Putting Prevention First Act - Title X Family Planning Services Act of 2004 - Authorizes appropriations for family planning services grants and contracts under the Public Health Services Act.
Family Planning State Empowerment Act - Amends title XIX (Medicaid) of the Social Security Act to allow States to provide family planning services and supplies to certain individuals not otherwise eligible for Medicaid.
Equity in Prescription Insurance and Contraceptive Coverage Act - Amends the Employee Retirement Income Security Act of 1974 and the Public Health Service Act (PHSA) to prohibit a group health plan, and a health insurance issuer providing group coverage, from excluding or restricting benefits in any way for prescription contraceptive drugs, devices, and outpatient services if the plan provides benefits for other outpatient prescription drugs, devices, or outpatient services. Amends the PHSA to apply those prohibitions to coverage offered in the individual market.
Emergency Contraception Education Act - Directs the Secretary of Health and Human Services to develop and disseminate information on emergency contraception to the public and to health care providers.
Compassionate Assistance for Rape Emergencies Act - Requires hospitals, as a condition of receiving Federal funds, to offer and to provide, upon request, emergency contraception to victims of sexual assault.
Family Life Education Act - Requires the Secretary to make grants to States for family life education, including education on abstinence and contraception to prevent teenage pregnancy and sexually transmitted diseases.
Preventing Teen Pregnancy Act - Amends the PHSA to authorize the Secretary to award grants to public and private entities to establish or expand teenage pregnancy prevention programs.
[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4192 Introduced in House (IH)]
108th CONGRESS
2d Session
H. R. 4192
To expand access to preventive health care services and education
programs that help reduce unintended pregnancy, reduce infection with
sexually transmitted disease, and reduce the number of abortions.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
April 21, 2004
Ms. Slaughter (for herself, Ms. DeGette, Mr. Greenwood, Mrs. Johnson of
Connecticut, Mr. Allen, Mr. Baird, Ms. Baldwin, Ms. Berkley, Mr. Bishop
of New York, Mr. Blumenauer, Mr. Brown of Ohio, Mrs. Capps, Mr. Cardin,
Mrs. Christensen, Mr. Crowley, Mr. Davis of Illinois, Mrs. Davis of
California, Mr. DeFazio, Ms. DeLauro, Mr. Doggett, Mr. Dooley of
California, Mr. Emanuel, Mr. Filner, Mr. Frank of Massachusetts, Mr.
Frost, Mr. Gonzalez, Mr. Grijalva, Ms. Harman, Mr. Hinchey, Mr.
Hoeffel, Ms. Norton, Mr. Holt, Mr. Honda, Ms. Hooley of Oregon, Mr.
Inslee, Mr. Israel, Ms. Jackson-Lee of Texas, Mr. Jackson of Illinois,
Mr. Kennedy of Rhode Island, Ms. Kilpatrick, Mr. Larsen of Washington,
Ms. Lee, Ms. Lofgren, Mrs. Lowey, Mrs. Maloney, Ms. Majette, Mrs.
McCarthy of New York, Ms. McCarthy of Missouri, Ms. McCollum, Mr.
McDermott, Ms. Millender-McDonald, Mr. Moran of Virginia, Mr. Nadler,
Mr. Olver, Ms. Pelosi, Mr. Rothman, Ms. Roybal-Allard, Ms. Linda T.
Sanchez of California, Mr. Sanders, Ms. Schakowsky, Mr. Scott of
Virginia, Mr. Serrano, Mr. Shays, Mr. Simmons, Ms. Solis, Mr. Tierney,
Mrs. Jones of Ohio, Mr. Udall of Colorado, Mr. Van Hollen, Ms. Waters,
Ms. Watson, Mr. Waxman, Mr. Weiner, Mr. Wexler, Ms. Woolsey, Mr. Wu,
and Mr. Wynn) introduced the following bill; which was referred to the
Committee on Energy and Commerce, and in addition to the Committees on
Education and the Workforce and Ways and Means, for a period to be
subsequently determined by the Speaker, in each case for consideration
of such provisions as fall within the jurisdiction of the committee
concerned
_______________________________________________________________________
A BILL
To expand access to preventive health care services and education
programs that help reduce unintended pregnancy, reduce infection with
sexually transmitted disease, and reduce the number of abortions.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Putting Prevention
First Act''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Findings.
TITLE I--TITLE X OF PUBLIC HEALTH SERVICE ACT
Sec. 101. Short title.
Sec. 102. Authorization of appropriations.
TITLE II--FAMILY PLANNING STATE EMPOWERMENT
Sec. 201. Short title.
Sec. 202. State option to provide family planning services and supplies
to additional low-income individuals.
Sec. 203. State option to extend the period of eligibility for
provision of family planning services and
supplies.
TITLE III--EQUITY IN PRESCRIPTION INSURANCE AND CONTRACEPTIVE COVERAGE
Sec. 301. Short title.
Sec. 302. Amendments to Employee Retirement Income Security Act of
1974.
Sec. 303. Amendments to Public Health Service Act relating to the group
market.
Sec. 304. Amendment to Public Health Service Act relating to the
individual market.
TITLE IV--EMERGENCY CONTRACEPTION EDUCATION AND INFORMATION
Sec. 401. Short title.
Sec. 402. Emergency contraception education and information programs.
TITLE V--COMPASSIONATE ASSISTANCE FOR RAPE EMERGENCIES
Sec. 501. Short title.
Sec. 502. Survivors of sexual assault; provision by hospitals of
emergency contraceptives without charge.
TITLE VI--FAMILY LIFE EDUCATION
Sec. 601. Short title.
Sec. 602. Findings.
Sec. 603. Assistance to reduce teen pregnancy, HIV/AIDS, and other
sexually transmitted diseases and to
support healthy adolescent development.
Sec. 604. Sense of Congress.
Sec. 605. Evaluation of programs.
Sec. 606. Definitions.
Sec. 607. Appropriations.
TITLE VII--TEENAGE PREGNANCY PREVENTION
Sec. 701. Short title.
Sec. 702. Teenage pregnancy prevention.
SEC. 2. FINDINGS.
The Congress finds as follows:
(1) Although the Centers for Disease Control and Prevention
(``CDC'') included family planning in its published list of the
``Ten Great Public Health Achievements in the 20th Century'',
the United States still has one of the highest rates of
unintended pregnancies among industrialized nations.
(2) Each year, three million pregnancies, nearly half of
all pregnancies, in the United States are unintended; and half
of unintended pregnancies end in abortion.
(3) In 2000, 34 million women--half of all women of
reproductive age (ages 15-44)--were in need of contraceptive
services and supplies to help prevent unintended pregnancy, and
half of those were in need of public support for such care.
(4) The United States also has the highest rate of
infection with sexually transmitted diseases (``STDs'') of any
industrialized country: in 2000 there were approximately 18.9
million new cases of STDs.
(5) Increasing access to family planning services will
improve women's health and reduce the rates of unintended
pregnancy, abortion, and infection with STDs. Contraceptive use
saves public health dollars: every dollar spent on providing
family planning services saves an estimated $3 in expenditures
for pregnancy-related and newborn care for Medicaid alone.
(6) Contraception is basic health care that improves the
health of women and children by enabling women to plan and
space births.
(7) Women experiencing unintended pregnancy are at greater
risks for physical abuse and women having closely spaced births
are at greater risk of maternal death.
(8) The child born from an unintended pregnancy is at
greater risk of low birth weight, dying in the first year of
life, being abused, and not receiving sufficient resources for
healthy development.
(9) The ability to control fertility also allows couples to
achieve economic stability by facilitating greater educational
achievement and participation in the workforce.
(10) The average American woman desires two children and
spends five years of her life pregnant or trying to get
pregnant and roughly 30 years trying to prevent pregnancy;
without contraception, a sexually active woman has an 85
percent chance of becoming pregnant within a year.
(11) Many poor and low-income women cannot afford to
purchase contraceptive services and supplies on their own. 12.1
million or 20 percent of all women aged 15-24 were uninsured in
2002, and that proportion has increased by 10 percent since
1999.
(12) Public health programs like Medicaid and Title X, the
national family planning program, provide high-quality family
planning services and other preventive health care to
underinsured or uninsured individuals who may otherwise lack
access to health care.
(13) Medicaid is the single largest source of public
funding for family planning services and HIV/AIDS care in the
United States. Half of all public dollars spent on
contraceptive services and supplies in the United States are
provided through Medicaid and approximately 5.5 million women
of reproductive age--nearly one in ten women between the ages
of 15 and 44--rely on Medicaid for their basic health care
needs.
(14) Each year, Title X services enable Americans to
prevent approximately one million unintended pregnancies, and
one in three women of reproductive age who obtains testing or
treatment for STDs does so at a Title X-funded clinic. In 2002,
Title X-funded clinics provided three million Pap tests, 5.2
million STD tests, and 494,000 HIV tests.
(15) The increasing number of uninsured, stagnant funding,
health care inflation, new and expensive contraceptive
technologies, and improved but expensive screening and
treatment for cervical cancer and STDs, have diminished the
ability of Title X funded clinics to adequately serve all those
in need. Taking inflation into account, funding for the Title X
program declined 57 percent between 1980 and 2003.
(16) While Medicaid is the largest source of subsidized
family planning services, many States have had to make
significant cuts in their Medicaid programs due to budget
pressures putting many women at risk of losing coverage for
family planning services.
(17) In addition, eligibility for Medicaid in many States
is severely restricted leaving family planning services
financially out of reach for many poor women. Many States have
demonstrated tremendous success with Medicaid family planning
waivers that allow them to expand access to Medicaid family
planning services. However, the administrative burden of
applying for a waiver poses a significant barrier to States
that would like to expand their Medicaid family planning
programs.
(18) Many private health plans still do not cover
contraceptive services and supplies. The lack of contraceptive
coverage in health insurance plans places many effective forms
of contraception beyond the financial reach of many women.
(19) Including contraceptive coverage in private health
care plans saves employers money: not covering contraceptives
in employee health plans costs employers 15 to 17 percent more
than providing such coverage.
(20) Emergency contraception is a safe and effective way to
prevent unintended pregnancy after unprotected sex. It is
estimated that the use of emergency contraception could cut the
number of unintended pregnancies in half, thereby reducing the
need for abortion.
(21) In 2000, 51,000 abortions were prevented by use of
emergency contraception; increased use of emergency
contraception accounted for up to 43 percent of the total
decline in abortions between 1994 and 2000.
(22) Access to comprehensive sex education is critical to
reducing rates of unintended pregnancy, abortion, and STD
infection among teens. Over 60 percent of teens have had sex
before they graduate from high school and nine out of ten
people have sex before they get married. 822,000 teenagers
become pregnant each year; 35 percent of teen girls become
pregnant at least once before turning 20; and 78 percent of
teenage pregnancies are unintended. Nearly half (48 percent) of
new STD cases are among people ages 15-24, even though these
youth make up only a quarter of the sexually active population.
(23) The American Medical Association, the American Nurses
Association, the American Academy of Pediatrics, the American
College of Obstetricians and Gynecologists, the American Public
Health Association, and the Society for Adolescent Medicine,
support responsible sexuality education that includes
information about both abstinence and contraception.
(24) Comprehensive sex education protects adolescent
health. A recent survey found that only 15 percent of American
parents believe that schools should just teach about
abstinence.
(25) A recent study showed that teens who took pledges to
remain virgins until marriage were just as likely to contract
STDs as teens who did not take virginity pledges and that
although teens taking the pledges delayed sexual debut, they
were less likely to use condoms once they were sexually active.
(26) Teens who receive sex education that includes
discussion of contraception are more likely than those who
receive abstinence-only messages to delay sex and to have fewer
partners and use contraceptives when they do become sexually
active.
TITLE I--TITLE X OF PUBLIC HEALTH SERVICE ACT
SEC. 101. SHORT TITLE.
This title may be cited as the ``Title X Family Planning Services
Act of 2004''.
SEC. 102. AUTHORIZATION OF APPROPRIATIONS.
For the purpose of making grants and contracts under section 1001
of the Public Health Service Act, there are authorized to be
appropriated $643,000,000 for fiscal year 2005, and such sums as may be
necessary for each subsequent fiscal year.
TITLE II--FAMILY PLANNING STATE EMPOWERMENT
SEC. 201. SHORT TITLE.
This title may be cited as the ``Family Planning State Empowerment
Act''.
SEC. 202. STATE OPTION TO PROVIDE FAMILY PLANNING SERVICES AND SUPPLIES
TO ADDITIONAL LOW-INCOME INDIVIDUALS.
(a) In General.--Title XIX of the Social Security Act (42 U.S.C.
1396 et seq.) is amended--
(1) by redesignating section 1935 as section 1936; and
(2) by inserting after section 1934 the following:
``state option to provide family planning services and supplies to
additional low-income individuals
``Sec. 1935.
``(a) In General.--A State may elect (through a State plan
amendment) to make medical assistance described in section
1905(a)(4)(C) available to any individual not otherwise eligible for
such assistance--
``(1) whose family income does not exceed an income level
(specified by the State) that does not exceed the greatest of--
``(A) 200 percent of the income official poverty
line (as defined by the Office of Management and
Budget, and revised annually in accordance with section
673(2) of the Community Services Block Grant Act)
applicable to a family of the size involved;
``(B) in the case of a State that has in effect (as
of the date of the enactment of this section) a waiver
under section 1115 to provide such medical assistance
to individuals based on their income level (expressed
as a percent of the poverty line), the eligibility
income level as provided under such waiver; or
``(C) the eligibility income level (expressed as a
percent of such poverty line) that has been specified
under the plan (including under section 1902(r)(2)),
for eligibility of pregnant women for medical
assistance; and
``(2) at the option of the State, whose resources do not
exceed a resource level specified by the State, which level is
not more restrictive than the resource level applicable under
the waiver described in paragraph (1)(B) or to pregnant women
under paragraph (1)(C).
``(b) Flexibility.--A State may exercise the authority under
subsection (a) with respect to one or more classes of individuals
described in such subsection.''.
(b) Conforming Amendment.--Section 1905(a) of such Act (42 U.S.C.
1396d(a)) is amended, in the matter before paragraph (1)--
(1) by striking ``and'' at the end of clause (xii);
(2) by adding ``and'' at the end of clause (xiii); and
(3) by inserting after clause (xiii) the following new
clause:
``(xiv) individuals described in section 1935, but only
with respect to items and services described in paragraph
(4)(C),''.
(c) Effective Date.--The amendments made by this section apply to
medical assistance provided on and after October 1, 2004.
SEC. 203. STATE OPTION TO EXTEND THE PERIOD OF ELIGIBILITY FOR
PROVISION OF FAMILY PLANNING SERVICES AND SUPPLIES.
(a) In General.--Section 1902(e) of the Social Security Act (42
U.S.C. 1396a(e)) is amended by adding at the end the following new
paragraph:
``(13) At the option of a State, the State plan may provide that,
in the case of an individual who was eligible for medical assistance
described in section 1905(a)(4)(C), but who no longer qualifies for
such assistance because of an increase in income or resources or
because of the expiration of a post-partum period, the individual may
remain eligible for such assistance for such period as the State may
specify, but the period of extended eligibility under this paragraph
shall not exceed a continuous period of 24 months for any individual.
The State may apply the previous sentence to one or more classes of
individuals and may vary the period of extended eligibility with
respect to different classes of individuals.''.
(b) Effective Date.--The amendments made by subsection (a) apply to
medical assistance provided on and after October 1, 2004.
TITLE III--EQUITY IN PRESCRIPTION INSURANCE AND CONTRACEPTIVE COVERAGE
SEC. 301. SHORT TITLE.
This title may be cited as the ``Equity in Prescription Insurance
and Contraceptive Coverage Act''.
SEC. 302. AMENDMENTS TO EMPLOYEE RETIREMENT INCOME SECURITY ACT OF
1974.
(a) In General.--Subpart B of part 7 of subtitle B of title I of
the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1185 et
seq.) is amended by adding at the end the following:
``SEC. 714. STANDARDS RELATING TO BENEFITS FOR CONTRACEPTIVES.
``(a) Requirements for Coverage.--A group health plan, and a health
insurance issuer providing health insurance coverage in connection with
a group health plan, may not--
``(1) exclude or restrict benefits for prescription
contraceptive drugs or devices approved by the Food and Drug
Administration, or generic equivalents approved as
substitutable by the Food and Drug Administration, if such plan
or coverage provides benefits for other outpatient prescription
drugs or devices; or
``(2) exclude or restrict benefits for outpatient
contraceptive services if such plan or coverage provides
benefits for other outpatient services provided by a health
care professional (referred to in this section as `outpatient
health care services').
``(b) Prohibitions.--A group health plan, and a health insurance
issuer providing health insurance coverage in connection with a group
health plan, may not--
``(1) deny to an individual eligibility, or continued
eligibility, to enroll or to renew coverage under the terms of
the plan because of the individual's or enrollee's use or
potential use of items or services that are covered in
accordance with the requirements of this section;
``(2) provide monetary payments or rebates to a covered
individual to encourage such individual to accept less than the
minimum protections available under this section;
``(3) penalize or otherwise reduce or limit the
reimbursement of a health care professional because such
professional prescribed contraceptive drugs or devices, or
provided contraceptive services, described in subsection (a),
in accordance with this section; or
``(4) provide incentives (monetary or otherwise) to a
health care professional to induce such professional to
withhold from a covered individual contraceptive drugs or
devices, or contraceptive services, described in subsection
(a).
``(c) Rules of Construction.--
``(1) In general.--Nothing in this section shall be
construed--
``(A) as preventing a group health plan and a
health insurance issuer providing health insurance
coverage in connection with a group health plan from
imposing deductibles, coinsurance, or other cost-
sharing or limitations in relation to--
``(i) benefits for contraceptive drugs
under the plan or coverage, except that such a
deductible, coinsurance, or other cost-sharing
or limitation for any such drug shall be
consistent with those imposed for other
outpatient prescription drugs otherwise covered
under the plan or coverage;
``(ii) benefits for contraceptive devices
under the plan or coverage, except that such a
deductible, coinsurance, or other cost-sharing
or limitation for any such device shall be
consistent with those imposed for other
outpatient prescription devices otherwise
covered under the plan or coverage; and
``(iii) benefits for outpatient
contraceptive services under the plan or
coverage, except that such a deductible,
coinsurance, or other cost-sharing or
limitation for any such service shall be
consistent with those imposed for other
outpatient health care services otherwise
covered under the plan or coverage;
``(B) as requiring a group health plan and a health
insurance issuer providing health insurance coverage in
connection with a group health plan to cover
experimental or investigational contraceptive drugs or
devices, or experimental or investigational
contraceptive services, described in subsection (a),
except to the extent that the plan or issuer provides
coverage for other experimental or investigational
outpatient prescription drugs or devices, or
experimental or investigational outpatient health care
services; or
``(C) as modifying, diminishing, or limiting the
rights or protections of an individual under any other
Federal law.
``(2) Limitations.--As used in paragraph (1), the term
`limitation' includes--
``(A) in the case of a contraceptive drug or
device, restricting the type of health care
professionals that may prescribe such drugs or devices,
utilization review provisions, and limits on the volume
of prescription drugs or devices that may be obtained
on the basis of a single consultation with a
professional; or
``(B) in the case of an outpatient contraceptive
service, restricting the type of health care
professionals that may provide such services,
utilization review provisions, requirements relating to
second opinions prior to the coverage of such services,
and requirements relating to preauthorizations prior to
the coverage of such services.
``(d) Notice Under Group Health Plan.--The imposition of the
requirements of this section shall be treated as a material
modification in the terms of the plan described in section 102(a)(1),
for purposes of assuring notice of such requirements under the plan,
except that the summary description required to be provided under the
last sentence of section 104(b)(1) with respect to such modification
shall be provided by not later than 60 days after the first day of the
first plan year in which such requirements apply.
``(e) Preemption.--Nothing in this section shall be construed to
preempt any provision of State law to the extent that such State law
establishes, implements, or continues in effect any standard or
requirement that provides coverage or protections for participants or
beneficiaries that are greater than the coverage or protections
provided under this section.
``(f) Definition.--In this section, the term `outpatient
contraceptive services' means consultations, examinations, procedures,
and medical services, provided on an outpatient basis and related to
the use of contraceptive methods (including natural family planning) to
prevent an unintended pregnancy.''.
(b) Clerical Amendment.--The table of contents in section 1 of the
Employee Retirement Income Security Act of 1974 (29 U.S.C. 1001) is
amended by inserting after the item relating to section 713 the
following:
``Sec. 714. Standards relating to benefits for contraceptives.''.
(c) Effective Date.--The amendments made by this section shall
apply with respect to plan years beginning on or after January 1, 2005.
SEC. 303. AMENDMENTS TO PUBLIC HEALTH SERVICE ACT RELATING TO THE GROUP
MARKET.
(a) In General.--Subpart 2 of part A of title XXVII of the Public
Health Service Act (42 U.S.C. 300gg-4 et seq.) is amended by adding at
the end the following:
``SEC. 2707. STANDARDS RELATING TO BENEFITS FOR CONTRACEPTIVES.
``(a) Requirements for Coverage.--A group health plan, and a health
insurance issuer providing health insurance coverage in connection with
a group health plan, may not--
``(1) exclude or restrict benefits for prescription
contraceptive drugs or devices approved by the Food and Drug
Administration, or generic equivalents approved as
substitutable by the Food and Drug Administration, if such plan
or coverage provides benefits for other outpatient prescription
drugs or devices; or
``(2) exclude or restrict benefits for outpatient
contraceptive services if such plan or coverage provides
benefits for other outpatient services provided by a health
care professional (referred to in this section as `outpatient
health care services').
``(b) Prohibitions.--A group health plan, and a health insurance
issuer providing health insurance coverage in connection with a group
health plan, may not--
``(1) deny to an individual eligibility, or continued
eligibility, to enroll or to renew coverage under the terms of
the plan because of the individual's or enrollee's use or
potential use of items or services that are covered in
accordance with the requirements of this section;
``(2) provide monetary payments or rebates to a covered
individual to encourage such individual to accept less than the
minimum protections available under this section;
``(3) penalize or otherwise reduce or limit the
reimbursement of a health care professional because such
professional prescribed contraceptive drugs or devices, or
provided contraceptive services, described in subsection (a),
in accordance with this section; or
``(4) provide incentives (monetary or otherwise) to a
health care professional to induce such professional to
withhold from covered individual contraceptive drugs or
devices, or contraceptive services, described in subsection
(a).
``(c) Rules of Construction.--
``(1) In general.--Nothing in this section shall be
construed--
``(A) as preventing a group health plan and a
health insurance issuer providing health insurance
coverage in connection with a group health plan from
imposing deductibles, coinsurance, or other cost-
sharing or limitations in relation to--
``(i) benefits for contraceptive drugs
under the plan or coverage, except that such a
deductible, coinsurance, or other cost-sharing
or limitation for any such drug shall be
consistent with those imposed for other
outpatient prescription drugs otherwise covered
under the plan or coverage;
``(ii) benefits for contraceptive devices
under the plan or coverage, except that such a
deductible, coinsurance, or other cost-sharing
or limitation for any such device shall be
consistent with those imposed for other
outpatient prescription devices otherwise
covered under the plan or coverage; and
``(iii) benefits for outpatient
contraceptive services under the plan or
coverage, except that such a deductible,
coinsurance, or other cost-sharing or
limitation for any such service shall be
consistent with those imposed for other
outpatient health care services otherwise
covered under the plan or coverage;
``(B) as requiring a group health plan and a health
insurance issuer providing health insurance coverage in
connection with a group health plan to cover
experimental or investigational contraceptive drugs or
devices, or experimental or investigational
contraceptive services, described in subsection (a),
except to the extent that the plan or issuer provides
coverage for other experimental or investigational
outpatient prescription drugs or devices, or
experimental or investigational outpatient health care
services; or
``(C) as modifying, diminishing, or limiting the
rights or protections of an individual under any other
Federal law.
``(2) Limitations.--As used in paragraph (1), the term
`limitation' includes--
``(A) in the case of a contraceptive drug or
device, restricting the type of health care
professionals that may prescribe such drugs or devices,
utilization review provisions, and limits on the volume
of prescription drugs or devices that may be obtained
on the basis of a single consultation with a
professional; or
``(B) in the case of an outpatient contraceptive
service, restricting the type of health care
professionals that may provide such services,
utilization review provisions, requirements relating to
second opinions prior to the coverage of such services,
and requirements relating to preauthorizations prior to
the coverage of such services.
``(d) Notice.--A group health plan under this part shall comply
with the notice requirement under section 714(d) of the Employee
Retirement Income Security Act of 1974 with respect to the requirements
of this section as if such section applied to such plan.
``(e) Preemption.--Nothing in this section shall be construed to
preempt any provision of State law to the extent that such State law
establishes, implements, or continues in effect any standard or
requirement that provides coverage or protections for enrollees that
are greater than the coverage or protections provided under this
section.
``(f) Definition.--In this section, the term `outpatient
contraceptive services' means consultations, examinations, procedures,
and medical services, provided on an outpatient basis and related to
the use of contraceptive methods (including natural family planning) to
prevent an unintended pregnancy.''.
(b) Effective Date.--The amendments made by this section shall
apply with respect to group health plans for plan years beginning on or
after January 1, 2005.
SEC. 304. AMENDMENT TO PUBLIC HEALTH SERVICE ACT RELATING TO THE
INDIVIDUAL MARKET.
(a) In General.--Part B of title XXVII of the Public Health Service
Act (42 U.S.C. 300gg-41 et seq.) is amended--
(1) by redesignating the first subpart 3 (relating to other
requirements) as subpart 2; and
(2) by adding at the end of subpart 2 the following:
``SEC. 2753. STANDARDS RELATING TO BENEFITS FOR CONTRACEPTIVES.
``The provisions of section 2707 shall apply to health insurance
coverage offered by a health insurance issuer in the individual market
in the same manner as they apply to health insurance coverage offered
by a health insurance issuer in connection with a group health plan in
the small or large group market.''.
(b) Effective Date.--The amendment made by this section shall apply
with respect to health insurance coverage offered, sold, issued,
renewed, in effect, or operated in the individual market on or after
January 1, 2005.
TITLE IV--EMERGENCY CONTRACEPTION EDUCATION AND INFORMATION
SEC. 401. SHORT TITLE.
This title may be cited as the ``Emergency Contraception Education
Act''.
SEC. 402. EMERGENCY CONTRACEPTION EDUCATION AND INFORMATION PROGRAMS.
(a) Definitions.--For purposes of this section:
(1) Emergency contraception.--The term ``emergency
contraception'' means a drug or device (as the terms are
defined in section 201 of the Federal Food, Drug, and Cosmetic
Act (21 U.S.C. 321)) or a drug regimen that is--
(A) used after sexual relations; and
(B) prevents pregnancy, by preventing ovulation,
fertilization of an egg, or implantation of an egg in a
uterus.
(2) Health care provider.--The term ``health care
provider'' means an individual who is licensed or certified
under State law to provide health care services and who is
operating within the scope of such license.
(3) Institution of higher education.--The term
``institution of higher education'' has the same meaning given
such term in section 1201(a) of the Higher Education Act of
1965 (20 U.S.C. 1141(a)).
(4) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(b) Emergency Contraception Public Education Program.--
(1) In general.--The Secretary, acting through the Director
of the Centers for Disease Control and Prevention, shall
develop and disseminate to the public information on emergency
contraception.
(2) Dissemination.--The Secretary may disseminate
information under paragraph (1) directly or through
arrangements with nonprofit organizations, consumer groups,
institutions of higher education, Federal, State, or local
agencies, clinics and the media.
(3) Information.--The information disseminated under
paragraph (1) shall include, at a minimum, a description of
emergency contraception, and an explanation of the use, safety,
efficacy, and availability of such contraception.
(c) Emergency Contraception Information Program for Health Care
Providers.--
(1) In general.--The Secretary, acting through the
Administrator of the Health Resources and Services
Administration and in consultation with major medical and
public health organizations, shall develop and disseminate to
health care providers information on emergency contraception.
(2) Information.--The information disseminated under
paragraph (1) shall include, at a minimum--
(A) information describing the use, safety,
efficacy and availability of emergency contraception;
(B) a recommendation regarding the use of such
contraception in appropriate cases; and
(C) information explaining how to obtain copies of
the information developed under subsection (b), for
distribution to the patients of the providers.
(d) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $10,000,000 for each of the
fiscal years 2005 through 2009.
TITLE V--COMPASSIONATE ASSISTANCE FOR RAPE EMERGENCIES
SEC. 501. SHORT TITLE.
This title may be cited as the ``Compassionate Assistance for Rape
Emergencies Act''.
SEC. 502. 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 any health-related program, unless the hospital meets the
conditions specified in subsection (b) in the case of--
(1) any woman who presents 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 presents 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 does not cause an
abortion; and
(B) emergency contraception is effective in most
cases in preventing pregnancy after unprotected sex.
(2) The hospital promptly offers emergency contraception to
the woman, and promptly provides such contraception to her 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) The term ``emergency contraception'' means a drug, drug
regimen, or device that is--
(A) used postcoitally;
(B) prevents pregnancy by delaying ovulation,
preventing fertilization of an egg, or preventing
implantation of an egg in a uterus; and
(C) is approved by the Food and Drug
Administration.
(2) The term ``hospital'' has the meanings given such term
in title XVIII of the Social Security Act, including the
meaning applicable in such title for purposes of making
payments for emergency services to hospitals that do not have
agreements in effect under such title.
(3) The term ``Secretary'' means the Secretary of Health
and Human Services.
(4) The term ``sexual assault'' means coitus in which the
woman involved does not consent or lacks the legal capacity to
consent.
(d) Effective Date; Agency Criteria.--This section takes effect
upon the expiration of the 180-day period beginning on the date of
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.
TITLE VI--FAMILY LIFE EDUCATION
SEC. 601. SHORT TITLE.
This title may be cited as the ``Family Life Education Act''.
SEC. 602. FINDINGS.
The Congress finds as follows:
(1) The American Medical Association (``AMA''), the
American Nurses Association (``ANA''), the American Academy of
Pediatrics (``AAP''), the American College of Obstetricians and
Gynecologists (``ACOG''), the American Public Health
Association (``APHA''), and the Society of Adolescent Medicine
(``SAM''), support responsible sexuality education that
includes information about both abstinence and contraception.
(2) Recent scientific reports by the Institute of Medicine,
the American Medical Association and the Office on National
AIDS Policy stress the need for sexuality education that
includes messages about abstinence and provides young people
with information about contraception for the prevention of teen
pregnancy, HIV/AIDS and other sexually transmitted diseases
(``STDs'').
(3) Research shows that teenagers who receive sexuality
education that includes discussion of contraception are more
likely than those who receive abstinence-only messages to delay
sexual activity and to use contraceptives when they do become
sexually active.
(4) Comprehensive sexuality education programs respect the
diversity of values and beliefs represented in the community
and will complement and augment the sexuality education
children receive from their families.
(5) The median age of puberty is 13 years and the average
age of marriage is over 26 years old. American teens need
access to full, complete, and medically and factually accurate
information regarding sexuality, including contraception, STD/
HIV prevention, and abstinence.
(6) Although teen pregnancy rates are decreasing, there are
still between 750,000 and 850,000 teen pregnancies each year.
Between 75 and 90 percent of teen pregnancies among 15- to 19-
year olds are unintended.
(7) Research shows that 75 percent of the decrease in teen
pregnancy between 1988 and 1995 was due to improved
contraceptive use, while 25 percent was due to increased
abstinence.
(8) More than eight out of ten Americans believe that young
people should have information about abstinence and protecting
themselves from unplanned pregnancies and sexually transmitted
diseases.
(9) United States teens acquire an estimated 4,000,000
sexually transmitted infections each year. By age 24, at least
one in three sexually active people will have contracted a
sexually transmitted disease.
(10) An average of two young people in the United States
are infected with HIV every hour of every day. African
Americans and Hispanic youth have been disproportionately
affected by the HIV/AIDS epidemic. Although less than 16
percent of the adolescent population in the United States is
African American, nearly 50 percent of AIDS cases through June
2000 among 13- to 19-year olds were among Blacks. Hispanics
comprise 13 percent of the population and 20 percent of the
reported adolescent AIDS cases though June 2000.
SEC. 603. ASSISTANCE TO REDUCE TEEN PREGNANCY, HIV/AIDS, AND OTHER
SEXUALLY TRANSMITTED DISEASES AND TO SUPPORT HEALTHY
ADOLESCENT DEVELOPMENT.
(a) In General.--Each eligible State shall be entitled to receive
from the Secretary of Health and Human Services, for each of the fiscal
years 2005 through 2009, a grant to conduct programs of family life
education, including education on both abstinence and contraception for
the prevention of teenage pregnancy and sexually transmitted diseases,
including HIV/AIDS.
(b) Requirements for Family Life Programs.--For purposes of this
title, a program of family life education is a program that--
(1) is age-appropriate and medically accurate;
(2) does not teach or promote religion;
(3) teaches that abstinence is the only sure way to avoid
pregnancy or sexually transmitted diseases;
(4) stresses the value of abstinence while not ignoring
those young people who have had or are having sexual
intercourse;
(5) provides information about the health benefits and side
effects of all contraceptives and barrier methods as a means to
prevent pregnancy;
(6) provides information about the health benefits and side
effects of all contraceptives and barrier methods as a means to
reduce the risk of contracting sexually transmitted diseases,
including HIV/AIDS;
(7) encourages family communication about sexuality between
parent and child;
(8) teaches young people the skills to make responsible
decisions about sexuality, including how to avoid unwanted
verbal, physical, and sexual advances and how not to make
unwanted verbal, physical, and sexual advances; and
(9) teaches young people how alcohol and drug use can
affect responsible decisionmaking.
(c) Additional Activities.--In carrying out a program of family
life education, a State may expend a grant under subsection (a) to
carry out educational and motivational activities that help young
people--
(1) gain knowledge about the physical, emotional,
biological, and hormonal changes of adolescence and subsequent
stages of human maturation;
(2) develop the knowledge and skills necessary to ensure
and protect their sexual and reproductive health from
unintended pregnancy and sexually transmitted disease,
including HIV/AIDS throughout their lifespan;
(3) gain knowledge about the specific involvement of and
male responsibility in sexual decisionmaking;
(4) develop healthy attitudes and values about adolescent
growth and development, body image, gender roles, racial and
ethnic diversity, sexual orientation, and other subjects;
(5) develop and practice healthy life skills including
goal-setting, decisionmaking, negotiation, communication, and
stress management;
(6) promote self-esteem and positive interpersonal skills
focusing on relationship dynamics, including, but not limited
to, friendships, dating, romantic involvement, marriage and
family interactions; and
(7) prepare for the adult world by focusing on educational
and career success, including developing skills for employment
preparation, job seeking, independent living, financial self-
sufficiency, and workplace productivity.
SEC. 604. SENSE OF CONGRESS.
It is the sense of Congress that while States are not required to
provide matching funds, they are encouraged to do so.
SEC. 605. EVALUATION OF PROGRAMS.
(a) In General.--For the purpose of evaluating the effectiveness of
programs of family life education carried out with a grant under
section 603, evaluations of such program shall be carried out in
accordance with subsections (b) and (c).
(b) National Evaluation.--
(1) In general.--The Secretary shall provide for a national
evaluation of a representative sample of programs of family
life education carried out with grants under section 603. A
condition for the receipt of such a grant is that the State
involved agree to cooperate with the evaluation. The purposes
of the national evaluation shall be the determination of--
(A) the effectiveness of such programs in helping
to delay the initiation of sexual intercourse and other
high-risk behaviors;
(B) the effectiveness of such programs in
preventing adolescent pregnancy;
(C) the effectiveness of such programs in
preventing sexually transmitted disease, including HIV/
AIDS;
(D) the effectiveness of such programs in
increasing contraceptive knowledge and contraceptive
behaviors when sexual intercourse occurs; and
(E) a list of best practices based upon essential
programmatic components of evaluated programs that have
led to success in subparagraphs (A) through (D).
(2) Report.--A report providing the results of the national
evaluation under paragraph (1) shall be submitted to the
Congress not later than March 31, 2008, with an interim report
provided on a yearly basis at the end of each fiscal year.
(c) Individual State Evaluations.--
(1) In general.--A condition for the receipt of a grant
under section 603 is that the State involved agree to provide
for the evaluation of the programs of family education carried
out with the grant in accordance with the following:
(A) The evaluation will be conducted by an
external, independent entity.
(B) The purposes of the evaluation will be the
determination of--
(i) the effectiveness of such programs in
helping to delay the initiation of sexual
intercourse and other high-risk behaviors;
(ii) the effectiveness of such programs in
preventing adolescent pregnancy;
(iii) the effectiveness of such programs in
preventing sexually transmitted disease,
including HIV/AIDS; and
(iv) the effectiveness of such programs in
increasing contraceptive knowledge and
contraceptive behaviors when sexual intercourse
occurs.
(2) Use of grant.--A condition for the receipt of a grant
under section 603 is that the State involved agree that not
more than 10 percent of the grant will be expended for the
evaluation under paragraph (1).
SEC. 606. DEFINITIONS.
For purposes of this title:
(1) The term ``eligible State'' means a State that submits
to the Secretary an application for a grant under section 603
that is in such form, is made in such manner, and contains such
agreements, assurances, and information as the Secretary
determines to be necessary to carry out this title.
(2) The term ``HIV/AIDS'' means the human immunodeficiency
virus, and includes acquired immune deficiency syndrome.
(3) The term ``medically accurate'', with respect to
information, means information that is supported by research,
recognized as accurate and objective by leading medical,
psychological, psychiatric, and public health organizations and
agencies, and where relevant, published in peer review
journals.
(4) The term ``Secretary'' means the Secretary of Health
and Human Services.
SEC. 607. APPROPRIATIONS.
(a) In General.--For the purpose of carrying out this title, there
is authorized to be appropriated $100,000,000 for each of the fiscal
years 2005 through 2009.
(b) Allocations.--Of the amounts appropriated under subsection (a)
for a fiscal year--
(1) not more than 7 percent may be used for the
administrative expenses of the Secretary in carrying out this
title for that fiscal year; and
(2) not more than 10 percent may be used for the national
evaluation under section 605(b).
TITLE VII--TEENAGE PREGNANCY PREVENTION
SEC. 701. SHORT TITLE.
This title may be cited as the ``Preventing Teen Pregnancy Act''.
SEC. 702. TEENAGE PREGNANCY PREVENTION.
Part P of title III of the Public Health Service Act (42 U.S.C.
280g et seq.) is amended by inserting after section 399N the following
section:
``SEC. 399O. TEENAGE PREGNANCY PREVENTION GRANTS.
``(a) Authority.--The Secretary may award on a competitive basis
grants to public and private entities to establish or expand teenage
pregnancy prevention programs.
``(b) Grant Recipients.--Grant recipients under this section may
include State and local not-for-profit coalitions working to prevent
teenage pregnancy, State, local, and tribal agencies, schools, entities
that provide afterschool programs, and community and faith-based
groups.
``(c) Priority.--In selecting grant recipients under this section,
the Secretary shall give--
``(1) highest priority to applicants seeking assistance for
programs targeting communities or populations in which--
``(A) teenage pregnancy or birth rates are higher
than the corresponding State average; or
``(B) teenage pregnancy or birth rates are
increasing; and
``(2) priority to applicants seeking assistance for
programs that--
``(A) will benefit underserved or at-risk
populations such as young males or immigrant youths; or
``(B) will take advantage of other available
resources and be coordinated with other programs that
serve youth, such as workforce development and after
school programs.
``(d) Use of Funds.--Funds received by an entity as a grant under
this section shall be used for programs that--
``(1) replicate or substantially incorporate the elements
of one or more teenage pregnancy prevention programs that have
been proven (on the basis of rigorous scientific research) to
delay sexual intercourse or sexual activity, increase condom or
contraceptive use (without increasing sexual activity), or
reduce teenage pregnancy; and
``(2) incorporate one or more of the following strategies
for preventing teenage pregnancy: encouraging teenagers to
delay sexual activity; sex and HIV education; interventions for
sexually active teenagers; preventive health services; youth
development programs; service learning programs; and outreach
or media programs.
``(e) Complete Information.--Programs receiving funds under this
section that choose to provide information on HIV/AIDS or contraception
or both must provide information that is complete and medically
accurate.
``(f) Relation to Abstinence-Only Programs.--Funds under this
section are not intended for use by abstinence-only education programs.
Abstinence-only education programs that receive Federal funds through
the Maternal and Child Health Block Grant, the Administration for
Children and Families, the Adolescent Family Life Program, and any
other program that uses the definition of `abstinence education' found
in section 510(b) of the Social Security Act are ineligible for
funding.
``(g) Applications.--Each entity seeking a grant under this section
shall submit an application to the Secretary at such time and in such
manner as the Secretary may require.
``(h) Matching Funds.--
``(1) In general.--The Secretary may not award a grant to
an applicant for a program under this section unless the
applicant demonstrates that it will pay, from funds derived
from non-Federal sources, at least 25 percent of the cost of
the program.
``(2) Applicant's share.--The applicant's share of the cost
of a program shall be provided in cash or in kind.
``(i) Supplementation of Funds.--An entity that receives funds as a
grant under this section shall use the funds to supplement and not
supplant funds that would otherwise be available to the entity for
teenage pregnancy prevention.
``(j) Evaluations.--
``(1) In general.--The Secretary shall--
``(A) conduct or provide for a rigorous evaluation
of 10 percent of programs for which a grant is awarded
under this section;
``(B) collect basic data on each program for which
a grant is awarded under this section; and
``(C) upon completion of the evaluations referred
to in subparagraph (A), submit to the Congress a report
that includes a detailed statement on the effectiveness
of grants under this section.
``(2) Cooperation by grantees.--Each grant recipient under
this section shall provide such information and cooperation as
may be required for an evaluation under paragraph (1).
``(k) Definition.--For purposes of this section, the term `rigorous
scientific research' means based on a program evaluation that:
``(1) Measured impact on sexual or contraceptive behavior,
pregnancy or childbearing.
``(2) Employed an experimental or quasi-experimental design
with well-constructed and appropriate comparison groups.
``(3) Had a sample size large enough (at least 100 in the
combined treatment and control group) and a follow-up interval
long enough (at least six months) to draw valid conclusions
about impact.
``(l) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section $20,000,000 for fiscal year
2005, and such sums as may be necessary for each subsequent fiscal
year. In addition, there are authorized to be appropriated for
evaluations under subsection (j) such sums as may be necessary for
fiscal year 2005 and each subsequent fiscal year.''.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and the Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and the Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and the Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and the Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Employer-Employee Relations.
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