,,ii  #aacth ,,congress  #ast ,session  
,s4 #aca  ,,in ,,the ,,senate ,,of ,,the
 ,,united ,,states  ,january #bd        
7legislative day1 ,january #c71 #bjac   
,mrs4 ,murray 7for herself1 ,mr4        
,begich1 and ,mr4 ,tester7 introduced   
the following bill2 which was read twice
 and referred to the ,committee on      
,veterans' ,affairs  ,a ,,bill  ,to     
amend title #ch1 ,united ,states ,code1 
to improve the reproductive assistance  
provided by the ,department of ,veterans
 ,affairs to severely wounded1 ill1 or  
injured veterans and their spouses1 and 
for other purposes4  #a4 ,short title   
,this ,act may be cited as the ,women   
,veterans and ,other ,health ,care      
,improvements ,act of #bjac4  #b4       
,clarification that fertility counseling
 and treatment are medical services     
which the ,secretary may furnish to     
veterans like other medical services    
,section #agja7f7 of title #ch1 ,united 
,states ,code1 is amended by adding at  
the end the following new subparagraph3 

7,h7 ,fertility counseling and          
treatment1 including treatment using    
assisted reproductive technology4  4    
#c4 ,reproductive treatment and care for
 spouses and surrogates of veterans  7a7
 ,in general ,subchapter ,,viii of      
chapter #ag of title #ch1 ,united       
,states ,code1 is amended by adding at  
the end the following new section3      
#aghh4 ,reproductive treatment and care 
for spouses and surrogates of veterans  
7a7 ,in general ,the ,secretary shall   
furnish fertility counseling and        
treatment1 including through the use of 
assisted reproductive technology1 to a  
spouse or surrogate of a severely       
wounded1 ill1 or injured veteran who has
 an infertility condition incurred or   
aggravated in line of duty in the active
 military1 naval1 or air service and who
 is enrolled in the system of annual    
patient enrollment established under    
section #agje7;a7 of this title if the  
spouse or surrogate and the veteran     
apply jointly for such counseling and   

treatment through a process prescribed  
by the ,secretary4  7b7 ,coordination of
 care for other spouses and surrogates  
,in the case of a spouse or surrogate of
 a veteran not described in subsection  
7a7 who is seeking fertility counseling 
and treatment1 the ,secretary may       
coordinate fertility counseling and     
treatment for such spouse or surrogate4 
7c7 ,construction ,nothing in this      
section shall be construed to require   
the ,secretary--  7#a7 to find or       
certify a surrogate for a veteran or to 
connect a surrogate with a veteran2 or  
7#b7 to furnish maternity care to a     
spouse or surrogate of a veteran4  7d7  
,assisted reproductive technology       
defined ,in this section1 the term      
assisted reproductive technology        
includes in vitro fertilization and     
other fertility treatments in which both
 eggs and sperm are handled when        
clinically appropriate4  4  7b7         
,clerical amendment ,the table of       
sections at the beginning of chapter #ag

 of such title is amended by inserting  
after the item relating to section #aghg
 the following new item3  #aghh4        
,reproductive treatment and care for    
spouses and surrogates of veterans4  4  
#d4 ,adoption assistance for severely   
wounded veterans  7a7 ,in general       
,subchapter ,,viii of chapter #ag of    
title #ch1 ,united ,states ,code1 as    
amended by section #c1 is further       
amended by adding at the end the        
following new section3  #aghi4 ,adoption
 assistance  7a7 ,in general ,the       
,secretary may pay an amount1 not to    
exceed the limitation amount1 to assist 
a covered veteran in the adoption of one
 or more children4  7b7 ,covered veteran
 ,for purposes of this section1 a       
covered veteran is any severely wounded1
 ill1 or injured veteran who--  7#a7 has
 an infertility condition incurred or   
aggravated in line of duty in the active
 military1 naval1 or air service2 and   
7#b7 is enrolled in the system of annual
 patient enrollment established under   

section #agje7;a7 of this title4  7c7   
,limitation amount ,for purposes of this
 section1 the limitation amount is the  
amount equal to the lesser of--  7#a7   
the cost the ,department would incur if 
the ,secretary were to provide a covered
 veteran with one cycle of in vitro     
fertilization1 as determined by the     
,secretary2 and  7#b7 the cost the      
,department would incur by paying the   
expenses of three adoptions by covered  
veterans1 as determined by the          
,secretary4  4  7b7 ,clerical amendment 
,the table of sections at the beginning 
of chapter #ag of such title1 as amended
 by section #c1 is further amended by   
inserting after the item relating to    
section #aghh the following new item3   
#aghi4 ,adoption assistance4  4  #e4    
,annual report on provision of fertility
 counseling and treatment furnished by  
,department of ,veterans ,affairs  7a7  
,in general ,not later than one year    
after the date of the enactment of this 
,act and not less frequently than once  

each year thereafter1 the ,secretary of 
,veterans ,affairs shall submit to the  
,committee on ,veterans' ,affairs of the
 ,senate and the ,committee on          
,veterans' ,affairs of the ,house of    
,representatives a report on the        
fertility counseling and treatment      
furnished by the ,department of         
,veterans ,affairs during the year      
preceding the submittal of the report4  
7b7 ,elements ,each report submitted    
under subsection 7a7 shall include1 for 
the period covered by the report1 the   
following3  7#a7 ,the number of veterans
 who received fertility counseling or   
treatment furnished by the ,department  
of ,veterans ,affairs1 disaggregated by 
era of military service of such         
veterans4  7#b7 ,the number of spouses  
and surrogates of veterans who received 
fertility counseling or treatment       
furnished by the ,department4  7#c7 ,the
 cost to the ,department of furnishing  
fertility counseling and treatment1     
disaggregated by cost of services and   

administration4  7#d7 ,the average cost 
to the ,department per recipient of such
 counseling and treatment4  7#e7 ,in    
cases in which the ,department furnished
 fertility treatment through the use of 
assisted reproductive technology1 the   
average number of cycles per person     
furnished4  7#f7 ,a description of how  
fertility counseling and treatment      
services of the ,department are         
coordinated with similar services of the
 ,department of ,defense4  #f4          
,regulations on furnishing of fertility 
counseling and treatment and adoption   
assistance by ,department of ,veterans  
,affairs  7a7 ,in general ,not later    
than #edj days after the date of the    
enactment of this ,act1 the ,secretary  
of ,veterans ,affairs shall prescribe   
regulations--  7#a7 on the furnishing of
 fertility treatment to veterans using  
assisted reproductive technology2  7#b7 
to carry out section #aghh of title #ch1
 ,united ,states ,code1 as added by     
section #c2 and  7#c7 to carry out      

section #aghi of such title1 as added by
 section #d4  7b7 ,limitation           
,notwithstanding any other provision of 
law1 during the period beginning on the 
date of the enactment of this ,act and  
ending on the date on which the         
,secretary prescribes regulations under 
subsection 7a71 the ,secretary may not  
furnish--  7#a7 to a veteran any        
fertility treatment that uses an        
assisted reproductive technology that   
the ,secretary has not used in the      
provision of a fertility treatment to a 
veteran before the date of the enactment
 of this ,act2  7#b7 any fertility      
counseling or treatment under section   
#aghh of title #ch1 ,united ,states     
,code1 as added by section #c2 or  7#c7 
any assistance under section #aghi of   
such title1 as added by section #d4  7c7
 ,assisted reproductive technology      
defined ,in this section1 the term      
assisted reproductive technology has the
 meaning given the term in section #aghh
 of such title1 as added by section #c4 

#g4 ,coordination between ,department of
 ,veterans ,affairs and ,department of  
,defense on furnishing of fertility     
counseling and treatment ,the ,secretary
 of ,veterans ,affairs and the          
,secretary of ,defense shall share best 
practices and facilitate referrals1 as  
they consider appropriate1 on the       
furnishing of fertility counseling and  
treatment4  #h4 ,facilitation of        
reproduction and infertility research   
7a7 ,in general ,subchapter ,,ii of     
chapter #gc of title #ch1 ,united       
,states ,code1 is amended by adding at  
the end the following new section3      
#gccj;,b4 ,facilitation of reproduction 
and infertility research  7a7           
,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 military1 naval1 or air   
service1 such as spinal cord injury1    
that affects the veterans' ability to   
reproduce4  7b7 ,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 ,administration4  4   
7b7 ,clerical amendment ,the table of   
sections at the beginning of chapter #gc
 of such title is amended by inserting  
after the item relating to section      
#gccj;,a the following new item3        
#gccj;,b4 ,facilitation of reproduction 
and infertility research4  4  7c7       
,report ,not later than three years     
after the date of the enactment of this 
,act1 the ,secretary of ,veterans       

,affairs shall submit to ,congress a    
report on the research activities       
conducted by the ,secretary under       
section #gccj;,b of title #ch1 ,united  
,states ,code1 as added by subsection   
7a74  #i4 ,requirement to improve       
,department of ,veterans ,affairs women 
veterans contact center ,the ,secretary 
of ,veterans ,affairs shall enhance the 
capabilities of the ,department of      
,veterans ,affairs women veterans       
contact center--  7#a7 to respond to    
requests by women veterans for          
assistance with accessing health care   
and benefits furnished under laws       
administered by the ,secretary2 and     
7#b7 for referral of such veterans to   
community resources to obtain assistance
 with services not furnished by the     
,department4  #aj4 ,modification of     
pilot program on counseling in retreat  
settings for women veterans newly       
separated from service in the ,armed    
,forces  7a7 ,increase in number of     
locations ,subsection 7c7 of section    

#bjc of the ,caregivers and ,veterans   
,omnibus ,health ,services ,act of #bjaj
 7,public ,law #aaa-afc2 #ch ,u4,s4,c4  
#agab;,a note7 is amended by striking   
three locations and inserting #ad       
locations4  7b7 ,extension of duration  
,subsection 7d7 of such section is      
amended by striking #b-year and         
inserting four-year4  7c7 ,authorization
 of appropriations ,subsection 7f7 of   
such section is amended--  7#a7 by      
striking ,secretary of ,veterans        
,affairs for each and inserting the     
following3 8,secretary of ,veterans     
,affairs--  7#a7 for each  2  7#b7 in   
paragraph 7#a71 as designated by        
paragraph 7#a71 by striking the period  
at the end and inserting 2 and2 and     
7#c7 by adding at the end the following 
new paragraph3  7#b7 for each of fiscal 
years #bjac and #bjad1 #djj1jjj to carry
 out the pilot program4  4  #aa4        
,program on assistance for child care   
for certain veterans  7a7 ,assistance   
for child care for certain veterans     

receiving health care  7#a7 ,in general 
,subchapter ,i of chapter #ag of title  
#ch1 ,united ,states ,code1 is amended  
by adding at the end the following new  
section3  #agji;,b4 ,assistance for     
child care for certain veterans         
receiving health care  7a7 ,program     
required ,the ,secretary shall carry out
 a program to provide1 subject to       
subsection 7b71 assistance to qualified 
veterans described in subsection 7c7 to 
obtain child care so that such veterans 
can receive health care services        
described in subsection 7c74  7b7       
,limitation on period of payments       
,assistance may only be provided to a   
qualified veteran under this section for
 receipt of child care during the period
 that the qualified veteran--  7#a7     
receives the types of health care       
services described in subsection 7c7 at 
a facility of the ,department2 and  7#b7
 requires travel to and return from such
 facility for the receipt of such health
 care services4  7c7 ,qualified veterans

 ,for purposes of this section1 a       
qualified veteran is a veteran who is-- 
7#a7 the primary caretaker of a child or
 children2 and  7#b7 7,a7 receiving from
 the ,department--  7i7 regular mental  
health care services2  7ii7 intensive   
mental health care services2 or  7iii7  
such other intensive health care        
services that the ,secretary determines 
that provision of assistance to the     
veteran to obtain child care would      
improve access to such health care      
services by the veteran2 or  7,b7 in    
need of regular or intensive mental     
health care services from the           
,department1 and but for lack of child  
care services1 would receive such health
 care services from the ,department4    
7d7 ,locations ,the ,secretary shall    
carry out the program in no fewer than  
three ,veterans ,integrated ,service    
,networks selected by the ,secretary for
 purposes of the program4  7e7 ,forms of
 child care assistance  7#a7 ,child care
 assistance under this section may      

include the following3  7,a7 ,stipends  
for the payment of child care offered by
 licensed child care centers 7either    
directly or through a voucher program7  
which shall be1 to the extent           
practicable1 modeled after the          
,department of ,veterans ,affairs ,child
 ,care ,subsidy ,program established    
pursuant to section #fcj of the         
,treasury and ,general ,government      
,appropriations ,act1 #bjjb 7,public    
,law #ajg-fg2 #aae ,stat4 #eeb74  7,b7  
,direct provision of child care at an   
on-site facility of the ,department of  
,veterans ,affairs4  7,c7 ,payments to  
private child care agencies4  7,d7      
,collaboration with facilities or       
programs of other ,federal departments  
or agencies4  7,e7 ,such other forms of 
assistance as the ,secretary considers  
appropriate4  7#b7 ,in the case that    
child care assistance under this section
 is provided as a stipend under         
paragraph 7#a77;,a71 such stipend shall 
cover the full cost of such child care4 

4  7#b7 ,conforming amendment ,section  
#bje7;e7 of the ,caregivers and         
,veterans ,omnibus ,health ,services    
,act of #bjaj 7,public ,law #aaa-afc2   
#ch ,u4,s4,c4 #agaj note7 is amended by 
inserting but not after the date of the 
enactment of the ,women ,veterans and   
,other ,health ,care ,improvements ,act 
of #bjac before the period at the end4  
7#c7 ,clerical amendment ,the table of  
sections at the beginning of such       
chapter is amended by inserting after   
the item relating to section #agji;,a   
the following new item3  #agji;,b4      
,assistance for child care for certain  
veterans receiving health care4  4  7b7 
,assistance for child care for certain  
veterans receiving readjustment         
counseling and related mental health    
services  7#a7 ,in general ,subchapter  
,i of chapter #ag of such title1 as     
amended by subsection 7a77#a71 is       
further amended by adding at the end the
 following new section3  #agji;,c4      
,assistance for child care for certain  

veterans receiving readjustment         
counseling and related mental health    
services  7a7 ,program required ,the    
,secretary shall carry out a program to 
provide1 subject to subsection 7b71     
assistance to qualified veterans        
described in subsection 7c7 to obtain   
child care so that such veterans can    
receive readjustment counseling and     
related mental health services4  7b7    
,limitation on period of payments       
,assistance may only be provided to a   
qualified veteran under this section for
 receipt of child care during the period
 that the qualified veteran receives    
readjustment counseling and related     
health care services at a ,vet ,center4 
7c7 ,qualified veterans ,for purposes of
 this section1 a qualified veteran is a 
veteran who is--  7#a7 the primary      
caretaker of a child2 and  7#b7 7,a7    
receiving from the ,department regular  
readjustment counseling and related     
mental health services2 or  7,b7 in need
 of readjustment counseling and related 

mental health services from the         
,department1 and but for lack of child  
care services1 would receive such       
counseling and services from the        
,department4  7d7 ,locations ,the       
,secretary shall carry out the program  
under this section in no fewer than     
three ,readjustment ,counseling ,service
 ,regions selected by the ,secretary for
 purposes of the program4  7e7 ,forms of
 child care assistance  7#a7 ,child care
 assistance under this section may      
include the following3  7,a7 ,stipends  
for the payment of child care offered by
 licensed child care centers 7either    
directly or through a voucher program7  
which shall be1 to the extent           
practicable1 modeled after the          
,department of ,veterans ,affairs ,child
 ,care ,subsidy ,program established    
pursuant to section #fcj of the         
,treasury and ,general ,government      
,appropriations ,act1 #bjjb 7,public    
,law #ajg-fg2 #aae ,stat4 #eeb74  7,b7  
,payments to private child care         

agencies4  7,c7 ,collaboration with     
facilities or programs of other ,federal
 departments or agencies4  7,d7 ,such   
other forms of assistance as the        
,secretary considers appropriate4  7#b7 
,in the case that child care assistance 
under this subsection is provided as a  
stipend under paragraph 7#a77;,a71 such 
stipend shall cover the full cost of    
such child care4  7f7 ,vet ,center      
defined ,in this section1 the term ,vet 
,center means a center for readjustment 
counseling and related mental health    
services for veterans under section     
#agab;,a of this title4  4  7#b7        
,clerical amendment ,the table of       
sections at the beginning of such       
chapter1 as amended by subsection       
7a77#c71 is further amended by inserting
 after the item relating to section     
#agji;,b the following new item3        
#agji;,c4 ,assistance for child care for
 certain veterans receiving readjustment
 counseling and related mental health   
services4  4  #ab4 ,contractor user fees

  7a7 ,in general ,chapter #c of title  
#ch1 ,united ,states ,code1 is amended  
by adding at the end the following new  
section3  #cbc4 ,contractor user fees   
7a7 ,fee requirement ,except as provided
 in subsection 7c7 and subject to       
subsection 7d71 the ,secretary shall    
impose a fee upon each person with whom 
the ,secretary engages in a contract for
 a good or service as a condition of the
 contract4  7b7 ,fee amount  7#a7 ,the  
amount of a fee imposed upon a person   
under subsection 7a7 with respect to a  
contract shall be equal to the lesser   
of--  7,a7 the amount which is equal to 
seven percent of the total value of the 
contract2 and  7,b7 the amount which is 
equal to the total value of the contract
 multiplied by the applicable percentage
 for such fiscal year4  7#b7 ,the       
applicable percentage for a fiscal year 
shall be equal to the percentage by     
which--  7,a7 the annual estimate of the
 total value of contracts for such      
fiscal year1 exceeds  7,b7 the annual   

estimate of the total cost of fertility 
counseling and treatment for such fiscal
 year4  7#c7 ,before each fiscal year1  
the ,secretary shall establish1 for     
purposes of this section1 the annual    
estimate of the total value of contracts
 for the next fiscal year1 which shall  
be the ,secretary's estimate of what the
 aggregate value will be of all         
contracts in which the ,secretary will  
engage in the next fiscal year4  7#d7   
,before each fiscal year1 the ,secretary
 shall establish1 for purposes of this  
section1 the annual estimate of the     
total cost of fertility counseling and  
treatment for the next fiscal year1     
which shall be the ,secretary's estimate
 of what the total cost to the          
,department will be in the next fiscal  
year of--  7,a7 furnishing fertility    
counseling and treatment1 including     
through the use of assisted reproductive
 technology1 to individuals under laws  
administered by the ,secretary in the   
next fiscal year2 and  7,b7 making      

payments under section #aghi of this    
title in the next fiscal year4  7c7     
,waiver ,the ,secretary may waive the   
fee required by subsection 7a7 for a    
person as the ,secretary considers      
appropriate if the person is an         
individual or a small business concern4 
7d7 ,limitation on collection ,no fee   
may be collected under subsection 7a7   
except to the extent that the           
expenditure of the fee to pay the costs 
of activities and services for which the
 fee is imposed is provided for in      
advance in an appropriations ,act4  7e7 
,department of ,veterans ,affairs       
,fertility ,counseling and ,treatment   
,fund  7#a7 ,there is in the ,treasury a
 fund to be known as the ,department of 
,veterans ,affairs ,fertility           
,counseling and ,treatment ,fund4  7#b7 
,all amounts received by the ,secretary 
under subsection 7a7 shall be deposited 
in the fund4  7#c7 7,a7 ,subject to the 
provisions of appropriations ,acts1     
amounts in the fund shall be available1 

without fiscal year limitation1 to the  
,secretary for the following purposes3  
7i7 ,to furnish fertility counseling and
 treatment1 including through the use of
 assisted reproductive technology1 to   
individuals under laws administered by  
the ,secretary4  7ii7 ,to make payments 
under section #aghi of this title4  7,b7
 ,amounts available under subparagraph  
7,a7 may not be used for any purposes   
other than a purpose set forth in clause
 7i7 or 7ii7 of that subparagraph4  7#d7
 ,amounts received by the ,secretary    
under subsection 7a7 shall be treated   
for the purposes of sections #bea and   
#beb of the ,balanced ,budget and       
,emergency ,deficit ,control ,act of    
#aihe 7#b ,u4,s4,c4 #ija1 #ijb7 as      
offsets to discretionary appropriations 
7rather than as offsets to direct       
spending7 to the extent that such       
amounts are made available for          
expenditure in appropriations ,acts for 
the purposes specified in paragraph 7#c7
 of this subsection4  7f7 ,small        

business concern defined ,in this       
section1 the term small business concern
 has the meaning given such term under  
section #c of the ,small ,business ,act 
7#ae ,u4,s4,c4 #fcb74  4  7b7 ,clerical 
amendment ,the table of sections at the 
beginning of chapter #c of such title is
 amended by adding after the item       
relating to section #cbb the following  
new item3  #cbc4 ,contractor user fees4 
4