I
107TH CONGRESS
2D SESSION
H. R. 4032
To amend titles V and XIX of the Social Security Act and chapter 89
of title 5, United States Code, to provide coverage for domestic violence
screening and treatment under the maternal and child health block
grant program, the Medicaid Program, and the Federal employees health
benefits program.
IN THE HOUSE OF REPRESENTATIVES
MARCH 20, 2002
Mrs. CAPPS (for herself, Mr. LATOURETTE, Mr. WAXMAN, and Mr. GREEN-
WOOD) introduced the following bill; which was referred to the Committee
on Energy and Commerce, and in addition to the Committee on Govern-
ment Reform, for a period to be subsequently determined by the Speaker,
in each case for consideration of such provisions as fall within the juris-
diction of the committee concerned
A BILL
To amend titles V and XIX of the Social Security Act
and chapter 89 of title 5, United States Code, to provide
coverage for domestic violence screening and treatment
under the maternal and child health block grant pro-
gram, the Medicaid Program, and the Federal employees
health benefits program.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; FINDINGS.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Domestic Violence Screening and Treatment Act of
2002’’.
(b) FINDINGS.—Congress finds the following:
(1) Nearly one-third of American women (31
percent) report being physically or sexually abused
by a husband or boyfriend at some point in their
lives, and about 1200 women are murdered every
year by their intimate partner, nearly 3 each day.
(2) 85 percent of violent victimizations are ex-
perienced by women.
(3) 37 percent of all women who sought care in
hospital emergency rooms for violence-related inju-
ries were injured by a current or former spouse, boy-
friend, or girlfriend.
(4) In addition to injuries sustained during vio-
lent episodes, physical and psychological abuse are
linked to a number of adverse physical health effects
including arthritis, chronic neck or back pain, mi-
graine and other frequent headaches, stammering,
problems with vision, and sexually transmitted infec-
tions, including HIV/AIDS.
(5) Medical services for abused women cost an
estimated $857.3 million every year.
(6) Each year, at least six percent of all preg-
nant women, about 240,000 pregnant women, in this
country are battered by the men in their lives. This
battering leads to complications of pregnancy, in-
cluding low weight gain, anemia, infections, and first
and second trimester bleeding.
(7) Pregnant and recently pregnant women are
more likely to be victims of homicide than to die of
any other cause, and evidence exists that a signifi-
cant proportion of all female homicide victims are
killed by their intimate partners.
(8) Children who witness domestic violence are
more likely to exhibit behavioral and physical health
problems including depression, anxiety, and violence
towards peers. They are also more likely to attempt
suicide, abuse drugs and alcohol, run away from
home, engage in teenage prostitution, and commit
sexual assault crimes.
(9) Fifty percent of men who frequently assault
their wives frequently assault their children. The
U.S. Advisory Board on Child Abuse and Neglect
suggests that domestic violence may be the single
major precursor to child abuse and neglect fatalities
in this country.
(10) Currently, about 10 percent of primary
care physicians routinely screen for intimate partner
abuse during new patient visits and nine percent
routinely screen during periodic checkups.
(11) Recent clinical studies have proven the ef-
fectiveness of a 2-minute screening for early detec-
tion of abuse of pregnant women. Additional longitu-
dinal studies have tested a 10-minute intervention
that was proven highly effective in increasing the
safety of pregnant abused women. Comparable re-
search does not yet exist to support the effectiveness
of screening men.
(12) 70 to 81 percent of the patients studied
reported that they would like their healthcare pro-
viders to ask them privately about intimate partner
violence.
SEC. 2. COVERAGE OF DOMESTIC VIOLENCE SCREENING
AND TREATMENT UNDER THE MEDICAID
PROGRAM.
(a) IN GENERAL.—Section 1905 of the Social Secu-
rity Act (42 U.S.C. 1396d) is amended—
(1) in subsection (a)(26), by striking ‘‘and’’ at
the end;
(2) by redesignating paragraph (27) of sub-
section (a) as paragraph (28); and
(3) by inserting after paragraph (26) of sub-
section (a) the following new paragraph:
‘‘(27) domestic violence screening and treat-
ment services (as defined in subsection (x));’’; and
(4) by adding at the end the following new sub-
section:
‘‘(x) The term ‘domestic violence screening and treat-
ment services’ means the following services (as specified
under the State plan) furnished by an attending health
care provider (or, in the case of services described in para-
graph (3), under arrangements between the provider and
domestic violence experts) to women 18 years of age or
older:
‘‘(1) Routine verbal screening for domestic vio-
lence by a provider if the provider has not previously
screened the patient or if the patient has been
screened but the patient indicates that she is in a
new relationship regardless of whether there are any
clinical indicators or suspicion of abuse.
‘‘(2) Danger assessment for women who posi-
tively identify for domestic violence, including an im-
mediate safety assessment, an initial risk assess-
ment, and follow-up risk assessments during subse-
quent visits.
‘‘(3) Treatment relating to domestic violence,
including the following:
‘‘(A) Safety education to assist the patient
in developing a plan to promote her safety and
well-being, such as keeping an emergency kit,
talking to someone, and arranging for a place
to stay, and appropriate follow up.
‘‘(B) Health education which provides writ-
ten and verbal information about domestic vio-
lence, its impact on health, options for services,
and any necessary follow up.
‘‘(C) Psycho-social and counseling services
that include an initial assessment, development
of a plan of care, individual or group counseling
(as needed), and follow-up assessment, treat-
ment, or intervention.
‘‘(D) Documentation of screening, assess-
ment, treatment, referrals, injuries, and ill-
nesses related to domestic violence and who in-
flicted them, using appropriate diagnostic codes
and absolute confidentiality (except as required
by applicable State law).
‘‘(4) Referral and case coordination for addi-
tional services, including services from domestic vio-
lence programs, community agencies, and judicial
and other systems.’’.
(b) EFFECTIVE DATE.—The amendments made by
this section shall take effect on the date of the enactment
of this Act and shall apply to services furnished on or after
such date.
SEC. 3. FEDERAL EMPLOYEES HEALTH BENEFITS PRO-
GRAM.
(a) IN GENERAL.—Section 8902 of title 5, United
States Code, is amended by adding at the end the fol-
lowing:
‘‘(p)(1) A contract may not be made or a plan ap-
proved which does not include coverage for domestic vio-
lence screening and treatment services.
‘‘(2) For purposes of this subsection, the term ‘do-
mestic violence screening and treatment services’ has the
meaning given such term in section 1905(x) of the Social
Security Act.’’.
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) shall apply to contracts made, and plans
approved, after the end of the 6-month period beginning
on the date of the enactment of this Act.
SEC. 4. MATERNAL AND CHILD HEALTH SERVICES BLOCK
GRANT.
(a) REQUIREMENT FOR PORTION OF EXPENDITURES
ON
DOMESTIC
VIOLENCE
SCREENING
AND
TREAT-
MENT.—Section 505(a)(5) of the Social Security Act (42
U.S.C. 705(a)(5)) is amended—
(1) by striking ‘‘and’’ at the end of subpara-
graph (E);
(2) by striking the period at the end of sub-
paragraph (F) and inserting ‘‘; and’’; and
(3) by inserting after subparagraph (F) the fol-
lowing new subparagraph:
‘‘(G) the State will set aside a reasonable
portion (based upon the State’s previous use of
funds under this title) of the funds provided for
domestic violence screening and treatment serv-
ices (as defined in section 1902(x)).’’.
(b) PREFERENCE IN CERTAIN FUNDING.—Section
502(b)(2) of such Act (42 U.S.C. 702(b)(2)) is amended
by adding at the end the following new subparagraph:
‘‘(C) Of the amounts retained for projects described
in subparagraphs (A) through (F) of section 501(a)(3),
the Secretary shall provide preference to qualified appli-
cants which demonstrate that the activities to be carried
out with such amounts includes training of providers in
how to screen for, and treat, domestic violence and train-
ing that includes—
‘‘(i) identifying victims of domestic violence and
maintaining complete medical records that include
documentation of the examination, treatment given,
and referrals made, and recording the location and
nature of the victim’s injuries;
‘‘(ii) examining and treating such victims, with-
in the scope of the health professional’s discipline,
training, and practice (including medical advice re-
garding the dynamics and nature of domestic vio-
lence);
‘‘(iii) assessing the immediate and short-term
safety of the victim and assisting the victim in devel-
oping a plan to promote his or her safety; and
‘‘(iv) referring the victim to public and private
nonprofit private entities that provide services for
such victims.’’.
(c) REPORTING DATA.—Section 506(a)(2) of such
Act (42 U.S.C. 706(a)(2)) is amended by adding at the
end the following new subparagraph:
‘‘(F) Information on how funds provided under
this title are used to screen for and treat domestic
violence.’’.
(d) SEPARATE PROGRAM FOR DOMESTIC VIOLENCE
SCREENING AND TREATMENT.—Title V of such Act is
amended by adding at the end the following new section:
‘‘SEPARATE PROGRAM FOR DOMESTIC VIOLENCE
SCREENING AND TREATMENT
‘‘SEC. 511. (a) For the purpose described in sub-
section (b), the Secretary shall, for fiscal year 2003 and
each subsequent fiscal year, allot to each State which has
transmitted an application for the fiscal year under section
505(a) an amount equal to the product of
‘‘(1) the amount appropriated in subsection (d)
for the fiscal year; and
‘‘(2) the percentage determined for the State
under section 502(c)(1)(B)(ii).
‘‘(b) The purpose of an allotment under subsection
(a) to a State is to enable the State to provide for domestic
violence screening and treatment, including the provision
of domestic violence screening and treatment services (as
defined in section 1905(x)), increasing the number of
women screened, assessed, treated, and referred and in-
cluding training of health care providers on how to identify
and respond to victims of domestic violence.
‘‘(c)(1) Sections 503, 507, and 508 apply to allot-
ments under subsection (a) to the same extent and in the
same manner as such sections apply to allotments under
section 502(c).
‘‘(2) Sections 505 and 506 apply to allotments under
subsection (a) to the extent determined by the Secretary
to be appropriate.
‘‘(d) For the purpose of allotments under subsection
(a), there is authorized to be appropriated for each fiscal
year, beginning with fiscal year 2003, such sums as may
be necessary.’’.
(e) EFFECTIVE DATE.—The amendments made by
subsections (a) and (b) shall apply to fiscal years begin-
ning after the date of the enactment of this Act and the
amendment made by subsection (c) shall apply to annual
reports submitted for such fiscal years.
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