Routine HIV Screening Coverage Act of 2012 - Amends the Public Health Service Act, the Employee Retirement Income Security Act (ERISA), and the Internal Revenue Code to require group health plans and health insurance issuers offering group or individual health insurance coverage to provide coverage for routine HIV screening under terms and conditions no less favorable than for other routine preventive health services. Prohibits such a plan from taking specified actions to avoid the requirements of this Act.
Requires inclusion of a notice of such screening coverage in the uniform summary of benefits and coverage explanation provided by the group health plan or health insurance issuer.
Defines "routine HIV screening" as having the meaning given the term by the Secretary of Health and Human Services (HHS) after consultation with the the Office of National AIDS Policy, the Centers for Disease Control and Prevention (CDC), health care professionals, and other qualified individuals.
Applies requirements of this Act to health insurance coverage offered under the Federal Employees Health Benefits Program.
[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.
<all>
Introduced in House
Introduced in House
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.
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.
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.
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.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
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Referred to the Subcommittee on Health, Employment, Labor, and Pensions.