,i #aacth ,,congress #ast ,session ,h4 ,r4 #cgbc ,,in ,,the ,,house ,,of ,,representatives ,december #ab1 #bjac,mr4 ,cassidy 7for himself1 ,mr4 ,guthrie1 and ,mr4 ,dent7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committee on ,veterans' ,affairs1 for a period to be subsequently determined by the ,speaker1 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 to revise and extend the program for viral hepatitis surveillance1 education1 and testing in order to prevent deaths from chronic liver disease and liver cancer1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,viral ,hepatitis ,testing ,act of #bjac4 #b4 ,findings ,congress finds the following3 7#a7 ,approximately #e1cjj1jjj ,americans are chronically infected with the hepatitis ,b virus 7referred to in this section as ,,hbv71 the hepatitis ,c virus 7referred to in this section as ,,hcv71 or both4 7#b7 ,in the ,united ,states1 chronic ,,hbv and ,,hcv are among the most common causes of liver cancer1 one of the most lethal and fastest growing cancers in the ,united ,states4 ,chronic ,,hbv and ,,hcv are among the most common causes of chronic liver disease1 liver cirrhosis1 and the most common indication for liver transplantation4 ,more than #ae1jjj deaths per year in the ,united ,states can be attributed to chronic ,,hbv and ,,hcv4 ,chronic ,,hcv is also a leading cause of death in ,americans living with ,,hiv_/,,aids4 ,many of those living with ,,hiv_/,,aids are coinfected with chronic ,,hbv1 ,,hcv1 or both4 7#c7 ,according to the ,centers for ,disease ,control and ,prevention 7referred to in this section as the ,,cdc71 approximately #b percent of the population of the ,united ,states is living with chronic ,,hbv1 ,,hcv1 or both4 ,the ,,cdc has recognized ,,hcv as the ,nation's most common chronic bloodborne virus infection4 7#d7 ,,hbv is easily transmitted and is #ajj times more infectious than ,,hiv4 ,according to the ,,cdc1 ,,hbv is transmitted through contact with infectious blood1 semen1 or other body fluids4 ,,hcv is transmitted by contact with infectious blood1 particularly through percutaneous exposures 7i4e4 puncture through the skin74 7#e7 ,the ,,cdc conservatively estimates that in #bjaa approximately #af1fjj ,americans were newly infected with ,,hcv and more than #ah1hjj ,americans were newly infected with ,,hbv4 ,these estimates could be much higher due to many reasons1 including lack of screening education and awareness1 and perceived marginalization of the populations at risk4 7#f7 ,in #bjab ,,cdc released new guidelines recommending every person born from #aide through #aife receive a one-time ,,hcv test4 ,among the estimated #ajb million 7#a4f million chronically ,,hcv-infected7 eligible for screening1 birth-cohort screening leads to #gd1jjj fewer cases of decompensated cirrhosis1 #df1jjj fewer cases of hepatocellular carcinoma1 #ae1jjj fewer liver transplants and #abj1jjj fewer ,,hcv-related deaths versus risk-based screening4 7#g7 ,in #bjac1 the ,united ,states ,preventative ,task ,force 7,,uspstf7 issued a ,grade ,b rating for screening for hepatitis ,c virus 7,,hcv7 infection in persons at high risk for infection and adults born between #aide and #aife4 ,in #bjji1 the ,,uspstf issued a ,grade ,a for screening pregnant women for the hepatitis ,b virus 7,,hbv7 during their first prenatal visit4 7#h7 ,there were #ce outbreaks 7#ai of ,,hbv1 #af of ,,hcv7 reported to ,,cdc for investigation from #bjjh-bjab related to healthcare acquired infection of ,,hbv and ,,hcv1 #cc of which occurred in non-hospital settings4 ,there were more than #ii1ige patients potentially exposed to one of the viruses4 7#i7 ,chronic ,,hbv and chronic ,,hcv usually do not cause symptoms early in the course of the disease1 but after many years of a clinically silent phase1 ,,cdc estimates show more than #cc percent of infected individuals will develop cirrhosis1 end-stage liver disease1 or liver cancer4 ,since most individuals with chronic ,,hbv1 ,,hcv1 or both are unaware of their infection1 they do not know to take precautions to prevent the spread of their infection and can unknowingly exacerbate their own disease progression4 7#aj7 ,,hbv and ,,hcv disproportionately affect certain populations in the ,united ,states4 ,although representing about #f percent of the population1 ,asian and ,pacific ,islanders account for over half of up to #a1djj1jjj domestic chronic ,,hbv cases4 ,baby boomers 7those born between #aide and #aife7 account for more than #ge percent of domestic chronic ,,hcv cases4 ,in addition1 ,african-,americans1 ,latinos 7,latinas71 and ,american ,indian_/,native ,alaskans are among the groups which have disproportionately high rates of ,,hbv infections1 ,,hcv infections1 or both in the ,united ,states4 7#aa7 ,for both chronic ,,hbv and chronic ,,hcv1 behavioral changes can slow disease progression if a diagnosis is made early4 ,early diagnosis1 which is determined through simple diagnostic tests1 can also reduce the risk of transmission and disease progression through education and vaccination of household members and other susceptible persons at risk4 7#ab7 ,advancements have led to the development of improved diagnostic tests for viral hepatitis4 ,these tests1 including rapid1 point of care testing and others in development1 can facilitate testing1 notification of results and post-test counseling1 and referral to care at the time of the testing visit4 ,in particular1 these tests are also advantageous because they can be used simultaneously with ,,hiv rapid testing for persons at risk for both ,,hcv and ,,hiv infections4 7#ac7 ,for those chronically infected with ,,hbv or ,,hcv1 regular monitoring can lead to the early detection of liver cancer at a stage where a cure is still possible4 ,liver cancer is the second deadliest cancer in the ,united ,states2 however1 liver cancer has received little funding for research1 prevention1 or treatment4 7#ad7 ,treatment for chronic ,,hcv can eradicate the disease in approximately #ge percent of those currently treated4 ,the treatment of chronic ,,hbv can effectively suppress viral replication in the overwhelming majority 7over #hj percent7 of those treated1 thereby reducing the risk of transmission and progression to liver scarring or liver cancer1 even though a complete cure is much less common than for ,,hcv4 7#ae7 ,to combat the viral hepatitis epidemic in the ,united ,states1 in ,may #bjaa1 the ,department of ,health and ,human ,services released1 ,combating the ,silent ,epidemic of ,viral ,hepatitis3 ,action ,plan for the ,prevention1 ,care ,treatment of ,viral ,hepatitis4 ,the ,institute of ,medicine of the ,national ,academies produced a #bjaj report on the ,federal response to ,,hbv and ,,hcv titled3 ,hepatitis and ,liver ,cancer3 ,a ,national ,strategy for ,prevention and ,control of ,hepatitis ,b and ,c4 ,the recommendations and guidelines provide a framework for ,,hbv and ,,hcv prevention1 education1 control1 research1 and medical management programs4 7#af7 ,the annual health care costs attributable to viral hepatitis in the ,united ,states are significant4 ,for ,,hbv1 it is estimated to be approximately #b1ejj1jjj1jjj 7#b1jjj per infected person74 ,in #bjjj1 the lifetime cost of ,,hbv--before the availability of most current therapies--was approximately #hj1jjj per chronically infected person1 totaling more than #ajj1jjj1jjj1jjj4 ,for ,,hcv1 medical costs for patients are expected to increase from #cj1jjj1jjj1jjj in #bjji to over #he1jjj1jjj1jjj in #bjbd4 ,avoiding these costs by screening and diagnosing individuals earlier--and connecting them to appropriate treatment and care will save lives and critical health care dollars4 ,currently1 without a comprehensive screening1 testing and diagnosis program1 most patients are diagnosed too late when they need a liver transplant costing at least #cad1jjj for uncomplicated cases or when they have liver cancer or end stage liver disease which costs between #cj1ihj to #aaj1egf per hospital admission4 ,as health care costs continue to grow1 it is critical that the ,federal ,government invests in effective mechanisms to avoid documented cost drivers4 7#ag7 ,according to the ,institute of ,medicine report in #bjaj 7described in paragraph 7#ac771 chronic ,,hbv and ,,hcv infections cause substantial morbidity and mortality despite being preventable and treatable4 ,deficiencies in the implementation of established guidelines for the prevention1 diagnosis1 and medical management of chronic ,,hbv and ,,hcv infections perpetuate personal and economic burdens4 ,existing grants are not sufficient to address the scale of the health burden presented by ,,hbv and ,,hcv4 7#ah7 ,the ,secretary of ,health and ,human ,services has the discretion to carry out this ,act directly and through whichever of the agencies of the ,public ,health ,service the ,secretary determines to be appropriate1 which may 7in the ,secretary's discretion7 include the ,centers for ,disease ,control and ,prevention1 the ,health ,resources and ,services ,administration1 the ,substance ,abuse and ,mental ,health ,services ,administration1 the ,national ,institutes of ,health 7including the ,national ,institute on ,minority ,health and ,health ,disparities71 and other agencies of such ,service4 7#ai7 ,for over a decade1 the ,centers for ,disease ,control and ,prevention's ,viral ,hepatitis ,prevention ,coordinator 7,,vhpc7 program has been the only national program dedicated to the prevention and control of the viral hepatitis epidemics administering the duties currently specified by ,section #cag,n of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdg;b-#ae7 at ,state and local health departments4 ,v,h,p,cs provide the technical expertise necessary for the management and coordination of activities to prevent viral hepatitis infection and disease with little to no ,federal funding for program implementation or development4 ,further1 these coordinators help integrate viral hepatitis prevention services into health care settings and public health programs that serve adults at risk for viral hepatitis4 #c4 ,revision and extension of hepatitis surveillance1 education1 and testing program 7a7 ,in general ,section #cag,n of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdg;b-#ae7 is amended-- 7#a7 by amending the section heading to read as follows3 ,surveillance1 education1 testing1 and linkage to care regarding hepatitis virus2 7#b7 by redesignating subsections 7b7 and 7c7 as subsections 7d7 and 7e71 respectively2 and 7#c7 by striking subsection 7a7 and inserting the following3 7a7 ,in general ,the ,secretary shall1 in accordance with this section1 carry out surveillance1 education1 and testing programs with respect to hepatitis ,b and hepatitis ,c virus infections 7referred to in this section as ,,hbv and ,,hcv1 respectively74 ,the ,secretary may carry out such programs directly and through grants to public and nonprofit private entities1 including ,states1 political subdivisions of ,states1 territories1 ,indian tribes1 and public-private partnerships4 7b7 ,national system ,in carrying out subsection 7a71 the ,secretary shall1 in consultation with ,states and other public or nonprofit private entities and public-private partnerships described in subsection 7d71 establish a national system with respect to ,,hbv and ,,hcv with the following goals3 7#a7 ,to determine the incidence and prevalence of such infections1 including providing for the reporting of acute and chronic cases4 7#b7 ,with respect to the population of individuals who have such an infection1 to carry out testing programs to increase the number of individuals who are aware of their infection to #ej percent by ,december #ca1 #bjad1 and to #ge percent by ,december #ca1 #bjaf4 7#c7 ,to develop and disseminate public information and education programs for the detection and control of such infections4 7#d7 ,to improve the education1 training1 and skills of health professionals in the detection1 control1 and care and treatment1 of such infections4 7#e7 ,to provide appropriate referrals for counseling and medical care and treatment of infected individuals and to ensure1 to the extent practicable1 the provision of appropriate follow-up services4 7c7 ,high-,risk populations2 chronic cases 7#a7 ,in general ,the ,secretary shall determine the populations that1 for purposes of this section1 are considered at high-risk for ,,hbv or ,,hcv4 ,the ,secretary shall include the following among those considered at high-risk3 7,a7 ,for ,,hbv1 individuals born in countries in which #b percent or more of the population has ,,hbv or who are a part of a high-risk category as identified by the ,centers for ,disease ,control and ,prevention4 7,b7 ,for ,,hcv1 individuals born between #aide and #aife or who are a part of a high-risk category as identified by the ,centers for ,disease ,control and ,prevention4 7,c7 ,those who have been exposed to the blood of infected individuals or of high-risk individuals or who are family members of such individuals4 7#b7 ,priority in programs ,in providing for programs under this section1 the ,secretary shall give priority-- 7,a7 to early diagnosis of chronic cases of ,,hbv or ,,hcv in high-risk populations under paragraph 7#a72 and 7,b7 to education1 and referrals for counseling and medical care and treatment1 for individuals diagnosed under subparagraph 7,a7 in order to-- 7i7 reduce their risk of dying from end-stage liver disease and liver cancer1 and of transmitting the infection to others2 7ii7 determine the appropriateness for treatment to reduce the risk of progression to cirrhosis and liver cancer2 7iii7 receive ongoing medical management1 including regular monitoring of liver function and screenings for liver cancer2 7iv7 receive1 as appropriate1 drug1 alcohol abuse1 and mental health treatment2 7v7 in the case of women of childbearing age1 receive education on how to prevent ,,hbv perinatal infection1 and to alleviate fears associated with pregnancy or raising a family2 and 7vi7 receive such other services as the ,secretary determines to be appropriate4 7#c7 ,cultural context ,in providing for services pursuant to paragraph 7#b7 for individuals who are diagnosed under subparagraph 7,a7 of such paragraph1 the ,secretary shall seek to ensure that the services are provided in a culturally and linguistically appropriate manner4 7d7 ,public-,private partnerships 7#a7 ,in general ,in carrying out this section1 and not later than #fj days after the date of the enactment of the ,viral ,hepatitis ,testing ,act of #bjac1 the ,secretary shall1 in consultation with the ,assistant ,secretary for ,health1 the ,director of the ,centers for ,disease ,control and ,prevention1 the ,health ,resources and ,services ,administration1 the ,substance ,abuse and ,mental ,health ,services ,administration1 the ,office of ,minority ,health1 the ,indian ,health ,service1 other relevant agencies1 and non-government stakeholder entities1 establish and support public-private partnerships that facilitate the surveillance1 education1 screening1 testing1 and linkage to care programs authorized by this section4 7#b7 ,duties ,public-private partnerships established or supported under paragraph 7#a7 shall-- 7,a7 focus primarily on the surveillance1 education1 screening1 testing1 and linkage to care programs authorized by this section2 7,b7 generate resources1 in addition to the funds made available pursuant to subsection 7f71 to carry out the surveillance1 education1 screening1 testing1 and linkage to care programs authorized in this section by leveraging ,federal funding with non-,federal funding and support2 7,c7 allow for investments in such programs of financial or in-kind resources by each of the partners involved in the partnership2 7,d7 include corporate and industry entities1 academic institutions1 public and non-profit organizations1 community and faith-based organizations1 foundations1 and other governmental and non-governmental organizations2 and 7,e7 advance the core goals of each of the partners of the partnership as determined by the ,secretary in development of the partnership4 7#c7 ,annual reports ,the ,secretary shall provide to the ,congress an annual report on the public-private partnerships established under this subsection4 ,each such report shall include-- 7,a7 the number of public-private partnerships established2 7,b7 specific and quantifiable information on the surveillance1 education1 screening1 testing1 and linkage to care activities conducted as well as the outcomes achieved through each of the public-private partnerships2 7,c7 the amount of ,federal funding or resources dedicated to the public-private partnerships2 7,d7 the amount of non-,federal funding or resources leveraged through the public-private partnerships2 and 7,e7 a plan for the following year that outlines future activities4 7#d7 ,limitation ,no more than #be percent of the funds made available to carry out this section may be used for public-private partnerships established or supported under this subsection4 7#e7 ,linkage to care ,for purposes of this section1 the term linkage to care means1 with respect to an individual with a diagnosis of ,,hbv or ,,hcv1 the referral of such individual to clinical care for a thorough evaluation of their clinical status to determine the need for treatment1 vaccination for ,,hbv1 or other therapy4 7e7 ,agency for healthcare research and quality ,,hbv and ,,hcv guidelines ,due to the rapidly evolving standard of care associated with diagnosing and treating viral hepatitis infection1 the ,director of the ,agency for ,healthcare ,research and ,quality shall convene the ,preventive ,services ,task ,force under section #iae7;a7 to review its recommendation for screening for ,,hbv and ,,hcv infection every #c years4 7f7 ,funding 7#a7 ,in general ,in addition to any amounts otherwise authorized by this ,act1 there are authorized to be appropriated to carry out this section-- 7,a7 #be1jjj1jjj for fiscal year #bjad2 7,b7 #ce1jjj1jjj for fiscal year #bjae2 and 7,c7 #bj1jjj1jjj for fiscal year #bjaf4 7#b7 ,grants ,of the amounts appropriated pursuant to paragraph 7#a7 for a fiscal year1 the ,secretary shall reserve not less than #hj percent for making grants under subsection 7a74 7#c7 ,source of funds ,the funds made available to carry out this section shall be derived exclusively from the funds appropriated or otherwise made available for planning and evaluation under this ,act4 4 7b7 ,savings ,provision ,the amendments made by this section shall not be construed to require termination of any program or activity carried out by the ,secretary of ,health and ,human ,services under section #cag,n of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdg;b-#ae7 as in effect on the day before the date of the enactment of this ,act4 #d4 ,hepatitis ,c screening and evaluation of needed care for veterans 7a7 ,in general ,subchapter ,,ii of chapter #ag of title #ch1 ,united ,states ,code1 is amended by adding at the end the following3 #agbj;,h4 ,hepatitis ,c screening and evaluation of needed care for veterans 7a7 ,in general 7#a7 ,the ,secretary shall establish and carry out a plan to provide veterans described in paragraph 7#b7 with-- 7,a7 a risk assessment for the hepatitis ,c virus2 and 7,b7 if a veteran is diagnosed with such virus-- 7i7 a thorough evaluation of the clinical status of the veteran to determine the need for treatment1 vaccination1 or other therapy2 and 7ii7 information with respect to the needs determined under clause 7i74 7#b7 ,veterans described in this paragraph are veterans who-- 7,a7 are enrolled in the health care system established under section #agje7;a7 of this title2 and 7,b7 were born between #aide and #aife4 7b7 ,compliance 7#a7 ,the ,secretary shall use the plan established under subsection 7a77#a7 as a key measure in determining performance under the ,,va ,handbook ,performance ,management ,system1 or the successor to such handbook1 to ensure the compliance of such plan4 7#b7 ,if the ,secretary determines that a medical facility of the ,department complies with the plan established under subsection 7a77#a7 at a rate less than #ajj percent1 the ,secretary shall treat the director of such medical facility as less than fully successfulwith respect to the performance appraisal that is used for the basis for determining performance awards under the handbook described in paragraph 7#a74 7c7 ,annual report ,the ,secretary shall submit annually to ,congress a report on the compliance of each medical facility of the ,department with the plan established under subsection 7a77#a74 4 7b7 ,clerical amendment ,the table of sections at the beginning of such chapter is amended by inserting after the item relating to section #agbj;,g the following new item3 #agbj;,h4 ,hepatitis ,c screening and evaluation of needed care for veterans4 4