I

104TH CONGRESS

2D SESSION H. R. 3937

To amend title XIX of the Social Security Act with respect to preventing

the transmission of the human immunodeficiency virus (commonly known

as HIV), and for other purposes.

IN THE HOUSE OF REPRESENTATIVES

AUGUST 1, 1996

Mr. COBURN (for himself, Ms. MOLINARI, Mr. DELAY, Mrs. FOWLER, Mr.

WELDON of Florida, Mr. NORWOOD, Mr. HUTCHINSON, Mr. LARGENT,

Mr. SOUDER, Mr. STOCKMAN, Mr. DORNAN, and Mr. HOSTETTLER) introduced the following bill; which was referred to the Committee on Commerce

A BILL

To amend title XIX of the Social Security Act with respect

to preventing the transmission of the human

immunodeficiency virus (commonly known as HIV), 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.

4 This Act may be cited as the ‘‘HIV Prevention Act

5 of 1996’’.

6 SEC. 2. FINDINGS.

7 The Congress finds as follows:
2

•HR 3937 IH

1 (1) The States should recognize that the terms

2 ‘‘acquired immune deficiency syndrome’’ and

3 ‘‘AIDS’’ are obsolete. In the case of individuals who

4 are infected with the human immunodeficiency virus

5 (commonly known as HIV), the more important

6 medical fact for the individuals and for the protec7 tion of the public health is the fact of infection, and

8 not just the later development of AIDS (the stage at

9 which the infection causes symptoms). The term

10 ‘‘HIV disease’’, meaning infection with HIV regard11 less of whether the infection has progressed to

12 AIDS, more correctly defines the medical condition.

13 (2) The medical, public health, political, and

14 community leadership must focus on the full course

15 of HIV disease rather than concentrating on later

16 stages of the disease. Continual focus on AIDS rath17 er than the entire spectrum of HIV disease has left

18 our Nation unable to deal adequately with the epi19 demic. Federal and State data collection efforts

20 should focus on obtaining data as early as possible

21 after infection occurs, while continuing to collect

22 data on the symptomatic stage of the disease.

23 (3) Recent medical breakthroughs may enable

24 doctors to treat HIV disease as a chronic disease

25 rather than as a terminal disease. Early intervention
3

•HR 3937 IH

1 in the progression of the infection is imperative to

2 prolonging and improving the lives of individuals

3 with the disease.

4 (4) The Centers for Disease Control and Pre5 vention has recommended partner notification as a

6 primary prevention service. The health needs of the

7 general public, and the care and protection of those

8 who do not have the disease, should be balanced

9 with the needs of individuals with the disease in a

10 manner that allows for the infected individuals to re11 ceive optimal medical care and for public health

12 services to protect the uninfected.

13 (5) Individuals with HIV disease have an obli14 gation to protect others from being exposed to HIV

15 by avoiding behaviors that place others at risk of be16 coming infected. Each of the States should have in

17 effect laws that provide that the intentional or reck18 less exposure of others to HIV is a felony, even if

19 the infection is not transmitted.

20 SEC. 3. ESTABLISHMENT OF HIV-RELATED REQUIREMENTS

21 IN MEDICAID PROGRAM.

22 (a) IN GENERAL.—Title XIX of the Social Security

23 Act (42 U.S.C. 1396 et seq.) is amended—

24 (1) in section 1902(a)—
4

•HR 3937 IH

1 (A) in paragraph (61), by striking ‘‘and’’

2 after the semicolon at the end;

3 (B) in paragraph (62), by striking the pe4 riod at the end and inserting ‘‘; and’’; and

5 (C) by inserting after paragraph (62) the

6 following paragraph:

7 ‘‘(63) meet the requirements of section 1930A

8 (relating to the prevention of the transmission of the

9 human immunodeficiency virus, commonly known as

10 HIV).’’; and

11 (2) by inserting after section 1930 the following

12 section:

13 ‘‘PREVENTION OF TRANSMISSION OF HIV

14 ‘‘SEC. 1930A. (a) For purposes of section

15 1902(a)(63), a State plan meets the requirements of this

16 subsection if the plan demonstrates to the satisfaction of

17 the Secretary that the law or regulations of the State are

18 in accordance with the following:

19 ‘‘(1) The State requires that, in the case of a

20 health professional or other entity that provides for

21 the performance of a test for HIV on an individual,

22 the entity confidentially report positive test results

23 to the State public health officer, together with any

24 additional necessary information, in order to carry

25 out the following purposes:
5

•HR 3937 IH

1 ‘‘(A) The performance of statistical and

2 epidemiological analyses of the incidence in the

3 State of cases of such disease.

4 ‘‘(B) The performance of statistical and

5 epidemiological analyses of the demographic

6 characteristics of the population of individuals

7 in the State who have the disease.

8 ‘‘(C) The assessment of the adequacy of

9 preventive services in the State with respect to

10 the disease.

11 ‘‘(2)(A) The State requires that the public

12 health officer of the State carry out a program to

13 inform individuals that the individuals may have

14 been exposed to HIV (referred to in this paragraph

15 as ‘partner notification’). For purposes of this para16 graph, the term ‘partner’ includes the sexual part17 ners of individuals with HIV disease, and the part18 ners of such individuals in the sharing of hypo19 dermic needles for the intravenous injection of

20 drugs.

21 ‘‘(B) The State requires that any information

22 collected for purposes of partner notification be suf23 ficient for the following purposes:

24 ‘‘(i) To provide the partners of the in25 dividual with HIV disease with an appro-
6

•HR 3937 IH

1 priate opportunity to learn that the part2 ners have been exposed to HIV.

3 ‘‘(ii) To provide the partners with

4 counseling and testing for HIV disease.

5 ‘‘(iii) To provide the individual who

6 has the disease with information regarding

7 therapeutic measures for preventing and

8 treating the deterioration of the immune

9 system and conditions arising from the dis10 ease, and to provide the individual with

11 other preventive information.

12 ‘‘(iv) With respect to an individual

13 who undergoes testing for HIV disease but

14 does not seek the results of the testing, to

15 recall and provide the individual with coun16 seling, therapeutic information, and other

17 information regarding preventative health

18 services appropriate for the individual.

19 ‘‘(C) The State cooperates with the Director of

20 the Centers for Disease Control and Prevention in

21 carrying out a national program of partner notifica22 tion, including the sharing of information between

23 the public health officers of the States.

24 ‘‘(3) With respect to a defendant against whom

25 an information or indictment is presented for a
7

•HR 3937 IH

1 crime in which by force or threat of force the per2 petrator compels the victim to engage in sexual ac3 tivity, the State requires as follows:

4 ‘‘(A) That the defendant be tested for HIV

5 disease if—

6 ‘‘(i) the nature of the alleged crime is

7 such that the sexual activity would have

8 placed the victim at risk of becoming in9 fected with HIV; or

10 ‘‘(ii) the victim requests that the de11 fendant be so tested.

12 ‘‘(B) That if the conditions specified in

13 subparagraph (A) are met, the defendant un14 dergo the test not later than 48 hours after the

15 date on which the information or indictment is

16 presented, and that as soon thereafter as is

17 practicable the results of the test be made avail18 able to the victim; the defendant (or if the de19 fendant is a minor, to the legal guardian of the

20 defendant); the attorneys of the victim; the at21 torneys of the defendant; the prosecuting attor22 neys; the judge presiding at the trial, if any;

23 and the principal public health official for the

24 local governmental jurisdiction in which the

25 crime is alleged to have occurred.
8

•HR 3937 IH

1 ‘‘(C) That, if the results of the test indi2 cate that the defendant has HIV disease, such

3 fact may, as relevant, be considered in the judi4 cial proceedings conducted with respect to the

5 alleged crime.

6 ‘‘(4)(A) With respect to a patient who is to un7 dergo an invasive medical procedure that would

8 place the health professionals involved at risk of be9 coming infected with HIV, the State—

10 ‘‘(i) authorizes such health professionals to

11 provide that the procedure will not be per12 formed unless the patient undergoes a test for

13 HIV disease and the health professionals are

14 notified of the results of the test; and

15 ‘‘(ii) requires that, if such test is per16 formed and the patient has positive test results,

17 the patient be informed of the results.

18 ‘‘(B) The State authorizes funeral-services

19 practitioners to provide that invasive procedures will

20 not be performed unless the body involved undergoes

21 a test for HIV disease and the practitioners are no22 tified of the results of the test.

23 ‘‘(5) The State requires that, if a health care

24 entity (including a hospital) transfers a body to a fu25 neral-services practitioner and such entity knows
9

•HR 3937 IH

1 that the body is infected with HIV, the entity notify

2 the funeral-services practitioner of such fact.

3 ‘‘(6) The State requires that, if a health profes4 sional knows that the professional has HIV disease,

5 the professional notify a patient of the professional

6 before performing any invasive medical procedure on

7 the patient.

8 ‘‘(b) For purposes of this section, the term ‘HIV’

9 means the human immunodeficiency virus; and the term

10 ‘HIV disease’ means infection with HIV and includes any

11 condition arising from such infection.’’.

12 (b) SENSE OF CONGRESS REGARDING HEALTH PRO13 FESSIONALS WITH HIV DISEASE.—It is the sense of the

14 Congress that, with respect to health professionals who

15 have HIV disease and who perform invasive medical proce16 dures on patients, the medical profession should develop

17 guidelines to assist such professionals in complying with

18 requirements established by the States pursuant to section

19 1930A(a)(6) of the Social Security Act (as added by sub20 section (a) of this section).

21 (c) APPLICABILITY OF REQUIREMENTS.—

22 (1) IN GENERAL.—Except as provided in para23 graph (2), the amendment made by subsection (a)

24 applies upon the expiration of the 120-day period be25 ginning on the date of the enactment of this Act.
10

•HR 3937 IH

1 (2) DELAYED APPLICABILITY FOR CERTAIN

2 STATES.—In the case of the State involved, if the

3 Secretary determines that a requirement established

4 by the amendment made by subsection (a) cannot be

5 implemented in the State without the enactment of

6 State legislation, then such requirement applies to

7 the State on and after the first day of the first cal8 endar quarter that begins after the close of the first

9 regular session of the State legislature that begins

10 after the date of the enactment of this Act. For pur11 poses of the preceding sentence, in the case of a

12 State that has a 2-year legislative session, each year

13 of such session is deemed to be a separate regular

14 session of the State legislature.

15 (c) RULE OF CONSTRUCTION.—Part D of title XXVI

16 of the Public Health Service Act (42 U.S.C. 300ff–71 et

17 seq.) is amended by inserting after section 2675 the fol18 lowing section:

19 ‘‘SEC. 2675A. RULE OF CONSTRUCTION.

20 ‘‘With respect to an entity that is an applicant for

21 or a recipient of financial assistance under this title, com22 pliance by the entity with any State law or regulation that

23 is consistent with section 1930A of the Social Security Act

24 may not be considered to constitute a violation of any con25 dition under this title for the receipt of such assistance.’’.
11

•HR 3937 IH

1 SEC. 4. SENSE OF CONGRESS REGARDING INTENTIONAL

2 TRANSMISSION OF HIV.

3 It is the sense of the Congress that the States should

4 have in effect laws providing that, in the case of individ5 uals who know they have HIV disease, it is a felony for

6 the individuals to engage in any behaviors that the individ7 uals know will place others at risk of infection with the

8 disease, regardless of whether the behaviors actually

9 transmit the infection.

10 SEC. 5. SENSE OF CONGRESS REGARDING CONFIDENTIAL11 ITY.

12 It is the sense of the Congress that strict confidential13 ity should be maintained in carrying out the provisions

14 of section 1930A of the Social Security Act (as added by

15 section 3(a) of this Act).

Æ