,,ii #aafth ,,congress #ast ,session ,s4 #djb ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,february #g1 #bjai,mrs4 ,murray 7for herself1 ,ms4 ,murkowski1 ,mr4 ,blumenthal1 ,mrs4 ,shaheen1 ,ms4 ,harris1 ,mr4 ,sanders1 ,ms4 ,smith1 ,ms4 ,hassan1 ,mr4 ,leahy1 ,ms4 ,klobuchar1 ,mrs4 ,gillibrand1 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 7#a7 ,community health aide and community health practitioner ,the terms community health aide and community health practitioner have the meanings within the meaning of section #aai of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afafl74 7#b7 ,,mfe ,the term medical forensic examination or ,,mfe means an examination provided to a sexual assault survivor by medical personnel trained to gather evidence of a sexual assault in a manner suitable for use in a court of law4 7#c7 ,,sae ,the term sexual assault examiner or ,,sae means a registered nurse1 advanced practice nurse1 physician1 or physician assistant specifically trained to provide care to sexual assault forensic examinations4 7#d7 ,,safe ,the term sexual assault forensic examiner or ,,safe means a medical practitioner who has specialized forensic training in treating sexual assault survivors and conducting medical forensic examinations4 7#e7 ,,sane ,the term sexual assault nurse examiner or ,,sane means a registered nurse who has specialized forensic training in treating sexual assault survivors and conducting medical forensic examinations4 7#f7 ,,sart ,the term sexual assault response team or ,,sart means a multidisciplinary team that provides a specialized and immediate response to survivors of sexual assault1 and may include health care personnel1 law enforcement representatives1 community-based survivor advocates1 prosecutors1 and forensic scientists4 7#g7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services4 7#h7 ,sexual assault ,the term sexual assault means any nonconsensual sexual act proscribed by ,federal1 tribal1 or ,state law1 including when the individual lacks capacity to consent4 ,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 shall award grants to ,states to develop and implement ,state surveys to identify-- 7#a7 the availability of and patient access to trained ,,safe1 ,,sane1 and other providers who perform ,m,f,es2 7#b7 the hospitals or clinics that offer ,m,f,es and whether each hospital or clinic has full-time1 part-time1 or on-call coverage2 7#c7 regional1 provider1 or other barriers to access sexual assault care and services1 including ,m,f,es2 7#d7 billing and reimbursement practices for ,m,f,es1 including private health insurance1 ,medicare1 ,medicaid1 the ,state's victims compensation program1 and any other crime funding or other sources of funding that contribute to payment for such examinations2 7#e7 ,state requirements1 minimum standards1 and protocols for training sexual assault examiners2 7#f7 ,state requirements1 minimum standards1 and protocols for training non-,,sane or ,,safe emergency services personnel involved in ,m,f,es2 7#g7 the availability of ,,safe or ,,sane training1 frequency of when training is convened1 the providers of such training1 the ,state's role in such training1 and what process or procedures are in place for continuing education of such examiners2 7#h7 the dedicated ,federal and ,state funding to support ,,safe or ,,sane training2 and 7#i7 funding opportunities for ,,sane or ,,safe training and continuing education4 7c7 ,eligibility ,to be eligible to receive a grant under this section1 a ,state shall-- 7#a7 have public1 private1 or nonprofit 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 awarded under this section shall be published by the ,secretary on the website of the ,department of ,health and ,human ,services on a biennial basis4 7#b7 ,campaigns ,a ,state that receives a grant under this section shall carry out the following3 7,a7 ,make the findings of the survey conducted under the grant public4 7,b7 ,use the findings to develop a strategic action plan to increase the number of trained examiners available in the ,state and create policies to increase survivor access to trained examiners4 7,c7 ,use the findings to develop and implement a public awareness campaign that includes the following3 7i7 ,an online toolkit describing how and where sexual assault survivors can obtain assistance and care1 including ,m,f,es1 in the ,state4 7ii7 ,a ,model ,standard ,response ,protocol for health care providers to implement upon arrival of a patient seeking care for sexual assault4 7iii7 ,a ,model ,sexual ,assault ,response ,team ,protocol incorporating interdisciplinary community coordination between hospitals1 emergency departments1 hospital administration1 local rape crisis programs1 law enforcement1 prosecuting attorneys1 and other health and human service agencies and stakeholders with respect to delivering survivor-centered sexual assault care and ,m,f,es4 7iv7 ,a notice of ,state and ,federal laws prohibiting charging or billing survivors of sexual assault for care and services related to sexual assault4 7e7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section1 #b1jjj1jjj for each of fiscal years #bjai through #bjbd4 #ajb4 ,improving and strengthening the sexual assault examiner workforce clinical and continuing education pilot program 7a7 ,purpose ,it is the purpose of this section to establish a pilot program to develop1 test1 and implement training and continuing education which expands and supports the availability of ,,safe1 ,,sae1 and ,,sane1 providers and services for survivors of sexual assault4 7b7 ,establishment 7#a7 ,in general ,not later than #a year after the date of enactment of this ,act1 the ,secretary shall establish a ,national ,continuing and ,clinical ,education ,pilot ,program for ,s,a,f,es1 ,s,a,n,es1 and other individuals who perform such examinations in consultation with the ,department of ,justice1 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 ,crime of the ,department of ,justice1 the ,office on ,violence ,against ,women of the ,department of ,justice1 and the ,office on ,women's ,health of the ,department of ,health and ,human ,services and with input from regional and national organizations with expertise in forensic nursing1 rape trauma or crisis counseling1 investigating rape and gender violence cases1 survivors' advocacy and support1 sexual assault prevention education1 rural health1 and responding to sexual violence in ,native communities4 ,such pilot program shall be #b years in duration4 7#b7 ,functions ,the pilot program established under paragraph 7#a7 shall develop1 pilot1 implement1 and update1 as appropriate1 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 or ,,sane practice of care1 including-- 7,a7 training and continuing education to help support ,s,a,f,es or ,s,a,n,es practicing in rural or underserved areas2 7,b7 training to help connect sexual assault survivors who are ,native ,american with ,s,a,f,es or ,s,a,n,es1 including through emergency first aid1 referrals1 culturally competent support1 and forensic evidence collection in rural communities2 7,c7 replication of successful ,,sane or ,,safe programs to help develop and improve the evidence base for ,m,f,es2 and 7,d7 training to increase the number of medical professionals who are considered ,s,a,f,es or ,s,a,n,es based on the recommendations of the ,national ,sexual ,assault ,forensic ,examination ,training ,standards issued by the ,department of ,justice on ,violence ,against ,women4 7#c7 ,eligibility to participate in pilot programs ,the ,secretary shall ensure that ,,safe or ,,sane services provided under the pilot program established under paragraph 7#a71 and other medical forensic examiner services under the pilot program 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 ,a community health practitioner or a community health aide who has completed level ,,iii or level ,,iv certification and training requirements4 7#d7 ,nature of training ,the continuing education program established under this section shall incorporate and reflect current best practices and standards on ,m,f,es consistent with the purpose of this section4 7c7 ,availability ,after termination of the pilot program established under subsection 7b77#a71 the training and continuing education program established under such program 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 ,the ,task ,force established under section #bja shall review and recommend updates to the training and continuing education program after the termination of the pilot program4 7d7 ,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 termination of the pilot program as provided for in paragraph 7#a71 the ,secretary or the ,task ,force established under section #bja 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 7e7 ,authorization ,there are authorized to be appropriated to carry out this section #e1jjj1jjj for each of fiscal years #bjai through #bjba4 #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 ,crime of the ,department of ,justice1 the ,office on ,women's ,health of the ,department of ,health and ,human ,services1 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 or ,,sane competencies1 including-- 7#a7 providing comprehensive medical care to sexual assault patients2 7#b7 demonstrating the ability to conduct a ,,mfe 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 website of the ,department of ,health and ,human ,services an online public map of ,,safe1 ,,sane1 and other forensic medical examiners4 ,such maps shall clarify if there is full-time1 part-time1 or on-call coverage4 7#b7 ,states ,a ,state that receives ,federal funds shall maintain and make available an online public map displaying the number and location of available ,,safe or ,,sane programs and other forensic medical examiners in the ,state4 ,such maps shall clarify if there is full-time1 part-time1 or on-call coverage4 #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 survivors who present at the hospital for ,m,f,es in the year for which the report is being prepared2 7#b7 the number of personnel who are trained and practicing as a ,,sane or ,,safe to perform sexual assault exams1 indicating the employment basis of such personnel as either full-time1 part-time1 or on-call2 7#c7 the number of sexual assault exams performed by ,s,a,n,es or ,s,a,f,es2 7#d7 the number of sexual assault exams performed by personnel other than a ,,sane or ,,safe2 7#e7 the training that such ,s,a,f,es or ,s,a,n,es undergo for purposes of maintaining competency2 and 7#f7 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 identify barriers to improving access to ,,safe_/,,sane and other forensic medical examiners4 7b7 ,membership ,the ,task ,force shall include a representative from 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 ,crime of the ,department of ,justice1 the ,office on ,women's ,health of the ,department of ,health and ,human ,services1 and the ,office on ,violence ,against ,women of the ,department of ,justice1 a survivor of sexual assault1 and representatives from regional and national organizations with expertise in forensic nursing1 rape trauma or crisis counseling1 investigating rape and gender violence cases1 survivors' advocacy and support1 sexual assault prevention education1 rural health1 and responding to sexual violence in ,native communities4 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 identify barriers to the recruitment1 training1 and retention of ,s,a,f,es1 ,s,a,r,ts1 ,s,a,n,es1 and others who perform such examinations2 7#b7 make recommendations for improving access to medical forensic examinations1 including the feasibility of1 or barriers to1 utilizing mobile units2 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 ,not later than #a year after first convening1 the ,task ,force shall report to the ,secretary in a public document 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 ,m,f,es and treatments relating to sexual assault4 7#b7 ,report ,not later than #ah months 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 assault that includes the ,task ,force4 #bjb4 ,institutions of higher education campus action plan ,each institution of higher education that receives ,federal funds shall-- 7#a7 inform survivors of sexual assault about the availability of ,m,f,es1 including the nearest available locations at which such examinations are provided by a ,,sane and that ,federal law requires such exams to be provided at no cost to the survivor2 and 7#b7 make the information described in paragraph 7#a7 available on the website of the institution1 to the extent practicable4 #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 survivors of sexual assault4 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 services and to test the provisions of such services at new facilities in expanded health care settings4 7c7 ,grants ,under the program1 the ,secretary shall award #c-year grants to eligible entities that meet the requirements established by the ,secretary4 7d7 ,eligible entities ,to be eligible to receive a grant under this section1 an entity shall-- 7#a7 be-- 7,a7 a rural health care services provider or community-based service 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-- 7i7 assign rural health care service providers to the high-volume hospitals for clinical practicum hours to qualify such providers as a ,,safe_/,,sane2 or 7ii7 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 served2 or 7,b7 an organization described in section #eja7;c77#c7 of the ,internal ,revenue ,code of #aihf and exempt from taxation under #eja7;a7 of that ,act1 that provides legal training and technical assistance to tribal communities and to organizations and agencies serving ,native people2 and 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 one fiscal year to the next without obtaining approval from the ,secretary4 7f7 ,authorization of appropriations 7#a7 ,in general ,there is authorized to be appropriated to carry out this section #aa1jjj1jjj for each of fiscal years #bjai through #bjbd4 7#b7 ,set-aside ,of the amount appropriated under this subsection for a fiscal year1 the ,secretary shall reserve #ae percent of such amount for purposes of making grants to entities that are affiliated with ,indian tribes or tribal organizations 7as defined in section #d of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #ecjd771 or ,urban ,indian organizations 7as defined in section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc774 ,amounts reserved may be used to support referrals and the delivery of emergency first aid1 culturally competent support1 and forensic evidence collection training4 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 ,m,f,es 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 ,m,f,es4 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;j7a77#b774 #bjf4 ,oversight ,not later than one 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#cd ,u4,s4,c4 #abbia 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 survivors4