```

[Congressional Record Volume 155, Number 1 (Tuesday, January 6, 2009)]
[Senate]
[Pages S46-S53]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By 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):
  S. 21. A bill to reduce unintended pregnancy, reduce abortions, and 
improve access to women's heath care; to the Committee on Health, 
Education, Labor, and Pensions.
  Mr. REID. Mr. President, I ask unanimous consent that the text of the 
bill be printed in the Record.

[[Page S47]]

  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                 S. 21

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

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Prevention 
     First Act''.
       (b) Table of Contents.--The table of contents for this Act 
     is as follows:

Sec. 1. Short title; table of contents.
Sec. 2. Findings.

             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.

             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.

     SEC. 2. FINDINGS.

       The Congress finds as follows:
       (1) Healthy People 2010 sets forth a reduction of 
     unintended pregnancies as an important health objective for 
     the Nation to achieve over the first decade of the new 
     century, a goal first articulated in the 1979 Surgeon 
     General's Report, Healthy People, and reiterated in Healthy 
     People 2000: National Health Promotion and Disease Prevention 
     Objectives.
       (2) Although the Centers for Disease Control and Prevention 
     (referred to in this section as the ``CDC'') included family 
     planning in its published list of the Ten Great Public Health 
     Achievements in the 20th Century, the United States still has 
     one of the highest rates of unintended pregnancies among 
     industrialized nations.
       (3) Each year, nearly half of all pregnancies in the United 
     States are unintended, and nearly half of unintended 
     pregnancies end in abortion.
       (4) In 2006, 36,200,000 women, more than half of all women 
     of reproductive age, were in need of contraceptive services 
     and supplies to help prevent unintended pregnancy, and nearly 
     half of those were in need of public support for such care.
       (5) The United States has some of the highest rates of 
     sexually transmitted infections (STIs) among industrialized 
     nations. In 2006, there were approximately 19,000,000 new 
     cases of STIs, almost half of them occurring in young people 
     ages 15 to 24. According to the Centers for Disease Control 
     and Prevention, in addition to the burden on public health, 
     STIs impose a tremendous economic burden with direct medical 
     costs as high as $14,700,000,000 each year in 2006 dollars.
       (6) Contraceptive use can improve overall health by 
     enabling women to plan and space their pregnancies and has 
     contributed to dramatic declines in maternal and infant 
     mortality. Widespread use of contraceptives has been the 
     driving force in reducing unintended pregnancies and sexually 
     transmitted infections (STIs), and reducing the need for 
     abortion in this nation. Contraceptive use also saves public 
     health dollars. For every dollar spent to provide services in 
     publicly funded family planning clinics, $4.02 in Medicaid 
     expenses are saved because unintended births are averted.
       (7) Reducing unintended pregnancy improves maternal health 
     and is an important strategy in efforts to reduce maternal 
     mortality. Women experiencing unintended pregnancy are at 
     greater risk for physical abuse.
       (8) A child born from an unintended pregnancy is at greater 
     risk than a child born from an intended pregnancy of low 
     birth weight, dying in the first year of life, being abused, 
     and not receiving sufficient resources for healthy 
     development.
       (9) The ability to control fertility allows couples to 
     achieve economic stability by facilitating greater 
     educational achievement and participation in the workforce.
       (10) Contraceptives are effective in preventing unintended 
     pregnancy when used consistently and correctly. Without 
     contraception, a sexually active woman has an 85 percent 
     chance of becoming pregnant within a year.
       (11) Approximately 50 percent of unintended pregnancies 
     occur among women who do not use contraception.
       (12) Many poor and low-income women cannot afford to 
     purchase contraceptive services and supplies on their own. 
     The number of women needing subsidized services has increased 
     by more than 1,000,000 (7 percent) since 2000. A poor woman 
     in the United States is now nearly 4 times as likely as a 
     more affluent woman to have an unplanned pregnancy. Between 
     1994 and 2001, unintended pregnancy among low-income women 
     increased by 29 percent, while unintended pregnancy decreased 
     by 20 percent among women with higher incomes.
       (13) Public health programs, such as the Medicaid program 
     and family planning programs under title X of the Public 
     Health Service Act, provide high-quality family planning 
     services and other preventive health care to underinsured or 
     uninsured individuals who may otherwise lack access to health 
     care.
       (14) Medicaid has become an essential source of support for 
     the provision of subsidized family planning services and 
     supplies. It is the single largest source of public funds 
     supporting these services. In 2001, the program provided 6 in 
     10 of all public dollars spent on family planning services. 
     In 2006, 12 percent of women of reproductive age (7,300,000 
     women ages 15 to 44) looked to Medicaid for their care and 37 
     percent of poor women of reproductive age rely upon Medicaid.
       (15) Approximately 1,400,000 unintended pregnancies and 
     600,000 abortions are averted each year because of services 
     provided in publicly funded clinics. In 2006, Title X (of the 
     Public Health Service Act) service providers performed more 
     than 2,400,000 Pap tests, 2,400,000 breast exams, and 
     5,800,000 tests for sexually transmitted diseases, including 
     652,426 HIV tests and 2,300,000 Chlamydia tests. One in 4 
     women who obtain reproductive health services from a medical 
     provider do so at a publicly funded clinic.
       (16) The stagnant funding for public family planning 
     programs in combination with the increasing demand for 
     subsidized services, the rising costs of contraceptive 
     services and supplies, and the high cost of improved 
     screening and treatment for cervical cancer and sexually 
     transmitted infections has diminished the ability of clinics 
     receiving funds under title X of the Public Health Services 
     Act to adequately serve all those in need. At present, 
     clinics are able to reach just 41 percent of the women 
     needing subsidized services. Had Title X funding kept up with 
     inflation since fiscal year 1980, it would now be funded at 
     $759,000,000, instead of its fiscal year 2007 funding level 
     of $283,000,000. Taking inflation into account, funding for 
     Title X in constant dollars is 63 percent lower today than it 
     was in fiscal year 1980.
       (17) While the Medicaid program remains the largest source 
     of subsidized family planning services, States are facing 
     significant budgetary pressures to cut their Medicaid 
     programs, putting many women at risk of losing coverage for 
     family planning services.
       (18) In addition, eligibility under the Medicaid program in 
     many States is severely restricted, which leaves family 
     planning services financially out of reach for many poor 
     women. Many States have demonstrated tremendous success with 
     Medicaid family planning waivers that allow States to expand 
     access to Medicaid family planning services. However, the 
     administrative burden of applying for a waiver poses a 
     significant barrier to States that would like to expand their 
     coverage of family planning programs through Medicaid.
       (19) As of December of 2008, 27 States offered expanded 
     family planning benefits as a result of Medicaid family 
     planning waivers. The cost-effectiveness of these waivers was 
     affirmed by a recent evaluation funded by the Centers for 
     Medicare & Medicaid Services. This evaluation of six waivers 
     found that all family planning programs under such waivers 
     resulted in significant savings to both the Federal and State 
     governments. Moreover, the researchers found measurable 
     reductions in unintended pregnancy.

[[Page S48]]

       (20) Although employer-sponsored health plans have improved 
     coverage of contraceptive services and supplies, largely in 
     response to State contraceptive coverage laws, there is still 
     significant room for improvement. The ongoing lack of 
     coverage in health insurance plans, particularly in self-
     insured and individual plans, continues to place effective 
     forms of contraception beyond the financial reach of many 
     women.
       (21) Including contraceptive coverage in private health 
     care plans saves employers money. Not covering contraceptives 
     in employee health plans costs employers 15 to 17 percent 
     more than providing such coverage.
       (22) Approved for use by the Food and Drug Administration, 
     emergency contraception is a safe and effective way to 
     prevent unintended pregnancy after unprotected sex. Research 
     confirms that easier access to emergency contraceptives does 
     not increase sexual risk-taking or sexually transmitted 
     diseases.
       (23) The available evidence shows that many women do not 
     know about emergency contraception, do not know where to get 
     it, or are unable to access it. Overcoming these obstacles 
     could help ensure that more women use emergency contraception 
     consistently and correctly.
       (24) A November 2006 study of declining pregnancy rates 
     among teens concluded that the reduction in teen pregnancy 
     between 1995 and 2002 is primarily the result of increased 
     use of contraceptives. As such, it is critically important 
     that teens receive accurate, unbiased information about 
     contraception.
       (25) The American Medical Association, the American Nurses 
     Association, the American Academy of Pediatrics, the American 
     College of Obstetricians and Gynecologists, the American 
     Public Health Association, and the Society for Adolescent 
     Medicine, support responsible sex education that includes 
     information about both abstinence and contraception.
       (26) Teens who receive comprehensive sex education that 
     includes discussion of contraception as well as abstinence 
     are more likely than those who receive abstinence-only 
     messages to delay sex, to have fewer partners, and to use 
     contraceptives when they do become sexually active.
       (27) Government-funded abstinence-only-until-marriage 
     programs are precluded from discussing contraception except 
     to talk about failure rates. An October 2006 report by the 
     Government Accountability Office found that the Department of 
     Health and Human Services does not review the materials of 
     recipients of grants administered by such department for 
     scientific accuracy and requires grantees to review their own 
     materials for scientific accuracy. The GAO also reported on 
     the Department's total lack of appropriate and customary 
     measurements to determine if funded programs are effective. 
     In addition, a separate letter from the Government 
     Accountability Office found that the Department of Health and 
     Human Services is in violation of Federal law by failing to 
     enforce a requirement under the Public Health Service Act 
     that Federally-funded grantees working to address the 
     prevention of sexually transmitted diseases, including 
     abstinence-only-until-marriage programs, must provide 
     medically accurate information about the effectiveness of 
     condoms.
       (28) Recent scientific reports by the Institute of 
     Medicine, the American Medical Association, and the Office on 
     National AIDS Policy stress the need for sex education that 
     includes messages about abstinence and provides young people 
     with information about contraception for the prevention of 
     teen pregnancy, HIV/AIDS, and other sexually transmitted 
     diseases.
       (29) A 2006 statement from the American Public Health 
     Association (``APHA'') ``recognizes the importance of 
     abstinence education, but only as part of a comprehensive 
     sexuality education program . . . APHA calls for repealing 
     current federal funding for abstinence-only programs and 
     replacing it with funding for a new Federal program to 
     promote comprehensive sexuality education, combining 
     information about abstinence with age-appropriate sexuality 
     education.''
       (30) Comprehensive sex education programs respect the 
     diversity of values and beliefs represented in the community 
     and will complement and augment the sex education children 
     receive from their families.
       (31) Over 60 percent of the 56,300 annual new cases of HIV 
     infections in the United States occur in youth ages 13 
     through 24. African American and Latino youth have been 
     disproportionately affected by the HIV/AIDS epidemic. In 
     2005, Blacks and Latinos accounted for 84 percent of all new 
     HIV infections among 13 to 19 year olds and 76 percent of HIV 
     infections among 20 to 24 year olds in the United States even 
     though, together, they represent only about 32 percent of 
     people in these ages. Teens in the United States contract an 
     estimated 9,000,000 sexually transmitted infections each 
     year. By age 24, at least 1 in 4 sexually active people 
     between the ages of 15 and 24 will have contracted a sexually 
     transmitted infection.
       (32) Approximately 50 young people a day, an average of two 
     young people every hour of every day, are infected with HIV 
     in the United States.
       (33) In 1990, Congress passed the Medicaid Anti-
     Discriminatory Drug Price and Patient Benefit Restoration Act 
     to ensure that Medicaid receives the lowest drug prices in 
     the marketplace. Congress intentionally protected the 
     practice of pharmaceutical companies offering charitable 
     organizations and clinics nominally-priced drugs. As an 
     unintended consequence of the Deficit Reduction Act of 2005, 
     birth control prices have skyrocketed for millions of women 
     who depend on safety net providers for their birth control. 
     Birth control that previously cost only $5 to $10 per month 
     is now prohibitively expensive, running as much as $40 or $50 
     a month. Many family planning health centers have absorbed 
     much of this price increase, further straining already 
     limited resources. As the economic crisis worsens, women and 
     their families are increasingly turning to health care safety 
     net providers, such as family planning health centers, for a 
     reliable source of care.

             TITLE I--TITLE X OF PUBLIC HEALTH SERVICE ACT

     SEC. 101. SHORT TITLE.

       This title may be cited as the ``Title X Family Planning 
     Services Act of 2009''.

     SEC. 102. AUTHORIZATION OF APPROPRIATIONS.

       For the purpose of making grants and contracts under 
     section 1001 of the Public Health Service Act, there are 
     authorized to be appropriated $700,000,000 for fiscal year 
     2010 and such sums as may be necessary for each subsequent 
     fiscal year.

 TITLE II--EQUITY IN PRESCRIPTION INSURANCE AND CONTRACEPTIVE COVERAGE

     SEC. 201. SHORT TITLE.

       This title may be cited as the ``Equity in Prescription 
     Insurance and Contraceptive Coverage Act of 2007''.

     SEC. 202. AMENDMENTS TO EMPLOYEE RETIREMENT INCOME SECURITY 
                   ACT OF 1974.

       (a) In General.--Subpart B of part 7 of subtitle B of title 
     I of the Employee Retirement Income Security Act of 1974 (29 
     U.S.C. 1185 et seq.) is amended by adding at the end the 
     following:

     ``SEC. 715. STANDARDS RELATING TO BENEFITS FOR 
                   CONTRACEPTIVES.

       ``(a) Requirements for Coverage.--A group health plan, and 
     a health insurance issuer providing health insurance coverage 
     in connection with a group health plan, may not--
       ``(1) exclude or restrict benefits for prescription 
     contraceptive drugs or devices approved by the Food and Drug 
     Administration, or generic equivalents approved as 
     substitutable by the Food and Drug Administration, if such 
     plan or coverage provides benefits for other outpatient 
     prescription drugs or devices; or
       ``(2) exclude or restrict benefits for outpatient 
     contraceptive services if such plan or coverage provides 
     benefits for other outpatient services provided by a health 
     care professional (referred to in this section as `outpatient 
     health care services').
       ``(b) Prohibitions.--A group health plan, and a health 
     insurance issuer providing health insurance coverage in 
     connection with a group health plan, may not--
       ``(1) deny to an individual eligibility, or continued 
     eligibility, to enroll or to renew coverage under the terms 
     of the plan because of the individual's or enrollee's use or 
     potential use of items or services that are covered in 
     accordance with the requirements of this section;
       ``(2) provide monetary payments or rebates to a covered 
     individual to encourage such individual to accept less than 
     the minimum protections available under this section;
       ``(3) penalize or otherwise reduce or limit the 
     reimbursement of a health care professional because such 
     professional prescribed contraceptive drugs or devices, or 
     provided contraceptive services, described in subsection (a), 
     in accordance with this section; or
       ``(4) provide incentives (monetary or otherwise) to a 
     health care professional to induce such professional to 
     withhold from a covered individual contraceptive drugs or 
     devices, or contraceptive services, described in subsection 
     (a).
       ``(c) Rules of Construction.--
       ``(1) In general.--Nothing in this section shall be 
     construed--
       ``(A) as preventing a group health plan and a health 
     insurance issuer providing health insurance coverage in 
     connection with a group health plan from imposing 
     deductibles, coinsurance, or other cost-sharing or 
     limitations in relation to--
       ``(i) benefits for contraceptive drugs under the plan or 
     coverage, except that such a deductible, coinsurance, or 
     other cost-sharing or limitation for any such drug shall be 
     consistent with those imposed for other outpatient 
     prescription drugs otherwise covered under the plan or 
     coverage;
       ``(ii) benefits for contraceptive devices under the plan or 
     coverage, except that such a deductible, coinsurance, or 
     other cost-sharing or limitation for any such device shall be 
     consistent with those imposed for other outpatient 
     prescription devices otherwise covered under the plan or 
     coverage; and
       ``(iii) benefits for outpatient contraceptive services 
     under the plan or coverage, except that such a deductible, 
     coinsurance, or other cost-sharing or limitation for any such 
     service shall be consistent with those imposed for other 
     outpatient health care services otherwise covered under the 
     plan or coverage;
       ``(B) as requiring a group health plan and a health 
     insurance issuer providing health insurance coverage in 
     connection with a group health plan to cover experimental or 
     investigational contraceptive drugs or devices, or 
     experimental or investigational contraceptive services, 
     described in subsection (a), except to the extent that the 
     plan or issuer provides coverage for other experimental or

[[Page S49]]

     investigational outpatient prescription drugs or devices, or 
     experimental or investigational outpatient health care 
     services; or
       ``(C) as modifying, diminishing, or limiting the rights or 
     protections of an individual under any other Federal law.
       ``(2) Limitations.--As used in paragraph (1), the term 
     `limitation' includes--
       ``(A) in the case of a contraceptive drug or device, 
     restricting the type of health care professionals that may 
     prescribe such drugs or devices, utilization review 
     provisions, and limits on the volume of prescription drugs or 
     devices that may be obtained on the basis of a single 
     consultation with a professional; or
       ``(B) in the case of an outpatient contraceptive service, 
     restricting the type of health care professionals that may 
     provide such services, utilization review provisions, 
     requirements relating to second opinions prior to the 
     coverage of such services, and requirements relating to 
     preauthorizations prior to the coverage of such services.
       ``(d) Notice Under Group Health Plan.--The imposition of 
     the requirements of this section shall be treated as a 
     material modification in the terms of the plan described in 
     section 102(a)(1), for purposes of assuring notice of such 
     requirements under the plan, except that the summary 
     description required to be provided under the last sentence 
     of section 104(b)(1) with respect to such modification shall 
     be provided by not later than 60 days after the first day of 
     the first plan year in which such requirements apply.
       ``(e) Preemption.--Nothing in this section shall be 
     construed to preempt any provision of State law to the extent 
     that such State law establishes, implements, or continues in 
     effect any standard or requirement that provides coverage or 
     protections for participants or beneficiaries that are 
     greater than the coverage or protections provided under this 
     section.
       ``(f) Definition.--In this section, the term `outpatient 
     contraceptive services' means consultations, examinations, 
     procedures, and medical services, provided on an outpatient 
     basis and related to the use of contraceptive methods 
     (including natural family planning) to prevent an unintended 
     pregnancy.''.
       (b) Clerical Amendment.--The table of contents in section 1 
     of the Employee Retirement Income Security Act of 1974 (29 
     U.S.C. 1001) is amended by inserting after the item relating 
     to section 713 the following:

``Sec. 715. Standards relating to benefits for contraceptives.''.
       (c) Effective Date.--The amendments made by this section 
     shall apply with respect to plan years beginning on or after 
     January 1, 2010.

     SEC. 203. AMENDMENTS TO PUBLIC HEALTH SERVICE ACT RELATING TO 
                   THE GROUP MARKET.

       (a) In General.--Subpart 2 of part A of title XXVII of the 
     Public Health Service Act (42 U.S.C. 300gg-4 et seq.) is 
     amended by adding at the end the following:

     ``SEC. 2708. STANDARDS RELATING TO BENEFITS FOR 
                   CONTRACEPTIVES.

       ``(a) Requirements for Coverage.--A group health plan, and 
     a health insurance issuer providing health insurance coverage 
     in connection with a group health plan, may not--
       ``(1) exclude or restrict benefits for prescription 
     contraceptive drugs or devices approved by the Food and Drug 
     Administration, or generic equivalents approved as 
     substitutable by the Food and Drug Administration, if such 
     plan or coverage provides benefits for other outpatient 
     prescription drugs or devices; or
       ``(2) exclude or restrict benefits for outpatient 
     contraceptive services if such plan or coverage provides 
     benefits for other outpatient services provided by a health 
     care professional (referred to in this section as `outpatient 
     health care services').
       ``(b) Prohibitions.--A group health plan, and a health 
     insurance issuer providing health insurance coverage in 
     connection with a group health plan, may not--
       ``(1) deny to an individual eligibility, or continued 
     eligibility, to enroll or to renew coverage under the terms 
     of the plan because of the individual's or enrollee's use or 
     potential use of items or services that are covered in 
     accordance with the requirements of this section;
       ``(2) provide monetary payments or rebates to a covered 
     individual to encourage such individual to accept less than 
     the minimum protections available under this section;
       ``(3) penalize or otherwise reduce or limit the 
     reimbursement of a health care professional because such 
     professional prescribed contraceptive drugs or devices, or 
     provided contraceptive services, described in subsection (a), 
     in accordance with this section; or
       ``(4) provide incentives (monetary or otherwise) to a 
     health care professional to induce such professional to 
     withhold from covered individual contraceptive drugs or 
     devices, or contraceptive services, described in subsection 
     (a).
       ``(c) Rules of Construction.--
       ``(1) In general.--Nothing in this section shall be 
     construed--
       ``(A) as preventing a group health plan and a health 
     insurance issuer providing health insurance coverage in 
     connection with a group health plan from imposing 
     deductibles, coinsurance, or other cost-sharing or 
     limitations in relation to--
       ``(i) benefits for contraceptive drugs under the plan or 
     coverage, except that such a deductible, coinsurance, or 
     other cost-sharing or limitation for any such drug shall be 
     consistent with those imposed for other outpatient 
     prescription drugs otherwise covered under the plan or 
     coverage;
       ``(ii) benefits for contraceptive devices under the plan or 
     coverage, except that such a deductible, coinsurance, or 
     other cost-sharing or limitation for any such device shall be 
     consistent with those imposed for other outpatient 
     prescription devices otherwise covered under the plan or 
     coverage; and
       ``(iii) benefits for outpatient contraceptive services 
     under the plan or coverage, except that such a deductible, 
     coinsurance, or other cost-sharing or limitation for any such 
     service shall be consistent with those imposed for other 
     outpatient health care services otherwise covered under the 
     plan or coverage;
       ``(B) as requiring a group health plan and a health 
     insurance issuer providing health insurance coverage in 
     connection with a group health plan to cover experimental or 
     investigational contraceptive drugs or devices, or 
     experimental or investigational contraceptive services, 
     described in subsection (a), except to the extent that the 
     plan or issuer provides coverage for other experimental or 
     investigational outpatient prescription drugs or devices, or 
     experimental or investigational outpatient health care 
     services; or
       ``(C) as modifying, diminishing, or limiting the rights or 
     protections of an individual under any other Federal law.
       ``(2) Limitations.--As used in paragraph (1), the term 
     `limitation' includes--
       ``(A) in the case of a contraceptive drug or device, 
     restricting the type of health care professionals that may 
     prescribe such drugs or devices, utilization review 
     provisions, and limits on the volume of prescription drugs or 
     devices that may be obtained on the basis of a single 
     consultation with a professional; or
       ``(B) in the case of an outpatient contraceptive service, 
     restricting the type of health care professionals that may 
     provide such services, utilization review provisions, 
     requirements relating to second opinions prior to the 
     coverage of such services, and requirements relating to 
     preauthorizations prior to the coverage of such services.
       ``(d) Notice.--A group health plan under this part shall 
     comply with the notice requirement under section 715(d) of 
     the Employee Retirement Income Security Act of 1974 with 
     respect to the requirements of this section as if such 
     section applied to such plan.
       ``(e) Preemption.--Nothing in this section shall be 
     construed to preempt any provision of State law to the extent 
     that such State law establishes, implements, or continues in 
     effect any standard or requirement that provides coverage or 
     protections for enrollees that are greater than the coverage 
     or protections provided under this section.
       ``(f) Definition.--In this section, the term `outpatient 
     contraceptive services' means consultations, examinations, 
     procedures, and medical services, provided on an outpatient 
     basis and related to the use of contraceptive methods 
     (including natural family planning) to prevent an unintended 
     pregnancy.''.
       (b) Effective Date.--The amendments made by this section 
     shall apply with respect to group health plans for plan years 
     beginning on or after January 1, 2010.

     SEC. 204. AMENDMENT TO PUBLIC HEALTH SERVICE ACT RELATING TO 
                   THE INDIVIDUAL MARKET.

       (a) In General.--Part B of title XXVII of the Public Health 
     Service Act (42 U.S.C. 300gg-41 et seq.) is amended--
       (1) by redesignating the first subpart 3 (relating to other 
     requirements) as subpart 2; and
       (2) by adding at the end of subpart 2 the following:

     ``SEC. 2754. STANDARDS RELATING TO BENEFITS FOR 
                   CONTRACEPTIVES.

       ``The provisions of section 2708 shall apply to health 
     insurance coverage offered by a health insurance issuer in 
     the individual market in the same manner as they apply to 
     health insurance coverage offered by a health insurance 
     issuer in connection with a group health plan in the small or 
     large group market.''.
       (b) Effective Date.--The amendment made by this section 
     shall apply with respect to health insurance coverage 
     offered, sold, issued, renewed, in effect, or operated in the 
     individual market on or after January 1, 2008.

      TITLE III--EMERGENCY CONTRACEPTION EDUCATION AND INFORMATION

     SEC. 301. SHORT TITLE.

       This title may be cited as the ``Emergency Contraception 
     Education Act of 2009''.

     SEC. 302. EMERGENCY CONTRACEPTION EDUCATION AND INFORMATION 
                   PROGRAMS.

       (a) Definitions.--For purposes of this section:
       (1) Emergency contraception.--The term ``emergency 
     contraception'' means a drug or device (as the terms are 
     defined in section 201 of the Federal Food, Drug, and 
     Cosmetic Act (21 U.S.C. 321)) or a drug regimen that is--
       (A) used after sexual relations;
       (B) prevents pregnancy, by preventing ovulation, 
     fertilization of an egg, or implantation of an egg in a 
     uterus; and
       (C) approved by the Food and Drug Administration.
       (2) Health care provider.--The term ``health care 
     provider'' means an individual who is licensed or certified 
     under State law to provide health care services and who is 
     operating within the scope of such license.
       (3) Institution of higher education.--The term 
     ``institution of higher education'' has

[[Page S50]]

     the same meaning given such term in section 101(a) of the 
     Higher Education Act of 1965 (20 U.S.C. 1001(a)).
       (4) Secretary.--The term ``Secretary'' means the Secretary 
     of Health and Human Services.
       (b) Emergency Contraception Public Education Program.--
       (1) In general.--The Secretary, acting through the Director 
     of the Centers for Disease Control and Prevention, shall 
     develop and disseminate to the public information on 
     emergency contraception.
       (2) Dissemination.--The Secretary may disseminate 
     information under paragraph (1) directly or through 
     arrangements with nonprofit organizations, consumer groups, 
     institutions of higher education, Federal, State, or local 
     agencies, clinics, and the media.
       (3) Information.--The information disseminated under 
     paragraph (1) shall include, at a minimum, a description of 
     emergency contraception and an explanation of the use, 
     safety, efficacy, and availability of such contraception.
       (c) Emergency Contraception Information Program for Health 
     Care Providers.--
       (1) In general.--The Secretary, acting through the 
     Administrator of the Health Resources and Services 
     Administration and in consultation with major medical and 
     public health organizations, shall develop and disseminate to 
     health care providers information on emergency contraception.
       (2) Information.--The information disseminated under 
     paragraph (1) shall include, at a minimum--
       (A) information describing the use, safety, efficacy, and 
     availability of emergency contraception;
       (B) a recommendation regarding the use of such 
     contraception in appropriate cases; and
       (C) information explaining how to obtain copies of the 
     information developed under subsection (b) for distribution 
     to the patients of the providers.
       (d) Authorization of Appropriations.--There are authorized 
     to be appropriated to carry out this section such sums as may 
     be necessary for each of the fiscal years 2010 through 2014.

        TITLE IV--COMPASSIONATE ASSISTANCE FOR RAPE EMERGENCIES

     SEC. 401. SHORT TITLE.

       This title may be cited as the ``Compassionate Assistance 
     for Rape Emergencies Act of 2009''.

     SEC. 402. SURVIVORS OF SEXUAL ASSAULT; PROVISION BY HOSPITALS 
                   OF EMERGENCY CONTRACEPTIVES WITHOUT CHARGE.

       (a) In General.--Federal funds may not be provided to a 
     hospital under any health-related program, unless the 
     hospital meets the conditions specified in subsection (b) in 
     the case of--
       (1) any woman who presents at the hospital and states that 
     she is a victim of sexual assault, or is accompanied by 
     someone who states she is a victim of sexual assault; and
       (2) any woman who presents at the hospital whom hospital 
     personnel have reason to believe is a victim of sexual 
     assault.
       (b) Assistance for Victims.--The conditions specified in 
     this subsection regarding a hospital and a woman described in 
     subsection (a) are as follows:
       (1) The hospital promptly provides the woman with medically 
     and factually accurate and unbiased written and oral 
     information about emergency contraception, including 
     information explaining that--
       (A) emergency contraception does not cause an abortion; and
       (B) emergency contraception is effective in most cases in 
     preventing pregnancy after unprotected sex.
       (2) The hospital promptly offers emergency contraception to 
     the woman, and promptly provides such contraception to her on 
     her request.
       (3) The information provided pursuant to paragraph (1) is 
     in clear and concise language, is readily comprehensible, and 
     meets such conditions regarding the provision of the 
     information in languages other than English as the Secretary 
     may establish.
       (4) The services described in paragraphs (1) through (3) 
     are not denied because of the inability of the woman or her 
     family to pay for the services.
       (c) Definitions.--For purposes of this section:
       (1) The term ``emergency contraception'' means a drug, drug 
     regimen, or device that--
       (A) is used postcoitally;
       (B) prevents pregnancy by delaying ovulation, preventing 
     fertilization of an egg, or preventing implantation of an egg 
     in a uterus; and
       (C) is approved by the Food and Drug Administration.
       (2) The term ``hospital'' has the meanings given such term 
     in title XVIII of the Social Security Act, including the 
     meaning applicable in such title for purposes of making 
     payments for emergency services to hospitals that do not have 
     agreements in effect under such title.
       (3) The term ``Secretary'' means the Secretary of Health 
     and Human Services.
       (4) The term ``sexual assault'' means coitus in which the 
     woman involved does not consent or lacks the legal capacity 
     to consent.
       (d) Effective Date; Agency Criteria.--This section takes 
     effect upon the expiration of the 180-day period beginning on 
     the date of the enactment of this Act. Not later than 30 days 
     prior to the expiration of such period, the Secretary shall 
     publish in the Federal Register criteria for carrying out 
     this section.

       TITLE V--AT-RISK COMMUNITIES TEEN PREGNANCY PREVENTION ACT

     SEC. 501. SHORT TITLE.

       This title may be cited as the ``At-Risk Communities Teen 
     Pregnancy Prevention Act of 2009''.

     SEC. 502. TEENAGE PREGNANCY PREVENTION.

       Part P of title III of the Public Health Service Act (42 
     U.S.C. 280g et seq.) is amended by inserting after section 
     399N the following section:

     ``SEC. 399N-1. TEENAGE PREGNANCY PREVENTION GRANTS.

       ``(a) Authority.--The Secretary may award on a competitive 
     basis grants to public and private entities to establish or 
     expand teenage pregnancy prevention programs.
       ``(b) Grant Recipients.--Grant recipients under this 
     section may include State and local not-for-profit coalitions 
     working to prevent teenage pregnancy, State, local, and 
     tribal agencies, schools, entities that provide after-school 
     programs, and community and faith-based groups.
       ``(c) Priority.--In selecting grant recipients under this 
     section, the Secretary shall give--
       ``(1) highest priority to applicants seeking assistance for 
     programs targeting communities or populations in which--
       ``(A) teenage pregnancy or birth rates are higher than the 
     corresponding State average; or
       ``(B) teenage pregnancy or birth rates are increasing; and
       ``(2) priority to applicants seeking assistance for 
     programs that--
       ``(A) will benefit underserved or at-risk populations such 
     as young males or immigrant youths; or
       ``(B) will take advantage of other available resources and 
     be coordinated with other programs that serve youth, such as 
     workforce development and after school programs.
       ``(d) Use of Funds.--Funds received by an entity as a grant 
     under this section shall be used for programs that--
       ``(1) replicate or substantially incorporate the elements 
     of one or more teenage pregnancy prevention programs that 
     have been proven (on the basis of rigorous scientific 
     research) to delay sexual intercourse or sexual activity, 
     increase condom or contraceptive use without increasing 
     sexual activity, or reduce teenage pregnancy; and
       ``(2) incorporate one or more of the following strategies 
     for preventing teenage pregnancy: encouraging teenagers to 
     delay sexual activity; sex and HIV education; interventions 
     for sexually active teenagers; preventive health services; 
     youth development programs; service learning programs; and 
     outreach or media programs.
       ``(e) Complete Information.--Programs receiving funds under 
     this section that choose to provide information on HIV/AIDS 
     or contraception or both must provide information that is 
     complete and medically accurate.
       ``(f) Relation to Abstinence-Only Programs.--Funds under 
     this section are not intended for use by abstinence-only 
     education programs. Abstinence-only education programs that 
     receive Federal funds through the Maternal and Child Health 
     Block Grant, the Administration for Children and Families, 
     the Adolescent Family Life Program, and any other program 
     that uses the definition of `abstinence education' found in 
     section 510(b) of the Social Security Act are ineligible for 
     funding.
       ``(g) Applications.--Each entity seeking a grant under this 
     section shall submit an application to the Secretary at such 
     time and in such manner as the Secretary may require.
       ``(h) Matching Funds.--
       ``(1) In general.--The Secretary may not award a grant to 
     an applicant for a program under this section unless the 
     applicant demonstrates that it will pay, from funds derived 
     from non-Federal sources, at least 25 percent of the cost of 
     the program.
       ``(2) Applicant's share.--The applicant's share of the cost 
     of a program shall be provided in cash or in kind.
       ``(i) Supplementation of Funds.--An entity that receives 
     funds as a grant under this section shall use the funds to 
     supplement and not supplant funds that would otherwise be 
     available to the entity for teenage pregnancy prevention.
       ``(j) Evaluations.--
       ``(1) In general.--The Secretary shall--
       ``(A) conduct or provide for a rigorous evaluation of 10 
     percent of programs for which a grant is awarded under this 
     section;
       ``(B) collect basic data on each program for which a grant 
     is awarded under this section; and
       ``(C) upon completion of the evaluations referred to in 
     subparagraph (A), submit to the Congress a report that 
     includes a detailed statement on the effectiveness of grants 
     under this section.
       ``(2) Cooperation by grantees.--Each grant recipient under 
     this section shall provide such information and cooperation 
     as may be required for an evaluation under paragraph (1).
       ``(k) Definition.--For purposes of this section, the term 
     `rigorous scientific research' means based on a program 
     evaluation that:
       ``(1) Measured impact on sexual or contraceptive behavior, 
     pregnancy or childbearing.
       ``(2) Employed an experimental or quasi-experimental design 
     with well-constructed and appropriate comparison groups.
       ``(3) Had a sample size large enough (at least 100 in the 
     combined treatment and control group) and a follow-up 
     interval long

[[Page S51]]

     enough (at least six months) to draw valid conclusions about 
     impact.
       ``(l) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section such 
     sums as may be necessary for fiscal year 2010 and each 
     subsequent fiscal year.''.

     SEC. 503. RESEARCH.

       (a) In General.--The Secretary of Health and Human 
     Services, acting through the Director of the Centers for 
     Disease Control and Prevention, shall make grants to public 
     or nonprofit private entities to conduct, support, and 
     coordinate research on the prevention of teen pregnancy in 
     eligible communities, including research on the factors 
     contributing to the disproportionate rates of teen pregnancy 
     in such communities.
       (b) Research.--In carrying out subsection (a), the 
     Secretary of Health and Human Services shall support research 
     that--
       (1) investigates and determines the incidence and 
     prevalence of teen pregnancy in communities described in such 
     subsection;
       (2) examines--
       (A) the extent of the impact of teen pregnancy on--
       (i) the health and well-being of teenagers in the 
     communities; and
       (ii) the scholastic achievement of such teenagers;
       (B) the variance in the rates of teen pregnancy by--
       (i) location (such as inner cities, inner suburbs, and 
     outer suburbs);
       (ii) population subgroup (such as Hispanic, Asian-Pacific 
     Islander, African-American, Native American); and
       (iii) level of acculturation;
       (C) the importance of the physical and social environment 
     as a factor in placing communities at risk of increased rates 
     of teen pregnancy; and
       (D) the importance of aspirations as a factor affecting 
     young women's risk of teen pregnancy; and
       (3) is used to develop--
       (A) measures to address race, ethnicity, socioeconomic 
     status, environment, and educational attainment and the 
     relationship to the incidence and prevalence of teen 
     pregnancy; and
       (B) efforts to link the measures to relevant databases, 
     including health databases.
       (c) Priority.--In making grants under subsection (a), the 
     Secretary of Health and Human Services shall give priority to 
     research that incorporates--
       (1) interdisciplinary approaches; or
       (2) a strong emphasis on community-based participatory 
     research.
       (d) Authorization of Appropriations.--For the purpose of 
     carrying out this section, there is authorized to be 
     appropriated such sums as may be necessary for each of the 
     fiscal years 2010 through 2014.

     SEC. 504. GENERAL REQUIREMENTS.

       (a) Medically Accurate Information.--A grant may be made 
     under this title only if the applicant involved agrees that 
     all information provided pursuant to the grant will be age-
     appropriate, factually and medically accurate and complete, 
     and scientifically based.
       (b) Cultural Context of Services.--A grant may be made 
     under this title only if the applicant involved agrees that 
     information, activities, and services under the grant that 
     are directed toward a particular population group will be 
     provided in the language and cultural context that is most 
     appropriate for individuals in such group.
       (c) Application for Grant.--A grant may be made under this 
     title only if an application for the grant is submitted to 
     the Secretary of Health and Human Services and the 
     application is in such form, is made in such manner, and 
     contains such agreements, assurances, and information as the 
     Secretary of Health and Human Services determines to be 
     necessary to carry out the program involved.

            TITLE VI--ACCURACY OF CONTRACEPTIVE INFORMATION

     SEC. 601. SHORT TITLE.

       This title may be cited as the ``Truth in Contraception Act 
     of 2009''.

     SEC. 602. ACCURACY OF CONTRACEPTIVE INFORMATION.

       Notwithstanding any other provision of law, any information 
     concerning the use of a contraceptive provided through any 
     federally funded sex education, family life education, 
     abstinence education, comprehensive health education, or 
     character education program shall be medically accurate and 
     shall include health benefits and failure rates relating to 
     the use of such contraceptive.

             TITLE VII--UNINTENDED PREGNANCY REDUCTION ACT

     SEC. 701. SHORT TITLE.

       This title may be cited as the ``Unintended Pregnancy 
     Reduction Act of 2009''.

     SEC. 702. MEDICAID; CLARIFICATION OF COVERAGE OF FAMILY 
                   PLANNING SERVICES AND SUPPLIES.

       Section 1937(b) of the Social Security Act (42 U.S.C. 
     1396u-7(b)) is amended by adding at the end the following:
       ``(5) Coverage of family planning services and supplies.--
     Notwithstanding the previous provisions of this section, a 
     State may not provide for medical assistance through 
     enrollment of an individual with benchmark coverage or 
     benchmark-equivalent coverage under this section unless such 
     coverage includes for any individual described in section 
     1905(a)(4)(C), medical assistance for family planning 
     services and supplies in accordance with such section.''.

     SEC. 703. EXPANSION OF FAMILY PLANNING SERVICES.

       (a) Coverage as Mandatory Categorically Needy Group.--
       (1) In general.--Section 1902(a)(10)(A)(i) of the Social 
     Security Act (42 U.S.C. 1396a(a)(10)(A)(i)) is amended--
       (A) in subclause (VI), by striking ``or'' at the end;
       (B) in subclause (VII), by adding ``or'' at the end; and
       (C) by adding at the end the following new subclause:

       ``(VIII) who are described in subsection (dd) (relating to 
     individuals who meet the income standards for pregnant 
     women);''.

       (2) Group described.--Section 1902 of the Social Security 
     Act (42 U.S.C. 1396a) is amended by adding at the end the 
     following new subsection:
       ``(dd)(1) Individuals described in this subsection are 
     individuals--
       ``(A) meet at least the income eligibility standards 
     established under the State plan as of January 1, 2009, for 
     pregnant women or such higher income eligibility standard for 
     such women as the State may establish; and
       ``(B) are not pregnant.
       ``(2) At the option of a State, individuals described in 
     this subsection may include individuals who are determined to 
     meet the income eligibility standards referred to in 
     paragraph (1)(A) under the terms and conditions applicable to 
     making eligibility determinations for medical assistance 
     under this title under a waiver to provide the benefits 
     described in clause (XV) of the matter following subparagraph 
     (G) of section 1902(a)(10) granted to the State under section 
     1115 as of January 1, 2007.''.
       (3) Limitation on benefits.--Section 1902(a)(10) of the 
     Social Security Act (42 U.S.C. 1396a(a)(10)) is amended in 
     the matter following subparagraph (G)--
       (A) by striking ``and (XIV)'' and inserting ``(XIV)''; and
       (B) by inserting ``, and (XV) the medical assistance made 
     available to an individual described in subsection (dd) shall 
     be limited to family planning services and supplies described 
     in 1905(a)(4)(C) including medical diagnosis and treatment 
     services that are provided pursuant to a family planning 
     service in a family planning setting;'' after ``cervical 
     cancer''.
       (4) Conforming amendments.--Section 1905(a) of the Social 
     Security Act (42 U.S.C. 1396d(a)) is amended in the matter 
     preceding paragraph (1)--
       (A) in clause (xii), by striking ``or'' at the end;
       (B) in clause (xii), by adding ``or'' at the end; and
       (C) by inserting after clause (xiii) the following:
       ``(xiv) individuals described in section 1902(dd),''.
       (b) Presumptive Eligibility.--
       (1) In general.--Title XIX of the Social Security Act (42 
     U.S.C. 1396 et seq.) is amended by inserting after section 
     1920B the following:

         ``presumptive eligibility for family planning services

       ``Sec. 1920C.  (a) State Option.--A State plan approved 
     under section 1902 may provide for making medical assistance 
     available to an individual described in section 1902(dd) 
     (relating to individuals who meet certain income eligibility 
     standards) during a presumptive eligibility period. In the 
     case of an individual described in section 1902(dd)), such 
     medical assistance shall be limited to family planning 
     services and supplies described in 1905(a)(4)(C) including 
     medical diagnosis and treatment services that are provided 
     pursuant to a family planning service in a family planning 
     setting.
       ``(b) Definitions.--For purposes of this section:
       ``(1) Presumptive eligibility period.--The term 
     `presumptive eligibility period' means, with respect to an 
     individual described in subsection (a), the period that--
       ``(A) begins with the date on which a qualified entity 
     determines, on the basis of preliminary information, that the 
     individual is described in section 1902(dd); and
       ``(B) ends with (and includes) the earlier of--
       ``(i) the day on which a determination is made with respect 
     to the eligibility of such individual for services under the 
     State plan; or
       ``(ii) in the case of such an individual who does not file 
     an application by the last day of the month following the 
     month during which the entity makes the determination 
     referred to in subparagraph (A), such last day.
       ``(2) Qualified entity.--
       ``(A) In general.--Subject to subparagraph (B), the term 
     `qualified entity' means any entity that--
       ``(i) is eligible for payments under a State plan approved 
     under this title; and
       ``(ii) is determined by the State agency to be capable of 
     making determinations of the type described in paragraph 
     (1)(A).
       ``(B) Rule of construction.--Nothing in this paragraph 
     shall be construed as preventing a State from limiting the 
     classes of entities that may become qualified entities.
       ``(c) Administration.--
       ``(1) In general.--The State agency shall provide qualified 
     entities with--
       ``(A) such forms as are necessary for an application to be 
     made by an individual described in subsection (a) for medical 
     assistance under the State plan; and

[[Page S52]]

       ``(B) information on how to assist such individuals in 
     completing and filing such forms.
       ``(2) Notification requirements.--A qualified entity that 
     determines under subsection (b)(1)(A) that an individual 
     described in subsection (a) is presumptively eligible for 
     medical assistance under a State plan shall--
       ``(A) notify the State agency of the determination within 5 
     working days after the date on which determination is made; 
     and
       ``(B) inform such individual at the time the determination 
     is made that an application for medical assistance is 
     required to be made by not later than the last day of the 
     month following the month during which the determination is 
     made.
       ``(3) Application for medical assistance.--In the case of 
     an individual described in subsection (a) who is determined 
     by a qualified entity to be presumptively eligible for 
     medical assistance under a State plan, the individual shall 
     apply for medical assistance by not later than the last day 
     of the month following the month during which the 
     determination is made.
       ``(d) Payment.--Notwithstanding any other provision of this 
     title, medical assistance that--
       ``(1) is furnished to an individual described in subsection 
     (a)--
       ``(A) during a presumptive eligibility period;
       ``(B) by a entity that is eligible for payments under the 
     State plan; and
       ``(2) is included in the care and services covered by the 
     State plan, shall be treated as medical assistance provided 
     by such plan for purposes of clause (4) of the first sentence 
     of section 1905(b).''.
       (2) Conforming amendments.--
       (A) Section 1902(a)(47) of the Social Security Act (42 
     U.S.C. 1396a(a)(47)) is amended by inserting before the 
     semicolon at the end the following: ``and provide for making 
     medical assistance available to individuals described in 
     subsection (a) of section 1920C during a presumptive 
     eligibility period in accordance with such section.''.
       (B) Section 1903(u)(1)(D)(v) of such Act (42 U.S.C. 
     1396b(u)(1)(D)(v)) is amended--
       (i) by striking ``or for'' and inserting ``, for''; and
       (ii) by inserting before the period the following: ``, or 
     for medical assistance provided to an individual described in 
     subsection (a) of section 1920C during a presumptive 
     eligibility period under such section''.

     SEC. 704. EFFECTIVE DATE.

       (a) In General.--Except as provided in paragraph (2), the 
     amendments made by this title take effect on October 1, 2009.
       (b) Extension of Effective Date for State Law Amendment.--
     In the case of a State plan under title XIX of the Social 
     Security Act (42 U.S.C. 1396 et seq.) which the Secretary of 
     Health and Human Services determines requires State 
     legislation in order for the plan to meet the additional 
     requirements imposed by the amendments made by this title, 
     the State plan shall not be regarded as failing to comply 
     with the requirements of such title solely on the basis of 
     its failure to meet these additional requirements before the 
     first day of the first calendar quarter beginning after the 
     close of the first regular session of the State legislature 
     that begins after the date of the enactment of this Act. For 
     purposes of the previous sentence, in the case of a State 
     that has a 2-year legislative session, each year of the 
     session is considered to be a separate regular session of the 
     State legislature.

            TITLE VIII--RESPONSIBLE EDUCATION ABOUT LIFE ACT

     SEC. 801. SHORT TITLE.

       This title may be cited as the ``Responsible Education 
     About Life Act of 2009''.

     SEC. 802. ASSISTANCE TO REDUCE TEEN PREGNANCY, HIV/AIDS, AND 
                   OTHER SEXUALLY TRANSMITTED DISEASES AND TO 
                   SUPPORT HEALTHY ADOLESCENT DEVELOPMENT.

       (a) In General.--Each eligible State shall be eligible to 
     receive from the Secretary of Health and Human Services, for 
     each of the fiscal years 2010 through 2014, a grant to 
     conduct programs of family life education, including 
     education on both abstinence and contraception for the 
     prevention of teenage pregnancy and sexually transmitted 
     diseases, including HIV/AIDS.
       (b) Requirements for Family Life Programs.--For purposes of 
     this title, a program of family life education is a program 
     that--
       (1) is age-appropriate and medically accurate;
       (2) does not teach or promote religion;
       (3) teaches that abstinence is the only sure way to avoid 
     pregnancy or sexually transmitted diseases;
       (4) stresses the value of abstinence while not ignoring 
     those young people who have had or are having sexual 
     intercourse;
       (5) provides information about the health benefits and side 
     effects of all contraceptives and barrier methods as a means 
     to prevent pregnancy and reduce the risk of contracting 
     sexually transmitted diseases, including HIV/AIDS;
       (6) encourages family communication between parent and 
     child about sexuality;
       (7) teaches young people the skills to make responsible 
     decisions about sexuality, including how to avoid unwanted 
     verbal, physical, and sexual advances; and
       (8) teaches young people how alcohol and drug use can 
     effect responsible decision making.
       (c) Additional Activities.--In carrying out a program of 
     family life education, a State may expend a grant under 
     subsection (a) to carry out educational and motivational 
     activities that help young people--
       (1) gain knowledge about the physical, emotional, 
     biological, and hormonal changes of adolescence and 
     subsequent stages of human maturation;
       (2) develop the knowledge and skills necessary to ensure 
     and protect their sexual and reproductive health from 
     unintended pregnancy and sexually transmitted disease, 
     including HIV/AIDS throughout their lifespan;
       (3) gain knowledge about the specific involvement and 
     responsibility of males in sexual decision making;
       (4) develop healthy attitudes and values about adolescent 
     growth and development, body image, racial and ethnic 
     diversity, and other related subjects;
       (5) develop and practice healthy life skills, including 
     goal-setting, decision making, negotiation, communication, 
     and stress management;
       (6) develop healthy relationships, including the prevention 
     of dating and relationship violence;
       (7) promote self-esteem and positive interpersonal skills 
     focusing on relationship dynamics, including friendships, 
     dating, romantic involvement, marriage and family 
     interactions; and
       (8) prepare for the adult world by focusing on educational 
     and career success, including developing skills for 
     employment preparation, job seeking, independent living, 
     financial self-sufficiency, and workplace productivity.

     SEC. 803. SENSE OF CONGRESS.

       It is the sense of Congress that while States are not 
     required under this title to provide matching funds, with 
     respect to grants authorized under section 802(a), they are 
     encouraged to do so.

     SEC. 804. EVALUATION OF PROGRAMS.

       (a) In General.--For the purpose of evaluating the 
     effectiveness of programs of family life education carried 
     out with a grant under section 802, evaluations of such 
     program shall be carried out in accordance with subsections 
     (b) and (c).
       (b) National Evaluation.--
       (1) In general.--The Secretary shall provide for a national 
     evaluation of a representative sample of programs of family 
     life education carried out with grants under section 802. A 
     condition for the receipt of such a grant is that the State 
     involved agree to cooperate with the evaluation. The purposes 
     of the national evaluation shall be the determination of--
       (A) the effectiveness of such programs in helping to delay 
     the initiation of sexual intercourse and other high-risk 
     behaviors;
       (B) the effectiveness of such programs in preventing 
     adolescent pregnancy;
       (C) the effectiveness of such programs in preventing 
     sexually transmitted disease, including HIV/AIDS;
       (D) the effectiveness of such programs in increasing 
     contraceptive knowledge and contraceptive behaviors when 
     sexual intercourse occurs; and
       (E) a list of best practices based upon essential 
     programmatic components of evaluated programs that have led 
     to success in subparagraphs (A) through (D).
       (2) Report.--A final report providing the results of the 
     national evaluation under paragraph (1) shall be submitted to 
     Congress not later than March 31, 2015, with an interim 
     report provided on an annual basis at the end of each fiscal 
     year under section 802(a).
       (c) Individual State Evaluations.--
       (1) In general.--A condition for the receipt of a grant 
     under section 802 is that the State involved agree to provide 
     for the evaluation of the programs of family education 
     carried out with the grant in accordance with the following:
       (A) The evaluation will be conducted by an external, 
     independent entity.
       (B) The purposes of the evaluation will be the 
     determination of--
       (i) the effectiveness of such programs in helping to delay 
     the initiation of sexual intercourse and other high-risk 
     behaviors;
       (ii) the effectiveness of such programs in preventing 
     adolescent pregnancy;
       (iii) the effectiveness of such programs in preventing 
     sexually transmitted disease, including HIV/AIDS; and
       (iv) the effectiveness of such programs in increasing 
     contraceptive knowledge and contraceptive behaviors when 
     sexual intercourse occurs.
       (2) Use of grant.--A condition for the receipt of a grant 
     under section 802 is that the State involved agree that not 
     more than 10 percent of the grant will be expended for the 
     evaluation under paragraph (1).

     SEC. 805. DEFINITIONS.

       For purposes of this title:
       (1) The term ``eligible State'' means a State that submits 
     to the Secretary an application for a grant under section 802 
     that is in such form, is made in such manner, and contains 
     such agreements, assurances, and information as the Secretary 
     determines to be necessary to carry out this title.
       (2) The term ``HIV/AIDS'' means the human immunodeficiency 
     virus, and includes acquired immune deficiency syndrome.
       (3) The term ``medically accurate'', with respect to 
     information, means information that is supported by research, 
     recognized as accurate and objective by leading medical, 
     psychological, psychiatric, and public health organizations 
     and agencies, and where relevant, published in peer review 
     journals.
       (4) The term ``Secretary'' means the Secretary of Health 
     and Human Services.

[[Page S53]]

     SEC. 806. APPROPRIATIONS.

       (a) In General.--For the purpose of carrying out this 
     title, there are authorized to be appropriated such sums as 
     may be necessary for each of the fiscal years 2010 through 
     2014.
       (b) Allocations.--Of the amounts appropriated under 
     subsection (a) for a fiscal year--
       (1) not more than 7 percent may be used for the 
     administrative expenses of the Secretary in carrying out this 
     title for that fiscal year; and
       (2) not more than 10 percent may be used for the national 
     evaluation under section 804(b).

             TITLE IX--PREVENTION THROUGH AFFORDABLE ACCESS

     SEC. 901. SHORT TITLE.

       This title may be cited as the ``Prevention Through 
     Affordable Access Act''.

     SEC. 902. RESTORING AND PROTECTING ACCESS TO DISCOUNT DRUG 
                   PRICES FOR UNIVERSITY-BASED AND SAFETY-NET 
                   CLINICS.

       (a) Restoring Nominal Pricing.--Section 1927(c)(1)(D)(i) of 
     the Social Security Act (42 U.S.C. 1396r-8(c)(1)(D)(i)) is 
     amended--
       (1) by redesignating subclause (IV) as subclause (VI); and
       (2) by inserting after subclause (III) the following new 
     subclauses:

       ``(IV) An entity that is operated by a health center of an 
     institution of higher education, the primary purpose of which 
     is to provide health services to students of that 
     institution.
       ``(V) An entity that is a public or private nonprofit 
     entity that provides a service or services described under 
     section 1001(a) of the Public Health Service Act.''.

       (b) Effective Date.--The amendments made by this section 
     shall be effective as of the date of the enactment of this 
     Act.
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