1.This Act may be cited as
the Compassionate Assistance for Rape
Emergencies Act of 2007
.
2.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. Timely access to
emergency contraception could help many of these rape survivors avoid the
additional trauma of facing an unintended pregnancy.
(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 if taken in the first 72 hours of sex.
(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 to women of all
ages.
(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
one-third of women of reproductive age remain unaware of emergency
contraception. Therefore, women who have been sexually assaulted are unlikely
to ask for emergency contraception.
(10)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.
(11)Victims of sexual assault are at increased
risk of contracting sexually transmitted diseases.
(12)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 60,000
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 4 of those infected individuals may expect to die of liver
failure.
(13)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.
(14)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.
(15)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.Survivors of
sexual assault; provision by hospitals of emergency contraceptives without
charge
(a)Federal funds may not be provided to a hospital under
title XVIII of the Social Security Act or to a State, with respect to services
of a hospital, under title XIX of such Act, 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 an
over-the-counter medication for women ages 18 and over and is a safe and
effective way to prevent pregnancy after unprotected intercourse or
contraceptive failure if taken in a timely manner;
(B)emergency
contraception is more effective the sooner it is taken; and
(C)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 or her family to pay for the services.
(c)For
purposes of this section:
(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 section 1861(e)
of the Social Security Act (42 U.S.C. 1395x(e)), and includes critical access
hospitals, as defined in section 1861(mm)(1) of such Act (42 U.S.C.
1395x(mm)(1)).
(3)The
term Secretary means the Secretary of Health and Human
Services.
(4)
(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 apply to all individuals.
(d)Effective Date;
Agency CriteriaThis section takes 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 shall
publish in the Federal Register criteria for carrying out this section.
4.Prevention of
sexually transmitted disease
(a)In
this section:
(1)The
term hospital has the meaning given such term in section 1861(e)
of the Social Security Act (42 U.S.C. 1395x(e)), and includes critical access
hospitals, as defined in section 1861(mm)(1) of such Act (42 U.S.C.
1395x(mm)(1)).
(2)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.
(3)The term Secretary means the
Secretary of Health and Human Services.
(4)
(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 apply to all individuals.
(b)Federal funds may
not be provided to a hospital under title XVIII of the Social Security Act (42
U.S.C. 1395 et seq.) or to a State, with respect to services of a hospital,
under title XIX of such Act (42 U.S.C. 1396 et seq.), unless the hospital
provides risk assessment, counseling, and treatment as required under this
section to a survivor of sexual assault described in subsection (c).
(c)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 states 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.
(d)Requirement for
risk assessment, counseling, and treatmentThe following shall apply with respect to a
hospital described in subsection (b):
(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 or the
individual’s family 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)Any information provided pursuant to this
subsection shall be in clear and concise language, be readily comprehensible,
and meet such conditions regarding the provision of the information in
languages other than English as the Secretary may establish.
(5)The services described in
paragraphs (1) through (3) shall not be denied because of the inability of the
individual involved or the individual’s family to pay for the services.
(e)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.
(f)Effective Date;
Agency CriteriaThis section takes 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 shall
publish in the Federal Register criteria for carrying out this section.