,,ii #aafth ,,congress #b;d ,session ,s4 #chbf ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,may #ba1 #bjbj,mr4 ,blumenthal 7for himself and ,mrs4 ,gillibrand7 introduced the following bill2 which was read twice and referred to the ,committee on ,armed ,services ,a ,,bill ,to require the ,secretary of ,defense to provide additional resources1 including doula support1 for pregnant beneficiaries under the ,,tricare program1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,,tricare ,coverage for ,doula ,support ,act4 #b4 ,additional resources1 including doula support1 for pregnant beneficiaries under the ,,tricare program 7a7 ,findings ,congress finds the following3 7#a7 ,in #bjah1 #eb1ece members of the ,armed ,forces and their dependents gave birth at military medical treatment facilities or civilian hospitals where the ,department of ,defense purchased care4 7#b7 ,as required pursuant to the ,house report accompanying ,h4,r4 #eeae1 #aaeth ,congress 7,house ,report #aae-hgd71 under the heading ,report on rate of maternal mortality among members of the ,armed ,forces under the heading ,legislative provisions not adopted1 the report submitted by the ,secretary of ,defense titled ,maternal and ,infant ,mortality ,rates in the ,military ,health ,system showed that rates of maternal and infant mortality in the military health system are lower than national averages but also recommended expanding available resources for prenatal1 childbirth1 and postnatal communication1 as well as education for pregnant beneficiaries under the ,,tricare program4 7#c7 ,doula support1 which includes continuous non-clinical one-to-one emotional1 physical1 and informational support around the time of birth1 as well as support during pregnancy and postpartum1 could be one such resource for pregnant beneficiaries4 7#d7 ,studies have shown that doula support can decrease maternal anxiety and depression that can contribute to postpartum depression1 and also that doula support reduces the likelihood of consequential and costly interventions1 such as cesarean birth and epidural pain relief4 7#e7 ,research has also shown that doula support increases the likelihood of a shorter labor1 a spontaneous vaginal birth1 higher ,apgar scores for babies1 and a positive childbirth experience1 which subsequently lowers the cost of maternity care while improving the health of women and infants4 7#f7 ,the ,expert ,panel on ,improving ,maternal and ,infant ,health ,outcomes in ,medicaid and the ,children's ,health ,insurance ,program of the ,centers for ,medicare ,medicaid ,services recommends providing coverage for continuous doula support during labor4 7#g7 ,members of the ,armed ,forces and military spouses are uniquely positioned to maximize the benefits of doula support due to the nature of training1 deployments1 frequent permanent changes of station1 and other mission requirements that can contribute to isolation during pregnancy and birth1 or prevent birthing partners from being present during childbirth4 7#h7 ,members of the ,armed ,forces who are single1 members of the ,armed ,forces and military spouses with deployed birthing partners1 and minority women who face racial bias in access to health care might find doula support particularly beneficial4 7#i7 ,there are currently no specific programs of the ,department of ,defense for labor support1 but the ,my ,career ,advancement ,account program of the ,department provides funding for military spouses to receive training to become doulas4 7b7 ,additional resources for pregnant ,,tricare beneficiaries 7#a7 ,in general ,in providing maternity care for pregnant beneficiaries under the ,,tricare program under chapter #ee of title #aj1 ,united ,states ,code1 the ,secretary of ,defense shall provide to such beneficiaries additional resources for prenatal and postnatal communication and education1 including doula support4 7#b7 ,prohibition on cost sharing ,the ,secretary shall not require a beneficiary under the ,,tricare program to pay any fee or other cost-sharing requirement for the receipt of additional resources under paragraph 7#a74 7#c7 ,implementation ,not later than one year after the date of the enactment of this ,act1 the ,secretary shall finalize implementation of the provision of additional resources required under paragraph 7#a74 7c7 ,advisory committee 7#a7 ,in general ,not later than #ahj days after the date of the enactment of this ,act1 the ,secretary of ,defense shall establish an advisory committee to assist the ,department of ,defense in carrying out the requirements under this section4 7#b7 ,selection of members ,the ,secretary shall select the members of the advisory committee required under paragraph 7#a71 which shall include the selection of-- 7,a7 members who are racially and ethnically diverse2 7,b7 members who are trained doulas2 and 7,c7 members who are members of the ,armed ,forces or family members of members of the ,armed ,forces4 7#c7 ,duties ,the duties of the advisory committee established under paragraph 7#a7 are to guide the ,department of ,defense through the implementation of the requirements under this section by providing recommendations to the ,department on the following items3 7,a7 ,expansion of the ,,tricare program to cover doula support4 7,b7 ,identification of appropriate certifications to qualify an individual to provide doula support under the ,,tricare program4 7,c7 ,establishment of reimbursement rates for doula support under the ,,tricare program4 7,d7 ,outreach to beneficiaries under the ,,tricare program to educate those beneficiaries on the benefits of doula support and the availability of such support4 7d7 ,survey and report 7#a7 ,survey ,not later than one year after the date of the enactment of this ,act1 and annually thereafter1 the ,secretary shall administer a survey to determine-- 7,a7 how many members of the ,armed ,forces or spouses of such members give birth while their spouse or birthing partner is unable to be present due to deployment1 training1 or other mission requirements2 7,b7 how many single members of the ,armed ,forces give birth alone2 and 7,c7 how many members of the ,armed ,forces or spouses of such members use doula support1 or are interested in using doula support1 during pregnancy and childbirth4 7#b7 ,matters covered by the survey ,the survey administered under paragraph 7#a7 shall include an identification of the following3 7,a7 ,the race1 ethnicity1 age1 sex1 relationship status1 military service1 military occupation1 and rank1 as applicable1 of each individual surveyed4 7,b7 ,the service- or mission-specific reason the member of the ,armed ,forces was not present during the birth1 if applicable4 7,c7 ,if individuals surveyed were members of the ,armed ,forces or the spouses of such members1 or both4 7,d7 ,the length of advanced notice received by individuals surveyed that the member of the ,armed ,forces would be unable to be present during the birth1 if applicable4 7,e7 ,any resources or support that the individuals surveyed found useful during the pregnancy and birth process1 including doula support4 7#c7 ,report ,the ,secretary shall submit to the congressional defense committees an annual report on the results of the survey administered under paragraph 7#a7 for the year covered by the report4 7e7 ,definitions ,in this section3 7#a7 ,congressional defense committees ,the term congressional defense committees has the meaning given that term in section #aja7;a77#af7 of title #aj1 ,united ,states ,code4 7#b7 ,doula 7,a7 ,in general ,the term doula means an individual who is trained as described in subparagraph 7,b7 to provide non-medical advice1 information1 emotional support1 and physical comfort to an individual during the individual's pregnancy1 childbirth1 and postpartum period by an organization that has been established for not less than five years and that requires the completion of continuing education4 7,b7 ,training described ,training described in this subparagraph is training in nationally recognized core doula competencies1 which may include competency in reproductive and birth justice frameworks1 race equity1 cultural humility1 home visiting skills1 and knowledge of social services4 7#c7 ,,tricare program ,the term ,,tricare program has the meaning given that term in section #ajgb of title #aj1 ,united ,states ,code4 #c4 ,expansion of evaluation on effectiveness of ,,tricare program to include data on births at military medical treatment facilities and civilian hospitals under the ,,tricare program ,section #gag7;a7 of the ,national ,defense ,authorization ,act for ,fiscal ,year #aiif 7,public ,law #ajd-ajf2 #aj ,u4,s4,c4 #ajgc note7 is amended-- 7#a7 in paragraph 7#b71 by striking 2 and and inserting a semicolon2 7#b7 in paragraph 7#c77;,b77v71 by striking the period at the end and inserting 2 and2 and 7#c7 by adding at the end the following new paragraph3 7#d7 assess data relating to births at each military medical treatment facility or civilian hospital under the ,,tricare program during the one-year period preceding the evaluation1 including-- 7,a7 the number of births1 disaggregated by military service and rank of the individual giving birth or their spouse1 as appropriate2 7,b7 whether the individual giving birth is a member of the ,armed ,forces1 a spouse of such a member1 or other dependent of such a member2 7,c7 the race1 ethnicity1 age1 and relationship status of the individual giving birth2 7,d7 any effects of implicit or explicit bias in maternal health care under the ,,tricare program1 or evidence of racial or socioeconomic barriers to such care2 and 7,e7 such other demographic information about the individual giving birth as the ,secretary considers appropriate4 4