I 

111TH CONGRESS 

1ST SESSION H. R. 4140 

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 

NOVEMBER 19, 2009 

Mr. HASTINGS of Florida (for himself, Mrs. CHRISTENSEN, Ms. CLARKE, Mr. 

CLEAVER, Mr. CONYERS, Mr. AL GREEN of Texas, Mr. GRIJALVA, Ms. 

JACKSON-LEE of Texas, Mr. MEEKS of New York, Mr. RANGEL, Ms. 

ROYBAL-ALLARD, Mr. RUSH, Mr. TOWNS, Ms. WASSERMAN SCHULTZ, 

Ms. WATERS, Ms. WATSON, and Mr. WEXLER) 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 Labor, 

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. 

2 This Act may be cited as the ‘‘Increasing Access to 

3 Voluntary Screening for HIV/AIDS and STIs Act of 

4 2009’’. 

5 SEC. 2. FINDINGS. 

6 Congress finds the following: 

7 (1) Over 15,000,000 sexually transmitted infec8 tions are reported each year, and 50 percent of sexu9 ally active Americans will contract an STI at some 

10 point in their lives, the majority of which may be 

11 asymptomatic for an extended amount of time. 

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

13 are living with HIV, and someone is infected with 

14 HIV in the United States every 9.5 minutes. 

15 (3) Many common long-term and initially 

16 asymptomatic STIs such as chlamydia, gonorrhea, 

17 herpes, syphilis, inflammatory pelvic disease, and 

18 HIV/AIDS remain undiagnosed, or diagnosed at 

19 later stages, leading to increased rates of mortality, 

20 morbidity, disability, and transmission. 

21 (4) Stigma, culture, language, lack of edu22 cation, lack of insurance, limited time, cost and re23 sources in medical settings, and an inaccurate per24 ception of risk among communities and providers all 

25 contribute to insufficient rates of screening for HIV/ 

26 AIDS and STIs. 


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1 (5) The Centers for Disease Control and Pre2 vention and the United States Preventive Services 

3 Task Force recognize screening as an effective pub4 lic health tool that allows providers to administer 

5 treatment before symptoms develop and implement 

6 interventions that will reduce the likelihood of HIV/ 

7 AIDS and STI transmission and reduce the develop8 ment of adverse outcomes. 

9 (6) The CDC recommends that voluntary 

10 screening for HIV/AIDS be integrated into routine 

11 clinical care while preserving patient confidentiality 

12 and the right of the patient to decline testing and 

13 screening. 

14 (7) Nearly 25 percent of persons living with 

15 HIV/AIDS are age 50 years or older, and the overall 

16 HIV/AIDS population is aging due to life-extending 

17 anti-retroviral drugs. 

18 (8) Inaccurate perceptions of risk among health 

19 care providers and patients, misdiagnosis, ageism, 

20 generational mind-sets, and biological factors have 

21 contributed to increased rates in transmission and 

22 late detection of HIV/AIDS and STIs over the past 

23 decade. 

24 (9) Although African-Americans account for 

25 about 13 percent of the United States population, 


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1 they account for nearly half of all HIV/AIDS infec2 tions and have higher instances of mortality and 

3 morbidity for most STIs and HIV/AIDS. Also, Afri4 can-American women who have sex with men ac5 count for the majority of HIV/AIDS infections 

6 among all women in the United States. 

7 (10) HIV/AIDS continues to be most prevalent 

8 among men who have sex with men. Continued sup9 port and increased funding for community-based 

10 programs and behavioral interventions that are cul11 turally competent are key to reaching MSM, espe12 cially young MSM of color. 

13 (11) Transgender persons are particularly vul14 nerable to contracting HIV/AIDS and STIs due to 

15 high rates of survival sex among trans-females, dis16 crimination in education, employment, and housing, 

17 and the absence of education and prevention meth18 ods culturally relevant to the transgender commu19 nity. 

20 (12) Health care providers must be properly 

21 educated to treat groups, such as MSM, transgender 

22 persons, African-Americans, and Latinos who are 

23 disproportionately affected by HIV/AIDS and other 

24 STIs, and also improve interventions for groups that 

25 have been historically under-represented in health 


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1 interventions for STIs, such as women who have sex 

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

3 and Pacific Islander Americans, Native Americans, 

4 and persons living with disabilities. 

5 (13) Women living with mobility impairments 

6 often lack access to screening for STIs and other 

7 women’s health services such as pelvic examinations 

8 and mammograms due to, among other factors, the 

9 lack of provider awareness, experience, and inacces10 sible equipment. 

11 (14) All individuals engaging in oral, anal, or 

12 genital sexual contact must have access to voluntary 

13 screening for HIV/AIDS and other STIs. Screening 

14 must be confidential, rapid, accurate, and medically 

15 appropriate. Screening must be offered regardless of 

16 age, race, class, sexual behavior, gender identity, or 

17 disability. 

18 SEC. 3. PURPOSE. 

19 The purposes of this Act are as follows: 

20 (1) Increase access, quality, and affordability 

21 for voluntary and medically appropriate screening 

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

23 gonorrhea, syphilis, and human papillomavirus, for 

24 all persons engaging in various forms of sexual ac25 tivity, including oral, genital, or anal sex. 


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

2 of HIV/AIDS and other STIs. 

3 (3) Reduce the disproportionate incidence of 

4 HIV/AIDS and other STIs in certain groups 

5 through early detection and treatment and com6 prehensive education for health care providers, cen7 ters, and communities. 

8 (4) Support the execution of other scientifically 

9 based interventions that are culturally competent 

10 and age appropriate and are proven to reduce the in11 cidence of HIV/AIDS and other STIs. 

12 SEC. 4. DEFINITIONS. 

13 In this Act: 

14 (1) CDC.—The term ‘‘CDC’’ means the Cen15 ters for Disease Control and Prevention. 

16 (2) CMS.—The term ‘‘CMS’’ means the Cen17 ters for Medicare & Medicaid Services. 

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

19 the Director of the Centers for Disease Control and 

20 Prevention. 

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

22 infection with the human immunodeficiency virus 

23 and includes acquired immune deficiency syndrome 

24 and any condition arising from such syndrome. 


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

2 have sex with men. 

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

4 the Secretary of Health and Human Services. 

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

6 the 50 States, the District of Columbia, the Virgin 

7 Islands, Guam, and Puerto Rico. 

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

9 transmitted infection that is recognized by the CDC, 

10 including chlamydia, gonorrhea, syphilis, and human 

11 papillomavirus. 

12 (9) WSW.—The term ‘‘WSW’’ women who 

13 have sex with women. 

14 TITLE I—HEALTH CARE 

15 PROGRAMS 

16 SEC. 101. MEDICAID. 

17 (a) HIGHER FEDERAL MATCHING PERCENTAGE FOR

18 ROUTINE HIV/AIDS AND STI SCREENING SERVICES.— 

19 Section 1903 of the Social Security Act (42 U.S.C. 1396b) 

20 is amended— 

21 (1) in subsection (a)— 

22 (A) by redesignating paragraph (7) as 

23 paragraph (8); and 

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

25 following new paragraph: 


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1 ‘‘(7) an amount equal to 83 percent of the 

2 sums expended during such quarter which are at3 tributable to the costs of providing routine HIV/ 

4 AIDS and STI screening services (as defined in sub5 section (aa)(1)) if the conditions described in sub6 section (aa)(2) are met; plus’’; and 

7 (2) by adding at the end the following new sub8 section: 

9 ‘‘(aa) ROUTINE HIV/AIDS AND STI SCREENING

10 SERVICES.— 

11 ‘‘(1) IN GENERAL.—For purposes of this sec12 tion, the term ‘routine HIV/AIDS and STI screening 

13 services’ means the following: 

14 ‘‘(A) An HIV/AIDS or STI screening test 

15 (and, if such test is reactive, a confirmatory 

16 test), including the interpretation of such tests, 

17 that is provided as part of medical care in any 

18 health care setting (other than an inpatient 

19 hospital setting) for an individual who— 

20 ‘‘(i) is at least 13 years of age, and in 

21 the case of a beneficiary who is under 13 

22 years of age if the appropriate health care 

23 provider reasonably determines that the 

24 beneficiary is at risk for infection; 


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

2 provider (directly, through information 

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

6 HIV/AIDS or an STI or, subject to para7 graph (3), within the previous 6 months to 

8 have had any test for HIV/AIDS or an 

9 STI; and 

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

11 test will be administered and has not ob12 jected to such a test. 

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

14 the results of the tests at the time of such ex15 amination. 

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

17 tests positive for HIV/AIDS on the screening 

18 and confirmatory tests, 

19 ‘‘(i) post-test counseling concerning 

20 HIV/AIDS at the time, and as part of, 

21 such examination; or 

22 ‘‘(ii) a referral to appropriate medical 

23 or mental health services. 

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

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


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1 to routine HIV/AIDS or STI screening services, are 

2 that— 

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

4 under this title is reasonable and closely ap5 proximates the payment amount for such serv6 ices under part B of title XVIII; 

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

8 title for the provision of such services; and 

9 ‘‘(C) in the case of a State for which a po10 litical subdivision is required to contribute to11 wards the non-Federal share of expenditures for 

12 routine HIV/AIDS or STI screening services, 

13 the increase in the Federal share applicable 

14 under subsection (a)(5) to such services is first 

15 applied to reduce the contribution (but not 

16 below zero) required by such political subdivi17 sion. 

18 ‘‘(3) DEFINITIONS.—For purposes of this sub19 section: 

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

21 means infection with the human immuno22 deficiency virus and includes acquired immune 

23 deficiency syndrome and any condition arising 

24 from such syndrome. 


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1 ‘‘(B) STI.—The term ‘STI’ means a sexu2 ally transmitted infection that is recognized by 

3 the CDC, including chlamydia, gonorrhea, 

4 syphilis, and human papillomavirus.’’. 

5 (b) CONFORMING AMENDMENTS.— 

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

7 1919(h)(2) of such Act (42 U.S.C. 1396r(h)(2)) are 

8 each amended by striking ‘‘1903(a)(7)’’ and insert9 ing ‘‘1903(a)(8)’’. 

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

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

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

13 ‘‘1903(a)(8)’’. 

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

15 1396u–8(d)(4)) is amended by striking 

16 ‘‘1903(a)(7)’’ and inserting ‘‘1903(a)(8)’’. 

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

18 1396w(j)) is amended by striking ‘‘paragraph (7)’’ 

19 and inserting ‘‘paragraph (8)’’. 

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

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

22 the date of the enactment of this section. 


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1 SEC. 102. SCREENING TESTS FOR MEDICARE BENE2 FICIARIES. 

3 (a) BROAD APPROACH.—The Administrator of the 

4 Centers for Medicare & Medicaid Services should adopt 

5 a broad approach in implementing a policy towards vol6 untary screening for HIV/AIDS and STIs for all Medicare 

7 eligible individuals who are 13 years of age or older. 

8 (b) TESTS AND REIMBURSEMENT.—In carrying out 

9 such approach, the Administrator of CMS should— 

10 (1) give confirmatory tests for HIV/AIDS and 

11 STIs to Medicare eligible individuals who are 13 

12 years of age or older with reactive results for HIV/ 

13 AIDS or STIs and provide Medicare reimbursement 

14 for such tests; and 

15 (2) reimburse Medicare eligible individuals who 

16 are 13 years of age or older for blood and rapid oral 

17 swab HIV/AIDS tests and STI blood tests. 

18 SEC. 103. VOLUNTARY SCREENING BY FEDERALLY QUALI19 FIED HEALTH CENTERS. 

20 (a) GRANTS.—The Secretary, acting through the Ad21 ministrator of the Health Resources and Services Admin22 istration, may award grants to Federally qualified health 

23 centers to provide, as part of medical care in a health care 

24 setting, voluntary screening for HIV/AIDS and STIs to 

25 eligible individuals. 


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1 (b) SECONDARY PAYOR PROVISION.—A Federally 

2 qualified health center that receives a grant under this 

3 section may not use funds from such grant to pay for a 

4 screening test if payment has been made for such test, 

5 or payment can reasonably be expected to be made— 

6 (1) under an insurance policy; 

7 (2) under a Federal or State health benefits 

8 program, including titles XIX and XXI of the Social 

9 Security Act; or 

10 (3) by an entity that provides health services on 

11 a prepaid basis. 

12 (c) DEFINITIONS.—In this section: 

13 (1) ELIGIBLE INDIVIDUAL.—The term ‘‘eligible 

14 individual’’ means an individual who— 

15 (A) can give legal consent under the laws 

16 of his or her State; 

17 (B) has been informed by a healthcare pro18 vider that a screening test for HIV/AIDS or 

19 STIs will be administered; and 

20 (C) has not objected to such test. 

21 (2) FEDERALLY QUALIFIED HEALTH CEN22 TER.—The term ‘‘Federally qualified health center’’ 

23 has the meaning given such term under section 

24 1861(aa)(4) of the Social Security Act (42 U.S.C. 

25 1395ww). 


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1 (3) SCREENING.—The term ‘‘screening’’ in2 cludes— 

3 (A) the interpretation of screening tests; 

4 and 

5 (B) in the case of a reactive result for an 

6 initial screening test for HIV/AIDS or STIs, a 

7 confirmatory test. 

8 SEC. 104. COVERAGE FOR ROUTINE HIV/AIDS AND STI 

9 SCREENING UNDER GROUP HEALTH PLANS. 

10 (a) GROUP HEALTH PLANS.— 

11 (1) PUBLIC HEALTH SERVICE ACT AMEND12 MENTS.—Subpart 2 of part A of title XXVII of the 

13 Public Health Service Act is amended by adding at 

14 the end the following new section: 

15 ‘‘SEC. 2708. COVERAGE FOR ROUTINE HIV/AIDS AND STI 

16 SCREENING. 

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

18 insurance issuer offering group health insurance coverage, 

19 shall provide coverage for routine HIV/AIDS and STI 

20 screening under terms and conditions that are no less fa21 vorable than the terms and conditions applicable to other 

22 routine health screenings. 

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

24 health insurance issuer offering group health insurance 

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

17 shall comply with the notice requirement under section 

18 715(d) of the Employee Retirement Income Security Act 

19 of 1974 with respect to the requirements of this section 

20 as if such section applied to such plan. 

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

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

23 of enactment of this section with respect to health insur24 ance coverage that requires coverage of at least the covVerDate Nov 24 2008 03:20 Nov 21, 2009 Jkt 089200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\H4140.IH H4140

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1 erage of HIV/AIDS or STI screening otherwise required 

2 under this section.’’. 

3 (2) ERISA AMENDMENTS.—The Employee Re4 tirement Income Security Act of 1974 is amended as 

5 follows: 

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

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

8 new section: 

9 ‘‘SEC. 715. COVERAGE FOR ROUTINE HIV/AIDS AND STI 

10 SCREENING. 

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

12 insurance issuer offering group health insurance coverage, 

13 shall provide coverage for routine HIV screening under 

14 terms and conditions that are no less favorable than the 

15 terms and conditions applicable to other routine health 

16 screenings. 

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

18 health insurance issuer offering group health insurance 

19 coverage, shall not— 

20 ‘‘(1) deny to an individual eligibility, or contin21 ued eligibility, to enroll or to renew coverage under 

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

23 avoiding the requirements of this section; 

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

25 on the basis that there are no known risk factors 


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1 present, or the screening is not clinically indicated, 

2 medically necessary, or pursuant to a referral, con3 sent, or recommendation by any health care pro4 vider; 

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

6 other benefits to individuals to encourage such indi7 viduals to accept less than the minimum protections 

8 available under this section; 

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

10 reimbursement of a provider because such provider 

11 provided care to an individual participant or bene12 ficiary in accordance with this section; 

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

14 to a provider to induce such provider to provide care 

15 to an individual participant or beneficiary in a man16 ner inconsistent with this section; or 

17 ‘‘(6) deny to an individual participant or bene18 ficiary continued eligibility to enroll or to renew cov19 erage under the terms of the plan, solely because of 

20 the results of an HIV test or other HIV screening 

21 procedure for the individual or any other individual. 

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

23 section shall be construed— 


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1 ‘‘(1) to require an individual who is a partici2 pant or beneficiary to undergo HIV/AIDS or STI 

3 screening; or 

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

5 from imposing deductibles, coinsurance, or other 

6 cost-sharing in relation to HIV/AIDS or STI screen7 ing, except that such deductibles, coinsurance or 

8 other cost-sharing may not be greater than the 

9 deductibles, coinsurance, or other cost-sharing im10 posed on other routine health screenings. 

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

12 group health plan, and a health insurance issuer providing 

13 health insurance coverage in connection with a group 

14 health plan, shall provide notice to each participant and 

15 beneficiary under such plan regarding the coverage re16 quired by this section in accordance with regulations pro17 mulgated by the Secretary. Such notice shall be in writing 

18 and prominently positioned in any literature or cor19 respondence made available or distributed by the plan or 

20 issuer and shall be transmitted, by whichever is earliest 

21 of the following: 

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

23 issuer to the participant or beneficiary. 

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

25 sent to the participant or beneficiary. 


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1 ‘‘(3) Not later than July 1, 2010. 

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

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

4 shall be construed to preempt any State law in effect 

5 on the date of enactment of this section with respect 

6 to health insurance coverage that requires coverage 

7 of at least the coverage of HIV/AIDS or STI screen8 ing otherwise required under this section. 

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

10 construed to affect or modify the provisions of sec11 tion 514 with respect to group health plans.’’. 

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

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

14 and inserting ‘‘sections 711 and 715’’. 

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

16 such Act, by inserting after the item relating to 

17 section 714 the following new item: 

‘‘Sec. 715. Coverage for routine HIV/AIDS and STI screening.’’. 

18 (3) INTERNAL REVENUE CODE AMEND19 MENTS.—The Internal Revenue Code of 1986 is 

20 amended as follows: 

21 (A) In subchapter B of chapter 100, by in22 serting after section 9813 the following: 


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1 ‘‘SEC. 9814. 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) In the table of contents for such sub2 chapter, by inserting after the item relating to 

3 section 9813 the following new item: 

‘‘Sec. 9814. Coverage for HIV/AIDS and STI screening.’’. 

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

5 ‘‘section 9811’’ and inserting ‘‘sections 9811 

6 and 9814’’. 

7 (b) APPLICATION TO INDIVIDUAL HEALTH INSUR8 ANCE COVERAGE.— 

9 (1) Part B of title XXVII of the Public Health 

10 Service Act is amended by inserting after section 

11 2753 the following new section: 

12 ‘‘SEC. 2754. COVERAGE FOR ROUTINE HIV/AIDS AND STI 

13 SCREENING. 

14 ‘‘(a) IN GENERAL.—The provisions of section 2708 

15 (other than subsection (d)) shall apply to health insurance 

16 coverage offered by a health insurance issuer in the indi17 vidual market in the same manner as it applies to health 

18 insurance coverage offered by a health insurance issuer 

19 in connection with a group health plan in the small or 

20 large group market. 

21 ‘‘(b) NOTICE.—A health insurance issuer under this 

22 part shall comply with the notice requirement under sec23 tion 715(d) of the Employee Retirement Income Security 

24 Act of 1974 with respect to the requirements referred to 


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1 in subsection (a) as if such section applied to such issuer 

2 and such issuer were a group health plan.’’. 

3 (2) Section 2762(b)(2) of such Act (42 U.S.C. 

4 300gg–62(b)(2)) is amended by striking ‘‘section 

5 2751’’ and inserting ‘‘sections 2751 and 2754’’. 

6 (c) APPLICATION UNDER FEDERAL EMPLOYEES

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

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

9 following new subsection: 

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

11 which does not comply with the requirements of section 

12 2708 of the Public Health Service Act.’’. 

13 (d) EFFECTIVE DATES.—The amendments made— 

14 (1) by subsections (a) and (c) of this section 

15 apply with respect to group health plans and health 

16 benefit plans for plan years beginning on or after 

17 July 1, 2010; and 

18 (2) by subsection (b) of this section shall apply 

19 with respect to health insurance coverage offered, 

20 sold, issued, renewed, in effect, or operated in the 

21 individual market on or after January 1, 2010. 

22 (e) COORDINATION OF ADMINISTRATION.—The Sec23 retary of Labor, the Secretary of Health and Human Serv24 ices, and the Secretary of the Treasury shall ensure, 


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1 through the execution of an interagency memorandum of 

2 understanding among such Secretaries, that— 

3 (1) regulations, rulings, and interpretations 

4 issued by such Secretaries relating to the same mat5 ter over which two or more such Secretaries have re6 sponsibility under the provisions of this section (and 

7 the amendments made thereby) are administered so 

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

9 (2) coordination of policies relating to enforcing 

10 the same requirements through such Secretaries in 

11 order to have a coordinated enforcement strategy 

12 that avoids duplication of enforcement efforts and 

13 assigns priorities in enforcement. 

14 SEC. 105. OPTIONAL MEDICAID COVERAGE OF LOW-INCOME 

15 HIV/AIDS INFECTED INDIVIDUALS. 

16 (a) IN GENERAL.—Section 1902 of the Social Secu17 rity Act (42 U.S.C. 1396a) is amended— 

18 (1) in subsection (a)(10)(A)(ii)— 

19 (A) by striking ‘‘or’’ at the end of sub20 clause (XVIII); 

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

22 (XIX); and 

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


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1 ‘‘(XX) who are described in sub2 section (gg) (relating to HIV/AIDS 

3 infected individuals);’’; and 

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

5 ‘‘(gg) individuals described in this subsection are in6 dividuals not described in subsection (a)(10)(A)(i)— 

7 ‘‘(1) who have HIV/AIDS infection, as defined 

8 under section 1903(aa); 

9 ‘‘(2) whose income (as determined under the 

10 State plan under this title with respect to disabled 

11 individuals) does not exceed the maximum amount 

12 of income a disabled individual described in sub13 section (a)(10)(A)(i) may have and obtain medical 

14 assistance under the plan; and 

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

16 State plan under this title with respect to disabled 

17 individuals) do not exceed the maximum amount of 

18 resources a disabled individual described in sub19 section (a)(10)(A)(i) may have and obtain medical 

20 assistance under the plan.’’. 

21 (b) ENHANCED MATCH.—The first sentence of sec22 tion 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 

25 (XVIII) or (XX) of section 1902(a)(10)(A)(ii)’’. 


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1 (c) CONFORMING AMENDMENTS.—Section 1905(a) of 

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

3 in the matter preceding paragraph (1)— 

4 (1) by striking ‘‘or’’ at the end of clause (xii); 

5 (2) by adding ‘‘or’’ at the end of clause (xiii); 

6 and 

7 (3) by inserting after clause (xiii) the following: 

8 ‘‘(xiv) individuals described in section 

9 1902(gg);’’. 

10 (d) EXEMPTION FROM FUNDING LIMITATION FOR

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

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

13 the following: 

14 ‘‘(5) DISREGARDING MEDICAL ASSISTANCE FOR

15 OPTIONAL LOW-INCOME HIV/AIDS INFECTED INDI16 VIDUALS.—The limitations under subsection (f) and 

17 the previous provisions of this subsection shall not 

18 apply to amounts expended for medical assistance 

19 for individuals described in section 1902(gg) who are 

20 only eligible for such assistance on the basis of sec21 tion 1902(a)(10)(A)(ii)(XX).’’. 

22 (e) EFFECTIVE DATE.—The amendments made by 

23 this section shall apply to calendar quarters beginning on 

24 or after the date of the enactment of this section, without 


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1 regard to whether or not final regulations to carry out 

2 such amendments have been promulgated by such date. 

3 TITLE II—INCREASED DATA COL4 LECTION AND EDUCATION 

5 FOR HISTORICALLY UNDER6 REPRESENTED POPULATIONS 

7 SEC. 201. PEOPLE LIVING WITH DISABILITIES. 

8 (a) TRACKING OF INFORMATION.—The Director 

9 shall— 

10 (1) track national HIV/AIDS and STI screen11 ing trends and the burdens of HIV/AIDS and STIs 

12 among people with disabilities, including such per13 sons with mental, physical, cognitive, intellectual, or 

14 developmental disabilities; and 

15 (2) identify and assess the barriers that prevent 

16 such persons from accessing HIV/AIDS and STI 

17 screening. 

18 (b) TRACKING METHODOLOGY.— 

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

20 by the Secretary under subsection (a) shall— 

21 (A) focus upon historically under-rep22 resented communities, including the deaf and 

23 hearing loss-related community and the cog24 nitive, intellectual, developmental, mobility, or 

25 mental health disability communities; and 


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1 (B) consider other factors that may con2 tribute to increased burdens of HIV/AIDS and 

3 STIs, including race, socio-economic status, re4 gion, gender identity, and sexual behavior. 

5 (2) SEXUAL ASSAULT DATA.—Tracking under 

6 subsection (a) shall include data collection on the in7 cidence of sexual assault on people with mental, 

8 physical, cognitive, intellectual, or developmental dis9 abilities for the purposes of understanding the prev10 alence of HIV/AIDS and STIs that result from such 

11 assaults. 

12 (c) DEAF AND HEARING LOSS COMMUNITY.— 

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

14 through the Director, shall work with appropriate 

15 organizations and institutions to make comprehen16 sive sex education materials that promote voluntary 

17 screening for HIV/AIDS and STIs accessible to the 

18 deaf and hearing loss community through language 

19 (including American Sign Language), modalities (in20 cluding highly graphic formats with minimal text), 

21 and culturally appropriate information delivery. 

22 (2) HEALTH CAREERS AND EDUCATION.—The 

23 Secretary shall— 

24 (A) work with appropriate individuals, or25 ganizations, and institutions to increase the 


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1 number of people who are deaf or living with 

2 hearing loss in public health careers for the 

3 purposes of— 

4 (i) building the public health infra5 structure to improve data collection; and 

6 (ii) health information dissemination 

7 to people who are deaf or who live with 

8 hearing loss; and 

9 (B) engage students in elementary school, 

10 high school, college, and graduate school for the 

11 purposes of carrying out this paragraph. 

12 (d) COGNITIVE AND INTELLECTUAL DISABILITY

13 COMMUNITY.—The Secretary, acting through the Direc14 tor, shall work with appropriate national and local organi15 zations to make comprehensive sex education materials ac16 cessible to people with intellectual disabilities by— 

17 (1) using plain language; 

18 (2) educating service providers about the signs 

19 and symptoms of sexual assault among people with 

20 cognitive and intellectual disabilities; and 

21 (3) using other appropriate information delivery 

22 strategies. 

23 (e) WOMEN LIVING WITH SEVERE PHYSICAL DIS24 ABILITIES.—The Secretary, acting through the Director, 

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


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1 access to pelvic examinations, mammograms, and other 

2 women’s health services for women with severe mobility 

3 impairments with the goal of improving access to such 

4 services. 

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

6 (a) NATIONAL SCREENING GUIDELINES.—The Sec7 retary, acting through the Director, shall work with Fed8 eral, State, and local health entities to ensure that na9 tional screening guidelines for cervical cancer state that 

10 WSW should be subject to the same screening guidelines 

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

12 (b) INFORMATION COLLECTION.—The Secretary, act13 ing through the Director, shall, with respect to the WSW 

14 community— 

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

16 AIDS and other STIs; and 

17 (2) collect information on— 

18 (A) the burdens and behavior of HIV/ 

19 AIDS and STIs; and 

20 (B) other reproductive health concerns. 

21 SEC. 203. TRANSGENDER COMMUNITY. 

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

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

24 local health entities and transgender communities to im25 prove information collection concerning the transmission, 


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

2 in transgender communities. 

3 (b) INFORMATION CLASSIFICATION.—For purposes 

4 of acquiring a comprehensive understanding of the unique 

5 health trends among, and aspects of, the transgender com6 munity, the Secretary shall promulgate regulations requir7 ing that, for purposes of public health studies requiring 

8 data collection, the fact that an individual is transgender 

9 shall be a distinct category and data point. 

10 SEC. 204. REPORT. 

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

12 date of the enactment of this Act, the Secretary shall sub13 mit a report to Congress on the activities required under 

14 this Act. 

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

16 under subsection (a) shall include— 

17 (1) information on the success of voluntary 

18 screening for HIV/AIDS, STIs, and other preventa19 tive methods geared toward Medicaid and Medicare 

20 beneficiaries, patients at Federally qualified health 

21 centers, individuals with health insurance, MSM, 

22 WSW, persons living with disabilities, the 

23 transgender community, and other groups that have 

24 been historically underrepresented in public health 

25 interventions for HIV/AIDS and STIs; and 


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1 (2) recommendations on how to improve exist2 ing measures with respect to race, socioeconomic 

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

4 sexual behavior— 

5 (A) to increase access to screening; and 

6 (B) to decrease the disparities in mortality 

7 and morbidity from STIs. 

Æ 


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