H. R. 2471—820 
(B) in paragraph (4)(C), by inserting after ‘‘sex,’’ the 
following: ‘‘sexual orientation, gender identity,’’; and 
(5) in subsection (e), by striking ‘‘$12,000,000 for each 
of fiscal years 2014 through 2018’’ and inserting ‘‘$15,000,000 
for each of fiscal years 2023 through 2027, of which not less 
than 10 percent shall be made available for grants to histori-
cally Black colleges and universities’’. 
(b) 
REPORT
ON
BEST
PRACTICES
REGARDING
DOMESTIC 
VIOLENCE, DATING VIOLENCE, SEXUAL ASSAULT, AND STALKING ON 
CAMPUSES.—Not later than 1 year after the date of enactment 
of this Act, the Secretary of Education shall submit to Congress 
a report, which shall include— 
(1) an evaluation of programs, events, and educational 
materials related to domestic violence, dating violence, sexual 
assault, and stalking; and 
(2) an assessment of best practices and guidance from 
the evaluation described in paragraph (1), which shall be made 
publicly available online to universities and college campuses 
to use as a resource. 
SEC. 304. STUDY ON STATE COVERAGE OF FORENSIC EXAMINATIONS 
AND RELATED COSTS FOLLOWING A SEXUAL ASSAULT. 
Not later than 270 days after the date of enactment of this 
Act, the Comptroller General of the United States shall issue a 
report to Congress on requirements and funding of States for 
forensic exams conducted after sexual assaults and any related 
medical expenses, as applicable, which shall include, with respect 
to each State— 
(1) the total annual cost of conducting forensic exams 
described in section 2010(b) of part T of title I of the Omnibus 
Crime Control and Safe Streets Act of 1968 (34 U.S.C. 
10449(b)); 
(2) each funding source used to pay for the forensic exams 
described in section 2010(b) of part T of title I of the Omnibus 
Crime Control and Safe Streets Act of 1968 (34 U.S.C. 
10449(b)); 
(3) a description of any laws or policies of the State to 
ensure that individuals do not receive bills for all or part 
of the cost of forensic exams conducted after sexual assaults, 
consistent with section 2010(b) of part T of title I of the Omni-
bus Crime Control and Safe Streets Act of 1968 (34 U.S.C. 
10449(b)), including any oversight to ensure those individuals 
do not receive bills; 
(4) an identification of any best practices implemented 
by the State to ensure that individuals do not receive bills 
for forensic exams conducted after sexual assaults; 
(5) any requirements under laws of the State relating to 
payment for medical expenses and ancillary costs relating to 
a sexual assault, which may include treatment of injuries asso-
ciated with the assault, imaging (including x-rays, MRIs, and 
CAT scans), and other emergency medical care required as 
a result of the sexual assault for which a victim receives a 
forensic exam; and 
(6) if a law of the State requires the State to pay for 
the medical expenses described in paragraph (5)— 
(A) a detailed list of which medical expenses require 
coverage;
H. R. 2471—821 
(B) the total annual cost of medical expenses relating 
to a sexual assault for which a victim receives a forensic 
exam outside of the cost of the forensic exam; and 
(C) each funding source the State uses to pay for 
medical expenses relating to a sexual assault for which 
a victim receives a forensic exam. 
TITLE IV—VIOLENCE REDUCTION 
PRACTICES 
SEC. 401. STUDY CONDUCTED BY THE CENTERS FOR DISEASE CON-
TROL AND PREVENTION. 
Section 402 of the Violence Against Women and Department 
of Justice Reauthorization Act of 2005 (42 U.S.C. 280b–4) is 
amended— 
(1) in subsection (b), by striking ‘‘violence against women’’ 
and inserting ‘‘violence against adults, youth,’’; and 
(2) in subsection (c), by striking ‘‘the fiscal years 2014 
through 2018’’ and inserting ‘‘fiscal years 2023 through 2027’’. 
SEC. 402. SAVING MONEY AND REDUCING TRAGEDIES THROUGH 
PREVENTION (SMART PREVENTION) GRANTS. 
Section 41303 of the Violence Against Women Act of 1994 
(34 U.S.C. 12463) is amended— 
(1) in subsection (a), by striking ‘‘taking a comprehensive 
approach that focuses on youth, children exposed to violence, 
and men’’ and inserting ‘‘focusing on men and youth’’; 
(2) in subsection (b)— 
(A) by striking ‘‘for the following purposes:’’ and all 
that follows through ‘‘(3) ENGAGING MEN AS LEADERS AND 
MODELS.—To develop’’ and inserting ‘‘to develop’’; and 
(B) by inserting ‘‘and youth’’ after ‘‘men’’ the first 2 
times it appears; 
(3) in subsection (d)(3)— 
(A) in subparagraph (A), by striking ‘‘and’’ at the end; 
(B) in subparagraph (B), by striking the period at 
the end and inserting ‘‘; and’’; and 
(C) by adding at the end the following: 
‘‘(C) include a focus on the unmet needs of underserved 
populations.’’; 
(4) in subsection (f), by striking ‘‘$15,000,000 for each of 
fiscal years 2014 through 2018’’ and inserting ‘‘$20,000,000 
for each of fiscal years 2023 through 2027’’; and 
(5) by striking subsection (g). 
TITLE V—STRENGTHENING THE 
HEALTH CARE SYSTEM’S RESPONSE 
SEC. 501. GRANTS TO STRENGTHEN THE HEALTH CARE SYSTEM’S 
RESPONSE TO DOMESTIC VIOLENCE, DATING VIOLENCE, 
SEXUAL ASSAULT, AND STALKING. 
Section 399P of the Public Health Service Act (42 U.S.C. 280g– 
4) is amended— 
(1) in subsection (a)—
H. R. 2471—822 
(A) in paragraph (1), by inserting ‘‘community health 
workers, violence prevention advocates working with health 
providers,’’ after ‘‘health staff,’’; 
(B) in paragraph (2), by striking ‘‘for medical’’ and 
all that follows through ‘‘stalking; and’’ and inserting ‘‘for 
medical, psychology, dental, social work, nursing, and other 
health profession students, interns, residents, fellows, or 
current health care providers (including midwives and 
doulas);’’; and 
(C) in paragraph (3)— 
(i) by striking ‘‘response’’ and inserting ‘‘capacity’’; 
(ii) by inserting ‘‘prevent and respond to’’ after 
‘‘(including behavioral and mental health programs) 
to’’; and 
(iii) by striking the period at the end and inserting 
a semicolon; and 
(D) by adding at the end the following: 
‘‘(4) the development or enhancement and implementation 
of training programs to improve the capacity of early childhood 
programs to address domestic violence, dating violence, sexual 
assault, and stalking among families they serve; and 
‘‘(5) the development or enhancement and implementation 
of comprehensive statewide strategies for health and violence 
prevention programs to work together to promote primary 
prevention of domestic violence, dating violence, sexual assault, 
and stalking.’’; 
(2) in subsection (b)(1)— 
(A) in subparagraph (A)(i)— 
(i) by striking ‘‘to identify and provide’’ and 
inserting ‘‘to provide universal education on healthy 
relationships and provide trauma-informed’’; and 
(ii) by striking ‘‘and’’ at the end; 
(B) in subparagraph (A)(ii)— 
(i) by striking ‘‘culturally competent clinical 
training components’’ and inserting ‘‘training compo-
nents that center the experiences of, and are developed 
in collaboration with, culturally specific individuals and 
American Indians and Alaska Natives, and include 
community-defined practices such as the use of doulas, 
midwives, and traditional healers,’’; 
(ii) by inserting ‘‘(including labor and sex traf-
ficking)’’ after ‘‘other forms of violence and abuse’’; 
and 
(iii) by striking ‘‘disparities’’ and inserting ‘‘inequi-
ties’’; 
(C) in subparagraph (A), by inserting after clause (ii) 
the following: 
‘‘(iii) are designed to be inclusive of the experiences 
of all individuals, including LGBT individuals, and 
include training on improving equity and reducing 
disparities in access to health care services and preven-
tion resources; and 
‘‘(iv) include training on the use of a universal 
prevention education approach to both prevent and 
respond to domestic violence, dating violence, sexual 
assault, or stalking in health care settings;’’;
H. R. 2471—823 
(D) in subparagraph (B), in the matter preceding clause 
(i), by striking ‘‘response of the health care system’’ and 
inserting ‘‘capacity of the health care system to prevent 
and respond’’; 
(E) in subparagraph (B)(i)— 
(i) by striking ‘‘identifying and responding to’’ 
inserting ‘‘identifying, responding to, and promoting 
prevention of’’; 
(ii) by inserting ‘‘during in-person or virtual visits’’ 
after ‘‘and stalking’’; and 
(iii) by inserting ‘‘and to maximize victim choice 
on the use and sharing of their health information’’ 
before the semicolon at the end; 
(F) in subparagraph (B)(ii)— 
(i) by striking ‘‘on-site access to’’ and all that fol-
lows through the semicolon at the end and inserting 
the following: ‘‘services to address the safety, medical, 
and mental health needs of patients by— 
‘‘(I) increasing the capacity of existing health 
care professionals (including professionals who 
specialize in trauma or in substance use disorders) 
in behavioral and mental health care, community 
health workers, and public health staff to address 
domestic violence, dating violence, sexual assault, 
stalking, and children exposed to violence; 
‘‘(II) contracting with or hiring advocates for 
victims of domestic violence or sexual assault to 
provide such services; or 
‘‘(III) providing funding to State domestic and 
sexual violence coalitions to improve the capacity 
of such coalitions to coordinate and support health 
advocates and other health system partnerships;’’; 
(G) in subparagraph (B)(iii)— 
(i) by striking ‘‘of identification’’ and inserting ‘‘of 
prevention’’; 
(ii) by inserting ‘‘during in-person or virtual visits’’ 
after ‘‘and stalking’’; and 
(iii) by striking ‘‘and’’ at the end; 
(H) in subparagraph (B)(iv)— 
(i) by inserting ‘‘and promote prevention during 
in-person or virtual visits,’’ after ‘‘or stalking,’’; and 
(ii) by striking the period at the end and inserting 
a semicolon; 
(I) in subparagraph (B), by adding at the end the 
following: 
‘‘(v) the development, implementation, dissemina-
tion, and evaluation of best practices, tools, and 
training materials, including culturally relevant tools, 
for mental health, behavioral health, and substance 
use disorder professionals to identify and respond to 
domestic violence, sexual violence, stalking, and dating 
violence; and 
‘‘(vi) the development and provision of culturally 
relevant training and follow-up technical assistance 
to health care professionals, and public health staff, 
and allied health professionals to identify, assess, treat, 
and refer clients who are victims of domestic violence,
H. R. 2471—824 
dating violence, sexual assault, or stalking from cul-
turally specific communities and promote prevention, 
using tools and training materials, developed by and 
for culturally specific communities, with priority given 
to trainings provided by culturally specific organiza-
tions; and’’; and 
(J) by inserting after subparagraph (B) the following: 
‘‘(C) design and implement comprehensive strategies 
to prevent domestic or sexual violence including through 
the use of universal education in clinical and public health 
settings, hospitals, clinics and other health settings.’’; 
(3) in subsection (b)(2)(A)— 
(A) in the subparagraph heading, by striking ‘‘CHILD 
AND ELDER ABUSE’’ and inserting ‘‘CHILD ABUSE AND ABUSE 
IN LATER LIFE’’; and 
(B) by striking ‘‘child or elder abuse’’ and inserting 
‘‘child abuse or abuse in later life’’; 
(4) in subsection (b)(2)(C)(i), by striking ‘‘elder abuse’’ and 
inserting ‘‘abuse in later life’’; 
(5) in subsection (b)(2)(C)(ii), by inserting ‘‘programs that 
promote the prevention of sexual assault as well as’’ after 
‘‘implementation of’’; 
(6) in subsection (b)(2)(C)(iii)— 
(A) by inserting ‘‘and exposure to violence across 
generations’’ after ‘‘abuse’’; and 
(B) by striking ‘‘or’’ at the end; 
(7) in subsection (b)(2)(C)(iv)— 
(A) by inserting ‘‘mental health,’’ after ‘‘dental,’’; and 
(B) by striking ‘‘exams.’’ and inserting ‘‘exams and 
certifications;’’; 
(8) in subsection (b)(2)(C), by inserting after clause (iv) 
the following: 
‘‘(v) providing funding to culturally specific 
organizations to improve the capacity of such organiza-
tions to engage and partner with health care providers 
to support victims and meet increased referrals from 
health systems; 
‘‘(vi) developing a State-level pilot program to— 
‘‘(I) improve the response of substance use dis-
order treatment programs, harm reduction pro-
grams for people who use substances, and systems 
to domestic violence, dating violence, sexual 
assault, and stalking; 
‘‘(II) improve the capacity of substance use 
disorder treatment programs, harm reduction pro-
grams for people who use substances, and systems 
to serve survivors of domestic violence, dating 
violence, sexual assault, and stalking dealing with 
substance use disorder; and 
‘‘(III) 
improve 
the 
capacity 
of 
domestic 
violence, dating violence, sexual assault, and 
stalking programs to serve survivors who have 
substance use history; or 
‘‘(vii) developing and utilizing existing technical 
assistance and training resources to improve the 
capacity of substance use disorder treatment programs
H. R. 2471—826 
(A) 
by 
striking 
‘‘$10,000,000’’ 
and 
inserting 
‘‘$20,000,000’’; and 
(B) by striking ‘‘2014 through 2018’’ and inserting 
‘‘2023 through 2027’’; and 
(17) in subsection (h)— 
(A) by striking ‘‘herein’’; and 
(B) by striking ‘‘provided for’’. 
SEC. 502. MATERNAL MORTALITY OR MORBIDITY STUDY. 
(a) STUDY.—The Secretary of Health and Human Services, 
acting through the Director of the Centers for Disease Control 
and Prevention and in consultation with the Attorney General, 
the Director of the Indian Health Service, and other stakeholders 
(including community based organizations), shall conduct a study 
on the leading causes of pregnancy-associated morbidity and mor-
tality and the extent which domestic violence, dating violence, 
sexual assault, or stalking throughout the United States contribute 
to the risk of maternal mortality or morbidity. 
(b) REPORTS.—Not later than 3 years after the date of enact-
ment of this Act, the Secretary of Health and Human Services, 
in consultation with the Attorney General, the Director of the 
Indian Health Service, and other stakeholders (including community 
based organizations), shall report to Congress on the study con-
ducted under subsection (a), which shall include the following: 
(1) An analysis of the extent to which domestic violence, 
dating violence, sexual assault, or stalking contribute to preg-
nancy-associated morbidity and mortality. 
(2) An analysis of the impact of domestic violence, dating 
violence, sexual assault, or stalking on access to health care. 
(3) A breakdown of individuals particularly impacted by 
domestic violence, dating violence, sexual assault, or stalking, 
by race and ethnicity, disability status, and sexual orientation 
and gender identity. 
(4) An analysis of the impact of domestic violence, dating 
violence, sexual assault, or stalking on Tribal communities 
and among Indians. 
(5) An assessment of the factors that increase risks for 
infant and maternal mortality or morbidity among victims of 
domestic violence, dating violence, sexual assault, or stalking. 
(6) Recommendations for legislative or policy changes to 
help reduce infant and maternal mortality rates. 
(7) Best practices to reduce pregnancy-related deaths 
among survivors of domestic violence, dating violence, sexual 
assault, or stalking. 
(8) Any other information on maternal mortality or mor-
bidity the Secretary determines appropriate to include in the 
report. 
SEC. 503. UNDERSTANDING SEXUAL ASSAULT CARE IN HEALTH SYS-
TEMS. 
(a) PURPOSE.—It is the purpose of this section to identify areas 
for improvement in health care delivery systems providing forensic 
examinations to survivors of sexual assault. 
(b) GRANTS.—The Secretary of Health and Human Services 
(referred to in this section as ‘‘the Secretary’’) shall award grants 
to States and Indian Tribes to develop and implement State and 
Tribal surveys to identify—
H. R. 2471—827 
(1) the availability of, and patient access to, medical 
forensic examinations; 
(2) the training level of the health care providers who 
perform medical forensic examinations; 
(3) the hospitals or clinics that offer medical forensic 
examinations and whether each hospital or clinic has full- 
time, part-time, or on-call coverage; 
(4) barriers to medical forensic examinations provided 
through sexual assault care and services; 
(5) billing and reimbursement practices for medical forensic 
examinations; 
(6) State and Tribal requirements, minimum standards, 
and protocols for training sexual assault examiners for sexual 
assault forensic examiners and for other personnel involved 
in medical forensic examinations; 
(7) the availability of sexual assault forensic examiner 
training, the frequency of such training, the providers of such 
training, the State’s or Indian Tribe’s role in such training, 
and the processes or procedures in place for continuing edu-
cation of such examiners; and 
(8) the dedicated Federal and State funding available to 
support sexual assault forensic examiner training. 
(c) ELIGIBILITY.—To be eligible to receive a grant under this 
section, a State or Indian Tribe shall 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 con-
ducted under grants awarded under this section shall be pub-
lished by the Secretary on the website of the Department 
of Health and Human Services on a biennial basis. 
(2) CAMPAIGNS.—A State or Indian Tribe that receives a 
grant under this section shall carry out the following activities: 
(A) Make the findings of the survey conducted using 
amounts received under the grant public, including a map 
showing health care providers who perform medical forensic 
examinations, based on the findings from the State and 
Tribal surveys under subsection (b)(3). 
(B) Use the findings to develop a strategic action plan 
to increase the number of trained medical forensic exam-
iners available in the State or Tribal community and create 
policies to increase survivor access to trained examiners. 
(C) Use the findings to develop and implement a public 
awareness campaign that includes the following: 
(i) An online toolkit describing how and where 
sexual assault survivors can obtain assistance and 
care, including medical forensic examinations, in the 
State or Tribal community. 
(ii) A model standard response protocol for health 
care providers to implement upon arrival of a patient 
seeking care for sexual assault. 
(iii) A model sexual assault response team protocol 
incorporating interdisciplinary community coordination 
between hospitals, emergency departments, hospital 
administration, local rape crisis programs, law enforce-
ment, prosecuting attorneys, and other health and 
human service agencies and stakeholders with respect
H. R. 2471—828 
to delivering survivor-centered sexual assault care and 
medical forensic examinations. 
(iv) A notice of applicable laws prohibiting charging 
or billing survivors of sexual assault for care and serv-
ices related to sexual assault. 
(e) AUTHORIZATION OF APPROPRIATIONS.—There is authorized 
to be appropriated to carry out this section $7,000,000 for each 
of fiscal years 2023 through 2027. 
SEC. 504. NATIONAL REPORT ON SEXUAL ASSAULT SERVICES IN OUR 
NATION’S HEALTH SYSTEM. 
(a) IN GENERAL.—Not later than 1 year after the date of enact-
ment of this Act, and annually thereafter, the Agency for Healthcare 
Research and Quality, in consultation with the Centers for Medicare 
& Medicaid Services, the Centers for Disease Control and Preven-
tion, the Health Resources and Services Administration, the Indian 
Health Service, the Office for Victims of Crime of the Department 
of Justice, the Office on Women’s Health of the Department of 
Health and Human Services, and the Office of Violence Against 
Women of the Department of Justice (collectively referred to in 
this section as the ‘‘Agencies’’), shall submit to the Secretary of 
Health and Human Services (referred to in this section as ‘‘the 
Secretary’’) a report of existing Federal, Indian Tribe, and State 
practices relating to medical forensic examinations which may 
include the findings of the surveys developed under section 503. 
(b) CORE COMPETENCIES.—In conducting activities under this 
section, the Agencies shall address sexual assault forensic examina-
tion competencies, including— 
(1) providing medical care to sexual assault patients; 
(2) demonstrating the ability to conduct a medical forensic 
examination, including 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 
(5) other competencies, as the Agencies determine appro-
priate. 
(c) PUBLICATION.—The Agency for Healthcare Research and 
Quality shall establish, maintain, and publish on the website of 
the Department of Health and Human Services an online public 
map of availability of sexual assault forensic examinations. Such 
maps shall clarify if there is full-time, part-time, or on-call coverage. 
(d) REPORT
TO CONGRESS.—Not later than 60 days after 
receiving the report described in subsection (a), the Secretary shall 
submit to the Committee on Health, Education, Labor, and Pensions 
of the Senate and the Committee on Energy and Commerce and 
the Committee on Education and Labor of the House of Representa-
tives recommendations for improving sexual assault forensic exam-
ination competencies based on the report described in subsection 
(a). 
SEC. 505. IMPROVING AND STRENGTHENING THE SEXUAL ASSAULT 
EXAMINER WORKFORCE CLINICAL AND CONTINUING EDU-
CATION PILOT PROGRAM. 
(a) PURPOSE.—It is the purpose of this section to establish 
a pilot program to develop, test, and implement training and con-
tinuing education that expands and supports the availability of
H. R. 2471—829 
medical forensic examination services for survivors of sexual 
assault. 
(b) ESTABLISHMENT.— 
(1) IN
GENERAL.—Not later than 1 year after the date 
of enactment of this Act, the Secretary of Health and Human 
Services (referred to in this section as ‘‘the Secretary’’) shall 
establish a National Continuing and Clinical Education Pilot 
Program for sexual assault forensic examiners, sexual assault 
nurse examiners, and other individuals who perform medical 
forensic examinations. 
(2) CONSULTATION.—In establishing such program, the Sec-
retary shall consult with the Centers for Medicare & Medicaid 
Services, 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 Depart-
ment 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 shall 
solicit input from regional, national, and Tribal organizations 
with expertise in forensic nursing, rape trauma or crisis coun-
seling, investigating rape and gender violence cases, survivors’ 
advocacy and support, sexual assault prevention education, 
rural health, and responding to sexual violence in Tribal 
communities. 
(c) FUNCTIONS.—The pilot program established under sub-
section (b) shall develop, pilot, implement, and update, as appro-
priate, continuing and clinical education program modules, 
webinars, and programs for all hospitals and providers to increase 
access to medical forensic examination services and address ongoing 
competency issues in medical forensic examination services, 
including— 
(1) training and continuing education to help support sexual 
assault forensic examiners practicing in rural or underserved 
areas; 
(2) training to help connect sexual assault survivors who 
are Indian with sexual assault forensic examiners, including 
through emergency first aid, referrals, culturally competent 
support, and forensic evidence collection in rural communities; 
(3) replication of successful sexual assault forensic exam-
ination programs to help develop and improve the evidence 
base for medical forensic examinations; and 
(4) training to increase the number of medical professionals 
who are considered sexual assault forensic examiners based 
on the recommendations of the National Sexual Assault 
Forensic Examination Training Standards issued by the Office 
on Violence Against Women of the Department of Justice. 
(d) ELIGIBILITY TO PARTICIPATE IN PILOT PROGRAMS.—The Sec-
retary shall ensure that medical forensic examination services pro-
vided under the pilot program established under subsection (b), 
and other medical forensic examiner services under the pilot pro-
gram are provided by health care providers who are also one of 
the following: 
(1) A physician, including a resident physician. 
(2) A nurse practitioner. 
(3) A nurse midwife. 
(4) A physician assistant. 
(5) A certified nurse specialist.