I 

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. CA ́RDENAS, Ms. WILSON of Florida, Miss GONZA ́LEZ-COLO ́N 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. 

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

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Violence Against 

5 Women Health Act of 2019’’. 


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1 SEC. 2. FINDINGS. 

2 Congress finds that— 

3 (1) millions of Americans continue to experience 

4 domestic or sexual violence each year with more 

5 than three women murdered by their partners each 

6 day; 

7 (2) this type of violence and abuse results in 

8 short-term and chronic physical and behavioral 

9 health consequences that have a significant economic 

10 burden to victims and communities; 

11 (3) new CDC data found the lifetime per-victim 

12 cost of intimate partner violence was $103,767 for 

13 women victims with 59 percent going to medical 

14 costs and public funding paid 37 percent of this 

15 total cost; 

16 (4) victims are also at a higher risk for devel17 oping addictions to tobacco, alcohol, or drugs; for ex18 ample, 31 percent to 67 percent of women in sub19 stance use disorder treatment programs report expe20 riencing domestic violence within the past year; 

21 (5) over 50 percent of survivors of domestic vio22 lence have experienced depression, post-traumatic 

23 stress disorder, and substance use and 23 percent 

24 have experienced suicidality; 

25 (6) a study conducted by the National Domestic 

26 Violence Hotline, in conjunction with the National 


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1 Center on Domestic Violence, Trauma & Mental 

2 Health practice mental health and substance use co3 ercion where abusers intentionally undermine their 

4 partners’ sanity or sobriety, control their access to 

5 medication, and sabotage their treatment and recov6 ery efforts among other coercion tactics; 

7 (7) researchers have also found that exposure 

8 to multiple childhood traumas such as sexual abuse 

9 and domestic violence can cause long-term negative 

10 physical and emotional health outcomes such as 

11 heart disease, cancer and depression; 

12 (8) health care providers can identify survivors 

13 of violence and interventions can decrease risk for 

14 violence and improve health outcomes, but health 

15 providers need training and systems level support in 

16 order to do so; 

17 (9) Congress authorized a public health re18 sponse to victims of domestic and sexual violence in 

19 the Violence Against Women Act of 2005; 

20 (10) since its enactment, the VAWA Health 

21 program has trained more than 13,000 health care 

22 providers to assess for and respond to domestic and 

23 sexual violence in over 230 clinical settings serving 

24 more than 1.3 million patients; 


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1 (11) last year, the Health Resources & Services 

2 Administration made this issue a priority across all 

3 of its bureaus and released the ‘‘HRSA Strategy to 

4 Address Intimate Partner Violence 2017–2020’’ with 

5 four key priorities: 

6 (A) Train the Nation’s health care and 

7 public health workforce to address intimate 

8 partner violence (IPV) at the community and 

9 health systems levels. 

10 (B) Develop partnerships to raise aware11 ness about IPV within HRSA and HHS. 

12 (C) Increase access to quality IPV-in13 formed health care services across all popu14 lations. 

15 (D) Address gaps in knowledge about IPV 

16 risks, impacts, and interventions.; and 

17 (12) a strong public health response can pre18 vent and address the immediate and long-term 

19 health impacts of this type of violence and abuse. 

20 SEC. 3. GRANTS TO STRENGTHEN THE HEALTH CARE SYS21 TEM’S RESPONSE TO DOMESTIC VIOLENCE, 

22 DATING VIOLENCE, SEXUAL ASSAULT, AND 

23 STALKING, AND FOR OTHER PURPOSES. 

24 Section 399P of the Public Health Service Act (42 

25 U.S.C. 280g–4) is amended— 


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1 (1) in subsection (a)— 

2 (A) in paragraph (2), by striking ‘‘and’’ at 

3 the end; 

4 (B) in paragraph (3), by striking the pe5 riod at the end and inserting ‘‘; and’’; and 

6 (C) by adding at the end the following: 

7 ‘‘(4) development or enhancement and imple8 mentation of training programs to improve the ca9 pacity of early childhood programs to address do10 mestic violence, dating violence, sexual assault, and 

11 stalking among families they serve.’’; 

12 (2) in subsection (b)— 

13 (A) in paragraph (1)— 

14 (i) in subparagraph (A)(ii), by insert15 ing after ‘‘and other forms of violence and 

16 abuse’’ the following: ‘‘(including labor and 

17 sex trafficking)’’; and 

18 (ii) in subparagraph (B)— 

19 (I) in clause (ii)— 

20 (aa) by striking ‘‘on-site ac21 cess to’’; and 

22 (bb) by striking ‘‘or to 

23 model other services appropriate 

24 to the geographic and cultural 

25 needs of a site’’ and inserting the 


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1 following: ‘‘or by providing fund2 ing to national, State, Tribal, or 

3 territorial domestic and sexual vi4 olence coalitions to improve their 

5 capacity to coordinate and sup6 port health advocates and health 

7 system partnerships’’; 

8 (II) in clause (iii), by striking 

9 ‘‘and’’ at the end; 

10 (III) in clause (iv), by striking 

11 the period at the end and inserting ‘‘, 

12 with priority given to programs ad13 ministered through the Health Re14 sources and Services Administration, 

15 Office of Women’s Health; and’’; and 

16 (IV) by adding at the end the fol17 lowing: 

18 ‘‘(v) the development, dissemination, 

19 and evaluation of best practices, tools and 

20 training materials for behavioral health 

21 professionals to identify and respond to do22 mestic violence, sexual violence, stalking, 

23 and dating violence.’’; and 

24 (B) in paragraph (2)— 


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1 (i) in subparagraph (A), to read as 

2 follows: 

3 ‘‘(A) CHILD ABUSE AND ABUSE IN LATER

4 LIFE.—To the extent consistent with the pur5 pose of this section, a grantee may address, as 

6 part of a comprehensive programmatic ap7 proach implemented under a grant under this 

8 section, issues relating to child abuse or abuse 

9 in later life.’’; and 

10 (ii) in subparagraph (C)— 

11 (I) in clause (i), by striking 

12 ‘‘elder abuse’’ and inserting ‘‘abuse in 

13 later life’’; 

14 (II) in clause (iv)— 

15 (aa) by inserting ‘‘, mental 

16 health’’ after ‘‘dental’’; 

17 (bb) by inserting ‘‘and cer18 tification’’ after ‘‘exams’’; and 

19 (cc) by striking the period at 

20 the end and inserting ‘‘; and’’; 

21 and 

22 (III) by adding at the end the 

23 following: 

24 ‘‘(v) development of a state-level pilot 

25 program to improve the response of subVerDate Sep 11 2014 20:11 Feb 19, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H973.IH H973

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1 stance use disorder treatment programs 

2 and systems to domestic violence, dating 

3 violence, sexual assault, and stalking and 

4 the capacity of domestic violence, dating 

5 violence, sexual assault, and stalking to 

6 serve survivors dealing with substance use 

7 disorder; and 

8 ‘‘(vi) development and utilization of 

9 existing technical assistance and training 

10 resources to improve the capacity of sub11 stance use disorder treatment programs to 

12 address domestic violence, dating violence, 

13 sexual assault, and stalking among pa14 tients they serve.’’; 

15 (3) in subsection (d)(2)— 

16 (A) in subparagraph (A)— 

17 (i) by inserting ‘‘or behavioral 

18 health,’’ after ‘‘a State department (or 

19 other division) of health,’’; and 

20 (ii) by striking ‘‘mental health care’’ 

21 and inserting ‘‘behavioral health care’’; and 

22 (B) in subparagraph (B)— 

23 (i) by striking ‘‘or health system’’ and 

24 inserting ‘‘behavioral health treatment sys25 tem’’; and 


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1 (ii) by striking ‘‘mental health care’’ 

2 and inserting ‘‘behavioral health care’’; 

3 (4) in subsection (f), to read as follows: 

4 ‘‘(f) RESEARCH, AND EVALUATION, AND DATA COL5 LECTION.— 

6 ‘‘(1) IN GENERAL.—Of the funds made avail7 able to carry out this section for any fiscal year, the 

8 Secretary may use not more than 20 percent to 

9 make a grant or enter into a contract for research, 

10 and evaluation, or data collection of— 

11 ‘‘(A) grants awarded under this section; 

12 and 

13 ‘‘(B) other training for health professionals 

14 and effective interventions in the health care or 

15 behavioral health setting that prevent domestic 

16 violence, dating violence, and sexual assault 

17 across the lifespan, prevent the health effects of 

18 such violence, and improve the safety and 

19 health of individuals who are currently being 

20 victimized. 

21 ‘‘(2) RESEARCH AND DATA COLLECTION.—Re22 search or data collection authorized in paragraph (1) 

23 may include— 

24 ‘‘(A) research on the effects of domestic vi25 olence, dating violence, sexual assault, and 


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1 childhood exposure to domestic, dating or sex2 ual violence on health behaviors, health condi3 tions, and health status of individuals, families, 

4 and populations, including underserved popu5 lations; 

6 ‘‘(B) research to determine effective health 

7 care interventions to respond to and prevent do8 mestic violence, dating violence, sexual assault, 

9 and stalking; 

10 ‘‘(C) research on the impact of domestic, 

11 dating and sexual violence, childhood exposure 

12 to such violence, and stalking on the health care 

13 system, health care utilization, health care 

14 costs, and health status; 

15 ‘‘(D) research on the impact of adverse 

16 childhood experiences on adult experience with 

17 domestic violence, dating violence, sexual as18 sault, stalking and adult health outcomes, in19 cluding how to reduce or prevent the impact of 

20 adverse childhood experiences through the 

21 health care setting; 

22 ‘‘(E) research on the intersection of sub23 stance use disorder and domestic violence, dat24 ing violence, sexual assault, and stalking, in25 cluding effect of coerced use and efforts by an 


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1 abusive partner or other to interfere with sub2 stance use disorder treatment and recovery; and 

3 ‘‘(F) improved data collection using exist4 ing federal surveys by including questions about 

5 domestic violence, dating violence, sexual as6 sault, or stalking and substance use disorder, 

7 coerced use, and mental health.’’; and 

8 (5) in subsection (g), by striking ‘‘2014 through 

9 2018’’ and inserting ‘‘2019 through 2023’’. 

Æ 


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