[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 402 Introduced in Senate (IS)]
<DOC>
116th CONGRESS
1st Session
S. 402
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
February 7, 2019
Mrs. Murray (for herself, Ms. Murkowski, Mr. Blumenthal, Mrs. Shaheen,
Ms. Harris, Mr. Sanders, Ms. Smith, Ms. Hassan, Mr. Leahy, Ms.
Klobuchar, Mrs. Gillibrand, 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:
(1) Community health aide and community health
practitioner.--The terms ``community health aide'' and
``community health practitioner'' have the meanings within the
meaning of section 119 of the Indian Health Care Improvement
Act (25 U.S.C. 1616l).
(2) MFE.--The term ``medical forensic examination'' or
``MFE'' means an examination provided to a sexual assault
survivor by medical personnel trained to gather evidence of a
sexual assault in a manner suitable for use in a court of law.
(3) SAE.--The term ``sexual assault examiner'' or ``SAE''
means a registered nurse, advanced practice nurse, physician,
or physician assistant specifically trained to provide care to
sexual assault forensic examinations.
(4) SAFE.--The term ``sexual assault forensic examiner'' or
``SAFE'' means a medical practitioner who has specialized
forensic training in treating sexual assault survivors and
conducting medical forensic examinations.
(5) SANE.--The term ``sexual assault nurse examiner'' or
``SANE'' means a registered nurse who has specialized forensic
training in treating sexual assault survivors and conducting
medical forensic examinations.
(6) SART.--The term ``sexual assault response team'' or
``SART'' means a multidisciplinary team that provides a
specialized and immediate response to survivors of sexual
assault, and may include health care personnel, law enforcement
representatives, community-based survivor advocates,
prosecutors, and forensic scientists.
(7) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(8) Sexual assault.--The term ``sexual assault'' means any
nonconsensual sexual act proscribed by Federal, tribal, or
State law, including when the individual lacks capacity to
consent.
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 shall award grants to States to develop
and implement State surveys to identify--
(1) the availability of and patient access to trained SAFE,
SANE, and other providers who perform MFEs;
(2) the hospitals or clinics that offer MFEs and whether
each hospital or clinic has full-time, part-time, or on-call
coverage;
(3) regional, provider, or other barriers to access sexual
assault care and services, including MFEs;
(4) billing and reimbursement practices for MFEs, including
private health insurance, Medicare, Medicaid, the State's
victims compensation program, and any other crime funding or
other sources of funding that contribute to payment for such
examinations;
(5) State requirements, minimum standards, and protocols
for training sexual assault examiners;
(6) State requirements, minimum standards, and protocols
for training non-SANE or SAFE emergency services personnel
involved in MFEs;
(7) the availability of SAFE or SANE training, frequency of
when training is convened, the providers of such training, the
State's role in such training, and what process or procedures
are in place for continuing education of such examiners;
(8) the dedicated Federal and State funding to support SAFE
or SANE training; and
(9) funding opportunities for SANE or SAFE training and
continuing education.
(c) Eligibility.--To be eligible to receive a grant under this
section, a State shall--
(1) have public, private, or nonprofit 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 awarded under this section shall be
published by the Secretary on the website of the Department of
Health and Human Services on a biennial basis.
(2) Campaigns.--A State that receives a grant under this
section shall carry out the following:
(A) Make the findings of the survey conducted under
the grant public.
(B) Use the findings to develop a strategic action
plan to increase the number of trained examiners
available in the State and create policies to increase
survivor access to trained examiners.
(C) Use the findings to develop and implement a
public awareness campaign that includes the following:
(i) An online toolkit describing how and
where sexual assault survivors can obtain
assistance and care, including MFEs, in the
State.
(ii) A Model Standard Response Protocol for
health care providers to implement upon arrival
of a patient seeking care for sexual assault.
(iii) A Model Sexual Assault Response Team
Protocol incorporating interdisciplinary
community coordination between hospitals,
emergency departments, hospital administration,
local rape crisis programs, law enforcement,
prosecuting attorneys, and other health and
human service agencies and stakeholders with
respect to delivering survivor-centered sexual
assault care and MFEs.
(iv) A notice of State and Federal laws
prohibiting charging or billing survivors of
sexual assault for care and services related to
sexual assault.
(e) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, $2,000,000 for each of fiscal
years 2019 through 2024.
SEC. 102. IMPROVING AND STRENGTHENING THE SEXUAL ASSAULT EXAMINER
WORKFORCE CLINICAL AND CONTINUING EDUCATION PILOT
PROGRAM.
(a) Purpose.--It is the purpose of this section to establish a
pilot program to develop, test, and implement training and continuing
education which expands and supports the availability of SAFE, SAE, and
SANE, providers and services for survivors of sexual assault.
(b) Establishment.--
(1) In general.--Not later than 1 year after the date of
enactment of this Act, the Secretary shall establish a National
Continuing and Clinical Education Pilot Program for SAFEs,
SANEs, and other individuals who perform such examinations in
consultation with the Department of Justice, 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 of the Department of Justice, the Office on
Violence Against Women of the Department of Justice, and the
Office on Women's Health of the Department of Health and Human
Services and with input from regional and national
organizations with expertise in forensic nursing, rape trauma
or crisis counseling, investigating rape and gender violence
cases, survivors' advocacy and support, sexual assault
prevention education, rural health, and responding to sexual
violence in Native communities. Such pilot program shall be 2
years in duration.
(2) Functions.--The pilot program established under
paragraph (1) shall 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 or SANE practice of care, including--
(A) training and continuing education to help
support SAFEs or SANEs practicing in rural or
underserved areas;
(B) training to help connect sexual assault
survivors who are Native American with SAFEs or SANEs,
including through emergency first aid, referrals,
culturally competent support, and forensic evidence
collection in rural communities;
(C) replication of successful SANE or SAFE programs
to help develop and improve the evidence base for MFEs;
and
(D) training to increase the number of medical
professionals who are considered SAFEs or SANEs based
on the recommendations of the National Sexual Assault
Forensic Examination Training Standards issued by the
Department of Justice on Violence Against Women.
(3) Eligibility to participate in pilot programs.--The
Secretary shall ensure that SAFE or SANE services provided
under the pilot program established under paragraph (1), and
other medical forensic examiner services under the pilot
program shall be provided by health care providers who are also
one of the following:
(A) A physician, including a resident physician.
(B) A nurse practitioner.
(C) A nurse midwife.
(D) A physician assistant.
(E) A certified nurse specialist.
(F) A registered nurse.
(G) A community health practitioner or a community
health aide who has completed level III or level IV
certification and training requirements.
(4) Nature of training.--The continuing education program
established under this section shall incorporate and reflect
current best practices and standards on MFEs consistent with
the purpose of this section.
(c) Availability.--After termination of the pilot program
established under subsection (b)(1), the training and continuing
education program established under such program shall be available to
all SAFEs, SANEs, and other providers employed by, or any individual
providing services through, facilities that receive Federal funding.
The Task Force established under section 201 shall review and recommend
updates to the training and continuing education program after the
termination of the pilot program.
(d) Effective Date.--
(1) In general.--The pilot program established under this
section shall terminate on the date that is 2 years after the
date of such establishment.
(2) Authority for modifications.--Upon termination of the
pilot program as provided for in paragraph (1), the Secretary
or the Task Force established under section 201 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.
(e) Authorization.--There are authorized to be appropriated to
carry out this section $5,000,000 for each of fiscal years 2019 through
2021.
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 of the Department of Justice,
the Office on Women's Health of the Department of Health and Human
Services, 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 or SANE competencies,
including--
(1) providing comprehensive medical care to sexual assault
patients;
(2) demonstrating the ability to conduct a MFE 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 website of the
Department of Health and Human Services an online public map of
SAFE, SANE, and other forensic medical examiners. Such maps
shall clarify if there is full-time, part-time, or on-call
coverage.
(2) States.--A State that receives Federal funds shall
maintain and make available an online public map displaying the
number and location of available SAFE or SANE programs and
other forensic medical examiners in the State. Such maps shall
clarify if there is full-time, part-time, or on-call coverage.
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 survivors who present at
the hospital for MFEs in the year for which the report is being
prepared;
(2) the number of personnel who are trained and practicing
as a SANE or SAFE to perform sexual assault exams, indicating
the employment basis of such personnel as either full-time,
part-time, or on-call;
(3) the number of sexual assault exams performed by SANEs
or SAFEs;
(4) the number of sexual assault exams performed by
personnel other than a SANE or SAFE;
(5) the training that such SAFEs or SANEs undergo for
purposes of maintaining competency; and
(6) 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 identify barriers to improving access to SAFE/
SANE and other forensic medical examiners.
(b) Membership.--The Task Force shall include a representative from
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 of the Department of Justice, the Office on Women's Health of the
Department of Health and Human Services, and the Office on Violence
Against Women of the Department of Justice, a survivor of sexual
assault, and representatives from regional and national organizations
with expertise in forensic nursing, rape trauma or crisis counseling,
investigating rape and gender violence cases, survivors' advocacy and
support, sexual assault prevention education, rural health, and
responding to sexual violence in Native communities.
(c) Objectives.--To assist and standardize State-level efforts to
improve medical forensic evidence collection relating to sexual
assault, the Task Force shall--
(1) identify barriers to the recruitment, training, and
retention of SAFEs, SARTs, SANEs, and others who perform such
examinations;
(2) make recommendations for improving access to medical
forensic examinations, including the feasibility of, or
barriers to, utilizing mobile units;
(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.--Not later than 1 year after first
convening, the Task Force shall report to the Secretary in a
public document 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 MFEs and
treatments relating to sexual assault.
(2) Report.--Not later than 18 months 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 that includes the Task Force.
SEC. 202. INSTITUTIONS OF HIGHER EDUCATION CAMPUS ACTION PLAN.
Each institution of higher education that receives Federal funds
shall--
(1) inform survivors of sexual assault about the
availability of MFEs, including the nearest available locations
at which such examinations are provided by a SANE and that
Federal law requires such exams to be provided at no cost to
the survivor; and
(2) make the information described in paragraph (1)
available on the website of the institution, to the extent
practicable.
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 survivors of sexual assault.
``(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 and to test the provisions of
such services at new facilities in expanded health care settings.
``(c) Grants.--Under the program, the Secretary shall award 3-year
grants to eligible entities that meet the requirements established by
the Secretary.
``(d) Eligible Entities.--To be eligible to receive a grant under
this section, an entity shall--
``(1) be--
``(A) a rural health care services provider or
community-based service 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--
``(i) assign rural health care service
providers to the high-volume hospitals for
clinical practicum hours to qualify such
providers as a SAFE/SANE; or
``(ii) 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; or
``(B) an organization described in section
501(c)(3) of the Internal Revenue Code of 1986 and
exempt from taxation under 501(a) of that Act, that
provides legal training and technical assistance to
tribal communities and to organizations and agencies
serving Native people; and
``(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 one fiscal year to the next without obtaining
approval from the Secretary.
``(f) Authorization of Appropriations.--
``(1) In general.--There is authorized to be appropriated
to carry out this section $11,000,000 for each of fiscal years
2019 through 2024.
``(2) Set-aside.--Of the amount appropriated under this
subsection for a fiscal year, the Secretary shall reserve 15
percent of such amount for purposes of making grants to
entities that are affiliated with Indian tribes or tribal
organizations (as defined in section 4 of the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 5304)),
or Urban Indian organizations (as defined in section 4 of the
Indian Health Care Improvement Act (25 U.S.C. 1603)). Amounts
reserved may be used to support referrals and the delivery of
emergency first aid, culturally competent support, and forensic
evidence collection training.''.
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, MFEs
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, MFEs.
``(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(a)(2)).
SEC. 206. OVERSIGHT.
Not later than one 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 (34 U.S.C.
12291 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
survivors.
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