[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 2336 Introduced in Senate (IS)]







108th CONGRESS
  2d Session
                                S. 2336

   To expand access to preventive health care services and education 
 programs that help reduce unintended pregnancy, reduce infection with 
   sexually transmitted disease, and reduce the number of abortions.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             April 22, 2004

   Mr. Reid (for himself, Mr. Chafee, Mrs. Boxer, Mrs. Murray, Mrs. 
  Clinton, Mr. Corzine, and Mr. Lautenberg) introduced the following 
  bill; which was read twice and referred to the Committee on Health, 
                     Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
   To expand access to preventive health care services and education 
 programs that help reduce unintended pregnancy, reduce infection with 
   sexually transmitted disease, and reduce the number of abortions.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Putting Prevention 
First Act''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Findings.
             TITLE I--TITLE X OF PUBLIC HEALTH SERVICE ACT

Sec. 101. Short title.
Sec. 102. Authorization of appropriations.
              TITLE II--FAMILY PLANNING STATE EMPOWERMENT

Sec. 201. Short title.
Sec. 202. State option to provide family planning services and supplies 
                            to additional low-income individuals.
Sec. 203. State option to extend the period of eligibility for 
                            provision of family planning services and 
                            supplies.
 TITLE III--EQUITY IN PRESCRIPTION INSURANCE AND CONTRACEPTIVE COVERAGE

Sec. 301. Short title.
Sec. 302. Amendments to Employee Retirement Income Security Act of 
                            1974.
Sec. 303. Amendments to Public Health Service Act relating to the group 
                            market.
Sec. 304. Amendment to Public Health Service Act relating to the 
                            individual market.
      TITLE IV--EMERGENCY CONTRACEPTION EDUCATION AND INFORMATION

Sec. 401. Short title.
Sec. 402. Emergency contraception education and information programs.
         TITLE V--COMPASSIONATE ASSISTANCE FOR RAPE EMERGENCIES

Sec. 501. Short title.
Sec. 502. Survivors of sexual assault; provision by hospitals of 
                            emergency contraceptives without charge.
                    TITLE VI--FAMILY LIFE EDUCATION

Sec. 601. Short title.
Sec. 602. Findings.
Sec. 603. Assistance to reduce teen pregnancy, HIV/AIDS, and other 
                            sexually transmitted diseases and to 
                            support healthy adolescent development.
Sec. 604. Sense of Congress.
Sec. 605. Evaluation of programs.
Sec. 606. Definitions.
Sec. 607. Appropriations.
                TITLE VII--TEENAGE PREGNANCY PREVENTION

Sec. 701. Short title.
Sec. 702. Teenage pregnancy prevention.

SEC. 2. FINDINGS.

    The Congress finds as follows:
            (1) Although the Centers for Disease Control and Prevention 
        (``CDC'') included family planning in its published list of the 
        ``Ten Great Public Health Achievements in the 20th Century'', 
        the United States still has one of the highest rates of 
        unintended pregnancies among industrialized nations.
            (2) Each year, three million pregnancies, nearly half of 
        all pregnancies, in the United States are unintended; and half 
        of unintended pregnancies end in abortion.
            (3) In 2000, 34 million women--half of all women of 
        reproductive age (ages 15-44)--were in need of contraceptive 
        services and supplies to help prevent unintended pregnancy, and 
        half of those were in need of public support for such care.
            (4) The United States also has the highest rate of 
        infection with sexually transmitted diseases (``STDs'') of any 
        industrialized country: in 2000 there were approximately 18.9 
        million new cases of STDs.
            (5) Increasing access to family planning services will 
        improve women's health and reduce the rates of unintended 
        pregnancy, abortion, and infection with STDs. Contraceptive use 
        saves public health dollars: every dollar spent on providing 
        family planning services saves an estimated $3 in expenditures 
        for pregnancy-related and newborn care for Medicaid alone.
            (6) Contraception is basic health care that improves the 
        health of women and children by enabling women to plan and 
        space births.
            (7) Women experiencing unintended pregnancy are at greater 
        risks for physical abuse and women having closely spaced births 
        are at greater risk of maternal death.
            (8) The child born from an unintended pregnancy is at 
        greater risk of low birth weight, dying in the first year of 
        life, being abused, and not receiving sufficient resources for 
        healthy development.
            (9) The ability to control fertility also allows couples to 
        achieve economic stability by facilitating greater educational 
        achievement and participation in the workforce.
            (10) The average American woman desires two children and 
        spends five years of her life pregnant or trying to get 
        pregnant and roughly 30 years trying to prevent pregnancy; 
        without contraception, a sexually active woman has an 85 
        percent chance of becoming pregnant within a year.
            (11) Many poor and low-income women cannot afford to 
        purchase contraceptive services and supplies on their own. 12.1 
        million or 20 percent of all women aged 15-24 were uninsured in 
        2002, and that proportion has increased by 10 percent since 
        1999.
            (12) Public health programs like Medicaid and Title X, the 
        national family planning program, provide high-quality family 
        planning services and other preventive health care to 
        underinsured or uninsured individuals who may otherwise lack 
        access to health care.
            (13) Medicaid is the single largest source of public 
        funding for family planning services and HIV/AIDS care in the 
        United States. Half of all public dollars spent on 
        contraceptive services and supplies in the United States are 
        provided through Medicaid and approximately 5.5 million women 
        of reproductive age--nearly one in ten women between the ages 
        of 15 and 44--rely on Medicaid for their basic health care 
        needs.
            (14) Each year, Title X services enable Americans to 
        prevent approximately one million unintended pregnancies, and 
        one in three women of reproductive age who obtains testing or 
        treatment for STDs does so at a Title X-funded clinic. In 2002, 
Title X-funded clinics provided three million Pap tests, 5.2 million 
STD tests, and 494,000 HIV tests.
            (15) The increasing number of uninsured, stagnant funding, 
        health care inflation, new and expensive contraceptive 
        technologies, and improved but expensive screening and 
        treatment for cervical cancer and STDs, have diminished the 
        ability of Title X funded clinics to adequately serve all those 
        in need. Taking inflation into account, funding for the Title X 
        program declined 57 percent between 1980 and 2003.
            (16) While Medicaid is the largest source of subsidized 
        family planning services, many States have had to make 
        significant cuts in their Medicaid programs due to budget 
        pressures putting many women at risk of losing coverage for 
        family planning services.
            (17) In addition, eligibility for Medicaid in many States 
        is severely restricted leaving family planning services 
        financially out of reach for many poor women. Many States have 
        demonstrated tremendous success with Medicaid family planning 
        waivers that allow them to expand access to Medicaid family 
        planning services. However, the administrative burden of 
        applying for a waiver poses a significant barrier to States 
        that would like to expand their Medicaid family planning 
        programs.
            (18) Many private health plans still do not cover 
        contraceptive services and supplies. The lack of contraceptive 
        coverage in health insurance plans places many effective forms 
        of contraception beyond the financial reach of many women.
            (19) Including contraceptive coverage in private health 
        care plans saves employers money: not covering contraceptives 
        in employee health plans costs employers 15 to 17 percent more 
        than providing such coverage.
            (20) Emergency contraception is a safe and effective way to 
        prevent unintended pregnancy after unprotected sex. It is 
        estimated that the use of emergency contraception could cut the 
        number of unintended pregnancies in half, thereby reducing the 
        need for abortion.
            (21) In 2000, 51,000 abortions were prevented by use of 
        emergency contraception; increased use of emergency 
        contraception accounted for up to 43 percent of the total 
        decline in abortions between 1994 and 2000.
            (22) Access to comprehensive sex education is critical to 
        reducing rates of unintended pregnancy, abortion, and STD 
        infection among teens. Over 60 percent of teens have had sex 
        before they graduate from high school and nine out of ten 
        people have sex before they get married. 822,000 teenagers 
        become pregnant each year; 35 percent of teen girls become 
        pregnant at least once before turning 20; and 78 percent of 
        teenage pregnancies are unintended. Nearly half (48 percent) of 
        new STD cases are among people ages 15-24, even though these 
        youth make up only a quarter of the sexually active population.
            (23) The American Medical Association, the American Nurses 
        Association, the American Academy of Pediatrics, the American 
        College of Obstetricians and Gynecologists, the American Public 
        Health Association, and the Society for Adolescent Medicine, 
        support responsible sexuality education that includes 
        information about both abstinence and contraception.
            (24) Comprehensive sex education protects adolescent 
        health. A recent survey found that only 15 percent of American 
        parents believe that schools should just teach about 
        abstinence.
            (25) A recent study showed that teens who took pledges to 
        remain virgins until marriage were just as likely to contract 
        STDs as teens who did not take virginity pledges and that 
        although teens taking the pledges delayed sexual debut, they 
        were less likely to use condoms once they were sexually active.
            (26) Teens who receive sex education that includes 
        discussion of contraception are more likely than those who 
        receive abstinence-only messages to delay sex and to have fewer 
        partners and use contraceptives when they do become sexually 
        active.

             TITLE I--TITLE X OF PUBLIC HEALTH SERVICE ACT

SEC. 101. SHORT TITLE.

    This Act may be cited as the ``Title X Family Planning Services Act 
of 2004''.

SEC. 102. AUTHORIZATION OF APPROPRIATIONS.

    For the purpose of making grants and contracts under section 1001 
of the Public Health Service Act, there are authorized to be 
appropriated $643,000,000 for fiscal year 2005, and such sums as may be 
necessary for each subsequent fiscal year.

              TITLE II--FAMILY PLANNING STATE EMPOWERMENT

SEC. 201. SHORT TITLE.

    This Act may be cited as the ``Family Planning State Empowerment 
Act''.

SEC. 202. STATE OPTION TO PROVIDE FAMILY PLANNING SERVICES AND SUPPLIES 
              TO ADDITIONAL LOW-INCOME INDIVIDUALS.

    (a) In General.--Title XIX of the Social Security Act (42 U.S.C. 
1396 et seq.) is amended--
            (1) by redesignating section 1935 as section 1936; and
            (2) by inserting after section 1934 the following:

  ``state option to provide family planning services and supplies to 
                   additional low-income individuals

    ``Sec. 1935.
    ``(a) In General.--A State may elect (through a State plan 
amendment) to make medical assistance described in section 
1905(a)(4)(C) available to any individual not otherwise eligible for 
such assistance--
            ``(1) whose family income does not exceed an income level 
        (specified by the State) that does not exceed the greatest of--
                    ``(A) 200 percent of the income official poverty 
                line (as defined by the Office of Management and 
                Budget, and revised annually in accordance with section 
                673(2) of the Community Services Block Grant Act) 
                applicable to a family of the size involved;
                    ``(B) in the case of a State that has in effect (as 
                of the date of the enactment of this section) a waiver 
                under section 1115 to provide such medical assistance 
                to individuals based on their income level (expressed 
                as a percent of the poverty line), the eligibility 
                income level as provided under such waiver; or
                    ``(C) the eligibility income level (expressed as a 
                percent of such poverty line) that has been specified 
                under the plan (including under section 1902(r)(2)), 
                for eligibility of pregnant women for medical 
                assistance; and
            ``(2) at the option of the State, whose resources do not 
        exceed a resource level specified by the State, which level is 
        not more restrictive than the resource level applicable under 
        the waiver described in paragraph (1)(B) or to pregnant women 
        under paragraph (1)(C).
    ``(b) Flexibility.--A State may exercise the authority under 
subsection (a) with respect to one or more classes of individuals 
described in such subsection.''.
    (b) Conforming Amendment.--Section 1905(a) of such Act (42 U.S.C. 
1396d(a)) is amended, in the matter before paragraph (1)--
            (1) by striking ``and'' at the end of clause (xii);
            (2) by adding ``and'' at the end of clause (xiii); and
            (3) by inserting after clause (xiii) the following new 
        clause:
            ``(xiv) individuals described in section 1935, but only 
        with respect to items and services described in paragraph 
        (4)(C),''.
    (c) Effective Date.--The amendments made by this section apply to 
medical assistance provided on and after October 1, 2004.

SEC. 203. STATE OPTION TO EXTEND THE PERIOD OF ELIGIBILITY FOR 
              PROVISION OF FAMILY PLANNING SERVICES AND SUPPLIES.

    (a) In General.--Section 1902(e) of the Social Security Act (42 
U.S.C. 1396a(e)) is amended by adding at the end the following new 
paragraph:
    ``(13) At the option of a State, the State plan may provide that, 
in the case of an individual who was eligible for medical assistance 
described in section 1905(a)(4)(C), but who no longer qualifies for 
such assistance because of an increase in income or resources or 
because of the expiration of a post-partum period, the individual may 
remain eligible for such assistance for such period as the State may 
specify, but the period of extended eligibility under this paragraph 
shall not exceed a continuous period of 24 months for any individual. 
The State may apply the previous sentence to one or more classes of 
individuals and may vary the period of extended eligibility with 
respect to different classes of individuals.''.
    (b) Effective Date.--The amendments made by subsection (a) apply to 
medical assistance provided on and after October 1, 2004.

 TITLE III--EQUITY IN PRESCRIPTION INSURANCE AND CONTRACEPTIVE COVERAGE

SEC. 301. SHORT TITLE.

    This Act may be cited as the ``Equity in Prescription Insurance and 
Contraceptive Coverage Act''.

SEC. 302. AMENDMENTS TO EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 
              1974.

    (a) In General.--Subpart B of part 7 of subtitle B of title I of 
the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1185 et 
seq.) is amended by adding at the end the following:

``SEC. 714. STANDARDS RELATING TO BENEFITS FOR CONTRACEPTIVES.

    ``(a) Requirements for Coverage.--A group health plan, and a health 
insurance issuer providing health insurance coverage in connection with 
a group health plan, may not--
            ``(1) exclude or restrict benefits for prescription 
        contraceptive drugs or devices approved by the Food and Drug 
        Administration, or generic equivalents approved as 
        substitutable by the Food and Drug Administration, if such plan 
        or coverage provides benefits for other outpatient prescription 
        drugs or devices; or
            ``(2) exclude or restrict benefits for outpatient 
        contraceptive services if such plan or coverage provides 
        benefits for other outpatient services provided by a health 
        care professional (referred to in this section as `outpatient 
        health care services').
    ``(b) Prohibitions.--A group health plan, and a health insurance 
issuer providing health insurance coverage in connection with a group 
health plan, may not--
            ``(1) deny to an individual eligibility, or continued 
        eligibility, to enroll or to renew coverage under the terms of 
        the plan because of the individual's or enrollee's use or 
        potential use of items or services that are covered in 
        accordance with the requirements of this section;
            ``(2) provide monetary payments or rebates to a covered 
        individual to encourage such individual to accept less than the 
        minimum protections available under this section;
            ``(3) penalize or otherwise reduce or limit the 
        reimbursement of a health care professional because such 
        professional prescribed contraceptive drugs or devices, or 
        provided contraceptive services, described in subsection (a), 
        in accordance with this section; or
            ``(4) provide incentives (monetary or otherwise) to a 
        health care professional to induce such professional to 
        withhold from a covered individual contraceptive drugs or 
        devices, or contraceptive services, described in subsection 
        (a).
    ``(c) Rules of Construction.--
            ``(1) In general.--Nothing in this section shall be 
        construed--
                    ``(A) as preventing a group health plan and a 
                health insurance issuer providing health insurance 
                coverage in connection with a group health plan from 
                imposing deductibles, coinsurance, or other cost-
                sharing or limitations in relation to--
                            ``(i) benefits for contraceptive drugs 
                        under the plan or coverage, except that such a 
                        deductible, coinsurance, or other cost-sharing 
                        or limitation for any such drug shall be 
                        consistent with those imposed for other 
                        outpatient prescription drugs otherwise covered 
                        under the plan or coverage;
                            ``(ii) benefits for contraceptive devices 
                        under the plan or coverage, except that such a 
                        deductible, coinsurance, or other cost-sharing 
                        or limitation for any such device shall be 
                        consistent with those imposed for other 
                        outpatient prescription devices otherwise 
                        covered under the plan or coverage; and
                            ``(iii) benefits for outpatient 
                        contraceptive services under the plan or 
                        coverage, except that such a deductible, 
                        coinsurance, or other cost-sharing or 
                        limitation for any such service shall be 
                        consistent with those imposed for other 
                        outpatient health care services otherwise 
                        covered under the plan or coverage;
                    ``(B) as requiring a group health plan and a health 
                insurance issuer providing health insurance coverage in 
                connection with a group health plan to cover 
                experimental or investigational contraceptive drugs or 
                devices, or experimental or investigational 
                contraceptive services, described in subsection (a), 
                except to the extent that the plan or issuer provides 
                coverage for other experimental or investigational 
                outpatient prescription drugs or devices, or 
                experimental or investigational outpatient health care 
                services; or
                    ``(C) as modifying, diminishing, or limiting the 
                rights or protections of an individual under any other 
                Federal law.
            ``(2) Limitations.--As used in paragraph (1), the term 
        `limitation' includes--
                    ``(A) in the case of a contraceptive drug or 
                device, restricting the type of health care 
                professionals that may prescribe such drugs or devices, 
                utilization review provisions, and limits on the volume 
                of prescription drugs or devices that may be obtained 
                on the basis of a single consultation with a 
                professional; or
                    ``(B) in the case of an outpatient contraceptive 
                service, restricting the type of health care 
                professionals that may provide such services, 
                utilization review provisions, requirements relating to 
                second opinions prior to the coverage of such services, 
                and requirements relating to preauthorizations prior to 
                the coverage of such services.
    ``(d) Notice Under Group Health Plan.--The imposition of the 
requirements of this section shall be treated as a material 
modification in the terms of the plan described in section 102(a)(1), 
for purposes of assuring notice of such requirements under the plan, 
except that the summary description required to be provided under the 
last sentence of section 104(b)(1) with respect to such modification 
shall be provided by not later than 60 days after the first day of the 
first plan year in which such requirements apply.
    ``(e) Preemption.--Nothing in this section shall be construed to 
preempt any provision of State law to the extent that such State law 
establishes, implements, or continues in effect any standard or 
requirement that provides coverage or protections for participants or 
beneficiaries that are greater than the coverage or protections 
provided under this section.
    ``(f) Definition.--In this section, the term `outpatient 
contraceptive services' means consultations, examinations, procedures, 
and medical services, provided on an outpatient basis and related to 
the use of contraceptive methods (including natural family planning) to 
prevent an unintended pregnancy.''.
    (b) Clerical Amendment.--The table of contents in section 1 of the 
Employee Retirement Income Security Act of 1974 (29 U.S.C. 1001) is 
amended by inserting after the item relating to section 713 the 
following:

``Sec. 714. Standards relating to benefits for contraceptives.''.
    (c) Effective Date.--The amendments made by this section shall 
apply with respect to plan years beginning on or after January 1, 2005.

SEC. 303. AMENDMENTS TO PUBLIC HEALTH SERVICE ACT RELATING TO THE GROUP 
              MARKET.

    (a) In General.--Subpart 2 of part A of title XXVII of the Public 
Health Service Act (42 U.S.C. 300gg-4 et seq.) is amended by adding at 
the end the following:

``SEC. 2707. STANDARDS RELATING TO BENEFITS FOR CONTRACEPTIVES.

    ``(a) Requirements for Coverage.--A group health plan, and a health 
insurance issuer providing health insurance coverage in connection with 
a group health plan, may not--
            ``(1) exclude or restrict benefits for prescription 
        contraceptive drugs or devices approved by the Food and Drug 
        Administration, or generic equivalents approved as 
        substitutable by the Food and Drug Administration, if such plan 
        or coverage provides benefits for other outpatient prescription 
        drugs or devices; or
            ``(2) exclude or restrict benefits for outpatient 
        contraceptive services if such plan or coverage provides 
        benefits for other outpatient services provided by a health 
        care professional (referred to in this section as `outpatient 
        health care services').
    ``(b) Prohibitions.--A group health plan, and a health insurance 
issuer providing health insurance coverage in connection with a group 
health plan, may not--
            ``(1) deny to an individual eligibility, or continued 
        eligibility, to enroll or to renew coverage under the terms of 
        the plan because of the individual's or enrollee's use or 
        potential use of items or services that are covered in 
        accordance with the requirements of this section;
            ``(2) provide monetary payments or rebates to a covered 
        individual to encourage such individual to accept less than the 
        minimum protections available under this section;
            ``(3) penalize or otherwise reduce or limit the 
        reimbursement of a health care professional because such 
        professional prescribed contraceptive drugs or devices, or 
        provided contraceptive services, described in subsection (a), 
        in accordance with this section; or
            ``(4) provide incentives (monetary or otherwise) to a 
        health care professional to induce such professional to 
        withhold from covered individual contraceptive drugs or 
        devices, or contraceptive services, described in subsection 
        (a).
    ``(c) Rules of Construction.--
            ``(1) In general.--Nothing in this section shall be 
        construed--
                    ``(A) as preventing a group health plan and a 
                health insurance issuer providing health insurance 
                coverage in connection with a group health plan from 
                imposing deductibles, coinsurance, or other cost-
                sharing or limitations in relation to--
                            ``(i) benefits for contraceptive drugs 
                        under the plan or coverage, except that such a 
                        deductible, coinsurance, or other cost-sharing 
                        or limitation for any such drug shall be 
                        consistent with those imposed for other 
outpatient prescription drugs otherwise covered under the plan or 
coverage;
                            ``(ii) benefits for contraceptive devices 
                        under the plan or coverage, except that such a 
                        deductible, coinsurance, or other cost-sharing 
                        or limitation for any such device shall be 
                        consistent with those imposed for other 
                        outpatient prescription devices otherwise 
                        covered under the plan or coverage; and
                            ``(iii) benefits for outpatient 
                        contraceptive services under the plan or 
                        coverage, except that such a deductible, 
                        coinsurance, or other cost-sharing or 
                        limitation for any such service shall be 
                        consistent with those imposed for other 
                        outpatient health care services otherwise 
                        covered under the plan or coverage;
                    ``(B) as requiring a group health plan and a health 
                insurance issuer providing health insurance coverage in 
                connection with a group health plan to cover 
                experimental or investigational contraceptive drugs or 
                devices, or experimental or investigational 
                contraceptive services, described in subsection (a), 
                except to the extent that the plan or issuer provides 
                coverage for other experimental or investigational 
                outpatient prescription drugs or devices, or 
                experimental or investigational outpatient health care 
                services; or
                    ``(C) as modifying, diminishing, or limiting the 
                rights or protections of an individual under any other 
                Federal law.
            ``(2) Limitations.--As used in paragraph (1), the term 
        `limitation' includes--
                    ``(A) in the case of a contraceptive drug or 
                device, restricting the type of health care 
                professionals that may prescribe such drugs or devices, 
                utilization review provisions, and limits on the volume 
                of prescription drugs or devices that may be obtained 
                on the basis of a single consultation with a 
                professional; or
                    ``(B) in the case of an outpatient contraceptive 
                service, restricting the type of health care 
                professionals that may provide such services, 
                utilization review provisions, requirements relating to 
                second opinions prior to the coverage of such services, 
                and requirements relating to preauthorizations prior to 
                the coverage of such services.
    ``(d) Notice.--A group health plan under this part shall comply 
with the notice requirement under section 714(d) of the Employee 
Retirement Income Security Act of 1974 with respect to the requirements 
of this section as if such section applied to such plan.
    ``(e) Preemption.--Nothing in this section shall be construed to 
preempt any provision of State law to the extent that such State law 
establishes, implements, or continues in effect any standard or 
requirement that provides coverage or protections for enrollees that 
are greater than the coverage or protections provided under this 
section.
    ``(f) Definition.--In this section, the term `outpatient 
contraceptive services' means consultations, examinations, procedures, 
and medical services, provided on an outpatient basis and related to 
the use of contraceptive methods (including natural family planning) to 
prevent an unintended pregnancy.''.
    (b) Effective Date.--The amendments made by this section shall 
apply with respect to group health plans for plan years beginning on or 
after January 1, 2005.

SEC. 304. AMENDMENT TO PUBLIC HEALTH SERVICE ACT RELATING TO THE 
              INDIVIDUAL MARKET.

    (a) In General.--Part B of title XXVII of the Public Health Service 
Act (42 U.S.C. 300gg-41 et seq.) is amended--
            (1) by redesignating the first subpart 3 (relating to other 
        requirements) as subpart 2; and
            (2) by adding at the end of subpart 2 the following:

``SEC. 2753. STANDARDS RELATING TO BENEFITS FOR CONTRACEPTIVES.

    ``The provisions of section 2707 shall apply to health insurance 
coverage offered by a health insurance issuer in the individual market 
in the same manner as they apply to health insurance coverage offered 
by a health insurance issuer in connection with a group health plan in 
the small or large group market.''.
    (b) Effective Date.--The amendment made by this section shall apply 
with respect to health insurance coverage offered, sold, issued, 
renewed, in effect, or operated in the individual market on or after 
January 1, 2005.

      TITLE IV--EMERGENCY CONTRACEPTION EDUCATION AND INFORMATION

SEC. 401. SHORT TITLE.

    This Act may be cited as the ``Emergency Contraception Education 
Act''.

SEC. 402. EMERGENCY CONTRACEPTION EDUCATION AND INFORMATION PROGRAMS.

    (a) Definitions.--For purposes of this section:
            (1) Emergency contraception.--The term ``emergency 
        contraception'' means a drug or device (as the terms are 
        defined in section 201 of the Federal Food, Drug, and Cosmetic 
        Act (21 U.S.C. 321)) or a drug regimen that is--
                    (A) used after sexual relations; and
                    (B) prevents pregnancy, by preventing ovulation, 
                fertilization of an egg, or implantation of an egg in a 
                uterus.
            (2) Health care provider.--The term ``health care 
        provider'' means an individual who is licensed or certified 
        under State law to provide health care services and who is 
        operating within the scope of such license.
            (3) Institution of higher education.--The term 
        ``institution of higher education'' has the same meaning given 
        such term in section 1201(a) of the Higher Education Act of 
        1965 (20 U.S.C. 1141(a)).
            (4) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
    (b) Emergency Contraception Public Education Program.--
            (1) In general.--The Secretary, acting through the Director 
        of the Centers for Disease Control and Prevention, shall 
        develop and disseminate to the public information on emergency 
        contraception.
            (2) Dissemination.--The Secretary may disseminate 
        information under paragraph (1) directly or through 
        arrangements with nonprofit organizations, consumer groups, 
        institutions of higher education, Federal, State, or local 
        agencies, clinics and the media.
            (3) Information.--The information disseminated under 
        paragraph (1) shall include, at a minimum, a description of 
        emergency contraception, and an explanation of the use, safety, 
        efficacy, and availability of such contraception.
    (c) Emergency Contraception Information Program for Health Care 
Providers.--
            (1) In general.--The Secretary, acting through the 
        Administrator of the Health Resources and Services 
        Administration and in consultation with major medical and 
        public health organizations, shall develop and disseminate to 
        health care providers information on emergency contraception.
            (2) Information.--The information disseminated under 
        paragraph (1) shall include, at a minimum--
                    (A) information describing the use, safety, 
                efficacy and availability of emergency contraception;
                    (B) a recommendation regarding the use of such 
                contraception in appropriate cases; and
                    (C) information explaining how to obtain copies of 
                the information developed under subsection (b), for 
                distribution to the patients of the providers.
    (d) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $10,000,000 for each of the 
fiscal years 2005 through 2009.

         TITLE V--COMPASSIONATE ASSISTANCE FOR RAPE EMERGENCIES

SEC. 501. SHORT TITLE.

    This Act may be cited as the ``Compassionate Assistance for Rape 
Emergencies Act''.

SEC. 502. SURVIVORS OF SEXUAL ASSAULT; PROVISION BY HOSPITALS OF 
              EMERGENCY CONTRACEPTIVES WITHOUT CHARGE.

    (a) In General.--Federal funds may not be provided to a hospital 
under any health-related program, unless the hospital meets the 
conditions specified in subsection (b) in the case of--
            (1) any woman who presents at the hospital and states that 
        she is a victim of sexual assault, or is accompanied by someone 
        who states she is a victim of sexual assault; and
            (2) any woman who presents at the hospital whom hospital 
        personnel have reason to believe is a victim of sexual assault.
    (b) Assistance for Victims.--The conditions specified in this 
subsection regarding a hospital and a woman described in subsection (a) 
are as follows:
            (1) The hospital promptly provides the woman with medically 
        and factually accurate and unbiased written and oral 
        information about emergency contraception, including 
        information explaining that--
                    (A) emergency contraception does not cause an 
                abortion; and
                    (B) emergency contraception is effective in most 
                cases in preventing pregnancy after unprotected sex.
            (2) The hospital promptly offers emergency contraception to 
        the woman, and promptly provides such contraception to her on 
        her request.
            (3) The information provided pursuant to paragraph (1) is 
        in clear and concise language, is readily comprehensible, and 
        meets such conditions regarding the provision of the 
        information in languages other than English as the Secretary 
        may establish.
            (4) The services described in paragraphs (1) through (3) 
        are not denied because of the inability of the woman or her 
        family to pay for the services.
    (c) Definitions.--For purposes of this section:
            (1) The term ``emergency contraception'' means a drug, drug 
        regimen, or device that is--
                    (A) used postcoitally;
                    (B) prevents pregnancy by delaying ovulation, 
                preventing fertilization of an egg, or preventing 
                implantation of an egg in a uterus; and
                    (C) is approved by the Food and Drug 
                Administration.
            (2) The term ``hospital'' has the meanings given such term 
        in title XVIII of the Social Security Act, including the 
        meaning applicable in such title for purposes of making 
        payments for emergency services to hospitals that do not have 
        agreements in effect under such title.
            (3) The term ``Secretary'' means the Secretary of Health 
        and Human Services.
            (4) The term ``sexual assault'' means coitus in which the 
        woman involved does not consent or lacks the legal capacity to 
        consent.
    (d) Effective Date; Agency Criteria.--This section takes effect 
upon the expiration of the 180-day period beginning on the date of 
enactment of this Act. Not later than 30 days prior to the expiration 
of such period, the Secretary shall publish in the Federal Register 
criteria for carrying out this section.

                    TITLE VI--FAMILY LIFE EDUCATION

SEC. 601. SHORT TITLE.

    This Act may be cited as the ``Family Life Education Act''.

SEC. 602. FINDINGS.

    The Congress finds as follows:
            (1) The American Medical Association (``AMA''), the 
        American Nurses Association (``ANA''), the American Academy of 
        Pediatrics (``AAP''), the American College of Obstetricians and 
        Gynecologists (``ACOG''), the American Public Health 
        Association (``APHA''), and the Society of Adolescent Medicine 
        (``SAM''), support responsible sexuality education that 
        includes information about both abstinence and contraception.
            (2) Recent scientific reports by the Institute of Medicine, 
        the American Medical Association and the Office on National 
        AIDS Policy stress the need for sexuality education that 
        includes messages about abstinence and provides young people 
        with information about contraception for the prevention of teen 
        pregnancy, HIV/AIDS and other sexually transmitted diseases 
        (``STDs'').
            (3) Research shows that teenagers who receive sexuality 
        education that includes discussion of contraception are more 
        likely than those who receive abstinence-only messages to delay 
        sexual activity and to use contraceptives when they do become 
        sexually active.
            (4) Comprehensive sexuality education programs respect the 
        diversity of values and beliefs represented in the community 
        and will complement and augment the sexuality education 
        children receive from their families.
            (5) The median age of puberty is 13 years and the average 
        age of marriage is over 26 years old. American teens need 
        access to full, complete, and medically and factually accurate 
        information regarding sexuality, including contraception, STD/
        HIV prevention, and abstinence.
            (6) Although teen pregnancy rates are decreasing, there are 
        still between 750,000 and 850,000 teen pregnancies each year. 
        Between 75 and 90 percent of teen pregnancies among 15- to 19-
        year olds are unintended.
            (7) Research shows that 75 percent of the decrease in teen 
        pregnancy between 1988 and 1995 was due to improved 
        contraceptive use, while 25 percent was due to increased 
        abstinence.
            (8) More than eight out of ten Americans believe that young 
        people should have information about abstinence and protecting 
        themselves from unplanned pregnancies and sexually transmitted 
        diseases.
            (9) United States teens acquire an estimated 4,000,000 
        sexually transmitted infections each year. By age 24, at least 
        one in three sexually active people will have contracted a 
        sexually transmitted disease.
            (10) An average of two young people in the United States 
        are infected with HIV every hour of every day. African 
        Americans and Hispanic youth have been disproportionately 
        affected by the HIV/AIDS epidemic. Although less than 16 
        percent of the adolescent population in the United States is 
        African American, nearly 50 percent of AIDS cases through June 
        2000 among 13- to 19-year olds were among Blacks. Hispanics 
        comprise 13 percent of the population and 20 percent of the 
        reported adolescent AIDS cases though June 2000.

SEC. 603. ASSISTANCE TO REDUCE TEEN PREGNANCY, HIV/AIDS, AND OTHER 
              SEXUALLY TRANSMITTED DISEASES AND TO SUPPORT HEALTHY 
              ADOLESCENT DEVELOPMENT.

    (a) In General.--Each eligible State shall be entitled to receive 
from the Secretary of Health and Human Services, for each of the fiscal 
years 2005 through 2009, a grant to conduct programs of family life 
education, including education on both abstinence and contraception for 
the prevention of teenage pregnancy and sexually transmitted diseases, 
including HIV/AIDS.
    (b) Requirements for Family Life Programs.--For purposes of this 
title, a program of family life education is a program that--
            (1) is age-appropriate and medically accurate;
            (2) does not teach or promote religion;
            (3) teaches that abstinence is the only sure way to avoid 
        pregnancy or sexually transmitted diseases;
            (4) stresses the value of abstinence while not ignoring 
        those young people who have had or are having sexual 
        intercourse;
            (5) provides information about the health benefits and side 
        effects of all contraceptives and barrier methods as a means to 
        prevent pregnancy;
            (6) provides information about the health benefits and side 
        effects of all contraceptives and barrier methods as a means to 
        reduce the risk of contracting sexually transmitted diseases, 
        including HIV/AIDS;
            (7) encourages family communication about sexuality between 
        parent and child;
            (8) teaches young people the skills to make responsible 
        decisions about sexuality, including how to avoid unwanted 
        verbal, physical, and sexual advances and how not to make 
        unwanted verbal, physical, and sexual advances; and
            (9) teaches young people how alcohol and drug use can 
        affect responsible decisionmaking.
    (c) Additional Activities.--In carrying out a program of family 
life education, a State may expend a grant under subsection (a) to 
carry out educational and motivational activities that help young 
people--
            (1) gain knowledge about the physical, emotional, 
        biological, and hormonal changes of adolescence and subsequent 
        stages of human maturation;
            (2) develop the knowledge and skills necessary to ensure 
        and protect their sexual and reproductive health from 
        unintended pregnancy and sexually transmitted disease, 
        including HIV/AIDS throughout their lifespan;
            (3) gain knowledge about the specific involvement of and 
        male responsibility in sexual decisionmaking;
            (4) develop healthy attitudes and values about adolescent 
        growth and development, body image, gender roles, racial and 
        ethnic diversity, sexual orientation, and other subjects;
            (5) develop and practice healthy life skills including 
        goal-setting, decisionmaking, negotiation, communication, and 
        stress management;
            (6) promote self-esteem and positive interpersonal skills 
        focusing on relationship dynamics, including, but not limited 
        to, friendships, dating, romantic involvement, marriage and 
        family interactions; and
            (7) prepare for the adult world by focusing on educational 
        and career success, including developing skills for employment 
        preparation, job seeking, independent living, financial self-
        sufficiency, and workplace productivity.

SEC. 604. SENSE OF CONGRESS.

    It is the sense of Congress that while States are not required to 
provide matching funds, they are encouraged to do so.

SEC. 605. EVALUATION OF PROGRAMS.

    (a) In General.--For the purpose of evaluating the effectiveness of 
programs of family life education carried out with a grant under 
section 603, evaluations of such program shall be carried out in 
accordance with subsections (b) and (c).
    (b) National Evaluation.--
            (1) In general.--The Secretary shall provide for a national 
        evaluation of a representative sample of programs of family 
        life education carried out with grants under section 603. A 
        condition for the receipt of such a grant is that the State 
        involved agree to cooperate with the evaluation. The purposes 
        of the national evaluation shall be the determination of--
                    (A) the effectiveness of such programs in helping 
                to delay the initiation of sexual intercourse and other 
                high-risk behaviors;
                    (B) the effectiveness of such programs in 
                preventing adolescent pregnancy;
                    (C) the effectiveness of such programs in 
                preventing sexually transmitted disease, including HIV/
                AIDS;
                    (D) the effectiveness of such programs in 
                increasing contraceptive knowledge and contraceptive 
                behaviors when sexual intercourse occurs; and
                    (E) a list of best practices based upon essential 
                programmatic components of evaluated programs that have 
                led to success in subparagraphs (A) through (D).
            (2) Report.--A report providing the results of the national 
        evaluation under paragraph (1) shall be submitted to the 
        Congress not later than March 31, 2008, with an interim report 
        provided on a yearly basis at the end of each fiscal year.
    (c) Individual State Evaluations.--
            (1) In general.--A condition for the receipt of a grant 
        under section 603 is that the State involved agree to provide 
        for the evaluation of the programs of family education carried 
        out with the grant in accordance with the following:
                    (A) The evaluation will be conducted by an 
                external, independent entity.
                    (B) The purposes of the evaluation will be the 
                determination of--
                            (i) the effectiveness of such programs in 
                        helping to delay the initiation of sexual 
                        intercourse and other high-risk behaviors;
                            (ii) the effectiveness of such programs in 
                        preventing adolescent pregnancy;
                            (iii) the effectiveness of such programs in 
                        preventing sexually transmitted disease, 
                        including HIV/AIDS; and
                            (iv) the effectiveness of such programs in 
                        increasing contraceptive knowledge and 
                        contraceptive behaviors when sexual intercourse 
                        occurs.
            (2) Use of grant.--A condition for the receipt of a grant 
        under section 603 is that the State involved agree that not 
        more than 10 percent of the grant will be expended for the 
        evaluation under paragraph (1).

SEC. 606. DEFINITIONS.

    For purposes of this title:
            (1) The term ``eligible State'' means a State that submits 
        to the Secretary an application for a grant under section 603 
        that is in such form, is made in such manner, and contains such 
        agreements, assurances, and information as the Secretary 
        determines to be necessary to carry out this title.
            (2) The term ``HIV/AIDS'' means the human immunodeficiency 
        virus, and includes acquired immune deficiency syndrome.
            (3) The term ``medically accurate'', with respect to 
        information, means information that is supported by research, 
        recognized as accurate and objective by leading medical, 
        psychological, psychiatric, and public health organizations and 
        agencies, and where relevant, published in peer review 
        journals.
            (4) The term ``Secretary'' means the Secretary of Health 
        and Human Services.

SEC. 607. APPROPRIATIONS.

    (a) In General.--For the purpose of carrying out this title, there 
is authorized to be appropriated $100,000,000 for each of the fiscal 
years 2005 through 2009.
    (b) Allocations.--Of the amounts appropriated under subsection (a) 
for a fiscal year--
            (1) not more than 7 percent may be used for the 
        administrative expenses of the Secretary in carrying out this 
        title for that fiscal year; and
            (2) not more than 10 percent may be used for the national 
        evaluation under section 605(b).

                TITLE VII--TEENAGE PREGNANCY PREVENTION

SEC. 701. SHORT TITLE.

    This Act may be cited as the ``Preventing Teen Pregnancy Act''.

SEC. 702. TEENAGE PREGNANCY PREVENTION.

    Part P of title III of the Public Health Service Act (42 U.S.C. 
280g et seq.) is amended by inserting after section 399N the following 
section:

``SEC. 399O. TEENAGE PREGNANCY PREVENTION GRANTS.

    ``(a) Authority.--The Secretary may award on a competitive basis 
grants to public and private entities to establish or expand teenage 
pregnancy prevention programs.
    ``(b) Grant Recipients.--Grant recipients under this section may 
include State and local not-for-profit coalitions working to prevent 
teenage pregnancy, State, local, and tribal agencies, schools, entities 
that provide afterschool programs, and community and faith-based 
groups.
    ``(c) Priority.--In selecting grant recipients under this section, 
the Secretary shall give--
            ``(1) highest priority to applicants seeking assistance for 
        programs targeting communities or populations in which--
                    ``(A) teenage pregnancy or birth rates are higher 
                than the corresponding State average; or
                    ``(B) teenage pregnancy or birth rates are 
                increasing; and
            ``(2) priority to applicants seeking assistance for 
        programs that--
                    ``(A) will benefit underserved or at-risk 
                populations such as young males or immigrant youths; or
                    ``(B) will take advantage of other available 
                resources and be coordinated with other programs that 
                serve youth, such as workforce development and after 
                school programs.
    ``(d) Use of Funds.--Funds received by an entity as a grant under 
this section shall be used for programs that--
            ``(1) replicate or substantially incorporate the elements 
        of one or more teenage pregnancy prevention programs that have 
        been proven (on the basis of rigorous scientific research) to 
        delay sexual intercourse or sexual activity, increase condom or 
        contraceptive use (without increasing sexual activity), or 
        reduce teenage pregnancy; and
            ``(2) incorporate one or more of the following strategies 
        for preventing teenage pregnancy: encouraging teenagers to 
        delay sexual activity; sex and HIV education; interventions for 
        sexually active teenagers; preventive health services; youth 
        development programs; service learning programs; and outreach 
        or media programs.
    ``(e) Complete Information.--Programs receiving funds under this 
section that choose to provide information on HIV/AIDS or contraception 
or both must provide information that is complete and medically 
accurate.
    ``(f) Relation to Abstinence-Only Programs.--Funds under this 
section are not intended for use by abstinence-only education programs. 
Abstinence-only education programs that receive Federal funds through 
the Maternal and Child Health Block Grant, the Administration for 
Children and Families, the Adolescent Family Life Program, and any 
other program that uses the definition of `abstinence education' found 
in section 510(b) of the Social Security Act are ineligible for 
funding.
    ``(g) Applications.--Each entity seeking a grant under this section 
shall submit an application to the Secretary at such time and in such 
manner as the Secretary may require.
    ``(h) Matching Funds.--
            ``(1) In general.--The Secretary may not award a grant to 
        an applicant for a program under this section unless the 
        applicant demonstrates that it will pay, from funds derived 
        from non-Federal sources, at least 25 percent of the cost of 
        the program.
            ``(2) Applicant's share.--The applicant's share of the cost 
        of a program shall be provided in cash or in kind.
    ``(i) Supplementation of Funds.--An entity that receives funds as a 
grant under this section shall use the funds to supplement and not 
supplant funds that would otherwise be available to the entity for 
teenage pregnancy prevention.
    ``(j) Evaluations.--
            ``(1) In general.--The Secretary shall--
                    ``(A) conduct or provide for a rigorous evaluation 
                of 10 percent of programs for which a grant is awarded 
                under this section;
                    ``(B) collect basic data on each program for which 
                a grant is awarded under this section; and
                    ``(C) upon completion of the evaluations referred 
                to in subparagraph (A), submit to the Congress a report 
                that includes a detailed statement on the effectiveness 
                of grants under this section.
            ``(2) Cooperation by grantees.--Each grant recipient under 
        this section shall provide such information and cooperation as 
        may be required for an evaluation under paragraph (1).
    ``(k) Definition.--For purposes of this section, the term `rigorous 
scientific research' means based on a program evaluation that:
            ``(1) Measured impact on sexual or contraceptive behavior, 
        pregnancy or childbearing.
            ``(2) Employed an experimental or quasi-experimental design 
        with well-constructed and appropriate comparison groups.
            ``(3) Had a sample size large enough (at least 100 in the 
        combined treatment and control group) and a follow-up interval 
        long enough (at least six months) to draw valid conclusions 
        about impact.
    ``(l) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $20,000,000 for fiscal year 
2005, and such sums as may be necessary for each subsequent fiscal 
year. In addition, there are authorized to be appropriated for 
evaluations under subsection (j) such sums as may be necessary for 
fiscal year 2005 and each subsequent fiscal year.''.
                                 <all>