Access to Contraception for Women Servicemembers and Dependents Act of 2014 - Expands the TRICARE health care program managed by the Department of Defense (DOD) to entitle additional female beneficiaries and dependents to care related to the prevention of pregnancy. (Currently, such care is limited to certain female members of the uniformed service or a reserve component performing active duty or certain servicewomen performing inactive-duty training.) Prohibits cost-sharing from being imposed or collected for such pregnancy prevention care, including for any method of contraception provided through a facility of the uniformed services, the TRICARE retail pharmacy program, or the national mail-order pharmacy program.
Provides for such pregnancy prevention care to include all methods of contraception approved by the Food and Drug Administration (FDA), sterilization procedures, and patient education and counseling.
Directs the DOD Secretary to: (1) ensure that every military treatment facility has a sufficient stock of a broad range of FDA-approved methods of contraception to dispense to any women members of the Armed Forces and female covered beneficiaries who receive care through such facility; (2) disseminate clinical practice guidelines and decision support tools to DOD-employed health care providers; (3) ensure that women members of the Armed Forces have access to contraception counseling during health care visits; and (4) establish an education program for all members of the Armed Forces, including both men and women members, consisting of a uniform standard curriculum on family planning.
Requires questions regarding family planning services and counseling to be incorporated into DOD health surveys.
Requires every military treatment facility, upon request, to provide emergency contraception, or information about FDA-approved methods of emergency contraception, to any woman who: (1) states to personnel that she is a victim of sexual assault or is accompanied by another individual who states that the woman is a victim of sexual assault, or (2) is reasonably believed to be a survivor of sexual assault.
[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[S. 2687 Introduced in Senate (IS)]
113th CONGRESS
2d Session
S. 2687
To amend title 10, United States Code, to ensure that women members of
the Armed Forces and their families have access to the contraception
they need in order to promote the health and readiness of all members
of the Armed Forces, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
July 30, 2014
Mrs. Shaheen (for herself, Mr. Reid, Mrs. Murray, Mr. Brown, Mrs.
Gillibrand, Mrs. Boxer, Mr. Durbin, Ms. Baldwin, Mr. Blumenthal, Ms.
Stabenow, Mrs. Feinstein, Ms. Hirono, Mr. Franken, Mr. Schatz, Mr.
Tester, Mr. Wyden, Ms. Warren, and Mr. Begich) introduced the following
bill; which was read twice and referred to the Committee on Armed
Services
_______________________________________________________________________
A BILL
To amend title 10, United States Code, to ensure that women members of
the Armed Forces and their families have access to the contraception
they need in order to promote the health and readiness of all members
of the Armed Forces, 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.
This Act may be cited as the ``Access to Contraception for Women
Servicemembers and Dependents Act of 2014''.
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) Women are serving in the Armed Forces at increasing
rates, playing a critical role in the national security of the
United States. More than 350,000 women serve on active duty in
the Armed Forces or in the Selected Reserve.
(2) Nearly 10,000,000 members of the Armed Forces
(including members of the National Guard and Reserves),
military retirees, their families, their survivors, and certain
former spouses, including nearly 5,000,000 female
beneficiaries, are eligible for health care through the
Department of Defense.
(3) Contraception is critical for women's health and is
highly effective at reducing unintended pregnancy. The Centers
for Disease Control and Prevention describe contraception as
one of the 10 greatest public health achievements of the
twentieth century.
(4) Contraception has played a direct role in the greater
participation of women in education and employment. Increased
wages and increased control over reproductive decisions provide
women with educational and professional opportunities that have
increased gender equality over the decades since contraception
was introduced.
(5) Studies have shown that when cost barriers to the full
range of methods of contraception are eliminated, and women
receive comprehensive counseling on the various methods of
contraception (including highly effective Long-Acting
Reversible Contraceptives (LARCs)), rates of unintended
pregnancy decline dramatically.
(6) Research has also shown that investments in effective
contraception save public and private dollars.
(7) The 2011 recommendations of the Institute of Medicine
on women's preventive health services include recommendations
that health insurance plans cover all methods of contraception
approved by the Food and Drug Administration, sterilization
procedures, and patient education and counseling for all women
with reproductive capacity without any cost-sharing
requirements.
(8) The recommendations described in paragraph (7) are
reflected in provisions of the Patient Protection and
Affordable Care Act (Public Law 111-148), and thus group and
individual health insurance plans must provide such coverage.
The recommendations have also been adopted by the Office of
Personnel Management, and thus all health insurance plans that
are part of the Federal Employees Health Benefits Program must
provide such coverage.
(9) Under the TRICARE program, servicewomen on active duty
have full coverage of all prescription drugs, including
contraception, without cost-sharing requirements. However,
servicewomen not on active duty, and female dependents of
members of the Armed Forces, who receive health care through
the TRICARE program do not have similar coverage of all
prescription methods of contraception approved by the Food and
Drug Administration without cost-sharing.
(10) Studies indicate that servicewomen need comprehensive
counseling for pregnancy prevention, particularly in their
predeployment preparations, and the lack thereof is
contributing to unintended pregnancies among servicewomen.
(11) An analysis by Ibis Reproductive Health of the 2008
Survey of Health Related Behaviors among Active Duty Military
Personnel found a high unintended pregnancy rate among
servicewomen. Adjusting for the difference between age
distribution in the Armed Forces and the general population,
the rate of unintended pregnancy among servicewomen is higher
than for the general population.
(12) With the integrated use of electronic medical records
throughout the Department of Defense, the technological
infrastructure exists to develop clinical decision support
tools. These tools, which are incorporated into the electronic
medical record, allow for a point-of-care feedback loop that
can be used to enhance patient decisionmaking, case and patient
management, and care coordination. Benefits of clinical
decision support tools include increased quality of care and
enhanced health outcomes, improved efficiency, and provider and
patient satisfaction.
(13) The Defense Advisory Committee on Women in the
Services (DACOWITS) has recommended that all the Armed Forces,
to the extent that they have not already, implement initiatives
that inform servicemembers of the importance of family
planning, educate them on methods of contraception, and make
various methods of contraception available, based on the
finding that family planning can increase the overall readiness
and quality of life of all members of the military.
(14) Health care, including family planning for survivors
of sexual assault in the Armed Forces is a critical issue.
Servicewomen on active duty report rates of unwanted sexual
contact at approximately 16 times those of the comparable
general population of women in the United States. Through
regulations, the Department of Defense already supports a
policy of ensuring that servicewomen who are sexually assaulted
have access to emergency contraception.
SEC. 3. CONTRACEPTION COVERAGE PARITY UNDER THE TRICARE PROGRAM.
(a) In General.--Section 1074d of title 10, United States Code, is
amended--
(1) in subsection (a), by inserting ``for Members and
Former Members'' after ``Services Available'';
(2) by redesignating subsection (b) as subsection (d); and
(3) by inserting after subsection (a) the following new
subsections:
``(b) Care Related to Prevention of Pregnancy.--Female covered
beneficiaries shall be entitled to care related to the prevention of
pregnancy described by subsection (d)(3).
``(c) Prohibition on Cost-Sharing for Certain Services.--
Notwithstanding section 1074g(a)(6) of this title or any other
provision of law, cost-sharing may not be imposed or collected for care
related to the prevention of pregnancy provided pursuant to subsection
(a) or (b), including for any method of contraception provided, whether
provided through a facility of the uniformed services, the TRICARE
retail pharmacy program, or the national mail-order pharmacy
program.''.
(b) Care Related to Prevention of Pregnancy.--Subsection (d)(3) of
such section, as redesignated by subsection (a)(2) of this section, is
further amended by inserting before the period at the end the
following: ``(including all methods of contraception approved by the
Food and Drug Administration, sterilization procedures, and patient
education and counseling in connection therewith)''.
(c) Conforming Amendment.--Section 1077(a)(13) of such title is
amended by striking ``section 1074d(b)'' and inserting ``section
1074d(d)''.
SEC. 4. ACCESS TO BROAD RANGE OF METHODS OF CONTRACEPTION APPROVED BY
THE FOOD AND DRUG ADMINISTRATION FOR MEMBERS OF THE ARMED
FORCES AND MILITARY DEPENDENTS AT MILITARY TREATMENT
FACILITIES.
(a) In General.--Commencing not later than 180 days after the date
of the enactment of this Act, the Secretary of Defense shall ensure
that every military treatment facility has a sufficient stock of a
broad range of methods of contraception approved by the Food and Drug
Administration, as recommended by the Centers for Disease Control and
Prevention and the Office of Population Affairs of the Department of
Health and Human Services, to be able to dispense at any time any such
method of contraception to any women members of the Armed Forces and
female covered beneficiaries who receive care through such facility.
(b) Covered Beneficiary Defined.--In this section, the term
``covered beneficiary'' has the meaning given that term in section
1072(5) of title 10, United States Code.
SEC. 5. COMPREHENSIVE STANDARDS AND ACCESS TO CONTRACEPTION COUNSELING
FOR MEMBERS OF THE ARMED FORCES.
(a) Purpose.--The purpose of this section is to ensure that all
health care providers employed by the Department of Defense who provide
care for women members of the Armed Forces, including general
practitioners, are provided, through clinical practice guidelines, the
most current evidence-based and evidence-informed standards of care
with respect to methods of contraception and counseling on methods of
contraception.
(b) Clinical Practice Guidelines.--
(1) In general.--Not later than one year after the date of
the enactment of this Act, the Secretary of Defense shall
compile clinical practice guidelines for health care providers
described in subsection (a) on standards of care with respect
to methods of contraception and counseling on methods of
contraception for women members of the Armed Forces.
(2) Sources.--The Secretary shall compile clinical practice
guidelines under this subsection from among clinical practice
guidelines established by appropriate health agencies and
professional organizations, including the following:
(A) The United States Preventive Services Task
Force.
(B) The Centers for Disease Control and Prevention.
(C) The Office of Population Affairs of the
Department of Health and Human Services.
(D) The American College of Obstetricians and
Gynecologists.
(E) The Association of Reproductive Health
Professionals.
(F) The American Academy of Family Physicians.
(G) The Agency for Healthcare Research and Quality.
(3) Updates.--The Secretary shall from time to time update
the list of clinical practice guidelines compiled under this
subsection to incorporate into such guidelines new or updated
standards of care with respect to methods of contraception and
counseling on methods of contraception.
(4) Dissemination.--
(A) Initial dissemination.--As soon as practicable
after the compilation of clinical practice guidelines
pursuant to paragraph (1), but commencing not later
than one year after the date of the enactment of this
Act, the Secretary shall provide for rapid
dissemination of the clinical practice guidelines to
health care providers described in subsection (a).
(B) Updates.--As soon as practicable after the
adoption under paragraph (3) of any update to the
clinical practice guidelines compiled pursuant to this
subsection, the Secretary shall provide for the rapid
dissemination of such clinical practice guidelines, as
so updated, to health care providers described in
subsection (a).
(C) Protocols.--Clinical practice guidelines, and
any updates to such guidelines, shall be disseminated
under this paragraph in accordance with administrative
protocols developed by the Secretary for that purpose.
(c) Clinical Decision Support Tools.--
(1) In general.--Not later than one year after the date of
the enactment of this Act, the Secretary shall, in order to
assist health care providers described in subsection (a),
develop and implement clinical decision support tools that
reflect, through the clinical practice guidelines compiled
pursuant to subsection (b), the most current evidence-based and
evidence-informed standards of care with respect to methods of
contraception and counseling on methods of contraception.
(2) Updates.--The Secretary shall from time to time update
the clinical decision support tools developed under this
subsection to incorporate into such tools new or updated
guidelines on methods of contraception and counseling on
methods of contraception.
(3) Dissemination.--Clinical decision support tools, and
any updates to such tools, shall be disseminated under this
subsection in accordance with administrative protocols
developed by the Secretary for that purpose. Such protocols
shall be similar to the administrative protocols developed
under subsection (b)(4)(C).
(d) Access to Contraception Counseling.--As soon as practicable
after the date of the enactment of this Act, the Secretary shall ensure
that women members of the Armed Forces have access to counseling on the
full range of methods of contraception provided by health care
providers described in subsection (a) during health care visits,
including, but not limited to, visits as follows:
(1) During predeployment health care visits, with the
counseling to be provided during such visits emphasizing the
interaction between anticipated deployment conditions and
various methods of contraception.
(2) During health care visits during deployment.
(3) During annual physical examinations.
(e) Incorporation Into Surveys of Questions on Servicewomen
Experiences With Family Planning Services and Counseling.--
(1) In general.--Not later than 90 days after the date of
the enactment of this Act, the Secretary shall integrate into
the Department of Defense surveys specified in paragraph (2)
questions designed to obtain information on the experiences of
women members of the Armed Forces--
(A) in accessing family planning services and
counseling;
(B) in using family planning methods, which method
was preferred and whether deployment conditions
affected the decision on which family planning method
or methods to be used; and
(C) if pregnant, whether the pregnancy was
intended.
(2) Covered surveys.--The surveys into which questions
shall be integrated as described in paragraph (1) are the
following:
(A) The Health Related Behavior Survey of Active
Duty Military Personnel.
(B) The Health Care Survey of Department of Defense
Beneficiaries.
SEC. 6. EDUCATION ON FAMILY PLANNING FOR MEMBERS OF THE ARMED FORCES.
(a) Education Program.--
(1) In general.--Not later than one year after the date of
the enactment of this Act, the Secretary of Defense shall
establish an education program for all members of the Armed
Forces, including both men and women members, consisting of a
uniform standard curriculum on family planning.
(2) Sense of congress.--It is the sense of Congress that
the standard curriculum should use the latest technology
available to efficiently and effectively deliver information to
members of the Armed Forces.
(b) Elements.--The standard curriculum under subsection (a) shall
include the following:
(1) Information on the importance of providing
comprehensive family planning for members of the Armed Forces,
and their commanding officers, and on the positive impact
family planning can have on the health and readiness of the
Armed Forces.
(2) Current, medically accurate information.
(3) Clear, user-friendly information on the full range of
methods of contraception and where members of the Armed Forces
can access their chosen method of contraception.
(4) Information on all applicable laws and policies so that
members are informed of their rights and obligations.
(5) Information on patients' rights to confidentiality.
(6) Information on the unique circumstances encountered by
members of the Armed Forces, and the effects of such
circumstances on the use of contraception.
SEC. 7. PREGNANCY PREVENTION ASSISTANCE AT MILITARY TREATMENT
FACILITIES FOR WOMEN WHO ARE SEXUAL ASSAULT SURVIVORS.
(a) Purpose.--The purpose of this section is to provide in statute,
and to enhance, existing regulations that require health care providers
at military treatment facilities to consult with survivors of sexual
assault once clinically stable regarding options for emergency
contraception and any necessary follow-up care, including the provision
of the emergency contraception.
(b) In General.--The assistance specified in subsection (c) shall
be provided at every military treatment facility to the following:
(1) Any woman who presents at a military treatment facility
and states to personnel of the facility that she is a victim of
sexual assault or is accompanied by another individual who
states that the woman is a victim of sexual assault.
(2) Any woman who presents at a military treatment facility
and is reasonably believed by personnel of such facility to be
a survivor of sexual assault.
(c) Assistance.--
(1) In general.--The assistance specified in this
subsection shall include the following:
(A) The prompt provision by appropriate staff of
the military treatment facility of comprehensive,
medically and factually accurate, and unbiased written
and oral information about all methods of emergency
contraception approved by the Food and Drug
Administration.
(B) The prompt provision by such staff of emergency
contraception to a woman upon her request.
(C) Notification to the woman of her right to
confidentiality in the receipt of care and services
pursuant to this section.
(2) Nature of information.--The information provided
pursuant to paragraph (1)(A) shall be provided in language that
is clear and concise, is readily comprehensible, and meets such
conditions (including conditions regarding the provision of
information in languages other than English) as the Secretary
may provide in the regulations under this section.
<all>
Introduced in Senate
Read twice and referred to the Committee on Armed Services.
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