II 

111TH CONGRESS 

1ST SESSION S. 1446 

To amend title XIX of the Social Security Act to provide incentives for 

increased use of HIV screening tests under the Medicaid program. 

IN THE SENATE OF THE UNITED STATES 

JULY 14, 2009 

Mrs. GILLIBRAND introduced the following bill; which was read twice and 

referred to the Committee on Finance 

A BILL 

To amend title XIX of the Social Security Act to provide 

incentives for increased use of HIV screening tests under 

the Medicaid program. 

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

3 SECTION 1. INCENTIVES TO INCREASE USE OF HIV 

4 SCREENING TESTS UNDER THE MEDICAID 

5 PROGRAM. 

6 (a) HIGHER FEDERAL MATCHING PERCENTAGE FOR

7 ROUTINE HIV SCREENING SERVICES.—Section 1903 of 

8 the Social Security Act (42 U.S.C. 1396b) is amended— 

9 (1) in subsection (a)— 

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1 (A) by redesignating paragraph (7) as 

2 paragraph (8); and 

3 (B) by inserting after paragraph (6) the 

4 following new paragraph: 

5 ‘‘(7) an amount equal to 90 percent of the 

6 sums expended during such quarter which are at7 tributable to the costs of providing routine HIV 

8 screening services (as defined in subsection (aa)(1)) 

9 if the conditions described in subsection (aa)(2) are 

10 met; plus’’; and 

11 (2) by adding at the end the following new sub12 section: 

13 ‘‘(aa) ROUTINE HIV SCREENING SERVICES.— 

14 ‘‘(1) IN GENERAL.—For purposes of this sec15 tion, the term ‘routine HIV screening services’ 

16 means the following: 

17 ‘‘(A) An HIV screening test (and, if such 

18 test is positive, a confirmatory HIV test), in19 cluding the interpretation of such tests, that is 

20 provided as part of medical care in any health 

21 care setting (other than an inpatient hospital 

22 setting) for an individual who— 

23 ‘‘(i) is at least 13, but not more than 

24 64, years of age; 

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1 ‘‘(ii) is not known to the health care 

2 provider (directly, through information 

3 provided by the individual, or through ac4 cess to an electronic medical record) pre5 viously ever to have had a positive test for 

6 HIV or, subject to paragraph (3), within 

7 the previous 6 months to have had any test 

8 for HIV; and 

9 ‘‘(iii) has been informed that such a 

10 test will be administered and has not ob11 jected to such a test. 

12 ‘‘(B) Informing an individual so tested of 

13 the results of the tests at the time of such ex14 amination. 

15 ‘‘(C) In the case of such an individual who 

16 tests positive for HIV on the screening and con17 firmatory tests, post-test counseling concerning 

18 HIV at the time, and as part of, such examina19 tion. 

20 ‘‘(2) CONDITIONS.—For purposes of subsection 

21 (a)(7), the conditions of this paragraph, with respect 

22 to routine HIV screening services, are that— 

23 ‘‘(A) the payment amount for such services 

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1 proximates the payment amount for such serv2 ices under part B of title XVIII; 

3 ‘‘(B) no cost-sharing is imposed under this 

4 title for the provision of such services; and 

5 ‘‘(C) in the case of a State for which a po6 litical subdivision is required to contribute to7 wards the non-Federal share of expenditures for 

8 routine HIV screening services, the increase in 

9 the Federal share applicable under subsection 

10 (a)(5) to such services is first applied to reduce 

11 the contribution (but not below zero) required 

12 by such political subdivision. 

13 ‘‘(3) EXCEPTION.—The limitation under para14 graph (1)(A)(ii) with respect to having a test for 

15 HIV within the previous 6 months shall not apply to 

16 an individual if the individual indicates that, because 

17 of the individual’s possible exposure to HIV during 

18 the intervening period, the individual is at increased 

19 risk of acquiring HIV since such previous test.’’. 

20 (b) CONFORMING AMENDMENTS.— 

21 (1) Subparagraphs (E) and (F) of section 

22 1919(h)(2) of such Act (42 U.S.C. 1396r(h)(2)) are 

23 each amended by striking ‘‘1903(a)(7)’’ and insert24 ing ‘‘1903(a)(8)’’. 

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1 (2) Paragraphs (1) and (2) of section 1931(h) 

2 of such Act (42 U.S.C. 1396u–1(h)) are each 

3 amended by striking ‘‘1903(a)(7)’’ and inserting 

4 ‘‘1903(a)(8)’’. 

5 (3) Section 1938(d)(4) of such Act (42 U.S.C. 

6 1396u–8(d)(4)) is amended by striking 

7 ‘‘1903(a)(7)’’ and inserting ‘‘1903(a)(8)’’. 

8 (4) Section 1940(j) of such Act (42 U.S.C. 

9 1396w(j)) is amended by striking ‘‘paragraph (7)’’ 

10 and inserting ‘‘paragraph (8)’’. 

11 (c) EFFECTIVE DATE.—The amendments made by 

12 subsection (a) shall apply to services furnished on or after 

13 the date of the enactment of this Act. 

14 (d) REPORT.—Not later 2 years after the date of the 

15 enactment of this Act, the Secretary of Health and 

16 Human Services shall submit a report to Congress on bar17 riers that exist for Medicaid beneficiaries to access routine 

18 HIV screening services (as defined in section 1903(aa) of 

19 the Social Security Act, as added by subsection (a)(2)). 

20 Such report shall include recommendations on how to re21 duce such barriers to access such services. 

Æ 

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