TRICARE Coverage for Doula Support Act

II 116TH CONGRESS 2D SESSION S. 3826 To require the Secretary of Defense to provide additional resources, including doula support, for pregnant beneficiaries under the TRICARE program, and for other purposes. IN THE SENATE OF THE UNITED STATES MAY 21, 2020 Mr. BLUMENTHAL (for himself and Mrs. GILLIBRAND) introduced the fol- lowing bill; which was read twice and referred to the Committee on Armed Services A BILL To require the Secretary of Defense to provide additional resources, including doula support, for pregnant bene- ficiaries under the TRICARE program, 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. 3 This Act may be cited as the ‘‘TRICARE Coverage 4 for Doula Support Act’’. 5 VerDate Sep 11 2014 04:08 Jun 14, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S3826.IS S3826 pbinns on DSKJLVW7X2PROD with BILLS 2 •S 3826 IS SEC. 2. ADDITIONAL RESOURCES, INCLUDING DOULA SUP- 1 PORT, FOR PREGNANT BENEFICIARIES 2 UNDER THE TRICARE PROGRAM. 3 (a) FINDINGS.—Congress finds the following: 4 (1) In 2018, 52,535 members of the Armed 5 Forces and their dependents gave birth at military 6 medical treatment facilities or civilian hospitals 7 where the Department of Defense purchased care. 8 (2) As required pursuant to the House report 9 accompanying H.R. 5515, 115th Congress (House 10 Report 115–874), under the heading ‘‘Report on rate 11 of maternal mortality among members of the Armed 12 Forces’’ under the heading ‘‘LEGISLATIVE PROVI- 13 SIONS NOT ADOPTED’’, the report submitted by the 14 Secretary of Defense titled ‘‘Maternal and Infant 15 Mortality Rates in the Military Health System’’ 16 showed that rates of maternal and infant mortality 17 in the military health system are lower than national 18 averages but also recommended expanding available 19 resources for prenatal, childbirth, and postnatal 20 communication, as well as education for pregnant 21 beneficiaries under the TRICARE program. 22 (3) Doula support, which includes continuous 23 non-clinical one-to-one emotional, physical, and in- 24 formational support around the time of birth, as well 25 VerDate Sep 11 2014 04:08 Jun 14, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S3826.IS S3826 pbinns on DSKJLVW7X2PROD with BILLS 3 •S 3826 IS as support during pregnancy and postpartum, could 1 be one such resource for pregnant beneficiaries. 2 (4) Studies have shown that doula support can 3 decrease maternal anxiety and depression that can 4 contribute to postpartum depression, and also that 5 doula support reduces the likelihood of consequential 6 and costly interventions, such as cesarean birth and 7 epidural pain relief. 8 (5) Research has also shown that doula support 9 increases the likelihood of a shorter labor, a sponta- 10 neous vaginal birth, higher Apgar scores for babies, 11 and a positive childbirth experience, which subse- 12 quently lowers the cost of maternity care while im- 13 proving the health of women and infants. 14 (6) The Expert Panel on Improving Maternal 15 and Infant Health Outcomes in Medicaid and the 16 Children’s Health Insurance Program of the Centers 17 for Medicare & Medicaid Services recommends pro- 18 viding coverage for continuous doula support during 19 labor. 20 (7) Members of the Armed Forces and military 21 spouses are uniquely positioned to maximize the ben- 22 efits of doula support due to the nature of training, 23 deployments, frequent permanent changes of station, 24 and other mission requirements that can contribute 25 VerDate Sep 11 2014 04:08 Jun 14, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S3826.IS S3826 pbinns on DSKJLVW7X2PROD with BILLS 4 •S 3826 IS to isolation during pregnancy and birth, or prevent 1 birthing partners from being present during child- 2 birth. 3 (8) Members of the Armed Forces who are sin- 4 gle, members of the Armed Forces and military 5 spouses with deployed birthing partners, and minor- 6 ity women who face racial bias in access to health 7 care might find doula support particularly beneficial. 8 (9) There are currently no specific programs of 9 the Department of Defense for labor support, but 10 the My Career Advancement Account program of the 11 Department provides funding for military spouses to 12 receive training to become doulas. 13 (b) ADDITIONAL RESOURCES FOR PREGNANT 14 TRICARE BENEFICIARIES.— 15 (1) IN GENERAL.—In providing maternity care 16 for pregnant beneficiaries under the TRICARE pro- 17 gram under chapter 55 of title 10, United States 18 Code, the Secretary of Defense shall provide to such 19 beneficiaries additional resources for prenatal and 20 postnatal communication and education, including 21 doula support. 22 (2) PROHIBITION ON COST SHARING.—The Sec- 23 retary shall not require a beneficiary under the 24 TRICARE program to pay any fee or other cost- 25 VerDate Sep 11 2014 04:08 Jun 14, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S3826.IS S3826 pbinns on DSKJLVW7X2PROD with BILLS 5 •S 3826 IS sharing requirement for the receipt of additional re- 1 sources under paragraph (1). 2 (3) IMPLEMENTATION.—Not later than one 3 year after the date of the enactment of this Act, the 4 Secretary shall finalize implementation of the provi- 5 sion of additional resources required under para- 6 graph (1). 7 (c) ADVISORY COMMITTEE.— 8 (1) IN GENERAL.—Not later than 180 days 9 after the date of the enactment of this Act, the Sec- 10 retary of Defense shall establish an advisory com- 11 mittee to assist the Department of Defense in car- 12 rying out the requirements under this section. 13 (2) SELECTION OF MEMBERS.—The Secretary 14 shall select the members of the advisory committee 15 required under paragraph (1), which shall include 16 the selection of— 17 (A) members who are racially and eth- 18 nically diverse; 19 (B) members who are trained doulas; and 20 (C) members who are members of the 21 Armed Forces or family members of members 22 of the Armed Forces. 23 (3) DUTIES.—The duties of the advisory com- 24 mittee established under paragraph (1) are to guide 25 VerDate Sep 11 2014 04:08 Jun 14, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S3826.IS S3826 pbinns on DSKJLVW7X2PROD with BILLS 6 •S 3826 IS the Department of Defense through the implementa- 1 tion of the requirements under this section by pro- 2 viding recommendations to the Department on the 3 following items: 4 (A) Expansion of the TRICARE program 5 to cover doula support. 6 (B) Identification of appropriate certifi- 7 cations to qualify an individual to provide doula 8 support under the TRICARE program. 9 (C) Establishment of reimbursement rates 10 for doula support under the TRICARE pro- 11 gram. 12 (D) Outreach to beneficiaries under the 13 TRICARE program to educate those bene- 14 ficiaries on the benefits of doula support and 15 the availability of such support. 16 (d) SURVEY AND REPORT.— 17 (1) SURVEY.—Not later than one year after the 18 date of the enactment of this Act, and annually 19 thereafter, the Secretary shall administer a survey to 20 determine— 21 (A) how many members of the Armed 22 Forces or spouses of such members give birth 23 while their spouse or birthing partner is unable 24 VerDate Sep 11 2014 04:08 Jun 14, 2020 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S3826.IS S3826 pbinns on DSKJLVW7X2PROD with BILLS 7 •S 3826 IS to be present due to deployment, training, or 1 other mission requirements; 2 (B) how many single members of the 3 Armed Forces give birth alone; and 4 (C) how many members of the Armed 5 Forces or spouses of such members use doula 6 support, or are interested in using doula sup- 7 port, during pregnancy and childbirth. 8 (2) MATTERS COVERED BY THE SURVEY.—The 9 survey administered under paragraph (1) shall in- 10 clude an identification of the following: 11 (A) The race, ethnicity, age, sex, relation- 12 ship status, military service, military occupa- 13 tion, and rank, as applicable, of each individual 14 surveyed. 15 (B) The service- or mission-specific reason 16 the member of the Armed Forces was not 17 present during the birth, if applicable. 18 (C) If individuals surveyed were members 19 of the Armed Forces or the spouses of such 20 members, or both. 21 (D) The length of advanced notice received 22 by individuals surveyed that the member of the 23 Armed Forces would be unable to be present 24 during the birth, if applicable. 25 VerDate Sep 11 2014 04:08 Jun 14, 2020 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S3826.IS S3826 pbinns on DSKJLVW7X2PROD with BILLS 8 •S 3826 IS (E) Any resources or support that the indi- 1 viduals surveyed found useful during the preg- 2 nancy and birth process, including doula sup- 3 port. 4 (3) REPORT.—The Secretary shall submit to 5 the congressional defense committees an annual re- 6 port on the results of the survey administered under 7 paragraph (1) for the year covered by the report. 8 (e) DEFINITIONS.—In this section: 9 (1) CONGRESSIONAL DEFENSE COMMITTEES.— 10 The term ‘‘congressional defense committees’’ has 11 the meaning given that term in section 101(a)(16) 12 of title 10, United States Code. 13 (2) DOULA.— 14 (A) IN GENERAL.—The term ‘‘doula’’ 15 means an individual who is trained as described 16 in subparagraph (B) to provide non-medical ad- 17 vice, information, emotional support, and phys- 18 ical comfort to an individual during the individ- 19 ual’s pregnancy, childbirth, and postpartum pe- 20 riod by an organization that has been estab- 21 lished for not less than five years and that re- 22 quires the completion of continuing education. 23 (B) TRAINING DESCRIBED.—Training de- 24 scribed in this subparagraph is training in na- 25 VerDate Sep 11 2014 04:08 Jun 14, 2020 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S3826.IS S3826 pbinns on DSKJLVW7X2PROD with BILLS 9 •S 3826 IS tionally recognized core doula competencies, 1 which may include competency in reproductive 2 and birth justice frameworks, race equity, cul- 3 tural humility, home visiting skills, and knowl- 4 edge of social services. 5 (3) TRICARE PROGRAM.—The term 6 ‘‘TRICARE program’’ has the meaning given that 7 term in section 1072 of title 10, United States Code. 8 SEC. 3. EXPANSION OF EVALUATION ON EFFECTIVENESS 9 OF TRICARE PROGRAM TO INCLUDE DATA ON 10 BIRTHS AT MILITARY MEDICAL TREATMENT 11 FACILITIES AND CIVILIAN HOSPITALS UNDER 12 THE TRICARE PROGRAM. 13 Section 717(a) of the National Defense Authorization 14 Act for Fiscal Year 1996 (Public Law 104–106; 10 U.S.C. 15 1073 note) is amended— 16 (1) in paragraph (2), by striking ‘‘; and’’ and 17 inserting a semicolon; 18 (2) in paragraph (3)(B)(v), by striking the pe- 19 riod at the end and inserting ‘‘; and’’; and 20 (3) by adding at the end the following new 21 paragraph: 22 ‘‘(4) assess data relating to births at each mili- 23 tary medical treatment facility or civilian hospital 24 VerDate Sep 11 2014 04:08 Jun 14, 2020 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S3826.IS S3826 pbinns on DSKJLVW7X2PROD with BILLS 10 •S 3826 IS under the TRICARE program during the one-year 1 period preceding the evaluation, including— 2 ‘‘(A) the number of births, disaggregated 3 by military service and rank of the individual 4 giving birth or their spouse, as appropriate; 5 ‘‘(B) whether the individual giving birth is 6 a member of the Armed Forces, a spouse of 7 such a member, or other dependent of such a 8 member; 9 ‘‘(C) the race, ethnicity, age, and relation- 10 ship status of the individual giving birth; 11 ‘‘(D) any effects of implicit or explicit bias 12 in maternal health care under the TRICARE 13 program, or evidence of racial or socioeconomic 14 barriers to such care; and 15 ‘‘(E) such other demographic information 16 about the individual giving birth as the Sec- 17 retary considers appropriate.’’. 18 Æ VerDate Sep 11 2014 04:08 Jun 14, 2020 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6301 E:\BILLS\S3826.IS S3826 pbinns on DSKJLVW7X2PROD with BILLS