I 
115TH CONGRESS 
2D SESSION 
H. R. 6387 
To plan, develop, and make recommendations to increase access to sexual 
assault examinations for survivors by holding hospitals accountable and 
supporting the providers that serve them. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 16, 2018 
Ms. JAYAPAL (for herself, Mr. KING of New York, Ms. KUSTER of New 
Hampshire, Ms. WASSERMAN SCHULTZ, and Ms. MOORE) introduced the 
following bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committees on Ways and Means, and Edu-
cation and the Workforce, for a period to be subsequently determined by 
the Speaker, in each case for consideration of such provisions as fall with-
in the jurisdiction of the committee concerned 
A BILL 
To plan, develop, and make recommendations to increase 
access to sexual assault examinations for survivors by 
holding hospitals accountable and supporting the pro-
viders that serve them. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Survivors’ Access to 
Supportive Care Act’’ or ‘‘SASCA’’. 
VerDate Sep 11 2014 
21:30 Jul 17, 2018
Jkt 079200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H6387.IH
H6387
sradovich on DSK3GMQ082PROD with BILLS
SEC. 2. PURPOSE. 
It is the purpose of this Act to increase access to 
medical forensic sexual assault examinations and treat-
ment provided by sexual assault forensic examiners for 
survivors by identifying and addressing gaps in obtaining 
those services. 
SEC. 3. DEFINITIONS. 
In this Act: 
(1) COMMUNITY
HEALTH
AIDE
AND
COMMU-
NITY HEALTH PRACTITIONER.—The terms ‘‘commu-
nity health aide’’ and ‘‘community health practi-
tioner’’ have the meanings within the meaning of 
section 119 of the Indian Health Care Improvement 
Act (25 U.S.C. 1616l). 
(2) MFE.—The term ‘‘medical forensic exam-
ination’’ or ‘‘MFE’’ means an examination provided 
to a sexual assault survivor by medical personnel 
trained to gather evidence of a sexual assault in a 
manner suitable for use in a court of law. 
(3) SAE.—The term ‘‘sexual assault examiner’’ 
or ‘‘SAE’’ means a registered nurse, advanced prac-
tice nurse, physician, or physician assistant specifi-
cally trained to provide care to sexual assault foren-
sic examinations. 
(4) SAFE.—The term ‘‘sexual assault forensic 
examiner’’ or ‘‘SAFE’’ means a medical practitioner 
VerDate Sep 11 2014 
21:30 Jul 17, 2018
Jkt 079200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H6387.IH
H6387
sradovich on DSK3GMQ082PROD with BILLS
who has specialized forensic training in treating sex-
ual assault survivors and conducting medical foren-
sic examinations. 
(5) SANE.—The term ‘‘sexual assault nurse 
examiner’’ or ‘‘SANE’’ means a registered nurse 
who has specialized forensic training in treating sex-
ual assault survivors and conducting medical foren-
sic examinations. 
(6) SART.—The term ‘‘sexual assault response 
team’’ or ‘‘SART’’ means a multidisciplinary team 
that provides a specialized and immediate response 
to survivors of sexual assault, and may include 
health care personnel, law enforcement representa-
tives, community-based survivor advocates, prosecu-
tors, and forensic scientists. 
(7) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
(8) SEXUAL ASSAULT.—The term ‘‘sexual as-
sault’’ means any nonconsensual sexual act pro-
scribed by Federal, tribal, or State law, including 
when the individual lacks capacity to consent. 
VerDate Sep 11 2014 
21:30 Jul 17, 2018
Jkt 079200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H6387.IH
H6387
sradovich on DSK3GMQ082PROD with BILLS
TITLE I—STRENGTHENING THE 
SEXUAL ASSAULT EXAMINER 
WORKFORCE 
SEC. 101. UNDERSTANDING SEXUAL ASSAULT CARE. 
(a) PURPOSE.—It is the purpose of this section to 
identify areas for improvement in health care delivery sys-
tems providing services to survivors of sexual assault. 
(b) GRANTS.—The Secretary shall award grants to 
States to develop and implement State surveys to iden-
tify— 
(1) the availability of and patient access to 
trained SAFE, SANE, and other providers who per-
form MFEs; 
(2) the hospitals or clinics that offer MFEs and 
whether each hospital or clinic has full-time, part- 
time, or on-call coverage; 
(3) regional, provider, or other barriers to ac-
cess sexual assault care and services, including 
MFEs; 
(4) billing and reimbursement practices for 
MFEs, including private health insurance, Medicare, 
Medicaid, the State’s victims compensation program, 
and any other crime funding or other sources of 
funding that contribute to payment for such exami-
nations; 
VerDate Sep 11 2014 
21:30 Jul 17, 2018
Jkt 079200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H6387.IH
H6387
sradovich on DSK3GMQ082PROD with BILLS
(5) State requirements, minimum standards, 
and protocols for training sexual assault examiners; 
(6) State requirements, minimum standards, 
and protocols for training non-SANE or SAFE 
emergency services personnel involved in MFEs; 
(7) the availability of SAFE or SANE training, 
frequency of when training is convened, the pro-
viders of such training, the State’s role in such 
training, and what process or procedures are in 
place for continuing education of such examiners; 
(8) the dedicated Federal and State funding to 
support SAFE or SANE training; and 
(9) funding opportunities for SANE or SAFE 
training and continuing education. 
(c) ELIGIBILITY.—To be eligible to receive a grant 
under this section, a State shall— 
(1) have public, private, or nonprofit hospitals 
that receive Federal funding; and 
(2) submit to the Secretary an application 
through a competitive process to be determined by 
the Secretary. 
(d) PUBLIC DISSEMINATION AND CAMPAIGN.— 
(1) PUBLIC AVAILABILITY.—The results of the 
surveys conducted under grants awarded under this 
section shall be published by the Secretary on the 
VerDate Sep 11 2014 
21:30 Jul 17, 2018
Jkt 079200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H6387.IH
H6387
sradovich on DSK3GMQ082PROD with BILLS
website of the Department of Health and Human 
Services on a biennial basis. 
(2) CAMPAIGNS.—A State that receives a grant 
under this section shall carry out the following: 
(A) Make the findings of the survey con-
ducted under the grant public. 
(B) Use the findings to develop a strategic 
action plan to increase the number of trained 
examiners available in the State and create poli-
cies to increase survivor access to trained exam-
iners. 
(C) Use the findings to develop and imple-
ment a public awareness campaign that in-
cludes the following: 
(i) An online toolkit describing how 
and where sexual assault survivors can ob-
tain assistance and care, including MFEs, 
in the State. 
(ii) A Model Standard Response Pro-
tocol for healthcare providers to implement 
upon arrival of a patient seeking care for 
sexual assault. 
(iii) A Model Sexual Assault Response 
Team Protocol incorporating interdiscipli-
nary community coordination between hos-
VerDate Sep 11 2014 
21:30 Jul 17, 2018
Jkt 079200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H6387.IH
H6387
sradovich on DSK3GMQ082PROD with BILLS
(1) IN GENERAL.—Not later than 1 year after 
the date of enactment of this Act, the Secretary 
shall establish a National Continuing and Clinical 
Education Pilot Program for SAFEs, SANEs, and 
other individuals who perform such examinations in 
consultation with the Department of Justice, the 
Centers for Medicare & Medicaid Services, the Cen-
ters for Disease Control and Prevention, the Health 
Resources and Services Administration, the Indian 
Health Service, the Office for Victims of Crime of 
the Department of Justice, the Office on Violence 
Against Women of the Department of Justice, and 
the Office on Women’s Health of the Department of 
Health and Human Services and with input from re-
gional and national organizations with expertise in 
forensic nursing, rape trauma or crisis counseling, 
investigating rape and gender violence cases, sur-
vivors’ advocacy and support, sexual assault preven-
tion education, rural health, and responding to sex-
ual violence in Native communities. Such pilot pro-
gram shall be 2 years in duration. 
(2) FUNCTIONS.—The pilot program estab-
lished under paragraph (1) shall develop, pilot, im-
plement, and update, as appropriate, continuing and 
clinical education program modules, webinars, and 
VerDate Sep 11 2014 
21:30 Jul 17, 2018
Jkt 079200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H6387.IH
H6387
sradovich on DSK3GMQ082PROD with BILLS
programs for all hospitals and providers to increase 
access to SANE and SAFE services and address on-
going competency issues in SAFE or SANE practice 
of care, including— 
(A) training and continuing education to 
help support SAFEs or SANEs practicing in 
rural or underserved areas; 
(B) training to help connect sexual assault 
survivors who are Native American with SAFEs 
or SANEs, including through emergency first 
aid, referrals, culturally competent support, and 
forensic evidence collection in rural commu-
nities; 
(C) replication of successful SANE or 
SAFE programs to help develop and improve 
the evidence base for MFEs; and 
(D) training to increase the number of 
medical 
professionals 
who 
are 
considered 
SAFEs or SANEs based on the recommenda-
tions of the National Sexual Assault Forensic 
Examination Training Standards issued by the 
Department of Justice on Violence Against 
Women. 
(3) ELIGIBILITY
TO
PARTICIPATE
IN
PILOT 
PROGRAMS.—The Secretary shall ensure that SAFE 
VerDate Sep 11 2014 
21:30 Jul 17, 2018
Jkt 079200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H6387.IH
H6387
sradovich on DSK3GMQ082PROD with BILLS
or SANE services provided under the pilot program 
established under paragraph (1), and other medical 
forensic examiner services under the pilot program 
shall be provided by healthcare providers who are 
also one of the following: 
(A) A physician, including a resident phy-
sician. 
(B) A nurse practitioner. 
(C) A nurse midwife. 
(D) A physician assistant. 
(E) A certified nurse specialist. 
(F) A registered nurse. 
(G) A community health practitioner or a 
community health aide who has completed level 
III or level IV certification and training re-
quirements. 
(4) NATURE
OF
TRAINING.—The continuing 
education program established under this section 
shall incorporate and reflect current best practices 
and standards on MFEs consistent with the purpose 
of this section. 
(c) AVAILABILITY.—After termination of the pilot 
program established under subsection (b)(1), the training 
and continuing education program established under such 
program shall be available to all SAFEs, SANEs, and 
VerDate Sep 11 2014 
21:30 Jul 17, 2018
Jkt 079200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H6387.IH
H6387
sradovich on DSK3GMQ082PROD with BILLS
other providers employed by, or any individual providing 
services through, facilities that receive Federal funding. 
The Task Force established under section 201 shall review 
and recommend updates to the training and continuing 
education program after the termination of the pilot pro-
gram. 
(d) EFFECTIVE DATE.— 
(1) IN
GENERAL.—The pilot program estab-
lished under this section shall terminate on the date 
that is 2 years after the date of such establishment. 
(2) AUTHORITY
FOR
MODIFICATIONS.—Upon 
termination of the pilot program as provided for in 
paragraph (1), the Secretary or the Task Force es-
tablished under section 201 may implement modi-
fications relating to training and continuing edu-
cation requirements based on such program to in-
crease access to SANE and SAFE services for sur-
vivors of sexual assault. 
(e) AUTHORIZATION.—There are authorized to be ap-
propriated to carry out this section $5,000,000 for each 
of fiscal years 2019 through 2021. 
SEC. 103. NATIONAL REPORT ON SEXUAL ASSAULT SERV-
ICES IN OUR NATION’S HEALTH SYSTEM. 
(a) IN GENERAL.—Not later than 1 year after the 
date of enactment of this Act, and annually thereafter, 
VerDate Sep 11 2014 
21:30 Jul 17, 2018
Jkt 079200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6201
E:\BILLS\H6387.IH
H6387
sradovich on DSK3GMQ082PROD with BILLS
the Agency for Healthcare Research and Quality, in con-
sultation with the Centers for Medicare & Medicaid Serv-
ices, the Centers for Disease Control and Prevention, the 
Health Resources and Services Administration, the Indian 
Health Service, the Office for Victims of Crime of the De-
partment of Justice, the Office on Women’s Health of the 
Department of Health and Human Services, and the Of-
fice of Violence Against Women of the Department of Jus-
tice (hereafter referred to in this section collectively as the 
‘‘Agencies’’), shall submit to the Secretary a report of ex-
isting Federal and State practices relating to SAFEs, 
SANEs, and others who perform such examinations which 
reflects the findings of the surveys developed under section 
101. 
(b) CORE COMPETENCIES.—In conducting activities 
under this section, the Agencies shall address SAFE or 
SANE competencies, including— 
(1) providing comprehensive medical care to 
sexual assault patients; 
(2) demonstrating the ability to conduct a MFE 
to include an evaluation for evidence collection; 
(3) showing compassion and sensitivity towards 
survivors of sexual assault; 
(4) testifying in Federal, State, local, and tribal 
courts; and 
VerDate Sep 11 2014 
21:30 Jul 17, 2018
Jkt 079200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6201
E:\BILLS\H6387.IH
H6387
sradovich on DSK3GMQ082PROD with BILLS