Violence Against Women Health Act of 2019

I 116TH CONGRESS 1ST SESSION H. R. 973 To amend the Public Health Service Act to provide for additional programs funded by grants to strengthen the healthcare system’s response to domestic violence, dating violence, sexual assault, and stalking, and for other purposes. IN THE HOUSE OF REPRESENTATIVES FEBRUARY 5, 2019 Mrs. DINGELL (for herself, Mr. KATKO, Ms. CLARKE of New York, Ms. CAS- TOR of Florida, Mrs. RODGERS of Washington, Ms. ESHOO, Ms. STEFANIK, Ms. ROYBAL-ALLARD, Mr. CA´RDENAS, Ms. WILSON of Flor- ida, Miss GONZA´LEZ-COLO´N of Puerto Rico, and Mr. MARSHALL) intro- duced the following bill; which was referred to the Committee on Energy and Commerce A BILL To amend the Public Health Service Act to provide for additional programs funded by grants to strengthen the healthcare system’s response to domestic violence, dating violence, sexual assault, and stalking, and for other pur- poses. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Violence Against 4 Women Health Act of 2019’’. 5 VerDate Sep 11 2014 20:11 Feb 19, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H973.IH H973 tkelley on DSKBCP9HB2PROD with BILLS 2 •HR 973 IH SEC. 2. FINDINGS. 1 Congress finds that— 2 (1) millions of Americans continue to experience 3 domestic or sexual violence each year with more 4 than three women murdered by their partners each 5 day; 6 (2) this type of violence and abuse results in 7 short-term and chronic physical and behavioral 8 health consequences that have a significant economic 9 burden to victims and communities; 10 (3) new CDC data found the lifetime per-victim 11 cost of intimate partner violence was $103,767 for 12 women victims with 59 percent going to medical 13 costs and public funding paid 37 percent of this 14 total cost; 15 (4) victims are also at a higher risk for devel- 16 oping addictions to tobacco, alcohol, or drugs; for ex- 17 ample, 31 percent to 67 percent of women in sub- 18 stance use disorder treatment programs report expe- 19 riencing domestic violence within the past year; 20 (5) over 50 percent of survivors of domestic vio- 21 lence have experienced depression, post-traumatic 22 stress disorder, and substance use and 23 percent 23 have experienced suicidality; 24 (6) a study conducted by the National Domestic 25 Violence Hotline, in conjunction with the National 26 VerDate Sep 11 2014 20:11 Feb 19, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H973.IH H973 tkelley on DSKBCP9HB2PROD with BILLS 3 •HR 973 IH Center on Domestic Violence, Trauma & Mental 1 Health practice mental health and substance use co- 2 ercion where abusers intentionally undermine their 3 partners’ sanity or sobriety, control their access to 4 medication, and sabotage their treatment and recov- 5 ery efforts among other coercion tactics; 6 (7) researchers have also found that exposure 7 to multiple childhood traumas such as sexual abuse 8 and domestic violence can cause long-term negative 9 physical and emotional health outcomes such as 10 heart disease, cancer and depression; 11 (8) health care providers can identify survivors 12 of violence and interventions can decrease risk for 13 violence and improve health outcomes, but health 14 providers need training and systems level support in 15 order to do so; 16 (9) Congress authorized a public health re- 17 sponse to victims of domestic and sexual violence in 18 the Violence Against Women Act of 2005; 19 (10) since its enactment, the VAWA Health 20 program has trained more than 13,000 health care 21 providers to assess for and respond to domestic and 22 sexual violence in over 230 clinical settings serving 23 more than 1.3 million patients; 24 VerDate Sep 11 2014 20:11 Feb 19, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H973.IH H973 tkelley on DSKBCP9HB2PROD with BILLS 4 •HR 973 IH (11) last year, the Health Resources & Services 1 Administration made this issue a priority across all 2 of its bureaus and released the ‘‘HRSA Strategy to 3 Address Intimate Partner Violence 2017–2020’’ with 4 four key priorities: 5 (A) Train the Nation’s health care and 6 public health workforce to address intimate 7 partner violence (IPV) at the community and 8 health systems levels. 9 (B) Develop partnerships to raise aware- 10 ness about IPV within HRSA and HHS. 11 (C) Increase access to quality IPV-in- 12 formed health care services across all popu- 13 lations. 14 (D) Address gaps in knowledge about IPV 15 risks, impacts, and interventions.; and 16 (12) a strong public health response can pre- 17 vent and address the immediate and long-term 18 health impacts of this type of violence and abuse. 19 SEC. 3. GRANTS TO STRENGTHEN THE HEALTH CARE SYS- 20 TEM’S RESPONSE TO DOMESTIC VIOLENCE, 21 DATING VIOLENCE, SEXUAL ASSAULT, AND 22 STALKING, AND FOR OTHER PURPOSES. 23 Section 399P of the Public Health Service Act (42 24 U.S.C. 280g–4) is amended— 25 VerDate Sep 11 2014 20:11 Feb 19, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H973.IH H973 tkelley on DSKBCP9HB2PROD with BILLS 5 •HR 973 IH (1) in subsection (a)— 1 (A) in paragraph (2), by striking ‘‘and’’ at 2 the end; 3 (B) in paragraph (3), by striking the pe- 4 riod at the end and inserting ‘‘; and’’; and 5 (C) by adding at the end the following: 6 ‘‘(4) development or enhancement and imple- 7 mentation of training programs to improve the ca- 8 pacity of early childhood programs to address do- 9 mestic violence, dating violence, sexual assault, and 10 stalking among families they serve.’’; 11 (2) in subsection (b)— 12 (A) in paragraph (1)— 13 (i) in subparagraph (A)(ii), by insert- 14 ing after ‘‘and other forms of violence and 15 abuse’’ the following: ‘‘(including labor and 16 sex trafficking)’’; and 17 (ii) in subparagraph (B)— 18 (I) in clause (ii)— 19 (aa) by striking ‘‘on-site ac- 20 cess to’’; and 21 (bb) by striking ‘‘or to 22 model other services appropriate 23 to the geographic and cultural 24 needs of a site’’ and inserting the 25 VerDate Sep 11 2014 20:11 Feb 19, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H973.IH H973 tkelley on DSKBCP9HB2PROD with BILLS 6 •HR 973 IH following: ‘‘or by providing fund- 1 ing to national, State, Tribal, or 2 territorial domestic and sexual vi- 3 olence coalitions to improve their 4 capacity to coordinate and sup- 5 port health advocates and health 6 system partnerships’’; 7 (II) in clause (iii), by striking 8 ‘‘and’’ at the end; 9 (III) in clause (iv), by striking 10 the period at the end and inserting ‘‘, 11 with priority given to programs ad- 12 ministered through the Health Re- 13 sources and Services Administration, 14 Office of Women’s Health; and’’; and 15 (IV) by adding at the end the fol- 16 lowing: 17 ‘‘(v) the development, dissemination, 18 and evaluation of best practices, tools and 19 training materials for behavioral health 20 professionals to identify and respond to do- 21 mestic violence, sexual violence, stalking, 22 and dating violence.’’; and 23 (B) in paragraph (2)— 24 VerDate Sep 11 2014 20:11 Feb 19, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H973.IH H973 tkelley on DSKBCP9HB2PROD with BILLS 7 •HR 973 IH (i) in subparagraph (A), to read as 1 follows: 2 ‘‘(A) CHILD ABUSE AND ABUSE IN LATER 3 LIFE.—To the extent consistent with the pur- 4 pose of this section, a grantee may address, as 5 part of a comprehensive programmatic ap- 6 proach implemented under a grant under this 7 section, issues relating to child abuse or abuse 8 in later life.’’; and 9 (ii) in subparagraph (C)— 10 (I) in clause (i), by striking 11 ‘‘elder abuse’’ and inserting ‘‘abuse in 12 later life’’; 13 (II) in clause (iv)— 14 (aa) by inserting ‘‘, mental 15 health’’ after ‘‘dental’’; 16 (bb) by inserting ‘‘and cer- 17 tification’’ after ‘‘exams’’; and 18 (cc) by striking the period at 19 the end and inserting ‘‘; and’’; 20 and 21 (III) by adding at the end the 22 following: 23 ‘‘(v) development of a state-level pilot 24 program to improve the response of sub- 25 VerDate Sep 11 2014 20:11 Feb 19, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H973.IH H973 tkelley on DSKBCP9HB2PROD with BILLS 8 •HR 973 IH stance use disorder treatment programs 1 and systems to domestic violence, dating 2 violence, sexual assault, and stalking and 3 the capacity of domestic violence, dating 4 violence, sexual assault, and stalking to 5 serve survivors dealing with substance use 6 disorder; and 7 ‘‘(vi) development and utilization of 8 existing technical assistance and training 9 resources to improve the capacity of sub- 10 stance use disorder treatment programs to 11 address domestic violence, dating violence, 12 sexual assault, and stalking among pa- 13 tients they serve.’’; 14 (3) in subsection (d)(2)— 15 (A) in subparagraph (A)— 16 (i) by inserting ‘‘or behavioral 17 health,’’ after ‘‘a State department (or 18 other division) of health,’’; and 19 (ii) by striking ‘‘mental health care’’ 20 and inserting ‘‘behavioral health care’’; and 21 (B) in subparagraph (B)— 22 (i) by striking ‘‘or health system’’ and 23 inserting ‘‘behavioral health treatment sys- 24 tem’’; and 25 VerDate Sep 11 2014 20:11 Feb 19, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H973.IH H973 tkelley on DSKBCP9HB2PROD with BILLS 9 •HR 973 IH (ii) by striking ‘‘mental health care’’ 1 and inserting ‘‘behavioral health care’’; 2 (4) in subsection (f), to read as follows: 3 ‘‘(f) RESEARCH, AND EVALUATION, AND DATA COL- 4 LECTION.— 5 ‘‘(1) IN GENERAL.—Of the funds made avail- 6 able to carry out this section for any fiscal year, the 7 Secretary may use not more than 20 percent to 8 make a grant or enter into a contract for research, 9 and evaluation, or data collection of— 10 ‘‘(A) grants awarded under this section; 11 and 12 ‘‘(B) other training for health professionals 13 and effective interventions in the health care or 14 behavioral health setting that prevent domestic 15 violence, dating violence, and sexual assault 16 across the lifespan, prevent the health effects of 17 such violence, and improve the safety and 18 health of individuals who are currently being 19 victimized. 20 ‘‘(2) RESEARCH AND DATA COLLECTION.—Re- 21 search or data collection authorized in paragraph (1) 22 may include— 23 ‘‘(A) research on the effects of domestic vi- 24 olence, dating violence, sexual assault, and 25 VerDate Sep 11 2014 20:11 Feb 19, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H973.IH H973 tkelley on DSKBCP9HB2PROD with BILLS 10 •HR 973 IH childhood exposure to domestic, dating or sex- 1 ual violence on health behaviors, health condi- 2 tions, and health status of individuals, families, 3 and populations, including underserved popu- 4 lations; 5 ‘‘(B) research to determine effective health 6 care interventions to respond to and prevent do- 7 mestic violence, dating violence, sexual assault, 8 and stalking; 9 ‘‘(C) research on the impact of domestic, 10 dating and sexual violence, childhood exposure 11 to such violence, and stalking on the health care 12 system, health care utilization, health care 13 costs, and health status; 14 ‘‘(D) research on the impact of adverse 15 childhood experiences on adult experience with 16 domestic violence, dating violence, sexual as- 17 sault, stalking and adult health outcomes, in- 18 cluding how to reduce or prevent the impact of 19 adverse childhood experiences through the 20 health care setting; 21 ‘‘(E) research on the intersection of sub- 22 stance use disorder and domestic violence, dat- 23 ing violence, sexual assault, and stalking, in- 24 cluding effect of coerced use and efforts by an 25 VerDate Sep 11 2014 20:11 Feb 19, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H973.IH H973 tkelley on DSKBCP9HB2PROD with BILLS 11 •HR 973 IH abusive partner or other to interfere with sub- 1 stance use disorder treatment and recovery; and 2 ‘‘(F) improved data collection using exist- 3 ing federal surveys by including questions about 4 domestic violence, dating violence, sexual as- 5 sault, or stalking and substance use disorder, 6 coerced use, and mental health.’’; and 7 (5) in subsection (g), by striking ‘‘2014 through 8 2018’’ and inserting ‘‘2019 through 2023’’. 9 Æ VerDate Sep 11 2014 20:11 Feb 19, 2019 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6301 E:\BILLS\H973.IH H973 tkelley on DSKBCP9HB2PROD with BILLS