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Federal Laws

There are many federal laws and regulations that impact SANE programs. It is beyond the scope of this Guide to provide a detailed analysis of how each law may impact a SANE program. If your program receives federal financial assistance, the applicable federal civil rights laws will apply to all of the operations of your organization. If you are developing a program in a hospital, it is important to request that the in-house legal counsel and risk management director review the program's policies and procedures. If you are developing a program outside of a hospital, it is important to seek legal services to assist in the development of the business structure, facility licensing, hiring practices, and employer policies. It is essential to seek legal advice early in the process of developing a SANE program to ensure that the program is in compliance with all federal laws and regulations.

Table B: Federal Laws Impacting SANE Practice

Federal Law Protections Provided

Emergency Medical Treatment and Active Labor Act

42 United States Code (U.S.C.) § 1395dd

Provides emergency treatment and stabilization to anyone presenting to an emergency room with either an emergency medical condition or in active labor. 

Heath Insurance Portability and Accountability Act (HIPAA)

45 Code of Federal Regulations (CFR) Parts 160, 162, and 164

Describes how health care providers and other covered entities will maintain the privacy of patients’ protected health information. It also provides patients access to their protected health information. 

Health Information Technology for Economic and Clinical Health (HITECH) Act

42 U.S.C. § 300jj et seq., § 17901

Addresses the privacy and security concerns of electronic medical records. 

Federal Child Abuse Reporting Laws

42 U.S.C. § 13031 

Describes laws for reporting child abuse on federal lands or in federal facilities.

Americans with Disabilities Act

42 U.S.C. § 12101

Protects the rights of persons with disabilities. This law protects all persons, including both patients and health care providers with disabilities. 

Prohibits discrimination in both employment and in the delivery of services or benefits against persons with disabilities in state and local government services, public accommodations, or commercial facilities.

Title IX of the Education Amendments of 1972

20 U.S.C. § 1681 et seq.

Prohibits discrimination on the basis of sex by any federally funded education program. The Amendments include rules and regulations related to the reporting and handling of sexual assault.

Section 504 Rehabilitation Act 

29 U.S.C. § 701

Prohibits discrimination based on disability by organizations receiving federal funding.

Prison Rape Elimination Act

42 U.S.C. § 15601
Final Rule, 28 CFR Part 115

Provides direction to correctional facilities for the provision of care for inmates that report sexual assault.

Civil Rights Act, Title VI

42 U.S.C. § 2000d

Prevents discrimination based on race, color, or nationality. Requires health care organizations receiving federal funds directly or indirectly from the U.S. Department of Health and Human Services (HHS) to take reasonable steps to ensure that persons with limited English proficiency have meaningful access to programs and activities.

Section 1557 of the Patient Protection and Affordable Care Act

42 U.S.C. 18116

Prevents discrimination based on race, color, national origin, sex, age, or disability, under any health program or activity, any part of which is receiving federal financial assistance, or under any program or activity that is administered by an Executive Agency or any entity established under Title I of the Affordable Care Act or its amendments.

Age Discrimination Act 1975

29 USC §6101

Prevents discrimination based on age by programs receiving federal financial assistance.


The Violence Against Women Act (VAWA) 

The Violence Against Women Act was originally enacted in 1994 and has been reauthorized by Congress three times, in 2000, 2005, and 2013. VAWA provides communities with tools to improve responses to victims of domestic violence, dating violence, sexual assault, and stalking, and enhances services available for victims.

Violence Against Women Acts of 1994, 2000, 2005, and 2013

Public Laws 103-322, 106-386, 109-162, and 113-4

Forensic Examination Payment

  1. As a condition for certain grant funds, the state or another governmental entity must “bear the full out-of-pocket costs” for medical forensic examinations.
  2. Victims must have access to examinations free of charge, regardless of their cooperation with law enforcement or the criminal justice system.
  3. States can use formula grant funds to pay for forensic examinations, but only if victims are not required to submit the costs to their personal insurance carriers and the exam is conducted by a trained examiner. It does not need to be a SANE or SAFE, but does need to be someone with sexual assault training.
  4. States can use a victim's insurance to pay for the cost of the examination, but a victim cannot receive a bill for any out-of-pocket costs, such as a copay or a deductible.
  5. States must coordinate with health care providers in the region to notify victims of sexual assault about the availability of rape exams at no cost to the victim.
  6. For members of federally recognized tribes, the Indian Health Service is the payer of last resort. 
  7. For information about the VAWA Forensic Compliance Technical Assistance project, visit the End Violence Against Women International website


  1. VAWA and subsequent legislation provide immigration relief to victims of domestic violence and sexual assault. U visas are specifically designated for victims of certain crimes, including sexual assault, who are cooperating with law enforcement.
  2. All sexual assault victims should be provided with information regarding U visa relief in the event that the information would be helpful.
  3. A T visa provides temporary nonimmigrant status to victims of "severe forms of human trafficking" who are cooperating with law enforcement.
  4. SANE programs should develop partnerships with organizations serving immigrants in order to make the appropriate referrals.

The Sexual Assault Forensic Evidence Reporting (SAFER) Act of 2013

  1. VAWA of 2013 includes the SAFER Act.
  2. The SAFER Act encourages jurisdictions to conduct audits of backlogged and untested sexual assault evidence. 
  3. The SAFER Act also requires the National Institute of Justice to develop recommendations regarding the processing of DNA evidence in sexual assault cases.