[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[S. 2948 Introduced in Senate (IS)]

<DOC>






114th CONGRESS
  2d Session
                                S. 2948

To plan, develop, and make recommendations to increase access to sexual 
assault examinations for survivors by holding hospitals accountable and 
               supporting the providers that serve them.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 18, 2016

     Mrs. Murray (for herself, Mrs. Shaheen, Mrs. McCaskill, Mrs. 
 Gillibrand, Ms. Baldwin, Mrs. Boxer, Mr. Blumenthal, Mr. Bennet, and 
  Mr. Wyden) introduced the following bill; which was read twice and 
  referred to the Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
To plan, develop, and make recommendations to increase access to sexual 
assault examinations for survivors by holding hospitals accountable and 
               supporting the providers that serve them.

    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 ``Survivors' Access to Supportive Care 
Act'' or ``SASCA''.

SEC. 2. PURPOSE.

    It is the purpose of this Act to increase access to medical 
forensic sexual assault examinations and treatment provided by sexual 
assault forensic examiners for survivors by identifying and addressing 
gaps in obtaining those services.

SEC. 3. DEFINITIONS.

    In this Act:
     (a) Terms Relating to GAO Report.--In this Act, the following 
terms shall, with respect to hospitals that receive Federal funds, have 
the meanings given such terms in the report of the Government 
Accountability Office entitled ``Information on Training, Funding, and 
the Availability of Forensic Examiners'' (GAO-16-334: Published: Mar 
18, 2016):
            (1) MFE.--The term ``medical forensic examination'' or 
        ``MFE''.
            (2) SAFE.--The term ``sexual assault forensic examiner'' or 
        ``SAFE''.
            (3) SANE.--The term ``sexual assault nurse examiner'' or 
        ``SANE''.
            (4) SART.--The term ``sexual assault response team'' or 
        ``SART''.
    (b) Other Terms.--In this Act:
            (1) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
            (2) Sexual assault.--The term ``sexual assault'' has the 
        meaning given such term by the Federal Bureau of Investigation 
        in the Uniform Crime Reporting Program's Summary Reporting 
        System.

      TITLE I--STRENGTHENING THE SEXUAL ASSAULT EXAMINER WORKFORCE

SEC. 101. UNDERSTANDING SEXUAL ASSAULT CARE.

    (a) Purpose.--It is the purpose of this section to identify areas 
for improvement in health care delivery systems providing services to 
survivors of sexual assault.
    (b) Grants.--The Secretary may award grants to State governments 
for the development and implementation of State surveys on health care 
provider access for sexual assault forensic examination services to 
identify--
            (1) State requirements, minimum standards, and protocols 
        for training sexual assault examiners;
            (2) State requirements, minimum standards, and protocols 
        for training non-SANE/SAFE emergency services personnel 
        involved in sexual assault medical forensic examinations;
            (3) the availability of, and patient access to, trained 
        SAFE, SANE, and other providers who perform such examinations;
            (4) regional, provider, or other barriers to access sexual 
        assault care and services;
            (5) the dedicated Federal and State funding to support 
        SAFE/SANE training;
            (6) funding opportunities for SANE/SAFE training and 
        continuing education;
            (7) billing and reimbursement practices for medical 
        forensic examinations including private health insurance, 
        Medicare, Medicaid, the State's victims compensation program 
        and any other crime funding or special sources of funding that 
        contribute to payment for such examinations;
            (8) an assessment of which hospitals and States are not in 
        compliance with Federal law, are not providing survivors of 
        sexual assault for their medical forensic examination or sexual 
        assault examination, and which are billing such survivors for 
        such services; and
            (9) the availability of SAFE/SANE training, frequency of 
        which training is convened, the providers of such training, 
        what (if any) is the State's role in such training, and what 
        process or procedures are in place for continuing education of 
        such examiners.
    (c) Eligibility.--To be eligible to receive a grant under this 
section, an entity shall--
            (1) be a State with public, private, and non-profit 
        hospitals that receive Federal funding; and
            (2) submit to the Secretary an application through a 
        competitive process to be determined by the Secretary.
    (d) Public Dissemination and Campaign.--
            (1) Public availability.--The results of the surveys 
        conducted under grants under this section shall be published by 
        the Secretary on the Internet website of the Department of 
        Health and Human Services on a biennial basis.
            (2) Campaigns.--An entity that receives a grant under this 
        section shall--
                    (A) make the findings of the survey conducted under 
                the grant public;
                    (B) develop policies, best practices 
                recommendations, and an action plan to increase access 
                to SAFE/SANE; and
                    (C) utilize such findings to develop and implement 
                a public awareness campaign to improve patient access 
                to services and providers, and improve hospital and 
                stakeholder practices, with respect to sexual assault 
                forensic examinations.
    (e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $2,000,000 for each of fiscal 
years 2017 through 2019.

SEC. 102. IMPROVING AND STRENGTHENING THE SEXUAL ASSAULT EXAMINER 
              WORKFORCE PILOT PROGRAM.

    (a) Purpose.--It is the purpose of this section to establish a 
pilot program to develop, test, and implement SAFE training which 
expands the availability of SAFE, SANE, and SART providers for 
survivors of sexual assault.
    (b) Eligibility To Provide Services.--With respect to hospitals 
that receive Federal funds, SAFE/SANE services, and other forensic 
medical examiner services shall be provided by health care providers 
who are also one of the following:
            (1) A physician, including a resident physician.
            (2) A nurse practitioner.
            (3) A nurse midwife.
            (4) A physician assistant.
            (5) A certified nurse specialist.
            (6) A registered nurse.
            (7) Where a provider of the type described in paragraphs 
        (1) through (6) is not available, such services may be provided 
        by an individual who has completed sexual assault forensic 
        examiner training and maintained continuing education in such 
        training, as developed by the Secretary and the Task Force 
        under section 201.
    (c) Training and Continuing Education.--
            (1) Establishment.--
                    (A) In general.--Not later than 1 year after the 
                date of enactment of this Act, the Secretary, in 
                consultation with the Attorney General, the Centers for 
                Medicare & Medicaid Services, the Centers for Disease 
                Control and Prevention, the Health Resources and 
                Services Administration, the Indian Health Service, the 
                Office for Victims of Crime, the Office on Women's 
                Health, and the Department of Justice Office on 
                Violence Against Women, and with input from national 
                experts such as the International Association of 
                Forensic Nurses, the Emergency Nurses Association, the 
                Rape, Abuse, and Incest National Network, the National 
                Alliance to End Sexual Violence, the National Sexual 
                Violence Resource Center, and others shall--
                            (i) establish a national continuing and 
                        clinical education pilot program for SAFEs, 
                        SANEs, and other individuals who perform such 
                        examinations; and
                            (ii) develop, pilot, implement, and update 
                        as appropriate continuing and clinical 
                        education program modules, webinars, and 
                        programs for all hospitals and providers to 
                        increase access to SANE and SAFE services and 
                        address ongoing competency issues in SAFE/SANE 
                        practice of care.
                    (B) Application.--The training and continuing 
                education program established under subparagraph (A) 
                shall be available to all SAFEs, SANEs, and other 
                providers employed by, or any individual providing 
                services through, facilities that receive Federal 
                funding.
            (2) Elements.--The training and continuing education 
        program established under this subsection shall require that 
        the provision of training in sexual assault medical forensic 
        examinations be provided by qualified personnel who possess--
                    (A) the minimum training required to be considered 
                a SAFE/SAFE described in paragraph (1); or
                    (B) training and clinical or forensic experience in 
                sexual assault forensic examinations similar to that 
                required for a certification described in subparagraph 
                (A) based in part on the recommendations of the 
                National Sexual Assault Forensic Examination Training 
                Standards issued by the Department of Justice on 
                Violence Against Women.
            (3) Nature of training.--The training provided under the 
        training and clinical and continuing education program 
        established under this subsection shall incorporate and reflect 
        current best practices and standards on sexual assault medical 
        forensic examinations consistent with the purpose described in 
        section 2, such as the use of telemedicine consistent with 
        section 201.
            (4) Applicability of training requirements.--
                    (A) In general.--Effective beginning 1 year after 
                the date of the enactment of this Act, a licensed 
                medical professional shall not provide SAFE/SANE 
                services, or provide any other forensic medical 
                examiner services, unless the professional has 
                completed--
                            (i) all training required under the 
                        training and continuing education pilot program 
                        established in this subsection;
                            (ii) all training required to be considered 
                        a SANE by the International Association of 
                        Forensic Nurses; or
                            (iii) all training required to be certified 
                        or credentialed as a SAFE/SANE by the 
                        applicable State issuing body.
                    (B) Continued application of clinical education and 
                training.--If a practicing SAFE/SANE was qualified or 
                trained through a practical training program (such as 
                the International Association of Forensic Nurses SANE 
                training) prior to the date of enactment of this Act, 
                such examiner shall be permitted to continue to provide 
                services as a SAFE or SANE so long as such examiner 
                meets the applicable continuing clinical education 
                requirements.
                    (C) Rule of construction.--Nothing in this Act (or 
                the amendments made by this Act) shall be construed to 
                preempt any provision of Federal or State law to the 
                extent that such Federal or State law provides 
                protections for survivor's access to SAFE/SANE care 
                that are greater than the protections provided for in 
                this Act (or amendments).
            (5) Effective date.--
                    (A) In general.--The pilot program established 
                under this section shall terminate on the date that is 
                2 years after the date of such establishment.
                    (B) Authority for modifications.--Upon the 
                expiration of the pilot program as provided for in 
                subparagraph (A), the Secretary may implement 
                modifications relating to training and continuing 
                education requirements based on such program to 
                increase access to SANE and SAFE services for survivors 
                of sexual assault.
                    (C) Technical assistance.--The Secretary and the 
                Attorney General shall provide technical assistance and 
                guidance to ensure compliance with the requirements of 
                this section.
                    (D) Preemption.--Nothing in this section shall be 
                construed to preempt any provision of Federal or State 
                law to the extent that such Federal or State law 
                provides protections for survivors of sexual assault 
                that are greater than the protections provided for in 
                this section.

SEC. 103. NATIONAL REPORT ON SEXUAL ASSAULT SERVICES IN OUR NATION'S 
              HEALTH SYSTEM.

    (a) In General.--Not later than 1 year after the date of enactment 
of this Act, and annually thereafter, the Agency for Healthcare 
Research and Quality, in consultation with the Centers for Medicare & 
Medicaid Services, the Centers for Disease Control and Prevention, the 
Health Resources and Services Administration, the Indian Health 
Service, the Office for Victims of Crime, the Office on Women's Health, 
and the Office of Violence Against Women of the Department of Justice 
(hereafter referred to in this section collectively as the 
``Agencies''), shall submit to the Secretary a report of existing 
Federal and State practices relating to SAFEs, SANEs, and others who 
perform such examinations which reflects the findings of the surveys 
developed under section 101.
    (b) Core Competencies.--In conducting activities under this 
section, the Agencies shall address SAFE/SANE competencies including--
            (1) providing comprehensive medical care to sexual assault 
        patients;
            (2) demonstrating the ability to conduct a medical forensic 
        examination to include an evaluation for evidence collection;
            (3) showing compassion and sensitivity towards survivors of 
        sexual assault;
            (4) testifying in Federal, State, local, and tribal courts; 
        and
            (5) other competencies as determined appropriate by the 
        Agencies.
    (c) Publication.--
            (1) AHRQ.--The Agency for Healthcare Research and Quality 
        shall establish, maintain, and publish on the Internet website 
        of the Department of Health and Human Services an online public 
        map of SAFE, SANE, and other forensic medical examiners 
        available to the Department of Health and Human Services.
            (2) States.--A State that receives Federal funds shall 
        maintain and make available a State map displaying the number 
        of available SAFE/SANE programs and other forensic medical 
        examiners.

SEC. 104. HOSPITAL REPORTING.

    Not later than 1 year after the date of enactment of this Act, and 
annually thereafter, a hospital that receives Federal funds shall 
submit to the Secretary a report that identifies the level of community 
access provided by the hospital to trained SAFEs, SARTs, SANEs, and 
others who perform such examinations. Such report shall describe--
            (1) the number of sexual assault forensic examinations done 
        in the hospital in the year for which the report is being 
        prepared;
            (2) the training that such SAFEs/SANEs undergo, both 
        initially and for recertification;
            (3) the number of SAFEs/SANEs employed by the hospital, 
        differentiating between part-time and full-time employees; and
            (4) the SAFE/SANE standards of care applied by the 
        hospital.

                      TITLE II--STANDARDS OF CARE

SEC. 201. NATIONAL SEXUAL ASSAULT CARE AND TREATMENT TASK FORCE.

    (a) Establishment.--The Secretary shall establish a task force to 
be known as the ``SASCA Task Force'' (referred to in this section as 
the ``Task Force'') to review State guidelines, procedures, practices, 
training, and employment and retention data for SAFE/SANE and other 
forensic medical examiners.
    (b) Appointments.--The Secretary, in consultation with the Centers 
for Medicare & Medicaid Services, the Centers for Disease Control and 
Prevention, the Health Resources and Services Administration, the 
Indian Health Service, the Office for Victims of Crime, the Office on 
Women's Health, and the Department of Justice Office on Violence 
Against Women, and key stakeholders such as the International 
Association of Forensic Nurses, the Rape, Abuse, and Incest National 
Network, the National Domestic Violence Hotline, the National Alliance 
to End Sexual Violence, the National Sexual Violence Resource Center, 
and community-based organizations shall appoint experts to the Task 
Force.
    (c) Objectives.--To assist and standardize State-level efforts to 
improve medical forensic evidence collection relating to sexual 
assault, the Task Force shall--
            (1) review State-level practices for SAFEs, SARTs, SANEs, 
        and others who perform such examinations to ensure that such 
        practices are consistent with established national training, 
        certification, and practice recommendations;
            (2) create a best practices guide for forensic medical 
        examiners relating to sexual assault;
            (3) improve coordination of services, and other protocols 
        regarding the care and treatment of sexual assault survivors 
        and the preservation of evidence between law enforcement 
        officials and health care providers; and
            (4) update national minimum standards for forensic medical 
        examiner training and forensic medical evidence collection 
        relating to sexual assault.
    (d) Transparency Requirements.--
            (1) In general.--The Task Force shall report to the 
        Secretary, at such time, in such manner, and containing such 
        information as may be specified by the Secretary, on--
                    (A) the recommendation for best practices with 
                respect to improving medical forensic evidence 
                collection relating to sexual assault; and
                    (B) the national minimum standards for medical 
                forensic examinations and treatments relating to sexual 
                assault.
            (2) Report.--Not later than one year after the date of 
        enactment of this Act, the Secretary shall submit to Congress a 
        report on the findings and conclusions of the Task Force.
    (e) Annual Summit.--The Secretary shall convene an annual 
stakeholder meeting to address gaps in health care provider care 
relating to sexual assault. Such meetings shall include the Task Force, 
as well as the Centers for Medicare & Medicaid Services, the Centers 
for Disease Control and Prevention, the Health Resources and Services 
Administration, the Indian Health Service, the Office for Victims of 
Crime, the Office on Women's Health, and the Department of Justice 
Office on Violence Against Women, and key stakeholders such as the 
International Association of Forensic Nurses, the Rape, Abuse, and 
Incest National Network, National Alliance to End Sexual Violence, 
National Sexual Violence Resource Center and community-based 
organizations.

SEC. 202. INSTITUTES OF HIGHER EDUCATION CAMPUS ACTION PLAN.

    (a) In General.--Each institution of higher education that receives 
Federal funds shall make publicly available a written plan of the steps 
the institution takes to ensure access to sexual assault medical 
forensic examinations and treatments. Such plan shall include 
information about the availability of services, and a statement that 
Federal law requires that such exams be provided free of charge.
    (b) Access to Examinations.--Each institution of higher education 
that receives Federal funds shall, to the extent practicable, ensure 
that students have access to sexual assault medical forensic 
examination by employing the use of a SAFE/SANE in the campus medical 
facility or hospital or by entering into a memorandum of understanding 
or formal agreement with at least one local health care facility to 
provide such service if no appropriate medical facility is available on 
campus, including the cost of transportation for students to access 
services.

SEC. 203. EXPANDING ACCESS TO UNIFIED CARE.

    Part B of title VIII of the Public Health Service Act (42 U.S.C. 
296j et seq.) is amended by adding at the end the following:

``SEC. 812. DEMONSTRATION GRANTS FOR SEXUAL ASSAULT EXAMINER TRAINING 
              PROGRAMS.

    ``(a) Establishment of Program.--The Secretary shall establish a 
demonstration program (referred to in this section as the `program') to 
award grants to eligible partnered entities for the clinical training 
of SAFEs/SANEs (including registered nurses, nurse practitioners, nurse 
midwives, clinical nurse specialists, physician assistants, and 
physicians) to administer medical forensic examinations and treatments 
to victims of sexual assault in hospitals, health centers, and other 
emergency health care service provider settings, including Federally 
qualified health centers, clinics receiving funding under title X, and 
other health care providers as determined appropriate by the Secretary.
    ``(b) Purpose.--The purpose of the program is to enable each grant 
recipient to expand access to SAFE/SANE services by providing new 
providers with the clinical training necessary to establish and 
maintain competency in SAFE/SANE services.
    ``(c) Grants.--Under the program, the Secretary shall award 3-year 
grants to eligible entities that meet the requirements established by 
the Secretary, for the purpose of operating the SAFE/SANE training 
programs described in subsection (a) at such entities and to test the 
provision of such services at new facilities in expanded health care 
settings.
    ``(d) Eligible Entities.--To be eligible to receive a grant under 
this section, an entity shall--
            ``(1) be a rural health care services provider (as defined 
        by the Secretary), a center or clinic under section 330, or a 
        health center receiving assistance under title X, acting in 
        partnership with a high-volume emergency services provider or a 
        hospital currently providing sexual assault medical forensic 
        examinations performed by SANEs or SAFEs, that will use grant 
        funds to--
                    ``(A) assign rural health care service providers to 
                the high-volume hospitals for clinical practicum hours 
                to qualify such providers as a SAFE/SANE; or
                    ``(B) assign practitioners at high-volume hospitals 
                to a rural health care services providers to instruct, 
                oversee, and approve clinical practicum hours in the 
                community to be served.
            ``(2) submit to the Secretary an application at such time, 
        in such manner, and containing such information as the 
        Secretary may require, including a description of whether the 
        applicant will provide services under subparagraph (A) or (B) 
        of paragraph (1).
    ``(e) Grant Amount.--Each grant awarded under this section shall be 
in an amount not to exceed $400,000 per year. A grant recipient may 
carry over funds from 1 fiscal year to the next without obtaining 
approval from the Secretary.
    ``(f) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $10,000,000 for each of fiscal 
years 2016 through 2019.''.

SEC. 204. TECHNICAL ASSISTANCE GRANTS AND LEARNING COLLECTIVES.

    Part B of title VIII of the Public Health Service Act (42 U.S.C. 
296j et seq.), as amended by section 203, is further amended by adding 
at the end the following:

``SEC. 812A. TECHNICAL ASSISTANCE CENTER AND REGIONAL LEARNING 
              COLLECTIVES.

    ``(a) In General.--The Secretary shall establish a State and 
provider technical resource center to provide technical assistance to 
health care providers to increase the quality of, and access to, sexual 
assault examinations by entering into contracts with national experts 
(such as the International Forensic Nurses Association and others).
    ``(b) Regional Learning Collectives.--The Secretary shall convene 
State and hospital regional learning collectives to assist health care 
providers and States in sharing best practices, discussing practices, 
and improving the quality of, and access to, sexual assault 
examinations.
    ``(c) Repository.--The Secretary shall establish and maintain a 
secure Internet-based data repository to serve as an online learning 
collective for State and entity collaborations. An entity receiving a 
grant under section 812 may use such repository for--
            ``(1) technical assistance; and
            ``(2) best practice sharing.''.

SEC. 205. QUALITY STRATEGIES.

    The Secretary shall identify SAFE/SANE access and quality in 
hospitals and other appropriate health care facilities as a national 
priority for improvement under section 399HH(a)(2) of the Public Health 
Service Act (42 U.S.C. 280j).

SEC. 206. OVERSIGHT.

    Not later than 1 year after the date of enactment of this Act, the 
Office of the Inspector General shall issue a report concerning 
hospital compliance with section 1867 of the Social Security Act (42 
U.S.C. 1395dd) and the Violence Against Women Act of 1994 (42 U.S.C. 
13701 et seq.) with respect to access to, and reimbursements for, 
sexual assault medical forensic examinations at the national, State, 
and individual hospital level. Such report shall address hospital 
awareness of reimbursements, total reimbursed costs, and any costs for 
victims.
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