II 

110TH CONGRESS 

1ST SESSION S. 1240 

To provide for the provision by hospitals receiving Federal funds through 

the Medicare program or Medicaid program of emergency contraceptives 

to women who are survivors of sexual assault. 

IN THE SENATE OF THE UNITED STATES 

APRIL 26, 2007 

Mrs. CLINTON (for herself, Mr. MENENDEZ, Mrs. BOXER, Ms. CANTWELL, 

Mr. KERRY, Mrs. MURRAY, and Mr. LAUTENBERG) introduced the following bill; which was read twice and referred to the Committee on Finance 

A BILL 

To provide for the provision by hospitals receiving Federal 

funds through the Medicare program or Medicaid program of emergency contraceptives to women who are 

survivors of sexual assault. 

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 ‘‘Compassionate Assist5 ance for Rape Emergencies Act of 2007’’. 

6 SEC. 2. FINDINGS. 

7 The Congress finds as follows: 


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1 (1) It is estimated that 25,000 to 32,000 

2 women become pregnant each year as a result of 

3 rape or incest. Timely access to emergency contra4 ception could help many of these rape survivors 

5 avoid the additional trauma of facing an unintended 

6 pregnancy. 

7 (2) A 1996 study of rape-related pregnancies 

8 (published in the American Journal of Obstetrics 

9 and Gynecology) found that 50 percent of the preg10 nancies described in paragraph (1) ended in abor11 tion. 

12 (3) Surveys have shown that many hospitals do 

13 not routinely provide emergency contraception to 

14 women seeking treatment after being sexually as15 saulted. 

16 (4) The risk of pregnancy after sexual assault 

17 has been estimated to be 4.7 percent in survivors 

18 who were not protected by some form of contracep19 tion at the time of the attack. 

20 (5) The Food and Drug Administration has de21 clared emergency contraception to be safe and effec22 tive in preventing unintended pregnancy if taken in 

23 the first 72 hours of sex. 

24 (6) Medical research strongly indicates that the 

25 sooner emergency contraception is administered, the 


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1 greater the likelihood of preventing unintended preg2 nancy. 

3 (7) In light of the safety and effectiveness of 

4 emergency contraceptive pills, both the American 

5 Medical Association and the American College of 

6 Obstetricians and Gynecologists have endorsed more 

7 widespread availability of such pills to women of all 

8 ages. 

9 (8) The American College of Emergency Physi10 cians and the American College of Obstetricians and 

11 Gynecologists agree that offering emergency contra12 ception to female patients after a sexual assault 

13 should be considered the standard of care. 

14 (9) Approximately one-third of women of repro15 ductive age remain unaware of emergency contracep16 tion. Therefore, women who have been sexually as17 saulted are unlikely to ask for emergency contracep18 tion. 

19 (10) It is essential that all hospitals that pro20 vide emergency medical treatment provide emergency 

21 contraception as a treatment option to any woman 

22 who has been sexually assaulted, so that she may 

23 prevent an unintended pregnancy. 

24 (11) Victims of sexual assault are at increased 

25 risk of contracting sexually transmitted diseases. 


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1 (12) Some sexually transmitted infections can2 not be reliably cured if treatment is delayed, and 

3 may result in high morbidity and mortality. HIV has 

4 killed over 520,000 individuals in the United States, 

5 and the Centers for Disease Control and Prevention 

6 currently estimates that over 1,000,000 individuals 

7 in the United States are infected with the virus. 

8 Even modern drug treatment has failed to cure in9 fected individuals. Nearly 60,000 individuals in the 

10 United States are infected with hepatitis B each 

11 year, with some individuals unable to fully recover. 

12 An estimated 1,250,000 individuals in the United 

13 States remain chronically infected with the hepatitis 

14 B virus and at present, 1 in 4 of those infected indi15 viduals may expect to die of liver failure. 

16 (13) It is possible to prevent some sexually 

17 transmitted diseases by treating an exposed indi18 vidual promptly. The use of post-exposure prophy19 laxis using antiretroviral drugs has been dem20 onstrated to effectively prevent the establishment of 

21 HIV infection. Hepatitis B infection may also be 

22 eliminated if an exposed individual receives prompt 

23 treatment. 

24 (14) The Centers for Disease Control and Pre25 vention has recommended risk evaluation and approVerDate Aug 31 2005 23:00 Apr 27, 2007 Jkt 059200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1240.IS S1240

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1 priate application of post-exposure treatment for vic2 tims of sexual assault. For such individuals, imme3 diate treatment is the only means to prevent a life4 threatening infection. 

5 (15) It is essential that all hospitals that pro6 vide emergency medical treatment provide assess7 ment and treatment of sexually transmitted infec8 tions to minimize the harm to victims of sexual as9 sault. 

10 SEC. 3. SURVIVORS OF SEXUAL ASSAULT; PROVISION BY 

11 HOSPITALS OF EMERGENCY CONTRACEP12 TIVES WITHOUT CHARGE. 

13 (a) IN GENERAL.—Federal funds may not be pro14 vided to a hospital under title XVIII of the Social Security 

15 Act or to a State, with respect to services of a hospital, 

16 under title XIX of such Act, unless the hospital meets the 

17 conditions specified in subsection (b) in the case of— 

18 (1) any woman who arrives at the hospital and 

19 states that she is a victim of sexual assault, or is ac20 companied by someone who states she is a victim of 

21 sexual assault; and 

22 (2) any woman who arrives at the hospital 

23 whom hospital personnel have reason to believe is a 

24 victim of sexual assault. 


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1 (b) ASSISTANCE FOR VICTIMS.—The conditions spec2 ified in this subsection regarding a hospital and a woman 

3 described in subsection (a) are as follows: 

4 (1) The hospital promptly provides the woman 

5 with medically and factually accurate and unbiased 

6 written and oral information about emergency con7 traception, including information explaining that— 

8 (A) emergency contraception has been ap9 proved by the Food and Drug Administration 

10 as an over-the-counter medication for women 

11 ages 18 and over and is a safe and effective 

12 way to prevent pregnancy after unprotected 

13 intercourse or contraceptive failure if taken in 

14 a timely manner; 

15 (B) emergency contraception is more effec16 tive the sooner it is taken; and 

17 (C) emergency contraception does not 

18 cause an abortion and cannot interrupt an es19 tablished pregnancy. 

20 (2) The hospital promptly offers emergency 

21 contraception to the woman, and promptly provides 

22 such contraception to her at the hospital on her re23 quest. 

24 (3) The information provided pursuant to para25 graph (1) is in clear and concise language, is readily 


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1 comprehensible, and meets such conditions regarding 

2 the provision of the information in languages other 

3 than English as the Secretary may establish. 

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

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

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

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

8 (1) EMERGENCY CONTRACEPTION.—The term 

9 ‘‘emergency contraception’’ means a drug, drug regi10 men, or device that is— 

11 (A) approved by the Food and Drug Ad12 ministration to prevent pregnancy; and 

13 (B) is used postcoitally. 

14 (2) HOSPITAL.—The term ‘‘hospital’’ has the 

15 meaning given such term in section 1861(e) of the 

16 Social Security Act (42 U.S.C. 1395x(e)), and in17 cludes critical access hospitals, as defined in section 

18 1861(mm)(1) of such Act (42 U.S.C. 

19 1395x(mm)(1)). 

20 (3) SECRETARY.—The term ‘‘Secretary’’ means 

21 the Secretary of Health and Human Services. 

22 (4) SEXUAL ASSAULT.— 

23 (A) IN GENERAL.—The term ‘‘sexual as24 sault’’ means a sexual act (as defined in sub25 paragraphs (A) through (C) of section 2246(2) 


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1 of title 18, United States Code) where the vic2 tim involved does not consent or lacks the ca3 pacity to consent. 

4 (B) APPLICATION OF PROVISIONS.—The 

5 definition in subparagraph (A) shall apply to all 

6 individuals. 

7 (d) EFFECTIVE DATE; AGENCY CRITERIA.—This sec8 tion takes effect upon the expiration of the 180-day period 

9 beginning on the date of the enactment of this Act. Not 

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

11 the Secretary shall publish in the Federal Register criteria 

12 for carrying out this section. 

13 SEC. 4. PREVENTION OF SEXUALLY TRANSMITTED DIS14 EASE. 

15 (a) DEFINITIONS.—In this section: 

16 (1) HOSPITAL.—The term ‘‘hospital’’ has the 

17 meaning given such term in section 1861(e) of the 

18 Social Security Act (42 U.S.C. 1395x(e)), and in19 cludes critical access hospitals, as defined in section 

20 1861(mm)(1) of such Act (42 U.S.C. 

21 1395x(mm)(1)). 

22 (2) LICENSED MEDICAL PROFESSIONAL.—The 

23 term ‘‘licensed medical professional’’ means a doctor 

24 of medicine, doctor of osteopathy, registered nurse, 

25 physician assistant, or any other health care profesVerDate Aug 31 2005 23:00 Apr 27, 2007 Jkt 059200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S1240.IS S1240

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1 sional determined to be appropriate by the Sec2 retary. 

3 (3) SECRETARY.—The term ‘‘Secretary’’ means 

4 the Secretary of Health and Human Services. 

5 (4) SEXUAL ASSAULT.— 

6 (A) IN GENERAL.—The term ‘‘sexual as7 sault’’ means a sexual act (as defined in sub8 paragraphs (A) through (C) of section 2246(2) 

9 of title 18, United States Code) where the vic10 tim involved does not consent or lacks the ca11 pacity to consent. 

12 (B) APPLICATION OF PROVISIONS.—The 

13 definition in subparagraph (A) shall apply to all 

14 individuals. 

15 (b) GENERAL REQUIREMENT.—Federal funds may 

16 not be provided to a hospital under title XVIII of the So17 cial Security Act (42 U.S.C. 1395 et seq.) or to a State, 

18 with respect to services of a hospital, under title XIX of 

19 such Act (42 U.S.C. 1396 et seq.), unless the hospital pro20 vides risk assessment, counseling, and treatment as re21 quired under this section to a survivor of sexual assault 

22 described in subsection (c). 

23 (c) SURVIVORS OF SEXUAL ASSAULT.—An individual 

24 is a survivor of a sexual assault described in this sub25 section if the individual— 


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1 (1) arrives at the hospital and states that the 

2 individual is a victim of sexual assault, or is accom3 panied to the hospital by another individual who 

4 states that the first individual is a victim of sexual 

5 assault; or 

6 (2) arrives at the hospital and hospital per7 sonnel have reason to believe the individual is a vic8 tim of sexual assault. 

9 (d) REQUIREMENT FOR RISK ASSESSMENT, COUN10 SELING, AND TREATMENT.—The following shall apply 

11 with respect to a hospital described in subsection (b): 

12 (1) RISK ASSESSMENT.—A hospital shall 

13 promptly provide a survivor of a sexual assault with 

14 an assessment of the individual’s risk of contracting 

15 sexually transmitted infections described in para16 graph (2)(A), which assessment shall be conducted 

17 by a licensed medical professional and be based 

18 upon— 

19 (A) available information regarding the as20 sault as well as the subsequent findings from 

21 medical examination and any tests that may be 

22 conducted; and 

23 (B) established standards of risk assess24 ment, which shall include consideration of any 

25 recommendations established by the Centers for 


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1 Disease Control and Prevention, and may also 

2 incorporate consideration of findings of peer-re3 viewed clinical studies and appropriate research 

4 utilizing in vitro and non-human primate mod5 els of infection. 

6 (2) COUNSELING.—A hospital shall provide a 

7 survivor of a sexual assault with advice, provided by 

8 a licensed medical professional, concerning— 

9 (A) significantly prevalent sexually trans10 mitted infections for which effective post-expo11 sure prophylaxis exists, and for which the defer12 ral of treatment would either significantly re13 duce treatment efficacy or pose substantial risk 

14 to the individual’s health; and 

15 (B) the requirement that prophylactic 

16 treatment for infections described in subpara17 graph (A) shall be provided to the individual 

18 upon request, regardless of the ability of the in19 dividual or the individual’s family to pay for 

20 such treatment. 

21 (3) TREATMENT.—A hospital shall provide a 

22 survivor of a sexual assault, upon request, with pro23 phylactic treatment for infections described in para24 graph (2)(A). 


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1 (4) LANGUAGE.—Any information provided 

2 pursuant to this subsection shall be in clear and con3 cise language, be readily comprehensible, and meet 

4 such conditions regarding the provision of the infor5 mation in languages other than English as the Sec6 retary may establish. 

7 (5) ABILITY TO PAY.—The services described in 

8 paragraphs (1) through (3) shall not be denied be9 cause of the inability of the individual involved or 

10 the individual’s family to pay for the services. 

11 (e) RULE OF CONSTRUCTION.—Nothing in this sec12 tion shall be construed to— 

13 (1) require that a hospital provide prophylactic 

14 treatment for a victim of sexual assault when risk 

15 assessment (according to recommendations estab16 lished by the Centers for Disease Control and Pre17 vention) clearly recommends against the application 

18 of post-exposure prophylaxis; 

19 (2) prohibit a hospital from seeking reimburse20 ment for the cost of services provided under this sec21 tion to the extent that health insurance may provide 

22 reimbursement for such services; and 

23 (3) establish a requirement that any victim of 

24 sexual assault submit to diagnostic testing for the 

25 presence of any infectious disease. 


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1 (f) EFFECTIVE DATE; AGENCY CRITERIA.—This sec2 tion takes effect upon the expiration of the 180-day period 

3 beginning on the date of the enactment of this Act. Not 

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

5 the Secretary shall publish in the Federal Register criteria 

6 for carrying out this section. 

Æ 


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