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[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 3945 Introduced in Senate (IS)]

109th CONGRESS
  2d Session
                                S. 3945

 To provide for the provision by hospitals of emergency contraceptives 
   to women, and post-exposure prophylaxis for sexually transmitted 
      disease to individuals, who are survivors of sexual assault.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                           September 26, 2006

Mrs. Clinton (for herself, Mrs. Murray, Mr. Lautenberg, Mrs. Boxer, Mr. 
    Menendez, Ms. Cantwell, Mr. Kennedy, Mr. Inouye, Mr. Kerry, Mr. 
Jeffords, and Mr. Chafee) introduced the following bill; which was read 
 twice and referred to the Committee on Health, Education, Labor, and 
                                Pensions

_______________________________________________________________________

                                 A BILL

 
 To provide for the provision by hospitals of emergency contraceptives 
   to women, and post-exposure prophylaxis for sexually transmitted 
      disease to individuals, who are survivors of sexual assault.

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

SECTION 1. SHORT TITLE.

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

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) It is estimated that 25,000 to 32,000 women become 
        pregnant each year as a result of rape or incest. An estimated 
        22,000 of these pregnancies could be prevented if rape or 
        incest survivors had timely access to emergency contraception.
            (2) A 1996 study of pregnancies resulting from rape or 
        incest (published in the American Journal of Obstetrics and 
        Gynecology) found that 50 percent of the pregnancies described 
        in paragraph (1) ended in abortion.
            (3) Surveys have shown that many hospitals do not routinely 
        provide emergency contraception to women seeking treatment 
        after being sexually assaulted.
            (4) The risk of pregnancy after sexual assault has been 
        estimated to be 4.7 percent in survivors who were not protected 
        by some form of contraception at the time of the attack.
            (5) The Food and Drug Administration has declared emergency 
        contraception to be safe and effective in preventing unintended 
        pregnancy, reducing the risk by as much as 89 percent if taken 
        within days of unprotected intercourse and up to 95 percent if 
        taken in the first 24 hours after unprotected intercourse.
            (6) Medical research strongly indicates that the sooner 
        emergency contraception is administered, the greater the 
        likelihood of preventing unintended pregnancy.
            (7) In light of the safety and effectiveness of emergency 
        contraceptive pills, both the American Medical Association and 
        the American College of Obstetricians and Gynecologists have 
        endorsed more widespread availability of such pills.
            (8) The American College of Emergency Physicians and the 
        American College of Obstetricians and Gynecologists agree that 
        offering emergency contraception to female patients after a 
        sexual assault should be considered part of the standard of 
        care.
            (9) Approximately 30 percent of United States women of 
        reproductive age are unaware of the availability of emergency 
        contraception.
            (10) New data from a survey of women having abortions 
        estimates that 51,000 abortions were prevented by use of 
        emergency contraception in 2000 and that increased use of 
        emergency contraception accounted for 43 percent of the 
        decrease in total abortions between 1994 and 2000.
            (11) It is essential that all hospitals that provide 
        emergency medical treatment provide emergency contraception as 
        a treatment option to any woman who has been sexually 
        assaulted, so that she may prevent an unintended pregnancy.
            (12) Victims of sexual assault are at increased risk of 
        contracting sexually transmitted diseases.
            (13) Some sexually transmitted infections cannot be 
        reliably cured if treatment is delayed, and may result in high 
        morbidity and mortality. HIV has killed over 520,000 
        individuals in the United States, and the Centers for Disease 
        Control and Prevention currently estimates that over 1,000,000 
        individuals in the United States are infected with the virus. 
        Even modern drug treatment has failed to cure infected 
        individuals. Nearly 80,000 individuals in the United States are 
        infected with hepatitis B each year, with some individuals 
        unable to fully recover. An estimated 1,250,000 individuals in 
        the United States remain chronically infected with the 
        hepatitis B virus and at present, 1 in 5 of those infected 
        individuals may expect to die of liver failure.
            (14) It is possible to prevent some sexually transmitted 
        diseases by treating an exposed individual promptly. The use of 
        post-exposure prophylaxis using antiretroviral drugs has been 
        demonstrated to effectively prevent the establishment of HIV 
        infection. Hepatitis B infection may also be eliminated if an 
        exposed individual receives prompt treatment.
            (15) The Centers for Disease Control and Prevention has 
        recommended risk evaluation and appropriate application of 
        post-exposure treatment for victims of sexual assault. For such 
        individuals, immediate treatment is the only means to prevent a 
        life-threatening infection.
            (16) It is essential that all hospitals that provide 
        emergency medical treatment provide assessment and treatment of 
        sexually transmitted infections to minimize the harm to victims 
        of sexual assault.

SEC. 3. DEFINITIONS.

    In this Act:
            (1) Emergency contraception.--The term ``emergency 
        contraception'' means a drug, drug regimen, or device that is--
                    (A) approved by the Food and Drug Administration to 
                prevent pregnancy; and
                    (B) is used postcoitally.
            (2) Hospital.--The term ``hospital'' has the meaning given 
        such term in title XVIII of the Social Security Act (42 U.S.C. 
        1395 et seq.), including the meaning applicable in such title 
        for purposes of making payments for emergency services to 
        hospitals that do not have agreements in effect under such 
        title. Such term includes a health care facility that is 
        located within, or that enters into a contract with, a 
        correctional institution or a post-secondary educational 
        institution.
            (3) Licensed medical professional.--The term ``licensed 
        medical professional'' means a doctor of medicine, doctor of 
        osteopathy, registered nurse, physician assistant, or any other 
        health care professional determined to be appropriate by the 
        Secretary.
            (4) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
            (5) Sexual assault.--
                    (A) In general.--The term ``sexual assault'' means 
                a sexual act (as defined in subparagraphs (A) through 
                (C) of section 2246(2) of title 18, United States Code) 
                where the victim involved does not consent or lacks the 
                capacity to consent.
                    (B) Application of provisions.--The definition in 
                subparagraph (A) shall--
                            (i) in the case of section 2, apply to 
                        males and females, as appropriate;
                            (ii) in the case of section 4, apply only 
                        to females; and
                            (iii) in the case of section 5, apply to 
                        all individuals.

SEC. 4. 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 arrives 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 arrives 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) Information.--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 has been approved by 
                the Food and Drug Administration as a safe and 
                effective way to prevent pregnancy after unprotected 
                intercourse or contraceptive failure if taken in a 
                timely manner, and is more effective the sooner it is 
                taken; and
                    (B) emergency contraception does not cause an 
                abortion and cannot interrupt an established pregnancy.
            (2) Emergency contraception.--The hospital promptly offers 
        emergency contraception to the woman, and promptly provides 
        such contraception to her at the hospital on her request.
            (3) Conditions for information.--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) Provision despite inability to pay.--The services 
        described in paragraphs (1) through (3) are not denied because 
        of the inability of the woman to pay for the services.

SEC. 5. PREVENTION OF [SEXUALLY TRANSMITTED] DISEASE.

    (a) In General.--Federal funds may not be provided to a hospital 
under any health-related program, unless the hospital provides risk 
assessment, counseling, and treatment as required under this section to 
a survivor of sexual assault described in subsection (b).
    (b) Survivors of Sexual Assault.--An individual is a survivor of a 
sexual assault described in this subsection if the individual--
            (1) arrives at the hospital and states that the individual 
        is a victim of sexual assault, or is accompanied to the 
        hospital by another individual who declares that the first 
        individual is a victim of sexual assault; or
            (2) arrives at the hospital and hospital personnel have 
        reason to believe the individual is a victim of sexual assault.
    (c) Requirement for Risk Assessment, Counseling, and Treatment.--
The following shall apply with respect to a hospital described in 
subsection (a):
            (1) Risk assessment.--A hospital shall promptly provide a 
        survivor of a sexual assault with an assessment of the 
        individual's risk of contracting sexually transmitted 
        infections described in paragraph (2)(A), which assessment 
        shall be conducted by a licensed medical professional and be 
        based upon--
                    (A) available information regarding the assault as 
                well as the subsequent findings from medical 
                examination and any tests that may be conducted; and
                    (B) established standards of risk assessment which 
                shall include consideration of any recommendations 
                established by the Centers for Disease Control and 
                Prevention, and may also incorporate consideration of 
                findings of peer-reviewed clinical studies and 
                appropriate research utilizing in vitro and non-human 
                primate models of infection.
            (2) Counseling.--A hospital shall provide a survivor of a 
        sexual assault with advice, provided by a licensed medical 
        professional, concerning--
                    (A) significantly prevalent sexually transmitted 
                infections for which effective post-exposure 
                prophylaxis exists, and for which the deferral of 
                treatment would either significantly reduce treatment 
                efficacy or pose substantial risk to the individual's 
                health; and
                    (B) the requirement that prophylactic treatment for 
                infections described in subparagraph (A) shall be 
                provided to the individual upon request, regardless of 
                the ability of the individual to pay for such 
                treatment.
            (3) Treatment.--A hospital shall provide a survivor of a 
        sexual assault, upon request, with prophylactic treatment for 
        infections described in paragraph (2)(A).
            (4) Ability to pay.--The services described in paragraphs 
        (1) through (3) shall not be denied because of the inability of 
        the individual involved to pay for the services.
            (5) Language.--Any information provided pursuant to this 
        subsection shall be clear and concise, readily comprehensible, 
        and meet such conditions regarding the provision of the 
        information in languages other than English as the Secretary 
        may establish.
    (d) Rule of Construction.--Nothing in this section shall be 
construed to--
            (1) require that a hospital provide prophylactic treatment 
        for a victim of sexual assault when risk assessment (according 
        to recommendations established by the Centers for Disease 
        Control and Prevention) clearly recommends against the 
        application of post-exposure prophylaxis;
            (2) prohibit a hospital from seeking reimbursement for the 
        cost of services provided under this section to the extent that 
        health insurance may provide reimbursement for such services; 
        and
            (3) establish a requirement that any victim of sexual 
        assault submit to diagnostic testing for the presence of any 
        infectious disease.

SEC. 6. AGENCY CRITERIA.

    Not later than 30 days prior to the expiration of the period 
described in section 7, the Secretary shall publish in the Federal 
Register criteria for meeting the conditions described in sections 4 
and 5.

SEC. 7. EFFECTIVE DATE.

    This Act takes effect on the expiration of the 180-day period 
beginning on the date of the enactment of this Act.
                                 <all>
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