[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 844 Placed on Calendar Senate (PCS)]






                                                        Calendar No. 78
109th CONGRESS
  1st Session
                                 S. 844

 To expand access to preventive health care services that help reduce 
   unintended pregnancy, reduce the number of abortions, and improve 
                     access to women's health care.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             April 19, 2005

Mrs. Clinton (for herself and Mr. Reid) introduced the following bill; 
                     which was read the first time

                             April 20, 2005

            Read the second time and placed on the calendar

_______________________________________________________________________

                                 A BILL


 
 To expand access to preventive health care services that help reduce 
   unintended pregnancy, reduce the number of abortions, and improve 
                     access to women's health care.

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

SECTION 1. 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--TEENAGE PREGNANCY PREVENTION

Sec. 601. Short title.
Sec. 602. Teenage pregnancy prevention.
            TITLE VII--ACCURACY OF CONTRACEPTIVE INFORMATION

Sec. 701. Short title.
Sec. 702. Accuracy of contraceptive information.

SEC. 2. FINDINGS.

    The Congress finds as follows:
            (1) Although the Centers for Disease Control and Prevention 
        (referred to in this section as the ``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, 3,000,000 pregnancies, nearly half of all 
        pregnancies, in the United States are unintended, and nearly 
        half of unintended pregnancies end in abortion.
            (3) In 2002, 34,000,000 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 of any 
        industrialized country. In 2003 there were approximately 
        19,000,000 new cases of sexually transmitted diseases. 
        According to the CDC (November 2004), these sexually 
        transmitted diseases impose a tremendous economic burden with 
        direct medical costs as high as $15,500,000,000 per year.
            (5) Increasing access to family planning services will 
        improve women's health and reduce the rates of unintended 
        pregnancy, abortion, and infection with sexually transmitted 
        diseases. 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 
        risk 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) The percentage of sexually active women ages 15 
        through 44 who were not using contraception increased from 5.4 
        percent to 7.4 percent in 2002, an increase of 37 percent, 
        according to the CDC. This represents an apparent increase of 
        1,430,000 women and could raise the rate of unintended 
        pregnancy.
            (12) Many poor and low-income women cannot afford to 
        purchase contraceptive services and supplies on their own. 
        12,100,000 or 20 percent of all women ages 15 through 24 were 
        uninsured in 2002, and that proportion has increased by 10 
        percent since 1999.
            (13) Public health programs like Medicaid and title X (of 
        the Public Health Service Act), 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.
            (14) 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 5,500,000 women of 
        reproductive age--nearly one in 10 women between the ages of 
15 and 44--rely on Medicaid for their basic health care needs.
            (15) Each year, title X services enable Americans to 
        prevent approximately 1,000,000 unintended pregnancies, and one 
        in three women of reproductive age who obtains testing or 
        treatment for sexually transmitted diseases does so at a title 
        X-funded clinic. In 2003, title X-funded clinics provided 
        2,800,000 Pap tests, 5,100,000 sexually transmitted disease 
        tests, and 526,000 HIV tests.
            (16) 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 sexually transmitted 
        diseases, 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 by 58 percent 
        between 1980 and 2003.
            (17) While Medicaid remains the largest source of 
        subsidized family planning services, States are facing 
        significant budgetary pressures to cut their Medicaid programs, 
        putting many women at risk of losing coverage for family 
        planning services.
            (18) 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 coverage of family planning 
        programs through Medicaid.
            (19) As of January of 2005, 21 States offered expanded 
        family planning benefits as a result of Medicaid family 
        planning waivers. The cost-effectiveness of these waivers was 
        affirmed by a recent evaluation funded by the Centers for 
        Medicare & Medicaid. This evaluation of six waivers found that 
        all such programs resulted in significant savings to both the 
        Federal and State governments. Moreover, the researchers found 
        measurable reductions in unintended pregnancy.
            (20) Although employer-sponsored health plans have improved 
        coverage of contraceptive services and supplies, largely in 
        response to State contraceptive coverage laws, there is still 
        significant room for improvement. The ongoing lack of coverage 
        in health insurance plans, particularly in self-insured and 
        individual plans, continues to place effective forms of 
        contraception beyond the financial reach of many women.
            (21) 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.
            (22) Approved for use by the Food and Drug Administration, 
        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. New research confirms that easier access to emergency 
        contraceptives does not increase sexual risk-taking or sexually 
        transmitted diseases.
            (23) In 2000, 51,000 abortions were prevented by the 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.
            (24) A February 2004 CDC study of declining birth and 
        pregnancy rates among teens concluded that the reduction in 
        teen pregnancy between 1991 and 2001 suggests that increased 
        abstinence and increased use of contraceptives were equally 
        responsible for the decline. As such, it is critically 
        important that teens receive accurate, unbiased information 
        about contraception.
            (25) Thirteen percent of all teens give birth before age 
        20. 88 percent of births to teens age 17 or younger were 
        unintended. 24 percent of Hispanic females gave birth before 
        the age of 20. (CDC, December 2004.)
            (26) 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.
            (27) 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.
            (28) Government-funded abstinence only programs are 
        precluded from discussing contraception except to talk about 
        failure rates. A December 2004 review of federally-funded 
        abstinence-only programs by the United States House of 
        Representatives Committee on Government Reform (Minority Staff) 
        found that many federally-funded abstinence-only program 
        curricula distort public health data and misrepresent the 
        effectiveness of contraception. Information on the 
        effectiveness of condoms, in preventing pregnancy and sexually 
        transmitted diseases, including HIV, was often highly 
        inaccurate.

             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 2005''.

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 2006, 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 1936 as section 1937; and
            (2) by inserting after section 1935 the following:

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

    ``Sec. 1936.
    ``(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, 2005.

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, 2005.

 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, 2006.

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, 2006.

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, 2006.

      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;
                    (B) prevents pregnancy, by preventing ovulation, 
                fertilization of an egg, or implantation of an egg in a 
                uterus; and
                    (C) approved by the Food and Drug Administration.
            (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 2006 through 2010.

         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--
                    (A) is 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--TEENAGE PREGNANCY PREVENTION

SEC. 601. SHORT TITLE.

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

SEC. 602. 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. 399N-1. 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 
2006, 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 2006 and each subsequent fiscal year.''.

            TITLE VII--ACCURACY OF CONTRACEPTIVE INFORMATION

SEC. 701. SHORT TITLE.

    This title may be cited as the ``Truth in Contraception Act''.

SEC. 702. ACCURACY OF CONTRACEPTIVE INFORMATION.

    Notwithstanding any other provision of law, any information 
concerning the use of a contraceptive provided through any federally-
funded sex education, family life education, abstinence education, 
comprehensive health education, or character education program shall be 
medically accurate and shall include health benefits and failure rates 
relating to the use of such contraceptive.




                                                        Calendar No. 78

109th CONGRESS

  1st Session

                                 S. 844

_______________________________________________________________________

                                 A BILL

 To expand access to preventive health care services that help reduce 
   unintended pregnancy, reduce the number of abortions, and improve 
                     access to women's health care.

_______________________________________________________________________

                             April 20, 2005

            Read the second time and placed on the calendar