the term assisted reproductive technology includes in vitro fertilization and other fertility treatments in which both eggs and sperm are handled when clinically appropriate. . (b) Clerical amendment The table of sections at the beginning of chapter 17 of such title is amended by inserting after the item relating to section 1787 the following new item: 1788. Reproductive treatment and care for spouses and surrogates of veterans. . 4. Adoption assistance for severely wounded veterans (a) In general Subchapter VIII of chapter 17 of title 38, United States Code, as amended by section 3, is further amended by adding at the end the following new section: 1789. Adoption assistance (a) In general The Secretary may pay an amount, not to exceed the limitation amount, to assist a covered veteran in the adoption of one or more children. (b) Covered veteran For purposes of this section, a covered veteran is any severely wounded, ill, or injured veteran who— (1) has an infertility condition incurred or aggravated in line of duty in the active military, naval, or air service; and (2) is enrolled in the system of annual patient enrollment established under section 1705(a) of this title. (c) Limitation amount For purposes of this section, the limitation amount is the amount equal to the lesser of— (1) the cost the Department would incur if the Secretary were to provide a covered veteran with one cycle of in vitro fertilization, as determined by the Secretary; and (2) the cost the Department would incur by paying the expenses of three adoptions by covered veterans, as determined by the Secretary. . (b) Clerical amendment The table of sections at the beginning of chapter 17 of such title, as amended by section 3, is further amended by inserting after the item relating to section 1788 the following new item: 1789. Adoption assistance. . 5. Annual report on provision of fertility counseling and treatment furnished by Department of Veterans Affairs (a) In general Not later than one year after the date of the enactment of this Act and not less frequently than once each year thereafter, the Secretary of Veterans Affairs shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a report on the fertility counseling and treatment furnished by the Department of Veterans Affairs during the year preceding the submittal of the report. (b) Elements Each report submitted under subsection (a) shall include, for the period covered by the report, the following: (1) The number of veterans who received fertility counseling or treatment furnished by the Department of Veterans Affairs, disaggregated by era of military service of such veterans. (2) The number of spouses and surrogates of veterans who received fertility counseling or treatment furnished by the Department. (3) The cost to the Department of furnishing fertility counseling and treatment, disaggregated by cost of services and administration. (4) The average cost to the Department per recipient of such counseling and treatment. (5) In cases in which the Department furnished fertility treatment through the use of assisted reproductive technology, the average number of cycles per person furnished. (6) A description of how fertility counseling and treatment services of the Department are coordinated with similar services of the Department of Defense. 6. Regulations on furnishing of fertility counseling and treatment and adoption assistance by Department of Veterans Affairs (a) In general Not later than 540 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall prescribe regulations— (1) on the furnishing of fertility treatment to veterans using assisted reproductive technology; (2) to carry out section 1788 of title 38, United States Code, as added by section 3; and (3) to carry out section 1789 of such title, as added by section 4. (b) Limitation Notwithstanding any other provision of law, during the period beginning on the date of the enactment of this Act and ending on the date on which the Secretary prescribes regulations under subsection (a), the Secretary may not furnish— (1) to a veteran any fertility treatment that uses an assisted reproductive technology that the Secretary has not used in the provision of a fertility treatment to a veteran before the date of the enactment of this Act; (2) any fertility counseling or treatment under section 1788 of title 38, United States Code, as added by section 3; or (3) any assistance under section 1789 of such title, as added by section 4. (c) Assisted reproductive technology defined In this section, the term assisted reproductive technology has the meaning given the term in section 1788 of such title, as added by section 3. 7. Coordination between Department of Veterans Affairs and Department of Defense on furnishing of fertility counseling and treatment The Secretary of Veterans Affairs and the Secretary of Defense shall share best practices and facilitate referrals, as they consider appropriate, on the furnishing of fertility counseling and treatment. 8. Facilitation of reproduction and infertility research (a) In general Subchapter II of chapter 73 of title 38, United States Code, is amended by adding at the end the following new section: 7330B. Facilitation of reproduction and infertility research (a) Facilitation of research required The Secretary shall facilitate research conducted collaboratively by the Secretary of Defense and the Secretary of Health and Human Services to improve the ability of the Department of Veterans Affairs to meet the long-term reproductive health care needs of veterans who have a genitourinary service-connected disability or a condition that was incurred or aggravated in line of duty in the active military, naval, or air service, such as spinal cord injury, that affects the veterans' ability to reproduce. (b) Dissemination of information The Secretary shall ensure that information produced by the research facilitated under this section that may be useful for other activities of the Veterans Health Administration is disseminated throughout the Veterans Health Administration. . (b) Clerical amendment The table of sections at the beginning of chapter 73 of such title is amended by inserting after the item relating to section 7330A the following new item: 7330B. Facilitation of reproduction and infertility research. . (c) Report Not later than three years after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to Congress a report on the research activities conducted by the Secretary under section 7330B of title 38, United States Code, as added by subsection (a). 9. Requirement to improve Department of Veterans Affairs women veterans contact center The Secretary of Veterans Affairs shall enhance the capabilities of the Department of Veterans Affairs women veterans contact center— (1) to respond to requests by women veterans for assistance with accessing health care and benefits furnished under laws administered by the Secretary; and (2) for referral of such veterans to community resources to obtain assistance with services not furnished by the Department. 10. Modification of pilot program on counseling in retreat settings for women veterans newly separated from service in the Armed Forces (a) Increase in number of locations Subsection (c) of section 203 of the Caregivers and Veterans Omnibus Health Services Act of 2010 (Public Law 111–163; 38 U.S.C. 1712A note) is amended by striking three locations and inserting 14 locations . (b) Extension of duration Subsection (d) of such section is amended by striking 2-year and inserting four-year . (c) Authorization of appropriations Subsection (f) of such section is amended— (1) by striking Secretary of Veterans Affairs for each and inserting the following: “Secretary of Veterans Affairs— (1) for each ; (2) in paragraph (1), as designated by paragraph (1), by striking the period at the end and inserting ; and ; and (3) by adding at the end the following new paragraph: (2) for each of fiscal years 2013 and 2014, $400,000 to carry out the pilot program. . 11. Program on assistance for child care for certain veterans (a) Assistance for child care for certain veterans receiving health care (1) In general Subchapter I of chapter 17 of title 38, United States Code, is amended by adding at the end the following new section: 1709B. Assistance for child care for certain veterans receiving health care (a) Program required The Secretary shall carry out a program to provide, subject to subsection (b), assistance to qualified veterans described in subsection (c) to obtain child care so that such veterans can receive health care services described in subsection (c). (b) Limitation on period of payments Assistance may only be provided to a qualified veteran under this section for receipt of child care during the period that the qualified veteran— (1) receives the types of health care services described in subsection (c) at a facility of the Department; and (2) requires travel to and return from such facility for the receipt of such health care services. (c) Qualified veterans For purposes of this section, a qualified veteran is a veteran who is— (1) the primary caretaker of a child or children; and (2) (A) receiving from the Department— (i) regular mental health care services; (ii) intensive mental health care services; or (iii) such other intensive health care services that the Secretary determines that provision of assistance to the veteran to obtain child care would improve access to such health care services by the veteran; or (B) in need of regular or intensive mental health care services from the Department, and but for lack of child care services, would receive such health care services from the Department. (d) Locations The Secretary shall carry out the program in no fewer than three Veterans Integrated Service Networks selected by the Secretary for purposes of the program. (e) Forms of child care assistance (1) Child care assistance under this section may include the following: (A) Stipends for the payment of child care offered by licensed child care centers (either directly or through a voucher program) which shall be, to the extent practicable, modeled after the Department of Veterans Affairs Child Care Subsidy Program established pursuant to section 630 of the Treasury and General Government Appropriations Act, 2002 ( Public Law 107–67 ; 115 Stat. 552). (B) Direct provision of child care at an on-site facility of the Department of Veterans Affairs. (C) Payments to private child care agencies. (D) Collaboration with facilities or programs of other Federal departments or agencies. (E) Such other forms of assistance as the Secretary considers appropriate. (2) In the case that child care assistance under this section is provided as a stipend under paragraph (1)(A), such stipend shall cover the full cost of such child care. . (2) Conforming amendment Section 205(e) of the Caregivers and Veterans Omnibus Health Services Act of 2010 ( Public Law 111–163 ; 38 U.S.C. 1710 note) is amended by inserting but not after the date of the enactment of the Women Veterans and Other Health Care Improvements Act of 2013 before the period at the end. (3) Clerical amendment The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 1709A the following new item: 1709B. Assistance for child care for certain veterans receiving health care. . (b) Assistance for child care for certain veterans receiving readjustment counseling and related mental health services (1) In general Subchapter I of chapter 17 of such title, as amended by subsection (a)(1), is further amended by adding at the end the following new section: 1709C. Assistance for child care for certain veterans receiving readjustment counseling and related mental health services (a) Program required The Secretary shall carry out a program to provide, subject to subsection (b), assistance to qualified veterans described in subsection (c) to obtain child care so that such veterans can receive readjustment counseling and related mental health services. (b) Limitation on period of payments Assistance may only be provided to a qualified veteran under this section for receipt of child care during the period that the qualified veteran receives readjustment counseling and related health care services at a Vet Center. (c) Qualified veterans For purposes of this section, a qualified veteran is a veteran who is— (1) the primary caretaker of a child; and (2) (A) receiving from the Department regular readjustment counseling and related mental health services; or (B) in need of readjustment counseling and related mental health services from the Department, and but for lack of child care services, would receive such counseling and services from the Department. (d) Locations The Secretary shall carry out the program under this section in no fewer than three Readjustment Counseling Service Regions selected by the Secretary for purposes of the program. (e) Forms of child care assistance (1) Child care assistance under this section may include the following: (A) Stipends for the payment of child care offered by licensed child care centers (either directly or through a voucher program) which shall be, to the extent practicable, modeled after the Department of Veterans Affairs Child Care Subsidy Program established pursuant to section 630 of the Treasury and General Government Appropriations Act, 2002 ( Public Law 107–67 ; 115 Stat. 552). (B) Payments to private child care agencies. (C) Collaboration with facilities or programs of other Federal departments or agencies. (D) Such other forms of assistance as the Secretary considers appropriate. (2) In the case that child care assistance under this subsection is provided as a stipend under paragraph (1)(A), such stipend shall cover the full cost of such child care. (f) Vet Center defined In this section, the term Vet Center means a center for readjustment counseling and related mental health services for veterans under section 1712A of this title. . (2) Clerical amendment The table of sections at the beginning of such chapter, as amended by subsection (a)(3), is further amended by inserting after the item relating to section 1709B the following new item: 1709C. Assistance for child care for certain veterans receiving readjustment counseling and related mental health services. . 12. Contractor user fees (a) In general Chapter 3 of title 38, United States Code, is amended by adding at the end the following new section: 323. Contractor user fees (a) Fee requirement Except as provided in subsection (c) and subject to subsection (d), the Secretary shall impose a fee upon each person with whom the Secretary engages in a contract for a good or service as a condition of the contract. (b) Fee amount (1) The amount of a fee imposed upon a person under subsection (a) with respect to a contract shall be equal to the lesser of— (A) the amount which is equal to seven percent of the total value of the contract; and (B) the amount which is equal to the total value of the contract multiplied by the applicable percentage for such fiscal year. (2) The applicable percentage for a fiscal year shall be equal to the percentage by which— (A) the annual estimate of the total value of contracts for such fiscal year, exceeds (B) the annual estimate of the total cost of fertility counseling and treatment for such fiscal year. (3) Before each fiscal year, the Secretary shall establish, for purposes of this section, the annual estimate of the total value of contracts for the next fiscal year, which shall be the Secretary's estimate of what the aggregate value will be of all contracts in which the Secretary will engage in the next fiscal year. (4) Before each fiscal year, the Secretary shall establish, for purposes of this section, the annual estimate of the total cost of fertility counseling and treatment for the next fiscal year, which shall be the Secretary's estimate of what the total cost to the Department will be in the next fiscal year of— (A) furnishing fertility counseling and treatment, including through the use of assisted reproductive technology, to individuals under laws administered by the Secretary in the next fiscal year; and (B) making payments under section 1789 of this title in the next fiscal year. (c) Waiver The Secretary may waive the fee required by subsection (a) for a person as the Secretary considers appropriate if the person is an individual or a small business concern. (d) Limitation on collection No fee may be collected under subsection (a) except to the extent that the expenditure of the fee to pay the costs of activities and services for which the fee is imposed is provided for in advance in an appropriations Act. (e) Department of Veterans Affairs Fertility Counseling and Treatment Fund (1) There is in the Treasury a fund to be known as the Department of Veterans Affairs Fertility Counseling and Treatment Fund. (2) All amounts received by the Secretary under subsection (a) shall be deposited in the fund. (3) (A) Subject to the provisions of appropriations Acts, amounts in the fund shall be available, without fiscal year limitation, to the Secretary for the following purposes: (i) To furnish fertility counseling and treatment, including through the use of assisted reproductive technology, to individuals under laws administered by the Secretary. (ii) To make payments under section 1789 of this title. (B) Amounts available under subparagraph (A) may not be used for any purposes other than a purpose set forth in clause (i) or (ii) of that subparagraph. (4) Amounts received by the Secretary under subsection (a) shall be treated for the purposes of sections 251 and 252 of the Balanced Budget and Emergency Deficit Control Act of 1985 ( 2 U.S.C. 901 , 902) as offsets to discretionary appropriations (rather than as offsets to direct spending) to the extent that such amounts are made available for expenditure in appropriations Acts for the purposes specified in paragraph (3) of this subsection. (f) Small business concern defined In this section, the term small business concern has the meaning given such term under section 3 of the Small Business Act (15 U.S.C. 632). . (b) Clerical amendment The table of sections at the beginning of chapter 3 of such title is amended by adding after the item relating to section 322 the following new item: 323. Contractor user fees. .