I 
111TH CONGRESS 
1ST SESSION H. R. 2137 
To amend the Public Health Service Act, the Employee Retirement Income 
Security Act of 1974, the Internal Revenue Code of 1986, and title 
5, United States Code, to require individual and group health insurance 
coverage and group health plans and Federal employees health benefit 
plans to provide coverage for routine HIV screening. 
IN THE HOUSE OF REPRESENTATIVES 
APRIL 28, 2009 
Ms. WATERS (for herself, Mr. STARK, Mrs. CHRISTENSEN, Ms. LEE of Cali-
fornia, Mr. MEEKS of New York, and Mr. FRANK of Massachusetts) in-
troduced the following bill; which was referred to the Committee on En-
ergy and Commerce, and in addition to the Committees on Education and 
Labor, 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 amend the Public Health Service Act, the Employee Re-
tirement Income Security Act of 1974, the Internal Rev-
enue Code of 1986, and title 5, United States Code, 
to require individual and group health insurance coverage 
and group health plans and Federal employees health 
benefit plans to provide coverage for routine HIV screen-
ing. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE; FINDINGS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Routine HIV Screening Coverage Act of 2009’’. 
(b) FINDINGS.—Congress finds the following: 
(1) HIV/AIDS continues to infect and kill thou-
sands of Americans, 25 years after the first cases 
were reported. 
(2) It has been estimated that at least 1.6 mil-
lion Americans have been infected with HIV since 
the beginning of the epidemic and over 500,000 of 
them have died. 
(3) The HIV/AIDS epidemic has disproportion-
ately impacted African-Americans and Hispanic- 
Americans and its impact on women is growing. 
(4) It has been estimated that almost one quar-
ter of those infected with HIV in the United States 
do not know they are infected. 
(5) Not all individuals who have been infected 
with HIV demonstrate clinical indications or fall into 
high risk categories. 
(6) 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/AIDS 
treatment and prevention efforts and that early di-
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agnosis is critical in order for people with HIV/ 
AIDS to receive life-extending therapy. 
(7) On September 21, 2006, the Centers for 
Disease Control and Prevention released new guide-
lines that recommend routine HIV screening in 
health care settings for all patients aged 13–64, re-
gardless of risk. 
(8) Standard health insurance plans generally 
cover HIV screening when there are clinical indica-
tions of infection or when there are known risk fac-
tors present. 
(9) Requiring health insurance plans to cover 
routine HIV screening could play a critical role in 
preventing the spread of HIV/AIDS and allowing in-
fected individuals to receive effective treatment. 
SEC. 2. COVERAGE FOR ROUTINE HIV SCREENING UNDER 
GROUP HEALTH PLANS, INDIVIDUAL HEALTH 
INSURANCE COVERAGE, AND FEHBP. 
(a) GROUP HEALTH PLANS.— 
(1) PUBLIC
HEALTH
SERVICE
ACT
AMEND-
MENTS.—Subpart 2 of part A of title XXVII of the 
Public Health Service Act is amended by adding at 
the end the following new section: 
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‘‘SEC. 2708. COVERAGE FOR ROUTINE HIV SCREENING. 
‘‘(a) COVERAGE.—A group health plan, and a health 
insurance issuer offering group health insurance coverage, 
shall provide coverage for routine HIV screening under 
terms and conditions that are no less favorable than the 
terms and conditions applicable to other routine health 
screenings. 
‘‘(b) PROHIBITIONS.—A group health plan, and a 
health insurance issuer offering group 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 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 referral, con-
sent, or recommendation by any health care pro-
vider; 
‘‘(3) provide monetary payments, rebates, or 
other benefits to individuals to encourage such indi-
viduals to accept less than the minimum protections 
available under this section; 
‘‘(4) penalize or otherwise reduce or limit the 
reimbursement of a provider because such provider 
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provided care to an individual participant or bene-
ficiary in accordance with this section; 
‘‘(5) provide incentives (monetary or otherwise) 
to a provider to induce such provider to provide care 
to an individual participant or beneficiary in a man-
ner inconsistent with this section; or 
‘‘(6) deny to an individual participant or bene-
ficiary continued eligibility to enroll or to renew cov-
erage under the terms of the plan, solely because of 
the results of an HIV test or other HIV screening 
procedure for the individual or any other individual. 
‘‘(c) RULES OF CONSTRUCTION.—Nothing in this 
section shall be construed— 
‘‘(1) to require an individual who is a partici-
pant or beneficiary to undergo HIV screening; or 
‘‘(2) as preventing a group health plan or issuer 
from imposing deductibles, coinsurance, or other 
cost-sharing in relation to HIV screening, except 
that such deductibles, coinsurance or other cost- 
sharing may not be greater than the deductibles, co-
insurance, or other cost-sharing imposed on other 
routine health screenings. 
‘‘(d) NOTICE.—A group health plan under this part 
shall comply with the notice requirement under section 
715(d) of the Employee Retirement Income Security Act 
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of 1974 with respect to the requirements of this section 
as if such section applied to such plan. 
‘‘(e) PREEMPTION.—Nothing in this section shall be 
construed to preempt any State law in effect on the date 
of enactment of this section with respect to health insur-
ance coverage that requires coverage of at least the cov-
erage of HIV screening otherwise required under this sec-
tion.’’. 
(2) ERISA AMENDMENTS.—(A) Subpart B of 
part 7 of subtitle B of title I of the Employee Re-
tirement Income Security Act of 1974 is amended by 
adding at the end the following new section: 
‘‘SEC. 715. COVERAGE FOR ROUTINE HIV SCREENING. 
‘‘(a) COVERAGE.—A group health plan, and a health 
insurance issuer offering group health insurance coverage, 
shall provide coverage for routine HIV screening under 
terms and conditions that are no less favorable than the 
terms and conditions applicable to other routine health 
screenings. 
‘‘(b) PROHIBITIONS.—A group health plan, and a 
health insurance issuer offering group health insurance 
coverage, shall not— 
‘‘(1) deny to an individual eligibility, or contin-
ued eligibility, to enroll or to renew coverage under 
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the terms of the plan, solely for the purpose of 
avoiding the requirements of this section; 
‘‘(2) deny coverage for routine HIV 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 referral, con-
sent, or recommendation by any health care pro-
vider; 
‘‘(3) provide monetary payments, rebates, or 
other benefits to individuals to encourage such indi-
viduals to accept less than the minimum protections 
available under this section; 
‘‘(4) penalize or otherwise reduce or limit the 
reimbursement of a provider because such provider 
provided care to an individual participant or bene-
ficiary in accordance with this section; 
‘‘(5) provide incentives (monetary or otherwise) 
to a provider to induce such provider to provide care 
to an individual participant or beneficiary in a man-
ner inconsistent with this section; or 
‘‘(6) deny to an individual participant or bene-
ficiary continued eligibility to enroll or to renew cov-
erage under the terms of the plan, solely because of 
the results of an HIV test or other HIV screening 
procedure for the individual or any other individual. 
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‘‘(c) RULES OF CONSTRUCTION.—Nothing in this 
section shall be construed— 
‘‘(1) to require an individual who is a partici-
pant or beneficiary to undergo HIV screening; or 
‘‘(2) as preventing a group health plan or issuer 
from imposing deductibles, coinsurance, or other 
cost-sharing in relation to HIV screening, except 
that such deductibles, coinsurance or other cost- 
sharing may not be greater than the deductibles, co-
insurance, or other cost-sharing imposed on other 
routine health screenings. 
‘‘(d) NOTICE UNDER GROUP HEALTH PLAN.—A 
group health plan, and a health insurance issuer providing 
health insurance coverage in connection with a group 
health plan, shall provide notice to each participant and 
beneficiary under such plan regarding the coverage re-
quired by this section in accordance with regulations pro-
mulgated by the Secretary. Such notice shall be in writing 
and prominently positioned in any literature or cor-
respondence made available or distributed by the plan or 
issuer and shall be transmitted— 
‘‘(1) in the next mailing made by the plan or 
issuer to the participant or beneficiary; 
‘‘(2) as part of any yearly informational packet 
sent to the participant or beneficiary; or 
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‘‘(3) not later than January 1, 2010; 
whichever is earliest. 
‘‘(e) PREEMPTION, RELATION TO STATE LAWS.— 
‘‘(1) IN
GENERAL.—Nothing in this section 
shall be construed to preempt any State law in effect 
on the date of enactment of this section with respect 
to health insurance coverage that requires coverage 
of at least the coverage of HIV screening otherwise 
required under this section. 
‘‘(2) ERISA.—Nothing in this section shall be 
construed to affect or modify the provisions of sec-
tion 514 with respect to group health plans.’’. 
(B) Section 732(a) of such Act (29 U.S.C. 
1191a(a)) is amended by striking ‘‘section 711’’ and 
inserting ‘‘sections 711 and 715’’. 
(C) The table of contents in section 1 of such 
Act is amended by inserting after the item relating 
to section 714 the following new item: 
‘‘Sec. 715. Coverage for routine HIV screening.’’. 
(3) 
INTERNAL
REVENUE
CODE
AMEND-
MENTS.—(A) Subchapter B of chapter 100 of the 
Internal Revenue Code of 1986 is amended by in-
serting after section 9813 the following: 
‘‘SEC. 9814. COVERAGE FOR ROUTINE HIV SCREENING. 
‘‘(a) COVERAGE.—A group health plan shall provide 
coverage for routine HIV screening under terms and con-
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ditions that are no less favorable than the terms and con-
ditions applicable to other routine health screenings. 
‘‘(b) PROHIBITIONS.—A group health plan 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 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 referral, con-
sent, or recommendation by any health care pro-
vider; 
‘‘(3) provide monetary payments, rebates, or 
other benefits to individuals to encourage such indi-
viduals to accept less than the minimum protections 
available under this section; 
‘‘(4) penalize or otherwise reduce or limit the 
reimbursement of a provider because such provider 
provided care to an individual participant or bene-
ficiary in accordance with this section; 
‘‘(5) provide incentives (monetary or otherwise) 
to a provider to induce such provider to provide care 
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to an individual participant or beneficiary in a man-
ner inconsistent with this section; or 
‘‘(6) deny to an individual participant or bene-
ficiary continued eligibility to enroll or to renew cov-
erage under the terms of the plan, solely because of 
the results of an HIV test or other HIV screening 
procedure for the individual or any other individual. 
‘‘(c) RULES OF CONSTRUCTION.—Nothing in this 
section shall be construed— 
‘‘(1) to require an individual who is a partici-
pant or beneficiary to undergo HIV screening; or 
‘‘(2) as preventing a group health plan or issuer 
from imposing deductibles, coinsurance, or other 
cost-sharing in relation to HIV screening, except 
that such deductibles, coinsurance or other cost- 
sharing may not be greater than the deductibles, co-
insurance, or other cost-sharing imposed on other 
routine health screenings.’’. 
(B) The table of sections of such subchapter is 
amended by inserting after the item relating to sec-
tion 9813 the following new item: 
‘‘Sec. 9814. Coverage for routine HIV screening.’’. 
(C) Section 4980D(d)(1) of such Code is 
amended by striking ‘‘section 9811’’ and inserting 
‘‘sections 9811 and 9814’’. 
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(b) APPLICATION TO INDIVIDUAL HEALTH INSUR-
ANCE COVERAGE.—(1) Part B of title XXVII of the Pub-
lic Health Service Act is amended by inserting after sec-
tion 2753 the following new section: 
‘‘SEC. 2754. COVERAGE FOR ROUTINE HIV SCREENING. 
‘‘(a) IN GENERAL.—The provisions of section 2708 
(other than subsection (d)) shall apply to health insurance 
coverage offered by a health insurance issuer in the indi-
vidual market in the same manner as it applies to health 
insurance coverage offered by a health insurance issuer 
in connection with a group health plan in the small or 
large group market. 
‘‘(b) NOTICE.—A health insurance issuer under this 
part shall comply with the notice requirement under sec-
tion 715(d) of the Employee Retirement Income Security 
Act of 1974 with respect to the requirements referred to 
in subsection (a) as if such section applied to such issuer 
and such issuer were a group health plan.’’. 
(2) Section 2762(b)(2) of such Act (42 U.S.C. 
300gg–62(b)(2)) is amended by striking ‘‘section 2751’’ 
and inserting ‘‘sections 2751 and 2754’’. 
(c) APPLICATION
UNDER
FEDERAL
EMPLOYEES 
HEALTH BENEFITS PROGRAM (FEHBP).—Section 8902 
of title 5, United States Code, is amended by adding at 
the end the following new subsection: 
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‘‘(p) A contract may not be made or a plan approved 
which does not comply with the requirements of section 
2708 of the Public Health Service Act.’’. 
(d) EFFECTIVE DATES.—(1) The amendments made 
by subsections (a) and (c) apply with respect to group 
health plans and health benefit plans for plan years begin-
ning on or after January 1, 2010. 
(2) The amendments made by subsection (b) shall 
apply with respect to health insurance coverage offered, 
sold, issued, renewed, in effect, or operated in the indi-
vidual market on or after January 1, 2010. 
(e) COORDINATION OF ADMINISTRATION.—The Sec-
retary of Labor, the Secretary of Health and Human Serv-
ices, and the Secretary of the Treasury shall ensure, 
through the execution of an interagency memorandum of 
understanding among such Secretaries, that— 
(1) regulations, rulings, and interpretations 
issued by such Secretaries relating to the same mat-
ter over which two or more such Secretaries have re-
sponsibility under the provisions of this section (and 
the amendments made thereby) are administered so 
as to have the same effect at all times; and 
(2) coordination of policies relating to enforcing 
the same requirements through such Secretaries in 
order to have a coordinated enforcement strategy 
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that avoids duplication of enforcement efforts and 
assigns priorities in enforcement. 
Æ 
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