[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 1280 Introduced in Senate (IS)]
<DOC>
117th CONGRESS
1st Session
S. 1280
To improve the reproductive assistance provided by the Department of
Defense and the Department of Veterans Affairs to certain members of
the Armed Forces, veterans, and their spouses or partners, and for
other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
April 21, 2021
Mrs. Murray (for herself, Ms. Duckworth, Mr. Durbin, Ms. Warren, Mr.
Markey, Mr. Sanders, Mr. Blumenthal, Mr. Bennet, Mr. Coons, Mr. Wyden,
Mr. Brown, Mrs. Shaheen, Mr. Warnock, Ms. Hassan, and Ms. Klobuchar)
introduced the following bill; which was read twice and referred to the
Committee on Veterans' Affairs
_______________________________________________________________________
A BILL
To improve the reproductive assistance provided by the Department of
Defense and the Department of Veterans Affairs to certain members of
the Armed Forces, veterans, and their spouses or partners, and for
other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Veteran Families
Health Services Act of 2021''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--REPRODUCTIVE AND FERTILITY PRESERVATION ASSISTANCE FOR MEMBERS
OF THE ARMED FORCES
Sec. 101. Definitions.
Sec. 102. Provision of fertility treatment and counseling to certain
members of the Armed Forces and spouses,
partners, and gestational surrogates of
such members.
Sec. 103. Establishment of fertility preservation procedures after an
injury or illness.
Sec. 104. Cryopreservation and storage of gametes of members of the
Armed Forces on active duty.
Sec. 105. Assistance with and continuity of care regarding reproductive
and fertility preservation services.
Sec. 106. Coordination between Department of Defense and Department of
Veterans Affairs on furnishing of fertility
treatment and counseling.
TITLE II--REPRODUCTIVE AND ADOPTION ASSISTANCE FOR VETERANS
Sec. 201. Inclusion of fertility treatment and counseling under the
definition of medical services in title 38.
Sec. 202. Fertility treatment and counseling for certain veterans and
spouses, partners, and gestational
surrogates of such veterans.
Sec. 203. Adoption assistance for certain veterans.
Sec. 204. Assistance with and continuity of care regarding reproductive
and fertility preservation services.
Sec. 205. Facilitation of reproduction and infertility research.
Sec. 206. Annual report on fertility treatment and counseling furnished
by Department of Veterans Affairs.
Sec. 207. Report on timeliness and adequacy of access by veterans to
fertility treatment and counseling services
furnished by Department of Veterans
Affairs.
Sec. 208. Regulations on furnishing of fertility treatment and
counseling and adoption assistance by
Department of Veterans Affairs.
TITLE I--REPRODUCTIVE AND FERTILITY PRESERVATION ASSISTANCE FOR MEMBERS
OF THE ARMED FORCES
SEC. 101. DEFINITIONS.
In this title:
(1) Active duty.--The term ``active duty'' has the meaning
given that term in section 101(d)(1) of title 10, United States
Code.
(2) Armed forces.--The term ``Armed Forces'' has the
meaning given the term ``armed forces'' in section 101(a)(4) of
such title.
SEC. 102. PROVISION OF FERTILITY TREATMENT AND COUNSELING TO CERTAIN
MEMBERS OF THE ARMED FORCES AND SPOUSES, PARTNERS, AND
GESTATIONAL SURROGATES OF SUCH MEMBERS.
(a) Fertility Treatment and Counseling.--
(1) In general.--The Secretary of Defense shall furnish
fertility treatment and counseling, including through the use
of assisted reproductive technology, to a covered member of the
Armed Forces or a spouse, partner, or gestational surrogate of
such a member.
(2) Eligibility for treatment and counseling.--Fertility
treatment and counseling shall be furnished under paragraph (1)
without regard to the sex, gender identity, sexual orientation,
or marital status of the covered member of the Armed Forces.
(3) In vitro fertilization.--In the case of in vitro
fertilization treatment furnished under paragraph (1), the
Secretary may furnish not more than three completed cycles or
six attempted cycles of in vitro fertilization, whichever
occurs first, to an individual under such paragraph.
(b) Procurement of Gametes.--If a covered member of the Armed
Forces is unable to provide their gametes for purposes of fertility
treatment under subsection (a), the Secretary shall, at the election of
such member, allow such member to receive such treatment with donated
gametes and pay or reimburse such member the reasonable costs of
procuring gametes from a donor.
(c) Rule of Construction.--Nothing in this section shall be
construed to require the Secretary--
(1) to find or certify a gestational surrogate for a
covered member of the Armed Forces or to connect a gestational
surrogate with such a member; or
(2) to find or certify gametes from a donor for a covered
member of the Armed Forces or to connect such a member with
gametes from a donor.
(d) Definitions.--In this section:
(1) Assisted reproductive technology.--The term ``assisted
reproductive technology'' includes in vitro fertilization and
other fertility treatments in which both eggs and sperm are
handled when clinically appropriate.
(2) Covered member of the armed forces.--The term ``covered
member of the Armed Forces'' means a member of the Armed Forces
who has an infertility condition, unless the Secretary can show
that the member was completely infertile before service on
active duty in the Armed Forces.
(3) Fertility treatment.--The term ``fertility treatment''
includes the following:
(A) Procedures that use assisted reproductive
technology.
(B) Sperm retrieval.
(C) Egg retrieval.
(D) Artificial insemination.
(E) Embryo transfer.
(F) Such other treatments as the Secretary of
Defense considers appropriate.
(4) Infertility condition.--The term ``infertility
condition'' includes--
(A) a diagnosis of infertility; or
(B) the inability to conceive or safely carry a
pregnancy to term, including as a result of treatment
for another condition.
(5) Partner.--The term ``partner'', with respect to a
member of the Armed Forces, means an individual selected by the
member who agrees to share with the member the parental
responsibilities with respect to any child born as a result of
the use of any fertility treatment under this section.
SEC. 103. ESTABLISHMENT OF FERTILITY PRESERVATION PROCEDURES AFTER AN
INJURY OR ILLNESS.
(a) In General.--The Secretary of Defense, acting through the
Assistant Secretary of Defense for Health Affairs, shall establish
procedures for the retrieval of gametes, as soon as medically
appropriate, from a member of the Armed Forces in cases in which the
fertility of such member is potentially jeopardized as a result of an
injury or illness incurred or aggravated while serving on active duty
in the Armed Forces in order to preserve the medical options of such
member.
(b) Consent for Retrieval of Gametes.--Gametes may be retrieved
from a member of the Armed Forces under subsection (a) only--
(1) with the specific consent of the member; or
(2) if the member is unable to consent, if a medical
professional determines that--
(A) the future fertility of the member is
potentially jeopardized as a result of an injury or
illness described in subsection (a) or will be
potentially jeopardized as a result of treating such
injury or illness;
(B) the member lacks the capacity to consent to the
retrieval of gametes and is likely to regain such
capacity; and
(C) the retrieval of gametes under this section is
in the medical interest of the member.
(c) Consent for Use of Retrieved Gametes.--Gametes retrieved from a
member of the Armed Forces under subsection (a) may be used only--
(1) with the specific consent of the member; or
(2) if the member has lost the ability to consent
permanently, as determined by a medical professional, as
specified in an advance directive or testamentary instrument
executed by the member.
(d) Disposal of Gametes.--In accordance with regulations prescribed
by the Secretary for purpose of this subsection, the Secretary shall
dispose of gametes retrieved from a member of the Armed Forces under
subsection (a)--
(1) with the specific consent of the member; or
(2) if the member--
(A) has lost the ability to consent permanently, as
determined by a medical professional; and
(B) has not specified the use of their gametes in
an advance directive or testamentary instrument
executed by the member.
SEC. 104. CRYOPRESERVATION AND STORAGE OF GAMETES OF MEMBERS OF THE
ARMED FORCES ON ACTIVE DUTY.
(a) In General.--The Secretary of Defense shall provide members of
the Armed Forces on active duty in the Armed Forces with the
opportunity to cryopreserve and store their gametes prior to--
(1) deployment to a combat zone; or
(2) a duty assignment that includes a hazardous assignment,
as determined by the Secretary.
(b) Period of Time.--
(1) In general.--The Secretary shall provide for the
cryopreservation and storage of gametes of any member of the
Armed Forces under subsection (a) in a facility of the
Department of Defense or of a private entity and the
transportation of such gametes, at no cost to the member, until
the date that is one year after the retirement, separation, or
release of the member from the Armed Forces.
(2) Continued cryopreservation and storage.--At the end of
the one-year period specified in paragraph (1), the Secretary
shall permit an individual whose gametes were cryopreserved and
stored in a facility of the Department as described in that
paragraph to select, including pursuant to an advance medical
directive or military testamentary instrument completed under
subsection (c), one of the following options:
(A) To continue such cryopreservation and storage
in such facility with the cost of such cryopreservation
and storage borne by the individual.
(B) To transfer the gametes to a private
cryopreservation and storage facility selected by the
individual.
(C) To transfer the gametes to a facility of the
Department of Veterans Affairs if cryopreservation and
storage is available to the individual at such
facility.
(3) Disposal of gametes.--If an individual described in
paragraph (2) does not make a selection under subparagraph (A),
(B), or (C) of such paragraph, the Secretary may dispose of the
gametes of the individual not earlier than the date that is 90
days after the end of the one-year period specified in
paragraph (1) with respect to the individual.
(c) Advance Medical Directive and Military Testamentary
Instrument.--A member of the Armed Forces who elects to cryopreserve
and store their gametes under this section must complete an advance
medical directive, as defined in section 1044c(b) of title 10, United
States Code, and a military testamentary instrument, as defined in
section 1044d(b) of such title, that explicitly specifies the use of
their cryopreserved and stored gametes if such member dies or otherwise
loses the capacity to consent to the use of their cryopreserved and
stored gametes.
(d) Agreements.--To carry out this section, the Secretary may enter
into agreements with private entities that provide cryopreservation,
transportation, and storage services for gametes.
SEC. 105. ASSISTANCE WITH AND CONTINUITY OF CARE REGARDING REPRODUCTIVE
AND FERTILITY PRESERVATION SERVICES.
The Secretary of Defense shall ensure that employees of the
Department of Defense assist members of the Armed Forces--
(1) in navigating the services provided under this title;
(2) in finding a provider that meets the needs of such
members with respect to such services; and
(3) in continuing the receipt of such services without
interruption during a permanent change of station for such
members.
SEC. 106. COORDINATION BETWEEN DEPARTMENT OF DEFENSE AND DEPARTMENT OF
VETERANS AFFAIRS ON FURNISHING OF FERTILITY TREATMENT AND
COUNSELING.
(a) In General.--The Secretary of Defense and the Secretary of
Veterans Affairs shall share best practices and facilitate referrals,
as they consider appropriate, on the furnishing of fertility treatment
and counseling to individuals eligible for the receipt of such
counseling and treatment from the Secretaries.
(b) Memorandum of Understanding.--The Secretary of Defense and the
Secretary of Veterans Affairs shall enter into a memorandum of
understanding--
(1) providing that the Secretary of Defense will ensure
access by the Secretary of Veterans Affairs to gametes of
veterans stored by the Department of Defense for purposes of
furnishing fertility treatment under section 1720K of title 38,
United States Code, as added by section 202(a); and
(2) authorizing the Department of Veterans Affairs to
compensate the Department of Defense for the cryopreservation,
transportation, and storage of gametes of veterans under
section 104.
TITLE II--REPRODUCTIVE AND ADOPTION ASSISTANCE FOR VETERANS
SEC. 201. INCLUSION OF FERTILITY TREATMENT AND COUNSELING UNDER THE
DEFINITION OF MEDICAL SERVICES IN TITLE 38.
Section 1701(6) of title 38, United States Code, is amended by
adding at the end the following new subparagraph:
``(I) Fertility treatment and counseling, including
treatment using assisted reproductive technology.''.
SEC. 202. FERTILITY TREATMENT AND COUNSELING FOR CERTAIN VETERANS AND
SPOUSES, PARTNERS, AND GESTATIONAL SURROGATES OF SUCH
VETERANS.
(a) In General.--Subchapter II of chapter 17 of title 38, United
States Code, is amended by adding at the end the following new section:
``Sec. 1720K. Fertility treatment and counseling for certain veterans
and spouses, partners, and gestational surrogates of such
veterans
``(a) In General.--(1) The Secretary shall furnish fertility
treatment and counseling, including through the use of assisted
reproductive technology, to a covered veteran or a spouse, partner, or
gestational surrogate of a covered veteran if the veteran, and the
spouse, partner, or gestational surrogate of the veteran, as
applicable, apply jointly for such treatment and counseling through a
process prescribed by the Secretary.
``(2) Fertility treatment and counseling shall be furnished under
paragraph (1) without regard to the sex, gender identity, sexual
orientation, or marital status of the covered veteran.
``(3) In the case of in vitro fertilization treatment furnished
under paragraph (1), the Secretary may furnish not more than three
completed cycles or six attempted cycles of in vitro fertilization,
whichever occurs first, to an individual under such paragraph.
``(b) Procurement of Gametes.--If a covered veteran is unable to
provide their gametes for purposes of fertility treatment under
subsection (a), the Secretary shall, at the election of such member,
allow such veteran to receive such treatment with donated gametes and
pay or reimburse such veteran the reasonable costs of procuring gametes
from a donor.
``(c) Coordination of Care for Other Individuals.--In the case of a
veteran or a spouse, partner, or gestational surrogate of a veteran not
described in subsection (a) who is seeking fertility treatment and
counseling, the Secretary may coordinate fertility treatment and
counseling for such veteran, spouse, partner, or gestational surrogate.
``(d) Outreach and Training.--The Secretary shall carry out an
outreach and training program to ensure veterans and health care
providers of the Department are aware of--
``(1) the availability of and eligibility requirements for
fertility treatment and counseling under this section; and
``(2) any changes to fertility treatment and counseling
covered under this section.
``(e) Rule of Construction.--Nothing in this section shall be
construed to require the Secretary--
``(1) to find or certify a gestational surrogate for a
covered veteran or to connect a gestational surrogate with a
covered veteran; or
``(2) to furnish maternity care to a covered veteran or
spouse, partner, or gestational surrogate of a covered veteran
in addition to what is otherwise required by law.
``(f) Definitions.--In this section:
``(1) The term `assisted reproductive technology' includes
in vitro fertilization and other fertility treatments in which
both eggs and sperm are handled when clinically appropriate.
``(2) The term `covered veteran' means a veteran who--
``(A) has an infertility condition, unless the
Secretary can show that the veteran was completely
infertile before service in the active military, naval,
or air service; and
``(B) is enrolled in the system of annual patient
enrollment established under section 1705(a) of this
title.
``(3) The term `fertility treatment' includes the
following:
``(A) Procedures that use assisted reproductive
technology.
``(B) Sperm retrieval.
``(C) Egg retrieval.
``(D) Artificial insemination.
``(E) Embryo transfer.
``(F) Such other treatments as the Secretary
considers appropriate.
``(4) The term `infertility condition' includes--
``(A) a diagnosis of infertility; or
``(B) the inability to conceive or safely carry a
pregnancy to term, including as a result of treatment
for another condition.
``(5) The term `partner', with respect to a veteran, means
an individual selected by the veteran who agrees to share with
the veteran the parental responsibilities with respect to any
child born as a result of the use of any fertility treatment
under this section.''.
(b) Clerical Amendment.--The table of sections at the beginning of
subchapter II of chapter 17 of such title is amended by inserting after
the item relating to section 1720J the following new item:
``1720K. Fertility treatment and counseling for certain veterans and
spouses, partners, and gestational
surrogates of such veterans.''.
SEC. 203. ADOPTION ASSISTANCE FOR CERTAIN 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:
``Sec. 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, without regard to the sex, gender identity,
sexual orientation, or marital status of the covered veteran.
``(b) Limitation Amount.--For purposes of this section, the
limitation amount is the amount equal to the cost the Department would
incur by paying the expenses of three adoptions by covered veterans, as
determined by the Secretary.
``(c) Covered Veteran Defined.--In this section, the term `covered
veteran' has the meaning given that term in section 1720K(f) of this
title.''.
(b) Clerical Amendment.--The table of sections at the beginning of
subchapter VIII of chapter 17 of such title is amended by inserting
after the item relating to section 1788 the following new item:
``1789. Adoption assistance.''.
SEC. 204. ASSISTANCE WITH AND CONTINUITY OF CARE REGARDING REPRODUCTIVE
AND FERTILITY PRESERVATION SERVICES.
The Secretary of Veterans Affairs shall ensure that employees of
the Department of Veterans Affairs assist veterans--
(1) in navigating the services provided under this title
and the amendments made by this title;
(2) in finding a provider that meets the needs of such
veterans with respect to such services; and
(3) in continuing the receipt of such services without
interruption if such veterans move to a different geographic
location.
SEC. 205. 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:
``Sec. 7330D. 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 a spinal cord injury, military sexual trauma, or a
mental health condition, that affects the ability of the veteran 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
subchapter II of chapter 73 of such title is amended by inserting after
the item relating to section 7330C the following new item:
``7330D. Facilitation of reproduction and infertility research.''.
(c) Report.--
(1) In general.--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 7330D of title 38,
United States Code, as added by subsection (a).
(2) Elements.--The report submitted under paragraph (1)
shall include demographic data on veterans included in the
research conducted under section 7330D of title 38, United
States Code, as added by subsection (a), disaggregated by age,
race, ethnicity, sex, gender identity, sexual orientation,
marital status, type of disability (if applicable), and
geographic location of such veterans.
SEC. 206. ANNUAL REPORT ON FERTILITY TREATMENT AND COUNSELING 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 annually
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 treatment and counseling furnished by the Department of
Veterans Affairs, including through non-Department providers, 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 were diagnosed with clinical
infertility, disaggregated by age, race, ethnicity, sex, gender
identity, sexual orientation, marital status, type of
disability (if applicable), geographic location, era of
military service, and, to the extent possible to determine, the
cause of infertility of such veterans.
(2) The number of veterans who received fertility treatment
or counseling furnished by the Department of Veterans Affairs,
including through non-Department providers, disaggregated by
age, race, ethnicity, sex, gender identity, sexual orientation,
marital status, type of disability (if applicable), geographic
location, era of military service, and, to the extent possible
to determine, the cause of infertility of such veterans.
(3) The number of veterans who self-reported difficulty
becoming pregnant or successfully carrying a pregnancy to term
to a health care provider of the Department or a non-Department
provider, disaggregated by age, race, ethnicity, sex, gender
identity, sexual orientation, marital status, type of
disability (if applicable), and geographic location of such
veterans.
(4) The number of veterans who were exposed to hazardous
chemical or biological agents during service in the Armed
Forces who--
(A) received a clinical diagnosis of infertility;
or
(B) self-reported difficulty becoming pregnant or
successfully carrying a pregnancy to term.
(5) The number of spouses, partners, and gestational
surrogates of veterans who received fertility treatment or
counseling furnished by the Department, including through non-
Department providers.
(6) The cost to the Department of furnishing fertility
treatment and counseling, including through non-Department
providers, disaggregated by cost of services and
administration.
(7) The average cost to the Department per recipient of
fertility treatment and counseling.
(8) In cases in which the Department furnished fertility
treatment through the use of assisted reproductive technology,
including through non-Department providers, the average number
of cycles per person furnished, disaggregated by type of
treatment.
(9) A description of how fertility treatment and counseling
services of the Department, including those services provided
through non-Department providers, are coordinated with similar
services of the Department of Defense, including the average
wait time for veterans to transfer from the health system of
the Department of Defense to the Veterans Health
Administration.
(c) Definitions.--In this section, the terms ``assisted
reproductive technology'' and ``partner'' have the meanings given those
terms in section 1720K(f) of title 38, United States Code, as added by
section 202(a).
SEC. 207. REPORT ON TIMELINESS AND ADEQUACY OF ACCESS BY VETERANS TO
FERTILITY TREATMENT AND COUNSELING SERVICES FURNISHED BY
DEPARTMENT OF VETERANS AFFAIRS.
(a) In General.--Not later than 180 days after the date of the
enactment of this Act, and not less frequently than every 180 days
thereafter, the Secretary of Veterans Affairs shall submit to Congress
a report containing data on the timeliness and adequacy of access by
veterans to fertility treatment and counseling services furnished by
the Department of Veterans Affairs, including through non-Department
providers.
(b) Elements.--Each report submitted under subsection (a) shall
include, for the period covered by the report, the following:
(1) The average number of days from when a veteran first
seeks fertility treatment to when a referral for such treatment
is made and the average number of days from when such referral
is made to when an appointment for such treatment occurs,
disaggregated by facility of the Department or non-Department
provider.
(2) The average number of days from when a veteran first
seeks fertility counseling to when a referral for such
counseling is made and the average number of days from when
such referral is made to when an appointment for such
counseling occurs, disaggregated by facility of the Department
or non-Department provider.
(3) The number of available providers of the Department and
non-Department providers for fertility treatment and counseling
in each State or territory, disaggregated by facility.
(4) The average number of days it takes for the Secretary
to pay claims for fertility treatment and counseling services
from non-Department providers under section 1703D of title 38,
United States Code.
SEC. 208. REGULATIONS ON FURNISHING OF FERTILITY TREATMENT AND
COUNSELING AND ADOPTION ASSISTANCE BY DEPARTMENT OF
VETERANS AFFAIRS.
Not later than 18 months after the date of the enactment of this
Act, the Secretary of Veterans Affairs shall prescribe regulations--
(1) to carry out section 1720K of title 38, United States
Code, as added by section 202(a); and
(2) to carry out section 1789 of such title, as added by
section 203(a).
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