I 

111TH CONGRESS 

1ST SESSION H. R. 463 

To expand access to preventive health care services that help reduce unintended pregnancy, reduce abortions, and improve access to women’s 

health care. 

IN THE HOUSE OF REPRESENTATIVES 

JANUARY 13, 2009 

Ms. SLAUGHTER (for herself, Ms. DEGETTE, Ms. DELAURO, Ms. HARMAN, 

Ms. LEE of California, Mrs. LOWEY, Mr. ROTHMAN of New Jersey, Mr. 

WAXMAN, Mr. ABERCROMBIE, Mr. ACKERMAN, Mr. ADLER of New Jersey, Mr. ARCURI, Ms. BALDWIN, Ms. BERKLEY, Mr. BERMAN, Mrs. 

BIGGERT, Mr. BISHOP of New York, Mr. BISHOP of Georgia, Mr. 

BLUMENAUER, Mr. BOUCHER, Mr. BRADY of Pennsylvania, Mr. BRALEY

of Iowa, Mrs. CAPPS, Mr. CAPUANO, Mr. CARNAHAN, Mr. CHANDLER, 

Mr. CLAY, Mr. COHEN, Mr. CONNOLLY of Virginia, Mr. CROWLEY, Mrs. 

DAVIS of California, Mr. DELAHUNT, Mr. DICKS, Mr. ELLISON, Mr. 

ENGEL, Mr. FARR, Mr. FATTAH, Mr. FILNER, Mr. FRANK of Massachusetts, Ms. GIFFORDS, Mrs. GILLIBRAND, Mr. AL GREEN of Texas, Mr. 

GENE GREEN of Texas, Mr. GRIJALVA, Mr. HALL of New York, Mr. 

HARE, Mr. HIGGINS, Mr. HINCHEY, Ms. HIRONO, Mr. HODES, Mr. 

HOLT, Mr. HONDA, Mr. INSLEE, Mr. ISRAEL, Ms. JACKSON-LEE of 

Texas, Mr. KENNEDY, Ms. KILROY, Mr. KIND, Mr. KUCINICH, Mr. 

LANGEVIN, Mr. LARSEN of Washington, Mr. LEVIN, Mr. LOEBSACK, Ms. 

ZOE LOFGREN of California, Mrs. MALONEY, Ms. MATSUI, Ms. MCCOLLUM, Mr. MCDERMOTT, Mr. MCGOVERN, Mr. MCNERNEY, Mr. MEEKS

of New York, Mr. GEORGE MILLER of California, Mr. MITCHELL, Ms. 

MOORE of Wisconsin, Mr. MOORE of Kansas, Mr. MURPHY of Connecticut, Mr. PATRICK J. MURPHY of Pennsylvania, Mr. NADLER of New 

York, Mrs. NAPOLITANO, Ms. NORTON, Mr. OLVER, Mr. PAYNE, Mr. PETERS, Ms. PINGREE of Maine, Mr. PRICE of North Carolina, Mr. RANGEL, Ms. ROYBAL-ALLARD, Mr. RUPPERSBERGER, Mr. RUSH, Mr. RYAN

of Ohio, Ms. LORETTA SANCHEZ of California, Mr. SARBANES, Ms. 

SCHAKOWSKY, Mr. SCHIFF, Ms. SCHWARTZ, Mr. SERRANO, Mr. SHERMAN, Mr. SIRES, Mr. STARK, Ms. SUTTON, Mrs. TAUSCHER, Mr. THOMPSON of California, Ms. TSONGAS, Ms. VELA ́ZQUEZ, Ms. WASSERMAN

SCHULTZ, Mr. WELCH, Mr. WEXLER, Ms. WOOLSEY, Mr. WU, Mr. 

YARMUTH, and Mr. VAN HOLLEN) introduced the following bill; which 

was referred to the Committee on Energy and Commerce, and in addition 

to the Committees on Ways and Means and Education and Labor, for 


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a period to be subsequently determined by the Speaker, in each case for 

consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To expand access to preventive health care services that 

help reduce unintended pregnancy, reduce abortions, and 

improve access to women’s health care. 

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

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

5 ‘‘Prevention First Act of 2009’’. 

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

7 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Findings. 

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. 


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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 TEENAGE PREGNANCY 

PREVENTION ACT 

Sec. 501. Short title. 

Sec. 502. Teen pregnancy prevention. 

Sec. 503. Research. 

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. Limitations on use of funds. 

Sec. 806. Definitions. 

Sec. 807. Authorization of appropriations. 

1 SEC. 2. FINDINGS. 

2 The Congress finds as follows: 

3 (1) Healthy People 2010 sets forth a reduction 

4 of unintended pregnancies as an important health 

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

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

8 and reiterated in Healthy People 2000: National 


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1 Health Promotion and Disease Prevention Objec2 tives. 

3 (2) Although the Centers for Disease Control 

4 and Prevention (referred to in this section as the 

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

6 list of the Ten Great Public Health Achievements in 

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

8 the highest rates of unintended pregnancies among 

9 industrialized nations. 

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

11 the United States are unintended, and nearly half of 

12 unintended pregnancies end in abortion. 

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

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

15 of contraceptive services and supplies to help prevent 

16 unintended pregnancy, and nearly half of those were 

17 in need of public support for such care. 

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

19 rates of sexually transmitted infections (referred to 

20 in this section as ‘‘STIs’’) among industrialized na21 tions. In 2006, there were approximately 19,000,000 

22 new cases of STIs, almost half of them occurring in 

23 young people ages 15 to 24. According to the CDC, 

24 in addition to the burden on public health, STIs im25 pose a tremendous economic burden with direct medVerDate Nov 24 2008 01:51 Jan 15, 2009 Jkt 079200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H463.IH H463

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1 ical costs as high as $14,700,000,000 each year in 

2 2006 dollars. 

3 (6) Contraceptive use can improve overall 

4 health by enabling women to plan and space their 

5 pregnancies and has contributed to dramatic de6 clines in maternal and infant mortality. Widespread 

7 use of contraceptives has been the driving force in 

8 reducing unintended pregnancies and sexually trans9 mitted infections, and reducing the need for abortion 

10 in this nation. Contraceptive use also saves public 

11 health dollars. For every dollar spent to provide 

12 services in publicly funded family planning clinics, 

13 $4.02 in Medicaid expenses are saved because unin14 tended births are averted. 

15 (7) Reducing unintended pregnancy improves 

16 maternal health and is an important strategy in ef17 forts to reduce maternal mortality. Women experi18 encing unintended pregnancy are at greater risk for 

19 physical abuse. 

20 (8) A child born from an unintended pregnancy 

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

22 pregnancy of low birth weight, dying in the first 

23 year of life, being abused, and not receiving suffi24 cient resources for healthy development. 


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1 (9) The ability to control fertility allows couples 

2 to achieve economic stability by facilitating greater 

3 educational achievement and participation in the 

4 workforce. 

5 (10) Contraceptives are effective in preventing 

6 unintended pregnancy when used consistently and 

7 correctly. Without contraception, a sexually active 

8 woman has an 85 percent chance of becoming preg9 nant within a year. 

10 (11) Approximately 50 percent of unintended 

11 pregnancies occur among women who do not use 

12 contraception. 

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

14 afford to purchase contraceptive services and sup15 plies on their own. The number of women needing 

16 subsidized services has increased by more than 

17 1,000,000 (seven percent) since 2000. A poor 

18 woman in the United States is now nearly four times 

19 as likely as a more affluent woman to have an un20 planned pregnancy. Between 1994 and 2001, unin21 tended pregnancy among low-income women in22 creased by 29 percent, while unintended pregnancy 

23 decreased by 20 percent among women with higher 

24 incomes. 


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1 (13) Public health programs, such as the Med2 icaid program and family planning programs under 

3 title X of the Public Health Service Act, provide 

4 high-quality family planning services and other pre5 ventive health care to underinsured or uninsured in6 dividuals who may otherwise lack access to health 

7 care. 

8 (14) Medicaid has become an essential source of 

9 support for the provision of subsidized family plan10 ning services and supplies. It is the single largest 

11 source of public funds supporting these services. In 

12 2001, the program provided six in ten of all public 

13 dollars spent on family planning services. In 2006, 

14 12 percent of women of reproductive age (7,300,000 

15 women between the ages of 15 and 44) looked to 

16 Medicaid for their care and 37 percent of poor 

17 women of reproductive age rely upon Medicaid. 

18 (15) Approximately 1,400,000 unintended preg19 nancies and 600,000 abortions are averted each year 

20 because of services provided in publicly funded clin21 ics. In 2006, title X service providers performed 

22 more than 2,400,000 Pap tests, 2,400,000 breast 

23 exams, and 5,800,000 tests for STIs, including 

24 652,426 HIV tests and 2,300,000 Chlamydia tests. 

25 One in four women who obtain reproductive health 


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1 services from a medical provider does so at a pub2 licly funded clinic. 

3 (16) The stagnant funding for public family 

4 planning programs in combination with the increas5 ing demand for subsidized services; the rising costs 

6 of contraceptive services and supplies, and the high 

7 cost of improved screening and treatment for cer8 vical cancer and sexually transmitted infections has 

9 diminished the ability of clinics receiving funds 

10 under title X of the Public Health Services Act to 

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

12 are able to reach just 41 percent of the women need13 ing subsidized services. Had title X funding kept up 

14 with inflation since FY 1980, it would now be fund15 ed at $759,000,000, instead of its fiscal year 2007 

16 funding level of $283,000,000. Taking inflation into 

17 account, funding for title X in constant dollars is 63 

18 percent lower today than it was in FY 1980. 

19 (17) While the Medicaid program remains the 

20 largest source of subsidized family planning services, 

21 States are facing significant budgetary pressures to 

22 cut their Medicaid programs, putting many women 

23 at risk of losing coverage for family planning serv24 ices. 


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1 (18) In addition, eligibility under the Medicaid 

2 program in many States is severely restricted, which 

3 leaves family planning services financially out of 

4 reach for many poor women. Many States have dem5 onstrated tremendous success with Medicaid family 

6 planning waivers that allow States to expand access 

7 to Medicaid family planning services. However, the 

8 administrative burden of applying for a waiver poses 

9 a significant barrier to States that would like to ex10 pand their coverage of family planning programs 

11 through Medicaid. 

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

13 expanded family planning benefits as a result of 

14 Medicaid family planning waivers. The cost-effective15 ness of these waivers was affirmed by a recent eval16 uation funded by the Centers for Medicare & Med17 icaid Services. This evaluation of six waivers found 

18 that all family planning programs under such waiv19 ers resulted in significant savings to both the Fed20 eral and State governments. Moreover, the research21 ers found measurable reductions in unintended preg22 nancy. 

23 (20) Although employer-sponsored health plans 

24 have improved coverage of contraceptive services and 

25 supplies, largely in response to State contraceptive 


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1 coverage laws, there is still significant room for im2 provement. The ongoing lack of coverage in health 

3 insurance plans, particularly in self-insured and indi4 vidual plans, continues to place effective forms of 

5 contraception beyond the financial reach of many 

6 women. 

7 (21) Including contraceptive coverage in private 

8 health care plans saves employers money. Not cov9 ering contraceptives in employee health plans costs 

10 employers 15 to 17 percent more than providing 

11 such coverage. 

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

13 Administration, emergency contraception is a safe 

14 and effective way to prevent unintended pregnancy 

15 after unprotected sex. Research confirms that easier 

16 access to emergency contraceptives does not increase 

17 sexual risk-taking or sexually transmitted diseases. 

18 (23) The available evidence shows that many 

19 women do not know about emergency contraception, 

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

21 it. Overcoming these obstacles could help ensure that 

22 more women use emergency contraception consist23 ently and correctly. 

24 (24) A November 2006 study of declining preg25 nancy rates among teens concluded that the reducVerDate Nov 24 2008 01:51 Jan 15, 2009 Jkt 079200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H463.IH H463

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1 tion in teen pregnancy between 1995 and 2002 is 

2 primarily the result of increased use of contracep3 tives. As such, it is critically important that teens 

4 receive accurate, unbiased information about contra5 ception. 

6 (25) The American Medical Association, the 

7 American Nurses Association, the American Acad8 emy of Pediatrics, the American College of Obstetri9 cians and Gynecologists, the American Public Health 

10 Association, and the Society for Adolescent Medi11 cine, support responsible sexuality education that in12 cludes information about both abstinence and con13 traception. 

14 (26) Teens who receive comprehensive sexuality 

15 education that includes discussion of contraception 

16 as well as abstinence are more likely than those who 

17 receive abstinence-only messages to delay sex, to 

18 have fewer partners, and to use contraceptives when 

19 they do become sexually active. 

20 (27) Government-funded abstinence-only-until21 marriage programs are precluded from discussing 

22 contraception except to talk about failure rates. An 

23 October 2006 report by the Government Account24 ability Office found that the Department of Health 

25 and Human Services does not review the materials 


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1 of recipients of grants administered by such Depart2 ment for scientific accuracy and requires grantees to 

3 review their own materials for scientific accuracy. 

4 The GAO also reported on the Department’s total 

5 lack of appropriate and customary measurements to 

6 determine if funded programs are effective. In addi7 tion, a separate letter from the Government Ac8 countability Office found that the Department of 

9 Health and Human Services is in violation of Fed10 eral law by failing to enforce a requirement under 

11 the Public Health Service Act that federally funded 

12 grantees working to address the prevention of sexu13 ally transmitted diseases, including abstinence-only14 until-marriage programs, must provide medically ac15 curate information about the effectiveness of 

16 condoms. 

17 (28) Recent scientific reports by the Institute of 

18 Medicine, the American Medical Association, and the 

19 Office on National AIDS Policy stress the need for 

20 sexuality education that includes messages about ab21 stinence and provides young people with information 

22 about contraception for the prevention of teen preg23 nancy, HIV/AIDS, and other sexually transmitted 

24 diseases. 


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1 (29) A 2006 statement from the American Pub2 lic Health Association (referred to in this section as 

3 ‘‘APHA’’) states that APHA ‘‘recognizes the impor4 tance of abstinence education, but only as part of a 

5 comprehensive sexuality education program . . . 

6 APHA calls for repealing current Federal funding 

7 for abstinence-only programs and replacing it with 

8 funding for a new Federal program to promote com9 prehensive sexuality education, combining informa10 tion about abstinence with age-appropriate sexuality 

11 education.’’. 

12 (30) Comprehensive sexuality education pro13 grams respect the diversity of values and beliefs rep14 resented in the community and will complement and 

15 augment the sexuality education children receive 

16 from their families. 

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

18 cases of HIV infections in the United States occur 

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

20 Latino youth have been disproportionately affected 

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

22 Latinos accounted for 84 percent of all new HIV in23 fections among 13- to 19-year-olds and 76 percent 

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

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1 resent only about 32 percent of people in these ages. 

2 Teens in the United States contract an estimated 

3 9,000,000 sexually transmitted infections each year. 

4 By age 24, at least one in four sexually active people 

5 between the ages of 15 and 24 will have contracted 

6 a sexually transmitted infection. 

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

8 average of 2 young people every hour of every day, 

9 are infected with HIV in the United States. 

10 TITLE I—TITLE X OF PUBLIC 

11 HEALTH SERVICE ACT 

12 SEC. 101. SHORT TITLE. 

13 This title may be cited as the ‘‘Title X Family Plan14 ning Services Act of 2009’’. 

15 SEC. 102. AUTHORIZATION OF APPROPRIATIONS. 

16 Section 1001(d) of the Public Health Service Act is 

17 amended by striking all that follows ‘‘there are authorized 

18 to be appropriated’’ and inserting ‘‘$700,000,000 for fis19 cal year 2010 and such sums as may be necessary for each 

20 subsequent fiscal year’’. 


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

4 SEC. 201. SHORT TITLE. 

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

6 Insurance and Contraceptive Coverage Act of 2009’’. 

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

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

10 B of title I of the Employee Retirement Income Security 

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

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

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

16 health plan, and a health insurance issuer providing health 

17 insurance coverage in connection with a group health plan, 

18 may not— 

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

20 contraceptive drugs or devices approved by the Food 

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


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

2 contraceptive services if such plan or coverage pro3 vides benefits for other outpatient health care serv4 ices. 

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

6 health insurance issuer providing health insurance cov7 erage in connection with a group health plan, may not— 

8 ‘‘(1) deny to an individual eligibility, or contin9 ued eligibility, to enroll or to renew coverage under 

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

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

12 that are covered in accordance with the requirements 

13 of this section; 

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

15 a covered individual to encourage such individual to 

16 accept less than the minimum protections available 

17 under this section; 

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

19 reimbursement of a health care professional because 

20 such professional prescribed contraceptive drugs or 

21 devices, or provided contraceptive services, described 

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

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

24 to a health care professional to induce such profes25 sional to withhold from a covered individual contraVerDate Nov 24 2008 01:51 Jan 15, 2009 Jkt 079200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\H463.IH H463

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1 ceptive drugs or devices, or contraceptive services, 

2 described in subsection (a). 

3 ‘‘(c) RULES OF CONSTRUCTION.— 

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

5 shall be construed— 

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

7 and a health insurance issuer providing health 

8 insurance coverage in connection with a group 

9 health plan from imposing deductibles, coinsur10 ance, or other cost-sharing or limitations in re11 lation to— 

12 ‘‘(i) benefits for contraceptive drugs 

13 under the plan or coverage, except that 

14 such a deductible, coinsurance, or other 

15 cost-sharing or limitation for any such 

16 drug shall be consistent with those imposed 

17 for other outpatient prescription drugs oth18 erwise covered under the plan or coverage; 

19 ‘‘(ii) benefits for contraceptive devices 

20 under the plan or coverage, except that 

21 such a deductible, coinsurance, or other 

22 cost-sharing or limitation for any such de23 vice shall be consistent with those imposed 

24 for other outpatient prescription devices 


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1 otherwise covered under the plan or cov2 erage; and 

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

5 except that such a deductible, coinsurance, 

6 or other cost-sharing or limitation for any 

7 such service shall be consistent with those 

8 imposed for other outpatient health care 

9 services otherwise covered under the plan 

10 or coverage; 

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

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

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

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

18 that the plan or issuer provides coverage for 

19 other experimental or investigational outpatient 

20 prescription drugs or devices, or experimental 

21 or investigational outpatient health care serv22 ices; or 

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

24 the rights or protections of an individual under 

25 any other Federal law. 


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

2 the term ‘limitation’ includes— 

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

4 device— 

5 ‘‘(i) restricting the type of health care 

6 professionals that may prescribe such 

7 drugs or devices; 

8 ‘‘(ii) utilization review provisions; and 

9 ‘‘(iii) limits on the volume of prescrip10 tion drugs or devices that may be obtained 

11 on the basis of a single consultation with 

12 a professional; or 

13 ‘‘(B) in the case of an outpatient contra14 ceptive service— 

15 ‘‘(i) restricting the type of health care 

16 professionals that may provide such serv17 ices; 

18 ‘‘(ii) utilization review provisions; 

19 ‘‘(iii) requirements relating to second 

20 opinions prior to the coverage of such serv21 ices; and 

22 ‘‘(iv) requirements relating to 

23 preauthorizations prior to the coverage of 

24 such services. 


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

2 imposition of the requirements of this section shall be 

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

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

5 notice of such requirements under the plan, except that 

6 the summary description required to be provided under the 

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

8 modification shall be provided by not later than 60 days 

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

10 requirements apply. 

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

12 construed to preempt any provision of State law to the 

13 extent that such State law establishes, implements, or con14 tinues in effect any standard or requirement that provides 

15 coverage or protections for participants or beneficiaries 

16 that are greater than the coverage or protections provided 

17 under this section. 

18 ‘‘(f) DEFINITIONS.—In this section: 

19 ‘‘(1) OUTPATIENT CONTRACEPTIVE SERV20 ICES.—The term ‘outpatient contraceptive services’ 

21 means consultations, examinations, procedures, and 

22 medical services, provided on an outpatient basis 

23 and related to the use of contraceptive methods (in24 cluding natural family planning) to prevent an unin25 tended pregnancy. 


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1 ‘‘(2) OUTPATIENT HEALTH CARE SERVICES.— 

2 The term ‘outpatient health care services’ means 

3 outpatient services provided by a health care profes4 sional.’’. 

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

6 in section 1 of the Employee Retirement Income Security 

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

8 after the item relating to section 714 the following: 

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

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

10 this section shall apply with respect to plan years begin11 ning on or after January 1, 2010. 

12 SEC. 203. AMENDMENTS TO PUBLIC HEALTH SERVICE ACT 

13 RELATING TO THE GROUP MARKET. 

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

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

16 300gg–4 et seq.) is amended by adding at the end the 

17 following: 

18 ‘‘SEC. 2708. STANDARDS RELATING TO BENEFITS FOR CON19 TRACEPTIVES. 

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

21 health plan, and a health insurance issuer providing health 

22 insurance coverage in connection with a group health plan, 

23 may not— 

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

25 contraceptive drugs or devices approved by the Food 


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1 and Drug Administration, or generic equivalents ap2 proved as substitutable by the Food and Drug Ad3 ministration, if such plan or coverage provides bene4 fits for other outpatient prescription drugs or de5 vices; or 

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

7 contraceptive services if such plan or coverage pro8 vides benefits for other outpatient health care serv9 ices. 

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

11 health insurance issuer providing health insurance cov12 erage in connection with a group health plan, may not— 

13 ‘‘(1) deny to an individual eligibility, or contin14 ued eligibility, to enroll or to renew coverage under 

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

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

17 that are covered in accordance with the requirements 

18 of this section; 

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

20 a covered individual to encourage such individual to 

21 accept less than the minimum protections available 

22 under this section; 

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

24 reimbursement of a health care professional because 

25 such professional prescribed contraceptive drugs or 


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1 devices, or provided contraceptive services, described 

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

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

4 to a health care professional to induce such profes5 sional to withhold from covered individual contracep6 tive drugs or devices, or contraceptive services, de7 scribed in subsection (a). 

8 ‘‘(c) RULES OF CONSTRUCTION.— 

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

10 shall be construed— 

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

12 and a health insurance issuer providing health 

13 insurance coverage in connection with a group 

14 health plan from imposing deductibles, coinsur15 ance, or other cost-sharing or limitations in re16 lation to— 

17 ‘‘(i) benefits for contraceptive drugs 

18 under the plan or coverage, except that 

19 such a deductible, coinsurance, or other 

20 cost-sharing or limitation for any such 

21 drug shall be consistent with those imposed 

22 for other outpatient prescription drugs oth23 erwise covered under the plan or coverage; 

24 ‘‘(ii) benefits for contraceptive devices 

25 under the plan or coverage, except that 


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1 such a deductible, coinsurance, or other 

2 cost-sharing or limitation for any such de3 vice shall be consistent with those imposed 

4 for other outpatient prescription devices 

5 otherwise covered under the plan or cov6 erage; and 

7 ‘‘(iii) benefits for outpatient contra8 ceptive services under the plan or coverage, 

9 except that such a deductible, coinsurance, 

10 or other cost-sharing or limitation for any 

11 such service shall be consistent with those 

12 imposed for other outpatient health care 

13 services otherwise covered under the plan 

14 or coverage; 

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

16 a health insurance issuer providing health in17 surance coverage in connection with a group 

18 health plan to cover experimental or investiga19 tional contraceptive drugs or devices, or experi20 mental or investigational contraceptive services, 

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

22 that the plan or issuer provides coverage for 

23 other experimental or investigational outpatient 

24 prescription drugs or devices, or experimental 


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1 or investigational outpatient health care serv2 ices; or 

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

4 the rights or protections of an individual under 

5 any other Federal law. 

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

7 the term ‘limitation’ includes— 

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

9 device— 

10 ‘‘(i) restricting the type of health care 

11 professionals that may prescribe such 

12 drugs or devices; 

13 ‘‘(ii) utilization review provisions; and 

14 ‘‘(iii) limits on the volume of prescrip15 tion drugs or devices that may be obtained 

16 on the basis of a single consultation with 

17 a professional; or 

18 ‘‘(B) in the case of an outpatient contra19 ceptive service— 

20 ‘‘(i) restricting the type of health care 

21 professionals that may provide such serv22 ices; 

23 ‘‘(ii) utilization review provisions; 


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1 ‘‘(iii) requirements relating to second 

2 opinions prior to the coverage of such serv3 ices; and 

4 ‘‘(iv) requirements relating to 

5 preauthorizations prior to the coverage of 

6 such services. 

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

8 shall comply with the notice requirement under section 

9 715(d) of the Employee Retirement Income Security Act 

10 of 1974 with respect to the requirements of this section 

11 as if such section applied to such plan. 

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

13 construed to preempt any provision of State law to the 

14 extent that such State law establishes, implements, or con15 tinues in effect any standard or requirement that provides 

16 coverage or protections for enrollees that are greater than 

17 the coverage or protections provided under this section. 

18 ‘‘(f) DEFINITIONS.—In this section: 

19 ‘‘(1) OUTPATIENT CONTRACEPTIVE SERV20 ICES.—The term ‘outpatient contraceptive services’ 

21 means consultations, examinations, procedures, and 

22 medical services, provided on an outpatient basis 

23 and related to the use of contraceptive methods (in24 cluding natural family planning) to prevent an unin25 tended pregnancy. 


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1 ‘‘(2) OUTPATIENT HEALTH CARE SERVICES.— 

2 The term ‘outpatient health care services’ means 

3 outpatient services provided by a health care profes4 sional.’’. 

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

6 this section shall apply with respect to group health plans 

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

8 SEC. 204. AMENDMENT TO PUBLIC HEALTH SERVICE ACT 

9 RELATING TO THE INDIVIDUAL MARKET. 

10 (a) IN GENERAL.—Part B of title XXVII of the Pub11 lic Health Service Act (42 U.S.C. 300gg–41 et seq.) is 

12 amended by adding at the end of subpart 2 the following: 

13 ‘‘SEC. 2754. STANDARDS RELATING TO BENEFITS FOR CON14 TRACEPTIVES. 

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

16 insurance coverage offered by a health insurance issuer 

17 in the individual market in the same manner as such pro18 visions apply to health insurance coverage offered by a 

19 health insurance issuer in connection with a group health 

20 plan in the small or large group market.’’. 

21 (a) EFFECTIVE DATE.—The amendment made by 

22 this section shall apply with respect to health insurance 

23 coverage offered, sold, issued, renewed, in effect, or oper24 ated in the individual market on or after January 1, 2010. 


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1 TITLE III—EMERGENCY CON2 TRACEPTION EDUCATION 

3 AND INFORMATION 

4 SEC. 301. SHORT TITLE. 

5 This title may be cited as the ‘‘Emergency Contracep6 tion Education Act of 2009’’. 

7 SEC. 302. EMERGENCY CONTRACEPTION EDUCATION AND 

8 INFORMATION PROGRAMS. 

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

10 (1) EMERGENCY CONTRACEPTION.—The term 

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

12 (as such terms are defined in section 201 of the 

13 Federal Food, Drug, and Cosmetic Act (21 U.S.C. 

14 321)) or a drug regimen that— 

15 (A) is used after sexual relations; 

16 (B) prevents pregnancy, by preventing ovu17 lation, fertilization of an egg, or implantation of 

18 an egg in a uterus; and 

19 (C) is approved by the Food and Drug Ad20 ministration. 

21 (2) HEALTH CARE PROVIDER.—The term 

22 ‘‘health care provider’’ means an individual who is li23 censed or certified under State law to provide health 

24 care services and who is operating within the scope 

25 of such license. 


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1 (3) INSTITUTION OF HIGHER EDUCATION.—The 

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

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

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

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

6 the Secretary of Health and Human Services. 

7 (b) EMERGENCY CONTRACEPTION PUBLIC EDU8 CATION PROGRAM.— 

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

10 through the Director of the Centers for Disease 

11 Control and Prevention, shall develop and dissemi12 nate to the public information on emergency contra13 ception. 

14 (2) DISSEMINATION.—The Secretary may dis15 seminate information under paragraph (1) directly 

16 or through arrangements with nonprofit organiza17 tions, consumer groups, institutions of higher edu18 cation, Federal, State, or local agencies, clinics, and 

19 the media. 

20 (3) INFORMATION.—The information dissemi21 nated under paragraph (1) shall include, at a min22 imum, a description of emergency contraception and 

23 an explanation of the use, safety, efficacy, and avail24 ability of such contraception. 


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1 (c) EMERGENCY CONTRACEPTION INFORMATION

2 PROGRAM FOR HEALTH CARE PROVIDERS.— 

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

4 through the Administrator of the Health Resources 

5 and Services Administration and in consultation 

6 with major medical and public health organizations, 

7 shall develop and disseminate to health care pro8 viders information on emergency contraception. 

9 (2) INFORMATION.—The information dissemi10 nated under paragraph (1) shall include, at a min11 imum— 

12 (A) information describing the use, safety, 

13 efficacy, and availability of emergency contra14 ception; 

15 (B) a recommendation regarding the use of 

16 such contraception in appropriate cases; and 

17 (C) information explaining how to obtain 

18 copies of the information developed under sub19 section (b) for distribution to the patients of 

20 the providers. 

21 (d) AUTHORIZATION OF APPROPRIATIONS.—There 

22 are authorized to be appropriated to carry out this section 

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

24 2010 through 2014. 


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1 TITLE IV—COMPASSIONATE AS2 SISTANCE FOR RAPE EMER3 GENCIES 

4 SEC. 401. SHORT TITLE. 

5 This title may be cited as the ‘‘Compassionate Assist6 ance for Rape Emergencies Act of 2009’’. 

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

8 HOSPITALS OF EMERGENCY CONTRACEP9 TIVES WITHOUT CHARGE. 

10 (a) IN GENERAL.—Federal funds may not be pro11 vided to a hospital under any health-related program, un12 less the hospital meets the conditions specified in sub13 section (b) in the case of— 

14 (1) any woman who presents at the hospital 

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

16 is accompanied by someone who states she is a vic17 tim of sexual assault; and 

18 (2) any woman who presents at the hospital 

19 whom hospital personnel have reason to believe is a 

20 victim of sexual assault. 

21 (b) ASSISTANCE FOR VICTIMS.—The conditions spec22 ified in this subsection regarding a hospital and a woman 

23 described in subsection (a) are as follows: 

24 (1) The hospital promptly provides the woman 

25 with medically and factually accurate and unbiased 


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1 written and oral information about emergency con2 traception, including information explaining that— 

3 (A) emergency contraception does not 

4 cause an abortion; and 

5 (B) emergency contraception is effective in 

6 most cases in preventing pregnancy after un7 protected sex. 

8 (2) The hospital promptly offers emergency 

9 contraception to the woman, and promptly provides 

10 such contraception to her on her request. 

11 (3) The information provided pursuant to para12 graph (1) is in clear and concise language, is readily 

13 comprehensible, and meets such conditions regarding 

14 the provision of the information in languages other 

15 than English as the Secretary may establish. 

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

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

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

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

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

21 a drug, drug regimen, or device that— 

22 (A) is used postcoitally; 

23 (B) prevents pregnancy by delaying ovula24 tion, preventing fertilization of an egg, or pre25 venting implantation of an egg in a uterus; and 


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

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

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

5 including— 

6 (A) the meaning given such term in section 

7 1861(e) of such Act; 

8 (B) the meaning given the term ‘‘psy9 chiatric hospital’’ in section 1861(f) of such 

10 Act; 

11 (C) the meaning given to the term ‘‘critical 

12 access hospital’’ under section 1861(mm) of 

13 such Act; and 

14 (D) the meaning applicable such title for 

15 purposes of making payments for emergency 

16 services to hospitals that do not have agree17 ments in effect under such title. 

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

19 of Health and Human Services. 

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

21 which the woman involved does not consent or lacks 

22 the legal capacity to consent. 

23 (d) EFFECTIVE DATE; AGENCY CRITERIA.—This sec24 tion takes effect upon the expiration of the 180-day period 

25 beginning on the date of the enactment of this title. Not 


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

2 the Secretary shall publish in the Federal Register criteria 

3 for carrying out this section. 

4 TITLE V—AT-RISK COMMUNITIES 

5 TEENAGE PREGNANCY PRE6 VENTION ACT 

7 SEC. 501. SHORT TITLE. 

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

9 Teenage Pregnancy Prevention Act of 2009’’. 

10 SEC. 502. TEEN PREGNANCY PREVENTION. 

11 (a) TEENAGE PREGNANCY PREVENTION GRANTS.— 

12 Part P of title III of the Public Health Service Act (42 

13 U.S.C. 280g et seq.) is amended by inserting at the end 

14 the following section: 

15 ‘‘SEC. 399U. TEENAGE PREGNANCY PREVENTION GRANTS. 

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

17 competitive basis grants to public and private entities to 

18 establish or expand teenage pregnancy prevention pro19 grams. 

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

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

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


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

2 this section, the Secretary shall give— 

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

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

7 higher than the corresponding State average; or 

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

9 increasing; and 

10 ‘‘(2) priority to applicants seeking assistance 

11 for programs that— 

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

13 populations such as young males or immigrant 

14 youths; or 

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

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

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

20 as a grant under this section may only be used for pro21 grams that— 

22 ‘‘(1) replicate or substantially incorporate the 

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

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

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

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

7 HIV education; interventions for sexually active 

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

11 ‘‘(3) provide information that is age-appro12 priate, factually and medically accurate and com13 plete, and scientifically based; and 

14 ‘‘(4) provide any information, activities, and 

15 services that are directed toward a particular popu16 lation group in a language and cultural context that 

17 is most appropriate for individual in such group. 

18 ‘‘(e) RELATION TO ABSTINENCE-ONLY PROGRAMS.— 

19 Funds under this section are not intended for use by absti20 nence-only education programs. Abstinence-only education 

21 programs that receive Federal funds through the Maternal 

22 and Child Health Block Grant, the Administration for 

23 Children and Families, the Adolescent Family Life Pro24 gram, and any other program that uses the definition of 

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1 cial Security Act are ineligible for funding under this sec2 tion. 

3 ‘‘(f) APPLICATIONS.—Each entity seeking a grant 

4 under this section shall submit an application to the Sec5 retary at such time and in such form, is made in such 

6 manner, and contains such agreements, assurances, and 

7 information as the Secretary determines to be necessary 

8 to carry out the program involved. 

9 ‘‘(g) MATCHING FUNDS.— 

10 ‘‘(1) IN GENERAL.—The Federal share of the 

11 cost of an activity carried out with a grant under 

12 this section may not exceed 75 percent of cost of the 

13 activity. 

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

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

16 cash or in kind. 

17 ‘‘(h) MAINTENANCE OF EFFORT.—As condition of 

18 making a grant under this section to an entity during any 

19 fiscal year, the Secretary shall require that the entity ex20 pend, during such fiscal year, not less than the amount 

21 of funds from non-Federal sources expended by such enti22 ty for teenage pregnancy prevention during the fiscal year 

23 preceding the first fiscal year for which such grant is made 

24 to such entity. 

25 ‘‘(i) EVALUATIONS.— 


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

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

3 evaluation of 10 percent of programs for which 

4 a grant is awarded under this section for the 

5 purpose of determining the effectiveness of such 

6 programs; 

7 ‘‘(B) collect and analyze data relating to 

8 program effectiveness on each program for 

9 which a grant is awarded under this section; 

10 and 

11 ‘‘(C) upon completion of the evaluations 

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

13 Congress a report that includes a detailed state14 ment on the effectiveness of grants under this 

15 section. 

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

17 recipient under this section shall provide such infor18 mation and cooperation as may be required by the 

19 Secretary for purposes of an evaluation or data col20 lection under paragraph (1). 

21 ‘‘(j) DEFINITION.—For purposes of this section, the 

22 term ‘rigorous scientific research’ means research based 

23 on a program evaluation that— 

24 ‘‘(1) measured impact of the program on sexual 

25 or contraceptive behavior, pregnancy or childbearing; 


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1 ‘‘(2) employed an experimental or quasi-experi2 mental design with well-constructed and appropriate 

3 comparison groups; and 

4 ‘‘(3) had a sample size large enough (at least 

5 100 in the combined treatment and control group) 

6 and a follow-up interval long enough (at least 6 

7 months) to draw valid conclusions about such im8 pact. 

9 ‘‘(k) AUTHORIZATION OF APPROPRIATIONS.—There 

10 are authorized to be appropriated to carry out this section 

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

12 each subsequent fiscal year.’’. 

13 (b) TECHNICAL CORRECTIONS.—Part P of title III 

14 of the Public Health Service Act (42 U.S.C. 280g et seq.) 

15 is amended by— 

16 (1) redesignating the second section 399R (as 

17 added by section 2 of Public Law 110–373) as sec18 tion 399S; and 

19 (2) redesignating the third section 399R (as 

20 added by section 3 of Public Law 110–374) as sec21 tion 399T. 

22 SEC. 503. RESEARCH. 

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

24 Human Services, acting through the Director of the Cen25 ters for Disease Control and Prevention, shall make grants 


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

2 and coordinate research on the prevention of teen preg3 nancy in eligible communities, including research on the 

4 factors contributing to the disproportionate rates of teen 

5 pregnancy in such communities. 

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

7 Secretary of Health and Human Services shall support re8 search that— 

9 (1) investigates and determines the incidence 

10 and prevalence of teen pregnancy in communities de11 scribed in such subsection; 

12 (2) examines— 

13 (A) the extent of the impact of teen preg14 nancy on— 

15 (i) the health and well-being of teen16 agers in the communities; and 

17 (ii) the scholastic achievement of such 

18 teenagers; 

19 (B) the variance in the rates of teen preg20 nancy by— 

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

22 suburbs, and outer suburbs); 

23 (ii) population subgroup (such as His24 panic, Asian-Pacific Islander, African25 American, and Native American); and 


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1 (iii) level of acculturation; 

2 (C) the importance of the physical and so3 cial environment as a factor in placing commu4 nities at risk of increased rates of teen preg5 nancy; and 

6 (D) the importance of aspirations as a fac7 tor affecting young women’s risk of teen preg8 nancy; and 

9 (3) is used to develop— 

10 (A) measures to address race, ethnicity, so11 cioeconomic status, environment, and edu12 cational attainment and the relationship to the 

13 incidence and prevalence of teen pregnancy; and 

14 (B) efforts to link the measures to relevant 

15 databases, including health databases. 

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

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

18 give priority to research that incorporates— 

19 (1) interdisciplinary approaches; or 

20 (2) a strong emphasis on community-based 

21 participatory research. 

22 (d) REQUIREMENTS.—A grant may be made under 

23 this section only if— 

24 (1) the applicant agrees that all information 

25 provided pursuant to the grant will be age-approVerDate Nov 24 2008 01:51 Jan 15, 2009 Jkt 079200 PO 00000 Frm 00041 Fmt 6652 Sfmt 6201 E:\BILLS\H463.IH H463

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1 priate, factually and medically accurate and com2 plete, and scientifically based; 

3 (2) the applicant agrees that information, ac4 tivities, and services under the grant that are di5 rected toward a particular population group will be 

6 provided in the language and cultural context that is 

7 most appropriate for individuals in such group; and 

8 (3) an application for the grant is submitted to 

9 the Secretary of Health and Human Services and 

10 the application is in such form, is made in such 

11 manner, and contains such agreements, assurances, 

12 and information as the Secretary of Health and 

13 Human Services determines to be necessary to carry 

14 out the program involved. 

15 (e) AUTHORIZATION OF APPROPRIATIONS.—For the 

16 purpose of carrying out this section, there is authorized 

17 to be appropriated such sums as may be necessary for 

18 each of the fiscal years 2010 through 2014. 

19 TITLE VI—ACCURACY OF 

20 CONTRACEPTIVE INFORMATION 

21 SEC. 601. SHORT TITLE. 

22 This title may be cited as the ‘‘Truth in Contracep23 tion Act of 2009’’. 


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1 SEC. 602. ACCURACY OF CONTRACEPTIVE INFORMATION. 

2 Notwithstanding any other provision of law, any in3 formation concerning the use of a contraceptive provided 

4 through any federally funded sex education, family life 

5 education, abstinence education, comprehensive health 

6 education, or character education program shall be medi7 cally accurate and shall include health benefits and failure 

8 rates relating to the use of such contraceptive. 

9 TITLE VII—UNINTENDED 

10 PREGNANCY REDUCTION ACT 

11 SEC. 701. SHORT TITLE. 

12 This title may be cited as the ‘‘Unintended Preg13 nancy Reduction Act of 2009’’. 

14 SEC. 702. MEDICAID; CLARIFICATION OF COVERAGE OF 

15 FAMILY PLANNING SERVICES AND SUPPLIES. 

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

17 1396u–7(b)) is amended by adding at the end the fol18 lowing: 

19 ‘‘(5) COVERAGE OF FAMILY PLANNING SERV20 ICES AND SUPPLIES.—Notwithstanding the previous 

21 provisions of this section, a State may not provide 

22 for medical assistance through enrollment of an indi23 vidual with benchmark coverage or benchmark-equiv24 alent coverage under this section unless such cov25 erage includes, for any individual described in sec26 tion 1905(a)(4)(c)), medical assistance for family 


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1 planning services and supplies in accordance with 

2 such section.’’. 

3 SEC. 703. EXPANSION OF FAMILY PLANNING SERVICES. 

4 (a) COVERAGE AS A MANDATORY CATEGORICALLY

5 NEEDY GROUP.— 

6 (1) IN GENERAL.—Section 1902(a)(10)(A)(I) of 

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

8 1396a(a)(10)(A)(I)) is amended— 

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

10 the end; 

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

12 the end; and 

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

14 subclause: 

15 ‘‘(VIII) who are described in sub16 section (dd) (relating to individuals 

17 who meet the income standards for 

18 pregnant women);’’. 

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

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

21 by adding at the end the following new subsection: 

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

23 individuals who— 

24 ‘‘(A) meet at least the income eligibility stand25 ards established under the State plan as of January 


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

2 eligibility standard for such women as the State may 

3 establish; and 

4 ‘‘(B) are not pregnant. 

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

6 in this subsection may include individuals who are deter7 mined to meet the income eligibility standards referred to 

8 in paragraph (1)(A) under the terms and conditions appli9 cable to making eligibility determinations for medical as10 sistance under this title under a waiver to provide the ben11 efits described in clause (XV) of the matter following sub12 paragraph (G) of section 1902(a)(10) granted to the State 

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

14 (3) LIMITATION ON BENEFITS.—Section 

15 1902(a)(10) of the Social Security Act (42 U.S.C. 

16 1396a(a)(10)) is amended in the matter following 

17 subparagraph (G)— 

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

19 ‘‘(XIV)’’; and 

20 (B) by striking the semicolon at the end 

21 and inserting ‘‘, and (XV) the medical assist22 ance made available to an individual described 

23 in subsection (dd) who is eligible for medical as24 sistance only because of subparagraph 

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1 ning services and supplies described in 

2 1905(a)(4)(C) and, at the State’s option, med3 ical diagnosis or treatment services that are 

4 provided in conjunction with a family planning 

5 service in a family planning setting provided 

6 during the period in which such an individual is 

7 eligible;’’. 

8 (4) CONFORMING AMENDMENTS.—Section 

9 1905(a) of the Social Security Act (42 U.S.C. 

10 1396d(a)) is amended in the matter preceding para11 graph (1)— 

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

13 end; 

14 (B) in clause (xiii), by adding ‘‘or’’ at the 

15 end; and 

16 (C) by inserting after clause (xiii) the fol17 lowing: 

18 ‘‘(xiv) individuals described in section 

19 1902(dd),’’. 

20 (b) PRESUMPTIVE ELIGIBILITY.— 

21 (1) IN GENERAL.—Title XIX of the Social Se22 curity Act (42 U.S.C. 1396 et seq.) is amended by 

23 inserting after section 1920B the following: 


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1 ‘‘PRESUMPTIVE ELIGIBILITY FOR FAMILY PLANNING

2 SERVICES

3 ‘‘SEC. 1920C. (a) STATE OPTION.—A State plan ap4 proved under section 1902 may provide for making med5 ical assistance available to an individual described in sec6 tion 1902(dd) (relating to individuals who meet the in7 come eligibility standard for pregnant women in the State) 

8 during a presumptive eligibility period. In the case of an 

9 individual described in section 1902(dd) who is eligible for 

10 medical assistance only because of subparagraph 

11 (A)(10)(I)(VIII), such medical assistance may be limited 

12 to family planning services and supplies described in 

13 1905(a)(4)(C) and, at the State’s option, medical diag14 nosis or treatment services that are provided in conjunc15 tion with a family planning service in a family planning 

16 setting provided during the period in which such an indi17 vidual is eligible. 

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

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

20 term ‘presumptive eligibility period’ means, with re21 spect to an individual described in subsection (a), 

22 the period that— 

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

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1 liminary information, that the individual is de2 scribed in section 1902(dd); and 

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

4 of— 

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

6 is made with respect to the eligibility of 

7 such individual for services under the State 

8 plan; or 

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

10 who does not file an application by the last 

11 day of the month following the month dur12 ing which the entity makes the determina13 tion referred to in subparagraph (A), such 

14 last day. 

15 ‘‘(2) QUALIFIED ENTITY.— 

16 ‘‘(A) IN GENERAL.—Subject to subpara17 graph (B), the term ‘qualified entity’ means 

18 any entity that— 

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

20 State plan approved under this title; and 

21 ‘‘(ii) is determined by the State agen22 cy to be capable of making determinations 

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

24 ‘‘(B) REGULATIONS.—The Secretary may 

25 issue regulations further limiting those entities 


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1 that may become qualified entities in order to 

2 prevent fraud and abuse and for other reasons. 

3 ‘‘(C) RULE OF CONSTRUCTION.—Nothing 

4 in this paragraph shall be construed as pre5 venting a State from limiting the classes of en6 tities that may become qualified entities, con7 sistent with any limitations imposed under sub8 paragraph (B). 

9 ‘‘(c) ADMINISTRATION.— 

10 ‘‘(1) IN GENERAL.—The State agency shall pro11 vide qualified entities with— 

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

13 application to be made by an individual de14 scribed in subsection (a) for medical assistance 

15 under the State plan; and 

16 ‘‘(B) information on how to assist such in17 dividuals in completing and filing such forms. 

18 ‘‘(2) NOTIFICATION REQUIREMENTS.—A quali19 fied entity that determines under subsection 

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

21 (a) is presumptively eligible for medical assistance 

22 under a State plan shall— 

23 ‘‘(A) notify the State agency of the deter24 mination within 5 working days after the date 

25 on which determination is made; and 


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

2 the determination is made that an application 

3 for medical assistance is required to be made by 

4 not later than the last day of the month fol5 lowing the month during which the determina6 tion is made. 

7 ‘‘(3) APPLICATION FOR MEDICAL ASSIST8 ANCE.—In the case of an individual described in 

9 subsection (a) who is determined by a qualified enti10 ty to be presumptively eligible for medical assistance 

11 under a State plan, the individual shall apply for 

12 medical assistance by not later than the last day of 

13 the month following the month during which the de14 termination is made. 

15 ‘‘(d) PAYMENT.—Notwithstanding any other provi16 sion of this title, medical assistance that— 

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

18 subsection (a) during a presumptive eligibility period 

19 by an entity that is eligible for payments under the 

20 State plan; and 

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

22 by the State plan, 

23 shall be treated as medical assistance provided by such 

24 plan for purposes of clause (4) of the first sentence of 

25 section 1905(b).’’. 


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1 (2) CONFORMING AMENDMENTS.— 

2 (A) Section 1902(a)(47) of the Social Se3 curity Act (42 U.S.C. 1396a(a)(47)) is amend4 ed by inserting before the semicolon at the end 

5 the following: ‘‘and provide for making medical 

6 assistance available to individuals described in 

7 subsection (a) of section 1920C during a pre8 sumptive eligibility period in accordance with 

9 such section.’’. 

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

11 (42 U.S.C. 1396b(u)(1)(D)(v)) is amended— 

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

13 ‘‘, for’’; and 

14 (ii) by inserting before the period the 

15 following: ‘‘, or for medical assistance pro16 vided to an individual described in sub17 section (a) of section 1920C during a pre18 sumptive eligibility period under such sec19 tion’’. 

20 SEC. 704. EFFECTIVE DATE. 

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

22 (2), the amendments made by this title take effect on Oc23 tober 1, 2010. 

24 (b) EXTENSION OF EFFECTIVE DATE FOR STATE

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


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

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

3 determines requires State legislation in order for the plan 

4 to meet the additional requirements imposed by the 

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

6 be regarded as failing to comply with the requirements of 

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

8 additional requirements before the first day of the first 

9 calendar quarter beginning after the close of the first reg10 ular session of the State legislature that begins after the 

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

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

13 year legislative session, each year of the session is consid14 ered to be a separate regular session of the State legisla15 ture. 

16 TITLE VIII—RESPONSIBLE 

17 EDUCATION ABOUT LIFE ACT 

18 SEC. 801. SHORT TITLE. 

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

20 About Life Act of 2009’’. 


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

2 AIDS, AND OTHER SEXUALLY TRANSMITTED 

3 DISEASES AND TO SUPPORT HEALTHY ADO4 LESCENT DEVELOPMENT. 

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

6 Human Services may make grants to eligible States to 

7 conduct sex education programs, including programs that 

8 provide education on both abstinence and contraception 

9 for the prevention of teenage pregnancy and sexually 

10 transmitted diseases, including HIV/AIDS. 

11 (b) REQUIREMENTS FOR SEX EDUCATION PRO12 GRAMS.—For purposes of this title, a sex education pro13 gram is a program that— 

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

15 (2) stresses the value of abstinence while not ig16 noring those young people who have had or are hav17 ing sexual intercourse; 

18 (3) provides information about the health bene19 fits and side effects of all contraceptive and barrier 

20 methods used— 

21 (A) as a means to prevent pregnancy; and 

22 (B) to reduce the risk of contracting sexu23 ally transmitted disease, including HIV/AIDS; 

24 (4) encourages family communication between 

25 parent and child about sexuality; 


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1 (5) teaches young people the skills to make re2 sponsible decisions about sexuality, including how to 

3 avoid unwanted verbal, physical, and sexual ad4 vances and how to avoid making verbal, physical, 

5 and sexual advances that are not wanted by the 

6 other party; 

7 (6) teaches young people how alcohol and drug 

8 use can affect responsible decision making; and 

9 (7) does not teach or promote religion; 

10 (c) ADDITIONAL ACTIVITIES.—In carrying out a pro11 gram of sex education, a State may expend a grant under 

12 subsection (a) to carry out educational and motivational 

13 activities that help young people— 

14 (1) gain knowledge about the physical, emo15 tional, biological, and hormonal changes of adoles16 cence and subsequent stages of human maturation; 

17 (2) develop the knowledge and skills necessary 

18 to ensure and protect their sexual and reproductive 

19 health from unintended pregnancy and sexually 

20 transmitted disease, including HIV/AIDS through21 out their lifespan; 

22 (3) gain knowledge about the specific involve23 ment and responsibility of males in sexual decision 

24 making; 


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1 (4) develop healthy attitudes and values about 

2 adolescent growth and development, body image, ra3 cial and ethnic diversity, and other related subjects; 

4 (5) develop and practice healthy life skills, in5 cluding goal-setting, decision making, negotiation, 

6 communication, and stress management; 

7 (6) develop healthy relationships, including 

8 skills to prevent dating and sexual violence; 

9 (7) promote self-esteem and positive inter10 personal skills focusing on relationship dynamics, in11 cluding friendships, dating, romantic involvement, 

12 marriage and family interactions; and 

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

14 educational and career success, including developing 

15 skills for employment, job seeking, independent liv16 ing, financial self-sufficiency, and workplace produc17 tivity. 

18 SEC. 803. SENSE OF CONGRESS. 

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

20 required under this title to provide matching funds, with 

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

22 are encouraged to do so. 

23 SEC. 804. EVALUATION OF PROGRAMS. 

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

25 effectiveness of programs of sex education carried out with 


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1 a grant under section 802, evaluations of such programs 

2 shall be carried out in accordance with subsections (b) and 

3 (c)). 

4 (b) NATIONAL EVALUATION.— 

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

6 for a national evaluation of a representative sample 

7 of programs of sex education carried out with grants 

8 under section 802 to determine— 

9 (A) the effectiveness of such programs in 

10 helping to delay the initiation of sexual inter11 course and other high-risk behaviors; 

12 (B) the effectiveness of such programs in 

13 preventing adolescent pregnancy; 

14 (C) the effectiveness of such programs in 

15 preventing sexually transmitted disease, includ16 ing HIV/AIDS; 

17 (D) the effectiveness of such programs in 

18 increasing contraceptive knowledge and contra19 ceptive behaviors when sexual intercourse oc20 curs; and 

21 (E) a list of best practices based upon es22 sential programmatic components of evaluated 

23 programs that have led to success in subpara24 graphs (A) through (D). 


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1 (2) GRANT CONDITION.—A condition for the re2 ceipt of a grant under section 802 is that the State 

3 involved agree to cooperate with the evaluation 

4 under paragraph (1). 

5 (3) REPORTS.—The Secretary shall submit to 

6 Congress— 

7 (A) not later than the end of each fiscal 

8 year during the 5-year period beginning with 

9 fiscal year 2010, an interim report on the na10 tional evaluation under paragraph (1); and 

11 (B) not later than March 31, 2015, a final 

12 report providing the results of such national 

13 evaluation. 

14 (c) INDIVIDUAL STATE EVALUATIONS.— 

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

16 of a grant under section 802 is that the State in17 volved agree to provide for the evaluation of the pro18 grams of family education carried out with the grant 

19 in accordance with the following: 

20 (A) The evaluation will be conducted by an 

21 external, independent entity. 

22 (B) The purposes of the evaluation will be 

23 the determination of— 


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1 (i) the effectiveness of such programs 

2 in helping to delay the initiation of sexual 

3 intercourse and other high-risk behaviors; 

4 (ii) the effectiveness of such programs 

5 in preventing adolescent pregnancy; 

6 (iii) the effectiveness of such pro7 grams in preventing sexually transmitted 

8 disease, including HIV/AIDS; and 

9 (iv) the effectiveness of such programs 

10 in increasing contraceptive knowledge and 

11 contraceptive behaviors when sexual inter12 course occurs. 

13 SEC. 805. LIMITATIONS ON USE OF FUNDS. 

14 (a) LIMITATIONS ON SECRETARY.—Of the amounts 

15 appropriated for a fiscal year for purposes of this title, 

16 the Secretary may not use more than— 

17 (1) 7 percent of such amounts for administra18 tive expenses related to carrying out this title for 

19 that fiscal year; and 

20 (2) 10 percent of such amounts for the national 

21 evaluation under section 804(b). 

22 (b) LIMITATIONS TO STATES.—Of amounts provided 

23 to an eligible State under the section 802(a), the eligible 

24 entity may not use more than 10 percent of the grant to 

25 conduct any evaluation under section 804(c). 


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1 SEC. 806. DEFINITIONS. 

2 For purposes of this title: 

3 (1) The term ‘‘age-appropriate’’ refers to topics, 

4 messages, and teaching methods suitable to par5 ticular ages or age groups of children and adoles6 cents, based on developing cognitive, emotional, and 

7 behavioral capacity typical for the age or age group. 

8 (2) The term ‘‘eligible State’’ means a State 

9 that submits to the Secretary an application for a 

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

11 made in such manner, and contains such agree12 ments, assurances, and information as the Secretary 

13 determines to be necessary to carry out this title. 

14 (3) The term ‘‘HIV/AIDS’’ means the human 

15 immunodeficiency virus, and includes acquired im16 mune deficiency syndrome. 

17 (4) The term ‘‘medically accurate’’, with respect 

18 to information, means information that is supported 

19 by research, recognized as accurate and objective by 

20 leading medical, psychological, psychiatric, and pub21 lic health organizations and agencies, and where rel22 evant, published in peer review journals. 

23 (5) The term ‘‘Secretary’’ means the Secretary 

24 of Health and Human Services. 


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1 SEC. 807. AUTHORIZATION OF APPROPRIATIONS. 

2 For the purpose of carrying out this title, there are 

3 authorized to be appropriated such sums as may be nec4 essary for each of the fiscal years 2010 through 2014. 

Æ 


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