[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 1264 Introduced in Senate (IS)]







109th CONGRESS
  1st Session
                                S. 1264

 To provide for the provision by hospitals of emergency contraceptives 
   to women, and post-exposure prophylaxis for sexually transmitted 
      disease to individuals, who are survivors of sexual assault.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             June 16, 2005

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

_______________________________________________________________________

                                 A BILL


 
 To provide for the provision by hospitals of emergency contraceptives 
   to women, and post-exposure prophylaxis for sexually transmitted 
      disease to individuals, who are survivors of sexual assault.

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

SECTION 1. SHORT TITLE.

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

SEC. 2. FINDINGS.

    The Congress finds as follows:
            (1) It is estimated that 25,000 to 32,000 women become 
        pregnant each year as a result of rape or incest. An estimated 
        22,000 of these pregnancies could be prevented if rape 
        survivors had timely access to emergency contraception.
            (2) A 1996 study of rape-related pregnancies (published in 
        the American Journal of Obstetrics and Gynecology) found that 
        50 percent of the pregnancies described in paragraph (1) ended 
        in abortion.
            (3) Surveys have shown that many hospitals do not routinely 
        provide emergency contraception to women seeking treatment 
        after being sexually assaulted.
            (4) The risk of pregnancy after sexual assault has been 
        estimated to be 4.7 percent in survivors who were not protected 
        by some form of contraception at the time of the attack.
            (5) The Food and Drug Administration has declared emergency 
        contraception to be safe and effective in preventing unintended 
        pregnancy, reducing the risk by as much as 89 percent if taken 
        within days of unprotected intercourse and up to 95 percent if 
        taken in the first 24 hours.
            (6) Medical research strongly indicates that the sooner 
        emergency contraception is administered, the greater the 
        likelihood of preventing unintended pregnancy.
            (7) In light of the safety and effectiveness of emergency 
        contraceptive pills, both the American Medical Association and 
        the American College of Obstetricians and Gynecologists have 
        endorsed more widespread availability of such pills.
            (8) The American College of Emergency Physicians and the 
        American College of Obstetricians and Gynecologists agree that 
        offering emergency contraception to female patients after a 
        sexual assault should be considered the standard of care.
            (9) Approximately 30 percent of American women of 
        reproductive age are unaware of the availability of emergency 
        contraception.
            (10) New data from a survey of women having abortions 
        estimates that 51,000 abortions were prevented by use of 
        emergency contraception in 2000 and that increased use of 
        emergency contraception accounted for 43 percent of the 
        decrease in total abortions between 1994 and 2000.
            (11) It is essential that all hospitals that provide 
        emergency medical treatment provide emergency contraception as 
        a treatment option to any woman who has been sexually 
        assaulted, so that she may prevent an unintended pregnancy.
            (12) Victims of sexual assault are at increased risk of 
        contracting sexually transmitted diseases.
            (13) Some sexually-transmitted infections cannot be 
        reliably cured if treatment is delayed, and may result in high 
        morbidity and mortality. HIV has killed over 520,000 Americans, 
        and the Centers for Disease Control and Prevention currently 
        estimates that over 1,000,000 Americans are infected with the 
        virus. Even modern drug treatment has failed to cure infected 
        individuals. Nearly 80,000 Americans are infected with 
        hepatitis B each year, with some individuals unable to fully 
        recover. An estimated 1,250,000 Americans remain chronically 
        infected with the hepatitis B virus and at present, one in five 
        of these may expect to die of liver failure.
            (14) It is possible to prevent some sexually transmitted 
        diseases by treating an exposed individual promptly. The use of 
        post-exposure prophylaxis using antiretroviral drugs has been 
        demonstrated to effectively prevent the establishment of HIV 
        infection. Hepatitis B infection may also be eliminated if an 
        exposed individual receives prompt treatment.
            (15) The Centers for Disease Control and Prevention has 
        recommended risk evaluation and appropriate application of 
        post-exposure treatment for victims of sexual assault. For such 
        individuals, immediate treatment is the only means to prevent a 
        life threatening infection.
            (16) It is essential that all hospitals that provide 
        emergency medical treatment provide assessment and treatment of 
        sexually-transmitted infections to minimize the harm to victims 
        of sexual assault.

SEC. 3. 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 has been approved by 
                the Food and Drug Administration as a safe and 
                effective way to prevent pregnancy after unprotected 
                intercourse or contraceptive failure if taken in a 
                timely manner, and is more effective the sooner it is 
                taken; and
                    (B) emergency contraception does not cause an 
                abortion and cannot interrupt an established pregnancy.
            (2) The hospital promptly offers emergency contraception to 
        the woman, and promptly provides such contraception to her at 
        the hospital 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 to pay for 
        the services.

SEC. 4. PREVENTION OF TRANSMISSIBLE DISEASE.

    (a) In General.--No hospital shall receive Federal funds unless 
such hospital provides risk assessment, counseling, and treatment as 
required under this section to a survivor of sexual assault described 
in subsection (b).
    (b) Survivors of Sexual Assault.--An individual is a survivor of a 
sexual assault as described in this subsection if the individual--
            (1) presents at the hospital and declares that the 
        individual is a victim of sexual assault, or the individual is 
        accompanied to the hospital by another individual who declares 
        that the first individual is a victim of a sexual assault; or
            (2) presents at the hospital and hospital personnel have 
        reason to believe the individual is a victim of sexual assault.
    (c) Requirement for Risk Assessment, Counseling, and Treatment.--
The following shall apply with respect to a hospital described in 
subsection (a):
            (1) Risk assessment.--A hospital shall promptly provide a 
        survivor of a sexual assault with an assessment of the 
        individual's risk for contracting sexually transmitted 
        infections as described in paragraph (2)(A), which shall be 
        conducted by a licensed medical professional and be based 
        upon--
                    (A) available information regarding the assault as 
                well as the subsequent findings from medical 
                examination and any tests that may be conducted; and
                    (B) established standards of risk assessment which 
                shall include consideration of any recommendations 
                established by the Centers for Disease Control and 
                Prevention, and may also incorporate findings of peer-
                reviewed clinical studies and appropriate research 
                utilizing in vitro and non-human primate models of 
                infection.
            (2) Counseling.--A hospital shall provide a survivor of a 
        sexual assault with advice, provided by a licensed medical 
        professional, concerning--
                    (A) significantly prevalent sexually transmissible 
                infections for which effective post-exposure 
                prophylaxis exists, and for which the deferral of 
                treatment would either significantly reduce treatment 
                efficacy or would pose substantial risk to the 
                individual's health; and
                    (B) the requirement that prophylactic treatment for 
                infections as described in subparagraph (A) shall be 
                provided to the individual upon request, regardless of 
                the ability of the individual to pay for such 
                treatment.
            (3) Treatment.--A hospital shall provide a survivor of a 
        sexual assault, upon request, with prophylactic treatment for 
        infections described in paragraph (2)(A).
            (4) Ability to pay.--The services described in paragraphs 
        (1) through (3) shall not be denied because of the inability of 
        the individual involved to pay for the services.
            (5) Language.--Any information provided pursuant to this 
        subsection shall be clear and concise, readily comprehensible, 
        and meet such conditions regarding the provision of the 
        information in languages other than English as the Secretary 
        may establish.
    (d) Rule of Construction.--Nothing in this section shall be 
construed to--
            (1) require that a hospital provide prophylactic treatment 
        for a victim of sexual assault when risk evaluation according 
        to criteria adopted by the Centers for Disease Control and 
        Prevention clearly recommend against the application of post-
        exposure prophylaxis;
            (2) prohibit a hospital from seeking reimbursement for the 
        cost of services provided under this section to the extent that 
        health insurance may reimburse for such services; and
            (3) establish a requirement that any victim of sexual 
        assault submit to diagnostic testing for the presence of any 
        infectious disease.
    (e) Limitation.--Federal funds may not be provided to a hospital 
under any health-related program unless the hospital complies with the 
requirements of this section.

SEC. 5. DEFINITIONS.

    In this Act:
            (1) Emergency contraception.--The term ``emergency 
        contraception'' means a drug, drug regimen, or device that is--
                    (A) approved by the Food and Drug Administration to 
                prevent pregnancy; and
                    (B) is used postcoitally.
            (2) Hospital.--The term ``hospital'' has the meaning 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. Such term includes a 
        health care facility that is located within, or contracted to, 
        a correctional institution or a post-secondary educational 
        institution.
            (3) Licensed medical professional.--The term ``licensed 
        medical professional'' means a doctor of medicine, doctor of 
        osteopathy, registered nurse, physician assistant, or any other 
        healthcare professional determined appropriate by the 
        Secretary.
            (4) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
            (5) Sexual assault.--
                    (A) In general.--The term ``sexual assault'' means 
                a sexual act (as defined in subparagraphs (A) through 
                (C) of section 2246(2) of title 18, United States Code) 
                where the victim involved does not consent or lacks the 
                capacity to consent.
                    (B) Application of provisions.--The definition 
                under subparagraph (A) shall--
                            (i) in the case of section 2, apply to 
                        males and females, as appropriate;
                            (ii) in the case of section 3, apply only 
                        to females; and
                            (iii) in the case of section 4, apply to 
                        all individuals.

SEC. 6. EFFECTIVE DATE; AGENCY CRITERIA.

    This Act shall take effect upon the expiration of the 180-day 
period beginning on the date of the enactment of this Act. Not later 
than 30 days prior to the expiration of such period, the Secretary of 
Health and Human Services shall publish in the Federal Register 
criteria for carrying out this Act.
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