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[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5492 Introduced in House (IH)]
<DOC>
118th CONGRESS
1st Session
H. R. 5492
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 HOUSE OF REPRESENTATIVES
September 14, 2023
Mr. Larsen of Washington (for himself, Ms. Jacobs, Ms. Norton, Mrs.
Dingell, Ms. Houlahan, Ms. Omar, Mr. McGovern, Mr. Krishnamoorthi, Mr.
Connolly, and Ms. Titus) introduced the following bill; which was
referred to the Committee on Veterans' Affairs, and in addition to the
Committee on Armed Services, for a period to be subsequently determined
by the Speaker, in each case for consideration of such provisions as
fall within the jurisdiction of the committee concerned
_______________________________________________________________________
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 2023''.
(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 reproductive genetic material
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. 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 to an individual under such paragraph--
(A) not more than three completed oocyte
retrievals; and
(B) unlimited embryo transfers in accordance with
the guidelines of the American Society for Reproductive
Medicine.
(b) Procurement of Reproductive Genetic Material.--If a covered
member of the Armed Forces is unable to provide their reproductive
genetic material 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 reproductive genetic
material and pay or reimburse such member the reasonable costs of
procuring such material 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 reproductive genetic material from a
donor for a covered member of the Armed Forces or to connect
such a member with reproductive genetic material 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) Transfer of reproductive genetic material.
(F) Medications as prescribed or necessary for
fertility.
(G) 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 reproduce 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 reproductive genetic material, 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 Reproductive Genetic Material.--
Reproductive genetic material 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 reproductive genetic material and is
likely to regain such capacity; and
(C) the retrieval of reproductive genetic material
under this section is in the medical interest of the
member.
(c) Consent for Use of Retrieved Reproductive Genetic Material.--
Reproductive genetic material 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 Reproductive Genetic Material.--In accordance with
regulations prescribed by the Secretary for purpose of this subsection,
the Secretary shall dispose of reproductive genetic material 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 reproductive
genetic material in an advance directive or
testamentary instrument executed by the member.
SEC. 104. CRYOPRESERVATION AND STORAGE OF REPRODUCTIVE GENETIC MATERIAL
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 reproductive genetic
material prior to--
(1) deployment to a combat zone; or
(2) a duty assignment that includes a hazardous assignment,
including--
(A) assignments resulting in exposure to
perfluoroalkyl or polyfluoroalkyl substances; and
(B) such other assignments as determined by the
Secretary.
(b) Period of Time.--
(1) In general.--The Secretary shall provide for the
cryopreservation and storage of reproductive genetic material
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 material, 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 reproductive genetic material
was 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 material to a private
cryopreservation and storage facility selected by the
individual.
(C) To transfer the material to a facility of the
Department of Veterans Affairs if cryopreservation and
storage is available to the individual at such
facility.
(3) Disposal of reproductive genetic material.--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 reproductive genetic material 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 reproductive genetic material 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
reproductive genetic material if such member dies or otherwise loses
the capacity to consent to the use of their cryopreserved and stored
reproductive genetic material.
(d) Agreements.--To carry out this section, the Secretary may enter
into agreements with private entities that provide cryopreservation,
transportation, and storage services for reproductive genetic material.
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 reproductive
genetic material 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 reproductive genetic material 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:
``(J) 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) Requirement.--
``(1) In general.--Notwithstanding any other provision of
law, the Secretary shall furnish fertility treatment and
counseling, including through the use of assisted reproductive
technology, to a covered veteran and the spouse, partner, or
gestational surrogate of the veteran if the veteran, and the
spouse, partner, or gestational surrogate of the veteran, as
applicable, each provide informed consent for such treatment
and counseling, including for each cycle of treatment
authorized under this section, through a process prescribed by
the Secretary.
``(2) Provision of 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 veteran.
``(3) In vitro fertilization.--In the case of in vitro
fertilization treatment furnished under paragraph (1), the
Secretary may furnish to an individual under such paragraph--
``(A) not more than three completed oocyte
retrievals; and
``(B) unlimited embryo transfers in accordance with
the guidelines of the American Society for Reproductive
Medicine.
``(b) Procurement of Reproductive Genetic Material.--If a covered
veteran is unable to provide their reproductive genetic material 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 reproductive genetic material and pay or
reimburse such veteran the reasonable costs of procuring such material
from a donor.
``(c) 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.
``(d) Ownership, Use, Disposition, or Destruction of Reproductive
Genetic Material.--
``(1) In general.--Issues or disputes regarding ownership
of reproductive genetic material, future use of such material,
disposition of such material, or destruction of such material
shall be the sole responsibility of the covered veteran, the
spouse, partner, or gestational surrogate of the veteran, and
the private facility storing such material.
``(2) Role of department.--The role of the Department under
this section is limited to furnishing the treatment and
counseling required under this section when requested by a
covered veteran.
``(3) Ownership and custody of reproductive genetic
material.--The Department will not have ownership or custody of
any reproductive genetic material obtained pursuant to
treatment under this section and will not be involved in the
ultimate disposition of such material or disputes between or
among any parties with respect to such material.
``(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) Transfer of reproductive genetic material.
``(F) Medications as prescribed or necessary for
fertility.
``(G) Such other treatments as the Secretary
considers appropriate.
``(4) The term `gestational surrogate' means an individual
who carries a fetus through pregnancy and gives birth to a baby
for another individual or couple.
``(5) The term `infertility condition' includes--
``(A) a diagnosis of infertility; or
``(B) the inability to reproduce or safely carry a
pregnancy to term, including as a result of treatment
for another condition.
``(6) The term `partner', with respect to a covered
veteran, means an individual--
``(A) 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; and
``(B) whom the veteran certifies to the Department
is the partner of the veteran and therefore, based on
that certification, is eligible for treatment and
counseling 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. 1790. 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 1789 the following new item:
``1790. 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. 7330E. 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 7330D the following new item:
``7330E. Facilitation of reproduction and infertility research.''.
SEC. 206. REGULATIONS ON FURNISHING OF FERTILITY TREATMENT AND
COUNSELING AND ADOPTION ASSISTANCE BY DEPARTMENT OF
VETERANS AFFAIRS.
Not later than two years 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 1790 of such title, as added by
section 203(a).
<all>
Introduced in House
Introduced in House
Referred to the Committee on Veterans' Affairs, and in addition to the Committee on Armed Services, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Veterans' Affairs, and in addition to the Committee on Armed Services, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Health.
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