109th CONGRESS
2d Session
H. R. 6309
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/AIDS screening.
IN THE HOUSE OF REPRESENTATIVES
September 29, 2006
Ms. WATERS (for herself, Mrs. CHRISTENSEN, Ms. LEE, Ms. CARSON, and Ms.
JACKSON-LEE of Texas) introduced the following bill; which was referred
to the Committee on Energy and Commerce, and in addition to the Committees
on Education and the Workforce, Ways and Means, 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/AIDS 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/AIDS Screening
Coverage Act of 2006'.
(b) Findings- Congress finds the following:
(1) HIV/AIDS continues to infect and kill thousands of Americans, 25 years
after the first cases were reported.
(2) It has been estimated that at least 1.6 million Americans have been
infected by HIV/AIDS since the beginning of the epidemic and over 500,000
of them have died.
(3) The HIV/AIDS epidemic has disproportionately impacted African Americans
and Hispanic Americans and its impact on women is growing.
(4) It has been estimated that between 24 and 27 percent of those infected
with HIV/AIDS in the United States do not know they are infected.
(5) Not all individuals who have been infected with HIV/AIDS demonstrate
clinical indications or fall into high risk categories.
(6) The Centers for Disease Control and Prevention has determined that
increasing the proportion of people who know their HIV/AIDS 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.
(7) On September 21, 2006, the Centers for Disease Control and Prevention
released new guidelines that recommend routine HIV/AIDS screening in health
care settings for all patients aged 13-64, regardless of risk.
(8) Standard health insurance plans generally cover HIV/AIDS screening
when there are clinical indications of infection or when there are known
risk factors present.
(9) Requiring health insurance plans to cover routine HIV/AIDS screening
could play a critical role in preventing the spread of HIV/AIDS and allowing
infected individuals to receive effective treatment.
SEC. 2. COVERAGE FOR ROUTINE HIV/AIDS SCREENING UNDER GROUP HEALTH PLANS,
INDIVIDUAL HEALTH INSURANCE COVERAGE, AND FEHBP.
(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. 2707. COVERAGE FOR ROUTINE HIV/AIDS SCREENING.
`(a) Coverage- A group health plan, and a health insurance issuer offering
group health insurance coverage, shall provide coverage for routine HIV/AIDS
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 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 test or other HIV/AIDS 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 screening; or
`(2) as preventing a group health plan or issuer from imposing deductibles,
coinsurance, or other cost-sharing in relation to HIV/AIDS 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 714(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 screening otherwise required under this section.'.
(2) ERISA AMENDMENTS- (A) Subpart B of part 7 of subtitle B of title I
of the Employee Retirement Income Security Act of 1974 is amended by adding
at the end the following new section:
`SEC. 714. COVERAGE FOR ROUTINE HIV/AIDS SCREENING.
`(a) Coverage- A group health plan, and a health insurance issuer offering
group health insurance coverage, shall provide coverage for routine HIV/AIDS
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 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 test or other HIV/AIDS 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 screening; or
`(2) as preventing a group health plan or issuer from imposing deductibles,
coinsurance, or other cost-sharing in relation to HIV/AIDS 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--
`(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; or
`(3) not later than January 1, 2007;
`(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 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) Section 732(a) of such Act (29 U.S.C. 1191a(a)) is amended by striking
`section 711' and inserting `sections 711 and 714'.
(C) The table of contents in section 1 of such Act is amended by inserting
after the item relating to section 713 the following new item:
`Sec. 714. Coverage for routine HIV/AIDS screening.'.
(3) INTERNAL REVENUE CODE AMENDMENTS- (A) Subchapter B of chapter 100
of the Internal Revenue Code of 1986 is amended by inserting after section
9812 the following:
`SEC. 9813. COVERAGE FOR ROUTINE HIV/AIDS SCREENING.
`(a) Coverage- A group health plan shall provide coverage for routine HIV/AIDS
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 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 test or other HIV/AIDS 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 screening; or
`(2) as preventing a group health plan or issuer from imposing deductibles,
coinsurance, or other cost-sharing in relation to HIV/AIDS 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) The table of sections of such subchapter is amended by inserting after
the item relating to section 9812 the following new item:
`Sec. 9813. Coverage for routine HIV/AIDS screening.'.
(C) Section 4980D(d)(1) of such Code is amended by striking `section 9811'
and inserting `sections 9811 and 9813'.
(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
2752 the following new section:
`SEC. 2753. COVERAGE FOR ROUTINE HIV/AIDS SCREENING.
`(a) In General- The provisions of section 2707 (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 714(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 2753'.
(c) 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 2707 of the Public Health Service Act.'.
(d) Effective Dates- (1) The amendments made by subsections (a) and (c)
apply with respect to group health plans and health benefit plans for plan
years beginning on or after January 1, 2007.
(2) The amendments made by subsection (b) 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, 2007.
(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.
END
