To provide for the provision by hospitals of emergency contraceptives to women, and post-exposure prophylaxis for sexually transmitted disease to individuals, who are survivors of sexual assault.

June 16, 2005

Mr. CORZINE (for himself, Mrs. CLINTON, Mrs. MURRAY, Mr. LAUTENBERG, Mrs. BOXER, Ms. CANTWELL, Mr. KENNEDY, Mr. INOUYE, and Mr. KERRY) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions

To provide for the provision by hospitals of emergency contraceptives to women, and post-exposure prophylaxis for sexually transmitted disease to individuals, who are survivors of sexual assault.

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 `Compassionate Assistance for Rape Emergencies Act'.

SEC. 2. FINDINGS.

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. An estimated 22,000 of these pregnancies could be prevented if rape survivors had timely access to emergency contraception.

(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, reducing the risk by as much as 89 percent if taken within days of unprotected intercourse and up to 95 percent if taken in the first 24 hours.

(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.

(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 30 percent of American women of reproductive age are unaware of the availability of emergency contraception.

(10) New data from a survey of women having abortions estimates that 51,000 abortions were prevented by use of emergency contraception in 2000 and that increased use of emergency contraception accounted for 43 percent of the decrease in total abortions between 1994 and 2000.

(11) 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.

(12) Victims of sexual assault are at increased risk of contracting sexually transmitted diseases.

(13) 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 Americans, and the Centers for Disease Control and Prevention currently estimates that over 1,000,000 Americans are infected with the virus. Even modern drug treatment has failed to cure infected individuals. Nearly 80,000 Americans are infected with hepatitis B each year, with some individuals unable to fully recover. An estimated 1,250,000 Americans remain chronically infected with the hepatitis B virus and at present, one in five of these may expect to die of liver failure.

(14) 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.

(15) 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.

(16) 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.

SEC. 3. SURVIVORS OF SEXUAL ASSAULT; PROVISION BY HOSPITALS OF EMERGENCY CONTRACEPTIVES WITHOUT CHARGE.

(a) In General- Federal funds may not be provided to a hospital under any health-related program, unless the hospital meets the conditions specified in subsection (b) in the case of--

(1) any woman who presents 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 presents at the hospital whom hospital personnel have reason to believe is a victim of sexual assault.

(b) Assistance for Victims- 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 a safe and effective way to prevent pregnancy after unprotected intercourse or contraceptive failure if taken in a timely manner, and is more effective the sooner it is taken; and

(B) 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 to pay for the services.

SEC. 4. PREVENTION OF TRANSMISSIBLE DISEASE.

(a) In General- No hospital shall receive Federal funds unless such hospital provides risk assessment, counseling, and treatment as required under this section to a survivor of sexual assault described in subsection (b).

(b) Survivors of Sexual Assault- An individual is a survivor of a sexual assault as described in this subsection if the individual--

(1) presents at the hospital and declares that the individual is a victim of sexual assault, or the individual is accompanied to the hospital by another individual who declares that the first individual is a victim of a sexual assault; or

(2) presents at the hospital and hospital personnel have reason to believe the individual is a victim of sexual assault.

(c) Requirement for Risk Assessment, Counseling, and Treatment- The following shall apply with respect to a hospital described in subsection (a):

(1) RISK ASSESSMENT- A hospital shall promptly provide a survivor of a sexual assault with an assessment of the individual's risk for contracting sexually transmitted infections as described in paragraph (2)(A), which 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 findings of peer-reviewed clinical studies and appropriate research utilizing in vitro and non-human primate models of infection.

(2) COUNSELING- A hospital shall provide a survivor of a sexual assault with advice, provided by a licensed medical professional, concerning--

(A) significantly prevalent sexually transmissible infections for which effective post-exposure prophylaxis exists, and for which the deferral of treatment would either significantly reduce treatment efficacy or would pose substantial risk to the individual's health; and

(B) the requirement that prophylactic treatment for infections as described in subparagraph (A) shall be provided to the individual upon request, regardless of the ability of the individual to pay for such treatment.

(3) TREATMENT- A hospital shall provide a survivor of a sexual assault, upon request, with prophylactic treatment for infections described in paragraph (2)(A).

(4) ABILITY TO PAY- The services described in paragraphs (1) through (3) shall not be denied because of the inability of the individual involved to pay for the services.

(5) LANGUAGE- Any information provided pursuant to this subsection shall be clear and concise, readily comprehensible, and meet such conditions regarding the provision of the information in languages other than English as the Secretary may establish.

(d) Rule of Construction- Nothing in this section shall be construed to--

(1) require that a hospital provide prophylactic treatment for a victim of sexual assault when risk evaluation according to criteria adopted by the Centers for Disease Control and Prevention clearly recommend 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 reimburse 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.

(e) Limitation- Federal funds may not be provided to a hospital under any health-related program unless the hospital complies with the requirements of this section.

SEC. 5. DEFINITIONS.

In this Act:

(1) EMERGENCY CONTRACEPTION- 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) HOSPITAL- The term `hospital' has the meaning given such term in title XVIII of the Social Security Act, including the meaning applicable in such title for purposes of making payments for emergency services to hospitals that do not have agreements in effect under such title. Such term includes a health care facility that is located within, or contracted to, a correctional institution or a post-secondary educational institution.

(3) LICENSED MEDICAL PROFESSIONAL- The term `licensed medical professional' means a doctor of medicine, doctor of osteopathy, registered nurse, physician assistant, or any other healthcare professional determined appropriate by the Secretary.

(4) SECRETARY- The term `Secretary' means the Secretary of Health and Human Services.

(5) SEXUAL ASSAULT-

(A) IN GENERAL- 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 PROVISIONS- The definition under subparagraph (A) shall--

(i) in the case of section 2, apply to males and females, as appropriate;

(ii) in the case of section 3, apply only to females; and

(iii) in the case of section 4, apply to all individuals.

SEC. 6. EFFECTIVE DATE; AGENCY CRITERIA.

This Act shall take 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 of Health and Human Services shall publish in the Federal Register criteria for carrying out this Act.

END