[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 164 Introduced in House (IH)]
<DOC>
115th CONGRESS
1st Session
H. R. 164
To provide for an evidence-based strategy for voluntary screening for
HIV/AIDS and other common sexually transmitted infections, and for
other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
January 3, 2017
Mr. Hastings introduced the following bill; which was referred to the
Committee on Energy and Commerce, and in addition to the Committees on
Education and the Workforce, Ways and Means, and Oversight and
Government Reform, for a period to be subsequently determined by the
Speaker, in each case for consideration of such provisions as fall
within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To provide for an evidence-based strategy for voluntary screening for
HIV/AIDS and other common sexually transmitted infections, and for
other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Increasing Access
to Voluntary Screening for HIV/AIDS and STIs Act of 2017''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Findings.
Sec. 3. Purpose.
Sec. 4. Definitions.
TITLE I--COVERAGE OF HIV/AIDS AND STI SCREENING UNDER PUBLIC HEALTH
CARE PROGRAMS AND GROUP HEALTH PLANS; COVERAGE OF CARE UNDER MEDICAID.
Sec. 101. Coverage of routine HIV/AIDS and STI screening tests under
Medicaid.
Sec. 102. Coverage of HIV/AIDS and STI screening tests under Medicare.
Sec. 103. Coverage for routine HIV/AIDS and STI screening under group
health plans.
Sec. 104. Optional Medicaid coverage of low-income HIV/AIDS infected
individuals.
TITLE II--INCREASED DATA COLLECTION AND EDUCATION FOR HISTORICALLY
UNDERREPRESENTED POPULATIONS
Sec. 201. People living with disabilities.
Sec. 202. Women who have sex with women.
Sec. 203. Transgender community.
Sec. 204. Report.
SEC. 2. FINDINGS.
Congress finds the following:
(1) The CDC estimates 20,000,000 new sexually transmitted
infections (STIs) occur each year in the United States, and 50
percent of sexually active Americans will contract a STI at
some point in their lives, the majority of which may be
asymptomatic for an extended amount of time.
(2) Over 1,200,000 people in the United States are living
with HIV, and someone is infected with HIV in the United States
every 9.5 minutes.
(3) HIV/AIDS and STIs are syndemics. HIV infection can
increase a person's risk for acquiring certain STIs, as well as
affect their frequency, severity, and healing time, while STIs
increase the risk of HIV transmission, impaired fertility,
reproductive tract cancer, and adverse pregnancy outcomes.
(4) Many common long-term and initially asymptomatic STIs
such as chlamydia, gonorrhea, herpes, syphilis, inflammatory
pelvic disease, viral hepatitis, and HIV/AIDS remain
undiagnosed, or diagnosed at later stages, leading to increased
rates of mortality, morbidity, disability, and transmission.
(5) In fact, the CDC estimates over 3.6 million Americans
are living with chronic hepatitis and most do not know they are
infected. Chronic hepatitis B can remain asymptomatic for years
and, left undiagnosed and untreated, can lead to serious
complications. Additionally, individuals infected with
hepatitis C virus (HCV) are at risk for chronic liver disease
or other HCV-related chronic diseases decades after infection.
(6) Stigma, culture, language, lack of education, lack of
insurance, limited time, cost and resources in medical
settings, and an inaccurate perception of risk among
communities and providers all contribute to insufficient rates
of screening for HIV/AIDS and STIs.
(7) The Centers for Disease Control and Prevention and the
United States Preventive Services Task Force recognize
screening as an effective public health tool that allows
providers to administer treatment before symptoms develop and
implement interventions that will reduce the likelihood of HIV/
AIDS and STI transmission and reduce the development of adverse
outcomes.
(8) The CDC recommends that voluntary screening for HIV/
AIDS be integrated into routine clinical care while preserving
patient confidentiality and the right of the patient to decline
testing and screening.
(9) The CDC also recommends that all unvaccinated,
uninfected persons being evaluated for a STI should receive
hepatitis B vaccination. Furthermore, anti-HCV testing is
recommended for routine screening of asymptomatic persons based
on their risk for infection or based on a recognized exposure.
(10) Inaccurate perceptions of risk among health care
providers and patients, misdiagnosis, ageism, generational
mind-sets, and biological factors have contributed to increased
rates in transmission and late detection of HIV/AIDS and STIs
over the past decade.
(11) Health equity and disparities remain a significant
public health challenge, with the burden of HIV/AIDS and STIs
falling disproportionately on different populations.
(12) Although African-Americans account for about 13
percent of the United States population, they account for
nearly half of all HIV/AIDS cases and infections and have
higher instances of mortality and morbidity for most STIs and
HIV/AIDS. Also, African-American women who have sex with men
account for the majority of HIV/AIDS infections among all women
in the United States.
(13) HIV/AIDS continues to be most prevalent among men who
have sex with men (MSM). Continued support and increased
funding for community-based programs and behavioral
interventions that are culturally competent are key to reaching
MSM, especially young MSM of color.
(14) Transgender persons are particularly vulnerable to
contracting HIV/AIDS and STIs due to high rates of survival sex
among trans-females, discrimination in education, employment,
and housing, and the absence of education and prevention
methods culturally relevant to the transgender community.
(15) Health care providers must be properly educated to
treat groups, such as MSM, transgender persons, African-
Americans, and Latinos who are disproportionately affected by
HIV/AIDS and other STIs, and also improve interventions for
groups that have been historically underrepresented in health
interventions for STIs, such as women who have sex with women,
individuals over the age of 50, Asian and Pacific Islander
Americans, Native Americans, and persons living with
disabilities.
(16) Women living with mobility impairments often lack
access to screening for STIs and other women's health services
such as pelvic examinations and mammograms due to, among other
factors, the lack of provider awareness, experience, and access
to equipment.
(17) All individuals engaging in oral, anal, or genital
sexual contact must have access to voluntary screening for HIV/
AIDS and other STIs. Screening must be confidential, rapid,
accurate, and medically appropriate. Screening must be offered
regardless of age, race, class, sexual behavior, sexual
orientation, gender identity, or disability.
(18) The Congress supports the goals of the National HIV/
AIDS Strategy and, in particular, the goal of 90 percent of
individuals knowing their HIV/AIDS status.
SEC. 3. PURPOSE.
The purposes of this Act are as follows:
(1) Increase access, quality, and affordability for
voluntary and medically appropriate screening for HIV/AIDS and
other STIs, including chlamydia, gonorrhea, syphilis, viral
hepatitis, and human papillomavirus, for all persons engaging
in various forms of sexual activity, including oral, genital,
or anal sex.
(2) Reduce the spread, morbidity, and mortality of HIV/AIDS
and other STIs.
(3) Reduce the disproportionate incidence of HIV/AIDS and
other STIs in certain groups through early detection and
treatment and comprehensive education for health care
providers, centers, and communities.
(4) Support the execution of other scientifically based
interventions that are culturally competent and age appropriate
and are proven to reduce the incidence of HIV/AIDS and other
STIs.
SEC. 4. DEFINITIONS.
In this Act:
(1) CDC.--The term ``CDC'' means the Centers for Disease
Control and Prevention.
(2) CMS.--The term ``CMS'' means the Centers for Medicare &
Medicaid Services.
(3) Director.--The term ``Director'' means the Director of
the Centers for Disease Control and Prevention.
(4) HIV/AIDS.--The term ``HIV/AIDS'' means infection with
the human immunodeficiency virus and includes acquired immune
deficiency syndrome and any condition arising from such
syndrome.
(5) MSM.--The term ``MSM'' means men who have sex with men.
(6) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(7) State.--The term ``State'' means each of the 50 States,
the District of Columbia, the United States Virgin Islands,
Guam, the Commonwealth of Puerto Rico, the Commonwealth of the
Northern Mariana Islands, and American Samoa.
(8) STI.--The term ``STI'' means a sexually transmitted
infection that is recognized by the CDC, including chlamydia,
gonorrhea, syphilis, viral hepatitis, and human papillomavirus.
(9) WSW.--The term ``WSW'' means women who have sex with
women.
TITLE I--COVERAGE OF HIV/AIDS AND STI SCREENING UNDER PUBLIC HEALTH
CARE PROGRAMS AND GROUP HEALTH PLANS; COVERAGE OF CARE UNDER MEDICAID.
SEC. 101. COVERAGE OF ROUTINE HIV/AIDS AND STI SCREENING TESTS UNDER
MEDICAID.
(a) Inclusion in State Plan.--Section 1902(a) of the Social
Security Act (42 U.S.C. 1396a(a)) is amended in paragraph (10)(A), in
the matter before clause (i), by striking ``and (28)'' and inserting
``(28), and (29)''.
(b) Inclusion in Medical Assistance.--
(1) In general.--Section 1905(a) of the Social Security Act
(42 U.S.C. 1396d(a)) is amended--
(A) in paragraph (28), by striking ``and'' at the
end;
(B) by redesignating paragraph (29) as paragraph
(30); and
(C) by inserting after paragraph (28) the
following:
``(29) routine HIV/AIDS and STI screening services (as
defined in subsection (ee)).''.
(2) Definition of services.--Section 1905 of such Act is
amended by adding at the end the following:
``(ee)(1) For purposes of this section, the term `routine HIV/AIDS
and STI screening services' means all of the following:
``(A) A screening test for HIV/AIDS or any other STI, if
such test is provided to an individual who--
``(i) is eligible for medical assistance under the
State plan; and
``(ii) is described in clauses (ii) through (v) of
section 1861(jjj)(1)(A).
``(B) Each of the services described in subparagraphs (B)
through (F) of section 1861(jjj)(1).
``(2) Definitions.--For purposes of this subsection, the terms
`HIV/AIDS' and `STI' have the same meaning given such terms in section
1861(jjj)(2).''.
(c) No Cost Sharing for HIV/AIDS Testing.--
(1) In general.--Section 1916(a)(2) of the Social Security
Act (42 U.S.C. 1396o(a)(2)) is amended--
(A) in subparagraph (D), by striking ``or'' at the
end;
(B) in subparagraph (E), by striking ``; and'' at
the end and inserting ``, or''; and
(C) by adding at the end the following:
``(F) routine HIV/AIDS and STI screening services
(as such term is defined in section 1905(ee)); and''.
(2) Limitation on state option for alternative cost
sharing.--Section 1916A(b)(3)(B) of the Social Security Act (42
U.S.C. 1396o-1(b)(3)(B)) is amended by adding at the end the
following:
``(xi) Routine HIV/AIDS and STI screening
services (as such term is defined in section
1905(ee)).''.
(d) Effective Date.--
(1) In general.--Except as provided by paragraph (2), the
amendments made by this section shall take effect on the date
of the enactment of this section and shall apply to services
furnished on or after such date.
(2) Rules for changes requiring state legislation.--In the
case of a State plan for medical assistance under title XIX of
the Social Security Act which the Secretary of Health and Human
Services determines requires State legislation (other than
legislation appropriating funds) in order for the plan to meet
the additional requirement imposed by the amendments made by
this section, the State plan shall not be regarded as failing
to comply with the requirements of such title solely on the
basis of its failure to meet this additional requirement before
the first day of the first calendar quarter beginning after the
close of the first regular session of the State legislature
that begins after the date of the enactment of this Act. For
purposes of the previous sentence, in the case of a State that
has a 2-year legislative session, each year of such session
shall be deemed to be a separate regular session of the State
legislature.
SEC. 102. COVERAGE OF HIV/AIDS AND STI SCREENING TESTS UNDER MEDICARE.
Section 1861 of the Social Security Act is amended--
(1) in subsection (s)--
(A) by striking ``and'' at the end of paragraph
(14);
(B) by striking the period at the end of paragraph
(15) and inserting ``; and'';
(C) by redesignating paragraphs (16) and (17) as
paragraphs (17) and (18), respectively; and
(D) by inserting after paragraph (15) the
following:
``(16) routine HIV/AIDS and STI screening services (as such
term is defined in subsection (jjj)).''; and
(2) by adding at the end the following:
``(jjj) Routine HIV/AIDS and STI Screening Services.--(1) For
purposes of this section, the term `routine HIV/AIDS and STI screening
services' means all of the following:
``(A) A screening test for HIV/AIDS or any other STI, if
such test is provided in any health care setting (other than an
inpatient hospital setting) and is provided to an individual
who--
``(i) is enrolled in part B;
``(ii) is at least 13 years of age;
``(iii) with respect to a test for HIV/AIDS, is not
known to the health care provider (directly, through
information provided by the individual, or through
access to an electronic medical record) to have had a
previous positive test for HIV/AIDS;
``(iv) subject to subparagraph (B), with respect to
a test for HIV/AIDS or a STI, is not known to the
health care provider (directly, through information
provided by the individual, or through access to an
electronic medical record) to have had a test for the
same condition within the previous 6 months; and
``(v) has been informed that such a test will be
administered and has not objected to such a test.
``(B) If a test described under subparagraph (A) is
reactive and is for--
``(i) HIV/AIDS, a confirmatory test; or
``(ii) a STI other than HIV/AIDS, if reasonable and
necessary, a confirmatory test.
``(C) The interpretation of any tests provided under
subparagraph (A) and subparagraph (B).
``(D) Informing an individual who receives a test under
subparagraph (A) or subparagraph (B) of the results of such
tests as close in time as possible to the determination of such
results.
``(E) If an individual tests positive for HIV/AIDS on a
screening test under subparagraph (A) and any confirmatory test
under subparagraph (B)--
``(i) post-test counseling concerning HIV/AIDS and
STIs at the time the individual is informed of the
results of the test; and
``(ii) if appropriate, a referral to medical or
mental health services.
``(F) If an individual tests positive for a STI on a
screening test under subparagraph (A) and any confirmatory test
under subparagraph (B), the provision of information to such
individual on the risk of STIs and HIV/AIDS and behaviors that
reduce the risk of exposure to such conditions.
``(2) Definitions.--For purposes of this subsection:
``(A) HIV/AIDS.--The term `HIV/AIDS' means infection with
the human immunodeficiency virus and includes acquired immune
deficiency syndrome and any condition arising from such
syndrome.
``(B) STI.--The term `STI' means a sexually transmitted
infection or sexually transmitted disease that is recognized by
the Centers for Disease Control and Prevention, including
chlamydia, gonorrhea, syphilis, hepatitis B, hepatitis C, and
human papillomavirus.''.
SEC. 103. COVERAGE FOR ROUTINE HIV/AIDS AND STI SCREENING UNDER GROUP
HEALTH PLANS.
(a) Group Health Plans.--
(1) Public health service act amendment.--Title XXVII of
the Public Health Service Act is amended by inserting after
section 2728 of such Act (42 U.S.C. 300gg-28), as redesignated
by section 1001(2) of the Patient Protection and Affordable
Care Act (Public Law 111-148), the following:
``SEC. 2729. COVERAGE FOR ROUTINE HIV/AIDS AND STI SCREENING.
``(a) Coverage.--A group health plan, and a health insurance issuer
providing group or individual health insurance coverage, shall provide
coverage for routine HIV/AIDS and STI screening under terms and
conditions that are no less favorable than the terms and conditions
applicable to other routine health screenings.
``(b) Prohibitions.--A group health plan, and a health insurance
issuer providing group or individual health insurance coverage, shall
not--
``(1) deny to an individual eligibility, or continued
eligibility, to enroll or to renew coverage under the terms of
the plan, solely for the purpose of avoiding the requirements
of this section;
``(2) deny coverage for routine HIV/AIDS or STI screening
on the basis that there are no known risk factors present, or
the screening is not clinically indicated, medically necessary,
or pursuant to a referral, consent, or recommendation by any
health care provider;
``(3) provide monetary payments, rebates, or other benefits
to individuals to encourage such individuals to accept less
than the minimum protections available under this section;
``(4) penalize or otherwise reduce or limit the
reimbursement of a provider because such provider provided care
to an individual participant or beneficiary in accordance with
this section;
``(5) provide incentives (monetary or otherwise) to a
provider to induce such provider to provide care to an
individual participant or beneficiary in a manner inconsistent
with this section; or
``(6) deny to an individual participant or beneficiary
continued eligibility to enroll or to renew coverage under the
terms of the plan, solely because of the results of an HIV/AIDS
or STI test, or other HIV/AIDS and STI screening procedure, for
the individual or any other individual.
``(c) Rules of Construction.--Nothing in this section shall be
construed--
``(1) to require an individual who is a participant or
beneficiary to undergo HIV/AIDS or STI screening; or
``(2) as preventing a group health plan or issuer from
imposing deductibles, coinsurance, or other cost-sharing in
relation to HIV/AIDS or STI screening, except that such
deductibles, coinsurance or other cost-sharing may not be
greater than the deductibles, coinsurance, or other cost-
sharing imposed on other routine health screenings.
``(d) Notice.--A group health plan under this part shall comply
with the notice requirement under section 716(d) of the Employee
Retirement Income Security Act of 1974 with respect to the requirements
of this section as if such section applied to such plan.
``(e) Preemption.--Nothing in this section shall be construed to
preempt any State law in effect on the date of enactment of this
section with respect to health insurance coverage that requires
coverage of at least the coverage of HIV/AIDS or STI screening
otherwise required under this section.''.
(2) ERISA amendments.--The Employee Retirement Income
Security Act of 1974 is amended as follows:
(A) In subpart B of part 7 of subtitle B of title
I, by adding at the end the following new section:
``SEC. 716. COVERAGE FOR ROUTINE HIV/AIDS AND STI SCREENING.
``(a) Coverage.--A group health plan, and a health insurance issuer
offering group health insurance coverage, shall provide coverage for
routine HIV screening under terms and conditions that are no less
favorable than the terms and conditions applicable to other routine
health screenings.
``(b) Prohibitions.--A group health plan, and a health insurance
issuer offering group health insurance coverage, shall not--
``(1) deny to an individual eligibility, or continued
eligibility, to enroll or to renew coverage under the terms of
the plan, solely for the purpose of avoiding the requirements
of this section;
``(2) deny coverage for routine HIV screening on the basis
that there are no known risk factors present, or the screening
is not clinically indicated, medically necessary, or pursuant
to a referral, consent, or recommendation by any health care
provider;
``(3) provide monetary payments, rebates, or other benefits
to individuals to encourage such individuals to accept less
than the minimum protections available under this section;
``(4) penalize or otherwise reduce or limit the
reimbursement of a provider because such provider provided care
to an individual participant or beneficiary in accordance with
this section;
``(5) provide incentives (monetary or otherwise) to a
provider to induce such provider to provide care to an
individual participant or beneficiary in a manner inconsistent
with this section; or
``(6) deny to an individual participant or beneficiary
continued eligibility to enroll or to renew coverage under the
terms of the plan, solely because of the results of an HIV test
or other HIV screening procedure for the individual or any
other individual.
``(c) Rules of Construction.--Nothing in this section shall be
construed--
``(1) to require an individual who is a participant or
beneficiary to undergo HIV/AIDS or STI screening; or
``(2) as preventing a group health plan or issuer from
imposing deductibles, coinsurance, or other cost-sharing in
relation to HIV/AIDS or STI screening, except that such
deductibles, coinsurance or other cost-sharing may not be
greater than the deductibles, coinsurance, or other cost-
sharing imposed on other routine health screenings.
``(d) Notice Under Group Health Plan.--A group health plan, and a
health insurance issuer providing health insurance coverage in
connection with a group health plan, shall provide notice to each
participant and beneficiary under such plan regarding the coverage
required by this section in accordance with regulations promulgated by
the Secretary. Such notice shall be in writing and prominently
positioned in any literature or correspondence made available or
distributed by the plan or issuer and shall be transmitted, by
whichever is earliest of the following:
``(1) In the next mailing made by the plan or issuer to the
participant or beneficiary.
``(2) As part of any yearly informational packet sent to
the participant or beneficiary.
``(3) Not later than July 1, 2017.
``(e) Preemption; Relation to State Laws.--
``(1) In general.--Nothing in this section shall be
construed to preempt any State law in effect on the date of
enactment of this section with respect to health insurance
coverage that requires coverage of at least the coverage of
HIV/AIDS or STI screening otherwise required under this
section.
``(2) ERISA.--Nothing in this section shall be construed to
affect or modify the provisions of section 514 with respect to
group health plans.''.
(B) In section 732(a) of the Employee Retirement
Income Security Act of 1974 (29 U.S.C. 1191a(a)), by
striking ``section 711'' and inserting ``sections 711
and 716''.
(C) In the table of contents in section 1 of such
Act, by inserting after the item relating to section
714 the following new item:
``Sec. 715. Additional market reforms.
``Sec. 716. Coverage for routine HIV/AIDS and STI screening.''.
(3) Internal revenue code amendments.--
(A) In general.--The Internal Revenue Code of 1986
is amended by inserting after section 9815 the
following new section:
``SEC. 9816. COVERAGE FOR ROUTINE HIV/AIDS AND STI SCREENING.
``(a) Coverage.--A group health plan shall provide coverage for
routine HIV/AIDS and STI screening under terms and conditions that are
no less favorable than the terms and conditions applicable to other
routine health screenings.
``(b) Prohibitions.--A group health plan shall not--
``(1) deny to an individual eligibility, or continued
eligibility, to enroll or to renew coverage under the terms of
the plan, solely for the purpose of avoiding the requirements
of this section;
``(2) deny coverage for routine HIV/AIDS or STI screening
on the basis that there are no known risk factors present, or
the screening is not clinically indicated, medically necessary,
or pursuant to a referral, consent, or recommendation by any
health care provider;
``(3) provide monetary payments, rebates, or other benefits
to individuals to encourage such individuals to accept less
than the minimum protections available under this section;
``(4) penalize or otherwise reduce or limit the
reimbursement of a provider because such provider provided care
to an individual participant or beneficiary in accordance with
this section;
``(5) provide incentives (monetary or otherwise) to a
provider to induce such provider to provide care to an
individual participant or beneficiary in a manner inconsistent
with this section; or
``(6) deny to an individual participant or beneficiary
continued eligibility to enroll or to renew coverage under the
terms of the plan, solely because of the results of an HIV/AIDS
or STI test, or other HIV/AIDS and STI screening procedure, for
the individual or any other individual.
``(c) Rules of Construction.--Nothing in this section shall be
construed--
``(1) to require an individual who is a participant or
beneficiary to undergo HIV/AIDS or STI screening; or
``(2) as preventing a group health plan or issuer from
imposing deductibles, coinsurance, or other cost-sharing in
relation to HIV/AIDS or STI screening, except that such
deductibles, coinsurance or other cost-sharing may not be
greater than the deductibles, coinsurance, or other cost-
sharing imposed on other routine health screenings.''.
(B) Conforming amendment.--Section 4980D(d)(1) of
such Code is amended by striking ``section 9811'' and
inserting ``sections 9811 and 9816''.
(C) Clerical amendment.--The table of contents for
subchapter B of chapter 1 of such Code is amended by
inserting after the item relating to section 9815 the
following new item:
``Sec. 9816. Coverage for routine HIV/AIDS and STI screening.''.
(b) Application Under Federal Employees Health Benefits Program.--
Section 8902 of title 5, United States Code, is amended by adding at
the end the following new subsection:
``(p) A contract may not be made or a plan approved which does not
comply with the requirements of section 2729 of the Public Health
Service Act.''.
(c) Effective Dates.--Notwithstanding any other provision of law,
the amendments made by subsections (a) and (b) shall apply with respect
to plan years beginning on or after July 1, 2017, and with respect to
health insurance coverage issued on or after such date.
(d) Coordination of Administration.--The Secretary of Labor, the
Secretary of Health and Human Services, and the Secretary of the
Treasury shall ensure, through the execution of an interagency
memorandum of understanding among such Secretaries, that--
(1) regulations, rulings, and interpretations issued by
such Secretaries relating to the same matter over which two or
more such Secretaries have responsibility under the provisions
of this section (and the amendments made thereby) are
administered so as to have the same effect at all times; and
(2) coordination of policies relating to enforcing the same
requirements through such Secretaries in order to have a
coordinated enforcement strategy that avoids duplication of
enforcement efforts and assigns priorities in enforcement.
SEC. 104. OPTIONAL MEDICAID COVERAGE OF LOW-INCOME HIV/AIDS INFECTED
INDIVIDUALS.
(a) In General.--Section 1902 of the Social Security Act (42 U.S.C.
1396a) is amended--
(1) in subsection (a)(10)(A)(ii)--
(A) by striking ``or'' at the end of subclause
(XXI);
(B) by adding ``or'' at the end of subclause
(XXII); and
(C) by adding at the end the following:
``(XXIII) on or before December 31,
2017, who are described in subsection
(ll) (relating to HIV/AIDS infected
individuals);''; and
(2) by adding at the end the following:
``(ll) individuals described in this subsection are individuals--
``(1) who are not described in subsection (a)(10)(A)(i);
``(2) who have HIV/AIDS, as defined under section 1905(ee);
``(3) whose income (as determined under the State plan
under this title with respect to disabled individuals) does not
exceed the maximum amount of income a disabled individual
described in subsection (a)(10)(A)(i) may have to obtain
medical assistance under the plan; and
``(4) whose resources (as determined under the State plan
under this title with respect to disabled individuals) do not
exceed the maximum amount of resources a disabled individual
described in subsection (a)(10)(A)(i) may have to obtain
medical assistance under the plan.''.
(b) Enhanced Match.--
(1) In general.--The first sentence of section 1905(b) of
the Social Security Act (42 U.S.C. 1396d(b)) is amended by
striking ``section 1902(a)(10)(A)(ii)(XVIII)'' and inserting
``subclause (XVIII) and subclause (XXIII) of section
1902(a)(10)(A)(ii)''.
(2) Conforming amendments.--Section 1905(a) of the Social
Security Act (42 U.S.C. 1396d(a)) is amended in the matter
preceding paragraph (1)--
(A) by striking ``or'' at the end of clause (xv);
(B) by striking ``or'' at the end of clause (xvi);
(C) by adding ``or'' at the end of clause (xvii);
and
(D) by inserting after clause (xvii) the following:
``(xviii) individuals described in section
1902(a)(10)(A)(ii)(XXIII);''.
(c) Exemption From Funding Limitation for Territories.--Section
1108(g) of the Social Security Act (42 U.S.C. 1308(g)) is amended by
adding at the end the following:
``(6) Disregarding medical assistance for optional low-
income hiv/aids infected individuals.--The limitations under
subsection (f) and the previous provisions of this subsection
shall not apply to amounts expended for medical assistance for
individuals described in section 1902(ll) who are only eligible
for such assistance on the basis of section
1902(a)(10)(A)(ii)(XXIII).''.
(d) Effective Date.--
(1) In general.--Except as provided by paragraph (2), the
amendments made by this section shall take effect on the date
of the enactment of this section and shall apply to services
furnished on or after such date.
(2) Rules for changes requiring state legislation.--In the
case of a State plan for medical assistance under title XIX of
the Social Security Act which the Secretary of Health and Human
Services determines requires State legislation (other than
legislation appropriating funds) in order for the plan to meet
the additional requirement imposed by the amendments made by
this section, the State plan shall not be regarded as failing
to comply with the requirements of such title solely on the
basis of its failure to meet this additional requirement before
the first day of the first calendar quarter beginning after the
close of the first regular session of the State legislature
that begins after the date of the enactment of this Act. For
purposes of the previous sentence, in the case of a State that
has a 2-year legislative session, each year of such session
shall be deemed to be a separate regular session of the State
legislature.
TITLE II--INCREASED DATA COLLECTION AND EDUCATION FOR HISTORICALLY
UNDERREPRESENTED POPULATIONS
SEC. 201. PEOPLE LIVING WITH DISABILITIES.
(a) Tracking of Information.--The Director shall--
(1) track national HIV/AIDS and STI screening trends and
the burdens of HIV/AIDS and STIs among people with
disabilities, including such persons with mental, physical,
cognitive, intellectual, or developmental disabilities; and
(2) identify and assess the barriers that prevent such
persons from accessing HIV/AIDS and STI screening.
(b) Tracking Methodology.--
(1) In general.--The tracking methods used by the Secretary
under subsection (a) shall--
(A) focus upon historically underrepresented
communities, including the deaf and hearing loss-
related community and the cognitive, intellectual,
developmental, mobility, or mental health disability
communities; and
(B) consider other factors that may contribute to
increased burdens of HIV/AIDS and STIs, including race,
socio-economic status, region, gender identity, and
sexual behavior.
(2) Sexual assault data.--Tracking under subsection (a)
shall include data collection on the incidence of sexual
assault on people with mental, physical, cognitive,
intellectual, or developmental disabilities for the purposes of
understanding the prevalence of HIV/AIDS and STIs that result
from such assaults.
(c) Deaf and Hearing Loss Community.--
(1) In general.--The Secretary, acting through the
Director, shall work with appropriate organizations and
institutions to make comprehensive sex education materials that
promote voluntary screening for HIV/AIDS and STIs accessible to
the deaf and hearing loss community through language (including
American Sign Language), modalities (including highly graphic
formats with minimal text), and culturally appropriate
information delivery.
(2) Health careers and education.--The Secretary shall--
(A) work with appropriate individuals,
organizations, and institutions to increase the number
of people who are deaf or living with hearing loss in
public health careers for the purposes of--
(i) building the public health
infrastructure to improve data collection; and
(ii) health information dissemination to
people who are deaf or who live with hearing
loss; and
(B) engage students in elementary school, high
school, college, and graduate school for the purposes
of carrying out this paragraph.
(d) Cognitive and Intellectual Disability Community.--The
Secretary, acting through the Director, shall work with appropriate
national and local organizations to make comprehensive sex education
materials accessible to people with intellectual disabilities by--
(1) using plain language;
(2) educating service providers about the signs and
symptoms of sexual assault among people with cognitive and
intellectual disabilities; and
(3) using other appropriate information delivery
strategies.
(e) Women Living With Severe Physical Disabilities.--The Secretary,
acting through the Director, shall work with Federal, State, and local
entities to track access to pelvic examinations, mammograms, and other
women's health services for women with severe mobility impairments with
the goal of improving access to such services.
SEC. 202. WOMEN WHO HAVE SEX WITH WOMEN.
(a) National Screening Guidelines.--The Secretary, acting through
the Director, shall work with Federal, State, and local health entities
to ensure that national screening guidelines for cervical cancer state
that WSW should be subject to the same screening guidelines for
cervical cancer as women who have sex only with men.
(b) Information Collection.--The Secretary, acting through the
Director, shall, with respect to the WSW community--
(1) track national trends in screening for HIV/AIDS and
other STIs; and
(2) collect information on--
(A) the burdens and behavior of HIV/AIDS and STIs;
and
(B) other reproductive health concerns.
SEC. 203. TRANSGENDER COMMUNITY.
(a) Data Collection.--The Secretary, acting through the Director,
shall work with Federal, State, and local health entities and
transgender communities to improve information collection concerning
the transmission, morbidity, and screening for HIV/AIDS and other STIs
in transgender communities.
(b) Information Classification.--For purposes of acquiring a
comprehensive understanding of the unique health trends among, and
aspects of, the transgender community, the Secretary shall promulgate
regulations requiring that, for purposes of public health studies
requiring data collection, the fact that an individual is transgender
shall be a distinct category and data point.
SEC. 204. REPORT.
(a) In General.--Not later than 3 years after the date of the
enactment of this Act, the Secretary shall submit a report to Congress
on the activities required under this Act.
(b) Contents.--The report issued to Congress under subsection (a)
shall include--
(1) information on the success of voluntary screening for
HIV/AIDS and STIs, as well as other methods for preventing the
transmission of HIV/AIDS and STIs among Medicaid and Medicare
beneficiaries, patients at federally qualified health centers,
individuals with health insurance, MSM, WSW, persons living
with disabilities, the transgender community, and other groups
that have been historically underrepresented in public health
interventions for HIV/AIDS and STIs; and
(2) recommendations on how to improve existing measures
with respect to race, socioeconomic status, region, gender
identity, disability, age, and sexual behavior--
(A) to increase access to screening; and
(B) to decrease the disparities in mortality and
morbidity from HIV/AIDS and other STIs.
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