II 

Calendar No. 78 

109TH CONGRESS 

1ST SESSION S. 844 

To expand access to preventive health care services that help reduce unintended pregnancy, reduce the number of abortions, and improve access 

to women’s health care. 

IN THE SENATE OF THE UNITED STATES 

APRIL 19, 2005 

Mrs. CLINTON (for herself and Mr. REID) introduced the following bill; which 

was read the first time 

APRIL 20, 2005 

Read the second time and placed on the calendar 

A BILL 

To expand access to preventive health care services that 

help reduce unintended pregnancy, reduce the number 

of abortions, and improve access to women’s health care. 

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

3 SECTION 1. TABLE OF CONTENTS. 

4 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 
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Sec. 101. Short title. 

Sec. 102. Authorization of appropriations. 

TITLE II—FAMILY PLANNING STATE EMPOWERMENT 

Sec. 201. Short title. 

Sec. 202. State option to provide family planning services and supplies to additional low-income individuals. 

Sec. 203. State option to extend the period of eligibility for provision of family 

planning services and supplies. 

TITLE III—EQUITY IN PRESCRIPTION INSURANCE AND 

CONTRACEPTIVE COVERAGE 

Sec. 301. Short title. 

Sec. 302. Amendments to Employee Retirement Income Security Act of 1974. 

Sec. 303. Amendments to Public Health Service Act relating to the group market. 

Sec. 304. Amendment to Public Health Service Act relating to the individual 

market. 

TITLE IV—EMERGENCY CONTRACEPTION EDUCATION AND 

INFORMATION 

Sec. 401. Short title. 

Sec. 402. Emergency contraception education and information programs. 

TITLE V—COMPASSIONATE ASSISTANCE FOR RAPE 

EMERGENCIES 

Sec. 501. Short title. 

Sec. 502. Survivors of sexual assault; provision by hospitals of emergency contraceptives without charge. 

TITLE VI—TEENAGE PREGNANCY PREVENTION 

Sec. 601. Short title. 

Sec. 602. Teenage pregnancy prevention. 

TITLE VII—ACCURACY OF CONTRACEPTIVE INFORMATION 

Sec. 701. Short title. 

Sec. 702. Accuracy of contraceptive information. 

1 SEC. 2. FINDINGS. 

2 The Congress finds as follows: 

3 (1) Although the Centers for Disease Control 

4 and Prevention (referred to in this section as the 

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

6 list of the Ten Great Public Health Achievements in 

7 the 20th Century, the United States still has one of 
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1 the highest rates of unintended pregnancies among 

2 industrialized nations. 

3 (2) Each year, 3,000,000 pregnancies, nearly 

4 half of all pregnancies, in the United States are un5 intended, and nearly half of unintended pregnancies 

6 end in abortion. 

7 (3) In 2002, 34,000,000 women—half of all 

8 women of reproductive age (ages 15–44)—were in 

9 need of contraceptive services and supplies to help 

10 prevent unintended pregnancy, and half of those 

11 were in need of public support for such care. 

12 (4) The United States also has the highest rate 

13 of infection with sexually transmitted diseases of any 

14 industrialized country. In 2003 there were approxi15 mately 19,000,000 new cases of sexually transmitted 

16 diseases. According to the CDC (November 2004), 

17 these sexually transmitted diseases impose a tremen18 dous economic burden with direct medical costs as 

19 high as $15,500,000,000 per year. 

20 (5) Increasing access to family planning serv21 ices will improve women’s health and reduce the 

22 rates of unintended pregnancy, abortion, and infec23 tion with sexually transmitted diseases. Contracep24 tive use saves public health dollars. Every dollar 

25 spent on providing family planning services saves an 
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1 estimated $3 in expenditures for pregnancy-related 

2 and newborn care for Medicaid alone. 

3 (6) Contraception is basic health care that im4 proves the health of women and children by enabling 

5 women to plan and space births. 

6 (7) Women experiencing unintended pregnancy 

7 are at greater risk for physical abuse and women 

8 having closely spaced births are at greater risk of 

9 maternal death. 

10 (8) The child born from an unintended preg11 nancy is at greater risk of low birth weight, dying 

12 in the first year of life, being abused, and not receiv13 ing sufficient resources for healthy development. 

14 (9) The ability to control fertility also allows 

15 couples to achieve economic stability by facilitating 

16 greater educational achievement and participation in 

17 the workforce. 

18 (10) The average American woman desires two 

19 children and spends five years of her life pregnant 

20 or trying to get pregnant and roughly 30 years try21 ing to prevent pregnancy. Without contraception, a 

22 sexually active woman has an 85 percent chance of 

23 becoming pregnant within a year. 

24 (11) The percentage of sexually active women 

25 ages 15 through 44 who were not using contracep-
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1 tion increased from 5.4 percent to 7.4 percent in 

2 2002, an increase of 37 percent, according to the 

3 CDC. This represents an apparent increase of 

4 1,430,000 women and could raise the rate of unin5 tended pregnancy. 

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

7 afford to purchase contraceptive services and sup8 plies on their own. 12,100,000 or 20 percent of all 

9 women ages 15 through 24 were uninsured in 2002, 

10 and that proportion has increased by 10 percent 

11 since 1999. 

12 (13) Public health programs like Medicaid and 

13 title X (of the Public Health Service Act), the na14 tional family planning program, provide high-quality 

15 family planning services and other preventive health 

16 care to underinsured or uninsured individuals who 

17 may otherwise lack access to health care. 

18 (14) Medicaid is the single largest source of 

19 public funding for family planning services and HIV/ 

20 AIDS care in the United States. Half of all public 

21 dollars spent on contraceptive services and supplies 

22 in the United States are provided through Medicaid 

23 and approximately 5,500,000 women of reproductive 

24 age—nearly one in 10 women between the ages of 
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1 15 and 44—rely on Medicaid for their basic health 

2 care needs. 

3 (15) Each year, title X services enable Ameri4 cans to prevent approximately 1,000,000 unintended 

5 pregnancies, and one in three women of reproductive 

6 age who obtains testing or treatment for sexually 

7 transmitted diseases does so at a title X-funded clin8 ic. In 2003, title X-funded clinics provided 

9 2,800,000 Pap tests, 5,100,000 sexually transmitted 

10 disease tests, and 526,000 HIV tests. 

11 (16) The increasing number of uninsured, stag12 nant funding, health care inflation, new and expen13 sive contraceptive technologies, and improved but ex14 pensive screening and treatment for cervical cancer 

15 and sexually transmitted diseases, have diminished 

16 the ability of title X funded clinics to adequately 

17 serve all those in need. Taking inflation into ac18 count, funding for the title X program declined by 

19 58 percent between 1980 and 2003. 

20 (17) While Medicaid remains the largest source 

21 of subsidized family planning services, States are 

22 facing significant budgetary pressures to cut their 

23 Medicaid programs, putting many women at risk of 

24 losing coverage for family planning services. 
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1 (18) In addition, eligibility for Medicaid in 

2 many States is severely restricted leaving family 

3 planning services financially out of reach for many 

4 poor women. Many States have demonstrated tre5 mendous success with Medicaid family planning 

6 waivers that allow them to expand access to Med7 icaid family planning services. However, the admin8 istrative burden of applying for a waiver poses a sig9 nificant barrier to States that would like to expand 

10 their coverage of family planning programs through 

11 Medicaid. 

12 (19) As of January of 2005, 21 States offered 

13 expanded family planning benefits as a result of 

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

18 such programs resulted in significant savings to both 

19 the Federal and State governments. Moreover, the 

20 researchers found measurable reductions in unin21 tended pregnancy. 

22 (20) Although employer-sponsored health plans 

23 have improved coverage of contraceptive services and 

24 supplies, largely in response to State contraceptive 

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

2 insurance plans, particularly in self-insured and indi3 vidual plans, continues to place effective forms of 

4 contraception beyond the financial reach of many 

5 women. 

6 (21) Including contraceptive coverage in private 

7 health care plans saves employers money. Not cov8 ering contraceptives in employee health plans costs 

9 employers 15 to 17 percent more than providing 

10 such coverage. 

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

12 Administration, emergency contraception is a safe 

13 and effective way to prevent unintended pregnancy 

14 after unprotected sex. It is estimated that the use of 

15 emergency contraception could cut the number of 

16 unintended pregnancies in half, thereby reducing the 

17 need for abortion. New research confirms that easier 

18 access to emergency contraceptives does not increase 

19 sexual risk-taking or sexually transmitted diseases. 

20 (23) In 2000, 51,000 abortions were prevented 

21 by the use of emergency contraception. Increased 

22 use of emergency contraception accounted for up to 

23 43 percent of the total decline in abortions between 

24 1994 and 2000. 
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1 (24) A February 2004 CDC study of declining 

2 birth and pregnancy rates among teens concluded 

3 that the reduction in teen pregnancy between 1991 

4 and 2001 suggests that increased abstinence and in5 creased use of contraceptives were equally respon6 sible for the decline. As such, it is critically impor7 tant that teens receive accurate, unbiased informa8 tion about contraception. 

9 (25) Thirteen percent of all teens give birth be10 fore age 20. 88 percent of births to teens age 17 or 

11 younger were unintended. 24 percent of Hispanic fe12 males gave birth before the age of 20. (CDC, De13 cember 2004.) 

14 (26) The American Medical Association, the 

15 American Nurses Association, the American Acad16 emy of Pediatrics, the American College of Obstetri17 cians and Gynecologists, the American Public Health 

18 Association, and the Society for Adolescent Medi19 cine, support responsible sexuality education that in20 cludes information about both abstinence and con21 traception. 

22 (27) Teens who receive sex education that in23 cludes discussion of contraception are more likely 

24 than those who receive abstinence-only messages to 
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1 delay sex and to have fewer partners and use contra2 ceptives when they do become sexually active. 

3 (28) Government-funded abstinence only pro4 grams are precluded from discussing contraception 

5 except to talk about failure rates. A December 2004 

6 review of federally-funded abstinence-only programs 

7 by the United States House of Representatives Com8 mittee on Government Reform (Minority Staff) 

9 found that many federally-funded abstinence-only 

10 program curricula distort public health data and 

11 misrepresent the effectiveness of contraception. In12 formation on the effectiveness of condoms, in pre13 venting pregnancy and sexually transmitted diseases, 

14 including HIV, was often highly inaccurate. 

15 TITLE I—TITLE X OF PUBLIC 

16 HEALTH SERVICE ACT 

17 SEC. 101. SHORT TITLE. 

18 This Act may be cited as the ‘‘Title X Family Plan19 ning Services Act of 2005’’. 

20 SEC. 102. AUTHORIZATION OF APPROPRIATIONS. 

21 For the purpose of making grants and contracts 

22 under section 1001 of the Public Health Service Act, there 

23 are authorized to be appropriated $643,000,000 for fiscal 

24 year 2006, and such sums as may be necessary for each 

25 subsequent fiscal year. 
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1 TITLE II—FAMILY PLANNING 

2 STATE EMPOWERMENT 

3 SEC. 201. SHORT TITLE. 

4 This Act may be cited as the ‘‘Family Planning State 

5 Empowerment Act’’. 

6 SEC. 202. STATE OPTION TO PROVIDE FAMILY PLANNING 

7 SERVICES AND SUPPLIES TO ADDITIONAL 

8 LOW-INCOME INDIVIDUALS. 

9 (a) IN GENERAL.—Title XIX of the Social Security 

10 Act (42 U.S.C. 1396 et seq.) is amended— 

11 (1) by redesignating section 1936 as section 

12 1937; and 

13 (2) by inserting after section 1935 the fol14 lowing: 

15 ‘‘STATE OPTION TO PROVIDE FAMILY PLANNING SERV16 ICES AND SUPPLIES TO ADDITIONAL LOW-INCOME

17 INDIVIDUALS

18 ‘‘SEC. 1936. 

19 ‘‘(a) IN GENERAL.—A State may elect (through a 

20 State plan amendment) to make medical assistance de21 scribed in section 1905(a)(4)(C) available to any indi22 vidual not otherwise eligible for such assistance— 

23 ‘‘(1) whose family income does not exceed an 

24 income level (specified by the State) that does not 

25 exceed the greatest of— 
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1 ‘‘(A) 200 percent of the income official 

2 poverty line (as defined by the Office of Man3 agement and Budget, and revised annually in 

4 accordance with section 673(2) of the Commu5 nity Services Block Grant Act) applicable to a 

6 family of the size involved; 

7 ‘‘(B) in the case of a State that has in ef8 fect (as of the date of the enactment of this sec9 tion) a waiver under section 1115 to provide 

10 such medical assistance to individuals based on 

11 their income level (expressed as a percent of the 

12 poverty line), the eligibility income level as pro13 vided under such waiver; or 

14 ‘‘(C) the eligibility income level (expressed 

15 as a percent of such poverty line) that has been 

16 specified under the plan (including under sec17 tion 1902(r)(2)), for eligibility of pregnant 

18 women for medical assistance; and 

19 ‘‘(2) at the option of the State, whose resources 

20 do not exceed a resource level specified by the State, 

21 which level is not more restrictive than the resource 

22 level applicable under the waiver described in para23 graph (1)(B) or to pregnant women under para24 graph (1)(C). 
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1 ‘‘(b) FLEXIBILITY.—A State may exercise the au2 thority under subsection (a) with respect to one or more 

3 classes of individuals described in such subsection.’’. 

4 (b) CONFORMING AMENDMENT.—Section 1905(a) of 

5 such Act (42 U.S.C. 1396d(a)) is amended, in the matter 

6 before paragraph (1)— 

7 (1) by striking ‘‘and’’ at the end of clause (xii); 

8 (2) by adding ‘‘and’’ at the end of clause (xiii); 

9 and 

10 (3) by inserting after clause (xiii) the following 

11 new clause: 

12 ‘‘(xiv) individuals described in section 1935, but 

13 only with respect to items and services described in 

14 paragraph (4)(C),’’. 

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

16 this section apply to medical assistance provided on and 

17 after October 1, 2005. 

18 SEC. 203. STATE OPTION TO EXTEND THE PERIOD OF ELIGI19 BILITY FOR PROVISION OF FAMILY PLAN20 NING SERVICES AND SUPPLIES. 

21 (a) IN GENERAL.—Section 1902(e) of the Social Se22 curity Act (42 U.S.C. 1396a(e)) is amended by adding at 

23 the end the following new paragraph: 

24 ‘‘(13) At the option of a State, the State plan may 

25 provide that, in the case of an individual who was eligible 
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1 for medical assistance described in section 1905(a)(4)(C), 

2 but who no longer qualifies for such assistance because 

3 of an increase in income or resources or because of the 

4 expiration of a post-partum period, the individual may re5 main eligible for such assistance for such period as the 

6 State may specify, but the period of extended eligibility 

7 under this paragraph shall not exceed a continuous period 

8 of 24 months for any individual. The State may apply the 

9 previous sentence to one or more classes of individuals and 

10 may vary the period of extended eligibility with respect 

11 to different classes of individuals.’’. 

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

13 subsection (a) apply to medical assistance provided on and 

14 after October 1, 2005. 

15 TITLE III—EQUITY IN PRESCRIP16 TION INSURANCE AND CON17 TRACEPTIVE COVERAGE 

18 SEC. 301. SHORT TITLE. 

19 This Act may be cited as the ‘‘Equity in Prescription 

20 Insurance and Contraceptive Coverage Act’’. 

21 SEC. 302. AMENDMENTS TO EMPLOYEE RETIREMENT IN22 COME SECURITY ACT OF 1974. 

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

24 B of title I of the Employee Retirement Income Security 
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1 Act of 1974 (29 U.S.C. 1185 et seq.) is amended by add2 ing at the end the following: 

3 ‘‘SEC. 714. STANDARDS RELATING TO BENEFITS FOR CON4 TRACEPTIVES. 

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

6 health plan, and a health insurance issuer providing health 

7 insurance coverage in connection with a group health plan, 

8 may not— 

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

10 contraceptive drugs or devices approved by the Food 

11 and Drug Administration, or generic equivalents ap12 proved as substitutable by the Food and Drug Ad13 ministration, if such plan or coverage provides bene14 fits for other outpatient prescription drugs or de15 vices; or 

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

17 contraceptive services if such plan or coverage pro18 vides benefits for other outpatient services provided 

19 by a health care professional (referred to in this sec20 tion as ‘outpatient health care services’). 

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

22 health insurance issuer providing health insurance cov23 erage in connection with a group health plan, may not— 

24 ‘‘(1) deny to an individual eligibility, or contin25 ued eligibility, to enroll or to renew coverage under 
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1 the terms of the plan because of the individual’s or 

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

3 that are covered in accordance with the requirements 

4 of this section; 

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

6 a covered individual to encourage such individual to 

7 accept less than the minimum protections available 

8 under this section; 

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

10 reimbursement of a health care professional because 

11 such professional prescribed contraceptive drugs or 

12 devices, or provided contraceptive services, described 

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

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

15 to a health care professional to induce such profes16 sional to withhold from a covered individual contra17 ceptive drugs or devices, or contraceptive services, 

18 described in subsection (a). 

19 ‘‘(c) RULES OF CONSTRUCTION.— 

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

21 shall be construed— 

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

23 and a health insurance issuer providing health 

24 insurance coverage in connection with a group 

25 health plan from imposing deductibles, coinsur-
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1 ance, or other cost-sharing or limitations in re2 lation to— 

3 ‘‘(i) benefits for contraceptive drugs 

4 under the plan or coverage, except that 

5 such a deductible, coinsurance, or other 

6 cost-sharing or limitation for any such 

7 drug shall be consistent with those imposed 

8 for other outpatient prescription drugs oth9 erwise covered under the plan or coverage; 

10 ‘‘(ii) benefits for contraceptive devices 

11 under the plan or coverage, except that 

12 such a deductible, coinsurance, or other 

13 cost-sharing or limitation for any such de14 vice shall be consistent with those imposed 

15 for other outpatient prescription devices 

16 otherwise covered under the plan or cov17 erage; and 

18 ‘‘(iii) benefits for outpatient contra19 ceptive services under the plan or coverage, 

20 except that such a deductible, coinsurance, 

21 or other cost-sharing or limitation for any 

22 such service shall be consistent with those 

23 imposed for other outpatient health care 

24 services otherwise covered under the plan 

25 or coverage; 
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1 ‘‘(B) as requiring a group health plan and 

2 a health insurance issuer providing health in3 surance coverage in connection with a group 

4 health plan to cover experimental or investiga5 tional contraceptive drugs or devices, or experi6 mental or investigational contraceptive services, 

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

8 that the plan or issuer provides coverage for 

9 other experimental or investigational outpatient 

10 prescription drugs or devices, or experimental 

11 or investigational outpatient health care serv12 ices; or 

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

14 the rights or protections of an individual under 

15 any other Federal law. 

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

17 the term ‘limitation’ includes— 

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

19 device, restricting the type of health care pro20 fessionals that may prescribe such drugs or de21 vices, utilization review provisions, and limits on 

22 the volume of prescription drugs or devices that 

23 may be obtained on the basis of a single con24 sultation with a professional; or 
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1 ‘‘(B) in the case of an outpatient contra2 ceptive service, restricting the type of health 

3 care professionals that may provide such serv4 ices, utilization review provisions, requirements 

5 relating to second opinions prior to the coverage 

6 of such services, and requirements relating to 

7 preauthorizations prior to the coverage of such 

8 services. 

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

10 imposition of the requirements of this section shall be 

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

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

13 notice of such requirements under the plan, except that 

14 the summary description required to be provided under the 

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

16 modification shall be provided by not later than 60 days 

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

18 requirements apply. 

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

20 construed to preempt any provision of State law to the 

21 extent that such State law establishes, implements, or con22 tinues in effect any standard or requirement that provides 

23 coverage or protections for participants or beneficiaries 

24 that are greater than the coverage or protections provided 

25 under this section. 
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1 ‘‘(f) DEFINITION.—In this section, the term ‘out2 patient contraceptive services’ means consultations, exami3 nations, procedures, and medical services, provided on an 

4 outpatient basis and related to the use of contraceptive 

5 methods (including natural family planning) to prevent an 

6 unintended pregnancy.’’. 

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

8 in section 1 of the Employee Retirement Income Security 

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

10 after the item relating to section 713 the following: 

‘‘Sec. 714. Standards relating to benefits for contraceptives.’’. 

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

12 this section shall apply with respect to plan years begin13 ning on or after January 1, 2006. 

14 SEC. 303. AMENDMENTS TO PUBLIC HEALTH SERVICE ACT 

15 RELATING TO THE GROUP MARKET. 

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

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

18 300gg–4 et seq.) is amended by adding at the end the 

19 following: 

20 ‘‘SEC. 2707. STANDARDS RELATING TO BENEFITS FOR CON21 TRACEPTIVES. 

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

23 health plan, and a health insurance issuer providing health 

24 insurance coverage in connection with a group health plan, 

25 may not— 
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1 ‘‘(1) exclude or restrict benefits for prescription 

2 contraceptive drugs or devices approved by the Food 

3 and Drug Administration, or generic equivalents ap4 proved as substitutable by the Food and Drug Ad5 ministration, if such plan or coverage provides bene6 fits for other outpatient prescription drugs or de7 vices; or 

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

9 contraceptive services if such plan or coverage pro10 vides benefits for other outpatient services provided 

11 by a health care professional (referred to in this sec12 tion as ‘outpatient health care services’). 

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

14 health insurance issuer providing health insurance cov15 erage in connection with a group health plan, may not— 

16 ‘‘(1) deny to an individual eligibility, or contin17 ued eligibility, to enroll or to renew coverage under 

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

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

20 that are covered in accordance with the requirements 

21 of this section; 

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

23 a covered individual to encourage such individual to 

24 accept less than the minimum protections available 

25 under this section; 
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1 ‘‘(3) penalize or otherwise reduce or limit the 

2 reimbursement of a health care professional because 

3 such professional prescribed contraceptive drugs or 

4 devices, or provided contraceptive services, described 

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

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

7 to a health care professional to induce such profes8 sional to withhold from covered individual contracep9 tive drugs or devices, or contraceptive services, de10 scribed in subsection (a). 

11 ‘‘(c) RULES OF CONSTRUCTION.— 

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

13 shall be construed— 

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

15 and a health insurance issuer providing health 

16 insurance coverage in connection with a group 

17 health plan from imposing deductibles, coinsur18 ance, or other cost-sharing or limitations in re19 lation to— 

20 ‘‘(i) benefits for contraceptive drugs 

21 under the plan or coverage, except that 

22 such a deductible, coinsurance, or other 

23 cost-sharing or limitation for any such 

24 drug shall be consistent with those imposed 
23 

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1 for other outpatient prescription drugs oth2 erwise covered under the plan or coverage; 

3 ‘‘(ii) benefits for contraceptive devices 

4 under the plan or coverage, except that 

5 such a deductible, coinsurance, or other 

6 cost-sharing or limitation for any such de7 vice shall be consistent with those imposed 

8 for other outpatient prescription devices 

9 otherwise covered under the plan or cov10 erage; and 

11 ‘‘(iii) benefits for outpatient contra12 ceptive services under the plan or coverage, 

13 except that such a deductible, coinsurance, 

14 or other cost-sharing or limitation for any 

15 such service shall be consistent with those 

16 imposed for other outpatient health care 

17 services otherwise covered under the plan 

18 or coverage; 

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

20 a health insurance issuer providing health in21 surance coverage in connection with a group 

22 health plan to cover experimental or investiga23 tional contraceptive drugs or devices, or experi24 mental or investigational contraceptive services, 

25 described in subsection (a), except to the extent 
24 

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1 that the plan or issuer provides coverage for 

2 other experimental or investigational outpatient 

3 prescription drugs or devices, or experimental 

4 or investigational outpatient health care serv5 ices; or 

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

7 the rights or protections of an individual under 

8 any other Federal law. 

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

10 the term ‘limitation’ includes— 

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

12 device, restricting the type of health care pro13 fessionals that may prescribe such drugs or de14 vices, utilization review provisions, and limits on 

15 the volume of prescription drugs or devices that 

16 may be obtained on the basis of a single con17 sultation with a professional; or 

18 ‘‘(B) in the case of an outpatient contra19 ceptive service, restricting the type of health 

20 care professionals that may provide such serv21 ices, utilization review provisions, requirements 

22 relating to second opinions prior to the coverage 

23 of such services, and requirements relating to 

24 preauthorizations prior to the coverage of such 

25 services. 
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1 ‘‘(d) NOTICE.—A group health plan under this part 

2 shall comply with the notice requirement under section 

3 714(d) of the Employee Retirement Income Security Act 

4 of 1974 with respect to the requirements of this section 

5 as if such section applied to such plan. 

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

7 construed to preempt any provision of State law to the 

8 extent that such State law establishes, implements, or con9 tinues in effect any standard or requirement that provides 

10 coverage or protections for enrollees that are greater than 

11 the coverage or protections provided under this section. 

12 ‘‘(f) DEFINITION.—In this section, the term ‘out13 patient contraceptive services’ means consultations, exami14 nations, procedures, and medical services, provided on an 

15 outpatient basis and related to the use of contraceptive 

16 methods (including natural family planning) to prevent an 

17 unintended pregnancy.’’. 

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

19 this section shall apply with respect to group health plans 

20 for plan years beginning on or after January 1, 2006. 

21 SEC. 304. AMENDMENT TO PUBLIC HEALTH SERVICE ACT 

22 RELATING TO THE INDIVIDUAL MARKET. 

23 (a) IN GENERAL.—Part B of title XXVII of the Pub24 lic Health Service Act (42 U.S.C. 300gg–41 et seq.) is 

25 amended— 
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1 (1) by redesignating the first subpart 3 (relat2 ing to other requirements) as subpart 2; and 

3 (2) by adding at the end of subpart 2 the fol4 lowing: 

5 ‘‘SEC. 2753. STANDARDS RELATING TO BENEFITS FOR CON6 TRACEPTIVES. 

7 ‘‘The provisions of section 2707 shall apply to health 

8 insurance coverage offered by a health insurance issuer 

9 in the individual market in the same manner as they apply 

10 to health insurance coverage offered by a health insurance 

11 issuer in connection with a group health plan in the small 

12 or large group market.’’. 

13 (b) EFFECTIVE DATE.—The amendment made by 

14 this section shall apply with respect to health insurance 

15 coverage offered, sold, issued, renewed, in effect, or oper16 ated in the individual market on or after January 1, 2006. 

17 TITLE IV—EMERGENCY CONTRA18 CEPTION EDUCATION AND IN19 FORMATION 

20 SEC. 401. SHORT TITLE. 

21 This Act may be cited as the ‘‘Emergency Contracep22 tion Education Act’’. 

23 SEC. 402. EMERGENCY CONTRACEPTION EDUCATION AND 

24 INFORMATION PROGRAMS. 

25 (a) DEFINITIONS.—For purposes of this section: 
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1 (1) EMERGENCY CONTRACEPTION.—The term 

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

3 (as the terms are defined in section 201 of the Fed4 eral Food, Drug, and Cosmetic Act (21 U.S.C. 321)) 

5 or a drug regimen that is— 

6 (A) used after sexual relations; 

7 (B) prevents pregnancy, by preventing ovu8 lation, fertilization of an egg, or implantation of 

9 an egg in a uterus; and 

10 (C) approved by the Food and Drug Ad11 ministration. 

12 (2) HEALTH CARE PROVIDER.—The term 

13 ‘‘health care provider’’ means an individual who is li14 censed or certified under State law to provide health 

15 care services and who is operating within the scope 

16 of such license. 

17 (3) INSTITUTION OF HIGHER EDUCATION.—The 

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

19 meaning given such term in section 1201(a) of the 

20 Higher Education Act of 1965 (20 U.S.C. 1141(a)). 

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

22 the Secretary of Health and Human Services. 

23 (b) EMERGENCY CONTRACEPTION PUBLIC EDU24 CATION PROGRAM.— 
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1 (1) IN GENERAL.—The Secretary, acting 

2 through the Director of the Centers for Disease 

3 Control and Prevention, shall develop and dissemi4 nate to the public information on emergency contra5 ception. 

6 (2) DISSEMINATION.—The Secretary may dis7 seminate information under paragraph (1) directly 

8 or through arrangements with nonprofit organiza9 tions, consumer groups, institutions of higher edu10 cation, Federal, State, or local agencies, clinics and 

11 the media. 

12 (3) INFORMATION.—The information dissemi13 nated under paragraph (1) shall include, at a min14 imum, a description of emergency contraception, and 

15 an explanation of the use, safety, efficacy, and avail16 ability of such contraception. 

17 (c) EMERGENCY CONTRACEPTION INFORMATION

18 PROGRAM FOR HEALTH CARE PROVIDERS.— 

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

20 through the Administrator of the Health Resources 

21 and Services Administration and in consultation 

22 with major medical and public health organizations, 

23 shall develop and disseminate to health care pro24 viders information on emergency contraception. 
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1 (2) INFORMATION.—The information dissemi2 nated under paragraph (1) shall include, at a min3 imum— 

4 (A) information describing the use, safety, 

5 efficacy and availability of emergency contra6 ception; 

7 (B) a recommendation regarding the use of 

8 such contraception in appropriate cases; and 

9 (C) information explaining how to obtain 

10 copies of the information developed under sub11 section (b), for distribution to the patients of 

12 the providers. 

13 (d) AUTHORIZATION OF APPROPRIATIONS.—There is 

14 authorized to be appropriated to carry out this section 

15 $10,000,000 for each of the fiscal years 2006 through 

16 2010. 

17 TITLE V—COMPASSIONATE AS18 SISTANCE FOR RAPE EMER19 GENCIES 

20 SEC. 501. SHORT TITLE. 

21 This Act may be cited as the ‘‘Compassionate Assist22 ance for Rape Emergencies Act’’. 
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1 SEC. 502. SURVIVORS OF SEXUAL ASSAULT; PROVISION BY 

2 HOSPITALS OF EMERGENCY CONTRACEP3 TIVES WITHOUT CHARGE. 

4 (a) IN GENERAL.—Federal funds may not be pro5 vided to a hospital under any health-related program, un6 less the hospital meets the conditions specified in sub7 section (b) in the case of— 

8 (1) any woman who presents at the hospital 

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

10 is accompanied by someone who states she is a vic11 tim of sexual assault; and 

12 (2) any woman who presents at the hospital 

13 whom hospital personnel have reason to believe is a 

14 victim of sexual assault. 

15 (b) ASSISTANCE FOR VICTIMS.—The conditions spec16 ified in this subsection regarding a hospital and a woman 

17 described in subsection (a) are as follows: 

18 (1) The hospital promptly provides the woman 

19 with medically and factually accurate and unbiased 

20 written and oral information about emergency con21 traception, including information explaining that— 

22 (A) emergency contraception does not 

23 cause an abortion; and 

24 (B) emergency contraception is effective in 

25 most cases in preventing pregnancy after un26 protected sex. 
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1 (2) The hospital promptly offers emergency 

2 contraception to the woman, and promptly provides 

3 such contraception to her on her request. 

4 (3) The information provided pursuant to para5 graph (1) is in clear and concise language, is readily 

6 comprehensible, and meets such conditions regarding 

7 the provision of the information in languages other 

8 than English as the Secretary may establish. 

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

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

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

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

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

14 a drug, drug regimen, or device that— 

15 (A) is used postcoitally; 

16 (B) prevents pregnancy by delaying ovula17 tion, preventing fertilization of an egg, or pre18 venting implantation of an egg in a uterus; and 

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

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

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

23 including the meaning applicable in such title for 

24 purposes of making payments for emergency services 
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1 to hospitals that do not have agreements in effect 

2 under such title. 

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

4 of Health and Human Services. 

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

6 which the woman involved does not consent or lacks 

7 the legal capacity to consent. 

8 (d) EFFECTIVE DATE; AGENCY CRITERIA.—This sec9 tion takes effect upon the expiration of the 180-day period 

10 beginning on the date of enactment of this Act. Not later 

11 than 30 days prior to the expiration of such period, the 

12 Secretary shall publish in the Federal Register criteria for 

13 carrying out this section. 

14 TITLE VI—TEENAGE 

15 PREGNANCY PREVENTION 

16 SEC. 601. SHORT TITLE. 

17 This title may be cited as the ‘‘Preventing Teen Preg18 nancy Act’’. 

19 SEC. 602. TEENAGE PREGNANCY PREVENTION. 

20 Part P of title III of the Public Health Service Act 

21 (42 U.S.C. 280g et seq.) is amended by inserting after 

22 section 399N the following section: 

23 ‘‘SEC. 399N–1. TEENAGE PREGNANCY PREVENTION GRANTS. 

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

25 competitive basis grants to public and private entities to 
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1 establish or expand teenage pregnancy prevention pro2 grams. 

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

4 this section may include State and local not-for-profit coa5 litions working to prevent teenage pregnancy, State, local, 

6 and tribal agencies, schools, entities that provide after7 school programs, and community and faith-based groups. 

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

9 this section, the Secretary shall give— 

10 ‘‘(1) highest priority to applicants seeking as11 sistance for programs targeting communities or pop12 ulations in which— 

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

14 higher than the corresponding State average; or 

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

16 increasing; and 

17 ‘‘(2) priority to applicants seeking assistance 

18 for programs that— 

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

20 populations such as young males or immigrant 

21 youths; or 

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

23 resources and be coordinated with other pro24 grams that serve youth, such as workforce de25 velopment and after school programs. 
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1 ‘‘(d) USE OF FUNDS.—Funds received by an entity 

2 as a grant under this section shall be used for programs 

3 that— 

4 ‘‘(1) replicate or substantially incorporate the 

5 elements of one or more teenage pregnancy preven6 tion programs that have been proven (on the basis 

7 of rigorous scientific research) to delay sexual inter8 course or sexual activity, increase condom or contra9 ceptive use (without increasing sexual activity), or 

10 reduce teenage pregnancy; and 

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

12 strategies for preventing teenage pregnancy: encour13 aging teenagers to delay sexual activity; sex and 

14 HIV education; interventions for sexually active 

15 teenagers; preventive health services; youth develop16 ment programs; service learning programs; and out17 reach or media programs. 

18 ‘‘(e) COMPLETE INFORMATION.—Programs receiving 

19 funds under this section that choose to provide informa20 tion on HIV/AIDS or contraception or both must provide 

21 information that is complete and medically accurate. 

22 ‘‘(f) RELATION TO ABSTINENCE-ONLY PROGRAMS.— 

23 Funds under this section are not intended for use by absti24 nence-only education programs. Abstinence-only education 

25 programs that receive Federal funds through the Maternal 
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1 and Child Health Block Grant, the Administration for 

2 Children and Families, the Adolescent Family Life Pro3 gram, and any other program that uses the definition of 

4 ‘abstinence education’ found in section 510(b) of the So5 cial Security Act are ineligible for funding. 

6 ‘‘(g) APPLICATIONS.—Each entity seeking a grant 

7 under this section shall submit an application to the Sec8 retary at such time and in such manner as the Secretary 

9 may require. 

10 ‘‘(h) MATCHING FUNDS.— 

11 ‘‘(1) IN GENERAL.—The Secretary may not 

12 award a grant to an applicant for a program under 

13 this section unless the applicant demonstrates that 

14 it will pay, from funds derived from non-Federal 

15 sources, at least 25 percent of the cost of the pro16 gram. 

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

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

19 cash or in kind. 

20 ‘‘(i) SUPPLEMENTATION OF FUNDS.—An entity that 

21 receives funds as a grant under this section shall use the 

22 funds to supplement and not supplant funds that would 

23 otherwise be available to the entity for teenage pregnancy 

24 prevention. 

25 ‘‘(j) EVALUATIONS.— 
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1 ‘‘(1) IN GENERAL.—The Secretary shall— 

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

3 evaluation of 10 percent of programs for which 

4 a grant is awarded under this section; 

5 ‘‘(B) collect basic data on each program 

6 for which a grant is awarded under this section; 

7 and 

8 ‘‘(C) upon completion of the evaluations 

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

10 Congress a report that includes a detailed state11 ment on the effectiveness of grants under this 

12 section. 

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

14 recipient under this section shall provide such infor15 mation and cooperation as may be required for an 

16 evaluation under paragraph (1). 

17 ‘‘(k) DEFINITION.—For purposes of this section, the 

18 term ‘rigorous scientific research’ means based on a pro19 gram evaluation that: 

20 ‘‘(1) Measured impact on sexual or contracep21 tive behavior, pregnancy or childbearing. 

22 ‘‘(2) Employed an experimental or quasi-experi23 mental design with well-constructed and appropriate 

24 comparison groups. 
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1 ‘‘(3) Had a sample size large enough (at least 

2 100 in the combined treatment and control group) 

3 and a follow-up interval long enough (at least six 

4 months) to draw valid conclusions about impact. 

5 ‘‘(l) AUTHORIZATION OF APPROPRIATIONS.—There 

6 are authorized to be appropriated to carry out this section 

7 $20,000,000 for fiscal year 2006, and such sums as may 

8 be necessary for each subsequent fiscal year. In addition, 

9 there are authorized to be appropriated for evaluations 

10 under subsection (j) such sums as may be necessary for 

11 fiscal year 2006 and each subsequent fiscal year.’’. 

12 TITLE VII—ACCURACY OF 

13 CONTRACEPTIVE INFORMATION 

14 SEC. 701. SHORT TITLE. 

15 This title may be cited as the ‘‘Truth in Contracep16 tion Act’’. 

17 SEC. 702. ACCURACY OF CONTRACEPTIVE INFORMATION. 

18 Notwithstanding any other provision of law, any in19 formation concerning the use of a contraceptive provided 

20 through any federally-funded sex education, family life 

21 education, abstinence education, comprehensive health 

22 education, or character education program shall be medi23 cally accurate and shall include health benefits and failure 

24 rates relating to the use of such contraceptive. 
Calendar No. 78 

109TH CONGRESS 

1ST SESSION S. 844 

A BILL 

To expand access to preventive health care services 

women’s health care. the number of abortions, and improve access to that help reduce unintended pregnancy, reduce 

APRIL 20, 2005 

Read the second time and placed on the calendar