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[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 463 Introduced in House (IH)]

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. Velazquez, 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 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.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Prevention First 
Act of 2009''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Findings.
             TITLE I--TITLE X OF PUBLIC HEALTH SERVICE ACT

Sec. 101. Short title.
Sec. 102. Authorization of appropriations.
 TITLE II--EQUITY IN PRESCRIPTION INSURANCE AND CONTRACEPTIVE COVERAGE

Sec. 201. Short title.
Sec. 202. Amendments to Employee Retirement Income Security Act of 
                            1974.
Sec. 203. Amendments to Public Health Service Act relating to the group 
                            market.
Sec. 204. Amendment to Public Health Service Act relating to the 
                            individual market.
      TITLE III--EMERGENCY CONTRACEPTION EDUCATION AND INFORMATION

Sec. 301. Short title.
Sec. 302. Emergency contraception education and information programs.
        TITLE IV--COMPASSIONATE ASSISTANCE FOR RAPE EMERGENCIES

Sec. 401. Short title.
Sec. 402. Survivors of sexual assault; provision by hospitals of 
                            emergency contraceptives without charge.
     TITLE V--AT-RISK COMMUNITIES 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.

SEC. 2. FINDINGS.

    The Congress finds as follows:
            (1) Healthy People 2010 sets forth a reduction of 
        unintended pregnancies as an important health objective for the 
        Nation to achieve over the first decade of the new century, a 
        goal first articulated in the 1979 Surgeon General's Report, 
        Healthy People, and reiterated in Healthy People 2000: National 
        Health Promotion and Disease Prevention Objectives.
            (2) Although the Centers for Disease Control and Prevention 
        (referred to in this section as the ``CDC'') included family 
        planning in its published list of the Ten Great Public Health 
        Achievements in the 20th Century, the United States still has 
        one of the highest rates of unintended pregnancies among 
        industrialized nations.
            (3) Each year, nearly half of all pregnancies in the United 
        States are unintended, and nearly half of unintended 
        pregnancies end in abortion.
            (4) In 2006, 36,200,000 women, more than half of all women 
        of reproductive age, were in need of contraceptive services and 
        supplies to help prevent unintended pregnancy, and nearly half 
        of those were in need of public support for such care.
            (5) The United States has some of the highest rates of 
        sexually transmitted infections (referred to in this section as 
        ``STIs'') among industrialized nations. In 2006, there were 
        approximately 19,000,000 new cases of STIs, almost half of them 
        occurring in young people ages 15 to 24. According to the CDC, 
        in addition to the burden on public health, STIs impose a 
        tremendous economic burden with direct medical costs as high as 
        $14,700,000,000 each year in 2006 dollars.
            (6) Contraceptive use can improve overall health by 
        enabling women to plan and space their pregnancies and has 
        contributed to dramatic declines in maternal and infant 
        mortality. Widespread use of contraceptives has been the 
        driving force in reducing unintended pregnancies and sexually 
        transmitted infections, and reducing the need for abortion in 
        this nation. Contraceptive use also saves public health 
        dollars. For every dollar spent to provide services in publicly 
        funded family planning clinics, $4.02 in Medicaid expenses are 
        saved because unintended births are averted.
            (7) Reducing unintended pregnancy improves maternal health 
        and is an important strategy in efforts to reduce maternal 
        mortality. Women experiencing unintended pregnancy are at 
        greater risk for physical abuse.
            (8) A child born from an unintended pregnancy is at greater 
        risk than a child born from an intended pregnancy of low birth 
        weight, dying in the first year of life, being abused, and not 
        receiving sufficient resources for healthy development.
            (9) The ability to control fertility allows couples to 
        achieve economic stability by facilitating greater educational 
        achievement and participation in the workforce.
            (10) Contraceptives are effective in preventing unintended 
        pregnancy when used consistently and correctly. Without 
        contraception, a sexually active woman has an 85 percent chance 
        of becoming pregnant within a year.
            (11) Approximately 50 percent of unintended pregnancies 
        occur among women who do not use contraception.
            (12) Many poor and low-income women cannot afford to 
        purchase contraceptive services and supplies on their own. The 
        number of women needing subsidized services has increased by 
        more than 1,000,000 (seven percent) since 2000. A poor woman in 
        the United States is now nearly four times as likely as a more 
        affluent woman to have an unplanned pregnancy. Between 1994 and 
        2001, unintended pregnancy among low-income women increased by 
        29 percent, while unintended pregnancy decreased by 20 percent 
        among women with higher incomes.
            (13) Public health programs, such as the Medicaid program 
        and family planning programs under title X of the Public Health 
        Service Act, provide high-quality family planning services and 
        other preventive health care to underinsured or uninsured 
        individuals who may otherwise lack access to health care.
            (14) Medicaid has become an essential source of support for 
        the provision of subsidized family planning services and 
        supplies. It is the single largest source of public funds 
        supporting these services. In 2001, the program provided six in 
        ten of all public dollars spent on family planning services. In 
        2006, 12 percent of women of reproductive age (7,300,000 women 
        between the ages of 15 and 44) looked to Medicaid for their 
        care and 37 percent of poor women of reproductive age rely upon 
        Medicaid.
            (15) Approximately 1,400,000 unintended pregnancies and 
        600,000 abortions are averted each year because of services 
        provided in publicly funded clinics. In 2006, title X service 
        providers performed more than 2,400,000 Pap tests, 2,400,000 
        breast exams, and 5,800,000 tests for STIs, including 652,426 
        HIV tests and 2,300,000 Chlamydia tests. One in four women who 
        obtain reproductive health services from a medical provider 
        does so at a publicly funded clinic.
            (16) The stagnant funding for public family planning 
        programs in combination with the increasing demand for 
        subsidized services; the rising costs of contraceptive services 
        and supplies, and the high cost of improved screening and 
        treatment for cervical cancer and sexually transmitted 
        infections has diminished the ability of clinics receiving 
        funds under title X of the Public Health Services Act to 
        adequately serve all those in need. At present, clinics are 
        able to reach just 41 percent of the women needing subsidized 
        services. Had title X funding kept up with inflation since FY 
        1980, it would now be funded at $759,000,000, instead of its 
        fiscal year 2007 funding level of $283,000,000. Taking 
        inflation into account, funding for title X in constant dollars 
        is 63 percent lower today than it was in FY 1980.
            (17) While the Medicaid program remains the largest source 
        of subsidized family planning services, States are facing 
        significant budgetary pressures to cut their Medicaid programs, 
        putting many women at risk of losing coverage for family 
        planning services.
            (18) In addition, eligibility under the Medicaid program in 
        many States is severely restricted, which leaves family 
        planning services financially out of reach for many poor women. 
        Many States have demonstrated tremendous success with Medicaid 
        family planning waivers that allow States to expand access to 
        Medicaid family planning services. However, the administrative 
        burden of applying for a waiver poses a significant barrier to 
        States that would like to expand their coverage of family 
        planning programs through Medicaid.
            (19) As of December 2008, 27 States offered expanded family 
        planning benefits as a result of Medicaid family planning 
        waivers. The cost-effectiveness of these waivers was affirmed 
        by a recent evaluation funded by the Centers for Medicare & 
        Medicaid Services. This evaluation of six waivers found that 
        all family planning programs under such waivers resulted in 
        significant savings to both the Federal and State governments. 
        Moreover, the researchers found measurable reductions in 
        unintended pregnancy.
            (20) Although employer-sponsored health plans have improved 
        coverage of contraceptive services and supplies, largely in 
        response to State contraceptive coverage laws, there is still 
        significant room for improvement. The ongoing lack of coverage 
        in health insurance plans, particularly in self-insured and 
        individual plans, continues to place effective forms of 
        contraception beyond the financial reach of many women.
            (21) Including contraceptive coverage in private health 
        care plans saves employers money. Not covering contraceptives 
        in employee health plans costs employers 15 to 17 percent more 
        than providing such coverage.
            (22) Approved for use by the Food and Drug Administration, 
        emergency contraception is a safe and effective way to prevent 
        unintended pregnancy after unprotected sex. Research confirms 
        that easier access to emergency contraceptives does not 
        increase sexual risk-taking or sexually transmitted diseases.
            (23) The available evidence shows that many women do not 
        know about emergency contraception, do not know where to get 
        it, or are unable to access it. Overcoming these obstacles 
        could help ensure that more women use emergency contraception 
        consistently and correctly.
            (24) A November 2006 study of declining pregnancy rates 
        among teens concluded that the reduction in teen pregnancy 
        between 1995 and 2002 is primarily the result of increased use 
        of contraceptives. As such, it is critically important that 
        teens receive accurate, unbiased information about 
        contraception.
            (25) The American Medical Association, the American Nurses 
        Association, the American Academy of Pediatrics, the American 
        College of Obstetricians and Gynecologists, the American Public 
        Health Association, and the Society for Adolescent Medicine, 
        support responsible sexuality education that includes 
        information about both abstinence and contraception.
            (26) Teens who receive comprehensive sexuality education 
        that includes discussion of contraception as well as abstinence 
        are more likely than those who receive abstinence-only messages 
        to delay sex, to have fewer partners, and to use contraceptives 
        when they do become sexually active.
            (27) Government-funded abstinence-only-until-marriage 
        programs are precluded from discussing contraception except to 
        talk about failure rates. An October 2006 report by the 
        Government Accountability Office found that the Department of 
        Health and Human Services does not review the materials of 
        recipients of grants administered by such Department for 
        scientific accuracy and requires grantees to review their own 
        materials for scientific accuracy. The GAO also reported on the 
        Department's total lack of appropriate and customary 
        measurements to determine if funded programs are effective. In 
        addition, a separate letter from the Government Accountability 
        Office found that the Department of Health and Human Services 
        is in violation of Federal law by failing to enforce a 
        requirement under the Public Health Service Act that federally 
        funded grantees working to address the prevention of sexually 
        transmitted diseases, including abstinence-only-until-marriage 
        programs, must provide medically accurate information about the 
        effectiveness of condoms.
            (28) Recent scientific reports by the Institute of 
        Medicine, the American Medical Association, and the Office on 
        National AIDS Policy stress the need for sexuality education 
        that includes messages about abstinence and provides young 
        people with information about contraception for the prevention 
        of teen pregnancy, HIV/AIDS, and other sexually transmitted 
        diseases.
            (29) A 2006 statement from the American Public Health 
        Association (referred to in this section as ``APHA'') states 
        that APHA ``recognizes the importance of abstinence education, 
        but only as part of a comprehensive sexuality education program 
        . . . APHA calls for repealing current Federal funding for 
        abstinence-only programs and replacing it with funding for a 
        new Federal program to promote comprehensive sexuality 
        education, combining information about abstinence with age-
        appropriate sexuality education.''.
            (30) Comprehensive sexuality education programs respect the 
        diversity of values and beliefs represented in the community 
        and will complement and augment the sexuality education 
        children receive from their families.
            (31) Over 60 percent of the 56,300 annual new cases of HIV 
        infections in the United States occur in youth ages 13 through 
        24. African-American and Latino youth have been 
        disproportionately affected by the HIV/AIDS epidemic. In 2005, 
        Blacks and Latinos accounted for 84 percent of all new HIV 
        infections among 13- to 19-year-olds and 76 percent of HIV 
        infections among 20- to 24-year-olds in the United States even 
        though, Black and Latinos represent only about 32 percent of 
        people in these ages. Teens in the United States contract an 
        estimated 9,000,000 sexually transmitted infections each year. 
        By age 24, at least one in four sexually active people between 
        the ages of 15 and 24 will have contracted a sexually 
        transmitted infection.
            (32) Approximately 50 young people a day, an average of 2 
        young people every hour of every day, are infected with HIV in 
        the United States.

             TITLE I--TITLE X OF PUBLIC HEALTH SERVICE ACT

SEC. 101. SHORT TITLE.

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

SEC. 102. AUTHORIZATION OF APPROPRIATIONS.

    Section 1001(d) of the Public Health Service Act is amended by 
striking all that follows ``there are authorized to be appropriated'' 
and inserting ``$700,000,000 for fiscal year 2010 and such sums as may 
be necessary for each subsequent fiscal year''.

 TITLE II--EQUITY IN PRESCRIPTION INSURANCE AND CONTRACEPTIVE COVERAGE

SEC. 201. SHORT TITLE.

    This title may be cited as the ``Equity in Prescription Insurance 
and Contraceptive Coverage Act of 2009''.

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

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

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

    ``(a) Requirements for Coverage.--A group health plan, and a health 
insurance issuer providing health insurance coverage in connection with 
a group health plan, may not--
            ``(1) exclude or restrict benefits for prescription 
        contraceptive drugs or devices approved by the Food and Drug 
        Administration, or generic equivalents approved as 
        substitutable by the Food and Drug Administration, if such plan 
        or coverage provides benefits for other outpatient prescription 
        drugs or devices; or
            ``(2) exclude or restrict benefits for outpatient 
        contraceptive services if such plan or coverage provides 
        benefits for other outpatient health care services.
    ``(b) Prohibitions.--A group health plan, and a health insurance 
issuer providing health insurance coverage in connection with a group 
health plan, may not--
            ``(1) deny to an individual eligibility, or continued 
        eligibility, to enroll or to renew coverage under the terms of 
        the plan because of the individual's or enrollee's use or 
        potential use of items or services that are covered in 
        accordance with the requirements of this section;
            ``(2) provide monetary payments or rebates to a covered 
        individual to encourage such individual to accept less than the 
        minimum protections available under this section;
            ``(3) penalize or otherwise reduce or limit the 
        reimbursement of a health care professional because such 
        professional prescribed contraceptive drugs or devices, or 
        provided contraceptive services, described in subsection (a), 
        in accordance with this section; or
            ``(4) provide incentives (monetary or otherwise) to a 
        health care professional to induce such professional to 
        withhold from a covered individual contraceptive drugs or 
        devices, or contraceptive services, described in subsection 
        (a).
    ``(c) Rules of Construction.--
            ``(1) In general.--Nothing in this section shall be 
        construed--
                    ``(A) as preventing a group health plan and a 
                health insurance issuer providing health insurance 
                coverage in connection with a group health plan from 
                imposing deductibles, coinsurance, or other cost-
                sharing or limitations in relation to--
                            ``(i) benefits for contraceptive drugs 
                        under the plan or coverage, except that such a 
                        deductible, coinsurance, or other cost-sharing 
                        or limitation for any such drug shall be 
                        consistent with those imposed for other 
                        outpatient prescription drugs otherwise covered 
                        under the plan or coverage;
                            ``(ii) benefits for contraceptive devices 
                        under the plan or coverage, except that such a 
                        deductible, coinsurance, or other cost-sharing 
                        or limitation for any such device shall be 
                        consistent with those imposed for other 
                        outpatient prescription devices otherwise 
                        covered under the plan or coverage; and
                            ``(iii) benefits for outpatient 
                        contraceptive services under the plan or 
                        coverage, except that such a deductible, 
                        coinsurance, or other cost-sharing or 
                        limitation for any such service shall be 
                        consistent with those imposed for other 
                        outpatient health care services otherwise 
                        covered under the plan or coverage;
                    ``(B) as requiring a group health plan and a health 
                insurance issuer providing health insurance coverage in 
                connection with a group health plan to cover 
                experimental or investigational contraceptive drugs or 
                devices, or experimental or investigational 
                contraceptive services, described in subsection (a), 
                except to the extent that the plan or issuer provides 
                coverage for other experimental or investigational 
                outpatient prescription drugs or devices, or 
                experimental or investigational outpatient health care 
                services; or
                    ``(C) as modifying, diminishing, or limiting the 
                rights or protections of an individual under any other 
                Federal law.
            ``(2) Limitations.--As used in paragraph (1), the term 
        `limitation' includes--
                    ``(A) in the case of a contraceptive drug or 
                device--
                            ``(i) restricting the type of health care 
                        professionals that may prescribe such drugs or 
                        devices;
                            ``(ii) utilization review provisions; and
                            ``(iii) limits on the volume of 
                        prescription drugs or devices that may be 
                        obtained on the basis of a single consultation 
                        with a professional; or
                    ``(B) in the case of an outpatient contraceptive 
                service--
                            ``(i) restricting the type of health care 
                        professionals that may provide such services;
                            ``(ii) utilization review provisions;
                            ``(iii) requirements relating to second 
                        opinions prior to the coverage of such 
                        services; and
                            ``(iv) requirements relating to 
                        preauthorizations prior to the coverage of such 
                        services.
    ``(d) Notice Under Group Health Plan.--The imposition of the 
requirements of this section shall be treated as a material 
modification in the terms of the plan described in section 102(a)(1), 
for purposes of assuring notice of such requirements under the plan, 
except that the summary description required to be provided under the 
last sentence of section 104(b)(1) with respect to such modification 
shall be provided by not later than 60 days after the first day of the 
first plan year in which such requirements apply.
    ``(e) Preemption.--Nothing in this section shall be construed to 
preempt any provision of State law to the extent that such State law 
establishes, implements, or continues in effect any standard or 
requirement that provides coverage or protections for participants or 
beneficiaries that are greater than the coverage or protections 
provided under this section.
    ``(f) Definitions.--In this section:
            ``(1) Outpatient contraceptive services.--The term 
        `outpatient contraceptive services' means consultations, 
        examinations, procedures, and medical services, provided on an 
        outpatient basis and related to the use of contraceptive 
        methods (including natural family planning) to prevent an 
        unintended pregnancy.
            ``(2) Outpatient health care services.--The term 
        `outpatient health care services' means outpatient services 
        provided by a health care professional.''.
    (b) Clerical Amendment.--The table of contents in section 1 of the 
Employee Retirement Income Security Act of 1974 (29 U.S.C. 1001) is 
amended by inserting after the item relating to section 714 the 
following:

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

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

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

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

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

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

    (a) In General.--Part B of title XXVII of the Public Health Service 
Act (42 U.S.C. 300gg-41 et seq.) is amended by adding at the end of 
subpart 2 the following:

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

    ``The provisions of section 2708 shall apply to health insurance 
coverage offered by a health insurance issuer in the individual market 
in the same manner as such provisions apply to health insurance 
coverage offered by a health insurance issuer in connection with a 
group health plan in the small or large group market.''.
    (a) Effective Date.--The amendment made by this section shall apply 
with respect to health insurance coverage offered, sold, issued, 
renewed, in effect, or operated in the individual market on or after 
January 1, 2010.

      TITLE III--EMERGENCY CONTRACEPTION EDUCATION AND INFORMATION

SEC. 301. SHORT TITLE.

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

SEC. 302. EMERGENCY CONTRACEPTION EDUCATION AND INFORMATION PROGRAMS.

    (a) Definitions.--For purposes of this section:
            (1) Emergency contraception.--The term ``emergency 
        contraception'' means a drug or device (as such terms are 
        defined in section 201 of the Federal Food, Drug, and Cosmetic 
        Act (21 U.S.C. 321)) or a drug regimen that--
                    (A) is used after sexual relations;
                    (B) prevents pregnancy, by preventing ovulation, 
                fertilization of an egg, or implantation of an egg in a 
                uterus; and
                    (C) is approved by the Food and Drug 
                Administration.
            (2) Health care provider.--The term ``health care 
        provider'' means an individual who is licensed or certified 
        under State law to provide health care services and who is 
        operating within the scope of such license.
            (3) Institution of higher education.--The term 
        ``institution of higher education'' has the same meaning given 
        such term in section 101(a) of the Higher Education Act of 1965 
        (20 U.S.C. 1001(a)).
            (4) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
    (b) Emergency Contraception Public Education Program.--
            (1) In general.--The Secretary, acting through the Director 
        of the Centers for Disease Control and Prevention, shall 
        develop and disseminate to the public information on emergency 
        contraception.
            (2) Dissemination.--The Secretary may disseminate 
        information under paragraph (1) directly or through 
        arrangements with nonprofit organizations, consumer groups, 
        institutions of higher education, Federal, State, or local 
        agencies, clinics, and the media.
            (3) Information.--The information disseminated under 
        paragraph (1) shall include, at a minimum, a description of 
        emergency contraception and an explanation of the use, safety, 
        efficacy, and availability of such contraception.
    (c) Emergency Contraception Information Program for Health Care 
Providers.--
            (1) In general.--The Secretary, acting through the 
        Administrator of the Health Resources and Services 
        Administration and in consultation with major medical and 
        public health organizations, shall develop and disseminate to 
        health care providers information on emergency contraception.
            (2) Information.--The information disseminated under 
        paragraph (1) shall include, at a minimum--
                    (A) information describing the use, safety, 
                efficacy, and availability of emergency contraception;
                    (B) a recommendation regarding the use of such 
                contraception in appropriate cases; and
                    (C) information explaining how to obtain copies of 
                the information developed under subsection (b) for 
                distribution to the patients of the providers.
    (d) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section such sums as may be necessary 
for each of the fiscal years 2010 through 2014.

        TITLE IV--COMPASSIONATE ASSISTANCE FOR RAPE EMERGENCIES

SEC. 401. SHORT TITLE.

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

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

    (a) In General.--Federal funds may not be provided to a hospital 
under any health-related program, unless the hospital meets the 
conditions specified in subsection (b) in the case of--
            (1) any woman who presents at the hospital and states that 
        she is a victim of sexual assault, or is accompanied by someone 
        who states she is a victim of sexual assault; and
            (2) any woman who presents at the hospital whom hospital 
        personnel have reason to believe is a victim of sexual assault.
    (b) Assistance for Victims.--The conditions specified in this 
subsection regarding a hospital and a woman described in subsection (a) 
are as follows:
            (1) The hospital promptly provides the woman with medically 
        and factually accurate and unbiased written and oral 
        information about emergency contraception, including 
        information explaining that--
                    (A) emergency contraception does not cause an 
                abortion; and
                    (B) emergency contraception is effective in most 
                cases in preventing pregnancy after unprotected sex.
            (2) The hospital promptly offers emergency contraception to 
        the woman, and promptly provides such contraception to her on 
        her request.
            (3) The information provided pursuant to paragraph (1) is 
        in clear and concise language, is readily comprehensible, and 
        meets such conditions regarding the provision of the 
        information in languages other than English as the Secretary 
        may establish.
            (4) The services described in paragraphs (1) through (3) 
        are not denied because of the inability of the woman or her 
        family to pay for the services.
    (c) Definitions.--For purposes of this section:
            (1) The term ``emergency contraception'' means a drug, drug 
        regimen, or device that--
                    (A) is used postcoitally;
                    (B) prevents pregnancy by delaying ovulation, 
                preventing fertilization of an egg, or preventing 
                implantation of an egg in a uterus; and
                    (C) is approved by the Food and Drug 
                Administration.
            (2) The term ``hospital'' has the meanings given such term 
        in title XVIII of the Social Security Act, including--
                    (A) the meaning given such term in section 1861(e) 
                of such Act;
                    (B) the meaning given the term ``psychiatric 
                hospital'' in section 1861(f) of such Act;
                    (C) the meaning given to the term ``critical access 
                hospital'' under section 1861(mm) of such Act; and
                    (D) the meaning applicable such title for purposes 
                of making payments for emergency services to hospitals 
                that do not have agreements in effect under such title.
            (3) The term ``Secretary'' means the Secretary of Health 
        and Human Services.
            (4) The term ``sexual assault'' means coitus in which the 
        woman involved does not consent or lacks the legal capacity to 
        consent.
    (d) Effective Date; Agency Criteria.--This section takes effect 
upon the expiration of the 180-day period beginning on the date of the 
enactment of this title. Not later than 30 days prior to the expiration 
of such period, the Secretary shall publish in the Federal Register 
criteria for carrying out this section.

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

SEC. 501. SHORT TITLE.

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

SEC. 502. TEEN PREGNANCY PREVENTION.

    (a) Teenage Pregnancy Prevention Grants.--Part P of title III of 
the Public Health Service Act (42 U.S.C. 280g et seq.) is amended by 
inserting at the end the following section:

``SEC. 399U. TEENAGE PREGNANCY PREVENTION GRANTS.

    ``(a) Authority.--The Secretary may award on a competitive basis 
grants to public and private entities to establish or expand teenage 
pregnancy prevention programs.
    ``(b) Grant Recipients.--Grant recipients under this section may 
include State and local not-for-profit coalitions working to prevent 
teenage pregnancy; State, local, and tribal agencies; schools; entities 
that provide after-school programs; and community and faith-based 
groups.
    ``(c) Priority.--In selecting grant recipients under this section, 
the Secretary shall give--
            ``(1) highest priority to applicants seeking assistance for 
        programs targeting communities or populations in which--
                    ``(A) teenage pregnancy or birth rates are higher 
                than the corresponding State average; or
                    ``(B) teenage pregnancy or birth rates are 
                increasing; and
            ``(2) priority to applicants seeking assistance for 
        programs that--
                    ``(A) will benefit underserved or at-risk 
                populations such as young males or immigrant youths; or
                    ``(B) will take advantage of other available 
                resources and be coordinated with other programs that 
                serve youth, such as workforce development and after-
                school programs.
    ``(d) Use of Funds.--Funds received by an entity as a grant under 
this section may only be used for programs that--
            ``(1) replicate or substantially incorporate the elements 
        of one or more teenage pregnancy prevention programs that have 
        been proven (on the basis of rigorous scientific research) to 
        delay sexual intercourse or sexual activity, increase condom or 
        contraceptive use without increasing sexual activity, or reduce 
        teenage pregnancy;
            ``(2) incorporate one or more of the following strategies 
        for preventing teenage pregnancy: encouraging teenagers to 
        delay sexual activity; sex and HIV education; interventions for 
        sexually active teenagers; preventive health services; youth 
        development programs; service learning programs; and outreach 
        or media programs;
            ``(3) provide information that is age-appropriate, 
        factually and medically accurate and complete, and 
        scientifically based; and
            ``(4) provide any information, activities, and services 
        that are directed toward a particular population group in a 
        language and cultural context that is most appropriate for 
        individual in such group.
    ``(e) Relation to Abstinence-Only Programs.--Funds under this 
section are not intended for use by abstinence-only education programs. 
Abstinence-only education programs that receive Federal funds through 
the Maternal and Child Health Block Grant, the Administration for 
Children and Families, the Adolescent Family Life Program, and any 
other program that uses the definition of `abstinence education' found 
in section 510(b) of the Social Security Act are ineligible for funding 
under this section.
    ``(f) Applications.--Each entity seeking a grant under this section 
shall submit an application to the Secretary at such time and in such 
form, is made in such manner, and contains such agreements, assurances, 
and information as the Secretary determines to be necessary to carry 
out the program involved.
    ``(g) Matching Funds.--
            ``(1) In general.--The Federal share of the cost of an 
        activity carried out with a grant under this section may not 
        exceed 75 percent of cost of the activity.
            ``(2) Applicant's share.--The applicant's share of the cost 
        of a program shall be provided in cash or in kind.
    ``(h) Maintenance of Effort.--As condition of making a grant under 
this section to an entity during any fiscal year, the Secretary shall 
require that the entity expend, during such fiscal year, not less than 
the amount of funds from non-Federal sources expended by such entity 
for teenage pregnancy prevention during the fiscal year preceding the 
first fiscal year for which such grant is made to such entity.
    ``(i) Evaluations.--
            ``(1) In general.--The Secretary shall--
                    ``(A) conduct or provide for a rigorous evaluation 
                of 10 percent of programs for which a grant is awarded 
                under this section for the purpose of determining the 
                effectiveness of such programs;
                    ``(B) collect and analyze data relating to program 
                effectiveness on each program for which a grant is 
                awarded under this section; and
                    ``(C) upon completion of the evaluations referred 
                to in subparagraph (A), submit to the Congress a report 
                that includes a detailed statement on the effectiveness 
                of grants under this section.
            ``(2) Cooperation by grantees.--Each grant recipient under 
        this section shall provide such information and cooperation as 
        may be required by the Secretary for purposes of an evaluation 
        or data collection under paragraph (1).
    ``(j) Definition.--For purposes of this section, the term `rigorous 
scientific research' means research based on a program evaluation 
that--
            ``(1) measured impact of the program on sexual or 
        contraceptive behavior, pregnancy or childbearing;
            ``(2) employed an experimental or quasi-experimental design 
        with well-constructed and appropriate comparison groups; and
            ``(3) had a sample size large enough (at least 100 in the 
        combined treatment and control group) and a follow-up interval 
        long enough (at least 6 months) to draw valid conclusions about 
        such impact.
    ``(k) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section such sums as may be necessary 
for fiscal year 2010 and each subsequent fiscal year.''.
    (b) Technical Corrections.--Part P of title III of the Public 
Health Service Act (42 U.S.C. 280g et seq.) is amended by--
            (1) redesignating the second section 399R (as added by 
        section 2 of Public Law 110-373) as section 399S; and
            (2) redesignating the third section 399R (as added by 
        section 3 of Public Law 110-374) as section 399T.

SEC. 503. RESEARCH.

    (a) In General.--The Secretary of Health and Human Services, acting 
through the Director of the Centers for Disease Control and Prevention, 
shall make grants to public or nonprofit private entities to conduct, 
support, and coordinate research on the prevention of teen pregnancy in 
eligible communities, including research on the factors contributing to 
the disproportionate rates of teen pregnancy in such communities.
    (b) Research.--In carrying out subsection (a), the Secretary of 
Health and Human Services shall support research that--
            (1) investigates and determines the incidence and 
        prevalence of teen pregnancy in communities described in such 
        subsection;
            (2) examines--
                    (A) the extent of the impact of teen pregnancy on--
                            (i) the health and well-being of teenagers 
                        in the communities; and
                            (ii) the scholastic achievement of such 
                        teenagers;
                    (B) the variance in the rates of teen pregnancy 
                by--
                            (i) location (such as inner cities, inner 
                        suburbs, and outer suburbs);
                            (ii) population subgroup (such as Hispanic, 
                        Asian-Pacific Islander, African-American, and 
                        Native American); and
                            (iii) level of acculturation;
                    (C) the importance of the physical and social 
                environment as a factor in placing communities at risk 
                of increased rates of teen pregnancy; and
                    (D) the importance of aspirations as a factor 
                affecting young women's risk of teen pregnancy; and
            (3) is used to develop--
                    (A) measures to address race, ethnicity, 
                socioeconomic status, environment, and educational 
                attainment and the relationship to the incidence and 
                prevalence of teen pregnancy; and
                    (B) efforts to link the measures to relevant 
                databases, including health databases.
    (c) Priority.--In making grants under subsection (a), the Secretary 
of Health and Human Services shall give priority to research that 
incorporates--
            (1) interdisciplinary approaches; or
            (2) a strong emphasis on community-based participatory 
        research.
    (d) Requirements.--A grant may be made under this section only if--
            (1) the applicant agrees that all information provided 
        pursuant to the grant will be age-appropriate, factually and 
        medically accurate and complete, and scientifically based;
            (2) the applicant agrees that information, activities, and 
        services under the grant that are directed toward a particular 
        population group will be provided in the language and cultural 
        context that is most appropriate for individuals in such group; 
        and
            (3) an application for the grant is submitted to the 
        Secretary of Health and Human Services and the application is 
        in such form, is made in such manner, and contains such 
        agreements, assurances, and information as the Secretary of 
        Health and Human Services determines to be necessary to carry 
        out the program involved.
    (e) Authorization of Appropriations.--For the purpose of carrying 
out this section, there is authorized to be appropriated such sums as 
may be necessary for each of the fiscal years 2010 through 2014.

            TITLE VI--ACCURACY OF CONTRACEPTIVE INFORMATION

SEC. 601. SHORT TITLE.

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

SEC. 602. ACCURACY OF CONTRACEPTIVE INFORMATION.

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

             TITLE VII--UNINTENDED PREGNANCY REDUCTION ACT

SEC. 701. SHORT TITLE.

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

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

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

SEC. 703. EXPANSION OF FAMILY PLANNING SERVICES.

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

         ``presumptive eligibility for family planning services

    ``Sec. 1920C.  (a) State Option.--A State plan approved under 
section 1902 may provide for making medical assistance available to an 
individual described in section 1902(dd) (relating to individuals who 
meet the income eligibility standard for pregnant women in the State) 
during a presumptive eligibility period. In the case of an individual 
described in section 1902(dd) who is eligible for medical assistance 
only because of subparagraph (A)(10)(I)(VIII), such medical assistance 
may be limited to family planning services and supplies described in 
1905(a)(4)(C) and, at the State's option, medical diagnosis or 
treatment services that are provided in conjunction with a family 
planning service in a family planning setting provided during the 
period in which such an individual is eligible.
    ``(b) Definitions.--For purposes of this section:
            ``(1) Presumptive eligibility period.--The term 
        `presumptive eligibility period' means, with respect to an 
        individual described in subsection (a), the period that--
                    ``(A) begins with the date on which a qualified 
                entity determines, on the basis of preliminary 
                information, that the individual is described in 
                section 1902(dd); and
                    ``(B) ends with (and includes) the earlier of--
                            ``(i) the day on which a determination is 
                        made with respect to the eligibility of such 
                        individual for services under the State plan; 
                        or
                            ``(ii) in the case of such an individual 
                        who does not file an application by the last 
                        day of the month following the month during 
                        which the entity makes the determination 
                        referred to in subparagraph (A), such last day.
            ``(2) Qualified entity.--
                    ``(A) In general.--Subject to subparagraph (B), the 
                term `qualified entity' means any entity that--
                            ``(i) is eligible for payments under a 
                        State plan approved under this title; and
                            ``(ii) is determined by the State agency to 
                        be capable of making determinations of the type 
                        described in paragraph (1)(A).
                    ``(B) Regulations.--The Secretary may issue 
                regulations further limiting those entities that may 
                become qualified entities in order to prevent fraud and 
                abuse and for other reasons.
                    ``(C) Rule of construction.--Nothing in this 
                paragraph shall be construed as preventing a State from 
                limiting the classes of entities that may become 
                qualified entities, consistent with any limitations 
                imposed under subparagraph (B).
    ``(c) Administration.--
            ``(1) In general.--The State agency shall provide qualified 
        entities with--
                    ``(A) such forms as are necessary for an 
                application to be made by an individual described in 
                subsection (a) for medical assistance under the State 
                plan; and
                    ``(B) information on how to assist such individuals 
                in completing and filing such forms.
            ``(2) Notification requirements.--A qualified entity that 
        determines under subsection (b)(1)(A) that an individual 
        described in subsection (a) is presumptively eligible for 
        medical assistance under a State plan shall--
                    ``(A) notify the State agency of the determination 
                within 5 working days after the date on which 
                determination is made; and
                    ``(B) inform such individual at the time the 
                determination is made that an application for medical 
                assistance is required to be made by not later than the 
                last day of the month following the month during which 
                the determination is made.
            ``(3) Application for medical assistance.--In the case of 
        an individual described in subsection (a) who is determined by 
        a qualified entity to be presumptively eligible for medical 
        assistance under a State plan, the individual shall apply for 
        medical assistance by not later than the last day of the month 
        following the month during which the determination is made.
    ``(d) Payment.--Notwithstanding any other provision of this title, 
medical assistance that--
            ``(1) is furnished to an individual described in subsection 
        (a) during a presumptive eligibility period by an entity that 
        is eligible for payments under the State plan; and
            ``(2) is included in the care and services covered by the 
        State plan,
shall be treated as medical assistance provided by such plan for 
purposes of clause (4) of the first sentence of section 1905(b).''.
            (2) Conforming amendments.--
                    (A) Section 1902(a)(47) of the Social Security Act 
                (42 U.S.C. 1396a(a)(47)) is amended by inserting before 
                the semicolon at the end the following: ``and provide 
                for making medical assistance available to individuals 
                described in subsection (a) of section 1920C during a 
                presumptive eligibility period in accordance with such 
                section.''.
                    (B) Section 1903(u)(1)(D)(v) of such Act (42 U.S.C. 
                1396b(u)(1)(D)(v)) is amended--
                            (i) by striking ``or for'' and inserting 
                        ``, for''; and
                            (ii) by inserting before the period the 
                        following: ``, or for medical assistance 
                        provided to an individual described in 
                        subsection (a) of section 1920C during a 
                        presumptive eligibility period under such 
                        section''.

SEC. 704. EFFECTIVE DATE.

    (a) In General.--Except as provided in paragraph (2), the 
amendments made by this title take effect on October 1, 2010.
    (b) Extension of Effective Date for State Law Amendment.--In the 
case of a State plan under title XIX of the Social Security Act (42 
U.S.C. 1396 et seq.) which the Secretary of Health and Human Services 
determines requires State legislation in order for the plan to meet the 
additional requirements imposed by the amendments made by this title, 
the State plan shall not be regarded as failing to comply with the 
requirements of such title solely on the basis of its failure to meet 
these additional requirements before the first day of the first 
calendar quarter beginning after the close of the first regular session 
of the State legislature that begins after the date of the enactment of 
this Act. For purposes of the previous sentence, in the case of a State 
that has a 2-year legislative session, each year of the session is 
considered to be a separate regular session of the State legislature.

            TITLE VIII--RESPONSIBLE EDUCATION ABOUT LIFE ACT

SEC. 801. SHORT TITLE.

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

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

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

SEC. 803. SENSE OF CONGRESS.

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

SEC. 804. EVALUATION OF PROGRAMS.

    (a) In General.--For the purpose of evaluating the effectiveness of 
programs of sex education carried out with a grant under section 802, 
evaluations of such programs shall be carried out in accordance with 
subsections (b) and (c)).
    (b) National Evaluation.--
            (1) In general.--The Secretary shall provide for a national 
        evaluation of a representative sample of programs of sex 
        education carried out with grants under section 802 to 
        determine--
                    (A) the effectiveness of such programs in helping 
                to delay the initiation of sexual intercourse and other 
                high-risk behaviors;
                    (B) the effectiveness of such programs in 
                preventing adolescent pregnancy;
                    (C) the effectiveness of such programs in 
                preventing sexually transmitted disease, including HIV/
                AIDS;
                    (D) the effectiveness of such programs in 
                increasing contraceptive knowledge and contraceptive 
                behaviors when sexual intercourse occurs; and
                    (E) a list of best practices based upon essential 
                programmatic components of evaluated programs that have 
                led to success in subparagraphs (A) through (D).
            (2) Grant condition.--A condition for the receipt of a 
        grant under section 802 is that the State involved agree to 
        cooperate with the evaluation under paragraph (1).
            (3) Reports.--The Secretary shall submit to Congress--
                    (A) not later than the end of each fiscal year 
                during the 5-year period beginning with fiscal year 
                2010, an interim report on the national evaluation 
                under paragraph (1); and
                    (B) not later than March 31, 2015, a final report 
                providing the results of such national evaluation.
    (c) Individual State Evaluations.--
            (1) In general.--A condition for the receipt of a grant 
        under section 802 is that the State involved agree to provide 
        for the evaluation of the programs of family education carried 
        out with the grant in accordance with the following:
                    (A) The evaluation will be conducted by an 
                external, independent entity.
                    (B) The purposes of the evaluation will be the 
                determination of--
                            (i) the effectiveness of such programs in 
                        helping to delay the initiation of sexual 
                        intercourse and other high-risk behaviors;
                            (ii) the effectiveness of such programs in 
                        preventing adolescent pregnancy;
                            (iii) the effectiveness of such programs in 
                        preventing sexually transmitted disease, 
                        including HIV/AIDS; and
                            (iv) the effectiveness of such programs in 
                        increasing contraceptive knowledge and 
                        contraceptive behaviors when sexual intercourse 
                        occurs.

SEC. 805. LIMITATIONS ON USE OF FUNDS.

    (a) Limitations on Secretary.--Of the amounts appropriated for a 
fiscal year for purposes of this title, the Secretary may not use more 
than--
            (1) 7 percent of such amounts for administrative expenses 
        related to carrying out this title for that fiscal year; and
            (2) 10 percent of such amounts for the national evaluation 
        under section 804(b).
    (b) Limitations to States.--Of amounts provided to an eligible 
State under the section 802(a), the eligible entity may not use more 
than 10 percent of the grant to conduct any evaluation under section 
804(c).

SEC. 806. DEFINITIONS.

    For purposes of this title:
            (1) The term ``age-appropriate'' refers to topics, 
        messages, and teaching methods suitable to particular ages or 
        age groups of children and adolescents, based on developing 
        cognitive, emotional, and behavioral capacity typical for the 
        age or age group.
            (2) The term ``eligible State'' means a State that submits 
        to the Secretary an application for a grant under section 802 
        that is in such form, is made in such manner, and contains such 
        agreements, assurances, and information as the Secretary 
        determines to be necessary to carry out this title.
            (3) The term ``HIV/AIDS'' means the human immunodeficiency 
        virus, and includes acquired immune deficiency syndrome.
            (4) The term ``medically accurate'', with respect to 
        information, means information that is supported by research, 
        recognized as accurate and objective by leading medical, 
        psychological, psychiatric, and public health organizations and 
        agencies, and where relevant, published in peer review 
        journals.
            (5) The term ``Secretary'' means the Secretary of Health 
        and Human Services.

SEC. 807. AUTHORIZATION OF APPROPRIATIONS.

    For the purpose of carrying out this title, there are authorized to 
be appropriated such sums as may be necessary for each of the fiscal 
years 2010 through 2014.
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