II

106TH CONGRESS

1ST SESSION S. 1605

To establish a program of formula grants to the States for programs to

provide pregnant women with alternatives to abortion, and for other purposes.

IN THE SENATE OF THE UNITED STATES

SEPTEMBER 21, 1999

Mr. SANTORUM introduced the following bill; which was read twice and

referred to the Committee on Health, Education, Labor, and Pensions

A BILL

To establish a program of formula grants to the States

for programs to provide pregnant women with alternatives to abortion, and for other purposes.

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

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Women and Children’s

5 Resources Act’’.

6 SEC. 2. FINDINGS AND PURPOSE.

7 (a) FINDINGS.—The Congress finds as follows:

8 (1) Women confronted with unplanned or crisis

9 pregnancy often are left with the impression that
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1 abortion is the only choice that they have in dealing

2 with their difficult circumstances.

3 (2) Women often lack accurate information,

4 supportive counseling and other assistance regarding

5 adoption and parenting alternatives to abortion.

6 (3) Organizations that provide accurate infor7 mation, supportive counseling and other assistance

8 regarding adoption and parenting alternatives to

9 abortion often lack sufficient resources to reach

10 women in need of their services and to provide for

11 their needs.

12 (b) PURPOSE.—The purpose of this Act is—

13 (1) to promote childbirth as a viable and posi14 tive alternative to abortion and to empower those

15 facing unplanned or crisis pregnancies to choose

16 childbirth rather than abortion;

17 (2) to carry out paragraph (1) by supporting

18 entities and projects that provide information, coun19 seling, and support services that assist women to

20 choose childbirth and to make informed decisions re21 garding the choice of adoption or parenting with re22 spect to their children; and

23 (3) to maximize the effectiveness of this Act by

24 providing funds only to those entities and projects

25 that have a stated policy of actively promoting child-
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1 birth instead of abortion and that have experience in

2 providing alternative-to-abortion services.

3 SEC. 3. FORMULA GRANTS TO STATES FOR ALTERNATIVE4 TO-ABORTION SERVICES PROGRAMS.

5 In the case of each State that in accordance with sec6 tion 6 submits to the Secretary of Health and Human

7 Services an application for a fiscal year, the Secretary

8 shall make a grant to the State for the year for carrying

9 out the purposes authorized in section 4(a) (subject to

10 amounts being appropriated under section 11 for the

11 year). The grant shall consist of the allotment determined

12 for the State under section 7.

13 SEC. 4. ESTABLISHMENT AND OPERATION OF STATE PRO14 GRAMS TO PROVIDE ALTERNATIVE-TO-ABOR15 TION SERVICES; ADMINISTRATION OF PRO16 GRAMS THROUGH CONTRACTS WITH ENTI17 TIES.

18 (a) IN GENERAL.—Grant funds provided under this

19 Act may be expended only for purposes of the establish20 ment and operation of a State program (carried out pursu21 ant to contracts under subsection (c)) designed to provide

22 alternative-to-abortion services (as defined in section 9) to

23 eligible individuals as described in subsection (b).

24 (b) ELIGIBLE INDIVIDUALS.—
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1 (1) IN GENERAL.—Subject to paragraph (2), an

2 individual is an eligible individual for purposes of

3 subsection (a) if—

4 (A) the individual is pregnant (or has rea5 sonable grounds to believe she may be preg6 nant);

7 (B) the individual (male or female) is the

8 parent or legal guardian of an infant under 12

9 months of age; or

10 (C) the individual is the spouse or other

11 partner of an individual described in subpara12 graph (A) or (B).

13 (2) PRIORITY FOR LOW-INCOME INDIVID14 UALS.—Grant funds provided under this Act shall be

15 awarded only to States that submit a grant applica16 tion that assures that the State program—

17 (A) will give priority to serving eligible in18 dividuals who are from low-income families; and

19 (B) will not impose a charge on any eligi20 ble individual from a low-income family except

21 to the extent that payment will be made by a

22 third party (including a government agency)

23 that is authorized or is under legal obligation to

24 pay such charge.
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1 (c) ADMINISTRATION OF PROGRAMS THROUGH CON2 TRACTS WITH EXPERIENCED ENTITIES AND SERVICE

3 PROVIDERS.—Grant funds provided under this Act shall

4 be awarded only to States that submit a grant application

5 that assures that the State program will be established

6 and operated in accordance with the following:

7 (1) ESTABLISHMENT AND OPERATION OF PRO8 GRAM.—

9 (A) PRIME CONTRACTOR.—The State shall

10 enter into a contract with a nonprofit private

11 entity that, under the contract, shall be des12 ignated as the ‘‘prime contractor’’ and shall

13 have the principal responsibility for admin14 istering the State program, including subcon15 tracting with service providers.

16 (B) SUBCONTRACTS WITH SERVICE PRO17 VIDERS.—The prime contractor shall enter into

18 subcontracts with service providers for reim19 bursement of alternative-to-abortion services

20 provided to eligible individuals on a fee-for-serv21 ice basis, as provided in paragraph (2)(C)(ii).

22 (C) EXPENDITURES OF GRANT.—The

23 prime contractor shall be authorized to expend

24 funds to administer the State program, reim25 burse service providers, and to provide addi-
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1 tional supportive services to assist such pro2 viders in providing alternative-to-abortion serv3 ices to eligible individuals consistent with the

4 purposes of this Act, including providing for a

5 toll-free referral system, advertising of alter6 native-to-abortion services, purchase of edu7 cational materials, and grants for new sites and

8 new project development.

9 (D) REQUIREMENT FOR PRIME CONTRAC10 TORS.—An entity may not become a prime con11 tractor unless, consistent with the overall pur12 pose of this Act, it has a stated policy of ac13 tively promoting childbirth instead of abortion.

14 (E) ADDITIONAL REQUIREMENTS FOR

15 PRIME CONTRACTORS.—An entity may not be16 come a prime contractor unless—

17 (i) for the 5-year period preceding the

18 date on which the entity applies to receive

19 the contract, it has been engaged primarily

20 in the provision of core services or it has

21 operated a project that provides such serv22 ices;

23 (ii) it already serves as a prime con24 tractor pursuant to a State appropriation
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1 designed to fund alternative-to-abortion

2 services; or

3 (iii) it is a subsidiary of an entity that

4 meets the criteria under clause (i) or (ii).

5 (F) REQUIREMENTS FOR SUBCONTRAC6 TORS.—An entity may not become a service

7 provider unless—

8 (i) it operates a service provider

9 project that has a stated policy of actively

10 promoting childbirth instead of abortion;

11 (ii) its project has been providing al12 ternative-to-abortion services to clients for

13 at least 1 year; and

14 (iii) its project is physically and finan15 cially separate from any entity that advo16 cates, performs, counsels for or refers for

17 abortion.

18 (G) RESTRICTION.—No prime contractor

19 or service provider project may perform abor20 tion, counsel for or refer for abortion, or advo21 cate abortion.

22 (2) EXPENDITURES UNDER THE PROGRAM.—

23 (A) EXPENDITURES FOR START-UP

24 COSTS.—For the first full fiscal year in which

25 a State program has received grant funds pur-
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1 suant to this Act, the State shall disburse grant

2 funds to the prime contractor for start-up costs,

3 in an amount not to exceed 10 percent of the

4 total amount of the grant made to the State for

5 that fiscal year.

6 (B) EXPENDITURES FOR ADMINISTRATIVE

7 COSTS.—For the first full fiscal year in which

8 a State program has received grant funds pur9 suant to this Act and for the 2 subsequent fis10 cal years, the State shall disburse grant funds

11 to the prime contractor for administrative costs,

12 in an amount not to exceed 20 percent of the

13 total amount of the grant made to the State for

14 those fiscal years. For all other fiscal years, the

15 State shall disburse grant funds for administra16 tive costs, in an amount not to exceed 15 per17 cent of the total amount of the grant made to

18 the State for the fiscal year.

19 (C) EXPENDITURES FOR SERVICE

20 COSTS.—

21 (i) DISBURSEMENT TO PRIME CON22 TRACTOR FOR SERVICE COSTS.—For each

23 fiscal year, the State shall disburse to the

24 prime contractor for service costs all re-
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1 maining grant funds not expended on per2 missible administrative or start-up costs.

3 (ii) SERVICE PROVIDER REIMBURSE4 MENT RATES.—The prime contractor shall

5 reimburse service providers for alternative6 to-abortion services provided to eligible in7 dividuals at the following fee-for-service

8 rates:

9 (I) $10 for every 10 minutes of

10 counseling for eligible individuals.

11 (II) $10 for every 10 minutes of

12 referral time spent.

13 (III) $20 per individual per hour

14 of class instruction provided.

15 (IV) $10 for each self-adminis16 tered pregnancy test kit provided.

17 (V) $10 for every pantry visit.

18 For fiscal year 2001 and subsequent fiscal

19 years, each of the dollar amounts specified

20 in this clause shall be adjusted to offset

21 the effects of inflation occurring after the

22 beginning of fiscal year 2000.

23 (d) ADDITIONAL RESTRICTIONS REGARDING EX24 PENDITURE OF GRANT FUNDS.—A State applying for a
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1 grant under this Act shall provide assurances, in its grant

2 application, as follows:

3 (1) No grant funds will be expended for any of

4 the following:

5 (A) Performing abortion, counseling for or

6 referring for abortion, or advocating abortion.

7 (B) Providing, referring for, or advocating

8 the use of contraceptive services, drugs, or de9 vices.

10 (2) No grant funds will be expended to make

11 payment for a service that is provided to an eligible

12 individual if payment for such service has already

13 been made, or can reasonably be expected to be

14 made—

15 (A) under any State compensation pro16 gram, under an insurance policy, or under any

17 Federal or State health benefits program; or

18 (B) by an entity that provides health serv19 ices on a prepaid basis.

20 (3) No grant funds will be expended—

21 (A) to provide inpatient hospital services;

22 (B) to make cash payments to intended re23 cipients of services;

24 (C) to purchase or improve land, purchase,

25 construct, or permanently improve (other than
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1 minor remodeling) any building or other facil2 ity; or

3 (D) to satisfy any requirement that non4 Federal funds be expended as a precondition of

5 the receipt of Federal funds.

6 SEC. 5. SERVICES PROVIDED BY RELIGIOUS ORGANIZA7 TIONS.

8 (a) PURPOSE.—The purpose of this section is to allow

9 States to contract with religious organizations pursuant

10 to section 4(c) on the same basis as any other nongovern11 mental provider without impairing the religious character

12 of such organizations, and without diminishing the reli13 gious freedom of eligible individuals served under the

14 State program.

15 (b) NONDISCRIMINATION AGAINST RELIGIOUS ORGA16 NIZATIONS.—Religious organizations are eligible, on the

17 same basis as any other nongovernmental organization, as

18 contractors to provide services under a State program de19 scribed in section 4(c) so long as the program is imple20 mented consistent with the Establishment Clause of the

21 United States Constitution. Neither the Federal Govern22 ment nor a State receiving a grant under this Act shall

23 discriminate against an organization which is or applies

24 to be a contractor under section 4(c) on the basis that

25 the organization has a religious character.
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1 (c) RELIGIOUS CHARACTER AND FREEDOM.—

2 (1) RELIGIOUS ORGANIZATIONS.—A religious

3 organization receiving a contract under section 4(c)

4 shall retain its independence from Federal, State,

5 and local governments, including such organization’s

6 control over the definition, development, practice,

7 and expression of its religious beliefs.

8 (2) ADDITIONAL SAFEGUARDS.—Neither the

9 Federal Government nor a State receiving a grant

10 under section 2 shall require a religious organization

11 to—

12 (A) alter its form of internal governance;

13 or

14 (B) remove religious art, icons, scripture,

15 or other symbols;

16 in order to be eligible for a contract under section

17 4(c).

18 (d) EMPLOYMENT PRACTICES.—

19 (1) TENETS AND TEACHINGS.—A religious or20 ganization that provides services under a program

21 described in section 4(c) may require that its em22 ployees providing assistance under such program ad23 here to the religious tenets and teachings of such or24 ganization, and such organization may require that
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1 those employees adhere to rules forbidding the use

2 of drugs or alcohol.

3 (2) TITLE VII EXEMPTION.—A religious organi4 zation’s exemption provided under section 702 of the

5 Civil Rights Act of 1964 (42 U.S.C. 2000e–1,

6 2000e–2(e)(2)) regarding employment practices shall

7 not be affected by the receipt of a contract under

8 section 4(c).

9 (e) RIGHTS OF BENEFICIARIES OF ASSISTANCE.—

10 (1) IN GENERAL.—If an eligible individual has

11 an objection to the religious character of the organi12 zation from which the individual receives, or would

13 receive, alternative-to-abortion services, the State

14 shall provide such individual within a reasonable pe15 riod of time after the date of such objection with the

16 names and addresses of alternative service providers

17 that offer a range of services similar to those offered

18 by the original service provider.

19 (2) NOTICE.—A State receiving a grant under

20 this Act shall ensure that notice is provided to indi21 viduals described in paragraph (1) of the rights of

22 such individuals under this section.

23 (f) NONDISCRIMINATION AGAINST BENEFICIARIES.—

24 A religious organization shall not discriminate against an

25 eligible individual in regard to providing alternative-to-
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1 abortion services on the basis of religion, a religious belief,

2 or refusal to actively participate in a religious practice.

3 (g) FISCAL ACCOUNTABILITY.—

4 (1) IN GENERAL.—Except as provided in para5 graph (2), any religious organization receiving a con6 tract under section 4(c) shall be subject to the same

7 regulations as other contractors to account in ac8 cordance with generally accepted accounting prin9 ciples for the use of such funds under this Act.

10 (2) LIMITED AUDIT.—If such organization seg11 regates funds received under this Act into separate

12 accounts, then only such funds shall be subject to

13 audit by the government.

14 (h) COMPLIANCE.—Any party which seeks to enforce

15 its rights under this section may assert a civil action for

16 injunctive relief exclusively in an appropriate State court

17 against the entity or agency that allegedly commits such

18 violation.

19 (i) LIMITATIONS ON USE OF FUNDS FOR CERTAIN

20 PURPOSES.—No grant funds obtained pursuant to this

21 Act shall be expended for sectarian worship, instruction,

22 or proselytization.

23 (j) PREEMPTION.—Nothing in this section shall be

24 construed to preempt any provision of a State constitution
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1 or State statute that prohibits or restricts the expenditure

2 of State funds in or by religious organizations.

3 (k) TREATMENT OF SERVICE PROVIDERS.—This sec4 tion applies to awards under section 4(c) made by prime

5 contractors to service providers to the same extent and

6 in the same manner as this section applies to awards

7 under such section by States to prime contractors.

8 SEC. 6. STATE APPLICATION FOR GRANT.

9 An application for a grant under this Act is in accord10 ance with this section if—

11 (1) the State submits the application not later

12 than the date specified by the Secretary;

13 (2) the application demonstrates that the State

14 program for which grant funds are sought will be es15 tablished and operated in compliance with all of the

16 requirements of this Act; and

17 (3) the application is in such form, is made in

18 such manner, and contains such agreements, assur19 ances, and information as the Secretary determines

20 are necessary to carry out this Act.

21 SEC. 7. DETERMINATION OF AMOUNT OF STATE ALLOT22 MENT.

23 (a) IN GENERAL.—The allotment of funds to be

24 granted to each State for a fiscal year is to be the State-
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1 calculated percentage of the total amount available under

2 section 11 for the fiscal year.

3 (b) STATE-CALCULATED PERCENTAGE.—The State4 calculated percentage shall be determined by dividing—

5 (1) the number of children born in the State to

6 women who were not married at the time of the

7 birth plus the number of abortions performed in the

8 State; by

9 (2) the number of children born in all States to

10 women who were not married at the time of the

11 birth plus the number of abortions performed in all

12 States as last reported by the Centers for Disease

13 Control and Prevention.

14 (c) UNALLOTTED FUNDS FOR FIRST THREE FISCAL

15 YEARS.—For the first 3 fiscal years for which funds are

16 appropriated under section 11, if excess funds are avail17 able due to the failure of any State to apply for grant

18 funds under this Act, such excess funds shall be allotted

19 to participating States in an amount equal to a percentage

20 of the excess funds determined by dividing—

21 (1) the number of children born in the partici22 pating State to women who were not married at the

23 time of the birth plus the number of abortions per24 formed in the participating State; by
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1 (2) the number of children born in all partici2 pating States to women who were not married at the

3 time of the birth plus the number of abortions per4 formed in all participating States as last reported by

5 the Centers for Disease Control and Prevention.

6 (d) UNALLOTTED FUNDS FOR SUBSEQUENT FISCAL

7 YEARS.—For years subsequent to the first 3 fiscal years

8 for which funds are appropriated under section 11, if ex9 cess funds are available due to the failure of any State

10 to apply for grant funds under this Act, such excess funds

11 shall be allotted to participating States in an amount

12 equal to a percentage of the total excess funds determined

13 by dividing—

14 (1) the amount of service costs expended by an

15 individual participating State under this Act during

16 the previous calendar year; by

17 (2) the total amount of service costs expended

18 by all participating States under this Act during the

19 previous calendar year.

20 SEC. 8. BIENNIAL REPORTS TO CONGRESS.

21 The Secretary shall submit to the Congress periodic

22 reports on the State programs carried out pursuant to this

23 Act. The first report shall be submitted not later than

24 February 1, 2001, and subsequent reports shall be sub25 mitted biennially thereafter.
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1 SEC. 9. DEFINITIONS.

2 In this Act:

3 (1) ADMINISTRATIVE COSTS.—The term ‘‘ad4 ministrative costs’’ means expenditures for costs as5 sociated with the administration of the State pro6 gram by the prime contractor, including salaries of

7 administrative office staff, taxes, employee benefits,

8 job placement costs, postage and shipping costs,

9 travel and lodging for administrative staff, office

10 rent, telephone and fax costs, insurance and office

11 supplies, professional development for administrative

12 staff and ongoing legal, accounting, and computer

13 consulting for the program. Such term does not in14 clude expenditures for start-up costs or service costs.

15 (2) ALTERNATIVE-TO-ABORTION SERVICES.—

16 The term ‘‘alternative-to-abortion services’’ means

17 core services and support services as defined in this

18 section.

19 (3) CORE SERVICES.—The term ‘‘core services’’

20 means the provision of information and counseling

21 that promotes childbirth instead of abortion and as22 sists pregnant women in making an informed deci23 sion regarding the alternatives of adoption or par24 enting with respect to their child.

25 (4) LOW-INCOME FAMILY.—The term ‘‘low-in26 come family’’ has the meaning given such term
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1 under section 1006(c) of the Public Health Service

2 Act (42 U.S.C. 300a–4(c)).

3 (5) SUPPORT SERVICES.—The term ‘‘support

4 services’’ means additional services and assistance

5 designed to assist eligible individuals to carry their

6 child to term and to support eligible individuals in

7 their parenting or adoption decision. These support

8 services include the provision of—

9 (A) self-administered pregnancy testing;

10 (B) baby food, maternity and baby cloth11 ing, and baby furniture;

12 (C) information and education, including

13 classes, regarding prenatal care, childbirth,

14 adoption, parenting, chastity (or abstinence);

15 and

16 (D) referrals for services consistent with

17 the purposes of this Act.

18 (6) PANTRY VISIT.—The term ‘‘pantry visit’’

19 means a visit by an eligible individual to a service

20 provider during which baby food, maternity or baby

21 clothing, or baby furniture are made available to the

22 individual free of charge.

23 (7) REFERRAL TIME.—The term ‘‘referral

24 time’’ means the time taken to research and set up
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1 an appointment on behalf of an eligible individual to

2 secure support through a referral.

3 (8) REFERRALS.—The term ‘‘referrals’’ means

4 action taken on behalf of an eligible individual to se5 cure additional support from a social service agency

6 or other entity. Referral may be for services, items

7 and assistance regarding physical and mental health

8 (prenatal, postnatal, and postpartum), food, cloth9 ing, housing, education, vocational training, and for

10 other services designed to assist pregnant women

11 and infants in need.

12 (9) SECRETARY.—The term ‘‘Secretary’’ means

13 the Secretary of Health and Human Services.

14 (10) SERVICE COSTS.—The term ‘‘service

15 costs’’ means expenditures for costs incurred by the

16 prime contractor to provide support for service pro17 vider projects, including salaries for technical sup18 port staff, taxes, employee benefits, job placement

19 costs, professional development and ongoing train20 ing, educational and informational material for eligi21 ble individuals and counselors, advertising costs, op22 eration of a toll-free referral system, travel for tech23 nical support staff, billing and database computer

24 consulting, seminars for counseling training, meet25 ings regarding program compliance requirements,
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1 minor equipment purchases for service provider

2 projects, new project development, and service pro3 vider reimbursements for alternative-to-abortion

4 services.

5 (11) SERVICE PROVIDER.—The term ‘‘service

6 provider’’ means a nongovernmental entity that op7 erates a service provider project and which enters

8 into a subcontract with the prime contractor that

9 provides for the reimbursement for alternative-to10 abortion services provided to eligible individuals.

11 (12) SERVICE PROVIDER PROJECT.—The term

12 ‘‘service provider project’’ means a project or pro13 gram operated by a service provider that provides al14 ternative-to-abortion services. All service provider

15 projects must provide core services and may also

16 provide support services.

17 (13) START-UP COSTS.—The term ‘‘start-up

18 costs’’ means expenditures associated with the initial

19 establishment of the State program, including the

20 cost of obtaining furniture, computers and acces21 sories, copy machines, consulting services, tele22 phones, and other office equipment and supplies.

23 (14) STATE.—The term ‘‘State’’ means each of

24 the several States, the District of Columbia, the

25 Commonwealth of Puerto Rico, American Samoa,
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1 Guam, the Commonwealth of the Northern Mariana

2 Islands, the Virgin Islands, and the Trust Territory

3 of the Pacific Islands.

4 SEC. 10. DATE CERTAIN FOR INITIAL GRANTS.

5 The Secretary shall begin making grants under this

6 Act not later than 180 days after the date on which

7 amounts are first appropriated under section 11, subject

8 to the receipt of State applications in accordance with sec9 tion 6.

10 SEC. 11. FUNDING.

11 For the purpose of carrying out this Act, there is au12 thorized to be appropriated $85,000,000 for each of the

13 fiscal years 2000 through 2004.

14 SEC. 12. OFFSET.

15 It is the sense of the Senate that overall funding for

16 the Department of Health and Human Services should not

17 be increased under this Act.

Æ