rensic medical exam to which the provisions of sub-
section (a) would apply but for application of para-
graph (1) and such plan or issuer denies such claim 
or imposes cost sharing on such claim, such plan or 
issuer shall— 
‘‘(A) at the time of such denial or imposi-
tion, notify the individual with respect to whom 
such exam was furnished of the manner in 
which such individual may seek reimbursement 
for such exam (or for the amount of such cost 
sharing so imposed, as applicable) from the 
State in which such exam was furnished; and 
‘‘(B) after receiving authorization from 
such individual, notify the appropriate State 
agency of the State in which such exam was 
furnished of such claim. 
‘‘(c) APPLICATION
OF SURPRISE BILLING PROVI-
SIONS.— 
‘‘(1) IN GENERAL.—The provisions of sections 
2799A–1 and 2799B–1 of the Public Health Service 
Act, 716, and 9816 of the Internal Revenue Code of 
1986 shall apply to a forensic medical exam for 
which a group health plan or health insurance issuer 
offering group health insurance coverage is respon-
sible for providing coverage at no cost sharing under 
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this section furnished to a participant or beneficiary 
of such plan or group health insurance coverage by 
a provider that does not have in effect a contractual 
relationship described in subsection (a) with such 
plan or coverage (as applicable) for furnishing such 
exam as if such exam was an emergency services 
furnished by a nonparticipating provider in an emer-
gency department of a hospital. 
‘‘(2) DEFINITIONS.—In this subsection, the 
terms ‘emergency service’ and ‘nonparticipating pro-
vider’ have the meanings given such terms in sub-
paragraphs (C)(i) and (G), respectively, of sections 
2799A–1(a)(3) of the Public Health Service Act, 
716(a)(3), and section 9816(a)(3) of the Internal 
Revenue Code of 1986. 
‘‘(d) DEFINITION.—For purposes of this section, the 
term ‘forensic medical exam’ means, with respect to an 
individual— 
‘‘(1) an examination for physical trauma; 
‘‘(2) a determination of penetration or force; 
‘‘(3) an interview of such individual; and 
‘‘(4) the collection and evaluation of evidence 
from such individual.’’. 
(2) TECHNICAL
AMENDMENT.—The table of 
contents in section 1 of such Act is amended by in-
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serting after the item relating to section 725 the fol-
lowing new item: 
‘‘Sec. 726. Required coverage of forensic medical exams with no cost sharing.’’. 
(c) IRC.— 
(1) IN
GENERAL.—Subchapter B of chapter 
100 of the Internal Revenue Code of 1986 is amend-
ed— 
(A) in section 9816(a)(3)(C)(ii), by insert-
ing ‘‘forensic medical exams (as defined in sec-
tion 9826(d)) furnished on or after January 1, 
2025 and’’ after ‘‘shall include’’; and 
(B) by adding at the end the following new 
section: 
‘‘SEC. 9826. REQUIRED COVERAGE OF FORENSIC MEDICAL 
EXAMS WITH NO COST SHARING. 
‘‘(a) IN GENERAL.—Except as provided in subsection 
(b), a group health plan shall provide coverage for and 
shall not impose any cost sharing requirements for a fo-
rensic medical exam (as defined in subsection (d)) fur-
nished by a sexual assault forensic examiner (as defined 
for purposes of section 304 of the DNA Sexual Assault 
Justice Act of 2004), a sexual assault nurse examiner (as 
so defined), or any other provider specified by the Sec-
retary, regardless of whether such forensic examiner, 
nurse examiner, or other provider has in effect a contrac-
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tual relationship with such plan for the furnishing of such 
exam or item or service. 
‘‘(b) NONAPPLICATION TO CERTAIN FORENSIC MED-
ICAL EXAMS OTHERWISE COVERED.— 
‘‘(1) IN
GENERAL.—The provisions of sub-
section (a) shall not apply with respect to a forensic 
medical exam furnished in a State for which such 
State is responsible for incurring the full out-of- 
pocket costs under section 2010 of the Omnibus 
Crime Control and Safe Streets Act of 1968. 
‘‘(2) NOTIFICATION.—In the case that a group 
health plan receives a claim for a forensic medical 
exam to which the provisions of subsection (a) would 
apply but for application of paragraph (1) and such 
plan denies such claim or imposes cost sharing on 
such claim, such plan shall— 
‘‘(A) at the time of such denial or imposi-
tion, notify the individual with respect to whom 
such exam was furnished of the manner in 
which such individual may seek reimbursement 
for such exam (or for the amount of such cost 
sharing so imposed, as applicable) from the 
State in which such exam was furnished; and 
‘‘(B) after receiving authorization from 
such individual, notify the appropriate State 
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agency of the State in which such exam was 
furnished of such claim. 
‘‘(c) APPLICATION
OF SURPRISE BILLING PROVI-
SIONS.— 
‘‘(1) IN GENERAL.—The provisions of sections 
2799A–1 and 2799B–1 of the Public Health Service 
Act, 716 of the Employee Retirement Income Secu-
rity Act of 1974, and 9816 shall apply to a forensic 
medical exam for which a group health plan is re-
sponsible for providing coverage at no cost sharing 
under this section furnished to an enrollee, partici-
pant, or beneficiary of such plan by a provider that 
does not have in effect a contractual relationship de-
scribed in subsection (a) with such plan for fur-
nishing such exam as if such exam was an emer-
gency service furnished by a nonparticipating pro-
vider in an emergency department of a hospital. 
‘‘(2) DEFINITIONS.—In this subsection, the 
terms ‘emergency service’ and ‘nonparticipating pro-
vider’ have the meanings given such terms in sub-
paragraphs (C)(i) and (G), respectively, of sections 
2799A–1(a)(3) of the Public Health Service Act, 
716(a)(3) of the Employee Retirement Income Secu-
rity Act of 1974, and section 9816(a)(3). 
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