I 
117TH CONGRESS 
2D SESSION 
H. R. 8891 
To amend the Public Health Service Act, the Employee Retirement Income 
Security Act of 1974, and the Internal Revenue Code of 1986 to require 
group health plans and health insurance issuers offering group or indi-
vidual health insurance coverage to provide coverage for forensic medical 
exams with no cost sharing, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 19, 2022 
Ms. SA´NCHEZ (for herself, Ms. MOORE of Wisconsin, and Mrs. MILLER of 
West Virginia) introduced the following bill; which was referred to the 
Committee on Energy and Commerce, and in addition to the Committees 
on Education and Labor, and Ways and Means, for a period to be subse-
quently determined by the Speaker, in each case for consideration of such 
provisions as fall within the jurisdiction of the committee concerned 
A BILL 
To amend the Public Health Service Act, the Employee Re-
tirement Income Security Act of 1974, and the Internal 
Revenue Code of 1986 to require group health plans 
and health insurance issuers offering group or individual 
health insurance coverage to provide coverage for forensic 
medical exams with no cost sharing, 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, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘No Surprises for Sur-
vivors Act of 2022’’. 
SEC. 2. REQUIRING COVERAGE OF FORENSIC MEDICAL 
EXAMS WITH NO COST SHARING. 
(a) PHSA.—Part D of title XXVII of the Public 
Health Service Act (42 U.S.C. 300gg–111 et seq.) is 
amended— 
(1) in section 2799A–1(a)(3)(C)(ii), by insert-
ing ‘‘forensic medical exams (as defined in section 
2799A–11(d)) furnished on or after January 1, 
2025 and’’ after ‘‘shall include’’; and 
(2) by adding at the end the following new sec-
tion: 
‘‘SEC. 2799A–11. REQUIRED COVERAGE OF FORENSIC MED-
ICAL EXAMS WITH NO COST SHARING. 
‘‘(a) IN GENERAL.—Except as provided in subsection 
(b), a group health plan and a health insurance issuer of-
fering group or individual health insurance coverage shall 
provide coverage for and shall not impose any cost sharing 
requirements for a forensic medical exam (as defined in 
subsection (d)) furnished by a sexual assault forensic ex-
aminer (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 spec-
ified by the Secretary, regardless of whether such forensic 
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examiner, nurse examiner, or other provider has in effect 
a contractual relationship with such plan or coverage 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 or health insurance issuer offering group 
or individual health insurance coverage receives a 
claim for a forensic medical exam to which the provi-
sions of subsection (a) would apply but for applica-
tion of paragraph (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 
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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, 716 of the Employee Re-
tirement Income Security Act of 1974, 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 or indi-
vidual health insurance coverage is responsible for 
providing coverage at no cost sharing under this sec-
tion furnished to an enrollee of such plan or group 
or individual health insurance coverage by a provider 
that does not have in effect a contractual relation-
ship described in subsection (a) with such plan or 
coverage (as applicable) for furnishing such exam as 
if such exam was an emergency service furnished by 
a nonparticipating provider in an emergency depart-
ment of a hospital. 
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‘‘(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), 716(a)(3) of the Employee Retire-
ment Income Security Act of 1974, 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.’’. 
(b) ERISA.— 
(1) IN GENERAL.—Subpart B of part 7 of sub-
title B of title I of the Employee Retirement Income 
Security Act of 1974 is amended— 
(A) in section 716(a)(3)(C)(ii), by insert-
ing ‘‘forensic medical exams (as defined in sec-
tion 726(d)) furnished on or after January 1, 
2025 and’’ after ‘‘shall include’’; and 
(B) by adding at the end the following new 
section: 
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‘‘SEC. 726. REQUIRED COVERAGE OF FORENSIC MEDICAL 
EXAMS WITH NO COST SHARING. 
‘‘(a) IN GENERAL.—Except as provided in subsection 
(b), a group health plan and a health insurance issuer of-
fering group health insurance coverage shall provide cov-
erage for and shall not impose any cost sharing require-
ments for a forensic medical exam (as defined in sub-
section (d)) furnished by a sexual assault forensic exam-
iner (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 spec-
ified by the Secretary, regardless of whether such forensic 
examiner, nurse examiner, or other provider has in effect 
a contractual relationship with such plan or coverage 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 or health insurance issuer offering group 
health insurance coverage receives a claim for a fo-
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