[House Report 111-165]
[From the U.S. Government Publishing Office]
111th Congress Report
HOUSE OF REPRESENTATIVES
1st Session 111-165
======================================================================
WOMEN VETERANS HEALTH CARE IMPROVEMENT ACT
_______
June 18, 2009.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Filner, from the Committee on Veterans' Affairs, submitted the
following
R E P O R T
[To accompany H.R. 1211]
[Including cost estimate of the Congressional Budget Office]
The Committee on Veterans' Affairs, to whom was referred the
bill (H.R. 1211) to amend title 38, United States Code, to
expand and improve health care services available to women
veterans, especially those serving in Operation Enduring
Freedom and Operation Iraqi Freedom, from the Department of
Veterans Affairs, and for other purposes, having considered the
same, report favorably thereon with amendments and recommend
that the bill as amended do pass.
CONTENTS
Page
Amendment........................................................ 2
Purpose and Summary.............................................. 2
Background and Need for Legislation.............................. 2
Hearings......................................................... 4
Subcommittee Consideration....................................... 4
Committee Consideration.......................................... 5
Committee Votes.................................................. 5
Committee Oversight Findings..................................... 5
Statement of General Performance Goals and Objectives............ 5
New Budget Authority, Entitlement Authority, and Tax Expenditures 5
Earmarks and Tax and Tariff Benefits............................. 5
Committee Cost Estimate.......................................... 5
Congressional Budget Office Estimate............................. 6
Federal Mandates Statement....................................... 8
Advisory Committee Statement..................................... 8
Constitutional Authority Statement............................... 8
Applicability to Legislative Branch.............................. 8
Section-by-Section Analysis of the Legislation................... 8
Changes in Existing Law Made by the Bill as Reported............. 10
Amendment
The amendment is as follows:
The amendments (stated in terms of the page and line numbers
of the introduced bill) are as follows:
Page 10, strike line 17 and all that follows through the end
of line 19, and insert the following:
```Sec. 1786. Hospital care and medical services for newborn children
of women veterans receiving maternity care''.
Page 11, line 1, strike ``14-day'' and insert ``seven-day''.
Page 15, line 22, strike ``(a)(2)(a)'' and insert
``(a)(2)(A)''.
Page 16, line 8, strike ``(a)(2)(a)'' and insert
``(a)(2)(A)''.
Purpose and Summary
H.R. 1211 was introduced on February 26, 2009, by
Representative Stephanie Herseth Sandlin of South Dakota,
Chairwoman of the Subcommittee on Economic Opportunity of the
Committee on Veterans' Affairs. This legislation would expand
and improve health care services available to women veterans,
especially those who served in Operation Enduring Freedom and
Operation Iraqi Freedom (OEF/OIF). H.R. 1211 would require the
Department of Veterans Affairs (VA) to implement a study on
health care barriers and to conduct a comprehensive assessment
of the VA's health care programs for women veterans. H.R. 1211,
as amended, would provide medical care for newborn children of
women veterans receiving maternity care; require training and
certification for VA mental health care providers who provide
care for veterans suffering from sexual trauma and post-
traumatic stress disorder; authorize a pilot program for child
care assistance to certain veterans receiving health care
services at VA facilities; and, mandate the addition of
recently separated women and minority veterans to serve on VA
advisory committees.
Background and Need for Legislation
The VA is facing a growing challenge to provide equal
access and high quality health care to the ever-increasing
population of women veterans. Today, there are approximately
1.7 million women veterans, or seven percent of the nearly 25
million veterans. Assuming that current enrollment rates remain
the same, the number of female veterans who use the VA system
will double in the next five years, making female veterans one
of the fastest growing subgroups of veterans.
The Committee recognizes that the VA has made many
improvements over the past two decades to the services offered
to women veterans. For example, Public Law 98-160 (97 Stat.
994) mandated the establishment of the Advisory Committee on
Women Veterans and over a decade later, Public Law 103-446 (108
Stat. 4668) established the Center for Women Veterans. These
two entities have been instrumental in furthering the awareness
of the needs and challenges women veterans face. While there
have been some legislative changes, VA remains largely a male-
dominated physical environment.
Today's women veterans face unique challenges and barriers
when seeking health care through the VA. For example, many
physical VA facilities still do not provide proper
accommodations for women veterans and often lack changing
tables in the bathrooms or spaces to ensure privacy for women.
In addition, the lack of child care, newborn care, and gender-
sensitive care for military sexual trauma and post-traumatic
stress disorder (PTSD) may hinder women veterans from seeking
VA health care services.
To better understand the barriers women veterans face when
accessing health care, the VA has taken steps to initiate
gender-specific research studies focused on women veterans. The
VA is currently conducting a study to identify the changing
health care needs of the growing women veteran population and
the barriers they experience within the VA health care system.
The Committee is concerned that the sample size of this study,
about 3,500 women veterans from a universe of about 1.7 million
women veterans, may be both insufficient and not entirely
representative of the overall population of women veterans.
H.R. 1211 would require the VA to build on this study by
requiring a larger sample size and ensuring representation of
women veterans from each Veterans Integrated Service Network
(VISN). In addition, H.R. 1211 would require the VA to conduct
a comprehensive assessment of women's health care programs at
each VA medical facility. This includes an assessment of
specialized programs for women with PTSD, homeless women, women
who require care for substance abuse or mental illnesses, and
women who require obstetric and gynecologic care. With a more
complete understanding of the health care barriers and the
current offering of special programs geared toward women
veterans, the VA will be better equipped to meet the needs of
the growing women veteran population.
This growing women veteran population also includes a large
subpopulation of women who are of childbearing age. In fact, of
the OEF/OIF women veterans who are enrolled and access the VA
health care system, almost all are under age 40. In fiscal year
2008, the VA provided obstetric care to over 1,100 unique
patients. While the VA provides prenatal and obstetric care to
women veterans, they do not have the authority to treat or pay
for the care of newborns. This is an inequity when compared to
other Federal health care programs, since generous newborn care
is provided through such programs as TRICARE Prime and CHAMPVA
(Civilian Health and Medical Program of the Department of
Veterans Affairs). H.R. 1211 would address this inequity by
providing short-term newborn care for women veterans who
receive their maternity care through the VA. Specifically, this
provision allows for seven days of newborn care. According to
the VA, 94 percent of mothers and their infants are released
from VA medical facilities within the first seven days. In
addition, this far exceeds the 48 to 96 hours of routine
newborn care provided by private group health insurance
policies. With this provision, women veterans will have the
opportunity to make alternate arrangements and secure private
health insurance for their newborns or enroll the infants in
public insurance programs such as Medicaid or the State
Children's Health Insurance Program.
Related to the issue of newborns, the lack of child care is
often cited as a key barrier to accessing health care by women
veterans with young children. This is especially an issue for
those who receive regular mental health or other intensive
health care services. Without the assurance of proper child
care, these women veterans are foregoing important services
which are crucial to their well-being. To address this problem,
H.R. 1211 would authorize the VA to implement a two-year pilot
program providing child care in a minimum of three VISNs. The
VA would have flexibility in designing the pilot program and
would be required to provide a report which includes
recommendations for the continuation or the expansion of this
demonstration.
Another issue facing the growing women veteran population
is sexual trauma and PTSD. This is especially magnified by the
changing role of women servicemembers in the current conflicts
in Iraq and Afghanistan, as evidenced by Team Lioness who were
the first female soldiers in U.S. history to be sent into
direct ground combat. Because of the historical predominance of
male veterans in VA health care settings, many VA providers
have little or no exposure to women veterans. To address this,
H.R. 1211 would require the VA to provide graduate medical
education, training, certification, and continuing medical
education for mental health professionals caring for veterans
suffering from military sexual trauma and PTSD.
To ensure that VA is responsive to the needs of OEF/OIF
women veterans, who are accessing VA health care services at
rates higher than women who served in previous conflicts, H.R.
1211 would require the VA to add recently separated women and
minority veterans to serve on the Advisory Committee on Women
Veterans and the Advisory Committee on Minority Veterans.
Hearings
On March 3, 2009, the Subcommittee on Health held a
legislative hearing on several bills introduced during the
111th Congress, including H.R. 1211.
The following witnesses testified: The Honorable Niki
Tsongas of Massachusetts; The Honorable Stephanie Herseth
Sandlin of South Dakota; Joy J. Ilem, Assistant National
Legislative Director, Disabled American Veterans; Joseph L.
Wilson, Deputy Director, Veterans Affairs and Rehabilitation
Commission, The American Legion; Eric A. Hilleman, Deputy
Director, National Legislative Service, Veterans of Foreign
Wars; Todd Bowers, Director of Government Affairs, Iraq and
Afghanistan Veterans of America; and Gerald M. Cross, M.D.,
FAAFP, Principal Deputy Under Secretary for Health, U.S.
Department of Veterans Affairs, accompanied by Walter Hall,
Assistant General Counsel, U.S. Department of Veterans Affairs.
Those submitting statements for the record included: The
Honorable Bob Filner of California; Thomas J. Berger, Ph.D.,
Senior Analyst for Veterans' Benefits and Mental Health Issues,
Vietnam Veterans of America; and, the Paralyzed Veterans of
America.
Subcommittee Consideration
On June 4, 2009, the Subcommittee on Health met in open
markup session and ordered H.R. 1211, as amended, favorably
forwarded to the full Committee by voice vote. During
consideration of the bill, the following amendment was
considered:
An amendment by Mr. Michaud of Maine to amend the
number of days of newborn care was agreed to by voice
vote.
Committee Consideration
On June 10, 2009, the full Committee met in an open markup
session, a quorum being present, and ordered H.R. 1211, as
amended, reported favorably to the House of Representatives by
voice vote.
Committee Votes
Clause 3(b) of rule XIII of the Rules of the House of
Representatives requires the Committee to list the record votes
on the motion to report the legislation and amendments thereto.
There were no record votes taken on amendments or in connection
with ordering H.R. 1211 reported to the House. A motion by Mr.
Stearns of Florida to order H.R. 1211, as amended, reported
favorably to the House of Representatives was agreed to by
voice vote.
Committee Oversight Findings
In compliance with clause 3(c)(1) of rule XIII and clause
2(b)(1) of rule X of the Rules of the House of Representatives,
the Committee's oversight findings and recommendations are
reflected in the descriptive portions of this report.
Statement of General Performance Goals and Objectives
In accordance with clause 3(c)(4) of rule XIII of the Rules
of the House of Representatives, the Committee's performance
goals and objectives are reflected in the descriptive portions
of this report.
New Budget Authority, Entitlement Authority, and Tax Expenditures
In compliance with clause 3(c)(2) of rule XIII of the Rules
of the House of Representatives, the Committee adopts as its
own the estimate of new budget authority, entitlement
authority, or tax expenditures or revenues contained in the
cost estimate prepared by the Director of the Congressional
Budget Office pursuant to section 402 of the Congressional
Budget Act of 1974.
Earmarks and Tax and Tariff Benefits
H.R. 1211 does not contain any congressional earmarks,
limited tax benefits, or limited tariff benefits as defined in
clause 9(d), 9(e), or 9(f) of rule XXI of the Rules of the
House of Representatives.
Committee Cost Estimate
The Committee adopts as its own the cost estimate on H.R.
1211 prepared by the Director of the Congressional Budget
Office pursuant to section 402 of the Congressional Budget Act
of 1974.
Congressional Budget Office Cost Estimate
Pursuant to clause 3(c)(3) of rule XIII of the Rules of the
House of Representatives, the following is the cost estimate
for H.R. 1211 provided by the Congressional Budget Office
pursuant to section 402 of the Congressional Budget Act of
1974:
U.S. Congress,
Congressional Budget Office,
Washington, DC, June 16, 2009.
Hon. Bob Filner,
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 1211, the Women
Veterans Health Care Improvement Act.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Sunita
D'Monte.
Sincerely,
Douglas W. Elmendorf.
Enclosure.
H.R. 1211--Women Veterans Health Care Improvement Act
Summary: H.R. 1211 would authorize several programs for
women veterans. CBO estimates that implementing the bill would
cost about $160 million over the 2010-2014 period, assuming
appropriation of the authorized and estimated amounts. Enacting
the bill would not affect direct spending or revenues.
H.R. 1211 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act (UMRA).
Estimated cost to the Federal Government: The estimated
budgetary impact of H.R. 1211 is shown in the following table.
The costs of this legislation fall within budget function 700
(veterans benefits and services).
Basis of estimate: The bill would authorize the
appropriation of $10.5 million in 2010 and $1.5 million in 2011
for a comprehensive assessment of health care programs at the
Department of Veterans Affairs (VA), a study on women veterans,
and a pilot program to provide child care. In addition to those
specified amounts, CBO estimates that other programs authorized
in the bill would require the appropriation of $152 million
over the 2010-2014 period for care provided to newborns and
certain training for mental health providers. In total, CBO
estimates that implementing the bill would cost $160 million
over the 2010-2014 period, assuming appropriation of the
specified and estimated amounts.
----------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars.--
-------------------------------------------------------
2010 2011 2012 2013 2014 2010-2014
----------------------------------------------------------------------------------------------------------------
CHANGES IN SPENDING SUBJECT TO APPROPRIATION
Care for Newborns:
Estimated Authorization Level....................... 18 20 21 22 24 105
Estimated Outlays................................... 16 19 21 22 24 102
Training for Mental Health Providers:
Estimated Authorization Level....................... 10 9 9 9 10 47
Estimated Outlays................................... 9 9 9 9 10 46
Assessment of Health Care Programs:
Authorization Level................................. 5 0 0 0 0 5
Estimated Outlays................................... 5 * * * 0 5
Study on Women Veterans:
Authorization Level................................. 4 0 0 0 0 4
Estimated Outlays................................... 4 * * 0 0 4
Pilot Program on Child Care:
Authorization Level................................. 2 2 0 0 0 3
Estimated Outlays................................... 1 2 * * 0 3
Total Changes:
Estimated Authorization Level................... 39 31 30 31 34 165
Estimated Outlays............................... 35 30 30 31 34 160
----------------------------------------------------------------------------------------------------------------
Note: Components may not sum to totals because of rounding; * = less than $500,000.
For this estimate, CBO assumes the legislation will be
enacted near the start of fiscal year 2010, that the specified
and estimated authorizations will be appropriated near the
start of each fiscal year, and that outlays will follow
historical patterns for similar and existing programs.
Care for Newborns. Section 201 would authorize VA to
provide care for up to seven days to the newborn children of
female veterans who receive maternity care through the
department. Based on data from VA, CBO estimates that about
6,600 babies would become eligible for such care in 2010 at an
average cost of $2,770 per baby. After adjusting for inflation
and population growth--the number of female veterans of
childbearing age is expected to rise in future years--CBO
estimates that implementing this provision would cost $102
million over the 2010-2014 period.
Training for Mental Health Providers. Section 202 would
require VA to educate, train, and certify mental health
professionals who specialize in treating sexual trauma. Based
on information from VA's Office of Mental Health Services, CBO
estimates that VA would need 66 employees a year to provide
training at a cost of about $46 million over the 2010-2014
period.
Assessment of Health Care Programs. Section 102 would
require the Secretary to undertake a comprehensive assessment
of VA's health care programs for women and would authorize the
appropriation of $5 million for that purpose.
Study on Women Veterans. Section 101 would require the
Secretary to conduct a study on the barriers faced by women
veterans in receiving VA health care and would authorize the
appropriation of $4 million for that purpose.
Pilot Program for Child Care. Section 203 would require VA
to implement a pilot program providing child care for certain
female veterans who use VA medical facilities, and would
authorize annual appropriations of $1.5 million for 2010 and
2011 for that purpose.
Intergovernmental and private-sector impact. H.R. 1211
contains no intergovernmental or private-sector mandates as
defined in UMRA. Any costs to state or local governments or
public entities would be incurred voluntarily.
Estimate prepared by: Federal Costs: Sunita D'Monte; Impact
on State, Local, and Tribal Governments: Shannon Fairchild;
Impact on the Private Sector: Elizabeth Bass.
Estimate approved by: Theresa Gullo, Deputy Assistant
Director for Budget Analysis.
Federal Mandates Statement
The Committee adopts as its own the estimate of Federal
mandates regarding H.R. 1211 prepared by the Director of the
Congressional Budget Office pursuant to section 423 of the
Unfunded Mandates Reform Act.
Advisory Committee Statement
No advisory committees within the meaning of section 5(b)
of the Federal Advisory Committee Act would be created by H.R.
1211.
Constitutional Authority Statement
Pursuant to clause 3(d)(1) of rule XIII of the Rules of the
House of Representatives, the Committee finds that the
Constitutional authority for H.R. 1211 is provided by Article
I, section 8 of the Constitution of the United States.
Applicability to Legislative Branch
The Committee finds that the legislation does not relate to
the terms and conditions of employment or access to public
services or accommodations within the meaning of section
102(b)(3) of the Congressional Accountability Act.
Section-by-Section Analysis of the Legislation
Section 101. Study of barriers for women veterans to health care from
the Department of Veterans Affairs
This section authorizes the VA to conduct a comprehensive
study, building on the work of the existing VA study (the
National Survey of Women Veterans in Fiscal Year 2007-2008) on
the barriers faced by women veterans in accessing care in the
VA health care system. The Study is to include a survey of
women veterans who use the VA for their health care and those
who do not use the VA. This survey is to be administered to a
representative sample of women veterans from each VISN which is
of sufficient sample size for the study results to be
statistically significant. Required elements of the study
include perceived stigma with seeking mental health care
services; effect of driving distance or availability of
transportation to the nearest medical facility; availability of
child care; acceptability of integrated primary care and
women's health clinics; understanding of eligibility
requirements for and scope of services available at the medical
center; perceptions of personal safety; gender sensitivity of
health care providers and staff; effectiveness of outreach;
location and operating hours of health care facilities; and,
other significant barriers identified by the Secretary of VA.
This section also requires the VA to submit to Congress an
implementation report no later than six months after the date
the VA publishes a final report on its current study and a
report no later than 30 months after the date of the VA
publishing a final report on the study.
This section authorizes appropriations of $4 million to
carry out the study.
Section 102. Comprehensive assessment of women's health care programs
of the Department of Veterans Affairs
This section requires the VA to conduct a comprehensive
assessment of the women's health care programs at each VA
medical center. The assessment is to include information on
demographics of the women veterans population; frequency with
which health care services are available and provided for women
veterans; sites where such services are available and provided;
and, the impact of waiting lists, geographic distance, and,
other factors in obstructing the receipt of services. Upon
conclusion of this comprehensive assessment, the VA is to
develop a plan to improve services for women veterans at each
VA medical center.
This section requires the VA to submit to Congress a report
no later than one year after the date of the enactment of the
Act and a GAO report is required no later than six months after
the VA submits the report, and authorizes $5 million in
appropriations to carry out the assessment.
Section 201. Medical care for newborn children of women veterans
receiving maternity care
This section authorizes the VA to provide medical care for
newborn children of women veterans receiving maternity care for
a period of seven days beginning on the date of the birth of
the child.
Section 202. Training and certification for mental health care
providers of the Department of Veterans Affairs on care for
veterans suffering from sexual trauma and post-traumatic stress
disorder
This section mandates the VA to carry out a program to
provide graduate medical education, training, certification,
and continuing medical education for mental health
professionals at the VA caring for veterans suffering from
military sexual trauma and PTSD.
This section requires an annual report to Congress covering
the number of mental health professionals, graduate medical
education trainees, and primary care providers certified under
the program required by this provision; number of women
veterans who received counseling, care, and services; number of
graduate medical education, training, certification, and
continuing medical education courses provided; number of
trained full-time employees required at each VA facility to
meet the needs of sexual trauma and PTSD; and any recommended
improvements for treating women veterans with sexual trauma and
PTSD.
Section 203. Pilot program for provision of child care assistance to
certain veterans receiving certain types of health care
services at department facilities
This section authorizes appropriations of $1.5 million
annually for FY 2010 and FY 2011 for the VA to conduct a child
care pilot program in at least three VISNs. Covered veterans
include those receiving regular mental health care services,
intensive mental health care services, and any other intensive
health care services deemed appropriate by the Secretary. Child
care assistance may include stipends for child care offered by
licensed child care centers either directly to the providers or
through a voucher program; development of partnerships with
private agencies; collaboration with facilities or programs of
other Federal agencies; and, the arrangement of after-school
care.
Section 204. Addition of recently separated women and minority veterans
to serve on advisory committees
This section requires the VA to add recently-separated
women and minority veterans to serve on the Advisory Committee
on Women Veterans and the Advisory Committee on Minority
Veterans, respectively.
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italic, existing law in which no change is
proposed is shown in roman):
TITLE 38, UNITED STATES CODE
* * * * * * *
PART I--GENERAL PROVISIONS
* * * * * * *
CHAPTER 5--AUTHORITY AND DUTIES OF THE SECRETARY
* * * * * * *
SUBCHAPTER III--ADVISORY COMMITTEES
* * * * * * *
Sec. 542. Advisory Committee on Women Veterans
(a)(1) * * *
(2)(A) The Committee shall consist of members appointed by
the Secretary from the general public, including--
(i) * * *
(ii) individuals who are recognized authorities in
fields pertinent to the needs of women veterans,
including the gender-specific health-care needs of
women; [and]
(iii) representatives of both female and male
veterans with service-connected disabilities, including
at least one female veteran with a service-connected
disability and at least one male veteran with a
service-connected disability[.]; and
(iv) women who are recently separated veterans.
* * * * * * *
Sec. 544. Advisory Committee on Minority Veterans
(a)(1) * * *
(2)(A) The Committee shall consist of members appointed by
the Secretary from the general public, including--
(i) * * *
* * * * * * *
(iii) veterans who are minority group members and who
have experience in a military theater of operations;
[and]
(iv) veterans who are minority group members and who
do not have such experience[.]; and
(v) recently separated veterans who are minority
group members.
* * * * * * *
PART II--GENERAL BENEFITS
* * * * * * *
CHAPTER 17--HOSPITAL, NURSING HOME, DOMICILIARY, AND MEDICAL CARE
Sec.
1701. Definitions.
* * * * * * *
1786. Hospital care and medical services for newborn children of women
veterans receiving maternity care.
* * * * * * *
SUBCHAPTER II--HOSPITAL, NURSING HOME, OR DOMICILIARY CARE AND MEDICAL
TREATMENT
* * * * * * *
Sec. 1720D. Counseling and treatment for sexual trauma
(a) * * *
* * * * * * *
(d) The Secretary shall carry out a program to provide
graduate medical education, training, certification, and
continuing medical education for mental health professionals
who provide counseling, care, and services under subsection
(a). In carrying out such program, the Secretary shall ensure
that all such mental health professionals have been trained in
a consistent manner and that such training includes principles
of evidence-based treatment and care for sexual trauma and
post-traumatic stress disorder.
(e) The Secretary shall submit to Congress an annual report
on the counseling, care, and services provided to veterans
pursuant to this section. Each report shall include data for
the year covered by the report with respect to each of the
following:
(1) The number of mental health professionals,
graduate medical education trainees, and primary care
providers who have been certified under the program
required by subsection (d) and the amount and nature of
continuing medical education provided under such
program to such professionals, trainees, and providers
who are so certified.
(2) The number of women veterans who received
counseling and care and services under subsection (a)
from professionals and providers who received training
under subsection (d).
(3) The number of graduate medical education,
training, certification, and continuing medical
education courses provided by reason of subsection (d).
(4) The number of trained full-time equivalent
employees required in each facility of the Department
to meet the needs of veterans requiring treatment and
care for sexual trauma and post-traumatic stress
disorder.
(5) Any recommended improvements for treating women
veterans with sexual trauma and post-traumatic stress
disorder.
(6) Such other information as the Secretary
determines to be appropriate.
[(d)] (f) In this section, the term ``sexual harassment''
means repeated, unsolicited verbal or physical contact of a
sexual nature which is threatening in character.
* * * * * * *
SUBCHAPTER VIII--HEALTH CARE OF PERSONS OTHER THAN VETERANS
* * * * * * *
Sec. 1786. Hospital care and medical services for newborn children of
women veterans receiving maternity care
In the case of a child of a woman veteran who is receiving
hospital care or medical services at a Department facility (or
in another facility pursuant to a contract entered into by the
Secretary) relating to the birth of that child, the Secretary
may furnish hospital care and medical services to that child at
that facility during the seven-day period beginning on the date
of the birth of the child.
* * * * * * *