I 112th CONGRESS 2d Session H. R. 4470 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.

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.

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:

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.