I 

111TH CONGRESS 

1ST SESSION H. R. 2137 

To amend the Public Health Service Act, the Employee Retirement Income 

Security Act of 1974, the Internal Revenue Code of 1986, and title 

5, United States Code, to require individual and group health insurance 

coverage and group health plans and Federal employees health benefit 

plans to provide coverage for routine HIV screening. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 28, 2009 

Ms. WATERS (for herself, Mr. STARK, Mrs. CHRISTENSEN, Ms. LEE of California, Mr. MEEKS of New York, and Mr. FRANK of Massachusetts) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and 

Labor, Ways and Means, and Oversight and Government Reform, 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 amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, the Internal Revenue Code of 1986, and title 5, United States Code, 

to require individual and group health insurance coverage 

and group health plans and Federal employees health 

benefit plans to provide coverage for routine HIV screening. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

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1 SECTION 1. SHORT TITLE; FINDINGS. 

2 (a) SHORT TITLE.—This Act may be cited as the 

3 ‘‘Routine HIV Screening Coverage Act of 2009’’. 

4 (b) FINDINGS.—Congress finds the following: 

5 (1) HIV/AIDS continues to infect and kill thou6 sands of Americans, 25 years after the first cases 

7 were reported. 

8 (2) It has been estimated that at least 1.6 mil9 lion Americans have been infected with HIV since 

10 the beginning of the epidemic and over 500,000 of 

11 them have died. 

12 (3) The HIV/AIDS epidemic has disproportion13 ately impacted African-Americans and Hispanic14 Americans and its impact on women is growing. 

15 (4) It has been estimated that almost one quar16 ter of those infected with HIV in the United States 

17 do not know they are infected. 

18 (5) Not all individuals who have been infected 

19 with HIV demonstrate clinical indications or fall into 

20 high risk categories. 

21 (6) The Centers for Disease Control and Pre22 vention has determined that increasing the propor23 tion of people who know their HIV status is an es24 sential component of comprehensive HIV/AIDS 

25 treatment and prevention efforts and that early diWWOODS2 on PRODPC68 with BILLS

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1 agnosis is critical in order for people with HIV/ 

2 AIDS to receive life-extending therapy. 

3 (7) On September 21, 2006, the Centers for 

4 Disease Control and Prevention released new guide5 lines that recommend routine HIV screening in 

6 health care settings for all patients aged 13–64, re7 gardless of risk. 

8 (8) Standard health insurance plans generally 

9 cover HIV screening when there are clinical indica10 tions of infection or when there are known risk fac11 tors present. 

12 (9) Requiring health insurance plans to cover 

13 routine HIV screening could play a critical role in 

14 preventing the spread of HIV/AIDS and allowing in15 fected individuals to receive effective treatment. 

16 SEC. 2. COVERAGE FOR ROUTINE HIV SCREENING UNDER 

17 GROUP HEALTH PLANS, INDIVIDUAL HEALTH 

18 INSURANCE COVERAGE, AND FEHBP. 

19 (a) GROUP HEALTH PLANS.— 

20 (1) PUBLIC HEALTH SERVICE ACT AMEND21 MENTS.—Subpart 2 of part A of title XXVII of the 

22 Public Health Service Act is amended by adding at 

23 the end the following new section: 

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1 ‘‘SEC. 2708. COVERAGE FOR ROUTINE HIV SCREENING. 

2 ‘‘(a) COVERAGE.—A group health plan, and a health 

3 insurance issuer offering group health insurance coverage, 

4 shall provide coverage for routine HIV screening under 

5 terms and conditions that are no less favorable than the 

6 terms and conditions applicable to other routine health 

7 screenings. 

8 ‘‘(b) PROHIBITIONS.—A group health plan, and a 

9 health insurance issuer offering group health insurance 

10 coverage, shall not— 

11 ‘‘(1) deny to an individual eligibility, or contin12 ued eligibility, to enroll or to renew coverage under 

13 the terms of the plan, solely for the purpose of 

14 avoiding the requirements of this section; 

15 ‘‘(2) deny coverage for routine HIV screening 

16 on the basis that there are no known risk factors 

17 present, or the screening is not clinically indicated, 

18 medically necessary, or pursuant to a referral, con19 sent, or recommendation by any health care pro20 vider; 

21 ‘‘(3) provide monetary payments, rebates, or 

22 other benefits to individuals to encourage such indi23 viduals to accept less than the minimum protections 

24 available under this section; 

25 ‘‘(4) penalize or otherwise reduce or limit the 

26 reimbursement of a provider because such provider 

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1 provided care to an individual participant or bene2 ficiary in accordance with this section; 

3 ‘‘(5) provide incentives (monetary or otherwise) 

4 to a provider to induce such provider to provide care 

5 to an individual participant or beneficiary in a man6 ner inconsistent with this section; or 

7 ‘‘(6) deny to an individual participant or bene8 ficiary continued eligibility to enroll or to renew cov9 erage under the terms of the plan, solely because of 

10 the results of an HIV test or other HIV screening 

11 procedure for the individual or any other individual. 

12 ‘‘(c) RULES OF CONSTRUCTION.—Nothing in this 

13 section shall be construed— 

14 ‘‘(1) to require an individual who is a partici15 pant or beneficiary to undergo HIV screening; or 

16 ‘‘(2) as preventing a group health plan or issuer 

17 from imposing deductibles, coinsurance, or other 

18 cost-sharing in relation to HIV screening, except 

19 that such deductibles, coinsurance or other cost20 sharing may not be greater than the deductibles, co21 insurance, or other cost-sharing imposed on other 

22 routine health screenings. 

23 ‘‘(d) NOTICE.—A group health plan under this part 

24 shall comply with the notice requirement under section 

25 715(d) of the Employee Retirement Income Security Act 

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1 of 1974 with respect to the requirements of this section 

2 as if such section applied to such plan. 

3 ‘‘(e) PREEMPTION.—Nothing in this section shall be 

4 construed to preempt any State law in effect on the date 

5 of enactment of this section with respect to health insur6 ance coverage that requires coverage of at least the cov7 erage of HIV screening otherwise required under this sec8 tion.’’. 

9 (2) ERISA AMENDMENTS.—(A) Subpart B of 

10 part 7 of subtitle B of title I of the Employee Re11 tirement Income Security Act of 1974 is amended by 

12 adding at the end the following new section: 

13 ‘‘SEC. 715. COVERAGE FOR ROUTINE HIV SCREENING. 

14 ‘‘(a) COVERAGE.—A group health plan, and a health 

15 insurance issuer offering group health insurance coverage, 

16 shall provide coverage for routine HIV screening under 

17 terms and conditions that are no less favorable than the 

18 terms and conditions applicable to other routine health 

19 screenings. 

20 ‘‘(b) PROHIBITIONS.—A group health plan, and a 

21 health insurance issuer offering group health insurance 

22 coverage, shall not— 

23 ‘‘(1) deny to an individual eligibility, or contin24 ued eligibility, to enroll or to renew coverage under 

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1 the terms of the plan, solely for the purpose of 

2 avoiding the requirements of this section; 

3 ‘‘(2) deny coverage for routine HIV screening 

4 on the basis that there are no known risk factors 

5 present, or the screening is not clinically indicated, 

6 medically necessary, or pursuant to a referral, con7 sent, or recommendation by any health care pro8 vider; 

9 ‘‘(3) provide monetary payments, rebates, or 

10 other benefits to individuals to encourage such indi11 viduals to accept less than the minimum protections 

12 available under this section; 

13 ‘‘(4) penalize or otherwise reduce or limit the 

14 reimbursement of a provider because such provider 

15 provided care to an individual participant or bene16 ficiary in accordance with this section; 

17 ‘‘(5) provide incentives (monetary or otherwise) 

18 to a provider to induce such provider to provide care 

19 to an individual participant or beneficiary in a man20 ner inconsistent with this section; or 

21 ‘‘(6) deny to an individual participant or bene22 ficiary continued eligibility to enroll or to renew cov23 erage under the terms of the plan, solely because of 

24 the results of an HIV test or other HIV screening 

25 procedure for the individual or any other individual. 

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1 ‘‘(c) RULES OF CONSTRUCTION.—Nothing in this 

2 section shall be construed— 

3 ‘‘(1) to require an individual who is a partici4 pant or beneficiary to undergo HIV screening; or 

5 ‘‘(2) as preventing a group health plan or issuer 

6 from imposing deductibles, coinsurance, or other 

7 cost-sharing in relation to HIV screening, except 

8 that such deductibles, coinsurance or other cost9 sharing may not be greater than the deductibles, co10 insurance, or other cost-sharing imposed on other 

11 routine health screenings. 

12 ‘‘(d) NOTICE UNDER GROUP HEALTH PLAN.—A 

13 group health plan, and a health insurance issuer providing 

14 health insurance coverage in connection with a group 

15 health plan, shall provide notice to each participant and 

16 beneficiary under such plan regarding the coverage re17 quired by this section in accordance with regulations pro18 mulgated by the Secretary. Such notice shall be in writing 

19 and prominently positioned in any literature or cor20 respondence made available or distributed by the plan or 

21 issuer and shall be transmitted— 

22 ‘‘(1) in the next mailing made by the plan or 

23 issuer to the participant or beneficiary; 

24 ‘‘(2) as part of any yearly informational packet 

25 sent to the participant or beneficiary; or 

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1 ‘‘(3) not later than January 1, 2010; 

2 whichever is earliest. 

3 ‘‘(e) PREEMPTION, RELATION TO STATE LAWS.— 

4 ‘‘(1) IN GENERAL.—Nothing in this section 

5 shall be construed to preempt any State law in effect 

6 on the date of enactment of this section with respect 

7 to health insurance coverage that requires coverage 

8 of at least the coverage of HIV screening otherwise 

9 required under this section. 

10 ‘‘(2) ERISA.—Nothing in this section shall be 

11 construed to affect or modify the provisions of sec12 tion 514 with respect to group health plans.’’. 

13 (B) Section 732(a) of such Act (29 U.S.C. 

14 1191a(a)) is amended by striking ‘‘section 711’’ and 

15 inserting ‘‘sections 711 and 715’’. 

16 (C) The table of contents in section 1 of such 

17 Act is amended by inserting after the item relating 

18 to section 714 the following new item: 

‘‘Sec. 715. Coverage for routine HIV screening.’’. 

19 (3) INTERNAL REVENUE CODE AMEND20 MENTS.—(A) Subchapter B of chapter 100 of the 

21 Internal Revenue Code of 1986 is amended by in22 serting after section 9813 the following: 

23 ‘‘SEC. 9814. COVERAGE FOR ROUTINE HIV SCREENING. 

24 ‘‘(a) COVERAGE.—A group health plan shall provide 

25 coverage for routine HIV screening under terms and conWWOODS2 on PRODPC68 with BILLS

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1 ditions that are no less favorable than the terms and con2 ditions applicable to other routine health screenings. 

3 ‘‘(b) PROHIBITIONS.—A group health plan shall 

4 not— 

5 ‘‘(1) deny to an individual eligibility, or contin6 ued eligibility, to enroll or to renew coverage under 

7 the terms of the plan, solely for the purpose of 

8 avoiding the requirements of this section; 

9 ‘‘(2) deny coverage for routine HIV screening 

10 on the basis that there are no known risk factors 

11 present, or the screening is not clinically indicated, 

12 medically necessary, or pursuant to a referral, con13 sent, or recommendation by any health care pro14 vider; 

15 ‘‘(3) provide monetary payments, rebates, or 

16 other benefits to individuals to encourage such indi17 viduals to accept less than the minimum protections 

18 available under this section; 

19 ‘‘(4) penalize or otherwise reduce or limit the 

20 reimbursement of a provider because such provider 

21 provided care to an individual participant or bene22 ficiary in accordance with this section; 

23 ‘‘(5) provide incentives (monetary or otherwise) 

24 to a provider to induce such provider to provide care 

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1 to an individual participant or beneficiary in a man2 ner inconsistent with this section; or 

3 ‘‘(6) deny to an individual participant or bene4 ficiary continued eligibility to enroll or to renew cov5 erage under the terms of the plan, solely because of 

6 the results of an HIV test or other HIV screening 

7 procedure for the individual or any other individual. 

8 ‘‘(c) RULES OF CONSTRUCTION.—Nothing in this 

9 section shall be construed— 

10 ‘‘(1) to require an individual who is a partici11 pant or beneficiary to undergo HIV screening; or 

12 ‘‘(2) as preventing a group health plan or issuer 

13 from imposing deductibles, coinsurance, or other 

14 cost-sharing in relation to HIV screening, except 

15 that such deductibles, coinsurance or other cost16 sharing may not be greater than the deductibles, co17 insurance, or other cost-sharing imposed on other 

18 routine health screenings.’’. 

19 (B) The table of sections of such subchapter is 

20 amended by inserting after the item relating to sec21 tion 9813 the following new item: 

‘‘Sec. 9814. Coverage for routine HIV screening.’’. 

22 (C) Section 4980D(d)(1) of such Code is 

23 amended by striking ‘‘section 9811’’ and inserting 

24 ‘‘sections 9811 and 9814’’. 

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1 (b) APPLICATION TO INDIVIDUAL HEALTH INSUR2 ANCE COVERAGE.—(1) Part B of title XXVII of the Pub3 lic Health Service Act is amended by inserting after sec4 tion 2753 the following new section: 

5 ‘‘SEC. 2754. COVERAGE FOR ROUTINE HIV SCREENING. 

6 ‘‘(a) IN GENERAL.—The provisions of section 2708 

7 (other than subsection (d)) shall apply to health insurance 

8 coverage offered by a health insurance issuer in the indi9 vidual market in the same manner as it applies to health 

10 insurance coverage offered by a health insurance issuer 

11 in connection with a group health plan in the small or 

12 large group market. 

13 ‘‘(b) NOTICE.—A health insurance issuer under this 

14 part shall comply with the notice requirement under sec15 tion 715(d) of the Employee Retirement Income Security 

16 Act of 1974 with respect to the requirements referred to 

17 in subsection (a) as if such section applied to such issuer 

18 and such issuer were a group health plan.’’. 

19 (2) Section 2762(b)(2) of such Act (42 U.S.C. 

20 300gg–62(b)(2)) is amended by striking ‘‘section 2751’’ 

21 and inserting ‘‘sections 2751 and 2754’’. 

22 (c) APPLICATION UNDER FEDERAL EMPLOYEES

23 HEALTH BENEFITS PROGRAM (FEHBP).—Section 8902 

24 of title 5, United States Code, is amended by adding at 

25 the end the following new subsection: 

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1 ‘‘(p) A contract may not be made or a plan approved 

2 which does not comply with the requirements of section 

3 2708 of the Public Health Service Act.’’. 

4 (d) EFFECTIVE DATES.—(1) The amendments made 

5 by subsections (a) and (c) apply with respect to group 

6 health plans and health benefit plans for plan years begin7 ning on or after January 1, 2010. 

8 (2) The amendments made by subsection (b) shall 

9 apply with respect to health insurance coverage offered, 

10 sold, issued, renewed, in effect, or operated in the indi11 vidual market on or after January 1, 2010. 

12 (e) COORDINATION OF ADMINISTRATION.—The Sec13 retary of Labor, the Secretary of Health and Human Serv14 ices, and the Secretary of the Treasury shall ensure, 

15 through the execution of an interagency memorandum of 

16 understanding among such Secretaries, that— 

17 (1) regulations, rulings, and interpretations 

18 issued by such Secretaries relating to the same mat19 ter over which two or more such Secretaries have re20 sponsibility under the provisions of this section (and 

21 the amendments made thereby) are administered so 

22 as to have the same effect at all times; and 

23 (2) coordination of policies relating to enforcing 

24 the same requirements through such Secretaries in 

25 order to have a coordinated enforcement strategy 

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1 that avoids duplication of enforcement efforts and 

2 assigns priorities in enforcement. 

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