,i #aaeth ,,congress #ast ,session ,h4 ,r4 #afd ,,in ,,the ,,house ,,of ,,representatives ,january #c1 #bjag,mr4 ,hastings introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committees on ,education and the ,workforce1 ,ways and ,means1 and ,oversight and ,government ,reform1 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 provide for an evidence-based strategy for voluntary screening for ,,hiv_/,,aids and other common sexually transmitted infections1 and for other purposes4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,increasing ,access to ,voluntary ,screening for ,,hiv_/,,aids and ,s,t,is ,act of #bjag4 7b7 ,table of contents ,the table of contents for this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4 ,sec4 #b4 ,findings4 ,sec4 #c4 ,purpose4 ,sec4 #d4 ,definitions4 ,title ,i--,coverage of ,,hiv_/,,aids and ,,sti screening under public health care programs and group health plans2 ,coverage of care under ,medicaid4 ,sec4 #aja4 ,coverage of routine ,,hiv_/,,aids and ,,sti screening tests under ,medicaid4 ,sec4 #ajb4 ,coverage of ,,hiv_/,,aids and ,,sti screening tests under ,medicare4 ,sec4 #ajc4 ,coverage for routine ,,hiv_/,,aids and ,,sti screening under group health plans4 ,sec4 #ajd4 ,optional ,medicaid coverage of low-income ,,hiv_/,,aids infected individuals4 ,title ,,ii--,increased data collection and education for historically underrepresented populations ,sec4 #bja4 ,people living with disabilities4 ,sec4 #bjb4 ,women who have sex with women4 ,sec4 #bjc4 ,transgender community4 ,sec4 #bjd4 ,report4 #b4 ,findings ,congress finds the following3 7#a7 ,the ,,cdc estimates #bj1jjj1jjj new sexually transmitted infections 7,s,t,is7 occur each year in the ,united ,states1 and #ej percent of sexually active ,americans will contract a ,,sti at some point in their lives1 the majority of which may be asymptomatic for an extended amount of time4 7#b7 ,over #a1bjj1jjj people in the ,united ,states are living with ,,hiv1 and someone is infected with ,,hiv in the ,united ,states every #i4e minutes4 7#c7 ,,hiv_/,,aids and ,s,t,is are syndemics4 ,,hiv infection can increase a person's risk for acquiring certain ,s,t,is1 as well as affect their frequency1 severity1 and healing time1 while ,s,t,is increase the risk of ,,hiv transmission1 impaired fertility1 reproductive tract cancer1 and adverse pregnancy outcomes4 7#d7 ,many common long-term and initially asymptomatic ,s,t,is such as chlamydia1 gonorrhea1 herpes1 syphilis1 inflammatory pelvic disease1 viral hepatitis1 and ,,hiv_/,,aids remain undiagnosed1 or diagnosed at later stages1 leading to increased rates of mortality1 morbidity1 disability1 and transmission4 7#e7 ,in fact1 the ,,cdc estimates over #c4f million ,americans are living with chronic hepatitis and most do not know they are infected4 ,chronic hepatitis ,b can remain asymptomatic for years and1 left undiagnosed and untreated1 can lead to serious complications4 ,additionally1 individuals infected with hepatitis ,c virus 7,,hcv7 are at risk for chronic liver disease or other ,,hcv-related chronic diseases decades after infection4 7#f7 ,stigma1 culture1 language1 lack of education1 lack of insurance1 limited time1 cost and resources in medical settings1 and an inaccurate perception of risk among communities and providers all contribute to insufficient rates of screening for ,,hiv_/,,aids and ,s,t,is4 7#g7 ,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 outcomes4 7#h7 ,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 screening4 7#i7 ,the ,,cdc also recommends that all unvaccinated1 uninfected persons being evaluated for a ,,sti should receive hepatitis ,b vaccination4 ,furthermore1 anti-,,hcv testing is recommended for routine screening of asymptomatic persons based on their risk for infection or based on a recognized exposure4 7#aj7 ,inaccurate perceptions of risk among health care providers and patients1 misdiagnosis1 ageism1 generational mind-sets1 and biological factors have contributed to increased rates in transmission and late detection of ,,hiv_/,,aids and ,s,t,is over the past decade4 7#aa7 ,health equity and disparities remain a significant public health challenge1 with the burden of ,,hiv_/,,aids and ,s,t,is falling disproportionately on different populations4 7#ab7 ,although ,african-,americans account for about #ac percent of the ,united ,states population1 they account for nearly half of all ,,hiv_/,,aids cases and infections and have higher instances of mortality and morbidity for most ,s,t,is and ,,hiv_/,,aids4 ,also1 ,african-,american women who have sex with men account for the majority of ,,hiv_/,,aids infections among all women in the ,united ,states4 7#ac7 ,,hiv_/,,aids continues to be most prevalent among men who have sex with men 7,,msm74 ,continued support and increased funding for community-based programs and behavioral interventions that are culturally competent are key to reaching ,,msm1 especially young ,,msm of color4 7#ad7 ,transgender persons are particularly vulnerable to contracting ,,hiv_/,,aids and ,s,t,is due to high rates of survival sex among trans-females1 discrimination in education1 employment1 and housing1 and the absence of education and prevention methods culturally relevant to the transgender community4 7#ae7 ,health care providers must be properly educated to treat groups1 such as ,,msm1 transgender persons1 ,african-,americans1 and ,latinos who are disproportionately affected by ,,hiv_/,,aids and other ,s,t,is1 and also improve interventions for groups that have been historically underrepresented in health interventions for ,s,t,is1 such as women who have sex with women1 individuals over the age of #ej1 ,asian and ,pacific ,islander ,americans1 ,native ,americans1 and persons living with disabilities4 7#af7 ,women living with mobility impairments often lack access to screening for ,s,t,is and other women's health services such as pelvic examinations and mammograms due to1 among other factors1 the lack of provider awareness1 experience1 and access to equipment4 7#ag7 ,all individuals engaging in oral1 anal1 or genital sexual contact must have access to voluntary screening for ,,hiv_/,,aids and other ,s,t,is4 ,screening must be confidential1 rapid1 accurate1 and medically appropriate4 ,screening must be offered regardless of age1 race1 class1 sexual behavior1 sexual orientation1 gender identity1 or disability4 7#ah7 ,the ,congress supports the goals of the ,national ,,hiv_/,,aids ,strategy and1 in particular1 the goal of #ij percent of individuals knowing their ,,hiv_/,,aids status4 #c4 ,purpose ,the purposes of this ,act are as follows3 7#a7 ,increase access1 quality1 and affordability for voluntary and medically appropriate screening for ,,hiv_/,,aids and other ,s,t,is1 including chlamydia1 gonorrhea1 syphilis1 viral hepatitis1 and human papillomavirus1 for all persons engaging in various forms of sexual activity1 including oral1 genital1 or anal sex4 7#b7 ,reduce the spread1 morbidity1 and mortality of ,,hiv_/,,aids and other ,s,t,is4 7#c7 ,reduce the disproportionate incidence of ,,hiv_/,,aids and other ,s,t,is in certain groups through early detection and treatment and comprehensive education for health care providers1 centers1 and communities4 7#d7 ,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 ,s,t,is4 #d4 ,definitions ,in this ,act3 7#a7 ,,cdc ,the term ,,cdc means the ,centers for ,disease ,control and ,prevention4 7#b7 ,,cms ,the term ,,cms means the ,centers for ,medicare ,medicaid ,services4 7#c7 ,director ,the term ,director means the ,director of the ,centers for ,disease ,control and ,prevention4 7#d7 ,,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 syndrome4 7#e7 ,,msm ,the term ,,msm means men who have sex with men4 7#f7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services4 7#g7 ,state ,the term ,state means each of the #ej ,states1 the ,district of ,columbia1 the ,united ,states ,virgin ,islands1 ,guam1 the ,commonwealth of ,puerto ,rico1 the ,commonwealth of the ,northern ,mariana ,islands1 and ,american ,samoa4 7#h7 ,,sti ,the term ,,sti means a sexually transmitted infection that is recognized by the ,,cdc1 including chlamydia1 gonorrhea1 syphilis1 viral hepatitis1 and human papillomavirus4 7#i7 ,,wsw ,the term ,,wsw means women who have sex with women4 ,i ,coverage of ,,hiv_/,,aids and ,,sti screening under public health care programs and group health plans2 ,coverage of care under ,medicaid4 #aja4 ,coverage of routine ,,hiv_/,,aids and ,,sti screening tests under ,medicaid 7a7 ,inclusion in ,state plan ,section #aijb7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77 is amended in paragraph 7#aj77;,a71 in the matter before clause 7i71 by striking and 7#bh7 and inserting 7#bh71 and 7#bi74 7b7 ,inclusion in medical assistance 7#a7 ,in general ,section #aije7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a77 is amended-- 7,a7 in paragraph 7#bh71 by striking and at the end2 7,b7 by redesignating paragraph 7#bi7 as paragraph 7#cj72 and 7,c7 by inserting after paragraph 7#bh7 the following3 7#bi7 routine ,,hiv_/,,aids and ,,sti screening services 7as defined in subsection 7ee774 4 7#b7 ,definition of services ,section #aije of such ,act is amended by adding at the end the following3 7ee7 7#a7 ,for purposes of this section1 the term routine ,,hiv_/,,aids and ,,sti screening services means all of the following3 7,a7 ,a screening test for ,,hiv_/,,aids or any other ,,sti1 if such test is provided to an individual who-- 7i7 is eligible for medical assistance under the ,state plan2 and 7ii7 is described in clauses 7ii7 through 7v7 of section #ahfa7;jjj77#a77;,a74 7,b7 ,each of the services described in subparagraphs 7,b7 through 7,f7 of section #ahfa7;jjj77#a74 7#b7 ,definitions ,for purposes of this subsection1 the terms ,,hiv_/,,aids and ,,sti have the same meaning given such terms in section #ahfa7;jjj77#b74 4 7c7 ,no cost sharing for ,,hiv_/,,aids testing 7#a7 ,in general ,section #aiaf7;a77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifo7a77#b77 is amended-- 7,a7 in subparagraph 7,d71 by striking or at the end2 7,b7 in subparagraph 7,e71 by striking 2 and at the end and inserting 1 or2 and 7,c7 by adding at the end the following3 7,f7 routine ,,hiv_/,,aids and ,,sti screening services 7as such term is defined in section #aije7;ee772 and 4 7#b7 ,limitation on ,state option for alternative cost sharing ,section #aiaf;,a7b77#c77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifo-#a7;b77#c77;,b77 is amended by adding at the end the following3 7xi7 ,routine ,,hiv_/,,aids and ,,sti screening services 7as such term is defined in section #aije7;ee774 4 7d7 ,effective date 7#a7 ,in general ,except as provided by paragraph 7#b71 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 date4 7#b7 ,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 7other than legislation appropriating funds7 in order for the plan to meet the additional requirement imposed by the amendments made by this section1 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 ,act4 ,for purposes of the previous sentence1 in the case of a ,state that has a #b-year legislative session1 each year of such session shall be deemed to be a separate regular session of the ,state legislature4 #ajb4 ,coverage of ,,hiv_/,,aids and ,,sti screening tests under ,medicare ,section #ahfa of the ,social ,security ,act is amended-- 7#a7 in subsection 7s7-- 7,a7 by striking and at the end of paragraph 7#ad72 7,b7 by striking the period at the end of paragraph 7#ae7 and inserting 2 and2 7,c7 by redesignating paragraphs 7#af7 and 7#ag7 as paragraphs 7#ag7 and 7#ah71 respectively2 and 7,d7 by inserting after paragraph 7#ae7 the following3 7#af7 routine ,,hiv_/,,aids and ,,sti screening services 7as such term is defined in subsection 7jjj774 2 and 7#b7 by adding at the end the following3 7jjj7 ,routine ,,hiv_/,,aids and ,,sti screening services 7#a7 ,for purposes of this section1 the term routine ,,hiv_/,,aids and ,,sti screening services means all of the following3 7,a7 ,a screening test for ,,hiv_/,,aids or any other ,,sti1 if such test is provided in any health care setting 7other than an inpatient hospital setting7 and is provided to an individual who-- 7i7 is enrolled in part ,b2 7ii7 is at least #ac years of age2 7iii7 with respect to a test for ,,hiv_/,,aids1 is not known to the health care provider 7directly1 through information provided by the individual1 or through access to an electronic medical record7 to have had a previous positive test for ,,hiv_/,,aids2 7iv7 subject to subparagraph 7,b71 with respect to a test for ,,hiv_/,,aids or a ,,sti1 is not known to the health care provider 7directly1 through information provided by the individual1 or through access to an electronic medical record7 to have had a test for the same condition within the previous #f months2 and 7v7 has been informed that such a test will be administered and has not objected to such a test4 7,b7 ,if a test described under subparagraph 7,a7 is reactive and is for-- 7i7 ,,hiv_/,,aids1 a confirmatory test2 or 7ii7 a ,,sti other than ,,hiv_/,,aids1 if reasonable and necessary1 a confirmatory test4 7,c7 ,the interpretation of any tests provided under subparagraph 7,a7 and subparagraph 7,b74 7,d7 ,informing an individual who receives a test under subparagraph 7,a7 or subparagraph 7,b7 of the results of such tests as close in time as possible to the determination of such results4 7,e7 ,if an individual tests positive for ,,hiv_/,,aids on a screening test under subparagraph 7,a7 and any confirmatory test under subparagraph 7,b7-- 7i7 post-test counseling concerning ,,hiv_/,,aids and ,s,t,is at the time the individual is informed of the results of the test2 and 7ii7 if appropriate1 a referral to medical or mental health services4 7,f7 ,if an individual tests positive for a ,,sti on a screening test under subparagraph 7,a7 and any confirmatory test under subparagraph 7,b71 the provision of information to such individual on the risk of ,s,t,is and ,,hiv_/,,aids and behaviors that reduce the risk of exposure to such conditions4 7#b7 ,definitions ,for purposes of this subsection3 7,a7 ,,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 syndrome4 7,b7 ,,sti ,the term ,,sti means a sexually transmitted infection or sexually transmitted disease that is recognized by the ,centers for ,disease ,control and ,prevention1 including chlamydia1 gonorrhea1 syphilis1 hepatitis ,b1 hepatitis ,c1 and human papillomavirus4 4 #ajc4 ,coverage for routine ,,hiv_/,,aids and ,,sti screening under group health plans 7a7 ,group health plans 7#a7 ,public ,health ,service ,act amendment ,title ,,xxvii of the ,public ,health ,service ,act is amended by inserting after section #bgbh of such ,act 7#db ,u4,s4,c4 #cjj;gg-#bh71 as redesignated by section #ajja7b7 of the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh71 the following3 #bgbi4 ,coverage for routine ,,hiv_/,,aids and ,,sti screening 7a7 ,coverage ,a group health plan1 and a health insurance issuer providing group or individual health insurance coverage1 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 screenings4 7b7 ,prohibitions ,a group health plan1 and a health insurance issuer providing group or individual health insurance coverage1 shall not-- 7#a7 deny to an individual eligibility1 or continued eligibility1 to enroll or to renew coverage under the terms of the plan1 solely for the purpose of avoiding the requirements of this section2 7#b7 deny coverage for routine ,,hiv_/,,aids or ,,sti screening on the basis that there are no known risk factors present1 or the screening is not clinically indicated1 medically necessary1 or pursuant to a referral1 consent1 or recommendation by any health care provider2 7#c7 provide monetary payments1 rebates1 or other benefits to individuals to encourage such individuals to accept less than the minimum protections available under this section2 7#d7 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 section2 7#e7 provide incentives 7monetary or otherwise7 to a provider to induce such provider to provide care to an individual participant or beneficiary in a manner inconsistent with this section2 or 7#f7 deny to an individual participant or beneficiary continued eligibility to enroll or to renew coverage under the terms of the plan1 solely because of the results of an ,,hiv_/,,aids or ,,sti test1 or other ,,hiv_/,,aids and ,,sti screening procedure1 for the individual or any other individual4 7c7 ,rules of ,construction ,nothing in this section shall be construed-- 7#a7 to require an individual who is a participant or beneficiary to undergo ,,hiv_/,,aids or ,,sti screening2 or 7#b7 as preventing a group health plan or issuer from imposing deductibles1 coinsurance1 or other cost-sharing in relation to ,,hiv_/,,aids or ,,sti screening1 except that such deductibles1 coinsurance or other cost-sharing may not be greater than the deductibles1 coinsurance1 or other cost-sharing imposed on other routine health screenings4 7d7 ,notice ,a group health plan under this part shall comply with the notice requirement under section #gaf7;d7 of the ,employee ,retirement ,income ,security ,act of #aigd with respect to the requirements of this section as if such section applied to such plan4 7e7 ,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 section4 4 7#b7 ,,erisa amendments ,the ,employee ,retirement ,income ,security ,act of #aigd is amended as follows3 7,a7 ,in subpart ,b of part #g of subtitle ,b of title ,i1 by adding at the end the following new section3 #gaf4 ,coverage for routine ,,hiv_/,,aids and ,,sti screening 7a7 ,coverage ,a group health plan1 and a health insurance issuer offering group health insurance coverage1 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 screenings4 7b7 ,prohibitions ,a group health plan1 and a health insurance issuer offering group health insurance coverage1 shall not-- 7#a7 deny to an individual eligibility1 or continued eligibility1 to enroll or to renew coverage under the terms of the plan1 solely for the purpose of avoiding the requirements of this section2 7#b7 deny coverage for routine ,,hiv screening on the basis that there are no known risk factors present1 or the screening is not clinically indicated1 medically necessary1 or pursuant to a referral1 consent1 or recommendation by any health care provider2 7#c7 provide monetary payments1 rebates1 or other benefits to individuals to encourage such individuals to accept less than the minimum protections available under this section2 7#d7 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 section2 7#e7 provide incentives 7monetary or otherwise7 to a provider to induce such provider to provide care to an individual participant or beneficiary in a manner inconsistent with this section2 or 7#f7 deny to an individual participant or beneficiary continued eligibility to enroll or to renew coverage under the terms of the plan1 solely because of the results of an ,,hiv test or other ,,hiv screening procedure for the individual or any other individual4 7c7 ,rules of construction ,nothing in this section shall be construed-- 7#a7 to require an individual who is a participant or beneficiary to undergo ,,hiv_/,,aids or ,,sti screening2 or 7#b7 as preventing a group health plan or issuer from imposing deductibles1 coinsurance1 or other cost-sharing in relation to ,,hiv_/,,aids or ,,sti screening1 except that such deductibles1 coinsurance or other cost-sharing may not be greater than the deductibles1 coinsurance1 or other cost-sharing imposed on other routine health screenings4 7d7 ,notice under group health plan ,a group health plan1 and a health insurance issuer providing health insurance coverage in connection with a group health plan1 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 ,secretary4 ,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 transmitted1 by whichever is earliest of the following3 7#a7 ,in the next mailing made by the plan or issuer to the participant or beneficiary4 7#b7 ,as part of any yearly informational packet sent to the participant or beneficiary4 7#c7 ,not later than ,july #a1 #bjag4 7e7 ,preemption2 relation to ,state laws 7#a7 ,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 section4 7#b7 ,,erisa ,nothing in this section shall be construed to affect or modify the provisions of section #ead with respect to group health plans4 4 7,b7 ,in section #gcb7;a7 of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aaia;a7a771 by striking section #gaa and inserting sections #gaa and #gaf4 7,c7 ,in the table of contents in section #a of such ,act1 by inserting after the item relating to section #gad the following new item3 ,sec4 #gae4 ,additional market reforms4 ,sec4 #gaf4 ,coverage for routine ,,hiv_/,,aids and ,,sti screening4 4 7#c7 ,internal ,revenue ,code amendments 7,a7 ,in general ,the ,internal ,revenue ,code of #aihf is amended by inserting after section #ihae the following new section3 #ihaf4 ,coverage for routine ,,hiv_/,,aids and ,,sti screening 7a7 ,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 screenings4 7b7 ,prohibitions ,a group health plan shall not-- 7#a7 deny to an individual eligibility1 or continued eligibility1 to enroll or to renew coverage under the terms of the plan1 solely for the purpose of avoiding the requirements of this section2 7#b7 deny coverage for routine ,,hiv_/,,aids or ,,sti screening on the basis that there are no known risk factors present1 or the screening is not clinically indicated1 medically necessary1 or pursuant to a referral1 consent1 or recommendation by any health care provider2 7#c7 provide monetary payments1 rebates1 or other benefits to individuals to encourage such individuals to accept less than the minimum protections available under this section2 7#d7 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 section2 7#e7 provide incentives 7monetary or otherwise7 to a provider to induce such provider to provide care to an individual participant or beneficiary in a manner inconsistent with this section2 or 7#f7 deny to an individual participant or beneficiary continued eligibility to enroll or to renew coverage under the terms of the plan1 solely because of the results of an ,,hiv_/,,aids or ,,sti test1 or other ,,hiv_/,,aids and ,,sti screening procedure1 for the individual or any other individual4 7c7 ,rules of construction ,nothing in this section shall be construed-- 7#a7 to require an individual who is a participant or beneficiary to undergo ,,hiv_/,,aids or ,,sti screening2 or 7#b7 as preventing a group health plan or issuer from imposing deductibles1 coinsurance1 or other cost-sharing in relation to ,,hiv_/,,aids or ,,sti screening1 except that such deductibles1 coinsurance or other cost-sharing may not be greater than the deductibles1 coinsurance1 or other cost-sharing imposed on other routine health screenings4 4 7,b7 ,conforming amendment ,section #dihj;,d7d77#a7 of such ,code is amended by striking section #ihaa and inserting sections #ihaa and #ihaf4 7,c7 ,clerical amendment ,the table of contents for subchapter ,b of chapter #a of such ,code is amended by inserting after the item relating to section #ihae the following new item3 ,sec4 #ihaf4 ,coverage for routine ,,hiv_/,,aids and ,,sti screening4 4 7b7 ,application under ,federal ,employees ,health ,benefits ,program ,section #hijb of title #e1 ,united ,states ,code1 is amended by adding at the end the following new subsection3 7p7 ,a contract may not be made or a plan approved which does not comply with the requirements of section #bgbi of the ,public ,health ,service ,act4 4 7c7 ,effective dates ,notwithstanding any other provision of law1 the amendments made by subsections 7a7 and 7b7 shall apply with respect to plan years beginning on or after ,july #a1 #bjag1 and with respect to health insurance coverage issued on or after such date4 7d7 ,coordination of administration ,the ,secretary of ,labor1 the ,secretary of ,health and ,human ,services1 and the ,secretary of the ,treasury shall ensure1 through the execution of an interagency memorandum of understanding among such ,secretaries1 that-- 7#a7 regulations1 rulings1 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 7and the amendments made thereby7 are administered so as to have the same effect at all times2 and 7#b7 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 enforcement4 #ajd4 ,optional ,medicaid coverage of low-income ,,hiv_/,,aids infected individuals 7a7 ,in general ,section #aijb of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7 is amended-- 7#a7 in subsection 7a77#aj77;,a77ii7-- 7,a7 by striking or at the end of subclause 7,,xxi72 7,b7 by adding or at the end of subclause 7,,xxii72 and 7,c7 by adding at the end the following3 7,,xxiii7 on or before ,december #ca1 #bjag1 who are described in subsection 7ll7 7relating to ,,hiv_/,,aids infected individuals72 2 and 7#b7 by adding at the end the following3 7ll7 individuals described in this subsection are individuals-- 7#a7 who are not described in subsection 7a77#aj77;,a77i72 7#b7 who have ,,hiv_/,,aids1 as defined under section #aije7;ee72 7#c7 whose income 7as determined under the ,state plan under this title with respect to disabled individuals7 does not exceed the maximum amount of income a disabled individual described in subsection 7a77#aj77;,a77i7 may have to obtain medical assistance under the plan2 and 7#d7 whose resources 7as determined under the ,state plan under this title with respect to disabled individuals7 do not exceed the maximum amount of resources a disabled individual described in subsection 7a77#aj77;,a77i7 may have to obtain medical assistance under the plan4 4 7b7 ,enhanced match 7#a7 ,in general ,the first sentence of section #aije7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7b77 is amended by striking section #aijb7;a77#aj77;,a77ii77,,xviii7 and inserting subclause 7,,xviii7 and subclause 7,,xxiii7 of section #aijb7;a77#aj77;,a77ii74 7#b7 ,conforming amendments ,section #aije7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a77 is amended in the matter preceding paragraph 7#a7-- 7,a7 by striking or at the end of clause 7xv72 7,b7 by striking or at the end of clause 7xvi72 7,c7 by adding or at the end of clause 7xvii72 and 7,d7 by inserting after clause 7xvii7 the following3 7xviii7 individuals described in section #aijb7;a77#aj77;,a77ii77,,xxiii72 4 7c7 ,exemption from funding limitation for territories ,section #aajh7;g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acjh7;g77 is amended by adding at the end the following3 7#f7 ,disregarding medical assistance for optional low-income ,,hiv_/,,aids infected individuals ,the limitations under subsection 7f7 and the previous provisions of this subsection shall not apply to amounts expended for medical assistance for individuals described in section #aijb7ll7 who are only eligible for such assistance on the basis of section #aijb7;a77#aj77;,a77ii77,,xxiii74 4 7d7 ,effective date 7#a7 ,in general ,except as provided by paragraph 7#b71 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 date4 7#b7 ,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 7other than legislation appropriating funds7 in order for the plan to meet the additional requirement imposed by the amendments made by this section1 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 ,act4 ,for purposes of the previous sentence1 in the case of a ,state that has a #b-year legislative session1 each year of such session shall be deemed to be a separate regular session of the ,state legislature4 ,,ii ,increased data collection and education for historically underrepresented populations #bja4 ,people living with disabilities 7a7 ,tracking of information ,the ,director shall-- 7#a7 track national ,,hiv_/,,aids and ,,sti screening trends and the burdens of ,,hiv_/,,aids and ,s,t,is among people with disabilities1 including such persons with mental1 physical1 cognitive1 intellectual1 or developmental disabilities2 and 7#b7 identify and assess the barriers that prevent such persons from accessing ,,hiv_/,,aids and ,,sti screening4 7b7 ,tracking methodology 7#a7 ,in general ,the tracking methods used by the ,secretary under subsection 7a7 shall-- 7,a7 focus upon historically underrepresented communities1 including the deaf and hearing loss-related community and the cognitive1 intellectual1 developmental1 mobility1 or mental health disability communities2 and 7,b7 consider other factors that may contribute to increased burdens of ,,hiv_/,,aids and ,s,t,is1 including race1 socio-economic status1 region1 gender identity1 and sexual behavior4 7#b7 ,sexual assault data ,tracking under subsection 7a7 shall include data collection on the incidence of sexual assault on people with mental1 physical1 cognitive1 intellectual1 or developmental disabilities for the purposes of understanding the prevalence of ,,hiv_/,,aids and ,s,t,is that result from such assaults4 7c7 ,deaf and hearing loss community 7#a7 ,in general ,the ,secretary1 acting through the ,director1 shall work with appropriate organizations and institutions to make comprehensive sex education materials that promote voluntary screening for ,,hiv_/,,aids and ,s,t,is accessible to the deaf and hearing loss community through language 7including ,american ,sign ,language71 modalities 7including highly graphic formats with minimal text71 and culturally appropriate information delivery4 7#b7 ,health careers and education ,the ,secretary shall-- 7,a7 work with appropriate individuals1 organizations1 and institutions to increase the number of people who are deaf or living with hearing loss in public health careers for the purposes of-- 7i7 building the public health infrastructure to improve data collection2 and 7ii7 health information dissemination to people who are deaf or who live with hearing loss2 and 7,b7 engage students in elementary school1 high school1 college1 and graduate school for the purposes of carrying out this paragraph4 7d7 ,cognitive and intellectual disability community ,the ,secretary1 acting through the ,director1 shall work with appropriate national and local organizations to make comprehensive sex education materials accessible to people with intellectual disabilities by-- 7#a7 using plain language2 7#b7 educating service providers about the signs and symptoms of sexual assault among people with cognitive and intellectual disabilities2 and 7#c7 using other appropriate information delivery strategies4 7e7 ,women living with severe physical disabilities ,the ,secretary1 acting through the ,director1 shall work with ,federal1 ,state1 and local entities to track access to pelvic examinations1 mammograms1 and other women's health services for women with severe mobility impairments with the goal of improving access to such services4 #bjb4 ,women who have sex with women 7a7 ,national screening guidelines ,the ,secretary1 acting through the ,director1 shall work with ,federal1 ,state1 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 men4 7b7 ,information collection ,the ,secretary1 acting through the ,director1 shall1 with respect to the ,,wsw community-- 7#a7 track national trends in screening for ,,hiv_/,,aids and other ,s,t,is2 and 7#b7 collect information on-- 7,a7 the burdens and behavior of ,,hiv_/,,aids and ,s,t,is2 and 7,b7 other reproductive health concerns4 #bjc4 ,transgender community 7a7 ,data collection ,the ,secretary1 acting through the ,director1 shall work with ,federal1 ,state1 and local health entities and transgender communities to improve information collection concerning the transmission1 morbidity1 and screening for ,,hiv_/,,aids and other ,s,t,is in transgender communities4 7b7 ,information classification ,for purposes of acquiring a comprehensive understanding of the unique health trends among1 and aspects of1 the transgender community1 the ,secretary shall promulgate regulations requiring that1 for purposes of public health studies requiring data collection1 the fact that an individual is transgender shall be a distinct category and data point4 #bjd4 ,report 7a7 ,in general ,not later than #c years after the date of the enactment of this ,act1 the ,secretary shall submit a report to ,congress on the activities required under this ,act4 7b7 ,contents ,the report issued to ,congress under subsection 7a7 shall include-- 7#a7 information on the success of voluntary screening for ,,hiv_/,,aids and ,s,t,is1 as well as other methods for preventing the transmission of ,,hiv_/,,aids and ,s,t,is among ,medicaid and ,medicare beneficiaries1 patients at federally qualified health centers1 individuals with health insurance1 ,,msm1 ,,wsw1 persons living with disabilities1 the transgender community1 and other groups that have been historically underrepresented in public health interventions for ,,hiv_/,,aids and ,s,t,is2 and 7#b7 recommendations on how to improve existing measures with respect to race1 socioeconomic status1 region1 gender identity1 disability1 age1 and sexual behavior-- 7,a7 to increase access to screening2 and 7,b7 to decrease the disparities in mortality and morbidity from ,,hiv_/,,aids and other ,s,t,is4