II 

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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Survivors’ Access to 

5 Supportive Care Act’’ or ‘‘SASCA’’. 


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1 SEC. 2. PURPOSE. 

2 It is the purpose of this Act to increase access to 

3 medical forensic sexual assault examinations and treat4 ment provided by sexual assault forensic examiners for 

5 survivors by identifying and addressing gaps in obtaining 

6 those services. 

7 SEC. 3. DEFINITIONS. 

8 In this Act: 

9 (1) COMMUNITY HEALTH AIDE AND COMMU10 NITY HEALTH PRACTITIONER.—The terms ‘‘commu11 nity health aide’’ and ‘‘community health practi12 tioner’’ have the meanings within the meaning of 

13 section 119 of the Indian Health Care Improvement 

14 Act (25 U.S.C. 1616l). 

15 (2) MFE.—The term ‘‘medical forensic exam16 ination’’ or ‘‘MFE’’ means an examination provided 

17 to a sexual assault survivor by medical personnel 

18 trained to gather evidence of a sexual assault in a 

19 manner suitable for use in a court of law. 

20 (3) SAE.—The term ‘‘sexual assault examiner’’ 

21 or ‘‘SAE’’ means a registered nurse, advanced prac22 tice nurse, physician, or physician assistant specifi23 cally trained to provide care to sexual assault foren24 sic examinations. 

25 (4) SAFE.—The term ‘‘sexual assault forensic 

26 examiner’’ or ‘‘SAFE’’ means a medical practitioner 


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1 who has specialized forensic training in treating sex2 ual assault survivors and conducting medical foren3 sic examinations. 

4 (5) SANE.—The term ‘‘sexual assault nurse 

5 examiner’’ or ‘‘SANE’’ means a registered nurse 

6 who has specialized forensic training in treating sex7 ual assault survivors and conducting medical foren8 sic examinations. 

9 (6) SART.—The term ‘‘sexual assault response 

10 team’’ or ‘‘SART’’ means a multidisciplinary team 

11 that provides a specialized and immediate response 

12 to survivors of sexual assault, and may include 

13 health care personnel, law enforcement representa14 tives, community-based survivor advocates, prosecu15 tors, and forensic scientists. 

16 (7) SECRETARY.—The term ‘‘Secretary’’ means 

17 the Secretary of Health and Human Services. 

18 (8) SEXUAL ASSAULT.—The term ‘‘sexual as19 sault’’ means any nonconsensual sexual act pro20 scribed by Federal, tribal, or State law, including 

21 when the individual lacks capacity to consent. 


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1 TITLE I—STRENGTHENING THE 

2 SEXUAL ASSAULT EXAMINER 

3 WORKFORCE 

4 SEC. 101. UNDERSTANDING SEXUAL ASSAULT CARE. 

5 (a) PURPOSE.—It is the purpose of this section to 

6 identify areas for improvement in health care delivery sys7 tems providing services to survivors of sexual assault. 

8 (b) GRANTS.—The Secretary shall award grants to 

9 States to develop and implement State surveys to iden10 tify— 

11 (1) the availability of and patient access to 

12 trained SAFE, SANE, and other providers who per13 form MFEs; 

14 (2) the hospitals or clinics that offer MFEs and 

15 whether each hospital or clinic has full-time, part16 time, or on-call coverage; 

17 (3) regional, provider, or other barriers to ac18 cess sexual assault care and services, including 

19 MFEs; 

20 (4) billing and reimbursement practices for 

21 MFEs, including private health insurance, Medicare, 

22 Medicaid, the State’s victims compensation program, 

23 and any other crime funding or other sources of 

24 funding that contribute to payment for such exami25 nations; 


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1 (5) State requirements, minimum standards, 

2 and protocols for training sexual assault examiners; 

3 (6) State requirements, minimum standards, 

4 and protocols for training non-SANE or SAFE 

5 emergency services personnel involved in MFEs; 

6 (7) the availability of SAFE or SANE training, 

7 frequency of when training is convened, the pro8 viders of such training, the State’s role in such 

9 training, and what process or procedures are in 

10 place for continuing education of such examiners; 

11 (8) the dedicated Federal and State funding to 

12 support SAFE or SANE training; and 

13 (9) funding opportunities for SANE or SAFE 

14 training and continuing education. 

15 (c) ELIGIBILITY.—To be eligible to receive a grant 

16 under this section, a State shall— 

17 (1) have public, private, or nonprofit hospitals 

18 that receive Federal funding; and 

19 (2) submit to the Secretary an application 

20 through a competitive process to be determined by 

21 the Secretary. 

22 (d) PUBLIC DISSEMINATION AND CAMPAIGN.— 

23 (1) PUBLIC AVAILABILITY.—The results of the 

24 surveys conducted under grants awarded under this 

25 section shall be published by the Secretary on the 


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1 website of the Department of Health and Human 

2 Services on a biennial basis. 

3 (2) CAMPAIGNS.—A State that receives a grant 

4 under this section shall carry out the following: 

5 (A) Make the findings of the survey con6 ducted under the grant public. 

7 (B) Use the findings to develop a strategic 

8 action plan to increase the number of trained 

9 examiners available in the State and create poli10 cies to increase survivor access to trained exam11 iners. 

12 (C) Use the findings to develop and imple13 ment a public awareness campaign that in14 cludes the following: 

15 (i) An online toolkit describing how 

16 and where sexual assault survivors can ob17 tain assistance and care, including MFEs, 

18 in the State. 

19 (ii) A Model Standard Response Pro20 tocol for health care providers to imple21 ment upon arrival of a patient seeking care 

22 for sexual assault. 

23 (iii) A Model Sexual Assault Response 

24 Team Protocol incorporating interdiscipli25 nary community coordination between hosVerDate Sep 11 2014 18:45 Feb 19, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S402.IS S402

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1 pitals, emergency departments, hospital 

2 administration, local rape crisis programs, 

3 law enforcement, prosecuting attorneys, 

4 and other health and human service agen5 cies and stakeholders with respect to deliv6 ering survivor-centered sexual assault care 

7 and MFEs. 

8 (iv) A notice of State and Federal 

9 laws prohibiting charging or billing sur10 vivors of sexual assault for care and serv11 ices related to sexual assault. 

12 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 

13 authorized to be appropriated to carry out this section, 

14 $2,000,000 for each of fiscal years 2019 through 2024. 

15 SEC. 102. IMPROVING AND STRENGTHENING THE SEXUAL 

16 ASSAULT EXAMINER WORKFORCE CLINICAL 

17 AND CONTINUING EDUCATION PILOT PRO18 GRAM. 

19 (a) PURPOSE.—It is the purpose of this section to 

20 establish a pilot program to develop, test, and implement 

21 training and continuing education which expands and sup22 ports the availability of SAFE, SAE, and SANE, pro23 viders and services for survivors of sexual assault. 

24 (b) ESTABLISHMENT.— 


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1 (1) IN GENERAL.—Not later than 1 year after 

2 the date of enactment of this Act, the Secretary 

3 shall establish a National Continuing and Clinical 

4 Education Pilot Program for SAFEs, SANEs, and 

5 other individuals who perform such examinations in 

6 consultation with the Department of Justice, the 

7 Centers for Medicare & Medicaid Services, the Cen8 ters for Disease Control and Prevention, the Health 

9 Resources and Services Administration, the Indian 

10 Health Service, the Office for Victims of Crime of 

11 the Department of Justice, the Office on Violence 

12 Against Women of the Department of Justice, and 

13 the Office on Women’s Health of the Department of 

14 Health and Human Services and with input from re15 gional and national organizations with expertise in 

16 forensic nursing, rape trauma or crisis counseling, 

17 investigating rape and gender violence cases, sur18 vivors’ advocacy and support, sexual assault preven19 tion education, rural health, and responding to sex20 ual violence in Native communities. Such pilot pro21 gram shall be 2 years in duration. 

22 (2) FUNCTIONS.—The pilot program estab23 lished under paragraph (1) shall develop, pilot, im24 plement, and update, as appropriate, continuing and 

25 clinical education program modules, webinars, and 


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1 programs for all hospitals and providers to increase 

2 access to SANE and SAFE services and address on3 going competency issues in SAFE or SANE practice 

4 of care, including— 

5 (A) training and continuing education to 

6 help support SAFEs or SANEs practicing in 

7 rural or underserved areas; 

8 (B) training to help connect sexual assault 

9 survivors who are Native American with SAFEs 

10 or SANEs, including through emergency first 

11 aid, referrals, culturally competent support, and 

12 forensic evidence collection in rural commu13 nities; 

14 (C) replication of successful SANE or 

15 SAFE programs to help develop and improve 

16 the evidence base for MFEs; and 

17 (D) training to increase the number of 

18 medical professionals who are considered 

19 SAFEs or SANEs based on the recommenda20 tions of the National Sexual Assault Forensic 

21 Examination Training Standards issued by the 

22 Department of Justice on Violence Against 

23 Women. 

24 (3) ELIGIBILITY TO PARTICIPATE IN PILOT

25 PROGRAMS.—The Secretary shall ensure that SAFE 


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1 or SANE services provided under the pilot program 

2 established under paragraph (1), and other medical 

3 forensic examiner services under the pilot program 

4 shall be provided by health care providers who are 

5 also one of the following: 

6 (A) A physician, including a resident phy7 sician. 

8 (B) A nurse practitioner. 

9 (C) A nurse midwife. 

10 (D) A physician assistant. 

11 (E) A certified nurse specialist. 

12 (F) A registered nurse. 

13 (G) A community health practitioner or a 

14 community health aide who has completed level 

15 III or level IV certification and training re16 quirements. 

17 (4) NATURE OF TRAINING.—The continuing 

18 education program established under this section 

19 shall incorporate and reflect current best practices 

20 and standards on MFEs consistent with the purpose 

21 of this section. 

22 (c) AVAILABILITY.—After termination of the pilot 

23 program established under subsection (b)(1), the training 

24 and continuing education program established under such 

25 program shall be available to all SAFEs, SANEs, and 


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1 other providers employed by, or any individual providing 

2 services through, facilities that receive Federal funding. 

3 The Task Force established under section 201 shall review 

4 and recommend updates to the training and continuing 

5 education program after the termination of the pilot pro6 gram. 

7 (d) EFFECTIVE DATE.— 

8 (1) IN GENERAL.—The pilot program estab9 lished under this section shall terminate on the date 

10 that is 2 years after the date of such establishment. 

11 (2) AUTHORITY FOR MODIFICATIONS.—Upon 

12 termination of the pilot program as provided for in 

13 paragraph (1), the Secretary or the Task Force es14 tablished under section 201 may implement modi15 fications relating to training and continuing edu16 cation requirements based on such program to in17 crease access to SANE and SAFE services for sur18 vivors of sexual assault. 

19 (e) AUTHORIZATION.—There are authorized to be ap20 propriated to carry out this section $5,000,000 for each 

21 of fiscal years 2019 through 2021. 

22 SEC. 103. NATIONAL REPORT ON SEXUAL ASSAULT SERV23 ICES IN OUR NATION’S HEALTH SYSTEM. 

24 (a) IN GENERAL.—Not later than 1 year after the 

25 date of enactment of this Act, and annually thereafter, 


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1 the Agency for Healthcare Research and Quality, in con2 sultation with the Centers for Medicare & Medicaid Serv3 ices, the Centers for Disease Control and Prevention, the 

4 Health Resources and Services Administration, the Indian 

5 Health Service, the Office for Victims of Crime of the De6 partment of Justice, the Office on Women’s Health of the 

7 Department of Health and Human Services, and the Of8 fice of Violence Against Women of the Department of Jus9 tice (hereafter referred to in this section collectively as the 

10 ‘‘Agencies’’), shall submit to the Secretary a report of ex11 isting Federal and State practices relating to SAFEs, 

12 SANEs, and others who perform such examinations which 

13 reflects the findings of the surveys developed under section 

14 101. 

15 (b) CORE COMPETENCIES.—In conducting activities 

16 under this section, the Agencies shall address SAFE or 

17 SANE competencies, including— 

18 (1) providing comprehensive medical care to 

19 sexual assault patients; 

20 (2) demonstrating the ability to conduct a MFE 

21 to include an evaluation for evidence collection; 

22 (3) showing compassion and sensitivity towards 

23 survivors of sexual assault; 

24 (4) testifying in Federal, State, local, and tribal 

25 courts; and 


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1 (5) other competencies as determined appro2 priate by the Agencies. 

3 (c) PUBLICATION.— 

4 (1) AHRQ.—The Agency for Healthcare Re5 search and Quality shall establish, maintain, and 

6 publish on the website of the Department of Health 

7 and Human Services an online public map of SAFE, 

8 SANE, and other forensic medical examiners. Such 

9 maps shall clarify if there is full-time, part-time, or 

10 on-call coverage. 

11 (2) STATES.—A State that receives Federal 

12 funds shall maintain and make available an online 

13 public map displaying the number and location of 

14 available SAFE or SANE programs and other foren15 sic medical examiners in the State. Such maps shall 

16 clarify if there is full-time, part-time, or on-call cov17 erage. 

18 SEC. 104. HOSPITAL REPORTING. 

19 Not later than 1 year after the date of enactment 

20 of this Act, and annually thereafter, a hospital that re21 ceives Federal funds shall submit to the Secretary a report 

22 that identifies the level of community access provided by 

23 the hospital to trained SAFEs, SARTs, SANEs, and oth24 ers who perform such examinations. Such report shall de25 scribe— 


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1 (1) the number of sexual assault survivors who 

2 present at the hospital for MFEs in the year for 

3 which the report is being prepared; 

4 (2) the number of personnel who are trained 

5 and practicing as a SANE or SAFE to perform sex6 ual assault exams, indicating the employment basis 

7 of such personnel as either full-time, part-time, or 

8 on-call; 

9 (3) the number of sexual assault exams per10 formed by SANEs or SAFEs; 

11 (4) the number of sexual assault exams per12 formed by personnel other than a SANE or SAFE; 

13 (5) the training that such SAFEs or SANEs 

14 undergo for purposes of maintaining competency; 

15 and 

16 (6) the SAFE/SANE standards of care applied 

17 by the hospital. 

18 TITLE II—STANDARDS OF CARE 

19 SEC. 201. NATIONAL SEXUAL ASSAULT CARE AND TREAT20 MENT TASK FORCE. 

21 (a) ESTABLISHMENT.—The Secretary shall establish 

22 a task force to be known as the ‘‘SASCA Task Force’’ 

23 (referred to in this section as the ‘‘Task Force’’) to iden24 tify barriers to improving access to SAFE/SANE and 

25 other forensic medical examiners. 


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1 (b) MEMBERSHIP.—The Task Force shall include a 

2 representative from the Centers for Medicare & Medicaid 

3 Services, the Centers for Disease Control and Prevention, 

4 the Health Resources and Services Administration, the In5 dian Health Service, the Office for Victims of Crime of 

6 the Department of Justice, the Office on Women’s Health 

7 of the Department of Health and Human Services, and 

8 the Office on Violence Against Women of the Department 

9 of Justice, a survivor of sexual assault, and representa10 tives from regional and national organizations with exper11 tise in forensic nursing, rape trauma or crisis counseling, 

12 investigating rape and gender violence cases, survivors’ ad13 vocacy and support, sexual assault prevention education, 

14 rural health, and responding to sexual violence in Native 

15 communities. 

16 (c) OBJECTIVES.—To assist and standardize State17 level efforts to improve medical forensic evidence collection 

18 relating to sexual assault, the Task Force shall— 

19 (1) identify barriers to the recruitment, train20 ing, and retention of SAFEs, SARTs, SANEs, and 

21 others who perform such examinations; 

22 (2) make recommendations for improving access 

23 to medical forensic examinations, including the feasi24 bility of, or barriers to, utilizing mobile units; 


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1 (3) improve coordination of services, and other 

2 protocols regarding the care and treatment of sexual 

3 assault survivors and the preservation of evidence 

4 between law enforcement officials and health care 

5 providers; and 

6 (4) update national minimum standards for fo7 rensic medical examiner training and forensic med8 ical evidence collection relating to sexual assault. 

9 (d) TRANSPARENCY REQUIREMENTS.— 

10 (1) IN GENERAL.—Not later than 1 year after 

11 first convening, the Task Force shall report to the 

12 Secretary in a public document on— 

13 (A) the recommendation for best practices 

14 with respect to improving medical forensic evi15 dence collection relating to sexual assault; and 

16 (B) the national minimum standards for 

17 MFEs and treatments relating to sexual as18 sault. 

19 (2) REPORT.—Not later than 18 months after 

20 the date of enactment of this Act, the Secretary 

21 shall submit to Congress a report on the findings 

22 and conclusions of the Task Force. 

23 (e) ANNUAL SUMMIT.—The Secretary shall convene 

24 an annual stakeholder meeting to address gaps in health 


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1 care provider care relating to sexual assault that includes 

2 the Task Force. 

3 SEC. 202. INSTITUTIONS OF HIGHER EDUCATION CAMPUS 

4 ACTION PLAN. 

5 Each institution of higher education that receives 

6 Federal funds shall— 

7 (1) inform survivors of sexual assault about the 

8 availability of MFEs, including the nearest available 

9 locations at which such examinations are provided 

10 by a SANE and that Federal law requires such 

11 exams to be provided at no cost to the survivor; and 

12 (2) make the information described in para13 graph (1) available on the website of the institution, 

14 to the extent practicable. 

15 SEC. 203. EXPANDING ACCESS TO UNIFIED CARE. 

16 Part B of title VIII of the Public Health Service Act 

17 (42 U.S.C. 296j et seq.) is amended by adding at the end 

18 the following: 

19 ‘‘SEC. 812. DEMONSTRATION GRANTS FOR SEXUAL ASSAULT 

20 EXAMINER TRAINING PROGRAMS. 

21 ‘‘(a) ESTABLISHMENT OF PROGRAM.—The Secretary 

22 shall establish a demonstration program (referred to in 

23 this section as the ‘program’) to award grants to eligible 

24 partnered entities for the clinical training of SAFEs/ 

25 SANEs (including registered nurses, nurse practitioners, 


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1 nurse midwives, clinical nurse specialists, physician assist2 ants, and physicians) to administer medical forensic ex3 aminations and treatments to survivors of sexual assault. 

4 ‘‘(b) PURPOSE.—The purpose of the program is to 

5 enable each grant recipient to expand access to SAFE/ 

6 SANE services by providing new providers with the clin7 ical training necessary to establish and maintain com8 petency in SAFE/SANE services and to test the provisions 

9 of such services at new facilities in expanded health care 

10 settings. 

11 ‘‘(c) GRANTS.—Under the program, the Secretary 

12 shall award 3-year grants to eligible entities that meet the 

13 requirements established by the Secretary. 

14 ‘‘(d) ELIGIBLE ENTITIES.—To be eligible to receive 

15 a grant under this section, an entity shall— 

16 ‘‘(1) be— 

17 ‘‘(A) a rural health care services provider 

18 or community-based service provider (as defined 

19 by the Secretary), a center or clinic under sec20 tion 330, or a health center receiving assistance 

21 under title X, acting in partnership with a high22 volume emergency services provider or a hos23 pital currently providing sexual assault medical 

24 forensic examinations performed by SANEs or 

25 SAFEs, that will use grant funds to— 


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1 ‘‘(i) assign rural health care service 

2 providers to the high-volume hospitals for 

3 clinical practicum hours to qualify such 

4 providers as a SAFE/SANE; or 

5 ‘‘(ii) assign practitioners at high-vol6 ume hospitals to a rural health care serv7 ices providers to instruct, oversee, and ap8 prove clinical practicum hours in the com9 munity to be served; or 

10 ‘‘(B) an organization described in section 

11 501(c)(3) of the Internal Revenue Code of 1986 

12 and exempt from taxation under 501(a) of that 

13 Act, that provides legal training and technical 

14 assistance to tribal communities and to organi15 zations and agencies serving Native people; and 

16 ‘‘(2) submit to the Secretary an application at 

17 such time, in such manner, and containing such in18 formation as the Secretary may require, including a 

19 description of whether the applicant will provide 

20 services under subparagraph (A) or (B) of para21 graph (1). 

22 ‘‘(e) GRANT AMOUNT.—Each grant awarded under 

23 this section shall be in an amount not to exceed $400,000 

24 per year. A grant recipient may carry over funds from one 


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1 fiscal year to the next without obtaining approval from 

2 the Secretary. 

3 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.— 

4 ‘‘(1) IN GENERAL.—There is authorized to be 

5 appropriated to carry out this section $11,000,000 

6 for each of fiscal years 2019 through 2024. 

7 ‘‘(2) SET-ASIDE.—Of the amount appropriated 

8 under this subsection for a fiscal year, the Secretary 

9 shall reserve 15 percent of such amount for purposes 

10 of making grants to entities that are affiliated with 

11 Indian tribes or tribal organizations (as defined in 

12 section 4 of the Indian Self-Determination and Edu13 cation Assistance Act (25 U.S.C. 5304)), or Urban 

14 Indian organizations (as defined in section 4 of the 

15 Indian Health Care Improvement Act (25 U.S.C. 

16 1603)). Amounts reserved may be used to support 

17 referrals and the delivery of emergency first aid, cul18 turally competent support, and forensic evidence col19 lection training.’’. 

20 SEC. 204. TECHNICAL ASSISTANCE GRANTS AND LEARNING 

21 COLLECTIVES. 

22 Part B of title VIII of the Public Health Service Act 

23 (42 U.S.C. 296j et seq.), as amended by section 203, is 

24 further amended by adding at the end the following: 


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1 ‘‘SEC. 812A. TECHNICAL ASSISTANCE CENTER AND RE2 GIONAL LEARNING COLLECTIVES. 

3 ‘‘(a) IN GENERAL.—The Secretary shall establish a 

4 State and provider technical resource center to provide 

5 technical assistance to health care providers to increase 

6 the quality of, and access to, MFEs by entering into con7 tracts with national experts (such as the International Fo8 rensic Nurses Association and others). 

9 ‘‘(b) REGIONAL LEARNING COLLECTIVES.—The Sec10 retary shall convene State and hospital regional learning 

11 collectives to assist health care providers and States in 

12 sharing best practices, discussing practices, and improving 

13 the quality of, and access to, MFEs. 

14 ‘‘(c) REPOSITORY.—The Secretary shall establish and 

15 maintain a secure Internet-based data repository to serve 

16 as an online learning collective for State and entity col17 laborations. An entity receiving a grant under section 812 

18 may use such repository for— 

19 ‘‘(1) technical assistance; and 

20 ‘‘(2) best practice sharing.’’. 

21 SEC. 205. QUALITY STRATEGIES. 

22 The Secretary shall identify SAFE/SANE access and 

23 quality in hospitals and other appropriate health care fa24 cilities as a national priority for improvement under sec25 tion 399HH(a)(2) of the Public Health Service Act (42 

26 U.S.C. 280j(a)(2)). 


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1 SEC. 206. OVERSIGHT. 

2 Not later than one year after the date of enactment 

3 of this Act, the Office of the Inspector General shall issue 

4 a report concerning hospital compliance with section 1867 

5 of the Social Security Act (42 U.S.C. 1395dd) and the 

6 Violence Against Women Act of 1994 (34 U.S.C. 12291 

7 et seq.) with respect to access to, and reimbursements for, 

8 sexual assault medical forensic examinations at the na9 tional, State, and individual hospital level. Such report 

10 shall address hospital awareness of reimbursements, total 

11 reimbursed costs, and any costs for survivors. 

Æ 


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