SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Increasing Access to 
Voluntary Screening for HIV/AIDS and STIs Act of 
2009’’. 
SEC. 2. FINDINGS. 
Congress finds the following: 
(1) Over 15,000,000 sexually transmitted infec-
tions are reported each year, and 50 percent of sexu-
ally active Americans will contract an STI at some 
point in their lives, the majority of which may be 
asymptomatic for an extended amount of time. 
(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) Many common long-term and initially 
asymptomatic STIs such as chlamydia, gonorrhea, 
herpes, syphilis, inflammatory pelvic disease, and 
HIV/AIDS remain undiagnosed, or diagnosed at 
later stages, leading to increased rates of mortality, 
morbidity, disability, and transmission. 
(4) 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. 
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(5) 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. 
(6) 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. 
(7) Nearly 25 percent of persons living with 
HIV/AIDS are age 50 years or older, and the overall 
HIV/AIDS population is aging due to life-extending 
anti-retroviral drugs. 
(8) Inaccurate perceptions of risk among health 
care providers and patients, misdiagnosis, ageism, 
generational mind-sets, and biological factors have 
contributed to increased rates in transmission and 
late detection of HIV/AIDS and STIs over the past 
decade. 
(9) Although African-Americans account for 
about 13 percent of the United States population, 
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they account for nearly half of all HIV/AIDS infec-
tions and have higher instances of mortality and 
morbidity for most STIs and HIV/AIDS. Also, Afri-
can-American women who have sex with men ac-
count for the majority of HIV/AIDS infections 
among all women in the United States. 
(10) HIV/AIDS continues to be most prevalent 
among men who have sex with men. Continued sup-
port and increased funding for community-based 
programs and behavioral interventions that are cul-
turally competent are key to reaching MSM, espe-
cially young MSM of color. 
(11) 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. 
(12) 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 
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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. 
(13) 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 inacces-
sible equipment. 
(14) 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, gender identity, or 
disability. 
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, and human papillomavirus, for 
all persons engaging in various forms of sexual ac-
tivity, including oral, genital, or anal sex. 
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(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-
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. 
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(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 Virgin 
Islands, Guam, and Puerto Rico. 
(8) STI.—The term ‘‘STI’’ means a sexually 
transmitted infection that is recognized by the CDC, 
including chlamydia, gonorrhea, syphilis, and human 
papillomavirus. 
(9) WSW.—The term ‘‘WSW’’ women who 
have sex with women. 
TITLE I—HEALTH CARE 
PROGRAMS 
SEC. 101. MEDICAID. 
(a) HIGHER FEDERAL MATCHING PERCENTAGE FOR 
ROUTINE HIV/AIDS AND STI SCREENING SERVICES.— 
Section 1903 of the Social Security Act (42 U.S.C. 1396b) 
is amended— 
(1) in subsection (a)— 
(A) by redesignating paragraph (7) as 
paragraph (8); and 
(B) by inserting after paragraph (6) the 
following new paragraph: 
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‘‘(7) an amount equal to 83 percent of the 
sums expended during such quarter which are at-
tributable to the costs of providing routine HIV/ 
AIDS and STI screening services (as defined in sub-
section (aa)(1)) if the conditions described in sub-
section (aa)(2) are met; plus’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(aa) ROUTINE HIV/AIDS AND STI SCREENING 
SERVICES.— 
‘‘(1) IN GENERAL.—For purposes of this sec-
tion, the term ‘routine HIV/AIDS and STI screening 
services’ means the following: 
‘‘(A) An HIV/AIDS or STI screening test 
(and, if such test is reactive, a confirmatory 
test), including the interpretation of such tests, 
that is provided as part of medical care in any 
health care setting (other than an inpatient 
hospital setting) for an individual who— 
‘‘(i) is at least 13 years of age, and in 
the case of a beneficiary who is under 13 
years of age if the appropriate health care 
provider reasonably determines that the 
beneficiary is at risk for infection; 
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‘‘(ii) is not known to the health care 
provider (directly, through information 
provided by the individual, or through ac-
cess to an electronic medical record) pre-
viously ever to have had a positive test for 
HIV/AIDS or an STI or, subject to para-
graph (3), within the previous 6 months to 
have had any test for HIV/AIDS or an 
STI; and 
‘‘(iii) has been informed that such a 
test will be administered and has not ob-
jected to such a test. 
‘‘(B) Informing an individual so tested of 
the results of the tests at the time of such ex-
amination. 
‘‘(C) In the case of such an individual who 
tests positive for HIV/AIDS on the screening 
and confirmatory tests, 
‘‘(i) post-test counseling concerning 
HIV/AIDS at the time, and as part of, 
such examination; or 
‘‘(ii) a referral to appropriate medical 
or mental health services. 
‘‘(2) CONDITIONS.—For purposes of subsection 
(a)(7), the conditions of this paragraph, with respect 
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to routine HIV/AIDS or STI screening services, are 
that— 
‘‘(A) the payment amount for such services 
under this title is reasonable and closely ap-
proximates the payment amount for such serv-
ices under part B of title XVIII; 
‘‘(B) no cost-sharing is imposed under this 
title for the provision of such services; and 
‘‘(C) in the case of a State for which a po-
litical subdivision is required to contribute to-
wards the non-Federal share of expenditures for 
routine HIV/AIDS or STI screening services, 
the increase in the Federal share applicable 
under subsection (a)(5) to such services is first 
applied to reduce the contribution (but not 
below zero) required by such political subdivi-
sion. 
‘‘(3) 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. 
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‘‘(B) STI.—The term ‘STI’ means a sexu-
ally transmitted infection that is recognized by 
the CDC, including chlamydia, gonorrhea, 
syphilis, and human papillomavirus.’’. 
(b) CONFORMING AMENDMENTS.— 
(1) Subparagraphs (E) and (F) of section 
1919(h)(2) of such Act (42 U.S.C. 1396r(h)(2)) are 
each amended by striking ‘‘1903(a)(7)’’ and insert-
ing ‘‘1903(a)(8)’’. 
(2) Paragraphs (1) and (2) of section 1931(h) 
of such Act (42 U.S.C. 1396u–1(h)) are each 
amended by striking ‘‘1903(a)(7)’’ and inserting 
‘‘1903(a)(8)’’. 
(3) Section 1938(d)(4) of such Act (42 U.S.C. 
1396u–8(d)(4)) 
is 
amended 
by 
striking 
‘‘1903(a)(7)’’ and inserting ‘‘1903(a)(8)’’. 
(4) Section 1940(j) of such Act (42 U.S.C. 
1396w(j)) is amended by striking ‘‘paragraph (7)’’ 
and inserting ‘‘paragraph (8)’’. 
(c) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply to services furnished on or after 
the date of the enactment of this section. 
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SEC. 
102. 
SCREENING 
TESTS 
FOR 
MEDICARE 
BENE-
FICIARIES. 
(a) BROAD APPROACH.—The Administrator of the 
Centers for Medicare & Medicaid Services should adopt 
a broad approach in implementing a policy towards vol-
untary screening for HIV/AIDS and STIs for all Medicare 
eligible individuals who are 13 years of age or older. 
(b) TESTS AND REIMBURSEMENT.—In carrying out 
such approach, the Administrator of CMS should— 
(1) give confirmatory tests for HIV/AIDS and 
STIs to Medicare eligible individuals who are 13 
years of age or older with reactive results for HIV/ 
AIDS or STIs and provide Medicare reimbursement 
for such tests; and 
(2) reimburse Medicare eligible individuals who 
are 13 years of age or older for blood and rapid oral 
swab HIV/AIDS tests and STI blood tests. 
SEC. 103. VOLUNTARY SCREENING BY FEDERALLY QUALI-
FIED HEALTH CENTERS. 
(a) GRANTS.—The Secretary, acting through the Ad-
ministrator of the Health Resources and Services Admin-
istration, may award grants to Federally qualified health 
centers to provide, as part of medical care in a health care 
setting, voluntary screening for HIV/AIDS and STIs to 
eligible individuals. 
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(b) SECONDARY PAYOR PROVISION.—A Federally 
qualified health center that receives a grant under this 
section may not use funds from such grant to pay for a 
screening test if payment has been made for such test, 
or payment can reasonably be expected to be made— 
(1) under an insurance policy; 
(2) under a Federal or State health benefits 
program, including titles XIX and XXI of the Social 
Security Act; or 
(3) by an entity that provides health services on 
a prepaid basis. 
(c) DEFINITIONS.—In this section: 
(1) ELIGIBLE INDIVIDUAL.—The term ‘‘eligible 
individual’’ means an individual who— 
(A) can give legal consent under the laws 
of his or her State; 
(B) has been informed by a healthcare pro-
vider that a screening test for HIV/AIDS or 
STIs will be administered; and 
(C) has not objected to such test. 
(2) FEDERALLY
QUALIFIED
HEALTH
CEN-
TER.—The term ‘‘Federally qualified health center’’ 
has the meaning given such term under section 
1861(aa)(4) of the Social Security Act (42 U.S.C. 
1395ww). 
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(3) SCREENING.—The term ‘‘screening’’ in-
cludes— 
(A) the interpretation of screening tests; 
and 
(B) in the case of a reactive result for an 
initial screening test for HIV/AIDS or STIs, a 
confirmatory test. 
SEC. 104. COVERAGE FOR ROUTINE HIV/AIDS AND STI 
SCREENING UNDER GROUP HEALTH PLANS. 
(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: 
‘‘SEC. 2708. COVERAGE FOR ROUTINE HIV/AIDS AND STI 
SCREENING. 
‘‘(a) COVERAGE.—A group health plan, and a health 
insurance issuer offering group health insurance coverage, 
shall provide coverage for routine HIV/AIDS and STI 
screening under terms and conditions that are no less fa-
vorable 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— 
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‘‘(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-
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 
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the results of an HIV/AIDS or STI test, or other 
HIV/AIDS and STI screening procedure, for the in-
dividual 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/AIDS or STI 
screening; or 
‘‘(2) as preventing a group health plan or issuer 
from imposing deductibles, coinsurance, or other 
cost-sharing in relation to HIV/AIDS or STI screen-
ing, except that such deductibles, coinsurance or 
other cost-sharing may not be greater than the 
deductibles, coinsurance, or other cost-sharing im-
posed 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 
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-
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erage of HIV/AIDS or STI screening otherwise required 
under this section.’’. 
(2) ERISA AMENDMENTS.—The Employee Re-
tirement Income Security Act of 1974 is amended as 
follows: 
(A) In subpart B of part 7 of subtitle B 
of title I, by adding at the end the following 
new section: 
‘‘SEC. 715. COVERAGE FOR ROUTINE HIV/AIDS AND STI 
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 
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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. 
‘‘(c) RULES OF CONSTRUCTION.—Nothing in this 
section shall be construed— 
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‘‘(1) to require an individual who is a partici-
pant or beneficiary to undergo HIV/AIDS or STI 
screening; or 
‘‘(2) as preventing a group health plan or issuer 
from imposing deductibles, coinsurance, or other 
cost-sharing in relation to HIV/AIDS or STI screen-
ing, except that such deductibles, coinsurance or 
other cost-sharing may not be greater than the 
deductibles, coinsurance, or other cost-sharing im-
posed 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, by whichever is earliest 
of the following: 
‘‘(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. 
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