Ending the HIV/AIDS Epidemic Act of 2012 - Sets forth provisions addressing HIV/AIDS, including through:
[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6138 Introduced in House (IH)]
112th CONGRESS
2d Session
H. R. 6138
To bring an end to the spread of HIV/AIDS in the United States and
around the world.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 18, 2012
Ms. Lee of California (for herself, Mr. Moran, Ms. Clarke of New York,
Ms. Schakowsky, Ms. Norton, Mr. Schiff, Ms. Woolsey, Mr. Towns, Mr.
Nadler, Mr. Conyers, Mr. Rangel, Mr. Hinchey, Mr. Serrano, Mr. Johnson
of Georgia, Mr. Honda, Ms. McCollum, Mr. Engel, Mr. Himes, Mr.
McDermott, Ms. Chu, Mr. Lewis of Georgia, Ms. Bass of California, Mrs.
Christensen, Ms. Linda T. Sanchez of California, Ms. Waters, Mr. Rush,
and Mr. Grijalva) introduced the following bill; which was referred to
the Committee on Energy and Commerce, and in addition to the Committees
on Foreign Affairs, Education and the Workforce, the Judiciary, Armed
Services, Financial Services, and Ways and Means, 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 bring an end to the spread of HIV/AIDS in the United States and
around the world.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Ending the HIV/AIDS Epidemic Act of
2012''.
SEC. 2. TABLE OF CONTENTS.
The table of contents of this Act is as follows:
Sec. 1. Short title.
Sec. 2. Table of contents.
Sec. 3. Statement of policy.
Sec. 4. Findings.
Sec. 5. Nondiscrimination.
DIVISION A--ENDING HIV/AIDS IN THE UNITED STATES
TITLE I--INCREASING AND TARGETING INVESTMENT TO MAXIMIZE PREVENTION AND
TREATMENT IMPACT
Sec. 101. Additional funding for AIDS Drug Assistance Program
treatments.
Sec. 102. Enhancing the national HIV surveillance system.
Sec. 103. Evidence-based strategies for improving linkage to and
retention in appropriate care.
Sec. 104. Improving entry into and retention in care and antiretroviral
adherence for persons with HIV.
Sec. 105. Health care professionals treating individuals with HIV/AIDS.
Sec. 106. HIV/AIDS provider loan repayment program.
Sec. 107. Reducing new HIV infections among injecting drug users.
Sec. 108. Support for expansion of comprehensive sexual health and
education programs.
Sec. 109. Elimination of abstinence-only education program.
TITLE II--ENDING STIGMA AND DISCRIMINATION THAT INHIBIT ACCESS TO CARE
AND MAKE PEOPLE MORE VULNERABLE
Sec. 201. Review of all Federal and State laws, policies, and
regulations regarding the criminal
prosecution of individuals for HIV-related
offenses.
TITLE III--ADDRESSING LEGAL AND POLICY BARRIERS TO ACCESSING HEALTH
CARE
Sec. 301. Repeal of limitation against use of funds for education or
information designed to promote or
encourage, directly, homosexual or
heterosexual activity or intravenous
substance abuse.
Sec. 302. Expanding support for condoms in prisons.
Sec. 303. Automatic reinstatement or enrollment in Medicaid for people
who test positive for HIV before reentering
communities.
TITLE IV--COORDINATING EFFORTS TO DRIVE GREATER EFFICIENCY AND IMPROVED
RESULTS
Sec. 401. Support data system review and indicators for monitoring HIV
care.
Sec. 402. Transfer of funds for implementation of National HIV/AIDS
Strategy.
Sec. 403. HIV integrated services delivery model demonstration.
Sec. 404. Report on the implementation of the National HIV/AIDS
Strategy.
DIVISION B--ENDING HIV/AIDS GLOBALLY
TITLE X--GLOBAL HIV/AIDS-FREE GENERATION STRATEGY
Sec. 1001. Global HIV/AIDS-Free Generation Strategy.
TITLE XI--USING FUNDS STRATEGICALLY TO MAXIMIZE RESULTS
Sec. 1101. Support for operations research to improve program delivery,
efficiency, impact, and effectiveness.
Sec. 1102. Increasing coordination and integration of HIV/AIDS programs
with development programs.
Sec. 1103. Increasing program effectiveness and sustainability to
achieve successful country ownership.
TITLE XII--ADDRESSING LEGAL AND POLICY BARRIERS TO ACCESSING HEALTH
CARE
Subtitle A--General Provisions
Sec. 1201. Support for laws and regulations that improve health
outcomes and promote human rights.
Sec. 1202. Intensifying efforts to establish effective programs for
engaging key affected populations.
Sec. 1203. Ensuring United States trade policy does not restrict access
to affordable medicines.
Subtitle B--Repeal of Certain Provisions of Public Law 108-25
Sec. 1211. Repeal of ``conscience clause'' requirement for eligibility
for assistance.
Sec. 1212. Repeal of limitation on use of funds for assistance for sex
workers.
Sec. 1213. Repeal of reporting requirement on activities promoting
abstinence and related activities.
Sec. 1214. Effective date.
TITLE XIII--DEFINITIONS
Sec. 1301. Definitions.
SEC. 3. STATEMENT OF POLICY.
It is the policy of the United States to achieve an AIDS-free
generation, and to--
(1) expand access to lifesaving antiretroviral therapy for
people living with HIV/AIDS and immediately link people to
continuous and coordinated high-quality care when they learn
they are infected with HIV;
(2) expand targeted efforts to prevent HIV infection using
a combination of effective, evidence-based approaches,
including the elimination of new pediatric HIV infections
worldwide, routine HIV screening, and universal access to HIV
prevention tools in the communities where HIV/AIDS is most
heavily concentrated;
(3) ensure laws, policies, and regulations do not impede
access to prevention, treatment, and care for people living
with HIV/AIDS or at risk for acquiring HIV;
(4) accelerate research for more efficacious HIV prevention
and treatments tools, a cure, and a vaccine; and
(5) respect the human rights and dignity of persons living
with HIV/AIDS.
SEC. 4. FINDINGS.
The Congress makes the following findings:
(1) An estimated 34,000,000 people around the world were
living with HIV at the end of 2010, up from 8,000,000 in 1990.
(2) The annual number of new HIV infections has gradually
declined, and due to the significant increase in people
receiving antiretroviral therapy, the number of AIDS-related
deaths has also declined.
(3) Over 1,200,000 people are estimated to be living with
HIV in the United States according to the Centers for Disease
Control and Prevention.
(4) One in five individuals living with HIV/AIDS in the
United States is unaware of being infected, and significant
disparities persist across different communities and
populations with regard to incidence of infection, access to
treatment, and health outcomes.
(5) Each year, 50,000 people become newly infected with HIV
in the United States.
(6) Among women, the rate of new HIV infection for African-
American women is nearly 15 times higher than White women,
while the rate among Hispanic women is nearly 4 times higher.
(7) In 1998, Congress created the National Minority AIDS
Initiative to provide technical assistance, build capacity, and
strengthen outreach efforts among local institutions and
community-based organizations that serve racial and ethnic
minorities living with or vulnerable to HIV/AIDS.
(8) In the United States, the only increase in HIV
incidence remains among young people ages 13 to 29,
specifically young men of color who have sex with men.
Additionally, only 84 percent of young people report learning
about HIV or AIDS in school, which is fewer than in previous
years.
(9) In 2009, the Ryan White HIV/AIDS Treatment Extension
Act of 2009 was enacted into law, reauthorizing Federal HIV/
AIDS care and treatment programs for 4 years and making funding
available to United States metropolitan areas, States, and
service providers to assist affected families and persons
living with HIV/AIDS with health care and support services.
(10) To combat the HIV epidemic in the United States, the
National HIV/AIDS Strategy (NHAS) from the White House Office
of National AIDS Policy provides a framework of increasing
access to care, reducing new infections, and eliminating HIV-
related health disparities. The vision of NHAS is: ``The United
States will become a place where new HIV infections are rare
and when they do occur, every person, regardless of age,
gender, race/ethnicity, sexual orientation, gender identity, or
socio-economic circumstance, will have unfettered access to
high quality, life extending care, free from stigma and
discrimination.''.
(11) In recent years, several thousand people across the
country were waiting to receive AIDS treatment through the AIDS
Drug Assistance Program authorized by the provisions popularly
known as the Ryan White CARE Act.
(12) 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. Additionally, the Centers for
Disease Control and Prevention recommends recommend routine HIV
screening in health care settings for all patients aged 13 to
64, regardless of risk.
(13) Advances in HIV diagnostic technology (such as rapid
HIV testing and, recently, the availability of over-the-counter
HIV tests) reduce barriers to testing and allow more people to
know their status.
(14) Routine HIV screening is a preventive health service,
and if health plans covered routine HIV screenings, health
providers would be more likely to recommend routine HIV
screening for their patients.
(15) 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.
(16) Developing countries continue to bear the brunt of the
HIV/AIDS epidemic, with sub-Saharan Africa accounting for 68
percent of all adults and children living with HIV/AIDS, 59
percent of whom are female.
(17) Despite global efforts, 1,000 children around the
world still contract HIV each day, the majority through mother-
to-child transmission of HIV.
(18) HIV prevalence among young people aged 15 to 24 has
declined in many countries most impacted by HIV; nevertheless,
young people still account for 42 percent of all new infections
among individuals aged 15 and older.
(19) A substantial number of HIV-positive women in HIV care
and treatment programs or prevention of mother-to-child
transmission (PMTCT) programs experience an unplanned
pregnancy.
(20) Making contraceptive services more widely available
through HIV care, treatment, and PMTCT programs would make it
easier for women to coordinate their HIV-related care with
their pregnancy prevention goals, and at the same time, help
prevent mother-to-child HIV transmission.
(21) In 2008, the Tom Lantos and Henry J. Hyde United
States Global Leadership Against HIV/AIDS, Tuberculosis, and
Malaria Reauthorization Act was enacted into law, reauthorizing
the President's Emergency Plan for AIDS Relief (PEPFAR) and
continued United States participation and contributions to the
Global Fund to Fight AIDS, Tuberculosis and Malaria.
(22) The United States President's Emergency Plan for AIDS
Relief (PEPFAR), which represents the largest commitment by any
nation to combat a single disease, has saved the lives of
millions of people around the world by establishing and
expanding the infrastructure necessary to deliver prevention,
care, and treatment services in low-resource settings.
(23) Over 7,000,000 people around the world currently
receive support for antiretroviral treatment as a result of
PEPFAR bilateral programs, the Global Fund, or both.
(24) Early detection and treatment of HIV can have
significant positive health effects. New research demonstrates
conclusively that treatment of individuals not only slows
disease progression, but can also reduce the risk of
transmission to other individuals by 96 percent.
(25) In most countries HIV is a disease that discriminates,
disproportionately affecting society's most vulnerable. Even in
generalized epidemics in which a significant share of the wider
population is living with HIV/AIDS, people in vulnerable
communities often have considerably higher rates of HIV
infection.
(26) Reaching men who have sex with men, transgender
people, people who inject drugs, sex workers, and other
vulnerable populations with effective HIV prevention and
treatment is critical to bringing the AIDS epidemic under
control.
(27) According to the Centers for Disease Control and
Prevention, approximately one-third of persons with HIV are co-
infected with hepatitis B virus (HBV) or hepatitis C virus
(HCV). About 80 percent of injection drug users with HIV
infection also have HCV. HIV co-infection more than triples the
risk for liver disease, liver failure, and liver-related death
from HCV.
(28) The Global Commission on HIV and the Law was launched
in June 2010 to examine laws and practices that criminalize
people living with and vulnerable to HIV and to develop
evidence-based recommendations for effective HIV responses that
promote and protect human rights.
(29) The 19th International AIDS Conference will be held in
Washington, DC, in 2012, from July 22 to 27, returning to the
United States after a nearly two-decade-long international
boycott that was lifted following the statutory repeal of a ban
on travel and immigration of people living with HIV/AIDS.
(30) The District of Columbia, the site of the XIX
International AIDS Conference, has an HIV prevalence rate of
over 2.7 percent, which far exceeds the threshold that
constitutes a ``generalized and severe'' epidemic, and is
comparable to the rate in many parts of the developing world.
(31) The XIX International AIDS Conference offers a unique
opportunity to change the course of the HIV/AIDS epidemic by
informing people globally about scientific advances in
treatment and prevention, building consensus to improve service
delivery and maximize outcomes, facilitating global civil
society engagement, and accelerating momentum toward a cure.
(32) At present, 34 States and 2 United States territories
have criminal statutes based on ``exposure'' to HIV. Most of
these laws were adopted before the availability of effective
antiretroviral treatment for HIV/AIDS.
(33) Although HIV/AIDS currently is viewed as a chronic,
treatable medical condition, people living with HIV in the
United States have been charged under aggravated assault,
attempted murder, and even bioterrorism statutes because
prosecutors, courts, and legislators continue to view and
characterize the blood, semen, and saliva of people living with
HIV as a ``deadly weapon''.
(34) The National Alliance of State and Territorial AIDS
Directors released a statement in February 2011 saying that
``HIV criminalization undercuts our most basic HIV prevention
and sexual health messages, and breeds ignorance, fear and
discrimination against people living with HIV''. NASTAD further
``supports efforts to examine and support level-headed, proven
public health approaches that end punitive laws that single out
HIV over other STDs and that impose penalties for alleged
nondisclosure, exposure and transmission that are severely
disproportionate to the actual resulting harm''.
(35) In 2010, the President released a National HIV/AIDS
Strategy (NHAS), which addressed HIV-specific criminal laws,
stating: ``[W]hile we understand the intent behind [these]
laws, they may not have the desired effect and they may make
people less willing to disclose their status by making people
feel at even greater risk of discrimination. In some cases, it
may be appropriate for legislators to reconsider whether
existing laws continue to further the public interest and
public health. In many instances, the continued existence and
enforcement of these types of laws run counter to scientific
evidence about routes of HIV transmission and may undermine the
public health goals of promoting HIV screening and
treatment.''.
(36) There is a disproportionately high rate of HIV/AIDS
among incarcerated persons, especially among minorities. The
Bureau of Justice Statistics (BJS) has determined that the rate
of confirmed AIDS cases is 2.4 times higher among incarcerated
persons than in the general population. Minorities account for
the majority of AIDS-related deaths among incarcerated persons,
African-American incarcerated individuals are 2.8 times more
likely than White incarcerated individuals and 1.4 times more
likely than Hispanic incarcerated individuals to die from AIDS-
related causes. Nearly two-thirds of AIDS-related deaths are
among Black, non-Hispanic males.
(37) Studies suggest that other sexually transmitted
infections (STIs), such as gonorrhea, chlamydia, syphilis,
genital herpes, viral hepatitis, and human papillomavirus, also
exist at a higher rate among incarcerated persons than in the
general population. For instance, researchers have estimated
that the rate of hepatitis C (HCV) infection among incarcerated
persons is somewhere between 8 and 20 times higher than that of
the general population.
(38) According to the Centers for Disease Control and
Prevention (CDC), latex condoms, when used consistently and
correctly, are highly effective in preventing the transmission
of HIV. Latex condoms also reduce the risk of other STIs.
Despite the effectiveness of condoms in reducing the spread of
STIs, the Bureau of Prisons does not recommend their use in
correctional facilities.
(39) The distribution of condoms in correctional facilities
is currently legal in certain parts of the United States and
the world. The States of Vermont and Mississippi, the District
of Columbia, and the cities of New York, San Francisco, Los
Angeles, Washington, DC, and Philadelphia allow condom
distribution in their correctional facilities. However, these
States and cities operate fewer than 1 percent of all
correctional facilities.
(40) Many correctional facilities in the United States do
not provide comprehensive testing and treatment programs to
reduce the spread of STIs. Fewer than half of correctional
facilities provide counseling to HIV-positive incarcerated
persons.
(41) Incarcerated individuals living with HIV/AIDS who are
eligible for Medicaid would benefit from prompt and automatic
enrollment upon their release in order to ensure their
continued ability to access health services, including
antiretroviral treatment.
(42) Research shows that stable housing leads to better
health outcomes for those living with HIV. Inadequate or
unstable housing is not only a barrier to effective treatment,
but also increases the likelihood of engaging in risky
behaviors leading to HIV infection. Insecure housing puts
people with HIV/AIDS at risk of premature death from exposure
to other diseases, poor nutrition, stress, and lack of medical
care.
(43) On July 16, 2012, the Food and Drug Administration
approved Truvada (emtricitabine/tenofovir disoproxil fumarate),
the first drug approved to reduce the risk of HIV infection in
uninfected individuals who are at high risk of HIV infection
and who may engage in sexual activity with HIV-infected
partners.
SEC. 5. NONDISCRIMINATION.
Programs funded under this Act shall not discriminate on the basis
of actual or perceived sex, race, color, ethnicity, national origin,
disability, sexual orientation, gender identity, or religion. Nothing
in this Act shall be construed to invalidate or limit rights, remedies,
procedures, or legal standards available to victims of discrimination
under any other Federal law or any law of a State or a political
subdivision of a State, including title VI of the Civil Rights Act of
1964 (42 U.S.C. 2000d et seq.), title IX of the Education Amendments of
1972 (20 U.S.C. 1681 et seq.), section 504 of the Rehabilitation Act of
1973 (29 U.S.C. 794), the Americans with Disabilities Act of 1990 (42
U.S.C. 12101 et seq.), and section 1557 of the Patient Protection and
Affordable Care Act (42 U.S.C. 18116).
DIVISION A--ENDING HIV/AIDS IN THE UNITED STATES
TITLE I--INCREASING AND TARGETING INVESTMENT TO MAXIMIZE PREVENTION AND
TREATMENT IMPACT
SEC. 101. ADDITIONAL FUNDING FOR AIDS DRUG ASSISTANCE PROGRAM
TREATMENTS.
Section 2623 of the Public Health Service Act (42 U.S.C. 300ff-31b)
is amended by adding at the end the following:
``(c) Additional Funding for AIDS Drug Assistance Program
Treatments.--In addition to amounts otherwise authorized to be
appropriated for carrying out this subpart, there are authorized to be
appropriated such sums as may be necessary to carry out sections
2612(b)(3)(B) and 2616 for each of fiscal years 2013 through 2015.''.
SEC. 102. ENHANCING THE NATIONAL HIV SURVEILLANCE SYSTEM.
(a) Grants.--The Secretary of Health and Human Services, acting
through the Director of the Centers for Disease Control and Prevention,
shall make grants to States to support integration of public health
surveillance systems into all electronic health records in order to
allow rapid communications between the clinical setting and health
departments, by means that include--
(1) providing technical assistance and policy guidance to
State and local health departments, clinical providers, and
other agencies serving individuals with HIV to improve the
interoperability of data systems relevant to monitoring HIV
care and supportive services;
(2) capturing longitudinal data pertaining to the
initiation and ongoing prescription or dispensing of
antiretroviral therapy for individuals diagnosed with HIV (such
as through pharmacy-based reporting);
(3) obtaining information--
(A) on a voluntary basis, on sexual orientation and
gender identity; and
(B) on sources of coverage (or the lack thereof)
for medical treatment (including coverage through
Medicaid, Medicare, the program under title XXVI of the
Public Health Service Act (42 U.S.C. 300ff-11 et seq.;
commonly referred to as the ``Ryan White HIV/AIDS
Program''), other public funding, private insurance,
and health maintenance organizations); and
(4) obtaining and using current geographic markers of
residence (such as current address, zip code, partial zip code,
and census block).
(b) Privacy and Security Safeguards.--In carrying out this section,
the Secretary of Health and Human Services shall ensure that
appropriate privacy and security safeguards are met to prevent
unauthorized disclosure of protected health information and compliance
with the HIPAA privacy and security law (as defined in section 3009 of
the Public Health Service Act (42 U.S.C. 300jj-19)) and other relevant
laws and regulations.
(c) Prohibition Against Improper Use of Data.--No grant under this
section may be used to allow or facilitate the collection or use of
surveillance or clinical data or records--
(1) for punitive measures of any kind, civil or criminal,
against the subject of such data or records; or
(2) for imposing any requirement or restriction with
respect to an individual without the individual's written
consent.
(d) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated such sums as may be necessary
for each of fiscal years 2013 through 2017.
SEC. 103. EVIDENCE-BASED STRATEGIES FOR IMPROVING LINKAGE TO AND
RETENTION IN APPROPRIATE CARE.
(a) Strategies.--The Secretary of Health and Human Services, in
collaboration with the Director of the Centers for Disease Control and
Prevention, the Administrator of the Substance Abuse and Mental Health
Services Administration, the Director of the Office of AIDS Research,
the Administrator of the Health Resources and Services Administration,
and the Administrator of the Centers for Medicare & Medicaid Services,
shall--
(1) identify evidence-based strategies most effective at
addressing the multifaceted issues that impede disease status
awareness and linkage to and retention in appropriate care,
taking into consideration health care systems issues, clinic
and provider issues, and individual psycho-social,
environmental, and other contextual factors;
(2) support the wide-scale implementation of the evidence-
based strategies identified pursuant to paragraph (1),
including through incorporating such strategies into health
care coverage supported by the Medicaid program under title XIX
of the Social Security Act (42 U.S.C. 1396 et seq.), the
program under title XXVI of the Public Health Service Act (42
U.S.C. 300ff-11 et seq.; commonly referred to as the ``Ryan
White HIV/AIDS Program''), and health plans purchased through
an American Health Benefit Exchange established pursuant to
section 1311 of the Patient Protection and Affordable Care Act
(42 U.S.C. 18031); and
(3) not later than 12 months after the date of the
enactment of this Act, submit a report to the Congress on the
status of activities under paragraphs (1) and (2).
(b) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated such sums as may be necessary
for fiscal years 2013 through 2017.
SEC. 104. IMPROVING ENTRY INTO AND RETENTION IN CARE AND ANTIRETROVIRAL
ADHERENCE FOR PERSONS WITH HIV.
(a) Sense of Congress.--It is the sense of the Congress that AIDS
research has led to scientific advancements that have--
(1) saved the lives of millions of people with HIV/AIDS;
(2) prevented millions of people from being infected; and
(3) had broad benefits that extend far beyond helping
people at risk for or living with HIV.
(b) In General.--The Secretary of Health and Human Services, acting
through the Director of the National Institutes of Health, shall
expand, intensify, and coordinate operational and translational
research and other activities of the National Institutes of Health
regarding methods--
(1) to increase adoption of evidence-based adherence
strategies within HIV care and treatment programs;
(2) to increase HIV testing and case detection rates;
(3) to reduce HIV-related health disparities;
(4) to ensure that research to improve adherence to HIV
care and treatment programs address the unique concerns of
women;
(5) to integrate HIV/AIDS prevention and care services with
mental health and substance use prevention and treatment
delivery systems; and
(6) to increase knowledge on the implementation of pre-
exposure prophylaxis (PrEP), including with respect to--
(A) who can benefit most from PrEP;
(B) how to provide PrEP safely and efficiently;
(C) how to integrate PrEP with other essential
prevention methods such as condoms; and
(D) how to ensure high levels of adherence.
(c) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated such sums as may be necessary
for fiscal years 2013 through 2017.
SEC. 105. HEALTH CARE PROFESSIONALS TREATING INDIVIDUALS WITH HIV/AIDS.
(a) In General.--The Secretary of Health and Human Services, acting
through the Administrator of the Health Resources and Services
Administration, shall expand, intensify, and coordinate workforce
initiatives of the Health Resources and Services Administration to
increase the capacity of the health workforce focusing primarily on
HIV/AIDS to meet the demand for culturally competent care, and may
award grants for any of the following:
(1) Development of curricula for training primary care
providers in HIV/AIDS prevention and care, including routine
HIV testing.
(2) Support to expand access to culturally and
linguistically accessible benefits counselors, trained peer
navigators, and mental and behavioral health professionals with
expertise in HIV/AIDS.
(3) Training health care professionals to provide care to
individuals with HIV/AIDS.
(4) Development by grant recipients under title XXVI of the
Public Health Service Act (42 U.S.C. 300ff-11 et seq.; commonly
referred to as the Ryan White HIV/AIDS Program) and other
persons, of policies for providing culturally relevant and
sensitive treatment to individuals with HIV/AIDS, with
particular emphasis on treatment to racial and ethnic
minorities, men who have sex with men, and women, young people,
and children with HIV/AIDS.
(5) Development and implementation of programs to increase
the use of telehealth to respond to HIV/AIDS-specific health
care needs in rural and minority communities, with particular
emphasis given to medically underserved communities and insular
areas.
(6) Evaluating interdisciplinary medical provider care team
models that promote high quality care.
(7) Training health care professionals to make them aware
of the high rates of chronic hepatitis B and chronic hepatitis
C in certain adult ethnic populations, and the importance of
prevention, detection, and medical management of hepatitis B
and hepatitis C and of liver cancer screening.
(b) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated such sums as may be necessary
for fiscal years 2013 through 2017.
SEC. 106. HIV/AIDS PROVIDER LOAN REPAYMENT PROGRAM.
(a) In General.--The Secretary may enter into an agreement with any
physician, nurse practitioner, or physician assistant under which--
(1) the physician, nurse practitioner, or physician
assistant agrees to serve as a medical provider for a period of
not less than 2 years--
(A) at a Ryan White-funded or title X-funded
facility with a critical shortage of doctors (as
determined by the Secretary); or
(B) in an area with a high incidence of HIV/AIDS;
and
(2) the Secretary agrees to make payments in accordance
with subsection (b) on the professional education loans of the
physician, nurse practitioner, or physician assistant.
(b) Manner of Payments.--The payments described in subsection (a)
shall be made by the Secretary as follows:
(1) Upon completion by the physician, nurse practitioner,
or physician assistant for whom the payments are to be made of
the first year of the service specified in the agreement
entered into with the Secretary under subsection (a), the
Secretary shall pay 30 percent of the principal of and the
interest on the individual's professional education loans.
(2) Upon completion by the physician, nurse practitioner,
or physician assistant of the second year of such service, the
Secretary shall pay another 30 percent of the principal of and
the interest on such loans.
(3) Upon completion by that individual of a third year of
such service, the Secretary shall pay another 25 percent of the
principal of and the interest on such loans.
(c) Applicability of Certain Provisions.--The provisions of subpart
III of part D of title III of the Public Health Service Act (42 U.S.C.
254l et seq.) shall, except as inconsistent with this section, apply to
the program carried out under this section in the same manner and to
the same extent as such provisions apply to the National Health Service
Corps Loan Repayment Program.
(d) Reports.--Not later than 18 months after the date of the
enactment of this Act, and annually thereafter, the Secretary shall
prepare and submit to the Congress a report describing the program
carried out under this section, including statements regarding the
following:
(1) The number of physicians, nurse practitioners, and
physician assistants enrolled in the program.
(2) The number and amount of loan repayments.
(3) The placement location of loan repayment recipients at
facilities described in subsection (a)(1).
(4) The default rate and actions required.
(5) The amount of outstanding default funds.
(6) To the extent that it can be determined, the reason for
the default.
(7) The demographics of individuals participating in the
program.
(8) An evaluation of the overall costs and benefits of the
program.
(e) Definitions.--In this section:
(1) The term ``HIV/AIDS'' means human immunodeficiency
virus and acquired immune deficiency syndrome.
(2) The term ``nurse practitioner'' means a nurse with an
advanced practice nursing licensure.
(3) The term ``physician'' means a graduate of a school of
medicine who has completed postgraduate training in general or
pediatric medicine.
(4) The term ``physician assistant'' means a medical
provider who completed an accredited physician assistant
training program and successfully passed the Physician
Assistant National Certifying Examination.
(5) The term ``professional education loan''--
(A) means a loan that is incurred for the cost of
attendance (including tuition, other reasonable
educational expenses, and reasonable living costs) at a
school of medicine, nursing, or physician assistant
training program; and
(B) includes only the portion of the loan that is
outstanding on the date the physician, nurse
practitioner, or physician assistant involved begins
the service specified in the agreement under subsection
(a).
(6) The term ``Ryan White-funded'' means, with respect to a
facility, receiving funds under title XXVI of the Public Health
Service Act (42 U.S.C. 300ff-11 et seq.).
(7) The term ``Secretary'' means the Secretary of Health
and Human Services.
(8) The term ``school of medicine'' has the meaning given
to that term in section 799B of the Public Health Service Act
(42 U.S.C. 295p).
(9) The term ``title X-funded'' means, with respect to a
facility, receiving funds under title X of the Public Health
Service Act (42 U.S.C. 300 et seq.).
(f) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated such sums as may be necessary
for fiscal years 2013 through 2017.
SEC. 107. REDUCING NEW HIV INFECTIONS AMONG INJECTING DRUG USERS.
(a) Sense of Congress.--It is the sense of the Congress that
providing sterile syringes and sterilized equipment to injecting drug
users substantially reduces risk of HIV infection , increases the
probability that they will initiate drug treatment, and does not
increase drug use.
(b) In General.--The Secretary of Health and Human Services may
provide grants and technical assistance for the purpose of reducing the
rate of HIV infections among injecting drug users through a
comprehensive package of services for such users, including the
provision of sterile syringes, education and outreach, access to
infectious disease testing, overdose prevention, and treatment for drug
dependence.
(c) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated such sums as may be necessary
for fiscal years 2013 through 2017.
SEC. 108. SUPPORT FOR EXPANSION OF COMPREHENSIVE SEXUAL HEALTH AND
EDUCATION PROGRAMS.
(a) Sense of Congress.--It is the sense of Congress that--
(1) federally funded sex education programs should aim to--
(A) reduce unintended pregnancy and sexually
transmitted infections, including HIV;
(B) promote safe and healthy relationships;
(C) use, and be informed by, the best scientific
information available;
(D) be built on characteristics of effective
programs;
(E) expand the existing body of evidence on
comprehensive sex education programs through program
evaluation;
(F) expand training programs for teachers of
comprehensive sex education;
(G) build on the personal responsibility education
programs funded under section 513 of the Social
Security Act (42 U.S.C. 713) and the President's Teen
Pregnancy Prevention program, funded under title II of
the Consolidated Appropriations Act, 2010 (Public Law
111-117; 123 Stat. 3253); and
(H) promote and uphold the rights of young people
to information in order to make healthy and responsible
decisions about their sexual health; and
(2) no Federal funds should be used for health education
programs that--
(A) deliberately withhold life-saving information
about HIV;
(B) are medically inaccurate or have been
scientifically shown to be ineffective;
(C) promote gender stereotypes;
(D) are insensitive and unresponsive to the needs
of sexually active adolescents;
(E) are insensitive and unresponsive to the needs
of lesbian, gay, bisexual, or transgender youth; or
(F) are inconsistent with the ethical imperatives
of medicine and public health.
(b) Grants for Comprehensive Sex Education for Adolescents.--
(1) Program authorized.--The Secretary, in coordination
with the Director of the Office of Adolescent Health, shall
award grants, on a competitive basis, to eligible entities to
enable such eligible entities to carry out programs that
provide adolescents with comprehensive sex education, as
described in paragraph (6).
(2) Duration.--Grants awarded under this subsection shall
be for a period of 5 years.
(3) Eligible entity.--In this subsection, the term
``eligible entity'' means a public or private entity that
focuses on adolescent health or education or has experience
working with adolescents, which may include--
(A) a State educational agency;
(B) a local educational agency;
(C) a tribe or tribal organization, as defined in
section 4 of the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450b);
(D) a State or local department of health;
(E) a State or local department of education;
(F) a nonprofit organization;
(G) a nonprofit or public institution of higher
education; or
(H) a hospital.
(4) Applications.--An eligible entity desiring a grant
under this subsection shall submit an application to the
Secretary at such time, in such manner, and containing such
information as the Secretary may require, including the
evaluation plan described in paragraph (7)(A).
(5) Priority.--In awarding grants under this subsection,
the Secretary shall give priority to eligible entities that--
(A) are State or local public entities, with an
additional priority for State or local educational
agencies; and
(B) address health disparities among young people
that are at highest risk for not less than 1 of the
following:
(i) Unintended pregnancies.
(ii) Sexually transmitted infections,
including HIV.
(iii) Dating violence and sexual assault.
(6) Use of funds.--
(A) In general.--Each eligible entity that receives
a grant under this subsection shall use grant funds to
carry out a program that provides adolescents with
comprehensive sex education that--
(i) replicates evidence-based sex education
programs;
(ii) substantially incorporates elements of
evidence-based sex education programs; or
(iii) creates a demonstration project based
on generally accepted characteristics of
effective sex education programs.
(B) Contents of sex education programs.--The sex
education programs funded under this subsection shall
include curricula and program materials that address--
(i) abstinence and delaying sexual
initiation;
(ii) the health benefits and side effects
of all contraceptive and barrier methods as a
means to prevent pregnancy and sexually
transmitted infections, including HIV;
(iii) healthy relationships, including the
development of healthy attitudes and skills
necessary for understanding--
(I) healthy relationships between
oneself and family, others, and
society; and
(II) the prevention of sexual
abuse, teen dating violence, bullying,
harassment, and suicide;
(iv) healthy life skills including goal-
setting, decisionmaking, interpersonal skills
(such as communication, assertiveness, and peer
refusal skills), critical thinking, self-esteem
and self-efficacy, and stress management;
(v) how to make responsible decisions about
sex and sexuality, including--
(I) how to avoid, and how to avoid
making, unwanted verbal, physical, and
sexual advances; and
(II) how alcohol and drug use can
affect responsible decisionmaking;
(vi) the development of healthy attitudes
and values about such topics as adolescent
growth and development, body image, gender
roles and gender identity, racial and ethnic
diversity, and sexual orientation; and
(vii) referral services for local health
clinics and services where adolescents can
obtain additional information and services
related to sexual and reproductive health,
dating violence and sexual assault, and suicide
prevention.
(7) Evaluation; report.--
(A) Independent evaluation.--Each eligible entity
applying for a grant under this subsection shall
develop and submit to the Secretary a plan for a
rigorous independent evaluation of such grant program.
The plan shall describe an independent evaluation
that--
(i) uses sound statistical methods and
techniques relating to the behavioral sciences,
including random assignment methodologies,
whenever possible;
(ii) uses quantitative data for assessments
and impact evaluations, whenever possible; and
(iii) is carried out by an entity
independent from such eligible entity.
(B) Selection of evaluated programs; budget.--
(i) Selection of evaluated programs.--The
Secretary shall select, at random, a subset of
the eligible entities that the Secretary has
selected to receive a grant under this
subsection to receive additional funding to
carry out the evaluation plan described in
subparagraph (A).
(ii) Budget for evaluation activities.--The
Secretary, in coordination with the Director of
the Office of Adolescent Health, shall
establish a budget for each eligible entity
selected under clause (i) for the costs of
carrying out the evaluation plan described in
subparagraph (A).
(C) Funds for evaluation.--The Secretary shall
provide eligible entities who are selected under
subparagraph (B)(i) with additional funds, in
accordance with the budget described in subparagraph
(B)(ii), to carry out and report to the Secretary on
the evaluation plan described in subparagraph (A).
(D) Performance measures.--The Secretary, in
coordination with the Director of the Centers for
Disease Control and Prevention, shall establish a
common set of performance measures to assess the
implementation and impact of grant programs funded
under this subsection. Such performance measures shall
include--
(i) output measures, such as the number of
individuals served and the number of hours of
service delivery;
(ii) outcome measures, including measures
relating to--
(I) the knowledge that youth
participating in the grant program have
gained about--
(aa) adolescent growth and
development;
(bb) relationship dynamics;
(cc) ways to prevent
unintended pregnancy and
sexually transmitted
infections, including HIV; and
(dd) sexual health;
(II) the skills that adolescents
participating in the grant program have
gained regarding--
(aa) negotiation and
communication;
(bb) decisionmaking and
goal-setting;
(cc) interpersonal skills
and healthy relationships; and
(dd) condom use; and
(III) the behaviors of adolescents
participating in the grant program,
including data about--
(aa) age of first
intercourse;
(bb) number of sexual
partners;
(cc) condom and
contraceptive use at first
intercourse;
(dd) recent condom and
contraceptive use; and
(ee) dating abuse and
lifetime history of domestic
violence, sexual assault,
dating violence, bullying,
harassment, and stalking.
(E) Report to the secretary.--Eligible entities
receiving a grant under this subsection who have been
selected to receive funds to carry out the evaluation
plan described in subparagraph (A), in accordance with
subparagraph (B)(i), shall collect and report to the
Secretary--
(i) the results of the independent
evaluation described in subparagraph (A); and
(ii) information about the performance
measures described in subparagraph (B).
(F) Effective programs.--The Secretary, in
coordination with the Director of the Centers for
Disease Control and Prevention, shall publish on the
Web site of the Centers for Disease Control and
Prevention, a list of programs funded under this
subsection that the Secretary has determined to be
effective programs.
(c) Grants for Comprehensive Sex Education at Institutions of
Higher Education.--
(1) Program authorized.--The Secretary, in coordination
with the Office of Adolescent Health and the Secretary of
Education, shall award grants, on a competitive basis, to
institutions of higher education to enable such institutions to
provide young people with comprehensive sex education,
described in paragraph (5)(B), with an emphasis on reducing
HIV, other sexually transmitted infections, and unintended
pregnancy through instruction about--
(A) abstinence and contraception;
(B) reducing dating violence, sexual assault,
bullying, and harassment;
(C) increasing healthy relationships; and
(D) academic achievement.
(2) Duration.--Grants awarded under this subsection shall
be for a period of 5 years.
(3) Applications.--An institution of higher education
desiring a grant under this subsection shall submit an
application to the Secretary at such time, in such manner, and
containing such information as the Secretary may require.
(4) Priority.--In awarding grants under this subsection,
the Secretary shall give priority to an institution of higher
education that--
(A) has an enrollment of needy students as defined
in section 318(b) of the Higher Education Act of 1965
(20 U.S.C. 1059e(b));
(B) is a Hispanic-serving institution, as defined
in section 502(a) of such Act (20 U.S.C. 1101a(a));
(C) is a Tribal College or University, as defined
in section 316(b) of such Act (20 U.S.C. 1059c(b));
(D) is an Alaska Native-serving institution, as
defined in section 317(b) of such Act (20 U.S.C.
1059d(b));
(E) is a Native Hawaiian-serving institution, as
defined in section 317(b) of such Act (20 U.S.C.
1059d(b));
(F) is a Predominately Black Institution, as
defined in section 318(b) of such Act (20 U.S.C.
1059e(b));
(G) is a Native American-serving, nontribal
institution, as defined in section 319(b) of such Act
(20 U.S.C. 1059f(b));
(H) is an Asian American and Native American
Pacific Islander-serving institution, as defined in
section 320(b) of such Act (20 U.S.C. 1059g(b)); or
(I) is a minority institution, as defined in
section 365 of such Act (20 U.S.C. 1067k), with an
enrollment of needy students, as defined in section 312
of such Act (20 U.S.C. 1058).
(5) Uses of funds.--
(A) In general.--An institution of higher education
receiving a grant under this subsection may use grant
funds to integrate issues relating to comprehensive sex
education into the academic or support sectors of the
institution of higher education in order to reach a
large number of students, by carrying out 1 or more of
the following activities:
(i) Developing educational content for
issues relating to comprehensive sex education
that will be incorporated into first-year
orientation or core courses.
(ii) Developing and employing schoolwide
educational programming outside of class that
delivers elements of comprehensive sex
education programs to students, faculty, and
staff.
(iii) Creating innovative technology-based
approaches to deliver sex education to
students, faculty, and staff.
(iv) Developing and employing peer-outreach
and education programs to generate discussion,
educate, and raise awareness among students
about issues relating to comprehensive sex
education.
(B) Contents of sex education programs.--Each
institution of higher education's program of
comprehensive sex education funded under this
subsection shall include curricula and program
materials that address information about--
(i) safe and responsible sexual behavior
with respect to the prevention of pregnancy and
sexually transmitted infections, including HIV,
including through--
(I) abstinence;
(II) a reduced number of sexual
partners; and
(III) the use of condoms and
contraception;
(ii) healthy relationships, including the
development of healthy attitudes and insights
necessary for understanding--
(I) relationships between oneself,
family, partners, others, and society;
and
(II) the prevention of sexual
abuse, dating violence, bullying,
harassment, and suicide; and
(iii) referral services to local health
clinics where young people can obtain
additional information and services related to
sexual and reproductive health, dating violence
and sexual assault, and suicide prevention.
(C) Optional components of sex education.--Each
institution of higher education's program of
comprehensive sex education may also include
information and skills development relating to--
(i) how to make responsible decisions about
sex and sexuality, including--
(I) how to avoid, and avoid making,
unwanted verbal, physical, and sexual
advances; and
(II) how alcohol and drug use can
affect responsible decisionmaking;
(ii) healthy life skills, including--
(I) goal-setting and
decisionmaking;
(II) interpersonal skills, such as
communication, assertiveness, and peer
refusal skills;
(III) critical thinking;
(IV) self-esteem and self-efficacy;
and
(V) stress management;
(iii) the development of healthy attitudes
and values about such topics as body image,
gender roles and gender identity, racial and
ethnic diversity, and sexual orientation; and
(iv) the responsibilities of parenting and
the skills necessary to parent well.
(6) Evaluation; report.--The requirements described in
section 125B(g) shall also apply to eligible entities receiving
a grant under this subsection in the same manner as such
requirements apply to eligible entities receiving grants under
section 125B.
(d) Grants for Pre-Service and In-Service Teacher Training.--
(1) Program authorized.--The Secretary, in coordination
with the Director of the Centers for Disease Control and
Prevention and the Secretary of Education, shall award grants,
on a competitive basis, to eligible entities to enable such
eligible entities to carry out the activities described in
paragraph (5).
(2) Duration.--Grants awarded under this subsection shall
be for a period of 5 years.
(3) Eligible entity.--In this subsection, the term
``eligible entity'' means--
(A) a State educational agency;
(B) a local educational agency;
(C) a tribe or tribal organization, as defined in
section 4 of the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450b);
(D) a State or local department of health;
(E) a State or local department of education;
(F) a nonprofit institution of higher education;
(G) a national or statewide nonprofit organization
that has as its primary purpose the improvement of
provision of comprehensive sex education through
effective teaching of comprehensive sex education; or
(H) a consortium of nonprofit organizations that
has as its primary purpose the improvement of provision
of comprehensive sex education through effective
teaching of comprehensive sex education.
(4) Application.--An eligible entity desiring a grant under
this subsection shall submit an application to the Secretary at
such time, in such manner, and containing such information as
the Secretary may require.
(5) Authorized activities.--
(A) Required activity.--Each eligible entity
receiving a grant under this subsection shall use grant
funds to train targeted faculty and staff, in order to
increase effective teaching of comprehensive sex
education for elementary school and secondary school
students.
(B) Permissible activities.--Each eligible entity
receiving a grant under this subsection may use grant
funds to--
(i) strengthen and expand the eligible
entity's relationships with--
(I) institutions of higher
education;
(II) State educational agencies;
(III) local educational agencies;
or
(IV) other public and private
organizations with a commitment to
comprehensive sex education and the
benefits of comprehensive sex
education;
(ii) support and promote research-based
training of teachers of comprehensive sex
education and related disciplines in elementary
schools and secondary schools as a means of
broadening student knowledge about issues
related to human development, relationships,
personal skills, sexual behavior, sexual
health, and society and culture;
(iii) support the dissemination of
information on effective practices and research
findings concerning the teaching of
comprehensive sex education;
(iv) support research on--
(I) effective comprehensive sex
education teaching practices; and
(II) the development of assessment
instruments and strategies to
document--
(aa) student understanding
of comprehensive sex education;
and
(bb) the effects of
comprehensive sex education;
(v) convene national conferences on
comprehensive sex education, in order to
effectively train teachers in the provision of
comprehensive sex education; and
(vi) develop and disseminate appropriate
research-based materials to foster
comprehensive sex education.
(C) Subgrants.--Each eligible entity receiving a
grant under this subsection may award subgrants to
nonprofit organizations, State educational agencies, or
local educational agencies to enable such organizations
or agencies to--
(i) train teachers in comprehensive sex
education;
(ii) support Internet or distance learning
related to comprehensive sex education;
(iii) promote rigorous academic standards
and assessment techniques to guide and measure
student performance in comprehensive sex
education;
(iv) encourage replication of best
practices and model programs to promote
comprehensive sex education;
(v) develop and disseminate effective,
research-based comprehensive sex education
learning materials;
(vi) develop academic courses on the
pedagogy of sex education at institutions of
higher education; or
(vii) convene State-based conferences to
train teachers in comprehensive sex education
and to identify strategies for improvement.
(e) Report to Congress.--
(1) In general.--Not later than 1 year after the date of
the enactment of this Act, and annually thereafter for a period
of 5 years, the Secretary shall prepare and submit to the
appropriate committees of Congress a report on the activities
to provide adolescents and young people with comprehensive sex
education funded under this section.
(2) Report elements.--The report described in paragraph (1)
shall include information about--
(A) the number of eligible entities and
institutions of higher education that are receiving
grant funds under subsections (b) and (c);
(B) the specific activities supported by grant
funds awarded under subsections (b) and (c);
(C) the number of adolescents served by grant
programs funded under subsection (b);
(D) the number of young people served by grant
programs funded under subsection (c); and
(E) the status of program evaluations described
under subsections (b) and (c).
(f) Limitation.--No Federal funds provided under this section may
be used for health education programs that--
(1) deliberately withhold life-saving information about
HIV;
(2) are medically inaccurate or have been scientifically
shown to be ineffective;
(3) promote gender stereotypes;
(4) are insensitive and unresponsive to the needs of
sexually active youth or lesbian, gay, bisexual, or transgender
youth; or
(5) are inconsistent with the ethical imperatives of
medicine and public health.
(g) Definitions.--In this section:
(1) ESEA definitions.--The terms ``elementary school'',
``local educational agency'', ``secondary school'', and ``State
educational agency'' have the meanings given the terms in
section 9101 of the Elementary and Secondary Education Act of
1965 (20 U.S.C. 7801).
(2) Age and developmentally appropriate.--The term ``age
and developmentally appropriate'' means suitable for a
particular age or age group of children and adolescents, based
on developing cognitive, emotional, and behavioral capacity
typical for that age or age group.
(3) Adolescents.--The term ``adolescents'' means
individuals who are ages 10 through 19 at the time of
commencement of participation in a program supported under this
section.
(4) Characteristics of effective programs.--The term
``characteristics of effective programs'' means the aspects of
evidence-based programs, including development, content, and
implementation of such programs, that--
(A) have been shown to be effective in terms of
increasing knowledge, clarifying values and attitudes,
increasing skills, and impacting upon behavior; and
(B) are widely recognized by leading medical and
public health agencies to be effective in changing
sexual behaviors that lead to sexually transmitted
infections, including HIV, unintended pregnancy, and
dating violence and sexual assault among young people.
(5) Comprehensive sex education.--The term ``comprehensive
sex education'' means a program that--
(A) includes age- and developmentally appropriate,
culturally and linguistically relevant information on a
broad set of topics related to sexuality including
human development, relationships, decisionmaking,
communication, abstinence, contraception, and disease
and pregnancy prevention;
(B) provides students with opportunities for
developing skills as well as learning information;
(C) is inclusive of lesbian, gay, bisexual,
transgender, and heterosexual young people; and
(D) aims to--
(i) provide scientifically accurate and
realistic information about human sexuality;
(ii) provide opportunities for individuals
to understand their own, their families', and
their communities' values, attitudes, and
insights about sexuality;
(iii) help individuals develop healthy
relationships and interpersonal skills; and
(iv) help individuals exercise
responsibility regarding sexual relationships,
which includes addressing abstinence, pressures
to become prematurely involved in sexual
intercourse, and the use of contraception and
other sexual health measures.
(6) Evidence-based program.--The term ``evidence-based
program'' means a sex education program that has been proven
through rigorous evaluation to be effective in changing sexual
behavior or incorporates elements of other sex education
programs that have been proven to be effective in changing
sexual behavior.
(7) Institution of higher education.--The term
``institution of higher education'' has the meaning given the
term in section 101 of the Higher Education Act of 1965 (20
U.S.C. 1001).
(8) Medically accurate and complete.--The term ``medically
accurate and complete'', when used with respect to a sex
education program, means that--
(A) the information provided through the program is
verified or supported by the weight of research
conducted in compliance with accepted scientific
methods and is published in peer-reviewed journals,
where applicable; or
(B)(i) the program contains information that
leading professional organizations and agencies with
relevant expertise in the field recognize as accurate,
objective, and complete; and
(ii) the program does not withhold information
about the effectiveness and benefits of correct and
consistent use of condoms and other contraceptives.
(9) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(10) Young people.--The term ``young people'' means
individuals who are ages 10 through 24 at the time of
commencement of participation in a program supported under this
section.
(h) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated such sums as may be necessary
for fiscal years 2013 through 2017.
SEC. 109. ELIMINATION OF ABSTINENCE-ONLY EDUCATION PROGRAM.
(a) In General.--Title V of the Social Security Act (42 U.S.C. 701
et seq.) is amended by striking section 510.
(b) Rescission.--Amounts appropriated for fiscal year 2012 under
section 510(d) of the Social Security Act (42 U.S.C. 710(d)) (as in
effect on the day before the date of enactment of this Act) that are
unobligated as of the date of enactment of this Act are rescinded.
(c) Reprogram of Eliminated Abstinence-Only Funds for the Personal
Responsibility Education Program (PREP).--Section 513(f) of the Social
Security Act (42 U.S.C. 713(f)) is amended by striking ``$75,000,000
for each of fiscal years 2010 through 2014'' and inserting
``$75,000,000 for each of fiscal years 2010 and 2011, an amount for
fiscal year 2012 equal to $75,000,000 increased by an amount equal to
the unobligated portion of funds appropriated for fiscal year 2012
under section 510(d) that are rescinded under section 109(b) of the
Ending the HIV/AIDS Epidemic Act of 2012, and $125,000,000 for each of
fiscal years 2013 through 2014''.
TITLE II--ENDING STIGMA AND DISCRIMINATION THAT INHIBIT ACCESS TO CARE
AND MAKE PEOPLE MORE VULNERABLE
SEC. 201. REVIEW OF ALL FEDERAL AND STATE LAWS, POLICIES, AND
REGULATIONS REGARDING THE CRIMINAL PROSECUTION OF
INDIVIDUALS FOR HIV-RELATED OFFENSES.
(a) Definitions.--
(1) HIV and hiv/aids.--The terms ``HIV'' and ``HIV/AIDS''
have the meanings given to such terms in section 2689 of the
Public Health Service Act (42 U.S.C. 300ff-88).
(2) State.--The term ``State'' includes the District of
Columbia, American Samoa, the Commonwealth of the Northern
Mariana Islands, Guam, Puerto Rico, and the United States
Virgin Islands.
(b) Sense of Congress Regarding Laws or Regulations Directed at
People Living With HIV/AIDS.--It is the sense of the Congress that
Federal and State laws, policies, and regulations regarding people
living with HIV/AIDS--
(1) should not place unique or additional burdens on such
individuals solely as a result of their HIV status; and
(2) should instead demonstrate a public health-oriented,
evidence-based, medically accurate, and contemporary
understanding of--
(A) the multiple factors that lead to HIV
transmission;
(B) the relative risk of HIV transmission routes;
(C) the current health implications of living with
HIV;
(D) the associated benefits of treatment and
support services for people living with HIV; and
(E) the impact of punitive HIV-specific laws and
policies on public health, on people living with or
affected by HIV, and on their families and communities.
(c) Review of All Federal and State Laws, Policies, and Regulations
Regarding the Criminal Prosecution of Individuals for HIV-Related
Offenses.--
(1) Review of federal and state laws.--
(A) In general.--No later than 90 days after the
date of the enactment of this Act, the Attorney
General, the Secretary of Health and Human Services,
and the Secretary of Defense acting jointly (in this
paragraph and paragraph (2) referred to as the
``designated officials'') shall initiate a national
review of Federal and State laws, policies,
regulations, and judicial precedents and decisions
regarding criminal and related civil commitment cases
involving people living with HIV/AIDS, including in
regards to the Uniform Code of Military Justice.
(B) Consultation.--In carrying out the review under
subparagraph (A), the designated officials shall ensure
diverse participation and consultation from each State,
including with--
(i) State attorneys general (or their
representatives);
(ii) State public health officials (or
their representatives);
(iii) State judicial and court system
officers, including judges, district attorneys,
prosecutors, defense attorneys, law
enforcement, and correctional officers;
(iv) members of the United States Armed
Forces, including members of other Federal
services subject to the Uniform Code of
Military Justice;
(v) people living with HIV/AIDS,
particularly those who have been subject to
HIV-related prosecution or who are from
communities whose members have been
disproportionately subject to HIV-specific
arrests and prosecutions;
(vi) legal advocacy and HIV/AIDS service
organizations that work with people living with
HIV/AIDS;
(vii) nongovernmental health organizations
that work on behalf of people living with HIV/
AIDS; and
(viii) trade organizations or associations
representing persons or entities described in
clauses (i) through (vii).
(C) Relation to other reviews.--In carrying out the
review under subparagraph (A), the designated officials
may utilize other existing reviews of criminal and
related civil commitment cases involving people living
with HIV/AIDS, including any such review conducted by
any Federal or State agency or any public health, legal
advocacy, or trade organization or association if the
designated officials determine that such reviews were
conducted in accordance with the principles set forth
in subsection (b).
(2) Report.--No later than 180 days after initiating the
review required by paragraph (1), the Attorney General shall
transmit to the Congress and make publicly available a report
containing the results of the review, which includes the
following:
(A) For each State and for the Uniform Code of
Military Justice, a summary of the relevant laws,
policies, regulations, and judicial precedents and
decisions regarding criminal cases involving people
living with HIV/AIDS, including, if applicable, the
following:
(i) A determination of whether such laws,
policies, regulations, and judicial precedents
and decisions place any unique or additional
burdens upon people living with HIV/AIDS.
(ii) A determination of whether such laws,
policies, regulations, and judicial precedents
and decisions demonstrate a public health-
oriented, evidence-based, medically accurate,
and contemporary understanding of--
(I) the multiple factors that lead
to HIV transmission;
(II) the relative risk of HIV
transmission routes;
(III) the current health
implications of living with HIV;
(IV) the associated benefits of
treatment and support services for
people living with HIV; and
(V) the impact of punitive HIV-
specific laws and policies on public
health, on people living with or
affected by HIV, and on their families
and communities.
(iii) An analysis of the public health and
legal implications of such laws, policies,
regulations, and judicial precedents, including
an analysis of the consequences of having a
similar penal scheme applied to comparable
situations involving other communicable
diseases.
(iv) An analysis of the proportionality of
punishments imposed under HIV-specific laws,
policies, regulations, and judicial precedents,
taking into consideration penalties attached to
violation of State laws against similar degrees
of endangerment or harm, such as driving while
intoxicated (DWI) or transmission of other
communicable diseases, or more serious harms,
such as vehicular manslaughter offenses.
(B) An analysis of common elements shared among
State laws, policies, regulations, and judicial
precedents.
(C) A set of best practice recommendations directed
to State governments, including State attorneys
general, public health officials, and judicial
officers, in order to ensure that laws, policies,
regulations, and judicial precedents regarding people
living with HIV/AIDS are in accordance with the
principles set forth in subsection (b).
(D) Recommendations for adjustments to the Uniform
Code of Military Justice, as may be necessary, in order
to ensure that laws, policies, regulations, and
judicial precedents regarding people living with HIV/
AIDS are in accordance with the principles set forth in
subsection (b).
(3) Guidance.--Within 90 days of the release of the report
required by paragraph (2), the Attorney General and the
Secretary of Health and Human Services, acting jointly, shall
develop and publicly release updated guidance for States based
on the set of best practice recommendations required by
paragraph (2)(C) in order to assist States dealing with
criminal and related civil commitment cases regarding people
living with HIV/AIDS.
(4) Monitoring and evaluation system.--Within 60 days of
the release of the guidance required by paragraph (3), the
Attorney General and the Secretary of Health and Human
Services, acting jointly, shall establish an integrated
monitoring and evaluation system which includes, where
appropriate, objective and quantifiable performance goals and
indicators to measure progress toward statewide implementation
in each State of the best practice recommendations required in
paragraph (2)(C), including to monitor, track, and evaluate the
effectiveness of assistance provided pursuant to subsection
(d).
(5) Adjustments to federal laws, policies, or
regulations.--Within 90 days of the release of the report
required by paragraph (2), the Attorney General, the Secretary
of Health and Human Services, and the Secretary of Defense,
acting jointly, shall develop and transmit to the President and
the Congress, and make publicly available, such proposals as
may be necessary to implement adjustments to Federal laws,
policies, or regulations, including to the Uniform Code of
Military Justice, based on the recommendations required by
paragraph (2)(D), either through Executive order or through
changes to statutory law.
(6) Authorization of appropriations.--
(A) In general.--There are authorized to be
appropriated such sums as may be necessary for the
purpose of carrying out this subsection. Amounts
authorized to be appropriated by the preceding sentence
are in addition to amounts otherwise authorized to be
appropriated for such purpose.
(B) Availability of funds.--Amounts appropriated
pursuant to the authorization of appropriations in
subparagraph (A) are authorized to remain available
until expended.
(d) Authorization To Provide Grants.--
(1) Grants by attorney general.--
(A) In general.--The Attorney General may provide
assistance to eligible State and local entities and
eligible nongovernmental organizations for the purpose
of incorporating the best practice recommendations
developed under subsection (c)(2)(C) within relevant
State laws, policies, regulations, and judicial
decisions regarding people living with HIV/AIDS.
(B) Authorized activities.--The assistance
authorized by subparagraph (A) may include--
(i) direct technical assistance to eligible
State and local entities in order to develop,
disseminate, or implement State laws, policies,
regulations, or judicial decisions that conform
with the best practice recommendations
developed under subsection (c)(2)(C);
(ii) direct technical assistance to
eligible nongovernmental organizations in order
to provide education and training, including
through classes, conferences, meetings, and
other educational activities, to eligible State
and local entities; and
(iii) subcontracting authority to allow
eligible State and local entities and eligible
nongovernmental organizations to seek technical
assistance from legal and public health experts
with a demonstrated understanding of the
principles underlying the best practice
recommendations developed under subsection
(c)(2)(C).
(2) Grants by secretary of hhs.--
(A) In general.--The Secretary of Health and Human
Services, acting through the Director of the Centers
for Disease Control and Prevention, may provide
assistance to State and local public health departments
and eligible nongovernmental organizations for the
purpose of supporting eligible State and local entities
to incorporate the best practice recommendations
developed under subsection (c)(2)(C) within relevant
State laws, policies, regulations, and judicial
decisions regarding people living with HIV/AIDS.
(B) Authorized activities.--The assistance
authorized by subparagraph (A) may include--
(i) direct technical assistance to State
and local public health departments in order to
support the development, dissemination, or
implementation of State laws, policies,
regulations, or judicial decisions that conform
with the set of best practice recommendations
developed under subsection (c)(2)(C);
(ii) direct technical assistance to
eligible nongovernmental organizations in order
to provide education and training, including
through classes, conferences, meetings, and
other educational activities, to State and
local public health departments; and
(iii) subcontracting authority to allow
State and local public health departments and
eligible nongovernmental organizations to seek
technical assistance from legal and public
health experts with a demonstrated
understanding of the principles underlying the
best practice recommendations developed under
subsection (c)(2)(C).
(3) Limitation.--As a condition of receiving assistance
through this subsection, eligible State and local entities,
State and local public health departments, and eligible
nongovernmental organizations shall agree--
(A) not to place any unique or additional burdens
on people living with HIV/AIDS solely as a result of
their HIV status; and
(B) that if the entity, department, or organization
promulgates any laws, policies, regulations, or
judicial decisions regarding people living with HIV/
AIDS, such actions shall demonstrate a public health-
oriented, evidence-based, medically accurate, and
contemporary understanding of--
(i) the multiple factors that lead to HIV
transmission;
(ii) the relative risk of HIV transmission
routes;
(iii) the current health implications of
living with HIV;
(iv) the associated benefits of treatment
and support services for people living with
HIV; and
(v) the impact of punitive HIV-specific
laws and policies on public health, on people
living with or affected by HIV, and on their
families and communities.
(4) Report.--No later than 1 year after the date of the
enactment of this Act, and annually thereafter, the Attorney
General and the Secretary of Health and Human Services, acting
jointly, shall transmit to Congress and make publicly available
a report describing, for each State, the impact and
effectiveness of the assistance provided through this Act. Each
such report shall include--
(A) a detailed description of the progress each
State has made, if any, in implementing the best
practice recommendations developed under subsection
(c)(2)(C) as a result of the assistance provided under
this subsection, and based on the performance goals and
indicators established as part of the monitoring and
evaluation system in subsection (c)(4);
(B) a brief summary of any outreach efforts
undertaken during the prior year by the Attorney
General and the Secretary of Health and Human Services
to encourage States to seek assistance under this
subsection in order to implement the best practice
recommendations developed under subsection (c)(2)(C);
(C) a summary of how assistance provided through
this subsection is being utilized by eligible State and
local entities, State and local public health
departments, and eligible nongovernmental organizations
and, if applicable, any contractors, including with
respect to nongovernmental organizations, the type of
technical assistance provided, and an evaluation of the
impact of such assistance on eligible State and local
entities; and
(D) a summary and description of eligible State and
local entities, State and local public health
departments, and eligible nongovernmental organizations
receiving assistance through this subsection, including
if applicable, a summary and description of any
contractors selected to assist in implementing such
assistance.
(5) Definitions.--For the purposes of this subsection:
(A) Eligible state and local entities.--The term
``eligible State and local entities'' means the
relevant individuals, offices, or organizations that
directly participate in the development, dissemination,
or implementation of State laws, policies, regulations,
or judicial decisions, including--
(i) State governments, including State
attorneys general, State departments of
justice, and State National Guards, or their
equivalents;
(ii) State judicial and court systems,
including trial courts, appellate courts, State
supreme courts and courts of appeal, and State
correctional facilities, or their equivalents;
and
(iii) local governments, including city and
county governments, district attorneys, and
local law enforcement departments, or their
equivalents.
(B) State and local public health departments.--The
term ``State and local public health departments''
means the following:
(i) State public health departments, or
their equivalents, including the chief officer
of such departments and infectious disease and
communicable disease specialists within such
departments.
(ii) Local public health departments, or
their equivalents, including city and county
public health departments, the chief officer of
such departments, and infectious disease and
communicable disease specialists within such
departments.
(iii) Public health departments or
officials, or their equivalents, within State
or local correctional facilities.
(iv) Public health departments or
officials, or their equivalents, within State
National Guards.
(v) Any other recognized State or local
public health organization or entity charged
with carrying out official State or local
public health duties.
(C) Eligible nongovernmental organizations.--The
term ``eligible nongovernmental organizations'' means
the following:
(i) Nongovernmental organizations,
including trade organizations or associations
that represent--
(I) State attorneys general, or
their equivalents;
(II) State public health officials,
or their equivalents;
(III) State judicial and court
officers, including judges, district
attorneys, prosecutors, defense
attorneys, law enforcement, and
correctional officers;
(IV) State National Guards;
(V) people living with HIV/AIDS;
(VI) legal advocacy and HIV/AIDS
service organizations that work with
people living with HIV/AIDS; and
(VII) nongovernmental health
organizations that work on behalf of
people living with HIV/AIDS.
(ii) Nongovernmental organizations,
including trade organizations or associations
that demonstrate a public-health oriented,
evidence-based, medically accurate, and
contemporary understanding of--
(I) the multiple factors that lead
to HIV transmission;
(II) the relative risk of HIV
transmission routes;
(III) the current health
implications of living with HIV;
(IV) the associated benefits of
treatment and support services for
people living with HIV; and
(V) the impact of punitive HIV-
specific laws and policies on public
health, on people living with or
affected by HIV, and on their families
and communities.
(6) Authorization of appropriations.--
(A) In general.--In addition to amounts otherwise
made available, there are authorized to be appropriated
to the Attorney General and the Secretary of Health and
Human Services such sums as may be necessary to carry
out this subsection for each of the fiscal years 2013
through 2017.
(B) Availability of funds.--Amounts appropriated
pursuant to the authorizations of appropriations in
subparagraph (A) are authorized to remain available
until expended.
TITLE III--ADDRESSING LEGAL AND POLICY BARRIERS TO ACCESSING HEALTH
CARE
SEC. 301. REPEAL OF LIMITATION AGAINST USE OF FUNDS FOR EDUCATION OR
INFORMATION DESIGNED TO PROMOTE OR ENCOURAGE, DIRECTLY,
HOMOSEXUAL OR HETEROSEXUAL ACTIVITY OR INTRAVENOUS
SUBSTANCE ABUSE.
Section 2500 of the Public Health Service Act (42 U.S.C. 300ee) is
amended--
(1) by striking subsection (c); and
(2) by redesignating subsection (d) as subsection (c).
SEC. 302. EXPANDING SUPPORT FOR CONDOMS IN PRISONS.
(a) Authority To Allow Community Organizations To Provide STI
Counseling, STI Prevention Education, and Sexual Barrier Protection
Devices in Federal Correctional Facilities.--
(1) Directive to attorney general.--Not later than 30 days
after the date of enactment of this Act, the Attorney General
shall direct the Bureau of Prisons to allow community
organizations to distribute sexual barrier protection devices
and to engage in STI counseling and STI prevention education in
Federal correctional facilities. These activities shall be
subject to all relevant Federal laws and regulations which
govern visitation in correctional facilities.
(2) Information requirement.--Any community organization
permitted to distribute sexual barrier protection devices under
paragraph (1) must ensure that the persons to whom the devices
are distributed are informed about the proper use and disposal
of sexual barrier protection devices in accordance with
established public health practices. Any community organization
conducting STI counseling or STI prevention education under
paragraph (1) must offer comprehensive sexuality education.
(3) Possession of device protected.--No Federal
correctional facility may, because of the possession or use of
a sexual barrier protection device--
(A) take adverse action against an incarcerated
person; or
(B) consider possession or use as evidence of
prohibited activity for the purpose of any Federal
correctional facility administrative proceeding.
(4) Implementation.--The Attorney General and Bureau of
Prisons shall implement this section according to established
public health practices in a manner that protects the health,
safety, and privacy of incarcerated persons and of correctional
facility staff.
(b) Sense of Congress Regarding Distribution of Sexual Barrier
Protection Devices in State Prison Systems.--It is the sense of the
Congress that States should allow for the legal distribution of sexual
barrier protection devices in State correctional facilities to reduce
the prevalence and spread of STIs in those facilities.
(c) Survey of and Report on Correctional Facility Programs Aimed
at Reducing the Spread of STIs.--
(1) Survey.--The Attorney General, after consulting with
the Secretary of Health and Human Services, State officials,
and community organizations, shall, to the maximum extent
practicable, conduct a survey of all Federal and State
correctional facilities, no later than 180 days after the date
of enactment of this Act and annually thereafter for 5 years,
to determine the following:
(A) Counseling, treatment, and supportive
services.--Whether the correctional facility requires
incarcerated persons to participate in counseling,
treatment, and supportive services related to STIs, or
whether it offers such programs to incarcerated
persons.
(B) Access to sexual barrier protection devices.--
Whether incarcerated persons can--
(i) possess sexual barrier protection
devices;
(ii) purchase sexual barrier protection
devices;
(iii) purchase sexual barrier protection
devices at a reduced cost; and
(iv) obtain sexual barrier protection
devices without cost.
(C) Incidence of sexual violence.--The incidence of
sexual violence and assault committed by incarcerated
persons and by correctional facility staff.
(D) Prevention education offered.--The type of
prevention education, information, or training offered
to incarcerated persons and correctional facility staff
regarding sexual violence and the spread of STIs,
including whether such education, information, or
training--
(i) constitutes comprehensive sexuality
education;
(ii) is compulsory for new incarcerated
persons and for new staff; and
(iii) is offered on an ongoing basis.
(E) STI testing.--Whether the correctional facility
tests incarcerated persons for STIs or gives them the
option to undergo such testing--
(i) at intake;
(ii) on a regular basis; and
(iii) prior to release.
(F) STI test results.--The number of incarcerated
persons who are tested for STIs and the outcome of such
tests at each correctional facility, disaggregated to
include results for--
(i) the type of sexually transmitted
infection tested for;
(ii) the race and/or ethnicity of
individuals tested;
(iii) the age of individuals tested; and
(iv) the gender of individuals tested.
(G) Prerelease referral policy.--Whether
incarcerated persons are informed prior to release
about STI-related services or other health services in
their communities, including free and low-cost
counseling and treatment options.
(H) Prerelease referrals made.--The number of
referrals to community-based organizations or public
health facilities offering STI-related or other health
services provided to incarcerated persons prior to
release, and the type of counseling or treatment for
which the referral was made.
(I) Reinstatement of medicaid benefits.--Whether
the correctional facility assists incarcerated persons
that were enrolled in the State Medicaid program prior
to their incarceration, in reinstating their enrollment
upon release and whether such individuals receive
referrals as provided by subparagraph (G) to entities
that accept the State Medicaid program, including if
applicable--
(i) the number of such individuals,
including those diagnosed with the human
immunodeficiency virus, that have been
reinstated;
(ii) a list of obstacles to reinstating
enrollment or to making determinations of
eligibility for reinstatement, if any; and
(iii) the number of individuals denied
enrollment.
(J) Other actions taken.--Whether the correctional
facility has taken any other action, in conjunction
with community organizations or otherwise, to reduce
the prevalence and spread of STIs in that facility.
(2) Privacy.--In conducting the survey, the Attorney
General shall not request or retain the identity of any person
who has sought or been offered counseling, treatment, testing,
or prevention education information regarding an STI (including
information about sexual barrier protection devices), or who
has tested positive for an STI.
(3) Report.--The Attorney General shall transmit to
Congress and make publicly available the results of the survey
required under paragraph (1), both for the Nation as a whole
and disaggregated as to each State and each correctional
facility. To the maximum extent possible, the Attorney General
shall issue the first report no later than 1 year after the
date of enactment of this Act and shall issue reports annually
thereafter for 5 years.
(d) Strategy.--
(1) Directive to attorney general.--The Attorney General,
in consultation with the Secretary of Health and Human
Services, State officials, and community organizations, shall
develop and implement a 5-year strategy to reduce the
prevalence and spread of STIs in Federal and State correctional
facilities. To the maximum extent possible, the strategy shall
be developed, transmitted to Congress, and made publicly
available no later than 180 days after the transmission of the
first report required under subsection (c)(3).
(2) Contents of strategy.--The strategy shall include the
following:
(A) Prevention education.--A plan for improving
prevention education, information, and training offered
to incarcerated persons and correctional facility
staff, including information and training on sexual
violence and the spread of STIs, and comprehensive
sexuality education.
(B) Sexual barrier protection device access.--A
plan for expanding access to sexual barrier protection
devices in correctional facilities.
(C) Sexual violence reduction.--A plan for reducing
the incidence of sexual violence among incarcerated
persons and correctional facility staff, developed in
consultation with the National Prison Rape Elimination
Commission.
(D) Counseling and supportive services.--A plan for
expanding access to counseling and supportive services
related to STIs in correctional facilities.
(E) Testing.--A plan for testing incarcerated
persons for STIs during intake, during regular health
exams, and prior to release, and that--
(i) is conducted in accordance with
guidelines established by the Centers for
Disease Control and Prevention;
(ii) includes pretest counseling;
(iii) requires that incarcerated persons
are notified of their option to decline testing
at any time;
(iv) requires that incarcerated persons are
confidentially notified of their test results
in a timely manner; and
(v) ensures that incarcerated persons
testing positive for STIs receive post-test
counseling, care, treatment, and supportive
services.
(F) Treatment.--A plan for ensuring that
correctional facilities have the necessary medicine and
equipment to treat and monitor STIs and for ensuring
that incarcerated persons living with or testing
positive for STIs receive and have access to care and
treatment services.
(G) Strategies for demographic groups.--A plan for
developing and implementing culturally appropriate,
sensitive, and specific strategies to reduce the spread
of STIs among demographic groups heavily impacted by
STIs.
(H) Linkages with communities and facilities.--A
plan for establishing and strengthening linkages to
local communities and health facilities that--
(i) provide counseling, testing, care, and
treatment services;
(ii) may receive persons recently released
from incarceration who are living with STIs;
and
(iii) accept payment through the State
Medicaid program.
(I) Enrollment in state medicaid programs.--Plans
to ensure that incarcerated persons who were--
(i) enrolled in their State Medicaid
program prior to incarceration in a
correctional facility are automatically re-
enrolled in such program upon their release;
and
(ii) not enrolled in their State Medicaid
program prior to incarceration, but who are
diagnosed with the human immunodeficiency virus
while incarcerated in a correctional facility,
are automatically enrolled in such program upon
their release.
(J) Other plans.--Any other plans developed by the
Attorney General for reducing the spread of STIs or
improving the quality of health care in correctional
facilities.
(K) Monitoring system.--A monitoring system that
establishes performance goals related to reducing the
prevalence and spread of STIs in correctional
facilities and which, where feasible, expresses such
goals in quantifiable form.
(L) Monitoring system performance indicators.--
Performance indicators that measure or assess the
achievement of the performance goals described in
subparagraph (I).
(M) Cost estimate.--A detailed estimate of the
funding necessary to implement the strategy at the
Federal and State levels for all 5 years, including the
amount of funds required by community organizations to
implement the parts of the strategy in which they take
part.
(3) Report.--The Attorney General shall transmit to
Congress and make publicly available an annual progress report
regarding the implementation and effectiveness of the strategy
described in paragraph (1). The progress report shall include
an evaluation of the implementation of the strategy using the
monitoring system and performance indicators provided for in
subparagraphs (I) and (J) of paragraph (2).
(e) Appropriations.--
(1) In general.--There are authorized to be appropriated
such sums as may be necessary to carry out this section for
each of fiscal years 2013 through 2019.
(2) Availability of funds.--Amounts made available under
paragraph (1) are authorized to remain available until
expended.
(f) Definitions.--For the purposes of this section:
(1) Community organization.--The term ``community
organization'' means a public health care facility or a
nonprofit organization which provides health- or STI-related
services according to established public health standards.
(2) Comprehensive sexuality education.--The term
``comprehensive sexuality education'' means sexuality education
that includes information about abstinence and about the proper
use and disposal of sexual barrier protection devices and which
is--
(A) evidence-based;
(B) medically accurate;
(C) age and developmentally appropriate;
(D) gender and identity sensitive;
(E) culturally and linguistically appropriate; and
(F) structured to promote critical thinking, self-
esteem, respect for others, and the development of
healthy attitudes and relationships.
(3) Correctional facility.--The term ``correctional
facility'' means any prison, penitentiary, adult detention
facility, juvenile detention facility, jail, or other facility
to which persons may be sent after conviction of a crime or act
of juvenile delinquency within the United States.
(4) Incarcerated person.--The term ``incarcerated person''
means any person who is serving a sentence in a correctional
facility after conviction of a crime.
(5) Sexually transmitted infection.--The term ``sexually
transmitted infection'' or ``STI'' means any disease or
infection that is commonly transmitted through sexual activity,
including HIV/AIDS, gonorrhea, chlamydia, syphilis, genital
herpes, viral hepatitis, and human papillomavirus.
(6) Sexual barrier protection device.--The term ``sexual
barrier protection device'' means any FDA-approved physical
device which has not been tampered with and which reduces the
probability of STI transmission or infection between sexual
partners, including female condoms, male condoms, and dental
dams.
(7) State.--The term ``State'' includes the District of
Columbia, American Samoa, the Commonwealth of the Northern
Mariana Islands, Guam, Puerto Rico, and the United States
Virgin Islands.
SEC. 303. AUTOMATIC REINSTATEMENT OR ENROLLMENT IN MEDICAID FOR PEOPLE
WHO TEST POSITIVE FOR HIV BEFORE REENTERING COMMUNITIES.
(a) In General.--Section 1902(e) of the Social Security Act (42
U.S.C. 1396a(e)) is amended by adding at the end the following:
``(15) Enrollment of ex-offenders.--
``(A) Automatic enrollment or reinstatement.--
``(i) In general.--The State plan shall
provide for the automatic enrollment or
reinstatement of enrollment of an eligible
individual--
``(I) if such individual is
scheduled to be released from a public
institution due to the completion of
sentence, not less than 30 days prior
to the scheduled date of the release;
and
``(II) if such individual is to be
released from a public institution on
parole or on probation, as soon as
possible after the date on which the
determination to release such
individual was made, and before the
date such individual is released.
``(ii) Exception.--If a State makes a
determination that an individual is not
eligible to be enrolled under the State plan--
``(I) on or before the date by
which the individual would be enrolled
under clause (i), such clause shall not
apply to such individual; or
``(II) after such date, the State
may terminate the enrollment of such
individual.
``(B) Relationship of enrollment to payment for
services.--
``(i) In general.--Subject to subparagraph
(A)(ii), an eligible individual who is
enrolled, or whose enrollment is reinstated,
under subparagraph (A) shall be eligible for
medical assistance that is provided after the
date that the eligible individual is released
from the public institution.
``(ii) Relationship to payment prohibition
for inmates.--No provision of this paragraph
may be construed to permit payment for care or
services for which payment is excluded under
subparagraph (A), following paragraph (29), in
section 1905(a).
``(C) Treatment of continuous eligibility.--
``(i) Suspension for inmates.--Any period
of continuous eligibility under this title
shall be suspended on the date an individual
enrolled under this title becomes an inmate of
a public institution (except as a patient of a
medical institution).
``(ii) Determination of remaining period.--
Notwithstanding any changes to State law
related to continuous eligibility during the
time that an individual is an inmate of a
public institution (except as a patient of a
medical institution), subject to clause (iii),
with respect to an eligible individual who was
subject to a suspension under subclause (I), on
the date that such individual is released from
a public institution the suspension of
continuous eligibility under such subclause
shall be lifted for a period that is equal to
the time remaining in the period of continuous
eligibility for such individual on the date
that such period was suspended under such
subclause.
``(iii) Exception.--If a State makes a
determination that an individual is not
eligible to be enrolled under the State plan--
``(I) on or before the date that
the suspension of continuous
eligibility is lifted under clause
(ii), such clause shall not apply to
such individual; or
``(II) after such date, the State
may terminate the enrollment of such
individual.
``(D) Automatic enrollment or reinstatement of
enrollment defined.--For purposes of this paragraph,
the term `automatic enrollment or reinstatement of
enrollment' means that the State determines eligibility
for medical assistance under the State plan without a
program application from, or on behalf of, the eligible
individual, but an individual can only be automatically
enrolled in the State Medicaid plan if the individual
affirmatively consents to being enrolled through
affirmation in writing, by telephone, orally, through
electronic signature, or through any other means
specified by the Secretary.
``(E) Eligible individual defined.--For purposes of
this paragraph, the term `eligible individual' means an
individual who is an inmate of a public institution
(except as a patient in a medical institution)--
``(i) who was enrolled under the State plan
for medical assistance immediately before
becoming an inmate of such an institution; or
``(ii) is diagnosed with human
immunodeficiency virus.''.
(b) Supplemental Funding for State Implementation of Automatic
Reinstatement of Medicaid Benefits.--
(1) In general.--Subject to paragraph (6), for each State
for which the Secretary of Health and Human Services has
approved an application under paragraph (3), the Federal
matching payments (including payments based on the Federal
medical assistance percentage) made to such State under section
1903 of the Social Security Act (42 U.S.C. 1396b) (excluding
any increase resulting from the application of section 5001 of
Public Law 111-5) shall be increased by 5.0 percentage points
for payments to the State for the activities permitted under
paragraph (2) or a period of one year.
(2) Use of funds.--A State may only use increased matching
payments authorized under paragraph (1)--
(A) to strengthen the State's enrollment and
administrative resources for the purpose of improving
processes for enrolling (or reinstating the enrollment
of) eligible individuals (as such term is defined in
section 1902(e)(15)(E) of the Social Security Act); and
(B) for medical assistance (as such term is defined
in section 1905(a) of the Social Security Act) provided
to such eligible individuals.
(3) Application and agreement.--The Secretary may only make
payments to a State in the increased amount if--
(A) the State has amended the State plan under
section 1902 of the Social Security Act to incorporate
the requirements of paragraph (5)(xv) of such section;
(B) the State has submitted an application to the
Secretary that includes a plan for implementing the
requirements of section 1902(e)(15) of the Social
Security Act under the State's amended State plan
before the end of the 90-day period beginning on the
date that the State receives increased matching
payments under paragraph (1);
(C) the State's application meets the satisfaction
of the Secretary; and
(D) the State enters an agreement with the
Secretary that states that--
(i) the State will only use the increased
matching funds for the uses permitted under
paragraph (2); and
(ii) at the end of the period under
paragraph (1), the State will submit to the
Secretary, and make publicly available, a
report that contains the information required
under paragraph (4).
(4) Required report information.--The information that is
required in the report under paragraph (3)(D)(ii) includes--
(A) the results of an evaluation of the impact of
the implementation of the requirements of section
1902(e)(15) of the Social Security Act on improving the
State's processes for enrolling of individuals who are
released from public institutions into the Medicaid
program;
(B) the number of individuals who were
automatically enrolled (or whose enrollment is
reinstated) under such section 1902(e)(15) during the
period under paragraph (1); and
(C) any other information that is required by the
Secretary.
(5) Increase in cap on medicaid payments to territories.--
Subject to paragraph (6), the amounts otherwise determined for
Puerto Rico, the United States Virgin Islands, Guam, the
Northern Mariana Islands, and American Samoa under subsections
(f) and (g) of section 1108 of the Social Security Act (42
U.S.C. 1308) shall each be increased by the necessary amount to
allow for the increase in the Federal matching payments under
paragraph (1), but only for the period under such subparagraph
for such State. In the case of such an increase for a
territory, subsection (a)(1) of such section 1108 shall be
applied without regard to any increase in payment made to the
territory under part E of title IV of such Act that is
attributable to the increase in Federal medical assistance
percentage effected under paragraph (1) for the territory.
(6) Limitations.--
(A) Timing.--With respect to a State, at the end of
the period under paragraph (1), no increased matching
payments may be made to such State under this
subsection.
(B) Maintenance of eligibility.--
(i) In general.--Subject to clause (ii), a
State is not eligible for an increase in its
Federal matching payments under paragraph (1),
or an increase in a cap amount under paragraph
(5), if eligibility standards, methodologies,
or procedures under its State plan under title
XIX of the Social Security Act (including any
waiver under such title or under section 1115
of such Act (42 U.S.C. 1315)) are more
restrictive than the eligibility standards,
methodologies, or procedures, respectively,
under such plan (or waiver) as in effect on the
date of enactment of this Act.
(ii) State reinstatement of eligibility
permitted.--A State that has restricted
eligibility standards, methodologies, or
procedures under its State plan under title XIX
of the Social Security Act (including any
waiver under such title or under section 1115
of such Act (42 U.S.C. 1315)) after the date of
enactment of this Act, is no longer ineligible
under subparagraph (A) beginning with the first
calendar quarter in which the State has
reinstated eligibility standards,
methodologies, or procedures that are no more
restrictive than the eligibility standards,
methodologies, or procedures, respectively,
under such plan (or waiver) as in effect on
such date.
(C) No waiver authority.--The Secretary may not
waive the application of this subsection under section
1115 of the Social Security Act or otherwise.
(D) Limitation of matching payments to 100
percent.--In no case shall an increase in Federal
matching payments under this subsection result in
Federal matching payments that exceed 100 percent.
(c) Effective Date.--
(1) In general.--Except as provided in paragraph (2), the
amendments made by subsection (a) shall take effect 180 days
after the date of the enactment of this Act and shall apply to
services furnished on or after such date.
(2) Rule 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 (other than
legislation appropriating funds) in order for the plan to meet
the additional requirement imposed by the amendments made by
this section, 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 Act. For
purposes of the previous sentence, in the case of a State that
has a 2-year legislative session, each year of such session
shall be deemed to be a separate regular session of the State
legislature.
TITLE IV--COORDINATING EFFORTS TO DRIVE GREATER EFFICIENCY AND IMPROVED
RESULTS
SEC. 401. SUPPORT DATA SYSTEM REVIEW AND INDICATORS FOR MONITORING HIV
CARE.
The Secretary of Health and Human Services, in collaboration with
the Assistant Secretary for Health, the Director of the Office of HIV/
AIDS and Infectious Disease Policy, the Director of the Centers for
Disease Control and Prevention, the Administrator of the Substance
Abuse and Mental Health Services Administration, the Director of the
Department of Housing and Urban Development, the Director of the Office
of AIDS Research, the Administrator of the Health Resources and
Services Administration, and the Administrator of the Centers for
Medicare & Medicaid Services, shall expand and coordinate efforts to
align metrics across agencies and modify Federal data systems, to--
(1) adopt the Institute of Medicine's clinical HIV care
indicators as the core metrics for monitoring the quality of
HIV care, mental health, substance abuse, and supportive
services;
(2) better enable assessment of the impact of the National
HIV/AIDS Strategy and the Patient Protection and Affordable
Care Act on improving HIV/AIDS care and access to supportive
services for individuals with HIV;
(3) expand the demographic data elements to be captured by
Federal data systems relevant to HIV care to permit calculation
of the indicators for subgroups of the population of people
with diagnosed HIV infection, including--
(A) age;
(B) race;
(C) ethnicity;
(D) sex (assigned at birth);
(E) gender identity;
(F) sexual orientation;
(G) current geographic marker of residence;
(H) income or poverty level; and
(I) primary means of reimbursement for medical
services (including Medicaid, Medicare, the Ryan White
HIV/AIDS Program, private insurance, health maintenance
organizations, and no coverage); and
(4) streamline data collection and systematically review
all existing reporting requirements for federally funded HIV/
AIDS programs to ensure that only essential data are collected.
SEC. 402. TRANSFER OF FUNDS FOR IMPLEMENTATION OF NATIONAL HIV/AIDS
STRATEGY.
Title II of the Public Health Service Act (42 U.S.C. 202 et seq.)
is amended by inserting after section 241 the following:
``SEC. 241A. TRANSFER OF FUNDS FOR IMPLEMENTATION OF NATIONAL HIV/AIDS
STRATEGY.
``(a) Transfer Authorization.--Of the discretionary appropriations
made available to the Department of Health and Human Services for any
fiscal year for programs and activities that, as determined by the
Secretary of Health and Human Services, pertain to HIV/AIDS, the
Secretary, in coordination with the Director of the Office of National
HIV/AIDS Policy, may transfer up to 1 percent of such appropriations to
the Office of the Assistant Secretary for Health for implementation of
the National HIV/AIDS Strategy.
``(b) Congressional Notification.--Not less than 30 days before
making any transfer under this section, the Secretary shall give notice
of the transfer to the Congress.
``(c) Definitions.--In this section:
``(1) The term `HIV/AIDS' has the meaning given to such
term in section 2689.
``(2) The term `National HIV/AIDS Strategy' means the
National HIV/AIDS Strategy for the United States issued by the
President in July 2010 and includes any subsequent revisions to
such Strategy.''.
SEC. 403. HIV INTEGRATED SERVICES DELIVERY MODEL DEMONSTRATION.
(a) In General.--Consistent with the National HIV/AIDS Strategy for
the United States and in accordance with this section, the Secretary of
Health and Human Services acting through the Center for Medicare &
Medicaid Innovation and in cooperation with CDC, HRSA, SAMHSA, and HUD,
shall conduct a 3-year demonstration project that is designed to
integrate services and funding under the Medicare and Medicaid
programs, under HIV-related programs conducted by the CDC, and under
the Ryan White HIV/AIDS Program, to reduce new HIV infections, to
increase the proportion of people who know their status, to increase
access to care, to improve health outcomes, to reduce HIV-related
health disparities among Medicaid and Medicare beneficiaries, and to
reduce the cost of care provided to HIV positive Medicare and Medicaid
beneficiaries.
(b) Objectives.--The objectives of the demonstration are the
following:
(1) To ensure the early identification of HIV positive
beneficiaries to reduce costly HIV-related clinical conditions
through HIV screening and rapid linkage to high quality HIV
medical care.
(2) To reduce new HIV infections among Medicaid and
Medicare beneficiaries through routine HIV testing, prevention
services for HIV negative beneficiaries, and intensive
``prevention for positive'' services for HIV positive
beneficiaries.
(3) To reduce morbidity, mortality, and high cost inpatient
and specialty care among HIV positive beneficiaries by ensuring
access to high quality HIV medical care, HIV medications, and
support services.
(4) To promote HIV treatment adherence and retention in
care through intensive case management, treatment education,
and outreach services.
(5) To effectively treat behavioral health conditions among
HIV positive beneficiaries that impair their HIV treatment
adherence and lead to secondary HIV infections through services
funded under Medicare and Medicaid and programs administered by
SAMHSA.
(6) To promote independence, treatment adherence, and
stable housing for HIV positive beneficiaries through highly
coordinated HIV health, housing, and support services funded by
HRSA and HUD.
(c) Demonstration Design.--
(1) In general.--The Secretary shall design the
demonstration to test both--
(A) the service delivery model described in
paragraph (2); and
(B) the payment model described in paragraph (3).
(2) Service delivery model.--
(A) In general.--Under the service delivery model
described in this paragraph, the demonstration shall
test comprehensive HIV testing, linkage to care, HIV
medical care, and ancillary services to individuals
enrolled under Medicare, Medicaid, or both. The service
delivery model will integrate services furnished under
Medicare and Medicaid with prevention services funded
by CDC for HIV positive beneficiaries, intensive case
management services funded by HRSA, behavioral services
funded by SAMHSA, and housing assistance services
funded through HUD.
(B) Core elements.--The model under this paragraph
shall have the following 8 core elements:
(i) HIV testing services that apply the
CDC's 2006 recommendations for universal opt-
out testing among Medicare and Medicaid
beneficiary populations.
(ii) Rapid linkage from HIV testing
settings to treatment for HIV positive
beneficiaries to ensure they are engaged in
care in a timely basis.
(iii) Access to high quality HIV
experienced medical care, laboratory
monitoring, HIV medications, and other required
services.
(iv) Routine screening and treatment for
HIV-related and other chronic conditions,
including behavioral health.
(v) Prevention and treatment education
services, including an adapted Medication
Therapy Management (MTM) program model, to
optimize the benefit of HIV therapeutics.
(vi) Risk-stratified medical case
management.
(vii) Provision of preventive care,
including counseling to prevent secondary HIV
infection.
(viii) Wrap-around support and housing
services.
(3) Payment model.--Under the payment model described in
this paragraph, the demonstration shall test the following:
(A) A prepaid capitated payment model that adjusts
payment for HIV and behavioral health acuity, to be
applied under contracts with managed care organizations
with demonstrated HIV experience.
(B) Use of funds under the Ryan White HIV/AIDS
Program to purchase capitated services from the
contracted managed care organizations.
(C) Provision of additional funds to support
services to the extent that Medicaid and Medicare
coverage is limited, including for services such as HIV
testing (for Medicaid beneficiaries), medical case
management, prevention case management, treatment
education, case finding, behavioral health services,
and housing assistance.
(d) Beneficiary Criteria.--Beneficiaries eligible for participation
in the demonstration are the following:
(1) Medicaid ffs beneficiaries.--Fee-for-service Medicaid
beneficiaries 18 years of age or older.
(2) Dual eligibles.--Individuals who are--
(A) entitled to medical assistance under Medicaid;
and
(B) entitled to benefits under part A, and enrolled
under part B, of Medicare but are not enrolled under a
Medicare Advantage plan under Medicare.
(e) Roles and Responsibilities in Demonstration.--
(1) In general.--Consistent with the National HIV/AIDS
Strategy for the United States, Federal agencies shall
coordinate their funding for the selected States or cities
covered under the demonstration to provide resources to fund
the delivery of services within the demonstration.
(2) HHS.--In carrying out the demonstration, the Secretary
shall--
(A) design the application process;
(B) solicit applications from 5 to 7 State Medicaid
agencies to host the demonstration;
(C) with respect to the service delivery model
described in subsection (c)(2), collaborate with the
CDC, HRSA, and the National Institutes of Health to
design a minimum service delivery model that reflects
the current standard of care as established by the
Public Health Service and CDC guidelines and
recommendations; and
(D) fund an evaluation of the demonstration to
ensure collection of system, provider, and beneficiary-
level data to address their routine reporting
requirements.
The Secretary may carry out the Secretary's authority under
this paragraph through CMMI.
(3) CDC.--The CDC shall collaborate with the Secretary and
CDC-funded HIV prevention grantees in the selected States and
cities to provide technical assistance to design cost-effective
HIV and sexually transmitted infection (STI) screening and
testing services for Medicaid and Medicare beneficiaries,
including partner notification services and communicable
disease reporting. CDC and CMS shall determine the extent to
which testing funds shall be supported jointly or separately by
these agencies.
(4) HRSA.--HRSA shall allocate funds available through the
Special Projects of National Significance (SPNS) Initiative
Program (under subpart I of part F of the Ryan White HIV/AIDS
Program) to support wrap-around core and support services not
covered under Medicare or Medicaid and shall authorize the use
of Ryan White HIV/AIDS Program funds to purchase services
through capitated managed care programs that meet or exceed the
services covered by the Ryan White HIV/AIDS Program at rates
that are no greater than current per capita expenditures. HRSA
is authorized to use funds under SPNS, and to waive such
requirements of SPNS as may be necessary, to carry out the
demonstration.
(5) SAMHSA.--SAMHSA shall allocate funds through the
Minority HIV/AIDS Initiative or other programs to support
behavioral health services not covered under Medicare or
Medicaid.
(6) HOPWA.--HUD shall directly allocate funds under the
Housing Opportunities for People With AIDS (HOPWA) program to
the States or cities participating in the demonstration to
provide supportive housing and other housing assistance to
beneficiaries who otherwise meet HOPWA eligibility criteria.
HUD is authorized to use such HOPWA funds, and to waive such
requirements under HOPWA as may be necessary, to carry out the
demonstration.
(7) State medicaid agencies.--Single State agencies
responsible for administration of the Medicaid program for
individuals who are accepted to participate in the
demonstration shall--
(A) collaborate with CMS to design or refine a
prepaid capitated payment model, to allocate and award
contracts with capitated managed care plans, to ensure
such plans meet State statutory or regulatory
requirements, to contract with a coordinating agency to
organize and deliver integrated HIV testing, medical
care, support, and housing services funded under
Medicare and Medicaid, other Federal, State, and local
government sponsors, and to coordinate their activities
with the State HIV/AIDS program; and
(B) identify and contract with a coordinating
agency to organize the demonstration in the State, to
establish a coordinating body representing State,
local, and provider agencies participating in the
demonstration, to establish systems of care that
integrate HIV prevention, testing, treatment, support,
and housing services, to establish mechanisms to gather
evaluation data for reporting to CMMI and other
participating Federal agencies, and to establish a
quality management program to monitor provider
performance in delivering the services provided to
participating beneficiaries under the demonstration.
(8) Managed care organizations.--Capitated managed care
organizations participating in the demonstration shall organize
and deliver services as specified by the minimum service
delivery model established by CMMI through a network of
providers with demonstrated HIV experience, high quality, and
sufficient provider capacity.
(f) Definitions.--In this section:
(1) CDC.--The term ``CDC'' means the Director of the
Centers for Disease Control and Prevention.
(2) CMMI.--The term ``CMMI'' means the Director of the
Center for Medicare and Medicaid Innovation.
(3) CMS.--The term ``CMS'' means the Administrator of the
Centers for Medicare & Medicaid Services.
(4) Demonstration.--The term ``demonstration'' means the
demonstration conducted under this section.
(5) HRSA.--The term ``HRSA'' means the Administrator of the
Health Resources and Services Administration.
(6) HUD.--The term ``HUD'' means the Secretary of Housing
and Urban Development.
(7) Medicare; medicaid.--The terms ``Medicare'' and
``Medicaid'' mean the programs under titles XVIII and XIX,
respectively, of the Social Security Act.
(8) National hiv/aids strategy for the united states.--The
term ``National HIV/AIDS Strategy for the United States'' has
the meaning given such term under section 241A(b) of the Public
Health Service Act.
(9) Ryan white hiv/aids program.--The term ``Ryan White
HIV/AIDS Program'' means the program under title XXVI of the
Public Health Service Act.
(10) SAMHSA.--The term ``SAMHSA'' means the Substance Abuse
and Mental Health Services Administration.
(11) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services, acting through CMMI.
SEC. 404. REPORT ON THE IMPLEMENTATION OF THE NATIONAL HIV/AIDS
STRATEGY.
(a) Report Required.--The President, in consultation with the heads
of all relevant agencies including the Department of Education, the
Department of Health and Human Services, the Department of Housing and
Urban Development, the Department of Justice, the Department of Labor,
the Department of Veterans Affairs, and the Social Security
Administration, shall enter an arrangement not later than 6 months
after the date of the enactment of this Act with the Institute of
Medicine of the National Academies (or, if the Institute declines to
enter into such an arrangement, another appropriate entity)--
(1) to prepare a report on the status of the implementation
of the National HIV/AIDS Strategy; and
(2) to transmit such report to the Congress and make
publicly available a report.
(b) Contents.--The report required by subsection (a) shall include
a description, analysis, and evaluation of--
(1) key steps taken by the Federal Government toward the
achievement of the goals of the National HIV/AIDS Strategy,
including the goals of--
(A) reducing the number of people who become
infected with HIV;
(B) increasing access to care and optimizing health
outcomes for people living with HIV; and
(C) reducing HIV-related health disparities;
(2) the extent to which the National HIV/AIDS Strategy has
improved coordination of efforts to maximize the effective
delivery of HIV/AIDS prevention, care, and treatment services
at the community level, including coordination--
(A) within and among Federal agencies and
departments;
(B) between the Federal Government and State and
local governments and health departments;
(C) between the Federal Government and nonprofit
foundations and civil society organizations, including
community- and faith-based organizations focused on
addressing the issue of HIV/AIDS; and
(D) between the Federal Government and private
businesses;
(3) efforts by the Federal Government to educate, involve,
and establish and strengthen partnerships with civil society
organizations, including community- and faith-based
organizations, in order to implement the National HIV/AIDS
Strategy and achieve its goals;
(4) how Federal resources are being deployed to implement
the Strategy, including--
(A) the amount of funding used to date, by each
Federal agency and department, to implement the
National HIV/AIDS Strategy;
(B) a brief summary for each Federal agency and
department of the number and function of all Federal
employees assisting in implementing the Strategy; and
(C) an estimate of the amount of funding necessary
to implement the National HIV/AIDS Strategy, by each
Federal agency and department, for the next fiscal
year; and
(5) what additional steps, if any, are necessary to fully
implement the National HIV/AIDS Strategy, including--
(A) whether any existing statutory laws, policies,
or regulations are impeding the implementation of the
National HIV/AIDS Strategy, at the Federal, State, or
local level, and whether any changes to such laws,
policies, or regulations are necessary or recommended;
and
(B) whether any Federal agencies or departments
require additional statutory authority to effectively
carry out their duties as part of the National HIV/AIDS
Strategy.
(c) Use of Previously Appropriated Funds.--Funding for the report
required under subsection (a) shall be derived from discretionary funds
of the departments and agencies specified in such subsection.
DIVISION B--ENDING HIV/AIDS GLOBALLY
TITLE X--GLOBAL HIV/AIDS-FREE GENERATION STRATEGY
SEC. 1001. GLOBAL HIV/AIDS-FREE GENERATION STRATEGY.
(a) Strategy.--The President, acting through the Coordinator of
United States Government Activities to Combat HIV/AIDS Globally, shall
establish a comprehensive, integrated, 5-year strategy to expand and
improve efforts to combat global HIV/AIDS, while promoting efficiency
and maximizing results. The strategy shall be referred to as the
``Global HIV/AIDS-Free Generation Strategy''.
(b) Contents.--The strategy shall--
(1) accelerate progress toward achieving the United States
goal of an AIDS-free generation;
(2) establish a limited number of measurable targets to
accelerate reductions in HIV incidence and HIV/AIDS-related
morbidity and mortality;
(3) strengthen existing and future compacts and framework
agreements authorized under section 104A(d)(8) of the Foreign
Assistance Act of 1961 (22 U.S.C. 2151b-2(d)(8));
(4) strengthen engagement with diplomatic efforts at all
levels of government to--
(A) continue to identify and promote linkages
between efforts to combat HIV/AIDS and other health
development issues and human rights issues;
(B) encourage and assist national governments to
pursue policies and legal frameworks that facilitate
and enable effective responses to HIV prevention, care,
and treatment services; and
(C) increase financial accountability;
(5) provide a plan to--
(A) support early diagnosis and initiation of HIV
treatment to achieve accelerated reductions of
incidence and morbidity;
(B) eliminate vertical transmission of HIV from
mother to child and support early diagnosis and
initiation of HIV treatment in infants and children;
(C) intensify efforts to expand access to
voluntarily medical male circumcision, male and female
condoms and other proven-effective HIV prevention
interventions, in combination with other evidence-based
modalities and structural interventions;
(D) reduce the risk of HIV infection and address
the HIV-related needs of sex workers, men who have sex
with men, transgender people, and people who inject
drugs;
(E) increase gender equity in HIV/AIDS programs and
services, including access to voluntary family planning
and reproductive health services and reducing violence
and coercion;
(F) expand partnership with implementers,
researchers, and academic organizations to improve the
science that guides the global response to HIV/AIDS;
(G) provide capacity development support to
increase meaningful engagement of civil society,
especially local indigenous organizations, that work in
the areas of human rights, women's and young people's
health and rights, and gay, lesbian, bisexual, and
transgender rights, in the development, implementation,
monitoring, and evaluation of United States-funded
programs;
(H) advance the efforts of developing countries to
develop health systems capable of managing their
epidemics, respond to broader health needs impacting
affected communities, and address new and emerging
health concerns; and
(I) defend, protect, and fulfill the human rights
of people living with HIV and those most at risk of HIV
infection.
(c) Consultation.--In developing the strategy, the President,
acting through the Coordinator of United States Government Activities
to Combat HIV/AIDS Globally, shall consult with--
(1) each executive branch agency administering United
States foreign assistance related to--
(A) improving global health;
(B) strengthening financial management systems; and
(C) monitoring and promoting human rights and
democracy;
(2) personnel at United States embassies and country
missions involved in the administration of the types of United
States foreign assistance described in paragraph (1);
(3) the appropriate congressional committees with
jurisdiction over the agencies described in paragraph (1);
(4) civil society and nongovernmental organizations engaged
in improving health care and health outcomes in developing
countries, including indigenous community and faith-based
organizations;
(5) international organizations engaged in improving health
care and health outcomes in developing countries and of which
the United States is a voting member, with which the United
States coordinates the delivery of foreign assistance, or to
which the United States contributes funding for the purpose of
providing such assistance;
(6) academic organizations, private foundations,
businesses, and other organizations engaged in improving health
care and health outcomes in developing countries and not
receiving United States funding for such purposes;
(7) other donor nations engaged in improving health care
and health outcomes in developing countries;
(8) countries receiving health-related United States
foreign assistance; and
(9) any other global, regional, or subregional
organizations or partnerships engaged in improving health care
and health outcomes in developing countries.
(d) Report.--Not later than 1 year after the date of the enactment
of this Act, the President shall submit to Congress a report that sets
forth the strategy described in this section.
TITLE XI--USING FUNDS STRATEGICALLY TO MAXIMIZE RESULTS
SEC. 1101. SUPPORT FOR OPERATIONS RESEARCH TO IMPROVE PROGRAM DELIVERY,
EFFICIENCY, IMPACT, AND EFFECTIVENESS.
(a) Sense of Congress.--It is the sense of the Congress that there
is a need and urgency to expand the range of interventions for
preventing the transmission of HIV, including behavioral prevention
research, operations research to optimize combination HIV prevention,
and research on medical technology to prevent HIV infection, including
microbicides, cost-effective female condoms, Pre-Exposure Prophylaxis
(PrEP), multipurpose technologies for the prevention of HIV and
unintended pregnancy, and vaccines.
(b) Statement of Policy.--It should be the policy of the United
States to ensure that efforts to combat HIV/AIDS globally should
expand, intensify, and coordinate operations research to improve the
quality, delivery, and impact of programming, including with respect
to--
(1) services appropriate for men who have sex with men,
transgender people, people who inject drugs, and sex workers;
(2) structural interventions to remove barriers that
inhibit effective implementation of HIV/AIDS-related foreign
assistance, including the analysis of laws and policies that
have a negative health impact and put individuals at increased
risk of HIV infection;
(3) scalable combination of prevention and treatment
approaches to HIV/AIDS;
(4) prevention and management of co-morbidities such as
tuberculosis, malaria, and viral hepatitis; and
(5) identification and follow up of HIV-positive infants
and children in resource-limited settings to increase the
proportion of children accessing HIV treatment and care
services.
SEC. 1102. INCREASING COORDINATION AND INTEGRATION OF HIV/AIDS PROGRAMS
WITH DEVELOPMENT PROGRAMS.
(a) Statement of Policy.--It should be the policy of the United
States to ensure that efforts to combat HIV/AIDS globally should
maximize efficiencies and the integration of services and programs to
achieve reduction in HIV transmission rates and the burden of HIV-
related morbidity and mortality, by means that include--
(1) ensuring that women and adolescent girls with HIV or
who are at risk of HIV infection and who do not wish to become
pregnant have access to voluntary contraceptive services,
including a range of contraceptive options, and voluntary
counseling to plan families, either directly or through
meaningful referrals to existing United States Agency for
International Development or local family planning programs
that provide counseling and a range of contraceptive options;
(2) integrating tuberculosis interventions with HIV
services, including case-finding and tuberculosis treatment,
expanding tuberculosis preventive therapy, and reducing other
opportunistic infections that accompany HIV/AIDS;
(3) ensuring young people with HIV are provided with
confidential and affordable access to youth-friendly
comprehensive sexual and reproductive health services and
supplies, including male and female condoms for the prevention
of pregnancy and sexually transmitted diseases, as relevant;
and
(4) working to promote and protect the human rights of
people living with HIV, including men who have sex with men,
transgender people, people who inject drugs, sex workers, and
other vulnerable populations, including indigenous people,
migrants, internally displaced people, young people,
incarcerated populations, and people with disabilities.
(b) Report.--Not later than 180 days after the date of the
enactment of this Act, the Secretary of State shall submit to the
appropriate congressional committees a report describing the
utilization of efficiencies in the delivery of HIV/AIDS treatment
services within and between United States-funded bilateral and
multilateral programs and partner countries, including to the extent
that such gains in efficiencies are being exhausted.
SEC. 1103. INCREASING PROGRAM EFFECTIVENESS AND SUSTAINABILITY TO
ACHIEVE SUCCESSFUL COUNTRY OWNERSHIP.
(a) Statement of Policy.--It should be the policy of the United
States to ensure that efforts to combat HIV/AIDS globally should help
developing countries significantly decrease the burden of HIV,
strengthen and improve their health systems, help build country
ownership, and increase financial accountability to ensure
sustainability and equitable access to health services, including by--
(1) assisting developing countries create, strengthen, and
implement their own evidence-based national HIV/AIDS
strategies, by means that include--
(A) supporting early diagnosis and initiation of
HIV and tuberculosis treatment to achieve accelerated
reductions of incidence and morbidity;
(B) eliminating the vertical transmission of HIV
from mother to child and supporting early diagnosis and
initiation of HIV treatment in infants and children;
(C) intensifying efforts to expand access to
voluntary medical male circumcision, male and female
condoms, harm reduction services, and other proven-
effective HIV prevention interventions, in combination
with other evidence-based modalities, including
structural interventions;
(D) intensifying efforts to eliminate HIV
infections among populations that are often at greatest
risk, including sex workers, men who have sex with men,
and people who inject drugs, and addressing the HIV-
related needs, including access to ART, of those
already infected;
(E) ensuring young people are provided with
comprehensive knowledge, skill-building programs, in
and out of school, to make informed and responsible
decisions for their sexual health, and are provided
with confidential and affordable access to youth-
friendly comprehensive sexual and reproductive health
services and supplies, including male and female
condoms;
(F) ensuring women with HIV or who are at risk of
HIV infection and who do not wish to become pregnant
have access to voluntary contraceptive services and
commodities, and women who desire pregnancy have access
to family planning counseling and maternal health
services free of judgment and discrimination; and
(G) encouraging policy changes to eliminate
discriminatory and stigmatizing polices that stand in
the way of access to health services by marginalized
and poor populations including punitive laws against
HIV exposure and potential transmission, sex work,
same-sex behavior, drug use, and gender expression;
(2) supporting meaningful community involvement and
participation, inclusive of poor, vulnerable, or marginalized
populations and their representative indigenous and civil
society organizations, in decisionmaking related to national
HIV/AIDS strategies and the delivery of health services,
including in decisions related to the adoption of health
policies and the total amount and distribution of health
funding;
(3) assisting countries to coordinate, regulate, and
harmonize the delivery of health services provided by the
United States and nongovernmental organizations, including
community and faith-based organizations, private foundations,
international organizations, and other donors, and to
coordinate or integrate such services with the health system to
the maximum extent practicable;
(4) using, to the maximum extent practicable, local and
regional entities for the provision of technical assistance,
and where the capacity of such entities is insufficient,
supporting capacity building to enable such entities to provide
such assistance;
(5) strengthening procurement and supply chain logistics to
help prevent drug and commodity stock outs, including male and
female condom shortages, and to help ensure the eventual
provision of microbicides for HIV prevention; and
(6) providing technical assistance and support to national
ministries of health, or their equivalents, and other relevant
ministries in overseeing the health systems of their countries
and monitoring and evaluating the effectiveness of such systems
in reducing mortality and improving health outcomes, including
preparing for the provision of HIV/AIDS, voluntary family
planning, non-communicable diseases, and reproductive health
services in emergency situations.
(b) Report.--Not later than 180 days after the date of the
enactment of this Act, the Secretary of State shall submit to the
appropriate congressional committees a report identifying benchmarks
that are directly relevant to significantly decreasing the burden of
the epidemic in each country receiving HIV-related foreign assistance
and provide context for helping countries and civil society to build
country ownership.
TITLE XII--ADDRESSING LEGAL AND POLICY BARRIERS TO ACCESSING HEALTH
CARE
Subtitle A--General Provisions
SEC. 1201. SUPPORT FOR LAWS AND REGULATIONS THAT IMPROVE HEALTH
OUTCOMES AND PROMOTE HUMAN RIGHTS.
It should be the policy of the United States to ensure that United
States foreign assistance should encourage and assist national
governments of developing countries to pursue policies and legal
frameworks that improve health outcomes, including policies and legal
frameworks that--
(1) are medically accurate and evidence-based and adhere to
the latest global public health standards for prevention,
treatment, and care;
(2) promote and improve the status of women and youth,
ensuring their ability to access and use health services
without fear or risk of gender-based violence, reprisal,
discrimination, stigmatization, arrest, or other mistreatment;
(3) work to remove criminalization of, stigmatization of,
and discrimination against poor, vulnerable, or marginalized
populations and enact laws and policies to promote and protect
the rights of such populations;
(4) avoid, to the maximum extent possible, reliance on
criminal laws and sanctions to address health issues;
(5) incorporate relevant policy guidance that addresses
structural barriers to accessing health care; and
(6) prioritize the creation of a legal, political, and
social environment that enables access to health services by
all members of the population.
SEC. 1202. INTENSIFYING EFFORTS TO ESTABLISH EFFECTIVE PROGRAMS FOR
ENGAGING KEY AFFECTED POPULATIONS.
It should be the policy of the United States to ensure that efforts
to combat HIV/AIDS globally should intensify efforts to establish
effective programs for engaging men who have sex with men, transgender
people, people who inject drugs, and sex workers in HIV prevention,
care, and treatment initiatives, by means that include--
(1) ensuring those eligible for treatment receive
antiretroviral treatment;
(2) providing sterile syringes, education, and outreach and
treatment for drug dependence for injecting drug users through
a comprehensive package of services;
(3) providing sexual health services, condoms, and other
HIV prevention services to sex workers, their clients, and
partners; and
(4) defending human rights and inherent dignity by
addressing laws and practices that prevent people from
accessing services and providing legal and social services to
individuals and communities to facilitate access to services
and to reduce violence, stigma, and discrimination.
SEC. 1203. ENSURING UNITED STATES TRADE POLICY DOES NOT RESTRICT ACCESS
TO AFFORDABLE MEDICINES.
In administering title III of the Trade Act of 1974 (19 U.S.C. 2411
et seq.), the United States Government shall not seek, through
negotiation or otherwise, the revocation or revision of any
intellectual property law or policy of a low- or middle-income country
that regulates HIV and opportunistic infection pharmaceuticals or
medical technologies if the law or policy of the country--
(1) promotes access to affordable HIV and opportunistic
infection pharmaceuticals or medical technologies for affected
populations in that country; and
(2) provides intellectual property protection consistent
with the Agreement on Trade-Related Aspects of Intellectual
Property Rights referred to in section 101(d)(15) of the
Uruguay Round Agreements Act (19 U.S.C. 3511(d)(15)).
Subtitle B--Repeal of Certain Provisions of Public Law 108-25
SEC. 1211. REPEAL OF ``CONSCIENCE CLAUSE'' REQUIREMENT FOR ELIGIBILITY
FOR ASSISTANCE.
Section 301 of the United States Leadership Against HIV/AIDS,
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7631) is amended by
striking subsection (d).
SEC. 1212. REPEAL OF LIMITATION ON USE OF FUNDS FOR ASSISTANCE FOR SEX
WORKERS.
Section 301 of the United States Leadership Against HIV/AIDS,
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7631), as amended by
section 711 of this Act, is further amended by striking subsections (e)
and (f).
SEC. 1213. REPEAL OF REPORTING REQUIREMENT ON ACTIVITIES PROMOTING
ABSTINENCE AND RELATED ACTIVITIES.
Section 403(a)(2) of the United States Leadership Against HIV/AIDS,
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7673(a)(2)) is
amended--
(1) by striking ``(2) Prevention strategy.--'' and all that
follows through ``In carrying out paragraph (1)'' and inserting
``(2) Prevention strategy.--In carrying out paragraph (1)'';
and
(2) by striking subparagraph (B).
SEC. 1214. EFFECTIVE DATE.
This subtitle and the amendments made by this subtitle--
(1) take effect on the date of the enactment of this Act;
and
(2) apply with respect to funds made available to carry out
the United States Leadership Against HIV/AIDS, Tuberculosis,
and Malaria Act of 2003 or any amendment made by that Act on or
after such date of enactment.
TITLE XIII--DEFINITIONS
SEC. 1301. DEFINITIONS.
In this division:
(1) Appropriate congressional committees.--The term
``appropriate congressional committees'' means--
(A) the Committee on Foreign Affairs and the
Committee on Appropriations of the House of
Representatives; and
(B) the Committee on Foreign Relations and the
Committee on Appropriations of the Senate.
(2) AIDS.--The term ``AIDS'' means the acquired immune
deficiency syndrome.
(3) HIV.--The term ``HIV'' means the human immunodeficiency
virus, the pathogen that causes AIDS.
(4) HIV/AIDS.--The term ``HIV/AIDS'' means, with respect to
an individual, an individual who is infected with HIV or living
with AIDS.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Foreign Affairs, Education and the Workforce, the Judiciary, Armed Services, Financial Services, and Ways and Means, 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 Foreign Affairs, Education and the Workforce, the Judiciary, Armed Services, Financial Services, and Ways and Means, 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 Foreign Affairs, Education and the Workforce, the Judiciary, Armed Services, Financial Services, and Ways and Means, 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 Foreign Affairs, Education and the Workforce, the Judiciary, Armed Services, Financial Services, and Ways and Means, 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 Foreign Affairs, Education and the Workforce, the Judiciary, Armed Services, Financial Services, and Ways and Means, 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.
Llama 3.2 · runs locally in your browser
Ask anything about this bill. The AI reads the full text to answer.
Enter to send · Shift+Enter for new line
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Foreign Affairs, Education and the Workforce, the Judiciary, Armed Services, Financial Services, and Ways and Means, 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 Foreign Affairs, Education and the Workforce, the Judiciary, Armed Services, Financial Services, and Ways and Means, 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.
Sponsor introductory remarks on measure. (CR H5026)
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Trade.
Referred to the Subcommittee on the Constitution.
Referred to the Subcommittee on Military Personnel.
Referred to the Subcommittee on Early Childhood, Elementary, and Secondary Education.
Referred to the Subcommittee on Higher Education and Workforce Training.
Referred to the Subcommittee on Insurance, Housing and Community Opportunity.