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Title I — Strengthening the Sexual Assault Examiner Workforce

S. 402 · 116th Congress · Feb 7, 2019 · Lineage

I Strengthening the Sexual Assault Examiner Workforce

Sec. 101 Understanding sexual assault care

(a)
Purpose— It is the purpose of this section to identify areas for improvement in health care delivery systems providing services to survivors of sexual assault.
(b)
Grants— The Secretary shall award grants to States to develop and implement State surveys to identify—
(1)
the availability of and patient access to trained SAFE, SANE, and other providers who perform MFEs;
(2)
the hospitals or clinics that offer MFEs and whether each hospital or clinic has full-time, part-time, or on-call coverage;
(3)
regional, provider, or other barriers to access sexual assault care and services, including MFEs;
(4)
billing and reimbursement practices for MFEs, including private health insurance, Medicare, Medicaid, the State’s victims compensation program, and any other crime funding or other sources of funding that contribute to payment for such examinations;
(5)
State requirements, minimum standards, and protocols for training sexual assault examiners;
(6)
State requirements, minimum standards, and protocols for training non-SANE or SAFE emergency services personnel involved in MFEs;
(7)
the availability of SAFE or SANE training, frequency of when training is convened, the providers of such training, the State’s role in such training, and what process or procedures are in place for continuing education of such examiners;
(8)
the dedicated Federal and State funding to support SAFE or SANE training; and
(9)
funding opportunities for SANE or SAFE training and continuing education.
(c)
Eligibility— To be eligible to receive a grant under this section, a State shall—
(1)
have public, private, or nonprofit hospitals that receive Federal funding; and
(2)
submit to the Secretary an application through a competitive process to be determined by the Secretary.
(d)
Public dissemination and campaign—
(1)
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 basis.
(2)
Campaigns— A State that receives a grant under this section shall carry out the following:
(A)
Make the findings of the survey conducted under the grant public.
(B)
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 examiners.
(C)
Use the findings to develop and implement a public awareness campaign that includes the following:
(i)
An online toolkit describing how and where sexual assault survivors can obtain assistance and care, including MFEs, in the State.
(ii)
A Model Standard Response Protocol for health care providers to implement upon arrival of a patient seeking care for sexual assault.
(iii)
A Model Sexual Assault Response Team Protocol incorporating interdisciplinary community coordination between hospitals, emergency departments, hospital administration, local rape crisis programs, law enforcement, prosecuting attorneys, and other health and human service agencies and stakeholders with respect to delivering survivor-centered sexual assault care and MFEs.
(iv)
A notice of State and Federal laws prohibiting charging or billing survivors of sexual assault for care and services related to sexual assault.
(e)
Authorization of appropriations— There is authorized to be appropriated to carry out this section, $2,000,000 for each of fiscal years 2019 through 2024.

Sec. 102 Improving and strengthening the sexual assault examiner workforce clinical and continuing education pilot program

(a)
Purpose— It is the purpose of this section to establish a pilot program to develop, test, and implement training and continuing education which expands and supports the availability of SAFE, SAE, and SANE, providers and services for survivors of sexual assault.
(b)
Establishment—
(1)
In general— Not later than 1 year after the date of enactment of this Act, the Secretary shall establish a National Continuing and Clinical Education Pilot Program for SAFEs, SANEs, and other individuals who perform such examinations in consultation with the Department of Justice, the Centers for Medicare & Medicaid Services, the Centers for Disease Control and Prevention, the Health Resources and Services Administration, the Indian Health Service, the Office for Victims of Crime of the Department of Justice, the Office on Violence Against Women of the Department of Justice, 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 nursing, rape trauma or crisis counseling, investigating rape and gender violence cases, survivors’ advocacy and support, sexual assault prevention education, rural health, and responding to sexual violence in Native communities. Such pilot program shall be 2 years in duration.
(2)
Functions— The pilot program established under paragraph (1) shall develop, pilot, implement, and update, as appropriate, continuing and clinical education program modules, webinars, 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 care, including—
(A)
training and continuing education to help support SAFEs or SANEs practicing in rural or underserved areas;
(B)
training to help connect sexual assault survivors who are Native American with SAFEs or SANEs, including through emergency first aid, referrals, culturally competent support, and forensic evidence collection in rural communities;
(C)
replication of successful SANE or SAFE programs to help develop and improve the evidence base for MFEs; and
(D)
training to increase the number of medical professionals who are considered SAFEs or SANEs based on the recommendations of the National Sexual Assault Forensic Examination Training Standards issued by the Department of Justice on Violence Against Women.
(3)
Eligibility to participate in pilot programs— The Secretary shall ensure that SAFE or SANE services provided under the pilot program established under paragraph (1), and other medical forensic examiner services under the pilot program shall be provided by health care providers who are also one of the following:
(A)
A physician, including a resident physician.
(B)
A nurse practitioner.
(C)
A nurse midwife.
(D)
A physician assistant.
(E)
A certified nurse specialist.
(F)
A registered nurse.
(G)
A community health practitioner or a community health aide who has completed level III or level IV certification and training requirements.
(4)
Nature of training— The continuing education program established under this section shall incorporate and reflect current best practices and standards on MFEs consistent with the purpose of this section.
(c)
Availability— After termination of the pilot program established under subsection (b)(1), the training and continuing education program established under such program shall be available to all SAFEs, SANEs, and other providers employed by, or any individual providing services through, facilities that receive Federal funding. The Task Force established under section 201 shall review and recommend updates to the training and continuing education program after the termination of the pilot program.
(d)
Effective date—
(1)
In general— The pilot program established under this section shall terminate on the date that is 2 years after the date of such establishment.
(2)
Authority for modifications— Upon termination of the pilot program as provided for in paragraph (1), the Secretary or the Task Force established under section 201 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 assault.
(e)
Authorization— There are authorized to be appropriated to carry out this section $5,000,000 for each of fiscal years 2019 through 2021.

Sec. 103 National report on sexual assault services in our nation’s health system

(a)
In general— Not later than 1 year after the date of enactment of this Act, and annually thereafter, the Agency for Healthcare Research and Quality, in consultation with the Centers for Medicare & Medicaid Services, the Centers for Disease Control and Prevention, the Health Resources and Services Administration, the Indian Health Service, the Office for Victims of Crime of the Department of Justice, the Office on Women’s Health of the Department of Health and Human Services, and the Office of Violence Against Women of the Department of Justice (hereafter referred to in this section collectively as the “Agencies”), shall submit to the Secretary a report of existing Federal and State practices relating to SAFEs, SANEs, and others who perform such examinations which reflects the findings of the surveys developed under section 101.
(b)
Core competencies— In conducting activities under this section, the Agencies shall address SAFE or SANE competencies, including—
(1)
providing comprehensive medical care to sexual assault patients;
(2)
demonstrating the ability to conduct a MFE to include an evaluation for evidence collection;
(3)
showing compassion and sensitivity towards survivors of sexual assault;
(4)
testifying in Federal, State, local, and tribal courts; and
(5)
other competencies as determined appropriate by the Agencies.
(c)
Publication—
(1)
AHRQ— The Agency for Healthcare Research and Quality shall establish, maintain, and publish on the website of the Department of Health and Human Services an online public map of SAFE, SANE, and other forensic medical examiners. Such maps shall clarify if there is full-time, part-time, or on-call coverage.
(2)
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 State. Such maps shall clarify if there is full-time, part-time, or on-call coverage.

Sec. 104 Hospital reporting

Not later than 1 year after the date of enactment of this Act, and annually thereafter, 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 SAFEs, SARTs, SANEs, and others who perform such examinations. Such report shall describe—
(1)
the number of sexual assault survivors who present at the hospital for MFEs in the year for which the report is being prepared;
(2)
the number of personnel who are trained and practicing as a SANE or SAFE to perform sexual assault exams, indicating the employment basis of such personnel as either full-time, part-time, or on-call;
(3)
the number of sexual assault exams performed by SANEs or SAFEs;
(4)
the number of sexual assault exams performed by personnel other than a SANE or SAFE;
(5)
the training that such SAFEs or SANEs undergo for purposes of maintaining competency; and
(6)
the SAFE/SANE standards of care applied by the hospital.