I 

115TH CONGRESS 

1ST SESSION H. R. 164 

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 

JANUARY 3, 2017 

Mr. HASTINGS 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, 

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

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

6 and STIs Act of 2017’’. 


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

2 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 UNDERREPRESENTED POPULATIONS 

Sec. 201. People living with disabilities. 

Sec. 202. Women who have sex with women. 

Sec. 203. Transgender community. 

Sec. 204. Report. 

3 SEC. 2. FINDINGS. 

4 Congress finds the following: 

5 (1) The CDC estimates 20,000,000 new sexu6 ally transmitted infections (STIs) occur each year in 

7 the United States, and 50 percent of sexually active 

8 Americans will contract a STI at some point in their 

9 lives, the majority of which may be asymptomatic for 

10 an extended amount of time. 

11 (2) Over 1,200,000 people in the United States 

12 are living with HIV, and someone is infected with 

13 HIV in the United States every 9.5 minutes. 


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

2 infection can increase a person’s risk for acquiring 

3 certain STIs, as well as affect their frequency, sever4 ity, and healing time, while STIs increase the risk 

5 of HIV transmission, impaired fertility, reproductive 

6 tract cancer, and adverse pregnancy outcomes. 

7 (4) Many common long-term and initially 

8 asymptomatic STIs such as chlamydia, gonorrhea, 

9 herpes, syphilis, inflammatory pelvic disease, viral 

10 hepatitis, and HIV/AIDS remain undiagnosed, or di11 agnosed at later stages, leading to increased rates of 

12 mortality, morbidity, disability, and transmission. 

13 (5) In fact, the CDC estimates over 3.6 million 

14 Americans are living with chronic hepatitis and most 

15 do not know they are infected. Chronic hepatitis B 

16 can remain asymptomatic for years and, left 

17 undiagnosed and untreated, can lead to serious com18 plications. Additionally, individuals infected with 

19 hepatitis C virus (HCV) are at risk for chronic liver 

20 disease or other HCV-related chronic diseases dec21 ades after infection. 

22 (6) Stigma, culture, language, lack of edu23 cation, lack of insurance, limited time, cost and re24 sources in medical settings, and an inaccurate per25 ception of risk among communities and providers all 


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1 contribute to insufficient rates of screening for HIV/ 

2 AIDS and STIs. 

3 (7) The Centers for Disease Control and Pre4 vention and the United States Preventive Services 

5 Task Force recognize screening as an effective pub6 lic health tool that allows providers to administer 

7 treatment before symptoms develop and implement 

8 interventions that will reduce the likelihood of HIV/ 

9 AIDS and STI transmission and reduce the develop10 ment of adverse outcomes. 

11 (8) The CDC recommends that voluntary 

12 screening for HIV/AIDS be integrated into routine 

13 clinical care while preserving patient confidentiality 

14 and the right of the patient to decline testing and 

15 screening. 

16 (9) The CDC also recommends that all 

17 unvaccinated, uninfected persons being evaluated for 

18 a STI should receive hepatitis B vaccination. Fur19 thermore, anti-HCV testing is recommended for rou20 tine screening of asymptomatic persons based on 

21 their risk for infection or based on a recognized ex22 posure. 

23 (10) Inaccurate perceptions of risk among 

24 health care providers and patients, misdiagnosis, 

25 ageism, generational mind-sets, and biological facVerDate Sep 11 2014 00:03 Jan 11, 2017 Jkt 069200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H164.IH H164

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1 tors have contributed to increased rates in trans2 mission and late detection of HIV/AIDS and STIs 

3 over the past decade. 

4 (11) Health equity and disparities remain a sig5 nificant public health challenge, with the burden of 

6 HIV/AIDS and STIs falling disproportionately on 

7 different populations. 

8 (12) Although African-Americans account for 

9 about 13 percent of the United States population, 

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

11 and infections and have higher instances of mor12 tality and morbidity for most STIs and HIV/AIDS. 

13 Also, African-American women who have sex with 

14 men account for the majority of HIV/AIDS infec15 tions among all women in the United States. 

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

17 among men who have sex with men (MSM). Contin18 ued support and increased funding for community19 based programs and behavioral interventions that 

20 are culturally competent are key to reaching MSM, 

21 especially young MSM of color. 

22 (14) Transgender persons are particularly vul23 nerable to contracting HIV/AIDS and STIs due to 

24 high rates of survival sex among trans-females, dis25 crimination in education, employment, and housing, 


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1 and the absence of education and prevention meth2 ods culturally relevant to the transgender commu3 nity. 

4 (15) Health care providers must be properly 

5 educated to treat groups, such as MSM, transgender 

6 persons, African-Americans, and Latinos who are 

7 disproportionately affected by HIV/AIDS and other 

8 STIs, and also improve interventions for groups that 

9 have been historically underrepresented in health 

10 interventions for STIs, such as women who have sex 

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

12 and Pacific Islander Americans, Native Americans, 

13 and persons living with disabilities. 

14 (16) Women living with mobility impairments 

15 often lack access to screening for STIs and other 

16 women’s health services such as pelvic examinations 

17 and mammograms due to, among other factors, the 

18 lack of provider awareness, experience, and access to 

19 equipment. 

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

21 genital sexual contact must have access to voluntary 

22 screening for HIV/AIDS and other STIs. Screening 

23 must be confidential, rapid, accurate, and medically 

24 appropriate. Screening must be offered regardless of 


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1 age, race, class, sexual behavior, sexual orientation, 

2 gender identity, or disability. 

3 (18) The Congress supports the goals of the 

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

5 goal of 90 percent of individuals knowing their HIV/ 

6 AIDS status. 

7 SEC. 3. PURPOSE. 

8 The purposes of this Act are as follows: 

9 (1) Increase access, quality, and affordability 

10 for voluntary and medically appropriate screening 

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

12 gonorrhea, syphilis, viral hepatitis, and human 

13 papillomavirus, for all persons engaging in various 

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

15 anal sex. 

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

17 of HIV/AIDS and other STIs. 

18 (3) Reduce the disproportionate incidence of 

19 HIV/AIDS and other STIs in certain groups 

20 through early detection and treatment and com21 prehensive education for health care providers, cen22 ters, and communities. 

23 (4) Support the execution of other scientifically 

24 based interventions that are culturally competent 


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1 and age appropriate and are proven to reduce the in2 cidence of HIV/AIDS and other STIs. 

3 SEC. 4. DEFINITIONS. 

4 In this Act: 

5 (1) CDC.—The term ‘‘CDC’’ means the Cen6 ters for Disease Control and Prevention. 

7 (2) CMS.—The term ‘‘CMS’’ means the Cen8 ters for Medicare & Medicaid Services. 

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

10 the Director of the Centers for Disease Control and 

11 Prevention. 

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

13 infection with the human immunodeficiency virus 

14 and includes acquired immune deficiency syndrome 

15 and any condition arising from such syndrome. 

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

17 have sex with men. 

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

19 the Secretary of Health and Human Services. 

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

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

22 States Virgin Islands, Guam, the Commonwealth of 

23 Puerto Rico, the Commonwealth of the Northern 

24 Mariana Islands, and American Samoa. 


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

2 transmitted infection that is recognized by the CDC, 

3 including chlamydia, gonorrhea, syphilis, viral hepa4 titis, and human papillomavirus. 

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

6 who have sex with women. 

7 TITLE I—COVERAGE OF HIV/ 

8 AIDS AND STI SCREENING 

9 UNDER PUBLIC HEALTH 

10 CARE PROGRAMS AND GROUP 

11 HEALTH PLANS; COVERAGE 

12 OF CARE UNDER MEDICAID. 

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

14 SCREENING TESTS UNDER MEDICAID. 

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

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

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

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

19 (b) INCLUSION IN MEDICAL ASSISTANCE.— 

20 (1) IN GENERAL.—Section 1905(a) of the So21 cial Security Act (42 U.S.C. 1396d(a)) is amend22 ed— 

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

24 at the end; 


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1 (B) by redesignating paragraph (29) as 

2 paragraph (30); and 

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

4 following: 

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

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

7 (2) DEFINITION OF SERVICES.—Section 1905 

8 of such Act is amended by adding at the end the fol9 lowing: 

10 ‘‘(ee)(1) For purposes of this section, the term ‘rou11 tine HIV/AIDS and STI screening services’ means all of 

12 the following: 

13 ‘‘(A) A screening test for HIV/AIDS or any 

14 other STI, if such test is provided to an individual 

15 who— 

16 ‘‘(i) is eligible for medical assistance under 

17 the State plan; and 

18 ‘‘(ii) is described in clauses (ii) through (v) 

19 of section 1861(jjj)(1)(A). 

20 ‘‘(B) Each of the services described in subpara21 graphs (B) through (F) of section 1861(jjj)(1). 

22 ‘‘(2) DEFINITIONS.—For purposes of this subsection, 

23 the terms ‘HIV/AIDS’ and ‘STI’ have the same meaning 

24 given such terms in section 1861(jjj)(2).’’. 

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


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

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

3 amended— 

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

5 at the end; 

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

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

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

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

10 services (as such term is defined in section 

11 1905(ee)); and’’. 

12 (2) LIMITATION ON STATE OPTION FOR ALTER13 NATIVE COST SHARING.—Section 1916A(b)(3)(B) of 

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

15 1(b)(3)(B)) is amended by adding at the end the fol16 lowing: 

17 ‘‘(xi) Routine HIV/AIDS and STI 

18 screening services (as such term is defined 

19 in section 1905(ee)).’’. 

20 (d) EFFECTIVE DATE.— 

21 (1) IN GENERAL.—Except as provided by para22 graph (2), the amendments made by this section 

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

24 section and shall apply to services furnished on or 

25 after such date. 


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1 (2) RULES FOR CHANGES REQUIRING STATE

2 LEGISLATION.—In the case of a State plan for med3 ical assistance under title XIX of the Social Security 

4 Act which the Secretary of Health and Human Serv5 ices determines requires State legislation (other than 

6 legislation appropriating funds) in order for the plan 

7 to meet the additional requirement imposed by the 

8 amendments made by this section, the State plan 

9 shall not be regarded as failing to comply with the 

10 requirements of such title solely on the basis of its 

11 failure to meet this additional requirement before 

12 the first day of the first calendar quarter beginning 

13 after the close of the first regular session of the 

14 State legislature that begins after the date of the en15 actment of this Act. For purposes of the previous 

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

17 legislative session, each year of such session shall be 

18 deemed to be a separate regular session of the State 

19 legislature. 

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

21 TESTS UNDER MEDICARE. 

22 Section 1861 of the Social Security Act is amended— 

23 (1) in subsection (s)— 

24 (A) by striking ‘‘and’’ at the end of para25 graph (14); 


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

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

3 (C) by redesignating paragraphs (16) and 

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

5 and 

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

7 following: 

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

9 services (as such term is defined in subsection 

10 (jjj)).’’; and 

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

12 ‘‘(jjj) ROUTINE HIV/AIDS AND STI SCREENING

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

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

15 of the following: 

16 ‘‘(A) A screening test for HIV/AIDS or any 

17 other STI, if such test is provided in any health care 

18 setting (other than an inpatient hospital setting) and 

19 is provided to an individual who— 

20 ‘‘(i) is enrolled in part B; 

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

22 ‘‘(iii) with respect to a test for HIV/AIDS, 

23 is not known to the health care provider (di24 rectly, through information provided by the in25 dividual, or through access to an electronic 


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1 medical record) to have had a previous positive 

2 test for HIV/AIDS; 

3 ‘‘(iv) subject to subparagraph (B), with re4 spect to a test for HIV/AIDS or a STI, is not 

5 known to the health care provider (directly, 

6 through information provided by the individual, 

7 or through access to an electronic medical 

8 record) to have had a test for the same condi9 tion within the previous 6 months; and 

10 ‘‘(v) has been informed that such a test 

11 will be administered and has not objected to 

12 such a test. 

13 ‘‘(B) If a test described under subparagraph 

14 (A) is reactive and is for— 

15 ‘‘(i) HIV/AIDS, a confirmatory test; or 

16 ‘‘(ii) a STI other than HIV/AIDS, if rea17 sonable and necessary, a confirmatory test. 

18 ‘‘(C) The interpretation of any tests provided 

19 under subparagraph (A) and subparagraph (B). 

20 ‘‘(D) Informing an individual who receives a 

21 test under subparagraph (A) or subparagraph (B) of 

22 the results of such tests as close in time as possible 

23 to the determination of such results. 

24 ‘‘(E) If an individual tests positive for HIV/ 

25 AIDS on a screening test under subparagraph (A) 


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1 and any confirmatory test under subparagraph 

2 (B)— 

3 ‘‘(i) post-test counseling concerning HIV/ 

4 AIDS and STIs at the time the individual is in5 formed of the results of the test; and 

6 ‘‘(ii) if appropriate, a referral to medical or 

7 mental health services. 

8 ‘‘(F) If an individual tests positive for a STI on 

9 a screening test under subparagraph (A) and any 

10 confirmatory test under subparagraph (B), the pro11 vision of information to such individual on the risk 

12 of STIs and HIV/AIDS and behaviors that reduce 

13 the risk of exposure to such conditions. 

14 ‘‘(2) DEFINITIONS.—For purposes of this subsection: 

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

16 means infection with the human immunodeficiency 

17 virus and includes acquired immune deficiency syn18 drome and any condition arising from such syn19 drome. 

20 ‘‘(B) STI.—The term ‘STI’ means a sexually 

21 transmitted infection or sexually transmitted disease 

22 that is recognized by the Centers for Disease Con23 trol and Prevention, including chlamydia, gonorrhea, 

24 syphilis, hepatitis B, hepatitis C, and human 

25 papillomavirus.’’. 


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

2 SCREENING UNDER GROUP HEALTH PLANS. 

3 (a) GROUP HEALTH PLANS.— 

4 (1) PUBLIC HEALTH SERVICE ACT AMEND5 MENT.—Title XXVII of the Public Health Service 

6 Act is amended by inserting after section 2728 of 

7 such Act (42 U.S.C. 300gg–28), as redesignated by 

8 section 1001(2) of the Patient Protection and Af9 fordable Care Act (Public Law 111–148), the fol10 lowing: 

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

12 SCREENING. 

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

14 insurance issuer providing group or individual health in15 surance coverage, shall provide coverage for routine HIV/ 

16 AIDS and STI screening under terms and conditions that 

17 are no less favorable than the terms and conditions appli18 cable to other routine health screenings. 

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

20 health insurance issuer providing group or individual 

21 health insurance coverage, shall not— 

22 ‘‘(1) deny to an individual eligibility, or contin23 ued eligibility, to enroll or to renew coverage under 

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

25 avoiding the requirements of this section; 


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

2 STI screening on the basis that there are no known 

3 risk factors present, or the screening is not clinically 

4 indicated, medically necessary, or pursuant to a re5 ferral, consent, or recommendation by any health 

6 care provider; 

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

8 other benefits to individuals to encourage such indi9 viduals to accept less than the minimum protections 

10 available under this section; 

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

12 reimbursement of a provider because such provider 

13 provided care to an individual participant or bene14 ficiary in accordance with this section; 

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

16 to a provider to induce such provider to provide care 

17 to an individual participant or beneficiary in a man18 ner inconsistent with this section; or 

19 ‘‘(6) deny to an individual participant or bene20 ficiary continued eligibility to enroll or to renew cov21 erage under the terms of the plan, solely because of 

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

23 HIV/AIDS and STI screening procedure, for the in24 dividual or any other individual. 


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

2 section shall be construed— 

3 ‘‘(1) to require an individual who is a partici4 pant or beneficiary to undergo HIV/AIDS or STI 

5 screening; or 

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

7 from imposing deductibles, coinsurance, or other 

8 cost-sharing in relation to HIV/AIDS or STI screen9 ing, except that such deductibles, coinsurance or 

10 other cost-sharing may not be greater than the 

11 deductibles, coinsurance, or other cost-sharing im12 posed on other routine health screenings. 

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

14 shall comply with the notice requirement under section 

15 716(d) of the Employee Retirement Income Security Act 

16 of 1974 with respect to the requirements of this section 

17 as if such section applied to such plan. 

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

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

20 of enactment of this section with respect to health insur21 ance coverage that requires coverage of at least the cov22 erage of HIV/AIDS or STI screening otherwise required 

23 under this section.’’. 


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1 (2) ERISA AMENDMENTS.—The Employee Re2 tirement Income Security Act of 1974 is amended as 

3 follows: 

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

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

6 new section: 

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

8 SCREENING. 

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

10 insurance issuer offering group health insurance coverage, 

11 shall provide coverage for routine HIV screening under 

12 terms and conditions that are no less favorable than the 

13 terms and conditions applicable to other routine health 

14 screenings. 

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

16 health insurance issuer offering group health insurance 

17 coverage, shall not— 

18 ‘‘(1) deny to an individual eligibility, or contin19 ued eligibility, to enroll or to renew coverage under 

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

21 avoiding the requirements of this section; 

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

23 on the basis that there are no known risk factors 

24 present, or the screening is not clinically indicated, 

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1 sent, or recommendation by any health care pro2 vider; 

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

4 other benefits to individuals to encourage such indi5 viduals to accept less than the minimum protections 

6 available under this section; 

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

8 reimbursement of a provider because such provider 

9 provided care to an individual participant or bene10 ficiary in accordance with this section; 

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

12 to a provider to induce such provider to provide care 

13 to an individual participant or beneficiary in a man14 ner inconsistent with this section; or 

15 ‘‘(6) deny to an individual participant or bene16 ficiary continued eligibility to enroll or to renew cov17 erage under the terms of the plan, solely because of 

18 the results of an HIV test or other HIV screening 

19 procedure for the individual or any other individual. 

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

21 section shall be construed— 

22 ‘‘(1) to require an individual who is a partici23 pant or beneficiary to undergo HIV/AIDS or STI 

24 screening; or 


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

2 from imposing deductibles, coinsurance, or other 

3 cost-sharing in relation to HIV/AIDS or STI screen4 ing, except that such deductibles, coinsurance or 

5 other cost-sharing may not be greater than the 

6 deductibles, coinsurance, or other cost-sharing im7 posed on other routine health screenings. 

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

9 group health plan, and a health insurance issuer providing 

10 health insurance coverage in connection with a group 

11 health plan, shall provide notice to each participant and 

12 beneficiary under such plan regarding the coverage re13 quired by this section in accordance with regulations pro14 mulgated by the Secretary. Such notice shall be in writing 

15 and prominently positioned in any literature or cor16 respondence made available or distributed by the plan or 

17 issuer and shall be transmitted, by whichever is earliest 

18 of the following: 

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

20 issuer to the participant or beneficiary. 

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

22 sent to the participant or beneficiary. 

23 ‘‘(3) Not later than July 1, 2017. 

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


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

2 shall be construed to preempt any State law in effect 

3 on the date of enactment of this section with respect 

4 to health insurance coverage that requires coverage 

5 of at least the coverage of HIV/AIDS or STI screen6 ing otherwise required under this section. 

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

8 construed to affect or modify the provisions of sec9 tion 514 with respect to group health plans.’’. 

10 (B) In section 732(a) of the Employee Re11 tirement Income Security Act of 1974 (29 

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

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

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

15 such Act, by inserting after the item relating to 

16 section 714 the following new item: 

‘‘Sec. 715. Additional market reforms. 

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

17 (3) INTERNAL REVENUE CODE AMEND18 MENTS.— 

19 (A) IN GENERAL.—The Internal Revenue 

20 Code of 1986 is amended by inserting after sec21 tion 9815 the following new section: 


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

2 SCREENING. 

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

4 coverage for routine HIV/AIDS and STI screening under 

5 terms and conditions that are no less favorable than the 

6 terms and conditions applicable to other routine health 

7 screenings. 

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

9 not— 

10 ‘‘(1) deny to an individual eligibility, or contin11 ued eligibility, to enroll or to renew coverage under 

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

13 avoiding the requirements of this section; 

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

15 STI screening on the basis that there are no known 

16 risk factors present, or the screening is not clinically 

17 indicated, medically necessary, or pursuant to a re18 ferral, consent, or recommendation by any health 

19 care provider; 

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

21 other benefits to individuals to encourage such indi22 viduals to accept less than the minimum protections 

23 available under this section; 

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

25 reimbursement of a provider because such provider 


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

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

4 to a provider to induce such provider to provide care 

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

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

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

11 HIV/AIDS and STI screening procedure, for the in12 dividual or any other individual. 

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

14 section shall be construed— 

15 ‘‘(1) to require an individual who is a partici16 pant or beneficiary to undergo HIV/AIDS or STI 

17 screening; or 

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

19 from imposing deductibles, coinsurance, or other 

20 cost-sharing in relation to HIV/AIDS or STI screen21 ing, except that such deductibles, coinsurance or 

22 other cost-sharing may not be greater than the 

23 deductibles, coinsurance, or other cost-sharing im24 posed on other routine health screenings.’’. 


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1 (B) CONFORMING AMENDMENT.—Section 

2 4980D(d)(1) of such Code is amended by strik3 ing ‘‘section 9811’’ and inserting ‘‘sections 

4 9811 and 9816’’. 

5 (C) CLERICAL AMENDMENT.—The table of 

6 contents for subchapter B of chapter 1 of such 

7 Code is amended by inserting after the item re8 lating to section 9815 the following new item: 

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

9 (b) APPLICATION UNDER FEDERAL EMPLOYEES

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

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

12 following new subsection: 

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

14 which does not comply with the requirements of section 

15 2729 of the Public Health Service Act.’’. 

16 (c) EFFECTIVE DATES.—Notwithstanding any other 

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

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

19 on or after July 1, 2017, and with respect to health insur20 ance coverage issued on or after such date. 

21 (d) COORDINATION OF ADMINISTRATION.—The Sec22 retary of Labor, the Secretary of Health and Human Serv23 ices, and the Secretary of the Treasury shall ensure, 

24 through the execution of an interagency memorandum of 

25 understanding among such Secretaries, that— 


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1 (1) regulations, rulings, and interpretations 

2 issued by such Secretaries relating to the same mat3 ter over which two or more such Secretaries have re4 sponsibility under the provisions of this section (and 

5 the amendments made thereby) are administered so 

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

7 (2) coordination of policies relating to enforcing 

8 the same requirements through such Secretaries in 

9 order to have a coordinated enforcement strategy 

10 that avoids duplication of enforcement efforts and 

11 assigns priorities in enforcement. 

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

13 HIV/AIDS INFECTED INDIVIDUALS. 

14 (a) IN GENERAL.—Section 1902 of the Social Secu15 rity Act (42 U.S.C. 1396a) is amended— 

16 (1) in subsection (a)(10)(A)(ii)— 

17 (A) by striking ‘‘or’’ at the end of sub18 clause (XXI); 

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

20 (XXII); and 

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

22 ‘‘(XXIII) on or before December 

23 31, 2017, who are described in sub24 section (ll) (relating to HIV/AIDS in25 fected individuals);’’; and 


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

2 ‘‘(ll) individuals described in this subsection are indi3 viduals— 

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

5 (a)(10)(A)(i); 

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

7 section 1905(ee); 

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

9 State plan under this title with respect to disabled 

10 individuals) does not exceed the maximum amount 

11 of income a disabled individual described in sub12 section (a)(10)(A)(i) may have to obtain medical as13 sistance under the plan; and 

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

15 State plan under this title with respect to disabled 

16 individuals) do not exceed the maximum amount of 

17 resources a disabled individual described in sub18 section (a)(10)(A)(i) may have to obtain medical as19 sistance under the plan.’’. 

20 (b) ENHANCED MATCH.— 

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

22 1905(b) of the Social Security Act (42 U.S.C. 

23 1396d(b)) is amended by striking ‘‘section 

24 1902(a)(10)(A)(ii)(XVIII)’’ and inserting ‘‘subclause 


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1 (XVIII) and subclause (XXIII) of section 

2 1902(a)(10)(A)(ii)’’. 

3 (2) CONFORMING AMENDMENTS.—Section 

4 1905(a) of the Social Security Act (42 U.S.C. 

5 1396d(a)) is amended in the matter preceding para6 graph (1)— 

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

8 (xv); 

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

10 (xvi); 

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

12 (xvii); and 

13 (D) by inserting after clause (xvii) the fol14 lowing: 

15 ‘‘(xviii) individuals described in sec16 tion 1902(a)(10)(A)(ii)(XXIII);’’. 

17 (c) EXEMPTION FROM FUNDING LIMITATION FOR

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

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

20 the following: 

21 ‘‘(6) DISREGARDING MEDICAL ASSISTANCE FOR

22 OPTIONAL LOW-INCOME HIV/AIDS INFECTED INDI23 VIDUALS.—The limitations under subsection (f) and 

24 the previous provisions of this subsection shall not 

25 apply to amounts expended for medical assistance 


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

2 only eligible for such assistance on the basis of sec3 tion 1902(a)(10)(A)(ii)(XXIII).’’. 

4 (d) EFFECTIVE DATE.— 

5 (1) IN GENERAL.—Except as provided by para6 graph (2), the amendments made by this section 

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

8 section and shall apply to services furnished on or 

9 after such date. 

10 (2) RULES FOR CHANGES REQUIRING STATE

11 LEGISLATION.—In the case of a State plan for med12 ical assistance under title XIX of the Social Security 

13 Act which the Secretary of Health and Human Serv14 ices determines requires State legislation (other than 

15 legislation appropriating funds) in order for the plan 

16 to meet the additional requirement imposed by the 

17 amendments made by this section, the State plan 

18 shall not be regarded as failing to comply with the 

19 requirements of such title solely on the basis of its 

20 failure to meet this additional requirement before 

21 the first day of the first calendar quarter beginning 

22 after the close of the first regular session of the 

23 State legislature that begins after the date of the en24 actment of this Act. For purposes of the previous 

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


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1 legislative session, each year of such session shall be 

2 deemed to be a separate regular session of the State 

3 legislature. 

4 TITLE II—INCREASED DATA COL5 LECTION AND EDUCATION 

6 FOR HISTORICALLY UNDER7 REPRESENTED POPULATIONS 

8 SEC. 201. PEOPLE LIVING WITH DISABILITIES. 

9 (a) TRACKING OF INFORMATION.—The Director 

10 shall— 

11 (1) track national HIV/AIDS and STI screen12 ing trends and the burdens of HIV/AIDS and STIs 

13 among people with disabilities, including such per14 sons with mental, physical, cognitive, intellectual, or 

15 developmental disabilities; and 

16 (2) identify and assess the barriers that prevent 

17 such persons from accessing HIV/AIDS and STI 

18 screening. 

19 (b) TRACKING METHODOLOGY.— 

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

21 by the Secretary under subsection (a) shall— 

22 (A) focus upon historically underrep23 resented communities, including the deaf and 

24 hearing loss-related community and the cogVerDate Sep 11 2014 00:03 Jan 11, 2017 Jkt 069200 PO 00000 Frm 00030 Fmt 6652 Sfmt 6201 E:\BILLS\H164.IH H164

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1 nitive, intellectual, developmental, mobility, or 

2 mental health disability communities; and 

3 (B) consider other factors that may con4 tribute to increased burdens of HIV/AIDS and 

5 STIs, including race, socio-economic status, re6 gion, gender identity, and sexual behavior. 

7 (2) SEXUAL ASSAULT DATA.—Tracking under 

8 subsection (a) shall include data collection on the in9 cidence of sexual assault on people with mental, 

10 physical, cognitive, intellectual, or developmental dis11 abilities for the purposes of understanding the prev12 alence of HIV/AIDS and STIs that result from such 

13 assaults. 

14 (c) DEAF AND HEARING LOSS COMMUNITY.— 

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

16 through the Director, shall work with appropriate 

17 organizations and institutions to make comprehen18 sive sex education materials that promote voluntary 

19 screening for HIV/AIDS and STIs accessible to the 

20 deaf and hearing loss community through language 

21 (including American Sign Language), modalities (in22 cluding highly graphic formats with minimal text), 

23 and culturally appropriate information delivery. 

24 (2) HEALTH CAREERS AND EDUCATION.—The 

25 Secretary shall— 


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1 (A) work with appropriate individuals, or2 ganizations, and institutions to increase the 

3 number of people who are deaf or living with 

4 hearing loss in public health careers for the 

5 purposes of— 

6 (i) building the public health infra7 structure to improve data collection; and 

8 (ii) health information dissemination 

9 to people who are deaf or who live with 

10 hearing loss; and 

11 (B) engage students in elementary school, 

12 high school, college, and graduate school for the 

13 purposes of carrying out this paragraph. 

14 (d) COGNITIVE AND INTELLECTUAL DISABILITY

15 COMMUNITY.—The Secretary, acting through the Direc16 tor, shall work with appropriate national and local organi17 zations to make comprehensive sex education materials ac18 cessible to people with intellectual disabilities by— 

19 (1) using plain language; 

20 (2) educating service providers about the signs 

21 and symptoms of sexual assault among people with 

22 cognitive and intellectual disabilities; and 

23 (3) using other appropriate information delivery 

24 strategies. 


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1 (e) WOMEN LIVING WITH SEVERE PHYSICAL DIS2 ABILITIES.—The Secretary, acting through the Director, 

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

4 access to pelvic examinations, mammograms, and other 

5 women’s health services for women with severe mobility 

6 impairments with the goal of improving access to such 

7 services. 

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

9 (a) NATIONAL SCREENING GUIDELINES.—The Sec10 retary, acting through the Director, shall work with Fed11 eral, State, and local health entities to ensure that na12 tional screening guidelines for cervical cancer state that 

13 WSW should be subject to the same screening guidelines 

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

15 (b) INFORMATION COLLECTION.—The Secretary, act16 ing through the Director, shall, with respect to the WSW 

17 community— 

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

19 AIDS and other STIs; and 

20 (2) collect information on— 

21 (A) the burdens and behavior of HIV/ 

22 AIDS and STIs; and 

23 (B) other reproductive health concerns. 


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1 SEC. 203. TRANSGENDER COMMUNITY. 

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

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

4 local health entities and transgender communities to im5 prove information collection concerning the transmission, 

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

7 in transgender communities. 

8 (b) INFORMATION CLASSIFICATION.—For purposes 

9 of acquiring a comprehensive understanding of the unique 

10 health trends among, and aspects of, the transgender com11 munity, the Secretary shall promulgate regulations requir12 ing that, for purposes of public health studies requiring 

13 data collection, the fact that an individual is transgender 

14 shall be a distinct category and data point. 

15 SEC. 204. REPORT. 

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

17 date of the enactment of this Act, the Secretary shall sub18 mit a report to Congress on the activities required under 

19 this Act. 

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

21 under subsection (a) shall include— 

22 (1) information on the success of voluntary 

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

24 methods for preventing the transmission of HIV/ 

25 AIDS and STIs among Medicaid and Medicare 

26 beneficiaries, patients at federally qualified health 


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1 centers, individuals with health insurance, MSM, 

2 WSW, persons living with disabilities, the 

3 transgender community, and other groups that have 

4 been historically underrepresented in public health 

5 interventions for HIV/AIDS and STIs; and 

6 (2) recommendations on how to improve exist7 ing measures with respect to race, socioeconomic 

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

9 sexual behavior— 

10 (A) to increase access to screening; and 

11 (B) to decrease the disparities in mortality 

12 and morbidity from HIV/AIDS and other STIs. 

Æ 


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