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Plain Text: Old Language
TITLE XXVI-HIV HEALTH CARE SERVICES PROGRAM
PART A-EMERGENCY RELIEF FOR AREAS WITH SUBSTANTIAL NEED FOR SERVICES
SEC.
2601. [300ff-11] ESTABLISHMENT OF PROGRAM OF GRANTS.
(a) ELIGIBLE AREAS.-The
Secretary, acting through the Administrator of the Health Resources and Services
Administration, shall, subject to subsections (b) through (d), make grants in
accordance with section 2603 for the purpose of assisting in the provision of
the services specified in section 2604 in any metropolitan area for which there
has been reported to the Director of the Centers for Disease Control and Prevention
a cumulative total of more than 2,000 cases of acquired immune deficiency syndrome
for the most recent period of 5 calendar years for which such data are available.
(b)
REQUIREMENT REGARDING CONFIRMATION OF CASES.-The Secretary may not make a grant
under subsection (a) for a metropolitan area unless, before making any payments
under the grant, the cases of acquired immune deficiency syndrome reported for
purposes of such subsection have been confirmed by the Secretary, acting through
the Director of the Centers for Disease Control and Prevention.
(c) REQUIREMENTS
REGARDING POPULATION.-
(1) NUMBER OF INDIVIDUALS.-
(A) IN GENERAL.-Except
as provided in subparagraph (B), the Secretary may not make a grant under this
section for a metropolitan area unless the area has a population of 500,000 or
more individuals.
(B) LIMITATION.-Subparagraph (A) does not apply to any metropolitan
area that was an eligible area under this part for fiscal year 1995 or any prior
fiscal year.
(2) GEOGRAPHIC BOUNDARIES.-For purposes of eligibility under this
part, the boundaries of each metropolitan area are the boundaries that were in
effect for the area for fiscal year 1994.
(d) CONTINUED STATUS AS ELIGIBLE
AREA.-Notwithstanding any other provision of this section, a metropolitan area
that was an eligible area under this part for fiscal year 1996 is an eligible
area for fiscal year 1997 and each subsequent fiscal year.
SEC.
2602. [300ff-12] ADMINISTRATION AND PLANNING COUNCIL.
(a) ADMINISTRATION.-
(1)
IN GENERAL.-Assistance made available under grants awarded under this part shall
be directed to the chief elected official of the city or urban county that administers
the public health agency that provides outpatient and ambulatory services to the
greatest number of individuals with AIDS, as reported to and confirmed by the
Centers for Disease Control and Prevention, in the eligible area that is awarded
such a grant.
(2) REQUIREMENTS.-
(A) IN GENERAL.-To receive assistance under
section 2601(a), the chief elected official of the eligible area involved shall-
(i)
establish, through intergovernmental agreements with the chief elected officials
of the political subdivisions described in subparagraph (B), an administrative
mechanism to allocate funds and services based on-
(I) the number of AIDS cases
in such subdivisions;
(II) the severity of need for outpatient and ambulatory
care services in such subdivisions; and
(III) the health and support services
personnel needs of such subdivisions; and
(ii) establish an HIV health services
planning council in accordance with subsection (b).
(B) LOCAL POLITICAL SUBDIVISION.-The
political subdivisions referred to in subparagraph (A) are those political subdivisions
in the eligible area-
(i) that provide HIV-related health services; and
(ii)
for which the number of cases reported for purposes of section 2601(a) constitutes
not less than 10 percent of the number of such cases reported for the eligible
area.
(b) HIV HEALTH SERVICES PLANNING COUNCIL.-
(1) ESTABLISHMENT.-To be
eligible for assistance under this part, the chief elected official described
in subsection (a)(1) shall establish or designate an HIV health services planning
council that shall reflect in its composition the demographics of the population
of individuals with HIV disease in the eligible area involved, with particular
consideration given to disproportionately affected and historically underserved
groups and subpopulations. Nominations for membership on the council shall be
identified through an open process and candidates shall be selected based on locally
delineated and publicized criteria. Such criteria shall include a conflict-of-interest
standard that is in accordance with paragraph (5).
(2) REPRESENTATION.-The
HIV health services planning council shall include representatives of-
(A)
health care providers, including federally qualified health centers;
(B) community-based
organizations serving affected populations and AIDS service organizations;
(C)
social service providers, including providers of housing and homeless services;
(D)
mental health and substance abuse providers;
(E) local public health agencies;
(F)
hospital planning agencies or health care planning agencies;
(G) affected communities,
including people with HIV disease and historically underserved groups and subpopulations;
(H)
nonelected community leaders;
(I) State government (including the State medicaid
agency and the agency administering the program under part B);
(J) grantees
under subpart II of part C;
(K) grantees under section 2671, or, if none are
operating in the area, representatives of organizations with a history of serving
children, youth, women, and families living with HIV and operating in the area;
(L)
grantees under other Federal HIV programs, including but not limited to providers
of HIV prevention services; and
(M) representatives of individuals who formerly
were Federal, State, or local prisoners, were released from the custody of the
penal system during the preceding 3 years, and had HIV disease as of the date
on which the individuals were so released.
(3) METHOD OF PROVIDING FOR COUNCIL.-
(A)
IN GENERAL.-In providing for a council for purposes of paragraph (1), a chief
elected official receiving a grant under section 2601(a) may establish the council
directly or designate an existing entity to serve as the council, subject to subparagraph
(B).
(B) CONSIDERATION REGARDING DESIGNATION OF COUNCIL.-In making a determination
of whether to establish or designate a council under subparagraph (A), a chief
elected official receiving a grant under section 2601(a) shall give priority to
the designation of an existing entity that has demonstrated experience in planning
for the HIV health care service needs within the eligible area and in the implementation
of such plans in addressing those needs. Any existing entity so designated shall
be expanded to include a broad representation of the full range of entities that
provide such services within the geographic area to be served.
(4) DUTIES.-The
planning council established or designated under paragraph (1) shall-
(A) determine
the size and demographics of the population of individuals with HIV disease;
(B)
determine the needs of such population, with particular attention to-
(i)
individuals with HIV disease who know their HIV status and are not receiving HIV-related
services; and
(ii) disparities in access and services among affected subpopulations
and historically underserved communities;
(C) establish priorities for the
allocation of funds within the eligible area, including how best to meet each
such priority and additional factors that a grantee should consider in allocating
funds under a grant based on the-
(i) size and demographics of the population
of individuals with HIV disease (as determined under subparagraph (A)) and the
needs of such population (as determined under subparagraph (B));
(ii) demonstrated
(or probable) cost effectiveness and outcome effectiveness of proposed strategies
and interventions, to the extent that data are reasonably available;
(iii)
priorities of the communities with HIV disease for whom the services are intended;
(iv)
coordination in the provision of services to such individuals with programs for
HIV prevention and for the prevention and treatment of substance abuse, including
programs that provide comprehensive treatment for such abuse;
(v) availability
of other governmental and non-governmental resources, including the State medicaid
plan under title XIX of the Social Security Act and the State Children's Health
Insurance Program under title XXI of such Act to cover health care costs of eligible
individuals and families with HIV disease; and
(vi) capacity development needs
resulting from disparities in the availability of HIV-related services in historically
underserved communities;
(D) develop a comprehensive plan for the organization
and delivery of health and support services described in section 2604 that-
(i)
includes a strategy for identifying individuals who know their HIV status and
are not receiving such services and for informing the individuals of and enabling
the individuals to utilize the services, giving particular attention to eliminating
disparities in access and services among affected subpopulations and historically
underserved communities, and including discrete goals, a timetable, and an appropriate
allocation of funds;
(ii) includes a strategy to coordinate the provision of
such services with programs for HIV prevention (including outreach and early intervention)
and for the prevention and treatment of substance abuse (including programs that
provide comprehensive treatment services for such abuse); and
(iii) is compatible
with any State or local plan for the provision of services to individuals with
HIV disease;
(E) assess the efficiency of the administrative mechanism in rapidly
allocating funds to the areas of greatest need within the eligible area, and at
the discretion of the planning council, assess the effectiveness, either directly
or through contractual arrangements, of the services offered in meeting the identified
needs;
(F) participate in the development of the statewide coordinated statement
of need initiated by the State public health agency responsible for administering
grants under part B;
(G) establish methods for obtaining input on community
needs and priorities which may include public meetings (in accordance with paragraph
(7)), conducting focus groups, and convening ad-hoc panels; and
(H) coordinate
with Federal grantees that provide HIV-related services within the eligible area.
(5)
CONFLICTS OF INTEREST.-
(A) IN GENERAL.-The planning council under paragraph
(1) may not be directly involved in the administration of a grant under section
2601(a). With respect to compliance with the preceding sentence, the planning
council may not designate (or otherwise be involved in the selection of) particular
entities as recipients of any of the amounts provided in the grant.
(B) REQUIRED
AGREEMENTS.-An individual may serve on the planning council under paragraph (1)
only if the individual agrees that if the individual has a financial interest
in an entity, if the individual is an employee of a public or private entity,
or if the individual is a member of a public or private organization, and such
entity or organization is seeking amounts from a grant under section 2601(a),
the individual will not, with respect to the purpose for which the entity seeks
such amounts, participate (directly or in an advisory capacity) in the process
of selecting entities to receive such amounts for such purpose.
(C) COMPOSITION
OF COUNCIL.-The following applies regarding the membership of a planning council
under paragraph (1):
(i) Not less than 33 percent of the council shall be individuals
who are receiving HIV-related services pursuant to a grant under section 2601(a),
are not officers, employees, or consultants to any entity that receives amounts
from such a grant, and do not represent any such entity, and reflect the demographics
of the population of individuals with HIV disease as determined under paragraph
(4)(A). For purposes of the preceding sentence, an individual shall be considered
to be receiving such services if the individual is a parent of, or a caregiver
for, a minor child who is receiving such services.
(ii) With respect to membership
on the planning council, clause (i) may not be construed as having any effect
on entities that receive funds from grants under any of parts B through F but
do not receive funds from grants under section 2601(a), on officers or employees
of such entities, or on individuals who represent such entities.
(6) GRIEVANCE
PROCEDURES.-A planning council under paragraph (l) shall develop procedures for
addressing grievances with respect to funding under this part, including procedures
for submitting grievances that cannot be resolved to binding arbitration. Such
procedures shall be described in the by-laws of the planning council and be consistent
with the requirements of subsection (c).
(7) PUBLIC DELIBERATIONS.-With respect
to a planning council under paragraph (1), the following applies:
(A) The council
may not be chaired solely by an employee of the grantee under section 2601(a).
(B)
In accordance with criteria established by the Secretary:
(i) The meetings
of the council shall be open to the public and shall be held only after adequate
notice to the public.
(ii) The records, reports, transcripts, minutes, agenda,
or other documents which were made available to or prepared for or by the council
shall be available for public inspection and copying at a single location.
(iii)
Detailed minutes of each meeting of the council shall be kept. The accuracy of
all minutes shall be certified to by the chair of the council.
(iv) This subparagraph
does not apply to any disclosure of information of a personal nature that would
constitute a clearly unwarranted invasion of personal privacy, including any disclosure
of medical information or personnel matters.
(c) GRIEVANCE PROCEDURES.-
(1)
FEDERAL RESPONSIBILITY.-
(A) MODELS.-The Secretary shall, through a process
that includes consultations with grantees under this part and public and private
experts in grievance procedures, arbitration, and mediation, develop model grievance
procedures that may be implemented by the planning council under subsection (b)(1)
and grantees under this part. Such model procedures shall describe the elements
that must be addressed in establishing local grievance procedures and provide
grantees with flexibility in the design of such local procedures.
(B) REVIEW.-The
Secretary shall review grievance procedures established by the planning council
and grantees under this part to determine if such procedures are adequate. In
making such a determination, the Secretary shall assess whether such procedures
permit legitimate grievances to be filed, evaluated, and resolved at the local
level.
(2) GRANTEES-To be eligible to receive funds under this part, a grantee
shall develop grievance procedures that are determined by the Secretary to be
consistent with the model procedures developed under paragraph (1)(A). Such procedures
shall include a process for submitting grievances to binding arbitration.
(d)
PROCESS FOR ESTABLISHING ALLOCATION PRIORITIES.-Promptly after the date of the
submission of the report required in section 501(b) of the Ryan White CARE Act
Amendments of 2000 (relating to the relationship between epidemiological measures
and health care for certain individuals with HIV disease), the Secretary, in consultation
with planning councils and entities that receive amounts from grants under section
2601(a) or 2611, shall develop epidemiologic measures-
(1) for establishing
the number of individuals living with HIV disease who are not receiving HIV-related
health services; and
(2) for carrying out the duties under subsection (b)(4)
and section 2617(b).
(e) TRAINING GUIDANCE AND MATERIALS.-The Secretary shall
provide to each chief elected official receiving a grant under section 2601(a)
guidelines and materials for training members of the planning council under paragraph
(1) regarding the duties of the council.
SEC.
2603. [300ff-13] TYPE AND DISTRIBUTION OF GRANTS.
(a) GRANTS BASED ON RELATIVE
NEED OF AREA.-
(1) IN GENERAL.-In carrying out section 2601(a), the Secretary
shall make a grant for each eligible area for which an application under section
2605(a) has been approved. Each such grant shall be made in an amount determined
in accordance with paragraph (3).
(2) EXPEDITED DISTRIBUTION.-Not later than
60 days after an appropriation becomes available to carry out this part for a
fiscal year, the Secretary shall, except in the case of waivers granted under
section 2605(c), disburse 50 percent of the amount appropriated under section
2677 for such fiscal year through grants to eligible areas under section 2601(a),
in accordance with paragraph (3). The Secretary shall reserve an additional percentage
of the amount appropriated under section 2677 for a fiscal year for grants under
part A to make grants to eligible areas under section 2601(a) in accordance with
paragraph (4).
(3) AMOUNT OF GRANT.-
(A) IN GENERAL.-Subject to the extent
of amounts made available in appropriations Acts, a grant made for purposes of
this paragraph to an eligible area shall be made in an amount equal to the product
of-
(i) an amount equal to the amount available for distribution under paragraph
(2) for the fiscal year involved; and
(ii) the percentage constituted by the
ratio of the distribution factor for the eligible area to the sum of the respective
distribution factors for all eligible areas.
(B) DISTRIBUTION FACTOR.-For purposes
of subparagraph (A)(ii), the term "distribution factor" means an amount
equal to the estimated number of living cases of acquired immune deficiency syndrome
in the eligible area involved, as determined under subparagraph (C).
(C) ESTIMATE
OF LIVING CASES.-The amount determined in this subparagraph is an amount equal
to the product of-
(i) the number of cases of acquired immune deficiency syndrome
in the eligible area during each year in the most recent 120-month period for
which data are available with respect to all eligible areas, as indicated by the
number of such cases reported to and confirmed by the Director of the Centers
for Disease Control and Prevention for each year during such period, except that
(subject to subparagraph (D)), for grants made pursuant to this paragraph for
fiscal year 2005 and subsequent fiscal years, the cases counted for each 12-month
period beginning on or after July 1, 2004, shall be cases of HIV disease (as reported
to and confirmed by such Director) rather than cases of acquired immune deficiency
syndrome; and
(ii) with respect to-
(I) the first year during such period,
.06;
(II) the second year during such period, .06;
(III) the third year
during such period, .08;
(IV) the fourth year during such period, .10;
(V)
the fifth year during such period, .16;
(VI) the sixth year during such period,
.16;
(VII) the seventh year during such period, .24;
(VIII) the eighth year
during such period, .40;
(IX) the ninth year during such period, .57; and
(X)
the tenth year during such period, .88.
The yearly percentage described in
subparagraph (ii) shall be updated biennially by the Secretary, after consultation
with the Centers for Disease Control and Prevention, and shall be reported to
the congressional committees of jurisdiction. The first such update shall occur
prior to the determination of grant awards under this part for fiscal year 1998.
Updates shall as applicable take into account the counting of cases of HIV disease
pursuant to clause (i).
(D) DETERMINATION OF SECRETARY REGARDING DATA ON HIV
CASES.-
(i) IN GENERAL.-Not later than July 1, 2004, the Secretary shall determine
whether there is data on cases of HIV disease from all eligible areas (reported
to and confirmed by the Director of the Centers for Disease Control and Prevention)
sufficiently accurate and reliable for use for purposes of subparagraph (C)(i).
In making such a determination, the Secretary shall take into consideration the
findings of the study under section 501(b) of the Ryan White CARE Act Amendments
of 2000 (relating to the relationship between epidemiological measures and health
care for certain individuals with HIV disease).
(ii) EFFECT OF ADVERSE DETERMINATION.-If
under clause (i) the Secretary determines that data on cases of HIV disease is
not sufficiently accurate and reliable for use for purposes of subparagraph (C)(i),
then notwithstanding such subparagraph, for any fiscal year prior to fiscal year
2007 the references in such subparagraph to cases of HIV disease do not have any
legal effect.
(iii) GRANTS AND TECHNICAL ASSISTANCE REGARDING COUNTING OF HIV
CASES.-Of the amounts appropriated under section 318B for a fiscal year, the Secretary
shall reserve amounts to make grants and provide technical assistance to States
and eligible areas with respect to obtaining data on cases of HIV disease to ensure
that data on such cases is available from all states and eligible areas as soon
as is practicable but not later than the beginning of fiscal year 2007.
(E)
UNEXPENDED FUNDS.-The Secretary may, in determining the amount of a grant for
a fiscal year under this paragraph, adjust the grant amount to reflect the amount
of unexpended and uncanceled grant funds remaining at the end of the fiscal year
preceding the year for which the grant determination is to be made. The amount
of any such unexpended funds shall be determined using the financial status report
of the grantee.
(4) INCREASES IN GRANT.-
(A) IN GENERAL.-For each fiscal
year in a protection period for an eligible area, the Secretary shall increase
the amount of the grant made pursuant to paragraph (2) for the area to ensure
that-
(i) for the first fiscal year in the protection period, the grant is
not less than 98 percent of the amount of the grant made for the eligible area
pursuant to such paragraph for the base year for the protection period;
(ii)
for any second fiscal year in such period, the grant is not less than 95 percent
of the amount of such base year grant;
(iii) for any third fiscal year in such
period, the grant is not less than 92 percent of the amount of the base year grant;
(iv)
for any fourth fiscal year in such period, the grant is not less than 89 percent
of the amount of the base year grant; and
(v) for any fifth or subsequent fiscal
year in such period, if, pursuant to paragraph (3)(D)(ii), the references in paragraph
(3)(C)(i) to HIV disease do not have any legal effect, the grant is not less than
85 percent of the amount of the base year grant.
(B) SPECIAL RULE.-If for fiscal
year 2005, pursuant to paragraph (3)(D)(ii), data on cases of HIV disease are
used for purposes of paragraph (3)(C)(i), the Secretary shall increase the amount
of a grant made pursuant to paragraph (2) for an eligible area to ensure that
the grant is not less than 98 percent of the amount of the grant made for the
area in fiscal year 2004.
(C) BASE YEAR; PROTECTION PERIOD.-With respect to
grants made pursuant to paragraph (2) for an eligible area:
(i) The base year
for a protection period is the fiscal year preceding the trigger grant-reduction
year.
(ii) The first trigger grant-reduction year is the first fiscal year
(after fiscal year 2000) for which the grant for the area is less than the grant
for the area for the preceding fiscal year.
(iii) A protection period begins
with the trigger grant-reduction year and continues until the beginning of the
first fiscal year for which the amount of the grant determined pursuant to paragraph
(2) for the area equals or exceeds the amount of the grant determined under subparagraph
(A).
(iv) Any subsequent trigger grant-reduction year is the first fiscal year,
after the end of the preceding protection period, for which the amount of the
grant is less than the amount of the grant for the preceding fiscal year.
(b)
SUPPLEMENTAL GRANTS.-
(1) IN GENERAL.-Not later than 150 days after the date
on which appropriations are made under section 2677 for a fiscal year, the Secretary
shall disburse the remainder of amounts not disbursed under section 2603(a)(2)
for such fiscal year for the purpose of making grants under section 2601(a) to
eligible areas whose application under section 2605(b)-
(A) contains a report
concerning the dissemination of emergency relief funds under subsection (a) and
the plan for utilization of such funds;
(B) demonstrates the severe need in
such area for supplemental financial assistance to combat the HIV epidemic;
(C)
demonstrates the existing commitment of local resources of the area, both financial
and in-kind, to combating the HIV epidemic;
(D) demonstrates the ability of
the area to utilize such supplemental financial resources in a manner that is
immediately responsive and cost effective;
(E) demonstrates that resources
will be allocated in accordance with the local demographic incidence of AIDS including
appropriate allocations for services for infants, children, youth, women, and
families with HIV disease;
(F) demonstrates the inclusiveness of the planning
council membership, with particular emphasis on affected communities and individuals
with HIV disease; and
(G) demonstrates the manner in which the proposed services
are consistent with the local needs assessment and the statewide coordinated statement
of need.
(2) AMOUNT OF GRANT.-
(A) IN GENERAL.-The amount of each grant
made for purposes of this subsection shall be determined by the Secretary based
on a weighting of factors under paragraph (1), with severe need under subparagraph
(B) of such paragraph counting one-third.
(B) SEVERE NEED.-In determining severe
need in accordance with paragraph (1)(B), the Secretary shall consider the ability
of the qualified applicant to expend funds efficiently and the impact of relevant
factors on the cost and complexity of delivering health care and support services
to individuals with HIV disease in the eligible area, including factors such as-
(i)
sexually transmitted diseases, substance abuse, tuberculosis, severe mental illness,
or other comorbid factors determined relevant by the Secretary;
(ii) new or
growing subpopulations of individuals with HIV disease;
(iii) homelessness;
(iv)
the current prevalence of HIV disease;
(v) an increasing need for HIV-related
services, including relative rates of increase in the number of cases of HIV disease;
and
(vi) unmet need for such services, as determined under section 2602(b)(4).
(C)
PREVALENCE.-In determining the impact of the factors described in subparagraph
(B), the Secretary shall, to the extent practicable, use national, quantitative
incidence data that are available for each eligible area. Not later than 18 months
after the date of the enactment of the Ryan White CARE Act Amendments of 2000,
the Secretary shall develop a mechanism to utilize such data. Such a mechanism
shall be modified to reflect the findings of the study under section 501(b) of
the Ryan White CARE Act Amendments of 2000 (relating to the relationship between
epidemiological measures and health care for certain individuals with HIV disease).
In
the absence of such data, the Secretary may consider a detailed description and
qualitative analysis of severe need, as determined under subparagraph (B), including
any local prevalence data gathered and analyzed by the eligible area.
(D)
PRIORITY.-Subsequent to the development of the quantitative mechanism described
in subparagraph (C), the Secretary shall phase in, over a 3-year period beginning
in fiscal year 1998, the use of such a mechanism to determine the severe need
of an eligible area compared to other eligible areas and to determine, in part,
the amount of supplemental funds awarded to the eligible area under this part.
(3)
REMAINDER OF AMOUNTS.-In determining the amount of funds to be obligated under
paragraph (1), the Secretary shall include amounts that are not paid to the eligible
areas under expedited procedures under section 2603(a)(2) as a result of-
(A)
the failure of any eligible area to submit an application under section 2605(c);
or
(B) any eligible area informing the Secretary that such eligible area does
not intend to expend the full amount of its grant under such section.
(4) FAILURE
TO SUBMIT.-
(A) IN GENERAL.-The failure of an eligible area to submit an application
for an expedited grant under section 2603(a)(2) shall not result in such area
being ineligible for a grant under this subsection.
(B) APPLICATION.-The application
of an eligible area submitted under section 2605(b) shall contain the assurances
required under subsection (a) of such section if such eligible area fails to submit
an application for an expedited grant under section 2603(a)(2).
(c) COMPLIANCE
WITH PRIORITIES OF HIV PLANNING COUNCIL.-
Notwithstanding any other provision
of this part, the Secretary, in carrying out section 2601(a), may not make any
grant under subsection (a) or (b) to an eligible area unless the application submitted
by such area under section 2605 for the grant involved demonstrates that the grants
made under subsections (a) and (b) to the area for the preceding fiscal year (if
any) were expended in accordance with the priorities applicable to such year that
were established, pursuant to section 2602(b)(4)(c), by the planning council serving
the area.
SEC.
2604. [300ff-14] USE OF AMOUNTS.
(a) REQUIREMENTS.-The Secretary may not make
a grant under section 2601(a) to the chief elected official of an eligible area
unless such political subdivision agrees that-
(1) subject to paragraph (2),
the allocation of funds and services within the eligible area will be made in
accordance with the priorities established, pursuant to section 2602(b)(3)(A),
by the HIV health services planning council that serves such eligible area; and
(2)
funds provided under section 2601 will be expended only for the purposes described
in subsections (b) and (c).
(b) PRIMARY PURPOSES.-
(1) IN GENERAL.-The
chief elected official shall use amounts received under a grant under section
2601 to provide direct financial assistance to entities described in paragraph
(2) for the purpose of delivering or enhancing HIV-related services, as follows:
(A)
Outpatient and ambulatory health services, including substance abuse treatment,
mental health treatment, and comprehensive treatment services, which shall include
treatment education and prophylactic treatment for opportunistic infections, for
individuals and families with HIV disease.
(B) Outpatient and ambulatory support
services (including case management), to the extent that such services facilitate,
enhance, support, or sustain the delivery, continuity, or benefits of health services
for individuals and families with HIV disease.
(C) Inpatient case management
services that prevent unnecessary hospitalization or that expedite discharge,
as medically appropriate, from inpatient facilities.
(D) Outreach activities
that are intended to identify individuals with HIV disease who know their HIV
status and are not receiving HIV-related services, and that are-
(i) necessary
to implement the strategy under section 2602(b)(4)(D), including activities facilitating
the access of such individuals to HIV-related primary care services at entities
described in paragraph (3)(A);
(ii) conducted in a manner consistent with the
requirements under sections 2605(a)(3) and 2651(b)(2); and
(iii) supplement,
and do not supplant, such activities that are carried out with amounts appropriated
under section 317.
(2) APPROPRIATE ENTITIES.-
(A) IN GENERAL.-Subject to
subparagraph (B), direct financial assistance may be provided under paragraph
(1) to public or nonprofit private entities,, or private for-profit entities if
such entities are the only available provider of quality HIV care in the area,
including hospitals (which may include Department of Veterans Affairs facilities),
community-based organizations, hospices, ambulatory care facilities, community
health centers, migrant health centers, homeless health centers, substance abuse
treatment programs, and mental health programs.
(B) PRIORITY.-In providing
direct financial assistance under paragraph (1) the chief elected official shall
give priority to entities that are currently participating in Health Resources
and Services Administration HIV health care demonstration projects.
(3) EARLY
INTERVENTION SERVICES.-
(A) IN GENERAL.-The purposes for which a grant under
section 2601 may be used include providing to individuals with HIV disease early
intervention services described in section 2651(b)(2), with follow-up referral
provided for the purpose of facilitating the access of individuals receiving the
services to HIV-related health services. The entities through which such services
may be provided under the grant include public health departments, emergency rooms,
substance abuse and mental health treatment programs, detoxification centers,
detention facilities, clinics regarding sexually transmitted diseases, homeless
shelters, HIV disease counseling and testing sites, health care points of entry
specified by eligible areas, federally qualified health centers, and entities
described in section 2652(a) that constitute a point of access to services by
maintaining referral relationships.
(B) CONDITIONS.-With respect to an entity
that proposes to provide early intervention services under subparagraph (A), such
subparagraph applies only if the entity demonstrates to the satisfaction of the
chief elected official for the eligible area involved that-
(i) Federal, State,
or local funds are otherwise inadequate for the early intervention services the
entity proposes to provide; and
(ii) the entity will expend funds pursuant
to such subparagraph to supplement and not supplant other funds available to the
entity for the provision of early intervention services for the fiscal year involved.
(4)
PRIORITY FOR WOMEN, INFANTS AND CHILDREN.-
(A) IN GENERAL.-For the purpose
of providing health and support services to infants, children, youth, and women
with HIV disease, including treatment measures to prevent the perinatal transmission
of HIV, the chief elected official of an eligible area, in accordance with the
established priorities of the planning council, shall for each of such populations
in the eligible area use, from the grants made for the area under section 2601(a)
for a fiscal year, not less than the percentage constituted by the ratio of the
population involved (infants, children, youth, or women in such area) with acquired
immune deficiency syndrome to the general population in such area of individuals
with such syndrome.
(B) WAIVER.-With respect to the population involved, the
Secretary may provide to the chief elected official of an eligible area a waiver
of the requirement of subparagraph (A) if such official demonstrates to the satisfaction
of the Secretary that the population is receiving HIV-related health services
through the State medicaid program under title XIX of the Social Security Act,
the State children's health insurance program under title XXI of such Act, or
other Federal or State programs.
(c) QUALITY MANAGEMENT.-
(1) REQUIREMENT.-The
chief elected official of an eligible area that receives a grant under this part
shall provide for the establishment of a quality management program to assess
the extent to which HIV health services provided to patients under the grant are
consistent with the most recent Public Health Service guidelines for the treatment
of HIV disease and related opportunistic infection, and as applicable, to develop
strategies for ensuring that such services are consistent with the guidelines
for improvement in the access to and quality of HIV health services.
(2) USE
OF FUNDS.-From amounts received under a grant awarded under this part for a fiscal
year, the chief elected official of an eligible area may (in addition to amounts
to which subsection (f)(1) applies) use for activities associated with the quality
management program required in paragraph (1) not more than the lesser of-
(A)
5 percent of amounts received under the grant; or
(B) $3,000,000.
(d) LIMITED
EXPENDITURES FOR PERSONNEL NEEDS.-
(1) IN GENERAL.-A chief elected official,
in accordance with paragraph (3), may use not to exceed 10 percent of amounts
received under a grant under section 2601 to provide financial assistance or services,
for the purposes described in paragraph (2), to any public or nonprofit private
entity, including hospitals (which may include Veterans Administration facilities),
nursing homes, subacute and transitional care facilities, and hospices that-
(A)
provide HIV-related care or services to a disproportionate share of low-income
individuals and families with HIV disease;
(B) incur uncompensated costs in
the provision of such care or services to such individuals and families;
(C)
have established, and agree to implement, a plan to evaluate the utilization of
services provided in the care of individuals and families with HIV disease; and
(D)
have established a system designed to ensure that such individuals and families
are referred to the most medically appropriate level of care as soon as such referral
is medically indicated.
(2) Use.-A chief elected official may use amounts referred
to in paragraph (1) to-
(A) provide direct financial assistance to institutions
and entities of the type referred to in such paragraph to assist such institutions
and entities in recruiting or training and paying compensation to qualified personnel
determined, under paragraph (3), to be necessary by the HIV health services planning
council, specifically for the care of individuals with HIV disease; or
(B)
in lieu of providing direct financial assistance, make arrangements for the provision
of the services of such qualified personnel to such institutions and entities.
(3)
REQUIREMENT OF DETERMINATION BY COUNCIL.-A chief elected official shall not use
any of the amounts received under a grant under section 2601(a) to provide assistance
or services under paragraph (2) unless the HIV health services planning council
of the eligible area has made a determination that, with respect to the care of
individuals with HIV disease-
(A) a shortage of specific health, mental health
or support service personnel exists within specific institutions or entities in
the eligible area;
(B) the shortage of such personnel has resulted in the inappropriate
utilization of inpatient services within the area; and
(C) assistance or services
provided to an institution or entity under paragraph (2), will not be used to
supplant the existing resources devoted by such institution or entity to the uses
described in such paragraph.
(e) REQUIREMENT OF STATUS AS MEDICAID PROVIDER.-
(1)
PROVISION OF SERVICE.-Subject to paragraph (2), the Secretary may not make a grant
under section 2601(a) for the provision of services under this section in a State
unless, in the case of any such service that is available pursuant to the State
plan approved under title XIX of the Social Security Act for the State-
(A)
the political subdivision involved will provide the service directly, and the
political subdivision has entered into a participation agreement under the State
plan and is qualified to receive payments under such plan; or
(B) the political
subdivision will enter into an agreement with a public or nonprofit private entity
under which the entity will provide the service, and the entity has entered into
such a participation agreement and is qualified to receive such payments.
(2)
WAIVER.-
(A) IN GENERAL.-In the case of an entity making an agreement pursuant
to paragraph (1)(B) regarding the provision of services, the requirement established
in such paragraph shall be waived by the HIV health services planning council
for the eligible area if the entity does not, in providing health care services,
impose a charge or accept reimbursement available from any third-party payor,
including reimbursement under any insurance policy or under any Federal or State
health benefits program.
(B) DETERMINATION.-A determination by the HIV health
services planning council of whether an entity referred to in subparagraph (A)
meets the criteria for a waiver under such subparagraph shall be made without
regard to whether the entity accepts voluntary donations for the purpose of providing
services to the public.
(f) ADMINISTRATION.-
(1) IN GENERAL.-The chief executive
officer of an eligible area shall not use in excess of 5 percent of amounts received
under a grant awarded under this part for administration,. In the case of entities
and subcontractors to which such officer allocates amounts received by the officer
under the grant, the officer shall ensure that, of the aggregate amount so allocated,
the total of the expenditures by such entities for administrative expenses does
not exceed 10 percent (without regard to whether particular entities expend more
than 10 percent for such expenses).
(2) ADMINISTRATIVE ACTIVITIES.-For the
purposes of paragraph (1), amounts may be used for administrative activities that
include-
(A) routine grant administration and monitoring activities, including
the development of applications for part A funds, the receipt and disbursal of
program funds, the development and establishment of reimbursement and accounting
systems, the preparation of routine programmatic and financial reports, and compliance
with grant conditions and audit requirements; and
(B) all activities associated
with the grantee's contract award procedures, including the development of requests
for proposals, contract proposal review activities, negotiation and awarding of
contracts, monitoring of contracts through telephone consultation, written documentation
or onsite visits, reporting on contracts, and funding reallocation activities.
(3)
SUBCONTRACTOR ADMINISTRATIVE COSTS.-For or the purposes of this subsection, subcontractor
administrative activities include-
(A) usual and recognized overhead, including
established indirect rates for agencies;
(B) management oversight of specific
programs funded under this title; and
(C) other types of program support such
as quality assurance, quality control, and related activities.
(g) CONSTRUCTION.-A
State may not use amounts received under a grant awarded under this part to purchase
or improve land, or to purchase, construct, or permanently improve (other than
minor remodeling) any building or other facility, or to make cash payments to
intended recipients of services.
SEC.
2605. [300ff-15] APPLICATION.
(a) IN GENERAL.-To be eligible to receive a grant
under section 2601, an eligible area shall prepare and submit to the Secretary
an application, in accordance with subsection (c) regarding a single application
and grant award, at such time, in such form, and containing such information as
the Secretary shall require, including assurances adequate to ensure-
(1)(A)
that funds received under a grant awarded under this part will be utilized to
supplement not supplant State funds made available in the year for which the grant
is awarded to provide HIV-related services as described in section 2604(b)(1);
(B)
that the political subdivisions within the eligible area will maintain the level
of expenditures by such political subdivisions for HIV-related services as described
in section 2604(b)(1) at a level that is equal to the level of such expenditures
by such political subdivisions for the preceding fiscal year; and
(C) that
political subdivisions within the eligible area will not use funds received under
a grant awarded under this part in maintaining the level of expenditures for HIV-related
services as required in subparagraph (B);
(2) that the eligible area has an
HIV health services planning council and has entered into intergovernmental agreements
pursuant to section 2602, and has developed or will develop the comprehensive
plan in accordance with section 2602(b)(3)(B);
(3) that entities within the
eligible area that receive funds under a grant under this part will maintain appropriate
relationships with entities in the eligible area served that constitute key points
of access to the health care system for individuals with HIV disease (including
emergency rooms, substance abuse treatment programs, detoxification centers, adult
and juvenile detention facilities, sexually transmitted disease clinics, HIV counseling
and testing sites, mental health programs, and homeless shelters), and other entities
under section 2604(b)(3) and 2652(a), for the purpose of facilitating early intervention
for individuals newly diagnosed with HIV disease and individuals knowledgeable
of their HIV status but not in care;
(4) that the chief elected official of
the eligible area will satisfy all requirements under section 2604(c);
(5)
that entities within the eligible area that will receive funds under a grant provided
under section 2601(a) shall participate in an established HIV community-based
continuum of care if such continuum exists within the eligible area;
(6) that
funds received under a grant awarded under this part will not be utilized to make
payments for any item or service to the extent that payment has been made, or
can reasonably be expected to be made, with respect to that item or service-
(A)
under any State compensation program, under an insurance policy, or under any
Federal or State health benefits program; or
(B) by an entity that provides
health services on a prepaid basis;
(7) to the maximum extent practicable,
that-
(A) HIV health care and support services provided with assistance made
available under this part will be provided without regard-
(i) to the ability
of the individual to pay for such services; and
(ii) to the current or past
health condition of the individual to be served;
(B) such services will be
provided in a setting that is accessible to low-income individuals with HIV-disease;
and
(C) a program of outreach will be provided to low-income individuals with
HIV-disease to inform such individuals of such services;
(8) that the applicant
has participated, or will agree to participate, in the statewide coordinated statement
of need process where it has been initiated by the State public health agency
responsible for administering grants under part B, and ensure that the services
provided under the comprehensive plan are consistent with the statewide coordinated
statement of need; and
(9) that the eligible area has procedures in place to
ensure that services provided with funds received under this part meet the criteria
specified in section 2604(b)(1).
(b) APPLICATION.-An eligible area that desires
to receive a grant under section 2603(b) shall prepare and submit to the Secretary
an application, in accordance with subsection (c) regarding a single application
and grant award, at such time, in such form, and containing such information as
the Secretary shall require, including the information required under such subsection
and information concerning-
(1) the number of individuals to be served within
the eligible area with assistance provided under the grant;
(2) demographic
data on the population of such individuals;
(3) the average cost of providing
each category of HIV-related health services and the extent to which such cost
is paid by third-party payors; and
(4) the aggregate amounts expended for each
such category of services.
(c) SINGLE APPLICATION AND GRANT AWARD.-
(1)
APPLICATION.-The Secretary may phase in the use of a single application that meets
the requirements of subsections (a) and (b) of section 2603 with respect to an
eligible area that desires to receive grants under section 2603 for a fiscal year.
(2)
GRANT AWARD.-The Secretary may phase in the awarding of a single grant to an eligible
area that submits an approved application under paragraph (1) for a fiscal year.
(d)
DATE CERTAIN FOR SUBMISSION.-
(1) REQUIREMENT.-Except as provided in paragraph
(2), to be eligible to receive a grant under section 2601(a) for a fiscal year,
an application under subsection (a) shall be submitted not later than 45 days
after the date on which appropriations are made under section 2677 for the fiscal
year.
(2) EXCEPTION.-The Secretary may extend the time for the submission of
an application under paragraph (1) for a period of not to exceed 60 days if the
Secretary determines that the eligible area has made a good faith effort to comply
with the requirement of such paragraph but has otherwise been unable to submit
its application.
(3) DISTRIBUTION BY SECRETARY.-Not later than 45 days after
receiving an application that meets the requirements of subsection (a) from an
eligible area, the Secretary shall distribute to such eligible area the amounts
awarded under the grant for which the application was submitted.
(4) REDISTRIBUTION.-Any
amounts appropriated in any fiscal year under this part and not obligated to an
eligible entity as a result of the failure of such entity to submit an application
shall be redistributed by the Secretary to other eligible entities in proportion
to the original grants made to such eligible areas under section 2601(a).
(e)
REQUIREMENTS REGARDING IMPOSITION OF CHARGES FOR SERVICES.-
(1) IN GENERAL.-The
Secretary may not make a grant under section 2601 to an eligible area unless the
eligible area provides assurances that in the provision of services with assistance
provided under the grant-
(A) in the case of individuals with an income less
than or equal to 100 percent of the official poverty line, the provider will not
impose charges on any such individual for the provision of services under the
grant;
(B) in the case of individuals with an income greater than 100 percent
of the official poverty line, the provider-
(i) will impose a charge on each
such individual for the provision of such services; and
(ii) will impose the
charge according to a schedule of charges that is made available to the public;
(C)
in the case of individuals with an income greater than 100 percent of the official
poverty line and not exceeding 200 percent of such poverty line, the provider
will not, for any calendar year, impose charges in an amount exceeding 5 percent
of the annual gross income of the individual involved;
(D) in the case of individuals
with an income greater than 200 percent of the official poverty line and not exceeding
300 percent of such poverty line, the provider will not, for any calendar year,
impose charges in an amount exceeding 7 percent of the annual gross income of
the individual involved; and
(E) in the case of individuals with an income
greater than 300 percent of the official poverty line, the provider will not,
for any calendar year, impose charges in an amount exceeding 10 percent of the
annual gross income of the individual involved.
(2) ASSESSMENT OF CHARGE.-With
respect to compliance with the assurance made under paragraph (1), a grantee or
entity receiving assistance under this part may, in the case of individuals subject
to a charge for purposes of such paragraph-
(A) assess the amount of the charge
in the discretion of the grantee, including imposing only a nominal charge for
the provision of services, subject to the provisions of such paragraph regarding
public schedules and regarding limitations on the maximum amount of charges; and
(B)
take into consideration the medical expenses of individuals in assessing the amount
of the charge, subject to such provisions.
(3) APPLICABILITY OF LIMITATION
ON AMOUNT OF CHARGE.- The Secretary may not make a grant under section 2601 to
an eligible area unless the eligible area agrees that the limitations established
in subparagraphs (C), (D) and (E) of paragraph (1) regarding the imposition of
charges for services applies to the annual aggregate of charges imposed for such
services, without regard to whether they are characterized as enrollment fees,
premiums, deductibles, cost sharing, copayments, coinsurance, or other charges.
(4)
WAIVER REGARDING SECONDARY AGREEMENTS.-The requirements established in paragraphs
(1) through (3) shall be waived in accordance with section 2604(d)(2).
SEC.
2606. [300ff-16] TECHNICAL ASSISTANCE.
The Administrator of the Health Resources
and Services Administration shall, beginning on the date of enactment of this
title, provide technical assistance, including assistance from other grantees,
contractors or subcontractors under this title to assist newly eligible metropolitan
areas in the establishment of HIV health services planning councils and, to assist
entities in complying with the requirements of this part in order to make such
entities eligible to receive a grant under this part. The Administrator may make
planning grants available to metropolitan areas, in an amount not to exceed $75,000
for any metropolitan area, projected to be eligible for funding under section
2601 in the following fiscal year. Such grant amounts shall be deducted from the
first year formula award to eligible areas accepting such grants. Not to exceed
1 percent of the amount appropriated for a fiscal year under section 2677 for
grants under part A may be used to carry out this section.
SEC.
2607. [300ff-17] DEFINITIONS.
For purposes of this part:
(1) ELIGIBLE AREA.-The
term "eligible area" means a metropolitan area meeting the requirements
of section 2601 that are applicable to the area.
(2) METROPOLITAN AREA.-The
term "metropolitan area" means an area referred to in the HIV/AIDS Surveillance
Report of the Centers for Disease Control and Prevention as a metropolitan area.
PART B-CARE GRANT PROGRAM
Subpart I-General Grant Provisions
SEC.
2611. [300ff-21] GRANTS.
(a) IN GENERAL.-The Secretary shall, subject to the
availability of appropriations, make grants to States to enable such States to
improve the quality, availability and organization of health care and support
services for individuals and families with HIV disease. The authority of the Secretary
to provide grants under part B is subject to section 2626(e)(2) (relating to the
decrease in perinatal transmission of HIV disease).
(b) PRIORITY FOR WOMEN,
INFANTS AND CHILDREN.-
(1) IN GENERAL.-For the purpose of providing health
and support services to infants, children, youth, and women with HIV disease,
including treatment measures to prevent the perinatal transmission of HIV, a State
shall for each of such populations use, of the funds allocated under this part
to the State for a fiscal year, not less than the percentage constituted by the
ratio of the population involved (infants, children, youth, or women in the State)
with acquired immune deficiency syndrome to the general population in the State
of individuals with such syndrome.
(2) WAIVER.-With respect to the population
involved, the Secretary may provide to a State a waiver of the requirement of
paragraph (1) if the State demonstrates to the satisfaction of the Secretary that
the population is receiving HIV-related health services through the State medicaid
program under title XIX of the Social Security Act, the State children's health
insurance program under title XXI of such Act, or other Federal or State programs.
SEC.
2612. [300ff-22] GENERAL USE OF GRANTS.
(a) IN GENERAL.-A State may use amounts
provided under grants made under this part-
(1) to provide the services described
in section 2604(b)(1) for individuals with HIV disease;
(2) to establish and
operate HIV care consortia within areas most affected by HIV disease that shall
be designed to provide a comprehensive continuum of care to individuals and families
with HIV disease in accordance with section 2613;
(3) to provide home- and
community-based care services for individuals with HIV disease in accordance with
section 2614;
(4) to provide assistance to assure the continuity of health
insurance coverage for individuals with HIV disease in accordance with section
2615; and
(5) to provide therapeutics to treat HIV disease to individuals with
HIV disease in accordance with section 2616.
Services described in paragraph
(1) shall be delivered through consortia designed as described in paragraph (2),
where such consortia exist, unless the State demonstrates to the Secretary that
delivery of such services would be more effective when other delivery mechanisms
are used. In making a determination regarding the delivery of services, the State
shall consult with appropriate representatives of service providers and recipients
of services who would be affected by such determination, and shall include in
its demonstration to the Secretary the findings of the State regarding such consultation.
(b)
SUPPORT SERVICES; OUTREACH.-The purposes for which a grant under this part may
be used include delivering or enhancing the following:
(1) Outpatient and ambulatory
support services under section 2611(a) (including case management) to the extent
that such services facilitate, enhance, support, or sustain the delivery, continuity,
or benefits of health services for individuals and families with HIV disease.
(2)
Outreach activities that are intended to identify individuals with HIV disease
who know their HIV status and are not receiving HIV-related services, and that
are-
(A) necessary to implement the strategy under section 2617(b)(4)(B), including
activities facilitating the access of such individuals to HIV-related primary
care services at entities described in subsection (c)(1);
(B) conducted in
a manner consistent with the requirement under section 2617(b)(6)(G) and 2651(b)(2);
and
(C) supplement, and do not supplant, such activities that are carried out
with amounts appropriated under section 317.
(c) EARLY INTERVENTION SERVICES.-
(1)
IN GENERAL.-The purposes for which a grant under this part may be used include
providing to individuals with HIV disease early intervention services described
in section 2651(b)(2), with follow-up referral provided for the purpose of facilitating
the access of individuals receiving the services to HIV-related health services.
The entities through which such services may be provided under the grant include
public health departments, emergency rooms, substance abuse and mental health
treatment programs, detoxification centers, detention facilities, clinics regarding
sexually transmitted diseases, homeless shelters, HIV disease counseling and testing
sites, health care points of entry specified by States or eligible areas, federally
qualified health centers, and entities described in section 2652(a) that constitute
a point of access to services by maintaining referral relationships.
(2) CONDITIONS.-With
respect to an entity that proposes to provide early intervention services under
paragraph (1), such paragraph applies only if the entity demonstrates to the satisfaction
of the State involved that-
(A) Federal, State, or local funds are otherwise
inadequate for the early intervention services the entity proposes to provide;
and
(B) the entity will expend funds pursuant to such paragraph to supplement
and not supplant other funds available to the entity for the provision of early
intervention services for the fiscal year involved.
(d) QUALITY MANAGEMENT.-
(1)
REQUIREMENT.-Each State that receives a grant under this part shall provide for
the establishment of a quality management program to assess the extent to which
HIV health services provided to patients under the grant are consistent with the
most recent Public Health Service guidelines for the treatment of HIV disease
and related opportunistic infection, and as applicable, to develop strategies
for ensuring that such services are consistent with the guidelines for improvement
in the access to and quality of HIV health services.
(2) USE OF FUNDS.-From
amounts received under a grant awarded under this part for a fiscal year, the
State may (in addition to amounts to which section 2618(b)(5) applies) use for
activities associated with the quality management program required in paragraph
(1) not more than the lesser of-
(A) 5 percent of amounts received under the
grant; or
(B) $3,000,000.
SEC.
2613. [300ff-23] GRANTS TO ESTABLISH HIV CARE CONSORTIA.
(a) CONSORTIA.-A State
may use amounts provided under a grant awarded under this part to provide assistance
under section 2612(a)(1) to an entity that-
(1) is an association of one or
more public, and one or more nonprofit private, (or private for-profit providers
or organizations if such entities are the only available providers of quality
HIV care in the area) health care and support service providers and community
based organizations operating within areas determined by the State to be most
affected by HIV disease; and
(2) agrees to use such assistance for the planning,
development and delivery, through the direct provision of services or through
entering into agreements with other entities for the provision of such services,
of comprehensive outpatient health and support services for individuals with HIV
disease; that may include-
(A) essential health services such as case management
services, medical, nursing, substance abuse treatment, mental health treatment,
and dental care, diagnostics, monitoring, prophylactic treatment for opportunistic
infections, treatment education to take place in the context of health care delivery,
and medical follow-up services, mental health, developmental, and rehabilitation
services, home health and hospice care; and
(B) essential support services
such as transportation services, attendant care, homemaker services, day or respite
care, benefits advocacy, advocacy services provided through public and nonprofit
private entities, and services that are incidental to the provision of health
care services for individuals with HIV disease including nutrition services, housing
referral services, and child welfare and family services (including foster care
and adoption services).
An entity or entities of the type described in this
subsection shall hereinafter be referred to in this title as a "consortium
or "consortia".
(b) ASSURANCES.-
(1) REQUIREMENT-To receive assistance
from a State under subsection (a), an applicant consortium shall provide the State
with assurances that-
(A) within any locality in which such consortium is to
operate, the populations and subpopulations of individuals and families with HIV
disease have been identified by the consortium, particularly those experiencing
disparities in access and services and those who reside in historically underserved
communities;
(B) the service plan established under subsection (c)(2) by such
consortium is consistent with the comprehensive plan under section 2617(b)(4)
and addresses the special care and service needs of the populations and subpopulations
identified under subparagraph (A); and
(C) except as provided in paragraph
(2), the consortium will be a single coordinating entity that will integrate the
delivery of services among the populations and subpopulations identified under
subparagraph (A).
(2) EXCEPTION.-Subparagraph (C) of paragraph (1) shall not
apply to any applicant consortium that the State determines will operate in a
community or locality in which it has been demonstrated by the applicant consortium
that-
(A) subpopulations exist within the community to be served that have
unique service requirements; and
(B) such unique service requirements cannot
be adequately and efficiently addressed by a single consortium serving the entire
community or locality.
(c) APPLICATION.-
(1) IN GENERAL.-To receive assistance
from the State under subsection (a), a consortium shall prepare and submit to
the State, an application that-
(A) demonstrates that the consortium includes
agencies and community-based organizations-
(i) with a record of service to
populations and subpopulations with HIV disease requiring care within the community
to be served; and
(ii) that are representative of populations and subpopulations
reflecting the local incidence of HIV and that are located in areas in which such
populations reside;
(B) demonstrates that the consortium has carried out an
assessment of service needs within the geographic area to be served and, after
consultation with the entities described in paragraph (2), has established a plan
to ensure the delivery of services to meet such identified needs that shall include-
(i)
assurances that service needs will be addressed through the coordination and expansion
of existing programs before new programs are created;
(ii) assurances that,
in metropolitan areas, the geographic area to be served by the consortium corresponds
to the geographic boundaries of local health and support services delivery systems
to the extent practicable;
(iii) assurances that, in the case of services for
individuals residing in rural areas, the applicant consortium shall deliver case
management services that link available community support services to appropriate
specialized medical services; and
(iv) assurances that the assessment of service
needs and the planning of the delivery of services will include participation
by individuals with HIV disease;
(C) demonstrates that adequate planning has
occurred to meet the special needs of families with HIV disease, including family
centered and youth centered care;
(D) demonstrates that the consortium has
created a mechanism to evaluate periodically-
(i) the success of the consortium
in responding to identified needs; and
(ii) the cost-effectiveness of the mechanisms
employed by the consortium to deliver comprehensive care;
(E) demonstrates
that the consortium will report to the State the results of the evaluations described
in subparagraph (D) and shall make available to the State or the Secretary, on
request, such data and information on the program methodology that may be required
to perform an independent evaluation; and
(F) demonstrates that adequate planning
occurred to address disparities in access and services and historically underserved
communities.
(2) CONSULTATION.-In establishing the plan required under paragraph
(1)(B), the consortium shall consult with-
(A)(i) the public health agency
that provides or supports ambulatory and outpatient HIV-related health care services
within the geographic area to be served; or
(ii) in the case of a public health
agency that does not directly provide such HIV-related health care services such
agency shall consult with an entity or entities that directly provide ambulatory
and outpatient HIV-related health care services within the geographic area to
be served;
(B) not less than one community-based organization that is organized
solely for the purpose of providing HIV-related support services to individuals
with HIV disease;
(C) grantees under section 2671, or, if none are operating
in the area, representatives in the area of organizations with a history of serving
children, youth, women, and families living with HIV; and
(D) the types of
entities described in section 2602(b)(2).
The organization to be consulted
under subparagraph (B) shall be at the discretion of the applicant consortium.
(d)
DEFINITION.-As used in this part, the term "family centered care" means
the system of services described in this section that is targeted specifically
to the special needs of infants, children, women, and families. Family centered
care shall be based on a partnership between parents, professionals, and the community
designed to ensure an integrated, coordinated, culturally sensitive, and community-based
continuum of care for children, women, and families with HIV disease.
(e) PRIORITY.-In
providing assistance under subsection (a), the State shall, among applicants that
meet the requirements of this section, give priority-
(1) first to consortia
that are receiving assistance from the Health Resources and Services Administration
for adult and pediatric HIV-related care demonstration projects; and then
(2)
to any other existing HIV care consortia.
SEC.
2614. [300ff-24] GRANTS FOR HOME- AND COMMUNITY-BASED CARE.
(a) USES.-A State
may use amounts provided under a grant awarded under this part to make grants
under section 2612(a)(2) to entities to-
(1) provide home- and community-based
health services for individuals with HIV disease pursuant to written plans of
care prepared by a case management team, that shall include appropriate health
care professionals, in such State for providing such services to such individuals;
(2)
provide outreach services to individuals with HIV disease, including those individuals
in rural areas; and
(3) provide for the coordination of the provision of services
under this section with the provision of HIV-related health services provided
by public and private entities.
(b) PRIORITY.-In awarding grants under subsection
(a), a State shall give priority to entities that provide assurances to the State
that-
(1) such entities will participate in HIV care consortia if such consortia
exist within the State; and
(2) such entities will utilize amounts provided
under such grants for the provision of home- and community-based services to low-income
individuals with HIV disease.
(c) DEFINITION.-As used in this part, the term
"home- and community-based health services"-
(1) means, with respect
to an individual with HIV disease, skilled health services furnished to the individual
in the individual's home pursuant to a written plan of care established by a case
management team, that shall include appropriate health care professionals, for
the provision of such services and items described in paragraph (2);
(2) includes-
(A)
durable medical equipment;
(B) homemaker or home health aide services and personal
care services furnished in the home of the individual;
(C) day treatment or
other partial hospitalization services;
(D) home intravenous and aerosolized
drug therapy (including prescription drugs administered as part of such therapy);
(E)
routine diagnostic testing administered in the home of the individual; and
(F)
appropriate mental health, developmental, and rehabilitation services; and
(3)
does not include-
(A) inpatient hospital services; and
(B) nursing home
and other long term care facilities.
SEC.
2615. [300ff-25] CONTINUUM OF HEALTH INSURANCE COVERAGE.
(a) In General.-A
State may use amounts received under a grant awarded under this part to establish
a program of financial assistance under section 2612(a)(3) to assist eligible
low-income individuals with HIV disease in-
(1) maintaining a continuity of
health insurance; or
(2) receiving medical benefits under a health insurance
program, including risk-pools.
(b) LIMITATIONS.-Assistance shall not be utilized
under subsection (a)-
(1) to pay any costs associated with the creation, capitalization,
or administration of a liability risk pool (other than those costs paid on behalf
of individuals as part of premium contributions to existing liability risk pools);
and
(2) to pay any amount expended by a State under title XIX of the Social
Security Act.
SEC.
2616. [300ff-26] PROVISION OF TREATMENTS.
(a) IN GENERAL.-A State shall use
a portion of the amounts provided under a grant awarded under this part to establish
a program under section 2612(a)(5) to provide therapeutics to treat HIV disease
or prevent the serious deterioration of health arising from HIV disease in eligible
individuals, including measures for the prevention and treatment of opportunistic
infections.
(b) ELIGIBLE INDIVIDUAL.-To be eligible to receive assistance from
a State under this section an individual shall-
(1) have a medical diagnosis
of HIV disease; and
(2) be a low-income individual, as defined by the State.
(c)
STATE DUTIES.-In carrying out this section the State shall-
(1) determine,
in accordance with guidelines issued by the Secretary, which treatments are eligible
to be included under the program established under this section;
(2) provide
assistance for the purchase of treatments determined to be eligible under paragraph
(1), and the provision of such ancillary devices that are essential to administer
such treatments;
(3) provide outreach to individuals with HIV disease, and
as appropriate to the families of such individuals;
(4) facilitate access to
treatments for such individuals;
(5) document the progress made in making therapeutics
described in subsection (a) available to individuals eligible for assistance under
this section; and
(6) encourage, support, and enhance adherence to and compliance
with treatment regimens, including related medical monitoring.
Of the amount
reserved by a State for a fiscal year for use under this section, the State may
not use more than 5 percent to carry out services under paragraph (6), except
that the percentage applicable with respect to such paragraph is 10 percent if
the State demonstrates to the Secretary that such additional services are essential
and in no way diminish access to the therapeutics described in subsection (a).
(d)
DUTIES OF THE SECRETARY.-In carrying out this section, the Secretary shall review
the current status of State drug reimbursement programs established under section
2612(2) and assess barriers to the expanded availability of the treatments described
in subsection (a). The Secretary shall also examine the extent to which States
coordinate with other grantees under this title to reduce barriers to the expanded
availability of the treatments described in subsection (a).
(e) USE OF HEALTH
INSURANCE AND PLANS.-
(1) IN GENERAL.-In carrying out subsection (a), a State
may expend a grant under this part to provide the therapeutics described in such
subsection by paying on behalf of individuals with HIV disease the costs of purchasing
or maintaining health insurance or plans whose coverage includes a full range
of such therapeutics and appropriate primary care services.
(2) LIMITATION.-The
authority established in paragraph (1) applies only to the extent that, for the
fiscal year involved, the costs of the health insurance or plans to be purchased
or maintained under such paragraph do not exceed the costs of otherwise providing
therapeutics described in subsection (a).
SEC.
2617. [300ff-27] STATE APPLICATION.
(a) IN GENERAL.-The Secretary shall not
make a grant to a State under this part for a fiscal year unless the State prepares
and submits, to the Secretary, an application at such time, in such form, and
containing such agreements, assurances, and information as the Secretary determines
to be necessary to carry out this part.
(b) DESCRIPTION OF INTENDED USES AND
AGREEMENTS.-The application submitted under subsection (a) shall contain-
(1)
a detailed description of the HIV-related services provided in the State to individuals
and families with HIV disease during the year preceding the year for which the
grant is requested, and the number of individuals and families receiving such
services, that shall include-
(A) a description of the types of programs operated
or funded by the State for the provision of HIV-related services during the year
preceding the year for which the grant is requested and the methods utilized by
the State to finance such programs;
(B) an accounting of the amount of funds
that the State has expended for such services and programs during the year preceding
the year for which the grant is requested; and
(C) information concerning-
(i)
the number of individuals to be served with assistance provided under the grant;
(ii)
demographic data on the population of the individuals to be served;
(iii) the
average cost of providing each category of HIV-related health services and the
extent to which such cost is paid by third-party payors; and
(iv) the aggregate
amounts expended for each such category of services;
(2) a determination of
the size and demographics of the population of individuals with HIV disease in
the State;
(3) a determination of the needs of such population, with particular
attention to-
(A) individuals with HIV disease who know their HIV status and
are not receiving HIV-related services; and
(B) disparities in access and services
among affected subpopulations and historically underserved communities;
(4)
a comprehensive plan that describes the organization and delivery of HIV health
care and support services to be funded with assistance received under this part
that shall include a description of the purposes for which the State intends to
use such assistance, and that-
(A) establishes priorities for the allocation
of funds within the State based on-
(i) size and demographics of the population
of individuals with HIV disease (as determined under paragraph (2)) and the needs
of such population (as determined under paragraph (3));
(ii) availability of
other governmental and non-governmental resources, including the State medicaid
plan under title XIX of the Social Security Act and the State Children's Health
Insurance Program under title XXI of such Act to cover health care costs of eligible
individuals and families with HIV disease;
(iii) capacity development needs
resulting from disparities in the availability of HIV-related services in historically
underserved communities and rural communities; and
(iv) the efficiency of the
administrative mechanism of the State for rapidly allocating funds to the areas
of greatest need within the State;
(B) includes a strategy for identifying
individuals who know their HIV status and are not receiving such services and
for informing the individuals of and enabling the individuals to utilize the services,
giving particular attention to eliminating disparities in access and services
among affected subpopulations and historically underserved communities, and including
discrete goals, a timetable, and an appropriate allocation of funds;
(C) includes
a strategy to coordinate the provision of such services with programs for HIV
prevention (including outreach and early intervention) and for the prevention
and treatment of substance abuse (including programs that provide comprehensive
treatment services for such abuse);
(D) describes the services and activities
to be provided and an explanation of the manner in which the elements of the program
to be implemented by the State with such assistance will maximize the quality
of health and support services available to individuals with HIV disease throughout
the State;
(E) provides a description of the manner in which services funded
with assistance provided under this part will be coordinated with other available
related services for individuals with HIV disease; and
(F) provides a description
of how the allocation and utilization of resources are consistent with the statewide
coordinated statement of need (including traditionally underserved populations
and subpopulations) developed in partnership with other grantees in the State
that receive funding under this title; and
(5) an assurance that the public
health agency administering the grant for the State will periodically convene
a meeting of individuals with HIV disease, representatives of grantees under each
part under this title, providers, and public agency representatives for the purpose
of developing a statewide coordinated statement of need; and
(6) an assurance
by the State that-
(A) the public health agency that is administering the grant
for the State engages in a public advisory planning process, including public
hearings, that includes the participants under paragraph (5), and the types of
entities described in section 2602(b)(2), in developing the comprehensive plan
under paragraph (4) and commenting on the implementation of such plan;
(B)
the State will-
(i) to the maximum extent practicable, ensure that HIV-related
health care and support services delivered pursuant to a program established with
assistance provided under this part will be provided without regard to the ability
of the individual to pay for such services and without regard to the current or
past health condition of the individual with HIV disease;
(ii) ensure that
such services will be provided in a setting that is accessible to low-income individuals
with HIV disease;
(iii) provide outreach to low-income individuals with HIV
disease to inform such individuals of the services available under this part;
and
(iv) in the case of a State that intends to use amounts provided under
the grant for purposes described in 2615 , submit a plan to the Secretary that
demonstrates that the State has established a program that assures that-
(I)
such amounts will be targeted to individuals who would not otherwise be able to
afford health insurance coverage; and
(II) income, asset, and medical expense
criteria will be established and applied by the State to identify those individuals
who qualify for assistance under such program, and information concerning such
criteria shall be made available to the public;
(C) the State will provide
for periodic independent peer review to assess the quality and appropriateness
of health and support services provided by entities that receive funds from the
State under this part;
(D) the State will permit and cooperate with any Federal
investigations undertaken regarding programs conducted under this part;
(E)
the State will maintain HIV-related activities at a level that is equal to not
less than the level of such expenditures by the State for the 1-year period preceding
the fiscal year for which the State is applying to receive a grant under this
part;
(F) the State will ensure that grant funds are not utilized to make payments
for any item or service to the extent that payment has been made, or can reasonably
be expected to be made, with respect to that item or service-
(i) under any
State compensation program, under an insurance policy, or under any Federal or
State health benefits program; or
(ii) by an entity that provides health services
on a prepaid basis; and
(G) entities within areas in which activities under
the grant are carried out will maintain appropriate relationships with entities
in the area served that constitute key points of access to the health care system
for individuals with HIV disease (including emergency rooms, substance abuse treatment
programs, detoxification centers, adult and juvenile detention facilities, sexually
transmitted disease clinics, HIV counseling and testing sites, mental health programs,
and homeless shelters), and other entities under section 2612(c) and 2652(a),
for the purposes of facilitating early intervention for individuals newly diagnosed
with HIV disease and individuals knowledgeable of their HIV status but not in
care.
(c) REQUIREMENTS REGARDING IMPOSITION OF CHARGES FOR SERVICES.-
(1)
IN GENERAL.-The Secretary may not make a grant under section 2611 to a State unless
the State provides assurances that in the provision of services with assistance
provided under the grant-
(A) in the case of individuals with an income less
than or equal to 100 percent of the official poverty line, the provider will not
impose charges on any such individual for the provision of services under the
grant;
(B) in the case of individuals with an income greater than 100 percent
of the official poverty line, the provider-
(i) will impose charges on each
such individual for the provision of such services; and
(ii) will impose charges
according to a schedule of charges that is made available to the public;
(C)
in the case of individuals with an income greater than 100 percent of the official
poverty line and not exceeding 200 percent of such poverty line, the provider
will not, for any calendar year, impose charges in an amount exceeding 5 percent
of the annual gross income of the individual involved;
(D) in the case of individuals
with an income greater than 200 percent of the official poverty line and not exceeding
300 percent of such poverty line, the provider will not, for any calendar year,
impose charges in an amount exceeding 7 percent of the annual gross income of
the individual involved; and
(E) in the case of individuals with an income
greater than 300 percent of the official poverty line, the provider will not,
for any calendar year, impose charges in an amount exceeding 10 percent of the
annual gross income of the individual involved.
(2) ASSESSMENT OF CHARGE.-With
respect to compliance with the assurance made under paragraph (1), a grantee under
this part may, in the case of individuals subject to a charge for purposes of
such paragraph-
(A) assess the amount of the charge in the discretion of the
grantee, including imposing only a nominal charge for the provision of services,
subject to the provisions of such paragraph regarding public schedules regarding
limitation on the maximum amount of charges; and
(B) take into consideration
the medical expenses of individuals in assessing the amount of the charge, subject
to such provisions.
(3) APPLICABILITY OF LIMITATION ON AMOUNT OF CHARGE.-The
Secretary may not make a grant under section 2611 unless the applicant of the
grant agrees that the limitations established in subparagraphs (C), (D), and (E)
of paragraph (1) regarding the imposition of charges for services applies to the
annual aggregate of charges imposed for such services, without regard to whether
they are characterized as enrollment fees, premiums, deductibles, cost sharing,
copayments, coinsurance, or other charges.
(4) WAIVER.-
(A) IN GENERAL.-The
State shall waive the requirements established in paragraphs (1) through (3) in
the case of an entity that does not, in providing health care services, impose
a charge or accept reimbursement from any third-party payor, including reimbursement
under any insurance policy or under any Federal or State health benefits program.
(B)
DETERMINATION.-A determination by the State of whether an entity referred to in
subparagraph (A) meets the criteria for a waiver under such subparagraph shall
be made without regard to whether the entity accepts voluntary donations regarding
the provision of services to the public.
(d) REQUIREMENT OF MATCHING FUNDS
REGARDING STATE ALLOTMENTS.-
(1) IN GENERAL.-In the case of any State to which
the criterion described in paragraph (3) applies, the Secretary may not make a
grant under this part unless the State agrees that, with respect to the costs
to be incurred by the State in carrying out the program for which the grant was
awarded, the State will, subject to subsection (b)(2), make available (directly
or through donations from public or private entities) non-Federal contributions
toward such costs in an amount equal to-
(A) for the first fiscal year of payments
under the grant, not less than l62/3 percent of such costs ($1 for each $5 of
Federal funds provided in the grant);
(B) for any second fiscal year of such
payments, not less than 20 percent of such costs ($1 for each $4 of Federal funds
provided in the grant);
(C) for any third fiscal year of such payments, not
less than 25 percent of such costs ($1 for each $3 of Federal funds provided in
the grant);
(D) for any fourth fiscal year of such payments, not less than
331/3 percent of such costs ($1 for each $2 of Federal funds provided in the grant);
and
(E) for any subsequent fiscal year of such payments, not less than 331/3
percent of such costs ($1 for each $2 of Federal funds provided in the grant).
(2)
DETERMINATION OF AMOUNT OF NON-FEDERAL CONTRIBUTION.-
(A) IN GENERAL.-Non-Federal
contributions required in paragraph (1) may be in cash or in kind, fairly evaluated,
including plant, equipment, or services. Amounts provided by the Federal Government,
and any portion of any service subsidized by the Federal Government, may not be
included in determining the amount of such non-Federal contributions.
(B) INCLUSION
OF CERTAIN AMOUNTS.-
(i) In making a determination of the amount of non-Federal
contributions made by a State for purposes of paragraph (1), the Secretary shall,
subject to clause (ii), include any non-Federal contributions provided by the
State for HIV-related services, without regard to whether the contributions are
made for programs established pursuant to this title;
(ii) In making a determination
for purposes of clause (i), the Secretary may not include any non-Federal contributions
provided by the State as a condition of receiving Federal funds under any program
under this title (except for the program established in this part) or under other
provisions of law.
(3) APPLICABILITY OF REQUIREMENT.-
(A) NUMBER OF CASES.-A
State referred to in paragraph (1) is any State for which the number of cases
of acquired immune deficiency syndrome reported to and confirmed by the Director
of the Centers for Disease Control and Prevention for the period described in
subparagraph (B) constitutes in excess of 1 percent of the aggregate number of
such cases reported to and confirmed by the Director for such period for the United
States.
(B) PERIOD OF TIME.-The period referred to in subparagraph (A) is the
2-year period preceding the fiscal year for which the State involved is applying
to receive a grant under subsection (a).
(C) PUERTO RICO.-For purposes of paragraph
(1), the number of cases of acquired immune deficiency syndrome reported and confirmed
for the Commonwealth of Puerto Rico for any fiscal year shall be deemed to be
less than 1 percent.
(4) DIMINISHED STATE CONTRIBUTION.-With respect to a State
that does not make available the entire amount of the non-Federal contribution
referred to in paragraph (1), the State shall continue to be eligible to receive
Federal funds under a grant under this part, except that the Secretary in providing
Federal funds under the grant shall provide such funds (in accordance with the
ratios prescribed in paragraph (1)) only with respect to the amount of funds contributed
by such State.
SEC.
2618. [300ff-28] DISTRIBUTION OF FUNDS.
(a) AMOUNT OF GRANT TO STATE.-
(1)
MINIMUM ALLOTMENT.-Subject to the extent of amounts made available under section
2677, the amount of a grant to be made under this part for-
(A) each of the
several States and the District of Columbia for a fiscal year shall be the greater
of-
(i)(I) with respect to a State or District that has less than 90 living
cases of acquired immune deficiency syndrome, as determined under paragraph (2)(D),
$200,000; or
(II) with respect to a State or District that has 90 or more
living cases of acquired immune deficiency syndrome, as determined under paragraph
(2)(D), $500,000;
(ii) an amount determined under paragraph (2) and then, as
applicable, increased under paragraph (2)(H); and
(B) each territory of the
United States, as defined in paragraph (3), shall be the greater of $50,000 or
an amount determined under paragraph (2).
(2) DETERMINATION.-
(A) FORMULA.-The
amount referred to in paragraph (1)(A)(ii) for a State and paragraph (1)(B) for
a territory of the United States shall be the product of-
(i) an amount equal
to the amount appropriated under section 2677 for the fiscal year involved for
grants under part B, subject to subparagraphs (H) and (I); and
(ii) the percentage
constituted by the sum of-
(I) the product of .80 and the ratio of the State
distribution factor for the State or territory (as determined under subsection
(B)) to the sum of the respective State distribution factors for all States or
territories; and
(II) the product of .20 and the ratio of the non-EMA distribution
factor for the State or territory (as determined under subparagraph (C)) to the
sum of the respective distribution factors for all States or territories.
(B)
STATE DISTRIBUTION FACTOR.-For purposes of subparagraph (A)(ii)(I), the term "State
distribution factor" means an amount equal to the estimated number of living
cases of acquired immune deficiency syndrome in the eligible area involved, as
determined under subparagraph (D).
(C) NON-EMA DISTRIBUTION FACTOR.-For purposes
of subparagraph (A)(ii)(II), the term "non-ema distribution factor"
means an amount equal to the sum of-
(i) the estimated number of living cases
of acquired immune deficiency syndrome in the State or territory involved, as
determined under subparagraph (D); less
(ii) the estimated number of living
cases of acquired immune deficiency syndrome in such State or territory that are
within an eligible area (as determined under part A).
(D) ESTIMATE OF LIVING
CASES.-The amount determined in this subparagraph is an amount equal to the product
of-
(i) the number of cases of acquired immune deficiency syndrome in the State
or territory during each year in the most recent 120-month period for which data
are available with respect to all States and territories, as indicated by the
number of such cases reported to and confirmed by the Director of the Centers
for Disease Control and Prevention for each year during such period, except that
(subject to subparagraph (E)), for grants made pursuant to this paragraph or section
2620 for fiscal year 2005 and subsequent fiscal years, the cases counted for each
12-month period beginning on or after July 1, 2004, shall be cases of HIV disease
(as reported to and confirmed by such Director) rather than cases of acquired
immune deficiency syndrome; and
(ii) with respect to each of the first through
the tenth year during such period, the amount referred to in section 2603(a)(3)(C)(ii).
(E)
DETERMINATION OF SECRETARY REGARDING DATA ON HIV CASES.-If under section 2603(a)(3)(D)(i)
the Secretary determines that data on cases of HIV disease are not sufficiently
accurate and reliable, then notwithstanding subparagraph (D) of this paragraph,
for any fiscal year prior to fiscal year 2007 the references in such subparagraph
to cases to HIV disease do not have any legal effect.
(F) PUERTO RICO, VIRGIN
ISLANDS, GUAM.-For purposes of subparagraph (D), the cost index for Puerto Rico,
the Virgin Islands, and Guam shall be 1.0.
(G) UNEXPENDED FUNDS.-The Secretary
may, in determining the amount of a grant for a fiscal year under this subsection,
adjust the grant amount to reflect the amount of unexpended and uncanceled grant
funds remaining at the end of the fiscal year preceding the year for which the
grant determination is to be made. The amount of any such unexpended funds shall
be determined using the financial status report of the grantee.
(H) LIMITATION.-
(i)
IN GENERAL.-The Secretary shall ensure that the amount of a grant awarded to a
State or territory under section 2611 or subparagraph (I)(i) for a fiscal year
is not less than-
(I) with respect to fiscal year 2001, 99 percent;
(II)
with respect to fiscal year 2002, 98 percent;
(III) with respect to fiscal
year 2003, 97 percent;
(IV) with respect to fiscal year 2004, 96 percent; and
(V)
with respect to fiscal year 2005, 95 percent,
of the amount such State or territory
received for fiscal year 2000 under section 2611 or subparagraph (I)(i), respectively
(notwithstanding such subparagraph). In administering this subparagraph, the Secretary
shall, with respect to States or territories that will under such section receive
grants in amounts that exceed the amounts that such States received under such
section or subparagraph for fiscal year 2000, proportionally reduce such amounts
to ensure compliance with this subparagraph. In making such reductions, the Secretary
shall ensure that no such State receives less than that State received for fiscal
year 2000.
(ii) RATABLE REDUCTION.-If the amount appropriated under section
2677 for a fiscal year and available for grants under section 2611 or subparagraph
(I)(i) is less than the amount appropriated and available for fiscal year 2000
under section 2611 or subparagraph (I)(i), respectively, the limitation contained
in clause (i) for the grants involved shall be reduced by a percentage equal to
the percentage of the reduction in such amounts appropriated and available.
(I)
APPROPRIATIONS FOR TREATMENT DRUG PROGRAM.-
(i) FORMULA GRANTS.-With respect
to the fiscal year involved, if under section 2677 an appropriations Act provides
an amount exclusively for carrying out section 2616, the portion of such amount
allocated to a State shall be the product of-
(I) 100 percent of such amount,
less the percentage reserved under clause (ii)(V); and
(II) the percentage
constituted by the ratio of the State distribution factor for the State (as determined
under subparagraph (B)) to the sum of the State distribution factors for all States.
(ii)
SUPPLEMENTAL TREATMENT DRUG GRANTS.-
(I) IN GENERAL.-From amounts made available
under subclause (V), the Secretary shall make supplemental grants to States described
in subclause (II) to enable such States to increase access to therapeutics described
in section 2616(a), as provided by the State under section 2616(c)(2).
(II)
ELIGIBLE STATES.-For purposes of subclause (I), a State described in this subclause
is a State that, in accordance with criteria established by the Secretary, demonstrates
a severe need for a grant under such subclause. In developing such criteria, the
Secretary shall consider eligibility standards, formulary composition, and the
number of eligible individuals at or below 200 percent of the official poverty
line to whom the State is unable to provide therapeutics described in section
2616(a).
(III) STATE REQUIREMENTS.-The Secretary may not make a grant to a
State under this clause unless the State agrees that-
(aa) the State will
make available (directly or through donations from public or private entities)
non-Federal contributions toward the activities to be carried out under the grant
in an amount equal to $1 for each $4 of Federal funds provided in the grant; and
(bb)
the State will not impose eligibility requirements for services or scope of benefits
limitations under section 2616(a) that are more restrictive than such requirements
in effect as of January 1, 2000.
(IV) USE AND COORDINATION.-Amounts made available
under a grant under this clause shall only be used by the State to provide HIV/AIDS-related
medications. The State shall coordinate the use of such amounts with the amounts
otherwise provided under section 2616(a) in order to maximize drug coverage.
(V)
FUNDING.-For the purpose of making grants under this clause, the Secretary shall
each fiscal year reserve 3 percent of the amount referred to in clause (i) with
respect to section 2616, subject to subclause (VI).
(VI) LIMITATION.-In reserving
amounts under subclause (V) and making grants under this clause for a fiscal year,
the Secretary shall ensure for each State that the total of the grant under section
2611 for the State for the fiscal year and the grant under clause (i) for the
State for the fiscal year is not less than such total for the State for the preceding
fiscal year.
(3) DEFINITIONS.-As used in this subsection-
(A) the term "State"
means each of the 50 States, the District of Columbia, the Commonwealth of Puerto
Rico, the Virgin Islands, and Guam; and
(B) the term "territory of the
United States" means, American Samoa, the Commonwealth of the Northern Mariana
Islands, the Republic of the Marshall Islands, the Federated States of Micronesia,
and the Republic of Palau, and only for purposes of paragraph (1) the Commonwealth
of Puerto Rico.
(b) ALLOCATION OF ASSISTANCE BY STATES.-
(2) ALLOWANCES.-Prior
to allocating assistance under this subsection, a State shall consider the unmet
needs of those areas that have not received financial assistance under part A.
(3)
PLANNING AND EVALUATIONS.-Subject to paragraph (5) and except as provided in paragraph
(6), a State may not use more than 10 percent of amounts received under a grant
awarded under this part for planning and evaluation activities.
(4) ADMINISTRATION.-
(A)
IN GENERAL.-Subject to paragraph (5) and except as provided in paragraph (6),
a State may not use more than 10 percent of amounts received under a grant awarded
under this part for administration. In the case of entities and subcontractors
to which the State allocates amounts received by the State under the grant (including
consortia under section 2613), the State shall ensure that, of the aggregate amount
so allocated, the total of the expenditures by such entities for administrative
expenses does not exceed 10 percent (without regard to whether particular entities
expend more than 10 percent for such expenses).
(B) ADMINISTRATIVE ACTIVITIES.-For
the purposes of subparagraph (A), amounts may be used for administrative activities
that include routine grant administration and monitoring activities.
(C) SUBCONTRACTOR
ADMINISTRATIVE COSTS.-For the purposes of this paragraph, subcontractor administrative
activities include-
(i) usual and recognized overhead, including established
indirect rates for agencies;
(ii) management oversight of specific programs
funded under this title; and
(iii) other types of program support such as quality
assurance, quality control, and related activities.
(5) LIMITATION ON USE OF
FUNDS.-Except as provided in paragraph (6), a State may not use more than a total
of 15 percent of amounts received under a grant awarded under this part for the
purposes described in paragraphs (3) and (4).
(6) EXCEPTION.-With respect to
a State that receives the minimum allotment under subsection (a)(1) for a fiscal
year, such State, from the amounts received under a grant awarded under this part
for such fiscal year for the activities described in paragraphs (3) and (4), may,
notwithstanding paragraphs (3), (4), and (5), use not more than that amount required
to support one full-time-equivalent employee.
(7) CONSTRUCTION.-A State may
not use amounts received under a grant awarded under this part to purchase or
improve land, or to purchase, construct, or permanently improve (other than minor
remodeling) any building or other facility, or to make cash payments to intended
recipients of services.
(c) EXPEDITED DISTRIBUTION.-
(1) IN GENERAL.-Not
less than 75 percent of the amounts received under a grant awarded to a State
under this part shall be obligated to specific programs and projects and made
available for expenditure not later than-
(A) in the case of the first fiscal
year for which amounts are received, 150 days after the receipt of such amounts
by the State; and
(B) in the case of succeeding fiscal years, 120 days after
the receipt of such amounts by the State.
(2) PUBLIC COMMENT.-Within the time
periods referred to in paragraph (1), the State shall invite and receive public
comment concerning methods for the utilization of such amounts.
(d) REALLOCATION.-Any
amounts appropriated in any fiscal year and made available to a State under this
part that have not been obligated as described in subsection (d) shall be repaid
to the Secretary and reallotted to other States in proportion to the original
grants made to such States.
SEC.
2619. [300ff-29] TECHNICAL ASSISTANCE.
The Secretary shall provide technical
assistance in administering and coordinating the activities authorized under section
2612, including technical assistance for the development and implementation of
statewide coordinated statements of need.
SEC.
2620. [300ff-30] SUPPLEMENTAL GRANTS.
(a) IN GENERAL.-The Secretary shall award
supplemental grants to States determined to be eligible under subsection (b) to
enable such States to provide comprehensive services of the type described in
section 2612(a) to supplement the services otherwise provided by the State under
a grant under this subpart in emerging communities within the State that are not
eligible to receive grants under part A.
(b) ELIGIBILITY.-To be eligible to
receive a supplemental grant under subsection (a), a State shall-
(1) be eligible
to receive a grant under this subpart;
(2) demonstrate the existence in the
State of an emerging community as defined in subsection (d)(1); and
(3) submit
the information described in subsection (c).
(c) REPORTING REQUIREMENTS.-A
State that desires a grant under this section shall, as part of the State application
submitted under section 2617, submit a detailed description of the manner in which
the State will use amounts received under the grant and of the severity of need.
Such description shall include-
(1) a report concerning the dissemination
of supplemental funds under this section and the plan for the utilization of such
funds in the emerging community;
(2) a demonstration of the existing commitment
of local resources, both financial and in-kind;
(3) a demonstration that the
State will maintain HIV-related activities at a level that is equal to not less
than the level of such activities in the State for the 1-year period preceding
the fiscal year for which the State is applying to receive a grant under this
part;
(4) a demonstration of the ability of the State to utilize such supplemental
financial resources in a manner that is immediately responsive and cost effective;
(5)
a demonstration that the resources will be allocated in accordance with the local
demographic incidence of AIDS including appropriate allocations for services for
infants, children, women, and families with HIV disease;
(6) a demonstration
of the inclusiveness of the planning process, with particular emphasis on affected
communities and individuals with HIV disease; and
(7) a demonstration of the
manner in which the proposed services are consistent with local needs assessments
and the statewide coordinated statement of need.
(d) DEFINITION OF EMERGING
COMMUNITY.-In this section, the term 'emerging community' means a metropolitan
area-
(1) that is not eligible for a grant under part A; and
(2) for which
there has been reported to the Director of the Centers for Disease Control and
Prevention a cumulative total of between 500 and 1,999 cases of acquired immune
deficiency syndrome for the most recent period of 5 calendar years for which such
data are available (except that, for fiscal year 2005 and subsequent fiscal years,
cases of HIV disease shall be counted rather than cases of acquired immune deficiency
syndrome if cases of HIV disease are being counted for purposes of section 2618(a)(2)(D)(i)).
(e)
FUNDING.-
(1) IN GENERAL.-Subject to paragraph (2), with respect to each fiscal
year beginning with fiscal year 2001, the Secretary, to carry out this section,
shall utilize-
(A) the greater of-
(i) 25 percent of the amount appropriated
under section 2677 to carry out part B, excluding the amount appropriated under
section 2618(a)(2)(I), for such fiscal year that is in excess of the amount appropriated
to carry out such part in the fiscal year preceding the fiscal year involved;
or
(ii) $5,000,000,
to provide funds to States for use in emerging communities
with at least 1,000, but less than 2,000, cases of AIDS as reported to and confirmed
by the Director of the Centers for Disease Control and Prevention for the five
year period preceding the year for which the grant is being awarded; and
(B)
the greater of-
(i) 25 percent of the amount appropriated under section 2677
to carry out part B, excluding the amount appropriated under section 2618(a)(2)(I),
for such fiscal year that is in excess of the amount appropriated to carry out
such part in the fiscal year preceding the fiscal year involved; or
(ii) $5,000,000,
to
provide funds to States for use in emerging communities with at least 500, but
less than 1,000, cases of AIDS reported to and confirmed by the Director of the
Centers for Disease Control and Prevention for the five year period preceding
the year for which the grant is being awarded.
(2) TRIGGER OF FUNDING.-This
section shall be effective only for fiscal years beginning in the first fiscal
year in which the amount appropriated under section 2677 to carry out part B,
excluding the amount appropriated under section 2618(a)(2)(I), exceeds by at least
$20,000,000 the amount appropriated under section 2677 to carry out part B in
fiscal year 2000, excluding the amount appropriated under section 2618(a)(2)(I).
(3)
MINIMUM AMOUNT IN FUTURE YEARS.-Beginning with the first fiscal year in which
amounts provided for emerging communities under paragraph (1)(A) equals $5,000,000
and under paragraph (1)(B) equals $5,000,000, the Secretary shall ensure that
amounts made available under this section for the types of emerging communities
described in each such paragraph in subsequent fiscal years is at least $5,000,000.
(4)
DISTRIBUTION.-Grants under this section for emerging communities shall be formula
grants. There shall be two categories of such formula grants, as follows:
(A)
One category of such grants shall be for emerging communities for which the cumulative
total of cases for purposes of subsection (d)(2) is 999 or fewer cases. The grant
made to such an emerging community for a fiscal year shall be the product of-
(i) an amount equal to 50 percent of the amount available pursuant to this
subsection for the fiscal year involved; and
(ii) a percentage equal to the
ratio constituted by the number of cases for such emerging community for the fiscal
year over the aggregate number of such cases for such year for all emerging communities
to which this subparagraph applies.
(B) The other category of formula grants
shall be for emerging communities for which the cumulative total of cases for
purposes of subsection (d)(2) is 1,000 or more cases. The grant made to such an
emerging community for a fiscal year shall be the product of-
(i) an amount
equal to 50 percent of the amount available pursuant to this subsection for the
fiscal year involved; and
(ii) a percentage equal to the ratio constituted
by the number of cases for such community for the fiscal year over the aggregate
number of such cases for the fiscal year for all emerging communities to which
this subparagraph applies.
Subpart
II-Provisions Concerning Pregnancy
and Perinatal Transmission of HIV
SEC.
2625. [300ff-33] CDC GUIDELINES FOR PREGNANT WOMEN.
(a) REQUIREMENT.-Notwithstanding
any other provision of law, a State shall, not later than 120 days after the date
of enactment of this subpart, certify to the Secretary that such State has in
effect regulations or measures to adopt the guidelines issued by the Centers for
Disease Control and Prevention concerning recommendations for human immunodeficiency
virus counseling and voluntary testing for pregnant women.
(b) NONCOMPLIANCE.-If
a State does not provide the certification required under subsection (a) within
the 120-day period described in such subsection, such State shall not be eligible
to receive assistance for HIV counseling and testing under this section until
such certification is provided.
(c) ADDITIONAL FUNDS REGARDING WOMEN AND INFANTS.-
(1)
IN GENERAL.-If a State provides the certification required in subsection (a) and
is receiving funds under part B for a fiscal year, the Secretary may (from the
amounts available pursuant to paragraph (2)) make a grant to the State for the
fiscal year for the following purposes:
(A) Making available to pregnant women
appropriate counseling on HIV disease.
(B) Making available outreach efforts
to pregnant women at high risk of HIV who are not currently receiving prenatal
care.
(C) Making available to such women voluntary HIV testing for such disease.
(D)
Offsetting other State costs associated with the implementation of this section
and subsections (a) and (b) of section 2626.
(E) Offsetting State costs associated
with the implementation of mandatory newborn testing in accordance with this title
or at an earlier date than is required by this title.
(F) Making available
to pregnant women with HIV disease, and to the infants of women with such disease,
treatment services for such disease in accordance with applicable recommendations
of the Secretary.
(2) FUNDING.-
(A) AUTHORIZATION OF APPROPRIATIONS.-For
the purpose of carrying out this subsection, there are authorized to be appropriated
$30,000,000 for each of the fiscal years 2001 through 2005. Amounts made available
under section 2677 for carrying out this part are not available for carrying out
this section unless otherwise authorized.
(B) ALLOCATIONS FOR CERTAIN STATES.-
(i)
IN GENERAL.-Of the amounts appropriated under subparagraph (A) for a fiscal year
in excess of $10,000,000-
(I) the Secretary shall reserve the applicable percentage
under clause (iv) for making grants under paragraph (1) both to States described
in clause (ii) and States described in clause (iii); and
(II) the Secretary
shall reserve the remaining amounts for other States, taking into consideration
the factors described in subparagraph (C)(iii), except that this subclause does
not apply to any State that for the fiscal year involved is receiving amounts
pursuant to subclause (I).
(ii) REQUIRED TESTING OF NEWBORNS.-For purposes
of clause (i)(I), the States described in this clause are States that under law
(including under regulations or the discretion of State officials) have-
(I)
a requirement that all newborn infants born in the State be tested for HIV disease
and that the biological mother of each such infant, and the legal guardian of
the infant (if other than the biological mother), be informed of the results of
the testing; or
(II) a requirement that newborn infants born in the State be
tested for HIV disease in circumstances in which the attending obstetrician for
the birth does not know the HIV status of the mother of the infant, and that the
biological mother of each such infant, and the legal guardian of the infant (if
other than the biological mother), be informed of the results of the testing.
(iii)
MOST SIGNIFICANT REDUCTION IN CASES OF PERINATAL TRANSMISSION.-For purposes of
clause (i)(I), the States described in this clause are the following (exclusive
of States described in clause (ii)), as applicable:
(I) For fiscal years 2001
and 2002, the two States that, relative to other States, have the most significant
reduction in the rate of new cases of the perinatal transmission of HIV (as indicated
by the number of such cases reported to the Director of the Centers for Disease
Control and Prevention for the most recent periods for which the data are available).
(II)
For fiscal years 2003 and 2004, the three States that have the most significant
such reduction.
(III) For fiscal year 2005, the four States that have the most
significant such reduction.
(iv) APPLICABLE PERCENTAGE.-For purposes of clause
(i), the applicable amount for a fiscal year is as follows:
(I) For fiscal
year 2001, 33 percent.
(II) For fiscal year 2002, 50 percent.
(III) For
fiscal year 2003, 67 percent.
(IV) For fiscal year 2004, 75 percent.
(V)
For fiscal year 2005, 75 percent.
(C) CERTAIN PROVISIONS.-With respect to grants
under paragraph (1) that are made with amounts reserved under subparagraph (B)
of this paragraph:
(i) Such a grant may not be made in an amount exceeding
$4,000,000.
(ii) If pursuant to clause (i) or pursuant to an insufficient number
of qualifying applications for such grants (or both), the full amount reserved
under subparagraph (B) for a fiscal year is not obligated, the requirement under
such subparagraph to reserve amounts ceases to apply.
(iii) In the case of
a State that meets the conditions to receive amounts reserved under subparagraph
(B)(i)(II), the Secretary shall in making grants consider the following factors:
(I)
The extent of the reduction in the rate of new cases of the perinatal transmission
of HIV.
(II) The extent of the reduction in the rate of new cases of perinatal
cases of acquired immune deficiency syndrome.
(III) The overall incidence of
cases of infection with HIV among women of childbearing age.
(IV) The overall
incidence of cases of acquired immune deficiency syndrome among women of childbearing
age.
(V) The higher acceptance rate of HIV testing of pregnant women.
(VI)
The extent to which women and children with HIV disease are receiving HIV-related
health services.
(VII) The extent to which HIV-exposed children are receiving
health services appropriate to such exposure.
(3) PRIORITY.-In awarding grants
under this subsection the Secretary shall give priority to States that have the
greatest proportion of HIV seroprevalance among child bearing women using the
most recent data available as determined by the Centers for Disease Control and
Prevention.
(4) MAINTENANCE OF EFFORT.-A condition for the receipt of a grant
under paragraph (1) is that the State involved agree that the grant will be used
to supplement and not supplant other funds available to the State to carry out
the purposes of the grant.
SEC.
2626. [300ff-34] PERINATAL TRANSMISSION OF HIV DISEASE; CONTINGENT REQUIREMENT
REGARDING STATE GRANTS UNDER THIS PART.
(a) ANNUAL DETERMINATION OF REPORTED
CASES.-A State shall annually determine the rate of reported cases of AIDS as
a result of perinatal transmission among residents of the State.
(b) CAUSES
OF PERINATAL TRANSMISSION.-In determining the rate under subsection (a), a State
shall also determine the possible causes of perinatal transmission. Such causes
may include-
(1) the inadequate provision within the State of prenatal counseling
and testing in accordance with the guidelines issued by the Centers for Disease
Control and Prevention;
(2) the inadequate provision or utilization within
the State of appropriate therapy or failure of such therapy to reduce perinatal
transmission of HIV, including-
(A) that therapy is not available, accessible
or offered to mothers; or
(B) that available therapy is offered but not accepted
by mothers; or
(3) other factors (which may include the lack of prenatal care)
determined relevant by the State.
(c) CDC REPORTING SYSTEM.-Not later than
4 months after the date of enactment of this subpart, the Director of the Centers
for Disease Control and Prevention shall develop and implement a system to be
used by States to comply with the requirements of subsections (a) and (b). The
Director shall issue guidelines to ensure that the data collected is statistically
valid.
SEC. 2627.
[300ff-37] STATE HIV TESTING PROGRAMS ESTABLISHED PRIOR TO OR AFTER ENACTMENT.
Nothing
in this subpart shall be construed to disqualify a State from receiving grants
under this title if such State has established at any time prior to or after the
date of enactment of this subpart a program of mandatory HIV testing.
SEC.
2628. [300ff-37a] RECOMMENDATIONS FOR REDUCING INCIDENCE OF PERINATAL TRANSMISSION.
(a)
STUDY BY INSTITUTE OF MEDICINE.-
(1) IN GENERAL.-The Secretary shall request
the Institute of Medicine to enter into an agreement with the Secretary under
which such Institute conducts a study to provide the following:
(A) For the
most recent fiscal year for which the information is available, a determination
of the number of newborn infants with HIV born in the United States with respect
to whom the attending obstetrician for the birth did not know the HIV status of
the mother.
(B) A determination for each State of any barriers, including legal
barriers, that prevent or discourage an obstetrician from making it a routine
practice to offer pregnant women an HIV test and a routine practice to test newborn
infants for HIV disease in circumstances in which the obstetrician does not know
the HIV status of the mother of the infant.
(C) Recommendations for each State
for reducing the incidence of cases of the perinatal transmission of HIV, including
recommendations on removing the barriers identified under subparagraph (B).
If
such Institute declines to conduct the study, the Secretary shall enter into an
agreement with another appropriate public or nonprofit private entity to conduct
the study.
(2) REPORT.-The Secretary shall ensure that, not later than 18 months
after the effective date of this section, the study required in paragraph (1)
is completed and a report describing the findings made in the study is submitted
to the appropriate committees of the Congress, the Secretary, and the chief public
health official of each of the States.
(b) PROGRESS TOWARD RECOMMENDATIONS.-In
fiscal year 2004, the Secretary shall collect information from the States describing
the actions taken by the States toward meeting the recommendations specified for
the States under subsection (a)(1)(C).
(c) SUBMISSION OF REPORTS TO CONGRESS.-The
Secretary shall submit to the appropriate committees of the Congress reports describing
the information collected under subsection (b).
Subpart III-Certain Partner Notification Programs
SEC.
2631. [300ff-38] GRANTS FOR PARTNER NOTIFICATION PROGRAMS.
(a) IN GENERAL.-In
the case of States whose laws or regulations are in accordance with subsection
(b), the Secretary, subject to subsection (c)(2), may make grants to the States
for carrying out programs to provide partner counseling and referral services.
(b)
DESCRIPTION OF COMPLIANT STATE PROGRAMS.-For purposes of subsection (a), the laws
or regulations of a State are in accordance with this subsection if under such
laws or regulations (including programs carried out pursuant to the discretion
of State officials) the following policies are in effect:
(1) The State requires
that the public health officer of the State carry out a program of partner notification
to inform partners of individuals with HIV disease that the partners may have
been exposed to the disease.
(2)(A) In the case of a health entity that provides
for the performance on an individual of a test for HIV disease, or that treats
the individual for the disease, the State requires, subject to subparagraph (B),
that the entity confidentially report the positive test results to the State public
health officer in a manner recommended and approved by the Director of the Centers
for Disease Control and Prevention, together with such additional information
as may be necessary for carrying out such program.
(B) The State may provide
that the requirement of subparagraph (A) does not apply to the testing of an individual
for HIV disease if the individual underwent the testing through a program designed
to perform the test and provide the results to the individual without the individual
disclosing his or her identity to the program. This subparagraph may not be construed
as affecting the requirement of subparagraph (A) with respect to a health entity
that treats an individual for HIV disease.
(3) The program under paragraph
(1) is carried out in accordance with the following:
(A) Partners are provided
with an appropriate opportunity to learn that the partners have been exposed to
HIV disease, subject to subparagraph (B).
(B) The State does not inform partners
of the identity of the infected individuals involved.
(C) Counseling and testing
for HIV disease are made available to the partners and to infected individuals,
and such counseling includes information on modes of transmission for the disease,
including information on prenatal and perinatal transmission and preventing transmission.
(D)
Counseling of infected individuals and their partners includes the provision of
information regarding therapeutic measures for preventing and treating the deterioration
of the immune system and conditions arising from the disease, and the provision
of other prevention-related information.
(E) Referrals for appropriate services
are provided to partners and infected individuals, including referrals for support
services and legal aid.
(F) Notifications under subparagraph (A) are provided
in person, unless doing so is an unreasonable burden on the State.
(G) There
is no criminal or civil penalty on, or civil liability for, an infected individual
if the individual chooses not to identify the partners of the individual, or the
individual does not otherwise cooperate with such program.
(H) The failure
of the State to notify partners is not a basis for the civil liability of any
health entity who under the program reported to the State the identity of the
infected individual involved.
(I) The State provides that the provisions of
the program may not be construed as prohibiting the State from providing a notification
under subparagraph (A) without the consent of the infected individual involved.
(4)
The State annually reports to the Director of the Centers for Disease Control
and Prevention the number of individuals from whom the names of partners have
been sought under the program under paragraph (1), the number of such individuals
who provided the names of partners, and the number of partners so named who were
notified under the program.
(5) The State cooperates with such Director in
carrying out a national program of partner notification, including the sharing
of information between the public health officers of the States.
(c) REPORTING
SYSTEM FOR CASES OF HIV DISEASE; PREFERENCE IN MAKING GRANTS.-In making grants
under subsection (a), the Secretary shall give preference to States whose reporting
systems for cases of HIV disease produce data on such cases that is sufficiently
accurate and reliable for use for purposes of section 2618(a)(2)(D)(i).
(d)
AUTHORIZATION OF APPROPRIATIONS.-For the purpose of carrying out this section,
there are authorized to be appropriated $30,000,000 for fiscal year 2001, and
such sums as may be necessary for each of the fiscal years 2002 through 2005.
PART C-EARLY INTERVENTION SERVICES
Subpart I-Categorical Grants
SEC.
2651. [300ff-51] ESTABLISHMENT OF PROGRAM.
(a) IN GENERAL.-For the purposes
described in subsection (b), the Secretary, acting through the Administrator of
the Health Resources and Services Administration, may make grants to public and
nonprofit private entities specified in section 2652(a).
(b) PURPOSES OF GRANTS.-
(1)
IN GENERAL.-The Secretary may not make a grant under subsection (a) unless the
applicant for the grant agrees to expend the grant for the purposes of providing,
on an outpatient basis, each of the early intervention services specified in paragraph
(2) with respect to HIV disease, and unless the applicant agrees to expend not
less than 50 percent of the grant for such services that are specified in subparagraphs
(B) through (E) of such paragraph for individuals with HIV disease.
(2) SPECIFICATION
OF EARLY INTERVENTION SERVICES.-The early intervention services referred to in
paragraph (1) are-
(A) counseling individuals with respect to HIV disease in
accordance with section 2662;
(B) testing individuals with respect to such
disease, including tests to confirm the presence of the disease, tests to diagnose
the extent of the deficiency in the immune system, and tests to provide information
on appropriate therapeutic measures for preventing and treating the deterioration
of the immune system and for preventing and treating conditions arising from the
disease;
(C) referrals described in paragraph (3);
(D) other clinical and
diagnostic services regarding HIV disease, and periodic medical evaluations of
individuals with the disease;
(E) providing the therapeutic measures described
in subparagraph (B).
(3) REFERRALS.-The services referred to in paragraph (2)(C)
are referrals of individuals with HIV disease to appropriate providers of health
and support services, including, as appropriate-
(A) to entities receiving
amounts under part A or B for the provision of such services;
(B) to biomedical
research facilities of institutions of higher education that offer experimental
treatment for such disease, or to community-based organizations or other entities
that provide such treatment; or
(C) to grantees under section 2671, in the
case of a pregnant woman.
(4) REQUIREMENT OF AVAILABILITY OF ALL EARLY INTERVENTION
SERVICES THROUGH EACH GRANTEE.-
(A) IN GENERAL.-The Secretary may not make
a grant under subsection (a) unless the applicant for the grant agrees that each
of the early intervention services specified in paragraph (2) will be available
through the grantee. With respect to compliance with such agreement, such a grantee
may expend the grant to provide the early intervention services directly, and
may expend the grant to enter into agreements with public or nonprofit private
entities, or private for-profit entities if such entities are the only available
provider of quality HIV care in the area, under which the entities provide the
services.
(B) OTHER REQUIREMENTS.-Grantees described in-
(i) paragraphs
(1), (2), (5), and (6) of section 2652(a) shall use not less than 50 percent of
the amount of such a grant to provide the services described in subparagraphs
(A), (B), (D), and (E) of section 2651(b)(2) directly and on-site or at sites
where other primary care services are rendered; and
(ii) paragraphs (3) and
(4) of section 2652(a) shall ensure the availability of early intervention services
through a system of linkages to community-based primary care providers, and to
establish mechanisms for the referrals described in section 2651(b)(2)(C), and
for follow-up concerning such referrals.
(5) OPTIONAL SERVICES.-A grantee under
subsection (a)-
(A) may expend the grant to provide outreach services to individuals
who may have HIV disease or may be at risk of the disease, and who may be unaware
of the availability and potential benefits of early treatment of the disease,
and to provide outreach services to health care professionals who may be unaware
of such availability and potential benefits; and
(B) may, in the case of individuals
who seek early intervention services from the grantee, expend the grant-
(i)
for case management to provide coordination in the provision of health care services
to the individuals and to review the extent of utilization of the services by
the individuals; and
(ii) to provide assistance to the individuals regarding
establishing the eligibility of the individuals for financial assistance and services
under Federal, State, or local programs providing for health services, mental
health services, social services, or other appropriate services.
(c) PARTICIPATION
IN CERTAIN CONSORTIUM.-The Secretary may not make a grant under subsection (a)
unless the applicant for the grant agrees to make reasonable efforts to participate
in a consortium established with a grant under section 2612(a)(1) regarding comprehensive
services to individuals with HIV disease, if such a consortium exists in the geographic
area with respect to which the applicant is applying to receive such a grant.
SEC.
2652. [300ff-52] MINIMUM QUALIFICATIONS OF GRANTEES.
(a) IN GENERAL.-The entities
referred to in section 2651(a) are public entities and nonprofit private entities
that are-
(1) migrant health centers under section 329 or community health
centers under section 330;
(2) grantees under section 340 (regarding health
services for the homeless);
(3) grantees under section 1001 (regarding family
planning) other than States;
(4) comprehensive hemophilia diagnostic and treatment
centers;
(5) Federally-qualified health centers under section 1905(l)(2)(B)
of the Social Security Act; or
(6) nonprofit private entities that provide
comprehensive primary care services to populations at risk of HIV disease.
(b)
STATUS AS MEDICAID PROVIDER.-
(1) IN GENERAL.-Subject to paragraph (2), the
Secretary may not make a grant under section 2651 for the provision of services
described in subsection (b) of such section in a State unless, in the case of
any such service that is available pursuant to the State plan approved under title
XIX of the Social Security Act for the State-
(A) the applicant for the grant
will provide the service directly, and the applicant has entered into a participation
agreement under the State plan and is qualified to receive payments under such
plan; or
(B) the applicant for the grant will enter into an agreement with
a public or nonprofit private entity, or a private for-profit entity if such entity
is the only available provider of quality HIV care in the area, under which the
entity will provide the service, and the entity has entered into such a participation
agreement and is qualified to receive such payments.
(2) WAIVER REGARDING CERTAIN
SECONDARY AGREEMENTS.-
(A) In the case of an entity making an agreement pursuant
to paragraph (1)(B) regarding the provision of services, the requirement established
in such paragraph regarding a participation agreement shall be waived by the Secretary
if the entity does not, in providing health care services, impose a charge or
accept reimbursement available from any third-party payor, including reimbursement
under any insurance policy or under any Federal or State health benefits program.
(B)
A determination by the Secretary of whether an entity referred to in subparagraph
(A) meets the criteria for a waiver under such subparagraph shall be made without
regard to whether the entity accepts voluntary donations regarding the provision
of services to the public.
SEC.
2653. [300ff-53] PREFERENCES IN MAKING GRANTS.
(a) IN GENERAL.-In making grants
under section 2651, the Secretary shall give preference to any qualified applicant
experiencing an increase in the burden of providing services regarding HIV disease,
as indicated by the factors specified in subsection (b).
(b) SPECIFICATION
OF FACTORS.-
(1) IN GENERAL.-In the case of the geographic area with respect
to which the entity involved is applying for a grant under section 2651, the factors
referred to in subsection (a), as determined for the period specified in paragraph
(2), are-
(A) the number of cases of acquired immune deficiency syndrome;
(B)
the rate of increase in such cases;
(C) the lack of availability of early intervention
services;
(D) the number of other cases of sexually transmitted diseases, and
the number of cases of tuberculosis and of drug abuse;
(E) the rate of increase
in each of the cases specified in subparagraph (D);
(F) the lack of availability
of primary health services from providers other than such applicant; and
(G)
the distance between such area and the nearest community that has an adequate
level of availability of appropriate HIV-related services, and the length of time
required to travel such distance.
(2) RELEVANT PERIOD OF TIME.-The period referred
to in paragraph (1) is the 2-year period preceding the fiscal year for which the
entity involved is applying to receive a grant under section 2651.
(c) EQUITABLE
ALLOCATIONS.-In providing preferences for purposes of subsection (b), the Secretary
shall equitably allocate the preferences among urban and rural areas.
(d) CERTAIN
AREAS.-Of the applicants who qualify for preference under this section-
(1)
the Secretary shall give preference to applicants that will expend the grant under
section 2651 to provide early intervention under such section in rural areas;
and
(2) the Secretary shall give special consideration to areas that are underserved
with respect to such services.
SEC.
2654. [300ff-54] MISCELLANEOUS PROVISIONS.
(a) SERVICES FOR INDIVIDUALS WITH
HEMOPHILIA.-In making grants under section 2651, the Secretary shall ensure that
any such grants made regarding the provision of early intervention services to
individuals with hemophilia are made through the network of comprehensive hemophilia
diagnostic and treatment centers.
(b) TECHNICAL ASSISTANCE.-The Secretary may,
directly or through grants or contracts, provide technical assistance to nonprofit
private entities regarding the process of submitting to the Secretary applications
for grants under section 2651, and may provide technical assistance with respect
to the planning, development, and operation of any program or service carried
out pursuant to such section.
(c) PLANNING AND DEVELOPMENT GRANTS.-
(1)
IN GENERAL.-The Secretary may provide planning grants to public and nonprofit
private entities for purposes of-
(A) enabling such entities to provide HIV
early intervention services; and
(B) assisting the entities in expanding their
capacity to provide HIV-related health services, including early intervention
services, in low-income communities and affected subpopulations that are underserved
with respect to such services (subject to the condition that a grant pursuant
to this subparagraph may not be expended to purchase or improve land, or to purchase,
construct, or permanently improve, other than minor remodeling, any building or
other facility).
(2) REQUIREMENT.-The Secretary may only award a grant to an
entity under paragraph (1) if the Secretary determines that the entity will use
such grant to assist the entity in qualifying for a grant under section 2651.
(3)
PREFERENCE.-In awarding grants under paragraph (1), the Secretary shall give preference
to entities that provide primary care services in rural or underserved communities.
(4)
AMOUNT AND DURATION OF GRANTS.-
(A) EARLY INTERVENTION SERVICES.-A grant under
paragraph (1)(A) may be made in an amount not to exceed $50,000.
(B) CAPACITY
DEVELOPMENT.-
(i) AMOUNT. -A grant under paragraph (1)(B) may be made in an
amount not to exceed $150,000.
(ii) DURATION.-The total duration of a grant
under paragraph (1)(B), including any renewal, may not exceed 3 years.
(5)
LIMITATION.-Not to exceed 5 percent of the amount appropriated for a fiscal year
under section 2655 may be used to carry out this section.
SEC.
2655. [300ff-55] AUTHORIZATION OF APPROPRIATIONS.
For the purpose of making
grants under section 2651, there are authorized to be appropriated such sums as
may be necessary for each of the fiscal years 2001 through 2005.
Subpart II-General Provisions
SEC.
2661. [300ff-61] CONFIDENTIALITY AND INFORMED CONSENT.
(a) CONFIDENTIALITY.-The
Secretary may not make a grant under this part unless, in the case of any entity
applying for a grant under section 2651, the entity agrees to ensure that information
regarding the receipt of early intervention services pursuant to the grant is
maintained confidentially in a manner not inconsistent with applicable law.
(b)
INFORMED CONSENT.-
(1) IN GENERAL.-The Secretary may not make a grant under
this part unless the applicant for the grant agrees that, in testing an individual
for HIV disease, the applicant will test an individual only after obtaining from
the individual a statement, made in writing and signed by the individual, declaring
that the individual has undergone the counseling described in section 2662(a)
and that the decision of the individual with respect to undergoing such testing
is voluntarily made.
(2) PROVISIONS REGARDING ANONYMOUS TESTING.-
(A) If,
pursuant to section 2664(b), an individual will undergo testing pursuant to this
part through the use of a pseudonym, a grantee under such section shall be considered
to be in compliance with the agreement made under paragraph (1) if the individual
signs the statement described in such subsection using the pseudonym.
(B) If,
pursuant to section 2664(b), an individual will undergo testing pursuant to this
part without providing any information relating to the identity of the individual,
a grantee under such section shall be considered to be in compliance with the
agreement made under paragraph (1) if the individual orally provides the declaration
described in such paragraph.
SEC.
2662. [300ff-62] PROVISION OF CERTAIN COUNSELING SERVICES.
(a) COUNSELING BEFORE
TESTING-The Secretary may not make a grant under this part unless the applicant
for the grant agrees that, before testing an individual for HIV disease, the applicant
will provide to the individual appropriate counseling regarding the disease (based
on the most recently available scientific data), including counseling on-
(1)
measures for the prevention of exposure to, and the transmission of, HIV;
(2)
the accuracy and reliability of the results of testing for HIV disease;
(3)
the significance of the results of such testing, including the potential for developing
acquired immune deficiency syndrome;
(4) encouraging the individual, as appropriate,
to undergo such testing;
(5) the benefits of such testing, including the medical
benefits of diagnosing HIV disease in the early stages and the medical benefits
of receiving early intervention services during such stages;
(6) provisions
of law relating to the confidentiality of the process of receiving such services,
including information regarding any disclosures that may be authorized under applicable
law and information regarding the availability of anonymous counseling and testing
pursuant to section 2664(b); and
(7) provisions of applicable law relating
to discrimination against individuals with HIV disease.
(b) COUNSELING OF INDIVIDUALS
WITH NEGATIVE TEST RESULTS-The Secretary may not make a grant under this part
unless the applicant for the grant agrees that, if the results of testing conducted
for HIV disease indicate that an individual does not have the disease, the applicant
will review for the individual the information provided pursuant to subsection
(a), including-
(1) the information described in paragraphs (1) through (3)
of such subsection; and
(2) the appropriateness of further counseling, testing,
and education of the individual regarding such disease.
(c) COUNSELING OF INDIVIDUALS
WITH POSITIVE TEST RESULTS.-The Secretary may not make a grant under this part
unless the applicant for the grant agrees that, if the results of testing for
HIV disease indicate that the individual has the disease, the applicant will provide
to the individual appropriate counseling regarding such disease, including-
(1)
reviewing the information described in paragraphs (1) through (3) of subsection
(a);
(2) reviewing the appropriateness of further counseling, testing, and
education of the individual regarding such disease; and
(3) providing counseling-
(A)
on the availability, through the applicant, of early intervention services;
(B)
on the availability in the geographic area of appropriate health care, mental
health care, and social and support services, including providing referrals for
such services, as appropriate;
(C)(i) that explains the benefits of locating
and counseling any individual by whom the infected individual may have been exposed
to HIV and any individual whom the infected individual may have exposed to HIV;
and
(ii) that emphasizes it is the duty of infected individuals to disclose
their infected status to their sexual partners and their partners in the sharing
of hypodermic needles; that provides advice to infected individuals on the manner
in which such disclosures can be made; and that emphasizes that it is the continuing
duty of the individuals to avoid any behaviors that will expose others to HIV.
(D)
on the availability of the services of public health authorities with respect
to locating and counseling any individual described in subparagraph (C).
(d)
ADDITIONAL REQUIREMENTS REGARDING APPROPRIATE COUNSELING.-The Secretary may not
make a grant under this part unless the applicant for the grant agrees that, in
counseling individuals with respect to HIV disease, the applicant will ensure
that the counseling is provided under conditions appropriate to the needs of the
individuals.
(e) COUNSELING OF EMERGENCY RESPONSE EMPLOYEES.-The Secretary
may not make a grant under this part to a State unless the State agrees that,
in counseling individuals with respect to HIV disease, the State will ensure that,
in the case of emergency response employees, the counseling is provided to such
employees under conditions appropriate to the needs of the employees regarding
the counseling.
(f) RULE OF CONSTRUCTION REGARDING COUNSELING WITHOUT TESTING.-Agreements
made pursuant to this section may not be construed to prohibit any grantee under
this part from expending the grant for the purpose of providing counseling services
described in this section to an individual who does not undergo testing for HIV
disease as a result of the grantee or the individual determining that such testing
of the individual is not appropriate.
SEC.
2663. [300ff-63] APPLICABILITY OF REQUIREMENTS REGARDING CONFIDENTIALITY, INFORMED
CONSENT, AND COUNSELING.
The Secretary may not make a grant under this part
unless the applicant for the grant agrees that, with respect to testing for HIV
disease, any such testing carried out by the applicant will, without regard to
whether such testing is carried out with Federal funds, be carried out in accordance
with conditions described in sections 2661 and 2662.
SEC.
2664. [300ff-64] ADDITIONAL REQUIRED AGREEMENTS.
(a) REPORTS TO SECRETARY.-The
Secretary may not make a grant under this part unless-
(1) the applicant submits
to the Secretary-
(A) a specification of the expenditures made by the applicant
for early intervention services for the fiscal year preceding the fiscal year
for which the applicant is applying to receive the grant; and
(B) an estimate
of the number of individuals to whom the applicant has provided such services
for such fiscal year; and
(2) the applicant agrees to submit to the Secretary
a report providing-
(A) the number of individuals to whom the applicant provides
early intervention services pursuant to the grant;
(B) epidemiological and
demographic data on the population of such individuals;
(C) the extent to which
the costs of HIV-related health care for such individuals are paid by third-party
payors;
(D) the average costs of providing each category of early intervention
service; and
(E) the aggregate amounts expended for each such category.
(b)
PROVISION OF OPPORTUNITIES FOR ANONYMOUS COUNSELING AND TESTING.-The Secretary
may not make a grant under this part unless the applicant for the grant agrees
that, to the extent permitted under State law, regulation or rule, the applicant
will offer substantial opportunities for an individual-
(1) to undergo counseling
and testing regarding HIV disease without being required to provide any information
relating to the identity of the individual; and
(2) to undergo such counseling
and testing through the use of a pseudonym.
(c) PROHIBITION AGAINST REQUIRING
TESTING AS CONDITION OF RECEIVING OTHER HEALTH SERVICES.-The Secretary may not
make a grant under this part unless the applicant for the grant agrees that, with
respect to an individual seeking health services from the applicant, the applicant
will not require the individual to undergo testing for HIV as a condition of receiving
any health services unless such testing is medically indicated in the provision
of the health services sought by the individual.
(d) MAINTENANCE OF SUPPORT.-The
Secretary may not make a grant under this part unless the applicant for the grant
agrees to maintain the expenditures of the applicant for early intervention services
at a level equal to not less than the level of such expenditures maintained by
the State for the fiscal year preceding the fiscal year for which the applicant
is applying to receive the grant.
(e) REQUIREMENTS REGARDING IMPOSITION OF
CHARGES FOR SERVICES.-
(1) IN GENERAL.-The Secretary may not make a grant under
this part unless, subject to paragraph (5), the applicant for the grant agrees
that-
(A) in the case of individuals with an income less than or equal to 100
percent of the official poverty line, the applicant will not impose a charge on
any such individual for the provision of early intervention services under the
grant;
(B) in the case of individuals with an income greater than 100 percent
of the official poverty line, the applicant-
(i) will impose a charge on each
such individual for the provision of such services; and
(ii) will impose the
charge according to a schedule of charges that is made available to the public.
(2)
LIMITATION ON CHARGES REGARDING INDIVIDUALS SUBJECT TO CHARGES.-With respect to
the imposition of a charge for purposes of paragraph (1)(B)(ii), the Secretary
may not make a grant under this part unless, subject to paragraph (5), the applicant
for the grant agrees that-
(A) in the case of individuals with an income greater
than 100 percent of the official poverty line and not exceeding 200 percent of
such poverty line, the applicant will not, for any calendar year, impose charges
in an amount exceeding 5 percent of the annual gross income of the individual
involved;
(B) in the case of individuals with an income greater than 200 percent
of the official poverty line and not exceeding 300 percent of such poverty line,
the applicant will not, for any calendar year, impose charges in an amount exceeding
7 percent of the annual gross income of the individual involved; and
(C) in
the case of individuals with an income greater than 300 percent of the official
poverty line, the applicant will not, for any calendar year, impose charges in
an amount exceeding 10 percent of the annual gross income of the individual involved.
(3)
ASSESSMENT OF CHARGE.-With respect to compliance with the agreement made under
paragraph (1), a grantee under this part may, in the case of individuals subject
to a charge for purposes of such paragraph-
(A) assess the amount of the charge
in the discretion of the grantee, including imposing only a nominal charge for
the provision of services, subject to the provisions of such paragraph regarding
public schedules and of paragraph (2) regarding limitations on the maximum amount
of charges; and
(B) take into consideration the medical expenses of individuals
in assessing the amount of the charge, subject to such provisions.
(4) APPLICABILITY
OF LIMITATION ON AMOUNT OF CHARGE.-The Secretary may not make a grant under this
part unless the applicant for the grant agrees that the limitations established
in paragraph (2) regarding the imposition of charges for services applies to the
annual aggregate of charges imposed for such services, without regard to whether
they are characterized as enrollment fees, premiums, deductibles, cost sharing,
copayments, coinsurance, or similar charges.
(5) WAIVER REGARDING CERTAIN SECONDARY
AGREEMENTS.-The requirement established in paragraph (1)(B)(i) shall be waived
by the Secretary in the case of any entity for whom the Secretary has granted
a waiver under section 2652(b)(2).
(f) RELATIONSHIP TO ITEMS AND SERVICES UNDER
OTHER PROGRAMS.-
(1) IN GENERAL.-The Secretary may not make a grant under this
part unless the applicant for the grant agrees that, subject to paragraph (2),
the grant will not be expended by the applicant, or by any entity receiving amounts
from the applicant for the provision of early intervention services, to make payment
for any such service to the extent that payment has been made, or can reasonably
be expected to be made, with respect to such service-
(A) under any State compensation
program, under an insurance policy, or under any Federal or State health benefits
program; or
(B) by an entity that provides health services on a prepaid basis.
(2)
APPLICABILITY TO CERTAIN SECONDARY AGREEMENTS FOR PROVISION OF SERVICES.-An agreement
made under paragraph (1) shall not apply in the case of an entity through which
a grantee under this part provides early intervention services if the Secretary
has provided a waiver under section 2652(b)(2) regarding the entity.
(g) ADMINISTRATION
OF GRANT.-The Secretary may not make a grant under this part unless the applicant
for the grant agrees that-
(1) the applicant will not expend amounts received
pursuant to this part for any purpose other than the purposes described in the
subpart under which the grant involved is made;
(2) the applicant will establish
such procedures for fiscal control and fund accounting as may be necessary to
ensure proper disbursement and accounting with respect to the grant;
(3) the
applicant will not expend more than 10 percent including planning and evaluation
of the grant for administrative expenses with respect to the grant;
(4) the
applicant will submit evidence that the proposed program is consistent with the
statewide coordinated statement of need and agree to participate in the ongoing
revision of such statement of need; and
(5) the applicant will provide for
the establishment of a quality management program-
(A) to assess the extent
to which medical services funded under this title that are provided to patients
are consistent with the most recent Public Health Service guidelines for the treatment
of HIV disease and related opportunistic infections, and as applicable, to develop
strategies for ensuring that such services are consistent with the guidelines;
and
(B) to ensure that improvements in the access to and quality of HIV health
services are addressed.
SEC.
2665. [300ff-65] REQUIREMENT OF SUBMISSION OF APPLICATION CONTAINING CERTAIN AGREEMENTS
AND ASSURANCES.
The Secretary may not make a grant under this part unless-
(1)
an application for the grant is submitted to the Secretary containing agreements
and assurances in accordance with this part and containing the information specified
in section 2664(a)(1);
(2) with respect to such agreements, the application
provides assurances of compliance satisfactory to the Secretary; and
(3) the
application otherwise is in such form, is made in such manner, and contains such
agreements, assurances, and information as the Secretary determines to be necessary
to carry out this part.
SEC.
2666. [300ff-66] PROVISION BY SECRETARY OF SUPPLIES AND SERVICES IN LIEU OF GRANT
FUNDS.
(a) IN GENERAL.-Upon the request of a grantee under this part, the Secretary
may, subject to subsection (b), provide supplies, equipment, and services for
the purpose of aiding the grantee in providing early intervention services and,
for such purpose, may detail to the State any officer or employee of the Department
of Health and Human Services.
(b) LIMITATION.-With respect to a request described
in subsection (a), the Secretary shall reduce the amount of payments under the
grant involved by an amount equal to the costs of detailing personnel and the
fair market value of any supplies, equipment, or services provided by the Secretary.
The Secretary shall, for the payment of expenses incurred in complying with such
request, expend the amounts withheld.
SEC.
2667. [300ff-67] USE OF FUNDS.
Counseling programs carried out under this part-
(1)
shall not be designed to promote or encourage, directly, intravenous drug abuse
or sexual activity, homosexual or heterosexual;
(2) shall be designed to reduce
exposure to and transmission of HIV disease by providing accurate information;
and
(3) shall provide information on the health risks of promiscuous sexual
activity and intravenous drug abuse.
PART D-GENERAL PROVISIONS
SEC.
2671. [300ff-71] GRANTS FOR COORDINATED SERVICES AND ACCESS TO RESEARCH FOR WOMEN,
INFANTS, CHILDREN, AND YOUTH.
(a) IN GENERAL.-The Secretary, acting through
the Administrator of the Health Resources and Services Administration and in consultation
with the Director of the National Institutes of Health, shall make grants to public
and nonprofit private entities that provide primary care (directly or through
contracts) for the following purposes:
(1) Providing through such entities,
in accordance with this section, opportunities for women, infants, children, and
youth to be voluntary participants in research of potential clinical benefit to
individuals with HIV disease.
(2) In the case of women, infants, children,
and youth with HIV disease, and the families of such individuals, providing to
such individuals-
(A) health care on an outpatient basis; and
(B) additional
services in accordance with subsection (d).
(b) PROVISIONS REGARDING PARTICIPATION
IN RESEARCH.-
(1) IN GENERAL.-With respect to the projects of research with
which an applicant under subsection (a) is concerned, the Secretary may make a
grant under such subsection to the applicant only if the following conditions
are met:
(A) The applicant agrees to make reasonable efforts-
(i) to identify
which of the patients of the applicant are women, infants, children, and youth
who would be appropriate participants in the projects;
(ii) to carry out clause
(i) through the use of criteria provided for such purpose by the entities that
will be conducting the projects of research; and
(iii) to offer women, infants,
children, and youth the opportunity to participate in the projects (as appropriate),
including the provision of services under subsection (d)(3).
(B) The applicant
agrees that, in the case of the research-related functions to be carried out by
the applicant pursuant to subsection (a)(1), the applicant will comply with accepted
standards that are applicable to such functions (including accepted standards
regarding informed consent and other protections for human subjects).
(C) The
applicant will demonstrate linkages to research and how access to such research
is being offered to patients.
(2) PROHIBITION.-Receipt of services by a patient
shall not be conditioned upon the consent of the patient to participate in research.
(c)
PROVISIONS REGARDING CONDUCT OF RESEARCH.-
(1) IN GENERAL.-With respect to
eligibility for a grant under subsection (a):
(A) A project of research for
which subjects are sought pursuant to such subsection may be conducted by the
applicant for the grant, or by an entity with which the applicant has made arrangements
for purposes of the grant.
The grant may not be expended for the conduct of
any project of research, except for such research-related functions as are appropriate
for providing opportunities under subsection (a)(1) (including the functions specified
in subsection (b)(1)).
(B) The grant may be made only if the Secretary makes
the following determinations:
(i) The applicant or other entity (as the case
may be under subparagraph (A)) is appropriately qualified to conduct the project
of research. An entity shall be considered to be so qualified if any research
protocol of the entity has been recommended for funding under this Act pursuant
to technical and scientific peer review through the National Institutes of Health.
(ii)
The project of research is being conducted in accordance with a research protocol
to which the Secretary gives priority regarding the prevention or treatment of
HIV disease in women, infants, children, or youth, subject to paragraph (2).
(2)
LIST OF RESEARCH PROTOCOLS.-
(A) IN GENERAL.-From among the research protocols
described in paragraph (1)(B)(ii), the Secretary shall establish a list of research
protocols that are appropriate for purposes of subsection (a)(1). Such list shall
be established only after consultation with public and private entities that conduct
such research, and with providers of services under subsection (a) and recipients
of such services.
(B) DISCRETION OF SECRETARY.-The Secretary may authorize
the use, for purposes of subsection (a)(1), of a research protocol that is not
included on the list under subparagraph (A). The Secretary may waive the requirement
specified in paragraph (1)(B)(ii) in such circumstances as the Secretary determines
to be appropriate.
(d) ADDITIONAL SERVICES FOR PATIENTS AND FAMILIES.-A grant
under subsection (a) may be made only if the applicant for the grant agrees as
follows:
(1) The applicant will provide for the case management of the patient
involved and the family of the patient.
(2) The applicant will provide for
the patient and the family of the patient-
(A) referrals for inpatient hospital
services, treatment for substance abuse, and mental health services; and
(B)
referrals for other social and support services, as appropriate.
(3) The applicant
will provide the patient and the family of the patient with such transportation,
child care, and other incidental services as may be necessary to enable the patient
and the family to participate in the program established by the applicant pursuant
to such subsection.
(4) The applicant will provide individuals with information
and education on opportunities to participate in HIV/AIDS-related clinical research.
(e)
COORDINATION WITH OTHER ENTITIES.-A grant under subsection (a) may be made only
if the applicant for the grant agrees as follows:
(1) The applicant will coordinate
activities under the grant with other providers of health care services under
this Act, and under title V of the Social Security Act.
(2) The applicant will
participate in the statewide coordinated statement of need under part B (where
it has been initiated by the public health agency responsible for administering
grants under part B) and in revisions of such statement.
(f) ADMINISTRATION.-
(1)
APPLICATION.-A grant under subsection (a) may be made only if an application for
the grant is submitted to the Secretary and the application is in such form, is
made in such manner, and contains such agreements, assurances, and information
as the Secretary determines to be necessary to carry out this section.
(2)
QUALITY MANAGEMENT PROGRAM.-A grantee under this section shall implement a quality
management program to assess the extent to which HIV health services provided
to patients under the grant are consistent with the most recent Public Health
Service guidelines for the treatment of HIV disease and related opportunistic
infection, and as applicable, to develop strategies for ensuring that such services
are consistent with the guidelines for improvement in the access to and quality
of HIV health services.
(g) COORDINATION WITH NATIONAL INSTITUTES OF HEALTH.-The
Secretary shall develop and implement a plan that provides for the coordination
of the activities of the National Institutes of Health with the activities carried
out under this section. In carrying out the preceding sentence, the Secretary
shall ensure that projects of research conducted or supported by such Institutes
are made aware of applicants and grantees under subsection (a), shall require
that the projects, as appropriate, enter into arrangements for purposes of such
subsection, and shall require that each project entering into such an arrangement
inform the applicant or grantee under such subsection of the needs of the project
for the participation of women, infants, children, and youth. The Secretary acting
through the Director of NIH, shall examine the distribution and availability of
ongoing and appropriate HIV/AIDS-related research projects to existing sites under
this section for purposes of enhancing and expanding voluntary access to HIV-related
research, especially within communities that are not reasonably served by such
projects. Not later than 12 months after the date of the enactment of the Ryan
White CARE Act Amendments of 2000, the Secretary shall prepare and submit to the
appropriate committees of Congress a report that describes the findings made by
the Director and the manner in which the conclusions based on those findings can
be addressed.
(h) ANNUAL REVIEW OF PROGRAMS; EVALUATIONS.-
(1) REVIEW REGARDING
ACCESS TO AND PARTICIPATION IN PROGRAMS.-With respect to a grant under subsection
(a) for an entity for a fiscal year, the Secretary shall, not later than 180 days
after the end of the fiscal year, provide for the conduct and completion of a
review of the operation during the year of the program carried out under such
subsection by the entity. The purpose of such review shall be the development
of recommendations, as appropriate, for improvements in the following:
(A)
Procedures used by the entity to allocate opportunities and services under subsection
(a) among patients of the entity who are women, infants, children, or youth.
(B)
Other procedures or policies of the entity regarding the participation of such
individuals in such program.
(2) EVALUATIONS.-The Secretary shall, directly
or through contracts with public and private entities, provide for evaluations
of programs carried out pursuant to subsection (a).
(i) LIMITATION ON ADMINISTRATIVE
EXPENSES.-
(1) DETERMINATION BY SECRETARY.-Not later than 12 months after the
date of the enactment of the Ryan White CARE Act Amendments of 2000, the Secretary,
in consultation with grantees under this part, shall conduct a review of the administrative,
program support, and direct service-related activities that are carried out under
this part to ensure that eligible individuals have access to quality, HIV-related
health and support services and research opportunities under this part, and to
support the provision of such services.
(2) REQUIREMENTS.-
(A) IN GENERAL.-Not
later than 180 days after the expiration of the 12-month period referred to in
paragraph (1) the Secretary, in consultation with grantees under this part, shall
determine the relationship between the costs of the activities referred to in
paragraph (1) and the access of eligible individuals to the services and research
opportunities described in such paragraph.
(B) LIMITATION.-After a final determination
under subparagraph (A), the Secretary may not make a grant under this part unless
the grantee complies with such requirements as may be included in such determination.
(j)
TRAINING AND TECHNICAL ASSISTANCE.-Of the amounts appropriated under subsection
(j) for a fiscal year, the Secretary may use not more than five percent to provide,
directly or through contracts with public and private entities (which may include
grantees under subsection (a)), training and technical assistance to assist applicants
and grantees under subsection (a) in complying with the requirements of this section.
(k)
AUTHORIZATION OF APPROPRIATIONS.-For the purpose of carrying out this section,
there are authorized to be appropriated such sums as may be necessary for each
of the fiscal years 1996 through 2000.
SEC.
2672. [300ff-72] PROVISIONS RELATING TO BLOOD BANKS.
(a) INFORMATIONAL AND
TRAINING PROGRAMS.-The Secretary shall-
(1) develop and make available to technical
and supervisory personnel employed at blood banks and facilities that produce
blood products, materials and information concerning measures that may be implemented
to protect the safety of the blood supply with respect to the activities of such
personnel, including-
(A) state-of-the-art diagnostic and testing procedures
relating to pathogens in the blood supply; and
(B) quality assurance procedures
relating to the safety of the blood supply and of blood products; and
(2) develop
and implement a training program that is designed to increase the number of employees
of the Department of Health and Human Services who are qualified to conduct inspections
of blood banks and facilities that produce blood products.
(b) Updates.-The
Secretary shall periodically review and update the materials and information made
available under informational or training programs conducted under subsection
(a).
(c) AUTHORIZATION OF APPROPRIATIONS.-There are authorized to be appropriated
to carry out this section, $1,500,000 for fiscal year 1991, and such sums as may
be necessary in each of the fiscal years 1992 through 1995.
SEC.
2673. [300ff-73] RESEARCH, EVALUATION, AND ASSESSMENT PROGRAM.
(a) ESTABLISHMENT.-The
Secretary, acting through the Director of the Agency for Healthcare Research and
Quality, shall establish a program to enable independent research to be conducted
by individuals and organizations with appropriate expertise in the fields of health,
health policy, and economics (particularly health care economics) to develop-
(1)
a comparative assessment of the impact and cost-effectiveness of major models
for organizing and delivering HIV-related health care, mental health care, early
intervention, and support services, that shall include a report concerning patient
outcomes, satisfaction, perceived quality of care, and total cumulative cost,
and a review of the appropriateness of such models for the delivery of health
and support services to infants, children, women, and families with HIV disease;
(2)
through a review of private sector financing mechanisms for the delivery of HIV-related
health and support services, an assessment of strategies for maintaining private
health benefits for individuals with HIV disease and an assessment of specific
business practices or regulatory barriers that could serve to reduce access to
private sector benefit programs;
(3) an assessment of the manner in which different
points-of-entry to the health care system affect the cost, quality, and outcome
of the care and treatment of individuals and families with HIV disease; and
(4)
a summary report concerning the major and continuing unmet needs in health care,
mental health care, early intervention, and support services for individuals and
families with HIV disease in urban and rural areas.
(b) REPORT.-Not later than
2 years after the date of enactment of this title, and periodically thereafter,
the Secretary shall prepare and submit, to the Committee on Energy and Commerce
of the House of Representatives and the Committee on Labor and Human Resources
of the Senate, a progress report that contains the findings and assessments developed
under subsection (a).
(c) AUTHORIZATION OF APPROPRIATIONS.-There are authorized
to be appropriated to carry out this section, such sums as may be necessary for
each of the fiscal years 1991 through 1995.
SEC.
2674. [300ff-74] EVALUATIONS AND REPORTS.
(a) Evaluations.-The Secretary shall,
directly or through grants and contracts, evaluate programs carried out under
this title.
(b) REPORT TO CONGRESS.-The Secretary shall, not later than October
1, 1996, and annually thereafter, prepare and submit to the appropriate Committees
of Congress a report-
(1) evaluating the programs carried out under this title;
and
(2) making such recommendations for administrative and legislative initiatives
with respect to this title as the Secretary determines to be appropriate.
(c)
AUTHORIZATION OF APPROPRIATIONS.-There are authorized to be appropriated to carry
out this section, such sums as may be necessary for each of the fiscal years 2001
through 2005.
(d) ALLOCATION OF FUNDS.-The Secretary shall carry out this section
with amounts available under section 241. Such amounts are in addition to any
other amounts that are available to the Secretary for such purpose.
SEC.
2675. [300ff-75] COORDINATION.
(a) REQUIREMENT.-The Secretary shall ensure
that the Health Resources and Services Administration, the Centers for Disease
Control and Prevention, the Substance Abuse and Mental Health Services Administration,
and the Health Care Financing Administration coordinate the planning, funding,
and implementation of Federal HIV programs to enhance the continuity of care and
prevention services for individuals with HIV disease or those at risk of such
disease. The Secretary shall consult with other Federal agencies, including the
Department of Veterans Affairs, as needed and utilize planning information submitted
to such agencies by the States and entities eligible for support.
(b) REPORT.-The
Secretary shall biennially prepare and submit to the appropriate committees of
the Congress a report concerning the coordination efforts at the Federal, State,
and local levels described in this section, including a description of Federal
barriers to HIV program integration and a strategy for eliminating such barriers
and enhancing the continuity of care and prevention services for individuals with
HIV disease or those at risk of such disease.
(c) INTEGRATION BY STATE.-As
a condition of receipt of funds under this title, a State shall assure the Secretary
that health support services funded under this title will be integrated with each
other, that programs will be coordinated with other available programs (including
Medicaid) and that the continuity of care and prevention services of individuals
with HIV disease is enhanced.
(d) INTEGRATION BY LOCAL OR PRIVATE ENTITIES.-As
a condition of receipt of funds under this title, a local government or private
nonprofit entity shall assure the Secretary that services funded under this title
will be integrated with each other, that programs will be coordinated with other
available programs (including Medicaid) and that the continuity of care and prevention
services of individuals with HIV is enhanced.
(e) RECOMMENDATIONS REGARDING
RELEASE OF PRISONERS.-After consultation with the Attorney General and the Director
of the Bureau of Prisons, with States, with eligible areas under part A, and with
entities that receive amounts from grants under part A or B, the Secretary, consistent
with the coordination required in subsection (a), shall develop a plan for the
medical case management of and the provision of support services to individuals
who were Federal or State prisoners and had HIV disease as of the date on which
the individuals were released from the custody of the penal system. The Secretary
shall submit the plan to the Congress not later than 2 years after the date of
the enactment of the Ryan White CARE Act Amendments of 2000.
SEC.
2675A. [300ff-75a] AUDITS.
For fiscal year 2002 and subsequent fiscal years,
the Secretary may reduce the amounts of grants under this title to a State or
political subdivision of a State for a fiscal year if, with respect to such grants
for the second preceding fiscal year, the State or subdivision fails to prepare
audits in accordance with the procedures of section 7502 of title 31, United States
Code. The Secretary shall annually select representative samples of such audits,
prepare summaries of the selected audits, and submit the summaries to the Congress.
SEC.
2675B. [300ff-75b] ADMINISTRATIVE SIMPLIFICATION REGARDING PARTS A AND B.
(a)
COORDINATED DISBURSEMENT.-After consultation with the States, with eligible areas
under part A, and with entities that receive amounts from grants under part A
or B, the Secretary shall develop a plan for coordinating the disbursement of
appropriations for grants under part A with the disbursement of appropriations
for grants under part B in order to assist grantees and other recipients of amounts
from such grants in complying with the requirements of such parts. The Secretary
shall submit the plan to the Congress not later than 18 months after the date
of the enactment of the Ryan White CARE Act Amendments of 2000. Not later than
2 years after the date on which the plan is so submitted, the Secretary shall
complete the implementation of the plan, notwithstanding any provision of this
title that is inconsistent with the plan.
(b) BIENNIAL APPLICATIONS.-After
consultation with the States, with eligible areas under part A, and with entities
that receive amounts from grants under part A or B, the Secretary shall make a
determination of whether the administration of parts A and B by the Secretary,
and the efficiency of grantees under such parts in complying with the requirements
of such parts, would be improved by requiring that applications for grants under
such parts be submitted biennially rather than annually. The Secretary shall submit
such determination to the Congress not later than 2 years after the date of the
enactment of the Ryan White CARE Act Amendments of 2000.
(c) APPLICATION SIMPLIFICATION.-After
consultation with the States, with eligible areas under part A, and with entities
that receive amounts from grants under part A or B, the Secretary shall develop
a plan for simplifying the process for applications under parts A and B. The Secretary
shall submit the plan to the Congress not later than 18 months after the date
of the enactment of the Ryan White CARE Act Amendments of 2000. Not later than
2 years after the date on which the plan is so submitted, the Secretary shall
complete the implementation of the plan, notwithstanding any provision of this
title that is inconsistent with the plan.
SEC.
2676. [300ff-76] DEFINITIONS.
For purposes of this title:
(1) COUNSELING.-The
term "counseling" means such counseling provided by an individual trained
to provide such counseling.
(2) DESIGNATED OFFICER OF EMERGENCY RESPONSE EMPLOYEES.-The
term "designated officer of emergency response employees" means an individual
designated under section 2686 by the public health officer of the State involved.
(3)
EMERGENCY.-The term "emergency" means an emergency involving injury
or illness.
(4) EMERGENCY RESPONSE EMPLOYEE.-The term "emergency response
employees" means firefighters, law enforcement officers, paramedics, emergency
medical technicians, funeral-service practitioners, and other individuals (including
employees of legally organized and recognized volunteer organizations, without
regard to whether such employees receive nominal compensation) who, in the course
of professional duties, respond to emergencies in the geographic area involved.
(5)
EMPLOYER OF EMERGENCY RESPONSE EMPLOYEES.-The term "employer of emergency
response employees" means an organization that, in the course of professional
duties, responds to emergencies in the geographic area involved.
(6) EXPOSED.-The
term "exposed", with respect to HIV disease or any other infectious
disease, means to be in circumstances in which there is a significant risk of
becoming infected with the etiologic agent for the disease involved.
(7) FAMILIES
WITH HIV DISEASE.-The term "families with HIV disease" means families
in which one or more members have HIV disease.
(8) HIV.-The term "HIV"
means infection with the etiologic agent for acquired immune deficiency syndrome.
(9)
HIV DISEASE.-The term "HIV disease" means infection with the etiologic
agent for acquired immune deficiency syndrome, and includes any condition arising
from such syndrome.
(10) OFFICIAL POVERTY LINE.-The term "official poverty
line" means the poverty line established by the Director of the Office of
Management and Budget and revised by the Secretary in accordance with section
673(2) of the Omnibus Budget Reconciliation Act of 1981.
(11) PERSON.-The term
"person" includes one or more individuals, governments (including the
Federal Government and the governments of the States), governmental agencies,
political subdivisions, labor unions, partnerships, associations, corporations,
legal representatives, mutual companies, joint-stock companies, trusts, unincorporated
organizations, receivers, trustees, and trustees in cases under title 11, United
States Code.
(12) STATE.-The term "State", except as otherwise specifically
provided, means each of the 50 States, the District of Columbia, the Virgin Islands,
Guam, American Samoa, the Commonwealth of the Northern Mariana Islands, Puerto
Rico, and the Republic of the Marshall Islands.
SEC.
2677. [300ff-77] AUTHORIZATION OF APPROPRIATIONS.
(a) PART A.-For the purpose
of carrying out part A, there are authorized to be appropriated such sums as may
be necessary for each of the fiscal years 2001 through 2005.
(b) PART B.-For
the purpose of carrying out part B, there are authorized to be appropriated such
sums as may be necessary for each of the fiscal years 2001 through 2005.
SEC.
2678. [300ff-78] PROHIBITION ON PROMOTION OF CERTAIN ACTIVITIES.
None of the
funds authorized under this title shall be used to fund AIDS programs, or to develop
materials, designed to promote or encourage, directly, intravenous drug use or
sexual activity, whether homosexual or heterosexual. Funds authorized under this
title may be used to provide medical treatment and support services for individuals
with HIV.
PART E-EMERGENCY RESPONSE EMPLOYEES
Subpart I-Guidelines and Model Curriculum
SEC.
2680. [300ff-80] GRANTS FOR IMPLEMENTATION.
(a) IN GENERAL.-With respect to
the recommendations contained in the guidelines and the model curriculum developed
under section 253 of Public Law 100-607, the Secretary shall make grants to States
and political subdivisions of States for the purpose of assisting grantees regarding
the initial implementation of such portions of the recommendations as are applicable
to emergency response employees.
(b) REQUIREMENT OF APPLICATION.-The Secretary
may not make a grant under subsection (a) unless an application for the grant
is submitted to the Secretary and the application is in such form, is made in
such manner, and contains such agreements, assurances, and information as the
Secretary determines to be necessary to carry out this section.
(c) AUTHORIZATION
OF APPROPRIATIONS.-For the purpose of carrying out this section, there is authorized
to be appropriated $5,000,000 for each of the fiscal years 1991 through 1995.
Subpart II-Notifications of Possible Exposure to Infectious Diseases
SEC.
2681. [300ff-81] INFECTIOUS DISEASES AND CIRCUMSTANCES RELEVANT TO NOTIFICATION
REQUIREMENTS.
(a) IN GENERAL.-Not later than 180 days after the date of the
enactment of the Ryan White Comprehensive AIDS Resources Emergency Act of 1990,
the Secretary shall complete the development of-
(1) a list of potentially
life-threatening infectious diseases to which emergency response employees may
be exposed in responding to emergencies;
(2) guidelines describing the circumstances
in which such employees may be exposed to such diseases, taking into account the
conditions under which emergency response is provided; and
(3) guidelines describing
the manner in which medical facilities should make determinations for purposes
of section 2683(d).
(b) SPECIFICATION OF AIRBORNE INFECTIOUS DISEASES.-The
list developed by the Secretary under subsection (a)(1) shall include a specification
of those infectious diseases on the list that are routinely transmitted through
airborne or aerosolized means.
(c) DISSEMINATION.-The Secretary shall-
(1)
transmit to State public health officers copies of the list and guidelines developed
by the Secretary under subsection (a) with the request that the officers disseminate
such copies as appropriate throughout the States; and
(2) make such copies
available to the public.
SEC.
2682. [300ff-82] ROUTINE NOTIFICATIONS WITH RESPECT TO AIRBORNE INFECTIOUS DISEASES
IN VICTIMS ASSISTED.
(a) ROUTINE NOTIFICATION OF DESIGNATED OFFICER.-
(1)
DETERMINATION BY TREATING FACILITY.-If a victim of an emergency is transported
by emergency response employees to a medical facility and the medical facility
makes a determination that the victim has an airborne infectious disease, the
medical facility shall notify the designated officer of the emergency response
employees who transported the victim to the medical facility of the determination.
(2)
DETERMINATION BY FACILITY ASCERTAINING CAUSE OF DEATH.-If a victim of an emergency
is transported by emergency response employees to a medical facility and the victim
dies at or before reaching the medical facility, the medical facility ascertaining
the cause of death shall notify the designated officer of the emergency response
employees who transported the victim to the initial medical facility of any determination
by the medical facility that the victim had an airborne infectious disease.
(b)
REQUIREMENT OF PROMPT NOTIFICATION.-With respect to a determination described
in paragraph (1) or (2), the notification required in each of such paragraphs
shall be made as soon as is practicable, but not later than 48 hours after the
determination is made.
SEC.
2683. [300ff-83] REQUEST FOR NOTIFICATIONS WITH RESPECT TO VICTIMS ASSISTED.
(a)
INITIATION OF PROCESS BY EMPLOYEE.-If an emergency response employee believes
that the employee may have been exposed to an infectious disease by a victim of
an emergency who was transported to a medical facility as a result of the emergency,
and if the employee attended, treated, assisted, or transported the victim pursuant
to the emergency, then the designated officer of the employee shall, upon the
request of the employee, carry out the duties described in subsection (b) regarding
a determination of whether the employee may have been exposed to an infectious
disease by the victim.
(b) INITIAL DETERMINATION BY DESIGNATED OFFICER.-The
duties referred to in subsection (a) are that-
(1) the designated officer involved
collect the facts relating to the circumstances under which, for purposes of subsection
(a), the employee involved may have been exposed to an infectious disease; and
(2)
the designated officer evaluate such facts and make a determination of whether,
if the victim involved had any infectious disease included on the list issued
under paragraph (1) of section 2681(a), the employee would have been exposed to
the disease under such facts, as indicated by the guidelines issued under paragraph
(2) of such section.
(c) SUBMISSION OF REQUEST TO MEDICAL FACILITY.-
(1)
IN GENERAL.-If a designated officer makes a determination under subsection (b)(2)
that an emergency response employee may have been exposed to an infectious disease,
the designated officer shall submit to the medical facility to which the victim
involved was transported a request for a response under subsection (d) regarding
the victim of the emergency involved.
(2) FORM OF REQUEST.-A request under
paragraph (1) shall be in writing and be signed by the designated officer involved,
and shall contain a statement of the facts collected pursuant to subsection (b)(1).
(d)
EVALUATION AND RESPONSE REGARDING REQUEST TO MEDICAL FACILITY.-
(1) IN GENERAL
.-If a medical facility receives a request under subsection (c), the medical facility
shall evaluate the facts submitted in the request and make a determination of
whether, on the basis of the medical information possessed by the facility regarding
the victim involved, the emergency response employee was exposed to an infectious
disease included on the list issued under paragraph (1) of section 2681(a), as
indicated by the guidelines issued under paragraph (2) of such section.
(2)
NOTIFICATION OF EXPOSURE.-If a medical facility makes a determination under paragraph
(1) that the emergency response employee involved has been exposed to an infectious
disease, the medical facility shall, in writing, notify the designated officer
who submitted the request under subsection (c) of the determination.
(3) FINDING
OF NO EXPOSURE.-If a medical facility makes a determination under paragraph (1)
that the emergency response employee involved has not been exposed to an infectious
disease, the medical facility shall, in writing, inform the designated officer
who submitted the request under subsection (c) of the determination.
(4) INSUFFICIENT
INFORMATION.-
(A) If a medical facility finds in evaluating facts for purposes
of paragraph (1) that the facts are insufficient to make the determination described
in such paragraph, the medical facility shall, in writing, inform the designated
officer who submitted the request under subsection (c) of the insufficiency of
the facts.
(B)(i) If a medical facility finds in making a determination under
paragraph (1) that the facility possesses no information on whether the victim
involved has an infectious disease included on the list under section 2681(a),
the medical facility shall, in writing, inform the designated officer who submitted
the request under subsection (c) of the insufficiency of such medical information.
(ii)
If after making a response under clause (i) a medical facility determines that
the victim involved has an infectious disease, the medical facility shall make
the determination described in paragraph (1) and provide the applicable response
specified in this subsection.
(e) TIME FOR MAKING RESPONSE.-After receiving
a request under subsection (c) (including any such request resubmitted under subsection
(g)(2)), a medical facility shall make the applicable response specified in subsection
(d) as soon as is practicable, but not later than 48 hours after receiving the
request.
(f) DEATH OF VICTIM OF EMERGENCY.-
(1) FACILITY ASCERTAINING CAUSE
OF DEATH.-If a victim described in subsection (a) dies at or before reaching the
medical facility involved, and the medical facility receives a request under subsection
(c), the medical facility shall provide a copy of the request to the medical facility
ascertaining the cause of death of the victim, if such facility is a different
medical facility than the facility that received the original request.
(2)
RESPONSIBILITY OF FACILITY.-Upon the receipt of a copy of a request for purposes
of paragraph (1), the duties otherwise established in this subpart regarding medical
facilities shall apply to the medical facility ascertaining the cause of death
of the victim in the same manner and to the same extent as such duties apply to
the medical facility originally receiving the request.
(g) ASSISTANCE OF PUBLIC
HEALTH OFFICER.-
(1) EVALUATION OF RESPONSE OF MEDICAL FACILITY REGARDING INSUFFICIENT
FACTS.-
(A) In the case of a request under subsection (c) to which a medical
facility has made the response specified in subsection (d)(4)(A) regarding the
insufficiency of facts, the public health officer for the community in which the
medical facility is located shall evaluate the request and the response, if the
designated officer involved submits such documents to the officer with the request
that the officer make such an evaluation.
(B) As soon as is practicable after
a public health officer receives a request under paragraph (1), but not later
than 48 hours after receipt of the request, the public health officer shall complete
the evaluation required in such paragraph and inform the designated officer of
the results of the evaluation.
(2) FINDINGS OF EVALUATION.-
(A) If an evaluation
under paragraph (1)(A) indicates that the facts provided to the medical facility
pursuant to subsection (c) were sufficient for purposes of determinations under
subsection (d)(1)-
(i) the public health officer shall, on behalf of the designated
officer involved, resubmit the request to the medical facility; and
(ii) the
medical facility shall provide to the designated officer the applicable response
specified in subsection (d).
(B) If an evaluation under paragraph (1)(A) indicates
that the facts provided in the request to the medical facility were insufficient
for purposes of determinations specified in subsection (c)-
(i) the public
health officer shall provide advice to the designated officer regarding the collection
and description of appropriate facts; and
(ii) if sufficient facts are obtained
by the designated officer-
(I) the public health officer shall, on behalf of
the designated officer involved, resubmit the request to the medical facility;
and
(II) the medical facility shall provide to the designated officer the appropriate
response under subsection (c).
SEC.
2684. [300ff-84] PROCEDURES FOR NOTIFICATION OF EXPOSURE.
(a) CONTENTS OF NOTIFICATION
TO OFFICER.-In making a notification required under section 2682 or section 2683(d)(2),
a medical facility shall provide-
(1) the name of the infectious disease involved;
and
(2) the date on which the victim of the emergency involved was transported
by emergency response employees to the medical facility involved.
(b) MANNER
OF NOTIFICATION.-If a notification under section 2682 or section 2683(d)(2) is
mailed or otherwise indirectly made-
(1) the medical facility sending the notification
shall, upon sending the notification, inform the designated officer to whom the
notification is sent of the fact that the notification has been sent; and
(2)
such designated officer shall, not later than 10 days after being informed by
the medical facility that the notification has been sent, inform such medical
facility whether the designated officer has received the notification.
SEC.
2685. [300ff-85] NOTIFICATION OF EMPLOYEE.
(a) IN GENERAL.-After receiving
a notification for purposes of section 2682 or 2683(d)(2), a designated officer
of emergency response employees shall, to the extent practicable, immediately
notify each of such employees who-
(1) responded to the emergency involved;
and
(2) as indicated by guidelines developed by the Secretary, may have been
exposed to an infectious disease.
(b) CERTAIN CONTENTS OF NOTIFICATION TO EMPLOYEE.-A
notification under this subsection to an emergency response employee shall inform
the employee of-
(1) the fact that the employee may have been exposed to an
infectious disease and the name of the disease involved;
(2) any action by
the employee that, as indicated by guidelines developed by the Secretary, is medically
appropriate; and
(3) if medically appropriate under such criteria, the date
of such emergency.
(c) RESPONSES OTHER THAN NOTIFICATION OF EXPOSURE.-After
receiving a response under paragraph (3) or (4) of subsection (d) of section 2683,
or a response under subsection (g)(1) of such section, the designated officer
for the employee shall, to the extent practicable, immediately inform the employee
of the response.
SEC.
2686. [300ff-86] SELECTION OF DESIGNATED OFFICERS.
(a) IN GENERAL.-For the
purposes of receiving notifications and responses and making requests under this
subpart on behalf of emergency response employees, the public health officer of
each State shall designate 1 official or officer of each employer of emergency
response employees in the State.
(b) PREFERENCE IN MAKING DESIGNATIONS.-In
making the designations required in subsection (a), a public health officer shall
give preference to individuals who are trained in the provision of health care
or in the control of infectious diseases.
SEC.
2687. [300ff-87] LIMITATIONS WITH RESPECT TO DUTIES OF MEDICAL FACILITIES.
The
duties established in this subpart for a medical facility-
(1) shall apply
only to medical information possessed by the facility during the period in which
the facility is treating the victim for conditions arising from the emergency,
or during the 60-day period beginning on the date on which the victim is transported
by emergency response employees to the facility, whichever period expires first;
and
(2) shall not apply to any extent after the expiration of the 30-day period
beginning on the expiration of the applicable period referred to in paragraph
(1), except that such duties shall apply with respect to any request under section
2683(c) received by a medical facility before the expiration of such 30-day period.
SEC.
2688. [300ff-88] RULES OF CONSTRUCTION.
(a) LIABILITY OF MEDICAL FACILITIES
AND DESIGNATED OFFICERS.-This subpart may not be construed to authorize any cause
of action for damages or any civil penalty against any medical facility, or any
designated officer, for failure to comply with the duties established in this
subpart.
(b) TESTING.-This subpart may not, with respect to victims of emergencies,
be construed to authorize or require a medical facility to test any such victim
for any infectious disease.
(c) CONFIDENTIALITY.-This subpart may not be construed
to authorize or require any medical facility, any designated officer of emergency
response employees, or any such employee, to disclose identifying information
with respect to a victim of an emergency or with respect to an emergency response
employee.
(d) FAILURE TO PROVIDE EMERGENCY SERVICES.-This subpart may not be
construed to authorize any emergency response employee to fail to respond, or
to deny services, to any victim of an emergency.
SEC.
2689. [300ff-89] INJUNCTIONS REGARDING VIOLATION OF PROHIBITION.
(a) IN GENERAL.-The
Secretary may, in any court of competent jurisdiction, commence a civil action
for the purpose of obtaining temporary or permanent injunctive relief with respect
to any violation of this subpart.
(b) FACILITATION OF INFORMATION ON VIOLATIONS.-The
Secretary shall establish an administrative process for encouraging emergency
response employees to provide information to the Secretary regarding violations
of this subpart. As appropriate, the Secretary shall investigate alleged such
violations and seek appropriate injunctive relief.
SEC.
2690. [300ff-90] APPLICABILITY OF SUBPART.
This subpart shall not apply in
a State if the chief executive officer of the State certifies to the Secretary
that the law of the State is in substantial compliance with this subpart.
PART F-DEMONSTRATION AND TRAINING
Subpart I-Special Projects of National Significance
SEC.
2691. [300ff-101] SPECIAL PROJECTS OF NATIONAL SIGNIFICANCE.
(a) IN GENERAL.-Of
the amount appropriated under each of parts A, B, C, and D of this title for each
fiscal year, the Secretary shall use the greater of $20,000,000 or 3 percent of
such amount appropriated under each such part, but not to exceed $25,000,000,
to administer a special projects of national significance program to award direct
grants to public and nonprofit private entities including community-based organizations
to fund special programs for the care and treatment of individuals with HIV disease.
(b)
GRANTS.-The Secretary shall award grants under subsection (a) based on-
(1)
the need to assess the effectiveness of a particular model for the care and treatment
of individuals with HIV disease;
(2) the innovative nature of the proposed
activity; and
(3) the potential replicability of the proposed activity in other
similar localities or nationally.
(c) SPECIAL PROJECTS.-Special projects of
national significance shall include the development and assessment of innovative
service delivery models that are designed to-
(1) address the needs of special
populations;
(2) assist in the development of essential community-based service
delivery infrastructure; and
(3) ensure the ongoing availability of services
for Native American communities to enable such communities to care for Native
Americans with HIV disease.
(d) SPECIAL POPULATIONS.-Special projects of national
significance may include the delivery of HIV health care and support services
to traditionally underserved populations including-
(1) individuals and families
with HIV disease living in rural communities;
(2) adolescents with HIV disease;
(3)
Indian individuals and families with HIV disease;
(4) homeless individuals
and families with HIV disease;
(5) hemophiliacs with HIV disease; and
(6)
incarcerated individuals with HIV disease.
(e) SERVICE DEVELOPMENT GRANTS.-Special
projects of national significance may include the development of model approaches
to delivering HIV care and support services including-
(1) programs that support
family-based care networks and programs that build organizational capacity critical
to the delivery of care in minority communities;
(2) programs designed to prepare
AIDS service organizations and grantees under this title for operation within
the changing health care environment; and
(3) programs designed to integrate
the delivery of mental health and substance abuse treatment with HIV services.
(f)
COORDINATION.-The Secretary may not make a grant under this section unless the
applicant submits evidence that the proposed program is consistent with the statewide
coordinated statement of need, and the applicant agrees to participate in the
ongoing revision process of such statement of need.
(g) REPLICATION.-The Secretary
shall make information concerning successful models developed under this part
available to grantees under this title for the purpose of coordination, replication,
and integration. To facilitate efforts under this subsection, the Secretary may
provide for peer-based technical assistance from grantees funded under this part.
Subpart II-AIDS Education and Training Centers
SEC.
2692. [300ff-111] HIV/AIDS COMMUNITIES, SCHOOLS, AND CENTERS.
(a) SCHOOLS;
CENTERS.-
(1) IN GENERAL.-The Secretary may make grants and enter into contracts
to assist public and nonprofit private entities and schools and academic health
science centers in meeting the costs of projects-
(A) to train health personnel,
including practitioners in programs under this title and other community providers,
in the diagnosis, treatment, and prevention of HIV disease, including the prevention
of the perinatal transmission of the disease, including measures for the prevention
and treatment of opportunistic infections, and including (as applicable to the
type of health professional involved), prenatal and other gynecological care for
women with HIV disease;
(B) to train the faculty of schools of, and graduate
departments or programs of, medicine, nursing, osteopathic medicine, dentistry,
public health, allied health, and mental health practice to teach health professions
students to provide for the health care needs of individuals with HIV disease;
(C)
To develop and disseminate curricula and resource materials relating to the care
and treatment of individuals with such disease and the prevention of the disease
among individuals who are at risk of contracting the disease; and
(D) to develop
protocols for the medical care of women with HIV disease, including prenatal and
other gynecological care for such women.
(2) PREFERENCE IN MAKING GRANTS.-In
making grants under paragraph (1), the Secretary shall give preference to qualified
projects which will-
(A) train, or result in the training of, health professionals
who will provide treatment for minority individuals with HIV disease and other
individuals who are at high risk of contracting such disease; and
(B) train,
or result in the training of, minority health professionals and minority allied
health professionals to provide treatment for individuals with such disease.
(3)
APPLICATION.-No grant or contract may be made under paragraph (1) unless an application
is submitted to the Secretary in such form, at such time, and containing such
information, as the Secretary may prescribe.
(b) DENTAL SCHOOLS.-
(1) IN
GENERAL.-
(A) GRANTS.-The Secretary may make grants to dental schools and programs
described in subparagraph (B) to assist such schools and programs with respect
to oral health care to patients with HIV disease.
(B) ELIGIBLE APPLICANTS.-For
purposes of this subsection, the dental schools and programs referred to in this
subparagraph are dental schools and programs that were described in section 777(b)(4)(B)
as such section was in effect on the day before the date of the enactment of the
Health Professions Education Partnerships Act of 1998 (Public Law 105-392) and
in addition dental hygiene programs that are accredited by the Commission on Dental
Accreditation.
(2) APPLICATION.-Each dental school or program described in
section the section referred to in paragraph (1)(B) may annually submit an application
documenting the unreimbursed costs of oral health care provided to patients with
HIV disease by that school or hospital during the prior year.
(3) DISTRIBUTION.-The
Secretary shall distribute the available funds among all eligible applicants,
taking into account the number of patients with HIV disease served and the unreimbursed
oral health care costs incurred by each institution as compared with the total
number of patients served and costs incurred by all eligible applicants.
(4)
MAINTENANCE OF EFFORT.-The Secretary shall not make a grant under this subsection
if doing so would result in any reduction in State funding allotted for such purposes.
(5)
COMMUNITY-BASED CARE.-The Secretary may make grants to dental schools and programs
described in paragraph (1)(B) that partner with community-based dentists to provide
oral health care to patients with HIV disease in unserved areas. Such partnerships
shall permit the training of dental students and residents and the participation
of community dentists as adjunct faculty.
(c) AUTHORIZATION OF APPROPRIATIONS.-
(1)
SCHOOLS; CENTERS-For the purpose of grants under subsection (a), there are authorized
to be appropriated such sums as may be necessary for each of the fiscal years
2001 through 2005.
(2) DENTAL SCHOOLS.-
(A) IN GENERAL.-For the purpose
of grants under paragraphs (1) through (4) of subsection (b), there are authorized
to be appropriated such sums as may be necessary for each of the fiscal years
2001 through 2005.
(B) COMMUNITY-BASED CARE.-For the purpose of grants under
subsection (b)(5), there are authorized to be appropriated such sums as may be
necessary for each of the fiscal years 2001 through 2005.