,,ii  #aadth ,,congress  #b;d ,session  
,s4 #bidh  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,may #ah1 #bjaf
 ,mrs4 ,murray 7for herself1 ,mrs4      
,shaheen1 ,mrs4 ,mc,caskill1 ,mrs4      
,gillibrand1 ,ms4 ,baldwin1 ,mrs4       
,boxer1 ,mr4 ,blumenthal1 ,mr4 ,bennet1 
and ,mr4 ,wyden7 introduced the         
following bill2 which was read twice and
 referred to the ,committee on ,health1 
,education1 ,labor1 and ,pensions  ,a   
,,bill  ,to plan1 develop1 and make     
recommendations to increase access to   
sexual assault examinations for         
survivors by holding hospitals          
accountable and supporting the providers
 that serve them4  #a4 ,short title     
,this ,act may be cited as the          
,survivors' ,access to ,supportive ,care
 ,act or ,,sasca4  #b4 ,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  
services4  #c4 ,definitions ,in this    
,act3 7a7 ,terms relating to ,,gao      
report ,in this ,act1 the following     
terms shall1 with respect to hospitals  
that receive ,federal funds1 have the   
meanings given such terms in the report 
of the ,government ,accountability      
,office entitled ,information on        
,training1 ,funding1 and the            
,availability of ,forensic ,examiners   
7,,gao-#af-ccd3 ,published3 ,mar #ah1   
#bjaf73  7#a7 ,,mfe ,the term medical   
forensic examination or ,,mfe4  7#b7    
,,safe ,the term sexual assault forensic
 examiner or ,,safe4  7#c7 ,,sane ,the  
term sexual assault nurse examiner or   
,,sane4  7#d7 ,,sart ,the term sexual   
assault response team or ,,sart4  7b7   
,other terms ,in this ,act3 7#a7        
,secretary ,the term ,secretary means   
the ,secretary of ,health and ,human    
,services4  7#b7 ,sexual assault ,the   
term sexual assault has the meaning     
given such term by the ,federal ,bureau 

of ,investigation in the ,uniform ,crime
 ,reporting ,program's ,summary         
,reporting ,system4  ,i ,strengthening  
the ,sexual ,assault ,examiner          
,workforce  #aja4 ,understanding sexual 
assault care  7a7 ,purpose ,it is the   
purpose of this section to identify     
areas for improvement in health care    
delivery systems providing services to  
survivors of sexual assault4  7b7       
,grants ,the ,secretary may award grants
 to ,state governments for the          
development and implementation of ,state
 surveys on health care provider access 
for sexual assault forensic examination 
services to identify--  7#a7 ,state     
requirements1 minimum standards1 and    
protocols for training sexual assault   
examiners2  7#b7 ,state requirements1   
minimum standards1 and protocols for    
training non-,,sane_/,,safe emergency   
services personnel involved in sexual   
assault medical forensic examinations2  
7#c7 the availability of1 and patient   
access to1 trained ,,safe1 ,,sane1 and  

other providers who perform such        
examinations2  7#d7 regional1 provider1 
or other barriers to access sexual      
assault care and services2  7#e7 the    
dedicated ,federal and ,state funding to
 support ,,safe_/,,sane training2  7#f7 
funding opportunities for ,,sane_/,,safe
 training and continuing education2     
7#g7 billing and reimbursement practices
 for medical forensic examinations      
including private health insurance1     
,medicare1 ,medicaid1 the ,state's      
victims compensation program and any    
other crime funding or special sources  
of funding that contribute to payment   
for such examinations2  7#h7 an         
assessment of which hospitals and       
,states are not in compliance with      
,federal law1 are not providing         
survivors of sexual assault for their   
medical forensic examination or sexual  
assault examination1 and which are      
billing such survivors for such         
services2 and  7#i7 the availability of 
,,safe_/,,sane training1 frequency of   

which training is convened1 the         
providers of such training1 what 7if    
any7 is the ,state's role in such       
training1 and what process or procedures
 are in place for continuing education  
of such examiners4  7c7 ,eligibility ,to
 be eligible to receive a grant under   
this section1 an entity shall-- 7#a7 be 
a ,state with public1 private1 and      
non-profit hospitals that receive       
,federal funding2 and  7#b7 submit to   
the ,secretary an application through a 
competitive process to be determined by 
the ,secretary4  7d7 ,public            
dissemination and campaign  7#a7 ,public
 availability ,the results of the       
surveys conducted under grants under    
this section shall be published by the  
,secretary on the ,internet website of  
the ,department of ,health and ,human   
,services on a biennial basis4  7#b7    
,campaigns ,an entity that receives a   
grant under this section shall-- 7,a7   
make the findings of the survey         
conducted under the grant public2  7,b7 

develop policies1 best practices        
recommendations1 and an action plan to  
increase access to ,,safe_/,,sane2 and  
7,c7 utilize such findings to develop   
and implement a public awareness        
campaign to improve patient access to   
services and providers1 and improve     
hospital and stakeholder practices1 with
 respect to sexual assault forensic     
examinations4  7e7 ,authorization of    
appropriations ,there is authorized to  
be appropriated to carry out this       
section1 #b1jjj1jjj for each of fiscal  
years #bjag through #bjai4  #ajb4       
,improving and strengthening the sexual 
assault examiner workforce pilot program
  7a7 ,purpose ,it is the purpose of    
this section to establish a pilot       
program to develop1 test1 and implement 
,,safe training which expands the       
availability of ,,safe1 ,,sane1 and     
,,sart providers for survivors of sexual
 assault4  7b7 ,eligibility ,to ,provide
 services ,with respect to hospitals    
that receive ,federal funds1            

,,safe_/,,sane services1 and other      
forensic medical examiner services shall
 be provided by health care providers   
who are also one of the following3  7#a7
 ,a physician1 including a resident     
physician4  7#b7 ,a nurse practitioner4 
7#c7 ,a nurse midwife4  7#d7 ,a         
physician assistant4  7#e7 ,a certified 
nurse specialist4  7#f7 ,a registered   
nurse4  7#g7 ,where a provider of the   
type described in paragraphs 7#a7       
through 7#f7 is not available1 such     
services may be provided by an          
individual who has completed sexual     
assault forensic examiner training and  
maintained continuing education in such 
training1 as developed by the ,secretary
 and the ,task ,force under section     
#bja4  7c7 ,training and continuing     
education  7#a7 ,establishment  7,a7 ,in
 general ,not later than #a year after  
the date of enactment of this ,act1 the 
,secretary1 in consultation with the    
,attorney ,general1 the ,centers for    
,medicare  ,medicaid ,services1 the     

,centers for ,disease ,control and      
,prevention1 the ,health ,resources and 
,services ,administration1 the ,indian  
,health ,service1 the ,office for       
,victims of ,crime1 the ,office on      
,women's ,health1 and the ,department of
 ,justice ,office on ,violence ,against 
,women1 and with input from national    
experts such as the ,international      
,association of ,forensic ,nurses1 the  
,emergency ,nurses ,association1 the    
,rape1 ,abuse1 and ,incest ,national    
,network1 the ,national ,alliance to    
,end ,sexual ,violence1 the ,national   
,sexual ,violence ,resource ,center1 and
 others shall--  7i7 establish a        
national continuing and clinical        
education pilot program for ,s,a,f,es1  
,s,a,n,es1 and other individuals who    
perform such examinations2 and  7ii7    
develop1 pilot1 implement1 and update as
 appropriate continuing and clinical    
education program modules1 webinars1 and
 programs for all hospitals and         
providers to increase access to ,,sane  

and ,,safe services and address ongoing 
competency issues in ,,safe_/,,sane     
practice of care4  7,b7 ,application    
,the training and continuing education  
program established under subparagraph  
7,a7 shall be available to all          
,s,a,f,es1 ,s,a,n,es1 and other         
providers employed by1 or any individual
 providing services through1 facilities 
that receive ,federal funding4  7#b7    
,elements ,the training and continuing  
education program established under this
 subsection shall require that the      
provision of training in sexual assault 
medical forensic examinations be        
provided by qualified personnel who     
possess--  7,a7 the minimum training    
required to be considered a             
,,safe_/,,safe described in paragraph   
7#a72 or  7,b7 training and clinical or 
forensic experience in sexual assault   
forensic examinations similar to that   
required for a certification described  
in subparagraph 7,a7 based in part on   
the recommendations of the ,national    

,sexual ,assault ,forensic ,examination 
,training ,standards issued by the      
,department of ,justice on ,violence    
,against ,women4  7#c7 ,nature of       
training ,the training provided under   
the training and clinical and continuing
 education program established under    
this subsection shall incorporate and   
reflect current best practices and      
standards on sexual assault medical     
forensic examinations consistent with   
the purpose described in section #b1    
such as the use of telemedicine         
consistent with section #bja4  7#d7     
,applicability of training requirements 
7,a7 ,in general ,effective beginning #a
 year after the date of the enactment of
 this ,act1 a licensed medical          
professional shall not provide          
,,safe_/,,sane services1 or provide any 
other forensic medical examiner         
services1 unless the professional has   
completed--  7i7 all training required  
under the training and continuing       
education pilot program established in  

this subsection2  7ii7 all training     
required to be considered a ,,sane by   
the ,international ,association of      
,forensic ,nurses2 or  7iii7 all        
training required to be certified or    
credentialed as a ,,safe_/,,sane by the 
applicable ,state issuing body4  7,b7   
,continued application of clinical      
education and training ,if a practicing 
,,safe_/,,sane was qualified or trained 
through a practical training program    
7such as the ,international ,association
 of ,forensic ,nurses ,,sane training7  
prior to the date of enactment of this  
,act1 such examiner shall be permitted  
to continue to provide services as a    
,,safe or ,,sane so long as such        
examiner meets the applicable continuing
 clinical education requirements4  7,c7 
,rule of construction ,nothing in this  
,act 7or the amendments made by this    
,act7 shall be construed to preempt any 
provision of ,federal or ,state law to  
the extent that such ,federal or ,state 
law provides protections for survivor's 

access to ,,safe_/,,sane care that are  
greater than the protections provided   
for in this ,act 7or amendments74  7#e7 
,effective date  7,a7 ,in general ,the  
pilot program established under this    
section shall terminate on the date that
 is #b years after the date of such     
establishment4  7,b7 ,authority for     
modifications ,upon the expiration of   
the pilot program as provided for in    
subparagraph 7,a71 the ,secretary 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        
assault4  7,c7 ,technical assistance    
,the ,secretary and the ,attorney       
,general shall provide technical        
assistance and guidance to ensure       
compliance with the requirements of this
 section4  7,d7 ,preemption ,nothing in 
this section shall be construed to      
preempt any provision of ,federal or    
,state law to the extent that such      

,federal or ,state law provides         
protections for survivors of sexual     
assault that are greater than the       
protections provided for in this        
section4  #ajc4 ,national report on     
sexual assault services in our nation's 
health system  7a7 ,in general ,not     
later than #a year after the date of    
enactment of this ,act1 and annually    
thereafter1 the ,agency for ,healthcare 
,research and ,quality1 in consultation 
with the ,centers for ,medicare         
,medicaid ,services1 the ,centers for   
,disease ,control and ,prevention1 the  
,health ,resources and ,services        
,administration1 the ,indian ,health    
,service1 the ,office for ,victims of   
,crime1 the ,office on ,women's ,health1
 and the ,office of ,violence ,against  
,women of the ,department of ,justice   
7hereafter referred to in this section  
collectively as the ,agencies71 shall   
submit to the ,secretary a report of    
existing ,federal and ,state practices  
relating to ,s,a,f,es1 ,s,a,n,es1 and   

others who perform such examinations    
which reflects the findings of the      
surveys developed under section #aja4   
7b7 ,core competencies ,in conducting   
activities under this section1 the      
,agencies shall address ,,safe_/,,sane  
competencies including--  7#a7 providing
 comprehensive medical care to sexual   
assault patients2  7#b7 demonstrating   
the ability to conduct a medical        
forensic examination to include an      
evaluation for evidence collection2     
7#c7 showing compassion and sensitivity 
towards survivors of sexual assault2    
7#d7 testifying in ,federal1 ,state1    
local1 and tribal courts2 and  7#e7     
other competencies as determined        
appropriate by the ,agencies4  7c7      
,publication  7#a7 ,,ahrq ,the ,agency  
for ,healthcare ,research and ,quality  
shall establish1 maintain1 and publish  
on the ,internet website of the         
,department of ,health and ,human       
,services an online public map of       
,,safe1 ,,sane1 and other forensic      

medical examiners available to the      
,department of ,health and ,human       
,services4  7#b7 ,states ,a ,state that 
receives ,federal funds shall maintain  
and make available a ,state map         
displaying the number of available      
,,safe_/,,sane programs and other       
forensic medical examiners4  #ajd4      
,hospital reporting ,not later than #a  
year after the date of enactment of this
 ,act1 and annually thereafter1 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 ,s,a,f,es1 ,s,a,r,ts1 ,s,a,n,es1
 and others who perform such            
examinations4 ,such report shall        
describe--  7#a7 the number of sexual   
assault forensic examinations done in   
the hospital in the year for which the  
report is being prepared2  7#b7 the     
training that such ,s,a,f,es_/,s,a,n,es 
undergo1 both initially and for         
recertification2  7#c7 the number of    

,s,a,f,es_/,s,a,n,es employed by the    
hospital1 differentiating between       
part-time and full-time employees2 and  
7#d7 the ,,safe_/,,sane standards of    
care applied by the hospital4  ,,ii     
,standards of care  #bja4 ,national     
,sexual ,assault ,care and ,treatment   
,task ,force  7a7 ,establishment ,the   
,secretary shall establish a task force 
to be known as the ,,sasca ,task ,force 
7referred to in this section as the     
,task ,force7 to review ,state          
guidelines1 procedures1 practices1      
training1 and employment and retention  
data for ,,safe_/,,sane and other       
forensic medical examiners4  7b7        
,appointments ,the ,secretary1 in       
consultation with the ,centers for      
,medicare  ,medicaid ,services1 the     
,centers for ,disease ,control and      
,prevention1 the ,health ,resources and 
,services ,administration1 the ,indian  
,health ,service1 the ,office for       
,victims of ,crime1 the ,office on      
,women's ,health1 and the ,department of

 ,justice ,office on ,violence ,against 
,women1 and key stakeholders such as the
 ,international ,association of         
,forensic ,nurses1 the ,rape1 ,abuse1   
and ,incest ,national ,network1 the     
,national ,domestic ,violence ,hotline1 
the ,national ,alliance to ,end ,sexual 
,violence1 the ,national ,sexual        
,violence ,resource ,center1 and        
community-based organizations shall     
appoint experts to the ,task ,force4    
7c7 ,objectives ,to assist and          
standardize ,state-level efforts to     
improve medical forensic evidence       
collection relating to sexual assault1  
the ,task ,force shall--  7#a7 review   
,state-level practices for ,s,a,f,es1   
,s,a,r,ts1 ,s,a,n,es1 and others who    
perform such examinations to ensure that
 such practices are consistent with     
established national training1          
certification1 and practice             
recommendations2  7#b7 create a best    
practices guide for forensic medical    
examiners relating to sexual assault2   

7#c7 improve coordination of services1  
and other protocols regarding the care  
and treatment of sexual assault         
survivors and the preservation of       
evidence between law enforcement        
officials and health care providers2 and
  7#d7 update national minimum standards
 for forensic medical examiner training 
and forensic medical evidence collection
 relating to sexual assault4  7d7       
,transparency requirements  7#a7 ,in    
general ,the ,task ,force shall report  
to the ,secretary1 at such time1 in such
 manner1 and containing such information
 as may be specified by the ,secretary1 
on--  7,a7 the recommendation for best  
practices with respect to improving     
medical forensic evidence collection    
relating to sexual assault2 and  7,b7   
the national minimum standards for      
medical forensic examinations and       
treatments relating to sexual assault4  
7#b7 ,report ,not later than one year   
after the date of enactment of this     
,act1 the ,secretary shall submit to    

,congress a report on the findings and  
conclusions of the ,task ,force4  7e7   
,annual summit ,the ,secretary shall    
convene an annual stakeholder meeting to
 address gaps in health care provider   
care relating to sexual assault4 ,such  
meetings shall include the ,task ,force1
 as well as the ,centers for ,medicare  
,medicaid ,services1 the ,centers for   
,disease ,control and ,prevention1 the  
,health ,resources and ,services        
,administration1 the ,indian ,health    
,service1 the ,office for ,victims of   
,crime1 the ,office on ,women's ,health1
 and the ,department of ,justice ,office
 on ,violence ,against ,women1 and key  
stakeholders such as the ,international 
,association of ,forensic ,nurses1 the  
,rape1 ,abuse1 and ,incest ,national    
,network1 ,national ,alliance to ,end   
,sexual ,violence1 ,national ,sexual    
,violence ,resource ,center and         
community-based organizations4  #bjb4   
,institutes of higher education campus  
action plan  7a7 ,in general ,each      

institution of higher education that    
receives ,federal funds shall make      
publicly available a written plan of the
 steps the institution takes to ensure  
access to sexual assault medical        
forensic examinations and treatments4   
,such plan shall include information    
about the availability of services1 and 
a statement that ,federal law requires  
that such exams be provided free of     
charge4  7b7 ,access to examinations    
,each institution of higher education   
that receives ,federal funds shall1 to  
the extent practicable1 ensure that     
students have access to sexual assault  
medical forensic examination by         
employing the use of a ,,safe_/,,sane in
 the campus medical facility or hospital
 or by entering into a memorandum of    
understanding or formal agreement with  
at least one local health care facility 
to provide such service if no           
appropriate medical facility is         
available on campus1 including the cost 
of transportation for students to access

 services4  #bjc4 ,expanding access to  
unified care ,part ,b of title ,,viii of
 the ,public ,health ,service ,act 7#db 
,u4,s4,c4 #bif;j et seq47 is amended by 
adding at the end the following3  #hab4 
,demonstration grants for sexual assault
 examiner training programs  7a7        
,establishment of program ,the          
,secretary shall establish a            
demonstration program 7referred to in   
this section as the program7 to award   
grants to eligible partnered entities   
for the clinical training of            
,s,a,f,es_/,s,a,n,es 7including         
registered nurses1 nurse practitioners1 
nurse midwives1 clinical nurse          
specialists1 physician assistants1 and  
physicians7 to administer medical       
forensic examinations and treatments to 
victims of sexual assault in hospitals1 
health centers1 and other emergency     
health care service provider settings1  
including ,federally qualified health   
centers1 clinics receiving funding under
 title ,x1 and other health care        

providers as determined appropriate by  
the ,secretary4  7b7 ,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 services4  
7c7 ,grants ,under the program1 the     
,secretary shall award #c-year grants to
 eligible entities that meet the        
requirements established by the         
,secretary1 for the purpose of operating
 the ,,safe_/,,sane training programs   
described in subsection 7a7 at such     
entities and to test the provision of   
such services at new facilities in      
expanded health care settings4  7d7     
,eligible entities ,to be eligible to   
receive a grant under this section1 an  
entity shall-- 7#a7 be a rural health   
care services provider 7as defined by   
the ,secretary71 a center or clinic     
under section #ccj1 or a health center  
receiving assistance under title ,x1    

acting in partnership with a high-volume
 emergency services provider or a       
hospital currently providing sexual     
assault medical forensic examinations   
performed by ,s,a,n,es or ,s,a,f,es1    
that will use grant funds to--  7,a7    
assign rural health care service        
providers to the high-volume hospitals  
for clinical practicum hours to qualify 
such providers as a ,,safe_/,,sane2 or  
7,b7 assign practitioners at high-volume
 hospitals to a rural health care       
services providers to instruct1 oversee1
 and approve clinical practicum hours in
 the community to be served4  7#b7      
submit to the ,secretary an application 
at such time1 in such manner1 and       
containing such information as the      
,secretary may require1 including a     
description of whether the applicant    
will provide services under subparagraph
 7,a7 or 7,b7 of paragraph 7#a74  7e7   
,grant amount ,each grant awarded under 
this section shall be in an amount not  
to exceed #djj1jjj per year4 ,a grant   

recipient may carry over funds from #a  
fiscal year to the next without         
obtaining approval from the ,secretary4 
7f7 ,authorization of appropriations ,to
 carry out this section1 there is       
authorized to be appropriated           
#aj1jjj1jjj for each of fiscal years    
#bjaf through #bjai4  4  #bjd4          
,technical assistance grants and        
learning collectives ,part ,b of title  
,,viii of the ,public ,health ,service  
,act 7#db ,u4,s4,c4 #bif;j et seq471 as 
amended by section #bjc1 is further     
amended by adding at the end the        
following3  #hab;,a4 ,technical         
assistance center and regional learning 
collectives  7a7 ,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  
of1 and access to1 sexual assault       
examinations by entering into contracts 
with national experts 7such as the      
,international ,forensic ,nurses        

,association and others74  7b7 ,regional
 learning collectives ,the ,secretary   
shall convene ,state and hospital       
regional learning collectives to assist 
health care providers and ,states in    
sharing best practices1 discussing      
practices1 and improving the quality of1
 and access to1 sexual assault          
examinations4  7c7 ,repository ,the     
,secretary shall establish and maintain 
a secure ,internet-based data repository
 to serve as an online learning         
collective for ,state and entity        
collaborations4 ,an entity receiving a  
grant under section #hab may use such   
repository for--  7#a7 technical        
assistance2 and  7#b7 best practice     
sharing4  4  #bje4 ,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           
#cii;,,hh7a77#b7 of the ,public ,health 
,service ,act 7#db ,u4,s4,c4 #bhj;j74   

#bjf4 ,oversight ,not later than #a year
 after the date of enactment of this    
,act1 the ,office of the ,inspector     
,general shall issue a report concerning
 hospital compliance with section #ahfg 
of the ,social ,security ,act 7#db      
,u4,s4,c4 #acie;dd7 and the ,violence   
,against ,women ,act of #aiid 7#db      
,u4,s4,c4 #acgja et seq47 with respect  
to access to1 and reimbursements for1   
sexual assault medical forensic         
examinations at the national1 ,state1   
and individual hospital level4 ,such    
report shall address hospital awareness 
of reimbursements1 total reimbursed     
costs1 and any costs for victims4