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[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 402 Introduced in Senate (IS)]

<DOC>

116th CONGRESS
  1st Session
                                 S. 402

To plan, develop, and make recommendations to increase access to sexual 
assault examinations for survivors by holding hospitals accountable and 
               supporting the providers that serve them.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                            February 7, 2019

Mrs. Murray (for herself, Ms. Murkowski, Mr. Blumenthal, Mrs. Shaheen, 
    Ms. Harris, Mr. Sanders, Ms. Smith, Ms. Hassan, Mr. Leahy, Ms. 
  Klobuchar, Mrs. Gillibrand, and Mr. Wyden) introduced the following 
  bill; which was read twice and referred to the Committee on Health, 
                     Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL

 
To plan, develop, and make recommendations to increase access to sexual 
assault examinations for survivors by holding hospitals accountable and 
               supporting the providers that serve them.

    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 ``Survivors' Access to Supportive Care 
Act'' or ``SASCA''.

SEC. 2. PURPOSE.

    It is the purpose of this Act to increase access to medical 
forensic sexual assault examinations and treatment provided by sexual 
assault forensic examiners for survivors by identifying and addressing 
gaps in obtaining those services.

SEC. 3. DEFINITIONS.

    In this Act:
            (1) Community health aide and community health 
        practitioner.--The terms ``community health aide'' and 
        ``community health practitioner'' have the meanings within the 
        meaning of section 119 of the Indian Health Care Improvement 
        Act (25 U.S.C. 1616l).
            (2) MFE.--The term ``medical forensic examination'' or 
        ``MFE'' means an examination provided to a sexual assault 
        survivor by medical personnel trained to gather evidence of a 
        sexual assault in a manner suitable for use in a court of law.
            (3) SAE.--The term ``sexual assault examiner'' or ``SAE'' 
        means a registered nurse, advanced practice nurse, physician, 
        or physician assistant specifically trained to provide care to 
        sexual assault forensic examinations.
            (4) SAFE.--The term ``sexual assault forensic examiner'' or 
        ``SAFE'' means a medical practitioner who has specialized 
        forensic training in treating sexual assault survivors and 
        conducting medical forensic examinations.
            (5) SANE.--The term ``sexual assault nurse examiner'' or 
        ``SANE'' means a registered nurse who has specialized forensic 
        training in treating sexual assault survivors and conducting 
        medical forensic examinations.
            (6) SART.--The term ``sexual assault response team'' or 
        ``SART'' means a multidisciplinary team that provides a 
        specialized and immediate response to survivors of sexual 
        assault, and may include health care personnel, law enforcement 
        representatives, community-based survivor advocates, 
        prosecutors, and forensic scientists.
            (7) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
            (8) Sexual assault.--The term ``sexual assault'' means any 
        nonconsensual sexual act proscribed by Federal, tribal, or 
        State law, including when the individual lacks capacity to 
        consent.

      TITLE I--STRENGTHENING THE SEXUAL ASSAULT EXAMINER WORKFORCE

SEC. 101. UNDERSTANDING SEXUAL ASSAULT CARE.

    (a) Purpose.--It is the purpose of this section to identify areas 
for improvement in health care delivery systems providing services to 
survivors of sexual assault.
    (b) Grants.--The Secretary shall award grants to States to develop 
and implement State surveys to identify--
            (1) the availability of and patient access to trained SAFE, 
        SANE, and other providers who perform MFEs;
            (2) the hospitals or clinics that offer MFEs and whether 
        each hospital or clinic has full-time, part-time, or on-call 
        coverage;
            (3) regional, provider, or other barriers to access sexual 
        assault care and services, including MFEs;
            (4) billing and reimbursement practices for MFEs, including 
        private health insurance, Medicare, Medicaid, the State's 
        victims compensation program, and any other crime funding or 
        other sources of funding that contribute to payment for such 
        examinations;
            (5) State requirements, minimum standards, and protocols 
        for training sexual assault examiners;
            (6) State requirements, minimum standards, and protocols 
        for training non-SANE or SAFE emergency services personnel 
        involved in MFEs;
            (7) the availability of SAFE or SANE training, frequency of 
        when training is convened, the providers of such training, the 
        State's role in such training, and what process or procedures 
        are in place for continuing education of such examiners;
            (8) the dedicated Federal and State funding to support SAFE 
        or SANE training; and
            (9) funding opportunities for SANE or SAFE training and 
        continuing education.
    (c) Eligibility.--To be eligible to receive a grant under this 
section, a State shall--
            (1) have public, private, or nonprofit hospitals that 
        receive Federal funding; and
            (2) submit to the Secretary an application through a 
        competitive process to be determined by the Secretary.
    (d) Public Dissemination and Campaign.--
            (1) Public availability.--The results of the surveys 
        conducted under grants awarded under this section shall be 
        published by the Secretary on the website of the Department of 
        Health and Human Services on a biennial basis.
            (2) Campaigns.--A State that receives a grant under this 
        section shall carry out the following:
                    (A) Make the findings of the survey conducted under 
                the grant public.
                    (B) Use the findings to develop a strategic action 
                plan to increase the number of trained examiners 
                available in the State and create policies to increase 
                survivor access to trained examiners.
                    (C) Use the findings to develop and implement a 
                public awareness campaign that includes the following:
                            (i) An online toolkit describing how and 
                        where sexual assault survivors can obtain 
                        assistance and care, including MFEs, in the 
                        State.
                            (ii) A Model Standard Response Protocol for 
                        health care providers to implement upon arrival 
                        of a patient seeking care for sexual assault.
                            (iii) A Model Sexual Assault Response Team 
                        Protocol incorporating interdisciplinary 
                        community coordination between hospitals, 
                        emergency departments, hospital administration, 
                        local rape crisis programs, law enforcement, 
                        prosecuting attorneys, and other health and 
                        human service agencies and stakeholders with 
                        respect to delivering survivor-centered sexual 
                        assault care and MFEs.
                            (iv) A notice of State and Federal laws 
                        prohibiting charging or billing survivors of 
                        sexual assault for care and services related to 
                        sexual assault.
    (e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $2,000,000 for each of fiscal 
years 2019 through 2024.

SEC. 102. IMPROVING AND STRENGTHENING THE SEXUAL ASSAULT EXAMINER 
              WORKFORCE CLINICAL AND CONTINUING EDUCATION PILOT 
              PROGRAM.

    (a) Purpose.--It is the purpose of this section to establish a 
pilot program to develop, test, and implement training and continuing 
education which expands and supports the availability of SAFE, SAE, and 
SANE, providers and services for survivors of sexual assault.
    (b) Establishment.--
            (1) In general.--Not later than 1 year after the date of 
        enactment of this Act, the Secretary shall establish a National 
        Continuing and Clinical Education Pilot Program for SAFEs, 
        SANEs, and other individuals who perform such examinations in 
        consultation with the Department of Justice, the Centers for 
        Medicare & Medicaid Services, the Centers for Disease Control 
        and Prevention, the Health Resources and Services 
        Administration, the Indian Health Service, the Office for 
        Victims of Crime of the Department of Justice, the Office on 
        Violence Against Women of the Department of Justice, and the 
        Office on Women's Health of the Department of Health and Human 
        Services and with input from regional and national 
        organizations with expertise in forensic nursing, rape trauma 
        or crisis counseling, investigating rape and gender violence 
        cases, survivors' advocacy and support, sexual assault 
        prevention education, rural health, and responding to sexual 
        violence in Native communities. Such pilot program shall be 2 
        years in duration.
            (2) Functions.--The pilot program established under 
        paragraph (1) shall develop, pilot, implement, and update, as 
        appropriate, continuing and clinical education program modules, 
        webinars, and programs for all hospitals and providers to 
        increase access to SANE and SAFE services and address ongoing 
        competency issues in SAFE or SANE practice of care, including--
                    (A) training and continuing education to help 
                support SAFEs or SANEs practicing in rural or 
                underserved areas;
                    (B) training to help connect sexual assault 
                survivors who are Native American with SAFEs or SANEs, 
                including through emergency first aid, referrals, 
                culturally competent support, and forensic evidence 
                collection in rural communities;
                    (C) replication of successful SANE or SAFE programs 
                to help develop and improve the evidence base for MFEs; 
                and
                    (D) training to increase the number of medical 
                professionals who are considered SAFEs or SANEs based 
                on the recommendations of the National Sexual Assault 
                Forensic Examination Training Standards issued by the 
                Department of Justice on Violence Against Women.
            (3) Eligibility to participate in pilot programs.--The 
        Secretary shall ensure that SAFE or SANE services provided 
        under the pilot program established under paragraph (1), and 
        other medical forensic examiner services under the pilot 
        program shall be provided by health care providers who are also 
        one of the following:
                    (A) A physician, including a resident physician.
                    (B) A nurse practitioner.
                    (C) A nurse midwife.
                    (D) A physician assistant.
                    (E) A certified nurse specialist.
                    (F) A registered nurse.
                    (G) A community health practitioner or a community 
                health aide who has completed level III or level IV 
                certification and training requirements.
            (4) Nature of training.--The continuing education program 
        established under this section shall incorporate and reflect 
        current best practices and standards on MFEs consistent with 
        the purpose of this section.
    (c) Availability.--After termination of the pilot program 
established under subsection (b)(1), the training and continuing 
education program established under such program shall be available to 
all SAFEs, SANEs, and other providers employed by, or any individual 
providing services through, facilities that receive Federal funding. 
The Task Force established under section 201 shall review and recommend 
updates to the training and continuing education program after the 
termination of the pilot program.
    (d) Effective Date.--
            (1) In general.--The pilot program established under this 
        section shall terminate on the date that is 2 years after the 
        date of such establishment.
            (2) Authority for modifications.--Upon termination of the 
        pilot program as provided for in paragraph (1), the Secretary 
        or the Task Force established under section 201 may implement 
        modifications relating to training and continuing education 
        requirements based on such program to increase access to SANE 
        and SAFE services for survivors of sexual assault.
    (e) Authorization.--There are authorized to be appropriated to 
carry out this section $5,000,000 for each of fiscal years 2019 through 
2021.

SEC. 103. NATIONAL REPORT ON SEXUAL ASSAULT SERVICES IN OUR NATION'S 
              HEALTH SYSTEM.

    (a) In General.--Not later than 1 year after the date of enactment 
of this Act, and annually thereafter, the Agency for Healthcare 
Research and Quality, in consultation with the Centers for Medicare & 
Medicaid Services, the Centers for Disease Control and Prevention, the 
Health Resources and Services Administration, the Indian Health 
Service, the Office for Victims of Crime of the Department of Justice, 
the Office on Women's Health of the Department of Health and Human 
Services, and the Office of Violence Against Women of the Department of 
Justice (hereafter referred to in this section collectively as the 
``Agencies''), shall submit to the Secretary a report of existing 
Federal and State practices relating to SAFEs, SANEs, and others who 
perform such examinations which reflects the findings of the surveys 
developed under section 101.
    (b) Core Competencies.--In conducting activities under this 
section, the Agencies shall address SAFE or SANE competencies, 
including--
            (1) providing comprehensive medical care to sexual assault 
        patients;
            (2) demonstrating the ability to conduct a MFE to include 
        an evaluation for evidence collection;
            (3) showing compassion and sensitivity towards survivors of 
        sexual assault;
            (4) testifying in Federal, State, local, and tribal courts; 
        and
            (5) other competencies as determined appropriate by the 
        Agencies.
    (c) Publication.--
            (1) AHRQ.--The Agency for Healthcare Research and Quality 
        shall establish, maintain, and publish on the website of the 
        Department of Health and Human Services an online public map of 
        SAFE, SANE, and other forensic medical examiners. Such maps 
        shall clarify if there is full-time, part-time, or on-call 
        coverage.
            (2) States.--A State that receives Federal funds shall 
        maintain and make available an online public map displaying the 
        number and location of available SAFE or SANE programs and 
        other forensic medical examiners in the State. Such maps shall 
        clarify if there is full-time, part-time, or on-call coverage.

SEC. 104. HOSPITAL REPORTING.

    Not later than 1 year after the date of enactment of this Act, and 
annually thereafter, a hospital that receives Federal funds shall 
submit to the Secretary a report that identifies the level of community 
access provided by the hospital to trained SAFEs, SARTs, SANEs, and 
others who perform such examinations. Such report shall describe--
            (1) the number of sexual assault survivors who present at 
        the hospital for MFEs in the year for which the report is being 
        prepared;
            (2) the number of personnel who are trained and practicing 
        as a SANE or SAFE to perform sexual assault exams, indicating 
        the employment basis of such personnel as either full-time, 
        part-time, or on-call;
            (3) the number of sexual assault exams performed by SANEs 
        or SAFEs;
            (4) the number of sexual assault exams performed by 
        personnel other than a SANE or SAFE;
            (5) the training that such SAFEs or SANEs undergo for 
        purposes of maintaining competency; and
            (6) the SAFE/SANE standards of care applied by the 
        hospital.

                      TITLE II--STANDARDS OF CARE

SEC. 201. NATIONAL SEXUAL ASSAULT CARE AND TREATMENT TASK FORCE.

    (a) Establishment.--The Secretary shall establish a task force to 
be known as the ``SASCA Task Force'' (referred to in this section as 
the ``Task Force'') to identify barriers to improving access to SAFE/
SANE and other forensic medical examiners.
    (b) Membership.--The Task Force shall include a representative from 
the Centers for Medicare & Medicaid Services, the Centers for Disease 
Control and Prevention, the Health Resources and Services 
Administration, the Indian Health Service, the Office for Victims of 
Crime of the Department of Justice, the Office on Women's Health of the 
Department of Health and Human Services, and the Office on Violence 
Against Women of the Department of Justice, a survivor of sexual 
assault, and representatives from regional and national organizations 
with expertise in forensic nursing, rape trauma or crisis counseling, 
investigating rape and gender violence cases, survivors' advocacy and 
support, sexual assault prevention education, rural health, and 
responding to sexual violence in Native communities.
    (c) Objectives.--To assist and standardize State-level efforts to 
improve medical forensic evidence collection relating to sexual 
assault, the Task Force shall--
            (1) identify barriers to the recruitment, training, and 
        retention of SAFEs, SARTs, SANEs, and others who perform such 
        examinations;
            (2) make recommendations for improving access to medical 
        forensic examinations, including the feasibility of, or 
        barriers to, utilizing mobile units;
            (3) improve coordination of services, and other protocols 
        regarding the care and treatment of sexual assault survivors 
        and the preservation of evidence between law enforcement 
        officials and health care providers; and
            (4) update national minimum standards for forensic medical 
        examiner training and forensic medical evidence collection 
        relating to sexual assault.
    (d) Transparency Requirements.--
            (1) In general.--Not later than 1 year after first 
        convening, the Task Force shall report to the Secretary in a 
        public document on--
                    (A) the recommendation for best practices with 
                respect to improving medical forensic evidence 
                collection relating to sexual assault; and
                    (B) the national minimum standards for MFEs and 
                treatments relating to sexual assault.
            (2) Report.--Not later than 18 months after the date of 
        enactment of this Act, the Secretary shall submit to Congress a 
        report on the findings and conclusions of the Task Force.
    (e) Annual Summit.--The Secretary shall convene an annual 
stakeholder meeting to address gaps in health care provider care 
relating to sexual assault that includes the Task Force.

SEC. 202. INSTITUTIONS OF HIGHER EDUCATION CAMPUS ACTION PLAN.

    Each institution of higher education that receives Federal funds 
shall--
            (1) inform survivors of sexual assault about the 
        availability of MFEs, including the nearest available locations 
        at which such examinations are provided by a SANE and that 
        Federal law requires such exams to be provided at no cost to 
        the survivor; and
            (2) make the information described in paragraph (1) 
        available on the website of the institution, to the extent 
        practicable.

SEC. 203. EXPANDING ACCESS TO UNIFIED CARE.

    Part B of title VIII of the Public Health Service Act (42 U.S.C. 
296j et seq.) is amended by adding at the end the following:

``SEC. 812. DEMONSTRATION GRANTS FOR SEXUAL ASSAULT EXAMINER TRAINING 
              PROGRAMS.

    ``(a) Establishment of Program.--The Secretary shall establish a 
demonstration program (referred to in this section as the `program') to 
award grants to eligible partnered entities for the clinical training 
of SAFEs/SANEs (including registered nurses, nurse practitioners, nurse 
midwives, clinical nurse specialists, physician assistants, and 
physicians) to administer medical forensic examinations and treatments 
to survivors of sexual assault.
    ``(b) Purpose.--The purpose of the program is to enable each grant 
recipient to expand access to SAFE/SANE services by providing new 
providers with the clinical training necessary to establish and 
maintain competency in SAFE/SANE services and to test the provisions of 
such services at new facilities in expanded health care settings.
    ``(c) Grants.--Under the program, the Secretary shall award 3-year 
grants to eligible entities that meet the requirements established by 
the Secretary.
    ``(d) Eligible Entities.--To be eligible to receive a grant under 
this section, an entity shall--
            ``(1) be--
                    ``(A) a rural health care services provider or 
                community-based service provider (as defined by the 
                Secretary), a center or clinic under section 330, or a 
                health center receiving assistance under title X, 
                acting in partnership with a high-volume emergency 
                services provider or a hospital currently providing 
                sexual assault medical forensic examinations performed 
                by SANEs or SAFEs, that will use grant funds to--
                            ``(i) assign rural health care service 
                        providers to the high-volume hospitals for 
                        clinical practicum hours to qualify such 
                        providers as a SAFE/SANE; or
                            ``(ii) assign practitioners at high-volume 
                        hospitals to a rural health care services 
                        providers to instruct, oversee, and approve 
                        clinical practicum hours in the community to be 
                        served; or
                    ``(B) an organization described in section 
                501(c)(3) of the Internal Revenue Code of 1986 and 
                exempt from taxation under 501(a) of that Act, that 
                provides legal training and technical assistance to 
                tribal communities and to organizations and agencies 
                serving Native people; and
            ``(2) submit to the Secretary an application at such time, 
        in such manner, and containing such information as the 
        Secretary may require, including a description of whether the 
        applicant will provide services under subparagraph (A) or (B) 
        of paragraph (1).
    ``(e) Grant Amount.--Each grant awarded under this section shall be 
in an amount not to exceed $400,000 per year. A grant recipient may 
carry over funds from one fiscal year to the next without obtaining 
approval from the Secretary.
    ``(f) Authorization of Appropriations.--
            ``(1) In general.--There is authorized to be appropriated 
        to carry out this section $11,000,000 for each of fiscal years 
        2019 through 2024.
            ``(2) Set-aside.--Of the amount appropriated under this 
        subsection for a fiscal year, the Secretary shall reserve 15 
        percent of such amount for purposes of making grants to 
        entities that are affiliated with Indian tribes or tribal 
        organizations (as defined in section 4 of the Indian Self-
        Determination and Education Assistance Act (25 U.S.C. 5304)), 
        or Urban Indian organizations (as defined in section 4 of the 
        Indian Health Care Improvement Act (25 U.S.C. 1603)). Amounts 
        reserved may be used to support referrals and the delivery of 
        emergency first aid, culturally competent support, and forensic 
        evidence collection training.''.

SEC. 204. TECHNICAL ASSISTANCE GRANTS AND LEARNING COLLECTIVES.

    Part B of title VIII of the Public Health Service Act (42 U.S.C. 
296j et seq.), as amended by section 203, is further amended by adding 
at the end the following:

``SEC. 812A. TECHNICAL ASSISTANCE CENTER AND REGIONAL LEARNING 
              COLLECTIVES.

    ``(a) In General.--The Secretary shall establish a State and 
provider technical resource center to provide technical assistance to 
health care providers to increase the quality of, and access to, MFEs 
by entering into contracts with national experts (such as the 
International Forensic Nurses Association and others).
    ``(b) Regional Learning Collectives.--The Secretary shall convene 
State and hospital regional learning collectives to assist health care 
providers and States in sharing best practices, discussing practices, 
and improving the quality of, and access to, MFEs.
    ``(c) Repository.--The Secretary shall establish and maintain a 
secure Internet-based data repository to serve as an online learning 
collective for State and entity collaborations. An entity receiving a 
grant under section 812 may use such repository for--
            ``(1) technical assistance; and
            ``(2) best practice sharing.''.

SEC. 205. QUALITY STRATEGIES.

    The Secretary shall identify SAFE/SANE access and quality in 
hospitals and other appropriate health care facilities as a national 
priority for improvement under section 399HH(a)(2) of the Public Health 
Service Act (42 U.S.C. 280j(a)(2)).

SEC. 206. OVERSIGHT.

    Not later than one year after the date of enactment of this Act, 
the Office of the Inspector General shall issue a report concerning 
hospital compliance with section 1867 of the Social Security Act (42 
U.S.C. 1395dd) and the Violence Against Women Act of 1994 (34 U.S.C. 
12291 et seq.) with respect to access to, and reimbursements for, 
sexual assault medical forensic examinations at the national, State, 
and individual hospital level. Such report shall address hospital 
awareness of reimbursements, total reimbursed costs, and any costs for 
survivors.
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