I 

112TH CONGRESS 

2D SESSION H. R. 4470 

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

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

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

coverage and group health plans and Federal employees health benefit 

plans to provide coverage for routine HIV screening. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 19, 2012 

Ms. WATERS (for herself, Ms. LEE of California, Mrs. CHRISTENSEN, and Ms. 

BORDALLO) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on 

Ways and Means, Education and the Workforce, and Oversight and Government Reform, for a period to be subsequently determined by the 

Speaker, in each case for consideration of such provisions as fall within 

the jurisdiction of the committee concerned 

A BILL 

To amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, the Internal Revenue Code of 1986, and title 5, United States Code, 

to require individual and group health insurance coverage 

and group health plans and Federal employees health 

benefit plans to provide coverage for routine HIV screening. 

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


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1 SECTION 1. SHORT TITLE; FINDINGS. 

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

3 ‘‘Routine HIV Screening Coverage Act of 2012’’. 

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

5 (1) HIV/AIDS continues to infect and kill thou6 sands of Americans, more than 30 years after the 

7 first cases were reported. 

8 (2) It has been estimated that approximately 

9 1.7 million Americans have been infected with HIV 

10 since the beginning of the epidemic and over 

11 600,000 of them have died. 

12 (3) The HIV/AIDS epidemic has disproportion13 ately impacted African-Americans, Latino-Ameri14 cans, and other racial and ethnic minorities. 

15 (4) It has been estimated that 20 percent of 

16 those infected with HIV in the United States do not 

17 know they are infected. 

18 (5) The Centers for Disease Control and Pre19 vention has determined that increasing the propor20 tion of people who know their HIV status is an es21 sential component of comprehensive HIV/AIDS 

22 treatment and prevention efforts and that early di23 agnosis is critical in order for people with HIV/ 

24 AIDS to receive life-extending therapy. 

25 (6) The Centers for Disease Control and Pre26 vention recommends routine HIV screening in health 


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1 care settings for all patients aged 13–64, regardless 

2 of risk. 

3 (7) Some health plans do not cover routine HIV 

4 screening, but only cover HIV tests for patients with 

5 known or perceived risk factors for HIV/AIDS and 

6 patients who demonstrate symptoms of AIDS. 

7 (8) Not all individuals who have been infected 

8 with HIV fall into high-risk categories or dem9 onstrate symptoms of AIDS. 

10 (9) If health plans covered routine HIV 

11 screenings, health providers would be more likely to 

12 recommend routine HIV screening for their patients. 

13 (10) Section 2713 of the Public Health Service 

14 Act (42 U.S.C. 300gg–13), as amended by section 

15 1001 of the Patient Protection and Affordable Care 

16 Act (Public Law 111–148), requires that health 

17 plans cover preventive health services without impos18 ing cost sharing requirements. 

19 (11) Routine HIV screening is a preventive 

20 health service. 

21 (12) Requiring health plans to cover routine 

22 HIV screening as a preventive health service without 

23 imposing cost sharing requirements could play a 

24 critical role in preventing the spread of HIV and alVerDate Mar 15 2010 05:52 Apr 24, 2012 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H4470.IH H4470

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1 lowing infected individuals to receive effective treat2 ment. 

3 SEC. 2. COVERAGE FOR ROUTINE HIV SCREENING UNDER 

4 GROUP HEALTH PLANS, HEALTH INSURANCE 

5 COVERAGE, AND FEHBP. 

6 (a) GROUP HEALTH PLANS.— 

7 (1) PUBLIC HEALTH SERVICE ACT AMEND8 MENTS.—Subpart II of part A of title XXVII of the 

9 Public Health Service Act is amended by inserting 

10 the following new section after section 2719A: 

11 ‘‘SEC. 2719B. COVERAGE FOR ROUTINE HIV SCREENING. 

12 ‘‘(a) IN GENERAL.—A group health plan and a health 

13 insurance issuer offering group or individual health insur14 ance coverage— 

15 ‘‘(1) shall provide coverage for routine HIV 

16 screening; and 

17 ‘‘(2) shall not impose terms and conditions (in18 cluding cost sharing requirements) with respect to 

19 such screening that are less favorable for a partici20 pant or beneficiary than the terms and conditions 

21 applicable to items and services described in section 

22 2713(a). 

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

24 health insurance issuer offering group or individual health 

25 insurance coverage shall 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 or coverage, solely for the pur4 pose of avoiding the requirements of this section; 

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

6 on the basis that— 

7 ‘‘(A) there are no known risk factors for 

8 HIV present; or 

9 ‘‘(B) the screening is not— 

10 ‘‘(i) clinically indicated; 

11 ‘‘(ii) medically necessary; or 

12 ‘‘(iii) pursuant to a referral or rec13 ommendation by any health care provider; 

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

15 other benefits to individuals to encourage such indi16 viduals to accept less than the minimum protections 

17 available under this section; 

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

19 reimbursement of a provider because such provider 

20 provided care to an individual participant or bene21 ficiary in accordance with this section; or 

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

23 to a provider to induce such provider to provide care 

24 to an individual participant or beneficiary in a man25 ner inconsistent with this section. 


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

2 section shall be construed to require an individual who is 

3 a participant or beneficiary of a group health plan or 

4 health insurance coverage to undergo HIV screening. 

5 ‘‘(d) PREEMPTION.—Nothing in this section shall be 

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

7 of enactment of this section with respect to health insur8 ance coverage that requires coverage of at least the cov9 erage of HIV screening otherwise required under this sec10 tion.’’. 

11 (2) INCLUSION OF NOTICE IN UNIFORM COV12 ERAGE DOCUMENTS.—Section 2715(b)(3)(B) of the 

13 Public Health Service Act (42 U.S.C. 300gg–15) is 

14 amended— 

15 (A) in clause (i), by striking ‘‘and’’ at the 

16 end; 

17 (B) by redesignating clause (ii) as clause 

18 (iii); and 

19 (C) by inserting after clause (i) the fol20 lowing: 

21 ‘‘(ii) the coverage for routine HIV 

22 screening required under section 2719B; 

23 and’’. 

24 (3) ROUTINE HIV SCREENING DEFINED

25 THROUGH CONSULTATION PROCESS.—Section 


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1 2791(d) is amended by adding at the end the fol2 lowing new paragraph: 

3 ‘‘(22) ROUTINE HIV SCREENING.—The term 

4 ‘routine HIV screening’ shall have the meaning 

5 given such term by the Secretary. In defining such 

6 term, the Secretary shall consult with the Office of 

7 National AIDS Policy, the Centers for Disease Con8 trol and Prevention, health care professionals with 

9 expertise in HIV treatment and prevention, advo10 cates for people living with HIV, and other qualified 

11 individuals.’’. 

12 (4) CONFORMING AMENDMENTS.— 

13 (A) ERISA.—Section 715(a)(1) of the 

14 Employee Retirement Income Security Act of 

15 1974 (29 U.S.C. 1185d(a)(1)) is amended by 

16 inserting ‘‘and the Routine HIV Screening Cov17 erage Act of 2012’’ after ‘‘Patient Protection 

18 and Affordable Care Act’’. 

19 (B) IRC.—Section 9815(a)(1) of the Inter20 nal Revenue Code of 1986 is amended by in21 serting ‘‘and the Routine HIV Screening Cov22 erage Act of 2012’’ after ‘‘Patient Protection 

23 and Affordable Care Act’’. 

24 (b) APPLICATION UNDER FEDERAL EMPLOYEES

25 HEALTH BENEFITS PROGRAM (FEHBP).—Section 8902 


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

2 the end the following new subsection: 

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

4 which does not comply with the requirements of section 

5 2719B of the Public Health Service Act.’’. 

6 (c) EFFECTIVE DATE.—This section and the amend7 ments made by this section shall be effective for plan years 

8 beginning on or after the date that is 1 year after the 

9 date of the enactment of this Act. 

Æ 


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