I 

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. 

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; TABLE OF CONTENTS. 

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

3 ‘‘Increasing Access to Voluntary Screening for HIV/AIDS 

4 and STIs Act of 2011’’. 

5 (b) TABLE OF CONTENTS.—The table of contents for 

6 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. 

7 SEC. 2. FINDINGS. 

8 Congress finds the following: 

9 (1) Almost 19,000,000 new sexually trans10 mitted infections (STIs) occur each year in the 

11 United States, and 50 percent of sexually active 

12 Americans will contract a STI at some point in their 

13 lives, the majority of which may be asymptomatic for 

14 an extended amount of time. 


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1 (2) Over 1,000,000 people in the United States 

2 are living with HIV, and someone is infected with 

3 HIV in the United States every 9.5 minutes. 

4 (3) HIV/AIDS and STIs are syndemics. HIV 

5 infection can increase a person’s risk for acquiring 

6 certain STIs, as well as affect their frequency, sever7 ity, and healing time, while STIs increase the risk 

8 of HIV transmission, impaired fertility, reproductive 

9 tract cancer, and adverse pregnancy outcomes. 

10 (4) Many common long-term and initially 

11 asymptomatic STIs such as chlamydia, gonorrhea, 

12 herpes, syphilis, inflammatory pelvic disease, viral 

13 hepatitis, and HIV/AIDS remain undiagnosed, or di14 agnosed at later stages, leading to increased rates of 

15 mortality, morbidity, disability, and transmission. 

16 (5) In fact, an estimated 4.4 million Americans 

17 are living with chronic hepatitis and most do not 

18 know they are infected. Chronic hepatitis B can re19 main asymptomatic for years and, left undiagnosed 

20 and untreated, can lead to serious complications. 

21 Additionally, individuals infected with hepatitis C 

22 virus (HCV) are at risk for chronic liver disease or 

23 other HCV-related chronic diseases decades after in24 fection. 


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1 (6) Stigma, culture, language, lack of edu2 cation, lack of insurance, limited time, cost and re3 sources in medical settings, and an inaccurate per4 ception of risk among communities and providers all 

5 contribute to insufficient rates of screening for HIV/ 

6 AIDS and STIs. 

7 (7) The Centers for Disease Control and Pre8 vention and the United States Preventive Services 

9 Task Force recognize screening as an effective pub10 lic health tool that allows providers to administer 

11 treatment before symptoms develop and implement 

12 interventions that will reduce the likelihood of HIV/ 

13 AIDS and STI transmission and reduce the develop14 ment of adverse outcomes. 

15 (8) The CDC recommends that voluntary 

16 screening for HIV/AIDS be integrated into routine 

17 clinical care while preserving patient confidentiality 

18 and the right of the patient to decline testing and 

19 screening. 

20 (9) The CDC also recommends that all 

21 unvaccinated, uninfected persons being evaluated for 

22 a STI should receive hepatitis B vaccination. Fur23 thermore, anti-HCV testing is recommended for rou24 tine screening of asymptomatic persons based on 


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1 their risk for infection or based on a recognized ex2 posure. 

3 (10) Inaccurate perceptions of risk among 

4 health care providers and patients, misdiagnosis, 

5 ageism, generational mind-sets, and biological fac6 tors have contributed to increased rates in trans7 mission and late detection of HIV/AIDS and STIs 

8 over the past decade. 

9 (11) Health equity and disparities remain a sig10 nificant public health challenge, with the burden of 

11 HIV/AIDS and STIs falling disproportionately on 

12 different populations. 

13 (12) Although African-Americans account for 

14 about 12 percent of the United States population, 

15 they account for nearly half of all HIV/AIDS cases 

16 and infections and have higher instances of mor17 tality and morbidity for most STIs and HIV/AIDS. 

18 Also, African-American women who have sex with 

19 men account for the majority of HIV/AIDS infec20 tions among all women in the United States. 

21 (13) HIV/AIDS continues to be most prevalent 

22 among men who have sex with men (MSM). Contin23 ued support and increased funding for community24 based programs and behavioral interventions that 


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1 are culturally competent are key to reaching MSM, 

2 especially young MSM of color. 

3 (14) Transgender persons are particularly vul4 nerable to contracting HIV/AIDS and STIs due to 

5 high rates of survival sex among trans-females, dis6 crimination in education, employment, and housing, 

7 and the absence of education and prevention meth8 ods culturally relevant to the transgender commu9 nity. 

10 (15) Health care providers must be properly 

11 educated to treat groups, such as MSM, transgender 

12 persons, African-Americans, and Latinos who are 

13 disproportionately affected by HIV/AIDS and other 

14 STIs, and also improve interventions for groups that 

15 have been historically under-represented in health 

16 interventions for STIs, such as women who have sex 

17 with women, individuals over the age of 50, Asian 

18 and Pacific Islander Americans, Native Americans, 

19 and persons living with disabilities. 

20 (16) Women living with mobility impairments 

21 often lack access to screening for STIs and other 

22 women’s health services such as pelvic examinations 

23 and mammograms due to, among other factors, the 

24 lack of provider awareness, experience, and access to 

25 equipment. 


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1 (17) All individuals engaging in oral, anal, or 

2 genital sexual contact must have access to voluntary 

3 screening for HIV/AIDS and other STIs. Screening 

4 must be confidential, rapid, accurate, and medically 

5 appropriate. Screening must be offered regardless of 

6 age, race, class, sexual behavior, sexual orientation, 

7 gender identity, or disability. 

8 (18) The Congress supports the goals of the 

9 National HIV/AIDS Strategy and, in particular, the 

10 goal of 90 percent of individuals knowing their HIV/ 

11 AIDS status. 

12 SEC. 3. PURPOSE. 

13 The purposes of this Act are as follows: 

14 (1) Increase access, quality, and affordability 

15 for voluntary and medically appropriate screening 

16 for HIV/AIDS and other STIs, including chlamydia, 

17 gonorrhea, syphilis, viral hepatitis, and human 

18 papillomavirus, for all persons engaging in various 

19 forms of sexual activity, including oral, genital, or 

20 anal sex. 

21 (2) Reduce the spread, morbidity, and mortality 

22 of HIV/AIDS and other STIs. 

23 (3) Reduce the disproportionate incidence of 

24 HIV/AIDS and other STIs in certain groups 

25 through early detection and treatment and comVerDate Mar 15 2010 06:14 May 10, 2011 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H1774.IH H1774

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1 prehensive education for health care providers, cen2 ters, and communities. 

3 (4) Support the execution of other scientifically 

4 based interventions that are culturally competent 

5 and age appropriate and are proven to reduce the in6 cidence of HIV/AIDS and other STIs. 

7 SEC. 4. DEFINITIONS. 

8 In this Act: 

9 (1) CDC.—The term ‘‘CDC’’ means the Cen10 ters for Disease Control and Prevention. 

11 (2) CMS.—The term ‘‘CMS’’ means the Cen12 ters for Medicare & Medicaid Services. 

13 (3) DIRECTOR.—The term ‘‘Director’’ means 

14 the Director of the Centers for Disease Control and 

15 Prevention. 

16 (4) HIV/AIDS.—The term ‘‘HIV/AIDS’’ means 

17 infection with the human immunodeficiency virus 

18 and includes acquired immune deficiency syndrome 

19 and any condition arising from such syndrome. 

20 (5) MSM.—The term ‘‘MSM’’ means men who 

21 have sex with men. 

22 (6) SECRETARY.—The term ‘‘Secretary’’ means 

23 the Secretary of Health and Human Services. 

24 (7) STATE.—The term ‘‘State’’ means each of 

25 the 50 States, the District of Columbia, the United 


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1 States Virgin Islands, Guam, the Commonwealth of 

2 Puerto Rico, the Commonwealth of the Northern 

3 Mariana Islands, and American Samoa. 

4 (8) STI.—The term ‘‘STI’’ means a sexually 

5 transmitted infection that is recognized by the CDC, 

6 including chlamydia, gonorrhea, syphilis, viral hepa7 titis, and human papillomavirus. 

8 (9) WSW.—The term ‘‘WSW’’ means women 

9 who have sex with women. 

10 TITLE I—COVERAGE OF HIV/ 

11 AIDS AND STI SCREENING 

12 UNDER PUBLIC HEALTH 

13 CARE PROGRAMS AND GROUP 

14 HEALTH PLANS; COVERAGE 

15 OF CARE UNDER MEDICAID. 

16 SEC. 101. COVERAGE OF ROUTINE HIV/AIDS AND STI 

17 SCREENING TESTS UNDER MEDICAID. 

18 (a) INCLUSION IN STATE PLAN.—Section 1902(a) of 

19 the Social Security Act (42 U.S.C. 1396a(a)) is amended 

20 in paragraph (10)(A), in the matter before clause (i), by 

21 striking ‘‘and (28)’’ and inserting ‘‘(28), and (29)’’. 

22 (b) INCLUSION IN MEDICAL ASSISTANCE.— 

23 (1) IN GENERAL.—Section 1905(a) of the So24 cial Security Act (42 U.S.C. 1396d(a)) is amend25 ed— 


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1 (A) in paragraph (28), by striking ‘‘and’’ 

2 at the end; 

3 (B) by redesignating paragraph (29) as 

4 paragraph (30); and 

5 (C) by inserting after paragraph (28) the 

6 following: 

7 ‘‘(29) routine HIV/AIDS and STI screening 

8 services (as defined in subsection (ee)).’’. 

9 (2) DEFINITION OF SERVICES.—Section 1905 

10 of such Act is amended by adding at the end the fol11 lowing: 

12 ‘‘(ee)(1) For purposes of this section, the term ‘rou13 tine HIV/AIDS and STI screening services’ means all of 

14 the following: 

15 ‘‘(A) A screening test for HIV/AIDS or 

16 any other STI, if such test is provided to an in17 dividual who— 

18 ‘‘(i) is eligible for medical assistance 

19 under the State plan; and 

20 ‘‘(ii) is described in clauses (ii) 

21 through (v) of section 1861(iii)(1)(A). 

22 ‘‘(B) Each of the services described in sub23 paragraphs (B) through (F) of section 

24 1861(iii)(1). 


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1 ‘‘(2) DEFINITIONS.—For purposes of this sub2 section, the terms ‘HIV/AIDS’ and ‘STI’ have the 

3 same meaning given such terms in section 

4 1861(iii)(2).’’. 

5 (c) NO COST SHARING FOR HIV/AIDS TESTING.— 

6 (1) IN GENERAL.—Section 1916(a)(2) of the 

7 Social Security Act (42 U.S.C. 1396o(a)(2)) is 

8 amended— 

9 (A) in subparagraph (D), by striking ‘‘or’’ 

10 at the end; 

11 (B) in subparagraph (E), by striking ‘‘; 

12 and’’ at the end and inserting ‘‘, or’’; and 

13 (C) by adding at the end the following: 

14 ‘‘(F) routine HIV/AIDS and STI screening 

15 services (as such term is defined in section 

16 1905(ee)); and’’. 

17 (2) LIMITATION ON STATE OPTION FOR ALTER18 NATIVE COST SHARING.—Section 1916A(b)(3)(B) of 

19 the Social Security Act (42 U.S.C. 1396o– 

20 1(b)(3)(B)) is amended by adding at the end the fol21 lowing: 

22 ‘‘(xi) Routine HIV/AIDS and STI 

23 screening services (as such term is defined 

24 in section 1905(ee)).’’. 

25 (d) EFFECTIVE DATE.— 


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1 (1) IN GENERAL.—Except as provided by para2 graph (2), the amendments made by this section 

3 shall take effect on the date of the enactment of this 

4 section and shall apply to services furnished on or 

5 after such date. 

6 (2) RULES FOR CHANGES REQUIRING STATE

7 LEGISLATION.—In the case of a State plan for med8 ical assistance under title XIX of the Social Security 

9 Act which the Secretary of Health and Human Serv10 ices determines requires State legislation (other than 

11 legislation appropriating funds) in order for the plan 

12 to meet the additional requirement imposed by the 

13 amendments made by this section, the State plan 

14 shall not be regarded as failing to comply with the 

15 requirements of such title solely on the basis of its 

16 failure to meet this additional requirement before 

17 the first day of the first calendar quarter beginning 

18 after the close of the first regular session of the 

19 State legislature that begins after the date of the en20 actment of this Act. For purposes of the previous 

21 sentence, in the case of a State that has a 2-year 

22 legislative session, each year of such session shall be 

23 deemed to be a separate regular session of the State 

24 legislature. 


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1 SEC. 102. COVERAGE OF HIV/AIDS AND STI SCREENING 

2 TESTS UNDER MEDICARE. 

3 Section 1861 of the Social Security Act is amended— 

4 (1) in subsection (s)— 

5 (A) by striking ‘‘and’’ at the end of para6 graph (14); 

7 (B) by striking the period at the end of 

8 paragraph (15) and inserting ‘‘; and’’; 

9 (C) by redesignating paragraphs (16) and 

10 (17) as paragraphs (17) and (18), respectively; 

11 and 

12 (D) by inserting after paragraph (15) the 

13 following: 

14 ‘‘(16) routine HIV/AIDS and STI screening 

15 services (as such term is defined in subsection 

16 (iii)).’’; and 

17 (2) by adding at the end the following: 

18 ‘‘(iii) ROUTINE HIV/AIDS AND STI SCREENING

19 SERVICES.—(1) For purposes of this section, the term 

20 ‘routine HIV/AIDS and STI screening services’ means all 

21 of the following: 

22 ‘‘(A) A screening test for HIV/AIDS or 

23 any other STI, if such test is provided in any 

24 health care setting (other than an inpatient 

25 hospital setting) and is provided to an indi26 vidual who— 


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1 ‘‘(i) is enrolled in part B; 

2 ‘‘(ii) is at least 13 years of age; 

3 ‘‘(iii) with respect to a test for HIV/ 

4 AIDS, is not known to the health care pro5 vider (directly, through information pro6 vided by the individual, or through access 

7 to an electronic medical record) to have 

8 had a previous positive test for HIV/AIDS; 

9 ‘‘(iv) subject to subparagraph (B), 

10 with respect to a test for HIV/AIDS or a 

11 STI, is not known to the health care pro12 vider (directly, through information pro13 vided by the individual, or through access 

14 to an electronic medical record) to have 

15 had a test for the same condition within 

16 the previous 6 months; and 

17 ‘‘(v) has been informed that such a 

18 test will be administered and has not ob19 jected to such a test. 

20 ‘‘(B) If a test described under subpara21 graph (A) is reactive— 

22 ‘‘(i) and is for HIV/AIDS, a confirm23 atory test; 


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1 ‘‘(ii) and is for a STI other than HIV/ 

2 AIDS, if reasonable and necessary, a con3 firmatory test. 

4 ‘‘(C) The interpretation of any tests pro5 vided under subparagraph (A) and subpara6 graph (B). 

7 ‘‘(D) Informing an individual who receives 

8 a test under subparagraph (A) or subparagraph 

9 (B) of the results of such tests as close in time 

10 as possible to the determination of such results. 

11 ‘‘(E) If an individual tests positive for 

12 HIV/AIDS on a screening test under subpara13 graph (A) and any confirmatory test under sub14 paragraph (B)— 

15 ‘‘(i) post-test counseling concerning 

16 HIV/AIDS and STIs at the time the indi17 vidual is informed of the results of the 

18 test; and 

19 ‘‘(ii) if appropriate, a referral to med20 ical or mental health services. 

21 ‘‘(F) If an individual tests positive for a 

22 STI on a screening test under subparagraph 

23 (A) and any confirmatory test under subpara24 graph (B), the provision of information to such 

25 individual on the risk of STIs and HIV/AIDS 


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1 and behaviors that reduce the risk of exposure 

2 to such conditions. 

3 ‘‘(2) DEFINITIONS.—For purposes of this sub4 section: 

5 ‘‘(A) HIV/AIDS.—The term ‘HIV/AIDS’ 

6 means infection with the human immuno7 deficiency virus and includes acquired immune 

8 deficiency syndrome and any condition arising 

9 from such syndrome. 

10 ‘‘(B) STI.—The term ‘STI’ means a sexu11 ally transmitted infection or sexually trans12 mitted disease that is recognized by the Centers 

13 for Disease Control and Prevention, including 

14 chlamydia, gonorrhea, syphilis, hepatitis B, hep15 atitis C, and human papillomavirus.’’. 

16 SEC. 103. COVERAGE FOR ROUTINE HIV/AIDS AND STI 

17 SCREENING UNDER GROUP HEALTH PLANS. 

18 (a) GROUP HEALTH PLANS.— 

19 (1) PUBLIC HEALTH SERVICE ACT AMEND20 MENTS.— 

21 (A) IN GENERAL.—Title XXVII of the 

22 Public Health Service Act is amended by insert23 ing after section 2728 of such Act (42 U.S.C. 

24 300gg–28), as redesignated by section 1001(2) 


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1 of the Patient Protection and Affordable Care 

2 Act (Public Law 111–148), the following: 

3 ‘‘SEC. 2729. COVERAGE FOR ROUTINE HIV/AIDS AND STI 

4 SCREENING. 

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

6 insurance issuer providing group or individual health in7 surance coverage, shall provide coverage for routine HIV/ 

8 AIDS and STI screening under terms and conditions that 

9 are no less favorable than the terms and conditions appli10 cable to other routine health screenings. 

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

12 health insurance issuer providing group or individual 

13 health insurance coverage, shall not— 

14 ‘‘(1) deny to an individual eligibility, or contin15 ued eligibility, to enroll or to renew coverage under 

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

17 avoiding the requirements of this section; 

18 ‘‘(2) deny coverage for routine HIV/AIDS or 

19 STI screening on the basis that there are no known 

20 risk factors present, or the screening is not clinically 

21 indicated, medically necessary, or pursuant to a re22 ferral, consent, or recommendation by any health 

23 care provider; 

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

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1 viduals to accept less than the minimum protections 

2 available under this section; 

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

4 reimbursement of a provider because such provider 

5 provided care to an individual participant or bene6 ficiary in accordance with this section; 

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

8 to a provider to induce such provider to provide care 

9 to an individual participant or beneficiary in a man10 ner inconsistent with this section; or 

11 ‘‘(6) deny to an individual participant or bene12 ficiary continued eligibility to enroll or to renew cov13 erage under the terms of the plan, solely because of 

14 the results of an HIV/AIDS or STI test, or other 

15 HIV/AIDS and STI screening procedure, for the in16 dividual or any other individual. 

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

18 section shall be construed— 

19 ‘‘(1) to require an individual who is a partici20 pant or beneficiary to undergo HIV/AIDS or STI 

21 screening; or 

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

23 from imposing deductibles, coinsurance, or other 

24 cost-sharing in relation to HIV/AIDS or STI screen25 ing, except that such deductibles, coinsurance or 


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1 other cost-sharing may not be greater than the 

2 deductibles, coinsurance, or other cost-sharing im3 posed on other routine health screenings. 

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

5 shall comply with the notice requirement under section 

6 716(d) of the Employee Retirement Income Security Act 

7 of 1974 with respect to the requirements of this section 

8 as if such section applied to such plan. 

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

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

11 of enactment of this section with respect to health insur12 ance coverage that requires coverage of at least the cov13 erage of HIV/AIDS or STI screening otherwise required 

14 under this section.’’. 

15 (B) APPLICATION RULE.—For purposes of 

16 applying section 2729 of the Public Health 

17 Service Act, as inserted by subparagraph (A), 

18 to individual health insurance coverage before 

19 2014, the provisions of such section shall be 

20 treated as also included under part B of title 

21 XXVII of the Public Health Service Act. 

22 (2) ERISA AMENDMENTS.—The Employee Re23 tirement Income Security Act of 1974 is amended as 

24 follows: 


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1 (A) In subpart B of part 7 of subtitle B 

2 of title I, by adding at the end the following 

3 new section: 

4 ‘‘SEC. 716. COVERAGE FOR ROUTINE HIV/AIDS AND STI 

5 SCREENING. 

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

7 insurance issuer offering group health insurance coverage, 

8 shall provide coverage for routine HIV screening under 

9 terms and conditions that are no less favorable than the 

10 terms and conditions applicable to other routine health 

11 screenings. 

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

13 health insurance issuer offering group health insurance 

14 coverage, shall not— 

15 ‘‘(1) deny to an individual eligibility, or contin16 ued eligibility, to enroll or to renew coverage under 

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

18 avoiding the requirements of this section; 

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

20 on the basis that there are no known risk factors 

21 present, or the screening is not clinically indicated, 

22 medically necessary, or pursuant to a referral, con23 sent, or recommendation by any health care pro24 vider; 


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

2 other benefits to individuals to encourage such indi3 viduals to accept less than the minimum protections 

4 available under this section; 

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

6 reimbursement of a provider because such provider 

7 provided care to an individual participant or bene8 ficiary in accordance with this section; 

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

10 to a provider to induce such provider to provide care 

11 to an individual participant or beneficiary in a man12 ner inconsistent with this section; or 

13 ‘‘(6) deny to an individual participant or bene14 ficiary continued eligibility to enroll or to renew cov15 erage under the terms of the plan, solely because of 

16 the results of an HIV test or other HIV screening 

17 procedure for the individual or any other individual. 

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

19 section shall be construed— 

20 ‘‘(1) to require an individual who is a partici21 pant or beneficiary to undergo HIV/AIDS or STI 

22 screening; or 

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

24 from imposing deductibles, coinsurance, or other 

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1 ing, except that such deductibles, coinsurance or 

2 other cost-sharing may not be greater than the 

3 deductibles, coinsurance, or other cost-sharing im4 posed on other routine health screenings. 

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

6 group health plan, and a health insurance issuer providing 

7 health insurance coverage in connection with a group 

8 health plan, shall provide notice to each participant and 

9 beneficiary under such plan regarding the coverage re10 quired by this section in accordance with regulations pro11 mulgated by the Secretary. Such notice shall be in writing 

12 and prominently positioned in any literature or cor13 respondence made available or distributed by the plan or 

14 issuer and shall be transmitted, by whichever is earliest 

15 of the following: 

16 ‘‘(1) In the next mailing made by the plan or 

17 issuer to the participant or beneficiary. 

18 ‘‘(2) As part of any yearly informational packet 

19 sent to the participant or beneficiary. 

20 ‘‘(3) Not later than July 1, 2012. 

21 ‘‘(e) PREEMPTION; RELATION TO STATE LAWS.— 

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

23 shall be construed to preempt any State law in effect 

24 on the date of enactment of this section with respect 

25 to health insurance coverage that requires coverage 


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1 of at least the coverage of HIV/AIDS or STI screen2 ing otherwise required under this section. 

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

4 construed to affect or modify the provisions of sec5 tion 514 with respect to group health plans.’’. 

6 (B) In section 732(a) of such Act (29 

7 U.S.C. 1191a(a)), by striking ‘‘section 711’’ 

8 and inserting ‘‘sections 711 and 716’’. 

9 (C) In the table of contents in section 1 of 

10 such Act, by inserting after the item relating to 

11 section 715 the following new item: 

‘‘Sec. 716. Coverage for routine HIV/AIDS and STI screening.’’. 

12 (3) INTERNAL REVENUE CODE AMEND13 MENTS.—The Internal Revenue Code of 1986 is 

14 amended as follows: 

15 (A) In subchapter B of chapter 100, by in16 serting after section 9815 the following: 

17 ‘‘SEC. 9816. COVERAGE FOR ROUTINE HIV/AIDS AND STI 

18 SCREENING. 

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

20 coverage for routine HIV/AIDS and STI screening under 

21 terms and conditions that are no less favorable than the 

22 terms and conditions applicable to other routine health 

23 screenings. 

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

25 not— 


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1 ‘‘(1) deny to an individual eligibility, or contin2 ued eligibility, to enroll or to renew coverage under 

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

4 avoiding the requirements of this section; 

5 ‘‘(2) deny coverage for routine HIV/AIDS or 

6 STI screening on the basis that there are no known 

7 risk factors present, or the screening is not clinically 

8 indicated, medically necessary, or pursuant to a re9 ferral, consent, or recommendation by any health 

10 care provider; 

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

12 other benefits to individuals to encourage such indi13 viduals to accept less than the minimum protections 

14 available under this section; 

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

16 reimbursement of a provider because such provider 

17 provided care to an individual participant or bene18 ficiary in accordance with this section; 

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

20 to a provider to induce such provider to provide care 

21 to an individual participant or beneficiary in a man22 ner inconsistent with this section; or 

23 ‘‘(6) deny to an individual participant or bene24 ficiary continued eligibility to enroll or to renew cov25 erage under the terms of the plan, solely because of 


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1 the results of an HIV/AIDS or STI test, or other 

2 HIV/AIDS and STI screening procedure, for the in3 dividual or any other individual. 

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

5 section shall be construed— 

6 ‘‘(1) to require an individual who is a partici7 pant or beneficiary to undergo HIV/AIDS or STI 

8 screening; or 

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

10 from imposing deductibles, coinsurance, or other 

11 cost-sharing in relation to HIV/AIDS or STI screen12 ing, except that such deductibles, coinsurance or 

13 other cost-sharing may not be greater than the 

14 deductibles, coinsurance, or other cost-sharing im15 posed on other routine health screenings.’’. 

16 (B) In the table of contents for such sub17 chapter, by inserting after the item relating to 

18 section 9815 the following new item: 

‘‘Sec. 9816. Coverage for HIV/AIDS and STI screening.’’. 

19 (C) In section 4980D(d)(1), by striking 

20 ‘‘section 9811’’ and inserting ‘‘sections 9811 

21 and 9816’’. 

22 (b) APPLICATION UNDER FEDERAL EMPLOYEES

23 HEALTH BENEFITS PROGRAM.—Section 8902 of title 5, 

24 United States Code, is amended by adding at the end the 

25 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 2729 of the Public Health Service Act.’’. 

4 (c) EFFECTIVE DATES.—Notwithstanding any other 

5 provision of law, the amendments made by subsections (a) 

6 and (b) shall apply with respect to plan years beginning 

7 on or after July 1, 2012, and with respect to health insur8 ance coverage issued on or after such date. 

9 (d) COORDINATION OF ADMINISTRATION.—The Sec10 retary of Labor, the Secretary of Health and Human Serv11 ices, and the Secretary of the Treasury shall ensure, 

12 through the execution of an interagency memorandum of 

13 understanding among such Secretaries, that— 

14 (1) regulations, rulings, and interpretations 

15 issued by such Secretaries relating to the same mat16 ter over which two or more such Secretaries have re17 sponsibility under the provisions of this section (and 

18 the amendments made thereby) are administered so 

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

20 (2) coordination of policies relating to enforcing 

21 the same requirements through such Secretaries in 

22 order to have a coordinated enforcement strategy 

23 that avoids duplication of enforcement efforts and 

24 assigns priorities in enforcement. 


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1 SEC. 104. OPTIONAL MEDICAID COVERAGE OF LOW-INCOME 

2 HIV/AIDS INFECTED INDIVIDUALS. 

3 (a) IN GENERAL.—Section 1902 of the Social Secu4 rity Act (42 U.S.C. 1396a) is amended— 

5 (1) in subsection (a)(10)(A)(ii)— 

6 (A) by striking ‘‘or’’ at the end of sub7 clause (XXI); 

8 (B) by adding ‘‘or’’ at the end of subclause 

9 (XXII); and 

10 (C) by adding at the end the following: 

11 ‘‘(XXIII) on or before December 

12 31, 2013, who are described in sub13 section (ll) (relating to HIV/AIDS in14 fected individuals);’’; and 

15 (2) by adding at the end the following: 

16 ‘‘(ll) individuals described in this subsection are indi17 viduals— 

18 ‘‘(1) who are not described in subsection 

19 (a)(10)(A)(i); 

20 ‘‘(2) who have HIV/AIDS, as defined under 

21 section 1905(ee); 

22 ‘‘(3) whose income (as determined under the 

23 State plan under this title with respect to disabled 

24 individuals) does not exceed the maximum amount 

25 of income a disabled individual described in subVerDate Mar 15 2010 06:14 May 10, 2011 Jkt 099200 PO 00000 Frm 00027 Fmt 6652 Sfmt 6201 E:\BILLS\H1774.IH H1774

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1 section (a)(10)(A)(i) may have to obtain medical as2 sistance under the plan; and 

3 ‘‘(4) whose resources (as determined under the 

4 State plan under this title with respect to disabled 

5 individuals) do not exceed the maximum amount of 

6 resources a disabled individual described in sub7 section (a)(10)(A)(i) may have to obtain medical as8 sistance under the plan.’’. 

9 (b) ENHANCED MATCH.— 

10 (1) IN GENERAL.—The first sentence of section 

11 1905(b) of the Social Security Act (42 U.S.C. 

12 1396d(b)) is amended by striking ‘‘section 

13 1902(a)(10)(A)(ii)(XVIII)’’ and inserting ‘‘subclause 

14 (XVIII) and subclause (XXIII) of section 

15 1902(a)(10)(A)(ii)’’. 

16 (2) CONFORMING AMENDMENTS.—Section 

17 1905(a) of the Social Security Act (42 U.S.C. 

18 1396d(a)) is amended in the matter preceding para19 graph (1)— 

20 (A) by striking ‘‘or’’ at the end of clause 

21 (xv); 

22 (B) by striking ‘‘or’’ at the end of clause 

23 (xvi), as amended by Public Law 111–148; 

24 (C) by adding ‘‘or’’ at the end of clause 

25 (xvii); and 


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1 (D) by inserting after clause (xvii) the fol2 lowing: 

3 ‘‘(xviii) individuals described in sec4 tion 1902(a)(10)(A)(ii)(XXIII);’’. 

5 (c) EXEMPTION FROM FUNDING LIMITATION FOR

6 TERRITORIES.—Section 1108(g) of the Social Security 

7 Act (42 U.S.C. 1308(g)) is amended by adding at the end 

8 the following: 

9 ‘‘(6) DISREGARDING MEDICAL ASSISTANCE FOR

10 OPTIONAL LOW-INCOME HIV/AIDS INFECTED INDI11 VIDUALS.—The limitations under subsection (f) and 

12 the previous provisions of this subsection shall not 

13 apply to amounts expended for medical assistance 

14 for individuals described in section 1902(ll) who are 

15 only eligible for such assistance on the basis of sec16 tion 1902(a)(10)(A)(ii)(XXIII).’’. 

17 (d) EFFECTIVE DATE.— 

18 (1) IN GENERAL.—Except as provided by para19 graph (2), the amendments made by this section 

20 shall take effect on the date of the enactment of this 

21 section and shall apply to services furnished on or 

22 after such date. 

23 (2) RULES FOR CHANGES REQUIRING STATE

24 LEGISLATION.—In the case of a State plan for med25 ical assistance under title XIX of the Social Security 


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1 Act which the Secretary of Health and Human Serv2 ices determines requires State legislation (other than 

3 legislation appropriating funds) in order for the plan 

4 to meet the additional requirement imposed by the 

5 amendments made by this section, the State plan 

6 shall not be regarded as failing to comply with the 

7 requirements of such title solely on the basis of its 

8 failure to meet this additional requirement before 

9 the first day of the first calendar quarter beginning 

10 after the close of the first regular session of the 

11 State legislature that begins after the date of the en12 actment of this Act. For purposes of the previous 

13 sentence, in the case of a State that has a 2-year 

14 legislative session, each year of such session shall be 

15 deemed to be a separate regular session of the State 

16 legislature. 

17 TITLE II—INCREASED DATA COL18 LECTION AND EDUCATION 

19 FOR HISTORICALLY UNDER20 REPRESENTED POPULATIONS 

21 SEC. 201. PEOPLE LIVING WITH DISABILITIES. 

22 (a) TRACKING OF INFORMATION.—The Director 

23 shall— 

24 (1) track national HIV/AIDS and STI screen25 ing trends and the burdens of HIV/AIDS and STIs 


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1 among people with disabilities, including such per2 sons with mental, physical, cognitive, intellectual, or 

3 developmental disabilities; and 

4 (2) identify and assess the barriers that prevent 

5 such persons from accessing HIV/AIDS and STI 

6 screening. 

7 (b) TRACKING METHODOLOGY.— 

8 (1) IN GENERAL.—The tracking methods used 

9 by the Secretary under subsection (a) shall— 

10 (A) focus upon historically under-rep11 resented communities, including the deaf and 

12 hearing loss-related community and the cog13 nitive, intellectual, developmental, mobility, or 

14 mental health disability communities; and 

15 (B) consider other factors that may con16 tribute to increased burdens of HIV/AIDS and 

17 STIs, including race, socio-economic status, re18 gion, gender identity, and sexual behavior. 

19 (2) SEXUAL ASSAULT DATA.—Tracking under 

20 subsection (a) shall include data collection on the in21 cidence of sexual assault on people with mental, 

22 physical, cognitive, intellectual, or developmental dis23 abilities for the purposes of understanding the prev24 alence of HIV/AIDS and STIs that result from such 

25 assaults. 


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1 (c) DEAF AND HEARING LOSS COMMUNITY.— 

2 (1) IN GENERAL.—The Secretary, acting 

3 through the Director, shall work with appropriate 

4 organizations and institutions to make comprehen5 sive sex education materials that promote voluntary 

6 screening for HIV/AIDS and STIs accessible to the 

7 deaf and hearing loss community through language 

8 (including American Sign Language), modalities (in9 cluding highly graphic formats with minimal text), 

10 and culturally appropriate information delivery. 

11 (2) HEALTH CAREERS AND EDUCATION.—The 

12 Secretary shall— 

13 (A) work with appropriate individuals, or14 ganizations, and institutions to increase the 

15 number of people who are deaf or living with 

16 hearing loss in public health careers for the 

17 purposes of— 

18 (i) building the public health infra19 structure to improve data collection; and 

20 (ii) health information dissemination 

21 to people who are deaf or who live with 

22 hearing loss; and 

23 (B) engage students in elementary school, 

24 high school, college, and graduate school for the 

25 purposes of carrying out this paragraph. 


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1 (d) COGNITIVE AND INTELLECTUAL DISABILITY

2 COMMUNITY.—The Secretary, acting through the Direc3 tor, shall work with appropriate national and local organi4 zations to make comprehensive sex education materials ac5 cessible to people with intellectual disabilities by— 

6 (1) using plain language; 

7 (2) educating service providers about the signs 

8 and symptoms of sexual assault among people with 

9 cognitive and intellectual disabilities; and 

10 (3) using other appropriate information delivery 

11 strategies. 

12 (e) WOMEN LIVING WITH SEVERE PHYSICAL DIS13 ABILITIES.—The Secretary, acting through the Director, 

14 shall work with Federal, State, and local entities to track 

15 access to pelvic examinations, mammograms, and other 

16 women’s health services for women with severe mobility 

17 impairments with the goal of improving access to such 

18 services. 

19 SEC. 202. WOMEN WHO HAVE SEX WITH WOMEN. 

20 (a) NATIONAL SCREENING GUIDELINES.—The Sec21 retary, acting through the Director, shall work with Fed22 eral, State, and local health entities to ensure that na23 tional screening guidelines for cervical cancer state that 

24 WSW should be subject to the same screening guidelines 

25 for cervical cancer as women who have sex only with men. 


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1 (b) INFORMATION COLLECTION.—The Secretary, act2 ing through the Director, shall, with respect to the WSW 

3 community— 

4 (1) track national trends in screening for HIV/ 

5 AIDS and other STIs; and 

6 (2) collect information on— 

7 (A) the burdens and behavior of HIV/ 

8 AIDS and STIs; and 

9 (B) other reproductive health concerns. 

10 SEC. 203. TRANSGENDER COMMUNITY. 

11 (a) DATA COLLECTION.—The Secretary, acting 

12 through the Director, shall work with Federal, State, and 

13 local health entities and transgender communities to im14 prove information collection concerning the transmission, 

15 morbidity, and screening for HIV/AIDS and other STIs 

16 in transgender communities. 

17 (b) INFORMATION CLASSIFICATION.—For purposes 

18 of acquiring a comprehensive understanding of the unique 

19 health trends among, and aspects of, the transgender com20 munity, the Secretary shall promulgate regulations requir21 ing that, for purposes of public health studies requiring 

22 data collection, the fact that an individual is transgender 

23 shall be a distinct category and data point. 


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1 SEC. 204. REPORT. 

2 (a) IN GENERAL.—Not later than 3 years after the 

3 date of the enactment of this Act, the Secretary shall sub4 mit a report to Congress on the activities required under 

5 this Act. 

6 (b) CONTENTS.—The report issued to Congress 

7 under subsection (a) shall include— 

8 (1) information on the success of voluntary 

9 screening for HIV/AIDS and STIs, as well as other 

10 methods for preventing the transmission of HIV/ 

11 AIDS and STIs among Medicaid and Medicare 

12 beneficiaries, patients at federally qualified health 

13 centers, individuals with health insurance, MSM, 

14 WSW, persons living with disabilities, the 

15 transgender community, and other groups that have 

16 been historically underrepresented in public health 

17 interventions for HIV/AIDS and STIs; and 

18 (2) recommendations on how to improve exist19 ing measures with respect to race, socioeconomic 

20 status, region, gender identity, disability, age, and 

21 sexual behavior— 

22 (A) to increase access to screening; and 

23 (B) to decrease the disparities in mortality 

24 and morbidity from HIV/AIDS and other STIs. 

Æ 


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