H.R. 3224 — what changed

added “(10) The Director of Women’s Health.”

added “7310. Office of Women’s Health

added “(a) Establishment

added “(1) The Under Secretary for Health shall establish and operate in the Veterans Health Administration the Office of Women’s Health (hereinafter in this section referred to as the “Office”). The Office shall be located at the Central Office of the Department of Veterans Affairs.

added “(2) The head of the Office is the Director of Women’s Health (hereinafter in this section referred to as the “Director”). The Director shall report to the Under Secretary for Health.

added “(3) The Under Secretary for Health shall provide the Office with such staff and other support as may be necessary for the Office to carry out effectively its functions under this section.

added “(4) The Under Secretary for Health may reorganize existing offices within the Veterans Health Administration as of the date of the enactment of this section in order to avoid duplication with the functions of the Office.

added “(b) Purpose—The functions of the Office include the following:

added “(1) To provide a central office for monitoring and encouraging the activities of the Veterans Health Administration with respect to the provision, evaluation, and improvement of women veterans’ health care services in the Department.

added “(2) To develop and implement standards of care for the provision of health care for women veterans in the Department.

added “(3) To monitor and identify deficiencies in standards of care for the provision of health care for women veterans in the Department, to provide technical assistance to medical facilities of the Department to address and remedy deficiencies, and to perform oversight of implementation of standards of care for women veterans’ health care in the Department.

added “(4) To monitor and identify deficiencies in standards of care for the provision of health care for women veterans provided through the community pursuant to this title, and to provide recommendations to the appropriate office to address and remedy any deficiencies.

added “(5) To oversee distribution of resources and information related to women veterans’ health programming under this title.

added “(6) To promote the expansion and improvement of clinical, research, and educational activities of the Veterans Health Administration with respect the health care of women veterans.

added “(7) To provide, as part of the annual budgeting process, recommendations with respect to the amount of funds to be requested for furnishing hospital care and medical services to women veterans pursuant to chapter 17 of this title, including, at a minimum, recommendations that ensure that such amount of funds either reflect or exceed the proportion of veterans enrolled in the patient enrollment system under section 1705 of this title who are women.

added “(8) To provide recommendations to the Under Secretary for Health with respect to modifying the Veterans Equitable Resource Allocation system to ensure that resource allocations under such system reflect the health care needs of women veterans.

added “(9) To carry out such other duties as the Under Secretary for Health may require.

added “(c) Recommendations—If the Under Secretary for Health determines not to implement any recommendation made by the Director with respect to the allocation of resources to address the health care needs of women veterans, the Secretary shall notify the appropriate congressional committees of such determination by not later than 30 days after the date on which the Under Secretary for Health receives the recommendation. Each such notification shall include the following:

added “(1) The reasoning of the Under Secretary for Health in making such determination.

added “(2) An alternative, if one is selected, to such recommendation that the Under Secretary for Health will carry out to fulfill the health care needs of women veterans.

added “(d) Standards of care—In this section, the standards of care for the provision of health care for women veterans in the Department shall include, at a minimum, the following:

added “(1) Requirement for—

added “(A) at least one designated women’s health primary care provider at each medical center whose duties include, to the extent practicable, providing training to other health care providers of the Department with respect to the needs of women veterans; and

added “(B) at least one designated women’s health primary care provider at each community-based outpatient clinic of the Department who may serve female patients as a percentage of the total duties of the provider.

added “(2) Other requirements as determined by the Under Secretary for Health.

added “(e) Outreach—The Director shall ensure that—

added “(1) not less frequently than biannually, each medical facility of the Department holds a public forum for women veterans that occurs outside of regular business hours; and

added “(2) not less frequently than quarterly, each medical facility of the Department convenes a focus group of women veterans that includes a discussion of harassment occurring at such facility.

added “(f) Definitions—In this section:

added “(1) The term appropriate congressional committees has the meaning given that term in section 7310A of this title.

added “(2) The term facility of the Department has the meaning given the term in section 1701(3).

added “(3) The term Veterans Equitable Resource Allocation system means the resource allocation system established pursuant to section 429 of the Departments of Veterans Affairs and Housing and Urban Development, and Independent Agencies Appropriations Act, 1997 (Public Law 104–204; 110 Stat. 2929).

added “7310A. Annual reports on women’s health

added “(a) Annual reports—Not later than December 1 of each year, the Director of Women’s Health shall submit to the appropriate congressional committees a report containing the matters under subsections (b) through (g).

added “(b) Office of Women’s Health—Each report under subsection (a) shall include a description of—

added “(1) actions taken by the Office of Women’s Health in the preceding fiscal year to improve the Department’s provision of health care to women veterans;

added “(2) any identified deficiencies related to the Department’s provision of health care to women veterans and the standards of care established in section 7310 of this title, and the Department’s plan to address such deficiencies;

added “(3) the funding and personnel provided to the Office and whether additional funding or personnel are needed to meet the requirements of such section; and

added “(4) other information that would be of interest to the appropriate congressional committees with respect to oversight of the Department’s provision of health care to women veterans.

added “(c) Access to gender-specific services—Each report under subsection (a) shall include an analysis of the access of women veterans to gender-specific services under contracts, agreements, or other arrangements with non-Department medical providers entered into by the Secretary for the provision of hospital care or medical services to veterans. Such analysis shall include data and performance measures for the availability of gender specific services, including—

added “(1) the average wait time between the veteran’s preferred appointment date and the date on which the appointment is completed;

added “(2) the average driving time required for veterans to attend appointments; and

added “(3) reasons why appointments could not be scheduled with non-Department medical providers.

added “(d) Locations where women veterans are using health care—Each report under subsection (a) shall include an analysis of the use by women veterans of health care from the Department, including the following information:

added “(1) The number of women veterans who reside in each State.

added “(2) The number of women veterans in each State who are enrolled in the system of patient enrollment of the Department established and operated under section 1705(a) this title.

added “(3) Of the women veterans who are so enrolled, the number who have received health care under the laws administered by the Secretary at least one time during the one-year period preceding the submittal of the report.

added “(4) The number of women veterans who have been seen at each medical facility of the Department during such year.

added “(5) The number of appointments that women veterans have had at each such facility during such year.

added “(6) If known, an identification of the medical facility of the Department in each Veterans Integrated Service Network with the largest rate of increase in patient population of women veterans as measured by the increase in unique women veteran patient use.

added “(7) If known, an identification of the medical facility of the Department in each Veterans Integrated Service Network with the largest rate of decrease in patient population of women veterans as measured by the decrease in unique women veterans patient use.

added “(e) Models of care—Each report under subsection (a) shall include an analysis of the use by the Department of general primary care clinics, separate but shared spaces, and women's health centers as models of providing health care to women veterans. Such analysis shall include the following:

added “(1) The number of facilities of the Department that fall into each such model, disaggregated by Veterans Integrated Service Network and State.

added “(2) A description of the criteria used by the Department to determine which such model is most appropriate for each facility of the Department.

added “(3) An assessment of how the Department decides to make investments to modify facilities to a different model.

added “(4) A description of what, if any, plans the Department has to modify facilities from general primary care clinics to another model.

added “(5) An assessment of whether any facilities could be modified to a separate but shared space for a women’s health center within planned investments under the strategic capital investment planning process of the Department.

added “(6) An assessment of whether any facilities could be modified to a separate or shared space, or women’s health center with minor modifications to existing plans under the strategic capital investment planning process of the Department.

added “(7) An assessment of whether the Department has a goal for how many facilities should fall into each such model.

added “(f) Staffing—Each report under subsection (a) shall include an analysis of the staffing of the Department relating to the treatment of women, including the following, disaggregated by Veterans Integrated Service Network and State (except with respect to paragraph (4)):

added “(1) The number of women’s health centers.

added “(2) The number of patient aligned care teams of the Department relating to women's health.

added “(3) The number of full- and part-time gynecologists of the Department.

added “(4) The number of designated women’s health care providers of the Department, disaggregated by facility of the Department.

added “(5) The number of health care providers of the Department who have completed a mini-residency for women’s health care through Women Veterans Health Care Mini-Residency Program of the Department during the one-year period preceding the submittal of the report, and the number that plan to participate in such a mini-residency during the one-year period following such date.

added “(6) The number of designated women’s health care providers of the Department who have sufficient female patients to retain their competencies and proficiencies.

added “(g) Accessibility and treatment options—Each report under subsection (a) shall include an analysis of the accessibility and treatment options for women veterans, including the following:

added “(1) An assessment of wheelchair accessibility of women’s health centers of the Department, including, with respect to each such facility, an assessment of such accessibility for each kind of treatment provided at the center, including with respect to radiology and mammography, that addresses all relevant factors, including door sizes, hoists, and equipment.

added “(2) The options for women veterans to access female mental health providers and primary care providers.

added “(3) The options for women veterans at medical facilities of the Department with respect to clothing sizes, including for gowns, drawstring pants, and pajamas.

added “(h) Definitions—In this section:

added “(1) The term appropriate congressional committees means—

added “(A) the Committees on Veterans’ Affairs of the House of Representatives and the Senate; and

added “(B) the Committees on Appropriations of the House of Representatives and the Senate.

added “(2) The term gender-specific services means mammography, obstetric care, gynecological care, and such other services as the Secretary determines appropriate.”

added The Secretary of Veterans Affairs shall expand the capabilities of the Women Veterans Call Center of the Department of Veterans Affairs to include a text messaging capability.

added “1720J. Medical services for women veterans

added “(a) Access to care—The Secretary shall ensure that women’s health primary care services are available during regular business hours at every medical center and community based outpatient clinic of the Department.

added “(b) Study on extended hours of care—The Secretary shall conduct a study to assess—

added “(1) the use of extended hours as a means of reducing barriers to care;

added “(2) the need for extended hours based on interviews with women veterans and employees; and

added “(3) the best practices and resources required to implement use of extended hours.

added “(c) Annual report to Congress—Not later than September 30 of each year, the Secretary 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 compliance with subsection (a).”

added Section 1720D of title 38, United States Code, is amended—

added “(g) In this section, the term former member of the Armed Forces includes the following:

added “(1) A veteran described in section 101(2) of this title.

added “(2) An individual not described in paragraph (1) who was discharged or released from the Armed Forces under a condition that is not honorable but not—

added “(A) a dishonorable discharge; or

added “(B) a discharge by court-martial.”

added “1712D. Counseling in retreat settings for women veterans and other individuals

added “(a) Program

added “(1) Commencing not later than January 1, 2021, the Secretary shall carry out, through the Readjustment Counseling Service of the Veterans Health Administration, a program to provide reintegration and readjustment services described in subsection (b) in group retreat settings to covered individuals, including cohorts of women veterans who are eligible for readjustment counseling services under section 1712A of this title.

added “(2) The participation of a covered individual in the program under paragraph (1) shall be at the election of the individual.

added “(b) Covered services—The services provided to a covered individual under the program under subsection (a)(1) shall include the following:

added “(1) Information on reintegration into the family, employment, and community of the individual.

added “(2) Financial counseling.

added “(3) Occupational counseling.

added “(4) Information and counseling on stress reduction.

added “(5) Information and counseling on conflict resolution.

added “(6) Such other information and counseling as the Secretary considers appropriate to assist the individual in reintegration into the family, employment, and community of the veteran.

added “(c) Biennial reports—Not later than December 31, 2022, and each even-numbered year thereafter, the Secretary shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a report on the program under subsection (a)(1).

added “(d) Covered individual defined—In this section, the term covered individual means—

added “(1) Any veteran who is enrolled in the system of annual patient enrollment under section 1705 of this title.

added “(2) Any survivor or dependent of a veteran who is eligible for medical care under section 1781 of this title.”

added “(f) Annual report—Not later than 60 days after the end of each fiscal year, the Secretary 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 health care services provided under subsection (a) during such fiscal year, including the number of newborn children who received such services during such fiscal year.”

added “(3) another location, including a health care facility, if the veteran delivers the child before arriving at a facility described in paragraph (1) or (2).”

added “(c) Transportation

added “(1) Transportation furnished under subsection (a) to, from, or between care settings to meet the needs of a newborn child includes costs for either or both the newborn child and parents.

added “(2) Transportation furnished under subsection (a) is transportation by ambulance, including air ambulance, or other appropriate medically staffed modes of transportation—

added “(A) to another health care facility (including a specialty pediatric hospital) that accepts transfer of the newborn child or otherwise provides post-delivery care services when the treating facility is not capable of furnishing the care or services required; or

added “(B) to a health care facility in a medical emergency of such nature that a prudent layperson reasonably expects that delay in seeking immediate medical attention would be hazardous to life or health.

added “(3) Amounts paid by the Department for transportation under this section shall be derived from the Medical Services appropriations account of the Department.

added “(d) Reimbursement or payment for health care services or transportation

added “(1) Pursuant to regulations the Secretary shall prescribe to establish rates of reimbursement and any limitations thereto under this section, the Secretary shall directly reimburse a covered entity for health care services or transportation services provided under this section, unless the cost of the services or transportation is covered by an established agreement or contract. If such an agreement or contract exists, its negotiated payment terms shall apply.

added “(2)

added “(A) Reimbursement or payment by the Secretary under this section on behalf of an individual to a covered entity shall, unless rejected and refunded by the covered entity within 30 days of receipt, extinguish any liability on the part of the individual for the health care services or transportation covered by such payment.

added “(B) Neither the absence of a contract or agreement between the Secretary and a covered entity nor any provision of a contract, agreement, or assignment to the contrary shall operate to modify, limit, or negate the requirements of subparagraph (A).

added “(3) In this subsection, the term covered entity means any individual, transportation carrier, organization, or other entity that furnished or paid for health care services or transportation under this section.

added “(e) Exception—Pursuant to such regulations as the Secretary shall prescribe to carry out this section, the Secretary may furnish more than 14 days of health care services described in subsection (b), and transportation necessary to receive such services, to a newborn child based on medical necessity if the child is in need of additional care, including a case in which the newborn child has been discharged or released from a hospital and requires readmittance to ensure the health and welfare of the newborn child.”

added Section 542(c)(1) of title 38, United States Code, is amended—

added “(C) an assessment of the effects of intimate partner violence on women veterans; and”

added Not later than one year after the date of the enactment of this Act, 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 availability from the Department of Veterans Affairs of prosthetic items made for women veterans, including an assessment of the availability of such prosthetic items at each medical facility of the Department. The report shall—

added Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a report containing a study on the Women Veteran Coordinator program of the Veterans Benefits Administration of the Department of Veterans Affairs. Such study shall identify the following:

added “533. Anti-harassment and anti-sexual assault policy

added “(a) Establishment—The Secretary of Veterans Affairs shall establish a comprehensive policy to end harassment and sexual assault, including sexual harassment and gender-based harassment, throughout the Department of Veterans Affairs. This policy shall include the following:

added “(1) A process for employees and contractors of the Department to respond to reported incidents of harassment and sexual assault committed by any non-Department individual within a facility of the Department, including with respect to accountability or disciplinary measures.

added “(2) A process for employees and contractors of the Department to respond to reported incidents of harassment and sexual assault of any non-Department individual within a facility of the Department.

added “(3) A process for any non-Department individual to report harassment and sexual assault described in paragraph (1), including an option for confidential reporting, and for the Secretary to respond to and address such reports.

added “(4) Clear mechanisms for non-Department individuals to readily identify to whom and how to report incidents of harassment and sexual assault committed by another non-Department individual.

added “(5) Clear mechanisms for employees and contractors of the Department to readily identify to whom and how to report incidents of harassment and sexual assault and how to refer non-Department individuals with respect to reporting an incident of harassment or sexual assault.

added “(6) A process for, and mandatory reporting requirement applicable to, any employee or contractor of the Department who witnesses harassment or sexual assault described in paragraph (1) or (2) within a facility of the Department, regardless of whether the individual affected by such harassment or sexual assault wants to report such harassment or sexual assault.

added “(7) The actions possible, including disciplinary actions, for employees or contractors of the Department who fail to report incidents of harassment and sexual assault described in paragraph (1) or (2) that the employees or contractors witness.

added “(8) On an annual or more frequent basis, mandatory training for employees and contractors of the Department regarding how to report and address harassment and sexual assault described in paragraphs (1) and (2), including bystander intervention training.

added “(9) On an annual or more frequent basis, the distribution of the policy under this subsection and anti-harassment and anti-sexual assault educational materials by mail or email to each individual receiving a benefit under a law administered by the Secretary.

added “(10) The prominent display of anti-harassment and anti-sexual assault messages in each facility of the Department, including how non-Department individuals may report harassment and sexual assault described in paragraphs (1) and (2) at such facility and the points of contact under subsection (b).

added “(11) The posting on internet websites of the Department, including the main internet website regarding benefits of the Department and the main internet website regarding health care of the Department, of anti-harassment and anti-sexual assault banners specifically addressing harassment and sexual assault described in paragraphs (1) and (2).

added “(b) Points of contact—The Secretary shall designate, as a point of contact to receive reports of harassment and sexual assault described in paragraphs (1) and (2) of subsection (a)—

added “(1) at least one individual, in addition to law enforcement, at each facility of the Department (including Vet Centers under section 1712A of this title), with regard to that facility;

added “(2) at least one individual employed in each Veterans Integrated Service Network, with regards to facilities in that Veterans Integrated Service Network;

added “(3) at least one individual employed in each regional benefits office;

added “(4) at least one individual employed at each location of the National Cemetery Administration; and

added “(5) at least one individual employed at the Central Office of the Department to track reports of such harassment and sexual assault across the Department, disaggregated by facility.

added “(c) Accountability—The Secretary shall establish a policy to ensure that each facility of the Department and each director of a Veterans Integrated Service Network is responsible for addressing harassment and sexual assault at the facility and the Network. Such policy shall include—

added “(1) a remediation plan for facilities that experience five or more incidents of sexual harassment, sexual assault, or combination thereof, during any single fiscal year; and

added “(2) taking appropriate actions under chapter 7 or subchapter V of chapter 74 of this title.

added “(d) Data—The Secretary shall ensure that the in-take process for veterans at medical facilities of the Department includes a survey to collect the following information:

added “(1) Whether the veteran feels safe at the facility and whether any events occurred at the facility that affect such feeling.

added “(2) Whether the veteran wants to be contacted later by the Department with respect to such safety issues.

added “(e) Working group

added “(1) The Secretary shall establish a working group to assist the Secretary in implementing policies to carry out this section.

added “(2) The working group established under paragraph (1) shall consist of representatives from—

added “(A) veterans service organizations;

added “(B) State, local, and Tribal veterans agencies; and

added “(C) other persons the Secretary determines appropriate.

added “(3) The working group established under paragraph (1) shall develop, and the Secretary shall carry out—

added “(A) an action plan for addressing changes at the local level to reduce instances of harassment and sexual assault;

added “(B) standardized media for veterans service organizations and other persons to use in print and on the internet with respect to reducing harassment and sexual assault; and

added “(C) bystander intervention training for veterans.

added “(f) Reports—The Secretary shall submit to the Committees on Veterans’ Affairs of the Senate and the House of Representatives an annual report on harassment and sexual assault described in paragraphs (1) and (2) of subsection (a) in facilities of the Department. Each such report shall include the following:

added “(1) Results of harassment and sexual assault programming, including the End Harassment program.

added “(2) Results of studies from the Women’s Health Practice-Based Research Network of the Department relating to harassment and sexual assault.

added “(3) Data collected on incidents of sexual harassment and sexual assault.

added “(4) A description of any actions taken by the Secretary during the year preceding the date of the report to stop harassment and sexual assault at facilities of the Department.

added “(5) An assessment of the implementation of the training required in subsection (a)(7).

added “(6) A list of resources the Secretary determines necessary to prevent harassment and sexual assault at facilities of the Department.

added “(g) Definitions—In this section:

added “(1) The term non-Department individual means any individual present at a facility of the Department who is not an employee or contractor of the Department.

added “(2) The term sexual harassment has the meaning given that term in section 1720D of this title.”

added Section 2044(e) of title 38, United States Code, is amended by adding at the end the following new paragraph:

added “(4) Not less than $20,000,000 shall be available under paragraph (1)(H) for the provision of financial assistance under subsection (a) to organizations that have a focus on providing assistance to women veterans and their families.”