102 
(D) LIMITATION OF MATCHING PAYMENTS 
TO 100 PERCENT.—In no case shall an increase 
in Federal matching payments under this sub-
section result in Federal matching payments 
that exceed 100 percent. 
(c) EFFECTIVE DATE.— 
(1) IN GENERAL.—Except as provided in para-
graph (2), the amendments made by subsection (a) 
shall take effect 180 days after the date of the en-
actment of this Act and shall apply to services fur-
nished on or after such date. 
(2) RULE
FOR
CHANGES
REQUIRING
STATE 
LEGISLATION.—In the case of a State plan for med-
ical assistance under title XIX of the Social Security 
Act which the Secretary of Health and Human Serv-
ices determines requires State legislation (other than 
legislation appropriating funds) in order for the plan 
to meet the additional requirement imposed by the 
amendments made by this section, the State plan 
shall not be regarded as failing to comply with the 
requirements of such title solely on the basis of its 
failure to meet this additional requirement before 
the first day of the first calendar quarter beginning 
after the close of the first regular session of the 
State legislature that begins after the date of the en-
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actment of this Act. For purposes of the previous 
sentence, in the case of a State that has a 2-year 
legislative session, each year of such session shall be 
deemed to be a separate regular session of the State 
legislature. 
TITLE 
IV—COORDINATING 
EF-
FORTS TO DRIVE GREATER 
EFFICIENCY AND IMPROVED 
RESULTS 
SEC. 401. SUPPORT DATA SYSTEM REVIEW AND INDICA-
TORS FOR MONITORING HIV CARE. 
The Secretary of Health and Human Services, in col-
laboration with the Assistant Secretary for Health, the Di-
rector of the Office of HIV/AIDS and Infectious Disease 
Policy, the Director of the Centers for Disease Control and 
Prevention, the Administrator of the Substance Abuse and 
Mental Health Services Administration, the Director of 
the Department of Housing and Urban Development, the 
Director of the Office of AIDS Research, the Adminis-
trator of the Health Resources and Services Administra-
tion, and the Administrator of the Centers for Medicare 
& Medicaid Services, shall expand and coordinate efforts 
to align metrics across agencies and modify Federal data 
systems, to— 
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(1) adopt the Institute of Medicine’s clinical 
HIV care indicators as the core metrics for moni-
toring the quality of HIV care, mental health, sub-
stance abuse, and supportive services; 
(2) better enable assessment of the impact of 
the National HIV/AIDS Strategy and the Patient 
Protection and Affordable Care Act on improving 
HIV/AIDS care and access to supportive services for 
individuals with HIV; 
(3) expand the demographic data elements to be 
captured by Federal data systems relevant to HIV 
care to permit calculation of the indicators for sub-
groups of the population of people with diagnosed 
HIV infection, including— 
(A) age; 
(B) race; 
(C) ethnicity; 
(D) sex (assigned at birth); 
(E) gender identity; 
(F) sexual orientation; 
(G) current geographic marker of resi-
dence; 
(H) income or poverty level; and 
(I) primary means of reimbursement for 
medical services (including Medicaid, Medicare, 
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the Ryan White HIV/AIDS Program, private 
insurance, health maintenance organizations, 
and no coverage); and 
(4) streamline data collection and systematically 
review all existing reporting requirements for feder-
ally funded HIV/AIDS programs to ensure that only 
essential data are collected. 
SEC. 402. TRANSFER OF FUNDS FOR IMPLEMENTATION OF 
NATIONAL HIV/AIDS STRATEGY. 
Title II of the Public Health Service Act (42 U.S.C. 
202 et seq.) is amended by inserting after section 241 the 
following: 
‘‘SEC. 241A. TRANSFER OF FUNDS FOR IMPLEMENTATION 
OF NATIONAL HIV/AIDS STRATEGY. 
‘‘(a) TRANSFER AUTHORIZATION.—Of the discre-
tionary appropriations made available to the Department 
of Health and Human Services for any fiscal year for pro-
grams and activities that, as determined by the Secretary 
of Health and Human Services, pertain to HIV/AIDS, the 
Secretary, in coordination with the Director of the Office 
of National HIV/AIDS Policy, may transfer up to 1 per-
cent of such appropriations to the Office of the Assistant 
Secretary for Health for implementation of the National 
HIV/AIDS Strategy. 
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‘‘(b) CONGRESSIONAL NOTIFICATION.—Not less than 
30 days before making any transfer under this section, 
the Secretary shall give notice of the transfer to the Con-
gress. 
‘‘(c) DEFINITIONS.—In this section: 
‘‘(1) The term ‘HIV/AIDS’ has the meaning 
given to such term in section 2689. 
‘‘(2) The term ‘National HIV/AIDS Strategy’ 
means the National HIV/AIDS Strategy for the 
United States issued by the President in July 2010 
and includes any subsequent revisions to such Strat-
egy.’’. 
SEC. 403. HIV INTEGRATED SERVICES DELIVERY MODEL 
DEMONSTRATION. 
(a) IN GENERAL.—Consistent with the National 
HIV/AIDS Strategy for the United States and in accord-
ance with this section, the Secretary of Health and 
Human Services acting through the Center for Medicare 
& Medicaid Innovation and in cooperation with CDC, 
HRSA, SAMHSA, and HUD, shall conduct a 3-year dem-
onstration project that is designed to integrate services 
and funding under the Medicare and Medicaid programs, 
under HIV-related programs conducted by the CDC, and 
under the Ryan White HIV/AIDS Program, to reduce new 
HIV infections, to increase the proportion of people who 
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know their status, to increase access to care, to improve 
health outcomes, to reduce HIV-related health disparities 
among Medicaid and Medicare beneficiaries, and to reduce 
the cost of care provided to HIV positive Medicare and 
Medicaid beneficiaries. 
(b) OBJECTIVES.—The objectives of the demonstra-
tion are the following: 
(1) To ensure the early identification of HIV 
positive beneficiaries to reduce costly HIV-related 
clinical conditions through HIV screening and rapid 
linkage to high quality HIV medical care. 
(2) To reduce new HIV infections among Med-
icaid and Medicare beneficiaries through routine 
HIV testing, prevention services for HIV negative 
beneficiaries, and intensive ‘‘prevention for positive’’ 
services for HIV positive beneficiaries. 
(3) To reduce morbidity, mortality, and high 
cost inpatient and specialty care among HIV positive 
beneficiaries by ensuring access to high quality HIV 
medical care, HIV medications, and support services. 
(4) To promote HIV treatment adherence and 
retention in care through intensive case manage-
ment, treatment education, and outreach services. 
(5) To effectively treat behavioral health condi-
tions among HIV positive beneficiaries that impair 
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their HIV treatment adherence and lead to sec-
ondary HIV infections through services funded 
under Medicare and Medicaid and programs admin-
istered by SAMHSA. 
(6) To promote independence, treatment adher-
ence, and stable housing for HIV positive bene-
ficiaries through highly coordinated HIV health, 
housing, and support services funded by HRSA and 
HUD. 
(c) DEMONSTRATION DESIGN.— 
(1) IN GENERAL.—The Secretary shall design 
the demonstration to test both— 
(A) the service delivery model described in 
paragraph (2); and 
(B) the payment model described in para-
graph (3). 
(2) SERVICE DELIVERY MODEL.— 
(A) IN GENERAL.—Under the service deliv-
ery model described in this paragraph, the dem-
onstration shall test comprehensive HIV test-
ing, linkage to care, HIV medical care, and an-
cillary services to individuals enrolled under 
Medicare, Medicaid, or both. The service deliv-
ery model will integrate services furnished 
under Medicare and Medicaid with prevention 
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109 
services funded by CDC for HIV positive bene-
ficiaries, intensive case management services 
funded by HRSA, behavioral services funded by 
SAMHSA, and housing assistance services 
funded through HUD. 
(B) CORE ELEMENTS.—The model under 
this paragraph shall have the following 8 core 
elements: 
(i) HIV testing services that apply the 
CDC’s 2006 recommendations for uni-
versal opt-out testing among Medicare and 
Medicaid beneficiary populations. 
(ii) Rapid linkage from HIV testing 
settings to treatment for HIV positive 
beneficiaries to ensure they are engaged in 
care in a timely basis. 
(iii) Access to high quality HIV expe-
rienced medical care, laboratory moni-
toring, HIV medications, and other re-
quired services. 
(iv) Routine screening and treatment 
for HIV-related and other chronic condi-
tions, including behavioral health. 
(v) Prevention and treatment edu-
cation services, including an adapted Medi-
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cation Therapy Management (MTM) pro-
gram model, to optimize the benefit of 
HIV therapeutics. 
(vi) Risk-stratified medical case man-
agement. 
(vii) Provision of preventive care, in-
cluding counseling to prevent secondary 
HIV infection. 
(viii) Wrap-around support and hous-
ing services. 
(3) PAYMENT
MODEL.—Under the payment 
model described in this paragraph, the demonstra-
tion shall test the following: 
(A) A prepaid capitated payment model 
that adjusts payment for HIV and behavioral 
health acuity, to be applied under contracts 
with managed care organizations with dem-
onstrated HIV experience. 
(B) Use of funds under the Ryan White 
HIV/AIDS Program to purchase capitated serv-
ices from the contracted managed care organi-
zations. 
(C) Provision of additional funds to sup-
port services to the extent that Medicaid and 
Medicare coverage is limited, including for serv-
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111 
ices such as HIV testing (for Medicaid bene-
ficiaries), medical case management, prevention 
case management, treatment education, case 
finding, behavioral health services, and housing 
assistance. 
(d) BENEFICIARY CRITERIA.—Beneficiaries eligible 
for participation in the demonstration are the following: 
(1) MEDICAID
FFS
BENEFICIARIES.—Fee-for- 
service Medicaid beneficiaries 18 years of age or 
older. 
(2) DUAL ELIGIBLES.—Individuals who are— 
(A) entitled to medical assistance under 
Medicaid; and 
(B) entitled to benefits under part A, and 
enrolled under part B, of Medicare but are not 
enrolled under a Medicare Advantage plan 
under Medicare. 
(e) ROLES AND RESPONSIBILITIES IN DEMONSTRA-
TION.— 
(1) IN GENERAL.—Consistent with the National 
HIV/AIDS Strategy for the United States, Federal 
agencies shall coordinate their funding for the se-
lected States or cities covered under the demonstra-
tion to provide resources to fund the delivery of serv-
ices within the demonstration. 
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(2) HHS.—In carrying out the demonstration, 
the Secretary shall— 
(A) design the application process; 
(B) solicit applications from 5 to 7 State 
Medicaid agencies to host the demonstration; 
(C) with respect to the service delivery 
model described in subsection (c)(2), collaborate 
with the CDC, HRSA, and the National Insti-
tutes of Health to design a minimum service de-
livery model that reflects the current standard 
of care as established by the Public Health 
Service and CDC guidelines and recommenda-
tions; and 
(D) fund an evaluation of the demonstra-
tion to ensure collection of system, provider, 
and beneficiary-level data to address their rou-
tine reporting requirements. 
The Secretary may carry out the Secretary’s author-
ity under this paragraph through CMMI. 
(3) CDC.—The CDC shall collaborate with the 
Secretary and CDC-funded HIV prevention grantees 
in the selected States and cities to provide technical 
assistance to design cost-effective HIV and sexually 
transmitted infection (STI) screening and testing 
services for Medicaid and Medicare beneficiaries, in-
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113 
cluding partner notification services and commu-
nicable disease reporting. CDC and CMS shall deter-
mine the extent to which testing funds shall be sup-
ported jointly or separately by these agencies. 
(4) HRSA.—HRSA shall allocate funds avail-
able through the Special Projects of National Sig-
nificance (SPNS) Initiative Program (under subpart 
I of part F of the Ryan White HIV/AIDS Program) 
to support wrap-around core and support services 
not covered under Medicare or Medicaid and shall 
authorize the use of Ryan White HIV/AIDS Pro-
gram funds to purchase services through capitated 
managed care programs that meet or exceed the 
services covered by the Ryan White HIV/AIDS Pro-
gram at rates that are no greater than current per 
capita expenditures. HRSA is authorized to use 
funds under SPNS, and to waive such requirements 
of SPNS as may be necessary, to carry out the dem-
onstration. 
(5) SAMHSA.—SAMHSA shall allocate funds 
through the Minority HIV/AIDS Initiative or other 
programs to support behavioral health services not 
covered under Medicare or Medicaid. 
(6) HOPWA.—HUD shall directly allocate 
funds under the Housing Opportunities for People 
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With AIDS (HOPWA) program to the States or cit-
ies participating in the demonstration to provide 
supportive housing and other housing assistance to 
beneficiaries who otherwise meet HOPWA eligibility 
criteria. HUD is authorized to use such HOPWA 
funds, and to waive such requirements under 
HOPWA as may be necessary, to carry out the dem-
onstration. 
(7) STATE MEDICAID AGENCIES.—Single State 
agencies responsible for administration of the Med-
icaid program for individuals who are accepted to 
participate in the demonstration shall— 
(A) collaborate with CMS to design or re-
fine a prepaid capitated payment model, to allo-
cate and award contracts with capitated man-
aged care plans, to ensure such plans meet 
State statutory or regulatory requirements, to 
contract with a coordinating agency to organize 
and deliver integrated HIV testing, medical 
care, support, and housing services funded 
under Medicare and Medicaid, other Federal, 
State, and local government sponsors, and to 
coordinate their activities with the State HIV/ 
AIDS program; and 
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(B) identify and contract with a coordi-
nating agency to organize the demonstration in 
the State, to establish a coordinating body rep-
resenting State, local, and provider agencies 
participating in the demonstration, to establish 
systems of care that integrate HIV prevention, 
testing, treatment, support, and housing serv-
ices, to establish mechanisms to gather evalua-
tion data for reporting to CMMI and other par-
ticipating Federal agencies, and to establish a 
quality management program to monitor pro-
vider performance in delivering the services pro-
vided to participating beneficiaries under the 
demonstration. 
(8) 
MANAGED
CARE
ORGANIZATIONS.— 
Capitated managed care organizations participating 
in the demonstration shall organize and deliver serv-
ices as specified by the minimum service delivery 
model established by CMMI through a network of 
providers with demonstrated HIV experience, high 
quality, and sufficient provider capacity. 
(f) DEFINITIONS.—In this section: 
(1) CDC.—The term ‘‘CDC’’ means the Direc-
tor of the Centers for Disease Control and Preven-
tion. 
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(2) CMMI.—The term ‘‘CMMI’’ means the Di-
rector of the Center for Medicare and Medicaid In-
novation. 
(3) CMS.—The term ‘‘CMS’’ means the Ad-
ministrator of the Centers for Medicare & Medicaid 
Services. 
(4) DEMONSTRATION.—The term ‘‘demonstra-
tion’’ means the demonstration conducted under this 
section. 
(5) HRSA.—The term ‘‘HRSA’’ means the Ad-
ministrator of the Health Resources and Services 
Administration. 
(6) HUD.—The term ‘‘HUD’’ means the Sec-
retary of Housing and Urban Development. 
(7) MEDICARE; MEDICAID.—The terms ‘‘Medi-
care’’ and ‘‘Medicaid’’ mean the programs under ti-
tles XVIII and XIX, respectively, of the Social Secu-
rity Act. 
(8) NATIONAL
HIV/AIDS
STRATEGY
FOR
THE 
UNITED STATES.—The term ‘‘National HIV/AIDS 
Strategy for the United States’’ has the meaning 
given such term under section 241A(b) of the Public 
Health Service Act. 
(9) RYAN
WHITE
HIV/AIDS
PROGRAM.—The 
term ‘‘Ryan White HIV/AIDS Program’’ means the 
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program under title XXVI of the Public Health 
Service Act. 
(10) SAMHSA.—The term ‘‘SAMHSA’’ means 
the Substance Abuse and Mental Health Services 
Administration. 
(11) 
SECRETARY.—The 
term 
‘‘Secretary’’ 
means the Secretary of Health and Human Services, 
acting through CMMI. 
SEC. 404. REPORT ON THE IMPLEMENTATION OF THE NA-
TIONAL HIV/AIDS STRATEGY. 
(a) REPORT REQUIRED.—The President, in consulta-
tion with the heads of all relevant agencies including the 
Department of Education, the Department of Health and 
Human Services, the Department of Housing and Urban 
Development, the Department of Justice, the Department 
of Labor, the Department of Veterans Affairs, and the So-
cial Security Administration, shall enter an arrangement 
not later than 6 months after the date of the enactment 
of this Act with the Institute of Medicine of the National 
Academies (or, if the Institute declines to enter into such 
an arrangement, another appropriate entity)— 
(1) to prepare a report on the status of the im-
plementation of the National HIV/AIDS Strategy; 
and 
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(2) to transmit such report to the Congress and 
make publicly available a report. 
(b) CONTENTS.—The report required by subsection 
(a) shall include a description, analysis, and evaluation 
of— 
(1) key steps taken by the Federal Government 
toward the achievement of the goals of the National 
HIV/AIDS Strategy, including the goals of— 
(A) reducing the number of people who be-
come infected with HIV; 
(B) increasing access to care and opti-
mizing health outcomes for people living with 
HIV; and 
(C) reducing HIV-related health dispari-
ties; 
(2) the extent to which the National HIV/AIDS 
Strategy has improved coordination of efforts to 
maximize the effective delivery of HIV/AIDS preven-
tion, care, and treatment services at the community 
level, including coordination— 
(A) within and among Federal agencies 
and departments; 
(B) between the Federal Government and 
State and local governments and health depart-
ments; 
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(C) between the Federal Government and 
nonprofit foundations and civil society organiza-
tions, including community- and faith-based or-
ganizations focused on addressing the issue of 
HIV/AIDS; and 
(D) between the Federal Government and 
private businesses; 
(3) efforts by the Federal Government to edu-
cate, involve, and establish and strengthen partner-
ships with civil society organizations, including 
community- and faith-based organizations, in order 
to implement the National HIV/AIDS Strategy and 
achieve its goals; 
(4) how Federal resources are being deployed to 
implement the Strategy, including— 
(A) the amount of funding used to date, by 
each Federal agency and department, to imple-
ment the National HIV/AIDS Strategy; 
(B) a brief summary for each Federal 
agency and department of the number and 
function of all Federal employees assisting in 
implementing the Strategy; and 
(C) an estimate of the amount of funding 
necessary to implement the National HIV/AIDS 
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Strategy, by each Federal agency and depart-
ment, for the next fiscal year; and 
(5) what additional steps, if any, are necessary 
to fully implement the National HIV/AIDS Strategy, 
including— 
(A) whether any existing statutory laws, 
policies, or regulations are impeding the imple-
mentation of the National HIV/AIDS Strategy, 
at the Federal, State, or local level, and wheth-
er any changes to such laws, policies, or regula-
tions are necessary or recommended; and 
(B) whether any Federal agencies or de-
partments require additional statutory authority 
to effectively carry out their duties as part of 
the National HIV/AIDS Strategy. 
(c) USE OF PREVIOUSLY APPROPRIATED FUNDS.— 
Funding for the report required under subsection (a) shall 
be derived from discretionary funds of the departments 
and agencies specified in such subsection. 
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DIVISION B—ENDING HIV/AIDS 
GLOBALLY 
TITLE X—GLOBAL HIV/AIDS- 
FREE GENERATION STRATEGY 
SEC. 1001. GLOBAL HIV/AIDS-FREE GENERATION STRAT-
EGY. 
(a) STRATEGY.—The President, acting through the 
Coordinator of United States Government Activities to 
Combat HIV/AIDS Globally, shall establish a comprehen-
sive, integrated, 5-year strategy to expand and improve 
efforts to combat global HIV/AIDS, while promoting effi-
ciency and maximizing results. The strategy shall be re-
ferred to as the ‘‘Global HIV/AIDS-Free Generation 
Strategy’’. 
(b) CONTENTS.—The strategy shall— 
(1) accelerate progress toward achieving the 
United States goal of an AIDS-free generation; 
(2) establish a limited number of measurable 
targets to accelerate reductions in HIV incidence 
and HIV/AIDS-related morbidity and mortality; 
(3) strengthen existing and future compacts 
and framework agreements authorized under section 
104A(d)(8) of the Foreign Assistance Act of 1961 
(22 U.S.C. 2151b–2(d)(8)); 
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(4) strengthen engagement with diplomatic ef-
forts at all levels of government to— 
(A) continue to identify and promote link-
ages between efforts to combat HIV/AIDS and 
other health development issues and human 
rights issues; 
(B) encourage and assist national govern-
ments to pursue policies and legal frameworks 
that facilitate and enable effective responses to 
HIV prevention, care, and treatment services; 
and 
(C) increase financial accountability; 
(5) provide a plan to— 
(A) support early diagnosis and initiation 
of HIV treatment to achieve accelerated reduc-
tions of incidence and morbidity; 
(B) eliminate vertical transmission of HIV 
from mother to child and support early diag-
nosis and initiation of HIV treatment in infants 
and children; 
(C) intensify efforts to expand access to 
voluntarily medical male circumcision, male and 
female condoms and other proven-effective HIV 
prevention interventions, in combination with 
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other evidence-based modalities and structural 
interventions; 
(D) reduce the risk of HIV infection and 
address the HIV-related needs of sex workers, 
men who have sex with men, transgender peo-
ple, and people who inject drugs; 
(E) increase gender equity in HIV/AIDS 
programs and services, including access to vol-
untary family planning and reproductive health 
services and reducing violence and coercion; 
(F) expand partnership with implementers, 
researchers, and academic organizations to im-
prove the science that guides the global re-
sponse to HIV/AIDS; 
(G) provide capacity development support 
to increase meaningful engagement of civil soci-
ety, especially local indigenous organizations, 
that work in the areas of human rights, wom-
en’s and young people’s health and rights, and 
gay, lesbian, bisexual, and transgender rights, 
in the development, implementation, moni-
toring, and evaluation of United States-funded 
programs; 
(H) advance the efforts of developing coun-
tries to develop health systems capable of man-
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aging their epidemics, respond to broader 
health needs impacting affected communities, 
and address new and emerging health concerns; 
and 
(I) defend, protect, and fulfill the human 
rights of people living with HIV and those most 
at risk of HIV infection. 
(c) CONSULTATION.—In developing the strategy, the 
President, acting through the Coordinator of United 
States Government Activities to Combat HIV/AIDS Glob-
ally, shall consult with— 
(1) each executive branch agency administering 
United States foreign assistance related to— 
(A) improving global health; 
(B) strengthening financial management 
systems; and 
(C) monitoring and promoting human 
rights and democracy; 
(2) personnel at United States embassies and 
country missions involved in the administration of 
the types of United States foreign assistance de-
scribed in paragraph (1); 
(3) the appropriate congressional committees 
with jurisdiction over the agencies described in para-
graph (1); 
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125 
(4) civil society and nongovernmental organiza-
tions engaged in improving health care and health 
outcomes in developing countries, including indige-
nous community and faith-based organizations; 
(5) international organizations engaged in im-
proving health care and health outcomes in devel-
oping countries and of which the United States is a 
voting member, with which the United States coordi-
nates the delivery of foreign assistance, or to which 
the United States contributes funding for the pur-
pose of providing such assistance; 
(6) academic organizations, private foundations, 
businesses, and other organizations engaged in im-
proving health care and health outcomes in devel-
oping countries and not receiving United States 
funding for such purposes; 
(7) other donor nations engaged in improving 
health care and health outcomes in developing coun-
tries; 
(8) countries receiving health-related United 
States foreign assistance; and 
(9) any other global, regional, or subregional 
organizations or partnerships engaged in improving 
health care and health outcomes in developing coun-
tries. 
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(d) REPORT.—Not later than 1 year after the date 
of the enactment of this Act, the President shall submit 
to Congress a report that sets forth the strategy described 
in this section. 
TITLE XI—USING FUNDS STRA-
TEGICALLY TO MAXIMIZE RE-
SULTS 
SEC. 1101. SUPPORT FOR OPERATIONS RESEARCH TO IM-
PROVE PROGRAM DELIVERY, EFFICIENCY, 
IMPACT, AND EFFECTIVENESS. 
(a) SENSE OF CONGRESS.—It is the sense of the Con-
gress that there is a need and urgency to expand the range 
of interventions for preventing the transmission of HIV, 
including behavioral prevention research, operations re-
search to optimize combination HIV prevention, and re-
search on medical technology to prevent HIV infection, in-
cluding microbicides, cost-effective female condoms, Pre- 
Exposure Prophylaxis (PrEP), multipurpose technologies 
for the prevention of HIV and unintended pregnancy, and 
vaccines. 
(b) STATEMENT OF POLICY.—It should be the policy 
of the United States to ensure that efforts to combat HIV/ 
AIDS globally should expand, intensify, and coordinate 
operations research to improve the quality, delivery, and 
impact of programming, including with respect to— 
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(1) services appropriate for men who have sex 
with men, transgender people, people who inject 
drugs, and sex workers; 
(2) structural interventions to remove barriers 
that inhibit effective implementation of HIV/AIDS- 
related foreign assistance, including the analysis of 
laws and policies that have a negative health impact 
and put individuals at increased risk of HIV infec-
tion; 
(3) scalable combination of prevention and 
treatment approaches to HIV/AIDS; 
(4) 
prevention 
and 
management 
of 
co- 
morbidities such as tuberculosis, malaria, and viral 
hepatitis; and 
(5) identification and follow up of HIV-positive 
infants and children in resource-limited settings to 
increase the proportion of children accessing HIV 
treatment and care services. 
SEC. 1102. INCREASING COORDINATION AND INTEGRATION 
OF HIV/AIDS PROGRAMS WITH DEVELOP-
MENT PROGRAMS. 
(a) STATEMENT OF POLICY.—It should be the policy 
of the United States to ensure that efforts to combat HIV/ 
AIDS globally should maximize efficiencies and the inte-
gration of services and programs to achieve reduction in 
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HIV transmission rates and the burden of HIV-related 
morbidity and mortality, by means that include— 
(1) ensuring that women and adolescent girls 
with HIV or who are at risk of HIV infection and 
who do not wish to become pregnant have access to 
voluntary contraceptive services, including a range of 
contraceptive options, and voluntary counseling to 
plan families, either directly or through meaningful 
referrals to existing United States Agency for Inter-
national Development or local family planning pro-
grams that provide counseling and a range of con-
traceptive options; 
(2) integrating tuberculosis interventions with 
HIV services, including case-finding and tuberculosis 
treatment, expanding tuberculosis preventive ther-
apy, and reducing other opportunistic infections that 
accompany HIV/AIDS; 
(3) ensuring young people with HIV are pro-
vided with confidential and affordable access to 
youth-friendly comprehensive sexual and reproduc-
tive health services and supplies, including male and 
female condoms for the prevention of pregnancy and 
sexually transmitted diseases, as relevant; and 
(4) working to promote and protect the human 
rights of people living with HIV, including men who 
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have sex with men, transgender people, people who 
inject drugs, sex workers, and other vulnerable popu-
lations, including indigenous people, migrants, inter-
nally displaced people, young people, incarcerated 
populations, and people with disabilities. 
(b) REPORT.—Not later than 180 days after the date 
of the enactment of this Act, the Secretary of State shall 
submit to the appropriate congressional committees a re-
port describing the utilization of efficiencies in the delivery 
of HIV/AIDS treatment services within and between 
United States-funded bilateral and multilateral programs 
and partner countries, including to the extent that such 
gains in efficiencies are being exhausted. 
SEC. 1103. INCREASING PROGRAM EFFECTIVENESS AND 
SUSTAINABILITY TO ACHIEVE SUCCESSFUL 
COUNTRY OWNERSHIP. 
(a) STATEMENT OF POLICY.—It should be the policy 
of the United States to ensure that efforts to combat HIV/ 
AIDS globally should help developing countries signifi-
cantly decrease the burden of HIV, strengthen and im-
prove their health systems, help build country ownership, 
and increase financial accountability to ensure sustain-
ability and equitable access to health services, including 
by— 
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(1) 
assisting 
developing 
countries 
create, 
strengthen, and implement their own evidence-based 
national HIV/AIDS strategies, by means that in-
clude— 
(A) supporting early diagnosis and initi-
ation of HIV and tuberculosis treatment to 
achieve accelerated reductions of incidence and 
morbidity; 
(B) eliminating the vertical transmission of 
HIV from mother to child and supporting early 
diagnosis and initiation of HIV treatment in in-
fants and children; 
(C) intensifying efforts to expand access to 
voluntary medical male circumcision, male and 
female condoms, harm reduction services, and 
other proven-effective HIV prevention interven-
tions, in combination with other evidence-based 
modalities, including structural interventions; 
(D) intensifying efforts to eliminate HIV 
infections among populations that are often at 
greatest risk, including sex workers, men who 
have sex with men, and people who inject 
drugs, and addressing the HIV-related needs, 
including access to ART, of those already in-
fected; 
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(E) ensuring young people are provided 
with comprehensive knowledge, skill-building 
programs, in and out of school, to make in-
formed and responsible decisions for their sex-
ual health, and are provided with confidential 
and affordable access to youth-friendly com-
prehensive sexual and reproductive health serv-
ices and supplies, including male and female 
condoms; 
(F) ensuring women with HIV or who are 
at risk of HIV infection and who do not wish 
to become pregnant have access to voluntary 
contraceptive services and commodities, and 
women who desire pregnancy have access to 
family planning counseling and maternal health 
services free of judgment and discrimination; 
and 
(G) encouraging policy changes to elimi-
nate discriminatory and stigmatizing polices 
that stand in the way of access to health serv-
ices by marginalized and poor populations in-
cluding punitive laws against HIV exposure and 
potential transmission, sex work, same-sex be-
havior, drug use, and gender expression; 
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(2) supporting meaningful community involve-
ment and participation, inclusive of poor, vulnerable, 
or marginalized populations and their representative 
indigenous and civil society organizations, in deci-
sionmaking related to national HIV/AIDS strategies 
and the delivery of health services, including in deci-
sions related to the adoption of health policies and 
the total amount and distribution of health funding; 
(3) assisting countries to coordinate, regulate, 
and harmonize the delivery of health services pro-
vided by the United States and nongovernmental or-
ganizations, including community and faith-based 
organizations, private foundations, international or-
ganizations, and other donors, and to coordinate or 
integrate such services with the health system to the 
maximum extent practicable; 
(4) using, to the maximum extent practicable, 
local and regional entities for the provision of tech-
nical assistance, and where the capacity of such enti-
ties is insufficient, supporting capacity building to 
enable such entities to provide such assistance; 
(5) strengthening procurement and supply 
chain logistics to help prevent drug and commodity 
stock outs, including male and female condom short-
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ages, and to help ensure the eventual provision of 
microbicides for HIV prevention; and 
(6) providing technical assistance and support 
to national ministries of health, or their equivalents, 
and other relevant ministries in overseeing the 
health systems of their countries and monitoring and 
evaluating the effectiveness of such systems in re-
ducing mortality and improving health outcomes, in-
cluding preparing for the provision of HIV/AIDS, 
voluntary family planning, non-communicable dis-
eases, and reproductive health services in emergency 
situations. 
(b) REPORT.—Not later than 180 days after the date 
of the enactment of this Act, the Secretary of State shall 
submit to the appropriate congressional committees a re-
port identifying benchmarks that are directly relevant to 
significantly decreasing the burden of the epidemic in each 
country receiving HIV-related foreign assistance and pro-
vide context for helping countries and civil society to build 
country ownership. 
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134 
TITLE XII—ADDRESSING LEGAL 
AND POLICY BARRIERS TO 
ACCESSING HEALTH CARE 
Subtitle A—General Provisions 
SEC. 1201. SUPPORT FOR LAWS AND REGULATIONS THAT 
IMPROVE HEALTH OUTCOMES AND PROMOTE 
HUMAN RIGHTS. 
It should be the policy of the United States to ensure 
that United States foreign assistance should encourage 
and assist national governments of developing countries 
to pursue policies and legal frameworks that improve 
health outcomes, including policies and legal frameworks 
that— 
(1) are medically accurate and evidence-based 
and adhere to the latest global public health stand-
ards for prevention, treatment, and care; 
(2) promote and improve the status of women 
and youth, ensuring their ability to access and use 
health services without fear or risk of gender-based 
violence, reprisal, discrimination, stigmatization, ar-
rest, or other mistreatment; 
(3) work to remove criminalization of, stig-
matization of, and discrimination against poor, vul-
nerable, or marginalized populations and enact laws 
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and policies to promote and protect the rights of 
such populations; 
(4) avoid, to the maximum extent possible, reli-
ance on criminal laws and sanctions to address 
health issues; 
(5) incorporate relevant policy guidance that 
addresses structural barriers to accessing health 
care; and 
(6) prioritize the creation of a legal, political, 
and social environment that enables access to health 
services by all members of the population. 
SEC. 1202. INTENSIFYING EFFORTS TO ESTABLISH EFFEC-
TIVE PROGRAMS FOR ENGAGING KEY AF-
FECTED POPULATIONS. 
It should be the policy of the United States to ensure 
that efforts to combat HIV/AIDS globally should intensify 
efforts to establish effective programs for engaging men 
who have sex with men, transgender people, people who 
inject drugs, and sex workers in HIV prevention, care, and 
treatment initiatives, by means that include— 
(1) ensuring those eligible for treatment receive 
antiretroviral treatment; 
(2) providing sterile syringes, education, and 
outreach and treatment for drug dependence for in-
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