[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4140 Introduced in House (IH)]

111th CONGRESS
  1st Session
                                H. R. 4140

 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

                           November 19, 2009

Mr. Hastings of Florida (for himself, Mrs. Christensen, Ms. Clarke, Mr. 
Cleaver, Mr. Conyers, Mr. Al Green of Texas, Mr. Grijalva, Ms. Jackson-
Lee of Texas, Mr. Meeks of New York, Mr. Rangel, Ms. Roybal-Allard, Mr. 
Rush, Mr. Towns, Ms. Wasserman Schultz, Ms. Waters, Ms. Watson, and Mr. 
   Wexler) introduced the following bill; which was referred to the 
Committee on Energy and Commerce, and in addition to the Committees on 
   Ways and Means, Education and Labor, 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.

    This Act may be cited as the ``Increasing Access to Voluntary 
Screening for HIV/AIDS and STIs Act of 2009''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) Over 15,000,000 sexually transmitted infections are 
        reported each year, and 50 percent of sexually active Americans 
        will contract an STI at some point in their lives, the majority 
        of which may be asymptomatic for an extended amount of time.
            (2) Over 1,000,000 people in the United States are living 
        with HIV, and someone is infected with HIV in the United States 
        every 9.5 minutes.
            (3) Many common long-term and initially asymptomatic STIs 
        such as chlamydia, gonorrhea, herpes, syphilis, inflammatory 
        pelvic disease, and HIV/AIDS remain undiagnosed, or diagnosed 
        at later stages, leading to increased rates of mortality, 
        morbidity, disability, and transmission.
            (4) Stigma, culture, language, lack of 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.
            (5) 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.
            (6) The CDC recommends that voluntary screening for HIV/
        AIDS be integrated into routine clinical care while preserving 
        patient confidentiality and the right of the patient to decline 
        testing and screening.
            (7) Nearly 25 percent of persons living with HIV/AIDS are 
        age 50 years or older, and the overall HIV/AIDS population is 
        aging due to life-extending anti-retroviral drugs.
            (8) Inaccurate perceptions of risk among health care 
        providers and patients, misdiagnosis, ageism, generational 
        mind-sets, and biological factors have contributed to increased 
        rates in transmission and late detection of HIV/AIDS and STIs 
        over the past decade.
            (9) Although African-Americans account for about 13 percent 
        of the United States population, they account for nearly half 
        of all HIV/AIDS 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.
            (10) HIV/AIDS continues to be most prevalent among men who 
        have sex with men. 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.
            (11) 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.
            (12) Health care providers must be properly educated to 
        treat groups, such as MSM, transgender persons, African-
        Americans, and Latinos who are disproportionately affected by 
        HIV/AIDS and other STIs, and also improve interventions for 
        groups that have been historically under-represented in health 
        interventions for STIs, such as women who have sex with women, 
        individuals over the age of 50, Asian and Pacific Islander 
        Americans, Native Americans, and persons living with 
        disabilities.
            (13) Women living with mobility impairments often lack 
        access to screening for STIs and other women's health services 
        such as pelvic examinations and mammograms due to, among other 
        factors, the lack of provider awareness, experience, and 
        inaccessible equipment.
            (14) All individuals engaging in oral, anal, or genital 
        sexual contact must have access to voluntary screening for HIV/
        AIDS and other STIs. Screening must be confidential, rapid, 
        accurate, and medically appropriate. Screening must be offered 
        regardless of age, race, class, sexual behavior, gender 
        identity, or disability.

SEC. 3. PURPOSE.

    The purposes of this Act are as follows:
            (1) Increase access, quality, and affordability for 
        voluntary and medically appropriate screening for HIV/AIDS and 
        other STIs, including chlamydia, gonorrhea, syphilis, and human 
        papillomavirus, for all persons engaging in various forms of 
        sexual 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 Virgin Islands, Guam, and Puerto 
        Rico.
            (8) STI.--The term ``STI'' means a sexually transmitted 
        infection that is recognized by the CDC, including chlamydia, 
        gonorrhea, syphilis, and human papillomavirus.
            (9) WSW.--The term ``WSW'' women who have sex with women.

                     TITLE I--HEALTH CARE PROGRAMS

SEC. 101. MEDICAID.

    (a) Higher Federal Matching Percentage for Routine HIV/AIDS and STI 
Screening Services.--Section 1903 of the Social Security Act (42 U.S.C. 
1396b) is amended--
            (1) in subsection (a)--
                    (A) by redesignating paragraph (7) as paragraph 
                (8); and
                    (B) by inserting after paragraph (6) the following 
                new paragraph:
            ``(7) an amount equal to 83 percent of the sums expended 
        during such quarter which are attributable to the costs of 
        providing routine HIV/AIDS and STI screening services (as 
        defined in subsection (aa)(1)) if the conditions described in 
        subsection (aa)(2) are met; plus''; and
            (2) by adding at the end the following new subsection:
    ``(aa) Routine HIV/AIDS and STI Screening Services.--
            ``(1) In general.--For purposes of this section, the term 
        `routine HIV/AIDS and STI screening services' means the 
        following:
                    ``(A) An HIV/AIDS or STI screening test (and, if 
                such test is reactive, a confirmatory test), including 
                the interpretation of such tests, that is provided as 
                part of medical care in any health care setting (other 
                than an inpatient hospital setting) for an individual 
                who--
                            ``(i) is at least 13 years of age, and in 
                        the case of a beneficiary who is under 13 years 
                        of age if the appropriate health care provider 
                        reasonably determines that the beneficiary is 
                        at risk for infection;
                            ``(ii) is not known to the health care 
                        provider (directly, through information 
                        provided by the individual, or through access 
                        to an electronic medical record) previously 
                        ever to have had a positive test for HIV/AIDS 
                        or an STI or, subject to paragraph (3), within 
                        the previous 6 months to have had any test for 
                        HIV/AIDS or an STI; and
                            ``(iii) has been informed that such a test 
                        will be administered and has not objected to 
                        such a test.
                    ``(B) Informing an individual so tested of the 
                results of the tests at the time of such examination.
                    ``(C) In the case of such an individual who tests 
                positive for HIV/AIDS on the screening and confirmatory 
                tests,
                            ``(i) post-test counseling concerning HIV/
                        AIDS at the time, and as part of, such 
                        examination; or
                            ``(ii) a referral to appropriate medical or 
                        mental health services.
            ``(2) Conditions.--For purposes of subsection (a)(7), the 
        conditions of this paragraph, with respect to routine HIV/AIDS 
        or STI screening services, are that--
                    ``(A) the payment amount for such services under 
                this title is reasonable and closely approximates the 
                payment amount for such services under part B of title 
                XVIII;
                    ``(B) no cost-sharing is imposed under this title 
                for the provision of such services; and
                    ``(C) in the case of a State for which a political 
                subdivision is required to contribute towards the non-
                Federal share of expenditures for routine HIV/AIDS or 
                STI screening services, the increase in the Federal 
                share applicable under subsection (a)(5) to such 
                services is first applied to reduce the contribution 
                (but not below zero) required by such political 
                subdivision.
            ``(3) 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 that is recognized by the CDC, 
                including chlamydia, gonorrhea, syphilis, and human 
                papillomavirus.''.
    (b) Conforming Amendments.--
            (1) Subparagraphs (E) and (F) of section 1919(h)(2) of such 
        Act (42 U.S.C. 1396r(h)(2)) are each amended by striking 
        ``1903(a)(7)'' and inserting ``1903(a)(8)''.
            (2) Paragraphs (1) and (2) of section 1931(h) of such Act 
        (42 U.S.C. 1396u-1(h)) are each amended by striking 
        ``1903(a)(7)'' and inserting ``1903(a)(8)''.
            (3) Section 1938(d)(4) of such Act (42 U.S.C. 1396u-
        8(d)(4)) is amended by striking ``1903(a)(7)'' and inserting 
        ``1903(a)(8)''.
            (4) Section 1940(j) of such Act (42 U.S.C. 1396w(j)) is 
        amended by striking ``paragraph (7)'' and inserting ``paragraph 
        (8)''.
    (c) Effective Date.--The amendments made by subsection (a) shall 
apply to services furnished on or after the date of the enactment of 
this section.

SEC. 102. SCREENING TESTS FOR MEDICARE BENEFICIARIES.

    (a) Broad Approach.--The Administrator of the Centers for Medicare 
& Medicaid Services should adopt a broad approach in implementing a 
policy towards voluntary screening for HIV/AIDS and STIs for all 
Medicare eligible individuals who are 13 years of age or older.
    (b) Tests and Reimbursement.--In carrying out such approach, the 
Administrator of CMS should--
            (1) give confirmatory tests for HIV/AIDS and STIs to 
        Medicare eligible individuals who are 13 years of age or older 
        with reactive results for HIV/AIDS or STIs and provide Medicare 
        reimbursement for such tests; and
            (2) reimburse Medicare eligible individuals who are 13 
        years of age or older for blood and rapid oral swab HIV/AIDS 
        tests and STI blood tests.

SEC. 103. VOLUNTARY SCREENING BY FEDERALLY QUALIFIED HEALTH CENTERS.

    (a) Grants.--The Secretary, acting through the Administrator of the 
Health Resources and Services Administration, may award grants to 
Federally qualified health centers to provide, as part of medical care 
in a health care setting, voluntary screening for HIV/AIDS and STIs to 
eligible individuals.
    (b) Secondary Payor Provision.--A Federally qualified health center 
that receives a grant under this section may not use funds from such 
grant to pay for a screening test if payment has been made for such 
test, or payment can reasonably be expected to be made--
            (1) under an insurance policy;
            (2) under a Federal or State health benefits program, 
        including titles XIX and XXI of the Social Security Act; or
            (3) by an entity that provides health services on a prepaid 
        basis.
    (c) Definitions.--In this section:
            (1) Eligible individual.--The term ``eligible individual'' 
        means an individual who--
                    (A) can give legal consent under the laws of his or 
                her State;
                    (B) has been informed by a healthcare provider that 
                a screening test for HIV/AIDS or STIs will be 
                administered; and
                    (C) has not objected to such test.
            (2) Federally qualified health center.--The term 
        ``Federally qualified health center'' has the meaning given 
        such term under section 1861(aa)(4) of the Social Security Act 
        (42 U.S.C. 1395ww).
            (3) Screening.--The term ``screening'' includes--
                    (A) the interpretation of screening tests; and
                    (B) in the case of a reactive result for an initial 
                screening test for HIV/AIDS or STIs, a confirmatory 
                test.

SEC. 104. COVERAGE FOR ROUTINE HIV/AIDS AND STI SCREENING UNDER GROUP 
              HEALTH PLANS.

    (a) Group Health Plans.--
            (1) Public health service act amendments.--Subpart 2 of 
        part A of title XXVII of the Public Health Service Act is 
        amended by adding at the end the following new section:

``SEC. 2708. COVERAGE FOR ROUTINE HIV/AIDS AND STI SCREENING.

    ``(a) Coverage.--A group health plan, and a health insurance issuer 
offering group health insurance coverage, shall provide coverage for 
routine HIV/AIDS and STI screening under terms and conditions that are 
no less 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/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 715(d) of the Employee 
Retirement Income Security Act of 1974 with respect to the requirements 
of this section as if such section applied to such plan.
    ``(e) Preemption.--Nothing in this section shall be construed to 
preempt any State law in effect on the date of enactment of this 
section with respect to health 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. 715. COVERAGE FOR ROUTINE HIV/AIDS AND STI SCREENING.

    ``(a) Coverage.--A group health plan, and a health insurance issuer 
offering group health insurance coverage, shall provide coverage for 
routine HIV screening under terms and conditions that are no less 
favorable than the terms and conditions applicable to other routine 
health screenings.
    ``(b) Prohibitions.--A group health plan, and a health insurance 
issuer offering group health insurance coverage, shall not--
            ``(1) deny to an individual eligibility, or 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, 2010.
    ``(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 such Act (29 U.S.C. 
                1191a(a)), by striking ``section 711'' and inserting 
                ``sections 711 and 715''.
                    (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. Coverage for routine HIV/AIDS and STI screening.''.
            (3) Internal revenue code amendments.--The Internal Revenue 
        Code of 1986 is amended as follows:
                    (A) In subchapter B of chapter 100, by inserting 
                after section 9813 the following:

``SEC. 9814. 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) In the table of contents for such subchapter, 
                by inserting after the item relating to section 9813 
                the following new item:

``Sec. 9814. Coverage for HIV/AIDS and STI screening.''.
                    (C) In section 4980D(d)(1), by striking ``section 
                9811'' and inserting ``sections 9811 and 9814''.
    (b) Application to Individual Health Insurance Coverage.--
            (1) Part B of title XXVII of the Public Health Service Act 
        is amended by inserting after section 2753 the following new 
        section:

``SEC. 2754. COVERAGE FOR ROUTINE HIV/AIDS AND STI SCREENING.

    ``(a) In General.--The provisions of section 2708 (other than 
subsection (d)) shall apply to health insurance coverage offered by a 
health insurance issuer in the individual market in the same manner as 
it applies to health insurance coverage offered by a health insurance 
issuer in connection with a group health plan in the small or large 
group market.
    ``(b) Notice.--A health insurance issuer under this part shall 
comply with the notice requirement under section 715(d) of the Employee 
Retirement Income Security Act of 1974 with respect to the requirements 
referred to in subsection (a) as if such section applied to such issuer 
and such issuer were a group health plan.''.
            (2) Section 2762(b)(2) of such Act (42 U.S.C. 300gg-
        62(b)(2)) is amended by striking ``section 2751'' and inserting 
        ``sections 2751 and 2754''.
    (c) 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 2708 of the Public Health 
Service Act.''.
    (d) Effective Dates.--The amendments made--
            (1) by subsections (a) and (c) of this section apply with 
        respect to group health plans and health benefit plans for plan 
        years beginning on or after July 1, 2010; and
            (2) by subsection (b) of this section shall apply with 
        respect to health insurance coverage offered, sold, issued, 
        renewed, in effect, or operated in the individual market on or 
        after January 1, 2010.
    (e) 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. 105. 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 
                (XVIII);
                    (B) by adding ``or'' at the end of subclause (XIX); 
                and
                    (C) by adding at the end the following:
                                    ``(XX) who are described in 
                                subsection (gg) (relating to HIV/AIDS 
                                infected individuals);''; and
            (2) by adding at the end the following:
    ``(gg) individuals described in this subsection are individuals not 
described in subsection (a)(10)(A)(i)--
            ``(1) who have HIV/AIDS infection, as defined under section 
        1903(aa);
            ``(2) 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 and obtain 
        medical assistance under the plan; and
            ``(3) 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 and obtain 
        medical assistance under the plan.''.
    (b) Enhanced Match.--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) 
or (XX) of section 1902(a)(10)(A)(ii)''.
    (c) Conforming Amendments.--Section 1905(a) of the Social Security 
Act (42 U.S.C. 1396d(a)) is amended in the matter preceding paragraph 
(1)--
            (1) by striking ``or'' at the end of clause (xii);
            (2) by adding ``or'' at the end of clause (xiii); and
            (3) by inserting after clause (xiii) the following:
                            ``(xiv) individuals described in section 
                        1902(gg);''.
    (d) 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:
            ``(5) 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(gg) who are only eligible 
        for such assistance on the basis of section 
        1902(a)(10)(A)(ii)(XX).''.
    (e) Effective Date.--The amendments made by this section shall 
apply to calendar quarters beginning on or after the date of the 
enactment of this section, without regard to whether or not final 
regulations to carry out such amendments have been promulgated by such 
date.

  TITLE II--INCREASED DATA COLLECTION AND EDUCATION FOR HISTORICALLY 
                     UNDER-REPRESENTED 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 under-represented 
                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, STIs, and other preventative methods geared toward 
        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 STIs.
                                 <all>