SASCA

I 116TH CONGRESS 1ST SESSION H. R. 1082 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 HOUSE OF REPRESENTATIVES FEBRUARY 7, 2019 Ms. JAYAPAL (for herself and Mr. KING of New York) introduced the fol- lowing bill; which was referred to the Committee on Energy and Com- merce, and in addition to the Committees on Ways and Means, and Edu- cation and Labor, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To plan, develop, and make recommendations to increase access to sexual assault examinations for survivors by holding hospitals accountable and supporting the pro- viders that serve them. 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 ‘‘Survivors’ Access to 4 Supportive Care Act’’ or ‘‘SASCA’’. 5 VerDate Sep 11 2014 20:32 Mar 21, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H1082.IH H1082 tkelley on DSKBCP9HB2PROD with BILLS 2 •HR 1082 IH SEC. 2. PURPOSE. 1 It is the purpose of this Act to increase access to 2 medical forensic sexual assault examinations and treat- 3 ment provided by sexual assault forensic examiners for 4 survivors by identifying and addressing gaps in obtaining 5 those services. 6 SEC. 3. DEFINITIONS. 7 In this Act: 8 (1) COMMUNITY HEALTH AIDE AND COMMU- 9 NITY HEALTH PRACTITIONER.—The terms ‘‘commu- 10 nity health aide’’ and ‘‘community health practi- 11 tioner’’ have the meanings within the meaning of 12 section 119 of the Indian Health Care Improvement 13 Act (25 U.S.C. 1616l). 14 (2) MFE.—The term ‘‘medical forensic exam- 15 ination’’ or ‘‘MFE’’ means an examination provided 16 to a sexual assault survivor by medical personnel 17 trained to gather evidence of a sexual assault in a 18 manner suitable for use in a court of law. 19 (3) SAE.—The term ‘‘sexual assault examiner’’ 20 or ‘‘SAE’’ means a registered nurse, advanced prac- 21 tice nurse, physician, or physician assistant specifi- 22 cally trained to provide care to sexual assault foren- 23 sic examinations. 24 (4) SAFE.—The term ‘‘sexual assault forensic 25 examiner’’ or ‘‘SAFE’’ means a medical practitioner 26 VerDate Sep 11 2014 20:32 Mar 21, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H1082.IH H1082 tkelley on DSKBCP9HB2PROD with BILLS 3 •HR 1082 IH who has specialized forensic training in treating sex- 1 ual assault survivors and conducting medical foren- 2 sic examinations. 3 (5) SANE.—The term ‘‘sexual assault nurse 4 examiner’’ or ‘‘SANE’’ means a registered nurse 5 who has specialized forensic training in treating sex- 6 ual assault survivors and conducting medical foren- 7 sic examinations. 8 (6) SART.—The term ‘‘sexual assault response 9 team’’ or ‘‘SART’’ means a multidisciplinary team 10 that provides a specialized and immediate response 11 to survivors of sexual assault, and may include 12 health care personnel, law enforcement representa- 13 tives, community-based survivor advocates, prosecu- 14 tors, and forensic scientists. 15 (7) SECRETARY.—The term ‘‘Secretary’’ means 16 the Secretary of Health and Human Services. 17 (8) SEXUAL ASSAULT.—The term ‘‘sexual as- 18 sault’’ means any nonconsensual sexual act pro- 19 scribed by Federal, tribal, or State law, including 20 when the individual lacks capacity to consent. 21 VerDate Sep 11 2014 20:32 Mar 21, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H1082.IH H1082 tkelley on DSKBCP9HB2PROD with BILLS 4 •HR 1082 IH TITLE I—STRENGTHENING THE 1 SEXUAL ASSAULT EXAMINER 2 WORKFORCE 3 SEC. 101. UNDERSTANDING SEXUAL ASSAULT CARE. 4 (a) PURPOSE.—It is the purpose of this section to 5 identify areas for improvement in health care delivery sys- 6 tems providing services to survivors of sexual assault. 7 (b) GRANTS.—The Secretary shall award grants to 8 States to develop and implement State surveys to iden- 9 tify— 10 (1) the availability of and patient access to 11 trained SAFE, SANE, and other providers who per- 12 form MFEs; 13 (2) the hospitals or clinics that offer MFEs and 14 whether each hospital or clinic has full-time, part- 15 time, or on-call coverage; 16 (3) regional, provider, or other barriers to ac- 17 cess sexual assault care and services, including 18 MFEs; 19 (4) billing and reimbursement practices for 20 MFEs, including private health insurance, Medicare, 21 Medicaid, the State’s victims compensation program, 22 and any other crime funding or other sources of 23 funding that contribute to payment for such exami- 24 nations; 25 VerDate Sep 11 2014 20:32 Mar 21, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1082.IH H1082 tkelley on DSKBCP9HB2PROD with BILLS 5 •HR 1082 IH (5) State requirements, minimum standards, 1 and protocols for training sexual assault examiners; 2 (6) State requirements, minimum standards, 3 and protocols for training non-SANE or SAFE 4 emergency services personnel involved in MFEs; 5 (7) the availability of SAFE or SANE training, 6 frequency of when training is convened, the pro- 7 viders of such training, the State’s role in such 8 training, and what process or procedures are in 9 place for continuing education of such examiners; 10 (8) the dedicated Federal and State funding to 11 support SAFE or SANE training; and 12 (9) funding opportunities for SANE or SAFE 13 training and continuing education. 14 (c) ELIGIBILITY.—To be eligible to receive a grant 15 under this section, a State shall— 16 (1) have public, private, or nonprofit hospitals 17 that receive Federal funding; and 18 (2) submit to the Secretary an application 19 through a competitive process to be determined by 20 the Secretary. 21 (d) PUBLIC DISSEMINATION AND CAMPAIGN.— 22 (1) PUBLIC AVAILABILITY.—The results of the 23 surveys conducted under grants awarded under this 24 section shall be published by the Secretary on the 25 VerDate Sep 11 2014 20:32 Mar 21, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H1082.IH H1082 tkelley on DSKBCP9HB2PROD with BILLS 6 •HR 1082 IH website of the Department of Health and Human 1 Services on a biennial basis. 2 (2) CAMPAIGNS.—A State that receives a grant 3 under this section shall carry out the following: 4 (A) Make the findings of the survey con- 5 ducted under the grant public. 6 (B) Use the findings to develop a strategic 7 action plan to increase the number of trained 8 examiners available in the State and create poli- 9 cies to increase survivor access to trained exam- 10 iners. 11 (C) Use the findings to develop and imple- 12 ment a public awareness campaign that in- 13 cludes the following: 14 (i) An online toolkit describing how 15 and where sexual assault survivors can ob- 16 tain assistance and care, including MFEs, 17 in the State. 18 (ii) A Model Standard Response Pro- 19 tocol for health care providers to imple- 20 ment upon arrival of a patient seeking care 21 for sexual assault. 22 (iii) A Model Sexual Assault Response 23 Team Protocol incorporating interdiscipli- 24 nary community coordination between hos- 25 VerDate Sep 11 2014 20:32 Mar 21, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H1082.IH H1082 tkelley on DSKBCP9HB2PROD with BILLS 7 •HR 1082 IH pitals, emergency departments, hospital 1 administration, local rape crisis programs, 2 law enforcement, prosecuting attorneys, 3 and other health and human service agen- 4 cies and stakeholders with respect to deliv- 5 ering survivor-centered sexual assault care 6 and MFEs. 7 (iv) A notice of State and Federal 8 laws prohibiting charging or billing sur- 9 vivors of sexual assault for care and serv- 10 ices related to sexual assault. 11 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 12 authorized to be appropriated to carry out this section, 13 $2,000,000 for each of fiscal years 2019 through 2024. 14 SEC. 102. IMPROVING AND STRENGTHENING THE SEXUAL 15 ASSAULT EXAMINER WORKFORCE CLINICAL 16 AND CONTINUING EDUCATION PILOT PRO- 17 GRAM. 18 (a) PURPOSE.—It is the purpose of this section to 19 establish a pilot program to develop, test, and implement 20 training and continuing education which expands and sup- 21 ports the availability of SAFE, SAE, and SANE, pro- 22 viders and services for survivors of sexual assault. 23 (b) ESTABLISHMENT.— 24 VerDate Sep 11 2014 20:32 Mar 21, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H1082.IH H1082 tkelley on DSKBCP9HB2PROD with BILLS 8 •HR 1082 IH (1) IN GENERAL.—Not later than 1 year after 1 the date of enactment of this Act, the Secretary 2 shall establish a National Continuing and Clinical 3 Education Pilot Program for SAFEs, SANEs, and 4 other individuals who perform such examinations in 5 consultation with the Department of Justice, the 6 Centers for Medicare & Medicaid Services, the Cen- 7 ters for Disease Control and Prevention, the Health 8 Resources and Services Administration, the Indian 9 Health Service, the Office for Victims of Crime of 10 the Department of Justice, the Office on Violence 11 Against Women of the Department of Justice, and 12 the Office on Women’s Health of the Department of 13 Health and Human Services and with input from re- 14 gional and national organizations with expertise in 15 forensic nursing, rape trauma or crisis counseling, 16 investigating rape and gender violence cases, sur- 17 vivors’ advocacy and support, sexual assault preven- 18 tion education, rural health, and responding to sex- 19 ual violence in Native communities. Such pilot pro- 20 gram shall be 2 years in duration. 21 (2) FUNCTIONS.—The pilot program estab- 22 lished under paragraph (1) shall develop, pilot, im- 23 plement, and update, as appropriate, continuing and 24 clinical education program modules, webinars, and 25 VerDate Sep 11 2014 20:32 Mar 21, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H1082.IH H1082 tkelley on DSKBCP9HB2PROD with BILLS 9 •HR 1082 IH programs for all hospitals and providers to increase 1 access to SANE and SAFE services and address on- 2 going competency issues in SAFE or SANE practice 3 of care, including— 4 (A) training and continuing education to 5 help support SAFEs or SANEs practicing in 6 rural or underserved areas; 7 (B) training to help connect sexual assault 8 survivors who are Native American with SAFEs 9 or SANEs, including through emergency first 10 aid, referrals, culturally competent support, and 11 forensic evidence collection in rural commu- 12 nities; 13 (C) replication of successful SANE or 14 SAFE programs to help develop and improve 15 the evidence base for MFEs; and 16 (D) training to increase the number of 17 medical professionals who are considered 18 SAFEs or SANEs based on the recommenda- 19 tions of the National Sexual Assault Forensic 20 Examination Training Standards issued by the 21 Department of Justice on Violence Against 22 Women. 23 (3) ELIGIBILITY TO PARTICIPATE IN PILOT 24 PROGRAMS.—The Secretary shall ensure that SAFE 25 VerDate Sep 11 2014 20:32 Mar 21, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H1082.IH H1082 tkelley on DSKBCP9HB2PROD with BILLS 10 •HR 1082 IH or SANE services provided under the pilot program 1 established under paragraph (1), and other medical 2 forensic examiner services under the pilot program 3 shall be provided by health care providers who are 4 also one of the following: 5 (A) A physician, including a resident phy- 6 sician. 7 (B) A nurse practitioner. 8 (C) A nurse midwife. 9 (D) A physician assistant. 10 (E) A certified nurse specialist. 11 (F) A registered nurse. 12 (G) A community health practitioner or a 13 community health aide who has completed level 14 III or level IV certification and training re- 15 quirements. 16 (4) NATURE OF TRAINING.—The continuing 17 education program established under this section 18 shall incorporate and reflect current best practices 19 and standards on MFEs consistent with the purpose 20 of this section. 21 (c) AVAILABILITY.—After termination of the pilot 22 program established under subsection (b)(1), the training 23 and continuing education program established under such 24 program shall be available to all SAFEs, SANEs, and 25 VerDate Sep 11 2014 20:32 Mar 21, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H1082.IH H1082 tkelley on DSKBCP9HB2PROD with BILLS 11 •HR 1082 IH other providers employed by, or any individual providing 1 services through, facilities that receive Federal funding. 2 The Task Force established under section 201 shall review 3 and recommend updates to the training and continuing 4 education program after the termination of the pilot pro- 5 gram. 6 (d) EFFECTIVE DATE.— 7 (1) IN GENERAL.—The pilot program estab- 8 lished under this section shall terminate on the date 9 that is 2 years after the date of such establishment. 10 (2) AUTHORITY FOR MODIFICATIONS.—Upon 11 termination of the pilot program as provided for in 12 paragraph (1), the Secretary or the Task Force es- 13 tablished under section 201 may implement modi- 14 fications relating to training and continuing edu- 15 cation requirements based on such program to in- 16 crease access to SANE and SAFE services for sur- 17 vivors of sexual assault. 18 (e) AUTHORIZATION.—There are authorized to be ap- 19 propriated to carry out this section $5,000,000 for each 20 of fiscal years 2019 through 2021. 21 SEC. 103. NATIONAL REPORT ON SEXUAL ASSAULT SERV- 22 ICES IN OUR NATION’S HEALTH SYSTEM. 23 (a) IN GENERAL.—Not later than 1 year after the 24 date of enactment of this Act, and annually thereafter, 25 VerDate Sep 11 2014 20:32 Mar 21, 2019 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H1082.IH H1082 tkelley on DSKBCP9HB2PROD with BILLS 12 •HR 1082 IH the Agency for Healthcare Research and Quality, in con- 1 sultation with the Centers for Medicare & Medicaid Serv- 2 ices, the Centers for Disease Control and Prevention, the 3 Health Resources and Services Administration, the Indian 4 Health Service, the Office for Victims of Crime of the De- 5 partment of Justice, the Office on Women’s Health of the 6 Department of Health and Human Services, and the Of- 7 fice of Violence Against Women of the Department of Jus- 8 tice (hereafter referred to in this section collectively as the 9 ‘‘Agencies’’), shall submit to the Secretary a report of ex- 10 isting Federal and State practices relating to SAFEs, 11 SANEs, and others who perform such examinations which 12 reflects the findings of the surveys developed under section 13 101. 14 (b) CORE COMPETENCIES. 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