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S. 1240 (110th): Compassionate Assistance for Rape Emergencies Act of 2007


The text of the bill below is as of Apr 26, 2007 (Introduced). The bill was not enacted into law.


II

110th CONGRESS

1st Session

S. 1240

IN THE SENATE OF THE UNITED STATES

April 26, 2007

(for herself, Mr. Menendez, Mrs. Boxer, Ms. Cantwell, Mr. Kerry, Mrs. Murray, and Mr. Lautenberg) introduced the following bill; which was read twice and referred to the Committee on Finance

A BILL

To provide for the provision by hospitals receiving Federal funds through the Medicare program or Medicaid program of emergency contraceptives to women who are survivors of sexual assault.

1.

Short title

This Act may be cited as the Compassionate Assistance for Rape Emergencies Act of 2007.

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. Timely access to emergency contraception could help many of these rape survivors avoid the additional trauma of facing an unintended pregnancy.

(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 if taken in the first 72 hours of sex.

(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 to women of all ages.

(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 one-third of women of reproductive age remain unaware of emergency contraception. Therefore, women who have been sexually assaulted are unlikely to ask for emergency contraception.

(10)

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.

(11)

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

(12)

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 individuals in the United States, and the Centers for Disease Control and Prevention currently estimates that over 1,000,000 individuals in the United States are infected with the virus. Even modern drug treatment has failed to cure infected individuals. Nearly 60,000 individuals in the United States are infected with hepatitis B each year, with some individuals unable to fully recover. An estimated 1,250,000 individuals in the United States remain chronically infected with the hepatitis B virus and at present, 1 in 4 of those infected individuals may expect to die of liver failure.

(13)

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.

(14)

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.

(15)

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.

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 title XVIII of the Social Security Act or to a State, with respect to services of a hospital, under title XIX of such Act, unless the hospital meets the conditions specified in subsection (b) in the case of—

(1)

any woman who arrives 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 arrives 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 an over-the-counter medication for women ages 18 and over and is a safe and effective way to prevent pregnancy after unprotected intercourse or contraceptive failure if taken in a timely manner;

(B)

emergency contraception is more effective the sooner it is taken; and

(C)

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 or her family to pay for the services.

(c)

Definitions

For purposes of this section:

(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 section 1861(e) of the Social Security Act (42 U.S.C. 1395x(e)), and includes critical access hospitals, as defined in section 1861(mm)(1) of such Act (42 U.S.C. 1395x(mm)(1)).

(3)

Secretary

The term Secretary means the Secretary of Health and Human Services.

(4)

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 in subparagraph (A) shall apply to all individuals.

(d)

Effective Date; Agency Criteria

This section takes 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 shall publish in the Federal Register criteria for carrying out this section.

4.

Prevention of sexually transmitted disease

(a)

Definitions

In this section:

(1)

Hospital

The term hospital has the meaning given such term in section 1861(e) of the Social Security Act (42 U.S.C. 1395x(e)), and includes critical access hospitals, as defined in section 1861(mm)(1) of such Act (42 U.S.C. 1395x(mm)(1)).

(2)

Licensed medical professional

The term licensed medical professional means a doctor of medicine, doctor of osteopathy, registered nurse, physician assistant, or any other health care professional determined to be appropriate by the Secretary.

(3)

Secretary

The term Secretary means the Secretary of Health and Human Services.

(4)

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 in subparagraph (A) shall apply to all individuals.

(b)

General requirement

Federal funds may not be provided to a hospital under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) or to a State, with respect to services of a hospital, under title XIX of such Act (42 U.S.C. 1396 et seq.), unless the hospital provides risk assessment, counseling, and treatment as required under this section to a survivor of sexual assault described in subsection (c).

(c)

Survivors of sexual assault

An individual is a survivor of a sexual assault described in this subsection if the individual—

(1)

arrives at the hospital and states that the individual is a victim of sexual assault, or is accompanied to the hospital by another individual who states that the first individual is a victim of sexual assault; or

(2)

arrives at the hospital and hospital personnel have reason to believe the individual is a victim of sexual assault.

(d)

Requirement for risk assessment, counseling, and treatment

The following shall apply with respect to a hospital described in subsection (b):

(1)

Risk assessment

A hospital shall promptly provide a survivor of a sexual assault with an assessment of the individual’s risk of contracting sexually transmitted infections described in paragraph (2)(A), which assessment 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 consideration of 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 transmitted infections for which effective post-exposure prophylaxis exists, and for which the deferral of treatment would either significantly reduce treatment efficacy or pose substantial risk to the individual’s health; and

(B)

the requirement that prophylactic treatment for infections described in subparagraph (A) shall be provided to the individual upon request, regardless of the ability of the individual or the individual’s family 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)

Language

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

(5)

Ability to pay

The services described in paragraphs (1) through (3) shall not be denied because of the inability of the individual involved or the individual’s family to pay for the services.

(e)

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 assessment (according to recommendations established by the Centers for Disease Control and Prevention) clearly recommends 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 provide reimbursement 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.

(f)

Effective Date; Agency Criteria

This section takes 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 shall publish in the Federal Register criteria for carrying out this section.