```

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 973 Introduced in House (IH)]

<DOC>

116th CONGRESS
  1st Session
                                H. R. 973

   To amend the Public Health Service Act to provide for additional 
    programs funded by grants to strengthen the healthcare system's 
  response to domestic violence, dating violence, sexual assault, and 
                   stalking, and for other purposes.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                            February 5, 2019

   Mrs. Dingell (for herself, Mr. Katko, Ms. Clarke of New York, Ms. 
Castor of Florida, Mrs. Rodgers of Washington, Ms. Eshoo, Ms. Stefanik, 
 Ms. Roybal-Allard, Mr. Cardenas, Ms. Wilson of Florida, Miss Gonzalez-
Colon of Puerto Rico, and Mr. Marshall) introduced the following bill; 
       which was referred to the Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL

 
   To amend the Public Health Service Act to provide for additional 
    programs funded by grants to strengthen the healthcare system's 
  response to domestic violence, dating violence, sexual assault, and 
                   stalking, and for other purposes.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Violence Against Women Health Act of 
2019''.

SEC. 2. FINDINGS.

    Congress finds that--
            (1) millions of Americans continue to experience domestic 
        or sexual violence each year with more than three women 
        murdered by their partners each day;
            (2) this type of violence and abuse results in short-term 
        and chronic physical and behavioral health consequences that 
        have a significant economic burden to victims and communities;
            (3) new CDC data found the lifetime per-victim cost of 
        intimate partner violence was $103,767 for women victims with 
        59 percent going to medical costs and public funding paid 37 
        percent of this total cost;
            (4) victims are also at a higher risk for developing 
        addictions to tobacco, alcohol, or drugs; for example, 31 
        percent to 67 percent of women in substance use disorder 
        treatment programs report experiencing domestic violence within 
        the past year;
            (5) over 50 percent of survivors of domestic violence have 
        experienced depression, post-traumatic stress disorder, and 
        substance use and 23 percent have experienced suicidality;
            (6) a study conducted by the National Domestic Violence 
        Hotline, in conjunction with the National Center on Domestic 
        Violence, Trauma & Mental Health practice mental health and 
        substance use coercion where abusers intentionally undermine 
        their partners' sanity or sobriety, control their access to 
        medication, and sabotage their treatment and recovery efforts 
        among other coercion tactics;
            (7) researchers have also found that exposure to multiple 
        childhood traumas such as sexual abuse and domestic violence 
        can cause long-term negative physical and emotional health 
        outcomes such as heart disease, cancer and depression;
            (8) health care providers can identify survivors of 
        violence and interventions can decrease risk for violence and 
        improve health outcomes, but health providers need training and 
        systems level support in order to do so;
            (9) Congress authorized a public health response to victims 
        of domestic and sexual violence in the Violence Against Women 
        Act of 2005;
            (10) since its enactment, the VAWA Health program has 
        trained more than 13,000 health care providers to assess for 
        and respond to domestic and sexual violence in over 230 
        clinical settings serving more than 1.3 million patients;
            (11) last year, the Health Resources & Services 
        Administration made this issue a priority across all of its 
        bureaus and released the ``HRSA Strategy to Address Intimate 
        Partner Violence 2017-2020'' with four key priorities:
                    (A) Train the Nation's health care and public 
                health workforce to address intimate partner violence 
                (IPV) at the community and health systems levels.
                    (B) Develop partnerships to raise awareness about 
                IPV within HRSA and HHS.
                    (C) Increase access to quality IPV-informed health 
                care services across all populations.
                    (D) Address gaps in knowledge about IPV risks, 
                impacts, and interventions.; and
            (12) a strong public health response can prevent and 
        address the immediate and long-term health impacts of this type 
        of violence and abuse.

SEC. 3. GRANTS TO STRENGTHEN THE HEALTH CARE SYSTEM'S RESPONSE TO 
              DOMESTIC VIOLENCE, DATING VIOLENCE, SEXUAL ASSAULT, AND 
              STALKING, AND FOR OTHER PURPOSES.

    Section 399P of the Public Health Service Act (42 U.S.C. 280g-4) is 
amended--
            (1) in subsection (a)--
                    (A) in paragraph (2), by striking ``and'' at the 
                end;
                    (B) in paragraph (3), by striking the period at the 
                end and inserting ``; and''; and
                    (C) by adding at the end the following:
            ``(4) development or enhancement and implementation of 
        training programs to improve the capacity of early childhood 
        programs to address domestic violence, dating violence, sexual 
        assault, and stalking among families they serve.'';
            (2) in subsection (b)--
                    (A) in paragraph (1)--
                            (i) in subparagraph (A)(ii), by inserting 
                        after ``and other forms of violence and abuse'' 
                        the following: ``(including labor and sex 
                        trafficking)''; and
                            (ii) in subparagraph (B)--
                                    (I) in clause (ii)--
                                            (aa) by striking ``on-site 
                                        access to''; and
                                            (bb) by striking ``or to 
                                        model other services 
                                        appropriate to the geographic 
                                        and cultural needs of a site'' 
                                        and inserting the following: 
                                        ``or by providing funding to 
                                        national, State, Tribal, or 
                                        territorial domestic and sexual 
                                        violence coalitions to improve 
                                        their capacity to coordinate 
                                        and support health advocates 
                                        and health system 
                                        partnerships'';
                                    (II) in clause (iii), by striking 
                                ``and'' at the end;
                                    (III) in clause (iv), by striking 
                                the period at the end and inserting ``, 
                                with priority given to programs 
                                administered through the Health 
                                Resources and Services Administration, 
                                Office of Women's Health; and''; and
                                    (IV) by adding at the end the 
                                following:
                            ``(v) the development, dissemination, and 
                        evaluation of best practices, tools and 
                        training materials for behavioral health 
                        professionals to identify and respond to 
                        domestic violence, sexual violence, stalking, 
                        and dating violence.''; and
                    (B) in paragraph (2)--
                            (i) in subparagraph (A), to read as 
                        follows:
                    ``(A) Child abuse and abuse in later life.--To the 
                extent consistent with the purpose of this section, a 
                grantee may address, as part of a comprehensive 
                programmatic approach implemented under a grant under 
                this section, issues relating to child abuse or abuse 
                in later life.''; and
                            (ii) in subparagraph (C)--
                                    (I) in clause (i), by striking 
                                ``elder abuse'' and inserting ``abuse 
                                in later life'';
                                    (II) in clause (iv)--
                                            (aa) by inserting ``, 
                                        mental health'' after 
                                        ``dental'';
                                            (bb) by inserting ``and 
                                        certification'' after 
                                        ``exams''; and
                                            (cc) by striking the period 
                                        at the end and inserting ``; 
                                        and''; and
                                    (III) by adding at the end the 
                                following:
                            ``(v) development of a state-level pilot 
                        program to improve the response of substance 
                        use disorder treatment programs and systems to 
                        domestic violence, dating violence, sexual 
                        assault, and stalking and the capacity of 
                        domestic violence, dating violence, sexual 
                        assault, and stalking to serve survivors 
                        dealing with substance use disorder; and
                            ``(vi) development and utilization of 
                        existing technical assistance and training 
                        resources to improve the capacity of substance 
                        use disorder treatment programs to address 
                        domestic violence, dating violence, sexual 
                        assault, and stalking among patients they 
                        serve.'';
            (3) in subsection (d)(2)--
                    (A) in subparagraph (A)--
                            (i) by inserting ``or behavioral health,'' 
                        after ``a State department (or other division) 
                        of health,''; and
                            (ii) by striking ``mental health care'' and 
                        inserting ``behavioral health care''; and
                    (B) in subparagraph (B)--
                            (i) by striking ``or health system'' and 
                        inserting ``behavioral health treatment 
                        system''; and
                            (ii) by striking ``mental health care'' and 
                        inserting ``behavioral health care'';
            (4) in subsection (f), to read as follows:
    ``(f) Research, and Evaluation, and Data Collection.--
            ``(1) In general.--Of the funds made available to carry out 
        this section for any fiscal year, the Secretary may use not 
        more than 20 percent to make a grant or enter into a contract 
        for research, and evaluation, or data collection of--
                    ``(A) grants awarded under this section; and
                    ``(B) other training for health professionals and 
                effective interventions in the health care or 
                behavioral health setting that prevent domestic 
                violence, dating violence, and sexual assault across 
                the lifespan, prevent the health effects of such 
                violence, and improve the safety and health of 
                individuals who are currently being victimized.
            ``(2) Research and data collection.--Research or data 
        collection authorized in paragraph (1) may include--
                    ``(A) research on the effects of domestic violence, 
                dating violence, sexual assault, and childhood exposure 
                to domestic, dating or sexual violence on health 
                behaviors, health conditions, and health status of 
                individuals, families, and populations, including 
                underserved populations;
                    ``(B) research to determine effective health care 
                interventions to respond to and prevent domestic 
                violence, dating violence, sexual assault, and 
                stalking;
                    ``(C) research on the impact of domestic, dating 
                and sexual violence, childhood exposure to such 
                violence, and stalking on the health care system, 
                health care utilization, health care costs, and health 
                status;
                    ``(D) research on the impact of adverse childhood 
                experiences on adult experience with domestic violence, 
                dating violence, sexual assault, stalking and adult 
                health outcomes, including how to reduce or prevent the 
                impact of adverse childhood experiences through the 
                health care setting;
                    ``(E) research on the intersection of substance use 
                disorder and domestic violence, dating violence, sexual 
                assault, and stalking, including effect of coerced use 
                and efforts by an abusive partner or other to interfere 
                with substance use disorder treatment and recovery; and
                    ``(F) improved data collection using existing 
                federal surveys by including questions about domestic 
                violence, dating violence, sexual assault, or stalking 
                and substance use disorder, coerced use, and mental 
                health.''; and
            (5) in subsection (g), by striking ``2014 through 2018'' 
        and inserting ``2019 through 2023''.
                                 <all>
```