I 
112TH CONGRESS 
1ST SESSION H. R. 1774 
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 
MAY 5, 2011 
Mr. HASTINGS of Florida (for himself, Mr. CONYERS, Mr. GRIJALVA, Ms. LEE 
of California, Mr. MCGOVERN, Mr. JACKSON of Illinois, Ms. WASSERMAN 
SCHULTZ, Mr. BRADY of Pennsylvania, Mr. HINCHEY, Ms. NORTON, Mr. 
DEUTCH, Mr. PAYNE, Mr. SERRANO, Mr. RUSH, Mrs. CHRISTENSEN, Ms. 
MOORE, Mr. CLAY, Mr. JOHNSON of Georgia, Mr. QUIGLEY, Mr. FRANK 
of Massachusetts, Ms. SCHAKOWSKY, Mr. RANGEL, Mr. POLIS, Mr. 
CICILLINE, Mr. DAVIS of Illinois, and Ms. BALDWIN) introduced the fol-
lowing bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committees on Education and the Work-
force, Ways and Means, and Oversight and Government Reform, for a 
period to be subsequently determined by the Speaker, in each case for 
consideration of such provisions as fall within the jurisdiction of the com-
mittee 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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
VerDate Mar 15 2010 
06:14 May 10, 2011
Jkt 099200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H1774.IH
H1774
jbell on DSKDVH8Z91PROD with BILLS
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Increasing Access to Voluntary Screening for HIV/AIDS 
and STIs Act of 2011’’. 
(b) TABLE OF CONTENTS.—The table of contents for 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
Sec. 2. Findings. 
Sec. 3. Purpose. 
Sec. 4. Definitions. 
TITLE I—COVERAGE OF HIV/AIDS AND STI SCREENING UNDER 
PUBLIC 
HEALTH 
CARE 
PROGRAMS 
AND 
GROUP 
HEALTH 
PLANS; COVERAGE OF CARE UNDER MEDICAID. 
Sec. 101. Coverage of routine HIV/AIDS and STI screening tests under Med-
icaid. 
Sec. 102. Coverage of HIV/AIDS and STI screening tests under Medicare. 
Sec. 103. Coverage for routine HIV/AIDS and STI screening under group 
health plans. 
Sec. 104. Optional Medicaid coverage of low-income HIV/AIDS infected individ-
uals. 
TITLE II—INCREASED DATA COLLECTION AND EDUCATION FOR 
HISTORICALLY UNDER-REPRESENTED POPULATIONS 
Sec. 201. People living with disabilities. 
Sec. 202. Women who have sex with women. 
Sec. 203. Transgender community. 
Sec. 204. Report. 
SEC. 2. FINDINGS. 
Congress finds the following: 
(1) Almost 19,000,000 new sexually trans-
mitted infections (STIs) occur each year in the 
United States, and 50 percent of sexually active 
Americans will contract a STI at some point in their 
lives, the majority of which may be asymptomatic for 
an extended amount of time. 
VerDate Mar 15 2010 
06:14 May 10, 2011
Jkt 099200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H1774.IH
H1774
jbell on DSKDVH8Z91PROD with BILLS
(2) Over 1,000,000 people in the United States 
are living with HIV, and someone is infected with 
HIV in the United States every 9.5 minutes. 
(3) HIV/AIDS and STIs are syndemics. HIV 
infection can increase a person’s risk for acquiring 
certain STIs, as well as affect their frequency, sever-
ity, and healing time, while STIs increase the risk 
of HIV transmission, impaired fertility, reproductive 
tract cancer, and adverse pregnancy outcomes. 
(4) Many common long-term and initially 
asymptomatic STIs such as chlamydia, gonorrhea, 
herpes, syphilis, inflammatory pelvic disease, viral 
hepatitis, and HIV/AIDS remain undiagnosed, or di-
agnosed at later stages, leading to increased rates of 
mortality, morbidity, disability, and transmission. 
(5) In fact, an estimated 4.4 million Americans 
are living with chronic hepatitis and most do not 
know they are infected. Chronic hepatitis B can re-
main asymptomatic for years and, left undiagnosed 
and untreated, can lead to serious complications. 
Additionally, individuals infected with hepatitis C 
virus (HCV) are at risk for chronic liver disease or 
other HCV-related chronic diseases decades after in-
fection. 
VerDate Mar 15 2010 
06:14 May 10, 2011
Jkt 099200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H1774.IH
H1774
jbell on DSKDVH8Z91PROD with BILLS
(6) Stigma, culture, language, lack of edu-
cation, lack of insurance, limited time, cost and re-
sources in medical settings, and an inaccurate per-
ception of risk among communities and providers all 
contribute to insufficient rates of screening for HIV/ 
AIDS and STIs. 
(7) The Centers for Disease Control and Pre-
vention and the United States Preventive Services 
Task Force recognize screening as an effective pub-
lic health tool that allows providers to administer 
treatment before symptoms develop and implement 
interventions that will reduce the likelihood of HIV/ 
AIDS and STI transmission and reduce the develop-
ment of adverse outcomes. 
(8) The CDC recommends that voluntary 
screening for HIV/AIDS be integrated into routine 
clinical care while preserving patient confidentiality 
and the right of the patient to decline testing and 
screening. 
(9) The CDC also recommends that all 
unvaccinated, uninfected persons being evaluated for 
a STI should receive hepatitis B vaccination. Fur-
thermore, anti-HCV testing is recommended for rou-
tine screening of asymptomatic persons based on 
VerDate Mar 15 2010 
06:14 May 10, 2011
Jkt 099200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H1774.IH
H1774
jbell on DSKDVH8Z91PROD with BILLS
their risk for infection or based on a recognized ex-
posure. 
(10) Inaccurate perceptions of risk among 
health care providers and patients, misdiagnosis, 
ageism, generational mind-sets, and biological fac-
tors have contributed to increased rates in trans-
mission and late detection of HIV/AIDS and STIs 
over the past decade. 
(11) Health equity and disparities remain a sig-
nificant public health challenge, with the burden of 
HIV/AIDS and STIs falling disproportionately on 
different populations. 
(12) Although African-Americans account for 
about 12 percent of the United States population, 
they account for nearly half of all HIV/AIDS cases 
and infections and have higher instances of mor-
tality and morbidity for most STIs and HIV/AIDS. 
Also, African-American women who have sex with 
men account for the majority of HIV/AIDS infec-
tions among all women in the United States. 
(13) HIV/AIDS continues to be most prevalent 
among men who have sex with men (MSM). Contin-
ued support and increased funding for community- 
based programs and behavioral interventions that 
VerDate Mar 15 2010 
06:14 May 10, 2011
Jkt 099200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H1774.IH
H1774
jbell on DSKDVH8Z91PROD with BILLS
are culturally competent are key to reaching MSM, 
especially young MSM of color. 
(14) Transgender persons are particularly vul-
nerable to contracting HIV/AIDS and STIs due to 
high rates of survival sex among trans-females, dis-
crimination in education, employment, and housing, 
and the absence of education and prevention meth-
ods culturally relevant to the transgender commu-
nity. 
(15) Health care providers must be properly 
educated to treat groups, such as MSM, transgender 
persons, African-Americans, and Latinos who are 
disproportionately affected by HIV/AIDS and other 
STIs, and also improve interventions for groups that 
have been historically under-represented in health 
interventions for STIs, such as women who have sex 
with women, individuals over the age of 50, Asian 
and Pacific Islander Americans, Native Americans, 
and persons living with disabilities. 
(16) Women living with mobility impairments 
often lack access to screening for STIs and other 
women’s health services such as pelvic examinations 
and mammograms due to, among other factors, the 
lack of provider awareness, experience, and access to 
equipment. 
VerDate Mar 15 2010 
06:14 May 10, 2011
Jkt 099200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H1774.IH
H1774
jbell on DSKDVH8Z91PROD with BILLS
(17) All individuals engaging in oral, anal, or 
genital sexual contact must have access to voluntary 
screening for HIV/AIDS and other STIs. Screening 
must be confidential, rapid, accurate, and medically 
appropriate. Screening must be offered regardless of 
age, race, class, sexual behavior, sexual orientation, 
gender identity, or disability. 
(18) The Congress supports the goals of the 
National HIV/AIDS Strategy and, in particular, the 
goal of 90 percent of individuals knowing their HIV/ 
AIDS status. 
SEC. 3. PURPOSE. 
The purposes of this Act are as follows: 
(1) Increase access, quality, and affordability 
for voluntary and medically appropriate screening 
for HIV/AIDS and other STIs, including chlamydia, 
gonorrhea, syphilis, viral hepatitis, and human 
papillomavirus, for all persons engaging in various 
forms of sexual activity, including oral, genital, or 
anal sex. 
(2) Reduce the spread, morbidity, and mortality 
of HIV/AIDS and other STIs. 
(3) Reduce the disproportionate incidence of 
HIV/AIDS and other STIs in certain groups 
through early detection and treatment and com-
VerDate Mar 15 2010 
06:14 May 10, 2011
Jkt 099200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H1774.IH
H1774
jbell on DSKDVH8Z91PROD with BILLS
prehensive education for health care providers, cen-
ters, and communities. 
(4) Support the execution of other scientifically 
based interventions that are culturally competent 
and age appropriate and are proven to reduce the in-
cidence of HIV/AIDS and other STIs. 
SEC. 4. DEFINITIONS. 
In this Act: 
(1) CDC.—The term ‘‘CDC’’ means the Cen-
ters for Disease Control and Prevention. 
(2) CMS.—The term ‘‘CMS’’ means the Cen-
ters for Medicare & Medicaid Services. 
(3) DIRECTOR.—The term ‘‘Director’’ means 
the Director of the Centers for Disease Control and 
Prevention. 
(4) HIV/AIDS.—The term ‘‘HIV/AIDS’’ means 
infection with the human immunodeficiency virus 
and includes acquired immune deficiency syndrome 
and any condition arising from such syndrome. 
(5) MSM.—The term ‘‘MSM’’ means men who 
have sex with men. 
(6) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
(7) STATE.—The term ‘‘State’’ means each of 
the 50 States, the District of Columbia, the United 
VerDate Mar 15 2010 
06:14 May 10, 2011
Jkt 099200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H1774.IH
H1774
jbell on DSKDVH8Z91PROD with BILLS
States Virgin Islands, Guam, the Commonwealth of 
Puerto Rico, the Commonwealth of the Northern 
Mariana Islands, and American Samoa. 
(8) STI.—The term ‘‘STI’’ means a sexually 
transmitted infection that is recognized by the CDC, 
including chlamydia, gonorrhea, syphilis, viral hepa-
titis, and human papillomavirus. 
(9) WSW.—The term ‘‘WSW’’ means women 
who have sex with women. 
TITLE 
I—COVERAGE 
OF 
HIV/ 
AIDS 
AND 
STI 
SCREENING 
UNDER 
PUBLIC 
HEALTH 
CARE PROGRAMS AND GROUP 
HEALTH PLANS; COVERAGE 
OF CARE UNDER MEDICAID. 
SEC. 101. COVERAGE OF ROUTINE HIV/AIDS AND STI 
SCREENING TESTS UNDER MEDICAID. 
(a) INCLUSION IN STATE PLAN.—Section 1902(a) of 
the Social Security Act (42 U.S.C. 1396a(a)) is amended 
in paragraph (10)(A), in the matter before clause (i), by 
striking ‘‘and (28)’’ and inserting ‘‘(28), and (29)’’. 
(b) INCLUSION IN MEDICAL ASSISTANCE.— 
(1) IN GENERAL.—Section 1905(a) of the So-
cial Security Act (42 U.S.C. 1396d(a)) is amend-
ed— 
VerDate Mar 15 2010 
06:14 May 10, 2011
Jkt 099200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H1774.IH
H1774
jbell on DSKDVH8Z91PROD with BILLS
(A) in paragraph (28), by striking ‘‘and’’ 
at the end; 
(B) by redesignating paragraph (29) as 
paragraph (30); and 
(C) by inserting after paragraph (28) the 
following: 
‘‘(29) routine HIV/AIDS and STI screening 
services (as defined in subsection (ee)).’’. 
(2) DEFINITION OF SERVICES.—Section 1905 
of such Act is amended by adding at the end the fol-
lowing: 
‘‘(ee)(1) For purposes of this section, the term ‘rou-
tine HIV/AIDS and STI screening services’ means all of 
the following: 
‘‘(A) A screening test for HIV/AIDS or 
any other STI, if such test is provided to an in-
dividual who— 
‘‘(i) is eligible for medical assistance 
under the State plan; and 
‘‘(ii) is described in clauses (ii) 
through (v) of section 1861(iii)(1)(A). 
‘‘(B) Each of the services described in sub-
paragraphs 
(B) 
through 
(F) 
of 
section 
1861(iii)(1). 
VerDate Mar 15 2010 
06:14 May 10, 2011
Jkt 099200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H1774.IH
H1774
jbell on DSKDVH8Z91PROD with BILLS
(1) IN GENERAL.—Except as provided by para-
graph (2), the amendments made by this section 
shall take effect on the date of the enactment of this 
section and shall apply to services furnished on or 
after such date. 
(2) RULES
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-
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. 
VerDate Mar 15 2010 
06:14 May 10, 2011
Jkt 099200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6201
E:\BILLS\H1774.IH
H1774
jbell on DSKDVH8Z91PROD with BILLS
SEC. 102. COVERAGE OF HIV/AIDS AND STI SCREENING 
TESTS UNDER MEDICARE. 
Section 1861 of the Social Security Act is amended— 
(1) in subsection (s)— 
(A) by striking ‘‘and’’ at the end of para-
graph (14); 
(B) by striking the period at the end of 
paragraph (15) and inserting ‘‘; and’’; 
(C) by redesignating paragraphs (16) and 
(17) as paragraphs (17) and (18), respectively; 
and 
(D) by inserting after paragraph (15) the 
following: 
‘‘(16) routine HIV/AIDS and STI screening 
services (as such term is defined in subsection 
(iii)).’’; and 
(2) by adding at the end the following: 
‘‘(iii) ROUTINE HIV/AIDS AND STI SCREENING 
SERVICES.—(1) For purposes of this section, the term 
‘routine HIV/AIDS and STI screening services’ means all 
of the following: 
‘‘(A) A screening test for HIV/AIDS or 
any other STI, if such test is provided in any 
health care setting (other than an inpatient 
hospital setting) and is provided to an indi-
vidual who— 
VerDate Mar 15 2010 
06:14 May 10, 2011
Jkt 099200
PO 00000
Frm 00013
Fmt 6652
Sfmt 6201
E:\BILLS\H1774.IH
H1774
jbell on DSKDVH8Z91PROD with BILLS
‘‘(i) is enrolled in part B; 
‘‘(ii) is at least 13 years of age; 
‘‘(iii) with respect to a test for HIV/ 
AIDS, is not known to the health care pro-
vider (directly, through information pro-
vided by the individual, or through access 
to an electronic medical record) to have 
had a previous positive test for HIV/AIDS; 
‘‘(iv) subject to subparagraph (B), 
with respect to a test for HIV/AIDS or a 
STI, is not known to the health care pro-
vider (directly, through information pro-
vided by the individual, or through access 
to an electronic medical record) to have 
had a test for the same condition within 
the previous 6 months; and 
‘‘(v) has been informed that such a 
test will be administered and has not ob-
jected to such a test. 
‘‘(B) If a test described under subpara-
graph (A) is reactive— 
‘‘(i) and is for HIV/AIDS, a confirm-
atory test; 
VerDate Mar 15 2010 
06:14 May 10, 2011
Jkt 099200
PO 00000
Frm 00014
Fmt 6652
Sfmt 6201
E:\BILLS\H1774.IH
H1774
jbell on DSKDVH8Z91PROD with BILLS
‘‘(ii) and is for a STI other than HIV/ 
AIDS, if reasonable and necessary, a con-
firmatory test. 
‘‘(C) The interpretation of any tests pro-
vided under subparagraph (A) and subpara-
graph (B). 
‘‘(D) Informing an individual who receives 
a test under subparagraph (A) or subparagraph 
(B) of the results of such tests as close in time 
as possible to the determination of such results. 
‘‘(E) If an individual tests positive for 
HIV/AIDS on a screening test under subpara-
graph (A) and any confirmatory test under sub-
paragraph (B)— 
‘‘(i) post-test counseling concerning 
HIV/AIDS and STIs at the time the indi-
vidual is informed of the results of the 
test; and 
‘‘(ii) if appropriate, a referral to med-
ical or mental health services. 
‘‘(F) If an individual tests positive for a 
STI on a screening test under subparagraph 
(A) and any confirmatory test under subpara-
graph (B), the provision of information to such 
individual on the risk of STIs and HIV/AIDS 
VerDate Mar 15 2010 
06:14 May 10, 2011
Jkt 099200
PO 00000
Frm 00015
Fmt 6652
Sfmt 6201
E:\BILLS\H1774.IH
H1774
jbell on DSKDVH8Z91PROD with BILLS
and behaviors that reduce the risk of exposure 
to such conditions. 
‘‘(2) DEFINITIONS.—For purposes of this sub-
section: 
‘‘(A) HIV/AIDS.—The term ‘HIV/AIDS’ 
means infection with the human immuno-
deficiency virus and includes acquired immune 
deficiency syndrome and any condition arising 
from such syndrome. 
‘‘(B) STI.—The term ‘STI’ means a sexu-
ally transmitted infection or sexually trans-
mitted disease that is recognized by the Centers 
for Disease Control and Prevention, including 
chlamydia, gonorrhea, syphilis, hepatitis B, hep-
atitis C, and human papillomavirus.’’. 
SEC. 103. COVERAGE FOR ROUTINE HIV/AIDS AND STI 
SCREENING UNDER GROUP HEALTH PLANS. 
(a) GROUP HEALTH PLANS.— 
(1) PUBLIC
HEALTH
SERVICE
ACT
AMEND-
MENTS.— 
(A) IN
GENERAL.—Title XXVII of the 
Public Health Service Act is amended by insert-
ing after section 2728 of such Act (42 U.S.C. 
300gg–28), as redesignated by section 1001(2) 
VerDate Mar 15 2010 
06:14 May 10, 2011
Jkt 099200
PO 00000
Frm 00016
Fmt 6652
Sfmt 6201
E:\BILLS\H1774.IH
H1774
jbell on DSKDVH8Z91PROD with BILLS
of the Patient Protection and Affordable Care 
Act (Public Law 111–148), the following: 
‘‘SEC. 2729. COVERAGE FOR ROUTINE HIV/AIDS AND STI 
SCREENING. 
‘‘(a) COVERAGE.—A group health plan, and a health 
insurance issuer providing group or individual health in-
surance coverage, shall provide coverage for routine HIV/ 
AIDS and STI screening under terms and conditions that 
are no less favorable than the terms and conditions appli-
cable to other routine health screenings. 
‘‘(b) PROHIBITIONS.—A group health plan, and a 
health insurance issuer providing group or individual 
health insurance coverage, shall not— 
‘‘(1) deny to an individual eligibility, or contin-
ued eligibility, to enroll or to renew coverage under 
the terms of the plan, solely for the purpose of 
avoiding the requirements of this section; 
‘‘(2) deny coverage for routine HIV/AIDS or 
STI screening on the basis that there are no known 
risk factors present, or the screening is not clinically 
indicated, medically necessary, or pursuant to a re-
ferral, consent, or recommendation by any health 
care provider; 
‘‘(3) provide monetary payments, rebates, or 
other benefits to individuals to encourage such indi-
VerDate Mar 15 2010 
06:14 May 10, 2011
Jkt 099200
PO 00000
Frm 00017
Fmt 6652
Sfmt 6201
E:\BILLS\H1774.IH
H1774
jbell on DSKDVH8Z91PROD with BILLS