II 116TH CONGRESS 1ST SESSION S. 319 To improve the reproductive assistance provided by the Department of De- fense and the Department of Veterans Affairs to severely wounded, ill, or injured members of the Armed Forces, veterans, and their spouses or partners, and for other purposes. IN THE SENATE OF THE UNITED STATES FEBRUARY 4, 2019 Mrs. MURRAY 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 De- partment of Defense and the Department of Veterans Affairs to severely wounded, ill, or injured members of the Armed Forces, veterans, and their spouses or part- ners, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 3 (a) SHORT TITLE.—This Act may be cited as the 4 ‘‘Women Veterans and Families Health Services Act of 5 2019’’. 6 VerDate Sep 11 2014 21:27 Feb 14, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S319.IS S319 pbinns on DSK79D2C42PROD with BILLS 2 •S 319 IS (b) TABLE OF CONTENTS.—The table of contents for 1 this Act is as follows: 2 Sec. 1. Short title; table of contents. TITLE I—REPRODUCTIVE AND FERTILITY PRESERVATION ASSISTANCE FOR MEMBERS OF THE ARMED FORCES Sec. 101. Provision of fertility treatment and counseling to certain members of the Armed Forces and spouses, partners, and gestational sur- rogates of such members. Sec. 102. Establishment of fertility preservation procedures after an injury or illness. Sec. 103. Cryopreservation and storage of gametes of members of the Armed Forces on active duty. Sec. 104. Coordination between Department of Defense and Department of Veterans Affairs on furnishing of fertility treatment and coun- seling. TITLE II—REPRODUCTIVE, ADOPTION, AND CHILD CARE 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 severely wounded veterans. Sec. 204. Annual report on fertility treatment and counseling furnished by De- partment of Veterans Affairs. Sec. 205. Regulations on furnishing of fertility treatment and counseling and adoption assistance by Department of Veterans Affairs. Sec. 206. Facilitation of reproduction and infertility research. Sec. 207. Requirement to improve Department of Veterans Affairs women vet- erans contact center. Sec. 208. Modification of pilot program on counseling in retreat settings for women veterans newly separated from service in the Armed Forces. Sec. 209. Program on assistance for child care for certain veterans. VerDate Sep 11 2014 21:27 Feb 14, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6211 E:\BILLS\S319.IS S319 pbinns on DSK79D2C42PROD with BILLS 3 •S 319 IS TITLE I—REPRODUCTIVE AND 1 FERTILITY PRESERVATION 2 ASSISTANCE FOR MEMBERS 3 OF THE ARMED FORCES 4 SEC. 101. PROVISION OF FERTILITY TREATMENT AND 5 COUNSELING TO CERTAIN MEMBERS OF THE 6 ARMED FORCES AND SPOUSES, PARTNERS, 7 AND GESTATIONAL SURROGATES OF SUCH 8 MEMBERS. 9 (a) FERTILITY TREATMENT AND COUNSELING.— 10 (1) IN GENERAL.—The Secretary of Defense 11 shall furnish fertility treatment and counseling, in- 12 cluding through the use of assisted reproductive 13 technology, to a covered member of the Armed 14 Forces or a spouse, partner, or gestational surrogate 15 of such a member. 16 (2) ELIGIBILITY FOR TREATMENT AND COUN- 17 SELING.—Fertility treatment and counseling shall be 18 furnished under paragraph (1) without regard to the 19 sex or marital status of the covered member of the 20 Armed Forces. 21 (3) IN VITRO FERTILIZATION.—In the case of 22 in vitro fertilization treatment furnished under para- 23 graph (1), the Secretary may furnish not more than 24 three completed cycles or six attempted cycles of in 25 VerDate Sep 11 2014 21:27 Feb 14, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S319.IS S319 pbinns on DSK79D2C42PROD with BILLS 4 •S 319 IS vitro fertilization, whichever occurs first, to an indi- 1 vidual under such paragraph. 2 (b) PROCUREMENT OF GAMETES.—If a covered 3 member of the Armed Forces is unable to provide their 4 gametes for purposes of fertility treatment under sub- 5 section (a), the Secretary shall, at the election of such 6 member, allow such member to receive such treatment 7 with donated gametes and pay or reimburse such member 8 the reasonable costs of procuring gametes from a donor. 9 (c) RULE OF CONSTRUCTION.—Nothing in this sec- 10 tion shall be construed to require the Secretary— 11 (1) to find or certify a gestational surrogate for 12 a covered member of the Armed Forces or to con- 13 nect a gestational surrogate with such a member; or 14 (2) to find or certify gametes from a donor for 15 a covered member of the Armed Forces or to con- 16 nect such a member with gametes from a donor. 17 (d) DEFINITIONS.—In this section: 18 (1) ASSISTED REPRODUCTIVE TECHNOLOGY.— 19 The term ‘‘assisted reproductive technology’’ in- 20 cludes in vitro fertilization and other fertility treat- 21 ments in which both eggs and sperm are handled 22 when clinically appropriate. 23 (2) COVERED MEMBER OF THE ARMED 24 FORCES.—The term ‘‘covered member of the Armed 25 VerDate Sep 11 2014 21:27 Feb 14, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S319.IS S319 pbinns on DSK79D2C42PROD with BILLS 5 •S 319 IS Forces’’ means a severely wounded, ill, or injured 1 member of the Armed Forces who has an infertility 2 condition incurred or aggravated while serving on 3 active duty in the Armed Forces. 4 (3) FERTILITY TREATMENT.—The term ‘‘fer- 5 tility treatment’’ includes the following: 6 (A) Procedures that use assisted reproduc- 7 tive technology. 8 (B) Sperm retrieval. 9 (C) Egg retrieval. 10 (D) Artificial insemination. 11 (E) Embryo transfer. 12 (F) Such other treatments as the Sec- 13 retary of Defense considers appropriate. 14 (4) PARTNER.—The term ‘‘partner’’, with re- 15 spect to a member of the Armed Forces, means an 16 individual selected by the member who agrees to 17 share with the member the parental responsibilities 18 with respect to any child born as a result of the use 19 of any fertility treatment under this section. 20 SEC. 102. ESTABLISHMENT OF FERTILITY PRESERVATION 21 PROCEDURES AFTER AN INJURY OR ILLNESS. 22 (a) IN GENERAL.—The Secretary of Defense, acting 23 through the Assistant Secretary of Defense for Health Af- 24 fairs, shall establish procedures for the retrieval of 25 VerDate Sep 11 2014 21:27 Feb 14, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S319.IS S319 pbinns on DSK79D2C42PROD with BILLS 6 •S 319 IS gametes, as soon as medically appropriate, from a member 1 of the Armed Forces in cases in which the fertility of such 2 member is potentially jeopardized as a result of an injury 3 or illness incurred or aggravated while serving on active 4 duty in the Armed Forces in order to preserve the medical 5 options of such member. 6 (b) CONSENT FOR RETRIEVAL OF GAMETES.— 7 Gametes may be retrieved from a member of the Armed 8 Forces under subsection (a) only— 9 (1) with the specific consent of the member; or 10 (2) if the member is unable to consent, if a 11 medical professional determines that— 12 (A) the future fertility of the member is 13 potentially jeopardized as a result of an injury 14 or illness described in subsection (a) or will be 15 potentially jeopardized as a result of treating 16 such injury or illness; 17 (B) the member lacks the capacity to con- 18 sent to the retrieval of gametes and is likely to 19 regain such capacity; and 20 (C) the retrieval of gametes under this sec- 21 tion is in the medical interest of the member. 22 (c) CONSENT FOR USE OF RETRIEVED GAMETES.— 23 Gametes retrieved from a member of the Armed Forces 24 under subsection (a) may be used only— 25 VerDate Sep 11 2014 21:27 Feb 14, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S319.IS S319 pbinns on DSK79D2C42PROD with BILLS 7 •S 319 IS (1) with the specific consent of the member; or 1 (2) if the member has lost the ability to consent 2 permanently, as determined by a medical profes- 3 sional, as specified in an advance directive or testa- 4 mentary instrument executed by the member. 5 (d) DISPOSAL OF GAMETES.—In accordance with 6 regulations prescribed by the Secretary for purpose of this 7 subsection, the Secretary shall dispose of gametes re- 8 trieved from a member of the Armed Forces under sub- 9 section (a)— 10 (1) with the specific consent of the member; or 11 (2) if the member— 12 (A) has lost the ability to consent perma- 13 nently, as determined by a medical professional; 14 and 15 (B) has not specified the use of their 16 gametes in an advance directive or testa- 17 mentary instrument executed by the member. 18 SEC. 103. CRYOPRESERVATION AND STORAGE OF GAMETES 19 OF MEMBERS OF THE ARMED FORCES ON AC- 20 TIVE DUTY. 21 (a) IN GENERAL.—The Secretary of Defense shall 22 provide members of the Armed Forces on active duty in 23 the Armed Forces with the opportunity to cryopreserve 24 VerDate Sep 11 2014 21:27 Feb 14, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S319.IS S319 pbinns on DSK79D2C42PROD with BILLS 8 •S 319 IS and store their gametes prior to deployment to a combat 1 zone. 2 (b) PERIOD OF TIME.— 3 (1) IN GENERAL.—The Secretary shall provide 4 for the cryopreservation and storage of gametes of 5 any member of the Armed Forces under subsection 6 (a), at no cost to the member, in a facility of the 7 Department of Defense or of a private entity pursu- 8 ant to a contract under subsection (d) until the date 9 that is one year after the retirement, separation, or 10 release of the member from the Armed Forces. 11 (2) CONTINUED CRYOPRESERVATION AND 12 STORAGE.—At the end of the one-year period speci- 13 fied in paragraph (1), the Secretary shall permit an 14 individual whose gametes were cryopreserved and 15 stored in a facility of the Department as described 16 in that paragraph to select, including pursuant to an 17 advance medical directive or military testamentary 18 instrument completed under subsection (c), one of 19 the following options: 20 (A) To continue such cryopreservation and 21 storage in such facility with the cost of such 22 cryopreservation and storage borne by the indi- 23 vidual. 24 VerDate Sep 11 2014 21:27 Feb 14, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S319.IS S319 pbinns on DSK79D2C42PROD with BILLS 9 •S 319 IS (B) To transfer the gametes to a private 1 cryopreservation and storage facility selected by 2 the individual. 3 (C) To transfer the gametes to a facility of 4 the Department of Veterans Affairs if 5 cryopreservation and storage is available to the 6 individual at such facility. 7 (3) DISPOSAL OF GAMETES.—If an individual 8 described in paragraph (2) does not make a selection 9 under subparagraph (A), (B), or (C) of such para- 10 graph, the Secretary may dispose of the gametes of 11 the individual not earlier than the date that is 90 12 days after the end of the one-year period specified 13 in paragraph (1) with respect to the individual. 14 (c) ADVANCE MEDICAL DIRECTIVE AND MILITARY 15 TESTAMENTARY INSTRUMENT.—A member of the Armed 16 Forces who elects to cryopreserve and store their gametes 17 under this section must complete an advance medical di- 18 rective, as defined in section 1044c(b) of title 10, United 19 States Code, and a military testamentary instrument, as 20 defined in section 1044d(b) of such title, that explicitly 21 specifies the use of their cryopreserved and stored gametes 22 if such member dies or otherwise loses the capacity to con- 23 sent to the use of their cryopreserved and stored gametes. 24 VerDate Sep 11 2014 21:27 Feb 14, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S319.IS S319 pbinns on DSK79D2C42PROD with BILLS 10 •S 319 IS (d) AGREEMENTS.—To carry out this section, the 1 Secretary may enter into agreements with private entities 2 that provide cryopreservation and storage services for 3 gametes. 4 SEC. 104. COORDINATION BETWEEN DEPARTMENT OF DE- 5 FENSE AND DEPARTMENT OF VETERANS AF- 6 FAIRS ON FURNISHING OF FERTILITY TREAT- 7 MENT AND COUNSELING. 8 (a) IN GENERAL.—The Secretary of Defense and the 9 Secretary of Veterans Affairs shall share best practices 10 and facilitate referrals, as they consider appropriate, on 11 the furnishing of fertility treatment and counseling to in- 12 dividuals eligible for the receipt of such counseling and 13 treatment from the Secretaries. 14 (b) MEMORANDUM OF UNDERSTANDING.—The Sec- 15 retary of Defense and the Secretary of Veterans Affairs 16 shall enter into a memorandum of understanding— 17 (1) providing that the Secretary of Defense will 18 ensure access by the Secretary of Veterans Affairs 19 to gametes of veterans stored by the Department of 20 Defense for purposes of furnishing fertility treat- 21 ment under section 1720J of title 38, United States 22 Code, as added by section 202; and 23 (2) authorizing the Department of Veterans Af- 24 fairs to compensate the Department of Defense for 25 VerDate Sep 11 2014 21:27 Feb 14, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S319.IS S319 pbinns on DSK79D2C42PROD with BILLS 11 •S 319 IS the cryopreservation and storage of gametes of vet- 1 erans under section 103. 2 TITLE II—REPRODUCTIVE, 3 ADOPTION, AND CHILD CARE 4 ASSISTANCE FOR VETERANS 5 SEC. 201. INCLUSION OF FERTILITY TREATMENT AND 6 COUNSELING UNDER THE DEFINITION OF 7 MEDICAL SERVICES IN TITLE 38. 8 Section 1701(6) of title 38, United States Code, is 9 amended by adding at the end the following new subpara- 10 graph: 11 ‘‘(I) Fertility treatment and counseling, in- 12 cluding treatment using assisted reproductive 13 technology.’’. 14 SEC. 202. FERTILITY TREATMENT AND COUNSELING FOR 15 CERTAIN VETERANS AND SPOUSES, PART- 16 NERS, AND GESTATIONAL SURROGATES OF 17 SUCH VETERANS. 18 (a) IN GENERAL.—Subchapter II of chapter 17 of 19 title 38, United States Code, is amended by adding at the 20 end the following new section: 21 VerDate Sep 11 2014 21:27 Feb 14, 2019 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S319.IS S319 pbinns on DSK79D2C42PROD with BILLS 12 •S 319 IS ‘‘§ 1720J. Fertility treatment and counseling for cer- 1 tain veterans and spouses, partners, and 2 gestational surrogates of such veterans 3 ‘‘(a) IN GENERAL.—(1) The Secretary shall furnish 4 fertility treatment and counseling, including through the 5 use of assisted r [Text truncated for display. Full text available on Congress.gov.]