Text of US HB 6138 (2012)

I 112TH CONGRESS 2D SESSION H. R. 6138 To bring an end to the spread of HIV/AIDS in the United States and around the world. IN THE HOUSE OF REPRESENTATIVES JULY 18, 2012 Ms. LEE of California (for herself, Mr. MORAN, Ms. CLARKE of New York, Ms. SCHAKOWSKY, Ms. NORTON, Mr. SCHIFF, Ms. WOOLSEY, Mr. TOWNS, Mr. NADLER, Mr. CONYERS, Mr. RANGEL, Mr. HINCHEY, Mr. SERRANO, Mr. JOHNSON of Georgia, Mr. HONDA, Ms. MCCOLLUM, Mr. ENGEL, Mr. HIMES, Mr. MCDERMOTT, Ms. CHU, Mr. LEWIS of Georgia, Ms. BASS of California, Mrs. CHRISTENSEN, Ms. LINDA T. SA´NCHEZ of California, Ms. WATERS, Mr. RUSH, and Mr. GRIJALVA) introduced the following bill; which was referred to the Committee on Energy and Com- merce, and in addition to the Committees on Foreign Affairs, Education and the Workforce, the Judiciary, Armed Services, Financial Services, and Ways and Means, 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 committee concerned A BILL To bring an end to the spread of HIV/AIDS in the United States and around the world. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Ending the HIV/AIDS 4 Epidemic Act of 2012’’. 5 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 2 •HR 6138 IH SEC. 2. TABLE OF CONTENTS. 1 The table of contents of this Act is as follows: 2 Sec. 1. Short title. Sec. 2. Table of contents. Sec. 3. Statement of policy. Sec. 4. Findings. Sec. 5. Nondiscrimination. DIVISION A—ENDING HIV/AIDS IN THE UNITED STATES TITLE I—INCREASING AND TARGETING INVESTMENT TO MAXIMIZE PREVENTION AND TREATMENT IMPACT Sec. 101. Additional funding for AIDS Drug Assistance Program treatments. Sec. 102. Enhancing the national HIV surveillance system. Sec. 103. Evidence-based strategies for improving linkage to and retention in appropriate care. Sec. 104. Improving entry into and retention in care and antiretroviral adher- ence for persons with HIV. Sec. 105. Health care professionals treating individuals with HIV/AIDS. Sec. 106. HIV/AIDS provider loan repayment program. Sec. 107. Reducing new HIV infections among injecting drug users. Sec. 108. Support for expansion of comprehensive sexual health and education programs. Sec. 109. Elimination of abstinence-only education program. TITLE II—ENDING STIGMA AND DISCRIMINATION THAT INHIBIT ACCESS TO CARE AND MAKE PEOPLE MORE VULNERABLE Sec. 201. Review of all Federal and State laws, policies, and regulations regard- ing the criminal prosecution of individuals for HIV-related of- fenses. TITLE III—ADDRESSING LEGAL AND POLICY BARRIERS TO ACCESSING HEALTH CARE Sec. 301. Repeal of limitation against use of funds for education or information designed to promote or encourage, directly, homosexual or het- erosexual activity or intravenous substance abuse. Sec. 302. Expanding support for condoms in prisons. Sec. 303. Automatic reinstatement or enrollment in Medicaid for people who test positive for HIV before reentering communities. TITLE IV—COORDINATING EFFORTS TO DRIVE GREATER EFFICIENCY AND IMPROVED RESULTS Sec. 401. Support data system review and indicators for monitoring HIV care. Sec. 402. Transfer of funds for implementation of National HIV/AIDS Strat- egy. Sec. 403. HIV integrated services delivery model demonstration. Sec. 404. Report on the implementation of the National HIV/AIDS Strategy. DIVISION B—ENDING HIV/AIDS GLOBALLY TITLE X—GLOBAL HIV/AIDS-FREE GENERATION STRATEGY VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6211 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 3 •HR 6138 IH Sec. 1001. Global HIV/AIDS-Free Generation Strategy. TITLE XI—USING FUNDS STRATEGICALLY TO MAXIMIZE RESULTS Sec. 1101. Support for operations research to improve program delivery, effi- ciency, impact, and effectiveness. Sec. 1102. Increasing coordination and integration of HIV/AIDS programs with development programs. Sec. 1103. Increasing program effectiveness and sustainability to achieve suc- cessful country ownership. TITLE XII—ADDRESSING LEGAL AND POLICY BARRIERS TO ACCESSING HEALTH CARE Subtitle A—General Provisions Sec. 1201. Support for laws and regulations that improve health outcomes and promote human rights. Sec. 1202. Intensifying efforts to establish effective programs for engaging key affected populations. Sec. 1203. Ensuring United States trade policy does not restrict access to af- fordable medicines. Subtitle B—Repeal of Certain Provisions of Public Law 108–25 Sec. 1211. Repeal of ‘‘conscience clause’’ requirement for eligibility for assist- ance. Sec. 1212. Repeal of limitation on use of funds for assistance for sex workers. Sec. 1213. Repeal of reporting requirement on activities promoting abstinence and related activities. Sec. 1214. Effective date. TITLE XIII—DEFINITIONS Sec. 1301. Definitions. SEC. 3. STATEMENT OF POLICY. 1 It is the policy of the United States to achieve an 2 AIDS-free generation, and to— 3 (1) expand access to lifesaving antiretroviral 4 therapy for people living with HIV/AIDS and imme- 5 diately link people to continuous and coordinated 6 high-quality care when they learn they are infected 7 with HIV; 8 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 4 •HR 6138 IH (2) expand targeted efforts to prevent HIV in- 1 fection using a combination of effective, evidence- 2 based approaches, including the elimination of new 3 pediatric HIV infections worldwide, routine HIV 4 screening, and universal access to HIV prevention 5 tools in the communities where HIV/AIDS is most 6 heavily concentrated; 7 (3) ensure laws, policies, and regulations do not 8 impede access to prevention, treatment, and care for 9 people living with HIV/AIDS or at risk for acquiring 10 HIV; 11 (4) accelerate research for more efficacious HIV 12 prevention and treatments tools, a cure, and a vac- 13 cine; and 14 (5) respect the human rights and dignity of 15 persons living with HIV/AIDS. 16 SEC. 4. FINDINGS. 17 The Congress makes the following findings: 18 (1) An estimated 34,000,000 people around the 19 world were living with HIV at the end of 2010, up 20 from 8,000,000 in 1990. 21 (2) The annual number of new HIV infections 22 has gradually declined, and due to the significant in- 23 crease in people receiving antiretroviral therapy, the 24 number of AIDS-related deaths has also declined. 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 5 •HR 6138 IH (3) Over 1,200,000 people are estimated to be 1 living with HIV in the United States according to 2 the Centers for Disease Control and Prevention. 3 (4) One in five individuals living with HIV/ 4 AIDS in the United States is unaware of being in- 5 fected, and significant disparities persist across dif- 6 ferent communities and populations with regard to 7 incidence of infection, access to treatment, and 8 health outcomes. 9 (5) Each year, 50,000 people become newly in- 10 fected with HIV in the United States. 11 (6) Among women, the rate of new HIV infec- 12 tion for African-American women is nearly 15 times 13 higher than White women, while the rate among 14 Hispanic women is nearly 4 times higher. 15 (7) In 1998, Congress created the National Mi- 16 nority AIDS Initiative to provide technical assist- 17 ance, build capacity, and strengthen outreach efforts 18 among local institutions and community-based orga- 19 nizations that serve racial and ethnic minorities liv- 20 ing with or vulnerable to HIV/AIDS. 21 (8) In the United States, the only increase in 22 HIV incidence remains among young people ages 13 23 to 29, specifically young men of color who have sex 24 with men. Additionally, only 84 percent of young 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 6 •HR 6138 IH people report learning about HIV or AIDS in school, 1 which is fewer than in previous years. 2 (9) In 2009, the Ryan White HIV/AIDS Treat- 3 ment Extension Act of 2009 was enacted into law, 4 reauthorizing Federal HIV/AIDS care and treatment 5 programs for 4 years and making funding available 6 to United States metropolitan areas, States, and 7 service providers to assist affected families and per- 8 sons living with HIV/AIDS with health care and 9 support services. 10 (10) To combat the HIV epidemic in the United 11 States, the National HIV/AIDS Strategy (NHAS) 12 from the White House Office of National AIDS Pol- 13 icy provides a framework of increasing access to 14 care, reducing new infections, and eliminating HIV- 15 related health disparities. The vision of NHAS is: 16 ‘‘The United States will become a place where new 17 HIV infections are rare and when they do occur, 18 every person, regardless of age, gender, race/eth- 19 nicity, sexual orientation, gender identity, or socio- 20 economic circumstance, will have unfettered access 21 to high quality, life extending care, free from stigma 22 and discrimination.’’. 23 (11) In recent years, several thousand people 24 across the country were waiting to receive AIDS 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 7 •HR 6138 IH treatment through the AIDS Drug Assistance Pro- 1 gram authorized by the provisions popularly known 2 as the Ryan White CARE Act. 3 (12) The Centers for Disease Control and Pre- 4 vention has determined that increasing the propor- 5 tion of people who know their HIV status is an es- 6 sential component of comprehensive HIV/AIDS 7 treatment and prevention efforts and that early di- 8 agnosis is critical in order for people with HIV/ 9 AIDS to receive life-extending therapy. Additionally, 10 the Centers for Disease Control and Prevention rec- 11 ommends recommend routine HIV screening in 12 health care settings for all patients aged 13 to 64, 13 regardless of risk. 14 (13) Advances in HIV diagnostic technology 15 (such as rapid HIV testing and, recently, the avail- 16 ability of over-the-counter HIV tests) reduce barriers 17 to testing and allow more people to know their sta- 18 tus. 19 (14) Routine HIV screening is a preventive 20 health service, and if health plans covered routine 21 HIV screenings, health providers would be more 22 likely to recommend routine HIV screening for their 23 patients. 24 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 8 •HR 6138 IH (15) Requiring health plans to cover routine 1 HIV screening as a preventive health service without 2 imposing cost sharing requirements could play a 3 critical role in preventing the spread of HIV and al- 4 lowing infected individuals to receive effective treat- 5 ment. 6 (16) Developing countries continue to bear the 7 brunt of the HIV/AIDS epidemic, with sub-Saharan 8 Africa accounting for 68 percent of all adults and 9 children living with HIV/AIDS, 59 percent of whom 10 are female. 11 (17) Despite global efforts, 1,000 children 12 around the world still contract HIV each day, the 13 majority through mother-to-child transmission of 14 HIV. 15 (18) HIV prevalence among young people aged 16 15 to 24 has declined in many countries most im- 17 pacted by HIV; nevertheless, young people still ac- 18 count for 42 percent of all new infections among in- 19 dividuals aged 15 and older. 20 (19) A substantial number of HIV-positive 21 women in HIV care and treatment programs or pre- 22 vention of mother-to-child transmission (PMTCT) 23 programs experience an unplanned pregnancy. 24 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 9 •HR 6138 IH (20) Making contraceptive services more widely 1 available through HIV care, treatment, and PMTCT 2 programs would make it easier for women to coordi- 3 nate their HIV-related care with their pregnancy 4 prevention goals, and at the same time, help prevent 5 mother-to-child HIV transmission. 6 (21) In 2008, the Tom Lantos and Henry J. 7 Hyde United States Global Leadership Against HIV/ 8 AIDS, Tuberculosis, and Malaria Reauthorization 9 Act was enacted into law, reauthorizing the Presi- 10 dent’s Emergency Plan for AIDS Relief (PEPFAR) 11 and continued United States participation and con- 12 tributions to the Global Fund to Fight AIDS, Tu- 13 berculosis and Malaria. 14 (22) The United States President’s Emergency 15 Plan for AIDS Relief (PEPFAR), which represents 16 the largest commitment by any nation to combat a 17 single disease, has saved the lives of millions of peo- 18 ple around the world by establishing and expanding 19 the infrastructure necessary to deliver prevention, 20 care, and treatment services in low-resource settings. 21 (23) Over 7,000,000 people around the world 22 currently receive support for antiretroviral treatment 23 as a result of PEPFAR bilateral programs, the 24 Global Fund, or both. 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 10 •HR 6138 IH (24) Early detection and treatment of HIV can 1 have significant positive health effects. New research 2 demonstrates conclusively that treatment of individ- 3 uals not only slows disease progression, but can also 4 reduce the risk of transmission to other individuals 5 by 96 percent. 6 (25) In most countries HIV is a disease that 7 discriminates, disproportionately affecting society’s 8 most vulnerable. Even in generalized epidemics in 9 which a significant share of the wider population is 10 living with HIV/AIDS, people in vulnerable commu- 11 nities often have considerably higher rates of HIV 12 infection. 13 (26) Reaching men who have sex with men, 14 transgender people, people who inject drugs, sex 15 workers, and other vulnerable populations with effec- 16 tive HIV prevention and treatment is critical to 17 bringing the AIDS epidemic under control. 18 (27) According to the Centers for Disease Con- 19 trol and Prevention, approximately one-third of per- 20 sons with HIV are co-infected with hepatitis B virus 21 (HBV) or hepatitis C virus (HCV). About 80 per- 22 cent of injection drug users with HIV infection also 23 have HCV. HIV co-infection more than triples the 24 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 11 •HR 6138 IH risk for liver disease, liver failure, and liver-related 1 death from HCV. 2 (28) The Global Commission on HIV and the 3 Law was launched in June 2010 to examine laws 4 and practices that criminalize people living with and 5 vulnerable to HIV and to develop evidence-based rec- 6 ommendations for effective HIV responses that pro- 7 mote and protect human rights. 8 (29) The 19th International AIDS Conference 9 will be held in Washington, DC, in 2012, from July 10 22 to 27, returning to the United States after a 11 nearly two-decade-long international boycott that 12 was lifted following the statutory repeal of a ban on 13 travel and immigration of people living with HIV/ 14 AIDS. 15 (30) The District of Columbia, the site of the 16 XIX International AIDS Conference, has an HIV 17 prevalence rate of over 2.7 percent, which far ex- 18 ceeds the threshold that constitutes a ‘‘generalized 19 and severe’’ epidemic, and is comparable to the rate 20 in many parts of the developing world. 21 (31) The XIX International AIDS Conference 22 offers a unique opportunity to change the course of 23 the HIV/AIDS epidemic by informing people globally 24 about scientific advances in treatment and preven- 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 12 •HR 6138 IH tion, building consensus to improve service delivery 1 and maximize outcomes, facilitating global civil soci- 2 ety engagement, and accelerating momentum toward 3 a cure. 4 (32) At present, 34 States and 2 United States 5 territories have criminal statutes based on ‘‘expo- 6 sure’’ to HIV. Most of these laws were adopted be- 7 fore the availability of effective antiretroviral treat- 8 ment for HIV/AIDS. 9 (33) Although HIV/AIDS currently is viewed as 10 a chronic, treatable medical condition, people living 11 with HIV in the United States have been charged 12 under aggravated assault, attempted murder, and 13 even bioterrorism statutes because prosecutors, 14 courts, and legislators continue to view and charac- 15 terize the blood, semen, and saliva of people living 16 with HIV as a ‘‘deadly weapon’’. 17 (34) The National Alliance of State and Terri- 18 torial AIDS Directors released a statement in Feb- 19 ruary 2011 saying that ‘‘HIV criminalization under- 20 cuts our most basic HIV prevention and sexual 21 health messages, and breeds ignorance, fear and dis- 22 crimination against people living with HIV’’. 23 NASTAD further ‘‘supports efforts to examine and 24 support level-headed, proven public health ap- 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 13 •HR 6138 IH proaches that end punitive laws that single out HIV 1 over other STDs and that impose penalties for al- 2 leged nondisclosure, exposure and transmission that 3 are severely disproportionate to the actual resulting 4 harm’’. 5 (35) In 2010, the President released a National 6 HIV/AIDS Strategy (NHAS), which addressed HIV- 7 specific criminal laws, stating: ‘‘[W]hile we under- 8 stand the intent behind [these] laws, they may not 9 have the desired effect and they may make people 10 less willing to disclose their status by making people 11 feel at even greater risk of discrimination. In some 12 cases, it may be appropriate for legislators to recon- 13 sider whether existing laws continue to further the 14 public interest and public health. In many instances, 15 the continued existence and enforcement of these 16 types of laws run counter to scientific evidence about 17 routes of HIV transmission and may undermine the 18 public health goals of promoting HIV screening and 19 treatment.’’. 20 (36) There is a disproportionately high rate of 21 HIV/AIDS among incarcerated persons, especially 22 among minorities. The Bureau of Justice Statistics 23 (BJS) has determined that the rate of confirmed 24 AIDS cases is 2.4 times higher among incarcerated 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 14 •HR 6138 IH persons than in the general population. Minorities 1 account for the majority of AIDS-related deaths 2 among incarcerated persons, African-American in- 3 carcerated individuals are 2.8 times more likely than 4 White incarcerated individuals and 1.4 times more 5 likely than Hispanic incarcerated individuals to die 6 from AIDS-related causes. Nearly two-thirds of 7 AIDS-related deaths are among Black, non-Hispanic 8 males. 9 (37) Studies suggest that other sexually trans- 10 mitted infections (STIs), such as gonorrhea, 11 chlamydia, syphilis, genital herpes, viral hepatitis, 12 and human papillomavirus, also exist at a higher 13 rate among incarcerated persons than in the general 14 population. For instance, researchers have estimated 15 that the rate of hepatitis C (HCV) infection among 16 incarcerated persons is somewhere between 8 and 20 17 times higher than that of the general population. 18 (38) According to the Centers for Disease Con- 19 trol and Prevention (CDC), latex condoms, when 20 used consistently and correctly, are highly effective 21 in preventing the transmission of HIV. Latex 22 condoms also reduce the risk of other STIs. Despite 23 the effectiveness of condoms in reducing the spread 24 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 15 •HR 6138 IH of STIs, the Bureau of Prisons does not recommend 1 their use in correctional facilities. 2 (39) The distribution of condoms in correctional 3 facilities is currently legal in certain parts of the 4 United States and the world. The States of Vermont 5 and Mississippi, the District of Columbia, and the 6 cities of New York, San Francisco, Los Angeles, 7 Washington, DC, and Philadelphia allow condom 8 distribution in their correctional facilities. However, 9 these States and cities operate fewer than 1 percent 10 of all correctional facilities. 11 (40) Many correctional facilities in the United 12 States do not provide comprehensive testing and 13 treatment programs to reduce the spread of STIs. 14 Fewer than half of correctional facilities provide 15 counseling to HIV-positive incarcerated persons. 16 (41) Incarcerated individuals living with HIV/ 17 AIDS who are eligible for Medicaid would benefit 18 from prompt and automatic enrollment upon their 19 release in order to ensure their continued ability to 20 access health services, including antiretroviral treat- 21 ment. 22 (42) Research shows that stable housing leads 23 to better health outcomes for those living with HIV. 24 Inadequate or unstable housing is not only a barrier 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 16 •HR 6138 IH to effective treatment, but also increases the likeli- 1 hood of engaging in risky behaviors leading to HIV 2 infection. Insecure housing puts people with HIV/ 3 AIDS at risk of premature death from exposure to 4 other diseases, poor nutrition, stress, and lack of 5 medical care. 6 (43) On July 16, 2012, the Food and Drug Ad- 7 ministration approved Truvada (emtricitabine/ 8 tenofovir disoproxil fumarate), the first drug ap- 9 proved to reduce the risk of HIV infection in 10 uninfected individuals who are at high risk of HIV 11 infection and who may engage in sexual activity with 12 HIV-infected partners. 13 SEC. 5. NONDISCRIMINATION. 14 Programs funded under this Act shall not discrimi- 15 nate on the basis of actual or perceived sex, race, color, 16 ethnicity, national origin, disability, sexual orientation, 17 gender identity, or religion. Nothing in this Act shall be 18 construed to invalidate or limit rights, remedies, proce- 19 dures, or legal standards available to victims of discrimi- 20 nation under any other Federal law or any law of a State 21 or a political subdivision of a State, including title VI of 22 the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.), 23 title IX of the Education Amendments of 1972 (20 U.S.C. 24 1681 et seq.), section 504 of the Rehabilitation Act of 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 17 •HR 6138 IH 1973 (29 U.S.C. 794), the Americans with Disabilities Act 1 of 1990 (42 U.S.C. 12101 et seq.), and section 1557 of 2 the Patient Protection and Affordable Care Act (42 3 U.S.C. 18116). 4 DIVISION A—ENDING HIV/AIDS 5 IN THE UNITED STATES 6 TITLE I—INCREASING AND TAR- 7 GETING INVESTMENT TO 8 MAXIMIZE PREVENTION AND 9 TREATMENT IMPACT 10 SEC. 101. ADDITIONAL FUNDING FOR AIDS DRUG ASSIST- 11 ANCE PROGRAM TREATMENTS. 12 Section 2623 of the Public Health Service Act (42 13 U.S.C. 300ff–31b) is amended by adding at the end the 14 following: 15 ‘‘(c) ADDITIONAL FUNDING FOR AIDS DRUG AS- 16 SISTANCE PROGRAM TREATMENTS.—In addition to 17 amounts otherwise authorized to be appropriated for car- 18 rying out this subpart, there are authorized to be appro- 19 priated such sums as may be necessary to carry out sec- 20 tions 2612(b)(3)(B) and 2616 for each of fiscal years 21 2013 through 2015.’’. 22 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 18 •HR 6138 IH SEC. 102. ENHANCING THE NATIONAL HIV SURVEILLANCE 1 SYSTEM. 2 (a) GRANTS.—The Secretary of Health and Human 3 Services, acting through the Director of the Centers for 4 Disease Control and Prevention, shall make grants to 5 States to support integration of public health surveillance 6 systems into all electronic health records in order to allow 7 rapid communications between the clinical setting and 8 health departments, by means that include— 9 (1) providing technical assistance and policy 10 guidance to State and local health departments, clin- 11 ical providers, and other agencies serving individuals 12 with HIV to improve the interoperability of data sys- 13 tems relevant to monitoring HIV care and sup- 14 portive services; 15 (2) capturing longitudinal data pertaining to 16 the initiation and ongoing prescription or dispensing 17 of antiretroviral therapy for individuals diagnosed 18 with HIV (such as through pharmacy-based report- 19 ing); 20 (3) obtaining information— 21 (A) on a voluntary basis, on sexual orienta- 22 tion and gender identity; and 23 (B) on sources of coverage (or the lack 24 thereof) for medical treatment (including cov- 25 erage through Medicaid, Medicare, the program 26 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00018 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 19 •HR 6138 IH under title XXVI of the Public Health Service 1 Act (42 U.S.C. 300ff–11 et seq.; commonly re- 2 ferred to as the ‘‘Ryan White HIV/AIDS Pro- 3 gram’’), other public funding, private insurance, 4 and health maintenance organizations); and 5 (4) obtaining and using current geographic 6 markers of residence (such as current address, zip 7 code, partial zip code, and census block). 8 (b) PRIVACY AND SECURITY SAFEGUARDS.—In car- 9 rying out this section, the Secretary of Health and Human 10 Services shall ensure that appropriate privacy and security 11 safeguards are met to prevent unauthorized disclosure of 12 protected health information and compliance with the 13 HIPAA privacy and security law (as defined in section 14 3009 of the Public Health Service Act (42 U.S.C. 300jj– 15 19)) and other relevant laws and regulations. 16 (c) PROHIBITION AGAINST IMPROPER USE OF 17 DATA.—No grant under this section may be used to allow 18 or facilitate the collection or use of surveillance or clinical 19 data or records— 20 (1) for punitive measures of any kind, civil or 21 criminal, against the subject of such data or records; 22 or 23 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00019 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 20 •HR 6138 IH (2) for imposing any requirement or restriction 1 with respect to an individual without the individual’s 2 written consent. 3 (d) AUTHORIZATION OF APPROPRIATIONS.—To carry 4 out this section, there are authorized to be appropriated 5 such sums as may be necessary for each of fiscal years 6 2013 through 2017. 7 SEC. 103. EVIDENCE-BASED STRATEGIES FOR IMPROVING 8 LINKAGE TO AND RETENTION IN APPRO- 9 PRIATE CARE. 10 (a) STRATEGIES.—The Secretary of Health and 11 Human Services, in collaboration with the Director of the 12 Centers for Disease Control and Prevention, the Adminis- 13 trator of the Substance Abuse and Mental Health Services 14 Administration, the Director of the Office of AIDS Re- 15 search, the Administrator of the Health Resources and 16 Services Administration, and the Administrator of the 17 Centers for Medicare & Medicaid Services, shall— 18 (1) identify evidence-based strategies most ef- 19 fective at addressing the multifaceted issues that im- 20 pede disease status awareness and linkage to and re- 21 tention in appropriate care, taking into consideration 22 health care systems issues, clinic and provider 23 issues, and individual psycho-social, environmental, 24 and other contextual factors; 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00020 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 21 •HR 6138 IH (2) support the wide-scale implementation of 1 the evidence-based strategies identified pursuant to 2 paragraph (1), including through incorporating such 3 strategies into health care coverage supported by the 4 Medicaid program under title XIX of the Social Se- 5 curity Act (42 U.S.C. 1396 et seq.), the program 6 under title XXVI of the Public Health Service Act 7 (42 U.S.C. 300ff–11 et seq.; commonly referred to 8 as the ‘‘Ryan White HIV/AIDS Program’’), and 9 health plans purchased through an American Health 10 Benefit Exchange established pursuant to section 11 1311 of the Patient Protection and Affordable Care 12 Act (42 U.S.C. 18031); and 13 (3) not later than 12 months after the date of 14 the enactment of this Act, submit a report to the 15 Congress on the status of activities under para- 16 graphs (1) and (2). 17 (b) AUTHORIZATION OF APPROPRIATIONS.—To carry 18 out this section, there are authorized to be appropriated 19 such sums as may be necessary for fiscal years 2013 20 through 2017. 21 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00021 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 22 •HR 6138 IH SEC. 104. IMPROVING ENTRY INTO AND RETENTION IN 1 CARE AND ANTIRETROVIRAL ADHERENCE 2 FOR PERSONS WITH HIV. 3 (a) SENSE OF CONGRESS.—It is the sense of the Con- 4 gress that AIDS research has led to scientific advance- 5 ments that have— 6 (1) saved the lives of millions of people with 7 HIV/AIDS; 8 (2) prevented millions of people from being in- 9 fected; and 10 (3) had broad benefits that extend far beyond 11 helping people at risk for or living with HIV. 12 (b) IN GENERAL.—The Secretary of Health and 13 Human Services, acting through the Director of the Na- 14 tional Institutes of Health, shall expand, intensify, and co- 15 ordinate operational and translational research and other 16 activities of the National Institutes of Health regarding 17 methods— 18 (1) to increase adoption of evidence-based ad- 19 herence strategies within HIV care and treatment 20 programs; 21 (2) to increase HIV testing and case detection 22 rates; 23 (3) to reduce HIV-related health disparities; 24 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00022 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 23 •HR 6138 IH (4) to ensure that research to improve adher- 1 ence to HIV care and treatment programs address 2 the unique concerns of women; 3 (5) to integrate HIV/AIDS prevention and care 4 services with mental health and substance use pre- 5 vention and treatment delivery systems; and 6 (6) to increase knowledge on the implementa- 7 tion of pre-exposure prophylaxis (PrEP), including 8 with respect to— 9 (A) who can benefit most from PrEP; 10 (B) how to provide PrEP safely and effi- 11 ciently; 12 (C) how to integrate PrEP with other es- 13 sential prevention methods such as condoms; 14 and 15 (D) how to ensure high levels of adherence. 16 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 17 out this section, there are authorized to be appropriated 18 such sums as may be necessary for fiscal years 2013 19 through 2017. 20 SEC. 105. HEALTH CARE PROFESSIONALS TREATING INDI- 21 VIDUALS WITH HIV/AIDS. 22 (a) IN GENERAL.—The Secretary of Health and 23 Human Services, acting through the Administrator of the 24 Health Resources and Services Administration, shall ex- 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00023 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 24 •HR 6138 IH pand, intensify, and coordinate workforce initiatives of the 1 Health Resources and Services Administration to increase 2 the capacity of the health workforce focusing primarily on 3 HIV/AIDS to meet the demand for culturally competent 4 care, and may award grants for any of the following: 5 (1) Development of curricula for training pri- 6 mary care providers in HIV/AIDS prevention and 7 care, including routine HIV testing. 8 (2) Support to expand access to culturally and 9 linguistically accessible benefits counselors, trained 10 peer navigators, and mental and behavioral health 11 professionals with expertise in HIV/AIDS. 12 (3) Training health care professionals to pro- 13 vide care to individuals with HIV/AIDS. 14 (4) Development by grant recipients under title 15 XXVI of the Public Health Service Act (42 U.S.C. 16 300ff–11 et seq.; commonly referred to as the Ryan 17 White HIV/AIDS Program) and other persons, of 18 policies for providing culturally relevant and sen- 19 sitive treatment to individuals with HIV/AIDS, with 20 particular emphasis on treatment to racial and eth- 21 nic minorities, men who have sex with men, and 22 women, young people, and children with HIV/AIDS. 23 (5) Development and implementation of pro- 24 grams to increase the use of telehealth to respond to 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00024 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 25 •HR 6138 IH HIV/AIDS-specific health care needs in rural and 1 minority communities, with particular emphasis 2 given to medically underserved communities and in- 3 sular areas. 4 (6) Evaluating interdisciplinary medical pro- 5 vider care team models that promote high quality 6 care. 7 (7) Training health care professionals to make 8 them aware of the high rates of chronic hepatitis B 9 and chronic hepatitis C in certain adult ethnic popu- 10 lations, and the importance of prevention, detection, 11 and medical management of hepatitis B and hepa- 12 titis C and of liver cancer screening. 13 (b) AUTHORIZATION OF APPROPRIATIONS.—To carry 14 out this section, there are authorized to be appropriated 15 such sums as may be necessary for fiscal years 2013 16 through 2017. 17 SEC. 106. HIV/AIDS PROVIDER LOAN REPAYMENT PRO- 18 GRAM. 19 (a) IN GENERAL.—The Secretary may enter into an 20 agreement with any physician, nurse practitioner, or phy- 21 sician assistant under which— 22 (1) the physician, nurse practitioner, or physi- 23 cian assistant agrees to serve as a medical provider 24 for a period of not less than 2 years— 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00025 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 26 •HR 6138 IH (A) at a Ryan White-funded or title X- 1 funded facility with a critical shortage of doc- 2 tors (as determined by the Secretary); or 3 (B) in an area with a high incidence of 4 HIV/AIDS; and 5 (2) the Secretary agrees to make payments in 6 accordance with subsection (b) on the professional 7 education loans of the physician, nurse practitioner, 8 or physician assistant. 9 (b) MANNER OF PAYMENTS.—The payments de- 10 scribed in subsection (a) shall be made by the Secretary 11 as follows: 12 (1) Upon completion by the physician, nurse 13 practitioner, or physician assistant for whom the 14 payments are to be made of the first year of the 15 service specified in the agreement entered into with 16 the Secretary under subsection (a), the Secretary 17 shall pay 30 percent of the principal of and the in- 18 terest on the individual’s professional education 19 loans. 20 (2) Upon completion by the physician, nurse 21 practitioner, or physician assistant of the second 22 year of such service, the Secretary shall pay another 23 30 percent of the principal of and the interest on 24 such loans. 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00026 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 27 •HR 6138 IH (3) Upon completion by that individual of a 1 third year of such service, the Secretary shall pay 2 another 25 percent of the principal of and the inter- 3 est on such loans. 4 (c) APPLICABILITY OF CERTAIN PROVISIONS.—The 5 provisions of subpart III of part D of title III of the Public 6 Health Service Act (42 U.S.C. 254l et seq.) shall, except 7 as inconsistent with this section, apply to the program car- 8 ried out under this section in the same manner and to 9 the same extent as such provisions apply to the National 10 Health Service Corps Loan Repayment Program. 11 (d) REPORTS.—Not later than 18 months after the 12 date of the enactment of this Act, and annually thereafter, 13 the Secretary shall prepare and submit to the Congress 14 a report describing the program carried out under this sec- 15 tion, including statements regarding the following: 16 (1) The number of physicians, nurse practi- 17 tioners, and physician assistants enrolled in the pro- 18 gram. 19 (2) The number and amount of loan repay- 20 ments. 21 (3) The placement location of loan repayment 22 recipients at facilities described in subsection (a)(1). 23 (4) The default rate and actions required. 24 (5) The amount of outstanding default funds. 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00027 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 28 •HR 6138 IH (6) To the extent that it can be determined, the 1 reason for the default. 2 (7) The demographics of individuals partici- 3 pating in the program. 4 (8) An evaluation of the overall costs and bene- 5 fits of the program. 6 (e) DEFINITIONS.—In this section: 7 (1) The term ‘‘HIV/AIDS’’ means human im- 8 munodeficiency virus and acquired immune defi- 9 ciency syndrome. 10 (2) The term ‘‘nurse practitioner’’ means a 11 nurse with an advanced practice nursing licensure. 12 (3) The term ‘‘physician’’ means a graduate of 13 a school of medicine who has completed post- 14 graduate training in general or pediatric medicine. 15 (4) The term ‘‘physician assistant’’ means a 16 medical provider who completed an accredited physi- 17 cian assistant training program and successfully 18 passed the Physician Assistant National Certifying 19 Examination. 20 (5) The term ‘‘professional education loan’’— 21 (A) means a loan that is incurred for the 22 cost of attendance (including tuition, other rea- 23 sonable educational expenses, and reasonable 24 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00028 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 29 •HR 6138 IH living costs) at a school of medicine, nursing, or 1 physician assistant training program; and 2 (B) includes only the portion of the loan 3 that is outstanding on the date the physician, 4 nurse practitioner, or physician assistant in- 5 volved begins the service specified in the agree- 6 ment under subsection (a). 7 (6) The term ‘‘Ryan White-funded’’ means, 8 with respect to a facility, receiving funds under title 9 XXVI of the Public Health Service Act (42 U.S.C. 10 300ff–11 et seq.). 11 (7) The term ‘‘Secretary’’ means the Secretary 12 of Health and Human Services. 13 (8) The term ‘‘school of medicine’’ has the 14 meaning given to that term in section 799B of the 15 Public Health Service Act (42 U.S.C. 295p). 16 (9) The term ‘‘title X-funded’’ means, with re- 17 spect to a facility, receiving funds under title X of 18 the Public Health Service Act (42 U.S.C. 300 et 19 seq.). 20 (f) AUTHORIZATION OF APPROPRIATIONS.—To carry 21 out this section, there are authorized to be appropriated 22 such sums as may be necessary for fiscal years 2013 23 through 2017. 24 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00029 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 30 •HR 6138 IH SEC. 107. REDUCING NEW HIV INFECTIONS AMONG INJECT- 1 ING DRUG USERS. 2 (a) SENSE OF CONGRESS.—It is the sense of the Con- 3 gress that providing sterile syringes and sterilized equip- 4 ment to injecting drug users substantially reduces risk of 5 HIV infection , increases the probability that they will ini- 6 tiate drug treatment, and does not increase drug use. 7 (b) IN GENERAL.—The Secretary of Health and 8 Human Services may provide grants and technical assist- 9 ance for the purpose of reducing the rate of HIV infections 10 among injecting drug users through a comprehensive 11 package of services for such users, including the provision 12 of sterile syringes, education and outreach, access to infec- 13 tious disease testing, overdose prevention, and treatment 14 for drug dependence. 15 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 16 out this section, there are authorized to be appropriated 17 such sums as may be necessary for fiscal years 2013 18 through 2017. 19 SEC. 108. SUPPORT FOR EXPANSION OF COMPREHENSIVE 20 SEXUAL HEALTH AND EDUCATION PRO- 21 GRAMS. 22 (a) SENSE OF CONGRESS.—It is the sense of Con- 23 gress that— 24 (1) federally funded sex education programs 25 should aim to— 26 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00030 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 31 •HR 6138 IH (A) reduce unintended pregnancy and sex- 1 ually transmitted infections, including HIV; 2 (B) promote safe and healthy relation- 3 ships; 4 (C) use, and be informed by, the best sci- 5 entific information available; 6 (D) be built on characteristics of effective 7 programs; 8 (E) expand the existing body of evidence 9 on comprehensive sex education programs 10 through program evaluation; 11 (F) expand training programs for teachers 12 of comprehensive sex education; 13 (G) build on the personal responsibility 14 education programs funded under section 513 15 of the Social Security Act (42 U.S.C. 713) and 16 the President’s Teen Pregnancy Prevention pro- 17 gram, funded under title II of the Consolidated 18 Appropriations Act, 2010 (Public Law 111– 19 117; 123 Stat. 3253); and 20 (H) promote and uphold the rights of 21 young people to information in order to make 22 healthy and responsible decisions about their 23 sexual health; and 24 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00031 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 32 •HR 6138 IH (2) no Federal funds should be used for health 1 education programs that— 2 (A) deliberately withhold life-saving infor- 3 mation about HIV; 4 (B) are medically inaccurate or have been 5 scientifically shown to be ineffective; 6 (C) promote gender stereotypes; 7 (D) are insensitive and unresponsive to the 8 needs of sexually active adolescents; 9 (E) are insensitive and unresponsive to the 10 needs of lesbian, gay, bisexual, or transgender 11 youth; or 12 (F) are inconsistent with the ethical im- 13 peratives of medicine and public health. 14 (b) GRANTS FOR COMPREHENSIVE SEX EDUCATION 15 FOR ADOLESCENTS.— 16 (1) PROGRAM AUTHORIZED.—The Secretary, in 17 coordination with the Director of the Office of Ado- 18 lescent Health, shall award grants, on a competitive 19 basis, to eligible entities to enable such eligible enti- 20 ties to carry out programs that provide adolescents 21 with comprehensive sex education, as described in 22 paragraph (6). 23 (2) DURATION.—Grants awarded under this 24 subsection shall be for a period of 5 years. 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00032 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 33 •HR 6138 IH (3) ELIGIBLE ENTITY.—In this subsection, the 1 term ‘‘eligible entity’’ means a public or private enti- 2 ty that focuses on adolescent health or education or 3 has experience working with adolescents, which may 4 include— 5 (A) a State educational agency; 6 (B) a local educational agency; 7 (C) a tribe or tribal organization, as de- 8 fined in section 4 of the Indian Self-Determina- 9 tion and Education Assistance Act (25 U.S.C. 10 450b); 11 (D) a State or local department of health; 12 (E) a State or local department of edu- 13 cation; 14 (F) a nonprofit organization; 15 (G) a nonprofit or public institution of 16 higher education; or 17 (H) a hospital. 18 (4) APPLICATIONS.—An eligible entity desiring 19 a grant under this subsection shall submit an appli- 20 cation to the Secretary at such time, in such man- 21 ner, and containing such information as the Sec- 22 retary may require, including the evaluation plan de- 23 scribed in paragraph (7)(A). 24 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00033 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 34 •HR 6138 IH (5) PRIORITY.—In awarding grants under this 1 subsection, the Secretary shall give priority to eligi- 2 ble entities that— 3 (A) are State or local public entities, with 4 an additional priority for State or local edu- 5 cational agencies; and 6 (B) address health disparities among 7 young people that are at highest risk for not 8 less than 1 of the following: 9 (i) Unintended pregnancies. 10 (ii) Sexually transmitted infections, 11 including HIV. 12 (iii) Dating violence and sexual as- 13 sault. 14 (6) USE OF FUNDS.— 15 (A) IN GENERAL.—Each eligible entity 16 that receives a grant under this subsection shall 17 use grant funds to carry out a program that 18 provides adolescents with comprehensive sex 19 education that— 20 (i) replicates evidence-based sex edu- 21 cation programs; 22 (ii) substantially incorporates ele- 23 ments of evidence-based sex education pro- 24 grams; or 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00034 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 35 •HR 6138 IH (iii) creates a demonstration project 1 based on generally accepted characteristics 2 of effective sex education programs. 3 (B) CONTENTS OF SEX EDUCATION PRO- 4 GRAMS.—The sex education programs funded 5 under this subsection shall include curricula 6 and program materials that address— 7 (i) abstinence and delaying sexual ini- 8 tiation; 9 (ii) the health benefits and side effects 10 of all contraceptive and barrier methods as 11 a means to prevent pregnancy and sexually 12 transmitted infections, including HIV; 13 (iii) healthy relationships, including 14 the development of healthy attitudes and 15 skills necessary for understanding— 16 (I) healthy relationships between 17 oneself and family, others, and soci- 18 ety; and 19 (II) the prevention of sexual 20 abuse, teen dating violence, bullying, 21 harassment, and suicide; 22 (iv) healthy life skills including goal- 23 setting, decisionmaking, interpersonal skills 24 (such as communication, assertiveness, and 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00035 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 36 •HR 6138 IH peer refusal skills), critical thinking, self- 1 esteem and self-efficacy, and stress man- 2 agement; 3 (v) how to make responsible decisions 4 about sex and sexuality, including— 5 (I) how to avoid, and how to 6 avoid making, unwanted verbal, phys- 7 ical, and sexual advances; and 8 (II) how alcohol and drug use 9 can affect responsible decisionmaking; 10 (vi) the development of healthy atti- 11 tudes and values about such topics as ado- 12 lescent growth and development, body 13 image, gender roles and gender identity, 14 racial and ethnic diversity, and sexual ori- 15 entation; and 16 (vii) referral services for local health 17 clinics and services where adolescents can 18 obtain additional information and services 19 related to sexual and reproductive health, 20 dating violence and sexual assault, and sui- 21 cide prevention. 22 (7) EVALUATION; REPORT.— 23 (A) INDEPENDENT EVALUATION.—Each 24 eligible entity applying for a grant under this 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00036 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 37 •HR 6138 IH subsection shall develop and submit to the Sec- 1 retary a plan for a rigorous independent evalua- 2 tion of such grant program. The plan shall de- 3 scribe an independent evaluation that— 4 (i) uses sound statistical methods and 5 techniques relating to the behavioral 6 sciences, including random assignment 7 methodologies, whenever possible; 8 (ii) uses quantitative data for assess- 9 ments and impact evaluations, whenever 10 possible; and 11 (iii) is carried out by an entity inde- 12 pendent from such eligible entity. 13 (B) SELECTION OF EVALUATED PRO- 14 GRAMS; BUDGET.— 15 (i) SELECTION OF EVALUATED PRO- 16 GRAMS.—The Secretary shall select, at 17 random, a subset of the eligible entities 18 that the Secretary has selected to receive a 19 grant under this subsection to receive addi- 20 tional funding to carry out the evaluation 21 plan described in subparagraph (A). 22 (ii) BUDGET FOR EVALUATION ACTIVI- 23 TIES.—The Secretary, in coordination with 24 the Director of the Office of Adolescent 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00037 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 38 •HR 6138 IH Health, shall establish a budget for each 1 eligible entity selected under clause (i) for 2 the costs of carrying out the evaluation 3 plan described in subparagraph (A). 4 (C) FUNDS FOR EVALUATION.—The Sec- 5 retary shall provide eligible entities who are se- 6 lected under subparagraph (B)(i) with addi- 7 tional funds, in accordance with the budget de- 8 scribed in subparagraph (B)(ii), to carry out 9 and report to the Secretary on the evaluation 10 plan described in subparagraph (A). 11 (D) PERFORMANCE MEASURES.—The Sec- 12 retary, in coordination with the Director of the 13 Centers for Disease Control and Prevention, 14 shall establish a common set of performance 15 measures to assess the implementation and im- 16 pact of grant programs funded under this sub- 17 section. Such performance measures shall in- 18 clude— 19 (i) output measures, such as the num- 20 ber of individuals served and the number 21 of hours of service delivery; 22 (ii) outcome measures, including 23 measures relating to— 24 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00038 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 39 •HR 6138 IH (I) the knowledge that youth par- 1 ticipating in the grant program have 2 gained about— 3 (aa) adolescent growth and 4 development; 5 (bb) relationship dynamics; 6 (cc) ways to prevent unin- 7 tended pregnancy and sexually 8 transmitted infections, including 9 HIV; and 10 (dd) sexual health; 11 (II) the skills that adolescents 12 participating in the grant program 13 have gained regarding— 14 (aa) negotiation and commu- 15 nication; 16 (bb) decisionmaking and 17 goal-setting; 18 (cc) interpersonal skills and 19 healthy relationships; and 20 (dd) condom use; and 21 (III) the behaviors of adolescents 22 participating in the grant program, 23 including data about— 24 (aa) age of first intercourse; 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00039 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 40 •HR 6138 IH (bb) number of sexual part- 1 ners; 2 (cc) condom and contracep- 3 tive use at first intercourse; 4 (dd) recent condom and con- 5 traceptive use; and 6 (ee) dating abuse and life- 7 time history of domestic violence, 8 sexual assault, dating violence, 9 bullying, harassment, and stalk- 10 ing. 11 (E) REPORT TO THE SECRETARY.—Eligi- 12 ble entities receiving a grant under this sub- 13 section who have been selected to receive funds 14 to carry out the evaluation plan described in 15 subparagraph (A), in accordance with subpara- 16 graph (B)(i), shall collect and report to the Sec- 17 retary— 18 (i) the results of the independent eval- 19 uation described in subparagraph (A); and 20 (ii) information about the perform- 21 ance measures described in subparagraph 22 (B). 23 (F) EFFECTIVE PROGRAMS.—The Sec- 24 retary, in coordination with the Director of the 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00040 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 41 •HR 6138 IH Centers for Disease Control and Prevention, 1 shall publish on the Web site of the Centers for 2 Disease Control and Prevention, a list of pro- 3 grams funded under this subsection that the 4 Secretary has determined to be effective pro- 5 grams. 6 (c) GRANTS FOR COMPREHENSIVE SEX EDUCATION 7 AT INSTITUTIONS OF HIGHER EDUCATION.— 8 (1) PROGRAM AUTHORIZED.—The Secretary, in 9 coordination with the Office of Adolescent Health 10 and the Secretary of Education, shall award grants, 11 on a competitive basis, to institutions of higher edu- 12 cation to enable such institutions to provide young 13 people with comprehensive sex education, described 14 in paragraph (5)(B), with an emphasis on reducing 15 HIV, other sexually transmitted infections, and un- 16 intended pregnancy through instruction about— 17 (A) abstinence and contraception; 18 (B) reducing dating violence, sexual as- 19 sault, bullying, and harassment; 20 (C) increasing healthy relationships; and 21 (D) academic achievement. 22 (2) DURATION.—Grants awarded under this 23 subsection shall be for a period of 5 years. 24 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00041 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 42 •HR 6138 IH (3) APPLICATIONS.—An institution of higher 1 education desiring a grant under this subsection 2 shall submit an application to the Secretary at such 3 time, in such manner, and containing such informa- 4 tion as the Secretary may require. 5 (4) PRIORITY.—In awarding grants under this 6 subsection, the Secretary shall give priority to an in- 7 stitution of higher education that— 8 (A) has an enrollment of needy students as 9 defined in section 318(b) of the Higher Edu- 10 cation Act of 1965 (20 U.S.C. 1059e(b)); 11 (B) is a Hispanic-serving institution, as 12 defined in section 502(a) of such Act (20 13 U.S.C. 1101a(a)); 14 (C) is a Tribal College or University, as 15 defined in section 316(b) of such Act (20 16 U.S.C. 1059c(b)); 17 (D) is an Alaska Native-serving institution, 18 as defined in section 317(b) of such Act (20 19 U.S.C. 1059d(b)); 20 (E) is a Native Hawaiian-serving institu- 21 tion, as defined in section 317(b) of such Act 22 (20 U.S.C. 1059d(b)); 23 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00042 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 43 •HR 6138 IH (F) is a Predominately Black Institution, 1 as defined in section 318(b) of such Act (20 2 U.S.C. 1059e(b)); 3 (G) is a Native American-serving, non- 4 tribal institution, as defined in section 319(b) 5 of such Act (20 U.S.C. 1059f(b)); 6 (H) is an Asian American and Native 7 American Pacific Islander-serving institution, as 8 defined in section 320(b) of such Act (20 9 U.S.C. 1059g(b)); or 10 (I) is a minority institution, as defined in 11 section 365 of such Act (20 U.S.C. 1067k), 12 with an enrollment of needy students, as de- 13 fined in section 312 of such Act (20 U.S.C. 14 1058). 15 (5) USES OF FUNDS.— 16 (A) IN GENERAL.—An institution of higher 17 education receiving a grant under this sub- 18 section may use grant funds to integrate issues 19 relating to comprehensive sex education into the 20 academic or support sectors of the institution of 21 higher education in order to reach a large num- 22 ber of students, by carrying out 1 or more of 23 the following activities: 24 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00043 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 44 •HR 6138 IH (i) Developing educational content for 1 issues relating to comprehensive sex edu- 2 cation that will be incorporated into first- 3 year orientation or core courses. 4 (ii) Developing and employing 5 schoolwide educational programming out- 6 side of class that delivers elements of com- 7 prehensive sex education programs to stu- 8 dents, faculty, and staff. 9 (iii) Creating innovative technology- 10 based approaches to deliver sex education 11 to students, faculty, and staff. 12 (iv) Developing and employing peer- 13 outreach and education programs to gen- 14 erate discussion, educate, and raise aware- 15 ness among students about issues relating 16 to comprehensive sex education. 17 (B) CONTENTS OF SEX EDUCATION PRO- 18 GRAMS.—Each institution of higher education’s 19 program of comprehensive sex education funded 20 under this subsection shall include curricula 21 and program materials that address informa- 22 tion about— 23 (i) safe and responsible sexual behav- 24 ior with respect to the prevention of preg- 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00044 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 45 •HR 6138 IH nancy and sexually transmitted infections, 1 including HIV, including through— 2 (I) abstinence; 3 (II) a reduced number of sexual 4 partners; and 5 (III) the use of condoms and con- 6 traception; 7 (ii) healthy relationships, including 8 the development of healthy attitudes and 9 insights necessary for understanding— 10 (I) relationships between oneself, 11 family, partners, others, and society; 12 and 13 (II) the prevention of sexual 14 abuse, dating violence, bullying, har- 15 assment, and suicide; and 16 (iii) referral services to local health 17 clinics where young people can obtain addi- 18 tional information and services related to 19 sexual and reproductive health, dating vio- 20 lence and sexual assault, and suicide pre- 21 vention. 22 (C) OPTIONAL COMPONENTS OF SEX EDU- 23 CATION.—Each institution of higher education’s 24 program of comprehensive sex education may 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00045 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 46 •HR 6138 IH also include information and skills development 1 relating to— 2 (i) how to make responsible decisions 3 about sex and sexuality, including— 4 (I) how to avoid, and avoid mak- 5 ing, unwanted verbal, physical, and 6 sexual advances; and 7 (II) how alcohol and drug use 8 can affect responsible decisionmaking; 9 (ii) healthy life skills, including— 10 (I) goal-setting and decision- 11 making; 12 (II) interpersonal skills, such as 13 communication, assertiveness, and 14 peer refusal skills; 15 (III) critical thinking; 16 (IV) self-esteem and self-efficacy; 17 and 18 (V) stress management; 19 (iii) the development of healthy atti- 20 tudes and values about such topics as body 21 image, gender roles and gender identity, 22 racial and ethnic diversity, and sexual ori- 23 entation; and 24 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00046 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 47 •HR 6138 IH (iv) the responsibilities of parenting 1 and the skills necessary to parent well. 2 (6) EVALUATION; REPORT.—The requirements 3 described in section 125B(g) shall also apply to eligi- 4 ble entities receiving a grant under this subsection 5 in the same manner as such requirements apply to 6 eligible entities receiving grants under section 125B. 7 (d) GRANTS FOR PRE-SERVICE AND IN-SERVICE 8 TEACHER TRAINING.— 9 (1) PROGRAM AUTHORIZED.—The Secretary, in 10 coordination with the Director of the Centers for 11 Disease Control and Prevention and the Secretary of 12 Education, shall award grants, on a competitive 13 basis, to eligible entities to enable such eligible enti- 14 ties to carry out the activities described in para- 15 graph (5). 16 (2) DURATION.—Grants awarded under this 17 subsection shall be for a period of 5 years. 18 (3) ELIGIBLE ENTITY.—In this subsection, the 19 term ‘‘eligible entity’’ means— 20 (A) a State educational agency; 21 (B) a local educational agency; 22 (C) a tribe or tribal organization, as de- 23 fined in section 4 of the Indian Self-Determina- 24 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00047 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 48 •HR 6138 IH tion and Education Assistance Act (25 U.S.C. 1 450b); 2 (D) a State or local department of health; 3 (E) a State or local department of edu- 4 cation; 5 (F) a nonprofit institution of higher edu- 6 cation; 7 (G) a national or statewide nonprofit orga- 8 nization that has as its primary purpose the im- 9 provement of provision of comprehensive sex 10 education through effective teaching of com- 11 prehensive sex education; or 12 (H) a consortium of nonprofit organiza- 13 tions that has as its primary purpose the im- 14 provement of provision of comprehensive sex 15 education through effective teaching of com- 16 prehensive sex education. 17 (4) APPLICATION.—An eligible entity desiring a 18 grant under this subsection shall submit an applica- 19 tion to the Secretary at such time, in such manner, 20 and containing such information as the Secretary 21 may require. 22 (5) AUTHORIZED ACTIVITIES.— 23 (A) REQUIRED ACTIVITY.—Each eligible 24 entity receiving a grant under this subsection 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00048 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 49 •HR 6138 IH shall use grant funds to train targeted faculty 1 and staff, in order to increase effective teaching 2 of comprehensive sex education for elementary 3 school and secondary school students. 4 (B) PERMISSIBLE ACTIVITIES.—Each eligi- 5 ble entity receiving a grant under this sub- 6 section may use grant funds to— 7 (i) strengthen and expand the eligible 8 entity’s relationships with— 9 (I) institutions of higher edu- 10 cation; 11 (II) State educational agencies; 12 (III) local educational agencies; 13 or 14 (IV) other public and private or- 15 ganizations with a commitment to 16 comprehensive sex education and the 17 benefits of comprehensive sex edu- 18 cation; 19 (ii) support and promote research- 20 based training of teachers of comprehen- 21 sive sex education and related disciplines 22 in elementary schools and secondary 23 schools as a means of broadening student 24 knowledge about issues related to human 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00049 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 50 •HR 6138 IH development, relationships, personal skills, 1 sexual behavior, sexual health, and society 2 and culture; 3 (iii) support the dissemination of in- 4 formation on effective practices and re- 5 search findings concerning the teaching of 6 comprehensive sex education; 7 (iv) support research on— 8 (I) effective comprehensive sex 9 education teaching practices; and 10 (II) the development of assess- 11 ment instruments and strategies to 12 document— 13 (aa) student understanding 14 of comprehensive sex education; 15 and 16 (bb) the effects of com- 17 prehensive sex education; 18 (v) convene national conferences on 19 comprehensive sex education, in order to 20 effectively train teachers in the provision of 21 comprehensive sex education; and 22 (vi) develop and disseminate appro- 23 priate research-based materials to foster 24 comprehensive sex education. 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00050 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 51 •HR 6138 IH (C) SUBGRANTS.—Each eligible entity re- 1 ceiving a grant under this subsection may 2 award subgrants to nonprofit organizations, 3 State educational agencies, or local educational 4 agencies to enable such organizations or agen- 5 cies to— 6 (i) train teachers in comprehensive 7 sex education; 8 (ii) support Internet or distance learn- 9 ing related to comprehensive sex education; 10 (iii) promote rigorous academic stand- 11 ards and assessment techniques to guide 12 and measure student performance in com- 13 prehensive sex education; 14 (iv) encourage replication of best 15 practices and model programs to promote 16 comprehensive sex education; 17 (v) develop and disseminate effective, 18 research-based comprehensive sex edu- 19 cation learning materials; 20 (vi) develop academic courses on the 21 pedagogy of sex education at institutions 22 of higher education; or 23 (vii) convene State-based conferences 24 to train teachers in comprehensive sex edu- 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00051 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 52 •HR 6138 IH cation and to identify strategies for im- 1 provement. 2 (e) REPORT TO CONGRESS.— 3 (1) IN GENERAL.—Not later than 1 year after 4 the date of the enactment of this Act, and annually 5 thereafter for a period of 5 years, the Secretary shall 6 prepare and submit to the appropriate committees of 7 Congress a report on the activities to provide adoles- 8 cents and young people with comprehensive sex edu- 9 cation funded under this section. 10 (2) REPORT ELEMENTS.—The report described 11 in paragraph (1) shall include information about— 12 (A) the number of eligible entities and in- 13 stitutions of higher education that are receiving 14 grant funds under subsections (b) and (c); 15 (B) the specific activities supported by 16 grant funds awarded under subsections (b) and 17 (c); 18 (C) the number of adolescents served by 19 grant programs funded under subsection (b); 20 (D) the number of young people served by 21 grant programs funded under subsection (c); 22 and 23 (E) the status of program evaluations de- 24 scribed under subsections (b) and (c). 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00052 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 53 •HR 6138 IH (f) LIMITATION.—No Federal funds provided under 1 this section may be used for health education programs 2 that— 3 (1) deliberately withhold life-saving information 4 about HIV; 5 (2) are medically inaccurate or have been sci- 6 entifically shown to be ineffective; 7 (3) promote gender stereotypes; 8 (4) are insensitive and unresponsive to the 9 needs of sexually active youth or lesbian, gay, bisex- 10 ual, or transgender youth; or 11 (5) are inconsistent with the ethical imperatives 12 of medicine and public health. 13 (g) DEFINITIONS.—In this section: 14 (1) ESEA DEFINITIONS.—The terms ‘‘elemen- 15 tary school’’, ‘‘local educational agency’’, ‘‘secondary 16 school’’, and ‘‘State educational agency’’ have the 17 meanings given the terms in section 9101 of the Ele- 18 mentary and Secondary Education Act of 1965 (20 19 U.S.C. 7801). 20 (2) AGE AND DEVELOPMENTALLY APPRO- 21 PRIATE.—The term ‘‘age and developmentally appro- 22 priate’’ means suitable for a particular age or age 23 group of children and adolescents, based on devel- 24 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00053 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 54 •HR 6138 IH oping cognitive, emotional, and behavioral capacity 1 typical for that age or age group. 2 (3) ADOLESCENTS.—The term ‘‘adolescents’’ 3 means individuals who are ages 10 through 19 at 4 the time of commencement of participation in a pro- 5 gram supported under this section. 6 (4) CHARACTERISTICS OF EFFECTIVE PRO- 7 GRAMS.—The term ‘‘characteristics of effective pro- 8 grams’’ means the aspects of evidence-based pro- 9 grams, including development, content, and imple- 10 mentation of such programs, that— 11 (A) have been shown to be effective in 12 terms of increasing knowledge, clarifying values 13 and attitudes, increasing skills, and impacting 14 upon behavior; and 15 (B) are widely recognized by leading med- 16 ical and public health agencies to be effective in 17 changing sexual behaviors that lead to sexually 18 transmitted infections, including HIV, unin- 19 tended pregnancy, and dating violence and sex- 20 ual assault among young people. 21 (5) COMPREHENSIVE SEX EDUCATION.—The 22 term ‘‘comprehensive sex education’’ means a pro- 23 gram that— 24 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00054 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 55 •HR 6138 IH (A) includes age- and developmentally ap- 1 propriate, culturally and linguistically relevant 2 information on a broad set of topics related to 3 sexuality including human development, rela- 4 tionships, decisionmaking, communication, ab- 5 stinence, contraception, and disease and preg- 6 nancy prevention; 7 (B) provides students with opportunities 8 for developing skills as well as learning informa- 9 tion; 10 (C) is inclusive of lesbian, gay, bisexual, 11 transgender, and heterosexual young people; 12 and 13 (D) aims to— 14 (i) provide scientifically accurate and 15 realistic information about human sexu- 16 ality; 17 (ii) provide opportunities for individ- 18 uals to understand their own, their fami- 19 lies’, and their communities’ values, atti- 20 tudes, and insights about sexuality; 21 (iii) help individuals develop healthy 22 relationships and interpersonal skills; and 23 (iv) help individuals exercise responsi- 24 bility regarding sexual relationships, which 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00055 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 56 •HR 6138 IH includes addressing abstinence, pressures 1 to become prematurely involved in sexual 2 intercourse, and the use of contraception 3 and other sexual health measures. 4 (6) EVIDENCE-BASED PROGRAM.—The term 5 ‘‘evidence-based program’’ means a sex education 6 program that has been proven through rigorous eval- 7 uation to be effective in changing sexual behavior or 8 incorporates elements of other sex education pro- 9 grams that have been proven to be effective in 10 changing sexual behavior. 11 (7) INSTITUTION OF HIGHER EDUCATION.—The 12 term ‘‘institution of higher education’’ has the 13 meaning given the term in section 101 of the Higher 14 Education Act of 1965 (20 U.S.C. 1001). 15 (8) MEDICALLY ACCURATE AND COMPLETE.— 16 The term ‘‘medically accurate and complete’’, when 17 used with respect to a sex education program, means 18 that— 19 (A) the information provided through the 20 program is verified or supported by the weight 21 of research conducted in compliance with ac- 22 cepted scientific methods and is published in 23 peer-reviewed journals, where applicable; or 24 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00056 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 57 •HR 6138 IH (B)(i) the program contains information 1 that leading professional organizations and 2 agencies with relevant expertise in the field rec- 3 ognize as accurate, objective, and complete; and 4 (ii) the program does not withhold infor- 5 mation about the effectiveness and benefits of 6 correct and consistent use of condoms and 7 other contraceptives. 8 (9) SECRETARY.—The term ‘‘Secretary’’ means 9 the Secretary of Health and Human Services. 10 (10) YOUNG PEOPLE.—The term ‘‘young peo- 11 ple’’ means individuals who are ages 10 through 24 12 at the time of commencement of participation in a 13 program supported under this section. 14 (h) AUTHORIZATION OF APPROPRIATIONS.—To carry 15 out this section, there are authorized to be appropriated 16 such sums as may be necessary for fiscal years 2013 17 through 2017. 18 SEC. 109. ELIMINATION OF ABSTINENCE-ONLY EDUCATION 19 PROGRAM. 20 (a) IN GENERAL.—Title V of the Social Security Act 21 (42 U.S.C. 701 et seq.) is amended by striking section 22 510. 23 (b) RESCISSION.—Amounts appropriated for fiscal 24 year 2012 under section 510(d) of the Social Security Act 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00057 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 58 •HR 6138 IH (42 U.S.C. 710(d)) (as in effect on the day before the date 1 of enactment of this Act) that are unobligated as of the 2 date of enactment of this Act are rescinded. 3 (c) REPROGRAM OF ELIMINATED ABSTINENCE-ONLY 4 FUNDS FOR THE PERSONAL RESPONSIBILITY EDUCATION 5 PROGRAM (PREP).—Section 513(f) of the Social Security 6 Act (42 U.S.C. 713(f)) is amended by striking 7 ‘‘$75,000,000 for each of fiscal years 2010 through 2014’’ 8 and inserting ‘‘$75,000,000 for each of fiscal years 2010 9 and 2011, an amount for fiscal year 2012 equal to 10 $75,000,000 increased by an amount equal to the unobli- 11 gated portion of funds appropriated for fiscal year 2012 12 under section 510(d) that are rescinded under section 13 109(b) of the Ending the HIV/AIDS Epidemic Act of 14 2012, and $125,000,000 for each of fiscal years 2013 15 through 2014’’. 16 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00058 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 59 •HR 6138 IH TITLE II—ENDING STIGMA AND 1 DISCRIMINATION THAT IN- 2 HIBIT ACCESS TO CARE AND 3 MAKE PEOPLE MORE VUL- 4 NERABLE 5 SEC. 201. REVIEW OF ALL FEDERAL AND STATE LAWS, 6 POLICIES, AND REGULATIONS REGARDING 7 THE CRIMINAL PROSECUTION OF INDIVID- 8 UALS FOR HIV-RELATED OFFENSES. 9 (a) DEFINITIONS.— 10 (1) HIV AND HIV/AIDS.—The terms ‘‘HIV’’ and 11 ‘‘HIV/AIDS’’ have the meanings given to such terms 12 in section 2689 of the Public Health Service Act (42 13 U.S.C. 300ff–88). 14 (2) STATE.—The term ‘‘State’’ includes the 15 District of Columbia, American Samoa, the Com- 16 monwealth of the Northern Mariana Islands, Guam, 17 Puerto Rico, and the United States Virgin Islands. 18 (b) SENSE OF CONGRESS REGARDING LAWS OR REG- 19 ULATIONS DIRECTED AT PEOPLE LIVING WITH HIV/ 20 AIDS.—It is the sense of the Congress that Federal and 21 State laws, policies, and regulations regarding people liv- 22 ing with HIV/AIDS— 23 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00059 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 60 •HR 6138 IH (1) should not place unique or additional bur- 1 dens on such individuals solely as a result of their 2 HIV status; and 3 (2) should instead demonstrate a public health- 4 oriented, evidence-based, medically accurate, and 5 contemporary understanding of— 6 (A) the multiple factors that lead to HIV 7 transmission; 8 (B) the relative risk of HIV transmission 9 routes; 10 (C) the current health implications of liv- 11 ing with HIV; 12 (D) the associated benefits of treatment 13 and support services for people living with HIV; 14 and 15 (E) the impact of punitive HIV-specific 16 laws and policies on public health, on people liv- 17 ing with or affected by HIV, and on their fami- 18 lies and communities. 19 (c) REVIEW OF ALL FEDERAL AND STATE LAWS, 20 POLICIES, AND REGULATIONS REGARDING THE CRIMINAL 21 PROSECUTION OF INDIVIDUALS FOR HIV-RELATED OF- 22 FENSES.— 23 (1) REVIEW OF FEDERAL AND STATE LAWS.— 24 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00060 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 61 •HR 6138 IH (A) IN GENERAL.—No later than 90 days 1 after the date of the enactment of this Act, the 2 Attorney General, the Secretary of Health and 3 Human Services, and the Secretary of Defense 4 acting jointly (in this paragraph and paragraph 5 (2) referred to as the ‘‘designated officials’’) 6 shall initiate a national review of Federal and 7 State laws, policies, regulations, and judicial 8 precedents and decisions regarding criminal and 9 related civil commitment cases involving people 10 living with HIV/AIDS, including in regards to 11 the Uniform Code of Military Justice. 12 (B) CONSULTATION.—In carrying out the 13 review under subparagraph (A), the designated 14 officials shall ensure diverse participation and 15 consultation from each State, including with— 16 (i) State attorneys general (or their 17 representatives); 18 (ii) State public health officials (or 19 their representatives); 20 (iii) State judicial and court system 21 officers, including judges, district attor- 22 neys, prosecutors, defense attorneys, law 23 enforcement, and correctional officers; 24 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00061 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 62 •HR 6138 IH (iv) members of the United States 1 Armed Forces, including members of other 2 Federal services subject to the Uniform 3 Code of Military Justice; 4 (v) people living with HIV/AIDS, par- 5 ticularly those who have been subject to 6 HIV-related prosecution or who are from 7 communities whose members have been 8 disproportionately subject to HIV-specific 9 arrests and prosecutions; 10 (vi) legal advocacy and HIV/AIDS 11 service organizations that work with people 12 living with HIV/AIDS; 13 (vii) nongovernmental health organi- 14 zations that work on behalf of people living 15 with HIV/AIDS; and 16 (viii) trade organizations or associa- 17 tions representing persons or entities de- 18 scribed in clauses (i) through (vii). 19 (C) RELATION TO OTHER REVIEWS.—In 20 carrying out the review under subparagraph 21 (A), the designated officials may utilize other 22 existing reviews of criminal and related civil 23 commitment cases involving people living with 24 HIV/AIDS, including any such review con- 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00062 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 63 •HR 6138 IH ducted by any Federal or State agency or any 1 public health, legal advocacy, or trade organiza- 2 tion or association if the designated officials de- 3 termine that such reviews were conducted in ac- 4 cordance with the principles set forth in sub- 5 section (b). 6 (2) REPORT.—No later than 180 days after ini- 7 tiating the review required by paragraph (1), the At- 8 torney General shall transmit to the Congress and 9 make publicly available a report containing the re- 10 sults of the review, which includes the following: 11 (A) For each State and for the Uniform 12 Code of Military Justice, a summary of the rel- 13 evant laws, policies, regulations, and judicial 14 precedents and decisions regarding criminal 15 cases involving people living with HIV/AIDS, 16 including, if applicable, the following: 17 (i) A determination of whether such 18 laws, policies, regulations, and judicial 19 precedents and decisions place any unique 20 or additional burdens upon people living 21 with HIV/AIDS. 22 (ii) A determination of whether such 23 laws, policies, regulations, and judicial 24 precedents and decisions demonstrate a 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00063 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 64 •HR 6138 IH public health-oriented, evidence-based, 1 medically accurate, and contemporary un- 2 derstanding of— 3 (I) the multiple factors that lead 4 to HIV transmission; 5 (II) the relative risk of HIV 6 transmission routes; 7 (III) the current health implica- 8 tions of living with HIV; 9 (IV) the associated benefits of 10 treatment and support services for 11 people living with HIV; and 12 (V) the impact of punitive HIV- 13 specific laws and policies on public 14 health, on people living with or af- 15 fected by HIV, and on their families 16 and communities. 17 (iii) An analysis of the public health 18 and legal implications of such laws, poli- 19 cies, regulations, and judicial precedents, 20 including an analysis of the consequences 21 of having a similar penal scheme applied to 22 comparable situations involving other com- 23 municable diseases. 24 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00064 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 65 •HR 6138 IH (iv) An analysis of the proportionality 1 of punishments imposed under HIV-spe- 2 cific laws, policies, regulations, and judicial 3 precedents, taking into consideration pen- 4 alties attached to violation of State laws 5 against similar degrees of endangerment or 6 harm, such as driving while intoxicated 7 (DWI) or transmission of other commu- 8 nicable diseases, or more serious harms, 9 such as vehicular manslaughter offenses. 10 (B) An analysis of common elements 11 shared among State laws, policies, regulations, 12 and judicial precedents. 13 (C) A set of best practice recommendations 14 directed to State governments, including State 15 attorneys general, public health officials, and 16 judicial officers, in order to ensure that laws, 17 policies, regulations, and judicial precedents re- 18 garding people living with HIV/AIDS are in ac- 19 cordance with the principles set forth in sub- 20 section (b). 21 (D) Recommendations for adjustments to 22 the Uniform Code of Military Justice, as may 23 be necessary, in order to ensure that laws, poli- 24 cies, regulations, and judicial precedents re- 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00065 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 66 •HR 6138 IH garding people living with HIV/AIDS are in ac- 1 cordance with the principles set forth in sub- 2 section (b). 3 (3) GUIDANCE.—Within 90 days of the release 4 of the report required by paragraph (2), the Attor- 5 ney General and the Secretary of Health and 6 Human Services, acting jointly, shall develop and 7 publicly release updated guidance for States based 8 on the set of best practice recommendations required 9 by paragraph (2)(C) in order to assist States dealing 10 with criminal and related civil commitment cases re- 11 garding people living with HIV/AIDS. 12 (4) MONITORING AND EVALUATION SYSTEM.— 13 Within 60 days of the release of the guidance re- 14 quired by paragraph (3), the Attorney General and 15 the Secretary of Health and Human Services, acting 16 jointly, shall establish an integrated monitoring and 17 evaluation system which includes, where appropriate, 18 objective and quantifiable performance goals and in- 19 dicators to measure progress toward statewide im- 20 plementation in each State of the best practice rec- 21 ommendations required in paragraph (2)(C), includ- 22 ing to monitor, track, and evaluate the effectiveness 23 of assistance provided pursuant to subsection (d). 24 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00066 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 67 •HR 6138 IH (5) ADJUSTMENTS TO FEDERAL LAWS, POLI- 1 CIES, OR REGULATIONS.—Within 90 days of the re- 2 lease of the report required by paragraph (2), the 3 Attorney General, the Secretary of Health and 4 Human Services, and the Secretary of Defense, act- 5 ing jointly, shall develop and transmit to the Presi- 6 dent and the Congress, and make publicly available, 7 such proposals as may be necessary to implement 8 adjustments to Federal laws, policies, or regulations, 9 including to the Uniform Code of Military Justice, 10 based on the recommendations required by para- 11 graph (2)(D), either through Executive order or 12 through changes to statutory law. 13 (6) AUTHORIZATION OF APPROPRIATIONS.— 14 (A) IN GENERAL.—There are authorized to 15 be appropriated such sums as may be necessary 16 for the purpose of carrying out this subsection. 17 Amounts authorized to be appropriated by the 18 preceding sentence are in addition to amounts 19 otherwise authorized to be appropriated for 20 such purpose. 21 (B) AVAILABILITY OF FUNDS.—Amounts 22 appropriated pursuant to the authorization of 23 appropriations in subparagraph (A) are author- 24 ized to remain available until expended. 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00067 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 68 •HR 6138 IH (d) AUTHORIZATION TO PROVIDE GRANTS.— 1 (1) GRANTS BY ATTORNEY GENERAL.— 2 (A) IN GENERAL.—The Attorney General 3 may provide assistance to eligible State and 4 local entities and eligible nongovernmental orga- 5 nizations for the purpose of incorporating the 6 best practice recommendations developed under 7 subsection (c)(2)(C) within relevant State laws, 8 policies, regulations, and judicial decisions re- 9 garding people living with HIV/AIDS. 10 (B) AUTHORIZED ACTIVITIES.—The assist- 11 ance authorized by subparagraph (A) may in- 12 clude— 13 (i) direct technical assistance to eligi- 14 ble State and local entities in order to de- 15 velop, disseminate, or implement State 16 laws, policies, regulations, or judicial deci- 17 sions that conform with the best practice 18 recommendations developed under sub- 19 section (c)(2)(C); 20 (ii) direct technical assistance to eligi- 21 ble nongovernmental organizations in order 22 to provide education and training, includ- 23 ing through classes, conferences, meetings, 24 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00068 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 69 •HR 6138 IH and other educational activities, to eligible 1 State and local entities; and 2 (iii) subcontracting authority to allow 3 eligible State and local entities and eligible 4 nongovernmental organizations to seek 5 technical assistance from legal and public 6 health experts with a demonstrated under- 7 standing of the principles underlying the 8 best practice recommendations developed 9 under subsection (c)(2)(C). 10 (2) GRANTS BY SECRETARY OF HHS.— 11 (A) IN GENERAL.—The Secretary of 12 Health and Human Services, acting through the 13 Director of the Centers for Disease Control and 14 Prevention, may provide assistance to State and 15 local public health departments and eligible 16 nongovernmental organizations for the purpose 17 of supporting eligible State and local entities to 18 incorporate the best practice recommendations 19 developed under subsection (c)(2)(C) within rel- 20 evant State laws, policies, regulations, and judi- 21 cial decisions regarding people living with HIV/ 22 AIDS. 23 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00069 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 70 •HR 6138 IH (B) AUTHORIZED ACTIVITIES.—The assist- 1 ance authorized by subparagraph (A) may in- 2 clude— 3 (i) direct technical assistance to State 4 and local public health departments in 5 order to support the development, dissemi- 6 nation, or implementation of State laws, 7 policies, regulations, or judicial decisions 8 that conform with the set of best practice 9 recommendations developed under sub- 10 section (c)(2)(C); 11 (ii) direct technical assistance to eligi- 12 ble nongovernmental organizations in order 13 to provide education and training, includ- 14 ing through classes, conferences, meetings, 15 and other educational activities, to State 16 and local public health departments; and 17 (iii) subcontracting authority to allow 18 State and local public health departments 19 and eligible nongovernmental organizations 20 to seek technical assistance from legal and 21 public health experts with a demonstrated 22 understanding of the principles underlying 23 the best practice recommendations devel- 24 oped under subsection (c)(2)(C). 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00070 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 71 •HR 6138 IH (3) LIMITATION.—As a condition of receiving 1 assistance through this subsection, eligible State and 2 local entities, State and local public health depart- 3 ments, and eligible nongovernmental organizations 4 shall agree— 5 (A) not to place any unique or additional 6 burdens on people living with HIV/AIDS solely 7 as a result of their HIV status; and 8 (B) that if the entity, department, or orga- 9 nization promulgates any laws, policies, regula- 10 tions, or judicial decisions regarding people liv- 11 ing with HIV/AIDS, such actions shall dem- 12 onstrate a public health-oriented, evidence- 13 based, medically accurate, and contemporary 14 understanding of— 15 (i) the multiple factors that lead to 16 HIV transmission; 17 (ii) the relative risk of HIV trans- 18 mission routes; 19 (iii) the current health implications of 20 living with HIV; 21 (iv) the associated benefits of treat- 22 ment and support services for people living 23 with HIV; and 24 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00071 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 72 •HR 6138 IH (v) the impact of punitive HIV-spe- 1 cific laws and policies on public health, on 2 people living with or affected by HIV, and 3 on their families and communities. 4 (4) REPORT.—No later than 1 year after the 5 date of the enactment of this Act, and annually 6 thereafter, the Attorney General and the Secretary 7 of Health and Human Services, acting jointly, shall 8 transmit to Congress and make publicly available a 9 report describing, for each State, the impact and ef- 10 fectiveness of the assistance provided through this 11 Act. Each such report shall include— 12 (A) a detailed description of the progress 13 each State has made, if any, in implementing 14 the best practice recommendations developed 15 under subsection (c)(2)(C) as a result of the as- 16 sistance provided under this subsection, and 17 based on the performance goals and indicators 18 established as part of the monitoring and eval- 19 uation system in subsection (c)(4); 20 (B) a brief summary of any outreach ef- 21 forts undertaken during the prior year by the 22 Attorney General and the Secretary of Health 23 and Human Services to encourage States to 24 seek assistance under this subsection in order 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00072 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 73 •HR 6138 IH to implement the best practice recommenda- 1 tions developed under subsection (c)(2)(C); 2 (C) a summary of how assistance provided 3 through this subsection is being utilized by eli- 4 gible State and local entities, State and local 5 public health departments, and eligible non- 6 governmental organizations and, if applicable, 7 any contractors, including with respect to non- 8 governmental organizations, the type of tech- 9 nical assistance provided, and an evaluation of 10 the impact of such assistance on eligible State 11 and local entities; and 12 (D) a summary and description of eligible 13 State and local entities, State and local public 14 health departments, and eligible nongovern- 15 mental organizations receiving assistance 16 through this subsection, including if applicable, 17 a summary and description of any contractors 18 selected to assist in implementing such assist- 19 ance. 20 (5) DEFINITIONS.—For the purposes of this 21 subsection: 22 (A) ELIGIBLE STATE AND LOCAL ENTI- 23 TIES.—The term ‘‘eligible State and local enti- 24 ties’’ means the relevant individuals, offices, or 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00073 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 74 •HR 6138 IH organizations that directly participate in the de- 1 velopment, dissemination, or implementation of 2 State laws, policies, regulations, or judicial deci- 3 sions, including— 4 (i) State governments, including State 5 attorneys general, State departments of 6 justice, and State National Guards, or 7 their equivalents; 8 (ii) State judicial and court systems, 9 including trial courts, appellate courts, 10 State supreme courts and courts of appeal, 11 and State correctional facilities, or their 12 equivalents; and 13 (iii) local governments, including city 14 and county governments, district attorneys, 15 and local law enforcement departments, or 16 their equivalents. 17 (B) STATE AND LOCAL PUBLIC HEALTH 18 DEPARTMENTS.—The term ‘‘State and local 19 public health departments’’ means the fol- 20 lowing: 21 (i) State public health departments, or 22 their equivalents, including the chief officer 23 of such departments and infectious disease 24 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00074 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 75 •HR 6138 IH and communicable disease specialists with- 1 in such departments. 2 (ii) Local public health departments, 3 or their equivalents, including city and 4 county public health departments, the chief 5 officer of such departments, and infectious 6 disease and communicable disease special- 7 ists within such departments. 8 (iii) Public health departments or offi- 9 cials, or their equivalents, within State or 10 local correctional facilities. 11 (iv) Public health departments or offi- 12 cials, or their equivalents, within State Na- 13 tional Guards. 14 (v) Any other recognized State or 15 local public health organization or entity 16 charged with carrying out official State or 17 local public health duties. 18 (C) ELIGIBLE NONGOVERNMENTAL ORGA- 19 NIZATIONS.—The term ‘‘eligible nongovern- 20 mental organizations’’ means the following: 21 (i) Nongovernmental organizations, 22 including trade organizations or associa- 23 tions that represent— 24 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00075 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 76 •HR 6138 IH (I) State attorneys general, or 1 their equivalents; 2 (II) State public health officials, 3 or their equivalents; 4 (III) State judicial and court offi- 5 cers, including judges, district attor- 6 neys, prosecutors, defense attorneys, 7 law enforcement, and correctional offi- 8 cers; 9 (IV) State National Guards; 10 (V) people living with HIV/AIDS; 11 (VI) legal advocacy and HIV/ 12 AIDS service organizations that work 13 with people living with HIV/AIDS; 14 and 15 (VII) nongovernmental health or- 16 ganizations that work on behalf of 17 people living with HIV/AIDS. 18 (ii) Nongovernmental organizations, 19 including trade organizations or associa- 20 tions that demonstrate a public-health ori- 21 ented, evidence-based, medically accurate, 22 and contemporary understanding of— 23 (I) the multiple factors that lead 24 to HIV transmission; 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00076 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 77 •HR 6138 IH (II) the relative risk of HIV 1 transmission routes; 2 (III) the current health implica- 3 tions of living with HIV; 4 (IV) the associated benefits of 5 treatment and support services for 6 people living with HIV; and 7 (V) the impact of punitive HIV- 8 specific laws and policies on public 9 health, on people living with or af- 10 fected by HIV, and on their families 11 and communities. 12 (6) AUTHORIZATION OF APPROPRIATIONS.— 13 (A) IN GENERAL.—In addition to amounts 14 otherwise made available, there are authorized 15 to be appropriated to the Attorney General and 16 the Secretary of Health and Human Services 17 such sums as may be necessary to carry out 18 this subsection for each of the fiscal years 2013 19 through 2017. 20 (B) AVAILABILITY OF FUNDS.—Amounts 21 appropriated pursuant to the authorizations of 22 appropriations in subparagraph (A) are author- 23 ized to remain available until expended. 24 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00077 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 78 •HR 6138 IH TITLE III—ADDRESSING LEGAL 1 AND POLICY BARRIERS TO 2 ACCESSING HEALTH CARE 3 SEC. 301. REPEAL OF LIMITATION AGAINST USE OF FUNDS 4 FOR EDUCATION OR INFORMATION DE- 5 SIGNED TO PROMOTE OR ENCOURAGE, DI- 6 RECTLY, HOMOSEXUAL OR HETEROSEXUAL 7 ACTIVITY OR INTRAVENOUS SUBSTANCE 8 ABUSE. 9 Section 2500 of the Public Health Service Act (42 10 U.S.C. 300ee) is amended— 11 (1) by striking subsection (c); and 12 (2) by redesignating subsection (d) as sub- 13 section (c). 14 SEC. 302. EXPANDING SUPPORT FOR CONDOMS IN PRIS- 15 ONS. 16 (a) AUTHORITY TO ALLOW COMMUNITY ORGANIZA- 17 TIONS TO PROVIDE STI COUNSELING, STI PREVENTION 18 EDUCATION, AND SEXUAL BARRIER PROTECTION DE- 19 VICES IN FEDERAL CORRECTIONAL FACILITIES.— 20 (1) DIRECTIVE TO ATTORNEY GENERAL.—Not 21 later than 30 days after the date of enactment of 22 this Act, the Attorney General shall direct the Bu- 23 reau of Prisons to allow community organizations to 24 distribute sexual barrier protection devices and to 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00078 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 79 •HR 6138 IH engage in STI counseling and STI prevention edu- 1 cation in Federal correctional facilities. These activi- 2 ties shall be subject to all relevant Federal laws and 3 regulations which govern visitation in correctional 4 facilities. 5 (2) INFORMATION REQUIREMENT.—Any com- 6 munity organization permitted to distribute sexual 7 barrier protection devices under paragraph (1) must 8 ensure that the persons to whom the devices are dis- 9 tributed are informed about the proper use and dis- 10 posal of sexual barrier protection devices in accord- 11 ance with established public health practices. Any 12 community organization conducting STI counseling 13 or STI prevention education under paragraph (1) 14 must offer comprehensive sexuality education. 15 (3) POSSESSION OF DEVICE PROTECTED.—No 16 Federal correctional facility may, because of the pos- 17 session or use of a sexual barrier protection device— 18 (A) take adverse action against an incar- 19 cerated person; or 20 (B) consider possession or use as evidence 21 of prohibited activity for the purpose of any 22 Federal correctional facility administrative pro- 23 ceeding. 24 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00079 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 80 •HR 6138 IH (4) IMPLEMENTATION.—The Attorney General 1 and Bureau of Prisons shall implement this section 2 according to established public health practices in a 3 manner that protects the health, safety, and privacy 4 of incarcerated persons and of correctional facility 5 staff. 6 (b) SENSE OF CONGRESS REGARDING DISTRIBUTION 7 OF SEXUAL BARRIER PROTECTION DEVICES IN STATE 8 PRISON SYSTEMS.—It is the sense of the Congress that 9 States should allow for the legal distribution of sexual bar- 10 rier protection devices in State correctional facilities to re- 11 duce the prevalence and spread of STIs in those facilities. 12 (c) SURVEY OF AND REPORT ON CORRECTIONAL FA- 13 CILITY PROGRAMS AIMED AT REDUCING THE SPREAD OF 14 STIS.— 15 (1) SURVEY.—The Attorney General, after con- 16 sulting with the Secretary of Health and Human 17 Services, State officials, and community organiza- 18 tions, shall, to the maximum extent practicable, con- 19 duct a survey of all Federal and State correctional 20 facilities, no later than 180 days after the date of 21 enactment of this Act and annually thereafter for 5 22 years, to determine the following: 23 (A) COUNSELING, TREATMENT, AND SUP- 24 PORTIVE SERVICES.—Whether the correctional 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00080 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 81 •HR 6138 IH facility requires incarcerated persons to partici- 1 pate in counseling, treatment, and supportive 2 services related to STIs, or whether it offers 3 such programs to incarcerated persons. 4 (B) ACCESS TO SEXUAL BARRIER PROTEC- 5 TION DEVICES.—Whether incarcerated persons 6 can— 7 (i) possess sexual barrier protection 8 devices; 9 (ii) purchase sexual barrier protection 10 devices; 11 (iii) purchase sexual barrier protection 12 devices at a reduced cost; and 13 (iv) obtain sexual barrier protection 14 devices without cost. 15 (C) INCIDENCE OF SEXUAL VIOLENCE.— 16 The incidence of sexual violence and assault 17 committed by incarcerated persons and by cor- 18 rectional facility staff. 19 (D) PREVENTION EDUCATION OFFERED.— 20 The type of prevention education, information, 21 or training offered to incarcerated persons and 22 correctional facility staff regarding sexual vio- 23 lence and the spread of STIs, including whether 24 such education, information, or training— 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00081 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 82 •HR 6138 IH (i) constitutes comprehensive sexuality 1 education; 2 (ii) is compulsory for new incarcerated 3 persons and for new staff; and 4 (iii) is offered on an ongoing basis. 5 (E) STI TESTING.—Whether the correc- 6 tional facility tests incarcerated persons for 7 STIs or gives them the option to undergo such 8 testing— 9 (i) at intake; 10 (ii) on a regular basis; and 11 (iii) prior to release. 12 (F) STI TEST RESULTS.—The number of 13 incarcerated persons who are tested for STIs 14 and the outcome of such tests at each correc- 15 tional facility, disaggregated to include results 16 for— 17 (i) the type of sexually transmitted in- 18 fection tested for; 19 (ii) the race and/or ethnicity of indi- 20 viduals tested; 21 (iii) the age of individuals tested; and 22 (iv) the gender of individuals tested. 23 (G) PRERELEASE REFERRAL POLICY.— 24 Whether incarcerated persons are informed 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00082 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 83 •HR 6138 IH prior to release about STI-related services or 1 other health services in their communities, in- 2 cluding free and low-cost counseling and treat- 3 ment options. 4 (H) PRERELEASE REFERRALS MADE.— 5 The number of referrals to community-based 6 organizations or public health facilities offering 7 STI-related or other health services provided to 8 incarcerated persons prior to release, and the 9 type of counseling or treatment for which the 10 referral was made. 11 (I) REINSTATEMENT OF MEDICAID BENE- 12 FITS.—Whether the correctional facility assists 13 incarcerated persons that were enrolled in the 14 State Medicaid program prior to their incarcer- 15 ation, in reinstating their enrollment upon re- 16 lease and whether such individuals receive refer- 17 rals as provided by subparagraph (G) to entities 18 that accept the State Medicaid program, includ- 19 ing if applicable— 20 (i) the number of such individuals, in- 21 cluding those diagnosed with the human 22 immunodeficiency virus, that have been re- 23 instated; 24 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00083 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 84 •HR 6138 IH (ii) a list of obstacles to reinstating 1 enrollment or to making determinations of 2 eligibility for reinstatement, if any; and 3 (iii) the number of individuals denied 4 enrollment. 5 (J) OTHER ACTIONS TAKEN.—Whether the 6 correctional facility has taken any other action, 7 in conjunction with community organizations or 8 otherwise, to reduce the prevalence and spread 9 of STIs in that facility. 10 (2) PRIVACY.—In conducting the survey, the 11 Attorney General shall not request or retain the 12 identity of any person who has sought or been of- 13 fered counseling, treatment, testing, or prevention 14 education information regarding an STI (including 15 information about sexual barrier protection devices), 16 or who has tested positive for an STI. 17 (3) REPORT.—The Attorney General shall 18 transmit to Congress and make publicly available 19 the results of the survey required under paragraph 20 (1), both for the Nation as a whole and 21 disaggregated as to each State and each correctional 22 facility. To the maximum extent possible, the Attor- 23 ney General shall issue the first report no later than 24 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00084 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 85 •HR 6138 IH 1 year after the date of enactment of this Act and 1 shall issue reports annually thereafter for 5 years. 2 (d) STRATEGY.— 3 (1) DIRECTIVE TO ATTORNEY GENERAL.—The 4 Attorney General, in consultation with the Secretary 5 of Health and Human Services, State officials, and 6 community organizations, shall develop and imple- 7 ment a 5-year strategy to reduce the prevalence and 8 spread of STIs in Federal and State correctional fa- 9 cilities. To the maximum extent possible, the strat- 10 egy shall be developed, transmitted to Congress, and 11 made publicly available no later than 180 days after 12 the transmission of the first report required under 13 subsection (c)(3). 14 (2) CONTENTS OF STRATEGY.—The strategy 15 shall include the following: 16 (A) PREVENTION EDUCATION.—A plan for 17 improving prevention education, information, 18 and training offered to incarcerated persons 19 and correctional facility staff, including infor- 20 mation and training on sexual violence and the 21 spread of STIs, and comprehensive sexuality 22 education. 23 (B) SEXUAL BARRIER PROTECTION DEVICE 24 ACCESS.—A plan for expanding access to sexual 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00085 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 86 •HR 6138 IH barrier protection devices in correctional facili- 1 ties. 2 (C) SEXUAL VIOLENCE REDUCTION.—A 3 plan for reducing the incidence of sexual vio- 4 lence among incarcerated persons and correc- 5 tional facility staff, developed in consultation 6 with the National Prison Rape Elimination 7 Commission. 8 (D) COUNSELING AND SUPPORTIVE SERV- 9 ICES.—A plan for expanding access to coun- 10 seling and supportive services related to STIs in 11 correctional facilities. 12 (E) TESTING.—A plan for testing incarcer- 13 ated persons for STIs during intake, during 14 regular health exams, and prior to release, and 15 that— 16 (i) is conducted in accordance with 17 guidelines established by the Centers for 18 Disease Control and Prevention; 19 (ii) includes pretest counseling; 20 (iii) requires that incarcerated persons 21 are notified of their option to decline test- 22 ing at any time; 23 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00086 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 87 •HR 6138 IH (iv) requires that incarcerated persons 1 are confidentially notified of their test re- 2 sults in a timely manner; and 3 (v) ensures that incarcerated persons 4 testing positive for STIs receive post-test 5 counseling, care, treatment, and supportive 6 services. 7 (F) TREATMENT.—A plan for ensuring 8 that correctional facilities have the necessary 9 medicine and equipment to treat and monitor 10 STIs and for ensuring that incarcerated per- 11 sons living with or testing positive for STIs re- 12 ceive and have access to care and treatment 13 services. 14 (G) STRATEGIES FOR DEMOGRAPHIC 15 GROUPS.—A plan for developing and imple- 16 menting culturally appropriate, sensitive, and 17 specific strategies to reduce the spread of STIs 18 among demographic groups heavily impacted by 19 STIs. 20 (H) LINKAGES WITH COMMUNITIES AND 21 FACILITIES.—A plan for establishing and 22 strengthening linkages to local communities and 23 health facilities that— 24 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00087 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 88 •HR 6138 IH (i) provide counseling, testing, care, 1 and treatment services; 2 (ii) may receive persons recently re- 3 leased from incarceration who are living 4 with STIs; and 5 (iii) accept payment through the State 6 Medicaid program. 7 (I) ENROLLMENT IN STATE MEDICAID 8 PROGRAMS.—Plans to ensure that incarcerated 9 persons who were— 10 (i) enrolled in their State Medicaid 11 program prior to incarceration in a correc- 12 tional facility are automatically re-enrolled 13 in such program upon their release; and 14 (ii) not enrolled in their State Med- 15 icaid program prior to incarceration, but 16 who are diagnosed with the human im- 17 munodeficiency virus while incarcerated in 18 a correctional facility, are automatically 19 enrolled in such program upon their re- 20 lease. 21 (J) OTHER PLANS.—Any other plans de- 22 veloped by the Attorney General for reducing 23 the spread of STIs or improving the quality of 24 health care in correctional facilities. 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00088 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 89 •HR 6138 IH (K) MONITORING SYSTEM.—A monitoring 1 system that establishes performance goals re- 2 lated to reducing the prevalence and spread of 3 STIs in correctional facilities and which, where 4 feasible, expresses such goals in quantifiable 5 form. 6 (L) MONITORING SYSTEM PERFORMANCE 7 INDICATORS.—Performance indicators that 8 measure or assess the achievement of the per- 9 formance goals described in subparagraph (I). 10 (M) COST ESTIMATE.—A detailed estimate 11 of the funding necessary to implement the 12 strategy at the Federal and State levels for all 13 5 years, including the amount of funds required 14 by community organizations to implement the 15 parts of the strategy in which they take part. 16 (3) REPORT.—The Attorney General shall 17 transmit to Congress and make publicly available an 18 annual progress report regarding the implementation 19 and effectiveness of the strategy described in para- 20 graph (1). The progress report shall include an eval- 21 uation of the implementation of the strategy using 22 the monitoring system and performance indicators 23 provided for in subparagraphs (I) and (J) of para- 24 graph (2). 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00089 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 90 •HR 6138 IH (e) APPROPRIATIONS.— 1 (1) IN GENERAL.—There are authorized to be 2 appropriated such sums as may be necessary to 3 carry out this section for each of fiscal years 2013 4 through 2019. 5 (2) AVAILABILITY OF FUNDS.—Amounts made 6 available under paragraph (1) are authorized to re- 7 main available until expended. 8 (f) DEFINITIONS.—For the purposes of this section: 9 (1) COMMUNITY ORGANIZATION.—The term 10 ‘‘community organization’’ means a public health 11 care facility or a nonprofit organization which pro- 12 vides health- or STI-related services according to es- 13 tablished public health standards. 14 (2) COMPREHENSIVE SEXUALITY EDUCATION.— 15 The term ‘‘comprehensive sexuality education’’ 16 means sexuality education that includes information 17 about abstinence and about the proper use and dis- 18 posal of sexual barrier protection devices and which 19 is— 20 (A) evidence-based; 21 (B) medically accurate; 22 (C) age and developmentally appropriate; 23 (D) gender and identity sensitive; 24 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00090 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 91 •HR 6138 IH (E) culturally and linguistically appro- 1 priate; and 2 (F) structured to promote critical thinking, 3 self-esteem, respect for others, and the develop- 4 ment of healthy attitudes and relationships. 5 (3) CORRECTIONAL FACILITY.—The term ‘‘cor- 6 rectional facility’’ means any prison, penitentiary, 7 adult detention facility, juvenile detention facility, 8 jail, or other facility to which persons may be sent 9 after conviction of a crime or act of juvenile delin- 10 quency within the United States. 11 (4) INCARCERATED PERSON.—The term ‘‘incar- 12 cerated person’’ means any person who is serving a 13 sentence in a correctional facility after conviction of 14 a crime. 15 (5) SEXUALLY TRANSMITTED INFECTION.—The 16 term ‘‘sexually transmitted infection’’ or ‘‘STI’’ 17 means any disease or infection that is commonly 18 transmitted through sexual activity, including HIV/ 19 AIDS, gonorrhea, chlamydia, syphilis, genital her- 20 pes, viral hepatitis, and human papillomavirus. 21 (6) SEXUAL BARRIER PROTECTION DEVICE.— 22 The term ‘‘sexual barrier protection device’’ means 23 any FDA-approved physical device which has not 24 been tampered with and which reduces the prob- 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00091 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 92 •HR 6138 IH ability of STI transmission or infection between sex- 1 ual partners, including female condoms, male 2 condoms, and dental dams. 3 (7) STATE.—The term ‘‘State’’ includes the 4 District of Columbia, American Samoa, the Com- 5 monwealth of the Northern Mariana Islands, Guam, 6 Puerto Rico, and the United States Virgin Islands. 7 SEC. 303. AUTOMATIC REINSTATEMENT OR ENROLLMENT 8 IN MEDICAID FOR PEOPLE WHO TEST POSI- 9 TIVE FOR HIV BEFORE REENTERING COMMU- 10 NITIES. 11 (a) IN GENERAL.—Section 1902(e) of the Social Se- 12 curity Act (42 U.S.C. 1396a(e)) is amended by adding at 13 the end the following: 14 ‘‘(15) ENROLLMENT OF EX-OFFENDERS.— 15 ‘‘(A) AUTOMATIC ENROLLMENT OR REIN- 16 STATEMENT.— 17 ‘‘(i) IN GENERAL.—The State plan 18 shall provide for the automatic enrollment 19 or reinstatement of enrollment of an eligi- 20 ble individual— 21 ‘‘(I) if such individual is sched- 22 uled to be released from a public insti- 23 tution due to the completion of sen- 24 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00092 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 93 •HR 6138 IH tence, not less than 30 days prior to 1 the scheduled date of the release; and 2 ‘‘(II) if such individual is to be 3 released from a public institution on 4 parole or on probation, as soon as 5 possible after the date on which the 6 determination to release such indi- 7 vidual was made, and before the date 8 such individual is released. 9 ‘‘(ii) EXCEPTION.—If a State makes a 10 determination that an individual is not eli- 11 gible to be enrolled under the State plan— 12 ‘‘(I) on or before the date by 13 which the individual would be enrolled 14 under clause (i), such clause shall not 15 apply to such individual; or 16 ‘‘(II) after such date, the State 17 may terminate the enrollment of such 18 individual. 19 ‘‘(B) RELATIONSHIP OF ENROLLMENT TO 20 PAYMENT FOR SERVICES.— 21 ‘‘(i) IN GENERAL.—Subject to sub- 22 paragraph (A)(ii), an eligible individual 23 who is enrolled, or whose enrollment is re- 24 instated, under subparagraph (A) shall be 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00093 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 94 •HR 6138 IH eligible for medical assistance that is pro- 1 vided after the date that the eligible indi- 2 vidual is released from the public institu- 3 tion. 4 ‘‘(ii) RELATIONSHIP TO PAYMENT 5 PROHIBITION FOR INMATES.—No provision 6 of this paragraph may be construed to per- 7 mit payment for care or services for which 8 payment is excluded under subparagraph 9 (A), following paragraph (29), in section 10 1905(a). 11 ‘‘(C) TREATMENT OF CONTINUOUS ELIGI- 12 BILITY.— 13 ‘‘(i) SUSPENSION FOR INMATES.—Any 14 period of continuous eligibility under this 15 title shall be suspended on the date an in- 16 dividual enrolled under this title becomes 17 an inmate of a public institution (except as 18 a patient of a medical institution). 19 ‘‘(ii) DETERMINATION OF REMAINING 20 PERIOD.—Notwithstanding any changes to 21 State law related to continuous eligibility 22 during the time that an individual is an in- 23 mate of a public institution (except as a 24 patient of a medical institution), subject to 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00094 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 95 •HR 6138 IH clause (iii), with respect to an eligible indi- 1 vidual who was subject to a suspension 2 under subclause (I), on the date that such 3 individual is released from a public institu- 4 tion the suspension of continuous eligibility 5 under such subclause shall be lifted for a 6 period that is equal to the time remaining 7 in the period of continuous eligibility for 8 such individual on the date that such pe- 9 riod was suspended under such subclause. 10 ‘‘(iii) EXCEPTION.—If a State makes 11 a determination that an individual is not 12 eligible to be enrolled under the State 13 plan— 14 ‘‘(I) on or before the date that 15 the suspension of continuous eligibility 16 is lifted under clause (ii), such clause 17 shall not apply to such individual; or 18 ‘‘(II) after such date, the State 19 may terminate the enrollment of such 20 individual. 21 ‘‘(D) AUTOMATIC ENROLLMENT OR REIN- 22 STATEMENT OF ENROLLMENT DEFINED.—For 23 purposes of this paragraph, the term ‘automatic 24 enrollment or reinstatement of enrollment’ 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00095 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 96 •HR 6138 IH means that the State determines eligibility for 1 medical assistance under the State plan without 2 a program application from, or on behalf of, the 3 eligible individual, but an individual can only be 4 automatically enrolled in the State Medicaid 5 plan if the individual affirmatively consents to 6 being enrolled through affirmation in writing, 7 by telephone, orally, through electronic signa- 8 ture, or through any other means specified by 9 the Secretary. 10 ‘‘(E) ELIGIBLE INDIVIDUAL DEFINED.— 11 For purposes of this paragraph, the term ‘eligi- 12 ble individual’ means an individual who is an 13 inmate of a public institution (except as a pa- 14 tient in a medical institution)— 15 ‘‘(i) who was enrolled under the State 16 plan for medical assistance immediately be- 17 fore becoming an inmate of such an insti- 18 tution; or 19 ‘‘(ii) is diagnosed with human im- 20 munodeficiency virus.’’. 21 (b) SUPPLEMENTAL FUNDING FOR STATE IMPLE- 22 MENTATION OF AUTOMATIC REINSTATEMENT OF MED- 23 ICAID BENEFITS.— 24 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00096 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 97 •HR 6138 IH (1) IN GENERAL.—Subject to paragraph (6), 1 for each State for which the Secretary of Health and 2 Human Services has approved an application under 3 paragraph (3), the Federal matching payments (in- 4 cluding payments based on the Federal medical as- 5 sistance percentage) made to such State under sec- 6 tion 1903 of the Social Security Act (42 U.S.C. 7 1396b) (excluding any increase resulting from the 8 application of section 5001 of Public Law 111–5) 9 shall be increased by 5.0 percentage points for pay- 10 ments to the State for the activities permitted under 11 paragraph (2) or a period of one year. 12 (2) USE OF FUNDS.—A State may only use in- 13 creased matching payments authorized under para- 14 graph (1)— 15 (A) to strengthen the State’s enrollment 16 and administrative resources for the purpose of 17 improving processes for enrolling (or reinstating 18 the enrollment of) eligible individuals (as such 19 term is defined in section 1902(e)(15)(E) of the 20 Social Security Act); and 21 (B) for medical assistance (as such term is 22 defined in section 1905(a) of the Social Secu- 23 rity Act) provided to such eligible individuals. 24 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00097 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 98 •HR 6138 IH (3) APPLICATION AND AGREEMENT.—The Sec- 1 retary may only make payments to a State in the in- 2 creased amount if— 3 (A) the State has amended the State plan 4 under section 1902 of the Social Security Act 5 to incorporate the requirements of paragraph 6 (5)(xv) of such section; 7 (B) the State has submitted an application 8 to the Secretary that includes a plan for imple- 9 menting the requirements of section 10 1902(e)(15) of the Social Security Act under 11 the State’s amended State plan before the end 12 of the 90-day period beginning on the date that 13 the State receives increased matching payments 14 under paragraph (1); 15 (C) the State’s application meets the satis- 16 faction of the Secretary; and 17 (D) the State enters an agreement with 18 the Secretary that states that— 19 (i) the State will only use the in- 20 creased matching funds for the uses per- 21 mitted under paragraph (2); and 22 (ii) at the end of the period under 23 paragraph (1), the State will submit to the 24 Secretary, and make publicly available, a 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00098 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 99 •HR 6138 IH report that contains the information re- 1 quired under paragraph (4). 2 (4) REQUIRED REPORT INFORMATION.—The in- 3 formation that is required in the report under para- 4 graph (3)(D)(ii) includes— 5 (A) the results of an evaluation of the im- 6 pact of the implementation of the requirements 7 of section 1902(e)(15) of the Social Security 8 Act on improving the State’s processes for en- 9 rolling of individuals who are released from 10 public institutions into the Medicaid program; 11 (B) the number of individuals who were 12 automatically enrolled (or whose enrollment is 13 reinstated) under such section 1902(e)(15) dur- 14 ing the period under paragraph (1); and 15 (C) any other information that is required 16 by the Secretary. 17 (5) INCREASE IN CAP ON MEDICAID PAYMENTS 18 TO TERRITORIES.—Subject to paragraph (6), the 19 amounts otherwise determined for Puerto Rico, the 20 United States Virgin Islands, Guam, the Northern 21 Mariana Islands, and American Samoa under sub- 22 sections (f) and (g) of section 1108 of the Social Se- 23 curity Act (42 U.S.C. 1308) shall each be increased 24 by the necessary amount to allow for the increase in 25 VerDate Mar 15 2010 20:34 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00099 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 100 •HR 6138 IH the Federal matching payments under paragraph 1 (1), but only for the period under such subpara- 2 graph for such State. In the case of such an increase 3 for a territory, subsection (a)(1) of such section 4 1108 shall be applied without regard to any increase 5 in payment made to the territory under part E of 6 title IV of such Act that is attributable to the in- 7 crease in Federal medical assistance percentage ef- 8 fected under paragraph (1) for the territory. 9 (6) LIMITATIONS.— 10 (A) TIMING.—With respect to a State, at 11 the end of the period under paragraph (1), no 12 increased matching payments may be made to 13 such State under this subsection. 14 (B) MAINTENANCE OF ELIGIBILITY.— 15 (i) IN GENERAL.—Subject to clause 16 (ii), a State is not eligible for an increase 17 in its Federal matching payments under 18 paragraph (1), or an increase in a cap 19 amount under paragraph (5), if eligibility 20 standards, methodologies, or procedures 21 under its State plan under title XIX of the 22 Social Security Act (including any waiver 23 under such title or under section 1115 of 24 such Act (42 U.S.C. 1315)) are more re- 25 VerDate Mar 15 2010 20:34 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00100 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 101 •HR 6138 IH strictive than the eligibility standards, 1 methodologies, or procedures, respectively, 2 under such plan (or waiver) as in effect on 3 the date of enactment of this Act. 4 (ii) STATE REINSTATEMENT OF ELIGI- 5 BILITY PERMITTED.—A State that has re- 6 stricted eligibility standards, methodolo- 7 gies, or procedures under its State plan 8 under title XIX of the Social Security Act 9 (including any waiver under such title or 10 under section 1115 of such Act (42 U.S.C. 11 1315)) after the date of enactment of this 12 Act, is no longer ineligible under subpara- 13 graph (A) beginning with the first calendar 14 quarter in which the State has reinstated 15 eligibility standards, methodologies, or pro- 16 cedures that are no more restrictive than 17 the eligibility standards, methodologies, or 18 procedures, respectively, under such plan 19 (or waiver) as in effect on such date. 20 (C) NO WAIVER AUTHORITY.—The Sec- 21 retary may not waive the application of this 22 subsection under section 1115 of the Social Se- 23 curity Act or otherwise. 24 VerDate Mar 15 2010 20:34 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00101 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 102 •HR 6138 IH (D) LIMITATION OF MATCHING PAYMENTS 1 TO 100 PERCENT.—In no case shall an increase 2 in Federal matching payments under this sub- 3 section result in Federal matching payments 4 that exceed 100 percent. 5 (c) EFFECTIVE DATE.— 6 (1) IN GENERAL.—Except as provided in para- 7 graph (2), the amendments made by subsection (a) 8 shall take effect 180 days after the date of the en- 9 actment of this Act and shall apply to services fur- 10 nished on or after such date. 11 (2) RULE FOR CHANGES REQUIRING STATE 12 LEGISLATION.—In the case of a State plan for med- 13 ical assistance under title XIX of the Social Security 14 Act which the Secretary of Health and Human Serv- 15 ices determines requires State legislation (other than 16 legislation appropriating funds) in order for the plan 17 to meet the additional requirement imposed by the 18 amendments made by this section, the State plan 19 shall not be regarded as failing to comply with the 20 requirements of such title solely on the basis of its 21 failure to meet this additional requirement before 22 the first day of the first calendar quarter beginning 23 after the close of the first regular session of the 24 State legislature that begins after the date of the en- 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00102 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 103 •HR 6138 IH actment of this Act. For purposes of the previous 1 sentence, in the case of a State that has a 2-year 2 legislative session, each year of such session shall be 3 deemed to be a separate regular session of the State 4 legislature. 5 TITLE IV—COORDINATING EF- 6 FORTS TO DRIVE GREATER 7 EFFICIENCY AND IMPROVED 8 RESULTS 9 SEC. 401. SUPPORT DATA SYSTEM REVIEW AND INDICA- 10 TORS FOR MONITORING HIV CARE. 11 The Secretary of Health and Human Services, in col- 12 laboration with the Assistant Secretary for Health, the Di- 13 rector of the Office of HIV/AIDS and Infectious Disease 14 Policy, the Director of the Centers for Disease Control and 15 Prevention, the Administrator of the Substance Abuse and 16 Mental Health Services Administration, the Director of 17 the Department of Housing and Urban Development, the 18 Director of the Office of AIDS Research, the Adminis- 19 trator of the Health Resources and Services Administra- 20 tion, and the Administrator of the Centers for Medicare 21 & Medicaid Services, shall expand and coordinate efforts 22 to align metrics across agencies and modify Federal data 23 systems, to— 24 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00103 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 104 •HR 6138 IH (1) adopt the Institute of Medicine’s clinical 1 HIV care indicators as the core metrics for moni- 2 toring the quality of HIV care, mental health, sub- 3 stance abuse, and supportive services; 4 (2) better enable assessment of the impact of 5 the National HIV/AIDS Strategy and the Patient 6 Protection and Affordable Care Act on improving 7 HIV/AIDS care and access to supportive services for 8 individuals with HIV; 9 (3) expand the demographic data elements to be 10 captured by Federal data systems relevant to HIV 11 care to permit calculation of the indicators for sub- 12 groups of the population of people with diagnosed 13 HIV infection, including— 14 (A) age; 15 (B) race; 16 (C) ethnicity; 17 (D) sex (assigned at birth); 18 (E) gender identity; 19 (F) sexual orientation; 20 (G) current geographic marker of resi- 21 dence; 22 (H) income or poverty level; and 23 (I) primary means of reimbursement for 24 medical services (including Medicaid, Medicare, 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00104 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 105 •HR 6138 IH the Ryan White HIV/AIDS Program, private 1 insurance, health maintenance organizations, 2 and no coverage); and 3 (4) streamline data collection and systematically 4 review all existing reporting requirements for feder- 5 ally funded HIV/AIDS programs to ensure that only 6 essential data are collected. 7 SEC. 402. TRANSFER OF FUNDS FOR IMPLEMENTATION OF 8 NATIONAL HIV/AIDS STRATEGY. 9 Title II of the Public Health Service Act (42 U.S.C. 10 202 et seq.) is amended by inserting after section 241 the 11 following: 12 ‘‘SEC. 241A. TRANSFER OF FUNDS FOR IMPLEMENTATION 13 OF NATIONAL HIV/AIDS STRATEGY. 14 ‘‘(a) TRANSFER AUTHORIZATION.—Of the discre- 15 tionary appropriations made available to the Department 16 of Health and Human Services for any fiscal year for pro- 17 grams and activities that, as determined by the Secretary 18 of Health and Human Services, pertain to HIV/AIDS, the 19 Secretary, in coordination with the Director of the Office 20 of National HIV/AIDS Policy, may transfer up to 1 per- 21 cent of such appropriations to the Office of the Assistant 22 Secretary for Health for implementation of the National 23 HIV/AIDS Strategy. 24 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00105 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 106 •HR 6138 IH ‘‘(b) CONGRESSIONAL NOTIFICATION.—Not less than 1 30 days before making any transfer under this section, 2 the Secretary shall give notice of the transfer to the Con- 3 gress. 4 ‘‘(c) DEFINITIONS.—In this section: 5 ‘‘(1) The term ‘HIV/AIDS’ has the meaning 6 given to such term in section 2689. 7 ‘‘(2) The term ‘National HIV/AIDS Strategy’ 8 means the National HIV/AIDS Strategy for the 9 United States issued by the President in July 2010 10 and includes any subsequent revisions to such Strat- 11 egy.’’. 12 SEC. 403. HIV INTEGRATED SERVICES DELIVERY MODEL 13 DEMONSTRATION. 14 (a) IN GENERAL.—Consistent with the National 15 HIV/AIDS Strategy for the United States and in accord- 16 ance with this section, the Secretary of Health and 17 Human Services acting through the Center for Medicare 18 & Medicaid Innovation and in cooperation with CDC, 19 HRSA, SAMHSA, and HUD, shall conduct a 3-year dem- 20 onstration project that is designed to integrate services 21 and funding under the Medicare and Medicaid programs, 22 under HIV-related programs conducted by the CDC, and 23 under the Ryan White HIV/AIDS Program, to reduce new 24 HIV infections, to increase the proportion of people who 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00106 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 107 •HR 6138 IH know their status, to increase access to care, to improve 1 health outcomes, to reduce HIV-related health disparities 2 among Medicaid and Medicare beneficiaries, and to reduce 3 the cost of care provided to HIV positive Medicare and 4 Medicaid beneficiaries. 5 (b) OBJECTIVES.—The objectives of the demonstra- 6 tion are the following: 7 (1) To ensure the early identification of HIV 8 positive beneficiaries to reduce costly HIV-related 9 clinical conditions through HIV screening and rapid 10 linkage to high quality HIV medical care. 11 (2) To reduce new HIV infections among Med- 12 icaid and Medicare beneficiaries through routine 13 HIV testing, prevention services for HIV negative 14 beneficiaries, and intensive ‘‘prevention for positive’’ 15 services for HIV positive beneficiaries. 16 (3) To reduce morbidity, mortality, and high 17 cost inpatient and specialty care among HIV positive 18 beneficiaries by ensuring access to high quality HIV 19 medical care, HIV medications, and support services. 20 (4) To promote HIV treatment adherence and 21 retention in care through intensive case manage- 22 ment, treatment education, and outreach services. 23 (5) To effectively treat behavioral health condi- 24 tions among HIV positive beneficiaries that impair 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00107 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 108 •HR 6138 IH their HIV treatment adherence and lead to sec- 1 ondary HIV infections through services funded 2 under Medicare and Medicaid and programs admin- 3 istered by SAMHSA. 4 (6) To promote independence, treatment adher- 5 ence, and stable housing for HIV positive bene- 6 ficiaries through highly coordinated HIV health, 7 housing, and support services funded by HRSA and 8 HUD. 9 (c) DEMONSTRATION DESIGN.— 10 (1) IN GENERAL.—The Secretary shall design 11 the demonstration to test both— 12 (A) the service delivery model described in 13 paragraph (2); and 14 (B) the payment model described in para- 15 graph (3). 16 (2) SERVICE DELIVERY MODEL.— 17 (A) IN GENERAL.—Under the service deliv- 18 ery model described in this paragraph, the dem- 19 onstration shall test comprehensive HIV test- 20 ing, linkage to care, HIV medical care, and an- 21 cillary services to individuals enrolled under 22 Medicare, Medicaid, or both. The service deliv- 23 ery model will integrate services furnished 24 under Medicare and Medicaid with prevention 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00108 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 109 •HR 6138 IH services funded by CDC for HIV positive bene- 1 ficiaries, intensive case management services 2 funded by HRSA, behavioral services funded by 3 SAMHSA, and housing assistance services 4 funded through HUD. 5 (B) CORE ELEMENTS.—The model under 6 this paragraph shall have the following 8 core 7 elements: 8 (i) HIV testing services that apply the 9 CDC’s 2006 recommendations for uni- 10 versal opt-out testing among Medicare and 11 Medicaid beneficiary populations. 12 (ii) Rapid linkage from HIV testing 13 settings to treatment for HIV positive 14 beneficiaries to ensure they are engaged in 15 care in a timely basis. 16 (iii) Access to high quality HIV expe- 17 rienced medical care, laboratory moni- 18 toring, HIV medications, and other re- 19 quired services. 20 (iv) Routine screening and treatment 21 for HIV-related and other chronic condi- 22 tions, including behavioral health. 23 (v) Prevention and treatment edu- 24 cation services, including an adapted Medi- 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00109 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 110 •HR 6138 IH cation Therapy Management (MTM) pro- 1 gram model, to optimize the benefit of 2 HIV therapeutics. 3 (vi) Risk-stratified medical case man- 4 agement. 5 (vii) Provision of preventive care, in- 6 cluding counseling to prevent secondary 7 HIV infection. 8 (viii) Wrap-around support and hous- 9 ing services. 10 (3) PAYMENT MODEL.—Under the payment 11 model described in this paragraph, the demonstra- 12 tion shall test the following: 13 (A) A prepaid capitated payment model 14 that adjusts payment for HIV and behavioral 15 health acuity, to be applied under contracts 16 with managed care organizations with dem- 17 onstrated HIV experience. 18 (B) Use of funds under the Ryan White 19 HIV/AIDS Program to purchase capitated serv- 20 ices from the contracted managed care organi- 21 zations. 22 (C) Provision of additional funds to sup- 23 port services to the extent that Medicaid and 24 Medicare coverage is limited, including for serv- 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00110 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 111 •HR 6138 IH ices such as HIV testing (for Medicaid bene- 1 ficiaries), medical case management, prevention 2 case management, treatment education, case 3 finding, behavioral health services, and housing 4 assistance. 5 (d) BENEFICIARY CRITERIA.—Beneficiaries eligible 6 for participation in the demonstration are the following: 7 (1) MEDICAID FFS BENEFICIARIES.—Fee-for- 8 service Medicaid beneficiaries 18 years of age or 9 older. 10 (2) DUAL ELIGIBLES.—Individuals who are— 11 (A) entitled to medical assistance under 12 Medicaid; and 13 (B) entitled to benefits under part A, and 14 enrolled under part B, of Medicare but are not 15 enrolled under a Medicare Advantage plan 16 under Medicare. 17 (e) ROLES AND RESPONSIBILITIES IN DEMONSTRA- 18 TION.— 19 (1) IN GENERAL.—Consistent with the National 20 HIV/AIDS Strategy for the United States, Federal 21 agencies shall coordinate their funding for the se- 22 lected States or cities covered under the demonstra- 23 tion to provide resources to fund the delivery of serv- 24 ices within the demonstration. 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00111 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 112 •HR 6138 IH (2) HHS.—In carrying out the demonstration, 1 the Secretary shall— 2 (A) design the application process; 3 (B) solicit applications from 5 to 7 State 4 Medicaid agencies to host the demonstration; 5 (C) with respect to the service delivery 6 model described in subsection (c)(2), collaborate 7 with the CDC, HRSA, and the National Insti- 8 tutes of Health to design a minimum service de- 9 livery model that reflects the current standard 10 of care as established by the Public Health 11 Service and CDC guidelines and recommenda- 12 tions; and 13 (D) fund an evaluation of the demonstra- 14 tion to ensure collection of system, provider, 15 and beneficiary-level data to address their rou- 16 tine reporting requirements. 17 The Secretary may carry out the Secretary’s author- 18 ity under this paragraph through CMMI. 19 (3) CDC.—The CDC shall collaborate with the 20 Secretary and CDC-funded HIV prevention grantees 21 in the selected States and cities to provide technical 22 assistance to design cost-effective HIV and sexually 23 transmitted infection (STI) screening and testing 24 services for Medicaid and Medicare beneficiaries, in- 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00112 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 113 •HR 6138 IH cluding partner notification services and commu- 1 nicable disease reporting. CDC and CMS shall deter- 2 mine the extent to which testing funds shall be sup- 3 ported jointly or separately by these agencies. 4 (4) HRSA.—HRSA shall allocate funds avail- 5 able through the Special Projects of National Sig- 6 nificance (SPNS) Initiative Program (under subpart 7 I of part F of the Ryan White HIV/AIDS Program) 8 to support wrap-around core and support services 9 not covered under Medicare or Medicaid and shall 10 authorize the use of Ryan White HIV/AIDS Pro- 11 gram funds to purchase services through capitated 12 managed care programs that meet or exceed the 13 services covered by the Ryan White HIV/AIDS Pro- 14 gram at rates that are no greater than current per 15 capita expenditures. HRSA is authorized to use 16 funds under SPNS, and to waive such requirements 17 of SPNS as may be necessary, to carry out the dem- 18 onstration. 19 (5) SAMHSA.—SAMHSA shall allocate funds 20 through the Minority HIV/AIDS Initiative or other 21 programs to support behavioral health services not 22 covered under Medicare or Medicaid. 23 (6) HOPWA.—HUD shall directly allocate 24 funds under the Housing Opportunities for People 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00113 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 114 •HR 6138 IH With AIDS (HOPWA) program to the States or cit- 1 ies participating in the demonstration to provide 2 supportive housing and other housing assistance to 3 beneficiaries who otherwise meet HOPWA eligibility 4 criteria. HUD is authorized to use such HOPWA 5 funds, and to waive such requirements under 6 HOPWA as may be necessary, to carry out the dem- 7 onstration. 8 (7) STATE MEDICAID AGENCIES.—Single State 9 agencies responsible for administration of the Med- 10 icaid program for individuals who are accepted to 11 participate in the demonstration shall— 12 (A) collaborate with CMS to design or re- 13 fine a prepaid capitated payment model, to allo- 14 cate and award contracts with capitated man- 15 aged care plans, to ensure such plans meet 16 State statutory or regulatory requirements, to 17 contract with a coordinating agency to organize 18 and deliver integrated HIV testing, medical 19 care, support, and housing services funded 20 under Medicare and Medicaid, other Federal, 21 State, and local government sponsors, and to 22 coordinate their activities with the State HIV/ 23 AIDS program; and 24 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00114 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 115 •HR 6138 IH (B) identify and contract with a coordi- 1 nating agency to organize the demonstration in 2 the State, to establish a coordinating body rep- 3 resenting State, local, and provider agencies 4 participating in the demonstration, to establish 5 systems of care that integrate HIV prevention, 6 testing, treatment, support, and housing serv- 7 ices, to establish mechanisms to gather evalua- 8 tion data for reporting to CMMI and other par- 9 ticipating Federal agencies, and to establish a 10 quality management program to monitor pro- 11 vider performance in delivering the services pro- 12 vided to participating beneficiaries under the 13 demonstration. 14 (8) MANAGED CARE ORGANIZATIONS.— 15 Capitated managed care organizations participating 16 in the demonstration shall organize and deliver serv- 17 ices as specified by the minimum service delivery 18 model established by CMMI through a network of 19 providers with demonstrated HIV experience, high 20 quality, and sufficient provider capacity. 21 (f) DEFINITIONS.—In this section: 22 (1) CDC.—The term ‘‘CDC’’ means the Direc- 23 tor of the Centers for Disease Control and Preven- 24 tion. 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00115 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 116 •HR 6138 IH (2) CMMI.—The term ‘‘CMMI’’ means the Di- 1 rector of the Center for Medicare and Medicaid In- 2 novation. 3 (3) CMS.—The term ‘‘CMS’’ means the Ad- 4 ministrator of the Centers for Medicare & Medicaid 5 Services. 6 (4) DEMONSTRATION.—The term ‘‘demonstra- 7 tion’’ means the demonstration conducted under this 8 section. 9 (5) HRSA.—The term ‘‘HRSA’’ means the Ad- 10 ministrator of the Health Resources and Services 11 Administration. 12 (6) HUD.—The term ‘‘HUD’’ means the Sec- 13 retary of Housing and Urban Development. 14 (7) MEDICARE; MEDICAID.—The terms ‘‘Medi- 15 care’’ and ‘‘Medicaid’’ mean the programs under ti- 16 tles XVIII and XIX, respectively, of the Social Secu- 17 rity Act. 18 (8) NATIONAL HIV/AIDS STRATEGY FOR THE 19 UNITED STATES.—The term ‘‘National HIV/AIDS 20 Strategy for the United States’’ has the meaning 21 given such term under section 241A(b) of the Public 22 Health Service Act. 23 (9) RYAN WHITE HIV/AIDS PROGRAM.—The 24 term ‘‘Ryan White HIV/AIDS Program’’ means the 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00116 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 117 •HR 6138 IH program under title XXVI of the Public Health 1 Service Act. 2 (10) SAMHSA.—The term ‘‘SAMHSA’’ means 3 the Substance Abuse and Mental Health Services 4 Administration. 5 (11) SECRETARY.—The term ‘‘Secretary’’ 6 means the Secretary of Health and Human Services, 7 acting through CMMI. 8 SEC. 404. REPORT ON THE IMPLEMENTATION OF THE NA- 9 TIONAL HIV/AIDS STRATEGY. 10 (a) REPORT REQUIRED.—The President, in consulta- 11 tion with the heads of all relevant agencies including the 12 Department of Education, the Department of Health and 13 Human Services, the Department of Housing and Urban 14 Development, the Department of Justice, the Department 15 of Labor, the Department of Veterans Affairs, and the So- 16 cial Security Administration, shall enter an arrangement 17 not later than 6 months after the date of the enactment 18 of this Act with the Institute of Medicine of the National 19 Academies (or, if the Institute declines to enter into such 20 an arrangement, another appropriate entity)— 21 (1) to prepare a report on the status of the im- 22 plementation of the National HIV/AIDS Strategy; 23 and 24 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00117 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 118 •HR 6138 IH (2) to transmit such report to the Congress and 1 make publicly available a report. 2 (b) CONTENTS.—The report required by subsection 3 (a) shall include a description, analysis, and evaluation 4 of— 5 (1) key steps taken by the Federal Government 6 toward the achievement of the goals of the National 7 HIV/AIDS Strategy, including the goals of— 8 (A) reducing the number of people who be- 9 come infected with HIV; 10 (B) increasing access to care and opti- 11 mizing health outcomes for people living with 12 HIV; and 13 (C) reducing HIV-related health dispari- 14 ties; 15 (2) the extent to which the National HIV/AIDS 16 Strategy has improved coordination of efforts to 17 maximize the effective delivery of HIV/AIDS preven- 18 tion, care, and treatment services at the community 19 level, including coordination— 20 (A) within and among Federal agencies 21 and departments; 22 (B) between the Federal Government and 23 State and local governments and health depart- 24 ments; 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00118 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 119 •HR 6138 IH (C) between the Federal Government and 1 nonprofit foundations and civil society organiza- 2 tions, including community- and faith-based or- 3 ganizations focused on addressing the issue of 4 HIV/AIDS; and 5 (D) between the Federal Government and 6 private businesses; 7 (3) efforts by the Federal Government to edu- 8 cate, involve, and establish and strengthen partner- 9 ships with civil society organizations, including 10 community- and faith-based organizations, in order 11 to implement the National HIV/AIDS Strategy and 12 achieve its goals; 13 (4) how Federal resources are being deployed to 14 implement the Strategy, including— 15 (A) the amount of funding used to date, by 16 each Federal agency and department, to imple- 17 ment the National HIV/AIDS Strategy; 18 (B) a brief summary for each Federal 19 agency and department of the number and 20 function of all Federal employees assisting in 21 implementing the Strategy; and 22 (C) an estimate of the amount of funding 23 necessary to implement the National HIV/AIDS 24 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00119 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 120 •HR 6138 IH Strategy, by each Federal agency and depart- 1 ment, for the next fiscal year; and 2 (5) what additional steps, if any, are necessary 3 to fully implement the National HIV/AIDS Strategy, 4 including— 5 (A) whether any existing statutory laws, 6 policies, or regulations are impeding the imple- 7 mentation of the National HIV/AIDS Strategy, 8 at the Federal, State, or local level, and wheth- 9 er any changes to such laws, policies, or regula- 10 tions are necessary or recommended; and 11 (B) whether any Federal agencies or de- 12 partments require additional statutory authority 13 to effectively carry out their duties as part of 14 the National HIV/AIDS Strategy. 15 (c) USE OF PREVIOUSLY APPROPRIATED FUNDS.— 16 Funding for the report required under subsection (a) shall 17 be derived from discretionary funds of the departments 18 and agencies specified in such subsection. 19 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00120 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 121 •HR 6138 IH DIVISION B—ENDING HIV/AIDS 1 GLOBALLY 2 TITLE X—GLOBAL HIV/AIDS- 3 FREE GENERATION STRATEGY 4 SEC. 1001. GLOBAL HIV/AIDS-FREE GENERATION STRAT- 5 EGY. 6 (a) STRATEGY.—The President, acting through the 7 Coordinator of United States Government Activities to 8 Combat HIV/AIDS Globally, shall establish a comprehen- 9 sive, integrated, 5-year strategy to expand and improve 10 efforts to combat global HIV/AIDS, while promoting effi- 11 ciency and maximizing results. The strategy shall be re- 12 ferred to as the ‘‘Global HIV/AIDS-Free Generation 13 Strategy’’. 14 (b) CONTENTS.—The strategy shall— 15 (1) accelerate progress toward achieving the 16 United States goal of an AIDS-free generation; 17 (2) establish a limited number of measurable 18 targets to accelerate reductions in HIV incidence 19 and HIV/AIDS-related morbidity and mortality; 20 (3) strengthen existing and future compacts 21 and framework agreements authorized under section 22 104A(d)(8) of the Foreign Assistance Act of 1961 23 (22 U.S.C. 2151b–2(d)(8)); 24 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00121 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 122 •HR 6138 IH (4) strengthen engagement with diplomatic ef- 1 forts at all levels of government to— 2 (A) continue to identify and promote link- 3 ages between efforts to combat HIV/AIDS and 4 other health development issues and human 5 rights issues; 6 (B) encourage and assist national govern- 7 ments to pursue policies and legal frameworks 8 that facilitate and enable effective responses to 9 HIV prevention, care, and treatment services; 10 and 11 (C) increase financial accountability; 12 (5) provide a plan to— 13 (A) support early diagnosis and initiation 14 of HIV treatment to achieve accelerated reduc- 15 tions of incidence and morbidity; 16 (B) eliminate vertical transmission of HIV 17 from mother to child and support early diag- 18 nosis and initiation of HIV treatment in infants 19 and children; 20 (C) intensify efforts to expand access to 21 voluntarily medical male circumcision, male and 22 female condoms and other proven-effective HIV 23 prevention interventions, in combination with 24 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00122 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 123 •HR 6138 IH other evidence-based modalities and structural 1 interventions; 2 (D) reduce the risk of HIV infection and 3 address the HIV-related needs of sex workers, 4 men who have sex with men, transgender peo- 5 ple, and people who inject drugs; 6 (E) increase gender equity in HIV/AIDS 7 programs and services, including access to vol- 8 untary family planning and reproductive health 9 services and reducing violence and coercion; 10 (F) expand partnership with implementers, 11 researchers, and academic organizations to im- 12 prove the science that guides the global re- 13 sponse to HIV/AIDS; 14 (G) provide capacity development support 15 to increase meaningful engagement of civil soci- 16 ety, especially local indigenous organizations, 17 that work in the areas of human rights, wom- 18 en’s and young people’s health and rights, and 19 gay, lesbian, bisexual, and transgender rights, 20 in the development, implementation, moni- 21 toring, and evaluation of United States-funded 22 programs; 23 (H) advance the efforts of developing coun- 24 tries to develop health systems capable of man- 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00123 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 124 •HR 6138 IH aging their epidemics, respond to broader 1 health needs impacting affected communities, 2 and address new and emerging health concerns; 3 and 4 (I) defend, protect, and fulfill the human 5 rights of people living with HIV and those most 6 at risk of HIV infection. 7 (c) CONSULTATION.—In developing the strategy, the 8 President, acting through the Coordinator of United 9 States Government Activities to Combat HIV/AIDS Glob- 10 ally, shall consult with— 11 (1) each executive branch agency administering 12 United States foreign assistance related to— 13 (A) improving global health; 14 (B) strengthening financial management 15 systems; and 16 (C) monitoring and promoting human 17 rights and democracy; 18 (2) personnel at United States embassies and 19 country missions involved in the administration of 20 the types of United States foreign assistance de- 21 scribed in paragraph (1); 22 (3) the appropriate congressional committees 23 with jurisdiction over the agencies described in para- 24 graph (1); 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00124 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 125 •HR 6138 IH (4) civil society and nongovernmental organiza- 1 tions engaged in improving health care and health 2 outcomes in developing countries, including indige- 3 nous community and faith-based organizations; 4 (5) international organizations engaged in im- 5 proving health care and health outcomes in devel- 6 oping countries and of which the United States is a 7 voting member, with which the United States coordi- 8 nates the delivery of foreign assistance, or to which 9 the United States contributes funding for the pur- 10 pose of providing such assistance; 11 (6) academic organizations, private foundations, 12 businesses, and other organizations engaged in im- 13 proving health care and health outcomes in devel- 14 oping countries and not receiving United States 15 funding for such purposes; 16 (7) other donor nations engaged in improving 17 health care and health outcomes in developing coun- 18 tries; 19 (8) countries receiving health-related United 20 States foreign assistance; and 21 (9) any other global, regional, or subregional 22 organizations or partnerships engaged in improving 23 health care and health outcomes in developing coun- 24 tries. 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00125 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 126 •HR 6138 IH (d) REPORT.—Not later than 1 year after the date 1 of the enactment of this Act, the President shall submit 2 to Congress a report that sets forth the strategy described 3 in this section. 4 TITLE XI—USING FUNDS STRA- 5 TEGICALLY TO MAXIMIZE RE- 6 SULTS 7 SEC. 1101. SUPPORT FOR OPERATIONS RESEARCH TO IM- 8 PROVE PROGRAM DELIVERY, EFFICIENCY, 9 IMPACT, AND EFFECTIVENESS. 10 (a) SENSE OF CONGRESS.—It is the sense of the Con- 11 gress that there is a need and urgency to expand the range 12 of interventions for preventing the transmission of HIV, 13 including behavioral prevention research, operations re- 14 search to optimize combination HIV prevention, and re- 15 search on medical technology to prevent HIV infection, in- 16 cluding microbicides, cost-effective female condoms, Pre- 17 Exposure Prophylaxis (PrEP), multipurpose technologies 18 for the prevention of HIV and unintended pregnancy, and 19 vaccines. 20 (b) STATEMENT OF POLICY.—It should be the policy 21 of the United States to ensure that efforts to combat HIV/ 22 AIDS globally should expand, intensify, and coordinate 23 operations research to improve the quality, delivery, and 24 impact of programming, including with respect to— 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00126 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 127 •HR 6138 IH (1) services appropriate for men who have sex 1 with men, transgender people, people who inject 2 drugs, and sex workers; 3 (2) structural interventions to remove barriers 4 that inhibit effective implementation of HIV/AIDS- 5 related foreign assistance, including the analysis of 6 laws and policies that have a negative health impact 7 and put individuals at increased risk of HIV infec- 8 tion; 9 (3) scalable combination of prevention and 10 treatment approaches to HIV/AIDS; 11 (4) prevention and management of co- 12 morbidities such as tuberculosis, malaria, and viral 13 hepatitis; and 14 (5) identification and follow up of HIV-positive 15 infants and children in resource-limited settings to 16 increase the proportion of children accessing HIV 17 treatment and care services. 18 SEC. 1102. INCREASING COORDINATION AND INTEGRATION 19 OF HIV/AIDS PROGRAMS WITH DEVELOP- 20 MENT PROGRAMS. 21 (a) STATEMENT OF POLICY.—It should be the policy 22 of the United States to ensure that efforts to combat HIV/ 23 AIDS globally should maximize efficiencies and the inte- 24 gration of services and programs to achieve reduction in 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00127 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 128 •HR 6138 IH HIV transmission rates and the burden of HIV-related 1 morbidity and mortality, by means that include— 2 (1) ensuring that women and adolescent girls 3 with HIV or who are at risk of HIV infection and 4 who do not wish to become pregnant have access to 5 voluntary contraceptive services, including a range of 6 contraceptive options, and voluntary counseling to 7 plan families, either directly or through meaningful 8 referrals to existing United States Agency for Inter- 9 national Development or local family planning pro- 10 grams that provide counseling and a range of con- 11 traceptive options; 12 (2) integrating tuberculosis interventions with 13 HIV services, including case-finding and tuberculosis 14 treatment, expanding tuberculosis preventive ther- 15 apy, and reducing other opportunistic infections that 16 accompany HIV/AIDS; 17 (3) ensuring young people with HIV are pro- 18 vided with confidential and affordable access to 19 youth-friendly comprehensive sexual and reproduc- 20 tive health services and supplies, including male and 21 female condoms for the prevention of pregnancy and 22 sexually transmitted diseases, as relevant; and 23 (4) working to promote and protect the human 24 rights of people living with HIV, including men who 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00128 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 129 •HR 6138 IH have sex with men, transgender people, people who 1 inject drugs, sex workers, and other vulnerable popu- 2 lations, including indigenous people, migrants, inter- 3 nally displaced people, young people, incarcerated 4 populations, and people with disabilities. 5 (b) REPORT.—Not later than 180 days after the date 6 of the enactment of this Act, the Secretary of State shall 7 submit to the appropriate congressional committees a re- 8 port describing the utilization of efficiencies in the delivery 9 of HIV/AIDS treatment services within and between 10 United States-funded bilateral and multilateral programs 11 and partner countries, including to the extent that such 12 gains in efficiencies are being exhausted. 13 SEC. 1103. INCREASING PROGRAM EFFECTIVENESS AND 14 SUSTAINABILITY TO ACHIEVE SUCCESSFUL 15 COUNTRY OWNERSHIP. 16 (a) STATEMENT OF POLICY.—It should be the policy 17 of the United States to ensure that efforts to combat HIV/ 18 AIDS globally should help developing countries signifi- 19 cantly decrease the burden of HIV, strengthen and im- 20 prove their health systems, help build country ownership, 21 and increase financial accountability to ensure sustain- 22 ability and equitable access to health services, including 23 by— 24 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00129 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 130 •HR 6138 IH (1) assisting developing countries create, 1 strengthen, and implement their own evidence-based 2 national HIV/AIDS strategies, by means that in- 3 clude— 4 (A) supporting early diagnosis and initi- 5 ation of HIV and tuberculosis treatment to 6 achieve accelerated reductions of incidence and 7 morbidity; 8 (B) eliminating the vertical transmission of 9 HIV from mother to child and supporting early 10 diagnosis and initiation of HIV treatment in in- 11 fants and children; 12 (C) intensifying efforts to expand access to 13 voluntary medical male circumcision, male and 14 female condoms, harm reduction services, and 15 other proven-effective HIV prevention interven- 16 tions, in combination with other evidence-based 17 modalities, including structural interventions; 18 (D) intensifying efforts to eliminate HIV 19 infections among populations that are often at 20 greatest risk, including sex workers, men who 21 have sex with men, and people who inject 22 drugs, and addressing the HIV-related needs, 23 including access to ART, of those already in- 24 fected; 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00130 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 131 •HR 6138 IH (E) ensuring young people are provided 1 with comprehensive knowledge, skill-building 2 programs, in and out of school, to make in- 3 formed and responsible decisions for their sex- 4 ual health, and are provided with confidential 5 and affordable access to youth-friendly com- 6 prehensive sexual and reproductive health serv- 7 ices and supplies, including male and female 8 condoms; 9 (F) ensuring women with HIV or who are 10 at risk of HIV infection and who do not wish 11 to become pregnant have access to voluntary 12 contraceptive services and commodities, and 13 women who desire pregnancy have access to 14 family planning counseling and maternal health 15 services free of judgment and discrimination; 16 and 17 (G) encouraging policy changes to elimi- 18 nate discriminatory and stigmatizing polices 19 that stand in the way of access to health serv- 20 ices by marginalized and poor populations in- 21 cluding punitive laws against HIV exposure and 22 potential transmission, sex work, same-sex be- 23 havior, drug use, and gender expression; 24 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00131 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 132 •HR 6138 IH (2) supporting meaningful community involve- 1 ment and participation, inclusive of poor, vulnerable, 2 or marginalized populations and their representative 3 indigenous and civil society organizations, in deci- 4 sionmaking related to national HIV/AIDS strategies 5 and the delivery of health services, including in deci- 6 sions related to the adoption of health policies and 7 the total amount and distribution of health funding; 8 (3) assisting countries to coordinate, regulate, 9 and harmonize the delivery of health services pro- 10 vided by the United States and nongovernmental or- 11 ganizations, including community and faith-based 12 organizations, private foundations, international or- 13 ganizations, and other donors, and to coordinate or 14 integrate such services with the health system to the 15 maximum extent practicable; 16 (4) using, to the maximum extent practicable, 17 local and regional entities for the provision of tech- 18 nical assistance, and where the capacity of such enti- 19 ties is insufficient, supporting capacity building to 20 enable such entities to provide such assistance; 21 (5) strengthening procurement and supply 22 chain logistics to help prevent drug and commodity 23 stock outs, including male and female condom short- 24 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00132 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 133 •HR 6138 IH ages, and to help ensure the eventual provision of 1 microbicides for HIV prevention; and 2 (6) providing technical assistance and support 3 to national ministries of health, or their equivalents, 4 and other relevant ministries in overseeing the 5 health systems of their countries and monitoring and 6 evaluating the effectiveness of such systems in re- 7 ducing mortality and improving health outcomes, in- 8 cluding preparing for the provision of HIV/AIDS, 9 voluntary family planning, non-communicable dis- 10 eases, and reproductive health services in emergency 11 situations. 12 (b) REPORT.—Not later than 180 days after the date 13 of the enactment of this Act, the Secretary of State shall 14 submit to the appropriate congressional committees a re- 15 port identifying benchmarks that are directly relevant to 16 significantly decreasing the burden of the epidemic in each 17 country receiving HIV-related foreign assistance and pro- 18 vide context for helping countries and civil society to build 19 country ownership. 20 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00133 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 134 •HR 6138 IH TITLE XII—ADDRESSING LEGAL 1 AND POLICY BARRIERS TO 2 ACCESSING HEALTH CARE 3 Subtitle A—General Provisions 4 SEC. 1201. SUPPORT FOR LAWS AND REGULATIONS THAT 5 IMPROVE HEALTH OUTCOMES AND PROMOTE 6 HUMAN RIGHTS. 7 It should be the policy of the United States to ensure 8 that United States foreign assistance should encourage 9 and assist national governments of developing countries 10 to pursue policies and legal frameworks that improve 11 health outcomes, including policies and legal frameworks 12 that— 13 (1) are medically accurate and evidence-based 14 and adhere to the latest global public health stand- 15 ards for prevention, treatment, and care; 16 (2) promote and improve the status of women 17 and youth, ensuring their ability to access and use 18 health services without fear or risk of gender-based 19 violence, reprisal, discrimination, stigmatization, ar- 20 rest, or other mistreatment; 21 (3) work to remove criminalization of, stig- 22 matization of, and discrimination against poor, vul- 23 nerable, or marginalized populations and enact laws 24 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00134 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 135 •HR 6138 IH and policies to promote and protect the rights of 1 such populations; 2 (4) avoid, to the maximum extent possible, reli- 3 ance on criminal laws and sanctions to address 4 health issues; 5 (5) incorporate relevant policy guidance that 6 addresses structural barriers to accessing health 7 care; and 8 (6) prioritize the creation of a legal, political, 9 and social environment that enables access to health 10 services by all members of the population. 11 SEC. 1202. INTENSIFYING EFFORTS TO ESTABLISH EFFEC- 12 TIVE PROGRAMS FOR ENGAGING KEY AF- 13 FECTED POPULATIONS. 14 It should be the policy of the United States to ensure 15 that efforts to combat HIV/AIDS globally should intensify 16 efforts to establish effective programs for engaging men 17 who have sex with men, transgender people, people who 18 inject drugs, and sex workers in HIV prevention, care, and 19 treatment initiatives, by means that include— 20 (1) ensuring those eligible for treatment receive 21 antiretroviral treatment; 22 (2) providing sterile syringes, education, and 23 outreach and treatment for drug dependence for in- 24 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00135 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 136 •HR 6138 IH jecting drug users through a comprehensive package 1 of services; 2 (3) providing sexual health services, condoms, 3 and other HIV prevention services to sex workers, 4 their clients, and partners; and 5 (4) defending human rights and inherent dig- 6 nity by addressing laws and practices that prevent 7 people from accessing services and providing legal 8 and social services to individuals and communities to 9 facilitate access to services and to reduce violence, 10 stigma, and discrimination. 11 SEC. 1203. ENSURING UNITED STATES TRADE POLICY DOES 12 NOT RESTRICT ACCESS TO AFFORDABLE 13 MEDICINES. 14 In administering title III of the Trade Act of 1974 15 (19 U.S.C. 2411 et seq.), the United States Government 16 shall not seek, through negotiation or otherwise, the rev- 17 ocation or revision of any intellectual property law or pol- 18 icy of a low- or middle-income country that regulates HIV 19 and opportunistic infection pharmaceuticals or medical 20 technologies if the law or policy of the country— 21 (1) promotes access to affordable HIV and op- 22 portunistic infection pharmaceuticals or medical 23 technologies for affected populations in that country; 24 and 25 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00136 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 137 •HR 6138 IH (2) provides intellectual property protection 1 consistent with the Agreement on Trade-Related As- 2 pects of Intellectual Property Rights referred to in 3 section 101(d)(15) of the Uruguay Round Agree- 4 ments Act (19 U.S.C. 3511(d)(15)). 5 Subtitle B—Repeal of Certain 6 Provisions of Public Law 108–25 7 SEC. 1211. REPEAL OF ‘‘CONSCIENCE CLAUSE’’ REQUIRE- 8 MENT FOR ELIGIBILITY FOR ASSISTANCE. 9 Section 301 of the United States Leadership Against 10 HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 11 U.S.C. 7631) is amended by striking subsection (d). 12 SEC. 1212. REPEAL OF LIMITATION ON USE OF FUNDS FOR 13 ASSISTANCE FOR SEX WORKERS. 14 Section 301 of the United States Leadership Against 15 HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 16 U.S.C. 7631), as amended by section 711 of this Act, is 17 further amended by striking subsections (e) and (f). 18 SEC. 1213. REPEAL OF REPORTING REQUIREMENT ON AC- 19 TIVITIES PROMOTING ABSTINENCE AND RE- 20 LATED ACTIVITIES. 21 Section 403(a)(2) of the United States Leadership 22 Against HIV/AIDS, Tuberculosis, and Malaria Act of 23 2003 (22 U.S.C. 7673(a)(2)) is amended— 24 VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00137 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 138 •HR 6138 IH (1) by striking ‘‘(2) PREVENTION STRATEGY.— 1 ’’ and all that follows through ‘‘In carrying out para- 2 graph (1)’’ and inserting ‘‘(2) PREVENTION STRAT- 3 EGY.—In carrying out paragraph (1)’’; and 4 (2) by striking subparagraph (B). 5 SEC. 1214. EFFECTIVE DATE. 6 This subtitle and the amendments made by this sub- 7 title— 8 (1) take effect on the date of the enactment of 9 this Act; and 10 (2) apply with respect to funds made available 11 to carry out the United States Leadership Against 12 HIV/AIDS, Tuberculosis, and Malaria Act of 2003 13 or any amendment made by that Act on or after 14 such date of enactment. 15 TITLE XIII—DEFINITIONS 16 SEC. 1301. DEFINITIONS. 17 In this division: 18 (1) APPROPRIATE CONGRESSIONAL COMMIT- 19 TEES.—The term ‘‘appropriate congressional com- 20 mittees’’ means— 21 (A) the Committee on Foreign Affairs and 22 the Committee on Appropriations of the House 23 of Representatives; and 24 VerDate Mar 15 2010 20:34 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00138 Fmt 6652 Sfmt 6201 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS 139 •HR 6138 IH (B) the Committee on Foreign Relations 1 and the Committee on Appropriations of the 2 Senate. 3 (2) AIDS.—The term ‘‘AIDS’’ means the ac- 4 quired immune deficiency syndrome. 5 (3) HIV.—The term ‘‘HIV’’ means the human 6 immunodeficiency virus, the pathogen that causes 7 AIDS. 8 (4) HIV/AIDS.—The term ‘‘HIV/AIDS’’ 9 means, with respect to an individual, an individual 10 who is infected with HIV or living with AIDS. 11 Æ VerDate Mar 15 2010 02:22 Jul 20, 2012 Jkt 019200 PO 00000 Frm 00139 Fmt 6652 Sfmt 6301 E:\BILLS\H6138.IH H6138 rfrederick on DSK6VPTVN1PROD with BILLS