[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4470 Introduced in House (IH)]

112th CONGRESS
  2d Session
                                H. R. 4470

To amend the Public Health Service Act, the Employee Retirement Income 
 Security Act of 1974, the Internal Revenue Code of 1986, and title 5, 
 United States Code, to require individual and group health insurance 
 coverage and group health plans and Federal employees health benefit 
          plans to provide coverage for routine HIV screening.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             April 19, 2012

 Ms. Waters (for herself, Ms. Lee of California, Mrs. Christensen, and 
Ms. Bordallo) 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 the Workforce, 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 amend the Public Health Service Act, the Employee Retirement Income 
 Security Act of 1974, the Internal Revenue Code of 1986, and title 5, 
 United States Code, to require individual and group health insurance 
 coverage and group health plans and Federal employees health benefit 
          plans to provide coverage for routine HIV screening.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; FINDINGS.

    (a) Short Title.--This Act may be cited as the ``Routine HIV 
Screening Coverage Act of 2012''.
    (b) Findings.--Congress finds the following:
            (1) HIV/AIDS continues to infect and kill thousands of 
        Americans, more than 30 years after the first cases were 
        reported.
            (2) It has been estimated that approximately 1.7 million 
        Americans have been infected with HIV since the beginning of 
        the epidemic and over 600,000 of them have died.
            (3) The HIV/AIDS epidemic has disproportionately impacted 
        African-Americans, Latino-Americans, and other racial and 
        ethnic minorities.
            (4) It has been estimated that 20 percent of those infected 
        with HIV in the United States do not know they are infected.
            (5) The Centers for Disease Control and Prevention has 
        determined that increasing the proportion of people who know 
        their HIV status is an essential component of comprehensive 
        HIV/AIDS treatment and prevention efforts and that early 
        diagnosis is critical in order for people with HIV/AIDS to 
        receive life-extending therapy.
            (6) The Centers for Disease Control and Prevention 
        recommends routine HIV screening in health care settings for 
        all patients aged 13-64, regardless of risk.
            (7) Some health plans do not cover routine HIV screening, 
        but only cover HIV tests for patients with known or perceived 
        risk factors for HIV/AIDS and patients who demonstrate symptoms 
        of AIDS.
            (8) Not all individuals who have been infected with HIV 
        fall into high-risk categories or demonstrate symptoms of AIDS.
            (9) If health plans covered routine HIV screenings, health 
        providers would be more likely to recommend routine HIV 
        screening for their patients.
            (10) Section 2713 of the Public Health Service Act (42 
        U.S.C. 300gg-13), as amended by section 1001 of the Patient 
        Protection and Affordable Care Act (Public Law 111-148), 
        requires that health plans cover preventive health services 
        without imposing cost sharing requirements.
            (11) Routine HIV screening is a preventive health service.
            (12) Requiring health plans to cover routine HIV screening 
        as a preventive health service without imposing cost sharing 
        requirements could play a critical role in preventing the 
        spread of HIV and allowing infected individuals to receive 
        effective treatment.

SEC. 2. COVERAGE FOR ROUTINE HIV SCREENING UNDER GROUP HEALTH PLANS, 
              HEALTH INSURANCE COVERAGE, AND FEHBP.

    (a) Group Health Plans.--
            (1) Public health service act amendments.--Subpart II of 
        part A of title XXVII of the Public Health Service Act is 
        amended by inserting the following new section after section 
        2719A:

``SEC. 2719B. COVERAGE FOR ROUTINE HIV SCREENING.

    ``(a) In General.--A group health plan and a health insurance 
issuer offering group or individual health insurance coverage--
            ``(1) shall provide coverage for routine HIV screening; and
            ``(2) shall not impose terms and conditions (including cost 
        sharing requirements) with respect to such screening that are 
        less favorable for a participant or beneficiary than the terms 
        and conditions applicable to items and services described in 
        section 2713(a).
    ``(b) Prohibitions.--A group health plan and a health insurance 
issuer offering 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 or coverage, solely for the purpose of avoiding the 
        requirements of this section;
            ``(2) deny coverage for routine HIV screening on the basis 
        that--
                    ``(A) there are no known risk factors for HIV 
                present; or
                    ``(B) the screening is not--
                            ``(i) clinically indicated;
                            ``(ii) medically necessary; or
                            ``(iii) pursuant to a referral 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; or
            ``(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.
    ``(c) Rules of Construction.--Nothing in this section shall be 
construed to require an individual who is a participant or beneficiary 
of a group health plan or health insurance coverage to undergo HIV 
screening.
    ``(d) 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 screening otherwise required 
under this section.''.
            (2) Inclusion of notice in uniform coverage documents.--
        Section 2715(b)(3)(B) of the Public Health Service Act (42 
        U.S.C. 300gg-15) is amended--
                    (A) in clause (i), by striking ``and'' at the end;
                    (B) by redesignating clause (ii) as clause (iii); 
                and
                    (C) by inserting after clause (i) the following:
                            ``(ii) the coverage for routine HIV 
                        screening required under section 2719B; and''.
            (3) Routine hiv screening defined through consultation 
        process.--Section 2791(d) is amended by adding at the end the 
        following new paragraph:
            ``(22) Routine hiv screening.--The term `routine HIV 
        screening' shall have the meaning given such term by the 
        Secretary. In defining such term, the Secretary shall consult 
        with the Office of National AIDS Policy, the Centers for 
        Disease Control and Prevention, health care professionals with 
        expertise in HIV treatment and prevention, advocates for people 
        living with HIV, and other qualified individuals.''.
            (4) Conforming amendments.--
                    (A) ERISA.--Section 715(a)(1) of the Employee 
                Retirement Income Security Act of 1974 (29 U.S.C. 
                1185d(a)(1)) is amended by inserting ``and the Routine 
                HIV Screening Coverage Act of 2012'' after ``Patient 
                Protection and Affordable Care Act''.
                    (B) IRC.--Section 9815(a)(1) of the Internal 
                Revenue Code of 1986 is amended by inserting ``and the 
                Routine HIV Screening Coverage Act of 2012'' after 
                ``Patient Protection and Affordable Care Act''.
    (b) Application Under Federal Employees Health Benefits Program 
(FEHBP).--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 2719B of the Public Health 
Service Act.''.
    (c) Effective Date.--This section and the amendments made by this 
section shall be effective for plan years beginning on or after the 
date that is 1 year after the date of the enactment of this Act.
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