I 
113TH CONGRESS 
1ST SESSION H. R. 3723 
To amend the Public Health Service Act to revise and extend the program 
for viral hepatitis surveillance, education, and testing in order to prevent 
deaths from chronic liver disease and liver cancer, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
DECEMBER 12, 2013 
Mr. CASSIDY (for himself, Mr. GUTHRIE, and Mr. DENT) introduced the fol-
lowing bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committee on Veterans’ Affairs, for a pe-
riod to be subsequently determined by the Speaker, in each case for con-
sideration of such provisions as fall within the jurisdiction of the com-
mittee concerned 
A BILL 
To amend the Public Health Service Act to revise and extend 
the program for viral hepatitis surveillance, education, 
and testing in order to prevent deaths from chronic 
liver disease and liver cancer, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Viral Hepatitis Testing 
Act of 2013’’. 
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SEC. 2. FINDINGS. 
Congress finds the following: 
(1) Approximately 5,300,000 Americans are 
chronically infected with the hepatitis B virus (re-
ferred to in this section as ‘‘HBV’’), the hepatitis C 
virus (referred to in this section as ‘‘HCV’’), or 
both. 
(2) In the United States, chronic HBV and 
HCV are among the most common causes of liver 
cancer, one of the most lethal and fastest growing 
cancers in the United States. Chronic HBV and 
HCV are among the most common causes of chronic 
liver disease, liver cirrhosis, and the most common 
indication for liver transplantation. More than 
15,000 deaths per year in the United States can be 
attributed to chronic HBV and HCV. Chronic HCV 
is also a leading cause of death in Americans living 
with HIV/AIDS. Many of those living with HIV/ 
AIDS are coinfected with chronic HBV, HCV, or 
both. 
(3) According to the Centers for Disease Con-
trol and Prevention (referred to in this section as 
the ‘‘CDC’’), approximately 2 percent of the popu-
lation of the United States is living with chronic 
HBV, HCV, or both. The CDC has recognized HCV 
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as the Nation’s most common chronic bloodborne 
virus infection. 
(4) HBV is easily transmitted and is 100 times 
more infectious than HIV. According to the CDC, 
HBV is transmitted through contact with infectious 
blood, semen, or other body fluids. HCV is trans-
mitted by contact with infectious blood, particularly 
through percutaneous exposures (i.e. puncture 
through the skin). 
(5) The CDC conservatively estimates that in 
2011 approximately 16,600 Americans were newly 
infected with HCV and more than 18,800 Americans 
were newly infected with HBV. These estimates 
could be much higher due to many reasons, includ-
ing lack of screening education and awareness, and 
perceived marginalization of the populations at risk. 
(6) In 2012 CDC released new guidelines rec-
ommending every person born from 1945 through 
1965 receive a one-time HCV test. Among the esti-
mated 102 million (1.6 million chronically HCV-in-
fected) eligible for screening, birth-cohort screening 
leads to 74,000 fewer cases of decompensated cir-
rhosis, 46,000 fewer cases of hepatocellular car-
cinoma, 15,000 fewer liver transplants and 120,000 
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fewer HCV-related deaths versus risk-based screen-
ing. 
(7) In 2013, the United States Preventative 
Task Force (USPSTF) issued a Grade B rating for 
screening for hepatitis C virus (HCV) infection in 
persons at high risk for infection and adults born 
between 1945 and 1965. In 2009, the USPSTF 
issued a Grade A for screening pregnant women for 
the hepatitis B virus (HBV) during their first pre-
natal visit. 
(8) There were 35 outbreaks (19 of HBV, 16 
of HCV) reported to CDC for investigation from 
2008–2012 related to healthcare acquired infection 
of HBV and HCV, 33 of which occurred in non-hos-
pital settings. There were more than 99,975 patients 
potentially exposed to one of the viruses. 
(9) Chronic HBV and chronic HCV usually do 
not cause symptoms early in the course of the dis-
ease, but after many years of a clinically ‘‘silent’’ 
phase, CDC estimates show more than 33 percent of 
infected individuals will develop cirrhosis, end-stage 
liver disease, or liver cancer. Since most individuals 
with chronic HBV, HCV, or both are unaware of 
their infection, they do not know to take precautions 
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to prevent the spread of their infection and can un-
knowingly exacerbate their own disease progression. 
(10) HBV and HCV disproportionately affect 
certain populations in the United States. Although 
representing about 6 percent of the population, 
Asian and Pacific Islanders account for over half of 
up to 1,400,000 domestic chronic HBV cases. Baby 
boomers (those born between 1945 and 1965) ac-
count for more than 75 percent of domestic chronic 
HCV cases. In addition, African-Americans, Latinos 
(Latinas), and American Indian/Native Alaskans are 
among the groups which have disproportionately 
high rates of HBV infections, HCV infections, or 
both in the United States. 
(11) For both chronic HBV and chronic HCV, 
behavioral changes can slow disease progression if a 
diagnosis is made early. Early diagnosis, which is 
determined through simple diagnostic tests, can also 
reduce the risk of transmission and disease progres-
sion through education and vaccination of household 
members and other susceptible persons at risk. 
(12) Advancements have led to the development 
of improved diagnostic tests for viral hepatitis. 
These tests, including rapid, point of care testing 
and others in development, can facilitate testing, no-
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tification of results and post-test counseling, and re-
ferral to care at the time of the testing visit. In par-
ticular, these tests are also advantageous because 
they can be used simultaneously with HIV rapid 
testing for persons at risk for both HCV and HIV 
infections. 
(13) For those chronically infected with HBV 
or HCV, regular monitoring can lead to the early de-
tection of liver cancer at a stage where a cure is still 
possible. Liver cancer is the second deadliest cancer 
in the United States; however, liver cancer has re-
ceived little funding for research, prevention, or 
treatment. 
(14) Treatment for chronic HCV can eradicate 
the disease in approximately 75 percent of those cur-
rently treated. The treatment of chronic HBV can 
effectively suppress viral replication in the over-
whelming majority (over 80 percent) of those treat-
ed, thereby reducing the risk of transmission and 
progression to liver scarring or liver cancer, even 
though a complete cure is much less common than 
for HCV. 
(15) To combat the viral hepatitis epidemic in 
the United States, in May 2011, the Department of 
Health and Human Services released, Combating the 
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Silent Epidemic of Viral Hepatitis: Action Plan for 
the Prevention, Care & Treatment of Viral Hepa-
titis. The Institute of Medicine of the National 
Academies produced a 2010 report on the Federal 
response to HBV and HCV titled: Hepatitis and 
Liver Cancer: A National Strategy for Prevention 
and Control of Hepatitis B and C. The recommenda-
tions and guidelines provide a framework for HBV 
and HCV prevention, education, control, research, 
and medical management programs. 
(16) The annual health care costs attributable 
to viral hepatitis in the United States are signifi-
cant. For HBV, it is estimated to be approximately 
$2,500,000,000 ($2,000 per infected person). In 
2000, the lifetime cost of HBV—before the avail-
ability of most current therapies—was approximately 
$80,000 per chronically infected person, totaling 
more than $100,000,000,000. For HCV, medical 
costs for patients are expected to increase from 
$30,000,000,000 in 2009 to over $85,000,000,000 
in 2024. Avoiding these costs by screening and diag-
nosing individuals earlier—and connecting them to 
appropriate treatment and care will save lives and 
critical health care dollars. Currently, without a 
comprehensive screening, testing and diagnosis pro-
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gram, most patients are diagnosed too late when 
they need a liver transplant costing at least 
$314,000 for uncomplicated cases or when they have 
liver cancer or end stage liver disease which costs 
between $30,980 to $110,576 per hospital admis-
sion. As health care costs continue to grow, it is crit-
ical that the Federal Government invests in effective 
mechanisms to avoid documented cost drivers. 
(17) According to the Institute of Medicine re-
port in 2010 (described in paragraph (13)), chronic 
HBV and HCV infections cause substantial mor-
bidity and mortality despite being preventable and 
treatable. Deficiencies in the implementation of es-
tablished guidelines for the prevention, diagnosis, 
and medical management of chronic HBV and HCV 
infections perpetuate personal and economic bur-
dens. Existing grants are not sufficient to address 
the scale of the health burden presented by HBV 
and HCV. 
(18) The Secretary of Health and Human Serv-
ices has the discretion to carry out this Act directly 
and through whichever of the agencies of the Public 
Health Service the Secretary determines to be ap-
propriate, which may (in the Secretary’s discretion) 
include the Centers for Disease Control and Preven-
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tion, the Health Resources and Services Administra-
tion, the Substance Abuse and Mental Health Serv-
ices Administration, the National Institutes of 
Health (including the National Institute on Minority 
Health and Health Disparities), and other agencies 
of such Service. 
(19) For over a decade, the Centers for Disease 
Control and Prevention’s Viral Hepatitis Prevention 
Coordinator (VHPC) program has been the only na-
tional program dedicated to the prevention and con-
trol of the viral hepatitis epidemics administering 
the duties currently specified by Section 317N of the 
Public Health Service Act (42 U.S.C. 247b–15) at 
State and local health departments. VHPCs provide 
the technical expertise necessary for the manage-
ment and coordination of activities to prevent viral 
hepatitis infection and disease with little to no Fed-
eral funding for program implementation or develop-
ment. Further, these coordinators help integrate 
viral hepatitis prevention services into health care 
settings and public health programs that serve 
adults at risk for viral hepatitis. 
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SEC. 3. REVISION AND EXTENSION OF HEPATITIS SURVEIL-
LANCE, EDUCATION, AND TESTING PROGRAM. 
(a) IN GENERAL.—Section 317N of the Public 
Health Service Act (42 U.S.C. 247b–15) is amended— 
(1) by amending the section heading to read as 
follows: ‘‘SURVEILLANCE, EDUCATION, TESTING, 
AND LINKAGE TO CARE REGARDING HEPATITIS 
VIRUS’’; 
(2) by redesignating subsections (b) and (c) as 
subsections (d) and (e), respectively; and 
(3) by striking subsection (a) and inserting the 
following: 
‘‘(a) IN GENERAL.—The Secretary shall, in accord-
ance with this section, carry out surveillance, education, 
and testing programs with respect to hepatitis B and hep-
atitis C virus infections (referred to in this section as 
‘HBV’ and ‘HCV’, respectively). The Secretary may carry 
out such programs directly and through grants to public 
and nonprofit private entities, including States, political 
subdivisions of States, territories, Indian tribes, and pub-
lic-private partnerships. 
‘‘(b) NATIONAL SYSTEM.—In carrying out subsection 
(a), the Secretary shall, in consultation with States and 
other public or nonprofit private entities and public-pri-
vate partnerships described in subsection (d), establish a 
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national system with respect to HBV and HCV with the 
following goals: 
‘‘(1) To determine the incidence and prevalence 
of such infections, including providing for the report-
ing of acute and chronic cases. 
‘‘(2) With respect to the population of individ-
uals who have such an infection, to carry out testing 
programs to increase the number of individuals who 
are aware of their infection to 50 percent by Decem-
ber 31, 2014, and to 75 percent by December 31, 
2016. 
‘‘(3) To develop and disseminate public infor-
mation and education programs for the detection 
and control of such infections. 
‘‘(4) To improve the education, training, and 
skills of health professionals in the detection, con-
trol, and care and treatment, of such infections. 
‘‘(5) To provide appropriate referrals for coun-
seling and medical care and treatment of infected in-
dividuals and to ensure, to the extent practicable, 
the provision of appropriate follow-up services. 
‘‘(c) HIGH-RISK POPULATIONS; CHRONIC CASES.— 
‘‘(1) IN GENERAL.—The Secretary shall deter-
mine the populations that, for purposes of this sec-
tion, are considered at high-risk for HBV or HCV. 
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The Secretary shall include the following among 
those considered at high-risk: 
‘‘(A) For HBV, individuals born in coun-
tries in which 2 percent or more of the popu-
lation has HBV or who are a part of a high- 
risk category as identified by the Centers for 
Disease Control and Prevention. 
‘‘(B) For HCV, individuals born between 
1945 and 1965 or who are a part of a high-risk 
category as identified by the Centers for Dis-
ease Control and Prevention. 
‘‘(C) Those who have been exposed to the 
blood of infected individuals or of high-risk in-
dividuals or who are family members of such in-
dividuals. 
‘‘(2) PRIORITY IN PROGRAMS.—In providing for 
programs under this section, the Secretary shall give 
priority— 
‘‘(A) to early diagnosis of chronic cases of 
HBV or HCV in high-risk populations under 
paragraph (1); and 
‘‘(B) to education, and referrals for coun-
seling and medical care and treatment, for indi-
viduals diagnosed under subparagraph (A) in 
order to— 
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‘‘(i) reduce their risk of dying from 
end-stage liver disease and liver cancer, 
and of transmitting the infection to others; 
‘‘(ii) determine the appropriateness 
for treatment to reduce the risk of progres-
sion to cirrhosis and liver cancer; 
‘‘(iii) receive ongoing medical manage-
ment, including regular monitoring of liver 
function and screenings for liver cancer; 
‘‘(iv) receive, as appropriate, drug, al-
cohol abuse, and mental health treatment; 
‘‘(v) in the case of women of child-
bearing age, receive education on how to 
prevent HBV perinatal infection, and to al-
leviate fears associated with pregnancy or 
raising a family; and 
‘‘(vi) receive such other services as the 
Secretary determines to be appropriate. 
‘‘(3) CULTURAL
CONTEXT.—In providing for 
services pursuant to paragraph (2) for individuals 
who are diagnosed under subparagraph (A) of such 
paragraph, the Secretary shall seek to ensure that 
the services are provided in a culturally and linguis-
tically appropriate manner. 
‘‘(d) PUBLIC-PRIVATE PARTNERSHIPS.— 
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