II 

111TH CONGRESS 

1ST SESSION S. 21 

To reduce unintended pregnancy, reduce abortions, and improve access to 

women’s health care. 

IN THE SENATE OF THE UNITED STATES 

JANUARY 6, 2009 

Mr. REID (for himself, Mrs. CLINTON, Mr. AKAKA, Mr. INOUYE, Mr. 

WHITEHOUSE, Mr. LAUTENBERG, Mrs. MURRAY, Mr. MENENDEZ, Mr. 

LEVIN, Mr. BAUCUS, Mr. KERRY, Mrs. BOXER, Mr. CARPER, Mrs. FEINSTEIN, and Ms. STABENOW) introduced the following bill; which was read 

twice and referred to the Committee on Health, Education, Labor, and 

Pensions 

A BILL 

To reduce unintended pregnancy, reduce abortions, and 

improve access to women’s health care. 

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; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Prevention First Act’’. 

6 (b) TABLE OF CONTENTS.—The table of contents for 

7 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Findings. 


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TITLE I—TITLE X OF PUBLIC HEALTH SERVICE ACT 

Sec. 101. Short title. 

Sec. 102. Authorization of appropriations. 

TITLE II—EQUITY IN PRESCRIPTION INSURANCE AND 

CONTRACEPTIVE COVERAGE 

Sec. 201. Short title. 

Sec. 202. Amendments to Employee Retirement Income Security Act of 1974. 

Sec. 203. Amendments to Public Health Service Act relating to the group market. 

Sec. 204. Amendment to Public Health Service Act relating to the individual 

market. 

TITLE III—EMERGENCY CONTRACEPTION EDUCATION AND 

INFORMATION 

Sec. 301. Short title. 

Sec. 302. Emergency contraception education and information programs. 

TITLE IV—COMPASSIONATE ASSISTANCE FOR RAPE 

EMERGENCIES 

Sec. 401. Short title. 

Sec. 402. Survivors of sexual assault; provision by hospitals of emergency contraceptives without charge. 

TITLE V—AT-RISK COMMUNITIES TEEN PREGNANCY 

PREVENTION ACT 

Sec. 501. Short title. 

Sec. 502. Teen pregnancy prevention. 

Sec. 503. Research. 

Sec. 504. General requirements. 

TITLE VI—ACCURACY OF CONTRACEPTIVE INFORMATION 

Sec. 601. Short title. 

Sec. 602. Accuracy of contraceptive information. 

TITLE VII—UNINTENDED PREGNANCY REDUCTION ACT 

Sec. 701. Short title. 

Sec. 702. Medicaid; clarification of coverage of family planning services and 

supplies. 

Sec. 703. Expansion of family planning services. 

Sec. 704. Effective date. 

TITLE VIII—RESPONSIBLE EDUCATION ABOUT LIFE ACT 

Sec. 801. Short title. 

Sec. 802. Assistance to reduce teen pregnancy, HIV/AIDS, and other sexually 

transmitted diseases and to support healthy adolescent development. 

Sec. 803. Sense of Congress. 

Sec. 804. Evaluation of programs. 

Sec. 805. Definitions. 

Sec. 806. Appropriations. 


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TITLE IX—PREVENTION THROUGH AFFORDABLE ACCESS 

Sec. 901. Short title. 

Sec. 902. Restoring and protecting access to discount drug prices for university-based and safety-net clinics. 

1 SEC. 2. FINDINGS. 

2 The Congress finds as follows: 

3 (1) Healthy People 2010 sets forth a reduction 

4 of unintended pregnancies as an important health 

5 objective for the Nation to achieve over the first dec6 ade of the new century, a goal first articulated in 

7 the 1979 Surgeon General’s Report, Healthy People, 

8 and reiterated in Healthy People 2000: National 

9 Health Promotion and Disease Prevention Objec10 tives. 

11 (2) Although the Centers for Disease Control 

12 and Prevention (referred to in this section as the 

13 ‘‘CDC’’) included family planning in its published 

14 list of the Ten Great Public Health Achievements in 

15 the 20th Century, the United States still has one of 

16 the highest rates of unintended pregnancies among 

17 industrialized nations. 

18 (3) Each year, nearly half of all pregnancies in 

19 the United States are unintended, and nearly half of 

20 unintended pregnancies end in abortion. 

21 (4) In 2006, 36,200,000 women, more than 

22 half of all women of reproductive age, were in need 

23 of contraceptive services and supplies to help prevent 


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1 unintended pregnancy, and nearly half of those were 

2 in need of public support for such care. 

3 (5) The United States has some of the highest 

4 rates of sexually transmitted infections (STIs) 

5 among industrialized nations. In 2006, there were 

6 approximately 19,000,000 new cases of STIs, almost 

7 half of them occurring in young people ages 15 to 

8 24. According to the Centers for Disease Control 

9 and Prevention, in addition to the burden on public 

10 health, STIs impose a tremendous economic burden 

11 with direct medical costs as high as 

12 $14,700,000,000 each year in 2006 dollars. 

13 (6) Contraceptive use can improve overall 

14 health by enabling women to plan and space their 

15 pregnancies and has contributed to dramatic de16 clines in maternal and infant mortality. Widespread 

17 use of contraceptives has been the driving force in 

18 reducing unintended pregnancies and sexually trans19 mitted infections (STIs), and reducing the need for 

20 abortion in this Nation. Contraceptive use also saves 

21 public health dollars. For every dollar spent to pro22 vide services in publicly funded family planning clin23 ics, $4.02 in Medicaid expenses are saved because 

24 unintended births are averted. 


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1 (7) Reducing unintended pregnancy improves 

2 maternal health and is an important strategy in ef3 forts to reduce maternal mortality. Women experi4 encing unintended pregnancy are at greater risk for 

5 physical abuse. 

6 (8) A child born from an unintended pregnancy 

7 is at greater risk than a child born from an intended 

8 pregnancy of low birth weight, dying in the first 

9 year of life, being abused, and not receiving suffi10 cient resources for healthy development. 

11 (9) The ability to control fertility allows couples 

12 to achieve economic stability by facilitating greater 

13 educational achievement and participation in the 

14 workforce. 

15 (10) Contraceptives are effective in preventing 

16 unintended pregnancy when used consistently and 

17 correctly. Without contraception, a sexually active 

18 woman has an 85 percent chance of becoming preg19 nant within a year. 

20 (11) Approximately 50 percent of unintended 

21 pregnancies occur among women who do not use 

22 contraception. 

23 (12) Many poor and low-income women cannot 

24 afford to purchase contraceptive services and sup25 plies on their own. The number of women needing 


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1 subsidized services has increased by more than 

2 1,000,000 (7 percent) since 2000. A poor woman in 

3 the United States is now nearly 4 times as likely as 

4 a more affluent woman to have an unplanned preg5 nancy. Between 1994 and 2001, unintended preg6 nancy among low-income women increased by 29 

7 percent, while unintended pregnancy decreased by 

8 20 percent among women with higher incomes. 

9 (13) Public health programs, such as the Med10 icaid program and family planning programs under 

11 title X of the Public Health Service Act, provide 

12 high-quality family planning services and other pre13 ventive health care to underinsured or uninsured in14 dividuals who may otherwise lack access to health 

15 care. 

16 (14) Medicaid has become an essential source of 

17 support for the provision of subsidized family plan18 ning services and supplies. It is the single largest 

19 source of public funds supporting these services. In 

20 2001, the program provided 6 in 10 of all public dol21 lars spent on family planning services. In 2006, 12 

22 percent of women of reproductive age (7,300,000 

23 women ages 15 to 44) looked to Medicaid for their 

24 care and 37 percent of poor women of reproductive 

25 age rely upon Medicaid. 


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1 (15) Approximately 1,400,000 unintended preg2 nancies and 600,000 abortions are averted each year 

3 because of services provided in publicly funded clin4 ics. In 2006, Title X (of the Public Health Service 

5 Act) service providers performed more than 

6 2,400,000 Pap tests, 2,400,000 breast exams, and 

7 5,800,000 tests for sexually transmitted diseases, in8 cluding 652,426 HIV tests and 2,300,000 

9 Chlamydia tests. One in 4 women who obtain repro10 ductive health services from a medical provider do so 

11 at a publicly funded clinic. 

12 (16) The stagnant funding for public family 

13 planning programs in combination with the increas14 ing demand for subsidized services, the rising costs 

15 of contraceptive services and supplies, and the high 

16 cost of improved screening and treatment for cer17 vical cancer and sexually transmitted infections has 

18 diminished the ability of clinics receiving funds 

19 under title X of the Public Health Services Act to 

20 adequately serve all those in need. At present, clinics 

21 are able to reach just 41 percent of the women need22 ing subsidized services. Had Title X funding kept up 

23 with inflation since fiscal year 1980, it would now be 

24 funded at $759,000,000, instead of its fiscal year 

25 2007 funding level of $283,000,000. Taking inflaVerDate Nov 24 2008 02:53 Jan 07, 2009 Jkt 079200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S21.IS S21

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1 tion into account, funding for Title X in constant 

2 dollars is 63 percent lower today than it was in fis3 cal year 1980. 

4 (17) While the Medicaid program remains the 

5 largest source of subsidized family planning services, 

6 States are facing significant budgetary pressures to 

7 cut their Medicaid programs, putting many women 

8 at risk of losing coverage for family planning serv9 ices. 

10 (18) In addition, eligibility under the Medicaid 

11 program in many States is severely restricted, which 

12 leaves family planning services financially out of 

13 reach for many poor women. Many States have dem14 onstrated tremendous success with Medicaid family 

15 planning waivers that allow States to expand access 

16 to Medicaid family planning services. However, the 

17 administrative burden of applying for a waiver poses 

18 a significant barrier to States that would like to ex19 pand their coverage of family planning programs 

20 through Medicaid. 

21 (19) As of December of 2008, 27 States offered 

22 expanded family planning benefits as a result of 

23 Medicaid family planning waivers. The cost-effective24 ness of these waivers was affirmed by a recent eval25 uation funded by the Centers for Medicare & MedVerDate Nov 24 2008 02:53 Jan 07, 2009 Jkt 079200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S21.IS S21

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1 icaid Services. This evaluation of six waivers found 

2 that all family planning programs under such waiv3 ers resulted in significant savings to both the Fed4 eral and State governments. Moreover, the research5 ers found measurable reductions in unintended preg6 nancy. 

7 (20) Although employer-sponsored health plans 

8 have improved coverage of contraceptive services and 

9 supplies, largely in response to State contraceptive 

10 coverage laws, there is still significant room for im11 provement. The ongoing lack of coverage in health 

12 insurance plans, particularly in self-insured and indi13 vidual plans, continues to place effective forms of 

14 contraception beyond the financial reach of many 

15 women. 

16 (21) Including contraceptive coverage in private 

17 health care plans saves employers money. Not cov18 ering contraceptives in employee health plans costs 

19 employers 15 to 17 percent more than providing 

20 such coverage. 

21 (22) Approved for use by the Food and Drug 

22 Administration, emergency contraception is a safe 

23 and effective way to prevent unintended pregnancy 

24 after unprotected sex. Research confirms that easier 


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1 access to emergency contraceptives does not increase 

2 sexual risk-taking or sexually transmitted diseases. 

3 (23) The available evidence shows that many 

4 women do not know about emergency contraception, 

5 do not know where to get it, or are unable to access 

6 it. Overcoming these obstacles could help ensure that 

7 more women use emergency contraception consist8 ently and correctly. 

9 (24) A November 2006 study of declining preg10 nancy rates among teens concluded that the reduc11 tion in teen pregnancy between 1995 and 2002 is 

12 primarily the result of increased use of contracep13 tives. As such, it is critically important that teens 

14 receive accurate, unbiased information about contra15 ception. 

16 (25) The American Medical Association, the 

17 American Nurses Association, the American Acad18 emy of Pediatrics, the American College of Obstetri19 cians and Gynecologists, the American Public Health 

20 Association, and the Society for Adolescent Medi21 cine, support responsible sex education that includes 

22 information about both abstinence and contracep23 tion. 

24 (26) Teens who receive comprehensive sex edu25 cation that includes discussion of contraception as 


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1 well as abstinence are more likely than those who re2 ceive abstinence-only messages to delay sex, to have 

3 fewer partners, and to use contraceptives when they 

4 do become sexually active. 

5 (27) Government-funded abstinence-only-until6 marriage programs are precluded from discussing 

7 contraception except to talk about failure rates. An 

8 October 2006 report by the Government Account9 ability Office found that the Department of Health 

10 and Human Services does not review the materials 

11 of recipients of grants administered by such depart12 ment for scientific accuracy and requires grantees to 

13 review their own materials for scientific accuracy. 

14 The GAO also reported on the Department’s total 

15 lack of appropriate and customary measurements to 

16 determine if funded programs are effective. In addi17 tion, a separate letter from the Government Ac18 countability Office found that the Department of 

19 Health and Human Services is in violation of Fed20 eral law by failing to enforce a requirement under 

21 the Public Health Service Act that Federally funded 

22 grantees working to address the prevention of sexu23 ally transmitted diseases, including abstinence-only24 until-marriage programs, must provide medically acVerDate Nov 24 2008 02:53 Jan 07, 2009 Jkt 079200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S21.IS S21

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1 curate information about the effectiveness of 

2 condoms. 

3 (28) Recent scientific reports by the Institute of 

4 Medicine, the American Medical Association, and the 

5 Office on National AIDS Policy stress the need for 

6 sex education that includes messages about absti7 nence and provides young people with information 

8 about contraception for the prevention of teen preg9 nancy, HIV/AIDS, and other sexually transmitted 

10 diseases. 

11 (29) A 2006 statement from the American Pub12 lic Health Association (‘‘APHA’’) ‘‘recognizes the 

13 importance of abstinence education, but only as part 

14 of a comprehensive sexuality education program . . . 

15 APHA calls for repealing current Federal funding 

16 for abstinence-only programs and replacing it with 

17 funding for a new Federal program to promote com18 prehensive sexuality education, combining informa19 tion about abstinence with age-appropriate sexuality 

20 education.’’ 

21 (30) Comprehensive sex education programs re22 spect the diversity of values and beliefs represented 

23 in the community and will complement and augment 

24 the sex education children receive from their fami25 lies. 


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1 (31) Over 60 percent of the 56,300 annual new 

2 cases of HIV infections in the United States occur 

3 in youth ages 13 through 24. African-American and 

4 Latino youth have been disproportionately affected 

5 by the HIV/AIDS epidemic. In 2005, Blacks and 

6 Latinos accounted for 84 percent of all new HIV in7 fections among 13 to 19 year olds and 76 percent 

8 of HIV infections among 20 to 24 year olds in the 

9 United States even though, together, they represent 

10 only about 32 percent of people in these ages. Teens 

11 in the United States contract an estimated 

12 9,000,000 sexually transmitted infections each year. 

13 By age 24, at least 1 in 4 sexually active people be14 tween the ages of 15 and 24 will have contracted a 

15 sexually transmitted infection. 

16 (32) Approximately 50 young people a day, an 

17 average of two young people every hour of every day, 

18 are infected with HIV in the United States. 

19 (33) In 1990, Congress passed the Medicaid 

20 Anti-Discriminatory Drug Price and Patient Benefit 

21 Restoration Act to ensure that Medicaid receives the 

22 lowest drug prices in the marketplace. Congress in23 tentionally protected the practice of pharmaceutical 

24 companies offering charitable organizations and clin25 ics nominally priced drugs. As an unintended conVerDate Nov 24 2008 02:53 Jan 07, 2009 Jkt 079200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\S21.IS S21

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1 sequence of the Deficit Reduction Act of 2005, birth 

2 control prices have skyrocketed for millions of 

3 women who depend on safety net providers for their 

4 birth control. Birth control that previously cost only 

5 $5 to $10 per month is now prohibitively expensive, 

6 running as much as $40 or $50 a month. Many fam7 ily planning health centers have absorbed much of 

8 this price increase, further straining already limited 

9 resources. As the economic crisis worsens, women 

10 and their families are increasingly turning to health 

11 care safety net providers, such as family planning 

12 health centers, for a reliable source of care. 

13 TITLE I—TITLE X OF PUBLIC 

14 HEALTH SERVICE ACT 

15 SEC. 101. SHORT TITLE. 

16 This title may be cited as the ‘‘Title X Family Plan17 ning Services Act of 2009’’. 

18 SEC. 102. AUTHORIZATION OF APPROPRIATIONS. 

19 For the purpose of making grants and contracts 

20 under section 1001 of the Public Health Service Act, there 

21 are authorized to be appropriated $700,000,000 for fiscal 

22 year 2010 and such sums as may be necessary for each 

23 subsequent fiscal year. 


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1 TITLE II—EQUITY IN PRESCRIP2 TION INSURANCE AND CON3 TRACEPTIVE COVERAGE 

4 SEC. 201. SHORT TITLE. 

5 This title may be cited as the ‘‘Equity in Prescription 

6 Insurance and Contraceptive Coverage Act of 2007’’. 

7 SEC. 202. AMENDMENTS TO EMPLOYEE RETIREMENT IN8 COME SECURITY ACT OF 1974. 

9 (a) IN GENERAL.—Subpart B of part 7 of subtitle 

10 B of title I of the Employee Retirement Income Security 

11 Act of 1974 (29 U.S.C. 1185 et seq.) is amended by add12 ing at the end the following: 

13 ‘‘SEC. 715. STANDARDS RELATING TO BENEFITS FOR CON14 TRACEPTIVES. 

15 ‘‘(a) REQUIREMENTS FOR COVERAGE.—A group 

16 health plan, and a health insurance issuer providing health 

17 insurance coverage in connection with a group health plan, 

18 may not— 

19 ‘‘(1) exclude or restrict benefits for prescription 

20 contraceptive drugs or devices approved by the Food 

21 and Drug Administration, or generic equivalents ap22 proved as substitutable by the Food and Drug Ad23 ministration, if such plan or coverage provides bene24 fits for other outpatient prescription drugs or de25 vices; or 


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1 ‘‘(2) exclude or restrict benefits for outpatient 

2 contraceptive services if such plan or coverage pro3 vides benefits for other outpatient services provided 

4 by a health care professional (referred to in this sec5 tion as ‘outpatient health care services’). 

6 ‘‘(b) PROHIBITIONS.—A group health plan, and a 

7 health insurance issuer providing health insurance cov8 erage in connection with a group health plan, may not— 

9 ‘‘(1) deny to an individual eligibility, or contin10 ued eligibility, to enroll or to renew coverage under 

11 the terms of the plan because of the individual’s or 

12 enrollee’s use or potential use of items or services 

13 that are covered in accordance with the requirements 

14 of this section; 

15 ‘‘(2) provide monetary payments or rebates to 

16 a covered individual to encourage such individual to 

17 accept less than the minimum protections available 

18 under this section; 

19 ‘‘(3) penalize or otherwise reduce or limit the 

20 reimbursement of a health care professional because 

21 such professional prescribed contraceptive drugs or 

22 devices, or provided contraceptive services, described 

23 in subsection (a), in accordance with this section; or 

24 ‘‘(4) provide incentives (monetary or otherwise) 

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1 sional to withhold from a covered individual contra2 ceptive drugs or devices, or contraceptive services, 

3 described in subsection (a). 

4 ‘‘(c) RULES OF CONSTRUCTION.— 

5 ‘‘(1) IN GENERAL.—Nothing in this section 

6 shall be construed— 

7 ‘‘(A) as preventing a group health plan 

8 and a health insurance issuer providing health 

9 insurance coverage in connection with a group 

10 health plan from imposing deductibles, coinsur11 ance, or other cost-sharing or limitations in re12 lation to— 

13 ‘‘(i) benefits for contraceptive drugs 

14 under the plan or coverage, except that 

15 such a deductible, coinsurance, or other 

16 cost-sharing or limitation for any such 

17 drug shall be consistent with those imposed 

18 for other outpatient prescription drugs oth19 erwise covered under the plan or coverage; 

20 ‘‘(ii) benefits for contraceptive devices 

21 under the plan or coverage, except that 

22 such a deductible, coinsurance, or other 

23 cost-sharing or limitation for any such de24 vice shall be consistent with those imposed 

25 for other outpatient prescription devices 


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1 otherwise covered under the plan or cov2 erage; and 

3 ‘‘(iii) benefits for outpatient contra4 ceptive services under the plan or coverage, 

5 except that such a deductible, coinsurance, 

6 or other cost-sharing or limitation for any 

7 such service shall be consistent with those 

8 imposed for other outpatient health care 

9 services otherwise covered under the plan 

10 or coverage; 

11 ‘‘(B) as requiring a group health plan and 

12 a health insurance issuer providing health in13 surance coverage in connection with a group 

14 health plan to cover experimental or investiga15 tional contraceptive drugs or devices, or experi16 mental or investigational contraceptive services, 

17 described in subsection (a), except to the extent 

18 that the plan or issuer provides coverage for 

19 other experimental or investigational outpatient 

20 prescription drugs or devices, or experimental 

21 or investigational outpatient health care serv22 ices; or 

23 ‘‘(C) as modifying, diminishing, or limiting 

24 the rights or protections of an individual under 

25 any other Federal law. 


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1 ‘‘(2) LIMITATIONS.—As used in paragraph (1), 

2 the term ‘limitation’ includes— 

3 ‘‘(A) in the case of a contraceptive drug or 

4 device, restricting the type of health care pro5 fessionals that may prescribe such drugs or de6 vices, utilization review provisions, and limits on 

7 the volume of prescription drugs or devices that 

8 may be obtained on the basis of a single con9 sultation with a professional; or 

10 ‘‘(B) in the case of an outpatient contra11 ceptive service, restricting the type of health 

12 care professionals that may provide such serv13 ices, utilization review provisions, requirements 

14 relating to second opinions prior to the coverage 

15 of such services, and requirements relating to 

16 preauthorizations prior to the coverage of such 

17 services. 

18 ‘‘(d) NOTICE UNDER GROUP HEALTH PLAN.—The 

19 imposition of the requirements of this section shall be 

20 treated as a material modification in the terms of the plan 

21 described in section 102(a)(1), for purposes of assuring 

22 notice of such requirements under the plan, except that 

23 the summary description required to be provided under the 

24 last sentence of section 104(b)(1) with respect to such 

25 modification shall be provided by not later than 60 days 


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1 after the first day of the first plan year in which such 

2 requirements apply. 

3 ‘‘(e) PREEMPTION.—Nothing in this section shall be 

4 construed to preempt any provision of State law to the 

5 extent that such State law establishes, implements, or con6 tinues in effect any standard or requirement that provides 

7 coverage or protections for participants or beneficiaries 

8 that are greater than the coverage or protections provided 

9 under this section. 

10 ‘‘(f) DEFINITION.—In this section, the term ‘out11 patient contraceptive services’ means consultations, exami12 nations, procedures, and medical services, provided on an 

13 outpatient basis and related to the use of contraceptive 

14 methods (including natural family planning) to prevent an 

15 unintended pregnancy.’’. 

16 (b) CLERICAL AMENDMENT.—The table of contents 

17 in section 1 of the Employee Retirement Income Security 

18 Act of 1974 (29 U.S.C. 1001) is amended by inserting 

19 after the item relating to section 713 the following: 

‘‘Sec. 715. Standards relating to benefits for contraceptives.’’. 

20 (c) EFFECTIVE DATE.—The amendments made by 

21 this section shall apply with respect to plan years begin22 ning on or after January 1, 2010. 


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1 SEC. 203. AMENDMENTS TO PUBLIC HEALTH SERVICE ACT 

2 RELATING TO THE GROUP MARKET. 

3 (a) IN GENERAL.—Subpart 2 of part A of title 

4 XXVII of the Public Health Service Act (42 U.S.C. 

5 300gg–4 et seq.) is amended by adding at the end the 

6 following: 

7 ‘‘SEC. 2708. STANDARDS RELATING TO BENEFITS FOR CON8 TRACEPTIVES. 

9 ‘‘(a) REQUIREMENTS FOR COVERAGE.—A group 

10 health plan, and a health insurance issuer providing health 

11 insurance coverage in connection with a group health plan, 

12 may not— 

13 ‘‘(1) exclude or restrict benefits for prescription 

14 contraceptive drugs or devices approved by the Food 

15 and Drug Administration, or generic equivalents ap16 proved as substitutable by the Food and Drug Ad17 ministration, if such plan or coverage provides bene18 fits for other outpatient prescription drugs or de19 vices; or 

20 ‘‘(2) exclude or restrict benefits for outpatient 

21 contraceptive services if such plan or coverage pro22 vides benefits for other outpatient services provided 

23 by a health care professional (referred to in this sec24 tion as ‘outpatient health care services’). 


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1 ‘‘(b) PROHIBITIONS.—A group health plan, and a 

2 health insurance issuer providing health insurance cov3 erage in connection with a group health plan, may not— 

4 ‘‘(1) deny to an individual eligibility, or contin5 ued eligibility, to enroll or to renew coverage under 

6 the terms of the plan because of the individual’s or 

7 enrollee’s use or potential use of items or services 

8 that are covered in accordance with the requirements 

9 of this section; 

10 ‘‘(2) provide monetary payments or rebates to 

11 a covered individual to encourage such individual to 

12 accept less than the minimum protections available 

13 under this section; 

14 ‘‘(3) penalize or otherwise reduce or limit the 

15 reimbursement of a health care professional because 

16 such professional prescribed contraceptive drugs or 

17 devices, or provided contraceptive services, described 

18 in subsection (a), in accordance with this section; or 

19 ‘‘(4) provide incentives (monetary or otherwise) 

20 to a health care professional to induce such profes21 sional to withhold from covered individual contracep22 tive drugs or devices, or contraceptive services, de23 scribed in subsection (a). 

24 ‘‘(c) RULES OF CONSTRUCTION.— 


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1 ‘‘(1) IN GENERAL.—Nothing in this section 

2 shall be construed— 

3 ‘‘(A) as preventing a group health plan 

4 and a health insurance issuer providing health 

5 insurance coverage in connection with a group 

6 health plan from imposing deductibles, coinsur7 ance, or other cost-sharing or limitations in re8 lation to— 

9 ‘‘(i) benefits for contraceptive drugs 

10 under the plan or coverage, except that 

11 such a deductible, coinsurance, or other 

12 cost-sharing or limitation for any such 

13 drug shall be consistent with those imposed 

14 for other outpatient prescription drugs oth15 erwise covered under the plan or coverage; 

16 ‘‘(ii) benefits for contraceptive devices 

17 under the plan or coverage, except that 

18 such a deductible, coinsurance, or other 

19 cost-sharing or limitation for any such de20 vice shall be consistent with those imposed 

21 for other outpatient prescription devices 

22 otherwise covered under the plan or cov23 erage; and 

24 ‘‘(iii) benefits for outpatient contra25 ceptive services under the plan or coverage, 


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1 except that such a deductible, coinsurance, 

2 or other cost-sharing or limitation for any 

3 such service shall be consistent with those 

4 imposed for other outpatient health care 

5 services otherwise covered under the plan 

6 or coverage; 

7 ‘‘(B) as requiring a group health plan and 

8 a health insurance issuer providing health in9 surance coverage in connection with a group 

10 health plan to cover experimental or investiga11 tional contraceptive drugs or devices, or experi12 mental or investigational contraceptive services, 

13 described in subsection (a), except to the extent 

14 that the plan or issuer provides coverage for 

15 other experimental or investigational outpatient 

16 prescription drugs or devices, or experimental 

17 or investigational outpatient health care serv18 ices; or 

19 ‘‘(C) as modifying, diminishing, or limiting 

20 the rights or protections of an individual under 

21 any other Federal law. 

22 ‘‘(2) LIMITATIONS.—As used in paragraph (1), 

23 the term ‘limitation’ includes— 

24 ‘‘(A) in the case of a contraceptive drug or 

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1 fessionals that may prescribe such drugs or de2 vices, utilization review provisions, and limits on 

3 the volume of prescription drugs or devices that 

4 may be obtained on the basis of a single con5 sultation with a professional; or 

6 ‘‘(B) in the case of an outpatient contra7 ceptive service, restricting the type of health 

8 care professionals that may provide such serv9 ices, utilization review provisions, requirements 

10 relating to second opinions prior to the coverage 

11 of such services, and requirements relating to 

12 preauthorizations prior to the coverage of such 

13 services. 

14 ‘‘(d) NOTICE.—A group health plan under this part 

15 shall comply with the notice requirement under section 

16 715(d) of the Employee Retirement Income Security Act 

17 of 1974 with respect to the requirements of this section 

18 as if such section applied to such plan. 

19 ‘‘(e) PREEMPTION.—Nothing in this section shall be 

20 construed to preempt any provision of State law to the 

21 extent that such State law establishes, implements, or con22 tinues in effect any standard or requirement that provides 

23 coverage or protections for enrollees that are greater than 

24 the coverage or protections provided under this section. 


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1 ‘‘(f) DEFINITION.—In this section, the term ‘out2 patient contraceptive services’ means consultations, exami3 nations, procedures, and medical services, provided on an 

4 outpatient basis and related to the use of contraceptive 

5 methods (including natural family planning) to prevent an 

6 unintended pregnancy.’’. 

7 (b) EFFECTIVE DATE.—The amendments made by 

8 this section shall apply with respect to group health plans 

9 for plan years beginning on or after January 1, 2010. 

10 SEC. 204. AMENDMENT TO PUBLIC HEALTH SERVICE ACT 

11 RELATING TO THE INDIVIDUAL MARKET. 

12 (a) IN GENERAL.—Part B of title XXVII of the Pub13 lic Health Service Act (42 U.S.C. 300gg–41 et seq.) is 

14 amended— 

15 (1) by redesignating the first subpart 3 (relat16 ing to other requirements) as subpart 2; and 

17 (2) by adding at the end of subpart 2 the fol18 lowing: 

19 ‘‘SEC. 2754. STANDARDS RELATING TO BENEFITS FOR CON20 TRACEPTIVES. 

21 ‘‘The provisions of section 2708 shall apply to health 

22 insurance coverage offered by a health insurance issuer 

23 in the individual market in the same manner as they apply 

24 to health insurance coverage offered by a health insurance 


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1 issuer in connection with a group health plan in the small 

2 or large group market.’’. 

3 (b) EFFECTIVE DATE.—The amendment made by 

4 this section shall apply with respect to health insurance 

5 coverage offered, sold, issued, renewed, in effect, or oper6 ated in the individual market on or after January 1, 2008. 

7 TITLE III—EMERGENCY CON8 TRACEPTION EDUCATION 

9 AND INFORMATION 

10 SEC. 301. SHORT TITLE. 

11 This title may be cited as the ‘‘Emergency Contracep12 tion Education Act of 2009’’. 

13 SEC. 302. EMERGENCY CONTRACEPTION EDUCATION AND 

14 INFORMATION PROGRAMS. 

15 (a) DEFINITIONS.—For purposes of this section: 

16 (1) EMERGENCY CONTRACEPTION.—The term 

17 ‘‘emergency contraception’’ means a drug or device 

18 (as the terms are defined in section 201 of the Fed19 eral Food, Drug, and Cosmetic Act (21 U.S.C. 321)) 

20 or a drug regimen that is— 

21 (A) used after sexual relations; 

22 (B) prevents pregnancy, by preventing ovu23 lation, fertilization of an egg, or implantation of 

24 an egg in a uterus; and 


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1 (C) approved by the Food and Drug Ad2 ministration. 

3 (2) HEALTH CARE PROVIDER.—The term 

4 ‘‘health care provider’’ means an individual who is li5 censed or certified under State law to provide health 

6 care services and who is operating within the scope 

7 of such license. 

8 (3) INSTITUTION OF HIGHER EDUCATION.—The 

9 term ‘‘institution of higher education’’ has the same 

10 meaning given such term in section 101(a) of the 

11 Higher Education Act of 1965 (20 U.S.C. 1001(a)). 

12 (4) SECRETARY.—The term ‘‘Secretary’’ means 

13 the Secretary of Health and Human Services. 

14 (b) EMERGENCY CONTRACEPTION PUBLIC EDU15 CATION PROGRAM.— 

16 (1) IN GENERAL.—The Secretary, acting 

17 through the Director of the Centers for Disease 

18 Control and Prevention, shall develop and dissemi19 nate to the public information on emergency contra20 ception. 

21 (2) DISSEMINATION.—The Secretary may dis22 seminate information under paragraph (1) directly 

23 or through arrangements with nonprofit organiza24 tions, consumer groups, institutions of higher eduVerDate Nov 24 2008 02:53 Jan 07, 2009 Jkt 079200 PO 00000 Frm 00028 Fmt 6652 Sfmt 6201 E:\BILLS\S21.IS S21

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1 cation, Federal, State, or local agencies, clinics, and 

2 the media. 

3 (3) INFORMATION.—The information dissemi4 nated under paragraph (1) shall include, at a min5 imum, a description of emergency contraception and 

6 an explanation of the use, safety, efficacy, and avail7 ability of such contraception. 

8 (c) EMERGENCY CONTRACEPTION INFORMATION

9 PROGRAM FOR HEALTH CARE PROVIDERS.— 

10 (1) IN GENERAL.—The Secretary, acting 

11 through the Administrator of the Health Resources 

12 and Services Administration and in consultation 

13 with major medical and public health organizations, 

14 shall develop and disseminate to health care pro15 viders information on emergency contraception. 

16 (2) INFORMATION.—The information dissemi17 nated under paragraph (1) shall include, at a min18 imum— 

19 (A) information describing the use, safety, 

20 efficacy, and availability of emergency contra21 ception; 

22 (B) a recommendation regarding the use of 

23 such contraception in appropriate cases; and 

24 (C) information explaining how to obtain 

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1 section (b) for distribution to the patients of 

2 the providers. 

3 (d) AUTHORIZATION OF APPROPRIATIONS.—There 

4 are authorized to be appropriated to carry out this section 

5 such sums as may be necessary for each of the fiscal years 

6 2010 through 2014. 

7 TITLE IV—COMPASSIONATE AS8 SISTANCE FOR RAPE EMER9 GENCIES 

10 SEC. 401. SHORT TITLE. 

11 This title may be cited as the ‘‘Compassionate Assist12 ance for Rape Emergencies Act of 2009’’. 

13 SEC. 402. SURVIVORS OF SEXUAL ASSAULT; PROVISION BY 

14 HOSPITALS OF EMERGENCY CONTRACEP15 TIVES WITHOUT CHARGE. 

16 (a) IN GENERAL.—Federal funds may not be pro17 vided to a hospital under any health-related program, un18 less the hospital meets the conditions specified in sub19 section (b) in the case of— 

20 (1) any woman who presents at the hospital 

21 and states that she is a victim of sexual assault, or 

22 is accompanied by someone who states she is a vic23 tim of sexual assault; and 


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1 (2) any woman who presents at the hospital 

2 whom hospital personnel have reason to believe is a 

3 victim of sexual assault. 

4 (b) ASSISTANCE FOR VICTIMS.—The conditions spec5 ified in this subsection regarding a hospital and a woman 

6 described in subsection (a) are as follows: 

7 (1) The hospital promptly provides the woman 

8 with medically and factually accurate and unbiased 

9 written and oral information about emergency con10 traception, including information explaining that— 

11 (A) emergency contraception does not 

12 cause an abortion; and 

13 (B) emergency contraception is effective in 

14 most cases in preventing pregnancy after un15 protected sex. 

16 (2) The hospital promptly offers emergency 

17 contraception to the woman, and promptly provides 

18 such contraception to her on her request. 

19 (3) The information provided pursuant to para20 graph (1) is in clear and concise language, is readily 

21 comprehensible, and meets such conditions regarding 

22 the provision of the information in languages other 

23 than English as the Secretary may establish. 


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1 (4) The services described in paragraphs (1) 

2 through (3) are not denied because of the inability 

3 of the woman or her family to pay for the services. 

4 (c) DEFINITIONS.—For purposes of this section: 

5 (1) The term ‘‘emergency contraception’’ means 

6 a drug, drug regimen, or device that— 

7 (A) is used postcoitally; 

8 (B) prevents pregnancy by delaying ovula9 tion, preventing fertilization of an egg, or pre10 venting implantation of an egg in a uterus; and 

11 (C) is approved by the Food and Drug Ad12 ministration. 

13 (2) The term ‘‘hospital’’ has the meanings given 

14 such term in title XVIII of the Social Security Act, 

15 including the meaning applicable in such title for 

16 purposes of making payments for emergency services 

17 to hospitals that do not have agreements in effect 

18 under such title. 

19 (3) The term ‘‘Secretary’’ means the Secretary 

20 of Health and Human Services. 

21 (4) The term ‘‘sexual assault’’ means coitus in 

22 which the woman involved does not consent or lacks 

23 the legal capacity to consent. 

24 (d) EFFECTIVE DATE; AGENCY CRITERIA.—This sec25 tion takes effect upon the expiration of the 180-day period 


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1 beginning on the date of the enactment of this Act. Not 

2 later than 30 days prior to the expiration of such period, 

3 the Secretary shall publish in the Federal Register criteria 

4 for carrying out this section. 

5 TITLE V—AT-RISK COMMUNITIES 

6 TEEN PREGNANCY PREVEN7 TION ACT 

8 SEC. 501. SHORT TITLE. 

9 This title may be cited as the ‘‘At-Risk Communities 

10 Teen Pregnancy Prevention Act of 2009’’. 

11 SEC. 502. TEENAGE PREGNANCY PREVENTION. 

12 Part P of title III of the Public Health Service Act 

13 (42 U.S.C. 280g et seq.) is amended by inserting after 

14 section 399N the following section: 

15 ‘‘SEC. 399N–1. TEENAGE PREGNANCY PREVENTION GRANTS. 

16 ‘‘(a) AUTHORITY.—The Secretary may award on a 

17 competitive basis grants to public and private entities to 

18 establish or expand teenage pregnancy prevention pro19 grams. 

20 ‘‘(b) GRANT RECIPIENTS.—Grant recipients under 

21 this section may include State and local not-for-profit coa22 litions working to prevent teenage pregnancy, State, local, 

23 and tribal agencies, schools, entities that provide after24 school programs, and community and faith-based groups. 


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1 ‘‘(c) PRIORITY.—In selecting grant recipients under 

2 this section, the Secretary shall give— 

3 ‘‘(1) highest priority to applicants seeking as4 sistance for programs targeting communities or pop5 ulations in which— 

6 ‘‘(A) teenage pregnancy or birth rates are 

7 higher than the corresponding State average; or 

8 ‘‘(B) teenage pregnancy or birth rates are 

9 increasing; and 

10 ‘‘(2) priority to applicants seeking assistance 

11 for programs that— 

12 ‘‘(A) will benefit underserved or at-risk 

13 populations such as young males or immigrant 

14 youths; or 

15 ‘‘(B) will take advantage of other available 

16 resources and be coordinated with other pro17 grams that serve youth, such as workforce de18 velopment and after school programs. 

19 ‘‘(d) USE OF FUNDS.—Funds received by an entity 

20 as a grant under this section shall be used for programs 

21 that— 

22 ‘‘(1) replicate or substantially incorporate the 

23 elements of one or more teenage pregnancy preven24 tion programs that have been proven (on the basis 

25 of rigorous scientific research) to delay sexual interVerDate Nov 24 2008 02:53 Jan 07, 2009 Jkt 079200 PO 00000 Frm 00034 Fmt 6652 Sfmt 6201 E:\BILLS\S21.IS S21

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1 course or sexual activity, increase condom or contra2 ceptive use without increasing sexual activity, or re3 duce teenage pregnancy; and 

4 ‘‘(2) incorporate one or more of the following 

5 strategies for preventing teenage pregnancy: encour6 aging teenagers to delay sexual activity; sex and 

7 HIV education; interventions for sexually active 

8 teenagers; preventive health services; youth develop9 ment programs; service learning programs; and out10 reach or media programs. 

11 ‘‘(e) COMPLETE INFORMATION.—Programs receiving 

12 funds under this section that choose to provide informa13 tion on HIV/AIDS or contraception or both must provide 

14 information that is complete and medically accurate. 

15 ‘‘(f) RELATION TO ABSTINENCE-ONLY PROGRAMS.— 

16 Funds under this section are not intended for use by absti17 nence-only education programs. Abstinence-only education 

18 programs that receive Federal funds through the Maternal 

19 and Child Health Block Grant, the Administration for 

20 Children and Families, the Adolescent Family Life Pro21 gram, and any other program that uses the definition of 

22 ‘abstinence education’ found in section 510(b) of the So23 cial Security Act are ineligible for funding. 

24 ‘‘(g) APPLICATIONS.—Each entity seeking a grant 

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1 retary at such time and in such manner as the Secretary 

2 may require. 

3 ‘‘(h) MATCHING FUNDS.— 

4 ‘‘(1) IN GENERAL.—The Secretary may not 

5 award a grant to an applicant for a program under 

6 this section unless the applicant demonstrates that 

7 it will pay, from funds derived from non-Federal 

8 sources, at least 25 percent of the cost of the pro9 gram. 

10 ‘‘(2) APPLICANT’S SHARE.—The applicant’s 

11 share of the cost of a program shall be provided in 

12 cash or in kind. 

13 ‘‘(i) SUPPLEMENTATION OF FUNDS.—An entity that 

14 receives funds as a grant under this section shall use the 

15 funds to supplement and not supplant funds that would 

16 otherwise be available to the entity for teenage pregnancy 

17 prevention. 

18 ‘‘(j) EVALUATIONS.— 

19 ‘‘(1) IN GENERAL.—The Secretary shall— 

20 ‘‘(A) conduct or provide for a rigorous 

21 evaluation of 10 percent of programs for which 

22 a grant is awarded under this section; 

23 ‘‘(B) collect basic data on each program 

24 for which a grant is awarded under this section; 

25 and 


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1 ‘‘(C) upon completion of the evaluations 

2 referred to in subparagraph (A), submit to the 

3 Congress a report that includes a detailed state4 ment on the effectiveness of grants under this 

5 section. 

6 ‘‘(2) COOPERATION BY GRANTEES.—Each grant 

7 recipient under this section shall provide such infor8 mation and cooperation as may be required for an 

9 evaluation under paragraph (1). 

10 ‘‘(k) DEFINITION.—For purposes of this section, the 

11 term ‘rigorous scientific research’ means based on a pro12 gram evaluation that: 

13 ‘‘(1) Measured impact on sexual or contracep14 tive behavior, pregnancy or childbearing. 

15 ‘‘(2) Employed an experimental or quasi-experi16 mental design with well-constructed and appropriate 

17 comparison groups. 

18 ‘‘(3) Had a sample size large enough (at least 

19 100 in the combined treatment and control group) 

20 and a follow-up interval long enough (at least six 

21 months) to draw valid conclusions about impact. 

22 ‘‘(l) AUTHORIZATION OF APPROPRIATIONS.—There 

23 are authorized to be appropriated to carry out this section 

24 such sums as may be necessary for fiscal year 2010 and 

25 each subsequent fiscal year.’’. 


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1 SEC. 503. RESEARCH. 

2 (a) IN GENERAL.—The Secretary of Health and 

3 Human Services, acting through the Director of the Cen4 ters for Disease Control and Prevention, shall make grants 

5 to public or nonprofit private entities to conduct, support, 

6 and coordinate research on the prevention of teen preg7 nancy in eligible communities, including research on the 

8 factors contributing to the disproportionate rates of teen 

9 pregnancy in such communities. 

10 (b) RESEARCH.—In carrying out subsection (a), the 

11 Secretary of Health and Human Services shall support re12 search that— 

13 (1) investigates and determines the incidence 

14 and prevalence of teen pregnancy in communities de15 scribed in such subsection; 

16 (2) examines— 

17 (A) the extent of the impact of teen preg18 nancy on— 

19 (i) the health and well-being of teen20 agers in the communities; and 

21 (ii) the scholastic achievement of such 

22 teenagers; 

23 (B) the variance in the rates of teen preg24 nancy by— 

25 (i) location (such as inner cities, inner 

26 suburbs, and outer suburbs); 


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1 (ii) population subgroup (such as His2 panic, Asian-Pacific Islander, African3 American, Native American); and 

4 (iii) level of acculturation; 

5 (C) the importance of the physical and so6 cial environment as a factor in placing commu7 nities at risk of increased rates of teen preg8 nancy; and 

9 (D) the importance of aspirations as a fac10 tor affecting young women’s risk of teen preg11 nancy; and 

12 (3) is used to develop— 

13 (A) measures to address race, ethnicity, so14 cioeconomic status, environment, and edu15 cational attainment and the relationship to the 

16 incidence and prevalence of teen pregnancy; and 

17 (B) efforts to link the measures to relevant 

18 databases, including health databases. 

19 (c) PRIORITY.—In making grants under subsection 

20 (a), the Secretary of Health and Human Services shall 

21 give priority to research that incorporates— 

22 (1) interdisciplinary approaches; or 

23 (2) a strong emphasis on community-based 

24 participatory research. 


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1 (d) AUTHORIZATION OF APPROPRIATIONS.—For the 

2 purpose of carrying out this section, there is authorized 

3 to be appropriated such sums as may be necessary for 

4 each of the fiscal years 2010 through 2014. 

5 SEC. 504. GENERAL REQUIREMENTS. 

6 (a) MEDICALLY ACCURATE INFORMATION.—A grant 

7 may be made under this title only if the applicant involved 

8 agrees that all information provided pursuant to the grant 

9 will be age-appropriate, factually and medically accurate 

10 and complete, and scientifically based. 

11 (b) CULTURAL CONTEXT OF SERVICES.—A grant 

12 may be made under this title only if the applicant involved 

13 agrees that information, activities, and services under the 

14 grant that are directed toward a particular population 

15 group will be provided in the language and cultural context 

16 that is most appropriate for individuals in such group. 

17 (c) APPLICATION FOR GRANT.—A grant may be 

18 made under this title only if an application for the grant 

19 is submitted to the Secretary of Health and Human Serv20 ices and the application is in such form, is made in such 

21 manner, and contains such agreements, assurances, and 

22 information as the Secretary of Health and Human Serv23 ices determines to be necessary to carry out the program 

24 involved. 


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1 TITLE VI—ACCURACY OF 

2 CONTRACEPTIVE INFORMATION 

3 SEC. 601. SHORT TITLE. 

4 This title may be cited as the ‘‘Truth in Contracep5 tion Act of 2009’’. 

6 SEC. 602. ACCURACY OF CONTRACEPTIVE INFORMATION. 

7 Notwithstanding any other provision of law, any in8 formation concerning the use of a contraceptive provided 

9 through any federally funded sex education, family life 

10 education, abstinence education, comprehensive health 

11 education, or character education program shall be medi12 cally accurate and shall include health benefits and failure 

13 rates relating to the use of such contraceptive. 

14 TITLE VII—UNINTENDED 

15 PREGNANCY REDUCTION ACT 

16 SEC. 701. SHORT TITLE. 

17 This title may be cited as the ‘‘Unintended Preg18 nancy Reduction Act of 2009’’. 

19 SEC. 702. MEDICAID; CLARIFICATION OF COVERAGE OF 

20 FAMILY PLANNING SERVICES AND SUPPLIES. 

21 Section 1937(b) of the Social Security Act (42 U.S.C. 

22 1396u–7(b)) is amended by adding at the end the fol23 lowing: 

24 ‘‘(5) COVERAGE OF FAMILY PLANNING SERV25 ICES AND SUPPLIES.—Notwithstanding the previous 


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1 provisions of this section, a State may not provide 

2 for medical assistance through enrollment of an indi3 vidual with benchmark coverage or benchmark-equiv4 alent coverage under this section unless such cov5 erage includes for any individual described in section 

6 1905(a)(4)(C), medical assistance for family plan7 ning services and supplies in accordance with such 

8 section.’’. 

9 SEC. 703. EXPANSION OF FAMILY PLANNING SERVICES. 

10 (a) COVERAGE AS MANDATORY CATEGORICALLY

11 NEEDY GROUP.— 

12 (1) IN GENERAL.—Section 1902(a)(10)(A)(i) of 

13 the Social Security Act (42 U.S.C. 

14 1396a(a)(10)(A)(i)) is amended— 

15 (A) in subclause (VI), by striking ‘‘or’’ at 

16 the end; 

17 (B) in subclause (VII), by adding ‘‘or’’ at 

18 the end; and 

19 (C) by adding at the end the following new 

20 subclause: 

21 ‘‘(VIII) who are described in sub22 section (dd) (relating to individuals 

23 who meet the income standards for 

24 pregnant women);’’. 


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1 (2) GROUP DESCRIBED.—Section 1902 of the 

2 Social Security Act (42 U.S.C. 1396a) is amended 

3 by adding at the end the following new subsection: 

4 ‘‘(dd)(1) Individuals described in this subsection are 

5 individuals— 

6 ‘‘(A) meet at least the income eligibility stand7 ards established under the State plan as of January 

8 1, 2009, for pregnant women or such higher income 

9 eligibility standard for such women as the State may 

10 establish; and 

11 ‘‘(B) are not pregnant. 

12 ‘‘(2) At the option of a State, individuals described 

13 in this subsection may include individuals who are deter14 mined to meet the income eligibility standards referred to 

15 in paragraph (1)(A) under the terms and conditions appli16 cable to making eligibility determinations for medical as17 sistance under this title under a waiver to provide the ben18 efits described in clause (XV) of the matter following sub19 paragraph (G) of section 1902(a)(10) granted to the State 

20 under section 1115 as of January 1, 2007.’’. 

21 (3) LIMITATION ON BENEFITS.—Section 

22 1902(a)(10) of the Social Security Act (42 U.S.C. 

23 1396a(a)(10)) is amended in the matter following 

24 subparagraph (G)— 


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1 (A) by striking ‘‘and (XIV)’’ and inserting 

2 ‘‘(XIV)’’; and 

3 (B) by inserting ‘‘, and (XV) the medical 

4 assistance made available to an individual de5 scribed in subsection (dd) shall be limited to 

6 family planning services and supplies described 

7 in 1905(a)(4)(C) including medical diagnosis 

8 and treatment services that are provided pursu9 ant to a family planning service in a family 

10 planning setting;’’ after ‘‘cervical cancer’’. 

11 (4) CONFORMING AMENDMENTS.—Section 

12 1905(a) of the Social Security Act (42 U.S.C. 

13 1396d(a)) is amended in the matter preceding para14 graph (1)— 

15 (A) in clause (xii), by striking ‘‘or’’ at the 

16 end; 

17 (B) in clause (xii), by adding ‘‘or’’ at the 

18 end; and 

19 (C) by inserting after clause (xiii) the fol20 lowing: 

21 ‘‘(xiv) individuals described in section 

22 1902(dd),’’. 

23 (b) PRESUMPTIVE ELIGIBILITY.— 


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1 (1) IN GENERAL.—Title XIX of the Social Se2 curity Act (42 U.S.C. 1396 et seq.) is amended by 

3 inserting after section 1920B the following: 

4 ‘‘PRESUMPTIVE ELIGIBILITY FOR FAMILY PLANNING

5 SERVICES

6 ‘‘SEC. 1920C. (a) STATE OPTION.—A State plan ap7 proved under section 1902 may provide for making med8 ical assistance available to an individual described in sec9 tion 1902(dd) (relating to individuals who meet certain in10 come eligibility standards) during a presumptive eligibility 

11 period. In the case of an individual described in section 

12 1902(dd), such medical assistance shall be limited to fam13 ily planning services and supplies described in 

14 1905(a)(4)(C) including medical diagnosis and treatment 

15 services that are provided pursuant to a family planning 

16 service in a family planning setting. 

17 ‘‘(b) DEFINITIONS.—For purposes of this section: 

18 ‘‘(1) PRESUMPTIVE ELIGIBILITY PERIOD.—The 

19 term ‘presumptive eligibility period’ means, with re20 spect to an individual described in subsection (a), 

21 the period that— 

22 ‘‘(A) begins with the date on which a 

23 qualified entity determines, on the basis of pre24 liminary information, that the individual is de25 scribed in section 1902(dd); and 


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1 ‘‘(B) ends with (and includes) the earlier 

2 of— 

3 ‘‘(i) the day on which a determination 

4 is made with respect to the eligibility of 

5 such individual for services under the State 

6 plan; or 

7 ‘‘(ii) in the case of such an individual 

8 who does not file an application by the last 

9 day of the month following the month dur10 ing which the entity makes the determina11 tion referred to in subparagraph (A), such 

12 last day. 

13 ‘‘(2) QUALIFIED ENTITY.— 

14 ‘‘(A) IN GENERAL.—Subject to subpara15 graph (B), the term ‘qualified entity’ means 

16 any entity that— 

17 ‘‘(i) is eligible for payments under a 

18 State plan approved under this title; and 

19 ‘‘(ii) is determined by the State agen20 cy to be capable of making determinations 

21 of the type described in paragraph (1)(A). 

22 ‘‘(B) RULE OF CONSTRUCTION.—Nothing 

23 in this paragraph shall be construed as pre24 venting a State from limiting the classes of en25 tities that may become qualified entities. 


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1 ‘‘(c) ADMINISTRATION.— 

2 ‘‘(1) IN GENERAL.—The State agency shall pro3 vide qualified entities with— 

4 ‘‘(A) such forms as are necessary for an 

5 application to be made by an individual de6 scribed in subsection (a) for medical assistance 

7 under the State plan; and 

8 ‘‘(B) information on how to assist such in9 dividuals in completing and filing such forms. 

10 ‘‘(2) NOTIFICATION REQUIREMENTS.—A quali11 fied entity that determines under subsection 

12 (b)(1)(A) that an individual described in subsection 

13 (a) is presumptively eligible for medical assistance 

14 under a State plan shall— 

15 ‘‘(A) notify the State agency of the deter16 mination within 5 working days after the date 

17 on which determination is made; and 

18 ‘‘(B) inform such individual at the time 

19 the determination is made that an application 

20 for medical assistance is required to be made by 

21 not later than the last day of the month fol22 lowing the month during which the determina23 tion is made. 

24 ‘‘(3) APPLICATION FOR MEDICAL ASSIST25 ANCE.—In the case of an individual described in 


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1 subsection (a) who is determined by a qualified enti2 ty to be presumptively eligible for medical assistance 

3 under a State plan, the individual shall apply for 

4 medical assistance by not later than the last day of 

5 the month following the month during which the de6 termination is made. 

7 ‘‘(d) PAYMENT.—Notwithstanding any other provi8 sion of this title, medical assistance that— 

9 ‘‘(1) is furnished to an individual described in 

10 subsection (a)— 

11 ‘‘(A) during a presumptive eligibility pe12 riod; 

13 ‘‘(B) by a entity that is eligible for pay14 ments under the State plan; and 

15 ‘‘(2) is included in the care and services covered 

16 by the State plan, shall be treated as medical assist17 ance provided by such plan for purposes of clause 

18 (4) of the first sentence of section 1905(b).’’. 

19 (2) CONFORMING AMENDMENTS.— 

20 (A) Section 1902(a)(47) of the Social Se21 curity Act (42 U.S.C. 1396a(a)(47)) is amend22 ed by inserting before the semicolon at the end 

23 the following: ‘‘and provide for making medical 

24 assistance available to individuals described in 

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1 sumptive eligibility period in accordance with 

2 such section.’’. 

3 (B) Section 1903(u)(1)(D)(v) of such Act 

4 (42 U.S.C. 1396b(u)(1)(D)(v)) is amended— 

5 (i) by striking ‘‘or for’’ and inserting 

6 ‘‘, for’’; and 

7 (ii) by inserting before the period the 

8 following: ‘‘, or for medical assistance pro9 vided to an individual described in sub10 section (a) of section 1920C during a pre11 sumptive eligibility period under such sec12 tion’’. 

13 SEC. 704. EFFECTIVE DATE. 

14 (a) IN GENERAL.—Except as provided in paragraph 

15 (2), the amendments made by this title take effect on Oc16 tober 1, 2009. 

17 (b) EXTENSION OF EFFECTIVE DATE FOR STATE

18 LAW AMENDMENT.—In the case of a State plan under 

19 title XIX of the Social Security Act (42 U.S.C. 1396 et 

20 seq.) which the Secretary of Health and Human Services 

21 determines requires State legislation in order for the plan 

22 to meet the additional requirements imposed by the 

23 amendments made by this title, the State plan shall not 

24 be regarded as failing to comply with the requirements of 

25 such title solely on the basis of its failure to meet these 


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1 additional requirements before the first day of the first 

2 calendar quarter beginning after the close of the first reg3 ular session of the State legislature that begins after the 

4 date of the enactment of this Act. For purposes of the 

5 previous sentence, in the case of a State that has a 2- 

6 year legislative session, each year of the session is consid7 ered to be a separate regular session of the State legisla8 ture. 

9 TITLE VIII—RESPONSIBLE 

10 EDUCATION ABOUT LIFE ACT 

11 SEC. 801. SHORT TITLE. 

12 This title may be cited as the ‘‘Responsible Education 

13 About Life Act of 2009’’. 

14 SEC. 802. ASSISTANCE TO REDUCE TEEN PREGNANCY, HIV/ 

15 AIDS, AND OTHER SEXUALLY TRANSMITTED 

16 DISEASES AND TO SUPPORT HEALTHY ADO17 LESCENT DEVELOPMENT. 

18 (a) IN GENERAL.—Each eligible State shall be eligi19 ble to receive from the Secretary of Health and Human 

20 Services, for each of the fiscal years 2010 through 2014, 

21 a grant to conduct programs of family life education, in22 cluding education on both abstinence and contraception 

23 for the prevention of teenage pregnancy and sexually 

24 transmitted diseases, including HIV/AIDS. 


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1 (b) REQUIREMENTS FOR FAMILY LIFE PROGRAMS.— 

2 For purposes of this title, a program of family life edu3 cation is a program that— 

4 (1) is age-appropriate and medically accurate; 

5 (2) does not teach or promote religion; 

6 (3) teaches that abstinence is the only sure way 

7 to avoid pregnancy or sexually transmitted diseases; 

8 (4) stresses the value of abstinence while not ig9 noring those young people who have had or are hav10 ing sexual intercourse; 

11 (5) provides information about the health bene12 fits and side effects of all contraceptives and barrier 

13 methods as a means to prevent pregnancy and re14 duce the risk of contracting sexually transmitted dis15 eases, including HIV/AIDS; 

16 (6) encourages family communication between 

17 parent and child about sexuality; 

18 (7) teaches young people the skills to make re19 sponsible decisions about sexuality, including how to 

20 avoid unwanted verbal, physical, and sexual ad21 vances; and 

22 (8) teaches young people how alcohol and drug 

23 use can effect responsible decision making. 

24 (c) ADDITIONAL ACTIVITIES.—In carrying out a pro25 gram of family life education, a State may expend a grant 


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1 under subsection (a) to carry out educational and motiva2 tional activities that help young people— 

3 (1) gain knowledge about the physical, emo4 tional, biological, and hormonal changes of adoles5 cence and subsequent stages of human maturation; 

6 (2) develop the knowledge and skills necessary 

7 to ensure and protect their sexual and reproductive 

8 health from unintended pregnancy and sexually 

9 transmitted disease, including HIV/AIDS through10 out their lifespan; 

11 (3) gain knowledge about the specific involve12 ment and responsibility of males in sexual decision 

13 making; 

14 (4) develop healthy attitudes and values about 

15 adolescent growth and development, body image, ra16 cial and ethnic diversity, and other related subjects; 

17 (5) develop and practice healthy life skills, in18 cluding goal-setting, decisionmaking, negotiation, 

19 communication, and stress management; 

20 (6) develop healthy relationships, including the 

21 prevention of dating and relationship violence; 

22 (7) promote self-esteem and positive inter23 personal skills focusing on relationship dynamics, in24 cluding friendships, dating, romantic involvement, 

25 marriage and family interactions; and 


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1 (8) prepare for the adult world by focusing on 

2 educational and career success, including developing 

3 skills for employment preparation, job seeking, inde4 pendent living, financial self-sufficiency, and work5 place productivity. 

6 SEC. 803. SENSE OF CONGRESS. 

7 It is the sense of Congress that while States are not 

8 required under this title to provide matching funds, with 

9 respect to grants authorized under section 802(a), they 

10 are encouraged to do so. 

11 SEC. 804. EVALUATION OF PROGRAMS. 

12 (a) IN GENERAL.—For the purpose of evaluating the 

13 effectiveness of programs of family life education carried 

14 out with a grant under section 802, evaluations of such 

15 program shall be carried out in accordance with sub16 sections (b) and (c). 

17 (b) NATIONAL EVALUATION.— 

18 (1) IN GENERAL.—The Secretary shall provide 

19 for a national evaluation of a representative sample 

20 of programs of family life education carried out with 

21 grants under section 802. A condition for the receipt 

22 of such a grant is that the State involved agree to 

23 cooperate with the evaluation. The purposes of the 

24 national evaluation shall be the determination of— 


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1 (A) the effectiveness of such programs in 

2 helping to delay the initiation of sexual inter3 course and other high-risk behaviors; 

4 (B) the effectiveness of such programs in 

5 preventing adolescent pregnancy; 

6 (C) the effectiveness of such programs in 

7 preventing sexually transmitted disease, includ8 ing HIV/AIDS; 

9 (D) the effectiveness of such programs in 

10 increasing contraceptive knowledge and contra11 ceptive behaviors when sexual intercourse oc12 curs; and 

13 (E) a list of best practices based upon es14 sential programmatic components of evaluated 

15 programs that have led to success in subpara16 graphs (A) through (D). 

17 (2) REPORT.—A final report providing the re18 sults of the national evaluation under paragraph (1) 

19 shall be submitted to Congress not later than March 

20 31, 2015, with an interim report provided on an an21 nual basis at the end of each fiscal year under sec22 tion 802(a). 

23 (c) INDIVIDUAL STATE EVALUATIONS.— 

24 (1) IN GENERAL.—A condition for the receipt 

25 of a grant under section 802 is that the State inVerDate Nov 24 2008 02:53 Jan 07, 2009 Jkt 079200 PO 00000 Frm 00054 Fmt 6652 Sfmt 6201 E:\BILLS\S21.IS S21

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1 volved agree to provide for the evaluation of the pro2 grams of family education carried out with the grant 

3 in accordance with the following: 

4 (A) The evaluation will be conducted by an 

5 external, independent entity. 

6 (B) The purposes of the evaluation will be 

7 the determination of— 

8 (i) the effectiveness of such programs 

9 in helping to delay the initiation of sexual 

10 intercourse and other high-risk behaviors; 

11 (ii) the effectiveness of such programs 

12 in preventing adolescent pregnancy; 

13 (iii) the effectiveness of such pro14 grams in preventing sexually transmitted 

15 disease, including HIV/AIDS; and 

16 (iv) the effectiveness of such programs 

17 in increasing contraceptive knowledge and 

18 contraceptive behaviors when sexual inter19 course occurs. 

20 (2) USE OF GRANT.—A condition for the re21 ceipt of a grant under section 802 is that the State 

22 involved agree that not more than 10 percent of the 

23 grant will be expended for the evaluation under 

24 paragraph (1). 


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1 SEC. 805. DEFINITIONS. 

2 For purposes of this title: 

3 (1) The term ‘‘eligible State’’ means a State 

4 that submits to the Secretary an application for a 

5 grant under section 802 that is in such form, is 

6 made in such manner, and contains such agree7 ments, assurances, and information as the Secretary 

8 determines to be necessary to carry out this title. 

9 (2) The term ‘‘HIV/AIDS’’ means the human 

10 immunodeficiency virus, and includes acquired im11 mune deficiency syndrome. 

12 (3) The term ‘‘medically accurate’’, with respect 

13 to information, means information that is supported 

14 by research, recognized as accurate and objective by 

15 leading medical, psychological, psychiatric, and pub16 lic health organizations and agencies, and where rel17 evant, published in peer review journals. 

18 (4) The term ‘‘Secretary’’ means the Secretary 

19 of Health and Human Services. 

20 SEC. 806. APPROPRIATIONS. 

21 (a) IN GENERAL.—For the purpose of carrying out 

22 this title, there are authorized to be appropriated such 

23 sums as may be necessary for each of the fiscal years 2010 

24 through 2014. 

25 (b) ALLOCATIONS.—Of the amounts appropriated 

26 under subsection (a) for a fiscal year— 


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1 (1) not more than 7 percent may be used for 

2 the administrative expenses of the Secretary in car3 rying out this title for that fiscal year; and 

4 (2) not more than 10 percent may be used for 

5 the national evaluation under section 804(b). 

6 TITLE IX—PREVENTION 

7 THROUGH AFFORDABLE ACCESS 

8 SEC. 901. SHORT TITLE. 

9 This title may be cited as the ‘‘Prevention Through 

10 Affordable Access Act’’. 

11 SEC. 902. RESTORING AND PROTECTING ACCESS TO DIS12 COUNT DRUG PRICES FOR UNIVERSITY13 BASED AND SAFETY-NET CLINICS. 

14 (a) RESTORING NOMINAL PRICING.—Section 

15 1927(c)(1)(D)(i) of the Social Security Act (42 U.S.C. 

16 1396r–8(c)(1)(D)(i)) is amended— 

17 (1) by redesignating subclause (IV) as sub18 clause (VI); and 

19 (2) by inserting after subclause (III) the fol20 lowing new subclauses: 

21 ‘‘(IV) An entity that is operated 

22 by a health center of an institution of 

23 higher education, the primary purpose 

24 of which is to provide health services 

25 to students of that institution. 


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1 ‘‘(V) An entity that is a public or 

2 private nonprofit entity that provides 

3 a service or services described under 

4 section 1001(a) of the Public Health 

5 Service Act.’’. 

6 (b) EFFECTIVE DATE.—The amendments made by 

7 this section shall be effective as of the date of the enact8 ment of this Act. 

Æ 


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