Text of US HB 1774 (2011)

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- 1 tives of the United States of America in Congress assembled, 2 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 2 •HR 1774 IH SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 1 (a) SHORT TITLE.—This Act may be cited as the 2 ‘‘Increasing Access to Voluntary Screening for HIV/AIDS 3 and STIs Act of 2011’’. 4 (b) TABLE OF CONTENTS.—The table of contents for 5 this Act is as follows: 6 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. 7 Congress finds the following: 8 (1) Almost 19,000,000 new sexually trans- 9 mitted infections (STIs) occur each year in the 10 United States, and 50 percent of sexually active 11 Americans will contract a STI at some point in their 12 lives, the majority of which may be asymptomatic for 13 an extended amount of time. 14 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 3 •HR 1774 IH (2) Over 1,000,000 people in the United States 1 are living with HIV, and someone is infected with 2 HIV in the United States every 9.5 minutes. 3 (3) HIV/AIDS and STIs are syndemics. HIV 4 infection can increase a person’s risk for acquiring 5 certain STIs, as well as affect their frequency, sever- 6 ity, and healing time, while STIs increase the risk 7 of HIV transmission, impaired fertility, reproductive 8 tract cancer, and adverse pregnancy outcomes. 9 (4) Many common long-term and initially 10 asymptomatic STIs such as chlamydia, gonorrhea, 11 herpes, syphilis, inflammatory pelvic disease, viral 12 hepatitis, and HIV/AIDS remain undiagnosed, or di- 13 agnosed at later stages, leading to increased rates of 14 mortality, morbidity, disability, and transmission. 15 (5) In fact, an estimated 4.4 million Americans 16 are living with chronic hepatitis and most do not 17 know they are infected. Chronic hepatitis B can re- 18 main asymptomatic for years and, left undiagnosed 19 and untreated, can lead to serious complications. 20 Additionally, individuals infected with hepatitis C 21 virus (HCV) are at risk for chronic liver disease or 22 other HCV-related chronic diseases decades after in- 23 fection. 24 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 4 •HR 1774 IH (6) Stigma, culture, language, lack of edu- 1 cation, lack of insurance, limited time, cost and re- 2 sources in medical settings, and an inaccurate per- 3 ception of risk among communities and providers all 4 contribute to insufficient rates of screening for HIV/ 5 AIDS and STIs. 6 (7) The Centers for Disease Control and Pre- 7 vention and the United States Preventive Services 8 Task Force recognize screening as an effective pub- 9 lic health tool that allows providers to administer 10 treatment before symptoms develop and implement 11 interventions that will reduce the likelihood of HIV/ 12 AIDS and STI transmission and reduce the develop- 13 ment of adverse outcomes. 14 (8) The CDC recommends that voluntary 15 screening for HIV/AIDS be integrated into routine 16 clinical care while preserving patient confidentiality 17 and the right of the patient to decline testing and 18 screening. 19 (9) The CDC also recommends that all 20 unvaccinated, uninfected persons being evaluated for 21 a STI should receive hepatitis B vaccination. Fur- 22 thermore, anti-HCV testing is recommended for rou- 23 tine screening of asymptomatic persons based on 24 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 5 •HR 1774 IH their risk for infection or based on a recognized ex- 1 posure. 2 (10) Inaccurate perceptions of risk among 3 health care providers and patients, misdiagnosis, 4 ageism, generational mind-sets, and biological fac- 5 tors have contributed to increased rates in trans- 6 mission and late detection of HIV/AIDS and STIs 7 over the past decade. 8 (11) Health equity and disparities remain a sig- 9 nificant public health challenge, with the burden of 10 HIV/AIDS and STIs falling disproportionately on 11 different populations. 12 (12) Although African-Americans account for 13 about 12 percent of the United States population, 14 they account for nearly half of all HIV/AIDS cases 15 and infections and have higher instances of mor- 16 tality and morbidity for most STIs and HIV/AIDS. 17 Also, African-American women who have sex with 18 men account for the majority of HIV/AIDS infec- 19 tions among all women in the United States. 20 (13) HIV/AIDS continues to be most prevalent 21 among men who have sex with men (MSM). Contin- 22 ued support and increased funding for community- 23 based programs and behavioral interventions that 24 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 6 •HR 1774 IH are culturally competent are key to reaching MSM, 1 especially young MSM of color. 2 (14) Transgender persons are particularly vul- 3 nerable to contracting HIV/AIDS and STIs due to 4 high rates of survival sex among trans-females, dis- 5 crimination in education, employment, and housing, 6 and the absence of education and prevention meth- 7 ods culturally relevant to the transgender commu- 8 nity. 9 (15) Health care providers must be properly 10 educated to treat groups, such as MSM, transgender 11 persons, African-Americans, and Latinos who are 12 disproportionately affected by HIV/AIDS and other 13 STIs, and also improve interventions for groups that 14 have been historically under-represented in health 15 interventions for STIs, such as women who have sex 16 with women, individuals over the age of 50, Asian 17 and Pacific Islander Americans, Native Americans, 18 and persons living with disabilities. 19 (16) Women living with mobility impairments 20 often lack access to screening for STIs and other 21 women’s health services such as pelvic examinations 22 and mammograms due to, among other factors, the 23 lack of provider awareness, experience, and access to 24 equipment. 25 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 7 •HR 1774 IH (17) All individuals engaging in oral, anal, or 1 genital sexual contact must have access to voluntary 2 screening for HIV/AIDS and other STIs. Screening 3 must be confidential, rapid, accurate, and medically 4 appropriate. Screening must be offered regardless of 5 age, race, class, sexual behavior, sexual orientation, 6 gender identity, or disability. 7 (18) The Congress supports the goals of the 8 National HIV/AIDS Strategy and, in particular, the 9 goal of 90 percent of individuals knowing their HIV/ 10 AIDS status. 11 SEC. 3. PURPOSE. 12 The purposes of this Act are as follows: 13 (1) Increase access, quality, and affordability 14 for voluntary and medically appropriate screening 15 for HIV/AIDS and other STIs, including chlamydia, 16 gonorrhea, syphilis, viral hepatitis, and human 17 papillomavirus, for all persons engaging in various 18 forms of sexual activity, including oral, genital, or 19 anal sex. 20 (2) Reduce the spread, morbidity, and mortality 21 of HIV/AIDS and other STIs. 22 (3) Reduce the disproportionate incidence of 23 HIV/AIDS and other STIs in certain groups 24 through early detection and treatment and com- 25 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 8 •HR 1774 IH prehensive education for health care providers, cen- 1 ters, and communities. 2 (4) Support the execution of other scientifically 3 based interventions that are culturally competent 4 and age appropriate and are proven to reduce the in- 5 cidence of HIV/AIDS and other STIs. 6 SEC. 4. DEFINITIONS. 7 In this Act: 8 (1) CDC.—The term ‘‘CDC’’ means the Cen- 9 ters for Disease Control and Prevention. 10 (2) CMS.—The term ‘‘CMS’’ means the Cen- 11 ters for Medicare & Medicaid Services. 12 (3) DIRECTOR.—The term ‘‘Director’’ means 13 the Director of the Centers for Disease Control and 14 Prevention. 15 (4) HIV/AIDS.—The term ‘‘HIV/AIDS’’ means 16 infection with the human immunodeficiency virus 17 and includes acquired immune deficiency syndrome 18 and any condition arising from such syndrome. 19 (5) MSM.—The term ‘‘MSM’’ means men who 20 have sex with men. 21 (6) SECRETARY.—The term ‘‘Secretary’’ means 22 the Secretary of Health and Human Services. 23 (7) STATE.—The term ‘‘State’’ means each of 24 the 50 States, the District of Columbia, the United 25 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 9 •HR 1774 IH States Virgin Islands, Guam, the Commonwealth of 1 Puerto Rico, the Commonwealth of the Northern 2 Mariana Islands, and American Samoa. 3 (8) STI.—The term ‘‘STI’’ means a sexually 4 transmitted infection that is recognized by the CDC, 5 including chlamydia, gonorrhea, syphilis, viral hepa- 6 titis, and human papillomavirus. 7 (9) WSW.—The term ‘‘WSW’’ means women 8 who have sex with women. 9 TITLE I—COVERAGE OF HIV/ 10 AIDS AND STI SCREENING 11 UNDER PUBLIC HEALTH 12 CARE PROGRAMS AND GROUP 13 HEALTH PLANS; COVERAGE 14 OF CARE UNDER MEDICAID. 15 SEC. 101. COVERAGE OF ROUTINE HIV/AIDS AND STI 16 SCREENING TESTS UNDER MEDICAID. 17 (a) INCLUSION IN STATE PLAN.—Section 1902(a) of 18 the Social Security Act (42 U.S.C. 1396a(a)) is amended 19 in paragraph (10)(A), in the matter before clause (i), by 20 striking ‘‘and (28)’’ and inserting ‘‘(28), and (29)’’. 21 (b) INCLUSION IN MEDICAL ASSISTANCE.— 22 (1) IN GENERAL.—Section 1905(a) of the So- 23 cial Security Act (42 U.S.C. 1396d(a)) is amend- 24 ed— 25 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 10 •HR 1774 IH (A) in paragraph (28), by striking ‘‘and’’ 1 at the end; 2 (B) by redesignating paragraph (29) as 3 paragraph (30); and 4 (C) by inserting after paragraph (28) the 5 following: 6 ‘‘(29) routine HIV/AIDS and STI screening 7 services (as defined in subsection (ee)).’’. 8 (2) DEFINITION OF SERVICES.—Section 1905 9 of such Act is amended by adding at the end the fol- 10 lowing: 11 ‘‘(ee)(1) For purposes of this section, the term ‘rou- 12 tine HIV/AIDS and STI screening services’ means all of 13 the following: 14 ‘‘(A) A screening test for HIV/AIDS or 15 any other STI, if such test is provided to an in- 16 dividual who— 17 ‘‘(i) is eligible for medical assistance 18 under the State plan; and 19 ‘‘(ii) is described in clauses (ii) 20 through (v) of section 1861(iii)(1)(A). 21 ‘‘(B) Each of the services described in sub- 22 paragraphs (B) through (F) of section 23 1861(iii)(1). 24 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 11 •HR 1774 IH ‘‘(2) DEFINITIONS.—For purposes of this sub- 1 section, the terms ‘HIV/AIDS’ and ‘STI’ have the 2 same meaning given such terms in section 3 1861(iii)(2).’’. 4 (c) NO COST SHARING FOR HIV/AIDS TESTING.— 5 (1) IN GENERAL.—Section 1916(a)(2) of the 6 Social Security Act (42 U.S.C. 1396o(a)(2)) is 7 amended— 8 (A) in subparagraph (D), by striking ‘‘or’’ 9 at the end; 10 (B) in subparagraph (E), by striking ‘‘; 11 and’’ at the end and inserting ‘‘, or’’; and 12 (C) by adding at the end the following: 13 ‘‘(F) routine HIV/AIDS and STI screening 14 services (as such term is defined in section 15 1905(ee)); and’’. 16 (2) LIMITATION ON STATE OPTION FOR ALTER- 17 NATIVE COST SHARING.—Section 1916A(b)(3)(B) of 18 the Social Security Act (42 U.S.C. 1396o– 19 1(b)(3)(B)) is amended by adding at the end the fol- 20 lowing: 21 ‘‘(xi) Routine HIV/AIDS and STI 22 screening services (as such term is defined 23 in section 1905(ee)).’’. 24 (d) EFFECTIVE DATE.— 25 VerDate Mar 15 2010 06:14 May 10, 2011 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H1774.IH H1774 jbell on DSKDVH8Z91PROD with BILLS 12 •HR 1774 IH (1) IN GENERAL.—Except as provided by para- 1 graph (2), the amendments made by this section 2 shall take effect on the date of the enactment of this 3 section and shall apply to services furnished on or 4 after such date. 5 (2) RULES FOR CHANGES REQUIRING STATE 6 LEGISLATION.—In the case of a State plan for med- 7 ical assistance under title XIX of the Social Security 8 Act which the Secretary of Health and Human Serv- 9 ices determines requires State legislation (other than 10 legislation appropriating funds) in order for the plan 11 to meet the additional requirement imposed by the 12 amendments made by this section, the State plan 13 shall not be regarded as failing to comply with the 14 requirements of such title solely on the basis of its 15 failure to meet this additional requirement before 16 the first day of the first calendar quarter beginning 17 after the close of the first regular session of the 18 State legislature that begins after the date of the en- 19 actment of this Act. For purposes of the previous 20 sentence, in the case of a State that has a 2-year 21 legislative session, each year of such session shall be 22 deemed to be a separate regular session of the State 23 legislature. 24 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 13 •HR 1774 IH SEC. 102. COVERAGE OF HIV/AIDS AND STI SCREENING 1 TESTS UNDER MEDICARE. 2 Section 1861 of the Social Security Act is amended— 3 (1) in subsection (s)— 4 (A) by striking ‘‘and’’ at the end of para- 5 graph (14); 6 (B) by striking the period at the end of 7 paragraph (15) and inserting ‘‘; and’’; 8 (C) by redesignating paragraphs (16) and 9 (17) as paragraphs (17) and (18), respectively; 10 and 11 (D) by inserting after paragraph (15) the 12 following: 13 ‘‘(16) routine HIV/AIDS and STI screening 14 services (as such term is defined in subsection 15 (iii)).’’; and 16 (2) by adding at the end the following: 17 ‘‘(iii) ROUTINE HIV/AIDS AND STI SCREENING 18 SERVICES.—(1) For purposes of this section, the term 19 ‘routine HIV/AIDS and STI screening services’ means all 20 of the following: 21 ‘‘(A) A screening test for HIV/AIDS or 22 any other STI, if such test is provided in any 23 health care setting (other than an inpatient 24 hospital setting) and is provided to an indi- 25 vidual who— 26 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 14 •HR 1774 IH ‘‘(i) is enrolled in part B; 1 ‘‘(ii) is at least 13 years of age; 2 ‘‘(iii) with respect to a test for HIV/ 3 AIDS, is not known to the health care pro- 4 vider (directly, through information pro- 5 vided by the individual, or through access 6 to an electronic medical record) to have 7 had a previous positive test for HIV/AIDS; 8 ‘‘(iv) subject to subparagraph (B), 9 with respect to a test for HIV/AIDS or a 10 STI, is not known to the health care pro- 11 vider (directly, through information pro- 12 vided by the individual, or through access 13 to an electronic medical record) to have 14 had a test for the same condition within 15 the previous 6 months; and 16 ‘‘(v) has been informed that such a 17 test will be administered and has not ob- 18 jected to such a test. 19 ‘‘(B) If a test described under subpara- 20 graph (A) is reactive— 21 ‘‘(i) and is for HIV/AIDS, a confirm- 22 atory test; 23 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 15 •HR 1774 IH ‘‘(ii) and is for a STI other than HIV/ 1 AIDS, if reasonable and necessary, a con- 2 firmatory test. 3 ‘‘(C) The interpretation of any tests pro- 4 vided under subparagraph (A) and subpara- 5 graph (B). 6 ‘‘(D) Informing an individual who receives 7 a test under subparagraph (A) or subparagraph 8 (B) of the results of such tests as close in time 9 as possible to the determination of such results. 10 ‘‘(E) If an individual tests positive for 11 HIV/AIDS on a screening test under subpara- 12 graph (A) and any confirmatory test under sub- 13 paragraph (B)— 14 ‘‘(i) post-test counseling concerning 15 HIV/AIDS and STIs at the time the indi- 16 vidual is informed of the results of the 17 test; and 18 ‘‘(ii) if appropriate, a referral to med- 19 ical or mental health services. 20 ‘‘(F) If an individual tests positive for a 21 STI on a screening test under subparagraph 22 (A) and any confirmatory test under subpara- 23 graph (B), the provision of information to such 24 individual on the risk of STIs and HIV/AIDS 25 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 16 •HR 1774 IH and behaviors that reduce the risk of exposure 1 to such conditions. 2 ‘‘(2) DEFINITIONS.—For purposes of this sub- 3 section: 4 ‘‘(A) HIV/AIDS.—The term ‘HIV/AIDS’ 5 means infection with the human immuno- 6 deficiency virus and includes acquired immune 7 deficiency syndrome and any condition arising 8 from such syndrome. 9 ‘‘(B) STI.—The term ‘STI’ means a sexu- 10 ally transmitted infection or sexually trans- 11 mitted disease that is recognized by the Centers 12 for Disease Control and Prevention, including 13 chlamydia, gonorrhea, syphilis, hepatitis B, hep- 14 atitis C, and human papillomavirus.’’. 15 SEC. 103. COVERAGE FOR ROUTINE HIV/AIDS AND STI 16 SCREENING UNDER GROUP HEALTH PLANS. 17 (a) GROUP HEALTH PLANS.— 18 (1) PUBLIC HEALTH SERVICE ACT AMEND- 19 MENTS.— 20 (A) IN GENERAL.—Title XXVII of the 21 Public Health Service Act is amended by insert- 22 ing after section 2728 of such Act (42 U.S.C. 23 300gg–28), as redesignated by section 1001(2) 24 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 17 •HR 1774 IH of the Patient Protection and Affordable Care 1 Act (Public Law 111–148), the following: 2 ‘‘SEC. 2729. COVERAGE FOR ROUTINE HIV/AIDS AND STI 3 SCREENING. 4 ‘‘(a) COVERAGE.—A group health plan, and a health 5 insurance issuer providing group or individual health in- 6 surance coverage, shall provide coverage for routine HIV/ 7 AIDS and STI screening under terms and conditions that 8 are no less favorable than the terms and conditions appli- 9 cable to other routine health screenings. 10 ‘‘(b) PROHIBITIONS.—A group health plan, and a 11 health insurance issuer providing group or individual 12 health insurance coverage, shall not— 13 ‘‘(1) deny to an individual eligibility, or contin- 14 ued eligibility, to enroll or to renew coverage under 15 the terms of the plan, solely for the purpose of 16 avoiding the requirements of this section; 17 ‘‘(2) deny coverage for routine HIV/AIDS or 18 STI screening on the basis that there are no known 19 risk factors present, or the screening is not clinically 20 indicated, medically necessary, or pursuant to a re- 21 ferral, consent, or recommendation by any health 22 care provider; 23 ‘‘(3) provide monetary payments, rebates, or 24 other benefits to individuals to encourage such indi- 25 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 18 •HR 1774 IH viduals to accept less than the minimum protections 1 available under this section; 2 ‘‘(4) penalize or otherwise reduce or limit the 3 reimbursement of a provider because such provider 4 provided care to an individual participant or bene- 5 ficiary in accordance with this section; 6 ‘‘(5) provide incentives (monetary or otherwise) 7 to a provider to induce such provider to provide care 8 to an individual participant or beneficiary in a man- 9 ner inconsistent with this section; or 10 ‘‘(6) deny to an individual participant or bene- 11 ficiary continued eligibility to enroll or to renew cov- 12 erage under the terms of the plan, solely because of 13 the results of an HIV/AIDS or STI test, or other 14 HIV/AIDS and STI screening procedure, for the in- 15 dividual or any other individual. 16 ‘‘(c) RULES OF CONSTRUCTION.—Nothing in this 17 section shall be construed— 18 ‘‘(1) to require an individual who is a partici- 19 pant or beneficiary to undergo HIV/AIDS or STI 20 screening; or 21 ‘‘(2) as preventing a group health plan or issuer 22 from imposing deductibles, coinsurance, or other 23 cost-sharing in relation to HIV/AIDS or STI screen- 24 ing, except that such deductibles, coinsurance or 25 VerDate Mar 15 2010 06:14 May 10, 2011 Jkt 099200 PO 00000 Frm 00018 Fmt 6652 Sfmt 6201 E:\BILLS\H1774.IH H1774 jbell on DSKDVH8Z91PROD with BILLS 19 •HR 1774 IH other cost-sharing may not be greater than the 1 deductibles, coinsurance, or other cost-sharing im- 2 posed on other routine health screenings. 3 ‘‘(d) NOTICE.—A group health plan under this part 4 shall comply with the notice requirement under section 5 716(d) of the Employee Retirement Income Security Act 6 of 1974 with respect to the requirements of this section 7 as if such section applied to such plan. 8 ‘‘(e) PREEMPTION.—Nothing in this section shall be 9 construed to preempt any State law in effect on the date 10 of enactment of this section with respect to health insur- 11 ance coverage that requires coverage of at least the cov- 12 erage of HIV/AIDS or STI screening otherwise required 13 under this section.’’. 14 (B) APPLICATION RULE.—For purposes of 15 applying section 2729 of the Public Health 16 Service Act, as inserted by subparagraph (A), 17 to individual health insurance coverage before 18 2014, the provisions of such section shall be 19 treated as also included under part B of title 20 XXVII of the Public Health Service Act. 21 (2) ERISA AMENDMENTS.—The Employee Re- 22 tirement Income Security Act of 1974 is amended as 23 follows: 24 VerDate Mar 15 2010 06:14 May 10, 2011 Jkt 099200 PO 00000 Frm 00019 Fmt 6652 Sfmt 6201 E:\BILLS\H1774.IH H1774 jbell on DSKDVH8Z91PROD with BILLS 20 •HR 1774 IH (A) In subpart B of part 7 of subtitle B 1 of title I, by adding at the end the following 2 new section: 3 ‘‘SEC. 716. COVERAGE FOR ROUTINE HIV/AIDS AND STI 4 SCREENING. 5 ‘‘(a) COVERAGE.—A group health plan, and a health 6 insurance issuer offering group health insurance coverage, 7 shall provide coverage for routine HIV screening under 8 terms and conditions that are no less favorable than the 9 terms and conditions applicable to other routine health 10 screenings. 11 ‘‘(b) PROHIBITIONS.—A group health plan, and a 12 health insurance issuer offering group health insurance 13 coverage, shall not— 14 ‘‘(1) deny to an individual eligibility, or contin- 15 ued eligibility, to enroll or to renew coverage under 16 the terms of the plan, solely for the purpose of 17 avoiding the requirements of this section; 18 ‘‘(2) deny coverage for routine HIV screening 19 on the basis that there are no known risk factors 20 present, or the screening is not clinically indicated, 21 medically necessary, or pursuant to a referral, con- 22 sent, or recommendation by any health care pro- 23 vider; 24 VerDate Mar 15 2010 06:14 May 10, 2011 Jkt 099200 PO 00000 Frm 00020 Fmt 6652 Sfmt 6201 E:\BILLS\H1774.IH H1774 jbell on DSKDVH8Z91PROD with BILLS 21 •HR 1774 IH ‘‘(3) provide monetary payments, rebates, or 1 other benefits to individuals to encourage such indi- 2 viduals to accept less than the minimum protections 3 available under this section; 4 ‘‘(4) penalize or otherwise reduce or limit the 5 reimbursement of a provider because such provider 6 provided care to an individual participant or bene- 7 ficiary in accordance with this section; 8 ‘‘(5) provide incentives (monetary or otherwise) 9 to a provider to induce such provider to provide care 10 to an individual participant or beneficiary in a man- 11 ner inconsistent with this section; or 12 ‘‘(6) deny to an individual participant or bene- 13 ficiary continued eligibility to enroll or to renew cov- 14 erage under the terms of the plan, solely because of 15 the results of an HIV test or other HIV screening 16 procedure for the individual or any other individual. 17 ‘‘(c) RULES OF CONSTRUCTION.—Nothing in this 18 section shall be construed— 19 ‘‘(1) to require an individual who is a partici- 20 pant or beneficiary to undergo HIV/AIDS or STI 21 screening; or 22 ‘‘(2) as preventing a group health plan or issuer 23 from imposing deductibles, coinsurance, or other 24 cost-sharing in relation to HIV/AIDS or STI screen- 25 VerDate Mar 15 2010 06:14 May 10, 2011 Jkt 099200 PO 00000 Frm 00021 Fmt 6652 Sfmt 6201 E:\BILLS\H1774.IH H1774 jbell on DSKDVH8Z91PROD with BILLS 22 •HR 1774 IH ing, except that such deductibles, coinsurance or 1 other cost-sharing may not be greater than the 2 deductibles, coinsurance, or other cost-sharing im- 3 posed on other routine health screenings. 4 ‘‘(d) NOTICE UNDER GROUP HEALTH PLAN.—A 5 group health plan, and a health insurance issuer providing 6 health insurance coverage in connection with a group 7 health plan, shall provide notice to each participant and 8 beneficiary under such plan regarding the coverage re- 9 quired by this section in accordance with regulations pro- 10 mulgated by the Secretary. Such notice shall be in writing 11 and prominently positioned in any literature or cor- 12 respondence made available or distributed by the plan or 13 issuer and shall be transmitted, by whichever is earliest 14 of the following: 15 ‘‘(1) In the next mailing made by the plan or 16 issuer to the participant or beneficiary. 17 ‘‘(2) As part of any yearly informational packet 18 sent to the participant or beneficiary. 19 ‘‘(3) Not later than July 1, 2012. 20 ‘‘(e) PREEMPTION; RELATION TO STATE LAWS.— 21 ‘‘(1) IN GENERAL.—Nothing in this section 22 shall be construed to preempt any State law in effect 23 on the date of enactment of this section with respect 24 to health insurance coverage that requires coverage 25 VerDate Mar 15 2010 06:14 May 10, 2011 Jkt 099200 PO 00000 Frm 00022 Fmt 6652 Sfmt 6201 E:\BILLS\H1774.IH H1774 jbell on DSKDVH8Z91PROD with BILLS 23 •HR 1774 IH of at least the coverage of HIV/AIDS or STI screen- 1 ing otherwise required under this section. 2 ‘‘(2) ERISA.—Nothing in this section shall be 3 construed to affect or modify the provisions of sec- 4 tion 514 with respect to group health plans.’’. 5 (B) In section 732(a) of such Act (29 6 U.S.C. 1191a(a)), by striking ‘‘section 711’’ 7 and inserting ‘‘sections 711 and 716’’. 8 (C) In the table of contents in section 1 of 9 such Act, by inserting after the item relating to 10 section 715 the following new item: 11 ‘‘Sec. 716. Coverage for routine HIV/AIDS and STI screening.’’. (3) INTERNAL REVENUE CODE AMEND- 12 MENTS.—The Internal Revenue Code of 1986 is 13 amended as follows: 14 (A) In subchapter B of chapter 100, by in- 15 serting after section 9815 the following: 16 ‘‘SEC. 9816. COVERAGE FOR ROUTINE HIV/AIDS AND STI 17 SCREENING. 18 ‘‘(a) COVERAGE.—A group health plan shall provide 19 coverage for routine HIV/AIDS and STI screening under 20 terms and conditions that are no less favorable than the 21 terms and conditions applicable to other routine health 22 screenings. 23 ‘‘(b) PROHIBITIONS.—A group health plan shall 24 not— 25 VerDate Mar 15 2010 06:14 May 10, 2011 Jkt 099200 PO 00000 Frm 00023 Fmt 6652 Sfmt 6201 E:\BILLS\H1774.IH H1774 jbell on DSKDVH8Z91PROD with BILLS 24 •HR 1774 IH ‘‘(1) deny to an individual eligibility, or contin- 1 ued eligibility, to enroll or to renew coverage under 2 the terms of the plan, solely for the purpose of 3 avoiding the requirements of this section; 4 ‘‘(2) deny coverage for routine HIV/AIDS or 5 STI screening on the basis that there are no known 6 risk factors present, or the screening is not clinically 7 indicated, medically necessary, or pursuant to a re- 8 ferral, consent, or recommendation by any health 9 care provider; 10 ‘‘(3) provide monetary payments, rebates, or 11 other benefits to individuals to encourage such indi- 12 viduals to accept less than the minimum protections 13 available under this section; 14 ‘‘(4) penalize or otherwise reduce or limit the 15 reimbursement of a provider because such provider 16 provided care to an individual participant or bene- 17 ficiary in accordance with this section; 18 ‘‘(5) provide incentives (monetary or otherwise) 19 to a provider to induce such provider to provide care 20 to an individual participant or beneficiary in a man- 21 ner inconsistent with this section; or 22 ‘‘(6) deny to an individual participant or bene- 23 ficiary continued eligibility to enroll or to renew cov- 24 erage under the terms of the plan, solely because of 25 VerDate Mar 15 2010 06:14 May 10, 2011 Jkt 099200 PO 00000 Frm 00024 Fmt 6652 Sfmt 6201 E:\BILLS\H1774.IH H1774 jbell on DSKDVH8Z91PROD with BILLS 25 •HR 1774 IH the results of an HIV/AIDS or STI test, or other 1 HIV/AIDS and STI screening procedure, for the in- 2 dividual or any other individual. 3 ‘‘(c) RULES OF CONSTRUCTION.—Nothing in this 4 section shall be construed— 5 ‘‘(1) to require an individual who is a partici- 6 pant or beneficiary to undergo HIV/AIDS or STI 7 screening; or 8 ‘‘(2) as preventing a group health plan or issuer 9 from imposing deductibles, coinsurance, or other 10 cost-sharing in relation to HIV/AIDS or STI screen- 11 ing, except that such deductibles, coinsurance or 12 other cost-sharing may not be greater than the 13 deductibles, coinsurance, or other cost-sharing im- 14 posed on other routine health screenings.’’. 15 (B) In the table of contents for such sub- 16 chapter, by inserting after the item relating to 17 section 9815 the following new item: 18 ‘‘Sec. 9816. Coverage for HIV/AIDS and STI screening.’’. (C) In section 4980D(d)(1), by striking 19 ‘‘section 9811’’ and inserting ‘‘sections 9811 20 and 9816’’. 21 (b) APPLICATION UNDER FEDERAL EMPLOYEES 22 HEALTH BENEFITS PROGRAM.—Section 8902 of title 5, 23 United States Code, is amended by adding at the end the 24 following new subsection: 25 VerDate Mar 15 2010 06:14 May 10, 2011 Jkt 099200 PO 00000 Frm 00025 Fmt 6652 Sfmt 6201 E:\BILLS\H1774.IH H1774 jbell on DSKDVH8Z91PROD with BILLS 26 •HR 1774 IH ‘‘(p) A contract may not be made or a plan approved 1 which does not comply with the requirements of section 2 2729 of the Public Health Service Act.’’. 3 (c) EFFECTIVE DATES.—Notwithstanding any other 4 provision of law, the amendments made by subsections (a) 5 and (b) shall apply with respect to plan years beginning 6 on or after July 1, 2012, and with respect to health insur- 7 ance coverage issued on or after such date. 8 (d) COORDINATION OF ADMINISTRATION.—The Sec- 9 retary of Labor, the Secretary of Health and Human Serv- 10 ices, and the Secretary of the Treasury shall ensure, 11 through the execution of an interagency memorandum of 12 understanding among such Secretaries, that— 13 (1) regulations, rulings, and interpretations 14 issued by such Secretaries relating to the same mat- 15 ter over which two or more such Secretaries have re- 16 sponsibility under the provisions of this section (and 17 the amendments made thereby) are administered so 18 as to have the same effect at all times; and 19 (2) coordination of policies relating to enforcing 20 the same requirements through such Secretaries in 21 order to have a coordinated enforcement strategy 22 that avoids duplication of enforcement efforts and 23 assigns priorities in enforcement. 24 VerDate Mar 15 2010 06:14 May 10, 2011 Jkt 099200 PO 00000 Frm 00026 Fmt 6652 Sfmt 6201 E:\BILLS\H1774.IH H1774 jbell on DSKDVH8Z91PROD with BILLS 27 •HR 1774 IH SEC. 104. OPTIONAL MEDICAID COVERAGE OF LOW-INCOME 1 HIV/AIDS INFECTED INDIVIDUALS. 2 (a) IN GENERAL.—Section 1902 of the Social Secu- 3 rity Act (42 U.S.C. 1396a) is amended— 4 (1) in subsection (a)(10)(A)(ii)— 5 (A) by striking ‘‘or’’ at the end of sub- 6 clause (XXI); 7 (B) by adding ‘‘or’’ at the end of subclause 8 (XXII); and 9 (C) by adding at the end the following: 10 ‘‘(XXIII) on or before December 11 31, 2013, who are described in sub- 12 section (ll) (relating to HIV/AIDS in- 13 fected individuals);’’; and 14 (2) by adding at the end the following: 15 ‘‘(ll) individuals described in this subsection are indi- 16 viduals— 17 ‘‘(1) who are not described in subsection 18 (a)(10)(A)(i); 19 ‘‘(2) who have HIV/AIDS, as defined under 20 section 1905(ee); 21 ‘‘(3) whose income (as determined under the 22 State plan under this title with respect to disabled 23 individuals) does not exceed the maximum amount 24 of income a disabled individual described in sub- 25 VerDate Mar 15 2010 06:14 May 10, 2011 Jkt 099200 PO 00000 Frm 00027 Fmt 6652 Sfmt 6201 E:\BILLS\H1774.IH H1774 jbell on DSKDVH8Z91PROD with BILLS 28 •HR 1774 IH section (a)(10)(A)(i) may have to obtain medical as- 1 sistance under the plan; and 2 ‘‘(4) whose resources (as determined under the 3 State plan under this title with respect to disabled 4 individuals) do not exceed the maximum amount of 5 resources a disabled individual described in sub- 6 section (a)(10)(A)(i) may have to obtain medical as- 7 sistance under the plan.’’. 8 (b) ENHANCED MATCH.— 9 (1) IN GENERAL.—The first sentence of section 10 1905(b) of the Social Security Act (42 U.S.C. 11 1396d(b)) is amended by striking ‘‘section 12 1902(a)(10)(A)(ii)(XVIII)’’ and inserting ‘‘subclause 13 (XVIII) and subclause (XXIII) of section 14 1902(a)(10)(A)(ii)’’. 15 (2) CONFORMING AMENDMENTS.—Section 16 1905(a) of the Social Security Act (42 U.S.C. 17 1396d(a)) is amended in the matter preceding para- 18 graph (1)— 19 (A) by striking ‘‘or’’ at the end of clause 20 (xv); 21 (B) by striking ‘‘or’’ at the end of clause 22 (xvi), as amended by Public Law 111–148; 23 (C) by adding ‘‘or’’ at the end of clause 24 (xvii); and 25 VerDate Mar 15 2010 06:14 May 10, 2011 Jkt 099200 PO 00000 Frm 00028 Fmt 6652 Sfmt 6201 E:\BILLS\H1774.IH H1774 jbell on DSKDVH8Z91PROD with BILLS 29 •HR 1774 IH (D) by inserting after clause (xvii) the fol- 1 lowing: 2 ‘‘(xviii) individuals described in sec- 3 tion 1902(a)(10)(A)(ii)(XXIII);’’. 4 (c) EXEMPTION FROM FUNDING LIMITATION FOR 5 TERRITORIES.—Section 1108(g) of the Social Security 6 Act (42 U.S.C. 1308(g)) is amended by adding at the end 7 the following: 8 ‘‘(6) DISREGARDING MEDICAL ASSISTANCE FOR 9 OPTIONAL LOW-INCOME HIV/AIDS INFECTED INDI- 10 VIDUALS.—The limitations under subsection (f) and 11 the previous provisions of this subsection shall not 12 apply to amounts expended for medical assistance 13 for individuals described in section 1902(ll) who are 14 only eligible for such assistance on the basis of sec- 15 tion 1902(a)(10)(A)(ii)(XXIII).’’. 16 (d) EFFECTIVE DATE.— 17 (1) IN GENERAL.—Except as provided by para- 18 graph (2), the amendments made by this section 19 shall take effect on the date of the enactment of this 20 section and shall apply to services furnished on or 21 after such date. 22 (2) RULES FOR CHANGES REQUIRING STATE 23 LEGISLATION.—In the case of a State plan for med- 24 ical assistance under title XIX of the Social Security 25 VerDate Mar 15 2010 06:14 May 10, 2011 Jkt 099200 PO 00000 Frm 00029 Fmt 6652 Sfmt 6201 E:\BILLS\H1774.IH H1774 jbell on DSKDVH8Z91PROD with BILLS 30 •HR 1774 IH Act which the Secretary of Health and Human Serv- 1 ices determines requires State legislation (other than 2 legislation appropriating funds) in order for the plan 3 to meet the additional requirement imposed by the 4 amendments made by this section, the State plan 5 shall not be regarded as failing to comply with the 6 requirements of such title solely on the basis of its 7 failure to meet this additional requirement before 8 the first day of the first calendar quarter beginning 9 after the close of the first regular session of the 10 State legislature that begins after the date of the en- 11 actment of this Act. For purposes of the previous 12 sentence, in the case of a State that has a 2-year 13 legislative session, each year of such session shall be 14 deemed to be a separate regular session of the State 15 legislature. 16 TITLE II—INCREASED DATA COL- 17 LECTION AND EDUCATION 18 FOR HISTORICALLY UNDER- 19 REPRESENTED POPULATIONS 20 SEC. 201. PEOPLE LIVING WITH DISABILITIES. 21 (a) TRACKING OF INFORMATION.—The Director 22 shall— 23 (1) track national HIV/AIDS and STI screen- 24 ing trends and the burdens of HIV/AIDS and STIs 25 VerDate Mar 15 2010 06:14 May 10, 2011 Jkt 099200 PO 00000 Frm 00030 Fmt 6652 Sfmt 6201 E:\BILLS\H1774.IH H1774 jbell on DSKDVH8Z91PROD with BILLS 31 •HR 1774 IH among people with disabilities, including such per- 1 sons with mental, physical, cognitive, intellectual, or 2 developmental disabilities; and 3 (2) identify and assess the barriers that prevent 4 such persons from accessing HIV/AIDS and STI 5 screening. 6 (b) TRACKING METHODOLOGY.— 7 (1) IN GENERAL.—The tracking methods used 8 by the Secretary under subsection (a) shall— 9 (A) focus upon historically under-rep- 10 resented communities, including the deaf and 11 hearing loss-related community and the cog- 12 nitive, intellectual, developmental, mobility, or 13 mental health disability communities; and 14 (B) consider other factors that may con- 15 tribute to increased burdens of HIV/AIDS and 16 STIs, including race, socio-economic status, re- 17 gion, gender identity, and sexual behavior. 18 (2) SEXUAL ASSAULT DATA.—Tracking under 19 subsection (a) shall include data collection on the in- 20 cidence of sexual assault on people with mental, 21 physical, cognitive, intellectual, or developmental dis- 22 abilities for the purposes of understanding the prev- 23 alence of HIV/AIDS and STIs that result from such 24 assaults. 25 VerDate Mar 15 2010 06:14 May 10, 2011 Jkt 099200 PO 00000 Frm 00031 Fmt 6652 Sfmt 6201 E:\BILLS\H1774.IH H1774 jbell on DSKDVH8Z91PROD with BILLS 32 •HR 1774 IH (c) DEAF AND HEARING LOSS COMMUNITY.— 1 (1) IN GENERAL.—The Secretary, acting 2 through the Director, shall work with appropriate 3 organizations and institutions to make comprehen- 4 sive sex education materials that promote voluntary 5 screening for HIV/AIDS and STIs accessible to the 6 deaf and hearing loss community through language 7 (including American Sign Language), modalities (in- 8 cluding highly graphic formats with minimal text), 9 and culturally appropriate information delivery. 10 (2) HEALTH CAREERS AND EDUCATION.—The 11 Secretary shall— 12 (A) work with appropriate individuals, or- 13 ganizations, and institutions to increase the 14 number of people who are deaf or living with 15 hearing loss in public health careers for the 16 purposes of— 17 (i) building the public health infra- 18 structure to improve data collection; and 19 (ii) health information dissemination 20 to people who are deaf or who live with 21 hearing loss; and 22 (B) engage students in elementary school, 23 high school, college, and graduate school for the 24 purposes of carrying out this paragraph. 25 VerDate Mar 15 2010 06:14 May 10, 2011 Jkt 099200 PO 00000 Frm 00032 Fmt 6652 Sfmt 6201 E:\BILLS\H1774.IH H1774 jbell on DSKDVH8Z91PROD with BILLS 33 •HR 1774 IH (d) COGNITIVE AND INTELLECTUAL DISABILITY 1 COMMUNITY.—The Secretary, acting through the Direc- 2 tor, shall work with appropriate national and local organi- 3 zations to make comprehensive sex education materials ac- 4 cessible to people with intellectual disabilities by— 5 (1) using plain language; 6 (2) educating service providers about the signs 7 and symptoms of sexual assault among people with 8 cognitive and intellectual disabilities; and 9 (3) using other appropriate information delivery 10 strategies. 11 (e) WOMEN LIVING WITH SEVERE PHYSICAL DIS- 12 ABILITIES.—The Secretary, acting through the Director, 13 shall work with Federal, State, and local entities to track 14 access to pelvic examinations, mammograms, and other 15 women’s health services for women with severe mobility 16 impairments with the goal of improving access to such 17 services. 18 SEC. 202. WOMEN WHO HAVE SEX WITH WOMEN. 19 (a) NATIONAL SCREENING GUIDELINES.—The Sec- 20 retary, acting through the Director, shall work with Fed- 21 eral, State, and local health entities to ensure that na- 22 tional screening guidelines for cervical cancer state that 23 WSW should be subject to the same screening guidelines 24 for cervical cancer as women who have sex only with men. 25 VerDate Mar 15 2010 06:14 May 10, 2011 Jkt 099200 PO 00000 Frm 00033 Fmt 6652 Sfmt 6201 E:\BILLS\H1774.IH H1774 jbell on DSKDVH8Z91PROD with BILLS 34 •HR 1774 IH (b) INFORMATION COLLECTION.—The Secretary, act- 1 ing through the Director, shall, with respect to the WSW 2 community— 3 (1) track national trends in screening for HIV/ 4 AIDS and other STIs; and 5 (2) collect information on— 6 (A) the burdens and behavior of HIV/ 7 AIDS and STIs; and 8 (B) other reproductive health concerns. 9 SEC. 203. TRANSGENDER COMMUNITY. 10 (a) DATA COLLECTION.—The Secretary, acting 11 through the Director, shall work with Federal, State, and 12 local health entities and transgender communities to im- 13 prove information collection concerning the transmission, 14 morbidity, and screening for HIV/AIDS and other STIs 15 in transgender communities. 16 (b) INFORMATION CLASSIFICATION.—For purposes 17 of acquiring a comprehensive understanding of the unique 18 health trends among, and aspects of, the transgender com- 19 munity, the Secretary shall promulgate regulations requir- 20 ing that, for purposes of public health studies requiring 21 data collection, the fact that an individual is transgender 22 shall be a distinct category and data point. 23 VerDate Mar 15 2010 06:14 May 10, 2011 Jkt 099200 PO 00000 Frm 00034 Fmt 6652 Sfmt 6201 E:\BILLS\H1774.IH H1774 jbell on DSKDVH8Z91PROD with BILLS 35 •HR 1774 IH SEC. 204. REPORT. 1 (a) IN GENERAL.—Not later than 3 years after the 2 date of the enactment of this Act, the Secretary shall sub- 3 mit a report to Congress on the activities required under 4 this Act. 5 (b) CONTENTS.—The report issued to Congress 6 under subsection (a) shall include— 7 (1) information on the success of voluntary 8 screening for HIV/AIDS and STIs, as well as other 9 methods for preventing the transmission of HIV/ 10 AIDS and STIs among Medicaid and Medicare 11 beneficiaries, patients at federally qualified health 12 centers, individuals with health insurance, MSM, 13 WSW, persons living with disabilities, the 14 transgender community, and other groups that have 15 been historically underrepresented in public health 16 interventions for HIV/AIDS and STIs; and 17 (2) recommendations on how to improve exist- 18 ing measures with respect to race, socioeconomic 19 status, region, gender identity, disability, age, and 20 sexual behavior— 21 (A) to increase access to screening; and 22 (B) to decrease the disparities in mortality 23 and morbidity from HIV/AIDS and other STIs. 24 Æ VerDate Mar 15 2010 06:14 May 10, 2011 Jkt 099200 PO 00000 Frm 00035 Fmt 6652 Sfmt 6301 E:\BILLS\H1774.IH H1774 jbell on DSKDVH8Z91PROD with BILLS