,i  #aai? ,,congress  #a/ ,session  ,h4 
,r4 #ehie  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,octob] #ca1          
#bjbe,mrs4 ,trahan 7= h]self1 ,mr4      
,mc,govern1 & ,mrs4 ,d+ell7 introduc$ ! 
foll[+ bill2 :i* 0 ref]r$ to !          
,committee on ,ways & ,means1 & 9       
addition to ! ,committee on ,en]gy &    
,comm]ce1 = a p]iod to be subsequ5tly   
det]m9$ by ! ,speak]1 9 ea* case =      
consid]ation ( su* provisions z fall )9 
! jurisdiction ( ! committee conc]n$  ,a
 ,,bill  ,to am5d title ,,xviii ( !     
,social ,security ,act to e/abli% c]ta9 
/&>ds & requirem5ts ) respect to obta9+ 
in=m$ cons5t & provid+ *ap]ones =       
provid]s ( s]vices p>ticipat+ 9 !       
,m$ic>e program4  #a4 ,%ort title ,?is  
,act may be cit$ z ! ,protect ,pati5ts f
 ,heal?c>e ,abuse ,act4  #b4 ,e/abli%+  
/&>ds & requirem5ts ) respect to obta9+ 
in=m$ cons5t & provid+ *ap]ones z a     
,m$ic>e condition ( p>ticipation        
,section #ahff ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #acie;cc7 is am5d$--

  7#a7 9 subsection 7a77#a7-- 7,a7 9    
subp>agraph 7,x71 by /rik+ & at ! end2  
7,b7 9 subp>agraph 7,y71 by /rik+ !     
p]iod at ! end & ins]t+ 1 &2 &  7,c7 by 
ins]t+ aft] subp>agraph 7,y7 ! foll[+   
new subp>agraph3  7,z7 beg9n+ ,janu>y   
#a1 #bjbf1 9 ! case ( a provid] (       
s]vices1 to comply ) ! in=m$ cons5t &   
*ap]one requirem5ts describ$ 9          
subsection 7l74  2 &  7#b7 by add+ at ! 
end ! foll[+ new subsection3  7l7 ,in=m$
 cons5t & *ap]one requirem5ts  7#a7 ,9  
g5]al ,= purposes ( subsection          
7a77#a77,z71 ! in=m$ cons5t & *ap]one   
requirem5ts are1 ) respect to a provid] 
( s]vices-- 7,a7 ! writt5 notification  
requirem5t describ$ 9 p>agraph 7#b72 &  
7,b7 ! *ap]one tra9+ & education        
requirem5t describ$ 9 p>agraph 7#c74    
7#b7 ,writt5 notification requirem5t ,= 
purposes ( p>agraph 7#a71 ! requirem5t  
describ$ 9 ?is p>agraph is1 ) respect to
 a provid] ( s]vices1 t ! provid]       
ma9ta9s writt5 policies & proc$ures )   
respect to all adult individuals receiv+

 m$ical c>e by or ?r\gh su* provid] to  
provide writt5 in=mation to ea* su*     
individual conc]n+ ! "r ( su* individual
 or a surrogate ( su* individual 7to !  
ext5t p]mitt$ "u ,/ate law7 to make     
in=m$ decisions ) respect to ! c>e ( su*
 individual1 includ+--  7,a7 ! "r to be 
in=m$ ( ! individual's heal? /atus2     
7,b7 ! "r to be involv$ 9 plann+ = !    
individual's c>e2  7,c7 ! "r to provide 
in=m$ cons5t ) respect to an item or    
s]vice be=e su* item or s]vice is       
furni%$ to su* individual2 &  7,d7 ! "r 
to reque/ ! pres5ce ( a *ap]one dur+ a  
s5sitive proc$ure4  7#c7 ,*ap]one tra9+ 
& education requirem5t ,= purposes (    
p>agraph 7#a71 ! requirem5t describ$ 9  
?is p>agraph is1 ) respect to a provid] 
( s]vices1 t ! provid] provides = !     
education & tra9+ ( appropriate /aff 7z 
det]m9$ by ! provid]7 ) respect to !    
rights ( individuals receiv+ m$ical c>e 
by or ?r\gh su* provid] describ$ 9      
p>agraph 7#b74 ,su* tra9+ & education   
%all include-- 7,a7 tra9+ 9 h[ to p]=m !

 functions ( a *ap]one dur+ a s5sitive  
proc$ure2  7,b7 education ) respect to  
:at con/itutes a s5sitive proc$ure2 &   
7,c7 education ) respect to an          
individual's "r to provide in=m$ cons5t 
to items & s]vices be+ furni%$ to su*   
individual1 z describ$ 9 p>agraph       
7#b77;,c74  7#d7 ,def9itions ,9 ?is     
subsection1 ! foll[+ def9itions apply3  
7,a7 ,*ap]one ,! t]m *ap]one means1 )   
respect to m$ical c>e furni%$ to an     
individual by or ?r\gh a provid] (      
s]vices1 an appropriate /aff memb] 7z   
det]m9$ by ! provid]7--  7i7 :o is tra9$
 & educat$ 9 accordance ) p>agraph 7#c72
 &  7ii7 :o is pres5t dur+ a s5sitive   
proc$ure furni%$ 9 connection ) su* c>e 
9 ord] to--  7,i7 act z a witness to !  
proc$ure2  7,,ii7 provide a com=table1  
safe environm5t consi/5t ) ! g5]ally    
accept$ /&>d ( c>e = su* proc$ure2 &    
7,,iii7 report sexual abuse 7z def9$ 9  
section #bbdb ( title #ah1 ,unit$ ,/ates
 ,code7 to an appropriate sup]visor 7z  
designat$ by ! provid]74  7,b7 ,in=m$   

cons5t ,! t]m in=m$ cons5t means1 )     
respect to an item or s]vice furni%$ to 
an individual by or ?r\gh a provid] (   
s]vices1 t ! individual und]/&s ! risks1
 b5efits1 & alt]natives ( su* item or   
s]vice4  7,c7 ,s5sitive proc$ure ,! t]m 
s5sitive proc$ure means1 ) respect to   
m$ical c>e furni%$ to an individual by  
or ?r\gh a provid] ( s]vices1 any ( !   
foll[+ proc$ures furni%$ 9 connection ) 
su* c>e3 7i7 ,any physical exam9ation1  
surg]y1 or o!r proc$ure involv+ !       
individual's g5italia1 brea/s1 p]ianal  
region1 or rectum4  7ii7 ,any o!r       
physical exam9ation1 surg]y1 or o!r     
proc$ure t ! individual consid]s to be  
s5sitive4  4