1.This Act may be cited as the
Compassionate Assistance for Rape
Emergencies Act
.
2.Congress finds the following:
(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 or incest survivors had timely
access to emergency contraception.
(2)A 1996 study of pregnancies resulting from
rape or incest (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 after unprotected intercourse.
(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 part of the standard of care.
(9)Approximately 30 percent of United States
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 individuals in the United States, and
the Centers for Disease Control and Prevention currently estimates that over
1,000,000 individuals in the United States are infected with the virus. Even
modern drug treatment has failed to cure infected individuals. Nearly 80,000
individuals in the United States are infected with hepatitis B each year, with
some individuals unable to fully recover. An estimated 1,250,000 individuals in
the United States remain chronically infected with the hepatitis B virus and at
present, 1 in 5 of those infected individuals 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.
3.In this Act:
(1)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)The term hospital has the
meaning given such term in title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.),
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 that enters into a contract with, a correctional institution or a
post-secondary educational institution.
(3)Licensed
medical professionalThe term
licensed medical professional means a doctor of medicine, doctor
of osteopathy, registered nurse, physician assistant, or any other health care
professional determined to be appropriate by the Secretary.
(4)The term Secretary means the
Secretary of Health and Human Services.
(5)
(A)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
provisionsThe definition in
subparagraph (A) shall—
(i)in the case of section 2, apply to males
and females, as appropriate;
(ii)in the case of section 4, apply only to
females; and
(iii)in the case of section 5, apply to all
individuals.
4.Survivors of sexual
assault; provision by hospitals of emergency contraceptives without
charge
(a)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 arrives 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 arrives at the hospital whom
hospital personnel have reason to believe is a victim of sexual assault.
(b)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)Conditions for
informationThe 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)Provision despite
inability to payThe services
described in paragraphs (1) through (3) are not denied because of the inability
of the woman to pay for the services.
5.Prevention of
sexually transmitted disease
(a)Federal funds may not
be provided to a hospital under any health-related program, unless the 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 assaultAn individual
is a survivor of a sexual assault described in this subsection if the
individual—
(1)arrives at the hospital and states that the
individual is a victim of sexual assault, or is accompanied to the hospital by
another individual who declares that the first individual is a victim of sexual
assault; or
(2)arrives 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 treatmentThe following shall apply with respect to a
hospital described in subsection (a):
(1)A hospital shall
promptly provide a survivor of a sexual assault with an assessment of the
individual’s risk of contracting sexually transmitted infections described in
paragraph (2)(A), which assessment 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
consideration of findings of peer-reviewed clinical studies and appropriate
research utilizing in vitro and non-human primate models of infection.
(2)A hospital shall provide a survivor of a
sexual assault with advice, provided by a licensed medical professional,
concerning—
(A)significantly prevalent sexually
transmitted infections for which effective post-exposure prophylaxis exists,
and for which the deferral of treatment would either significantly reduce
treatment efficacy or pose substantial risk to the individual’s health;
and
(B)the requirement that prophylactic treatment
for infections 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)A hospital shall provide a survivor of a
sexual assault, upon request, with prophylactic treatment for infections
described in paragraph (2)(A).
(4)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)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)Nothing in this
section shall be construed to—
(1)require that a hospital provide
prophylactic treatment for a victim of sexual assault when risk assessment
(according to recommendations established by the Centers for Disease Control
and Prevention) clearly recommends 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 provide reimbursement 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.
6.Not later than 30
days prior to the expiration of the period described in section 7, the
Secretary shall publish in the Federal Register criteria for meeting the
conditions described in sections 4 and 5.
7.This Act takes effect on
the expiration of the 180-day period beginning on the date of the enactment of
this Act.