698 
such form satisfies the requirements estab-
lished under such subparagraph, with such 
process to include establishment and oper-
ation of a 24-hour, toll-free telephone num-
ber and email address to provide for expe-
dited communication. 
‘‘(ii) FAILURE
TO
RESPOND.—If an 
individual or the referring health care pro-
vider does not receive a response or re-
quest for additional information from the 
State agency following the 48-hour period 
described in clause (i), the information 
provided in the form may be presumed to 
satisfy the requirements established under 
this paragraph. 
‘‘(b) ENCOURAGEMENT OF PARTICIPATION IN AP-
PROVED CLINICAL TRIALS.— 
‘‘(1) REASONABLY
ACCESSIBLE
PROVIDER.— 
For purposes of participation in an approved clinical 
trial by an individual eligible for medical assistance 
under this title, the State agency administering the 
State plan shall make reasonable efforts to ensure 
that the individual is provided with access to a pro-
vider who is— 
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‘‘(A) participating in the approved clinical 
trial; 
‘‘(B) located not more than 25 miles from 
the residence of the individual (or, if no such 
provider is available, as close as possible to the 
residence of the individual); and 
‘‘(C) a participating provider under the 
State plan or has been deemed to be a partici-
pating provider under the State plan for pur-
poses of providing medical assistance to the in-
dividual during their participation in the ap-
proved clinical trial. 
‘‘(2) INFORMATIONAL MATERIALS.—The State 
agency administering the plan approved under this 
title shall develop informational materials and pro-
grams to encourage participating providers to make 
appropriate referrals to physicians and other appro-
priate health care professionals who can provide in-
dividuals with access to approved clinical trials. 
‘‘(c) DEFINITION OF APPROVED CLINICAL TRIAL.— 
The term ‘approved clinical trial’ has the same meaning 
as provided under subsection (d) of the section 2709 of 
the Public Health Service Act that relates to coverage for 
individuals participating in approved clinical trials.’’. 
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(b) CONFORMING AMENDMENT.—Section 1902(a) of 
the Social Security Act (42 U.S.C. 1396a(a)), as amended 
by section 734(c), is amended— 
(1) by striking ‘‘and’’ at the end of paragraph 
(86); 
(2) by striking the period at the end of para-
graph (87) and inserting ‘‘; and’’; and 
(3) by inserting after paragraph (87) the fol-
lowing new paragraph: 
‘‘(88) provide that participation in an approved 
clinical trial and coverage of routine patient costs 
associated with such trial for an individual eligible 
for medical assistance under this title is conducted 
in accordance with the requirements under section 
1944.’’. 
(c) EFFECTIVE DATE.— 
(1) IN GENERAL.—Except as provided in para-
graph (2), the amendments made by this section 
shall apply to calendar quarters beginning on or 
after October 1, 2020. 
(2) DELAY
PERMITTED
FOR
STATE
PLAN 
AMENDMENT.—In the case of a State plan for med-
ical assistance under title XIX of the Social Security 
Act (42 U.S.C. 1396 et seq.) which the Secretary of 
Health and Human Services determines requires 
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State legislation (other than legislation appro-
priating funds) in order for the plan to meet the ad-
ditional requirements imposed by the amendments 
made by this section, the State plan shall not be re-
garded as failing to comply with the requirements of 
such title solely on the basis of its failure to meet 
these additional requirements 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 enactment 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 sepa-
rate regular session of the State legislature. 
SEC. 737. GUIDE ON EVIDENCE-BASED STRATEGIES FOR 
PUBLIC HEALTH DEPARTMENT OBESITY PRE-
VENTION PROGRAMS. 
(a) DEVELOPMENT AND DISSEMINATION OF AN EVI-
DENCE-BASED STRATEGIES GUIDE.—The Secretary of 
Health and Human Services (referred to in this section 
as the ‘‘Secretary’’), acting through the Director of the 
Centers for Disease Control and Prevention, not later than 
2 years after the date of enactment of this Act, shall— 
(1) develop a guide on evidence-based strategies 
for State, territorial, and local health departments to 
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use to build and maintain effective obesity preven-
tion and reduction programs, and, in consultation 
with stakeholders that have expertise in Tribal 
health, a guide on such evidence-based strategies 
with respect to Indian Tribes and Tribal organiza-
tions for such Indian Tribes and Tribal organiza-
tions to use for such purpose, both of which guides 
shall— 
(A) describe an integrated program struc-
ture for implementing interventions proven to 
be effective in preventing and reducing the inci-
dence of obesity; and 
(B) recommend— 
(i) optimal resources, including staff-
ing and infrastructure, for promoting nu-
trition and obesity prevention and reduc-
tion; and 
(ii) strategies for effective obesity pre-
vention programs for State and local 
health departments, Indian Tribes, and 
Tribal organizations, including strategies 
related to— 
(I) the application of evidence- 
based and evidence-informed practices 
to prevent and reduce obesity rates; 
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(II) the development, implemen-
tation, and evaluation of obesity pre-
vention and reduction strategies for 
specific communities and populations; 
(III) demonstrated knowledge of 
obesity prevention practices that re-
duce associated preventable diseases, 
health conditions, death, and health 
care costs; 
(IV) best practices for the coordi-
nation of efforts to prevent and re-
duce obesity and related chronic dis-
eases; 
(V) addressing the underlying 
risk factors and social determinants of 
health that impact obesity rates; and 
(VI) interdisciplinary coordina-
tion between relevant public health of-
ficials specializing in fields such as 
nutrition, physical activity, epidemi-
ology, communications, and policy im-
plementation, and collaboration be-
tween public health officials and com-
munity-based organizations; and 
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(2) disseminate the guides and current re-
search, evidence-based practices, tools, and edu-
cational materials related to obesity prevention, con-
sistent with the guide, to State and local health de-
partments, Indian Tribes, and Tribal organizations. 
(b) TECHNICAL ASSISTANCE.—The Secretary, acting 
through the Director of the Centers for Disease Control 
and Prevention, shall provide technical assistance to State 
and local health departments, Indian Tribes, and Tribal 
organizations to support such health departments in im-
plementing the guide developed under subsection (a)(1). 
(c) INDIAN TRIBES; TRIBAL ORGANIZATIONS.—In 
this section, the terms ‘‘Indian Tribe’’ and ‘‘Tribal organi-
zation’’ have the meanings given the terms ‘‘Indian tribe’’ 
and ‘‘tribal organization’’, respectively, in section 4 of the 
Indian Self-Determination and Education Assistance Act 
(25 U.S.C. 5304). 
Subtitle E—HIV/AIDS 
SEC. 741. STATEMENT OF POLICY. 
It is the policy of the United States to achieve an 
AIDS-free generation, and to— 
(1) expand access to lifesaving antiretroviral 
therapy for people living with HIV and immediately 
link people to continuous and coordinated high-qual-
ity care when they learn they are living with HIV; 
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(2) expand targeted efforts to prevent HIV in-
fection using a combination of effective, evidence- 
based approaches, including routine HIV screening, 
and universal access to HIV prevention tools in com-
munities disproportionately impacted by HIV, par-
ticularly communities of color; 
(3) ensure laws, policies, and regulations do not 
impede access to prevention, treatment, and care for 
people living with HIV or disproportionately im-
pacted by HIV; 
(4) accelerate research for more efficacious HIV 
prevention and treatments tools, a cure, and a vac-
cine; and 
(5) respect the human rights and dignity of 
persons living with HIV. 
SEC. 742. FINDINGS. 
The Congress finds the following: 
(1) Over 1,100,000 people are estimated to be 
living with HIV in the United States according to 
the Centers for Disease Control and Prevention, 14 
percent of whom are unaware they are living with 
HIV. 
(2) Annually there are about 37,600 new HIV 
infections and 15,800 deaths in people with an HIV 
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diagnoses in 50 States and 6 dependent areas of the 
United States. 
(3) The Centers for Disease Control and Pre-
vention estimates that, in 2017, there were approxi-
mately 38,700 people newly diagnosed with HIV. 
The estimated number of annual new HIV infections 
declined 9 percent from 2010 to 2016. However, the 
number of new infections is increasing among cer-
tain populations, such as Latino gay and bisexual 
men, where annual infections increase 21 percent. 
(4) HIV disproportionately affects certain popu-
lations in the United States. Though African Ameri-
cans represent approximately 12 percent of the pop-
ulation, African Americans account for almost half 
(42 percent) of all people living with HIV in the 
United States. African-American men who have sex 
with men account for 26 percent of all new HIV in-
fections and have remained stable from 2010 to 
2016. 
(5) Disparities continue to exist among Latinos 
and Hispanics; in 2017, Latinos and Hispanics 
made up 18 percent of the United States population 
and 26 percent of new infections. 
(6) Though the rate of new infections among 
American Indians and Alaska Natives (referred to in 
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this section as ‘‘AI/AN’’) is proportional to their 
population size, from 2010 to 2016, the annual 
number of HIV diagnoses increased 46 percent 
among AI/AN overall and 81 percent among AI/AN 
gay and bisexual men. 
(7) Asian Americans account for about 2 per-
cent of new HIV infections, but in 2013, 22 percent 
were undiagnosed, the highest rate of undiagnosed 
HIV among any race or ethnicity. Between 2010 
and 2016, the number of Asians receiving an HIV 
diagnosis increased by 42 percent. 
(8) The latest data from the Centers for Dis-
ease Control and Prevention indicates that new in-
fections among women declined 21 percent between 
2010 and 2016. 
(9) The history of HIV shows that culturally 
relevant and gender-responsive supportive services, 
including psychosocial support, treatment literacy, 
case management, and transportation are necessary 
strategies to reach and engage women and girls in 
medical care. 
(10) Among the 3 million HIV testing events 
reported to the Centers for Disease Control and Pre-
vention in 2017, the percentage of transgender peo-
ple who received a new HIV diagnosis was 3 times 
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the national average. A 2019 systematic review and 
meta-analysis found that an estimated 14 percent of 
transgender women have HIV. By race/ethnicity, an 
estimated 44 percent of Black/African-American 
transgender women, 26 percent of Hispanic/Latina 
transgender women, and 7 percent of White 
transgender women have HIV. The limited data 
available on transgender individuals point to a dis-
proportionate burden of HIV infection. 
(11) Stigma and discrimination contribute to 
such disparities. 
(12) The Centers for Disease Control and Pre-
vention has determined that increasing the propor-
tion of people who know their HIV status is an es-
sential component of comprehensive HIV treatment 
and prevention efforts and that early diagnosis is 
critical in order for people with HIV to receive life- 
extending therapy. Additionally, the Centers for Dis-
ease Control and Prevention recommend routine 
HIV screening in health care settings for all patients 
aged 13 to 64, regardless of risk. 
(13) In 1998, Congress created the National 
Minority AIDS Initiative to provide technical assist-
ance, build capacity, and strengthen outreach efforts 
among local institutions and community-based orga-
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nizations that serve racial and ethnic minorities liv-
ing with or vulnerable to HIV. 
(14) To combat the HIV epidemic in the United 
States, the National HIV/AIDS Strategy (referred 
to in this section as ‘‘NHAS’’) provides a framework 
of increasing access to care, reducing new infections, 
and eliminating HIV-related health disparities. The 
vision of NHAS is ‘‘The United States will become 
a place where new HIV infections are rare and when 
they do occur, every person, regardless of age, gen-
der, race/ethnicity, gender identity, or socioeconomic 
circumstance, will have unfettered access to high 
quality, life-extending care, free from stigma and 
discrimination.’’. 
(15) In January 2019, the Department of 
Health and Human Services began implementing the 
‘‘Ending the HIV Epidemic: A Plan for America’’. 
The initiative seeks to reduce the number of new 
HIV infections in the United States by 75 percent 
by 2025, and then by at least 90 percent by 2030, 
for an estimated 250,000 total HIV infection avert-
ed. 
(16) At present, many States and United 
States territories have criminal statutes based on 
‘‘exposure’’ to HIV. Most of these laws were adopted 
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before the availability of effective antiretroviral 
treatment for HIV/AIDS. 
(17) Research shows that stable housing leads 
to better health outcomes for those living with HIV. 
Inadequate or unstable housing is not only a barrier 
to effective treatment, but also increases the likeli-
hood of engaging in risky behaviors leading to HIV 
infection. Insecure housing puts people with HIV/ 
AIDS at risk of premature death from exposure to 
other diseases, poor nutrition, and lack of medical 
care. 
(18) Due to advances in treatment, many peo-
ple living with HIV today are living healthy lives and 
have the ability and desire to fully participate in all 
aspects of community life, including employment. 
Research associates being employed with tremendous 
economic, social, and health benefits for many people 
living with HIV. 
(19) The common benefits associated with em-
ployment include income, autonomy, productivity, 
and status within society, daily structure, making a 
contribution to one’s community, and increased skills 
and self-esteem. Research also indicates that many 
people with disabilities, including people living with 
HIV, report perceiving themselves as being less dis-
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abled or not disabled at all, when working. Further-
more, some studies link working with better physical 
and mental health outcomes for people living with 
HIV when compared to those who are not working. 
Preliminary data also suggest that transitioning to 
employment is associated with reduced HIV-related 
health risk behavior for many people. 
(20) In July 2012, the Food and Drug Admin-
istration approved the first drug to be used as pre- 
exposure prophylaxis (PrEP). PrEP reduces the risk 
of HIV infection in HIV-negative individuals. Stud-
ies have shown that PrEP reduces HIV transmission 
from sex by about 99 percent when taken consist-
ently. Despite increases in PrEP uptake, PrEP use 
remains low among gay and bisexual men of color. 
The Centers for Disease Control and Prevention 
found that uptake was lower among African-Amer-
ican (26 percent) and Latino (30 percent) men com-
pared with White men (42 percent). Similarly, PrEP 
awareness was lower among African-American (86 
percent) and Latino (87 percent) men compared 
with White men (95 percent). While clinical research 
on transgender populations and PrEP is currently 
limited, the Centers for Disease Control and Preven-
tion recommends PrEP use in transgender popu-
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lations. In September 2019, the Food and Drug Ad-
ministration approved the second drug to be used as 
PrEP. 
(21) Syringe service programs have been associ-
ated with lowered HIV infections, lower hepatitis C 
infections, and increased linkage to substance use 
treatment. 
(22) There is now conclusive scientific evidence 
that a person living with HIV who is on 
antiretroviral therapy and is durably virally sup-
pressed (defined as having a consistent viral load of 
less than <200 copies/ml) does not sexually trans-
mit HIV. The conclusive evidence about the highly 
effective preventative benefits of antiretroviral ther-
apy provides an unprecedented opportunity to im-
prove the lives of people living with HIV, improve 
treatment uptake and adherence, and advocate for 
expanded access to treatment and care. 
SEC. 743. ADDITIONAL FUNDING FOR AIDS DRUG ASSIST-
ANCE PROGRAM TREATMENTS. 
Section 2623 of the Public Health Service Act (42 
U.S.C. 300ff–31b) is amended by adding at the end the 
following: 
‘‘(c) ADDITIONAL FUNDING FOR AIDS DRUG AS-
SISTANCE
PROGRAM
TREATMENTS.—In addition to 
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amounts otherwise authorized to be appropriated for car-
rying out this subpart, there are authorized to be appro-
priated such sums as may be necessary to carry out sec-
tions 2612(b)(3)(B) and 2616 for each of fiscal years 
2021 through 2024.’’. 
SEC. 744. ENHANCING THE NATIONAL HIV SURVEILLANCE 
SYSTEM. 
(a) GRANTS.—The Secretary of Health and Human 
Services, acting through the Director of the Centers for 
Disease Control and Prevention, shall make grants to 
States to support integration of public health surveillance 
systems into all electronic health records in order to allow 
rapid communications between the clinical setting and 
health departments, by means that include— 
(1) providing technical assistance and policy 
guidance to State and local health departments, clin-
ical providers, and other agencies serving individuals 
with HIV to improve the interoperability of data sys-
tems relevant to monitoring HIV care and sup-
portive services; 
(2) capturing longitudinal data pertaining to 
the initiation and ongoing prescription or dispensing 
of antiretroviral therapy for individuals diagnosed 
with HIV (such as through pharmacy-based report-
ing); 
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714 
(3) obtaining information— 
(A) on a voluntary basis, on sexual orienta-
tion and gender identity; and 
(B) on sources of coverage (or the lack of 
coverage) for medical treatment (including cov-
erage through the Medicaid program, the Medi-
care program, the program under title XXVI of 
the Public Health Service Act (42 U.S.C. 
300ff–11 et seq.); commonly referred to as the 
‘‘Ryan White HIV/AIDS Program’’), other pub-
lic funding, private insurance, and health main-
tenance organizations); and 
(4) obtaining and using current geographic 
markers of residence (such as current address, zip 
code, partial zip code, and census block). 
(b) PRIVACY AND SECURITY SAFEGUARDS.—In car-
rying out this section, the Secretary of Health and Human 
Services shall ensure that appropriate privacy and security 
safeguards are met to prevent unauthorized disclosure of 
protected health information and compliance with the 
HIPAA privacy and security law (as defined in section 
3009 of the Public Health Service Act (42 U.S.C. 300jj– 
19)) and other relevant laws and regulations. 
(c) PROHIBITION
AGAINST
IMPROPER
USE
OF 
DATA.—No grant under this section may be used to allow 
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or facilitate the collection or use of surveillance or clinical 
data or records— 
(1) for punitive measures of any kind, civil or 
criminal, against the subject of such data or records; 
or 
(2) for imposing any requirement or restriction 
with respect to an individual without the individual’s 
written consent. 
(d) AUTHORIZATION OF APPROPRIATIONS.—To carry 
out this section, there are authorized to be appropriated 
such sums as may be necessary for each of fiscal years 
2021 through 2024. 
SEC. 745. EVIDENCE-BASED STRATEGIES FOR IMPROVING 
LINKAGE TO AND RETENTION IN APPRO-
PRIATE CARE. 
(a) STRATEGIES.—The Secretary of Health and 
Human Services, in collaboration with the Director of the 
Centers for Disease Control and Prevention, the Assistant 
Secretary for Mental Health and Substance Use, the Di-
rector of the Office of AIDS Research, the Administrator 
of the Health Resources and Services Administration, and 
the Administrator of the Centers for Medicare & Medicaid 
Services, shall— 
(1) identify evidence-based strategies most ef-
fective at addressing the multifaceted issues that im-
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pede disease status awareness and linkage to and re-
tention in appropriate care, taking into consideration 
health care systems issues, clinic and provider 
issues, and individual psychosocial, environmental, 
and other contextual factors; 
(2) support the wide-scale implementation of 
the evidence-based strategies identified pursuant to 
paragraph (1), including through incorporating such 
strategies into health care coverage supported by the 
Medicaid program under title XIX of the Social Se-
curity Act (42 U.S.C. 1396 et seq.), the program 
under title XXVI of the Public Health Service Act 
(42 U.S.C. 300ff–11 et seq.; commonly referred to 
as the ‘‘Ryan White HIV/AIDS Program’’), and 
health plans purchased through an American Health 
Benefit Exchange established pursuant to section 
1311 of the Patient Protection and Affordable Care 
Act (42 U.S.C. 18031); and 
(3) not later than 1 year after the date of the 
enactment of this Act, submit a report to the Con-
gress on the status of activities under paragraphs 
(1) and (2). 
(b) AUTHORIZATION OF APPROPRIATIONS.—To carry 
out this section, there are authorized to be appropriated 
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such sums as may be necessary for fiscal years 2021 
through 2024. 
SEC. 746. IMPROVING ENTRY INTO AND RETENTION IN 
CARE AND ANTIRETROVIRAL ADHERENCE 
FOR PERSONS WITH HIV. 
(a) SENSE OF CONGRESS.—It is the sense of Con-
gress that AIDS research has led to scientific advance-
ments that have— 
(1) saved the lives of millions of people living 
with HIV; 
(2) prevented millions from new diagnoses; and 
(3) had broad benefits that extend far beyond 
helping people at risk for or living with HIV. 
(b) IN GENERAL.—The Secretary of Health and 
Human Services, acting through the Director of the Na-
tional Institutes of Health, shall expand, intensify, and co-
ordinate operational and translational research and other 
activities of the National Institutes of Health regarding 
methods— 
(1) to increase adoption of evidence-based ad-
herence strategies within HIV care and treatment 
programs; 
(2) to increase HIV testing and case detection 
rates; 
(3) to reduce HIV-related health disparities; 
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(4) to ensure that research to improve adher-
ence to HIV care and treatment programs address 
the unique concerns of women; 
(5) to integrate HIV prevention and care serv-
ices with mental health and substance use preven-
tion and treatment delivery systems; 
(6) to increase knowledge on the implementa-
tion of preexposure prophylaxis (referred to in this 
section as ‘‘PrEP’’), including with respect to— 
(A) who can benefit most from PrEP; 
(B) how to provide PrEP safely and effi-
ciently; 
(C) how to integrate PrEP with other es-
sential prevention methods such as condoms; 
and 
(D) how to ensure high levels of adherence; 
and 
(7) to increase knowledge of undetectable and 
untransmittable when a person living with HIV who 
is on antiretroviral therapy and is durably virally 
suppressed (defined as having a consistent viral load 
of less than <200 copies/ml) cannot sexually trans-
mit HIV. 
(c) AUTHORIZATION OF APPROPRIATIONS.—To carry 
out this section, there are authorized to be appropriated 
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supplies of such medications to meet inmates’ 
medical needs. Health care personnel and phar-
macy personnel shall also develop and imple-
ment automatic renewal systems for these medi-
cations to prevent interruptions in care. 
(D) Correctional staff, health care per-
sonnel, and pharmacy personnel shall develop 
and implement distribution procedures to en-
sure timely and confidential access to medica-
tions. 
(7) PROTECTION OF CONFIDENTIALITY.— 
(A) Health care personnel shall develop 
and implement procedures to ensure the con-
fidentiality of inmate tests, diagnoses, and 
treatment. Health care personnel and correc-
tional staff shall receive regular training on the 
implementation of these procedures. Penalties 
for violations of inmate confidentiality by health 
care personnel or correctional staff shall be 
specified and strictly enforced. 
(B) HIV testing, counseling, and treat-
ment shall be provided in a confidential setting 
where other routine health services are provided 
and in a manner that allows the inmate to re-
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00782
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS