I 
116TH CONGRESS 
1ST SESSION 
H. R. 973 
To amend the Public Health Service Act to provide for additional programs 
funded by grants to strengthen the healthcare system’s response to 
domestic violence, dating violence, sexual assault, and stalking, and for 
other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 5, 2019 
Mrs. DINGELL (for herself, Mr. KATKO, Ms. CLARKE of New York, Ms. CAS-
TOR of Florida, Mrs. RODGERS of Washington, Ms. ESHOO, Ms. 
STEFANIK, Ms. ROYBAL-ALLARD, Mr. CA´RDENAS, Ms. WILSON of Flor-
ida, Miss GONZA´LEZ-COLO´N of Puerto Rico, and Mr. MARSHALL) intro-
duced the following bill; which was referred to the Committee on Energy 
and Commerce 
A BILL 
To amend the Public Health Service Act to provide for 
additional programs funded by grants to strengthen the 
healthcare system’s response to domestic violence, dating 
violence, sexual assault, and stalking, and for other pur-
poses. 
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 ‘‘Violence Against 
Women Health Act of 2019’’. 
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SEC. 2. FINDINGS. 
Congress finds that— 
(1) millions of Americans continue to experience 
domestic or sexual violence each year with more 
than three women murdered by their partners each 
day; 
(2) this type of violence and abuse results in 
short-term and chronic physical and behavioral 
health consequences that have a significant economic 
burden to victims and communities; 
(3) new CDC data found the lifetime per-victim 
cost of intimate partner violence was $103,767 for 
women victims with 59 percent going to medical 
costs and public funding paid 37 percent of this 
total cost; 
(4) victims are also at a higher risk for devel-
oping addictions to tobacco, alcohol, or drugs; for ex-
ample, 31 percent to 67 percent of women in sub-
stance use disorder treatment programs report expe-
riencing domestic violence within the past year; 
(5) over 50 percent of survivors of domestic vio-
lence have experienced depression, post-traumatic 
stress disorder, and substance use and 23 percent 
have experienced suicidality; 
(6) a study conducted by the National Domestic 
Violence Hotline, in conjunction with the National 
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Center on Domestic Violence, Trauma & Mental 
Health practice mental health and substance use co-
ercion where abusers intentionally undermine their 
partners’ sanity or sobriety, control their access to 
medication, and sabotage their treatment and recov-
ery efforts among other coercion tactics; 
(7) researchers have also found that exposure 
to multiple childhood traumas such as sexual abuse 
and domestic violence can cause long-term negative 
physical and emotional health outcomes such as 
heart disease, cancer and depression; 
(8) health care providers can identify survivors 
of violence and interventions can decrease risk for 
violence and improve health outcomes, but health 
providers need training and systems level support in 
order to do so; 
(9) Congress authorized a public health re-
sponse to victims of domestic and sexual violence in 
the Violence Against Women Act of 2005; 
(10) since its enactment, the VAWA Health 
program has trained more than 13,000 health care 
providers to assess for and respond to domestic and 
sexual violence in over 230 clinical settings serving 
more than 1.3 million patients; 
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(11) last year, the Health Resources & Services 
Administration made this issue a priority across all 
of its bureaus and released the ‘‘HRSA Strategy to 
Address Intimate Partner Violence 2017–2020’’ with 
four key priorities: 
(A) Train the Nation’s health care and 
public health workforce to address intimate 
partner violence (IPV) at the community and 
health systems levels. 
(B) Develop partnerships to raise aware-
ness about IPV within HRSA and HHS. 
(C) Increase access to quality IPV-in-
formed health care services across all popu-
lations. 
(D) Address gaps in knowledge about IPV 
risks, impacts, and interventions.; and 
(12) a strong public health response can pre-
vent and address the immediate and long-term 
health impacts of this type of violence and abuse. 
SEC. 3. GRANTS TO STRENGTHEN THE HEALTH CARE SYS-
TEM’S RESPONSE TO DOMESTIC VIOLENCE, 
DATING VIOLENCE, SEXUAL ASSAULT, AND 
STALKING, AND FOR OTHER PURPOSES. 
Section 399P of the Public Health Service Act (42 
U.S.C. 280g–4) is amended— 
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(1) in subsection (a)— 
(A) in paragraph (2), by striking ‘‘and’’ at 
the end; 
(B) in paragraph (3), by striking the pe-
riod at the end and inserting ‘‘; and’’; and 
(C) by adding at the end the following: 
‘‘(4) development or enhancement and imple-
mentation of training programs to improve the ca-
pacity of early childhood programs to address do-
mestic violence, dating violence, sexual assault, and 
stalking among families they serve.’’; 
(2) in subsection (b)— 
(A) in paragraph (1)— 
(i) in subparagraph (A)(ii), by insert-
ing after ‘‘and other forms of violence and 
abuse’’ the following: ‘‘(including labor and 
sex trafficking)’’; and 
(ii) in subparagraph (B)— 
(I) in clause (ii)— 
(aa) by striking ‘‘on-site ac-
cess to’’; and 
(bb) by striking ‘‘or to 
model other services appropriate 
to the geographic and cultural 
needs of a site’’ and inserting the 
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following: ‘‘or by providing fund-
ing to national, State, Tribal, or 
territorial domestic and sexual vi-
olence coalitions to improve their 
capacity to coordinate and sup-
port health advocates and health 
system partnerships’’; 
(II) in clause (iii), by striking 
‘‘and’’ at the end; 
(III) in clause (iv), by striking 
the period at the end and inserting ‘‘, 
with priority given to programs ad-
ministered through the Health Re-
sources and Services Administration, 
Office of Women’s Health; and’’; and 
(IV) by adding at the end the fol-
lowing: 
‘‘(v) the development, dissemination, 
and evaluation of best practices, tools and 
training materials for behavioral health 
professionals to identify and respond to do-
mestic violence, sexual violence, stalking, 
and dating violence.’’; and 
(B) in paragraph (2)— 
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(i) in subparagraph (A), to read as 
follows: 
‘‘(A) CHILD ABUSE AND ABUSE IN LATER 
LIFE.—To the extent consistent with the pur-
pose of this section, a grantee may address, as 
part of a comprehensive programmatic ap-
proach implemented under a grant under this 
section, issues relating to child abuse or abuse 
in later life.’’; and 
(ii) in subparagraph (C)— 
(I) in clause (i), by striking 
‘‘elder abuse’’ and inserting ‘‘abuse in 
later life’’; 
(II) in clause (iv)— 
(aa) by inserting ‘‘, mental 
health’’ after ‘‘dental’’; 
(bb) by inserting ‘‘and cer-
tification’’ after ‘‘exams’’; and 
(cc) by striking the period at 
the end and inserting ‘‘; and’’; 
and 
(III) by adding at the end the 
following: 
‘‘(v) development of a state-level pilot 
program to improve the response of sub-
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(ii) by striking ‘‘mental health care’’ 
and inserting ‘‘behavioral health care’’; 
(4) in subsection (f), to read as follows: 
‘‘(f) RESEARCH, AND EVALUATION, AND DATA COL-
LECTION.— 
‘‘(1) IN GENERAL.—Of the funds made avail-
able to carry out this section for any fiscal year, the 
Secretary may use not more than 20 percent to 
make a grant or enter into a contract for research, 
and evaluation, or data collection of— 
‘‘(A) grants awarded under this section; 
and 
‘‘(B) other training for health professionals 
and effective interventions in the health care or 
behavioral health setting that prevent domestic 
violence, dating violence, and sexual assault 
across the lifespan, prevent the health effects of 
such violence, and improve the safety and 
health of individuals who are currently being 
victimized. 
‘‘(2) RESEARCH AND DATA COLLECTION.—Re-
search or data collection authorized in paragraph (1) 
may include— 
‘‘(A) research on the effects of domestic vi-
olence, dating violence, sexual assault, and 
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childhood exposure to domestic, dating or sex-
ual violence on health behaviors, health condi-
tions, and health status of individuals, families, 
and populations, including underserved popu-
lations; 
‘‘(B) research to determine effective health 
care interventions to respond to and prevent do-
mestic violence, dating violence, sexual assault, 
and stalking; 
‘‘(C) research on the impact of domestic, 
dating and sexual violence, childhood exposure 
to such violence, and stalking on the health care 
system, health care utilization, health care 
costs, and health status; 
‘‘(D) research on the impact of adverse 
childhood experiences on adult experience with 
domestic violence, dating violence, sexual as-
sault, stalking and adult health outcomes, in-
cluding how to reduce or prevent the impact of 
adverse childhood experiences through the 
health care setting; 
‘‘(E) research on the intersection of sub-
stance use disorder and domestic violence, dat-
ing violence, sexual assault, and stalking, in-
cluding effect of coerced use and efforts by an 
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abusive partner or other to interfere with sub-
stance use disorder treatment and recovery; and 
‘‘(F) improved data collection using exist-
ing federal surveys by including questions about 
domestic violence, dating violence, sexual as-
sault, or stalking and substance use disorder, 
coerced use, and mental health.’’; and 
(5) in subsection (g), by striking ‘‘2014 through 
2018’’ and inserting ‘‘2019 through 2023’’. 
Æ 
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