```

[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1774 Introduced in House (IH)]

112th CONGRESS
  1st Session
                                H. R. 1774

 To provide for an evidence-based strategy for voluntary screening for 
  HIV/AIDS and other common sexually transmitted infections, and for 
                            other purposes.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                              May 5, 2011

 Mr. Hastings of Florida (for himself, Mr. Conyers, Mr. Grijalva, Ms. 
Lee of California, Mr. McGovern, Mr. Jackson of Illinois, Ms. Wasserman 
   Schultz, Mr. Brady of Pennsylvania, Mr. Hinchey, Ms. Norton, Mr. 
Deutch, Mr. Payne, Mr. Serrano, Mr. Rush, Mrs. Christensen, Ms. Moore, 
      Mr. Clay, Mr. Johnson of Georgia, Mr. Quigley, Mr. Frank of 
 Massachusetts, Ms. Schakowsky, Mr. Rangel, Mr. Polis, Mr. Cicilline, 
Mr. Davis of Illinois, and Ms. Baldwin) 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, 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 provide for an evidence-based strategy for voluntary screening for 
  HIV/AIDS and other common sexually transmitted infections, and for 
                            other purposes.

    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 ``Increasing Access 
to Voluntary Screening for HIV/AIDS and STIs Act of 2011''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Findings.
Sec. 3. Purpose.
Sec. 4. Definitions.
  TITLE I--COVERAGE OF HIV/AIDS AND STI SCREENING UNDER PUBLIC HEALTH 
 CARE PROGRAMS AND GROUP HEALTH PLANS; COVERAGE OF CARE UNDER MEDICAID.

Sec. 101. Coverage of routine HIV/AIDS and STI screening tests under 
                            Medicaid.
Sec. 102. Coverage of HIV/AIDS and STI screening tests under Medicare.
Sec. 103. Coverage for routine HIV/AIDS and STI screening under group 
                            health plans.
Sec. 104. Optional Medicaid coverage of low-income HIV/AIDS infected 
                            individuals.
  TITLE II--INCREASED DATA COLLECTION AND EDUCATION FOR HISTORICALLY 
                     UNDER-REPRESENTED POPULATIONS

Sec. 201. People living with disabilities.
Sec. 202. Women who have sex with women.
Sec. 203. Transgender community.
Sec. 204. Report.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) Almost 19,000,000 new sexually transmitted infections 
        (STIs) occur each year in the United States, and 50 percent of 
        sexually active Americans will contract a STI at some point in 
        their lives, the majority of which may be asymptomatic for an 
        extended amount of time.
            (2) Over 1,000,000 people in the United States are living 
        with HIV, and someone is infected with HIV in the United States 
        every 9.5 minutes.
            (3) HIV/AIDS and STIs are syndemics. HIV infection can 
        increase a person's risk for acquiring certain STIs, as well as 
        affect their frequency, severity, and healing time, while STIs 
        increase the risk of HIV transmission, impaired fertility, 
        reproductive tract cancer, and adverse pregnancy outcomes.
            (4) Many common long-term and initially asymptomatic STIs 
        such as chlamydia, gonorrhea, herpes, syphilis, inflammatory 
        pelvic disease, viral hepatitis, and HIV/AIDS remain 
        undiagnosed, or diagnosed at later stages, leading to increased 
        rates of mortality, morbidity, disability, and transmission.
            (5) In fact, an estimated 4.4 million Americans are living 
        with chronic hepatitis and most do not know they are infected. 
        Chronic hepatitis B can remain asymptomatic for years and, left 
        undiagnosed and untreated, can lead to serious complications. 
        Additionally, individuals infected with hepatitis C virus (HCV) 
        are at risk for chronic liver disease or other HCV-related 
        chronic diseases decades after infection.
            (6) Stigma, culture, language, lack of education, lack of 
        insurance, limited time, cost and resources in medical 
        settings, and an inaccurate perception of risk among 
        communities and providers all contribute to insufficient rates 
        of screening for HIV/AIDS and STIs.
            (7) The Centers for Disease Control and Prevention and the 
        United States Preventive Services Task Force recognize 
        screening as an effective public health tool that allows 
        providers to administer treatment before symptoms develop and 
        implement interventions that will reduce the likelihood of HIV/
        AIDS and STI transmission and reduce the development of adverse 
        outcomes.
            (8) The CDC recommends that voluntary screening for HIV/
        AIDS be integrated into routine clinical care while preserving 
        patient confidentiality and the right of the patient to decline 
        testing and screening.
            (9) The CDC also recommends that all unvaccinated, 
        uninfected persons being evaluated for a STI should receive 
        hepatitis B vaccination. Furthermore, anti-HCV testing is 
        recommended for routine screening of asymptomatic persons based 
        on their risk for infection or based on a recognized exposure.
            (10) Inaccurate perceptions of risk among health care 
        providers and patients, misdiagnosis, ageism, generational 
        mind-sets, and biological factors have contributed to increased 
        rates in transmission and late detection of HIV/AIDS and STIs 
        over the past decade.
            (11) Health equity and disparities remain a significant 
        public health challenge, with the burden of HIV/AIDS and STIs 
        falling disproportionately on different populations.
            (12) Although African-Americans account for about 12 
        percent of the United States population, they account for 
        nearly half of all HIV/AIDS cases and infections and have 
        higher instances of mortality and morbidity for most STIs and 
        HIV/AIDS. Also, African-American women who have sex with men 
        account for the majority of HIV/AIDS infections among all women 
        in the United States.
            (13) HIV/AIDS continues to be most prevalent among men who 
        have sex with men (MSM). Continued support and increased 
        funding for community-based programs and behavioral 
        interventions that are culturally competent are key to reaching 
        MSM, especially young MSM of color.
            (14) Transgender persons are particularly vulnerable to 
        contracting HIV/AIDS and STIs due to high rates of survival sex 
        among trans-females, discrimination in education, employment, 
        and housing, and the absence of education and prevention 
        methods culturally relevant to the transgender community.
            (15) Health care providers must be properly educated to 
        treat groups, such as MSM, transgender persons, African-
        Americans, and Latinos who are disproportionately affected by 
        HIV/AIDS and other STIs, and also improve interventions for 
        groups that have been historically under-represented in health 
        interventions for STIs, such as women who have sex with women, 
        individuals over the age of 50, Asian and Pacific Islander 
        Americans, Native Americans, and persons living with 
        disabilities.
            (16) Women living with mobility impairments often lack 
        access to screening for STIs and other women's health services 
        such as pelvic examinations and mammograms due to, among other 
        factors, the lack of provider awareness, experience, and access 
        to equipment.
            (17) All individuals engaging in oral, anal, or genital 
        sexual contact must have access to voluntary screening for HIV/
        AIDS and other STIs. Screening must be confidential, rapid, 
        accurate, and medically appropriate. Screening must be offered 
        regardless of age, race, class, sexual behavior, sexual 
        orientation, gender identity, or disability.
            (18) The Congress supports the goals of the National HIV/
        AIDS Strategy and, in particular, the goal of 90 percent of 
        individuals knowing their HIV/AIDS status.

SEC. 3. PURPOSE.

    The purposes of this Act are as follows:
            (1) Increase access, quality, and affordability for 
        voluntary and medically appropriate screening for HIV/AIDS and 
        other STIs, including chlamydia, gonorrhea, syphilis, viral 
        hepatitis, and human papillomavirus, for all persons engaging 
        in various forms of sexual activity, including oral, genital, 
        or anal sex.
            (2) Reduce the spread, morbidity, and mortality of HIV/AIDS 
        and other STIs.
            (3) Reduce the disproportionate incidence of HIV/AIDS and 
        other STIs in certain groups through early detection and 
        treatment and comprehensive education for health care 
        providers, centers, and communities.
            (4) Support the execution of other scientifically based 
        interventions that are culturally competent and age appropriate 
        and are proven to reduce the incidence of HIV/AIDS and other 
        STIs.

SEC. 4. DEFINITIONS.

    In this Act:
            (1) CDC.--The term ``CDC'' means the Centers for Disease 
        Control and Prevention.
            (2) CMS.--The term ``CMS'' means the Centers for Medicare & 
        Medicaid Services.
            (3) Director.--The term ``Director'' means the Director of 
        the Centers for Disease Control and Prevention.
            (4) HIV/AIDS.--The term ``HIV/AIDS'' means infection with 
        the human immunodeficiency virus and includes acquired immune 
        deficiency syndrome and any condition arising from such 
        syndrome.
            (5) MSM.--The term ``MSM'' means men who have sex with men.
            (6) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
            (7) State.--The term ``State'' means each of the 50 States, 
        the District of Columbia, the United States Virgin Islands, 
        Guam, the Commonwealth of Puerto Rico, the Commonwealth of the 
        Northern Mariana Islands, and American Samoa.
            (8) STI.--The term ``STI'' means a sexually transmitted 
        infection that is recognized by the CDC, including chlamydia, 
        gonorrhea, syphilis, viral hepatitis, and human papillomavirus.
            (9) WSW.--The term ``WSW'' means women who have sex with 
        women.

  TITLE I--COVERAGE OF HIV/AIDS AND STI SCREENING UNDER PUBLIC HEALTH 
 CARE PROGRAMS AND GROUP HEALTH PLANS; COVERAGE OF CARE UNDER MEDICAID.

SEC. 101. COVERAGE OF ROUTINE HIV/AIDS AND STI SCREENING TESTS UNDER 
              MEDICAID.

    (a) Inclusion in State Plan.--Section 1902(a) of the Social 
Security Act (42 U.S.C. 1396a(a)) is amended in paragraph (10)(A), in 
the matter before clause (i), by striking ``and (28)'' and inserting 
``(28), and (29)''.
    (b) Inclusion in Medical Assistance.--
            (1) In general.--Section 1905(a) of the Social Security Act 
        (42 U.S.C. 1396d(a)) is amended--
                    (A) in paragraph (28), by striking ``and'' at the 
                end;
                    (B) by redesignating paragraph (29) as paragraph 
                (30); and
                    (C) by inserting after paragraph (28) the 
                following:
            ``(29) routine HIV/AIDS and STI screening services (as 
        defined in subsection (ee)).''.
            (2) Definition of services.--Section 1905 of such Act is 
        amended by adding at the end the following:
    ``(ee)(1) For purposes of this section, the term `routine HIV/AIDS 
and STI screening services' means all of the following:
                    ``(A) A screening test for HIV/AIDS or any other 
                STI, if such test is provided to an individual who--
                            ``(i) is eligible for medical assistance 
                        under the State plan; and
                            ``(ii) is described in clauses (ii) through 
                        (v) of section 1861(iii)(1)(A).
                    ``(B) Each of the services described in 
                subparagraphs (B) through (F) of section 1861(iii)(1).
            ``(2) Definitions.--For purposes of this subsection, the 
        terms `HIV/AIDS' and `STI' have the same meaning given such 
        terms in section 1861(iii)(2).''.
    (c) No Cost Sharing for HIV/AIDS Testing.--
            (1) In general.--Section 1916(a)(2) of the Social Security 
        Act (42 U.S.C. 1396o(a)(2)) is amended--
                    (A) in subparagraph (D), by striking ``or'' at the 
                end;
                    (B) in subparagraph (E), by striking ``; and'' at 
                the end and inserting ``, or''; and
                    (C) by adding at the end the following:
                    ``(F) routine HIV/AIDS and STI screening services 
                (as such term is defined in section 1905(ee)); and''.
            (2) Limitation on state option for alternative cost 
        sharing.--Section 1916A(b)(3)(B) of the Social Security Act (42 
        U.S.C. 1396o-1(b)(3)(B)) is amended by adding at the end the 
        following:
                            ``(xi) Routine HIV/AIDS and STI screening 
                        services (as such term is defined in section 
                        1905(ee)).''.
    (d) Effective Date.--
            (1) In general.--Except as provided by paragraph (2), the 
        amendments made by this section shall take effect on the date 
        of the enactment of this section and shall apply to services 
        furnished on or after such date.
            (2) Rules for changes requiring state legislation.--In the 
        case of a State plan for medical assistance under title XIX of 
        the Social Security Act which the Secretary of Health and Human 
        Services determines requires State legislation (other than 
        legislation appropriating funds) in order for the plan to meet 
        the additional requirement imposed by the amendments made by 
        this section, the State plan shall not be regarded as failing 
        to comply with the requirements of such title solely on the 
        basis of its failure to meet this additional requirement before 
        the first day of the first calendar quarter beginning after the 
        close of the first regular session of the State legislature 
        that begins after the date of the enactment of this Act. For 
        purposes of the previous sentence, in the case of a State that 
        has a 2-year legislative session, each year of such session 
        shall be deemed to be a separate regular session of the State 
        legislature.

SEC. 102. COVERAGE OF HIV/AIDS AND STI SCREENING TESTS UNDER MEDICARE.

    Section 1861 of the Social Security Act is amended--
            (1) in subsection (s)--
                    (A) by striking ``and'' at the end of paragraph 
                (14);
                    (B) by striking the period at the end of paragraph 
                (15) and inserting ``; and'';
                    (C) by redesignating paragraphs (16) and (17) as 
                paragraphs (17) and (18), respectively; and
                    (D) by inserting after paragraph (15) the 
                following:
            ``(16) routine HIV/AIDS and STI screening services (as such 
        term is defined in subsection (iii)).''; and
            (2) by adding at the end the following:
    ``(iii) Routine HIV/AIDS and STI Screening Services.--(1) For 
purposes of this section, the term `routine HIV/AIDS and STI screening 
services' means all of the following:
                    ``(A) A screening test for HIV/AIDS or any other 
                STI, if such test is provided in any health care 
                setting (other than an inpatient hospital setting) and 
                is provided to an individual who--
                            ``(i) is enrolled in part B;
                            ``(ii) is at least 13 years of age;
                            ``(iii) with respect to a test for HIV/
                        AIDS, is not known to the health care provider 
                        (directly, through information provided by the 
                        individual, or through access to an electronic 
                        medical record) to have had a previous positive 
                        test for HIV/AIDS;
                            ``(iv) subject to subparagraph (B), with 
                        respect to a test for HIV/AIDS or a STI, is not 
                        known to the health care provider (directly, 
                        through information provided by the individual, 
                        or through access to an electronic medical 
                        record) to have had a test for the same 
                        condition within the previous 6 months; and
                            ``(v) has been informed that such a test 
                        will be administered and has not objected to 
                        such a test.
                    ``(B) If a test described under subparagraph (A) is 
                reactive--
                            ``(i) and is for HIV/AIDS, a confirmatory 
                        test;
                            ``(ii) and is for a STI other than HIV/
                        AIDS, if reasonable and necessary, a 
                        confirmatory test.
                    ``(C) The interpretation of any tests provided 
                under subparagraph (A) and subparagraph (B).
                    ``(D) Informing an individual who receives a test 
                under subparagraph (A) or subparagraph (B) of the 
                results of such tests as close in time as possible to 
                the determination of such results.
                    ``(E) If an individual tests positive for HIV/AIDS 
                on a screening test under subparagraph (A) and any 
                confirmatory test under subparagraph (B)--
                            ``(i) post-test counseling concerning HIV/
                        AIDS and STIs at the time the individual is 
                        informed of the results of the test; and
                            ``(ii) if appropriate, a referral to 
                        medical or mental health services.
                    ``(F) If an individual tests positive for a STI on 
                a screening test under subparagraph (A) and any 
                confirmatory test under subparagraph (B), the provision 
                of information to such individual on the risk of STIs 
                and HIV/AIDS and behaviors that reduce the risk of 
                exposure to such conditions.
            ``(2) Definitions.--For purposes of this subsection:
                    ``(A) HIV/AIDS.--The term `HIV/AIDS' means 
                infection with the human immunodeficiency virus and 
                includes acquired immune deficiency syndrome and any 
                condition arising from such syndrome.
                    ``(B) STI.--The term `STI' means a sexually 
                transmitted infection or sexually transmitted disease 
                that is recognized by the Centers for Disease Control 
                and Prevention, including chlamydia, gonorrhea, 
                syphilis, hepatitis B, hepatitis C, and human 
                papillomavirus.''.

SEC. 103. COVERAGE FOR ROUTINE HIV/AIDS AND STI SCREENING UNDER GROUP 
              HEALTH PLANS.

    (a) Group Health Plans.--
            (1) Public health service act amendments.--
                    (A) In general.--Title XXVII of the Public Health 
                Service Act is amended by inserting after section 2728 
                of such Act (42 U.S.C. 300gg-28), as redesignated by 
                section 1001(2) of the Patient Protection and 
                Affordable Care Act (Public Law 111-148), the 
                following:

``SEC. 2729. COVERAGE FOR ROUTINE HIV/AIDS AND STI SCREENING.

    ``(a) Coverage.--A group health plan, and a health insurance issuer 
providing group or individual health insurance coverage, shall provide 
coverage for routine HIV/AIDS and STI screening under terms and 
conditions that are no less favorable than the terms and conditions 
applicable to other routine health screenings.
    ``(b) Prohibitions.--A group health plan, and a health insurance 
issuer providing group or individual health insurance coverage, shall 
not--
            ``(1) deny to an individual eligibility, or continued 
        eligibility, to enroll or to renew coverage under the terms of 
        the plan, solely for the purpose of avoiding the requirements 
        of this section;
            ``(2) deny coverage for routine HIV/AIDS or STI screening 
        on the basis that there are no known risk factors present, or 
        the screening is not clinically indicated, medically necessary, 
        or pursuant to a referral, consent, or recommendation by any 
        health care provider;
            ``(3) provide monetary payments, rebates, or other benefits 
        to individuals to encourage such individuals to accept less 
        than the minimum protections available under this section;
            ``(4) penalize or otherwise reduce or limit the 
        reimbursement of a provider because such provider provided care 
        to an individual participant or beneficiary in accordance with 
        this section;
            ``(5) provide incentives (monetary or otherwise) to a 
        provider to induce such provider to provide care to an 
        individual participant or beneficiary in a manner inconsistent 
        with this section; or
            ``(6) deny to an individual participant or beneficiary 
        continued eligibility to enroll or to renew coverage under the 
        terms of the plan, solely because of the results of an HIV/AIDS 
        or STI test, or other HIV/AIDS and STI screening procedure, for 
        the individual or any other individual.
    ``(c) Rules of Construction.--Nothing in this section shall be 
construed--
            ``(1) to require an individual who is a participant or 
        beneficiary to undergo HIV/AIDS or STI screening; or
            ``(2) as preventing a group health plan or issuer from 
        imposing deductibles, coinsurance, or other cost-sharing in 
        relation to HIV/AIDS or STI screening, except that such 
        deductibles, coinsurance or other cost-sharing may not be 
        greater than the deductibles, coinsurance, or other cost-
        sharing imposed on other routine health screenings.
    ``(d) Notice.--A group health plan under this part shall comply 
with the notice requirement under section 716(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 State law in effect on the date of enactment of this 
section with respect to health insurance coverage that requires 
coverage of at least the coverage of HIV/AIDS or STI screening 
otherwise required under this section.''.
                    (B) Application rule.--For purposes of applying 
                section 2729 of the Public Health Service Act, as 
                inserted by subparagraph (A), to individual health 
                insurance coverage before 2014, the provisions of such 
                section shall be treated as also included under part B 
                of title XXVII of the Public Health Service Act.
            (2) ERISA amendments.--The Employee Retirement Income 
        Security Act of 1974 is amended as follows:
                    (A) In subpart B of part 7 of subtitle B of title 
                I, by adding at the end the following new section:

``SEC. 716. COVERAGE FOR ROUTINE HIV/AIDS AND STI SCREENING.

    ``(a) Coverage.--A group health plan, and a health insurance issuer 
offering group health insurance coverage, shall provide coverage for 
routine HIV screening under terms and conditions that are no less 
favorable than the terms and conditions applicable to other routine 
health screenings.
    ``(b) Prohibitions.--A group health plan, and a health insurance 
issuer offering group health insurance coverage, shall not--
            ``(1) deny to an individual eligibility, or continued 
        eligibility, to enroll or to renew coverage under the terms of 
        the plan, solely for the purpose of avoiding the requirements 
        of this section;
            ``(2) deny coverage for routine HIV screening on the basis 
        that there are no known risk factors present, or the screening 
        is not clinically indicated, medically necessary, or pursuant 
        to a referral, consent, or recommendation by any health care 
        provider;
            ``(3) provide monetary payments, rebates, or other benefits 
        to individuals to encourage such individuals to accept less 
        than the minimum protections available under this section;
            ``(4) penalize or otherwise reduce or limit the 
        reimbursement of a provider because such provider provided care 
        to an individual participant or beneficiary in accordance with 
        this section;
            ``(5) provide incentives (monetary or otherwise) to a 
        provider to induce such provider to provide care to an 
        individual participant or beneficiary in a manner inconsistent 
        with this section; or
            ``(6) deny to an individual participant or beneficiary 
        continued eligibility to enroll or to renew coverage under the 
        terms of the plan, solely because of the results of an HIV test 
        or other HIV screening procedure for the individual or any 
        other individual.
    ``(c) Rules of Construction.--Nothing in this section shall be 
construed--
            ``(1) to require an individual who is a participant or 
        beneficiary to undergo HIV/AIDS or STI screening; or
            ``(2) as preventing a group health plan or issuer from 
        imposing deductibles, coinsurance, or other cost-sharing in 
        relation to HIV/AIDS or STI screening, except that such 
        deductibles, coinsurance or other cost-sharing may not be 
        greater than the deductibles, coinsurance, or other cost-
        sharing imposed on other routine health screenings.
    ``(d) Notice Under Group Health Plan.--A group health plan, and a 
health insurance issuer providing health insurance coverage in 
connection with a group health plan, shall provide notice to each 
participant and beneficiary under such plan regarding the coverage 
required by this section in accordance with regulations promulgated by 
the Secretary. Such notice shall be in writing and prominently 
positioned in any literature or correspondence made available or 
distributed by the plan or issuer and shall be transmitted, by 
whichever is earliest of the following:
            ``(1) In the next mailing made by the plan or issuer to the 
        participant or beneficiary.
            ``(2) As part of any yearly informational packet sent to 
        the participant or beneficiary.
            ``(3) Not later than July 1, 2012.
    ``(e) Preemption; Relation to State Laws.--
            ``(1) In general.--Nothing in this section shall be 
        construed to preempt any State law in effect on the date of 
        enactment of this section with respect to health insurance 
        coverage that requires coverage of at least the coverage of 
        HIV/AIDS or STI screening otherwise required under this 
        section.
            ``(2) ERISA.--Nothing in this section shall be construed to 
        affect or modify the provisions of section 514 with respect to 
        group health plans.''.
                    (B) In section 732(a) of such Act (29 U.S.C. 
                1191a(a)), by striking ``section 711'' and inserting 
                ``sections 711 and 716''.
                    (C) In the table of contents in section 1 of such 
                Act, by inserting after the item relating to section 
                715 the following new item:

``Sec. 716. Coverage for routine HIV/AIDS and STI screening.''.
            (3) Internal revenue code amendments.--The Internal Revenue 
        Code of 1986 is amended as follows:
                    (A) In subchapter B of chapter 100, by inserting 
                after section 9815 the following:

``SEC. 9816. COVERAGE FOR ROUTINE HIV/AIDS AND STI SCREENING.

    ``(a) Coverage.--A group health plan shall provide coverage for 
routine HIV/AIDS and STI screening under terms and conditions that are 
no less favorable than the terms and conditions applicable to other 
routine health screenings.
    ``(b) Prohibitions.--A group health plan shall not--
            ``(1) deny to an individual eligibility, or continued 
        eligibility, to enroll or to renew coverage under the terms of 
        the plan, solely for the purpose of avoiding the requirements 
        of this section;
            ``(2) deny coverage for routine HIV/AIDS or STI screening 
        on the basis that there are no known risk factors present, or 
        the screening is not clinically indicated, medically necessary, 
        or pursuant to a referral, consent, or recommendation by any 
        health care provider;
            ``(3) provide monetary payments, rebates, or other benefits 
        to individuals to encourage such individuals to accept less 
        than the minimum protections available under this section;
            ``(4) penalize or otherwise reduce or limit the 
        reimbursement of a provider because such provider provided care 
        to an individual participant or beneficiary in accordance with 
        this section;
            ``(5) provide incentives (monetary or otherwise) to a 
        provider to induce such provider to provide care to an 
        individual participant or beneficiary in a manner inconsistent 
        with this section; or
            ``(6) deny to an individual participant or beneficiary 
        continued eligibility to enroll or to renew coverage under the 
        terms of the plan, solely because of the results of an HIV/AIDS 
        or STI test, or other HIV/AIDS and STI screening procedure, for 
        the individual or any other individual.
    ``(c) Rules of Construction.--Nothing in this section shall be 
construed--
            ``(1) to require an individual who is a participant or 
        beneficiary to undergo HIV/AIDS or STI screening; or
            ``(2) as preventing a group health plan or issuer from 
        imposing deductibles, coinsurance, or other cost-sharing in 
        relation to HIV/AIDS or STI screening, except that such 
        deductibles, coinsurance or other cost-sharing may not be 
        greater than the deductibles, coinsurance, or other cost-
        sharing imposed on other routine health screenings.''.
                    (B) In the table of contents for such subchapter, 
                by inserting after the item relating to section 9815 
                the following new item:

``Sec. 9816. Coverage for HIV/AIDS and STI screening.''.
                    (C) In section 4980D(d)(1), by striking ``section 
                9811'' and inserting ``sections 9811 and 9816''.
    (b) Application Under Federal Employees Health Benefits Program.--
Section 8902 of title 5, United States Code, is amended by adding at 
the end the following new subsection:
    ``(p) A contract may not be made or a plan approved which does not 
comply with the requirements of section 2729 of the Public Health 
Service Act.''.
    (c) Effective Dates.--Notwithstanding any other provision of law, 
the amendments made by subsections (a) and (b) shall apply with respect 
to plan years beginning on or after July 1, 2012, and with respect to 
health insurance coverage issued on or after such date.
    (d) Coordination of Administration.--The Secretary of Labor, the 
Secretary of Health and Human Services, and the Secretary of the 
Treasury shall ensure, through the execution of an interagency 
memorandum of understanding among such Secretaries, that--
            (1) regulations, rulings, and interpretations issued by 
        such Secretaries relating to the same matter over which two or 
        more such Secretaries have responsibility under the provisions 
        of this section (and the amendments made thereby) are 
        administered so as to have the same effect at all times; and
            (2) coordination of policies relating to enforcing the same 
        requirements through such Secretaries in order to have a 
        coordinated enforcement strategy that avoids duplication of 
        enforcement efforts and assigns priorities in enforcement.

SEC. 104. OPTIONAL MEDICAID COVERAGE OF LOW-INCOME HIV/AIDS INFECTED 
              INDIVIDUALS.

    (a) In General.--Section 1902 of the Social Security Act (42 U.S.C. 
1396a) is amended--
            (1) in subsection (a)(10)(A)(ii)--
                    (A) by striking ``or'' at the end of subclause 
                (XXI);
                    (B) by adding ``or'' at the end of subclause 
                (XXII); and
                    (C) by adding at the end the following:
                                    ``(XXIII) on or before December 31, 
                                2013, who are described in subsection 
                                (ll) (relating to HIV/AIDS infected 
                                individuals);''; and
            (2) by adding at the end the following:
    ``(ll) individuals described in this subsection are individuals--
            ``(1) who are not described in subsection (a)(10)(A)(i);
            ``(2) who have HIV/AIDS, as defined under section 1905(ee);
            ``(3) whose income (as determined under the State plan 
        under this title with respect to disabled individuals) does not 
        exceed the maximum amount of income a disabled individual 
        described in subsection (a)(10)(A)(i) may have to obtain 
        medical assistance under the plan; and
            ``(4) whose resources (as determined under the State plan 
        under this title with respect to disabled individuals) do not 
        exceed the maximum amount of resources a disabled individual 
        described in subsection (a)(10)(A)(i) may have to obtain 
        medical assistance under the plan.''.
    (b) Enhanced Match.--
            (1) In general.--The first sentence of section 1905(b) of 
        the Social Security Act (42 U.S.C. 1396d(b)) is amended by 
        striking ``section 1902(a)(10)(A)(ii)(XVIII)'' and inserting 
        ``subclause (XVIII) and subclause (XXIII) of section 
        1902(a)(10)(A)(ii)''.
            (2) Conforming amendments.--Section 1905(a) of the Social 
        Security Act (42 U.S.C. 1396d(a)) is amended in the matter 
        preceding paragraph (1)--
                    (A) by striking ``or'' at the end of clause (xv);
                    (B) by striking ``or'' at the end of clause (xvi), 
                as amended by Public Law 111-148;
                    (C) by adding ``or'' at the end of clause (xvii); 
                and
                    (D) by inserting after clause (xvii) the following:
                            ``(xviii) individuals described in section 
                        1902(a)(10)(A)(ii)(XXIII);''.
    (c) Exemption From Funding Limitation for Territories.--Section 
1108(g) of the Social Security Act (42 U.S.C. 1308(g)) is amended by 
adding at the end the following:
            ``(6) Disregarding medical assistance for optional low-
        income hiv/aids infected individuals.--The limitations under 
        subsection (f) and the previous provisions of this subsection 
        shall not apply to amounts expended for medical assistance for 
        individuals described in section 1902(ll) who are only eligible 
        for such assistance on the basis of section 
        1902(a)(10)(A)(ii)(XXIII).''.
    (d) Effective Date.--
            (1) In general.--Except as provided by paragraph (2), the 
        amendments made by this section shall take effect on the date 
        of the enactment of this section and shall apply to services 
        furnished on or after such date.
            (2) Rules for changes requiring state legislation.--In the 
        case of a State plan for medical assistance under title XIX of 
        the Social Security Act which the Secretary of Health and Human 
        Services determines requires State legislation (other than 
        legislation appropriating funds) in order for the plan to meet 
        the additional requirement imposed by the amendments made by 
        this section, the State plan shall not be regarded as failing 
        to comply with the requirements of such title solely on the 
        basis of its failure to meet this additional requirement before 
        the first day of the first calendar quarter beginning after the 
        close of the first regular session of the State legislature 
        that begins after the date of the enactment of this Act. For 
        purposes of the previous sentence, in the case of a State that 
        has a 2-year legislative session, each year of such session 
        shall be deemed to be a separate regular session of the State 
        legislature.

  TITLE II--INCREASED DATA COLLECTION AND EDUCATION FOR HISTORICALLY 
                     UNDER-REPRESENTED POPULATIONS

SEC. 201. PEOPLE LIVING WITH DISABILITIES.

    (a) Tracking of Information.--The Director shall--
            (1) track national HIV/AIDS and STI screening trends and 
        the burdens of HIV/AIDS and STIs among people with 
        disabilities, including such persons with mental, physical, 
        cognitive, intellectual, or developmental disabilities; and
            (2) identify and assess the barriers that prevent such 
        persons from accessing HIV/AIDS and STI screening.
    (b) Tracking Methodology.--
            (1) In general.--The tracking methods used by the Secretary 
        under subsection (a) shall--
                    (A) focus upon historically under-represented 
                communities, including the deaf and hearing loss-
                related community and the cognitive, intellectual, 
                developmental, mobility, or mental health disability 
                communities; and
                    (B) consider other factors that may contribute to 
                increased burdens of HIV/AIDS and STIs, including race, 
                socio-economic status, region, gender identity, and 
                sexual behavior.
            (2) Sexual assault data.--Tracking under subsection (a) 
        shall include data collection on the incidence of sexual 
        assault on people with mental, physical, cognitive, 
        intellectual, or developmental disabilities for the purposes of 
        understanding the prevalence of HIV/AIDS and STIs that result 
        from such assaults.
    (c) Deaf and Hearing Loss Community.--
            (1) In general.--The Secretary, acting through the 
        Director, shall work with appropriate organizations and 
        institutions to make comprehensive sex education materials that 
        promote voluntary screening for HIV/AIDS and STIs accessible to 
        the deaf and hearing loss community through language (including 
        American Sign Language), modalities (including highly graphic 
        formats with minimal text), and culturally appropriate 
        information delivery.
            (2) Health careers and education.--The Secretary shall--
                    (A) work with appropriate individuals, 
                organizations, and institutions to increase the number 
                of people who are deaf or living with hearing loss in 
                public health careers for the purposes of--
                            (i) building the public health 
                        infrastructure to improve data collection; and
                            (ii) health information dissemination to 
                        people who are deaf or who live with hearing 
                        loss; and
                    (B) engage students in elementary school, high 
                school, college, and graduate school for the purposes 
                of carrying out this paragraph.
    (d) Cognitive and Intellectual Disability Community.--The 
Secretary, acting through the Director, shall work with appropriate 
national and local organizations to make comprehensive sex education 
materials accessible to people with intellectual disabilities by--
            (1) using plain language;
            (2) educating service providers about the signs and 
        symptoms of sexual assault among people with cognitive and 
        intellectual disabilities; and
            (3) using other appropriate information delivery 
        strategies.
    (e) Women Living With Severe Physical Disabilities.--The Secretary, 
acting through the Director, shall work with Federal, State, and local 
entities to track access to pelvic examinations, mammograms, and other 
women's health services for women with severe mobility impairments with 
the goal of improving access to such services.

SEC. 202. WOMEN WHO HAVE SEX WITH WOMEN.

    (a) National Screening Guidelines.--The Secretary, acting through 
the Director, shall work with Federal, State, and local health entities 
to ensure that national screening guidelines for cervical cancer state 
that WSW should be subject to the same screening guidelines for 
cervical cancer as women who have sex only with men.
    (b) Information Collection.--The Secretary, acting through the 
Director, shall, with respect to the WSW community--
            (1) track national trends in screening for HIV/AIDS and 
        other STIs; and
            (2) collect information on--
                    (A) the burdens and behavior of HIV/AIDS and STIs; 
                and
                    (B) other reproductive health concerns.

SEC. 203. TRANSGENDER COMMUNITY.

    (a) Data Collection.--The Secretary, acting through the Director, 
shall work with Federal, State, and local health entities and 
transgender communities to improve information collection concerning 
the transmission, morbidity, and screening for HIV/AIDS and other STIs 
in transgender communities.
    (b) Information Classification.--For purposes of acquiring a 
comprehensive understanding of the unique health trends among, and 
aspects of, the transgender community, the Secretary shall promulgate 
regulations requiring that, for purposes of public health studies 
requiring data collection, the fact that an individual is transgender 
shall be a distinct category and data point.

SEC. 204. REPORT.

    (a) In General.--Not later than 3 years after the date of the 
enactment of this Act, the Secretary shall submit a report to Congress 
on the activities required under this Act.
    (b) Contents.--The report issued to Congress under subsection (a) 
shall include--
            (1) information on the success of voluntary screening for 
        HIV/AIDS and STIs, as well as other methods for preventing the 
        transmission of HIV/AIDS and STIs among Medicaid and Medicare 
        beneficiaries, patients at federally qualified health centers, 
        individuals with health insurance, MSM, WSW, persons living 
        with disabilities, the transgender community, and other groups 
        that have been historically underrepresented in public health 
        interventions for HIV/AIDS and STIs; and
            (2) recommendations on how to improve existing measures 
        with respect to race, socioeconomic status, region, gender 
        identity, disability, age, and sexual behavior--
                    (A) to increase access to screening; and
                    (B) to decrease the disparities in mortality and 
                morbidity from HIV/AIDS and other STIs.
                                 <all>
```