DOULA for VA Act of 2020

II 116TH CONGRESS 2D SESSION S. 4753 To require the Secretary of Veterans Affairs to establish a pilot program to furnish doula services to veterans. IN THE SENATE OF THE UNITED STATES SEPTEMBER 29, 2020 Mr. BOOKER (for himself and Mrs. BLACKBURN) introduced the following bill; which was read twice and referred to the Committee on Veterans’ Affairs A BILL To require the Secretary of Veterans Affairs to establish a pilot program to furnish doula services to veterans. 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 ‘‘Delivering Optimally 4 Urgent Labor Access for Veterans Affairs Act of 2020’’ 5 or the ‘‘DOULA for VA Act of 2020’’. 6 SEC. 2. PILOT PROGRAM ON DOULA SUPPORT FOR VET- 7 ERANS. 8 (a) FINDINGS.—Congress finds the following: 9 VerDate Sep 11 2014 03:28 Oct 17, 2020 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S4753.IS S4753 kjohnson on DSK79L0C42PROD with BILLS 2 •S 4753 IS (1) There are approximately 2,300,000 women 1 within the veteran population in the United States. 2 (2) The number of women veterans using serv- 3 ices from the Veterans Health Administration has 4 increased by 28.8 percent from 423,642 in 2014 to 5 545,670 in 2019. 6 (3) During the period of 2010 through 2015, 7 the use of maternity services from the Veterans 8 Health Administration increased by 44 percent. 9 (4) Although prenatal care and delivery is not 10 provided in facilities of the Department of Veterans 11 Affairs, pregnant women seek care from the Depart- 12 ment for other conditions may also need emergency 13 care and require coordination of services through the 14 Veterans Community Care Program under section 15 1703 of title 38, United States Code. 16 (5) The number of unique women veteran pa- 17 tients with an obstetric delivery paid for by the De- 18 partment increased by 1,778 percent from 200 deliv- 19 eries in 2000 to 3,756 deliveries in 2015. 20 (6) The number of women age 35 years or older 21 with an obstetric delivery paid for by the Depart- 22 ment increased 16-fold from fiscal year 2000 to fis- 23 cal year 2015. 24 VerDate Sep 11 2014 03:28 Oct 17, 2020 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S4753.IS S4753 kjohnson on DSK79L0C42PROD with BILLS 3 •S 4753 IS (7) A study in 2010 found that veterans return- 1 ing from Operation Enduring Freedom and Oper- 2 ation Iraqi Freedom who experienced pregnancy 3 were twice as likely to have a diagnosis of depres- 4 sion, anxiety, posttraumatic stress disorder, bipolar 5 disorder, or schizophrenia as those who had not ex- 6 perienced a pregnancy. 7 (8) The number of women veterans of reproduc- 8 tive age seeking care from the Veterans Health Ad- 9 ministration continues to grow (more than 185,000 10 as of fiscal year 2015). 11 (b) PROGRAM.— 12 (1) IN GENERAL.—Not later than one year 13 after the date of the enactment of this Act, the Sec- 14 retary of Veterans Affairs shall establish a pilot pro- 15 gram to furnish doula services to covered veterans 16 through eligible entities by expanding the Whole 17 Health model of the Department of Veterans Af- 18 fairs, or successor model, to measure the impact 19 that doula support services have on birth and mental 20 health outcomes of pregnant veterans (in this section 21 referred to as the ‘‘pilot program’’). 22 (2) CONSIDERATION.—In carrying out the pilot 23 program, the Secretary shall consider all types of 24 VerDate Sep 11 2014 03:28 Oct 17, 2020 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S4753.IS S4753 kjohnson on DSK79L0C42PROD with BILLS 4 •S 4753 IS doulas, including traditional and community-based 1 doulas. 2 (3) CONSULTATION.—In designing and imple- 3 menting the pilot program the Secretary shall con- 4 sult with stakeholders, including— 5 (A) organizations representing veterans, 6 including veterans that are disproportionately 7 impacted by poor maternal health outcomes; 8 (B) community-based health care profes- 9 sionals, including doulas, and other stake- 10 holders; and 11 (C) experts in promoting health equity and 12 combating racial bias in health care settings. 13 (4) GOALS.—The goals of the pilot program are 14 the following: 15 (A) To improve— 16 (i) maternal, mental health, and in- 17 fant care outcomes; 18 (ii) integration of doula support serv- 19 ices into the Whole Health model of the 20 Department, or successor model; and 21 (iii) the experience of women receiving 22 maternity care from the Department, in- 23 cluding by increasing the ability of a 24 VerDate Sep 11 2014 03:28 Oct 17, 2020 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S4753.IS S4753 kjohnson on DSK79L0C42PROD with BILLS 5 •S 4753 IS woman to develop and follow her own 1 birthing plan. 2 (B) To reengage veterans with the Depart- 3 ment after giving birth. 4 (c) LOCATIONS.—The Secretary shall carry out the 5 pilot program in— 6 (1) the three Veterans Integrated Service Net- 7 works of the Department that have the highest per- 8 centage of female veterans enrolled in the patient 9 enrollment system of the Department established 10 and operated under section 1705(a) of title 38, 11 United States Code, compared to the total number 12 of enrolled veterans in such Network; and 13 (2) the three Veterans Integrated Service Net- 14 works that have the lowest percentage of female vet- 15 erans enrolled in the patient enrollment system com- 16 pared to the total number of enrolled veterans in 17 such Network. 18 (d) OPEN PARTICIPATION.—The Secretary shall 19 allow any eligible entity or covered veteran interested in 20 participating in the pilot program to participate in the 21 pilot program. 22 (e) SERVICES PROVIDED.— 23 (1) IN GENERAL.—Under the pilot program, a 24 covered veteran shall receive not more than 10 ses- 25 VerDate Sep 11 2014 03:28 Oct 17, 2020 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S4753.IS S4753 kjohnson on DSK79L0C42PROD with BILLS 6 •S 4753 IS sions of care from a doula under the Whole Health 1 model of the Department, or successor model, under 2 which a doula works as an advocate for the veteran 3 alongside the medical team for the veteran. 4 (2) SESSIONS.—Sessions covered under para- 5 graph (1) shall be as follows: 6 (A) Three or four sessions before labor and 7 delivery. 8 (B) One session during labor and delivery. 9 (C) Three or four sessions after post- 10 partum, which may be conducted via the mobile 11 application for VA Video Connect. 12 (f) ADMINISTRATION OF PILOT PROGRAM.— 13 (1) IN GENERAL.—The Center for Women Vet- 14 erans under section 318 of title 38, United States 15 Code, in consultation with the Advisory Committee 16 on Women Veterans established under section 542 of 17 such title (in this section referred to as the ‘‘Advi- 18 sory Committee’’), shall— 19 (A) coordinate services and activities under 20 the pilot program; 21 (B) oversee the administration of the pilot 22 program; and 23 VerDate Sep 11 2014 03:28 Oct 17, 2020 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S4753.IS S4753 kjohnson on DSK79L0C42PROD with BILLS 7 •S 4753 IS (C) conduct onsite assessments of medical 1 facilities of the Department that are partici- 2 pating in the pilot program. 3 (2) GUIDELINES FOR VETERAN-SPECIFIC 4 CARE.—The Center for Women Veterans, in con- 5 sultation with the Advisory Committee, shall estab- 6 lish guidelines under the pilot program for training 7 doulas on military sexual trauma and post traumatic 8 stress disorder. 9 (3) AMOUNTS FOR CARE.—The Advisory Com- 10 mittee may recommend to the Secretary appropriate 11 payment amounts for care and services provided 12 under the pilot program, which shall not exceed 13 $3,500 per doula per veteran. 14 (4) INCLUSION OF OTHER MEMBERS IN ADVI- 15 SORY COMMITTEE.—Only for purposes of carrying 16 out the duties of the Advisory Committee under this 17 section, the Secretary shall appoint to the Advisory 18 Committee representatives of organizations that pro- 19 vide doula services, including representatives that 20 can speak to the unique challenges endured by vet- 21 erans of color. 22 (g) DOULA SERVICE COORDINATOR.— 23 (1) IN GENERAL.—The Secretary, in consulta- 24 tion with the Center for Women Veterans and the 25 VerDate Sep 11 2014 03:28 Oct 17, 2020 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S4753.IS S4753 kjohnson on DSK79L0C42PROD with BILLS 8 •S 4753 IS Advisory Committee, shall establish a Doula Service 1 Coordinator within the functions of the Maternity 2 Care Coordinator at each medical facility of the De- 3 partment that is participating in the pilot program. 4 (2) DUTIES.—A Doula Service Coordinator es- 5 tablished under paragraph (1) at a medical facility 6 shall be responsible for— 7 (A) working with eligible entities, doulas, 8 and covered veterans participating in the pilot 9 program; and 10 (B) managing payment between eligible en- 11 tities and the Department under the pilot pro- 12 gram. 13 (3) TRACKING OF INFORMATION.—A doula pro- 14 viding services under the pilot program shall report 15 to the applicable Doula Service Coordinator after 16 each session conducted under the pilot program. 17 (4) COORDINATION WITH WOMEN’S PROGRAM 18 MANAGER.—A Doula Service Coordinator for a med- 19 ical facility of the Department shall coordinate with 20 the women’s program manager for that facility in 21 carrying out the duties of the Doula Service Coordi- 22 nator under the pilot program. 23 (h) TERM OF PILOT PROGRAM.—The Secretary shall 24 conduct the pilot program for a period of 5 years. 25 VerDate Sep 11 2014 03:28 Oct 17, 2020 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S4753.IS S4753 kjohnson on DSK79L0C42PROD with BILLS 9 •S 4753 IS (i) TECHNICAL ASSISTANCE.—The Secretary shall 1 establish a process to provide technical assistance to eligi- 2 ble entities and doulas participating in the pilot program. 3 (j) REPORT.— 4 (1) IN GENERAL.—Not later than one year 5 after the date of the enactment of this Act, and an- 6 nually thereafter for each year in which the pilot 7 program is carried out, the Secretary shall submit to 8 the Committee on Veterans’ Affairs of the Senate 9 and the Committee on Veterans’ Affairs of the 10 House of Representatives a report on the pilot pro- 11 gram. 12 (2) FINAL REPORT.—As part of the final report 13 submitted under paragraph (1), the Secretary shall 14 include recommendations on whether the model 15 studied in the pilot program should be continued or 16 more widely adopted by the Department. 17 (k) AUTHORIZATION OF APPROPRIATIONS.—There 18 are authorized to be appropriated to the Secretary, for 19 each of fiscal years 2021 through 2026, such sums as may 20 be necessary to carry out this section. 21 (l) DEFINITIONS.—In this section: 22 (1) COVERED VETERAN.—The term ‘‘covered 23 veteran’’ means a pregnant veteran or a formerly 24 pregnant veteran (with respect to sessions post- 25 VerDate Sep 11 2014 03:28 Oct 17, 2020 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S4753.IS S4753 kjohnson on DSK79L0C42PROD with BILLS 10 •S 4753 IS partum) who is enrolled in the patient enrollment 1 system of the Department of Veterans Affairs under 2 section 1705 of title 38, United States Code. 3 (2) ELIGIBLE ENTITY.—The term ‘‘eligible enti- 4 ty’’ means an entity that provides medically accu- 5 rate, comprehensive maternity services to covered 6 veterans under the laws administered by the Sec- 7 retary, including under the Veterans Community 8 Care Program under section 1703 of title 38, United 9 States Code. 10 (3) VA VIDEO CONNECT.—The term ‘‘VA Video 11 Connect’’ means the program of the Department of 12 Veterans Affairs to connect veterans with their 13 health care team from anywhere, using encryption to 14 ensure a secure and private session. 15 Æ VerDate Sep 11 2014 03:28 Oct 17, 2020 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6301 E:\BILLS\S4753.IS S4753 kjohnson on DSK79L0C42PROD with BILLS